On October 26th, 2023 the Cape Cod Times published the following article written by Rasheek Tabassum Mujib.

October is the global breast cancer awareness month. Here’s what to know about Cape Cod.

In 1991, when Cheryl Osimo, a former elementary school teacher and a Barnstable resident, was diagnosed with breast cancer at an early age, she was determined to find out why she had gotten the disease so young. 

Osimo, now executive director of Massachusetts Breast Cancer Coalition, spends all her time raising awareness about the disease.

According to the National Cancer Institute, nearly 298,000 women in the United States will be diagnosed with breast cancer and more than 43,000 will die of the disease in 2023. One in eight women will develop breast cancer in their lifetime.

October is globally observed as the breast cancer awareness month. 

Massachusetts has a high incidence rate, but Cape Cod has an alarming rate

“Massachusetts as a whole has an incidence rate higher than the national average; the national incidence rate is 127 patients per 100,000 women, whereas in Massachusetts we’re at 136 patients,” said Dr. Jill Oxley, breast surgeon and director of Breast Care Services at Cape Cod Healthcare. 

According to the coalition, 1993 statewide data showed breast cancer incidence rates were significantly higher on Cape Cod than in the rest of Massachusetts. The rates have been relatively stable since then. 

According to the National Cancer Institute, and based on data from 2016 through 2020, Barnstable County has approximately 310 new breast cancer cases in females annually, regardless of age or race.

Rates of breast cancer in Barnstable County are 14% higher than Massachusetts and 22% higher than the U.S. average

Based on the most recent information from the National Cancer Institute, rates of breast cancer in Barnstable County are 14% higher than the rate in Massachusetts and 22% higher than the U.S. average, for the years 2016 to 2020. 

Researches indicate environmental links to higher rates 

The Silent Spring Institute, based in Newton, was founded in 1994 and focuses on environmental links to the disease. 

After its initial research, the Institute found that between 1982 and 1992, breast cancer incidence was 21% higher on Cape Cod than in the rest of Massachusetts, and women with greater exposure to pesticides suffered even higher rates.

“Our mission at Silent Spring is to identify how everyday chemical exposures can relate to breast cancer risk,” said Laurel Schaider, senior scientist at the Institute. “We’ve developed materials and tips to help people take steps in their everyday lives to reduce their exposures that could play a role in breast cancer.”

In July 2021, a study by the Institute showed that several hundred common chemicals, including pesticides, ingredients in consumer products, food additives, and drinking water contaminants, could increase the risk of breast cancer by causing cells in breast tissue to produce more of the hormones estrogen or progesterone.

In October 2022, from another study, scientists identified hundreds of chemicals, called endocrine disrupting chemicals, that disrupt or interfere with natural hormones. These endocrine-disrupting chemicals can alter the progression of mammary gland development, hampering breastfeeding, increase mammary tissue density, all of which can have an effect on developing cancer.

Since such chemicals are used in common products like hair dyes, food packaging, pesticides, and furniture, they can also end up in drinking water and accumulate in household dust, making people exposed to them unknowingly. 

“These findings have motivated our work to better understand the levels of water contaminants in public and private drinking water wells on Cape Cod,” said Schaider. “The EPA currently regulates around 90 contaminants in drinking water and there are a lot that aren’t regulated, so the groundwater on Cape Cod which is the source of drinking water for all residents is relatively vulnerable to contamination.”

“We also found weak evidence of links between increased breast cancer risk and having lived near cranberry bogs when DDT and other pesticides were used,” Schaider said. “Other studies have shown that exposures to DDT do increase a woman’s breast cancer risk.”

Scientists study effects of PFAS chemicals on cancer rates

A lot of the research work is currently focused on PFAS contamination. PFAS, or perfluoroalkyl and polyfluoroalkyl substances, are called “forever chemicals” because they do not break down.

The coalition is currently a community partner for three national projects; STEEP (Sources, Transport, Exposure, and Effects of PFASs) Superfund Research Center, PFAS-REACH (Research, Education, and Action for Community Health), and the third project is part of a larger multi-state study funded by the CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) on PFAS health effects.

The Multi-Site Study focus is to learn more about how PFAS chemicals can affect the health of adults and children. The data collection was done in Hyannis and Ayer, where nearly 700 adults and 100 children completed questionnaires, had clinic visits and provided blood samples. 

The STEEP Superfund Research Program, led by the University of Rhode Island, has been measuring PFAS levels in private wells on Cape Cod. 

“We have been working with the Mashpee Wampanoag Tribe to measure PFAS levels in local fish and shellfish, and are surveying members of the Tribe to learn more about their awareness of PFAS and their fish consumption patterns,” said Osimo, who also serves as the Cape Cod coordinator for Silent Spring Institute. 

“We also want to learn more about PFAS exposures in Hyannis other than drinking water, which is now being filtered to remove PFAS,” said Osimo. 

Still no definite answer to why Cape Cod has a higher rate

Even though so much research and studies have been conducted, there is no definitive answer to why Cape Cod has such a higher rate compared to the rest of the state. 

“We did not find a single environmental factor, sort of a smoking gun, that indicates to us that there’s one single factor about the Cape that makes the difference,” said Schaider. 

For Osimo, being a cancer survivor, it was imperative to find an answer to this burning question. 

“I thought that by this time decades later, I would have the answers to share with the community, along with my family members, but we don’t have an answer,” said Osimo. “I have more questions now about PFAS and other possible chemical links.”

According to Osimo, only 5% to 10% of all cancers are genetic and she strongly believes the changing environment has a strong role in that increase.

According to Schaider, another important finding is that it can be very difficult to evaluate the role of the environment with respect to breast cancer risk since exposures can happen during certain critical windows in a woman’s life, even in the womb, during early childhood, puberty and adulthood. 

Does Cape Cod have enough resources to deal with cancer patients?

“We have all the resources here on Cape Cod and I strongly believe anyone can get the absolute best care here on the Cape,” said Osimo. During her diagnosis, Osimo had done all her treatment procedures on the Cape. 

Cape Cod Hospital, Falmouth Hospital and the Cuda Breast Care Center in Hyannis, all part of Cape Cod Healthcare, have state of the art treatment facilities and equipment, said Oxley. 

The Cuda Women’s Imaging Center has a monthly support group for women within two years of a diagnosis of breast cancer. There are other support groups available through the cancer center, the American Cancer Society and Cape Wellness Collaborative. 

According to Oxley, once a patient has been diagnosed with breast cancer, there’s a support survivorship program that includes resources at the cancer center. 

A program called Living Fit for You by Cape Cod Seniors is a six-week program for cancer patients on Cape Cod and there is a breast cancer-specific program available as well.

What should Cape Codders do? 

Mammograms are the only tests that have been shown to decrease deaths from breast cancer and there are different guidelines available for screening, said Oxley.

A woman who has an average risk of developing breast cancer should have an annual screening mammograms starting at age 40 and continue as long as she is in good health,

Oxley suggests that every woman should have a risk assessment at age 25 and no later than age 30, especially women who are Black or have Jewish ancestry. 

For someone who is at increased risk of breast cancer or someone who wants to have a more in-person evaluation, there is a high risk clinic at the CUDA center in Hyannis, Oxley said. 

“For people who want to learn more about what they can do, I’d recommend our app from the Institute, which provides research-based tips for how people can reduce their exposure to chemicals of concern in their everyday lives,” said Schaider. 

Osimo also suggests that people should get more involved in public policy and other community engagement programs.