2008–2009 Annual Report  i President’s Cancer Panel REDUCING ENVIRONMENTAL CANCER RISK What We Can Do Now U.S. DEPARTMENT OF HEALTH20 0A8N–D20 H09U AMNANNU ASLE REVPICOERST | P NRaEtSiIoDnEaNl TIn’Ss tCitAuNtCesE Ro fP HANeaElLth National Cancer Institute 1 The President’s Cancer Panel LaSalle D. Leffall, Jr., M.D., F.A.C.S., Chair Charles R. Drew Professor of Surgery Howard University College of Medicine Washington, DC 20059 Margaret L. Kripke, Ph.D. Vivian L. Smith Chair and Professor Emerita The University of Texas M.D. Anderson Cancer Center Houston, TX 77030 This report is submitted to the President of the United States in fulfllment of the obligations of the President’s Cancer Panel to appraise the National Cancer Program as established in accordance with the National Cancer Act of 1971 (P.L. 92-218), the Health Research Extension Act of 1987 (P.L. 99-158), the National Institutes of Health Revitalization Act of 1993 (P.L. 103-43), and Title V, Part A, Public Health Service Act (42 U.S.C. 281 et seq.). April 2010 For further information on the President’s Cancer Panel or additional copies of this report, please contact: Abby B. Sandler, Ph.D. Executive Secretary President’s Cancer Panel 6116 Executive Boulevard Suite 220, MSC 8349 Bethesda, MD 20814-8349 301-451-9399 2008–2009 Annual Report i President’s Cancer Panel REDUCING ENVIRONMENTAL CANCER RISK What We Can Do Now Suzanne H. Reuben  for  The President’s Cancer Panel April 2010 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Cancer Institute The President The White House Washington, DC 20500 Dear Mr. President: Though overall cancer incidence and mortality have continued to decline in recent years, the disease continues to devastate the lives of far too many Americans. In 2009 alone, approximately 1.5 million American men, women, and children were diagnosed with cancer, and 562,000 died from the disease. With the growing body of evidence linking environmental exposures to cancer, the public is becoming increasingly aware of the unacceptable burden of cancer resulting from environmental and occupational exposures that could have been prevented through appropriate national action. The Administration’s commitment to the cancer community and recent focus on critically needed reform of the Toxic Substances Control Act is praiseworthy. However, our Nation still has much work ahead to identify the many existing but unrecognized environmental carcinogens and eliminate those that are known from our workplaces, schools, and homes. To jumpstart this national effort, the President’s Cancer Panel (the Panel) dedicated its 2008–2009 activities to examining the impact of environmental factors on cancer risk. The Panel considered industrial, occupational, and agricultural exposures as well as exposures related to medical practice, military activities, modern lifestyles, and natural sources. In addition, key regulatory, political, industrial, and cultural barriers to understanding and reducing environmental and occupational carcinogenic exposures were identifed. The attached report presents the Panel’s recommendations to mitigate or eliminate these barriers. The Panel was particularly concerned to fnd that the true burden of environmentally induced cancer has been grossly underestimated. With nearly 80,000 chemicals on the market in the United States, many of which are used by millions of Americans in their daily lives and are un- or understudied and largely unregulated, exposure to potential environmental carcinogens is widespread. One such ubiquitous chemical, bisphenol A (BPA), is still found in many consumer products and remains unregulated in the United States, despite the growing link between BPA and several diseases, including various cancers. While BPA has received considerable media coverage, the public remains unaware of many common environmental carcinogens such as naturally occurring radon and manufacturing and combustion by-products such as formaldehyde and benzene. Most also are unaware that children are far more vulnerable to environmental toxins and radiation than adults. Efforts to inform the public of such harmful exposures and how to prevent them must be increased. All levels of government, from federal to local, must work to protect every American from needless disease through rigorous regulation of environmental pollutants. Environmental exposures that increase the national cancer burden do not represent a new front in the ongoing war on cancer. However, the grievous harm from this group of carcinogens has not been addressed adequately by the National Cancer Program. The American people—even before they are born—are bombarded continually with myriad combinations of these dangerous exposures. The Panel urges you most strongly to use the power of your offce to remove the carcinogens and other toxins from our food, water, and air that needlessly increase health care costs, cripple our Nation’s productivity, and devastate American lives. Sincerely, LaSalle D. Leffall, Jr., M.D., F.A.C.S. Margaret L. Kripke, Ph.D. Chair 6 2008–2009 ANNUAL REPORT | PRESIDENT’S CANCER PANEL Executive Summary i Preface PART 1  Overview 1 PART 2  Sources and Types of Environmental Contaminants  25 Chapter 1 Exposure to Contaminants from Industrial and Manufacturing Sources 29 Chapter 2 Exposure to Contaminants from Agricultural Sources 43 Chapter 3 Environmental Exposures Related to Modern Lifestyles 51 Chapter 4 Exposure to Hazards from Medical Sources 63 Chapter 5 Exposure to Contaminants and Other Hazards from Military Sources 77 Chapter 6 Exposure to Environmental Hazards from Natural Sources 89 PART 3  Taking Action to Reduce Environmental Cancer Risk:   What We Can Do  95 Conclusions 97 Policy, Research, and Program Recommendations 103 What Individuals Can Do: Recommendations 111 References 115 Appendices Appendix A President’s Cancer Panel Meetings: Environmental Factors in Cancer—Participants A-1 Appendix B Recommendations of NIOSH Expert Panel for Improving Occupational Cancer Research Methods A-5 Appendix C Selected International, U.S., and European Carcinogen Classifcation Systems A-9 Appendix D Selected Federal Laws Related to Environmental Hazards A-17 Appendix E Federal Agencies Involved in Environmental Regulation or Research A-31 Appendix F Summary of Environmental and Occupational Links with Cancer A-37 Appendix G Electromagnetic Energy—Overview A-47 Appendix H Electromagnetic Energy Units of Measure A-51 Appendix I Research Recommended by PCP Meeting Participants A-53 TABLE OF CONTENTS 8 2008–2009 ANNUAL REPORT | PRESIDENT’S CANCER PANEL Executive Summary Despite overall decreases in incidence and mortality, cancer continues to shatter and steal the lives of Americans. Approximately 41 percent of Americans will be diagnosed with cancer at some point in their lives, and about 21 percent will die from cancer. The incidence of some cancers, including some most common among children, is increasing for unexplained reasons. Public and governmental awareness of environmental infuences on cancer risk and other health issues has increased substantially in recent years as scientifc and health care communities, policymakers, and individuals strive to understand and ameliorate the causes and toll of human disease. A growing body of research documents myriad established and suspected environmental factors linked to genetic, immune, and endocrine dysfunction that can lead to cancer and other diseases. Between September 2008 and January 2009, the President’s Cancer Panel (the Panel) convened four meetings to assess the state of environmental cancer research, policy, and programs addressing known and potential effects of environmental exposures on cancer. The Panel received testimony from 45 invited experts from academia, government, industry, the environmental and cancer advocacy communities, and the public. This report summarizes the Panel’s fndings and conclusions based on the testimony received and additional information gathering. The Panel’s recommendations delineate concrete actions that governments; industry; the research, health care, and advocacy communities; and individuals can take to reduce cancer risk related to environmental contaminants, excess radiation, and other harmful exposures. Key Issues for Reducing Environmental Cancer Risk Issues impeding control of environmental cancer risks include those related to limited research on environmental infuences on cancer; conficting or inadequate exposure measurement, assessment, and classifcation; and ineffective regulation of environmental chemical and other hazardous exposures. 2008–2009 ANNUAL REPORT | PRESIDENT’S CANCER PANEL i Environmental Cancer Research encountered by humans. These data—and the exposure limits extrapolated from them— Research on environmental causes of fail to take into account harmful effects that cancer has been limited by low priority may occur only at very low doses. Further, and inadequate funding. As a result, the chemicals typically are administered when cadre of environmental oncologists is laboratory animals are in their adolescence, relatively small, and both the consequences a methodology that fails to assess the impact of cumulative lifetime exposure to known of in utero, childhood, and lifelong exposures. carcinogens and the interaction of specifc In addition, agents are tested singly rather environmental contaminants remain largely than in combination. unstudied. There is a lack of emphasis on environmental research as a route to primary Regulation of Environmental cancer prevention, particularly compared with research emphases on genetic and Contaminants molecular mechanisms in cancer. The prevailing regulatory approach in the United States is reactionary rather than Environmental Exposure precautionary. That is, instead of taking Measurement, Methodologic, preventive action when uncertainty exists about the potential harm a chemical or Assessment, and Classifcation other environmental contaminant may Issues cause, a hazard must be incontrovertibly demonstrated before action to ameliorate it Efforts to identify, quantify, and control is initiated. Moreover, instead of requiring environmental exposures that raise cancer industry or other proponents of specifc risk, including both single agents and chemicals, devices, or activities to prove combinations of exposures, have been their safety, the public bears the burden of complicated by the use of different measures, proving that a given environmental exposure exposure limits, assessment processes, and is harmful. Only a few hundred of the classifcation structures across agencies more than 80,000 chemicals in use in the in the U.S. and among nations. In addition, United States have been tested for safety. efforts have been compromised by a lack of effective measurement methods and U.S. regulation of environmental tools; delay in adopting available newer contaminants is rendered ineffective by fve technologies; inadequate computational major problems: (1) inadequate funding models; and weak, fawed, or uncorroborated and insuffcient staffng, (2) fragmented and studies. overlapping authorities coupled with uneven and decentralized enforcement, (3) excessive Some scientists maintain that current toxicity regulatory complexity, (4) weak laws and testing and exposure limit-setting methods regulations, and (5) undue industry infuence. fail to accurately represent the nature of Too often, these factors, either singly or in human exposure to potentially harmful combination, result in agency dysfunction chemicals. Current toxicity testing relies and a lack of will to identify and remove heavily on animal studies that utilize doses hazards. substantially higher than those likely to be ii 2008–2009 ANNUAL REPORT | PRESIDENT’S CANCER PANEL