Young girls may hold key to breast cancer - early puberty

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**The " Living With Cancer " series*

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" Girls who have their first period before age 11 are at triple the risk

for breast cancer, compared to those who have it after. Those who have

it before age 12 are at double the risk. "

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Young girls may hold key to breast cancer

Sunday, December 9, 2007

By LINDY WASHBURN

STAFF WRITER

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What if you could do something to save your daughter from ever

developing breast cancer?

Would you insist on breastfeeding her as an infant? Never use plastic

while microwaving her food? Guide her to an active lifestyle, with

exercise each day? Prepare low-fat meals from scratch? Make sure the

school did, too? Buy organic?

We've all heard of changes in diet and lifestyle to prevent cancer in

adults. But it looks more and more as if a cancer-free adulthood is

determined years earlier -- maybe even before birth.

If my own experience raising kids is a guide, these things are easier

said than done. But having recently come through cancer treatment

myself, I'd want to do anything I could to prevent my children from ever

having a doctor tell them they have cancer. First, however, I'd like to

know which recommendations are supported by scientific evidence.

Answers may be coming.

Scientists now are focusing on childhood development and environmental

influences as factors in certain cancers. One of the hottest topics: the

declining age of sexual maturity in girls and its links to breast cancer.

Girls who have their first period before age 11 are at triple the risk

for breast cancer, compared to those who have it after. Those who have

it before age 12 are at double the risk.

The link between early puberty and breast cancer is estrogen. The

greater the lifelong exposure to estrogen, the greater the risk of

breast cancer. The years between a girl's first period and her first

pregnancy -- when her breast cells have not differentiated and are

multiplying rapidly -- appear to be a time of particular vulnerability

to mutation or environmental damage.

The audience always gasps when Bandera, an epidemiologist at The

Cancer Institute of New Jersey, presents those facts.

Bandera's " Jersey Girls Study " is one of a few around the country -- and

the only one in New Jersey -- trying to tease out the environmental,

hormonal and nutritional factors involved in causing early puberty.

" I want to go beyond breast-cancer prevention and help these girls, "

Bandera says. " I want to understand what causes early puberty -- not

just menarche [the arrival of the first period], but breast development

and pubic hair growth. We're looking at diet and physical activity,

collecting body measurements, asking about environmental exposures, even

prenatally and in early childhood. "

She's especially interested in diet and whether eating organic food can

delay the onset of puberty.

A girl's genes set the tempo of puberty's arrival -- her timing will be

similar to her mother's, for the most part. But the variation from one

generation to the next is more than half determined by environmental

influences, experts say.

The arrival of a girl's first period is the last step in a series of

changes that generally unfolds over a 4½-year period, beginning with the

production of new hormones and usually proceeding to breast development,

growth of pubic and underarm hair and menstruation.

Today's mothers know that their daughters and daughters' friends develop

sexually at younger ages than the mothers did. Ilise Zimmerman, a

women's health agency executive from Haworth who also coaches girls'

basketball, says she's amazed each year at the voluptuousness of her

12-year-old players. " We see it when we order T-shirts, " she says.

" There are no size 'smalls.' "

While the age at first menstrual period has declined slightly over the

last two decades, the onset of the other signs of puberty is dropping

faster, and appears to be influenced in part by different factors.

" They moved up that little talk they do for the girls now to fourth

grade, " says Dottino, a Mercer County mother of four whose

10-year-old daughter is part of the study. " A lot of parents don't want

to talk about it. "

Puberty at age 6

As early as the third grade, nearly half of African-American girls and

15 percent of white girls begin breast development or pubic-hair growth.

The average age to begin breast development, according to a landmark

1997 study, is 8 years and 9 months for African-American girls and

around the 10th birthday for white girls. The cause of the racial

difference is not known.

So many girls now begin puberty at younger ages that the Pediatric

Endocrine Society officially lowered the definition of precocious

puberty, from 8 years old to 6 for African-American girls and 7 for

white girls.

The Jersey Girls Study -- which is to include approximately 150 9- and

10-year-olds -- asks whether the girl was fed breast milk, milk formula

or soy as an infant; whether she sucked on a pacifier; and what her

birth weight and growth rate were, among other questions. The girl's

physician and mother report periodically on her physical maturation. The

girls are asked to spit in a cup so their DNA can be extracted from the

saliva. Their urine is tested for chemical compounds and hormones. Their

food consumption for three days in a two-week period is analyzed.

" It makes you realize how many things go on in a day that affect a

child's health, " says Dottino, the Mercer County mom. " We had to track

hair products, shampoos, perfumes, everything she ate. "

Dottino's own mother had breast cancer 15 years ago, so she values the

study's potential contribution to breast-cancer prevention. " It was

pretty interesting to track everything, " she said. " You look at all the

crap these kids eat. "

Michele King of Lawrenceville, the mother of five girls ages 2 to 13,

has two daughters in the study. She says that " using organic dairy

products has always been part of what we did, but five years ago, we

expanded to more natural products throughout our diet. " The girls

complained a bit, especially about the whole-grain cookies.

The study showed the girls that " it's not just Mom and Dad who think

about this, " King says. " Other people do, too. There must be something

to it. "

She adds: " I'll be curious to see where this all goes. "

Early puberty has other downsides besides the future risk of breast

cancer. It's associated with more risky behaviors, such as smoking,

drinking and unprotected sex, and depression and anxiety. That is not to

say, of course, that all girls with early periods turn out that way, but

the risk is greater.

" We have to have the conversation earlier " about the consequences of

early sexual activity, says Zimmerman, chief executive of the Northern

New Jersey Maternal-Child Health Consortium and the mother of two daughters.

Obesity a factor

Scientists are concentrating on two broad factors associated with

puberty's early onset: obesity and hormonally active chemicals in the

environment.

" Girls who are heavier go into puberty earlier, " says Dr. Biro, a

pediatrician and the principal investigator in a study of 400 girls at

the University of Cincinnati College of Medicine. American girls eat

more than they did 30 years ago and exercise less. Childhood obesity is

three times as common. Fat is related to hormone levels.

Not only does " over-nutrition " contribute to earlier onset of puberty,

but exercise -- by upping the production of certain hormones and taking

weight off -- delays it.

At the same time, girls today live in a world with microwave ovens,

computers, and fertilized and bio-engineered lawns and crops.

" We've become a plastic nation -- a plastic nation that super-sizes

everything, " Biro says. " It's the chemicals we're all exposed to by

putting plastics in microwaves, using cleaning agents around the house

and spreading lawn-care products on the grass " that, in combination, can

mess with hormone levels.

Research in 2002 found that the combination of 11 different chemicals

people are exposed to in everyday life, each present below the level

known to cause any observable effect, produced a cumulative effect. When

all were present together, " Poof! There was an estrogenic effect, " Biro

says. " I find that incredibly sobering. "

Phthalates, the substances that make plastic soft and pliable, are used

in food packaging, IV tubing and personal-care products. They've been

found in breast milk and in the urine of average Americans, and are the

subject of intensive study about their possible role in cancer, early

puberty in girls, low sperm counts and male reproductive disorders.

California became the first state to ban phthalates in toys and baby

products in October. The European Parliament also banned some forms of

plasticizers and restricted others in children's items in 2005. Canada

has had voluntary restrictions in place since 1998. Not New Jersey.

" We shouldn't be nuking anything that isn't in glass or porcelain in our

microwaves, " says Biro, ruefully describing his own past history of

reheating Saran-wrapped leftovers. " I was dosing myself with

phthalates. " Microwaving can cause phthalates to leach into food,

according to a fact sheet prepared by the federally funded Breast Cancer

and the Environment Research Center at the University of Cincinnati.

Common-sense steps

What else should a parent do? For the most part, the recommendations

about preventing early puberty, at least so far, are common-sense

approaches to good health.

Help your kids maintain a healthy weight. Encourage physical activity.

Eat plenty of fruits and vegetables.

When I asked Bandera, the mother of a 10-year-old daughter and a

14-year-old son, how she combined her role as a scientist and a mother

in raising her kids, she said there's no need to overdo it.

She buys healthy food, including whole grains, organic milk, and plenty

of fruits and vegetables, and tries to cook from scratch. She tries to

keep her kids active. And she models the healthy choices she'd like them

to make: She doesn't smoke or drink; she controls her weight and stays

active.

" They're going to be exposed to other things sooner or later, " she says,

" but they will know what the good choice is. That's all you can do. Then

you hope for the best. "

I have two sons and no daughters. But I think this is sound advice for

all of us, if we want to spare our children the suffering of cancer.

E-mail: washburn@...

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Participants still being sought

The Jersey Girls Study is still recruiting participants.

Healthy 9- and 10-year-old girls who live with their biological mothers

are eligible. Girls who are twins, triplets or other multiples, or who

have certain chronic health conditions, are not eligible.

The girls will receive a free analysis of their dietary intake, body

measurements (including percent body fat), a $25 gift card and some cute

knickknacks.

The study is a collaboration of The Cancer Institute of New Jersey, the

Wood Medical School, UMDNJ's School of Public Health, and

the Environmental and Occupational Health Sciences Institute.

If the number of potential participants from northern New Jersey

warrants, says Dr. Bandera, the principal investigator, the

research team will arrange with a local hospital or pediatrician's

office to assess the girls on a single evening, or a series of evenings.

For further information, call or e-mail

jerseygirlstudy@....

-- Lindy Washburn

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About the series

Lindy Washburn, who covers health care, and Brody, who writes

about family issues, are the authors of the ongoing series Living With

Cancer. Their stories, which run separately, will appear occasionally.

Earlier installments can be found at northjersey.com/livingwithcancer.

Copyright © 2007 North Jersey Media Group Inc.

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