By Rebecca Vesely
Friday, February 7, 2003
Experts and everyday women are at a loss to explain the alarmingly high breast cancer rate in one of the nation's wealthiest counties. Also: Poland's abortion wars.
TIBURON, Calif. (WOMENSENEWS)--On a sunny Saturday morning, more than 2,000 volunteers fanned out over the affluent suburbs north of San Francisco to conduct a door-to-door search for clues to the mystery plaguing this community: Why are so many women here getting breast cancer?
Marin County has a breast cancer rate nearly 40 percent higher than the national average. Breast cancer diagnoses in Marin climbed 37 percent over the past decade, compared to just 3 percent in other urban California counties.
Women in Marin do have more early-stage diagnoses than in other counties. However, the death rate has increased slightly, signaling that more women not only develop breast cancer but more die from the disease. Nationwide, more than 40,000 women die of breast cancer each year.
"We're going to have to mobilize people to get answers," says Laura St. Claire, a breast cancer survivor and steering committee member of the Marin Cancer Project, the nonprofit group that conducted the survey. "We can't rely on the government for answers."
Researchers say that Marin's unusual demographics offer some clues. With a mere 250,000 residents, Marin is one of the nation's smallest counties--and one of the wealthiest. The average household income is $80,000, nearly $30,000 more than the national average. The median price for a single family home is $530,000, making it one of the least affordable areas to live.
White women in the highest socioeconomic class are 27 percent more likely to get breast cancer than other women, according to the Northern California Cancer Center. The reasons for this are unclear, though the risk factors for breast cancer include delayed childbirth or having no children, which is common among higher-income women.
St. Claire, who is in her early 40s, doesn't fall into this category. Diagnosed with breast cancer last year, she had two children while in her mid 20s. Her twin sister, who lives outside of Marin, is childless and does not have breast cancer.
"My story doesn't fit with what researchers are telling us about why women in Marin get breast cancer," St. Claire says.
Going door to door for the Marin Cancer Project survey in the picture-perfect town of Tiburon, residents cited the environment as a leading suspect. Those who live in multi-million dollar homes here worry about everything from landfills to pesticides to bottled water. One woman lamented that she couldn't eat swordfish anymore because of fears of high mercury content.
"I just don't believe that the high rate of incidence of breast cancer is due to later childbearing," says Marcia Rubenstein, who lives in Tiburon. "It's got to be something environmental. Maybe it's toxins leached in the soil."
So far, researchers have not found a smoking gun linking environmental factors to cancer in the area.
Two state senators plan to introduce legislation early next year that would fund a pilot program to monitor breast milk for chemical contaminants--the first of its kind in the nation. The hope is that breast milk could provide some clues as to whether pesticides, detergents, plastics or other chemical products are contributing to breast cancer.
Last month, Democratic Rep. Lynn Woolsey of Marin received a plan of action she requested from the National Cancer Institute, National Institutes of Health and Centers for Disease Control and Prevention on breast cancer in her district. The task force will define the role of known risk factors and employ new technologies to measure environmental exposures.
"We've just begun to get to the bottom of what is happening to women in Marin County," Woolsey said in a statement. "Enhancing community efforts by coordinating with federal agencies that have the resources to scientifically research the incidence of breast cancer will go a long way to determining what is causing the high rate of the disease and help us figure out what we can do."
Christina Clarke, a research scientist at the Northern California Cancer Center and leading expert on breast cancer in Marin, says that understanding the core risk factors--including childbirth, hormone-replacement therapy and alcohol use--is key to understanding the skyrocketing incidence of breast cancer. A study of 150,000 women published this month in the British Journal of Cancer found that just one alcoholic drink a day increases a woman's chances of getting breast cancer by 6 percent.
Clarke points to an ongoing survey of more than 133,000 female teachers and administrators in California. The survey found invasive breast cancer rates among non-Hispanic white teachers 51 percent higher than the incidence rate of other white women of a similar age in the state. The survey included questions on alcohol use, hormone replacement therapy, oral contraceptives, and radiation exposure--questions that have not been asked of Marin women on a large scale.
"Teachers have a very similar breast cancer rates and socioeconomic profile to Marin county women," Clarke says. "All the data point to a demographic group with established risk factors irrespective of where we live."
Alarmingly, other wealthy areas have high rates of breast cancer, but they are masked because cancer rates are reported for counties, not cities, Clarke says. A forthcoming report by researchers at the California State University, Los Angeles suggests that Malibu, Beverly Hills and Bel Air have the highest breast cancer rates in Los Angeles County.
Woolsey's task force will recalculate cancer rates in all of California so that Marin breast cancer rates can be compared to those of other counties.
Hormone replacement therapy use in Marin is also being closely examined. Higher-income white women historically have taken hormone replacement drugs more than other women. In the 1970s, soaring endometrial cancer rates in Marin were ultimately linked to the use of estrogen therapy by postmenopausal women. As a result, estrogen-only therapy was replaced with a combination of estrogen and progestin. Researchers now suspect that this combination therapy could be linked to breast cancer.
In July, the Women's Health Initiative halted a multi-year study of 16,000 healthy post-menopausal women when researchers found that breast cancer rates were 26 percent higher among women on estrogen-progestin pills than among those given placebos.
The effects of estrogen-only therapies on women who have undergone hysterectomies is now being studies by the Women's Health Initiative in a separate clinical trial, with results expected in 2005.
The Northern California Cancer Center is combing through cancer data from other states that have wealthy populations within larger counties, such as New Jersey, Virginia and Connecticut to find out if those areas have breast cancer rates similar to Marin.
"I don't want people to think, 'This is happening in Marin so it doesn't affect me,'" Clarke says. "Marin is a real window into a particular demographic group; it's a canary in a coal mine."
Rebecca Vesely is the West Coast bureau chief for Women's Enews.
Marin Cancer Project--The Marin Community Health Survey:
Northern California Cancer Center:
Marin Breast Cancer Watch:
Polish Federation for Women and Family Planning:
NEWW Polska--Network of East-West Women:
OSKA--National Women's Information Center http://www.oska.org.pl/english/index.html
By Shana Penn
(WOMENSENEWS)--Pro-choice advocates in Poland faced a serious setback last week in their battle to reform the country's severely restrictive abortion law.
Last Tuesday, the post-communist government, apparently bowing to church pressure, requested permission from the European Union for the right to preserve Polish laws on the "protection of human life" in Poland's membership agreements.
In response, Polish women's rights advocates appealed to the European Union and insisted the amendment be rejected "since the majority of the society (approximately 60 percent) opposes the strict 'anti-abortion' law." Signed by more than 20 groups representing thousands of women throughout Poland, the open letter pointed out that the government, by submitting to church pressure without consulting its citizenry or responding to the strong protests made by women's organizations, had forsaken democratic practices.
During the communist era, abortion was legal in Poland, but in 1993, four years after the nation became a democracy, the government passed a veritable abortion ban. Polish law limits legal termination of pregnancy to incidents of rape and incest; to when the woman's health or life is threatened; or to cases where the fetus is damaged. Among European nations, the Polish law is second in severity only to Ireland's reproductive health constraints.
Last summer the European Parliament urged member states in a non-binding appeal to liberalize their reproductive rights legislation. The Polish Catholic Church began protesting that "Europeanization" would undermine "Polish values," namely its longstanding ban on most abortions.
Ireland and Malta, other candidate countries to the European Union, have also obtained similar protocols in their accession treaties, legally ensuring that European law, including future law, cannot alter their abortion restrictions.
The governing party, the Democratic Left Alliance--a social democratic offspring of Poland's former anti-cleric communist party--had promised to liberalize the abortion law during its parliamentary election campaign in 2001. After Poland was officially invited to join the European Union in December, the government's Secretary General Marek Dyduch weighed in favor of reforming the abortion law following its admission in 2004.
"We are not giving up our campaign promises regarding reproductive rights. After the referendum, we will begin to liberalize the anti-abortion law, which we know will be unacceptable to the Catholic Church," declared Dyduch.
While women's groups applauded his public endorsement of reproductive freedoms, the Catholic Church demanded a government retraction and a legal guarantee that European Union membership will not force changes in the restrictive abortion law.
Now, with the request to the European Union, the government apparently has capitulated to the church's demands. The turnaround is apparently an attempt to assure church support in this predominantly Catholic country--viewed as essential for passage of a national referendum on whether Poland should enter the European Union.
However, the Polish government's request was not strong enough for Cardinal Jozef Glemp, head of the Polish Catholic Church. He demanded a special clause calling for the "separateness" of Poland's anti-abortion stance and for the European Union constitution to recognize Poland's "national sovereignty" on abortion.
Shana Penn is the author of "National Secret: The Women Who Brought Democracy to Poland" (University of Michigan Press, forthcoming).