This document discusses the rising incidence of cancer worldwide and in India. It focuses on breast cancer incidence from a study conducted at IMS & SUM Hospital. The study found the highest incidence of breast cancer was in the 41-50 age group, and 29% of cases were young breast cancer. The document then discusses xenoestrogens like Bisphenol A (BPA) found in plastics and their role in the development of hormone-dependent cancers like breast and prostate cancer. Laboratory experiments detected high levels of BPA in plastic water bottles and containers that were old or exposed to heat. BPA acts as a weak estrogen and is poorly removed from the body, potentially creating an estrogen-excess situation linked to

1. Our own story- Pathetic polythene
Prof (Dr) Viyatprajna Acharya, MD, PhD
IMS & SUM Hospital,
Siksha ‘O’ Anusandhan University

2. 1996

3. 28 February 2019 IMS & SUM HOSPITAL, S'O'A DEEMED TO BE UNIVERSITY,
Can we call cancer
epidemic???

4. Are we bettering in cancer
diagnostics or really the
incidence is menacingly
increasing???

5. • In 2012, an estimated 14.1
million new cases of cancer
occurred worldwide.
• >4 in ten cancers – in Low HDI
countries
• The four most common cancers
occurring worldwide are lung,
female breast, bowel and
prostate cancer.
• These four account for around 4
in 10 of all cancers diagnosed
worldwide.

6. 28 February 2019
IMS & SUM HOSPITAL, S'O'A UNIVERSITY,
ODISHA
Swapping of breast CA and cervical CA incidence in India!!!

7. 28 February 2019
IMS & SUM HOSPITAL, S'O'A UNIVERSITY,
ODISHA
GLOBOCAN 2012- Cancer incidences inIndia

8. • Bhubaneswar- ~ 10 lakhs (1 million)
population
• 422 Sq km
• IMS & SUM Hospital- 750+300 bedded
• OPD - 2300 patients / day
28 February 2019
IMS & SUM HOSPITAL, S'O'A UNIVERSITY, ODISHA

9. Retrospective study of 9 mth done
28 February 2019
Breast CA incidence in SUM Hospital
21-30
31-40
41-50
51-60
61-70
~300 cases of CA
breast CA was the highest
Highest incidence in 41-50 yr age group
YOUNG BREAST CA- 29% cases !!!

10. YOUNG BREAST CARCINOMA ON THE RISE
• Youngest patient
was 16 years!!!
• Changed lifestyle
• Environmental
factors
• Obesity
• Improved
awareness
• Early diagnosis

11. My own story……
• Everyday milk curdled
• Learning lesson for me
• Came across a new
term-
XENOESTROGENS

12. XENOESTROGENS???
• Foreign estrogens
• ESTROGEN ANALOGUES
• Similar in structure as estrogen
• Plant source- phytoestrogens
They mimic estrogens!!!
28 February 2019
IMS & SUM HOSPITAL, S'O'A UNIVERSITY,
ODISHA

13. Xenoestrogens
• 4-Methylbenzylidene camphor (4-MBC) (sunscreen
lotions)
• Butylated hydroxyanisole / BHA (food preservative)
• Atrazine (weedkiller)
• Bisphenol A (monomer for polycarbonate plastic and
epoxy resin;
• BPS- insecticides and pesticides
• Antioxidant in plasticizers
• Dieldrin (insecticide)
• DDT (insecticide)
• Endosulfan (insecticide)
• Erythrosine / FD&C Red No. 3
• Heptachlor (insecticide)
• Phenosulfothiazine (a red dye)
• Phthalates (plasticizers)
• DEHP (plasticizer for PVC)
emulsion polymerization;
laboratory detergents; pesticides)
• Polychlorinated biphenyls / PCBs
(in electrical oils, lubricants,
adhesives, paints)
• Parabens (lotions)
• Lindane /
hexachlorocyclohexane
(insecticide)
• Methoxychlor (insecticide)
• Nonylphenol and derivatives
(industrial surfactants; emulsifiers
for

14. 28 February 2019
IMS & SUM HOSPITAL, S'O'A UNIVERSITY,
ODISHA

15. Phytoestrogens
• The coumestans
• Prenylflavonoids
• Isoflavones
Estrogenic as well as anti-estrogenic and claimed to be
beneficial in preventing breast CA

16. What is Bisphenol A?
• Bisphenol A (BPA)- 2, 2 bis (4-hydroxyphenyl) propane
• intermediate in the synthesis of epoxy resins,
polycarbonate plastics
• Chemical structure very similar to estrogen- estrogen
structural analogue
• Unbreakable hard plastics usually contain this

17. Where do we find BPA ??
• Ubiquitous chemical

18. Detected in 95% of 56 dust samples, with the concentrations ranging
between 0.8 mg to 10 mg per gram of dust
• Sports equipments
• Recycled paper items
• Medical equipments- catheters, dental implants
• Coating material- 9% of all BPA
• Dental materials- bis-GMA (Bisphenol A-glycidyl methacrylate),
fillings, sealants, crown material

19. Chemistry of BPA
• synthesized by the condensation of phenol with
acetone in the presence of a catalyst, a strongly
acidic ion exchange resin
• Moderately water soluble
• Moderate bioaccumulation
• Metabolized by liver- T1/2 5.4 hrs

20. Why should we bother about BPA???
• Phenolic structure- interacts with estrogen
receptor
• Acts as agonist (ER-beta)or dual action (ER-
alpha)
• Create estrogen-excess like situation
• Involved in pathogenesis of endocrine
disorders

21. Associated with…
• Female and male infertility
• Precocious puberty
• Hormone dependent tumours- Breast and prostate
• PCOS
• Metabolic disorders- Insulin resistance, DM

22. Our lab experiment with BPA
• Decided on assaying BPA in water
samples from different sources and in
fluid food samples
• Settled for only water samples due to
lack of infrastructure
• Our most common sources of BPA
ares plastic containers for water, food
in pouches etc

23. Materials and Methods
• Study done at IMS & SUM Hospital and SPS of
S’O’A (DU) University
• Assayed by HPLC-PDA (JASCO-Japan) by
standard method
• Calibration curve set with Bisphenol A standard
(Hi-media)
• BPA was extracted from samples by liquid-liquid
phase extraction
• Sample findings compared with standard curve

24. Water sample sources
• Water supply source from town
• Tube-well water
• Water in new pet bottle
• Water in scratched pet bottle
• Plastic water pouch
• New pet bottle exposed to all climatic
conditions for 2 months
• Water in baby feeding bottle, new and
scratched
• Microwaved water in plastic container
• Hot water poured into a polythene bag
• BPA-free container

25. Results???
Water sample AUC BPA Value in µg/ml
Water supply of the city by pipe 0.1 <1
Water from pond 0.12 <1
Water from new pet bottle 0.14 <1
Water from a used and scratched pet bottle 6.9 5.95
Water from a plastic water pouch 7.7 9.32
A new pet bottle of water exposed to sunlight
and all climatic condition over 2 months
8.1 11.01
Microwaved water in plastic bowl 7.8 10.02
Water in BPA-free plastic container 0.02 <1
Water in polythene 490 2044 (2mg)
Water in a new baby feeding bottle 0.04 <1
Water in an old and scratched baby feeding 6.8 5.53

26. Statistically significant against uncontaminated water
• Samples of scratched pet bottles, baby feeding bottle was ~1000
times; BPA in climate exposed water was maximum
• Hot water poured in polythene bag was worst- 1 crore times!!!

27. BPA and Breast CA
• Endocrine disrupter
• Weak estrogenic activity
• Estrogen excess like situation created
• Poorly removed from the body as compared to natural estrogen
• In vitro studies- human breast cancer cell lines exposed to BPA
showed increased proliferation and oxidative stress
• Similar results for MCF-7 estrogen receptor positive cells (ER +)
- low levels of BPA significantly increased its proliferation and
the expression of the progesterone receptors

28. Breast CA pathogenesis is multifactorial

29. • Postmenopausal women- High BPA correlated with
↑mammographic density
• occupational exposure to BPA increased incidence of
breast cancer
• ↑BPA- associated with precocious puberty, male and
female infertility too !
• In utero exposure to BPA- led to precocious puberty
• PCOS- activation of the hypothalamic GnRH pulse
generator leading to a constant increase of plasma LH
concentrations which in turn stimulate the ovarian
androgen production and impair proper ovarian follicle
development
• Associated with laryngeal and lung cancers also!!

30. BPA directly increases androgen secretion

31. • Endocrine disruptor
• In utero and infancy exposures to BPA can increase
prostate CA
• BPA activates a tumor-derived AR mutant (T877A),
leading to androgen-independent prostate cancer cell
proliferation
• Rat experiments have strengthened the research

33. Epigenetic changes

34. Plastic load on the world
• Annual global production of
plastics skyrocketed, from two
million metric tons in 1950 to a
jaw-dropping 400 million metric
tons in 2015.
• Since 1950s our civilization has
produced a whopping 8.3 billion
tons of the stuff.

35. Strangest notion: It won’t happen to me!!!

36. Are we ready with the substitutes?- Yes and No
If we don’t have the attitude

37. Plastic alternatives- Milk protein, chicken feathers,
Liquid wood, PLA polyesters (lactic acid)
The contemporary milk-based plastic doesn’t crack easily, and it is less toxic

38. PDC
•PDC- Pro- degradant concentrates
• Degrade into CO2, water and biomass residues
•Single use plastic packages, landfill covers, disposable
diapers, trash bags etc

39. What next? Research, awareness creation and legal
reinforcement should go hand in hand
• Cancer incidence has to be studied
• Urinary or serum BPA should be correlated with hormone
dependent CAs
• Action of BPA on human cell line- dose, duration exposure to be
studied
• Ban polythenes from water and food sources
• Plastic alternatives
• Strict quality control needed in polythenes

40. LET’S START THE CHANGE
WITH OURSELVES

41. Punarmushikobhava!!!

42. Sarve Santu Niraamayaah

43. Please visit my website for more ppt on
Medical Biochemistry
www.vpacharya.com