Breast cancer exposed

Speaking to Portal, Breast Cancer UK makes the case for a shift in focus from breast cancer awareness to preventative action on harmful chemical pollutants

More people are today surviving breast cancer than ever before: women’s ten-year survival rate was estimated at 78% in England and Wales in 2010-11, while female breast cancer mortality rates in the UK as a whole are predicted to fall by 26% between 2014 and 2035 – important progress that can be attributed to huge strides forward in treatment, diagnosis and screening.

But this success disguises an alarming reality: while mortality is going down, the number of newly diagnosed cases is going up. Breast cancer rates have risen by 102% in England since records began in 1971, and they are expected to rise by 2% across the UK between 2014 and 2035 – adding considerable pressure to an already overburdened healthcare system and causing immeasurable pain to thousands of people up and down the country.

That’s why Breast Cancer UK is calling for a shift in focus from breast cancer awareness to preventative action and, in particular, greater efforts to promote, understand and reduce the link between rising incidence rates and exposure to man-made chemical pollutants.

Speaking to Portal, the charity outlines its main areas of attack, explains why prevention should always be prioritised over cure, and highlights what more UK and EU governments could be doing to effectively reverse this worrying breast cancer trend.

What are Breast Cancer UK’s key areas of concern when it comes to the link between chemicals, environmental pollutants and breast cancer?

Breast cancer rates are rising, and there is growing scientific evidence to suggest that our environmental exposure to certain chemical pollutants may be partially responsible for our increasing vulnerability to the disease.

We’re concerned about carcinogens and a group of chemicals called endocrine disrupting chemicals (EDCs), which can interfere with the human hormone system in such a way as to make us more susceptible to diseases like breast cancer.

Particularly worrying are the potentially harmful effects of prenatal exposures to EDCs and carcinogens. Prenatal exposure to harmful chemicals can increase breast cancer risk later in life. EDCs can affect postnatal breast development or increase sensitivity of the breast to carcinogens, and carcinogens may predispose the developing foetus to cancer later in life through epigenetic effects.1

We are also concerned about the additive effects of ‘chemical cocktails’ (EDCs and EDCs in combination with other hazardous compounds).2 We are not exposed to one chemical at a time, but to a daily cocktail of chemicals. EDCs are present in many everyday products such as food and cosmetics, as well as in polluted air, soil and water. Data shows that certain EDCs and carcinogens bio-accumulate (build up) in body fluids and/or tissues, and this may cause long-term harm to breast tissue and increase our risk of diseases like breast cancer.3

Decades of scientific evidence have demonstrated a link between breast cancer and environmental pollutants, but is the public sufficiently aware of this danger? 

No, we do not believe that the public are sufficiently aware of the links between exposure to environmental pollutants and breast cancer. Many members of the public we talk to have no idea that there is a group of chemicals that can interfere with hormones or that these chemicals can be found in many everyday products. The vast majority of public information about breast cancer relates to symptoms, the importance of early diagnosis and the availability of drugs to treat the disease.

Only recently has greater attention begun to turn towards prevention and risk factors for breast cancer. Even now, although there is slightly greater awareness of the link between breast cancer and synthetic hormones such as hormone replacement therapy (HRT) and the contraceptive pill – which are themselves EDCs – very little attention is given to environmental risk factors in either policy making or public health information.

That’s why we’ve recently launched our Ambassador Programme where we train volunteers to go out into their local communities and give talks about the risk factors for breast cancer and show people what they can do to reduce their risk – including reducing their exposure to potentially harmful chemicals.

How far do efforts – in finance and research, etc. – still prioritise treatment and cure over prevention?

Efforts to prevent cancers – all cancers, including breast cancer – remain a relatively low priority in comparison to efforts to improve diagnosis and treatment, and find a cure.

Although breast cancer research in total is comparatively well funded in the UK, the proportion of funding that is spent on prevention is low (Fig. 1).4 In 2014 government and charity partners provided £42.2m (~€50m) for breast cancer research. However, just 4% of this research funding went into prevention.

Of equal concern is the fact that just 1% of total research funding was invested in projects that would help us understand the exogenous causes (or aetiology) of breast cancer, which includes lifestyle factors, infectious agents (such as viruses), and environmental and occupational exposures such as radiation and EDCs. This percentage represents less than 10% of the total research budget (12%) invested into breast cancer aetiology.

Around 40% of breast cancers have no known attributable cause;5 we are a long way from really understanding what causes many breast cancers, and until we invest in trying to find out the answers we will struggle to reduce incidence rates.

NHS cancer strategies must also do more to look at all the ways in which the environment influences cancer incidence, and explore how we can make our environment a healthier place to live. A healthier environment, as well as a healthier lifestyle, is key to reducing incidence rates, preventing needless suffering and reducing the burden on the NHS.

2015 saw the publication of the five-step manifesto for the UK government ‘Prevention is better than cure’ – what has the initial reaction been to this, and are you optimistic that the message is being heard in the UK?

The public’s response to our manifesto was generally positive – few people would disagree that prevention is better than cure, and generally people do want to see more being done to prevent disease, but this hasn’t translated into policy commitments. For example, the most recent five-year cancer strategy ‘Achieving World Class Cancer Outcomes, Taking the Strategy Forward’6 stated that its aim was to ‘spearhead a radical upgrade in prevention and public health’, but sadly there is little evidence of anything radical in the prevention measures and objectives announced.

While the strategy does reference chemical and environmental cancer risks, its prevention targets are limited to lifestyle choices: smoking, alcohol consumption and obesity. There has been a systematic failure across the policy making spectrum to confront the role that our environment, including our exposure to harmful chemicals, plays in increasing cancer risk. None of the UK cancer plans nor the National Prevention Research Initiative (NPRI),7 which set out to ‘develop and implement successful, cost-effective ways of reducing people’s risk of illnesses by influencing their behaviour and lifestyle’, have fully acknowledged or explored ways in which to identify, understand and/or eliminate the environmental factors that contribute to breast and other cancers. In our opinion this is a significant flaw in current cancer prevention policy and suggests that our messages are not yet being heard in the UK.

What wider role could EU policy makers take in helping to prevent breast cancer?

The EU has an important role to play in helping to prevent breast cancer. Although far from perfect, the EU has some of the best chemicals regulations and environmental protections in the world. The EU must build on its precautionary approach and not bow to pressure to prioritise short-term economic interests over public health. The EU should be bold in declaring its priority to work in the interests of EU citizens, not vested interests.

In previous decades, mercury was used to treat seeds, DDT (dichlorodiphenyltrichloroethane) was sprayed on fields, and PCBs (polychlorinated biphenyls) were used in paper, furniture and paints. We now know that these chemicals cause cancer, but the health of millions of people had to suffer before action was taken. The EU has made significant progress since then, but we cannot let today’s policy makers forget the lessons of recent history. The EU’s precautionary approach and tough regulations on environmental health are under threat, and we must all work to protect them.

More widely, what are Breast Cancer UK’s main priorities moving forwards?

Breast Cancer UK has several key priorities moving forwards. We will work to continue to improve the public’s awareness of the links between environmental exposures and increased breast cancer risk, and especially to reach out to pregnant women and mums-to-be with advice on how to reduce their own exposures to help protect the future health of their unborn child.

We will also work to promote greater awareness and action on prevention amongst policy makers in government, health institutions and health charities. We want to see a change in the cancer conversation in a way that pushes prevention higher up on the policy making agenda. More radical public health policies that place prevention at their heart should be a solution to pressing public health and NHS finance issues. Regulatory changes and awareness of risk factors don’t have to cost extra money and could save the public purse millions.

It is not yet clear how Brexit will affect the current protections and regulations afforded by membership of the EU. We will be keeping a close eye on developments and will be seeking to ensure that on leaving the EU, the UK does not regress and cut regulation in a miscalculated endeavour to gain short-term economic advantage, while losing out in the long term.

A significant proportion of breast cancers have no definitive or attributable cause; we would like to support research in this area to fill the gaps in our knowledge, both through our own funding programme and by encouraging government (and other) research funding initiatives to focus on breast cancer aetiology, with an emphasis on the environmental causes of breast cancer.

References

1          Macon M B and Fenton SE (2013). Endocrine Disruptors and the Breast: Early Life Effects and Later Life Disease. Journal of Mammary Gland Biology and Neoplasia 18: 43-61 http://www.ncbi.nlm.nih.gov/pubmed/23417729

2          Kortenkamp A (2008). Low dose mixture effects of endocrine disrupters: implications for risk assessment and epidemiology. International Journal of Andrology 31(2): 233-40 http://www.ncbi.nlm.nih.gov/pubmed/18248400

3          Bonefeld-Jørgensen EC et al. (2014). Biomonitoring and Hormone-Disrupting Effect Biomarkers of Persistent Organic Pollutants in vitro and ex vivo. Basic & Clinical Pharmacology & Toxicology 115: 118-128. https://www.ncbi.nlm.nih.gov/pubmed/24797035

4          http://www.ncri.org.uk/resources/. Specific breast cancer spend data supplied on request

5          Parkin D et al. (2011). The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. British Journal of Cancer 105: S77-S81

6          NHS (2016). Achieving World-Class Cancer Outcomes: Taking the strategy forward. Five year forward view. May 2016 https://www.england.nhs.uk/wp-content/uploads/2016/05/cancer-strategy.pdf (accessed 24 Nov 2016)

7          NPRI Scientific Review Group (2015). Initiative outcomes and Future Approaches. September 2015 http://www.mrc.ac.uk/research/initiatives/national-prevention-research-initiative-npri/ (accessed 24 Nov 2016)

Breast Cancer UK

www.breastcanceruk.org.uk

This article first appeared in issue 13 of Horizon 2020 Projects: Portal, which is now available here.