Environmental cancer: because it's there

President Obama got some advice yesterday from a special Presidential Cancer Panel. The Panel was mandated under the National Cancer Act of 1971 and included a strong staff and leading cancer specialists. The focus was on cancers we get from environmental exposures. It is strong stuff, but it is also stuff experts in cancer epidemiology have known for a long time. Unfortunately the environmental cancer prevention message too often gets submerged in the "you gave cancer to yourself because of how you live" message or triumphant news about the latest therapy for cancer you've already got (the typical line from the American Cancer Society). And Senators and Congressthings don't champion programs because their spouses didn't get cancer.

The report includes recommendations for stronger and more integrated regulation of carcinogens by Federal agencies, more attention to the unequal burden of carcinogenic exposures borne by “migrant and other farm workers, and residents of high-poverty areas and cancer ‘hot spots’” to reduce their risks, increased action to minimize radiation exposure from medical sources, more support for Green Chemistry and alternatives assessment, and the obligatory call for individuals to reduce their own exposures wherever possible. Compared to previous statements by such organizations as the American Cancer Society and even some reports from the National Cancer Institute, today’s report is a breath of fresh air. (Richard Clapp and Molly Jacobs, Presidential Panel presenters)

This report is a comprehensive look at the things we are involuntarily exposed to in our hospitals, doctors' offices, communities and workplaces that give us one of the most dread diseases in our society. It points out that these factors have been grossly underestimated in the past because of “flawed and grossly outdated methodology.” Again, no surprise to experts but a message most unwelcome to those for whom this information is, shall we say, inconvenient. And as Clapp and Jacobs report, the push back has started in earnest, led by the notorious industry water carriers at the wingnut American Council on Science and Health:

The counter-offensive by groups like the American Council on Science and Health is already underway, "Cancer death rates are going down. The so-called environmental trace levels of chemicals play no role whatsoever in the etiology of cancer” (see LA Times coverage) Yet it is important for cancer prevention advocates to take the pieces of the President’s Cancer Panel report that speaks to their concerns and bring it to their constituencies so it can serve as a guide for their own organization’s programs. Only in this way will the report have “legs” beyond today’s release. For example, the PCP report provides strong support for the Toxic Substances Control Act reform process that is currently underway in the U.S. Congress. This landmark report needs to see the light of day in whatever forum possible.

The battle is joined. Again. It's been going on behind the scenes for a long time, and behind the scenes is just where the ACSH and the American Cancer Society would like to keep it. But this time it's being sent out from a more visible source, what NY Times columnist Nicholas Kristof called the “Mount Everest of the medical mainstream.”

There's a mountain of evidence about the environment and cancer. And the Cancer Panel was standing atop that Mount Everest.

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The counter-offensive by groups like the American Council on Science and Health is already underway, "Cancer death rates are going down. The so-called environmental trace levels of chemicals play no role whatsoever in the etiology of cancerâ

"On"? How... neutral.

Less ambiguous, and therefore more honest, would be "American Council against Science and Health".

By David MarjanoviÄ (not verified) on 08 May 2010 #permalink

Excuse my ignorance, but why does the American Cancer Society not want to deal with environmental cancers?

Erika: It is not in their field of interest. Their constituency has been people who have had themselves or had family members with cancer or in the case of one environmental carcinogen, cigarettes, a personal behavior. They aren't opposed to regulating true carcinogens that are environmental or occupational but it is much more peripheral to their interests and tend to resist those things which take the spotlight off of things their contributors are most concerned about. This has been their history and continues to be. Have you ever contributed to the ACS because you wanted companies to stop polluting the air with carcinogens or contaminating the water? If you have, you are in a small minority of their contributors.

Thanks! I was just curious. I don't know much about the ACS, nor have I contributed to their programs.

ACS has come under criticism in the past, for being too focused on cancer screenings and not on prevention. They also have or had a kind of sweetheart deal with Weight Watchers (they even gave Sarah Ferguson, a then-spokesperson for Weight Watchers, an ACS Mother of the Year award a few years back for no discernible reason, since she has never done anything for cancer) and they got kind of mad about the Presidents Cancer Panel pointing out that environmental chemicals and toxins are important. ACS apparently would like us to think most cancer is caused by your "lilfestyle" behaaviors.

The highly profitable cancer industry hates this new report from the Presidential Cancer Panel. A serious effort at prevention might result in fewer customers. They would much rather sell us the latest high-priced surgical procedure or blockbuster drug.

As Samuel Epstein pointed out recently at the Huffington Post:

"Meanwhile, the incidence of a wide range of cancers, other than those due to smoking, has escalated sharply from 1975 to 2005, when the latest NCI statistics were published. These include malignant melanoma (172%), Non-Hodgkin's lymphoma (79%), thyroid (116%), testes (60%), and childhood cancers (38%)."

Elena, until you can produce some *very* good sources supporting your claims about bee embryos, I'm going to interpret all of your copypasta as utter drivel.

@6 Jeff - "The highly profitable cancer industry hates this new report from the Presidential Cancer Panel. A serious effort at prevention might result in fewer customers. They would much rather sell us the latest high-priced surgical procedure or blockbuster drug."

What, pray tell, is the "cancer industry?" I do cancer surgery (since you blasted "high-priced surgical procedures" specifically), did two of them this week (colon resections.) I would love for effective prevention to put me out of the cancer business. I don't relish the 42-year-old who comes in with locally-advanced and metastatic rectal cancer, who I know from the first meeting has a low probability of 5 year survival, which I know means that his 3 young children will grow up without a Dad and that his wife will struggle emotionally and financially for years to come. Am I glad he has cancer, so I "get" to do his operation? Am I thinking at all about the money I will make by doing his operation? You are an ignorant ass to suggest that I am. Ask any "cancer surgeon" you know (do you actually know any?), and I guarantee you they would love for this portion of their business to dry up. Believe me, there are easier ways to earn a living.

I don't exalt that cancer exists so that I can do these operations. I do these operations because, so far, we have not eliminated the need for cancer surgery.

What, pray tell, is the "cancer industry?"

We could start with The National Cancer Institute and its grant recipients. Did you have a chance to read Epstein's piece over at Huffpo? The NCI has completely ignored the Congressional directive to develop ways of preventing cancer. It spends its multi-billion dollar budget on "damage control - screening, diagnosis, treatment, and clinical trials."

I'm not questioning the skill and dedication of many cancer surgeons. If I'm ever diagnosed with cancer I want the best doctor possible.

@SurgPA My father was your basic mainstream MD. He taught at an Ivy med school, chief of staff at a hospital, large private practice, articles in JAMA, NEJM, etc. Many (many) years ago he was on television saying agent orange caused no harm. Why? because the government told him it didn't and he believed them. When he found out the truth - and that he had been lied to - and they were using him - he dedicated his time to truth finding in medicine, public health, etc. He was the first person to tell me about the cancer industry.

In honor of his quest, let me ask you to research low dose naltrexone and cancer. I could tell you it prevents cancer and has cured terminal cases, but it sounds outrageous and unbelievable. Please research it and tell me what you think. This is an off label use of an FDA approved drug - off patent - so no one will do major trials. It works like this:

"The treatment seems to work by causing the body to secrete endorphins (metenkephalin and beta-endorphin), which attach to cancers having opiate receptors, shrinking the tumors and inhibiting their growth. Low dose naltrexone may also help cancer patients by up regulating opioid receptors in cancer cells. When metenkephalin and/or beta-endorphins, are attached to cancer cells while they are dividing, it seems to stimulate a process of programmed cell death or apoptosis, thus killing some cancer cells. Low dose naltrexone may also work by so stimulating certain immune system cells that tend to kill cancer cells, including T4 and natural killer cells."

There are a lot of cases online about terminal patients alive with ldn treatment. Their doctors gave up on them and they found MD's using it. These aren't quacks - you will see. I promise they are MD/PhD's in some cases, using proper protocol to document and report their work.

There are some MD's with their presentations to NIH about cancer regression with ldn on youtube. LDN has also been through clinical trials (Penn State and Stanford) for Crohn's and fibromyalgia respectively. Huge success. But that's another story.

Normalizing the immune system is the mechanism of action. If you are not part of the industry, suspend what you think you know and do some research.

And to prevent colon cancer, take vit B6:

1)Theodoratou E, Farrington SM, Tenesa A et al. Dietary vitamin B6 intake and the risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev. 2008 Jan;17(1):171-82.

(2) Matsubara K, Komatsu S, Oka T, Kato N. Vitamin B6-mediated suppression of colon tumorigenesis, cell proliferation, and angiogenesis (review). J Nutr Biochem. 2003 May;14(5):246-50. See also: Komatsu S, Yanaka N, Matsubara K, Kato N. Antitumor effect of vitamin B6 and its mechanisms. Biochim Biophys Acta. 2003 Apr 11;1647(1-2):127-30. "Epidemiological studies have reported an inverse association between vitamin B(6) intake and colon cancer risk." http://www.ncbi.nlm.nih.gov/pubmed/12686121

(3) Zhang SM et al. Folate, vitamin B6, multivitamin supplements, and colorectal cancer risk in women. Am J Epidemiol. 2006 January 15; 163(2): 108-115. http://aje.oxfordjournals.org/cgi/content/full/163/2/108 .

Revere, thanks for your blog. You and your readers may be interested in my blog about it: http://bit.ly/c12fcz. I do hope the report provides some impetus to dealing with cancer & other diseases where environmental exposures are a major factor, and that we can address the problem at the population level instead of blaming the victims all the time by attributing causes exclusively to genes & "lifestyle factors."

Valerie: Nice job. You got it right. Unfortunately Maggie Fox at Reutersswallowed the ACS line in its entirety. There were a lot of people she could have talked to but didn't.


In the report's cover letter to the president, Leffall and Kripke state:

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

But when I read further into the report to see the actual data, all I find are statements about how previous estimates are unreliable, and how environmental causes MAY be much more significant that previously thought. I didn't see much (if any) actual data to show that environmental cancers ARE much more common than previously thought.

You state that there is a "mountain of evidence about the environment and cancer." Are there any particular reveiws or citations that you can recommend that show the true magnitude of environmentally-caused cancers?

qetzal: There is a substantial literature on the underestimate. The original estimate that gets cited often goes back to a paper in JNCI in 1981 by Doll and Peto which has clear assumptions that lead to underestimates of environmental and occupational cancer (said to be about 10% combined), but other estimates by NCI put a high of about 38%. An industry sponsored estimate by Stallones put it at about 20%. Even if we take the 10% number, it means that about 150 people will die today from environmental or occupational cancer. If this were a mine accident or a scaffold fall or an explosion on an oil rig it would make headlines around the world. Even most car bombs don't come close to this and this happens every day, day in and day out. Moroever of the remaining 90%, much is entangled with synergisms with personal habits like diet and smoking. In most industry favored estimates almost all lung cancers are attributed to smoking even though we know that smoking combines with occupational carcinogens to multiply the risks, not just add them. These are involuntary exposure which no one chooses to undergo. Why do we concentrate on the ones that people do choose and be largely silent on the ones that are done to us? Environmental and occupational cancers kill more people each year than motor vehicle accidents, even by the conservative estimates of Doll and Peto.

Regarding the specific evidence, we know many industrial sourced chemicals that cause cancer. We know hardly anything about how obesity does or does not cause cancer, although it is always dragged out as a major cause. Maybe. As for cigarettes, it's a no-brainer. Let's try to get people off the cigarette habit. That discussion is over. So why keep bringing it up. We are trying hard to do something about it. Not so with the other exposures.

@6, 9-

Ok, let's start with NIH. Highly profitable? (or do you count our tax dollars in their profits)? I'm not sure congress thinks so each cycle when NIH presents their budget request. NIH has a secret mission to perpetuate cancer incidence/prevalence to maintain their customer base? That's a pretty strong assertion, got evidence of this intent? In terms of "selling surgeries," last I looked, the NIH wasn't collecting royalties on the surgeries I do, so I'm not sure they even have a theoretical profit motive in "selling the latest high-priced surgeries." You claim not to question the dedication of surgeons; just who then is doing the surgeries you railed against @6?

Oops, I misread your prior post as NIH, not NCI. I don't know the NCI, but they're certainly not profitting from my surgeries, so I still don't see how they gain from "high priced surgical procedures." My ending question stands...

NCI (the National Cancer Institute) is part of NIH. One thing to understand is that these government agencies are not always as independent as they seem. ACS and NCI have a very cozy relationship. NCI investigators need to keep on the right side of the right people in the field of cancer. Why? Lots of reasons. NCI investigators get reviewed by those same people and can lose their internal research funding if the reviewers are unfavorable. Like others (think of an assistant professor), their career advancement and continued funding depends to a large extent on staying on the right side of the right people. They need to get favorable reviews, to get invited to the right meetings, to get their articles published in the right journals. NCI invites leading experts in to give advice about future reesarch directions, where to put NCI's research money and so on. Not surprisingly, the leading experts' advice is rather self-serving and tells NCI to direct funding to where it will most benefit the same experts.

So, no,"NCI" as an institution does not profit,but there are lots of reasons and ways that NCI is not independent either. Certain kinds of funders give money to ACS and others don't. ACS shapes the agenda somewhat according to its funders' interests and NCI follows ACS to a considerable degree.

Nowadays environmental problems are too big to be managed by individual persons or individual countries. In other words, it is an international problem. To what extent do you agree or disagree?