Bisphenol-A or BPA - a substance that is used in food packaging such as in the epoxy lining of food cans and in polycarbonate bottles has been a subject of intense controversy and concern over the last few months.  On Nov 11, I wrote a post listing the specific canned and other foods that were of concern vis-a-vis BPA ingestion, and earlier in June this year, I wrote about the results of a Harvard study that confirmed the leaching of BPA from polycarbonate plastic bottles.   This month, additional research on BPA has brought to surface new and pressing health concerns regarding the ingestion of this chemical.

A recent study by the French National Institute of Agronomic Research (INRA) found that BPA caused a negative reaction in the intestine of rats - even at doses that were 1/10th of the  daily amount considered safe for humans.  Results from this study suggested that BPA lowered the permeability of the intestines and the immune system’s response to digestive inflammation, and that newborn rats exposed to BPA in the uterus and during feeding had a higher risk of developing severe intestinal inflammation in adulthood.  Previous studies on BPA have indicated that high levels of this chemical in the bloodstream are significantly associated with heart disease, diabetes, and abnormally elevated levels of certain liver enzymes, and furthermore, that BPA exposure during development has carcinogenic effects and produces precursors of breast cancer.

In light of the cumulative evidence indicating numerous concerns with BPA consumption, The National Institute of Environmental Health Sciences (NIEHS) and the National Toxicology Program have warned people – particularly pregnant women and children – not to consume BPA.  The NIEHS has also launched a $30 million research initiative to investigate the effects of BPA, and the United Nations will be holding a summit on BPA safety in 2010.

BISPHENOL-A AND YOUR HEALTH – WHAT YOU CAN DO NOW

Given the mounting evidence indicating that ingestion of BPA may lead to significant health problems, it appears prudent to minimize exposure to BPA via food packaging that utilizes this chemical.  While the US Food and Drug Administration has not yet issued the final word on BPA safety (It has postponed release of its final report), research does indicate that there is significant evidence and good reason to be concerned about BPA consumption.  For this reason, you should carefully review and act on the guidelines presented in previous posts (links above) to minimize BPA exposure.  Here are some key reminders:

1.  Review products that have been found to have high levels of BPA  and minimize or avoid their consumption altogether (These particularly include canned green beans, canned soups, and certain canned juice drinks).

2.  Choose fresh over canned or packaged foods whenever possible.

3.  Do not reheat food or drink in the microwave in plastic containers – Use only glass.

4.  Do not consume food or beverage from containers with the numbers 3 or 7  listed inside the recycle symbol on the container.

IN THE FINAL ANALYSIS…

….I feel both obliged and compelled (in my position as a research scientist, and by virtue of my experience is studying chronic diseases) to share with all that nearly everyday I meet people who “wonder” where their particular chronic disease “came from.”  While it is true that even with all the tools and knowledge at our disposal, we are sometimes unable to discern the ultimate cause(s) of certain diseases, I find that most of us do not begin to take full advantage of the facts we do know that can help us minimize the prospects of disease.  

In Medicine, we learn that, “A disturbed biochemistry is always the antecedent to observed pathology.”  In simple language, that statement simply means that before a disease fully manifests itself, there is almost always (that is, in most cases) a window of time in which we may be able to prevent the disease and/or alter its course.   Given that fact, I wonder how many of us truly take seriously the power that is vested in our own hands both to prevent and/or alter the course of a great many diseases.

Increasingly, in the US and the West, the list of environmental and other exposures that may have  a detrimental, and perhaps even a fatal effect on our health appears to be increasing.  BPA is yet another exposure against which evidence indicates serious caution may be warranted.  Notwithstanding that fact, I have been told that many are going to find it “impossible” to choose fresh green beans over canned, or to undergo the inconvenience of not warming foods in plastic ware.  This is just a friendly reminder to all that it can be exponentially more inconvenient to deal with disease when it occurs, especially in contrast to the “inconvenience” caused by taking the relatively simple steps that can be taken to avoid it.   The window of time to minimize the risk of disease in now; the power to do so is in our hands.  Let’s be sure to use it, and use it well.

October is Breast Cancer Awareness Month, and while it is critically important to raise awareness of breast cancer prevention in general; it is also a particularly important time for us ALL – whether we are physicians, research scientists, women, or men – to become acutely aware of a relatively rare, but all too often, poorly understood cancer known as Inflammatory Breast Cancer, or IBC.  

WHY TALK ABOUT IBC, IF IT IS INDEED RARE?

The answer of course, is simple.  First, every life matters, and education and awareness saves lives.  And, second, precisely because IBC is relatively rare (It accounts for 1 to 5% of all breast cancer cases in the US (1)), it is frequently not “caught” early by patients, and is further often misdiagnosed or even completely missed by physicians.  The delay caused in obtaining prompt and necessary treatment by the combination of these two factors is simply too costly, as this disease progresses rapidly and can become lethal in a very short period of time. 

GETTING THE FACTS

IBC is a type of breast cancer in which cancer cells block the lymph vessels in the skin of the breast.  This cancer is referred to as “Inflammatory” because the breast can look externally swollen, red or inflamed.  One of the main reasons why this cancer often goes undiagnosed is because women relate only the presence of a “lump” to breast cancer.  However, it is crucially important for all women (and even some physicians) to know that a breast lump is NOT a necessary pre-condition for breast cancer, and this is especially true in the case of IBC.  Generally, IBC tends to grow in “nests” or “sheets” rather than as a solid tumor.  Here are additional symptoms that are typical of IBC:

• An unexpected pink, red or dark colored area on the breast, usually accompanied with itching or discomfort.
• Swelling of the breast, often up to a cup size or more very rapidly.
• Thickening of breast tissue or ridges on the skin
• Retraction of the nipple
• Discharge from the nipple – may or may not be bloody
• Sharp or stabbing pains in the breast, or a perceptible ache in the breast area
• Breast may feel warm to touch
• Alteration in color or texture of the areola (area surrounding the nipple)
• Swollen lymph nodes under the arm or above the collar bone (or in BOTH places)

The median age at time of diagnosis of IBC is 56 years, relative to about 62 years for non-IBC breast cancer.

LEARNING MORE ABOUT IBC DIAGNOSIS

The presence of IBC is confirmed by clinical examination, usually a biopsy, mammogram, and ultrasound.  IBC is generally diagnosed as Stage IIIB or Stage IV breast cancer.  Stage IIIB refers to cancer that is locally advanced, and Stage IV refers to cancer that has metastasized to other organs of the body.  The resources provided at the bottom of this post are valuable for learning more on IBC Staging.

TREATMENT

IBC treatment generally consists of chemotherapy, surgery, radiation, and hormonal therapy.  Chemotherapy with anti-cancer drugs is generally the first line of treatment for most patients with IBC (It is often referred to as Neoadjuvant therapy).  Post-chemotherapy, patients may undergo surgery or radiation therapy to the chest wall.  Additionally, IBC patients may receive more treatments (such as additional chemo- or hormone-therapy) to help prevent cancer recurrence.   Hormonal therapy is generally geared to reduce the effects of the hormone estrogen that can promote cancer growth. 

IBC PROGNOSIS

As IBC is more likely to have metastasized (that is, spread to other parts of the body) at the time of diagnosis, relative to non-IBC cases (2), the 5-year survival rate for IBC patients is generally between 25 and 50%.   These figures are significantly lower than the survival rates for patients with non-IBC breast cancer.  However, as with all statistics, average survival figures cannot be applied to predicting the prognosis for any particular individual. 

CURRENT RESEARCH AND NEW TREATMENT PROSPECTS

IBC has only recently been recognized as a unique and genetically distinct form of breast cancer (3).  Recently, scientists from the The Cancer Institute at NYU Langone Medical Center identified a key gene—eIF4G1—that is over expressed in the majority of cases of IBC, allowing cells to form highly mobile clusters that are responsible for the rapid metastasis that makes IBC an effective killer.  It is anticipated that this finding will lead to the identification of new approaches, therapies and a new class of drugs to target and treat IBC.  This may be a promising development as IBC generally responds poorly to chemotherapy, radiation, and other current treatments for breast cancer.

PREVENTING TRAGEDIES  & UNDERSTANDING THE CRITICALLY IMPORTANT ROLE OF EDUCATION AND AWARENESS

Perhaps the most unfortunate tragedy associated with IBC is that the absence of a typical “lump” in the breast causes this cancer to be frequently misdiagnosed and misclassified.  Due to the fact that IBC symptoms are often erroneously mistaken for an infection, physicians tend to prescribe antibiotics to patients – which results in unintentional, but a potentially fatal delay in treatment.  Due to the fact that IBC is an extremely aggressive cancer, it can often cause death within 18 to 24 months of diagnosis. 

WHAT YOU CAN DO:  EDUCATE YOURSELF AND OTHERS ABOUT IBC

Here are some simple action steps you can take to help increase awareness of IBC, and promote education about this deadly cancer:

1.  If this is the first time you have read or learnt about IBC, please recognize that there are numerous others for whom knowledge of this disease would be new as well.  Please pass on this post to ALL those it may benefit. 

2.  Utilize the selected important resource links at the end of this post to learn more about IBC.  Share these links with others as well.

3.  This post will be made available at The Prevention Revolution on Facebook.  If you have a question you may want to discuss or share an important comment, please join us on that site. 

4.  Finally, help us SAVE LIVES by joining the cause of  EDUCATION OF INFLAMMATORY BREAST CANCER.  Consider inviting your friends and family to support this effort.

Together, we CAN and SHOULD do more to stop this deadly killer. 

NOTES

1.  Merajver SD, Sabel MS. Inflammatory breast cancer. In: Harris JR, Lippman ME, Morrow M, Osborne CK, editors. Diseases of the Breast. 3^rd ed. Philadelphia: Lippincott Williams and Wilkins, 2004.

2.  Chittoor SR, Swain SM. Locally advanced breast cancer: Role of medical oncology. In: Bland KI, Copeland EM, editors. The Breast: Comprehensive Management of Benign and Malignant Diseases. Vol. 2. 2^nd ed. Philadelphia: W.B. Saunders Company, 1998.

3.  Key gene in deadly breast cancer identified (Science Daily – June 2009)

IBC RESOURCES

IBC Q & A – National Cancer Institute

IBC Research Foundation

Mayo Clinic Guide to IBC

MD Anderson IBC Page and Important Links

Information on IBC Clinical Trials - Click on Stage IIIB Clinical Trials

IBC – Clinical progress and the main problems that must be addressed (Full Text Access)

The IBC Foundation

The IBC Support Mailing List Site