Document J3N3aLMvwVzYzRBwk5pwp6qNr

MCOICIMC mericani used to think of can cer--when they permitted themselves to think of it at ali as one of those roll-of-the-dice diseases: mysterious, unpredictable and. if your number came up, unavoidably fatal. But recently, they lave been learn ing something new and, in a sense, for more frightening about cancer. In the vast majority of cases, cancer may be a man-made disease. Tojudge from newspapers, magazines and television, even the simple acts of eating, drinking, breathing and touching may expose Americans to some possible cause of cancer. Women have been warned not to eat beef liver because it may produce cancer ofthe vagina. Sever al of the nation's major sources of water have been found to contain an industrial chemical that causes cancer in laboratory rats. Polyvinyl chloride (PVC), a plastic used in food wrapping, is also under suspicion. Some housewives began to shun bacon and ham after they were told these products contain dangerous "the introduction into the universe of potentchemical agents which are largely untested far advene public-health ef fects." Epstein notes that cuncer ratr have nearly tripled since 1900 (part*, because of increased life expectancy, portly because of better diagnostic tech niques), and thut they have gone up 1 per cent a year since 1933--not to mention the mysterious but still tentative 3.8 per cent increase indicated far 1975. "There is no question," he says, "that cancer is a major epidemic." Though a number of Epstein's col leagues might choose to state the case less dramatically, few disagree that the environment and what man nas done to it loom increasingly as the major sources of the second greatest killer (after heart attacks) in the nation. In coincidental support of this thesis. Academic Press this week will publish a massive, 544page report entitled "Persons at High Risk of Cancer." Based on a symposium sponsored by the National Cancer Insti tute and the American Cancer Society, Figures indicate pcrcont.vv* oi estimated 1976 cancer deaths aps the report offers a sweeping and meticu all is the fact that the latest statistics show lously documented appraisal ofthe most a cancer-death rise of 3.8 per cent for recent research on the epidemiology of 1975--though this may be revised when cancer in man--with special emphasis all the figures are in. on the possible roles of diet, drugs, Small wonder, then, that many scien radiation and the workplace. tific experts have begun to regard the environment--everything we come into contact with--as a far more significant A source of cancer than aberrant cellular lready, the concern about mutation. Even if the headlines tend the role of the environment in cancer sometimes to overstate the case, there seems to presage a major shift in the seems little doubt that the newest fron application of cancer research funds. tier in cancer research has now become Critics charge that the NCI has so far the environment itself. Already the failed to devote an appropriate slice ofits World Health Organization estimates $690million budget to research on cancer that up to 85 per cent of all cancer cases control and prevention and on the identi are the direct result ofexposure to envi fication of carcinogens in the environ ronmental factors of one kind or an ment. They say that NCI researchers are other--in many instances almost fatalis spending an inordinate amount on basic tically self-inflicted by such habits os research, including $90 million on a virus overeating, smoking, overdrinking and program that hits yet to uncover a human- excessive exposure to sunlight and dan cancvr virus. The critics charge that even gerous chemicals in the factories. if such a vims is found, it would account Some scientists, like Dr. Samuel S. for only a small number ofcancer eases. Epstein, an environmental toxicologist Of the remaining $600 million in the at Case Western Reserve University NCI budget, only $45 million will go this Medical School, think tluit the past two- year into research on carcinogens. But or three decades have witnessed a phe even this sum represents a new cmplu' nomenon unique in the history of man- sis oiicunccr prevention. Only $7 milti 2 o N ewawe^w 62 BFG21663 ! 2257301 wai devoted to such projects a few years ago. Anti eventually, NCI plans to spend an additional $.50 million on a program to Study the rule of diet alone in cancer. Last summer, NCI published a "Cancer Atlas'* based on a survey ofcancer deaths in the 3,056 counties ofthe contiguous 48 states. "It's generating a lot of ideas of where to look and what to do," says Marvin Schneiderman of NCI. Among the patterns emerging from the cancer map (page 67) were the high rates of bladder cancer in the industrialized Northeast as well as excessive lung and liver cancer rates in smelting-industry communities. In recent months, the search for can cer-causing substances in the environ ment has stined a welter ofcontroversy, involving environmentalists, industry and the scientists themselves. Even the experts disagree somewhat on what sub stances are hazardous and what ought to be done about them when they are found. Of more than 1,400 chemicals, drugs and pollutants now suspected of causing cancer--mostly on the basis of animal tests--only about 22 are now widely held to be carcinogenic to man. amounts in the last 30 years to make polyvinyl chloride, a plastic frnmd in a vast unray of items, including (bod con tainers and phonograph records. In 1973, Italiun reseachcrs found that VC pro duced Uver tumors in rats. The findings were largely ignored until it was learned that the same kind oftumor--exceeding ly rare under ordinary circumstances-- had taken the lives of three workers at the B.F. Goodrich plant in Louisville, Ky. Only then were revised standards on exposure put into effect F_ or the scientists, there are two major problems in uncovering cancercausing substances. The first is the long "latent* period--often twenty to 35 yean--between the beginning of expo sure to a carcinogenic substance and the appearance of malignant disease. In ad dition, scientists find themselves in dis agreement on how big a dose of a substance is enough to trigger cancer. Some researchers point out that almost anything, including sugar and salt, will cause trouble if given in a large enough Responsibility for protecting the pub lic from carcinogens is shared by a bu reaucratic web of government agencies that includes the Environmental Protec tion Agency, the National Institute for Occupational Safety and Health, the Occupational Safety and Health Admin istration and the U.S. Food and Drug Administration. Not surprisingly, their responsibilities not only overlap but are "ften in direct conflict, with different policies setting different standards for updating suspect chemicals. Most experts agree on the need for a jw that would mandate testing of all Vw chemicals and drugs for toxicity-- eluding the tendency to cause cant--before, not after, they enter the :'vironment. "Ifyou wait tiil people are ]t by the epidemic,'* says the NCI's Dr. l**rto Saffiotti, "it's too late." Such a 'I has lain before Congress for five <rs. and many critics charge it has been ' ked by industry pressure. I be consumcrists point to the recent l>l-chloride episode us a stark e.xnm`*1 tin.- failure of the present system to b a dangerous chemical before it '*< trouble. Vinyl chloride is a pus 'l hits been used in ever-increasing dose. Most regulations are based on die idea that there is a "threshold" of expo sure, below which there is no risk. But many experts insist there is no such thing as a safe leveL "Lower concentrations simply mean lower incidence," says Ep stein. "There is no threshold." The second and equally controversial question is whether testing in animals is a reliable indicator of what a substance will do to man. The amount of a sub stance required to cause cancer in an an imal may not realistically reflect the amount that humans can safely be ex posed to. But toxicologist Epstein insists that animal results are applicable to man. "Information in tests from well-designed and valid animal systems," he says, "con stitutes very strong evidence for a cancer hazard in humans." Some manufacturers have been sus pected ofhiding or falsifying test results indicating a cancer hazard. Last week. Newsweek learned, the EP.\ and the Department of Health, Lducntion and Welfare were thinking oftaking criminal action against several corporations and commercial testing labs for just such fraud. Tin* agencies are also planning to look into conflict-of-interest charges in- 26. 1976 LEUKEMIA AND LYMPHOMAS 9% ALL OTHER 13% Sou/co: The American Cancer Society rWfc h* nwn HrLwUMd BFG21664 2257301 f-V' &&& I'MksmhmL' DAUGHTERS OF DES For Grace Malloy, childbearing did had reached her pituitary gland, and notcome easily. Althoughher first Marilyn underwent a grueling six- daughter was bom in 1946 withoutweek regimen of"whole head" radia complications, a subsequent pregnan tion. When all her hair fell out as a re cyended in miscarriage. When during sult, she still refused to give in to self- her next pregnancy she also showed pity and kept up an active social life, signs of miscarrying, her doctor pre wearing a bright scarf over her head. scribed diethylstiibestrol (DES), a Butatnight Mrs. Malloycould hearher synthetic estrogen widely used in daughter moaning in pain with the suchcasesatthe time.Aseconddaugh cancer that was continuing its lethal ter, Patti, was delivered in 1951. After spread through her arms, legs, spine yet another miscarriage, Mrs. Malloy and brain. Soon she was blindandcon became pregnant a fifth time and was fined to a wheelchair. Marilyn died on again given DES. Another daughter, May 26, 1974, two weeks before her Marilyn, was bom in 1956, high-school class's graduation. It was not until Patti and Marilyn Gulb Today, sitting in her elegant, were 19 and 14 that Grace Malloy read sun-filled La Jolla, CaliT, living room, a newspaper report linking DES to a Crace Malloy tells Marilyn's story rare but deadly form ofvaginal cancer with self-control. She does not savor in young women whose mothers had pathos. Nor does she feel any personal taken the hormone during pregnancy. guilt over her daughter's tragic death. Alarmed, Mrs. Malloy asked her doc "I had no way of knowing what those tor if there was anything to this pills would do," she says. "Thousands '`scare." "You bet your life there Is," ofwomen took them, but we all did it he replied. "You'd better get those in the best of faith, because our doc girls in for an examination right tors prescribed them." away." The result was bad news: Nonetheless, Grace Malloy is not Marilyn had vaginal cancer. without bitterness about what hap Malignancy: In an operation lasting pened to her family--ond what still more than twelve hours, Marilyn's may lie ahead. Her older daughter, vagina and nearby lymph glands were Patti, now 25, has been diagnosed ns removed; an artificial vagimi was con having vaginal adenosis, a lesion that structed using skin grafts from her appears benign but could be the pre legs. The doctors were hopeful that cursor of cancer. In spite of long they hod excised the entire malignan standing reservations. Patti recently cy, but a year later they discovered decided to get married, and her doc that the cuticcrhud spread to one lung, tors claim her prospects for a healthy the esophagus and the lining of the future are good. But there is no guar heart. Following another operation, antee; for the time being, Patti can Marilyn recovered sufficiently to re only wait--like thousands of .other sume her passion--horseback riding. young women with the same hishw A short time later Marilyn's condi ry--and pray tliat the killer that tion worsened. She lost her appetite, claimed her sister may pass her by. suffered from nausea and severe head aches. Tests revealed that the cancer SELtOUANN *itft LAWRENCE SHOOK nUJoa*,CM. been shown to cause breast cancer. One recent study suggested that the risk of breast cancer was increases) for women who took the Pill tiefore having their first child and for those with a history of benign breast tumors. But at least three other surveys foiled to show a connection between oral contraceptives and breast cancer. Drugs used to prevent rejection of organ transplants by suppressing the immune response have also been found to cause cancer. Among more than 6,000 kidney-transplant recipients, the risk of lymphatic cancer was found to be 35 times greater than normal. Ofconcern to some experts is the fact that one such drug, methotrexate, is being prescribed for the treatment ofsevere psoriasis. 3. RADIATION here is no question that X-rays and Tsimilar forms ofradiation can cause leukemia and other forms ofcancer ifreceived in high doses. Survivors ofthe Hiroshima and Nagasaki atomic blasts have shown a significantly higher than average incidence ofleukemia, as well as ofcancers ofthe breast; bowel and brain. Recently, it has been found that those treated with radiation in childhood for tonsilitis, enlarged thymus glands and other condition* during the 1940s and 1950s have an increased risk of thyroid cancers. What is not clear. Is how much risk there may be from exposure to conventional diagnostic X-rays. According to Lome Houten ofRoswell Park Memorial Institute, Buffalo, N.Y. the amount of radiation from a single's,^ abdominal X-ray increases the risk of leukemia. One rad (the standard unit of dosage) of radiation, says Houten, ages the cells it strikes by one year. Thus, a 50year-old man who has received 10 rads has the susceptibility of nonlymphatic leukemia--a form of the disease that strikes adults--ofa 60-year-old. In addi tion, irradiation ofmen and women dur ingtheir reproductive years increases the likelihood that their offspring will devel op leukemia. On the basis ofthese obser vations, Houten thinks that noone should undergo routine screening X-rays--in cluding mammography to detect breast cancer--below the age of 50. An excep tion, in his view, would be a woman with a family history ofbreast cancer. But other cancer experts disagree. Dr. Luther Brady of Hahnemann Medical College, for one, disputes Houtcn's cor relation between diagnostic X-rays and leukemia. "1 don't think anylkxiy has confirmed that 1 rad increases the risk of leukemia." he says. E. Cuyler Hammond f* also disagrees with Houtcn's feeling almut mammography. "The benefit ex- Ol cecds the risk," says Hammond, "il it is a orisk at all." Ultraviolet radiation from the sun increases the risk ofskin c;utccr. A committec ofthe National Academy of Science ^ recently estimated that among whit persons living along the 40th pamllcK 66 Newsweek BFG21667