issue 198 - August 1989
Richard Swift explains
how we can tackle the
All of us must come to terms with cancer. Most will know the disease personally or through friends and family. Yet there remains a reluctance to speak the word - a dread of the death sentence so often associated with it. Cancer lays bare the comfortable fiction that we will live forever.
This reluctance to talk about cancer is a problem. Fear blocks the possibilities of prevention - both personal and collective. We abdicate understanding to doctors and scientists in the hope of some 'miracle cure'. Most cancer-fighting resources are absorbed in the so-far futile search for a medical solution.
There are two traditional ways of dealing with cancer. The first uses medical treatment: surgery and, more recently, chemotherapy - both of which can have drastic side effects and quite mixed success. A second way has been to concentrate on the psychology of the sufferer. This is also a very mixed bag. Gentler forms of therapy - relaxation, diet, counselling, massage - make people better able to resist their cancer. But the dubious psychological notion of a 'cancer personality' has become a 'new age' variant of the blame-the-victim philosophy. This approach links cancer to the psychological shortcomings of the victim: cancer is seen as an expression of blocked emotions or an inability to deal with pressure and stress.
More recently, health activists have focused on the environmental causes of cancer. The disease is said to be embedded in the very core of industrial society. According to this view, seriously tackling cancer means changing our diet, stamping out smoking and examining the industrial use of carcinogenic (cancer-causing) chemicals and other dangerous substances.
This can't be done without stepping on some people's toes. Fortunes are made by selling tobacco and by a petro-chemical industry that depends on the use of carcinogenic chemicals. Just as smokers are addicted to tobacco, so our economy is addicted to chemicals. We use them to flavour our food, fatten our cattle and ripen our fruit. We also use them in the factory, on the farm and in our homes. The companies that manufacture these chemicals assure us they are perfectly safe. (The tobacco industry says the same thing about smoking.) Yet there is a long list of chemicals and pharmaceuticals that have turned out to be anything but safe. DDT, saccharin, DES (used during menopause), vinyl chloride and asbestos are now generally agreed to increase the risk of cancer. Their use has either been banned or severely restricted in most industrial countries.
The evidence linking cancer with the industrial environment was further strengthened when researchers started to 'map' the disease. Concentrations of cancer were discovered cheek-by-jowl with petro-chemical factories. New Jersey, which has the highest cancer rates in the US, is also one of the most important centres of petro-chemical production.i
Mapping has also revealed 'clusters' of cancers around chemical factories, nuclear reactors, refineries and in farming areas where there is heavy pesticide use. Cancer mapping in Sydney, Australia, has shown a correlation between class and cancer. Working-class communities like South Sydney, Leichhardt and Marrickville all show high cancer rates, especially for men.2
Cancer prevention, whether related to personal habits or industrial exposure, requires a strong program of public education, grassroots pressure and political action. In this area the cancer research and medical establishment treads very carefully. Pure research (no matter how ineffective) attracts many more dollars than campaigns exposing dangerous corporate practices. The Canadian Cancer Society, to its credit, has established a political advocacy office in Ottawa, mostly to tackle tobacco-related issues. But as Society President Doug Barr points out: 'A few years ago you couldn't even spell the word advocacy in this organization.' The major cancer organizations in the US and Europe still need some spelling lessons.
There may be controversy about the causes of cancer. But one thing seems certain: there is no plague of cancer. Even though the disease is the second leading cause of death in industrial countries there are no runaway rates of increase - except for lung cancer.
Nor is cancer a contagious plague-like disease. Instead it involves a slow process of poisoning from so many sources that it is impossible to pinpoint with absolute certainty any particular cause. Most cancer develops as a result of years of exposure to carcinogenic triggers that set off the uncontrollable growth of malignant cells. The disease seems to be built up gradually. The more cigarettes you smoke, the more asbestos fibers you breathe, the more fatty or smoked food you eat, the more you are exposed to radiation - the more you increase your chances of developing a tumour. Low-level radiation expert, Rosalie Bertell, believes there are large numbers of 'sub-clinical cancers' that may or may not develop into full-blown cancer.
So much is known about cancer and yet so little. For example, tobacco use can be correlated closely with lung and several other cancers. Yet there is no certainty that even a heavy smoker will get cancer. The chances of developing the disease increase with the amount of exposure to a carcinogen (for example, arsenic, benzene or asbestos) but even a minor exposure may result in a tumour. In one case a woman who pushed a tea cart through an asbestos plant once a week for a year developed a rare asbestos-related cancer.3
Billions of dollars have been spent searching for causes and cures. Yet survival rates have not improved over the past two decades. Little progress has been made on stopping or slowing down the disease once it has started. Surgery is still the best bet. Drug and radiation therapy are effective for a few cancers but not with others. So far the search for a cure must be regarded as a qualified failure. Indeed, because cancer is actually some 200 different but related diseases, it is possible that the search for a single cure may be futile.
When it comes to estimating the risks associated with any particular carcinogen, it's hard to sort out science from politics and economics, Critics like Dr Samuel Epstein, author of The Politics of Cancer, charge that our 'chemical society' and the irresponsible corporations that run it are creating a cancer epidemic. But that case has been weakened by overstatement. Exaggerated claims have allowed the chemical industry to counter-attack, accusing environmentalists of whipping up irrational 'cancerphobia'. Cancer researchers are joining the fray on both sides. One well-known cancer researcher, Bruce Ames, actually campaigned against Proposition 65, a citizens' initiative in California to control carcinogens. He felt the proposition would produce regulations that found chemicals guilty until proven innocent'.4
Scientific claims in this war of words show dramatic differences of opinion. For example, there is no doubt that people will die of cancer as a result of the Chernobyl nuclear disaster. But how many? Estimates range from 5,000 to 100,000 deaths over the next 40 years.5 If very rigorous scientific proof is required it may be impossible to verify either estimate; but the threat is still real.
The consensus now is that the majority of cancers are due to 'lifestyle' factors. Over 30 per cent of cancers are due to smoking. Between four and 20 per cent are said to result from workplace exposures.6 Guesstimates at general environmental causes are between ten and 15 per cent.7 But it is impossible to account for many factors. The cancer potential of a bad diet (or even a not-so-bad diet) is certainly enhanced by carcinogenic hormones in beef - or healthy doses of pesticides like Alar, which was widely-used on apples in North America until it was recently withdrawn from the market. How are we to measure the gradual weakening of the immune system, as seen in the recent spate of immune deficiency diseases like Epstein Barr virus or the huge number of people with serious allergies? How many cancers occur due to fragile immune systems bombarded by scores of environmental pollutants'? And how can you judge the effects of two or more carcinogens working together to create a tumour, a synergistic effect that can magnify risks many times?
Many tumours take decades to develop. so it is impossible to judge the full impact of the chemical revolution on cancer rates. But a revolution it has been: since 1940 the production of synthetic chemicals has increased 200-fold. Tens of thousands of chemicals are now in regular industrial use. Some of the most frequently used are among the minority that are proven carcinogens. For example, 28 billion pounds of benzene (associated with bone marrow cancer) are produced worldwide every year.
Toxic chemicals can enter the food chain and our water supply at any number of points. Some go directly onto our food. In the US alone 2.6 billion pounds of pesticides are used every year. Others leach into the soil and ground water or go directly into our lakes and rivers. In North America, 140,000 toxic waste dumps have so far been identified - many of them leak dangerous chemicals into the surrounding environment. And industry continues to spew tons of toxic chemicals into the air. The effects are truly global. High levels of PCBs (polychlorinated biphenyls) occur in sea animals that are part of the diet of Inuit hunters in the high Arctic. Dr Kenneth Rahn of the University of Rhode Island found radiation from the Chernobyl nuclear disaster took only II days to reach the US east coast.
Cancer researchers sometimes say that the prevalence of cancer in the Third World shows that the 'chemical society' is not totally to blame. If cancer is a by-product of industrialism, they argue, it would be largely absent from the less industrialized parts of the world. In fact, the pattern and types of cancer in the Third World are very different from those in industrial countries. Liver, stomach, cervical and mouth cancers tend to predominate in the Third World while they are relatively rare or on the decrease in industrial society. Most of these cancers can be traced to inadequate diet or a lack of medical services such as regular check-ups to screen for cervical cancer. Others, like liver cancer, are caused by viruses like hepatitis B - and go untreated because available vaccines are too expensive. In this sense Third World cancers are diseases of underdevelopment.
But developing nations are fast joining the chemical society - without the regulatory niceties that provide some control of dangerous carcinogens in Europe and North America. Some two million people around the world are exposed to chemical poisoning and the vast majority of these are in the Third World where banned herbicides and pesticides are still in common use. It will be decades before we know how many cancers will result from this unsafe use. In Zambia, for example, dried fish in market stalls is sometimes sprayed with DDT to repel the flies. In newly-industrializing countries like Brazil, Mexico, and India, legislation to protect workers and communities from carcinogens either does not exist or is rarely enforced.
The World Health Organization (WHO) is worried that slick marketing by global tobacco giants like RI Reynolds and Philip Morris will produce a virtual epidemic of lung cancers in the Third World, where smoking is increasing dramatically, particularly among men. By 1975 the male lung cancer rate in Shanghai had reached 50.2 per thousand - higher than much of Europe and North America.
As the Third World becomes more integrated into the chemical society the overall cancer profile will change. To the cancers of underdevelopment will be added the cancers of industry and consumer habit - lung, breast, colon and bladder. Already more than half of the world's six million cancers occur in the Third World where most patients cannot afford treatment, even in the rare places where it is available. In all of sub-Saharan Africa there are 75 cancer specialists to serve 285 million people.
According to the WHO, over a third of these cancers are preventable and another third curable if caught in time. What is needed is a prevention program that highlights the root causes of the disease. This means educating people so they can change those habits that are within their control. But more importantly it means breaking our dependency on industrial chemicals where there is any chance they may be carcinogenic. After all most smokers know they are taking a risk. But most people don't know, or haven't a lot of choice, when they are exposed to carcinogens at work or in their communities.
We must identify the links between personal activities (like smoking, drinking and eating unhealthy foods) and the social and economic pressures in people's lives. Our cultural climate makes such self-destructive behaviour attractive and profitable. But such habits are not freely-chosen; they are related to questions of gender and class. Those who are devalued most by our economy (women, working people, racial minorities) find it hardest to change because they have the fewest options and the least to lose.
Groups like the anti-pesticide Toxic Action Group in Aotearoa or the Ontario-based Non-Smokers Rights Group are developing a politics of prevention that tackles cancer at the source. They are in a common struggle with unions fighting for worker safety from the British Midlands to the steel mills of the Ruhr valley.
Who knows'? One day we may see the kind of grassroots action described by novelist Audre Lorde in her Cancer Journals: 'An army of one-breasted women (who have had mastectomies) descending on Congress to demand that the use of carcinogenic hormones in beef-feed be outlawed.'
1 'Reducing Environmental Risk', Transaction, Robert H. Harris et ai., March/April, 1981.
2 The Quick and the Dead: A Biomedical Atlas of Sydney, John B. Gibson and Arne Johansen, Reed Sydney.
3 'Preventing Catastrophe', Barry Castleman, Transaction, March-Aprii. 1981
4 'The Environmental Cancer Debate Updated', Rick Hester, Science for the People, Jan/ Feb. 1989.
5 The Chenobyl Disaster, V Haynes and M Bojcun, Hogarth Press, 1988.
6 Hester, op. cit.
7 The Toxic Cloud, Michael H Brown, Harper and Row, 1987.
8 Brown, op. cit.
Worth Reading On
The literature on cancer usually deals with single causes. But you can get a good (if politically safe) overview from James T Patterson's The Dread Disease (Harvard University Press, Cambridge, Ma, 1987). The environmentalist case is strongly argued in Samuel Epstein's controversial The Politics of Cancer (Sierra Club Books, San Francisco, 1980). For a recent update of the debate see the Jan/Feb, 1989 issue of Science for the People (897 Main St.. Cambridge, MA, USA 02139: Sub' scriptions $15 a year). On specitic carcinogens Paul Brodeur's Outrageous Misconduct (Pantheon, New York, 1985) about the asbestos industry is excellent. Two contrasting yet personal books about cancer are Susan Sontag's classic Illness as Metaphor (Farrar, Straus and Giroux, New York, 1987) and Audre Lorde's moving The Cancer Journals (Spinsters, San Francisco, 1980)