By Roger Segelken
"Why is this happening to me?" is frequently the breast cancer victim's first question. Then, "What will this mean for my daughters? Does breast cancer run in our family? Have we been exposed to some carcinogen?"
According to two alumnae who approach the breast cancer problem from different directions, the most frustrating question often is: "How do I make sense of all the conflicting information about the causes of breast cancer?"
Ruby T. Senie, a 1957 graduate of the College of Human Ecology, and Suzanne M. Snedeker, a 1978 HumEc graduate, are trying to help people concerned with breast cancer the medical community as well as the general public make sense of it all.
Senie, an associate professor of clinical public health at Cornell University Medical College and associate attending epidemiologist with the Breast Service of Memorial Sloan-Kettering Cancer Center, is focusing on research and communicating findings to the public. She is an epidemiologist involved with the Long Island Breast Cancer Study Project, which is addressing concerns of some citizens who fear that chemical pesticides in the environment are responsible for "clusters" of breast cancer in that suburban area. She also is developing the Metropolitan New York Registry of Breast Cancer Families, while working on two epidemiological research questions: Does subsequent pregnancy influence breast cancer survival? And can soy dietary supplements reduce menopausal symptoms in women at increased risk of breast cancer?
Snedeker, an adjunct assistant professor of toxicology in the Institute of Comparative and Environmental Toxicology at Cornell's Center for the Environment, is a project leader of the new Program on Breast Cancer and Environmental Risk Factors in New York State. That project, based in the Institute for Comparative and Environmental Toxicology at Cornell, is compiling critical evaluations of the scientific literature on the relationship between environmental factors such as pesticides and dietary factors and breast cancer risk.
"When I was young, polio was the greatest fear," Senie said. "Today many women have a similar fear of breast cancer, but there's a difference: We are not even close to having a vaccine for breast cancer or any means of prevention. I spend much of my time teaching people about how research is done and about the limitations of most studies."
Senie, who also holds a nursing degree from the Cornell University-New York Hospital School of Nursing, a master's degree in nursing education from Columbia University Teachers College and a doctorate in epidemiology and public health from Yale University School of Medicine, returned to Memorial Sloan-Kettering in 1992 after serving as senior epidemiologist in the women's reproductive health division of the Centers for Disease Control in Atlanta. Her Metropolitan New York Registry of Breast Cancer Families, supported by a $5.6 million grant from the National Cancer Institute, is one of only six such registries in the world.
"Women ask why they can't volunteer for breast cancer case-control studies, but those studies wouldn't be scientifically valid if women self-selected to participate," Senie noted. "However, families are invited to participate in the registry. Volunteers will be asked to provide biologic specimens and exposure information, and relatives from several generations will be asked to join."
The family registry will help medical science understand the link between inheritance and environmental exposures in breast cancer risk, Senie said. Other family-related patterns may also be identified. Some of those patterns are environmental, such as exposures in the home or community and diet during childhood. Other suspected risk factors, including cyclical hormone levels and obesity, may contribute to breast cancer in families, while some risk factors may be cultural, such as age at first birth.
Perhaps because there's little we can do about the genes we inherit, people direct their energy to environmental risk factors, said Senie, whose family will be included in the registry. She grew up on Long Island, in a family with a history of breast cancer and understands Long Island women who worry about chemicals that make the lawns and golf courses so lush, green and disease-free.
"It's true, the rate of breast cancer mortality is high on Long Island, and we don't know why," Senie said. "Women of Long Island feel they are sitting on dynamite. But they are not alone."
Just how not-alone women with breast cancer are and what's being done about it can be appreciated through the information resources that Snedeker's program is developing. Data, such as the county-by-county incidence of breast cancer in New York state, were not easily accessible to the general public until the Program on Breast Cancer and Environmental Risk Factors (BCERF) began.
To reach the widest possible constituency, information in the environmental risk factor database will be posted on a World Wide Web site http://www.cfe.cornell.edu/bcerf/ and the program also plans publications and educational presentations.
"For consumers, it is often very difficult to get good, sound, science-based information on the role of environmental risk factors and breast cancer," Snedeker said. "To address this important need, our database will evaluate the most recent scientific data on this subject and translate the data into usable information." Certain pesticides and dietary factors will be the first to be evaluated for the database, she noted.
Advocacy groups, consumers, public-policy makers, legislators and those in the public-health field make up the audience for the database, which is translated to understandable language. A more technical version will be available to scientists.
After Cornell, Snedeker earned a Ph.D. in nutrition at the University of Wisconsin and completed post-doctoral training in reproductive toxicology and mammary gland biology at the National Institute of Environmental Health Sciences. Before joining the BCERF program in 1995, she served as project officer in the National Toxicology Program's Reproductive Toxicology Group, designing studies to evaluate the effects of long-term exposure to environmental estrogens on reproduction and development of breast cancer and other cancers.
The results of studies like the ones that Senie and others are conducting across the United States and around the world will be available with help interpreting them on the BCERF data base, Snedeker said. "Some of these studies appear to be equivocal and even contradictory," she warned. "It's up to us to help the public understand what the results mean and even what some of the contradictions tell us."