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.

Birnbaum shared a laugh with Thelma Jones, from the Breast Cancer Fund, and Adams-Campbell. “We got involved with environmental health because … this is where the community wanted us to go,” Adams-Campbell said. (Photo courtesy of John Schelp)

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.”

Anacostia is a vibrant and busy neighborhood in southeast Washington, D.C., just east of the Anacostia River, for which it is named. (Photo courtesy of John Schelp)

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.

Richardson (left) entertained a question from the audience. (Photo courtesy of Erik Kvalsvik)

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.

Members of the Anacostia community filled a hall at Thurgood Marshall Academy Public Charter School to discuss the links between the environment and breast cancer. (Photo courtesy of Seren Snow)

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.

The panel represented a cross-section of community members, health officials, advocates, and scientists. From left, Birnbaum, Adams-Campbell, Nesbitt, Williams, Lippman, Byrne. (Photo courtesy of Seren Snow)

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.

“There are social and physical environments that are linked to poor health outcomes,” said Nesbitt, center, during the panel discussion. (Photo courtesy of Erik Kvalsvik)

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.

Community members listened to panelists. “We go to places where people don’t know what they need to know,” said Williams, speaking of her foundation’s work in the community. (Photo courtesy of Erik Kvalsvik)

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.)