National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

BREAST CANCER
AND THE ENVIRONMENT

A LIFE COURSE APPROACH

Committee on Breast Cancer and the Environment:
The Scientific Evidence, Research Methodology, and Future Directions

Board on Health Care Services

Board on Health Sciences Policy

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by a contract between the National Academy of Sciences and Susan G. Komen for the Cure®. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Library of Congress Cataloging-in-Publication Data

Institute of Medicine (U.S.). Committee on Breast Cancer and the Environment: The Scientific Evidence, Research Methodology, and Future Directions.

  Breast cancer and the environment : a life course approach / Committee on Breast Cancer and the Environment: The Scientific Evidence, Research Methodology, and Future Directions, Board on Health Care Services, Board on Health Sciences Policy.

        p. ; cm.

  Includes bibliographical references.

  ISBN 978-0-309-22069-9 (pbk.) — ISBN 978-0-309-22070-5 (PDF)

  I. Title.

  [DNLM: 1. Breast Neoplasms—etiology. 2. Environmental Exposure—adverse effects. 3. Breast Neoplasms—prevention & control. 4. Risk Factors. WP 870]

  362.19699’449—dc23

2012007110

Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2012 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Cover credit: Illustration by Diana Ong/Getty Images.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2012. Breast cancer and the environment: A life course approach. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

“Knowing is not enough; we must apply.
Willing is not enough; we must do.“

                                        —Goethe















images

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

 

COMMITTEE ON BREAST CANCER AND THE
ENVIRONMENT: THE SCIENTIFIC EVIDENCE, RESEARCH
METHODOLOGY, AND FUTURE DIRECTIONS

IRVA HERTZ-PICCIOTTO (Chair), Professor and Chief, Division of Environmental and Occupational Health, University of California, Davis

LUCILE ADAMS-CAMPBELL, Professor of Oncology, Associate Director, Minority Health and Health Disparities Research, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center

PEGGY DEVINE, Founder and President, Cancer Information and Support Network

DAVID EATON, Associate Vice Provost for Research, and Professor and Director, Center for Ecogenetics and Environmental Health, University of Washington

S. KATHARINE HAMMOND, Professor, Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley

KATHY J. HELZLSOUER, Director, The Prevention and Research Center, Mercy Medical Center

ROBERT A. HIATT, Professor and Chair, Department of Epidemiology and Biostatistics, and Director, Population Sciences, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco

CHANITA HUGHES HALBERT, Associate Professor, Department of Psychiatry, University of Pennsylvania, and Director, Center for Community-Based Research and Health Disparities

DAVID J. HUNTER, Dean for Academic Affairs and Vincent L. Gregory Professor in Cancer Prevention, Harvard School of Public Health

BARNETT KRAMER, Editor-in-Chief, Journal of the National Cancer Institute, and Editor-in-Chief, National Cancer Institute Physician Data Query (PDQ) Screening and Prevention Editorial Board

BRYAN M. LANGHOLZ, Professor, Division of Biostatistics, Department of Preventive Medicine, University of Southern California (resigned July 2011)

PEGGY REYNOLDS, Senior Research Scientist, Cancer Prevention Institute of California

JOYCE S. TSUJI, Principal Scientist, Center for Toxicology and Mechanistic Biology, Exponent

CHERYL LYN WALKER, Welch Professor and Director, Institute of Biosciences and Technology, Texas A&M Health Science Center

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

LAUREN ZEISE, Chief, Reproductive and Cancer Hazard Assessment Branch, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency

Study Staff

LOIS JOELLENBECK, Study Director

JANE DURCH, Senior Program Officer

SHARYL NASS, Senior Program Officer

NIHARIKA SATHE, Research Assistant (from November 2010)

CASSANDRA CACACE, Research Assistant (until December 2010)

ASHLEY McWILLIAMS, Senior Program Assistant (until December 2010)

PATRICK BURKE, Financial Associate

ROGER HERDMAN, Director, Board on Health Care Services

ANDREW POPE, Director, Board on Health Sciences Policy

Commissioned Paper Authors

REBECCA SMITH-BINDMAN, University of California, San Francisco School of Medicine

LINDA DIX-COOPER, University of California, Berkeley

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

 

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Mary Helen Barcellos-Hoff, NYU Langone Medical Center

Julia G. Brody, Silent Spring Institute

Diana Chingos, USC Norris Comprehensive Cancer Center

Kathryn Guyton, U.S. Environmental Protection Agency

Leena Hilakivi-Clarke, Georgetown Lombardi Comprehensive Cancer Center

William A. Knaus, The University of Virginia Health Sciences Center

Ruth M. Parker, Emory University School of Medicine

Lorenz Rhomberg, Gradient

Stephen H. Safe, Texas A&M University

Michael Thun, American Cancer Society

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

David M. Umbach, National Institute of Environmental Health Sciences, National Institutes of Health

Sandy Walsh, California Breast Cancer Organizations

Noel S. Weiss, University of Washington

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by David G. Hoel, Medical University of South Carolina, and David A. Savitz, Brown University. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

 

Acknowledgments

The committee is grateful for the contribution of participants at its three public meetings. The presentations and discussions at these meetings were valuable in informing the committee about relevant research findings, issues of interest in the research community, the perspectives of advocacy organizations, and the concerns of individuals with breast cancer and their families. The agendas for these meetings appear in Appendix A.

The committee was also ably assisted by Linda Dix-Cooper from the University of California, Berkeley, and Dr. Rebecca Smith-Bindman from the University of California, San Francisco, from whom the committee commissioned papers.

The study was conducted with the generous support of Susan G. Komen for the Cure®. The Institute of Medicine staff worked closely with Dr. Amelie Ramirez, who is a member of the Susan G. Komen for the Cure Scientific Advisory Board and Director of the Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio. Dr. Ramirez was helpful and supportive as the committee’s point of contact with the Scientific Advisory Board, which originally requested this study. In addition, Kendall Bergman graciously assisted the staff in the administrative coordination with Komen for the Cure.

The committee and project staff appreciate the work of copy editor Laura Penny and gratefully acknowledge valuable assistance within the National Academies from Laura Harbold DeStefano, Greta Gorman, Diedtra Henderson, Jillian Laffrey, William McLeod, Janice Mehler, Abbey Meltzer, Michael Park, Christine Stencel, Vilija Teel, and Lauren Tobias.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

C-1   Compilation of Evidence Categories Used by Selected Organizations

C-2   Supplemental Criteria Used by IARC and WCRF/AICR in Evaluation of Evidence

D-1   Summary of Estimates of Population Attributable Risk for Risk Factors for Breast Cancer

F-1   Selected Units of Ionizing Radiation

F-2   Summary of U.S. Population’s Annual Exposure to Ionizing Radiation from Different Sources, 2006–2010

F-3   Typical Effective Doses of Radiation for Common Conventional X-ray and CT Procedures

F-4   Typical Annual Occupational Exposures to Radiation

F-5   Estimated Number of Future Breast Cancers That Might Occur Related to a Single Year of Medical Radiation Exposure

FIGURES

2-1   Age-specific incidence rates for invasive and in situ breast cancer among women in the United States, 2004–2008

2-2   Age-adjusted incidence of invasive and in situ breast cancer in women, United States, 1975–2008

2-3   Age-specific incidence rates for invasive and in situ breast cancer among white and black women in the United States, 2004–2008

2-4   Multiple levels on which environmental exposures may act to influence breast cancer

2-5   A schematic illustration of the potential for environmental exposures at various levels and times over the life course to influence the initiation and progression of breast cancer

4-1   Overview of risk factors associated with breast cancer

4-2   Illustration of an evidence-based complex-systems model of postmenopausal breast cancer causation

4-3   Sources and amounts (g/yr) of dioxin-like compounds released in the United States in 1987, 1995, and 2000

4-4   Estimated releases of perfluorooctane sulfonyl fluoride (POSF) from 1970 to 2012 and exponential temporal trends in biota

4-5   Genetic variants associated with breast cancer arrayed on the basis of their frequency and their impact on breast cancer risk

4-6   Development of the mammary gland in rats following in utero exposure to atrazine (ATR) and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)

Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

5-1   Schematic representation of (a) the breast, showing lobules and ducts, (b) ductal carcinoma in situ (DCIS), and (c) invasive ductal cancer

5-2   Breast cancer risk by pack-years of smoking before and after first childbirth among parous women, U.S. Radiologic Technologists Health Study, 1983–1998

F-1   Energy spectrum of radiation

F-2   Sample doses of and exposures to ionizing radiation

F-3   Proportion of radiation from various sources, 1985 (left) and 2006 (right)

F-4   Median effective radiation dose (interquartile range, minimum, and maximum) for each type of CT study

F-5   Estimated range in the lifetime attributable risk of cancer if a 20-year-old woman underwent one of several types of CT studies using observed radiation dose

F-6   Projected number of future cancers (mean and 95% uncertainty limits) that could be related to CT scan use in the United States in 2007, according to cancer type

BOXES

S-1   Study Charge

S-2   Environmental Factors Included in the Committee’s Evidence Review

1-1   Study Charge

2-1   Breast Cancer in Men

2-2   Data on Breast Cancer

3-1   Environmental Factors Included in the Committee’s Evidence Review

5-1   Life Stages Representing Potential Windows of Susceptibility for Breast Carcinogenesis and Hypothesized Mechanisms of Carcinogenesis

5-2   Nongenomic Estrogen Receptor Signaling by Environmental Estrogens

Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

Acronyms and Abbreviations

ACS   

American Cancer Society

ADH   

alcohol dehydrogenase

ADI   

acceptable daily intake

AFFF   

aqueous fire fighting foams

AFP   

alpha fetoprotein

AhR   

aryl hydrocarbon receptor

AHRQ   

Agency for Healthcare Research and Quality

AICR   

American Institute for Cancer Research

ALDH   

aldehyde dehydrogenase

AMPK   

AMP-activated protein kinase

AR   

attributable risk

ASTDR   

Agency for Toxic Substances and Disease Registry

ATH   

adipose tissue hypoxia

        
BaP   

benzo[a]pyrene

BBD   

benign breast disease

BCAC   

Breast Cancer Association Consortium

BMI   

body mass index

BPA   

bisphenol A

BPC3   

Breast and Prostate Cancer Cohort Consortium

        
CAR   

constitutive androstate receptor

CDC   

Centers for Disease Control and Prevention

CFR   

Code of Federal Regulations

CGEMS   

Cancer Genetic Markers of Susceptibility project

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
CI   

confidence interval

CISNET   

Cancer Intervention and Surveillance Modeling Network

CT   

computed tomography

CTS   

California Teachers Study

CYP   

cytochrome P-450

        
DAG   

directed acyclic graphs

DBP   

disinfection by-products

DCIS   

ductal carcinoma in situ

DDE   

dichlorodiphenyldichloroethylene

DDT   

dichlorodiphenyltrichloroethane

DEHP   

di(2-ethylhexyl) phthalate; also bis(2-ethylhexyl) phthalate

DEP   

diethyl phthalate

DES   

diethylstilbestrol

DHEA   

dehydroepiandrosterone

DINP   

diisononyl phthalate

DMBA   

7,12-dimethylbenz[a]anthracene

DNA   

deoxyribonucleic acid

DSHEA   

Dietary Supplement Health and Education Act

        
ECA   

European Chemical Agency

ECM   

extracellular matrix

EDC   

endocrine disrupting compound

EFSA   

European Food Safety Authority

EGFR   

epidermal growth factor receptor

ELF-EMF   

extremely low frequency electromagnetic field

EPA   

Environmental Protection Agency

ER   

estrogen receptor

ER–   

estrogen receptor negative

ER+   

estrogen receptor positive

ERE   

estrogen response element

        
FAO   

Food and Agriculture Organization of the United Nations

FDA   

Food and Drug Administration

FSH   

follicle stimulating hormone

        
GAO   

Government Accountability Office

GST   

glutathione S-transferase

GWAS   

genome-wide association studies

        
HER   

human epidermal growth factor receptor

HERS   

Heart and Estrogen/Progestin Replacement Study

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
HHS   

Department of Health and Human Services

HPA axis   

hypothalamic–pituitary–adrenal axis

HPG axis   

hypothalamic–pituitary–gonadal axis

HPV program   

High Production Volume Chemical program

HR   

hazard ratio

HT   

hormone therapy

        
IARC   

International Agency for Research on Cancer

IGF   

insulin-like growth factor

IGFBP   

insulin-like growth factor binding protein

IOM   

Institute of Medicine

IPCS   

(WHO) International Program on Chemical Safety

        
LH   

leutenizing hormone

        
MAPK   

mitogen-activated protein kinase

MBzP   

monobenzyl phthalate

MCPP   

mono-(3-carboxylpropyl) phthalate

MEP   

monoethyl phthalate

MMTV   

mouse mammary tumor virus

MNU   

N-methyl-N-nitrosourea; also N-nitroso-N-methylurea

MPA   

medroxyprogesterone acetate

MQSA   

Mammography Quality Standards Act

MRFIT   

Multiple Risk Factor Intervention Trial

mRNA   

messenger RNA

        
NAS   

National Academy of Sciences

NAT   

N-acetyltransferase

NCI   

National Cancer Institute

NHANES   

National Health and Nutrition Examination Survey

NHS   

Nurses’ Health Study

NIAAA   

National Institute on Alcohol Abuse and Alcoholism

NIEHS   

National Institute of Environmental Health Sciences

NIH   

National Institutes of Health

NNH   

number needed to harm

NNT   

number needed to treat

NPCR   

National Program of Cancer Registries

NRC   

National Research Council

NTP   

National Toxicology Program

        
OEHHA   

Office of Environmental Health Hazard Assessment

OR   

odds ratio

OSHA   

Occupational Safety and Health Administration

Page xxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
OVX   

ovariectomized

        
PAH   

polycyclic aromatic hydrocarbon

PAR   

population attributable risk

PBDE   

polybrominated diphenyl ether

PCB   

polychlorinated biphenyl

PDQ   

Physician Data Query

PFOA   

perfluorooctanoic acid

PFOS   

perfluorooctanesulfonic acid

PI3K   

phosphoinositide 3-kinase

PND   

postnatal day

PPAR   

peroxisome proliferator-activated receptor

ppm   

parts per million

PR   

progesterone receptor

PR–   

progesterone receptor negative

PR+   

progesterone receptor positive

PSA   

prostate specific antigen

        
REACH   

Registration, Evaluation, Authorisation and Restriction of Chemical Substances

RNA   

ribonucleic acid

ROC   

receiver operating characteristic

ROS   

reactive oxygen species

RR   

relative risk

        
SEER   

Surveillance, Epidemiology, and End Results Program

SERD   

selective estrogen receptor down-regulator

SERM   

selective estrogen receptor modulator

SHBG   

sex hormone binding globulin

SNP   

single nucleotide polymorphism

STAR   

Study of Tamoxifen and Raloxifene

        
TCDD   

2,3,7,8-tetrachlorodibenzo-p-dioxin

TDLU   

terminal duct lobular unit

TNBC   

triple negative breast cancer

TNF   

tumor necrosis factor

TSCA   

Toxic Substances Control Act

        
USPSTF   

U.S. Preventive Services Task Force

UV   

ultraviolet radiation

        
VOC   

volatile organic compound

Page xxiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
           
WCRF   

World Cancer Research Fund

WECARE   

Women’s Environment, Cancer, and Radiation Epidemiology Study

WHI   

Women’s Health Initiative

WHO   

World Health Organization

        
XOR   

xanthine oxidoreductase

Page xxiv Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR1
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR2
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR3
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR4
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR5
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR6
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR8
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR9
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR10
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR11
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR12
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR13
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR14
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR15
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR16
Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR17
Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR18
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR19
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR20
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR21
Page xxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR22
Page xxiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR23
Page xxiv Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Breast Cancer and the Environment: A Life Course Approach. Washington, DC: The National Academies Press. doi: 10.17226/13263.
×
PageR24
Next: Summary »
Breast Cancer and the Environment: A Life Course Approach Get This Book
×
Buy Paperback | $75.00 Buy Ebook | $59.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Breast cancer remains the most common invasive cancer among women. The primary patients of breast cancer are adult women who are approaching or have reached menopause; 90 percent of new cases in U.S. women in 2009 were diagnosed at age 45 or older. Growing knowledge of the complexity of breast cancer stimulated a transition in breast cancer research toward elucidating how external factors may influence the etiology of breast cancer.

Breast Cancer and the Environment reviews the current evidence on a selection of environmental risk factors for breast cancer, considers gene-environment interactions in breast cancer, and explores evidence-based actions that might reduce the risk of breast cancer. The book also recommends further integrative research into the elements of the biology of breast development and carcinogenesis, including the influence of exposure to a variety of environmental factors during potential windows of susceptibility during the full life course, potential interventions to reduce risk, and better tools for assessing the carcinogenicity of environmental factors. For a limited set of risk factors, evidence suggests that action can be taken in ways that may reduce risk for breast cancer for many women: avoiding unnecessary medical radiation throughout life, avoiding the use of some forms of postmenopausal hormone therapy, avoiding smoking, limiting alcohol consumption, increasing physical activity, and minimizing weight gain.

Breast Cancer and the Environment sets a direction and a focus for future research efforts. The book will be of special interest to medical researchers, patient advocacy groups, and public health professionals.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!