Lagerquist_Poster - Arizona State University
Lagerquist_Poster - Arizona State University
The Geography of Breast Cancer
Kyrene del Pueblo Middle School
“Breast CanCer is the most Commonly diagnosed
CanCer in ameriCan women.” (reynolds, et al., 2005, p.
Teaching is an art and a science. As it turns out so is medicine. Until I had cancer I
always thought there was a cut and dry formula for medical treatments. I learned quickly
this is not true. When I was told my options for treatment and asked to decide how I
wanted to be treated, I knew there was no definite answer. Even after this experience, I
expected to be able to research and find “the” answer. Instead, I found even more factors
which affect breast cancer and other areas of life. What I gained is an even stronger
belief in the importance of geography education and a way to help my students see
geography’s importance. Unless you believe geography is just maps and memorizing
places, I was not taught geography as a student. When I started teaching social studies, I
began seeing the importance of geography and this started my quest to learn more.
Bringing what I learned to my students was difficult because it was hard to make them
interested. One of the simplest ways to explain geography is to use the Five Themes of
Geography; the five themes of geography are Location, Place, Movement, Regions and
Human Environment Interaction. These themes are a way to organize geography. I use
the Five Themes of Geography with my students because it helps them organize the new
information I teach them. Each of the Five Themes can be connected to Breast Cancer.
Using my personal experience with cancer and combining it with geography, I found a way
to expose students to the importance of geography. By joining geography with something
as serious as cancer, it helps demonstrate geography’s value. The geography of breast
cancer is extremely complicated because there are so many potential factors which
influence disease and because of this, the research is difficult The research is made even
more difficult because of the amount of time it takes and because you are dealing with life
Include mountains, rivers, beaches, wildlife, and soil. (Things from nature)
In 2004, McKelvey studied Cape Cod and found breast cancer risk was elevated among women
living on Cape Cod for five or more years. There was suspected environmental exposures which
included pesticides and drinking water contamination. The industrialization of the area may
contribute to breast cancer cases.
A special area of study
Epidemiological studies seek to identify whether risk factors, such as
diet, socio-economic status and occupation, are associated with
specific outcomes, such as breast cancer, in human populations. p.2
(Jacquez, et al 2003)
Movement is defined as the movement of people, ideas and goods from one place to
•“Cancer latency (the time between causative exposures and cancer onset) is estimated to
be between 5-40 years.” p.3 (Jacquez, Geoffrey and Greiling. 2003)
•We are a transient society and this movement makes it extremely difficult to pinpoint a
breast cancer cause.
•We don’t know if the cancer exposure takes place where you are born, where you grow up
or where you end out living.
“The task then will be to explore these extensive environmental history data in a
Geographic Information System for particular features of the hot spot regions with the potential
for human exposure. (e.g., past pesticide application).” (Paulu, C. et al, May 2002)
Einbeigi (2002) was able to show populations which don’t have much change have a direct
connection between gene mutation and breast cancer. Einbeigi wrote, “in closed populations, as in
Iceland or among Ashkenazi Jews, mutations in the BRCA1 and BRAC2 genes are prevalent in
cancer subjects” (Einbeigi et al., 2002, p.153).
“However, few studies have evaluated the contributions of education, income, employment and
insurance coverage, which also vary by both region and race, to the observed differences in
survival.” p.338 (Grann, V et al. 2006)
The Five Themes of Geography
5.Human Environmental Interaction.
Location is answering: where is it?
--2 types of location
1.Absolute Location the latitude and longitude (a global location) or a street
address (local location).
2.Relative Location is described by landmarks, time,
direction or distance from one place to another and may
associate a particular place with another.
Breast cancer incidence is higher in the industrialized world. -- 92 per 100,000 or more are
stricken with breast cancer in the industrialized world compared to parts of Africa and Asia
where the rate is less than 22 per 100,000.
In both the crude and adjusted analysis, breast cancer incidence was elevated among
women who had lived on Cape Cod for 5 or more years (McKelvey et al., 2004)
Geography can help us to determine locations of increased breast cancer incidence.
Even population size has an effect
“We found that patients receiving care at very low-volume hospitals had a 60% higher
risk of death than patients receiving care at high-volume hospitals.” (Roohan, et
A region is the basic unit of study in geography. A region is an area that displays a coherent
unity in terms of the government, language, or possibly the landform or situation. Regions
are human constructs that can be mapped and analyzed.
3 Types of Regions
1.Formal regions are those defined by governmental or administrative boundaries.
Ex. United States
Physical Regions are included in this category.
Ex. The Rockies
2.Functional regions are those defined by a function (i. e.,
TVA, United Airlines Service area or a newspaper service
area). If the function ceases to exists, the region no longer
These characteristics are derived from the ideas and actions of people that result in
changes to the environment, such as buildings, roads, clothing, and food habits.
“Breast cancer takes many years to develop – often up to 30 or more years- because of the many
changes that must occur before a normal cell becomes a cancerous cell that divides out of control.”
p. 5 (Snedeker, S., 2002)
•Human subjects– you can’t just expose people to potential cancer to see what happens.
•Following cancer victims is also difficult because death limits the information you can obtain.
World Breast Cancer Rates
3.Vernacular regions are those loosely defined by people's
perception (i. e., The South, The Middle East).
Jacquez and Greiling (2003) examined whether
there is a statistically significant clusters of cancer on Long Island. They found there
were 2 local clusters of lower SMR (70-83% of New York’s average) and 2 clusters with
an SMR (30-50 % higher). SMR is the standardized Mortality Rate. One of the clusters
is in Southampton and the other cluster was located in Wainscot.
Regional Variations in Breast Cancer Incidence Among California Women.” Reynold’s
(2005) research was done in California to look at possible differences in breast cancer
diagnosis in different regions.
Overall the regional rate differences for lobular cancers were greater than for all breast
Human Environmental Interaction is defined as how do humans and the environment affect
each other-Humans adapt to the environment.
Humans modify the environment.
Humans depend to the environment
Place is the personality of geography. There are 2 types of characteristics;
“Exposure to vitamin D at the time the breasts are developing, particularly around
adolescence, is important” (Marchione, 2006, p.1). High levels of vitamin D equaled a
50% lower risk of breast cancer and even modestly higher levels of vitamin D resulted in
a 10% less risk.
Even though there is a large quantity of research trying to understand the causes of breast
cancer, it is still a major health issue. Breast cancer incidence and mortality patterns are
extremely complex and with so many potential factors to the disease it is extremely difficult to
pinpoint a cause or causes. Improved screenings and treatments have changed the outcomes
and therefore the research is even more difficult. Epidemiology studies of breast cancer will
continue to give insights to the complex causes of breast cancer. Hopefully, someday it will lead
us to prevention of the disease.
I may not be able to find research which gives me a direct cause to cancer, but I can show my
students the importance of geography through this type of research. Nearly everyone is touched
by cancer in some way and this provides common ground. Using breast cancer as the vehicle to
explore geography increases interest and shows students how valuable it is to learn about
geography. When something as serious as cancer can be explored by geography it makes
geography become important. When teaching my social studies curriculum I am always trying to
instill in my students the ability to examine a problem and draw a conclusion through the
information and data they can access. Being able to make well informed decisions during their
life time is more valuable than anything else I can teach them. Teaching them the geography of
cancer also lets me show them a piece of my past where I was faced with a problem and had to
make choices using the information I could find. I hope my student will not have to make life and
death choices, but if they do, I hope some of what I have taught them will help. I am also excited
to show students about career choices which involve geography, such as epidemiology.
Althusis, P., et al. (2005). Global trends in breast cancer incidence and mortality 1973-1997. International Journal of
Epidemiology, 34, 405-412.
Baak, Jan. P., et al. (1992). Differences in breast cancer survival are correlated with differences in differentiation and rate
of proliferation. Institute of Pathology Free University Hospital, , 989-992.
Baider, L., et al. (2002). Effects of age on coping and psychological distress in women diagnosed with breast cancer:
Review of literature and analysis of two different geographical settings Oncology Hematology, 46(September 26), 5-16.
Einbeigi, Z., et al. (2002). Clustering of individuals with both breast and ovarian cancer. Clustering of Individuals with both
Breast and Ovarian Cancer, 41(2), 153-157.
European ancestry increases breast cancer risk among latinas.(2008). American Association for Cancer Research,
Fang, J., et al. (1996). Cancer mortality of Chinese in new your city 1988-1992 International Journal of Epidemiology,
Fitzgerald, M., et al. (1996). Germ-line BRCA1 mutations in Jewish and non-Jewish women with early-onset breast
cancer. The New England Journal of Medicine, 334(January 18), 143-149.
Grann, V., et al. (2006). Regional and racial disparities in breast cancer-specific mortality. Social Science and Medicine.,
Gregorio, D. I. (2002). Geographic differences in invasive and in situ breast cancer incidence according to precise
geographic coordinates, Connecticut, 1991-1995 International Journal of Cancer., 100, 194-198.
Gregorio, David. I., et al. (2001). Geographical differences in primary therapy for early-stage breast cancer Annals of
Surgical Oncology, 8(November, 10), 844-849.
Harder, B. (2006). Melatonin-depleted blood spurs tumor growth. Science News Online, 169(1), 8.
Harlap, S., et al. (2001). Epithelial ovarian carcinoma and European birthplace of grandparents. Gynecologic Oncology,
Jacquez, G., & Greiling, D. (2003). Local clustering in breast, lung and colorectal cancer in long island, new york
International Journal of Health Geographics, 2(3)
Jacquez, G., & Greling, D. (2003). Geographic boundaries in breast, lung and colorectal cancers in relation to exposure
to air toxics in long island, New York International Journal of Health Geographics, 2(4)
Kulldorff, M.,et al. (1997). Breast cancer clusters in the northeast united states: A geographic analysis. American Journal
of Epidemiology, 146(2), 161-170.
Lewis-Miehl, E., et al. (1996). Breast cancer risk and residence near industry or traffic in Nassau and suffolk counties,
long island, New York. Archives of Environmental Health, 51(July/August), 255-265.
Lopez-Cervantes, M., et al. (2004). Dichlorodiphenyltrichloroethane burden and breast cancer risk: A meta-analysis of
the epidemiologic evidence. Environmental Health Perspectives, 102(2)
Lyman, F. (2006). Advocacy groups ignore breast cancer hot spots Alternet, (October 19), 2008.
Lyman, F. (2006). The geography of breast cancer. Ms. Magazine, Fall
Marchione, M. (2006). Vitamin D battles breast cancer Milwakee Journal Sentinel, (April 10)
McKelvey, W. et al. (2004). Association between residence on cape cod, Massachusetts, and breast cancer. AEP, 14,
Merkin, et al. (2002). Geographic socioeconomic status, race, and advanced-stage breast cancer in New York city.
American Journal of Public Health, 92(January), 64-67.
Mobley., et al. (2008). Heterogeneity in mammography use across then nation: Separating evidence of disparities from
the disproportionate effects of geography International Journal of Health Geography, 7(32)
Paulu, C. et al. (2002). Exploring associations between residential location and breast cancer incidence in a case-control
study. Environmental Health Perspectives, 110(9), 471-478.
Phend, C. (2006). Vitamin D retards breast cancer progression. Medpage Today, (October 17)
Polsky., et al. (2006). Variations in chemotherapy utilization in ovarian cancer: The relative contribution of geography.
Health Services Research, 41(6), 2201-2218.
Reynolds, P., et al. (2005). Regional variations in breast cancer incidence among California women, 1988-1997 Cancer
Causes and Control, 16(12), 139-150.
Roohan, et al. (1988). Hospital volume differences and five-year survival from breast cancer. American Journal of Public
Health, 88(4), 454 – 457.
Sheenan, et al. (2004). The geographic distribution of breast cancer incidence in Massachusetts 1988 to 1997 adjusted
for covariates. International Journal of Health Geographics, 3(17)
Snedeker., S. (2002). Environmental chemicals and breast cancer risk fact sheet # 45.
Van der Wall., E. (2001). Mitotic activity index IDs high-risk node-negative breast cancer Oncology News, 10(3), 1-3.
Vieira, V. et al. (2008). A spatial-temporal analysis of breast cancer in upper cape cod, Massachusetts. International
Journal of Health Geography, (October)
Viel, J., et al. (2008). Dioxin emissions from a municipal solid waste incinerator and risk of invasive breast cancer: A
population-based case-control study with gis-derived exposure. International Journal of Health Geography, 7(4)
Vinnakota, S., & Lam, N. (2006). Socioeconomic inequality of cancer mortality in the united states: A spatial data mining
approach. International Journal of Health Geography, (April)
Zhu., Y., et al. (2005). Period3 structural variation: A circadian biomarker associated with breast cancer in young women.
Cancer Epidemiology Biomarker and Prevention, 14, 268-270.