By Elizabeth Grossman
If the recommendations of the just published President's Cancer Panel report, Reducing Environmental Cancer Risk: What We Can Do Now, become part of a comprehensive national policy agenda, the United States will have a remarkable new cancer prevention strategy - one that includes aggressive efforts to reduce and eliminate chemical exposures that can lead to and cause cancer, including those in the workplace.
Released on May 6th , the report (which includes over 450 sources) is remarkable for its embrace of environmental health science research that has not yet been incorporated into routine medical practice - and for its hard-hitting recommendations that call for a precautionary approach to regulating environmental contaminants.
"We debated a long time about addressing environmental issues," Dr. Margaret Kripke, professor of immunology at the University of Texas M.D. Anderson Cancer Center and member of the President's Cancer Panel, told me. "We were concerned," said Kripke, "that this had not been addressed in recent reports. When you think about what's happened in the last thirty years," in terms of potential exposures, she said, "it's hard to imagine that there's less risk."
The past thirty years has also seen an enormous growth in our understanding of how chemicals behave biologically and how exposures can affect human health. We now know that timing of exposure and low levels of exposure can have profound effects - sometimes affecting more than one generation. We've also learned that many substances previously thought to be biologically unavailable are in fact active.
"The Panel was particularly concerned to find that the true burden of environmentally induced cancer has been grossly underestimated," say Cancer Panel members Dr. LaSalle D. Leffall, professor of surgery at Howard University School of Medicine, and Dr. Kripke in their letter presenting the report to President Obama. Both panel members were appointed by President George W. Bush. (The third seat on the panel, last held by Lance Armstrong, is currently vacant.)
The underestimated exposures, write panel members, include occupational exposures.
"Many millions of workers are exposed on the job to toxic and potentially carcinogenic or endocrine-disrupting chemicals, metals, fibers, combustion by-products, and other substances. Their exposures tend to be at considerably higher levels than those typically experienced by the general population," notes the report.
The report singles out the military as a major source of occupational and environmental chemical exposures that can increase cancer risk. It points out that occupational exposure can become a source of family exposure as workers bring contaminants home on clothing and shoes. It also discusses increasing exposure to hazardous chemicals via consumer products and the hazards of increased use of medical radiation. For people experiencing occupational exposures, this means additional risks.
The report also notes that burdens of exposure are not borne equally by all communities or community members, particularly when it comes to occupational and industrial exposures: "The reality of this unequal burden is not just a health issue, but an issue of environmental justice." [p25]
When it comes to occupational exposures, both Jeanne Rizzo RN, president and CEO of the Breast Cancer Fund, and Jeff Ruch, executive director of Public Employees for Environmental Responsibility, note that occupational health and safety programs have focused nearly exclusively on safety rather than health. This they explain has contributed to what the President's Cancer Panel report characterizes as inadequate attention to occupational chemical exposures that can lead to diseases of long latency, like cancer.
Among the report's recommendations is to update exposure assessments in U.S. workers. The last such study it points out, was conducted in the 1980s. That study - the 1981 Doll and Peto study - says Richard Clapp, Professor of Environmental Health, Boston University School of Public Health, "grossly underestimates" workplace exposures and was conducted with flawed methodology. The report concurs and also calls for occupational exposure studies that take into account multiple chemical exposures and their synergistic effects.
"Occupational and environmental factors need to be considered in diagnoses," said Abby Sandler, executive secretary to the President's Cancer Panel, on a call discussing the report.
"With the growing body of evidence linking environmental exposures to cancer, the public is becoming increasingly aware of the unacceptable burden of cancer resulting from environmental and occupational exposures that could have been prevented through appropriate national action," write Cancer Panel members Drs. Leffall and Kripke in their letter to President Obama.
While substantial research gaps do exist, write Cancer Panel members. "in a great many instances, we know enough to act."
What action this report will prompt remains to be seen, but its recommendations coincide with what environmental health advocates would like to see in reform of the Toxic Substances Control Act (TSCA) now up for debate in Congress - and with the direction the Obama administration EPA has been heading with its chemicals policy. Perhaps this will begin to shift the current focus of occupational health and safety that PEER director Jeff Ruch describes as "95 percent safety, not health."
Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Salon, The Washington Post, The Nation, Mother Jones, Grist, and the Huffington Post. Chasing Molecules was chosen by Booklist as one of the Top 10 Science & Technology Books of 2009 and won a 2010 Gold Nautilus Award for investigative journalism.
I agree with what's written above, but I'm puzzled. You point out that we are woefully behind studying and setting standards to prevent occupational exposures to carcinogens, but then the only policy reform you single out is TSCA reform. Why would you just ignore the prospect of OSHA reform? Clearly, OSHA needs to be substantially reformed so that it is able to quickly set tough workplace exposure standards and, on top of that, to be able to set preventive standards using the precautionary principle, without having to wait for the dead bodies to pile up.
My understanding, based on the link to further information about TSCA reform, is that the proposed act would mandate safety testing for all industrial chemicals before they enter the market as well as all chemicals currently in production, in contrast to the current system where the EPA is only able to regulate chemicals that have been shown to cause harm since coming into use. It seems to me that this would be a pretty important piece of legislation, and one that would presumably lead to reform of occupational health & safety measures.
(caveat: I'm not American and certainly not an expert on the subject, so might well be misunderstanding which agency would have jurisdiction.)
Bob: Yes, agreed â excellent point about OSHA reform. The report in fact is critical of OSHA - how personal exposure levels have been set and their effectiveness, among other shortcomings. Report's recommendations also list agencies involved, including OSHA. These details may well be the subject of a subsequent Pump Handle posting. Intent here was to introduce readers to the report's main points, including its overall emphasis on the importance of occupational chemical exposures. Thanks for raising this point; OSHA reform in context of chemical exposures will clearly be an ongoing subject of discussion here.
OSHA does need to be a part of policy reform that addresses the overwhelming level of occupational exposures to carcinogens. I'm sure they're tuned into where the opportunities are both in TSCA reform and independent of TSCA reform.
As many readers likely already know, OSHA held OSHA Listens on March 4, 2010, a stakeholder meeting to solicit comments and suggestions on self-identified key issues facing the agency. To help get input on these "key issues," the agency asked 9 questions. Question # 9 asks specifically about permissible exposure limits (PELs):
"In the late 1980s, OSHA and its stakeholders worked together to update the Permissible Exposure Limits (PELs) (exposure limits for hazardous substances; most adopted in 1971), but the effort was unsuccessful. Should updating the PELs be a priority for the agency? Are there suggestions for ways to update the PELs, or other ways to control workplace chemical exposures?"
There were a lot of comments submitted on the PELs issue, and although PELs aren't on the most recent regulatory agenda, the issue is on OSHA's radar. Workers are often the first and worst exposed to cancer-causing chemicals and all that's clear to me at this point is that we need to fix that, but it's not clear how or who will overhaul the broken and ineffective PELs system. The org I work for, Worksafe, is going to keep working on California's painfully slow PEL-setting-and-updating process and other more effective ways to really protect working people.
I only had a chance to look at some sections of the report, those which I have some expertise in, and I am quite disappointed in the scholarship. The section on nitrate in drinking water is very shoddy and shows a lack of understanding of nitrate physiology in the body and is (I think) alarmist. One of the alarmist publications they cite had a response:
which did discuss the physiology. Nitrate from all sources is well absorbed, nitrate from drinking water at 10's of ppm and nitrate from green leafy vegetables at 2,000 to 5,000 ppm. The salivary glands then concentrate nitrate ~10x from plasma into saliva where commensal bacteria on the tongue reduce it to nitrite and when that nitrite containing saliva is swallowed, the nitrosative conditions might occur in the stomach. Nitrate from drinking water, nitrate from green leafy vegetables is all the same.
A better discussion of nitrate in drinking water (by people who do know the physiology) is here
I get the sense that the authors of the cancer report have the agenda of pushing âorganicâ farming methods which do not use chemical fertilizers, including nitrogen and phosphate, and are willing to âstretchâ the science to fit their agenda. I see this as very misguided and harmful. If humans are to grow enough food to sustain a population of 7+ billion, the use of chemical fertilizer is unavoidable. That chemical fertilizer needs to be safe, it needs to have low levels of toxins that can accumulate, but it is unsustainable to farm land, remove nutrients as crops and not replace them. Plants don't care what the source of the mineral nutrients is. They mostly take them up as inorganic ions.
I do not agree with the report where it states "The report singles out the military as a major source of occupational and environmental chemical exposures that can increase cancer risk." I spent over 13 years of my military career as a US Air Force Bioenvironmental Engineer, running industrial hygiene programs at several bases. I can assure you that if there is a place that has been described as pristine compared to many private industries is the US Air Force. I know that the US Navy also has a very active industrial hygiene program. I would like to know what military activities are considered to expose military workers to carcinogens in a worst manner than workers in private industry.
One possibility is that they cleaned up the work areas just before your inspections!