Don’t Be Fooled by the Limelight on Lifestyle as a Cancer Risk

Laura Orlando August 11, 2017

One hundred years after the first world war, more than 80,000 chemicals are registered for industrial use in the United States and an estimated 2,000 new ones are introduced each year.

Chem­i­cal com­pounds that inca­pac­i­tate or kill, like phos­gene, chlo­rine and sul­fur mus­tard, were put into Ger­man artillery shells and deliv­ered by how­itzers on the front­lines in World War I. The diam­e­ter of the shells was 5.9 inch­es, prompt­ing British sol­diers to call them five-nines.” By the end of the war, both sides were lob­bing them. Whether or not a five-nine loaded with a chem­i­cal weapon land­ed in your trench had noth­ing to do with luck or lifestyle. War cre­at­ed the con­di­tions for the expo­sure to the chemicals.

By the end of World War II, chem­i­cal man­u­fac­tur­ers like DuPont, Shell and Mon­san­to shift­ed their mil­i­tary pro­duc­tion to the domes­tic war on pests.” At the Rocky Moun­tain Arse­nal out­side of Den­ver, the U.S. Army’s Chem­i­cal Corps made chem­i­cal weapons along­side pri­vate chem­i­cal com­pa­nies like Shell Oil Com­pa­ny, which leased Army facil­i­ties at RMA to make pesticides.

Today the U.S. chem­i­cal man­u­fac­tur­ing indus­try is an $800 bil­lion busi­ness that has reg­is­tered over 80,000 chem­i­cals for use in the Unit­ed States, with 2,000 new ones intro­duced each year. You and I are repos­i­to­ries for these chem­i­cals. Toss your cig­a­rettes in the trash bin, but you’re still breath­ing ben­zene from vehi­cle exhaust and indus­tri­al emis­sions. The Cen­ters for Dis­ease Control’s Fourth Nation­al Report on Human Expo­sure to Envi­ron­men­tal Chem­i­cals, issued in 2009 with updat­ed data in 2017, looked for 308 syn­thet­ic chem­i­cals in the blood or urine of Amer­i­cans. Most were wide­ly detected. 

Some, like per­chlo­rate, which can cause endocrine sys­tem and repro­duc­tive prob­lems and is con­sid­ered by the EPA to be a like­ly human car­cino­gen,” was found in the urine of every­one test­ed. With unavoid­able expo­sures to tox­i­cants at every stage of life, stop­ping the sys­temic poi­son­ing of our food, water, air, and soil is fun­da­men­tal to giv­ing indi­vid­u­als a decent chance to opti­mize their own health.

In 2017, more than 1.6 mil­lion peo­ple will be diag­nosed with can­cer in the Unit­ed States. A small per­cent­age of these can­cers can be attrib­uted to genet­ic trou­bles, where­as the remain­ing 90-to-95 per­cent of can­cers are from influ­ences out­side the body that change what hap­pens inside — some of which you can con­trol and some you can­not. Those that we are told we can con­trol, such as cig­a­rette smok­ing, diet, alco­hol, sun expo­sure, stress, obe­si­ty, and phys­i­cal inac­tiv­i­ty, are labeled lifestyle fac­tors,” or lifestyle for short. 

An indi­vid­ual through their actions can help man­age cancer’s progress or low­er the risk of get­ting can­cer in the first place; assum­ing one has the time, mon­ey, edu­ca­tion and job options that allow one to make choic­es and know what choic­es to make.

Yet an empha­sis on lifestyle always seems to come at the expense of mean­ing­ful pub­lic pol­i­cy dis­cus­sions. It diverts pub­lic atten­tion from the col­lec­tive prob­lem solv­ing and soci­etal deci­sion-mak­ing process­es about how chem­i­cals can, and under what con­di­tions, cause harm, and what to do about it.

(Illus­tra­tion: Haz­ards Mag­a­zine)

A 2015 Cal­i­for­nia study that con­sist­ed of a 54-year fol­low-up of 20,754 preg­nan­cies showed that women exposed in the womb to high lev­els of the pes­ti­cide DDT have a near­ly four­fold increased risk of devel­op­ing breast can­cer. At its peak use in 1962, over 85,000 tons of the pes­ti­cide were used. A child in her moth­er’s womb exposed to the chem­i­cal had no choice in the mat­ter. It is the respon­si­bil­i­ty of soci­ety, not the indi­vid­ual, to con­trol can­cer-caus­ing chem­i­cals.

So here we are, 100 years after World War I, and every Amer­i­can lacks pro­tec­tions from chem­i­cals man­u­fac­tured or used by U.S. cor­po­ra­tions that degrade human health. Rory O’Neill, a pro­fes­sor of occu­pa­tion­al and envi­ron­men­tal health pol­i­cy at the Uni­ver­si­ty of Stir­ling, Scot­land, who is an edi­tor of Haz­ards Mag­a­zine and the Work Can­cer Haz­ards blog, tells us not to be fooled by the lime­light on lifestyle for can­cer risk. In the fol­low­ing post, slight­ly edit­ed, he writes:

There are sev­er­al prob­lems with the empha­sis on lifestyle, for a slew of chron­ic dis­or­ders, from can­cer, to dia­betes, to car­dio­vas­cu­lar dis­ease, to neu­ro­log­i­cal dis­ease, to…. Heck, all of them, and you can add in men­tal ill­ness and sui­cide on top. This is not because the lifestyle effects are not real, but because:

It’s a smoke­screen 1: Where research shows gen­uine con­cerns about occu­pa­tion­al and envi­ron­men­tal risks, the find­ings are ques­tioned regard­less of the strength of the evi­dence, and there is a cook­ie cut­ter response that says lifestyle is the real prob­lem. This is dri­ven by a berserk­ly well-resourced can­cer indus­try sell­ing this line, a process described well by Devra Davis, Janette Sher­man, Joe LaDou and a noble suc­ces­sion of others

It’s a smoke­screen 2: Where research ques­tions a link, there is a cho­rus of let’s put this occu­pa­tion­al and envi­ron­men­tal red her­ring behind us, and there is a cook­ie cut­ter response that says lifestyle is the real prob­lem. Wit­ness what hap­pened with the recent (and woe­ful) Oxford Uni­ver­si­ty paper dis­miss­ing the night work and breast can­cer risk. This was wide­ly and uncrit­i­cal­ly report­ed in the media. A BBC head­line blared Breast can­cer risk not increased’ by night shifts.” When pos­i­tive find­ings are pub­lished, link­ing a chem­i­cal or work­place to can­cer, this nev­er hap­pens — the lifestyl­ists are wait­ing in the wings with their rebut­tal every time. (For more infor­ma­tion about night shifts and breast can­cer, and a crit­i­cal review of the Oxford Uni­ver­si­ty paper, see this sto­ry.

It’s your fault. When chang­ing lifestyle is invoked as the key to pre­ven­tion, the tone is gen­er­al­ly one of blame — you have the wrong diet, you drink too much alco­hol, you smoke, you don’t exer­cise. But these are con­se­quences, not caus­es. Low wages, bad jobs, under-employ­ment, unem­ploy­ment, inse­cu­ri­ty, and being born into and trapped in the low­er socioe­co­nom­ic stra­ta are the prob­lems that need address­ing. These cir­cum­stances dri­ve bad habits by remov­ing pos­i­tive choic­es. For exam­ple, you may have to choose” processed, sug­ar-laden foods if your bud­get and your long hours in mul­ti­ple min­i­mum wage or less jobs may the alter­na­tive prac­ti­cal­ly impossible.

Over­loaded, stressed work­ers smoke and are more like­ly to demon­strate all the oth­er bad habits. Put them on the night shift with no access to decent food and no prospect of decent sleep pat­terns and you soup up the effect. Add in prej­u­dice based on gen­der or race, and you ampli­fy these effects. With­out look­ing at the socioe­co­nom­ic dri­vers of peo­ples’ choic­es,” blam­ing lifestyle just adds insult to injury.

Sci­ence is biased: Pub­licly fund­ed inde­pen­dent occu­pa­tion­al and envi­ron­men­tal health sci­ence — by either aca­d­e­mics or statu­to­ry agen­cies — is becom­ing rare. Research is increas­ing­ly (and fre­quent­ly covert­ly) fund­ed by indus­tries moti­vat­ed by con­cerns about the legal impli­ca­tions of med­ical research and not con­cerns about pub­lic health. Wit­ness the 40-year wait for the new U.S. beryl­li­um stan­dard, which was intro­duced in March 2016; the res­pirable sil­i­ca stan­dard; the sci­ence-fraud” and ongo­ing defense of chrysotile asbestos use (only just banned in Cana­da, and thanks to indus­try lob­by­ing still legal in the Unit­ed States); denial of low lev­el ben­zene expo­sures caus­ing can­cers (thanks ACS — Amer­i­can Can­cer Soci­ety); the links between Parkin­sons and man­ganese; lack of reg­u­la­tion of endocrine dis­rupt­ing chem­i­cals; and the list goes on.

The tobac­co industry’s play­book gets bounced from one indus­try to the next, with the high­ly remu­ner­a­tive process of seed­ing doubt enough to per­pet­u­ate anoth­er gen­er­a­tion of expo­sures and anoth­er decade or two of profits.

The issue is not whether or not we own up to the real role that lifestyle fac­tors play in caus­ing can­cer. It is that we under­stand how the lifestyle excuse is used to dimin­ish or deny the role played by indus­try, by social prej­u­dice and by eco­nom­ic dis­ad­van­tage in per­pet­u­at­ing the cir­cum­stances that lead to many can­cers and that influ­ence can­cer sur­vival rates. Yet when we raise these issues we are shout­ed down and we are finan­cial­ly out-gunned by the same cor­po­rate inter­ests that ben­e­fit from the can­cer sta­tus quo.

It’s your choice, red tape or bloody ban­dages.” — Rory O’Neill, edi­tor of Haz­ard Mag­a­zine, talks com­pla­cent gov­ern­ment, health and safe­ty, labor and exploita­tion at a con­fer­ence in 2013. (Video: Phillip Lewis / YouTube)

Lau­ra Orlan­do is a mem­ber of the Rur­al Amer­i­ca In These Times Board of Edi­tors. She is a civ­il engi­neer and teach­es in the envi­ron­men­tal health depart­ment at the Boston Uni­ver­si­ty School of Pub­lic Health. Lau­ra grew up on a farm near Ben­ton Har­bor, Michi­gan. She is a grad­u­ate of the Uni­ver­si­ty of Michi­gan and the Har­vard Kennedy School of Government.
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