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Acknowledgment

Acknowledgment. Of the work of CCO/OCTRF. Environmental & Occupational Carcinogens. Presentation to Cancer Care Ontario July 1999. Objectives. Review some of the current science and politics of environmental and occupational carcinogens as a public health issue

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Acknowledgment

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  1. Acknowledgment Of the work of CCO/OCTRF

  2. Environmental & OccupationalCarcinogens Presentation toCancer Care OntarioJuly 1999

  3. Objectives • Review some of the current science and politics of environmental and occupational carcinogens as a public health issue • Should this issue be added to the existing mandate of the Prevention Unit of Cancer Care Ontario?

  4. Definition of Environmental Carcinogens(“toxics”) • Industrial effluents • household chemical products • agricultural and home pesticides • radionuclides

  5. “Everyday Carcinogens”citizen’s conference • McMaster University • March 1999 • Epstein, Connett, Steingraber, Hume Hall • CCO: Dr. R. Schabas

  6. Background paper Everyday Carcinogens: Stopping Cancer before it starts Background Paper for the March 26 & 27, 1999 Workshop on Primary Cancer Prevention

  7. Chemicals in our industrialized society • 70,000 - 100,000 in everyday use in North America • 3,000 in high volume use • Effect on Human Health ???? • 80%: “ limited toxicologic data, especially for chronic effects” A. B. Miller, Task Force on Cancer Prevention

  8. Canada1999 • 23,000 chemicals approved for use • 31: completed toxicity testing Lancet, June 5, 1999

  9. What is the amount of Toxic chemical releasesfrom industrial sources?

  10. Toxic Chemical EmissionsNPRI, TRI data • Ontario: 1200 tonnes/wk • Great Lakes Basin: 2500 tonnes/wk • Canada: 200,000 tonnes / year suspected/known carcinogens: 13,000 tonnes/ year • North America 1 million tonnes / yr

  11. Canadian pesticide use • Annual • 50,000 tonnes S. Elston, April 1999

  12. Environment Canada Jan 1999Inventory of releases: dioxins/furans/hcb • Total dioxin releases 1997 • 468 gm TEQ/year ( 1 lb)

  13. Dioxinin Canadian Breast Milk • 5 - 6 month Canadian infant taking in 750 ml milk daily: • Breast milk: 25 times Tolerable Daily Intake, WHO • formula: 5 times “ “ • WHO TDI Dioxin 1998, 1 - 4 (2.5) pg/kg body wgt/day

  14. 1992 estimated daily intake of dioxin from breast milk/formulapg TEQ/Kg body wgt/day

  15. Industrial toxics What pollutants?What chemicals?

  16. Organic chemicals: a. non chlorinated: methanol, ammonia toluene, benzene, methyl ethyl ketone, ethylene glycol, APE’s, phthalates

  17. “Persistent toxic substances”“Persistent organic pollutants, POPs” b. Chlorinated/brominated organic chemicals, COC’s 11,000 e.g. TCE, Perc, vinyl chloride pcb’s, dioxins, furans

  18. Persistent Organic Pollutants: • 40’s: first industrial production of COC’s • 60’s: chlorinated pesticides (DDT) • 70’s: PCB’s, CFC’s • 80’s: dioxins, furans • 90’s: APE’s (surfactants, detergents,etc) bisphenols (polycarbonate subunit) pthalates (plasticisers)

  19. Sources of chlorinated organic chemicals • Pulp and paper (chlorine bleaching) • PVC plastics (petroleum industry) • Pesticides (see Canadian dioxin inventory) • pharmaceutic industry(e.g.dichloromethane) • intermediates (chlorine chemical industry) • refrigerants (cfc’s, cfhc’s) • solvents • waste incineration (PVC plastic)

  20. Health effects of Toxics • Cancer • Sexuality (reproduction and development) • brain injury (neuropsychological) • hormonal (endocrine disrupters) • acquired immune deficiency (aids) • liver

  21. Causes of cancer Spectrum of opinion

  22. Canadian Cancer Society1999 statistics report • “Canadian’s bad habits or exposure to toxic substances cannot be blamed for the growth of new cancer cases. The main culprit is simply the aging of the population.” • Dr. Barbara Whylie, director of medical affairs and cancer control • Globe and Mail, April 9, l999 “Aging populace behind the jump in cancer rates.”

  23. CCO prevention unitmandate Lifestyles • Tobacco • diet • physical activity • (occupational cancer: “tentative”)

  24. Ontario Ministry of HealthStatement of Environmental Values • “Move to effective prevention and promotion activities in the control of cancer and support the elimination of pollutants and carcinogens as causative agents.” • “The Ontario Ministry of Health has failedto act on eradicating environmental toxinsknown to cause cancer.”Eva Ligeti,ECO,1999

  25. Environment Canada: Toxics“Ottawa wants to cut industrial discharges”Globe and Mail, April 9, l999 • reduce public exposure to toxic substances and carcinogens by: • major cuts (up to 90%) in industrial discharges of benzene, lead, mercury, dioxin, chromium Christine Stewart, Minister of Environment • voluntary reductions

  26. What is theGeneral Medical literature Saying about toxics?

  27. 500 articles on Environmental toxics , 1992 - 1998, (general medical literature Database) • Canadian Medical Association Journal • JAMA • New England Journal of Medicine • British Medical Journal • The Lancet

  28. 500 Journal articles on Toxics1992 - 1998

  29. According to the medical literature carcinogens cause cancer

  30. Dr. Bernard Dixon, editor BMJ,June 11, l995 “Cancer is essentially a disease of genes which are triggered into mischief by external carcinogens such as chemicals and radiation.”

  31. Dr. Anthony Miller,U of T EpidemiologyJAMA Feb 9, l994 “We must remember the long natural history of cancer, and that the full effect of exposures to carcinogensin early life may not be seen until those exposed reach advanced age.”

  32. Dr. David KesslerU. S. FDA, Joint Report of Pesticide Use, June l993 “We know that children are overexposed, and we know that the chemicals are toxic. But when cancer or chronic neurological, immune or reproductive problems show up years later there will be no footprints left.”

  33. Dr. Devra Davis: “There are critical periods in development, e.g. the first trimester of pregnancyand adolescence, when sensitivity to carcinogenesis is high. Timing of exposure to chemicals and radiation can be more important than dose.”

  34. Drs. W.D. Foulkes, S. V. HodgsonInherited Susceptibility to CancerBMJ June 5, l999 “it is likely that most cases of cancer occur because an individual has been exposed to certain carcinogenic and environmental agents and that inherited factors have made them more susceptible to the effects of these agents.” Dr. F. Rassool , Hematologist, King’s College Hospital, London

  35. Common cancers:Toxic chemical causes: medical literature • Lung • bowel • breast • prostate

  36. 1. Lung cancer& cigaret smoking • Tang, (Smithville, USA),Lancet Oct 26, l996 • 80% due to cigarette smoking • 4000 chemicals in Cigarette smoke • Benzo (a) pyrene • DNA damage to p53 tumor suppressor gene

  37. Environmental exposure,Benzo (a) pyrenein the Great Lakes Basin • IJC, International Joint Commission • 11 critical contaminants: pcb, dioxin, furan, ddt, toxaphene, mirex, dieldrin, hcb, methyl mercury, alkylated lead, benzo(a)pyrene

  38. ……Eastern Ontario • Meyer’s Pier Park, Belleville • founded on a coal gasification waste site • Risk Assessment :significant cancer risk from PAH’s (benzo(a)pyrene), benzene, arsenic

  39. Lung cancer &Occupational exposure • 1991 , Fingerhut, Steenland, NEJM • 1999, Steenland, Fingerhut, J NCI • exposure of industrial workers to Dioxins • higher incidence of: • lung cancer, sarcoma and total cancers

  40. 2. Bowel cancer:Chlorinated drinking water (I) • Will King, OCTRF/Queen’s University • Dec 6 , l995 • chlorinated water • 10% increase in bowel (and bladder) cancer • ?Trihalomethanes

  41. Bowel cancer:chlorinated drinking water (II) • Doyle, Univ of Minnesota • Lancet, Aug 23, l997 • 28,000 post menopausal women in Iowa • chlorinated drinking water • increased colon cancer

  42. 3. Breast Cancer Incidence, TotalOntario Cancer Registry, 1965 -1995

  43. Breast Ca and Organochlorides:20 researchers Unger, l984 Mussala-Rauhamaa, l990 Falck, l992, Dewally, l994 Krieger, 1994 Wolff, 1993 Hulka, Stark, 1995 Barnett, 1997 Davis, Bradlow, 1996 Van't veer , 1997 Moysich, Vena, 1997 Safe, 1997 Hunter et al, 1997 Hoyer, 1998

  44. Breast cancer & Breast feeding • Moysich, Vena, SUNY Buffalo, l997 • women from Love Canal area, western NY • organochlorine exposure • breast feeding was a protective factor vs breast cancer: lower blood levels of DDE • “The chief mechanism for eliminating organochlorides from the breastis lactation, whichflushes them from the system.”

  45. ...Recipient of this toxic flush …...Newborn breast feeding infant

  46. Uncommon/Rare cancers Toxic chemical causes, medical literature

  47. Uncommon/rare cancers:rates of increase1 - 2 - 4% per year • NHL • testicular cancer • melanoma • Brain tumor • Childhood cancer

  48. Question Would these uncommon/rare cancers be uncommon/rare today if they had sustained 1 (2, 4)% annual rates of increase overlong intervals?

  49. 1. Non Hodgkin’s Lymphomas, I • Adami et al, Sweden • BMJ, June 10, l995 • 2 - 4% annual increase • in a number of countries

  50. Non-Hodgkin’s Lymphomas, III • Rothman, Cantor • Lancet, July 26, l997 • occurrence of NHL related to PCB levels • ?immunosuppression, with EBV susceptibility

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