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4270) note that each normal cell in a person’s body may be exposed to as many as 50,000 DNA-damaging events each day, and that oxygen free radicals are a major source of DNA damage. that critical events in the origins of breast cancer can occur very early in life; the variety of pathways through which breast cancer risks may be shaped; and the potential significance of both the timing of exposures and the way combinations of factors determine the effect on risks for different types of breast cancer. (Based on November 2010 SEER data submission, posted to the SEER website, 2011.) (accessed June 1, 2011).
Komen for the Cure and its Scientific Advisory Board.
Komen for the Cure funds research on prevention, diagnosis, and treatment of breast cancer, and also provides educational information and support services for the public and health care providers.
Although more needs to be learned about both the mechanisms by which breast cancers arise and the array of factors that influence risk for them, much has been established.
Among the factors generally accepted as increasing women’s risk are older age, having a first child at an older age or never having a child, exposure to ionizing radiation, and use of certain forms of postmenopausal hormone therapy (HT).
Since the mid-1970s, when the National Cancer Institute (NCI) began compiling continuous cancer statistics, the annual incidence of invasive breast cancer rose from 105 cases per 100,000 women to 142 per 100,000 women in 1999 (NCI, 2011). In 2008, the incidence of breast cancer was 129 cases per 100,000 women.
Further reduction of the incidence of breast cancer is a high priority, but finding ways to achieve this is a challenge. As reflected in NCI data, the incidence in 2002 was 136 cases per 100,000 women, compared with 127 in 2003 (NCI, 2011). A portion of the decline in breast cancer incidence since 1999 is attributed to this reduced use of HT (e.g., Ravdin et al., 2007; Farhat et al., 2010). The committee includes a member from the patient advocacy community. The committee met in person five times from April 2010 through February 2011 and conducted additional deliberations by conference call. The Statement of Task for the IOM study appears in Box 1-1. The members of the study committee were selected to contribute expertise in epidemiology, toxicology, risk assessment, biostatistics, molecular carcinogenesis, gene–environment interactions, communication of health messages, environmental health science, exposure assessment, and health care. It is likely that many such procarcinogenic events may never be entirely preventable because, although potentially modifiable, they are consequences of basic biologic processes, such as oxidative damage to DNA from endogenous metabolism, or stimulation of cell growth through normal hormonal processes. The decrease in breast-cancer incidence in 2003 in the United States. Although such biological “background” mutagenesis is unavoidable, highly efficient protective pathways, such as DNA repair and immune surveillance, are effective at reducing the impacts of procarcinongenic events (Loeb and Nishimura, 2010; Bissell and Hines, 2011). This report presents the results of a study commissioned to review the current evidence on environmental risk factors for breast cancer, consider gene–environment interactions in breast cancer, explore evidence-based actions that might reduce the risk of breast cancer, and recommend research in these areas. STUDY CHARGE AND COMMITTEE ACTIVITIES This study resulted from a request to the Institute of Medicine (IOM) by Susan G.