[Senate Hearing 107-565]
[From the U.S. Government Publishing Office]
S. Hrg. 107-565
CANCER CLUSTERS IN LONG ISLAND, NY
=======================================================================
FIELD HEARING
BEFORE THE
COMMITTEE ON
ENVIRONMENT AND PUBLIC WORKS
UNITED STATES SENATE
ONE HUNDRED SEVENTH CONGRESS
FIRST SESSION
ON
ASSESSING THE POTENTIAL LINKS BETWEEN ENVIRONMENTAL CONTAMINATION AND
CHRONIC DISEASES
__________
JUNE 11, 2001--GARDEN CITY, NY
__________
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COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS\1\
one hundred seventh congress
first session
HARRY REID, Nevada, Chairman
BOB SMITH, New Hampshire, Ranking Republican Member
MAX BAUCUS, Montana JOHN W. WARNER, Virginia
BOB GRAHAM, Florida JAMES M. INHOFE, Oklahoma
JOSEPH I. LIEBERMAN, Connecticut CHRISTOPHER S. BOND, Missouri
BARBARA BOXER, California GEORGE V. VOINOVICH, Ohio
RON WYDEN, Oregon MICHAEL D. CRAPO, Idaho
THOMAS R. CARPER, Delaware LINCOLN CHAFEE, Rhode Island
HILLARY RODHAM CLINTON, New York ROBERT F. BENNETT, Utah
JON S. CORZINE, New Jersey BEN NIGHTHORSE CAMPBELL, Colorado
Eric Washburn, Democratic Staff Director
Dave Conover, Republican Staff Director
\1\Note: On June 6, 2001, the majority of the Senate changed
from Republican to Democrat when Senator James M. Jeffords,
of Vermont, changed party affiliation from Republican to
Independent. Senator Harry Reid, of Nevada, assumed the
chairmanship of the committee.
(ii)
C O N T E N T S
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Page
JUNE 11, 2001--GARDEN CITY, NY
OPENING STATEMENTS
Chafee, Hon. Lincoln, U.S. Senator from the State of Rhode Island 6
Clinton, Hon. Hillary Rodham, U.S. Senator from the State of New
York........................................................... 2
Reid, Hon. Harry, U.S. Senator from the State of Nevada.......... 1
WITNESSES
Ackerman, Hon. Gary L., Representative from the State of New York 8
Balboni, Hon. Michael, State Senator from New York............... 11
DiNapoli, Hon. Thomas P., Assemblyman, New York State Assembly... 12
Prepared statement........................................... 68
New York Assembly Bill Text 7320, March 21, 2001............. 70
New York Assembly Bill Text 8672, May 7, 2001................ 71
Frankel, Gail, field coordinator and advocate, on behalf of the
National Breast Cancer Coalition, Centereach, NY............... 37
Prepared statement........................................... 187
Gammon, Marlie, Ph.D., associate professor of Epidemiology,
School of Public Health, University of North Carolina at Chapel
Hill........................................................... 34
Prepared statement........................................... 174
Goldman, Lynn R., M.D., M.P.H., professor, Environmental Health
Sciences, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD.................................................. 54
Prepared statement........................................... 207
Grucci, Hon. Felix J., Jr., Representative from the State of New
York........................................................... 9
Hare, James E., councilman, City of Elmira, NY................... 19
Prepared statement........................................... 86
Israel, Hon. Steve, Representative from the State of New York.... 10
Jackson, Richard J., M.D., M.P.H., director, National Center for
Environmental Health, Centers for Disease Control and
Prevention, Department of Health and Human Services............ 48
Prepared statement........................................... 189
Juchatz, Amy, M.P.H., health program analyst, Suffolk County
Department of Health Services.................................. 39
Prepared statement........................................... 188
King, Hon. Peter T., Representative from the State of New York... 14
Landrigan, Phil, M.D., M.Sc., Ethel H. Wise, professor and
chairman, Department of Community and Preventive Medicine,
Mount Sinai School of Medicine................................. 15
Prepared statement........................................... 72
McCarthy, Hon. Carolyn, Representative from the State of New York 7
Miller, Karen Joy, founder and president, Huntington, NY Breast
Cancer Action Coalition........................................ 22
Prepared statement........................................... 128
Senie, Ruby, T., Ph.D., professor of Clinical Public Health,
Mailman School of Public Health of Columbia University......... 35
Article, Breast Cancer, Metropolitan New York Registry......178-186
Prepared statement........................................... 174
Tobin, Tim, Elmira, NY........................................... 21
Prepared statement........................................... 128
Todd, Randall L., M.D., State epidemiologist, Nevada State Health
Division....................................................... 17
Prepared statement........................................... 81
Winn, Deborah, Ph.D., acting associate director, Epidemiology and
Genetics Research Program, Division of Cancer Control and
Population Sciences, National Cancer Institute, National
Institutes of Health, Department of Health and Human Services.. 50
Prepared statement........................................... 192
Wilson, Samuel, H., M.D., deputy director, National Institute of
Environmental Health Sciences.................................. 52
Prepared statement........................................... 205
ADDITIONAL MATERIAL
Articles:
Darmouth College, March 15, 2001, Darmouth Researchers Warns
of Chemicals Added to Drinking Water....................... 243
Lee, John R., M.D., Is Fluoridation Scientifically Defensible 244
Metropolitan New York Registry..............................178-186
Mesa Tribune, Arizona, December 5, 1999, Former Fan of
Fluoridation Now Warns of its Perils....................... 248
Southside High School Property History....................... 98
The National Treasury Employee Union, Chapter 280, Why EPA's
Headquarters Union of Scientists Opposes Fluoridation...... 239
Fact Sheets, Southside High School, New York State Department of
Health........................................................112-127
Letters:
Brentwood/Bay Shore Breast Cancer Coalition.................. 224
City of Elmira, NY..........................................102-105
Cobis, Elaine Marie.......................................... 219
Conti, Michael............................................... 219
Feingold Association of the United States...................214-218
Harter, Secrest & Emery LLP.................................. 89
House Committee on Science................................... 238
Mercury issues, several citizens............................. 217
New York States Coalition Opposed to Fluoridation, Inc....... 236
Roy, Sylvia.................................................. 100
STAR Foundation.............................................. 221
List, Fluoride Information on the Web............................ 250
Plan, Citizen Participation Plan for Remediation of The American
LaFrance Facility Town of Southport, Chemung County, NY........ 107
Statements:
Balaban, Barbara J., Somers, NY.............................. 250
Kopf, Carol S., Levittown, NY................................ 225
Pace, Lorraine, founder of Breast Cancer Mapping Project, co-
president, Breast Cancer Help, Inc......................... 226
Research Associates Jay M. Gould, Ph.D., director; Ernest J.
Sternglass, Ph.D., chief scientist; Jerry Brown, Ph.D.;
Joseph Mangano, M.P.H., M.B.A.; William McDonnell, M.A.;
Marsha Marks, A.C. S.W., L.C.S.W.; Janette Sherman, M.D.
and William Reid, M.D., Radiation and Public Health
Project, New York, NY...................................... 230
Schoenfeld, Elinor, M.D., associate professor, Stony Brook
University School of Medicine.............................. 210
Serotoff, Mark, Townline Civic Association, Environmental
Carcinogens on Long Island, NY............................. 212
Survey, Results of the Huntington Breast Health Survey Data.....131-173
CANCER CLUSTERS IN LONG ISLAND, NY
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MONDAY, JUNE 11, 2001
U.S. Senate,
Committee on Environment and Public Works,
Garden City, NY.
The committee met, pursuant to notice, at 9 a.m. in The
Ballroom, Ruth Harley Student Center, Adelphi University,
Garden City, NY, Hon. Harry Reid (acting chairman of the
committee) presiding.
Present: Senators Reid, Clinton, and Chafee.
OPENING STATEMENT OF HON. HARRY REID, U.S. SENATOR FROM THE
STATE OF NEVADA
Senator Reid. I'd like to call this meeting of the
Committee on Environment and Public Works to order. My name is
Harry Reid, I'm chairman of the Environment and Public Works
Committee.
Today we're meeting in New York, and as appropriate, the
Senator from the State of New York will conduct this hearing,
Senator Clinton, a member of the committee.
[The prepared statement of Senator Reid follows:]
Statement of Senator Harry Reid, U.S. Senator from the State of Nevada
I want to express my appreciation to Senator Clinton for holding
this hearing, and for her leadership on the crucial issues that we will
focus on today.
I have had the pleasure of working very closely with Senator
Clinton on a number of important matters over the past 5 months, and
want to take this opportunity to report that she is doing a tremendous
job, both on the Environment and Public Works Committee and in the
Senate at large. You are very fortunate to have her representing you.
Her service on both the Environment and Public Works Committee and
on the Health Committee, her mastery of complex health and environment-
related issues, and her commitment and vision in addressing those
issues, contribute to her being an outstanding advocate for New Yorkers
and for the Nation in addressing environment-related health problems of
concern to citizens throughout the Country.
I also want to thank my colleague Senator Lincoln Chafee for being
here today. Senator Chafee also serves on the Environment Committee
and, like his father the late Senator John Chafee, Lincoln Chafee has
been a true champion of many issues that American's hold most dear,
including protection of our environment and public health.
I particularly want to recognize Senator Chafee's leadership in
promoting research into the role the environment plays in the
development of breast cancer, with the introduction last month of the
Breast Cancer and Environmental Research Act, which Senator Clinton and
I also have cosponsored.
This is the second hearing of the Environment Committee this year
to focus on potential links between the environment and chronic
disease, and how we can better understand and respond to disease
outbreaks. In April Senator Clinton accompanied me for the first
hearing, in my State of Nevada, in the city of Fallon.
The Fallon community is facing a tragic situation--14 children have
been diagnosed with childhood leukemia in less than 2 years, where two
cases would be statistically likely for this small community. In just
the 2 months since the hearing, two more children have been diagnosed,
and one child has died of the disease.
There are many theories as to possible causes or contributing
factors, but at this point we simply do not know why so many children
have been stricken with this terrible disease. Ongoing efforts by the
Centers for Disease Control and the State Health officers include
investigations into potential exposures to a number of environmental
contaminants.
I look forward to learning more about progress in the Fallon
investigation from the State of Nevada's epidemiologist, Dr. Randall
Todd, who will testify on the first panel. Dr. Todd, I want to
acknowledge your dedication in working on the Fallon investigation and
to thank you for traveling such a long distance to be here.
As those of you here today well know, disease clusters are not
confined to Nevada or New York. Communities throughout the United
States are facing the same challenges and frustrations experienced in
Long Island, in Elmira, and in Fallon, NV.
There is widespread concern among the citizens of this country
about what environmental contaminants we are exposed to in our day-to-
day lives, and what effect exposures may have on our health and the
health of our families.
But, unfortunately, there is not a coordinated system in this
country to support communities and States in responding to disease
outbreaks, or to track chronic diseases so that we might better
understand possible links to environmental exposure. Too often
communities and States are forced to reinvent the wheel, and face these
events alone, without the necessary resources, information or
expertise.
While a number of Federal agencies are doing an excellent job
supporting State and local officials in addressing community health
concerns, the support system often seems uncoordinated, ad hoc, and too
little too late.
There is a tremendous need to improve our understanding of the
causes of chronic diseases and in turn to better protect public health
through preventative measures. This need presents an opportunity that
in my view we as a Nation cannot afford to pass up.
The time is long overdue for the Federal Government to craft a
coordinated approach for rapidly and effectively responding to the
needs of communities for support and guidance in identifying and
addressing chronic disease clusters.
When we return to Washington, I look forward to working with
Senators Clinton and Chafee, and other colleagues in the Senate and the
House on both sides of the aisle, on legislation: (1) to bridge this
critical gap in our knowledge concerning chronic diseases and related
environmental factors, and (2) to establish a system to coordinate and
support the investigation of and response to chronic disease outbreaks
when they do occur.
I apologize in advance that I will not be able to stay for the
entire hearing, as my duties as Assistant Majority Leader require that
I get back to Washington. However, I will carefully review all of the
testimony prepared for today's hearing.
I look forward to hearing from the witnesses.
Senator Reid. Senator Clinton.
OPENING STATEMENT OF HON. HILLARY RODHAM CLINTON, U.S. SENATOR
FROM THE STATE OF NEW YORK
Senator Clinton. Thank you very much, Chairman Reid.
Welcome to New York. I'm delighted that you and Senator
Chafee from Rhode Island could join us for this important
hearing. This is the second in a series of hearings about a
very important issue, the potential link between our
environment and chronic diseases and disease clusters,
including especially here on Long Island, high rates of breast
cancer.
I don't think I need to explain to anyone here at Adelphi,
which has pioneered work on not only reaching out to breast
cancer survivors, but also the investigation of environmental
issues, that this is an issue that many of us live with and
have very personal connections with.
While breast cancer incidence rates for New York State
overall are below the national average, those for Long Island
consistently exceed that national average. The hearing that
Senator Reid convened in Fallon, NV, which I was very pleased
to attend, focused on childhood leukemia clusters, a problem
that has just so affected that small community. At the time, I
told Senator Reid about the high incidence of breast cancer
here on Long Island and other cancers and chronic diseases that
we have in clusters around New York, and that led to this
hearing.
We all know that disease clusters and overall increases in
the rates of chronic disease are not confined to New York or
Nevada. We face these challenges around our country. According
to the Centers for Disease Control, birth defects are the
leading cause of infant mortality. Yet, the cause of about 70
percent of all birth defects is unknown.
The CDC also reports that from 1980 to 1984, cases of self-
reported asthma increased 75 percent, an increase of epidemic
proportions. New York has the second highest rate of people
suffering from asthma, surpassed only by California. Asthma is
the No. 1 cause of school absenteeism.
A recent report by the National Academy of Sciences
estimates that 25 percent of developmental disorders in
children is caused by environmental factors. Between 1986 and
1995, there was an almost 22 percent increase in endocrine and
metabolic disorders, such as diabetes, a 20 percent increase in
neurological disorders, such as Parkinson's, and nearly a 20
percent increase in respiratory diseases. We are totally in the
dark as to how many children in this country are suffering from
autism, yet we know that the numbers are increasing.
That's why we're here today looking for answers. We're
looking for answers to the questions that many of you have
asked yourself, ``Why do I have breast cancer?'' ``Why does my
child have leukemia?'' ``Why does my child have asthma or
trouble learning in school?'' ``Is there something in my
environment that is making me or my family sick?''
Well, we're going to be looking for those answers in a
bipartisan way in both Houses of Congress this year. I'm
looking forward to hearing from our witnesses, because we want
to take this information and testimony back to Washington so
that we can come together to determine what steps we need to
take in order to do whatever is possible at the Federal level
to try to aid in the search for answers to these unanswered
questions.
Senator Reid and some of our colleagues and I are already
working on legislation to address the problem of disease
clusters. We want to establish ways to bridge the gap in our
understanding of chronic disease and environmental factors. We
believe our Nation needs to coordinate its support,
investigation of and response to chronic disease outbreaks,
with the ultimate goal of preventing them in the first place.
This hearing will add to the body of knowledge that we are
acquiring. I want to thank all of you for coming, and I
particularly want to thank my colleagues. First, my friend and
our chairman, Senator Reid, who is also now the new Assistant
Senate Majority Leader. I want to thank Senator Reid for giving
us the opportunity to hold this hearing and for taking time off
his even busier schedule to attend.
It's a pleasure and an honor working with Senator Reid. The
service that he offers our entire country is something that I
have just marveled at. He seems to be absolutely tireless as he
represents the people of Nevada and does the work that is
required in the Senate. I want to thank him for his leadership
and his friendship and for his dedication to addressing the
shortcomings in our environmental protection and public health
systems, so that we can find answers for the people in Fallon,
Long Island and throughout America.
I also want to thank Senator Lincoln Chafee of Long Island
for joining us. He has been a true leader on the environment,
and in fact, is the lead sponsor of the Breast Cancer and
Environmental Research Act, along with Senator Reid--
legislation of which I am proud to be a cosponsor, which is
carried in the House by our colleague, Nita Lowey.
Senator Chafee has been serving as the chairman of the
Superfund Subcommittee, and he played a very significant role
in the unanimous passage of the very first brownfields bill in
the U.S. Senate. I have greatly enjoyed getting to know Senator
Chafee, and look forward to a long and productive working
relationship with him.
I also want to thank my colleagues from the House who
represent Long Island. We are privileged to be in the district
of Congresswoman Carolyn McCarthy. Carolyn has been a leader on
many issues, in particularly on the issue of breast cancer,
representing so many of her constituents, and I thank her for
that. I would also like to welcome the other members of our
delegation, Congressman Gary Ackerman and Congressman Felix
Grucci, and to thank them and all the members of the New York
delegation, including Senator D'Amato, for everything they've
done to help us fight breast cancer here on Long Island and
across America.
I want to thank our hosts today. I extend my appreciation
to Adelphi University. The committee is very honored to be
here, and to have a chance to hold this hearing at a university
that is home to the Adelphi Breast Cancer Hot Line and Support
Program. I want to thank President Robert Scott, Provost
Marshall Walsh, Hillary Rutton, the director of the Hot Line
and Support Program, and the many volunteers like my friend,
Marie Kaplan, who are there day in and day out, answering 4,000
calls a year.
I would like to welcome any of the State officials who we
have here. I know several of them were intending to come. Is
Assemblyman Tom DiNapoli here? Tom, thank you for coming.
Senator Michael Balboni, I appreciate greatly your being here
and hope that we can have you address this important issue as
well.
With that, I turn this hearing over to our chairman.
Chairman Reid.
Senator Reid. Senator Clinton, thank you very much.
I have worked very closely with Senator Clinton these past
5 months. She's done a tremendous job as a member of this
committee and a member of the Health Committee. She is someone
who's a quick learner and she started the hearing we had in
Fallon a short time ago.
I also want to take just a brief minute to note the
presence of my friend, Lincoln Chafee. Every time, and I'm sure
he gets tired of me saying this, but I had the honor of serving
with his father. When we go through the list of great
legislators in our country, his father, John Chafee, certainly
is on that list. I served with him from the time I came to the
Senate and this committee, and he was an inspiration to me.
We're happy to have his son, who has every indication of being
just as good as his dad.
This is the second hearing, as Senator Clinton has
indicated, that we're holding on this subject of a cancer
cluster. In Fallon, NV, which is a community much different
than this urban community that we have here in Long Island, NY,
urban compared to Nevada, it's a community 60 miles south of
Reno. We have in that little community a real, I don't want to
call it a plague, but people are so frightened. The standard
would be that about one and a half children would have
childhood leukemia. We now have 15 children with childhood
leukemia. We don't know the cause of that. We don't know
whether it's caused by the naturally occurring heavy arsenic in
the water. We don't know whether it's caused by the heavy
application of pesticides and other things on the farms that
they've had there for 100 years. We don't know if it's caused
by the military base which is one of the largest military bases
in the country--it's a Naval flying center--Fallon Naval Air
Station. Top guns there use millions of gallons of fuel every
year. We know that there have been some fuel spills.
We don't know if it's being caused by a virus. There's now
a theory that it's being caused by a virus. British scientists
believe that they can prove that some of the cancer that's been
caused over is caused by heavy inflow and outflow of people
into an area. Certainly, we have that there with the military
base.
We don't know. Or is it a combination of those? We don't
know. We cannot accept the answer that we've had in a number of
these cancer clusters, it just happens. We don't know why this
happens, we cannot let that happen. We need to establish a
cause.
That's why I'm so thankful that Dr. Randall Todd, the State
of Nevada State epidemiologist, is here with us today. He's
going to be able to recount some of the things that are going
on in Fallon.
One of the other things that we have in Fallon, we really
don't know how many children are sick, because of the kids that
have left that military base. We're doing our best to check it
out, but we simply don't know.
Cancer clusters are not confined to Fallon, NV. That's why
we're here in Long Island. Communities throughout the United
States are facing these same challenges and frustrations
experienced here in Elmira and in Fallon, NV.
I would just say in passing, in Nevada you always know
where you are. In New York, I never know where I am.
[Laughter.]
Senator Reid. There are towns, boroughs, cities--whatever
else--but I'm glad we're here.
There's widespread concern among citizens of this country
about environmental contaminants, and we've already mentioned a
few of them. Kids get asthma, it's almost standard now for
children. Why? We don't know. What effect do exposures have on
our health and the health of our families? That's why Senator
Clinton and Senator Chafee are here with us. There is a belief
that our environment is causing some of these diseases.
We don't have a coordinated system in this country for how
to respond to these disease outbreaks. So one of the things
we're going to come up with, with these hearings, we're going
to do it legislatively, the Federal Government, each time
there's a cancer cluster, they have to re-establish how they're
going to move into this area. We have the National Centers for
Disease Control, National Institutes of Health, EPA, a number
of Government agencies who in effect are stepping on themselves
trying to figure out what to do. We want to have a protocol
established, like when there's an airplane accident, with the
National Transportation Safety Board, there is a way that they
come in and the different agencies of the Federal Government
react. We're going to do our best to do that.
The Federal Government agencies are doing their best.
They're doing an excellent job of supporting State and local
officials addressing community health concerns. But the support
system many times seems to be uncoordinated, ad hoc, and simply
too little too late. There is a need to improve our
understanding of the causes of chronic diseases and in turn, to
better protect public health through preventive measures.
Public health is something we don't talk about much in this
country. We need to talk about it much more. The time is long
overdue for the Federal Government to craft an orderly approach
for rapidly and effectively responding to the needs of
communities for support and guidance in identifying and
addressing disease clusters.
When we return to Washington, I look forward to our
continued work, that is, Senators Clinton and Chafee, others
and I, on trying to come up with legislation to bridge this
critical gap in our knowledge concerning chronic diseases and
related environmental factors and establish a system to support
investigation and response to chronic disease outbreaks when
they do occur.
I want to extend my appreciation to members of the House
for being here. Congressman Ackerman and I came to the House
together. We were freshmen members of the House together. The
other two Representatives I see and work with in Washington, we
look forward to working with them even more closely as a result
of this unfortunate occurrence of cancer we have in Long
Island.
Senator Clinton. Thank you very much, Chairman Reid.
Senator Chafee.
OPENING STATEMENT OF HON. LINCOLN CHAFEE, U.S. SENATOR FROM THE
STATE OF RHODE ISLAND
Senator Chafee. Thank you very much, Senator Clinton, for
organizing this morning's forum. We're very grateful to you for
doing that. It's a great deal of work, and I understand that.
I'm anxious to hear the three panels that you've organized, and
I know we're going to learn a lot. As Senator Reid said maybe a
dozen times in his opening statement, ``We don't know what
causes these clusters, and that's why we're here, and we look
forward to your testimony.''
Thank you.
[The prepared statement of Senator Chafee follows:]
Statement of Lincoln D. Chafee, U.S. Senator from the State of
Rhode Island
Good morning. I am pleased to be here today for this important
hearing.
This hearing is very important for many reasons. The first and
foremost is the fact that breast cancer mortality rates are up to 20
percent higher in Long Island than the national average. This is an
alarming statistic, which deserves this close examination by the
Environment and Public Works Committee.
Many scientists believe that certain groups of women have genetic
variations that may make them more susceptible to adverse environmental
exposures. A study recently conducted in Sweden showed that
environmental factors may matter more than genetics in determining
whether a woman is diagnosed with breast cancer. This study found that
the environment--what we eat, breathe, drink, and smoke, including how
we live and which chemicals we are exposed to--accounts for roughly
twice the risk of cancer than genes do.
There is a reason so many women in Long Island are being diagnosed
with breast cancer, and I believe that the environment here holds the
key to this mystery.
I am particularly pleased to participate in this hearing today
because of its relevance to legislation I recently introduced with
Senator Harry Reid. We introduced S. 830, the Breast Cancer and
Environmental Research Act this past May, and we are pleased that
Senator Clinton is a primary cosponsor. S. 830 will establish research
centers that would be the first in the Nation to specifically study the
environmental factors that may be related to the development of breast
cancer. The lack of agreement within the scientific community and among
breast cancer advocates on this question highlights the need for
further study.
This bill will enable scientists and researchers to conduct more
comprehensive and conclusive research to determine the impact of the
environment on breast cancer. S. 830 will require each Center of
Excellence to collaborate with community organizations in the area,
including those that represent women with breast cancer. Consumer
advocates would also be involved in all phases of this program. While
it is generally believed that the environment plays some role in the
development of breast cancer, the extent of that role is not
understood. Before we can find the answers, we must determine the right
questions to ask. We need to step back and gather evidence before we
come to conclusions, and that is the purpose of our legislation.
On that note, I would like to turn it over to the witnesses so we
can hear their stories and learn from their expertise.
Senator Clinton. Thank you.
Congresswoman McCarthy.
STATEMENT OF HON. CAROLYN McCARTHY, REPRESENTATIVE FROM THE
STATE OF NEW YORK
Ms. McCarthy. Thank you, Senator Clinton. I want to thank
Senator Reid and Senator Chafee and my colleagues here from
Long Island. I have to say thank you to Dr. Scott from Adelphi.
He had been wonderful in allowing us to use Adelphi on a number
of occasions, and Hillary Rutton for the Breast Cancer Hot
Line.
This is something that concerns all of us here on Long
Island. I don't think there is anyone who doesn't know someone
who doesn't have breast cancer or prostate cancer. But you
know, as a nurse, I have to say, we have to look at all
cancers, naturally we should be attacking it on every level of
cancer. I'm sorry to say that I have three neighbors that I
have grown up with, and all three, one, two, three, they're all
suffering with lung cancer, all diagnosed within the last 3
months.
So this is something that concerns all of us, and our whole
delegation. It doesn't matter whether it's here, doesn't matter
whether it's in Gary's district, Peter King's, Steve Israel's,
Felix Grucci's, it concerns all of us. I'm sure that when we
start looking into the different causes, and we don't know all
the causes, let's eliminate, let's get some scientific
evidence, and then start working on those areas that we can.
I want to thank Gary Ackerman and Felix Grucci. We're on a
bill that will help breast cancer survivors be able to take
their medications, open it up to other people that can buy into
Medicare if they have breast cancer. This is another way of
trying to do what we can to help the people in Long Island, NY,
the whole country. This is something Senator Reid has said. We
have to coordinate everybody, from the Federal level, so that
we can attack this hideous disease. It's probably one of the
most important things, in my opinion, that can help all
Americans, and certainly the people of New York and Long
Island.
Thank you.
Senator Reid. Thank you, Congresswoman McCarthy.
Congressman Ackerman.
STATEMENT OF HON. GARY L. ACKERMAN, REPRESENTATIVE FROM THE
STATE OF NEW YORK
Mr. Ackerman. Thank you very much, Madam Chair, Mr.
Chairman, Senator Chafee. I appreciate the convening of this
very critical hearing and I'd like to begin my comments by
expressing my profound thanks for selecting Long Island for
this very, very important hearing. When you think about one of
the reasons, it's an honor that we'd rather not have. That is
because we are in a place where we see one of the great hot
spots, as they are called, in our country.
I'd also like to express my appreciation to the many
soldiers in the battle against breast cancer. Many of them are
here in this room right now, and too many to name. But their
dedication and tireless efforts are critical, and they're so
deeply appreciated by all of us.
We're here today to discuss the possible connection between
the environment and chronic illnesses such as breast cancer. In
addition, we need to explore what efforts should be undertaken
by the Federal Government to address this problem. One of the
legislative accomplishments of which I am most proud to have
worked on is the establishment of the Long Island breast cancer
study. As all here know, this is a multi-study effort to
investigate whether environmental factors are responsible for
breast cancer in Suffolk, Nassau, and Hardy counties in New
York, as well as Connecticut. This historic investigation began
in 1993, and is funded and coordinated by the National Cancer
Institute, in collaboration with the National Institute of
Environmental Health Science.
This comprehensive study consists of more than 10 studies
that includes human population studies, the establishment of
the Family Breast and Ovarian Cancer Registry and laboratory
research. We all eagerly await the findings of this study,
which should hopefully be released within the next few months.
Long Island's very high breast cancer rate, along with
recent scientific studies, seems to suggest that there can be a
connection between a person's environment and his or her risk
of developing cancer. In the case of breast cancer, the
question is, why do women on Long Island seem to be at greater
risk of developing this disease? Someone said that Long Island
is simply the unfortunate setting for a convergence of known
risk factors, such as socioeconomic and reproductive
characteristics. However, others have suggested that local
environmental contaminants are playing a key role in driving up
the mortality incidents.
In October 1993, I had called for and asked to be convened
and testified at a field hearing of the House Government
Operations Subcommittee on Human Resources. The committee was
then chaired by Congressman Ed Towns, who also attended. It was
also attended by all of the representatives to Congress, the
House, of Long Island, and also Senator D'Amato. The hearing
focused on the possible link between cancer and the
environment, and we discussed all of the factors.
I was first made aware of this problem after
reapportionment had taken place and I was new to this part of
our State, coming from Queens County, so far away. You have
every right to be confused, Senator Reid, I don't know where I
am half the time, either. I was first made aware of the problem
by Karen Joy Miller, who is really an American hero. I remember
our first conversation, it was Karen who convinced me that we
needed to have such a hearing, because of these clusters. We
didn't know whether or not and still don't that there was some
causation that came from factors that might have been airborne,
soilborne or waterborne, whether it was something that occurred
from things that we did with the soil when this was a very rich
farm land so many years ago. The hearing proved to be very
interesting.
At the time I testified on the broader issue of how
pollutants and contaminants in our environment act on our
health, and at the time I predicted that the issue would become
more important in the years to come. It's now 8 years later,
and we're witnessing this as a national health problem. Long
Island is not the only location in the country where such
cancer clusters exist.
I want to commend Senator Clinton, Senator Chafee and
Chairman Reid for examining this issue in Long Island today, as
well as having convened a hearing in Nevada. This cross-country
coverage serves to highlight the breadth and diversity of this
health crisis that affects not only New Yorkers but all
Americans. I look forward to the testimony of our panelists and
to our colleagues here today. Thank you very much.
Senator Clinton. Thank you, Congressman Ackerman.
Congressman Grucci.
STATEMENT OF HON. FELIX J. GRUCCI, JR., REPRESENTATIVE FROM THE
STATE OF NEW YORK
Mr. Grucci. Thank you, Senator. I'd like to thank the
Senate Environment and Public Works Committee for hosting this
event today. I think these types of hearings serve a very good
and noble purpose for us to understand the issues and ways to
resolve them. You know, there are approximately 3 million women
that are diagnosed with breast cancer, a million of them don't
know it yet. This year alone, 233,000 women will be diagnosed
with breast cancer, and 40,000 of them won't be able to fight
back the disease. That's a frightening statistic, a sad
commentary for a Nation as rich and as good and as wholesome as
this one is, that we have to find a cure for this dreaded
disease.
My career in Congress isn't as long and as rich as some who
are sitting at this table, but my fight for helping to find a
cure for breast cancer dates from the time when I was a town
supervisor. My municipality, the town of Brook Haven, was one
of the first municipalities in Long Island to join in on the
mapping program that was being done.
We also used some innovative concepts to help find funding
dollars, much-needed funding dollars. When people would violate
the ordinances of the town of Brook Haven, when we imposed the
fines on them, I directed those fines be used by our local
hospitals, it was St. Charles, Stonybrook or Brook Haven, to
use that money to help find a cure for breast cancer, cervical
cancer, prostate cancer and cancer of all types is a dreaded
disease that affects this country and does such great harm to
our citizens, to our families.
I know that we're preaching probably to the choir, because
while you are all here, there are still a lot of chairs yet to
be filled, and still a lot of people yet to reach. I think
Congress has a responsibility to help meet that need, whether
it's funding for environmental research, to see if indeed there
is a connection and what that connection is between our
environment and diseases that afflict us, whether it's to pass
legislation to make the processes to finding a peaceful life
more accessible, whether it's the overnight stays in the
hospital, whether it's reconstructive surgery for women,
whether it's finding the cure through more research dollars.
I'm proud to be a member of this Congress, and I'm proud to
be sitting up here amongst this panel of individuals who have
demonstrated their willingness to help find these cures. We've
passed legislation, we're going to be pass legislation, we're
going to be dealing with health care issues. All of this is
going to be very important as the coming days arrive. I'm eager
to hear from our panelists. I was reviewing their names and
their backgrounds. It seems to me that we're going to get a
great deal of knowledge from today's meeting.
I want to thank Senator Clinton and the Senators for being
here. I think this is a very productive meeting and I look
forward to its outcome. Thank you.
Senator Clinton. Thank you, Congressman.
Congressman Israel.
STATEMENT OF HON. STEVE ISRAEL, REPRESENTATIVE FROM THE STATE
OF NEW YORK
Mr. Israel. Thank you, Senator. Let me also thank you for
the leadership that you've shown on this profoundly important
issue, and I thank your Senate colleagues for joining us this
morning.
I appreciate the opportunity to testify on this issue, as a
new Member of Congress. For 7 years prior to joining the House,
I worked as a town councilman in Huntington with Karen Miller,
whom Congressman Ackerman referred to and who will be
testifying later, and the Huntington Breast Cancer Action
Coalition in the local fight against breast cancer. One of the
projects we initiated was a town-wide mapping and survey and
analysis of breast cancer incidence. By chance, it just happens
to be the map just behind me on the podium.
I learned something from those clusters that are so visible
on those maps. Breast cancer cannot be categorized as a Federal
issue or State issue or county issue or town issue. It extends
across jurisdictions, boundaries, political parties. It extends
to too many neighborhoods, too many families, too many women,
too many streets throughout this area. In fact, Suffolk County
has the dubious distinction of having more breast cancer cases
than almost any other community in our Nation, 2,000 Suffolk
County women are diagnosed with breast cancer every single
year. What's worse is that we still don't completely understand
why women in certain communities are more susceptible to this
disease.
We have an obligation to them, we have an obligation to our
families to work as partners toward the critical goal of
eradicating breast cancer, and we need to start with the
Federal budget. Congress and the Bush administration are just
starting the annual wrangling over the budget. We can't allow
this year's Federal investment in breast cancer research to be
caught in that debate. We have to break breast cancer research
out of this trap by building a broad base of support for
legislation to increase this critical funding.
So I'm hoping that President Bush will support this year's
budget and increase the breast cancer research. In addition to
that, I want to thank Congressman King, who I believe is
scheduled to be here later, for his Taxpayers Cancer Research
Funding Act of 2001, which I have cosponsored. This legislation
will add a new checkoff on the income tax return to allow for a
$5 contribution to a special breast and prostate cancer
research fund. That will enable all of us to work together as a
country to increase the funding of the National Cancer
Institute, which will in turn enable the NCI to increase their
research grants to the medical community.
Each year, too many of our loved ones lose their lives to
breast cancer. But with increased Federal investment in
biomedical research, we will not only improve treatment for
this debilitating disease, we will also find a cure. Our
mothers, our daughters, our sisters and friends deserve no
less. It is time to erase incidence of breast cancer on the map
behind me.
Thank you.
Senator Clinton. Thank you, Congressman. I'd like to ask
the first panel to make its way to the table, and I'd like to
ask for two brief comments from two of our local legislative
leaders at the State level, Assemblyman Tom DiNapoli and
Senator Balboni, if you would each like to make a brief comment
while the panel gets settled.
STATEMENT OF HON. MICHAEL BALBONI, STATE SENATOR FROM NEW YORK
Senator Balboni. Senator Clinton, I'd like to thank you
very much for the invitation to join you today. Members of the
House and Senate, welcome to Long Island.
I know the strong advocacy in the House and I look forward
to the results of this panel. I'd like to make a pitch that
perhaps you may not have heard. Long Island presents certainly
the challenges and the obstacles that come with being No. 1 in
terms of the rate of cancer. But it also presents an
opportunity. You will find here, I would argue, more than any
place in the Nation, a galvanized, energized electorate who
understands the issue, because it's so personal to them, it
affects them so pervasively.
What you also find here is a unique set of biotechnology
opportunities where perhaps we can take the information that
researchers and scientists present and turn it into cures. So I
would ask that you would consider that when you step back from
this hearing and consider all the information, consider also
the need to move the information to a cure, and that's best
done with our biotechnology.
Thank you very much.
Senator Clinton. Thank you, Senator.
STATEMENT OF HON. THOMAS P. DiNAPOLI, NEW YORK
STATE ASSEMBLY
Mr. DiNapoli. Good morning. It really is a pleasure to join
with Senator Balboni in offering some brief comments. Senator
Clinton, I'll leave some written testimony for your committee
to deliberate on.
Welcome to Senators Reid and Chafee. It's always good to
see our hard working Long Island delegation here, Congresswoman
McCarthy, Congressman Ackerman, Congressman Grucci and
Congressman Israel, and Congressman King as well. To Senator
Clinton, we certainly want to express some particular words of
appreciation. I know that last year we had many occasions to
speak about the issues and concerns in the Long Island
community. I know the voices have resonated most loudly and
clearly with you are the voices of survivors of breast cancer
and other health impairments on the island and their families.
We all appreciate your bringing this very distinguished panel
to Long Island to hear our concerns.
As Senator Balboni said, in so many places in New York
State, Long Island has been the epicenter for activity and
concern on this issue. I know you're going to hear from
important scientific testifiers today, but certainly, I'm sure
the most compelling testimony you will hear will be from the
grass roots activists on Long Island, the women particularly
who have kept this issue in the forefront.
I want to offer a few words of consideration for you to
bring back some New York ideas to Washington as you complete
your agenda there. Because in New York State, we have been
grappling with the very important question of what are the
environmental impacts as far as our public health, particularly
with regard to cancer. Obviously, in all the years and all the
studies going back to the original Stonybrook breast cancer
study and the small area incident study the department of
health was involved with at my request a number of years ago,
this is still very much an open question.
So we certainly urge your continuing investment of Federal
dollars in research through the ongoing national study. We
could certainly use help as far as technical assistance and
dollars to help with our State efforts to continue this
research. A particular area is the effort to do mapping not
only of the incidence of cancer and cancer clusters, but to do
a coordination of the information that we have with sites of
environmental contamination in proximity to cancer clusters.
As part of the written testimony I'm submitting, there are
considerations in the pending Assembly bill A404 that provides
specific requirements on our State Department of Health and
Department of Environmental Conservation to coordinate these
kinds of mapping and environmental facility contamination
impacts. We could use your help in coming up with the dollars
and seeing that we can adequately fund these studies.
Your colleague, Senator Schumer, was helpful in identifying
a million dollars in aid through Federal EPA to help us map
contamination of MTBE on Long Island. That's a very important
issue to us, as the local representatives know, we depend for
our drinking water supply on a sole source aquifer system. MTBE
is certainly a pollutant and a possible human carcinogen, it
has become ubiquitous in our environment and it is very
important that we maximize our efforts to clean it up. Because
while research is important, there are steps we can take to
reduce our exposure to these kinds of harmful chemicals and
substances.
Along that line, I would recommend to you that New York
State will review once again the resolution that the State
legislature sent to Congress back in 1999 calling for a Federal
ban on MTBE, to eliminate it as an oxygenate in our gasoline.
New York State was the first State to have adopted a State ban.
I'm very pleased that it has held up in court so far. Certainly
dealing with that particular contaminant, it's very important
that there be a Federal response and Federal action.
I would also point out that New York State has enacted the
first ever pesticide neighbor notification law, thanks to the
efforts of many Long Island activists. It's a very important,
common sense, right-to-know piece of legislation that helps
people reduce their exposures to toxic substances and chemicals
in the environment, also worthy of your consideration to be
replicated on the national level.
I'll just conclude with the idea of a sentence that would
be helpful to us as well. In the northeast region there are
particularly health concerns about West Nile virus.
Unfortunately, many of the funding programs put an emphasis on
aerial spraying, creating other kinds of concerns about
exposure to harmful toxic substances. We, in New York State,
are trying to put more of a priority on non-spraying control
techniques. We could use your help in terms of providing
dollars to help us buy those kinds of incentives so localities
can move in a different direction than traditional pest control
has allowed for.
We're also working with the Long Island Breast Cancer
Action Coalition. We're working on legislation this session to
come up with a children's health incentive fund that will give
dollars and grants to schools throughout our State, to give
them extra money to help them move away from pesticides and
other types of toxic substances when dealing with pest control.
Again, an incentive-based approach will to help change the
behavior, help promote best practices so we reduce harmful
exposures. That again would be a program that would be aided by
Federal support, certainly is worthy of your review and
replication on a national level as well.
Again, thank you for coming to Long Island, certainly on
behalf of Senator Balboni and myself, and all of our State
legislative colleagues, recognize that this needs to be a
partnership between the State government and the Federal
Government and working with the local communities so we can get
to the bottom of this very important question. I thank all of
you, particularly Senator Clinton, for your interest on this
issue. Thank you.
Senator Clinton. Thank you very much, Mr. DiNapoli, for a
very good list of issues that we should take back with us to
Washington. I look forward to reviewing more closely your
written testimony which has more details about this.
We've been joined by Congressman Peter King.
Congressman King.
STATEMENT OF HON. PETER T. KING, REPRESENTATIVE FROM THE STATE
OF NEW YORK
Mr. King. Thank you, Senator Clinton. I'll be very brief. I
just want at the outset to thank Senator Clinton for convening
this meeting and for the leadership she's shown, not just as a
Senator, but in the previous Administration, where she worked
so hard to focus public attention on breast cancer.
I also want to welcome Senator Chafee and Senator Reid, and
of course all my other colleagues from Long Island.
There's probably not a person on Long Island that doesn't
have a close family member or friend who suffers from breast
cancer. There are clusters throughout Long Island. There seems
to be an unusually high rate of incidence of breast cancer on
Long Island. Certainly those of us in the Long Island
delegation have always appreciated just how importantly this
issue has been treated, totally in a bipartisan manner, with
tremendous cooperation and certainly, from the time I've been
in Congress, I give Congressman Ackerman so much of the credit
for keeping the delegation united and working with us and
fighting hard on this issue for more funding and for research.
Certainly the Federal breast cancer study has been going on now
for a number of years, and we await the findings of that. This
hearing, I think, is one more very significant step to moving
forward, trying to find reasons why, trying to understand why
there are these unusually large numbers of breast cancer on
Long Island, why we have these cancer clusters.
Senator Clinton, I thank you for convening this. I regret
the fact that I could not get here sooner. I look forward to
the testimony and again, I thank you for your leadership.
Senator Clinton. Thank you, Congressman King.
The first panel we're going to hear from today consists of
a number of people with first-hand experience as well as expert
experience. The first witness is Dr. Phil Landrigan, professor
of Pediatrics, and director of the Center for Children's Health
and the Environment at the Department of Community and
Preventive Medicine at Mount Sinai. The second witness is Dr.
Randall Todd, Nevada State epidemiologist, who is here to tell
us about how his State of Nevada is responding to the
continuing challenge of the childhood leukemia cluster in
Fallon, NV.
Next, we will hear from Mr. Jim Hare, a councilman from
Elmira, NY, who will tell us about how Elmira has dealt with a
potential childhood cancer cluster associated with a high
school there. He will be joined by Mr. Tim Tobin, who is a
parent of one of the students diagnosed with cancer at that
school. I want to thank both Mr. Hare and Mr. Tobin, who had to
take off from school to be here. They're both teachers, and I
appreciate their willingness to do that.
Finally, we'll hear from Karen Joy Miller, founder and
president of Huntington Breast Cancer Action Coalition, someone
who herself has been diagnosed with breast cancer, but has been
a leader, as we've heard from several already, in the fight
against breast cancer on behalf of us all.
I'd like to remind all of our witnesses today that everyone
has a lot to say. We have a number of questions here that we
want to be able to ask. So it would be helpful if you do your
best to stay within the 5-minute guideline. You'll see these
little lights up here, green means you're in good shape, yellow
means you have a minute to go, and red means you're out of
time. So do the very best you can. This is the same system we
follow in the Senate.
I can remember as a very new beginning Senator having the
then-chairman of the Health Committee gavel me to be quiet. So
I know that it's hard to get everything you need to say in a
short period of time. But we'll do our best to do that.
We have votes in the Senate tonight, so we'll need to make
certain that this hearing is wrapped up no later than 1 p.m. in
order for Senator Chafee and myself to make it back to
Washington in time for the vote. Because of his added
responsibilities as the new Assistant Majority Leader, Senator
Reid will have to leave even earlier, because his
responsibilities are such, he has to actually be on the floor
when the Senate is in session.
We'll take no breaks during this hearing. After each panel,
we'll allow one question from the members, if they have any, up
here. Then we'll go on to the next panel.
Thank you very much for being here.
Dr. Landrigan, please proceed.
STATEMENT OF PHIL LANDRIGAN, M.D., MSc., ETHEL H. WISE
PROFESSOR AND CHAIRMAN, DEPARTMENT OF COMMUNITY AND PREVENTIVE
MEDICINE, MOUNT SINAI SCHOOL OF MEDICINE
Dr. Landrigan. Thank you, Senator Clinton, Chairman Reid,
Senator Chafee and members of the New York delegation. I'm
delighted that you're taking this interest in cancer and
chronic disease, and I praise you for your leadership in the
issue.
Today the leading causes of illness and death in the
American population are very different from those of 50 or 100
years ago. A century ago, the big diseases were the infectious
diseases--smallpox, cholera, yellow fever, measles. Today, as
you have said in your opening statements, the big diseases are
asthma, which has doubled in frequency, certain birth defects
and of course, cancer.
According to the American Cancer Society, more than a half
million Americans, 550,000 Americans, are going to die this
year of cancer. It's a major problem in our country, exceeded
only by heart disease as cause of death. Breast cancer, as
we've said multiple times already this morning, is an enormous
problem. This year, across the United States, 182,000 cases of
breast cancer will be diagnosed in American women, and also
1,400 new cases in American men. The incidence of female breast
cancer has increased by 40 percent since we started keeping
national records in the early 1970's. The actual rate has
increased per million women by 40 percent.
I am a pediatrician, and I am very much concerned about
pediatric cancer. Rates of incidence of pediatric cancer have
increased in this country over the past three decades. There's
a graph at the back of my testimony which shows that incidence
has increased as mortality has gone down. The decrease in
mortality is the good news. It reflects the fact that we've
invested enormous dollars into devising treatments for cancer,
but the bad news is the incidence is going up. Leukemia has
increased by 12 percent since the early 1970's, brain cancer,
which is the second most common form of cancer, has gone up by
30 percent. In young men between the ages of 15 and 30 years of
age, there's been an almost 68 percent increase in the
incidence of testicular cancer.
What are the causes of these increases that have made
childhood cancer the third leading cause of death in childhood,
exceeded only by unintentional injury and by homicide? What are
the reasons? Some would argue that it's all due to better
diagnosis, the fact that we have MRIs and CT scans enables us
to detect cancers that otherwise we would have not picked up.
I'm troubled by that argument. I've been practicing pediatrics
for 30 years. My professional career spans the time in which
this increase has occurred, and I really don't think we were
missing a third of childhood cancers two and a half decades
ago. This is a devastating disease, kids with cancer are
terribly sick, they make it to the hospital, they come to
medical attention. Perhaps better diagnosis has enabled us to
pick up a few additional cases, but not 30 percent more.
So what could be the responsible factors? I'm sure that
diet and lifestyle have contributed to some extent. The viral
hypothesis is certainly receiving active consideration. I doubt
that it's genetic change, genetic change just doesn't happen
that quickly. So that brings us to the environment. We need to
give very, very serious consideration to the notion that toxic
chemicals in the environment have at least contributed to the
increasing incidence of childhood cancer, female breast cancer,
and other cancers in this Nation.
There are some 85,000 synthetic chemicals at loose in our
environment today that did not exist in 1950. The chemical
industry has been extremely ingenious at producing chemical
substances. Unfortunately, they have not been nearly so good at
testing these chemicals that they've produced. Fewer than half
of the 85,000 chemicals that are out there have ever been
tested to determine whether or not they have the capacity to
cause toxicity or whether or not they have the capacity to
cause carcinogenicity. Fewer than 10 percent of chemicals have
ever been tested to determine whether they can be toxic to
children and to human development. We need to do a much better
job of chemical testing.
What are some of the other things we need to do? We need to
invest heavily in what's been called disease tracking or
disease surveillance. Senator Reid, you mentioned this. We need
to have sophisticated, intelligent systems in this country that
can plot trends in disease, that can plot the geographic
occurrence of disease, that can enable us to spot clusters
early. We need to put more money into research that elucidates
the causes of cancer. The overwhelming majority of our cancer
research dollars have gone into determining and developing
better treatments. Obviously money well spent, but now it's
time to open a second front in the war on cancer and to
identify the causes of cancer and seek ways to prevent cancer
at its roots.
I think the bottom line here is that cancer is indeed, as
Congresswoman McCarthy said, ``a hideous disease,'' a terrible,
devastating disease that destroys patients, destroys families,
destroys communities. But it's also a preventable disease.
We've not made the investment into cancer prevention that we
must make in this country. It is time to do so. I commend you
for convening this hearing today to look into the issue of
cancer prevention. Thank you.
Senator Clinton. Thank you, Dr. Landrigan.
Dr. Todd, thank you for coming all the way from Nevada.
STATEMENT OF RANDALL L. TODD, M.D., STATE EPIDEMIOLOGIST,
NEVADA STATE HEALTH DIVISION
Dr. Todd. Thank you, Senator Clinton, Senator Reid, and
other members of the committee, for inviting me here today to
share some information about our State's investigation into a
cluster of childhood leukemia cases in Churchill County. I
would like to provide you with a brief background and
description of what has happened and is continuing to happen in
Nevada and share some of the lessons we are learning that may
be useful here in New York or elsewhere in the country.
In July 2000, we were informed of concerns among the
medical community in Churchill County that the number of
recently diagnosed cases of childhood leukemia appeared to be
unusually high. After confirming this, our initial
investigation consisted of face-to-face interviews with each of
the case families. We've also tested the water supply to each
local residence where a case family lives or has previously
lived. We used for these tests the battery of analyses that are
required for public water systems under the Safe Drinking Water
Act. Unfortunately, our water analysis to date has not revealed
any results that would explain this cluster.
After our initial data gathering was complete, we convened
a panel of national experts from Federal agencies and academia.
We asked these experts to review our processes and data and
provide us with advice on further steps to take this
investigation hopefully to some definitive answers. They
continue to be convened and are guiding our processes.
Given our rather bleak public health resources in Nevada,
we found it was essential to utilize advice and resources
provided through the Centers for Disease Control and Prevention
as well as the Federal Agency for Toxic Substances and Disease
Registry. I would like to comment on some obstacles that we
have encountered and some lessons we are learning. A
potentially serious obstacle to our ongoing investigation has
come from the legal profession. We are now being challenged to
provide copies of our data collection instruments as well as
actual case data. These demands are coming at a time when we
are just beginning to do what we call case-control studies. The
danger here, aside from obvious concerns about confidentiality,
arises when unofficial parallel investigators introduce
informational biases into the study population that may blur
subtle distinctions between case and comparison families that
would otherwise have provided us with important clues.
We have also experienced media sponsored investigations
resulting in spurious connections among case families that are
in our opinion over-interpreted, they are widely publicized and
frequently result in panic among residents of the community at
large. I believe these issues point to a need for some type of
investigative privilege that would protect the scientific
integrity of an ongoing public health inquiry.
Another phenomenon that arises in high profile cluster
investigations is the emergence of self-proclaimed experts who
promise to find answers more quickly than public health
officials. These experts all have a tendency to tell the
community what they want to hear, create distrust between the
community and public health officials, and cause a waste of
resources as health officials investigate and attempt to dispel
myths and misinformation.
A lesson we have learned from this is that it is essential
to keep the community well informed as to the progress of the
investigation. Even seemingly mundane but necessary activities
are of interest to the public and help concerned individuals to
understand that the investigation is continuing. We conducted a
public meeting for the community early on in the investigation,
we established a toll-free hot line that people can call for
information, and developed a web page with information that is
specific to the investigation. These steps have not been
enough. Consequently, we have begun to do weekly media
briefings and last week conducted the first of what we expect
will become a monthly open forum with the community. At our
first open forum we had over 150 people in attendance asking
questions for more than 2 hours. This is in a community with a
little over 8,000 people. We also say that involvement of the
local medical community in these meetings has been essential to
building trust.
One common question that is frequently asked by the public
is whether they should move away from the area. Unfortunately,
we cannot provide them with a science-based answer at this
time. We have, however, been able to obtain State emergency
funds that have been used to increase staffing by local mental
health professionals. This provides a mechanism for individuals
to receive assistance in making decisions in the face of
scientific uncertainty.
In closing, I would like to mention some things that might
be done on a national level that could assist other communities
facing a cluster of disease. First, because most children with
cancer receive their definitive diagnosis and initial treatment
at major cancer centers that may be located in a neighboring
State, there can be significant delays in reporting to the
central cancer registry in their State of residence. Some form
of national cancer registration for childhood cancers at least
would be very helpful in this regard.
Second, a standardized national protocol from agencies such
as the CDC and the Agency for Toxic Substances and Disease
Registry would allow them to respond to State and local
concerns more quickly. It has been exceptionally difficult to
explain to an impatient public why it should take so long to
develop a scientific protocol, have it approved by the
appropriate committees for the protection of human subjects,
and then implement it in the field. Having some things done in
advance would go a long way toward minimizing this frustration
in the community.
I hope these remarks have been helpful. I would be pleased
to answer your questions.
Senator Clinton. Thank you very much, Dr. Todd.
Mr. Hare.
STATEMENT OF JAMES E. HARE, COUNCILMAN, CITY OF ELMIRA, NY
Mr. Hare. Senator Reid, Senator Clinton, Senator Chafee and
members of the House, I appreciate the opportunity to speak
with you this morning.
I have been a teacher at Southside High School in Elmira,
NY, for over 16 years. I was at the school when it opened, left
of a short period and have been back there since 1986. My son
attended the school and graduated in 1997, and as a former
Mayor of Elmira and currently a city councilman representing, a
south side district, many of any constituents have a direct
connection with the school.
I believe there is a story to tell which should be of some
interest to your committee. A logical question is why Southside
now? The school stood there for 20 years, but for 20 years
there have been questions, because the school is located on a
former 83-acre industrial site, and the industrial site was
demolished to build the school. There have been questions for
years, but a number of things came together last year which
made us decide to investigate.
Neighboring Scott Technologies, purchased the property and
have conducted a 4-month, $900,000 voluntary cleanup of
materials at the site. According to newspaper reports, ``Tons
of contaminated soil, storage tanks and equipment containing an
alphabet soup of hazardous wastes were removed . . . that
included removal of 2,000 cubic feet of contaminated soil,
abandoned fuel and chemical storage tanks and electrical
equipment containing polychlorinated biphenyls commonly known
as PCBs.'' Other chemicals found and removed included arsenic,
lead, zinc, cadmium and the solvents toluene, ethylbenzine and
xylenes.
The site was given a clean bill of health by the State as
the work was done under the supervision of the New York State
Department of Environmental Conservation. It should be pointed
out that the contaminated soil ``did contain hazardous waste
sometimes in levels 1,000 times higher than allowed by the
conservation department.'' I have a copy of that report, this
is the property right next to the school, and the school is on
what used to be the rest of the plant.
Also last year, NYSDEC completed an investigation of
petroleum contamination initially found in the vicinity of
Miller's Pond, just to the east of the school. The
investigation began after a sheen in Miller's Pond was reported
to DEC in 1995. The contamination is believed to have resulted
from the activity of industries that previously occupied the
area. The source of contamination was found to be under the gym
at Southside High School. Bioremediation is being used now to
clean it up.
Finally, at a meeting of students in the school auditorium
last year, organized to promote participation in the Relay for
Life it was reported that six Southside students had cancer.
That made 13 cases since 1997. I was stunned. I had known of
cancer cases and two of my son's classmates were survivors, but
six in 1 year was an eye-opener.
As a teacher in the building, a parent and councilman, I
wrestled with what to do. What we did is we pull together an ad
hoc committee in my living room, consisting of Mr. Tobin and
his wife, whose son currently is a survivor of testicular
cancer, the Patros family, whose son graduated with my son,
he's a survivor of testicular cancer, Mike and Luann Smith,
whose daughter graduated with my son, and he is the emergency
management director for Chemung County, and Dan Royle, the
other councilman from Southside who has had two sons graduate
from Southside and has another son planning to go there.
We wrote a letter to the School Board posing some
questions. Quite frankly, there had been discussions of this
for years, and I was anxious as to why the school board didn't
show any curiosity. But after our letter, they did, and they
have been very positive in terms of their response.
We met with Tom Kump, who is the Chemung County health
director and was also a member of the school board member at
that time. He has since resigned the position on the school
board because he felt that was a conflict of interest in terms
of this issue.
One of the things that concerned us in the beginning,
however, was the response of the New York State Department of
Health, because as a quote from a staff member that said on
April 14, ``We get a myriad of calls of this nature. We respond
to all of them. But in order to prioritize it we need to review
the facts to determine if it's an unusual type of cancer, the
same type of cancer, the timeframe, and are there any logical
explanations for what is occurring.'' That was April 14.
On April 30, a State environmental expert commented that
testing of the soil at Southside would begin for chemicals and
contaminants similar to those found on the adjacent industrial
site. Then one of the engineers stated that the conservation
department never had any reason to believe there was metal
contamination at the school.
On May 2, after a preliminary investigation, State health
officials said that Southside High School was not a health
hazard to students. Headlines read ``High School Found Safe.''
These responses indicate that the bureaucracy has trouble
responding, because they have to prioritize, that they have
funds they have to come up with. Fortunately for Elmira, I
think some quick pressure was put on, including a behind the
scenes phone call by our chancellor of the Board of Regents,
Carl Hayden.
Our committee decided that we needed some experts to ask
the right questions. The school district didn't respond, we the
city took the role of a non-partisan observer. The city council
courageously stepped forward and hired an expert lawyer, Craig
Slater, from Buffalo, who had been involved with Love Canal and
had done some environmental work for us. Working with our
committee, he was able to provide expert analysis of what was
going on. Our new superintendent responded by forming an
advisory committee, which Mr. Tobin will talk about, to
investigate it. Quite frankly, the community I think came
together in trying to investigate this problem in a very open
way. All meetings were open, the press covered it very well,
surprisingly to some degree, the reporter doing the work was a
former Southside student, our mayor is a former Southside
student. So the community has come together, and as I think was
perhaps alluded to previously, it has been a totally open
process. While we can't answer questions the way many would
like to have them answered, I do think the community feels a
thorough investigation has been undertaken.
Senator Clinton. Thank you very much, Mr. Hare.
Mr. Tobin.
STATEMENT OF TIM TOBIN, ELMIRA, NY
Mr. Tobin. Senators Reid, Clinton and Chafee, members of
the House of Representatives. My son, Michael, was diagnosed
with testicular cancer on November 22, 1999. At that time, he
was a 15-year-old sophomore who ran cross-country, track, and
raced bicycles. Nothing I can say can describe the feelings his
mother and I experienced when told, ``Your son has cancer.''
Michael underwent immediate surgery. On January 1, 2000, we
flew to Indianapolis for additional surgery at the center where
Lance Armstrong was also treated.
Within a week of my son's diagnosis and first surgery, a
parent whose son was diagnosed with testicular cancer 2 years
prior contacted me. This father and I began a dialog about
cancer and the oddities of this disease. It would not be long
until a third young man would come to be diagnosed with
testicular cancer. Researching National Cancer Institute Data,
first to find information about the nature, treatments, and
survivability of this cancer, and later to assess the
``peculiarities'' of testicular cancer cases among young men
led me to a startling discovery.
The National Cancer Institute data for the occurrence of
testicular cancer is between 3 to 4 cases per 100,000. Almost
70 percent of these cases occur in men in their mid-twenties to
early forties. Rates for people of Hispanic descent, such as my
son, are less. The National Cancer Institute statistics, in
addition to with what I would later learn about chemicals used
in industrial manufacturing, led me to this conclusion: I had a
greater statistical likelihood of developing testicular cancer
than my son, unless there was another factor at play. Coupled
with the growing awareness of other cancer cases, this was
cause for concern and inquiry.
Elmira, NY has been home to many former industrial sites
typically found in northeastern cities. My son's high school
was built on a site that had experienced 100 years of
industrial use. During the years of manufacturing, some of the
chemicals used and that are still present on the site include,
but are not limited to PCBs, chromium, beryllium, arsenic,
lead, nickel, zinc, phthalates and trichloroethylene. All of
the above chemicals are known to, or believed to be
carcinogenic.
In evaluating the site various criteria was used to
determine safety. Many of the chemicals in the soils at the
school and in the industrial site that still stands right next
door exceed acceptable human exposure limits from either the
EPA or the New York State Department of Environmental
Conservation. However, they were still determined to be safe.
In many cases, the New York State Department of Health, in a
preliminary draft of August 22, 2000, said exposure would not
occur due to a ``well established grass cover.''
I have also read recent studies on phthalates that have
indicated that exposure to this chemical causes ``testicular
lesions'' in lab animals. This was from the Center for the
Evaluation of Risks to Human Reproduction. I also must question
the inherent contradiction that this area is safe when several
experts have repeatedly stated that we could not build this
facility here today as it would not pass industrial standards.
Nowhere in all of the data, studies, and reports from any
of the different investigate or public health agencies, is
there a mention that this site is on or directly contiguous to
a DEC Class 2 Superfund site.
I would submit that clear-cut standards of chemical levels
and exposure levels be implemented across the board. Further
discussion, such as issues raised by the U.S. News and World
Report in its June 19, 2000 edition or measures recommended by
the Center for Environmental Justice in its study ``Poisoned
School--Invisible Threats, Visible Actions,'' needs to be
engaged. Clean-up measures should be taken to meet these
standards. Public notification of schools when an industrial
cleanup takes place is a must.
In September 1999, such a cleanup was taking place during
school hours at the site next door to my son's school. I can
only imagine the chemical exposure that children were
unknowingly subjected to from this activity.
I believe that industrial waste is a danger to humans. I
believe that a more diligent, cooperative approach to fix the
problem, rather than place blame, is needed. I believe that
these substances are enhancing the risks and rates of cancer in
our children. This is one risk that needs to, and can be,
eliminated.
I would like to thank the city of Elmira and its elected
officials for the position and leadership they have taken on
this issue. I would further like to thank all of the members of
the committee for your interest in this matter. Thank you.
Senator Clinton. Thank you, Mr. Tobin.
Ms. Miller.
STATEMENT OF KAREN JOY MILLER, FOUNDER AND PRESIDENT,
HUNTINGTON, NY BREAST CANCER ACTION COALITION
Ms. Miller. There is no cancer-free zone. Our toxic
environment affects each one of us, in fact, all of us.
I'm very nervous about the 5 minutes, so I'm going to go
right on to my point and then I'll try to give you some
testimony. On Long Island here we work as a cooperative, so a
lot of people have provided it.
We're here to ask you, our valued representatives, to
please take on some major new initiatives. There must be
incentives to encourage environmental research. Breast cancer
activists across the country have helped to raise multiple
millions of dollars for research. But environmental researchers
have been getting seriously shortchanged by funding agencies
like the NCI. Breast cancer research must be more
interdisciplinary and more focused on environmental
contaminants.
That research must be done with the active assistance of
the breast cancer community. Government must improve its data
bases so that scientists can do their work properly. Today's
cancer registries are woefully inadequate. They do not collect
the many forms of information that are vital to researchers.
Work with us to improve these registries.
We all need better information so that we can make
healthier lifestyle choices. We need the Federal Government to
provide information in a format that's easy to use and easy to
understand.
We also ask our Government to speak openly about the
precautionary principle. It's no longer as simple as saying,
get our mammogram, while our environment is being tested. We
need honesty at a Federal level about the health risks we face.
In 1994, the FDA recommended that doctors record in
patient's files information to calculate the absorbed dose of
radiation to the patient. Right now most doctors have no idea
how much radiation their patients are exposed to. The fact that
many of us see many different specialists compounds that
problem. Please address this vital public health issue and
remember that radiation is a proven environmental cause of
breast cancer.
Additionally, we need medical coverage for routine testing
of toxic buildup in our bodies. Coverage must include viable
treatments to cleanse the body should the results be positive.
The successful elimination of lead from children's blood, as
well as from the environment, serves as a good example. It's
time to replace the policy of acceptable risk in industrial
practices with actual risk-reducing regulations that are fully
protective of public health.
To date, the effects of groundwater on breast cancer have
not been adequately researched. Many on Long Island are
concerned that our water distribution systems increase our
cancer risks, and this needs more attention.
The Senate, we hope, will ratify the international POPs
treaty dealing with the Persistent Organic Pollutants such as
PCB's, chlordane and dioxins. The elimination of these
contaminants must begin without delay.
Good morning, I'm Karen Miller.
[Laughter.]
Ms. Miller. I have lived on Long Island for 33 happy years
raising three children with my husband Michael. In 1987, that
was the year our peaceful existence was shattered by the news
of my breast cancer diagnosis. Thanks to the wonderful support
of my immediate family, I was eventually able to regain my
stability.
Once on my feet, I was fortunate enough to find three other
women in my town of Huntington who were willing to ask the
vital question, ``Why?'' Together we started the Huntington
Breast Cancer Action Coalition, whose first major project was
to map the incidence of breast cancer within our township. We
always knew that education equaled power, the power to create
change. With that in mind, we set out to arm ourselves with
solid information. We all read all we could, asked innumerable
questions and along the way were lucky enough to meet the
experts and learn from them.
Breast cancer is a disease that has been puzzling us for
centuries. We have come a long way in solving this puzzle but
it is an undeniable fact that we have just begun the serious
research into understanding the relationship between the
toxicity in our environment and disease. Even though we are all
hearing about the major breakthroughs in the fight against
cancer, such as the completed Genome Project and the new wonder
drug Gleevec, there is a long way to go before we can rest
easy.
Our efforts of our Coalition along with many grass roots
groups nationwide have laid the groundwork by increasing the
public's awareness of breast cancer. The growing number of
women who have had regular mammograms is proof of that very
effort. Yet, despite all this, rates of breast cancer have
jumped since 1973 almost 40 percent. That's very serious cause
for alarm.
Earlier, I mentioned the mapping project initiated by our
coalition. Please take a moment over here and look at the dots.
Each of these dots, no matter what the color, represents a
woman who is also asking the question, ``Why?'' She is willing
to help any of the researchers with what they want to know. She
is willing to disclose confidential information about herself,
her medical history, her occupation, her lifestyle. She is one
of the millions who want to know why.
Our high-tech world makes our lives more comfortable and
convenient by the day, yet that very same world bears
responsibility for our toxic pollution. Industrialization has
been at the core of our success as a society, but the price has
been much too high in terms of our health.
In the spirit of cooperation and community, we sincerely
hope that your persistence and assistance during the next 4
years will make a real difference in the fight against breast
cancer. When I learned I had breast cancer in 1987, I was
devastated, my family was devastated. Improved methods of
protection and cure are essential, but certainly they are not
enough. We must get rid of the root causes of cancer, all
cancer.
There is a growing body of evidence that supports our
claims. Industrial toxins are killing us. Please help us to
clarify our understanding and work with us to reduce our
exposure to these awful chemicals that have become so pervasive
in our community. In our hearts and in our minds, we know that
change is possible, and we appeal to all of you in the next 4
years to give us those changes. Thank you.
Senator Clinton. Thank you very, very much.
I want to thank all of the panelists. We just heard, I
think, very eloquently how this is a problem and an issue that
spans all of New York State and our entire country. Many other
people who wanted to be here could not, and they have provided
us with testimony that I can assure you will be read and
analyzed.
For example, I want to thank the Elmira School
superintendent for sending additional materials regarding
Southside High School. All of those materials will be included
in the official hearing record. The hearing record will be open
for 2 more weeks, and anyone who wants to submit written
testimony can do so. It will also be included in the official
record. The address for sending in written testimony is posted
outside the room today.
With respect specifically to Mr. Hare and Mr. Tobin's
point, I have last week offered an amendment to the Education
Act, which we are debating right now in the Senate, to do an
investigation to determine the safety of our schools, to really
put some dollars behind a Government investigation to find out
what factors in the school buildings that our children spend so
much time in might possibly harm their health, whether it's
very bad and clogged insulation and venting and air
conditioning systems, or asbestos, or the industrial chemical
problems that both Mr. Hare and Mr. Tobin spoke of. We need to
know the facts, because we entrust our children into our
schools and we should know exactly what conditions might be
there that could affect their health and then take action to
try to remedy that.
Now I'd like to turn to Senator Reid for his questions for
this first panel.
Senator Reid. Senator Clinton, thank you very much. The
panel has been excellent.
Dr. Landrigan, it's true, is it not, that children's
central nervous system in their bodies is generally more
susceptible to these elements that we talk about, the arsenic,
cadmium and all these other things in the environment that
shouldn't be there?
Dr. Landrigan. Yes, sir, that's absolutely true. From 1998
to 1993, I chaired a committee at the National Academy of
Sciences that was given responsibility by the Senate to look at
children's vulnerability to pesticides and other environmental
chemicals. We concluded that children are not little adults in
terms of their susceptibility to chemicals, and we said that we
find that that susceptibility had a poor bases.
First, children are more heavily exposed than adults. Pound
for pound, children breathe more air, they drink more water,
they eat more food, so they take more toxins into their bodies.
Then of course, kids play on the ground, when they drop a
lollipop onto the rug, when the rug has been treated with
pesticides, when they pick up and lick that lollipop, they take
the pesticides directly into their bodies, practices that most
adults don't engage in.
Kids are biologically more sensitive. Their nervous system
is an extraordinarily complex entity. There are billions of
cells, those cells have to move to their assigned positions,
they have to establish literally trillions of connections. That
whole developmental ballet, that whole choreography is
extraordinarily delicate and easily disrupted. So if a child is
exposed in the womb or in the first years of life to lead, to
PCBs, to certain pesticides, to methyl mercury, the child can
end up with loss of intelligence, altered behavior, and those
effects can last lifelong.
Also, children don't have the metabolic machinery that
enables them to break down and get rid of toxic chemicals like
pesticides. So the chemicals stay longer in their bodies.
Last, the fourth reason why children are more susceptible
is the simple actuarial fact that they've got more life ahead
of them. They've got six, seven, eight decades of life ahead of
them. So if the cells, for example, that are responsible for
protecting the nervous system against Parkinson's disease, if
those cells take a hit in infancy, nothing may show up for six
decades. But the theory is now being actively explored that
exposures earlier in life can lead to chronic diseases of the
nervous system, such as Alzheimer's.
Senator Reid. I knew the answer to the question, but I
certainly couldn't articulate it as you have. Because when I
was chairman of the subcommittee on this committee a number of
years ago, when we had the majority, we were able to look at
lead-based paint and what a terrible devastating effect that
has on children. We looked at products that had an impact on
children, which was significant, but also adults, alar, that
they used on peaches and grapes and apples. We were able to get
that withdrawn.
I was so impressed with your testimony, because we had just
started there on my subcommittee to look at how we handle
chemicals in the environment. We so easily allow them to get
into the environment, but it's almost impossible to get them
out of the environment. If we determine a chemical is
dangerous, we have no apparatus in the Federal Government, one
that works well, at least, to get rid of that product. As
you've indicated, there are tens of thousands of chemicals and
we've only tested far less than 10 percent of them. So that's a
real problem.
We also see this Southside High School, how large is it?
How many students?
Mr. Tobin. We have about 1,100 students.
Senator Reid. I've read the testimony. It's interesting
that, for those of you who may not be aware, there's a pool of
water, a lake or whatever you want to call that, it's called
the pool that never freezes, because it's so heavily laden with
chemicals. That's really unfortunate. Even a layman would have
to think some of the sickness of these children is related to
this building. I certainly think we need to help it some way,
in taking a look at this.
I'm also concerned about this tracking system we talked
about, and Dr. Landrigan, you had mentioned it. With all the
scientific apparatus we now have at our disposal, if there were
directives from Washington saying that all cancer cases, and we
could categorize them in some degree, had to be reported to a
central system, that would help all you, isn't that true?
Dr. Landrigan. Absolutely, sir. One of the problems we have
in this country is that we have disease tracking systems for
the infectious diseases that go back into the 1950's that are
really pretty solid, for measles, for hepatitis, and more
recently for AIDS. But by contrast, the tracking for chronic
diseases, like cancer, like asthma, like birth defects, like
developmental disabilities, is very scattered, weak and
fragmentary. I would commend to you the report of the Pew
Commission on Public Health, that Senator Wiecker chaired, the
report was released a year or so ago. Dr. Lynn Goldman, who's
going to be testifying later today, was staff to that
commission. They've made some elegant recommendations about the
importance of disease tracking in this country.
Senator Reid. You would agree, Dr. Todd, that would be a
tremendous help to this almost insurmountable problem you've
found with the lack of resources in the State to do this heavy
job that you have?
Dr. Todd. Yes, I would, Senator, it would be very helpful.
The one caveat that I would mention is that some of the
information that would be useful to us in public health in
doing these investigations is infrequently collected in the
illness care system and hospital system. It's all been useful
to know what the occupation or the usual occupation of the
patient was. That may or may not be in the patient record. If
it's not there, we can't abstract it and we can't generalize
from the data as easily as we would like to.
Senator Reid. One of the things I'm impressed with that is
now beginning to occur in the State of Nevada, there's a very
generous man in the State of Utah who's given more than a
quarter of a billion dollars to the University of Utah Medical
School. There's a cancer institute now established called
Huntsman Institute. The reason I'm so impressed is that it
shows a little bit of what can be done.
As you know, in Utah, the LDS church has collected hundreds
of millions of names of people for genealogical purposes. But
it's my understanding, one of the things the Huntsman Institute
is doing, in this cancer that they're studying, they go back
and check out what happened to the father, the grandfather, the
great grandfather, and determine if there's any linkage as far
as the types of disease from which that person died. Now, some
things like that would be helpful, is that a fair statement,
Dr. Todd, Dr. Landrigan?
Dr. Todd. Yes, absolutely, very helpful.
Dr. Landrigan. Yes, sir, and the particular way in which
they would help is that that kind of linkage study would enable
researchers to look at the respective contribution of genetics
and environment to the causes of cancer. Clearly, both
contribute, most malignancy is probably a result of the
combination of the two that occurs when a person with a
particular genetic makeup is exposed to a particular
environmental toxin. If you can trace back through the family
and see that three generations ago, lots of toxic chemicals
were not present, and compare that earlier experience with the
experience today, the lessons could be profound, to really tell
us what chemicals are doing.
Senator Reid. Senator Clinton, can I ask a couple more
questions, because I have to leave early? They can take my
time.
I have a couple of other questions. Dr. Todd, one of the
things that we're being criticized you and I, in the State of
Nevada, is we're not moving quickly enough. How do you respond
to that question?
Dr. Todd. Well, I sort of tell people that looking for
causes, as we're doing, looking for scientifically, is
something akin to trawling for fish out on a reef. You can only
trawl so fast. We could put more power to the throttle and
perhaps make the boat go 30 knots, but we wouldn't catch fish,
if that was our objective.
Good science sometimes takes a while to accomplish and get
the correct answer. We have other people out there that are
promising answers. I have no doubt they can find answers. I
have doubts that they'll be the correct answers. I have little
doubt that the answers they find will be connected to deep
pockets. If that's your objective, then yes, you can move more
quickly. But we're trying to do this quickly as the state of
science will allow us to move.
Senator Reid. Also, the State of Nevada, like many State
public health agencies, are tremendously understaffed and
under-funded. Is that a fair statement? I know you don't want
to get fired for saying this, but the fact is, that's true.
I'll state it, you won't have to answer.
[Laughter.]
Senator Reid. I would also ask Dr. Todd this. We now have
the Centers for Disease Control, it's involved in the problems
in the State of Nevada. We have the Agency for Toxic Substances
and Disease Registry, we have the Environmental Protection
Agency. From your contact with these entities, have they been
helpful to you?
Dr. Todd. They've been extremely helpful. They are the best
and they have access to some of the best scientists in the
world to bring the appropriate analysis to bear on the
situation. As I mentioned earlier, though, the frustrating part
is that we're sort of inventing this as we go along. While
there has to be a certain amount of customization for a
particular situation, having some of these protocols prepared
in advance so that it could be more quickly implemented in the
field would be useful and would be appreciated by the
community.
Senator Reid. That's one of the things the House members
and the Senators are going to work on. If something happens
like in Fallon or Long Island, Federal agencies have a system
whereby they move in the same way every time and are not
reinventing the wheel, like we've had to do in Fallon.
Thank you, Senator Clinton.
Senator Clinton. Thank you.
Senator Chafee.
Senator Chafee. Thank you very much, Senator Clinton.
Probably the first warnings came in the early 1960's from
Rachel Carson when she wrote her book ``Silent Spring,'' on the
dangers of toxins and pesticides to our health. Of course, she
did die of breast cancer. So it's been a long time, it's been
40 years since then, we're still working on it.
Ms. Miller, you've asked a few things of us, and I'll in
return ask one of you. That is, we do have a bill that Senator
Clinton and Senator Reid mentioned. It's legislation that would
establish research centers to study the environmental factors
that may be related to the development of breast cancer. The
bill would enable scientists and researchers to conduct more
comprehensive and conclusive research in determining the impact
of the environment on breast cancer.
Of course, all these bills have a number, this one is S.
830, and it would require centers of excellence to collaborate
with community organizations in the area, including those that
represent women with breast cancer. As you mentioned, it's
important to have consumer advocates involved in all phases of
the program, which this bill does require.
So I'll ask in return your help with S. 830, either in
improving it, or if you're in agreement with it, in pushing it
to make it law.
Ms. Miller. Senator Chafee, thank you so much, Senator Reid
and Senator Clinton. I am in agreement with that bill, but I
would very carefully make sure that it is interdisciplinary. I
am keenly aware, when we give money to research institutions
that environmental researchers are seriously shortchanged. So I
would ask you to really look at that issue and make sure that
they get most of the pie. We have the technology now, we have
the dynamics. We've got to keep the group working together.
Thank you.
Senator Chafee. Very good. I will mention, it does
appropriate $30 million over 5 years, and we'll take your
advice on making it interdisciplinary, try to achieve that.
Also just note that as Senator Reid was saying earlier,
that he's very unpopular with the farmers in Nevada. It just
shows how difficult it is, because of course some of these
chemicals are so helpful to them in growing their crops. It
just shows some of the difficulties, as Dr. Landrigan said,
they want to do more testing on some of these chemicals, but of
course, there are those who are going to be opposed to that.
That is some of the difficulty with what we're trying to
accomplish.
Thank you very much for your testimony.
Senator Clinton. Thank you very much, Senator Chafee.
Senator Reid. I would just say also, there's a little bit
of water involved in my unpopularity, also.
Senator Clinton. Part of the challenge, though, it's sort
of a chicken and egg issue. We have to have the tracking system
so we can gather the information to make the case, so that
people who might otherwise say, why are you singling me out or
why are you asking me to do something with this chemical, they
will themselves be able to see the results.
So I think that part of our real challenge is to get the
information and then be able to make the case.
Mr. Hare.
Mr. Hare. I think that is important. A point I would like
to make has to do with the investigation. When DEC came into
Elmira, they did come in a little bit reluctantly. Their
initial response, in my opinion, was somewhat cursory. It was
the hiring of Craig Slater, I believe, by the city, that made
the DEC more accountable and the school district.
Now, we do not have, technically, a cluster in Elmira. I
need to make that point. But in the DEC investigation, they did
not even do a phase one in terms of where the operation of this
plan had been, and the metals and the processes in the various
locations. The city did that for them. The school district
undertook some of that.
I wanted to point it out, because we, in 1997, received a
$200,000 brownfields demonstration title grant. The city has
asked, and EPA Region II is considering a reallocation of a
portion of the brownfields award to reimburse the city for part
of its assessment.
I think that is something, if it's not a matter of policy,
you might want to look at that would allow communities a little
flexibility here. Because certainly the cost of these things is
an issue. While you're talking about tracking illnesses after
they've occurred, investigating more thoroughly the sites, part
of this goes to that, as well as to what other uses that
funding is for.
But I think helping to reimburse a community might make
them more willing to undertake this. Because we have people in
our community who are not directly impacted by the cancer issue
who do believe maybe we've run the course here. We need to
continue to push that.
Senator Clinton. I appreciate your saying that. As I said
when I introduced Senator Chafee, he played a major role in
working out the bipartisan compromise on the brownfields
legislation. He and Senator Reid really carried that. I was
pleased that one of my amendments that would prioritize based
on disease presence in an area, would give people the first in
line priority for these brownfields dollars. Because it's not
just that there is a brownfield site that needs to be cleaned
up, but if there is a Southside High School or another site
that seems to be associated with a prevalence of disease, that
that would be the site that would get the first call on those
dollars. Because I think we have to start linking our
environmental cleanup and disease clusters.
Congresswoman McCarthy.
Ms. McCarthy. Thank you. Thank you all for your testimony.
One of the curiosities that I always had, I'll go back Dr.
Todd, when we see the clusters, not just the breast cancer, not
just the prostate cancer, I'm often wondering, in those areas,
because we know some of these chemicals can have different
effects on different age populations, whether they're the
youngest or the oldest. I'm just curious if we could do a
tracking system in the future, that if you have a cluster of,
say, breast cancer, how many kids do we have in that cluster
also with leukemia? How many kids in that area? Then chemicals,
this chemical.
I just got the report on my water in Mineola. It was great.
It tastes great. I can't even pronounce three pages of the
stuff in there that make my water good.
Now, I know all these things make my water better. How do I
know if something in that ingredient is not having an effect on
my body, because maybe I have an abnormality to that piece of
material that's in there? This is where the legislation, as
we're marking through, and through these hearings, I think we
have to look. With the computers and the technology that we
have today, I see no reason why we can't do the tracking.
Now, obviously we're going to have outcries from the
chemical industries. Listen, all these chemicals were made for
reasons, hopefully, to make our lives better. We didn't know.
We have to look at prevention. Because we are finding the drugs
to cure us. But what caused it? That hopefully, through the
legislation, are things that we have to look at.
I happen to agree with you strongheartedly. Not only are we
not diagnosing, but as a nurse, you're doctors, scientific
people, kids are going to get sick, adults are going to get
sick. We have an increase overall in what is causing it. I
happen to think it could be a combination. Here on Long Island,
it might be the water, maybe some planes flying overhead. We
have to start looking at each and every and put them together.
That's what the tracking, hopefully in the legislation that we
can do on a Federal level.
We will have a battle. As you said, there will be lawsuits
out there. But again, I always look at it this way, at what
cost is it to our country on the health care system if we don't
make the strives. As I said, I'm not blaming anyone on this. I
just think technology has gone very fast, and we don't know the
whole issue on the body.
Because I just see so much pain out there, breast cancer,
prostate cancer, leukemia. Now we're seeing more and more
higher levels of retardation. These things just come. There
isn't a link. We on this table have in my opinion a moral
obligation to work with the scientists and everybody else to
come up with the reasons.
So with that, I thank you again for hearing this committee
and having a open dialog on this.
Senator Clinton. Dr. Landrigan, did you want to respond?
Dr. Landrigan. Just a quick comment, Congresswoman.
Thank you very much for those remarks. I think there are
three things that the Congress can help us with that speak very
directly to the issues you've raised. First, we've already
discussed, disease tracking. Second, we need to track levels of
chemicals in the blood of Americans. The CDC released a report
this spring showing that most of Americans, and they tested
5,000 adults from all parts of the country, have traces in
their bodies of at least 20 different chemicals.
Twenty-five years ago the first chemical that we started
tracking was lead. As soon as we realized that 99 percent of
children in this country had elevated levels of lead in their
body, we took a deliberate action, that is to say, we got lead
out of gasoline, based on chemical monitoring. What has
resulted has been a better than 90 percent decline in the
prevalence of lead poisoning in this country, due to that one
bold regulatory action.
The third thing we need, and you spoke to it when you
talked about the chemicals in drinking water, we need to have a
right to know. People need to know what's in the air, what's in
their food, what chemicals are being laid down in their
communities and schools, neighbor notification laws, right-to-
know legislation, analogous on a national scale to Proposition
65 in California.
Senator Clinton. Thank you.
Congressman Ackerman.
Mr. Ackerman. I thank the panel for their great testimony.
Following up on what you just said, Dr. Landrigan, the public
does have a right to know. But what does the public do once
they know? That's really an immediate problem that we face.
Maybe I'll address this first to the members of the scientific
community on the panel, both doctors.
When a young couple makes a determination of where they
want to live, they consider a number of factors. They consider
the job market, they consider the school system. We are going
to be developing very quickly nationally, based on this
conversation we're having from your panel, the ability to make
a determination about these clusters all over the country. How
seriously should people take this?
I know you're not in a policymaking position from this
point, so I'll ask you a personal question, as a father, to
another person, would you move into one of these communities
that had very hot clusters of any numbers of things if you had
a young family with young children?
Dr. Landrigan. Well, I'm a pediatrician, a parent and now,
thanks to the good work of my son and his wife, a grandparent.
I'd be cautious. I realize that 99 percent of the time we never
find a specific cause for a cluster. I've been involved myself
when I worked at CDC in many cluster investigations. So I don't
think the existence of the cluster per se means that the
community is contaminated.
But I would certainly take it as an input to my decision.
We give people information about lead in homes and radon in
homes and asbestos in homes. We tell them where the nearest
high tension power line is. I think it's at least reasonable to
make this information available and trust that people will make
intelligent judgments.
Mr. Ackerman. I think part of the problem is we're not able
yet to make intelligent judgments because we don't know what
the impact is. I think people would like to get some guidance,
at some level or another, from somebody who knows, supposedly
knows more than they do.
Senator Clinton. Dr. Todd, what's your answer to that?
Dr. Todd. You bring up, Congressman, a very important point
in the area of risk communication. When you get a little bit of
information without a lot of ability to interpret it, it
creates problems and it creates panic within a community.
In Fallon, for example, we have people that are considering
moving to a neighboring community known as Fern Lake. It's
maybe a half hour's drive away. It also is over a highway that
has one of the worst collision rates on State roads. So they're
trading a perception of lower risk by moving away from a
cluster area for a higher risk on the highways as they make
their commute.
These are difficult things, and there really aren't good
scientific answers to help people make those kinds of decisions
right now.
Mr. Ackerman. I realize that, and you said, good science
takes a while. I wrote that down when you said that. Most
people realize they have one life to live and want to make
decisions in a proper manner. The situation, for example, in
Love Canal, people were warned against that, but by the time
they were warned against it, a lot of people, it was too late
for them and their families.
I'd like to ask the advocates, starting with Ms. Miller,
what they think about this. We certainly don't want to start a
panic or a rumor that you shouldn't move into certain
communities. That's not the idea, because every neighborhood is
going to have some problem or another. But there are certainly
hot spots, as we've determined.
Ms. Miller. You know, I wonder if we're over-using the term
cluster. Actually, I think if you give it any name, it might
cause some problems and panic. But actually, if you look
specifically at the Huntington community or communities across
Long Island that have done breast cancer mapping, these are
people that are willing to say, start with me, you can come
into my home, I'll tell you all about my lifestyle, I'll tell
you where I grew up, where I work, I'll let you live with me as
long as you hopefully can prevent the next generation from
getting this disease.
So basically, if we see a school or we see a block or a
community, that's a really good place to start. We should
downplay because cancer, while we're saying there might be
areas of people that are wiling to be looked at and work with
the researchers, that cancer has no boundaries. So we've got to
go back to say, we live in a toxic environment, it's OK to say
it, and the education has to come into how we can lower our
risks in the air we breathe, the food we eat, the water we
drink.
So I think if we improve education and teach people how to
be more proactive, I think we'll do a lot over the next year.
Senator Clinton. Gary, I'm going to have to let you off and
let Mr. Tobin answer. We're going to have to move on to the
next panel, I've just been told we have to move.
But I think it's fair to say we really appreciate what
Karen just pointed out, that we find cancer everywhere. We find
it in every kind of setting, along with other chronic diseases.
I think the real key is to get the real information and not to,
as Dr. Todd reminded us, create a panic.
Because part of, it's ironic that we know the leading cause
of cancer in terms of an environmental causation is tobacco, we
still sell it, we still permit it to be advertised. We know
people freely go out and smoke, causing all kinds of cancer,
and I believe second-hand cancer. So these are very complicated
kinds of issues, and I think we have to look at that and in the
next round, of course, I'll start with the members who didn't
get to ask a question.
Mr. Tobin, how is your son doing?
Mr. Tobin. Quite well, thank you. We expect a long, healthy
life for him at this point in time, thank you for asking.
If I may just address a few things that were mentioned a
few moments ago, Senator Reid mentioned possibly the concept of
a national reporting system. In the situation in Elmira, one of
the problems, we have a community where a lot of our best and
brightest get up and leave, not to return. In the year and a
half since this has been going on, we had a young man drive in
from Florida, 26, with cancer, we had a young man, 25, living
in Texas, they may not appear in the statistics at all. New
York has a reciprocal agreement with Pennsylvania, we're just
north of the border, maybe 8 or 10 miles. So I think Senator
Reid's suggestion of some type of national reporting system
would work well.
Ironically, some of the initial data that New York State
put forth about the incident rates in Elmira, because of the
nature or whatever of the reporting system, my son was not
included in the statistics. He missed the cutoff date, I guess
is what that would be.
The second point, to Congresswoman McCarthy, about
rethinking possibly how we put aggregates of cancer data
together, one of the things that gnaws at me when I listen to
it now and again is when someone says, this cancer is
statistically insignificant. It really offends me as a parent
that someone's child is statistically insignificant. Sometimes
we get caught up in the world of science and overlook human
beings.
Following up on Congresswoman McCarthy's suggestion, if you
look at, in our area, we've had a young man of 20 with colon
cancer. We had a young man 28 with a rare brain cancer. We've
had stomach cancers. They become statistically separate,
because it's one case of this or one case of that. But if they
become an aggregate, maybe there is something else. With the
good doctors to my right here, that the young body does react
differently, I think that also may be beneficial, to take both
of your points. I would appreciate something with regard to
that action. Thank you.
Senator Clinton. I want to thank this first panel. It's
done a wonderful job in setting the tone and providing us lots
to think about. We will look forward to continuing to followup
this in our work.
Now I'd like the second panel to come and join. As they do,
I'm going to be introducing them as they take their places.
We're going to be hearing, on the second panel, from Dr.
Marilie Gammon, who's the principal investigator for the Breast
Cancer and Environment Study, part of the overall Long Island
Breast Cancer Study project. She's here with us today from the
University of North Carolina in Chapel Hill.
We'll also hear from Dr. Ruby Senie, who is the principal
investigator for the Metropolitan New York Registry of Breast
Cancer Families, also part of the study project. She's here
with us today from Columbia University.
Gail Frankel is with us from Centereach, NY, representing
the National Breast Cancer Coalition. Amy Juchatz is here from
the Suffolk County Department of Health Services. We especially
appreciate her participation. This is a wonderful opportunity
for us to get a preliminary briefing about the breast cancer
study project here on Long Island. But of course, the study's
not finished. We know that there's a lot of data still to be
analyzed. So I appreciate both Dr. Gammon and Dr. Senie coming
to give us sort of a preliminary look at what they're finding.
Dr. Gammon, would you please begin?
STATEMENT OF MARILIE GAMMON, Ph.D., ASSOCIATE PROFESSOR OF
EPIDEMIOLOGY, SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF NORTH
CAROLINA AT CHAPEL HILL
Dr. Gammon. Thank you, Senator Clinton, for your invitation
to come speak. As mentioned, I am the principal investigator of
the largest and most comprehensive of the projects in the Long
Island Breast Cancer Study Project. The primary aims of that
study are to look at several environmental contaminants, in
relationship to the risk of breast cancer. In other words,
we're trying to figure out, are there environmental
contaminants that really can be linked to the cause of breast
cancer.
We have two classes of compounds that we've been examining.
The first is polycyclic aromatic hydrocarbons. These are
combustion products from incomplete combustion. Sources would
be diesel fuel, tobacco smoke, among those who are cigarette
smokers, and also components of the diet. When you barbecue
your food, it's that black junk on the meat and vegetables.
They are known carcinogens in rodents, but their effect on the
breast in humans is unclear.
The other class of compounds that we've been addressing is
organochlorine compounds. These are persistent compounds that
can be found in the body, they have a long half-life. They're
things like DDT, its breakdown product DDE in the body. Another
class of compounds that we're looking at is PCBs, which you've
heard mentioned, and other pesticides including chlordane and
dieldrin. All of those are measurable in the body, through
blood samples. They're stored in the body's fat, and they have
a half-life of about 10 years. So even though many of the
compounds have been banned, they are still measurable in
people's bodies.
So for the study, we assembled a multi-disciplinary team of
scientists in New York City and on Long Island. What we did is
over a year period, we identified every case of breast cancer
that was newly diagnosed in that year period. We identified
some 2,000 women. We then got physician permission to approach
the woman to interview her. We administered a 100-minute
questionnaire in person. We also collected blood samples, urine
samples, and samples of dust, water and soil among the
subsample of women who had lived in their homes 15 years or
longer.
Simultaneously, we identified a group of control women
without a history of breast cancer. This would be our
comparison group. Again, we call it frequency match, in other
words, the distribution of cases of women who get breast cancer
predominantly are over age 50, something like 75 to 80 percent
of women who are diagnosed with breast cancer are over age 50.
Because age is a predictor of cancer, you want to make sure
that the age range of women that we use as our control group is
the same.
So we made sure that the women that we randomly selected
from the communities were of similar age distribution as our
cases. We also administered the same questionnaire, collected
their blood and urine samples, and among the subsample of women
who were long-term residents of Long Island, we collected dust,
soil and water.
Many of those data have been analyzed in a laboratory. We
have submitted three papers for publication that address those
primary hypothesis. We are continuing to analyze the data,
because it's a wealth of multi-disciplinary data. It is pretty
unique.
Another very unique aspect to this study is that we
collaborated with the women activists on Long Island, including
Karen Miller and many, many others in the group. That has been
very interesting, and my first experience in working with
activists and scientists.
Thank you.
Senator Clinton. Thank you, Dr. Gammon.
Dr. Senie.
STATEMENT OF RUBY T. SENIE, Ph.D., PROFESSOR OF CLINICAL PUBLIC
HEALTH, MAILMAN SCHOOL OF PUBLIC HEALTH OF COLUMBIA UNIVERSITY
Dr. Senie. Thank you very much for inviting me to the
panel, to this hearing. I have prepared some slides and I would
like to talk from them.
Senator Clinton. I think they're going to drop a screen.
There's a screen coming down.
Dr. Senie. As principal investigator of the Metropolitan
Breast Cancer Family Registry, I have had the privilege of
working with many families on Long Island and Manhattan, and I
will tell you, I'm very happy to have this privilege to tell
you about the Family Registry and how it has five collaborating
centers across, actually around the globe. Together, these six
sites will be able to contribute greatly to studies of the
environment and breast cancer.
In New York, we have recruited currently 1,500 families,
and we've just recently been renewed for another 5 years. We
plan to increase the number of minority families. I look
forward to showing you the sites at which the other registries
are located. Notice Huntsman, we heard about from Senator Reid,
Melbourne, Australia, Northern California Cancer Center, Fox
Chase in Philadelphia, in Toronto, the Cancer Control of
Ontario. Here we are in New York.
The Metropolitan New York Registry includes the 1,500
families. Our goals from all the six sites have been to bank
data and biospecimens as a resource for family-based gene-
environment research, as compared to the case control study of
Long Island. We recruit members of high-risk families through
cancer registries, and through clinics. We're very careful to
protect the confidentiality of our participants. We inform
family members of our study findings and of additional research
opportunities for them.
Each family is asked to include three or more participating
relatives, males and females; 18 is the youngest age, with or
without a history of cancer. Deceased relatives can be included
by a proxy questionnaire and tumor tissue.
To enroll in the registry, we ask for maternal or paternal
relatives to meet one of the following: a male with breast
cancer, a female with breast or ovarian cancer diagnosed at a
very young age, a female diagnosed with both diseases, or three
or more relatives who are older in diagnosis.
We ask each to sign an informed consent. We have a family
history form that asks for all relatives in the family and
their cancer history. We ask for personal health history,
dietary intake, and we collect blood and urine samples. We also
do an annual followup creating a cohort of families.
These are some of our instruments used by the New York
Registry. Each site has its instruments that overlap with the
same questions.
We protect confidentiality by assigning coded identifiers.
We removed all identifiers from the personal information. The
data is entered into our secure computer system, and then
transmitted to a central data base in California. All six sites
send their data together. The genetic information is protected
to prevent employment or insurance discrimination. We received
an NIH certificate of confidentiality.
Benefits for participants include referrals for genetic
counseling and testing, if they're interested. Participants are
satisfied to be contributing to important studies. We
distribute registry newsletters to participants with the latest
research findings. I included one in the packet today. We hold
seminars in Manhattan and on Long Island.
An Ashkenazi component was added by the NCI after the three
founder mutations were identified. The NCI provided the funds
for recruitment, testing and counseling. Four sites
participated, including New York, Philadelphia Fox Chase,
Toronto and Melbourne, the sites where most Ashkenazi Jews in
the six sites live. It's interesting that only 25 percent of
the New York families asked for genetic counseling and test
results.
However, we do have quite a few carriers. This pedigree
presents one family. Notice the family carries the mutation
6174delT. One tiny component of the BRCA2 gene was deleted,
which led to this family having this mutation. Notice the
patient with the yellow and red lines. She has sadly been
diagnosed with three cancers. So far she's fine, after her
pancreatic cancer has been treated. She has also been
successfully treated for breast and ovarian cancer.
Notice her sister, a mutation carrier also, is free of any
cancer. Her elderly paternal aunt, who is 83 years old, also
has a mutation but no history of cancer. But that aunt's
daughter has a mutation and was diagnosed with ovarian cancer.
Another sister, an elderly woman at the time of diagnosis of
ovarian cancer, is no longer living.
This is a complicated slide, but notice on the left the
boxes with red around them indicate the carriers among the more
than 2,400 Ashkenazi samples tested across the four
participating sites. There were 336 individuals with a
mutation, 46 men, 289 women. Of those, 130 have no cancer. It
is quite amazing. You see, we all know that the risk of cancer
is higher, but it isn't an absolute. Notice in the bottom left,
192 breast and ovarian patients who are among the carriers, 1
male and 191 females. But to the right, 886 breast and ovarian
patients in our registry, 11 men, 875 women. None of these
participants have one of the known Ashkenazi founder mutations.
We have the opportunity with the Registry to do much
environmental research. We can compare Registry families of
similar familial and genetic risks residing in very different
geographic environments. We can study paired relatives who live
apart as adults following shared childhood exposures. My sister
lives in Paris, and sadly she's been diagnosed with breast
cancer. We grew up in Rockville Centre, Long Island not far
from here. I live in Manhattan and another sister lives in
Florida. We don't understand what the factors are that affect
risk in our family.
We can also assess the biomarkers of exposure in the stored
specimens. We have blood, urine and tumor tissue samples that
may provide clues to adverse environmental exposures that may
have occurred many years earlier. As technology advances, we'll
have a better way of understanding the effect of early
exposures that can be measured today.
During our 5 years of renewal, fortunately we will be
continuing until 2005, we will maintain the data base and the
biospecimens we have, collect additional information for any
new studies and assess additional exposures. We'll increase our
minority family participation, expand the number of
participants in each family, and conduct gene-environment
studies, some of which are already underway. We will be
expanding on those studies as new technology permits.
Thank you very much for this opportunity. I'm sure the
Registry of all six sites will continue to contribute greatly
to environmental research.
Senator Clinton. Thank you very much, Dr. Senie, for a very
informative description of the very complicated research you're
doing. I appreciate that.
Ms. Frankel.
STATEMENT OF GAIL FRANKEL, FIELD COORDINATOR AND ADVOCATE, ON
BEHALF OF THE NATIONAL BREAST CANCER COALITION, CENTEREACH, NY
Ms. Frankel. Good morning. My name is Gail Frankel and I am
from Centereach, and Brookhaven, Long Island, NY. I am an 8-
year breast cancer survivor. I am a volunteer with the Adelphi
New York State Breast Cancer Hotline and Support Program.
I am speaking to you today as a proud member of the
National Breast Cancer Coalition. I would like to thank this
committee for holding this hearing, and I would like to thank
Senator Reid, Senator Chafee, along with Representatives Lowey
Myrick, for cosponsoring the Breast Cancer and Environmental
Research Act. Thank you especially to my Senator, Senator
Clinton, for your support of this legislation and your
commitment to this issue. Thank you to all the committee
members for inviting me here to testify today.
As you know, the National Breast Cancer Coalition is a
grass-roots organization dedicated to ending breast cancer
through the power of action and advocacy. The Coalition's main
goals are to increase Federal funding for breast cancer
research and collaborate with the scientific community to
design and implement new models of research, to improve access
to high quality health care and breast cancer clinical trials
for all women, and to expand the influence of breast cancer
advocates in all aspects of the breast cancer decisionmaking
process.
NBCC truly appreciates the fact that you are focusing on
the issue of preventing this disease. We all wonder what causes
breast cancer. I too have questions about what caused my breast
cancer. Diagnosed at 53, I was told that even though my mother
died at age 48 from the disease, my breast cancer was unlikely
to be due to an inherited genetic defect since inherited cancer
usually shows up at an earlier age in offspring. No other high-
risk factors applied to me. Did my diagnosis have something to
do with where I live? The sad truth is nobody knows. There is
no conclusive evidence about what causes this disease.
As a volunteer for the Adelphi New York State Breast Cancer
Hotline and Support Program, and as a breast cancer survivor
myself, I understand all too well the concerns women in New
York have regarding the possible link between the environment
and breast cancer. While it is generally believed that the
environment plays some role in the development of this disease,
the extent of that role is not yet understood. NBCC believes
that now is the time to focus our attention and public
resources on developing an overall strategy to look at all
aspects of this question. We can no longer afford to spend
time, dollars and lives on isolated issues.
It is with that goal in mind that NBCC convened its first
Environmental Summit in September 1998. This summit brought
together more than 50 experts, including scientists, advocates,
government officials, and policymakers to begin developing a
comprehensive strategy for studying the potential links between
breast cancer and the environment. Participants came to this
summit with many diverse perspectives. Some felt strongly that
the environment is to blame for breast cancer. Others thought
the cause is purely genetic. A third group believed that breast
cancer is caused by some combination of the two.
While the participants differed in their perspectives, they
ultimately agreed that the lack of evidence about the
environment and breast cancer highlights the need for further
studies on this issue. Furthermore, the decision of which
questions to research should not be made in a vacuum, rather it
should be made as part of an overall strategy of looking at all
questions, prioritizing them, determining where we have some
answers, and moving forward from that point.
That is exactly what the bipartisan Breast Cancer and
Environmental Research Act is meant to achieve: a
collaborative, coordinated, nationwide effort to address this
issue.
This legislation recommends a responsible approach to the
questions around this issue by authorizing $30 million per year
for 5 years to allow the National Institutes of Environmental
Health Sciences to create grants for the development and
operation of collaborative research centers to study
environmental factors that may be related to the development of
breast cancer. Under a peer reviewed grant-making process,
modeled after the incredibly successful Department of Defense
Breast Cancer Research Program, the NIEHS director could award
grants to public or non-profit entities for the development and
operation of up to eight centers for the purpose of conducting
multidisciplinary research on the links between breast cancer
and the environment.
The legislation would require each center to be a
collaborative effort of various institutions, companies and
community organizations in the geographic areas where the
research is being conducted, and includes consumer advocates.
The enactment of such legislation would bring together a
diverse group of entities, which would be able to take a broad
look at the issue and develop a strategy based on differing
perspectives. Like the support for the Department of Defense
Breast Cancer Research Program, this legislation already has
broad bipartisan support from across the political spectrum.
We recognize that this is a unique approach to looking at
the environment and breast cancer. But time and time again,
scientists, advocates and policymakers have told us that what
is needed is a coordinated, responsible, innovative strategy.
That is exactly what this bill offers. We appreciate that you,
members of the committee, have the courage and vision to
support this innovative approach.
Thank you again for the opportunity to testify today, and I
would be happy to answer any questions.
Senator Clinton. Thank you very much, Ms. Frankel.
Ms. Juchatz.
STATEMENT OF AMY JUCHATZ, HEALTH PROGRAM ANALYST, SUFFOLK
COUNTY DEPARTMENT OF HEALTH SERVICES
Ms. Juchatz. Good morning. My name is Amy Juchatz. I am a
toxicologist with the Suffolk County Department of Health
Services, I'm in the Division of Environmental Quality. I'm
somewhat new to the Suffolk County Department of Health. I
apologize that Dr. Bradley, our commissioner, could not be here
today, but I hope to answer your questions as best I can.
Basically, the role of the Suffolk County Health Department
in evaluating cancer clusters and investigating cancer clusters
and looking into possible environmental factors is primarily
supportive in nature. It is primarily the State Health
Department that actually conducts the investigations, looking
at cancer incidence and whether there is a cancer cluster, and
then our role at the local level is to look at local issues,
help them by conducting site visits, looking through county
historical data, and if warranted, to conduct some
environmental sampling.
A good example of that is the Long Island Breast Cancer
Study. We analyzed, our laboratory analyzed approximately 700
drinking water samples and provided that analysis. We have a
fairly extensive groundwater and drinking water monitoring
program and we can analyze many contaminants, including over
100 pesticides and pesticide degradance, which is a big effort
within our department.
I have also been asked to speak to you a little bit about a
new task force that has been created in Suffolk County. Due to
concerns of local citizens, the Suffolk County legislature
created a rhabdomyosarcoma task force. I have brought with me
my written testimony as well as the legislation and the
resolution to establish that task force.
If you're like I was a few years ago, you may never have
heard of rhabdomyosarcoma. I also brought along a packet of
information here from the American Cancer Society that
describes what it is and tells a little bit about it. But
basically, it's a rare cancer of the soft tissues, and it's
primarily a cancer in children. I think over 90 percent of the
cancer cases of rhabdomyosarcoma are in people less than 20
years of age, and primarily at a younger age.
The resolution outlines various task for our Suffolk County
rhabdomyosarcoma task force. One of the primary ones is to
develop a survey so we can better understand the incidence of
rhabdomyosarcoma in Suffolk County, and as well to investigate
the history, the incidence and possible causes, environmental
factors of rhabdomyosarcoma.
I hope that my brief presentation is helpful, and I would
be glad to answer any questions you may have.
Thank you.
Senator Clinton. Ms. Juchatz, how many children have been
diagnosed with rhabdomyosarcoma?
Ms. Juchatz. It depends on what timeframe you're looking
at. We have on average about two to three cases a year of
rhabdomyosarcoma. There have been some years where there's been
a little spike, and that of five cases. Overall, I think it
really depends on when you start looking at that data.
Senator Clinton. You've got now a task force formed to try
to determine if there are any connections. Are you calling this
a cancer cluster yet?
Ms. Juchatz. Not yet. From the preliminary analysis, it
actually looks like there is not a cancer cluster, but that may
just be that we haven't looked close enough and hard enough.
That's what the task force, along with the State Health
Department, is doing.
Senator Clinton. I thought it was important that we hear
from a local health department, because this is really going to
have to be a concerted effort by local, State and Federal
agencies working together in a way that we never have to track
and report on chronic diseases like cancers. It's going to take
a whole new mind set.
One of the previous witnesses, I think either Dr. Landrigan
or Dr. Todd, pointed out that we have a good system when we're
confronted by infectious disease. We have a reporting and
tracking system, we have good cooperation between local, State
and Federal health departments and agencies. We are only now
focusing on the fact we need to do a comparable job when it
comes to the chronic diseases.
What someone like Ms. Juchatz does on the local level as a
toxicologist is a necessary part of that chain of
responsibility. So I thank you for being here.
I want just to ask Dr. Senie and Dr. Gammon, you're in the
midst of this important study and I thought your slides were
just really helpful, Dr. Senie. Basically, is it fair to say
that in your crafting of the genetic patterns with families,
you are finding that there are some patterns, but there are
also some unanswered questions, why would one sister in a
family which has BRCA1, BRCA2, the kind of genetic marker for
breast cancer, develop the disease, and others wouldn't. Are
you suggesting that there may then be environmental factors in
addition to the genetic factors at work?
Dr. Senie. Yes, I think precisely, in addition to the BRCA1
and BRCA2, we have many more common genetic factors, called
polymorphisms, that I described in the written testimony that
may be playing as important a role, if not more important.
These may interact with BRCA1 and BRCA2 and potentially with
environmental factors. I think we have to face the truth, that
our bodies are very complex. Exposures that we can measure may
be just scratching the surface, maybe there are a lot of things
we haven't even thought about, and maybe some we really can't
measure.
Senator Clinton. Dr. Gammon, would you like to add?
Dr. Gammon. Yes. Dr. Senie's project and my project in a
sense are looking at very similar questions, but addressing
them using different methodologies. By using the population
base study like I'm doing, we take a sample of people, you're
not selecting them thinking that they're going to have a
genetic basis. Because although we believe that cancer is
basically a defect of the genes, there are many things that
come into play. They can be environmentally induced, they can
just happen sporadically, we don't understand what's going on.
As we know, the BRCA1 and BRCA2 gene actually account for a
very small percentage of breast cancers, it's under 10 percent.
That would be a very high estimate. So we do believe that it's
the smaller genetic polymorphisms, in other words, the
variations in how the genes vary from person to person,
interact with environmental exposures to bring on disease.
So strong components of both Dr. Senie's project and my own
are to look at these interactions between what's happening
genetically and what's happening environmentally. I think
that's probably a very productive route to go, it's just a slow
process.
Senator Clinton. Senator Chafee.
Senator Chafee. Thank you, Senator Clinton, once again.
Dr. Gammon, you mentioned in your study that you benefit
greatly from having experience of working with the activists in
the field. I think that solutions to this insidious disease
have been so elusive, that I think that's very important.
Everybody that's been affected thus might have become an
activist and highly motivated to find solutions and working
with the scientists, I think is going to bear fruit. So I
applaud you for that effort.
Thank you for all the testimony.
Dr. Gammon. Well, thank you. It's really interesting, there
is a survey done out of Harvard where they showed that over
half of the American public thinks that cancer, particularly
breast cancer, is caused by environmental agents. Yet only a
very small fraction of scientists believe that. So I think that
without the interest of the activists, it would be slow going.
People in the previous panel had stressed that
environmental research, especially with regard to breast
cancer, has not gotten much focus, and I think that's true. The
effort of the Long Island Breast Cancer Study in general, all
of the projects together, have been a major thrust in that
area. So without the activists, I think we would be much
further behind than we are now.
Senator Clinton. I agree with that. I think the activists
on breast cancer have changed our health care system for the
better. Now we owe it to all of the survivors and everyone who
is no longer with us to really do the work on the environmental
connections that Ms. Frankel and others have spoken about.
Congressman King.
Mr. King. Thank you, Senator Clinton.
I'd like to followup on this issue of the environment and
issues that go beyond genetics or heredity. I know that
personalized statements are not very scientific, I know
anecdotal evidence is not very scientific. Just in my own case,
I had grandparents that lived into their late 90's. I had aunts
and uncles, 70's, 80's, 90's, there was not one incidence of
cancer in our family. Yet my father and his two brothers died
of cancer in their early 60's, my mother is a breast cancer
survivor, I have a niece who has a problem with cancer.
Having said all of that, I've spoken with any number of
other families who have similar instances where there was no
prior history of cancer whatsoever, and starting maybe with the
people who were born in the mid-teens, early 1920's, it seems
that that generation has a disproportionate number of cancers
compared with the previous generations. It's not just that
they're living longer, it's not that they're being better
tested.
It seems as the generations become more advanced, there's
more incidence of breast cancer, prostate cancer, childhood
cancers, rarer forms of cancer that haven't been heard of
before. With all of the scientific testing that's being done on
the breast cancer study on Long Island, and I'm certainly not
trying to prejudge, I know all the work that's gone into it.
But I would certainly hope that we could find it. Whether
it's disciplinary findings or grants research, cross-checking,
whatever, there has to be some environmental factor. There has
to be something, whether it's the food, the chemicals, the air,
the radiation, any number of factors--something has changed.
It's not just people living longer.
I ask if any of you can give us some concept about what you
think this might be leading to or what you think might be
there.
Dr. Gammon. Let me clarify my statement about the
interaction between genes and the environment, and maybe I
could do a better job of explaining what I meant. My apologies.
Mr. King. No need to apologize.
Dr. Gammon. I think that as Dr. Landrigan pointed out,
people's genetic makeups have not changed in that short period
of time, that's impossible. But that certain people have a
certain genetic makeup that may make them more susceptible. If
the environmental exposure isn't there, then it doesn't matter
if they're susceptible or not.
So I think all along, there's been variation on how people
are susceptible to cancer or not. But if the exposure is not
there, they're not going to get it. That's what I mean by
interaction, both agents have to, both the environmental
component has to be there and both the genetic component has to
be there. Studying of the environmental components happens to
be very, very difficult. It's extremely challenging. We don't
have the technology in a lot of ways to be able to measure in
people's bodies a lot of the exposures. We're concerned about
long-term exposures. So we may have the capability of
determining what you were exposed to yesterday, but we believe
cancer takes 10 or 20 years to develop. So we don't have a good
way a lot of times to measure what happened 10 or 20 years ago.
You're going to hear later testimony from the National
Cancer Institute that one of the components of the Long Island
Breast Cancer Study Project is a GIS mapping of historical
exposures. We're hoping that by having this map, we'll be able
to geographically recreate historically what a specific person
were exposed to, and try to link that to their cancer burden.
So part of the problem is that we're strapped by limits of
technology, and as Dr. Senie said, as new technology develops,
by having these banks of specimens and studies ready to go, we
can capitalize on these new developments.
So that's what I think both studies are trying to do, is
being able to draw on the new technologies developed. The GIS
system, no one has done the kind of extensive work that the
National Cancer Institute is now taking the lead on doing,
specifically for the Long Island Breast Cancer Study.
Senator Clinton. Dr. Senie, do you want to add anything to
Congressman King's question?
Dr. Senie. Yes, I think we focus a lot of our discussion on
the external environment. We have to also think about changes
in some of our own behaviors. Some of the medications we use,
maybe even the natural ones we really don't know how many of
these agents affect our bodies over the long haul. Some studies
that have been reported may need to be redone each time a
medication, for example, oral contraceptives, or hormone
replacement therapy, are modified. These are constantly going
through evolution. Every time they change the formulas, the
drug may have a different effect on an individual woman. That
is one of the problems. The genetic polymorphisms, that I
mentioned earlier, may affect how our bodies use estrogen.
So for some women, the pill may have no adverse effect but
for other women who carry a particular polymorphism, the pill
may be harmful. This kind of association is now being studied
in the registry of families. We even think pregnancy may have
positive or negative effects on a woman's body.
Mr. King. Thank you, Senator.
Senator Clinton. Thank you very much.
Congressman Grucci.
Mr. Grucci. Thank you, Senator.
Senator, I do have with me also a study and a report,
testimony actually from Dr. Elinor Schoenfeld, from Stony Brook
University, that I would like to make part of this testimony
being done here today. As we all know, Stony Brook University,
in cooperation with Acadia National Laboratory is doing some
great research work on cancer and breast cancer detection. So I
think this report can be very helpful to us all in dealing with
this terrible disease.
Ms. Frankel, I'd just like to ask you a question. Coming
from Brookhaven, and as you probably remember, I was a
supervisor there not too long ago, and we conducted a breast
cancer study. I wasn't encouraged by the response that we got
back, less than 40 percent of the surveys that were sent out,
and I was told that we needed to have about 60 percent for it
to have any kind of statistical reality to it.
I was just wondering how we in Washington might be able to
help you all in getting the information so we could have the
information, then open up to getting that out to the people. Is
there any suggestion you have to help us do the job better?
Ms. Frankel. That's a tough question. Mainly because a lot
of people are very private, and they don't want anybody to know
anything about them or about their health. With the problem of
privacy not being ensured, I don't know if you would get a lot
of help.
I did get your questionnaire and I sent it back
immediately. I was actually thrilled to have gotten it, because
I said, here's a man who's going to do something about breast
cancer on Long Island. I didn't know why, you have just
explained why it died away. But I think we have to ensure
people's medical privacy if we want them to divulge it.
Mr. Grucci. Then you probably remember from the survey that
it was indeed drawn up by a medical professional and we tried
to incorporate all those privacies into it. But this is a very
significant issue, and we all really need to be prepared to do
all that we can to make it happen, happen meaning finding a
cure for this dreaded disease.
I was a cosponsor of the environmental legislation that's
being talked about here today. I think it's important that we
try to find that link. I guess anyone on the panel might, if
they could answer this question for me. When we speak in terms
of the environment, what areas are we focusing on? Are we
focusing on just groundwater, are we looking at groundwater and
air, are we looking at the origins where people would come
from? What is the definition of environment in terms of these
types of studies?
Dr. Gammon. I think scientists define the word environment
maybe more broadly than the public does. So that would include
the groundwater, it would include air pollution, all those
things that I think the public views as their environment.
But we also include things like dietary intake, medications
you may have used, occupational exposures. So for instance, we
did a migration study, and the migration studies have clearly
shown that when women migrate from a low incidence area like
Japan, where breast cancer is not very common, and the migrate
to the United States to a high incidence area like Los Angeles,
that their incidence rates quickly, within a couple of
generations, approach that that's going on with Caucasian women
in the United States, indicating that it's not genes, it has to
be environment, either environment as Dr. Senie alluded to,
changes in their diet, or changes in their environmental
exposures. It's probably both.
So that's to answer that question. I would also like to
take the opportunity to comment on your comment, on several
things that you said about confidentiality. As an
epidemiologist, we're torn between the two worlds of wanting to
have as much information as we can to be able to conduct our
scientific studies, with as much heredity and accuracy as we
can, and we also appreciate the patient confidentiality. So a
lot of the laws that are getting passed or are being considered
leave very restrictive and make it very difficult for
epidemiologist to conduct research on the environment and
cancer.
So there's two different things going on in Congress. One
is that trying to protect patients' rights, which is a very
laudable goal, but it also hems, the way some of them are
written, it would make it very difficult to conduct the kinds
of studies that we are conducting right now.
The other issue is wanting to figure out what causes
cancer, and is it the environment. For that we will need
registries. Registries record things a lot of people would
consider invasions. So those two issues need to be brought
together and resolved, both patients' rights taken into
consideration and also the public's right to figure out what's
causing cancer. So I wanted to comment on that.
I do want to thank you for bringing up the study from Stony
Brook, because they are collaborating and they have a project
as part of the Long Island Breast Cancer Study Project where
they're looking at electromagnetic fields. The women to be
interviewed in our study, they went back to their homes and
they took electromagnetic field measurements. So this group of
women has been incredibly, this is a group of women who's
proven that they are interested and want to know what's going
on, whether the environment is contributing to breast cancer.
Senator Clinton. By electromagnetic studies, you're talking
about power lines?
Dr. Gammon. Yes, exactly.
Senator Clinton. Congressman Israel.
Mr. Israel. Thank you. I'll just make a quick comment about
the Federal role and then a question. With respect to mapping
and registries, it seems to me that if the Federal Government
has found a way to return a $300 or $600 tax rebate check to
every single income tax filer in America this fall, they can
also find a way to make sure that the broadest number of
Americans receives these kinds of surveys, and also the
research that we're doing. Where there is a will, there is a
way.
One of the running themes that's sweeping through both
panels is that this challenge is so broad, and different
organizations, research centers, scientists, are addressing it
in so many different ways, breast cancer advocacy groups at
Brook Haven, Huntington have done local geographic mapping. Dr.
Gammon has conducted and is conducting her research as part of
the Long Island Breast Cancer Study. The Suffolk County
Department of Health Services is doing its site visits and
analyzing historic data.
I think it really points to the need to pass the Breast
Cancer Environmental Research Act to create centers of
excellence, and no region that I can think of is better poised
for such a center than Long Island. We have SUNY Stony Brook,
we have Cold Spring Harbor Laboratories, we have Adelphi, we
have one of the strongest bases of biotechnology businesses in
America. There is that unique convergence that would really
benefit by these centers of excellence.
But an indispensable partner in all this is the Federal
Government. My question to all the panelists is, are we doing
enough? In 1991, we budgeted a total of $133 million for
biomedical research into breast cancer. This year we're
budgeting about $524 million. It sounds like a lot of money.
The question, pure and simple, is, is it enough, can we do
better in terms of Federal investments into biomedical research
for breast cancer?
Senator Clinton. Dr. Gammon, do you want to start?
Dr. Gammon. It does sound like a lot of money. But research
takes a lot of money. I think one of the issues that we need to
address, biomedical is a broad area. We're addressing things
like health care, treatment, trying to find the cure. We're
talking about today more about trying to figure out what causes
cancer. That kind of research just doesn't get the big fanfare
that a lot of times the treatment studies do.
So I think that research costs a lot of money and it's very
labor intensive. So yes, I think having more money is helpful.
It costs a lot of money to do the Long Island study.
Interdisciplinary research, research on a large scale, which
gives it a greater validity, costs a lot of money.
Senator Clinton. Dr. Senie.
Dr. Senie. Truthfully, there needs to be some capped costs.
We can't put all of our money into breast cancer, and yet
obviously, many of us here are wishing that we had more to
spend. I have to say that when you get into more complex
studies such as ours, especially when genetics are involved,
just to study BRCA1 and BRCA2 costs $1,200 under a special NCI-
NIH arrangement with Mariann Genetics, per sample.
You take a family like the one I showed you, we could have
chosen the wrong person to test, and we'd have a negative
family. Just think of that, per family we get $1,200. I'm
really torn about how to decide who in those 1,500 families to
test. We will have somebody for genetic testing, but to do gene
environment, you still have to know who are the carriers.
Then to look for the polymorphisms, they cost a lot less,
but maybe about $200 per polymorphism. There are hundreds of
them. Probably, we'll never figure out all of it. So it's a
very complex area.
Senator Clinton. Gail?
Ms. Frankel. Yes, of course we could always use more money.
But I think under the circumstances, we have to use what money
we can wisely. That's why we think the NIEHS will do such a
great job, $30 million a year is not a lot in the scheme of
things, and it would be used wisely. In fact, going back to
Representative Grucci's question about what constitutes the
environment; his question is set up in the bill we're
supporting. The plan is to start with what questions to ask, so
we don't go all over the place and just throw the money away.
Senator Clinton. Ms. Juchatz.
Ms. Juchatz. I'd like to reiterate again, we can always use
more money. There's more things that we can do. But again, I
think it is important that you look at it wisely and in a
larger scheme and make sure we're refunneling it at the
appropriate place.
But one thing to mention in terms of environmental factors,
when we go in and take a sample of groundwater or soil or even
a blood sample, we're kind of looking at a snapshot in time. As
was mentioned, we're looking at cancer maybe taking 10, 20
years to develop with that latency period. So the question we
really want to answer is what were they exposed to 10 or 20
years ago. That's a hard one, really, to get at.
I think maybe something that may develop in later time is
more a perspective study when we start looking at people
without breast cancer and looking at their environment and
following them through and seeing who develops breast cancer
and if there is some correlation then between environment. But
it's a difficult thing to grab hold of.
Senator Clinton. I want to thank this panel. It's been so
helpful. One of the real issues that you've raised is how to
direct scarce dollars toward different kinds of research. We
have been very generous in funding the National Institutes of
Health, NCI and other related agencies. But we haven't gotten
enough dollars going into this kind of research. So we need to
take a hard look at what we're doing and how better to direct
the other research dollars we do spend.
I thank this panel, and now I'd like to introduce our third
panel, which consists of representatives from a number of our
Federal agencies. They are on the front lines and they also
have specific ideas that go directly to Congressman Israel's
question about, what we could do to better direct our dollars.
How can we make this the national priority that it needs to be?
One of the arguments that's being made now is that in addition
to directing money at specific diseases like breast cancer, we
need to put more money into general, basic scientific research
and medical research. If you have a preordained idea about what
you're looking for, you might miss some very good leads that
come from more general scientific research.
So I think there are lots of issues about what we need to
be doing here, and this final panel has, I think a lot of at
least potential answers for us. I'm very grateful that all of
you could be here. Some of you have traveled from long
distances. I understand Dr. Jackson, who will be our first
witness, changed his travel plans because he cares so much
about this issue and what we should be doing as a Nation.
Our first witness will be Dr. Dick Jackson, director of the
National Center for Environmental Health at the Centers for
Disease Control and Prevention. He will be followed by Dr.
Deborah Winn, acting associate director of the Division of
Genetics and Epidemiology at the National Cancer Institute.
Then we will hear from Dr. Sam Wilson, deputy director of the
National Institute of Environmental Health Sciences, and he
will be followed by Dr. Lynn Goldman from the Bloomberg School
of Public Health at Johns Hopkins University, who is part of a
very important study done by the Pew Charitable Trusts about
tracking chronic diseases.
Each of the panelists who appears on this third panel has
devoted many years to public service and have taken some of the
toughest jobs in our Government, trying to keep us healthy,
trying to send up the warning signals when we weren't doing
what we should be doing, grappling with very difficult issues.
I personally want to thank each of you for your public service
and for being part of our national public health system, which
deserves more attention and more resources because of the job
that it does.
So with that, let me call on first Dr. Jackson.
STATEMENT OF RICHARD J. JACKSON, M.D., M.P.H., DIRECTOR,
NATIONAL CENTER FOR ENVIRONMENTAL HEALTH, CENTERS FOR DISEASE
CONTROL AND PREVENTION, DEPARTMENT OF HEALTH AND HUMAN SERVICES
Dr. Jackson. Good morning, Senator, good morning, members
of the committee. Thank you for inviting CDC to testify at this
important field hearing.
I'm joined in the audience by Dr. Marian Mandel, from the
Division of Cancer Prevention and Control at CDC. If there are
specific questions about the registries, I would ask for her to
be able to join me at that time.
I will submit my full testimony for the record and just
highlight comments that need to be added here.
The critical message that I want to convey here is that
looking at cancer cluster risks in isolation from disease
tracking and from environmental tracking will ultimately fail.
It has to be a seamless system where this is all connected
together.
Up until now, in many ways, we've had almost a chasm
between the world of environmental tracking, and the world of
disease tracking, between what is going on in the environment,
what is actually going on in the environmental regulatory world
of engineering and toxicology testing, and what is going on in
the medical world. Studying environmental health hazards is
very hard. I've done many of these field investigations, you go
into communities that are very upset, rightfully so; they're
very concerned and there's a lot of media presence. You're
trying to answer questions about something that happened 5, 10,
15, 20 years before in terms of people's exposures.
A sister agency to NCEH, NIOSH, the National Institute of
Occupational Safety and Health, have an advantage in the sense
that they go into a workplace where there might be records of
what people were exposed to, and they can find out who worked
in that particular setting. When we go into an environmental
investigation, oftentimes we're really trusting people's
memories, there's very poor record keeping of what goes on.
Oftentimes, people are suspicious of telling the Government
where they were or what they were exposed to or what they did.
So these are very difficult investigations, but we've
brought some new tools to it. I will touch on those as I go
along.
One thing that's very hard to explain to the public as one
gets into disease cluster investigations is that almost 90
percent of the time when you go into a cluster, it really is
not a cluster. Cancer is a common disease, about one and a
quarter million people develop non-skin cancer every year,
about a half million die of it. So when you actually look at
patterns in a population and compare it to the cluster you're
looking at, the cluster kind of disappears.
For those clusters that are investigated and where we do
identify a statistical increase, most of the time we still
don't find an environmental cause. But that's interesting and
in contrast to what the public believes. We human beings
understand that when we see something, it's an effect of
something around us. I'm convinced that in the public's mind,
disease clusters are environmental until proven otherwise.
Simply waving your hands and saying, ``oh, well, it will never
pan out,'' is completely unsatisfying to members of the public.
But also if you go into a disease cluster or cancer cluster
investigation, you need to start the environmental
investigation at the same time, and not wait months or even
years to start the environmental investigation. That isn't to
say clusters are all environmental, it is to say that
environmental concerns are always a part of the community's
concern. You have to deal with that concern and try to give
answers to questions.
Now, the problem is that most State health agencies are
very weak when it comes to environmental epidemiology. Senator,
as you mentioned, the commitment I had today was to go to the
State epidemiologists' meeting, and I will be going to that
after this. State epidemiologist have voted in repeated
resolutions about their need to have serious epidemiologic
capacity in environmental health. It's great to have collected
environmental data, it is great to have collected cancer data.
But you've got to have someone smart, who can answer a
question, who can speak in a language that human beings can
understand, who is able to be that ``intake'' person. I was
very impressed and have been very impressed with Dr. Todd of
Nevada, that he's been able to stand these two very difficult
roles very well. But these are not easy issues.
I would say that in the last five meetings, I've gone to
the State epidemiologists, they have roundly pressured me and
criticized CDC for not providing a training program, a pipeline
for State epidemiologists, people who can understand both of
these roles and speak the language of both sides. I think we at
CDC owe it to the States to help them provide this.
We need different elements to deal with the environmental
elements of the clusters. We've got to be able to track what's
going on in the environment. I would assert that EPA has done a
very good job of figuring out what's in the air, what's in the
water and what's in the food. We know pretty well what's in the
environment. We have been much weaker at knowing what's in
human beings.
This is the report that CDC came out with in March; it is
our down payment on a review of 100 different chemicals
residing in the bodies of the American people. Every year CDC
goes out and we test, actually put our hands on, 5,000 people,
draw blood, urine and other specimens from them. This report
from the 5,000 people we sampled in 1999 documents body burden
levels of 27 chemicals in the American people. It documents a
75 percent reduction in tobacco byproducts in non-smokers.
Senator Clinton. That's good news.
Dr. Jackson. It's very good news. In fact, having good
data, real data on the population, will point us to some
situations that are good news. In other situations, it's going
to point where we need to put more strength. For example, we
found higher levels of certain plasticizing agents, called
phthalates, in women of reproductive age, higher levels than
one would have predicted in advance of doing this study.
The second use of having this biologic data is that
researchers, such as the individuals you just heard speak in
the earlier panel, need to have background levels of what's in
the population. Not to say that these chemicals are normal, but
a community wants to know, are we different from any other
community in America? You've got to have those levels on the
overall population if you want to answer that question.
The third element is disease tracking capacity, such as
cancer registries, birth defect registries. There again, you
have to speed their getting in place. There are other disease
registries around neurological diseases that I think the public
is very interested and concerned in. I know we public health
researchers are as well.
I think my closing comment is that I hope that whatever is
done to address this issue of clusters, that it not be
stovepiped, that there be an effort to connect these various
elements together in a rational, useful way. It really makes a
difference in people's lives when the local health departments
work, they're the ones that were there in the cluster area long
before it occurred, they're going to be around long after it
occurred. The same is true with State health departments. Let's
build that infrastructure, let's make those people more
competent to deal with these problems.
I think that's the message I would like to leave with you
today, and thank you for inviting me.
Senator Clinton. Thank you very much, Dr. Jackson. I really
appreciate, while we're waiting for the screen to come down,
Dr. Jackson's pointing out the CDC biomonitoring study. Do you
have any extra copies of that, Dr. Jackson? I think we want to
be sure we get copies to at least all the members of the panel,
so that they can see the work that is being done, to know what
our internal environment looks like.
Dr. Jackson. Yes, Senator, we'll get them.
STATEMENT OF DEBORAH WINN, Ph.D., ACTING ASSOCIATE DIRECTOR,
EPIDEMIOLOGY AND GENETICS RESEARCH PROGRAM, DIVISION OF CANCER
CONTROL AND POPULATION SCIENCES, NATIONAL CANCER INSTITUTE,
NATIONAL INSTITUTES OF HEALTH, DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Dr. Winn. I want to thank you for inviting me today and for
giving me an opportunity to talk to you about NCI research on
cancer, genes and the environment.
Today, I will cover NCI's approach to cancer surveillance,
the Long Island Geographic Information System Project, and
NCI's strategic plan for research investment in genes and the
environment. Many chemical, physical and biological agents in
the environment, such as ultraviolet radiation, toxic
substances, and viruses, have the potential to increase the
risk of cancer. However, the scientific community, as you heard
earlier, usually thinks of the environment as having a much
broader scope.
It includes, to us, not only the physical, chemical and
biological environment, but also lifestyle behaviors,
medications and occupation. People are often exposed to many
factors simultaneously, or may be exposed to some carcinogens
in many forms. For example, exposures to the carcinogen
benzo(a)pyrene may come from air, tobacco, diet and occupation.
Geographic patterns of cancer occurrence may provide
important clues to the environmental causes of cancer. NCI has
two programs to help identify geographic areas of high cancer
risk. The Surveillance, Epidemiology, and End Results Program
provides a picture of cancer incidence, mortality and survival
in 13 States and major metropolitan areas. The NCI's Atlas of
Cancer Mortality, which you see here, contains maps, text,
tables and figures showing the geographic patterns of cancer
death rates throughout the United States from 1950 to 1994, for
more than 40 cancers.
The NCI has used the atlases to generate leads for in-depth
epidemiologic studies that have in the past shed light on
factors contributing to cancer risks. We expect to develop new
leads from the most recent cancer maps.
Here the slide from the atlas shows mortality rates from
1970 to 1994 by State economic area for cancer of the breast.
The deepest red areas are those with rates in the top 10
percent of U.S. rates. The maps show very clearly the high
breast cancer death rates among white women in the northeastern
United States. The pattern is not the same for black women.
Dr. Winn. To understand the reasons behind these high
breast cancer rates, the Long Island Breast Cancer Study
Project was initiated. The Long Island Breast Cancer Study
Project consists of more than 10 studies of breast cancer,
including human population studies, the establishment of a
family breast and ovarian cancer registry, and laboratory
research. Earlier you heard from Dr. Senie and Dr. Gammon.
The project also includes the Long Island Geographic
Information System (GIS-H). Geographic information systems are
powerful computer systems for mapping and analyzing
relationships over time and space between multiple layers of
data. The Long Island GIS-H will include more than 80 data sets
containing information on a wide range of environmental and
health data for Suffolk and Nassau counties integrated into a
single system. It will have researchers' tool boxes, with the
software and statistical tools needed to analyze the data, and
a web site including a mapping facility. The public mapping
facility will be available early in 2002, if not before.
The system includes data on contaminated drinking water,
hazardous municipal waste, electromagnetic fields, pesticides
and other toxic chemicals, and indoor ambient air pollution.
The Long Island Geographic Information System will provide
researchers a new tool to investigate relationships between
breast cancer and the environment in Suffolk and Nassau
counties, and to estimate exposures to environmental
contaminants. The public will be able to use the web sites to
examine patterns of environmental exposures and breast cancer.
There is often a tendency in cancer research to focus on
genes and cancer or the environment and cancer, but we're
learning it's more complicated than that. Some cancers are
associated with defects in one or a few genes. However, most
cancers involve many genes. Individuals may inherit defects in
these genes, or they may experience environmental exposures or
other circumstances that cause gene mutations, which are
changes in gene structure. If alterations occur in genes that
control such functions as metabolism of carcinogens, DNA
repair, or metabolism of nutrients, then cellular processes may
become abnormal.
Even among individuals who have inherited cancer disposing
genes, like the BRCA1 gene, the risk of developing cancers
appears to be modified by genetic and environmental factors. So
the interaction is important.
It then becomes important to understand the relevance of
these complex interactions to people. Can we predict an exposed
person's risk? What is the impact of predictive testing and
cancer risk assessment on individuals and their families?
Opportunities now exist to determine how variations in
genes combine with environmental and other factors to induce
cancer in the general population. NCI has developed a strategic
plan to discover the genetic and environmental and lifestyle
factors and their interactions that define cancer risk, and
develop new strategies for early detection and treatment.
Finally, the objectives of this initiative on genes and the
environment are to identify new environmental risk factors and
susceptibility to genes and determine their interactions in
cancer causation, refine cancer risk models, and to develop
other tools to conduct studies to address clinical and
behavioral and societal impacts, such as whether women who
inherit the BRCA1 gene should take hormone replacement therapy.
By marrying the study of the distribution and the
environmental causes of cancer, and cutting edge genetic and
related molecular technologies, we should be able to design new
approaches to preventing cancer. Thank you.
Senator Clinton. Thank you very much, Dr. Winn.
Dr. Wilson.
STATEMENT OF SAMUEL H. WILSON, M.D., DEPUTY DIRECTOR, NATIONAL
INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES
Dr. Wilson. Thank you for inviting me to discus the
influence of environment on human health. The goals of
environmental health and environmental health research are
establishing and maintaining a healthy, livable environment for
humans and other species, and promoting an environment that
improves well-being in all aspects of mental and physical
health. This environment must be sustained into the future, and
be a setting in which population growth and manufacturing and
agriculture can thrive.
We all recognize that many important achievements have
helped create a healthier, cleaner environment. Our past
research strategies have allowed many successes in
understanding mechanisms of environmentally-linked diseases. To
continue making strides in the future, we will need to focus on
the interplay of genes and environment. It is this interplay,
of gene-environment interactions, that holds the greatest
promise in the fight to prevent and control environmentally-
related diseases, including cancer and other chronic diseases.
This is the main point I want to make today, this point
concerning gene-environment interactions. There are two recent
advances in the field of human genetics on one hand and
environmental health on the other that define our future
research strategy. First, we now have the sequence of the human
genome in hand. We are beginning to understand the individual
to individual variations that modify susceptibility to disease.
Second, we are now working with an expanded definition or
view of environmental exposures that includes diet, lifestyle,
socioeconomic factors, and other factors including
environmental pollutants. This expanded view of environmental
factors will allow us to conduct more meaningful studies of
environmental contributions to disease in the future.
The research model of understanding a relatively rare but
strong disease gene or a strong environmental toxicant has
served us very well in the past in defining the molecular
biology of disease and in prevention. However, this model will
not be sufficient to address the more common diseases, since
only a small percentage of disease can be attributed to the
rare dominant disease genes, or to the high level and very
strong toxicants. Instead, new science and a new scientific
tool box will be needed, along with more research involving
common genes that modify an individual's response to
environmental factors.
Fortunately, the genomics era will provide us with this new
tool box. Along with the expanded view of the environmental
factors, the field of environmental health research has an
exciting new opportunity.
I will now very briefly describe some of the work pointing
to the role of the environment in major diseases, and how
understanding gene-environment interactions will improve our
ability to prevent disease. In the past few years, we've seen a
number of studies that illustrate the importance of the
environment. For example, by comparing disease rates in twins,
scientists have managed to tease apart the relative
contributions of environment and genes.
We now know that environment accounts for over 50 percent
of cancer risk, depending on the site of the cancer. Twin
studies of Parkinson's disease reveal that environment accounts
for 85 percent of the risk of the late onset cases of this
disease. For autoimmune diseases, such as MS and Lou Gehrig's
disease, environmental factors account for 60 to 75 percent of
the disease risk.
But the environment, even though it is a major determinant,
is not the only determinant. Two people with the same exposures
and the same environmental history can have a very different
outcome concerning diseases. Differences in susceptibility due
to variations in genes, individual variations in a gene's
coding for proteins that are critical in the body's response to
environmental stress, account for these individual differences.
These proteins include metabolism enzymes, DNA repair enzymes,
as we've heard, signaling molecules, and receptors, among
others. Someone inheriting a gene that produces a weak or
ineffective form of one of these proteins will be more
susceptible than a second person inheriting a gene that makes a
more effective protein. This is because the first person might
be less able to break down or handle a toxicant and/or the
repair of a specific cellular damage will be less efficient.
Thus, understanding the combination of these modifier genes
and the specific environmental exposures is critical in
understanding the causes of disease. Neither factor acts alone,
but it is the two interacting or acting in concert.
In conclusion, I will say that preventing disease is now
the most important service of public health policy. The most
effective way to prevent disease is to understand the cause and
change the conditions that permit it to occur. A key strategy
to prevent many diseases will be to use the knowledge gained
from gene-environment interaction research to estimate
individual risks, and then to use this information to design
approaches for better health and for better treatment.
Finally, we at the NIEHS have been working with a new model
for research that provides for citizen participation. We
believe that citizen participation in research will generate
more relevant findings and will suggest better real world
research questions, and will also serve to enhance
communication for the participants in the entire research
project and for the neighborhoods.
Thank you very much for this opportunity. I'll be happy to
answer questions.
Senator Clinton. Thank you, Dr. Wilson.
Dr. Goldman.
STATEMENT OF LYNN R. GOLDMAN, M.D., M.P.H., PROFESSOR,
ENVIRONMENTAL HEALTH SCIENCES, JOHNS HOPKINS BLOOMBERG SCHOOL
OF PUBLIC HEALTH, BALTIMORE, MD
Dr. Goldman. Senator Clinton, Senator Chafee, and members
of the New York Congressional Delegation, thank you for the
opportunity to provide perspective to this issue today. I'm a
pediatrician and an epidemiologist, and I'm a professor at the
Johns Hopkins University Bloomberg School of Public Health.
Prior to coming to Hopkins, I served in the Clinton
administration as Assistant Administrator at EPA for
Prevention, Pesticides and Toxic Substances. Prior to that, I
was State environmental epidemiologist for the State of
California. In that position, I actually investigated a number
of clusters and helped to write California's first handbook
manual on how to do that.
At Hopkins, I serve as principal investigator for
children's health for the Pew Environmental Health Commission,
which was a blue ribbon independent panel charged with
developing recommendations to improve the Nation's health
defenses against environmental threats. Finally, I am also a
member of the Environmental Defense Board of Trustees.
My perspective is that our public health service is falling
short in terms of its duty to watch over the safety and health
of Americans, and especially when it comes to chronic diseases.
Chronic diseases are responsible for 7 out of 10 deaths in this
country. More than a third of our population, over 100 million
men, women and children suffer from chronic diseases. These
diseases cost our citizens and our Government $325 billion a
year.
By 2020, chronic diseases are estimated to afflict 134
million Americans and cost $1 trillion a year. CDC estimates
that 70 percent are preventable. But our Federal Government is
not actively pursuing means to prevent these diseases.
You heard today from the personal perspective from people
in Elmira, the people who have been involved with the Fallon
and Long Island cancer problems, about the intense personal
suffering, the community suffering that occurs with these
clusters. I've experienced that myself in public health.
As a public health scientist, I'm aware that this is a
problem that is repeated in communities across the country. In
1997, there were almost 1,100 requests by the public to
investigate suspected cancer clusters. Many of these no doubt
were preventable, most of them were not investigated. Even
though we know about the importance of increasing our
investigations of chronic diseases, and the staggering human
and financial toll they have on our country, we do not have the
systems in place to track chronic diseases, nor do we have the
capacity to respond to these health crises.
Our agencies, as you have heard, are doing a great job
tracking and responding to communicable diseases. This is a
model that we know can be an effective model for preventing
disease and encouraging public health.
Why is this the case? I think that part of what has
happened is that we have simply failed to modernize our system
as the health problems have changed over time. As a former
chemical and pesticides regulator, I personally am appalled by
the amount of ignorance that we have about chemicals in our
environment, and our inability to be sure that we're doing the
right thing to prevent chronic diseases.
In 1997, Environmental Defense looked at what we know about
the most common chemicals in commerce, the 2,800 that are
produced at at least a million pounds per year. They found an
enormous amount of ignorance about those chemicals. When I was
at EPA, we looked at them systematically. Only 7 percent had
screening level information about toxicity and 40 percent had
no information at all. We simply knew nothing about them.
There are efforts underway to increase the amount of
information, but we're very much on the upward part of the
curve on this. We also don't know very much about how many of
these chemicals are in our bodies. We think that the work that
CDC is doing to generate that information is a good start, but
the reality is we don't know what's in breast milk, we don't
know what's in the workplace, we don't know what's in the
products that we are using or are that are in our homes, that
are intended for our children.
With the Pew Commission, I wrote a report on birth defects.
In this country, we do have some efforts to track birth
defects. In that we found that 17 States did not track birth
defects at all. Birth defects cause 22 percent of infant
mortality, that's children under the age of a year. The State
of New York does have a system, but it's a system that received
a B on our report card. Why? Because the data are not
comparable with the data that are collected in other States. We
cannot use the data to be able to make comparisons, to be able
to say, these patterns in New York are unusual or not.
We know that 25 percent of developmental diseases, such as
cerebral palsy, autism and mental retardation are caused by
environmental factors, but only a handful of States track
those. Asthma, we have an epidemic of asthma in this country.
Again, we do not see tracking efforts for asthma. In fact,
asthma rates have nearly doubled over the last decade and we
still don't know why.
So the Pew Commission developed a number of recommendations
to try to address the situation. First, though, we need to
build a coordinated system of tracking diseases. We need to
track diseases like asthma, the developmental diseases, the
neurologic diseases, birth defects, cancers, diseases that are
likely to be preventable. We also need to track exposures,
exposures to heavy metals, pesticides, air contaminants, so
that we know what are the chemicals to which people are
actually exposed.
We need to have an early warning system that would alert
communities of health crises such as lead poisonings or mercury
poisonings. Our existing systems can be very slow to identify
outbreaks like the West Nile or food illness outbreaks. We need
to have systems that identify those more rapidly.
Third, we need to improve our response to identify disease
clusters and other health crises. I think you've heard today
about how those efforts need to integrate from the Federal to
State all the way to the local level. One of the
recommendations from the Pew Commission for the tracking
network is about $275 million, less than $1 for every woman,
man and child in the United States.
It's ironic that we have mapped the entire human genome but
yet we do not know what are the environmental agents that can
trigger the gene-environmental interactions that cause disease.
We do have the technology, we have the know-how, we have the
knowledge, but we have not put the same level of effort into
identifying the triggers for disease as we have for identifying
the genetic susceptibilities to disease.
Polling has been done on this issue, 63 percent of the
American public feels that public health spending is more
important than cutting taxes. Seven out of ten registered
voters feel that public health spending is more important than
spending on a national defense missile system. A recent public
opinion poll by Princeton indicates that 9 out of 10 registered
voters support the creation of a national health tracking
system.
We know that the local agencies have faced declining funds,
inadequately trained personnel, outdated laboratories, and we
know that the CDC and ATSDR and NIH have not had the funding to
give the States the guidance that they need, the standards that
they need, the training, even on a very fundamental level, the
laboratory support that they need in order to be able to do
these investigations.
Who is guarding our health? The public health service has
fallen short of its duty, lacking the troops, leadership and
the tracking system. This is exactly where the Federal
Government is needed. The Federal Government is essential to
the success of State and local agencies in being able to
address these problems. Yet, ironically, what we've seen is the
proposed budget recommendations have put forward severe cuts
for the Nation's chronic disease prevention programs.
We need to be going in the opposite direction. We need to
invest in preventing asthma, preventing cancer, preventing
neurological problems in our children. There will be many more
lives lost and much more suffering until we set out to do that.
Thank you again for this opportunity to testify.
Senator Clinton. Well, it won't surprise you that I agree
with her 100 percent.
[Laughter.]
Senator Clinton. I so appreciate the panel's testimony. I
just want to re-emphasize that there are many, many people in
our public health system at all levels who are heroically
struggling against great odds. We are not giving them the tools
that they need to do the job that they want to do and that we
expect them to do.
I think that the Pew Commission's recommendations are so on
target about what we should do. We have a great capacity in our
country to muster resources and set goals and achieve them. We
now, because of the improvements in information technology and
the mapping of the human genome, are at the point where we can
make these investments, as Dr. Goldman and the others have
suggested, and they will really pay off.
We couldn't have done it 10 years ago or 20 years ago. We
really were strongly in the dark to just make sense of a lot of
this. We now have the tools, and if we don't do it, then we
have failed to do what we should do to protect our national
health.
I would like now to call on Senator Chafee.
Senator Chafee. There are four doctors on this panel, and
earlier Dr. Landrigan mentioned, if I recall, that there was
some thought that there might be a virus associated with
cancer. It's the first time I've heard that. What is the
general consensus as we study disease, and the implication of a
virus?
We'll start with Dr. Winn.
Dr. Winn. I believe you are referring to the potential
cluster of leukemia in Nevada. There is a concern that a
possible leukemia causing virus has been introduced there
because it's an area with a lot of people moving in and out. I
think that it will be a real challenge to try and investigate
that theory further. There are epidemiologic methods that we
use to try and model individuals interactions with one another,
so that we might see if there is a potential for an infectious
cause.
Certainly viruses are related to other cancers.
Senator Clinton. Dr. Wilson.
Dr. Wilson. We know very well that virus infection is
related to certain types of cancer, such as liver cancer,
cervical cancer and so on. But the risk of developing cancer
even after the viral infection is also influenced by
environmental exposures. The evidence on this is very clear.
So we do know that viral infection is one of the factors in
cancer etiology.
Senator Clinton. Dr. Jackson.
Dr. Jackson. Earlier speakers suggested looking at people
today and going back 20 years or so ago to see what was in
their blood. A study that was done jointly with the other
agencies here, the laboratory work was very interesting, a low-
level increased risk for non-Hodgkins lymphoma if you had a
certain chemical in your blood, but in fact if you had a
certain herpes virus at the same time, instead of a fourfold
risk, it was about a twentyfold risk.
So I think for many of these it's not going to be genes
alone, it's not going to be environment alone, it's not going
to be a specific chemical or a specific virus, it's probably
all of them together.
Senator Clinton. Congresswoman McCarthy.
Ms. McCarthy. Thank you. Thank you for the testimony. I see
a number of, I hope I'm not the only one sitting here thinking,
``Oh, my God, what a nightmare we have finding legislation to
help all of you.'' It's not just a matter of getting the money.
Let's be realistic about this. We have other forces that will
try to stop us from trying to get the money.
I've seen here in New York State when we've tried to do
something on just notifying the neighbors on pesticides, we had
large corporations fighting us on that. I'm not saying it's the
fault of the chemical companies. But let's be realistic as far
as the politics. That's what we're going to be dealing with
when we go back down to Washington. We are going to have so
many groups after us not to do the research on environmental
issues that we care very much about. That's where the grass
roots across this Nation has to get involved, to have their
voices heard. Because I don't think there is anyone here that
wouldn't like to see more money go into the research that we
need, especially in public health, going between the Federal,
State and local. There's politics involved.
We will do our job. I hope that our committees find the
right answers to help you do your job. But let's not kid
ourselves. We've been talking about this for a number of years,
and we've been stopped at every single turn. So with that, if
any of you had a wish, where would you like to see us go as far
as legislation?
Senator Clinton. Dr. Jackson, do you want to start, please?
Dr. Jackson. I really fear that the infrastructure of
public health, knowing how the system works, it's pretty broken
in the environmental arena. I think the way the funding comes
in, it's so tightly circumscribed around a certain disease
entity or a certain public health concern, that the system is
really not working as well.
If I had one wish, it would be to see that, we're really
looking at a systematic improvement and maybe not one more
disease focus, disease focus, etc.
Senator Clinton. Dr. Winn.
Dr. Winn. We have a critical need for biomarkers studies.
Biomarkers are biochemical or molecular indicators of exposures
or damage to tissues and cells. If we have better biomarkers of
exposure, we might understand the mechanisms by which
environmental agents produce cancer.
We also might have an early warning system so that you
could identify individuals at risk before clinical disease
actually occurs. So I think in that arena, biomarkers are very
useful because we can't always undertake very large studies
that go on for many, many years. We need indicators that give
us answers much sooner.
Senator Clinton. Dr. Wilson.
Dr. Wilson. I would answer that by following up on a point
that Senator Clinton made earlier. That is that we need
information, we need to get the information. That circumstance
will allow us to implement the kinds of public health changes
that we're all thinking about. So this topic of getting the
information is the most important topic. As I said during my
comments, I think we have a unique new opportunity at this
point in time, given the new technologies and the Human Genome
Project, given the new information technology resources, and
given the increased enthusiasm and focus on gene-environment
interaction and environmental health.
So I believe it's a unique point in this field and in the
area of public health, where we can truly get the information,
since for the first time we know enough to know what to do.
That wasn't the case, as you said, earlier, 10 years ago.
Senator Clinton. Dr. Goldman.
Dr. Goldman. If I had to just ask for one thing, because
there are so many things that need to be done, it would be for
a bold stroke, and that would be the nationwide health tracking
system. I think that is an effort that could receive broad
public support. When Pew went around for support for the
recommendations, we received a core of support from public
health scientists and environmental health scientists and all
the usual suspects, who realized how frayed the fabric of
public health really is in this country.
But also we had support from medical groups, like the
American Academy of Pediatrics, we had support from managed
care organizations, we even had support from the American
Chemistry Council, the industry organization. So I think that
you could perhaps construct a broader tent around the public
health agenda that could help in the future in terms of
generating information, very specific information that might be
needed for all those other things.
Senator Clinton. In fact, if you look up there on the
easel, that's one of the ads that Health Track is running,
which shows that this is a national problem. I think, Carolyn,
we could put together a very strong argument to bring together
a political coalition that not only crosses party lines but
geographic lines, industry lines and that sort of thing, we
should try to do.
Congressman Ackerman.
Mr. Ackerman. Thank you very much, Senator. Thank you
especially for everything that you've done, for finding Dr.
Goldman for us. Thank you for putting her on last. I wish she
was on a little earlier, you would have saved my blood pressure
from going through the roof.
I am so frustrated, and I'm frustrated because of the lack
of outrage that we have today at this hearing. I don't know
why, but for some reason, I think that the medical community,
the scientific community, should be banging their fists and
pounding the table and making demands on us, rather than some
of the things I've heard here today. Everybody I know is very
well educated and very, very polite. I heard thank you for the
$30 million to do this, and you're very generous, and we know
that we have to accept political realities.
Nonsense. We make the political realities up here. We
should be changing the political realities. Dr. Goldman talks
about $275 million to do a nationwide tracking system that was
suggested by the Pew Foundation. Wouldn't that be marvelous?
Two hundred seventy-five thousand dollars, what is that? I'm as
strong on national defense as anybody else, but we spent a
billion dollars a copy for a B1 bomber, and how many blew up
when we were trying to make them? That's billion dollars, not
million, billion.
Star Wars we're talking about now, trillions of dollars.
Half of the scientific community says it's not going to work
anyway, but we have to protect ourselves. Listen, more people
died of cancer in the last 4 years than in World War I, World
War II, the Korean War and the Vietnam War all together. I know
that people are worried, but I know more people who have died
this year of cancer than people who have died from a bomb
falling on their head. Not that we shouldn't be concerned about
both, but we have to get our priorities straightened out, and
we're not doing that in our society.
I wish the scientific community had the same kind of table
pounding initiatives that some of the women, especially that
are here today, have done in my office making their demands. I
heard from the scientific community today, it's a remarkable
change from the hearing we had 8 years ago. Eight years ago,
the Director of the National Institutes of Health said, ``well,
yes,'' to Senator D'Amato, when he testified at our hearing, we
should be taking a look at the environment and basically it was
what we would call in my scientific community pooh-poohed the
whole notion.
After Senator D'Amato left, and 90 percent of the press
corps with him, at the insistence of some of the advocates, I
said, ``Well, how much money are you going to put into this to
take a look at this problem?'' He said, ``We don't have any
money for it.'' Then we reconvened, if people here remember, we
reconvened that meeting very quickly in Washington and
basically read people the riot act, which resulted in almost
everybody saying, ``well,'' nobody said, ``There's no
connection.'' I think Dr. Jackson came as close to it, by
saying that we really have to take another look, and the public
is misinformed when they come to these very quick conclusions.
Nonetheless, I think everybody, yourself included, Dr.
Jackson, I give you a lot of credit for that, and Dr. Wilson
especially, that there has to be a coalition between the
scientific community, the academic community and the people out
there. My mother used to, God rest her soul, she used to have a
great expression, she'd say, ``If you want to help me, help me
my way.'' We have to really help the people who instinctively
know this issue and have called it to our attention. If the
scientific community had the same kind of spirit that the
advocates have shown, I think we would have gone a lot further
than we have come at this moment.
One of the things that I heard earlier from the director of
the Long Island study, and I think it was terrific, because
``we've come a long way, baby,'' as they said in the
commercial, the fact that just to get the community advocates
involved with the scientific community in doing the project so
they would have input was a huge fight. It was acknowledged
here today that that is important by so many of the people who
have just recently spoken, on this particular panel. There
should be legislation that require any kind of project that
proceeds, that the advocacy groups participate in some fashion.
I guess that was a pretty long question. So if anybody
wants to respond, you have 30 seconds.
Senator Clinton. Dr. Goldman.
Dr. Goldman. Well, I obviously agree with what he said. I
think in particular your last comment about involving the
community is so important. In my experience, the community
sometimes has very high hopes for what science can do for them
and what scientists can find in doing these investigations.
They need to be engaged from the very beginning so that their
expectations are absolutely tuned with what can be done, but
also so that they understand exactly what is being dedicated to
look at the problem.
Sometimes communities are absolutely, as you pointed out,
they're absolutely outraged when they find out the numbers of
burdens that are on these agencies and the amount of
prioritization that has to be done, so that something that
perhaps deserves a comprehensive investigation gets a few weeks
of somebody's time, which is an absolute outrage, and you're
correct about that.
Senator Clinton. Congressman King.
Mr. King. Thank you, Senator Clinton. I'd also like to
thank the panel. Really the clear inference of the testimony
today, certainly this panel, is the interaction between genes
and environmental factors, looking as Dr. Winn said, for
biomarkers, early warning signs. It seems to me then what we're
talking about somewhere in the future is that almost the
ordinary annual checkup would be a system of cross tabs. We
just wouldn't be looking for one thing, we'd be almost seeing
what a person's experience has been, what the genetic factors
are, and it would be much more complicated than it is today.
Now, are we talking about seeing that in our lifetimes? Is
that around the corner? Is that within our grasp or are we
still basically talking about individual advancements that
hopefully will come together some time in the future? Can you
put any time on it?
Also before you get to that, in answer to my good friend
Gary, I think that national defense is very important, our
defense budget is less than it was percentage wise before Pearl
Harbor. Obviously, we have to do more. I would support any
increased funding for environmental factors and others. But
part of what we get paid for in Congress is to walk and chew
gum at the same time. I think we can deal with national defense
and hopefully advance health policy.
Since I talk after Gary, I figured I'd take a shot at him,
because he can't get back at me.
[Laughter.]
Mr. King. In all seriousness, I go back to, what sort of
timeframe are we talking about? Is there one as to when this
can be brought together in a cohesive fashion, to bring it
together where it actually is going to impact the ordinary
person to give the early warning signs?
Senator Clinton. Dr. Jackson.
Dr. Jackson. Representative King, I was the lead person
under the President's Executive Order on Children's Health and
the environment. One of the reason it's important to focus on
children is not just the reason Dr. Landrigan mentioned, but in
fact, a lot of the issues were grappling with it's going to
take a generation or two to really begin to put these responses
together. First of all, laboratory methods that we're analyzing
not just 27 chemicals, but hundreds of chemicals, literally
counting molecules in that little teaspoon of blood you get
from an individual. That will actually come, but it's going to
be 5, 10 years in the pipeline. We'll add about 25 chemicals a
year.
The computational ability, you've got 40,000 genes, you've
got 100, maybe 200 chemicals. To really do these studies, we
need eventually to do some kind of longitudinal cohort, by that
I mean a Framingham, where one would go forward, look at
environmental chemicals, look at their genes and have the
computer ability to look at thousands, tens of thousands of
people. That kind of research capability twill come.
You don't want to be pushing tests on the public unless you
have an ability to interpret them, whether it's a genetic test
or a chemical test or any other kind. In fact, I worry that
pushing tests on people where you really aren't sure what it
means and you aren't sure you're going to do them some good is
a trap we need to avoid.
Senator Clinton. Dr. Winn.
Dr. Winn. I would agree with Dr. Jackson about what you do
when you have information from tests, and how you communicate
risks to individuals, and what can they do with that
information. It will require a fair bit of research to
understand how to do that and how to do it properly.
I think it's going to be a while before we can, in some
systematic way, link major surveillance systems that look at
cancer morbidity and mortality with surveillance systems that
look at the environment. It's been an incredible challenge to
create the Long Island geographic information system. It's a
huge statistical and informatics effort. It will be important
to try and develop systems like it more easily and develop
systems to do that much better, so that they can be used much
more broadly and provide information much more rapidly.
Senator Clinton. Dr. Wilson, you answered this question,
would you also respond a little bit to what Congressman
Ackerman said about citizen-based participatory research, and
maybe talk a little bit about what you're doing in your lab? I
really do think that the women and the men of Long Island,
particularly the breast cancer activists, created citizen-based
participatory research. All the women in this room and so many
others on Long Island has a major role in changing how we do
medical research. So would you just comment on that?
Dr. Wilson. Let me comment on that first. I think this
change in style of conducting research, if you will, is really
a major step forward in the biomedical research community. In
our experience at our institute at NIH, we have supported for
some time 55 centers of excellence. We have worked to foster
community outreach programs in these centers. All 55 of them
currently have active community outreach programs.
In some of the centers, community groups are actually
participating in the day-to-day conduct of research. The groups
are helping to set priorities on what should be looked at, and
helping in reviewing results and coming up with the models for
publication of results. We're extremely impressed with the way
this program is working and have begun to fund additional
community-based programs to conduct research on their own, so
to speak, without the direct linkage to a university.
This style of research, I think, is one of the most
effective new techniques we have come across in the overall
strategy of the best ways to deal with environmental-health
science research.
Moving on to this question by Representative King, I think
that the trend of individualized risk assessment, so that we
would be able to take our individual risks under consideration
as we make choices about lifestyle and environmental exposures
and so on, is a trend that we're already seeing and we'll see
much more of just in the next 5 years. I agree with Dr. Jackson
and Dr. Winn that it will be some time beyond that time period
before we truly understand this concept of gene-environment
interactions, in order go be able to make more robust use of
it.
But in the next 5 years, we will have this type of
information on individual risk as a function of our individual
gene makeup and our individual exposures that will make a big
difference in how we conduct medicine and also how we make
personal choices about lifestyle.
Senator Clinton. Dr. Goldman.
Dr. Goldman. Yes, first to the issue of the individual risk
assessment, that's an area I think that is around the corner,
as has been said by others. In fact, I think Congress is going
to need to look at it very carefully in terms of making sure
that this is done in a multidisciplinary way, and that the way
the information is communicated to people is understandable to
them and that they actually are encouraged by it to take the
right actions to protect themselves.
I think that there are some real uncertainties about how
this kind of information will actually be used by patients when
it's provided to them. Then again, when we don't know what the
triggers are, if you have information that maybe you have a
genetic susceptibility, but you don't know what triggers it in
the environment, what is that going to mean to you? What is
that going to do in terms of influencing your behavior and how
are you going to them change your lifestyle? Maybe people will
throw up their hands and say, ``I don't know what to do about
it, since you're not telling me, well, then, what steps should
I take to protect myself.''
In terms of the public health issue, the issue of a
national public health tracking system, much of that could be
achieved in very short order. Much of it we know how to do.
It's just a matter of deploying troops, putting in place the
leadership, putting in place the methodology to do it. It's
been more of a matter of not having those troops and that
leadership and the efforts in place.
Dr. Jackson mentioned the fact that a lot of new laboratory
procedures might need to be developed over time. There it's
very difficult to predict. I remember 10 years ago when we were
first talking about mapping the human genome as being a much
longer term project than it was at the end of the day. I think
it's very difficult to predict, when you allow scientists to be
creative in coming up with solutions to the problem, how long
it will take them to solve the problem. It could take a very
long time by curing cancer, yes. But it could also take a
shorter time than we think it will. I think what's important is
getting people started on the task of trying to solve that,
which we haven't done.
Senator Clinton. Thank you very much. As Congresswoman
McCarthy whispered to me, the privacy issues around this are
very difficult, the insurance issues are mind-boggling. As we
all learn that we are each of us susceptible to something, that
means we are all uninsurable which of course leads me to
suggest that we have insurance for everyone, but that's an
issue for another field hearing in the future.
I also wanted to point out that in Senator Reid's and
Senator Chafee's legislation on breast cancer and environmental
research, it includes a specific provision for citizen
participation. I think Gail Frankel had addressed that. So
we're beginning to see some real results from a lot of this
work. We just really have to accelerate our efforts, so we can
get where we need to go a little faster.
Congressman Grucci.
Mr. Grucci. Thank you, Senator.
Dr. Winn, I'm looking at the chart that you have in your
Power Point presentation. It's very striking that the northeast
is an area of heavy concentration. The farther south you go and
the farther west you go, there's less and less reported
mortality rates for breast cancer.
When you go to the west, obviously you have the farm belt,
and then you go down to the south and you have the oil fields
and the oil refineries, and you move farther west, you have the
area where we did our nuclear research, and explosions on
surface and subsurface. In your opinion, why wouldn't you think
there would be a bigger concentration out in those areas? I
know one of the things we've always been concerned about here
on Long Island is because it was a farming area, and it still
is an agricultural area as you go farther out east. We were
concerned about the chemicals that were being put on the ground
to either ward off the pests or help grow the product.
Why wouldn't you think that there would be some more red in
those areas of the country where I just pointed out?
Dr. Winn. If some of these chemicals are associated with
breast cancer, it could simply be that there might be so much
more land out there that some of the potential sources of toxic
substances are less likely to be in contact with individuals
compared to, say, the northeastern United States, which is very
densely populated and potential exposures may be nearer to
population centers. It could also have something to do with
some of the reproductive patterns that are known to be
associated with breast cancer as well. If women outside of the
northeast are less likely to have some of the reproductive risk
factors, then that might be a reason why there might not be an
excess there.
Mr. Grucci. It just seems very striking that it's all
concentrated up in the northeast, which leads me to believe
that we have to work harder up here in order to convince our
colleagues in the south and west that this is a priority issue
and ought to be a priority issue. I just would point that out.
In our dialog, as we go forward in determining how to spend the
moneys that are coming into Washington, I think that we can do
a lot with the resources that are there.
But as you look to the south and to the west, this issue
doesn't rise to the top. We need to be more focused on making
that happen. I think working in concert with our other
colleagues, Republicans and Democrats, to the south and to the
west of us, would be very helpful in making that happen.
Dr. Winn. The maps are based on mortality rates and
mortality rates are influenced by the stage at which cancers
are diagnosed. If in the northeast women are diagnosed at a
more advanced stage than women elsewhere, then the high
mortality rates in the northeast may reflect that. So some of
the factors that affect staging and treatment might also come
into play.
Senator Clinton. Dr. Goldman, did you want to respond?
Dr. Goldman. Yes, I think there are two things to think
about, and one is, as the ex-environmental epidemiologist from
California, I'd like to point out that a couple of areas that
look small on the map have a lot in them. There's San
Francisco, there's Sacramento, the Los Angeles area, also share
those higher rates.
But the other thing is that perhaps the exposures that are
related to breast cancer are more intense in the northeast and
Great Lakes area, and certain California areas. But that
doesn't mean that those exposures aren't also responsible for
breast cancer in other parts of the country. So by looking at
places that are higher, that enables you to perhaps identify
exposures that you can then use as a basis for fighting breast
cancer in the whole country. It just so happens those are the
places where you can really perhaps hone in and study those
exposures, because you see higher rates there.
So that ought to be the way you have everybody be, and say,
``yes, we want to prevent this disease,'' so let's look at it
here.
Mr. Grucci. I totally agree with you, and I'm just
suggesting that when others look at this map from around the
country, the issues that we're seeing here, the clusters that
we've having and the high rate of breast cancer, all cancer in
general, if it's not being seen elsewhere, this is not going to
be a priority. I would just suggest that we need to stay
focused, that any help they can give us, whether it's
supporting this legislation or additional legislation that
needs to come down is going to be very important.
Senator Clinton. Congressman Israel.
Mr. Israel. Thank you, and because I'm last up, before I
ask my question, let me again thank Senator Clinton for her
leadership in bringing this hearing here. We will cross party
lines on this issue.
Dr. Winn, in your testimony you discuss what you call a new
NCI tool, the geographic information system to allow for the
examination and tracking of cancer rates. I would just ask you
to explain how that would fit into Dr. Goldman's recommendation
for a nationwide health tracking system. Then I'll ask Dr.
Goldman to comment on that.
Dr. Winn. This geographic information system links
environmental exposures with health outcomes. We are very
concerned about privacy. If you're looking at the web site and
you're trying to analyze environment and cancer relationships
you can't actually identify individual people, so this system
is not really useful in a clinical setting or for helping an
individual person with their health choices and helping them
control their environmental exposures. It's more a system of
surveillance and an analytical tool, rather than something that
can be used to help specific individuals.
Dr. Goldman. I think it very much would fit in. I think
that just as we want to map the human genome, we want to map
exposures and rates of chronic disease. That provides very
valuable clues, just as with these breast cancer maps we see,
some very valuable clues to what might be involved with
causation of breast cancer.
I can also say that privacy protection was one of the
recommendations of the Pew Environmental Health Commission, as
part of the national health tracking system. The public health
system has a very strong record of privacy protection. But if
you're going to expand tracking, you need to expand those
protections. There are ways to do that, to collect the
information, to keep the information that can allow the
identification of individuals out of the hands of anybody who
might misuse it, whether it's an insurance company or a sales
person or whoever.
Senator Clinton. Well, I want to thank the panel very much.
There may be additional questions that we will want to submit
to the panelists, and particularly this last panel. There are a
number of issues that I think may have arisen during the course
of the hearing that we want further expert advice on.
I know that many of the issues that we've raised today are
ones that are not easily answerable. But I don't think that
excuses us from making our best efforts at trying to answer
them. What has struck me since I've been looking into the whole
question of chronic disease and cancer clusters is how little
we really have done in a concerted way to try to find answers.
We have had an under-resourced public health system, we have
not given the kind of support on the chronic disease side that
we did with respect to infectious and communicable diseases.
I think now is the time, and why this hearing is so
important, and why the previous hearing in Fallon and the
hearing I just participated in last week in the Senate on
cancer clusters all are leading us to the awareness that now is
the time for us to act. There are certain questions that rise
to the level of urgency and you have to respond or then you're
going to be, I think, accused of negligence or irresponsibility
for failing to respond.
It just may be that all of the stars are in alignment, that
these are the issues that we now can address and try to find
solutions for. I personally think that the work that Dr.
Goldman and her colleagues did with the Pew Trust Health Track
Project gives us a good road map. That was a very long study.
It looked at the resources available in the public sector and
where we were lacking. I think that the delegation from New
York, which does, as Congressman Grucci has said, has a very
specific interest in this, we can lead the way.
But this is not just a New York or northeast problem.
Although the intensity may be greater in some parts of the
country, this is a national problem. Although cancer, and
certain kinds of cancer, may be more prevalent in certain parts
of our Nation, other chronic diseases are increasingly
prevalent in other parts of our Nation. So this kind of mapping
will give us information that will help everyone. Certainly as
mobile a Nation as we are, as we move from place to place, this
is information that citizens have a right to know.
So I really believe we can make the case that this is
important for our entire country, important specifically for
the needs of our public health system, but most importantly for
the well being and health of ourselves but particularly our
children, since we've heard a lot today about the impact of all
of these exposures and environmental factors when it comes to
our children.
I think it's also important that we also set out what our
individual responsibility might be and begin to think about
approaching health from that perspective. It is an individual
responsibility to stop smoking. It is an individual
responsibility to be as careful as we can, insofar as we know,
about our own diet. But an individual cannot really take
responsibility for the exposures in our air and our water and
our food that we don't have any direct control over. It's not
something we in our individual family behind closed doors in
our house can control.
So we have to have a very clear understanding of what we
expect the individual to do as we gather information, and how
we try to create some systems of accountability that will say
to individuals, you know, if you are going to smoke and
exposure yourself and your family members to tobacco, there is
not only a risk but a cost associated with that. Then we have
to do the best job we can to map out and get our more
collective risks well know, so that we can take community
action, national action against them.
I think it's very exciting that we're at this point where
we can be actually thinking about this.
So I want to thank all of the panel members. If you have
any last thoughts you'd like to leave us with, anyone have a
last word?
Then we'll keep the record open for 2 weeks. Anyone who has
additional testimony to submit, we welcome that. We will also
be asking additional questions to clarify the record.
I want to thank my colleagues from New York who joined in
this hearing. I want to thank especially our host,
Congresswoman Carolyn McCarthy, Congressman Ackerman,
Congressman King, Congressman Grucci and Congressman Israel. I
particularly want to thank my two fellow Senators, Senator
Reid, who is currently the Chairman of the Environment and
Public Works Committee, but that may change in the next days,
as it is likely that Senator Jeffords will chair this important
committee. Senator Jeffords shares our concern about a lot of
the issues.
I particularly want to thank Senator Chafee from one of our
northeast neighbors, Rhode Island, where he has seen firsthand
in this public service, having been in elective office, even
though he looks so very young, in elective office for a long
time, including being mayor of a city. He has seen the
challenges to our public health system and takes very seriously
the environmental concerns that we've been addressing.
So it's been a great pleasure to have you. I want to thank
Adelphi for doing so much to make this important hearing
possible, in addition to their ongoing educational mission, the
breast cancer hotline and support program. They're on the
forefront of doing a lot of environmental work, adding a
masters in environmental studies, which is particularly
appropriate for those who live on Long Island to be able to
engage in this study right here at Adelphi.
Mr. Ackerman. Senator, if I can assume a prerogative, on
behalf of the entire Long Island delegation, all of whom are
here sitting right through the final gavel, to thank the Senate
Committee for coming here and bringing this hearing to Long
Island. We especially want to thank you, and congratulate you
first of all, I believe that this is the very first hearing
that you have actually chaired as a member of the U.S. Senate.
You have made us all very, very proud, and thank you for
helping to make us all well.
[Applause.]
Senator Clinton. The hearing is adjourned.
[Whereupon, the committee was adjourned, to reconvene at
the call of the chair.]
[Additional materials submitted for the record follow:]
Statement of NYS Assemblyman Thomas P. DiNapoli, The Assembly State of
New York, Albany
I want to thank our own U.S. Senator, Hillary Clinton, the new
Senate Majority Whip, Harry Reid, Senator Chafee, members of our Long
Island congressional Delegation, and all of the members of the Senate
``Cancer Coalition,'' for taking the lead in examining the possible
connection between the quality of the environment and the health of the
public.
I share your concern regarding the incidence of cancers and other
serious medical conditions here on Long Island and across the country
and their possible environmental connections. I applaud your efforts to
address these concerns in forums and hearings such as this.
It is difficult to narrow down the environmental variables, which
increase the possibility of greater health risk. However, it has been
my privilege to work with so many dedicated and outstanding Long Island
leaders and advocates--many will be addressing you today--who are
fighting to address a number of issues which have environmental impact
and which evidence strongly indicates have associated--often long-
term--health impacts.
I would like to take a few minutes to talk about the steps that we
are taking in New York State toward reducing the use of and exposure to
potential harmful environmental conditions.
I believe many of these actions could be aided and supplemented by
the Federal Government through the creation of a stronger partnership
of public and private activities to address these growing concerns.
Last year, your colleague Senator Charles Schumer provided $1
million, through the Environmental Protection Agency (EPA), to enhance
New York State efforts in mapping MtBE spills so that we can more
effectively address these spills. This initiative was just the
beginning of what needs to be done to map environmental hazards in New
York State.
A few years ago, the New York State Legislature appropriated
$1,000,000 to the State Health Department for cancer cluster mapping.
Following a gubernatorial veto, the administration instead indicated it
would provide cancer mapping administratively, through the Department
of Health (DOH).
To many observers, the DOH process has produced maps that lack
sufficient detail to provide the citizens of the State with usable and
accurate cancer information.
The NYS Assembly subsequently introduced legislation (A. 404)
mandating that the New York State Department of Environmental
Conservation (DEC) and the Department of Health jointly develop a
comprehensive computer-based environmental facility/cancer incidence
map plotting system. The legislation requires these agencies to provide
detailed information regarding environmental facilities and reported
cancer incidences by census block throughout the State. Environmental
facilities include sewage plants, hazardous waste facilities, factories
and power plants that emit air pollution, and Superfund sites. This
data will help researchers and the public look for, analyze and better
understand the connection between environmental pollution and cancer
rates in the general population.
There have also been efforts at the Federal level to provide
accurate information regarding environmental facilities through
environmental mapping web sites. The Federal Housing and Urban
Development Agency and the EPA maintain environmental-mapping
capabilities that identify environmental facilities including the
facility name, address, environmental compliance history, chemicals
released and permitted emission levels. These efforts are valuable
models that could and should be implemented at the State level.
Currently the State Department of Environmental Conservation is
attempting to implement a similarly informative web site service. The
information available via the DEC web site is limited in that it only
provides the identification of a facility at a street address. It does
not provide detailed information such as the facility name, type, what
chemicals are being emitted, levels of emission, or compliance history.
We believe the Federal Government through funding and technical
assistance could help New York develop a much-needed comprehensive
mapping capability. This is an obvious compliment to the National
Institute of Health's ongoing breast cancer study.
While these mapping and research efforts are developing, there are
other activities that we can take to reduce exposure to contaminants
and toxic materials in our environment.
An important issue where the Federal Government should join with
New York--and California--is to immediately move to set a schedule
toward banning the use of the gasoline oxygenate, MtBE.
In 1999, New York State sent a resolution to Congress, calling for
a ban of this oxygenate, which is proven to pollute surface and
groundwater supplies. While Congress has not yet acted, last year New
York State passed the first law in the Nation that bans the use of this
contaminant in gasoline sold in our State as of January 1, 2004.
The use of MtBE originated in the effort to reduce air pollution
caused by motor vehicles. MtBE was listed as a possible human
carcinogen, and unfortunately, as a result of numerous spills, leaks
and atmospheric deposition, it has become a ubiquitous contaminant in
surface and groundwater throughout New York. On Long Island, for
example, it has been detected in 63 of Nassau County's monitoring
wells, 55 public supply wells, and more than 250 private wells. The
chemical has been discovered at approximately 500 sites on Long Island
where spills and leaks involving gasoline have occurred.
This new law was challenged in court by the Oxygenated Fuels
Association, but just last week we were pleased to hear that the
Federal court upheld this law. (Federal District Court Judge Norman
Mordue ruled that the Clean Air Act's preemption of State laws for the
purposes of motor vehicle emission control does not apply to this New
York State law, which is a public health measure designed to protect
drinking water quality in the State.)
This is an important victory in our continuing efforts to protect
drinking water in New York State as MtBE has been classified by EPA as
a possible human carcinogen, and enters groundwater through leaking
vehicle gasoline tanks, pipelines, overfilling of tanks, and automobile
accidents. The sandy soils of Long Island are particularly vulnerable
to MtBE contamination.
I stand before you today to once again call upon Congress to follow
the path set by New York and California, and ban the use of MtBE in
gasoline to prevent the serious public health, safety, and
environmental and economic implications that are associated with
continued long-term use of MtBE.
Last year--after 7 years of trying--New York enacted the most
comprehensive pesticide notification legislation in the Nation. This
law requires schools and day-care facilities to establish a pesticide
application notification procedure, including notifying parents of
their right to be informed 48 hours before pesticides are applied at
these facilities. It also allows counties to adopt a local law
requiring notification of neighbors before pesticides are commercially
applied on adjacent properties and requiring homeowners to flag their
yard after applying pesticides themselves.
As a society we need to move away from the widespread use of
(several million pounds per year) pesticides and the dependence on
toxic and hazardous chemicals in our quest for the greenest lawns, weed
free gardens, and elimination of pests and insects. Alternatively, we
must find ways, and provide the educational and financial resources to
reduce our dependence on these chemicals (i.e. IPM programs) and move
to non-toxic products, alternative mechanisms, and a greater focus on
preventive techniques.
I am optimistic that through a number of provisions contained in
the ``Pesticide Neighbor Notification Act'' the public will gain a
better understanding of the chemicals and contaminants that make-up the
pesticides, fertilizers, and herbicides that are being poured, placed,
and sprayed around us. This type of public right to know legislation is
worthy of replication throughout the country.
There are two other initiatives that are before the State
Legislature that I believe people throughout the country, particularly
our youngest and frailest citizens, would benefit from and which could
be enhanced with Federal support:
Here in New York and throughout the northeastern region, local
governments have been struggling to eliminate mosquitoes and control
the spread of West Nile Virus. However, too many localities have
focused too much of their efforts on aerial or ground spraying to
control mosquito populations. More proactive methods of combating the
spread of the virus including surveillance, public education,
environmental monitoring and non-spraying vector control have received
inadequate attention.
If enacted, legislation (A. 7320) would provide a 75 percent match
for county expenditures of up to $100,000 (from the current maximum of
$5,000) for surveillance and monitoring and up to $200,000 (from the
current maximum of $50,000) for non-spraying vector control activities.
As regions of the country have specific concerns where pesticide
control is necessary, by providing an increased level of funding, the
Federal Government can will help ensure that the health threat is
addressed by providing an incentive to avoid the widespread spraying of
pesticides when less toxic means are available.
The second bill that I would like to call to your attention also
uses financial aid as an incentive to change current practices.
I am currently working with 1 in 9: The Long Island Breast Cancer
Action Coalition on legislation (A. 8672) entitled, ``The Children's
Health Incentive Fund.'' This legislation would provide school
districts with financial aid to help them move away from the use of
harmful chemicals in the buildings where our children learn and on the
fields on which they play. The bill is designed to offer State funds as
an incentive for school districts to use non-toxic products and
practices as alternatives to using potentially dangerous pesticides,
fertilizers, and herbicides in and around our schools.
While many of the environmentally sensitive products are more
expensive and some alternative practices take more time, by offering
financial help to the 700 plus school districts in New York to use
safer products and practices, our children, school personnel, and the
environment will benefit from reduced exposure to potentially
dangerous, toxic, and hazardous chemicals.
I thank you for your interest in this most important matter and I
am grateful for your consideration and examination of the Long Island
community.
______
New York State Assembly Bill No. 7320
2001-2002 Regular Sessions
March 21, 2001
Introduced by M. of A. DiNapoli, Weisenberg, Glick, Colman, Hooper,
Schimminger, Davis, Galef--Multi-Sponsored by--M. of A.A. Cohen,
Colton, Gromack, Jacobs, McEneny, Sanders, Wright--read once and
referred to the Committee on Health
AN ACT to amend the public health law, in relation to amount of
State aid given for mosquito control
The People of the State of New York, Represented in Senate and
Assembly, Do Enact as Follows:
Section 1. Section 611 of the public health law, as added by
chapter 901 of the laws of 1986, is amended to read as follows:
S 611. State aid; mosquito and vector control. 1. Where a county or
municipal agency designated by the county health department or part
county department of health conducts a mosquito and vector (control)
surveillance program approved by the department OR CONDUCTS
ENVIRONMENTAL MONITORING PURSUANT TO PARAGRAPH (C) OF SUBDIVISION FOUR
OF THIS SECTION, it shall be provided State aid reimbursement at (the
same percentage rate as basic public health services are reimbursed
under paragraph (a) of subdivision two of section six hundred five of
this article) A RATE OF SEVENTY-FIVE PERCENT, provided however that,
the total State aid reimbursement provided pursuant to this section to
such county or municipal agency shall not exceed (five) ONE HUNDRED
thousand dollars. The reimbursement provided pursuant to this section
shall be made from funds appropriated for the operation of local health
departments pursuant to title one of this article.
2. Where a county or municipal agency designated by a county health
department or a part-county health department conducts a mosquito and
vector control program approved by the department, it shall be provided
State aid reimbursement at (the same percentage rate as basic public
health services are reimbursed under paragraph (a) of subdivision two
of section six hundred five of this article) A RATE OF SEVENTY-FIVE
PERCENT, provided however, that the total State aid reimbursement
provided pursuant to this section to such county or municipal agency
shall not exceed (fifty) TWO HUNDRED thousand dollars. The
reimbursement provided pursuant to this section shall be made from
funds appropriated for the operation of local health departments
pursuant to title one of this article AND SHALL BE PROVIDED ONLY FOR
THE FOLLOWING ACTIVITIES:
(A) ACTIONS UNDERTAKEN TO EDUCATE THE GENERAL PUBLIC ABOUT
TECHNIQUES AND STRATEGIES THEY CAN TAKE TO CONTROL MOSQUITO AND VECTOR
BREEDING ACTIVITIES ON PROPERTIES THEY OWN OR INHABIT AND ACTIONS
UNDERTAKEN TO EDUCATE THE GENERAL PUBLIC ABOUT THE HEALTH AND
ENVIRONMENTAL IMPACTS ASSOCIATED WITH PESTICIDE USED FOR MOSQUITO AND
VECTOR CONTROL; OR
(B) ACTIONS UNDERTAKEN TO REDUCE MOSQUITO AND VECTOR BREEDING
INCLUDING: THE USE OF BIOLOGICAL CONTROL AGENTS SUCH AS, BUT NOT
LIMITED TO, MOSQUITO EATING FISH AND PREDATORY INSECTS SUCH AS
DRAGONFLIES; THE MODIFICATION AND MANAGEMENT OF MOSQUITO AND VECTOR
BREEDING HABITATS; THE USE OF LARVICIDES THAT ARE BIOPESTICIDES THAT
ARE REGISTERED PURSUANT TO TITLE SEVEN OF ARTICLE THIRTY-THREE OF THE
ENVIRONMENTAL CONSERVATION LAW; AND THE USE OF ALTERNATIVE TECHNOLOGIES
SUCH AS, BUT NOT LIMITED TO, MOSQUITO TRAPS.
3. Under (emergency situations) A PUBLIC HEALTH THREAT DECLARATION,
the department shall reimburse counties or municipalities at the same
percentage rate as basic public health services are reimbursed under
paragraph (a) of subdivision two of section six hundred five of this
article for the cost of emergency vector control measures as approved
by the department. (Such funds shall be made available from funds
appropriated for the operation of local health departments, only to
those counties or municipalities which have expended all other State
aid which may be available for mosquito and vector control and
surveillance programs.)
4. ANY FUNDS REIMBURSED BY THE DEPARTMENT FOR ACTIONS RELATED TO
WEST NILE VIRUS PURSUANT TO PARAGRAPH (B) OF SUBDIVISION TWO AND/OR
SUBDIVISION THREE OF THIS SECTION SHALL BE RELEASED ONLY UPON AN
AFFIRMATIVE FINDING THAT:
(A) THE ACTIONS ARE CONSISTENT WITH THE NEW YORK STATE WEST NILE
VIRUS RESPONSE PLAN;
(B) THE ACTIONS COMPLY WITH ALL PESTICIDE PERMITS, PRODUCT
REGISTRATION AND LABELING PROVISIONS;
(C) THE ACTIONS ARE COUPLED WITH AN ENVIRONMENTAL MONITORING
PROTOCOL THAT DOCUMENTS THE EFFICACY OF THE ACTION AND THE DEGREE AND
TYPE OF IMPACTS THAT OCCUR IN HUMANS AND OTHER NON-TARGET SPECIES AND
ENVIRONMENTAL QUALITY; AND
(D) NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, ANY
ACTIONS THAT WOULD OTHERWISE REQUIRE AN AQUATIC PESTICIDE PERMIT OR
FRESHWATER WETLAND PERMIT, SHALL BE CARRIED OUT PURSUANT TO SUCH PERMIT
UNDER A PUBLIC HEALTH THREAT DECLARATION.
S 2. This act shall take effect immediately.
______
New York State Assembly Bill No. 8672
2001-2002 Regular Sessions
May 7, 2001
Introduced by Committee on Rules--(at request of M. of A. DiNapoli,
Wright, Lavelle, Canestrari, Christensen, Colton, Davis, Eddington,
Englebright, Gordon, Gromack, Hooper, Matusow, Mayersohn, McEneny,
Millman, Nolan, Pheffer, Sidikman, Sweeney, Weinstein, Weisenberg)--
read once and referred to the Committee on Health
AN ACT to amend the State finance law, in relation to establishing
the children's health incentive fund; and making an appropriation
therefor
The people of the State of New York, represented in Senate and
Assembly, do enact as follows:
Section 1. Legislative findings. The legislature hereby finds that
a significant amount of potentially dangerous chemicals are being used
in and around our State's public schools. Exposure to environmental
chemicals at school during critical developmental periods has been
linked to childhood cancers, asthma, learning disabilities, and
hyperactive behavior disorders. Both synthetic pesticides and chemical
fertilizers are being used in large quantities in and around our
schools. Many of these chemicals are known to cause a variety of
illnesses and effect the environment adversely. Absent an incentive-
based program to use least toxic pesticides and low leaching
fertilizers, our children will continue to be exposed to potentially
dangerous chemicals. The children's health incentive fund will enable
schools to transition to better management practices with least toxic
products.
Cutting edge pest control products and natural fertilizers are now
available on the market. However, these products are often more
expensive to purchase and use. By offering incentives to school
districts to adopt these products and practices, the children of New
York State and the environment will have reduced exposure to
potentially dangerous pesticides and fertilizers.
S 2. The State finance law is amended by adding a new section 83-a
to read as follows:
S 83-A. Children's Health Incentive Fund.
1. There is hereby established in the custody of the State
Comptroller and the Department of Environmental Conservation a fund to
be known as the ``Children's Health Incentive Fund'' which shall
provide a mechanism to reduce chemical exposure in schools. Such fund
shall provide a monetary incentive to schools for the use of least
toxic pest control products and fertilizers.
2. The fund shall consist of all monies appropriated for its
purpose and shall be paid out on the audit and warrant of the State
Comptroller on vouchers certified or approved by the Commissioner of
the Department of Environmental Conservation for amounts up to ninety
cents per full-time enrolled student annually for the purchase of least
toxic pest control products and fertilizers by each school district,
Board of Cooperative Educational Services, charter school, private
school or parochial school. Annually, in order to qualify to receive
monies from this fund, the school district, Board of Cooperative
Educational Services, charter school, private school or parochial
school shall submit receipts for these products and any other records
or forms required by such department pursuant to rules and regulations.
3. The Commissioner of the Department of Environmental Conservation
shall promulgate rules and regulations specifying products eligible to
receive monies from this fund. Such products shall include only the
following:
(A) Low-Water solubility and slow-release, fertilizers, soil
conditioners and compost where low-water solubility means thirty
percent or more of total nitrogen shall be water insoluble or
controlled release. Fertilizers, soil conditioners and compost derived
from or comprised of human sewage sludge or septage shall not be
eligible to receive monies from this fund;
(B) Nonvolatile rodenticides in tamper resistant bait stations;
(C) Silica gels that do not contain synthetic pesticides or
synergists;
(D) Pesticides classified by the United States Environmental
Protection Agency as an exempt material under 40 C.F.R. PART 152.25;
(E) Boric acid; and
(F) Horticultural oils that do not contain synthetic pesticides or
synergists and that are not petroleum-based.
S 3. The sum of three million dollars ($3,000,000), or so much
thereof as may be necessary, is hereby appropriated out of any moneys
in the State treasury in the general fund to the credit of the State
purposes account not otherwise appropriated to the department of
environmental conservation for the purpose of complying with the
provisions of section two of this act. Such funds shall be payable upon
the audit and warrant of the State comptroller on vouchers certified or
approved by the commissioner of environmental conservation or his or
her duly designated representative in the manner prescribed by law.
S 4. This act shall take effect immediately and apply to school
years beginning on or after July 1, 2001.
__________
Statement of Philip J. Landrigan, M.D., M.Sc., Ethel H. Wise Professor
and Chair, Department of Community and Preventative Medicine, Professor
of Pediatrics, Director, Center for Children's Health and the
Environment, Mount Sinai School of Medicine, New York, NY
Chairman Reid, Senator Clinton, and members of the New York
congressional delegation, I am pleased to appear before you today to
discuss rising rates of cancer and other chronic diseases in the
American population and the linkages between cancer and the
environment.
I would like also to discuss with you a blueprint for substantially
reducing cancer rates in this Nation. The centerpiece of this plan will
be the construction of a strong national capacity in public health and
preventive medicine that will enable us to locate, track, understand
and prevent the environmental causes of cancer.1
My name is Philip J. Landrigan, M.D. I am Chair of the Department
of Community and Preventive Medicine and Professor of Pediatrics at the
Mount Sinai School of Medicine in New York City. I direct the Center
for Children's Health and the Environment at Mount Sinai, a policy
research center supported by The Pew Charitable Trusts. I am a
pediatrician and epidemiologist.
RISING RATES OF CHRONIC DISEASE IN THE AMERICAN POPULATION
Today, the leading causes of illness and death in the United States
are chronic diseases and injuries.2 Rates of asthma have
more than doubled. Incidence of certain birth defects of the
reproductive organs such as hypospadias have doubled.
Neurodevelopmental disorders such as dyslexia, attention deficit/
hyperactivity disorder (ADHD) and autism are highly prevalent and cause
untold misery to children and their families. Chronic diseases of the
brain and central nervous system such as Parkinson's disease have
increased in frequency.
Cancer is a particular problem. Cancer will kill approximately
550,000 people in the United States this year, according to the
American Cancer Society. Cancer is the second leading cause of death,
exceeded only by heart disease. It is the second leading cause of lost
years of potential life.3
Breast cancer is a major problem in New York and across the Nation.
An estimated 182,000 cases of breast cancer are expected to be
diagnosed this year among American women, and about 1,400 new cases of
breast cancer are expected to be diagnosed in men.3 Rates of
breast cancer have risen in the United States, and the cumulative
increase in incidence since the early 1970's has been more than 40
percent.
Pediatric cancer is another major problem. An estimated 12,400
children and young people will be diagnosed with cancer in the United
States in the year 2001. Cancer is the third most common cause of death
in American children, exceeded only by unintentional injuries and
homicide. Thus it is the leading cause of death from disease in our
young people. The two most common forms of childhood malignancy are
leukemia and brain cancer, and together these two diseases account for
about two-thirds of pediatric cancer.4 Although death rates
for childhood cancer are down, thanks to early detection and vastly
improved treatment, the reported incidence, i.e., the number of new
cases of cancer per million children has increased over the past two
decades please see attached graphs).4
For acute lymphoblastic leukemia (ALL), the most common pediatric
malignancy, incidence increased from 23.1 cases per million children in
the early 1970's to a peak of 28.2 per million in the 1980's, and then
declined somewhat to a level of 26.8 per million in 1996. This
represents an overall increase since the early 1970's of about 12
percent, an increase that is statistically significant.4
For primary brain cancer (glioma), a sharp and statistically
significant increase in incidence has been noted from 23 cases per
million children in the early 1970's to 29.0 per million in the late
1990's. This represents an overall increase in incidence over the past
three decades of nearly 30 percent, an increase that is statistically
quite significant.3
For testicular cancer, incidence in young men 15-30 years of age
has increased over the past 30 years by 68 percent. This increase
occurred entirely in white men, and was not seen in black men. It is
statistically highly significant.5
The causes of these increases in cancer are incompletely understood
Some have argued that better diagnostic detection and changing
definitions of cancer may account for a major fraction of the
increase.6 I would agree that new diagnostic technologies
have made some contribution to reported increases in cancer incidence,
but I cannot agree that it is the whole story. I would point out that
childhood cancer is not a subtle disease. Sadly, it is a devastating
and extremely serious illness. It makes children terribly ill, arid it
brings them to the hospital. Thus it seems unlikely to me that large
numbers of children with cancer would have escaped medical detection
only 25 years ago, at a time when many doctors of my generation were
already practicing pediatrics.
A further argument against the notion that better diagnostic
detection accounts for the entire reported increase in childhood cancer
is that any increase due to better diagnosis would have produced only a
temporary rise in reported incidence at the time of introduction of the
new technology, reflecting diagnosis at an earlier stage of illness.
That temporary increase would then be expected to be followed by a
return to baseline. In fact, however, no such return to baseline
incidence of childhood brain cancer has occurred in the United States
over the past 30 years. In fact, the incidence rate for childhood brain
cancer has continued to rise inexorably, and this upward trend is seen
in both boys and girls in all regions of the United States.7
These facts argue that most of the reported rise in incidence of
childhood cancer is a real increase.
It is highly likely that environmental toxins in air, food, dust,
soil and drinking water have contributed to increasing rates of cancer
in Americans of all ages, including our children. The known and
suspected causes of childhood cancer include benzene, other solvents,
radiation, arsenic, parental smoking, certain pesticides and certain
chemicals in the environment that have the potential to disrupt the
function of the endocrine system. Maternal consumption during pregnancy
of cured meats containing nitrites, such as sausage and bacon has been
shown to increase risk of childhood brain cancer. There are also
protective factors. Maternal consumption of folic acid during
pregnancy, and the practice of nursing an infant appear to be
protective factors that can reduce incidence of childhood cancer. Those
facts are signs of hope.
CANCER AND THE ENVIRONMENT--AN HISTORICAL PERSPECTIVE
Considerable progress toward cancer control has stemmed from the
recognition that chemical agents in the environment can cause
cancer.8 In 1775, Sir Percivall Pott, a British surgeon,
reported for the first time an association between childhood cancer and
an environmental agent.9 Pott noted that the ``climbing boys
of London'', teenage lads employed as chimney sweeps, experienced a
devastating incidence of cancer of the scrotum. He correctly attributed
the development of those tumors to occupational exposure to soot. In
1895, Rehn noted a high frequency of cancer of the urinary bladder
among workers in the aniline dye industry.10 He attributed
the causation of those tumors to aromatic amines. More recently
etiologic associations have been recognized between benzene and
leukemia,11 asbestos and lung cancer,12
bischloromethylether and lung cancer,13 vinyl chloride
monomer and angiosarcoma of the liver,14 tobacco and lung
cancer,15 and chewing tobacco and cancer of the
mouth.16
Toxicologic studies stimulated by those clinical and epidemiologic
observations have led to fundamental advances in the understanding of
cancer biology. Benzo(a)pyrene, a polynuclear aromatic hydrocarbon
compound found in soot, has been found to induce skin cancer in
experimental animals.17 That finding provides a molecular
basis for Pott's observations of the link between soot and scrotal
cancer. Likewise -naphthylamine, a chemical found in aniline
dye manufacture, has been shown to cause cancer of the bladder in
experimental animals, thus providing an explanation for the observation
of Rehn.18 Chemical carcinogens found in tobacco and tobacco
smoke provide a biological basis for the observation that cigarette
smoking causes lung cancer and that chewing tobacco causes cancer of
the month and oropharynx.
Common themes that run through these tales of discovery are an (1)
the importance of tracking data on cancer incidence, (2) an openness to
the possibility that environmental factors can cause cancer and (3) a
willingness to pursue clinical and epidemiologic observations to
discover the biological mechanisms by which environmental agents cause
malignancy.
The recognition of environmental carcinogenesis has had a profound
influence on our understanding of human cancer. No longer must cancer
be regarded as an inescapable consequence of aging or the result of
unexplainable ``natural forces.'' Quite the contrary. It is now
realized that chemical carcinogenesis is not exceptional and that well
over half of human cancers--perhaps as many as 80-90 percent
worldwide--are caused by environmental exposures.19 I should
note that in this context ``environmental factors'' include not only
exposures to industrial chemicals and pollutants but also exposures to
such factors as diet, alcohol, tobacco, drugs, radiation and sexual
behavior.
The concept that the environment is responsible for a great
majority of human cancer received strong collaboration in a landmark
study published recently from Sweden.20 This study which
examined patterns of cancer in 44,788 pairs of twins found sharp
discrepancies in cancer incidence even between identical twins. These
differences, even in persons of identical genetic composition, indicate
that environment plays a major role in the causation of malignancy.
The most hopeful implication of the discovery of that many
thousands of cancer cases are caused by exposures in the environment is
that a very high proportion of all human cancer ought to be
preventable. Prevention can be accomplished by reducing exposures to
environmental carcinogens.8
CHEMICAL EXPOSURES IN TODAY'S WORLD
Americans today face environmental hazards that were neither known
nor suspected a few decades ago. Americans today are at risk of
exposure to over 85,000 synthetic chemicals, most of which have been
invented since World War II. Americans are most likely to be exposed to
the 28,000 high-production-volume (HPV) chemicals that the U.S.
Environmental Protection Agency estimates are produced in quantities of
over one million pounds per year.21 These chemicals are the
most widely dispersed in foods, household products, pesticides, air,
food and drinking water. The National Academy of Sciences has found
that children are the group within the American population most
vulnerable to these chemical hazards.22
No basic toxicity information is publicly available for 43 percent
of the high-production-volume chemicals according to the EPA. And
although children are now recognized to be especially vulnerable to
chemicals in the environment, only 7 percent of HPV chemicals have been
examined for their potential toxicity to children or to human
development.21
The percentage of cancer in Americans that is caused by toxic
chemicals in the environment is not known We do, however, know that
many chemicals are proven human carcinogens, that many more are
suspected human carcinogens on the basis of animal testing, and that
most chemicals have never been tested.
A BLUEPRINT FOR CANCER PREVENTION IN THE UNITED STATES
The following are elements of a comprehensive plan for the
prevention of environmental cancer in the United States.
Disease and exposure tracking.--It will be essential to continue to
provide support to the Centers for Disease Control and Prevention (CDC)
and to the National Cancer Institute (NCI) to enable these agencies to
monitor the number of cases of cancer and other chronic diseases that
occur each year among Americans of all ages and in every part of the
country.1 The tracking of cancer, asthma, birth defects and
other chronic diseases has lagged historically behind the tracking of
infectious diseases such as measles and smallpox. Now, however, that
the chronic diseases have become the major causes of morbidity and
mortality in the United States, we must remedy this situation and aim
ourselves with accurate information on the temporal and geographic
distribution of cancer and other chronic diseases. Such information is
essential for targeting prevention.
Also it will be essential to continue to provide support to the CDC
to enable CDC to continue each year to monitor the levels of chemicals
in the blood of Americans and to make this information available to the
public. The combination of information on chemical exposure with data
on cancer incidence will undoubtedly spark research that will identify
specific preventable environmental causes of cancer and other chronic
diseases.
A classic example of the importance of disease tracking to cancer
prevention is provided by the story of oral cancer among women in the
American South, In the early 1970's the National Cancer Institute
published an Atlas of Cancer Mortality by County in the United States.
Examination of the maps in this atlas revealed a strikingly high
incidence of oral cancer among women across the southeastern United
States from Virginia to Texas The cause of that increase was initially
not known However, publication of the maps stimulated extensive
research, and one of those studies was an epidemiologic investigation
undertaken by Dr. Debra Winn. This classic study found an extremely
strong association between oral cancer and the use of chewing
tobacco.16 Once this association had been discovered,
programs of prevention were put in place. This represents a textbook
example of how disease tracking can lead to discovery of the factors
responsible for disease and then to prevention.
Premarket testing of the toxic and carcinogenic potential all new
chemical compounds is a most effective approach to the prevention of
environmental disease. Unfortunately, premarket testing has often not
been undertaken. A 1984 analysis by the National Research Council
showed that most chemical compounds have never been tested for their
carcinogenic potential.23 That unfortunate figure has not
improved appreciably in the intervening years, and the number of new
chemical substances released into the environment has increased
substantially during that time.
In addition to doing more toxicity testing, we also need to develop
more sensitive approaches to testing that can reliably detect the long-
term consequences of exposures to toxic chemicals in early life.
Extensive experiences demonstrated that infants and young children are
uniquely vulnerable to certain chemicals that are relatively harmless
to adults. To detect the unanticipated consequences of early exposures
to such chemicals, it will be necessary to develop new approaches to
assay prenatal, perinatal and childhood toxicity. For certain classes
of chemicals it may, in part, be necessary to undertake experimental
studies in which chemicals are administered shortly after birth and the
experimental subjects then followed over their entire life
span.22 This approach will replicate the human condition in
which exposures in the earliest stages in life may produce disease only
decades later. It may thus enhance detection of the environmental
causes of late illness. Functional tests of neurotoxicity and of
immune, endocrine and reproductive toxicity are also need to be much
more widely applied then they are at present.
Right-to-know is the concept that American families have the right
to be informed of the nature and toxic properties of the chemicals that
they may encounter in their air, food, drinking water, schools and
communities. It is a powerful took for cancer prevention, and it
complements and extends the efficacy of regulation.
Right-to-know information empowers families and enables them to
take intelligent decisions to reduce their own and their children's
exposures to toxic substances Right-to-know has proven an extremely
effective means for reducing toxic exposures. For example, EPA's Toxic
Release Inventory (TRI) an annual listing of the nature and amounts of
toxic chemicals released to the environment by polluting industries in
the United States has highlighted those industries that are the worst
actors and has resulted in many of these industries' taking aggressive
steps to reduce their toxic emissions. Likewise Proposition 65 in
California requires manufacturers to list hazardous materials on the
labels of consumer products. This labeling requirement has resulted in
the removal of many toxic products from the market in California and
nationwide.
It will be necessary now to consider development of national right-
to-know legislation in the United States that extends to consumers
across this Nation the sort of knowledge now available only on the west
coast.
Regulatory standards issued by the Environmental Protection Agency
and the Occupational Safety and Health Administration are an
extraordinarily important mechanism for the prevention of environmental
cancer. These standards regulate permissible uses of carcinogenic
chemicals and establish levels above which workers and the public may
not legally be exposed. Standards have brought about substantial
reductions in exposures to carcinogens, including asbestos, benzene,
vinyl chloride and PCBs. All standards are however, inherently
arbitrary--they imply safety when safety does not exist. There is no
bright line between the level of exposure to a toxic substance that
causes cancer and that which is safe; there is instead a continuum of
toxicity. Standards therefore need continually to be re-examined in the
light of new data, and when necessary revised.
Traditionally, regulatory standards in this Nation have been built
on the assumption that the entire American population is comprised of
70-kilogram young adult males. Estimates of risks have been based on
the exposures and the sensitivities of this ``average'' person, and
standards have been set at levels to protect this person's health. The
only Federal environmental law that specifically acknowledges the
unique sensitivities of infants and children is the Food Quality
Protection Act of 1996 This legislation, which governs the use of
pesticides in agriculture, requires that standards be set at levels
that will specifically protect infants and children from harm to their
health In the years ahead, it will be necessary to extend the model of
the Food Quality Protection Act to other environmental legislation so
that all environmental standards are set at levels that will protect
the health of the most vulnerable among us.
Research.--A vigorous national research program is an essential
element of a comprehensive blueprint for cancer prevention. In this
Nation we have traditionally directed the major portion of our cancer
research portfolio into discovering new cancer treatments. This
approach has yielded great benefits. Death rates from many cancers, in
particular pediatric cancers and testicular cancer, have been
substantially reduced. Thirty years ago when I was still a pediatric
resident, every child with leukemia died of their disease. Today more
than three-fourths of children with leukemia survive and live to play
another day.
Now it is time to open a second front on the war on cancer. We need
to increase substantially our investment in prevention oriented
research. It maybe instructive to contrast our approach to cancer
research with our approach to research on cardiovascular disease. The
national portfolio on Cardiovascular Disease has long emphasized a
search for the preventable causes of disease. This tradition began in
1948 when the U.S. Public Health Service established the Framingham
Heart Study in Framingham, MA with the specific goal of identifying the
preventable causes of heart disease and stroke. The study was initiated
in the years after World War II when Americans had returned home to new
prosperity, were eating a diet extremely high in cholesterol, were
smoking at unprecedentedly high rates and experiencing massively
increasing rates of heart disease and stroke. The Framingham Study and
other studies like it identified the preventable environmental risk
factors for heart disease such as hypertension, cholesterol, obesity,
cigarette smoking, diabetes and sedentary lifestyles. Once these risk
factors had been identified, aggressive programs of prevention were put
into place. The result has been a reduction in heart disease rates
among American men and women of nearly 50 percent over the past five
decades. That reduction represents one of the great triumphs of public
health in the past half century. We need now to do the same for cancer.
CONCLUSION
Cancer is a complex, multifactorial, profoundly frightening and
often deadly disease But also cancer is a preventable disease Many
thousands of cancer deaths in this Nation every year are caused by
toxins in the environment, and those are cases that can and should be
prevented.
Cancer prevention requires a carefully orchestrated, precisely
targeted series of programs in prevention and research. These programs
can result in enormous reductions in cancer incidence, suffering and
death. The challenge before us as a Nation is to craft such programs.
We must track disease. We must test chemicals. We must educate and
inform our citizens. We must commit to research in cancer prevention
resources of the magnitude that we have historically committed to
research in cancer treatment. Cancer prevention is cost-effective.
Cancer prevention makes sense. And cancer prevention is the right thing
to do.
Thank you. I shall be pleased to answer your questions.
______
References
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and Occupational Hazards. Annals of the New York Academy of Sciences
895:1-9, 1999.
3. American Cancer Society. www.cancer.org/statistics.
4. Howe, H.L., Wingo, P.A., Thun, M.J., RiesLAG, Rosenberg, H.M.,
Feigal, E.G., Edwards, B.K. Annual Report to the Nation on the Status
of Cancer (1973 through 1998), Featuring Cancers With Recent Increasing
Trends. J. Natl. Cancer Inst. 2001; 93:824-842.
5. National Cancer Institute. Surveillance, Epidemiology, End-
Results (SEER) Data Base. Bethesda: National Cancer Institute.
6. Linet M.S., RiesLAG, Smith, M.A., Tarone, R.E., Devesa, S.S.,
Cancer Surveillance Series: Recent Trends in Childhood Cancer Incidence
and Morality in the United States. J. Natl. Cancer Inst. 1999; 91:1051-
1058.
7. Schechter, C.B. Brain and Other Central Nervous System Cancers:
Recent Trends in Incidence and Mortality. J. Natl. Cancer Inst. 1999;
91:2050.
8. Landrigan, P.J. The prevention of occupational cancer
(editorial). CA, 1996; 46:67-69.
9. Pott, P. Chirurigical observations relative to the cataract, the
polypus of the nose, the cancer and the scrotum, the different kinds of
ruptures, and the mortification of the toes and feet. Hewes, Clarke and
Collins, London, 1775.
10. Rehn L. Blasengeschwuelste bei Fuchsinarbeitern. Arch Klin Chur
1895; 50:588-600.
11. Delore P., Borgomano, C. Acute leukemia following benzene
poisoning. On the toxic origin of certain acute leukemias and their
relation to serious anemias. J Med Lyon 1928; 9:227-233.
12. Hammond E.C., Selikoff I.J., Churg J. Asbestos exposure,
smoking and neoplasia. JAMA 1968; 204:106-112.
13. Figueroa, W.G., Raszowski R., Weiss, W. Lung cancer in
chloromethyl methyl ether workers. N Engl J. Med 1973; 228:10 96-1097.
14. Creech, J.L., Jr., Johnson, M.N. Angiosarcoma of the liver in
the manufacture of polyvinyl chloride. J Occup Med 1974; 16:150-151.
15. Doll, R., Hill, A.B. Lung cancer and other causes of death in
relation to smoking--a second report on the morality of British
doctors. Br. Med. J. 1956; 2:1071-1077.
16. Winn, D.M. Smokeless tobacco and cancer: the epidemiologic
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17. Kenneway, E.L. On the cancer-producing factors in tar. Br. Med.
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18. Hueper, W.C., Wilery F.H., Wolfe H.D. Experimental production
of bladder tumors in dogs by administration of beta-naphtylamine. J.
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19. Higginson J., Muir C.S. The role of epidemiology in elucidating
the importance of environmental factors in human cancer. Cancer Detect
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20. Lichtenstein P., Holm N.V., Verkasalo P.K., Iliadou A., Kaprio
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and heritable factors in the causation of cancer. New Engl J. Med.
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21. Environmental Protection Agency. Chemical Hazard Data
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[GRAPHIC] [TIFF OMITTED] T0650.106
Statement of Randall L. Todd, M.D., State Epidemiologist, Nevada State
Health Division
Good morning Mr. Chairman. Thank you for the invitation to share
information about our State's investigation into a cluster of childhood
leukemia cases in Churchill County Nevada. I would like to provide you
with a brief background and description of what has happened and is
continuing to happen in Nevada and share some of the lessons we are
learning that may be useful here in New York.
In July 2000, we were informed of concerns among the medical
community in Churchill County that the number of recently diagnosed
cases of childhood leukemia appeared unusually high. At the time we
were first contacted there had been six cases diagnosed over a 5-month
period of time. The usual rate of occurrence in a community of this
size would be about 1 case every 5 years. Currently we have identified
8 cases of Acute Lymphocytic Leukemia (ALL) that were diagnosed in
2000. Another case had been diagnosed in 1999 and one case of Acute
Myelocytic Leukemia (AML) has been diagnosed this year. For
investigational purposes we have interviewed an additional 4 case
families with recently diagnosed children having ALL and prior
residence in Churchill County.
Our initial investigation consisted of face-to-face interviews with
each case family. This involved a detailed review of residential
history, sources of drinking and cooking water, in-home water
treatment, chemical exposures, parental occupations, and medical
history. We have also tested the water supplied to each local residence
where a case family lives or has previously lived. About 50 percent of
the case family residences were supplied with water from a regulated
municipal source. The others obtained water from private domestic
wells. We have tested all water, regardless of source, using the
battery of analyses required for public water systems under the Safe
Drinking Water Act.
Our water analysis to date has not revealed any results that would
explain this cluster. There are high levels of naturally occurring
arsenic. However, this has been present for throughout the history of
the region and has not been specifically linked to the development of
childhood leukemia. There are also some areas in which shallow and
intermediate depth wells may exceed safe levels of uranium. This is
also naturally occurring and is not found at all in the municipal water
which comes from a much deeper aquifer. None of our water samples have
detected significant levels of volatile or synthetic organic compounds.
After our initial data gathering was complete we convened a panel
of national experts from Federal agencies and academia. These experts
reviewed our processes and data. They also provided and continue to
provide advice on further steps that should be taken to continue the
investigation. I have included a copy of their initial report with the
written copy of this testimony.
Although I am not familiar with the public health resources in New
York, I suspect that Nevada has a somewhat leaner infrastructure. We
have, therefore, found it essential to utilize advice and resources
provided through the Centers for Disease Control and Prevention (CDC)
as well as the Agency for Toxic Substances and Disease Registry
(ATSDR).
I would like to briefly comment on some obstacles that we have
encountered and lessons we are learning. A potentially serious obstacle
to our ongoing investigation has come from the legal profession. We are
now being challenged to provide copies of our data collection
instruments as well as actual data. These demands are coming at a time
when we are just beginning to do case-control studies. The danger,
aside from obvious concerns about confidentiality, arises when
unofficial parallel investigators introduce informational biases into
the study population that may blur subtle distinctions between case and
comparison families that would otherwise have provided important clues.
We have also experienced media sponsored investigations resulting in
spurious connections among case families that are over interpreted and
result in panic among residents of the community at large. I believe
these issues point to a need for lawmakers to provide some form of
investigative privilege that would protect the scientific integrity of
an ongoing public health inquiry.
Another phenomenon that arises in high profile cluster
investigations is the emergence of self-proclaimed experts who promise
to find answers more quickly than public health officials. Some of
these individuals have legitimate scientific credentials from fields of
study that are only tangentially related to the issues under study.
Others are completely without scientific training. All of them have a
tendency to tell the community what they want to hear, create distrust
between the community and public health officials, and cause a waste of
resources as health officials investigate and attempt to dispel myths
and misinformation.
A lesson we have learned from this is that it is essential to keep
the community well informed as to the progress of the investigation.
Even seemingly mundane but necessary activities are of interest to the
public and help concerned individuals to understand that the
investigation is continuing. We conducted a public meeting for the
community early on in the investigation, established a toll-free
hotline that people can call for information, and developed a web page
with information specific to the investigation. We have begun to do
weekly media briefings and last week conducted the first of what we
expect will become a monthly open forum with the community. At our
first open forum we had over 150 people in attendance asking questions
for more than 2 hours. Staff to the investigation remained for an
additional hour answering one-on-one questions. Involvement of the
local medical community in these meetings is essential. One common
question that is frequently asked by the public is whether or not they
should move away from the area. Unfortunately, we cannot provide them
with a science-based answer at this time. We have, however, been able
to obtain State emergency funds that have been used to increase
staffing by local mental health professionals. This provides a
mechanism for individuals to receive assistance in making decisions in
the face of scientific uncertainty and to deal with other stressful
aspects of living in a community where a significant health concern is
constantly the center of attention.
In closing, I would like to mention some things that might be done
on a national level that could assist other communities facing a
cluster of disease. First, because most children with cancer receive
their definitive diagnosis and initial treatment at major cancer
centers that may be located in a neighboring State, there can be
significant delays in reporting to the central cancer registry in their
State of residence. Some form of national cancer registration for
childhood cancers would be very helpful in this regard. Second, when
faced with a cancer cluster, the public attention invariably turns to
the environment. There is a seemingly infinite number of possibilities
when it comes to evaluating environmental concerns within the context
of an emerging or ongoing cluster. A set of national recommendations
for environmental surveillance would be helpful in this regard. Third,
a standardized national protocol from agencies such as CDC and ATSDR
would allow them to respond to State and local concerns more quickly.
It has been exceptionally difficult to explain to an impatient public
why it should take so long to develop a scientific protocol, have it
approved by the appropriate committees for the protection of human
subjects, and then implement it in the field. Having some things done
in advance would go a long way toward minimizing this frustration in
the community.
I hope these remarks have been helpful. I would be pleased to
answer any questions the committee may have.
______
Attachment
Review and Recommendations of the Expert Panel Dr. Leslie L. Robinson,
Professor, Department of Pediatrics, School of Medicine, Director,
Division of Pediatric Epidemiology and Clinical Research, University of
Minnesota Cancer Center; Dr. Thomas Sinks, Associate Director for
Science, National Center for Environmental Health, Centers for Disease
Control and Prevention; Dr. Allan H. Smith, Professor of Epidemiology,
School of Public Health, University of California, Berkeley; Dr.
Malcolm Smith, Head, Pediatric Section, Cancer Therapy Evaluation
Program, National Cancer Institute, National Institutes of Health; Dr.
Mary E. Guinan, Nevada State Health Officer; Dr. L.D. Brown, Director,
Nevada State Health Laboratory; Dr. Randall L. Todd, Nevada State
Epidemiologist; and Dr. Burton A. Dudding, Professor, Behavioral
Pediatric and Adolescent Medicine, University of Nevada School of
Medicine
The expert panel was convened on February 15, 2001, in Reno, NV by
Dr. Mary Guinan, Nevada State Health Officer. The panel reviewed the
Nevada State Health Division's investigation of acute lymphocytic
(lymphoblastic) leukemia (ALL) cases that had been diagnosed in
Churchill County, NV. The panel considered possible follow-up actions
and priorities by the Nevada Health Division. The meeting of the expert
panel was attended by panel members and staff from the Nevada Health
Division, University of Nevada School of Medicine, Nevada Governor's
Office, U.S. Senate (Senator John Ensign's Office and Senator Reid's
staff on U.S. Senate Committee on Environment and Natural Resources),
and the Fallon Naval Air Base. This report summarizes the panel's
review and recommendations.
The expert panel recognized the difficulty in evaluating and
investigating excess occurrences of ALL. The panel members acknowledged
that the cause(s) of ALL are insufficiently understood to single out a
specific factor as explaining the observed excess in Fallon, NV. The
panel members were familiar with previous investigations of ALL
clusters, all of which had failed to uncover an explanation of the
cause of these excesses. At the same time, the panel members confirmed
that the excess occurrence of ALL in Fallon, NV is unusual; not only
because of its large number of observed cases among so small
population-at-risk over a short time period, but also because further
observed ALL cases had been diagnosed after the initial recognition of
the ALL excess. The members of the expert panel acknowledged the
excellent work of the staff of the Nevada Health Division on this
investigation.
Scientific understanding of the biology of ALL prevented the
committee members from predicting the cause of the observed excess of
cases in Fallon. The committee is aware of at least three distinct sets
of possibilities. The first set of theories collectively point toward a
cancer causing chemical contaminant (e.g., human carcinogen) as the
causal agent for the ALL epidemic. Theories about a chemical in the
environment have received the greatest amount of public attention and
community concern. The expert panel recognizes the need to address
community concern regarding the presence of a hazardous chemical
contaminant. However, the absence of cases of acute myeloid leukemia,
the type of leukemia most commonly associated with toxic chemical
exposure (1-3), argues against the Fallon cases being the result of
toxic exposures. The panel members were skeptical that a chemical
exposure could explain the excess cases of ALL in Fallon, NV. A second
possible explanation relates to the theory of what is called poulation
mixing in which clusters of ALL have been reported associated with
unusual mixing of people, often in relatively isolated rural areas (4-
11). The population mixing theory initially focused on the possibility
of an unidentified infectious agent (i.e., a virus). However, the
current consensus is that exposure to a variety of infectious agents
(i.e., viral and bacterial) may trigger an unusual and rare reaction
that affects a very small number of children within the susceptible
population. The hypothesis suggests that ALL is not infectious,
spreading from one person to another; but an unusual complication to a
common infection within a susceptible population. The population-mixing
theory is supported by the observation that excesses of ALL eventually
subside, presumably because of increased population immunity. This
theory requires further examination. The panel believes it reasonable
to test this hypothesis by calculating rates of ALL in other rural
areas of the United States having significant population mixing.
However, such an effort falls outside the mandate of the Nevada Health
Division. Finally, the possibility that the excess of ALL cases is due
to random chance cannot be totally excluded as an explanation. The
panel acknowledges, however, that the excess of ALL cases in Fallon, NV
is not likely to represent a ``chance'' occurrence.
The expert panel recommends to the Nevada Health Division six
follow-up steps in the investigation of the excess occurrence of ALL in
Fallon, NV (see Table 1).
The purpose of these next steps are to: (1) efficiently expand
case-finding efforts, (2) categorize the observed ALL cases by
clinically relevant disease biomarkers, (3) identify potential excess
environmental exposures unique to the community by a cross-sectional
exposure assessment of selective contaminants and an evaluation of
contaminant releases into the local environment with assessment of
completed pathways for the case families, (4) collect and bank biologic
specimens for future scientific investigations, (5) determine the time
course and characteristics of population movements into the Fallon area
for the period 1990 to 2000, and (6) maintain an expert panel to peer
review investigative protocols and study results, consider future use
of banked specimens, and provide ongoing consultation to the Nevada
Health Division.
The expert panel also discussed the importance of high
concentrations of arsenic in municipal and private drinking water
supplies. The panel members expressed doubt that arsenic consumption in
drinking water, by itself, could explain the observed ALL excess for
several reasons: (1) The excess occurrence of ALL began in 1999,
whereas the arsenic concentrations in drinking water have been
consistently elevated for many years. (2) The case children who makeup
the excess occurrence of ALL differ in respect to their consumption of
arsenic contaminated drinking water. (3) Epidemiologic studies of
arsenic exposed populations have not linked arsenic exposure with adult
or childhood leukemia. One recent article suggests a weak association
between childhood leukemia risk and exposure to low levels of arsenic
in drinking water (12). The panel has reviewed the article and believes
that the study is inadequate to support a conclusion that ALL is
related to arsenic in drinking water. Each panel members expressed
concern that the ongoing exposure to excess levels of arsenic in
drinking water was a human health hazard, regardless of its
relationship to the excess of ALL. The Fallon municipal water supply is
contaminated with arsenic (As) at a level 10 times the EPA recommended
standard for arsenic in drinking water. The panel was also aware that
an unknown proportion of Churchill County drinking water wells,
unregulated by the Federal Safe Drinking Water Act (SDWA), are at least
as contaminated as the Fallon municipal water supply. Arsenic is
recognized by the Report on Carcinogens of the National Toxicology
Program as a known human carcinogen on the basis of epidemiologic
studies that have linked arsenic exposure with an excess of skin,
bladder, and lung cancers in exposed human populations.
The expert panel recommends that arsenic concentrations in the
Fallon municipal drinking water be reduced to a level no more than that
currently recommended by EPA (e.g.; 10 g/L) as soon as
possible. The panel strongly encourages the Nevada Health Division, and
other State agencies, to proceed with recommendations for testing
arsenic in all drinking water wells in Churchill County that are
unregulated by the SDWA. The State health division should work to
create a process providing this service when necessary and develop a
set of recommendations for preventing arsenic exposure based on
reported test results. The State health division should consider
maintaining a listing of wells that have been tested along with test
results.
TABLE 1.--INVESTIGATING THE EXCESS OCCURRENCE OF ACUTE LYMPHOCYTIC
(LYMPHOBLASTIC) LEUKEMIA IN FALLON, NV: PHASE II RECOMMENDATIONS OF THE
EXPERT PANEL (FEBRUARY 15, 2001)
Priority: Task/Time frame/Collaborators
1. Efficiently expand case-finding efforts. The panel members
encourage the Nevada Health Division to continue limited case-finding
strategies. The panel members recommended limited expansion of case-
finding by linking to:
a. The national Childhood Oncology Group (COG) database(s) to
identify all children with ALL having a residence at time of
diagnosis in the State of Nevada. The purpose of this would be
to evaluate completeness of the Nevada tumor registry and
identify additional ALL cases from Churchill County.
b. An ongoing case-control study of ALL being conducted in
California to review residential history of cases for previous
residence in Churchill County, NV.
c. The California State Tumor Registry to identify any
children with ALL with a Nevada residence at time of diagnosis.
Time frame.--These additional steps could be done within 2 months
after satisfactory negotiations regarding patient confidentiality are
completed.
Potential Collaborators.--Clinical Oncology Group, California Tumor
Registry, California ALL research team.
2. Categorize the observed ALL cases by clinically relevant disease
biomarkers. Cancer cells from each case-child have probably been
collected and undergone immunophenotyping and cytogenetic testing. The
health division should collect this information. If testing has not
been done and tumor cells have been stored, the health division should
secure samples and have them tested. These materials could be reviewed
or tested at two independent laboratories. The distribution of these
results among the case-children from Fallon can be compared against
other children with ALL to determine if these distribution are similar
or if the distribution among the Fallon case-series is unique.
Time frame.--The health division should proceed to determine
availability of data or tumor cells as soon as possible.
Potential Collaborators.--Pediatric oncologists, Childhood Oncology
Group, National Cancer Institute.
3. Identify potential excess environmental exposures unique to the
community. The health division should conduct limited testing for
current exposures in environmental media or human samples as well as
evaluate contaminant releases into the local environment and assess the
potential for human exposure to such contaminants. This analysis would
be used to identify chemicals that are (and are not) elevated in the
community and to consider if additional data collection is required.
a. A cross-sectional exposure assessment of selective
contaminants would include examination of drinking water, human
blood and urine of family members, and possibly dust collected
from homes where case-children did and did not live. Testing
should be limited to compounds for which normative data are
available. The expert panel recommended testing for volatile
organic compounds in drinking water and human tissues;
radioactive isotopes in drinking water; selected heavy metals
in drinking water, household dust, and human tissues; and
pesticides in human tissues and in household dust.
b. An evaluation of contaminant releases into the local
environment with assessment of completed pathways for the case
families. The expert panel recommends collecting environmental
releases data, including that from local industry and the
Fallon Naval Air Station. An assessment of the potential for
environmentally-released chemicals to result in human exposure
should also be conducted, including potential for case-children
to have been exposed.
Time frame.--These activities will require development of survey
and sampling protocols and appropriate review of consent forms and
confidentiality agreements. The committee anticipates start-up of these
activities during the months of March or April and available results
within 1 year.
Potential Collaborators.--National Center for Environmental Health,
Centers for Disease Control and Prevention; Agency for Toxic Substances
and Disease Registries; Jonathan Buckley (University of Southern
California) for input on measuring house dust for pesticide residues,
heavy metals, PAHs.
4. Collect and bank biologic specimens for future scientific
investigations. The members of the panel recognize how limited our
knowledge is of the cause(s) of ALL and the difficulty investigators
have had in identifying the causes of similar ALL excesses. The panel
members believe that collection of biologic specimens from case-
children and family members may be useful for future research
investigations into the cause(s) of ALL. A small amount of blood and
urine, and perhaps buccal cells, should be collected, maintained, and
made available for future research.
Time frame.--Collection of specimens could occur simultaneously
with the exposure assessment (see 3A) or include samples taken during
clinical care. a protocol for collection, storage, and access to
samples must be developed and reviewed by an Institutional Review Board
for compliance with human subject research.
Potential Collaborators.--Nevada Public Health Laboratory, National
Center for Environmental Health, Centers for Disease Control and
Prevention, National Cancer Institute as possible repositories for the
tissue bank.
5. Determine the time course and characteristics of population
movement into the Fallon area for the period 1990-2000. The expert
panel recommends collecting demographic data concerning changes in the
population of Fallon, specifically looking for evidence of large
migration of new long-term residents into the community during this
time period. The appended table illustrates the kind of first-level
information that is relevant to this issue.
Time frame.--Initial data collection within 2 months.
Potential Collaborators.--Public school systems and Fallon Naval
Airbase (for information concerning migration patterns), Drs. Les
Robison and Malcolm Smith (for consultation to identify the specific
data required).
6. Maintain the expert panel to peer review investigative protocols
and study results, review proposals for future use of banked specimens,
and provide ongoing consultation to the Nevada Health Division.
REFERENCE LIST
1. Felix, C.A. Secondary leukemias induced by topoisomerase-
targeted drugs. Biochim Biophys Acta 1998; 233-55.
2. Bennett, J.M., Moloney, W.C., Greene, M.H., Boice, J.D. Acute
myeloid leukemia and other myelopathic disorders following treatment
with alkylating agents. Hematol.Pathol. 1987; 99-104.
3. Rothman, N., Smith, M.T., Hayes, R.B., Traver, R.D., Hoener, B.,
Campleman, S., Li, G.L., Dosemeci, M., Linet, M., Zhang, L., Xi, L.,
Wacholder, S., Lu, W., Meyer, K.B., Titenko-Holland, N., Stewart, J.T.,
Yin, S., Ross, D. Benzene poisoning, a risk factor for hematological
malignancy, is associated with the NQO1 609C->T mutation and rapid
fractional excretion of chlorzoxazone. Cancer Res 1997; 2839-42.
4. Kinlen, L.J., Epidemiological evidence for an infective basis in
childhood leukaemia [editorial]. Br. J. Cancer 1995; 1-5.
5. Kinlen, I.J., Clarke, K., Hudson, C. Evidence from population
mixing in British New Towns 1946-85 of an infective basis for childhood
leukemia. Lancet 1990; 577-82.
6. Kinlen, L.J., Hudson, C. Childhood leukemia and poliomyelitis in
relation to military encampments in England and Wales in the period of
national military service, 1950-63. B.M.J. 1991; 1357-62.
7. Kinlen, L.J., O'Brien, F., Clarke, K., Balkwill, A., Matthews,
F. Rural population mixing and childhood leukemia: effects of the North
Sea oil industry in Scotland, including the area near Dounreay nuclear
site. B.M.J. 1993; 743-8.
8. Kinlen, L.J., Petidou, E. Childhood leukemia and rural
population movements: Greece, Italy, and other countries. Cancer Causes
Control 1995; 445-50.
9. Kinlen, L.J. High-contact paternal occupations, infection and
childhood leukemia: five studies of unusual population-mixing of
adults. Br.J. Cancer 1997; 1539-1545.
10. Alexander, F.E., Chan, L.C., Lam, T.H., Yuen, P., Leung, N.K.,
Ha, S.Y., Yuen, H.L., Li, C.K., Lau, Y.L., Greaves, M.F. Clustering of
childhood leukemia in Hong Kong: association with the childhood peak
and common acute lymphoblastic leukemia and with population mixing.
Br.J. Cancer 1997; 457-63.
11. Petridou, E., Revinthi, K., Alexander, F.E., Haidas, S.,
Koliouskas D., Kosmidis, H., Piperopoulou, F., Tzortzatou, F.,
Trichopoulos, D., Space-time clustering of childhood leukemia in
Greece: evidence supporting a viral actiology. Br.J. Cancer 1996; 1278-
83.
12. Infante-Rivard et al. Drinking water contaminants and childhood
leukemia. Epidemiology 2001; 12:13-19.
__________
Statement of James R. Hare, Councilman, City of Elmira, NY
Senator Reid and members of the Committee on Environment and Public
Works:
I appreciate the opportunity to speak with you this morning. I have
been a teacher at Southside High School in Elmira, NY, for over 16
years. I was at the school when it opened in 1979, then went to another
school for 6 years and resumed in 1986 and have been there since. My
son attended Southside for 4 years, graduating in 1997, and as a former
Mayor of Elmira and currently a city councilman representing, a south
side district, many of any constituents have a direct connection with
the school.
I believe there is a story to tell about Southside which may be of
some help to your investigation. For the last year the school and its
grounds have been undergoing tests for hazardous wastes because of its
location on part of an 83-acre former industrial site and the fact that
there appears to be an inordinate number of cancer cases among the
student body. (I have a timeline for use of the property for you).
A logical question is why now? Why after 20 years of use are these
questions being raised? The fact is people have wondered about this
site since the school was built. It has been stated publicly by NYSDOH
and environmental officials that with today's standards the school
would not be built on this site, but 20 years ago these standards and
the sensitivity we have today were not present. Yet at least privately
many have been troubled by the fact that part of the old plant remains
standing and in use, right next door to the school and by reports of
illness, specifically cancer over the years. (I have a letter from a
retired teacher to that effect).
It all came together last year. Scott Technologies, Inc., of
Mayfield, OH, who are the current owners of the property adjacent to
Southside High School undertook a voluntary cleanup which took 4 months
and cost $900,000. According to newspaper reports, ``Tons of
contaminated soil, storage tanks and equipment containing an alphabet
soup of hazardous wastes were removed . . . that included removal of
2,000 cubic feet of contaminated soil, abandoned fuel and chemical
storage tanks and electrical equipment containing polychlorinated
biphenyls commonly known as PCB's''. Other chemicals found and removed
include, ``arsenic, lead, zinc, cadmium and the solvents toluene,
ethybenzine and xylenes'' (Star Gazette, April 23, 2000). The site was
given a clean hill of health by the State as the work was done under
the supervision of the NYSDEC. It should be pointed out that
contaminated soil ``did contain hazardous waste some in levels 1,000
times higher than allowed by the conservation department. (Star
Gazette, April 23, 2000) I have a copy of the Citizen Participation
Plan for Remediation of the American LaFrance Facility prepared for
Scott Technologies).
Also last year NYSDEC completed an investigation of petroleum
contamination initially found in the vicinity of Miller Pond. The
investigation began after a sheen in Miller Pond was reported to DEC in
1995. The contamination is believed to have resulted from the activity
of industries that previously occupied the area. The source of
contamination was found to be under the gym at Southside High School.
DEC used a technique called bioremediation to address the fuel oil
contamination. (DED Fact Sheet, April 2000).
Finally, at a meeting of students in the school auditorium last
year, organized to promote participation in the Relay for Life it was
reported that six Southside students had cancer. That made 13 cases
since 1997. I was stunned. I had known of some cases and two of my
son's classmates were survivors, but six in 1 year was an eye-opener.
I wrestled for a bit with my responsibility as an employee, a
parent, and as a councilman and decided that questions needed to be
asked. I called together an ad hoc committee to meet at my home. Tim
and Margaret Tobin, whose son currently is a junior at Southside and is
a cancer survivor, Andy and Julie Patros whose son graduated with mine
and is a cancer survivor, Mike and Luann Smith, whose daughter
graduated with mine and Mike is the Emergency Management Director for
Chemung County and a former Southport Town Board Member, and Councilman
Dan Royle who has had two sons graduate from Southside and has another
planning to go there. We agreed to draft a letter to the Elmira City
School Board, on City Council stationery raising a number of issues,
dated April 8 (I have a copy of that letter and another letter from our
group).
We did not release our letter to the press, but it found its way
there. The Elmira Star Gazette began what I believe to be one of its
best journalistic endeavors investigating and reporting of the cancer
issue at Southside. Margaret Costello, who did much of the reporting is
a Southside graduate.
I must say that the school board which had shown no curiosity about
this issue previously responded positively to our letter. Tom Kump,
director of the Chemung County Health Department and a school board
member met with us and the process of investigation got underway.
On April 14, Kris Smith of NYSDOH was quoted, ``We get a myriad of
calls of this nature. We respond to all of them. But in order to
prioritize it we need to review the facts to determine if its an
unusual type of cancer, the same type of cancer, the timeframe, and are
there any logical explanations for what is occurring.'' (Star Gazette,
April 14, 2000).
On April 30, it was reported that ``State environmental experts
would begin testing the soil at Southside . . . for chemicals and
contaminants similar to those found on the adjacent industrial site''.
One of the environmental engineers stated that the conservation
department never had any reason to believe there was metal
contamination at the school (Star Gazette, April 30, 2000) HELLO.
On May 2, after a preliminary investigation State health officials
said that Southside High School was not a health hazard to students.
Headlines read ``High School Found Safe''. (Star Gazette, May 2, 2000).
These responses indicate that situations like ours face a mix of
competing concerns which the State must react to based on time,
resources, and bureaucratic inclination. This is tough to digest for
those directly impacted and quite frankly raises the question about how
thorough the State will be when they do investigate. What I believe we
learned is that the more pressure that can be put on the State the
better the investigation will be. But to be effective in applying
pressure the local community has to know what questions to ask and to
whom they should be directed.
At this point our committee recognized that we needed assistance,
so that the issues would be qualitatively addressed. Our Mayor, Stephen
Hughes (Southside graduate) and our City Manager recommended that we
approach Craig Slater, an environmental attorney from Buffalo, who had
done some work for Elmira, and has been involved with Love Canal.
Courageously, the City Council authorized expenditure of $15,000 for
Craig's services in the interest of protecting the public. In 1997, the
City applied for and received a $200,000 Brownfields Demonstration
Pilot Grant. The city has asked, and EPA Region is considering, a
reallocation of a portion of the Brownfields award to reimburse city of
Southside related assessment costs.'' With the advice of Craig Slater
we also hired Barron and Associates/and Golder Associates as
consultants to do a Phase I analysis. Craig, and our committee would
serve as a third party separate from the interests of the school
district and the State, we would represent the community. Craig's
expertise positioned the public to be able to ask the right questions,
challenge methodology used by the State and I think energized the
school district to more aggressively seek answers.
I have for you Mr. Slater's response and comments on the
investigation which has taken place at Southside. I believe his
response should provide you with some insight about the nature of this
investigation. For instance, he raises questions about the methodology
of site investigation (they did no phase one, the City did), and he
questions comparison values which appear to be ``derived from generic
residential exposure scenarios, and not site-specific exposure
scenarios''.
The Elmira School District also acted responsibly in my opinion.
Once our new Superintendent, Laura Sherwood came on board, she met with
Tim Tobin and myself for some historical perspective. The district
hired a special attorney Rick Kennedy from Hodgson Russ Andrews Woods
and Goodyear. She formed a reputable advisory committee, including Tim
Tobin, Julie Patros, and Craig Slater as co-chair with the school
attorney. In addition, the district hired their own consultants Brian
C. Sendfelder, CHMM from Golder Associates and Dr. Rosalind Schoof from
Gradient Corporation to analyze information. Also the school district
voted to close the athletic fields until more could be learned. All
committee meetings were open to the public and press Mr. Tobin will
discuss the work of the committee.
WHAT ARE THE LESSONS WE HAVE LEARNED?
1. We have learned thus far that while the site raises serious
questions it is difficult to make a direct link between what is in the
soil and cancer.
2. We have resolved that the air and water quality in the building
is safe and we have identified ``hot spots'' on the school grounds.
3. I believe we have demonstrated that a community can work
together to search for the truth if the process is open and conducted
professionally. We may disagree on the conclusions and unanswered
questions remain, but a great deal of time and money has been spent to
examine the problem.
4. The ability to access expert help serving the community interest
was extremely important to the credibility of what was done. It made
both the State and the school district assume more accountability.
5. The school district has undertaken an extensive survey of alumni
to research health issues, particularly cancer, which have not surfaced
and might shed more light on what has been investigated so far.
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Statement of Tim Tobin, Elmira, NY
My son, Michael, was diagnosed with testicular cancer on November
22, 1999. At that time, he was a 15-year-old sophomore, who ran cross-
country, track, and raced bicycles. Nothing I can say can describe the
feelings his mother and I experienced when told ``your son has
cancer''. Michael underwent immediate surgery. In January 2000, we flew
to Indianapolis for additional surgery at the center where Lance
Armstrong was treated.
Within a week of my son's diagnosis and first surgery, a parent
whose son was diagnosed with testicular cancer 2 years prior contacted
me. This father and I began a dialog about cancer and the oddities of
this disease. It would not be long until a third young man would come
to be diagnosed with testicular cancer. Researching National Cancer
Institute Data, first to find information about the nature, treatments,
and survivability of this cancer, and later to assess the
``peculiarities'' of testicular cancer cases among young men led me to
a startling discovery.
The NCI data for the occurrence of testicular cancer is between 3
to 4 cases per 100,000. Almost 70 percent of these cases occur in men
in their mid twenties to early forties. Rates for people of Hispanic
descent, such as my son, are less. The NCI statistics, in addition to
with what I would later learn about chemicals used in industrial
manufacturing that are in the ground where my son attends school, lead
me to this conclusion--I had a greater statistical likelihood of
developing testicular cancer than my son, unless there was another
factor at play. Coupled with the growing awareness of other cancer
cases, this was cause for concern and inquiry.
Elmira, NY has been home to many former industrial sites typically
found in northeastern cities. My son's high school was built on a site
that had experienced 100 years of industrial use. During the years of
manufacture, some of the chemicals used and that are still present on
the site include, but are not limited to PCB's, chromium, beryllium,
arsenic, lead, nickel, zinc, phthalates and trichloroethelene. All of
the above chemicals are known to, or highly likely, to be carcinogenic.
In evaluating the site various criteria was used to determine
safety. Many of the chemicals in the soils at Southside High School and
in the industrial site that still stands right next door exceed
acceptable human exposure limits from either the EPA or the NYSDEC.
However, they were still determined to be safe. In many cases, the
NYSDOH stated that exposure would not occur due to a ``well established
grass cover'' (NYSDOH Preliminary Draft August 22, 2000)
I have also read recent Federal studies on phthalates have
indicated that exposure to this chemical causes ``testicular lesions''
in lab animals. (Center for the Evaluation of Risks to Human
Reproduction). I also must question the inherent contradiction that
this area is safe when several experts have repeatedly stated that ``we
could not build this facility here today as it would not pass
industrial standards.'' And no where in all of the data, studies, and
reports from any of the different investigate or public health
agencies, is there a mention that this site is on or directly
contiguous to a DEC Class 2 Superfund site. This information, taken
directly from DEC files by NYPIRG, was published in the Elmira Star-
Gazette on May 30, 2001.
I would submit that clear-cut standards of chemical levels and
exposure levels be implemented across the board. Further discussion,
such as issues raised by the U.S. News and World Report on June 19,
2000 or measures recommended in ``Poisoned School--Invisible Threats,
Visible Actions,'' needs to be engaged. Clean-up measures should be
taken to meet these standards. Public notification of schools when an
industrial cleanup takes place is a must. In September 1999, such a
cleanup was taking place during school hours at the site next door to
my son's school. I can only imagine the chemical exposure that children
were unknowingly subjected to from this activity.
I believe that industrial waste is a danger to humans. I believe
that a more diligent, cooperative approach to ``fix'' the problem,
rather than place blame is needed.
In particular, I believe that these substances are enhancing the
risks and rates of cancer in our children. This is one risk that needs
to, and can be, eliminated.
I would like to thank the city of Elmira and its elected officials
for the position and leadership they have taken on this issue. I would
like to thank all of the members of the committee for your interest in
this matter.
__________
Statement of Karen Joy Miller, Founder and President, Huntington, NY,
Breast Cancer Action Coalition
Good morning. I am Karen Joy Miller from Huntington Long Island and
I'd like to begin by thanking this esteemed panel for allowing me to
testify today. Senator Reid, Senator Clinton, Congressman Ackerman,
Congressman King, Congresswoman McCarthy, Congressman Grucci and
Congressman Israel, you have all been very supportive of grassroots
efforts to put an end to breast cancer and this hearing is evidence of
your concern.
I have lived on Long Island for 33 happy years raising three
children with my husband Michael. 1987 was the year when our peaceful
existence was shattered by the news of my breast cancer diagnosis.
Thanks to the wonderful support of my immediate family. I was
eventually able to regain my breath. Once on my feet, I was fortunate
enough to find three other women in my town who were willing to ask the
vital question: WHY? Together we started the Huntington Breast Cancer
Action Coalition, whose first major project was to map the incidence of
breast cancer within our township. I always knew that education equaled
power . . . the power to create change. With that in mind, I set out to
arm myself with solid information. I read all I could, asked
innumerable questions and along the way was lucky enough to meet the
experts and learn from them.
Breast cancer is a disease that has been puzzling us for centuries.
We have come a long way in solving this puzzle but it is an undeniable
fact that we have just begun the serious research into understanding
the relationship between the toxicity of our environment and disease.
Even though we are all hearing about the major breakthroughs in the
fight against cancer, such as the completed Genome Project and the new
wonder drug Gleevec, there is a long way to go before we can rest easy.
The efforts of our Coalition along with many grassroots groups
nationwide, have laid the groundwork by increasing public's awareness
of breast cancer. The growing number of women having regular mammograms
is proof of that very effort. Yet, despite the heightened awareness and
vigilance, breast cancer rates have jumped by 40 percent since 1973.
THAT IS SERIOUS cause for alarm!
Earlier I mentioned the mapping project initiated by our coalition
Huntington Breast Cancer Action Coalition. Please take a moment to look
at the dots. Each of these dots, no matter what the color, represents a
woman who is ALSO asking the question why? She is willing to provide
any answers the researchers want to know. She is willing to tell you
confidential information about herself. She is one of the millions who
want to know WHY?
Our high-tech world makes our lives more comfortable and convenient
by the day, yet that same world bears responsibility for toxic
pollution. Industrialization has been at the core of our success as a
society, but the price has been much too high in terms of our health.
Breast cancer activists as well as informed people everywhere
believe that toxins in the environment may be just as responsible for
creating genetic abnormalities, as are inherited factors. Widespread
and cumulative exposure to toxic agents in the air we breathe, the
water we drink, the food we eat and the constant radiation our bodies
absorb, may be causing dangerous alterations to the healthy cells in
our bodies. Our immune system simply cannot fight them all off and
ultimately cancer takes hold.
I am here to ask you, our valued representatives, to PLEASE take on
some major new initiatives:
There must be incentives to encourage environmental
research. Breast cancer activists all across this country have helped
raise multiple millions of dollars for research. But environmental
researchers have been getting seriously short-changed by funding
agencies like NCI. Breast cancer research must be more
interdisciplinary and more focused on environmental contaminants. And
that research must be done with the active assistance of the breast
cancer community.
Government must improve its data bases so that scientists
can do their work properly. Today's cancer registries are woefully
inadequate. They do not collect many forms of information that are
vital for researchers. Work with us to improve these cancer registries.
We all need better information so we can make healthier
lifestyle choices. We need the Federal Government to provide that
information in a format that is easy to use and understand.
We also ask that our government speak openly about the
precautionary principle. It is no longer as simple as telling the
public to ``Get a Mammogram''. While our environment is being tested,
we need honesty on a Federal level about the health risks we face.
In 1994 the FDA recommended that doctors record in
patient's files information to calculate the absorbed dose of radiation
to the patient. Right now most doctors have no idea how much radiation
their patients are exposed to. The fact that many of us see different
specialists, compounds the problem. Please address this vital public
health issue and remember that radiation is a proven environmental
cause of breast cancer.
To date, the effects of groundwater on breast cancer have
not been adequately researched. Many on Long Island are concerned that
our water distribution systems increase our cancer risks, and this
needs greater attention.
The Senate must ratify the international POPS treaty
dealing with the Persistent Organic Pollutants such as PCB's, chlordane
and dioxins. The elimination of these contaminants must begin without
delay.
It is high time to reverse these trends, and with your help it can
be done.
In the spirit of cooperation and community, we sincerely hope that
your persistence and assistance during these next 4 years will make a
REAL difference in the fight against breast cancer. . . . When I
learned that I had breast cancer in 1987, I was devastated. My family
was devastated. Improved methods of detection and cure are essential,
but they are not enough. We must get at the root causes of breast and
other cancers. There is a growing body of evidence that supports our
claims.
Industrial toxins are killing us. Please help us to clarify our
understanding of risks and work with us to reduce our exposure to these
awful chemicals that have become so pervasive in our communities. In
our hearts and minds, we know these are possible and we appeal to you
to speed up that process.
Thank you.
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Statement of Marilie Gammon, Ph.D., Associate Professor of
Epidemiology, School of Public Health, University of North Carolina at
Chapel Hill
Good morning Chairman Reid, Senator Clinton, and distinguished
members the committee. I am Dr. Marilie Gammon, of the University of
North Carolina at Chapel Hill; formerly of Columbia University in New
York. I would like to thank you for inviting me to talk with you about
how our environment may influence our cancer risk.
I am the principle investigator of the Breast Cancer and the
Environment on Long Island Study\1\, which is the cornerstone of the
Long Island Breast Cancer Study Project (LIBCSP). The LIBCSP, funded by
the National Cancer Institute (NCI) and the National Institute for
Environmental Health Sciences (NIEHS), is a multistudy investigation of
possible environmental causes of breast cancer on Long Island, and is a
collaborative effort of New York City and Long Island researchers. My
study is investigating whether certain environmental contaminants
increase risk of breast cancer among women in Nassua and Suffolk
counties. The primary aims are to determine if organochlorine
pesticides, including DDT, polychlorinated biphenyls (PCBs), dieldrin,
chlordane, and polycyclic aromatic hydrocarbons (PAH), a ubiquitous
pollutant caused by incomplete combustion of various chemicals
including diesel fuel and cigarette smoke, are associated with risk for
breast cancer.
---------------------------------------------------------------------------
\1\ The study is sometimes referred to as the Columbia case-control
study, because Dr. Gammon began the study while at Columbia University,
New York, NY.
---------------------------------------------------------------------------
For this population-based study, all women in Nassau and Suffolk
counties who were newly diagnosed with breast cancer during a 1-year
period that ended mid-1997 (cases) were invited to participate. A
comparison group (controls) of women who did not have breast cancer
were randomly selected from the two counties. Altogether about 1,500
cases and 1,500 controls participated. The study participants completed
a questionnaire administered by interview in their homes, and provided
pre- and post-treatment blood samples and urine samples. In addition, a
random sample of participants who had resided in their homes for at
least 15 years participated in a study in which house dust, tap water,
and yard soil samples were collected (home study). About 340 cases and
340 controls participated in this component of the study.
Blood and urine samples from 400 of the cases with invasive cancer,
200 of the cases with in situ disease, and 400 of the controls were
randomly selected from the study population and analyzed. Laboratory
analyses were conducted to measure organochlorine pesticides and PAH-
DNA adducts in blood (PAHs bind to DNA), and urinary markers of
estrogen metabolism. For the home study, samples were assayed for
pesticides and PAHs.
The blood and urine samples of all African-American study
participants were analyzed to increase the data available for this
group. Further, all African-American women participants who had lived
in their homes for at least 15 years were invited to be part of the
home study.
Statistical analyses of the questionnaire data are now in progress.
These data will be coupled with the results of the laboratory analyses
to assess the risk for breast cancer associated with organochlorine
pesticides and PAHs. Findings addressing the two primary hypotheses are
expected to be published later this year.
Newly undertaken research includes examination of the possible
interaction between susceptibility markers and environmental risk
factors on risk for breast cancer. Further, tumor and blood markers of
estrogen and PAH metabolism are being studied, and the laboratory
analyses are now underway. Results from these newer efforts are
expected in the year 2002.
I would be pleased to answer any questions you may have.
__________
Statement of Ruby T. Senie, Ph.D., Professor of Clinical Public Health,
Mailman School of Public Health of Columbia University
Mr. Chairman and members of the committee: My name is Ruby T. Senie
and I am a member of the faculty in the Department of Epidemiology of
the Mailman School of Public Health and Principal Investigator of the
Metropolitan NY Registry. Breast cancer has been the focus my research
for more than 25 years. I wish to thank you, Mr. Chairman, and members
of the committee, for convening this hearing on Long Island to discuss
the potential influence of environmental exposures on breast cancer
risk. Although increased susceptibility to breast and ovarian cancer
has been associated with genetic mutations of BRCA1 and BRCA2,
researchers have recognized that risk is also influenced by
environmental exposures, lifestyle factors, health behaviors, and other
components of the genome. A major challenge to investigators is the
ability to quantify the risk associated with potentially harmful
environmental exposures that may have occurred many years in the past;
however, new technology has enabled the establishment of the field of
molecular epidemiology. With these advanced tools, investigators are
investigating potentially harmful exposures; reduction or avoidance of
such exposures may eventually provide avenues for primary prevention of
breast cancer.
I appreciate the opportunity to describe the purposes and
achievements of the Metropolitan NY Registry and the five other sites
contributing to the Cooperative Family Registry for Breast Cancer
Studies [CFRBCS]. The initial goal of the CFRBCS, funded by the
National Cancer Institute in 1995, was to encourage participation of
key members of cancer-prone families. The families invited to join the
Registry have been identified through high-risk clinics and population-
based cancer registries. The role of family-based research for
etiologic studies, specifically of the interactions of genetic risk
with environmental exposures, was defined and potential
multidisciplinary projects were described.
A major challenge for the CFRBCS Steering Committee was to develop
a universal consent form to meet the Institutional Review Board [IRB]
criteria of the six CFRBCS international sites. The consent form
appropriately informs participants of the interdisciplinary research
that will be conducted using the data and biospecimens they contribute
and that findings from these studies may benefit their own families as
well as society at large. The consent form also assures the protection
and maintenance of confidentiality of all family members while
minimizing any risks that may be associated with their
participation.\1\
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\1\ Daly, M.B., Offit, K., Li, F., Glendon, G., Yaker, A., West,
D., Koenig, B., McCredie, M., Venne, V., Nayfield, S., Seminara, D.,
Participation in the cooperative family registry for breast cancer
studies: issues of informed consent. J. Nat. Cancer. Inst. 92:452-6
(2000)
---------------------------------------------------------------------------
Each participant has been asked to provide medical history, family
and lifestyle information as well as blood and urine samples.
Permission to obtain sections of tumor tissue is also requested of
participants with a history of breast or ovarian cancer or whose
affected relative is deceased. These data and biospecimens provide a
valuable resource for qualified scientists who are studying avenues to
prevent, diagnosis, and treat breast cancer. To ensure the appropriate
use of the invaluable and limited biospecimens, senior breast cancer
researchers of the Advisory Committee evaluate the merits of each
submitted research proposal. Approved projects are then assessed by the
Research Monitoring and Ethics Review Panel to assure that standards of
medical ethics are maintained and the confidentiality of data is
guaranteed.
Family-based genetic studies necessitate the participation of three
or more relatives per family; therefore, women and men with and without
a history of cancer are included. Although the need for enrollment of
families rather than isolated individuals within families has created a
sense of community among participants who share our common goals, some
individuals have hesitated to encourage their relatives to participate.
Some hesitancy has been due to the perception that genetic studies are
qualitatively different from other types of medical research
contributing to fear of genetic discrimination. To reassure
participants and to protect their privacy a Certificate of
Confidentiality has been obtained from the Department of Health and
Human Services prohibiting names or identifying characteristics from
ever being released for any purpose.
Due to the rapid progress of scientific research, especially in the
field of genetics, the exact nature of future studies using the
Registry resources could not be fully described to individuals
considering participation. Therefore, a commitment was made by the
CFRBCS team of investigators to inform Registry participants of ongoing
research and results through biannual newsletters and educational
seminars. [Current issue from NY is attached] Through these mechanisms
participants are also advised of additional research opportunities in
which their active participation might provide personal benefit while
contributing to cancer prevention options, improved screening
modalities and enhanced therapeutic modalities.
Our international CFRBCS now includes more than 6,000 families of
whom 1,150 were recruited by the New York Registry team. To identify a
diverse population of cancer-prone families from the New York
metropolitan area, several of the researchers contributing to the Long
Island case-control study also collaborated in forming the NY Registry.
Families at high risk were defined as having one or more first or
second degree relatives with: early onset breast cancer, a history of
both breast and ovarian cancer, male breast cancer, or three or more
older aged relatives with breast or ovarian cancer. These criteria for
the NY Registry have enabled recruitment of a genetically diverse
cohort of families with a spectrum of risk with potentially inherited
susceptibility to breast cancer.
Data and biospecimens are collected from all participating
relatives using common instruments and laboratory protocols. Coded
personal health information, dietary intake, treatment for breast and/
or ovarian cancer, and pedigree data are routinely transmitted to
CFRBCS Informatics Center. Biospecimens including blood and tumor
tissue samples are banked at each collaborating site following rigid
quality control procedures. Annual followup with all participants has
been conducted to maintain an accurate record of cancer history and
current status of participating family members as well as those who
have not agreed to join.
Data files from all six Registry sites are merged and made
available to approved investigators by the CFRBCS Informatics Center.
Code numbers enable linking of family and personal history data with
genetic analyses; personal identifiers are never available. The
development of research proposals has progressed concurrently with
family recruitment. The banked data and specimens are now being used by
New York colleagues as well as investigators across the country in many
interdisciplinary studies to assess the risk of breast cancer and
breast cancer prognosis associated with susceptibility genes and the
interaction of these genes with environmental exposures.
Familial aggregation of breast cancer has been recognized for
centuries; however, the identification of BRCA1 and BRCA2 indicated the
importance of having a cohort of families for studies linking genetic
and environmental factors for breast cancer studies. Following
identification of specific mutations in BRCA1 and BRCA2 among members
of breast cancer families of Ashkenazi heritage, supplemental funds
were awarded to four of the six CFRBCS sites including the New York
Registry. These funds enabled enhanced recruitment efforts and offer
genetic counseling and test results to interested members of this
subgroup.
Genetic testing assessed the presence of the three founder
mutations including 185delAG and 5382insC on BRCA1 and 6174delT located
on BRCA2. A total of 336 mutations carriers among men and women of
Ashkenazi heritage have been identified in the 1,417 Ashkenazi families
currently participating in the CFRBCS. Of the 1,078 Ashkenazi
participants with a history of breast or ovarian cancer, 18 percent
were found to have inherited one the founder mutations. More than 1,220
blood samples from 93 New York Ashkenazi families have been tested for
the founder mutations. Of these, 144 carriers have been identified
including 120 women and 24 men. In addition to breast and ovarian
cancer, some carriers have reported malignancies of other sites
including prostate, colon, and melanoma. Sixty-one, eighteen men and
forty-three women, found to have a mutation of either BRCA1 and BRCA2
have not been diagnosed with any cancer; however, most are younger than
age 60 and remain at elevated risk. Although genetic counseling with
provisions providing genetic test results was offered to all
participants of Ashkenazi heritage, approximately 25 percent requested
these services. However, during followup calls, additional family
members are now expressing interest in learning their carrier status.
Although a large increase in disease risk has been associated with
inheritance of mutant alleles of the two known breast cancer
susceptibility genes, BRCA1 and BRCA2, these genetic mutations account
for only a small proportion of breast cancer cases. Investigators are
now recognizing the contribution of ``low-risk'' genetic variations to
breast cancer risk. Single nucleotide polymorphisms (SNPs) which occur
frequently in the regulatory and coding regions of genes, may confer an
increase in cancer risk or modify the cancer risk induced by other
factors. The common occurrence of SNPs in the population could
contribute more to cancer incidence than the BRCA1 and BRCA2. SNPs may
interact with environmental exposures modifying their independent
effects disease risk. Studies of many SNPs are currently being
conducted by CFRBCS investigators.
Enrollment of family members is often complicated by the geographic
dispersion of living relatives necessitating much recruitment by phone
and mail. However, this dispersion may be an asset for studies of
suspected environmental contaminants. The metropolitan area includes
regions of downstate New York as well as counties of New Jersey and
Connecticut close to Manhattan. More than 300 participating families
residing on Long Island have a first degree relative living outside the
metropolitan area. To assess the impact of geographic dispersion that
may implicate environmental exposures in breast cancer patterns within
families, studies of paired sisters and parent-offspring sets may
provide unique opportunities to assess cancer risk among individuals
with shared exposures during formative years and differing geographic
environments later in life. In addition, the more than 6,000 enrolled
CFRBCS families are widely dispersed geographically providing the
opportunity to assess breast cancer risk in relation in environmental
exposures, BRCA\1/2\ mutation status and SNPs. As technology advances
enable reliable measures of environmental contaminants, Registry sites
could collect additional data and biospecimens to enhance currently
banked samples in order to assess risk in relation to the interaction
of specific genetic factors and suspected adverse exposures.
The Metropolitan NY Registry and 5 collaborating sites of the
CFRBCS have recently been awarded an additional 5 years of support
indicating the importance placed on this project by Dr. Richard
Klausner, director of the NCI, and Dr. Barbara Rimer, director of the
Division of Cancer Control and Population Sciences. These funds will
support additional recruitment, specifically of minority families, in
order to provide adequate numbers for subgroup multidisciplinary
studies. Disparities in risk and prognosis of breast cancer will be
studied in relation to genetic, environmental, and treatment factors.
Continuing followup interviews will be conducted providing
opportunities to assess specific environmental exposures suspected of
increasing breast cancer risk as well as changes in exposures reported
at entry to the Registry.
The NY Registry and the collaborating sites of the CFRBCS provide a
unique resource for current and future studies of breast cancer risk
associated with genetic factors, environmental exposures, life style
factors, and personal behaviors. During the next 5 years the Registry
should contribute greatly to identifying avenues for reducing the
incidence and enhancing prognosis of breast cancer. I feel privileged
to be leading the New York Registry team and to be contributing to
breast cancer research supported by the National Cancer Institute.
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Statement of Gail Frankel, Field Coordinator and Advocate, on behalf of
the National Breast Cancer Coalition
BACKGROUND AND INTRODUCTION
Good morning. My name is Gail Frankel and I am from Centereach, NY.
I am an 8-year breast cancer survivor. I am also a volunteer with the
Adelphi Breast Cancer Hotline and Support Program.
I am here today as a proud member of the National Breast Cancer
Coalition (NBCC).
Thank you Chairman Reid (D-NV), for holding this hearing, and along
with Senator Chafee (R-RI), Representative Lowey (D-NY), and
Representative Myrick (R-NC), for cosponsoring the Breast Cancer and
Environmental Research Act. Thank you also to my Senator, Senator
Clinton (D-NY), for your support of this legislation and your
commitment to this issue. And thank you to all the committee members
for inviting me here to testify today.
As you know, the National Breast Cancer Coalition is a grassroots
organization dedicated to ending breast cancer through the power of
action and advocacy. The Coalition's main goals are to increase Federal
funding for breast cancer research and collaborate with the scientific
community to design and implement new models of research; improve
access to high quality health care and breast cancer clinical trials
for all women, and; expand the influence of breast cancer advocates in
all aspects of the breast cancer decisionmaking process.
NBCC truly appreciates the fact that you are focusing on the issue
of preventing this disease. We all wonder what causes breast cancer. I
too have questions about what caused my breast cancer. Diagnosed at 53,
I was told that even though my mother died at age 48 from the disease,
my breast cancer was unlikely to be due to an inherited genetic defect
since inherited cancer usually shows up at an earlier age in offspring.
No other high risk factors applied to me. Did my diagnosis have
something to do with where I live? The sad truth is nobody knows; there
is no conclusive evidence about what causes this disease.
THE ENVIRONMENT AND BREAST CANCER
As a volunteer for the Adelphi Breast Cancer Hotline and Support
Program, and as a breast cancer survivor myself, I understand all too
well the concerns women in New York have regarding the possible link
between the environment and breast cancer.
While it is generally believed that the environment plays some role
in the development of this disease, the extent of that role is not yet
understood. NBCC believes that now is the time to focus our attention
and public resources on developing an overall strategy to look at all
aspects of this question. We can no longer afford to spend time,
dollars and lives on isolated issues.
It is with that goal in mind that NBCC convened its first
Environmental Summit in September 1998. This Summit brought together
more than 50 experts, including scientists, advocates, government
officials, and policymakers to begin developing a comprehensive
strategy for studying the potential links between breast cancer and the
environment.
Participants at this Summit brought many diverse perspectives. Some
felt strongly that the environment is to blame for breast cancer.
Others thought the cause is purely genetic. A third group believed that
breast cancer is caused by some combination of the environment and
genetics. While the participants differed in their perspectives, they
ultimately agreed that the lack of evidence about the environment and
breast cancer highlights the need for further studies on this issue.
Furthermore, the decision of which questions to research should not be
made in a vacuum, rather it should be made as part of an overall
strategy of looking at all questions, prioritizing them, determining
where we have some answers, and moving forward from that point. That is
exactly what the bipartisan Breast Cancer and Environmental Research
Act is meant to achieve: a collaborative, coordinated, nationwide
effort to address this issue.
PEER-REVIEWED ENVIRONMENTAL BREAST CANCER RESEARCH--A MODEL FOR
OTHER DISEASES
This legislation would take a responsible approach to the questions
around this issue by authorizing $30 million per year for 5 years to
allow the National Institutes of Environmental Health Sciences (NIEHS)
to make grants for the development and operation of collaborative
research centers to study environmental factors that may be related to
the development of breast cancer.
Under a peer-reviewed grant-making process, modeled after the
incredibly successful Department of Defense Breast Cancer Research
Program, the NIEHS Director could award grants to public or non-profit
entities for the development and operation of up to eight centers for
the purpose of conducting multi-disciplinary research on the links
between breast cancer and the environment.
This legislation would require each center to be a collaborative
effort of various institutions, companies and community organizations
in the geographic areas where the research is being conducted, and
would include consumer advocates. The enactment of such legislation
would bring together a diverse group of entities, which would be able
to take a broad look at the issue and develop a strategy based on
differing perspectives.
And, like the support for the DOD BCRP, this legislation already
has broad bipartisan support from across the political spectrum.
CONCLUSION
We recognize that this is a unique approach to looking at the
environment and breast cancer. But time and time again, scientists,
advocates and policymakers have told us that what is needed is a
coordinated, responsible, innovative strategy. That is exactly what
this bill would be. We appreciate that you, Members of the committee,
have the courage and vision to support this innovative approach.
Thank you again for the opportunity to testify today, and I would
be happy to answer any questions.
__________
Statement of Amy Juchatz, M.P.H., Suffolk County Department of
Health Services
Good morning. My name is Amy Juchatz. I am a toxicologist with the
Suffolk County Department of Health Services, in the Division of
Environmental Quality.
The Suffolk County Department of Health Services is often asked to
become involved in the investigation of cancer cluster investigations.
Typically, our role is supportive to the New York State Department of
Health, which investigates suspected cancer clusters. The State health
department maintains a Cancer Registry. Access to the cancer registry
data, especially in regard to small area analyses, is restricted due to
confidentiality concerns.
In concert with the State health department activities, the Suffolk
County Department of Health Services provides support at the local
level such as conducting site visits, meeting with concerned citizens,
reviewing historical health department records and information
pertaining to each situation or by conducting related environmental
sampling. In addition to these support activities the Suffolk County
Department of Health Services also perform extensive monitoring of
groundwater and drinking water for a wide range of contaminants,
including over 100 pesticides and their breakdown products.
Recently, the Suffolk County Department of Health Services
performed such tasks following an investigation by the State health
department of a cancer cluster identified among former students at a
local high school.
The Long Island Breast Cancer Study, being conducted by the
National Cancer Institute, is another good example of our supportive
role. We transported and analyzed approximately 700 drinking water
samples from residences of breast cancer cases and controls. These
samples were analyzed for an array of possible contaminants, including
inorganics, volatile organic chemicals, heavy metals and chlorinated
pesticides.
Recently, the Suffolk County Legislature passed a resolution
creating a task force to investigate the occurrence of a rare childhood
cancer known as rhabdomyosarcoma. Specifically, this resolution created
the Suffolk County Rhabdomyosarcoma Task Force for the purpose of
developing a comprehensive survey, intended to better identify the
incidence of rhabdomyosarcoma in Suffolk County. The Task Force has
just recently formed and had our first meeting in March.
Local citizens initially raised concern about rhabdomyosarcoma
incidence. The State Health Department has examined the
rhabdomyosarcoma incidence data to see if any potential cancer cluster
was evident. To date, the State has not been able to observe any
geographical clustering, but are re-evaluating the State data base
along with supplemental data provided by the concerned citizens.
I hope that the information that I have provided is helpful to this
committee in its deliberations of cancer clusters and the possible role
of the environment. I would be glad to address any questions you may
have.
Thank you.
Statement of Richard J. Jackson, M.D., M.P.H., Director, National
Center for Environmental Health of the Centers for Disease Control and
Prevention, Department of Health and Human Services
Good morning. I am Dr. Richard Jackson, director of the National
Center for Environmental Health (NCEH) of the Centers for Disease
Control and Prevention (CDC). I would like to thank the committee for
inviting me here today to discuss how environmental exposures can
potentially affect the public's health, and the role that the public
health community can play in addressing these issues.
OVERVIEW
It is well known that short-term, high-level exposures to
environmental chemicals can cause adverse health effects. Much of what
is known about these types of exposures is based on occupational
exposure research involving individuals or small groups of people who
have been potentially exposed to environmental chemicals. However, less
is known about the effects that long-term low-dose exposures can have
on people's health, particularly when the potentially exposed
population is large. Health effects such as birth defects,
developmental disorders, neurological and immunological diseases, and
cancer are often attributed to environmental exposures. When the
suspected exposure source is found in a specific location, or community
in a higher number than would be expected when compared to comparable
locations, people in the community become concerned that there is a
disease ``cluster''. Furthermore, people are also worried that
something in their environment is causing the cluster.
DISEASE CLUSTERS
Disease clusters, such as cancer clusters, can have a devastating
impact on individuals, families, and communities. From a public health
perspective, the ``perception'' of a cluster in a community may be as
important as, or more important than, an actual cluster. Public concern
increases quickly when people think there is a cancer cluster in their
community and that they and/or their children will be harmed. These
situations deserve prompt and effective public health attention.
In the public's mind, cancer clusters are caused by something in
the environment until proven otherwise. While certain clusters may
result from environmental exposures, we need to consider many possible
explanations before drawing conclusions. When searching for the cause
of a cancer cluster, public health workers will have the opportunity to
review the unique environmental aspects of a community and identify
existing known environmental hazards. If public health workers identify
a public health hazard, they should quickly remedy the situation.
Public health action to remove a known human health hazard should not
be delayed.
Cancer cluster reports are common because cancer is common. The
American Cancer Society predicts that this year 1,220,000 Americans
will be diagnosed with non-dermatologic cancer; and over 553,000
Americans will die this year because of all types of cancer.
Fortunately, we are making progress in preventing and controlling
cancer. CDC recently reported good news from California where lung
cancer incidence fell 14 percent between 1988 and 1997. The reported
decline may be related, in part, to the significant declines in smoking
rates as a result of California tobacco control programs. We also know
that early detection of cancer through cancer screenings saves lives.
But, the preventible causes of many cancers remain elusive.
I can assure you that CDC and Agency for Toxic Substances and
Disease Registry (ATSDR) are committed to a public health system that
can quickly identify and respond to community concerns about cancer
clusters. Cancer cluster activities must be integrated into the broader
public health approach to cancer prevention and environmental hazard
control. A community suspects that a cancer cluster exists when more
cases of cancer have occurred than are expected and when there is a
possibility that the cases share a common cause. A few cancer cluster
investigations have led to the discovery of preventable causes, but
this is the exception rather than the rule. These investigations
involved astute researchers and physicians who identified an excess of
extraordinarily rare cancers among their patients (e.g.; adenocarcinoma
of the vagina and diethylstilbestrol; Kaposi's sarcoma and HIV virus;
liver angiosarcoma and vinyl chloride monomer) or who identified a
cluster of certain cancers known to have a single preventable cause
(e.g.; mesothelioma and asbestos).
Approximately 85 to 90 percent of investigations of suspected
cancer clusters find no increased cancer incidence. Even though 10 to
15 percent of investigated clusters do show that the study population
has a higher than expected cancer risk, this increased risk, may be due
to the random distribution of cancer within a population (i.e. chance).
The causes of the remaining clusters are unknown. Routine analysis of
cancer registry data to identify cancer clusters can increase the
number of chance clusters. Statistical tests of cancer registry data
cannot separate observed clusters caused by chance from those due to an
unrecognized common cause.
Although cancer clusters rarely provide a scientific opportunity to
identify a new cause of cancer, public health agencies require the
capacity and technical expertise to support a staged response to public
inquiries about cancer clusters. Public health agencies require the
scientific and technical expertise to identify when an excess cancer
has occurred and to reassure communities when it does not. Cancer
clusters are reported throughout the United States. A survey by the
Council of State and Territorial Epidemiologists found that 41 State
health departments reported 1,900 cancer inquiries in 1996. We don't
know the total number of reported cancer clusters because there is no
national tracking system to identify suspected or confirmed clusters.
MEASURING ENVIRONMENTAL EXPOSURES
Our challenge is to address the public's fear that something in
their ``environment'' is causing the cluster. To effectively determine
the public health impact of a chronic environmental exposure, three
things are tracked. First, we cannot know the hazards of chemicals in
humans unless we monitor what chemicals actually are in the
environment. Tracking toxic chemicals in the environment must include
the amount, concentration, and geographic distribution of known and
potential toxic chemicals. Some systems for tracking this type of data
already exists, for example, within the U.S. Environmental Protection
Agency's (EPA) Toxic Release Inventory which collects data down to the
local level. There are also EPA and State data bases for water, air,
and pesticide environmental contaminants.
Second, actual human exposure levels are tracked through
measurement of chemicals in human blood and urine through a process
known as ``biomonitoring.'' CDC released the first annual National
Report on Human Exposure to Environmental Chemicals. This first edition
of the Report presents levels of 27 environmental chemicals measured in
the U.S. population. These chemicals include metals (e.g., lead,
mercury, and uranium), cotinine (a marker of environmental tobacco
smoke exposure), organophosphate pesticide metabolites, and phthalate
metabolites. An example of what we have observed so far is a decline
from 71 percent in the early1990's to 32 percent in1999 for non-smoking
Americans exposed to environmental tobacco smoke. We are expanding the
Report to include 100 environmental chemicals. Chemicals under
consideration for future Reports include carcinogenic volatile organic
compounds, carcinogenic polyaromatic hydrocarbons, dioxins, furans,
polychlorinated biphenyls, trihalomethanes, haloacetic acids, carbamate
pesticides, and organochlorine pesticides. This data will be collected
annually and the number of chemicals tracked will increase, but this
data is currently only available on a national level.
Finally, health outcomes are to be tracked over time. Specifically,
both disease events and trends in health risk behavior need to be
monitored over time through tracking systems such as vital statistics,
health surveys, and disease registries. As we build a comprehensive
disease tracking system in the U.S. that can provide data on a range of
chronic conditions at the national, State, and local levels, it will be
designed so that the data collected can be linked to the data from the
other two tracking components. A comprehensive, nationwide exposure and
disease tracking system is the only means to access the magnitude and
nature of health risks from environmental exposures.
A STAGED RESPONSE TO CLUSTERS
I will now describe the components of a staged response to clusters
which includes the multi-level, multi-agency public health response
that is required to address potential health problems and public
concerns related to potential environmental exposures.
THE STATE ROLE
Cancer cluster concerns should be addressed by State health
departments working as closely as possible to the affected community. A
staged response is called for, and this requires that State and local
agencies establish a set of core competencies. The first competency is
the ability to determine if a cancer cluster represents an excess
cancer risk for the community. The second competency is the ability to
respond to a cancer cluster concern. A third competency is the ability
to link information about environmental contamination with cancer
registry data.
Most State health departments have developed protocols for
responding to cancer clusters, however, these approaches and capacities
vary from State to State.
High quality, population-based cancer registries are a critical
tool for health departments to address cancer cluster concerns. CDC
currently supports statewide, population-based cancer registries in 45
States, three territories, and the District of Columbia through the
National Program of Cancer Registries (NPCR). The National Cancer
Institute includes the remaining five States as part of its
Surveillance, Epidemiology, and End-Results Program. These registries
systematically collect and analyze cancer incidence and mortality data
to identify and monitor cancer trends over time, guide cancer control
activities, and suggest leads for further research. CDC's NPCR
represents a unique opportunity to strengthen cancer reporting and
registration in the United States. The NPCR collects information on
cancer cases for 96 percent of the nation's population. Since 1997, the
number of NPCR-supported State cancer registries that have been
certified for quality by the North American Association of Central
Cancer Registries has increased from 9 to 29.
Data collected by State cancer registries can be used to guide
planning and evaluation of cancer control programs; help set priorities
for allocating health resources; and advance clinical, epidemiologic,
and health services research. Cancer registry data is essential to be
able to determine cancer patterns among various populations, to monitor
cancer trends over time, and to identify and evaluate suspected
clusters of cancer.
To maximize the benefits of State-based cancer registries, CDC is
developing the NPCR-Cancer Surveillance System for receiving,
assessing, enhancing, aggregating, and disseminating data from NPCR
programs. This system will provide valuable feedback to help State
registries improve the quality and usefulness of their data, and the
system could support important data linkages with other cancer data
bases. Availability of data on a regional and national level will also
facilitate studies in areas such as rare cancers, cancer among
children, cancer among racial and ethnic minority populations, and
occupation-related cancer.
Effective State health departments are reliant on experience staff
who can access and use cancer registry information, interpret these
data and act appropriately upon the results. CDC is currently exploring
various strategies to meet these needs.
When we are able to identify environmental health hazards in
affected communities and link cancer registry information with
environmental exposure data, states well be able to better address
community concerns.
THE CDC AND ATSDR ROLES
CDC and ATSDR respond to cancer clusters by providing
infrastructure support, national leadership, and technical assistance
to States. Technical assistance has included peer review and
consultation, field investigations, and assessment of environmental
exposures. CDC has enhanced State infrastructure by funding State-wide
population-based cancer registries that enable health departments to
review cancer incidence data and assess reported cancer clusters. In
1989, CDC sponsored the National Conference on the Clustering of Health
Events; the proceedings appear in a supplement to the American Journal
of Epidemiology (volume 132, July 1990). In addition, CDC published
Guidelines for Investigating Clusters of Health Events in July 1990.
The guidelines can be accessed at: http://www.cdc.gov/mmwr/preview/
mmwrhtml/00001797.htm CDC continues to review these documents and the
current science to be able to revise guidelines as appropriate.
ATSDR and CDC are involved in responding to cancer clusters. I have
already mentioned CDC's support of State-wide cancer registration. CDC
conducts exposure assessments and epidemiologic studies that evaluate
how people are exposed to environmental hazards and that identify
preventable environmental causes of cancer. CDC's environmental health
laboratory measures known and suspected cancer-causing agents in human
blood and urine. CDC also addresses exposures to cancer causing-agents
in the work place by conducting laboratory science and epidemiological
investigations. CDC also responds to requests from employers,
employees, and other government agencies for investigations involving
possible work-related cancer.
ATSDR includes selected cancers among its seven priority health
outcomes. ATSDR has responded to requests for cancer cluster
investigations, especially those near hazardous waste sites. In
addition, ATSDR educates concerned communities about cancer causes and
prevention and publishes Toxicologic Profiles, a series of 137
monographs about cancerous and other health effects of hazardous
substances, chemicals, and compounds found in waste sites. ATSDR also
has been involved in research projects about the relationship between
environmental exposure and the development of selected childhood
cancers.
NEXT STEPS
CDC and ATSDR are working toward a number of activities to assist
State health departments respond to cancer cluster and other inquiries
related to potential health risks from environmental exposures. CDC is
establishing a single point of contact through which all of these
disease cluster inquiries might flow. This office would coordinate the
CDC and ATSDR response, drawing upon needed expertise throughout CDC
and ATSDR and other Federal agencies. CDC, in coordination with State
and local health departments will develop recommendations or guidelines
for responding, identifying, and following-up on disease cluster
inquiries.
We are in the process of developing a public health system that is
capable of monitoring exposure to chemicals linking the monitoring data
to actual health outcome information, and utilizing the results to
identify and respond to disease cluster inquiries. This will require a
partnership among CDC, ATSDR and State health departments. Disease
cluster investigations have rarely led to new discoveries into the
causes of cancer, developmental disabilities, and other health
outcomes. However, other positive public health outcomes can result.
One example comes from a community in California. At this site, a
pesticide investigation did not find any causal links between
environmental exposure and disease; however, it did lead to the
implementation of many positive public health actions such as increased
health insurance coverage, pesticide tracking and better working
conditions.
CDC and ATSDR will continue to work with States on their disease
registries and help provide public health professionals with the
knowledge and skill to use these systems to respond to the public. CDC
and ATSDR are working with the States to build their environmental
public health capacity. Through comprehensive, coordinated efforts and
in partnership with many governmental, nongovernmental and community-
based organizations we will continue to improve America's environmental
public health will be assured.
Thank you for the opportunity to testify before you today. I would
be happy to answer any questions you might have.
__________
Statement of Deborah Winn, Ph.D., acting associate director,
Epidemiology and Genetics Research Program Division of Cancer Control
and Prevention, National Cancer Institute, National Institutes of
Health, Department of Health and Human Services
Good morning. I am Deborah Winn, Ph.D., acting associate director,
Epidemiology and Genetics Research Program, National Cancer Institute
(NCI). Thank you, Senator Clinton and distinguished members of the
committee, for inviting me to talk with you about NCI research on
cancer, genes, and the environment. Conceptual and technical
breakthroughs and the often breathtaking pace of scientific discovery
have engendered among cancer researchers a tremendous sense of optimism
that new avenues will be found to prevent, detect, diagnose, and treat
cancer. Nowhere is the sense of promise greater or the potential more
profound than at the interface of epidemiology and genetics. By
marrying the study of the distribution and causes of cancer in human
populations with cutting-edge genetic and related molecular
technologies, we will, over time, be able to design new approaches to
health and cancer care based on an understanding of how genes modify
and interact with environmental exposures.
THE ENVIRONMENT, GENES AND CANCER
The term ``environment'' refers not only to air, water, and soil,
but also to substances and conditions in the home and workplace. It
includes dietary components; the use of tobacco, alcohol, or drugs;
exposure to chemicals, and sunlight and other forms of radiation; and
infectious agents. Lifestyle, economic, and behavioral factors are all
aspects of our environment. To date, we know that tobacco is the
environmental exposure most significant to the cancer burden. Factors
that are absent from our environment, as well as those that are
present, influence our cancer risk.
Cancer susceptibility is another critical piece of the puzzle. For
example, why does one person with a cancer-causing exposure develop
cancer, while another does not?
Genes may be the key. We know that disruption of fundamental
cellular processes contributes to the development and progression of
the more common, non-hereditary forms of cancer. Yet even among
individuals who have inherited cancer-predisposing genes, the risk of
developing cancer appears to be modified by other genetic and
environmental factors. There is mounting evidence that a person's
genetic make-up may influence susceptibility or even resistance to
cancer-causing exposures.
Some cancers are associated with defects in one or a few genes. An
example is the Li-Fraumeni syndrome, which involves an inherited tumor
suppressor gene and is associated with familial occurrences of breast
cancer and certain other cancers. However, most cancers involve many
genes. Individuals may inherit defects in these genes, or they may
experience environmental exposures or other circumstances that cause
gene mutations, which are changes in gene structure. Most mutations do
not affect the normal processes of cells in which they occur; but if
alterations occur in genes that control such functions as metabolism of
carcinogens, DNA repair, metabolism of nutrients, hormones and other
factors, cell cycle control factors, or immune function, among others,
cellular processes may become abnormal. Cancer arises through the
accumulation of multiple mutations in genes resulting from multiple
exposures over a period of years or decades.
Understanding the interaction of genes with other genes and
environmental factors in the development of cancer is critical. Gene-
environment interactions are evident when the risk from an
environmental exposure varies depending on individual genetic make-up.
For example, the CYP family of genes controls metabolism of some
carcinogens. Each of us has CYP genes, but the exact structure of the
genes varies from person to person. People with specific variants face
a higher risk, by two to ten fold, of developing tobacco-related
cancers such as lung cancer, esophageal cancer, and cancer of the oral
cavity, than those individuals who have other CYP gene variants. This
risk increases as the level of exposure to tobacco smoke increases.
Furthermore, certain combinations of CYP variants, and variants of
another gene, GSMT1, interact, resulting in even greater risks of these
cancers.
NCI APPROACH TO THE STUDY OF GENE-ENVIRONMENT INTERACTIONS
The NCI has greatly expanded its efforts to identify the genetic
and environmental risk factors leading to cancer susceptibility in
individuals, families, and populations; evaluate the interactions of
these risk factors; assess the relevance of these risk factors to
clinical practice and public health; and address the diverse and
complex scientific, ethical, legal, and social issues associated with
this research. The NCI has identified the study of genes and the
environment as a high priority research area with great potential for
discovery. As our knowledge base expands in this critical area, we will
be able to quantify the cancer risks associated with specific
environmental and genetic factors and their interactions, and design
new approaches to health and cancer care based on an understanding of
how genes modify and interact with environmental exposures.
NCI's investment in the study of genetics has yielded enormous
dividends. For example, NCI's Cancer Genome Anatomy Project has
resulted in the discovery of approximately 40,000 new genes. New
technologies have permitted scientists to determine which genes are
active in normal or in cancerous tissues. There has been an exponential
increase in the pace of identifying genes that maintain the integrity
of our genetic material, regulate cell growth and development, and
determine our response to hormones and other chemicals produced by the
body or in the environment. Related discoveries have enabled us to
characterize the function of hundreds of new genes and pathways. Vast
public data bases contain millions of entries describing gene sequences
and their location in the human genome.
NCI has expanded the tools available to the cancer genetics
research community through the World Wide Web. Through the Genetic
Annotation Initiative of the Cancer Genome Anatomy Project, scientists
have identified more than 20,000 genetic variations, and they expect to
expand that number to nearly 500,000 by 2002. Researchers are using
sophisticated computer programs to identify variations in specific
genes in people with cancer to determine which variants are associated
with certain types of cancer and whether some variants occur more often
in some populations. New technology development through the Innovative
Molecular Analysis Technologies Program is also improving our ability
to effectively analyze the large volumes of samples and data in these
population-based studies.
Members of the Mouse Models of Human Cancers Consortium (MMHCC) are
developing and validating mouse models--mice with cancers similar to
the major human cancers that can be inherited. These models will be
made available to scientists for research. Composed of 20 groups of
investigators from institutions across the country, the MMHCC uses Web-
based discussion forums and other communication tools to integrate
emerging knowledge about cancer susceptibility from animal models with
studies on human populations. The MMHCC also supports a repository for
models of key cancers caused by specific gene variants.
We have gained tremendous insight into risks for cancer by
examining the personal and medical histories of high-risk families and
investigating how cancer-predisposing genes are modified by other genes
and environmental factors in these families. For example, through the
Cooperative Family Registries for breast/ovarian and colorectal
cancers, we have collected clinical, epidemiological, and pathological
data as well as biospecimens for over 8,000 high-risk families.
Analysis of this information may lead to targeted approaches for the
prevention, detection, and diagnosis of cancer.
Establishing significant and valid evidence for gene-environment
interactions requires studies of large populations over long periods of
time. In cohort studies, information on exposures to factors that might
affect cancer risk and biologic samples are collected from individuals
in large population subgroups. By systematically following these people
over time to determine who develops cancer and who remains cancer free,
scientists can understand the risk of developing cancer for those with
specified exposures and genetic profiles. In this way, early detection
can be directed to those at greatest risk, and diagnosis and treatment
can be tailored to individual needs. NCI is establishing a Cohort
Consortium of investigators from around the world to facilitate the
pooling of data on very large numbers of people, foster collaborative
links among resources, and organize collaborative studies. Another type
of large population study is case-control studies, which
retrospectively examine exposure histories and genetic profiles of
people who already have cancer (cases) and compare them with those of
people who have not developed cancer (controls). NCI is assembling a
Case-Control Consortium to support large-scale studies of gene-
environment interactions for less common cancers.
LONG ISLAND BREAST CANCER STUDY PROJECT
One illustration of NCI's approach to the investigation of the
relationship between genes and the environment in the development of
cancer is the Long Island Breast Cancer Study Project (LIBCSP): a
multistudy research initiative examining the possible role of
environmental factors in breast cancer in Suffolk, Nassau, and
Schoharie counties in New York and Tolland County, Connecticut, where
rates of breast cancer incidence are elevated. The LIBCSP used a full
array of scientific approaches to study breast cancer on Long Island,
and consisted of more than 10 studies that include human population
(epidemiologic) studies, the establishment of a family registry for
breast and ovarian cancer, and laboratory research on mechanisms of
action and susceptibility in breast cancer development.
Originally conceived as part of the LIBCSP, a new tool has been
created by NCI to help overcome the frustrations associated with
studying geographic variations of disease: a prototype computer system
called the Geographic Information System for Health (GIS-H). The GIS-H
allows examination and tracking, over time and space, of cancer rates
with any geographically defined factor that might contribute to the
cancer burden. It is the largest and most comprehensive system of its
type developed for the study of breast cancer. The GIS-H is a new
approach for researchers to use in investigating relationships between
breast cancer and the environment, and to estimate exposures to
environmental contamination. The GIS-H data layers will include
geographic data for precise mapping and geographic location of features
in all data layers. Demographic data on health care facilities, health
care surveys, breast cancer, and the environment will also be included.
The environmental data will include information on contaminated
drinking water; sources of indoor and ambient air pollution, including
emissions from aircraft; electromagnetic fields; pesticides and other
toxic chemicals; hazardous and municipal waste; and radiation. The
system will rely chiefly on existing data bases obtained from Federal,
State, and local governments, and private sources--including historical
information on environmental exposures from residents--with emphasis
placed on high-quality data. More than 80 data bases are slated to be
included in the system. The GIS-H provides the opportunity to apply a
powerful emerging technology to the study of environmental causes of
breast cancer and is anticipated to be ready for investigator-initiated
pilot studies this year.
ATLAS OF CANCER MORTALITY
Because geographic patterns of cancer may provide important clues
to the causes of cancer, the NCI has, for over 30 years, studied
geographic patterns of cancer mortality across the United States. Our
most recent effort in this area is an updated atlas of cancer
mortality. The new Atlas of Cancer Mortality in the United States,
1950--1994, prepared and published by the NCI, is a book and website of
maps, text, tables, and figures showing the geographic patterns of
cancer death rates throughout the United States for more than 40
cancers, and features 254 color-coded maps that show the geographic
variations during 1970-94 compared to those during 1950-69. The color
maps make it easy to pinpoint geographic areas with average, below
average, or elevated rates. The Atlas, and related information, can be
explored at http://www.nci.nih.gov/atlasplus/. The website allows the
user to tailor the data interactively, to produce maps by race, gender,
time period, age group, State, State economic area, or county level;
and to develop bar charts and trend line graphs. The site also provides
links to related sites. The Atlas has been designed so it is accessible
not only to researchers, but to the public, consumer advocates, and
everyone who is working to improve public health.
The Atlas does not provide information about why death rates may be
higher in certain localities than in others, but it can generate leads
for in-depth epidemiologic studies that may shed light on factors
contributing to cancer risks. Possible risk factors include tobacco
use, occupational exposures, dietary habits, ethnic background, and
environmental exposures from the air or water. In addition, geographic
differences in mortality rates may reflect differences in access to
medical care, such as screening, diagnosis, or treatment. We anticipate
that many of the leads provided by the new Atlas will guide further
epidemiologic and public health activities aimed at preventing cancer.
The NCI is encouraging research proposals for new interdisciplinary
studies that use the GIS-H and the Atlas of Cancer Mortality to explore
geographic variations of cancer incidence and mortality and speed the
process of scientific discovery and application. To date, about 30
applications have been received in response to this new initiative.
NEW RESEARCH DIRECTIONS
Now, more than ever before, opportunities exist to determine how
variations in genes combine with environmental and other factors to
induce cancer. NCI has identified key priority areas for research on
genes, the environment, and cancer, and designed a strategy to
capitalize on the opportunities before us. We intend to focus expanded
effort on identifying and characterizing gene variations involved in
molecular pathways important in cancer development, and new
environmental risk factors--and determining their interactions in
cancer causation. We are planning initiatives that will develop new
ways to assess and measure environmental exposures for use in
population studies; develop new experimental models that parallel human
cancer-related genes, pathways, and processes; and identify cancer-
predisposing genes in high-risk families and investigate how expression
of these genes is modified by other genes and environmental factors.
New insights into genetic susceptibility, environmental
carcinogens, and their potential interactions can be incorporated into
cancer risk prediction models that can in turn be used to estimate
individual risk. We now want to refine cancer risk prediction methods
and models to integrate genetic and environmental determinants of
cancer.
Clinical trials involving genetically high-risk individuals can
increase our understanding of the clinical, behavioral, and societal
issues associated with cancer susceptibility. We plan to expand
enrollment of genetically high-risk individuals into clinical protocols
and conduct studies to address the clinical, behavioral, and societal
issues associated with cancer susceptibilities.
CONCLUSION
More than two hundred years ago, as our ancestors abandoned the
theory that cancer was the result of an imbalance of bodily humors,
scientists first observed that cancer could be linked directly to an
environmental agent. As the 21st century dawns, scientific discovery is
occurring at a pace that would have astounded our forebears. We have
known for a long time that our environment, including our lifestyle
choices and economic circumstances, influences our risk for developing
cancer; but we have not understood exactly how, or why some people are
more susceptible to these influences than others. Over the past decade,
there has been an explosion of information on the fundamental nature of
cancer, and with the rapid development of dazzling new technologies and
tools, we grow closer every day to solving these mysteries that have
long confounded us. Success is within our grasp. So, while the
questions are complex and our progress has been hard-won, our hope is
strong and our dedication is unwavering for a simple reason that each
of us here today understands: our goal is to eradicate cancer and save
the lives of those who would otherwise be lost to us.
Thank you for this opportunity to tell you about NCI's work. I
would be pleased to answer any questions you may have.
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Statement of Samuel H. Wilson, M.D., Deputy Director, National
Institute of Environmental Health Sciences
I appreciate this opportunity to talk with you about environmental
influences on our health. This subject is timely because here at the
beginning of a new century we are assembling the tools that will enable
us to detect environmental triggers of disease more precisely and more
meaningfully. This ability will come about because of advances in an
entirely different field, that of genomics which is the study of genes
and of what genes do. The Human Genome Project, which has been the
topic of much recent press coverage, was initiated in part to determine
what genes are important in disease development. What we are finding,
though, is that few genes serve as major determinants of disease risk.
Instead, it is the interaction of our genes and our environmental
exposures that sets the stage for the majority of disease development.
Indeed, for many diseases, our genetic makeup by itself accounts for
only a small part of our disease risk. It is our environment, acting in
concert with our particular genetic susceptibilities, that confers a
major part of our disease risk. Thus gene-environment interaction is
where our attention must focus and where the major strides in
environmental health research will be made in the future. In my
testimony I will (1) describe some of the work that illustrates the
significant role of environmental factors in major diseases, (2)
describe how understanding gene-environment interactions will improve
our ability to identify the precise environmental triggers of diseases,
and (3) give examples of some of the research that NIEHS has initiated
to address these topics. I will also touch on our expanded view of what
constitutes ``environment'' and how diet and socioeconomic status must
be included in this view.
The past few years have seen a remarkable number of studies that
have identified the importance of environment in major diseases. By
comparing rates among fraternal and identical twins, scientists have
been able to tease apart the relative contributions of genes and of
environment for several major diseases. Based on twin studies in
Scandinavia, we now know that environment accounts for more than 50
percent of cancer risk, with genes accounting for the remainder of
risk. Twin studies on Parkinson's Disease reveal that environment
accounts for 85 percent of the risk in the late-onset cases of this
disease. For autoimmune diseases such as multiple sclerosis and Lou
Gehrig's Disease, environmental factors account for 60 percent to 75
percent of disease risk. Clearly, then, our environment is a major
determinant of our health and of our relative risk for disease. It also
spans a broad number of diseases and disorders. To give you an example,
at the National Institute of Environmental Health Sciences we are
investigating environmental triggers for cancer, Parkinson's Disease,
birth defects, infertility, autoimmune diseases, hypertension, asthma
and other respiratory disorders, learning and behavioral disorders, and
uterine fibroids.
Although many people think of ``environment'' in terms of
pollutants and industrial by-products, environmental factors encompass
a much larger universe. They include diet and nutrients,
pharmaceuticals, infectious organisms, natural compounds such as
aflatoxin found in grains, herbal formulations, and our socio-economic
environment. It is this totality of environmental factors that is
proving to have a major role in human health and in disease
development.
Environment, though, is not the total answer in disease
development. Two people with the same exposure can have very different
outcomes. Obviously not everyone who smokes cigarettes gets lung
cancer, nor does every asthmatic respond to dust mite and cockroach
allergens. We all have different susceptibilities to environmental
agents. Many of these differences in susceptibility appear to be due to
variations in genes coding for proteins critical in the body's response
to environmental agents.
These proteins include metabolizing enzymes, DNA repair enzymes,
cell cycle control proteins, cell signaling proteins, and receptor
proteins. Someone inheriting a gene that produces a weak or ineffective
form of one of these critical proteins will be more susceptible than
someone inheriting a gene that produces a more effective form. That is
because the first person might be less able to break down or excrete
environmental compounds or to repair cellular damage caused by
environmental agents. Thus understanding gene-environment interactions
is critical in defining the environmental contribution to disease.
Neither acts alone. It is the two acting in concert that lays the
foundation for disease and dysfunction.
For these reasons the National Institute of Environmental Health
Sciences (NIEHS) established the Environmental Genome Project (EGP).
The EGP is a survey of the important genetic variants that affect
people's responses to environmental agents. The EGP is a natural
outgrowth of the Human Genome Project. In fact, understanding gene-
environment interactions will be the only way to extract the full
benefit from our investments in the Human Genome Project. That is
because only a few, relatively rare, diseases are caused by defects in
a single gene. A large number of diseases and disorders result from
inadequacies in common environmental response genes and can only lead
to disease in the presence of a particular exposure.
The Environmental Genome Project ushers in a new era for
environmental health science research. Previously individual variation
in responsiveness to exposures generated a high ``background noise''
that could often mask the contribution of environmental agents to
disease risk, particularly at the low levels to which most of us are
exposed. Now, as we identify important genetic variants that alter
response to environmental agents, scientists can better control for the
confounding variable of individual susceptibility when they study
environmentally caused diseases. In the future, we expect to be able to
followup on results of twin studies by identifying the actual
environmental components that comprise the major part of disease risk.
It should be noted, though, that timing is everything for
environmental exposures. Certain stages of life impart a much greater
vulnerability. Early human development, infancy, and childhood are
among these stages. The carefully orchestrated events by which a
fertilized cell develops into a sentient being offer many opportunities
for environmental interference and disruption. In fact, children can
suffer adverse effects from environmental exposures at doses that cause
no apparent problems in adults. We are greatly interested in the
potential of birth registries and prospective cohorts to decipher the
genetic and environmental contributions to many diseases, particularly
in children. We have joined with the Norwegian government on a study of
cleft palate, a common birth defect. Norway has one of the highest
reported rates of cleft palate in the world, as well as a highly
organized birth registry that records these defects. For this study,
both genetic samples and data on environmental exposures of mothers and
infants are being collected. When completed, this study will provide
the largest and most comprehensive collection of data ever obtained on
the genetic and environmental components of this birth defect.
The NIEHS is also building on plans currently under way in Norway
to recruit 100,000 pregnant women and their children. These families
would be followed in a lifetime cohort study of health. NIEHS will
collect and store blood and urine of these women for the purpose of
assessing environmental and other exposures during pregnancy. This
information on exposures of the fetus will be used to study the effects
of environmental factors during this crucial period on birth defects,
developmental problems, childhood diseases, and even diseases of
adulthood that result from exposures early in life. In addition, NIEHS,
CDC, and the National Institute of Child Health and Human Development
have the lead for a similar longitudinal study on environmental
influences on children's health in this country. This study was
recommended by the President's Task Force on Environmental Health Risks
and Safety Risks to Children in 1998 and mandated by the Children's
Health Act of 2000.
Another study under design at NIEHS is the Sisters Study of breast
cancer. This study would examine environmentally associated risks of
breast cancer by recruiting women who have a sister already diagnosed
with breast cancer. Because these women are at increased risk of breast
cancer, twice as many breast cancer cases are expected as would be
identified in any other cohort of similar size. Biologic specimens will
be collected and stored at recruitment, and extensive questionnaires
will be submitted regularly. Breast cancer risk will be assessed in
terms of exposure to natural hormones, environmental hormone
disruptors, growth factors, dietary components, and environmental
contaminants such as pesticides and solvents. This study will also
assess the importance of gene-environment interactions.
Studies continue to validate the importance of nutrition in
maintaining health and preventing disease. Whole grain foods, for
example, have been identified in NIEHS rodent studies as being
protective against breast cancer and have been shown to protect against
stroke in a NIH-supported longitudinal study of nurses. Nutrition is a
major environmental risk component of many diseases. For this reason,
the NIEHS has partnered with the NIH Office of Dietary Supplements
(ODS) to fund a Center for Phytochemical and Phytonutrient Studies.
This center is currently investigating the ability of dietary
phytochemicals to prevent or treat prostate cancer, the role of
phytoestrogens in altering immune response and possibly predisposing
some women to autoimmune diseases, and the capacity of bioflavonoids to
protect brain tissue from oxidative damage.
One of the major environmental challenges we face is that of
exposure assessment--that is, defining exactly what chemicals are in
our environment and how much is absorbed in our bodies. This type of
information is invaluable to the NIEHS in designing relevant
epidemiologic and laboratory studies that can determine the types of
effects that can arise from environmental exposures. The NIEHS
collaborates with the United States Geological Survey and the Centers
for Disease Control and Prevention to use their expertise and data
bases to develop a better understanding of common environmental
exposures in this country. We are also collaborating with our sister
agency, the National Cancer Institute, on the Agricultural Health
Study. In this study we are assessing exposures common to agricultural
settings and evaluating their influence on risk of developing
conditions such as cancer, Parkinson's, infertility, birth defects,
respiratory dysfunction, and other problems.
In conclusion, I would like to make the case that preventing
disease is one of the most important services of our public health
network. Protecting people from avoidable illness and death saves
money, spares suffering, and improves the quality of life for society.
The most effective way to prevent disease and disability is to
understand the cause of an illness and change the conditions that
permit it to occur. A key strategy to prevent many diseases or delay
disease progression is to minimize or eliminate adverse effects of
chemicals in the environment. This preventive strategy underlies the
field of environmental health and is a core principle guiding NIEHS-
funded research.
Because of its emphasis on prevention, environmental health science
research is rarely played out in the high-tech, treatment-oriented
arena of modern clinical centers. Rather, some of our most important
work is done in agricultural fields, among migrant workers, in inner-
city neighborhoods, and in public schools. The practice of
environmental health science often requires engaging the efforts of our
most disadvantaged citizens. NIEHS has been experimenting with new
models of research that provide for citizen participation. It is our
feeling that citizen-based participatory research will generate more
relevant findings, will suggest better real-world research questions,
and will serve as a communication tool for the participants and their
neighbors.
I would be pleased to answer any questions.
__________
Statement of Lynn R. Goldman, M.D., M.P.H., Professor, Environmental
Health Sciences, John Hopkins Bloomberg Schools of Public Health
Chairman Reid, Senator Clinton, and members of the New York
Congressional Delegation, thank you for the opportunity to come to New
York to provide real perspective to our nation's ability to respond to
crises in our communities.
My name is Dr. Lynn Goldman and I am a pediatrician and an
environmental epidemiologist. I have an extensive background in the
area of pesticide health and environmental effects and environmental
risks to children. Between 1985 and 1992 I served in various positions
in the California Department of Health Services, most recently as Chief
of the Division of Environmental and Occupational Disease Control.
Among other things, I was responsible for the conduct of a number of
epidemiological investigations of the impacts of environmental
exposures to health, especially the health of children. I carried out
several investigations of childhood cancer clusters. In 1993 I was
appointed by President Clinton and confirmed by the Senate to serve as
Assistant Administrator for Prevention, Pesticides and Toxic Substances
at the U.S. Environmental Protection Agency (EPA).
In that position, I was responsible for the nation's pesticide and
toxic chemicals regulatory programs at the EPA. In January 1999 I left
the EPA and joined the Johns Hopkins University where I presently am
Professor at the Bloomberg School of Public Health. I served as the
principal investigator for children's health for the Pew Environmental
Health Commission--a blue ribbon independent panel charged with
developing recommendations to improve the nation's health defenses
against environmental threats. I currently am a member of the
Environmental Defense Board of Trustees.
Our public health service is falling short in its duty to watch
over the safety and health of Americans, particularly when it comes to
chronic diseases that may be associated with environmental factors.
Chronic diseases are responsible for 7 out of 10 deaths in this
country. More than a third of our population, over 100 million men,
women and children suffer from chronic diseases. These diseases cost
our citizens and government, $325 billion a year. By 2020 chronic
diseases are estimated to afflict 134 million Americans and cost $1
trillion a year. And the CDC estimates that 70 percent are preventable.
But our Federal Government is not actively pursuing how to prevent
this epidemic of chronic diseases.
As a Nation, we have been increasing our research into how to treat
disease. As a result, we have some good news here. More children with
leukemia survive today than ever before. We have also seen some success
with reducing exposure to tobacco and the marketing of tobacco to our
children. But there is bad news. The rates of a number of non-smoking
related cancers--childhood brain cancer, breast cancer, non-Hodgkin's
lymphoma, liver cancer, myeloid leukemia, thyroid cancers and a several
other tumor types--have been steadily rising for the past two decades.
A review of the National Cancer Institute Atlas of Cancer Mortality
shows clear geographic differences in rates of a number of cancers,
differences that should serve as clues for followup studies and efforts
to prevent cancer. As a Nation, we have not invested in preventing
chronic diseases.
You heard today from those who have experienced firsthand the
tragic cluster of childhood leukemia in Fallon and the breast cancer
epidemic on Long Island. These crises are tragedies on both the
personal and community level. My heart goes out to these communities.
But as a health scientist, I am aware that this is problem that is
repeated in communities all across the country. In 1997, there were
almost 1,100 requests by the public to investigate suspected cancer
clusters. Many of these are preventable diseases; preventable tragedies
and our public health resources are insufficient to effectively respond
to these challenges. In too many cases, there was not the capacity to
investigate these problems.
Even though we know about the increasing importance of chronic
diseases and the staggering human and financial toll they have on our
country, we have no systems in place to track chronic diseases nor do
we have the capability to respond to these health crises. Our Federal,
State, and local agencies only systemically track and respond to
infectious diseases such as polio, yellow fever and typhoid. These are
diseases that a national tracking and response system helped to
eradicate back in the late 1800's.
Over a century later, we never modernized our public health system
to respond to today's health threats. As a result, we are hamstringing
our health specialists from finding solutions and effectively taking
action--regardless if it's childhood cancer or a nationwide asthma
epidemic.
As a former chemical and pesticide regulator, I am appalled by the
lack of information to make wise decisions about chemicals in the
environment and our inability to be sure that we are doing what we
should be doing to prevent chronic diseases. In 1997, Environmental
Defense looked at what we know about chemicals in commerce at high
volume (greater than a million pounds a year) in the United States.
They found surprising and disturbing gaps in the information available
to government and the public, a finding later confirmed both by EPA and
by industry. Indeed, EPA's analysis indicated that that only 7 percent
have screening level information about toxic effects and more than 40
percent have no information at all. To compound our ignorance, we do
not know which chemicals are winding up in our bodies and the bodies of
our children. For example, which contaminants are in breast milk? This
is basic information that is needed, both to understand the risks and
more importantly to make the right decisions to protect the public from
harmful exposures.
Clearly, we cannot make wise decisions about the risks of chemicals
given this state of ignorance. Incentives need to be created to
generate information about hazards and exposures to industrial
chemicals that are in our food and water, products used in the home and
intended for children, and in the workplace.
Further, we also need this tracking information so that we can
carry out the studies that will identify what might be causing high
rates of chronic disease in communities in the United States. Let me
give you an example of our scattered State health tracking systems.
With the Pew Commission I wrote a report on birth defects
that rated the State's efforts to monitor birth defects. Even though
birth defects are the No. 1 cause of infant mortality, 17 States do not
track birth defects. The Pew Commission gave Nevada and the 16 other
States an F in its report, ``Healthy from the Start'' which was
released in late 1999. New York received a ``B'', meaning that while
there are good efforts underway the registry does not collect data that
are compatible with the national standard set by the CDC. As a result,
data from New York can't necessarily be compared to those from other
States, hindering the ability of scientists to determine patterns of
diseases and their causes.
Whereas the National Academy of Science estimates that 25
percent of developmental diseases such as cerebral palsy, autism and
mental retardation are caused by environmental factors, only a handful
of States have any efforts at all to track these diseases.
Cancer registries in many States have been severely
neglected for years. Even in California, when I was there, we saw
support deteriorate to the point where the registry could collect the
data, but not analyze it or use it to take action to respond to cancer
threats.
The Pew Environmental Health Commission based out of the Johns
Hopkins School of Public Health studied our nation's capacity to
identify and respond to chronic disease clusters for 2 years and
proposed creating a nationwide Health Tracking Network to solve this
problem.
The Nationwide Health Tracking Network is based on four principles:
(1) building a coordinated system of tracking chronic diseases and
associated environmental factors; (2) providing the resources and
training to local health departments to analyze the data; (3)
immediately responding to health problems identified through the
system; and (4) providing the national leadership to coordinate health
and environmental activities throughout the Federal Government so that
these programs do not operate in isolation of one another.
The Nationwide Health Tracking Network consists of five components:
1. Establishing essential data collection systems: The first
component builds on existing health and environmental data collection
systems and establishes data collection systems where they do not
exist. The Network will coordinate with the local, State and Federal
health agencies to collect this critical data. In all fifty States, the
Network would track:
Asthma and other respiratory diseases;
Developmental diseases such as autism, cerebral palsy, and
mental retardation;
Neurological diseases such Alzheimer's, multiple
sclerosis, and Parkinson's;
Birth defects; and
Cancers, especially in children.
The Network also would track exposures to:
Heavy metals such as mercury and lead;
Pesticides such as organophosphates and carbamates;
Air contaminants such as toluene and carbamates;
Organic compounds such as PCB's and dioxins; and
Drinking water contaminants, including pathogens.
Building upon the existing systems for infectious diseases, the
Federal Government will establish the standards for the health and
exposure data collection necessary to create uniformity throughout the
system. With Federal resources such as funding, training and lab
access, State and local public health agencies will collect, report and
analyze the data.
2. Creating an Early Warning System: The second component is an
Early Warning System that would immediately alert communities of health
crises such as lead, pesticide and mercury poisonings. The existing
system of local health officials, hospitals and poison centers that
alert our communities to outbreaks like food illness and the West Nile
virus would also alert our communities to these health crises.
3. Improving response to chronic disease emergencies: The third
component consists of improving our response to identified disease
clusters and other health crises. The Network would coordinate Federal,
State and local health officials into rapid response teams to quickly
investigate these health problems, providing the teams with trained
personnel and the necessary equipment.
4. Addressing unique local health problems: The fourth component is
a pilot program consisting of 20 regional and State programs that would
investigate local health crises and clusters that are currently not
part of the nationwide Health Tracking Network. These programs would
alert the public and health officials to new developing disease
clusters outside of the nationwide Health Tracking Network. These
pilots programs also would serve as models for tracking systems for
inclusion in the Network.
5. Creating community and academic partnerships: The fifth
component establishes relationships with five Academic centers and with
our communities. Our community relationships would ensure that the
tracking data is accessible and useful on a local level, and our
research relationships would train the work force, analyze data, and
develop links between the tracking results and preventive measures.
(The background and basis for this Network and other Commission
findings and recommendations are attached as part of the written
testimony. These are also available on the Commission's website.)
This Network would provide our communities, scientists, doctors,
hospitals and public health officials with missing data on where
chronic diseases are clustering and associated environmental factors
that would enable us to develop prevention strategies. Over thirty key
health organizations have endorsed this recommendation, ranging from
Aetna U.S. Health Care to the American Cancer Society to the American
Academy of Pediatrics to the Association of State and Territorial
Health Officers (ASTHO).
Developing prevention strategies are critical to reducing the $325
billion a year Americans spend on chronic diseases. As noted above, the
estimated cost of chronic disease is predicted to rise to $1 trillion
in less than 15 years. The estimated cost of the Network is about $275
million or less than 1 dollar per every man, woman and child.
It is ironic that we have mapped the entire human genome and yet we
don't have the most basic information about the diseases that are
killing us. We are learning about the genetic susceptibilities in the
population but we do not have a clue which chemicals might be
triggering these genes to create disease. We have learned how to spend
millions upon millions to treat chronic diseases like asthma and cancer
but the Federal Government has not identified the reasons why asthma
and rates of certain cancers are rising. We need to spend our tax
dollars more effectively by identifying which chronic diseases are
increasing and which exposures may be impacting our health.
The most cost effective use of tax dollars today would be to invest
in preventing the leading killers in this country. And the American
public agrees. The American public is so concerned about this issue
that 63 percent feel that public health spending is more important than
cutting taxes. Seven out of ten registered voters (73 percent) feel
that public health spending is more important than spending on a
national missile defense system.
A recent public opinion poll by Princeton Survey Research
Associates revealed that nine out of ten (89 percent) registered voters
support the creation of a national system.
Most local health departments face declining funding, inadequate
training for staff, limited or no laboratory access, and outdated
information systems. CDC and ATSDR have not been able to adequately
help. For instance, there is no Federal funding for an environmental
health specialist or even chronic disease investigator almost all
States. Nor does CDC or the Agency for Toxic Substances and Disease
Registries (ATSDR) give States written guidance, standards or protocols
on how to investigate the cancer clusters.
On a Federal level, there are a few programs that relate to chronic
diseases, but do not track and respond to the increases in rates of
chronic disease. The irony is the Administration's proposed budget
recommends severe cuts for the nation's chronic disease prevention
programs. We need to be going in the exact opposite direction. Health
defense should be the country's No. 1 commitment.
Who is guarding our health? The answer is that the public health
service has fallen short of its duty--lacking the tracking, troops and
leadership. This is exactly where our Federal Government is needed--to
develop the tracking and monitoring systems, supply the troops and
offer the leadership to prevent chronic disease.
To modernize our public health resources so that we can identify
clusters before they grow, we must take rapid action to control their
spread and find solutions to prevent diseases. CDC must be given the
direct mandate to aggressively respond to communities' concerns like
those on Long Island and in Fallon, with modern tools and health-
tracking systems. And Congress must prioritize $275 million per year,
less than a dollar per person to make this happen. It is just a tenth
of 1 percent of the overall spending of health care dollars in this
country.
Without this type of investment, we will only watch asthma, certain
cancers and other chronic disease rates continue to rise. There will be
many more lives lost to preventable diseases. And that will be the
greatest tragedy of all.
Thank you for the opportunity to testify today.
__________
Statement of Elinor Schoenfeld, M.D., Associate Professor, Stony Brook
University School of Medicine
My name is Dr. Elinor Schoenfeld and I am an associate professor in
the Department of Preventive Medicine at the School of Medicine,
University of New York at Stony Brook. On behalf of the University at
Stony Brook, I would like to thank you for giving us the opportunity to
be a part of these hearings. The research community at the University
at Stony Brook is engaged in many aspects of environmental research and
the impact the environment has on health. With the University's close
collaborations with many other organizations on Long Island, the
University would be an ideal resource for research collaborations to
study the impact of the Long Island environment on community health. We
are the only medical school located in Suffolk County. The Health
Sciences Center houses the schools of Medicine, Nursing, Health
Technology and Management, Social Welfare and Dentistry. Each school
provides for the teaching of health professionals to serve the health
care needs of the community. In addition, each school provides for the
development of researchers in many fields of basic and clinical
sciences.
The Department of Preventive Medicine within the School of Medicine
has an outstanding team of epidemiologists and occupational medicine
specialists with a special interest in cancer and the environment. We
have a long-standing relationship with the community to investigate
concerns about possible disease clusters on Long Island. In addition,
we have a strong interest and involvement with breast cancer research
on Long Island. Currently, we are conducting the Electromagnetic Fields
and Breast Cancer on Long Island Study, which is investigating the
possibility that electromagnetic fields increase the risk of breast
cancer. This EMF study is federally funded and is one of the studies of
the Long Island Breast Cancer Study Project.
The EMF and Breast Cancer on Long Island Study is a population-
based case-control study of women in Nassau and Suffolk Counties, New
York. Women were eligible for this study if they participated in the
Long Island Breast Cancer Study Project case-control study, were either
diagnosed with breast cancer between August 1, 1996 and June 20, 1997
or were population-based controls accrued through random-digit dialing
(women ages 30-64) or HCFA files (over age 65), and lived in their
current residence for 15 years or more.
The measurement protocol for the study was based on the results of
a comprehensive pilot study. The measurement protocol included spot
measurements (at the front door, bedroom and most lived in room), 24-
hour measurements (bedroom and most lived-in room). Participants were
queried on their use of electrical appliances, age of the home, number
of years in the home, occupational history, electric train travel, and
light-at-night. At a second visit, the wiring around the home was
diagrammed by trained technicians. Results from this study will be
available later this year.
Another potential resource for evaluating the impact of the
environment on health for the local community is the Long Island Cancer
Center, which appointed it first director, Dr. John Kovach, this past
year. The goal of the Long Island Cancer Center is to provide
comprehensive cancer care to all Long Islander's while providing an
environment to conduct both clinical and basic research into the causes
and treatment of cancer.
There are many features of University at Stony Brook and the School
of Medicine which present a unique opportunity to develop a truly
comprehensive cancer program which integrates the best of academic
research at a basic and translational level with clinical trials,
patient care, community hospitals, community physicians and the
community at large. The special aspects of the program are:
1. University at Stony Brook Department of Preventive Medicine and
Epidemiology has a 20-year history of working with the State Department
of Health, the State of New York, and the Federal Government in
studying the cancer problem on Long Island. This includes mapping
potential toxic sites throughout the Island, the study of ``hot spots''
of breast cancer on Long Island as part of the federally funded Long
Island Breast Cancer Project, and cancer education in the schools,
communities at large and community physicians. To facilitate these Long
island epidemiology studies, the Department of Preventive Medicine has
established mechanisms for data collection, storage, retrieval and
analysis while assuring confidentiality of the data. This is a unique
resource for a cancer center poised to apply advances in molecular
biology and genomics to the problem of human cancer. The special
opportunities available to Stony Brook and to the citizens of Long
Island are to develop a population-based cancer data base focusing
initially on breast and prostate cancer, two leading cancers in men and
women respectfully in the United States.
2. University at Stony Brook and the School of Medicine currently
receive over $10 million annually in total support form the National
Cancer Institute. This level of support is above the median support
received by the 68 Comprehensive Cancer Centers in the United States.
3. The University Stony Brook and the School of Medicine already
possess four program grants from the National Institutes of Health.
These attest to the quality and the integration of multiple
investigators into cohesive programs, the hallmark of comprehensive
centers. The awards include two program grants to explore environmental
causes of genetic damage; a third grant in Tumor Virology and a fourth
grant supporting General Clinical Research Center.
4. The School of Medicine possesses outstanding expertise in all
clinical aspects of cancer diagnosis and treatment. These include
outstanding cancer surgery for brain, lung, gastrointestinal, breast
and ovarian cancer; exceptional radiation oncology with state-of-the-
art equipment; and excellent medical oncologists for children's cancers
and adult cancers. The physicians consistently receive accolades from
the public regarding their compassion and thorough care.
5. The University at Stony Brook and Brookhaven National Laboratory
have exceptional resources in computer sciences, applied mathematics,
statistical genetics and biostatistics. Such depth in these areas is
rarely found in a single comprehensive cancer center. These disciplines
are increasingly important to medical research which relies more and
more the receipt, storage, retrieval and analysis of massive amounts of
data.
6. Strong working research relationships and a single graduate/
raining program between Cold Spring Harbor Laboratory and University at
Stony Brook and the School of Medicine provide special opportunities to
bring basic biological research relevant to the cancer problem to an
international level of quality. Cold Spring Harbor Laboratory has a
cancer center grant from the National Cancer Institute for its basic
science programs. With the completion of the Human Genome Project, an
ability to relate variations in human genetic sequence to specific
disease promises to provide un-paralleled insights into the causes of
disease and lead to new mechanisms of disease prevention and cure. Cold
Spring Harbor will benefit by access to physician scientists being
recruited to the cancer center at Stony Brook.
7. The close relationship between Brookhaven National Laboratory
and Stony Brook University provides unique resources for the cancer
center such as access to the synchrotron light source for structural
studies and to expertise relevant to development of advanced imaging
capabilities. Dr. Nora Volkow, director of Clinical Research at
Brookhaven National Laboratory and Dr. Linda Chang, the new medical
director of Brookhaven National Laboratory are national experts in
advanced imaging procedures.
Imaging research is aided enormously by the capability of
Brookhaven National Laboratory to generate a variety of short-lived
isotopes useful for the labeling of proteins and for positron emission
tomography (PET). Additional strength was added recently with the
recruitment of Dr. Helene Benveniste from Duke University. She is an
internationally recognized expert in micro-magnetic resonance imaging
(MRI) in the mouse. The State of New York recently provided $900,000 to
establish for Dr. Benvenistea state-of-the-art micro-MRI instrument.
8. Over the past 6 months, the Cancer Center has invited
investigators from other institutions with the kind of expertise needed
to enhance the comprehensive nature of the Long Island Cancer Center at
Stony Brook. Eleven speakers have presented seminars to one or another
of the focus groups of the cancer center. The consensus of these
investigators, who are already well funded from the National Cancer
Institute, is that there is outstanding science at the center and that
the setting at University at Stony Brook is ideal from an academic
standpoint.
Other University resources for the evaluation of the impact of the
environment on health include the Long Island Groundwater Research
Institute (LIGRI) which was established in 1994 to marshal the
resources and expertise of the University for the study of groundwater
hydrology and chemistry. One of the Institute's goals is to bring the
results of scientific research to bear on the region's most pressing
groundwater problems. Inquiries on all aspects of groundwater hydrology
and chemistry are welcome.
The resolution of hydrogeological and groundwater pollution
problems requires basic and applied research from a broad array of
disciplines. The Institute coordinates and expands the existing
potential for research by faculty, staff and students in groundwater
hydrology. The Institute maintains close communication with ground-
water professionals in the government and private sector in Long
Island. Through the University's Center for Regional Policy Studies, a
distinguished Advisory Council has been established with representation
of agencies with management responsibilities. In 1997 the Institute was
formally established by legislative act.
The Institute has become a member of ECAC joining the Maxwell
School and College of Engineering and Computer Science at Syracuse
University, the New York Water Resources Institute at Cornell
University and the Darrin Fresh Water Institute at the Rensselaer
Polytechnic Institute. The purpose of this group is to assist local
communities to access institutional expertise and resources to provide
outreach, education and support to government agencies through this
State-wide effort. As part of this effort, the Institute has been asked
to provide technical information to community groups (ABCO, NEARS)
concerned with contamination at Brookhaven National Laboratories. The
Institute also provided testimony for a joint legislative assembly
hearing on water quality and quality issues sponsored by the Commission
on Water Resource Needs, the Environmental Conservation Committee and
the Task Force on Food, Farm and Nutrition.
Given the community's awareness and the importance of cancer on
Long Island, we applaud today's hearing. As scientists studying the
link between cancer and the environment, we recognize the need for a
special effort and initiative in this area. We are prepared to lend our
efforts to meet the challenge to improve the health of the population
on Long Island.
__________
Statement of Mark Serotoff, Townline Civic Association, Environmental
Carcinogens on Long Island, NY
The importance of addressing the epidemic of cancer on Long Island
cannot be overemphasized. One-in-nine incidence of breast cancer, high
levels of pancreatic, esophageal, brain cancers, leukemia, lymphoma,
lung, testicular, colon, stomach, melanoma, multiple myelomas, liver,
kidney, bladder cancers and more are common. Such diverse presentations
result from varied causes: ingestion by mouth, skin, and respiration.
Ingestion includes exposure to chemicals in food and water. An
inspection of the year 2000 water quality statement from South
Huntington Water District reveals permissible levels of: 1,1,1-
Trichloroethane, Tetrachloroethane, Trichloroethene,
Bromodichloromethane, Chlorodibromomethane, 1,1-Dichloroethane, 1,2-
Dichloropropane, nitrates (fertilizers); all carcinogens. Most other
water district reports have similar levels of ``acceptable''
carcinogens. Farming on Long Island is the largest dollarwise in the
State and carcinogenic residues may be found on the produce, again,
within ``acceptable'' government standards.
There are five incinerators distributed around Long Island and over
a dozen power plants, with potentially a dozen more due to
deregulation. All use fossil-fuel and emit millions of pounds a year of
carcinogens in the form of particulate matter and volatile organic
compounds. Because these are on an ISLAND, there are very few suitable
locations for minimum impact on the population and environment. In some
neighborhoods, more than one of these major stationary sources are
side-by-side. Some existing, or proposed, are close to homes, schools,
hospitals and parks.
The unique topography and meteorology of Long Island result in
numerous stagnant days, especially in the ozone season (May to
October). Exposure to the aforementioned carcinogens as well as other
pollutants is significantly higher to the general population during
such times. Furthermore, the dearth of mass transit has resulted in an
extraordinary number of vehicle and truck (high-polluting diesel) trips
that add carcinogens and other pollutants to the air. In fact, the DEC
has classified Long Island for over 8 years as a ``non-attainment
region'' for ozone. That also implies high levels of the other
pollutants that cause heart/lung damage and cancer.
The proliferation of cellular communications has resulted in
countless cell towers and antennas that dot the Long Island landscape.
These are suspected of have carcinogenic effects. Some towers with
dozens of stations (antennae) are adjacent to dense residential
clusters. In addition, the same applies to high tension fines. Both
will become more prevalent with time.
Blessed with hundreds of miles of shoreline, sunbathers have ample
opportunity of sun exposure which is associated with melanoma.
The nature of a carcinogen is such that there is no safe limit of
exposure. The Delaney Amendment prohibited chemicals, compounds or
additives in food or drugs that showed any laboratory cancer causation.
It has since been repealed under industry pressure as too costly. The
next question is, ``To what degree will these carcinogens be removed
from the environment?'' or better, ``How much are we prepared to
spend?'' The current situation is unacceptable; additional (and more
costly) steps must be taken: If we want improved health and quality-of-
life, we must pay for it.
Residue on food can be reduced or eliminated by organic methods of
farming and more thorough cleaning. People will have to be educated to
accept good produce with cosmetic defects. Enact stricter standards for
residue.
Activated charcoal filters of greater sensitivity and more
stringent water purification and standards must be used until chemicals
are non-detectable in the potable water. Greater enforcement and
stricter regulations must be in place to prevent contamination of the
sole-source aquifer water supply. Less strict standards can be in place
for industrial processes, which may cut costs. Suffolk County Sanitary
Code Article 7 is a good example of a law meant to protect the aquifer
by prohibiting bulk storage of hazardous chemicals over deep-recharge
zones. However, it needs to be updated and is being challenged by power
producers, for example, that want to store hundreds of thousands of
gallons of hazardous liquids over prohibited aquifer recharge zones.
A relatively simple solution exists regarding the incinerators:
shut them ALL down. New York City has done it, with a considerably
larger population than Long Island. Turn the incinerators into refuse-
concentrating and recycling centers, and follow the NYC method of
disposal.
Regarding the absurdly high number of proposals for generators on
Long Island, mostly by out-of-state companies, a regional energy plan
must be formulated that will allow only the number of new power plants
that will be needed to meet expected demand, AFTER much greater effort
is made using renewables, efficiency and conservation. Any new
generators must be placed at existing sites, or as far from vulnerable
populations as possible. Tighten industrial emission standards.
Highly polluting diesels in heavy trucks may have their effects
reduced by night deliveries, with stricter and frequent inspections to
assure peak engine operation. A light rail line on, under or above the
LIE could lessen commercial traffic. Reinstate the ``luxury'' tax to
discourage gas guzzlers, with tax credits for economical vehicles.
Another possibility is to use the waterways and barge trucks or goods
to distribution depots. Rethink uncontrolled growth, development and
sprawl. The more there is, the more power plants and vehicle trips are
required.
Cell towers and antennae must be isolated from homes and schools if
possible. Satellite communication is an alternative, as well as a
highway antenna wire using lower power, as in the tunnels. Melanoma
from sun exposure can be reduced by public education including
sunscreens and body examinations.
The highest standard of living in the world has been achieved in
America with Long Island as a microcosm, but it has come with a price,
an epidemic of cancer. The solutions are known. Proven methods and
technology exist to greatly ameliorate the problem, but will we pay the
bill?
__________
Feingold Association of the United States,
Alexandria, VA, June 3, 2001.
Committee on Environment and Public Works,
U.S. Senate,
Washington, DC.
Dear Committee Member: On behalf of the Feingold Association, I
would like to express our deepest gratitude for the work of this
committee to focus attention on the possible links between
environmental contamination and chronic diseases. We are most
appreciative of the inclusion of food in defining environment, in light
of the purposes of our organization which are to generate public
awareness of the potential role of foods and synthetic additives in
behavior, learning and health problems, and to support members in the
implementation of the Feingold Program. The Feingold Program is based
on a diet eliminating certain salicylate-containing foods, all
synthetic colors, synthetic flavors, and the preservatives BHA, BHT,
and TBHQ.
Additionally, we appreciate the opportunity to provide information
which we hope will be valuable in our shared search for answers. As an
organization, we have been helping people for the past twenty-five
years and feel we can offer insight into possible connections between
foods, synthetic food additives and preservatives, other chemicals, the
body's processes of sulfation and salicylate metabolism, the immune
system, and chronic diseases such as ADHD, autism, and asthma.
The attached document was submitted previously to the Institute of
Medicine and the National Vaccine Advisory Committee in an effort to
address the need for further research into previously mentioned areas
as they may relate to concerns about vaccines and mercury more
specifically. It is vital to note that a positive response to the
Feingold Program may serve as a marker for those at risk for diseases
or damage from vaccines and/or vaccine ingredients. We feel this
information may also assist you in considering broader issues related
to the environment and chronic diseases. The need to identify the role
of diet is crucial and may provide the baseline for exploring and
determining root causes.
Your commitment to collaborative efforts in order to find answers
is most commendable and appreciated. It is our hope that you will be
taking a leadership role in identifying the way such work will be
coordinated. This should include the work of other government agencies
and officials, such as Senator Dan Burton, who similarly are obtaining
valuable input regarding chronic diseases such as ADHD, autism, and
asthma. We respectfully request the opportunity to participate in
ongoing dialog about these issues, which are of personal and
professional concern for those we serve. Thank you again for your
sensitive and proactive work to improve and ensure our public health.
Sincerely,
Sherri Luther Palmer,
President,
The Feingold Association of the Northeast.
Kathleen Bratby, M.S.N., R.N.,
President,
The Feingold Association of the United States.
______
Feingold Association of the United States,
Alexandria, VA, June 3, 2001.
Committee on Environment and Public Works,
U.S. Senate,
Washington, DC.
Dear Committee Member: The Feingold Association of the United
States, Inc., founded in 1976, is a non-profit organization whose
purposes are to generate public awareness of the potential role of
foods and synthetic additives in behavior, learning and health
problems, and to support its members in the implementation of the
Feingold Program.
The program is based on a diet eliminating certain salicylate-
containing foods, all synthetic colors, synthetic flavors, and the
preservatives BHA, Bill, and TBHQ.
We in the Feingold Association realize that the program is one of
many ``puzzle pieces'' in addressing behavior, learning, and health
problems such as those associated with autism and ADHD. It is often a
cornerstone of multimodal therapy for such children, and we feel that
more research into what is happening in the body's sulfation system, in
salicylate metabolism, or in other areas in which diet may play a role
should be important for improved treatment and prevention of ADHD and
autism.
Research in England and elsewhere (Harris et al, 1998; Waring &
Ngong, 1993; O'Reilly & Waring, 1993; Alberti, 1999) has shown that
children with late-onset autism are very low in the enzyme PST (phenol
sulfotransferase) and appear to have major problems in sulfation. This
appears to be related to food sensitivities (Scadding et al., 1988;
O'Reilly & Waring 1993; McFadden 1996) and common food additives
(Bamforth et al, 1993) as well. We ask for research to determine if:
(1) these may be the children at risk for autism or ADHD if vaccinated,
or (2) the vaccines suppress the sulfation system in any way, which
would put at risk all those who are below some threshold yet to be
determined.
Since many children with autism or ADHD respond to the Feingold
diet (Arnold, 1999; see also www.feingold.org/research--adhd.html and
www.feingold.org/research--autism.html), we would like to know why--
whether it could be an impact of some vaccination which creates the
problem that the diet can help, and/or whether the child has such a
problem naturally so that identifying this would screen for those who
may be at risk of actual damage by vaccine chemicals. In other words,
is the Feingold diet a treatment for some form of damage and/or would
the response to the Feingold diet be a marker to determine which
children are at risk?
In related work, Dr. Mary Megson has shown that children with
autism and/or ADHD have a defect in the G-Protein, and she is able to
identify them by family profile. This should be studied as a preventive
measure to identify those children at risk before vaccinating. Also,
according to Dr. Megson, there are ways to prevent or even correct such
damage in these children, and further research should be done based on
her work and any possible relationship to Feingold diet responders.
(See www.treatmentchoice.com/megson.html)
Additionally, research has shown that synthetic food additives
suppress levels of zinc (Brenner, 1979; Ward 1990, 1997), hormones and
enzymes (Bamforth et al 1993) and the immune system (Koutsogeorgopoulou
1998). We ask for research to be done on all the ingredients in
vaccines to determine any impact on zinc levels, zinc metabolism,
enzymes, hormones, and the immune system--and, conversely, whether
these reactions to synthetic additives would be markers to identify
children potentially at risk to develop ADHD or autism with (or
without) further vaccination.
The following statement was signed by attendees at the 25th Annual
Conference of the Feingold Association on September 22, 2000: We the
undersigned strongly suggest that vaccines containing mercury be stored
until such time that the effects of mercury buildup in multiple
vaccinations is better understood. If the effect is statistically
minimal, the vaccines may be used at a later date. If the high doses of
mercury are harmful, the vaccines can later be destroyed. Meanwhile,
current stores of mercury-free vaccines can be used and data gathered
about the effect of mercury-free vaccines.
A copy of this signed statement will accompany the hard copy of
this letter (by mail), and the original was submitted to the office of
the Surgeon General. We further call for research to recognize those
children who may be harmed by or have difficulty detoxifying such
toxins as mercury, phenol, formaldehyde, or other ingredients in
vaccines so they can be identified and protected.
When research is done on the hypothesis of whether vaccines are
related to autism and ADHD, the connection between vaccines and the
metabolic pathways involved in response to the Feingold diet should not
be ignored. We have identified areas for further research which we hope
will contribute to finding the answers we all need for the sake of our
future, our children. Thank you for the opportunity to provide these
materials, and we ask to be involved in ongoing dialog and efforts to
address public health issues such as these currently commanding
national attention.
Sincerely,
Kathy Bratby, MSN, RN,
President.
Jane Hersey,
National Director.
Shula Edelkind,
Research Librarian.
Pat Palmer,
Board Member Emeritus.
Colleen Smethers, CRNP (retired)
President, Feingold Assn.
of Southern California.
______
References
Alberti, A., Pirrone, P., Elia, M., Waring, R.H., Romano, C.,
Sulphation deficit in ``low-functioning'' autistic children: a pilot
study, Biological Psychiatry 1999 Aug 1; 46(3):420-4.
Arnold, L.E., Treatment Alternatives for Attention-Deficit/
Hyperactivity Disorder (ADHD), Journal of Attention Disorders, Vol. 3,
No. 1 (April 2000), 30-48.
Bamforth, K.J., Jones, A.L., Roberts, R.C., Coughtrie, M.W., Common
Food Additives are Potent Inhibitors of Human Liver 17 Aipha-
Ethinyloestradiol and Dopamine Sulphotransferases, Biochem Pharmacol,
1993, Nov. 17; 46(10):1713-20.
Brenner, A., Trace Mineral Levels in Hyperactive Children
Responding to the Feingold Diet, Journal of Pediatrics 1979 June;
94(6):944-5.
Harris, R.M., Hawker, R.J., Langman, M.J., Singh, S., Waring, R.H.,
Inhibition of Phenolsulphotransferase by Salicylic Acid: a Possible
Mechanism by Which Aspirin May Reduce Carcinogenesis, Gut 1998 Feb.;
42(2):272-5.
Koutsogeorgopoulou L., Maravelias D., Methenitou G., Koutselinis
A., Immunological Aspects of the Common Food Colorants, Amaranth and
Tartrazine, Vet Hum Toxicol, 1998, Feb. 40(1); 1-4
McFadden, S.A., Phenotypic Variation in Xenobiotic Metabolism and
Adverse Environmental Response: Focus on Sulfur-Dependent
Detoxification Pathways, Toxicology, July 1996, Vol. 111(1-3), pp. 43-
65
Megson, M., Testimony to the House Government Reform Committee on
Autism and Vaccines, April 6, 2000. (She can be reached at 7229 Forest
Ave., #211, Richmond, VA 23226)
O'Reilly, B.A. & Waring, R.H., Enzyme and Sulphur Oxidation
Deficiencies in Autistic Children with Known Food/Chemical
Intolerances, Journal of Orthomolecular Medicine, Vol. 8, No. 4, 1993.
Scadding, G.K., Ayesh R., Brostoff, J., Mitchell, S.C., Waring,
R.H., Smith, R.L., Poor Suiphoxidation Ability in Patients with Food
Sensitivity, British Medical Journal, 1988 July 9, 297 (6641): 105-7
Ward, N.I., Assessment of Chemical Factors in Relation to Child
Hyperactivity, Journal of Nutritional & Environmental Medicine
(Abingdon); 7 (4). 1997. 333-342.
Ward, N.I.; Soulsbury, K.A.; Zettel, V.H.; Colquhoun, I.D.; Bunday,
S; Barnes, B., The influence of the Chemical Additive Tartrazine on the
Zinc Status of Hyperactive Children: A Double-Blind Placebo-Controlled
Study. J. Nutr. Med.; 1(1). 1990. 51-58.
Waring, R.H. & Ngong, J.M., Sulphate Metabolism in Allergy-Induced
Autism: Relevance to the Disease Aetiology, Dept. of Biochemistry,
Birmingham U., Edgbaston, Birmingham, UK 1993.
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[GRAPHIC] [TIFF OMITTED] T0650.108
Elaine Marie Cobis,
Islip, NY.
Committee on Environment and Public Works,
U.S. Senate,
Washington, DC.
Dear Senator Hillary Clinton: Thank you for invitation to have the
opportunity to experience some of the efforts of your hard work. I
attended the Senate hearing at Adelphi University in Garden City, NY on
June 11, 2001. I felt humbled being in the presence of persons
dedicated to helping humanity. I have my own testimony of human
suffering which I believe can be attributed to the pollutants of the
environment.
As a Registered Nurse, I had the opportunity to care for patients
on the Oncology Unit which help me attain the expertise for caring for
patients afflicted with cancer. I applied my skills to caring for
patients in the home who required infusion therapy such as
chemotherapy, TPN and several forms of intravenous therapy.
In 1991, while working for HMSS, an infusion therapy company, I
cared for a 21-year-old student with a diagnose of leukemia. She lived
in a dorm for 2 years which was located at Stoney Brook University on
Long Island, NY. The dorm she lived in was closed down by a team of
epidemiologist of New York State in July 1991. The reason cited in a
Newsday column was that the cases of Leukemia, over the years, were too
numerous not to suspect problems with the building.
In 1992, I held a young girl in my arms till she breathed her last
labored breath. She was 23. Her killer was breast cancer. She lived in
Brentwood, Long Island. Her doctors, from Columbia Presbyterian
Hospital in Manhattan, suspected that she had breast cancer since age
16. A tumor on her right shoulder was discovered during a routine
physical examination for college at age 20. Her age alone raises
suspicion that the breast cancer was linked to the pollutants in the
environment. Brentwood, Long Island is home to Pilgrim Psychiatric
Center. This hospital has acres of land surrounding it, some of which
are the pine barrens. It is also home to a toxic dumpsite located on
the grounds of Pilgrim Psychiatric Center.
In 1989, I took tare of a 21-year-old male with advanced testicular
cancer. He lived in Brentwood, Long Island.
In 1991, an 11-year-old girl, my daughter's first cousin, was
diagnosed with thyroid cancer. She still is fighting this cancer with
yearly exams and treatments at Sloan Kettering Hospital. Thyroid
cancer, in a child, is extremely rare and is highly suspect to be
directly linked to environmental hazards.
I hope my testimony contributes to the many and will help attain
the honorable goal of establishing a national cancer reporting agency.
This will help gather information so that action can be taken to heal
this wounded Nation. We were once a clean and healthy land. Efforts
must be made to bring that health back to our noble land.
Sincerely,
Elaine Marie Cobis,
Registered Nurse.
__________
Michael Conti,
Oceanside, NY, June 16, 2001.
Committee on Environment and Public Works,
U.S. Senate,
Washington, DC.
To Whom it may concern: On Monday, June 11, 2001, at Adelphi
University I attended a hearing on environmental health concerns
chaired by Senator Clinton. Many prominent scientists were asked to
speak about their research efforts that were aimed toward investigating
the causes of cancer and other human illnesses. Unfortunately, none of
the scientists who spoke are doing research in an area that I feel
needs investigating.
Since the title of the hearing was Environmental Health Concerns,
it was very appropriate for the scientists to be asked to define
environment and to give examples. Environment was described as the
material things around us that we can see as well as the invisible
things. Therefore, the scientists would study the water and air for
pollutants as well as electromagnetic radiation. Their definition for
environment meant that they would be looking outside the human body.
Herein lies the problem.
I want the Senate Committee on the Environment and Public Works to
investigate the toxic microenvironment that exists in the mouths of
many Americans who have metallic filling materials in their teeth. For
hundreds of years teeth have been restored with a material commonly
called a silver filling or silver amalgam. This material is the end
result of mixing approximately equal parts of elemental liquid mercury
and an alloy powder composed chiefly of silver, and tin, and sometimes
smaller amounts of copper, zinc, palladium, or indium. However, the
composition of this amalgam has recently changed with the addition of
greater amounts of copper. According to scientific evidence high copper
amalgams are very deadly. A typical adult will usually have one or more
crowns containing some gold, silver, and palladium. Some other metals
such as chrome and nickel might also be present in a person who is also
wearing a removable partial denture. As you can see the mouth can be a
microenvironment of toxic metals which will leach into the body and
have the potential for causing disease. Besides poisoning the body,
microelectric currents are set up between these dissimilar metals which
is also harmful to the human body.
Teeth lie on meridians according to Chinese medicine. Chinese
medicine claims that problems associated with first molars are related
to breast cancer. I've been told this is true. I want the Senate to put
a team of people together to see if there is any truth to this
statement.
Finally, I would ask all members on this health committee to become
informed with the literature that is already available linking dental
work with human disease. I am enclosing a list of publications that you
must read before making any decisions. I urge you to read these books
rather than relying on the scientists from whom you heard on June 11.
I just want to include a short paragraph from my first e-mail to
Mrs. Clinton dated Thursday, May 3, 2001.
``I was pleased to hear on Monday and today in Paul Harvey's
broadcast of the news that the State of Maine has a bill before the
State legislature banning the use of mercury dental amalgam in pregnant
women. I would like you to initiate a similar bill for New York
State.''
I thank you in advance for the effort I know the committee will put
toward better health for Americans. Please keep me informed of your
decisions.
Sincerely,
Michael Conti.
______
Books Available Through Dams (See Guide to the Books for Descriptions of
Contents)
------------------------------------------------------------------------
Price/
book [In
dollars]
------------------------------------------------------------------------
GENERAL OVERVIEW, DENTAL-HEALTH ISSUES
DAMS Information Booklet (part of the information packet).. $4.00
DAMS Information Packet (includes DAMS booklet, list of 7.00
practitioners, etc.)......................................
Uninformed Consent: the Hidden Dangers in Dental Care, by 17.00
Hal Huggins, DDS & Levy, T................................
Whole Body Dentistry, the Missing Piece to Better Health by 21.00
Mark Breiner, DDS.........................................
Tooth Truth, by Frank Jerome, DDS.......................... 22.00
The Key to Ultimate Health, by Richard Hansen, DMD and 22.00
Ellen Brown, JD...........................................
Elements of Danger, the Hazards of Modern Dentistry by 16.00
Morton Walker, DPM........................................
Mercury Free, by James E. Hardy, DDS....................... 19.00
Dentistry Without Mercury, by Sa am Ziff, Michael Ziff, DDS 8.00
Solving the Puzzle of Mystery Syndromes (with patient 7.00
stories!) by Mary Davis...................................
SAFE REMOVAL OF MERCURY AMALGAM FILLINGS and HEAVY METAL
DETOXIFICATION
A Guide for the Patient (Specific detox protocols, 15.00
including IV-C) by Queen & Queen..........................
Standards of Care for Amalgam Removal, by Paul J. Pavlik, 15.00
DMD.......................................................
Dental Mercury Detox--by Ziff, Ziff & Hanson............... 8.00
Detoxification by Hal Huggins, DDS, MS..................... 15.00
Protocol for Amalgam Removal and Dental Revisions by Hal 18.00
Huggins, DDS, MS..........................................
ROOT CANALS
Root Canals, the Good, the Bad and the Ugly, by Gary 2.00
Strong, DDS...............................................
CAVITATIONS Chronic Pain & Jaw Bone Cavitation, by Gary 2.00
Strong, DDS...............................................
Beyond Amalgam, the Hidden Hazard of Jawbone Cavitations by 15.00
Susan Stockton............................................
SCIENTIFIC SUMMARIES:
Infertility and Birth Defects (also, auto-immune effects) 17.00
by Sam Ziff & M. Ziff, DDS................................
The Missing Link: Heart Disease as it Relates to Mercury, 14.00
by Ziff & Ziff............................................
Toxic Metal Syndrome (links to mental illness) by H.R. by 17.00
H.R. Casdorph & M Walker..................................
HEALTH RESOURCES Winning the War against Asthma & Allergies, 20.00
EW Cutler, DC
Fluoride, the Aging Factor by John Yiamouyiannis, Ph.D..... 17.00
What Your Doctor May Not Tell You About Menopause, by John 16.00
R. Lee, M.D...............................................
------------------------------------------------------------------------
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Contributions to DAMS are tax deductible. Above prices including
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availability of titles and to order by credit card by calling (800)
311-6265. For general questions, please call (612) 721-1144.
__________
STAR Foundation,
East Hampton, NY, June 20, 2001.
Committee on Environment and Public Works,
U.S. Senate,
Washington, DC.
Re: Environmental Carcinogens on Long Island, NY
These comments are submitted on behalf of STAR, Standing for Truth
About Radiation, a grassroots organization with 4,000 members concerned
about the toxic effects of nuclear radiation. We promote public
awareness, medical and scientific investigation, institutional
accountability, independent oversight, and responsible public health
and environmental policies. STAR actively promotes' alternative and
renewable energy technologies, as the available solution to nuclear
generated power.
Rising cancer rates oh Long Island are a great public concern.
Efforts to look for a cure to cancer are, laudable, but as a society,
we must also be looking to identify and minimize the man-made causes.
On Long Island, there are numerous issues of concern. Pesticide
contamination and industrial solvents have polluted large areas of
groundwater around the island. There are old, dirty power plants that
are ``grandfathered'' from the Clean Air Act that desperately need to
be replaced our up-graded. These issues deserve serious attention.
However, when looking at the cancer risks to the public, the most
widely ignored issue has been man-made radiation. Primarily, this has
resulted because the atomic program was a creation of the Federal
Government. The Federal Government promoted ``Atoms for Peace'' and
widely subsidized and promoted the inception of nuclear power.
Therefore, the issue has escaped objective, inclusive and transparent
analysis and public discourse. It is well settled that radiation causes
cancer, the debate is over at what level of exposure do cells start to
mutate. Radiation protection standards have been changed seven times
since their inception. However, as a society, we have been slow to come
to terms with the true costs associated with the atomic age. It was not
until last year, that a White House draft report linked 14 Department
of Energy (DOE) sites with increased rates of a variety of cancers and
other occupational illnesses. This is highly significant because it is
the first time that our government has acknowledged that people got
cancer from radiation exposure at Department of Energy facilities.
Indeed, after fifty years of disputing the fact, the Federal Government
is now recognizing ``credible evidence of increased risks due to
ionizing radiation exposure and chemical and physical hazards'' at DOE
facilities.
As a Nation, we must objectively analyze the public health
consequences of man-made radiation from nuclear reactors.
I. REACTOR EMISSIONS & HEALTH
Nuclear power reactors have been producing electricity since the
first unit began operations in 1957. Currently, 103 reactors are
operating in the U.S., producing about 20 percent of the nation's
electricity and about two-thirds of Americans live within 100 miles of
at least one nuclear reactor with approximately 42 million people
living downwind from commercial reactor.
Startup of new reactors and increased use of existing ones have
caused the net generation of electricity from reactors to nearly triple
(248 million to 727 million gigawatt hours) from 1980 to 1999.
Moreover, about half (51) of the reactors now licensed have been
operating for at least 24 years; Big Rock Point, in northern Michigan,
had the longest life span (34 years) before closing. Present trends
suggest that use of nuclear power reactors may proliferate in the
future. The U.S. Nuclear Regulatory Commission has received
applications to extend the licenses of 43 reactors from 40 to 60 years.
In addition, the Nuclear Energy Institute announced a goal of 50 new
nuclear reactors at its annual meeting in May 2001.
Rising use of aging nuclear reactors present health & safety issues
that needs to be addressed:
1. Do routine emissions of radioactivity into the air that are
inhaled and ingested, result in increased disease risk?
2. Does the buildup of nuclear waste from reactor operations pose a
threat to the health of local residents?
Because radioactivity can cause damage to the human immune,
genetic, and hormonal systems, an accurate assessment of risk to the
public is warranted. However, current regulatory policies do not
include any such assessment. The U.S. Nuclear Regulatory Commission has
approved the first five applications for reactor license extension,
with no consideration of disease rates among the local population.
II. NUCLEAR POWER REACTORS AND HEALTH
Only one national study has been done on disease rates near nuclear
power plants. In 1990, at the insistence of Senator Edward M. Kennedy,
the National Cancer Institute published data on cancer near nuclear
plants. While the study concluded that there was no connection between
radioactive emissions and cancer deaths, rates near many reactors rose
after reactor startup. Since 1990, the Federal Government has
undertaken no health studies of disease rates near nuclear power
plants.
However, the non-profit Radiation and Public Health Project (RPHP)
has undertaken the first-ever study that measures radioactivity in the
bodies of persons living near nuclear power reactors. In 1996, RPHP
launched the Tooth Fairy Project, which uses the same methodology of
calculating levels of Strontium-90 in baby teeth employed in the St.
Louis study during the 1 950's and 1960's.
Sr-90 is just one marker for the 100-200 radioactive chemicals that
are released in nuclear reactor operations, and it is a critical one.
Like calcium, Sr-90 attaches to the bone and teeth when it enters the
body, where it remains for many years due to its slow rate of decay
(half life of 28.7 years). It kills and impairs bone cells, and
penetrates the bone marrow, which is where the red blood cells critical
to immune function are formed. Of all man-made radioactive isotopes,
Sr-90 was the one that caused the greatest health concern during the
atmospheric bomb test years in the 1 950's and 1960's.
To date, RPHP has collected over 3000 baby teeth, mostly from areas
near reactors in California, Connecticut, Florida, New Jersey, New
York, and Pennsylvania. Strontium-90 concentrations have been measured
in nearly half (1463) of these teeth that have been tested by an
independent laboratory.
The average current concentration of Sr-90 is similar to that in
St. Louis in 1956, in the midst of the period of atmospheric nuclear
weapons testing. Results of the Tooth Fairy Project have been published
in three peer-reviewed medical journals. (27-29)
The largest number of teeth (563) have been measured for residents
of Suffolk County New York. Results show that the average level of Sr-
90 has steadily increased 40 percent from the early 1 980's to the mid-
1990's. Because above-ground bomb testing ceased in the early 1960's,
and old bomb fallout is decaying steadily, this trend indicates that a
current source of radioactive emissions is contributing to the buildup
of Sr-90 in teeth. This source can only be nuclear reactors.
----------------------------------------------------------------------------------------------------------------
Year of Birth No. of Teeth Avg. Sr-90+ Percent Change
----------------------------------------------------------------------------------------------------------------
1981-84............................................. 38 1.10 ..................
1985-88............................................. 157 1.38 ..................
1989-92............................................. 258 1.41 ..................
1993-96............................................. 45 1.54 +40.0
----------------------------------------------------------------------------------------------------------------
+Average picocuries of Strontium-90 per gram of calcium in baby teeth at birth.
In the same time period, cancer diagnosed in Suffolk County
children less than 10 years old steadily rose a nearly identical 49
percent. The data supports the theory that exposure to radioactive
emissions from nuclear reactors increases the risk of cancer,
especially in young persons.
Children are not the only humans affected by the radiation-cancer
connection. However, since the rapidly developing fetus and infant are
most sensitive to toxic exposures to radiation and other chemicals,
immediate adverse effects are most likely to occur. A latency period of
up to several decades between exposure and manifestation of cancer may
be necessary in adults.
----------------------------------------------------------------------------------------------------------------
Age 0-9 Cancer Cases per 100,000
Period Cases Avg. Pop. Pop. Percent Change
----------------------------------------------------------------------------------------------------------------
1981-84......................... 92 182,441 12.61 ..................
1985-89......................... 115 182,463 15.76 ..................
1989-92......................... 129 185,050 17.43 ..................
1993-96......................... 146 194,498 18.77 +48.9
----------------------------------------------------------------------------------------------------------------
III. LONG ISLAND--CHILDHOOD CANCER IN HIGH-RADIATION AREA
In the late 1990's, anecdotal news of an unusually high number of
cases of Rhabdomyosarcoma in northwestern Suffolk County children began
to surface. The usually rare soft tissue cancer was discovered in 23
children living in a small area. Parental concerns of victims prompted
the Suffolk legislature to authorize a RMS Task Force in the fall of
2000 to investigate the extent and cause of the outbreak.
While the cause(s) of rhabdomyosarcoma are generally unknown,
radiation exposure has been identified as a risk factor. Over one-
quarter of laboratory mice who had Sr-90 rubbed on their skin were
later diagnosed with rhabdomyosarcoma or a related cancer and pregnant
women who receive a pelvic X-ray are twice as likely to bear a child
who will be diagnosed with the disease. The RPHP Baby Teeth Study has
collected 57 teeth from the area of Suffolk County in which most
children with rhabdomyosarcoma live. The average concentration of Sr-90
in teeth is the highest in Suffolk County, at 1.48 picocuries of Sr-90
per gram of calcium. Teeth in other areas, such as the north and south
forks of Long Island and the middle of Suffolk County have barely half
that amount. RPHP is now conducting a case-control study, in which it
tests teeth from children with rhabdomyosarcoma to further establish
the link between the disease and environmental radiation. However, this
relationship deserves further study.
IV. CLOSING REACTORS--EIGHT U.S. NUCLEAR POWER PLANTS
When nuclear power reactors cease operations, there is an immediate
removal from the diet of all radioactive products that decay quickly,
and a more gradual removal of those that decay slowly. The reduction
should be greatest in nearby areas downwind of closed reactors; the
majority of airborne emissions are propelled in the downwind direction,
where radioactive gases and particles can be inhaled and are introduced
into the diet via precipitation. Since 1987, eight nuclear power plants
have closed, leaving at least a 70-mile-radius with no operating
reactors. In downwind counties within 40 miles of all eight of these,
the death rate among infants under 1 year of age plunged in the first 2
years after closing. RPHP is collecting baby teeth near one of these
areas (Rancho Seco, near Sacramento CA) to establish that the
improvement in health is accompanied by a declining level of in-body
radioactivity.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Infant Death Live Births Deaths/1000
Reactor, Closed ------------------------------------------------------------------------------ Percent
Before After Before After Before After Change
--------------------------------------------------------------------------------------------------------------------------------------------------------
LaCrosse WI, 1987............................................ 36 30 3507 3452 10.27 8.69 -15.4
Rancho Seco CA, 1989......................................... 418 390 44500 49414 9.39 7.89 -16.0
Ft. St. Vram CO, 1989........................................ 83 72 9725 9977 8.53 7.22 -15.4
Trojan OR, 1992.............................................. 253 204 30320 29799 8.34 6.85 -17.9
Big Rock Pt. MI, 1997........................................ 25 6* 2922 1529* 8.56 3.92* -54.2
Me. Yankee ME, 1997.......................................... 19 10* 3841 2201* 4.95 4,54* -8.3
Pilgrim MA, 1986............................................. 97 76 12956 13412 7.49 5.67 -24.3
Millstone CT, 1995........................................... 166 130 22261 21093 7.46 6.16 -17.4
TOTAL 8 AREAS................................................ 1097 918 130032 130877 8.44 7.01 -16.9
U.S. AVG 2-YR CH, 1986-98.................................... ........... ........... ........... ........... ........... ........... -6.4
--------------------------------------------------------------------------------------------------------------------------------------------------------
*Only 1998 data are available for post-shutdown periods for Big Rock Point and Maine Yankee.
V. POLICY IMPLICATIONS
Since the end of the cold war a decade ago, nuclear weapons are no
longer manufactured or tested. However, the production of electricity
from American nuclear reactors has reached an all-time high, and some
utility companies are considering a large-scale expansion of the
industry. These developments indicate that the protection of humans
from the potentially harmful effects of exposure to radioactive
emissions in the environment will be critical. To that end, we urge
Congress to take the following actions:
1. Conduct hearings examining the current knowledge on the impact
of environmental radiation on public health, including cancer.
2. Establish and support an independent medical and scientific
commission to evaluate the impact of environmental radiation on public
health, including cancer.
3. Institute a systematic program measuring radioactivity levels in
bodies of persons living near to and distant from U.S. nuclear power
reactors.
4. Conduct or support routine, periodic studies tracking disease
patterns and trends among persons living near to and distant from
nuclear power reactors. Studies should identify infants and children
separately from adults, and should focus on cancer.
5. Direct policymakers and regulators to include consideration of
disease patterns and trends within the local population when making
decisions to extend licenses of existing nuclear reactors.
6. Direct policymakers and regulators to include consideration of
potential health effects when making decisions to grant operating
licenses for new nuclear reactors.
7. Require that in-body radioactivity levels be evaluated in all
federally funded programs that investigate possible causes of elevated
cancer rates in the U.S.
In sum, it is irresponsible for the Federal Government to continue
to ignore the long-term health consequences of nuclear power. Available
information indicates that nuclear power increases regional cancer
rates and the long-term ramifications must be afforded much greater
attention. Thank you for your attention to this important issue.
Sincerely,
Scott M. Cullen,
Counsel.
__________
Brentwood/Bay Shore Breast Cancer Coalition,
Brentwood, NY, June 24, 2001.
Committee on Environment and Public Works,
U.S. Senate,
Washington, DC.
Ref: Statement for Hearing at Adelphi University, Garden City, Long
Island, June 11, 2001
Honored Committee Members: As a rule, prevention is the 1st
principle of public health, but this is not so in the case of Cancer.
Information of known and possible environmental causes is not brought
to bear on real world practices. This information is not available to
the public in a systematic way to enable people to make daily decisions
protective of their health and that of their families. Yet, reducing
exposure to toxins is an important Pt step to reducing cancer. This can
be done. I offer the example of reducing lead levels in children's
blood. It begins with testing all pre-schooler's blood for lead levels.
When blood levels are high, we go back to the home and community to
trace the source or sources of the lead. There is then remediation to
remove the source of exposure. The child's blood is chelated (cleansed)
of the lead at the same time. As a society we have removed lead from
gasoline and track it to other sources for removal. We should follow
the same approach for exposure to toxins that are known or suspected of
causing cancer. Animal studies and weight of evidence are enough for me
to exercise the precautionary principle. The key to the success of the
lead program is its specificity. It identifies the danger for the child
at risk, before serious health damage and points the way to medical and
environmental correction.
Routine testing to measure current levels of toxic body burdens
must be funded. A testing program would help to recognize and pinpoint
possible causes. Currently, one cause of toxin exposure is by nursing
mothers who unknowingly pass their stored toxins to their infants via
breast milk. This testing would allow a woman to take action, to have
the opportunity to cleanse their bodies before beginning to nurse.
Surely her infant is the last person she would want to expose to
toxins. This is her dearest one, at a most vulnerable time of life.
Testing can prevent this from ever happening.
This brings us to the question of risk evaluation. The current
``Acceptable Risk'' method that is based on a young healthy 70-kilogram
male and 1 chemical, and 1 route of exposure at a time is not health
protective. It does not deal with especially vulnerable people such as
children or those with illness, or impaired immune systems (such as
prior cancer treatment). It does not consider exposure to a variety of
toxins. One size risk doesn't fit all. We need a ``reducing risk''
regulatory policy, which continually reduces the levels of exposure. As
in the case of lead, we need to follow the toxins to their sources and
use this information to justify cleanups and changes in industrial
practices. There should be financial incentives for transitions to non-
toxic methods. Models, education and technical advise for non-toxic
alternatives should be funded.
Mounting a scientific study for cancer can take years. The
asthmatic child and parents can tell you that right now there is
something in that school room that can be measured, that triggers that
child's shortness of breath, that may in time be the cause of cancer of
many people. Now it seems like our children are as canaries in the
mine, pointing the problem out but at a terrible cost! We must react
and seek out the cause of their asthmatic symptom and remove it.
We have to deal with poisons whose health effects are not as simple
as dose and immediate death. These impact immune and hormonal systems,
but the cancer result appears after long periods of time, making it
very difficult to show direct cause and effect. Teaming up an open
system of access to this information, along with grassroots
participation, can help account for toxic effects on health and the
environment. The individual then making an informed decision to protect
health should expect the same of the government. We all have a stake in
promoting public health. We need the process to do this together. Fund
putting the work of science out in the field to identify contaminants
and their concentrations. Make this the first line of defense for the
prevention of disease.
Sincerely,
Elsa Ford,
BBBCC President.
__________
Statement of Carol S. Kopf, Levittown, NY
WATER FLUORIDE CHEMICALS LINKED TO CANCER
Arsenic levels high enough to pose a cancer risk are detected in
drinking water treated with, tooth decay preventing, fluoride
chemicals, which also contain trace amounts of other contaminants such
as lead, barium and beryllium (1). Over 60 percent of U.S. communities
purposely add impure fluoride into residents drinking water and
virtually 100 percent of us consume foods and beverages made with this
tainted water.
No discussion about the environment and health can be complete
without looking at the science behind water fluoridation and human
health--even at the low levels of fluoride added to U.S. water
supplies. While environmentalists fight to get legislators to clean up
toxic chemicals accidentally, or without forethought, injected into the
environment, water engineers across the country are purposely adding
cancer-causing industrial waste products into our nation's water
supply.
According to the National Sanitation Foundation (NSF), the only
three chemicals certified for fluoridation are: Hydrofluosilicic or
Fluosilicic acid, Sodium Fluoride, and Sodium Silicofluoride . . . the
most common contaminant detected in these products is Arsenic,''
reports NSF. ``The other significant contaminant found is Lead,'' they
report\1\ ``All of the fluoride chemicals used in the U.S. for water
fluoridation, sodium fluoride, sodium fluorosilicate, and fluorosilicic
acid, are byproducts of the phosphate fertilizer industry'' wrote Tom
Reeves, National Fluoridation Engineer, U.S. Centers for Disease
Control CDC). ``Arsenic . . . had an average of 0.43 parts per billion
(ppb) in the drinking water attributable to the fluoride chemical,'' he
reports.\2\
---------------------------------------------------------------------------
\1\ http://www. fluoridealert.org/NSF-letter.pdf
\2\ http://www.fluoridealert.org/ifin-230.htm
---------------------------------------------------------------------------
Also, CDC's ``Water Fluoridation A Manual for Engineers and
Technicians,'' (Reprinted 1991) reads, ``sodium silicofluoride is
widely used as a chemical for water fluoridation. As with most
silicofluorides, it is generally obtained as a by product from the
manufacture of phosphorus fertilizers.'' (page 15)
But dentists don't seem to know or admit this. However, legislators
trust them. The media cites them as fluoride experts. But dentists are
not experts on toxicology. And, too often, they spend more time
denigrating those opposed to fluoridation rather than reading up on the
science behind fluoridation.
In a newspaper interview, American Dental Association fluoridation
spokesman, Michael Easley, DDS, who promotes fluoridation via his
National Center for Fluoridation Policy and Research website at the
University of Buffalo, NY, was quoted as saying,``. . . there are the
contrived arguments that claim fluoride is a chemical pollutant, a
toxic byproduct . . . There is no scientific basis for any of these
claims.''\3\
---------------------------------------------------------------------------
\3\ http://www.buffalo.edu/reporter/vol30/vol30n17/n5.html
---------------------------------------------------------------------------
The American Water Works Association is worried about arsenic-
contaminated fluoride chemicals. If arsenic's maximum contaminant level
is reduced to 5 ppb, ``90 percent of the arsenic that would be
contributed by treatment chemicals is attributable to fluoride
addition,'' according to their journal, ``Opflow.''
Arsenic in drinking water causes bladder, lung and skin cancer, and
may cause kidney and liver cancer. Lead poisoning can cause learning
disabilities, behavioral problems, and at high levels, seizures, coma
and even death.
Some experts say safe levels for arsenic or lead don't exist.
Arsenic levels as high as 1.66 ppb have been found in
hydrofluosilicic treated drinking water (1), which, according to the
National Academy of Sciences, is a cancer risk.\4\.
---------------------------------------------------------------------------
\4\ http://www.nrdc.org/water/drinking/arsenic/chap1.asp
---------------------------------------------------------------------------
Also studies show that children who live in silicofluoridated
communities have higher blood lead levels than children who live in
sodium-or non-fluoridated communities.\5\
---------------------------------------------------------------------------
\5\ http://www.dartmouth.edu/~news/releases/marol/fluoride.html
---------------------------------------------------------------------------
Fluoridation began with the discovery that residents who drank and
ate foods irrigated with natural calcium fluoride had lower rates of
tooth decay but teeth that were yellow, brown and chipping (dental
fluorosis). Early researchers erroneously assumed that, since fluoride
discolored teeth, fluoride must also be the reason the teeth were less
decayed. They forgot to factor in the calcium. The U.S. is the most
artificially fluoridated country in the world (water, food, air and
dental products). Dental fluorosis is growing in our child population.
Yet, tooth decay is rampant in our poor and minority populations, some
of whom also display fluoride overdose symptoms (dental fluorosis) and
who, most often, live in fluoridated communities.
Fluoridation is especially a burden to the poor who can't afford to
buy bottled water and who are harmed the most by fluoride chemicals,
studies show. Calcium is the antidote to fluoride poisoning because it
binds with the fluoride to carry it safely out of the body.
Less fluoride is available to the body when one drinks calcium
fluoride. The fluoride contained in the phosphate fertilizer industry's
waste products usually dissolves partially, leaving free fluorine to
bind with the calcium the body needs then carries it out of the body.
The best solution is to stop fluoridating U.S. drinking water.
Fluoride is neither a nutrient nor essential to health and is
ubiquitous in the food supply. Unlike essential vitamins and minerals,
ingesting slightly above recommended doses of fluoride causes serious
adverse health effects including death. The best way to have great
teeth is to eat properly--something our poor and immigrant populations
have trouble doing. Nourish the child and their teeth will prosper and
the only side effects will be healthier children.
__________
Statement of Lorraine Pace, Founder of the Breast Cancer Mapping
Project and Co-President, Breast Cancer Help, Inc.
My name is Lorraine Pace. I am a breast cancer survivor, activist
and founder of the breast cancer mapping project. I have resided in the
same zip code of West Islip for 45 years. I am an active member in the
following organizations:
Division for Women's Advisory Council
Charter Member of the Suffolk County Breast Health
Partnership
Cornell Ad Hoc Advisory Board
National Breast Cancer Coalition
Vice President of Promote Long Island
Environmental Committee of the Long Island Association
New York State Breast & Cervical Cancer Advisory Board
Department of Health Cancer Surveillance and Early
Detection Board
NYS Breast Cancer Network
I was also on the following peer review boards:
Department of Defense
Health Research Science Board
For the Breast and Prostate Cancer Detection, Treatment
and Research Act funded by the cigarette tax in California
The first 50 years of my life were filled with family, a career in
real estate, and a return to college where I earned a bachelor and
masters degree. I am a mother of three, but nothing in those years
prepared me for my 50th year in 1992--the year I discovered that the
lump I had been feeling in my left breast for many years was what I had
feared all along--it was cancer and it spread to my lymph nodes. That
is when, I, Lorraine Pace, until then a typical suburban woman, became
an activist. I never smoked in my life and as far as drinking, I am an
occasional social drinker. I was not on hormone replacement therapy and
on birth control pills for only 2 months. I had all my children, John,
Lisa and Greg before the age of 30. I was in excellent health with good
eating habits and exercised regularly. Neither grandmother nor my
mother had breast cancer. I did everything that I was supposed to do
for early detection, including having regular mammography views since
my early 30's. I knew there had to be another reason why I developed
breast cancer.
I went to New York City to a breast cancer specialist. I went to
him every 6 months for many years, during which time I complained to
him about this change I felt in an old scar located in my left breast.
I was told repeatedly, ``Not to worry, it was only scar tissue'';
and since nothing showed up in all my mammography's, I was told to come
back in 6 months which I did. A month before my 50th birthday my
radiologist called to tell me that I would have to come back for more
views since they saw something suspicious in both breasts. I figured
that the lump that had been bothering me for years had finally showed
up in my mammography's. I went back to my radiologist and had more
views taken. I was then told to go for surgery on both sides of my
breasts. They discovered calcifications in the right breast and a
suspicious lump in the left breast.
After surgery the results of the tissue samples from both breasts
came back benign and I was told again not to worry. With stitches still
on both breasts, I went on to celebrate my 50th birthday. After all, I
had a lot to celebrate. I returned to my doctor to have my bandages and
stitches removed, but noticed the lump on my left side, which was in a
6 o'clock position was still there. Since I was told that my breasts
were fine, I did not worry about the lump.
Eight months after my surgery when I was on an airplane I started
to talk to the person next to me. He happened to be a mortician from
Suffolk County. During our conversation he informed me of all the young
women who lived on the east end of Long Island who were brought to his
funeral home who had died of breast cancer.
The very next day I went to see my breast cancer surgeon and asked
him to remove this so-called scar tissue. He agreed to remove it and
did a frozen section after many more mammography views. Within a few
minutes he came back with the results; yes, it was what I feared--
cancer and I would need additional surgery and an axially dissection.
He didn't seem concerned about the results of the dissection, but
neither was he concerned about the lump that I felt for many years. He
assured me that the lump, though malignant, probably had not spread
cancer to my lymph nodes. I received a call a week later to find out
that it had indeed spread to 3 of my lymph nodes. This is what spurred
me to become an activist, since I did not want other women to
experience what I did.
Mammography screening is the best tool we have presently for the
early detection and diagnosis of breast cancer. But it is not always
effective for young women or women with dense breasts. We must
therefore find a more precise and accurate method of screening women
for breast disease. After all, we have the technology to put a man on
the moon, surely we can find a better way to diagnose breast cancer. As
it is now, by the time a tumor is found in the breast, it has been
there for approximately 8-10 years. After all we have a blood test for
prostate why can't we have one for breast cancer?
Awhile after I was diagnosed with breast cancer, it struck me that
20 other women I knew had also been diagnosed. After a great deal of
thought, the one thing I could see that we had in common was that most
of us lived on dead-end streets. I started to think about what this
could mean.
Our community was lovely fresh air water views. The only thing that
was odd about this environment was that occasionally my tap water was
rusty. I began to wonder, if possibly, the metals that made the water
rusty could have anything to do with the breast cancer rate in my
neighborhood and the rest of Long Island. I read that the Center for
Disease Control was to come to Long Island. I testified before them and
showed my rusty water and asked them if there was any connection
between my breast cancer and my rusty water. Newsday took a picture of
me that appeared on the front page in the spring of 1992 titled,
``Asking for Answers.'' Joan Swirsky of the New York Times wrote
several articles after this article appeared. During this time I was
undergoing chemotherapy and shortly after radiation. NJ Burkett of
Channel 7 Eyewitness News did a series on breast cancer mapping and was
awarded the Folio Award for his coverage.
Once I began to suspect the culprit might be the water, I looked
around at other communities and at other environmental factors that
could be involved. I found that New York City has a much lower rate of
breast cancer than Long Island. Yet they are so close to us-just a few
miles. Is that because they get their water from upstate reservoirs? Or
they don't have lawns that they obsessively fertilize-dumping every
kind of killer chemicals into the underground aquifer that is our sole
source of water? Or is it because their wires are buried underground
instead of overhead like they are in parts of the suburbs?
And it's not only the chemicals that are put on our lawns that are
poisoning our water, but the chemicals put on our golf courses as well.
Older industries are also to blame that have dumped hazardous chemicals
into the ground for years.
When there appeared to be no answers to my questions, I asked my
oncologist, Dr. Michael Feinstein to help me prove a theory I had about
dead-end water mains. My concern was that if you lived on a dead-end
street the water did not circulate as well as if you lived in the
middle of the block and you were exposed to more contaminants. He
offered his help to see if this theory could be proved. On his days off
we met with former Suffolk County Health Commissioner, Dr. Mary Hibberd
and the head of the Suffolk County Water Authority, Michael LoGrande to
develop a survey. After these initial meetings, I and my friend Pat
approached our Congressman Tom Downey. He in turn sent us to Angie
Carpenter for a quote on printing the survey. She in turn sent me to
Ted Shiebler who worked in public relations at Good Samaritan. He then
called Lou Grasso, editor of Suffolk Life Newspaper. Lou Grasso and
Dave Wilmott, publisher of Suffolk Life contacted me and they in turn
printed the survey on their front page and this is how the breast
cancer mapping originated. Liz Tonis of Suffolk Life kept the community
apprised of the results of the surveys with ongoing articles in Suffolk
Life. My radiation oncologist, Dr. Allen G. Meek encouraged me to
pursue the mapping project. With the help of Maria Diorio and many
other volunteers from the neighborhood we put the responses from the
survey on to a map. This was done from my dining room table every day
for 18 months. The map showed clusters of breast cancer with definite
patterns of concentration in certain areas. This data was then analyzed
by Dr. Roger Grimson, a biostatistician from SUNY, Stony Brook. Without
the help of the volunteers this couldn't have been accomplished. After
the mapping was completed we received a 69 percent response from the
community and that was due partially to efforts by people in the
community such as Father Thomas Arnao of Our Lady of Lourdes Church in
West Islip. He was the first priest to get involved in the breast
cancer movement. He and other priests from the community encouraged
their parishioners to complete the surveys.
In 1992 I started the West Islip Breast Cancer coaltion. My
husband, John Pace formed the corporation and 501(c) 3 pro bono. He
also did the same for Breast Cancer Help, Inc. and for the Carol M.
Baldwin Breast Cancer Research Fund. Meanwhile, the idea of mapping has
caught on across Long Island, New York State, nationwide and abroad. I
received calls from women in Huntington, Great Neck, Babylon,
Southampton, Brookhaven, etc. asking for assistance on how to do
mapping in their towns. New York State Senators Owen Johnson and Caesar
Trunzo gave a grant to the West Islip Breast Cancer Coaltion to study
the map. The State legislature should be applauded for passing
legislation requiring cancer mapping for all of New York State. In fact
the NYS Department of Health was awarded the ``Gold'' Certification
from North American Association of Central Cancer Registries due to
Governor George Pataki's 4 million dollar increase in funding.
After leaving the West Islip Breast Cancer Coalition I started
Breast Cancer Help, Inc. with Father Thomas Arnao, who is now co-
president of Breast Cancer Help, Inc. We and our members are proud of
our many accomplishments, some of which are listed below:
Our Vice President spearheaded the national campaign to
create the first breast cancer awareness stamp. My daughter-in-law
painted a pink twisted ribbon as a possible example of this stamp. Our
group also supported the creation of the breast cancer research stamp.
Originating the breast cancer mapping project and helping
other coalitions to do mapping locally, nationally and abroad.
Initiating the move to establish the toll-free Cancer
Helpline at Stony Brook Hospital.
Leading the effort to organize and establish the annual
``Walk for Beauty'' in Stony Brook.
Supported the petition that resulted in President
Clinton's commitment to a National Action Plan to fight breast cancer
and a $250 million increase in Federal funding for breast cancer
research.
Initiating the change in Federal regulations that provides
insurance coverage for stem-cell infusion therapy for Federal employees
and their spouses who have breast cancer.
Support the passage of the NYS law that ends the practice
of drive-through mastectomies.
Initiating the move to update and expand the NYS Breast
Cancer Registry.
Leading the move to create the check-off for breast cancer
research and education on the NYS income tax form and supported the
subsequent legislation that authorizes the State to provide a dollar-
for-dollar match for each contribution made to breast cancer research
and education.
Helping to launch the Long Island Breast Cancer Study
Project.
Advocating the establishment of the NYS Pesticide
Registry.
Testifying at local, State and Federal hearings on the
environment and the possible link to breast cancer
Raising breast cancer awareness by generating local,
regional and national media coverage as well as by contributing to
public service programs, educational symposiums and fund-raisers
Supported the Neighborhood Notification Bill
Charter member of the Suffolk County Breast Health
Partnership
Member of the National Breast Cancer Coalition o Initiated
the Carol M. Baldwin Breast Cancer Research Fund at Stony Brook
Keynote speaker at the first breast cancer rally in
Suffolk County on the steps of the H. Lee Dennison Building in
Hauppauge. Suffolk County Executive Robert Gafthey supported this
rally.
Supporting passage of the NYS Adoption Bill that allows
breast cancer patients to adopt children.
In conclusion one of the most important things that need to be done
is to have a unified national cancer registry that includes residential
history and occupational history. This will give the scientists a
better way to track cancer for a possible link between the environment
and breast cancer. Residential history is important because if a woman
who is a lifelong resident of New York moves to Florida and is shortly
thereafter diagnosed with breast cancer she is on the Florida cancer
registry as having been diagnosed in Florida. This is misleading; in
reality she developed the tumor in New York. Occupational history
should also be included in the cancer registry. For instance if a
person is exposed to chemicals in their workplace, and is then
diagnosed with cancer, could the diagnosis be work related?
We need to have all the hazardous waste sites cleaned up, and the
people of Long Island should use pesticides that kill insects without
harming the environment. A population-based study should be done that
studies bio-markers such as the blood to determine what the possible
environmental cause(s) of cancer on Long Island are. We also need the
most advanced technology in our hospitals for the treatment and
diagnosis of cancer patients on Long Island. We need to find out why so
many young women are being diagnosed with breast cancer on the East End
of Long Island where there is a high incidence of this disease. We owe
it to the future generations to find the cause(s) and the cure of
breast cancer.
Statement by Research Associates Jay M. Gould, Ph.D., Director; Ernest
J. Sternglass, Ph.D., Chief Scientist; Jerry Brown, Ph.D.; Joseph
Mangano, M.P.H., M.B.A.; William McDonnell, M.A.; Marsha Marks, A.C.
S.W., L.C.S.W.; Janette Sherman, M.D. and William Reid, M.D., Radiation
and Public Health Project, New York, NY
I. INTRODUCTION
The Radiation and Public Health Project (RPHP) is an independent,
non-profit research and educational organization. The focus of RPHP's
work is to assess the health effects of exposures to radioactive
chemicals released into the environment by nuclear weapons tests and
nuclear reactor operations. Founded in 1985, RPHP maintains a staff of
professionals from the fields of radiation physics, toxicology,
epidemiology, and statistics. Its members have published numerous
medical journal articles and books on the radiation health issue (see
Appendix).
RPHP researchers understand that incidence of certain diseases and
conditions with potential environmental causes have risen in the U.S.
in the 1980's and 1990's. Infants and children may be hardest-hit,
suffering from increased rates of cancer, asthma, underweight births,
and ear infections. RPHP is attempting to document the contribution of
environmental radiation to these growing problems.
RPHP has documented substantial evidence linking environmental
radioactivity with increased cancer risk. Perhaps the strongest
evidence is the correlation of levels of radioactive Strontium-90 in
baby teeth with risk of childhood cancer in Long Island. The following
testimony outlines these findings and considers implications for public
policy.
II. NUCLEAR REACTOR EMISSIONS AND HEALTH
Currently, 103 nuclear power reactors are operating in the U.S.,
producing about 20 percent of the nation's electricity.\1\ These
reactors are located at 72 plants (sites) across the country. About
two-thirds of Americans live within 100 miles of at least one nuclear
reactor. Operating utilities have permanently closed a total of 22
reactors. In addition, 128 reactors that were proposed by utilities to
Federal regulators were later canceled before commencing operations.\2\
Startup of new reactors and increased use of existing ones have
caused the generation of electricity from reactors to nearly triple
(248 million to 727 million gigawatthours) from 1980 to 1999. (1)
Moreover, about half (51) of the reactors now licensed have been
operating for at least 24 years; the now-closed Big Rock Point reactor
in northern Michigan, had the longest life span of any U.S. reactor (34
years).
Present trends suggest that use of nuclear power reactors may
proliferate in the future. The U.S. Nuclear Regulatory Commission has
received applications to extend the licenses of 43 reactors from 40 to
60 years. In addition, the Nuclear Energy Institute announced a goal of
starting 50 new nuclear reactors at its annual meeting in May 2001.
Increasing use of aging nuclear reactors present environmental
health issues that need to be addressed, namely:
1. Do operations of reactors, which routinely emit man made
chemicals into the air that are inhaled and ingested in diet, result in
increased disease risk, including cancer?
2. Does the aging of reactors increase the chance of a serious
accident?
3. Does the buildup of nuclear waste from reactor operations pose a
threat to the health of local residents?
The focus of RPHP's work is primarily issue #1, health effects of
routine emissions of radioactive chemicals into the environment.
Because radioactivity can damage human health, an accurate
assessment of risk to the public is warranted. However, current
regulatory policies do not include any such assessment. The U.S.
Nuclear Regulatory Commission has approved the first five applications
for reactor license extension, with no consideration of disease rates,
including cancer, in persons living closest to reactors.
RPHP has investigated health effects of exposures to reactor
emissions, and wishes to present a summary of findings to the Senate
Committee on the Environment and Public Works, as it considers the
issue of environmental health.
III. ATOMIC BOMB TESTING--PRECURSOR TO REACTORS
Nuclear reactors employ fission of uranium atoms to generate
electricity. The fission process creates 100 to 200 radioactive
chemicals not found in nature, which may damage the immune, genetic,
and hormonal systems. These products include strontium, plutonium,
iodine, and other carcinogenic isotopes. The only other source of these
manmade chemicals is nuclear weapon explosions. Most fission products
generated by reactors are contained as radioactive waste, but a
fraction is emitted into the local air and water.
The detonation of many atomic weapons above the ground (100 in the
Nevada desert and 106 in the south Pacific) from 1946-62 represented
the first time in history that Americans were exposed to fission
products. The total output of these tests was equivalent to that of
about 10,000 Hiroshima bombs, while Soviet tests in this period
approximated another 30,000 Hiroshima bombs.\3\ Levels of radioactivity
in the American diet rose sharply. Radioactive Strontium-90 reached an
average concentration of 30.3 picocuries per liter in U.S. milk in May
1964, compared to about 5 in 1957.\4\
The 1963 Limited Test Ban Treaty prohibited atmospheric bomb tests
by the United States, Soviet Union, and Great Britain. President John
F. Kennedy made health effects of fallout, especially on children, a
focus of a speech urging Senate ratification of the treaty:
``. . . the number of children and grandchildren with cancer in
their bones, with leukemia in their blood, or with poison in their
lungs might seem statistically small to some, in comparison with
natural health hazards. But this is not a natural health hazard--and it
is not a statistical issue. The loss of even one human life, or the
malformation of even one baby--who may be born long after we are gone--
should be of concern to us all.''\5\
The period of atmospheric weapons testing was marked by minimal or
negative progress for several infant and child health measures. The 13
percent drop in the death rate for children under 1 year from 1951-65
was the slowest of the 20th century. Cancer diagnosed in children under
age 20 rose 29 percent (and leukemia rose 41 percent) from the late
1940's to the early 1960's in Connecticut, the only State that operated
a cancer registry at that time.
Recent public reports have acknowledged the harmful effects of
making and testing atomic bombs:
The National Cancer Institute published a study estimating
that radioactive iodine in the above-ground atomic bomb tests caused as
many as 220,000 Americans to develop thyroid cancer.\6\
The Institute of Medicine documented elevated rates of
death from prostate cancer, nasal cancer, and leukemia among 70,000
soldiers exposed to bomb blast fallout in Nevada.\7\
The U.S. Department of Energy acknowledged that 600,000
workers at 14 nuclear weapons plants suffered from excessively high
rates of 22 types of cancer due to occupational exposures.\8\
IV. NUCLEAR POWER REACTORS AND HEALTH
There has been a dearth of scientific, peer-reviewed studies
evaluating disease rates near U.S. nuclear power plants. Only one
national study has been done. In 1990, at the insistence of Senator
Edward M. Kennedy, the National Cancer Institute published data on
cancer near nuclear plants. While the study concluded that there was no
connection between radioactive emissions and cancer deaths, rates near
many reactors rose after reactor startup.\9\ Since 1990, no Federal
agency, including the Environmental Protection Agency and Nuclear
Regulatory Commission, has undertaken any studies of disease rates near
nuclear power plants.
The worst accident of any U.S. nuclear power reactor occurred at
Three Mile Island PA in March 1979. Substantial amounts of radioactive
gases and particles were released during the crisis, prompting the
Pennsylvania Governor to advise that pregnant women, infants, and small
children evacuate the 5-mile radius of the stricken reactor. Subsequent
studies of persons residing within 7.5 miles of Three Mile Island
showed that rates of leukemia, lymphoma, lung cancer, and colon cancer
jumped between 25 and 60 percent in the 7 years after the accident.\10\
Childhood cancer is generally believed to be one of the diseases
most affected by radiation exposure. In the U.S., only two articles
have documented elevated childhood cancer near nuclear power
reactors.11-12 By contrast, there are at least 11 articles
on childhood cancer in areas near various power plants in the United
Kingdom13-23, plus additional studies in other nations.
The lack of health studies near American nuclear reactors is
complemented by a lack of measurements of in-body levels of
radioactivity for persons living near nuclear reactors. Government-
supported programs to measure Strontium-90 in St. Louis baby teeth\24\
and in New York City and San Francisco bones\25\ were terminated in
1976 and 1982, respectively. Both primarily measured the effects of
bomb test fallout rather than nuclear power reactors.
V. EVIDENCE OF ADVERSE EFFECTS OF RADIATION FROM REACTORS
Long Island--Sr-90 and Childhood Cancer Increases Are Similar
RPHP is attempting to address the shortage of information on
radiation's health effects by documenting radioactivity levels in the
human body and comparing them with cancer and other health trends.
RPHP researchers have undertaken the first-ever study that measures
radioactivity in the bodies of persons living near nuclear power
reactors. In 1996, RPHP launched the Tooth Fairy Project, which uses
the same methodology of calculating levels of Strontium-90 in baby
teeth employed in St. Louis during the 1950's and 1960's. The chemical
enters the baby teeth through the mother's diet during pregnancy and
through the mother's bones.
Sr-90 is just a marker for the 100-200 radioactive chemicals that
are released in nuclear reactor operations, but it is a critical one.
Like calcium, Sr-90 attaches to the bone and teeth when it enters the
body, where it remains for many years due to its slow rate of decay
(half life of 28.7 years). It kills and impairs bone cells, and
penetrates the bone marrow, which is the red blood cells critical to
immune function are formed, making it a risk factor for all cancers. Of
all man-made radioactive chemicals, Sr-90 was the one that caused the
greatest health concern during the atmospheric bomb test years in the
1950's and 1960's. In 1956, Presidential candidate Adlai Stevenson
remarked that Sr-90 was ``the most dreadful poison in the world.''\26\
To date, RPHP has collected over 3000 baby teeth, mostly from areas
near reactors in California, Connecticut, Florida, New Jersey, New
York, and Pennsylvania. Strontium-90 concentrations have been measured
in nearly half (1463) of these teeth by Radiation Environmental
Management Systems (REMS) Inc., an independent laboratory in Waterloo
Canada.
The average current concentration of Sr-90 is similar to that in
St. Louis in 1956, in the midst of the period of atmospheric nuclear
weapons testing. Results of the Tooth Fairy Project have been published
in three peer-reviewed medical journals.27-29
The largest number of teeth (563) have been measured for residents
of Suffolk County New York, site of the Brookhaven National Lab and
surrounded by nearby reactors. Results show that the average level of
Sr-90 has steadily increased 40.0 percent from the early 1980's to the
mid-1990's. Because U.S. above-ground bomb testing ceased in the early
1960's, and old bomb fallout is decaying steadily, this trend indicates
that a current source of radioactive emissions is contributing to the
buildup of Sr-90 in teeth. This source can only be nuclear reactors.
Trends in Average Concentration of SR-90, Suffolk County, NY Baby Teeth, 1981-1996
----------------------------------------------------------------------------------------------------------------
Year of Birth No. of Teeth Avg. Sr-90+ Percent Change
----------------------------------------------------------------------------------------------------------------
1981-84............................................. 38 1.10 ..................
1985-88............................................. 157 1.38 ..................
1989-92............................................. 258 1.41 ..................
1993-96............................................. 45 1.54 +40.0
----------------------------------------------------------------------------------------------------------------
+Average picocuries of Strontium-90 per gram of calcium in baby teeth at birth.
In the same time period, cancer diagnosed in Suffolk County
children less than 10 years old steadily rose a nearly identical 49
percent.\30\ The data support the theory that exposure to radioactive
increases the risk of cancer, especially in young persons.
Trends in Cancer Incidence Age 0-9, Suffolk County, NY, 1981-1996
----------------------------------------------------------------------------------------------------------------
Age 0-9
Period ---------------------------------------- Cases per 100,000 Percent Change
Cancer Cases Avg. Pop. Pop.
----------------------------------------------------------------------------------------------------------------
1981-84......................... 92 182,441 12.61 ..................
1985-89......................... 115 182,463 15.76 ..................
1989-92......................... 129 185,050 17.43 ..................
1993-96......................... 146 194,498 18.77 +48.9
----------------------------------------------------------------------------------------------------------------
Children are not the only humans affected by the radiation-cancer
connection. However, since the rapidly developing fetus and infant are
most sensitive to toxic exposures to radiation and other chemicals,
immediate adverse effects are most likely to occur. A latency period of
up to several decades between exposure and manifestation of cancer may
be necessary in adults.
B. Long Island--Childhood Cancer Outbreak in High-Radiation Area
In the late I990's, news of an atypically large number of cases of
rhabdomyosarcoma in northwestern Suffolk County children began to
surface. This soft tissue cancer was diagnosed in 23 children living in
a small area, when one or two cases would normally be expected.
Publicly aired concerns of parents of victims prompted the Suffolk
legislature to authorize a Task Force to investigate the extent and
cause of the outbreak.
While the cause(s) of rhabdomyosarcoma are generally unknown,
radiation exposure has been identified as a risk factor. Over one-
quarter of laboratory mice who had Sr-90 rubbed on their skin were
later diagnosed with rhabdomyosarcoma or a related cancer.\31\ Pregnant
women who receive a pelvic X-ray are twice as likely to bear a child
who will be diagnosed with the disease.\32\
The RPHP Baby Teeth Study has collected 57 teeth from the area of
Suffolk County in which most children with rhabdomyosarcoma live. Teeth
from this region have the highest average concentration of Sr-90 in
Suffolk County, at 1.48 picocuries of Sr-90 per gram of calcium. Teeth
in other areas, such as the north and south forks of Long Island and
the middle of Suffolk County have barely half that amount. RPHP is now
conducting a case-control study, in which it tests teeth from children
with rhabdomyosarcoma to further establish the link between the disease
and environmental radiation.
C. San Luis Obispo, CA--Effects of Opening Reactors
Demonstrating a radiation-cancer link requires collection of valid
data on exposures. One relatively simple way of evaluating health
effects of exposures is to study children living near a recently opened
reactor, before and after the opening.
RPHP has collected 34 teeth from children born in San Luis Obispo
County in California, which is the site of the Diablo Canyon reactors
(started 1984 and 1985). Average Sr-90 levels for the county's children
born after the reactors began operations increased 49.6 percent. While
more teeth are needed to make results more significant, the finding
provides preliminary evidence of added environmental radioactivity
actually entering human bodies.
Trends in Average Concentration of Sr-90, San Luis Obispo County, CA
Baby Teeth, 1979-1994
------------------------------------------------------------------------
Year of Birth No. Teeth Avg. Sr-90+ Percent Ch.
------------------------------------------------------------------------
1979-85 (before startup)...... 15 1.35 ............
1986-94 (after startup)....... 19 2.02 +49.6
------------------------------------------------------------------------
+Average picocuries of Strontiuxn-90 per gram of calcium in baby teeth
at birth.
Several years after the startup of Diablo Canyon, cancer death
rates among children living in San Luis Obispo and adjoining Santa
Barbara County began to rise. The rate for children 19 and under was
74.5 percent higher in the 1990's than it was in the late 1980's.\33\
Again, these data support the theory that radiation exposure increases
the cancer burden in children (allowing several years between initial
exposure and death; many children who die of cancer live several years
after diagnosis).
Trends in Cancer Mortality Age 0-19, San Luis Obispo and Santa Barbara Counties, CA, 1985-1998
----------------------------------------------------------------------------------------------------------------
Deaths/
Year of Death Deaths Total Pop. 100,000 Pop. Percent Ch.
----------------------------------------------------------------------------------------------------------------
1985-89................................................. 16 742,569 2.16 ............
1990-98................................................. 57 1,515,911 3.76 +74.5
----------------------------------------------------------------------------------------------------------------
Reactor startups have adverse effects on all local citizens, not
just children, Thyroid cancer in two Connecticut counties increased
dramatically after nuclear reactors opened in the late 1960's.\34\
Thyroid cancer is especially sensitive to exposure to radioactive
iodine, which is present in the ``cocktail'' of chemicals in nuclear
reactor emissions.
D. Closing Reactors--Eight U.S. Nuclear Power Plants
When nuclear power reactors cease operations, there is an immediate
removal of all locally generated radioactive chemicals that decay
quickly, and a more gradual removal of those that decay slowly. The
reduction is greatest in nearby areas downwind of closed reactors; the
majority of airborne emissions are propelled in the downwind direction,
where radioactive gases and particles can be inhaled and are introduced
into the diet via precipitation.
Since 1987, eight nuclear power plants have closed, leaving at
least a 70 mile radius with no operating reactors. In downwind counties
within 40 miles of all eight sites, the death rate among infants under
1 year plunged in the first 2 years after closing.\35\ RPHP is
collecting baby teeth near one of these areas (Rancho Seco, near
Sacramento CA) to establish that the improvement in health is
accompanied by a declining level of in-body radioactivity.
Trend in Infant Mortality, Downwind Counties Near Closed Nuclear Reactors, Two Years Before vs. Two Years After Closing
--------------------------------------------------------------------------------------------------------------------------------------------------------
Infant Death Live Births Deaths/1000
Reactor, Closed ------------------------------------------------------------------------------ Percent
Before After Before After Before After Change
--------------------------------------------------------------------------------------------------------------------------------------------------------
LaCrosse WI, 1987............................................ 36 30 3507 3452 10.27 8.69 -15.4
Rancho Seco CA, 1989......................................... 418 390 44500 49414 9.39 7.89 -16.0
Ft. St. Vrain CO, 1989....................................... 83 72 9725 9977 8.53 7.22 -15.4
Trojan OR, 1992.............................................. 253 204 30320 29799 8.34 6.85 -17.9
Big Rock Pt. MI, 1997........................................ 25 6* 2922 1529* 8.56 3.92* -54.2
Me. Yankee ME, 1997.......................................... 19 10* 3841 2201* 4.95 4.54* -8.3
Pilgrim MA, 1986............................................. 97 76 12956 13412 7.49 5.67 -24.3
Millstone CT, 1995........................................... 166 130 22261 21093 7.46 6.16 -17.4
TOTAL 8 AREAS................................................ 1097 918 130032 130877 8.44 7.01 -16.9
U.S. AVG 2-YR CH, 1986-98.................................... ........... ........... ........... ........... ........... ........... -6.4
--------------------------------------------------------------------------------------------------------------------------------------------------------
*Only 1998 data are available for post-shutdown periods for Big Rock Point and Maine Yankee.
V. POLICY IMPLICATIONS--RADIATION HEALTH AND NUCLEAR REACTORS
Since atomic bombs were first manufactured and used during World
War II, exposure to man-made fission products has been a critical
environmental health issue. The relative novelty of these chemicals in
the environment underscores the need for thorough and objective
studies.
Since the conclusion of the cold war a decade ago, nuclear weapons
are no longer manufactured or tested. However, the production from
American nuclear power reactors has reached an all-time high, and
utility companies (supported by the Bush Administration) are
considering a large-scale expansion of the industry. These developments
indicate that protection of humans from the potentially harmful effects
of exposure to radioactive emissions in the environment will be
critical. To that end, we urge Congress to take the following actions:
1. Conduct hearings examining the current knowledge on the impact
of environmental radiation on public health, including cancer.
2. Establish and support an independent medical and scientific
commission to evaluate the impact of environmental radiation on public
health, including cancer.
3. Institute a systematic program measuring radioactivity levels in
bodies of persons living near to and distant from U.S. nuclear power
reactors.
4. Conduct or support routine, periodic studies tracking disease
patterns and trends among persons living near to and distant from
nuclear power reactors. Studies should identify infants and children
separately from adults, and should focus on cancer.
5. Direct policymakers and regulators to include consideration of
disease patterns and trends within the local population when making
decisions to extend licenses of existing nuclear reactors.
6. Direct policymakers and regulators to include consideration of
potential health effects when making decisions to grant operating
licenses for new nuclear reactors.
7. Require that in-body radioactivity levels be evaluated in all
federally funded programs that investigate possible causes of elevated
cancer rates in the U.S.
References:
1. U.S. Nuclear Regulatory Commission, http://www.nrc.gov/NRC/
NUR.gov/NRC/NUREGS/SR1350. See Table 7, U.S. Commercial Nuclear Power
Reactor Average Capacity Factor and Net Generation.
2. U.S. Nuclear Regulatory Commission data, August 12, 1999.
3. Norris, R.S. and Cochran, T.B. United States Nuclear Tests, July
1945 to December 31, 1992. Washington, DC: Natural Resources Defense
Council, 1994.
4. U.S. Public Health Service. Radiological Health Data.
Washington, DC: September 1964.
5. John F. Kennedy, Radio and Television Address to the American
People on the Nuclear Test Ban Treaty, July 26, 1963. In Public Papers
of the Presidents. Washington, DC: U.S. Government Printing Office,
1964.
6. National Cancer Institute. Estimated Exposures and Thyroid Doses
Received by the American People from Iodine-131 in Fallout Following
Nevada Atmospheric Nuclear Bomb Tests. NIH Publication No. 97-4264.
Washington, DC: U.S. Department of Health and Human Services, 1997.
7. Institute of Medicine. The Five Series Study: Mortality of
Military Participants in U.S. Nuclear Weapons Tests. Washington, DC:
National Academy Press, 1999.
8. Wald, M.L., U.S. Acknowledges Radiation Killed Weapons Workers.
The New York Times, January 29, 2000, Al.
9. Jablon, S., Hrubec, Z., Boice, J.D., Stone, B.J. Cancer in
Populations Living Near Nuclear Facilities, NIH Publication No. 90-874.
Washington, DC: U.S. Government Printing Office, 1990.
10. Hatch, M.C., Wallenstein, S., Beyea, J., Nieves, J.W., Susser,
M. Cancer rates after the Three Mile Island nuclear accident and
proximity of residence to the plant. American Journal of Public Health
1991; 81(6):719-24.
11. Hatch, M.C., Beyea, J., Nieves, J.W., Susser, M.L. Cancer near
the Three Mile Island nuclear plant: radiation emissions. American
Journal of Epidemiology 1990; 132(3):397-412.
12. Johnson, C.J. Cancer and infant mortality around a nuclear
power plant. American Journal of Public Health 1983; 73(10):1218.
13. Sharp, L., McKinney, P.A., Black, R.J. Incidence of childhood
brain and other non-haematopoietic neoplasms near nuclear sites in
Scotland, 1975-94, Occupational and Environmental Medicine 1999;
56(5):308-14.
14. Busby, C., Cato, M.S. Death rates from leukemia are higher than
expected in areas around nuclear sites in Berkshire and Oxfordshire.
British Medical Journal 1997; 315(7103):309.
15. Black, R.J., Sharp, L., Harkness, E.F., McKinney, P.A. Leukemia
and non-Hodgkin's Lymphoma: incidence in children and young adults
resident in the Dounreay area of Carthness, Scotland in 1968-91,
Journal of Epidemiology and Community Health 1994; 48(3):232-6.
16. Draper, G.J., Stiller, C.A., Cartwright, R.A., Craft, A.W.,
Vincent, J.J. Cancer in Cumbria and in the vicinity of the Sellafield
nuclear installation, 1963-90. British Medical Journal 1993;
306(6870):89-94.
17. Goldsmith, J.R. Nuclear installations and childhood cancer in
the UK: mortality and incidence for 0-9-year-old children, 1971-1980.
Science in the Total Environment 1992; 127(1-2):13-35.
18. Kinlen, L.J., Hudson, C.M., Stiller, C.A. Contacts between
adults as evidence for an infective origin of childhood leukemia: an
explanation for the excess near nuclear establishments in west
Berkshire? British Journal of Cancer 1991; 64(3):549-54.
19. Ewings, P.D., Bowie, C., Phillips, M.J., Johnson, S.A.
Incidence of leukemia in young people in the vicinity of Hinkley Point
nuclear power station, 1959-86. British Medical Journal 1989; 299
(6694):289-93.
20. Cook-Mozaffari, P.J., Darby, S.C., Doll, R., Forman, D.,
Hermon, C., Pike, M.C., Vincent T. Geographical variation in mortality
from leukemia and other cancers in England and Wales in relation to
proximity to nuclear installations, 1969-78. British Journal of Cancer
1989; 59(3):476-85.
21. Roman B., Beral, V., Carpenter, L., Watson, A., Barton, C.,
Ryder, H., Aston, D.L. Childhood leukemia in the West Berkshire and
Basingstoke and North Hampshire District Health Authorities in relation
to nuclear establishments in the vicinity. British Medical Journal
1987; 294(6572):597-602.
22. Forman, D., Cook-Mozaffari, P., Darby, S., Davey, G., Stratton,
I., Doll, R., Pike, M. Cancer near nuclear installations. Nature 1987;
329(6139):499-505.
23. Heasman, M.A., Kemp, I.W., Urquhart, J.D., Black, R. Childhood
leukemia in northern Scotland. Lancet 1986; 1(8475):266.
24. Rosenthal, H.L. Accumulation of environmental 90-Sr in teeth of
children. Proceedings of the Ninth Annual Hanford Biology Symposium. In
Radiation Biology of the Fetal and Juvenile Mammal, edited by MR Sikow
and DD Mahlum. U.S. Atomic Energy Commission, December 1969.
25. Klusek, C.S. Strontium-90 in Human Bone in the U.S., 1982. EML-
435. New York: U.S. Department of Energy, 1984.
26. Salisbury, H.E. Stevenson calls for world pact to curb H-bomb.
The New York Times, October 16, 1956, A1.
27. Gould, J.M., Sternglass, E.J., Sherman, J.D., Brown, J.,
McDonnell W., Mangano, J.J. Strontium-90 in deciduous teeth as a factor
in early childhood cancer. International Journal of Health Services
2000; 30(3):515-39.
28. Mangano, J.J., Sternglass, E.J., Gould, J.M., Sherman, J.D.,
Brown, J., McDonnell, W. Strontium-90 in newborns and childhood
disease. Archives of Environmental Health 2000; 55(4):240-4.
29. Gould, J.M., Sternglass, E.J., Mangano, J.J., McDonnell, W.,
Sherman, J.D., Brown, J. The Strontium-90 baby teeth study and
childhood cancer. European Journal of Oncology 2000; 5:119-25.
30. New York State Cancer Registry, Albany, NY. Data received April
21, 1999.
31. Gupta, A., Andrews, K.L., McDaniel, K.M., Nagle, R.B., Bowden,
G.T. Experimental induction of rhabdomyosarcoma in mice with
fractionated doses of B-irradiation. Journal of Cancer Research and
Clinical Oncology 1999; 125:257-67.
32. Grufferman, S., Mula, M.J., Olshan, A.F., Falletta, J.M.,
Pendergrass, T.W., Buckley, J., Maurer, H.M. In utero X-ray exposure
and risk of childhood rhabdomyosarcoma. Paediatric Perinatal
Epidemiology 1991; 5:A6-A7.
33. National Center for Health Statistics. Mortality data available
at http://www.cdc.gov, data and statistics, CDC Wonder. Uses ICD-9
diagnosis codes 140.0-239.9.
34. Mangano, J.J. A post-Chernobyl rise in thyroid cancer in
Connecticut, USA. European Journal of Cancer Prevention 1996; 5:75-81.
35. Mangano, J.J., Improvements in local infant health after
nuclear power reactor closing. Environmental Epidemiology and
Toxicology 2000; 2:32-36.
Appendix
Recent Professional Publications Radiation and Public Health Project
recent book publications
1. Gould, J.M. and members of RPHP. The Enemy Within: The High Cost
of Living Near Nuclear Reactors. New York: Four Walls Eight Windows,
1996.
2. Brown, J. and Brutoco, R. Profiles in Power: The Antinuclear
Movement and the Dawn of the Solar Age. New York: Twayne Publishers,
1997.
3. Mangano, J.J. Low-Level Radiation and Immune System Damage: An
Atomic Era Legacy. Boca Raton, FL: Lewis Publishers, 1998.
4. Sherman, J.D. Life's Delicate Balance: Causes and Prevention of
Breast Cancer. New York: Taylor and Francis, 2000.
recent medical journal articles
1. Gould, J.M. et al. Strontium-90 in deciduous teeth as a factor
in early childhood cancer. International Journal of Health Services
2000; 30(3):515-39.
2. Mangano, J.J. et al. Strontium-90 in newborns and childhood
disease. Archives of Environmental Health 2000; 55(4):240-4.
3. Gould, J.M. et al. The Strontium-90 baby teeth study and
childhood cancer. European Journal of Oncology 2000; 5(suppl. 2):119-
25.
4. Mangano, J.J. Improvements in local infant health after nuclear
power reactor closing. Environmental Epidemiology and Toxicology 2000;
2:32-6.
__________
New York States Coalition Opposed to Fluoridation, Inc.,
Old Bethpage, NY, June 13, 2001.
Committee on Environment and Public Works,
U.S. Senate,
Washington, DC.
Re: Testimony on Fluoride's Role In Environmental Pollution, Systemic
Health and Dental Health Problems, and a Practical Solution
Dear Chairman and Committee Members: Members of our organization
attended the hearing on environmental health concerns at Adelphi
University on Monday, June 11, 2001. Senator Hillary Clinton was an
excellent Chair of the hearing, along with Senators Henry Reid and
Lincoln Chafee. The participating legislators offered valuable input,
as did the panel participants. The discussions on breast cancer,
testicular cancer, leukemia clusters, birth defects, asthma, and other
health problems were very important. However, we believe the value of
the hearing would have been still more enhanced had an opportunity been
provided for those in the audience who wished to make a brief statement
or ask a pertinent question.
There was a missing factor that is important to bring to your
committee's attention. A number of the professional and civic
participants expressed their concern about the lack of controls,
allowing arsenic to enter our drinking water. Other panelists expressed
the disturbing fact that numerous chemicals are not even tested. Still
others talked about the concerns about lead exposure, etc. The
Precautionary Principle was pointed out by another panelist. Yet a
missing factor, a common denominator, could well be the role that
fluoride chemicals in our public water supplies play in the
environmental picture.
Fluoride is a cumulative enzyme poison. Fluoride is a prescription
drug when obtained at a pharmacy, yet is carelessly added to
fluoridated water supplies in order to try to reduce tooth decay.
Fluoride is classified as a contaminant by the Environmental Protection
Agency (EPA). Fluoridation deliberately adds hundreds of thousands of
tons of toxic nonbiodegradable fluoride chemicals to our already
endangered water supplies. The synergistic effects of fluoride with
other substances is not fully known. Fluoride accumulates in the body
like lead, and, in fact, is more toxic than lead and almost as toxic as
arsenic.
The public is being subjected involuntarily to fluoride ingestion
and exposure because of total fluoride intake that is now out of
control. Once fluoride is added to public drinking water, it is
impossible to control dosage. The fluoride enters our cooking water,
and, in fact, fluoride concentrates upon boiling. It enters the foods
and beverages grown in or processed in fluoridated areas. It is in our
toothpastes, rinses, medications, among other sources. It is even
breathed in from humidifiers. Dental fluorosis has become rampant in
our country. The problem is fluoride excess, not fluoride deficiency.
Our government agencies are working at cross purposes. There is an
increasing emphasis on reducing the pollution of our water supplies and
we are spending millions of dollars trying to clean up our environment.
Then we permit an increase in water pollution by the deliberate
addition to our drinking water of toxic fluoride (mostly
hydrofluosilicic acid, a waste by-product of the phosphate fertilizer
industry) with no regard to the amount of water consumed, the amount of
fluoride stored in the body, or the amount tolerated. Children and
adults with kidney and urinary tract disorders, and other dietary and
medical problems, require the ingestion of large quantities of water,
and fluoridated water compounds their problems.
Opposition to fluoridation is shared by no less than the
Environmental Protection Agency's (EPA) Headquarters Union,
representing over 1500 EPA professionals. They include toxicologists,
biologists, chemists, engineers, lawyers and other professionals). This
EPA professional union is in sharp disagreement with their own EPA
agency that promotes fluoridation. Dr. J. William Hirzy, chemist,
represents the EPA union. He has pointed out that their members are
``charged with assessing the safety of drinking water'' and that their
judgments are based, in part, on animal studies and human epidemiology
studies indicating ``a causal link between fluoride/fluoridation and
cancer, genetic damage, neurological impairment and bone pathology. Of
particular concern are the recent studies linking fluoride exposure to
lower IQ in children.''
Studies, including Government studies, report on populations that
are unusually susceptible to the toxic effects of fluoride: the
elderly, those with kidney, bone and cardiovascular problems, high
water consumers, the newborn, the nutritionally deficient, and others.
(U.S. Public Health Service, ``The Toxicological Profile for
Fluorides'' 1993, etc.) Published studies report an increase in hip
fractures in the elderly and osteosarcoma in young males in fluoridated
areas.
In Western Europe, where there is only perhaps 2 percent of the
population fluoridated, as opposed to over 60 percent in our heavily
fluoridated country (mostly without informed consent and at times even
without the knowledge of the public), dental health is essentially as
good as or better than in the United States. In Europe, industrial
fluosilicates are recognized for the problematical by-products of
industry.
Documents show that fluoride added to water also contains lead,
arsenic, antimony, cadmium, and other undesirable substances. In fact,
health agencies now concede there has been no safety testing of the
silicofluoride acid chemicals most commonly used to fluoridate public
drinking water, largely from phosphate fertilizer. Incredibly, these
fluoride products have not been tested as safe for human consumption.
That is why several U.S. Congressmen have contemplated hearings or
already initiated hearings.
Proponents of fluoridation are trying to downplay the important
research of Professor Roger Masters, which shows increased blood lead
levels in children in the artificially fluoridated water supplies where
fluosilicic acid is used. This should be given the most careful and
serious attention by our public health authorities.
Former Chairman of the Senate Environment & Public Works Committee,
Senator Bob Smith, has asked the EPA to review its standard for
fluoride in drinking water. Senator Crapo included a presentation by
Dr. William Hirzy of the EPA's Union of professionals at Headquarters
in Washington at his June 29, 2000 hearing, where Dr. Hirzy reported on
fluoridation's detrimental effects. U.S. Representative Sensenbrenner,
former Chairman of Committee on Science, also commenced an
investigation, as did U.S. Representative Calvert, former Subcommittee
Chairman of because of their safety concern.
Many letters and petitions went to the aforementioned committees
from citizens and community groups throughout the country, and from
other countries as well. The work had only begun. We respectfully ask
that you continue the investigation for the good and the protection of
the public.
Finally, the panelists at the June 11th meeting were concerned
because of the difficulty in ridding our environment of known toxic
chemicals. In contrast, with fluoridation, the answer is a simple
matter of turning off the fluoride valve. This was done in Riverhead,
Levittown, Carle Place, and Rouses Point, New York, areas within the
Water Authority of Western Nassau County, and many places throughout
the State, the country and abroad. Fluoridation was discontinued for a
variety of reasons, including health, pollution and freedom of choice
concerns, as well as accidental misfeeds, malfunction of the
fluoridation system, and human error, resulting in illness,
hospitalization, and even fatalities.
While we realize there could be multiple environmental factors
involved in the increase of chronic diseases, it is our strong position
that your efforts, genuine and vigorous as they are, would not be
complete without the inclusion of the fluoride factor. In this regard,
there are professionals of world-class caliber ready and willing to
discuss this matter with you, to meet with you, to appear before your
committee, to participate in your efforts with other members of the
scientific and medical fields, in your laudable search for answers.
We would appreciate the opportunity of discussing such
participation with you. We look forward to a constructive response.
Sincerely,
Paul Stephen Beeber,
President and General Counsel.
______
U.S. House of Representatives,
Committee on Science,
Washington, DC, September 7, 2000.
Paul Beeber,
Old Bethpage, NY.
Dear Mr. Beeber: Thank you for communicating with me regarding the
Environmental Protection Agency's (EPA) position on fluoride in
drinking water. It is my goal to ensure that all decisions made at the
EPA are based on sound science and are done in the proper risk-based
context.
The EPA spends millions of dollars on health and safety research
into substances that naturally occur or contaminate our drinking water,
including arsenic and radon, as well as substances that are added to
drinking water, including compounds that result from the breakdown of
chlorine, a chemical used for disinfection. Fluoride falls into each of
those categories--it is both naturally occurring and a drinking water
additive. Most of the research data that I have seen concerns the
safety of using sodium fluoride (NaF) as a fluoridation agent. However,
many of our nation's fluoridated water supplies use different
fluoridation agents, such as hydrofluosilicic acid or sodium
silicofluoride. Much less is known about these compounds. A research
program by EPA into the safety of all of the fluoride compounds we add
to our drinking water is overdue. That is not only sound science, it is
common sense.
Thank you again for sharing your views, on this important issue
with me. I would invite you to follow this and other issues of
importance to you on the Science Committee web site at www.house.gov/
science.
Sincerely,
F. James Sensenbrenner, Jr.,
Chairman.
______
[From the National Treasury Employees Union, Chapter 280]
Fluoridation Hazards
WHY EPA'S HEADQUARTERS UNION OF SCIENTISTS OPPOSES FLUORIDATION
The following documents why our union, formerly National Federation
of Federal Employees Local 2050 and since April 1998 Chapter 280 of the
National Treasury Employees Union, took the stand it did opposing
fluoridation of drinking water supplies. Our union is comprised of and
represents the approximately 1500 scientists, lawyers, engineers and
other professional employees at EPA Headquarters here in Washington,
DC.
The union first became interested in this issue rather by accident.
Like most Americans, including many physicians and dentists, most of
our members had thought that fluoride's only effects were beneficial--
reductions in tooth decay, etc. We too believed assurances of safety
and effectiveness of water fluoridation.\1\
---------------------------------------------------------------------------
\1\ For a history of how drinking water fluoridation began, see
``Fluoride, Teeth and the Atomic Bomb,'' by investigative reporters
Joel Griffiths and Chris Bryson, available on-line at http://
www.ia4u.net/~sherrell/bomb.htm
---------------------------------------------------------------------------
Then, as EPA was engaged in revising its drinking water standard
for fluoride in 1985, an employee came to the union with a complaint:
he said he was being forced to write into the regulation a statement to
the effect that EPA thought it was alright for children to have
``funky'' teeth. It was OK, EPA said, because it considered that
condition to be only a cosmetic effect, not an adverse health effect.
The reason for this EPA position was that it was under political
pressure to set its health-based standard for fluoride at 4 mg/liter.
At that level, EPA knew that a significant number of children develop
moderate to severe dental fluorosis, but since it had deemed the effect
as only cosmetic, EPA didn't have to set its health-based standard at a
lower level to prevent it.
We tried to settle this ethics issue quietly, within the family,
but EPA was unable or unwilling to resist external political pressure,
and we took the fight public with a union amicus curiae brief\2\ in a
lawsuit filed against EPA by a public interest group. The union has
published on this initial involvement period in detail.\1\
---------------------------------------------------------------------------
\2\ On-line at http://www.rvi. net/~ftluoride/amicus.htm
---------------------------------------------------------------------------
Since then our opposition to drinking water fluoridation has grown,
based on the scientific literature documenting the increasingly out-of-
control exposures to fluoride, the lack of benefit to dental health
from ingestion of fluoride and the hazards to human health from such
ingestion. These hazards include acute toxic hazard, such as to people
with impaired kidney function, as well as chronic toxic hazards of gene
mutations, cancer, reproductive effects, neurotoxicity, bone pathology
and dental fluorosis. First, a review of recent neurotoxicity research
results.
In 1995, Mullenix and co-workers\2\ showed that rats given fluoride
in drinking water at levels that give rise to plasma fluoride
concentrations in the range seen in humans suffer neurotoxic effects
that vary according to when the rats were given the fluoride--as adult
animals, as young animals, or through the placenta before birth. Those
exposed before birth were born hyperactive and remained so throughout
their lives. Those exposed as young or adult animals displayed
depressed activity. Then in 1998, Guan and co-workers\3\ gave doses
similar to those used by the Mullenix research group to try to
understand the mechanism(s) underlying the effects seen by the Mullenix
group. Guan's group found that several key chemicals in the brain--
those that form the membrane of brain cells--were substantially
depleted in rats given fluoride, as compared to those who did not get
fluoride.
Another 1998 publication by Varner, Jensen and others\4\ reported
on the brain-and kidney-damaging effects in rats that were given
fluoride in drinking water at the same level deemed ``optimal'' by pro-
fluoridation groups, namely 1 part per million (1 ppm). Even more
pronounced damage was seen in animals that got the fluoride in
conjunction with aluminum. These results are especially disturbing
because of the low dose level of fluoride that shows the toxic effect
in rats--rats are more resistant to fluoride than humans. This latter
statement is based on Muilenix's finding that it takes substantially
more fluoride in the drinking water of rats than of humans to reach the
same fluoride level in plasma. It is the level in plasma that
determines how much fluoride is ``seen'' by particular tissues in the
body. So when rats get 1 ppm in drinking water, their brains and
kidneys are exposed to much less fluoride than humans getting 1 ppm,
yet they are experiencing toxic effects. Thus we are compelled to
consider the likelihood that humans are experiencing damage to their
brains and kidneys at the ``optimal'' level of 1 ppm.
In support of this concern are results from two epidemiology
studies from China5,6 that show decreases in I.Q. in
children who get more fluoride than the control groups of children in
each study. These decreases are about 5 to 10 I.Q. points in children
aged 8 to 13 years.
Another troubling brain effect has recently surfaced: fluoride's
interference with the function of the brain's pineal gland. The pineal
gland produces melatonin which, among other roles, mediates the body's
internal clock, doing such things as governing the onset of puberty.
Jennifer Luke\7\ has shown that fluoride accumulates in the pineal
gland and inhibits its production of melatonin. She showed in test
animals that this inhibition causes an earlier onset of sexual
maturity, an effect reported in humans as well in 1956, as part of the
Kingston/Newburgh study, which is discussed below. In fluoridated
Newburgh, young girls experienced earlier onset of menstruation (on
average, by 6 months) than girls in non-fluoridated Kingston.\8\
From a risk assessment perspective, all these brain effect data are
particularly compelling and disturbing because they are convergent.
We looked at the cancer data with alarm as well. There are
epidemiology studies that are convergent with whole-animal and single-
cell studies (dealing with the cancer hazard), just as the
neurotoxicity research just mentioned all points in the same direction.
EPA fired the Office of Drinking Water's chief toxicologist, Dr.
William Marcus, who also was our local union's treasurer at the time,
for refusing to remain silent on the cancer risk issue.\9\ The judge
who heard the lawsuit he brought against EPA over the firing made that
finding--that EPA fired him over his fluoride work and not for the
phony reason put forward by EPA management at his dismissal. Dr. Marcus
won his lawsuit and is again at work at EPA. Documentation is available
on request.
The type of cancer of particular concern with fluoride, although
not the only type, is osteosarcoma, especially in males. The National
Toxicology Program conducted a 2-year study\10\ in which rats and mice
were given sodium fluoride in drinking water. The positive result of
that study (in which malignancies in tissues other than bone were also
observed), particularly in male rats, is convergent with a host of data
from tests showing fluoride's ability to cause mutations (a principal
``trigger'' mechanism for inducing a cell to become
cancerous)e.g., 11a, b, c, d and data showing increases in
osteosarcomas in young men in New Jersey,\12\ Washington and Iowa\13\
based on their drinking fluoridated water. It was his analysis,
repeated statements about all these and other incriminating cancer
data, and his requests for an independent, unbiased evaluation of them
that got Dr. Marcus fired.
Bone pathology other than cancer is a concern as well. An excellent
review of this issue was published by Diesendorf et al. in 1997.\14\
Five epidemiology studies have shown a higher rate of hip fractures in
flucridated vs. non-fluoridated communities.15a, b, c, d, e.
Crippling skeletal fluorosis was the endpoint used by EPA to set its
primary drinking water standard in 1986, and the ethical deficiencies
in that standard setting process prompted our union to join the Natural
Resources Defense Council in opposing the standard in court, as
mentioned above.
Regarding the effectiveness of fluoride in reducing dental
cavities, there has not been any double-blind study of fluoride's
effectiveness as a caries preventative. There have been many, many
small scale, selective publications on this issue that proponents cite
to justIfy fluoridation, but the largest and most comprehensivestudy,
one done by dentists trained by the National Institute of Dental
Research, on over 39,000 school children aged 5-17 years, shows no
significant differences (in terms of decayed, missing and filled teeth)
among caries incidences in fluoridated, non-fluoridated and partially
fluoridated communities.\16\ The latest publication\17\ on the 50-year
fluoridation experiment in two New York cities, Newburgh and Kingston,
shows the same thing. The only significant difference in dental health
between the two communities as a whole is that fluoridated Newburgh, NY
shows about twice the incidence of dental fluorosis (the first, visible
sign of fluoride chronic toxicity) as seen in non-fluoridated Kingston.
John Colquhoun's publication on this point of efficacy is
especially important.\18\ Dr. Coiquhoun was Principal Dental Officer
for Auckland, the largest city in New Zealand, and a staunch supporter
of fluoridation--until he was given the task of looking at the
worldwide, data on fluoridation's effectiveness in preventing cavities.
The paper is titled, ``Why I changed My Mind About Water
Fluoridation.'' In it Colquhoun provides details on how data were
manipulated to support fluoridation in English speaking countries,
especially the United States and New Zealand. This paper explains why
an ethical public health professional was compelled to do a 180 degree
turn on fluoridation.
Further on the point of the tide turning against drinking water
fluoridation, statements are now coming from other dentists in the pro-
fluoride camp who are starting to warn that topical fluoride (e.g.
fluoride in tooth paste) is the only significantly beneficial way in
which that substance affects dental health.19, 20, 21
However, if the concentrations of fluoride in the oral cavity are
sufficient to inhibit bacterial enzymes and cause other bacteriostatic
effects, then those concentrations are also capable of producing
adverse effects in mammalian tissue, which likewise relies on enzyme
systems. This statement is based not only on common sense, but also on
results of mutation studies which show that fluoride can cause gene
mutations in mammalian and lower order tissues at fluoride
concentrations estimated to be present in the mouth from fluoridated
tooth paste.\22\ Further, there were tumors of the oral cavity seen in
the NTP cancer study mentioned above, further strengthening concern
over the toxicity of topically applied fluoride.
In any event, a person can choose whether to use fluoridated tooth
paste or not (although finding non-fluoridated kinds is getting harder
and harder), but one cannot avoid fluoride when it is put into the
public water supplies.
So, in addition to our concern over the toxicity of fluoride, we
note the uncontrolled--and apparently uncontrollable--exposures to
fluoride that are occurring nationwide via drinking water, processed
foods, fluoride pesticide residues and dental care products. A recent
report in the lay media,\23\ that, according to the Centers for Disease
Control, at least 22 percent of America's children now have dental
fluorosis, is just one indication of this uncontrolled, excess
exposure. The finding of nearly 12 percent incidence of dental
fluorosis among children in un-fluoridated Kingston New York\17\ is
another. For governmental and other organizations to continue to push
for more exposure in the face of current levels of over-exposure
coupled with an increasing crescendo of adverse toxicity findings is
irrational and irresponsible at best.
Thus, we took the stand that a policy which makes the public water
supply a vehicle for disseminating this toxic and prophylactically
useless (via ingestion, at any rate) substance is wrong.
We have also taken a direct step to protect the employees we
represent from the risks of drinking fluoridated water. We applied
EPA's risk control methodology, the Reference Dose, to the recent
neurotoxicity data. The Reference Dose is the daily dose, expressed in
milligrams of chemical per kilogram of body weight, that a person can
receive over the long term with reasonable assurance of safety from
adverse effects. Application of this methodology to the Varner et
al.\4\ data leads to a Reference Dose for fluoride of 0.000007 mg/kg-
day. Persons who drink about one quart of fluoridated Water from the
public drinking water supply of the District of Columbia while at work
receive about 0.01mg/kg-day from that source alone. This amount of
fluoride is more than 100 times the Reference Dose. On the basis of
these results the union filed a grievance, asking that EPA provide un-
fluoridated drinking water to its employees.
The implication for the general public of these calculations is
clear. Recent, peer-reviewed toxicity data, when applied to EPA's
standard method for controlling risks from toxic chemicals, require an
immediate halt to the use of the nation's drinking water reservoirs as
disposal sites for the toxic waste of the phosphate fertilizer
industry.\24\
End-Note Literature Citations
1. Applying the NAEP code of ethics to the Environmental Protection
Agency and the fluoride in drinking water standard. Carton, R.J. and
Hirzy, J.W. Proceeding of the 23d Ann. Conf. of the National
Association of Environmental Professional. 20-24 June, 1998. (GEN 51-
61. On-line at URL. http//:www.rvi.net/~fluoride/naep.htm
2. Neurotoxicity of sodium fluoride in rats. Mullenix, P.J.
Denbesten, P.K., Schunior, A. and Kernan. W.J. Neurotoxicol. Teratol.
17 169-177 (1995)
3. Influence of chronic fluorosis on membrane lipids in rat brain.
Z.Z. Guan, Y.N. Wang. K.Q. Xiao, D.Y. Dai, Y.H. Chen, J.L. Liu, P.
Sindelar and G. Dallner. Neurotoxicology and Teratology 20 537-542
(1998).
4. Chronic administration of aluminum-fluoride or sodium-fluoride
to rats in drinking water: alterations in neuronal and cerebrovascular
integrity. Varner, J.A., Jensen, K.F., Horvath, W. And Isaacson, R.L.
Brain Research 784 284-298 (1998).
5. Effects of high fluoride water supply on children's
intelligence. Zhao, L.B., Liang, G.H., Zhang, D.N., and Wu, X.R.
Fluoride 29 190-192 (1996)
6. Effect of fluoride exposure on intelligence in children. Li.
X.S., Zhi, J.L., and Gao, R.O. Fluoride 28 (1995).
7. Effect of fluoride on the physiology of the pineal gland. Luke,
J.A. Caries Research 28 204 (1994).
8. Newburgh-Kingston caries-fluorine study XIII. Pediatric findings
after 10 years. Schlesinger, E.R., Overton, D.E., Chase, H.C., and
Cantwell, K.T. JADA 52 296-306 (1956).
9. Memorandum dated May 1, 1990. Subject: Fluoride Conference to
Review the NTP Draft Fluoride Report; From: Wm. L. Marcus, Senior
Science Advisor ODW; To: Alan B. Hais, Acting Director Criteria &
Standards Division ODW.
10. Toxicology and carcinogenesis studies of sodium fluoride in
F344/N rats and B6C3F1 mice. NPT Report No. 393 (1991).
11a. Chromosome aberrations, sister chromatid exchanges,
unscheduled DNA synthesis and morphological neoplastic transformation
in Syrian hamster embryo cells. Tsutsui et al. Cancer Research 44 938-
941 (1984).
11b. Cytotoxicity. chromosome aberrations and unscheduled DNA
synthesis in cultured human diploid fibroblasts. Tsutsui et al.
Mutation Research 139 193-198 (1984).
11c. Positive mouse lymphoma assay with and without S-9 activation;
positive sister chromatid exchange in Chinese hamster ovary cells with
and without S-9 activation; positive chromosome aberration without S-9
activation. Toxicology and carcinogenesis studies of sodium fluoride in
F344/N rats and B6C3F1 mice. NTP Report No. 393 (1991).
11d. An increase in the number of Down's syndrome babies born to
younger mothers in cities following fluoridation. Science and Public
Policy 12 36-46 (1985).
12. A brief report on the association of drinking water
fluoridation and the incidence of osteosarcoma among young males. Cohn,
P.D. New Jersey Department of Health (1992).
13. Surveillance, epidemiology and end results (SEER) program.
National Cancer Institute in Review of fluoride benefits and risks.
Department of Health and Human Services. F1-F7 (1991).
14. New evidence on fluoridation. Diesendorf, M., Colquhoun, J.,
Spittle, B.J., Everingham, D.N., and Clutterbuck, F.W. Australian and
New Zealand J. Public Health. 21 187-190 (1997).
15a. Regional variation in the incidence of hip fracture: U.S.
white women aged 65 years and older. Jacobsen, S.J., Goldberg, J.,
Miles, T.P. et al. JAMA 264 500-502 (1990)
15b. Hip fracture and fluoridation in Utah's elderly population.
Danielson, C., Lyon, J.L., Egger, M., and Goodenough, G.K. JAMA 268
746-748 (1992).
15c. The association between water fluoridation and hip fracture
among white women and men aged 65 years and older, a national
ecological study. Jacobsen, S.J., Goldberg, J., Cooper, C. and
Lockwood, S.A. Ann. Epidemiol. 2 617-626 (1992).
15d. Fluorine concentration is drinking water and fractures in the
elderly [letter]. Jacqmin-Gadda, H., Commenges, D. and Dartigues, J.F.
JAMA 273 775-776 (1995).
15e. Water fluoridation and hip fracture (letter). Cooper, C.,
Wickham, C.A.C., Barker, D.J.R. and Jacobson, S.J. JAMA 266 513-514
(1991).
16. Water fluoridation and tooth decay: Results from the 1986-1987
national survey of U.S. school children. Yiamouyannis, J. Fluoride 23
55-67 (1990).
17. Recommendations for fluoride use in children. Kumar, J.V. and
Green, E.L. New York Store Dent. J. (1998) 40-47.
18. Why I changed my mind about water fluoridation. Colquhoun, J.
Perspectives in Biol. And Medicine 41 1-16 (1997).
19. A re-examination of the pro-eruptive and post-eruptive
mechanism of the anti-caries effects of fluoride: is there any anti-
caries benefit from swallowing fluoride? Limeback, H. Community Dent.
Oral Epidemiol. 27 62-71 (1999).
20. Fluoride supplements for young children: an analysis of the
literature focussing on benefits and risks. Riordan, P.J. Community
Dent. Oral Epidemiol. 27 72-83 (1999).
21. Prevention and reversal of dental caries: role of low-level
fluoride. Featherstone, J.D. Community Dent. Oral Epidemiol. 27 31-40
(1999).
22. Appendix H. Review of fluoride benefits and risks. Department
of Health and Human Services. H1-H6 (1991).
23. Some young children get too much fluoride. Parker-Pope, T. Wall
Street Journal Dec. 21, 1998.
24. Letter from Rebecca Hammer, Deputy Assistant Administrator for
Water, to Leslie Russell re: EPA view on use of by-product fluosilicic
(sic) acid as low cost source of fluoride to water authorities. March
30, 1983.
OTHER CITATIONS (THIS SHORT LIST DOES NOT INCLUDE THE ENTIRE LITERATURE
ON FLUORIDE EFFECTS)
a. Exposure to high fluoride concentrations in drinking water is
associated with decreased birth rates. Freni, S.C.J. Toxicol. Environ.
Health 42 109-121 (1994)
b. Ameliorative effects of reduced food-borne fluoride on
reproduction in silver foxes. Eckerlin, R.H., Maylin, G.A., Krook, L.,
and Carmichael, D.T. Cornell Vet. 78 75-91 (1988).
c. Milk production of cows fed fluoride contaminated commercial
feed. Eckerlin, R.H., Maylin,. G.A., and Krook, L. Cornell Vet. 76 403-
404 (1986).
d. Maternal-fetal transfer of fluoride in pregnant women. Calders,
R., Chavine, J. Fermanian, J., Tortrat, D., and Laurent, A.M. Biol.
Neonate 54 263-26 (1988).
e. Effects of fluoride on screech owl reproduction: teratological
evaluation, growth, and blood chemistry in hatchlings. Hoffman, D.J.,
Pattee, O.H., and Wiemeyer, S.N. Toxicol. Lett. 26 19-24 (1985).
f. Fluoride intoxication in dairy calves. Maylin, G.A., Eckerlin,
R.H., and Krook, L. Cornell Vet. 77 84-98 (1987).
g. Fluoride inhibition of protein synthesis. Holland, R.I. Cell
Biol. Int. Rep. 3 701-705 (1979).
h. An unexpectedly strong hydrogen bond: ab initio calculations and
spectroscopic studies of amide-fluoride systems. Emsley, J., Jones,
D.J., Miller, J.M., Overill, R.E. and Waddilove, R.A. J. Am. Chem. Soc.
103 24-28 (1981).
i. The effect of sodium fluoride on the growth and differentiation
of human fetal osteoblasts. Song. X.D., Zhang, W.Z., Li, L.Y., Pang,
Z.L., and Tan, Y.B. Fluoride 21 149-158 (1988).
j. Modulation of phosphoinositide hydrolysis by NaF and aluminum in
rat cortical slices, Jope, R.S.J. Neurochem. 51 1731-1736 (1988).
k. The crystal structure of fluoride-inhibited cytochrome c
peroxidase. Edwards, S.L., Poulos, T.L., Kraut, J. J. Biol. Chem. 259
12984-12988 (1984).
l. Intracellular fluoride alters the kinetic properties of calcium
currents facilitating the investigation of synaptic events in
hippocampal neurons. Kay, A.R., Miles, R., and Wong, R.K.S. J.
Neurosci. 6 2915-2920 (1986).
m. Fluoride intoxication: a clinical-hygienic study with a review
of the literature and some experimental investigations. Roholm, K. H.K.
Lewis Ltd (London) (1937).
n. Toxin-induced blood vessel inclusions caused by the chronic
administration of aluminum and sodium fluoride and their implications
for dementia. Isaacson, R.L., Varner, J.A., and Jensen, K.F. Ann. N.Y.
Acad. Sci, 825 152-166 (1997).
o. Allergy and hypersensitivity to fluoride. Spittle, B. Fluoride
26 267-273 (1993)
______
[From Dartmouth College, March 15, 2001]
DARTMOUTH RESEARCHERS WARNS OF CHEMICALS ADDED TO DRINKING WATER
Hanover, NH--In a recent article in the journal, NeuroToxicology, a
research team led by Roger D. Masters, Dartmouth College Research
Professor and Nelson A. Rockefeller Professor of Government Emeritus,
reports evidence that public drinking water treated with sodium
silicofluoride or fluosilicic acid, known as silicofluorides (SiFs), is
linked to higher uptake of lead in children.
Sodium fluoride, first added to public drinking water in 3945, is
now used in less than 10 percent of fluoridation systems nationwide,
according to the Center for Disease Control's (CDC) 1992 Fluoridation
Census. Instead, SiF's are now used to treat drinking water delivered
to 140 million people. While sodium fluoride was tested on animals and
approved for human consumption, the same cannot be said for SiFs.
Masters and his collaborator Myron J. Coplan, a consulting chemical
engineer, formerly Vice President of Albany International Corporation,
led the team that has now studied the blood lead levels in over 400,000
children in three different samples. In each case, they found a
significant link between SiF-treated water and elevated blood lead
levels.
``We should stop using silicofluorides in our public water supply
until we know what they do,'' said Masters. Officials at the
Environmental Protection Agency have told Masters and Coplan that the
EPA has no information on health effects of chronic ingestion of SiF-
treated water.
In their latest study published in a special December 2000 issue of
NeuroToxicology, Masters, Coplan and their team analyzed data on blood
levels from more than 150,000 children ages 0 to 6. These tests were
part of a sample collected by the New York State Department of
Children's Health, mostly from 1994 to 1998 in comparable non-
fluoridated and SiF-treated public drinking water in communities with
populations of similar size. Socio-economic and demographic risk
factors for high blood lead were also considered using information from
the 1990 U.S. Census, The researchers found that the greatest
likelihood of children having elevated blood lead levels occurs when
they are exposed both to known risk factors, such as old house paint
and lead in soil or water, and to SIF-treated drinking water.
``Our research needs further laboratory testing,'' added Masters.
``This should have the highest priority because our preliminary
findings show correlations between SiF use and more behavior problems
due to known effects of lead on brain chemistry.'' Also requiring
further examination is German research that shows SiFs inhibit
cholinesterase, an enzyme that plays an important rote in regulating
neurotransmitters.
``If SiFs are cholinesterase inhibitors, this means that SiFs have
effects like the chemical agents linked to Gulf War Syndrome, chronic
fatigue syndrome and other puzzling conditions that plague millions of
Americans,'' said Masters. ``We need a better understanding of how SiFs
behave chemically and physiologically.''
Currently, a bill before the New Hampshire House of Representatives
would impose more stringent testing on fluoridating chemicals added to
public drinking water. On March 7, 2001, Masters and Coplan testified
in favor of the bill, HB 754, The Fluoride Product Quality Control Act,
at a public bearing. Masters contends that bill's requirement for
testing the silicofluorides is vital but needs to be complemented by
further research on neurotoxicity and behavior.
Masters and Coplan note that their recent studies contain the most
extensive empirical evidence of the health and behavioral costs of
these chemicals. ``If further research confirms our finding;'' Masters
added, ``this may well be the worst environmental poison since leaded
gasoline.''
______
Is Fluoridation Scientifically Defensible
(By John R. Lee, M.D.)
I. DOSAGE PROBLEMS: FOOD CHAIN FLUORIDE NOW EXCEEDS ``OPTIMAL'' INTAKE
Leverett, D.H. Fluorides and the Changing Prevalence of Dental
Caries. Science 217: 26-30, July 1982. Environmental fluoride may be
approaching a critical mass.
Lee, J.R. Optimal fluoridation--the concept and its application to
municipal water fluoridation. Western J Med 122: 431-6, May 1975.
Rose, D. & Marier, J.R. Environmental Fluoride 1977. National
Research Council of Canada, No. 16081, Ottawa, July 1978.
Shern et al Enamel biopsy results of children receiving fluoride
tablets. J Am Dent Assoc; 95:310-14, Aug. 1977. Dental enamel fluoride
concentrations of unfluoridated children; those receiving fluoride
supplements show no difference.
Smith, G. A surfeit of fluoride? Sci Pro Oxf; 69:429-42, 1985.
Waitrowski et al. Dietary fluoride intake of infants. Pediatrics;
55:517, 1975. Placental transfer fluoridates newborn, reduces available
fluoride binding sites.
Krook, L. The Cornell Veterinarian; Vol. 60 (Supplement 8), 1979.
Louw & vanWyk. J Dental Research, June 1981.
Maduska et al. Placental transfer of intravenous fluoride in the
pregnant ewe. Am J Obstet Gynecol; 136:84, 1980.
II. LACK OF DENTAL BENEFIT
Colquhoun, J. Fluoridation in New Zealand: New evidence. Am Lab;
17:(5) 66-72, (6)98-102, 1985.
Colquhoun, J. Child dental health differences in New Zealand.
Community Health Studies; 11:85-90, 1987.
Colquhoun, J., Mann R. Address before the 56th Congress of the
Australian and New Zealand Assoc. for the Advancement of Science, Jan.
26, 1987. A reexamination of New Zealand's fluoridation trial (Hastings
and Napier) finds gross irregularities in diagnostic procedures in
Hastings and obfuscation of comparable caries decline in control city,
Napier.
Colquhoun, J. Fluorides and the decline in tooth decay in New
Zealand. Fluoride; 26:125-134, 1993. Decline in tooth decay commenced
before and independently of fluoridation or other uses of fluoride.
DePaola, P.F. et al. Changes in caries prevalence of Massachusetts
children over 30 years. J Dental Res; 60:360, 1981. Reports a decline
in caries prevalence of 40-50 percent, both in fluoridated and in
unfluoridated communities.
Diesendorf, M. The mystery of declining tooth decay. Nature;
322:125-9, 1986.
Diesendorf, M. A Re-examination of Australian fluoridation trials.
Search; 17:256-61, 1986.
Douglas, et al. Impact of water fluoridation on dental practice and
dental manpower. J Am Dent Assoc; 84:355-67, 1972. When naturally
fluoridated and unfluoridated communities are compared, the cost and
nature of dental care are not significantly different; in fact,
dentists' income in fluoridated communities is higher.
Forst, J.A. Report by Bureau of Health Services, October 26, 1954.
Dental comparison of school children of Kingston and Newburgh, NY,
after 10 years fluoridation in Newburgh, finds better dental health in
unfluoridated Kingston.
Gish & Muhler. Effectiveness of a stannous fluoride dentifrice on
dental caries. J. Dentistry for Children; May-June 1971. The 5-year
increase in cavities in school children using fluoridated dentifrice
was the same as those using a non-fluoridated dentifrice.
Glass. Secular changes in caries prevalence in two Massachusetts
towns. Caries Research; 15:445-50, 1980. Decline in caries prevalence
in nonfluoridated community equals that of fluoridated community (1958-
1978).
Gray, A.S. Fluoridation: time for a new baseline? J. Canadian Dent
Assoc; 53:763-5, 1987. Expected benefit of fluoridation not found.
Kumar, V.K., Green, E.L., Wallace, W., Carnahan, T. Trends in
dental fluorosis and dental caries prevalences in Newburgh and
Kingston, NY. Am J Pub Health; May 1989; 79: 565-69. Caries decline
since 1955 in both communities: no advantage in fluoridated Newburgh.
More fluorosis (thru age 12) in Newburgh.
Schrotenboer. Editorial review, J Am Dent Assoc; 102, April 1981.
No proof that current decline in cavities is due to fluoridation.
Scott F. Editorial, Fluoridation: more evidence it is not safe or
effective. Am Lab; June 1986.
Tijmstra T et al. Community Dentistry and Oral Epidemiology: 6:227-
30, 1978. When children are matched by fathers' occupation, candy
consumption and toothbrushing habits, the supposed reduction in caries
among fluoride users vanishes.
Yiamouyiannis, J. Water fluoridation and tooth decay: results from
the 1986-1987 National Survey of U.S. schoolchildren. Fluoride; 23:55-
67, 1990. No difference.
Ziegelbecker, R. Fluoridated Water and Teeth. Fluoride; 14:123-8.
1981. European scientists, in evaluating USPHS claims of fluoride
dental benefits, find these supposed benefits are random, i.e. not
dose-related, and are unconvincing whereas the toxicity (dental
fluorosis) is dose-related.
National Dental Caries Prevalence Survey of 1979-80. NIH Pub. No.
82-2245, March 1982. Fails to demonstrate any advantage of artificial
fluoridation.
Robert Wood Johnson Foundation Special Report No. 2, National
Preventive Dentistry Demonstration Program 1983. Found no benefit from
topical treatments tried in a 4-year test in 10 differing communities.
III. TOXICITY: FLUORIDE IS TOXIC; NO LOWER LIMIT OF SAFETY FOUND
Bucher, J.R. et al. Results and conclusions of the National
Toxicology Program's rodent carcinogenicity studies with Na-F Int J
Cancer; 48 733-737. 1991
Clark, J., Taylor J. I.R. evidence for a strong hydrogen bond in
the fluoride-uracil system. J Chem Soc Comm: pp 466-68, 1981.
Clark, R. Neutrophil iodination reaction induced by fluoride:
implications for degranulation and metabolic activation. Blood: 57: No.
5 (May) 1981.
Colquhoun, J. Disfiguring dental fluorosis in Auckland. New
Zealand. Fluoride; 17:66-72. 1984.
DeChatelet et al. Effects of fluoride on the oxidative metabolism
of human neutrophils. Biochem Med: 25: 106-13, 1981.
Desai, V.K. et al. Epidemiological study of goitre in endemic
fluorosis district of Gujarat. Fluoride: 26:187-90,1993. Shows
correlation of fluorosis with goiter.
Edwards, S. et at. The crystal structure of fluoride-inhibited
cytochrome c peroxidase. J. Biolog Chem: 259:12984-8. 10 Oct 1984.
Emsley et al. Ab initio calculations of uracil-fluoride systems. J
Chem Soc Comm: pp 476-8. May 1982.
Emsley et al. An unexpectedly strong hydrogen bond: ab initio
calculations and spectroscopic studies of amidefluoride systems. Am
Chem Soc: Jan 1981.
Erickson. Mortality in selected cities with fluoridated and non-
fluoridated water supplies. N Eng J Med: 298:1112-6, 1978. Mortality
rates, after adjusting for age, sex, race and all recognized socio-
economic variables, are higher in fluoridated communities.
Fleisch, J. Haisch, R. Increase in antigen-induced release of slow
reacting substance of anaphylaxis from guinea pig lung by sodium
fluoride. Biochem Pharmacology: 29:1843-7. 1980.
Gibson, SLM. Effects of fluoride on immune system function. Comp
Med Res: 6:111113. 1992. Fluoride inhibits migrational ability of
leucocytes.
Goodman & Gilman, textbook. The Pharmacological Basis of
Therapeutics. 3d edition. pp 815-7.
Jagiello & Lin. Sodium fluoride as a potential mutagen in mammalian
eggs. AMA Archives of Environmental Health; Vol 29, Oct. 1974.
Klein, W. et al. DNA repair and environmental pollutants. The
Institute for Biology, Research Center, Seibersdorf.
Kumari, D.S. & Rao, P.R. Red cell membrane alterations in human
chronic fluoride toxicity. Biochem International; 23 (4): 639-48, 1991.
Increased lipid peroxidation.
Lee, J.R. Gilbert's syndrome and fluoridation. Fluoride: July 1983.
Switch from fluoridated to non-fluoridated water lowered bilirubin
levels.
Leverett, D.H. Prevalence of dental fluorosis in fluoridated and
nonfluoridated communities--a preliminary investigation. J Pub Health
Dent; 46:184-7.1986.
Manocha et al. Cytochemical responses of kidney, liver and nervous
system to fluoride ions in drinking water. Histochemical J.; 7:343-55,
1975.
Mohamed & Chandler. Cytological effects of sodium fluoride on
mitotic and meiotic chromosomes of mice. Chem & Eng News, Sept 10,
1976.
National Toxicology Program Technical Report on the Toxicology and
Carcinogenesis studies of sodium fluoride in F344/N rats and B6C3F1
Mice. NTP TR 393, NIH Pub. No. 90-2848. 1990. Osteosarcoma in male
rats, osteofluorosis in female rodents.
U.S. Public Health Service. Review of Fluoride benefits and risks,
report of the ad hoc subcommittee on fluoride, Feb 1991. Report of NTP
study plus SEER data on osteosarcoma in young men.
Spak, C.J. et al. Tissue response of gastric mucosa after ingestion
of fluoride. Brit Med J. 298: 1686-7, 1989.
Susheela, A.K. Fluorosis--early warning signs and diagnostic test.
Bull Nutr Foundation of India; 2 April 1989; 10:2. Multi-system early
warning signs and description of sialic acid/glycosaminoglycans test.
Susheela, A.K. et al. Prevalence of endemic fluorosis with
gastrointestinal manifestations in people living in some north-Indian
villages. Fluoride: 26:97-104. 1993. Positive correlation noted.
Susheela, A.K. et al. Fluoride ingestion and its correlation with
gastrointestinal discomfort. Fluoride; 25:5-22. 1992. Ingested fluoride
damages gastroduodenal mucosa and induces non-ulcer dyspepsia.
Tsutsui, T. et al. Sodium fluoride-induced morphological and
neoplastic transformation, chromosome aberrations, sister chromatid
exchanges and unscheduled DNA synthesis in Syrian hamster embryo cells.
Cancer Res; 44:938-41, March 1984.
Waldbott G.L., Lee, J.R. Toxicity from repeated low-grade exposure
to hydrogen fluoride--case report. Clin Toxicol: 13:391-402, 1978.
Yiamouyiannis, J. Fluoridation and cancer: the biology and
epidemiology of bone and oral cancer related to fluoridation. Fluoride:
26:83-96. 1993.
IV. FLUORIDE AND BONE
Alhava, E.M. et al. The effect of drinking water fluoridation on
the fluoride content, strength and mineral density of human bone. Acta
Orthop Scand: 51:413-20. 1980.
Arnala, I. Bone fluoride, histomorphometry and incidence of hip
fracture. Pub of the U. of Kuopio. Med Series Orig Rep. Kuopio. 1983.
Arnala, I et al. Effects of fluoride on bone in Finland:
histomophometry of cadavar bone from low and high fluoride areas. Acta
Ortho Scand; 56: 161-6, 1985.
Arnala, I et al. Hip fracture incidence not affected by
fluoridation. Acta Ortho Scand: 57:344-8. 1986. No benefit found from
fluoridation.
Avioli, L.V. Fluoride treatment of osteoporosis. Postgrad Med: A
Special Report, pp 26-27. 14 Sept 1987. Fluoride treatment has no place
in the treatment of osteoporosis.
Baylink, D.J. Bernstein, D.S. The effects of fluoride therapy on
metabolic bone disease. Clin Ortho & Rel Res: 55:51-85. 1967.
Bernstein, D.S., Cohen, P. Use of sodium fluoride in the treatment
of osteoporosis. J Clin Endocr; 27: 197-210, 1967.
Chlebna-Sokol, D. & Czerwinski, E. Bone structure assessment on
radiographs of distal radial metaphysis in children with dental
fluorosis. Fluoride; 26:3744, 1993. Dental fluorosis correlated with
increased trabecular X-ray density.
Cohn, P.D. An epidemiological report on drinking water and
fluoridation. New Jersey Dept. of Health report. Nov 1992. Osteosarcoma
in young men correlated with fluoridation.
Cooper, C., Wickham, CAC,. Barker, DJR, & Jacobsen, S.J. Water
fluoridation and hip fracture. J Am Med Assoc; 266:513. 1991.
Fluoridation correlated with increased hip fracture risk.
Czerwinski, E. et al. Bone and joint pathology in fluoride-exposed
workers. Archives of Environmental Health; 43:340-3, Sept./Oct. 1988.
Fisher, R.L. et al. Endemic fluorosis with spinal cord compression:
A case report and review. Arch Intern Med 149 697-700 1989 Spinal cord
compression due to fluoride-induced osteosclerosis
Hedlund, L.R., Gallagher, J.C. Increased incidence of hip fracture
in osteoporotic women treated with sodium fluoride J Bone & Min Res:
4:223-5 1989
Goggin, J.E. et al. Incidence of femoral fractures in
postmenopausal women. Pub Health Rep: 80:1005-12. 1965. No benefit
found in fluoridated areas.
Ho SC et al. Hip fracture rates in Hong Kong and the United States,
1988 through 1989. Am J Pub Health: 83:694-7, 1993. U.S. hip fracture
rates higher than in Hong Kong.
Jacobsen, S.J. et al. Regional variation in the incidence of hip
fracture. J Am Med Assoc: 264:500-502. 1990. Review of 541.985 hip
fractures in U.S. white women aged 65 years and older found strong
correlation with fluoridation status.
Jacobsen, S.J. et al. Hip fracture incidence before and after the
fluoridation of the public water supply, Rochester, Minnesota. Am J Pub
Health: 83:743-5.1993.
Kleerekoper, M. Presentation at the October meeting of the FDA
Advisory Committee, as reported in Medical World News. Oct. 23. 1989.
p. 42.
Madans et al. The relationship between hip fracture and water
fluoridation an analysis of national data Am I Public Health: 73:296-8.
1983.
Mahoney, M.C. et al. Bone cancer incidence rates in New York State:
time trends and fluoridated water. Am I Pub Health: 81:475-9. April
1991.
Munzenberg, K.J., Moller, F., Koch, W. Adverse effects of
osteoporosis treatment with fluoride. Munchener Medizinische
Wochenschrift: 133(5):56-8, 1991. Fluoride induced pain in extremeties
as a result of stress fractures and calciumphosphate deposition in
periarticular tissue.
National Toxicology Program fluoride/mammal study found increased
incidence of osteosarcoma in fluoridated male rats. Reported by Medical
Tribune, Nov. 13, 1989.
Riggs, B.L. et al. Effect of fluoride treatment on the fracture
rate in postmenopausal women with osteoporosis. N Eng J Med: 322:802-9,
1990. No benefit to spine, increased fracture incidence in non-
vertebral bones by fluoride.
Schnitzler, C.M., et al. Bone fragility of the peripheral skeleton
during fluoride therapy for osteoporosis. Clin Orthopaedics and Related
Res. 261:268-71. 1990. Fluoride therapy induced spontaneous fractures
three times that of untreated controls.
Simonen, O. & Laitnen, O. Does fluoridation of drinking-water
prevent bone fragility and osteoporosis? Lancet; 24(2):432-4, 1985.
Sowers, F.R. et al. The relationship of bone mass and fracture
history to fluoride and calcium intake: a study of three communities.
Am J Clin Nutr; 44:889-98. 1986.
Sowers, F.R. et al. A prospective study of bone mineral content and
fracture in communities with differential fluoride exposure. Am J Epid;
133:649-60,1991.
Suarez-Almazor, M.E. et al. The fluoridation of drinking water and
hip fracture hospitalization rates in two Canadian communities. Am J
Pub Health: 83:689-93, 1993.
Weingrad, T.R. et al. Periostitis due to low-dose fluoride
intoxication demonstrated by bone scanning. Clin Nuclear Med; 16:59-61,
1991.
Zong-Chen, L., En-Huei, W. Osteoporosis--an early radiographic sign
of endemic fluorosis. Skeletal Radiol: 15:350-3, 1986.
V. NO KNOWN ESSENTIAL USES FOR FLUORIDE
National Academy of Sciences. Fluorides. Chapter 5, Is fluoride as
essential element? Washington, DC 1971. The answer is NO.
Federal Register, p. 16006, 16 March 1979. All paragraphs
previously classifying fluoride as ``essential or probably essential''
were deleted by FDA. Fluoride is so ubiquitous that no diet can be
constructed for man that is deficient or lacking in fluoride. All
authorities agree.
Therefore, fluoridation of community water supplies is a failed
concept and should be abandoned.
Papers published by John R. Lee, MD:
Lee, J.R. Optimal fluoridation--the concept and its application to
municipal water fluoridation. Western J. Med 1975; 122:431-6. Waldbott,
G.L.
Lee, J.R. Toxicity from repeated low-grade exposure to hydrogen
fluoride. Clin Tox 1978; 13:391-402.
Lee, J.R. Gilbert's syndrome and fluoridation. Fluoride; July 1983.
Lee, J.R. Fluoridation and cancer. Cancer Forum 1989; 9:4-6.
Lee, J.R. Fluoride and osteoporosis. Editorial. Fluonde; 23:5 1-4.
1990.
Lee, J.R. Osteoporosis reversal--the role of progesterone.
International Clinical Nutrition Rev 1990: 10:384-91.
Lee, J.R. Hormonal and nutritional aspects of fluoridation. Health
& Nutrition Update; 6(4):4-8, 1991.
Lee, J.R. Significance of molecular configuration specificity: the
case of progesterone and osteoporosis. Townsend Letter for Doctors;
558-62, June 1993.
______
Recommended Reading
Fluoridation. The Great Dilemma by George L. Waldbott, M.D. with
Albert Burgstahler, Ph.D. and H. Lewis McKinney, Ph.D. Forward by Alton
Ochsner, M.D. Coronado Press, Inc. Box 3232, Lawrence, Kansas, 1978.
Fluoride the Aging Factor, 3d Ed., by John Yiamouyiannis, Ph.D.
Health Action Press, 6439 Taggart Rd., Delware, Ohio 43015, 1993.
The Fluoride Question--Panacea or Poison? by Anne-Lise Gotsche.
Stein & Day, Scarborough House, Briarctiff Manor, NY 10510.
Fluoride: The Freedom Fight by Hans Moolenburgh, MD. Mainstream
Press, Edinburgh, 1987.
Fluoride in Australia: A Case to Answer by Wendy Varney Hale &
Iremonger GPO Box 2552, Sydney, NSW, Australia, 1986.
``Fluoridation of Water,'' special report by Bette Hileman,
Chemical & Engineering News; 66(31):26-42, 1988.
The Costs, Effects, and Benefits of Preventive Dental Care: A
Literature Review by Craig B. Foch, Rand Note N-1732-RWJF, December
1981.
Environmental Fluoride 1977 by D. Rose and J. R. Marier, National
Research Council of Canada, 100 Sussex Drive, Ottawa, Ontario, Canada
K1A 0R6.
Fluoridation in New Zealand by Bruce Collins, New Zealand Pure
Water Assoc Box 2186, Tauranga, New Zealand.
Fluoridation, 1979 by Philip R.N. Sutton D.D.Sc., FRACDS 163 A New
Street Brighton Victoria, Australia 3186.
Social Studies of Science, ``Analyzing the Fluoridation
Controversy'' by Brian Martin, Vol. 18 (1988) pp. 331-63 (SAGE
Publications, 2111 W. Hillcrest, Newberry Park, CA 91320).
Scientific Knowledge in Controversy: The Social Dynamics of the
Fluoridation Debate by Brian Martin, State University of New York
Press, Albany NY, 1991.
Fluoride, Quarterly by the International Society for Fluoride
Research, 216 Atkinson Rd., Titerangi, Aukland 7, New Zealand.
The Fluoride Report, Quarterly by Truth About Fluoride, Inc. P.O.
Box 219, Buckeystown, MD 21717.
______
[From the Mesa Tribune, Arizona, December 5, 1999]
Former Fan of Fluoridation Now Warns of its Perils
(By Barry Forbes, Tribune Columnist)
``Why'd you do it, Doc? Why'd you toss the fluoride folks
overboard?''
I had just tracked down Dr. Hardy Limeback, B.Sc., Ph.D. in
Biochemistry, D.D.S., head of the Department of Preventive Dentistry
for the University of Toronto, and president of the Canadian
Association for Dental Research. (Whew.)
Dr. Limeback is Canada's leading fluoride authority and until
recently, the country's primary promoter of the controversial additive.
In a surprising newsmaker interview this past April, Dr. Limeback
announced a dramatic change of heart. ``Children under three should
never use fluoridated toothpaste,'' he counseled. ``Or drink
fluoridated water. And baby formula must never be made up using Toronto
tap water. Never.''
Why, I wondered? What could have caused such a powerful paradigm
shift?
``It's been building up for a couple of years,'' Limeback told me
during a recent telephone interview. ``But certainly the crowning blow
was the realization that we have been dumping contaminated fluoride
into water reservoirs for half a century. The vast majority of all
fluoride additives come front Tampa Bay, Florida smokestack scrubbers.
The additives are a toxic by-product of the super-phosphate fertilizer
industry.''
``Tragically,'' he continued, ``that means were not just dumping
toxic fluoride into our drinking water. We're also exposing innocent,
unsuspecting people to deadly elements of lead, arsenic and radium, all
of them carcinogenic. Because of the cumulative properties of toxins,
the detrimental effects on human health are catastrophic.''
A recent study at the University of Toronto confirmed Dr.
Limeback's worst fears. ``Residents of cities that fluoridate have
double the fluoride in their hip bones vis-a-vis the balance of the
population. Worse, we discovered that fluoride is actually altering the
basic architecture of human bones.''
Skeletal fluorosis is a debilitating condition that occurs when
fluoride accumulates in bones, making them extremely weak and brittle.
The earliest symptoms?
``Mottled and brittle teeth,'' Dr. Limeback told me. ``In Canada we
are now spending more money treating dental fluorosis than we do
treating cavities. That includes my own practice.'' One of the most
obvious living experiments today, Dr. Limeback believes, is a proof-
positive comparison benveen any two Canadian cities. ``Here in Toronto
we've been fluoridating for 36 years. Yet Vancouver--which has never
fluoridated--has a cavity rate lower than Toronto's.''
And, he pointed out, cavity rates are low all across the
industrialized world--including Europe. which is 98 percent fluoride
free. Low because of improved standards of living, less refined sugar,
regular dental checkups, flossing and frequent brushing. Now less than
2 cavities per child Canada-wide, he said.
``I don't get it, Doc. Last month, the Centers for Disease Control
(CDC) ran a puff piece all across America saying the stuff was better
than sliced bread. What's the story?''
``Unfortunately,'' he replied, ``the CDC is basing its position on
data that is 50 years old, and questionable at best. Absolutely no one
has done research on fluorosilicates, which is the junk they're dumping
into the drinking water.''
``On the other hand.'' he added, ``the evidence against systemic
fluoride in-take continues to pour in.''
``But Doc, the dentists.''
``I have absolutely no training in toxicity;'' he stated firmly.
``Your well-intentioned dentist is simply following 50 years of
misinformation from public health and the dental association. Me, too.
Unfortunately, we were wrong.''
Last week, Dr. Hardy Limeback addressed his faculty and students at
the University of Toronto, Department of Dentistry. In a poignant,
memorable meeting, he apologized to those gathered before him.
``Speaking as the head of preventive dentistry. I told them that I
had unintentionally mislead my colleagues and my students. For the past
15 years, I had refused to study the toxicology information that is
readily available to anyone. Poisoning our children was the furthest
thing from my mind.''
``The truth,'' he confessed to me, ``was a bitter pill to swallow.
But swallow it I did.'' South of the border, the paradigm shift has yet
to dawn. After half a century of delusion, the CDC, American Dental
Association and Public Health stubbornly and skillfully continue to
manipulate public opinion in favor of fluoridation.
Meantime, study after study is delivering the death knell of the
deadly toxin. Sure. fluoridation will be around for a long time yet,
but ultimately its supporters need to ready the life rafts. The
poisonous waters of doubt and confusion are bound to get choppier.
Are lawsuits inevitable?'' I asked the good doctor ``Remember
tobacco.'' was his short, succinct reply.
Welcome. Dr. Hardy Limeback, to the far side of the fluoride
equation.
It's lonely over here, but in our society loneliness and truth
frequently travel hand in band.
Thank you for the undeniable courage of your convictions.
AN INTRODUCTION TO FLUORIDE
The chemicals used in 90 percent of U.S. water
fluoridation programs are industrial-grade hazardous wastes captured in
the pollution-control scrubber systems of the Fluorine recovery in the
fertilizer industry-a review. Phosphorus & Potassium No. 103, Sept./
Oct. 1979.
``Our water department calculates that we would be buying
33 tons of chemicals/year . . . The kickerto this scheme is that the
amount intended for the targeted children is only 16 pounds of that 33
tons.'' Councilman Keith Beier, city of Escondido Council Meeting,
March 24, 1999.
All three fluoridation chemicals are more toxic than lead
and just slightly less toxic than arsenic. 100 times more fluoride is
added to drinking water than is le LD50 data. RE. Gosselin et al,
Clinical Toxicology of Commercial Products. 5th ed., 1984.: U.S. EPA
Maximum Contaminant Levels (MCL) EPA/NSF Standard 60.
Regarding the silicofluorides used in 90 percent of U.S.
fluoridation programs, EPA states, ``In collecting the data for the
fact sheet, EPA was not able to identify chronic studies for these
chemicals.'' Letter of June 23, 1999, from EPA Asst. Adm. J. Charles
Fox to U.S. Representative Ken Calvert, Chairman, Subcommittee on
Energy and the Environment, Washington, DC.
Water fluoridation mass medicates at a level higher than
the prescription schedule for your children. For example, the
schedule's dose for infants under 6 months is ``None.'' J. Am. Dental
Assoc. Dec. 1995.
66.4 percent of U.S. schoolchildren in so-called
``optimally'' fluoridated communities have at least one tooth that
displays the permanent visible signs of fluoride-overdose . . . dental
fluorosis: white spots, stains, opaque, chalky and brittle enamel. K.E.
Heller, et al, J of Public Health Denistry. Vol. 57: No. 3 Summer 1997.
African-American children experience twice the prevalence
of dental fluorosis as white children and it tends to be more severe.
National Research Council, Health Effects of Ingested Fluoride. 1993,
p. 44.
``This was the only contaminant up to this time that we
knew had a human health effect. Other drinking-water contaminants
(approx. 80) were recognized by the results of (high-dose) animal
studies only.'' EPA drinking-water analyst, David Schnare. The
Progressive. Dec. 1990.
``Our members' review of the body of evidence over the
last 11 years, including animal and human epidemiology studies,
indicate a causal link between fluoride/fluoridation and cancer,
genetic damage, neurological impairment, and bone pathology. Of
particular concern are recent epidemiology studies linking fluoride
exposure to lowered IQ in children.'' Letter of July 2, 1997, from J.
William Hirzy, Ph.D. to Jeff Green. The union (now NTEU, Chapter 280)
consists of and represents all of the toxicologists, chemists,
biologists and other professionals at EPA headquarters, Washington, DC.
Melatonin, the main pineal gland hormone now thought to
act as a `body clock', is inhibited by fluoride causing early onset of
sexual maturation in study animals. The mean age of menstruation for
girls in fluoridated test city Newburgh, New York, in 1956, was 5
months earlier than non-fluoridated control city, Kingston. Low
melatonin levels have been linked to both breast and prostate cancer.
Caries Research, Vol. 28, p. 204 1994. J Am Dent Asso, March 1956.
Breast Health Charles Simone, Princeton oncologist.
In a survey of over 280,000 Massachusetts children,
Dartmouth researchers found that where silicofluorides were used to
fluoridate water, children w above the danger level of 10 g/
dL. Dartmouth News. Office of Public Affairs, Hanover, NH. Aug. 31,
1999.
Filters and water purifiers do not remove fluoride.
Reverse-osmsis or distillation will, but are impractical for showers
and bathing. G. Whitford, Intake and Metabolism of Fluoride, Adv Dent
Res 8(1):5-14, June, 1994.
______
Fluoride Information on the Web (Partial List)
www.fluoridation.com
www.fluoridealert.org
www.citizens.org
www.orgsites.com/ny/nyscof
www.garynull.com/issues/fluoride/fluorideactionfile/htm
emporium.turnpike.net/p/pdha/health.htm
www.bruha.com/fluoride
www.fluoride-journal.com
www.zerowasteamerica.org/fluoride.htm
www.penweb.org/issues/fluoride/index.html
www.npwa-freeserve.co.uk (United Kingdom)
www.voice.buz.org/fluoridation/index.html (Ireland)
__________
Statement of Barbara J. Balaban, Somers, NY
Problem 1. Studying the environment is difficult.
Suggestion. We need interdisciplinary studies to bring together the
various specialists to put their expertise to work on the multi-faceted
problem. The Breast Cancer and Environmental Research Act (S. 830) will
provide such a framework.
Problem 2. We need advocates, scientists and industry to work on
these problems.
Suggestion. Re-authorize the National Action Plan on Breast Cancer,
which is no longer functioning.
Suggestion. Research funded by the Federal Government should
require the participation of consumers in the design and oversight of
requests for proposals and protocols, except in the case of those
unsuitable, highly scientific, laboratory studies.
Problem 3. Why focus on breast cancer rather than all diseases/
other diseases?
Suggestion. Because we have laid the groundwork for breast cancer/
environment studies we should view breast cancer as a model for
studying other diseases. What we learn will be applicable to other
illnesses.
Problem 4. Definition of clusters. Epidemiologists deny the
presence of cancer clusters.
Suggestion. We need a new definition of clusters. The one we use is
derived from studies of infectious diseases and not relevant to cancers
and other chronic diseases.
Problem 5. Cancer is not caused by any single exposure.
Suggestion. We need special emphasis on studying exposures
prenatally through young adulthood, when the body's cells are
undergoing the most rapid changes and are thought to be most vulnerable
to insult.
Suggestion. We need to study chemicals that are not labeled
carcinogenic, and to study chemicals in combination, not just
individually. It is possible that a non-carcinogenic chemical can
become carcinogenic when combined with another chemical.
Problem 6. We do not yet understand what environmental components
are linked to various diseases.
Suggestion. We need a national Geographic Information System to
record environmental conditions and be kept up to date. These can then
be accessed by researchers to better study various geographic areas.
Problem 7. Retrospective studies are not reliable. They rely on
(possibly faulty) memory. Also, many exposures are not able to be
detected in the body after a period of time.
Suggestion. Prospective studies should be financed.
Problem 8. Lacking specific evidence, what can we do to minimize
people's exposures to potentially dangerous environmental factors?
Suggestion. Insofar as is practical, invoke the Precautionary
Principle. When we have reason to suspect that a substance might be
dangerous, curb its use while further studies are carried out.
Chemicals should be proven safe before being allowed to be used, rather
than using them until they are proven dangerous.
Problem 9. Exposure to electro-magnetic fields are thought to be
dangerous.
Suggestion. Schools should incorporate a unit on electro-magnetic
fields. Students could be trained to use a gause meter to measure the
emfs in their schools and try to reconfigure classroom use to minimize
exposure. This would bring immediate benefit to the students as well as
providing an educational experience they can apply to other areas of
their lives.
Problem 10. Radiation is a proven cause of cancer.
Suggestion. Exposure to the medical uses of radiation can be
minimized. Authorize a comparative study in several hospitals to devise
ways of reducing patient exposure to medical radiation.