Tackling the environmental and chemical causes of breast cancer

Breast Cancer UK is dedicated to achieving the primary prevention of breast cancer by reducing public exposure to carcinogenic and other hazardous chemicals in our environment and everyday products.

Our missionContents

Our mission 1 Our vision 2Our charitable objectives 3Our work 4Founding principles 6Breast cancer incidence rates 8Why are more of us getting breast cancer? 10About Breast Cancer UK 22Support us 24

1

Our vision is a world in which the environmental and chemical causes of breast cancer have been eliminated so that fewer people have to live in fear, suffer the trauma of diagnosis, treatment, illness and potential death which results from the disease.

Our vision Our charitable objectivesFounded in 1999, Breast Cancer UK’s charitable objectives are:

Advancing health and saving lives by seeking to reduce the incidence of breast cancer by identifying its causes and encouraging a preventative approach.

Advancing the education of the public

(including patients, their families, the medical research establishment and others) about the causes, impact and prevention of breast cancer.

Collating, conducting or commissioning

research (including the analysis of clinical data and research) into the causes and treatment of breast cancer, and to publish the results thereof.

2 3

Our work

We campaign to encourage a preventative approach by calling for improvements in legislation and public health policies that reduce our exposure to chemicals associated with breast cancer. www.breastcanceruk.org.uk/policy-advocacy

We raise awareness amongst members of the public about the links between exposure to harmful chemicals and breast cancers; and provide practical solutions to help reduce exposure. www.breastcanceruk.org.uk/reduce-your-risk

We support scientific research into the links between breast cancer and exposure to carcinogenic, endocrine disrupting and other hazardous chemicals. www.breastcanceruk.org.uk/science-and-research

4

Founding principlesOur work is guided by the following principles:

The number of breast cancer cases in the UK can be reduced by addressing exposure to carcinogenic, environmental and chemical pollutants.

The public have a right to know about the

associations between carcinogenic and toxic chemicals used in everyday products and the risks of developing breast cancer, and that everything possible should be done to empower and enable people to make choices that improve their health.

There is enough scientific data on the harmful effects of certain carcinogenic and endocrine disrupting chemicals to justify immediate action to ban them and where there is little or no scientific data, there should not be a presumption that those chemicals are safe.

All claims and campaign messages must be backed up and referenced with sound scientific data.

We will not knowingly enter into any partnership

with any company that may directly or indirectly profit from chemicals associated with an increased risk of breast cancer.

Find out more about us at www.breastcanceruk.org.uk

6 7

Breast cancer incidence rates Over 53,000 breast

cancer cases were diagnosed in the UK in 2013.

Breast cancer accounts for 32% of women’s cancers.

Most breast cancers are diagnosed in women, although around 350 men are also diagnosed every year.

Between 2004 and 2014 age standardised incidence rates increased by 7.7%.

1 in 8 women will get breast cancer at some point in their lives. (This statistic used to be 1 in 9 in 2001 and before that, 1 in 12 in 1996).

1 in 5 of these cases will be in women under the age of 50.

Rising incidence rates are a global trend.

Breast cancer incidence is generally higher in wealthier nations.

Women who move from countries with lower breast cancer rates to countries with higher rates will acquire the higher risk profile of their adopted country.

Trends in incidence of female breast cancer in selected countries

Estimates of attributable causes of breast cancer

1% Alcohol

1% Overweight and obesity

3% Lack ofphysical exercise

3% Post menopausal hormones

3% Ionising radiation

5% Occupation

6% HRT

9% Oral contraception

25% Genetic/family

44% Other

120

100

80

60

40

20

0 1975

1980

1985

1990

1995

2000

2005

2010

1975

1980

1985

1990

1995

2000

2005

2010

1975

1980

1985

1990

1995

2000

2005

2010

Europe Asia Rest of the world

Australia

Canada

Colombia

Costa Rica

New Zealand

USA

China

India

Japan

Philippines

Singapore

Thailand

Denmark

Finland

France

Slovakia

Spain

England

Data source: Globocan (2012) IARC, WHO

8 9

Is it because we are living longer?

Whilst living longer does increase the risk of breast cancer, this alone cannot account for the increase in age standardised incidence rates, which continue to rise.

Is it because we are diagnosing more cases earlier due to improved awareness and screening rates?

The uptake of mammogram screening in the UK has not altered significantly since 2009 and recent figures may even suggest a slight downward trend.

Why are more of us getting breast cancer?

Risk of developing breast cancer before age 40 for BRCA2 carriers

0%

20%

40%

60%

46%

Women born after 1958

11%

Women born before 1958

One study showed that women with an inherited BRCA2 mutation born after 1958 have a higher risk of developing breast cancer by age 40 compared to those born before 1958. This suggests our modern lifestyles and environments could be making us more vulnerable to the disease.

Tea, M. K. et al. (2014). Central European BRCA2 mutation carriers: Birth cohort status correlates with onset of breast cancer. Maturitas 77: 68-72

10 11

Estimates of attributable causes of breast cancer

Lifestyle factors

Lack of exercise, increased alcohol consumption, diet, obesity, women having fewer children and at a later age, night-shift work and smoking are all risk factors for breast cancer.

Environmental factors

Ionising radiation (medical, industrial and naturally occurring), air pollution and other chemical pollutants have also been linked with an increased risk of breast cancer. However, it is simply not known what causes around 44% of breast cancer cases.

Estimates based on work by: Parkin, D. and Boyd, L. (2011). The Fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. British Journal of Cancer 105: S77-S81; and Economopoulou, P. et al. (2015). Beyond BRCA: New hereditary breast cancer susceptibility genes. Cancer Treatment reviews 41: 1-8.

44% Other

6% Alcohol

9% Overweight and obesity

3% Physical exercise

3% Post menopausal hormones

1% Ionising radiation5% Occupation

3% HRT

1% Oral contraception

25% Genetic/family

12

Oestrogen and cancer

Cancer occurs when abnormal cells grow in an uncontrolled manner.

High oestrogen levels are associated with an increased risk of breast cancer. This is because oestrogen encourages a high rate of cell division which means there is less time for DNA repair and an increased risk of mutations.

Find our more www.breastcanceruk.org.uk/science-and-research/biology-of-breast-cancer

1

2

Normalcell

DNAdamage

Natural responseresults in cell death

Cancer arises from DNA mutations in cells

How oestrogens and EDCs interact with breast cells

Oestrogensenter breast cells

1Oestrogen mimics (EDCs)are also able to enter cells

Bind with oestrogenreceptors

3 Enter the nucleus and bind to DNA

4 Cell proliferationis triggered.

4 Oestrogen and oestrogen mimics trigger increase in cell proliferation.

Cell divisionsand furthermutations Uncontrolled

cell growth (cancer)

2Bind with oestrogenreceptors

3 Enter the nucleus and bind to DNA

14

EDCs and Cancer

Scientific data suggest that exposure to endocrine disrupting chemicals or “EDCs” could provide an explanation as to why more and more of us are getting breast cancer.

EDCs interfere with the body’s hormones, e.g. female sex hormones, (oestrogens and progesterone), males sex hormones (androgens), insulin and thyroid hormones.

Some EDCs can mimic the actions of hormones – these are known as “agonists” or “mimics”. They bind to specific hormone receptors which induces the response normally associated with natural hormones. For example oestrogen mimics bind to oestrogen receptors. Others prevent natural hormones binding to their target receptor; these are known as antagonists.

1

2

Normalcell

DNAdamage

Natural responseresults in cell death

Cancer arises from DNA mutations in cells

How oestrogens and EDCs interact with breast cells

Oestrogensenter breast cells

1Oestrogen mimics (EDCs)are also able to enter cells

Bind with oestrogenreceptors

3 Enter the nucleus and bind to DNA

4 Cell proliferationis triggered.

4 Oestrogen and oestrogen mimics trigger increase in cell proliferation.

Cell divisionsand furthermutations Uncontrolled

cell growth (cancer)

2Bind with oestrogenreceptors

3 Enter the nucleus and bind to DNA

Some EDCs can alter whether genes are switched on or off; this is known as “epigenetic” control. This may increase cancer risk if, for example, a gene that helps to prevent a cell becoming cancerous (a tumour suppressor gene) is turned off.

Find out more at www.breastcanceruk.org.uk/science-and-research/endocrine-disrupting-chemicals

16 17

Combination effects

Some EDCs have been reported to cause adverse effects at very low dose levels. Exposure to multiple EDCs may also cause combination effects that are especially harmful. Even when each individual chemical is present at a level below the threshold considered to cause harm, in combination with others they could form a hazardous cocktail in the human body.

Early exposures

Exposure to EDCs during critical moments of development, for example in the womb, during early infancy, childhood or during puberty, could also increase the risk of developing breast cancer later in life.

Find our more at www.breastcanceruk.org.uk/science-and-research/in-utero-exposures

Other concerns about EDCs

EDCs are not only linked to breast cancer. They are also linked to widespread environmental pollution and adverse effects on wildlife as well as other human disease and illnesses. These include reproductive disorders, cancers, adrenal and bone disorders, reduced biodiversity, neurotoxicity and thyroid problems.

Whilst, it should be noted that not all scientists believe EDCs contribute to breast cancer incidence, the evidence that they play some part in increasing our vulnerability to the disease is starting to mount up.

18 19

Compound(s) Uses Source (examples)

Hormone disrupting effect

Bisphenol A (BPA) Plastics component; epoxy resin component

Linings in food cans; polycarbonate plastics, thermal receipt paper

Oestrogenic; Anti-androgenic; thyroid hormone antagonist; inhibits *aromatase

Parabens Preservatives (to promote shelf life)

Food, cosmetics, shampoo

Oestrogenic

Phthalates Plasticiser (soften plastics); fragrance; alcohol denaturant

PVC plastic, fragrance in air fresheners, cosmetics, detergents

Oestrogenic; anti-androgenic

Heavy metals e.g. cadmium

Industrial products (e.g. batteries); electroplating

Soil and water contaminants

Oestrogenic, anti-androgenic

Polychlorinated biphenyls (PCBs)

Banned (once used as component in insulating fluids; paints; as a plasticisers)

Soil contaminants

Many disrupt thyroid hormones; some oestrogenic; some anti-oestrogenic

Aluminium salts Control sweating

Antiperspirants Oestrogenic

Compound(s) Uses Source (examples)

Hormone disrupting effect

Triclosan Preservative (antimicrobial agent)

Toothpaste, antibacterial soaps

Decreases thyroid hormone levels; oestrogenic/ anti-oestrogenic; androgenic/ anti-androgenic

Pesticides e.g. glyphosate

herbicide (weed killer)

Agriculture, domestic use

Oestrogenic

UV filters e.g. benzophenones

Protection against UV rays; prevent product degradation

Sunscreens, face creams

Oestrogenic; interfere with thyroid hormones

Flame retardants e.g. tetrabromobisphenol A

Protection against fire

General appliancesElectrical equipment (most widely used in EU)

Interferes with oestrogen metabolism; thyroid

* Enzyme that converts testosterone to the oestrogen, oestradioll

Almost 1,000 compounds are known or suspected to be EDCs. Only a small fraction of these have been investigated in tests capable of identifying endocrine effects in intact organisms.

Endocrine disrupting chemicals

20 21

About Breast Cancer UK

Trustees

Dr Caroline Seddon ChairElspeth Mackeggie Gurney TreasurerMary DaviesKevin DimmerJill Giddins LLB

Income and expenditure

Dr Alison Giles Dr Athina KakavouliGeoff PageStephanie Reeves

Staff

Lynn Ladbrook Chief Executive OfficerDr Margaret Wexler Science Policy OfficerJack Brown Policy and Campaigns OfficerLouise Bowers Communications ManagerAmanda Smith Fundraising ManagerJacquie Fagan Administrator

2015 income

2% Trusts and grants

7% Gift Aid

8% Individual donations

1% Other

6% Legacies

14% Donations in memory

3% Corporate partners

59% Community fundraising

2015 expenditure

£32,593.66 Support

£37,287.46 Education

£3,593.45 Governance

£106,392.78 Science

£42,652.59 Fundraising

£47,870.59 Campaigns

In 2015 we raised over £288,000 and spent just over £270,000. 72% of funds went directly towards the charitable programme. The rest was used to help raise money and provide administrative support.

22 23

Support us

Breast Cancer UK is completely independent and relies largely on the generous support of members of the public – every penny raised will help us in our mission to help prevent breast cancer and put a stop to the environmental and chemical causes of the disease.

Make a regular donation

Set up a standing order to contribute monthly to Breast Cancer UK. Regular giving enables us to plan more effectively for the future.

Volunteer

We are always on the lookout for dedicated volunteers who might be able to help by collecting collection tins, becoming a local ambassador or supporting local events.

Leave a gift in your Will

After providing for your family, you may like to consider leaving Breast Cancer UK a gift in your will.

Become a corporate supporter

There are many ways in which businesses can support us: by making a corporate donation, selecting us as charity of the year or payroll giving.

Find out more

Call us on 0845 680 1322, email info@breastcanceruk.org.uk or visit our website www.breastcanceruk.org.uk

24

1 in 8 womenwill get breast cancer

at some point in their lives

Breast Cancer UK works to tackle the environmental and chemical causes of breast cancer.

Breast Cancer UKBM Box 7767London WC1N 3XXTel: 0845 680 1322

Breast Cancer UK Reg. Charity no: 1138866 | Reg. Company no. 7348408

DisclaimerThis work in no way claims to be a comprehensive treatment of the subject of all risk factors or chemicals associated with breast cancer. Breast Cancer UK has used all reasonable endeavours to ensure that the content of this leaflet is correct at the time of publishing, but no warranty is given to that effect nor any liability accepted for any loss or damage arising from the use of this leaflet.

Full references for this document are available from Breast Cancer UK

info@breastcanceruk.org.uk @breastcancer_uk breastcancerukwww.breastcanceruk.org.uk