Imagine yourself vacationing in what you may consider the perfect place – Cape Cod, Massachusetts.  Can you feel the crisp summer air brush against your skin while you walk or bicycle through Cape Cod’s quaint town?  Envision looking out at the windswept peninsula landscape and majestic views of the sea, sand dunes, marshes, and cranberry bogs.  The geographic features and award-winning golf courses attract tourists from around the world and is one of the top 20 places to travel in the United States (Best Places to Visit in the USA, 2015).  While this all seems so luxurious and relaxing, there’s something daunting about Cape Cod:  It has the highest rate of breast cancer in the state of Massachusetts. In fact, it’s 20% higher than any other area in MA and has the highest death rate from breast cancer.  Let’s put this into perspective:  That’s 153.8 cases per 100,000 in Cape Cod, compared to the rest of the state that averages at 132.3 per 100,000.  Women who live on Cape Cod for 25 to 29 years are at a 72% higher risk to develop breast cancer than women who have only lived there for a few years (McCormick, 2012).  So, why are breast cancer rates so high in Cape Cod?

The natural and man-made environments are the two major contributing factors responsible for the high rates, and this has impacted Cape Cod’s population physiologically and epidemically and even how they are socially and politically responding to it.

Barnstable County comprises of 15 towns in Cape Cod, totaling 413 square miles of terrain including forests, beaches, marshes, and bogs.  The “soil” in Cape Cod is made up of glacial outwash, till and other silt making it very permeable.  This allows water to drain well.  This means pollutants will seep into adjacent layers of soil and water it comes into contact with; therefore, these compounds are more than likely to be in residents’ drinking water.  These pollutants are also in the air.  Cape Cod has a “unique microclimate with a dual sea breeze circulation,” meaning any pollutants that are swept in this revolving air current will come right back.  It leaves high concentrations of contaminants from regional power plants and fossil fuels and is worse in the summer months.  The air quality in Cape Cod is 50% worse than Boston (Air Quality, 2002).

So, who has the highest rates of breast cancer in the Cape Cod area?  Researchers have mapped out pockets in Washpee, Sandwich and Falmouth Counties as well as Eastern Cape Cod (Aschengrau, Vieira, Webster, & Weinberg, 2002).  And even today, these areas are still saturated with chemical contaminants.  The major source of contamination comes from the Massachusetts Military Reserves (MMR).

Did you know the MMR used chemicals for training purposes, and they disposed of them via drains, “unlined” landfills, and drywells (circa 1911)? Also, a major fuel spill occurred in the 1970s, spewing 700,000 gallons of jet fuel into the ground water.  When these chemicals leached into the water, it created a ground plume.  Ground plumes are areas which contain abundant amounts of potentially toxic contaminants which can diffuse into our drinking water.  As of 2010, there are 12 ground plumes in the Cape Cod area. The largest one measures 2.5 miles.  Additionally, 78 additional contaminated areas have been discovered around the military base.  It is noted that these ground plumes move 1 to 2 feet per day (Goddard, 1997)! This wasn’t discovered until 1989, and since then, there have been strong efforts to clean these up.  Every day, environmental agencies filter 18 million gallons of contaminated water (Martin, Spring 2008), and the county expects each plume to take at least 30 years to completely clean.  Yes, you heard me right, 30 YEARS! Plume contaminants include anything from fuel, missile compounds, flammable waste liquids, and many other carcinogenic elements (Ground Water Plume, April 2010).

The MMR hasn’t been the only source for projecting contaminants into the environment.  Cape Cod is known for its cranberry bogs and is a known tourist and residential destination for golf-goers.  Additionally, the cape has many projects which require special measures to maintain their landscapes.  This includes high usage of pesticides, fungicides and herbicides.  These have been largely applied since the 1930s via power sprays, airplanes, and sprinkler systems.  “Specifically, breast cancer risk was approximately 20 to 80 percent higher for women who lived in or near areas treated for tree pests in 1948-1995, near cranberry bogs in 1948 to the mid-1970s, and, near agricultural land since the mid-1970s” (Findings of the Cape Cod Breast, 2006).

Also, further tests suggest that many other carcinogenic chemicals have been found above normal levels in the drinking water, like alkylphenol polyethoxylates (APEOs) (Brody, Geno, Melly, Rudel, & Sun, Feb 1998) and perfluorinated chemicals (PFCs).  Just outside of the Barnstable County Airport, high levels of PFCs were found in the Hyannis Water System, and a study has shown increased rates of breast cancer in this area (Tests Find New Contaminants, n.d.).

You may think the only way to be exposed to these chemicals is through the outdoor environment, but indoor exposure in Cape Cod homes has also been correlated with an increased breast cancer risk.  In a home-study conducted by Silent Spring Institute, 66 different endocrine disrupting compounds were found in 11 out of 120 homes at very high levels like, polychlorinated biphenyls (PCBs), polyaromatic hydrocarbons (PAHs), Di (2-ethyl hexyl) phthalate (DEHP), tris (2,3-dibromopropyl)phosphate, PBDEs (flame retardants).  They even found above-normal levels of pesticides, like DDT and chlordane, which had been brought inside via air circulation and the water supply (Findings of the Cape Cod Breast Cancer and Environment Study, 2006).

Scientists know that these chemicals are carcinogenic.  They classify them as endocrine disrupting compounds (EDCs).  EDCs mimic natural hormones, like estrogen and androgen, and can trick the brain into overproducing them.  They also attach themselves to cell receptor sites and “block the endogenous hormone from binding” (Endocrine Disruptors, Jan 2015).  This alters metabolization in organs, like the liver and kidneys, and also arrests the body’s communication system.  This results in inadequate gland and hormone response.

Estrogen is a messenger hormone and has many functions in the body, but it mainly impacts sexual development and functioning of reproductive organs in the female body.  When there is overproduction or a high exposure to estrogen, it stimulates breast tissue and cell growth and starts tumorigenesis, which can turn into metastatic cancer. So, when we have chemicals changing the body’s natural physiology, it becomes imbalanced and does not know how to get back to homeostasis.

While all of these chemicals possess carcinogenic properties (most of them now banned because of their posed cancer risks), there have been inconclusive studies that show little to no association to breast cancer specifically to some of the chemicals, like pesticides, in drinking water (Aschengrau, Brody, Kennedy, McKelvey, Rudel, & Swartz, 2006).  This could possibly be due to the lack of research, as well as too many variables in the sample. But, studies DO SHOW that because of how the groundwater is laid out in the Cape Cod environment, it would be easy for these chemicals to leak into the water supply (Cape Cod Breast Cancer and the Environment Atlas, n.d.)  Additionally, pesticide manufacturers, specifically made for cranberry bogs, cannot afford incentives to have the Environmental Protection Agency (EPA) evaluate and register the chemicals for safety.  These pesticides are used against EPA regulations under a different set of standards through the State of Massachusetts (Pesticide Use in Cranberries, 2005).

Government agencies also don’t test for most of these chemicals found in Cape Cod at water treatment facilities and only have to meet certain standards to be considered “safe.”  Plus, water treatment facilities don’t have to work synergistically with agencies like the EPA to follow specific guidelines.  There are a lot of gaps when safety is concerned, and I believe this is part of the problem.  This was especially evident in the 1900s when people were allowed to utilize and dispose of toxic chemicals freely.  With Cape Cod’s environment being susceptible to collecting contaminants naturally and the abundant human use of toxic chemicals, it makes sense as to why breast cancer rates are so high.

In 2006, Massachusetts was ranked first in the US for the incident rates of breast cancer, with Barnstable County possessing the most cases.  Sixty-one is the average age that women get diagnosed in the United States, but trends seem to show otherwise in Cape Cod where more women in their 40s are being diagnosed (Breast Cancer Statistics, April 2014).  In 1991, Cape Cod resident, Cheryl Osimo, was diagnosed at age 41.  She is a mother of two who has no family history of breast cancer and who led a healthy lifestyle.  She was scared and angry, just like many other Cape Cod women in her age bracket who were diagnosed. She advocates for change in environmental policy and is now the coordinator of the Cape Cod Breast Cancer and Environment Study (Lequire, 1998).

Only in the past couple of decades or so has the community been made aware of the causes of this devastating issue, which has resulted in formation of different advocate groups to try to change policy.  GreenCAPE (Cape Alliance for Pesticide Education) is an advocate group who opposes pesticides on Cape Cod.  They work to inform the residents and tourists of the chemically saturated sources and areas. Right now, they are proposing mechanical methods to get rid of weeds under the power lines instead of, once again, infusing their soil, air, and water with cancer-causing herbicides (NSTAR Spraying Herbicides, 2014).

Healthcare professionals have also been encouraging women to start getting mammograms earlier than the normal guidelines.   Advocate groups, like the Massachusetts Breast Cancer Coalition, hold annual campaigns and walks for mammogram testing.  Their mission statement is “dedicated to preventing environmental causes of breast cancer through community education, research advocacy, and changes to public policy.”  They have claimed that Massachusetts is the first state where breast cancer is an epidemic.

Researchers have dedicated years of work to reveal these probable causes of high breast cancer rates in Cape Cod. The environmental and political factors responsible for the detriment of the population on the cape should be fixed to reduce this health disparity. However, it will be a long road ahead because political change does not happen overnight and the chemical cleanup will take decades.  What can be improved is awareness in the Cape Cod community to enhance social congregation to advocate for change.  Disabling the full potential of humans by disease will only prevent a sustainable future for Cape Cod, Massachusetts.

We all continue to be contaminated without our consent!” – Margo Simon Golden, president of the board of Massachusetts Breast Cancer Coalition.


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