By Elizabeth Grossman
If the recommendations of the just published President’s Cancer Panel report, Reducing Environmental Cancer Risk: What We Can Do Now, become part of a comprehensive national policy agenda, the United States will have a remarkable new cancer prevention strategy – one that includes aggressive efforts to reduce and eliminate chemical exposures that can lead to and cause cancer, including those in the workplace.
Released on May 6th , the report (which includes over 450 sources) is remarkable for its embrace of environmental health science research that has not yet been incorporated into routine medical practice – and for its hard-hitting recommendations that call for a precautionary approach to regulating environmental contaminants.
“We debated a long time about addressing environmental issues,” Dr. Margaret Kripke, professor of immunology at the University of Texas M.D. Anderson Cancer Center and member of the President’s Cancer Panel, told me. “We were concerned,” said Kripke, “that this had not been addressed in recent reports. When you think about what’s happened in the last thirty years,” in terms of potential exposures, she said, “it’s hard to imagine that there’s less risk.”
The past thirty years has also seen an enormous growth in our understanding of how chemicals behave biologically and how exposures can affect human health. We now know that timing of exposure and low levels of exposure can have profound effects – sometimes affecting more than one generation. We’ve also learned that many substances previously thought to be biologically unavailable are in fact active.
“The Panel was particularly concerned to find that the true burden of environmentally induced cancer has been grossly underestimated,” say Cancer Panel members Dr. LaSalle D. Leffall, professor of surgery at Howard University School of Medicine, and Dr. Kripke in their letter presenting the report to President Obama. Both panel members were appointed by President George W. Bush. (The third seat on the panel, last held by Lance Armstrong, is currently vacant.)
The underestimated exposures, write panel members, include occupational exposures.
“Many millions of workers are exposed on the job to toxic and potentially carcinogenic or endocrine-disrupting chemicals, metals, fibers, combustion by-products, and other substances. Their exposures tend to be at considerably higher levels than those typically experienced by the general population,” notes the report.
The report singles out the military as a major source of occupational and environmental chemical exposures that can increase cancer risk. It points out that occupational exposure can become a source of family exposure as workers bring contaminants home on clothing and shoes. It also discusses increasing exposure to hazardous chemicals via consumer products and the hazards of increased use of medical radiation. For people experiencing occupational exposures, this means additional risks.
The report also notes that burdens of exposure are not borne equally by all communities or community members, particularly when it comes to occupational and industrial exposures: “The reality of this unequal burden is not just a health issue, but an issue of environmental justice.” [p25]
When it comes to occupational exposures, both Jeanne Rizzo RN, president and CEO of the Breast Cancer Fund, and Jeff Ruch, executive director of Public Employees for Environmental Responsibility, note that occupational health and safety programs have focused nearly exclusively on safety rather than health. This they explain has contributed to what the President’s Cancer Panel report characterizes as inadequate attention to occupational chemical exposures that can lead to diseases of long latency, like cancer.
Among the report’s recommendations is to update exposure assessments in U.S. workers. The last such study it points out, was conducted in the 1980s. That study – the 1981 Doll and Peto study – says Richard Clapp, Professor of Environmental Health, Boston University School of Public Health, “grossly underestimates” workplace exposures and was conducted with flawed methodology. The report concurs and also calls for occupational exposure studies that take into account multiple chemical exposures and their synergistic effects.
“Occupational and environmental factors need to be considered in diagnoses,” said Abby Sandler, executive secretary to the President’s Cancer Panel, on a call discussing the report.
“With the growing body of evidence linking environmental exposures to cancer, the public is becoming increasingly aware of the unacceptable burden of cancer resulting from environmental and occupational exposures that could have been prevented through appropriate national action,” write Cancer Panel members Drs. Leffall and Kripke in their letter to President Obama.
While substantial research gaps do exist, write Cancer Panel members. “in a great many instances, we know enough to act.”
What action this report will prompt remains to be seen, but its recommendations coincide with what environmental health advocates would like to see in reform of the Toxic Substances Control Act (TSCA) now up for debate in Congress – and with the direction the Obama administration EPA has been heading with its chemicals policy. Perhaps this will begin to shift the current focus of occupational health and safety that PEER director Jeff Ruch describes as “95 percent safety, not health.”
Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Salon, The Washington Post, The Nation, Mother Jones, Grist, and the Huffington Post. Chasing Molecules was chosen by Booklist as one of the Top 10 Science & Technology Books of 2009 and won a 2010 Gold Nautilus Award for investigative journalism.