Environmental Links to Womens Health

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Environmental Links to Womens Health

• Devra Davis, PhD, MPH
• UPMC UPCI
• Center for Environmental
• Professor, Department of Epidemiology
• Graduate School of Public Health

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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

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Whats the environment got to do with womens
health?

• Unexplained patterns of breast, cervix
  cancer/endometriosis
• Are evidence per se that environmental agents
  are key

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Clues about environment and Womens 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

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Change in U.S. Breast Cancer Incidence
1975-79, 1990-94
500 400 300 200 100 0
500 400 300 200 100 0
1990-94
White
Black
1985-89
1985-89
1980-84
1990-94
1975-79
1980-84
1975-79
Incidence per 100,000
40 50 60 70 80
40 50 60 70 80
Age (years)
Age (years)
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WHI EstrogenProgesterone Trial Findings, July
2002 (avg 5.2 y)new British data
Risks
40 ovarian cancer
Benefits
105 Dementia
Fracture Reduction (Hip 23)
24 CHD
39 Reduction Colorectal Cancer

31 Stroke
111 Pulmonary Emboli
24 Breast Cancer
Threshold Level
STOPPED Early, Clear Harm
Stopped 3.3 yrs early
Also DVTs
Judith Hsia, M.D. FDA testimony, Dec 2, 2004
JAMA. 2002288321-333
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Environmental Exposures can Act Like Hormones

• Disrupt metabolism
• Growth
• Repair
• Order

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Fewer than 1 in 10 cases of breast cancer arises
in women with germline mutations
Reasons why environment is a cause of cancer
National Cancer Institute
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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

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Identical twins dont have identical chromosomal
banding patterns
Chromosome 1
Chromosome 3
3 year old twins
Chromosome 12
Fraga, Mario F., et al. (2005) Proc Natl Acad Sci
USA 10210604-10609.
Chromosome 17
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As identical twins age, their chromosomes look
less similar
Chromosome 1
Chromosome 3
Chromosome 12
50 year old twins
Chromosome 17
PhotoMaryellen Mark, Ned Fred Mitchell
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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

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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

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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. 

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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
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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 111(1).
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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

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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

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Jobs with increased risk of cancer

• Solvent workers
• Chemists
• Nurses/Dentists
• and Physicians
• Painters
• Hair Dressers

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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
• .

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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
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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.
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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

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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

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www.environmentaloncology.orgUPMC Greening
Accomplishments

• Chemical Waste Reduction
• Water and Energy Conservation
• Environmental Policy