Health Care Paradigms

Cancer and the Environment

 

Imagine a road winding through high, steep cliffs.  In one section, there is a steep downgrade followed suddenly by a severely sharp curve bordered by a 100 foot sheer drop to jagged rocks below.  Chronically poor road conditions and the lack of any railing on the road contribute to a high rate of accidents on this section of road.  Now imagine that all of the vast resources of the residents of the area are poured into improved ambulance services for the crash victims, enhanced trauma care at the local hospitals, and the latest in emergency room diagnostic devices.  The resources at the bottom of the cliff are vast, and the individuals and corporations that supply them are lauded.  Much emotion is put into the effort to fund these measures.  Little energy is devoted to preventing the crashes in the first place.  The assumption is that the crashes must be inevitable and the “solution” is defined by reducing the number of fatalities.  A small faction of residents  advocate for the installation of better guardrails, road signs warning of the upcoming hazard, and improved automobile safety design.   Obviously these  are not mutually exclusive endeavors, but if one is to be pursued at the expense of the other, who in their right mind would choose the ambulance and trauma care over the safety and preventive measures?

In this story, the car crashes represent cancer cases in the U.S.   As an advocate and activist for the reform  of cancer prevention education and funding, I have been warning the public to be cautious about the potentially misleading information which the media and even large cancer advocacy groups tend to produce around cancer prevention.  There is a strong tendency to focus both education and funding on treatment first and “screening” second, with actual prevention often taking a back seat, if offered a ride in the car at all.

If you question my skepticism, ask any woman over 40 what she has learned about preventing breast cancer.  Chances are, she will respond with the magical word, “mammogram”.  Yet the truth is that mammograms do nothing whatsoever to prevent breast cancer, and in fact bombard the breast with one of the few things we know cause cancer, ionizing radiation[1].  Furthermore,  mammograms are not the tool they have been promoted to be.  Recent research from the U.S. Preventive Services Task Force (USPSTF) has  revealed evidence that mammograms for women under 50 are probably not helpful and after 50 are overutilized[2].  Their official recommendations are for NO routine mammograms  before age 50 and even after 50 mammograms should be only once every two years.  By age 75 the risks outweigh the benefits again.  They even debunked the value of the breast self-exam, or BSE[3].

The take-away from all this is that neither mammograms nor BSE’s affect breast cancer incidence whatsoever.  They detect cancer that has already occurred.  In a sense, they are the opposite of prevention: they show how badly we have failed to prevent cancer.  As I have written before, calling mammograms or any other screening device a preventive measure is like calling a pregnancy test a form of birth control.

Meanwhile, the relationship of lifestyle and environmental factors to cancer incidence has been underreported, underfunded, and underexamined.  Recently, the President’s Cancer Panel published its findings on environmental cancer risks, in association with the National Cancer Institute, the National Institutes of Health, and the U.S. Department of Health and Human Services[4].  In this report, the Panel stated,

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

“”¦Research on environmental causes of cancer has been limited by low priority and inadequate funding.  As a result the cadre of environmental oncologists is relatively small, and both the consequences of cumulative lifetime exposure to known carcinogens and the interaction of specific environmental contaminants remain largely unstudied[5].”

With the massive amounts of funding, both private and public, that are devoted towards cancer “research”, it is certainly somewhat troubling to hear the words “known carcinogens”, “environmental contaminants” and “unstudied” used in the same sentence.  The Panel later adds that,

“The prevailing regulatory approach in the United States is reactionary rather than precautionary.  That is, instead of taking preventive action when uncertainty exists about the potential harm a chemical or other environmental contaminant may cause, a hazard must be incontrovertibly demonstrated before action to ameliorate it is initiated”¦.Only a few hundred of the more than 80,000 chemicals in the United States have been tested for safety.[6]“

According to this report, less than one-half of one percent of the potentially carcinogenic chemicals in use in the U.S. have been proven safe.  This is a shocking statistic.  Among the factors influencing this data, the Panel includes “weak laws and regulations, and undue industry influence”, which means that the corporations that are profiting from the use of these potentially deadly chemicals are currently able to suppress regulatory control over their use.

The process of identifying and eliminating environmental causes of cancer has a massive flaw: not only does it fail to generate much capital, but it robs profit not only from the corporations that thrive on perpetuating harmful but highly cost-effective strategies, but also from the industries that subsist on the detection and treatment of the disease.  Financially speaking it is a lose-lose situation.  This results in what the Panel calls a “lack of will to identify and remove hazards”.  At worst, you have a situation as occurred in the case of the toxic chemical bisphenol A, or BPA, used in products like baby bottles and food and beverage can liners.

Extensive research has linked BPA to breast cancer, obesity, diabetes, and other serious medical problems.  The Center for the Evaluation of Risks to Human Reproduction concluded in 2008 that there is'”¦some concern for effects on the brain, behavior, and prostate gland in fetuses, infants and children at current human exposures to bisphenol A’.  Yet in 2008, the FDA ruled the BPA is safe even for infants, based on selected studies[my emphasis], some of which were industry-sponsored, and what is alleged to have been undue influence by industry lobbyists”¦[7]“

 

Included in the 168 page document as implicated carcinogenic contaminants are:

  • Contaminants from industrial and manufacturing sources including
    • Polyhalogenated biphenyls
    • Asbestos
    • Chromium (used in tanning industry)
    • Percholorethylene and trichloroethylene (PCE and TCE, used in dry cleaning)
    • Air pollution
    • Mercury
    • Formaldehyde
    • BPA
    • Phthalates
    • Nanotechnology
    • Contaminants from agricultural sources
      • Pesticides
      • Herbicides
      • Fertilizers
      • Veterinary pharmaceuticals

If you want to truly be part of the cancer prevention community, if you wish to help work towards a cure, you must insist that your efforts and contributions are devoted towards these objectives, not simply detection and treatment.  Clearly, these are not mutually exclusive goals, and we have a sacred obligation to help those unfortunate enough to have gotten cancer.  But if you could make an impact on the life of the future generations, would you rather help your great granddaughter to have a less painful double mastectomy or never have cancer in the first place?  If you answered the latter, you need to advocate for major changes in the way we view and support cancer research and education.  You can be part of that change.

For a good example of a place to start making sure your involvement serves your grandchildren instead of the ambulance service at the bottom of the cliff, check out the National Breast Cancer Coalition at www.knowbreastcancer.org , where they are focused on finding ways to prevent breast cancer from occurring in the first place.  There are other organizations like them out there.  You just have to know to ask the right questions.

 


[1] . National Academy of Sciences”“ National Research Council, Advisory Committee. Biological Effects of Ionizing Radiation (BEIR). Washington, D. C., 1972.

[2]Annals of Internal Medicine, Nov. 17, 2009

[3] ibid

[4] Reducing Environmental Cancer Risk, US Department of Health and Human Services, April 2010

[5] Reducing Environmental Cancer Risk, p.ii

[6] Reduing Cancer Risk, pii

[7] Reducing Cancer Risk, p.37

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