Cancer Is an Environmental Problem

​“In my experience, the attitude of most clinicians and cancer researchers is that environmental causes of cancer are not very important. That was certainly my attitude.” This was how doctor and cancer researcher Margaret Kripke began her presentation at the Cancer and Environment Forum in March. The forum, held jointly by several major U.S. cancer research centers, was meant to inform practicing clinicians about the everyday exposures that can increase a person’s likelihood of developing cancer. ​“My outlook on this subject changed very dramatically when I was a member of the President’s Cancer Panel,” said Kripke, who served on the panel in 2010. That year, the panel produced its first ever report on environmental causes of cancer. Kripke continued, ​“What I learned from this exercise was absolutely shocking to me.”

That 2010 report found that environmental exposures play a larger role in cancer formation than once believed by clinicians, and that these cancer risks are especially dangerous to children. Since then, researchers have narrowed their estimate: 70% to 90% of cancer development is driven by non-genetic, environmental factors. These can be factors like smoking or diet, but, as Kripke and her colleagues are focused on, also things like air quality and repetitive exposure to chemicals used in workplaces and homes.

In February of this year, President Joe Biden announced the relaunching of Cancer Moonshot, a funding initiative he originally spearheaded while vice president in 2016. The relaunch aims to gain congressional support around the goal of cutting cancer death rates in the United States in half in the next 25 years. The role of environmental risk factors is being acknowledged in this effort: The relaunching included the formation of an advisory ​“Cancer Cabinet,” which includes representatives from agencies like the Environmental Protection Agency and Food and Drug Administration. In his March State of the Union Address, Biden acknowledged the probable role that toxic smoke from military burn pits played in his own son’s cancer, and announced a Veterans Affairs rule streamlining access to medical care for veterans with cancers that research has linked to these pits.

But in the President’s proposed 2023 budget, no funds were earmarked for the National Institute of Environmental Health Sciences (NIEHS), the leading agency in researching environmental cancer risks, responsible for breakthroughs in toxicology research methods. Its parent agency, the National Institutes of Health, which houses 27 other institutes and centers including NIEHS, only received an overall $275 million increase in discretionary funding in the proposed budget. Ruthann Rudel of the Silent Spring Institute, a breast cancer research center that receives NIEHS funding, says that money for research on environmental causes of cancer is sorely needed. The studies are complex, requiring large samples of participants, followed for years at a time, to understand the consequences of being exposed.

A difficulty in performing this research is that basic information about potential carcinogens is missing. Kripke, who serves on the Silent Spring Institute’s board of directors, attributes this lack of information to the under-regulation of the industries that produce these chemicals in the first place. ​“We in this country operate on the basis of something called the reactionary principle for chemical production,” Kripke explains. ​“If it causes harm, then we regulate it, or remove it from the marketplace.”

But proving harm in the absence of regulation can be an uphill battle. That’s the challenge that the community of east Oakland, Calif. faced. At the end of last year, Communities for a Better Environment (CBE), an environmental justice group, sued a local facility, AB&I Foundry, over its emission of hexavalent chromium, a known carcinogen. While residents have been vocal about the high rates of health issues in their community, the lawsuit against the foundry was only possible after the passage of a local air quality district rule that required the district to assess all the health risks posed by the entire facility, rather than only the parts being regulated. That assessment found that the largest cancer risk AB&I Foundry produced was hexavalent chromium pollution being vented into the atmosphere. The machinery that produced the hexavalent chromium was exempt from permitting at the time of installation, and thus its pollution had never been officially tracked.

Until this, the only carcinogenic pollution officially being monitored from the foundry was lead. Esther Goolsby, an organizer with CBE, says that even though she has lived near the foundry for the past 30 years, she was not aware of what she and her neighbors were being exposed to until she joined CBE. ​“And knowing, only when I got older, what was there, and reflecting just on how it affects my children when growing up, and then all of the community that was there. And there are two elementaries, and a library. So, thinking about how long this has been going on — and we’re only just now getting action.”

The air quality district’s assessment would have been the first step in a multi-year process of bringing all of AB&I Foundry’s operations into regulation. Tyler Earl, a lawyer for CBE, says that the organization was pushing for the foundry to install abatement technology on the machinery to reduce its pollution. Instead, in March of this year, AB&I Foundry announced that it would be moving its entire operation to Texas. CBE did not interpret this is a win: Goolsby’s response was, ​“In Texas, they’re just going to go to another community and put toxins there.” AB&I Foundry cited increasing regulatory standards for its move. Earl said that the decision ​“underscored the importance of a just transition for workers at facilities such as this where the communities — particularly the black and brown folks who surround industrial facilities — have been paying the price for companies’ profits.”

Historically, environmental cancer risks were studied in unionized industrial settings, Rudel says, which often had centralized healthcare, detailed employment records, and advocates for workers, all of which fostered collaboration with research teams. But last year, the Bureau of Labor Statistics reported that only about one in 10 working Americans belonged to a union, a record low.

Worker organizing in any form still plays an essential role in the success and continuation of public health research. For example, Rudel co-leads the Women Workers Biomonitoring Collaborative, a research collaboration that studies occupational cancer risks for female firefighters, nurses and office workers. She attributes the collaboration’s existence to the employee advocacy groups that were the first to raise alarm bells about cancer similarities in coworkers. ​“But for many situations where people are exposed, including at work,” Rudel warns, ​“we don’t have that, and we will never have that. And so, we’ll never be able to study what came of those exposures.”

Deysi Flores, an organizer for the nonprofit Make the Road New York (MRNY), co-leads the Safe and Just Cleaners research partnership, which produces research on the health risks posed to household cleaners by cleaning products. Flores says that where the organization’s studies struggle to find funding is for all the associated programming and workplace advocacy that keeps workers engaged in the study. When organizing participants for Safe and Just Cleaners, in a profession often paid under the table, MRNY faced the challenge of connecting undocumented participants with preventative healthcare, so that they then could even participate in the research.

After that organizing experience, MRNY made universal healthcare coverage in New York a policy priority. Flores says, ​“What we see in the communities that we represent is that the most vulnerable workers are day laborers, those who are not having the most ideal worker protections. That means we must do a better job to include those workers into these processes of regulating the safety of the workplace.”