The US President’s Cancer Panel (PCP), charged with monitoring the national Cancer Program, recently surprised a lot of people working around harm to health from environmental chemicals with their most recent biannual report.
This is because it is the first time the PCP has focused on environmental causes of cancer, stating that “the true burden of environmentally induced cancers has been grossly underestimated” and strongly urging action to reduce widespread exposure to carcinogens.
The panel also criticised regulators and industry for using “woefully outdated” estimates of environmentally caused cancers to set regulations and “to justify its claims that specific products pose little or no cancer risk.”
The PCP is currently a two-member panel: Dr. LaSalle D. Lefall, Jr., a professor of surgery at Howard University and Margaret Kripke, a professor at University of Texas’ M.D. Anderson Cancer Center. They were appointed by President Bush, not President Obama.
The report brings the PCP into line with organisations including the Endocrine Society (ES), which published in 2009 a Scientific Statement voicing strong concern about potential harm from endocrine disrupting chemicals in the environment and consumer products, and the American Medical Association, which in 2008 passed resolutions stating that more attention needs to be paid to environment as a cause of illness and for medical professionals to receive more education in this area, and endorsed the ES concerns about endocrine disruptors.
The Lancet commented on the PCP report: “Cancer prevention must remain a top priority for the soon to be appointed director of the US National Cancer Institute. The federal government should impose and enforce stronger environmental laws which will decrease regulatory complexity, reduce industry’s influence, and encourage research directed toward the health effects of low doses of a combination agents.”
There is an enormous body of research (mostly animal and epidemiological, due to the ethical impossibility of doing RCTs in this area) linking environmental exposures to chemicals with cancer and a range of other diseases. Since 1970, age-adjusted rates of many cancers have increased drastically (e.g. rates of NHL and prostate have tripled).
The American Cancer Society was less than delighted with the PCP report (though Medscape Today points out this is not representative of the full range of opinion across the ACS), accusing the PCP of being “unbalanced” and diverting attention away from known causes, while implying environmental exposures are not a “modifiable” risk.
We have been alerted to an interesting article in this month’s ReSource journal, about whether or not the reuse of medical waste containers presents enough of a disease transmission risk to special treatment with regards to monitoring.
The same line of thought would apply to whether or not waste bins need to be incinerated along with their contents.
Abstract: Reusable plastic containers are commonly used to transport health care risk waste. Some regulatory authorities require disinfection, microbiological monitoring or process validation to ensure minimisation of a perceived risk of disease transmission from the containers.
The study surveyed scientific literature and relevant guidelines, and as no evidence of risk was found, recommends quality assurance resources be commensurate with these findings.
Disinfection, microbiological monitoring and microbiological validation are not indicated. Visual criteria for cleanliness together with written protocols will ensure risk-free use of the containers. Article available here (not free).
The piece is interesting because it serves as a reminder that not all that comes into contact with medical waste needs equal treatment.
As a low-contact surface, the author’s argue, the hazard posed by medical waste containers can be adequately dealt with by washing them with water and detergent, in the same way one would wash floors (another low-contact surface) – and that if medical devices which come into contact with mucous membranes require no monitoring, then waste bins certainly don’t.
Required reading for endocrinologists? Some key points from the Endocrine Society’s first Scientific StatementJuly 23, 2009 at 8:21 am | Posted in Briefing | Leave a comment
Last month, the Endocrine Society published its first Scientific Statement on endocrine disrupting chemicals (EDCs). [Endocrine Reviews 30(4):293-342, Diamanti-Kandarakis E et al. – download here].
The importance of the Statement cannot be understated: this is a leading medical/scientific body publishing a definitive statement about what we know about the risks posed by EDCs and how best to limit and manage them.
Endocrine disruptors have been making the news recently, particularly in the form of the plastic packaging and food tin lining additive bisphenol-A (BPA), which interferes with oestrogen pathways in the body. There are, however, many other EDCs out there – unregulated, biologically active at extremely low concentrations, with unknown health consequences.
Some of the key points to understand about EDCs are outlined below. From the Society’s own summary of its report, the emphasis on complexity of EDC interactions in the body is very striking:
An endocrine-disrupting substance is a compound, either natural or synthetic, which through environmental or inappropriate developmental exposures alters the hormonal and homeostatic systems that enable the organism to communicate with and respond to its environment.
Issues key to understanding the mechanisms of action and consequences of exposure to endocrine disrupting chemicals include age at exposure, latency from exposure, the mixture of chemicals, dose-response dynamics, and long-term latent effects. [...]
The evidence for adverse reproductive outcomes (infertility, cancers, malformations) from exposure to endocrine disrupting chemicals is strong, and there is mounting evidence for effects on other endocrine systems, including thyroid, neuroendocrine, obesity and metabolism, and insulin and glucose homeostasis.
Michael Lerner, vice-chair of the Collaborative on Health and the Environment (CHE) and President of Commonweal, a health and environmental research institute, recently highlighted 13 points in the report which he considers of particular importance. Six of these are as follows (the full list is available on request):
Note: Michael highlighted the important sections via email to the CHE listservs. CHE is an excellent source of information and discussion. For more information about signing up, go here.
Chapter 3. Relevance to medicine. “The field of endocrine disruption has particular pertinence to endocrinologists…The properties of these substances are particulary well suited for study by endocrinologists.” (page 4)
Chapter 6. Impacts of EDCs on female reproduction. These include polycystic ovarian syndrome, aneuploidy, POF, reproductive tract anomalies, uterine fibroids, endometriosis, and ectopic gestation. A treasure-trove of the best science condensed into five pages (pages 8-13).
Chapter 8. Male reproductive and developmental health. The focus is on disrupted reproductive function, manifest as reduced semen quality and infertility, altered fetal development, including hypospadias and cryptorchidism, and testicular germ cell cancer. Pthalates, PCBs, dioxins, and pesticides are each discussed as they impact semen quality. (pages 16-19)
Chapter 9. Prostate cancer and benign prostatic hyperplasia. Pesticides, environmental estrogens including DES, BPA, PCBs, , UV filters in sunscreens, cadmium, arsenic, vinclozin, DDT/DDE, are each discussed, with a note box with recommendations for prostate cancer research. (pages 19-22)
Chapter 12. Environmental chemical, obesity and metabolism. A wide-ranging and important section which uses DES in rodent studies as a poster-child and illustrates non-linear dose/response curves for EDCs with an important cautionary section on phytoestrogens like genistein in soy. At low levels these inhibit lipogenesis but at high levels they promote it. (page 33)
Chapter 13. Recommendations for the future. The need to link basic research to clinical practice, EDCs and the public, the need for a robust program of prevention using the precautionary principle for guidance, a call to TES to lobby for regulation seeking to decrease human exposure to EDCs, and this final statement:
Our chemical policies at the local, state and national levels, as well as globally, need to be formulated, financed and implemented to ensure the best public health.