Breast cancer researchexploring exposure to chemicalmixtures,
critical windows of susceptibility, and environmental agents with
the capacity to modify known risk factors are largely lacking [19].
And yet, history has provided us with experiments that document
that early life exposure to environmental agents can have a profound
impact on breast cancer, i.e., diethylstilbestrol(DES), ionizing
radiation from the atomic bomb, and DDT [20–22].
Globally, funding to investigate prevention in general and
avoidable environmental exposures specifically represents a small
fraction of the resources directed to cancer research [23] (Fig. 1).
This trend is mirrored in the United States, where only 6.5% of the
National Cancer Institute’s (NCI’s) $5.1 billion 2011 budget request
was allocated to “cancer prevention and control” [24]. A federal
interagency review of breast cancer and the environment found
that at most, 10–11% of breast cancer research projects funded by
the National Institutes of Health (NIH) and the US Department of
Defense focus on environmental health and that no other federal
agency supports substantial research on the environmental causes
of breast cancer [6].
Thus, we have looked neither well nor hard for the role of the
environment in breast cancer etiology. The gap produced by these
limitations in the research has led many to believe that the environment
plays little to no part in disease etiology. For example, the
NCI’s breast cancer prevention advice to patients downplays environmental
etiology, stating “studies have not proven that being
exposed to certain environmental exposures (such as chemicals,
metals, dust, and pollution) increase the risk of breast cancer” [25].
Times are changing. Over the past few years, calls for shedding
light on cancer and the environment have come from influential
entities, including the Institute of Medicine, [3] the President’s
Cancer Panel [8], the federal Interagency Breast Cancer and Environmental
Research Coordinating Committee (IBCERCC), [6] and
the Agency for Toxic Substances Disease Registry with the US
Centers for Disease Control and Prevention’s National Center for
Environmental Health [26]. A critical observation common to these
diverse reports is that the environment represents a vastly underutilized
pathway to prevention. As the IBCERCC stated, “By urgently
pursuing research, research translation, and communication on the
role of the environment in breast cancer, we have the potential to
prevent a substantial number of new cases of this disease in the
21st century” [6]. The California Breast Cancer Research Program
(CBCRP) is doing just that. Below we describe a four-year initiative
to set a research agenda that will illuminate the links between
the environment and breast cancer and uncover opportunities to
prevent disease.