WASHINGTON, DC -- Leading players in the war on cancer should do more to educate the American public about how to minimize its risk of contracting the disease, according to a new report from the Cancer Prevention Coalition (CPC).
Americans face increasing cancer risks from occupational and environmental exposure to industrial carcinogens, the report finds, but established government and nonprofit cancer organizations are fixated on treatment rather than prevention.
"This report makes it clear that we are losing the war against cancer," said Dr. Samuel Epstein, CPC chairman and author of "The Stop Cancer Before It Starts Campaign: How to Win the Losing War Against Cancer." "But," he said, "there are opportunities for reversing this trend."
Based on available data, the overall incidence of cancers in the American population is on the rise. Men have a little less than a one in two lifetime risk of developing cancer, for women the risk is a bit more than one in three.
Adjusted to reflect the aging population, the U.S. cancer incidence is up some 24 percent from 1973 to 1999. Mortality rates are up some 30 percent over the same time period.
But some argue these numbers are misleading, as the medical community's ability to identify cancer has improved over that time period. Still, cancer kills some 550,000 Americans each year and is the second leading cause of death. Some 1.3 million Americans contract cancer each year.
And the American war on cancer, Epstein said, has been undermined by the myopic focus on treatment by the National Cancer Institute (NCI), a government agency, and the American Cancer Society (ACS), a nationwide, community based voluntary health organization.
These organizations, he said, have been silent on a wide range of avoidable causes of cancer, other than personal lifestyle choices such as smoking. Epstein said there is enough evidence to warn people of the presence of industrial pollutants, the concentrations of pesticides in nonorganic fruits and vegetables and the possible risks of irradiated foods.
Mainstream cosmetics contain a wide range of carcinogenic materials, he said, and there are increased cancer risks from some prescription medications.
Epstein said neither NCI nor ACS has taken a strong stand on the dangers from carcinogenic exposures from pesticides or hazardous industrial waste.
"This has tacitly encouraged powerful corporate polluters and industries to continue manufacturing carcinogenic products," Epstein warned.
These organizations tend to "blame the victim" for contracting cancer, he said, rather than explore the environmental causation that could be responsible for their illness.
ACS spokesman Greg Donaldson said Epstein's comments about his organization and its commitment to prevention efforts are "simply false."
Identifying the specific cause of cancer is still often extremely difficult, Donaldson said. ACS is funding some $40 million in prevention programs, he said, including studies into environmental causation.
"We are committed to funding research on this," Donaldson said, "but we only speak when there is science based evidence one way or another."
The National Cancer Institute did not return calls for comment.
Epstein released the new report at a press briefing today in Washington, DC and announced that the Cancer Prevention Coalition and others will use it as a springboard for a new grassroots effort.
This effort aims to reform the National Cancer Institute and the American Cancer Society and to pressure federal and state governmental organizations to improve the public's understanding of how to limit their risks of contracting cancer.
The public should have access to a registry compiled by NCI of "avoidable carcinogens," Epstein said, and Congress may need to step in to ensure this happens.
What is frustrating, according to Dr. Nicholas Ashford, a Massachusetts Institute of Technology public policy expert, is that NCI should already be doing this.
"The legal mandate of NCI is to inform the public about avoidable causes of cancer," he said.
This mandate comes from the 1971 National Cancer Act, signed by President Richard Nixon, and was strengthened by amendments in 1988 that called for "an expanded and intensified research program for the prevention of cancer caused by occupational or environmental exposure to carcinogens."
Prompting significant changes to NCI under the current political climate in Washington will be very difficult, Epstein said, but there are opportunities at state and local levels.
The Cancer Prevention Coalition report calls on states to enact the equivalent of a toxics use reduction act passed in 1989 by Massachusetts. The law requires statewide industries to disclose the chemicals they use, and since its passage the state's environmental emissions decreased by 73 percent.
"This could set the stage for phasing out harmful carcinogens," Epstein said.
That should be the ultimate goal, said Ashford. "When we know there are safe alternatives, we should use them," he said. "We are not talking about bankrupting industry."
The effort to reform NCI will closely monitor how it spends its annual budget of some $4.6 billion. Tracking NCI's budget increases against the cancer incidence numbers, Epstein said that "the more money we spend on cancer, the more cancer we get."
But he does not argue that less money should be spent. Instead, Epstein said it should be spent better, with much more of it earmarked for prevention efforts.
NCI should be doing more research on avoidable exposures to industrial carcinogens, Epstein said, and should inform the public of known risks from occupational and environmental exposure to carcinogens.
The report suggests that both organizations should adopt the precautionary principle and research cancer clusters in the vicinity of major sources of urban pollution, power plants, petrochemical factories and Superfund hazardous waste sites.
This research, Epstein said, could complement the available data on air and water pollutants documented through the U.S. Environmental Protection Agency's National Toxic Release Inventory as well as data from states.
"We have not begun to win the war on cancer," said Dr. Richard Clapp, an epidemiological professor at the Boston University School of Public Health. "We have not even turned the corner."
"We have to move beyond the body count and begin to prevent exposures before they occur."
To view the report, log on to: http://www.preventcancer.com
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