American Journal of Public Health, December 1998, 88(12):1881-1882

In his 1978 book The Politics of Cancer, Dr. Samuel S. Epstein threw down the gauntlet. Cancer, he said, is a preventable disease "caused mainly by exposure to chemical or physical agents in the environment." There is no such thing as a safe level of exposure to a carcinogen. Cancer risk and incidence have risen steadily throughout the century in every age group, despite knowledge and legal protections.

The first half of Dr. Epstein's 1998 sequel, The Politics of Cancer Revisited, reprints the 1978 volume, detailing the impact of cancer and describing the methods, uses, and limitations of human and animal experiments; workplace and environmental case studies; dangers of consumer products; and problems with policies and data collection. The second half of the book consists of 7 new chapters and 12 appendices.

Highly critical of the government's "war on cancer," and of most government agencies charged with leading it, for their nearly complete disregard of cancer prevention and their cosy relationships with industry, Dr. Epstein cites chapter and verse on conflicts of interest, leadership defaults, administrative sabotage, scientific inadequacies, barriers to public disclosure, and other factors that have failed to protect the public from avoidable carcinogens.

Industry, labor, and public interest groups fare no better under Dr. Epstein's scrutiny, He notes industry's short term marketing focus, outdated technology, and resistance to regulation. While acknowledging the achievements of a few dedicated labor leaders, the author laments the slow pace of union activism on employee health and safety issues. With a few exceptions, professional organizations "have been indifferent, if not hostile, to environmental and occupational problems."

Special rebuke is reserved for the American Cancer Society for its refusal to support critical public health legislation and for conflicts of interest, misdirection of its considerable financial and political resources, misrepresentation of treatment success rates, nearly exclusive focus on diagnosis and cure to the detriment of prevention, and "basic failure to comprehend the importance of environmental and occupational causes of cancer."

Dr. Epstein's 1987 report to Congress notes that 1 in 3 Americans will be diagnosed with cancer and that 1 in 4 will die of it. Both incidence and mortality rates continue to rise, particularly among African Americans and the poor. Data through 10994 indicate that only modest increases in 5-year survival rates, which are most likely due to earlier detection and improved access to care rather than improved treatments.

He states that annual U.S. production of synthetic organic chemicals has increased from 1 billion pounds in the early 1940s to 400 billion in the 1980s. The great majority of these substances have not been tested adequately or at all for toxic, carcinogenic, or ecological effects, and much of the available data is suspect. About 10 million American workers are exposed to high volume carcinogens. An estimated 3 billion pounds of toxic industrial emissions are discharged annually into the air. More than one ton of toxic waste per person must be disposed of each year. Rising cancer rates, which reflect exposure to much lower levels of carcinogens in past decades, are rarely acknowledged, and toxic effects other than cancer are not even investigated.

Industry leaders, government agencies, and academic consultants continue to collude, says the author, in supporting anti-regulatory, antidisclosure policies. The National Cancer Institute and the American Cancer Society continue to direct their research funds toward treatment, refuse to investigate nontoxic alternative treatments, and adhere to a "blame the victim" concept of cancer causation, focusing on smoking, diet, and other lifestyle factors, to avoid addressing environmental carcinogens. Dr. Epstein cites the close association of these organizations with manufacturers of mammogram equipment and cancer drugs and their public silence on involuntary exposure to substances in the workplace and in food, air, water, cosmetics, household cleaners, and other consumer products that increase cancer risk.

The book includes a 1992 statement signed by 64 environmental and preventive medicine specialists and published responses by the National Cancer Institute and American Cancer Society, as well as articles by scientists in the United States and United Kingdom with rebuttals by Dr. Epstein. Two chapters outline what individuals can do on personal and political levels to prevent cancer. Appendices list known carcinogens, cancers resulting from drug treatment, and a variety of documents including citizen petitions to the Food and Drug Administration, press statements, a summary of cancer risks from food, beverages, and household products, and a list of resource groups with contact information.

Sonja Noring