9/7 topic: Why We Can't Prevent Cancer

[논둑길맨발로]

From: Rachel's Democracy and Health News #829, Oct. 27, 2005

WHY WE CAN'T PREVENT CANCER

By Peter Montague

암에 대한 두 가지 상반된 treatment  

In 1999, cancer surpassed heart disease as the number one killer of

people younger than 85 in the U.S.[1] Now a detailed report on the

causes of cancer tells us why: cancer has been steadily increasing in

the U.S. for 50 years as people have been exposed to more and more

cancer-causing agents, including chemicals and radiation.

Richard Clapp, Genevieve Howe, and Molly Jacobs Lefevre have just

published "Environmental and Occupational Causes of Cancer; A Review

of Recent Scientific Literature" and it is a real eye-opener.

But before we dive into this report looking for nuggets, let's set the

background.

About half of all cancer cases are fatal, and death by cancer is often

prolonged, painful, and very expensive. Those who manage to survive

cancer live out their lives molded by the after-effects of harsh

treatments popularly known as "slash and burn" -- surgery,

chemotherapy, radiation, or some combination of the three.

As more people are kept alive each year with their breasts or

testicles removed, the "cancer establishment" chalks up(기록하다) another

"victory" -- and no doubt the victims are glad to be alive -- but we

should acknowledge that there's something very wrong with calling this

"victory." Slash and burn seems more like a dreadful defeat.

The truth is, an epic struggle has been going on for 50 years between

the "slash and burn=victory" camp, versus those who think the only

real victory is prevention of disease. The struggle occurs across a

fault line(단층선) defined by money. To be blunt about it, there's no money in

prevention, and once you've got cancer you'll pay anything to try to

stay alive. Cancer treatment is therefore a booming business, and

cancer prevention is nowhere. That is the basic dynamic of the debate.

Cancer surgeons can achieve the status of rock stars among their

peers. Those who advocate prevention will most likely find themselves

without funding, ridiculed and despised by the chemical industry, the

pesticide industry, the asbestos industry, the oil industry and all

their minions -- lawyers, bankers, engineers, reporters, professors,

and politicians -- who make a fat living off those who pump out

cancer-causing products and dump out cancer-causing by-products, aka

toxic waste.

논쟁의 시작

The debate began 50 years ago when a powerful voice for prevention

spoke out from inside the National Cancer Institute (NCI). In 1948.

Wilhelm Hueper, a senior NCI scientist, wrote,

"Environmental carcinogenesis is the newest and one of the most

ominous of the end-products of our industrial environment. Though its

full scope and extent are still unknown, because it is so new and

because the facts are so extremely difficult to obtain, enough is

known to make it obvious that extrinsic [outside-the-body] carcinogens

present a very immediate and pressing problem in public and individual

health."

In 1964, Hueper and his NCI colleague, W. C. Conway, described

patterns in cancer incidence as "an epidemic in slow motion":

"Through a continued, unrestrained, needless, avoidable and, in part

reckless increasing contamination of the human environment with

chemical and physical carcinogens and with chemicals supporting and

potentiating their action, the stage is being set indeed for a future

occurrence of an acute, catastrophic epidemic, which once present

cannot effectively be checked for several decades with the means

available nor can its course appreciably be altered once it has been

set in motion," they wrote.[pg. 28]

Hueper of course was right. This is why 50% of all men and 40% of all

women in the U.S. now hear the chilling words, "You've got cancer" at

some point in their lives. That's right, 1 out of every 2 men now get

cancer in the U.S., and more than 1 out of every 3 women.

유해물질에의 노출과 암-Clapp, Howe and Lefevre의 연구가 시사하는 것

Clapp, Howe and Lefevre tell us that between 1950 and 2001 the

incidence rate for all types of cancer increased 85%, using

age-adjusted data, which means cancer isn't increasing because people

are living longer. People are getting more cancer because they're

exposed to more cancer-causing agents.

Contrary to well-funded rumors, the culprit isn't just tobacco or the

hundreds of toxic chemicals intentionally added to tobacco products.

Tobacco products remain the single most significant preventable cause

of cancer, but they have not been linked to the majority of cancers

nor to many of the cancers that have increased most rapidly in recent

decades including melanoma(피부암), lymphomas, testicular, brain, and bone

marrow(골수) cancers.[pg. 1]

No, it's more complicated than just tobacco with its toxic additives.

Most plastics, detergents, solvents, and pesticides and the

toxic-waste by-products of their manufacture came into being after

World War II. From the late 1950s to the late 1990s, we disposed of

more than 750 million tons of toxic chemical wastes.[pg. 27] Over 40

years, this represents more than two tons of toxic chemical wastes

discharged into the environment for each man, woman and child in the

U.S. No wonder some of it has come back to bite us.

Since the U.S. EPA began its Toxics Release Inventory (TRI) program in

1987, total releases have been reported as declining (though EPA does

not check the accuracy of industry's self-reporting). Despite the

reported decline, in 2002, the most recent year reported, 24,379

facilities in the U.S. reported releasing 4.79 billion pounds of over

650 different chemicals. (And TRI data do not include other enormous

discharges: toxic vehicle emissions, the majority of releases of

pesticides, volatile organic compounds, and fertilizers, or releases

from numerous other non-industrial sources.) In 2001, more than 1.2

billion pounds of pesticides were intentionally discharged into the

environment in the United States and over 5.0 billion pounds in the

whole world.[pg. 27]

While all this chemical dumping has been going on, incidence rates for

some cancer sites have increased particularly rapidly over the past

half century. From 1950-2001, melanoma of the skin increased by 690%,

female lung &bronchial cancer increased by 685%, prostate cancer by

286%, myeloma by 273%, thyroid cancer(갑상선암) by 258%, non-Hodgkin's lymphoma

by 249%, liver and intrahepatic duct cancer by 234%, male lung &

bronchial cancer by 204%, kidney and renal pelvis cancers(신우암) by 182%,

testicular cancer(고환암) by 143%, brain and other nervous system cancers by

136%, bladder cancer by 97%, female breast cancer by 90%, and cancer

in all sites by 86%.[pg. 25]

In the most recent 10-year period for which we have data (1992-2001),

liver cancer increased by 39%, thyroid cancer increased by 36%,

melanoma increased by 26%, soft tissue sarcomas (including heart) by

15%, kidney and renal pelvis cancers by 12%, and testicular cancer

increased by 4%.[pg. 25]

OK, so dumping chemicals into the environment has been a major

industrial pastime for 50 years, and cancers are increasing. But why

do we think these things are connected? What real evidence do we have

that environmental and occupational exposures contribute to cancer?

That's what the new Clapp-Howe-Lefevre report is about. It is a

review of recent scientific literature -- with emphasis on human

studies, not studies of laboratory animals. Indeed, the bulk of the

new Clapp-Howe-Lefevre report is a cancer-by-cancer compendium of what

recent human studies tell us about environmental and occupational

exposures that contribute to cancers of the bladder(방광), bone, brain,

breast, cervix(자궁경관), colon(결장), lymph nodes(임파절) (Hodgkin's disease and non-Hodgkin's lymphoma), kidney, larynx(후두), liver and bile ducts(담관), lungs,

nasal passages, ovaries(난소), pancreas(췌장), prostate, rectum(직장), soft tissues

(soft tissue sarcoma(육종)), skin, stomach, testicles, and thyroid, plus

leukemia(백혈병), mesothelioma(중피종), and multiple myeloma(골수종). (It is worth pointing out -- and Clapp-Howe-Lefevre do point it out -- that this compendium

owes a great debt to a data spreadsheet on cancer and its

environmental causes prepared by Sarah Janssen, Gina Solomon and Ted

Schettler, for which thanks are due the Collaborative on Health and

Environment.)

Many of the bad actor chemicals are well-known to us all: metals and

metallic dusts (arsenic(비소), lead, mercury, cadmium, hexavalent chromium,

nickel); solvents (benzene, carbon tet, TCE, PCE, xylene(크실렌), toluene(톨루엔),

among others); aromatic amines; petrochemicals and combustion

byproducts (polycyclic aromatic hydrocarbons, or PAHs); diesel

exhaust; ionizing radiation(전리방사선) (x-rays, for example); non-ionizing

radiation (magnetic fields, radio waves); metalworking fluids and

mineral oils; pesticides; N-nitroso compounds; hormone-disrupting

chemicals (found in many pesticides, fuels, plastics, detergents, and

prescription drugs); chlorination(염소화) byproducts in drinking water;

natural fibers (asbestos(석면), silica, wood dust); man-made fibers (fiber

glass, rock wool, ceramic fibers); reactive chemicals (such as

sulfuric acids(황산), vinyl chloride(염화비닐) monomer, and many others); petroleum

products; PCBs; dioxins; mustard gas; aromatic amines; environmental

tobacco smoke; and outdoor air pollution.

But there is additional evidence linking chemicals with cancer:

** Elevated cancer rates follow patterns -- the disease is more common

in cities, in farming states, near hazardous waste sites, downwind of

certain industrial activities, and around certain drinking-water

wells. Patterns of elevated cancer incidence and mortality have been

linked to areas of pesticide use, toxic work exposures, hazardous

waste incinerators, and other sources of pollution.[pg. 26]

** The U.S. EPA's long-delayed and heavily industry-influenced "Draft

Dioxin Reassessment" released in 2000 admitted that the weight of the

evidence from human studies suggests that, "the generally increased

risk of overall cancer is more likely than not due to exposure to TCDD

[dioxin] and its congeners [chemical relatives]." The report goes on

to conclude, "The consistency of this finding in the four major cohort(집단)

studies and the Seveso victims is corroborated by animal studies that

show TCDD to be a multisite, multisex, and multispecies carcinogen

with a mechanistic basis."[pg. 26]

** Farmers in industrialized nations die more often than the rest of

us from multiple myeloma, melanoma, prostate cancer, Hodgkin's

lymphoma(호지킨림프종), leukemia, and cancers of the lip and stomach. They have

higher rates of non-Hodgkin's lymphoma and brain cancer. Migrant

farmers experience elevated rates of multiple myeloma as well as

cancers of the stomach, prostate, and testicles.[pg. 26]

** The growing burden of cancer on children provides some of the most

convincing evidence of the role of environmental and occupational

exposures in causing cancers. Children do not smoke, drink alcohol, or

hold stressful jobs. Their lifestyles have not changed appreciably in

recent years. In proportion to their body weight, however, "children

drink 2.5 times more water, eat 3 to 4 times more food, and breathe 2

times more air" than adults." In addition, their developing bodies may

well be affected by parental exposures prior to conception, exposures

while growing in the uterus(자궁), and the contents of breast milk.

Clapp-Howe-Lefevre put it this way: "We have learned how to save more

lives, thankfully, but more children are still diagnosed with cancer

every year. The incidence of cancer in all sites combined among

children ages 0-19 increased by 22% from 13.8/100,000 in 1973 to 16.8

in 2000 and most of this increase occurred in the 1970s and 1980s.

Epidemiologic(역학적) studies have consistently linked higher risks of

childhood leukemia and childhood brain and central nervous system

cancers with parental and childhood exposure to particular toxic

chemicals including solvents, pesticides, petrochemicals, and certain

industrial by-products (namely dioxins and polycyclic aromatic

hydrocarbons [PAHs])."[pg. 26]

All in all, the Clapp-Howe-Lefevre report makes a compelling case that

many industrial chemicals contribute to many kinds of cancers. But

where this report really shines is in its clear call for

prevention. In all, there are relatively few products or substances

associated with cancer.[pgs. 10-11, 37-40] Everything doesn't cause

cancer, and many of the things that do could be shunned(avoided) and phased

out(prevented). In principle, a great deal of prevention is possible.

A lifestyle disease로서의 암-Doll-Peto연구와 미국 의료계의 주류적 시각

Thirty years into the prevention-vs-treatment debate -- in 1981 -- two

famous British scientists -- Sir Richard Doll and Sir Richard Peto

-- published an extremely influential study in which they estimated

that "only" 2 to 4% of all cancers are caused by environmental or

workplace exposures. With 1.2 million new cases of cancer each year in

the U.S., half of them fatal, 2% to 4% = 12,000 to 24,000 deaths each

year, most of them preventable. Doll and Peto said tobacco caused 30%

of all cancers and food caused another 35%. We now know that cancer

results from the interaction of our genes with exposure to several

cancer-causing agents. All the necessary exposures must occur to cause

a cancer -- if any one of them is missing, the cancer will not occur.

This is why prevention is important -- it really can work.

Because cancer requires multiple exposures to cancer-causing agents,

it is wrong and misleading to say that "Exposure to product A causes X

percent of all cancers." It simple doesn't work like that. Perhaps

Doll and Peto in 1981 did not know how such things worked, and they

boldly proceeded to estimate what percent of all cancers were

attributable to particular exposures. It was wrong, but their report

served as powerful ammunition for the prevention-is-pointless crowd.

If "only" 2 to 4% of all cancers were caused by environmental

exposures, then there was little incentive to prevent human exposure

to environmental agents, the argument went. What a welcome message

this was for the cancer-creation industries (petrochemicals, metals,

pesticides, asbestos, radiation, and others) and for the cancer

treatment industry! Damn the torpedoes -- full speed ahead!

The prevention-is-pointless crowd latched onto(cling to) the Doll and Peto study

and spread it everywhere. By the end of 2004, the original 1981

Doll-and-Peto paper had been cited in 441 subsequent scientific

papers.[pg. 4] But even more importantly, the federal National Cancer

Institute and the American Cancer Society (which, together, you could

call the "cancer establishment") adopted the Doll-Peto perspective,

that cancer is a lifestyle disease -- the victims themselves are

responsible -- and that prevention of environmental and occupational

exposures is not worth the effort. Remember this was the beginning of

the Reagan counterrevolution and the Doll-Peto paper fit right into

the new ideology -- government is bad, big corporations are good,

we're all individually responsible for whatever bad things happen to

us, and greed is good because it makes the world go 'round. In any

case, the NCI and the ACS largely adopted the Doll-Peto perspective,

and they poured the bucks into new cancer treatments, pretty much

ignoring prevention. Meanwhile, cancer incidence rates climbed

relentlessly -- making the cancer-treatment industry healthier and

wealthier, which allowed it to further erode support for prevention.

Now we are starting to shake off the stupor(인사불성) induced by the misleading

Doll-Peto arithmetic, which pretended to prove that environment and

occupational exposures are of no consequence.

포괄적 암 예방 프로그램(comprehensive cancer prevention programs) 의 중요성

Listen to this marvelously clear-eyed conclusion from the

Clapp-Howe-Lefevre report: "Comprehensive cancer prevention programs

need to reduce exposures from all avoidable sources. Cancer prevention

programs focused on tobacco use, diet, and other individual behaviors

disregard the lessons of science."[pg. 1]

And this: "Preventing carcinogenic exposures wherever possible should

be the goal and comprehensive cancer prevention programs should aim to

reduce exposures from all avoidable sources, including environmental

and occupational sources."[pg. 6]

And this: "Further research is needed, but we will never be able to

study and draw conclusions about the potential interactions of

exposure to every possible combination of the nearly 100,000 synthetic

chemicals in use today. Despite the small increased risk of developing

cancer following a single exposure to an environmental carcinogen, the

number of cancer cases that might be caused by environmental

carcinogens is likely quite large due to the ubiquity [presence

everywhere] of carcinogens. Thus, the need to limit exposures to

environmental and occupational carcinogens is urgent."[pg. 29]

And this: "The sum of the evidence regarding environmental and

occupational contributions to cancer justifies urgent acceleration of

policy efforts to prevent carcinogenic exposures. By implementing

precautionary policies, Europeans are creating a model that can be

applied in the U.S. to protect public health and the environment. To

ignore the scientific evidence is to knowingly permit tens of

thousands of unnecessary illnesses and deaths each year."[pg. 1]

What a blast of fresh air!

uncertainty에 근거한 예방조치 반대논리의 허구

The latest strategy from the cancer-creation industries is to claim

that we can't take action to prevent environmental and occupational

exposures because we don't have enough information. We're simply too

ignorant to make a move. More study is needed. [See Rachel's #824,

#825.] Clapp-Howe-Lefevre allow the eloquent writer Sandra

Steingraber to answer this argument. They say, "A main concern for

Sandra Steingraber, author of Living Downstream: An Ecologist Looks

at Cancer and the Environment, is not whether the greatest dangers

are presented by dump sites, workplace exposures, drinking water,

food, or air emissions:

"I am more concerned [writes Steingraber] that the uncertainty over

details is being used to call into doubt the fact that profound

connections do exist between human health and the environment. I am

more concerned that uncertainty is too often parlayed into an excuse

to do nothing until more research can be conducted."[pg. 29]

Clapp, Howe and Lefevre go on: "At the same time, uncertainty and

controversy are permanent players in scientific research. However,

they must not deter us from enacting regulations and policies based on

what we know and pursuing the wisdom of the precautionary principle.

This is not new thinking, as demonstrated by Sir Austin Bradford

Hill's 1965 address to the Royal Society of Medicine:

"All scientific work is incomplete [wrote Sir Austin Bradford Hill] --

whether it be observational or experimental. All scientific work is

liable to be upset or modified by advancing knowledge. That does not

confer upon us a freedom to ignore the knowledge we already have, or

to postpone action that it appears to demand at a given time."[pg. 29]

예방조치의 가이드라인 guidelines for preventive action

Clapp, Howe and Lefevre then offer some guidelines for preventive

action:

(1) The least toxic alternatives should always be used.

(2) Partial, but reliable, evidence of harm should compel us to act on

the side of caution to prevent needless sickness and death.

(3) The right of people to know what they are being exposed to must be

protected.

Clapp, Howe and Lefevre observe that "the United States has much to

learn" from the proposed European chemicals policy, known as REACH:

(1) requiring that industry be responsible for generating information

on chemicals, for eval‎!!!uating risks, and for assuring safety; another

way of saying this is, "No data, no market."

(2) extending responsibility for testing and management to the entire

manufacturing chain -- everyone who uses a chemical has a duty to

familiarize themselves with the consequences;

(3) using safer substitutes for chemicals of high concern; and,

(4) encouraging innovation in safer substitutes.[pg. 29]

In the words of ecologist Sandra Steingraber: "It is time to start

pursuing alternative paths. From the right to know and the duty to

inquire flows the obligation to act."[pg. 29]

발암성 유해환경 증가의 근본 원인-경제성장, 지구화 그리고 비용의 외재화

But while we're working in clear-eyed mode here, let's take our

exploration a bit further and look this problem squarely in the face.

The U.S. economy and culture are premised on endless growth. If I

loan you $100 in the expectation that you will pay me back $103 next

year, that extra 3% must come from somewhere. That "somewhere" has

physical dimensions -- something must be dug up or grown to produce

the additional 3%. That something must also be moved, processed, moved

again, packaged, promoted and sold, moved again, used, moved again,

and eventually discarded. Even if it is recycled many times,

ultimately it will be discarded into a natural ecosystem somewhere (at

which point nature begins moving it once again). The inescapable

second law of thermodynamics tells us that each of these steps will

inevitably be accompanied by waste, disorder and other disruptive

unintended consequences. Even if you create the extra 3% per year by

providing a "service" instead of a "product," you still require food,

water, shelter, energy, clothing, tools, transportation, commercial

space, medical care, municipal support services (like police, fire,

emergency services, and sewage treatment), leisure activities,

communications and information, schooling, and on and on.

An economy that is growing at 3% per year is doubling in size every 23

years -- requiring, every 23 years, a doubling in the number of

cities, food sources, mines, factories, power plants, vehicles,

highways, parking lots, schools, sewage treatment plants, hospitals,

prisons, discards, trash and dumps. For a very long time this kind of

rapid growth seemed tolerable. But now things are different -- the

earth is full of people and their artifacts. We can no longer throw

things "away" without affecting someone somewhere.

Something else is new as well. The modern, globalized financial

environment (in which money flows easily across international

borders), creates tremendous competitive pressure to attract

investment by increasing return to investors. That in turn creates

pressure to pass costs along to the general public. Economists call it

"externalizing" costs. If I dump my chemicals and make you sick, I

gain if I can get you to pay your own medical bills, and I gain again

if I can get taxpayers to clean up my mess. Firms have a natural

incentive to externalize their costs to the extent possible, but the

present "globalized" financial environment has increased that

incentive greatly, to improve return to investors.

---------

결론 

In sum, let us review the pressures that prevent prevention.

(1) In general, it is difficult to make prevention pay, but

remediation can pay handsomely(come down hansome돈을 후하게 쓰다); this is certainly true for the cancer industry. In general, financial-political-legal incentives are set up to reward those who create problems and those who supply remedies.

(2) Economic growth entails the continual creation of ever-more and

ever-larger messes. Even if we managed to "green" commerce in every

way we can think of today, damage to nature would still be roughly

proportional to the size of the human economy because the second law

of thermodynamics cannot be evaded. And we now know that damage to

nature gives rise to human disease in myriad ways. (For evidence,

follow leads found here, here, here, and here.) Now that the

earth is full, a growing economy creates palpably-growing health problems,

including immune system degradation giving rise to cancers.

(3) The modern economy creates irresistible pressure to increase stock

prices, which in turn creates relentless pressure to externalize costs

by hook or by crook.

So let's not kid ourselves. Yes, cancer must be prevented

because for the most part it can't be cured -- it can only be slashed

and burned away at enormous cost, personal, social and monetary.

But saying cancer must be prevented is one thing. Expecting

that it can be prevented within the framework of the modern

economy is another. We can never stop working to prevent cancer -- and

precautionary policies will always make sense no matter what kind of

economy we have -- but until we shift to an economy that doesn't

require growth, we'll find ourselves right where we are now -- on an

accelerating rat wheel. As a result, we can expect to be living with

more and more cancer at greater and greater cost to ourselves and to

our children, accompanied by ever-increasing pain. It is not a pretty

picture. But at least we can now see it clearly.

===============

[1] Richard Clapp, Genevieve Howe, and Molly Jacobs Lefevre,

Environmental and Occupational Causes of Cancer; A Review of Recent

Scientific Literature (Lowell, Mass.: University of Massachusetts at

Lowell, The Lowell Center for Sustainable Production, September, 2005.

Available here and here and here. Unless otherwise noted,

throughout this issue of Rachel's, footnote numbers inside square

brackets refer to pages in this report.

Return to Table of Contents

[DEBATE FOCUS]

암에 대한 두 가지 상반된 treatment  

유해물질에의 노출과 암-Clapp, Howe and Lefevre의 연구가 시사하는 것

A lifestyle disease로서의 암-Doll-Peto연구와 미국 의료계의 주류적 시각

포괄적 암 예방 프로그램(comprehensive cancer prevention programs) 의 중요성

uncertainty에 근거한 예방조치 반대논리의 허구

예방조치의 가이드라인 guidelines for preventive action과 그 의미

발암성 유해환경 증가의 근본 원인-경제성장, 지구화 그리고 비용의 외재화

[논둑길맨발로]

현대인의 무병장수 꿈의 최대의 적인 암, 그러나 그것에 대한 우리의 정보는 전적으로 의료시장에 의존하고 있습니다. 이 기사는 그러한 의료정보가 제약회사나 병원의 영리목적을 위해 얼마나 왜곡되어 있는지를 폭로하고 있습니다. 필자는 암은 유전병이 아니라 환경병으로 규정하고 의료계가 숨기고 있는 암의 사회환경적 요인을 예리하게 파헤치고 있습니다. 가족과 자신의 건강을 위해 필 정독!

[논둑길맨발로]

암에 대한 두 가지 상반된 treatment -수잔
유해물질에의 노출과 암-Clapp, Howe and Lefevre의 연구가 시사하는 것-테리
A lifestyle disease로서의 암-Doll-Peto연구와 미국 의료계의 주류적 시각-베로니카
포괄적 암 예방 프로그램(comprehensive cancer prevention programs) 의 중요성과 uncertainty에 근거한 예방조치 반대논리의 허구-데미
예방조치의 가이드라인 guidelines for preventive action과 그 의미-다 함께
발암성 유해환경 증가의 근본 원인-경제성장, 지구화 그리고 비용의 외재화-하나
결론-에드윈