We Must Raise Our Voices to Prevent Childhood Cancer
September 26, 2012
By Nancy Chuda, co-founder of Healthy Child Healthy World; and contributing author Philip J. Landrigan, MD, MSc Mt. Sinai Medical College
In 1991, our only child, Colette, at age five was diagnosed with a rare form of cancer called Wilm’s tumor. For the past two decades I have been writing a nonfiction memoir, The Flower That Shattered The Stone, that details the death Colette from cancer; the launch of The Colette Chuda Environmental Fund and the founding of Healthy Child Healthy World; the groundswell of scientific research in the past decade on environmental exposures and their effect on children; and the growth of the grass roots political movement to protect children against these assaults.
The Colette Chuda Environmental Fund was initially established to bridge the gap between work being conducted in environmental health research and the pediatric oncological and hematological communities. Our focus was the causation of childhood cancers in relation to environmental exposures.
Prior to 1991, little was known about the causation of many childhood cancers. Many scientists concurred that genetic susceptibility played a major role. Today, we understand that most cancers result from the interactions of genetic susceptibilities and environmental exposures. Here’s an eye-opener: The vast majority of the 85,000 chemicals used in the U.S. have never been tested for toxicity to people.
This means we don’t know the safety of most of the chemicals in the products that surround us every day. We do know that early life exposures to harmful substances can affect children and even affect their health decades later.
Given the limited resources available today for new initiatives, the National Institute of Environmental Health Sciences under the direction of Linda S. Birnbaum, Ph.D., is supporting research in every way possible to provide us with reliable information on the health effects of environmental exposures. Dr. Birnbaum states, “Because children are still developing, they can be more vulnerable than adults to the health effects of environmental contaminants. That’s why research on children’s health is a priority for NIEHS. We want to learn how to prevent diseases such as cancer, autism and obesity by changing our environment.”
Mary Gant who has served NIEHS as a liaison between the government agency and Congress for 25 years compares the rising incidence of childhood cancers and believes “the increase in the incidence of childhood cancer between 1999 and 2008 shows clearly that we need to increase our efforts in preventing cancer by understanding how environmental triggers coupled with genetic susceptibilities can initiate or promote cancer in our children.”
In my memoir I reveal the tremendous emotional impact that Colette’s diagnosis had on our family. “When children are stricken with cancer you fight for their lives. Your heart grows cold at the thought that they might die. The battle you wage is equal to all the world wars that have ever been fought. To see children clinging to their mother and father for life, to gaze into their eyes and see hope dwindling… to feel their confusion when words can no longer be uttered… to watch as trust, the very bond that glues them to our hips, slowly slips away. It is at these moments that you wish you had never been born, never to bear witness to such cruelty. As parents, we believed intuitively that something in the environment triggered our daughter’s cancer.”
Today, we have made tremendous progress thanks to the Environmental Protection Agency and the National Institute of Environmental Health Sciences which in 1998 established eight Children’s Environmental Health and Disease Prevention Research Centers to explore ways to reduce children’s health risks from environmental factors.
Dr. Philip Landrigan, a longtime colleague and founding member of Healthy Child Healthy World, was one the investigators to receive a grant to establish one of these centers at Mt. Sinai Medical College in New York. Recently I had the opportunity to get his viewpoint on the progress being made towards prevention.
Q: Is there an increasing incidence of childhood cancers?
A: In the past half century, mortality from childhood cancer has declined dramatically. This decline is the consequence of spectacular advances in medical and surgical treatment that, in turn, are based on great increases in understanding of cancer biology and therapeutics.
But in this same time span, the incidence of childhood cancer has increased significantly and has offset the declines in mortality. Cancer is now the second leading cause of death among children under age 15 in the United States. Mortality from childhood cancer is exceeded only by deaths from injury and violence.
Q: Which childhood cancers have increased?
A: Increases in incidence have occurred for three major malignancies of children and young adults, according to SEER data from the National Cancer Institute:
- Leukemia. Leukemia is the most common childhood cancer. Incidence of leukemia in 0-14 year-old US children increased from 3.3 per 100,000 in 1975 to 5.1 per 100,000 in 2005, 55% increase. Acute lymphocytic leukemia increased in the same years from 2.2 to 4.0 per 100,000, 81% increase.
- Primary Brain Cancer. This is the second leading cancer of children. Incidence of cancer of the brain and nervous system in 0-14 year-old children increased from 2.3 per 1000,000 in 1975 to 3.2 per 100,000 in 2005, 39% increase.
- Testicular Cancer. Incidence of testicular cancer in white men (most of them adolescents and young adult males) increased from 4.3 per 100,000 to 7.0 per 100,000 in 2005, 51% increase. Among black men in the same years, both the absolute incidence and the rate of increase were much lower – from 0.9 to 1.3 per 100,000.
Q: What are the reasons for these increases in incidence?
A: The increases in childhood cancers are certainly too rapid to be of genetic origin. Some have argued that they reflect improved access to medical care or the increasingly widespread availability of newer diagnostic technologies such as MRI and CAT scan. But while those explanations might explain a one-time “bump” in reported incidence they fail to account for the consistent increase in incidence of three different types of childhood and young adult cancer observed in the United States over a span of three decades. These increases in incidence of childhood cancer could be due, at least in part, to environmental exposures.
Q: When we first met and began our collaboration your reported analysis undertaken by the National Academy of Sciences (Pesticides in the Diets of Infants and Children, 1993) established that children are uniquely vulnerable to toxic exposures in the environment and that children have disproportionately heavier exposures to many chemicals. This study clearly laid the groundwork for emerging research which today reveals even more about the dangers of early childhood exposures to toxic and carcinogenic chemicals. What are some of the latest findings?
A: We are seeing evidence for environmental causation of childhood cancers. Clinical, epidemiological and toxicological studies spanning the past 60 years support the hypothesis that early exposures to environmental carcinogens can cause childhood cancer and that infants and children are uniquely vulnerable to certain environmental carcinogens. This evidence includes an epidemic of leukemia noted in the 1940’s and early 1950’s among young children who had been exposed in utero and in the first years after birth to ionizing radiation in the atomic bombings of Hiroshima and Nagasaki. We also understand the cause and effect relationship and the plausibility of transplacental carcinogenesis which occurred in a series of cases of Adenocarcinoma of the vagina in young women who had been exposed in utero to the synthetic estrogen diethylstilbestrol (DES). Young mothers who had been administered DES during pregnancy in an effort to prevent miscarriage had inadvertently passed the susceptibility to their daughters. At the time of birth they seemed normal however later they would develop adenocarcinoma at the time of puberty or in early adult life.
Q: The idea of parents passing on a greater proclivity to incidence of childhood cancers in very alarming. What does research reveal about prenatal occupational exposures?
A: Parental occupation before or during pregnancy in occupations that involve workplace exposure to volatile organic solvents, such as the painting and printing trades, has been associated in several retrospective studies with increased incidence of childhood leukemia.
Q: Pesticide exposure is perhaps one of the most dangerous forms, if not the most invasive, cumulative, bombardment to a child’s early development and thus their health. What does the latest research reveal? A: Each year in the United States more than 1 billion pounds of synthetic pesticides – insecticides, herbicides, rodenticides and fungicides – are applied in agriculture, homes, schools, parks, playgrounds and daycare centers. The National Toxicology Program has found in animal bioassays that a number of widely used pesticides are carcinogenic. Case-control epidemiologic studies have found consistent, modest associations between pesticide exposures in utero and in early childhood and acute lymphocytic leukemia, childhood brain cancer and childhood non-Hodgkin’s lymphoma. Rates of childhood leukemia are consistently elevated among children who grow up on farms, among children whose parents used pesticides in the home or garden, and among children of pesticide applicators.
Q: Is it possible to prevent childhood cancer through education?
A: Yes. Many cancers caused by environmental and occupational exposures can be prevented. Primary prevention that halt exposures is the single most effective strategy. Primary prevention reduces cancer incidence, and it saves lives and billions of dollars. David Christiani’s research in 2011 cites many successful examples including reductions in lung cancer and mesothelioma following bans on asbestos, reductions in bladder cancer after elimination of aniline dyes, reductions in leukemia following imposition of controls on benzene, and termination of hepatic angiosarcoma in chemical workers following introduction of closed-circuit technology for vinyl chloride polymerization.
Q:What can we do as citizens to reduce the vast amount of chemicals that are plaguing not only our children’s health but future generations to come?
A: We must have a national advocacy strategy that focuses on prevention. A sea change is needed in the national approach to cancer in the United States. Two fundamental problems of the current approach involve far too much emphasis on treatment of cancer albeit while important this approach does not get at root causes. Secondly, existing prevention efforts are devoted almost solely to lifestyle factors-smoking, exercise and diet. Again, important but not sufficient.
Q: In 2010 the President’s Cancer Panel report revealed that Congress must prevail to make cancer prevention the top priority. This is a major shift and some contend that it will take a Second War on Cancer in the efforts to stress cancer prevention, not cure. What is your opinion?
A: The Administration and the Congress must make the discovery and prevention of the environmental causes of childhood cancer a national priority for the United States of America.
Today, countless hundreds of thousands of children just like our daughter Colette, are being inadvertently exposed to hazardous chemicals at a time in their lives when they are uniquely sensitive to their long-term, detrimental effects. We have a mandate before us that can change the way we approach diseases, such as cancer, from diagnosis and treatment to prevention first., We can vote for our children’s future by supporting what we do know thanks to the scientists whose evidence support that the chemical buildup in our children’s bodies are adding to the rising incidence of numerous diseases, birth defects, and developmental disabilities, and we all must raise our voices and make that change.
As a mother who lost a child to a cancer we now know could have been prevented, I urge you to support the Safe Chemicals Act. Please join me in urging our senators to pass the Safe Chemicals Act. Here’s how your vote can make a difference.
Editors note: Nancy Chuda, co-founder of Healthy Child Healthy World, has been raising awareness of the links between chemicals in the environment and cancer for over 20 years. Nancy shares her unique perspective on National Childhood Cancer month and speaks to Dr. Philip J. Landrigan about the state of cancer prevention.