CBCRP Allocates Up to $23 Million to Understand and Solve Environmental Links to Breast Cancer and the Reasons Behind the Unequal Burden of the Disease

Katherine McKenzie, Ph.D.
Research Administrator and External Relations Manager

How many times have we been asked, “Are things in the environment causing my breast cancer?” “Why are more white women getting breast cancer while more black women are dying from the disease?” Health disparities have been documented for a century, and over sixty years of data exist to support a role for environmental factors in the etiology of breast cancer. Yet no blueprint or strategic plan to direct or coordinate health disparities research activity appears to exist, and most of the evidence linking the environment and breast cancer is circumstantial.

In 2004, we decided to develop a radically new funding approach in order to answer these questions. Already committed to supporting risky, out of the box research, it was time for us to apply that philosophy to our funding priorities. Instead of committing everything to investigatorinitiated awards, we set aside a third of our funding to support a carefully developed—and risky but potentially highly rewarding—program-directed funding strategy.

“Questions about disparities and the environment’s impact have been around for a long time,” said Debra Oto-Kent, breast cancer survivor, Continued on page 8 CBCRP Allocates Up to $23 Million to Understand and Solve Environmental Links to Breast Cancer and the Reasons Behind the Unequal Burden of the Disease Executive Director of the Health Education Council, and chair of the CBCRP’s advisory council from 2003 to 2005. “Now we have the opportunity to create solutions through leveraging California’s unique resources and supporting coordinated statewide efforts.”

The CBCRP recruited a blue-ribbon panel to oversee the entire process and ensure that it addressed actual, critical gaps in research: Olufunmilayo I. Olopade, M.D., molecular geneticist and oncologist at University of Chicago; Susan Shinagawa, cancer and chronic pain advocate and co-founder of the Intercultural Cancer Council; David R. Williams, Ph.D., health disparities researcher at Harvard University and Executive Director of the RWJ Commission to Build a Healthier America; Julia G. Brody, Ph.D., executive director of the Silent Spring Institute, and environmental pollutant researcher; Sandra Steingraber, Ph.D., biologist, environmental activist, author, and Distinguished Visiting Scholar at Ithaca College; and Mhel Kavanaugh-Lynch, M.D., M.P.H., director of the California Breast Cancer Research Program.

We extensively surveyed the state of the science in the two research fields and solicited input from hundreds of scientists, advocates, and clinicians around the country. After this intense decision-making process, we announced a $23 million funding strategy to support research that capitalizes upon California’s diverse populations and extensive research infrastructure to focus on complex and challenging questions that have thwarted traditional research approaches.

“This vision grew from our frustration of questions that weren’t getting answered through investigatorinitiated proposals,” said Teresa Burgess, Ph.D., Director, Oncology Research, Amgen Inc., and chair of the CBCRP’s advisory council from 2001 to 2002. “This is a tremendous opportunity for the California Breast Cancer Research Program to undertake critical studies that push these fields forward.”

Leveraging Diverse Populations
California has a robust research infrastructure that can be harnessed to answer some stubborn questions. We are investing in several approaches to determine whether the diverse population studies that are established and emerging in California can answer some of the critical questions.

A potentially fertile area for identifying the causal factors for breast cancer lies in the observation that when immigrants come to the U.S., their risk for developing the disease rises, often within a generation. We will spend up to $1.68 million to fund two transdisciplinary pilot studies to describe the changes in behavior, social and physical environment that can cause the dramatic increase in breast cancer risk that occurs as people immigrate to the U.S.

We can also leverage California populations to determine whether the timing of exposure to risk factors can play a role in developing susceptibility to breast cancer. In order to explore this possibility we are devoting $5 million to support a multigenerational human study to determine the relationship between pre-natal exposure to polychlorinated biphenyls (PCBs) and breast cancer.

We are funding a $300,000 feasibility study to determine whether the data from existing California studies can be combined to explain why people from different racial and ethnic groups who are with diagnosed with breast cancer at the same stage of advancement have different survival outcomes. If it proves feasible to combine the studies and answer meaningful research questions, the CBCRP has set aside $3.9 million to pursue the question.

We have also committed to a one-year $100,000 pilot study to develop the methodology to augment the statewide California Teachers Study with more diverse members and additional biological and survey data to elucidate the role of polycyclic aromatic hydrocarbons (PAHs) and Vitamin D in breast cancer. We have also committed to funding a $100,000 feasibility study for determining the effects of environmental exposures within a racially and ethnically diverse population on the development of breast cancer in a new cohort, Kaiser members enrolled in the Research Program on Genes, Environment and Health (RPGEH) patients. Up to $6 million will be set aside for a year to fund full projects of one these studies.

Understanding Complex Data
In order to analyze the information, it first has to be collected correctly. We are dedicating $400,000 to develop tools to improve the way we collect demographic information (race, ethnicity, migration history, disability status, socio-economic status, gender, and sexual orientation) that will increase the ability to understand how breast cancer impacts specific communities. Once defined, the CBCRP will work to add the criteria to current, commonly-used surveys to improve the ability of researchers to understand diverse communities.

A critical barrier to significant progress is explaining how multiple factors interact to cause breast cancer and how they contribute to disparities in incidence and mortality. We will invest $320,000 to convene a panel of experts from multiple disciplines (including social, environmental, and disparities scientists) to develop a complex model to illustrate the interconnected and non-linear relationships among breast cancer risks. We will also spend up to $1.1 million to develop biostatistical models to address how the multiple factors that come into play during one’s life may interact to affect breast cancer risk.

Informing Chemical Policies
The precautionary principle instructs us to make rational choices about what can be harming us now, and to find ways to act now. California has just launched the Green Chemistry Initiative, which will require companies that produce chemicals to demonstrate that they are safe before releasing them on the market. It is an excellent opportunity to integrate breast cancer information into the testing protocols now. We are committing $200,000 to identifying the core tests available immediately to inform chemical regulation policy about how to test for potential breast toxicity. We have committed an additional $5 million to adapt emerging assays and develop new, functionally relevant methods for screening chemicals for breast toxicity.

By investing in these diverse approaches, we expect to steer breast cancer research in new directions. “This is the most important thing happening in research right now,” said Lisa Wanzor, associate director of Breast Cancer Action and chair of the CBCRP’s advisory council from 2006 to 2007. “It took a lot of time and hard work to develop this strategy, but that’s what it takes, and this is a risk worth taking. This is what it means to be a leader, to do something different.”

California has unique resources and opportunities for research. The diversity of the population in terms of race, socio-economic class, rural/urban settings, and social structures make it a natural laboratory. The studies that we fund will take advantage of this, the research resources, and a political climate that allows us to explore question in a way that is impossible for any other state in the US.

The journey won’t end here. Most or all of these projects could be expanded, given additional funding. We will invite other research funders to join us in supporting these studies and help us open the door to an exciting new phase in breast cancer research.