THE CANCER WAR GRINDS ON

[Guest guest]

Is there a safe level of exposure to a cancer-causing chemical?

NCI says no: " There is no adequate evidence that there is a safe

level of exposure for any carcinogen. " And " Low exposure that

might be safe for one person might cause cancer in another....

Unfortunately, scientists have not yet developed any way to

measure a person's individual risk. Exposure to a low level of a

carcinogen thus has to be considered a risk for everyone, " NCI

says.

=======================Electronic Edition========================

.. .

.. RACHEL'S ENVIRONMENT & HEALTH WEEKLY #641 .

.. ---March 11, 1999--- .

.. HEADLINES: .

.. THE CANCER WAR GRINDS ON .

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THE CANCER WAR GRINDS ON

In 1996 Donna Shalala, U.S. Secretary of Health and Human

Services, declared that the war on cancer was finally showing

results. " This looks like a turning point in the 25-year war on

cancer, and it should be cause for celebration by every

American, " she said.[1] Shalala made her dramatic pronouncement

to underscore the fact that the death rate for all cancers

combined had declined 2.6% during the period 1991-1995. It was

the first sustained decline since the government started keeping

cancer statistics in the 1930s.

Cancer deaths declined for cancers of the lung and prostate in

men, breast and uterus in women, and colon/rectum in both sexes.

Since these are the most common cancers, they drove down the

overall death rate.

We suspect that these reported trends are questionable because

reputable studies indicate that many cancers remain undiagnosed

unless an autopsy is performed, and autopsy rates have declined

in recent years (see REHW #631).

However, for purposes of discussion, let's assume that the

government is right, that age-adjusted deaths from all cancers

combined really did decline 2.6% between 1991 and 1995.

Despite this bit of good news, the details of cancer in this

country are still awful. Cancer struck 1,228,000 Americans for

the first time in 1998, and 564,800 Americans died of cancer in

1998.[2] A man's chances of getting cancer during his lifetime are

now 48% (about 1 out of 2) and a woman's chances are now 38%

(about 4 out of 10). Clearly, we have a very long way to go

before we can claim that the " war on cancer " has been won.

Furthermore, the good news about cancer hides some terrible

injustices. For example, the largest declines in cancer death

rates between 1991 and 1995 occurred among African-Americans. The

death rate for all cancers combined declined 5.6% among blacks

between 1991 and 1995. The decline was especially great among

black men, whose cancer death rate decreased 8.1%, compared to

black women, who experienced a 2.5% decline during the same

period.

Despite this good news, the overall age-adjusted cancer death

rate is still 40% higher among black men compared to white men,

and 20% higher among black women compared to white women.[1]

Why do blacks die of cancer so much more than whites? The

Director of the National Cancer Institute, Klausner,

phrases it delicately: " less access to care and less aggressive

treatment " play a role, he says.[1] Less aggressive treatment?

There is an extensive body of literature showing that many

physicians give second-class medical care to black patients.[3]

Perhaps this occurs because blacks tend to be poorer than whites,

but perhaps it also results from a widely-shared (and perhaps

subconscious) racist view that blacks deserve less than whites.

The " cancer establishment " has a ready explanation for the

declining death rates from all cancers combined. They say roughly

half the overall 2.6% improvement in cancer death statistics,

1991-1995, can be accounted for by improvements in " life style "

-- less smoking, better diet, more exercise. They say the other

half results from better diagnosis and treatment -- more people

are being kept alive by chemotherapy, radiation, and surgery.

But Clapp at the Boston University School of Public

Health points out that heart disease is caused by these same

factors -- smoking, bad diet and insufficient exercise.[4]

Because of improvements in these factors, deaths from heart

disease have declined 49% during the past 25 years. If heart

disease and cancer are caused by the same factors, why has the

cancer death rate remained so high? It cannot be simply that

cancer is a disease of old age. Heart disease, too, is a disease

of old age. Is something else besides " life style " factors

causing cancer? It is a fair question.

We note that in a 1990 cancer prevention booklet titled

EVERYTHING DOESN'T CAUSE CANCER, the National Cancer Institute

(NCI) says, " Many cancers could be prevented by reducing our

exposure to carcinogens. " [5] The NCI identifies 30 chemicals or

industrial processes that are known to cause cancer in humans.

Furthermore, NCI says, " Of the several hundred other chemicals

that cause cancer in animals, however, it is not known how many

are also human carcinogens. Nevertheless, materials that cause

cancer in one type of animal usually are found to cause cancer in

others.... For these and other reasons, we should expect animal

carcinogens to be capable of causing cancer in humans. "

The NCI goes on to explain why weak cancer-causing chemicals

cannot be reliably identified among the 70,000 chemicals now in

industrial use. In a typical test of a chemical for

carcinogenicity, " groups of about 50 mice or rats of each sex are

exposed to the test substance at different dosages for about two

years. " At the end of the experiment, the animals are killed and

examined for cancer.

NCI goes on: " In the human population, large numbers of people

are exposed to low doses of chemicals, but the total impact may

not be small at all. For example, " NCI says, " a carcinogen might

cause one tumor in every 10,000 people exposed to it, which may

not seem great. But exposure of 230 million Americans would

result in 23,000 cancers -- a public health disaster. "

NCI goes on: " We obviously could not identify a carcinogen that

causes one cancer in every 10,000 exposed mice by running the

test on only 50 mice. To detect such a low cancer rate, we would

need tens of thousands of mice. This would cost many millions of

dollars per test. Testing more than a few chemicals in such a

fashion would be too expensive and time-consuming, " NCI says.

NCI also points out that it is difficult to identify which

carcinogens cause which cancers because " A chemical that causes

cancer of the liver in mice, for example, might cause cancer of

the breast in rats and cancer of the bladder in humans. "

Is there a safe level of exposure to a cancer-causing chemical?

NCI says no: " There is no adequate evidence that there is a safe

level of exposure for any carcinogen. " And " Low exposure that

might be safe for one person might cause cancer in another....

Unfortunately, scientists have not yet developed any way to

measure a person's individual risk. Exposure to a low level of a

carcinogen thus has to be considered a risk for everyone, " NCI

says.

Here is the big picture of cancer: Table 1 shows that during the

last 45 years, the incidence of all cancers combined has risen

1.0% each year and the death rate for all cancers has increased

at the rate of 0.2% each year. If we exclude lung cancer, the

increase in the incidence of all other cancers is still 0.8% each

year for the past 45 years, but the death rate has declined at

the rate of 0.4% each year. A rising incidence and a dropping

death rate, taken together, mean more people are learning to live

with cancer.

==========

[1] Jo Hoeksema and Law, " Cancer Mortality Rates

Fall: A Turning Point for the Nation, " JOURNAL OF THE NATIONAL

CANCER INSTITUTE Vol. 88, No. 23 (December 4, 1996), pgs.

1706-1707.

[2] Lynn A.G. Ries and others, SEER CANCER STATISTICS REVIEW,

1973-1995 (Bethesda, land: National Cancer Institute, 1998).

[3] For example, see the first 19 studies cited in A.

Schulman and others, " The Effect of Race and Sex on Physicians'

Recommendations for Cardiac Catheterization, " NEW ENGLAND JOURNAL

OF MEDICINE Vol. 340, No. 8 (February 25, 1999), pgs. 618-626.

[4] W. Clapp, " The Decline in U.S. Cancer Mortality from

1991 to 1995: What's Behind the Numbers? " INTERNATIONAL JOURNAL

OF HEALTH SERVICES Vol. 28, No. 4 (1998), pgs. 747-755.

[5] National Cancer Institute, EVERYTHING DOESN'T CAUSE CANCER

[NIH Publication No. 90-2039] (Bethesda, land: National

Cancer Institute, March, 1990).

Search terms: cancer; carcinogens; heart disease; morbidity

statistics; mortality statistics; national cancer institute;

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TABLE 1

U.S. Cancer Incidence and Deaths in 1995, and the Percent Change

in Age-Adjusted Rates of Incidence and Death per 100,000 U.S. .

Population, 1950-1995. .

.. .

.. -----ALL RACES------- ------WHITES---------

Cancer Incidence Deaths Percent Percent

type in 1995 in 1995 change in change in

.. (estimated) incidence, deaths,

.. 1950-1995 1950-1995

----------------------------------------------------------------

stomach 22,800 13,645 -76.6 -79.5

cervix 15,800 4,503 -79.3 -75.1

rectum 38,200 8,053 -26.8 -67.0

colon 100,000 49,591 +15.4 -19.1

larynx 11,600 3,871 +41.7 -13.1

testicles 7,100 314 +109.6 -72.3

bladder 50,500 11,083 +54.0 -34.8

Hodgkin's disease 7,800 1,431 +15.0 -73.0

childhood (0-14 yr) 8,300 1,584 +9.8 -66.5

leukemias 25,700 20,323 +8.9 -3.5

thyroid 13,900 1,122 +138.8 -49.9

ovaries 26,600 13,341 +2.4 +0.6

lung 169,900 151,099 +257.0 +261.2

skin melanomas 34,100 6,905 +426.0 +154.4

breast (female) 183,400 43,843 +56.1 -5.1

prostate 244,000 34,475 +204.0 +14.4

kidney 28,800 11,083 +128.9 +37.2

liver 18,500 11,191 +131.1 +30.9

non-Hodgkin's .

lymphomas 50,900 22,391 +199.3 +137.0

multiple myeloma 12,500 10,250 +199.5 +209.1

brain 17,200 12,062 +80.0 +46.3

pancreas 24,000 26,765 +10.8 +16.7

.. .

All types ex- .

cluding lung 1,082,100 387,338 +42.1 -16.6

..

All types 1,252,000 538,437 +54.8 +7.7

================= .

.. .

Source: L.A.G. Ries and others, editors, SEER CANCER STATISTICS

REVIEW 1973-1995 (Bethesda, MD: National Cancer Institute, 1998),

Table I-3. NIH says historical data for non-whites are not

considered reliable spanning the period 1950-1995 so historical

data are only given for whites. This report is available at

http://www-seer.ims.nci.nih.gov/Publications/CSR7395/.

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