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

March 21, 2010

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 13, 2010

“Nature doesn’t have a design problem. People do.” (Cradle to Cradle, part 2)

Continuation of Cradle to Cradle: Remaking the Way We Make Things (Part 1), book by McDonough and Braungart.

One of the themes of Cradle to Cradle is that in nature there is no such thing is waste.  In their words,”Waste equals food.”  They note that ecosystems truly recycle materials.  (They seem particularly fond of cherry trees and ant colonies as examples of how nature operates.)

In contrast, what society calls recycling, they call “downcycling” since in almost all cases, the “new” product recreated from the old is of lower quality each pass through the recycling stream.

In Chapter One, “A Question of Design,” McDonough & Braungart describe the use the example of the Titanic as a symbol of how we perceive technology and how it is a metaphor for the industrial infrastructure on which our society is built.

In what I found an intriguing perspective on the Industrial Revolution and the infrastructure produced by it, McDonough & Braungart ask you as the reader to imagine being given the assignment of retrospectively designing the Industrial Revolution—with the following requirements for the system:

That it:

  • put billions of pounds of toxic material into the air, water, and soil every year
  • produce some materials so dangerous they will require constant vigilance by future generations
  • result in gigantic amounts of waste
  • put valuable materials in holes all over the planet, where they can never be retrieved
  • require thousands of complex regulations—not to keep people and natural systems safe, but rather to keep them from being poisoned too quickly
  • measure productivity by how few people are working
  • create prosperity by digging up or cutting down natural resources and then burying or burning them
  • erode the diversity of species and cultural practices

Intentional or not, that’s what we’re doing.  Not wanting this to be taken out of context, I should note that McDonough and Braungart do discuss how this whole system developed.  I’ll cover that in the next part.  (Wow, I’ve managed to get through the first two pages of Chapter One.  ;-)  )

Links to these posts, as well as posts from other blogs, will be added to the Cradle to Cradle page.

February 24, 2010

Back in the real world: Human exposure to environmental chemicals

Another type of exposure besides exposure to 24/7 connectedness that is probably affecting kids is exposure to industrial chemicals.  The Centers for Disease Control and Prevention (CDC) recently released its fourth National Report on Human Exposure to Environmental Chemicals. (Fact Sheet / Executive Summary – 874 KB / Full report – 18 MB)

CDC has measured 212 chemicals in people’s blood or urine—75 of which have never before been measured in the U.S. population. The new chemicals include acrylamide, arsenic, environmental phenols, including bisphenol A (BPA) and triclosan, and perchlorate.  BPA was found in the urine of nearly all the people tested, a finding that indicates widespread exposure in the U.S. population.  Mercury, a known neurotoxin, was found in most of the study participants.

CDC notes:

Biomonitoring measurements are the most health-relevant assessments of exposure because they measure the amount of the chemical that actually gets into people from all environmental sources (e.g., air, soil, water, dust, or food) combined. With a few exceptions, it is the concentration of the chemical in people that provides the best exposure information to evaluate the potential for adverse health effects.

This is not a new issue.  Several years ago the Environmental Working Group released a report, Body Burden: The Pollution in Newborns, which measured industrial chemicals, pollutants, and pesticides in the umbilical cord blood of newborns.

287 chemicals were detected in umbilical cord blood, of which 180 cause cancer in humans or animals, 217 are toxic to the brain and nervous system, and 208 cause birth defects or abnormal development in animal tests.  The report notes that a number of human health problems are on the rise.  Fetal and childhood exposure can lead to childhood diseases or to diseases which don’t fully appear until adulthood.

So what can be done about this?

EWG has a blog on the Kid-Safe Chemical Act and the Environmental Defense Fund‘s Richard Denison has a blog on chemicals and nanomaterials.   EDF is also one of many organizations that has formed the “Safer Chemicals, Healthy Families” coalition, which is pushing for reforming the way the manufacture of industrial chemicals is regulated in the United States.  One of the U.S. Environmental Protection Agency’s main tools for doing that is a relatively unknown law called the Toxic Substances Control Act (TSCA).  The Safer Chemicals coalition presents a health case for strengthening TSCA.  (TSCA has actually been in the news quite a bit lately, so you might have heard about it.)

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