Toxic Overload, Vogue magazine, October 2006
By Jancee Dunn

The reports made international headlines: Women in two of the country's wealthiest ZIP codes had some of the highest rates of breast cancer not only in the United States but in the world. The first account, in 2002, surfaced in Marin County, California, an area north of San Francisco that is almost ridiculously scenic, filled with outdoorsy-chic women who seem to glow with health as they shop organic and bicycle to the yoga studio, leaving the Prius in the driveway. A year later, news spread of a breast cancer cluster (an unusually high rate of disease in a small area) on New York's Upper East Side, an equally desirable, urban enclave.

Residents of both areas had the highest possible standards of living. So why, then, did Marin women have 199 cases of breast cancer per 100,000 women, compared with 144 per 100,000 in other areas of the country? "I thought, It's gorgeous; who would get sick here?" says Judi Shils, a former TV producer for ABC and a longtime Marin residents who "can't even count" the number of friends with cancer. Panicked, she kept wondering if there was something toxic in the air or water. Was it the nearby Styrofoam-cup factory or the quarry? At community meetings, government officials rattled off the standard explanation, that Marin women perfectly fit the demographic for high rates: White and well educated, they had fewer children and at a later age. And with access to the best medicine has to offer, they were screened for cancer more often, so they likely had a higher rate of diagnosis. Shils and her frightened neighbors were told that it wasn’t about where they lived but rather how they lived.

A slim brunette whose laid-back Left Coast wardrobe of Seven jeans and a flowing cotton tops contrasts with her mile-a-minute demeanor, Shils was skeptical. "This is a health epidemic," says Shills, whose smooth skin belies her 49 years. "Why wouldn’t you look for environmental correlatives?" She quickly formed the Marin Cancer Project, a grassroots organizations that in its four years of existence has galvanized a fleet of volunteers to conduct a yearly door-to-door cancer survey, a disease-mapping process that it is preparing to go national. They have also raised half a million dollars for programs and research (currently ongoing) after being dissatisfied by the lack of conclusive research, which included a 2003 report citing Marin's high alcohol consumption as the primary risk factor.

Shils has also turned her sharp eye on her own household, using what activists call the precautionary principle. "I'm really kind of a neurotic, organic person," Shils says in a staccato voice, which slows and catches only when she talks about her parents' recent deaths from cancer. "I figure the things you can control in your life, you have to. We're watching people die here every day." She swapped her chemical cleaning products for vinegar and water, and leaves her shoes at the door so they don't track in contaminants. She sleeps in organic cotton sheets, eats organic food, stopped using nail polish ("I only get shaping and buffing"), buys chemical-free toothpaste and deodorant, and has banished bleach-"I've given up on my whites ever really being white."

The scientific world hasn't mobilized at quite the same frenetic rate as Shils, but in the past few years there has been a decided shift in the direction of breast cancer research. Until recently, scientists focused on genetics and lifestyles factors such as age, weight, exercise, and alcohol disease, but according to the Breast Cancer Fund, they explain less than half the risk. A smattering of new studies has looked for a link between cancer and exposure to chemicals, both large-scale (pesticides on golf courses, jet0fuel emissions from airports) and small (deodorants, hair dye, plastics). A 2005 report by the International Journal of Cancer suggested a link between secondhand smoke and the disease in young women, while a 2002 study in the Journal of the National Cancer Institute refuted the widespread rumor that deodorants and antiperspirants cause breast cancer. And the groundbreaking Sister Study, a fourteen-year analysis of women who have a sister with breast cancer, is examining each sister's house dust for harmful substances.

Yet despite all the work, the pace is excruciatingly slow: there are reportedly 3,000 commonly used chemicals in the United States, nearly half of which have never been tested for their impact on our health. What has researchers particularly concerned are chemicals called endocrine disruptors, found in a wide array of household products, that when inhaled, ingested, or absorbed through the skin mimic estrogen in the body. Excess estrogen is thought to boost the risk of breast cancer because it stimulates cell division, so when a cancer cell multiplies out of control, estrogen speeds the process.

Even with the greater awareness of chemicals, it is still maddeningly difficult to pinpoint an enviro-culprit. "I think if it were as simple as the link to smoking and lung cancer, we might have found it already," says Dale Sandler, M.P.H., Ph.D., chief of epidemiology at the National Institute of Environmental Health Sciences. A mobile population makes it difficult to conduct long-term studies, and each woman's history is unique. Add to that the fact that instead of one definitive suspect, there are hundreds, and it's tough for researchers to know where to begin. In the past few months alone, various reports have tied the disease to soy products, chest X rays, silicone implants, and sleeping with the lights on (the National Cancer Institute discovered that exposure to nighttime light limits the body's production of melatonin, a natural cancer fighter.)

After a breast cancer cluster was found in Long Island in the nineties, speculation ranged from pesticides to power lines to jet-fuel emissions from local airports, but a $30 million study in 2003 uncovered no definitive cause. Long Island's advocacy groups contend that it focused only on a narrow list of contaminants; they continue to press for more research. Similarly, after the cluster was discovered on the Upper East Side three years ago, researchers and residents alike worried about the area's heavy concentration of hospitals. (When hospitals dispose of their biomedical waste, often through incineration, pollutants can find their way into air and water.) "There are so many that we jokingly call my district 'bedpan alley,'" says New York State Senator Liz Krueger, ushering me into her cluttered midtown office. A cheerful, high-octane woman with a brown bob haircut, she tells me to pardon the mess as she eases behind a desk piled two feet high. A press aide darts in with coffee and wonders where to place the cup. Finally he just hands it to her.

When the report came out, Krueger says, she fielded calls from panicked Upper East Side women. She petitioned the Environmental Protection Agency to install air-quality monitors outside hospitals, but in a 2003 letter, an EPA representative wrote that the city's monitoring network "is not designed for, or capable of, performing localized analysis."

"The EPA wasn't interested," she says. "It's a political entity, like everything else. Up until recently, we were the only country that didn't notice global warming was a problem." After hammering away, she helped broker a $500,000, two-year study at NYU, still in progress, which is examining hospital pollution as well as radiation from local power plants. "We have to be much more assertive about demanding that our government not put its head in the sand," says Krueger.

Studies are ongoing. Research is inconclusive. How, then, to know what is safe? I decide to consult some of the country's leading authorities on the disease and start by asking about the most infamous culprit: underwire bras. "There was a book called 'Dressed to Kill' that said underwire bras block the drainage of lymph because they're too tight," says Susan Love, M.D., whose endless resume includes associate professor of clinical surgery at UCLA School of Medicine and founder of the Breast Cancer Coalition. "A man wrote it. I think his necktie blocked the drainage to his brain." She is similarly sanguine about dry-cleaning fluid, dairy products, and cosmetics that contain parabens, a common preservative, explaining that research is too inconclusive. Another source that has been vilified, electromagnetic fields from appliances, does not alarm her, either, although she steers clear of unnecessary X rays. "Low-dose radiation increases risk," she says, "so if an X ray is ever suggested, I say, 'How is this going to change my care?' If it isn't, then I don't. If I have a cold, I don't get a chest X-ray."

As for Teflon, an oft-cited red flag because it's created with perfluorooctanic acid, otherwise known as PFOA and a known carcinogen in animals, Sandler is not overly worried. "I have some Teflon pans, but I threw out the ones that were flaking," she says, drawing the line at eating particles of the stuff. (Teflon's manufacturer, Dupont, is voluntarily phasing out PFOA by 2015.)

Janet Gray, Ph.D., a biopsychologist at Vassar, eats soy products but avoids supplements known as genistein pills. "Some studies suggest megadoses of soy, especially taken postmenopausally, may be harmful," she says. She also shuns phthalates, a class of chemicals found in plastic bottles, food-storage bags, and plastic wrap. Numerous reports show that when plastic food-storage containers are heated, dangerous chemicals leach out, so Gray never microwaves food in plastic containers or with plastic wrap. "And do not drink out of plastic bottles if they've been in the sun," Gray adds. "If it smells 'plasticky,' it probably means plasticizers, including possibly phthalates, are leaching into the water."

The experts are quick to point out that all of this advice must be taken with equanimity: exposure to nail polish is more worrisome for your manicurist than for you. Barbara Brenner, executive director of the grassroots organization Breast Cancer Action, contracted the disease thirteen years ago and understands "the need to grab on to something. I think that women fear breast cancer more than any other disease, even though they're more likely to die of heart disease," she says. "I have never met - and I put myself in this category - people who are more control freaks than people who have lost control of their health."

After Julia Chiappetta. A stunner with a runner's taut body who looks decades younger than 52, learned she had breast cancer eight years ago (she is now cancer-free), she completely overhauled her life. She quit her high-stress job, became a vegan, and typhooned through her house as Shils had done, tossing out her microwave, makeup, cleaning solutions, and Teflon-coated cooking utensils. "Why take chances?" she says. "Why wait for research that could take years?"

In the meantime, do not make yourself crazy. "Don't feel like if you leave an appliance plugged in, you're doomed," says Love. "Watch your diet. Exercise regularly. Lobby for a better environment. Be prudent, but live your life and enjoy it. Just think how stressed out you get running around and unplugging everything."