Professional Documents
Culture Documents
by: Devra Lee Davis, PhD, MPH, Director, Center for Environmental Oncology of UPCI,
UPCOMING events
Adapted from The Secret History of the War on Cancer. February 13, 2008, 6:00 – 8:00 PM
Book Reading and Discussion:
Diagnostic radiation is a modern miracle three-dimensional look inside an old set of “Not Just a Pretty Face—
we have come to depend on. In 1979, The knees or cranky stomach, a patient does The Ugly Side of the Beauty Industry”
Nobel Prize in Medicine and Physiology not usually ask whether this remarkable Maryann Donovan, M.P.H., PhD., Scientific Director,
Center for Environmental Oncology
was awarded to Godfrey N. Hounsfield test might increase her long-term risk of
Talk by author Stacy Malkan
and Allen M. Cormack, the engineer and more serious ailments. Magee-Womens Hospital of UPMC
physicist who invented the system for cre- When my then eleven-year-old daughter To register, call
ating three-dimensional images of the hu- Magee’s education department at: 412-802-8299 or
was given a CT scan of her abdomen to visit magee.upmc.com
man body. Computerized imaging technol- see if she had a ruptured spleen, I was
ogy is now such a large, profitable industry just like most parents with a child in the
that it has its own futures market. Seven emergency room. All I wanted to know
times more CT scans are conducted today was that she would be okay. But when I
Visit our New and
than just ten years ago. (1) The leading asked the young radiologist if there was
manufacturer, Cardinal Health, is one of a way to shield my daughter’s chest, she
the twenty largest companies in the world, looked at me skeptically and asked, “Why? Improved Website!
with revenues of more than $81 billion a She doesn’t have any breasts.” I explained
year. (2) www.preventingcancernow.org
to her that we know that radiation expo-
New government regulations in the United sure to the chests of girls before puberty
States are shutting down what had been increases the chances that breast cancer Highmark Healthy Places, Healthy People
highly profitable ventures in which physi- will develop later on. The woman looked at
cians would prescribe tests on machines me as if I were slightly insane. Funding for this newsletter is provided by
they themselves owned. When offered a the Highmark Foundation and the Heinz Endowments.
Continued on page 2
www.environmentaloncology.org Helping to make prevention the cure for cancer.
Sen. John Edwards, and Tony Snow, for- in the Lancet in 1956, flew in the face of as-
mer press secretary to the White House, surances from obstetricians that the prac-
or those who had the disease as young tice was harmless. Stewart’s findings also
children, face lifetime risks of other can- upset those advocating the continued use
cers as a result. Other studies show that of nuclear weapons and testing. The year
the risks of cancer from radiation in can- 1956 was the peak year for above-ground
cer patients treated for Hodgkin’s disease nuclear weapons and testing and radio- Recent Expert Warnings on
could even be greater than those of the active fallout. Obstetricians and nuclear the Risks of CT Scans:
atom bomb survivors. This apparently weapons advocates alike maintained that The American College of Radiology calls
greater vulnerability of the weakened to small doses of radiation were harmless. for national standards for training and
certification of CT technologists and improved
the damaging effects of radiation is some- In fact, Stewart’s findings showed that a medical education programs regarding risks
thing that researchers like Alice Stewart single dose of diagnostic x-rays early in and benefits of radiological procedures
and Rosalie Bertell warned about nearly pregnancy more than doubled the child’s and non-radiological alternatives.
half a century ago. (6) The world is catch- risk of leukemia. (7) E. Stephen Amis, Priscilla F. Butler, Kimberly E.
ing up with them. Appelgate, et al., “American College of Radiology White
There is no question that in medical emer- Paper on Radiation Dose in Medicine,” Journal of the
Stewart’s work on the dangers of radiation gencies, CT scans save lives and eliminate American College of Radiology 4 (2007): 272-284. (www.
in England was simple and powerful. She exploratory surgery. But, experts increas- devradavis.com/6%20-%20ACRWhitePaper.pdf)
visited every county and county borough ingly agree (see sidebar) that the number Current uses of CT scan are expected to increase
health department in the country, hand- of scans can be reduced without compro- the rates of radiation-related cancer, especially
in children and young adults and should be
ing out questionnaires that asked mothers mising the ability to deliver health care.
reduced in non-emergency situations.
of children born between 1953 and 1955 For healthy individuals, and especially
David J. Brenner, Eric J. Hall, “Computed Tomography—
about things that happened to them when children, if a CT scan is recommended, it
An Increasing Source of Radiation Exposure,” The
they were pregnant. Within a year, she had is important to consider whether another New England Journal of Medicine 357:2277-2282
determined that the mothers of leukemic diagnostic tool, such as Magnetic Reso- (November 29, 2007): Number 22 http://content.
children were three times more likely to nance Imaging or ultrasound, neither of nejm.org/cgi/content/full/357/22/2277
have had routine x-rays of their abdomens which involves radiation, could be used
during pregnancy. These results, published instead. References for The Unrecognized
Risks of CT Scans:
Table 1 Radiation Risks of CT Scans Table 1. Davis, Devra. The Secret History of the War on Cancer.
Approx. New York: Basic Books, 2007, p. 413.
Equivalency in
Equivalent Dose 1. Brenner, D. J., & Hall, E. J. (2007). Computed tomogra-
Exam Type Machine Setting Relevant Organ Chest X-rays
to Relevant
.15 - .01 mSv* phy — an increasing source of radiation exposure. N Engl J
Organ (mSv)
Med, 357, 2277-2282. <http://content.nejm.org/cgi/content/
Pediatric Head full/357/22/2277>
Unadjusted a Brain 60 400-6000
CT Scan
2. “Cardinal Health Launches New PET Marketing Tools,”
Pediatric Head (2006). <http://nps.cardinal.com/nps/PETfoundations/current-
Adjusted b Brain 30 200-3000
CT Scan News.asp>
Ped. Abdomi- 3. Amis, E. S., Butler, P. F., & Applegate, K. E., et al. (2007)
Unadjusted Stomach 25 166-2500
nal CT Scan American College of Radiology White Paper on Radiation Dose
Ped. Abdomi- in Medicine. J Am Coll Radiol, 4, 272-284.
nal CT Scan Adjusted Stomach 6 40-600
See all references for The Unrecognized Risks of CT Scans on
Chest X-ray our website www.preventingcancernow.org
(PA/lateral) n/a Lung .01/.15 .01-.15
Screening
n/a Breast 3 20-300
Mammogram
Source: Society for Pediatric Radiology and National Cancer Institute, “Radiation & Pediatric Computed Tomography: A
Guide for Health Care Providers,” Summer 2002, http://www.cancer.gov/cancertopics/causes/radiation-risks-pediatric-CT
Winter 2008
a “Unadjusted” refers to using the same settings as for adults. b “Adjusted” refers to settings adjusted for body weight.
Volume 2 • Number 2
*Chest-x-ray equivalency based on NCI estimates in this table
Question:
Children, Playsets
and Wood Decks:
Safety?
Dear Center for Environmental Oncology,
as tuna, shark, king mackerel, swordfish, age woman uses about 12 products a day.
and tilefish. Children and pregnant wom- That could mean she is applying well over
en should not eat these fish. If a pregnant 100 different chemicals to her skin, hair
woman eats mercury-contaminated fish, and nails in a single day. The Federal Drug
the mercury travels from her bloodstream Administration (FDA) does not regulate or
and across the placenta to the fetus. require personal care product manufac-
turers to test products, so little or no data Protect Your Children
Experts recommend that when a woman is
exists on most of the chemicals of con- from Hidden Pesticides in
preparing for pregnancy she should avoid
cern. In the Unites States, we are guided Your Home
fish high in mercury for 3 to 6 months.
by the principle of “prove harm” before Some pesticides have been shown to cause cancer
When pregnant, a woman should eat up to in humans, especially when people are exposed
12 ounces a week of a variety of fish and regulating chemicals. In contrast, the
at high levels. Children are at increased risk for
shellfish that are lower in mercury (such European Union is guided by the “precau- pesticide poisoning because of their smaller
as salmon, canned light tuna, shrimp, pol- tionary principle” and has banned most of size and because pesticides may be applied to
these chemicals of concern. The best ap- surfaces that are easily accessed by children.
lock and catfish). Consumers also need to
be aware of the source of their fish, as only proach is prevention. Antibacterial Soaps and Disinfectants: May
a small percentage of fish are inspected. Thankfully, now there is an on-line guide contain any number of 275 different active ingredients
classified by the EPA as pesticides. Frequent use of
Check advisories about fish caught locally. with safety ratings of more than 23,000
antibacterial soaps selects for more resistant bacteria.
The safest fish are wild caught or farmed products at www.comesticsdatabase.
Alternative: Teach your children to wash their
in the United States by environmentally com. Skin, hair and nail care products are hands frequently with regular soap.
responsible operations. Next time you are rated for safety, depending on the chemi-
shopping, consider buying a can of salm- cals they contain as well as other criteria. Mothballs: Can cause serious health
problems if ingested or by inhaling the fumes.
on that is not only low in mercury but also All women, pregnant or otherwise, should
1,4 Dichlorobenzene, found in mothballs, may be
inexpensive and a good source of protein learn to always read product labels with reasonably anticipated to be a carcinogen.
and omega 3 fatty acids. the idea that fewer ingredients usually Alternative: Always keep mothballs out
For more information: means a lower risk. It is also a good idea of reach of children. Use cedar balls or
to avoid products with words like “fra- lavender sachets to ward off moths.
www.cfsan.fda.gov/seafood1;
www.epa.gov/ost/fish; www.ewg.org grance,” “parabens,” or “ phthalates” Synthetic Carpets: May contain anti-mildew
on the label and to avoid nail polish with pesticides, as well as toxic adhesives. Many chemicals
A friend told me that I should not use formaldehyde in it. Organic cosmetics and used on carpets are volatile organic compounds (VOCs),
make-up when I am pregnant. But, I look which may cause carcinogens to be released into the air.
personal care products are a safer alter-
so much better in make-up. What can I native, but there are still, as yet, no na- Alternatives: Choose alternative flooring: ceramic
use and still be safe? tiles, untreated hardwood, cotton or hemp rugs (with
tional standards established for using the
non-toxic adhesive and non-plastic backings.)
A teratogen is something that causes words “natural” or “organic” in personal
harm to a fetus, and there is no known care products. Paint: Several brands contain anti-mildew pesticides
way to predict if an individual fetus will and emit VOCs. Test paint chips from walls and windows
Magee-Womens Hospital is hosting a for lead, which is very dangerous to children’s health.
be sensitive or not to a substance. It de- book reading and discussion related to Alternatives: Choose “No-VOC” or natural milk
pends on the substance itself, how much safe cosmetics about the new book by paints. Keep children away from chipping and
exposure the pregnant woman/fetus had Stacy Malkan, entitled Not Just a Pretty peeling paint; clean sills with a damp rag.
to it, and for how long and when, during Face-The Ugly Side of the Beauty Indus-
the pregnancy, a woman is exposed. It is References:
try on Wednesday, February 13, 2008 from
thought that the most vulnerable period National Cancer Institute: www.cancer.gov
6:00-8:00 pm. Dr. Maryann Donovan of the
for the fetus is within the first 57 days of ATSDR: www.atsdr.cdc.gov
Center for Environmental Oncology will
pregnancy. also discuss these issues along with Mia
There are many concerns about personal Davis from the Safe Cosmetics Campaign. Winter 2008
care products and cosmetics. An aver- To register, call the education department Volume 2 • Number 2
Continued on page 12
Examples of Pesticides:
Insecticides:
organochlorines – endosulfan, lindane
synthetic pyrethroids – permethrin, deltamethrin
organophosphates – malathion, dichlorvos
Herbicides:
triazines – atrazine, simazine
others – 2,4-D, paraquat
Fungicides:
mancozeb, captan
In addition, there are a number of other We cannot rely solely on epidemiology Fumigants:
DBCP, ethylene dibromide
mechanisms by which pesticides might to unravel the relationship between pes-
influence the onset and progression of ticides and breast cancer—not least be- Adjuvants:
nonylphenol
breast cancer: through their influence on cause breast cancer can have such a long
the immune systems’ Natural Killer T-cells, latency period, it may be virtually impos- Contaminants:
dioxin, 1,4-dioxane
through interfering with cellular communi- sible to establish exposures in a meaning-
cation, or the function of enzymes on cell ful way. The relevant exposures may have
repair, or impeding the cell’s natural ability occurred very early in life or even at the
to cause tumor cells to die off. And there is fetal stage. The fetus is exquisitely sensi-
For More Resources about
evidence that a number of pesticides can tive to carcinogens and hormonally active
Pesticide Safety
adversly affect these mechanisms, raising substances. Recent studies covered in our
Pesticides
the risk of breast cancer. report indicate that when pregnant rats Environmental Protection Agency (EPA):
While the available evidence does not are exposed to the fungicide vinclozolin, Home Page
breast cancer incidence is elevated in www.epa.gov/pesticides/
prove that pesticides are causing breast
cancer in humans today, it does provide each of the four succeeding generations Pesticides Health and Safety (EPA)
(at least). Human Health Issues
proof that they have the potential to influ- www.epa.gov/pesticides/health/index.htm
ence its onset and development, and thus Table 2 (see page 8), adapted from the Si-
Information on Pesticides Health Issues
to raise the risk. lent Spring Institute, condenses informa- Center for Disease Control and Prevention (CDC)
So what do we do, while we wait for tion on 216 different chemicals proven to Health Studies
www.cdc.gov/nceh/hsb/pesticides/links.htm
evidence to accumulate? Continue using cause mammary tumors in animals. Some
these pesticides despite the warnings? of these are found in pesticides, and none
Hope for the best while we wait for ir- has ever been regulated for its potential to
refutable proof? Or take a precautionary induce breast cancer.
approach and drastically reduce the expo- Our report calls for a systemic change in To purchase Pesticides and Breast Cancer:
sure of girls and women – especially preg- our thinking about pesticides in order to re- A Wake Up Call, order at Pesticide Action
Network (PAN) Asia and the Pacific at
nant women—because of the heightened duce the risk of breast cancer. Regulatory
panap@panap.net
vulnerability of the neonate to carcinogens processes have to come to grips with the
and hormonally active chemicals? many different mechanisms that underlie
breast cancer and how pesticides may Winter 2008
influence these. The current paradigm in Volume 2 • Number 2
Continued on page 8
• Obtain and share data with policy- human or ecological health from
makers so that an action plan these levels of contaminants in fish;
may be made to solve the • To obtain data, evidence, and
identified problems, and; other information that can inform
• Form strategic partnerships policymakers in preparing for a regional
with stakeholder groups along approach to water management;
the Allegheny River to help ensure • To form strategic partnerships with
ongoing stewardship activities. the CEO-UPCI, GSPH, RiverQuest,
What are the expected outcomes of the Venture Outdoors, The Rachel Carson
Allegheny River Stewardship Project? Homestead, the Alle-Kiski Health
• To engage river community members, Foundation, and the Heinz
anglers, recreational boaters and the Endowments, in order to
general public (who generally galvanize the river communities,
obtain their drinking water from our groups, schools, and individuals
rivers) in the planning, execution and to become stewards of the river;
data analysis portions of the projects. • To raise awareness in this area of
Specifically, this project will teach the importance of the river to the
both interested adult and teenage public’s health and well being, not only
community members the procedures in the sense of drinking water or fish
associated with the catch consumption but for aesthetic, cultural,
and measurement, geographic historical and recreational values;
positioning, gender identification, Lessons learned from the project will be
dissection, analysis and interpretation transformed into long-term community
of results of the fish study; environmental and specific water quality
• To understand the different goals, so that the footprint of the project
concentrations of contaminants, which widens and deepens with the passage of
are of significance to public health, and time.
which are carcinogenic (able to cause What is the duration of the
cancer), estrogenic or toxic and have Allegheny Stewardship Project? PERSONAL POLLUTION
accumulated in the fish species along PROBLEM STATEMENT
Community meetings, focus groups, and
major sections of the Allegheny River;
surveys to determine priority locations Describe, name. and/or draw a current or past
• To correlate the concentrations of for actual river sampling are now being
environmental pollution problem that you are aware
contaminants in fish with proximity of that may be affecting your community or the
held and planned. Actual river fishing and Allegheny River Watershed in general. Please be as
to the liquid wastes (effluents) from water-and-sediment-sampling will occur specific as possible and try to tell us exactly where
industrial facilities, power plants at numerous locations on the Allegheny the problem(s) are occurring or has occurred. This
fallout or fly ash pile leeching into the River on weekends from May through ear-
may be an air, water, land, or mixed source pollution
waters, municipal sewer overflows, problem. This can also be mailed to Dr. Dan Volz at
ly June of 2008.Analysis of samples and re- Bridgeside Point, 100 Technology Drive, Suite 564,
former industrial waste sites and/ port preparation will continue through the BRIDG, Pittsburgh, PA 15219-3130. cdv5@pitt.edu
or areas of environmental degradation late fall of 2008. The project is expected to
• To identify human exposures to the last until Spring 2009, when researchers
contaminants found in fish will hold a series of community meetings
either through drinking water on outcomes of the sampling results. At
and/or eating the fish; that time, strategy for community action Winter 2008
• To understand the risk posed to to solve identified priority problems will be Volume 2 • Number 2
determined.