| || |
The U. S. National Cancer Institute (NCI) has instant access to the media, Public Relations operations, and close contacts with Congress. Fully utilizing these outreach resources NCI issues a prodigious ongoing stream of information, press releases, databases, and public educational materials. The latter include the Comprehensive Public Cancer Database System dealing with screening, diagnosis, clinical research, and the latest claimed advances in treatment. In sharp contrast, NCI makes little or no effort to warn the public of well-documented risks, based on experimental and/or epidemiological evidence, from unknowing exposure to a wide range of industrial carcinogens, including those in consumer products, food, cosmetics, toiletries, and household products. As importantly, the National Cancer Institute has also failed to warn of potential carcinogenic risks on the basis of incomplete or suggestive, although not definitive, evidence and also to direct high priority to research and advocacy on such risks. Such failure disregards fundamental principles of public health and the scientific basis of the Precautionary Principle. This mandates the categorical responsibility of industry to provide unequivocal evidence on the safety of any new candidate product or process before its introduction into commerce, thereby ensuring that it does not pose potential or recognized human or environmental risks.
Denial of Citizens’ Right-to-Know
The U. S. National Cancer Institute has not attempted to develop a registry of avoidable carcinogenic exposures, including body burden data (p. 19), and make it available to the public. This is in striking contrast to the extensive user-friendly public educational outreach programs of NCI and ACS on cancer treatment and screening. Until such a registry becomes available, in the absence of an acute emergency, patients should specifically request full documentation on the risks of any drug, available in the Warnings and Precautions section of the annual Physicians Desk Reference. This is also in striking contrast to the misleading May 1998 response by past NCI Director Klausner to a question by Congressman Obey whether NCI’s Cancer Information Service provides the public with a registry of avoidable carcinogens. NCI’s silence effectively denies U.S. citizens of their fundamental democratic Right-to-Know of information on avoidable causes of a wide range of cancers which could empower them to reduce their own risks of disease and death. In this, the cancer establishment appears to make common cause with the chemical industry.
This longstanding denial of citizens’ Right-to-Know impacts disproportionately on low income black and other ethnic minorities, besides raising serious concerns on environmental justice. These population sub-groups are at particularly high risk in view of their general discriminatory location near petrochemical plants, hazardous waste sites, municipal incinerators, and nuclear reactors. However, the cancer establishment has rarely, if ever, undertaken epidemiological cluster analyses of claimed excess incidences of a wide range of cancers in such communities, let alone investigate their relation to local exposure to industrial carcinogens.
The cancer establishment’s denial of Right-to-Know extends to failure to provide Federal and State agencies with scientific data on carcinogenicity on which regulatory decisions are critically based, claiming that this is not their responsibility. However, regulatory agencies are charged with a wide range of other responsibilities. They also lack the authority and wealth of scientific and educational resources specifically directed to cancer which are heavily invested in the cancer establishment; regulatory agencies are also susceptible to industry lobbying and, more importantly, pressure from pro-industry administrations. Most critically, NCI and ACS have rarely, if ever, provided such data to Congress as a necessary basis for developing appropriate legislation and regulatory authority, apart from failing to inform the public-at-large (12, 34).
It should be stressed that NCI's silence on primary cancer prevention is in violation of the 1971 National Cancer Act's specific charge "to disseminate cancer information to the public." This silence is in further denial of the 1988 Amendments to the National Cancer Program (Title 42, Sec. 285A), which call for "an expanded and intensified research program for the prevention of cancer caused by occupational or environmental exposure to carcinogens."
The silence of the ACS and its track record on primary prevention (Appendix V) is in contrast to their misleading claims for advocacy, as emphasized in its Cancer Facts and Figures 2002: "Cancer is a political, as well as medical, social, psychological, and economic issue. Every day, legislators make decisions that impact the lives of millions of Americans who have been touched by cancer. To affect those decisions positively, the Society has identified advocacy as part of its mission and as one of its top corporate priorities, and works nationwide to promote beneficial policies, laws, and regulations for those affected by cancer."
Avoidable causes fall into four categories, posing widely differing types of empowerment, ranging from the personal to political:
- Consumer products: NCI and ACS have failed to inform the public of available information on common carcinogenic ingredients and contaminants in food, cosmetics and toiletries, and household products. They have also failed to provide such information to Congress, and to urge regulatory agencies to require explicit identification and warning labels for all such carcinogens. Such market place pressures would then enable consumers to boycott those industries marketing unsafe products in favor of socially responsible businesses, which are increasingly marketing safer products.
- Medical: A wide range of carcinogenic drugs are commonly prescribed to patients in the absence of legally-required informed consent, and of any safe alternatives. The cancer establishment has failed to systematize such information and circulate it to all physicians and the public, and to recommend explicit warning labels on all carcinogenic drugs. Patients should thus request their physicians to provide them with any such evidence (experimental and epidemiological) of cancer risks, as identified in the Warnings and Precautions section of the annual Physicians Desk Reference (PDR). For drugs so identified, patients should request available non-carcinogenic alternatives.
There is now strong evidence that allegedly "low dose" ionizing radiation from diagnostic procedures, particularly CT scans and fluoroscopy, poses significant risks of cancer. These risks are avoidable, as average doses can be substantially reduced without any loss of image quality. Emergencies apart, patients should seek radiologists who are increasingly practicing dose-reduction imaging procedures.
- Environmental: The cancer establishment has failed to collate and systematize avoidable information on carcinogenic contaminants in air and water on an ongoing basis, and to make this readily available to the public (12). This information has now become available, at community and zip code locations, in the Environmental Defense’s Scorecard (p. 17). Such information would enable activist citizen groups to take political action at the state level in efforts to reduce these carcinogenic exposures. It should be stressed that neither NCI nor ACS have considered, let alone initiated, epidemiological analyses to investigate possible cancer clusters in highly polluted communities.
- Occupational: There is substantial information on a wide range of carcinogenic products and processes to which some 11 million men and 4 million women are exposed (12). While industries employing more than 10 workers are required, by the Occupational Safety and Health Administration, to supply them with Material Safety Data Sheets, such information is generally inadequate and often misleading. While some unions take aggressive action to reduce occupational carcinogenic exposure, this is by no means the rule. Furthermore, plants employing less than 10 workers, generally lower socio-economic ethnic minorities, are virtually exempt from any such protective measures. Again, NCI and ACS should systematize such information and make it fully available to unions and workers on a national basis.
Finally, the cancer establishment's massive funding of a nationwide network of research institutes and hospitals virtually ensures the silence or reticence of their captive epidemiologists and other scientists on primary prevention. These constraints were strikingly exemplified in a widely-publicized May 2002 Public Broadcasting Service television report, Kids and Chemicals, on the relationship between chemical exposures and childhood cancer, and other diseases. The program featured well-qualified experts, some funded by the cancer establishment, who expressed strong concerns while misleadingly stressing the inadequacy of current information. One stated: "We suspect that children who are exposed to pesticides are at greater risk of childhood cancer than other children. But mostly we don't know." Another claimed: "We have a very serious lack of information of how to go about preventing these diseases, because we haven't had enough information." For these reasons, the experts called for a “National Children's Study” over the next 20 years at a cost of $50 million annually. However, this proposal trivialized substantial and longstanding available scientific information on avoidable causes of childhood cancer, of which the public still remains uninformed by the cancer establishment. Additionally, no mention was made of the primary responsibility of the NCI and ACS, whose funding is more than adequate, to undertake further research on avoidable causes of childhood cancer.
1. Ries, L.A.G., Eisner, M.P., Kosary, C.L., Hankey, B.F., Miller, B.A., Clegg, L., Edwards, B.K. (eds). SEER Cancer Statistics Review, 1973-1999, National Cancer Institute, Bethesda, MD, 2002.
2. Dinse, G.E., Umbach, D.M., Sasco, A.J., Hoel, D.G., Davis, D.L. Unexplained Increases in Cancer Incidence in the United States from 1975 to 1994: Possible Sentinel Health Indicators? Ann. Rev. Public Health 20:173-209, 1999.
3. Edwards, B.K., Howe, H.L., Ries, L.A.G., Thun, M.J., Rosenberg, H.M., Yancik, R., Wingo, P.A., Jemal, A., Feigal E.G. Annual Report to the Nation on the Status of Cancer, 1973-1999, Featuring Implications of Age and Aging on the U.S. Cancer Burden.
Cancer, 94(10):2766-2792, 2002.
4. Davis, D., Hoel, D. (eds.). Trends in Cancer Mortality in Industrial Countries. New York Academy of Sciences 6001:1-347, 1990.
5. Bailar, J. & Gornik, H.L. Cancer Undefeated. New Eng. J. Med. 336(22):1569-1574, 1997.
6. Clapp, R.W. The Decline in U.S. Cancer Mortality from 1991 to 1995: What's Behind the Numbers? Int. J. Health Services 28(4):747-755, 1998.
7. Greenberg, D. Science, Money, and Politics. University of Chicago Press, Chicago, IL, 2001.
8. Clegg, L.X., Feuer, E.J., Midthune, D.N., Fay, M.P., Hankey, B.F. Impact of Reporting Delay and Reporting Error on Cancer Incidence Rates and Trends. J. Nat. Cancer Inst. 94:1537-1545, 2002.
9. Begley, S. New Statistics Show Increase, Not Decline in Cancer Rates. The Wall Street Journal, October 16, 2002, p. 1537.
10. Kolata, G. "Test Proves Fruitless, Fueling New Debate on Cancer Screening." The New York Times, April 9, 2002. (See also Gøtzche, P.C. Commentary: Medicalization of Risk Factors. BMJ 324:890-891, 2002.)
11. Fellers, L. "Taxol is One of the Best Cancer Drugs Ever Discovered by the Federal Government: Why Is It Beyond Some Patients' Reach?" The Washington Post Magazine, May 31, 1998.
12. Epstein, S.S. The Politics of Cancer, Revisited. East Ridge Press, Fremont Center, NY, 1998. (Extensive scientific information on the causes and prevention of cancer and public policy.)
13. Doll, R. & Peto, R. The Causes of Cancer: Quantitative Estimates of Avoidable Risks of Cancer in the U.S. Today. J. Nat. Cancer Inst. 66:1191-1308, 1981.
14. Stallones, R. A. & Downs, T.A. A Critical Review of Estimates of the Fraction of Cancer in the U.S. Related to Environmental Factors. Report to the American Industrial Health Council, Houston, University of Texas School of Public Health, 1979.
15. Landrigan, P. Commentary: Environmental Disease: A Preventable Epidemic. Am. J. Pub. Health 82 (7):941-943, 1992.
16. Anderson, S.J., Culver, A.A., Dorfman, M.H., Hughes, A.S. Expanding the Public's Right-to-Know: Materials Accounting Data as a Tool for Promoting Environmental Justice and Pollution Prevention. INFORM, Inc., www.informinc.org, New York, NY, 2000.
17. Greaves, P., Goonetilleke, R., Nunn, G., Topham, J., Orton, T. Two-Year Carcinogenicity Study of Tamoxifen in Alderley Park Wistar-Derived Rats. Cancer Research 53(17):3919-3924, 1993.
18. White, J. (CEO Canadian Cancer Society), Letter to Guelph Mercury, Ontario, Canada, April 9, 2002.
19. Kliewer, E.V., Smith, K.R. Breast Cancer Mortality Among Immigrants in Australia and Canada. J. Nat. Cancer Inst. 87 (15):1154-1161, 1995.
20. Lichtenstein, P., Holm, N., Verkasalo, P., Iliadou, A., Kaprio, J., Koskenvuo, M., Pukkala, E., Skytthe, A., Hemminki, K. Environmental and Heritable Factors in the Causation of Cancer: Analyses of Cohorts of Twins from Sweden, Denmark, and Finland. New Eng. J. Med. 343(2):78-85, 2000.
21. Willett, W.C. Balancing Life-style and Genomics Research for Disease Prevention. Science 296:695-698, 2002.
22. Epstein, S.S. Evaluation of the National Cancer Program and Proposed Reforms. Am. J. Ind. Med. 24:109-133, 1993.
23. Baker, B.P., Benbrook, C.M., Groth, E., Benbrook, K.L. Pesticide Residues in Conventional, Integrated Pest Management (IPM)-Grown and Organic Foods: Insights from Three U.S. Data Sets. Food Additives and Contaminants 19(5):427-446, 2002.
24. Epstein, S.S., Hauter, W. Preventing Food Poisoning: Sanitation not Irradiation. Int. J. Health Services 31(1):187-192, 2001. (This publication was endorsed by over 20 leading international scientists, besides consumer groups.)
25. Tourgeman, D.E, Amezcua, C., Boostanfar, R., Stanczyk, F.Z., Felix, C., Paulson, R.J. Agonistic Effects of Raloxifene on Ovarian Adenocarcinoma (OVCAR-3) Cells. Abstract. Presented at the 17th Annual Meeting of the European Society of Human Reproduction and Embryology, Lausanne, Switzerland, July 1-4, 2001.
26. National Toxicology Program, Toxicology and Carcinogenesis Studies of Methylphenidate Hydrochloride in F 344/N Rats and B6C3F1 Mice. Technical Report Series No. 439, July, 1995.
27. International Agency for Research on Cancer. Atrazine, 73:59-113, 1999.
28. Hayes, T.B., Collins, A., Lee, M., Mendoza, M., Noriega, N., Stuart, A., Vonk, A. Hermaphroditic, Demasculinized Frogs After Exposure to the Herbicide Atrazine at Low Ecologically Relevant Doses. Proc. Nat. Acad. Sci. 99(8):5476-5480, 2002.
29. Wilson, D. Fateful Harvest: The True Story of a Small Town Global Industry, and a Toxic Secret. Harper Collins, New York, 2001.
30. Busby, C., Bertell, R., Schmitze-Feuerhake, I., Cato, M.S., Yablokov, A. 2003 Recommendations of the ECRR (European Committee on Radiation Risk). Health Effects of Ionising Radiation Exposure at Low Doses for Radiation Protection Purposes. Regulators’ Edition, Green Audit, Brussels, 2003; supported by over 40 leading international radiation experts. (www.euradcom.org)
31. Gould, J.M., Sternglass, E.J., Sherman, J.D., Brown, J., McDonnell, W., Mangano, J.J. Strontium-90 in Deciduous Teeth as a Factor in Early Childhood Cancer. Int. J. Health Services 30(3):515-539, 2000.
32. Havas, M. Biological Effects of Non-ionizing Electromagnetic Energy. Environ. Rev. 8:173-253, 2000.
33. Epstein, S.S. GOT (genetically engineered) MILK! The Monsanto rBGH/BST Milk Wars Handbook. E-book and Print on Demand book, Seven Stories Press, www.sevenstories.com, 2001.
34. Epstein, S.S. Legislative Proposals for Reversing the Cancer Epidemic and Controlling Run-Away Industrial Technologies. Int. J. Health Services 30(2):353-371, 2000. (Based on an invited address to the Swedish Parliament following receipt of the Right Livelihood Award, aka The Alternative Nobel Prize).
Excerpted fromStop Cancer Before it Starts: How to Win the War on Cancer, 2003 by Samuel S. Epstein, M. D.
Cancer Prevention Coalition
University of Illinois at Chicago
School of Public Health
2121 W. Taylor St., MC 922
Chicago, IL 60612