A new and unique survey on breast cancer rates in California, conducted by Public Health Institute’s California Breast Cancer Mapping Project, turned up some hot spots in the state, and part of Ventura County is one of the hottest.
Prior surveys, such as the recent one by the American Cancer Society, tallied and categorized cancers strictly by county. But what if there was an area of concern that was distinctly within only one part of a county or in an area that stretched across county lines? Those red flags were simply not apparent and therefore not included in the statistics.
So Public Health Institute took a different approach. It looked at breast cancer cases geographically, without any artificial borders. It found four areas in the state where breast cancer rates were 10 percent to 20 percent higher than the state average.
Eric Roberts is a research scientist at Public Health Institute and led the mapping project. “The project’s purpose was to see whether mapping in small areas was a good idea and how it should be done.”
There are three ways to quantify cancer rates. “One way is individual risk factors,” Roberts said, “things such as race and ethnicity, child-bearing, tobacco and alcohol consumption, to name a few. Secondly, we usually look at it county by county. A third way looks at the geography but in a more flexible manner. Our findings are consistent with the individual risk factors in the areas of concern that we found. It makes clear there are nuances to it.”
East Ventura County/West Los Angeles
One of the four areas of concern was East Ventura County/West Los Angeles. It is roughly bordered by Moorpark on the west, Santa Clarita on the north, Beverly Hills on the east, and Malibu to the south.
Breast cancer rates along the border of Ventura and Los Angeles
counties are 10 to 20 percent higher than the state average
and known as an area of concern. There are four areas
of concern in California according to the Public Health Institute.
The number of breast cancer cases has declined since 2000 in the state. They have also declined at the same rate in the areas of concern. The rate remained 10 percent to 20 percent higher than the rest of the state.
The other areas were southern Orange County/western Riverside County, and two areas in Northern California — the Marin County area and the area just south of the city of San Francisco.
Predicting future cancer cases
The American Cancer Society conducted a survey by counties, and here is how Ventura County stacks up to two other counties with a similar population count, San Francisco County and Kern County.
In the annual prediction of how many cancers were expected to occur in 2012, Ventura County had a high number of breast cancer and melanoma cases. The survey indicated Ventura County would see 625 new cases of breast cancer and 240 cases of melanoma. San Francisco County was projected to have 545 new cases of breast cancer and 165 melanomas. Kern County expected fewer, 395 breast cancer cases and 95 cases of melanoma.
Those numbers are consistent with the breast cancer numbers found by the mapping project.
The Public Health Institute’s California Breast Cancer Mapping Project found
that east Ventura County has a 10 to 20 percent higher rate of breast cancer
than the state average. The former Santa Susana Field Lab, a rocket test site
that used radioactive materials known to cause breast cancer,
is nestled in the middle of “area of concern.”
One statistic that stood out in all of the studies was the disproportionate prevalence of breast cancer in non-Hispanic white women, especially when compared to the rate in Hispanic women.
Invasive breast cancer is found in white women at a much higher rate than for other ethnicities. In Ventura County, white women have 73 percent of the breast cancers and statewide have 68 percent. Hispanic women in Ventura County have 12 percent of the cancer cases and 15 percent in California.
Yet white women make up only 48 percent of the state population, less than half of the breast cancer percentage. In contrast, Hispanic women comprise 32 percent of the population. These statistics show that white women in California have a breast cancer rate one and a half times their actual population. On the other end, Hispanic women have breast cancer at a rate of half of their population.
Doctors disagree on mammograms
In all of these numbers, there is one that is vitally important, late-stage diagnosis. The state average of such cases is 37 percent. More than one-third of breast cancers in California are not diagnosed until they have reached a late stage and are the most difficult to treat.
There are a few possible reasons for this statistic. Recommendations as to when and how often to get a mammogram vary among experts. For example, the National Cancer Institute urges women to get their first mammogram at age 40. Twenty years ago, doctors recommended a first, baseline mammogram at age 35 with regular screenings beginning at 40.
Under Proposition 65, businesses must display signs that warn the public
about toxic and hazardous chemicals at the facility that can cause cancer.
Now, the U.S. Preventive Services Task Force has changed the formula. What had been accepted as prudent, annual mammograms, now has been changed to screenings every two years, beginning at age 50. The task force cited too many false positives that caused too much anxiety in women and too many unnecessary procedures.
There are, however, circumstances and risk factors that contribute to breast cancer and require annual screenings, such as smoking, family history, previous cancer and being a DES daughter. DES was a drug given to as many as 10 million pregnant women from 1938 until 1971, when it was withdrawn from the market. Not only did DES not stop early labor, for which it was prescribed, there was an unusually large number of very young women (whose pregnant mothers had been given DES) who were getting an extremely rare cancer. Now, as those same daughters reach menopause, noticeably higher breast cancer rates are becoming visible in that group.
Experts suspect other possible causes of white, affluent women getting breast cancer so often. It could be the decision to have children later in life, or not having children at all, or the use of hormone replacement therapy. Although synthetic hormones were generally removed from the picture when studies found they raised the rate of heart attacks, many women have flocked to bio-identical hormones for relief. These hormones are controversial. Some doctors prescribe them and other doctors tell their patients to just tough out the uncomfortable symptoms of menopause such as insomnia, hot flashes and brain fog.
Possible local culprits
Lisa Barreto, founder of the breast cancer support organization Ribbons for Life, knows something about breast cancer. She conquered the disease once. Now it has returned and she is in the midst of undergoing a series of surgeries. This, in addition to running a group that provides a forum for other women to exchange facts, feelings and progress reports about their breast cancer.
Lisa Barretto, a breast cancer survivor but also currently a
breast cancer patient, founded Ribbons for Life to provide an
emotional support network for local breast cancer patients.
Barreto feels that whatever may be raising the local rate of breast cancer is irrelevant once a woman joins her group. “The thing we are trying to focus on is, once you get it, statistics don’t matter to people,” she said. “They’ve got it and you want to do what you can to help those women and their families cope with it.”
As for the Ventura County higher rate, Barreto said, “Sometimes, when you hear all these different statistics, what are you going to do? Leave the county that you love?”
Barreto added that many things in our everyday life are carcinogenic, such as pesticides, cosmetics, even so-called pink products, those sold in pink packaging as part of a fundraising campaign during Breast Cancer Month every October.
Santa Susana Field Lab: One of the culprits?
Roberts of the Public Health Institute said people often point to a local source of contaminants such as a factory.
“There is no way to draw a causal connection between pollution and the area of concern,” Roberts said, “and at the same time, it is extremely relevant to the conversation. There’s no proof that the contamination doesn’t have anything to do with the breast cancer. And there’s no proof that it really does.”
Roberts added, “There’s no way to go from A to B.” The problem, he said, hinges on the variables found in every home. People get sick, people change jobs, and they often move. To scientifically study the surrounding population would require strict adherence to certain guidelines, something that is impossible in this situation.
But Roberts said that knowledge of environmental dangers might change the way decisions are made in urban planning, such as where to build a school or where to place a highway.
“The important thing is that people have the conversation about causes; and with this project, they have some facts,” he said. “And everyone is working from the same facts. It is a modest step forward.”
That is true in most areas of concern. But eastern Ventura County/West Los Angeles has a particularly dangerous source of huge amounts of pollution sitting just about in the bull’s-eye of the map of this area, the Santa Susana Field Lab. This particular site was used heavily during the Cold War years, and nuclear experiments were not halted until as late as 1989. The rocket tests did not cease until two workers were killed in the mid-1990s as they attempted to illegally dispose of toxic waste by shooting the barrels of waste with high-powered guns, as they had been doing for a long time. One of those barrels exploded, killing the two workers and severely injuring another.
Other activists are more certain about the health effects caused by the presence of some kinds of radiation and toxic chemicals. They point to the Santa Susana Field Lab’s (SSFL) absence of a meaningful clean-up of residual toxic substances. That means the contamination in the soil still gets swept up in the Santa Ana winds each year, drains into the underground water each time it rains. SSFL is the former Rocketdyne site and is now owned by the Boeing Company.
Dan Hirsch, co-founder of Committee to Bridge the Gap, has been actively involved in trying to get SSFL cleaned up since 1979. In testimony to Congress in 2008, Hirsch described the extent of some of the pollution at SSFL.
“More than 20,000 rocket and missile tests were conducted at the site, for NASA, the Navy and the Air Force,” Hirsch said. “Trichloroethylene (TCE) was used to wash down the rocket test stands after these firings, the way one might wash down one’s driveway with water, and the TCE was allowed to just run off and percolate into nearby soil.”
In addition to half a million gallons of TCE that was let loose into the environment, Hirsch said the list of toxins, in addition to the residual radiation from a total of five nuclear power plant accidents, is a long one.
“Vast quantities of other toxic materials — perchlorate, PCBs, dioxins, hydrazines, heavy metals, various volatile and semi-volatile organic compounds — were used at the site and spilled, released, buried or otherwise mishandled. Contaminated process water was used … to quench the rocket test stands, sending massive plumes of contaminated steam into the air and neighboring communities.”
Despite decades of efforts to force a cleanup of the super-contaminated site, including a California law that set the standard to which it must be cleaned and a deadline for compliance, no meaningful cleanup has taken place. Boeing sued the state in federal court over the new law, and won. Now, Boeing plans to do little cleanup, stating instead that the land is just fine, and the company intends to turn the area, as is, into a public park.
SSFL is located on top of a mountain that straddles Simi Valley and Chatsworth, on the border between eastern Ventura County and the western San Fernando Valley. Coincidentally, the area of concern identified by the mapping project was in exactly the same place and covers the portions of Los Angeles that also happens to follow the prevailing wind direction.
As associate director of Physicians for Social Responsibility — Los Angeles, Denise Duffield suspects there could be a possible connection between the pollutants at SSFL and the pattern of breast cancer.
The fact that women in the area of concern have a 10 percent to 20 percent higher rate of invasive breast cancer than the state average “is extraordinary and worrisome,” Duffield said. “However, cancer doesn’t come with a bar code so it is not easy to identify what caused it. The site (SSFL) is massively contaminated with the kinds of radiation and chemicals that can cause breast cancer.”
Recently, the EPA completed a survey of the extent of the contamination at SSFL. “The American Cancer Society says that some of the cancers most strongly linked to ionizing radiation exposure in studies include breast cancer. SSFL has extensive radiation contamination, as a recent EPA study showed in both sampling results and gamma spectrometry of the lab. In some places, ionizing radiation in excess of a thousand times background was recorded recently at the site.”
Despite the fact that the initial nuclear accident occurred more than half a century ago, the site continues to be heavily radioactive and polluted by a witch’s brew of carcinogenic chemicals.
“Cesium-137, strontium-90 and plutonium-239/240 are dangerous ionizing radionuclides and endanger the public,” Duffield said. “The site’s soil and groundwater are grossly polluted with TCE, which the American Cancer Society says there is evidence of an association between TCE and breast cancer.”
Duffield said the only way to stop contamination of the environment is for Boeing to clean up SSFL to the standards of the disputed state law before opening the land up to the public as a park.
The mapping project covered the years 2000 to 2008, the most recent year for which data was available. In 2008, a full 20 percent of the breast cancer patients in the area of concern did not have any health insurance.