This document discusses women's environmental health risks and the efforts of Magee-Womens Hospital of UPMC to educate patients and health professionals about reducing toxic exposures. It notes that women traditionally managed household environments which impact family health. It outlines Magee's initiatives like eliminating mercury, educating new parents on toxins, and hosting conferences on this topic. Magee partners with organizations like the Center for Environmental Oncology to promote primary prevention through environmental education.

1. Throughout history, women have tradi-
tionally controlled the environments of
their families and had major impacts on
their health and welfare. In fact, the term
“economy” derives from the Greek word
for oikos meaning home, reflecting the
central role of household management for
the nation. As a hospital dedicated to the
health and well being of women and chil-
dren, Magee-Womens Hospital of UPMC
is proud to have launched several major
efforts to promote environmental educa-
tion for its patients and health profes-
sionals. Designated a National Center of
Excellence in Women’s Health by the U.S.
Department of Health and Human Ser-
vices, over the past three years, Magee
has expanded its efforts to educate and
motivate women and their health profes-
sionals in the simple ways that home and
community-based activities affect their
health and that of their families.
This issue of “Healthy Choices, Healthy
Lives”, brought to you in partnership with
the Center for Environmental Oncology of
the University of Pittsburgh Cancer Insti-
tute and supported by the Healthy People,
Healthy Places Program of the Highmark
Foundation and the Heinz Endowments,
provides an overview of women’s special
environmental health risks. Furthering our
commitment to the health of women and
infants, Magee has eliminated nearly all
mercury-containing equipment from our
hospital. Mercury is a common ingredient
in thermometers, blood pressure cuffs, flu-
orescent lights, and batteries. Scientists
understand that as a heavy metal, mercury
leaves tracks throughout the environment
and can damage the nervous system of
animals and humans and impair their abil-
ity to have healthy offspring. The best way
to ensure that society has healthy children
is to prevent exposure to toxic agents from
occurring in the first place.
Center for Environmental Oncology
Spring 2009 • Volume 3 • Number 2
Funding for this newsletter is provided by
the Highmark Foundation and the Heinz Endowments.
Highmark Healthy Places, Healthy People
Continued on page 2
TABLE OF CONTENTS
Breast Cancer and Work: The Case for Prevention
by Devra Lee Davis, PhD, MPH, Director,
Center for Environmental Oncology of UPCI
Page 3
Nurses’ Chemical Exposures in the Workplace
by Judy Focareta, RN, Med
Page 5
Breast Milk and Environmental Pollutants
by Michele Ondeck, RN, MEd, IBCLC
Page 6
The Risks of CT Radiation,
by Shawn Farley, Director of Public Affairs,
American College of Radiology
Page 10
Additional Internet Resources
Page 12
UPCOMING events
April 18, 2009
11 AM – 4 PM
Earth Day Celebration
Frick Environmental Center
Beechwood Boulevard, Squirrel Hill, Pittsburgh
Come visit the Center for Environmental
Oncology’s booth!
Visit our Website for
up-to-date events!
www.environmentaloncology.org
Women and the Environment
by: Leslie C. Davis, President, Magee-Womens Hospital; vice president,
Women's Services, UPMC
In
cooperation
with

2. www.environmentaloncology.org
2 Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Spring 2009
Volume 3 • Number 2
Helping to make prevention the cure for cancer.
In recognition of our mercury-free com-
mitment, this past year, Magee received
the Making Medicine Mercury Free Award
as well as the Partner Recognition Award
from Hospitals for a Healthy Environment,
two premier national distinctions of en-
vironmental achievement in health care.
We have continued this effort to improve
environmental health by creating pro-
grams to educate prospective parents on
the importance of protecting the capacity
of men and women to have healthy
children if and when they choose to do so.
Since 2005, Magee has included environ-
mental education in its programming for
new parents, in patient education mate-
rials, and in its childbirth and newborn
classes. We are committed to inform-
ing and motivating parents, caregivers,
and the greater community in creating a
healthy, sustainable environment for our-
selves, our children, and our future.
At their initial prenatal visits, expectant
mothers receive a special calendar out-
lining monthly milestones for their preg-
nancies. This calendar offers information
on bathing products, infant feeding, and
safe nurseries, as well as tips for reduc-
ing toxic exposures in the home. As they
are discharged, all new mothers receive
information on avoiding toxins, including
limiting pesticides in the home, garden
and on pets; removing shoes at the door
so you do not track toxic chemicals inside;
limiting eating fish that are high in mercury
like swordfish, tilefish, shark, mackerel
(king) or canned albacore tuna; and read-
ing labels on cosmetics and personal care
products and choosing safer products,
when possible, using the National House-
hold Products Database of the National
Library of Medicine (http://hpd.nlm.nih.
gov) and the Environmental Work Group’s
information system at www.cosmeticdata-
base.com. Other suggestions given to new
parents are:
• Test your home for invisible radon gas
as it has been shown to increase
cancer risk
• Test your home for lead-based paint
if you are in an older home built
before 1980
• Install a carbon monoxide detector on
each level of your home
• Use low toxicity household cleaners
such as baking soda and vinegar
to avoid suspected carcinogens
• Choose low volatile organic compound
(VOC) furniture, paints and flooring,
if possible
Primary prevention remains the most
cost-effective way of promoting health.
We continue to partner with colleagues
at Children’s Hospital and the Center for
Environmental Oncology to develop in-
novative ways to educate health profes-
sionals and the public through the use of
films and public lectures on a wide range
of topics. In recognition of our education
and outreach to health care professionals
on topics of environmental health, Magee
received the 2007 Children’s Environmen-
tal Health Excellence Award from the U.S.
Environmental Protection Agency’s Office
of Children’s Health Protection.
Additionally,since2007,inpartnershipwith
the Heinz Endowments, Magee-Womens
Hospital of UPMC hosted two “Women’s
Health and the Environment” confer-
ences, bringing in nationally heralded
environmental health scientists who edu-
cated over 4,000 participants on the most
recent scientific evidence about environ-
mental exposures and how these expo-
sures impact our health. These scientists
raised awareness about environmental
Women and the Environment Continued From Page 1
Continued from page 1
UPCOMING events
April 21, 2009
8:30 AM – 12 noon
Magee-Womens Hospital of UPMC presents
Environmental Health Literacy for
HealthCare Providers
Speakers:
Dr. Melissa McDiarmid,University of
Maryland School of Medicine
Barbara Sattler, RN,DrPH, FAAN from the
University of Maryland School of Nursing
Dr. Jonathan Weinkle, Squirrel Hill Health Center &
Jewish Healthcare Foundation
Magee Auditorium
CE and CME credits available
For more information or to register,
please call 412-802-8290.
May 28, 2009
Why cancer is not an inevitable result of aging
Presentation: 6:00 - 7:30 PM
Q & A Session: 7:30 - 8:00 PM
Talk by Dr. Devra Davis, Director of
Center for Environmental Oncology of UPCI
Professor, Department of Epidemiology,
Graduate School of Public Health
2706 Mercer Road
New Castle, PA 16105
For more information, contact Kay at (412) 647-1062
or email info@environmentaloncology.org
July 1, 2009
October 7, 2009
6:30 – 9:00 PM
It is Easy Being Green Workshops
Environmental Toxins and Your Family’s Health
Magee-Womens Hospital of UPMC in collaboration
with the Center for Environmental Oncology of UPCI
Free and open to the public!
For more information or to register,
please call 412-802-8299
or email info@environmentaloncology.org
Continued on page 12

3. www.environmentaloncology.org
3Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Spring 2009
Volume 3 • Number 2
Highmark Foundation: Healthy Places, Healthy People
Patterns of breast cancer are unexplained.
(1) While rates of breast cancer are high-
er in white women than in black women,
the chances of dying from breast cancer
are generally greater for blacks than for
whites. One in five cases of breast cancer
occurs in white women under the age of
40, while one in four cases occurs in black
women this same age. The reasons why
breast cancer is more lethal in blacks
than whites and more common in young
black women remain a topic of intense
research interest. Only one in ten cases
of breast cancer occurs in a woman who
has inherited the risk of the disease from
either her mother or father. Identical twins
begin life from a single egg, but only one
may develop cancer. This means that most
cases come about as a result of things that
happen in the course of a lifetime of good
and bad exposures. Thus, most cases of
breast cancer do not result from inherited
defects, but arise as a result of complex in-
teractions that take place over the course
of a lifetime between genes and the envi-
ronments in which women live and work.
A substantial body of scientific evidence
indicates that exposures to common
chemicals and radiation, alone and in com-
bination, are important causes of breast
cancer. The challenge in understanding
the causes of breast cancer is consider-
able as the disease can arise decades
after critical exposures take place. The
disease may result from either hormon-
ally active materials or those that directly
damage DNA.(2) Pre-menopausal breast
cancer and post-menopausal breast can-
cer are likely to have different causes. The
National Institute of Environmental Health
Sciences has a major program of research
on several different classes of environ-
mental hazards that have been found to in-
crease the risk of breast cancer, including
some hormones and endocrine-disrupting
compounds, synthetic solvents, heavy
metals, pesticides, fossil fuel combustion
by-products, and both ionizing and non-
ionizing radiation. (1, 3)
The State of the Evidence report of the
Breast Cancer Fund evaluated more
than 600 peer-reviewed studies on breast
cancer and concluded that there are ma-
jor opportunities to reduce the risk of the
disease through lowering exposures in
many different workplaces.(4) The funda-
mental challenge to researchers and pol-
icy makers remains this: we seldom can
identify specific distinct causes of breast
cancer through public health research.
Toxic Chemicals Found in
Popular Children’s Bath
Products
A March 2009 study released by the Campaign for Safe
Cosmetics (CSC) reported that some popular children’s
bath products were contaminated with formaldehyde
and 1, 4-dioxane. (1) The CSC and its partner, Environ-
mental Working Group, sent 48 children’s bath products
to an independent laboratory in California to be tested.
More than half of these widely-used products contained
both formaldehyde and 1,4-dioxane. Both chemicals are
listed as “probable carcinogens” by the Environmental
Protection Agency (EPA). (2,3) Formaldehyde can also
cause adverse skin reactions in both children and adults
who are sensitive to the chemical. (4,5) The FDA lacks
the authority to test personal care products and does not
require that contaminants be listed on product labels.
Some products sold in the U.S. would be illegal in Europe,
which has more stringent standards regarding the use of
known or suspected carcinogens. Congress is examining
policies to reform cosmetic regulations.
References:
1. Campaign for Safe Cosmetics Report: Toxic Chemicals Found in Kid’s
Bath Products, published March 12, 2009, http://www.ewg.org/book/
export/html/27697.
2. U.S. Environmental Protection Agency. Technology Transfer Network
Air Toxics Web Site. “1,4-Dioxane (1,4 Diethyleneoxide).” http://www.
epa.gov/ttn/uatw/hlthef/dioxane.html
3. Environmental Protection Agency Technology Transfer Network Air
Toxics Web Site. “Formaldeyde.” http://www.epa.gov/ttn/atw/hlthef/
formalde.html
4. Boyvat A, Akyol A, Gurgey E. Contact sensitivity to preservatives in
Turkey. Contact Dermatitis. 2005; 52 (6): 333-337.
5. Jacob SE, Brod B and Crawford GH. Clinically Relevant Patch Test
Reactions in Children—A United States Study. Pediatric Dermatology.
2008; 25 (5): 520-527.
Breast Cancer and Work: The Case
for Prevention
by Devra Lee Davis, PhD, MPH, Director, Center for Environmental Oncology of UPCI
Continued on page 4

4. www.environmentaloncology.org
4 Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Spring 2009
Volume 3 • Number 2
Helping to make prevention the cure for cancer.
Choose Regular Soap over
Antibacterial Soap
Antibacterial soap and disinfectants may contain
triclosan or other active ingredients classified by the
EPA as pesticides. Studies by government scientists
have shown that regular use of antibacterial soap allows
bacteria to become resistant to them and can irritate
the skin, especially the skin of infants and children. In
fact, in 2005, an FDA panel, in an 11 to 1 vote, warned
that popular mass-marketed antibacterial soaps and
washes showed no evidence of preventing infections
more effectively than hand washing with regular soap.
The FDA asked for the panel’s advice because of
concerns that common antimicrobial agents used in the
soaps, such as triclosan and triclocarban, that can also
be found in products ranging from deodorants to plastics,
accumulate in groundwater and soil. As they build up
in the environment, these chemicals could eventually
contaminate drinking water and farmed food. This could
give rise to potentially dangerous resistant bacteria.
several experts caution that even the potential risk of
resistance may not be worth continued mass marketing
of soaps that have no proven benefit to consumers.
Drug-resistant bacteria are considered a major health
threat by public health experts. Some strains, including
S. aureus (staph), have shown increased levels of
resistance to multiple antibiotics. The safest solution
is to wash your hands frequently for 15 seconds at a
time with warm soapy water and using paper towels
or air drying to avoid transmitting infections.
References:
Allison.E. Aiello et al, "Consumer Antibacterial
Soaps: Effective or Just Risky?” Clinical
Infectious Diseases, 45 Suppl 2:S137-47, 2007
Litjen Tan, PhD; Nancy H. Nielsen, MD, PhD; Donald C.
Young, MD; Zoltran Trizna, MD, PhD; for the Council on
Scientific Affairs, American Medical Association, http://
archderm.ama-assn.org/cgi/content/abstract/138/8/1082/
Yet, every proven cause of cancer in hu-
mans has also been shown to cause can-
cer in animals when adequately studied.
Policymakers have agreed that in order
to prevent cancer in humans, we should
rely on experimental findings. Insisting on
proof that a given compound or profes-
sion increases the risk of breast cancer
in groups of women who have been well
studied over time before acting to control
or restrict suspected exposures effective-
ly means waiting for sufficient numbers of
illness or deaths to amass before acting to
prevent future harm.
We have made remarkable progress in
finding and treating breast cancer today.
Recently, deaths from breast cancer and
new cases of the disease have dropped in
older women. Some scientists believe that
the reduction in use of Hormone Replace-
ment Therapy accounts in large part for
some of these recent declines.(5) Other
known hormonally-active compounds that
are tied with increased breast cancer
include the pharmaceutical hormone
diethylstilbestrol (DES) which was given
to women to prevent miscarriage. Both
mothers and their daughters who were
exposed to DES have an increased risk of
breast cancer.
The fact that specific hormones have
been linked with increased risk of breast
cancer strongly suggests that compounds
that act like hormones—termed endocrine
disruptors or hormone mimics—may simi-
larly affect breast cancer risk. The arena
of prevention of the disease remains ripe
for major advances. Numerous studies
show that workplace factors can signifi-
cantly increase the risk of the disease.
Developing appropriate policies to reduce
such exposures should play an important
role in reducing the burden of breast can-
cer in the future.
Occupations Associated With Increased
Risk of Breast Cancer
• Aircraft and automotive workers
• Barbers and hairdressers
• Chemists and chemical
industry workers
• Clinical laboratory technologists
• Computer and peripheral
equipment operators
• Crop farmers and fruit and
vegetable packers
• Dental hygienists
• Dentists
• Dry cleaning workers
• Flight attendants
• Food, clothing and
transportation workers
• Furniture and woodworking
industry workers
• Homemakers
• Journalists
• Librarians
• Nurses, particularly
chemotherapy nurses
• Paper mill workers
• Physicians
• Publishing and printing
industry workers
• Meat wrappers and cutters
• Microelectronics workers
• Radiologic technologists
• Rubber and plastics industry workers
• Social workers
• Telephone workers
Breast Cancer and Work: The Case for Prevention Continued From Page 3
Continued on page 11
source: International Agency for Research on
Cancer, Monographs' and Annual Report on
Carcinogens, National Toxicology Program

5. www.environmentaloncology.org
5Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Spring 2009
Volume 3 • Number 2
Highmark Foundation: Healthy Places, Healthy People
As nurses, how often do we reach for a
germicidal sanitary wipe cloth to disinfect
a surface? How often do we wear gloves
when doing so? How many of us take
the time to check out the Material Safety
Data Sheet (MSDS) that tells us about the
health risks of the products we are using?
According to the American Nurses As-
sociation (ANA), “given the hectic pace
nurses face every day, most don’t think
twice about the products they use, or the
products that surround them, as they go
about their work.” Recently, the ANA col-
laborated in a pilot survey conducted by
the Environmental Working Group, which
documented exposures in the workplace
for 1500 nurses in all 50 states to chemi-
cals, pharmaceuticals and radiation.
Some of these exposures can also occur
in the home or school as part of customary
cleaning practices.
Following are some preliminary results:
• Nurses with high exposure to medica-
tions of any type (at least once a week for
at least 10 years) reported a 14% increase
in cancer incidence relative to nurses
with low or no exposure
• For nurses reporting high exposure to
antineoplastic drugs, this jumped to 40%
• Asthma rates increased up to 50% for
nurses with high exposures to disinfect-
ing and sterilizing agents, housekeeping
chemicals and latex
• Nurses with high exposure to ethyl-
ene oxide and antineoplastic drugs also
reported up to a 20% higher incidence of
miscarriage
According to the Environmental Working
Group “despite potential biases and limi-
tations, the findings are consistent with
lab and occupational studies of hazard-
ous agents.”
The complete survey results can be found
at www.ewg.org/reports/nursesurvey.
At UPMC Hospitals, there are policies in
place to protect nurses from exposure
to harmful chemicals. MSDS sheets are
available online and on the units. Con-
sistent with the recommendations of the
Nurses’ Chemical Exposures in the Workplace
by Judy Focareta, RN, MEd
ALTERNATIVES TO PESTICIDES
It is never a good idea to spray chemical pesticides inside
the home. Children can be especially impacted by them.
Try some of these safer alternatives to eliminating pests.
Cockroaches:
• Bay leaves
• Fine dusting of boric acid
• Equal parts of oatmeal, flour, & plaster
• Bait boxes
Ants:
• Sprinkle black pepper, chili powder or chalk
• Brush a 1 to 10 mixture of lavender & olive oil
into the tracks that ants follow
• Ants are known to avoid ferns & juniper leaves,
lavender flowers, & goldenrod
Moths:
• Cedar balls or chips
• Lavender
Fleas:
• Vacuum rugs and homes thoroughly & frequently
• Wash pet bedding weekly in hot soapy water
• Spray pet daily with 50/50 mixture of white vinegar
and water
• Mix brewer’s yeast, Vitamin B, or garlic tablets
into pet food
• Rub animal’s coat with fennel, rue & rosemary
• Use enzyme shampoos
Mice & Rats:
• Lavender, cedar oil, or camphor will repel
• Traps
• Baits
• Place cotton balls saturated with peppermint oil
in areas of rodent activity
For references, see www.environmentaloncology.org
Continued on page 9

6. www.environmentaloncology.org
6 Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Spring 2009
Volume 3 • Number 2
Helping to make prevention the cure for cancer.
Hidden Pesticides in Your
Home: How To Protect Your
Children
Many building & household products contain pesticides.
Some pesticides have been shown to cause cancer
in humans, especially when people are exposed at high
levels. Children are at increased risk for pesticide
poisoning because of their smaller size & because
pesticides may be stored improperly or applied to
surfaces that are accessed easily by children.
Culprits:
• Antibacterial Soaps & Disinfectants
• Mothballs
• Synthetic Carpets
• Wall & Shelf Paper
• Paint
Alternatives:
• Regular Soap
• Lavender sachets
• Untreated Hardwood
• Butcher Paper
• Non‐Vinyl wallpaper
• No‐VOC Paint
US Environmental Protection Agency. Prevention,
Pesticides and Toxic Substances (7506C);
EPA 735-F-93-050, September 21, 2004.
Breast Milk and Environmental Pollutants
by Michele Ondeck, RN, MEd, IBCLC
If you are pregnant or know someone who
is, you or your loved one might be weigh-
ing the risks and benefits of breastfeeding
the baby. With all the recent news about
environmental pollutants and their poten-
tial to contaminate a mother’s breast milk,
you might wonder about breastfeeding.
There is no doubt that human milk is the
best source of food for infants, because
it contains the optimal balance of fats,
carbohydrates, and proteins for babies,
and promotes healthy growth, immunity,
and development. While there is concern
about contamination of breast milk, the
reality is that babies fed formula get sick
far more often than babies fed breast milk.
Human milk is species-specific, which ac-
counts for its protective benefits to the
baby by helping the baby develop its im-
mune system. The American Academy of
Pediatrics recommends exclusive feeding
of breast milk for the first six months of life
and “breastfeeding should be continued at
least the first year of life and beyond for
as long as mutually desired by mother and
child”. (1)
Yet, it is important for a nursing mother to
become aware of the environmental expo-
sures that might contaminate breast milk
in order to reduce her exposure to these
toxins, when possible. The Mothers Milk
Project characterized how toxic contami-
nates from industrial waste around the St.
Lawrence River moved through the local
food chain. Nursing mothers who regu-
larly ate fish from the St. Lawrence River
had double the amount of toxic chemicals
called PCBs than those who did not. (2)
Sandra Steingraber, PhD, author and an
expert on the environmental links to can-
cer and reproductive health, brought the
concern of environmental pollution and
breastfeeding to the public in her book,

7. www.environmentaloncology.org
7Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Spring 2009
Volume 3 • Number 2
Highmark Foundation: Healthy Places, Healthy People
Having Faith: An Ecologist’s Journey to
Motherhood. She describes how the bi-
ology of breast milk protects babies and
how breastfed children are more “mature,
secure, and assertive, and score higher on
developmental tests”. Breast milk is pre-
ventive medicine. We need to ensure that
mother’s milk is protected from fat-seeking
pollutants that include dioxin and PCBs as
well as wood preservatives, termite poi-
sons, mothproofing agents, toilet deodor-
izers, insulating materials, dry-cleaning
fluids, gasoline vapors, and the chemical
by-products of garbage incineration. (3)
The research is clear: breast is best.
Breast-fed babies have fewer gastroin-
testinal, urinary tract, ear and respiratory
infections. Breast milk is also protective in
reducing diseases like Crohn’s, lymphoma
and diabetes during childhood. Mothers
benefit, too, with a reduced risk of pre-
menopausal breast cancer, ovarian can-
cer and postmenopausal hip fractures.
In the United States, public health policy
promotes breast-feeding, although ac-
commodations in public places are some-
times lacking. We also need a public
health policy to protect the environment
so that the food we and our infants eat,
the air we breathe and the water we drink
are not contaminated. One large source of
contamination is from chemicals referred
to as persistent organic pollutants (POPs).
The POPs, which a mother is exposed to
in her lifetime, are stored in her body fat
and then transferred into her milk during
breastfeeding. They include PCBs used in
manufacturing processes; dioxins primar-
ily from hazardous waste sites and the
incineration of municipal waste, flame re-
tardants; and organochloride pesticides.
The main sources of exposure to these
chemicals and other hazards, like mercu-
ry, occur when they enter our food supply,
primarily through fats found in dairy, meat
and fish. Over the years, a woman stores
chemicals in her body fat, and they be-
come what is referred to as her “body bur-
den.” In general, the older a women is, the
more pollutants she stores. During breast-
feeding, chemicals that are stored in her
body fat are then passed on to the baby in
the breast milk. This is why nursing moth-
ers reduce their body burden of pollutants
in the first six months of breastfeeding.
When comparing only breast-fed babies
of mothers who were exposed to very
high levels of PCBs with those who were
not exposed, exposed babies have poorer
psychomotor and cognitive performance.
Nonetheless, the World Health Organiza-
tion advises that the advantages of breast
milk outweigh the potential risk from envi-
ronmental pollutants in most cases.
The workplace can be another source of
environmental exposures for breastfeed-
ing women. There are no current estab-
lished “safe” levels of contaminants in
breast milk (4), so the best advice is to
reduce exposures to the extent possible.
Clothes and shoes that could be contami-
nated at the workplace with toxins such
as pesticides, asbestos, industrial chemi-
cals, dry cleaning chemicals, leads and
other metals, should be left there to avoid
bringing these contaminants into the fam-
ily home. All family members would benefit
from leaving shoes at the door to avoid
bringing contaminants into our homes.
Eating a healthy diet that is rich in veg-
etables, grains and fruits and low in satu-
rated fats is a good step to help reduce
an infant’s exposure to environmental
chemicals in breast milk. When possible,
try to purchase local and organic foods,
especially for produce known to be high-
est in pesticide residues such as peaches,
pears, berries, cherries, green beans,
Prevention of Toxic
Exposures and their impact
on a child’s development
A number of organizations advocate for the prevention
of toxic exposures and their impact on a child’s develop-
ment. One is the Greater Boston Physicians for Social
Responsibility. Their fact sheet on “Why Breast-Feeding
is Still Best for Baby” (2001) (www.psr.org/site/Doc-
Server/BFeasyeng2pg.10.18.pdf?docID=5205 ) is part of a
series In Harms Way-Training for Health Care Profession-
als. Another excellent and comprehensive resource for
childbearing families is the Healthy Child, Healthy World
website (http://healthychild.org ).
References:
Breast Milk and
Environmental Pollutants
1.) American Academy of Pediatrics Breastfeeding and the
Use of Human Milk. Pediatrics, 115, p. 496-506.
2.) Silliman, J., Fried, M. G., Ross, L., & Gutierrez, E. R. (2004). The
Mothers Milk Project Women of Color Organize for Reproductive
Justice, South End Press: Cambridge, MA, p.123-141.
3. Steingraber, Sandra. Having Faith: An Ecologist's Journey
to Motherhood. New York: Berkeley Books, 2001.
4.) Nickerson, K. (2006). Environmental Contaminants in Breast
Milk. Journal of Midwifery & Womens Health, 51(1): 26-34.
Continued on page 8

8. www.environmentaloncology.org
8 Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Spring 2009
Volume 3 • Number 2
Helping to make prevention the cure for cancer.
Breast Milk and Environmental Pollutants Continued From Page 7
Sunscreen primer
Sunscreen can provide a physical or chemical barrier
to block the sun’s damaging rays. The first sunscreens
were developed in the 1930s. Sunscreens today contain
a mixture of chemicals. A minimum SPF 15 is required to
protect against UVA and UVB exposure. Metal oxides, such
as titanium dioxide and zinc oxide, can contain nanopar-
ticles that absorb and reflect/scatter UV rays (1). They offer
protection against UVA and UVB while being transparent
on the skin. It is important to reapply regularly and to use
about an ounce of liquid product for each application.
Some information about sunscreen ingredients can be
found at www.ewg.org.
Self-identification catches two-thirds of melanoma cases,
so it is important to check your skin!:
• Remember ENU: Evolving New and Unusual moles
• Look for the ugly duckling: be suspicious of any mole
that is unlike the rest.
Be aware of the ABCDE rule when checking your skin:
A Asymmetry: One side of the mole differs from the other
B Border irregularity: Mole has ragged edges
C Color: Mole is not the same color throughout
D Diameter: Mole is larger than ¼ inch in diameter
E Evaluation: Always seek medical advice for any
skin abnormality you find
References:
1. Nash JF. Human safety and efficacy of ultraviolet filters
and sunscreen products. Dermatol. Clin. 2006. 35-51.
spinach and tomatoes. Fruits and vegeta-
bles should always be thoroughly washed
and scrubbed before eating. If you can
only afford conventional apples, pears
and peaches, you can peel their skins
before eating to reduce your exposure to
residues.
Maintaining a “normal” weight for your
height, exercising regularly and having a
diet that is vegetarian or of low fat dairy
and meats also reduces the body’s burden
of fat-seeking toxic compounds over time.
It is also recommended that everyone
limit their intake of fish that are highest
in mercury, including swordfish, tilefish,
shark, mackerel and tuna as well as local-
ly caught fish from areas with advisories.
But, pregnant women and nursing moth-
ers should try and avoid eating these fish,
if possible.
Additionally, about 15% of the population
has a private source of drinking water that
should be tested for contamination. Put-
ting home filters on your faucets or using
a charcoal filtered pitcher for your drink-
ing water can eliminate up to 98% of con-
taminants in your water. Besides keeping
contaminants out of the home, limiting
exposure to toxic fumes such as pesticide
sprays, house cleaning products, gaso-
line, and petroleum-based products while
pregnant and breastfeeding is also recom-
mended.
When saving breast milk for later feed-
ings, consider the storage container you
use. Plastic bottles, and containers made
of polycarbonate (recycling symbol #7)
can contain bisphenol A. This should be
avoided, as should plastics that contain
chemicals called phthalates. BPA and
some types of phtalates can mimic the
hormone estrogen and have been as-
sociated, in some research experiments,
with changes in the male reproductive
system and speeding up the growth of
breast cancer cells. In animal studies
of phthalates, hypospadias (a birth de-
fect in which the male urinary opening is
misplaced on the penis), reduced testos-
terone production, and decreased sperm
counts have been noted. New studies in
human male infants exposed to phtha-
lates in breast milk show lower androgen
(a male hormone) activity. Chemicals in
plastics can leach into breast milk or for-
mula during the heating process. That is
why glass bottles and containers are most
highly recommended and why major U.S.
manufacturers recently announced, after
pressure from consumers and retailers,
that they will no longer put BPA into baby
bottles.

9. www.environmentaloncology.org
9Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Spring 2009
Volume 3 • Number 2
Highmark Foundation: Healthy Places, Healthy People
American Nurses Association, nurses are
encouraged to familiarize themselves with
the potential hazards of the chemicals
they use and to take necessary precau-
tions. Personal protective equipment is
available, and whenever possible, safer
substitutes for these chemicals are con-
sidered.
However, even with these safeguards in
place, the reality is that nurses often as-
sume that the chemicals they are using
are not harmful. Often they are too busy
to take the time to read the MSDS or use
personal protective equipment. germicid-
al sanitary wipe cloths are an example of
this phenomenon.
Every day, nurses use germicidal sanitary
wipe cloths to disinfect surfaces.The chlo-
rinated germicidal chemicals in the wipes
are necessary in the health care setting
because they help to prevent the spread of
antibiotic resistant infection for both staff
and patients. The chemical ingredient in
these wipes has been linked in epidemio-
logical studies to increases in asthma and
immune system sensitization. Studies also
indicate that it may affect fertility.
MSDS sheets are available for this prod-
uct and clearly state the possible side ef-
fects of overexposure and the precautions
to take while using the product. Since the
chemical is absorbed through the skin,
nurses can reduce their exposures sig-
nificantly by simply wearing gloves when
using germicidal sanitary wipe cloths.
Although inhaling the chemical is con-
sidered to be less of a concern with the
wipes, they should be used in a well ven-
tilated space. If the chemical touches the
skin, nurses should wash thoroughly with
soap and water. Unfortunately, during the
course of a busy work day, many nurses
do not adhere to these precautions.
At Magee-Womens Hospital of UPMC
there are plans to create a multidisci-
plinary group to continue to promote safer
use of materials, to provide education for
staff and to determine if less toxic alterna-
tives to chemicals used are available. By
working together, we can create safer en-
vironments for both our nursing staff and
our patients.
FLEEING FROM FLEAS
Fleas are reddish brown to black, wingless external
parasites that are generally found on the skin of cats, dogs
and other animals.
What are symptoms of fleas?
• Flea bites are the major nuisance, though some cat
fleas are suspected of transmitting murine typhus
to humans.
• Bites itch and appear as a central red spot surrounded
by a red halo.
• Some people and pets may have an allergic reaction
to the bite.
How to manage fleas without using pesticides*
• Thoroughly clean pet beds and resting areas both
indoors and outdoors in hot soapy water.
• Thoroughly and regularly vacuum floors, rugs, carpets,
furniture, and crevices around corners to remove flea
eggs and larvae.
• Place vacuum bags in a sealed bag and throw out
since flea eggs and larvae can survive inside the bags.
• Use a special comb to remove fleas from your pet and
comb on regular intervals to reduce occurrence
of fleas.
• Spray your pet daily with a 50/50 mixture of
white vinegar and water.
• Use an enzyme shampoo on your pet.
• Mix brewer’s yeast, or vitamin B or garlic tablets
into their pet food.
• Rub animal’s coat with fennel, rue, and rosemary.
• Place eucalyptus seeds and leaves where the
animal sleeps.
• As a last resort and after consulting with a
veterinarian, use topical liquid spot treatment.
U.S. to Phase Out Bisphenol A (BPA)
from Baby Bottles!
Nearly a decade after efforts in Europe were made to limit children’s exposure to
BPA, and after the Center for Environmental Oncology and others publicized the
underlying science on BPA hazards, the six largest manufacturers of baby bottles
in the U.S. have said they will stop selling bottles made with BPA. Sunoco, a major
manufacturer of gas and chemicals, announced recently that it would no longer
sell BPA to producers of children’s products. BPA is a ubiquitous chemical com-
monly used to make many plastics. It mimics the hormone estrogen and has been
increasingly linked to a wide range of health effects, including an increased risk of
cancer. Research shows that BPA poses a particular danger to fetuses, infants and
children, because it can interfere with cell function at a point when bodies are still
developing. New research suggests that BPA has an effect at very low doses—
lower than the current safety standard set by the FDA. There is continuing concern
about manufacturers’ proposals to continue shipping BPA baby bottles overseas,
while banning it domestically
Nurses' Chemical Exposures in the Workplace Continued From Page 5

10. www.environmentaloncology.org
10 Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Spring 2009
Volume 3 • Number 2
Helping to make prevention the cure for cancer.
The Risks and Benefits of Ct Radiation
by Shawn Farley, Director of Public Affairs, American College of Radiology
Americans are exposed to seven times
more radiation from diagnostic scans than
in 1980, according to a recent report from
the National Council on Radiation Protec-
tion and Measurement.(1)
Although imaging techniques are increas-
ingly replacing more invasive techniques,
and are undoubtedly saving and extend-
ing lives, there are concerns about over-
utilization of imaging exams and possible
long-term health effects of repeated ra-
diation exposure from scans. Studies pub-
lished in the New England Journal of Med-
icine (NEJM) and Journal of the American
Medical Association (JAMA) in recent
years have suggested that repeated scan-
ning over time may raise a person’s risk of
developing cancer.(2)
In 2006, following a dramatic increase in
the number of such scans performed in the
previous decade. (3) Provider fears of liti-
gation, advancing technology, and patient
demand have contributed to the increase
in imaging. The executive director of the
NCRP also recently cited self-referral, the
process by which providers buy imaging
equipment and refer patients to these in-
office scanners, as a primary driver of the
dramatic increase in imaging and associ-
ated radiation exposure.
In response to the NCRP report, the Amer-
ican College of Radiology (ACR) urged
caution and asked patients not to put off
needed imaging care.(4) “Medical imaging
exams should not be performed unless the
benefittothepatientclearlyoutweighsany
associated risk. Patients must make these
risk/benefit decisions regarding their im-
aging care based on all the facts available
and in consultation with their doctors,”
said James H. Thrall, M.D., FACR, chair of
the ACR Board of Chancellors.
Patients should also seek out imaging care
at ACR-accredited facilities which ensures
that: the physician interpreting scans has
met stringent education and training stan-
dards; the technologists operating the
equipment are certified by the appropriate
body; and that the imaging equipment is
surveyed regularly by a medical physicist
to make sure that it is functioning properly
and is taking optimal images.
Patients are also urged to keep a record of
their X-ray history (5) and before undergo-
ing a scan, to ask their physician:
• Why do I need this exam?
• How will having this exam improve
my health care?
What can you do to
help make The Allegheny
Stewardship project a
success?
Volunteer to catch fish during the sampling season.
It will be fun! All gear and bait will be provided
by Venture Outdoors. Just purchase a fishing
license, which you can do online through the PA
Fish and Boat Commission. You can also take a
ride on or tour the RiverQuest Research vessel.
Volunteer to give hair, toenail, and/or urine
samples to researchers so we can gauge actual
biomarkers of exposure to river contaminants.
Contact Dr. Dan Volz, the project’s Principal
Investigator at cdv5@pitt.edu.
indoor clean air plants
Plants can clean the air inside your home and office. The
2-year study tested the following major indoor pollutants
and found that most ornamental indoor plants can help
clean the air of at least one type of toxin, and some are
able to remove all three of the following:
Place one ornamental indoor plant per 100 square
feet of office space. Select large leafy plants and mix
plant species to combat the full range of toxins. The
recommendation of the National Aeronautics and Space
Administration (NASA) is to use 15 to 18 good-sized
houseplants in six- to eight-inch diameter containers in
a 1,800 square-foot house and take care not to introduce
mold by using too much water.
For sidebar references, see www.environmentaloncology.org
Formaldehyde
Airborne Pollution Sources
Foam Insulation
Plywood / Particle Board
Carpeting
Furniture
Paper Products
Cleaners
Benzene
Airborne Pollution Sources
Tobacco Smoke
Petroleum Products
Synthetic Fibers
Plastics
Inks & Dyes
Rubber Products
Detergents
Trichloroethylene
Airborne Pollution Sources
Dry Cleaning
Inks & Dyes
Adhesives
Varnishes
Lacquers & Paints
Plant Solutions
Corn Plant
Spider Plant
Philodendron species
Bamboo Palm
Golden Pothos
Chrysanthemum
Plant Solutions
Dragon Tree
Dracaena
Potted Mum
Gerbera Daisy
Ribbon Plant
English Ivy
Peace Lily
Plant Solutions
Dragon Tree
Potted Mum
Peace Lily
Gerbera Daisy
Ribbon Plant
ShaulSchwarz/Stringer/News/GettyImages

11. www.environmentaloncology.org
11Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Spring 2009
Volume 3 • Number 2
Highmark Foundation: Healthy Places, Healthy People
• Are there alternatives that do not use
radiation which are equally as good?
• Is this facility ACR-accredited? (6)
• Is my child receiving a “kid-sized”
radiation dose? (for pediatric exams)
The Alliance for Radiation Safety in Pedi-
atric Imaging, encompassing 34 medical
organizations from the United States and
around the world, is conducting the Im-
age Gentlysm campaign to make providers
aware of opportunities to lower radiation
dose used in pediatric imaging. The cam-
paign’s Web site (www.imagegently.org)
provides protocols and other information
to help medical providers lower radiation
dose and tools to help parents keep track
of their children’s imaging exams.
For more information regarding radiation
exposure from medical imaging scans and
medical imaging in general, patients and
medical personnel can visit the “Radiol-
ogy Safety” section of the ACR Web site
(www.acr.org/safety) as well as the “Ra-
diation Safety” section of www.radiology-
info.org.
PERSONAL POLLUTION
PROBLEM STATEMENT
Describe, name. and/or draw a current or past
environmental pollution problem that you are aware
of that may be affecting your community or the
Allegheny River Watershed in general. Please be as
specific as possible and try to tell us exactly where
the problem(s) are occurring or has occurred. This
may be an air, water, land, or mixed source pollution
problem. This can also be mailed to Dr. Dan Volz at
Bridgeside Point, 100 Technology Drive, Suite 564,
BRIDG, Pittsburgh, PA 15219-3130. cdv5@pitt.edu
Continued on page 12
References:
The Risks and Benefits
of Ct Radiation
1. National Council on Radiation Protection and Measurement, Report
No. 160, Ionizing Radiation Exposure of the Population of the United
States. http://www.ncrponline.org/Press_Rel/Rept_160_Press_Release.
pdf
2. Brenner DJ, Hall EJ. Computed tomography—an increasing source of
radiation exposure. N Engl J Med 2007;357:2277–2284. http://content.
nejm.org/cgi/content/full/357/22/2277?ijkey=3c615c2b1729769d268345
6834dc2d1f62005ab7&keytype2=tf_ipsecsha
3. American College of Radiology. Utilization of Imaging. http://www.acr.
org/SecondaryMainMenuCategories/SocioeconomicResearch/utilization.
aspx
4. American College of Radiology white paper on radiation dose in
medicine. J Am Coll Radiol 4(5): 272-84. http://www.ncbi.nlm.nih.gov/
pubmed/17467608
5. Image Gently. My Child’s Medical Imaging Record. http://spr.affinis-
cape.com/associations/5364/files/Dose_Record_8.5x11_fold.pdf
6. ACR-Accredited Facility Search. http://www.acr.org/facility-search
References:
Breast Cancer and Work:
The Case for Prevention
1. Breast Cancer and the Environment Research Centers of the National
Institute of Environmental Health Sciences, http://www.bcerc.org
2. California Breast Cancer Research Program, http://www.cbcrp.org/
publications/papers/
3. Cornell University. Breast Cancer and Environmental Risk Factors,
http://envirocancer.cornell.edu/
4. Breast Cancer Fund:, http://www.breastcancerfund.org/evidence
5. Vassar College, Environmental Risks and Breast Cancer, http://erbc.
vassar.edu/erbc/
6. Silent Spring Institute: http://sciencereview.silentspring.org/index.cfm
7. Chlebowski et al., N Engl. J Med, 2009, 360:573-87
Breast Cancer and Work: The Case for Prevention Continued From Page 4
In each of the professions listed in the
blue box on page four, observations of
increased risks of breast cancer have
been generated based on detailed expo-
sure studies or an estimate of typical ex-
posures associated with certain jobs that
are consistently found to be associated
with a greater chance that breast cancer
will develop in thousands of workers. The
types of studies conducted include case
comparison analyses that contrast the
risk of breast cancer in individuals with
well characterized exposures to some
toxicants compared to other individuals
without such exposures. Other studies of
workplace risks have been developed by
following large numbers of workers with
well characterized common exposures
over time and comparing their overall pat-
terns of disease to patterns that occur in
other groups of workers that generally are
not exposed to the same agents.
Modern life is a mixture. As a result, the
ability to draw conclusions about the
causes of breast cancer or any other
chronic illness from observations of
workplace conditions remains one of the
most challenging parts of public health
research. Efforts to prevent breast can-
cer necessarily must rely on experimental
studies conducted in animals or in cell
cultures. With support from the Susan G.
Komen for the Cure Foundation, The Si-
lent Spring Institute evaluated studies on
more than 200 different compounds found
to cause breast tumors in animals in the
journal Cancer in 2007 (6) and concluded:
Many environmental pollutants that cause
mammary gland tumors in animals are
also hormonally active and mimic estro-
gen, which is a breast cancer risk fac-
tor. Human studies of breast cancer risk
factors have focused chiefly on those
associated with childbearing, behavior
and medical histories. Efforts to study the
environmental links to breast cancer in
humans have been hampered by limited
funding and major difficulties in conduct-
ing such research. Breast cancer can
take decades to form. Relevant exposures
to hormonally mimicking compounds can
also occur over long periods of time. In
instances of pre-menopausal breast can-
cer, pre-natal conditions and exposures
can also be important determinants. De-
spite the serious limits in epidemiological

12. Spring 2009
Volume 3 • Number 2
www.environmentaloncology.orgPrinted on chlorine-free 100% PCW Recycled Paper, with soy-inks.
Please share this newsletter and be
sure it is recycled.
Additional
Internet Resources
Breast Cancer Fund
www.breastcancerfund.org
Environmental Health News
www.environmentalhealthnews.org
Environmental Working Group
www.ewg.org
www.comesticsdatabase.com
Health Care Without Harm
www.hcwh.org
Healthy Child, Healthy World
www.healthychild.org
The CDC
www.cdc.gov
The Green Guide
www.thegreenguide.com
The National Cancer Institute
www.nci.nih.gov/cancertopics
Tobacco Free Kids
www.tobaccofreekids.org
Susan G. Komen for the Cure
cms.komen.org/komen/index.htm
Venture Outdoors
www.ventureoutdoors.org
Newsletter Editor: Sharon F. McDermott, MFA
12
research in this area, studies of workers
have consistently found elevated risks for
women who work with a number of chem-
icals, including polychlorinated biphenyls
(PCBs)—banned chemicals previously
used in electrical equipment and other
products. Women who work with organic
solvents, or common air pollutants and di-
oxins also have developed greater rates
of breast cancer than those without such
exposures.
Several major reviews of the field agree
that human studies of environmental risks
for breast cancer should take advantage
of new tools such as the ability to iden-
tify molecular markers of exposure and
indicators of genetic susceptibility. In the
absence of better studies in humans, a
prudent public policy position has been
crafted by the World Health Organization,
International Agency for Research on
Cancer. Studies that a given compound
induces cancer in experimental animals
should be interpreted as indicating that
this same compound constitutes a risk to
human health.
The Silent Spring Institute combined in-
formation from national and international
sources and identified 216 different chem-
icals that should be regarded as causes
of breast cancer in humans, because they
are proven to cause mammary tumors in
animals. The Women's Health Trial has
shown that the increased risk of breast
cancer tied with hormone replacement
therapy declined soon after this therapy
was discontinued. This strongly implies
that changing patterns of exposure to
other hormonally active compounds may
also have major benefits to reducing
breast cancer risk. (7)
“While it’s disturbing to learn that so
many chemicals may be linked to breast
cancer,” says Dr. Julia Brody, executive
director of Silent Spring Institute, “we
must remember that we have a great op-
portunity to save thousands of lives by
identifying those links, limiting exposure,
and finding safer alternatives. It’s critical
that we integrate this information into pol-
icies that govern chemical exposures.”
Women and the Environment Continued From Page 2
Breast Cancer and Work: The Case for Prevention Continued From Page 11
toxins present in our air, water, food and
the personal care products we use, and
how, even in low doses, the cumulative
affect of our exposure to these contami-
nants might increase our risks of devel-
oping cancer, heart disease, asthma and
other diseases. Another set of chemicals,
endocrine disruptors, such as bisphenol
A (BPA) found in baby bottles, toys, and
dental sealants, mimic our body’s natural
hormones and impact our endocrine sys-
tems. These conferences also highlighted
solutions and strategies that encouraged
women to lower their environmental expo-
sures and thus, reduce the health risks to
themselves and their loved ones. A com-
prehensive toolkit, which was developed
for these conferences, is available online
at: www.womenshealthandenvironment.
org/toolkit.
As a result of these and other efforts, ma-
jor manufacturers of baby bottles recently
announced that they will no longer use
BPA. For more information on health edu-
cation at Magee and for class schedules,
follow this link http://www.magee.edu/
hec/welcome.asp to our Health Education
Calendar.