Breasts (24 page)

CAMP LEJEUNE MAY BE A VERY TROUBLED SPOT, BUT IT’S HARDLY
unique. Now strongly suspected of causing human kidney cancer, TCE and PCE have been widely used both by the military and by many civilian industries. There are 130 military bases in the United States listed as National Priority sites under the Comprehensive Environmental Response, Compensation, and Liability Act, or the Superfund law. TCE alone has been detected in at least 852 Superfund sites across the United States, and the chemical is the most frequently detected organic solvent in groundwater. It is suspected of being present in 34 percent of the nation’s drinking water supplies. TCE has primarily been used as a degreaser, septic-system cleaner, and dry-cleaning agent. In the what-were-they-thinking annals, TCE was also once a pet food additive, coffee decaffeinating compound, wound disinfectant, and even an obstetrical anesthetic. The Food and Drug Administration banned these uses in 1977, but regulators did not formally limit TCE and PCE in drinking water until the late 1980s. In September 2011, the EPA formally reclassi
fied TCE from a “probable” to a “known” human carcinogen based on solid evidence linking it to kidney cancer and suggestive evidence of neurotoxicity, immunotoxicity, developmental toxicity, and endocrine effects.

PCE, sometimes called “perc,” is another chlorinated compound very similar to TCE. It is still used by most dry-cleaners, although the U.S. government is likely to stiffen regulations in the near future. Benzene, which is still a gasoline additive and smells vaguely sweet, was once used an aftershave. Now, according to Bradley Flohr, assistant director for policy, compensation, and pension services of the U.S. Department of Veteran Affairs, “we know for certain benzene is associated with acute myelocytic leukemia and other problems.”

Unfortunately, there’s more bad news: both TCE and PCE degrade into a potent toxic molecule, vinyl chloride. That too has been detected at some of the well sites. Vinyl chloride was one of the first chemicals ever designated a known human carcinogen by the U.S. National Toxicology Program and the International Agency for Research on Cancer.

But very little is known about what, if any, role these compounds play in breast cancer. Several studies have looked at breast cancers in both male and female workers exposed to these substances, but the results have been contradictory so far, and the study sizes have generally been very small. One recent European study found a doubled risk of male breast cancer in motor vehicle mechanics. “Petrol, organic petroleum solvents or polycyclic aromatic hydrocarbons are suspect,” it concluded. Vinyl chloride has been linked to breast cancer in workers making PVC plastic. Another study found a very moderately increased risk of breast cancer among aircraft maintenance workers exposed to TCE. Some studies found that dry-cleaning workers who are exposed to PCE
have a higher incidence of breast cancer, but other studies found a lower incidence.

A 1999 study looking at Danish women employed in other solvent-intensive industries found a doubled risk of breast cancer. Intriguingly, a set of studies looked at women on Cape Cod who had been unwittingly drinking public water laced with PCE from the lining in old pipes. Researcher Ann Aschengrau, an epidemiologist at Boston University’s School of Public Health, found that the women exposed to the highest levels of PCE had a 60 percent greater risk of breast cancer than those who were less exposed.

Aschengrau points out that both TCE and PCE are fat-loving compounds known to accumulate in breast tissue at high concentrations. It’s possible that special enzymes in breast tissue, notably in the ducts, might prevent the chemicals from breaking down. Once they’re sitting there, they could plausibly damage DNA in rapidly dividing breast tissue. As we saw in chapter 3, men have breast tissue also, and some men have more than others.

Just as it may seem ironic to have men lead the way down this particular path in breast cancer research, it is now the U.S. military—long resistant to notions of environmental health—that stands poised to become a pioneer, albeit a reluctant one, of environmental medicine. Of course, the armed forces have a long history of making its uniformed ranks sick. There was ionizing radiation from the Second World War through the cold war, Agent Orange during Vietnam, and, most recently, burn pits spewing dioxin and other compounds in the Iraqi outback. If you look at the increasing compensation claims being paid out to former Lejeune residents, it appears that TCE, PCE, and benzene will soon join the list of culprits. Every step of the way, Congress had to prod the Department of Defense to study the sicknesses and offer fair redress.

For the VA doctors, it continues to be an education. Terry Walters, director of the Environmental Agents Service at the Veterans Administration, came to the Wilmington meeting and spoke with me during a break about the challenges to her agency. “Exposure issues aren’t taught in med schools,” she said. “But for physicians within the VA, that should be our stock and trade. We should be experts in this. Getting that education out to Podunk or wherever is a big, big challenge. It’s not as mainstream as diabetes or cardiovascular disease. But every primary-care doctor should understand, if not specific information about benzene or TCE, then where to go to ask questions. My hope is that when a veteran comes in and says, ‘I was exposed to benzene,’ he or she won’t get a deer-in-the-headlights look from the doctor.”

HOW LIKELY IS IT THAT MANY OF OUR FRIENDS’ OR RELATIVES’
breast cancers are caused by an environmental agent? It’s virtually impossible to say. The American Cancer Society attributes only 2 to 6 percent of all cancers to chemical exposures, an estimate based partly on old and limited studies on occupational cancers. We learned about breast cancer and one environmental agent— radiation—from a large and unfortunate health experiment called the atomic bomb. For chemical exposures in a general population, though, confirmation is very difficult. We simply have too many mixed exposures over too long a time. “Epidemiology is what happens when you let all the rats out of the cages,” joked Frank Bove. There probably never will be a simple “smoking gun” in the search for causes of breast cancer in the general population. Our world and our genes are engaged in too complex a dalliance for that. After all, there are numerous types of breast cancer, dozens of cellular and
molecular pathways that can lead to them, and probably an untold number of factors, including genes, that can alter those pathways.

We do know that there are some hot spots for breast cancer near hazardous waste sites and industrial facilities. In Long Island, New York, Marin County, California, and Cape Cod, Massachusetts, breast cancer rates have risen faster than in the rest of the nation. These locales share a legacy of industrial, agricultural, and military pollution. But other factors are also higher there and confuse the picture: all are wealthy enclaves, where women have children later, take more hormone therapy, and drink more wine. No wonder the epidemiologists get their pants twisted up.

In the President’s Cancer Panel report released in April 2010, the authors stated that cancers caused by chemicals have been “grossly underestimated.” The authors of the two-hundred-page report took an unusually bold stance in urging better oversight of the chemical industry. Coauthor Margaret Kripke, an immunologist at the University of Texas MD Anderson Cancer Center, was once a skeptic on the topic of environmental disease. “I always assumed that before things were put on market, they would be tested,” said Kripke. “I learned that is not the case. I was so naive.”

Most of the major breast cancer organizations say there is no clear evidence that chemicals can cause breast cancer in humans. But in fact, there is little clear evidence that other things cause breast cancer, including the top favorites of obesity and smoking. If we look at all of the known red flags for breast cancer, such as reproductive and hormonal factors, family history, and radiation, they account for little over half of all breast cancers. Yet researchers have spent untold millions studying those things and very little studying chemicals. Perhaps it’s time, say many activists, to look deeper into chemical exposures, especially since damning evidence in ani
mals and in occupational studies is slowly mounting. The existing research is troubling enough that in 2010, the Susan G. Komen for the Cure foundation broke ranks to shell out $1.2 million to the National Academy of Sciences for a major review of the science on environmental exposures and breast cancer. The result: while chemical causes seem “plausible,” better science is needed.

“A lot of data do suggest chemicals cause tumors in mammalian systems,” ATSDR director Portier told me after the community meeting in North Carolina. He believes the environment, defined broadly to include smoking, nutrition, and chemical exposures, causes most cancers. “We have good studies now, for example with identical twins, that suggest the numbers could be as high as 75 percent, he said.

“There’s a growing body of animal evidence and sporadic human evidence that things we’re exposed to across a lifetime can cause breast cancer,” agreed Marion Kavanaugh-Lynch, director of the California Breast Cancer Research Program, which funds environmental studies with proceeds from the state’s cigarette tax. “If we can identify these chemicals now, we can more easily avoid them,” she said.

IT’S TOO LATE FOR NUMBER TWENTY-THREE ON PARTAIN’S
spreadsheet, who as an infant on the base attended a day-care center in the early 1980s that had been converted from a pesticide-mixing facility. (That was not one of our armed services’ smartest land-use decisions, even for its time.) He underwent a double mastectomy when he was eighteen years old. It’s too late for the handful of men Partain has found who are already dead. And it’s too late for Peter Devereaux, otherwise known as Number Seven. Pink is not a color he’d spent much time with. Camouflage, yes.

A native of Peabody, Massachusetts, Devereaux enlisted out of high school in 1980 and was stationed at Camp Lejeune until 1982. He was a field specialist in the Eighth Communications Battalion, and he lived in barracks that used drinking water from the Hadnot Point system. When he came home to Massachusetts after military maneuvers in the Philippines and Hawaii, he started working as a machinist. During the weekends, he pulled in extra income by landscaping, building patios, and moving heavy rocks and dirt around. He was also a serious athlete, running ultramarathons and boxing.

Now he can barely walk. Devereaux was so sick that he couldn’t attend the Wilmington meeting, so I called him afterward. He’s got a thick Boston accent. “In January 2008, I got breast cancer,” he told me on the phone from his home in North Andover. He was forty-five. “My hand had bumped into my chest in the morning. I figured I must have got elbowed playing hoop. Being a guy, you don’t even know about breast cancer. I never thought men could get it. But I told my wife, and she made me an appointment to see the doctor.” He was diagnosed with stage 3 breast cancer, meaning the cancer had spread to his lymph nodes.

Devereaux was dumbfounded.

“I felt like a freak. I got no breasts, how can this be? I’m a marine, I’m a bad ass, I work out all the time, I ate good, I exercised, stayed fit my whole life, never smoked or did drugs, and you try to figure out how can this have happened?” A month after Devereaux’s diagnosis, he received a letter in the mail from the U.S. Marine Corps at the behest of Congress. It stated that he might have been exposed to contaminated water while aboard Camp Lejeune, and it suggested that he and thousands of other marines register at a government website.

“When I got that letter in the mail, within one minute it made 100 percent sense to me that contaminated water was how
I got breast cancer,” he said. Devereaux found a website started by marines and their families, and soon he was in touch with six other men with breast cancer, including Partain. He agreed to speak out in newspapers and on TV in hopes of reaching more men who may have been exposed at Lejeune. “I gotta let others know, man. I wish they’d let us know twenty years ago, and it could have been a different result for me.”

Like many men with breast cancer, Devereaux was diagnosed at a late stage in the disease. His treatment included a mastectomy and the removal of twenty-two lymph nodes, followed by radiation and fourteen months of chemotherapy. “It beat the crap out of me,” he said. In 2009, though, he learned the cancer had spread to his spine, ribs, and hips. It was metastatic. “There’s no cure this time,” he said. Despite being a tough guy, he finds some comfort in the breast cancer community. “You go into all these pink buildings and places for your mammograms and appointments. You’re this dude and all these women are looking at you. I meet these women, and they’re so much more open and honest and easy to talk to about emotions. Guys, all we talk about are football, eating, farting, and girls. So [these women] really helped. I felt a burden lifted. I wanted to move forward. My goal now is to raise awareness.”

But being an expert in combat hasn’t hurt. Devereaux wanted to fight the Marine Corps for health-care benefits and help other sickened veterans get them too. Vets can only receive benefits if they have a condition related to their service. He’d been out for over twenty years. Finally, after a two-year argument, he became the second male veteran with breast cancer to convince the government that his cancer was as likely as not linked to the water at Camp Lejeune. To qualify for service-related illness benefits, veterans must prove that an environmental exposure had a 50 percent chance of
causing their problems. That may seem like a low bar, but of 3,400 total medical issues brought before the VA so far by former Lejeune residents, only 25 percent have been approved for benefits.

Not all the male breast cancer patients affiliated with Lejeune blame the base for their diagnosis. Take Bill Smith, a seventy-seven-year-old Floridian who was also treated for stage 3 breast cancer. I found him on the website set up by Ensminger and Partain. “I can’t say why I got this damned disease,” said Smith, who edited the base’s newspaper for two years in the late 1950s. “I lived a hard drinking, fun life. I worked the steel mills in Buffalo. I lived at Camp Lejeune. I don’t know where it came from. I can’t all of a sudden blame the Marine Corps. I don’t know and my doctors don’t know.”