The Ultimate Political Question -
Mark S. Muldoon
St. Catharines, Ontario.
Today, military conflicts are raging around the globe. However, perhaps the most crucial war that should be of keen interest to everyone in Canada is the war that uses our bodies as its battleground, namely, the war against cancer. It is being lost. The statistics are startling.
Health Canada's Cancer Bureau estimates that if current trends continue, the number of new cancer cases will increase by 70 per cent by the year 2010. This compares to only a 28 per cent increase during the present decade.(1) Presently, everyday 365 Canadians will learn they have cancer and 172 will die.(2) Canada currently ranks among the top ten countries in the world for the incidence of cancer.
These statistics are more troubling for residents of Ontario. Of the 5,400 annual cancer deaths in Canada, more than 2,000 of those deaths occur in Ontario alone.
Forty years ago, one in four Ontarians was diagnosed with cancer and one in five died from the disease. In 1999, the odds have worsened: one in three residents will get cancer at some point in their lifetime - one in two if we count non-melanoma skin cancers - and one in four will die from it.
The figures are stunning considering the amount of money poured into finding a cure and treating the disease over the years. The recent report by the Canadian Cancer Society blames the increase almost entirely on the aging of the population.(3)
However, there is a healthy amount of scepticism from several groups not only about the actual rate of cancer increase but its causes as well.
At a recent conference in Hamilton, Ontario, entitled 'Everyday Carcinogens: Stopping Cancer Before it Starts,'(4) several speakers argued that the incidence of cancer is presently at epidemic proportions and that our national and regional cancer agencies are not doing enough to stem the haemorrhaging of this disease throughout the population.
Liz Armstrong, the senior author of the background paper to the conference, states that simple counts comparing the incidence of cancer over time do not work because Canada's population is growing larger and older at the same time. To achieve a more accurate estimation of the cancer trends, it is necessary to standardize new data, that is, weight it to match age distribution in a census year (for example, 1991 for Canada and Ontario) and compare it to a fixed number of people (for example, cancers per 100,000) rather than a constantly growing total population.
The result of such a readjustment (see figure 1) indicates that over the last 30 years, among women, there has been a 29 per cent increase in breast cancer, a 349 per cent increase in women's lung cancer, a 116 per cent increase in melanoma, a 106 per cent increase in non-Hodgkin's lymphoma, and a 146 per cent increase in thyroid cancer. Among men, over the same time, there has been a 102 increase in prostate cancer, 273 per cent increase in melanoma, a 115 per cent increase in non-Hodgkin's lymphoma, a 65 per cent increase in testicular cancer, and a 133 per cent increase in thyroid cancer.(5)
Read in this way, Armstrong argues, the figures reveal more since the cancers that show the most dramatic rises, such as non-Hodgkin's lymphoma and melanoma, have acknowledged links to occupational and environmental hazards. This is true of the two very high profile cancers - breast and prostate - where a growing body of evidence argues that the massive increase in these cancers may be due inpart to exposure to chemical compounds that act as hormone disruptors. These chemical compounds are the ones everyone has frequent contact with - pharmaceuticals, pesticides, plastics and other products produced after World War II.
In Ontario alone, for example, testicular cancer, a hormone-dependent cancer, has risen by 65 per cent in the last 35 years with a 300 per cent increase specifically in males aged 15 to 29 years old.(6) This is one cancer hardly reserved for the greying population.
Moreover, Canadian Cancer Statistics 1998 report that 22 per cent of breast cancer cases occur in women under 50 and fully 66 per cent of cases are in women under 70. Twenty-two per cent represents 4,250 Canadian women under 50 who are diagnosed with breast cancer every year; nearly 13,000 are under 70.
The point of the Hamilton conference was precisely to bring these anomalies to light. Many of the speakers argued that our cancer institutions have failed to acknowledge the growing weight of evidence that many cancers may be a function of toxic chemical compounds in the environment. Cancer agencies, it was argued, should be focusing their attention much more on cancer prevention in the workplace and the home rather than spending almost all their funding on treatment and cure strategies.
And, there is warrant in this argument. The Ontario Cancer Registry only began collecting statistics in a systematic fashion in 1964 - at a time when the cancer rates were not 1 in 10, but already 1 in 4. Despite `the war on cancer' over the years, this ratio has not substantially changed. In fact it has only become worse.
The key issue for Armstrong - and many of the union representatives present at the conference - is that unlike choosing not to smoke, the general population has no choice but to involuntarily ingest a vast array of carcinogenic substances synthetically produced and found in our food and water, in the air we breathe, in the consumer products we use, and in the chemicals used in our workplaces.
Where in older studies, the health effects of such toxic chemicals was reported following only relatively high exposure to them as a result of accidental or occupational exposure, there is a growing body of evidence that strongly shows that health effects may occur at levels which are, or near to, those currently found in the general population as a consequence of unavoidable everyday human exposure to these compounds.(7)
In 1995, the Ontario Cancer Treatment and Research Foundation (OCTRF) estimated that, of the risk factors known to cause cancer in Canada, 29 per cent is attributable to tobacco, 20 per cent to diet, 9 per cent to occupation, 8 per cent to family history, and 6 per cent alcohol. Reproductive factors account for 4 per cent, 3 per cent is attributable to sexual activity, 1 per cent each to sunlight and ionizing radiation. Risk factors surrounding 18 per cent of fatal cancers are unknown.
Even if the conservative OCTRF figure of 9 per cent for cancer deaths from occupational exposures is underestimated, that still yields 5700 deaths in the workplace alone. None of these deaths have anything to do with the connection between cancer and aging, or cancer and lifestyle choice.
Dr. Samuel Epstein, a keynote speaker at the conference, is an internationally acknowledged expert in occupational and environmental medicine at the University of Illinois. He has written passionately in The Politics of Cancer Revisited (1998) that the cancer establishments in both Canada and the United States have failed the public by fixating themselves on finding the cause of cancer as solely a function of lifestyle, diet, or genetics. He generally refers to this strategy as the "blame-the-victim-approach."
However, the mounting evidence makes it very difficult to constantly blame the victim for the steady increases in the cancer rates. Epstein argues that the overall increase in cancers in the United States between 1950 to 1995 was 55 per cent of which lung cancer, primarily attributed to smoking, accounted for about 12 per cent. Over the same period, non-smoking cancers increased as follows: prostrate cancer, non-Hodgkin's lymphoma and multiple myeloma, 200 per cent; testis cancer, 110 per cent; brain and nervous system cancer, 80 per cent; and childhood cancer, 10 per cent. While lifestyle choices certainly impact cancer incidence, better living choices will still not reduce cancer levels to where they were 50 years ago. Rather, a closer look at the statistics in the U.S. will reveal that occupational exposures to environmental contaminants alone cause more than 30 per cent of all cancers.(8)
Epstein also discounts the other common explanation for the increase in cancer, namely, that it is a function of better detection methods. This explains nothing he responds. More incidences of cancer - however detected - simply tells you there is more cancer. Despite all the fanciful claims over the years - with the notable exception of some relatively rare cancers - our ability to treat and 'cure' most cancers, he argues, has remained virtually unchanged.(9)
Cancer Care Ontario (CCO) - established in 1997 to act as the provincial government's principal advisor on cancer issues - has been very reluctant to address the environmental issue and to pursue more preventive strategies.
In a presentation to the delegates at the Hamilton conference, Dr. Richard Schabas, head of Preventive Oncology for CCO, admitted that little provincial money is directed toward prevention. More disturbingly, outside of a single reference to occupational cancer, Dr. Schabas did his best to tacitly deny any links between environmental contaminants and cancer. In responding to a question, Dr. Schabas remarked that CCO would might consider taking a closer look at environmental contaminants in two to three years.
Proponents advocating more preventive strategies to manage the present cancer crisis demand that Cancer Care Ontario immediately adopt a 'weight of evidence approach.' The risks to human health, the proponents argue, are simply too great to wait for science to definitively find the exact causes of each of the individual cancers. And, as noted above, the weight of evidence is becoming robust and warrants immediate reaction.
In the mid-1960s, for example, the surgeon general of the United States acted on the weight of evidence linking smoking and second-hand smoke to lung cancer. This began the long process of prohibiting smoking on airplanes and in public buildings. It was only in 1996, however, that researchers discovered the substance in cigarette smoke, called benzo(a)pyrene, that causes the genetic mutation in lung cells that yields the same tumours experienced by smokers. In other words, positive proof of the link between smoking and lung cancer is very recent. How many deaths from smoking would there have been if our governments had waited until 1996 to warn against the dangers posed by tobacco?
This is a major concern of many labour unions today. It is not uncommon for workers in Ontario to experience various levels of exposure to toxic substances in the workplace and yet there are no strigent regulations to protect them. As one cancer survivor bluntly stated, she stopped replying to the different surveys by cancer agencies because none of them asked her where she worked.
How come government officials and cancer agencies are reluctant to move faster in protecting society by erring on the side of caution?
The cynical reply would be to suggest that cancer has become an multi-million dollar self-serving industry enjoined by pharmaceutical companies, the insurance industry, electronic manufacturers, and perhaps the medical profession itself. In fact, there is no dearth of credible voices who argue this thesis; Ralph W. Moss, The Cancer Industry (1996); Sharon Batt, Patient No More: The Politics of Breast Cancer (1994); Liane Clorfene-Casten, Breast Cancer: Poisons, Profits and Prevention (1996), Lois Marie Gibbs, Dying from Dioxin: A Citizens Guide to Reclaiming our Health and Rebuilding Democracy (1997); and John Stauber and Sheldon Rampton, Toxic Sludge is Good for You: Lies, Damn Lies and the Public Relations Industry (1995).
However, there is a bigger picture. First, some background information. It has been known for quite sometime that the air, water, and food in our biosphere has been contaminated with what are generally referred to as persistent organic pollutants (or, POPs for short). These chlorine-based chemicals (organochlorines) are all known or suspected to be carcinogenic. The particularly nasty ones to human health are dioxins, furans, PCBs, hexachlorocyclohexane, DDT, chlordane, heptachlor, aldrin, dieldrin, eldrin, toxaphene and mirex. All of these are industrial chemicals and pesticides that have been manufactured intentionally as well as some that are unintentional by-products of chemical processes or incineration.
Most of us living in the Great Lakes basin - and indeed worldwide - have been ingesting these chemicals for most of our lives.(10) Health Canada reports that food accounts for about 80 to 95 per cent of our daily intake of most persistent toxic contaminants.(11) These chemicals are fat-soluble and they accumulate in our body tissue. This accumulation is of great concern to many researchers today because POPs are known or suspected to be hormone disruptors.
In the now landmark book, Our Stolen Future: Are We Threatening Our Fertility, Intelligence, and Survival (1996), the author, Dr. Theo Colborn, strongly suggests that POPs are interfering with the hormones that control and regulate growth, health and behaviour in wildlife and humans, and are leading to birth defects, reproductive failures, problems of sexual development, reduced intellectual potential, attention deficit disorders and reduced sperm counts. The link between cancer and POPs lies in the fact that breast, ovary, uterus, testicle and prostate cancers are known to be or suspected to be hormonally-mediated.(12)
Directly connected to the role of hormone disruptors is the controversy over contaminant exposure to infants from breast feeding. The average breast-fed baby in Canada presently exceeds the World Health Organization's maximum 'tolerable daily intake' for dioxin by a factor of 15.(13) Dioxin is a by-product of incineration, especially of plastics. The most potent dioxin, TCDD, is a known human carcinogen. In the most highly exposed populations in Canada, namely the Arctic, the level of breast-milk contamination is several times higher again.(14)
The larger picture is that despite the growing body of disturbing links about hormone disruptors and persistent organic pollutants, especially the organochlorines mentioned above, the chemical industry has been producing some of these chemical compounds in large quantities for more than half a century. Despite the fact that some are now banned substances and not produced, they are all persistent and present in our environment. Since the 1940s, over 75,000 new chemical combinations created in labs have made their way into commerce and our everyday lives - plastics, pesticides, pharmaceutical, insulators, paints, dyes, detergents, degreasers, and so on. Most disturbing however is the fact that even the most basic toxicity testing results cannot be found in the public record for nearly 75 per cent of the top volume chemicals in commercial use.(15)
Hence, if cancer agencies should suddenly turn around and demand zero risk policies to be implemented, and to phase-out a whole host of chemicals, resistance from industry would be formidable.
And this is the crux of the matter. Many would argue that industry, bolstered by the lack of government regulation, has held its own to the detriment of public health.
As long as cancer victims - and indeed the general public - are led to believe that their lifestyle or genes are the sole cause of cancer, there is no need for the various industries to undergo costly changes to production processes or product design, and certainly no need to be concerned about occupational exposure to workers and the various contaminants in the workplace.
As it now stands, Ontario has no regulations for mandatory testing of the health effects of existing chemicals under its principal labour legislation, the Occupational Safety and Health Act (OSHA), no mandatory substitution of toxic chemicals, and no mandatory banning of the most toxic substances in the workplace.
In fact, the present provincial government has, for the most part, divested itself of previous responsibilities concerning environmental regulation and enforcement. Ontario is now one of the most toxic provinces in Canada, and the third worse polluter in North America.(16) In the words of Karen DeKoning, a cancer survivor and spokesperson for the Canadian Breast Cancer Network: "In an attempt to reduce the provincial deficit and balance the budget, our government has attacked the only framework we had to protect our health. Is our government now able to protect our health? It is quite probable that any savings in the budget of the Ministry of the Environment will be overshadowed down the road by increases in health care costs for cancer care."(17)
If only half of what the proponents for preventive cancer argue is valid, then the provincial government has basically abandoned the people of Ontario in terms of its position on cancer.
A prime example is the case of Dr. David Josephy at the University of Guelph. Late last year his team discovered aromatic amines (AAs), a possible breast carcinogen in human breast milk, for the first time. The results are found in the peer-reviewed journal, Chemical Research in Toxicology in January 1999. Today, Dr. Josephy cannot carry on his research because there is no money allocated in cancer agencies for such preventive research. Some would argue there is no profit is such research.
Yet, ethically, there is still a larger picture. To what degree as a society do we permit the continual accommodation to which we have all unwittingly submitted ourselves over the years with regard to environmental degradation?
We know that on hot summer days, for example, we cannot swim in parts of Lake Ontario and Erie because of the high bacteria counts. On those same hot days, children and the elderly in large urban centres are requested by health officials to stay in indoors. There are presently 1800 premature deaths in Ontario annually owing to the poisoned air.(18) Again, in the summer, without sufficient protection, the sun is a potential killer given the depletion of the ozone layer.
In short, we keep accommodating ourselves to a more and more diminished quality of life. And, on a yearly basis, we involuntarily ingest more and more toxic chemicals into our bodies. In the meantime, industries that produce toxic chemicals of all sorts lobby the governments to squash all talks of zero-discharge regulations and demand, rather, self-policing guidelines which mean, in effect, no regulation at all.
Something is terribly amiss here. Mothers with chronically ill children know it, cancer victims know it, cancer survivors know it, many doctors know it, and soon, given the statistics, no one will be unscathed by this sad situation.
Dr. Paul Connett, an international expert in the health effects from incineration, sounded the most ominous tone at the Hamilton conference. Some health organizations on both sides of the border are suggesting mothers shorten their breast feeding period from six months to four months. This, he argued, marks the beginning of the end of our culture as we know it. Instead of accommodating and protecting the well-being and health of its youngest citizens, governments presently prefer to give sole priority to the corporate profit motive. The end of a culture begins when it cannot stand for and choose life as its single most primary value.
At the end of the twentieth century, the war on cancer, a completely winnable war, is the ultimate political question.
Even if as a society we no longer have the moral spine to choose for life for its own sake, we should at least then take DeKoning's warning seriously that health care costs will sky-rocket in the next decade to the degree governments do not take the necessary precautionary approach to the present cancer crisis today.
In the immediate present, there are several legislative proposals that should be considered. First, prohibiting the production of new carcinogenic compounds and working toward a zero-discharge policy - through tax incentives - for ones still in production. Second, respecting the public's right-to-know what is harmful to their health by insisting that all chemicals suspected of, or posing, a carcinogenic danger be 'red flagged' on all household and industrial products - regardless of claims of confidentiality and trade secrecy. Third, the extreme necessity of putting criminal teeth back into laws that protect the public against those who willing distort or suppress information on the environmental, occupational, and consumer hazards of their products. Lastly, the need for an independent citizen safety agency to act as an intermediary between consumers, workers and the regulatory authorities and industry.
Rachel Carson, recently acknowledged by Time magazine as one of the great intellectual contributors of the twentieth-century,(19) sounded the first warning about cancer and the environment in her famous book Silent Spring (1962). She called cancer "the epidemic in slow motion." Carson indicated then that it is the minute exposures - "repeated over and over throughout the years" - to synthetic carcinogens that will cause humans the most harm.(20) Her legacy is coming true. She died in 1964 from breast cancer.
Cancer is the ultimate political question.
Figure 1. (click here -- opens in new window)
(from Liz Armstrong, "Everyday Carcinognes:
Stopping Cancer Before it Starts," p. 4)
1. Suzanne Morrison, "Health Canada Predicts Dramatic Rise in Cancer," The Hamilton Spectator, April 9, 1999.
2. Canadian Cancer Society. For more statistics see: http://www.cancer.ca/indexe.htm
3. Krista Foss, "Aging Populace Behind Jump in Cancer Rates," The Globe and Mail, April 9, 1999.
4. Everyday Carcinogens: Stopping Cancer Before it Starts, McMaster University, Hamilton, Ontario, March 26-7th, 1999.
5. Liz Armstrong, background paper for Everyday Carcinogens: Stopping Cancer Before it Starts, McMaster University, Hamilton, Ontario, Canada, March 1999, pp. 3-4.
6. See Brad Evenson, "More Men Suffer from Testicular Cancer - 'Something Strange is Going On': 60% Increase in Ontario," The National Post, January 26th, 1999.
7. See the sources in note 10 and the Colborn book quoted below. As well, contact Morag Simpson of Greenpeace - they have a literal library of material on this issue.
8. As quoted in background paper for Everyday Carcinogens: Stopping Cancer Before it Starts, McMaster University, Hamilton, Ontario, March 26-7th, 1999, p. 21.
9. Samuel Epstein, "Legislative Proposals for Reversing the Cancer Epidemic," in The Right Livelihood Award Presentation to the Swedish Parliament," Dec. 9, 1998.
10. See the entire spring edition (1998) of The Toledo Journal of Great Lakes' Law, Science and Policy; and, B.L. Johnson, et el., "Public Health Implications of Persistent Toxic Chemicals in the Great Lakes and St. Lawrence Basins," Journal of Great Lakes Research 24, no. 3(1998): 698-722.
11. "The Health and Environment Handbook for Health Professionals," prepared by the Great Lakes Health Effects Program, Health Canada and the Public Health Branch, Ontario Ministry of Health, October 1997, p. 125.
12. One of the keynote speakers (via video) at the Hamilton Conference was Sandra Steingraber. For her summary of this link see Sandra Steingraber, Living Downstream: A Scientist's Personal Investigation of Cancer and the Environment (New York: Vintage Books, 1998), p. 110.
13. This is common figure quoted throughout the literature. A thorough explanation of this figure is found in Michelle Allsopp, Ruth Stringer and Paul Johnston, Unseen Poisons: Levels of Organochlorine Chemicals in Human Tissues (Exeter, U.K.: Greenpeace Research Laboratories, 1998), 17.
14. See Arctic Pollution Issues: A State of the Arctic Environmental Report (Oslo, Norway: Arctic Monitoring and Assessment Programme, 1997), pp. 172ff.
15. As reported in the Environmental Defense Fund's 1998 annual report Toxic Ignorance; see its website: http://www.edf.org/pubs/Reports/ToxicIgnorance/
16. See Brian McAndrew, "Ontario Produces Nearly Half of Worst Pollutants: Province Bucks National Trend of Pollution Reduction," The Toronto Star, July 28th, 1998.
17. Presentation made to the First World Conference on Breast Cancer in Kingston, Ontario, July 1997.
18. Mark McNeil, "Region's Bad Air Kills 130 Yearly," The Hamilton Spectator, June 10, 1997. See also the Hamilton Air Quality Initiative Report, 1997, produced by the Region of Hamilton-Wentworth.
19. See Time, March 29th, 1999 edition.
20. Rachel Carson, Silent Spring (New York: Houghton Mifflin, 1962), 242.
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