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30.
a jolt of estrogen:
See, for example, Endogenous Hormones and Breast Cancer Collaborative Group, “Circulating Sex Hormones and Breast Cancer Risk Factors in Postmenopausal Women,”
British Journal of Cancer
105, no. 5 (2011): 709–22
[http://dx.doi.org/10.1038/bjc.2011.254]
; A. Heather Eliassen et al., “Endogenous Steroid Hormone Concentrations and Risk of Breast Cancer Among Premenopausal Women,”
Journal of the National Cancer Institute
98, no. 19 (October 4, 2006): 1406–15 [
http://jnci.oxfordjournals.org/content/98/19/1406.abstract
]; and Rudolf Kaaks et al., “Serum Sex Steroids in Premenopausal Women and Breast Cancer Risk,”
Journal of the National Cancer Institute
97, no. 10 (May 18, 2005): 755–65. [
http://jnci.oxfordjournals.org/content/97/10/755.abstract
]

31.
the list of known human carcinogens:
National Toxicology Program,
Report on Carcinogens,
12th ed. (Research Triangle Park, NC: U.S. Department of Health and Human Services, 2011). Available on the National Toxicology Program website. [
http://ntp-server.niehs.nih.gov/?objectid=03C9AF75-E1BF-FF40-DBA9EC0928DF8B15
]

32.
possibly increasing the risk of breast cancer:
See, for example, F. Clavel-Chapelon, “Differential Effects of Reproductive Factors on the Risk of Pre- and Postmenopausal Breast Cancer,”
British Journal of Cancer
86, no. 5 (March 4, 2002): 723–27. [
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2230628
]

33.
A few scientists blame the change on bisphenol A:
See, for example, Kembra L. Howdeshell et al., “Environmental Toxins: Exposure to Bisphenol A Advances Puberty,”
Nature
401, no. 6755 (October 21, 1999): 763–64 [
http://www.nature.com/nature/journal/v401/n6755/full/401763a0.html
]; and Laura N. Vandenberg, Ana M. Soto, et al., “Bisphenol-A and the Great Divide: A Review of Controversies in the Field of Endocrine Disruption,”
Endocrine Reviews
30, no. 1 (February 1, 2009): 75–95. [
http://edrv.endojournals.org/content/30/1/75.abstract
]

34.
a more widely accepted explanation involves nutrition:
See Sandra Steingraber, “The Falling Age of Puberty in U.S. Girls,” August 2007, Breast Cancer Fund website, [
http://www.breastcancerfund.org/media/publications/falling-age-of-puberty
] which includes citations to the research; and Sarah E. Anderson, Gerard E. Dallal, and Aviva Must, “Relative Weight and Race Influence
Average Age at Menarche,” part 1,
Pediatrics
111, no. 4 (April 2003): 844–50. [
http://www.ncbi.nlm.nih.gov/pubmed/12671122
]

35.
the age of menarche … has dropped:
Steingraber, “The Falling Age of Puberty,” 20.

36.
Lactation also appears to hold estrogen in check:
See World Cancer Research Fund/American Institute for Cancer Research,
Food, Nutrition, Physical Activity, and the Prevention of Cancer,
239–42.

37.
more menstrual cycles than her grandmother:
David Plotkin, “Good News and Bad News About Breast Cancer,”
The Atlantic,
June 1998. [
http://www.theatlantic.com/magazine/archive/1998/06/good-news-and-bad-news-about-breast-cancer/5504
]

38.
Hormone therapies … associated with some cancers:
For an overview see two reports on the National Cancer Institute website “Menopausal Hormone Therapy and Cancer” [
http://www.cancer.gov/cancertopics/factsheet/Risk/DES
] and “Diethylstilbestrol (DES) and Cancer,” both reviewed December 5, 2011. [
http://www.cancer.gov/cancertopics/factsheet/Risk/menopausal-hormones
]

39.
obesity, especially in older women:
Sabina Rinaldi et al., “Anthropometric Measures, Endogenous Sex Steroids and Breast Cancer Risk in Postmenopausal Women,”
International Journal of Cancer
118, no. 11 (June 1, 2006): 2832–39 [
http://www.ncbi.nlm.nih.gov/pubmed/16385576
]; and Petra H. Lahmann et al., “A Prospective Study of Adiposity and Postmenopausal Breast Cancer Risk,”
International Journal of Cancer
103, no. 2 (November 4, 2002): 246–52. [
http://onlinelibrary.wiley.com/doi/10.1002/ijc.10799/abstract
]

40.
reduce the chances of premenopausal women getting breast cancer:
Kaaks et al., “Serum Sex Steroids in Premenopausal Women and Breast Cancer Risk.” Also see Elisabete Weiderpass et al., “A Prospective Study of Body Size in Different Periods of Life and Risk of Premenopausal Breast Cancer,”
Cancer Epidemiology, Biomarkers & Prevention
13, no. 7 (July 2004): 1121–27; and L. J. Vatten and S. Kvinnsland, “Prospective Study of Height, Body Mass Index and Risk of Breast Cancer,”
Acta Oncologica
31, no. 2 (1992): 195–200. [
http://www.ncbi.nlm.nih.gov/pubmed/1622634
]

41.
oral contraceptives may slightly raise the odds:
“Oral Contraceptives and Cancer Risk,” National Cancer Institute, reviewed March 21, 2012.

42.
Alcohol … with digestive cancers:
The evidence for esophageal, liver, and other cancers is examined in Vincenzo Bagnardi et al., “Alcohol Consumption and the Risk of Cancer: A Meta-Analysis,”
Alcohol Research and Health: The Journal of the National Institute on Alcohol Abuse and Alcoholism
25, no. 4 (2001): 263–70. [
http://pubs.niaaa.nih.gov/publications/arh25-4/263-270.htm
]

43.
the risk from hepatitis viruses:
Heather M. Colvin and Abigail E. Mitchell, eds.,
Hepatitis and Liver Cancer
(Washington, DC: The National Academies Press, 2010), 29–30. [
http://www.nap.edu/catalog.php?record_id=12793
]

44.
exposure to aflatoxin:
See, for example, P. E. Jackson and J. D. Groopman, “Aflatoxin and Liver Cancer,”
Clinical Gastroenterology
13, no. 4 (December 1999): 545–55. [
http://www.ncbi.nlm.nih.gov/pubmed/10654919
]

45.
Consuming two or three drinks a day:
Wendy Y. Chen, Walter C. Willett, et al., “Moderate Alcohol Consumption During Adult Life, Drinking Patterns, and Breast Cancer Risk,”
JAMA: The Journal of the American Medical Association
306, no. 17 (November 2, 2011): 1884–90. [
http://jama.ama-assn.org/content/306/17/1884
]

46.
a woman between the ages of forty and forty-nine:
“Risk of Developing Breast Cancer,” Breastcancer.org website, last modified on March 14, 2012. [
http://www.breastcancer.org/symptoms/understand_bc/risk/understanding.jsp
]

47.
Even tallness is a risk factor:
Jane Green et al., “Height and Cancer Incidence in the Million Women Study,”
Lancet Oncology
12, no. 8 (August 2011): 785–94. [
http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70154-1/abstract
]

48.
Ecuadoran villagers with a kind of dwarfism:
Jaime Guevara-Aguirre et al., “Growth Hormone Receptor Deficiency Is Associated with a Major Reduction in Pro-Aging Signaling, Cancer, and Diabetes in Humans,”
Science Translational Medicine
3, no. 70 (February 16, 2011):70ra13 [
http://stm.sciencemag.org/content/3/70/70ra13.abstract
] and Mitch Leslie, “Growth Defect Blocks Cancer and Diabetes,”
Science
331, no. 6019 (February 18, 2011): 837. [
http://www.sciencemag.org/content/331/6019/837.summary
]

49.
measured not in small percentages:
See, for example, the rankings in the Harvard Cancer Risk Index, described in G. A. Colditz et al., “Harvard Report on Cancer Prevention Volume 4: Harvard Cancer Risk Index,”
Cancer Causes & Control
11, no. 6 (July 2000): 477–88. [
http://www.ncbi.nlm.nih.gov/pubmed/10880030
]

50.
factors of ten to twenty:
According to the “Lung Cancer Fact Sheet,” male smokers are twenty-three times more likely to develop lung cancer, and women thirteen times more likely, compared with people who never smoked (American Lung Association website, November 2010). [
http://www.lung.org/lung-disease/lung-cancer/resources/facts-figures/lung-cancer-fact- sheet.html
]

51.
the figure is more like 1 in 8:
Rebecca Goldin, “Lung Cancer Rates: What’s Your Risk?” March 8, 2006, Research at Statistical Assessment Service (STATS) website, George Mason University. [
http://stats.org/stories/2006/lung_cancer_rates_mar08_06.htm
]

52.
online Memorial Sloan-Kettering cancer prediction tool:
See “Cancer Care/Prediction Tools” on the Sloan-Kettering website. [
http://www.mskcc.org/cancer-care/adult/lung/prediction-tools
]

53.
one-tenth the risk:
“Summary Report: Analysis of Exposure and Risks to the Public from Radionuclides and Chemicals Released by the Cerro Grande Fire at Los Alamos June 12, 2002,” New Mexico Environment Department, Risk Assessment Corporation, report no. 5-NMED-2002-FINAL, Risk Assessment Corporation website. [
http://www.racteam.com/docs/Cerro_Grande_Fire_Summary_Report.pdf
]

54.
some evidence, weak and conflicting:
“Vitamin D and Cancer Prevention: Strengths and Limits of the Evidence,” National Cancer Institute website, reviewed June 16, 2010, [
http://www.cancer.gov/cancertopics/factsheet/prevention/vitamin-D
] and Cindy D. Davis, “Vitamin D and Cancer: Current Dilemmas and Future Research Needs,”
American Journal of Clinical Nutrition
88, no. 2 (August 2008): 565S–69S. [
http://www.ncbi.nlm.nih.gov/pubmed/18689403
]

55.
among male Finnish smokers:
Rachael Z. Stolzenberg-Solomon et al., “A Prospective Nested Case-control Study of Vitamin D Status and Pancreatic
Cancer Risk in Male Smokers,”
Cancer Research
66, no. 20 (October 15, 2006): 10213–19. [
http://www.ncbi.nlm.nih.gov/pubmed/17047087
]

56.
a distant second place:
Office of Radiation and Indoor Air,
EPA Assessment of Risks from Radon in Homes
(Washington, DC: United States Environmental Protection Agency, June 2003), EPA website [
http://www.epa.gov/radon/risk_assessment.html
] , and “WHO Handbook on Indoor Radon: a Public Health Perspective” (Geneva: World Health Organization, September 2009), WHO website. [
[http://www.who.int/ionizing_radiation/env/radon/en/index1.html]
]

57.
about 7 in 1,000:
Office of Radiation and Indoor Air,
EPA Assessment of Risks,
appendix D, 82. The number they give is, more precisely, 73 out of 10,000.

58.
constant exposure:
With some digging one can find that the calculations assume 70 percent of one’s time is spent indoors. Office of Radiation and Indoor Air,
EPA Assessment of Risks,
7, 44.

59.
an artist living there had reported:
Harry Otway and Jon Johnson, “A History of the Working Group to Address Los Alamos Community Health Concerns,” Los Alamos National Laboratory, January 2000, available on the website of the U.S. Department of Energy, Office of Scientific and Technical Information. [
http://www.osti.gov/bridge/purl.cover.jsp?purl=/751963- rNM6nM/webviewable/751963.pdf
]

60.
State health officials investigated:
William F. Athas and Charles R. Key, “Los Alamos Cancer Rate Study: Phase I,” New Mexico Department of Health
and New Mexico Tumor Registry, University of New Mexico Cancer Center, March 1993 (published on the UNM Health Sciences Center website [
http://hsc- sandia.health.unm.edu/som/nmtr/LAC%20Cancer%20Rate%20Study--Phase%201.pdf
], and William F. Athas, “Investigation of Excess Thyroid Cancer Incidence in Los Alamos County,” Division of Epidemiology, Evaluation, and Planning, New Mexico Department of Health, April 1996. Available on the Department of Energy website. [
http://www.doeal.gov/SWEIS/OtherDocuments/312%20athas1996- Investigation%20of%20excess%20thyroid.pdf
]

61.
Texas sharpshooter effect:
The term was coined in the mid 1970s by the epidemiologist Seymour Grufferman while he was investigating a reported Hodgkin’s lymphoma cluster on Long Island, New York. E-mail to author, June 10, 2012. Also see S. Grufferman, “Clustering and Aggregation of Exposures in Hodgkin’s Disease,”
Cancer
39 (1977): 1829–33; K. J. Rothman, “A Sobering Start for the Cluster Busters’ Conference,”
American Journal of Epidemiology
132, no. 1 suppl. (July 1990): S6–13 [
http://www.ncbi.nlm.nih.gov/pubmed/2356837
] and Atul Gawande, “The Cancer-Cluster Myth,”
New Yorker,
February 8, 1999.

62.
no harmful exposures from chemical or radioactive contamination:
Agency for Toxic Substances and Disease Registry, “Public Health Assessment for Los Alamos National Laboratory,” September 8, 2006, available on the website of the U.S. Department of Health and Human Services, Agency for Toxic Substances and Disease Registry. [
http://www.atsdr.cdc.gov/hac/pha//LosAlamosNationalLab/LosAlamosNationalLabPHA090806.pdf
]

63.
The Long Island cancer cluster:
“Report to the U.S. Congress: The Long Island Breast Cancer Study Project” (Washington, DC: Department of Health and Human Services, November 2004). [
http://www.cancer.gov/cancertopics/causes/breast/libcsp
] The findings are summarized in Deborah M. Winn, “Science and Society: The Long Island Breast Cancer Study Project,”
Nature Reviews Cancer
5, no. 12 (December 2005): 986–94 [
http://www.ncbi.nlm.nih.gov/pubmed/16341086
] and Renee Twombly, “Long Island Study Finds No Link Between Pollutants and Breast Cancer,”
Journal of the National Cancer Institute
94, no. 18 (2002): 1348–51. [
http://jnci.oxfordjournals.org/content/94/18/1348.short
]

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