Breast Cancer in Anacostia
For the latest in a series of community forums, Linda Birnbaum, Ph.D., director of NIEHS and the National Toxicology Program, visited southeast Washington, D.C. for the Anacostia Community Forum. The forum series, now in its twentieth year, has brought NIEHS directors face-to-face with community members across the nation so they can listen to concerns firsthand.
Before the Nov. 8 event at the Thurgood Marshall Academy Public Charter School, Birnbaum shared a meal at the local hangout Cheers at the Big Chair with event organizers, scientists, and community members.
“I know how important it is to listen to what folks in the community are saying,” Birnbaum said in her opening remarks. “Some of our best research is the result of strong community participation in the process.”
“The dinner beforehand was a highlight,” said John Schelp, from the NIEHS Office of Science Education and Diversity. “The director had a chance to break bread with community members, engage, and get a sense of community before heading down the street to the forum at the school.”
A Breast Cancer Hotspot
Anacostia is a historic, predominantly black neighborhood situated across the river from Capitol Hill. Once plagued by a reputation for extreme poverty, the area is changing rapidly. As a result, residents are turning their attention from violent crimes to other, more insidious dangers to their health and wellbeing.
“You’re in Ward 7 and Ward 8, where there are some of the highest breast cancer rates in the city,” said moderator Brenda Lee Richardson, a health advocate and resident of Ward 8. Anacostia leads the city in this dubious distinction, and Washington, D.C. leads the nation in both breast cancer incidence rates and breast cancer mortality rates. So organizers chose Anacostia as the place to discuss the links between the environment and the disease.
No Easy Answers
Most researchers agree that breast cancer arises through the complex interplay of a person’s unique genetic makeup and the environment around them.
“Environmental factors — like what’s in the food you eat, the water you drink, and the air you breathe — are more readily identified and modified than genetic factors, and therefore present a tremendous opportunity to prevent breast cancer and other diseases,” Birnbaum said.
Dozens of community members attended the public forum, which was hosted by the Georgetown Lombardi Comprehensive Cancer Center. Birnbaum and Richardson were joined by five other panelists.
- LaQuandra Nesbitt, M.D., director of the D.C. Department of Health.
- Marc Lippman, M.D., professor of oncology and medicine at Georgetown Lombardi Comprehensive Cancer Center.
- Celia Byrne, Ph.D., associate professor of preventive medicine and biostatistics at Uniformed Services University of Health Sciences.
- Lucile Adams-Campbell, Ph.D., professor of oncology at Georgetown Lombardi Comprehensive Cancer Center’s Capital Breast Care Center.
- Natalie Williams, founder of the Natalie Williams Breast Cancer Foundation.
Separate but Not Equal
One in eight women in the United States will be diagnosed with breast cancer in her lifetime. Although black women and white women are diagnosed with breast cancer at about the same rate, black women are more likely to die from the disease than white women.
Researchers are busy trying to tease apart the environmental exposures that might underlie these health disparities. “Stress, diabetes, obesity, fear, depression are all linked to cancer,” said panelist Lippman.
After she was diagnosed with breast cancer and underwent a double mastectomy, chemotherapy, and radiation, panelist Williams founded the Natalie Williams Breast Cancer Foundation to help other women like her.
“I’m not a scientist, I just know my story,” she said. “I just happen to be a breast cancer survivor.” Williams told the audience that she hoped they could all work together to try to understand and prevent breast cancer in the community.
As with other NIEHS community forums, most of the 90-minute meeting was reserved for the audience to voice concerns and ask questions on a wide variety of topics related to breast cancer. In the end, the event was as much about building community as it was about providing answers. “I’m so honored to be in the room with each and all of you,” Richardson said in her closing remarks. “This was like a healing process.”
(Marla Broadfoot, Ph.D., is a contract writer for the NIEHS Office of Communications and Public Liaison.)
San Joaquin Valley
In California's San Joaquin Valley, Linda Birnbaum, Ph.D., director of NIEHS and the National Toxicology Program, and others saw local organizations responding to the region's environmental health challenges.
The valley, also known as the Central Valley, was the setting of Birnbaum’s latest community tour and workshop. The visit followed a meeting of the NIEHS-funded Environmental Health Core Centers at the University of California at Davis (UCD).
Birnbaum regularly holds community tours and forums around the country to hear about local environmental health issues from residents and community organizations, with an emphasis on the role of scientific research in addressing those issues.
The Valley’s Complex Concerns
The UCD core center’s Community Stakeholder Advisory Committee helped plan a road trip to Stockton and Fresno that offered vivid illustrations of complex environmental health concerns and responses by community organizations.
The nearly 30-member tour group included Birnbaum and others from NIEHS; researchers and faculty from the UCD core center; members of the UCD Community Engagement Core; and representatives of California’s state government and community organizations.
Tour leaders explained that the region is home to large-scale agriculture, family farms, oil and gas drilling, and other industries. More people than ever before live in the valley, as housing prices soar in more densely developed parts of the state such as Los Angeles and San Francisco.
Air quality is affected by agricultural and industrial activities, and by pollution that blows inland from coastal cities. Groundwater in some areas contains naturally occurring compounds, such as benzene and arsenic. Where contamination has occurred, pesticides and industrial chemicals may be present.
The first stop was in South Stockton, at Fathers and Families of San Joaquin (FFSJ). The group addresses employment disparities, poverty, environmental health disparities, and other critical problems.
“We’re transforming South Stockton so we’re not the place of last resort but a community of first choice,” said FFSJ Executive Director Sammy Nunez. “Our children are sacred, and they’re breathing toxic air. Our children are blessed, and they’re drinking contaminated water.”
Birnbaum’s visit to Stockton was covered by the local news site Recordnet.com, in an article written by Joe Goldeen. “What Birnbaum took from the presentation was ‘the power of the people and the love’,” Goldeen reported.
“You have to be grounded in love to give people the ability to heal themselves,” Birnbaum said. “It can't come from the outside.”
One FFSJ project is a garden called Healing Roots, where newly planted trees offer symbols of strength and hope. “At some time [in the future] we'll come here … and this will be a beautiful oasis," Birnbaum said.
Fire Along the Freeway
En route to Fresno, the group passed a roadside fire, underscoring the air quality impact of wildfires. “I’ve done 22 community forums with the director,” said John Schelp, NIEHS community outreach coordinator.
“Driving past roadside fires in the San Joaquin Valley was one of the worst challenges my lungs have had,” he added. Members of the tour group shared their hotel with firefighters working in the Yosemite Valley.
A Meeting of the Minds
Ryan Jensen, from the Community Water Center, spoke about water quality, noting that the severe drought has led to heavy reliance on diminishing groundwater supplies. “Pumping water out of the aquifer draws the arsenic out of the pores,” he said. Groundwater provides the drinking and household water for residents of the Central Valley’s extensive rural areas.
Pesticide exposure was also raised at the meeting. “We’re not just talking about workers’ health, we’re talking about our families’ health,” said Fernando Serrano, Ph.D., from the Coalition Advocating for Pesticide Safety.
Agents of Change
The visitors learned how community groups are responding. Residents in one area convinced farmers of the strawberry fields surrounding their school to switch to organic methods, eliminating pesticide use.
UCD Core Center Director Irva Hertz-Piccioto, Ph.D., spoke of the value to researchers of getting out of the lab. “I feel like I’ve learned more in the last hour than in the last year,” she said. Her thoughts were echoed by Claudia Thompson, Ph.D., head of the NIEHS Population Health Branch. “It’s very important to see this up close,” she said.
Visitors and residents alike saw cause for hope. “We have a power triangle in this room — academics, advocates, and agencies all together,” said Jonathan London, Ph.D., from the UCD Community Engagement Core. “We’re here in the heart and brain trust of people working on environmental justice in the valley.”
Music & Your Health (Durham)
A unique mix of science and music drew an enthusiastic crowd April 22 for an NIEHS-sponsored Earth Day celebration at the downtown Durham Convention Center.
The Music and Your Health community forum featured talks by scientists and leaders of local organizations devoted to the healing power of music, with performances by professional and amateur musicians alike.
In opening remarks, NIEHS and National Toxicology Program (NTP) Director Linda Birnbaum, Ph.D., spoke of the presence of music in our environment. "We're particularly interested in its health benefits, making sure that music is a part of our everyday lives," Birnbaum said.
"What better way to talk about music in the environment than to tie it in with Earth Day?" asked co-organizer Laura Thomas, Ph.D., neuroscientist and scientific review officer in the NIEHS Division of Extramural Research and Training.
Continuing the musical journey
Planning began after co-organizer and NTP health scientist Brandy Beverly, Ph.D., learned about a similar event last June, which was a joint production of The Kennedy Center and the National Institutes of Health (NIH).
"I knew we needed to do something like that here," said Beverly, who is also a violinist with the Durham Medical Orchestra. "It's a great way to integrate music in our lives while exploring the science behind its benefits."
Beverly went to Thomas, who was part of the team led by NIH Director Francis Collins, M.D., that planned both the Kennedy Center event and an earlier conference in January 2017. John Schelp, from the NIEHS Office of Science Education and Diversity, assisted.
The program opened with Lumbee tribal member John Oxendine explaining the importance of music in ritual and daily life, and performing a haunting sample of traditional flute music. "When our elders sing the old songs they knew as a child, it's medicine to them," Oxendine said.
Kevin LaBar, Ph.D., professor of psychology and neuroscience at Duke University, explained the therapies that can result from understanding how the brain processes music.
"Music engages lots of different regions of the brain, and musical training can enhance those connections," said LaBar. "Using images, they've developed therapies to help people recover speech functions [lost due to strokes or other causes]."
Heidi White, M.D., vice chief of clinical affairs in the geriatrics division at Duke University School of Medicine, described a pilot study using a patient's musical preferences in the treatment of dementia.
"There was a statistically significant decrease in the severity of symptoms," said White. "There were also language improvements, a greater volume of speech, and more emphasis on reminiscence."
Neema Sharda, M.D., a geriatric physician at the Duke Center for the Study of Aging and Human Development, directs the Confusion Avoidance Led by Music (CALM) project. Her work also focuses on personalizing music and dementia, with an emphasis on pain management and what's known as postoperative delirium, a common complication for older patients.
"We hope to shrink the risk of delirium and use personalized music to modulate the need for pain medications," said Sharda. In one study, 65 percent of her patients reported a positive effect on mood and decreased delirium risk.
In the second session, Yasmine White, a music therapist and CEO and founder of Voices Together, described her work using music therapy to increase communication and socialization for individuals with developmental disabilities.
Kathryn Wyatt, co-founder of Kidznotes and director of El Sistema USA, discussed how El Sistema’s Venezuelan-based model creates social change by offering extracurricular musical training to socially and economically disadvantaged youth. Kidznotes, based at Duke, is El Sistema’s U.S. affiliate.
Max Puhala and Berk Ozturk, founders of Push Play Sing!, a participatory music program for people with disabilities, staged a remarkable demonstration with several clients. Other musical performers included the Durham Medical Orchestra, the Croasdaile Chorale, and Kidznotes.
Six-time Grammy-nominated jazz singer Nnenna Freelon closed the day with a beautiful interweaving of storytelling and song.
The event was a first for NIEHS. “Since I became director of NIEHS we’ve made a tradition of sponsoring community forums,” said Birnbaum. “We’re going to start making music a part of our journey towards health.”
According to Thomas, NIH plans to offer more opportunities to investigate music as a therapeutic intervention. “This event continues that conversation,” Thomas said.
(John Yewell is a contract writer for the NIEHS Office of Communications and Public Liaison.)