Preventing cancer

Jeanne Rizzo must have the patience of a saint. Day after day, year after year, she prods lawmakers and industry leaders to take the obvious steps toward preventing breast cancer. When they refuse one day, she tries again the next. And bit by bit, she begins to get the obvious done.

Rizzo is executive director of the San Francisco-based Breast Cancer Fund, the only national nonprofit focusing solely on eliminating the preventable causes of breast cancer. It’s a job that would drive an ordinary person mad, as, most of the time, lawmakers and industry leaders continue to deny the obvious. Does anyone think it’s acceptable that women have flame retardants in their breast milk? Can there be any justification for not banning known carcinogens that show up in our blood and fatty tissue? Yet, apparently, such things need to be explained.

So every year or so, BCF publishes a report with a detailed explanation, “State of the Evidence: What is the Connection Between the Environment and Breast Cancer?” BCF also lobbies for removing toxins from cosmetics and promotes the “precautionary principle"—the idea that if a product appears to be harmful, it should be proven safe before we’re exposed to it.

Rizzo took the reins of BCF after the death of her close friend Andrea Martin, the organization’s indomitable former executive director. Martin founded BCF after surviving two rounds of breast cancer. The two women began working together in 1997, when Rizzo was doing music, film and theater production, and Martin asked her to produce a benefit for BCF. Rizzo wound up putting a BCF fund-raising tent on tour with the Lilith Fair for two years. She also used her music connections to persuade Mary Chapin Carpenter, the Indigo Girls and k.d. lang to donate songs for a BCF documentary.

Rizzo’s first career was psychiatric nursing. Originally from New York, she came west in 1971 to work as head nurse at Marin, Calif., General Hospital’s inpatient psych unit and stayed on for three years. Always a big jazz fan, she and her then-husband missed the Big Apple’s vibrant music scene, so they imported some of it to San Francisco. They opened the Great American Music Hall in ‘72, and Rizzo ran it for 20 years. When she first started working with the Breast Cancer Fund, she had her own production company and was managing artists like Sweet Honey in the Rock.

She took on a more administrative role at BCF in 2001, when Andrea Martin developed a brain tumor. Rizzo became one of Martin’s primary caretakers during her long and agonizing illness and was with her when she died, so it made poetic as well as practical sense for her to assume the executive director position. She originally agreed to do the job for three years. That was five years ago, and she has no intention of leaving now.

We talked in the living room of her Tiburon home, perched on a hillside overlooking San Pablo Bay. Rizzo wore a conservative charcoal-colored pants suit and dark-framed glasses. She has a round face and gray hair, cropped very short. She has never lost her New York accent.

Let’s start with your campaign for safe cosmetics. Why focus on cosmetics?
We chose cosmetics because it’s a discretionary product marketed to women with a tremendous amount of effort around breast cancer identification. Avon, Revlon, Estee Lauder—all those companies market very heavily around [advocacy for curing] breast cancer. Estee Lauder is pouring money into research, which is a good thing. But to sell a product with questionable ingredients and not be willing to look at that—that’s what we’re challenging.

How is it that toxics in our makeup wind up in our breasts?
It’s absorbed through your skin and into your bloodstream, and it travels where it will, just like any other toxic chemical. It’s not just something that’s applied to the breast; it circulates throughout your body. When you have radiation to one part of your body, another part responds to it. So you can’t feel confident that if something’s on your hair that it’s not going to affect some other vital organ. And our position is that there’s absolutely no reason why a cancer-causing chemical or reproductive toxin needs to be in a discretionary product. It just doesn’t need to be there.

Those chemicals must serve some sort of purpose.
Sure. Your lipstick will stay on longer. You will be able to dye your hair a darker black. It’s cheaper to use parabens than to use a non-paraben preservative. If you have penetration enhancers in your lotion, it feels like it makes your skin softer. And we don’t know the long-term cumulative effect of a low-dose exposure to these multiple products. We do know that low-dose exposure in some instances is more damaging than high-dose exposure. And I might use 20 personal care products at a time, and I’m going to inhale diesel fumes, and I’m going to inhale emissions from the new carpet in the building where I work.

And we don’t know how that combination of exposures affects us.
We know that young girls are going into puberty earlier and earlier, or some portion of puberty. There’s this mixed maturation going on, where you’ve got little girls with breasts, and they don’t have pubic hair, or they have pubic hair, and they don’t have breasts.

Which is a sign of exposure to endocrine disrupters.
Right. There are things disrupting our endocrine systems that are ubiquitous. And you can reduce your own risk some, although you can do absolutely everything right and there’s still no guarantee you’ll be OK. But more importantly, we can shift the consciousness. We can change buying patterns so that manufacturers will change the way they make these products. You know, 20 years ago, we didn’t see bags of organic lettuce at Safeway. We have nontoxic cleaning products now. We have companies touting organic. So the market does shift with demand. The European Union has already demanded changes. Two years ago, they banned all carcinogens, mutagens and reproductive toxins from personal care products. That’s it!

So when you buy a bottle of nail polish in Paris, it’s free of all those toxins. And aren’t all these products made by the same companies that make ours?
Yes.

So they have different formulas?
Yes.

Oh, jeez.
So the first demand of our cosmetics campaign is, we want you to reformulate identically, worldwide. That’s Step One. Step Two is to evaluate all your ingredients over a period of time and eliminate not just carcinogens, mutagens and reproductive toxins—in Europe they’re called CMRs—but to also look at other endocrine-disrupting chemicals, allergens and neurotoxins. And we want you to be totally transparent about your ingredients. Those are the demands of the compact we’re calling for. So we went to the companies and asked them to reformulate, and the answer was quite simple: No.

Because?
Because “Europe is being too fussy, their demands are ridiculous, the products are perfectly safe, and if we reformulate something when no law requires it, we admit something we’re not going to admit.”

And they can get sued.
Right. So we ran a series of ads, and suddenly, Revlon said they were going to take phthalates [hormone-mimicking chemicals] out of their products. And people began talking a bit about becoming EU-compliant. As of a week ago, we had 263 companies in the United States who had signed the compact, including the Body Shop, which is huge. And they have three years to implement the compact: meet EU standards, examine all ingredients and remove CMRs, and use transparency in labeling.

What does transparent labeling mean?
It means you can’t claim “fragrance” as an ingredient. Instead, you’re going to see all the ingredients that go into making the fragrance.

What about all the other ways we get exposed to toxins? We know that all of our rivers are contaminated with herbicides and pesticides, and we’re eating fish out of these rivers.
The food supply is a tremendous problem, and there are groups working on those issues. There is a link between certain pesticides and breast cancer. And we tell people, don’t eat the big predator fish, which eat the littler fish and accumulate so much more toxin.

Another exposure is mammogram x-rays.
We had a bill passed in Sacramento to mandate quality assurance for all radiation equipment in the state.

But isn’t it crazy that the tool for diagnosing breast cancer is a cause of breast cancer?
Absolutely. Radiation is a known carcinogen. And finally last year the National Toxicology Program put it on the list of known breast carcinogens. That’s huge. These are the baby steps you take. Twenty years ago, we got way more rads than we get now—the dose is reduced ten-fold. But we know that radiation is cumulative, and ultimately, there’s no safe dose. So you put the mammography x-ray with the dental x-ray with the chest x-ray with the x-ray for your sprained ankle and whatever. We support an alternative to mammography. And there’s tremendous resistance to that. There’s an awful lot of equipment that’s been amortized over a number of years. Meanwhile, it is the best [diagnostic tool] we have. There’s not a good alternative, and the will to change it isn’t there. It’s not a priority.

So you’re saying, before we can get any action on finding an alternative, we have to raise awareness of the danger.
Absolutely. People have to understand that radiation exposure is not a good thing.

And the tightrope that you have to walk is, at the same time, you don’t want women to stop getting mammograms because it’s all we’ve got.
I want women to make an informed choice. I want them to decide, do they want a mammogram every single year or not?

What kind of choice is that? I’ve been getting mammograms every year since I was 18—when I didn’t need them—and now that I’m nearing 60, and I finally need them, how can I stop now? That’s an impossible choice.
It is. It’s absolutely impossible. And then, if, God forbid, you’re diagnosed with breast cancer, then you have radiation as part of your treatment. Young girls treated with radiation for non-Hodgkin’s lymphoma, for example, have a much higher incidence of breast cancer.

What about digital mammography? Does that give you a lower dose?
The argument is made both ways. When digital first came out, there was some concern that the exposure was actually greater. But digital versus regular mammography is not significantly different. And it’s not a good diagnostic tool for young women. So we say, let’s come up with an alternative to mammograms for young women—which would be good for all of us. Lynn Woolsey proposed some legislation to get funding for research into alternatives for young women. But it’s not a national priority.

Another outrage is hormone replacement therapy (HRT).
There is such pressure to market pills for menopause. We know that a woman’s lifetime exposure to estrogen increases risk. We want women to be fully informed, just like with radiation. There were women who came off HRT who found out they didn’t need it as much as they thought they did. There were other women for whom [hot flashes were] so debilitating that they felt they did need to be on it. So we recommend that those women look at all the alternatives and, if you need HRT, don’t stay on it for long.

But as soon as you go off HRT, your hot flashes come back, don’t they? My mother was having hot flashes at age 80 when she stopped.
That doesn’t happen for everyone. Some women can kind of bypass menopause with HRT. And some women do fine with alternatives—exercise, different diet, naturopathic remedies. But this generation of women had been told that you could be on HRT until you died. And women were demanding relief from the symptoms of menopause.

I don’t have much quarrel with doctors who are responding to demands from their patients. I object to doctors—like my gynecologist—who, faced with a patient with no symptoms and no reason to be on HRT, pushed it like some kind of fountain of youth.
Medicine is not immune from misogyny. The whole idea of HRT started as a way to keep your man at home, right? And maybe the doctor has a menopausal woman in his life that he doesn’t want to deal with.

[laughing] Let’s talk about the link between breast cancer and socioeconomic status. What does the affluence of Marin women have to do with breast cancer? [At one time, Marin County, Calif., had the nation’s highest rate of breast cancer.]
I try to stay away from the whole question of does Marin have a higher incidence. Seattle’s higher now. Washington state has the highest breast cancer rate in the country. What does that mean? Should the women in Marin be less worried now? Or the women in Long Island, or in Cape Cod? No! The fact that breast cancer is an epidemic should be the mobilizing force, not whether or not your area has a half a percentage higher incidence.

Right, but what intrigues a lot of people, me included, is the idea that having a lot of money somehow puts you at greater risk. What are the risk factors that affluence is connected to?
It’s clearly not caused by your ATM card. It’s a proxy for something. We know that some white educated women could very well be Ashkenazy Jews, so there’s a genetic link. Then there’s delayed childbirth, not breast-feeding as long, only having one child, using birth control pills and HRT because more affluent women have greater access to them. Do they tend to live where there are more PAHs (polycyclic aromatic hydrocarbons, by-products of combustion suspected to be carcinogenic) in the environment because of the backyard barbecues? But rather than trying to find out what’s making some communities so high, why not look at what makes this other community lower? What’s the pollution level there? What’s the chemical body burden there? I would love to do body burden analysis on people in Marin and people in Richmond and see what chemicals we’re exposed to—what’s the same and what’s different. What’s the difference or the similarity in our history of radiation exposure? That’s what we have to look at. African-American women are supposed to have a lower rate of breast cancer, but in Bayview Hunters Point, that’s not true—but they’re built on a toxic dump site. Or you go over to Richmond, where they’re next to the refineries. Or you go down to the Salinas Valley where the women are working with pesticides, and the Latina women there have a higher rate of breast cancer than [most Latinas]. So, do we use more cosmetics? Are we exposed to more electromagnetic fields? Do we eat higher up in the food chain and consume more toxic chemicals that way? One way to understand all this is to look at the body burden of people in different communities.

So you’re saying we should be doing body burden testing.
We should be doing biomonitoring.

Another thing that troubles me is the difficulty in doing good testing of environmental links. For instance, one of the things you talk about is the timing of exposure. Does it make a difference if your exposure occurs when you’re an infant or when you’re in puberty? Theoretically, you’d need to follow people for 60 years to find out whether or not they get breast cancer.
In Sweden, they do that. And when they found flame retardants in breast milk, they banned flame retardants. Simple. It doesn’t take a rocket scientist to know you don’t want to feed your baby flame retardants. You can talk about all the studies that we need to be doing, but you can also say, we need a precautionary principle paradigm. So, in the presence of information that suggests that there’s harm that can be caused in the environment, we need to take action. And you [the manufacturer] have to prove it’s safe.

Isn’t it even harder to try to prove a negative? To prove you won’t get sick from this chemical?
That’s right. So then they’ll change to more green production practices.

How will you ever get that passed?
Well, we got it passed in San Francisco, and it’s changing the purchasing practices there. It passed in Berkeley. So you’re not going to see diesel buses. They’re buying hybrid car fleets. They’re using chlorine-free, post-consumer waste paper. The city of San Francisco has $600 million in purchasing power. So now, [vendors] are lining up, figuring out what they have to do to meet the city’s criteria. So, yes, I think it’s possible. And we have to get the public thinking like this before we can make these changes. You start with the chemicals that bioaccumulate, the ones that are persistent, the chemicals that we know are carcinogenic. Begin to eliminate those. And if we did that, maybe we’d have less autism, less infertility, less learning disability, less breast cancer, less Parkinson’s. I’d like to see, in my lifetime, the numbers go in the other direction.

Do you have hope that they will?
I have to have hope, or I can’t do this work. I can’t get up every morning if I don’t have hope. I have to believe that we can really make a difference. And I think we have. I see a generation of young people asking different questions than we ever asked. So I feel like we’re contributing to the dialogue. If we leave some questions that weren’t being asked before, then I feel like we’ve done our job here on this planet.