=======================Electronic Edition========================
RACHEL’S ENVIRONMENT & HEALTH WEEKLY #412
—October 20, 1994—
News and resources for environmental justice.
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A TURNABOUT FOR CANCER POLICY?
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
===============
[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.
TABLE 1
U.S. Cancer Incidence (Occurrence) and Deaths in 1990, and the
Percent Change in Rates of Incidence and Death (Per 100,000
Population) During the Period 1950 to 1990.*
|
|
||||
|---|---|---|---|---|
| —–ALL RACES—— | —————-WHITES—————- | |||
| Cancer Type | Incidence in 1990 | Deaths in 1990 | Percent change in incidence, 1950-1990** |
Percent change in deaths, 1950-1990 |
|
|
||||
| mouth & pharynx | 30,500 | 8,405 | – 32.2 |
-28.3 |
| uterus | 33,000 | 6,027 | -3.8 | – 66.3 |
| stomach | 23,200 | 14,072 | -74.6 | – 76.3 |
| cervix | 13,500 | 4,627 | -75.1 | – 73.6 |
| esophagus | 10,600 | 9,719 | – 13.3 |
+9.4 |
| colon/rectum | 155,000 | 57,154 | +9.9 | – 28.2 |
| larynx | 12,300 | 3,709 | +59.3 | – 10.5 |
| testicles | 5,900 | 342 | +124.7 | – 68.6 |
| bladder | 49,000 | 10,340 | +53.7 | – 34.5 |
| Hodgkin’s | 7,400 | 1,632 | +26.9 | – 65.8 |
| childhood cancers |
7,600 | 1,697 | +1.3 | -59.2 |
| leukemia | 27,800 | 18,725 | +5.7 | – 2.4 |
| thyroid | 12,100 | 1,026 | +102.4 | – 50.3 |
| liver | 14,600 | 8,511 | +87.8 | +18.3 |
| pancreas | 28,100 | 25,081 | +11.8 | +16.9 |
| ovaries | 20,500 | 12,566 | +10.7 | +1.0 |
| lung | 157,000 | 141,146 | +258.6 | +261.5 |
| skin (melanomas) |
27,600 | 6,419 | +336.1 | +156.0 |
| breast (female) |
150,000 | 43,389 | +52.3 | +4.0 |
| prostate | 106,000 | 32,376 | +134.4 | +17.8 |
| kidney | 24,000 | 9,843 | +116.1 | +33.3 |
| brain | 15,600 | 11,630 | +73.6 | +47.9 |
| non-Hodgkin’s lymphoma |
35,600 | 18,461 | +171.9 | +113.7 |
| multiple myeloma |
11,800 | 8,896 | +182.5 | +189.8 |
| All types excluding lung | 883,000 | 364,149 | +31.7 | -14.4 |
| All types |
1,040,000 | 505,295 | +45.6 | +10.0 |
|
|
||||
Source: Barry A. Miller and others, editors, CANCER STATISTICS
REVIEW 1973-1990 [National Institutes of Health Publication No.
93-2789] (Bethesda, Md.: National Cancer Institute, 1993), Table
I-3, pg. I.27.
* All data are age-adjusted to the 1970 U.S. population.
** Certain data are for all races combined, not just whites;
specifically: all types; all types excluding lung; liver; brain;
and childhood cancers. For other cancers, the National Cancer
Institute says historical data for non-whites are not considered
reliable.
Descriptor terms: national cancer advisory board; ncab;
pesticides; solvents; cancer; carcinogens; hormones; estrogen;
androgen; prevention; food safety; tobacco; reproductive system;
cancer studies; cancer statistics; breast cancer; ovarian cancer;
stomach cancer; brain cancer; lymph system cancer; non-Hodgkin’s
lymphoma; health insurance; health policy; cancer policy;
poverty; African-Americans; health care reform; bill clinton;
president clinton; congress; national cancer institute; nci;