Asleep at the Wheel of the War on Cancer
This essay is in response to: What are we learning about the relationship between environmental toxicants and cancer? How should our regulatory system respond to this information?
Last year, President Obama boldly
pledged to reform the national health care system. Central to this reform is
containing health care costs which are soaring at about 6% each year. Clearly, this
is not possible without a plan to prevent us from getting cancer in the first
The cancer epidemic strikes one in three of us and takes the life of one in
four. This year, 1.5 million of us will be diagnosed with cancer, of whom, 560,000
people will die. After four decades of losing the cancer war, which President
Nixon declared in December 1971, we are taking minimal, if any, action to
protect us from this menace.
While research on cancer prevention and treatment of cancer is predominantly
the responsibility of the National Cancer Institute (NCI), other federal
agencies, FDA, OSHA, EPA, and CPSC are also involved. Unfortunately, such
action is minimal and uncoordinated.
Cancer is not only one of the most costly and sometimes deadly, it is also one
of the most preventable. The connection between losing the cancer war and the
need to control costs through prevention should be clear.
Based on recent NIH estimates, the total annual costs of cancer are $219
billion a year. The annual costs of diagnosis and treatment are $89 billion; those
of premature death are about $112 billion; and those costs of lost productivity
are estimated at $18 billion. The human costs are surely of far greater
Smoking remains the single largest cause of cancer, particularly lung cancer.
While lung cancer incidence rates in men have declined by 20% over the past
three decades, rates in women increased by 111%. As importantly, non-smoking
cancers -- due to known chemical and physical carcinogens -- have increased
substantially since 1975. Some of the more startling realities in the failure
to prevent cancer are illustrated by their soaring rates of increase since 1975.
- Malignant melanoma of the skin in adults is increasing by
168% due to the use of sunscreens in childhood that fail to block long wave
- Thyroid cancer is increasing by 124% due in large part to
- Non-Hodgkin's lymphoma is increasing 76% due mostly to
phenoxy herbicides and phenylenediamine hair dyes;
- Testicular cancer is increasing by 49% due to pesticides;
hormonal ingredients in cosmetics and personal care products; and estrogen
residues in meat;
- Childhood leukemia is increasing by 55% due to ionizing
radiation; domestic pesticides; nitrite preservatives in meats, particularly
hot dogs; and parental exposures to occupational carcinogens;
- Ovary cancer (mortality) for women over the age of 65 has
increased by 47% in African American women and 13% in Caucasian women due to
genital use of talc powder;
- Breast cancer is increasing 17% due to a wide range of
factors. These include: birth control pills; estrogen replacement therapy;
toxic hormonal ingredients in cosmetics and personal care products; diagnostic
radiation; and routine premenopausal mammography, with a cumulative breast dose
exposure of up to about five rads over ten years.
A wide range of evidence has related a
wide range of cancers to environmental exposures to carcinogens, including formaldehyde,
chlorinated organic pesticides, and organic solvents. The increasing incidence
of lung cancers has also been related to preventable occupational exposures to
asbestos, silica, chromium VI, formaldehyde, methylene chloride, benzene, and
The NCI is the primary federal agency ostensibly devoted exclusively to
fighting cancer. Paradoxically, the escalating incidence of cancer over the
last thirty years parallels its sharply escalating annual budget - from $690
million in 1975 to $5.2 billion this year. Of this a mere $131 million -- or
2.5%% -- is allocated to NCI's mission on Prevention and Early Detection.
However, in spite of well-documented
evidence relating the escalating incidence of cancer to a wide range of
avoidable carcinogenic exposures, the NCI remains "asleep at the
wheel," and has stubbornly refused to devote resources let alone attention
The NCI has ignored proddings from Congress and independent scientific experts
to develop a comprehensive registry of carcinogens. Worse still, the NCI claims
that most cancers are due to unhealthy behavior, such as smoking, poor
nutrition, inactivity, obesity, and overexposure to sunlight, and that a mere
6% are attributable to environmental and occupational exposures. These claims
are despite overwhelming evidence to the contrary.
Furthermore, the NCI has touted the
imminent success of new cancer treatments--promises that have seldom been borne
out. For instance, in 2004, Nobel Laureate Leland Hartwell, President of the
Fred Hutchinson Cancer Control Center, warned that Congress and the public are
paying NCI $4.7 billion a year, most of which is spent on "promoting
ineffective drugs" for terminal disease.
Congress now has an epochal opportunity to reform our health care system and
prevent cancer from occurring in the first place. By taking some simple steps
to achieve this, Congress should enact specific legislative reforms to the 1971
National Cancer Act:
- Declare that it is the national policy to reduce
carcinogenic exposures to confirmed or suspected carcinogens by at least half
during the next decade.
- Allocate at least 40% of the NCI budget to explicit
prevention-related programs for FY 2011, and 50% by FY 2014.
- Mandate the annual publication of a comprehensive register
of carcinogens. This will provide federal, state, and local governments, as
well as the public, with comprehensive information on carcinogens in the
workplace, environment, and consumer products so that necessary preventive
action can be promptly undertaken.
- Create a Deputy Director for Cancer Prevention of the NCI
who, together with the administrators of EPA, OSHA, CPSC, FDA, and other
relevant agencies, shall report to Congress annually on steps needed during the
next decade, under existing regulatory authority, to reduce the prevalence of
future preventable cancers.
- The NCI shall meet regularly with the administrators of EPA,
OSHA, CPSC, and FDA to identify opportunities to reduce exposures to
carcinogens in the environment, the workplace, pharmaceuticals, and consumer
products -- food, household products, and cosmetics and personal care products.
These steps alone will not win the war
against cancer, but they will be critical in redirecting a failing war on
cancer that can best be described as one of the most notorious public health
failures of the 20th century. Cancer prevention is a critical public policy
area in which reform is long overdue.
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