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Pink Ribbons, Inc Woman’s hour debate 28/3/12

The thorny issue of breast cancer prevention

One of the founder members of the Alliance for Cancer Prevention, Professor Andrew Watterson from the Centre for Public Health and Population Health Research at the University of Stirling joined Lea Pool, director of Pink Ribbons, Inc  and Maggie Alexander from Breakthrough, on Woman’s Hour to discuss the film.

Lea explained the difficulty she had in identifying where the money raised for breast cancer went, what she did find out was that only 5% of money raised goes to environmental causes. She explained the term “pinkwashing” which means, on the one hand selling products to raise money for the disease, while on the other, using ingredients in that product which are linked to causing the disease. She reflected that breast cancer is a good cause for big corporations as women make 80% of the buying decisions.

She talked of her surprised when, at one of the walks for breast cancer, there was less than an 18 second silence to remember those who had died from the disease, which was proceeded by loud music and much cheerfulness. She thought that for many people this is not the right way to remember those who have died or to contextualise this disease. Lea advises us to be more political astute and critical about where the money raised for breast cancer goes and how it spent.

Maggie Alexander said that Breakthrough is looking at unpicking the multiple causes of breast cancer which are a combination of genetics, lifestyle and environmental factors, 17% of the money they spend on research goes on addressing these causes.

Andrew Watterson thought that there is very little focus on prevention and the tendency is to look at the cancer rather than the cancer causing chemicals and substances, which is what the film is flagging up. 216 chemicals are linked to breast cancer. Yet, when there is talk about prevention it’s about lifestyle factors and what the individual can do, the known and suspected environmental and occupational risk factors are not addressed.

“However there is an awful lot that we don’t know, assessments have said that 50% of breast cancer we can’t explain, there is recent research done which indicates that something like 85% of breast cancers are due to long term exposures to environmental cancer causing substances, that would include diet and other things. So, there are areas we know can take effective action on.” said Andrew Watterson.

Along with the lack of action on prevention, there is much inequality in terms of exposure to carcinogens. This linked to the fact that some socio-economic groups are not only exposed to higher levels of carcinogens but to more types of carcinogens and often for a much longer time than other groups. This adds another dimension to the action needed to address this epidemic.

Research on night shift work estimates that 2,000 women in the UK will contract breast cancer because of this work, this is way over the figures presented for what environmental and occupational exposures will do in terms of breast cancer causation.

“There needs to be interventions now, along with treating cancer, preventing exposures to carcinogens is critical. We can prevent certain things, we can remove carcinogens, which is what the World Health Organisation (WHO) approach is, act upstream and stop people falling ill if you can and of course treat them when necessary”.

When you look at what the charities are doing on prevention, many of these messages are being lost, it’s only some groups like the Alliance for Cancer prevention which address prevention, the bigger charities are very pharmacologically focused.

Elements of the pink ribbon campaign have been taken over and skewed. Ironically companies that produce carcinogens that are linked to causing  breast cancer, are also sponsoring campaigns to support breast cancer.

Breakthrough’s corporate partners distribute pink ribbons and breast awareness messages and when they do sell products for breast cancer, Breakthrough gets between 10-30%. Maggie points out that breast cancer is a multifactorial disease and that current evidence is that environmental chemicals play a very small role in breast cancer. Andrew suggests that we know enough to act now.

The Alliance is interested in hearing about the evidence Breakthrough has looked at when arriving at the conclusion that “there is no good evidence”? What is the definition of “good evidence”?

If, as Breakthrough suggests in an item on their website about the woman’s hour piece, that there is ” no good evidence that exposure to environmental chemicals increases your risk of breast cancer, based on the levels that you would normally be exposed to in the UK”. What are the ‘normal’ levels? Are there any normal levels of manmade chemicals with CMR properties (carcinogenic, mutagenic and teratogenic)?

Are the Endocrine Disrupting Chemicals (EDC’s) – that we know can interfere and disrupt the action of  hormones in our bodies, at much lower levels than we previously thought – counted as “environmental chemicals”? If so, which environmental chemicals would we normally be exposed too ?

Given that many of these chemicals and substances are manmade and should be regulated anyway, if there is no good evidence to suggest these ‘normal’ levels are harmful, why do they need regulation?

If regulation has helped to decrease levels of certain environmental chemicals or substances, which ones are decreasing?

Isn’t part of the problem in our workplaces that the levels we are exposed to are not ‘normal’ and we don’t fully understand the actions of these chemicals or substances, so they are not properly regulated?

The scientific debate has moved on considerably since we all thought that the dose makes the poison i.e. it was how much of a chemical we were exposed to that caused the problem. We know the science now points to extremely low doses having an impact and it’s more the timing of the exposure rather than the dose that is the problem.

The alliance does not suggest that environmental and occupational risk factors are the main cause of breast or any other cancer, just a very much neglected one.

And lastly, if the WHO acknowledges the environmental and occupational risk factors for cancer, why is the cancer establishment lagging so far behind?

You can listen to the piece here, it begins at 19.05: Woman’s hour episode 28/3/12

Diesel exhaust is a serious cancer risk in miners.

Miners exposed to high levels of diesel exhaust face a dramatically increased lung cancer risk, a long delayed official US study has found. In a study of non-metal miners in the United States, federal government scientists reported that heavy exposure to diesel exhaust increased the risk of death from lung cancer.

The findings, delayed by a court challenge from a mine industry lobby group, were finally published on 2 March 2012 in two papers in the Journal of the National Cancer Institute. Michael D Attfield, who led one of the studies, found the risk of lung cancer among heavily exposed underground workers was five times the risk observed among workers in the lowest exposure category. The study also found a significantly increased risk of oesophageal cancer.

In a second study led by Debra T Silverman, where investigators took into account smoking and other lung cancer risk factors, the data showed a three-fold risk of lung cancer death overall and about a five-fold risk for heavily exposed underground workers. For never smokers, risk of lung cancer death increased with increasing diesel exhaust exposure. “These data are especially revealing as they show the effect of diesel exhaust in the absence of smoking,” said Silverman. Although based on small numbers, non-smokers with the highest level of diesel exposure were seven times more likely to die from lung cancer than non-smokers in the lowest exposure category.

“This landmark study has informed on the lung cancer risks for underground mine workers, but the findings suggest that the risks may extend to other workers exposed to diesel exhaust in the United States and abroad, and to people living in urban areas where diesel exhaust levels are elevated,” said Joseph F Fraumeni Jr, director of the National Cancer Institute’s Division of Cancer Epidemiology and Genetics.

In an accompanying editorial in the journal, Lesley Rushton, the epidemiologist at Imperial College in London who produced for the Health and Safety Executive (HSE) the revised UK estimate of workplace cancer risks, wrote: “These results indicate that stringent occupational and particu­larly environmental standards for diesel engine exhaust should be set and compli­ance ensured to have an impact on health outcomes.” The International Agency for Research on Cancer (IARC) is due to review diesel exhaust evidence in June. Some believe the US study could lead to the agency upgrading diesel exhaust from a “probably carcinogenic to humans” group 2a rating to group 1, a known cause of cancer in humans.

By Rory O’Neill

NCI news release and Q&A on the diesel exhaust and miners study. iWatch News. The Pump Handle. Hazards magazine.

Silverman DT, Samaniac CM, Lubin JH and others. The diesel exhaust in miners study: a nested case-control study of lung cancer and diesel exhaust, Journal of the National Cancer Institute, 2 March 2012. doi:10.1093/jnci/djs034 [ pdf].

Attfield MD, Schlieff PL, Lubin JH and others. The diesel exhaust in miners study: a cohort mortality study with emphasis on lung cancer. Journal of the National Cancer Institute, 2 March 2012. doi:10.1093/jnci/djs035 [ pdf].

Rushton L. The problem with diesel, Journal of the National Cancer Institute, 2 March 2012. doi: 10.1093/jnci/djs137 [ pdf].

State of the Art Assessment of Endocrine Disrupters

New report commissioned by DG Environment and prepared by Andreas Kortenkamp et al, presents the up to date picture on Endocrine Disrupting Chemicals (EDC’s). The report recommends that EDC’s are given a separate regulatory class category ‘ED’ and outlines the decision criteria that should be applied to determine whether a substance is an EDC or not and how they should be regulated.

Potency should not be used as a sole decider in EDC evaluation. “The weight-of-evidence approach will have to consider potency together with other factors such as severity and specificity of effect and irreversibility. Rigid potency-based cut-off values as decisive decision criteria are not recommended”.

The report can be downloaded here: State of the Art Assessment of Endocrine Disrupters

Press Release from HEAL: Report paves way for ban on “gender bender” hormone-disrupting chemicals


Controlling occupational cancers in Australia

An opinion piece in the Medical Journal of Australia on Controlling occupational cancers in Australia raises the concern that limited recognition has been given to work related cancer from researchers and policy makers. This is especially apparent when compared to the attention given to cancers related to tobacco use and sun exposure.  There is also is no strategy for measuring rates, mitigating risk and meeting individuals’ needs.

The piece cites the Asturias Declaration, developed by the WHO, which  recommends that all countries develop education campaigns to improve public knowledge of environmental causes of cancer and strategies for prevention.

Lin Fritschi et al, MJA 196 (3) · 20 February 2012 Controlling occupational cancers in Australia. 


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