These findings are typically reported in terms of relative risk, which reflects a comparison between the risk in a population exposed to a particular factor and that in a similar population that is not exposed.
Thus, a relative risk of 2. Similarly, a relative risk of 0. These examples are offered to illustrate the scale of the change in risk implied by typical epidemiologic findings; they are not a formal analysis. From a public health perspective, another important piece of information is the prevalence of the risk factor in the population. Finding that an environmental factor is associated with a large relative risk may still mean that it accounts for few cases of disease if the disease or the exposure is rare in that population.
Alternatively, an environmental exposure that is associated with only a small increase in risk may be contributing to a large number of cases if the exposure is very common in the population. However, if the exposure is so common that there is little variability across the population virtually everyone is exposed , it can be extremely difficult to identify the contribution from that exposure. Virtually all of the epidemiologic evidence regarding breast cancer risk is drawn from population-level analyses.
As a result, the conclusions reached on the basis of that evidence apply to an exposed population. With current knowledge, it is not possible to apply those conclusions to predict which individuals within that population are most likely to develop breast cancer. Nevertheless, an understanding of population-based estimates of risk can help people make personal choices that may lead to better health outcomes.
Several topics were defined as falling beyond the scope of the study. With the focus on environmental risk factors for breast cancer, the committee chose to devote little attention to the established associations between increased risk for breast cancer and reproductive events such as younger age at menarche, older age at first birth, lack of lactation, and older age at menopause. The committee also chose not to evaluate the established associations between breast cancer risk and higher birth weight and attained stature.
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Background is provided on many of these other factors in Chapter 2 , and the possibility that some environmental exposures may have an indirect influence on risk for breast cancer because they may affect the timing of these reproductive events is discussed in Chapter 5.
The committee also agreed that the nature and effectiveness of breast cancer screening, diagnosis, and treatment were generally beyond the scope of the study. It noted but did not analyze the impact of increased mammography and changes in screening practices since the s on the observed incidence of breast cancer.
The paper commissioned by the committee on medical sources of exposure to ionizing radiation took into account the contribution of mammography. The committee did not examine the appropriateness of screening recommendations or practices. The committee decided as well that its charge called for a focus on risk for the initial occurrence of breast cancer and not on recurrence or factors that might be associated with the risk of recurrence.
Although environmental exposures may well influence the risk of recurrence, that risk is also influenced by characteristics of tumors at the time of diagnosis and subsequent treatment and follow-up practices. Similarly, the committee concluded that its charge called for a focus on the incidence of breast cancer and not mortality. Influences on breast cancer mortality patterns include factors that affect diagnosis and treatment that are separate from the effects of environmental exposures on the incidence of the disease.
The committee did not explicitly assess environmental risk factors for male breast cancer, beyond the general assumption that some of the risk factors identified through studies in women may also be relevant to the development of breast cancer in men. Specifically, Chapter 2 provides important background for evaluating factors influencing breast cancer risk with a brief review of the biology of breast cancer and trends in incidence in the United States, along with discussion of the kinds of studies used to investigate breast cancer and environmental exposures.
Chapter 4 discusses the variety of challenges that complicate the study of environmental risk factors for breast cancer, as well as gene—environment interactions. Chapter 5 examines mechanisms of carcinogenesis and links them to a life course perspective on breast development and the potential for environmental factors to influence risk for breast cancer.
In Chapter 6 , the committee examines opportunities for evidence-based action to reduce risks for breast cancer and also considers the challenges of avoiding the unintentional introduction of new risks. Breast cancer facts and figures — Breast Cancer facts and figures — Baralt, L. A review of advocate—scientist collaboration in federally funded environmental breast cancer research centers. Environ Health Perspect 12 — Bissell, M. A proposed role of the microenvironment in restraining cancer progression.
Nat Med 17 3 — Brody, J. Moysich, O. Humblet, K. Attfield, G. Beehler, and R. Environmental pollutants and breast cancer: Epidemiologic studies. Cancer 12 Suppl — California Breast Cancer Research Program. Identifying gaps in breast cancer research: Addressing disparities and the roles of the physical and social environment. Farhat, G. Walker, D. Buist, T. Onega, and K. Changes in invasive breast cancer and ductal carcinoma in situ rates in relation to the decline in hormone therapy use.
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J Clin Oncol 28 35 — Loeb, L. Cancer Res 70 11 — SEER cancer statistics review, — Edited by S. Altekruse, C. Kosary, M. Krapcho, N. Neyman, R. Aminou, W. Waldron, J. Ruhl, N. Howlader, Z. Tatalovich, H.
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Food, nutrition, physical activity, and the prevention of cancer: A global perspective. JAMA 3 — Breast cancer remains the most common invasive cancer among women. The primary patients of breast cancer are adult women who are approaching or have reached menopause; 90 percent of new cases in U. Growing knowledge of the complexity of breast cancer stimulated a transition in breast cancer research toward elucidating how external factors may influence the etiology of breast cancer.
Breast Cancer and the Environment reviews the current evidence on a selection of environmental risk factors for breast cancer, considers gene-environment interactions in breast cancer, and explores evidence-based actions that might reduce the risk of breast cancer. The book also recommends further integrative research into the elements of the biology of breast development and carcinogenesis, including the influence of exposure to a variety of environmental factors during potential windows of susceptibility during the full life course, potential interventions to reduce risk, and better tools for assessing the carcinogenicity of environmental factors.
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For a limited set of risk factors, evidence suggests that action can be taken in ways that may reduce risk for breast cancer for many women: avoiding unnecessary medical radiation throughout life, avoiding the use of some forms of postmenopausal hormone therapy, avoiding smoking, limiting alcohol consumption, increasing physical activity, and minimizing weight gain.
Breast Cancer and the Environment sets a direction and a focus for future research efforts. The book will be of special interest to medical researchers, patient advocacy groups, and public health professionals. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.