Environmental Factors Causing Cancer?
Every so often my tendency to cynicism is jolted by brave and brilliant actions by people who heretofore have been under my radar. Earlier this month, LaSalle D. Leffall, Jr., M.D., F.A.C.S. professor of surgery at Howard University and Margaret L. Kripke, PhD, professor at M.D. Anderson Cancer Center took such action. They constitute the President's Cancer Panel and their report is Reducing Environmental Cancer Risk: What We Can Do Now. It riled the establishment cancer world by saying too little attention is being paid to the environmental factors that cause cancer. Key factors they added to the already proven hazards of asbestos, smoking and PCBs include but are not limited to chromium in water, radon, and ambient radiation.
Many SHARE advocates have been pressing this view for years. The New York State Breast Cancer Network (NYSBCN), of which SHARE is a Board Member and active participant, has made environmental issues one of its two top priorities. NYSBCN has been advocating the precautionary principle in government and industry for a long time. The precautionary principle is real simple: an ounce of prevention is worth a pound of cure. If there is a reasonable, evidence-based justification to think a substance is a carcinogen, then don't use it. If you wait for scientific research to prove beyond a shadow of a doubt that substance X is going to kill people, a lot of people are likely to get sick and many may die unnecessarily.
The precautionary principle is a good one for individuals to follow, and I'm thinking most SHARE participants do follow it, at least with regard to smoking, PCBs, pesticides and cosmetics. Good, we should. (See bcaction.org, takingprecaution.org)
But individual action is bound to be overwhelmed so long as industry and even government pour pollutants into the food we eat, the water we drink and the air we breathe. And this is where the two-person panel (appointed by former President George W. Bush) showed great courage: Drs. Leffall and Kripke came right out and said the precautionary principle makes sense. They also said regulation is lax, policy is weak, and assumptions are backward, and that these problems have reached crisis stage.
The major conclusions of the panel's 240-page report are:
- We Need to Determine the Full Extent of Environmental Influences on Cancer.
- The Nation Needs a Comprehensive, Cohesive Policy Agenda Regarding Environmental Contaminants and Protection of Human Health.
- Children Are at Special Risk for Cancer Due to Environmental Contaminants and Should Be Protected.
- Continued Epidemiologic and Other Environmental Cancer Research Is Needed.
In regard to research, the panel pointed out emphatically that goals, methods, and processes need an overhaul: To quote the report:
Meaningful measurement and assessment of the cancer risk associated with many environmental exposures is hampered by a lack of accurate measurement tools and methodologies. This is particularly true regarding cumulative (emphasis added) exposure to specific established or possible carcinogens.
People with any cancer are repeatedly exposed to several of the specific carcinogens the doctors cited as most dangerous:
Radon,
Low-dose radiofrequency and electromagnetic energy,
Endocrine disrupting chemicals,
Gene-environment interactions,
Emerging technologies (e.g., Nanoparticles)
The effects of multiple agent exposures are almost completely unresearched.
Doctors are not always sympathetic to the decision-making process a wise patient will go through when faced with a treatment involving one or more of these risks. To use a personal example, at check-up time my breast surgeon recommended an immediate second mammogram when my very recent one had been lost; she pooh-poohed my concern about unnecessary exposure to additional radiation and my preference to wait a couple of weeks while the radiologist found the original film. (I "fired" that doctor.)
Women and men in treatment for breast cancer or women in treatment for ovarian cancer constantly face the damned-if-I-do, damned-if -I don't choice: to accept a treatment suspected to be dangerous or to forego that treatment and fear their disease will progress more rapidly. It's never OK not to ask doctors about less toxic alternatives. It's always OK to consider alternatives to what a doctor recommends, so long as you understand the risks. The complexities involved here surpass my knowledge, but other breast cancer advocates have such knowledge. (See annieappleseedproject.org.)
The President's panel also stressed the need for assessing impacts on people and not just on laboratory animals, because people walk around with a large number of chemicals in their bodies that animals don't have. Techniques for doing this need to be developed to test many contaminants simultaneously. Presently, their report says, "incentives to encourage development of this research are nearly non-existent."
Advocates could and should continue to register their support for this recommendation of the panel: large, longitudinal studies to clarify the nature and magnitude of cancer risk attributable to environmental causes.
The panel recommends that medical personnel collect data from patients about exposures at home and in the workplace as part of the standard medical history. That would take a lot of precious time that most doctors don't have/don't get paid for. And health data privacy issues would be a serious concern--a concern which, if overcome, would possibly bias sample data.
While it would seem that ideally incorporating such data into automated medical records could contribute to better understanding of environmental factors in cancer and other illnesses, the fact remains that such data must be analyzed with rigor, and that such analyses are extremely costly. It's unrealistic to expect funding for many such analyses. So advocates will have to think carefully of how to best spend money in the short run and the long run. Perhaps collecting data on children's exposure would be the most cost-effective way to start this process.
Finally we must take note that the American Cancer Society (ACS) immediately raised alarm that focus on these many partially explored carcinogens will detract from focus on the main known carcinogens: tobacco use, obesity, alcohol, infections, hormones and sunlight, according to Michael J. Thun, MD, vice president emeritus, epidemiology and surveillance research, at the ACS. Dr Thun said to imply that pollutants are the major cause of cancer is "unbalanced". This strikes me as an overreaction; the very factors he says cause cancer may well be impacted by environmental pollutants--especially hormones. Still, it would indeed be criminal to give the tobacco industry any opportunity to successfully promote their poison, so advocates need to be certain their new environmental focus does not let known cancer causes off the hook.
This President's Panel report is a welcome call to action. Perhaps the best actions that advocates can take would be to
- take personal responsibility for avoiding what risks they can
- promote the precautionary principle
- mobilize to identify one or two target environmental factors for the next big resarch/policy push
Posted June 1, 2010.
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