Richard W. Clapp

Chemicals Policy in the 2008–2009 President's Cancer Panel Report

The Presidents Cancer Panel 2008–2009 report, Reducing Environmental Cancer Risk: What We Can Do Now, was a watershed event in the U.S. chemicals policy process. The report, which was released after two years of public meetings and input from a variety of scientists and organizations, concluded that the national cancer program has not adequately addressed “grievous harm” from chemical carcinogens. Consistent with public health principles, it recommended that a prevention-oriented approach to regulating chemicals should replace the current “reactionary” approach. Various responses of cancer organizations and spokespeople in the aftermath of the release of the report are described. The report explicitly supports the type of policy reform contemplated in the Toxic Chemicals Safety Act of 2010, which failed to pass in the 111th Congressional session. In the absence of meaningful action at the federal level, the report will still provide strong support for state and local policy initiatives in coming years.

Full cost accounting for the life cycle of coal.

Each stage in the life cycle of coal—extraction, transport, processing, and combustion—generates a waste stream and carries multiple hazards for health and the environment. These costs are external to the coal industry and are thus often considered “externalities.” We estimate that the life cycle effects of coal and the waste stream generated are costing the U.S. public a third to over one‐half of a trillion dollars annually. Many of these so‐called externalities are, moreover, cumulative. Accounting for the damages conservatively doubles to triples the price of electricity from coal per kWh generated, making wind, solar, and other forms of nonfossil fuel power generation, along with investments in efficiency and electricity conservation methods, economically competitive. We focus on Appalachia, though coal is mined in other regions of the United States and is burned throughout the world.

Occupational exposure to 60-Hertz magnetic fields and risk of breast cancer in women

&NA; We used data from a large population‐based case‐control study to test the hypothesis that women whose “usual occupation” entailed exposure to higher than background 60‐Hz magnetic fields had a higher risk of breast cancer than women without such exposure. Breast cancer cases were identified from four statewide tumor registries, and controls were randomly selected from lists of licensed drivers and Medicare beneficiaries. Information on usual occupation and breast cancer risk factors was obtained by telephone interview. We calculated adjusted odds ratios from logistic regression models for women holding occupations with potential for low, medium, or high magnetic field exposure, compared with background exposure. There was a modest increase in risk for women with potential for high exposure [odds ratio (OR) = 1.43; 95% confidence interval (CI) = 0.99‐2.09], and no increase for women with potential for medium (OR = 1.09; 95% CI = 0.83‐1.42) or low (OR = 1.02; 95% CI = 0.91‐1.15) exposure. The risk among premenopausal women in the highest‐exposure category was higher (OR = 1.98; 95% CI = 1.04‐3.78) than for postmenopausal women (OR = 1.33; 95% CI = 0.82‐2.17).

Strenuous physical activity in young adulthood and risk of breast cancer (United States).

The epidemiologic data on the relation between strenuous physical activity and breast cancer are limited and inconsistent. Because risk of breast cancer may be influenced by ovarian function which, in turn, is modulated by physical activity, the hypothesis that exercise may be associated with a reduced risk of breast cancer merits further investigation. We, therefore, conducted a large case-control study in 1988–91, and interviewed 6,888 women (17 to 74 years of age) with breast cancer in Maine, Massachusetts, New Hampshire, and Wisconsin (United States). Interviewed controls (9,539 women, 18 to 74 years of age) were selected randomly from lists of licensed drivers (for younger women) or from a roster of Medicare enrollees (for older women). We used multivariate adjusted odds ratios (OR) and 95 percent confidence intervals (CI) from logistic regression models to estimate relative risks between self-reported physical activity when 14 to 22 years of age and breast cancer. When compared with sedentary controls, women who reported any strenuous physical activity during ages 14 to 22 years had a modest reduction in the risk of breast cancer (OR=0.95, CI=0.93–0.97). However, those who exercised vigorously at least once a day had a 50 percent reduction in risk of breast cancer (OR=0.5, CI=0.4–0.7). These data support the hypothesis that women who are physically active have a reduced risk of breast cancer.

Use of health services before the diagnosis of melanoma: implications for early detection and screening.

Objective:To determine whether persons with melanoma were integrated into the health care system prior to diagnosis.Design:Population-based survey by mailed questionnaire.Patients/participants:216 persons with malignant melanoma diagnosed in Massachusetts in 1986.Main results:Of the 216 cases, 87% stated that they had regular physicians, 63% had seen those physicians in the year prior to diagnosis, but only 20% had regular dermatologists. Overall, only 24% had examined their own skin prior to diagnosis and 20% reported physician skin examinations.Conclusions:Persons diagnosed with melanoma reported extensive contact with regular physicians in the year prior to diagnosis. However, most of these persons neither received skin examinations nor examined their own skin during that time. While additional study is necessary to confirm these findings, the authors suggest that physicians caring for patients at risk for melanoma integrate melanoma screening into routine care.

Physical activity in usual occupation and risk of breast cancer (United States)

We have used data from a large population-based case-control study inthe United States to evaluate the effect of occupational physical activity onbreast cancer risk. Women diagnosed with breast cancer identified from fourstate cancer registries, and controls randomly selected from lists oflicensed drivers or Medicare beneficiaries, were interviewed by telephone forinformation on usual occupation and other factors. We classified usualoccupation into one of four categories of physical activity. After excludingsubjects for whom a strength rating could not be assigned, we had a finalsample size of 4,863 cases and 6,783 controls. Using conditional logisticregression models, we calculated adjusted odds ratios (OR) and 95 percentconfidence intervals (CI) for occupations having light, medium, and heavyactivity compared with sedentary ones. Women with heavy-activity occupationshad a lower risk of breast cancer than women with sedentary jobs (OR = 0.82,CI = 0.63-1.08), as di d women with jobs with medium activity (OR = 0.86, CI= 0.77-0.97) or light activity (OR = 0.92, CI = 0.84-1.01). There was asignificant decreasing trend in the ORs from sedentary to heavy work (P =0.007). Although limited by exposure misclassification, these data areconsistent with the hypothesis that physical activity reduces the risk ofbreast cancer.

Cutaneous melanoma mortality among the socioeconomically disadvantaged in Massachusetts.

OBJECTIVES To identify groups for melanoma prevention and early detection programs, this study explored the hypothesis that survival with cutaneous melanoma is disproportionately lower for persons of lower socioeconomic status. METHODS Massachusetts Cancer Registry and Registry of Vital Records and Statistics data (1982 through 1987) on 3288 incident cases and 1023 deaths from cutaneous melanoma were analyzed. Mortality/incidence ratios were calculated and compared, predictors of late stage disease were examined with logistic regression analysis, and a proportional hazards regression analysis that used death registration as the outcome measure for incident cases was performed. RESULTS Lower socioeconomic status was associated with a higher mortality/incidence ratio after adjustment for age and sex. For education, the mortality/incidence ratio was 0.37 in the lower group vs 0.25 in the higher group (rate ratio = 1.48, 95% confidence interval [CI] = 1.08, 2.03). Late stage disease was independently associated with lower income (rate ratio for lowest vs highest tertile = 1.64, 95% CI = 1.20, 2.25), and melanoma mortality among case patients was associated with lower education (rate ratio = 1.52, 95% CI = 1.09, 213). CONCLUSIONS Melanoma patients of lower socioeconomic status may be more likely to die from their melanoma than patients of higher socioeconomic status. Low- SES communities may be appropriate intervention targets.

Melanoma Epidemic: An Analysis of Six Decades of Data From the Connecticut Tumor Registry

PURPOSE Melanoma is the most commonly fatal form of skin cancer, with nearly 50,000 annual deaths worldwide. We sought to assess long-term trends in the incidence and mortality of melanoma in a state with complete and consistent registration. METHODS We used data from the Connecticut Tumor Registry, the original National Cancer Institute SEER site, to determine trends in invasive melanoma (1950-2007), in situ melanoma (1973-2007), tumor thickness (1993-2007), mortality (1950-2007), and mortality to incidence (1950-2007) among the 19,973 and 3,635 Connecticut residents diagnosed with invasive melanoma (1950-2007) and who died as a result of melanoma (1950-2007), respectively. Main outcome measures included trends in incidence and mortality by age, sex, and birth cohort. RESULTS In the initial period (1950-1954), a diagnosis of invasive melanoma was rare, with 1.9 patient cases per 100,000 for men and 2.6 patient cases per 100,000 for women. Between 1950 and 2007, overall incidence rates rose more than 17-fold in men (1.9 to 33.5 per 100,000) and more than nine-fold in women (2.6 to 25.3 per 100,000). During these six decades, mortality rates more than tripled in men (1.6 to 4.9 per 100,000) and doubled in women (1.3 to 2.6 per 100,000). Mortality rates were generally stable or decreasing in men and women through age 54 years. CONCLUSION Unremitting increases in incidence and mortality of melanoma call for a nationally coordinated effort to encourage and promote innovative prevention and early-detection efforts.

Systematic underreporting of cutaneous malignant melanoma in Massachusetts: Possible implications for national incidence figures

An independent tabulation of incidence of cutaneous malignant melanoma in Massachusetts indicates that 12% and perhaps as many as 19% of new cases of cutaneous malignant melanoma in Massachusetts are not recorded in the Massachusetts Cancer Registry, significantly more than the expected 5% (p = 0.0001). The increasing number of nonhospital medical settings in which melanomas can be diagnosed and/or treated appears to account for this discrepancy. We suspect that these findings in Massachusetts also apply to cancer reporting systems in other regions of the United States. We suggest that the true incidence of cutaneous malignant melanoma in Massachusetts, and perhaps in the United States, may be significantly higher than reported.

Differences in the carcinogenic evaluation of glyphosate between the International Agency for Research on Cancer (IARC) and the European Food Safety Authority (EFSA)

The International Agency for Research on Cancer (IARC) Monographs Programme identifies chemicals, drugs, mixtures, occupational exposures, lifestyles and personal habits, and physical and biological agents that cause cancer in humans and has evaluated about 1000 agents since 1971. Monographs are written by ad hoc Working Groups (WGs) of international scientific experts over a period of about 12 months ending in an eight-day meeting. The WG evaluates all of the publicly available scientific information on each substance and, through a transparent and rigorous process,1 decides on the degree to which the scientific evidence supports that substances potential to cause or not cause cancer in humans. For Monograph 112,2 17 expert scientists evaluated the carcinogenic hazard for four insecticides and the herbicide glyphosate.3 The WG concluded that the data for glyphosate meet the criteria for classification as a probable human carcinogen . The European Food Safety Authority (EFSA) is the primary agency of the European Union for risk assessments regarding food safety. In October 2015, EFSA reported4 on their evaluation of the Renewal Assessment Report5 (RAR) for glyphosate that was prepared by the Rapporteur Member State, the German Federal Institute for Risk Assessment (BfR). EFSA concluded that ‘glyphosate is unlikely to pose a carcinogenic hazard to humans and the evidence does not support classification with regard to its carcinogenic potential’. Addendum 1 (the BfR Addendum) of the RAR5 discusses the scientific rationale for differing from the IARC WG conclusion. Serious flaws in the scientific evaluation in the RAR incorrectly characterise the potential for a carcinogenic hazard from exposure to glyphosate. Since the RAR is the basis for the European Food Safety Agency (EFSA) conclusion,4 it is critical that these shortcomings are corrected. EFSA concluded ‘that there is very limited evidence for an association between glyphosate-based formulations …