1 acknowledgment of the work of cco/octrf. 2 environmental & occupational carcinogens...
TRANSCRIPT
1
Acknowledgment
Of the work of
CCO/OCTRF
2
Environmental & OccupationalCarcinogens
Presentation toCancer Care Ontario
July 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
8
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
10
Canada1999
• 23,000 chemicals approved for use
• 31: completed toxicity testing
Lancet, June 5, 1999
12
What is the amount of Toxic chemical releases
from industrial sources?
13
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
21
Canadian pesticide use
• Annual
• 50,000 tonnes S. Elston, April 1999
22
Environment Canada Jan 1999Inventory of releases:
dioxins/furans/hcb
• Total dioxin releases 1997
• 468 gm TEQ/year
( 1 lb)
25
Dioxin in 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
26
1992 estimated daily intake of dioxin from breast milk/formula
pg TEQ/Kg body wgt/day
0
10
20
30
40
50
60
1992 WHO TDI 1998
Breast milkformula
28
Industrial toxics
What pollutants?What chemicals?
29
Organic chemicals:
a. non chlorinated:
methanol, ammonia
toluene, benzene, methyl ethyl ketone, ethylene glycol, APE’s, phthalates
30
“Persistent toxic substances”“Persistent organic pollutants,
POPs”
b. Chlorinated/brominated organic chemicals, COC’s
11,000e.g. TCE, Perc, vinyl chloride
pcb’s, dioxins, furans
33
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)
34
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)
35
Health effects of Toxics
• Cancer
• Sexuality (reproduction and development)
• brain injury (neuropsychological)
• hormonal (endocrine disrupters)
• acquired immune deficiency (aids)
• liver
36
Causes of cancer
Spectrum of opinion
37
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.”
38
CCO prevention unitmandate
Lifestyles
• Tobacco
• diet
• physical activity
• (occupational cancer: “tentative”)
39
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 failed to act on eradicating environmental toxins known to cause cancer.” Eva Ligeti,ECO,1999
40
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
42
What is the
General Medical literature
Saying about
toxics?
43
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
44
500 Journal articles on Toxics1992 - 1998
0102030405060708090
100
1992 1993 1994 1995 1996 1997 1998
Year
Number of articlesappearing 1992 -1998
46
According to the medical literature
carcinogens cause cancer
47
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.”
48
Dr. Anthony Miller,U of T Epidemiology
JAMA Feb 9, l994
“We must remember the long natural history of cancer, and that the full effect of exposures to carcinogens in early life may not be seen until those exposed reach advanced age.”
49
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.”
50
Dr. Devra Davis:
“There are critical periods in development, e.g. the first trimester of pregnancy and adolescence, when sensitivity to carcinogenesis is high. Timing of exposure to chemicals and radiation can be more important than dose.”
51
Drs. W.D. Foulkes, S. V. HodgsonInherited Susceptibility to Cancer
BMJ 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
52
Common cancers:Toxic chemical causes:
medical literature
• Lung
• bowel
• breast
• prostate
53
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
54
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
55
……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
56
• 1991 , Fingerhut, Steenland, NEJM
• 1999, Steenland, Fingerhut, J NCI
• exposure of industrial workers to Dioxins
• higher incidence of:
• lung cancer, sarcoma and total cancers
Lung cancer & Occupational exposure
58
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
59
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
61
3. Breast Cancer Incidence, TotalOntario Cancer Registry,
1965 -1995
0
1020
30
4050
60
7080
90
1965
1967
1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
Age
Sta
ndar
dize
d R
ate
per
100,
000
62
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
63
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 breast is lactation, which flushes them from the system.”
64
...Recipient of this toxic flush
…...Newborn breast feeding infant
68
Uncommon/Rare cancers
Toxic chemical causes,
medical literature
69
Uncommon/rare cancers:rates of increase
1 - 2 - 4% per year• NHL
• testicular cancer
• melanoma
• Brain tumor
• Childhood cancer
70
Question
Would these uncommon/rare cancers
be uncommon/rare today
if they had sustained 1 (2, 4)% annual rates of increase
over long intervals?
72
1. Non Hodgkin’s Lymphomas, I
• Adami et al, Sweden
• BMJ, June 10, l995
• 2 - 4% annual increase • in a number of countries
74
Non-Hodgkin’s Lymphomas, III
• Rothman, Cantor
• Lancet, July 26, l997
• occurrence of NHL related to PCB levels
• ?immunosuppression, with EBV susceptibility
75
Non-Hodgkin’s Lymphomas, IV
• Hardell, Eriksson (Sweden)
• Cancer 1999; 85 (Lancet March 27, l999)
• fungicide, herbicide exposure
• increased risk of NHL• MCPA: 4-chloro 2 methyl phenoxyacetic acid
76
2. Testicular cancer
• 2 - 4 % annual increase for last 25 years
• Scandinavia, Europe, North America
• Canada, 2% annual increase
over 30 yrs
Weir, Jan 26,1999,CMAJ
77
Testicular cancerrate per 100,000
SEER data, U.S. DHHS
00.5
1
1.52
2.53
3.54
4.55
1973 1977 1981 1985 1989 1993
rate
78
Testicular cancerrate per 100,000
Ontario Cancer Registry
0
1
2
3
4
5
6
7
1964 - 1966 1994 - 1996
rate
79
Testicular cancer, II
• “It is a reasonable hypothesis that toxins acting during the early fetal development of the gonads are involved in the ….increase in the incidence of testicular germ cell cancer…..The likely culprits include DDT, PCBs, nonylphenol, bisphenols and vinclozolin.”
• L. Klotz, MD, CMAJ, Jan 26, 1999
81
3. Melanoma
• BMJ Jan 20, l996
• DOUBLING of rate in Southern Hemisphere
• chlorofluorocarbon release:
• ozone loss, increased u/v exposure
82
4. Adult Brain Cancer
• Workshop Group on Brain cancer
• CMAJ, March l5, l992
• DOUBLING of rate, 1969 - 1985
• age > 65
• occupational and non-occupational exposure to chemicals
83
5. Childhood cancer
1:600 children by age 15
84
Parliamentary Assistant to the federal Minister of the Environment
• P. Torsney , October l998
• AAUW/CFWW Cross Border Conference
• male: “25% increase”
• female: “42% increase”
in rates of Childhood Cancer
85
Childhood Cancer
• Dr. Anthony Miller
• CMAJ Dec l5, l994
• 1969 - 1988
• overall incidence: rose from 13 to 17 per 100,000
• 20% increase in 20 years
86
Canadian Childhood Cancer Control Program , I
Gibbons, Mao, Levy, Miller, CMAJ, Dec l5, l994
0
2
4
6
8
10
12
14
16
18
1969 1972 1975 1978 1981 1984 1987
No. of cases of cancerper 100,000 children,1969 - 1988
87
Canadian Childhood Cancer Control Program II,
Gibbons, Mao, Levy, Miller, CMAJ, Dec l5, l994
00.5
1
1.52
2.53
3.54
4.5
5
1969 1972 1975 1978 1981 1984 1987
No of cases ofchildhood leukemiaper 100,000, 1969 -1988
88
Childhood ALL
• Landrigan and Pui, NEJM Nov 9, l995
• SEER data, l973 to l991
• increased from 2.7 to 3.3 cases per 100,000
• 20% increase in 20 years• causes: unknown, ? Environmental toxins
89
ALL and EMF
• Greenberg, Green, HSC, June l999
• Intn’l J Cancer;J Cancer Causes & Control
• 201 children with leukemia in Toronto
• EMF exposure prenatally , to age 2
• 2.5 times more likely to have leukemia by 6
• ?differential genetic susceptibility
90
Childhood Brain Tumors
• Admitted to HSC:
• 1990: 60 1997: 100
• Dr. John McLaughlan,U of T Epidemiology• “There is strong evidence that children who live in
close proximity to hydro transformers, nuclear power plants and industrial toxins are at greater risk of brain tumors.”
• Medical Post, September l5, l998
92
Cdn J of Public HealthSupplement, May/June l998
(selected papers)
“Childhood Cancer and Environmental Contaminants”
• Mary Mcbride, B.C. Cancer Control Agency
• 185 references
93
Journal of Epidemiology and Community Health , 51 (1997)
“Hazard Proximity of Childhood cancers in Great Britain from 1953 - 1980”
• Knox, E, Gilman, E
• 22,458 children who died in Britain
• distance from hazardous industrial sites
102
Province of Ontario
Environmental politics
103
Three Ontario examples of Action,
Inaction and Reactionon toxics
1. PVC plastic production
2. Pulp and paper industry chlorine use
3. Waste incineration
104
1. PVC plastic
• IJC 1992 (and APHA)
discontinue production of PVC by Great Lakes Basin industry
• GO
(no action)
• since 1992 60% increase in PVC production
Ross Hume Hall, 1999
105
2. Pulp and paper industry chlorine use
• IJC 1992
phase out use of chlorine
• GO, mid 90’s
regulation: end chlorine discharges in pulp and paper effluent by 2002
• GO, late 90’s
regulation cancelled .
Effect…….
106
Eastern Ontario, 1993 - 98 Hastings/Northumberland/Peterborough
Trent River-Moira watershed
• “black liquor”: waste product of Domtar
• chlorinated Dioxins, furans
• Dust suppressant in 90 townships
• 50 million litres/yr (6100 tanker trucks)
109
3. Incineration of waste:municipal, medical, hazardous
• IJC 1992
stop waste incineration • GO, mid 90’s
stop waste incineration• GO, late 90’s
moratorium lifted
Effect…….
110
…….effect, Eastern Ontario, I
• Peterborough, Ontario
• April 15, 1999, feasibility hearings:
• municipal incinerator construction
111
…….effect, Eastern Ontario, II
• Trenton, Ontario
• April 1999, Norampac considering:
• hazardous waste incinerator for
• dioxin-contaminated pulp and paper waste
112
…..effect, Eastern Ontario III
• Cornwall, Ontario
• Public hearings June 9 - 12, l999
• hazardous waste incinerator
• “Material Resource Recovery Unit”
• PCB’s, CFC’s, mercaptan, pharmaceuticals
113
Incineration of Municipal/Medical Waste
• U. S. EPA / Canadian dioxin Inventory ‘99
• Largest/3rd largest source of Dioxin
• major source of Mercury
• North American environment
114
Incinerator health effects:Britain
• Cancer incidence near municipal solid waste incinerators in Great Britain
• Elliot et al, March 1996
• British Journal of Cancer
• incidence within l km of incinerator
• range: liver cancer: greatest increase, 37%
to: colorectal cancer: 5%
115
Incinerator health effects:Columbus, Ohio: dioxin emitter
• Robert Indian, Ohio Dep’t of Health• October 1994 (only 1 yr of data, small nos)• 1992 data, cancer incidence• local vs U. S cancer rates:• overall , 2 adjacent region• men: same/41% higher• women: 6/23 % higher• colorectal ,lung cancer, ovary higher
117
Eastern Ontario
• Dioxin-contaminated pulp effluent• Waste incineration
“Breast cancer rates are (already) somewhat (22%) higher in the Eastern CCO Region for reasons that are unclear.”
Ontario Cancer Registry, Cancer Care Ontario, September l998
118
Environmental Healthresearch
decline in publications
in the general medical literature
119
500 Journal articles on Toxics1992 - 1998
0102030405060708090
100
1992 1993 1994 1995 1996 1997 1998
Year
Number of articlesappearing 1992 -1998
120
Why the decline?Who would do such research?
• (Industry and corporations)
• Governments
• universities/academic researchers
121
Government
Support for
Environmental health research
122
Government of OntarioMoE operating budget
0
50
100
150
200
250
300
350
400
1994 1995 1996 1997
Annual OperatingBudget, MoE, 1994 - l997
123
Government of Canadatoxics research
• Canadian breast milk contaminant survey
• dioxin
• last: 1992
124
Concentrations of dioxins and furans in Canadian breast milk
pg/Kg Whole milk
0
100
200
300
400
500
600
700
800
900
1982 1986 1992
2,3,7,8 TCDDTEQ D + F
125
Dr. Pierre Belandformer commissioner, IJC
1998 GLU Citizen’s Hearings
“Governments are becoming more and more uninterested in the environment…..There is no 1998 data because there is no money to analyze and research.”
126
Federal Commissioner of Environment : Annual Report, May 25, 1999
• Brian Emmett, auditor general of environment
• “… the government is not doing its part to effectively manage the risks posed by toxic substances….Part of the problem is the diminishing capacity to do the research needed…
132
Summary &
Suggested Action
137
Problem Formulationin toxics and cancer
in Ontario
1.Research bias: away from prevention;
away from environmental research
2. in the presence of plenty of existing evidence , there is a lack of leadership in cancer prevention by pollution prevention in the Province of Ontario
138
Resolution: consider
2 additional elements in the mandate
of
Prevention Unit
CCO
139
CCO
Prevention Unitmandate, I
• Occupational cancer (definite)
• Tobacco
• diet
• physical activity
140
CCO
Prevention Unit mandate, II
• Occupational cancer
• Environmental carcinogens
• Tobacco
• diet
• physical activity
141
GO Task Force for the Primary Prevention of Cancer, April 1995
“Government should establish timetables to sunset the use of chlorine-containing compounds as industrial feedstocks and examine the means of reducing or eliminating other uses of chlorine, bearing in mind the priority to ban substances established as carcinogens.”
Drs. A.B. Miller et al
143
specific goals
Prevention Unit
of CCO
144
Promote:
• Eliminate PVC production
by plastics industry
• Eliminate chlorine use
by pulp and paper industry
• Eliminate incineration
by waste management industry
145
Others:
• Endorse Healthcare Without Harm
program for Ontario hospital waste management
• Encourage pesticide use reduction
at home
on the farm
146
Conclusion
Occupational and Environmental carcinogens are a significant public health issue.
What is the view of
the Prevention Unit of
Cancer Care Ontario?
147