I've been following the Cancer discussion and wanted to say I too have read
Living Downstream. It's the second coming of Silent Spring. It is
meticulously documented, makes sense out of all the myriad research, and most
importantly puts a face on cancer. I have referred to this work a number of
times in helping folks with water quality questions. I grew up just across
the Illinois line in Indiana, so Steingraber's words hit very close to home.
Anyone who is sincere about health and the environment needs to educate
themselves by reading Living Downstream.
Brent Ladd, Environmental Assessment Coordinator
> Howdy all,
> I am presently reading a book called "Living Downstream: A
> Scientist's Personal Investigation of Cancer and the
> Environment"(1997), by Sandra Steingraber, a Ph.d biologist and
> ecologist. It is extremely well-written, well-researched, and well-
> reasoned. I hope that everyone taking part in this discussion will
> look for it. Steingraber examines the evidence for cancer "clusters"--
> areas (geographical, cultural, occupational, etc.) that have higher
> rates of particular cancers compared to the general population--and
> possible environmental explanations. She begins in her own county
> in Illinois. I spent my own childhood in what was to become such
> a cluster. When I was born in Jacksonville, Arkansas in 1970 the
> town was home to a factory that produced Agent Orange. In the
> early 90's, the defunct factory was cleaned up with Superfund
> money. The public library has a filing cabinet documenting the
> dioxin contamination of the town and the high incidence of dioxin-
> associated cancers. IMO my generation and my parents' have
> been involuntary "experimental" subjects.
> Because I think this is a very important topic, and this information
> needs to be disseminated, I've taken the time to post the following
> excerpts. Please don't delete it--read it or save for later. These
> quotes are taken from the first 50 pages, all I've read so far. I think
> they speak well to the questions that have come up in this thread.
> "There are individuals who claim, as a form of dismissal, that links
> between cancer and environmental contamination are unproven and
> unprovable. There are others who believe that placing people in
> harm's way is wrong--whether the exact mechanisms by which this
> harm is inflicted can be precisely deciphered or not. At the very
> least, they argue, we are obliged to investigate, however imperfect
> our scientific tools: with the right to know comes the duty to inquire.
> "Happily, the latter perspective is gaining esteem as many
> leading cancer researchers acknowledge the need for an
> "upstream" focus. As explained at a recent international
> conference, this image comes from a fable about a village along a
> river. The residents who live here, according to a parable, began
> noticing increasing numbers of drowning people caught in the river's
> swift current and so went to work inventing ever more elaborate
> technologies to resuscitate them. So preoccupied were these
> heroic villagers with rescue and treatment that they never thought
> to look upstream to see who was pushing the victims in.
> "This book is a walk up that river.
> "When all the diagnoses of years past and present are tallied, an
> ongoing narrative emerges that tells us how the incidence of cancer
> has been and is changing. Changes in cancer incidence, in turn,
> provide key clues about the possible causes of cancer. For
> example, if heredity is suspected as the main cause of a certain
> kind of cancer, we would not expect to see its incidence rise
> rapidly over the course of a few human generations because genes
> cannot increase their frequency in the population that quickly. Or if
> a particular environmental carcinogen is suspected, we can see if a
> rise in incidence corresponds to the introduction of such
> substances into the workplace or the general environment (taking
> into account the lag time between exposure and onset of disease).
> Such an association does not constitute absolute proof, but it gives
> us ground to launch additional inquiries.
> "The work of compiling statistics on cancer incidence is carried
> out at a network of cancer registries, which exist in the U. S. at
> both the state and the federal levels. Theoretically, for each new
> cancer diagnosis, a report is sent to a registry [containing] a coded
> description of the type of cancer; the stage to which it has
> advanced; and the geographic region, age, sex, and ethnicity of the
> newly diagnosed person.
> "This incoming information is then processed, analyzed,
> audited, graphed, and disseminated by teams of statisticians. In
> and of itself, a head count is not very useful. The prevalence of
> cancer is higher now than it was a century ago, in part because
> there are simply more people now. There are also proportionally
> more older people alive now than ever before, and the aged tend to
> get more cancer than the young. Between 1970 and 1990, for
> example, the U.S. population increased by 22 percent, and the
> number of people over sixty-five increased by 55 percent. To
> eliminate the effects of the changing size and age structure of the
> population, cancer registries standardize the data. One way of
> doing this is to calculate a cancer incidence rate, which is
> traditionally expressed as the number of new cases of cancer for
> every 100,000 people per year. For example, in 1982, 90 out of
> every 100,000 women living in the state of Mass. were diagnosed
> with breast cancer. By 1990, the incidence rose to 112 out of
> "These numbers are also age-adjusted. That is, the data from
> all the differently aged people from any given year are weighted to
> match the age distribution of a particular census year. Thus
> standardized, the statistics from various years can be compared to
> each other. In this way, we know that the 24 percent rise in breast
> cancer in Mass. that occurred between 1982 and 1990 did not
> happen because the population of New England women was aging.
> Alternatively, cancer registry data can be made age-specific: the
> percentage of 45- to 49-year-olds contacting breast cancer can, for
> example, be compared with the percentage from a decade ago...
> "While still a matter of some debate, the most widely accepted
> estimate is that between 25 and 40 percent of the recent upsurge
> in breast cancer is attributable to earlier detection. Underlying this
> acceleration exists still a gradual, steady, and long-term increase
> in breast cancer incidence...This slow rise--between 1 and 2
> percent each year since 1940--predates the introduction of
> mammograms as a common diagnostic tool. Moreover, the groups
> of women in whom breast cancer incidence is ascending most
> swiftly--blacks and the elderly--are among those least served by
> mammography. Between 1973 and 1991, the incidence of breast
> cancer in females over 65 in the United States rose nearly 40
> percent, while the incidence of breast cancer in black females of all
> ages rose more than 30 percent.
> "All types combined, the incidence of cancer in the U.S. rose 49.3
> percent between 1950 and 1991. This is the longest reliable view
> we have available. If lung cancer is excluded, overall incidence still
> rose by 35 percent. Or, to express these figures in another way: at
> midcentury a cancer diagnosis was the expected fate of about 25
> percent of Americans...while today, about 40 percent of us (38.3
> percent of women and 48.2 percent of men) will contract the
> disease sometime within our lifespans. Cancer is now the second
> leading cause of death overall...More of the overall upsurge has
> occurred in the past two decades than in the previous two.
> "...[W]hile smoking remains the largest single known preventable
> cause of cancer, the majority of cancers cannot be traced back to
> cigarettes. Indeed, many of the cancers now exhibiting swift rates
> of increase--cancers of the brain, bone marrow, lymph nodes, skin,
> and testicles, for example--are not related to smoking. Testicular
> cancer is now the most common cancer to strike men in their
> twenties and thirties. Among young men both here and in Europe,
> it has doubled in frequency during the past two decades. These
> increases cannot be attributed to improved diagnostic practices.
> Brain cancer rates have risen particularly among the elderly.
> Between 1973 and 1991, brain cancers among all Americans rose
> 25 percent. Those over sixty-five suffered a 54 percent rise.
> "Mortality and incidence do not always track each other. No
> cancers are increasing in mortality while decreasing in incidence,
> but several cancers have increased in incidence even as their death
> rates have declined due to more effective treatments. According to
> SEER data, these include cancers of the ovary, testicle, colon and
> rectum, bladder, and thyroid. There are eight cancers whose
> incidence and mortality are both on the decline: those of the
> stomach, pancreas, larynx, mouth and pharynx, cervix and uterus,
> as well as Hodgkin's disease and leukemia...
> "However, these modest gains are swamped by the cancers
> that show both increasing incidence and increasing mortality:
> cancers of the brain, liver, breast, kidney, prostate, esophagus,
> skin (melanoma), bone marrow (multiple myeloma), and lymph
> (non-Hodgkins lymphoma) have all escalated over the past twenty
> years and show long-term increases that can be traced back at
> least forty years.
> "...'Explanations for these increases do not exist,' according to
> Philip Landrigan, a pediatrician and leading public health
> researcher...Clarification about carcinogins, Landrigan believes,
> requires an environmental line of inquiry:
> 'The possible contribution to recent cancer trends of the substantial
> worldwide increases in chemical production that have ocurred since
> World War II (and the resulting increases in human exposure to
> toxic chemicals in the environment) has not been adequately
> assessed. It needs to be systematically evaluated.'"
> "I am struck...by the symmetry between Landrigan's recommended
> course of action and an observation made thirty years earlier by
> two senior scientists at the National Cancer Institute, Wilhelm
> Hueper and W.C. Conway: 'Cancers of all types and all causes
> display even under already existing conditions, all the
> characteristics of an epidemic in slow motion.'...And yet the
> possible relationship between cancer and what Hueper and
> Conway called 'the growing chemicalization of the human economy'
> has not been pursued in any systematic, exhaustive way.
> "...The rise in cancer incidence over calendar time is one line of
> evidence that implicates environmental factors. The increase in
> cancer incidence among successive generations is another. A
> third line of evidence comes from a close cosideration of the
> cancers that exhibit particularly rapid rates of increase. If we
> restrict our view to these cancers, what patterns emerge?
> "...Melanoma accounts for only 5 percent of all skin cancers, but it
> is the most dangerous kind, accounting for 75 percent of skin
> cancer deaths. The U.S. incidence of melanoma rose nearly 350
> percent between 1950 and 1991, and mortality rose by 157
> percent. Between 1982 and 1989 alone, melanoma incidence
> jumped 83 percent...The accelerating incidence of melanoma
> means exposure to ultraviolet radiation is probably increasing. This
> could be happening for two reasons. First, more people are
> spending more time in the sun. Second, the sunlight to which we
> are exposed contains more ultraviolet rays.
> "...While the incidence of Hodgkin's disease has declined modestly
> over the past two decades, non-Hodgkin's lymphoma has shot up--
> approximately tripling in incidence since 1950. This increase is
> evident in both sexes and within all age groups except the very
> young...Lymphomas do seem to be consistently associated with
> exposure to synthetic chemicals, especially a class of pesticides
> known as phenoxy herbicides [including 2,4,5-T and 2,4-D, and the
> combination of these two, Agent Orange].
> "...Multiple myeloma is also associated with exposure to a variety
> of chemicals--metals, rubber, paint, industrial solvents, and
> petroleum. Farmers and agricultural workers exposed to
> pesticides and herbicides have higher rates of multiple myeloma
> than the general population. Multiple myeloma is on the rise in all
> major industrialized countries. But the parallel increase among
> both sexes argues against a purely occupational cause.
> According to one researcher who has examined multinational
> mortality trends, the patterns of multiple myeloma among
> generational cohorts suggest a general environmental exposure of
> some kind, common to all industrialized countries...
> "...The spatial features of cancer's occurrence around the globe
> clearly belie the notion that cancer is a random misfortune.
> Industrialized countries have disproportianately more cancers than
> countries with little or no industry (after adjusting for age and
> population size). One-half of all the world's cancers occur among
> people living in industrialized countries, even though we are only
> one-fifth of the world's population. Closely tracking industrialization
> are breast cancer rates, which are highest in North America and
> northern Europe, intermediate in southern Europe and Latin
> America, and lowest in Asia and Africa. Breast cancer rates are
> thirty times higher in the U.S. than in parts of Africa, for example.
> Breast cancer incidence in the U.S. is five times higher than it is in
> Japan, though this gap is rapidly narrowing. Of all the world's
> nations, Japan has the most rapidly rising rate of breast cancer.
> "Because we have no nationwide cancer registry, we also have no
> definitive geography of cancer incidence in the U.S. The National
> Cancer Institute has, however, published the two-volume 'Atlas of
> U.S. Cancer Mortality among Whites and Nonwhites: 1950-1980'--
> in essence, cancer death maps. Areas of high mortality are
> colored in scarlet, fuchsia, and orange; areas of unusually low
> mortality are painted deep blue...
> "Death from cancer is not randomly distributed in the U.S.
> Shades of red consistently light up the northeast coast, the Great
> Lakes area, and the mouth of the Mississippi River. For all
> cancers combined, these are the areas of highest mortality; they
> are also the areas of the most intense industrial activity."
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