1
Acknowledgment
Of the work of
CCO/OCTRF
2
Environmental & Occupational
Carcinogens
Presentation to
Cancer Care Ontario
July 1999
3
Objectives
• Review some of the current science and
politics of environmental and occupational
carcinogens as a public h...
4
Definition of
Environmental Carcinogens
(“toxics”)
• Industrial effluents
• household chemical products
• agricultural a...
5
“Everyday Carcinogens”
citizen’s conference
• McMaster University
• March 1999
• Epstein, Connett, Steingraber, Hume Hal...
6
Background paper
Everyday Carcinogens: Stopping Cancer
before it starts
Background Paper
for the March 26 & 27, 1999
Wor...
8
Chemicals
in our industrialized society
• 70,000 - 100,000 in everyday use in North
America
• 3,000 in high volume use
•...
10
Canada
1999
• 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 Emissions
NPRI, TRI data
• Ontario: 1200 tonnes/wk
• Great Lakes Basin: 2500 tonnes/wk
• Canada: 200,000...
21
Canadian pesticide use
• Annual
• 50,000 tonnes
S. Elston, April 1999
22
Environment Canada Jan 1999
Inventory of releases:
dioxins/furans/hcb
• Total dioxin releases 1997
• 468 gm TEQ/year
( ...
25
Dioxin
in Canadian Breast Milk
• 5 - 6 month Canadian infant taking in 750
ml milk daily:
• Breast milk: 25 times Toler...
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 ...
28
Industrial toxics
What pollutants?
What chemicals?
29
Organic chemicals:
a. non chlorinated:
methanol, ammonia
toluene, benzene, methyl ethyl ketone,
ethylene glycol, APE’s,...
30
“Persistent toxic substances”
“Persistent organic pollutants,
POPs”
b. Chlorinated/brominated organic
chemicals, COC’s
...
33
Persistent Organic Pollutants:
• 40’s: first industrial production of COC’s
• 60’s: chlorinated pesticides (DDT)
• 70’s...
34
Sources of
chlorinated organic chemicals
• Pulp and paper (chlorine bleaching)
• PVC plastics (petroleum industry)
• Pe...
35
Health effects
of Toxics
• Cancer
• Sexuality (reproduction and development)
• brain injury (neuropsychological)
• horm...
36
Causes of cancer
Spectrum of opinion
37
Canadian Cancer Society
1999 statistics report
• “Canadian’s bad habits or exposure to
toxic substances cannot be blame...
38
CCO prevention unit
mandate
Lifestyles
• Tobacco
• diet
• physical activity
• (occupational cancer: “tentative”)
39
Ontario Ministry of Health
Statement of Environmental Values
• “Move to effective prevention and
promotion activities i...
40
Environment Canada: Toxics
“Ottawa wants to cut industrial discharges”
Globe and Mail, April 9, l999
• reduce public ex...
42
What is the
General Medical literature
Saying about
toxics?
43
500 articles on Environmental
toxics , 1992 - 1998,
(general medical literature Database)
• Canadian Medical Associatio...
44
500 Journal articles on Toxics
1992 - 1998
0
10
20
30
40
50
60
70
80
90
100
1992 1993 1994 1995 1996 1997 1998
Year
Num...
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 mischie...
48
Dr. Anthony Miller,
U of T Epidemiology
JAMA Feb 9, l994
“We must remember the long natural
history of cancer, and that...
49
Dr. David Kessler
U. S. FDA,
Joint Report of Pesticide Use, June l993
“We know that children are overexposed,
and we kn...
50
Dr. Devra Davis:
“There are critical periods in development,
e.g. the first trimester of pregnancy and
adolescence, whe...
51
Drs. W.D. Foulkes, S. V. Hodgson
Inherited Susceptibility to Cancer
BMJ June 5, l999
“it is likely that most cases of c...
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 ch...
54
Environmental exposure,
Benzo (a) pyrene
in the Great Lakes Basin
• IJC, International Joint Commission
• 11 critical c...
55
……Eastern Ontario
• Meyer’s Pier Park, Belleville
• founded on a coal gasification waste site
• Risk Assessment :signif...
56
• 1991 , Fingerhut, Steenland, NEJM
• 1999, Steenland, Fingerhut, J NCI
• exposure of industrial workers to Dioxins
• h...
58
2. Bowel cancer:
Chlorinated drinking water (I)
• Will King, OCTRF/Queen’s University
• Dec 6 , l995
• chlorinated wate...
59
Bowel cancer:
chlorinated drinking water (II)
• Doyle, Univ of Minnesota
• Lancet, Aug 23, l997
• 28,000 post menopausa...
61
3. Breast Cancer Incidence, Total
Ontario Cancer Registry,
1965 -1995
0
10
20
30
40
50
60
70
80
90
1965
1967
1969
1971
...
62
Breast Ca and Organochlorides:
20 researchers
Unger, l984 Mussala-Rauhamaa, l990
Falck, l992, Dewally, l994
Krieger, 19...
63
Breast cancer & Breast feeding
• Moysich, Vena, SUNY Buffalo, l997
• women from Love Canal area, western NY
• organochl...
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
• Child...
70
Question
Would these uncommon/rare cancers
be uncommon/rare today
if they had sustained 1 (2, 4)% annual rates
of incre...
72
1. Non Hodgkin’s Lymphomas, I
• Adami et al, Sweden
• BMJ, June 10, l995
• 2 - 4% annual increase
• in a number of coun...
74
Non-Hodgkin’s Lymphomas, III
• Rothman, Cantor
• Lancet, July 26, l997
• occurrence of NHL related to PCB levels
• ?imm...
75
Non-Hodgkin’s Lymphomas, IV
• Hardell, Eriksson (Sweden)
• Cancer 1999; 85 (Lancet March 27, l999)
• fungicide, herbici...
76
2. Testicular cancer
• 2 - 4 % annual increase for last 25 years
• Scandinavia, Europe, North America
• Canada, 2% annu...
77
Testicular cancer
rate per 100,000
SEER data, U.S. DHHS
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
1973 1977 1981 1985 1989 1993
r...
78
Testicular cancer
rate 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 gon...
81
3. Melanoma
• BMJ Jan 20, l996
• DOUBLING of rate in Southern
Hemisphere
• chlorofluorocarbon release:
• ozone loss, in...
82
4. Adult Brain Cancer
• Workshop Group on Brain cancer
• CMAJ, March l5, l992
• DOUBLING of rate, 1969 - 1985
• age > 6...
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...
85
Childhood Cancer
• Dr. Anthony Miller
• CMAJ Dec l5, l994
• 1969 - 1988
• overall incidence:
rose from 13 to 17 per 100...
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
1...
87
Canadian Childhood Cancer
Control Program II,
Gibbons, Mao, Levy, Miller,
CMAJ, Dec l5, l994
0
0.5
1
1.5
2
2.5
3
3.5
4
...
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...
89
ALL and EMF
• Greenberg, Green, HSC, June l999
• Intn’l J Cancer;J Cancer Causes & Control
• 201 children with leukemia...
90
Childhood Brain Tumors
• Admitted to HSC:
• 1990: 60 1997: 100
• Dr. John McLaughlan,U of T Epidemiology
• “There is st...
92
Cdn J of Public Health
Supplement, May/June l998
(selected papers)
“Childhood Cancer and Environmental
Contaminants”
• ...
93
Journal of Epidemiology and
Community Health , 51 (1997)
“Hazard Proximity of Childhood cancers in
Great Britain from 1...
102
Province of Ontario
Environmental politics
103
Three Ontario examples of
Action,
Inaction and Reaction
on toxics
1. PVC plastic production
2. Pulp and paper industry...
104
1. PVC plastic
• IJC 1992 (and APHA)
discontinue production of PVC
by Great Lakes Basin industry
• GO
(no action)
• si...
105
2. Pulp and paper industry
chlorine use
• IJC 1992
phase out use of chlorine
• GO, mid 90’s
regulation: end chlorine d...
106
Eastern Ontario, 1993 - 98
Hastings/Northumberland/Peterborough
Trent River-Moira watershed
• “black liquor”: waste pr...
109
3. Incineration of waste:
municipal, medical, hazardous
• IJC 1992
stop waste incineration
• GO, mid 90’s
stop waste i...
110
…….effect, Eastern Ontario, I
• Peterborough, Ontario
• April 15, 1999, feasibility hearings:
• municipal incinerator ...
111
…….effect, Eastern Ontario, II
• Trenton, Ontario
• April 1999, Norampac considering:
• hazardous waste incinerator fo...
112
…..effect, Eastern Ontario III
• Cornwall, Ontario
• Public hearings June 9 - 12, l999
• hazardous waste incinerator
•...
113
Incineration of
Municipal/Medical Waste
• U. S. EPA / Canadian dioxin Inventory ‘99
• Largest/3rd largest source of Di...
114
Incinerator health effects:
Britain
• Cancer incidence near municipal solid
waste incinerators in Great Britain
• Elli...
115
Incinerator health effects:
Columbus, Ohio: dioxin emitter
• Robert Indian, Ohio Dep’t of Health
• October 1994 (only ...
117
Eastern Ontario
• Dioxin-contaminated pulp effluent
• Waste incineration
“Breast cancer rates are (already) somewhat
(...
118
Environmental Health
research
decline in publications
in the general medical literature
119
500 Journal articles on Toxics
1992 - 1998
0
10
20
30
40
50
60
70
80
90
100
1992 1993 1994 1995 1996 1997 1998
Year
Nu...
120
Why the decline?
Who would do such research?
• (Industry and corporations)
• Governments
• universities/academic resea...
121
Government
Support for
Environmental health research
122
Government of Ontario
MoE operating budget
0
50
100
150
200
250
300
350
400
1994 1995 1996 1997
Annual Operating
Budge...
123
Government of Canada
toxics 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
19...
125
Dr. Pierre Beland
former commissioner, IJC
1998 GLU Citizen’s Hearings
“Governments are becoming more and more
uninter...
126
Federal Commissioner of
Environment : Annual Report, May 25, 1999
• Brian Emmett, auditor general of environment
• “… ...
132
Summary
&
Suggested Action
137
Problem Formulation
in toxics and cancer
in Ontario
1.Research bias: away from prevention;
away from environmental res...
138
Resolution: consider
2 additional elements in the
mandate
of
Prevention Unit
CCO
139
CCO
Prevention Unit
mandate, 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 u...
143
specific goals
Prevention Unit
of CCO
144
Promote:
• Eliminate PVC production
by plastics industry
• Eliminate chlorine use
by pulp and paper industry
• Elimina...
145
Others:
• Endorse Healthcare Without Harm
program for Ontario hospital
waste management
• Encourage pesticide use redu...
146
Conclusion
Occupational and Environmental carcinogens
are a significant public health issue.
What is the view of
the P...
147
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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

    1. 1. 1 Acknowledgment Of the work of CCO/OCTRF
    2. 2. 2 Environmental & Occupational Carcinogens Presentation to Cancer Care Ontario July 1999
    3. 3. 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. 4. 4 Definition of Environmental Carcinogens (“toxics”) • Industrial effluents • household chemical products • agricultural and home pesticides • radionuclides
    5. 5. 5 “Everyday Carcinogens” citizen’s conference • McMaster University • March 1999 • Epstein, Connett, Steingraber, Hume Hall • CCO: Dr. R. Schabas
    6. 6. 6 Background paper Everyday Carcinogens: Stopping Cancer before it starts Background Paper for the March 26 & 27, 1999 Workshop on Primary Cancer Prevention
    7. 7. 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
    8. 8. 10 Canada 1999 • 23,000 chemicals approved for use • 31: completed toxicity testing Lancet, June 5, 1999
    9. 9. 12 What is the amount of Toxic chemical releases from industrial sources?
    10. 10. 13 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
    11. 11. 21 Canadian pesticide use • Annual • 50,000 tonnes S. Elston, April 1999
    12. 12. 22 Environment Canada Jan 1999 Inventory of releases: dioxins/furans/hcb • Total dioxin releases 1997 • 468 gm TEQ/year ( 1 lb)
    13. 13. 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
    14. 14. 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 milk formula
    15. 15. 28 Industrial toxics What pollutants? What chemicals?
    16. 16. 29 Organic chemicals: a. non chlorinated: methanol, ammonia toluene, benzene, methyl ethyl ketone, ethylene glycol, APE’s, phthalates
    17. 17. 30 “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. 18. 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)
    19. 19. 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)
    20. 20. 35 Health effects of Toxics • Cancer • Sexuality (reproduction and development) • brain injury (neuropsychological) • hormonal (endocrine disrupters) • acquired immune deficiency (aids) • liver
    21. 21. 36 Causes of cancer Spectrum of opinion
    22. 22. 37 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.”
    23. 23. 38 CCO prevention unit mandate Lifestyles • Tobacco • diet • physical activity • (occupational cancer: “tentative”)
    24. 24. 39 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
    25. 25. 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
    26. 26. 42 What is the General Medical literature Saying about toxics?
    27. 27. 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
    28. 28. 44 500 Journal articles on Toxics 1992 - 1998 0 10 20 30 40 50 60 70 80 90 100 1992 1993 1994 1995 1996 1997 1998 Year Number of articles appearing 1992 -1998
    29. 29. 46 According to the medical literature carcinogens cause cancer
    30. 30. 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.”
    31. 31. 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.”
    32. 32. 49 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.”
    33. 33. 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.”
    34. 34. 51 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
    35. 35. 52 Common cancers: Toxic chemical causes: medical literature • Lung • bowel • breast • prostate
    36. 36. 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
    37. 37. 54 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
    38. 38. 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
    39. 39. 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
    40. 40. 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
    41. 41. 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
    42. 42. 61 3. Breast Cancer Incidence, Total Ontario Cancer Registry, 1965 -1995 0 10 20 30 40 50 60 70 80 90 1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 AgeStandardizedRateper100,000
    43. 43. 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
    44. 44. 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.”
    45. 45. 64 ...Recipient of this toxic flush …...Newborn breast feeding infant
    46. 46. 68 Uncommon/Rare cancers Toxic chemical causes, medical literature
    47. 47. 69 Uncommon/rare cancers: rates of increase 1 - 2 - 4% per year • NHL • testicular cancer • melanoma • Brain tumor • Childhood cancer
    48. 48. 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?
    49. 49. 72 1. Non Hodgkin’s Lymphomas, I • Adami et al, Sweden • BMJ, June 10, l995 • 2 - 4% annual increase • in a number of countries
    50. 50. 74 Non-Hodgkin’s Lymphomas, III • Rothman, Cantor • Lancet, July 26, l997 • occurrence of NHL related to PCB levels • ?immunosuppression, with EBV susceptibility
    51. 51. 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
    52. 52. 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
    53. 53. 77 Testicular cancer rate per 100,000 SEER data, U.S. DHHS 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 1973 1977 1981 1985 1989 1993 rate
    54. 54. 78 Testicular cancer rate per 100,000 Ontario Cancer Registry 0 1 2 3 4 5 6 7 1964 - 1966 1994 - 1996 rate
    55. 55. 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
    56. 56. 81 3. Melanoma • BMJ Jan 20, l996 • DOUBLING of rate in Southern Hemisphere • chlorofluorocarbon release: • ozone loss, increased u/v exposure
    57. 57. 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
    58. 58. 83 5. Childhood cancer 1:600 children by age 15
    59. 59. 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
    60. 60. 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
    61. 61. 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 cancer per 100,000 children, 1969 - 1988
    62. 62. 87 Canadian Childhood Cancer Control Program II, Gibbons, Mao, Levy, Miller, CMAJ, Dec l5, l994 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 1969 1972 1975 1978 1981 1984 1987 No of cases of childhood leukemia per 100,000, 1969 - 1988
    63. 63. 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
    64. 64. 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
    65. 65. 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
    66. 66. 92 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
    67. 67. 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
    68. 68. 102 Province of Ontario Environmental politics
    69. 69. 103 Three Ontario examples of Action, Inaction and Reaction on toxics 1. PVC plastic production 2. Pulp and paper industry chlorine use 3. Waste incineration
    70. 70. 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
    71. 71. 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…….
    72. 72. 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)
    73. 73. 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…….
    74. 74. 110 …….effect, Eastern Ontario, I • Peterborough, Ontario • April 15, 1999, feasibility hearings: • municipal incinerator construction
    75. 75. 111 …….effect, Eastern Ontario, II • Trenton, Ontario • April 1999, Norampac considering: • hazardous waste incinerator for • dioxin-contaminated pulp and paper waste
    76. 76. 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
    77. 77. 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
    78. 78. 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%
    79. 79. 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
    80. 80. 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
    81. 81. 118 Environmental Health research decline in publications in the general medical literature
    82. 82. 119 500 Journal articles on Toxics 1992 - 1998 0 10 20 30 40 50 60 70 80 90 100 1992 1993 1994 1995 1996 1997 1998 Year Number of articles appearing 1992 -1998
    83. 83. 120 Why the decline? Who would do such research? • (Industry and corporations) • Governments • universities/academic researchers
    84. 84. 121 Government Support for Environmental health research
    85. 85. 122 Government of Ontario MoE operating budget 0 50 100 150 200 250 300 350 400 1994 1995 1996 1997 Annual Operating Budget, MoE, 1994 - l997
    86. 86. 123 Government of Canada toxics research • Canadian breast milk contaminant survey • dioxin • last: 1992
    87. 87. 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 TCDD TEQ D + F
    88. 88. 125 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.”
    89. 89. 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…
    90. 90. 132 Summary & Suggested Action
    91. 91. 137 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
    92. 92. 138 Resolution: consider 2 additional elements in the mandate of Prevention Unit CCO
    93. 93. 139 CCO Prevention Unit mandate, I • Occupational cancer (definite) • Tobacco • diet • physical activity
    94. 94. 140 CCO Prevention Unit mandate, II • Occupational cancer • Environmental carcinogens • Tobacco • diet • physical activity
    95. 95. 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
    96. 96. 143 specific goals Prevention Unit of CCO
    97. 97. 144 Promote: • Eliminate PVC production by plastics industry • Eliminate chlorine use by pulp and paper industry • Eliminate incineration by waste management industry
    98. 98. 145 Others: • Endorse Healthcare Without Harm program for Ontario hospital waste management • Encourage pesticide use reduction at home on the farm
    99. 99. 146 Conclusion Occupational and Environmental carcinogens are a significant public health issue. What is the view of the Prevention Unit of Cancer Care Ontario?
    100. 100. 147

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