By Jean English
“How do you explain,” asked Sharon Tisher of MOFGA’s Public Policy Committee, “that cancer in this country has increased since 1950 by 35%, excluding lung cancer?” Introducing a teach-in on cancer and the environment at the Common Ground Country Fair in September, Tisher cited a Bangor Daily News article stating that Maine ranks seventh in the country in cancer. “This is a death rate, not an incidence rate,” Tisher explained. “Unfortunately, the reporting of cancer is so variable from state to state that the U.S. government does not rank states for incidence (how often people get cancer), but they do rank for how many people die from cancer. For the 25-year period from 1973 to 1999, for men and women together, for all types of cancer, Maine ranked seventh in the country. This is not ‘the way life should be.’”
For women’s deaths from cancer from 1973 to 1999, Tisher continued, Maine ranked third – above Louisiana, home of Cancer Alley; above New Jersey. She noted that connections are known between cancer and obesity, and between cancer and tobacco products. She had gathered five teach-in panelists to discuss connections between cancer and the environment.
|Dr. Rebecca Van Benenden presented a primer on cancer at the Common Ground Country Fair teach-in on cancer and the environment. English photo.|
A Primer on Cancer
Dr. Rebecca Van Benenden from the University of Maine defined cancer as “a disease entity in which the fundamental rules of cell behavior break down. We are multicellular organisms, made of many different types of cells, and we all start out from an egg and a sperm cell that [unite and then] divide and divide … and then change,” so that eyes, hair, arms, legs, etc., are formed. “But each one of our cells actually has the same DNA, the same genetic material. So cells … need to know how to divide at the right time to survive in context to their surrounding cells, to their environment, to change or differentiate to become the specialized cell that it becomes.”
Cancer is a general term for more than 200 diseases in humans alone, affecting more than 35 tissues and organs in our bodies. “So we are classifying all these types of diseases by one name that means uncontrollable growth: Cells are not responding to signals the way they should.”
Van Benenden defined a tumor as a synonym for neoplasm, or new growth: “when cells become nonresponsive to growth control signals and they grow when they shouldn’t grow.” A tumor is a benign (harmless) growth, such as a wart, or less benign, such as squamous cell carcinoma, a type of skin cancer. These abnormal growths usually grow in only one site and can be excised and don’t spread.
“‘Cancer’ actually means a malignant growth – uncontrolled growth, but it goes beyond the site; it starts to invade places where it shouldn’t be.” Melanoma, for example, is a skin cancer in which cells grow down through the basal layer of skin and take on different properties that allow them to travel in the bloodstream, in the lymph system, set up sites in other places in the body and grow there.
“Development of cancer is a two-step process,” Van Benenden continued. “To overcome normal growth controls, something happens to the genetic material: a mutation occurs, a change in one of the chemical components of the DNA.” This mutation may give the cell some advantage over nearby cells, so that it outgrows its neighbors.” In the second step, progression, the cell grows more rapidly and does not respond to signals from the insular environment to stop. “It is changing, it becomes invasive again, and starts growing all through the body.”
Why don’t cells respond to normal controls? “The first thing that causes most cancers,” Van Benenden explained, “are spontaneous mutations, spontaneous changes in these chemical components of our genetic material. This happens way more often than you can possibly imagine. One type of change may occur 10,000 times in a cell in a day. The body has incredible systems of repair mechanisms that go in and repair this [before it can make any changes in the cell], so almost all the time you will never even notice it. This is [the] genetic component of your disease.”
The second component is environmental. Dioxin, for example, “actually works in the progression stage of cancers. It doesn’t cause mutations, but encourages these cells that have mutated to grow faster.”
Staying out of ultraviolet light is one way to prevent cancer. “Ultraviolet light is a very powerful mutagen and can cause genetic changes.” Also, viruses can change DNA or can increase one’s risk of developing mutations.
Three types of genes are important in cancer: First, oncogenes are positive growth regulators. “They have normal roles to stimulate a cell to grow. When these genes get changed, then the cell can become a cancer cell.”
Second, tumor suppressor genes are negative regulators of cell growth. Some classes of genes tell cells to grow, some tell them not to grow. “It’s this balance, keeping these things in context and responding correctly to signals from the environment, that tells your cell to grow at the right time, in the right place, and to change, to become the specific cell it is.”
Third, DNA repair genes – hundreds of them – fix spontaneous or environmentally produced mutations before cells can divide. Thus we are advised to eat a lot of foods with antioxidants, because oxidizing chemicals affect DNA repair. “If you can increase your supply of antioxidants, you help this repair process. This DNA repair system seems to fail as we get older.” These repair genes are probably knocked out in over half of human cancers by mutation and in all human cancers by other mechanisms. “Then all hell breaks loose. You have no brakes on your cells. They just keep dividing; they ignore those mutations in them.”
Benzo[a]pyrine, a potent carcinogen linked to cigarette smoking, removes an amino group from the base of DNA. “That site has been documented in this tumor suppressor gene.” Likewise, the powerful carcinogen aflatoxin B is found in mold. It was first discovered in moldy fish food that was causing tumors in fish. “A lot of people in Africa have a high incidence of liver cancer. A lot is linked to aflatoxin B1. This affects a particular place in a tumor suppressor gene.”
By starting to understand cancer at the molecular level, Van Benenden concluded, “we are starting to make the link between some of these chemical carcinogens, between ultraviolet light, and what’s happening in the cell.”
|Castine Verrill of the Maine Cancer Registry talked about cancer rates in Maine. English photo.|
Cancer Rates and Clusters in Maine
Castine Verrill, epidemiologist for the Bureau of Health’s Maine Cancer Registry, presented cancer statistics in Maine. The Maine Cancer Registry collects information on all of the cancer cases diagnosed in the state, as mandated by law. About 95% of the information comes from Maine’s 38 hospitals, which must report to the Registry quarterly. Information on cancer cases also comes from independent path labs; independent physicians’ offices; and death certificates. The information is used to calculate statistics on the county and state level. The Registry isn’t meant to find causes of cancer, but to identify areas where further research may be needed. “Larger groups, like the National Cancer Institute (NCI), do these studies,” said Verrill. Maine’s Registry is working with the NCI now on a study of bladder cancer incidence and mortality rates in the Northeast, which are higher than national rates.
In Maine, Verrill continued, age adjusted rates show that four cancers account for about 65% of all cancers in males: prostate, lung, colorectal and bladder. Two of these are very preventable: Smoking accounts for about 87% of lung cancers and for about 50% of bladder cancers. “Maine is one of the only states that have taken their funds from the tobacco settlement money and really used it to facilitate prevention of smoking and quitting smoking.”
Among women, breast, lung, colorectal and uterine cancers account for about 63% of cases. Screening “really helps detect” breast and colorectal cancers early so that effective treatments can be provided and mortality rates lowered.
From 1990 to 1998, the incidence (number of cases diagnosed) of cancer in males in Maine was generally lower than the national rate for males, but that just reversed. “The nation is dropping,” said Verrill, “but Maine is not making a lot of changes in the incidence rate.” The story for females is similar.
Maine’s mortality rate from all cancers is higher than the nationwide rate. The same is true for lung and colorectal cancer. “Because these two are so common, they really push that mortality rate up higher, especially with lung cancer,” explained Verrill. “In Maine, about 1000 people are diagnosed with lung cancer every year; of those, every year 900 die of lung cancer.” Asked whether smoking or radon was to blame, Verrill responded that about one-third of Maine’s homes have a radon level above the EPA standard, so radon “is a concern. But I think tobacco is more of a concern. From the early ’90s until about 1996, Maine’s smoking rate was a lot higher than the U.S. [rate]. It has only recently decreased.”
Verrill said that the Registry gets five or 10 calls a year about potential cancer clusters, but “a cancer cluster by definition is one cancer type, say leukemia, and is usually a very rare cancer, and usually occurring in an age group that you wouldn’t suspect” of having that cancer. Prostate, colorectal and breast cancers, she continued, are all very common cancers that have very different causes that may not be attributed to something specific in the environment, so many calls do not fit the definition of a cluster. Among those that the Registry has investigated, one – brain tumors in Fairfield citizens – did have a higher rate, but an environmental cause could not be found. “Even if we do find a high rate, finding the reason is really, really, really difficult … because cancer takes so long between the time you’re exposed to something and the time you get your cancer.” The Centers for Disease Control (CDC) used to investigate all questions of cancer clusters, and only 5% turned out to have a high rate; but the causes could not be found. Then the CDC turned such investigations over to the states, which don’t have the resources to do this work. “It’s important to look at more in-depth studies where the research can be monitored,” said Verrill.
For more information, see “Cancer Incidence & Mortality in Maine, 1997-1998,” Maine Cancer Registry, 207-287-5272; and www.state.me.us/dhs/bohdcfh/mcr.
|Jon Hinck of the Natural Resources Council of Maine described the types of toxic compounds that occur in Maine, while Dr. Ingrid Eriksson (left) discussed Oxford County’s high rates of cancer, and Terry Martin, R.N., (right) spoke about life – and death – in “Cancer Valley.” English photo.|
Toxic Compounds in Maine
Jon Hinck, toxics attorney for the Natural Resources Council of Maine, was asked to address the known or probable carcinogenic compounds in Maine’s environment. “Setting aside obvious environmental causes of cancer, like second-hand smoke,” he began, “one of the primary issues in Maine is dioxin. It’s difficult to know how it relates to Maine’s high cancer rate. We have a number of sources of dioxin – very prominently the pulp and paper industry. The good news is that there have been great reductions in some of the stuff the pulp and paper industry was doing in the last century. But the pulp and paper industry declined to go totally chlorine-free (TCF) with their bleaching process, and that technology – TCF – is still a viable, and environmentally preferable technology. We could provide continued pressure on the pulp and paper industry in Maine to go totally chlorine-free, and we would see a greater reduction in dioxins produced in this state.”
Incineration is another problem. A well-maintained, state-of-the-art incinerator is capable of “doing a pretty good job” of reducing toxic emissions to near undetectable levels, “but systems like that do not operate like that all the time in the real world. As long as we’re incinerating or burning, at low temperature, garbage and refuse in Maine, that will be a source of dioxins, dibenzofurans and other toxic compounds.”
Other problems include PCBs in such fish as bluefish and striped bass; mercury (a neurotoxin rather than a carcinogen) in freshwater fish; benzene in gasoline (“Some states have done a much better job at controlling fugitive emissions from pumps.”); toxins such as trihalomethanes and possibly compound MX or compound X, produced when drinking water is chlorinated; and MTBE, the gasoline additive and possible human carcinogen that travels further than gasoline when a spill occurs. “Those of us who rely on well water for drinking water may get MTBE when we’re half a mile from underground, leaking storage tanks.”
Hinck suggested that those who get public drinking water try to find out whether the water company has minimized the amount of chlorine it uses – bearing in mind that a disinfectant is also very valuable in water. Sharon Tisher noted that Bangor was required by the EPA to switch from chlorination to an ozone system, which is “a potential, economically viable alternative.”
In addition to the above list, pesticides and brominated flame retardants need more attention as potential causes of cancer or other health effects; and nanotechnology is a new threat that we should be “watching out for,” Hinck concluded.
Tisher pointed out that the most recent available data (2000) show that 880,095 pounds of active ingredient of pesticides identified by the EPA as possibly or probably carcinogenic were sold by large agricultural dealers in Maine – “and the number is probably much higher, because our net misses direct sales, the WalMarts and hardware stores.”
“I’m pleased and proud to discover that Maine is frequently in the forefront of the health and environmental movement … with regard to underground, leaking storage tanks, using tobacco money,” etc., said Hinck. “Maine was the first to recover mercury switches from automobiles.” But being first in the United States “should be put in a broader context … the U.S. has slipped behind many countries in the last 10 to 15 years. We frequently have to look to Europe to see what cutting edge environmentalism is today.”
Maine is involved in the national Environmental Public Health Tracking Program of the Centers for Disease Control (www.cdc.gov/nceh/tracking) , said Hinck, and in the Healthy Maine 2010 – Strategies for Addressing Environmental Health Priorities program of the Maine Bureau of Health (www.maine.gov/dhhs/boh/index.shtml). For more information about the Natural Resources Council of Maine, including sources of totally chlorine-free paper, see www.nrcm.org/default.asp.
Oxford County’s High Cancer Rates
In introducing Ingrid Eriksson, M.D., an orthopedic surgeon and member of the Western Maine Citizens for Clean Air and Water (WMCCAW), Tisher noted that putting a zip code into www.scorecard.org will reveal the National Toxics Release Inventory (TRI) rating of a community regarding toxics, links to major toxics polluters and what chemical emissions they report to the federal government. Doing so, said Tisher, ranks Oxford County, Maine, as “one of the worst 10% of all counties in the nation for particulates, which are emitted by both autos and factories. Mead Paper is the only stationery source identified in Oxford County. Fifty-three thousand people in Oxford County face a cancer risk more than 100 times the goal set by the Clean Air Act.”
Eriksson said that most of the more than 1 million new cases of invasive cancer diagnosed in the United States each year are diagnosed in the South and the Northeast. “We in Maine live downwind of 105 of the dirtiest coal-fired power plants in the United States. They’re producing the sulfates and particulates that perhaps are causing some of these cancers. Most are in Ohio, but one is in New Hampshire, five are in New York, and 21 are in Pennsylvania.
“We feel we can’t do much about that at our level; however, we can say something about what’s being polluted in our own neighborhood … We are mainly concerned about an area that the DEP has also wondered, could this be a cancer cluster?” That area is Rumford, which is in a bowl surrounded by high mountains. “The beautiful Androscoggin River loops around. In the middle of the loop is MeadWestvaco Paper Company,” which discharges into the water and, continuously, into the air.
Eriksson noted that the TRI data are based only on what the company reports to the government (614,000 pounds of air emissions in 2001, for instance), and that these are not measured but calculated releases. “Are there chemicals that are not reported?” she wonders. “When we met with the Maine DEP, we were told that only chloroform has been tested for as far as a big emission point from the mill.”
A preliminary study of cancer cases reported to the Cancer Registry between 1982-1993 found significantly more cancer cases in Rumford than in other areas of Maine. Also, for males, cancers of the respiratory system, prostate and non-Hodgkin’s lymphoma were higher, and for females, cancer of the thyroid and colon. Additional studies on thyroid cancer in women and non-Hodgkin’s lymphoma were recommended, but none have been done. These cancers do not constitute a cluster, per se, because they are different types of cancer, “but they certainly give us concern that cancer rates are high and that they may well be related to something going on in that valley with the water and the air.”
Our mandate, said Eriksson, is to test what’s in the air, water and blood, and relate those chemicals to disease incidences where those chemicals occur in high concentrations. “By monitoring, we can understand better what these chemicals are doing and try to decrease the amount of cancer.”
Terry Martin, a registered nurse and member of WMCCAW, awed, saddened and motivated teach-in participants with her powerful story. “I have no numbers, no statistics, just a story,” she said. She was “born and raised in the valley that is now known as Cancer Valley – the Rumford-Mexico area, which has harbored for a long time the secret of what goes on in the valley.” About two years ago, she and five other women started WMCCAW, to meet and discuss “things that weigh heavily on our minds.”
The towns of Rumford, Mexico, Dixfield and Peru “lie side by side along the Androscoggin River and are surrounded by very high mountain peaks that trap volatile organic compounds, like benzene, chloroform and carbon tetrachloride … The paper mill sits directly in the center of this geographical bowl, and we all live around the paper mill. We live in what they call Cancer Valley … The people in my hometown have become recycling units for the paper industry. Despite some significant investments by the paper mill to better filter its water discharging into the Androscoggin River, it is believed by some that effluents from the mill and from the mill’s landfill on nearby Farrington Mountain – which many believe is leaching into the ground water – continue to pollute the river, the brooks, the streams and groundwater.
“Our water is compromised. Our air is compromised as well. Right in the center of our town is a tower which is 412 feet tall. It’s an emissions stack, and it burns a mixture of chipped tires, which they call a ‘new source fuel’; paper mill sludge, which contains dioxins; coal and wood waste. In defense of the emissions from that stack, the environmental engineer from the paper mill said ‘the highest effects of chemical emissions from the mill would still expect to be seen in the immediately surrounding valley.’ That was his answer to the people who were living downwind of the emissions, feeling that they were now being assaulted by paper mill emissions.”
The Rumford area experiences air inversions. “Things go up,” explained Martin, “then, with nowhere to go and no wind, everything falls back into the valley.”
Martin says, “We’ve lost trust.” In 1989, in reaction to information released by the EPA about chloroform, “the paper company in my town published in its weekly newsletter, called The Wrap Sheet, the following quote: ‘We know of no scientifically credible data that would suggest that the employees of our mill or the residents of our community suffer from an abnormally high cancer rate from chloroform or from any other substance associated with our facility. Therefore, we know of no reason for anyone to be alarmed at the reports associated with this highly questionable database.’ The town’s most important employer and most powerful entity wanted everyone to know that the EPA warning was not something that they should be concerned about … The quote stated in reassuring words that the people in my valley were safe. I wonder if they didn’t know or care about the 1978 Kochiba study that found dioxin caused cancer in rats. Did this industry of leadership not know or care that the 1984 EPA dioxin water quality standards for the protection of human health against cancer were adopted? That this powerful paper company, employer to most of the town, [did] not know or care about the 1985 Maine DEP/DHS and DIF&W fish advisory consumption for the entire Androscoggin River designated to protect the general public against the cancer risks of dioxin? Did they not know that in 1987,” she continued, “the joint fish consumption advisory expanded to the Kennebec below Skowhegan, Penobscot below Lincoln, and Presumpscot below Westbrook?
“Did they not care or know about the 1988 dioxin monitoring program designed to track toxic chemical contamination in fish? We know they knew, because the then-vice president of that paper company was quoted as saying that Boise Cascade (now MeadWestvaco) asserts that dioxin does not pose a real health risk, and any effort to require this industry to reduce dioxin is unnecessary due to the lack of a definite link between dioxin and cancer.’”
In August of 1987, “No Margin for Error” was published, linking dioxin and the pulp and paper industry. It documented that the “EPA knew by 1980 that the pulp mills were potentially major dischargers of dioxin pollution, and in 1983 confirmed that fish downstream of several mills were heavily contaminated.”
Martin also cited a study showing higher rates of five cancers at the Rumford Community Hospital than in the national average of hospitals in the study. These cancers were documented as prostate, breast, colon, lung and lymphoma.
“In 1986, the top health officer, a physician, wrote in his end of the year report, ‘Dioxin, the carcinogenic agent of agent orange, used in Vietnam, has been found in the sludge of the local paper company. It is presently under investigation.’ The town report was published, but the physician’s report was not included as written. The selectmen didn’t want to offend the paper company by any reference to dioxin. The paper company, by the way, is the largest taxpayer.”
When the Maine DEP requested a soil removal plan before a new sewer line was installed, because soil adjacent to the river could contain elemental mercury at concentrations as high as 217 ppb, the town reported that the soil was removed and disposed of at the Farrington Mountain landfill.
“The CEO of the paper company in Rumford does not live in Rumford,” Martin remarked.
She noted that former governor Angus King “stated that he was committed to place dioxin in its appropriate position as an environmental priority and treat all Maine manufacturing fairly and equitably. While he is treating Maine manufacturing fairly and equitably, who is protecting the people? During that same year, he stated to the Penobscot Indian Nation regarding the fish in their tribal rivers being contaminated with mercury, ‘Instead of eating one fish a week, let them eat one fish a month. We all have to do our part.’”
Lacking state and paper company action, Rumford citizens contacted the media in Boston. “No one in Maine was interested in doing a story on a dying town. The paper company has a long arm, and a very powerful one.” A studio in Boston did a documentary on Rumford’s problem, which aired on a Boston ABC affiliate. “It has never been shown in Maine,” Martin states. “It is too controversial. It could upset the paper company. It’s become sort of a cult film; it’s shown in colleges and environmental studies. It’s called Cancer Valley. They did one in 1990, then came back and did a follow-up in 2001.
“My husband was the town physician. He died two years ago from one of the cancers believed to be caused by dioxin exposure. If we as people can take action, perhaps we can give some thought to a law in Michigan that states that a person shall not cause a permanent emission of an air contaminant or water vapor of quantities that cause, alone or in reaction with other air contaminants, either of the following: (a) injurious effects to human health or safety, animal life, plant life, or significant economic value of property; (b) unreasonable interference with the comfortable enjoyment of life and property.
“It is interesting to put a face on pain and suffering, loss of grandparents, loss of moms and dads. Dying from cancer is not something that’s an easy lesson to learn from.”
Western Maine Citizens for Clean Air and Water can be reached at PO Box 478, West Paris ME 04289; [email protected]. A Web site is being created.
The reporting of cancer is so variable from state to state that the U.S. government does not rank states for incidence (how often people get cancer), but they do rank for how many people die from cancer. For the 25-year period from 1973 to 1999, for men and women together, for all types of cancer, Maine ranked seventh in the country. This is not ‘the way life should be.’ – Sharon Tisher
Releases of Toxics in Maine
The following is a list of Maine’s 10 largest on- and off-site emitters of the toxic chemicals. No attempt has been made to adjust the totals to reflect the relative seriousness of the chemicals emitted. It is important to note that these chemical emissions are reported to EPA under the TRI and do not reflect illegal discharges of pollutants to the environment.
|McCain Foods USA Inc., Easton||2,707,025|
|S. D. Warren Co. Sappi Fine Paper N. A., Skowhegan||1,338,189|
|Domtar Maine Corp., Baileyville||961,517|
|International Paper, Jay||740,527|
|Mead Publishing Paper Div., Rumford||706,236|
|Fort James Operating Co., Old Town||475,681|
|International Paper Co., Bucksport||411,202|
|Lincoln Pulp & Paper Co. Inc., Lincoln||374,314|
|Great Northern Paper Inc., Millinocket||363,971|
|S. D. Warren Co., Westbrook||192,877|
Maine Cancer Registry Earns “D”
On September 24, the Trust for America’s Health, a national nonprofit organization that investigates the ability of our public health system to address current and emerging health threats, released a report evaluating 35 of the nation’s state cancer registries. Maine received a “D” grade, placing it among the four worst states evaluated. Maine needs to develop the ability to quickly recognize and track in “real-time” childhood cancers, to systematically combine data about cancer cases with other sources of information, such as nutrition, lifestyle and environmental factors, and needs increased funding to support adequate staffing. Maine is one of 15 states whose cancer registry was not certified by the North American Association of Central Cancer Registries for high quality 1999 incidence data (the latest year for which data are available). Maine also received a “D” grade for its birth defects monitoring program, only begun in May 2003. The Trust noted that Maine fails to track lupus and other killer autoimmune diseases and does not track developmental and learning disabilities, such as cerebral palsy, autism and mental retardation, even though the National Academy of Sciences estimates that 25% of these disabilities in U.S. children are caused by environmental factors.
In announcing the evaluation, TFAH executive director Shelley Hearne noted that “knowledge is power. In this case, what we don’t know can kill us … States can and should do better when it comes to tracking cancer and using that knowledge to win the war on cancer.”
Castine Verrill of the Maine Cancer Registry responded, “The Maine Cancer Registry will submit its data to the North American Association of Central Cancer Registries in December 2003 and will likely receive certification at that time.”
For more information see healthyamericans.org.
– Sharon Tisher