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Infectious Disease Declined in 1800s due to environmental improvements

Infectious Disease Declined in 1800s due to environmental improvements. Prior to introduction of vaccines Before widespread use of antibiotics Tied with cleaner development air and water safer workplaces and housing. What’s the environment got to do with women’s health?.

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Infectious Disease Declined in 1800s due to environmental improvements

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  1. Infectious Disease Declined in 1800s due to environmental improvements • Prior to introduction of vaccines • Before widespread use of antibiotics • Tied with cleaner development • air and water • safer workplaces and housing

  2. What’s the environment got to do with women’s health? • Unexplained patterns of breast, cervix cancer/endometriosis • Are evidence per se that ‘environmental’ agents are key

  3. Clues about “environment” and Women’s Health • Rates and patterns of premature sexual development, breast and cervix cancer and endometriosis are unexplained • Known causes are tied with hormonal alterations or genetic damage

  4. Change in U.S. Breast Cancer Incidence 1975-79, 1990-94 500 400 300 200 100 0 500 400 300 200 100 0 1990-94 White Black 1985-89 1985-89 1980-84 1990-94 1975-79 1980-84 1975-79 Incidence per 100,000 40 50 60 70 80 40 50 60 70 80 Age (years) Age (years)

  5. WHI Estrogen+Progesterone Trial Findings, July 2002 (avg 5.2 y)+new British data Risks +40% ovarian cancer Benefits +105% Dementia Fracture Reduction (Hip 23%) +24% CHD 39% Reduction Colorectal Cancer +31% Stroke +111% Pulmonary Emboli +24% Breast Cancer Threshold Level STOPPED Early, Clear Harm Stopped 3.3 yrs early Also: DVTs Judith Hsia, M.D. FDA testimony, Dec 2, 2004 JAMA. 2002;288:321-333

  6. Environmental Exposures can Act Like Hormones • Disrupt metabolism • Growth • Repair • Order

  7. Reasons why “environment” is a cause of cancer Fewer than 1 in 10 cases of breast cancer arises in women with germline mutations National Cancer Institute

  8. Clues about “environment” and disease • Cancer risk of adopted children mirrors that of their adoptive (NOT their biologic) parents • Fewer than half of identical twins get the same cancer • Migrants develop cancer risks of their new countries • Workers have higher rates • Racial and other patterns unexplained

  9. Identical twins don’t have identical chromosomal banding patterns Chromosome 1 Chromosome 3 3 year old twins Chromosome 12 Fraga, Mario F., et al. (2005) Proc Natl Acad Sci USA 102:10604-10609. Chromosome 17

  10. As identical twins age, their chromosomes look less similar Chromosome 1 Chromosome 3 Chromosome 12 50 year old twins Chromosome 17 Photo:Maryellen Mark, Ned & Fred Mitchell

  11. Cervix Cancer Patterns • Highest in U.S. Vietnamese women • Hispanics have higher rates than U.S. Blacks • Chinese have lowest rates in U.S. • Associated with Human Papilloma Virus, unprotected sex, passive and active smoking, agricultural and solvent exposures

  12. Patterns of Endometriosis • Prior to 1921, there were only twenty reports of the disease in the worldwide medical literature. • The National Institute of Child Health and Human Development estimates 10 to 20 percent of women of childbearing age are affected currently

  13. Suggested Environmental Causes of Endometriosis • 1993, Rier et al found that Rhesus monkeys with greatest dioxin exposure had greatest risk of endometriosis • The percentage of women with endometriosis reporting symptoms before the age of 15 has risen more than threefold since 1980s to nearly 4 out of every ten cases in 1998. 

  14. Premature sexual development* increased in African American girls • Development of breasts or pubic hair occurred • 37% and 51.5% in AA girls aged 7 and 8 respectively • 5.5% and 16% in Caucasian girls aged 7 and 8 respectively • Reason for racial disparities unknown Herman-Giddens ME, et al. (1997) Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings network. Pediatrics 99: 505-512. *adrenarche and thelarche

  15. Unexplained Toddler Breast Growth Davis DL, Tiwary C, Donovan MA, Axelrod D, and Sasco A. Redefining normal age of breast growth obscures potential environmental causes. Pediatrics 2007; 111(1).

  16. Differing Workplace Exposures For African Americans • 12.7% of the U.S. population • 20% of non-private household cleaning and building service occupations • 29% of textile pressing machine operators • 20% of laundering and dry-cleaning machine operators • 30% of bus drivers • 30% of barbers

  17. Differing Workplace Exposures • 1 in 8 Americans is African American • 1 in 5 African Americans works in household cleaning and building services, or laundering and dry-cleaning • 1 in 3 African Americans works as textile pressing machine operators, or as a bus driver, or barber

  18. Jobs with increased risk of cancer • Solvent workers • Chemists • Nurses/Dentists and Physicians • Painters • Hair Dressers

  19. New Environmental Findings • Sheep grazed for up to five years on a field treated with processed human sewage sludge that contains ambient levels of pesticides and synthetic estrogens . • Significant changes in mammary glands of pregnant ewes compared to those grazed on land treated with a standard fertilizer • Dr Paul Fowler, senior lecturer in reproductive physiology at Aberdeen University, 2007 • .

  20. New Dietary Findings • Post-menopausal women who ate large amounts (more than 103 grams) of processed meat a day RR. 1.64 • Effect evident with 57g of beef, pork or lamb a day British Journal Cancer, April, 2007, Jane Cade Leeds

  21. Unexplained Declines in the Births of Baby Boys • Since 1970, 135,000 fewer boys born than expected in the U.S. • 125,000 fewer in Japan • Father determines sex of baby Davis et al., Environmental Health Perspectives April, 2007.

  22. Center for Environmental Oncology Mission Statement • Provide a state-of-the-art, medical center-based, cross-disciplinary approach to identify controllable or avoidable causes of cancer linked with the environment • Create and assess interventions that inform, educate and change individual and institutional behaviors

  23. Goals • Hospital as model for healthy practices regarding toxins, energy, exercise and nutrition • Educate and train health professionals and communities regarding ‘healthy hospitals’ • Dynamic interactive analysis of public health, economic and other policy impacts of proposed interventions

  24. Chemical Waste Reduction Water and Energy Conservation Environmental Policy www.environmentaloncology.orgUPMC Greening Accomplishments

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