- Misguided policies
- Funding lucrative drug treatments
- Caving in to corporate interests
S. National Cancer Institute (NCI) has claimed to be committed to
preventing cancer, but its budget and policy priorities deny it.
Of an approximately $4.6 billion 2003 budget, the NCI allocates
less than one percent to researching occupational cancers, even
though they are the most preventable cancers. Over 10 percent of
adult cancer deaths result from occupational exposures, which are
also a recognized cause of cancer in children: parents exposed to
carcinogens on the job often expose their unborn children to the
same cancer-causing chemicals. And while the NCI says that diet
accounts for roughly one-third of all cancers, it spends just $1
million on education, media, and public outreach to promote the
consumption of fruits and vegetables for cancer prevention, while
ignoring well-documented evidence that produce contaminated with
carcinogenic pesticide residues increases risk. It also fails to
educate the public about the cancer risks posed by a wide range
of industrial by-products and contaminants, particularly dioxin.
The cancer establishment has a long history
of trivializing or ignoring prevention initiatives while claiming
war on cancer.
Both the National Cancer Institute and the American Cancer
Society (ACS) are fixated on damage control—screening, diagnosis, and
treatment—and genetic research, and are largely indifferent
to cancer prevention. For the American Cancer Society, that indifference
approaches outright hostility. What the cancer establishment calls
prevention is more aptly described as a "blame-the-victim" approach,
emphasizing poor lifestyle habits while downplaying the role
of avoidable exposures.
The cancer establishment has been most negligent
in its failure to provide Congress, regulatory agencies, and the
with well-documented scientific evidence of known cancer
This information is
for Congress if it is to protect the public by legislating
or banning the addition of recognized carcinogens, from food
pesticides. Regulatory agencies need it to create standards
for a wide range
of industrial carcinogens and, as citizens, we have a right
to know about and to protect ourselves from dangerous chemicals
our food, air, water, and consumer goods. Where was the cancer
establishment last May, when the Environmental Protection
Agency, entrusted with
keeping the nation's water supplies safe, approved arsenic
levels that pose a greater cancer risk than any other tap-water
(on the grounds that it could not justify the high costs
of regulation since most resulting cancers would be "curable")?
This aversion to prevention is complicated by
conflicts of interest springing from the cancer establishment's
with corporate America. The cancer drug industry regularly
National Cancer Institute for executive hires, prompting
former NCI Director Samuel Broder to charge that "the NCI has become what
amounts to a governmental pharmaceutical company." Meanwhile,
industrial interests are well represented on the American
Cancer Society's twenty-two member board, which was created
to solicit corporate contributions over $100,000. The board
from companies that either profit handsomely from treating
cancer, like Amgen, or contribute to the disease by polluting
with a wide range of carcinogens, like the major pesticide
manufacturer, American Cyanamid. It is no great surprise
that ACS policies more
often reflect the interests of these companies than those
of public health.
The U. S. National Cancer Institute grossly
exaggerates its alleged allocations for research
and advocacy on primary prevention, while trivializing
the role of industrial carcinogens as avoidable causes
that $350 million (17 percent) of its approximately $2
1992 budget was allocated to primary prevention. However,
expenditures (based on published independent estimates,
unchallenged by the
NCI) were less than $50 million (2.5 percent), of which
$19 million (0.9 percent)
was allocated to occupational cancer (24). Only $15 million
(0.03 percent) of the
$4.2 billion 2002 budget is allocated to intramural occupational
trivial allocations strikingly illustrate the NCI's past
and current reckless neglect
of primary cancer prevention.
NCI leadership has used manipulation and semantics to mislead
confuse Congress about its claimed allocations for primary cancer
The institute massively exaggerates such allocations by including
secondary prevention" screening, diagnosis, and chemoprevention
by the use of
dietary "nutraceuticals" or drugs such as tamoxifen in
questionable efforts to
reduce susceptibility to prior carcinogenic exposures. Not surprising
reaction by Rep. David Obey (D-WI) at hearings before a House Subcommittee
the Committee on Appropriations on March 16, 1992: "A number
have suggested that cancer prevention receives an even smaller
percentage of the
budget than what NCI considers primary prevention." This skepticism
detailed in later exchanges between Rep. Obey and Dr. Klausner.
questions and Dr. Klausner's responses of May 1, 1998, are summarized
followed by my comments on Klausner's responses (13).
Question: "Provide a breakdown of NCI's cancer prevention
categories— where prevention is the primary purpose of the
Answer: "Funding for primary prevention in 1997 was over $480
almost 50 percent [of which] was directed towards environmental
19 percent was directed towards nutrition research, 14 percent
and 2 percent was related to occupational exposures. . . . Opportunities
prevention are emerging and we anticipate fully to take advantage
opportunities." Comment: The claimed $480 million primary
approximately 20 percent of the budget, are inconsistent with
the NCI's February
1997 budget for "research dollars by various cancers," listing
an allocation of
$249 million for "cancer prevention and control." Furthermore,
was provided on the alleged 50 percent expenditure on "environmental
exposures." The 19 percent for nutrition research was
allocated to chemoprevention, in
attempts to protect against avoidable exposures to environmental
and to the "protective effects" of low-fat, high fruit
and vegetable diets, while
ignoring evidence on the role of dietary contamination with carcinogenic
As disturbing was the less than 2 percent allocated to occupation,
single most important cause of avoidable carcinogenic exposures.
of 15 percent of the alleged $480 million primary prevention expenditures
unaccounted for. In response to a later request for information
from the House
Committee on Government Reform and Oversight, Klausner responded
doubling this figure to approximately $1 billion.
than tobacco and exposure to sunlight, do you think that
the general public has been adequately informed about avoidable
Answer: "The NCI and other organizations including
the ACS ... have worked
for years to inform the public about lifestyle choices that could
decrease the risks of cancer— through NCI's Cancer Information
through distribution of millions of publications. In addition,
when testing shows
that chemicals cause cancer, NCI and other agencies including the
Toxicology Program (NTP) and the International Agency for Research
(IARC) publicize the test results."
Comment: This response illustrates the NCI's fixation
on personal responsibility
for cancer prevention. The NCI still takes no responsibility for
dissemination of scientific information on avoidable risks from
and unknowing exposures to a wide range of carcinogenic chemicals,
those identified and systematized by the IARC and, on a more limited
the NTP. And senior NCI scientists are on record as denigrating
relevance of carcinogenicity test data. Furthermore, the NCI has
rarely, if ever,
testified before Congress on the validity of published evidence
carcinogenic exposures, nor has it provided such information to
Question: "Should the NCI develop a registry of avoidable
make this information widely available to the public?"
Answer: "Such information is already available from
NCI's Cancer Information
Service— and also from IARC and the NTP."
Comment: The IARC and the NTP have not developed such
registries, nor is
it their mission.
Question: "During the hearing, you stated that NCI
could effectively spend
$5 billion by 2003. Provide a budget mechanism table that shows
would allocate this level of spending in 2003, compared to 1998."
Answer: "NCI envisions a three-pronged approach:
1. Sustain at full measure the proved research programs that have
to come this far.
2. Seize 'extraordinary opportunities' to further progress brought
our previous successes. Our goals in these areas are: Cancer genetics;
pre-clinical models of cancer; and imaging technologies, defining
of cancer cells.
3. Create and sustain mechanisms that will enable us to rapidly
findings from the laboratory into practical applications that will
Comment: This response is as broad in generalization as
it is sparse in detail.
The most revealing evidence of the NCI's highly restricted policies
prevention is detailed in its Cancer Progress Report of 2001 (9).
compares past "progress with the cancer-related targets set
forth in the Department
of Health and Human Services Objectives for the first decade of
the 21st century."
The report states that "behavioral factors," detailed
in nineteen pages, are
responsible for as much as 75 percent of all cancer deaths in the
while recognizing that "certain chemicals in the environment
are known to cause
cancer." However, these carcinogenic chemicals, summarily
dealt with in three
pages, are restricted to secondhand smoke; benzene in the air,
smoking and occupational exposures; and radon in the home.
even more limited comprehension (or greater neglect) of prevention
revealed in the "Highlights" of the NCI's Cancer Facts
of May 2001, which
begins "Cancer prevention is a major component and current
priority— to reduce
suffering and death from cancer. Research in the areas of diet
tobacco cessation, chemo-prevention, and early detection and screening
NCI's major cancer prevention programs" (25). No mention is
made of environmental
and occupational carcinogens.
When President Nixon launched the war on cancer
in 1971, the cancer establishment seized the opportunity to pursue
its own narrow self-interest.
Its policies and strategies on cancer continue to ignore the essential
steps required to wage an effective battle against the disease
and remain based on two myths: First, that there has been dramatic
progress in the treatment and cure of cancer. Second, that any
increase in cancer incidence and mortality is due to an aging population
and smoking—discounting evidence that occupational exposures
and urban air pollution are also implicated in many cases of lung
cancer—while denying any significant role for involuntary
and avoidable exposures to industrial carcinogens.
Cancer is preventable. But we'll make little
headway if public officials like Al Gore and Dianne Feinstein
fail to recognize the
importance of prevention and the critical need for drastic, immediate
reform. It is time for the cancer establishment to deploy its considerable
war chest toward implementing meaningful cancer prevention strategies
and eliminating the toxic output of industry. We must put lives
before profits. Only then will we begin to make real progress in
the war on cancer.
1. Ries, L. A. G., et al. SEER Cancer Statistics Review, 1973– 1999.
Institute, Bethesda, Md., 2002.
2. Dinse, G. E., et al. Unexplained increases in cancer incidence
in the United States from
1975 to 1994: Possible sentinel health indicators? Annu. Rev. Public
173– 209, 1999.
3. Edwards, B. K., et al. Annual report to the nation on the status
of cancer, 1973– 1999,
featuring implications of age and aging on the U. S. cancer burden.
Cancer 94( 10):
2766– 2792, 2002.
4. Davis, D., and Hoel, D. (eds.). Trends in Cancer Mortality in
New York Academy of Sciences, New York, 1990.
5. National Cancer Institute and American Cancer Society. Report
Card. Bethesda, Md.,
March 12, 1998.
6. Stolberg, S. G. New cancer cases decreasing in U. S. as deaths
do, too. New York
Times, March 13, 1998.
7. Bailar, J., and Gornik, H. L. Cancer undefeated. N. Engl. J.
Med. 336( 22): 1569– 1574, 1997.
8. Clapp, R. W. The decline in U. S. cancer mortality from 1991
to 1995: What's behind
the numbers? Int. J. Health Serv. 28( 4): 747– 755, 1998.
9. National Cancer Institute. Cancer Progress Report. Bethesda,
10. Greenberg, D. Science, Money, and Politics. University of Chicago
11. Kolata, G. Test proves fruitless, fueling new debate on cancer
screening. New York
Times, April 9, 2002.
12. Fellers, L. Taxol is one of the best cancer drugs ever discovered
by the federal
government: Why is it beyond some patients' reach? Washington Post
May 31, 1998.
13. Epstein, S. S. The Politics of Cancer, Revisited. East Ridge
Press, Fremont Center,
N. Y., 1998.
14. Doll, R., and Peto, R. The causes of cancer: Quantitative estimates
of avoidable risks
of cancer in the U. S. today. J. Natl. Cancer Inst. 66: 1191– 1308,
15. Stallones, R. A., and Downs, T. A. A Critical Review of Estimates
of the Fraction of
Cancer in the U. S. Related to Environmental Factors. Report to
the American Indus-trial
Health Council. University of Texas School of Public Health, Houston,
16. Landrigan, P. Commentary: Environmental disease: A preventable
epidemic. Am. J.
Public Health 82( 7): 941– 943, 1992.
17. Anderson, S. J., et al. Expanding the Public's Right-to-Know:
Data as a Tool for Promoting Environmental Justice and Pollution
New York, 2000 (www. informinc. org).
18. Doody, M. M., et al. Breast cancer mortality after diagnostic
from the U. S. scoliosis cohort study. Spine 25( 16): 2052– 2063,
19. Ford, L. Letter to J. W. Stratton, Interim Director, California
Agency, Sacramento, June 23, 1995.
20. Greaves, P., et al. Two-year carcinogenicity study of tamoxifen
in Alderley Park
Wistar-derived rats. Cancer Res. 53( 17): 3919– 3924, 1993.
21. Kliewer, E. V., and Smith, K. R. Breast cancer mortality among
Australia and Canada. J. Natl. Cancer Inst. 87( 15): 1154– 1161,
22. Lichtenstein, P., et al. Environmental and heritable factors
in the causation of cancer:
Analyses of cohorts of twins from Sweden, Denmark, and Finland.
N. Engl. J. Med.
343( 2): 78– 85, 2000.
23. Willett, W. C. Balancing life-style and genomics research for
Science 296: 695– 698, 2002.
24. Epstein, S. S. Evaluation of the National Cancer Program and
Am. J. Ind. Med. 24: 109– 133, 1993.
25. National Cancer Institute. Cancer Facts. Bethesda, Md., May
The High Stakes of
Cancer Prevention” by Samuel Epstein and Liza Gross, Tikkun
Magazine, Nov/Dec 2000 www.tikkun.org; and THE
CRISIS IN U. S. AND INTERNATIONAL
CANCER POLICY by Samuel S. Epstein, Nicholas A. Ashford, Barry
Castleman, Edward Goldsmith, Anthony Mazzocchi, and Quentin D. Young.
International Journal of Health Services Volume 32, 4:669-707, 2002.
Samuel S. Epstein, M.D., Chairman
Cancer Prevention Coalition
2121 W. Taylor St., M/C 922
Chicago, IL 60612