1

Acknowledgment

Of the work of

CCO/OCTRF

2

Environmental & OccupationalCarcinogens

Presentation toCancer Care Ontario

July 1999

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

Definition of Environmental Carcinogens

(“toxics”)

• Industrial effluents

• household chemical products

• agricultural and home pesticides

• radionuclides

5

“Everyday Carcinogens”citizen’s conference

• McMaster University

• March 1999

• Epstein, Connett, Steingraber, Hume Hall

• CCO: Dr. R. Schabas

6

Background paper

Everyday Carcinogens: Stopping Cancer before it starts

Background Paper

for the March 26 & 27, 1999

Workshop on Primary Cancer Prevention

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

10

Canada1999

• 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 EmissionsNPRI, 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

21

Canadian pesticide use

• Annual

• 50,000 tonnes S. Elston, April 1999

22

Environment Canada Jan 1999Inventory of releases:

dioxins/furans/hcb

• Total dioxin releases 1997

• 468 gm TEQ/year

( 1 lb)

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

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 milkformula

28

Industrial toxics

What pollutants?What chemicals?

29

Organic chemicals:

a. non chlorinated:

methanol, ammonia

toluene, benzene, methyl ethyl ketone, ethylene glycol, APE’s, phthalates

30

“Persistent toxic substances”“Persistent organic pollutants,

POPs”

b. Chlorinated/brominated organic chemicals, COC’s

11,000e.g. TCE, Perc, vinyl chloride

pcb’s, dioxins, furans

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)

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)

35

Health effects of Toxics

• Cancer

• Sexuality (reproduction and development)

• brain injury (neuropsychological)

• hormonal (endocrine disrupters)

• acquired immune deficiency (aids)

• liver

36

Causes of cancer

Spectrum of opinion

37

Canadian Cancer Society1999 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.”

38

CCO prevention unitmandate

Lifestyles

• Tobacco

• diet

• physical activity

• (occupational cancer: “tentative”)

39

Ontario Ministry of HealthStatement 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

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

42

What is the

General Medical literature

Saying about

toxics?

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

44

500 Journal articles on Toxics1992 - 1998

0102030405060708090

100

1992 1993 1994 1995 1996 1997 1998

Year

Number of articlesappearing 1992 -1998

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 mischief by external carcinogens such as chemicals and radiation.”

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.”

49

Dr. David KesslerU. 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.”

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.”

51

Drs. W.D. Foulkes, S. V. HodgsonInherited 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

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 chemicals in Cigarette smoke

• Benzo (a) pyrene

• DNA damage to p53 tumor suppressor gene

54

Environmental exposure,

Benzo (a) pyrenein 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

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

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

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

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

61

3. Breast Cancer Incidence, TotalOntario Cancer Registry,

1965 -1995

0

1020

30

4050

60

7080

90

1965

1967

1969

1971

1973

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

Age

Sta

ndar

dize

d R

ate

per

100,

000

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

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.”

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

• Childhood cancer

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?

72

1. Non Hodgkin’s Lymphomas, I

• Adami et al, Sweden

• BMJ, June 10, l995

• 2 - 4% annual increase • in a number of countries

74

Non-Hodgkin’s Lymphomas, III

• Rothman, Cantor

• Lancet, July 26, l997

• occurrence of NHL related to PCB levels

• ?immunosuppression, with EBV susceptibility

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

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

77

Testicular cancerrate per 100,000

SEER data, U.S. DHHS

00.5

1

1.52

2.53

3.54

4.55

1973 1977 1981 1985 1989 1993

rate

78

Testicular cancerrate 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 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

81

3. Melanoma

• BMJ Jan 20, l996

• DOUBLING of rate in Southern Hemisphere

• chlorofluorocarbon release:

• ozone loss, increased u/v exposure

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

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 Conference

• male: “25% increase”

• female: “42% increase”

in rates of Childhood Cancer

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

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 cancerper 100,000 children,1969 - 1988

87

Canadian Childhood Cancer Control Program II,

Gibbons, Mao, Levy, Miller, CMAJ, Dec l5, l994

00.5

1

1.52

2.53

3.54

4.5

5

1969 1972 1975 1978 1981 1984 1987

No of cases ofchildhood leukemiaper 100,000, 1969 -1988

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

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

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

92

Cdn J of Public HealthSupplement, May/June l998

(selected papers)

“Childhood Cancer and Environmental Contaminants”

• Mary Mcbride, B.C. Cancer Control Agency

• 185 references

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

102

Province of Ontario

Environmental politics

103

Three Ontario examples of Action,

Inaction and Reactionon toxics

1. PVC plastic production

2. Pulp and paper industry chlorine use

3. Waste incineration

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

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…….

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)

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…….

110

…….effect, Eastern Ontario, I

• Peterborough, Ontario

• April 15, 1999, feasibility hearings:

• municipal incinerator construction

111

…….effect, Eastern Ontario, II

• Trenton, Ontario

• April 1999, Norampac considering:

• hazardous waste incinerator for

• dioxin-contaminated pulp and paper waste

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

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

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%

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• colorectal ,lung cancer, ovary higher

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

118

Environmental Healthresearch

decline in publications

in the general medical literature

119

500 Journal articles on Toxics1992 - 1998

0102030405060708090

100

1992 1993 1994 1995 1996 1997 1998

Year

Number of articlesappearing 1992 -1998

120

Why the decline?Who would do such research?

• (Industry and corporations)

• Governments

• universities/academic researchers

121

Government

Support for

Environmental health research

122

Government of OntarioMoE operating budget

0

50

100

150

200

250

300

350

400

1994 1995 1996 1997

Annual OperatingBudget, MoE, 1994 - l997

123

Government of Canadatoxics 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

1982 1986 1992

2,3,7,8 TCDDTEQ D + F

125

Dr. Pierre Belandformer 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.”

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…

132

Summary &

Suggested Action

137

Problem Formulationin 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

138

Resolution: consider

2 additional elements in the mandate

of

Prevention Unit

CCO

139

CCO

Prevention Unitmandate, 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 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

143

specific goals

Prevention Unit

of CCO

144

Promote:

• Eliminate PVC production

by plastics industry

• Eliminate chlorine use

by pulp and paper industry

• Eliminate incineration

by waste management industry

145

Others:

• Endorse Healthcare Without Harm

program for Ontario hospital waste management

• Encourage pesticide use reduction

at home

on the farm

146

Conclusion

Occupational and Environmental carcinogens are a significant public health issue.

What is the view of

the Prevention Unit of

Cancer Care Ontario?

147