One patient’s view on primary prevention: The ultimate priority for () patients is for the medical profession to look more closely at primary prevention. I don't mean screening or eating more fruit and Breast vegetables. I mean spending more time cancer: and money on finding out why one in three of us in this country will develop cancer at some point during our lives. “At present, it is Primary prevention is far too low down possible neither to on the political agenda and for patients that's unacceptable. For us it is not just avoid breast cancer, gaining access to the best treatments available. It is about not getting cancer nor to prevent it, nor to in the first place. exercise a real choice Jane Stephenson, Chair UK Breast Cancer Coalition about whether or not Dedicated to the memory of all women we put ourselves who have died from breast cancer at risk...” UK Working Group on the Primary Prevention of Breast Cancer: an Breast (Cancer) UK environmental Breast Cancer Research Ethics and Advocacy Strategy WIth thanks to the case for primary prevention Contents It is our intention that ‘Breast cancer: an ’ 8 Summary 26 Common carcinogens and Endocrine will: 10 Primary prevention Disruptors (EDCs) – challenge a number of prevailing views and attitudes about 13 About cancer 29 Ethics and primary prevention 17 Breast cancer profile 31 International progress on primary breast cancer 18 and breast cancer prevention 21 Human exposures to carcinogens and 32 Prospects for primary prevention – establish a ‘novel’ view of breast cancer as a ‘preventable’ endocrine disruptors rather than ‘inevitable’ disease – address the under-acknowledged and non-lifestyle factors associated with breast cancer – provide a right-to-know document, providing essential At present, it is information to the general public possible neither to – challenge the government to prioritise the primary prevention of breast cancer avoid breast cancer, nor to prevent it, nor to exercise a ‘Breast cancer: an environmental disease’ has been produced as a: real choice about • public interest document – focusing on risk • general resource document – for individuals factors for breast cancer which are yet to be and groups planning or developing primary acknowledged and made part of the UK’s prevention campaign work whether or not we cancer prevention agenda • general reference document for anyone • UK-oriented document which can be readily concerned about breast cancer prevention in adapted for use in other countries particular, or disease prevention in general. put ourselves at • ‘right to know’ document – providing essential information to the general public risk. Deborah Hutton, ‘Breast cancer – private grief is turning into public outrage’ British Vogue 157 1993 Endorsements

Taking action to the European level UNISON is proud to be associated with 'Breast The Co-operative Bank refuses “to invest in The Scottish Breast Cancer Campaign cancer: an environmental disease'. Its origins lie any business whose core activity contributes to welcomes this much-needed Case, which The European Alliance in the Ban Lindane Campaign, which started in the manufacture of chemicals which are draws together the many studies linking Environment Network (EEN) has welcomed the UNISON East Midlands Region in 1994 and persistent in the environment and linked to long environmental with the incidence of the opportunity to support the campaign resulted in the banning of the pesticide Lindane term health concerns”. This investment decision breast cancer. publication, ‘Breast cancer: an environmental in the UK by 2000. This campaign brought is supported by 88% of customers, and so we disease’. As a first step in putting the spotlight on UNISON together with organisations including are pleased to have been able to support ‘Breast SBCC is confident that the publication will open what is known about the environmental causes of Pesticides Action Network UK, Friends of the cancer: an environmental disease’. up the debate on the primary prevention of breast cancer, this publication will help women Earth, Women's Environmental Network, the Soil breast cancer and will lobby government and other health advocates to build scientifically Association, Green Network and Breast UK. Man-made chemical contamination of our agencies to ensure that the report is given the based arguments that they can present to bodies is a fact of modern life. Up to 300 man- consideration it warrants. citizens and to their governments. The Case argued here is one of which we need made chemicals have been found in humans to make politicians, media and the public in but no one knows the long-term impact of these Moira Adams Director To help achieve European policy change, EEN general much more aware. The increasing and the risks they may pose. The Scottish Breast Cancer Campaign intends to work with Women’s Environmental incidence of breast cancer is unacceptable and Network and Breast Cancer UK to inspire groups we need a deeper understanding of why this has As advocates of the ‘precautionary principle’, in different countries to undertake national happened. As human beings with finely the Bank welcomes the case presented here campaign work. By sharing information on the balanced hormonal systems, we cannot be and the valuable contribution it will make to the links between cancer and environmental causes, separated from the environment around us. If we debate. It is an important first step in developing EEN aims to bring the arguments for the primary know that environment to be contaminated, then a truly preventative approach to breast cancer, prevention of breast cancer to the European surely we are right to assume that this has one that is less reliant on early detection and political agenda. consequences for the itself. instead demands that stronger safeguards to human health are immediately put in place. Diana Smith and Génon Jensen, More than one million UNISON’s members are European Public Health women. The rise in the rate of breast cancer is Kate Daley Campaigns manager Alliance Environment Network an important issue for them. We hope that this The Co-operative Bank www.env-health.org Case will stimulate debate and us towards effective prevention of this disease.

Jill Day Women’s Health Officer, East Midlands Region, UNISON Financial support has been provided by the European Commission through EPHA Environment Network Part-funded by UNISON’s General Political Fund Financially supported by The Co-operative Bank Financially supported by Scottish Breast Cancer Campaign 4 5 Netherlands Denmark France Belgium Sweden Finland Cancer worldwide 2000 Breast cancerUnited K ingdEuropeom 2000

Germany Ireland > This graph shows the total number of people worldwide Larynx Netherlands This graph shows the estimated incidence and mortality rates who have been diagnosed with the 14 most common Denmark Malta per 100,000 of the population using age-standardised rates Thyroid during the previous five years, and still living with France Iceland (ASRs). ASR allows the comparison of rates in populations that Kidney cancer in the year 2000. female Belgium Switzerland have different age structures and over different periods of time. male > Skin melanoma Sweden Luxemburg (Source: European Network of Cancer Registries fact sheet, December 2002) NM? Finland Norway Austria Oral cavity United Kingdom Hungary Corpus uteri Germany Within the European Union, every Ireland Italy Larynx Bladder 2.5 minutes a woman is diagnosed Malta Slovenia Thyroid Lung Moldova with breast cancer. Every 7.5 Iceland minutes a woman dies from the Kidney Stomach female Switzerland Portugal Skin melanoma Cervix uteri male Luxemburg Croatia disease. Stella Kyriakides, President of Europa Donna, the European NorwayCzech Republic NM? Prostate Breast Cancer Coalition. Sue Claridge, in ‘The Beacon’ Austria Albania Oral cavity Colorectal (Breast Cancer Network Australia’s magazine) Issue 29, Hungary Ukraine Corpus uteri Summer 2004 p10 Breast BItalyosnia-Herzegovina Bladder 0 1 2 3 4 SlFederalovenia Rep Yugoslavia Lung number of people in millions MoldRovaussian Federation Spain Industrial pollutants were first Stomach Note: the figures on the bottom line of this graph have been Portugal We have strong scientific evidence Greece identified in the 1940s and 1950sCe asrvix uteri simplified for the purposes of clarity. (Source: the World Croatia about toxic chemicals in the Health Organization (WHO) International Agency for Czech Republic Bulgaria causes of cancer by Wilhelm Prostate Research on Cancer: World Cancer Report 2003) environment that mimic female sex Albania Poland Colorectal Hueper, an American doctor Ukraine Romania hormones and overload a woman’s working in the chemicals industry.Breast Bosnia-Herzegovina Slovakia hormonal system, a known cause of Most of the industrial contaminants Estonia breast cancer. We know how 0 1 2 3 4 Federal Rep Yugoslavia affecting the health of present number of people in millions Russian Federation Latvia ASR (world) pesticides,incidence industrial pollutants, ASR (world) mortality generations did not exist before Spain Lithuania atomic radiation and other factors Hueper’s time. Toxicopathologist Greece Belarus are linked – part of the social Dr Vyvyan Howard informs us that, Bulgaria Macedonia context of breast cancer. Yet, neither in 2004, ‘the average person in the Poland 0 10 20 30 40 50 60 70 80 government 90 100 agencies nor societies street now has hundreds of groups Romania age-adjusted rate / 100,000 responsible for dealing with breast of completely novel compounds in Slovakia cancer acknowledge this context. their bodies that weren't there 60 Estonia WHY? Latvia ASR (world) incidence years ago. We can measure them in ASR (world) mortality Ross Hume Hall ‘Female Biology, Toxic Chemicals Lithuania and Preventing Breast Cancer: A Path Not Taken’ adult and foetal tissue. We have Belarus changed the chemical environment International Conference on Breast Cancer and the Macedonia Environment Ontario Canada November 1995 of the womb.’ 0 10 20 30 40 50 60 70 80 90 100 Quoted by Felicity Lawrence ‘Chemical World’ age-adjusted rate / 100,000 The Guardian May 15 2004 6 7 Summary ‘Breast cancer: an environmental The social, psychological and economic ‘Breast cancer: an environmental Primary prevention: disease’ sets out to impacts on women, their families, friends and disease’ the vital role of citizens – challenge a number of prevailing colleagues are incalculable, as are the – focuses on exposures to views and attitudes about breast healthcare and support costs borne by society. environmental agents that are Official disregard for evidence supporting cancer Fewer than 50% of breast cancer cases can be known or suspected of being primary prevention makes it clear that the only – establish a new view of breast attributed to officially recognised, ‘established’ implicated in breast cancer hope of seeing ‘primary prevention’ enacted into cancer as a 'preventable' rather and ‘probable’ risk factors which are understood – spells out the significance of low- law and implemented as policy lies with than 'inevitable' disease to increase a woman’s susceptibility to breast level, long-term and early-life citizens. From a strong basis of knowledge we – address the under-acknowledged cancer e.g. late onset of menopause, body exposures to environmental can: and non-lifestyle factors weight, diet, late-age pregnancy. Only two risk agents in promoting this disease – demand an end to the production and use of associated with breast cancer factors - ionizing radiation and inherited genetic – brings to public attention the toxic agents associated with breast cancer – inform and encourage new ways damage – are known to directly cause the scientifically based information – demand safe alternatives for those toxic of thinking about this disease and disease. routinely overlooked or dismissed substances proven to be essential e.g. food the many possibilities for its by government, industry and the preservatives prevention. However, a vast number of animal, human, cancer establishment. – insist that government, industry and science laboratory and field studies, dating from the demonstrate their joint responsibilities for Breast cancer is the major cancer affecting 1930s, continue to provide incontrovertible The main propositions in the Case are that: delivering primary prevention. women and the most common cancer in the evidence for the role of man-made – breast cancer is a preventable disease UK.(Cancer Research UK 2004). It kills more environmental agents in human such – cancer can be caused by exposures to As a matter of urgency : than one thousand women each month. With a as breast cancer. These are agents that can be numerous and varied cancer-causing and – we need to apply our knowledge steady rise in new cases year on year, the reduced, modified or eliminated. cancer-promoting environmental agents – to the task chance of a woman contracting the disease in large-scale prevention could be achieved by – we need to act now to reduce her lifetime rose from 1 in 12 to 1 in 9 in the five- eliminating such exposures production, release and use of year period 1996-2001. Earlier and improved – in the light of expanding knowledge about toxic substances detection accounts for only a limited number of specific environmental factors known or – we need to act now to reduce our cases in this rising trend. In any one year, breast suspected of implication in the incidence of dependence on toxic substances cancer can affect almost a quarter of a million breast cancer, the primary prevention of – we need to prioritise primary women in the UK. For example, in 2001 there breast cancer is an attainable goal prevention. were 41,000 new diagnoses, 15,000 deaths and – the ultimate responsibility for primary 172,000 women living with diagnoses made in prevention lies with government Notes: The UK includes England, Scotland, Northern Ireland the previous ten-year period. – equally important are the responsibilities for and Wales. These four countries are represented throughout the document. The content also applies in general to other Sources: Cancer Research UK & Office of National Statistics human and borne by countries, for example, the Republic of Ireland. (ONS) 2003 science and industry References from American sources are exact and will – on the basis of current knowledge, failure to therefore contain different spelling for key words, for example act to prevent breast cancer is to be complicit oestrogen (estrogen), foetal (fetal), behaviour (behavior). Any in causing death and disease for this and text within a square bracket has been inserted to clarify future generations. meaning. 8 9 Section 1 Primary prevention Fixation stopping us [from getting serious The objective in primary Fixation on treatment and control of the disease by about prevention] is the almost medical science leaves primary prevention in an extremely suffocating hold the medical- prevention is to prevent the marginal position on the national agenda. industrial complex retains over cancer policy, and the hugely disease process from The main error of the biomedical powerful chemical industry’s interest approach is the confusion between in protecting its products. disease processes and disease Professor Ross Hume-Hall ‘The Medical- starting. (Gray & Fowler 1984) origins. Instead of asking why an Industrial Complex’ pp62-68 The Ecologist illness occurs, and trying to remove Vol 28 no2 1998 the conditions that lead to it, medical ‘Primary prevention’ is about eliminating the causes of a The acceptance of breast cancer as a disease we have researchers try to understand the Ignorance disease before it can affect people. It is historically based to put up with is affirmed in a survey conducted by the biological mechanisms through We generally trust advice when it comes to us from on common sense and recognition of the proven or charity Breast Cancer Care. Asked about the challenges which the disease operates, so that government, especially when it is reinforced by the media suspected cause and effect of diseases. For example, the for breast cancer over the next 30 years, the majority of they can interfere with them … These and cancer charities. Both Scottish and UK government’s connection between poor standards of sanitation, the 80 breast cancer experts participating predicted that mechanisms, rather than the true cancer plans target lifestyle factors (exercise, diet, drainage, water supply and ventilation, and diseases such 30 years from now breast cancer will still be incurable origins, are seen as the causes of consumption and smoking) as the key to cancer as typhus, cholera and consumption, was recognised by but it will be a disease women live with, like disease in current medical thinking prevention. This narrow focus perpetuates ignorance that the British Parliament’s Select Committee on the Health or , rather than die from, and that the biggest and this confusion lies at the very dietary and environmental contaminants are significant of Towns in 1840. A primary prevention approach to a problem for the NHS will be the sheer number requiring centre of the conceptual problems of sources of human exposure to carcinogens which are multi-factorial disease (i.e. one believed to have resulted care. (‘Health Service Journal’ July 2003) contemporary medicine. impossible to avoid. from the interaction of genetic factors with environmental Fritjof Capra ‘The Turning Point – Science, factors) such as breast cancer would aim to reduce and When we think of breast cancer Society and the Rising Culture’ A narrow focus on lifestyle – like a eliminate, as far as possible, human exposures to all we think of it as unpreventable. Simon & Schuster USA 1982 pp149-150 narrow focus on genetic mechanisms substances or agents that are known to be, or suspected Jenni Murray (presenter) ‘Women’s Hour’ – obscures cancer’s environmental of being, implicated in the disease process. BBC Radio 4 November 3 2000 Vested interests and the status quo roots. It presumes that the ongoing A truth seldom aired is that there is no profit in contamination of our air, food, and Confusion prevention. The disease of cancer has spawned a major water is an immutable fact of the Barriers to a ‘primary The slogan ‘early detection is the best prevention’ has world industry and it is unlikely that such a massive and human condition to which we must prevention’ focus attained the status of a ‘truth’ in the public mind. In multi-faceted industry will welcome the prospect of its accommodate ourselves. fact, early detection, by whatever means, is only own demise in the shape of primary prevention. Dr Sandra Steingraber ‘Living Downstream: There are a number of attitudes, mindsets and detection. Equally persistent has been the promotion of An Ecologist Looks at Cancer and the misconceptions standing in the way of a primary regular mammograms as a ‘preventive measure’. A firm alliance between the Environment’ Virago UK 1998 p262 prevention focus on breast cancer. These include: Mammography is a tool for detecting breast problems, established cancer institutions and not for preventing them. the chemical, pharmaceutical and The media is the main source of public information in Acceptance nuclear industries has formed the today’s world. It is an all-pervasive global force in society We have been conditioned over time to accept cancer as Women have been sold the myth that medical-industrial complex … At its and is becoming an integral part of the public debate a fact of life (and death). Statistics tell us that breast the answer to breast cancer is early best, this complex provides better about breast cancer. However, the information industry – cancer affects 1 in 9 women while cancers in general detection and treatment. Dr Cathy Read diagnosis, new treatments and first- print and broadcast – is largely controlled by market affect 1 in 3 of the population. These frequently reported ‘Preventing Breast Cancer: the politics of an rate health-care facilities. At its forces and these exert strong influences on society, figures influence the gradual acceptance of breast cancer epidemic’ Harper Collins UK 1995 p8 worst, the medical-industrial complex especially through advertising. This can compromise as both a ‘normal’ disease and one that must inevitably blocks an all-embracing programme editorial decision- making or it can obscure core issues. affect some of us. for preventing cancer … What is For example, the survival of a women’s magazine or a 10 11 Section 2 About cancer TV channel in a very competitive marketplace will depend decisions about exposures to these upon revenue from advertisers selling products – often entities. ‘Cancer is not a single disease. It is a directed at women – that should arguably be part of the Dr Janette Sherman ‘Life’s Delicate Balance: type of disease. There are over 200 debate on causes of breast cancer. Therefore, it is A guide to causes and prevention of breast impossible to get issues like ‘primary prevention’ taken cancer’ Taylor & Francis USA 2000 p235 different cancers, and each occurs in up by mainstream media. One result, for example, is the widespread misconception that breast cancer is a largely The invisibility factor its own way. What they have in common inherited disease. Away from their source of production, there are no is that they all start in the same way – identifying clues, such as odour or colour, that might alert Genetic screening for women with an us to the many carcinogenic chemicals and sources of with a change in the normal make-up inherited ‘high risk’ of contracting harmful radiation in our everyday environment. The breast cancer still tends to dominate invisibility of such health hazards makes it difficult not of a cell … Cells are constantly at work popular media reporting, with the only to accept their existence but also their hazardous in our bodies, dividing and multiplying effect that most women estimate the nature. genetic cause of the disease to be far to repair damaged skin, maintain hair commoner than it is: around 5% of all The reason people don’t believe breast cancers. in radiation is, it’s out of sight, out growth and perform a hundred other Laura Potts ‘Stopping Breast Cancer Before it of mind. (NHS 2001) Starts’ Health Matters July 2001 Dr Alice Stewart ‘The Woman Who Knew Too everyday tasks.’ Much’ Gayle Greene University of Michigan ‘Damage to the genetic machinery of individual cells are constantly being repaired or removed from the Procrastination Press 1999 p213 cells can trigger a series of miscalculations, body by the immune system. An immune system that is There is a widespread tendency (among scientists, altering a cell’s normal function. When a gene is weakened (by illness, trauma, chemical and radiation industrialists and politicians) to claim the need for more Many harmful or suspect chemicals damaged by radiation or chemicals, or receives exposure or age), or is under-developed (as in the very research when challenged by prevention measures based (in drinking water) can’t be tasted or misinformation from a chemical messenger, and young), can compromise the repair process. Some of the on existing scientific knowledge. In the case of breast smelled even at dangerous levels. the mistaken signal is not corrected, the result substances (known from laboratory and animal tests) cancer prevention this delaying tactic devalues a half- Jeffrey Steingarten ‘The Man Who Ate is inappropriate or uncontrolled growth. This which damage or disrupt cells or cell functions are century of scientific endeavour, leaving policy makers Everything’ Headline USA 1998 pp61-62 is the basis of cancer. We have learned that , asbestos, , cigarette smoke, oestrogens, forever in the grip of ‘paralysis by analysis’. even irritation, as from chronic formaldehyde organochlorines, dioxins and radiation. Some directly Fear exposure, results in increased cell-turnover, damage the cell e.g. formaldehyde, others aid cancer ‘We need more study’ is the Fear of cancer feeds our resistance both to learning and the need for repair, and the potential for progression e.g. oestrogens. (Sources – Pepper et grandfather of all arguments for even thinking about the disease. interference with repair … Some alterations al/Parnell/Cornell University Breast Cancer Program ) taking no action. may be reversed by a cell’s innate repair P Infante & G Pohl ‘Living in a chemical world: Nothing in life is to be feared. It is mechanism; some alterations may go unnoticed; Cancer in young people actions and reactions to industrial carcinogens’ only to be understood. but other alterations become permanent and Once a disease almost exclusively associated with old-age, pp225-249 Teratogens, Carcinogens, Mutagens Marie Curie life-threatening, as when a cancer begins.’ cancer now affects all age groups, as shown by rising 8 1988 (Sherman 2000) rates in young people. The Automated Childhood Cancer Information System (ACCIS) project, an epidemiological A myriad of scientific papers exist study of cancer incidence in children and adolescents in concerning adverse effects from The susceptibility factor in cancer Europe since the 1970s, provides ‘clear evidence of exposure to radiation and from an increase of cancer incidence in childhood exposure to hundreds of chemicals. The timing and duration of exposures to potential and adolescence during past decades, and of There is more than enough cancer-causing agents are additional crucial factors in the the acceleration of this trend.’ information to make informed cancer process. In a healthy adult, damaged or altered (Steliarove-Foucher The Lancet 2004) 12 13 Carcinogens products and applications. The universal application of There are ‘adverse effects observable Physical carcinogens man-made chemicals in every sphere of modern life has in the pattern of human disease, both ‘Experts agree that most cancers are caused by made exposure to them an unavoidable, lifelong reality in foetal malformations and the The best known example is high-energy radiation, our bodies or parts of them being exposed to for each one of us. The vast majority of industrial increase in the incidence of cancer – including nuclear radiation and X-rays. certain substances over long periods of time. chemicals have never been tested for their potential to particularly in young people – and we These cancer causing substances are called cause or promote cancer. can observe that those changes have Radiation carcinogens.’(NHS 2001) taken place over the same period of Because ionising radiation is of sufficiently high energy to Chemicals and breast cancer time as the introduction of these disrupt electrons from atoms it is the most dangerous type Synthetic chemicals are in some cases proven to harm – novel chemicals.’ (Howard 2004) of radiation for all living . Chemical carcinogens and in other cases suspected of being harmful – to human health for a range of reasons: Several hundred chemicals are found in a wide range of ‘The harmful effects of atomic or ionizing The chemical agents of cancer have • the majority are based on carbon, and for this reason, commercial products and conditions we unknowingly radiation have been known since the early become entrenched in our world in ‘are particularly dangerous to us because encounter in our daily lives. Often overlooked by discoveries of Roentgen, Becquerel and two ways: first, and ironically, being based on carbon, the chemistry of all regulators is the variation in effects on a population from Madame Curie, but the present impacts and through man’s search for a better life, they readily enter human tissues and similar exposures, as recorded by biochemist and cancer mechanisms of nuclear pollution are still not and easier way of life; second, seriously disrupt the body’s complex researcher Ross Hume Hall: ‘Individuals vary fully understood. Radiation penetrates because the manufacture and sale of processes and complex chemical reactions.’ greatly in their susceptibility to toxic chemicals, biological matter and acts on the cells and their such chemicals has become an Harte et al ‘Toxics A-Z’ 1991 and the differences between men and women constituent parts by causing chemical, accepted part of our economy and • many of those which have been tested are known or can be punishingly large ... Women thus can fall molecular or physical damage often resulting in our way of life. (Carson 1962) suspected carcinogens victim to legal limits of residues of pesticides cell death or genetic mutation. Unlike most toxic • the increasing numbers found to disrupt the function of and waste chemicals in their supermarket chemicals, with radiation there appears to be no The main source of human exposures to carcinogens the endocrine [] system. This group has grapes or in their apple juice. Even at their best, level of dose below which damage cannot be today is man-made chemical compounds. particular significance for hormone-related cancers EPA [Environmental Protection Agency, USA] caused.’ (Markham 1994) such as breast cancer regulations disregard the susceptibility to By 1985 it could be stated as a fact that ‘nearly all of • some are both carcinogenic and hormone-disruptive cancer of 50 per cent of the population.’ Examples of some sources of ionizing radiation that we the synthetic [man-made] chemicals regularly e.g. atrazine, an agricultural pesticide widely used in (The Ecologist 1998) live with: used in industry today did not exist 40 years ago the UK • ‘natural sources – the sun (UV rays), [in the 1940s]. Of the 45,000 toxic chemicals • the increasing numbers found to ‘persist’ (remain a Assured by periodic statements from government and and radon, and building materials containing listed by the US National Institute of Safety and long time in the environment) as a result of being industry about the safety of regulated chemicals, and these elements Health (NIOSH) in 1980, 2,500 were identified as designed to be ‘stable compounds’ which are therefore lacking the information to challenge such assurances, • industrial sources – fallout from man-made carcinogens, 2,700 as mutagens [causing not broken down in the environment by micro- most of us are quite unaware that ‘little has been nuclear explosions and power station genetic change] and 300 as teratogens [causing organisms and in the human body by metabolic done to prevent exposure to carcinogenic accidents malformation of an embryo]. Less than 7,000 processes chemicals in the environment, despite ample • medical sources – X-rays had been adequately tested.’ (Grossart 1985) • the increasing numbers found to be ‘bio-accumulative’ evidence that chemical pollution of our air, • domestic sources – cathode ray tubes (build-up in the body, mostly in fatty tissue). Chemical water, food and the workplace is the major (computers and TVs), some smoke alarms and This is old, not new knowledge. Yet it was only during the compounds that accumulate in living tissues increase in cause of cancer.’ (Epstein 1990) fluorescent dials last 15 years of the 20th century that medical science number and concentration as they move up through the • our bodies – radioactive elements eg began to associate the unprecedented growth rates of food chain. It follows therefore, that humans, at the top potassium (natural) and strontium-90 (man- many diseases with modern chemicals. While in the same of the food chain, will have the highest concentrations made nuclear fission product [stored in our 15-year period some chemical compounds were banned • the capacity of many to cross the blood-brain and bones]).’ (Harland 1995) or reduced (in number and use) through tighter placental barriers regulations, man-made chemicals continued to be • the increased risk of resulting from the developed and marketed in an ever-widening range of combined effects of synthetic chemicals on the body. 14 15 Section 3 Breast cancer profile Electromagnetic field non-ionising radiation There can be no doubt that a major cause of cancer today Electromagnetic Fields (EMFs) are long-wave forms of is our involuntary exposure to carcinogens from an ever- For more than 100 years breast cancer non-ionising radiation. EMF emissions in the environment increasing number of sources in our environment, from has been recognised as a hormonally come from natural sources e.g. the sun, the earth’s higher-than-normal levels of background radiation in our magnetic field and from manufactured sources e.g. high- homes to hazardous chemicals in products. Although our related disease that is influenced by voltage power lines, power transmission stations and knowledge of cancer is incomplete, we do have sufficient environmental factors. electrical appliances such as computers, electric blankets, understanding of the processes involved to know that hairdryers, TV sets and microwave ovens. cancer incidence can be reduced. Breast cancer was a relatively rare condition until the • some breast cancer risk factors relate to early-life ‘Risks posed by EMFs depend on the distance mid-20th century, when incidence in industrialised exposures and changes e.g. radiation exposure, early from source and duration of exposure. For countries began to rise significantly. menstruation instance, transmission lines located only 200 to • many are events over which women have little or no 300 feet away expose people to fewer EMFs than Breast cancer is a ‘multi-factorial’ disease, a term control e.g. onset of menopause. many common domestic appliances … ‘describing a condition that is believed to have Substantial evidence … strongly suggests the resulted from the interaction of genetic factors, In theory, the only risk factors over which women have carcinogenicity of EMFs … at least eighteen with , or factors.’ (Oxford some control are diet, body weight, alcohol consumption occupational studies link EMF exposure to Medical Dictionary) We tend to think of breast cancer as and use of synthetic hormones e.g. HRT. The reality is leukemia, five to brain cancer and thirteen to one type of cancer, when in fact there are many different that these choices are moderated by many other factors – other cancers, including breast cancer.’ types of breast cancer. ‘Breast cancer is as diverse economic, social, cultural, pathological and psychological (Epstein Steinman LeVert 1997) as the breast itself, appearing in many different – affecting women’s lives. guises.’ (Plotkin1996) EMFs and melatonin EMFs interfere with the normal production of melatonin, ‘Lifestyle’ risk factors a hormone of particular significance when studying the Risk factors causes of breast cancer. Melatonin is ‘a hormone made Individual behavior and lifestyle by the pineal gland deep within the brain … [it] Risk is not a cause of illness. certainly play important roles, but is only secreted at night and is an important Risk is the result of exposure to today’s trend appears to be that regulator of the body’s 24 hour clock. It also a hazard, as in the formula individuals are considered not only regulates various hormones, including HAZARD + EXPOSURE = RISK. responsible for but also guilty of oestrogen. Laboratory tests have shown that Clearly, if either hazard or exposure causing their disease. melatonin also suppresses the growth of human is missing from the equation, there (Tomatis & Huff 2001) breast cancer cells.’ (Read 1995) is no risk. (Sherman 2000) Lifestyle factors constitute only part of the overall risk Working or sleeping in a situation of near-constant and ‘With the notable exception of ionising radiation picture for breast cancer, approximately 5%. Government bright, artificial ‘light at night’ (LAN) may interfere with and inherited genetic damage, none of the and media fixation on lifestyle factors as key both to the normal production and work of melatonin. Many established risk factors for breast cancer directly breast cancer risk and prevention leaves the problem scientists consider regular exposure to LAN an added risk cause the disease … Most … can be linked with entirely with women themselves. It makes sense to follow for breast cancer since it can affect regulatory control of increased lifetime exposure to oestrogen, other a healthy lifestyle but that is no guarantee that you will oestrogen (the hormone most strongly associated with hormones, and higher exposures early in life.’ not get cancer. A woman cannot protect herself absolutely breast cancer) as a result of LAN impact on the pineal (Davis Axelrod Sasco Bailey Gaynor 1998) from environmental factors beyond her control. And as gland. ‘Sleep interruption, especially in women those factors proliferate, her risk increases, no matter how working the graveyard shift, is associated with Some important points about breast cancer risk factors: many vegetables she eats, how many drinks she declines, an increased risk of breast cancer.’ • most cannot be altered e.g. age or pounds she loses. (O’Neill Risks 24) 16 17 Section 4 Hormones and breast cancer breast cancer because they mimic or Man-made hormone mimics differ in fundamental ways Today, breast, ovarian and disrupt hormones known to affect from oestrogens produced by plants and humans. One breast cancer risk. (Brody & Rudel 2003) important difference is the long-evolved ability of the endometrial uterine cancers are body to break down and excrete the natural oestrogens, Man-made chemical compounds with the ability to mimic whereas ‘many of the man-made compounds clinically categorized as ‘hormone- hormones produced by the body and to interfere with the resist normal breakdown and accumulate in the hormonal messaging systems that direct and regulate our body, exposing humans and animals to low-level dependent’ cancers. (Kelsey and Whittemore 1994) biological development and function are variously known but long-term exposure. This pattern of chronic as xenoestrogens, xenohormones, environmental hormone exposure is unprecedented in our oestrogens, hormone disruptors, hormone mimics or evolutionary experience.’ (Colborn et al 1996) hormonally active agents (HAAs), and endocrine Hormones are the key chemicals involved both in the 3)its effect on other hormones that stimulate disrupting chemicals (EDCs). Being fat-soluble compounds, most EDCs are not excreted development and the function of the breast. Breast breast cell division, and by normal body processes but are stored in body fat, thus development which precedes menstruation by individually 4)its support of the growth of estrogen- Authors of ‘Our Stolen Future’ describe EDCs as ‘thugs impacting on cells in the body over many years. variable times, and the changes in breast tissue which responsive tumors.’ on the biological information highway that begin with the first menstrual cycle, will depend on a (Cornell University fact sheet 9) sabotage vital communication. They mug the It is known that man-made EDCs can: complex interplay of hormones, mainly oestrogen, messengers or impersonate them. They jam • cross the placenta progesterone, prolactin and other growth factors. ‘The A woman’s lifetime exposure to oestrogen is influenced signals. They scramble messages. They sow • disrupt the development of the foetus breast is fairly quiescent from infancy until by her age at three stages in her reproductive history: disinformation. They wreak all manner of • have serious effects that might not be evident until puberty, then, under the influence of sex steroid • onset of menstruation () havoc. Because hormone messages orchestrate decades later hormones, remarkable changes occur … From • first full-term pregnancy many critical aspects of development, from • and that the human body can mistake a man-made here on in, the activity of the breast is firmly • onset of menopause. sexual differentiation to brain organization, chemical for a hormone. (Colborn et al 1996) locked into our hormonal cycles.’ (Read 1995) hormone-disrupting chemicals pose a ‘A study of breast cancer risk based on particular hazard before birth and early in life.’ Timing of exposure oestrogen levels in 15,000 women found that (Colborn et al 1996) Biologist and foetal toxicologist Dr Sandra Steingraber Oestrogen and breast cancer women with higher oestrogen levels were more defines life periods when hormonal disturbances pose the likely to go on to develop breast cancer.’ ‘EDCs are found in a large number of frequently greatest risks as ‘windows of vulnerability’. These occur: Throughout the life cycle, the (Toniolo et al 1993) used products such as weedkillers, foods, • ‘when the foetus is developing in the womb hormonal environment plays a petrol, insect sprays, cosmetics, shampoos, and minute changes in hormone levels switch critical role in the development of ‘Because total estrogen exposure is the single disinfectants, plastic linings of food cans, plastic on the development of each organ system breast cancer. (Brody & Rudel 2003) most important for breast cancer, bottles and some medicines. Another main • when newborn babies still have incomplete estrogenic chemicals, which would add to source of hormone disrupting chemicals are immune systems and no blood-brain barrier Oestrogen, the primary female sex hormone, has been this lifelong exposure, are an obvious suspect dioxin emissions from waste incineration plants. • when puberty, triggered by hormonal associated with breast cancer since the 19th century when when searching for the cause of rising rates In most Western European countries 95% of changes measured in low parts per billion, Scottish surgeon, George Beatson, observed that removal (of breast cancer) over the past half century.’ dioxins which humans absorb, enter our bodies to rapid cell division and DNA of the ovaries (the main source of oestrogen production) (Colborn et al 1996) in the form of food, particularly milk products replication reduced incidence of the disease in women. and fish oil.’ (van Dooren 1997) • in old age when the body’s defence mechanisms weaken.’ ‘Estrogen may be implicated in breast cancer Hormone disruptors and mimics Synthetic oestrogens are also found ‘in pesticides, in (Steingraber/Lawrence Guardian 2004) because of the growth hormones fed to chickens, cows and 1)its role in stimulating breast cell division Strong toxicologic evidence points other animals, and in the contraceptive pill and Bioaccumulation 2)its work during the critical periods of breast to a large number of ubiquitous Hormone Replacement Therapy prescribed to A characteristic common to most EDCs is that they build growth and development pollutants that are plausibly linked to women.’ (Hoult 1996) up (bioaccumulate) in fatty tissues where they remain 18 19 Section 5 Human exposures to carcinogens and endocrine disruptors potentially active for long periods of time. It is therefore EDCs acting in combination not surprising that ‘a growing number of experts Studies show that ‘hormone-disrupting chemicals aware of the rise in oestrogen-mimicking can act together and that small, seemingly How are we exposed? Occupation chemicals are beginning to suspect that it is insignificant quantities of individual chemicals not so much the fat that predisposes a woman can have a major cumulative effect’ (Colborn et al Diet The prevention of cancers to breast cancer but the which have 1996) and that ‘multiple estrogenic chemicals can Food is a major source of human exposure to attributable to occupational and accumulated in the fat that then build up in her act together to produce an effect even when synthetic (man-made) chemicals, many of which are bio- environmental exposures is primarily body.’ (Kenton 1995) each individual component of the mixture is accumulative, carcinogenic and disruptive to the hormonal achieved by regulatory action. below a threshold for effect.’ (Brody & Rudel 2003) system. Scientists have known about the connection Relevant measures include The bioaccumulation of toxins in fat cells inevitably between dietary contaminants and cancers for many years replacement of carcinogens with produces toxic effects in the body. UK scientist Peter Improved understanding of the number of ways in which because ‘both animal studies from the 1960s and alternative chemicals or processes, O’Neill points out that such toxic effects ‘may result EDCs affect breast cancer has developed from animal and human studies from the 1970s confirm the fact improved ventilation … A significant after a relatively long time period either laboratory tests and reveals that ‘[their] ability to that these dietary contaminants cause cancer. reduction in occupational cancers through levels rising above a threshold that bind to the oestrogen receptor (on a cell) Some studies show that carcinogens concentrate attributable to implementation of induces adverse effects or because some appears to be a relatively common phenomenon. in breast tissue, while other studies prove the preventive measures has been event causes the chemical to be released from Once there, the mimics may act as agonists point in a different way by showing higher demonstrated in many instances. the fat.’ (O’Neill 1993) [aids] or antagonists [blocks], jamming these concentrations of these carcinogens in the blood However, there remains a burden of switches on or off. However, there are other of breast cancer patients.’ (Epstein et al 1998) past exposure. (United Nations 2003) Low-level effects ways in which chemicals can affect the hormone The relative strength of EDCs is much lower than the system. Some chemicals are anti-androgenic, Toxicopathologist Dr Vyvyan Howard, a member of A review of more than 100 studies in occupational cancer, strength of hormones produced by humans. For this blocking the androgen [male hormone] the government’s advisory committee on pesticides, is conducted over the past 25 years, concludes that ‘few reason some scientists claim that EDCs cannot pose any receptor. Some may interfere with the synthesis concerned about the potential health effects of multiple high-quality studies directed specifically significant threats to human health. However, or of hormones, or with their pesticide residues on food and believes ‘there is towards women have been carried out to allow reproductive biologist Fred vom Saal points out that transport in the body.’ (Chemistry & Industry 1996) sufficient evidence already that the pesticide the unambiguous identification of occupational ‘vanishingly small amounts of free [natural] cocktail effect is producing changes. Exposure risk factors for breast cancer.’ (Labreche & estrogen are capable of altering the course of Because of the importance of hormones in developing to chemicals that disrupt hormones in the womb Goldberg 1997) Existing data about occupational risks for development in the womb. Given this exquisite and maintaining human health through all stages of life, could be the cause of the decreased age of breast cancer may be limited, but when considered sensitivity, even small amounts of a weak man-made chemicals that can mimic and, therefore, puberty in girls and early onset of puberty is alongside long-term observations of health workers and estrogen mimic – a chemical that is one interfere with the normal functions of hormones pose a linked to a greater chance of developing breast employee health records, it does provide clear evidence of thousand times less potent than the estradiol serious threat to public health now and for the future. cancer later in life.’ (Watson The Scotsman 2004) elevated incidence in certain occupations. made by the body itself – may nevertheless spell big trouble.’ (Colborn et al 1996) Hormones of the wrong kind, The widely promoted view that high intake of dietary Occupational studies provide fairly consistent evidence hormones too soon in a girl’s life, fat constitutes a risk for breast cancer is challenged by a for elevated risks associated with exposures to specific ‘Natural estrogens operate at extremely low hormones for too many years in a large-scale 1987 study, based on the eating habits of substances. For example, nurses represent one group with concentrations, measured in parts per trillion. woman’s life, too many chemicals nearly 90,000 nurses, which concluded that ‘there is elevated risk because their work involves substantial In contrast, these so-called weak estrogens are with hormonal action, and too great no association between dietary fat and breast exposure to chemicals. present in blood and body fat in concentrations a total hormonal load. Another key cancer. However, US diets are contaminated of parts per billion or parts per million – levels is the kind of hormones, the foreign with a wide range of carcinogens that Higher potential risk is associated with occupational sometimes thousands to millions of times chemicals. (Sherman 2000) concentrate in fatty foods and whose presence exposures to solvents such as formaldehyde, methylene greater than natural estrogens. So even though is not disclosed to the consumer.’ (Willett et al 1987 chloride and , and to benzene, the contaminant levels may seem miniscule, Epstein 1990) pesticides, styrene, acid mists, and some metals. Often- they are not necessarily inconsequential.’ overlooked white collar jobs involve chemical exposures (Colborn et al 1996) common to indoor work areas, such as: 20 21 • solvents in inks, cleaning materials, dyes, air sprays differ by sex. Little, however, is published a comprehensive review of pesticide research. on people without their informed • pesticides for control of insects, moulds known about the implications of This report identifies children as the group at greatest risk consent … If you pollute when you • second-hand smoke these differences for the effects of of serious illness and disease because of their constant do know that there is no safe dose with • flame retardants in furnishings, fabrics and electrical toxic exposures. (Messing 2003) exposure to low levels of pesticides in their food and their respect to causing extra cases of office equipment e.g. copiers, computers. environment – the latter is as a result of the widespread deadly cancers, then you are use of pesticides in homes, gardens and public spaces. committing premeditated random In terms of exposure to toxic chemicals, the highest When are we exposed? Early development is further explained as a period of murder. John Gofman MD PhD Professor of potential health risks for women are to be found in high-risk because, relative to their size, ‘children are molecular and cell biology and physician industries that are the largest users of chemicals. These Because cancer is a multi-causal exposed to more toxic chemicals in food, air and University of Berkeley USA 1998 are chemical, micro-electronics and textile manufacturers disease that unfolds over a period of water than adults because they breathe twice as – the last two being major employers of women. decades, exposures during young much air, eat three to four times more food, and Critical periods in female development adulthood, adolescence, childhood – drink as much as seven times more water.’ Radiation risks for girls during three critical periods Because of the intensity of their potential exposure to toxic and even prior to birth – are relevant (WWF 2003) have consistently been confirmed by studies showing that substances implicated in breast cancer, women working in to our present cancer risks. ‘females exposed to radiation prior to puberty the microelectronics industry producing components for (Steingraber 1998) Scientific knowledge about the exceptional vulnerability have a much greater risk of developing breast expanding technologies in communications e.g. computers of children to lifelong, irreversible effects from exposures cancer than do older women subject to the same and cell phones, represent both high incidence and Human exposures to carcinogens and endocrine to environmental contaminants has made no impact on a level of exposure … Radiation during the critical high risk categories for this cancer. The semiconductor disruptors can occur at any stage of human development regulatory system in which exposure levels deemed ‘safe’ periods when breast cells are first forming (silicon chip) sector of the industry uses toxic metals, from conception to death. As well as differing from males for adults are still assumed to be equally safe for children. prenatally or during early adolescence induces solvents, resins, gases, plasmas and acids in processes – body weight, body mass, fat-to-muscle ratios, proportionally more neoplastic [abnormal] requiring hundreds of different chemicals, some of which reproductive functions and hormones – women are Breast milk transformation of cells and is thereby more are known or suspected carcinogens and EDCs. particularly vulnerable to biological damage from More than 350 man-made contaminants have been carcinogenic than exposures later in life. exposures: found in human breast milk. Any chemicals stored in (Davis Axelrod Sasco Bailey Gaynor 1998) Although studies of occupational health risks drawn from • during periods of illness or trauma human body fat can potentially transfer to the newborn women’s work histories and experiences are urgently • during pregnancy infant during breast feeding. Dr Sandra Steingraber, ‘Breast cells are not fully mature in girls and needed, associations can be drawn from existing data • during the foetal development, early childhood an internationally renowned scientist with personal young women prior to their first full-term to provide enough evidence: and pubertal stages of life experience of cancer, describes human breast milk as pregnancy. Breast cells which are not fully • of increased risk of breast cancer for women • in the period from puberty to first pregnancy ‘the most chemically-contaminated food on the mature bind carcinogens more strongly than, experiencing specific occupational exposures • in the period after menopause planet.’ She chose to breastfeed both her children, in the and are not as efficient at repairing DNA damage • on which to base precautionary-based regulations • in old age. knowledge that despite the presence of toxins, ‘breast as, mature breast cells.’ (Clark Levine Snedecker 2003) to protect women from workplace hazards. milk is absolutely the best food for human The foetal stage infants. The data on the health benefits of breast Professor Karen Messing is one of many researchers in the Numerous studies show that: milk are absolutely unanimous that babies who Where are we exposed? field of occupational health calling for greater attention to • the foetus is exceptionally vulnerable to the effects of are breastfed are healthier, they die less often the differences in response to occupational exposures toxins from both the internal and external environment in their first year of life and they enjoy health Except for the original blueprint of between men and women. • exposures, particularly to EDCs and carcinogens, at the benefits for a lifetime.’ Use of formula milk as a our chromosomes, all the material foetal stage affect subsequent susceptibility to breast substitute for breast milk is not a solution to that is us – from bone to blood to Biological differences between the cancer, and to many other disease and developmental contaminants in breast milk because it is also likely to be breast tissue – has come to us from sexes may affect responses to effects in later life. chemically contaminated. the environment. (Steingraber 1998) workplace toxins. For example, bone, fat, and immune system metabolism Infancy to pre-puberty If you pollute when you do not know In every man-made and natural environment occupied by as well as cardiovascular and In April 2004 the Ontario College of Family Physicians if there is any safe dose, you are humans today we are exposed to toxins, many of which endocrine function are all known to (OCFP), representing more than 6,700 family doctors, performing improper experimentation are carcinogens and endocrine disruptors – in the water 22 23 we drink, the air we breathe, the food we eat, the places The most common-sense approach, according to Helen Air Conventional farming practice uses a non-selective we play in, the houses we live in, the machines we use, Lynn, Campaigns and Health Co-ordinator Women’s In the UK ‘most of us spend an average of 90% of approach to pest and disease control. Broad-scale the cars we drive, the places we work in and from the Environmental Network is that, ‘at least until the our lives indoors, the highest proportion of this application of more than 2,000 synthetic compounds ways we dispose of waste (landfills, incinerators). laws allowing such toxic substances into our being in winter, when indoor is at registered as pesticides tends to destroy not only the target homes are changed, we’d be better off … its worst. We are thus much more likely to but many other life forms both above and below ground, ‘Metabolic [bodily absorption and breakdown] cleaning our homes with lemon juice, vinegar breathe in and absorb into our bodies any gas, including the micro-organisms crucial to soil quality. pathways for naturally occurring chemicals and bicarbonate of soda, choosing furnishings, vapour or airborne particle that escapes into have been developed over millennia. This is not cosmetics and toiletries that are as natural as the air indoors. Without adequate ventilation, Water the case for the majority of man-made chemical possible and demanding products that are not we are in danger of concentrating our own The quality of the water we drink and use to prepare a compounds. These persistent toxic substances: just fit for their immediate purpose but are safe home-produced pollutants to the point where nd cook our food is vital to our health. As domestic water • remain in the biophysical environment for in all respects.’ (The Guardian 2004) our health may be threatened.’ (Harland 1993) supplies are now controlled by private water companies long periods of time there can be considerable variation in water quality. The • become widely dispersed Cosmetics Studies of household dust show that indoor air can be quality of the water supplied to our homes will depend on • bioconcentrate in plants and animals, Many of the 5,000 chemicals used in cosmetics and contaminated by: many factors. As well as the main constituents of natural including humans. toiletries have not been properly safety-tested. Some can • a build-up of chemicals released from use of cosmetic, water – oxygen, and salts – there are The is unable to break many of these trigger allergic reactions or chemical sensitivity, others personal care, cleaning, art and craft products ‘additives such as and aluminium toxic man-made substances down because they are suspected EDCs and have been linked to reproductive • vapours off-gassing from fabrics (curtains, cushions, nitrate that are designed to kill bacteria and have been developed precisely not to be readily disorders, effects on the immune system and cancer. One upholstery), floor coverings, electrical goods (TVs settle contaminants. After this comes the metabolized and detoxified.’ family of widely used cosmetics ingredients used as and computers), interior decorating materials increasing list of pollutants that are (Ontario Task Force Report 1995) preservatives, parabens, have been found in a small study (paint, varnishes) contaminating the sources of mains supply sample of human breast tumours. Parabens have since • sources of combustion such as gas, oil, wood, coal, water, whether from ground water, rivers, Medical oncologist Professor Dominique Belpomme been removed from most brands of deodorants and kerosene and tobacco products lakes or reservoirs.’ (Harland 1993) reports that in France, ‘between 70% and 80% of antiperspirants but are still used in many other cosmetics • central heating and cooling systems cancers are now due to environmental pollution products where they have the ability to penetrate the skin. • pollutants in air outside the home e.g. traffic Carcinogens are formed as a by-product of the from chemicals such as polycyclic aromatic ‘Concentrations of parabens in human breast tumours’ Darbre fumes, pesticides. disinfection process in water treatment. ‘Chlorine is, [PAHs], polyvinyl chloride [PVC], et al pp5-13 Journal of Applied Vol 24 issue1 2004 by far, the most common disinfectant used to some , nitrates, dioxins, some food www.annieappleseedproject.org/deodorantissue.html Soil treat drinking water; but other oxidants, such additives and pesticides.’ (Pesticides Action Network The lesson of history is that, even as chloramines, chlorine dioxide, and even (PAN) 2004) Exposure to environmental in temperate Europe, soil is all too ozone are also used. However, each of these carcinogens causes cancer, and it is vulnerable to foolish and greedy disinfectants can also produce disinfectant Living with environmental hazards therefore obvious that measures of farming practices. (Humphrys 2001) by-products, which may be carcinogenic or primary prevention aimed at otherwise deleterious.’ (Pepper et al 1996) We can encounter synthetic avoiding or drastically reducing Little is known about the quality, condition and general chemicals when we rock our babies, exposures will be the most efficient state of the soil in Britain today. What is known is that relax on our sofas, watch TV, or enjoy way to prevent environmentally depleted, contaminated or undernourished soil is unable Workplace a delicious dinner. All of us have an associated cancers. (Tomatis & Huff 2001) to sustain life. Problems for health and environment are A National Health Service (NHS) publication informs us intimate relationship with synthetic created by synthetic chemicals and materials that have that many jobs today involve regular contact with known chemicals, whether we want to or not The three elements that sustain life are air, soil and water been designed to persist in unaltered states in the carcinogens, for example, ‘benzene in rubber – chemicals that invisibly surround us and the quality of each is crucial to human health. environment. Whereas micro-organisms aid the gradual manufacture, wood dust from hardwood in our products, our air, our water, breakdown of natural compounds, the majority of furniture, vinyl chloride used to make PVC, food and land – chemicals that are synthetic compounds remain unaffected and unchanged cutting oils used by metal workers – these are getting into our bodies even if we try ‘because micro-organisms lack the enzymes just a few.’ It further informs us that ‘the Health and to avoid them. (DiGangi 2004) necessary for their disintegration.’ (Fellenberg 2000) Safety at Work Act (1974) obliges employers to 24 25 inform employees of the presence of toxic Common carcinogens and Bisphenol-A (BPA) EDC/B/P: Used in the manufacture plastic foams (cushion fillings, insulation), fabrics (leather, substances in the workplace and to take endocrine disruptors (EDCS) of polycarbonate plastics (used to make food and beverage furnishings, clothing, tea bags), building products (plywood, reasonable steps to protect workers from containers) and epoxy resins; also used in a wide range of particle board, flooring), decorating products (paints, exposures,’ and that ‘union safety Most of us are unknowingly and unavoidably exposed to products e.g. white dental fillings, nail polish, food sealants, pigments) and furniture. Exposure to formaldehyde representatives have the right to see industry carcinogens and EDCs from the following sources and packaging, lenses (eye and safety glasses), water filters, in the general environment comes from vehicle exhausts, data sheets on chemicals used in the consumer products on a daily basis. We absorb these adhesives, water pipe linings and flooring. BPA is an smoke (tobacco, coal, wood), dust and vapours off-gassing workplace.’ (Health Promotion England 2001) substances into our bodies through the respiratory tract, ingredient in resins used for lining cans of food and has been (being released) from construction, insulation and interior the gastro-intestinal tract and through the skin. found to leach into certain food products e.g. peas, mixed decorating materials, fashion and furnishing fabrics. Yet we learn from a WWF report that ‘workplace vegetables, mushrooms. exposure is responsible for an estimated 6,000 Key: Organochlorines (Ocs) C/EDC/B/P: Chlorine is a cancer deaths a year … Although Health and C Carcinogen Chloroform C/EDC/B: Chloroform is used industrially naturally occurring substance. Chlorine is combined with Safety legislation exists to control hazardous EDC Endocrine Disrupting Chemical as an extracting agent and solvent, as the working fluid in hydrogen and carbon to form organochlorines. Its chemicals, evidence and experience indicates B Bio-accumulative industrial refrigeration systems and in the manufacture of manipulation and use in forming artificial chemical products gaps in the regime.’ (WWF 2003) The commonest P Persistent in the environment cosmetics, dyes, drugs, fluorocarbons, glues and pesticides. has had devastating effects on the environment that we are cancer in women is not recognised as an occupational Chloroform is an ingredient in medicinal/pharmaceutical only just beginning to understand. Ocs are used in a vast disease and is therefore not included in occupational products such as cough syrups, liniments, mouthwashes and range of everyday products from pesticides to plastics, health and safety guidelines. Thus, women cannot expect Industrial chemicals toothpastes, and in domestic cleaning products containing detergents, cosmetics, bleaches and shampoos. to be informed, either by their employers or their safety bleach. Because chloroform is widely distributed in air and representatives, about workplace risks associated with Alkylphenol ethoxylates (APEs) EDC/B/P: APEs water, we are exposed to it in air emissions from pulp/paper Parabens (Alkyl Parahydroxy Benzoates) EDC/B: breast cancer. are used as surfactants to lower the surface tension of fluids and chemicals and drugs manufacture, vehicle exhausts, A group of chemicals used as preservatives in most so they can foam or penetrate solids. They are used in the tobacco smoke, burning of plastics, and evaporation from cosmetics, personal care products (deodorants, shampoos, The increased jeopardy for women manufacture of textiles and paper, and are found in paints, polluted waterways. We are also exposed through water toothpastes, moisturisers) and some foods and drinks (pie Women can encounter repeated low-level exposures to industrial detergents, pesticides, herbicides, plastics, sources such as tap water, showers and swimming pools. fillings, beers, jams, pickles). specific carcinogenic or endocrine-disrupting substances: insulating foams, cosmetics, nappies and sanitary towels • in places of work outside the home (as wetting agents), shampoos, hair colour products, shaving Ethylene Oxide (EO) C/EDC: Ethylene Oxide is an Phthalates C/EDC/B: Phthalates are a group of chemicals • inside the home from foods, insecticides, cleaning gels and spermicides. important industrial chemical used mainly in the manufacture used extensively in industry. Because they are classified as products, surface materials and treatments, internal of other chemicals and chemical products such as anti- ‘inert’ there is no product-labelling requirement for them. air quality, furnishings, and from building, interior Atrazine C/EDC/B: Atrazine is a pesticide approved for freeze, polyester, solvents, detergents, and polyurethane Their main use is in plastics manufacture, to soften and make decorating and hobby materials use in the UK, where it is used extensively on food crops. foam. It is also used as a fumigant (foods and spices), as a flexible rigid plastics like PVC. Phthalates are also used in the • outside the home from garden and pest sprays, It is one of 20 pesticides commonly found in drinking water, sterilizer (medical and dental), and for pest control (textiles, manufacture of lubricating oils, detergents and solvents, and in fertilizers, weed killers and residues have been found on radishes and carrots. books, furniture, product packaging). It is found in breast intravenous tubing and other polyvinyl chloride (PVC) plastics. • from long-term use of pharmaceutical drugs, cosmetics, implants (as result of sterilizing process), food residues, pest personal care products and hormone-based medications. Benzene C: A colourless, volatile, carcinogenic liquid control products, cosmetics and food packaging. General They are found as ingredients of inks, paints, adhesives, These substances, through accumulation in body fat, derived from petroleum (crude oil) and coal tar. It is in the environmental exposures come from food residues, tobacco and are used in cosmetic products as carriers for perfumes, could produce higher levels of toxicity than levels top 20 highest-by-volume industrial products. Benzene is smoke and air emissions from combustion of materials skin moisturisers and skin penetration enhancers, to denature resulting from single or intermittent exposures to the used industrially as a fuel (gasoline) and a solvent, and is containing EO. It was banned from use as a pesticide in 1991. alcohol, and as volatile ingredients in hairsprays, nail polish same substance. used in the manufacture of many other products – styrene, and perfumes. Phthalates in packaging materials such as plastics, resins, synthetic fibres, some rubbers, lubricants, Formaldehyde C: Used as preservative, germicide, paper, board, cellophane and plastic can leach from food dyes, detergents, drugs and pesticides. It is an ingredient disinfectant, fungicide, defoamer, tissue fixative, fumigant packaging into food contents. In 1999 the EU banned six in waxes, resins, oils and paints. (glasshouses), fabric finish, soil sterilant (mushroom houses), phthalates from use in children’s toys which are intended to silage additive, and bactericide (kills bacteria). be placed in the mouth by children under three years of age. Formaldehyde is found in household cleaners, cosmetics Two of these phthalates, DEHP and DBP, were also banned (nail varnish), personal care products (soaps, deodorants), in cosmetics from mid-2005 (EU Directive). 26 27 Section 6 Ethics and primary prevention The phthalate DEHP is mainly used in the manufacture of Most pesticides are fat-soluble, and many have been shown PVC products e.g. disposable medical products (intravenous to be carcinogenic and hormonally active. The concerns of The deliberate and routine tubing, oxygen therapy systems) because it is cheap, flexible scientists such as Rachel Carson about the potential harm to and clear. Because it does not bind with the plastic, DEHP human health from pesticides were widely refuted and release of carcinogens into the can leach out of a PVC product. The general population is discredited by industry and science in the 1960s. She warned exposed to DEHP in air, food, and water as a result of off- then that new synthetic insecticides ‘have immense environment is as unthinkable as gassing from products and emissions from industrial power not merely to but to enter into the the practice of slavery. (Steingraber 1997) facilities. Human exposure to DEHP begins in the womb most vital processes of the body … They destroy when DEHP crosses the placenta. the very enzymes whose function is to protect the body from harm; they block the oxidation Ethics and environmental hazards Important decisions impacting on public health Polycyclic Musk Compounds (synthetic musks) processes from which the body receives its and safety, the environment, as well as the C: A group of petrochemicals used as fragrances to energy; they prevent the normal functioning of The rationale for banning, reducing or eliminating man- social and economic benefit to civil society, substitute natural musk in cosmetics, personal care products various organs; and they may initiate in certain made carcinogens and endocrine-disrupting chemicals all hinge on the honesty of scientists and the and detergents. Musk xylene is a carcinogen, and the most cells the slow and irreversible change that from our environment is an ethical one. The release of reliability of scientific advice given … there acutely toxic compound in the group. leads to malignancy.’ (Carson 1962) such agents into the air we breathe, their presence in the must be open debate when scientists disagree food chain and the potential for their absorption in with one another … conducted in terms Styrene C/EDC/B/P: Raw materials for styrene production More than 40 years later, Marion Moses, scientist and human blood, bone, body tissue and organs are the most comprehensible to the general public, so that are derived from the petrol and coal-tar industries. One of the founder of the Pesticide Center in San Francisco, compelling reasons for making ethically based decisions the public can participate in making decisions.’ most widely used industrial chemicals, styrene is used as a wrote: ‘The toxic impact of pesticides on women’s to safeguard both environmental and human health. (Mae-Wan Ho) starting material in the manufacture of a wide range of health is only now emerging from decades of plastics – polystyrene foam, synthetic rubber, plastic food scientific and regulatory neglect … Long-term, The fact that One example of the importance of independence in wrap, photographic film, car parts, PVC piping, insulated low-level exposures (to pesticides) that do not • more than 300 man-made chemicals can be found in assessing health risks was a review of studies on selected cups, plastic bottles, spectacle lenses. cause acute illness are linked to chronic humans, and that chemicals (alachlor, atrazine, formaldehyde and diseases, cancer in children and adults, adverse • children are born with a toxic burden from the womb perchloroethylene) that ‘exposed industry bias in Styrene is used in adhesives, inks, cooking utensils, floor reproductive outcomes, Parkinson’s and other leads to questions about how our regulatory system findings where 60% of studies conducted by waxes and polishes, copier paper and toner, decorating neurological diseases, among others.’ allows this to happen. non-industry researchers found these chemicals materials (varnishes, putty, paints), metal cleaners, asphalt, (Jacobs & Dinham 2003) hazardous, while only 14% of industry- petrol products and carpet backing. We are exposed to ‘Despite the implicit and potential hazards, sponsored studies did so.’ (Fagin et al 1997) styrene in the general environment by emissions from chemical-manufacturing companies are not vehicle exhausts, tobacco smoke, incinerators and industrial required to show that their products are safe It smells, doesn’t it? When those sites, and by vapours from plastic and plastic foam products before they are marketed.’ (WWF 2003) who are assessing the danger of the (off-gassing). (nuclear) industry are in the pay of The scientific community and ethics of the industry. It’s like the fox guarding Pesticides prevention the hen house. (Stewart/Greene 1999) Pesticides constitute one of the largest groups of toxic, man- Despite growing recognition in the scientific community of made chemicals to which we are routinely and inescapably the impact of specific environmental factors on health, few The particular obligation for chemists exposed. ‘Pesticide’ (officially referred to as a ‘plant from that community are seen or heard expressing interest ‘One of the most basic philosophical reasons protection product’ since 2003) is a generic term for a group in primary prevention or concern about its neglect. that chemists must try to make the work they do of chemical compounds that are formulated specifically to and the substances they use as environmentally kill or alter the growth rates of living organisms. ‘Independent, honest scientists are absolutely benign as possible is that we can. With necessary in a present-day democracy, whether knowledge of how to manipulate and transform they are working within the Government, paid chemicals, coupled with the basic hazard data by the taxpayer, or in the commercial sector. that can be accessed readily from a variety of 28 29 Section 7 International progress on primary sources, chemists have it in their power to Human rights and primary International endorsement and promotion of this right is prevention reduce or eliminate the risk posed to themselves prevention found in: and society in general by the chemical • the 1998 Aarhus Convention: ‘Every person has enterprise.’ (Anastas & Warner 1998) The right to know (RTK) the right to live in an environment adequate Policies and to maintain his or her health and wellbeing.’ projects relating The precautionary principle Access to information is the www.europa.eu.int/comm/environment/aarhus cornerstone of democracy all over • the United Nations Commission on Human Rights to breast cancer It is a truth very certain that when it the world. It allows people to make proclamation made in 2001 that everyone has the right is not in our power to determine what informed decisions about their lives. to live in a world free from toxic pollution and prevention from is true, we ought to follow what is (International Centre Against Censorship 1997) environmental degradation. most probable. (Descartes) (Environmental News Service (ENS) New York 2001) other countries, The need to be informed about anything that has the at both national The precautionary principle is embodied in the v potential to affect our health is regarded as a right. ery tradition of public health. A significant example was The internationally recognised term ‘right to know’ refers and regional the control of cholera in the 19th century through to the right of people to have access to information that is improvement of public sanitation systems before scientific of concern to them. The right of workers to know about levels, provide evidence could show any causal link between cholera and hazards in the workplace is written into occupational poor sanitation. To use the precautionary principle is to health and safety laws i.e. the Health and Safety at Work some inspiring use the ethical and common sense approach to prevention Act 1974. There is no equivalent right to know outside models for the by taking action to prevent illness and death in the face of the workplace. Extension of this right to the general incomplete evidence. The two tests that underpin the community is fundamental to attaining reduction and UK. precautionary principle are: prevention of any disease. • scientific uncertainty • reasonable suspicion of harm. RTK consumer and community information We have to persist in claiming this right because Examples of inspiring policies and projects relating to Who decides? ‘governments of every persuasion use breast cancer prevention include: Final decisions regarding the protection of environmental censorship to conceal their policies on the and public health are bound to be political decisions environment, and to silence protestors. The REACH (Registration, Evaluation and because ‘weighing the relative importance of dumping of toxic waste, exploitation of Authorisation of Chemicals) protecting public health and economic interests agricultural land by multinational companies This proposed ‘new EU chemicals legislation’ aims to in the face of uncertainty is a public policy and the long-term effects of chemicals and overhaul and modernise the EU’s regulatory system for judgement, not a scientific one.’ (National Academy nuclear accidents are often shrouded in chemicals and to increase protection of human health Press 1999) The importance of establishing the secrecy.’ (Defending Free Speech Article 19 International and environment from exposure to chemicals. precautionary principle as the universal standard in Centre Against Censorship London 1997) www.europarl.org.uk both old and new policies pertaining to health and Sweden: Pollution Reduction Programme environment cannot be over-estimated. The right to live and work in a clean www.internat.naturvardsverket.se/ environment Denmark: The Danish Chemicals Strategy If the prospect of enough profit www.mst.dk comes in through the door, Every family should be able to obtain USA: The Environmental Oncology Center precaution often flies out of the water, food and air free from www.upci.upmc.edu window. (Humphrys 2001) chemical and radiological The Silent Spring Institute www.silentspring.org contamination. (Sherman 2000) Canada: The Toronto Cancer Prevention Coalition www.city.toronto.on.ca 30 31 Section 8 Prospects for primary prevention All of this points to the probability that most politicians and environment. And trade unions have responsibility Some of the causes of breast do recognise: for ensuring that the health and safety of people at work • the relationship between environment and health is protected in accord with workplace regulations. cancer and related diseases can • the environmental origins of most cancers • cancer (and breast cancer) as a largely preventable only be controlled by political disease Science and social action... (Davis et al 1998) • the existence of scientific evidence supporting primary prevention actions and policies. Few scientists would disagree with the two means for attaining prevention in the following statement: Current breast cancer • include no public warnings about man-made It would seem reasonable to assume therefore, that the ‘The most effective means of reducing (cancer) risk are, prevention options carcinogens and EDCs encountered in everyday life majority of government members, their advisers and civil (1) avoidance of tobacco use, consumption of • propose no strategies for the primary prevention of servants in related departments (health, industry, appropriate diets, and Medical prevention is electively available to women breast cancer e.g. banning production and use of environment, public health), must be equally aware of the (2) limiting exposure to occupational and other perceived to be in the ‘high-risk’ category for breast man-made carcinogens and EDCs. ‘ethical’ decisions and policy choices confronting environmental carcinogens.’ cancer. The choices are: government. (World Cancer Research Fund & American Institute for • oophorectomy – removal of ovaries (by surgery) or Cancer Research 1997) destruction of ovaries (by drugs or radiation) to Primary prevention: how well- eliminate a main source of oestrogen production informed are decision makers? Who is responsible for breast Yet the second of the two remains consistently under- • bilateral mastectomy – the surgical removal of both cancer prevention? acknowledged as a preventive measure by the very breasts. The UK parliamentary system is served well by community which once, among its most eminent cancer informational support from: Some of the causes of breast cancer researchers, ‘shared the belief that malignant Chemoprevention (prevention through the use • regular internal publications e.g. POST Technical and related diseases can only be diseases can be reduced significantly by of drugs) is designed to reduce or block the action of Report 108 ‘Hormone Mimicking Chemicals’ 1998; controlled by political and social determined efforts to identify environmental the hormone oestrogen, Tamoxifen and similar oestrogen- parliamentary proceedings (Hansard) action aimed at reducing the causes and to eliminate them or reduce their inhibiting drugs are currently used as a preventive • reports and briefings from government committees production, use, transport and impact.’ (Rachel Carson 1962) measure for women perceived to be in high-risk categories e.g. All-Party Parliamentary Group (APPG)* disposal of agents that directly or either for disease onset or for disease recurrence. on Breast Cancer. indirectly affect breast cancer Any future hope for science leading and influencing risks…The public and private sectors primary prevention policies lies with those scientists who UK government’s Cancer Prevention Plans – Government also seeks and hears policy and planning could, for example, devise policies to publicly acknowledge the association between the National Cancer Plan (NCP) 2000 and The Scottish advice from key people in academic institutions, from prevent, restrict, or reduce exposures environmental pollution and escalating cancer rates, and Cancer Plan (SCP) 2001 – aim to reduce cancer death professional bodies such as The Royal Society and the to agents in the household, who take up new challenges in research and development rates by 20% in people under the age of 75 by 2010. British Medical Association, and organisations like the workplace, and general environment e.g. green chemistry and endocrine disruption. For A large-scale public education campaign is targeting Pesticide Action Network UK (PAN). Perhaps most that extend the duration and onset of example Dr Nicholas Leadbeater and his research group lifestyle changes (exercise, diet, alcohol consumption and significant, in terms of future change, is the information breast growth or alter the hormonal at King’s College, London, are working in areas of smoking) regarded by both governments as key factors in reaching national parliaments from the European Union environment. Davis et al 1998 organic and inorganic synthesis and are interested in new cancer prevention. Ignoring the links between (EU) – a newly expanded federation of 25 member states ways to make molecules and cleaner ways to do chemistry environmental and occupational exposures to carcinogens including the UK. Responsibility for putting in place the legislative and and to minimise waste: ‘We want to make a product and EDCs as major and preventable factors in breast regulatory measures for preventing the cancer which each with no waste and no by-products and hence cancer, the government’s prevention campaigns: year affects almost a quarter of a million British women less chance of polluting the environment.’ • take no account of the vast amount of international * APPGs have no power either to make or alter laws but they do serve as lies first and foremost with government. (Royal Society Summer Science Exhibition London July 2002) scientific work establishing the association between sources of expert advice and information to others in government and breast cancer and environmental exposures to man- can therefore influence both government thinking and decisions on Science and industry bear responsibility for any adverse Hope rests also with those who are unequivocal about made carcinogens and EDCs topics such as breast cancer prevention. impacts of their actions and products on wildlife, people the task facing all governments. For example, Professor 32 33 Dominique Belpomme, medical oncologist at the profit from its products. ‘The pharmaceutical The need to reduce levels of chemical and radiation the potential to damage either of these University of Paris, believes: ‘Public health policies industry will always fund areas that are in their pollution is creating opportunities for new partnerships • to control industry behaviour in order to prevent must now focus on the relationship between best direct interests. Cancer prevention is not between science and industry. Whether by design or adverse effects on health and environment environment and health. Realistic primary currently one of these … We live in a commercial default, scientists and industries responding to such • to safeguard the population against science and prevention policies should be introduced with world and the major problem is that nobody is opportunities will benefit the health of future generations industry-produced hazards, particularly those with the aim of avoiding the deleterious factors willing to pay very much for vague prevention and the quality of the environment that supports future irreversible effects such as cancer. which we introduce into the environment.’ information – it has to be made more precise and life. As a consequence of government’s failure to adopt (PAN Europe Pesticide News 2004) more individual. People value treatment more effective preventive measures, citizens find themselves than prevention so that is where the profit now caught between two extremes: There is a need for: lies.’ (Dalgleish Richards Sikora 2004) Trade Unions • government policy promoting lifestyle changes as key • independent scientists to express their concerns in to prevention public forums History shows that industry: Trade unions could: • industries producing and marketing carcinogenic • government to heed the voices and warnings of • ‘has aggressively pursued short-term • take seriously the health of women members and ‘lifestyle’ products. independent scientists. economic goals, recklessly uncaring or workers by listening to and recording women’s views unmindful of harm to workers, local on the health risks and safety issues they experience in Prevention economics Independent scientific opinion, free from the constraints communities, and the environment. So far, their places of work In two reports prepared for the UK Treasury by Sir Derek of vested interests, will be crucial to the process of industry has shifted responsibility for the • take account of adverse health impacts of women’s Wanless on future health spending (April 2002, February developing primary prevention strategies. damage it has caused and has externalized multi-occupational work patterns 2004), he warns that ‘the huge sums invested in these costs onto society at large.’ (Epstein 1990) • identify and take remedial action on workplace and NHS modernisation will be wasted if the health Science is a continuous endeavour. • ‘neither plans nor accounts for the social and occupational factors which affect women’s health as service is hit by high levels of preventable But it will only help to stem the breast economic costs of its products and processes distinct from effects on male employees illness over the next 20 years.’ (‘Putting Health First’ cancer epidemic if its findings are on the environment and on people. Corporate • document and disseminate information about King’s Fund 2004) Both in economic and social terms, put to use by government and others accounting does not calculate the real value workplace hazards/risks for breast cancer. prevention is the common sense approach to sustainable, who make public policy. (Read 1995) of economic and human loss of the toxins they long-term health service provision. add to our lives.’ (Chernomas & Donner 2004) Government Directions for responsible government Industry Even when proposed changes are informed by science Deep public mistrust stemming from a recent history of and endorsed by government, co-operation from industry Implications of accepting that the government failures to protect public health (e.g. BSE Industry manufactures, produces, transports and markets sectors with a record of persistent and powerful cancer epidemic may essentially be and CJD) makes more urgent the need for resolute products in a great variety. Most are produced to enhance opposition to change – and of judging change in terms preventable will pose some difficult government action on many issues related to the primary and improve our daily lives. However, many chemically of real or perceived industry benefit – is highly unlikely problems for politicians and prevention of breast cancer. For example, a responsible based, chemically treated and radiation-emitting products without government leadership and legislative reform. decision-makers, who will have to government would: are proven and potential threats both to health and consider adopting policies that may • make the goal ‘pollution prevention’ instead environment. Industry is the major source of toxic ‘Industry’ is not a homogenous damage the economy in the short of ‘pollution control’ substances creating hazardous conditions in the entity….A general observation is that term in order to reap health benefits • adopt ‘the polluter pays’ policy environment. But to what extent is industry responsible market leaders, at least initially, are which will only become apparent • introduce a toxics reduction programme for human and environmental health? against new legislation as any several decades in the future. (Hens • actively promote the development and use of safe change threatens their position, but Howard Van Larebeke 2004) alternatives to hazardous substances In theory, all industry sectors, from laboratory to mine, that innovative, dynamic companies • integrate health and environment in policies from manufacture to market, have legally mandated frequently embrace new legislation Empowered by the people and obligated by law, it is the • get serious about occupational factors affecting responsibility for preventing adverse effects on human and as a way to acquire a greater market duty of government: the health of women environmental health as a result of their decisions, activities share. (International Chemical Secretariat • to protect public health and the environment from • honour the commitment made to implement the and products. In reality it is the business of industry to April 2004) man-made materials and practices that damage or have precautionary principle 34 35 • take stringent measures to protect vulnerable people, The cancer industry A cancer-industry view of its future Sources of information particularly children Authors of a report predicting a continuing rise in Where industry and government have failed in their • extend regulatory requirements to all chemical The ‘cancer industry’ is a generic term for the ever- cancer rates expect cancer will increasingly be managed responsibilities regarding provision of public information compounds, old and new expanding industry which has grown up around the with lifelong drug treatment and lifelong monitoring, as about human and environmental health hazards, • bring the UK’s outdated regulations into line with disease of cancer. It is a vast industry incorporating all in diabetes and asthma. The direct cost for managing the comparatively less well-resourced citizens have taken on advances in the field of toxicology services, products, materials and technologies required medical care of one cancer patient was approximately that responsibility themselves. Dedicating a huge effort in • extend the application of regulations to the whole for the orthodox management of the disease. £20,000 in 2004. If we are heading into a ‘positive time and energy, national, regional and local non-profit, community chemotherapy future’ then, ‘by 2025 this figure non-governmental organisations endeavour to fill • incorporate lay knowledge in the regulatory process Given its: could easily rise to £100,000 per patient per important gaps in public and consumer information by: • prioritise primary prevention of breast cancer • traditional preoccupation with control and year – a total of perhaps £1 million over a • producing information (print and electronic) • give breast cancer prevention the highest priority by management of the disease lifetime. We are starting to spend vast amounts • conducting awareness-raising campaigns. setting up a working group: • current preoccupation with new therapies (drug of UK tax on the National Health Service (NHS) - made up of professionals experienced in and gene) to meet future demands taking the total healthcare budget up to £80 Citizen action occupational and environmental cancers, • huge (research and financial) investment in therapies billion per year. We could consume a lot more Some recent breast cancer related actions taken by citizens independent scientists committed to cancer for a burgeoning future market than this in the future just on treating cancer. include: prevention, representatives of public interest • awareness that profits for society from ‘primary The explosion of new therapies in cancer care • The Ban Lindane Campaign: A coalition of union (employee, consumer, citizen) groups and breast prevention’ represent a loss of industry profits, is going to continue and pricing of these drugs and campaigning organisations succeeded in having a cancer, environment, union and workplace there would appear to be little hope for the ‘primary will remain high. If effective drugs emerge pesticide linked to breast cancer incidence banned from organisations prevention’ of breast cancer becoming a priority for the from the research and development pipeline, garden and agricultural use in 2000. - dedicated to the development of comprehensive cancer industry. the cancer drug market will be worth US$300 • ‘Think Before You Pink’ Campaign: The public primary prevention policies and strategies. billion globally by 2025.’ (Sikora ‘Cancer 2025: service union (UNISON) and Women’s Environmental This group would be given a proportion of annual health Evidence for this situation can be found in the long- the future of cancer care’ 2004) Network (WEN) directed a postcard campaign expenditure for the implementation of the policies and prevailing silence from the industry on environmental (October 2004) at major cosmetics companies. It strategies it recommends. and occupational factors in breast cancer (and other A thriving enterprise with a guaranteed future, ‘cancer’ questioned their support of the corporate-driven ‘Pink cancers of the reproductive system). Silence from this is a growth industry in every sense of the word. It would Ribbon Campaign’ (which promised a percentage of Reducing human exposures to carcinogens and EDCs source in particular deprives citizens of control over their be extremely unlikely that this particular industry would sales for research) while producing and selling products will require: health and their lives by depriving them of basic right to champion a case which has the potential to undermine its containing carcinogens and EDCs, and reminded target • a massive rethinking and reordering of priorities know information. This is the silence that allows very existence. companies that ‘safer alternatives are available. It’s time by science, industry and government industries to go on: for companies to phase out these chemicals’. • a political and cultural shift where protection of • producing carcinogens and carcinogenic products • A Bio-monitoring Survey: ‘Bio-monitoring’ is the public and environmental health takes priority over • using carcinogens and carcinogenic products. Citizens scientific testing of biological samples e.g. blood or protection of industry, trade and the economy urine to identify the presence and levels of certain • interaction and co-operation between independent Cancer charities Information is the key substances in the body. In partnership with the organisations and institutions. As major fundraisers for research and major providers of Without essential information (and adequate resources) National Federation of Women’s Institutes (NFWI) and public information and patient support services in the UK, citizens cannot take, or be expected to take, either The Co-operative Bank, WWF conducted a bio- Above all, future policies for protecting and benefiting cancer charities work in close association with the cancer individual or collective responsibility for disease monitoring survey in 2003. The aim of the survey was human, environmental and economic health will require industry. Primary prevention is not their objective. At this prevention. Without information we have no choice but to raise awareness about the presence of specific man- a return to the basic principles of common sense and a time (2005) the few that are addressing ‘prevention’ e.g. to remain: made chemicals in everyday products and situations valuing of life and the environment which sustains it. Breakthrough and World Cancer Research Fund (WCRF) • vulnerable to exposure and the extent to which these contaminate people. are endorsing and promoting the lifestyle focus of • ignorant about risk government campaigns, both in their literature and • powerless to choose. The Paris Appeal prevention-related research. In May 2004 a documented appeal was made to national decision makers, international organisations, the United 36 37 Nations (UN) and the European Union (EU) to apply the Public opinion, when it Breast cancer: an environmental disease The case for primary prevention precautionary principle to chemicals which constitute a danger to health and to support the proposed new EU is truly aroused, can be This Case was produced by We gratefully acknowledge Test readers As owner of the copyright, the UK the following members of the the practical and professional Judy Adams Working Group on the Primary chemicals legislation (REACH). unstoppable. (John Humphrys) Prevention of Breast Cancer gives UK Working Group on the help given to the development Moira Adams permission for the whole or part of The Paris Appeal has already been signed by numerous Primary Prevention of Breast and completion of this work Astra Blaug this document to be photocopied, Cancer: by the following people and Henry Brookman lent or passed on in electronic international scientists, Nobel Prize winners, 400 non- format, for use by members of the government organisations and 90,000 EU citizens. It has Information and campaign links organisations: Sheena Brookman public or an organisation working also been signed by two million doctors representing the Diana Ward Sandy Lawrence with the community, and for the Principal writer/researcher Editorial meeting hosts Maureen Morton latter’s benefit, but not for sale or Standing Committee of European Doctors (CPME). Alliance for Safe Alternatives www.safealternatives.org exchange. UK Working Group on www.artac.info Association for Research and Treatment against Cancer Chair Breast (Cancer) UK Sheena Brookman Jo Taylor the Primary Prevention of Breast www.artac.info Deborah Burton Dianne Dowling Gwynne Wallis Cancer requests anyone using Trustee Breast (Cancer) UK Morag Parnell Janet Williams this material to acknowledge The Human Rights Act Breast Cancer Fund www.breastcancerfund.org copyright ownership. Incorporated into the UK legal system Center for Green Chemistry www.greenchemistry.uml.edu Alison Craig Dept of Nursing and since 2000, the Human Rights Act Chemical Reaction www.chemicalreaction.org Trustee Breast (Cancer) UK Midwifery Stirling University Reference searches Disclaimers: Jill Day Pesticides Action Network UK Judy Adams This work in no way claims to be provides the appropriate framework Communities against Toxics a comprehensive treatment of the for citizens deciding to take the ‘civil www.communities-against-toxics.org.uk Women’s Health Officer East The London Haven Dr Jim Brophy subjects of breast cancer or action’ path to gain public attention Environmental Working Group www.ewg.org Midlands Region UNISON Rory O’Neill breast cancer prevention. Clare Dimmer Technical support Outreach Services Team Inclusion of website addresses and progress for primary prevention European Consumers’ Organisation (BEUC) www.beuc.org does not imply our endorsement or for related issues such as ‘right to Friends of the Earth (FoE) / Scotland (FoES) Secretary Breast (Cancer) UK Chris Bergen Baron’s Court Library of all the opinions expressed know’ (RTK). www.foe.co.uk and www.foe-scotland.org.uk Helen Lynn Kevin Dimmer Our particular thanks to therein. Green Network www.green-network.organics.org Trustee Breast UK/Campaigns Marjie Laredo Professor Andrew Watterson With no sign of leadership from government regarding Greenpeace www.greenpeace.org.uk and Health Co-ordinator Tony Mathias and Dr Ann Johnson for their primary prevention, and little evidence of a move towards Hazards Campaign www.hazardscampaign.org.uk Women’s Environmental Vanessa Ward-Mathias critical comment and advice. safer, carcinogen-free developments from industry, it is hazards magazine www.hazards.org Network UK Ivan Weedon clearly the responsibility of informed citizens to draw Health Care Without Harm www.noharm.org Morag Parnell Editor: Angela Burton attention to, and gain support for, the primary prevention Institute of Science in Society www.i-sis.org.uk Women’s Environmental Copy editor: Jennie Brice of breast cancer from those who influence policy, and London Hazards Centre www.lhc.org.uk Network (Scotland) Design and layout: from policy makers at all levels of government. Our Stolen Future www.ourstolenfuture.org David Cross, Rabina Stratton Pesticide Action Network UK (PAN-UK) www.pan-uk.org At present this document is only available online. This and Little has been done to prevent Soil Association www.soilassociation.org a summary version of the document can be downloaded at Printing: Seacourt exposure to carcinogenic chemicals in The Campaign for Safe Cosmetics www.safecosmetics.org www.nomorebreastcancer.org For more information contact This document is printed on the environment, despite ample Women’s Environmental Network (WEN) www.wen.org.uk [email protected] Revive Silk using vegetable evidence that chemical pollution of our Women in Europe for a Common Future www.wecf.org oil-based inks air, water, food and the workplace is the WWF – Chemicals and Health Campaign site © UK Working Group on the Primary Prevention of Breast Cancer 2005 major cause of cancer. On the contrary, www.wwf.org.uk/chemicals government, industry and a small coterie of scientists have combined to stymie efforts to introduce preventive As it is the nature of science that scientific measures, such as strict pollution Give the people the certainty never exists, the proper use of control standards. But cancer remains science and scientific findings is precisely a preventable disease. It is up to facts, and let them citizens to push for action. (Epstein 1990) decide. (Abraham Lincoln) to enable us to act with precaution. (Dr Mae-Wan Ho) 38 39