Breast Cancer, Breast Disease, and Pesticides
Condition: Breast Cancer
MeSH terms: Breast Neoplasms; Breast Diseases
Study type: Observational

Summary: 
      This study will collect information on the height and weight of women who participated in a
      1998 study in Triana, Alabama, on the risk of breast cancer and benign breast disease in
      relation to environmental exposure to the pesticide DDT and similar chemicals. This
      additional information is needed to calculate the participants' body mass index (BMI), which
      is required for completing analysis of the data.

      The 1998 study-a collaborative effort of the National Cancer Institute, the Triana Area
      Medical Fund, and the College of Nursing at the University of Alabama at
      Huntsville-investigated possible effects of DDT and other compounds on the risk of breast
      cancer, predominantly among African-American women in the area of Triana, Alabama. The study
      was initiated as a result of medical findings showing high blood levels of DDT among the
      local population who had consumed fish from a tributary of the Tennessee River that had been
      polluted by the discharge over several decades of large quantities of pesticides from a DDT
      production plant.

      Women participating in the study had a mammogram, physical examination, breast examination,
      and blood draw, and completed a questionnaire on diet and lifestyle factors. In order to
      complete analysis of the data and determine whether there is an association between
      environmental exposure to DDT and related chemicals and breast cancer risk, additional
      information on BMI is required.
    

Detailed description: 
      A DDT production plant in Alabama discharged large quantities of the pesticide into the
      tributaries of the Tennessee River for several decades before it was discovered in the
      1970's. A survey found that local primarily African-American, populations consuming fish from
      the river had accumulated body burdens of the chemical that were orders of magnitude above
      the general population. The settlement of law suits involving 1000 named plaintiffs by the
      Federal District Court in Birmingham, AL led to the development of the Triana Area Medical
      Fun, Inc. This fund provides 'health care and monitoring' for named plaintiffs as well as
      other residents of Triana who, as of August 1983, had not asked the Court for damages. The
      Board managing the activities of the Fund has given approval for this project.

      The National Cancer Institute, in collaboration with the Triana Area Medical Fund and the
      College of Nursing at the University of Alabama in Huntsville, is conducting a study to
      investigate the possible effects of environmental exposures, such as the pesticide DDT and
      other organochlorines compounds, on the risk of breast cancer. Individuals covered by the
      Triana Area Medical Fund and other nearby residents were asked to participate.

      The objective is to evaluate the risk of breast cancer associated with organochlorines
      exposures among predominatly African-American women. This project is comprised of two major
      components (1) comparison of blood serum levels of DDT, DDE and other organochlorines
      compounds among members of the Triana Area Medical Fund population with a high percentage of
      mammographic densities to women without this condition and (2) methodologic investigations on
      organochlorines retention/decay patterns within the well-characterized Triana Area Fund
      population.

      The investigators offered mammographic screening to all women within the cohort over the age
      of 35 (about 350), as well as others who requested it. As a service to the participants, the
      investigators provided a standard clinical chemistry on blood samples and made the results
      available to the subject and their physician, if they so chose. If individuals did not have a
      regular physician, they were assisted in locating one to provide consultation and
      interpretation of examination results. Standard blood chemistries were performed locally in
      Alabama. The remainder of the blood sample was processed and sent to NCI for analysis and
      storage. Serum analyses were conducted by the National Center for Environmental Health at the
      CDC.

      Results of the mammography, clinical examination and blood chemistries were provided to the
      participants in a manner agreeable to each. If the subject wished, the results were sent to
      her private physician. They made arrangements with several local hospitals to provide
      follow-up evaluation and therapy for women with breast diseases uncovered by mammography who
      lacked health insurance. Nurse practitioners or physicians involved in the study were
      available to discuss and explain results. For women who required additional diagnostic
      evaluation or therapy, they developed a follow back procedure to make sure appropriate
      actions are being taken.

      Data collection is complete. Two hundred twenty eight women received mammograms, a physical
      examination, provided a serum sample (50 ml) and completed a questionnaire on diet and
      lifestyle factors. During the past year the investigators obtained information on height and
      weight, which is necessary to calculate body mass indices. Analyses of the data are underway
      and manuscripts are being developed.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        A primarily African-American population living in the vicinity of a DDT production plant in
        Alabama.
      
Keywords: Epidemiology; DDT; BMI; Serum; Case-Control Study