We're delighted to welcome Dr. Polly Hoppin today. Dr. Hoppin is the Alleen O'Brien Graef speaker. Dr. Hoppin is a Research Professor of Public Health in the Department of Public Health, and Program Director of Environmental Health at the UMass Lowell Center for Sustainable Production. Her current work focuses on advancing the primary prevention of chronic disease via the design and implementation of multi-environmental initiatives. Greetings. My name is Polly Hoppin. I'm a Professor of Public Health at the University of Massachusetts, Lowell. I'm also a mother of two daughters who are in their 20s, and I'm married to a wonderful human being who might not have lived to see those daughters grow up, because he was diagnosed with metastatic cancer at the age of 34. But he did make it, thanks to amazing research on curing cancer, which is one important part of the puzzle, and not the one we're going to focus on today. My colleagues at the Lowell Center for Sustainable Production also have had direct experience with cancer: a 14-year-old niece who lost her life to thyroid cancer, a best friend who passed from lymphoma, others who've survived breast cancer. So it's personal for us, and this is not an unusual thing. I'm sure that it's true for many of you that in your professional cohorts, you have many of these same kinds of stories. But it's one reason why I'm so grateful to Bill Couzens and to the Board of Less Cancer and to all allies behind the scenes for having put Cancer Prevention Day together and for working hard all year to promote attention to what can be done to prevent cancer before it happens. I'm also really honored to be remembering today, Alleen O'Brien who was a member of the Less Cancer family and who passed of breast cancer. My field is environmental health, and in particular environmental chemicals. My colleagues and I study, we do research, we do strategic convenings to look at working conditions, living conditions, where people play, and how those impact their health; in particular, how that increases their cancer risk. The prescriptions we write are not for pharmaceuticals, they're for investments in research and they're for changes in public policy to test chemicals before they're put on the market for their carcinogenicity, before they're put into our shampoos, into our couches. They're for regulations to be enforced for air or water pollution. We educate legislators about incentives that can motivate businesses to design their products in different ways, so that carcinogens do not have to be part of the production process. These kinds of interventions are not usually thought of as cancer prevention, because cancer prevention still largely focuses on the individual. There's precision prevention, which as you all know, tailors interventions to particular genetic risks. There's education by clinicians or by non-profits about nutrition, about exercise, about cutting smoking, and these things are all extremely important parts of cancer prevention. But what they don't address is the conditions that make it sometimes almost impossible to make healthy choices; the cultural, political, economic barriers that get in the way of people thriving. That focus, which is a focus on a system rather than on an individual, is in the DNA of our university and in the Lowell Center for Sustainable Production. We have faculty and staff with training and environmental health sciences, epidemiology, chemistry, engineering, and policy collaborate at the intersection of chronic disease and the environment. Working on the issue is the DNA of our university and also the city of Lowell. I'm going to turn now and show you some slides that will tell you more about this work that we're doing within our University, but also with partners beyond to change the system upstream to promote cancer prevention. If it weren't COVID, I would be talking to you from the Wannalancit Mills Building in Lowell, Massachusetts. This is a picture of the Mill Buildings in the 1800s, which are now our offices, and offices and many other organizations, as well as condos. You'll see in the background the Merrimack River, which falls 32 feet over one mile, which makes for dramatic rapids as you walk across the bridges between campuses, and also a history of using water power to drive the largest site of textile production in the country. Several of these buildings are now part of a national park which honors all of the contradictions of the Industrial Revolution, extraordinary innovation and also hardship for the thousands of mostly young women who worked in the mills. During their 13-hour days, six days a week, these women breathed in particles of thread and cloth, working in sweltering temperatures in the summer. There's a fascinating history of strikes by these women and also of the development of the field of occupational health. These mills operated for 150 years with their power sources evolving and also the processes used to make textiles. In the early years, the millwork in Lowell was made possible by cotton produced by enslaved peoples, hundreds of miles to the south. After World War II, when chemical technologies used for war purposes needed to be repurposed, textile and then other manufacturing that sprang up in Lowell became dependent on highly hazardous chemicals. The injuries, the lung diseases, the psychological trauma that came with working in the mills, let alone with enslavement on cotton plantations, could not be addressed by individuals. These were systemic barriers to healthy environments that could only be addressed by systemic changes. Fast-forward to today and the core group of faculty and staff at the Lowell Center for Sustainable Production whose premise is that our systems of production and consumption are not only root causes of environmental and health problems, but also significant contributors to solutions. The primary message I have for you today is that changes to our systems of production and consumption will improve the environments where people work, live, and play. They are prescriptions for preventing cancers, and they should be top priorities for cancer research, for cancer charities, and for cancer advocates. Let's look at this opportunity for breast cancer. Here's a quote from an opinion piece published in Stat November by two renowned scientists, Margaret Kripke, a cancer researcher, now retired from MD Anderson Cancer Center and former president of the American Association for Cancer Research. Linda Birnbaum, who recently stepped down as the longtime director of the National Institute of Environmental Health Sciences. The NIH institute that focuses on the intersection between environment and health. They wrote, "Our government should take the steps it can to protect Americans from a public health crisis that is claiming thousands of lives. We aren't just talking about COVID-19 here. We're talking about breast cancer. This year alone in the US, an estimated 280,000 women and 2,600 men will be diagnosed with breast cancer and more than 42,000 women and 500 men will die from it. The majority of these individuals have no inherited risk or family history of the disease. Research has linked more than 200 commercial chemicals to the risk of developing breast cancer." They go on to say, and I'm paraphrasing now, "Ignoring the science on breast carcinogens puts all women at risk, but especially women of low-income and also of color who are disproportionately exposed to toxic chemicals and pollution. About the same time, I joined many others and signing a letter organized by Breast Cancer Action, this is on the right-hand side of the slide, to the National Cancer Institute, which details myriad sources of information on the potential for environmental chemical to contribute to breast cancer. The letter applauds NCI for supporting research in this area and also asks them to expand the information they provide on their website which the letter says currently under-represents the information on the topic. I can't overstate the influence of mass major cancer institutions in shaping not only the understanding of science among health professionals in the public, but also in shaping the dominant narratives about cancer prevention. I'll come back to this later. I'll give you one example of some of the innovative research going on to better understand the role of environmental chemicals in breast cancer. This is Barbara Cone, who's been leading phenomenal research on the multi-generational impacts of DDT, a pesticide used in World War II to kill mosquitoes that carry malaria or typhus and then repurposed for agriculture like in apple orchard in Washington State, pictured here, where four sisters who grew up who remember riding their bikes and being doused with DDT by a neighbor spraying his orchards. Dr. Cohn and researchers before her have worked with blood samples frozen from the 1950s testing them for levels of DDT and then following up to see if the women and their daughters did or did not develop breast cancer. In an earlier study, Dr. Cohn concluded that women exposed to DDT were five times more likely to develop breast cancer than those not exposed. The study cited here concluded that the daughters exposed in utero were almost four times more likely than controls to develop breast cancer. Dr. Cohn is now working with the third generation of women, the granddaughters of the women whose samples were frozen in the 1950s. Like the sisters who grew up in the Apple business in Washington state, here's another group of women concerned about the role of chemicals in their breast cancer. This is Janine Nicholson of the San Francisco Fire Department, who along with many of her colleagues are concerned that their work environment is contributing to elevated rates of breast cancer. San Francisco has more women on its firefighting force than any department in the country; approximately 16 percent of its firefighters are women. Of that number, 15 percent of female firefighters between the ages of 40 and 50 have been diagnosed with breast cancer, which is six times the national average. Colleagues at Silent Spring Institute, the University of California, Berkeley, the University of San Francisco, and others are monitoring exposures and have found that San Francisco Women firefighters are exposed to higher levels of certain toxic PFAS chemicals compared to women working in San Francisco offices. This class of chemicals is called "forever chemicals" because they persist in the environment and in our bodies, and they'd been linked to various cancers. They interfere with immune and endocrine function as well as breast development. One purpose of PFAS is waterproofing, and they are a primary ingredient in firefighting here as well as in firefighting foam. They and hundreds of other toxic chemicals are in furniture, building materials, particle board, all the things that in the tragic event of a fire would go up in flames. In both of these cases, the chemicals these women were exposed to were not the only factors that elevated their risk. A recent exhaustive review of the scientific literature on breast cancer has identified 23 contributing factors, some of which increased risk for breast cancer and some of which are associated with lower risk. You can see that toxic chemicals show up in several categories here; chemicals in consumer products, occupation, place-based chemicals. But the categories of risk factors also include factors more familiar to people working on cancer prevention: alcohol, physical activity, breastfeeding. Here's another way of looking at it. These are risk factors here in the great pyramid that we can't do anything about. They're handed to us as we're born. There's other risk factors that increase the risk of breast cancer, like shift work, that are potentially preventable. There are also factors that contribute to our resilience that are actually associated with lower risk, like strong social network. Stress, higher risk. Alcohol, tobacco avoidance, resilience in lower risk. Weak workplace protections, higher risk. Exercise and healthy diet, lower risk. Unregulated chemicals, higher risk. Just as there are factors that are to keep us healthy and resilient and others that increase our risk, some of these factors can be controlled by the individual and some cannot. Some involve both individual action and systemic change. For toxic chemicals, though there is only so much than an individual can do. About 80,000 chemicals are used throughout our economy with about 1,500 new ones added each year. You'd think that they would be tested for safety before they're allowed to be put on the market, but that is not the case in the US. For those that are regulated, like air pollution, you would expect that those regulations would be enforced. That is, unfortunately, not the case in many places across the country. You would hope that companies would need to account for the costs that toxic chemicals inflict on people in the environment so that there would be incentives for them to design products differently. Also, not the case. Firefighters can be trained to use respirators and wear protective gear, and that helps, but as long as there are highly hazardous chemicals in everything that burns, firefighters will be at risk. People in Pittsburgh or St. John the Baptist Parish in Louisiana can keep their kids inside on a bad air quality day, but when this happen multiple times a year and outdoor air penetrates and then persists indoors, their exposure to air pollution comprised of carcinogens is high. Many neighborhoods that suffer disproportionate amounts of air pollution also have poor water quality, which may contain carcinogens, crumbling schools, and other risk factors. Reducing exposures to toxic chemicals and finding long-term solutions requires change across a whole system. It's a system that's been stuck; stuck in using highly hazardous chemicals to produce goods that society demands, and stuck in paying more than any other Western nation to treat people who get sick as a result of unhealthy living and working conditions. A system that continues to cycle over and over again contributing to the rising rates of cancer that I've talked about. This feels like a daunting problem, and it is. But we are innovators in the US. We have a long history of social movements like the ones that the women in the textile mills helped to make happen. So five years ago, the Lowell Center invited other organizations to join us in mapping and analyzing this system and understanding the dynamics that keep it stuck, and in finding opportunities to shift those dynamics to catalyze change at the scale needed. We imagine going into a Home Depot and not having to read labels to find a paint thinner that is moderately rather than highly hazardous, but instead to be assured that no paint thinner sold there carries a risk of cancer. We imagine developing new housing for under-resourced communities or a new cancer center that are not located near polluting smokestacks, and the used building materials that are healthy for workers and building occupants. We imagine children growing up near apple orchards free of chemicals so that they don't develop breast cancer as women. We imagine not having to worry that our mother's exposure to pesticides increases our daughters risk of breast cancer. There were many insights that we gained as we studied the system, and I'll give you one example here. The system stay stuck because of feedback loops, and here's one. On the left-hand side, I've just mentioned that regulation is weak in this country, the US chemicals policy does not require testing before marketing. So that results in, at the top of the circular arrows here, minimal understanding of health impacts. Industry discredits the small scientific body of evidence that does exist and opposes regulation. At the same time, there are scientific norms which seek false certainty and conclusions about risks. Scientists tend to adopt a narrative of something being either a small problem or that there's no certainty, that there's no full-proof and that narrative is put out into the general public rather than a scientists saying, we don't have proof of safety and therefore it makes sense to be precautionary. As a result of that dominant narrative, the public becomes confused. They accept health problems as inevitable. They, therefore, throw up their hands in despair and don't advocate for stronger regulation, which results in regulation remaining weak and there, the cycle continues. Here's another feedback loop, but this one is driving in the right direction and we just need to strengthen it. We have some evidence on health impacts of toxic chemicals, which I've talked about today, and we also have evidence about the availability of safer alternatives. If both of those were increased, that would motivate consumers, state governments, retailers to reduce toxics because they would be concerned about harm and excited about opportunity. That in turn would incentivize more development of less hazardous products and safer jobs, because people would realize that it was possible and consumers wanted it, which in turn would provide examples and motivation for more investment, which in turn would strengthen the evidence on the health impacts and on the availability of safer alternatives and their positive impact on cancer prevention. Armed with a deep understanding of the system, the dynamics like these that I just showed you. Also, sectors and institutions that are involved, economic and social trends that are themselves making change in the system, all of that was part of our systems analysis. We formed a collaborative initiative to pursue those changes called the Cancer Free Economy Network. Over 50 organizations are now working together on a series of projects towards this goal, which we develop together within one generation to reduce the burden of cancer and other diseases by driving a dramatic and equitable transition away from toxic chemicals and towards safer alternatives. The word equitable is central for the Cancer Free Economy Network. This goal seeks to eliminate the unfair disparities and exposures to toxic chemicals where under-resourced communities and particular populations are disproportionately exposed to carcinogens because of where they live or work and because of policies and systems that explicitly allow that. The word equitable also refers to the importance of attending to the job security of people currently employed in high-hazard industries. In making a transition to a cancer-free economy, a priority needs to be eliminating these inequitable exposures and also ensuring healthy and well-paying jobs for all. In addition to the [inaudible] members of the Cancer Free Economy Network include organizations like Breast Cancer Prevention Partners, Women for a Healthy Environment, Alliance of Nurses for Healthy Environment, Silent Spring Institute, Bladder Cancer Advocacy Network, the National Medical Association, Latinas Contra Cancer, Wind of the Spirit, Clean Production Action, Children's Environmental Health Network, American Sustainable Business Council, the National Institute of Environmental Health Sciences, and many others. The projects we're working on together are grouped under four headings, which you see in these peach-colored bubbles and also pulled out in the boxes. The projects themselves are in green, and the idea is that together, the green projects catalyze the shifts in the peach-colored level of bubble, which we can directly impact. But then in turn, though we can't directly impact them, the peach bubbles will impact changes shown in the gray and ultimately those in gold. One of those three systemic changes in gold is reduced toxics body burden. All along the way, the dynamics that I described earlier are shifting. The project work is helping to reinforce the feedback loops that are driving in the right direction towards an economy that doesn't depend on chemicals that make us sick and disrupting the feedback loops that are driving in the wrong direction. Just a quick example of a project. One is the Childhood Cancer Prevention Initiative; this would be at the blue-green level, there at the bottom. This initiative targets three categories of chemicals that are strongly tied to childhood cancers: pesticides, paints and solvents, and near roadway air pollution. These also are risk factors for other cancers, including breast cancer. Another project is to engage cancer organizations like the National Cancer Institute, the American Association of Cancer Research in advancing the science on the role of environmental chemicals in cancer and making that information available to health professionals and to the public. An example of the letter that I signed organized by Breast Cancer Action that would've been an activity under this project. The systems approach means that not only are these exciting projects in themselves but together they have the potential to catalyze change with the scale needed. We're not under an illusion that we alone can do this, but we do believe this is making a substantial contribution to cancer prevention. I want to close with an invitation and an encouragement to you to think about the various hats that you wear and to find creative ways to incorporate the issue of environmental chemicals into your cancer prevention activities. Just a couple quick ideas. If you have occasion to meet with your state, county, federal representatives, encourage them to add environmental chemicals to their list of priorities and specifically to promote business opportunity for safer materials, as well as enforcing current regulations. If you are asked by your local radio station to speak about whether you think that your neighbors' concerns about cancer being associated with water pollution are valid, find ways to acknowledge that causation is difficult to be sure about, but that it makes full sense to reduce exposures that we know are hazardous. If you donate to a cancer researcher or a cancer support organization, encourage them to add environmental chemicals and pollution to their agendas. Influence the statewide cancer plan. All states have a cancer plan that usually doesn't include attention to environment, or if it does, again, largely individual behavior changes rather than systemic changes that cancer plan could promote inter-agency collaboration and work with non-governmental partners to make major changes in the use and production of toxic chemicals in your region. There are many other ideas and colleagues of mine in the Cancer Free Economy Network we'd be delighted to partner with you on any of them and others that you may have, so please be in touch. If you have a chance to be in the Boston area, we would love to see you when COVID is in the rear-view mirror [inaudible] and you can take time to visit the National Park and the amazing mill history while you're there. Thanks again to Bill, to all of you for your kind attention.
