The High Stakes of Cancer Prevention
Samuel S. Epstein and Liza Gross
Samuel S. Epstein, M.D., is a professor of occupational and environmental medicine at the University of Illinois Medical Center and the author of ten books including The Politics of Cancer. Liza Gross is a science and environmental health writer.
It's hard to find someone these days who hasn't had firsthand experience with cancer. Watching friends, neighbors, and loved ones struggle with the disease, more and more Americans sign up for walks, races, and donation pledges, hoping to help find the magic bullet--a cure. That cure, we hear again and again, is just around the corner. And now, for the first time since President Richard Nixon launched the war on cancer in 1971, public officials are talking about an all-out effort to wipe out the disease in our lifetime. After all, this is an election year, and cancer makes good politics. Who can argue against fighting cancer?
The question is how we go about it. Presidential hopeful Al Gore unveiled a plan in June 1999 to assure "revolutionary progress in preventing, detecting, and treating cancer in the 21st century." This past June he promised to double federal funding on cancer research to prevent and cure the most fatal cancers. Senator Dianne Feinstein (D-Calif.) launched her own cancer initiative last year, calling for a rehaul of the 1971 National Cancer Act through bipartisan legislation that "fully exploits current scientific opportunity and progress in the fight against cancer."
Both politicians have a very personal stake in the cancer debate. Gore lost his sister to lung cancer, an experience he described in grim detail in his famous 1996 Democratic National Convention speech. Feinstein lost her first husband to colon cancer, as well as many other family members and close friends to other forms of the disease. Yet, however well intentioned these initiatives are, neither proposal challenges the fundamental direction of the national cancer agenda. Gore's five-step plan makes no mention of preventing cancer until step four. Most of this "prevention" plank misleadingly focuses on improving access to screening tests and proposes campaigns limited to changing lifestyle habits and stopping children from smoking. Nowhere does Gore's proposal call for reducing or eliminating exposure to known carcinogens in our air, food, and water, in our consumer products (both personal care and household goods), or in our workplaces. Feinstein's initiative promises "to be as inclusive as possible in seeking input from the widest range of diverse sources," yet control of her proposal rests largely with the old guard of the cancer establishment, primarily represented by the American Cancer Society and the National Cancer Institute.
The cancer establishment has a long history of trivializing or ignoring prevention initiatives while claiming major gains in the war on cancer. Both the National Cancer Institute (NCI) and the American Cancer Society (ACS) are fixated on damage control--screening, diagnosis, and treatment--and genetic research, and are largely indifferent to cancer prevention. For the American Cancer Society, that indifference approaches outright hostility. What the cancer establishment calls prevention is more aptly described as a "blame-the-victim" approach, emphasizing poor lifestyle habits while downplaying the role of avoidable exposures.
The cancer establishment has been most negligent in its failure to provide Congress, regulatory agencies, and the public with well-documented scientific evidence of known cancer risks. This information is essential for Congress if it is to protect the public by legislating or banning the addition of recognized carcinogens, from food additives to pesticides. Regulatory agencies need it to create standards for a wide range of industrial carcinogens and, as citizens, we have a right to know about and to protect ourselves from dangerous chemicals that contaminate our food, air, water, and consumer goods. …