POEM FOR ELLIE
Just for you…a word or two…your image it keeps dancing through…my mind at times…I think of all the heartache you’ve been going through.
It really isn’t fair as such…so very few have done as much to dignify the human race… make this world a brighter place.
Ellie…you’re the Queen of Hearts…your selflessness and love imparts… the spirit of a better way…your smile is like an Autumn day…it warms the path of those you meet…it triumphs over life’s defeat.
Ellie…this is just to show…to prove to you that people know…the value of a precious stone.
Ellie…you are not alone!”
Poem for Ellie who died of breast cancer my first year of medical school — August 1976
A conundrum is a riddle. A confusing, difficult or resurfacing problem that challenges us to evolve our thinking. Breast cancer disparities by race and geographic location have posed a conundrum in the San Francisco Bay Area since 1995 when a statistically significant excess in invasive breast cancer cases was detected in women living in Bayview Hunters Point census tracts. Lead investigator Francis Taylor MD, MPH — Director of the Bureau of Epidemiology and Disease Control — said the reason for the high breast cancer rate “remains a puzzle.”
“The finding that Bayview women under the age of 50 contributed to a breast cancer incidence rate double that of San Francisco as a whole, was unexplainable. A total of 107 cases were detected. Only 83 cases were expected. Among African American women under 50 the number of cases detected was 28…only 13 were expected.”
Additionally, the Northern California Cancer Center had determined white women have the highest reported breast cancer rates in the world!
“The risk of radiogenic breast cancer appears to decrease with increasing age of exposure. These results suggest exposure of female breast tissue to ionizing radiation during the first four decades of life can induce breast cancer.” Incidence of female breast cancer among atomic bomb survivors — https://pubmed.ncbi.nlm.nih.gov/3685255/
A firm link between radiation exposure and breast cancer has been established in atomic bomb survivors, particularly women under the age of 20 when the bombs were dropped. The Atomic Bomb registry classifies breast cancer in women diagnosed in their 20’s and 30’s as radiogenic breast cancer. It is induced by exposure to ionizing radiation during late childhood or early teens when mitotic activity in breast tissue is awakened by puberty.
Based on a review of data from 1988 to 1992, Francis Taylor MD, MPH found women in BVHP census tracts under the age of 50 had double the cancer rates seen in San Francisco. This is a signature feature of a radiogenic breast cancer cluster. While Taylors findings were never published in peer reviewed journals, in 1997 Debbie Gillis MD compared cancer incidences in the Bay Area with San Francisco as a whole with Bayview Hunters Point using data derived from the Bureau of Epidemiology. Gillis confirmed Taylors findings.
“The Health Department conducted the study in response to pleas from the predominantly African American neighborhood. Many residents believe they’re victims of “environmental racism” suffering from cancer, asthma and diseases caused by industrial development no one else wanted.” Jane Kay — Examiner Environmental Writer August 18, 1995
Breast cancer incidence rates in San Francisco surpassed those in Japan and China in a 1982 study and were detected at a younger age. The National Cancer Institute analyzed new breast cancer cases by age and found across all races the average age at diagnosis was 62. In women aged 20–34 the percent of new cases was 1.9%. [https://emedicine.medscape.com/article/1697353]
“ I was convinced there was something there!”
The International Agency for Research on Cancer (ARC) and the National Toxicology Program (NTP) classify ionizing radiation as a known human carcinogen. Ionizing radiation has the energy to rip electrons from atoms and break chemical bonds in DNA molecules.
The 2006 National Academy of Sciences Biological Effects of Ionizing Radiation (BEIR VII) Report concludes the existing scientific evidence is consistent with the linear no-threshold model of radiation — induced cancers. According to this model, every fraction of ionizing radiation, no matter how small, constitutes an increased cancer risk…linear with dose. The LNT model forms the basis for current radiation regulation in Health Impacts of Low Dose Ionizing Radiation: Current Scientific Debate and Regulatory Issues.
The Greater Bay Area Cancer Registry is a population based registry under the National Cancer Institutes Surveillance, Epidemiology and End Results program. The nine participating counties operate under the California Department of Public Health Cancer Registry.
Patterns of breast cancer in the Bay Area — one of the highest breast cancer rates in the United States — were analyzed to identify patterns and inequities in defined populations.
According to Medscape, breast cancer is the most commonly diagnosed cancer among US women and the second leading cause of cancer deaths. Analyses reveals a higher age specific incidence of breast cancer among black women younger than age 40. Guan et al found patients in Bayview Hunters Point were more likely to have advanced Stage IIB breast cancer at diagnosis and more likely to be diagnosed with triple-negative breast cancers. African American women continue to experience the greatest disparities in breast cancer outcomes across the cities geographic regions.
After age 40, white women have higher breast cancer incidence rates. Data from 2017 shows higher death rates in black women with breast cancer in comparison to all racial and ethnic groups. According to SEER data from 1975–2000 incidence rates among black women younger than 50 increased by 22%.
Oppenheimer’s atomic bomb was picked up at the Hunters Point Naval Shipyard on July 15 1945 and dropped on Hiroshima August 6, 1945. One year later an estimated 100 target and support ships exposed to two 20 kiloton ‘Fat Man” plutonium bombs in Operations Crossroads nuclear weapons tests in the South Pacific were hauled back to the Hunters Point Naval Shipyard.
By 1975 women exposed to ionizing radiation were turning 30. Breast Cancer Epidemiology and Risk Factors: [https://emedicine.medscape.com/article/1697353-overview]
The Breast Cancer Necklace is the eponym HP Biomonitoring assigned to the unique pattern of breast cancer cases mapped in women living within the six block perimeter of the federal Superfund system. The cases roughly encircle the perimeter of the base — northeast to northwest, like a loose string of red pearls…or crime scene evidence!
In 2015, the California Council on Science and Technology reviewed existing scientific evidence and determined from a public health perspective, the most significant exposures to toxic air contaminants — including radioactive fugitive dust emissions — occur within one-half mile of an industrial operation. Based on its findings the Council recommended the state of California develop science-backed setback requirements to limit human exposures.
According to CDC guidelines a cancer cluster is defined as a greater than expected number of observed cases for a population similar in age, race or gender in a demographic region.
Equally important, the detection of anomalous patterns of disease within a cluster may aide in early identification of the source of chemical exposure. A Google search of circular cancer clusters conducted by HP Biomonitoring yields a circular cluster under investigation in Warwick, Rhode Island, a circular cluster under investigation in Delaware County, Pennsylvania and children diagnosed with cancer living a block apart in southern California downhill from the Santa Susana Field Laboratory in Los Angeles — site of a nuclear meltdown in 1959.
The semi-circular configuration of the Breast Cancer Necklace roughly outlines the perimeter of the base and fully incorporates the three geophysically contiguous Superfund sites. HPNS was placed on the National Priorities List as a Federal Superfund site in 1989 assigned an EPA Hazard Ranking Score of 80.
In 2012, a CERCLA Action was conducted on the Parcel E-2 Landfill that characterized it to contain radionuclides and PCB’s — both carcinogenic to humans. The Navy was fined $85,000. In 2016, Yosemite Slough was designated a Federal Superfund Site but was not listed on the NPL. Yosemite Slough courses westward toward the major transit center on 3rd Street and rests within four blocks of a “nest” of sensitive receptors that includes the Southeast Health Center — a Department of Public Health primary care satellite clinic.
In communities where circular cancer clusters are under investigation at the center of the cluster is a landfill or toxic dump!
The African American Breast Cancer Conference will be held on Sunday, October 1, 2023 at the Southeast Community Center located at 1400 Evans. Sponsored by Concerned Network of Women and organized by long time environmental health activist and expert Betty McGee to offer education on early detection of breast cancer in women of color.
HP Biomonitoring will present the theory the “Breast Cancer Necklace” encircling the six block perimeter of the naval base is a radiogenic cancer cluster induced by exposure to ionizing radiation emanating from its contaminated properties.
The Hunters Point Naval Shipyard Breast Cancer Necklace meets Atomic Bomb Registry definitions of a radiogenic breast cancer cluster because it includes women diagnosed in their 20’s and 30’s and a woman who died prematurely in her fifties.
At the request of the Hunters Point Community Biomonitoring Program, the Greater Bay Area Cancer Registry is determining the expected versus observed incidences of cancer in Bayview Hunters Point census tracts based on 2020 census data.
Independent of the GBACR analysis the Breast Cancer Necklace includes cases with highly anomalous features that include:
- Women living a block to two blocks apart along 3rd Street from Oakdale to Armstrong.
- A woman living two blocks west of the Crisp Road main gate who underwent excision for breast cancer subsequently diagnosed with multiple brain tumors — her dog died of a radiation induced tumor called a sarcoma in 2021.
- A doctor living in the South Basin region who underwent excision of a pulmonary nodule and surgery for a pituitary tumor, subsequently diagnosed with bilateral tumors of different pathologies in her middle ears.
- The young mother of a two year old girl “Peaches” — who died of a rare childhood cancer in 2020- completed radiation therapy for breast cancer in 2021, signed a non disclosure agreement with the shipyards developer and moved to a new home, according to family members and witnesses.
- A woman living on Quesada Avenue six blocks west of the radiation contaminated Parcel E-2 landfill diagnosed with breast cancer at age 27. her father died of colon cancer in 2016 after being diagnosed with prostate cancer.
- A woman minister living in the heavily contaminated South Basin region diagnosed with breast cancer. Her husband — also a minister — has been diagnosed with prostate cancer.
- A minister of a church built by his father located one block west of the shipyards main gate diagnosed with two different brain primary tumors defying the 0.6% lifetime risk of developing one brain tumor.
- Radiogenic cancer clusters within the main cluster in work locations including SFPD Building 606 and UCSF Compound Building 830.
- A radiogenic cancer cluster easily defined along Quesada community gardens located six blocks west of the industrial landfill.
- A woman diagnosed with breast cancer, skin cancer and a rare tumor on her foot after undergoing biomonitoring screening that detected multiple radioactive and carcinogenic heavy metals.
“The analysis revealed that the proportion of breast cancer diagnoses varied greatly by geographic area and race or ethnicity. While African American patients represented 7.2% of breast cancer diagnoses overall, they represented 25.5% of the diagnoses in the southern areas, that is, Bayview Hunters Point. In addition, tumor subtype differed by geographic area. Geographical areas in the East and Southeast had moe diagnoses of triple-negative breast cancer — around 12% — compared with other areas which were about 8%. However, the highest concentration of triple-negative breast cancer — 20%- was found among black or African American patients.”
Triple negative breast cancer is the most predominant cancer in sub-Saharan Africa, 22 countries of the Americas and the Caribbean. It is one of the most significant racial disparities in oncology and higher rates were detected in African Americans across all geographic areas of San Francisco…including those in which the population of African Americans is low.
“We find that geographic areas with Superfund sites have elevated cancer risks and elevated proportions of minority populations.” State of the Evidence 2017 — Breast Cancer and the Environment
Breast cancer in Bayview Hunters Point is clearly multifactorial. In addition to genetic and lifestyle risk factors, environmental toxins are identified known to induce breast cancer. Environmental risk factors in proven by evidence based research to be linked to breast cancer documented to be present at the Hunters Point Naval Shipyard include:
A. Superfund proximity — In a spatial study of the location of Superfund sites and associated cancer risk, Amin, et al. examined geographical areas in the US where the number of Superfund sites is high and examined the association between cancer incidence and the number of Superfund sites in counties with high minority populations. The EPA ECHO mapping and Enforcement tool identifies 14 properties in BVHP meet State or Federal Superfund status.
B. Cigarette smoking — Irrefutably linked to increased breast cancer risk. “Women who are current smokers and have been smoking for more than 10 years appear to have about a 10% higher risk of breast cancer than women who have never smoked” according to the Susan G. Komen Foundation. [https://www.komen.org]
C. Particulate Exposure — Published on September 11, 2023 in the Journal of the National Cancer Institute — in a large U.S. prospective cohort of 15,870 breast cancer cases, a 10ug/m3 increase in PM 2.5 concentrations was significantly associated with an increased breast cancer incidence. The association was seen in estrogen receptor positive breast cancer with a hazard ratio of 1.10 and a 95% confidence interval greater than 1.
D. Benzene Exposure — The World Health Organization classifies the volatile organic compound Benzene to be a Class I Carcinogen. Benzene is a chemical solvent linked to leukemia and hematological cancers. Experimental studies demonstrate exposure to benzene can induce breast cancer. [https://www.ncbi.nlm.nih.gov]
E. Arsenic Exposure — The International Agency for Research on Cancer has classified arsenic and arsenic compounds as Class I human carcinogens. Findings suggest exposure to arsenic, even at low levels, is associated with an increased risk of breast cancer.
F. PCB Exposures — Polychlorinated biphenyls are proven carcinogens. There are PCB hotspots at the Hunters Point Naval Shipyard located along the western fence line near populated regions. Epidemiological data strongly supports an increased risk of breast cancer and exposure to DES, DDT and radiation.
G. Carcinogenic Heavy Metals — heavy metals are proven to induce breast cancer. High concentrations of iron, nickel, chomium, zinc, cadmium, mercury and lead have been detected in cancerous breast biopsies and were also found in higher concentrations in serum and urine obtained from women diagnosed with breast cancer than in healthy women. [Biol Trace Elem Res. 2006; 113:9–18]
“Too many women are so afraid of breast cancer that they endanger their lives.” First Lady Betty Ford — Remarks to the American Cancer Society November 7, 1975
“My illness turned out to have a very special purpose — helping save other lives, and I am grateful for what I was able to do.” Betty Ford
Gerald R. Ford Presidential Library and Museum — https://www.fordlibrarymuseum.gov/library/bbfspeeches/751107.asp
National Breast Cancer Awareness Month is an annual international health campaign spearheaded by First Lady Betty Ford who underwent radical masectomy on September 28, 1974. Ford was found to have four positive nodes but beat the odds as a cancer survivor. Betty Ford died in 2011 at the age of 93.
The Hunters Point Biomonitoring Foundation has been funded by grant awards by the David & Lucile Packard Foundation, Greenaction for Health & Environmental Justice, Black Citizen.org, CalEPA EJ Small Grant #G21-EJ-030, the Environmental Justice Defense Fund/Windward Fund and is a proud member of the 2021 Inaugural Cohort of the Justice40 Initiative. HP Biomonitoring benefits from support by its associates — Golden State MD, James Dahlgren Medical, the Marie Harrison Community Foundation and the San Francisco Bay View Newspaper.