Transcript Document

Infectious Disease Declined in
1800s due to environmental
improvements
• Prior to introduction
of vaccines
• Before widespread
use of antibiotics
• Tied with cleaner
development
– air and water
– safer workplaces and
housing
What’s the environment got to do
with women’s health?
• Unexplained patterns
of breast, cervix
cancer/endometriosis
• Are evidence per se
that ‘environmental’
agents are key
Clues about “environment” and
Women’s Health
• Rates and patterns of
premature sexual development,
breast and cervix cancer and
endometriosis are unexplained
• Known causes are tied with
hormonal alterations or genetic
damage
Change in U.S. Breast Cancer
Incidence 1975-79, 1990-94
500
1990-94
White
1985-89
400
Incidence per 100,000
500
Black
400
1985-89
1980-84
1990-94
1980-84
1975-79
300
300
1975-79
200
200
100
100
0
0
40
50
60
Age (years)
70
80
40
50
60
70
Age (years)
80
WHI Estrogen+Progesterone Trial
Findings, July 2002 (avg 5.2 y)+new British data
Risks
+40% ovarian cancer
+105% Dementia
+24% CHD
+31%
Stroke
+111% Pulmonary
Emboli
+24%
Breast Cancer
Benefits
Fracture Reduction (Hip 23%)
39% Reduction
Colorectal Cancer
Threshold Level
STOPPED Early,
Clear Harm
Also: DVTs
Stopped 3.3 yrs early
Judith Hsia, M.D. FDA testimony, Dec 2, 2004
JAMA. 2002;288:321-333
Environmental Exposures can Act
Like Hormones
•
•
•
•
Disrupt metabolism
Growth
Repair
Order
Reasons why “environment”
is a cause of cancer
Fewer than 1 in 10 cases of breast
cancer arises in women with
germline mutations
National Cancer Institute
Clues about “environment”
and disease
• Cancer risk of adopted children
mirrors that of their adoptive
(NOT their biologic) parents
• Fewer than half of identical twins
get the same cancer
• Migrants develop cancer risks of
their new countries
• Workers have higher rates
• Racial and other patterns
unexplained
Identical twins don’t have
identical chromosomal banding
patterns
Chromosome 1
Chromosome 3
Chromosome 12
Chromosome 17
3 year old twins
Fraga, Mario F., et al. (2005) Proc Natl
Acad Sci USA 102:10604-10609.
As identical twins age, their
chromosomes look less similar
Chromosome 1
Chromosome 3
Chromosome 12
Chromosome 17
50 year old twins
Photo:Maryellen Mark, Ned & Fred Mitchell
Cervix Cancer Patterns
• Highest in U.S.
Vietnamese women
• Hispanics have higher
rates than U.S. Blacks
• Chinese have lowest rates
in U.S.
• Associated with Human
Papilloma Virus,
unprotected sex, passive
and active smoking,
agricultural and solvent
exposures
Patterns of Endometriosis
• Prior to 1921, there were
only twenty reports of the
disease in the worldwide
medical literature.
• The National Institute of
Child Health and Human
Development estimates 10
to 20 percent of women of
childbearing age are
affected currently
Suggested Environmental Causes of
Endometriosis
• 1993, Rier et al found that
Rhesus monkeys with
greatest dioxin exposure
had greatest risk of
endometriosis
• The percentage of women
with endometriosis
reporting symptoms
before the age of 15 has
risen more than threefold
since 1980s to nearly 4 out
of every ten cases in
1998.
Premature sexual development*
increased in African American girls
• Development of breasts or pubic hair occurred
– 37% and 51.5% in AA girls aged 7 and 8
respectively
– 5.5% and 16% in Caucasian girls aged 7 and 8
respectively
• Reason for racial disparities unknown
Herman-Giddens ME, et al. (1997) Secondary sexual characteristics and menses in
young girls seen in office practice: a study from the Pediatric Research in Office
Settings network. Pediatrics 99: 505-512.
*adrenarche and thelarche
Unexplained Toddler Breast Growth
Davis DL, Tiwary C, Donovan MA, Axelrod D,
and Sasco A. Redefining normal age of
breast growth obscures potential
environmental causes. Pediatrics 2007;
Differing Workplace Exposures For
African Americans
• 12.7% of the U.S.
population
• 20% of non-private
household cleaning and
building service
occupations
• 29% of textile pressing
machine operators
• 20% of laundering and
dry-cleaning machine
operators
• 30% of bus drivers
• 30% of barbers
Differing Workplace Exposures
• 1 in 8 Americans is
African American
• 1 in 5 African Americans
works in household
cleaning and building
services, or laundering
and dry-cleaning
• 1 in 3 African Americans
works as textile pressing
machine operators, or as
a bus driver, or barber
Jobs with increased risk
of cancer
• Solvent workers
• Chemists
• Nurses/Dentists
and Physicians
• Painters
• Hair Dressers
New Environmental Findings
• Sheep grazed for up to
five years on a field
treated with processed
human sewage sludge
that contains ambient
levels of pesticides and
synthetic estrogens .
• Significant changes in
mammary glands of
pregnant ewes compared
to those grazed on land
treated with a standard
fertilizer
•
Dr Paul Fowler, senior lecturer in
reproductive physiology at Aberdeen
University, 2007
New Dietary Findings
• Post-menopausal
women who ate large
amounts (more than
103 grams) of
processed meat a day
RR. 1.64
• Effect evident with
57g of beef, pork or
lamb a day
British Journal Cancer, April, 2007, Jane Cade
Leeds
Unexplained Declines in the Births
of Baby Boys
• Since 1970, 135,000 fewer boys born than
expected in the U.S.
• 125,000 fewer in Japan
• Father determines sex of baby
Davis et al., Environmental Health Perspectives
April, 2007.
Center for Environmental Oncology
Mission Statement
 Provide a state-of-the-art, medical
center-based, cross-disciplinary
approach to identify controllable or
avoidable causes of cancer linked
with the environment
 Create and assess interventions that
inform, educate and change
individual and institutional behaviors
Goals
 Hospital as model for healthy
practices regarding toxins, energy,
exercise and nutrition
 Educate and train health
professionals and communities
regarding ‘healthy hospitals’
 Dynamic interactive analysis of
public health, economic and other
policy impacts of proposed
interventions
www.environmentaloncology.org
UPMC Greening
Accomplishments
 Chemical Waste Reduction
 Water and Energy Conservation
 Environmental Policy