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Waiting For Science Can Cost Lives

By Devra Lee Davis, Deborah Axelrod and Mitchell Gaynor.
WHILE IT is not clear whether machines or hands can do a better job of counting presidential votes in this country, there is little doubt that computers have the power to transform the way that scientists look at breast cancer. Although each case of cancer occurs to an individual, the patterns these cases create can only be seen when they are looked at together. That is what computer-based mapping allows us to do with more sophistication than ever before.

At the end of this year, a decade after determined and creative women of Long Island went door-to-door and began plotting cases of breast cancer in the area, scientists finally released computer-generated maps tracking the disease.

This, on the heels of highly public concerns, after 10 different hospitals, public-health schools and medical research institutions were granted millions of federal dollars, and after the first contract issued for this work was withdrawn and put out for bid again.

So why are rates of breast cancer so high on Long Island? The short answer is, nobody knows for sure. And the same inconclusive results have occurred with computer maps in Cape Cod and San Francisco, two other regions with abnormally high breast cancer rates.

Waiting for the science of epidemiology to answer questions is a bit like watching the grass grow. Things take time and move slowly. But how long do we need to wait? By the time scientists have better answers, it will be too late for perhaps two or even three generations of women. And we know that if, as with cigarette smoking, we wait until evidence of human harm is overwhelming, too many people will have died. Millions of Americans succumbed to the hazards of smoking while its health risks were being debated, even though basic cause-and-effect patterns had already been clearly established for years. There is no need to repeat that experience.

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members, the women of Long Island, and their counterparts in Cape Cod and San Francisco, have been asking tough and important questions. Does the environment explain why women who have resided on Long Island for 40 years have four times the breast cancer rate than those who have lived there less than 10? Are the rates higher just because too many women are too rich, have eaten too much food, had their children later in life? Or that too many of them are Jewish? Do the breast cancer rates have anything to do with heavy use of lawn chemicals in homes and golf courses. Could the higher risk of breast cancer be tied with industrial pollution, traffic or nuclear-reactor releases? The fact is we can move ahead and reduce exposures to suspect materials while science continues to press ahead. We know enough already to reduce the risk of breast cancer in thousands of potential cases and to lower the chance of recurrence in others.

Consider this. Our research at Cornell Medical Center has shown that a number of widely used chemical compounds, such as some pesticides and fuels, alter the production of hormones, much the same way as do known cancer-causing agents. Researchers at the U.S. National Toxicology Program have identified numerous such compounds that create mammary tumors in male rodents. Chances are very good that these substances cause cancer in humans. Every compound known to cause cancer in humans also produces cancer in animals, when adequately tested.

And the compounds are not only present on Long Island; they"re present everywhere. Because many of them are so widely available in the environment, it becomes very difficult to find anyone who is not exposed. To insist on proof of human harm before taking action treats people like lab rats.
Still, the burden of proof to control compounds such as pesticides, solvents, plastics and fuels that cause cancer in animals is very difficult to meet. Many of these compounds are not regulated because the question of their carcinogenic qualities is debated. But much of the research debate is weak, at best.

A recent report from the American Health Foundation about Long Island breast cancer, for example, found no difference in organochlorine residues in women with breast cancer and those without the disease who lived on Long Island and New York City. Unfortunately, there are three major problems with this approach. First, women with advanced disease may have undergone changes in metabolism that alter what remains in their bodies, especially fat-loving, organochlorine residues. Second, critical exposures to cancer-causing agents from early in life cannot be measured years later. Finally, women who have lived in the same area are likely to have undergone similar exposures, which

lowers the chance of finding an effect from their environment. In fact, recent studies from Canada and Denmark that have taken samples from women more than a decade before cancer arises, and compared with women from different regions, have found that early exposures to higher levels of some organochlorine compounds do increase the risk of developing cancer.

The maps make one thing clear. Changes in genes cannot account for what is happening on Long Island or other places. Only one woman in 10 gets breast cancer because she was born with a defect. In the largest national study ever conducted among twins, published in the New England Journal of Medicine this summer, researchers found that identical twins who share 100 percent of the same genes developed the same type of cancer less than half the time. On Cape Cod, researchers from the Silent Spring Institute have shown that even when established risk factors such as the inheritance of defective genes are taken into account, the excess of breast cancer remains unexplained. Activists there and elsewhere are going to the scientists and saying, "Do something-now. We cannot afford to wait for science to be certain." Computer maps tell us we have a problem. They do not tell us what to do about it now.

Some three decades into the national war on cancer, the costs of treatment and worker loss each year run more than $100 billion. No matter how efficient health care systems may become, if we do not reduce the demand for care, we will not be able to meet the growing needs for treatment.

We must act sooner-and not wait for all the science to come in. We already know a lot about what exposures to things commonly found in our environment do to animals in the lab and wildlife. Based on this information, we can do a better job of figuring out how to keep people from developing breast cancer and other diseases.
Women must take preventive measures to reduce the risk of breast cancer and its recurrence. Also, the federal government and the private sector have to do a better job of putting the information we already have to use. One recent federal project in Grand Teton and Yellowstone national parks radically reduced the use of toxic janitorial compounds and lowered costs of water treatment in these fragile ecosystems. Cancer prevention also means redesigning and rethinking the products in our everyday lives and reducing the use of suspect materials. In Northern Europe, for instance, many countries have mandatory recycling of computers, major appliances, cars and other items that contain toxic materials.

Fueled by a now widely exposed disinformation campaign of the tobacco companies, we wasted 50 years debating whether we had sufficient proof to take actions against cigarettes. We cannot afford to make the same mistake again.

Devra Lee Davis is visiting professor at the Heinz School at Carnegie Mellon University and author of the forthcoming book "The Reckoning of Numbers." Deborah Axelrod is chief of Breast Services at St. Vincent"s Comprehensive Cancer Center in New York City and author with Rosie O"Donnell of "Bosom Buddies." Mitchell Gaynor is director of Cornell Medical School"s Center for Complementary and Integrative Medicine in New York City and author of three bestselling cancer books, including "Dr. Mitchell Gaynor"s Cancer Prevention Guide."