By Jane McArthur

February 4th was World Cancer Day. It prompted me to reflect on my PhD dissertation — which I defended five years ago this February — on women and environmental links to breast cancer. My study connected dots between risks for breast cancer and economic, industrial, health and social systems.

Susan, who I interviewed in my research, said, “I think we all, in the back of our mind, know the risk is there, but I just don’t think we have the means to implement a solution yet.”

Learning how environmental factors contribute to breast cancer helps us identify solutions and take action to prevent it. The body of knowledge on environmental health and breast cancer draws out understandings of gender, feminism, intersectionality, and justice, highlighting patriarchy, colonialism, capitalism, and inequality in the experiences of the disease. Research also suggests we need to create new systems that cease oppression, while pursuing justice to address breast and other cancers.

Our neighbourhoods, workplaces, communities and overall ecosystem are sites of exposure to breast cancer risks.

Ecological models of health illustrate how an individualized-level focus on breast cancer is flawed. Health is not just a biomedical issue; it is impacted by factors in the social world. We live within families, communities, ecosystems, and planetary-level conditions — a nested set of relationships.

We need systems-level changes for breast cancer prevention. Policies, regulations, and law can be shifted to address breast cancer risks in our environments.

Dr. Ted Schettler, who wrote The Ecology of Breast Cancer captures the approach with these words: “Breast cancer is not only a disease of abnormal cells but also of communities that we create and live in.”

It’s a powerful thought: we can create communities that reduce and eliminate breast cancer risks.

My community is one where we need some re-creating. I live in the Windsor-Essex Region in Ontario. A river separates us from Michigan in the United States. The Ambassador Bridge connects us.

The Bridge is the busiest border crossing in North America, with over 20,000 transport trucks and other vehicles crossing daily. The Bridge environment has heavy air pollution and in the mix of pollutants are definitive breast carcinogens. At the time I defended my dissertation, women at the Bridge were being diagnosed with breast cancer at rates at least 16 times higher than the rest of the county.

This is an environment deeply connected to and impacted by fossil fuel-based infrastructure.

Because of elevated breast cancer cases at the Bridge, I decided to investigate women’s knowledge of breast cancer’s environmental risks with the women who work there. I wanted to know how they understood their risks, how they placed the environment in their stories, and how they perceived and exercised agency – or action —  in the context of those risks.

The women’s words made concrete how our economic and ideological systems and fossil fuel-based economy are fundamental to their risk.

Women identified genetic predisposition and lifestyle factors as risks for breast cancer, but they also clearly pointed to environmental causes—vehicle exhaust, diesel emissions, and chemical exposures. And while the women linked these environmental exposures to breast cancer, they also reported that their employers, governments, and the compensation board did not recognize or validate these risks. Several women noted that physicians and oncologists rarely inquired about workplace or environmental exposures when taking their medical histories.

One woman reported she knew of 30 women at the Bridge who had been diagnosed with breast cancer — about a third of the women-identifying workforce.

Samantha talked about the failure to address breast cancer risk at the Bridge as a question of culture. She asked, “What do we value? Do we value women’s health, and how much? I think that that’s where you would find that the trade needs and pushing those trucks, pushing those cars — as we call it at work — is going to end up feeling more important to decision-makers or the power players than protecting an individual woman from risk.”

Samantha highlighted how economic and political frameworks influenced Bridge operations. She explained, “Because of the power of the lobby of the truck traffic, we get torn in two directions on this. Because our city is built on the auto industry, and so is Detroit, and so that industry relies on something called just-in-time supply. This is the industry that defines our area. So, when you talk about limiting environmental pollution, you are talking about limiting the trucks that deliver the different types of parts, which then limits the jobs of those workers who need those parts to build those vehicles.”

Samantha continued, “Can we not redefine these businesses in a less harmful way? But when we talk about reducing the harmful effect of traffic, what you are really talking about is redefining the whole trade relationship with every other country in the world… So, it’s a tricky question, and I think it feels very much out of our hands, which is another reason why I think it becomes very easy to shelve it because the question is too big. And you feel too powerless, because there is very little I think that you can do, unless you are talking about really getting rid of our dependence on fossil fuel.”

Larissa was optimistic. “I am hoping that if these risk factors are being shown to be an issue here that we can be that catalyst that helps everyone nationwide,” she said.

Many women felt strongly that their employer, governments and compensation board held some responsibility.

Jackie said, “There is a definite obligation to make sure people are in a healthy and safe work environment.”

Women pointed to the need for systemic changes. Policy, regulation, law and other risk-mitigation strategies, through a systems approach to breast cancer risks, create possibilities for preventive action in workplaces, communities and globally.

As Cindy said, “Sometimes, you just need someone to plant the right seed about things.”

The seed I want to plant is that breast cancer is a design problem. Our fossil fuel-based economy — which produces breast cancer, along with air pollution, plastics, endocrine disrupting chemicals and climate change — is a significant piece of the design problem. The Bridge environment and its impacts on workers are examples of these truths.

To prevent future breast cancers at the Bridge, in the community around it and communities across the globe, we need fundamental social change. That must include reframing how scientific research is conducted, making prevention a key goal, eliminating corporate interests and profits from the disease, and breaking the silence about environmental connections to breast cancer.

Awareness-raising alone is an ineffective solution to the breast cancer epidemic.

We must reduce, replace, and eliminate exposures to breast carcinogens and endocrine-disrupting chemicals in workplaces, communities and personal care products.

We must put controls on pollutants or develop alternatives to prevent air pollution linked to a higher risk of premenopausal breast cancer.

We must include social determinants of health and commercial determinants of health in our strategies to mitigate risk and prevent breast cancer disparities in women’s specific populations.

Many exposures are outside the control of individual women; they are involuntary exposures not modifiable with lifestyle or behavioural changes. Systemic changes with the protection of the public are fundamental to prevention.

The Canadian Environmental Protection Act (CEPA) and other environmental laws are breast cancer-prevention policies. In particular, the right to a healthy environment under CEPA must be upheld and can aid in cancer prevention.

We need the political will to implement, enforce and extend policies that prevent breast cancer: policies that deliver clean transportation and public transit systems; eliminate toxic chemicals from product manufacturing; support workers through just transitions; and restructure how we live, work, learn, travel, and play.

The knowledge and experience of the women from the Ambassador Bridge are important pieces of future breast cancer-prevention strategies, connecting the dots between phasing out our fossil fuel-based economy and breast cancer prevention.

Preventing exposure to toxic, fossil fuel-based pollutants is not only a moral and public health imperative; it is also a sound long-term investment that reduces health-care costs, strengthens communities, and advances human rights.