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State of the Evidence 2010 Table of Contents

Framework of the Scientific Review

I. Introduction

A. What we mean by “environment”
B. What we mean by “risk”
C. What we mean by “breast cancer”: One disease or many?

II. Breast Cancer and the Environment: Background

A. Breast cancer statistics: A brief introduction
B. Migration studies
C. Environmental chemicals in our bodies

III. Vulnerable Populations

A. Race and ethnicity
B. Accidental, occupational and home exposures
C. Timing of exposures

1. Prenatal exposures
2. Childhood and adolescent exposures
3. Pregnancy and lactation

IV. Complexity of Breast Cancer Causation

A. Mixtures and interactions
B. New models for thinking about dose-response relationships
C. Changes in cell processes: Genetic, epigenetic and tissue organizational effects

1. Primary breast cancer susceptibility genes
2. Lower penetrance genes (polygenetic model)
3. Mutagenesis
4. Epigenetics
5. Tissue Organization Field Theory (TOFT) of carcinogenesis

D. A “simple” model for thinking about the links between environmental toxicants and breast cancer
Figure: Complexity of Breast Cancer Causation

State of the Methodology

I. Introduction

II. Human Studies

A. Epidemiological studies
B. Chemical exposures: Air and dust measurements
C. Chemical exposures: GIS mapping
D. Biomonitoring
E. Genome-wide association studies: Acquired susceptibility
F. Community-based participatory research

III. Experimental Studies: Animal (In Vivo) Studies

IV. Experimental Studies: Cell Culture (In Vitro) Studies

V. Genomic Studies

Evidence Linking Environmental Factors and Breast Cancer

I. Introduction
Table: Summary of IARC and NTP Ratings

II. Hormones: Pharmaceutical and Personal Care Products

A. Background
B. Hormone replacement therapy (HRT)
C. Oral contraceptives
D. Infertility treatment drugs
E. Diethylstilbestrol (DES)
F. Hormones in personal care products

III. Endocrine-Disrupting Compounds (EDCs)

A. Background

1. Cell culture to human epidemiological studies: Evidence that we should be concerned about endocrine disruptors

B. Bisphenol A (BPA)
C. Phthalates
D. Parabens
E. Alkylphenols
F. Polycyclic aromatic hydrocarbons (PAHs)
G. Pesticides and herbicides

1. Triazine herbicides: Atrazine
2. Heptachlor
3. Dieldrin and aldrin
4. Other pesticides

H. Polybrominated diphenyl ether (PBDE) fire retardants
I. Dioxins
J. Persistent organochlorines

1. Dichloro-diphenyl-trichloroethane (DDT/DDE)
2. Polychlorinated biphenyls (PCBs)

K. Aromatic amines
L. Sunscreens (UV filters)
M. Tobacco smoke: Active and passive exposures
N. Metals

IV. Hormones in Foods: Natural and Additive

A. Phytoestrogens (plant estrogens)
B. Synthetic and genetically engineered hormones used in food production

1. Background
2. Zeranol (Ralgro)
3. Bovine growth hormone (rBGH)/recombinant bovine somatotropin (rBST)

V. Non-Endocrine-Disrupting Industrial Carcinogens

A. Benzene
B. Organic solvents other than benzene
C. Vinyl chloride
D. 1,3-butadiene
E. Ethylene oxide

VI. Light-at-Night and Melatonin

VII. Radiation

A. Non-ionizing radiation (electromagnetic fields)

1. Overview and mechanisms
2. Research exploring links between non-ionizing radiation and breast cancer risk

B. Ionizing radiation

1. Overview and mechanisms
2. Interactions between ionizing radiation and other factors
3. Evidence linking ionizing radiation and breast cancer risk
4. Medical radiation: Risks and benefits

a. CT scans
b. Mammography
c. Radiation therapy

Bisphenol A: Bridging Science and Action

From Science to Action

I. How to Use This Section

II. Food

A. Exposures of Concern
B. Vulnerable Populations
C. Current Regulation
D. Policy Recommendations
E. Agencies Responsible for Regulation
Tips for Reducing Exposure to Chemicals of Concern
Table: What Is the Connection Between Food and Breast Cancer?

III. Plastics

A. Exposures of Concern
B. Vulnerable Populations
C. Current Regulation
D. Policy Recommendations
E. Agencies Responsible for Regulation
Tips for Reducing Exposure to Chemicals of Concern in Plastics
Table: What Is the Connection Between Plastics and Breast Cancer?

IV. Cosmetics

A. Exposures of Concern
B. Vulnerable Populations
C. Current Regulation
D. Policy Recommendations
E. Agencies Responsible for Regulation
Tips for Reducing Exposure to Chemicals of Concern in Cosmetics
Table: What Is the Connection Between Cosmetics and Breast Cancer?

V. Household Products

A. Exposures of Concern
B. Vulnerable Populations
C. Current Regulation
D. Policy Recommendations
E. Agencies Responsible for Regulation
Tips for Reducing Exposure to Chemicals of Concern in Household Products
Table: What Is the Connection Between Household Products and Breast Cancer?

VI. Health Care

A. Exposures of Concern
B. Vulnerable Populations
C. Current Regulation
D. Policy Recommendations
E. Agencies Responsible for Regulation
Tips for Making Informed Health Care Decisions
Table: What Is the Connection Between Health Care Exposures and Breast Cancer?

VII. Air and Water

A. Exposures of Concern
B. Vulnerable Populations
C. Current Regulation
D. Policy Recommendations
E. Agencies Responsible for Regulation
Tips for Reducing Exposure to Chemicals of Concern in Air and Water
Table: What Is the Connection Between Air and Water Contaminants and Breast Cancer?

VIII. Conclusion

References