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WHAT CAUSES BREAST CANCER?
Breast cancer kills 46,000 women in the U.S. each year. On average, each of these women has her life cut short by 20 years, for a total loss of about a million person-years of productive life each year. Of course this huge cost to society is heaped on even greater burdens, the personal anguish and suffering, the motherless children, the shattered families.
The medical establishment dominated by male doctors pretends that the breast cancer epidemic will one day be reversed by some miracle cure, which we have now been promised for 50 years. Until that miracle arrives, we are told, there is nothing to be done except slice off women's breasts, pump their bodies full of toxic chemicals to kill cancer cells, burn them with radiation, and bury our dead. Meanwhile, the normal public health approach primary prevention languishes without mention and without funding. We know what causes the vast majority of cancers: exposure to carcinogens. What would a normal public health approach entail? Reduce the burden of cancer by reducing our exposure to carcinogens. One key idea has defined public health for more than 100 years: PREVENTION. But with cancer, everything is different. In the case of cancer, prevention has been banished from polite discussion.
Now a new, fully-documented book, by physician Janette D. Sherman, poses a fundamental challenge to all the doctors and researchers and health bureaucrats who have turned their backs on cancer prevention: "If cancers are not caused by chemicals, endocrine-disrupting chemicals, and ionizing radiation, what are the causes? How else can one explain the doubling, since 1940, of a woman's likelihood of developing breast cancer, increasing in tandem with prostate and childhood cancers?," Dr. Sherman asks.(pg. x) And if exposures are the problem, then ending exposures is the solution: "Actual prevention means eliminating factors that cause cancer in the first place."
Dr. Sherman is a practicing physician who has treated 8000 patients over 30 years. Unlike most physicians, she possesses an extensive knowledge of chemistry. Furthermore, she has become a historian by examining a large body of medical and public health literature dating back to the 19th century. It is this unique combination -- of historical view, knowledge of chemistry, deep personal experience as a physician, and an ethical clarity that PRIMARY PREVENTION is the proper policy -- that makes this book important and compelling.
The book begins with two chapters emphasizing the similarities among all living things that are made up of cells including humans, animals and plants. Cells in every creature can go awry and start to grow uncontrollably, a definition of cancer. Because all cell-based creatures are so similar, what we learn from one can often tell us something useful about another. For example, when we learn from the Smithsonian Institution that sharks get cancer from swimming in waters contaminated with industrial chemicals, we learn (or SHOULD learn) something useful about our own vulnerability to exotic chemicals.
Turning to breast cancer, Dr. Sherman lists the known "risk factors" the common characteristics shared by many women who get breast cancer: early menarche (age at which menstruation begins); late menopause (age at which menstruation ends); late childbirth and the birth of few or no children; no experience breast-feeding; obesity; high fat diet; being tall; having cancer of the ovaries or uterus; use of oral contraceptives; excessive use of alcohol.
"What is the message running through all of these 'risks?'" Dr. Sherman asks. "Hormones, hormones, and hormones. Hormones of the wrong kind, hormones too soon in a girl's life, hormones for too many years in a woman's life, too many chemicals with hormonal action, and too great a total hormonal load."
Dr. Sherman then turns her focus to the one fully-established cause of breast (and other) cancers: ionizing radiation, from x-rays, and from nuclear power plant emissions and the radioactive fallout from A-bomb tests.
These, then, are the environmental factors that give rise to breast cancer: exposures to cancer-causing chemicals, to hormonally-active chemicals, and to ionizing radiation in air, food and water. How do we know the environment air, food, water and ionizing radiation plays an important role in causing breast cancer? Because when Asian women move from their homelands to the U.S., their breast cancer rate soars. There is something in the environment of the U.S. (and other western industrial countries) causing an epidemic of this hormone-related disease. The medical research establishment likes to call it "lifestyle factors" but it's really environment. Air, food, water, ionizing radiation.
With this basic information in hand, Dr. Sherman then describes historically and today the exposure of women in the U.S. to a flood of carcinogenic and hormonally active chemicals, plus ionizing radiation.
Take common pharmaceutical products, for example. Canadian researchers have demonstrated enhanced cancer growth in mice given daily HUMAN-EQUIVALENT doses of three commonly-used antihistamines, which are sold under the trade names Claritin, Histamil and Atarax. Two years earlier the same researchers had reported breast cancer promotion in rodents fed clinically-relevant doses of antidepressant drugs, which are marketed as Elavil and Prozac. Millions of women in the U.S. are taking these drugs today.
At least 5 million women in the U.S. are currently taking Premarin the most often-prescribed form of estrogen (female sex hormone), to ease the transition through menopause. This is called "hormone replacement therapy" and it is routine, recommended medical practice in the U.S. A review of 51 studies of women taking hormone replacement therapy showed that those who never took hormones had a breast cancer rate ranging from 18 to 63 per 1000 women. Those who took hormones for five years showed an excess of 2 breast cancers per 1000 women; after 10 years of hormone therapy the excess breast cancer rate rose to 6 per 1000. The danger largely disappears 5 years after discontinuing use.
Hormones are big business. Despite evidence that synthetic hormones caused cancer in rodents and rabbits, American drug companies began selling synthetic hormones in 1934 in cosmetics, drugs, food additives, and animal feed. The best-known is DES (diethylstilbestrol) but there were and still are many others. The National Cancer Institute (NCI) in 1938 published a study showing that DES caused breast cancer in rodents. Three years later, in 1941, NCI published a second study confirming that DES caused breast cancer in rodents. That year the U.S. Food and Drug Administration (FDA) approved DES for commercial use in women.
DES is 400 times as potent as natural estrogen and can be made for pennies per pill. It was therefore phenomenally profitable and researchers aggressively sought new uses. DES soon was being used to prevent miscarriages, as a "morning after" pill to prevent pregnancies, and as a breast-enlargement cream. It wasn't long before researchers discovered that they could make chickens, cows and pigs grow faster if they fed them hormones, and a huge new market for hormones opened up. As early as 1947, a hormonal effect was reported among U.S. women who ate chicken treated with growth hormones. Between 1954 and 1973 three quarters of all beef cattle slaughtered in the U.S. grew fat on DES.
In 1971, human cancer from DES exposure was confirmed and in 1973 DES was banned from meat, so other growth hormones were substituted. Most recently, of course, the U.S. FDA has allowed the U.S. milk supply to be modified to increase the levels of a growth hormone (called IGF-1) known to stimulate growth of breast cells in women.
Still today most U.S. beef, chickens and pigs are intentionally contaminated with growth hormones which is why Europeans refuse to allow the import of U.S. beef. European scientists are asking the same question that Dr. Sherman raises: "[H] ormones are administered to meat animals to promote growth and weight gain. Why should humans expect to not respond similarly to such chemical stimuli?".
Then of course there are dozens probably, in fact hundreds of household chemicals and industrial byproducts that are hormonally active: pesticides, cleansers, solvents, plasticizers, surfactants, dyes, cosmetics, PCBs, dioxins, and so forth, that interfere with, or mimic, naturally-occurring hormones. We are awash in these, at low levels, from conception until death.
How many growth-stimulating and cancer-promoting hormones can we ingest or absorb through our lungs and skin before we feel the effects? No one in authority is asking that crucial question, but Janette Sherman is asking it, pointedly, and armed to the teeth with scientific evidence.
Then there is radioactivity. In 1984, a study of Mormon families in Utah downwind from the nuclear tests in Nevada reported elevated numbers of breast cancers. Girls who survived the bombing of Hiroshima are now dying in excessive numbers from breast cancer. Dr. John Gofman has reviewed 22 separate studies confirming unequivocally that exposure to ionizing radiation causes breast cancer. Janette Sherman does a good job of summarizing ecological studies showing that women living near nuclear power plants suffer from elevated numbers of breast cancers. These studies, by their nature, are suggestive and not conclusive. but there is ample reason to believe that all nuclear power plants leak radioactivity routinely into local air and water and that any exposure to ionizing radiation increases a woman's danger of breast cancer. The only way to PREVENT this problem is to end nuclear power permanently.
Why has the U.S. turned its back on the preventive approach to cancer? Dr. Sherman returns to this question throughout her book. For example, in a devastating chapter on Tamoxifen (a known cancer-causing chemical now approved by U.S. FDA for use in women), she asks, "Why is our primary well-funded National Cancer Institute not devoting its efforts to primary prevention? Has breast cancer, like so many aspects of our culture, become just another business opportunity?".
In the end, Dr. Sherman reaches a conclusion about that question: "There is a massing, in a few hands, of the control of production, distribution and use of pharmaceutical drugs and appliances; control of the sale and use of medical and laboratory tests; the consolidation and control of hospitals, nursing homes, and home care providers. We are no longer people who become sick. We have become markets. Is it any wonder that prevention receives so little attention? Cancer is a big and successful business!".
And, finally: "Reflecting on the purpose of the corporation to sell products and services and maximize profits, it becomes apparent that prevention cannot be in the interest of the bottom line. What a sad and bitter realization," she concludes.
Despite this sad and bitter conclusion, this is a powerful upbeat book about what citizens can and must do to end the epidemic of cancer that is sweeping the western world. If the truth shall set us free, this book is an important part of our collective liberation, freeing us from the lies and deceptions, the false promises of cancer cures always "just around the corner." Cancer is caused by exposure to carcinogens. The way to solve the cancer problem is to prevent exposures. This means we must end nuclear power, and demand clean food, water and air. Janette Sherman's contribution has been to give us a wealth of powerful evidence on which to act. Now it is up to us.
- Peter Montague
ARSENIC FROM YOUR TAP
President Bush has canceled a health regulation that would have reduced allowable levels of arsenic in U.S. drinking water from 50 parts per billion (ppb) to 10 ppb. According to the U.S. Environmental Protection Agency (EPA), arsenic in drinking water causes cancer of the skin, lungs, bladder and prostate in humans. Arsenic in drinking water is also linked to diabetes, cardiovascular disease, anemia, and disorders of the immune, nervous and reproductive systems, EPA says. Furthermore, recent evidence suggests that arsenic even at very low levels equivalent to 10 ppb in water interferes with hormones, making it a potent endocrine disrupter. Hormones are chemical messengers that the body produces to regulate critical life processes.
The current U.S. arsenic standard of 50 ppb was adopted in 1942. After a decade of study and public review of scientific evidence, EPA proposed the stricter standard while Bill Clinton was president. Mr. Bush reversed EPA's decision shortly after taking office.
Arsenic appears in two forms, organic and inorganic; in general, the inorganic form is more dangerous. Inorganic arsenic occurs naturally in some locales. In addition, at least six million pounds of arsenic are released into the environment of the U.S. each year by mining, coal burning, copper and lead smelting, wood-preserving treatments, municipal incinerators and the use of certain pesticides.
The International Agency for Research on Cancer, a division of the World Health Organization (WHO), and the U.S. EPA both agree that arsenic is known to cause cancer in humans. According to EPA, at least 11 million people in the U.S. currently drink water contaminated with arsenic at levels above 10 ppb.
The 10 ppb arsenic standard would have put the U.S. squarely in the mainstream. In 1993, the World Health Organization (WHO) set 10 ppb as the recommended limit for arsenic in drinking water. The 15-nation European Union adopted 10 ppb as a mandatory standard for arsenic in drinking water in 1998. WHO says even this level is not safe; for example, WHO estimates that lifetime exposure to water containing 10 ppb of arsenic will lead to six cases of skin cancer per 10,000 people.
A 1999 study by the U.S. National Academy of Sciences (NAS) recommended that the allowable levels of arsenic in U.S. drinking water should be lowered "as promptly as possible." Taking into consideration all forms of cancer, NAS said the current standard of 50 ppb "could easily result in a combined cancer risk on the order of 1 in 100."[8,pg.301] A one-in-100 risk is 10,000 times as great as the one-in-a-million risk that EPA usually deems "acceptable."
EPA estimated that cutting allowable arsenic from 50 to 10 ppb would prevent 1000 bladder cancers and 2000 to 5000 lung cancers during a human lifetime. EPA did not estimate the reductions in skin or prostate cancers, diabetes, nervous system damage, immune system damage, or cardiovascular disease.
Now a new study suggests that arsenic is a potent hormone disrupter.[9] Working with rat tumor cells, researchers have found that low-level arsenic exposure interferes with the activity of hormones known as glucocorticoids. Glucocorti-coids are involved in most of the human body's basic systems. They help to regulate the immune system, the central nervous system, and changes in blood, bones and kidneys, as well as the body's use of sugars, starches, fats, and proteins. Glucocorticoids affect weight, growth, and development.
Arsenic's hormone-disrupting activity may explain how arsenic promotes cancer. Studies of laboratory animals show that glucocorticoids suppress some tumors. Arsenic may promote cancers by interfering with this tumor-suppressing mechanism.
For President Bush, arsenic poisoning provides an opportunity for humor. At a dinner speech in March the President said, "As you know, we're studying safe levels for arsenic in drinking water. (laughter) To base our decision on sound science, the scientists told us we needed to test the water glasses of about 3,000 people. (laughter) Thank you for participating. (laughter)"
It is not entirely clear why Mr. Bush takes arsenic poisoning so lightly, but it may have something to do with his ties to the coal industry. Burning coal is a major source of arsenic contamination. Many landfills contain arsenic-laden ash produced by coal-burning power plants. Arsenic is likely to leak out of these landfills, contaminating groundwater.
Coal companies were major contributors to Mr. Bush's election campaign.Mr.Bush recently announced he was abandoning his campaign promise to regulate carbon dioxide emissions from power plants, and he has turned his back on the Kyoto Protocol, the international treaty to combat global warming. Representative Henry Waxman (D., Calif.) says Mr. Bush's arsenic policy is "another example of a special interest payback to industries that gave millions of dollars in campaign contributions."
The wood products industry, which uses arsenic to pressure-treat lumber, also stands to benefit from unsafe arsenic standards. A representative of the American Wood Preservers Institute said members of his organization were "relieved and delighted" by Mr. Bush's decision.
EPA spent ten years studying the dangers of arsenic in a public process before proposing the 10 ppb standard. The Bush administration now says the science behind the 10 ppb standard is "unclear." Furthermore, the Bush EPA questions whether the Clinton administration "fully understood" the costs of reducing arsenic contamination, even though the Clinton EPA published detailed cost estimates for public review and comment.
In developing the 10 ppb standard, EPA estimated that the total cost of reducing arsenic contamination to 10 ppb nationwide would be around $181 million a year. If this cost were paid entirely by households that use affected water supplies,it would average about 12 dollars per person per year.EPA says the total annual benefits from avoiding unnecessary bladder and lung cancers would range from $140 million to $198 million. In other words, the monetary benefits from reducing these two illnesses alone would match the costs of removing arsenic from drinking water. EPA did not estimate monetary benefits from avoiding other illnesses associated with arsenic exposure, such as skin, prostate, and lung cancer, diabetes, cardiovascular disease, and damage to the immune and nervous systems.
NEW YORK TIMES writer Gina Kolata has gone to bat for Mr. Bush on arsenic. By carefully selecting information, Kolata has managed to make the proposed 10 ppb arsenic regulation seem scientifically muddled and ultimately not worth the cost.[16] To begin with, she points out correctly that arsenic is natural: "God put it there," she quotes one scientist as saying, but she does not mention the millions of pounds of arsenic that corporations dump into air and water each year.
Kolata quotes an industry consultant who says he would bet a dollar that the "minuscule" number of lives to be saved by reducing arsenic levels is not statistically different from zero. Given that we know arsenic causes many different human diseases and given that we even know the mechanism by which this seems to occur (hormone disruption), it seems scientifically untenable and ethically bankrupt to assume "zero" effect when exposing tens of millions of people to arsenic in their drinking water.
Kolata cites EPA's estimate of how many bladder and lung cancers could be prevented by adopting the 10 ppb standard, but she does not mention the many other diseases that could be prevented by a safer standard. Kolata points out, correctly, that NAS did not recommend a specific level to which contamination should be reduced. However, she forgets to mention that the NAS urged the U.S. to reduce its arsenic "as promptly as possible," and that the NAS indicates that no level of arsenic exposure is known to be safe.
Kolata mentions correctly that the World Health Organization has set 10 ppb as its standard for arsenic in drinking water, but she says, "Most European countries have set their maximum arsenic levels at 20 parts per billion in water..." thus making it seem as if the WHO and the EPA are outside the mainstream. This is incorrect. The 15-nation European Union in 1998 adopted 10 ppb arsenic as a standard for drinking water; EU member nations are specifically prohibited from adopting a standard less stringent than 10 ppb.[6] Thirteen other European nations have applied for membership in the EU; when they achieve it, they too will be bound by the EU's 10 ppb arsenic standard.
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