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  • Which raises the question about the effects of human health, which is rather difficult to answer given that:
  • Furious production and consumption in North America, reflected in the exponential rise in the Dow Jones average in the past decade.
  • At the other end of the pipe, as a consequence of all of this activity there has been a very large outfall of toxic pollutants into the environment.
  • The bad news started arriving in the 60’s.
  • “ These COC’s have come from a number of sources, all of which have as a common denominator the chlorine chemical industry.” Namely:
  • At one end of the spectrum
  • At CCO you are not sure about toxics but you are concerned about bad habits.
  • At the other end of the spectrum
  • notes
  • NEJM has been a disappointment Of all the researchers on the subject the one who got to write the “definitive” editorial was Steven Safe, native of Belleville Ontario Very dismissive terms: (listed) Forgot to declare his funding source
  • Negative review of Steingraber’s book Forgot to mention that is employer was the (disgraced) ….
  • American Family Physician, Testicular Cancer, May 1, 1999
  • Klotz gives voice to a prevailing, commonly held, view
  • Very conservative in his interpretation of declining male sperm counts in relation to organochlorines Talking about testicular cancers as if they are “canaries in mine shafts”
  • Decline in research publications in the general medical literature began in 1996.
  • Decline started in l995, l year before the decline in research publications in the general medical literature began.
  • One would think that this would be a matter of urgent interest, ie the finding of 25 times the WHO TDI of dioxin in Canadian human breast milk, but…. Almost a decade has passed since the last assessment.
  • I have spoken to two eminent Ontario researchers about specific environmental issues and their possible impact on Ontario public health. “Interesting question, no time”
  • Attend an educational day at one of these institutions Gratitude Sheet published
  • Not difficult to see what some of these academic researching are spending their time researching. Corporations seem to have a tight grip on the research agenda of some Canadian university academic departments at least.
  • First of all we have learned that:
  • 1. In general/specifically
  • If tentative should be upgraded to definite Should be at the top of the list in the interest of the workers of the Province
  • On looking at the very interesting evidence from the litererature, and as well the environmental politics of the Province of Ontario
  • Thankyou for your attention.

Powerpoint presentation to Cancer Care Ontario, July 1999 Powerpoint presentation to Cancer Care Ontario, July 1999 Presentation Transcript

  • 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
    • Should this issue be added to the existing mandate of the Prevention Unit of Cancer Care Ontario?
  • Definition of Environmental Carcinogens ( “toxics”)
    • Industrial effluents
    • household chemical products
    • agricultural and home pesticides
    • radionuclides
  • “Everyday Carcinogens” citizen’s conference
    • McMaster University
    • March 1999
    • Epstein, Connett, Steingraber, Hume Hall
    • CCO: Dr. R. Schabas
  • Background paper
    • Everyday Carcinogens: Stopping Cancer before it starts
    • Background Paper
    • for the March 26 & 27, 1999
    • Workshop on Primary Cancer Prevention
  • Overview 25 minutes
    • What Toxics?
    • Causes of cancer
    • Medical literature on health effects
    • 3 Ontario examples
    • trends in Environmental Health Research
    • Problem formulation
    • Solutions
  • 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
  • Everyday & Industrial chemicals
    • “ Overwhelming majority (of toxic chemicals released into the environment) have never been adequately, if at all, tested for chronic toxic, carcinogenic, mutagenic or teratogenic effects , let alone for ecological effects.”
    • Dr . Samuel Epstein
  • Canada 1999
    • 23,000 chemicals approved for use
    • 31 : completed toxicity testing
    • Lancet, June 5, 1999
  • Dow Jones Industrial Average 1972 - 1999
  • What is the amount of Toxic chemical releases from industrial sources?
  • 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
  • Provincial Auditor of Ontario 1996: Toxics releases
    • 1200 tonnes in Province of Ontario /week
    • (1000 tonnes into the air)
  • CIELAP: Province of Ontario Hazardous Waste
    • Reported through manifests of offsite shipping of hazardous waste for disposal:
    • 1994: 1.4 million tonnes
    • 1997: 2.1 “ “
    • rate of growth: 3 times faster than provincial economy over that interval
    • Anne Mitchell, exec dir, CIELAP, Globe and Mail, July 2, l999
  • What is the Current toxic load entering the Great Lakes Basin?
    • Canadian NPRI, (1993)
    • U. S. EPA TRI , (l990)
    • 1000 tonnes per week
    • US GAO: 5% of total:
    • 20,000 tonnes per week
  • What is the Current toxic load entering the Great Lakes Basin? (36 million people)
    • Great Lakes United, 1997
    • 2500 tonnes per week
    • (100 truck loads)
  • Paul Muldoon, CELA amount of releases in Canada
    • NPRI data: 5% of actual total
    • legal releases
    • 200,000 tonnes per year
    • 13,000 tonnes suspected/known carcinogens
    • amounts increasing: less releases but increased incineration and offsite transfer
  • NAFTA: CEC Toxic Load in North America 1998
    • 1 million tonnes per year
  • U.S production/release of organic chemicals
    • 1940’s: 1 billion lbs
    • 1950’s: 30
    • 1980’s: 400
    • 1991: 3.6 billion lb chemical discharge
    • (Epstein, l998)
  • Canadian pesticide use
    • Annual
    • 50,000 tonnes
        • S. Elston, April 1999
  • Environment Canada Jan 1999 Inventory of releases: dioxins/furans/hcb
    • Total dioxin releases 1997
    • 468 gm TEQ/year
    • ( 1 lb)
  • Breast milk, Europe
    • WHO committee
    • Lancet, BMJ, May l997
    • 2 month old breast fed infant
    • receives 17 times the TDI of pcb’s and dioxins from breast milk ( 50 times)
    • breast feeding a “significant risk” ??
  • Toxics in Breast milk, Canada
    • Craan & Haines, GHEP, Canada
    • Arch Environ Contam Toxicol, l998. 35, 702-10
    • Twenty five years of Surveillance for Contaminants in Human Breast Milk
    • Canada: 6 surveys of human breast milk . 1967, 1970, 1975, 1982, 1986, 1992
  • 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
  • 1992 estimated daily intake of dioxin from breast milk/formula pg TEQ/Kg body wgt/day
  • Synthetic chemicals measurable in the human body 250 (177) Colborne et al, Our Stolen future (Steingraber , Living Downstream)
  • Industrial toxics What pollutants? What chemicals?
  • Organic chemicals:
    • a. non chlorinated:
    • methanol, ammonia
        • toluene, benzene, methyl ethyl ketone, ethylene glycol, APE’s, phthalates
  • “ 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
  • 2 . Heavy Metals:
    • Mercury, lead, arsenic, cadmium
    • Copper, zinc
  • 3. Classic Air Pollutants
    • Particulates (PM 10, PM 50)
    • Ozone
    • Acid Gases (Sox, Nox, HCl)
  • 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)
  • 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)
  • Health effects of Toxics
    • Cancer
    • Sexuality (reproduction and development)
    • brain injury (neuropsychological)
    • hormonal (endocrine disrupters)
    • acquired immune deficiency (aids)
    • liver
  • Causes of cancer Spectrum of opinion
  • 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.”
  • CCO prevention unit mandate
    • Lifestyles
    • Tobacco
    • diet
    • physical activity
    • (occupational cancer: “ tentative ”)
  • 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
  • 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
  • Causes of Cancer: 2 schools
    • Doll, Peto, NCI: Epstein:
    • industrial carcinogens 4% 2/3
    • occupational 4% 10%
    • smoking 30% 30%
    • fat consumption 30%
    • genetic (homozygous tumor suppressor genes) 5 - 10%
  • What is the General Medical literature Saying about toxics?
  • 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
  • 500 Journal articles on Toxics 1992 - 1998
  • Environmental Epidemiology of the Great Lakes: Human Health Effects of Industrial Pollutants, Effluents and Toxics November 1998
  • According to the medical literature carcinogens cause cancer
  • 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.”
  • 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.”
  • 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.”
  • 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.”
  • 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
  • Common cancers: Toxic chemical causes: medical literature
    • Lung
    • bowel
    • breast
    • prostate
  • 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
  • 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
  • ……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
    • 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
  • 2. Bowel cancer:
    • Buchberg, Siracusa JAMA Aug 2, 1995
    • Pla2s gene: tumor suppressor gene: APC
    • dietary fat
  • 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
  • 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
  • 3.Breast cancer incidence
    • Dr. Devra Davis, World Resources Institute
    • JAMA, Feb 9, l994
    • 19 % increase 1973 - 1987
  • 3. Breast Cancer Incidence, Total Ontario Cancer Registry, 1965 -1995
  • 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
  • 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 .”
  • ...Recipient of this toxic flush
    • …... Newborn breast feeding infant
  • NEJM editorial Oct 30, l997
    • on Breast cancer and chlorinated organic chemicals (Hunter study): “definitive”
    • Stephen Safe, Ph.D, Texas A&M
    • “ chemophobia, the unreasonable fear of chemicals”
    • “ paparazzi science”
    • undeclared funding source :
    • Chemical Manufacturers Association
  • NEJM Book Review
    • Nov 20, 1997
    • Living Downstream: an ecologist looks at Cancer and the Environment
    • Sandra Steingraber
    • Jerry Berke, Mass public health physician
    • W.R. Grace chemical company (Woburn)
    • Jan 22, l998: editorial Retraction
  • Dietary fat intake and breast cancer?
    • JAMA March 10, l999
    • Association of dietary intake of fat and fatty acids with risk of breast cancer
    • Holmes, Hunter et al
    • Harvard School of Public Health.
    • 3000 patients, Nurse’s Health Study
    • no association found
  • Uncommon/Rare cancers Toxic chemical causes, medical literature
  • Uncommon/rare cancers: rates of increase 1 - 2 - 4% per year
    • NHL
    • testicular cancer
    • melanoma
    • Brain tumor
    • Childhood cancer
  • Question
    • Would these uncommon/rare cancers
    • be uncommon/rare today
    • if they had sustained 1 (2, 4)% annual rates of increase
    • over long intervals?
  • Answer
    • No
    • must be a recent phenonomenon
  • 1. Non Hodgkin’s Lymphomas, I
    • Adami et al, Sweden
    • BMJ, June 10, l995
    • 2 - 4% annual increase
    • in a number of countries
  • Non-Hodgkin’s Lymphomas, II
    • Freedman
    • BMJ May 17, l997
    • mortality NOT associated with u/v exposure
    • ? Unsuspected environmental agents
  • Non-Hodgkin’s Lymphomas, III
    • Rothman, Cantor
    • Lancet, July 26, l997
    • occurrence of NHL related to PCB levels
    • ?immunosuppression, with EBV susceptibility
  • 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
  • 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
  • Testicular cancer rate per 100,000 SEER data, U.S. DHHS
  • Testicular cancer rate per 100,000 Ontario Cancer Registry
  • 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
  • Testicular cancer, III
    • “ Changes in male genitalia, such as the increasing incidence of testicular cancer in the U. S., could be like a canary in a mine shaft.”
    • Harry Fisch, director, Male Reproductive Centre, Columbia Presbyterian Medical Centre, New York
    • Globe and Mail, Jan 26, l999
  • 3. Melanoma
    • BMJ Jan 20, l996
    • DOUBLING of rate in Southern Hemisphere
    • chlorofluorocarbon release:
    • ozone loss, increased u/v exposure
  • 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
  • 5. Childhood cancer 1:600 children by age 15
  • 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
  • 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
  • Canadian Childhood Cancer Control Program , I Gibbons, Mao, Levy, Miller, CMAJ, Dec l5, l994
  • Canadian Childhood Cancer Control Program II, Gibbons, Mao, Levy, Miller, CMAJ, Dec l5, l994
  • 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
  • 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
  • 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
  • Canadian Institute of Child Health
    • What on Earth? A National Symposium on Environmental Contaminants and the Implications for Child Health
    • May l997, Ottawa
  • 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
  • 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
  • Non cancer effects: R eproduction & Development Toxic chemicals medical literature
  • Sexuality: Reproduction & Development 20 researchers
    • Scandinavia : Skakkebaek, Carlsen, Santti
    • Scotland : Stewart Ervine, Sharpe
    • England : Dodds , Sumpter, Sue Jobling
    • Dolk, Beral. Belgium : Comhaire
    • U.S: John McLaughlin
    • Soto, Sonnenschein, von Saal,
    • Connett, Colborn , Schecter
    • Carson, Guillett/Gross, Epstein, Hall, Davis
  • Reproductive effects of toxics: Women
    • Menstrual irregularities (shorter cycle)
    • miscarriage /pregnancy loss
    • premature ovarian failure (menopause)
    • endometriosis
    • Breast cancer
  • Reproductive effects of toxics: Men
    • Sperm counts : decline 50% in 50 yrs
    • smaller testicles (Klotz, CMAJ, Jan 1999) and micropenis with DES)
    • reduced male:female birth ratio
    • congenital defects : undescended testicle
    • hypospadias
    • (intersex: pseudohermaphroditism)
    • cancer: increase: testicle, ?prostate
  • Reproductive effects of toxics: embryo, fetus, neonate Birth cycle
    • Ovarian (follicle fluid) contamination
    • Recurrent pregnancy loss
    • intra uterine Growth Restriction
    • stillbirths
    • congenital defects(Helen Dolk:Eurhazocon)
    • declining male:female birth ratio
    • Breast milk contamination
  • Hypothesis
    • Chemical exposure occurs
    • early in prenatal development
    • programs disease
    • manifested sooner or later in life
    • eg. Exposure of male embryo to Xenoestrogens at 6 wks intrauterine life
  • Analogy: David Barker
    • Environmental epidemiology unit
    • Southhampton, U. K.
    • adult diseases: CAD, BP, DM, ?copd
    • prenatal nutrition, birth weight
    • “ programming the baby”
  • David Barker, II
    • Mothers, Babies, and Disease in Later Life
    • 1994, BMJ publishing group
    • Fetal and Infant Origins of Adult Diseases
    • 1992, BMJ publishing group
  • Province of Ontario Environmental politics
  • Three Ontario examples of Action, Inaction and Reaction on toxics 1. PVC plastic production 2. Pulp and paper industry chlorine use 3. Waste incineration
  • 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
  • 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…….
  • 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)
  • Dombind Health Study, 1998
    • “ On the very narrow issue of whether the use of Dombind constitutes a health hazard within the Health Protection and Promotion Act , I have concluded that it does not .”
    • Alex Hukowich, MOH, Peterborough
    • Belleville Intelligencer , Oct 21, l998
  • A disappointing (non) statement
    • given by a physician expert
    • in response to legitimate questions posed by concerned citizens
    • Empty: devoid of meaning
  • 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…….
  • ……. effect, Eastern Ontario, I
    • Peterborough , Ontario
    • April 15, 1999, feasibility hearings:
    • municipal incinerator construction
  • ……. effect, Eastern Ontario, II
    • Trenton , Ontario
    • April 1999, Norampac considering:
    • hazardous waste incinerator for
    • dioxin-contaminated pulp and paper waste
  • ….. 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
  • 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
  • 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%
  • 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
  • Incineration of hospital/medical waste, II
    • Lynn R. Goldman, MD, JAMA, Aug 12,98
    • EPA : assistant administrator for toxic substances
    • 2% of hospital waste needs incineration
    • 75% -100% actual
  • 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
  • Environmental Health research decline in publications in the general medical literature
  • 500 Journal articles on Toxics 1992 - 1998
  • Why the decline? Who would do such research?
    • (Industry and corporations)
    • Governments
    • universities/academic researchers
  • Government Support for Environmental health research
  • Government of Ontario MoE operating budget
  • Government of Canada toxics research
    • Canadian breast milk contaminant survey
    • dioxin
    • last: 1992
  • Concentrations of dioxins and furans in Canadian breast milk pg/Kg Whole milk
  • 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.”
  • 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…
  • University/Academic Environmental health research
  • Canadian university/academic toxics research
    • Cornelia Baines (Toronto, epidemiology)
    • East Liverpool hazardous waste incinerator:
    • “ interesting question, no time ”
    • Bob Reid (Kingston, Reproductive endocrinology)
    • Environmental estrogens:
    • “ interesting area, no time ” ……...
  • Queen’s University CME Office Ob/Gyn Day, March 31, l999 “gratefully acknowledges the support of”
    • 10 pharmaceutical companies
    • Berlex Canada Thylmer Inc
    • Eli Lilly Canada Parke Davis
    • Glaxo Wellcome Inc Ferring Inc
    • Merck Frosst Wyeth-Ayerst
    • Organon Canada Ltd Pharmacia & Upjohn
  • Cancer Prevention & Control Journal of the Canadian Oncology Society Vol 3, No 1, Feb 1999
    • Rhone-Poulenc Rorer Inc
    • Purdue Frederick
    • Janssen-Ortho Inc
    • Hoffmann-La Roche Ltd
    • SmithKline Beecham Pharma
    • Novartis Pharmaceuticals Canada Inc
    • Zeneca Pharma
  • Suggesting that
    • Corporations influence research agendas of academic departments
    • ?Environmental health research: north of No.7 highway
  • Summary & Suggested Action
  • Proof that industrial pollutants cause illness?
    • Limits to science :
    • epidemiology has proven to be weak in assessing the long term human health effects of toxics
  • Proof that industrial pollutants cause illness?
    • “ I thin that in the end we will have to take precautions based on evidence rather than proof . It’s the same with smoking. There is no proof that smoking causes lung cancer but there is lots of evidence.”
    • Niels Skakkebaek
  • Increasing Cancer Risk in Young Birth Cohorts in Sweden
    • Lancet, Adami, March 27, 1993
    • “ Our data strongly suggest increased
    • population exposure to carcinogens ….. .
    • Greater focus on aetiological research and primary prevention is the only realistic general strategy for cancer control in the absence of further improvements in treatment.”
  • Cancer Undefeated John Bailar III, Heather Gornik
    • May 29, 1997, NEJM
    • “ The effects of new treatments for cancer on mortality has been largely disappointing . The most promising approach to the control of cancer is a national commitment to prevention , with a concomitant rebalancing of the focus and funding of research.”
  • 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
  • Resolution: consider 2 additional elements in the mandate of Prevention Unit CCO
  • CCO Prevention Unit mandate, I
    • Occupational cancer (definite)
    • Tobacco
    • diet
    • physical activity
  • CCO Prevention Unit mandate, II
    • Occupational cancer
    • Environmental carcinogens
    • Tobacco
    • diet
    • physical activity
  • 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
  • 1995 Task force on Cancer Prevention
    • “ We urge action now”
  • specific goals Prevention Unit of CCO
  • Promote:
    • Eliminate PVC production
    • by plastics industry
    • Eliminate chlorine use
    • by pulp and paper industry
    • Eliminate incineration
    • by waste management industry
  • Others:
    • Endorse Healthcare Without Harm
    • program for Ontario hospital waste management
    • Encourage pesticide use reduction
    • at home
    • on the farm
  • Conclusion
    • Occupational and Environmental carcinogens are a significant public health issue.
    • What is the view of
    • the Prevention Unit of
    • Cancer Care Ontario?
  •