California County's Rate of Disease Is Almost 40% Higher Than U.S. Norm

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http://www.washingtonpost.com/wp-dyn/articles/A2126-2002Oct22.html

Breast Cancer Puzzle in Marin

California County's Rate of Disease Is Almost 40% Higher Than U.S. Norm

By Ellison

Special to The Washington Post

Wednesday, October 23, 2002; Page A03

Schadlich holds her son , 2, at her home in Larkspur, Calif.,

recently. The 42-year-old was diagnosed with breast cancer three years ago.

(RANDI LYNN BEACH FORTHE WASHINGTON POST)

SAN RAFAEL, Calif. -- Marin County, long-famed as a mecca for wealthy

hot-tubbers, has recently acquired a darker distinction. Women in these

scenic valleys north of San Francisco are being diagnosed with invasive

breast cancer at a higher rate than experts have found anywhere else in the

United States.

Over the past five years, non-Hispanic white women, the hardest-hit group in

this county, have received a diagnosis of breast cancer at a rate nearly 40

percent higher than the national norm. Just as striking is how the rate

steadily climbed through the 1990s, increasing 37 percent, compared with 3

percent for the rest of the San Francisco Bay Area.

Marin's predicament has acquired special import in an era when breast cancer

rates throughout the developed world have been rising, when more than 40,000

U.S. women are dying of the disease every year, and when scientists

increasingly are raising questions about the possible influence of exposure

to industrial chemicals. But even as local activists search for

environmental smoking guns -- such as links to toxic waste dumps or cellular

telephone towers -- experts say women here are most likely vulnerable

because of something in this county's lifestyle, rather than in its water.

" We don't think there's strong evidence of unique exposure to an

environmental harm, " says A. e, an epidemiologist at the

Northern California Cancer Center and a leading expert on Marin's plight.

e and other researchers say Marin's status may be largely explained by

its attributes as one of the nation's smallest urban counties. Its 250,000

residents are predominantly white and well-off financially, characteristics

long associated with higher rates of breast cancer. Cancer rates are

reported for counties, but not for cities and towns. If they were, e

says, places such as Beverly Hills, Calif., or Chevy Chase might exhibit

similarly high breast cancer rates.

Marin's status could potentially help women elsewhere if activists succeed

in encouraging further local research, making the county, as e hopes,

" a petri dish " to study what it is about the life of a professional,

well-off white woman that makes her so susceptible to breast cancer.

Evidence has been steadily accumulating to reinforce this connection.

Results published last month of an ongoing study of 133,479 California

teachers and administrators found a rate of invasive breast cancer that was

51 percent higher than that found in non-Hispanic white women of a similar

age throughout the state.

Researchers offer several possible explanations. Educated, professional

women, such as the teachers and a great portion of Marin's female residents,

generally have better access to medical care, including screening for

cancer; that leads to more diagnoses. Better medical care may also have

included more combined hormone replacement therapy, only recently linked to

increased breast cancer risk. Furthermore, in a family with two professional

incomes -- especially common in Marin, where the average household income

tops $80,000, almost $30,000 more than national average -- women often delay

having children or do not have them at all. These characteristics have long

been thought to increase the risk of breast cancer, the theory being that

such women have more menstrual cycles at a younger age, exposing them to

higher levels of estrogen, which can encourage tumor growth.

Beyond these issues, women here worry about a host of other possible dangers

hidden in what looks like a fortunate lifestyle: the hectic schedule of two

working spouses, pesticides on lawns, the chemicals in the plastic bottles

of the ubiquitous designer water.

" I've always thought it was the stress, " says Schadlich, 42, a

former real estate portfolio manager diagnosed with breast cancer three

years ago, just after the birth of her second child. " It takes a lot of

effort to maintain things here, with two parents working. My health was

always on the margin. "

Researchers have long known that chronic stress can harm people's immune

systems. In recent years, several studies have indicated that a common way

to cope -- by having a few drinks, as Schadlich says she often did -- is

associated with higher rates of breast cancer, though the medical reasons

for this remain unclear.

Schadlich says she quit drinking after her diagnosis. She also quit her job

and says she is trying to simplify her life. Even so, she felt frustrated

when her doctor, as she tells it, attributed her case to demographics.

The word raises the hackles of many women concerned about cancer,

particularly those who feel it dismisses concerns about circumstantial

evidence linking widely used chemicals, including some found in plastics and

pesticides, to rising rates of breast cancer.

" It's easy for them to say 'demographics', but -- hello? There hasn't been

enough research yet into what's in our air and in our soil and in the

products we use, " says Fern Orenstein, 44, a six-year cancer survivor and

health education specialist. " Maybe what it is isn't unique to Marin, but

maybe it is environmental, and we just have more of it here. "

So many residents share these suspicions that on Nov. 9, 3,000 community

volunteers for the Marin Cancer Project are planning to go door to door

polling residents and asking for a $1 donation to map the incidence of all

types of cancer. " The response has been like in the movie, 'Field of

Dreams,' " says the group's director, Judi Shils. " If you build it, they

will come. "

Still, tracking potential environmental factors in breast cancer is

extraordinarily difficult, experts say. The interaction between an

individual's genes and exposure to potential toxins is complex, and is why

some smokers get lung cancer, while other smokers do not.

In August, scientists involved in a study of reportedly high breast cancer

rates in Long Island said they had found no links to pollution or other

environmental factors. The research, supported by $30 million in federal

funding, had focused on industrial chemicals, including two recognized

" endocrine disruptors " -- substances that can affect hormonal systems. But

the lack of conclusions hasn't ended suspicions.

" We know that lifetime exposure to estrogen is a risk factor, " says Sheldon

Krimsky, a Tufts University professor who studies environmental health

hazards. " So it is logical that if we have chemicals that are creating more

estrogen, the risk may go up. " Such chemicals, says Krimsky, can be found in

cosmetics, lawn care products, household cleansers and certain plastics, but

research into their potentially harmful effects is moving " at a snail's

pace. "

The Marin Breast Cancer Watch, a group of survivors and other activists, has

been fighting to focus attention on environmental exposure since 1997, when

women began sticking pins on a map to see if the cancers were clustered.

Its members have supported five different small studies, funded by county,

state and federal agencies, including a three-year project comparing the

adolescent experiences of 300 Marin County breast cancer patients with those

of 300 local women who do not have the disease.

One finding that may be illuminating is how long women say they have lived

in the county. e hypothesizes that the climb in the local breast cancer

rate in the 1990s owes to departure of low-income women who could no longer

afford to live there. The group took pride in a recent visit from

Olden, director of the National Institute of Environmental Health Sciences

at the National Institutes of Health. " You've made your case that rates are

higher here than anywhere else, " he told them, " and you deserve our

attention. "

In an interview, however, Olden said he hadn't heard convincing evidence

linking the high cancer rates to any particular environmental problem. " It

looks like it's going to be demographics, " he said.

As the search goes on for exactly what that means -- what special risks

women here face -- Marin may have much to teach the country.

" There are lots of educated, affluent women scattered around the country, "

e says. " For them, Marin women may be canaries in the coal mine. "

© 2002 The Washington Post Company