Breast Cancer Research Funding Fails
WASHINGTON 12/9/04-In October, Congress passed legislation that lit the St. Louis Arch pink in recognition of Breast Cancer Awareness month. The resolution had two sponsors in the Senate and four in the House and was signed into law on Oct.20.
The move elicited an unexpected response from some breast cancer research advocates.
“Since Oct. 20, 3,069 women have died of breast cancer,” New Hampshire Breast Cancer Coalition President Nancy Ryan said last month. “Pink lights didn’t save any of them.”
Congress appropriated more than $4 billion last month for the National Cancer Institute’s efforts to save people from various forms of the disease. But that spending did not include funding for a program breast cancer research advocates had been pushing for two years and that had strong support in the House and Senate. Congress did not pass the bill specifically authorizing and appropriating $30 million over the next five years to create eight centers that would study the link between breast cancer and the environment. The bill had 62 sponsors in the Senate and 210 in the House and has been introduced three times in six years.
Hundreds of studies have explored the links between breast cancer and the environment. Many have ruled out a connection between certain chemicals and breast cancer, but researchers, and those who work with patients, said the need for additional funding and research persists.
“A lot of patients, especially the younger women in their 30s, 40s and 50s, the first thing they say is, ‘I eat well. I don’t smoke. It’s got to be the environment,’” said Elizabeth Hale Campoli, a registered nurse and program director at the Breast Care Center in Nashua. “It kind of gets them a little angry. They feel like they’ve done everything right.”
The Breast Cancer and Environmental Research Act, which would establish and fund eight research centers under the direction of the National Institute of Environmental Health Sciences, one of the National Institutes of Health, has died in committee in the three consecutive sessions since Rep. Nita Lowey (D-N.Y.) and Sen. Lincoln Chafee (R-R.I.) introduced it in 1999. In November, Sen. Harry Reid (D-Nev.), the Democratic leader-designate, “hot-lined” the bill, meaning it bypassed committee and was brought to the Senate floor for a vote that required the Senate’s unanimous consent. But opposition from the Republican side prevented its passage.
According to both a Chafee spokesman and breast cancer research advocates who lobbied for the bill, Sen. Judd Gregg blocked it in the committee he chaired. They said that instead, he favored allowing the National Institutes of Health and the National Cancer Institute to decide how to spend federal cancer research funds. It was a change that the bill’s advocates found unacceptable.
When asked after a recent Senate vote why he opposed the legislation, Gregg said, “I’m not going to comment on that.”
Fran Visco, president of the National Breast Cancer Coalition, which helped develop the legislation, said Gregg has “consistently blocked enactment.even though a bipartisan majority of the Senate supported the bill.”
Both Ryan and Hale Campoli also said their requests to meet with Gregg personally on trips to Washington to discuss the bill have been declined for two years in a row.
Sen. John Sununu (R-N.H.) supported the bill and Reps. Charles Bass (R-N.H.) and Jeb Bradley (R-N.H.) supported the House version.
“We were extremely disappointed that the bill did not move,” said Ryan, who, with other members of the New Hampshire coalition, canvassed Capitol Hill during the November lame-duck session to garner support for the bill.
Ryan has been “living with breast cancer,” as she puts it, since 1991. Her work at the New Hampshire coalition has been a full-time, unpaid job since she was diagnosed at the age of 41.
Though the numbers have decreased, New Hampshire breast cancer incidence rates are about eight percent higher than the national average and the death rate is slightly higher, according to National Cancer Institute data from 2001, the most recent year available. In that year, 931 women were diagnosed with breast cancer and 186 women died from the disease.
Previous and current studies on breast cancer and the environment have been somewhat inconclusive, researchers say, because of the difficulty of measuring the effects of environmental factors.
The largest and most expensive epidemiological study supported by the National Cancer Institute was the Long Island Breast Cancer Study, in a region where breast cancer incidence rates were higher than in other parts of the country. The study compared chemical levels in blood samples of women with breast cancer to those without the disease.
Parts of this study are still under way, but findings released in 2002 showed that there was no correlation between PCBs, including DDT, and increased instances of breast cancer.
“It sounds like a high-possibility prospect, but it hasn’t panned out in direct research,” said Dr. Linda Titus Ernstoff of Dartmouth-Hitchcock Medical Center, who reviewed the study and thousands of others on the manufactured chemical. “But it could be that we can’t measure it well in the blood because it has decreased over time. We can’t really take it off the suspect list.”
But a chemical known as PAH that is found in grilled foods, engine exhaust and cigarette smoke, did show some effect.
“That finding was not clear-cut to interpret,” said Dr. Deborah Winn of the National Cancer Institute, “But the investigators saw something with PAH.” She added: “It’s always hard to look at the environment and breast cancer. Exposures may have taken place in the past, and it may be hard to measure these exposures.”
Because measuring chemical levels in adults has sometimes produced inconclusive results, the National Cancer Institute and the National Institute of Environmental Health Sciences created four centers in 2002 to follow 1,800 six- and seven-year-old girls through puberty to see whether exposures to environmental agents affect speed of development.
The centers, in Cincinnati, Philadelphia, San Francisco and East Lansing, Mich, will also expose animals to chemical agents to see if they affect mammary gland development. Breast cancer research advocates involved in the study will explain the findings to the communities. The Lowey-Chafee bill did not appropriate money for these four centers.
“When we put [the research] together.we can really establish some kind of public policy,” said Dr. Jose Russo, lead investigator at the Fox Chase Cancer Center in Philadelphia, one of the four centers.
Russo and his counterparts at the other centers said that this study is extensive and unlike any that has taken place. But they added that their research is limited by funding and that additional questions will need to be answered.
“Four centers will scratch the surface about what we need to know about how the environment affects breast cancer,” said Dr. Sue Heffelfinger, the lead investigator at the University of Cincinnati.
Dr. Robert Hiatt, lead investigator at the University of California, agreed and said that with additional funding, the centers could expand the number of girls studied, get more details on their family lives and physical activity and could involve the community more.
“We’re likely to uncover more questions, and it would be good to have different centers in different parts of the country,” Hiatt said.
For now, early detection remains the best option for controlling breast cancer. The federally funded initiative that New Hampshire calls “Let No Woman Be Overlooked” began in 1997 under this assumption. The program provides free mammograms, pap smears and breast exams to low-income women. According to program coordinator Becky Bukowski, the program exceeded its goal of providing services for more than 3,000 women last year.
“Our ultimate goal is to reduce morbidity and mortality and we do that by enrolling people who wouldn’t necessarily go for screening and be screened at an early age,” Bukowski said.
The ultimate goal for Ryan, Hale Campoli and other advocates from New Hampshire and across the country who have worked on the bill is to end breast cancer, and they said they think the Lowey-Chafee breast cancer bill is a step in that direction. Rep. Lowey’s spokeswoman, Julie Edwards, said Lowey would reintroduce the bill next session. According to Hourahan, Chafee had not made a decision yet.
“We’re fighting to end this for all women,” Ryan said. “Scientists want to make breast cancer a chronic disease. I disagree. Our goals need to be to learn what is causing so much breast cancer and what we can do to prevent it.”
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