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Sunday, April 23, 2023

A new fight for prevention

The ravages of cancer 

GRACE VAN DEELEN in the New Lede

Marusic’s book will be published May 11.
About 600,000 people in the U.S. die of cancer each year, according to the National Cancer Institute. And rates of many types of cancer, including colon, breast, kidney, and thyroid cancer, are rising — especially among people under 50 years of age.

As President Biden resurrects his Cancer Moonshot program, aiming to cut the cancer death rate by 25%, a growing understanding that exposure to certain chemicals in the environment may also contribute to rising cancer rates has led to a new coalition of scientists and advocates working to alert the public and push regulators to protect people from carcinogens.

In her upcoming book, A New War on Cancer: The Unlikely Heroes Revolutionizing Prevention,  journalist Kristina Marusic profiles the efforts of those working to advance cancer prevention. The book weaves intimate stories from those dealing with cancer, inspiring work from scientists working to understand chemical exposures, and important context about the ways the US deals with cancer and chemical regulation.

Kristina Marusic is the author of A New War on Cancer: The Unlikely Heroes Revolutionizing Prevention.

The New Lede sat down with Marusic to discuss why preventing environmental exposures is the next big step in the war against cancer.

Q: What inspired you to highlight the role of environmental exposures in causing cancer in your book?

A: My younger sister was diagnosed with thyroid cancer when she was in her early 20s. And that made a big impression on me, as you can imagine. She’s doing well now and is healthy, but that was very scary and surprising, and it got me thinking about what might have caused her cancer. 

Half of all American men and one in three women are expected to get some type of cancer diagnosis in their lifetimes, so most Americans have had an intimate brush with cancer like that, either for themselves or a loved one.

I’m a journalist, and while I was writing a story on cancer and air pollution a few years ago, I learned that some types of cancer have been steadily climbing since we started tracking cancer rates back in the 1970s. 

I interviewed one researcher, Dr. Phil Landrigan, who pointed out that these increases are happening too fast to be caused by genetic changes, and they can’t be entirely explained by just having better diagnostic tools. The only other option is that the problem is in the environment. And I found that to be especially alarming.

This is a good time to talk about this issue because I do think we’re seeing a growing consensus within the scientific community about the need for further research on the ways that chemical exposures are impacting our cancer risk. And there’s an urgent need to incorporate this science into our regulations and communicate what the research community is finding to regulators.

Q: How do environmental exposures fit into what scientists already know about the causes of cancer?

A: One emerging theory is that cancer risk is like a pie chart, with a different cancer cause in each slice. These are things like inherited genetics and gene mutations, your parents’ and grandparents’ chemical exposures, your lifestyle habits, like diet and exercise, and your various exposures to things like cigarette smoke, air pollution, or cancer-causing chemicals in food or drinking water. And everyone’s pie looks a little different. But if just one piece of your pie goes missing, you won’t develop cancer.

That means that if we remove one piece that happens to be in many people’s pie charts, such as the presence of carcinogens in much of the drinking water across the United States or the amount of air pollution we’re all breathing, we could stop cancer from happening in all those people who had that slice in their pie chart.

Cancer is a complex disease with many risk factors, so scientists are still working to figure all of this out, but we have lots of clear evidence that reducing exposure to things that raise our cancer risk can lower cancer rates in communities as a whole.

Q: Why did you choose to focus on efforts to advance cancer prevention, rather than treatment?

A: We’ve gotten very, very good at curing cancer over the last 40 years. Cancer survival rates have more than doubled since the 1970s. But we’re not putting that same kind of effort into preventing cancer. 

Right now, only seven to nine percent of all global funding for cancer goes toward prevention. And then most of that funding goes for ad campaigns that are focused on individual lifestyle choices like not smoking, healthy diets, and exercise, which are important, but just aren’t the only things when it comes to prevention.

We know that widespread exposure to carcinogens is raising everyone’s cancer risk. Things could be so different if we’d spent the last 40 years giving the same kind of funding and energy and attention that we’ve given to treatment and to preventing widespread exposure to carcinogens.

Research on cancer prevention also doesn’t have the same potential to create profit as creating pharmaceuticals for treatment does. So funding and support for that kind of research is just less abundant. Advancing the ways that we treat and cure cancer is really important. It’s just that we also need to focus some of our efforts on prevention.

I wanted to tell stories of people who’ve made this their life’s work as an attempt to really humanize this issue. Because I think their dedication and passion about this is contagious.

Q: How are regulations in the US failing to protect public health?

A: It’s the right time to acknowledge that we can’t fully protect ourselves from carcinogens without protecting everyone from carcinogens, because they’re so ubiquitous. We can do this by more effectively regulating cancer-causing chemicals, which we do not currently do very well in the United States. 

In the US, generally, you can just put something on the market without doing any testing. And then when it’s proven unsafe ten or 20 years later, there are big class action lawsuits. Sometimes those lawsuits eventually result in new laws, but they often just kind of stand in for them. So it’s really backwards the way we’re doing it here. By the time we get around to regulating harmful chemicals, the damage has already been done.

We have enough evidence to know that effectively regulating these chemicals and reducing the amount of carcinogens we’re exposed to is going to also reduce cancer and other types of illness. Most of these chemicals are linked not just to cancer, but other problems, such as infertility and reproductive problems. We may not have all the answers yet, but we already have all the scientific evidence we need to take action to protect people.

The parallel example I give is how we dealt with SIDS [Sudden Infant Death Syndrome].  In the 1980s, scientists were noticing this trend that in Hong Kong, where cultural norms had most people putting their babies on their backs to sleep, there was way less SIDS. And in places where it was normalized to have babies sleeping on their stomach, there was more SIDS. 

There was this big debate in the scientific community, and some scientists felt really strongly that they couldn’t tell people to put their babies to sleep on their backs until they knew exactly why and how it helped prevent SIDS. But other scientists said “We don’t need to know how it works. We just observed that it’s happening, and we could save babies’ lives.” 

Those scientists won the debate, and since the “back to sleep” campaign was launched, the United States has seen a reduction in SIDS of about 50%. Similarly, we don’t have to wait for science to have all of the answers to be able to effectively regulate chemicals that we know raise our cancer risk.

Q: Is cancer an environmental justice issue?

A: Absolutely. It’s an environmental justice issue everywhere that people of color and low-income communities tend to be disproportionately affected by pollution, which increases cancer risk.

A number of studies have shown that Black Americans are disproportionately exposed to higher levels of air pollution across the United States, regardless of socioeconomic status. And that’s a lingering effect of structural racism in the form of practices like redlining.

Studies have also shown that black Americans buy more personal care products that contain cancer-causing chemicals. For example, hair relaxers tend to have a lot of endocrine-disrupting chemicals and cancer-causing chemicals in them. 

These are particularly products that are designed to help people achieve this white beauty standard of having straight hair. Feeling pressure to achieve that standard is a lingering effect of racial stigma. 

And so those two factors, along with additional stress from living in a racist society, mean that Black Americans generally experience greater cancer risk from their environments than their white counterparts. Compared to members of other races, Black Americans have higher rates of getting and dying from many kinds of cancer.

All of which is to say that certain communities experience disproportionate impacts from cancer-causing chemicals in the environment, and that is environmental injustice. We need to address that, and these communities absolutely deserve additional attention.

But this issue also impacts everyone, and none of us can fully protect ourselves without creating systemic changes that will protect everyone else, too. It’s really this kind of all-for-one situation.

The good news is that we don’t have to start from scratch when it comes to tackling this problem. There are lots of organizations that are already doing this work and are really effective, that are pushing for better regulations and that are providing resources and tools to help individuals and groups minimize their cancer risk in the meantime.