Breast Cancer and Personal Environmental Risk Factors
in Marin County- Pilot Study (PERFS)

Authors: Erdmann CA, Farren G, Baltzell K, Chew T, Clarkson C, Fleshman R, Leary C, Mizroch M, Orenstein F,
Russell ML, Souders-Mason V, Wrensch M
Institutions: Lawrence Berkeley National Laboratory
Marin Breast Cancer Watch
University of California, San Francisco
Funding: The Center for Disease Control through the Marin County Department of Health and Human Services

The goal of this community research collaboration was to develop methodologies and a questionnaire for a future population-based case-control study to investigate the role of selected environmental exposures in breast cancer development.

This pilot study focused on exposures that occurred during the ten-year period prior to a breast cancer diagnosis for cases and the last ten years for the control group, rather than historic exposures.

Exposure selection was based upon a combination of information derived from a comprehensive scientific literature review and levels of community concern.

Factors Selected for Detailed Study:

  • Alcohol use
  • Physical activity
  • Oral contraceptive use
  • Hormone replacement therapy use
  • Polycyclic aromatic hydrocarbons (PAH's are a group of chemicals that are formed during the incomplete burning of coal, oil, gas, wood, garbage, or other organic substances, such as tobacco and charbroiled meat.)
  • Light-at-night: an occupational risk factor associated with working the night shift

Community Input & Evaluation
Community members participated with academic researchers in all phases of the research. This included taking responsibility for extensive outreach and promotion for the first two methods of community input listed below. In addition to the distribution of approximately 4,000 flyers, community members promoted the invitation for community input by speaking on local radio and television broadcasts.

The intention was to:

  • Raise awareness about local breast cancer rates
  • Stimulate discussion among the community
  • Solicit information that could help guide the direction of current and future research

Community input was collected by:

  • Mail, email, telephone
  • Mapping workshops
  • An open-ended question included on the Adolescent Risk Factors Study (ARFS) that asked, "Do you have any ideas about what might cause breast cancer?"

Approximately, 336 unique concerns were expressed and compiled in a list of topics to be considered for current and future research. The research team organized these individual concerns into topical groupings as shown in Figure 1.

Most frequently mentioned concerns:

  • Pesticides (on hiking trails)
  • Water quality (chlorine, arsenic, asbestos in pipes, copper, degrading cement pipes)
  • Air contamination (Richmond oil refineries, vehicle emissions, Styrofoam factory in Corte Madera)
  • Hamilton Air Force Base

Although the majority of responses were in categories of environmental contamination, also mentioned were:

  • Stress
  • Personal care products
  • Diet
  • Medicines
  • Hormone replacement therapy
  • Genetics

There were many accomplishments during the course of the year and with the completion of this pilot study:

  • A questionnaire was developed
  • Nipple aspirate fluid (NAF) protocol was amended several times to improve successful collection within a field setting
  • Community mapping workshops were done with an enthusiastic community group
  • Community input was summarized
  • Interviews were conducted to pilot test the questionnaire
  • NAF specimens were analyzed
  • Articles were located and ideas shared
  • Hypotheses for future studies were developed

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