November 10, 2005

WHY WE CAN'T PREVENT CANCER

From: Rachel's Democracy and Health News #829, Oct. 27, 2005

By Peter Montague

In 1999, cancer surpassed heart disease as the number one killer of
people younger than 85 in the U.S.[1] Now a detailed report on the causes of cancer tells us why: cancer has been steadily increasing in the U.S. for 50 years as people have been exposed to more and more cancer-causing agents, including chemicals and radiation.
Richard Clapp, Genevieve Howe, and Molly Jacobs Lefevre have just
published "Environmental and Occupational Causes of Cancer; A Review of Recent Scientific Literature" and it is a real eye-opener.
But before we dive into this report looking for nuggets, let's set the
background.

About half of all cancer cases are fatal, and death by cancer is often
prolonged, painful, and very expensive. Those who manage to survive
cancer live out their lives molded by the after-effects of harsh
treatments popularly known as "slash and burn" -- surgery,
chemotherapy, radiation, or some combination of the three.

As more people are kept alive each year with their breasts or
testicles removed, the "cancer establishment" chalks up another
"victory" -- and no doubt the victims are glad to be alive -- but we
should acknowledge that there's something very wrong with calling this
"victory." Slash and burn seems more like a dreadful defeat.
The truth is, an epic struggle has been going on for 50 years between
the "slash and burn=victory" camp, versus those who think the only
real victory is prevention of disease. The struggle occurs across a
fault line defined by money. To be blunt about it, there's no money in
prevention, and once you've got cancer you'll pay anything to try to
stay alive. Cancer treatment is therefore a booming business, and
cancer prevention is nowhere. That is the basic dynamic of the debate.
Cancer surgeons can achieve the status of rock stars among their
peers. Those who advocate prevention will most likely find themselves
without funding, ridiculed and despised by the chemical industry, the
pesticide industry, the asbestos industry, the oil industry and all
their minions -- lawyers, bankers, engineers, reporters, professors,
and politicians -- who make a fat living off those who pump out
cancer-causing products and dump out cancer-causing by-products, aka
toxic waste.

The debate began 50 years ago when a powerful voice for prevention
spoke out from inside the National Cancer Institute (NCI). In 1948.
Wilhelm Hueper, a senior NCI scientist, wrote,
"Environmental carcinogenesis is the newest and one of the most
ominous of the end-products of our industrial environment. Though its
full scope and extent are still unknown, because it is so new and
because the facts are so extremely difficult to obtain, enough is
known to make it obvious that extrinsic [outside-the-body] carcinogens
present a very immediate and pressing problem in public and individual
health."

In 1964, Hueper and his NCI colleague, W. C. Conway, described
patterns in cancer incidence as "an epidemic in slow motion":
"Through a continued, unrestrained, needless, avoidable and, in part
reckless increasing contamination of the human environment with
chemical and physical carcinogens and with chemicals supporting and
potentiating their action, the stage is being set indeed for a future
occurrence of an acute, catastrophic epidemic, which once present
cannot effectively be checked for several decades with the means
available nor can its course appreciably be altered once it has been
set in motion," they wrote.[pg. 28]

Hueper of course was right. This is why 50% of all men and 40% of all
women in the U.S. now hear the chilling words, "You've got cancer" at
some point in their lives. That's right, 1 out of every 2 men now get
cancer in the U.S., and more than 1 out of every 3 women.
Clapp, Howe and Lefevre tell us that between 1950 and 2001 the
incidence rate for all types of cancer increased 85%, using
age-adjusted data, which means cancer isn't increasing because people
are living longer. People are getting more cancer because they're
exposed to more cancer-causing agents.

Contrary to well-funded rumors, the culprit isn't just tobacco or the
hundreds of toxic chemicals intentionally added to tobacco products.

Tobacco products remain the single most significant preventable cause
of cancer, but they have not been linked to the majority of cancers
nor to many of the cancers that have increased most rapidly in recent
decades including melanoma, lymphomas, testicular, brain, and bone
marrow cancers.[pg. 1]

No, it's more complicated than just tobacco with its toxic additives.
Most plastics, detergents, solvents, and pesticides and the
toxic-waste by-products of their manufacture came into being after
World War II. From the late 1950s to the late 1990s, we disposed of
more than 750 million tons of toxic chemical wastes.[pg. 27] Over 40
years, this represents more than two tons of toxic chemical wastes
discharged into the environment for each man, woman and child in the
U.S. No wonder some of it has come back to bite us.

Since the U.S. EPA began its Toxics Release Inventory (TRI) program in
1987, total releases have been reported as declining (though EPA does
not check the accuracy of industry's self-reporting). Despite the
reported decline, in 2002, the most recent year reported, 24,379
facilities in the U.S. reported releasing 4.79 billion pounds of over
650 different chemicals. (And TRI data do not include other enormous
discharges: toxic vehicle emissions, the majority of releases of
pesticides, volatile organic compounds, and fertilizers, or releases
from numerous other non-industrial sources.) In 2001, more than 1.2
billion pounds of pesticides were intentionally discharged into the
environment in the United States and over 5.0 billion pounds in the
whole world.[pg. 27]

While all this chemical dumping has been going on, incidence rates for
some cancer sites have increased particularly rapidly over the past
half century. From 1950-2001, melanoma of the skin increased by 690%,
female lung & bronchial cancer increased by 685%, prostate cancer by
286%, myeloma by 273%, thyroid cancer by 258%, non-Hodgkin's lymphoma
by 249%, liver and intrahepatic duct cancer by 234%, male lung &
bronchial cancer by 204%, kidney and renal pelvis cancers by 182%,
testicular cancer by 143%, brain and other nervous system cancers by
136%, bladder cancer by 97%, female breast cancer by 90%, and cancer
in all sites by 86%.[pg. 25]

In the most recent 10-year period for which we have data (1992-2001),
liver cancer increased by 39%, thyroid cancer increased by 36%,
melanoma increased by 26%, soft tissue sarcomas (including heart) by
15%, kidney and renal pelvis cancers by 12%, and testicular cancer
increased by 4%.[pg. 25]

OK, so dumping chemicals into the environment has been a major
industrial pastime for 50 years, and cancers are increasing. But why
do we think these things are connected? What real evidence do we have
that environmental and occupational exposures contribute to cancer?
That's what the new Clapp-Howe-Lefevre report is about. It is a
review of recent scientific literature -- with emphasis on human
studies, not studies of laboratory animals. Indeed, the bulk of the
new Clapp-Howe-Lefevre report is a cancer-by-cancer compendium of what
recent human studies tell us about environmental and occupational
exposures that contribute to cancers of the bladder, bone, brain,
breast, cervix, colon, lymph nodes (Hodgkin's disease and non-
Hodgkin's lymphoma), kidney, larynx, liver and bile ducts, lungs,
nasal passages, ovaries, pancreas, prostate, rectum, soft tissues
(soft tissue sarcoma), skin, stomach, testicles, and thyroid, plus
leukemia, mesothelioma, and multiple myeloma. (It is worth pointing
out -- and Clapp-Howe-Lefevre do point it out -- that this compendium
owes a great debt to a data spreadsheet on cancer and its
environmental causes prepared by Sarah Janssen, Gina Solomon and Ted
Schettler, for which thanks are due the Collaborative on Health and
Environment
.)

Many of the bad actor chemicals are well-known to us all: metals and
metallic dusts (arsenic, lead, mercury, cadmium, hexavalent chromium,
nickel); solvents (benzene, carbon tet, TCE, PCE, xylene, toluene,
among others); aromatic amines; petrochemicals and combustion
byproducts (polycyclic aromatic hydrocarbons, or PAHs); diesel
exhaust; ionizing radiation (x-rays, for example); non-ionizing
radiation (magnetic fields, radio waves); metalworking fluids and
mineral oils; pesticides; N-nitroso compounds; hormone-disrupting
chemicals (found in many pesticides, fuels, plastics, detergents, and
prescription drugs); chlorination byproducts in drinking water;
natural fibers (asbestos, silica, wood dust); man-made fibers (fiber
glass, rock wool, ceramic fibers); reactive chemicals (such as
sulfuric acids, vinyl chloride monomer, and many others); petroleum
products; PCBs; dioxins; mustard gas; aromatic amines; environmental
tobacco smoke; and outdoor air pollution.

But there is additional evidence linking chemicals with cancer:

** Elevated cancer rates follow patterns -- the disease is more common
in cities, in farming states, near hazardous waste sites, downwind of
certain industrial activities, and around certain drinking-water
wells. Patterns of elevated cancer incidence and mortality have been
linked to areas of pesticide use, toxic work exposures, hazardous
waste incinerators, and other sources of pollution.[pg. 26]

** The U.S. EPA's long-delayed and heavily industry-influenced "Draft
Dioxin Reassessment" released in 2000 admitted that the weight of the
evidence from human studies suggests that, "the generally increased
risk of overall cancer is more likely than not due to exposure to TCDD
[dioxin] and its congeners [chemical relatives]." The report goes on
to conclude, "The consistency of this finding in the four major cohort
studies and the Seveso victims is corroborated by animal studies that
show TCDD to be a multisite, multisex, and multispecies carcinogen
with a mechanistic basis."[pg. 26]

** Farmers in industrialized nations die more often than the rest of
us from multiple myeloma, melanoma, prostate cancer, Hodgkin's
lymphoma, leukemia, and cancers of the lip and stomach. They have
higher rates of non-Hodgkin's lymphoma and brain cancer. Migrant
farmers experience elevated rates of multiple myeloma as well as
cancers of the stomach, prostate, and testicles.[pg. 26]

** The growing burden of cancer on children provides some of the most
convincing evidence of the role of environmental and occupational
exposures in causing cancers. Children do not smoke, drink alcohol, or
hold stressful jobs. Their lifestyles have not changed appreciably in
recent years. In proportion to their body weight, however, "children
drink 2.5 times more water, eat 3 to 4 times more food, and breathe 2
times more air" than adults." In addition, their developing bodies may
well be affected by parental exposures prior to conception, exposures
while growing in the uterus, and the contents of breast milk.
Clapp-Howe-Lefevre put it this way: "We have learned how to save more
lives, thankfully, but more children are still diagnosed with cancer
every year. The incidence of cancer in all sites combined among
children ages 0-19 increased by 22% from 13.8/100,000 in 1973 to 16.8
in 2000 and most of this increase occurred in the 1970s and 1980s.
Epidemiologic studies have consistently linked higher risks of
childhood leukemia and childhood brain and central nervous system
cancers with parental and childhood exposure to particular toxic
chemicals including solvents, pesticides, petrochemicals, and certain
industrial by-products (namely dioxins and polycyclic aromatic
hydrocarbons [PAHs])."[pg. 26]

All in all, the Clapp-Howe-Lefevre report makes a compelling case that
many industrial chemicals contribute to many kinds of cancers. But
where this report really shines is in its clear call for
prevention. In all, there are relatively few products or substances
associated with cancer.[pgs. 10-11, 37-40] Everything doesn't cause
cancer, and many of the things that do could be shunned and phased
out. In principle, a great deal of prevention is possible.

Thirty years into the prevention-vs-treatment debate -- in 1981 -- two
famous British scientists -- Sir Richard Doll and Sir Richard Peto
-- published an extremely influential study in which they estimated
that "only" 2 to 4% of all cancers are caused by environmental or
workplace exposures. With 1.2 million new cases of cancer each year in
the U.S., half of them fatal, 2% to 4% = 12,000 to 24,000 deaths each
year, most of them preventable. Doll and Peto said tobacco caused 30%
of all cancers and food caused another 35%. We now know that cancer
results from the interaction of our genes with exposure to several
cancer-causing agents. All the necessary exposures must occur to cause
a cancer -- if any one of them is missing, the cancer will not occur.

This is why prevention is important -- it really can work.
Because cancer requires multiple exposures to cancer-causing agents,
it is wrong and misleading to say that "Exposure to product A causes X
percent of all cancers." It simple doesn't work like that. Perhaps
Doll and Peto in 1981 did not know how such things worked, and they
boldly proceeded to estimate what percent of all cancers were
attributable to particular exposures. It was wrong, but their report
served as powerful ammunition for the prevention-is-pointless crowd.

If "only" 2 to 4% of all cancers were caused by environmental
exposures, then there was little incentive to prevent human exposure
to environmental agents, the argument went. What a welcome message
this was for the cancer-creation industries (petrochemicals, metals,
pesticides, asbestos, radiation, and others) and for the cancer
treatment industry! Damn the torpedoes -- full speed ahead!
The prevention-is-pointless crowd latched onto the Doll and Peto study
and spread it everywhere. By the end of 2004, the original 1981
Doll-and-Peto paper had been cited in 441 subsequent scientific
papers.[pg. 4] But even more importantly, the federal National Cancer
Institute and the American Cancer Society (which, together, you could
call the "cancer establishment") adopted the Doll-Peto perspective,
that cancer is a lifestyle disease -- the victims themselves are
responsible -- and that prevention of environmental and occupational
exposures is not worth the effort. Remember this was the beginning of
the Reagan counterrevolution and the Doll-Peto paper fit right into
the new ideology -- government is bad, big corporations are good,
we're all individually responsible for whatever bad things happen to
us, and greed is good because it makes the world go 'round. In any
case, the NCI and the ACS largely adopted the Doll-Peto perspective,
and they poured the bucks into new cancer treatments, pretty much
ignoring prevention. Meanwhile, cancer incidence rates climbed
relentlessly -- making the cancer-treatment industry healthier and
wealthier, which allowed it to further erode support for prevention.

Now we are starting to shake off the stupor induced by the misleading
Doll-Peto arithmetic, which pretended to prove that environment and
occupational exposures are of no consequence. Listen to this marvelously clear-eyed conclusion from the Clapp-Howe-Lefevre report: "Comprehensive cancer prevention programs
need to reduce exposures from all avoidable sources. Cancer prevention
programs focused on tobacco use, diet, and other individual behaviors
disregard the lessons of science."[pg. 1]

And this: "Preventing carcinogenic exposures wherever possible should
be the goal and comprehensive cancer prevention programs should aim to
reduce exposures from all avoidable sources, including environmental
and occupational sources."[pg. 6]

And this: "Further research is needed, but we will never be able to
study and draw conclusions about the potential interactions of
exposure to every possible combination of the nearly 100,000 synthetic
chemicals in use today. Despite the small increased risk of developing
cancer following a single exposure to an environmental carcinogen, the
number of cancer cases that might be caused by environmental
carcinogens is likely quite large due to the ubiquity [presence
everywhere] of carcinogens. Thus, the need to limit exposures to
environmental and occupational carcinogens is urgent."[pg. 29]

And this: "The sum of the evidence regarding environmental and
occupational contributions to cancer justifies urgent acceleration of
policy efforts to prevent carcinogenic exposures. By implementing
precautionary policies, Europeans are creating a model that can be
applied in the U.S. to protect public health and the environment. To
ignore the scientific evidence is to knowingly permit tens of
thousands of unnecessary illnesses and deaths each year."[pg. 1]

What a blast of fresh air!

The latest strategy from the cancer-creation industries is to claim
that we can't take action to prevent environmental and occupational
exposures because we don't have enough information. We're simply too
ignorant to make a move. More study is needed. [See Rachel's #824,
#825.] Clapp-Howe-Lefevre allow the eloquent writer Sandra
Steingraber to answer this argument. They say, "A main concern for
Sandra Steingraber, author of Living Downstream: An Ecologist Looks
at Cancer and the Environment
, is not whether the greatest dangers
are presented by dump sites, workplace exposures, drinking water,
food, or air emissions:

"I am more concerned [writes Steingraber] that the uncertainty over
details is being used to call into doubt the fact that profound
connections do exist between human health and the environment. I am
more concerned that uncertainty is too often parlayed into an excuse
to do nothing until more research can be conducted."[pg. 29]
Clapp, Howe and Lefevre go on: "At the same time, uncertainty and
controversy are permanent players in scientific research. However,
they must not deter us from enacting regulations and policies based on
what we know and pursuing the wisdom of the precautionary principle.
This is not new thinking, as demonstrated by Sir Austin Bradford

Hill's
1965 address to the Royal Society of Medicine:
"All scientific work is incomplete [wrote Sir Austin Bradford Hill] --
whether it be observational or experimental. All scientific work is
liable to be upset or modified by advancing knowledge. That does not
confer upon us a freedom to ignore the knowledge we already have, or
to postpone action that it appears to demand at a given time."[pg. 29]
Clapp, Howe and Lefevre then offer some guidelines for preventive
action:

(1) The least toxic alternatives should always be used.

(2) Partial, but reliable, evidence of harm should compel us to act on
the side of caution to prevent needless sickness and death.

(3) The right of people to know what they are being exposed to must be
protected.

Clapp, Howe and Lefevre observe that "the United States has much to
learn" from the proposed European chemicals policy, known as REACH:

(1) requiring that industry be responsible for generating information
on chemicals, for evaluating risks, and for assuring safety; another
way of saying this is, "No data, no market."

(2) extending responsibility for testing and management to the entire
manufacturing chain -- everyone who uses a chemical has a duty to
familiarize themselves with the consequences;

(3) using safer substitutes for chemicals of high concern; and,

(4) encouraging innovation in safer substitutes.[pg. 29]

In the words of ecologist Sandra Steingraber: "It is time to start
pursuing alternative paths. From the right to know and the duty to
inquire flows the obligation to act."[pg. 29]

But while we're working in clear-eyed mode here, let's take our
exploration a bit further and look this problem squarely in the face.
The U.S. economy and culture are premised on endless growth. If I
loan you $100 in the expectation that you will pay me back $103 next
year, that extra 3% must come from somewhere. That "somewhere" has
physical dimensions -- something must be dug up or grown to produce
the additional 3%. That something must also be moved, processed, moved
again, packaged, promoted and sold, moved again, used, moved again,
and eventually discarded. Even if it is recycled many times,
ultimately it will be discarded into a natural ecosystem somewhere (at
which point nature begins moving it once again). The inescapable
second law of thermodynamics tells us that each of these steps will
inevitably be accompanied by waste, disorder and other disruptive
unintended consequences. Even if you create the extra 3% per year by
providing a "service" instead of a "product," you still require food,
water, shelter, energy, clothing, tools, transportation, commercial
space, medical care, municipal support services (like police, fire,
emergency services, and sewage treatment), leisure activities,
communications and information, schooling, and on and on.

An economy that is growing at 3% per year is doubling in size every 23
years -- requiring, every 23 years, a doubling in the number of
cities, food sources, mines, factories, power plants, vehicles,
highways, parking lots, schools, sewage treatment plants, hospitals,
prisons, discards, trash and dumps. For a very long time this kind of
rapid growth seemed tolerable. But now things are different -- the
earth is full of people and their artifacts. We can no longer throw
things "away" without affecting someone somewhere.

Something else is new as well. The modern, globalized financial
environment (in which money flows easily across international
borders), creates tremendous competitive pressure to attract
investment by increasing return to investors. That in turn creates
pressure to pass costs along to the general public. Economists call it
"externalizing" costs. If I dump my chemicals and make you sick, I
gain if I can get you to pay your own medical bills, and I gain again
if I can get taxpayers to clean up my mess. Firms have a natural
incentive to externalize their costs to the extent possible, but the
present "globalized" financial environment has increased that
incentive greatly, to improve return to investors.

In sum, let us review the pressures that prevent prevention.

(1) In general, it is difficult to make prevention pay, but
remediation can pay handsomely; this is certainly true for the cancer
industry. In general, financial-political-legal incentives are set up
to reward those who create problems and those who supply remedies.

(2) Economic growth entails the continual creation of ever-more and
ever-larger messes. Even if we managed to "green" commerce in every
way we can think of today, damage to nature would still be roughly
proportional to the size of the human economy because the second law
of thermodynamics cannot be evaded. And we now know that damage to
nature gives rise to human disease in myriad ways. (For evidence,
follow leads found here, here, here, and here.) Now that the
earth
is full, a growing economy creates palpably-growing health problems,
including immune system degradation giving rise to cancers.

(3) The modern economy creates irresistible pressure to increase stock
prices, which in turn creates relentless pressure to externalize costs
by hook or by crook.
So let's not kid ourselves. Yes, cancer must be prevented
because for the most part it can't be cured -- it can only be slashed
and burned away at enormous cost, personal, social and monetary.
But saying cancer must be prevented is one thing. Expecting
that it can be prevented within the framework of the modern
economy is another. We can never stop working to prevent cancer -- and
precautionary policies will always make sense no matter what kind of
economy we have -- but until we shift to an economy that doesn't
require growth, we'll find ourselves right where we are now -- on an
accelerating rat wheel. As a result, we can expect to be living with
more and more cancer at greater and greater cost to ourselves and to
our children, accompanied by ever-increasing pain. It is not a pretty
picture. But at least we can now see it clearly.
===============

[1] Richard Clapp, Genevieve Howe, and Molly Jacobs Lefevre,
Environmental and Occupational Causes of Cancer; A Review of Recent
Scientific Literature (Lowell, Mass.: University of Massachusetts at
Lowell, The Lowell Center for Sustainable Production, September, 2005.
Available here and here and here. Unless otherwise noted,
throughout this issue of Rachel's, footnote numbers inside square
brackets refer to pages in this report.

4 comments:

Sarah said...

Brilliant piece, and very relevant. I plan to post a link so more people can read what you have to say about this topic. Thank you.

Sarah said...

well, I mean what Peter had to say and you decided was important enough to include as an entire post. You know what I mean...

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