Women), and Marion (Mhel) Kavanaugh-Lynch (California Breast Cancer Research Program), Britt Reid (NCI), and Mary White (CDC). These presentations provided valuable information about ongoing Federal and non-Federal activities related to breast cancer and the environment research. The Committee would like to acknowledge the staff from the NHLBI Office of Committee Management Service Center, especially Kimberly Hetkowski as well as Kate Ryan of NIEHS for providing considerable administrative oversight and support of committee activities and meetings conducted during the production of this report. Finally, the Committee would like to acknowledge the numerous staff at Federal agencies and institutes, as well as the NGOs, who provided information regarding breast cancer research activities. The Committee is also grateful for the thoughtful review of the draft report by Federal agencies. Contract Support The Committee would like to thank staff of The Scientific Consulting Group, Inc. for their considerable contributions in the production of this report. These individuals include Kathryn Brown-Huamani, for the many hours spent compiling, editing, and revising documents and for her expert integration of the components of the report; Marcia Feinleib, for coordinating the project; Joanne Brodsky, for reviewing/editing the report, and Charles Wallace, for designing the printed report. The Committee’s work also was supported by Connie Engel (Breast Cancer Fund) and Casey Reed (Kelly Services contractor to the NTP) who provided essential information and materials to the Committee during the development of this report. 1-1 Breast Cancer and the Environment: Prioritizing Prevention 1 On October 8, 2008, Congress passed the Breast Cancer and Environmental Research Act.a The Act required the Secretary of the U.S. Department of Health and Human Services (HHS) to establish an Interagency Breast Cancer and Environmental Research Coordinating Committee (IBCERCC) of federal and nonfederal members to examine the current state of breast cancer and the environment research and make recommendations for eliminating any knowledge gaps in this area. The large and increasing burden of breast cancer demands innovative research and bold new approaches to uncover the intricate combination of factors inside and outside the body that lead to the disease. Based on our review of the state of the science, current programs and investments by federal agencies and nongovernmental organizations, and relevant communication efforts and policies, the IBCERCC offers seven recommendations to highlight the urgent need for coordinated, targeted efforts to identify and mitigate the environmental causes of breast cancer. Breast cancer takes a tremendous toll on women and men of all ages, races, and ethnicities, as well as on their families and communities. Breast cancer also has a huge impact on the health care system that treats and monitors those people who have been diagnosed with the disease and provides end-of-life care for those who die from it. Prevention is the key to reducing the emotional, physical, and financial burden of breast cancer. Despite decades of productive breast cancer research, the number of women diagnosed with the disease continues to rise. In 2012, an estimated 227,000 women and 2,200 men in the United States will be diagnosed with breast cancer, and approximately 40,000 women will die from it.1 Worldwide, breast cancer is the most commonly diagnosed malignancy and the leading cause of cancer death in women, accounting for approximately 14 percent of cancer deaths.2, 3 Researchers have long known that genetic and environmental factors individually contribute and interact with each other to increase breast cancer risk. Studies show that breast cancer rates can vary with changing environmental circumstances. Furthermore, the large majority of cases occur in women with no family history of breast cancer. Environmental factors are more readily identified and modified than genetic factors and therefore present a tremendous opportunity to prevent breast cancer. a Breast Cancer and Environmental Research Act of 2008, P. L. No. 110-354, 122 Stat. 3984 (October 8, 2008). http://www.gpo.gov/fdsys/pkg/PLAW-110publ354/pdf/PLAW-110publ354.pdf Executive Summary Prevention is the key to reducing the burden of breast cancer. 1 CHAPTER 1-2 Breast Cancer and the Environment: Prioritizing Prevention 1 mitigate the environmental causes of the disease has not been a priority. At the federal level, only a small number of efforts target breast cancer and the environment. The Committee notes that, at most, 10 to 11 percent of breast cancer research projects funded by the National Institutes of Health (NIH) and the U.S. Department of Defense (DoD) focus on environmental health. No other federal agency supports substantial research on the environmental causes of breast cancer. Other federal agencies and nongovernmental organizations, however, support and conduct research related to breast cancer and the environment and are important partners in any effort to prevent breast cancer. Breast cancer prevention is underfunded at the federal level in both research and public health programs, and future investments must focus on this area. Enhanced