Regulation of Carcinogens Is Four Decades Overdue

The Safe Chemicals Act of 2010, filed by Senator Frank Lautenberg (D-NJ) on April 15 this year amends the 1976 Toxic Substances Control Act. This would require manufacturers to prove the safety of chemicals before they are marketed. Of particular concern are carcinogens, to which the public remains dangerously exposed and uninformed.

In 1971, President Nixon declared the national "war against cancer," and the National Cancer Act was passed. This charged the National Cancer Institute (NCI) "to disseminate cancer information to the public."

The 1971 Act also authorized the President to appoint the director of NCI and control its budget, thus bypassing the scientific and budgetary authority of the director of 26 other National Institutes of Health (NIH). As a result of this anomaly, NCI's current $5.3 billion budget, 17% that of the entire NIH, remains beyond control of NIH's director. This special status of the NCI was challenged in 2003 by the National Academy of Sciences, at bicameral hearings of the House Energy and Commerce, and also by the Senate Health, Education, Labor and Pensions Committees.

Furthermore, contrary to the specific requirements of the 1971 Act, the NCI has still failed to "disseminate cancer information to the public," and to warn them of a wide range of avoidable causes of cancer.

The 1988 amendments to the National Cancer Program called for "an expanded and identified research program for the prevention of cancer caused by occupational or environmental exposure to carcinogens." However, these amendments have been and still remain ignored by the NCI.

For over four decades, NCI policies have been and remain fixated on damage control -- screening, diagnosis, treatment and related research. Meanwhile priorities for prevention, from avoidable exposures to carcinogens in air, water, consumer products, and the workplace have remained minimal.

To be sure, smoking remains the best-known and single largest cause of cancer, particularly lung cancer. While lung cancer incidence rates in men have declined by 20 percent over the past three decades, those in women have increased by 111 percent. But more importantly, non-smoking cancers -- due to known chemical and physical carcinogens -- have increased substantially since 1975. Some of the more startling realities in the failure to prevent cancer are illustrated by their soaring increases. Examples include:

-- Malignant melanoma of the skin in adults is increasing by 168 percent due to the use of sunscreens in childhood that fail to block long wave ultraviolet light

-- Thyroid cancer is increasing by 124 percent due in large part to ionizing radiation

-- Non-Hodgkin's lymphoma is increasing 76 percent due mostly to phenoxy herbicides; and phenylenediamine hair dyes

-- Testicular cancer is increasing by 49 percent due to pesticides; hormonal ingredients in cosmetics and personal care products; and estrogen residues in meat

-- Childhood leukemia is increasing by 55 percent due to ionizing radiation; domestic pesticides; nitrite preservatives in meats, particularly hot dogs; and parental exposures to occupational carcinogens

-- Ovary cancer (mortality) for women over the age of 65 has increased by 47 percent in African American women and 13 percent in Caucasian women due to genital use of talc powder

-- Breast cancer is increasing 17 percent due to a wide range of factors. These include: birth control pills; estrogen replacement therapy; toxic hormonal ingredients in cosmetics and personal care products; diagnostic radiation; and routine premenopausal mammography, with a cumulative breast dose exposure of up to about five rads over ten years. Reflecting these concerns, Representatives Debbie Wasserman-Schultz and Henry Waxman have introduced bills promoting educational campaigns, including teaching regular breast self examination to high school students.

Paradoxically, the escalating incidence of cancer over the last thirty years parallels its sharply escalating annual budget, from $690 million in 1975 to $6 billion this year. Of this, a mere $131 million is now allocated to NCI's mission on "Prevention and Early Detection." Furthermore, President Obama has proposed a five percent increase in funding the NCI for unspecified cancer research, with a doubling to $11.5 billion over the next eight years.

However, in spite of well-documented evidence relating the escalating incidence of cancer to a wide range of avoidable carcinogenic exposures, the NCI remains "asleep at the wheel," and has stubbornly refused to devote significant resources to prevention.

The NCI has also ignored proddings from Congress and independent scientific experts to develop a comprehensive registry of carcinogens. Worse still, the NCI has misled the public by claiming that most cancers are due to "unhealthy behavior," "blaming the victim," despite overwhelming evidence to the contrary. For instance, the NCI still claims that 94 percent of all cancers are due to "unhealthy behavior," such as smoking, poor nutrition, inactivity, obesity and over exposure to sunlight, while a mere six percent are attributable to environmental and occupational exposures.

These estimates are based on those published in 1981 by the late U.K. epidemiologist Richard Doll. However, from 1976 to 1999, Doll had been a closet consultant to U.K. and U.S. industries, including General Motors, Monsanto and the asbestos industry. Following revelation of these conflicts of interest, just prior to his death in 2002, Doll admitted that most cancers, other than those related to smoking and hormones, "are induced by exposure to chemicals often environmental."

Furthermore, the NCI has touted the imminent success of new cancer treatments. These promises have seldom borne out, and have been widely questioned by the independent scientific community. For instance, Nobel Laureate Leland Hartwell, President of the Fred Hutchinson Cancer Control Center, warned in 2004 that Congress and the public are paying NCI $4.7 billion a year, most of which is spent on "promoting ineffective drugs" for terminal disease.

Based on recent estimates by the National Institutes of Health, the total costs of cancer now reach $228 billion a year. The annual costs to taxpayers of diagnosis and treatment amount to $93 billion; the annual costs of premature death are conservatively estimated at $116 billion; and the annual costs due to lost productivity are conservatively estimated at $19 billion. These are quantifiable and inflationary economic costs. The human costs surely are of far greater magnitude.

We urge that the public support Senator Lautenberg's Safe Chemicals Act by contacting your local Congressperson here.

Samuel S. Epstein, MD
Professor emeritus Environmental & Occupational Medicine
University of Illinois Chicago School of Public Health
Chairman, Cancer Prevention Coalition,
Chicago, Illinois
Tel: 312-996-2297