Breast Cancer Incidence on Long Island: Environmental Impact

 A report by: Dr. Noelle Cutter (Molloy University) and Ben Honigsfeld

Breast cancer is a current health concern, affecting millions of women globally.  In 2023, it was the leading cause of death due to cancer in the United States (ref). While genetic factors and lifestyle choices play significant roles in its development, emerging evidence suggests that environmental exposures also contribute to breast cancer incidence rates. Long Island, New York, has garnered attention due to its elevated breast cancer rates compared to national averages, prompting investigations into the potential environmental factors driving this phenomenon. 

Whether environmental contaminants increase breast cancer risk among women on Long Island, NY, is unknown. In the early 1990s, breast cancer advocates petitioned the United States Congress to investigate the high rates of breast cancer on Long Island in the state of New York (1992-1996 117.8 per 100,000 in Nassau County, 113.6 in Suffolk county vs national average (NYS Cancer Registry, 2023). The resulting law led to the Long Island Breast Cancer Study Project (LIBCSP)--more than ten collaborative research projects designed to study the possible causes of this increased incidence of cancer. This project reported that there was no evidence that environmental exposures were responsible (ref, LIBCSP). However, the rate of BC on Long Island remains high compared to other regions in the United States (2016-2020 Nassau 145.9 and Suffolk 139.9) (NYS Cancer Registry, 2023). and has led to speculation that environmental risk factors remain an important cause of breast cancer. 

ENDOCRINE-DISRUPTING CHEMICALS (EDCS):
Endocrine-disrupting chemicals (EDCs) are natural or human-made chemicals that may mimic, block, or interfere with the body’s hormones, which are part of the endocrine system. These chemicals are associated with a wide array of health issues, including cancers (Safe, 2000). Endocrine disruptors are found in many everyday products, including some cosmetics, food and beverage packaging, toys, carpet, and pesticides. Some chemicals that act as flame retardants may also be endocrine disruptors. Long Island’s environment is full of potential sources of EDCs, which have been linked to an increase in breast cancer development. 

A study by Soto et al. (2015) highlighted the presence of EDCs such as bisphenol A (BPA) and phthalates in everyday consumer products, including plastics and personal care items. These chemicals can interfere with hormonal signaling pathways, such as the estrogen, androgen, and growth factor signaling pathways. EDCs such as BPA, phthalates, and certain pesticides can mimic estrogen's action by binding to estrogen receptors (ERs) and activating estrogen-responsive genes and turning on downstream transcription factors which are involved in pathways associated with many cancers, including breast cancer. The Androgen Signaling Pathway can also be impacted by EPCs.  Androgens, such as testosterone, play crucial roles in the development and maintenance of male reproductive tissues and secondary sexual characteristics. EDCs can disrupt androgen signaling by interfering with androgen receptor (AR) activation or inhibiting androgen synthesis. This disruption can impact reproductive health, development, and hormone-sensitive tissues in both males and females (Akdag et al., 2016). 

Additionally, the Growth Hormone/Insulin-like Growth Factor (GH/IGF) Signaling Pathways are critical regulators of growth, development, and metabolism. EDCs like polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) can interfere with GH/IGF signaling pathways, affecting cellular proliferation, differentiation, and apoptosis. Disruption of these pathways by EDCs may contribute to altered growth patterns and increased susceptibility to cancer and potentially increasing breast cancer risk. Moreover, Long Island's proximity to industrial sites and agricultural areas raises concerns about exposure to these environmental EDCs with studies suggesting a possible association between pesticide exposure and breast cancer incidence (Engel et al., 2017). Contact with these chemicals may occur through air, diet, skin, and water.

AIR & WATER POLLUTION:
Long Island's densely populated urban areas are susceptible to high levels of air pollution, including particulate matter and volatile organic compounds (VOCs), which have been implicated in breast cancer development (Hystad et al., 2013). Additionally, concerns have been raised about groundwater contamination from industrial activities and pesticide runoff from agricultural lands. A case control study investigating pesticide use on Long Island identified that women using higher amounts of pesticide in and around their homes had a greater than 30% increase in risk of developing breast cancer. In addition, use of most individual and combined lawn and garden pesticides examined by the study identified a consistent elevation in breast cancer risk (Teitelbaum et al., 2007). 

However, the lack of dose-response relationship and conflict of the LIBCSP study results indicates the need for additional research. In addition to pesticides, a major source of contamination is due to the Navy-Grumman groundwater plume. Beginning operation in the 1930s, the 600 acre Northrop Grumman-Bethpage Facility and Naval Weapons Industrial Reserve plant site was utilized for military industry and research until 1996 (DOJ, 2022). During this time, Northrop Grumman’s activities lead to the contamination of the soil and groundwater with volatile organic compounds, polychlorinated biphenyls, metals, and many others (NYSDOH, 2022). These contaminants were first detected in the 1970s, allowing for decades of unopposed groundwater, soil and air contamination. 

Furthermore, the New York Department of Health estimates that groundwater contamination reaches up to 750 feet deep, and stretches over 3800 acres (NYSDOH, 2022). This dumping took place on land now surrounded by residential neighborhoods, thus posing a major hazard to the community. As of March 2024, buried contaminants are still being discovered, with additional potential sources still expected to be present (DEC, 2024). 

There was also detection of similar contaminants at the Naval Weapons Industrial Reserve Plant in Calverton in eastern Long Island, which resulted in closure of all wells on the contaminated property in 2012 (NYSDOH, 2022). Amongst the contaminants identified as part of the Northrop-Grumman plume, concerns have been raised regarding 1,4 dioxane in particular, a solvent stabilizer rated by the EPA as a likely human carcinogen. In an evaluation of 4,400 water sources across the country, the EPA identified Long Island as having among the highest levels of 1,4 dioxane (EPA, 2021). In response, the Yale Superfund Research Center has initiated a series of 4 projects to measure the exposure to 1,4 dioxane and connection to adverse biological effects (Kim & Fortner, N.D.). 

In addition to spillage from Northrop-Grumman, the Hooker Chemical & Plastics Corp./Ruco Polymer Corp plant formerly located in Hicksville was discovered to have contaminated the groundwater with vinyl chloride, trichloroethylene, barium, cadmium, organic acids, and other compounds due to dumping practices. These activities were discovered in 1984 after several decades of operation, and groundwater cleanup is still underway (EPA, N.D.). Unfortunately, It is clear that Long Island has suffered decades of hazardous waste exposure through soil, water, and air. 

A study by Gammon et al. (2002) found an association between residential proximity to hazardous waste sites and increased breast cancer risk among Long Island women, highlighting the potential role of environmental pollutants in driving breast cancer incidence rates. Besides cancer, environmental pollution has also been linked to increased rates of cardiovascular, reproductive, neurological, gastrointestinal, respiratory, and developmental disorders among other complications (Shetty et al. 2023).

RADIATION EXPOSURE:
Long Island's history of nuclear facilities and radioactive waste sites raises concerns about radiation exposure and its impact on breast cancer risk. Namely, the Shoreham Nuclear Power Plant, decommissioned in 1994 before becoming fully operational due to public safety concerns. During the breakdown process, 5 million pounds of radioactive waste via 353 truckloads, as well as water barges to remove 560 irradiated fuel assemblies was required (NYT, 1994). In Upton, Suffolk County, Brookhaven National Laboratory experienced a tritium leak in 1998, leading to tritium in the groundwater above the state and federal drinking levels (Brookhaven Bulletin, 1998). This culminated in a shutdown of the High Flux Beam Reactor (ANS, 2022). The extent and harm of the leak remains a point of controversy, and has been designated as a superfund site by the EPA and is under periodic 5-year review (EPA, 2024). 

Irradiated surfaces were treated and the area remains at normal background levels according to state officials . While medical imaging and radiation therapy contribute to some extent, historical exposure to ionizing radiation from nuclear facilities may have long-term health consequences. A study by Boice et al. (2012) suggested an increased risk of breast cancer among individuals exposed to low-dose ionizing radiation, emphasizing the importance of monitoring and mitigating radiation hazards in the environment. The effects of ionizing radiation on the destabilization of DNA have been well documented, with research particularly emphasizing double strand breakage, and generation of reactive oxygen and nitrogen species (Helm & Rudel, 2020). 

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Furthermore, ionizing radiation has been found to cause epigenetic alterations, including alterations in DNA methylation and histone acetylation (Pogribny, 2019). with regards to breast cancer specifically, no association was found with high levels of UV radiation and overall breast cancer incidence (Gregoire et al., 2022) However, ionizing radiation has been demonstrated to increase the incidence of breast cancer in women in a dose-dependent manner, especially when the exposure occurs at a young age (Helm & Rudel, 2020).

Addressing the environmental impact on breast cancer incidence requires a collaborative effort involving community engagement, advocacy, and policy interventions. Clearly, more research is needed to ascertain the environmental impact on the increased incidence of breast cancer on Long Island.  By leveraging scientific research, community engagement, and policy advocacy, Long Island can work towards reducing breast cancer incidence rates and improving the overall health and well-being of its residents. 

References: https://prevention101.org/refs_6-13-2024-N.Cutter.html

CONTRIBUTORS

DR. NOELLE CUTTER is a professor of biology, ironman finisher, and advocate for dense breast screening.  United with an expanding research team dedicated to collecting data on women with dense breasts and screening options for these patients, her initiative aims to investigate and gather conclusive information about dense breasts in specific groups- including age, body mass index, and amount of physical activity and the underlying diagnostics of breast cancer tumors. This research program is under a partnership with Molloy College and Dr. Robert Bard, expert diagnostic cancer imaging specialist in NYC and other colleagues from the NY Cancer Resource Alliance. 

BENJAMIN HONIGSFELD began his interest in cancer research as part of the Advanced Science Research program in high school. Since then, Benjamin has contributed to research and publications regarding ovarian cancer, medulloblastoma, and brownfield site remediation, earning awards at LISEF, and MACUB. Benjamin is currently a third year medical student at Ben-Gurion University of the Negev and co-president of the internal medicine interest group.

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CHANGES IN BREAST CANCER CARE IN NEW YORK DURING THE COVID-19 PANDEMIC   By:  Alexandra Fiederlein | Cheyenne Rosado | Noelle Cutter

Breast cancer is the second most common malignancy among women in the United States. As such, the COVID-19 pandemic has caused medical facilities to change their methods of operation since March of 2020, including changes in diagnosis and treatment plans. New York (NY) has an unusually high incidence of breast cancer. This study analyzed the effects of the COVID-19 pandemic on breast cancer care (BCC) in NY. Women in NY that were diagnosed with or in remission for breast cancer were asked to take an online, anonymous survey regarding their BCC experience. For patients in treatment, 26% of women wished they had greater emotional support or had a family member included in their appointments. 39% of women do not feel they are receiving as good of care as before, while 31% feel they are receiving the same level of care. Additionally, 41% of women feel they received the same level of care over telemedicine. 

Our data show a negative correlation between the quality of care received during the pandemic and the wish for more emotional support and inclusion of supportive members in the care process (nonsignificant). There was less of a negative correlation between the quality of telemedicine care received during the pandemic and the wish for more emotional support and inclusion of supportive members in the care process (nonsignificant). This indicates that most women lacking emotional support reported worse BCC experiences, and telemedicine use was not as troublesome to patients as the lack of emotional support. Most women in treatment and in remission reported negative feelings like fear when asked about their BCC experiences. Our data show the importance of emotional support for breast cancer patients and those in remission during the COVID-19 pandemic. Our work could also provide clinicians with the knowledge necessary on how breast cancer care should be handled in an evolving pandemic such as COVID-19.

 

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