Marin County, Calif., just across the bay from San Francisco, is considered an extremely desirable place to live.
It boasts pristine woodlands, beautiful waterways and, with Mount Tamalpais as a stunning backdrop, some very pricey real estate.
Marin's population is predominantly white, affluent, highly educated and very health-conscious.
"I try to eat organic foods as much as I can," said Lynn Oberlander, a local resident. "I try to get my stress level down. I go to yoga. And I hike and I exercise."
But despite all the advantages, Marin County has the highest rate of breast cancer in America, possibly even in the world.
"They tend to be about 40 percent higher than the national average and about 30 percent higher than the rest of the Bay Area," said Tina Clarke, an epidemiologist with the Northern California Cancer Center, who has been studying breast cancer in Marin County since the mid-1990s.
Contact With Cancer
Almost every woman living there has seen it.
"You know, you can't be a middle-aged woman in Marin County and not be aware of the fact that the incidence of breast cancer is much higher here than elsewhere in the United States," said Kim Wright-Violic, a Marin County resident. "In a community that's this small, inevitably you know somebody who either has had cancer and is in remission or has died of cancer."
Among white women aged 45 to 64, the breast cancer rate in Marin has increased 72 percent in the last decade. One year was especially alarming.
"Between 1998 and 1999, there was a 20 percent increase in breast cancer in white, non-Hispanic women living in Marin County," said Janice Barlow, executive director of Marin Breast Cancer Watch, a grass-roots organization formed by alarmed residents in 1995 to study the problem. "It's huge."
For the most recent year for which data is available, 1999, a total of 285 women in Marin County were diagnosed with invasive breast cancer. A total of 53 died.
At the Marin Breast Cancer Watch, Clarke has compiled a portrait of the high-risk group, using census data and cancer registry information.
"Together that gives us a profile of women who are, you know, socioeconomically privileged, tend to be very well-educated, affluent, thereby kind of tend to be professional," Clarke said. "With the professional comes having fewer children or not having children at all, delaying child bearing all together.
Dr. Georgie Farren fits that profile. Ten years ago, at the age 42, with three very young daughters to care for, she was diagnosed with breast cancer.
"It was definitely a shock," she said. "I was at the time a runner and reasonably healthy, careful of what I did and what I ate."
Farren is involved in a study on whether risk factors from adolescence might contribute to the high rate.
"Two of those women have died of breast cancer since we began it," she said. "So, you know, it's a disease that's serious and it's taking its toll on the population."
Could the fact that educated, affluent women tend to get regular mammograms account for the high numbers being reported? Clarke says no.
"If everyone was just getting a lot of mammography and they were catching it earlier, I think you would expect that the Marin women would have less of the late-stage disease, but they have about the same proportion of the late-stage disease," she said. "And they have a much higher mortality rate, just like their incidence rates."