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Cancer: A Social & Political Problem
President Nixon and Congressional liberals alike have made much mileage out of the recently approved Conquest of Cancer program. Under the plan $1.5 billion (over 5 years) has been appropriated for scientific research to conquer cancer. The plan, however, does nothing about the environmental conditions that cause cancer. There is much debate as to whether the research will be of any benefit in attacking cancer. However, the World Health Organization has recently estimated that seventy five percent of cancer cases are environmentally caused, and hence potentially preventable. The route of preventing cancer deaths by improving peoples’ living conditions and environments is not politically spectacular, and does not get across the message that American technology and businesslike technique can solve any problem. In fact such a procedure would be threatening to both corporate profits and the American social system.
Air pollution is one significant cause of cancer. Cancers of the stomach, prostate, esophagus, and lung are all partly produced by contaminants in the air. Major studies of the relation between air contaminants and cancer incidence have been performed in Nashville and Buffalo. In each instance the city was divided into separate sections according to the level of particulate air pollution in the·section. Other things being equal, the incidence of stomach cancer and prostatic cancer was 1.5 to 3 times higher for residents of the most polluted area than for residents of the least polluted area. For cancer of the esophagus the ratio was five to. one. It is also worth noting that people in the lowest economic grouping had twice the stomach cancer incidence of those people in the highest grouping who lived in the same sector of the city. A person in the lowest economic group residing in the most polluted area had about three times the chance of contracting stomach cancer as someone in the top economic group, living in the cleanest area. Breathing dirty air and being poor, then, are significant factors responsible for many cancer deaths.
Logically an all out effort to conquer cancer would include an all out effort to clean up the air. In fact, no mention of air pollution is included in releases about the cancer war, and actual efforts to combat air pollution have been woefully inadequate. Local air pollution boards tend to be dominated by the industries they are supposed to regulate. As a result they prefer granting variances to enforcing existing regulation. These regulations are themselves frequently inadequate. California’s new set of regulations is among the best in the nation, but it includes no standards on hydrocarbons, a class of pollutants known to contain several carcinogenic (cancer producing) agents.
Automobiles are the largest contributor of hydrocarbons. New regulations on emissions will come into effect in three or four years. But the regulations will affect cars only when sold, and in the past cars with as few as 12,000 miles have fallen hopelessly short of meeting the existing standards. Moreover, auto companies plan to increase the number of cars on the road significantly. If they have their way any decreases in emissions by individual cars will be more than offset by heavier traffic. The real ways to attack the auto pollution problem involve fundamental changes, such as switching to a non-polluting external combustion engine, and the construction of efficient, cheap public transit systems. Neither of these measures suits either the auto manufacturers or the oil companies.
Industrial air is another prime source of cancer producing chemicals. Historically many of the early carcinogenic agents to be identified were associated with various industrial jobs. Among the agents known to be producing occupational cancers now are asbestos, radiation, chromates, nickel, and coal tar pitch volatiles. Statistics from the Metropolitan Life Statistical Bulletin show that industrial workers have about twice the lung cancer death rate of middle class people. For all cancers industrial workers have a 38% higher death rate.
Government agencies have in general done a wretched job in protecting workers’ health. The Occupational Health and Safety Administration is in charge of inspecting plants to make sure they meet Federal Standards. But O.S.H.A. receives funds to hire sufficient inspectors so that each workplace can be visited on the average once in 284 years. The head of the agency, George Guenther, a former textile executive, has repeatedly expressed concern that complaints by workers may not be responsible.
But even if Federal Standards were strictly enforced there still would be many occupationally induced cancers. Many threshold limits (the maximum permissible concentration in air) are set at levels convenient to the corporations, levels known to be high enough to produce some cancers. Many other chemicals are introduced annually into the industrial environment without any knowledge of their toxicity. The general philosophy of setting standards for toxic chemicals, is that the chemical is assumed safe until someone can prove it dangerous. Dr. H.E. Stockinger, chief of the Laboratory of Toxicology for the National Institute for Occupational Health and Safety, summed up this view in a recent Science Magazine article. According to Stockinger, unrealistic standards are ruinous to industry, unnecessarily severe standards must be avoided, and all criteria must be completely documented. Since Stockinger opposes reliance on animal data, the only method of documenting a standard completely that is acceptable to him, is to find numerous deaths among people exposed to the chemical.
The handling of the asbestos hazard is a good illustration of this philosophy in action. For a long time asbestos had been suspected of producing cancer, but its potential as a carcinogenic agent had not been considered in establishing the former threshold limit value. A recent study of asbestos workers in New York revealed lung cancer rates 7 to 10 times that of the population in general, as well as significantly elevated rates for other types of cancers. The response of 0.5 .H.A. was to cut the permissible concentration of asbestos in industrial air by 60%. Experts in occupational health think that this change will do little or no good at all in preventing cancer deaths. Since the cancer rate was so high to begin with, a 99% reduction would be appropriate. Union people now want the standard cut by another 60%, but think that a permissible level of 0 is both feasible and necessary. The O.S.H.A. apparently thinks that any further protection for the 5 million workers exposed to asbestos, is too expensive for the corporations involved. A recent inspection of a plant in Texas uncovered asbestos air concentrations fifteen times that permitted by present law. The O.S.H.A. cracked down, imposing a $300 fine.
Uranium miners have met a similar fate at the hands of a different Government agency, the Atomic Energy Commission. They have had lung cancer rates just a little lower than those of the asbestos workers. The Atomic Energy Commission bitterly fought against any cuts in radiation standards, and even commissioned the Arthur D. Little Company to study the economic impact of lower standards on corporations using uranium. Indeed the study did reveal that better health for miners would cost the companies something, but would not be prohibitive. The result is a somewhat lower permissible level of radiation exposure. But this level is still so high that biophysicist john Gofman estimates that a miner exposed to the permissible level of radiation for twenty years will have his risk of contracting cancer doubled. In general Government efforts to prevent occupational cancers have been something short of an all out attack on cancer.
Some additional recent studies have revealed the inadequacy of current standards. Coke workers at a steel plant were found to contract bladder cancer at eight times the rate of the general population. Standards on the relevant carcinogens were enforced, but they are outrageously inadequate. At a chemical plant in Redwood City six lung cancer cases among workers have been attributed to exposures to bichromethyl ether. These few studies indicate only a small fraction of the cancer cases caused by the present system of dealing with health hazards.
Uterine cancer, the second biggest cancer among the cancers that affect women, is another significant disease to consider. Women in the lower economic groups bear the brunt of the disease, with death rates from three to ten times greater than women in higher economic groups. For example in New York a study showed that black people have more than three times the incidence of uterine cancer than for white people. Overall death rates in the U.S. for non-whites are about twenty percent higher than for whites. For Puerto Ricans the ratio is about seven to one. A study in Britain revealed that wives of laborers have three times the risk of contracting uterine cancer than British women in general have, while wives of professional men have only one fifth the risk of the general population.
Some moralistic and right wing doctors have blamed this situation on the promiscuity of the lower classes. The truth is that uterine cancer is strongly correlated with prostitution, venereal disease, vaginal infection, and improper hygiene. A rise in the standard of living for poor people, with an accompanying increase in access to good medical care and information, would be a significant step in preventing uterine cancer. The general elimination to the oppression of women in our society would also be a giant move toward eliminating uterine cancer deaths. In an article in “Prevention of Cancer” (Butterworth, 1967) Dr. R.I.K. Elliot estimates that 80% of the incidence of uterine cancer could be eliminated through the improvement of hygiene.
Cancer of the uterus is also one cancer that responds to treatment. If detected early enough, an estimated 50% to 95% of the cases can be cured. But many poor women are not screened regularly, and would have no access to treatment if cancer were found. Clearly many, or most uterine cancer deaths could be eliminated through social change, and the extension of existing medical methods to everyone.
There are many other known or suspected cancer producing hazards affecting Americans. In most cases the appropriate Government agency cannot obtain sufficient funds to make a proper check of the carcinogenic potential of the hazard. Apparently this is because a positive result would require action not to the liking of some corporation. The Nixon Administration has put up about $30 million to study environmental carcinogens, but in “Evaluation of Environmental Carcinogens” (U.S:P.H.S. Report to the Surgion General, April 22, 1970) it is estimated that $1 billion is needed to test adequately carcinogens now affecting people. Moreover 25 new chemicals are added to the environment daily.
Cancer, like many other health problems results in large measure from the environmental and social conditions in which people live. Its solution requires social change, not merely the great American know-how that is advertised as the cure to all our problems. People will have to get together and use their political power if they want to deal with the problem.