The U. S. National Cancer Institute (NCI) has instant access to
the media, Public Relations operations, and close contacts with
Congress. Fully utilizing these outreach resources NCI issues
a prodigious ongoing stream of information, press releases, databases,
and public educational materials. The latter include the Comprehensive
Public Cancer Database System dealing with screening, diagnosis,
clinical research, and the latest claimed advances in treatment.
In sharp contrast, NCI makes little or no effort to warn the
public of well-documented risks, based on experimental and/or
epidemiological evidence, from unknowing exposure to a wide range
of industrial carcinogens, including those in consumer products,
food, cosmetics, toiletries, and household products. As importantly,
the National Cancer Institute has also failed to warn of potential
carcinogenic risks on the basis of incomplete or suggestive,
although not definitive, evidence and also to direct high priority
to research and advocacy on such risks. Such failure disregards
fundamental principles of public health and the scientific basis
of the Precautionary Principle. This mandates the categorical
responsibility of industry to provide unequivocal evidence on
the safety of any new candidate product or process before its
introduction into commerce, thereby ensuring that it does not
pose potential or recognized human or environmental risks.
Denial of Citizens’ Right-to-Know
The U. S. National Cancer Institute has not attempted to develop
a registry of avoidable carcinogenic exposures, including body
burden data (p. 19), and make it available to the public. This
is in striking contrast to the extensive user-friendly public
educational outreach programs of NCI and ACS on cancer treatment
and screening. Until such a registry becomes available, in the
absence of an acute emergency, patients should specifically request
full documentation on the risks of any drug, available in the
Warnings and Precautions section of the annual Physicians Desk
Reference. This is also in striking contrast to the misleading
May 1998 response by past NCI Director Klausner to a question
by Congressman Obey whether NCI’s Cancer Information Service
provides the public with a registry of avoidable carcinogens.
NCI’s silence effectively denies U.S. citizens of their
fundamental democratic Right-to-Know of information on avoidable
causes of a wide range of cancers which could empower them to
reduce their own risks of disease and death. In this, the cancer
establishment appears to make common cause with the chemical
This longstanding denial of citizens’ Right-to-Know
impacts disproportionately on low income black and other ethnic
besides raising serious concerns on environmental justice. These
population sub-groups are at particularly high risk in view of
their general discriminatory location near petrochemical plants,
hazardous waste sites, municipal incinerators, and nuclear reactors.
However, the cancer establishment has rarely, if ever, undertaken
epidemiological cluster analyses of claimed excess incidences of
a wide range of cancers in such communities, let alone investigate
their relation to local exposure to industrial carcinogens.
The cancer establishment’s denial of Right-to-Know extends
to failure to provide Federal and State agencies with scientific
data on carcinogenicity on which regulatory decisions are critically
based, claiming that this is not their responsibility. However,
regulatory agencies are charged with a wide range of other responsibilities.
They also lack the authority and wealth of scientific and educational
resources specifically directed to cancer which are heavily invested
in the cancer establishment; regulatory agencies are also susceptible
to industry lobbying and, more importantly, pressure from pro-industry
administrations. Most critically, NCI and ACS have rarely, if ever,
provided such data to Congress as a necessary basis for developing
appropriate legislation and regulatory authority, apart from failing
to inform the public-at-large (12, 34).
It should be stressed that NCI's silence
on primary cancer prevention is in violation of the 1971 National
Cancer Act's specific charge "to
disseminate cancer information to the public." This silence
is in further denial of the 1988 Amendments to the National Cancer
Program (Title 42, Sec. 285A), which call for "an expanded
and intensified research program for the prevention of cancer caused
by occupational or environmental exposure to carcinogens."
The silence of the ACS and its track record
on primary prevention (Appendix V) is in contrast to their misleading
claims for advocacy,
as emphasized in its Cancer Facts and Figures 2002: "Cancer
is a political, as well as medical, social, psychological, and
economic issue. Every day, legislators make decisions that impact
the lives of millions of Americans who have been touched by cancer.
To affect those decisions positively, the Society has identified
advocacy as part of its mission and as one of its top corporate
priorities, and works nationwide to promote beneficial policies,
laws, and regulations for those affected by cancer."
Avoidable causes fall into four categories,
posing widely differing types of empowerment, ranging from the
personal to political:
- Consumer products: NCI and ACS have failed to inform the
public of available information on common carcinogenic ingredients
contaminants in food, cosmetics and toiletries, and household
products. They have also failed to provide such information
and to urge regulatory agencies to require explicit identification
and warning labels for all such carcinogens. Such market place
pressures would then enable consumers to boycott those industries
marketing unsafe products in favor of socially responsible businesses,
which are increasingly marketing safer products.
- Medical: A wide
range of carcinogenic drugs are commonly prescribed to patients
in the absence of legally-required informed consent,
and of any safe alternatives. The cancer establishment has failed
to systematize such information and circulate it to all physicians
and the public, and to recommend explicit warning labels on all
carcinogenic drugs. Patients should thus request their physicians
to provide them with any such evidence (experimental and epidemiological)
of cancer risks, as identified in the Warnings and Precautions
section of the annual Physicians Desk Reference (PDR). For drugs
so identified, patients should request available non-carcinogenic
There is now strong evidence that allegedly "low dose" ionizing
radiation from diagnostic procedures, particularly CT scans and
fluoroscopy, poses significant risks of cancer. These risks are
avoidable, as average doses can be substantially reduced without
any loss of image quality. Emergencies apart, patients should seek
radiologists who are increasingly practicing dose-reduction imaging
- Environmental: The cancer establishment has failed to collate and
systematize avoidable information on carcinogenic contaminants
in air and water on an ongoing basis, and to make this readily
available to the public (12). This information has now become available,
at community and zip code locations, in the Environmental Defense’s
Scorecard (p. 17). Such information would enable activist citizen
groups to take political action at the state level in efforts to
reduce these carcinogenic exposures. It should be stressed that
neither NCI nor ACS have considered, let alone initiated, epidemiological
analyses to investigate possible cancer clusters in highly polluted
- Occupational: There is substantial information on a wide
range of carcinogenic products and processes to which some
men and 4 million women are exposed (12). While industries employing
more than 10 workers are required, by the Occupational Safety
and Health Administration, to supply them with Material Safety
Sheets, such information is generally inadequate and often misleading.
While some unions take aggressive action to reduce occupational
carcinogenic exposure, this is by no means the rule. Furthermore,
plants employing less than 10 workers, generally lower socio-economic
ethnic minorities, are virtually exempt from any such protective
measures. Again, NCI and ACS should systematize such information
and make it fully available to unions and workers on a national
Finally, the cancer establishment's massive funding of a
nationwide network of research institutes and hospitals virtually
the silence or reticence of their captive epidemiologists and
other scientists on primary prevention. These constraints were
exemplified in a widely-publicized May 2002 Public Broadcasting
Service television report, Kids and Chemicals, on the relationship
between chemical exposures and childhood cancer, and other diseases.
The program featured well-qualified experts, some funded by the
cancer establishment, who expressed strong concerns while misleadingly
stressing the inadequacy of current information. One stated: "We
suspect that children who are exposed to pesticides are at greater
risk of childhood cancer than other children. But mostly we don't
know." Another claimed: "We have a very serious lack
of information of how to go about preventing these diseases, because
we haven't had enough information." For these reasons, the
experts called for a “National Children's Study” over
the next 20 years at a cost of $50 million annually. However,
this proposal trivialized substantial and longstanding available
information on avoidable causes of childhood cancer, of which
the public still remains uninformed by the cancer establishment.
no mention was made of the primary responsibility of the NCI
and ACS, whose funding is more than adequate, to undertake further
research on avoidable causes of childhood cancer.
1. Ries, L.A.G., Eisner, M.P., Kosary, C.L., Hankey, B.F., Miller,
B.A., Clegg, L., Edwards, B.K. (eds). SEER Cancer Statistics
Review, 1973-1999, National Cancer Institute, Bethesda, MD, 2002.
2. Dinse, G.E., Umbach, D.M., Sasco, A.J., Hoel, D.G., Davis,
D.L. Unexplained Increases in Cancer Incidence in the United States
from 1975 to 1994: Possible Sentinel Health Indicators? Ann. Rev.
Public Health 20:173-209, 1999.
3. Edwards, B.K., Howe, H.L., Ries, L.A.G., Thun, M.J., Rosenberg,
H.M., Yancik, R., Wingo, P.A., Jemal, A., Feigal E.G. Annual Report
to the Nation on the Status of Cancer, 1973-1999, Featuring Implications
of Age and Aging on the U.S. Cancer Burden.
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6. Clapp, R.W. The Decline in U.S. Cancer Mortality from 1991
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Press, Chicago, IL, 2001.
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B.F. Impact of Reporting Delay and Reporting Error on Cancer Incidence
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11. Fellers, L. "Taxol is One of the Best Cancer Drugs Ever
Discovered by the Federal Government: Why Is It Beyond Some Patients'
Reach?" The Washington Post Magazine, May 31, 1998.
12. Epstein, S.S. The Politics of Cancer, Revisited. East Ridge
Press, Fremont Center, NY, 1998. (Extensive scientific information
on the causes and prevention of cancer and public policy.)
13. Doll, R. & Peto, R. The Causes
of Cancer: Quantitative Estimates of Avoidable Risks of Cancer
in the U.S. Today. J. Nat.
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14. Stallones, R. A. & Downs, T.A.
A Critical Review of Estimates of the Fraction of Cancer in the
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15. Landrigan, P. Commentary: Environmental Disease: A Preventable
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16. Anderson, S.J., Culver, A.A., Dorfman, M.H., Hughes, A.S.
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as a Tool for Promoting Environmental Justice and Pollution Prevention.
INFORM, Inc., www.informinc.org, New York, NY, 2000.
17. Greaves, P., Goonetilleke, R., Nunn, G., Topham, J., Orton,
T. Two-Year Carcinogenicity Study of Tamoxifen in Alderley Park
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18. White, J. (CEO Canadian Cancer Society), Letter to Guelph
Mercury, Ontario, Canada, April 9, 2002.
19. Kliewer, E.V., Smith, K.R. Breast Cancer Mortality Among Immigrants
in Australia and Canada. J. Nat. Cancer Inst. 87 (15):1154-1161,
20. Lichtenstein, P., Holm, N., Verkasalo, P., Iliadou, A., Kaprio,
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and Heritable Factors in the Causation of Cancer: Analyses of Cohorts
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and Organic Foods: Insights from Three U.S. Data Sets. Food Additives
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24. Epstein, S.S., Hauter, W. Preventing Food Poisoning: Sanitation
not Irradiation. Int. J. Health Services 31(1):187-192, 2001. (This
publication was endorsed by over 20 leading international scientists,
besides consumer groups.)
25. Tourgeman, D.E, Amezcua, C., Boostanfar, R., Stanczyk, F.Z.,
Felix, C., Paulson, R.J. Agonistic Effects of Raloxifene on Ovarian
Adenocarcinoma (OVCAR-3) Cells. Abstract. Presented at the 17th
Annual Meeting of the European Society of Human Reproduction and
Embryology, Lausanne, Switzerland, July 1-4, 2001.
26. National Toxicology Program, Toxicology and Carcinogenesis
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Stories Press, www.sevenstories.com, 2001.
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to the Swedish Parliament following receipt of the Right Livelihood
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Cancer Before it Starts: How to Win the War on Cancer, 2003
by Samuel S. Epstein, M. D.
Cancer Prevention Coalition
University of Illinois at Chicago
School of Public Health
2121 W. Taylor St., MC 922
Chicago, IL 60612