The GeographyThe Geography of Breast CancerDanna Lagerquist

Kyrene del Pueblo Middle School

GENETICS

References

Introduction

Teaching is an art and a science. As it turns out so is medicine. Until I had cancer I always thought there was a cut and dry formula for medical treatments. I learned quickly this is not true. When I was told my options for treatment and asked to decide how I wanted to be treated, I knew there was no definite answer. Even after this experience, I expected to be able to research and find “the” answer. Instead, I found even more factors which affect breast cancer and other areas of life. What I gained is an even stronger belief in the importance of geography education and a way to help my students see geography’s importance. Unless you believe geography is just maps and memorizing places, I was not taught geography as a student. When I started teaching social studies, I began seeing the importance of geography and this started my quest to learn more. Bringing what I learned to my students was difficult because it was hard to make them interested. One of the simplest ways to explain geography is to use the Five Themes of Geography; the five themes of geography are Location, Place, Movement, Regions and Human Environment Interaction. These themes are a way to organize geography. I use the Five Themes of Geography with my students because it helps them organize the new information I teach them. Each of the Five Themes can be connected to Breast Cancer. Using my personal experience with cancer and combining it with geography, I found a way to expose students to the importance of geography. By joining geography with something as serious as cancer, it helps demonstrate geography’s value. The geography of breast cancer is extremely complicated because there are so many potential factors which influence disease and because of this, the research is difficult The research is made even more difficult because of the amount of time it takes and because you are dealing with life and death.

The Five Themes of Geography

1.Location2.Place

3.Movement4.Regions

5.Human Environmental Interaction.

Location

Location is answering: where is it?--2 types of location

1.Absolute 2. Relative

Breast cancer incidence is higher in the industrialized world. -- 92 per 100,000 or more are stricken with breast cancer in the industrialized world compared to parts of Africa and Asia where the rate is less than 22 per 100,000.

Movement

HOT SPOTSIn both the crude and adjusted analysis, breast cancer incidence was elevated among women who had lived on Cape Cod for 5 or more years (McKelvey et al., 2004) Geography can help us to determine locations of increased breast cancer incidence.

Physical CharacteristicsInclude mountains, rivers, beaches, wildlife, and soil. (Things from nature)

Epidemiological studies seek to identify whether risk factors, such as diet, socio-economic status and occupation, are associated with

specific outcomes, such as breast cancer, in human populations. p.2 (Jacquez, et al 2003)

Movement is defined as the movement of people, ideas and goods from one place to another.

•“Cancer latency (the time between causative exposures and cancer onset) is estimated to be between 5-40 years.” p.3 (Jacquez, Geoffrey and Greiling. 2003) •We are a transient society and this movement makes it extremely difficult to pinpoint a breast cancer cause.•We don’t know if the cancer exposure takes place where you are born, where you grow up or where you end out living.

Regions

A region is the basic unit of study in geography.  A region is an area that displays a coherent unity in terms of the government, language, or possibly the landform or situation.  Regions are human constructs that can be mapped and analyzed.

3 Types of Regions

Althusis, P., et al. (2005). Global trends in breast cancer incidence and mortality 1973-1997. International Journal of Epidemiology, 34, 405-412. Baak, Jan. P., et al. (1992). Differences in breast cancer survival are correlated with differences in differentiation and rate of proliferation. Institute of Pathology Free University Hospital, , 989-992. Baider, L., et al. (2002). Effects of age on coping and psychological distress in women diagnosed with breast cancer: Review of literature and analysis of two different geographical settings Oncology Hematology, 46(September 26), 5-16. Einbeigi, Z., et al. (2002). Clustering of individuals with both breast and ovarian cancer. Clustering of Individuals with both Breast and Ovarian Cancer, 41(2), 153-157. European ancestry increases breast cancer risk among latinas.(2008). American Association for Cancer Research, (December 7) Fang, J., et al. (1996). Cancer mortality of Chinese in new your city 1988-1992 International Journal of Epidemiology, 25(5), 907-912. Fitzgerald, M., et al. (1996). Germ-line BRCA1 mutations in Jewish and non-Jewish women with early-onset breast cancer. The New England Journal of Medicine, 334(January 18), 143-149. Grann, V., et al. (2006). Regional and racial disparities in breast cancer-specific mortality. Social Science and Medicine., 62, 337-347. Gregorio, D. I. (2002). Geographic differences in invasive and in situ breast cancer incidence according to precise geographic coordinates, Connecticut, 1991-1995 International Journal of Cancer., 100, 194-198. Gregorio, David. I., et al. (2001). Geographical differences in primary therapy for early-stage breast cancer Annals of Surgical Oncology, 8(November, 10), 844-849. Harder, B. (2006). Melatonin-depleted blood spurs tumor growth. Science News Online, 169(1), 8. Harlap, S., et al. (2001). Epithelial ovarian carcinoma and European birthplace of grandparents. Gynecologic Oncology, 81, 25-32. Jacquez, G., & Greiling, D. (2003). Local clustering in breast, lung and colorectal cancer in long island, new york International Journal of Health Geographics, 2(3) Jacquez, G., & Greling, D. (2003). Geographic boundaries in breast, lung and colorectal cancers in relation to exposure to air toxics in long island, New York International Journal of Health Geographics, 2(4) Kulldorff, M.,et al. (1997). Breast cancer clusters in the northeast united states: A geographic analysis. American Journal of Epidemiology, 146(2), 161-170. Lewis-Miehl, E., et al. (1996). Breast cancer risk and residence near industry or traffic in Nassau and suffolk counties, long island, New York. Archives of Environmental Health, 51(July/August), 255-265. Lopez-Cervantes, M., et al. (2004). Dichlorodiphenyltrichloroethane burden and breast cancer risk: A meta-analysis of the epidemiologic evidence. Environmental Health Perspectives, 102(2) Lyman, F. (2006). Advocacy groups ignore breast cancer hot spots Alternet, (October 19), 2008. Lyman, F. (2006). The geography of breast cancer. Ms. Magazine, Fall Marchione, M. (2006). Vitamin D battles breast cancer Milwakee Journal Sentinel, (April 10) McKelvey, W. et al. (2004). Association between residence on cape cod, Massachusetts, and breast cancer. AEP, 14, 89-94. Merkin, et al. (2002). Geographic socioeconomic status, race, and advanced-stage breast cancer in New York city. American Journal of Public Health, 92(January), 64-67. Mobley., et al. (2008). Heterogeneity in mammography use across then nation: Separating evidence of disparities from the disproportionate effects of geography International Journal of Health Geography, 7(32) Paulu, C. et al. (2002). Exploring associations between residential location and breast cancer incidence in a case-control study. Environmental Health Perspectives, 110(9), 471-478. Phend, C. (2006). Vitamin D retards breast cancer progression. Medpage Today, (October 17) Polsky., et al. (2006). Variations in chemotherapy utilization in ovarian cancer: The relative contribution of geography. Health Services Research, 41(6), 2201-2218. Reynolds, P., et al. (2005). Regional variations in breast cancer incidence among California women, 1988-1997 Cancer Causes and Control, 16(12), 139-150. Roohan, et al. (1988). Hospital volume differences and five-year survival from breast cancer. American Journal of Public Health, 88(4), 454 – 457. Sheenan, et al. (2004). The geographic distribution of breast cancer incidence in Massachusetts 1988 to 1997 adjusted for covariates. International Journal of Health Geographics, 3(17) Snedeker., S. (2002). Environmental chemicals and breast cancer risk fact sheet # 45. Van der Wall., E. (2001). Mitotic activity index IDs high-risk node-negative breast cancer Oncology News, 10(3), 1-3. Vieira, V. et al. (2008). A spatial-temporal analysis of breast cancer in upper cape cod, Massachusetts. International Journal of Health Geography, (October) Viel, J., et al. (2008). Dioxin emissions from a municipal solid waste incinerator and risk of invasive breast cancer: A population-based case-control study with gis-derived exposure. International Journal of Health Geography, 7(4) Vinnakota, S., & Lam, N. (2006). Socioeconomic inequality of cancer mortality in the united states: A spatial data mining approach. International Journal of Health Geography, (April) Zhu., Y., et al. (2005). Period3 structural variation: A circadian biomarker associated with breast cancer in young women. Cancer Epidemiology Biomarker and Prevention, 14, 268-270.

“The task then will be to explore these extensive environmental history data in a Geographic Information System for particular features of the hot spot regions with the potential for human exposure. (e.g., past pesticide application).” (Paulu, C. et al, May 2002)

Einbeigi (2002) was able to show populations which don’t have much change have a direct connection between gene mutation and breast cancer. Einbeigi wrote, “in closed populations, as in Iceland or among Ashkenazi Jews, mutations in the BRCA1 and BRAC2 genes are prevalent in cancer subjects” (Einbeigi et al., 2002, p.153).

TIME

“Breast cancer takes many years to develop – often up to 30 or more years- because of the many changes that must occur before a normal cell becomes a cancerous cell that divides out of control.”

p. 5 (Snedeker, S., 2002)

“However, few studies have evaluated the contributions of education, income, employment and insurance coverage, which also vary by both region and race, to the observed differences in

survival.” p.338 (Grann, V et al. 2006)

•Human subjects– you can’t just expose people to potential cancer to see what happens. •Following cancer victims is also difficult because death limits the information you can obtain.

RESEARCH ISSUES

1.Absolute Location the latitude and longitude (a global location) or a street address (local location).

2.Relative Location is described by landmarks, time, direction or distance from one place to another and may associate a particular place with another.

1.Formal regions are those defined by governmental or administrative boundaries. Ex. United States

Physical Regions are included in this category.Ex. The Rockies

2.Functional regions are those defined by a function (i. e., TVA, United Airlines Service area or a newspaper service

area).  If the function ceases to exists, the region no longer exists.

3.Vernacular regions are those loosely defined by people's perception (i. e., The South, The Middle East). 

Jacquez and Greiling (2003) examined whether there is a statistically significant clusters of cancer on Long Island. They found there were 2 local clusters of lower SMR (70-83% of New York’s average) and 2 clusters with an SMR (30-50 % higher). SMR is the standardized Mortality Rate. One of the clusters is in Southampton and the other cluster was located in Wainscot.

Regional Variations in Breast Cancer Incidence Among California Women.” Reynold’s (2005) research was done in California to look at possible differences in breast cancer diagnosis in different regions.

Overall the regional rate differences for lobular cancers were greater than for all breast cancers.

In 2004, McKelvey studied Cape Cod and found breast cancer risk was elevated among women living on Cape Cod for five or more years. There was suspected environmental exposures which included pesticides and drinking water contamination. The industrialization of the area may contribute to breast cancer cases.

Even though there is a large quantity of research trying to understand the causes of breast cancer, it is still a major health issue. Breast cancer incidence and mortality patterns are extremely complex and with so many potential factors to the disease it is extremely difficult to pinpoint a cause or causes. Improved screenings and treatments have changed the outcomes and therefore the research is even more difficult. Epidemiology studies of breast cancer will continue to give insights to the complex causes of breast cancer. Hopefully, someday it will lead us to prevention of the disease.

“Breast Cancer is the most commonly diagnosed cancer in American women.” (Reynolds, et al., 2005, p. 139)

Place

Place is the personality of geography. There are 2 types of characteristics; 1.Human2.Physical

Human CharacteristicsThese characteristics are derived from the ideas and actions of people that result in

changes to the environment, such as buildings, roads, clothing, and food habits.

HEI

Human Environmental Interaction is defined as how do humans and the environment affect each other--

Humans adapt to the environment.Humans modify the environment.

Humans depend to the environment

“Exposure to vitamin D at the time the breasts are developing, particularly around adolescence, is important” (Marchione, 2006, p.1). High levels of vitamin D equaled a 50% lower risk of breast cancer and even modestly higher levels of vitamin D resulted in a 10% less risk.

World Breast Cancer Rates

Educational Connection

I may not be able to find research which gives me a direct cause to cancer, but I can show my students the importance of geography through this type of research. Nearly everyone is touched by cancer in some way and this provides common ground. Using breast cancer as the vehicle to explore geography increases interest and shows students how valuable it is to learn about geography. When something as serious as cancer can be explored by geography it makes geography become important. When teaching my social studies curriculum I am always trying to instill in my students the ability to examine a problem and draw a conclusion through the information and data they can access. Being able to make well informed decisions during their life time is more valuable than anything else I can teach them. Teaching them the geography of cancer also lets me show them a piece of my past where I was faced with a problem and had to make choices using the information I could find. I hope my student will not have to make life and death choices, but if they do, I hope some of what I have taught them will help. I am also excited to show students about career choices which involve geography, such as epidemiology.

Conclusions

“We found that patients receiving care at very low-volume hospitals had a 60% higher risk of death than patients receiving care at high-volume hospitals.” (Roohan, et

al.,1998., p455)

Even population size has an effect

A special area of study