Respectful Insolence

I’m a bit of an odd bird in the world of cancer. No, it’s not because I run a snarky skeptical blog that routinely deconstructs the nonsense that alt-med practitioners sprew far and wide, nor is it because I’ve developed a middling level of popularity that shocks me from time to time. Nor is it because I’ve taken on an obscure pseudonym based on a computer that looked like a Plexiglass box full of colored blinking lights from an even more obscure late 1970s British science fiction show with the low-budget asthetic of Tom Baker-era Doctor Who, although personally I sometimes wonder what it says about me that I cling to that persona so tightly. If I had to choose a character from Blake’s 7, perhaps I should have taken on Kerr Avon‘s persona instead. He was way more badass. Actually, what makes me an odd bird these days is that I’m both a surgeon and I still manage to run a lab. Sadly, there just aren’t very many surgeons doing basic and translational research these days, thanks to declining NIH funding, increasing clinical burden necessitated by declining reimbursements, and the increasing complexity of laboratory-based research. That’s not to say that there aren’t some surgeons out there doing excellent laboratory research, but sometimes I feel as though I’m part of an endangered species, particularly years like this when grants are running out and I need to renew my funding or secure new funding, the consequence of failure being the dissolution of my laboratory. It’s a tough world out there in biomedical research.

As tough as biomedical research is in cancer, to my mind far tougher is research trying to tease out the relationship between environmental exposures and cancer risk. If you want complicated, that’s complicated. For one thing, obtaining epidemiological data is incredibly labor- and cost-intensive, and rarely are the data clear cut. There’s always ambiguity, not to mention numerous confounding factors that conspire to exaggerate on the one hand or hide on the other hand correlations between environmental exposures and cancer. As a result, studies are often conflicting, and making sense of the morass of often contradictory studies can tax even the most skillful scientists and epidemiologists. Communicating the science and epidemiology linking environment and cancer to the public is even harder. What the lay person often sees is that one day a study is in the news telling him that X causes cancer and then a month later another study says that X doesn’t cause cancer. Is it any wonder that people are often confused over what is and is not dangerous? Add to this a distinct inability on the part of most people, even highly educated people, to weigh small risks against one another (an inability that has led to phenomena such as the anti-vaccine movement), and the task of trying to decide what is dangerous, what is not, how policy is formulated based on this science, and how to communicate the science and the policy derived from it to the public is truly Herculean.

The President’s Cancer Panel (PCP) marched straight into this fray last week by issuing its 2008-2009 Annual Report entitled Reducing Environmental Cancer Risk, What We Can Do Now. The Panel on Cancer was mandated under the National Cancer Act of 1971, the legislation passed as a result of President Richard Nixon’s declaration of “war on cancer,” and its function is to “monitor the development and execution of the activities of the National Cancer Program, and shall report directly to the President.” Previous reports have addressed subjects such as Promoting Healthy Lifestyles (2006-2007); Translating Research Into Cancer Care: Delivering on the Promise (2004-2005); Living Beyond Cancer: Finding a New Balance (2003-2004); and The Meaning of Race in Science–Considerations for Cancer Research (1997). Not surprisingly, this year’s report is more contentious than the average President’s Cancer Panel Report because few areas of cancer research are as controversial or impact as directly on public policy as the assessment of environmental risks of cancer and what to do about those risks.

The PCP report is very long (over 200 pages), which is why it’s good that the executive summary does a good job of boiling down the vastness of the report into a more digestable chunk. I read the whole thing, but the report started to get repetitive fairly quicky. It begins, as all such reports do, by pointing out the enormity of the cancer problem in the U.S. and then proposes to address the question of environmental influences on cancer through these areas:

  1. Exposure to Contaminants from Industrial and Manufacturing Sources. These include a wide variety of manufactured chemicals and industrial byproducts used in the manufacture of mass-produced products. The report notes that numerous chemicals used in manufacturing remain on products as residues or are integral parts of the products themselves. It is also noted that new chemicals are being created continually.
  2. Exposure to Contaminants from Agricultural Sources. There are numerous chemical exposures due to chemicals used in agriculture, particularly pesticides, solvents, and fillers. Some of these leech into the soil and water and produce exposure this way.
  3. Environmental Exposures Related to Modern Lifestyles. These exposures include pollution from vehicles, chemicals used in pest control, and exposure to radio waves and electromagnetic fields from cell phone radiation and electrical power lines, respectively.
  4. Exposure to Hazards from Medical Sources. This source consists primarily of radiation from medical tests and the potential of contamination of the environment from discarded pharmaceuticals.
  5. Exposure to Contaminants and Other Hazards from Military Sources. There still remain a lot of areas around military bases. Nearly 900 Superfund sites are abandoned military facilities or facilities that produced materials for military use.
  6. Exposure to Environmental Hazards from Natural Sources. This class of exposure includes naturally occurring carcinogens such as radon, uranium, and arsenic.

Overall, the report is a comprehensive look at environmental exposures that could potentially contribute to various cancers and that we can do something about. In all my years in cancer research, I can’t recall ever seeing its like coming from such a mainstream source. The panel proposes several suggested approaches to this problem, including:

  1. The adoption of a new “precautionary, prevention-oriented approach” to replace our “current reactionary approaches in which human harm must be proven before action is taken to reduce or eliminate exposure.” As a part of this approach, it is recommended that the burden of proof of safety should be shifted to the manufacturer, rather than the current burden of proof being upon the government to prove harm.
  2. A thorough new assessment of workplace and other exposures to quantify risk.
  3. A more coordinated system for promulgating environmental contaminant policy and regulations driven by science and free of political and industry influence.
  4. Epidemiological and hazard assessment research in areas where the evidence is unclear.
  5. New research tools and endpoints to assess environmental exposure and risk, including high throughput models to assess multiple exposures simultaneously, methods for long term monitoring and quantification of electromagnetic energy sources, such as power lines and cell phones.
  6. Better policies regarding cancer risk due to radon.
  7. Actions to minimize exposure to medical radiation sources.
  8. Addressing the unequal burden to known and suspected carcinogens.
  9. Encouraging physicians to take better health histories of environmental exposures.
  10. “Green chemistry” initiatives.
  11. Measures to increase public awareness of risk due to environmental exposures.

God, I hate buzzwords that include the term “green.” “Green our vaccines,” anyone?

Sarcasm over annoyingly politically correct terms aside, as you can see, if the recommendations, some of the details of which are fleshed out (mostly) in the 200 page report, if adopted would require enormous policy changes. Of course, one thing that must be remembered about reports like this is that they are every bit as much political documents as they are scientific and medical documents. After all, they point out problems that very well could require new laws and/or new regulations in order to address. This report definitely falls into this category in a big way because, if adopted, its recommendations would demand action by the government. Indeed, the report itself blames weak laws, lax enforcement, and overlapping and conflicting regulatory authority, but, more strongly, it blames the attitude that industrial chemicals are safe unless strong evidence that they are not safe emerges.

But how strong is the science?

From my perspective, the report is a mixed bag, mostly good but not all. It’s also rather annoying that, of the over 400 references, most of them appear to be government reports and review articles, with very little primary literature cited. First the good, though. The report emphasizes quite strongly that what we know about the environmental contribution to cancer has lagged far behind our knowledge of other aspects of cancer. More importantly, one aspect of the environmental contribution to cancer that we often don’t consider strongly enough is that children tend to be more susceptible to environmental insults of many kinds, particularly carcinogenic insults:

An analysis by the National Academy of Sciences27 found that children are particularly vulnerable to environmental contaminants for several reasons. Due to their smaller size, children’s exposures to toxics are disproportionately large compared with adults. Because their metabolic pathways are immature (particularly during fetal development and in the first months after birth), they are slower to metabolize, detoxify, and excrete many environmental chemicals. As a result, toxins remain active in their bodies for a longer period of time than would be the case in adults. In addition, children have lower levels of some chemical-binding proteins, allowing more of a toxic agent to reach various organs, and their blood-brain barrier is more porous than that of adults, allowing greater chemical exposures to the developing brain. Children’s bodies also are less able to repair damage due to toxic exposures, and the complex processes that take place during the rapid growth and development of children’s nervous, respiratory, immune, reproductive, and other organ systems are easily disrupted.

Children have many more years of life ahead of them than do adults–more time in which to be exposed to environmental toxics and time to develop diseases (including cancer) with long latency periods initiated by early exposures.

Moreover, at the same time that mortality rates for childhood cancers have been plummeting dramatically, the incidence of childhood cancers has been steadily climbing, as shown by this graph “borrowed” from the report:

i-0d468f737cfbdee765990f924c83d6a7-ChildhoodCancer-thumb-450x409-48612.jpg

The reason for this increase is not known, but genetics is an unlikely cause for such a rapid increase. In addition, it is unlikely that better diagnosis due to the introduction of MRI and better CT scanning is likely to be the cause, because the increase is too steady. That leaves environmental factors as one suspect for a major cause. Certainly, this is worth examining, as it may provide the “greatest bang for the buck.”. For example, lately, our cancer institute has become very interested in environmental contributors to breast cancer. One thing that has become clear is that such exposures may have their greatest effect in childhood or, in particular, during puberty, which is when the mammary gland undergoes its most rapid growth and development. Indeed, although this increases susceptibility to carcinogens in children has long been appreciated, but the characterization of these differences, again, has lagged behind other areas of cancer research. This is especially relevant to the section on the risk of medical radiation, with recent studies suggesting the possibility of tens of thousands of excess cancers in the U.S. due to medical radiation from the increasingly common use of CT scans and studies suggesting that radiation from mammography may contribute to a small number of breast cancers. Such studies could even benefit adults in terms of cancer risk, as well, as it’s known that the incidences of certain cancers are climbing for unknown reasons, and naturally environment is always going to be near the top of the list for suspected causes

Another good part of the report is its emphasis on the deficiencies in our current technology and tools for assessing the carcinogenic potential of various chemicals. Related to the report’s emphasis on how little we know about carcinogenesis in children, the report criticizes current animal models because they fail to capture the impacts of early exposures and miss the late effects of such exposures. Also problematic is that most animal studies use long-term, high-dose exposures that may have little relation to humans. Consequently, the report urges the development of alternatives to animal testing involving testing in human cells in vitro. I’m rather skeptical that this recommendation will produce much benefit very fast. After all, one reason we use animals is because, as imperfect as animal carcinogenesis studies are, the correlation between cell culture studies is even more unreliable than that of animal studies.

One recommendation of the report that intrigued me was its assessment of how science has generally focused on one compound at a time without considering how they may interact. This reminds me of how in the past we concentrated on one gene at a time as a causative agent for cancer (such as oncogenes); yet over the past ten years it has become increasingly clear that cancer is often driven by many genes, each of which individually plays a relatively small role. The Panel thus recommends the development of high throughput screens that can examine many chemicals at once and test for interactions, a recommendation that struck me as worthwhile, although I am having trouble envisioning what such a test would look like or how it would be validated. The problem, of course, is that, as more chemicals are tested, the possible combinations skyrocket exponentionally.

One major part of the report deals with one specific environmental exposure, the thousand pound gorilla these days, namely BPA, which was discussed in the context of the report’s increasing emphasis on the precautionary principle. This part of the report, to me, was a little bit dicey in that the precautionary principle is a very difficult to apply. I’ve discussed this matter before in the context of how preemptively removing mercury from vaccines helped fuel an anti-vaccine panic over the mercury in the thimerosal preservative that used to be in vaccines. The question of how much evidence is necessary to justify banning a compound doesn’t go away, and it still remains a profoundly political question. The report basically glosses over the question of where one should draw the line in implementing the principle, other than suggesting shifting it to more caution. It also dances around the question of how we would pay for this, given that the implementation of the recommendations in this report would require massive increases in the budgets of the relevant agencies–particularly since the report itself documents just how short-staffed and under-funded many of these agencies are.

One glaringly dubious part of the report compared to the rest is how it deals with the issue of cell phones and cancer. After emphasizing that there is no good evidence to support a link between cell phones and cancer and pointing out that the epidemiological evidence is in essence negative, the report proceeds as though a link between cell phone use and brain or head and neck tumors were biologically plausible. As I’ve described before, it’s not.

Indeed, from a biological standpoint, a strong link between cell phone use and brain cancer (or any other cancer) is not very plausible at all; in fact, it’s highly implausible. Cell phones do not emit ionizing radiation; they emit electromagnetic radiation in the microwave spectrum whose energy is far too low to cause the DNA damage that leads to mutations that lead to cancer. While it is possible that perhaps heating effects might contribute somehow to cancer, most cell phones, at least ones manufactured in the last decade or so, are low power radio transmitters. It is also necessary to acknowledge the possibility that there might be an as yet undiscovered biological mechanism by which low power radio waves can cause cancer, perhaps epigenetic or other, but the evidence there is very weak to nonexistent as well. Basically, based on what we know about carcinogenesis, a postulated link between cell phones and cancer is highly implausible. It’s not homeopathy-level implausible, but it’s pretty implausible nonetheless, perhaps approaching acupuncture-level implausible. Consequently, in the absence of much better evidence that suggests a mechanism or a “smoking gun” study linking cell phone use with cancer, I have a very hard time indeed managing to muster much enthusiasm about recommending more studies above and beyond the ones that are already being carried out, at least until we start to see some less confusing results. Yet recommend a lot more studies is exactly what this report does.

That annoyingly non-science-based (or, at best very weakly science-based) bit aside, though, the President’s Cancer Panel report is in general cautious and makes sensible policy recommendations. It also makes a number of (mostly) sensible recommendations for individual citizens. In general, it is cautious and highlights a neglected aspect of cancer research. That must be why the pro-industry group American Council on Science and Health (ACSH) is on the counterattack, for example:

Elizabeth M. Whelan, president of the American Council on Science and Health, whose views often coincide with industry’s, noted that despite the growing exposure to chemicals in the environment, “cancer death rates are going down. The so-called environmental trace levels of chemicals play no role whatsoever in the etiology of cancer.”

Notice one thing. Notice how Whelan points out that cancer death rates are going down. That much is true. However, the incidence rates of several cancers are climbing despite the decrease in tobacco use among the general public over the last three or four decades. With the single biggest cause of preventable cancers and death from other causes decreasing and certain cancers increasing too rapidly to be able to invoke a genetic cause, that leaves environmental influences. In any case, it reminds me of anti-vaccine loons pointing to how the death rates from various vaccine-preventable diseases were falling before the introduction of vaccines, when much of that decline in death rates was due to better treatment as incidence rates remained high. In this case, the decrease in death rates from cancer appears to be largely due to increased screening and better treatments. In any case, not content with interviews with the press, the ACSH continued the counterattack on its own website:

“This so-called Presidential Cancer Panel, which consists of two physicians, has obviously been politically pressured by the activists running the EPA,” says ACSH’s Dr. Gilbert Ross. “When they mention babies being ‘pre-polluted’ and the alleged dangers of all of these chemicals, they not only sign their name to activist screeds, they neglect to mention that the dose makes the poison, and that finding traces of chemicals at levels of parts-per-billion does not imply a health hazard. And of course they do not address the potential health hazards of banning important chemicals from consumer products.”

Of course, the obvious retort to that is that the presence of chemicals at levels of parts-per-billion doesn’t imply that there’s isn’t problem, either, but that’s apparently what ACSH wants you to believe. There’s a fine line between fear mongering and sound science sometimes, but the denialism of the ACSH on this issue is clear. In any case, we’ll never know if we don’t study the issue. It is probably true that most trace contaminants are not health hazards, it’s also very likely true that some of them are, and if we don’t study the issue we will never know. But that’s ACSH’s M.O.: Deny there is a problem; deny even the possibility that there might be a problem; criticize the tools used to study a problem even if they are the best we have, however imperfect. Sometimes ACSH even takes it to ridiculous extremes. In other words, other than tobacco, when it comes to the assessment of health risks to listen to ACSH is in essence to hear industry’s viewpoint, as Jon Stewart demonstrated so brilliantly last year:

Any organization that can claim with a straight face that encouraging healthy eating is “elitist” is not one that I can take seriously, even when it sometimes comes down on the right side of an issue, scientifically speaking, such as the issues of vaccines, cell phones and cancer, or tobacco.

A more reasonable criticism comes from the American Cancer Society’s Michael J. Thun, MD:

Issues highlighted in both reports include the accumulation of certain synthetic chemicals in humans and in the food chain; the large number of industrial chemicals that have not been adequately tested; the potentially greater susceptibility of children; the possibility that some chemicals or combinations of chemicals may have effects at low doses; and the potential risks from widely used medical imaging procedures that involve ionizing radiation.

Unfortunately, the perspective of the report is unbalanced by its implication that pollution is the major cause of cancer, and by its dismissal of cancer prevention efforts aimed at the major known causes of cancer (tobacco, obesity, alcohol, infections, hormones, sunlight) as “focused narrowly.”

I’m puzzled why Dr. Thun is so annoyed. For one thing, he seems to be missing the point by more than a bit, given that the very point of the report was to focus on an aspect of cancer prevention that the Panel considered to have been historically underrepresented. This year, the President’s Cancer Panel report was designed to focus on one aspect of cancer, namely environmental influences on cancer. As such, of course it emphasized–oh, you know–environmental influences on cancer. It’s also just plain wrong that the report “dismisses” cancer prevention efforts aimed at the stronger known exposures and risk factors for cancer; rather, it argues that we should be doing more to ameliorate cancer risk from environmental exposures, be it to chemicals or the excessive use of medical radiation in imaging tests. Basically, I found the ACS’s objections to be rather puzzling, given that just last fall the ACS published a position paper, many parts of which sound eerily similar to the President’s Cancer Panel report. For example, these are the things that the ACS recommends:

The position statement on cancer prevention also says:

  • New strategies for toxicity testing, including the assessment of carcinogenicity, should be implemented that will more effectively and efficiently screen the large number of chemicals to which people are exposed.
  • Occupational and community exposures should meet regulatory standards, and research to identify and reduce carcinogenic hazards should be supported.
  • The agencies that set and enforce environmental standards need to be appropriately funded and science-based to keep pace with scientific developments and to update their standards accordingly.
  • Although certain exposures are unavoidable, exposure to carcinogens should be minimized or eliminated whenever feasible.
  • The public should be provided with information so that they can make informed choices.
  • Communications should acknowledge and not trivialize public concerns, but at the same time should not exaggerate the potential magnitude or level of certainty of the potential risk.

This sounds a lot like the President’s Cancer Panel, except fot the last point, and I will admit that the President’s Cancer Panel report is a bit too certain in its tone when it comes to several issues. And, straight from the article:

The exposure levels to the general public are typically orders of magnitude lower than those experienced historically in occupational or other settings in which cancer risks have been demonstrated. The resulting cancer risks are generally so low that they cannot be measured directly. Nevertheless, there is reason to be concerned about low-level exposures to carcinogenic pollutants because of the multiplicity of substances, the involuntary nature of many exposures, and the potential that even low-level exposures contribute to the cancer burden when large numbers of people are exposed. Concerns about the toxic and carcinogenic potential of these exposures are amplified by broader public concerns regarding the effectiveness of hazard identification and the regulation of potentially toxic exposures in the United States and other economically developed countries, as well as high levels of exposures to known carcinogens that still occur in many developing countries.

All of this is very similar to what is in the President’s Cancer Panel report, the main difference being more of tone and emphasis than anything of major substance and a disagreement over whether environmental contributions to cancer other than the strong, well-characterized ones (like smoking) are underestimated or not. When the ACSH points to the ACS as “harshly criticizing” the report, even going so far as to entitle one post Praise be to Thun, it’s clearly exaggerating the extent of disagreement for its own purposes.

The President’s Cancer Panel report represents a document that is at the same time scientific, medical, and also highly political, and that needs to be remembered. It has also been heartening to epidemiologists and public health officials, some of whom have criticized the National Cancer Institute system for publicizing avoidable causes of cancer other than smoking to be “virtually non-existent.” This report, as flawed as parts of it are, represents a refreshing first step towards addressing that shortcoming. What I fear, though, is that this report will be used far more as a political weapon.

Comments

  1. #1 Doazic
    May 10, 2010

    Can you add a bullet point summary at the end of what your thoughts are? Some of us like to skip to the end.

  2. #2 momkat
    May 10, 2010

    tl;dr, because I have a meatspace life, but i’m sure you made lots of good points.

  3. #3 labrat
    May 10, 2010

    So thanks to another government report we still have no confidence the government is doing anything. If anybody is waiting on government action I’d say forget it. You are on your own to sort out what’s healthy. I’d guess malnutrition is a huge factor and it is well known that huge amounts of sugar and HFCS are being consumed. I stopped eating all canned foods too. I have a big list of things to avoid which wipes out most of the areas in the grocery store.

  4. #4 Mark P
    May 10, 2010

    says ACSH’s Dr. Gilbert Ross … finding traces of chemicals at levels of parts-per-billion does not imply a health hazard

    Perhaps Dr Ross should put our minds at rest by demonstrating the safety of ppb dosages by eating 100 grams of something laced with botulism at 10 parts per billion.

  5. #5 Adam_Y
    May 10, 2010

    Perhaps Dr Ross should put our minds at rest by demonstrating the safety of ppb dosages by eating 100 grams of something laced with botulism at 10 parts per billion.

    You are a living talking walking example of why that argument is true. You have a known cancer causing agent floating in your body right now. Not because of pollution but because its perfectly natural. Formaldehyde is produced in your body.

  6. #6 JLowe
    May 10, 2010

    Adam_Y: this is a good example of why we as a society are unable to think clearly about environmental carcinogens. Formaldehyde circulating in your body water isn’t carcinogenic. Formaldehyde inhaled into your nose and upper respiratory tract may be a human carcinogen.

  7. #7 D. C. Sessions
    May 10, 2010

    Formaldehyde circulating in your body water isn’t carcinogenic.

    You state that with such confidence.

    Formaldehyde, hydrogen peroxide, and a long list of other chemicals are indeed normal products of human metabolism. Our bodies have all sorts of interesting mechanisms to deal with them and the damage they cause.

    Which doesn’t mean that they don’t cause damage. Bear in mind that (contrary to a popular woo claim) animals in nature also get cancer.

    This whole topic keeps falling into the fallacy of “safe” and “unsafe,” black/white thinking. There is no such thing as safe.

  8. #8 JohnV
    May 10, 2010

    @Mark P

    Do you mean C. botulinum or it’s toxin (the botulinum toxin). You should at least use the correct terms if you’re going to mock someone :p

    Anyhow, your point in general is only valid when you manage to pick the most toxic natural substance ever seen. Which ties in to JLowe’s comment about not being able to think clearly about the problem.

  9. #9 Adam_Y
    May 10, 2010

    This whole topic keeps falling into the fallacy of “safe” and “unsafe,” black/white thinking. There is no such thing as safe.

    Because its a really dumb argument to be claiming that everything is dangerous. A lot of chemicals simply won’t kill you if unless you have a case of the stupids.

    God, I hate buzzwords that include the term “green.” “Green our vaccines,” anyone?

    Ehhh… Its not really a buzzword. Green chemistry is a process by which one produces chemicals and products in a manner that reduces wastes and uses less hazardous byproducts.

  10. #10 Orac
    May 10, 2010

    I know what “green” means when applied to just about anything, and, yes, it’s a buzzword–and an an annoying one, at that.

  11. #11 Denice Walter
    May 10, 2010

    I too dislike the term “green”(too much “bagage” and too vague)- as I search for alternatives I try to limit my exposure and usage.Sometimes it’s unavoidable: my cousin’s daughter is going that route as an architecture/planning student- sustainable,carbon-neutral,non-toxic,energy-effecient buildings and cities?- I also like visiting refurbished/”recycled” buildings and downtowns.

  12. #12 Adam_Y
    May 10, 2010

    I know what “green” means when applied to just about anything, and, yes, it’s a buzzword–and an an annoying one, at that.

    Considering the fact that there is a very strict definition in comparison to how Jenny McCarthy uses the word I doubt it. Then again I don’t know what name you could come up with that wouldn’t sound like a dumb platitude.
    Environmental friendly chemistry-Dumb
    Sustainable chemistry-Another buzzword

  13. #13 Pablo
    May 10, 2010

    Yes, “green chemistry” is a buzzword, but it has a very well-defined meaning and objective, as Adam_Y points out. To lump it in with “Green our vaccines” which is meaningless tripe, is not at all fair.

  14. #14 qetzal
    May 10, 2010

    My biggest gripe about the whole report was Lafall’s and Kripke’s cover letter to the president, where they claim:

    The Panel was particularly concerned to find that the true burden of environmentally induced cancer has been grossly underestimated.

    With a statement like that, I expect pretty clear data showing that environmental cancers are occuring at rates at least 2-3 fold higher than previously thought. But when you look for supporting citations, you find things like this (Overview, p. 2):

    Estimates of “attributable fractions” of the cancer burden due to occupation (approximately 4 percent), pollution (2 percent), industrial products (less than 1 percent), and medicines and medical procedures (1 percent) are now believed to underestimate significantly the true toll of cancer related to these exposures.

    This is followed by a discussion of why previous estimates may be inacurrate, and why true rates MAY be higher, but no citations or data showing that they really ARE “grossly” higher.

    That kind of crap – taking a legitimate concern and pretending it’s a proven certainty – is stupid and uncalled for. All it does is give detractors ammunition to dismiss the report as partisan and agenda-driven. Instead, they should have said right up front that the risk isn’t well-enough understood, but there are reasons to think it may be much more significant than previously though, and the whole field needs a lot more scrutiny.

  15. #15 Jarred C
    May 10, 2010

    Concerning the whole “Green Chemistry” thing, that’s been around for at least 1998. And while “green” is typically a buzzword (especially now-a-days), Green Chemistry is a specific set of recommendations (12 of them) as applied specifically to chemistry in order to reduce the amount of waste during a chemical reaction. This is particularly important on the mass production scale, and by applying it, companies have saved a massive amount of money.

    For anyone who’s never heard of it before, check out the 12 Principles from the EPA website:

    http://www.epa.gov/greenchemistry/pubs/principles.html

    (Requires a high school level knowledge of chemistry)

    Don’t hate the concept just because it has an annoying buzzword attached to it.

  16. #16 D. C. Sessions
    May 10, 2010

    Because its a really dumb argument to be claiming that everything is dangerous.

    Name one that isn’t. Warning: trick question.

    A lot of chemicals simply won’t kill you if unless you have a case of the stupids.

    Which doesn’t answer the question of subacute toxic effects, especially over the course of decades. We know that there are some substances which have such effects, but it’s insane to assume that we know all of them.

  17. #17 Pablo
    May 10, 2010

    Don’t hate the concept just because it has an annoying buzzword attached to it.

    I was going to bring up “nanoscience,” but then again, that’s one worth hating…

  18. #18 Jarred C
    May 10, 2010

    “A lot of chemicals simply won’t kill you if unless you have a case of the stupids.”

    There may be other reasons than “being stupid.”

    You could be uneducated: “Hold Your Wee For a Wii” contest in Sacramento, Ca killed a woman a few years ago with water poisoning. One of the dangers with ecstasy users is water toxicity; since the drug elevates your temperature, you would naturally think that drinking lots of water would combat this. Well, you’d be right; it does. However, too much has killed some of these drug abusers.

    You could be ignorant of (and/or lied to about) the effects of a specific chemical: As the owner of this company, I guarantee you that Mirex is safe, because the target is ants. How could something that hurts a little bug hurt you? Even though your covered in the powdered insecticide while working at our factory, it won’t harm you. Nor will it hurt your families when you carry all that insecticide dust home with you. Trust me.

    You could be ignorant of the presence of the chemical: as a Realtor, I strongly recommend this nice community next to the old Love Canal. It has wonderful schools for your children.

    A lot of times, when it concerns the chronic effects of a chemical, we’re not worried about the general public, we’re worried about specific populations that would be exposed to elevated levels, such as factory workers who may deal with the production of a product that uses a chemical in the process. These individuals are exposed to a much higher amount than most the rest of the population, and regulations need to be in place to protect them.

    Then again, this blog post is talking about cancer, and as far as I know, there are no known agents which produce cancer from an acute exposure. Well, except maybe diethylstilbestrol.

  19. #19 Orac
    May 10, 2010

    Don’t hate the concept just because it has an annoying buzzword attached to it.

    Straw man argument.

    I didn’t say I hated the concept, just the buzzword. The use of the “Green Our Vaccines” example was precisely to demonstrate how debased the term has become and to illustrate one reason why the whole term “green” has come to irritate me. These days it’s a marketing word far more than anything substantive.

    Quite frankly, it doesn’t matter to me whether “green chemistry” has a specific meaning to chemists (something I knew, by the way, because…well, its meaning is spelled out in the President’s Cancer Panel report). Its meaning has been so diluted by its common usage as a buzzword that I still hate the buzzword.

  20. #20 Jarred C
    May 10, 2010

    Orac,

    Fair enough. Oh, and it wasn’t a strawman argument, it was a misinterpretation of meaning. :)

  21. #21 Pablo
    May 10, 2010

    Orac – do you similarly hate Organic Chemistry because of what the common usage of “organic” has become?

    Do I need to stop calling myself an organic chemist because some idiots turned the word into a punchline?

  22. #22 Orac
    May 10, 2010

    Whatever.

    The whole “green” thing was one sentence in a 3,500 word essay. In other words, it’s minor, and the discussion of a throwaway remark of mine is derailing the thread. I’ll take my share of the blame for actually bothering to defend my remark and thus perpetuating the thread hijack, but no more. We’ll have to agree to disagree on this, because I’m not going to discuss it further.

    Do you have anything to say about the actual report or my post other than that you don’t like my annoyance with the buzzword “green” as applied to “green chemistry”?

  23. #23 The Olive Ridley
    May 10, 2010

    Green Chemistry is to you, a throwaway comment in a 3500 word blog post, which is otherwise well written and informative. But it displays a distressing lack of awareness on chemical exposure, and the need for using alternative, cleaner chemical routes. Yes, it is called Green chemistry, but it is real. It has to do with replacing toxic chlorinated solvents with non-toxic alternatives, it deals with the reduction of solvent use, it deals with using superheated steam and supercritical CO2 as replacement solvents, and so many other, real process changes.

    To you, it’s a buzzword. To the millions of workers who have to inhale hexane and dichloromethane everyday, it’s a lifeline.

  24. #24 Orac
    May 10, 2010

    Green Chemistry is to you, a throwaway comment in a 3500 word blog post, which is otherwise well written and informative. But it displays a distressing lack of awareness on chemical exposure, and the need for using alternative, cleaner chemical routes.

    Your comment displays a distressing lack of awareness about what a “straw man” argument is and ignores pretty much all the rest of the 3,500 word blog post other than the sentence or two that irritated you.

    Do you have anything substantive to say about the report itself or my discussion of it, you know, the rest of the 3,500 words or so?

  25. #25 Mu
    May 10, 2010

    I always get a kick out of the “Green Chemistry” guidelines of the EPA. Most of them are self contradictory in chemical process planing. Like the “avoid protection schemes and blocking groups”, which people do to do highly selective chemistry with minimal use of raw materials and to avoid the need for solvent and/or energy intensive separation of product and byproduct afterward. Similar, you develop a medication that’s shelf stable for 10 years instead of requiring refrigeration to last only 6 months, yes, it probably won’t break down in the environment as quickly as the first version.
    Sometimes I wonder if we shot ourselves in the foot by developing ppt analytical techniques. But then, most of those involve lots of solvents and high temperature and pressure. So maybe we green those away too.

  26. #26 Pablo
    May 10, 2010

    I don’t know if this part is your conclusion or the panel’s?

    the incidence of childhood cancers has been steadily climbing,

    Looking at the plot you posted, I don’t see anything that could be considered “steady” in the plot at all. The apparent trend is almost completely due to the choice of the starting point of 1975 and the years 1999 – 2002. The overall correlation of the line is r^2 = 0.2. However, make it start in 1976 and remove those 4 years at the end, and the slope is cut by more than half and the r^2 goes to 0.04. So those 5 points are really driving the plot and the correlation.

    Why is there so much more noise in that plot compared to the mortality, which is as steady as she goes.

  27. #27 Pablo
    May 10, 2010

    Like the “avoid protection schemes and blocking groups”, which people do to do highly selective chemistry with minimal use of raw materials and to avoid the need for solvent and/or energy intensive separation of product and byproduct afterward.

    Yeah, so the whole point is to develop selective chemistry so that you can do the transformations WITHOUT solvent, separation, OR protecting groups.

    Protecting groups are absolutely wasteful exercises, because the combination of protection/deprotection steps has a net no gain in the number of bonds in the molecule or the complexity. Yes, they are oftentimes necessary waste in order to make a productive modification, but if you can do it without having to use protecting groups, it is a more efficient and cleaner process.

  28. #28 Gil Ross MD/ACSH
    May 10, 2010

    I and my colleagues at ACSH are gratified that Orac reads our Daily Dispatch so assiduously, and we appreciate constructive criticism. Using terms such as pro-industry, however, detracts and distracts from objective fact-based discussion. We are pro-science and pro-consumer–when “industry” falls short of scientific validity, we call them on it: cigarette makers, homeopathic “healers,” and “dietary nutritional supplement” marketers have been our targets, among others. As for the PCP report, why is BPA the gorilla in the room? Even the most fervid anti-chemical fanatics have taken to pointing to “novel theories of endocrine disruption at low-levels” involving BPA, and numerous studies have failed to link BPA to any human cancer at any exposure–so how did BPA take center stage in the president’s CANCER panel? If you look at the language therein, you’ll see word-for-word congruences with numerous activist campaigns against it–so who really wrote this report? As for that supposedly-lethal experiment kindly Mark P suggested, bring it on Mark! If my math is correct, 100 G of some products “laced” with 10 parts per 100M of botulinum toxin would find me ingesting one microgram–while the lethal dose is 70 micrograms in humans. He undoubtedly unintentionally illustrated two items, the first of which is of importance: 1-the dose makes the poison–note that botox is also “laced” with b. toxin, oh my! 2-his pathetically inept suggestion shows that he is as scientifically clueless as he is vicious in this supposedly civilized discussion. Gil Ross MD acsh.org

  29. #29 Gil Ross MD/ACSH
    May 10, 2010

    Addendum to my above comment: I neglected to point out the real irony in the “eat botulinum and die” suggestion I debunked: Bisphenol-A (BPA) is widely credited with reducing the incidence of many canned-foodborne illnesses in its 50-year history of safe use in that area, specifically including the dreaded botulism. By the way, what do the ban-the-BPA advocates plan to replace it with? Gil Ross MD/ACSH.org

  30. #30 John
    May 10, 2010

    Orac,

    Good summary of the report. I think that the criticism from ACS stems from the fact that the PCP report implies that people can substantially decrease their cancer risk by following the report’s recommendations (my favorite is the recommendation to take off your shoes before entering your house to prevent pesticide exposure). Yes, these chemicals can cause cancer, but are unlikely to have much of an effect at the levels at which we are exposed. These are great things to recommend to live healthy, hygenic lifestyles. However, implying that they have a substantial effect on cancer risk may dilute the fact that there are a relatively small number of things that still cause the majority of cancers (smoking, obesity, alcohol, hormones). There is a big difference between saying that risks have been underestimated and saying that individual risks are large.

    These recommendations should be given with the emphasis being on that they are good recommendations for overall health/hygiene, and may also lessen your risk for cancer as opposed to recommending them because they decrease your risk of cancer. If you recommend them based on decreasing risk of cancer, that implies that there is evidence that they cause cancer in people exposed to them in the environment (which for the most part, there is not). When these recommendations are given on the basis that they can prevent cancer, it creates the public perception that they should be worry about them causing cancer (without much of a frame of reference in terms of level of risk), creating a “boy who cried wolf” scenario.

  31. #31 Orac
    May 10, 2010

    Using terms such as pro-industry, however, detracts and distracts from objective fact-based discussion. We are pro-science and pro-consumer–when “industry” falls short of scientific validity, we call them on it: cigarette makers, homeopathic “healers,” and “dietary nutritional supplement” marketers have been our targets, among others.

    Please don’t insult my readers’ intelligence with your disingenuousness. You know very well what I and others mean by “pro-industry.” We mean big pharma, pesticides, agribusiness, chemical, and the processed food industries, to name a few. While it is laudable that the ACSH accepts that tobacco use is a huge health threat (although I note of late that ACSH seems to be less than friendly to the idea that secondhand smoke causes health problems and that indoor smoking bans are a useful public health measure), that it also criticizes unscientific “alternative” medicine modalities and quackery, and that it supports our vaccination program, when it comes to virtually any other scientific issue of environmental exposure or health besides tobacco, ACSH nearly always comes down on the side of one of the aforementioned industries. Moreover, while supporting vaccines and attacking alt-med quackery are correct on a scientific basis, they also just so happen to be positions that align with the aforementioned industries. Coincidence?

    Of course, I’d be more than happy to be shown to be wrong about this assessment of ACSH, but having perused the ACSH website over the last couple of years I have yet to find an example of ACSH standing up to one of those industries. Perhaps Dr. Ross could educate me and provide a few examples of ACSH standing up to big pharma, big agriculture, or the chemical industry.

    Seriously. I can be persuaded.

  32. #32 Adam_Y
    May 10, 2010

    A lot of times, when it concerns the chronic effects of a chemical, we’re not worried about the general public, we’re worried about specific populations that would be exposed to elevated levels, such as factory workers who may deal with the production of a product that uses a chemical in the process. These individuals are exposed to a much higher amount than most the rest of the population, and regulations need to be in place to protect them.

    Nice to meet you. I’m one of those people that you are pretending to care about.

  33. #33 Andrew
    May 10, 2010

    Orac,

    Just a point which may be off topic but why was a straight line fitted to the cancer incidence graph? To my eyes it looks more like a sine wave. If so then an enviromental trigger becomes a far more interesting subject to study as it should be somewhat easier to disentangle from low level chemical exposure (and cure/prevent)

  34. #34 Jarred C.
    May 10, 2010

    Adam_Y, I’m not understanding why you’re projecting hostility towards me. Or are you assuming that I’m in a governmental group responsible for identifying and/or regulating exposure to chemicals?

    What I said was true, and the point of my post was to explain that there are more reasons than “being stupid” when it comes to being exposed to a toxin. (Or are you like my mother-in-law, who believes that uneducated is synonymous with stupid or low IQ? It gets annoying to have to constantly correct her on that.)

  35. #35 Jarred C
    May 10, 2010

    Andrew, the points are associated by year; it wouldn’t make sense as a sine wave correlating with year, as years are arbitrary. That’s my immediate thought, anyways.

  36. #36 Pablo
    May 10, 2010

    Andrew, the points are associated by year; it wouldn’t make sense as a sine wave correlating with year, as years are arbitrary. That’s my immediate thought, anyways

    While I don’t see any justification for a sine wave, as I pointed out above, there really isn’t any justification to conclude an increase, either.

  37. #37 gil ross MD/ACSH
    May 10, 2010

    Orac, you said: “Perhaps Dr. Ross could educate me and provide a few examples of ACSH standing up to big pharma, big agriculture, or the chemical industry. Seriously. I can be persuaded.”
    Unlike the large nonprofits such as AHA ALA ACS etc., ACSH has repeatedly pointed out how the FDA-approved NRTs for smoking cessation are by and large ineffective, and have campaigned for close to a decade for science-based approval of smokeless tobacco and (more recently) e-cigarettes as cessation aids/harm reduction products. As you know, ACSH’s credibility in the area of cigarette dangers is unquestioned. Big Pharma generously supports those groups and they–not necessarily of course having anything to do with funding–ignore and mislead about the facts on harm reduction. As you will of course agree, the problem of helping 45 million addicted adult smokers (in the USA alone) quit is a most important issue, given the one-year success rate of patches, meds., etc come in at less than 20%. Unacceptable–yet the official websites collude with Pharm to promote these drugs and state, “smokeless tobacco is not a safe substitute for cigarettes.” Of course it’s not! Tobacco abstinence is preferable–but nicotine addicts will get their drug: via lethal cigarettes, or 99% SAFER (not “safe”) snus, if given truthful information. Also, when the American Chemistry Council bought into the “let’s target chemicals” mantra from the EPA, we noted how off-base scientifically they were when they caved to the political zeitgeist, “going along to get along.”
    We haven’t “taken on” Agribusiness’ pesticides, Orac, because in truth there is simply no evidence that the approved use of ag. pesticides/herbicides is a cause of human disease at typical exposures. Do you have evidence to the contrary? I assume you don’t advocate buying organic produce to avoid those “dirty dozen” pesticide-laced fruits and veggies. I also assume you’d not want us to attack safe and useful products, whose evidence of toxicity is lacking, just to gain cred from chemophobic zealots. Lastly, please note that numerous academic experts in relevant fields have taken the PCP report to task.
    gil ross acsh

  38. #38 Scott
    May 10, 2010

    It looks close-ish to linear + scatter to me, but it’s honestly pretty much uninterpretable without proper error bars.

  39. #39 Pablo
    May 10, 2010

    It looks close-ish to linear + scatter to me, but it’s honestly pretty much uninterpretable without proper error bars.

    If the error bars are large, there is no pattern at all, and it is all indistinguishable.

    If the error bars are tiny, then it’s an extremely complicated function, with no discernible pattern.

    Either way, there’s no “steadily increasing” trend that can be deduced from it. Either it’s “there’s been no change” or “it’s way too complicated to draw any trend”

    As I said above, I don’t know who’s interpretation that was, Orac’s or the panel’s.

  40. #40 trrll
    May 10, 2010

    JLowe:

    Formaldehyde circulating in your body water isn’t carcinogenic. Formaldehyde inhaled into your nose and upper respiratory tract may be a human carcinogen.

    This seems extraordinarily improbable simply on biological grounds. Formaldehyde is a reactive molecule, so the most likely way in which it could produce cancer would be reacting with DNA. This implies that it can cross cell membranes, and indeed from its structure one would expect it to distribute freely throughout the body no matter where it comes from. So what is magical about inhalation? There is no cell in the body that formaldehyde could reach via inhalation that it could not reach through the bloodstream.

    It may well be the case that the risk of formaldehyde at the concentrations present in the blood is negligiblty small, but the same would apply to formaldehyde entering the body aty similar concentrations via other routes.

  41. #41 Orac
    May 10, 2010

    Except that formaldehyde is a strong irritant, at least of mucus membranes, which means that chronic exposure through inhalation might lead to chronic inflammation, which is one mechanism by which cancer occurs. Personally, I doubt formaldehyde is a major carcinogen except maybe for long-term industrial exposure, but I wouldn’t so easily brush off the possibility that exposure by inhalation is different than other exposures.

  42. #42 Scott
    May 10, 2010

    If the error bars are large, there is no pattern at all, and it is all indistinguishable.

    If the error bars are tiny, then it’s an extremely complicated function, with no discernible pattern.

    There is a happy medium where fitting a line to it can make sense. Really, a better way to do it would have been to fit a line, and report a confidence interval for the slope. Plots are nice, but they just don’t cut it for this level of quantification (i.e. is it flat or not), especially without the error bars.

    You could also explicitly test the data against the null hypothesis that the true incidence is constant. In an ideal world, that would be done prior to fitting the line.

    As I said above, I don’t know who’s interpretation that was, Orac’s or the panel’s.

    Since Orac nicely provided a link to the report, we don’t have to wonder. It states on page 4:

    Yet over the same period (1975–2006), cancer incidence in U.S. children under 20 years of age has increased (Figure 1).

    Figure 1, of course, is the graph in question. Entirely unquantified.

  43. #43 Harry Eagar
    May 10, 2010

    Nicely put about the complexity, Orac. Now go back and read yourself again, substituting ‘climate’ for ‘cancer.’

  44. #44 Orac
    May 10, 2010

    As I said above, I don’t know who’s interpretation that was, Orac’s or the panel’s.

    Actually, it was neither’s. It was the SEER database, which keeps track of cancer statistics for the entire country:

    http://seer.cancer.gov/csr/1975_2006/results_merged/topic_delay.pdf

    Scroll down to the second from the last page, Figure 28.1.

  45. #45 Kelli
    May 10, 2010

    Orac, Thanks for the post! Really well thought out and informative. You continue to do a great job sifting through the BS and giving people some real food for thought.

  46. #46 jj
    May 10, 2010

    Hmmm, I’ve alwasy had better luck growing lettuce for my salad in the winter, not the summer months…

  47. #47 Pablo
    May 10, 2010

    Yet over the same period (1975–2006), cancer incidence in U.S. children under 20 years of age has increased (Figure 1).

    Who added the “steadily increased” descriptor?

    Any error bars that are going to be big enough to justify using a linear fit, instead of some more complicated function, are going to be too big to conclude that there is any increase.

  48. #48 plaasjapie
    May 11, 2010

    this may be a bit OT, but Orac started it by discussing science fiction and grants in the beginning of the blog. I recently got hold of a DVD of “V” the original miniseries. In the plot the aliens appear to be human but are actually lizard like creatures underneath (now where have I heard of lizard like aliens before?) and their claims to have “come in peace” surprisingly turn out to be false.
    Getting to the point, they start causing scientists, who may reveal their true purpose, to disappear. Their spokesperson declares that this is because the evil scientists are taking part in a plot that will prevent them from sharing all their technology with humans. The reasoning behind this was that the scientists had already found the cures for most ills, like cancer, but were preventing other people from finding out about it because they would then lose their huge funding from research grants!
    So tell us Orac, is there a new conspiracy we should know about ie Big Academia? Maybe the scientists are not really shills for Big Pharma, but rather shills for Big Academia?
    Tell us about those billions in grant funding that you are hding from us!

  49. #49 WScott
    May 11, 2010

    It’s not homeopathy-level implausible, but it’s pretty implausible nonetheless, perhaps approaching acupuncture-level implausible.

    I for one look forward to the forthcoming Orac’s Implausibility Scale for alt.medicine practices.

  50. #50 Tracy W
    May 11, 2010

    A more coordinated system for promulgating environmental contaminant policy and regulations driven by science and free of political and industry influence.

    I.e., let’s skip all that complicated democracy stuff and just defer to the scientists. If you have a PhD you automatically know what degree of risk tolerance is right for other people.

    Sorry, this does sound nasty on my part. But, well, there’s no right answer to the right level of risk tolerance. Cars are clearly incredibly dangerous, with thousands of people being killed each year by them, but also clearly there’s no movement to ban them. People, en masse, really like cars. Yes, even in Europe with its good public transport and high gas taxes many people own cars (I am a Kiwi living in the UK, I’ve been to the USA and I like it in many ways, but it’s not my only experience of the world).

    For another example, take coal production. Coal mining is massively subsidised in Germany and Spain, despite the direct financial costs and despite the risk to the coal miners lives and despite the environmental costs. And the actual coal miners support this – they are not being kidnapped and forced to work in the mines. Many people in the UK hate Margaret Thatcher still for shutting down coal mining. Clearly some communities are willing to tolerate a lot of risk in terms of coal-mining. I think they’re crazy, but I don’t think I have a right to try to shut them out of the political process.

  51. #51 qetzal
    May 11, 2010

    Tracy,

    I agree with your overall point. Deciding how much harm may result from a given chemical at a given level is a scientific question. Deciding whether the benefits of using that chemical at that level outweigh the harm is ultimately a political question. Industry does indeed deserve the opportunity to weigh in on that political question.

    However, industry shouldn’t be able to use its financial resources to influence things ‘under the table.’ Nor should it be permitted to use outright deception. Perhaps what the authors should have said is “free of improper political and industry influence.”

  52. #52 Tracy W
    May 11, 2010

    qetzal, I would extend your statement a bit further, I don’t think that anyone, be they industry, trade unions, scientific associations, political parties or NGOs should be able to use their financial resources to influence things under the table. Nor do I think that any of them should be permitted to use outright deception, and I even more believe that the Government should not be permitted to use outright deception, but on the other hand, I have serious trust issues with letting any one have the right to decide what’s outright deception.

    I’m also aware that, as everyone I can think of consumes a far wider range of products than we produce, we have an incentive to pay more attention to political matters affecting us as workers/business owners than to political matters affecting us as consumers or taxpayers (for example, Orac himself has made some strong posts here about funding for medical research, but not in my memory about sugar quotas, I’m only picking on Orac here because he comes across as a fairly-open-minded, public-spirited and generous blinking box of lights so if his view is one-sided then most of ours are probably more so), so government agencies are probably always going to be presented with more arguments by the groups they’re meant to regulate than by the general public and thus are going to be at risk of regulatory capture. This always depresses me when I think about it.

  53. #53 realism
    May 13, 2010

    What am I to blame, other than something in the environment, for getting breast cancer at 31, with no family history? Why have rates of breast cancer under the age of 40 (a group not routinely screened) gone up almost 200% in the last ten years? My oncs said that they used to see one or two women in their 30s a year with breast cancer, now it’s almost 1/3 of their practice. Why??

  54. #54 Sam Dawes
    May 14, 2010

    More on the childhood cancer graph: After Figure 28.1 in the SEER program URL you gave, there appears a second figure for just childhood brain cancer. This shows an inflection point in 1990 and a leveling off in recent years. This was done using the “Joinpoint Regression Program” that the sophisticated biostatisticians at the National Cancer Institute have developed for interpreting trends in cancer statistics. If there were a similar inflection for all childhood cancer combined (Fig 28.1, and the figure in your post), they would have shown it. Your interpretation is correct, and thank you for your interesting post.

  55. #55 Poogles
    May 14, 2010

    “What am I to blame, other than something in the environment, for getting breast cancer at 31, with no family history?”

    Bad luck? Family history only means your chances of getting it too are higher. It does not mean that without a family history, you’re in the clear.

    “Why have rates of breast cancer under the age of 40 (a group not routinely screened) gone up almost 200% in the last ten years? My oncs said that they used to see one or two women in their 30s a year with breast cancer, now it’s almost 1/3 of their practice. Why??”

    Better awareness would be my first guess. Women in that age range may not be getting regular mammograms, but they are probably more likely to be doing self-exams and noticing changes due to the major increase in breast cancer awareness among the general population.

  56. #56 Pablo
    May 14, 2010

    “What am I to blame, other than something in the environment, for getting breast cancer at 31, with no family history?”

    I saw a poster at the doctor’s office the other day that said something like, “Less than 30% of all woman with breast cancer have it in their family.”

    (it might have been 40%)

    I thought it surprising. It did, however, also go on to say that family history is still probably the most important factor to evaluate the risk. But given that, it still only accounts for less than 30%

    Now, there are a few caveats that I would add
    1) I’m not sure it is true that family history is the biggest factor. For example, despite the stories, breast cancer is still predominately an “older” woman issue (no offense to anyone), in that more than 80ish% of cases are in post-menopausal women. So age plays a role.
    2) The less than 30% refers to all cases of breast cancer, including those of post-menopausal women, which account for 80%. I do not know how that breaks down by age. I wouldn’t be surprised to learn that younger cases are more likely to have a family history
    3) What is the current thinking about environmental causes of breast cancer? Are there any real solid triggers?

    (caveat: numbers are from memory, and could be off in some cases)

  57. #57 Jay Gordon
    May 15, 2010

    I’m sorry it has taken me so long to get to this post. It is really excellent.

    Thanks for looking hard at Cancer Panel’s report and highlighting both it’s strong points and weaknesses.

    Best,

    Jay

  58. #58 andrewo
    September 13, 2010

    This post has been tremendously helpful to me in recent days ( http://andrewottoson.com/2010/09/david-koch-clarifies-ncabs-role-but-did-he-overstep-it/ ) but FYI, the link to the main report appears to be broken.

    This one is working:

    http://deainfo.nci.nih.gov/advisory/pcp/annualReports/pcp08-09rpt/PCP_Report_08-09_508.pdf

  59. #59 Rait Saar
    December 26, 2011

    Does anyone know or could point me towards a research that would compare whether the breast cancer and fat meat link may depend on contamination of the meat/fat? There was a recent meta anaylysis stating fat rich diet has not to do with breast cancer, could the results depend on contamination level? Has this been discussed somewhere?
    Fat tissue may contain dioxins

    High fat diet increases sensitivity to maternal TCDD exposure, resulting in increased breast cancer incidence (on mice)