Environmental causes of cancer neglected, say US campaigners
Posted: 27 Mar 2003
by Samuel Epstein
Despite hugely increased funding for cancer research and prevention, the overall incidence of cancer in the United States has escalated to epidemic proportions in the last three decades. It now strikes about 1.3 million people and kills about 550,000 each year: nearly one in two men and more than one in three women now develop cancer in their lifetimes. The problem, says Dr Samuel Epstein, is that environmental causes have been largely ignored.
While smoking is unquestionably the single largest cause of lung cancer, besides a risk factor for some other cancers, the incidence of lung and other smoking-related cancers in US men has declined sharply. In striking contrast, there has been a major increase in the incidence of predominantly non-smoking cancers in men and women, especially among blacks, and also in childhood cancers. This increase in cancer and especially in non-smoking cancers, is reflected in the United Kingdom and other major industrialized nations.
Nevertheless, the US National Cancer Institute (NCI) has repeatedly made
misleading assurances of major progress in the war against cancer for over two
decades. NCI's 1998 Report Card, claimed a recent "reversal of an almost
20-year trend of increasing cancer cases." However, this
"reversal" was minimal and misleading. In October 2002, NCI admitted
to significant errors in underestimating its published incidence data, apart
from delays in reporting these data. Against this background, NCI Director
Andrew von Eschenbach's February 2003 pledge to "eliminate the suffering
and death due to cancer . . . and to do it by 2015" seem incongruous.
The escalating incidence of cancer does not reflect lack of resources. Since 1970, NCI's budget has increased approximately 30-fold, reaching $4.6 billion for 2003. Paradoxically, NCI's escalating budget over the last three decades is paralleled by the escalating incidence of cancer.
Apart from basic research, NCI's mindset remains fixated on "secondary" prevention or damage control - screening, diagnosis, and chemoprevention (the use of drugs or nutrients to reduce risks from prior avoidable carcinogenic exposures) - and treatment. This is coupled with indifference to primary prevention, preventing a wide range of avoidable, environmental causes of cancer, other than faulty lifestyle: smoking, inactivity, and fatty diet.
This exclusionary approach remains based on a scientifically discredited
1981 report by British epidemiologists, Drs. Richard Doll and Richard Peto.
Doll's strong pro-industry record over recent decades is still largely
unrecognised. They guesstimated that lifestyle factors are responsible for up
to 90 per cent of all cancers, with the balance arbitrarily assigned to
environmental and occupational causes.
In 1992, NCI claimed that its funding for prevention research was $350 million, 17 per cent of its approximately $2 billion budget; this claim manipulatively included funding for "secondary" prevention. However, independent estimates, unchallenged by NCI, were under $50 million, 2.5 per cent of its budget. In NCI's 2001 $3.7 billion budget, $444 million (12 per cent) was allocated to "Cancer Prevention and Control," with no reference to primary prevention.
The NCI conducts minimal research on avoidable exposures to a wide range of industrial carcinogens contaminating the totality of the environment - air, water, soil, the workplace, and consumer products - carcinogenic prescription drugs and "low dose" diagnostic medical radiation. As critically, NCI has failed to warn the public, media, Congress and regulatory agencies of such avoidable exposures to industrial and other carcinogens, incriminated in rodent tests and in epidemiological studies.
This failure to warn the public of cancer risks from avoidable exposures to industrial carcinogens and ionizing radiation is in striking contrast to NCI's prodigious stream of press releases, briefings and media reports claiming the latest advances in screening and treatment, and basic research. This silence also violates the 1988 Amendments to the National Cancer Program, calling for "an expanded and intensified research program for the prevention of cancer caused by occupational or environmental exposure to carcinogens".
The decades-long silence of NCI on a wide range of avoidable causes of cancer, other than personal lifestyle, has tacitly encouraged powerful corporate polluters and industries manufacturing carcinogenic products. Such corporate conduct has been characterised, "white collar crime," by Congressman J. Conyers in his 1979 and 1984 Bills, intended to extend such legislation to economically motivated crimes with adverse public health or environmental consequences. The NCI is thus complicit in these adverse public health consequences, and bears heavy responsibility for losing the winnable war against cancer and for the current cancer epidemic.
National cancer policies are now threatened more than ever before by NCI's indifference to primary prevention, and its silence on avoidable causes of cancer, other than personal lifestyle. As seriously, this silence reflects denial of citizens' democratic Right-to-Know and empowerment, and rejection of environmental justice, by sacrificing citizens' health and welfare to powerful corporate interests.
Representatives of consumer, labour, environmental, activist cancer groups, socially responsible business, and integrative and holistic medicine, strongly supported by independent scientists, must become actively engaged in developing the grass-roots STOP CANCER BEFORE IT STARTS Campaign, if the losing war against cancer is to be won.
The war against cancer must be fought by strategies based on primary prevention, rather than reactively on secondary prevention or damage control. As importantly, this war must be waged by leadership accountable to the public and not special interests.
Dr Samuel S. Epstein, is Chairman, The Cancer Prevention Coalition, and
Professor emeritus, Environmental and Occupational Medicine at the University
of Illinois at Chicago School of Public Health (Email: firstname.lastname@example.org). For a copy
of the full campaign report, detailed citations, and endorsements by
approximately 100 leading cancer prevention scientists, and representatives of
consumer, environmental, labour and citizen activist groups, see the Cancer Prevention
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