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HEADLINES: CANCER TRENDS
U.S. cancer trends are increasingly bleak. There are two ways to judge cancer trends: by incidence rates and by death rates. Cancer incidence refers to the number of new cases of cancer per 100,000 population, age-adjusted. Similarly, the cancer death rate is the number of cancer deaths per 100,000 population, age-adjusted. The purpose of adjusting for age is to eliminate trends that might occur simply because the average age of the population is increasing. In other words, age-adjusting eliminates the argument, "Cancer only SEEMS to be getting worse because people are living longer."
Table 1 presents the latest U.S. cancer statistics from the National Cancer Institute, covering the period 1950 to 1992 (the last year for which published data are available).[1] As the table makes clear, there are four cancers for which the news is entirely good: both incidence and deaths are declining (cervix, stomach, rectum, and uterus).
There are also eight cancers for which the news is mixed: incidence is increasing while deaths are declining. These cancers are striking a larger proportion of Americans each year, yet surgery, chemotherapy, and radiation treatments are keeping more victims alive. These are the eight cancers that more people are having to learn to live with: cancers of the colon, larynx, testicles, bladder, and thyroid, Hodgkin's disease, leukemias, and all childhood cancers.
Then there are 11 cancers for which the news is all bad: incidence is rising, and so is the death rate. These 11 are: cancers of the ovaries, lung, skin, female breast, prostate, kidney, liver, non-Hodgkin's lymphomas, multiple myeloma, brain, and pancreas.
In the U.S., the incidence of all cancers has increased 54.3% during the past 45 years, and the death rate for all cancers has increased 9.6%. However, lung cancer --which is caused mainly by cigarettes --dominates these increases. If lung cancer is excluded, the incidence of all cancers has still increased an impressive 40.8% during the past 45 years, but the death rate has declined 15.0% during the same period. This shows rather dramatically the extent to which more of us each year are "learning to live with cancer."
A recent review article by the staff of the National Cancer Institute (NCI) adds some perspective to these numbers.[2] Among men, prostate cancers account for two-thirds of the cancer incidence increase during the past 20 years. Notable increases have also occurred in non-Hodgkin's lymphomas and skin cancers (melanomas).
Among women, the major increases of the past 20 years occurred in cancers of the breast and lung, followed by non-Hodgkin's lymphomas and skin melanomas.
The NCI analysts found that, in general, the rising incidence of cancers in the U.S. is dominated by increases at older ages in breast, prostate, and lung.
Regarding breast cancer, the NCI analysts say that some, though not all, of the increase is accounted for by earlier detection. They point out that the biggest increase has occurred among estrogen-responsive tumors --that is to say, the kind of breast cancer that is increasing most rapidly is the kind that is influenced by the presence of estrogen, "suggesting that some of the changes are related to hormonal factors," the NCI analysts say.
Among men the biggest increase is found in prostate cancer --another cancer influenced by hormones. The NCI analysts say better diagnosis accounts for part, but not all, of the increase. They conclude, "it is possible that nutritional practices (e.g., increased consumption of fat and meat) have contributed to the upward trend."
These data hide significant differences between races. The highest incidence of cancer in the U.S. occurs among black men (557.2 cases per year among each 100,000 persons), followed by white men (464.0), then white women (348.0), then black women (331.8).
The incidence of colon cancer is 20% higher among blacks than among whites.[3] The incidence of multiple myeloma is about 50% higher among blacks than among whites, and the incidence of prostate cancer is 71% higher among blacks. (Multiple myeloma is cancer of the immune system's cells in the bone marrow.) Lung cancer --caused mainly by cigarette smoking --is 36% higher among blacks than among whites.[4]
Relative survival rates are poorer among blacks then among whites; generally, about 75% as many blacks as whites survive a particular cancer. Survival rates are thought to reflect socio-economic status. Thirty percent of blacks live in poverty vs. only 13% of whites.[4] Among blacks cancer tends to be at an advanced stage when it is first detected, compared to whites, which partially explains why black survival rates are poorer.
Much cancer is caused by "environmental factors," broadly defined to include food, drink, and habits such as smoking tobacco and basking in the sun.
Numerous studies have shown that environmental factors are far more important than genetic, inherited factors. Cancer rates differ from country to country. When people migrate from one country to another, within a generation or two their cancer rates have changed from those of their country of origin to those of their new homeland. For example, Japanese women living in Japan have a low rate of breast cancer; but Japanese women who move to the U.S. soon have U.S. rates of breast cancer.
These "migration studies" --of which there are now many in the literature[5] --tell us that many cancers are preventable. Unfortunately, there is a great deal of money to be made treating cancer, and little money to be made preventing cancer. And so cancer prevention today gets about one penny out of every dollar spent on cancer research.
So long as we continue to bathe ourselves in carcinogens in air, water, and food, and in chemicals that degrade our immune systems, more of us each passing year will have to learn to live with cancer. Present policies are exceedingly expensive (estimated at $72.5 billion in 1985) and don't make much sense from a public health viewpoint, but they make eminently good sense from the viewpoint of the cancer industry --those who cause it and those who sell services that ameliorate its effects. The cancer industry is robust and healthy; by comparison, the proponents of prevention are sickly, weak and pallid.
--Peter Montague (National Writers Union, UAW Local 1981/AFL-CIO)
[1] Source: C.L. Kosary and others, editors, SEER CANCER STATISTICS REVIEW 1973-1992 [National Institutes of Health Publication No. 96-2789] (Bethesda, Md.: National Cancer Institute, 1995), Table I-3, pg. 17. NIH says historical data for non-whites are not considered reliable spanning the period 1950-1992 so historical data are only given for whites.
[2] Susan S. Devesa and others, "Recent Cancer Trends in the United States," JOURNAL OF THE NATIONAL CANCER INSTITUTE Vol. 87, No. 3 (February 1, 1995), pgs. 175-182.
[3] Lynn A. Gloeckler Ries and others, "Cancer incidence, mortality, and patient survival in the United States," in David Schottenfeld and Joseph F. Fraumeni, Jr., editors, CANCER EPIDEMIOLOGY AND PREVENTION [SECOND EDITION] (New York: Oxford University Press, 1996), pgs. 168-191.
[4] John W. Horm and others, "Cancer incidence, mortality, and survival among racial and ethnic minority groups in the United States," in David Schottenfeld and Joseph F. Fraumeni, Jr., editors, CANCER EPIDEMIOLOGY AND PREVENTION [SECOND EDITION] (New York: Oxford University Press, 1996), pgs. 192-235.
[5] David B. Thomas and Margaret K. Karagas, "Migrant studies," in David Schottenfeld and Joseph F. Fraumeni, Jr., editors, CANCER EPIDEMIOLOGY AND PREVENTION [SECOND EDITION] (New York: Oxford University Press, 1996), pgs. 236-254.
TABLE 1
U.S. Cancer Incidence and Deaths in 1992, and the Percent Change in Age-Adjusted Rates of Incidence and Death per 100,000 U.S. Population, 1950-1992.
-----ALL RACES------- ------WHITES---------
Cancer Incidence Deaths Percent Percent
type in 1992 in 1992 change in change in
(estimated) incidence, deaths,
1950-1992 1950-1992
stomach 24,400 13,630 -74.8 -77.6
cervix 13,500 4,641 -76.6 -74.5
rectum 45,000 7,785 -21.3 -66.9
colon 111,000 49,204 +21.6 -15.0
larynx 12,500 3,966 +50.9 -7.4
testicles 6,300 355 +113.6 -69.6
bladder 51,600 10,705 +57.1 -34.8
Hodgkin's disease 7,400 1,639 +17.3 -67.8
childhood cancers 7,800 1,679 +4.9 -62.4
leukemias 28,200 19,417 +8.7 -2.1
thyroid 12,500 1,111 +115.3 -49.5
ovaries 21,000 13,181 +5.2 +2.5
lung 168,000 145,801 +267.4 +264.0
skin melanomas 32,000 6,568 +393.3 +155.0
breast (female) 180,000 43,063 +55.9 +0.2
prostate 132,000 34,238 +266.4 +20.7
kidney 26,500 10,427 +120.6 +37.2
liver 15,400 9,554 +107.3 +22.8
non-Hodgkin's
lymphomas 41,000 20,058 +183.6 +123.1
multiple myeloma 12,500 9,247 +235.8 +194.0
brain 16,900 11,941 +85.2 +50.4
pancreas 28,300 26,070 +13.6 +17.8
.
All types ex- 962,000 374,747 +40.8 -15.0
cluding lung
.
All types 1,130,000 520,548 +54.3 +9.6
Source: C.L. Kosary and others, editors, SEER CANCER STATISTICS REVIEW 1973-1992 [National Institutes of Health Publication No. 96-2789] (Bethesda, MD: National Cancer Institute, 1992), Table I-3, pg. 17. NIH says historical data for non-whites are not considered reliable spanning the period 1950-1992 so historical data are only given for whites.
Descriptor terms: cancer statistics; lung cancer; brain cancer; multiple myeloma; pancreatic cancer; non-hodgkin's lymphomas; liver cancer; kidney cancer; prostate cancer; breast cancer; skin cancer; melanoma; ovarian cancer; thyroid cancer; hormones; leukemia; childhood cancer; hodgkin's disease; bladder cancer; testicular cancer; laryngeal cancer; colon cancer; rectal cancer; cervical cancer; stomach cancer; african-americans; blacks; national cancer institute;
HEADLINES:
GENETIC ENGINEERING ERROR
According to the St. Louis POST-DISPATCH, Monsanto, the St. Louis chemical and biotechnology giant, last month announced it had recalled "small quantities" of a genetically engineered canola seed containing an unapproved gene that had gotten into the product by mistake. Canola is a crop grown for livestock feed, and for oil consumed by humans. The canola-recall story, only 84 words long, was buried in the POST-DISPATCH April 18, under a confusing headline, deep in a news-wrapup column on the business page.[1]
Putting the wrong gene into a commercial product by mistake is precisely the kind of error that opponents of genetic engineering have been predicting for a decade. Proponents of genetic engineering have said it could never happen because of rigorous quality-assurance by the industry itself and tight regulation by governments.
The recall was reportedly initiated by Monsanto Canada Ltd., and by Limagrain Canada Seeds, Inc., of Saskatoon, Saskatchewan, which was selling the seed under license from Monsanto. The recalled canola seed was "Roundup ready" --meaning it had been genetically engineered to withstand dousing with Monsanto's herbicide, glyphosate, which is marketed under the trade name Roundup. Since February, 1996, Monsanto has been marketing various genetically-engineered crops that are "Roundup-ready" in an effort to boost sales of Roundup, the herbicide responsible for a large proportion of Monsanto's annual profits.[2] (See REHW #521.) The idea is to douse Roundup-ready crops with Roundup to kill weeds, leaving the genetically-engineered crop intact. According to the Associated Press, Monsanto refused to disclose how much genetically misengineered canola seed is being recalled, but said the amount was "small."[1]
Canadian government officials say the quantity being recalled is not small. Brewster and Cathleen Kneen, publishers of the RAM'S HORN, a Canadian newsletter devoted to analysis of the food system, said that, in mid-April, Monsanto reported to the Evaluation Branch of the Biotechnology Strategies and Coordination Office of the Canadian government that it was recalling 60,000 bag units of two types of canola seeds (types LG3315 and LG3295) because one or both types contained the wrong gene.[3] Thus the amount recalled is sufficient to seed 600,000 to 750,000 acres of land. According to RAM'S HORN, some of the seed had already been planted when Monsanto discovered the mistake.
The MANITOBA CO-OPERATOR, a Canadian agricultural newspaper, quoted Ray Mowling, a Monsanto spokesperson, saying, "In some recent quality assurance testing by us, we've identified that there's a possible variety contamination."[4] Brewster Kneen of RAM'S HORN points out that it takes a long time to produce enough Roundup Ready seed for 600,000 acres, so this error went undetected for a substantial period.
Under Canadian law, there are three levels of approval for genetically engineered crops: environmental (meaning the crop can be planted), livestock (the resulting crop can be fed to livestock), and human (the resulting crop can be fed to humans). Two Roundup-resistant canola genes, RT-73 and RT-200, had been approved for planting, but only RT-73 was approved for livestock and humans. It was the unapproved RT-200 that somehow ended up in the seed that had to be recalled. "The preliminary testing showed it to be the wrong configuration, as opposed to the one approved," Monsanto's Mowling said.
Canola oil is used in low-fat foods, pharmaceuticals, nutritional supplements, confectionery products, margarine and shortening, personal care products, lubricants, soaps, and detergents.
The presence of the unapproved canola gene in a commercial product reveals, at a minimum, that Monsanto's quality-assurance programs failed in this instance, and that the biotechnology regulatory system in Canada is ineffective. The regulatory system in the U.S. is more lax than Canada's.
Limagrain's Gary Bauman said his company will try to discover how the mistake occurred. However, he said it will be difficult to trace exactly where in the process it happened because the seeds available for testing now are progeny (offspring) of the original seeds. "We may never know how it happened," he said.
Bauman later seemed to lay the blame squarely on Monsanto. He said only Monsanto has the expertise to detect genetic differences between seeds. "The apparent contamination, discovered by Monsanto, is something only they are able to detect. We are not even allowed to try to investigate how to look at and discover this gene within our own varieties," Bauman said.[5]
Recent history reveals that serious problems may occur when a genetically engineered product appears on the market without adequate testing. In 1989, a Japanese firm marketed an amino acid, L-tryptophan, which was produced from a genetically-engineered bacteria.[6,7,8] Unexpected trace contaminants --not all of which were ever identified chemically --appeared in the final product and an estimated 5 to 10 thousand people[9] in the U.S. fell ill with a new and exceedingly painful disease called eosinophilia-myalgia syndrome (EMS). At least 37 people died and thousands more were disabled. Something in the biotech-produced L-Tryptophan attacked people's immune systems. Their joints and muscles ached excruciatingly. Their limbs swelled. In many respects, their disease resembled scleroderma.
Studies of the new EMS disease revealed that people with the disease most likely got it from L-tryptophan produced by the fifth genetically-engineered version of a bacteria (called BACILLUS AMYLOLIQUEFACIENS V).[10,11] Unfortunately, the company producing the L-tryptophan made other changes in its production process when it introduced the new bacteria, so researchers have never been able to discern whether the disease was caused by the changes in production methods or by the genetically-altered bacteria (or both).
In any case, it is crystal clear that genetically-engineered products need extensive testing before their effects can be understood. The simple view, that genes control only one characteristic of a bacterium, plant or animal has been shown to be false. Genes contain a potential that can be expressed in various ways, depending upon the environment in which the gene grows. Thus a gene may develop in one way in one environment and another way in another environment. Testing in one environment may not reveal what the gene will do when it finds itself in another environment. This has been demonstrated elegantly by Craig Holdrege in his book, GENETICS AND THE MANIPULATION OF LIFE: THE FORGOTTEN FACTOR OF CONTEXT.[12]
Furthermore, Danish researchers have shown that genetically-manipulated genes (transgenes, they are called) in crops can make their way into nearby weeds under field conditions.[13] Thus genetic errors, of the kind made in Monsanto's canola seeds, may propagate into the environment and permanently alter the natural world in ways that no one is prepared to understand.
Still, Monsanto management has bet the company on biotech and has announced plans to press ahead aggressively. Roundup is Monsanto's best-selling and most profitable product, bringing Monsanto about $1.5 billion per year. "Roundup is the engine that's driving Monsanto," said Paul Raman, a chemical industry analyst for the investment banking firm S.G. Warburg & Co.[2]
"In five to 10 years Roundup could be a $4 billion product," Raman said. That extra money would come chiefly from expanding sales of crops that are genetically engineered to resist the weed killer.[2]
Monsanto announced eight months ago that it is selling off its chemical divisions in order to focus its business entirely on biotechnology-related products.[14]
"What you are seeing is the beginning of the agri-industrial complex," Sano Shimoda, president of BioScience Security, Inc., an investment banking company focusing on the biosciences, told BIOTECHNOLOGY NEWSWATCH, an industry newsletter.
"From the big picture standpoint Monsanto has the ability to be the dominant biotech-based ag-food company in the world," Shimoda said.
To get a stream of genetically-engineered products to market, Monsanto will need to convince the U.S. Food and Drug Administration (FDA) that these products are safe for human consumption. In the past, Monsanto has been able to do this partly because former Monsanto officials have become FDA officials, who have then been assigned to approve Monsanto products--in some cases, the products they worked on while at Monsanto.[15]
There can be no doubt that a high-level revolving door exists between Monsanto and the administration in Washington. The WASHINGTON POST reported April 21, 1997, that Marcia Hale, President Clinton's assistant for intergovernmental relations, would be taking a "sweet" job with Monsanto. She will coordinate public affairs and corporate strategy in the United Kingdom and Ireland for about six months. She will then come back to work out of Monsanto's Washington office to handle international and "other matters."[16]
The St. Louis POST-DISPATCH reported May 17, 1997, that Monsanto's vice-president, Virginia Weldon, is a "top candidate" for the job of chief of the U.S. Food and Drug Administration (FDA).[17]
--Peter Montague
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