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Here’s a list of critiques of the recently released (Dec. 2011) Institute of Medicine (IOM) report, “Breast Cancer and the Environment: A Life Course Approach“.

  1. Silent Spring Institute’s review of the IOM report.
  2. Silent Spring Institute’s critique of media coverage of the IOM report.
  3. Barbara Brenner’s response to the report. (Brenner is the former Executive Director for Breast Cancer Action.)
  4. Breast Cancer Fund’s response by President and CEO Jeanne Rizzo.
  5. Breast Cancer Action’s press release.
  6. Gayle Sulik’s critique of the report (Sulik is the author of Pink Ribbon Blues, about the fact that putting pink ribbons on commercial products does not make women healthier or reduce cases of breast cancer.)

Excerpts:

Barbara Brenner:

By defining ‘environment’ broadly to include lifestyle factors, the IOM report covers both involuntary exposures (those that require policy changes to control) and voluntary exposures (such as smoking and diet, including alcohol consumption), and focuses its risk reduction recommendations on the latter. (The IOM “Opportunities for Action” document is all about how women need to protect themselves.) These recommendations will only reinforce the inclination of women to blame themselves when they get breast cancer.

“The results of the report are hardly either surprising or overwhelming. In fact, the report repeats what has been known for over a decade.” […]

“So, the IOM report does not break new ground. Worse, it is silent on policy changes required to reduce involuntary exposures to toxins that may be contributing to the skyrocketing rates of breast and other cancers.” […]

“The reason that Komen has been so reluctant to look at chemical exposures is not hard to discern. Komen’s corporate partnerships are well known to most people in the breast cancer world. Komen is basically a wholly-owned subsidiary of corporate America. But not many people have thought about how those connections – to companies like Ford Motor Company, for example – inhibit what research Komen might be willing to do on toxics that are linked to breast cancer that come out of the tail pipes of cars. A very few people have even noticed that Komen is marketing a perfume called “Promise Me” that contains known or probable carcinogens.” […]

“With that background, consider how the IOM is constrained when it gets funding for its research from an organization like Komen. When Komen defines the research question as broadly as it did, the research results are destined to look as they do: like a repeat of all we already know.” […]

“The IOM report gives Komen just the cover it wanted to avoid looking at involuntary chemical exposures as a culprit in the breast cancer epidemic.”

Breast Cancer Fund:

“The Breast Cancer Fund has reviewed the Institute of Medicine’s new report Breast Cancer and the Environment, and our takeaway is that while it offers a useful review of some of the existing data on the disease’s links to environmental factors, it relies on an antiquated model of weighing the evidence and, therefore, does not go far enough to protect public health.” […]

We think it’s unacceptable to not inform the public about the potential harm of human chemical exposure in cases where lab studies show substantial evidence of harm. For example, the report finds that the chemical BPA is a ‘biologically plausible hazard,’ but says that the evidence does not necessarily warrant individual action to avoid the chemical. Yet if BPA were a potential pharmaceutical drug, it is highly doubtful that, given the adverse effects already seen in animal models, it would ever be allowed into clinical trials in humans. Indeed, we are all currently part of an uncontrolled human experiment on the effects of BPA exposure.

“The failure to take a precautionary approach may leave the public confused and even misinformed, as is evidenced by some of the initial media headlines about the report that say that chemicals are unproven to raise breast cancer risk, when the report itself indicated there are plausible reasons for concern.”

Breast Cancer Action’s Executive Director Karuna Jaggar:

“They too broadly define the environment as all factors not directly inherited through DNA which includes anything from genetic changes to tissue, to stress, to lifestyle choices and changes in abdominal fat rather than the chemicals we are all exposed to in our everyday lives.” […]

[W]e need to adopt the gold standard of prevention and that’s the precautionary principle because waiting for absolute proof is killing us. Instead, the IOM shrugged the burden of prevention onto women’s lifestyle choices.” […]

“[W]e don’t need reports that dink around with lifestyle choices—more exercise, less alcohol, avoiding excess weight, don’t smoke, etc.—which have at best an extremely small role in reducing breast cancer risk and which fail to acknowledge that not all women have equal access to healthy lifestyle choices. We need to apply precautionary principles that stop cancer before it starts.”

Gayle Sulik:

“It is already common knowledge that genetics alone cannot explain the rise in breast cancer incidence in the United States, which has been increasing about 1 percent per year for the past sixty years and rose by more than 40 percent between 1973 and 1998. Only 30 percent of breast cancer cases are attributed to the generally accepted risk factors, and notably, the longer immigrant women live in the U.S. the more likely they are to get breast cancer. International, national, state, and community-based organizations have been evaluating the role of environmental exposures for decades.” […]

“Despite the body of knowledge and the vast amount of ongoing scientific research to hone in on environmental links to cancer, the IOM report raises several concerns, including the fact that the report focuses on a definition of the environment that is much too broad (i.e., all factors that are not directly inherited through DNA, p. 1-4), with a strong emphasis on lifestyle factors as environmental. It also downplays the dangers of industrial chemicals (i.e., those that are biological plausible, but not causally confirmed in humans, p. 3-4), fails to stress precautionary principles when dealing with toxic substances that are implicated in the development of breast cancer (e.g., endocrine disruptors, p. 3-36), and puts too much emphasis on the weighty, but contradictory message that women should “take action” to reduce their breast cancer risk even though the report emphasizes that, “based on the existing literature…it [is] difficult to estimate the magnitude of the potential impact of these actions for either individuals or population groups.” (p. 6-19).” […]

If women are routinely charged with the responsibility of knowing their risk and taking proactive steps to reduce it, why shouldn’t society be held to the same standard?

Silent Spring Institute:

“The Institute of Medicine report on breast cancer and the environment is a clear statement to breast cancer doctors, many of them gathered in San Antonio where the report was released, that a cascade of scientific evidence shows that environmental chemicals have biological activity that plausibly links them to breast cancer risk.  That’s a significant step, because for years, medical experts have dismissed questions about environmental chemicals and breast cancer and ridiculed concerns about consumer products – from deodorants to plastics – as “myths,” saying that there’s no evidence that exposures cause breast cancer.  The “no evidence” messages ignored studies by Silent Spring Institute and others that show hundreds of chemicals in consumer products and pollution cause breast tumors in animals, mimic estrogen (a known breast cancer risk factor), and stunt breast  development.” […]

“Our own list of chemicals with both human and animal evidence of breast cancer risk is longer than the IOM’s and includes polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs), and common organic solvents.” […]

“It’s also an oversight that the IOM document does not mention an important study by Kaiser Permanente on breast cancer risk among women taking pharmaceuticals that cause mammary gland tumors in animal studies.  This study showed increased breast cancer risk from griseofulvin (an antifungal) in particular and also from furosemide and metronidazole (Friedman et al. 2008).” […]

What’s needed now is a clear statement by cancer heavyweights like Komen, the sponsor of the IOM report, saying the evidence of links between chemicals and breast cancer is mounting, and we’re past the point where we don’t know enough to act.  We desperately need breast cancer organizations to work for chemical safety testing for effects on breast cancer, reform of the Toxic Substances Control Act, and pollution policies that recognize breast cancer among the risks.  We also need them to invest in the IOM’s prevention research agenda on par with investments in improved screening and treatment.”

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