Townsend Letter for Doctors and Patients, BookCorners, April 1999

For decades, Samuel S. Epstein, M.D., Professor of Occupational and Environmental Medicine at the University of Illinois Medical Center (Chicago), has studied toxic and carcinogenic substances that are found in environmental pollution and in consumer products. During this career, he has been a consultant to the U.S. Senate Committee on Public Works and a member of the Environmental Protection Agency's Health Advisory Committee and the Department of Labor Advisory Committee on the Regulation of Occupational Carcinogens. Congress has frequently asked for his testimony; his expertise provided a basis for banning DDT, Aldrin, and Chlordane. Epstein is also recognized as the leading international authority on the hazards of bovine growth hormone (rBGH).

Epstein's scientific knowledge and his governmental experience led him to write The Politics of Cancer, published by Sierra Club Books in 1978. In it, he explains the rationale behind animal testing and epidemiological studies, the two methods currently used to determine a substance's carcinogenicity. Then, Epstein documents the relationships between exposure to environmental and occupational carcinogens and rising cancer rates. Exposure to many of these carcinogens is avoidable; they can be replaced by less harmful substances or used and disposed of with far greater care. Industry and the cancer establishment have balked at these solutions. Twenty years after the publication of The Politics of Cancer, Epstein has produced The Politics of Cancer Revisited, which contains a revised and expanded version of his 1978 classic and updated information on scientific developments and public policy. In it, Epstein charges the cancer establishment with "major responsibility for losing the winnable war against cancer."

The Politics of Cancer Revisited is a monumental work. Part I of the book explains the limitations and accuracies of cancer research. It also contains case histories of the research and political wrangling over several carcinogens, including asbestos, vinyl chloride, bischloromethylether, benzene, tobacco, red dyes #2 and #40, saccharin, acrylonitrile, female sex hormones, pesticides, aldrin/dieldrin, chlordane/heptachlor, and nitrosamines. Government and cancer establishment policies through 1978 are also presented. In Part II, Epstein spends less time on documenting specific cases and more on challenging and debunking current cancer establishment policy and its U.S. and British apologists. Much of this section takes the form of articles, reports, and press releases dated from 1987-1998. Appendices include documentation on the hazards of hormones in meat and milk, the many factors that contribute to breast cancer, and citizen petitions to the FDA regarding avoidable cancer risks.

Despite the cancer establishment's claim that "we" are winning the war against cancer, the incidence of cancer continues to increase. Epstein admits that many factors - including genetic, endocrine, immunological, viral, biochemical, and psychological factors - contribute to the development of cancer. The main factor that has brought about the dramatic increase in cancer over the last century, however, is the multitude of carcinogenic substances in the workplace and environment. The Preface to the First Edition of the 1978 book states: "Cancer is caused mainly by exposure to chemical or physical agents in the environment . The more of a carcinogen present in the human environment, hence the greater the exposure to it, the greater the chance of developing cancer from it . There is no known method for measuring or predicting a 'safe' level of exposure to any carcinogen below which cancer will result in any individual or population group."

Back in 1978, experts from the National Cancer Institute, the National Institute of Environmental Health Sciences, and the National Institute of Occupational Safety and Health used detailed epidemiological and statistical evidence to prepare a highly respected HEW report entitled, "Estimates of the Fraction of Cancer in the United States Related to Occupational Factors." In this report, the experts estimate that up to 38 percent of all cancer deaths during the years 1978-2008, would be linked to six 'high exposure,' occupational carcinogens: asbestos, arsenic, benzene, chromium, nickel oxides, and petroleum fractions. The estimates consider the effect of these carcinogens on workers only. It does not include their effect on the workers' families or household members (Workers bring carcinogenic chemicals and dust into their homes via clothes and skin), nor the effect on community members who are exposed to these substances via industrial pollution. Also, the report disregards the effect of radiation and all other known occupational carcinogens.

People are also exposed to industrial chemicals via consumer products. Epstein discusses several common carcinogens found in various products, foods, and prescription drugs. For example, diethanolamine (DEA), a carcinogen that is easily absorbed through the skin, is used in many cosmetics, soaps, and toiletries. Permanent and semi-permanent dark hair dye contains hazardous ingredients that produce 20% of the non-Hodgkin's lymphoma found in U.S. women. Food colorings, pesticides and fungicides, nitrites, and hormones are among the cancer-causing ingredients currently permitted in food. Over 95% of American beef cattle received carcinogenic growth-promoting hormone implants in 1990. Not only is the food adulterated, the packaging can be hazardous. Microwave packaging, plastic wrap, and cling film contain carcinogenic chemicals that can migrate into the food. Finally, prescription drugs, according to Epstein, "may pose the single most important class of unrecognized and avoidable cancer risks for the U.S. population." He cites, as an example, Evista, a new anti-osteoporosis drug that causes ovarian cancers at one-third of the recommended dose.

Industry, with the support of academic consultants and members of the cancer establishment, has intentionally downplayed these cancer risks. Despite strong evidence to the contrary, the cancer establishment attributes only 4% of cancer moralities to occupational exposure. Why? In Part II, Epstein documents the incestuous relationship of the National Cancer Institute (NCI), American Cancer Society (ACS), major cancer clinics, and industry. For example, Memorial Sloan-Kettering Comprehensive Cancer Center owns thousands of shares in cancer pharmaceutical companies - Bristol Myers, Eli Lilly, Squibb, and others. A 1988 list of the Center's overseers includes directors, presidents, and CEOs of drug, petroleum, and tobacco companies. The three-member, Presidentially-appointed Cancer Panel that controls NCI policies has included senior drug company executive and member of Sloan-Kettering Board of Overseers Benno C. Schmidt and Chairman of Occidental Petroleum, Armand Hammer.

One blatant example of the conflict-of-interest within the cancer establishment that Epstein cites is Zeneca Pharmaceuticals' funding of National Breast Cancer Awareness Month. Zeneca Pharmaceuticals has funded this multimillion-dollar ACS and NCI promotion that encourages women to troop in for an annual mammogram since 1984. (Because radiation is carcinogenic, Epstein is very critical of routine mammograms in pre-menopausal women, whose breasts tend to be highly sensitive to radiation). Zeneca manufactures tamoxifen, the top-selling breast cancer drug. Zeneca Pharmaceuticals' parent company is Imperial Chemical Industries, one of the world's largest manufacturers of chlorinated and other industrial chemicals, including chemicals that are known to cause breast cancer. None of the publications used for National Breast Cancer Awareness Month mentions the well-documented role of carcinogenic industrial chemicals in breast cancer.

Epstein lambasts the cancer establishment, with its close ties to industry, for blocking true cancer prevention. In February 1992, Epstein and three colleagues - former directors of federal agencies Drs. Eula Bingham and David Rall and Dr. Irwin D. Bross - expressed concerns about the current "war against cancer" and proposed reforms in a statement presented at a press conference. The statement was endorsed by 64 leading national experts in cancer prevention, public health, and preventive medicine. After noting the continual rise in the incidence of cancer, the statement reads: "We express further concerns that the generously funded cancer establishment, the National Cancer Institute (NCI), the American Cancer Society (ACS) and some 20 comprehensive cancer centers, have misled and confused the public and Congress by repeated claims that we are winning the war against cancer. In fact, the cancer establishment has continually minimized the evidence for increasing cancer rates, which it has largely attributed to smoking and dietary fat, while discounting or ignoring the causal role of avoidable exposures to industrial carcinogens in the air, food, water, and the workplace."

ACS not only ignores environmental and occupational carcinogens, the ACS has thrown the full weight of its prestige and money against laws that ban the deliberate addition of carcinogenic substances to foods and have campaigned for the continued use of organochlorine pesticides, some of which are known to cause breast cancer. "An economic boycott of the ACS," writes Epstein, "is now well overdue."

Not all man-made chemicals are carcinogenic. In fact, less than 10% of 140 industrial compounds suspected of being carcinogenic actually caused cancer in laboratory tests conducted from 1963 to 1969. The problem is that known carcinogens are permitted in the workplace, air, water, food, and consumer products. Epstein believes that organizing political action is needed to educate the media, the public, and Congress that much cancer is avoidable and to campaign for reduction in environmental carcinogens. He urges readers to support public interest groups and/or organized labor groups that have been responsible for many of the regulations against carcinogens that are already in place. To encourage such action, The Politics of Cancer Revisited contains a list of activist and resource groups in the U.S. and U.K.

Epstein also encourages consumers to vote with their shopping dollars. When companies see that consumers are spending money on safer products, they will seek alternatives to the carcinogenic products and processes that they presently use. Epstein refers to a book that he wrote with David Steinman called The Safe Shopper's Bible that informs consumers what products and food contain known carcinogens. Not only will avoiding these products hurt the manufacturers' pocketbook, it will also be a positive step in lessening one's risk of cancer.

The Politics of Cancer Revisited thoroughly depressed me. I knew that the "war on cancer" was a rip-off, but I didn't realize the extent of the collusion. Too, I'm depressed that the rise in incidence of cancer directly correlates to the ubiquitous use of carcinogens; and, no one - not government, not industry, not the medical establishment - is making any attempt to find or use less hazardous materials. We're paying the cost. The Politics of Cancer Revisited reflects over 20 years of fighting to have the truth known and recognized, Dr. Epstein has done his part in educating, in getting out the message that much of cancer is truly avoidable - not with magic drugs, or technological diagnostic devices, but by removing carcinogens from consumer products, workplaces, and the environment. It's up to use to hear it and act.

Julie Klotter