December 1, 2004 - Call Notes 

Thank you for a very interesting CHE Cancer call last week. I’ve included a summary as well as the full text so those who were not able to participate can see the discussion. I look forward to working with all of you on redefining this cancer discussion.

HIGHLIGHTS of the call:

1. We agreed that we share a concern that the widely cited Doll and Peto estimate that environmental contaminants are responsible for no more than 5% of all cancers no longer reflects recent progress in cancer research. We agreed that it would be useful to develop a common statement of concern on the limitations of the Doll and Peto study. We agreed that this effort to develop a common statement would run in tandem with the development of the much more extensive paper Dick Clapp and his colleagues are preparing on the role of environmental contaminants and other environmental factors in cancer, which we intend to review on the next call. We also discussed other significant issues of shared concern, as described in the notes below. The central consensus was that it was time to reframe the debate on the role of environmental contaminants and other environmental factors in cancer causation in a framework that more adequately reflects recent advances in the scientific understanding of cancer causation and prevention.

2. ACTION: We encourage those who have comments and suggestions on reframing this discussion to please send them to the group. We will compile and redistribute them to everyone in the form of a letter.

3. Our next call is March 2, 2004 at 9:00am Pacific/12:00 noon Eastern. The featured topic will be a review of the literature assessment that Dick Clapp, Molly Jacobs and Gen Howe are working on. We welcome other suggestions as well.

4. Please review the CHE Participant List posted online and send any changes to Jeanette Swafford at: info@healthandenvironment.org.

5. We have changed the password of the CHE Work in Progress section: Please contact Jeanette Swafford at: info@healthandenvironment.org for this password.


Call Attendees (in alphabetical order)

1. Amanda Hawes, Cal-COSH
2. Anna Dillingham, Trust for America’s Health
3. Bob Gould, Physicians for Social Responsibility
4. Deborah Forter, Mass Breast Cancer Coalition
5. Diana Zuckerman, National Center for Policy Research for Women and Families
6. Dick Clapp, Boston Univ School of Public Health, U Mass, Lowell
7. Eleni Sotos, Collaborative on Health and the Environment
8. Ellen Dorsey, Heinz Endowment
9. Genevieve Howe, Univ. of Mass, Lowell
10. Guy Dauncey, Author, Canada
11. Jackie Wilson, Consultant Physician
12. Jamie Harvie, Institute for Sustainable Future
13. Jeanette Swafford, Collaborative on Health and the Environment
14. Jeanne Rizzo, Breast Cancer Fund
15. Julia Brody, Silent Spring Institute
16. Karen Jacobs, filmmaker
17. Lisa Bailey, surgical oncologist, and board member of ACS-CA
18. Lisa Ledwidge, Institute for Energy and Environmental Research
19. Lisa Wanzor, Breast Cancer Action
20. Liz Armstrong, Breast Cancer Prevention Coalition, Canada
21. Michael Lerner, Commonweal
22. Molly Jacobs, Univ. of Mass, Lowell
23. Rob Tufel, National Brain Tumor Foundation
24. Steve Heilig, San Francisco Medical Society
25. Ted Schettler, Science and Environmental Health Network
26. Terry Nordbrock, Families Against Cancer and Toxics
27. Theo Colborn, TEDX
28. Tony DeLucia, East Tennessee State University


Agenda:

Introductions and Welcome – Jeanette Swafford, CHE
1. Science Update – Theo Colborn, TEDX
2. Research Update - Jeanne Rizzo, Breast Cancer Fund
3. Research Update - Julia Brody, Silent Spring Institute
4. NCI statement on cancer and the environment – Dick Clapp, BU SPH
5. Next Steps – Michael Lerner, Commonweal


1. Science Update – Theo Colborn, TEDX, Inc

An Update on Some Recent Cancer Studies with Possible Environmental Associations and Suggestions of Fetal Origin

1. In a study from Barcelona, Spain the authors reported that high body burdens of two PCB congeners, 28 and 118, were associated with an elevated risk of colorectal cancer. In this study, the authors collected non-fasting blood samples from 132 cases and 76 controls to do organochlorine chemistry analyses and they also collected tumor tissue from all 132 cases. In the tumor tissue they looked for point mutations in K-ras oncogenes and tumor suppressor P53 genes and found that K-ras was mutated in 38 % of the cases and p53 in 60%. Overall 81% of the tumors had K-ras and/or P53 gene mutations resulting in an increased risk of 2.89. PCB 118 fell out with the strongest association. PCB 118 is also one of the PCBs with a relatively high dioxin toxicity equivalent value (TEQ). PCB 28 has a very weak dioxin TEQ value.

2. This prompted me to go back to a recent report from Belgium in which the investigators found an association with two PCB congeners and breast cancer. I wanted to see if they were the same two congeners. They were not. In this study the association was made with PCB 153 and 138 in serum of women undergoing surgical intervention. There was a statistically significant higher concentration of total PCBs in the breast cancer cases (7.08 ppb) compared with controls (5.1).

Studies similar to these have been going on since chemists developed the technology to detect PCBs in the environment and human tissue. There are still serious problems comparing PCB chemistry from one study to another. And the battle continues whether studies such as these will ever reach certainty enough to determine etiology or provide support for prevention.

3. Back in July we found a paper where investigators used bone marrow samples from 837 children with acute lymphoblastic leukemia ALL and looked for K-ras and N-ras genes. 127 children (15%) had ras mutations.
Then working with those cases that had ras mutations they found that:
Paternal mind bending drug use double the odds to 2.0
Maternal mind bending drugs increased the odds to 3.1
Paternal amphetamines or diet pills use-- 4.1 None with the mother
Paternal exposure to plastic materials before birth --2.4 and postnatal exposure to solvents -- 1.8.
Maternal exposure to solvents -- 3.1
Maternal plastic exposure during preg 6.9
Maternal plastic exposure after pregnancy rose to 8.3.

They found that out of the 837 ALL cases, those with ras mutations were more likely to be younger at diagnosis. Parental exposure, especially paternal connections with mind bending drugs and diet pills, were also found in cases with younger children. This suggested to the investigators that ras mutations took place during gestation or in the germ cells preconceptually.

4. I close with a study that used data from the Northern California Childhood Leukemia Study. The group compared the dietary habits of 138 mothers whose children had ALL with mothers whose children did not have cancer. Diets for one year prior to pregnancy were compared. Parents were asked about 76 food items, vitamins, certain reduced-fat foods, and cooking fat.

The more vegetables, fruits, and proteins the lower the risk of ALL. Fruits, carrots, and cantaloupe had the highest inverse relationship. String beans and peas also had an inverse relationship. Beef and beans had the highest inverse relationship among the proteins. There appeared to be no relationship with vitamin supplements. They found that food containing antioxidants and glutathione were protective with ODDs as low as 0.18.

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Citations

1. Howsam, M, Grimalt, JO, Guino E, Navarro M, Marti-Rague J, Peinadao MA, Capella G, and Moreno V for the Bellvitge Colorectal Cancer Group. 2004. Organochlorine exposure and colorectal cancer risk. Environmental Health Perspectives 112(15): 1460-1466. (A team from Lille, France and Catalonia and Barcelona, Spain)

2. Charlier CJ, Albert AI, Zhang L, Dubois NG, Plomteux GJ. 2004. Polychlorinated biphenyls contamination in women with breast cancer. Clinica Chimica Acta 347:177-181. (A Leige, Belgium team).

3. Shu X, Perentesis JP, Wen W, Buckley JD, Boyle E, Ross, JA, Robison LL. 2004. Parental exposure to medications and hydrocarbons and ras mutations in children with acute lymphoblastic leukemia: A report from the Children’s Oncology Group. Cancer, Epidemiology, Biomarkers & Prevention 13(7):1230-1235. (A team from Vanderbilt, Univ Minn, The Childrens’ Oncology Group in Arcadia, CA, and the South Carolina Cancer Center, Columbia, SC.)

4. Jensen CD, Block G, Buffler P, Ma X, Selvin S, Month S, 2004. Maternal dietary risk factors in childhood acute lymphoblastic leukemia (United States). Cancer, Causes and Control 15(6):559-570. (A Berkeley Group).

2. Research Update - Jeanne Rizzo, Breast Cancer Fund

Many people on this call have been working on securing funding for breast cancer and the environment research for years. The outgoing Director of NIEHS, Ken Olden finally funded four research centers, totally $5 million a year for 7 years. They are UCSF/Kaiser, Fox Chase and Mt. Sinai, University of Cincinnati, and Michigan State University. Their mandate is to better understand early environmental exposures that influence puberty and the development of mammary glands. Scientists and advocates agree that understanding how the primary environmental agents (food, air, water, soil) contribute to early onset of puberty is the key. Early onset, second to gender, is the best indicator of developing breast cancer later in life. These centers will explore how normal breasts develop, using mouse model studies. The mice will be exposed to radiation as well as to synthetic chemicals that activists will help to define.

The epidemiological study will enroll 1500 girls and it will examine the cellular and sub- cellular pathways, focusing on the shift towards earlier puberty. They will be looking specifically at the interplay between genetic variations and environmental exposure that may put them at risk. Candidate agents will be studied in the laboratory model to determine cellular pathways.

Each center also has a community outreach and translation core which consists of community members who work with the scientists to design, implement and ultimately translate the findings for the community.

This was the first meeting and there were 250 attendees. People came from all over the country not just from the four research areas. We hope that they will receive additional funds so that they can expand work at each of the centers. There will be annual meetings going forward.

Participants in the epi study will be followed from birth, but they will not look at pre-natal exposure yet. We want to include pregnant women in the study as well, but that would require additional funds. The Lowey bill will be re-introduced and will hopefully pass and allow us to extend the bill backwards to examine pre-natal exposure as well.

3. Research Update - Julia Brody, Silent Spring Institute

As part of the Cape Cod Study, we studied 89 pollutants (endocrine disruptors and mammary carcinogens) in 120 Cape Cod homes. Silent Spring Institute published the results in Environmental Science & Technology. We also made a commitment to report the individual results from each home. Two weeks ago we mailed this information out to each household. We studied pesticides, flame retardants, phthalates and measured them in air, dust and urine. We chose a data-rich format so the women can see how they rank in relation to other houses, and in relation to federal health guidelines (where they exist).

We have a new grant from NIEHS to study the experience of the women learning what was in their home, as well as to expand the sampling program to Richmond, California. Fourteen homes had particularly high levels of contaminants, including toxins that had been banned years ago. We will be retesting these homes to see if we can identify the sources. If anyone has experience reporting results to individuals or has been part of a study, Julia would love to hear from you. (brody@silentspring.org)

Silent Spring Institute is also working on a one-year project, scheduled to end next August, for the Susan G. Komen Foundation. It involves assessing the literature on breast cancer and the environment. We will be focusing on environmental pollutants, diet, early life exposures, gene/environment interactions and physical activity. We’re developing a set of consistent evaluation criteria that can be applied across studies. It is a significant move on the part of the Komen Foundation to undertake this literature review. They were at the NIEHS conference that Jeanne spoke about. I’m very excited about their new focus and enthusiasm on a breast cancer and environment agenda.


4. NCI Discussion - Dick Clapp D.Sc., MPH, Boston Univ. and Univ. of Mass, Lowell

Earlier this year, the National Cancer Institute produced a statement on cancer and the environment. The question is “Does NCI get it right?” I’ll turn this over to Dick Clapp to lead us in this discussion.

Dick: I’ll talk about the pamphlet in a general and then refer to some specifics. Finally I’d like to talk about how this fits into the political arena right now.

There is a benchmark newsletter that goes along with this pamphlet and can be found online. The newsletter is an interview with Aaron Blair who is the Chief Occupational Epidemiology Branch at the National Cancer Institute and he had a lot to do with this pamphlet. He is somebody that I have known for twenty years and have cited his work. The International Society for Environmental Epidemiology gave him an award in August for his many years of work. Aaron is essentially carrying on the fight within the bureaucracy. His interview was unobjectionable. He cites two papers at the end of the interview, the first being a paper that everyone cites, even to this day: Doll and Peto 1981 and the updated Doll and Peto 1998. The update gives a table at the end on the proportion of deaths caused by different cancers. So, this is the backdrop and mainstream position on cancer and the environment and how the entire discussion is currently framed.

The original Doll and Peto study presents a range of cancer deaths from tobacco at 25%-40%. The updated study narrows it to 29%-31%. This introductory interview is worth looking at in order to understand the framing.

The 40-page pamphlet is more problematic. The first part focuses on what causes cancer and is rather boilerplate. It runs through the substances and exposures that are known to cause cancer. It begins, of course, with tobacco. Tobacco is actually a mixture, but if you consider it as a single substance, it is responsible for more cancer cases than any other single exposure. It is proper to call that an avoidable risk. The avoidance includes not only smoking, as well as changing what farmers grow and how the entire industry works.

Page 9 lists other non-controversial exposures including alcohol, ultra-violet radiation, viruses, ionizing radiation. The pesticide section is new however and different from what NCI has been saying in the past. This reflects the recent research that NCI has done on pesticides. They list the toxins and suggest that many of these are either cancer-causing or likely to cause cancer. They even direct you to their website that focuses on pesticides and cancer. This section reflects the work of Aaron Blair and there is more to come. This section was interesting and actually quite good.

The next section talks about medical drugs and solvents. They list well-known solvents that cause cancer. There is more to say about solvents than what it is this document though.

How to prevent exposures is on page 17. This is key. “Two-thirds of cancers are caused by environmental factors.” This is the overarching statement and the reason that the document was produced and framed this way. Then it says that most of these exposures can be linked to lifestyle issues like “tobacco use, excessive alcohol consumption, diet and physical inactivity”. They are speaking out of both sides of their mouth here by saying that 2/3 of cancer are due to the environment, but lifestyle choices are all we need to change it. This is the same old song. The bottom of the prevention list discusses occupational exposures and getting your employer to provide adequate ventilation. The list should start with not using carcinogenic substances in the first place and then follow with worker safety and engineering controls. This is my biggest complaint with this document.

They leave exams off the list for prostate cancer. That isn’t right. Trends since 1992 indicate that the overall incidence and mortality of cancer has started to come down, mainly because of lung cancer. That is the good news. However, other cancers are going up. They don’t talk about that enough.

Interesting that this NCI statement os out there but it is an artfully crafted document that appears broad in concept. However, in practice it is quite traditional and conservative.

Comments:

Liz Armstrong: From what I can see in this document, there is nothing about mixtures or about the timing of exposures. It also doesn’t discuss endocrine disruptors. There also isn’t anything about the precautionary principle either.

Michael Lerner: Did the interview reaffirm the Doll and Peto assessment that chemicals and environmental factors are less than 5%?

Dick Clapp: Yes, they mention occupational exposures, air and water pollution and medicines as less than 5%.

Michael Lerner: We recently looked at a commonly cited study from the Harvard Center for Cancer Prevention that indicates that environmental exposures account for 5% of cancers. Is that correct?

Dick Clapp: Yes, that is correct.

Michael Lerner: In your opinion is the Doll and Peto study correct in attributing 5% to environmental factors?

Dick Clapp: No, I don’t think that this is scientifically correct. This notion of mixtures is important. These percentages can’t add up to 100% because we’re all exposed to multiple things. The truism is that multiple exposures create cancer. It is fruitless and pointless to argue over the actual numbers and percentages. Nobody really knows. Every cancer is both environmental and genetic. Groups of exposures combined with an individual’ssusceptibility creates the environment.

Rob Tufel: In the interview it seems that cancer is talked about as one illness. In the pamphlet, do they break it down into individual cancers?

Dick Clapp: Yes, they talk about individual cancers.

Mandy Hawes: How often is occupation ever considered? Doctors and most studies usually don’t even ask about it. The data doesn’t even get collected so it is difficult to factor it in. Under recommendations for modifiable factors that we can do something about, OSHA standards are vastly less protective than environmental standards. There is no reason or excuse for the discrepancy. It would be a big one for NCI to take on, but it should at least be talked about. (People agreed.)

5. Next Steps: Michael Lerner, Commonweal

I’d like to encourage a pointed discussion of next steps. This is an incredible group on the call. The question is whether we can refine aframe for some collaborative work. Let me make a proposal. The Doll and Peto study as a benchmark that is still used by NCI and others does not serve the science of cancer prevention well at this point. This community could contribute to the dialogue on the science that insists that we move beyond this kind of statement. Would that move us forward on this?

Ted Schettler: I would like to talk more about Dick’s point that it is not only fruitless, but unwise to talk about percentages because the numbers don’t add up to 100%. It is a metaphor when in fact what we’re dealing with is really interactive factors including nutrition, environmental exposures and genetics. We need to reframe the entire discussion and change our language. Can we change the framework and create new language instead of critiquing the old?

Jeanne Rizzo: If we made all of the changes that are suggested here (in the pamphlet) we wouldn’t significantly reduce our environmental exposures by much. The involuntary exposure is a result of public policy that isn’t precautionary. This is what we need to talk about in order to shift the framework.

Michael Lerner: I propose that we make an effort to create a collaborative statement on this. We aren’t such a large group that we can’t attempt to do this. Those in the group who are interested should send around their comments. We would make an outline based on your input and include items like the OSHA standards and NCI assessment. Get a list of the points and some draft language.

Everyone: Yes, that makes sense.

Gen Howe: I agree very much with comments that have been made and I hope that the paper that I’m working on with Dick Clapp and Molly Jacobs will help address these concerns. We are going to be debunking the Doll and Peto study as well as summarizing the state of the science on occupational and environmental links to cancer. This will be done by the end of March. Input from all of you will be useful too.

Michael Lerner: These aren’t mutually exclusive. In fact they are reinforcing processes.

Steve Heilig: People who are working on this should take a look at the Paris Appeal and its language. The language might be useful.

Jeanette Swafford: I will post the Paris Appeal on the website so you won’t have to search for it. I will also gladly be a repository for any comments that circulate.

Our next call will be scheduled for March 2nd at 9:00am/12:00pm Eastern. Thank you to everyone. This has been an excellent call. I appreciate your taking the time out of your busy schedules to join us.