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#412 - Activist Malpractice, 19-Oct-1994

The National Cancer Advisory Board (NCAB), an official body of the
National Cancer Institute, last month issued a stinging indictment of
the nation's cancer programs. Furthermore, for the first time in memory
the Board said industrial chemicals, environmental chemicals that mimic
hormones, and pesticides need to be investigated as causes of cancer.

In 1971 the U.S. Congress declared "War on Cancer," but year after year
many cancers have steadily increased. See Table I. In a blunt
assessment of the failed War on Cancer, the NCAB last month said, "The
alarming statistics are that one in three people in this country will
be diagnosed with cancer during their lifetime; every minute, another
person in the United States dies of cancer; in 1994, 1.2 million new
cancer cases will add to the more than 8 million people in this country
alive today who have already been diagnosed; and within five years,
cancer will surpass heart disease as the leading cause of death," the
NCAB said. [pg. 9]

"The great strides made in understanding the disease still pale in
comparison to the problem. It is disturbing that since 1971 the overall
incidence of cancer has increased 18 percent, and the mortality rate
has grown by 7 percent. Tobacco use and inadequate health care access
account for much of this alarming and wholly unacceptable increase,"
the NCAB said. [pg. 10]

"While individuals have a responsibility to change high-risk behavior,
government and society have responsibilities to identify and prevent
workplace and environmental hazards, restrict advertising of unsafe
products, require accurate product labeling, and provide culturally
targeted education about cancer risk and prevention," the NCAB said.
[pg. 17]

Throughout its report, the NCAB makes reference to industrial
chemicals, environmental chemicals that mimic hormones, and pesticides,
as suspected causes of cancer. Until now, the National Cancer Institute
has taken the official position that chemicals cause such a small
percentage of cancers that they are not worth investigating.

In a turnabout, the NCAB now says, "The elimination or reduction of
exposure to carcinogenic agents is a priority in the prevention of
cancer. We are just beginning to understand the full range of health
effects resulting from the exposure to occupational and environmental
agents and factors." [pg. B-6]

And: "Lack of appreciation of the potential hazards of environmental
and food source contaminants, and laws, policies, and regulations
protecting and promoting tobacco use worsen the cancer problem and
drive up health care costs." [pg. 6]

The report makes 13 recommendations for applying research dollars more
effectively; recommendation No. I-5 says, "Examine and change laws and
regulatory policies and practices, including those related to the
environment and food supply, that contribute to the cancer problem and
frustrate cancer prevention and control efforts." [pg. 21]

Furthermore, under "recommendations for translational
research" (research to translate existing knowledge into practical
benefits) we find, "Establish the role of hormones in the etiology
[cause] and prevention of certain cancers." [pg. 26] And: "Develop
cancer risk assessments for occupational and environmental carcinogens,
based on sound epidemiologic evidence, potency of the carcinogen, and
prevalence of human exposure." [pg. 26] Recommendation II-2(4) reads:
"Establish the role of external hormones (e.g., from plant or
environmental sources) in the etiology [cause] and prevention of
certain cancers." [pg. 26]

The report says, "Cancers developing in reproductive tissues such as
the breast, ovary, endometrium, and prostate account for approximately
30 percent of all cancers. These tissues are dependent upon an
interactive network of various hormones (estrogens, progestins, and
androgens) for their structural and functional development. In recent
years, investigators have shown that there is a relationship between
the level and duration of hormone exposure and tumor development in
these hormonally sensitive tissues." [pg. B-5]

In an appendix, the NCAB report lists known and suspected causes of
various cancers. Pesticides are listed for cancers of the female
breast; the prostate; the stomach; the brain; and the lymph system
(non-Hodgkin's lymphoma). As Table I shows, several of these are major
killers and/or are rapidly increasing.

Perhaps most importantly, the report focuses on poverty as a major
stumbling block to winning the war on cancer: "Unless proven advances
in cancer prevention and care are made available to our people in all
walks of life, the cancer burden will never be markedly reduced.
Bringing existing knowledge and technologies to all of the people will
achieve the greatest and most rapid impact on cancer incidence,
suffering, and death," the NCAB says. [pg. 17]

"Over 38 million people have no health insurance at all; 50 million are
uninsured at some time during the year. Eighty million more have health
insurance insufficient to cover the costs of a catastrophic illness
such as cancer," the NCAB says. [pg. 18]

"The problem of access is severe among the 35 million poor. African-
Americans represent one-third of the poor although they comprise only
12 percent of the United States population. The poor, who typically
experience substandard living conditions, lower educational levels,
risk-promoting lifestyles, and insufficient access to health care, have
a higher incidence of many cancers, are diagnosed with more advanced
disease, and have lower survival rates than the more affluent. Even the
poor on Medicaid may fare no better than the uninsured," the NCAB says.
[pg. 18]

"Anecdotal evidence indicates that even those with insurance may delay
seeking diagnostic and other medical care for fear of employment
discrimination, future uninsurability, and financial ruin should cancer
be discovered," the NCAB says. [pg. 18]

Lastly, the report says that "Current health care reform
proposals" [i.e., the Clinton administration's proposals AND the
Republicans' suggested alternatives] "are devastating to the War on
Cancer" because they deny resources for research and for quality cancer
care. [pg. 5]

In sum, the National Cancer Institute is showing definite signs of
beginning to "get" the connection between environmental justice,
economic justice, and cancer prevention. So far, however, there are no
signs of an awakening in the White House or in Congress.

--Peter Montague


[1] Paul Calabresi and others, CANCER AT A CROSSROADS: A REPORT TO
CONGRESS FOR THE NATION (Bethesda, Md.: National Cancer Institute,
September, 1994). Available free; phone 1-800-422-6237.

TABLE 1 U.S. Cancer Incidence (Occurrence) and Deaths in 1990, and the
Percent Change in Rates of Incidence and Death (Per 100,000 Population)
During the Period 1950 to 1990.* .
-----ALL RACES------ ----------WHITES----------- . Percent Percent .
Incidence Deaths change in change in Cancer Type in 1990 in 1990
incidence, deaths, . 1950-1990** 1950-1990
mouth & pharynx 30,500 8,405 -32.2 -28.3 uterus 33,000 6,027 -3.8 -
66.3 stomach 23,200 14,072 -74.6 -76.3 cervix 13,500 4,627 -75.1 -73.6
esophagus 10,600 9,719 -13.3 +9.4 colon/rectum 155,000 57,154 +9.9 -
28.2 larynx 12,300 3,709 +59.3 -10.5 testicles 5,900 342 +124.7 -68.6
bladder 49,000 10,340 +53.7 -34.5 Hodgkin's 7,400 1,632 +26.9 -65.8
childhood . cancers 7,600 1,697 +1.3 -59.2 leukemia 27,800 18,725 +5.7
-2.4 thyroid 12,100 1,026 +102.4 -50.3 liver 14,600 8,511 +87.8 +18.3
pancreas 28,100 25,081 +11.8 +16.9 ovaries 20,500 12,566 +10.7 +1.0
lung 157,000 141,146 +258.6 +261.5 skin . (melanomas) 27,600 6,419
+336.1 +156.0 breast . (female) 50,000 43,389 +52.3 +4.0 prostate
106,000 32,376 +134.4 +17.8 kidney 24,000 9,843 +116.1 +33.3 brain
15,600 11,630 +73.6 +47.9 non-Hodgkin's . lymphoma 35,600 18,461 +171.9
+113.7 multiple . myeloma 11,800 8,896 +182.5 +189.8 . All types .
excluding . lung 883,000 364,149 +31.7 -14.4 . All types 1,040,000
505,295 +45.6 +10.0
Source: Barry A. Miller and others, editors, CANCER STATISTICS REVIEW
1973-1990 [National Institutes of Health Publication No. 93-2789]
(Bethesda, Md.: National Cancer Institute, 1993), Table I-3, pg. I.27.
. * All data are age-adjusted to the 1970 U.S. population. . ** Certain
data are for all races combined, not just whites; specifically: all
types; all types excluding lung; liver; brain; and childhood cancers.
For other cancers, the National Cancer Institute says historical data
for non-whites are not considered reliable.

Descriptor terms: national cancer advisory board; pesticides; solvents;
cancer; carcinogens; hormones; estrogen; androgens; prevention; food
safety; tobacco; reproductive system; cancer studies; cancer
statistics; breast cancer; ovarian cancer; stomach cancer; brain
cancer; lymph system cancer; non-Hodgkin's lymphoma; health insurance;
health policy; cancer policy; poverty; African-Americans; health care
reform; bill clinton; congress; nci;