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Environmental Threats to the Human Breast: Prenatal to Post-Menopausal Exposures

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Sent by support group:

Subject: Dr. Steingraber: Environmental Links to Breast Cancer

 From Dr. Janette Sherman:

It's the carcinogens that are giving us cancer!!!!!

>Sandra's talk Looking Upstream for Environmental Links to Breast Cancer
>Cincinnati Breast Cancer and the Environment Research Center
>May 14th, 2005
>
>Please share it widely.
Looking Upstream for Environmental Links to Breast Cancer

Cincinnati Breast Cancer and the Environment Research Center
May 14th, 2005


Keynote Speaker:  Sandra Steingraber, PhD
Environmental Threats to the Human Breast: Prenatal to Post-Menopausal
Exposures

Thank you.  What an honour to be here.  I know that whenever  speakers are
flown across state lines and  crowds are assembled, especially when
advocates and scientists have a chance to all meet together in
conversation, a lot of work has to go on behind the scenes to make that
happen, so thanks to everyone.

  I’m going to dedicate my presentation today to two women who were really
influential in my own work.  The first is Dr. Patricia Brown who is a
Mammologist with a specialty in the evolution of the mammary gland.  Pat
specifically looked at the function of fat in the breast and spent a lot of
her career arguing that the mammary fat pad in the breast was not just this
sort of inert matrix that the active part of the gland just  sat in, but
rather that it was an active inter-active part of  the breast itself.  And
she looked at stromal epithelial interactions especially as they related to
breast cancer risk.  She was an amazing researcher; she probably knows more
about the evolution of the mammalian breast than  any other biologist I
know and she read over both my book manuscripts in their entirety in draft
and offered her expertise and commentary.  When both my children were born
she sent wonderful gifts to them, and she just died in November, of breast
cancer.  Three months before her first grandchild was born.   She was a
person who, you know,  took her own callipers and measured her own tumour
growth and  her own CATscans and all the knowledge in the world that she
had about breast cancer  which was formidable, couldn’t, in the end, save
her life.  But it’s her work that makes my work possible, so I would like
to dedicate some of my comments to Pat today.

I’d also like to dedicate this talk to Deborah Tall who is a poet and an
essayist who wrote an amazing book called From Where We Stand, which is
about her own relationship to her  adopted homeland in upstate New
York.  And she really taught me a lot about how to write about
landscape.  Those of you who might be familiar with my book, Living
Downstream, know that part of it really is a love story between me and the
very toxic home town that I grew up in and in my most beloved
landscape.   Deborah is still living, but she is fighting for her life
now.  She has a very aggressive form of inflammatory breast cancer and for
those of you who know about breast cancer, it has been compared to a forest
fire for very good reason.  So … to Pat, and to Deborah today.

Let me begin autobiographically.  I was diagnosed with bladder cancer at
the age of  twenty and between my sophomore and junior years of college,
and I wasn’t the first one in my family to have bladder cancer.  My aunt
went on to die of transitional cell carcinoma of the bladder some years
after my diagnosis.  And, at the time of my diagnosis, my mom was in
treatment for pre-menopausal breast cancer.  In fact she was diagnosed
first at age 44 then had a metastasis and a re-occurrence at age 46.  My
mom is now 74 and she has outlived all predictions about her demise.  And
if she was here today she would tell you of how she has outlived three of
her oncologists;  two of whom died of cancer themselves.   I have several
uncles with prostate cancer and a 21-year old member of my family died of
colon cancer.  So, I have a lot of cancer in my family but the punch line
to my story is that I’m adopted, so that none of the people I just
mentioned to you are related to me genetically.  Because of that (including
my aunt with the same sort of cancer I had) so very early on in my life as
a biologist, I became interested in the idea that families have a lot more
than just chromosomes in common.  We also drink from the same drinking
water wells, we breathe from the same airspace, we shop at the same
supermarkets, we may work in the same kind of occupations.

The other effect that my diagnosis had on me was I made this big lateral
move in my career at that point.  Up to that point I had sort of run with
the “high-achieving, pre-med, biology” pack and after I came out of the
hospital, I never wanted to go back here again.  Even though, of course, as
a cancer survivor I am in and out of hospitals all the time, but I
certainly didn’t want it to be my workplace.  So,  instead of planning a
career in medicine, I went into research.  And the environment became
something that I was very interested in, particularly after I started
reading around in the medical literature about my own disease and  it turns
out that bladder cancer is considered a quintessential environmental
cancer.  In fact, we know more about the environmental links to bladder
cancer with evidence and data going all the way back to the 19th
century  than we do about almost any other kind of cancer; except maybe the
link between smoking and lung cancer.  So that the link between aromatic
amine exposure for example in bladder cancer is worked out in all kinds of
elegant detail with animal studies and human studies so that there is
absolute proof now about such links and aromatic amines and some other
chemicals are considered known human carcinogens, known  human bladder
carcinogens.  Beyond a doubt.  Evidence for the kind of cancer that I
had.  And, what surprised me at the time (it is no longer shocking to me
now) is to learn that those same chemicals, once they were determined and
proven to cause bladder cancer were never outlawed.  They are still in
commerce today.  So, even when we have absolute proof about cancer and an
environmental link we don’t necessarily move in our society to divorce our
economy from its current dependencies on those chemicals.  We may regulate
things more closely but we don’t necessarily eliminate substances.  What
also surprised me is, after all this research I had done, to go into my own
physician’s office to have a conversation with him about all this only to
find out that he wasn’t familiar with any of these data at all and had no
idea that there were such links between  environmental links to my cancer
which made me ask questions about why the culture of medicine itself seems
divorced from my field of biological enquiry which is the study of how
organisms interact with the environments that they inhabit.  Pre-medical
biology, it seems to me, and then medical school itself tends to focus on
the cellular level, and at most on a tissue, sort of histological level and
doctors very often, even the very good ones that have saved my life and
provided me great treatment are not necessarily versed in the kinds of
things that are bringing us here today to have a conversation about.  So,
while they are authorities on treatment, they are not necessarily
authorities on causality , particularly not  the environment.  It is just
not part of their training.  So that is why  the double insights I have
gained over the years as a cancer patient and an environmental biologist
myself.

In the early 1990’s, I was a Biology professor in Chicago.  I was labouring
hard, as Biology professors do, in my research and investigations.  And
then I became swept up in a social movement that was sweeping the city of
Chicago, as well as I think, the whole nation.  And that was the
radicalization of the breast cancer movement.  Women with breast cancer in
the early 90’s were really beginning to take a lesson from the AIDS
activists of about five years earlier who had done so much to lay bare the
political root causes of  HIV infection and were so successful in demanding
that we do prevention and education around HIV transmission even in the
face of incomplete data.  And were insisting that lines of inquiry and
virology follow certain pathways that people with AIDS demanded because
their lives depended on it.  That virologists do this work.  And so they
also succeeded in changing the lines of inquiry down which science was
directed and funded.  And so a lot of, especially lesbian activists, in the
1980’s took a lesson from their gay male brethren and came into the breast
cancer community, noticed that especially in the lesbian community
that  women were being devastated by breast cancer, did not have the same
kind of services, did not have the same kind of role at the table with the
scientists that their gay male brethren who were working in the AIDS
community had, were having a lot of victories.  So tried to re-create some
of those activist models in and around breast cancer.  And I was really
really compelled by what I saw because I have always felt that science is a
public servant and that we scientists who are doing the research should
always take the questions from the public.  What does the public want to
know?  And should be what we should go out there and try to do.

I came out of the closet really when I was thirty years old about being a
cancer survivor.  I had never talked about it, between the ages of 20 and
30.  But there were so many speak-outs, especially women with breast cancer
talking about cancer.  Awareness campaigns.  Things like the Wall of
Hope.  Kinds of  Art Tours that were going on, and I finally didn’t keep my
cancer a secret anymore nor the whole story about cancer in my family.  So,
I guess I want to say this to say that the work that you do, as advocates
in the breast cancer community has  all kinds of consequences you may not
have realized.  It had the power to make me quit my job and give up my 401K
and I moved to Harvard for a year on a fellowship to begin research on
cancer and the environment because women with breast cancer were asking me
where they could find such a book because they wanted to be able to read in
simple English “What is the state of the evidence around cancer and the
environment?”  And there really wasn’t such a book, so I quit my job and
went off to write it.  So, that is one of the powers of activism is that it
can make people do that.  It can inspire us.  We inspire each other, I
guess that is what I’m trying to say.

So, I spent a year at Harvard, in probably the best medical library in the
world, beginning the research on that book.  And then, after a year of
that, I realized what I really needed to do was go home.  Go home to my own
hometown in downstate Illinois, among the corn and soy bean fields, and the
ethanol distilleries and the pesticide factory right near my high school,
and the company that turns scrap metal into barbed wire that has a
Superfund site right behind its factory wall.  And find out what exactly
went on there.  I needed to go in search of my ecological roots.  So, after
a year at Harvard, I spent a year in my sister’s basement  back in Pekin,
Illinois, mucking around as a environmental detective in my own
hometown.  And, then I spent three more years sort of as a gypsy scholar in
various universities that had university libraries that I
needed:  Northeastern University, University of Illinois at Chicago being
two of them and got some funding.  And, as a result, four years later, was
the book Living Downstream.  Which I hope can serve as a   blueprint for
folks who want to do this kind of environmental investigation in their own
hometowns.

So, that’s kind of the background.  And so catch you up on the whole resume
of my life here.  Somewhere around … well, I should say I went on a book
tour with Living Downstream that was supposed to last two weeks and
essentially I was on the road with it for almost two years.   It was a
wonderful discovery to realize that the question on my mind “what was the
link between environmental health on one hand and human health on the
other” was also a question on a lot of people’s minds so I not only did the
usual things that authors do, you know sign books and borders and do the
Today Show, and do some grand rounds of physicians and all the rest but, I
was also invited to places like northern Alaska.  Where women were
concerned about the contamination of salmon streams by old military
installations, where solvents were leaking into salmon streams.   I went to
Ireland when the book was published abroad and talked to sheep farmers who
had inadvertently contaminated their drinking water wells with insecticides
that they used for sheep dip to keep parasites off their sheep.   I was
invited to southern Texas where retirees were worried about Superfund sites
and their drinking water supply.  I spoke with a lot a lot of breast cancer
groups all around the nation.  I essentially traveled through all fifty
states and did a couple of different tours of Europe, including having a
chance to address United Nations delegates about breast milk contamination
and the European Union about children’s environmental health in Belgium a
year ago.  Somewhere along the line, I met my husband, eloped and got
pregnant.  I don’t know how that happened because the egg and the sperm
weren’t often in the same time zone in the beginning of that relationship,
so I felt very lucky.  And so, I became a cancer patient at 20 and a mother
at 40.  Which I know that isn’t the order that most people live their life
in, but that’s how it worked out for me.  And, my ecstatic experience in
becoming a mother compelled me to look at some of the same chemicals I had
looked at in Living Downstream and their ability to influence cell division
and other things that we know are related to cancer risk, and now I’ll take
a look at the ways in which those same chemicals can trespass across the
placenta and enter the environment of a pregnant uterus.   And confront a
developing human being with the first toxic exposures at the time when the
body is just getting itself assembled.

So, for that work, I then moved to Cornell University because there is a
great program there in foetal toxicology.  So I spent another four years
working on my more recent book, Having Faith.  So that kind of brings us up
to the present.

So, what I want to do with you today is kind of take a look at the whole
life history of  the breast.  Talk about where breasts come from.  And
where are they going.  And then , once we do that, to sort of rewind the
tape, and take a look at the way toxic exposures can enter the picture at
various points in time and create certain kinds of risks.  Let me start out
with a guy in the 18th Century named Carlos Linnaeus.  He was a Swedish
taxonomist who was the guy who named all the animals of the world.  So, he
was a kind of a latter day Adam.  And he’s the guy who named us Homo
sapiens; the wise one.   And, he’s also the one who, in 1758, named the
warm-blooded, hairy branch of the animal kingdom: mammals.  That was his
name.  In Latin, mammalia.  That replaced a name that had been in place for
two thousand years prior to that, quadropedia, which meant the four-legged
one.  So, he re-named us the four-legged ones to the breast-bearing
ones.  And this decision was met with hoots of derision from his
colleagues.  The idea that he would name a whole class of animals after a
female organ was considered appalling.  A lot of his colleagues pointed out
that only half of all the members of the group had breasts and mammary
glands.  The other half, namely males, didn’t even have them so why would
you use that as your defining characteristic?  But he did.  And the name
has stuck.  It was a peculiar and radical decision actually, for the 18th
century, and I got very interested in why he did that.  So, here’s a little
footnote; if you have a lack of something interesting to say at a party,
you can pull this story up.  It turns out Linnaeus was hardly a
protofeminist.   I thought he might have been an early women’s rights
crusader, but actually just the opposite.  He did have a big political
agenda in naming the mammals mammals, but it had a lot to do with the
ongoing debate in Europe at the time over wet nursing.  In the mid 18th
century most infants, especially in France, were farmed out to professional
lactators.   It wasn’t just the high-born infants.  Almost everybody was
shuffling babies around and giving them to somebody else to
nurse.  And  Linnaeus was actively involved in a campaign to outlaw
wet-nursing and actively trying promote laws that would compel women to
breast feed their own babies.  He was a physician so he was legitimately
interested in infant mortality.  Which was considerable.  Because
especially the wet nurses own babies were farmed out then to people who
were feeding them not mother’s milk and those babies very often
died.   Linnaeus was not so much concerned about the rights of the wet
nursers and the fate of their babies;  he actually opposed the idea that
women should have any kind of role outside of the home.  And he compelled
women to be like beasts in the field.   So, he and other physicians, sought
to rein in women’s growing politician power in 18th century Europe, and his
strong beliefs that women should stay home and nurse babies was really
behind his decision to name the mammals mammals.  He wanted to really
underscore the task that we women are supposed to have.  His own wife had
eight children, all of which she nursed herself and apparently never left
the house.  So, I’m sorry to say that is the truth behind the mammal
thing.   I was hoping it was a different story, but it isn’t.

Despite the fact that an entire taxonomic category is named for the mammary
gland, we actually know very little about its basic biology.  Part of the
reason is legitimate; breasts just don’t fossilize.  So, unlike every thing
we know about how the inner ear came to be, we don’t know much about the
origin of the breast.  The idea that breasts are modified sweat glands is
pretty much a myth.  We think that probably they are more similar in their
history and current histology and physiology  to oil glands.  So the new
thinking now is that they arose from oil glands rather than sweat
glands.   Why males of all species have mammary glands present in some
rudimentary  form but they are not functional is an official evolutionary
mystery.  We have not figured that out yet.  Interestingly enough, not all
mammals … not all male mammals have the same amount of breast.  So, human
males actually are on the far end of having very well developed
breasts.   Our human males have both nipples and ducts.  On the other end
of the continuum would be the rodents.  And, rodents males have no
nipples.  So, we don’t understand that either.

Here are four things we do know.
We know that breasts are why mammals inherited the earth from
dinosaurs.  Having breasts allowed mammals to live in harsh environments
like the arctic, where there is not abundant food sources all year
round.  It allowed mammal mothers not to have to forage for food for
babies.  It allowed babies to grow faster because it is a very high calorie
food.  And, it’s a hedge against food shortages.  Now, that turns out to be
important.  The whole evolutionary history of the breast, to hedge against
famine, has a big role to play in breast cancer.  So, that is why I’m
mentioning it now.  So, just keep that little piece in mind.

Here’s another thing we know for sure.
The mammary gland predated live birth, so that the breast is actually
older, evolutionarily speaking, than the placenta.  We know this is true
because there are those funny little animals like platypuses that actually
lay eggs, but nurse their young.   So, the ability to nurse and the
modification of the oil glands to provide food for babies is older on the
evolutionary tree than the advent of the placenta and internal pregnancy
and birth.

We know that the number of breasts is approximately equal to the number of
offspring per birth times two.  Which is another way of saying; we have two
breasts because we usually have one baby.  And rats, pigs and rats, both
have twelve breasts because they have about six babies per litter.  Mice
have ten breasts.  The world record holder is a hedgehog in Madagascar that
has 24 mammary glands.  In most cases the mammary glands occupy this
mammary ridge which exists in two long lines along the underbelly.  But, in
a lot of species, the mammary glands themselves can be confined to either
one end of that ridge or the other, either in the chest as in bats and
primates or the groin, as in animals who stand up to nurse.  So,
essentially, if you stand up to nurse, your breasts are located in your
groin.  If you hold your baby while nursing, as in the case with primates
and bats, then you have breasts on the upper part of your chest.

The fourth thing we know for sure is that breast size in humans is
extremely variable but is unrelated to milk production.  The volume of a
breast is essentially made up of fat and connective tissue, and that as we
all know,  varies extremely among women.  But, the amount of glandular
tissue per breast is not very variable.  It is doled out in essentially
equal portions to all women.  So, that when you are nursing, you are
putting out about a quart of milk per day and that holds true for high-born
women, poor women, women in Africa, women in Europe, women in the US.  You
top out at about just under a quart of milk per day, no matter what your
breast size is.

There is a myth that humans are the only mammals that have permanent
breasts.  Breasts that we can actually see, even when we are not
lactating.  And that is not exactly true.  There is a lot of human
behavioural theory about that.  None of which I think actually holds
water.  It is true that our fat pad is located as these two lumps on our
chest wall in ways that for most women are sort of visible through their
clothes at various points of their life, but rodents and other mammals have
mammary fat pads too.  And they have them throughout their reproductive
lives, not just in lactating.  But, that they tend to be not arranged as
two lumps on the chest so that a rodent can have a mammary fat pad, some of
which actually extends up and around the shoulder.  It is just more
smoothly distributed under the skin so you can’t necessarily see it as a
big lump the way you can a human breast.  So, that’s kind of an
evolutionary sweep of the breast.

I want to now do a little bit of … how do I say it? … sort of a life
history, I guess, of the breast.  I’m going to go inside the breast and
talk about how it develops for a few minutes.  And here, I’m just going to
ask you to pay attention because I’m not going to show slides.   And I do
this deliberately, because as soon as the slides go up, I feel that there
is this division between the scientists and the non-scientists in the
room.  And those who are used to looking at anatomical diagrams, or tissue
micrographs or looking at x/y co-ordinates are just at an advantage so now
I’m going to be very democratic and you are all going to be disadvantaged
by not having any AV aids.  You’re going to have to imagine what I’m
saying, right?  Create a picture in your mind’s eye of what I’m saying.  I
actually think that you’ll remember this longer than if I were to give the
big slide show on it.

So, I’m going to ask you to imagine the inside of the breast and I’m going
to use some terms that I want you to remember because we are going to come
back to them.  So, here’s some basic anatomy.  Inside the breast,
essentially, is a tree.  The trunk of the tree is in the nipple, and as you
move back towards the chest wall the branches increase in number.  And
those branches are called ducts.  At the ends of those ducts, hanging like
little fruits are something called lobules.  And the lobules are eventually
where the milk is going to be made.  And the milk flows down the ducts and
into the nipple.   The ducts are all surrounded by a layer of muscle that
can contract.  This is called the myoepithelial layer.  And that allows the
milk to be propelled from the back of the chest wall where it is actually
manufactured and up toward the nipple.  Where the action of suckling and
peristaltic action of the tongue by the suckling infant in addition to the
propelling motion of those muscles in the mother’s breast, it’s going to
push the milk to the outside world.   You might not know this.  I didn’t
know this until I had a baby.  It was a surprise to me that a human nipple
is not like a faucet or a garden hose.  Even thought there are plenty of
other animals like goats and cows and rats that do have their nipples set
up that way, our nipples are more like sprinkling cans or shower heads so
that the ducts rather than coming together to form one big opening like a
garden hose instead there are 12 to 15 ducts that all open out onto the
nipple.  So that when the milk lets down, you may have seen Renaissance
pictures of this hanging in museums, so that when a women has a milk let
down reflex you see these shower like sprays of breast milk coming out of
the nipple.  So here I was, a mammalogist, finally pregnant and a mother at
forty and saw all these milk threads pouring from my breasts.  I had no
idea actually.  So, somehow the anatomy of the breast is a too well-kept
secret if I could manage to get a PhD in biology and not be aware of it all.

So, this whole tree-like structure is embedded in a matrix of fat and
connective tissue.  So that’s basically what the breast is, ok?  So, now
let’s go back and talk about how that structure actually develops
throughout the history of  a woman.  And we’ll start with all the way back
in prenatal life and we are going to start with a seven-week old
embryo.   Here the human body is the size of a grain of rice.  And this is
when the breast actually starts its development.   This is when the mammary
ridge actually rises up from the ectoderm which is the outermost layer of
the embryo and forms those two ridges down the belly of this little grain
of rice.  By the sixth month of pregnancy,  the breast is pretty much
finished.  It is as finished as it is going to be up until the changes
start at puberty.   You’ve got nipples.  You have ducts.  You have that
myoepithelial muscular layer around the ducts, you have lobules and you
even have the beginning of a fat pad.   And the breast basically stays like
that.  All throughout infancy and childhood.  So, you are pretty much done
at age six months pre-natal life and then you have the same breast all the
way up until puberty.

So what happens at puberty first, is increased blood levels of
estrogen.   And what the estrogen does is actually call for the deposition
of fat behind the nipple.  So, when we say that a girl’s breasts are
starting to develop, what we mean by that is that we can see fat being
deposited under the nipple.   The actual development of the glandular part
of the breast is completely invisible.  It’s not necessarily … it’s not
responsible for the volume of  breast or anything that we can see.   That’s
going on sort of back in the chest wall.  But, the estrogen does not only
deposit fat under the nipple, it also instructs those ducts to start to
divide and grow.  So that they get longer.  And they are getting longer  in
this direction back into the chest wall.  So the breasts are growing out
because of fat deposition, but what we can’t see is that the ducts are
growing back in this direction all during puberty.   Now, with the first
menses, a girl’s first period, which roughly correlates in time to within a
month or so of her first ovulation, there is a big spike in progesterone as
well.  And what the progesterone does is start those lobules budding.   So
you get lots and lots more lobules at the end of all those ducts.  So, it
is like a tree that starts to fruit, ok?  So the branches are growing, the
tree is starting to fruit and all that’s happening at puberty.   And you
might think that at the end of adolescence basically that the breast is
kind of done for awhile, at least up until pregnancy, but that turns out
not to be true.   The breast keeps going through this leisurely development
up until about age 35.

And through the yin and yang of each menstrual cycle you have further
development of those ducts and those lobules so it’s like a house that you
are adding an addition on to, but you are only working on it one weekend a
month.   So, slowly, slowly the renovations kind of get done.   But it goes
all the way up from puberty to about age 35.   And with each menstrual
cycle you have within that time period, new structures are budding and the
breast becomes slightly more elaborate.

Then you have pregnancy.  In pregnancy, the pace picks up and things really
start to move.  The progesterone in pregnancy goes way up and so does a
placental hormone called lactogen.   Which actually is a hormone that the
placenta makes.  It doesn’t go to the baby, it goes into the mother’s blood
to the breast.  And what the lactogen and progesterone do together is start
the ducts really developing.  The estrogen makes the ducts a lot
longer.  The lactogen and the progesterone differentiate the lobules.  The
estrogen also causes more fat to be deposited so a woman in pregnancy
usually notices that her breasts are growing larger.  Most importantly,
what the lobules start to do is they differentiate.  They turn into
structures we call acini.  Which are simply mature lobules which are now
capable of making milk.  So, until you go through a full term pregnancy,
the breasts are not capable of milk production.  You have to go through
these hormonal changes so the lobules are changed, matured into these
acini.  This turns out to be really critical because it turns out that …  I
should say the ducts are also now differentiated.  They don’t look like
immature tissue any more.  They look like they’re sort of finished.   For
those people who are used to looking at slides of immature and mature
tissue, you can tell by, not just in the breast but cells in general, how
differentiated they really are.  That’s critical because it turns out that
differentiated breast tissue, both the lobules and the ducts, are less
sensitive to the effects of carcinogens than undifferentiated, immature
tissue.  So, going through that maturing stage during pregnancy of the
breast is an important way to lower breast cancer risk.

Now during lactation, after the baby is born, the breast continues to
differentiate.  And that’s important too because that means the longer you
lactate (not just how many babies you have) but how long you nurse each one
of them confers additional protection against breast cancer risk because
you are continuing to mature and differentiate the breast tissue.   During
weaning, when the lactation ends, there’s a whole stage called involution
which the assini now turn back into lobules.  Connective tissue and other
non-glandular tissue takes the place of the glands and things kind of move
in the other direction.  They become more rudimentary again but the key is
the tissues always remain differentiated.  They never go back to their old,
immature state.   Now if there is another pregnancy, the breast grows all
over again so essentially if we are talking about the business end of a
breast  the glandular tissue, which is of course, the tissue that gives you
cancer, you grow a new breast with every pregnancy.  So that the glandular
tissue with weaning kind of senesces, it disappears and gets
rudimentary.  With the subsequent pregnancy, you grow brand new trees,
brand new fruiting structures on the ends of the trees so that you
basically have a new set of breasts with every pregnancy.  And then with
menopause, you get sort of a permanent involution where connective tissue
and fibrous tissue takes the place of a lot of the glandular tissue once
again.

So, my point in going through all this is to emphasize and I hope that was
an illustration of incredibly complex the breast is.  It is the only organ
that we know of in the human body that has such an indeterminate and
complex pattern of differentiation.  Breasts are never finished being
done.   They are always being remodelled.  They are always being changed,
depending on your reproductive history.   And I think that is the beginning
of seeing why it is so difficult to understand the role that the
environment plays   in breast cancer risk.  We know a lot now about
toxicology.   We know that our old way of thinking, that the dose makes the
poison, is really outmoded.   You’ve heard some great presentations
today  about how the timing makes the poison as well as the
dose.   Depending on the time of exposure; think about those thalidomide
pictures that you saw.  We know exactly what day thalidomide had to reach
that baby.  Like on Day 47 you saw these little reduction deficits.  On a
different day, if we gave that same drug you would see deformed ears.  On a
different day, you would see … you could have deformations in the fingers,
you could have it all the way up to here.  Depending on what was happening
on that particular day, we know exactly what the defect is going to
be.   We’ve worked all that out now for a lot of the prenatal birth
defects.   Because we know, that for most of the human body, you develop
from the head down.  And from the centre out.  So, when we see a defect
like a cleft palate or a hole in the heart we know that happened very early
on in pregnancy.  Something wrong with the fingers or toes, undescended
testicles we know that something went awry later on in the
pregnancy.  That’s because for most human structures they follow a certain
pattern of development and when we introduce a toxic exposure we see a
specific result depending on what body part was forming on that day, right?

But, when we look at the breast, timing seems to make the poison with the
breast too.  But if we looked, for example, at all thirty year olds, and we
wanted to know what happens if you introduce, let’s see a pesticide, into
the drinking water of all thirty year old women.  Well, all thirty year old
women, unlike all 47 day old embryos, aren’t in the same stage of
development.  Some thirty year old women like me are walking around  with
totally undifferentiated breast tissue because I hadn’t been pregnant
yet.  Other thirty year old women might be pregnant now and their breasts
are in that process of fruiting and growing.  Other thirty year old women
are  weaning or are in between two babies.  Some may have had five babies
already and are now completely done.  So you have this completely
indeterminate growth pattern that is completely a function of your
reproductive history.  So no woman of the same age necessarily is in the
same stage of breast development.  So if you are looking at how the timing
influences breast cancer outcome, you have so many different
variables.  And add to this the fact that breast cancer is not just caused
by one mechanism.  We believe now that there are at least four mechanisms
by which breast cancer can arise so let me go through these.

One is … the most commonly sited one which is genetic mutation.   You can
be exposed to a chemical of some kind or ionizing radiation that actually
breaks a gene and that genetic damage leads to the kind of runaway cell
growth we know as breast cancer.   But we also know that you don’t
necessarily have to mutate the gene itself with breast cancer.  You can
actually just alter gene expression.  Meaning a chemical can come in and
turn on a gene, or turn off a gene that was supposed to be on.  So, rather
than breaking the whole mechanism you’re just flipping different
switches.  You’re using the machine of the gene in a different way and that
itself can lead to breast cancer.  We also believe that, independently of
both those mechanisms, you can change the way cells interact with each
other in the breast.  So, we don’t even have to mess with the genes but
what we can do is mess with the tissue architecture itself.  And there is a
big theory now that is getting a lot of attention with a lot of fancy
language around it.  Just to remind those of you, what it is called; what
we are interested in is the interaction between the stroma of the breast
and the epithelial of the breast.  The stromal-epithelial
interaction.  This may sound like a familiar phrase.  If not, what you need
to know is that it is just the architecture of the various kinds of tissue
in the breast and if you alter the way one kind of tissue talks to another
kind of tissue, that itself can lead to breast cancer.  And we know that
there are certain chemical agents that actually can interfere with tissue
architecture, so that is getting some attention now in the research
community.  The fourth way that we can influence breast cancer is through
exposure to agents that alter the body’s natural production of
estrogen.  You’ve heard a lot today already so I won’t review it about the
way your own estrogen plays a role in breast cancer.  And the more of your
own estrogen you are exposed to over the course of your lifetime, the
higher the risk.  But if we expose you to agents that alter the way your
own estrogen is metabolized or made available in the body or we expose you
to chemicals that are estrogen-mimicking chemicals, that too can influence
breast cancer risk.

So here you have this indeterminate organ that is constantly growing and
retreating and changing depending on your reproductive history, you’ve got
four possible paths to tumour formation and you combine all those variables
and you have this very, very difficult scientific question to ask.  So, one
of the reasons why the picture on breast cancer and the environment is not
much clearer now than it was ten years ago when I was really in the thick
of researching all of this for Living Downstream has a lot to do with the
complexity of the science.

Happily, one of the other things that was hanging us up, which was that
nobody really cared about breasts.  Nobody really cared that much about
breast cancer, talking about now in the 1960’s and 70’s and 80’s.  But that
has all been changed.  Thanks to you advocates.  The research that you
heard today was made possible because of the agitation, all the letters
that you signed and everything that you all did.  Because research was not
being directed and not being funded looking at the role that the
environment was playing in breast cancer until breast cancer advocates
demanded that to happen.  So you are beginning to see the fruits of your
own labour now.  But the wheels of science grind slowly onward.  The breast
is just a really complicated organ as it turns out.

Okay, so now what I’ve said I wanted to do is rewind the tape and go back
and look at the development of the breast.  But this time, we are going to
talk about what happens when we introduce toxic chemicals at various points
in that development.  So let’s go back into the uterus for a minute and
talk about foetal exposures.  We don’t have a lot of human studies on
foetal exposures because obviously we wouldn‘t … it wouldn’t be ethical to
do controlled experiments on human foetuses.   But we do have some
clues.  We know from some data in Sweden, some human studies in Sweden,
that birth in Sweden is a predictive factor of your breast cancer
risk.  Let me sort of explain that a little bit more.  There are a lot of
immigrant studies, I’m sure you’ve heard of them, showing that when you
move from let’s say Japan to the US or from Canada to New Zealand, England
to the US, Africa to Israel; all these have been well documented.  I
That within two generations, your daughter’s breast cancer risk will come
to represent not your inherent ethnicity of the country of origin but
rather will come to match that of the country in which you now live.  So
clearly environment trumps ethnicity and genetics when it comes to breast
cancer risk.  But what the Swedes have done is even more elegant research
showing that being born in Sweden, just that fact alone, is predictive of
what your breast cancer risk will be than if you immigrate to Sweden when
you are twenty years old or if you are Swedish and you live somewhere
else.  In other words, if your prenatal life was spent in Sweden then you
move somewhere else, nevertheless, or your mother came from somewhere else
and she became pregnant with you and you were born in Sweden, being born in
Sweden means that your breast cancer risk will match that of most of the
women who live in Sweden.  So clearly, there is some kind of imprinting
that goes on during the period of pregnancy that creates a risk for breast
cancer.  I think I said that very badly.  Did that make
sense?  Okay.  Alright.  Some kind of long, run-on sentence there that
bothered me.

On the other hand, if you immigrate into Sweden in your twenties you retain
the pattern, the breast cancer risk of whatever country you came
from.  Okay.  So, that’s one clue that we have for foetal exposures through
these immigrant studies.  Now, with animals we have a lot more studies.  We
know, studies with mice for example, and you expose mice to a kind of
plastic called Bisphenol A and you expose a mother mouse in utero, you
actually alter the development of those ducts.   You remember the ducts,
the branches of the tree, in such a way that you predispose the foetus to
breast cancer later on in life.  Now, that may not be a sufficient exposure
but you alter the anatomy of the breast, that branching pattern of the tree
itself in such a way that a later exposure in adulthood is sufficient to
cause breast cancer.   Whereas mice who are not exposed in utero and have
sort of normal ductal branching patterns are then exposed to a toxic
solvent in adulthood, they are able to fend it off and don’t go on to get
breast cancer.  So there is something about predisposing exposures in
pregnancy that turn out to be really important in mice.  We also know with
dioxin in mice that if you are exposed prenatally, you actually alter the
ducts in such a way that they don’t mature fast enough later on in
life.  So you slow down the maturation of the ducts and remember having
immature ducts is bad.  Because immature ducts are more vulnerable to
cancer formation that differentiated ducts.   Anything that slows down the
maturation process of the ducts is not good.

A third study shows that certain kind of chemical exposures in mice
prenatally can actually lead to early puberty which you’ve been hearing a
lot about today.   Early puberty in humans, as we’ve heard, is linked to
increased breast cancer risk.  But, let’s go on for a moment and talk about
what goes on in pregnancy.  We believe that -- now we’re talking about
pregnancy not when you were in your mother’s womb, but when you become a
mother yourself -- we believe that the breasts are most vulnerable to toxic
exposures between puberty when the breasts, when all those ducts start to
grow and the lobules start to grow, between puberty and the first full term
pregnancy.  So that window of time is the most vulnerable window of time
for a breast.  Because it is growing, but it is undifferentiated.  That’s a
dangerous combination, right?  So, the longer that window of time for you
the higher your risk of breast cancer.  So, let me just compare my
reproductive life to my sister’s.   Both my sister and I got our periods at
age 13.  My sister had her first baby at 20.  I had mine at 40.  She’s now
a grandmother and I’m still nursing my three-year-old, even though she’s my
younger sister.  We have very different reproductive histories.  So let’s
see:  thirteen to twenty, she was walking around with undifferentiated
breast tissue for seven years.   I was walking around, thirteen to forty,
with undifferentiated breast tissue for 27 years.  Is that right?  Can that
be right?  Yes, that‘s right.  Wow.  I’m getting old.   It’s good to be old
when you’ve had cancer.  I like being 46; it’s a good age.   But still, 27
years of undifferentiated breast tissue.  So what does this mean?  Well, it
could mean that we advocate teenage pregnancy as the answer to the breast
cancer epidemic but I don’t think that would be … what do they say? … The
cure is worse than the disease.   So what does that mean?  It means that
those of us who do delay our reproductive lives and I don’t like that word
because I met my husband at 38 and I worked as fast as I could to get
pregnant, I wasn’t delaying anything.   I hadn’t met the right man yet,
right?  What it means is that we actually need more protection from
environmental carcinogens than other folks.  And so we might be able to
more safely choose to have babies in our forties if we divorce our economy
from chemicals known to cause breast cancer because we are walking around
on the world, as is any woman who doesn’t have a baby at all, who goes
through a whole lifetime of undifferentiated breast tissue.   So, I think
it’s a human rights issue here.   That all of us deserve equal protection
under the law whether we have mature breast tissue or immature breast
tissue.  So, I think that advocating earlier reproduction is not as
rational a program of breast cancer prevention as getting the carcinogens
out of our environment and therefore out of our breasts in the first place.

Let’s talk about breast feeding because this hasn’t received enough
attention yet today I don’t think.  Breast feeding … the longer you breast
feed your baby, the more you lower your own premenopausal breast cancer
risk.  We’ve known that for awhile and the data are really consistent on
that.   The longer the duration, the greater protection.   For years and
years it was less clear what protection breast feeding might offer to
postmenopausal breast cancer but the data are beginning to come in and they
are pretty impressive.  We don’t, in this country, breast feed … we have
one of the lowest breast feeding rates of any nation so it’s really hard to
study US data because we don’t have very many people out there breast
feeding a child for two to three years.  But in China they do.  In China,
women who breastfeed more than 24 months per child cut their postmenopausal
breast cancer rate by half.  By half.  This becomes therefore the largest
modifiable risk factor  that we could talk about.  More even than, with all
due respect to everything I heard about diet and exercise and everything
else, which I believe in and try to practice myself, I go home and through
out my safflower oil and try to replace it with some other things,  breast
feeding as not received enough attention I would argue as a modifiable risk
factor.  Not that we can go out and command women to breast feed, but what
we need to do certainly is to work to, for example, we’re one of the only
nations that doesn’t offer paid maternity leave.  If we could get women and
children together rather than having to warehouse babies at six weeks of
age into daycare and send women back to work which terribly sabotages the
breastfeeding symbiotic relationship between mother and child, we would not
only do more to increase breast feeding rates which is good for infant
behaviour, infant development but we would also prevent lots and lots of
breast cancers.  So, what I’m encouraging you to do I guess as breast
cancer advocates is work towards increasing breast feeding rates in this
country.  You will be saving the lives of mothers, and as we’ve heard
already, having been breast fed as an infant lowers breast cancer risk in
an adult.  So, breast feeding your daughters provides them a hedge against
breast feeding (sic?) and so it saves mother’s lives as well as daughter’s
lives.  Not only directly because of the immune factors in the breast milk
that the baby is getting but also because having been breast fed
significantly lowers your risk for obesity.  So, you are also probably
cutting down on precocious puberty, obesity in childhood, also by
breastfeeding.  So, in one stroke you are protecting and lowering breast
cancer risk in both the mothers and the infants.  Working towards breast
feeding is part of a breast cancer prevention project.  And, I have lots to
say on the topic of breast milk contamination which I’m not going to say
but if you have questions I’d be happy to answer that.  I spent the better
part of two years researching and writing about that in Having Faith and
that’s an important topic.  I was on CNN not long ago talking about the
presence of rocket fuel in breast milk and the problem with that etc. but I
just want to say now that having studied that data for two years I
nevertheless breast fed my own daughter Faith for three years and when I
had her brother, I’m still breastfeeding him.  So I’m a six-year lactator
at this point.  So the benefits of breast feeding for all of us outweigh
the risk.  But this society does not make it easy for women, especially
working women, to breastfeed.  And that’s something that we can all get
involved in.

Okay.  So, I want to spend my remaining moments doing two things.  I want
to talk about some specific chemicals that I’m worried about that I think
we can begin to take action on now.  And then I’m going to close by giving
you a little reading from my more recent book, Having Faith.  Those of you
who know me know that I always like to close by  reading from a …  after we
go through all the data and the bad stuff to read from sort of a joyful
passage to remind us all that this is really about life and that’s why we
do this work.  Let me do a little chemistry with you first then we’ll ease
up and read something which I hope you will enjoy.

So, we’ve got ourselves up to the point of the lactating breast.  So now
when I talk about an adult women’s breast.  We’ve spent a lot of time today
thinking about the ways that very early life exposures influence breast
cancer risk but there’s plenty of evidence to suggest that adult exposures
even after reproduction are still important.  And we know this to be true
because when we look at breast cancer among different occupations of women,
we don’t see a random distribution.  We see that women who are employed in
certain kinds of jobs have breast cancer risks that are either higher or
lower than normal.  And some of the women who have higher than expected
breast cancer risks include chemotherapy nurses.  And you might know that a
lot of chemotherapy drugs are themselves carcinogenic.  Women who work with
anaesthetic gasses in the operating rooms.  Women who are chemists or work
in chemical labs.  Women who work in the electronics industry, especially
those who are exposed to chlorinated solvents.  Hairdressers, who are
exposed to plenty of chemicals.  Also homemakers, which is
interesting.  Teachers and librarians, which is a very consistent pattern
we see in lots of different states in the United States and we see
corroborating data from Europe and we don’t quite understand what that’s
about yet.   Clearly then, even exposures that you have when you are a
working adult person are important.  So here’s what I want to close
with.  And there are so many chemicals that I could talk about, this is
where I really struggled.  So let me say this.  If you want to read about
all the chemicals that so far have been linked to breast cancer, some we
know a lot about, some we are just learning about,  this is what I would
refer to you.  (holds up book)  It is a wonderful monograph called State of
the Evidence:  What is the Connection between the Environment and Breast
Cancer.  Put out by Breast Cancer Fund and Breast Cancer Action, but
written by scientists and really vetted carefully.  I believe the science
in here is just really stellar.  It is really easy to read.  This is the
updated 2004 edition.  You can get it online if you like by going to
breastcancerfund.org.  breastcancerfund.org.  So, I would refer you to
that.  So, I am just going to hit a few things.  Not that they are
necessarily the most important ones, but the ones where I think action can
be taken right away.  So let me talk about … let me talk about lawn chemicals.

Lawn chemicals, especially one called atrazine, which is a weed killer, has
been banned in the European Union precisely because of troubling links to
breast and ovarian cancer that show up not only in human studies of women
farmers but also in animal studies.  The reason it’s not banned here, and
it’s our number one most popular pesticide in the United States, is because
there is some inconsistency in the data.  It appears to cause breast cancer
in one strain of rat but not in another strain of rat.  And the
manufacturer and regulatory agencies have looked at that uncertainty in the
data and have decided to err on the side, not of precaution, but rather on
the side of  “Well, let’s just continue to do more research and continue to
use atrazine in cornfields and in backyards anyway.”  I have a problem with
that conclusion.  I agree that the science is incomplete.  As a scientist,
I am very conservative and I don’t … I am confused about the case against
atrazine.   I don’t think we know everything.  But, as a woman and as the
mother of a daughter, I’m not confused at all.  I’m also a very
conservative mother.  And if there is … if we have troubling signs that
something is linked to breast cancer and it has become our number one
pesticide and it’s a very common contaminant of drinking water,  I think we
need to move to divorce our agricultural system and our backyard pest
control practices away from this chemical.  Until we get the science all
sorted out.  And if it turns out to be safe then we can start using it
again.  But I don’t think we should use our daughter’s breasts as an
uncontrolled human test for these things.  What we know for a fact about
atrazine is that it alters a pituitary hormone that governs ovulation.  And
we know that’s all worked out.   So, as far as I’m concerned, that’s all I
need to know.  Anything that messes around with my menstrual cycle does not
belong in my drinking water.  The question is “how does that alteration
of  pituitary/ovarian axis alter the hormonal status of menstruation in
such a way that it affects the breast?”   We haven’t worked that mechanism
out yet.  But some brand new research that I want to tell you about done by
the EPA on animals has linked atrazine exposure prenatally to precocious
puberty in rats.  And of course in humans this would mean puberty before
the age of eight.  Precocious puberty turns out to mean actually slower
puberty.  You think that a girl who starts getting her breasts developing
earlier gets through adolescence faster; she doesn’t.  She actually goes
through it in a more delayed way over a longer period of time.  So the
window of time that her breasts are maturing is more slow, and remember
immature breast tissue, especially rapidly growing immature breast tissue,
is a risk factor for breast cancer.  You’ve just got these very vulnerable
breasts out there for a longer period of time.  So if atrazine has the
ability to cause earlier puberty in rats, we now need to find out if that’s
what’s driving our observations of early puberty in humans.  That’s
research that really needs to be done, and that’s one of the things that
you advocates could be calling for.  Is a follow-up from this new EPA
research on the effect of atrazine on mammary gland development and its
possible link to precocious puberty.  The work is being done, it’s not
getting enough attention.  It needs to be funded better.  We need to be
looking at communities in the US where we know we have atrazine in the
public drinking water.  There are many of them.  To see if the girls who
are living in those communities have higher rates of precocious puberty
than girls whose drinking water does not have atrazine.  And that work is
not even … nobody is asking that question yet.  So it is really, again, it
is up to the breast cancer community to bring these questions to the
scientists and demand that this get done and get funded.

I am really excited about the possibility of getting rid of lawn chemicals
in the backyard.  Obviously all of us can just make that choice as
individuals.  But, more than that, we can encourage our schools and our
state parks and soccer fields and things like that to go organic.  You may
not know this but the whole nation state of Canada has essentially decided
that cosmetic use of pesticides are now banned.  As of this month, May 2005
and that law has already passed the Canadian Supreme Court and as you can
imagine, Chemlawn et al. took it all the way up to the Supreme Court of
Canada and they lost.   And what the Canadians have decided is essentially
that if you are not growing food, if you are just using pesticides for what
they call cosmetic reasons, the benefits are not outweighed by the
risks.  And there are very troubling risks, especially to children.  Not
just from breast cancer risk but paediatric tumours, especially brain
tumours and leukemias.  And on that basis, even though the data are
incomplete, the Canadians did decide to embrace the precautionary
principle.  And so all those beautiful gardens in Montreal and Toronto and
Vancouver … the law right now doesn’t affect every single province in
Canada but does effect the parts of Canada where most people live … all
those city and state parks are going to be pesticide-free from now on.  And
if you are an individual homeowner and you feel like you have to use a
pesticide, in order to get permission you have to go before a special
committee and beg permission to use it.  So the default is that nobody is
going to be using pesticides in their backyard.  I found that stunning and
when I was up at McGill University and asked about how in the world they
managed to do that.  To get that law.  Again, I can’t possibly mimic the
French accent, but the guy on the street just shrugged and said “But it is
just grass!  It is not worth it!”  Which is a very different mind set I
think than what a lot of us have here.  But the great example that the
Canadians are setting for us is something we can bring here.  And
obviously, they are going to be figuring out a lot of chemical-free ways of
having their beautiful gardens and beautiful landscaping that we’ll be able
to model here.  And Carol, if you don’t mind, at the very end of my talk,
if you don’t mind, I’d like you to say a few words about what you are doing
here in Cincinnati.  So, I don’t want to put you on the spot … so I’m going
to tell you now that I’m going to call on you in a second.  So, think about
lawn chemicals and atrazine and think about the ways in which you might get
involved in creating chemical-free lawns.  As a way of decreasing
precocious puberty and  helping the health of breasts of girls.

Organochlorines are a set of chemicals that I’m concerned about.   There
are a couple that I’m especially worried about.  One is PVC.  PVC is what
we call vinyl and its main use is in building materials.  To manufacture
PVC, you take a bunch of vinyl chloride molecules and you string them all
together.  PVC itself doesn’t seem to cause cancer, but vinyl chloride
certainly does.  It’s a known carcinogen of the liver.  But, also now
there’s evidence to suggest that women who work with vinyl chloride on the
job have higher rates of breast cancer.  This turns out to be important for
all of us because vinyl chloride factories are notoriously leaky.  Vinyl
chloride is a gas and it just leaks in just hundreds of pounds per day from
every single poly vinyl chloride factory in the US.  I wrote a story in
this month’s issue of  Orion (holds up magazine).  I brought a copy if you
want to see it.  About a PVC factory near my hometown in Illinois that a
year ago blew up.  Completely blew up, killed five workers, spread dioxin
all over the town, evacuated basically an entire county.  And there is
still ongoing investigations as to the long term environmental health
effects there.  But, even before that upset, people in this little town of
Illiopolis, Illinois were exposed to two hundred pounds per day, every
single day, of vinyl chloride and vinyl acetate leaking from that
plant.  So women who live in communities where your vinyl siding and your
vinyl credit cards and your vinyl wallpaper are made, their breasts are at
risk.  And,  when poly vinyl chloride is used in drinking water pipes and
landfilled other toxic chemicals that we know are linked to breast cancer
including vinyl chloride start wafting out of landfills, so if we can move
immediately to divorce architecture and building design from its current
dependency on PVC building materials, we will be protecting the breasts of
women in the manufacturing towns where the plastics are being made and the
dumpsites where the plastic gets dumped when you renovate your floor, when
you rip up your kitchen floor and you throw it away.  And probably in your
own home.  Because a lot of these … poly vinyl chloride is very brittle; it
is treated with plasticizers and phthalates and there is some disturbing
evidence to suggest that phthalates themselves are estrogenic.  They are
estrogen-mimicking chemicals that enter your airspace.  That’s that “new
car” smell that you smell in a car filled with vinyl.  The smell that you
smell in a new shower curtain that you hang.  It’s the plasticizers
themselves.  And they’re estrogenic.  So poly vinyl chloride is a bad
actor, but I’m pleased to tell you that “Green” architects are moving to
find substitutes for it already and there’s a lot of exciting things
happening now with the Healthy Building Network and the US Green Building
Council.  So, for those of you who are at all interested in home design, if
you are involved in the architecture world at all, here is something that
you could grab on to and work with.  Finding substitutes for PVC.

Dry cleaning.  Women in Massachusetts who are exposed to perchloroethylene,
which is the fluid we use to dry clean clothes have higher than expected
rates of breast cancer.   Perchloroethylene is a chlorinated solvent.  It’s
a very bad actor.  It causes bladder cancer, with some degree of
certainty.   Perchloroethylene was one of the chemicals in own my hometown
drinking water well, so I grew up drinking dry cleaning fluid.  I feel like
I have an intimate relationship with it.  Transforming the dry cleaning
industry is a campaign that we can take on as women with breast
cancer.  Dry cleaning industry sounds like a huge thing but  these are Mom
and Pop shops.  This isn’t Monsanto or Dow Chemical.  Oftentimes families
run dry cleaning shops.  They are very often immigrant families.   And
finding ways in which to help those families capitalize the transformation
into the new technology that already exists called “wet-cleaning”.   Which
allows plain old soap and water to be used to clean wool and silk
again.  Because we have computerized control over things like humidity and
agitation in the new machines.  It’s a wonderful invention.  But, it takes
money to get these things set up.  Once they are set up, wet cleaners don’t
cost any more.  It’s just as convenient.  You pick up your clothes the same
way you always do, but they don’t smell like dry cleaning fluid
anymore.  And you know you can go home at night knowing you are not going
to give a woman breast cancer from having dry cleaned your own
clothes.   And since women are the people who go into the dry cleaning
shops to drop off the dry cleaning and pick it up, we women have a role in
transforming the dry cleaning industry into a wet cleaning industry.  All
the clothes I’m wearing, I have wet cleaned and unfortunately that means
sending them back to Boston where I used to live because we have a wet
cleaner there.  But, I am trying to work in my own hometown to try to get a
wet cleaner here.  So, you need to investigate here in Cincinnati.  If you
have a wet cleaner, if you do you need to publicize it and give them some
business.  Investigate the wet cleaners that exist in other cities and work
on trying to bring one here.  That would be a perfect project, I think, for
a breast cancer advocacy group to do.

Nail salons, I have a lot of concerns about.   Nail salons use lots of
different chemicals that, some of which are hormone-mimicking.  Some of
which are simply toxic in other ways.  I don’t have a lot of data to offer
you yet.  I know of two or three on-going studies looking at the kinds of
solvents that are used in nail salons.  Often women of reproductive age run
these things.  Their clients are often young women.  I’ve seen babies and
infants in their little bucket car seats sitting next to the Mom while
she’s having her nails done.  People are working very close up with
sculptured nails without any ventilation.  In other words, if you were a
worker in a Fortune 500 company, you would be working under a hood with a
ventilator with some of these same chemicals that in these small corner
nail salons and shopping malls, there’s no real good regulation.  So,
there’s some ongoing preliminary inquiry into the air quality in nail
salons.  That might be something for those of you who are part of that
community to investigate and find out what goes on there.  Again, I’m not
saying that nail salons cause breast cancer.  I’m saying that the chemicals
used in nail salons are inherently toxic, a lot of them.  And the airspace
appears  to be contaminated with them and we need to find out what’s going
on.  And we need to direct research dollars down that way.

Smoking.  And, this is the last thing that I want to talk about.  And then
I’m going to read for you, and if you have more questions about different
chemicals I’d be happy to answer them.  I wanted to alert you to some new
studies showing that second hand smoke, especially if exposure occurs
before the first pregnancy, appears to cause breast cancer.   And the whole
study on smoking and breast cancer, the whole investigation has gone on for
a long time and its yielded conflicting data.  Probably for the following
reason.   When you are a smoker, you are exposed to lots of chemicals
linked to breast cancer but we don’t always see an increased rate of breast
cancer.   And now we think we understand why.   Its because there are
things in tobacco smoke that are so toxic that you actually kill off the
eggs in your ovaries.  This is why women who are smokers go into menopause,
on average, two or three years earlier than women who don’t smoke.  Women
shorten their fertile lifespan by being smokers.  By doing so, they also
lower their own circulating estrogen levels because they’re killing off all
their egg cells.  And so, the lowering of estrogen levels ironically is a
protection against breast cancer.  Even though a smoking woman is also
exposed to chemicals like vinyl chloride, which is in tobacco smoke, that
are known to cause breast cancer.  So that’s why the data are a little
contradictory.  Obviously there is no contradiction about lung cancer or
bladder cancer and smoking, but the data on breast cancer and smoking has
always been a little bit odd.   So, now we think we know why.  But, when
you are a second-hand smoker, you’re not getting enough smoke to kill off
the eggs and your ovaries.  So, you still have high circulating estrogens,
but you are getting all the breast carcinogens in the second-hand
smoke.  So, second-hand smoke appears to be as bad as smoking for risk of
breast cancer.  And that’s what the new California study is showing
us.  So, working for smoke-free workplaces, working for smoke-free public
places.  In New York State now, we finally have a law that you can’t smoke
anywhere that’s public, including bars and restaurants.  And of
course,  there was a hue and cry that bars and any drinking establishment
would just wither on the vine but actually they are doing better than ever
because all the non-smokers who never wanted to go to bars because didn’t
want to come home smelling of smoke are now going to bars again.  So,
everything’s just fine.  The only downside that I can see is that my kids
suddenly notice that everyone is smoking because all the smokers have to go
outside so they’re standing on the street corner.  And when the law passed,
suddenly my children started noticing “what are those people doing over
there?” because they never saw them before because they were all inside the
bar.  But, a lot of good questions have been raised now about what happens
when children are exposed, especially a girl whose breasts are just
beginning to form.  What happens when her parents are smoking in a
car?  What happens when her parents are smoking in a home?  And things like
that.  So, working against second-hand smoke is another great project.

So, here’s how I’m going to conclude this.  All of the stuff I’ve just
said, you don’t have to do it all.  None of us can do that.   We are all
musicians in an orchestra.  It’s now time to play the “Save the World, Save
Our Children Symphony”.    But you are just one musician.  And, you’re not
required to play a solo.  You’re only required to figure out what your
instrument is and to play it as well as you can.   So, if you are really
into gardening, take up the question of lawn chemicals.  If you are into
fashion and clothing, take up the question of dry cleaning.  If you are
part of a culture of people who enjoys nail salons, work on that.   Here’s
special project for anybody who has a connection with Proctor and
Gamble.  Work on the personal care product industry.  There are lots and
lots of estrogen-mimicking chemicals in things like conditioners and
deodorants and shampoos and cosmetics that aren’t on the label; that aren’t
being revealed.  And we need to know what these chemicals are.   So take a
look at the website, notsopretty.org ; which is a look at the cosmetic and
personal care product industry.  P&G especially, I think, needs to be a lot
more forthcoming with some of the ingredients that they are using.  And our
right-to-know as women, about what is in personal care products and
cosmetics, I think, trumps arguments for proprietary business secrets.  I’m
not happy with P&G right now.  You might be interested to know that I wrote
a story for a publication called Childbirth Forum on the dangers of mercury
in fish and fish consumption during pregnancy and how mercury sabotages
foetal brain growth development.  That particular journal, its audience is
childbirth educators, and it is solely funded by Proctor and Gamble.  Right
before the article was to come out they essentially killed the story.  They
refused to allow the editor to print that story.  I’m not sure why Proctor
and Gamble is so afraid to have a conversation about mercury in fish but
happily, I was able to publish the story in another magazine.  And also
tell the story of how Proctor and Gamble doesn’t want women to read this
story, and if you want to read that second story, you can find it
at:  inthesetimes.com  inthesetimes.com.  You could just google my name
probably, Steingraber/mercury/fish, and find it.  It’s online right
now.  But that’s my very first experience with censorship; what happened at
the hands of Proctor and Gamble.  So, those of you who have some “in” with
that company,  conversations need to be had with boards of directors and
people who are involved in research and development there about what kind
of ingredients are in the personal care products that women are using.

Now I’m going to close with a little discussion of  breasts.  This is a
scene from my book Having Faith, my more recent book, and I’ll read two
short selections.   The first is the first time I ever breast fed in
public.  And the second one is breast feeding Faith when she’s old enough
to talk about it.  The scene here opens in my own apartment, I now have a
seven-week-old infant and I haven’t really left the home much yet and I’m
dying to get out and go somewhere.  So, the phone suddenly rings:

“It is the secretary of the President of Illinois Wesleyan
University.  (That is my alma mater, by the way.)  The President, who is
travelling along the east coast has invited a few New England-area alumni
to a dinner tomorrow night at Boston’s Harvard Club.  Would Jeff and I like
to join them?  And the thought bubble above my head is: Yes!  Oh Yes! Oh
Yes!  And then what I really say is this:   ‘Well, that depends’ I say
slowly.  ‘I have a new baby.  I would need to bring her along.  Would she
be welcome too?’  ‘Of course!’ is the breezy answer.  ‘ I also breast
feed.  Is that a problem?’ ‘Let me get back to you.’ the secretary
says.  ‘Ok thanks.  Ok bye.’  I pace around, waiting for the phone to ring
again.   Why did I say that?  Why ask permission to nurse the baby?  On the
other hand, what if we went, I did and everyone was mortified?  For all my
bravado, I haven’t attempted public breast feeding yet unless you count the
waiting room at the paediatrician’s office.  The phone rings.  ‘Yes, of
course it would be fine.  The President explicitly says that it is
fine.’  ‘Terrific.  Thanks.  Bye.’  I don’t lose my nerve until we walk
into the private room filled with bejewelled women and pinstriped men
holding martini glasses.  I quickly surmise that this is a fund-raising
party but why I, who just applied for a deferment on my student loan, am on
this guest list escapes me.  Happily, Faith is the picture of slumbering
tranquility.  Our silver haired President makes his way over to pump Jeff’s
hand and admire the baby.  I look toward the dining room where waiters are
preparing the tables.  There are ten pieces of silverware at each
plate.  Everything goes swimmingly until the soup course, when Faith wakes
up and decides she wants to eat as well.  The President has just begun his
pitch for the new library.  Having read up on how to breast feed a baby in
fine dining situations, I slip off my jacket and deftly take the baby from
Jeff with one hand.  With the other, I draw my linen napkin up over her
head and  my shoulder to create a little tent.  Then, I reach under
it.  Unfasten the top two buttons of my blouse.  She latches on and begins
to suckle.  Perfect.  A second later, I learned something new about my
daughter which will hold true for her entire life as a nursling.  To
whit:  she does not abide covers over her head while she is eating.  With
some kind of flailing, martial arts move, she knocks the napkin off my
shoulder and into the soup bowl which catapults my soup spoon out of the
bowl and onto the centrepiece.  Faith continues to wave and kick wildly,
managing to wedge a foot in-between two buttonholes and thereby causing two
more buttons to pop open.  Caught under her heel, the edge of my blouse is
pushed all the way over to my arm and so that both breasts are now
completely exposed and I am essentially sitting naked at the
table.  Meanwhile, the clanging of silverware has caused all eyes to turn
away from the President and in my direction where Jeff is now attempting to
throw his own napkin over both wife and child.  All eyes instantly revert
back to the President, who doesn’t miss a beat of his speech and no one
looks in our direction again the whole evening.  The rest of the dinner
goes by uneventfully.  As the secretary said, ‘Of course it would be fine.’ ”

Ok, here is two and a half years later now.  And this scene here is a 4H fair.
“When I was a kid, I loved 4H Club and had a fairly illustrious career as a
member.  I received blue ribbons for both my rock collection and my sewing
project: a princess-style minidress complete with hand sewn button holes
and flat-felled seams, but I always knew that whatever my success in
geology and sewing, they could not compete with the prestige of the
agricultural projects.  The annual 4H Fair was, first and foremost, a
showcase for the farm kids whose projects had titles like: ‘Feeding and
Fattening for Market a Beef Steer’.  Little has changed.  The building’s
mooing sounds attract all the crowds and attract Faith too, so we walk
there ourselves.   Plenty of sheep, cows and even the occasional llama
graze the pastures near our house but Faith has never met them up
close.  She’s ecstatic.   What she notices first about the cows is their
big poops.  The next thing she notices is even more exciting.  Big
nums.  (Now I should say that every child who is still nursing while
they’re old enough to talk about it will invent a word for it.  And Faith’s
word for breast, breast milk, the act of nursing is num-nums.)  So, the
second thing she notices is big nums.  Big, big nums.  The goats are
similarly equipped, as are a couple of the sheep.   And  soon she is
checking all of the animals for mammary glands.  ‘Bunny nums?’ she asks as
we peruse the ribbon adorned bunny hutches.  I assure her that mummy
rabbits do have them but that they are very small.  ‘Chicken nums?’ she
asks at the poultry display.   I hesitate, then launch into a quick
discussion of vertebrate taxonomy, introducing the concept of mammals.  She
looks bewildered and I know I’ve explained too much.  Meanwhile the proud,
preadolescent owner of three champion hens asks if we want to feed them
some cracked corn.   Faith watches silently as they frantically peck up the
kernels.  ‘No nums!’ she finally says in a whisper.  We make another loop
around the stalls where the large animals are quartered.   Suddenly she
stops.   ‘Mammal?’ she asks, pointing at a brown Jersey named
Daisy.  ‘Mammal?’ she asks again, pointing at her calf.  ‘Mammal?’ she
enquires of the goats.  Her eyes light up.  ‘Mommy a mammal!’ she declares,
pointing at me.  And then, in a moment of epiphany, like Helen Keller
learning the word water, she looks down her own shirt.  ‘Faith a mammal!’
she announces triumphantly.  ‘Faith a mammal!’.

Thank you.