Book Description

The Ecology of Breast Cancer: the Promise of Prevention and the Hope for Healing looks broadly and deeply into the origins of breast cancer and some of the factors that influence recurrence and progression after initial treatment. It integrates an extensive amount of material from diverse sources. The analysis finds that interactions among many features woven into the fabric of our individual, family, and community lives create conditions that make breast cancer more or less likely. Thinking about this as a design problem helps us identify multi-level interventions that will reduce risk and improve outcomes after diagnosis.Preventing breast cancer and reducing recurrences requires measures that confront the systemic roots of the disease. Generally-accepted individual risk factors are important, but they simply do not explain why many people develop the disease. The food system, many aspects of the built and occupational environments, and pervasive hazardous environmental chemicals also contribute, and they cannot be addressed by individuals alone. The book briefly discusses known risk factors for breast cancer, including family and personal history, genetic susceptibility, early puberty, late menopause, late age of first child or having no children, dense breast tissue, chest irradiation, current use of oral contraceptives, combination hormone therapy, cigarette smoking, and alcohol consumption. It goes on to explore what we know about other variables, their interactions, and the importance of taking a life course approach, since breast biology and later risk of breast cancer can be influenced by conditions experienced during fetal development, infancy, childhood, and adolescence as well as adulthood. The first section of the book proposes that a systems perspective or an ecological framework is best suited for studying the origins of breast cancer and designing interventions intended to prevent it and improve outcomes following treatment. A second section reviews numerous studies addressing the roles of nutrition, physical activity, environmental chemicals, vitamin D, electromagnetic fields, shift work, and stress. Examples of interactions among these variables show the value of a systems-based approach to research and interventions. Section three synthesizes this information and identifies practical opportunities for individuals, health care professionals, public health officials, community planners, businesses, schools, governments, and farmers to help reduce the burden of this disease. Biomedical scientists and clinicians have made enormous advances in treating breast cancer in recent decades. Improved outcomes are likely due to combinations of earlier diagnosis, better understanding of cellular pathology, and refined, targeted therapeutic interventions. For many people with the disease, adding weight control, dietary interventions, exercise, stress reduction, and social support to their initial therapy has not only improved the quality of their lives but also reduced the risk of recurrence. A public health perspective widens the lens to look at breast cancer patterns in populations and offers additional insights into prevention and treatment. An ecological framework accommodates both individual and public health points-of-view and adds new science. It expands the ways we can study and address this disease. Finally, applying the ecological framework more widely to other complex disorders, including other kinds of cancer, diabetes, asthma, cardiovascular disease, learning disabilities, cognitive decline, and dementia, is likely to improve our understanding of their origins and point to better strategies for prevention and treatment. Changes in diet and the food system, the built environment, social environment, and reductions in hazardous chemical exposures designed to address breast cancer will help reduce the burden of many of these as well.