A substantial body of evidence links environmental exposures to increases in breast cancer incidence over the past decades. State and federal legislative initiatives that could help prevent breast cancer include: federal standards to achieve consistency in radiation-emitting medical and dental equipment; improved state quality assurance standards for radiation-emitting equipment; federal and state exposure limits for electromagnetic radiation; an overhaul of the federal Toxic Substances Control Act to reduce unsafe chemical exposures; strengthened premarket health and safety testing and regulation of pesticides; a federal ban on the manufacture, distribution and sale of consumer products containing bisphenol A and phthalates; and strengthened oversight and regulation of the cosmetics industry. We recommend public and private investment in research on low dose exposures, mixtures, and the timing of chemical exposures, as well as the development of health tracking and biomonitoring programs designed to link data from pollution surveillance systems with disease registries.

Breast Cancer Prevention Partners (BCPP) is leading the development of a first-ever, comprehensive breast cancer primary prevention plan for California. With a strong foundation of science and input from stakeholders, including academics, government regulators, nonprofit organizations, and impacted communities, we will create a policy agenda to reduce breast cancer in California. Most women who are diagnosed with breast cancer do not have any of the risk factors commonly associated with the disease. This raises questions about how we reduce risk for breast cancer at the individual, community, and societal levels. Our project seeks to explore the full range of prevention opportunities that can contribute to a statewide effort to reduce the incidence of breast cancer. Topics under exploration include individual and environmental exposures to toxic chemicals; exposure to ionizing radiation and other physical factors; structural barriers to a healthy diet and activity levels, such as food deserts and the built environment; workplace exposures and risk factors; impact of alcohol consumption and tobacco use; and the impact of racism and poverty on breast cancer risk. While all states have cancer plans, this project offers a unique approach. It turns the focus from the individual to societal changes. The interventions recommended will address systemic, society-level issues that increase risks for breast cancer. For instance, physical activity is protective against breast cancer. However, recommending to individuals that they become more active may be less effective than creating safe, walkable neighborhoods with recreational opportunities. It incorporates the important perspectives of communities affected by breast cancer into the recommended interventions. California’s numerous and diverse communities hold valuable information about the issues relevant to their local context and have an intimate understanding of their community’s strengths and barriers to effective change. BCPP engaged community advisors and conducted listening sessions across the state as part of a multistep process to include community knowledge. We have a strong commitment to ensure that social and environmental justice permeates the entire policy agenda. The process is guided by a multistakeholder advisory committee that includes some of California’s leading breast cancer, public health, social and environmental justice, and disease prevention experts. The project will generate a California policy agenda to reduce the incidence of breast cancer in the state. BCPP will work with stakeholders to implement the agenda in the coming years. While the focus of this groundbreaking approach will be squarely on breast cancer, the recommended interventions will undoubtedly impact numerous other cancers and adverse health impacts, and while the focus will be squarely on California, it will provide a road map for other states to prioritize primary prevention of breast cancer. Citation Format: Nancy Buermeyer, Connie L. Engel, Heather Sarantis, Ashley Babcock, Josie Daaboul, Janet Young, Janet Nudelman, M. Sharima Rasanayagam. A breast cancer primary prevention plan for the state of California [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr A38.

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