Acknowledgment
Of the work of
CCO/OCTRF
1
Environmental & Occupational
Carcinogens
Presentation to
Cancer Care Ontario
July 1999
2
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?
3
Definition of
Environmental Carcinogens
(“toxics”)
•
•
•
•
Industrial effluents
household chemical products
agricultural and home pesticides
radionuclides
4
“Everyday Carcinogens”
citizen’s conference
• McMaster University
• March 1999
• Epstein, Connett, Steingraber, Hume Hall
• CCO: Dr. R. Schabas
5
Background paper
Everyday Carcinogens: Stopping Cancer
before it starts
Background Paper
for the March 26 & 27, 1999
Workshop on Primary Cancer Prevention
6
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 Prevention8
Canada
1999
• 23,000 chemicals approved for use
• 31: completed toxicity testing
Lancet, June 5, 1999
10
What is the amount of
Toxic chemical releases
from industrial sources?
12
Toxic Chemical Emissions
NPRI, 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
13
Canadian pesticide use
• Annual
• 50,000 tonnes
S. Elston, April 1999
21
Environment Canada Jan 1999
Inventory of releases:
dioxins/furans/hcb
• Total dioxin releases 1997
•
468 gm TEQ/year
( 1 lb)
22
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
25
1992 estimated daily intake of
dioxin from breast milk/formula
pg TEQ/Kg body wgt/day
60
50
40
Breast milk
formula
30
20
10
0
1992
WHO TDI 1998
26
Industrial toxics
What pollutants?
What chemicals?
28
Organic chemicals:
a. non chlorinated:
methanol, ammonia
toluene, benzene, methyl ethyl ketone,
ethylene glycol, APE’s, phthalates
29
“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
30
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)
33
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
34
waste incineration (PVC plastic)
Health effects
of Toxics
• Cancer
• Sexuality (reproduction and development)
•
•
•
•
brain injury (neuropsychological)
hormonal (endocrine disrupters)
acquired immune deficiency (aids)
liver
35
Causes of cancer
Spectrum of opinion
36
Canadian Cancer Society
1999 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.”
37
CCO prevention unit
mandate
Lifestyles
• Tobacco
• diet
• physical activity
• (occupational cancer: “tentative”)
38
Ontario Ministry of Health
Statement 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
39
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
40
What is the
General Medical literature
Saying about
toxics?
42
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
43
500 Journal articles on Toxics
1992 - 1998
100
90
80
70
60
50
40
30
20
10
0
Number of articles
appearing 1992 -1998
1992 1993 1994 1995 1996 1997 1998
Year
44
According to the medical literature
carcinogens cause cancer
46
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.”
47
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.”
48
Dr. David Kessler
U. 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.”
49
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.”
50
Drs. W.D. Foulkes, S. V. Hodgson
Inherited 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
51
Common cancers:
Toxic chemical causes:
medical literature
•
•
•
•
Lung
bowel
breast
prostate
52
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
53
Environmental exposure,
Benzo (a) pyrene
in 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
54
……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
55
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
56
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
58
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
59
19
65
19
67
19
69
19
71
19
73
19
75
19
77
19
79
19
81
19
83
19
85
19
87
19
89
19
91
19
93
19
95
Age Standardized Rate per 100,000
3. Breast Cancer Incidence, Total
Ontario Cancer Registry,
1965 -1995
90
80
70
60
50
40
30
20
10
0
61
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, 1996Van't veer , 1997
Moysich, Vena, 1997
Safe, 1997
Hunter et al, 1997
Hoyer, 1998
62
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.”
63
...Recipient of this toxic flush
…...Newborn
breast feeding infant
64
Uncommon/Rare cancers
Toxic chemical causes,
medical literature
68
Uncommon/rare cancers:
rates of increase
1 - 2 - 4% per year
•
•
•
•
NHL
testicular cancer
melanoma
Brain tumor
• Childhood cancer
69
Question
Would these uncommon/rare cancers
be uncommon/rare today
if they had sustained 1 (2, 4)% annual rates
of increase
over long intervals?
70
1. Non Hodgkin’s Lymphomas, I
• Adami et al, Sweden
• BMJ, June 10, l995
• 2 - 4% annual increase
• in a number of countries
72
Non-Hodgkin’s Lymphomas, III
•
•
•
•
Rothman, Cantor
Lancet, July 26, l997
occurrence of NHL related to PCB levels
?immunosuppression, with EBV
susceptibility
74
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
75
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
76
Testicular cancer
rate per 100,000
SEER data, U.S. DHHS
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
rate
1973
1977
1981
1985
1989
1993
77
Testicular cancer
rate per 100,000
Ontario Cancer Registry
7
6
5
4
rate
3
2
1
0
1964 - 1966
1994 - 1996
78
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
79
3. Melanoma
• BMJ Jan 20, l996
• DOUBLING of rate in Southern
Hemisphere
• chlorofluorocarbon release:
• ozone loss, increased u/v exposure
81
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
82
5. Childhood cancer
1:600 children by age 15
83
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
84
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
85
Canadian Childhood Cancer Control
Program , I
Gibbons, Mao, Levy, Miller, CMAJ,
Dec l5, l994
18
16
14
12
10
No. of cases of cancer
per 100,000 children,
1969 - 1988
8
6
4
2
0
1969 1972 1975 1978 1981 1984 1987
86
Canadian Childhood Cancer Control
Program II,
Gibbons, Mao, Levy, Miller,
CMAJ, Dec l5, l994
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
No of cases of
childhood leukemia
per 100,000, 1969 1988
1969 1972 1975 1978 1981 1984 1987
87
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
88
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
89
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
90
Cdn J of Public Health
Supplement, May/June l998
(selected papers)
“Childhood Cancer and Environmental
Contaminants”
• Mary Mcbride, B.C. Cancer Control
Agency
• 185 references
92
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
93
Province of Ontario
Environmental politics
102
Three Ontario examples of
Action,
Inaction and Reaction
on toxics
1. PVC plastic production
2. Pulp and paper industry chlorine
use
3. Waste incineration
103
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
104
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…….
105
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)
106
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…….
109
…….effect, Eastern Ontario, I
• Peterborough, Ontario
• April 15, 1999, feasibility hearings:
• municipal incinerator construction
110
…….effect, Eastern Ontario, II
•
•
•
•
Trenton, Ontario
April 1999, Norampac considering:
hazardous waste incinerator for
dioxin-contaminated pulp and paper waste
111
…..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
112
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
113
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%
114
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
115
colorectal ,lung cancer, ovary higher
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
117
Environmental Health
research
decline in publications
in the general medical literature
118
500 Journal articles on Toxics
1992 - 1998
100
90
80
70
60
50
40
30
20
10
0
Number of articles
appearing 1992 -1998
1992 1993 1994 1995 1996 1997 1998
Year
119
Why the decline?
Who would do such research?
• (Industry and corporations)
• Governments
• universities/academic researchers
120
Government
Support for
Environmental health research
121
Government of Ontario
MoE operating budget
400
350
300
250
Annual Operating
Budget, MoE,
1994 - l997
200
150
100
50
0
1994
1995
1996
1997
122
Government of Canada
toxics research
• Canadian breast milk contaminant survey
• dioxin
• last: 1992
123
Concentrations of dioxins and
furans in Canadian breast milk
pg/Kg Whole milk
900
800
700
600
500
2,3,7,8 TCDD
TEQ D + F
400
300
200
100
0
1982
1986
1992
124
Dr. Pierre Beland
former 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.”
125
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…
126
Summary
&
Suggested Action
132
Problem Formulation
in 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
137
Resolution: consider
2 additional elements in the
mandate
of
Prevention Unit
CCO
138
CCO
Prevention Unit
mandate, I
• Occupational cancer (definite)
• Tobacco
• diet
• physical activity
139
CCO
Prevention Unit
mandate, II
• Occupational cancer
• Environmental carcinogens
• Tobacco
• diet
• physical activity
140
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
141
specific goals
Prevention Unit
of CCO
143
Promote:
• Eliminate PVC production
by plastics industry
• Eliminate chlorine use
by pulp and paper industry
• Eliminate incineration
by waste management industry
144
Others:
• Endorse
Healthcare Without Harm
program for Ontario hospital
waste management
• Encourage pesticide use reduction
at home
on the farm
145
Conclusion
Occupational and Environmental carcinogens
are a significant public health issue.
What is the view of
the Prevention Unit of
Cancer Care Ontario?
146
147