Resources in the State of California to study the environment and breast cancer
Resources exist in the State of California to conduct a comprehensive investigation of breast cancer and the environment. By combining these resources, California has an opportunity that no other state or country can match.
a. Unique geography and demographics
California has a unique physical environment in which to study breast cancer. Differences in geography (including soils, groundwater aquifers, and other features) provide a rich testing ground for environmental theories about breast cancer. Additional features of interest include the wide diversity in income, social class, and culture; influx of immigrants from low incidence areas such as Asia, including 1st, 2nd and 3rd generation immigrants from Asia and Latin America; urban, suburban, and rural areas; racial and ethnic diversity.
b. Unique databases
The presence of a statewide SEER-supported cancer registry insures ensures that high quality incidence data will be available. The California Cancer Registry was established in 1972 for the Los Angeles County region, and since 1988 includes the entire state. Even prior to SEER funding, the Registry received a “gold” rating, the highest level of certification for cancer registries. Reliable long-term estimates of cancer incidence, the ability to study in situ breast cancer and different histologic subtypes of breast cancer in large numbers, and the infrastructure to add new measures of social class and urban/rural status provide a strong foundation for breast cancer research.
Databases mandated by Proposition 65 that list pesticides and other pollutants are an important resource. The US EPA has estimated that 14.1 million persons nationwide routinely drink water contaminated with five or more herbicides. Ten percent of community water systems and 4 percent of rural wells in the US show persistently high levels of one or more pesticides or pesticide break down products. The fumigant DBCP is routinely found in groundwater in California, even though it was banned in 1979. These existing databases provide the ideal platform for future research studies. The databases could be readily supplemented through complementary data collection. Survey sampling methods could be used to characterize census tracts according to socioeconomic status, access to care, occupation, water quality, and other factors at minimal cost.
c. Research institutions and environment
The presence of several schools of public health, the strong resources of the State Health Department, and other groups have a long record of expertise in epidemiology and environmental sciences and engineering. Multi-center collaborations among these groups have been conducted in the past, and provide the basis for effective, efficient research studies in the future. Investigators with expertise in disease-mapping and cluster analysis, ecologic and other descriptive studies, and population-based epidemiologic studies are present in the state. Several institutions have long track records in the analysis of gene-environment interactions, and could be effective partners in studies that seek to determine the risk from low dose environmental exposures such as chemical pollution.
d. Local cancer advocacy and grass roots environmental groups
The presence of strong environmental and cancer advocacy groups in California provides opportunities for partnerships that will strengthen breast cancer research. The summit on breast cancer and the environment held in Santa Cruz, California, in 2002 included representatives from several advocacy groups. The report from the summit includes specific recommendations for community based participatory research. One recommendation was that several types of communities be considered: geographic (e.g., persons living in an area with high rates of breast cancer), demographic (e.g. persons of similar social class), consumer-oriented (e.g. patients with similar barriers to quality health care), and issueoriented (e.g. persons with a point view regarding pesticides as a cause of breast cancer). Each of these groups can make valuable contributions to the design and implementation of epidemiologic studies, most notably in the area of participant recruitment and retention (Plummer et al., 2002). The Office of the President of the University of California sponsors awards Community Research Collaboration grants. This program provides an ideal way to include community members in the research process, and has established technical assistance and outreach mechanisms to help such collaborations come about. Investigators in California who routinely work with advocacy groups include Margaret Wrensch and Georgianna Farren at the University of California, San Francisco, and Rajiv Bhatia and Karen Goodson-Pierce in the San Francisco Department of Public Health.
