The new President's Cancer Panel report on the environment shows us where to begin a meaningful program of cancer prevention.
This government, the offspring of our own choice, uninfluenced and unawed, has a just claim to your confidence and support.
- George Washington (inscribed on the wall of the U.S. Capitol Building)
On May 21, I participated in a congressional staff briefing organized by the Collaborative on Health and the Environment and the Breast Cancer Fund in conjunction with Senator Dianne Feinstein and Representative Debbie Wasserman Schultz. The topic was the President's Cancer Panel report, Reducing Environmental Cancer Risk: What We Can Do Now, released on May 6. The essay below represents the second half of my presentation. The first half appeared in this space on June 7. My co-presenters were physician Ted Schettler, M.D., M.P.H., science director of the Science and Environmental Health Network, and epidemiologist Richard Clapp, D.Sc., M.P.H., first director of the Massachusetts Cancer Registry and a professor at Boston University's School of Public Health.
When I testified before the President's Cancer Panel in October 2008, I spoke as a biologist. But when I read through the panel's final report shortly after its release on May 6, I was transported back to the moment of my own diagnosis in 1979.
In the summer between my sophomore and junior years of college, barely out of adolescence, I learned that I had bladder cancer. I was still tethered to a catheter tube and an IV drip when my surgeon delivered the bad news. He then proceeded to ask me a few questions that seemed surreal at the time: Had I ever smelted aluminum or vulcanized tires? Any exposures to textile dyes or dry-cleaning fluid?
The answers, I thought, were all no. I was the clean-living winner of the local Elks Club scholarship. Of course I wasn't out smelting aluminum. But back at the university library a few weeks later, I learned that these questions were the right ones. Bladder cancer is a quintessential environmental cancer, with long-standing established links to particular chemical exposures.
I also learned that, in spite of this vast body of knowledge, little had been done over the years to eliminate suspected bladder carcinogens from production, use, and disposal. There was a disconnect between scientific evidence and regulatory response.
There is also a disconnect between what we in the scientific community know about the roles that chemical exposures play in the story of cancer (quite a lot) and what cancer patients are told (typically, very little). I experienced this gap firsthand. Other than that initial, eye-opening conversation I had with my diagnosing physician while I was still exhaling anesthesia, no other doctor over the past thirty years has queried me about my environmental history. Instead, I am repeatedly asked about my family history.
It's true that my mother and I had cancer at the same time.
It's true that my aunt died of the same kind of bladder cancer that I had.
It's also true that I'm adopted.
The President's Cancer Panel report builds a sturdy bridge over both these disconnects. The report makes clear that the grievous harm from environmental carcinogens has not been adequately addressed by the National Cancer Program. It points out that members of the public - including cancer patients - are largely unaware of the growing body of evidence linking environmental exposures to cancer. This report brings the evidence out of the far-flung corners of the technical literature and lays it before the public: that's the first bridge it builds.
The report goes on to assert that the prevailing regulatory approach to environmental contaminants is dysfunctional. It is fragmented, underfunded, and weakened by industry influence, and it possesses "a lack of will to identify and remove hazards." Making toxic chemical regulation responsive to new scientific discoveries: that's bridge number two.
Fifteen years ago, prompted by questions posed to me by my original urologist, I returned to my hometown in Illinois as an environmental detective. You could say that I went in search of my ecological roots. Among other things, I discovered that the public drinking water wells there periodically contain traces of chemicals - dry-cleaning solvents - known to be linked to bladder cancer.
Like my diagnosing physician, the President's Cancer Panel asks the right questions. The answers it provides compel us all to become environmental detectives in our own communities.
I invite you to begin this journey at the Smithsonian Institution. Take a field trip to Hall of Human Origins and spend some time with our hairy ancestors. And while you are there consider this: the artist who created these magnificent sculptures, my friend and neighbor John Gurche, was diagnosed with brain cancer in the middle of his work. He's about my age and the father of three middle-school children, one of whom is my daughter's friend.
John managed to complete the commission despite his diagnosis. On the day of his final radiation treatment, he put the final touches on Lucy - sewing in her hair even while his own hair was falling out - but he was so exhausted that our other neighbor Fred had to pack Lucy up in his own car and drive her down here to Washington in the middle of the night in order to meet the installation deadline for the gala opening in March.
All of us cancer survivors have our Lance Armstrong stories - our tales of personal triumph in the face of unbelievable adversity. But, however they end, these are the easy stories. The harder ones are the public stories: Why is the rate of brain cancer rising among children and older adults? And what will future generations of children say about us if we choose to ignore these trends? Those are the questions I invite you to ponder while staring into the eyes of our forebear, Lucy.
Sandra Steingraber is the author of Living Downstream, newly published in second edition by Merloyd Lawrence Books/Da Capo Press to coincide with the release of the documentary film adaptation. This essay is one in a weekly series by Sandra exploring how the environment is within us. www.steingraber.com / www.livingdownstream.com
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