Document mbbV6ZDVjVoKo83GYdKVnqdMZ

JC lr2 INTERNAL CORRESPONDENCE METALS DIVISION To (Name) Division Location Messrs. F. L. Dedrickson J. F. Frost L. A. Wright Copy to Messrs. W. B. DeAtley F. J. Shortsleeve W. C. Thurber P.0. BOX 1029. GRAND JUNCTION. COLORAOO 8150; (3031 245 3700 Date February 13, 1980 Originating Deot. Answering letter dote SuDlCCt ;' 0 w * * RECEIVED FEB 1 S '-** V I believe you will find the attached articles regarding the causes of cancer to be informative. Dr. Demopoulos' article in particular provides an insight that has application to our own personal lives. Very truly yours, 0JM:gt Enel. // (/ ^7 /*' 0. J. Malacarne AMERICAN INDUSTRIAL HEALTH COUNCIL, INC. 1075 CENTRAL PARK AVENUE SCARSDALE. NEW YORK 10533 (914) 725-1492 October 25, 1979 TO: ALL AIHC MEMBERS ' CANCER CAUSATION received OCT 2 9 1979 T. W. CARMOOY FILE: 1 YR.------PERMANENT __ Gentlemen: At a meeting of the Synthetic Organic Chemical Manufacturers Association earlier this month. Or. Harry Demopoulos of the New York University Medical Center discussed in seme detail a number of important issues relating to cancer causation in theJJni.ted.States------- ---- ----------- ------------------------ ----*' We believe his talk is especially noteworthy in that it reflects the_ thinking of much of the independent scientific community with regard to misfocusad Federal efforts directed primarily at suspected industrial carcinogens in the workplace and environment. As Dr. Demopoulos points out in his talk: "University medical scientists...are absolutely enraged at what the Federal government has been doing. The rage stems from the fact that if we are to listen to the Federal government, we will be led down yet another primrose path, blaming industry and air and water pollution for most of the cancer burden, whereas, in fact, the answers to cancer lie elsewhere and have been very well defined through a lot of epidemiological research." We believe this speech is an important one and should receive the widesz >, possible circulation. Additional copies are available from our office. J -SfrTcers`177 Ronald A. Lang Executive Directo1 Enel. P.S. Also enclosed for your information is a reprint of a recent article from Science Magazine in which Dr. John Hiaginscn of the International Agency for Research on Cancer also discusses cancer causation. WASHINGTON OFFICE: 1612 K STREET. N. W,, WASHINGTON, D. C. 20006 (202) 659-0060 ENVIRONMENTALLY INDUCED CANCER...SEPARATING TRUTH FROM MYTH A Talk 3y Dr. Harry Cemopoulas Associate Professor of Pathology, New York University Medical Cent to the Synthetic Organic Chemical Manufaccurars Association, Inc. October 4, 1979 Hasbrouck Heights, N.J. 1- - I appreciate the opportunity to come here and address you. I welcome it very much. It is probably appropriate that this meeting is being held in New Jersey because I think many problems that have beset industry with respect to regulations are founded in some of the misconceived problems that have been painted in New Jersey. When I came hers in 1976, on a leave of absence, the Federal government had just released the National Cancer Institute (N.C.I.) mortality study by county that was conducted by looking at death certificates from 1950 to 1969; several N.C.I. epidemiologists, as well as members of the New Jersey Department of Environmental Protection, and Department of Health, concluded that after adding up the agecorrected, race-and sex-corrected death data, that New Jersey led all the other states in cancer deaths for white males, expressed per 100,000. Now, that was, indeed, a true statement. That was not a lie. The cancer rates in New Jersey were 205 white male cancer deaths per 100,000 versus the U.S. national average of 174 per 100,000. That created a big hullabaloo. It gave this state the label of "Cancer Alley." Some of the people who were in the New Jersey Department of Environ mental Protection at that time have subsequently moved to Washington and have continued to amplify this attitude. I must admit when I came to New Jersey, I shared the view that most New York City dwellers have, that New Jersey is a terrible place, it's horribly polluted. As a matter of fact, on February 16th of this year the New York Times published a map which was sort of the ultimate view that New York City dwellers have. It showed lung cancer rates in various parts of New York City, Staten Island, on the west side of Manhattan, and parts of 3rooklyn. The New York City Department of Health blamed polluted air wafting over the river into the city as the cause of these high cancer rates. The report ignored the fact, easily seen on the map, that there vast "skip" araas.and other cancer "hot spots" that were not in the path of such air flews. The New York City Department of Health report ignored rudimentary epidemiologic methods such as correcting all the data for sax and race. Further, no attempt was made to study cigarette consumption patterns. Ignored in all of these pronouncements and maps at the federal, state and city levels was the old scientific dictum of controls. This is what differentiates science from politics. When you look back at one cancer rates that were published and resulted in New Jersey being labeled "Cancer Alley," nobody mentioned the fact that Rhode Island was number two, with 203 cancer deaths per 100,000. No one mentioned that other heavily industrial ized. states did not have high cancer rates. When industry was being blamed in New Jersey, nobody looked at the cancer rates in Pennsylvania and Ohio which are remarkably similar to New Jersey, in terms of the proportion of workers who work in "dangerous" occupations and the number of people who live in communities that are in proximity to major industrial plants that can be viewed by some as polluting. Pennsylvania, Ohio and New Jersey have several things in common. About 40 percent of the workforce is engaged in what you would call heavy, "dirty" industry. Forty percent of the population in those states lives in proximity to so-called "dirty" plants. When you look at the cancer rates, however, Pennsylvania and Ohio have cancer rates that are like the U.S. national average. Yet, only New Jersey had higher cancer rates. The answer as to what is different about New Jersey is found very simply in the U.S. census. New Jersey has the most urbanized population; 90 percent of the population is urbanized and it also has the most dense urbanization. Only 70 percent of Ohio and Pennsylvania are urbanized. That 20 percent difference explains the difference in the cancer rates among the three states. 3efore it became politically popular to blame industry, the National Cancer Institute epidemiologists showed un equivocally that urban crowding was a predominant factor in cancer causation. It is clearly a surrogate for something else. New Jersey nas a rather small land mass 2- - and ovar 0 percent of the people are crowded into a rather small area in the north east part of the state. It is therefore,1 ike a large city and if you compare it to similar demographic areas, with equivalent land and population density, and lock at it in a controlled way, it is shocking to see that many other cities and counties and regions that-^do not have any industry have higher cancer rates than New Jersey. For example, SaririFrancisco; Washington, O.C.; Nassau County, which is an eastern suburb of New York City; Westchester County; these demographic areas have rates that are equal to or greater than New Jersey's, and those areas are devoid of heavy,polluting industry. If you look at other questions beyond urbanization and ask what are the surrogate factors, the ecologists would say, well, it`s urban air pollution, and it's still ultimately being derived from industry. Well, we tested that hypothesis. The hypothesis was that pollutants in the air and in the water are responsi ble for increasing the cancer rates by at least 25 to 30 percent. In order to test that hypothesis, we simply looked at the National Cancer Institues's own Third National Cancer Survey which surveyed 20 million people in this country, back in 1969, -70, and -71. Now, that was incidence data and as I said, it covered 20 million people. Our studies incidentally were conducted with the sole support of a grant from the National Cancer Institute when I served as the Director of the Cancer Institute of New Jersey in 1976. The diagnoses were far more accurate than the death certificates in the N.C.I.'s mortality study because these were surgical pathology specimens. The slides were all read by 3oard Certified pathologists. In that Third National Cancer Survey, there was a wealth of information and it was not originally designed to answer this hypothesis, but it came out that way. There were seven cities in that survey. Four of them were what we would call"clean" cities; San Francisco, Dallas, Minneapolis and Atlanta. They are urban centers without any kind of heavy industry. In that survey also were Detroit, Pittsburgh and Birmingham, the "Pittsourgh of the South." Those seven cities encompassed 16 million people. We did not massage the data; we simply lifted it cut of the tables and put the data next to each other and if the hypothesis was correct that industrial air pollution or urban air pollution were a major factor in cancer causation, we would have expected to have seen that four "clean" cities had lower cancer rates than the three "dirty"cities. We looked at overall cancer rates for white males as well as for black males, age-corrected, and to our surprise, the three " dirty" cities had an overall 8 percent lower cancer rate than the four`'claan" cities. I don't think the 8 percent is statistically significant, however, it invalidates the hypothesis. Furthermore, we looked at specific kinds of cancers that Blott, who is an NCI epidemiologist, and others have said are industry- types of cancers., like lung,, larynx, nasopharynx, stomach, lymphomas, leukemias, urinary bladder, liver and skin. These are all supposed to be in industry-associated types of cancers. The Third National Cancer Surve gave us site-specific cancer diagnosis, i.e., by an atcmic site. Those supposed industry-associated cancers were not higher or greater in incidence in the three "dirty" cities compared to the four "clean" cities. In Detroit, Pittsburgh and Birmingham,45 percent of the occupational workforce is engaged, and has been engaged for several decades, in industry that most people would say is worrisome. Further, these decades of exposure were without controls. And yet, we did not see greater cancer rates in these cities. A 45 percent workforce engaged in "dirty" industry translates into something like about 22 or 23 percent of the general population, whicn is a large enough percentage of the population to skew the data up higher if, in fact, these workers were being exposed to significant levels of carcinogenic hazards. This is the NCI's own data. We didn't manipulate it. And, curiously, in the OSHA hearings and in any discussions that I have ever held with people on the Federal level, nobody ever looks at the Third National Cancer Survey. It's almost -3- lifca their unwanted child because if you examine the data, within it is contained certain answers to questions that bedevil society, government, labor and industry. For example, there are questions raised about chronic Icw-cose exposures. Let's not worry just about the workers, what about the people in the communities? They are exposed to low-ccse emissions. What about the question of synergism, which is almost unanswerable in an experimental sense. The answers, again, to those questions, are found in the Third National Cancer Survey and the comparison of the three "dirty" cities with the four "clean" ones. Detroit, Pittsburgh and Birmingham have virtually every kind of pollutant chemical that you can imagine in the air and in the water. If synergism and chronic lcw-dcsa exposures were real hazards, and if, in fact, there were no thresholds,.we should have seen higher rates in those three "dirty" cities. They have been in "business" for several decades, and the chances existed. Now, there has to be a reason why we didn't see more of any type of cancer and the reason is as follows: There are thresholds. There is a threshold for virtually every substance that is noxious to mankind. There are thresholds for deadly viruses. There are thresholds for bacteria, funci, anything that is noxious and harmful to humans generally has a threshold, and this includes carcinogens. Now, clearly the exposures, although seemingly horrendous in the three "dirty" cities, were well below threshold levels because there was no effect. call, the Third National Cancer Survey showed 3% less cancer in the "dirty" cities. Re Another thing to keep in mind is there is a real biological reason to explain thresholds. It is not a magical thing. We 'nave CNA repair mechanisms that are very efficient. Furthermore, most carcinogens and many toxic substances act by what we term free radical chemical mechanisms. There are endogenous anti-oxidants that we have evolved with over the eons that protect us against free radical pathology. These anti oxidants can be overwhelmed with excessive coses of a carcinogen, such as occurs in laboratory animals, but human exposures are not at these doses, and we have not been overwhelmed, not even in Detroit, Pittsburgh, or Birmingham. It should be noted that the Third National Cancer Survey was conducted from 1969-1971. The cancers diagnosed at that time were starting to develop curing the 1940's and 1950's. In those years, air/water pollutants Mere not controlled, as they are new. We have therefore gone through "worst-case" conditions in our industrializedurban centers, and nothing happened. Those who beat the drums of doom, as in recent books written by non-scientists, are clearly leading a march c'cwn the wrong path in cancer prevention.Abundant controls exist new, and most of them are needed; seme are not, however. Another thing that proves that there are thresnclds is the experience with cigarette smoke. Cigarettes of the high-tar variety are perhaps the most carcinogenic substance that mankind deals with in a routine manoer cn a mass basis. Yet, it has been well proven through smoking dog studies; that thresholds exist; dogs, in cidentally, love to smoke. Once they are trained, they jump right into the box and puff like mad. The threshold studies were conducted through smoking dog studies, as well as through careful autopsies on individuals where the smoking history was well recorded, and where the bronchi were serially sectioned and examined. If you smoke 10 to 15 of the 1 mg. tar cigarettes, there are no carcinogenic hazards associatec with that. We don't even see the premalignant chances in the epithelium; so that here is the most carcinogenic substance that is massiy used and there is, decidedly, a threshold. Similarly, there are thresholds with alcohol. Alconol and cigarette smoke are synergistic and together if you smoke the: high-tar cigarettes and drink excessive quantities of alcohol, you find that you can account for 35 percent of the cancer baatris. :ms type or synergism is nrs. .ioji o. w.. e cancers of the mouth, larynx, esophagus and lung are caused by these two rectors a nd they are synergistic. 3ut, again, it has to be with excessive quantities of dis tilled liquor. It's the alcohol itself, not the.congeners or other substances that a re found in the drink. hew, the%isconceptions that have been brewing, first in flew Jersey, and later in Washington, have aroused not only the ire of yoa fellows in industry but the ire of University medical scientists who are in the comprehensive and specialized cancer centers such as MIT, Harvard, NYU, Columbia, University of Pennsylvania, MoArdle Cancer Center, and others. We are upset at what the Federal government has been doing. Our worry stems from the fact that if society is to listen to the Federal government, it will be led down yet another primrose path, blaming industry, air and water pollution for most of the cancer burden, whereas, infact, the answers to cancer lie elsewhere and have been very well defined through a great deal of epi dsmologic research and extensive laboratory research. Whoever attempts to lead the nation towards less cancer had better be correct, because the selection of the wrong path is the equivalent of leading millions of Americans to certain death. There were two symposia that were held. One on February 23th, March 1st, and March 2nd and another one, June 6th,7th and 3th in New York City. These two symposia were held by the independent university scientists from the comprehensive and specialized cancer centers in this country. The symposia were under the aegis of the New York Academy of Sciences, and the American Health Foundation, with the coooeration of the American Cancer Society, as well as the World Health Organization's International Agency for research on Cancer. We came up with the following predominant causes of cancer, and the wor,d,"pre dominant," is important. An analogous, situation is that tuberculosis is predominantly caused by the tubercle bacillus- While there are associated factors in causing tuberculosis, for example, poverty, crowding, and malnutrition, the predominant cause is still the tubercle bacillusjand if you want to eliminate that disease,you control the tubercle bacillus. Similarly, in cancer, there are predominant causes. The University scientists decided to sponsor and attend these two symposia, and to continue putting on such symposia as often as is humanly possible, in order to turn around the propaganda machine that has been launched by the Federal government. This machine is leading the country down the wrong path in cancer prevention and is killing many Americans through misinformation. The University scientists just went through a 15-year period of going up a blind alley looking for cancer viruses that weren't there. That cost a billion dollars. We cannot afford, not in monetary tarms nor in human terms, to spend another ten years and another billion dollars or more chasing the wrong culprit in cancer causation. There will be too many lives lest, especially when we know most of the answers for prevention at the present time. While we are still ignorant about" exactly hew a normal cell becomes malignant, we do knew how to avoid situations that have such a transformation as the end result. The answers to cancer prevention are as follows. And it's easy to keep the scorecard in mind. There are about 1,000 people a day that die of cancer in this country. 350 of them, or 35 percent, are going to. die today from having smoked high-tar cigarettes and having consumed excessive quantities of distilled liquor anc they will die from cancer of the mouth, larynx, esophagus and lung. Another 45 percent are attributable tc diet, and this figure was courageously Sw^ed by Dr. Arthur Upton,the Director of th.e National Cancer Institute,on Tuesday,befor a Subcormrittee on Nutrition. He has confirmed what the University scientists have been saying for the past few years. No other government scientist has had the integrity to state what Or. Upton stated; he further and strongly reccrrcriended major decreases in fat consumption, with increases in fresh fruit and vegetable csnst-mpcicn. percent of cancer deaths art related to disordered nutrition. Under the category of disordered nutrition, there are four subcatagories: e.xcess^calcrie excess fat ingestion; obesity, carrying around an extra 20 or AOpounds; andnurti- tional deficiencies such as fiber deficiency and Vitamin A deficiency. ----- .Vow, with Vitamin A you have to be careful. There is an optimum dose which happens to be the Recommended Gaily Allowance. To_o_much 7itami n A wi11 also cause cancer in addition to'being toxic. Too little Vitamin A' wi11--aTso~cause-cancer. ~ There is approximately 5 percent, of cancers that are occupationally induced due to previous exposures 20,20 and 40 years ago when even the best scientists did not knew that many chemicals were capable of causing cancer. Recall that most un iversity scientists and government scientists were engaged in chasing viruses and it's only recently that the blind-alley virus theory was proven invalid. There is evidence that the 5 percent of cancer deaths that are due to occupational exposures may have plateaued and may be on the way dewn. If you look at hemangio sarcomas that are caused by vinyl chloride mcncmer exposure, the latency periods and the ages of the patients are longer end older, respectively. It means they are developing at slower rates. Similarly, we did a study at NYU shewing that mesotheliomas, which are caused by asbestos exposures, are at a plataau. We do not see an increasing incidence of mesotheliomas, despite the fact that most of the people that we see at the NYU Cancer Center, where we treat 4,000 r.ew cancer patients a year, are drawn from places like the Veteran's Administra tion and 2el levee Hospital, and includes a fair number of construction workers, and 3roaklyn Navy Shipyard workers. Our Cancer Center is a general one, and does not have a specialized referral component for mesothdiemes, as at Mt. Sinai Hospital; therefore, our rates are indicative of the general razes. We have not been seeing an increasing incidence in mesothelioma over the past 22 to IS years. It's at a plateau. So that I think if controls are kept over the very dangerous chemicals and physical processes that you use in industry, I think we can continue to see what looks like a decline in occupational cancer, which we think, is currently around 5 percent. Sir Richard Doll and others think it's much lower, but I would caution you that you cannot relax. The chemicals that you deal with in ever in creasing quantities to meet consumer demands and to try zo remain competitive in a ferocious world market are cancerous,and I think there are elements of truth to what the government regulators say; we can see a major explosion in industrially caused cancer if we do not have sensible controls. The question is, how rigid should the controls be? I think that we can be less rigid than what QSKA and EPA have proposed recently since there is clear evidence that there is no need for that kind of rigidity. Occupational carcinogens are under control, and new chemicals are receiving close scrutiny; air and water pollution are blameless in carcinogenesis. A few other points that I would like to make in closing are that in addition to determining that cigarettes and alcohol, disordered nutrition, and occupational exposures cause 85 percent of the cancer deaths, there is another 3 percent that are caused by exposure to radiation which is largely background, not nuclear plants, but background radiation. We have enough radioactive potassium in our bodies, for example, to cause 4tooo radioactive decays per minute. That adds up. Another 2 percent of the cancer deaths are caused by preexisting medical dis orders, like chronic ulcerative colitis, chronic gastritis and things like that. And about 1 percent are caused by prescription drugs for the treatment of serious medical disorders. The symposium in June also determined, and this was brought forth by Or. Cuyler Hammond of the American Cancer Society, that almost zero percent of cancer deaths, it's something like .00001 percent, are caused by air sollution. Water pollution is in the same category of zero percent. Gtr.ar stu dies have -hewn that nuclear pcv.ar plant accidents, asbestos in hair dryers*' asbest os in school roc.v.sv and saccharin/ cyclarr.aces cannot cause cancer as presently used. And yet, those things that are listed as bs.wg;-Z2ro percent are uppermost in th e public's .mind. This is cue to the prepagan^^machfnes. We are treated :o cutr agecus remarks by individuals like Wolfe from Ralph Nader's group that asbestos is the second leading causa of cancer deaths in .Tales in this country. It's an absolu tely unfounded statement that,by no stretch of even Sellikoff's i.T.aginaticn, caul d that be true. And yet, individuals like this are placed politically cn the National Cancer Advisory 3card and govern, and help to govern the National Cancer Institute 's policy. It is terrifying because our nation can be led down the wrong path in pr sve.nticn; So you have an uphill fight in terms of public relations but I think chatjif controls are kept, truth and reason are on your side and I think that you^can win this battle that you are in. Thank you. Q: I assure that the reason for the higher cancer rates in the cities is due to the factors- you described,.to re shaking, and so on. Dr. Demopoulos: And they have far more disordered nutrition. The urban crowding is a surrogate for all of the faetprs that we know to cause cancer and it is proven too, with animal studies. The reason is ultimately the kinds of stress chat you get 'when you start crowding any living organisms together. This has been well-defined with rat behavioral studies '.mere if you take a room of a given size and keep putting more and more rats in there, even though you provide them with enough food and water, and places to sleep and rest, you will see back biting, tail biting, homosexuality, fighting and all the other things that you see in urban set tings. In medical schools, we are taught that certain diseases are urban diseases, i.e., they occur more frequently in urban areas, "or oxamole, obesity, hypertension, chronic ulcerative diseases of the GI tract (the gastrointestinal tract), heart disease , suicide, homicide, drug addiction, are ail far more carman in urban settings This includes the cities and their surrounding suburbs. New, I think to that list should be added cancer. And I don't think it's stress per se, but rather it's the way humans choose to relieve their stress, through gorging themselves, drinking themselves into oblivion, and surrounding themselves with smoke, that cause cancer. Q: I understood that in other parts of the world that different types of cancers occur. Dr. Demopoulos: Well, there are seme interesting reoorts that have come from China just recently. There are regions of China that have extraordinary rates of esophageal cancer, for example. Even their chickens have esophageal cancer. 3ut, that has bear- traced to the particular kind of food that these individuals make, they apparently take various kinds of vegetables and peel them and let them sit around for months and months and finally they eat that and their chickens eat the same scraps. There are other situations,where there has been a good deal of epidemiologic research done on the nutritional habits of people in correlating it with diseases, and it keeps coming back to what we eat that causes cancer. And, this is true also for atherosclerosis as well as premature aging. For example', there are tribes in Africa that make a habit of eating raw meat and blood together with milk and this is all they eat.They don't eat any fruits and vegetables. Their life expectancy is about 30 to 35 years of ace. They die of heart disease, strokes, hypertension and cancer. And it's the worldwide studies that have been the strongest implicators of diet as a predominant cause of cancer. Q: In your listing of causes, it seems to me that you came up with about 91 percent. Where is the other 9 percent? Dr. Oemopoulos: God. I think that we are not irnnortal and we have to accept -/ - certain tilings. I tni;:!< it's pert of ".he aging ? cess. Almost every ::.ala over the ace of 35, at autopsy, has cancer of ah.3 pro < " aca gland, if the pr state eland is adequately examined. These cancers are ic:*oscop;c and produce r.o sy aptc. s. Similarly, urinary bladder cancer is a cancer of he aged. It keeps climbing as you cat into-the SO and 90 year oid brockets. I hink it's an accompaniment co age and Dr. Handler, the President of the Net r.al Academy of Sciences, lies offered the hypothesis that oxygen, ar.e of tire csir a coxic jades known is responsible. Oxygen happens to be a diradical, t oxidates everything, including our lipids and I am sort of surprised, as a free r adical pathologist, that we can exist with oxygen. I wouldn't have cbcsc-.n it. thane would have been better. But, Dr. Handler has proposed that simply existing in an -aerobic atmosphere is cause enough to give us cancer, and wara it not for the major antioxidants tnat we have, we would have even more diseases. The c-cline in cancer of the stomach is appropriate to mention at this point in that regard. Cancer of the stomach used to be the commonest cancer killer in this country 40 and 50 years aco. Nowadays, it's a rare disease. In medical centers,we keep these cases extra days as teaching cases because medical students will never see another one like it in their career. The reason for the decline in stomach cancer is the increased consumption of fresh fruits and vegetables and the antioxidants therein. 3HT has probably helped. Dr. Arthur Upton concurs in this view, as do many University scientists. Q: Dees a significant segment of the scientific community, people working in cancer causation, feel the same way you do about the proolam? From ycur view, 'why is it that these scientific arguments abcut what industry is doing are presented by people like Wolfe, Epstein and 3arry Commoner? Why don't we ever hear from these people wio have spent their lives actually doing the research? Cr. Camopoulcs: A good reason is that Univ;r~iay medical scientists do not have a PR or propaganda machine, nor do they have a policy that they are trying to advocate, it's one of the defects of science.in general, that unless there is an organized effort to get the truth out of the medical journals wherein it is buried, you are going to have misconceptions, as we have new. I think the reasons for the origins of the misconception lie in the fact that as we prove the lack of validity of the virus hypothesis, there -was a void. Zvzr/zccy asked, -well, if it's not viruses, what is it? Unfortunately, the term "environmental cancer" came into being. That was seized as meaning the general community environment rather than the personal environment created by our habits, diet and lifestyle. There was a void, a cap, before the nutritional data was gathered epidemiologically and frem animal studies. We new knew what the predominant causes of cancer are but.at the time the virus theory was shown to be invalid, the "greenies" and the ecology people came into the picture and stole center stage and they are still at it and they are holding onto it ccme. hell or high water. They seem oblivious to the consequences of leading a march in cancer prevention-down the wrong path. Q: As a taxpayer who was able to pay for tearing the asbestos cut of all of the schools and other public buildings, I am gratified that you don't seem to think that's a terribly important factor. ^Brs-C=mopoulos: I think it's a tragic misconception and it's the height of vl-ocracy ^nd stupidity to see classrooms being torn apart. This recently happened in-New-ftrfk City where pretty close to half a million collars were spent redoing the whole school because of the asbestos scare. Somebody had gene in and sampled the air only in the classrooms and found asbestos there. The conclusion was that it was coming from the ceiling. They tore everything down and they went back and they sampled the air again. They found just as much asbestos. Then,and only then, did they go out and do what is called the control. They went to the outside air and sampled it several blocks away and they found even more asbestos in the outside air. The point is, asbestos is a natural product, it's all over the place. We use it . 5_ ':xz \r.z i valy in \.i b '.n ';acting3 , brake i *i r. js , :r.3t.";c " an, -vary;.,; '.q. :'.e coins is that the loses we get in school rooms one office buildirgs ore far below any kind of dancer level,yet within these come classrooms we cove smoking lernges. As the M.Y.U.- study has shown, we are not seeing in Je-r.ic of mescoho: lomas. If ycu go into the cafeterias end watch rut one < os ret, it's garmge, es fer as I am cercerned. '.coded with ret. ,'!o rres.i r. iios *r.d veceteo i os, ar.d these are wrong. It's as stupid -es Vinsn a cigarette otmeany used to advertise high-tar cigarettes as being geed for ycur :`T-zcne.'' Q: Is there any really definitive data cn the effect of the so-called social drugs like marijuana? Or. Oemcpculos: They haven't been used long enough nor in any good epidemiologic studies but just locking at tetrahydrocannabinol, that's a toxic substance. That will damage cell membranes and will damage C.'iA, so will LSD; so will most of these so-called recreational drugs. I think they era fearsome and they really should ce controlled for a variety cf reasons, inducing chair carcinogenic and muc-genic potential as well as the fact that they absolutely destroy nerve calls. The reason for producing a "high" is a lot of r.erve cells are just getting disconnected. The synapses are missing so that you .no lancer have the major inhibitions that are inherent in the electrical circuits in the brain that keep us under control. T don't mean moral inhibitions, I mean the ability to be able to focus on one thing at a time, to concentrate. The brain functions by blotting out everything else except -what ycu are supposed to pay attention to. The reason ycu gat a "high" and start seeing visions with LSD and mescaline is that a lot of circuits are disconnected and you can no longer focus on any one thing; virtually every circuit in your brain has been turned cn end is short circuiting. These drugs are very dangerous, whenever ycu start damaging call membranes like that, you damage a lot of call control mechanisms and open the way to birth defects, cancer and every other chronic disease, including aging. Q: In cur cc,--unity we neve had seme questions abcut asbasccs cement water pipes. Is there any problem? Dr. Cemcpoulos: I think in specific instances, ycu would have to sample water like that. Ycu would have to lock at it. I don't doubt that in occasional circum stances it is quite possible to carry carcinogenic loacs cf a chemical substance through the air and chrcugh the water, but I think they are unusual; where there are questions,I think you should take a lock and sae what the concentration is. The dose is all important, for sure. If it's a lew dose, I wouldn't worry about it. Q: Thera are numerous problems that you have mentioned in your discussion relative to society's view of the cancer situation, Humber one, you have tne terror factor, the fact that people are more afraid of cancer than thay are of heart disease. What, in your opinion, can communities, can we as concerned people, many of us, do to offset that view? Dr. Oemcpoulos: Well, I think you have already done one thing as industry groups, and that is, I think, coordinated programs as AIHC has carried out on behalf of industry are very important. You must be unswerving in the pursuit of truth, it's good business. T was shocked and amazed back in 2976 when I came hers to direct the Cancar Institute in Hew Jersey. The press and the Department of Environmental Protection in Trenton were literally tearing industry apart. I always thought that you fellows were really hot stuff and would have answered back and I was surprised that industry was just laying back being beaten up. There was no response. I onivorjity i by, you will cr'juli -ond society, '.'e hive !:: to stood up end bo cad sr.d ?Jecicnil Cincar Ir.s . i; uc.i from orint appT icaticns; :;cro /."j :s J -O l i .ns : / < ;/ ::1 r ' . -I j ; .< 3 :y .ltists > r j sr.a ::s :r s' 'j In you :r.S .Vt- cidtnce nf credit types ci.ncrs tillin'ny clucks irt Africa mid A<-'t i .c~l tied concluded diet about r.va-thirdx of cil concurs had tin ciTviruniiier.td cense end ...-err therefore throrcticdly prcve.ctcble. 77-nt is i : _c.tor.able iumn-.try. Cr.cs Oc;-Ji zed f obtained reed scatisiics from African black populations. -c were able '.-j calculate a theoretical cartcapt of what the low incidence of cnnr.-r cauid be. end any increased incidence cauid then be considered due to an environ ments! carrrponent. Actuary, the !d--a tc at. ;eouraphical differe-nces in err.err to-d- der.ee ere due to the er.v iron rectat aa_-s beck tre-ny veers before that. David Liv- t. rd :t i. A !*: i f ra.-.f i n has -L .; in :r./s 1. ..r-.: most p-.-acie havvr r.ot -j-jnc h.-ck to the err./ iitrte- cure. but leave used the word environ ment purely to mean chemicals. So. (feci, your conclusions rove been ir.i;:r.:c.yrr:.:d cil tiiinrj/ They have- bean misinterpreted. fc.t- r.iiy msu;h. r.ct .--..-.ung the mr.jortiy of the ; demists with whom 1 have car. taco, but by the chemical carctaPjen :c-apie . . j vc -a rc a ur r.. :rc < themv.:vv e-i an obvious miyieir t.en cf tunny human cancers. During the ITcO's. 15^0`s. and !';fO"s. ir.cuetry bad :ho-"n a gram deal cf injer.citivity to potential dangers in the - aivnr.op. ar.d in -.-.awiilirgncas to at tack cancer hnaaras. aaaccactsd with thechanging political all mate am.cr.v ;a;eadets and poiiticeaas and environmental oreesura groups. made it easy to place cfc;vi!i~:cn. er.d therefore the-idea thrx the ditfcrancas err eavlrur.rt: -.ntrl hnp a long history. My cartrtbucicn. ,f I --ty ay so. was limited tr.ereiy to giving a mere concrete cetimata of the impact of environmental factors, and to show that most cancers were r.ot due to genetic factors and thus that p.-evration -vis r.cc impossible. I ou-gat to make that clear because people arc giving me credit where it is net due. Hut when t used the term environment in these days. I was considering thereto/ environment, cultural as v.eil is chem ical. 3y cultural. I meant mode cf life. When we ran that study of blacks iniy3I'. we started looking at their diets, how they lived, .thileumber of children they had. the ige&menopause. the age The idea cf life--tyle was -ocily ar.o iildert.-.ed and not espressuale in ciccr.emical terms with the icchr.oicgy avaoiabie. Most scientists, myself included, den t like something woolly. Two. there was of menarche--all that was included in considerable -meres: in explaining hu the term environment. f`ve checked it in man cancer in terms cf virology. ;0 ;nat every dictiur.ary and every dictionary gives the -.time: environment is what surrounds people and impinges on them. The air you breathe, the culture you live in. the aericultural habits of your com munity. the social cultural habits, the so cial pressures, the physical chemicals with which you come in contact, the chemical carcirogenesis became -jr.fasnionuble. Tr.e textbooks of the !9:0'> tnus largely discussed occupational cancers which could be eomirmed by nice, dis tinct. end easy animal models. Sachs! Carson s book was a w-ntcrsned. us suitder.ly c became aware of the vast -auun ities ot new chemicals, pollutants, pesti- SCENCt. vot_ :0J. IS tSErTEMSEA ivr* oo!v;i-rM:j.i;4;joo.r.' o :he responiiatiity for nit environmental cancers on Ireus try. The environment thus became ider.tif.ed only with indus- t.mai chemicals. Even tocaceo was r.e- giecteu. This interaction cf scientific end octal hypotheses prevented wider arc - ogrition of the fact that many cancers canid not be erpiair.ed S3 simeiy. There's one other thin? I should say mat has led to the association of the term environment wim chemical carcinogens. The ecological movement. 1 suspect, found the extreme view convenient tte- cause of the fear of cancer. If they ccuid po-sibiy make people relieve that cancer w ^AA$. i:u ! a:i-----r- b.r.- i-arai putta:.!. .`..vJ :f J'tu t-ub.: tba-a V :f I--ling wbh .>. c 1 3 >;f female czr.crr?. braca- '.cb --r- :-.;ch in the United Slates and most .'rl-rs :cn:i.-.i for JO percent cf fa il.: i to-cnis nr.e- r:d c'..:pl't. ' r.-jrzl'.zi -ith that !; :i.~ 'l.-t -C Sail wk.-.'.-aS 1.1 ; t- :-_.ms. . . . The r-j of m.-.min the Ivan f.mria. f>.r pi*. I. J extent ivvly. V/..- e.-a l-.r.v:.. : :!- bran b--..g'nni;.-g:c have ::.e:V n-nn--h.e as early as 10 or ! I in portions ci :hu wcrid. oc-.prred to ica where it is often as 'i:c as IS. Ti:-t ;ii:Tcrcncc is probably ro- ` nri to dietary factors. Fer years have talked ::host a;: improving tflat. roll er p-.-ople. better p.-cpit. but this arto- naticaily leads to raodirloaaiar.3. far ex ample. of the p:iult-_ry axis. There changes themselves. ansceiated. w ith ce- laiof patterns. may :!a in together to -a-:::'/ the *a?^r::a.!:ty af an imaivid- eal. Cic: is ot.dcr uiv ir-- .rta 1 contra!, the behavioral patten is under environ mental conirci. so thists what 1 mean by environment. But as yea ter. it's a high ly an.maiex system. JerJImg -.th hta- ..so.-.s. ar.d -re fore .vn': -v :;.l me d eli. Arc :hcrc miy '.itida a.;;::'. goer Je- huvinn in men.' The mm arc fanny, you scm. . . . Thc- a-V'in of careers you -:eld r:r;-.i-.::a :o ! i 1 r for mi .a :i. a;-.a tcircccaj is :..wh smaller. if;a major scorers arc stomach. large intestine, and prostate. Now people have gone around Trying to prove that sc.vaai aedvity is re- iaic-J to prostatic cancer--frustrated sca- aal r;!a::or.sh?ss. and to forth. 3i:t. to date, r.ohndy has come up with a reason able solution. Now let's take prostate cancer in three groups of males. Japa nese. U.S. whiles, inti U.S. bioexs. \V< H coll the Janunese prostalie oancer incidence one. The incidence in L'.S. Whites would be about JO and in U.S. blacks, ho. You look it that ir.d there's r.o way you can possibly explain that ort exposure to air pollution, dirfusc dietary pollution, or anything like th=t. it is just rdicuious to try to do so. If. however, we look for -.vnat we coll latent carctnoma. -ve find that, in the United States, about 10 percent of ail men of 75 have a latent cancer sitting in their nrosrutes. And it > almost the same. 10 percent, in JuDan and Germany. So t 3m -y - : -J : this. :-3 c..a it ci J: t;..i... > .'.-/r.x.l ci thing ia :j :c C .1C. . --:ra thaa gcaj '.c-,c*Vk I. -td i;iah :!-.d :ama';v-iy I t t`: : B~-ar.i. r.r tl.c. lag that I *S ..a.t- ASc f-mcra--the an.cunt of N't. the amount cc fiber, ar.d so on. V.'e ;ay '.*.< cf hb -r is a risk factor for colon ccaccr. ;;c*w la the world can you r y laax cf c Is a car:ir.ogen? It's a rtdicalcc*. "t> ;::u - culd -.-ter to "the tarot ca.r;a.:;.a.'c tick footer, it It arret the cr.ly a: tsar/ ihi.-.g t.'tere Is that has, stood up fer JO years. But fats, pratr-.n. carb-ir/drate. v egetab he i.thibitcrs may abn : r Intprraat- alt.fi --r:h :s :.a thl' tsv .- .'. ^ "* ' t . ` : a- *t ;.o- *. ''iic--/ should ' -r h-.i 'th ri;sf cad jtt'-t fan't h.v.'.-a :!;e caewrrj. Thm ;:::y aht.-.g 1 con say is rrducu calories d :r\:-A . aaa; ;iy . j - -.: ra.*p.-..r. '.tut a.y arc ,-.t.-.a os to v.;i :.-np.:s. '.imply den t Vr.cw cr.cu.ph at the present time In many arms to advise ir;- islation or .narked changes of life-style, if you take Ccp.r.hagan. fer examcie. i.rr-o -.ric.T career is four 3 :rc m.v.a.n l.t Cap .rhegrn than in rlnfond. Yet both populations drtve cars ar.d iive exceedingly well. But there are significant dietary ditTcrences. So ycu mteht say. let's tell the Canes to cat the rr.h'h :yp-; cf >I;=e. But then you find that the rir.r.s have the highest rate cf heart disease in aura:;, ar.d prcbaciy in the world, so what they're gaining on the swings they're losing on the round abouts. One has to be tembly cautious. In my opinion, cf making zdvocattcn. Now you take urban ora rural Ccrraurc. People have said that breast and talon cancer are related to fat intake. '.Veil, when we compare urtran Copenhagon and rural Denmark, we and that the in cidence of cancer of the breast is Signer in the urban area .... but they eat much more fat in the rural area. ;0 per cent more. It s pane contrary to the hy pothesis. There is obviously something in the way they live in the rural area compared to (he (own that hasn't been ' ; ;' .'.-.s': y,-.-.-.- !Y i -:fo.m.. .r !" i : ' 'la't -- n :n Imply -hat .*.: f.- :. f thick it tetuoily of-r: a . f p.Ti.rb-l I. a.'-dl It. . x. :a d. J'.:. '/ - ; .a!:, .ats r.mal. ed la :.-rcos cf r.ariraal tar .r.-a-s. - itheut Letter tv.pec.ctvc aa. (In th..: her h atd. if cancers c:'d;a tltr.r.tive system or eadc-crlr.e-dspe.-.csat systraas are eveataaiiy raiated to ;b*sstyle. It sheuid act aatcraaaically be as sumed that car.cal of tbeeei wiii be Imparcible. t'aitn cbu:''.: aly. Crnyruirs can't ': .pls' ttc a.n rr..ty fart pro.--ar.cy to pretrer ag.u'nst breast caacer. but there is a good por.ribtiity that -e may be aale to mbrric It with ,i pfd when we-know about the b .:--hamical carats. Already there is tvi' .are that ..cr.aacepttv-m may .-abaca .; : r. . raas !.;-.lca: in f-.c brresr. J a a ~ are also tv. o iccurts iablaattag that acattaceptives cr.tcct aaamst ovarian ;ar.cer by i.-.hfatting avuiat-.an. I am cpt;m;s- that oace we have i better uacar. -r.sis ; cf'h ; r..-c.beair.m.c i-vclve-a .-.-d ,-i . ian to bab.avicr and .tubhtttaal patterns, cut ;nly may it be possible to Intervene with some success but aiso to identify ir.cividuals at high risk. Inter vention cf this type is already being cc.cdde.-ah I :s ca;le-i chempprev.er.t:cn. i ca.r.par.:;v hy :;e w acpm.ich to center control. However, the real reason ! in opti mistic is that in a wider ir.tellceruoi cli mate some scientists are no longer think ing in terms of simple carcinogens, muta gens. and initiation, but are developing l new sophisticated approach to stucy oil complex mechanisms involved in multi stage carcinogenesis. This is largely thanks to the work of Berenblum. even if in many circles this aoprcaon remains jnfashiorvuble. Lastly, -c do knew that there ore populations with low freeurnctes of these cancers: thus, the Japanese have a very low frepuency of breast can cer and the Finns have only a quarter of the coion cancer inctdence in the United States. Once we con explain these differ- ences at a more fundamental level. ! int confident that -e will be able to take ac tive measures to reduce this large grout* of cancers due to life--tyie in countries of hign incidence. sctSNCe. vot_ :ai r !iL;i ii 2 ; ! ! -r o T1 liU\ `-w it i H - ' Ml UI .'t"' *!- ! O I I :j - 4 :3 -i: .M i.t <\;nerri cruii4 =r-_ [. ;--n H'r'-'1'1 beet at--fer the prepornea cf er.-.-cere mm:h-:t_.b:e 13 various czaz^a. The r-vuive impcreeace cf aid (3) --fid. i.hav.crci or cuiucmi par-eree (O u: life-.rylc ere aniy very --rot: eesuerire. v33 going 10 .'.-veil trci.t p-.'liu-i n. ;..:3 v.O'jj'i .ina'sh: them lo fachitaro tiro aluars- o? of -voter, of the oir. or wanti;1/cr it -Z3. Nov/ I'm oil for deemin g up the air. and oil fer dramin; up treat streams. and oil for preventing Lave Cinda. but [ don't thins iiroui.'-roe the 'ron ; or- gutncr.t fer if. '.\> career the- -/-htppir'5 boy for y ire.-'---umi evil may proven: ettrotiv.e action '-.ben i: cices .Tatter, as wiih evgarettrs. I '.bins '.bat many p-.-ccie b.-.a a gut f-.-i'r.g that pciieiion :ugh: :o ro.ro _ -- You asked tr.e. were people dLshcn-ca:'., I den't ibir.ic that so --c prop!: in tentionally dishonest. bat rather that :b;y found it hur-i :o oca--t that general air pollution. i.ayvi.13 factory chimneys, and :be iixe are ant iho r.ujor ro.mes of cancer. I mean. peopic would love :o be ohlo :o prove (not cancer is da: to pollu tion cr the general environment. It would b: so easy to be abie to tiy '`!et as regu late ever/thinp to core exposure and we nave no mere cancer.'" The conceal is so. beouttfol that it wiil overw.-icim a .r-aas of facts to the contrary. You mean there is no relationship whatever between pollution tir.tl cancer? No. The dangers of point-scum: pollu tion are well recognized. But you canr.ct explain much cf existing cancer patterns only in terms of simDie general pciiution by industrial chemicals in low doses. You can't expiain why Geneva, a non- indusmaJ city. has more cancer than Bir- minpnom in the polluted central valleys of Breland. In the United States, repens ore coming oat that there are few dif ferences in cancer patterns between the so-tailed u'ir.y and clean cities. In fact, the only thing you can say is that air pol lution may. ana ( emphasize MAY. in crease lung cancer in cigarette tm.oiters. I'M Tbea-o aad rob-V midciaicloyicai dis- or.--aacies pi.rpiy . enact be explained by v.ehaticns ia general poiiaticn. Some y- however, be explained by dittcr- emcoo ia iifi-.tyle. In caber -erds. 1 beiievs that tv ..-a to bra is on cbeT.irai aarotno- - too has :'::c;r -i ?-:r approach to :ha enviro .-.-tal to -cry for many mL'.rom. I'rt ..ut ; roe :.Imuida''. .-lean up the ei-.vlreruner.:: of mm me you ahead. iiy. jm.t tb: timplistic mcprcro.-.l brs idea that :b-.rr::ay be boros of ....a.r.ogoas which, for practical purpoeen. are urur.portnat. if you consider iT.cxar.g pius aebeotos cr arexing pius cranium, these combinaaocs lead to mere lung car. rtrrs -everyti :y t.-.c-.v*. Hot the carobary. :h:n. tnoz i.raoi bits cf S3 cifferont caroinogens cad op to produce a cancer--there are stmpiy no eeptrimeatai cr human data, that this is the case. Ccroainly 1 used to brieve this my seif, and I spent t.any e.-.-s in the labcrotary too icing for sur-cale e.-.p or; mental medeis to study combinations cf chemieoii-- with little iucoees. Mcst worx has been carried out at relatively hjgn bases and models are more often additive rather than maidelicative. roar.herrore. tome carcinogens ever, inhibit the action cf others. The taister.oe of norenfee: doses of carcinogens has been very poorly ip. vestigated. and there is practically no re search on this subject apart from experi ments on two-stage carcinogenesis, whicti is 1 very di.Terent nor/. And. as 3erenblum has pointed out. we are prob ably being exposed to so many carcino gens ail the time that what haocens is mostly ir.eorr.alets at :he target-cel! lev el: the cells Jie ar.d nothing ever hap pens. 3ecause ycu and I walk across the ore exp-ro ,d to vindiobf. 'ich ii \ ' '-i!-i-n-.:egabard enrainsgrn. but vwr may cnly deveicp oce sbt'a mtacor in a lifetime, or even r.ar.e .... despite the thc-aaonds cr mulicr.s cr biiiiorrs cf ceils that have bars expo:.- : to tuniignt- Cniy a . ay ceil -- z- c.n to a cor.ear. So it r.-.y tb.ri aero er.p ;-,u.-c is cut. roam :ai rpidemicicgiaal vi-. vp-si.-.t. [ bsiisve .bn: attempts to prevent most taaners throu-p ran.mol cniy c: mutagens and rorai.-.cgens wrj prove to be 1 aiaap- .. :l:t:;.v; roach, as Ail ca.tsanrroaicn ;.:[/ ;n the inibaaion phase cf .aa.-.t- genseis. a.esocroh shceu'd be ai.-rctrl to caber possible factors. Teat's the mes sage which I feel is the adecuat: ium- .rc'cy cf the dam. cf the last 30 years. r-.yon-f c- :.e/ ar.d tcbccaa. -.or.aj do ,`cu rorer.:c:t i.-nscran: c;.n- -cr.rr.rs cf '.ife-iC/le? T wo. die: and behavior. Whas type: of behavior? Can I just explain what I mean by be havior in a 'irr.pie tense. Brian McMa hon and eaeer peceie showed, far ex ample. that if a woman had her hrs: cas'd at on early age. she protected herself against breast concert if she had the child it a later age. there was a much greater cr.ar.c: cf cancer. Now we xr.ow that pregnancy leads to changes in the body .... but we don't c.-.cw what those are. and here: the biochemical ex* pression of the behavioral pattern is in- complete. Cn the other hand, the tsrns behavior, as "when I am going to have my ant baby." is a technically accurate ly expressed term which largely beaer.CS on the culture in which you live. Another example is the fact that sexual activity from an early age leads to a lot more can cer of the cervix. Why. we don't jet C.ii'-wJw fo*/ l.'MI scizscz. vou ::j