Dr. Nima Grissom Photo Courtesy CPMC

Risk Factors For Breast Cancer Wrong Again

Dr. Nima Grissom Photo Courtesy CPMCRisk Factors For Breast Cancer, Wrong Again

Ignoring the Environmental Cause

by Jeffrey Dach MD

An article appeared in the San Fransisco Chronical entitled, “Risk Factors of Breast Cancer – How to Reduce Them” by Dr. Nima Grissom breast surgeon.

Breast cancer rates are Twenty Per Cent Higher in the San Fransisco Bay Area, and they don’t know why.(15-17) See the Map Below.

Dr. Nima Grissom is a cancer surgeon affiliated with the California Pacific Medical Center in San Francisco.

Breast Cancer Map San Fransisco Bay ElevatedLeft Image: Map of San Fransisco Bay area showing elevated breast cancer rates in Green Areas.Courtesy of California Breast Cancer Mapping Project (CBCMP_Report_FINAL)

Here is Dr Grissom says in the article:

I tell my patients there are certain factors that increase the risk of developing breast cancer. Among these:

— Growing older.
— A personal prior history of breast cancer, particularly before age 45.
— Early onset of periods.
— First pregnancy after age 35.
— Ethnic ties to Ashkenazis, a Jewish group that originated among the indigenous tribes of the Middle East.
— First-degree relatives – a parent, sibling or child – with breast cancer, particularly if the cancer appeared before age 45.
— History of a breast biopsy, particularly if irregular cells were found;
— Having dense breast tissue.

Dr Nima Grissom then goes on to state : “These risk factors are things you have no control over. ” end quote

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The Real Things that Cause Breast Cancer We Do Have Control Over

Anyone will recognize the glaring problem with this list.  Whenever you have a Cancer Map showing a cluster of cancer cases, this points to an environmental cause.(19)  After all, why does the government agency go to all the bother of constructing a map?  A Cancer Cluster implicates an environmental cause.

Chemicals in the environments, also called endocrine disruptors,  are known to cause breast cancer, yet mentioning this is omitted.(19)  Could this be a form of self censorship to avoid offending the chemical industry by lulling the people into sheep-like acceptance of their cancer fate? ?

Omitted from Dr Grissom’s list are all the real things that increase breast cancer risk that we do have control over.  Here they are:

1) Xeno-estrogens and Carcinogens in our Food and Environment that cause breast cancer.  Specifically pesticides, such as DDT Lindane, plastics  etc.(2-4)

2) Iodine deficiency is a known risk factor for fibrocystic breast disease and breast cancer.(7-11)

3) Synthetic hormones such as PremPro and Provera are known to increase risk of cancer.(13-14)

4) Vitamin D deficiency (26), and Selenium deficiency (20-25) are associated with increased cancer risk.  Supplementing both when tested and found low is a sound cancer prevention strategy. (20-26)

All of these risk factors are things we have control over.  We can reduce our exposure to pesticides and carcinogenic chemicals.(2-4)  We can test for and supplement with Iodine, Selenium and Vitamin D.(20-26)   We can avoid synthetic hormones that increase risk of breast cancer and use safer bioidentical human hormones instead. (13-14)

The Breast Cancer-Pesticide Link

In 2007,  178,480 women were diagnosed with breast cancer and 40,460 women died of breast cancer in the United States.

Considerable study has been devoted to proving a link between pesticides and breast cancer. Could there be such a link ?

Pesticides Banned in Israel and Breast Cancer Rates Fall.

The answer is yes. The pesticide-breast cancer link was clearly shown in research from Israel which linked three pesticides found in dairy products to increased cancer in mice. After a public outcry in 1978, the Israeli government was forced to ban the three pesticides, Benzene Hexachloride, DDT, and Lindane .(5,6)

After the banning of these pesticides in Israel, breast cancer mortality rates (which had increased every year for 25 years), dropped nearly 8 per cent for all age groups and dropped more than a thirty-three percent for women ages 25-34 in 1986. (5,6)

The Breast Cancer Iodine Link

Dr. B.A. Eskin published 80 papers over 30 years researching iodine and breast cancer, and he reports that iodine deficiency causes breast cancer and thyroid cancer in humans and animals.(7-11)  Iodine deficiency is also known to cause a pre-cancerous condition called fibrocystic breast disease.  Ghent published a paper in 1993 which showed iodine supplementation works quite well to reverse and resolve fibrocystic changes of the breast, and I have found this true in my clinical experience with patients and family members over the past ten years. (7-11)

The Synthetic Hormone Breast Cancer Link

A study published in the October 2010 issue of Journal of the American Medical Association (JAMA) reviewed 11 years of data from the Women’s Health Initiative Study. (13,14)

Dr.Chlebowski, concluded that the synthetic Prempro Pill used in the study increases breast cancer, and these cancers tend to be the more aggressive. As might be expected, there was also increased breast cancer mortality in the synthetic hormone group. Note: PremPro is made by Wyeth (Pfizer) and is a combination of a horse estrogen- Premarin plus progestin-Provera (medroxyprogesterone).

Three previous studies showed the same finding, that progestins cause breast cancer.

1) The Breast Cancer Detection Demonstration Project (BCDDP) had an increase in breast cancer when they used a progestin.

2) The Swedish Record Review had increase in breast cancer with a progestin.

3) The Million Woman Study had increase in breast cancer with progestin use.

In all these studies, they were using Progestins along with the estrogen, and that’s why they got those results..

Protection from Breast Cancer Conferred by Multiple Pregnancies

During the 16th century in Italy, breast cancer was quite rare.  An
Italian doctor, Bernardino Ramazzini,  noted in 1713 the relatively high incidence of breast cancer in nuns and wondered whether this was related to celibate lifestyle.  Recent studies confirm that early pregnancy and multiple pregnancies confer protection from breast cancer, while no  pregnancies (as in the nuns) leads to increased risk of breast cancer.  This  protection is thought to be conferred by high levels of progesterone…for more on this topic click here .

Five Oil Refineries in the Bay Area –  Chemical Carcinogen Link ?

Could the increased breast cancer rates come from the chemical carcinogens emitted by the five oil refineries in the Bay area ?

These are:     
Chevron Richmond Refinery (Chevron Corporation), Richmond
Shell Martinez Refinery (Royal Dutch Shell), Martinez
Golden Eagle Refinery (Tesoro Corporation), Martinez
San Francisco Refinery (ConocoPhillips), Rodeo
Benicia Refinery (Valero), Benicia

“The chemicals that are routinely released from petrochemical facilities tend to be carcinogenic, and there have been attempts to  link cancer rates to geographical proximity to oil facilities.

One such study   was conducted 30 years ago, and studied lung cancer rates among White males in Contra Costa County; it found that rates of cancer in industrial areas were some 40% higher than rates in non-industrial areas.

 Another study  around the same time period also found elevated rates of other types of  cancer, such as stomach, prostate, and kidney.  And while these are old  studies, the continuation of pollution from Bay Area refineries over the past 30 years should be enough to at least hypothesize that high rates of cancer have persisted.” end quote from “The oil industry of the Bay Area”: link to this article click here.

Denial is Sometimes the Best Treatment

You don’t have to worry because the IOM, the Institute of Medicine report Funded by the Susan Komen Foundation says there is no environmental link to breast cancer.  If you believe this, then I have a bridge to sell you.  Just go read this article by Samuel Epstein MD in the Huffington Post.

Jeffrey Dach MD

Articles with Related Interest

Rachel Carson Pesticides and Breast Cancer

Breast Cancer Prevention with Iodine Supplementation Part One

Iodine Prevents and Treats Breast Cancer Part Two

Iodine Treats Breast Cancer, Overwhelming Evidence

Think Purple for Breast Cancer Month

Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314
954-792-4663

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Dr. Nima Grissom Photo: Courtesy CPMC

Links and References

1) http://www.sfgate.com/health/article/Risk-factors-of-breast-cancer-how-to-reduce-them-5122484.php
Risk factors of breast cancer – how to reduce them
Published 5:54 pm, Tuesday, January 7, 2014
Dr. Nima Grissom Photo: Courtesy CPMC

Dr Grissom then goes on to talk about:  Genetic testing for BRCA mutations, and screening modalities, including mammography, ultrasound and MRI, for patients with increased risk and/or dense breast tissue.

Dr Grissom then mentions a drug, tamoxifen which she may recommend for patients at high risk.

Dr Grissom then mentions lifestyle changes such as exercise, improved diet, lowering alcohol consumption and normalizing vitamin D levels can also help.

Links to Breast Cancer and Pesticides :

2) Breast Cancer and Pesticide DDT, DDE Bibliography,

3) Breast Cancer Linked To Pesticide DDT, Study Suggests ScienceDaily (Oct. 9, 2007)

4) http://ecommons.library.cornell.edu/handle/1813/14300

The Program on Breast Cancer and Environmental Risk Factors (BCERF) at Cornell University is devoted to lowering the risk and incidence of cancer What Are Environmental Risk Factors?  Environmental risk factors may include chemicals in the home or workplace, BCERF provides information on the cancer risks associated with environmental factors.

5) http://onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.1990.tb32074.x/abstract

http://www.ncbi.nlm.nih.gov/pubmed/2264650

Jerome B. Westin and Elihu Richter, “The Israeli Breast-Cancer Anomaly,” in Devra Lee Davis and David Hoel, editors, TRENDS IN CANCER MORTALITY IN INDUSTRIAL COUNTRIES (New York: New York Academy of Sciences, 1990), pgs. 269-279.

6) http://www.ncbi.nlm.nih.gov/pubmed/8375952
Int J Health Serv. 1993;23(3):497-517.
Carcinogens in Israeli milk: a study in regulatory failure.
Westin JB. The potential danger to humans of exposure to chemicals shown to be carcinogenic in animals has become increasingly clear in the last 20 years. A gap still exists, however, between the appreciation of the risk by scientists and the willingness of public health authorities to reduce it. Three pesticides, shown repeatedly to produce over a dozen different types of cancer in rats and mice, were discovered in inordinately high concentrations in Israeli milk and dairy products. The three pesticides–alpha-BHC, gamma-BHC (lindane), and DDT–had been shown to be present for ten years or more at mean concentrations up to 100 times those found in U.S. dairy products–with resultant concentrations in breast milk being possibly 800 times greater than those in the United States–yet neither the Ministry of Health nor the Israel Cancer Association made any apparent moves either to warn the public or to rectify the situation. A small consumer organization, Consumer Shield, brought the issue into the open. Through public pressure, court action, and the threat of further legal redress–and despite repeated attacks in the media by the milk producers, the Ministry, and the Cancer Association–Consumer Shield forced the authorities to outlaw the use of alpha-BHC and lindane (DDT no longer being in general use). The ban resulted in a precipitous drop in the concentrations of these substances in Israeli milk. Recent epidemiological and laboratory findings suggest that the dramatic drop in breast cancer mortality rates subsequent to the pesticide ban could be a direct result of that ban.

 

(7) http://cancerres.aacrjournals.org/cgi/reprint/35/9/2332
Bernard A. Eskin et al. Rat mammary gland atypia produced by iodine blockade with perchlorate. Cancer Res. 1975 Sep;35(9):2332-9

(8) http://cancerres.aacrjournals.org/cgi/reprint/46/2/877
Dietary Iodine Deficiency as a Tumor Promoter and Carcinogen in Male F344/NCr Rats Masato Ohshima and Jerrold M. Ward. Cancer Research 46, 877-883, February 1, 1986

(9) http://content.nejm.org/cgi/content/full/353/3/229
Benign Breast Disease and the Risk of Breast Cancer. Hartmann, Lynn C. N Engl J Med Volume 353;3:229-237 July 21, 2005

(10) http://www.ncbi.nlm.nih.gov/pubmed/8221402
Ghent,W.R., Eskin,B.A., Low,D.A., Hill, L.P.. Iodine replacement in fibrocystic disease of the breast. Can J Surg 1993; 36:453-460.

(11) http://clinicaltrials.gov/ct/show/NCT00237523?order=1
Clinical Trial for Iodine treatment of Fibrocystic Breast Disease
Study for Treatment of Moderate or Severe, Periodic, “Cyclic”, Breast Pain. This study is ongoing, but not recruiting participants. Sponsored by:  Symbollon Pharmaceuticals ClinicalTrials.gov Identifier: NCT00237523

(12) http://jama.ama-assn.org/cgi/content/abstract/304/15/1684

Estrogen Plus Progestin and Breast Cancer Incidence and Mortality in Postmenopausal Women – Rowan T. Chlebowski, MD, PhD; et al.  for the WHI Investigators .  JAMA. 2010;304(15):1684-1692.

Participants were randomized to receive conjugated equine estrogens, 0.625 mg/d, and medroxyprogesterone acetate, 2.5 mg/d, in a single tablet (Prempro; Wyeth Ayerst, Collegeville, Pennsylvania) or an identical-appearing placebo pill.

Following the initial report of results from the WHI trial,1 a substantial decrease in breast cancer incidence occurred in the United States, which was attributed 24-25 to the marked decrease in postmenopausal hormone therapy use that occurred after publication of the trial results.26 The adverse influence of estrogen plus progestin on breast cancer mortality suggests that a future reduction in breast cancer mortality in the United States may be anticipated as well.

In intention-to-treat analysis, estrogen plus progestin compared with placebo increased the incidence of invasive breast cancer (385 cases [0.42% per year] vs 293 cases [0.34% per year], respectively; HR, 1.25; 95% confidence interval [CI], 1.07-1.46; P = .004). Figure 2 also shows quintiles of duration of study intervention based on time of participant entry into study and cessation of study intervention.

A significantly larger fraction of breast cancers presented with positive lymph nodes in the combined hormone therapy group compared with the placebo group (81 [23.7%] vs 43 [16.2%], respectively; HR, 1.78; 95% CI, 1.23-2.58; P = .03).

In conclusion, use of estrogen plus progestin increases the incidence of breast cancer, and the cancers are more commonly node-positive. Mortality data analyses suggest that breast cancer mortality may also be increased.

(14) http://jama.ama-assn.org/cgi/content/full/304/15/1719
Postmenopausal Hormone Therapy and Breast Cancer
An Uncertain Trade-off Peter B. Bach, MD, MAPP
JAMA. 2010;304(15):1719-1720. doi:10.1001/jama.2010.1528

15) San_Fransisco_Breast_Cancer_MAP_CBCMP_Report_FINAL

16) http://www.healthycal.org/archives/10449
Elevated rates of invasive breast cancer in Bay Area cities
January 3, 2013  The areas highlighted have higher than average rates of breast cancer. Map courtesy of the California Breast Cancer Mapping Project. By Leah Bartos  California Health Report

17) http://www.huffingtonpost.com/2012/11/27/bay-area-breast-cancer_n_2197193.html
Bay Area Breast Cancer Rates Higher Than Average In Two New Counties: Study   The Contra Costa Times  |  By Sandy Kleffman Updated: 11/27/2012

18) http://www.nytimes.com/2011/12/08/health/scientific-panel-finds-few-clear-environmental-links-to-breast-cancer.html?ref=health&_r=0
Scientific Panel Finds Few Clear Environmental Links to Breast Cancer By DENISE GRADY Published: December 7, 2011

19) http://www.ncbi.nlm.nih.gov/pubmed/20498677
Nat Rev Endocrinol. 2010 Jul;6(7):363-70. doi: 10.1038/nrendo.2010.87. Epub 2010 May 25.
Environmental causes of cancer: endocrine disruptors as carcinogens. Soto AM, Sonnenschein C.

Environmental endocrine disrupting chemicals (EDCs), including pesticides and industrial chemicals, have been and are released into the environment producing deleterious effects on wildlife and humans. The effects observed in animal models after exposure during organogenesis correlate positively with an increased incidence of malformations of the male genital tract and of neoplasms and with the decreased sperm quality observed in European and US populations. Exposure to EDCs generates additional effects, such as alterations in male and female reproduction and changes in neuroendocrinology, behavior, metabolism and obesity, prostate cancer and thyroid and cardiovascular endocrinology. This Review highlights the carcinogenic properties of EDCs, with a special focus on bisphenol A. However, humans and wildlife are exposed to a mixture of EDCs that act contextually. To explain this mindboggling complexity will require the design of novel experimental approaches that integrate the effects of different doses of structurally different chemicals that act at different ages on different target tissues. The key to this complex problem lies in the adoption of mathematical modeling and computer simulations afforded by system biology approaches. Regardless, the data already amassed highlight the need for a public policy to reduce exposure to EDCs.

20) http://www.ncbi.nlm.nih.gov/pubmed/3924710 Jpn J Cancer Res. 1985 May;76(5):374-7. Selenium in the blood of Japanese and American women with and without breast cancer and fibrocystic disease. Schrauzer GN, Molenaar T, Mead S, Kuehn K, Yamamoto H, Araki E.

21) http://www.ncbi.nlm.nih.gov/pubmed/2484517 Biol Trace Elem Res. 1988 Jan-Apr;15:205-12. The distribution of selenium in human blood samples of Israeli population–comparison between normal and breast cancer cases. Chaitchik S, Shenberg C, Nir-El Y, Mantel M. Elias Sourasky Medical Center Tel-Aviv, Israel.

22) http://cancerres.aacrjournals.org/cgi/content/abstract/51/17/4613  Cancer Research 51, 4613-4617, September 1, 1991. Inhibition of 7,12-Dimethylbenz(a)anthracene-induced Mammary Tumors and DNA Adducts by Dietary Selenite by Jinzhou Liu et al. University of Illinois

23) http://www.ncbi.nlm.nih.gov/pubmed/19843683 Cancer Epidemiol Biomarkers Prev. 2009 Nov;18(11):2923-8. Selenium supplementation reduced oxidative DNA damage in adnexectomized BRCA1 mutations carriers. by Dziaman T et al. Poland.

24) http://cebp.aacrjournals.org/content/14/5/1302.long Cancer Epidemiology, Biomarkers & Prevention May 2005 14; 1302. Increased Rates of Chromosome Breakage in BRCA1 Carriers Are Normalized by Oral Selenium Supplementation by Elzbieta Kowalska et al.

Although our sample size was small, our results were highly significant; in every case, selenium supplementation resulted in a reduced frequency of chromosome breaks.

25) http://www.hccpjournal.com/content/4/1/58 A Lowering of Breast and Ovarian Cancer Risk in Women with a BRCA1 Mutation by Selenium Supplementation of Diet by Tomasz Huzarski , Tomasz Byrski1, Jacek Gronwald1, Elżbieta Kowalska et al. Pomeranian Medical University, Szczecin, Poland in Hereditary Cancer in Clinical Practice 2006, 4:58

26) http://www.ncbi.nlm.nih.gov/pubmed/17368188
J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):708-11.
Vitamin D and prevention of breast cancer: pooled analysis.
Garland CF, Gorham ED, Mohr SB, Grant WB, Giovannucci EL, Lipkin M, Newmark H, Holick MF, Garland FC.
Author information
Abstract
BACKGROUND:

Inadequate photosynthesis or oral intake of Vitamin D are associated with high incidence and mortality rates of breast cancer in ecological and observational studies, but the dose-response relationship in individuals has not been adequately studied.
METHODS:

A literature search for all studies that reported risk by of breast cancer by quantiles of 25(OH)D identified two studies with 1760 individuals. Data were pooled to assess the dose-response association between serum 25(OH)D and risk of breast cancer.
RESULTS:

The medians of the pooled quintiles of serum 25(OH)D were 6, 18, 29, 37 and 48 ng/ml. Pooled odds ratios for breast cancer from lowest to highest quintile, were 1.00, 0.90, 0.70, 0.70 and 0.50 (p trend<0.001). According to the pooled analysis, individuals with serum 25(OH)D of approximately 52 ng/ml had 50% lower risk of breast cancer than those with serum <13 ng/ml. This serum level corresponds to intake of 4000 IU/day. This exceeds the National Academy of Sciences upper limit of 2000 IU/day. A 25(OH)D level of 52 ng/ml could be maintained by intake of 2000 IU/day and, when appropriate, about 12 min/day in the sun, equivalent to oral intake of 3000 IU of Vitamin D(3).
CONCLUSIONS:

Intake of 2000 IU/day of Vitamin D(3), and, when possible, very moderate exposure to sunlight, could raise serum 25(OH)D to 52 ng/ml, a level associated with reduction by 50% in incidence of breast cancer, according to observational studies.

Jeffrey Dach MD
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