I Wish I Were Far From the Madding Crowd

March 28, 2010

Risk factors for breast cancer – Missing one of the major ones?

Up to a third of breast cancers could be avoided (Yahoo! News)

http://news.yahoo.com/s/ap/20100325/ap_on_he_me/eu_med_avoiding_breast_cancer

European breast cancer conference in Barcelona. Carlo La Vecchia cited figures from the International Agency for Research on Cancer (website).  I couldn’t find the precise source for the figures, but perhaps they came from “Estimates of cancer incidence and mortality in Europe in 2008” (abstract only).

Conference website – http://www.ecco-org.eu/Conferences-and-Events/EBCC-7/page.aspx/840

Abstracts – http://www.ecco-org.eu/Conferences-and-Events/EBCC-7/Abstracts-online/page.aspx/2177

Or go directly to http://ex2.excerptamedica.com/ciw-10ebcc/

Type in “cancer” in the search field.  You should get 655 abstracts.

The focus of the conference was clearly on diagnosis and treatment with little to no discussion of environmental factors.  Certainly screening, diagnosis, and treatment are critical, but shouldn’t we try to prevent as much as we can?

More from the Yahoo story

Dr. Michelle Holmes of Harvard University, who has studied cancer and lifestyle factors, said people might wrongly think their chances of getting cancer depend more on their genes than their lifestyle.

“The genes have been there for thousands of years, but if cancer rates are changing in a lifetime, that doesn’t have much to do with genes,” she told The Associated Press in a phone interview from Cambridge, Mass.

Could perhaps increasing exposure to substances in the environment change rates in a lifetime?  That doesn’t have much to do with genes either.  Though if you’re being exposed to chemicals that interfered with how your genes were turned on and off before you were born, or are interfering with that now, perhaps it does.

Breast cancer is the most common cancer in women. In Europe, there were about 421,000 new cases and nearly 90,000 deaths in 2008, the latest available figures. The United States last year saw more than 190,000 new cases and 40,000 deaths.

Tara Beaumont, a clinical nurse specialist at Breast Cancer Care, a British charity, noted that three of the major risk factors for breast cancer — gender, age and family history — are clearly beyond anyone’s control.

What about environmental exposure to chemicals?

IARC, on its World Cancer Day page, notes that it has an active program in the identification of carcinogenic risks. The IARC Monographs identify environmental factors—including chemicals, complex mixtures, occupational exposures, physical and biological agents, and lifestyle factors—that can increase the risk of human cancer.

In other words, there are several other environmental factors besides lifestyle that have been identified.  See the articles below for examples of how environmental factors could be contributing to breast cancer.

While the advice to eat less and exercise more is good (in fact, given that no one really has much direct control over environmental exposures that advice is probably even more important), I find it disturbing that the major risk factors cited in news stories seem to be reduced to diet, lifestyle, gender, age, and family history (that is, genetics), leaving environment out of the picture.

Why is that?  Because it’s easier to blame cancer victims than to confront companies and industries that sell us products that release substances that can mess with our health and who continue to release carcinogens and endocrine disruptors into our air and water?  (I’ll refer you again to the TEDX site, “Prenatal Origins of Cancer” for more information on that.)

Another perspective

In a post “do patients need doctor navigators to use the internet?”, David Collins discusses a March 25 New England Journal of Medicine opinion piece titled “Untangling the Web — Patients, Doctors, and the Internet” in which the authors “expressed a lot of concerns about how the internet is putting patients in touch with a lot of questionable information about disease” and about how they thought that changes the doctor-patient relationship in an adverse way.  (While they do raise some good points about the quality of some of the information on the Internet, I tend to agree with Collins.)

The reason I’m citing that here is the following statement from his post:

When I joined cancer public health in the ’70s the medical community almost universally rejected the idea that food and nutrition had anything to do with the prevention of cancer. People who talked about a relation between nutrition and cancer were sneered at and called the “fruits and nuts” crowd. Thirty-five years later as I approached retirement I had to chuckle inwardly many times about the current enthusiasm for the view that diet and nutrition are key to the prevention of much cancer. These days ya gotta eat your greens and grains!

So even the experts can change their minds….

Finally, it seems that environmental factors only really get attention when there are clusters of rare cancers.

Democratic Senators Eye New EPA Role Investigating Local Cancer Clusters

Environmental Policy Alert – March 24, 2010

From InsideEPA.com’s Environmental NewsStand (pay-per-view news)

Note: The site has a one-time offer of three free articles or documents by creating a new account today.

Senate environment committee Chairwoman Barbara Boxer (D-CA) and Sen. Bill Nelson (D-FL) are working on legislation that would give EPA and the Department of Health & Human Services (HHS) a major new role helping local health agencies investigate and address cancer clusters and communicate risks to local residents.

Press release from Sen. Bill Nelson on legislation

Nelson plans to preview testimony he’s been invited to give at next Wednesday’s hearing (my blog post on the March 17 hearing), which aims to find ways to strengthen the federal government’s hand in investigating cancer clusters, like the Acreage.

Recent Acreage blog post on Nelson’s efforts

Right now the federal Environmental Protection Agency ( EPA ) and Department of Health and Human Services ( HHS ) usually don’t get involved absent a request from a state.
“This effort is aimed at finding ways to bring in more federal resources more rapidly to help protect people, especially little children,” said Nelson, who’s also expected on Friday to announce he’s partnering with U.S. Sen. Barbara Boxer on new legislation to do the same.
Sen. Nelson’s testimony at Senate committee hearing on EPA and children’s environmental health
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March 21, 2010

Sound advice to companies on endocrine disruptors

Found a post on endocrine disruptors that advises companies on steps they should be taking to deal with endocrine disruptors now.  You’re probably thinking what I thought when I first saw the post, “Yeah, right.”

I was pleasantly surprised.  It’s heartening to see an investment manager taking an enlightened  position like this.

The Chemicals That Should Be on Your Radar … but Probably Aren’t

By Richard Liroff – Published February 25, 2010
[This post is a follow up to Liroff’s earlier article “What Does the FDA’s BPA Decision Mean for Companies?” on GreenBiz.com.]

Liroff notes:

As a class, [endocrine disruptors (EDs)] can have profound and unparalleled impacts on families, communities and businesses because of their possible links to learning disabilities, selected cancers, reproductive disorders, diabetes and other health disorders.

Systematically identifying EDs, substituting safer substances and product designs, and reducing exposures promise sizeable payoffs from reduced health care burdens and enhanced employee productivity. Such actions help align consumer-facing companies in particular with consumers’ concerns about involuntary exposures to toxic chemicals in daily living.

Liroff lists several recent developments in public awareness regarding endocrine disruptors, describes what endocrine disruptors are and how they can affect health, and offers the following advice to chemical companies regarding endocrine disruptors:

1. Get educated.

He provides links to European, U.S. EPA, and NIEHS endocrine disruption websites as well as the The Endocrine Disruption Exchange (TEDX) list of resources.  (A very nice list!)

2. Make sure corporate science staff stay current.

Why the Adage ‘the Dose Makes the Poison’ Can Be Toxic to Corporate Chemicals Policy

Heed the advice of NIEHS’s Dr. Linda Birnbaum: “[T]he timing, as well as the dose, makes the poison.” The American Chemical Society, in a newly published statement on endocrine disruptors, echoes this view: “A large and growing body of environmental health literature shows that endocrine disrupting substances … do not fit the central tenet of regulatory toxicology, namely, that the ‘dose makes the poison.'”

3. Know the chemicals in your products and supply chain.

4. Take action. Join the leading edge companies who are actively screening their chemical inventories for endocrine disruptors and are taking steps to lower toxicity via safer chemical substitutes or designs….

[A] proactive approach of analysis and substitution, and responding to early warning signals, is more likely to buttress consumer confidence in your brand than defensive posturing that reflexively asserts “more research is needed” or “no cause-effect relationships have been shown.”

Richard A. Liroff, Ph.D., is founder and director of the Investor Environmental Health Network (IEHN). IEHN is a collaboration of investment managers that advocates for safer corporate chemicals policies to grow long-term shareholder value and reduce financial and reputational risks to companies. The business case for corporate safer chemicals policies, a list of shareholder resolutions on safer chemicals policies, and a roster of participants can be found on the IEHN website, www.iehn.org. Disclosure: Liroff serves as Vice-Chair of the Board of Directors of The Endocrine Disruption Exchange and served on the priority-setting work group of EPA’s Endocrine Disruption Screening and Testing Advisory Committee.

Global regulatory activities on endocrine disruptors

Regulating endocrine disrupting chemicals – A success story?

A very comprehensive writeup of recent activities by environmental agencies across the world.  Posted by Meghan White of Enhesa, a global environmental health and safety consultancy.  (I have no connection with this company in any way.)

She concludes:

Identifying products at risk and attempting to find alternatives to the use of EDC as far as possible would also be a key step in preparing for the implementation of any new stringent legislation being adopted. Bottom line, affected companies should not wait for government action to begin implementing measures to restrict or eliminate use of EDC. Invoking the idea of the precautionary principle is the way forward for dealing with EDC.

You say you want an Industrial Revolution (Cradle to Cradle, part 3)

McDonough and Braungart.  Cradle to Cradle: Remaking the Way We Make Things.

Remember the assignment McDonough and Braungart gave?  To design a system that creates enormous amounts of waste, lots of pollution, and burying or burning the results?  (Summarized in Nature doesn’t have a design problem. People do.” (Cradle to Cradle, part 2)

To explain how such a system evolved, they summarize the history of the Industrial Revolution, plus consequences of development of new technologies, increase in urbanization, and the design decisions that accumulated over time. Focus on selling the greatest volume of goods to the greatest number of people.  Shift from manual labor to efficient mechanization.  Mass production (for example, of automobiles).

Industry and natural “capital”

Western society had conflicting views of nature.  On the one hand, nature was a source of natural “capital” that seemed practically bottomless, a “mother earth” that was perpetually regenerative and could absorb all things and continue to grow.  On the other hand, it was also viewed a hostile and dangerous, as something to be conquered and tamed.

The Industrial Revolution was linear—making products and getting them to consumers without thinking about much else.  We now have a much different view of the world, one that recognizes that ecosystems are delicate, complex, and interconnected, and more vulnerable than we ever imagined.

The Industrial Revolution brought about many positive changes such as higher standards of living, increased life expectancy, improved medical care, and more widely available education.  However, fundamental flaws in the infrastructure design have resulted in devastating consequences.

The industrial system was designed on a linear, one-way “cradle-to-grave” model.  In such a system resources are extracted to make products which are sold, then eventually disposed of in a landfill or incinerator.  (Resources that are extracted include coal, oil, natural gas, iron, and so on.)

Buyers are called “consumers,” but McDonough and Braungart point out that consumers actually consume very little.  Most things are designed to be thrown away.

But where is “away”?  Of course, “away” does not really exist.  “Away” has gone away.

And we’re not very efficient at using what we do extract.  According to some studies, more than 90% of materials extracted to make durable goods in the U.S. become waste almost immediately.  (And only about 5% of the raw materials involved in the process of making and delivering a product end up in the product.)

It just occurred to me that McDonough and Braungart’s use of the Titanic as a metaphor for our industrial infrastructure may been appropriate in another way.  Did the Titanic sink itself?  No, it hit an iceberg, 90% of which lies below water.  In other words, the waste and trash we see, the 10%, is just the tip of the wasteberg.

McDonough and Braungart note that “built-in obsolescence” is part of the design of many products.  In fact, reflecting on this, I realized that the selling point of some products is their disposability.  That is to say, our desire for convenience has been an important part in developing the linear cradle-to-grave model.  I believe this also drives our approach to many diseases.

Rather than deal with a problem at the source, we look for a silver bullet, or a magic pill of some kind, to get us out of situations.  In some ways, this brings to mind Aron’s discussion of the role of Highly Sensitive Persons in society.  She notes that immigrant societies like those of the U.S., Canada, and Australia tend to value sensitivity (awareness) less than more mature societies.

So we charge blindly forward, expecting to be able to figure out some creative way to get ourselves out of any situation we find ourselves in.  (This is reinforced by the TV shows we watch, where many problems are solved in 30 to 60 minutes.)

In the short term, it’s easier to deal with things after the fact.  Responding comes naturally to us.  To be fair, we need to be able to respond appropriately to all sorts of different situations.  We can’t prepare for every contingency.

But when we’ve gotten to the point where business as usual is slowly killing the planet we should realize that we need to rethink the way we make things.  For example, in a recently published review of the scientific literature on plastics and health risk [1] (press release), Prof. Rolf Halden points out that the 300 million tons of plastics  produced would fill a series of train cars encircling the globe. He notes: “We’re doomed to live with yesterday’s plastic pollution and we are exacerbating the situation with each day of unchanged behavior.”

There is also a growing consensus that plastics and their additives are not always the benign companions we once assumed them to be.  Bisphenol A and phthalates, used in the production of many plastics, are thought to present risks to human health.

In addition, for many years, scientists assumed that polymers like plastics would not be much of a problem in terms of chemical effects.  However, it was discovered that chemicals associated with the production of such polymers such as Teflon® are accumulating in people’s bodies.   So-called perfluorochemicals were listed in the CDC National Exposure Report for the first time.

Future post – More reasons why the old industrial infrastructure’s approach has gotten us where we are.

*********
Halden, R.  “Plastics and Health Risks,” Annual Review of Public Health, Vol. 31: 179-194 (March 2010) – Abstract | Full Text | PDF (183 KB) – full text costs $)

March 19, 2010

Danish report on endocrine disruptors (late 2009)

I’ve been seeing reports about a 326-page Danish Environmental Protection Agency study that “has just been released” about “gender-bending chemicals.”  Was able to track down an Oct. 23, 2009, article on the Telegraph.co.uk site, “Why boys are turning into girls: Gender-bending chemicals are largely exempt from new EU regulations.”  Fairly recent, but not recent recent.  Geoffrey Lean, the Telegraph author, ties the Danish report in with other research to come up with the headline.  He states:

Yet gender-benders are largely exempt from new EU regulations controlling hazardous chemicals. Britain, then under Tony Blair’s premiership, was largely responsible for this – restricting their inclusion in the first draft of the legislation, and then causing even what was included to be watered down. Confidential documents show that it did so after pressure from George W Bush’s administration, which protested that US exports “could be impacted”.

Anyway, managed to track the report down on the Danish Ministry of the Environment site (site in English).

Survey and Health Assessment of the exposure of 2 year-olds to chemical substances in Consumer Products

Survey of Chemical Substances in Consumer Products, 102, 2009

Abstract
Two-year-olds are exposed to many chemical substances in daily life. Furthermore, they are particularly susceptible due to their physical size (large surface area/small volume). The primary focus will be on consumer products, but because the 2 year-old’s exposure to chemical substances involves not only food products but also food contact materials and articles, focus has also been placed on these sources. Exposure from indoor air and dust has also been evaluated based on existing measurements. Several endocrine disruptors were selected and focussed on in the risk assessment. They were selected for their known endocrine disrupting effects in animal studies, and an anticipated exposure of 2 year-old children to these substances through food products, indoor air and dust, or consumer products….

Based on the assumptions made in the report, it can be concluded that:

  • A few exposures to a high content of an endocrine disruptor, such as that of dibutyl phthalate (DBP) in rubber clogs may result in a critical risk for the 2 year-old.
  • The amounts that 2 year-olds absorb, in particular from the phthalate DBP (mostly from foods) and dioxins and dioxin-like PCBs (mostly from foods, and partly from indoor air and dust), constitute a risk for anti-androgen disruptions to the endocrine system.
  • The amounts that 2 year-olds absorb from the parabens propylparaben and butylparaben, in particular, can constitute a risk for oestrogen-like disruptions of the endocrine system. This contribution originates predominantly from cosmetic products such as oil-based creams/moisturising creams/lotions and sunscreen.

More information

Read the publication in HTML:

ContentsThe whole publication in HTML [887 kB] – Publication description (readable colophon) – In PDF-format [1.425 kB]

Chemicals assessed

Cumulative risk assessment of potential endocrine-like substances

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