At last – the idea that most cancer is caused by environmental factors is becoming mainstream.

A report by the President’s Cancer Panel, Reducing Environmental Cancer Risk: What We Can Do Now was published in April 2010 This latest annual report, for 2008–2009, was written by Suzanne H. Reuben for the cancer panel and published by the National Cancer Institute.

The facts about cancer are dismal. As the report says, about 41 percent of Americans will be diagnosed with cancer at some time in their lives, and some 21 percent will die of it. In 2009 approximately 1.5 million new cases of cancer were diagnosed, and about 562,000 died of it.

In 2009 cancer cost the United States approximately $263 billion, for direct medical costs, “indirect morbidity costs (cost of lost productivity due to illness)” and “indirect mortality costs (cost of lost productivity due to premature death),” according to the report.

A much smaller, unknown percentage of cancer is attributable to “natural” causes, such as DNA damage that can occur from a cell’s replication. A much larger percentage derives from human activity.

According to Environmental Cancer Risk, in the last few years “[a] growing body of research documents myriad established and suspected environmental factors linked to genetic, immune, and endocrine [hormonal] dysfunction that can lead to cancer and other diseases.”
"About 41 percent of Americans will be diagnosed with cancer at some time in their lives."
Carcinogens (cancer-causing agents) reside in the air, water, soil and some consumer products.

It’s not that scientists and physicians haven’t been finding for years that an Environmental Cancer Risk exists. In 1962 biologist Rachel Carson published Silent Spring. In 1978 physician Dr. Samuel Epstein published his book The Politics of Cancer. And in 1997 ecologist Sandra Steingraber published Living Downstream: An Ecologist Looks at Cancer and the Environment. Over the years, journals have published numerous studies on cancer and the environment, but for the most part the scientific and medical establishments have ignored or marginalized them.

Our industrialized society swims in a sea of carcinogens. As the report explains in detail, there are many ways people are exposed to environmental carcinogens -- through exposure to contaminants from industrial and manufacturing sources, occupational hazards, contaminants from agricultural and landscaping chemicals, contaminants that compose our modern lifestyles (such as emissions from vehicles, disinfection of public water supplies and chemicals used for household pest control).

Exposure comes from medical sources (radiation and nuclear medicine), contaminants and other hazards from military sources, and natural sources (such as radon and sunlight).

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Some of the most striking facts about cancer from Reducing Environmental Cancer Risk are:

  • Air emissions from vehicles, particularly from burning diesel fuel, are responsible for about 30 percent of cancer resulting from air pollution. “Diesel engine exhaust from school buses is of special concern because many children are exposed to it on a daily basis,” the report says.
  • “Americans now are estimated to receive half of their total [ionizing] radiation exposure from medical imaging [especially computed tomography scans]. … People who receive multiple scans or other tests that require radiation may accumulate doses equal to or exceeding that of Hiroshima atomic bomb survivors.” “The public,” the report says, “is largely unaware of the radiation doses delivered by [computed tomography], positron emission testing, and other examinations that involve ionizing radiation, or of potential lifetime medical radiation dose and associated cancer risk.”
  • "A growing body of research documents myriad established and suspected environmental factors linked to genetic, immune, and endocrine [hormonal] dysfunction that can lead to cancer and other diseases."

  • Radon exposure is the second most common cause of lung cancer in the United States and “the leading cause of lung cancer among people who have never smoked.” Approximately 21,000 deaths annually are attributable to radon-induced lung cancer. (People who smoke and are exposed to radon have an increased risk of cancer.)
  • Residents of the Marshall Islands developed cancer from exposure to radiation from U.S. nuclear weapons testing in the Pacific from 1946 to 1958, and “the U.S. has not met its obligation to provide for ongoing health needs” of those people.
  • Funding by the National Institute for Environmental Health Sciences for cancer-related environmental research has “remained flat” since fiscal year 1999.
  • Conventional scientific thinking holds that the likelihood of increased cancer risk occurs with an increasing dose of carcinogens. However, low doses of endocrine disruptors have health effects that contribute to the development of cancer.
  • Poor people are more likely to be exposed to carcinogens than other populations because they tend to work in such jobs as mining, construction, manufacturing, agriculture and some service industries. Further, the poor are more likely than others to live in highly contaminated environments.
  • “EPA estimated that in 2001, ocean-going ships emitted more than 54,000 tons of fine particulate matter, equivalent to the pollution from 117 coal-fired power plants; approximately 745 tons of smog-forming nitrogen oxides, comparable to the emissions from 800 million new cars.”
  • “Approximately 87 million people live in … ports and coastal areas. Moreover, emissions from [ocean-going] ships can travel hundreds of miles inland, affecting many millions more.”
  • The military is responsible for much of the carcinogenic chemical and radioactive discharges in the U.S., including perchlorate, tricholoroethylene, perchlororethylene, Agent Orange (dioxins), chromium and radiation exposure from nuclear weapons testing and manufacturing. The people affected are uranium miners, millworkers, ore transporters, “downwinders” and other communities near nuclear test sites, nuclear power and weapons plants, and uranium mines and mills.
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    “Tens of thousands [of] chemicals and other substances are in use that have never been evaluated and whose carcinogenicity is unknown.” Only a tiny fraction has been tested for causation of disease, and many more enter the market each year. Weak regulations and inadequate follow-up result from the fact that polluting industries have a grip on government agencies.

    One innovation in the report is its recommendation that in evaluating a chemical’s safety, the chemical should be assumed to be harmful even if its carcinogenicity hasn’t been proven unequivocally. The current approach is to assume that a chemical is innocent until proven guilty, and the public has to prove that a chemical already marketed is carcinogenic.
    "Tens of thousands [of] chemicals and other substances are in use that have never been evaluated and whose carcinogenicity is unknown."
    “While … diverse effects often are difficult to quantify with existing technologies and research methods, in a great many instances, we know enough to act,” the report says.

    Another of its innovations is the assumption that environmental agents exist and can cause cancer. The Cancer Establishment -- the American Cancer Society and National Cancer Institute -- largely ignores this fact and focuses on lifestyle exposures.

    Pointing the spotlight on lifestyle exposure distracts from industry’s role in causing cancer and blames the victim for the disease.

    As the report says, ”Environmental health, including cancer risk, has been largely excluded from overall national policy on protecting and improving the health of Americans. It is more effective to prevent disease than to treat it, but cancer prevention efforts have focused narrowly on smoking, other lifestyle behaviors, and chemopreventive interventions.”

    Another innovation is insisting on approaching prevention as “primary prevention,” preventing disease at the source, as opposed to early detection, which the cancer establishment conflates with primary prevention to keep people’s attention off the industrial sources of carcinogen exposure.

    “The reactionary approach,” the report says, “typically engenders secondary prevention measures (e.g., screening, other methods for early detection of disease) once a health hazard has become evident, rather than action to remove the hazard from the environment (primary prevention).”

    “The precautionary, prevention-oriented approach [the Precautionary Principle],” the report states, “should replace current reactionary approaches to environmental contaminants in which human harm must be proven before action is taken to reduce or eliminate exposure.”

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    Much of the report is devoted to what federal agencies, scientists and physicians can do to improve environmental health. Weak regulations and inadequate enforcement result from industry’s power over government agencies.

    The report devotes considerable space to what individuals can do to reduce their Environmental Cancer Risk, dividing the subject into three parts -- children, chemical exposures and radiation.
    "While … diverse effects often are difficult to quantify with existing technologies and research methods, in a great many instances, we know enough to act."
    Children are at special risk because of their “smaller body mass and rapid physical development, both of which magnify their vulnerability to known or suspected carcinogens including radiation.”

    Fetuses, infants, young children and adolescents are especially sensitive and can undergo genetic or other damage resulting from environmental exposures to the mother and the father even before conception.

    Parents and child care providers should screen children’s toys, foods, house and garden products, place spaces, medicines and medical tests “that will minimize children’s exposure to toxics.”

    There are way for individuals to reduce or eliminate exposure to hazardous chemicals in the workplace. People exposed to occupational carcinogens can reduce their families’ exposure by removing shoes upon entering the house and washing work clothes separately from other laundry.

    Filtering tap or well water is another act individuals can take. The report stresses that unless the tap water is known to be contaminated, people should choose it over bottled water. As the report puts it, “Some bottled water is simply drawn from municipal supplies and receives no additional filtration or other treatment.”

    In bottled water, one study found caffeine, two carcinogens, acetaminophen, arsenic, radioactive isotopes, nitrates and nitrites (from pesticide residue), solvents, degreasing agents and propellants.

    Individuals also can store and carry water in stainless steel, glass or other containers free of BPA, an endocrine disruptor, and phthalates. Avoid plastic containers, from which chemicals can leach into the water.

    Microwaving food and beverages in ceramic or glass instead of plastic will reduce exposure to chemicals that can leach into the food from plastic containers.

    Avoid using lawn pesticides and chemical fertilizers, and eat food free of pesticides, growth hormones and antibiotics.
    "Environmental health, including cancer risk, has been largely excluded from overall national policy on protecting and improving the health of Americans."
    To reduce your exposure to toxics in household products, consult the Household Products Database, operated by the U.S. Department of Health and Human Services.

    Properly dispose of pharmaceuticals, paints and household chemicals to avoid contamination of drinking water.

    Turn off lights and electrical devices that derive power from burning fossil fuels. Drive less, and walk, bicycle and use public transportation more.

    Avoid smoking and second-hand cigarette smoke.

    No one has determined whether electromagnetic energy is carcinogenic, so play it safe by using a headset with your cell phone and using the phone minimally.

    Periodically have your house checked for radon, and don’t buy one that hasn’t been inspected.

    “To reduce exposure to [ionizing] radiation from medical sources, patients should discuss with their health care providers the need for medical tests or procedures that involve radiation exposure.”

    Make sure, with computed tomography or another radiation-using procedure, that the benefits outweigh the risks; procedures that don’t use radiation might provide the same information.

    Try to keep track of the medical radiation you’re exposed to, and discuss it with your health care provider before you undergo a test or procedure that uses radiation.

    Avoid exposure to sunlight, which is composed of ultraviolet radiation, associated with skin cancer.

    Support research into the effects of exposure to combinations of chemicals, not as they are studied today, as individual chemicals in isolation from others. Real-life exposure usually consists of multiple chemicals.

    Support the use of “green” chemicals, or safe alternatives to carcinogenic chemicals, and insist that they undergo study with the Precautionary Principle to discern whether they’re truly green.

    Reducing Environmental Cancer Risk is available in PDF format. You can obtain a paperback copy of the report for free at 1-800-4-CANCER or National Cancer Institute.

    Linda Greene can be reached at lgreene@bloomington.in.us.