The National Cancer Advisory Board (NCAB), an official body of the National Cancer Institute, last month issued a stinging indictment of the nation's cancer programs. Furthermore, for the first time in memory the Board said industrial chemicals, environmental chemicals that mimic hormones, and pesticides need to be investigated as causes of cancer. [1]

In 1971 the U.S. Congress declared "War on Cancer," but year after year many cancers have steadily increased. See Table I. In a blunt assessment of the failed War on Cancer, the NCAB last month said, "The alarming statistics are that one in three people in this country will be diagnosed with cancer during their lifetime; every minute, another person in the United States dies of cancer; in 1994, 1.2 million new cancer cases will add to the more than 8 million people in this country alive today who have already been diagnosed; and within five years, cancer will surpass heart disease as the leading cause of death," the NCAB said. [pg. 9]

"The great strides made in understanding the disease still pale in comparison to the problem. It is disturbing that since 1971 the overall incidence of cancer has increased 18 percent, and the mortality rate has grown by 7 percent. Tobacco use and inadequate health care access account for much of this alarming and wholly unacceptable increase," the NCAB said. [pg. 10]

"While individuals have a responsibility to change high-risk behavior, government and society have responsibilities to identify and prevent workplace and environmental hazards, restrict advertising of unsafe products, require accurate product labeling, and provide culturally targeted education about cancer risk and prevention," the NCAB said. [pg. 17]

Throughout its report, the NCAB makes reference to industrial chemicals, environmental chemicals that mimic hormones, and pesticides, as suspected causes of cancer. Until now, the National Cancer Institute has taken the official position that chemicals cause such a small percentage of cancers that they are not worth investigating.

In a turnabout, the NCAB now says, "The elimination or reduction of exposure to carcinogenic agents is a priority in the prevention of cancer. We are just beginning to understand the full range of health effects resulting from the exposure to occupational and environmental agents and factors." [pg. B-6]

And: "Lack of appreciation of the potential hazards of environmental and food source contaminants, and laws, policies, and regulations protecting and promoting tobacco use worsen the cancer problem and drive up health care costs." [pg. 6]

The report makes 13 recommendations for applying research dollars more effectively; recommendation No. I-5 says, "Examine and change laws and regulatory policies and practices, including those related to the environment and food supply, that contribute to the cancer problem and frustrate cancer prevention and control efforts." [pg. 21]

Furthermore, under "recommendations for translational research" (research to translate existing knowledge into practical benefits) we find, "Establish the role of hormones in the etiology [cause] and prevention of certain cancers." [pg. 26] And: "Develop cancer risk assessments for occupational and environmental carcinogens, based on sound epidemiologic evidence, potency of the carcinogen, and prevalence of human exposure." [pg. 26] Recommendation II-2(4) reads: "Establish the role of external hormones (e.g., from plant or environmental sources) in the etiology [cause] and prevention of certain cancers." [pg. 26]

The report says, "Cancers developing in reproductive tissues such as the breast, ovary, endometrium, and prostate account for approximately 30 percent of all cancers. These tissues are dependent upon an interactive network of various hormones (estrogens, progestins, and androgens) for their structural and functional development. In recent years, investigators have shown that there is a relationship between the level and duration of hormone exposure and tumor development in these hormonally sensitive tissues." [pg. B-5]

In an appendix, the NCAB report lists known and suspected causes of various cancers. Pesticides are listed for cancers of the female breast; the prostate; the stomach; the brain; and the lymph system (non-Hodgkin's lymphoma). As Table I shows, several of these are major killers and/or are rapidly increasing.

Perhaps most importantly, the report focuses on poverty as a major stumbling block to winning the war on cancer: "Unless proven advances in cancer prevention and care are made available to our people in all walks of life, the cancer burden will never be markedly reduced. Bringing existing knowledge and technologies to all of the people will achieve the greatest and most rapid impact on cancer incidence, suffering, and death," the NCAB says. [pg. 17]

"Over 38 million people have no health insurance at all; 50 million are uninsured at some time during the year. Eighty million more have health insurance insufficient to cover the costs of a catastrophic illness such as cancer," the NCAB says. [pg. 18]

"The problem of access is severe among the 35 million poor. African-Americans represent one-third of the poor although they comprise only 12 percent of the United States population. The poor, who typically experience substandard living conditions, lower educational levels, risk-promoting lifestyles, and insufficient access to health care, have a higher incidence of many cancers, are diagnosed with more advanced disease, and have lower survival rates than the more affluent. Even the poor on Medicaid may fare no better than the uninsured," the NCAB says. [pg. 18]

"Anecdotal evidence indicates that even those with insurance may delay seeking diagnostic and other medical care for fear of employment discrimination, future uninsurability, and financial ruin should cancer be discovered," the NCAB says. [pg. 18]

Lastly, the report says that "Current health care reform proposals" [i.e., the Clinton administration's proposals AND the Republicans' suggested alternatives] "are devastating to the War on Cancer" because they deny resources for research and for quality cancer care. [pg. 5]

In sum, the National Cancer Institute is showing definite signs of beginning to "get" the connection between environmental justice, economic justice, and cancer prevention. So far, however, there are no signs of an awakening in the White House or in Congress.
                                                                         --Peter Montague
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[1] Paul Calabresi and others, CANCER AT A CROSSROADS: A REPORT TO CONGRESS FOR THE NATION (Bethesda, Md.: National Cancer Institute, September, 1994). Available free; phone 1-800-422-6237.