A new direction in the war on cancer
It may disappoint a lot of people, but diamonds actually don’t last forever—they will eventually degrade to graphite. Sadly, one thing that does seem to have been around forever is cancer. By the time the “War on Cancer” was declared with the passing of the National Cancer Act of 1971—itself a follow-up to 1944’s Public Service Act—cancer had become the second leading cause of death, after heart disease, since 1900.
This “before and after” year of measurement traces the rise of several of today’s leading crises from the conclusion of the Industrial Revolution and subsequent rise of modern chemistry. This modernization is symbolized by the mass proliferation of mechanized, factory-produced commodities within: the transportation sector, such as automobiles and energy; in food processing associated with agriculture (including tobacco and cigarettes), meat production, and chemical additives in an increasing number of canned and boxed goods on supermarket shelves; and the manufacturing of commercial products and materials used to build housing and everything that people put in them, from furnishings to routine household purchases.
According to the Centers for Disease Control and Prevention (CDC), the leading causes of death in 1900 were viral, bacterial, and fungi-related illnesses, especially pneumonia, tuberculosis, and diarrhea (and had been for many years). Heart disease was fourth and cancer was eighth, just above senility and right below “accidents.” However, as the 20th century progressed, and with it the consumption of fossil fuels, tobacco, and processed foods, global warming began to rise, cancers skyrocketed, and diabetes—which first made the CDC’s “Top Ten” list (at No. 10) in 1932—joined heart disease and cancer as a leading cause of death; by 1971, it was seventh.
“The tobacco industry and the chemical industry…were heavily involved in running the beginning of the war on cancer…Of course they weren’t too interested in figuring out how to control asbestos or benzene.”
—Devra Davis
An Update on the War
Half a century after the National Cancer Act, the War on Cancer has had decidedly mixed results. Heart disease remains the number one cause of death, with cancer still second and diabetes holding at seventh. The overall cancer death rate has declined more than 25 percent while the five-year survival rate has increased 36 percent; however, cancer is now responsible for the most deaths between the ages of 60 and 80, according to the American Association of Retired Persons (AARP).
Because cancer is “understood to be primarily a disease of aging,” the AARP argues that higher cancer survival rates and a longer life expectancy provides more time for either an initial diagnosis or a reoccurrence of a previously treated malignancy; for example, female breast cancer returns 25 percent of the time and is often much more aggressive when it does. The risk of developing invasive cancer is now a staggering 1 in 2 for men and 1 in for 3 women; collectively, almost 40 percent of the population will be diagnosed with cancer at some point in their lives. Furthermore, many individual cancers are on the rise, specifically female breast cancer, male prostate cancer, and cancers of the lung, colon, and rectum for both sexes, which are projected by the CDC to both increase and remain the leading causes of death from cancer by 2050.
Up to Half of All Cancers Remain Individually Preventable
The highest contributory factors for cancer in general remain consumption of carcinogens in food, alcohol, and tobacco; exposure to carcinogens at home, at work, and in the community; and individual genetics, which factor into a person’s ability to prevent carcinogens from causing cells to abnormally grow and multiply into tumors that can spread to surrounding tissues and other parts of the body. The focus since 1971 has been to fight the war on three fronts.
First, there have been an encouraging number of scientific and medical breakthroughs, including the invention of early detection strategies designed to find tumors as early as possible; the proliferation of anticancer therapy options; the development of cancer genomics, including genome sequencing; and the explosion of cancer drugs, although many turn out to either not be effective or to not significantly extend life.
The second approach is based on preventative measures, centered around efforts to discourage the consumption of tobacco, alcohol, and processed food and to avoid overexposure to the sun. According to the National Cancer Institute (NCI), while smoking rates have declined, obesity, with its proven track record of cause (eating processed foods) and effect (higher risks for cancer), has increased, and skin cancer has become the most common type of cancer. The AARP continues to argue that nearly half of all cancer cases and deaths could be eliminated by not smoking, drinking less, avoiding the sun, and achieving a healthy body weight, even though many Americans find it difficult to follow that advice.
Promoting new discoveries in the laboratory and changing personal habits for the better can only go so far. The third front has been to identify carcinogens (and other harmful chemicals) that have been allowed to enter the soil, water, and air and then mobilize political strategies to regulate or even ban their use in the workplace, the environment, and anything else associated with public health.
The Other Half is the Battleground
Devra Davis is the founding director of the Center for Environmental Oncology at the University of Pittsburgh Cancer Center (now the UPMC Hillman Cancer Center). In her book, The Secret History of the War on Cancer, she chronicles the long, frustrating process of targeting known carcinogens for elimination from industrial and commercial use, only to be circumvented by the chemical industry, elected officials, and government regulatory agencies. Opposing scientific viewpoints are challenged, criticized, watered down, delayed for release, or even taken to court, resulting in a meager number of chemical carcinogen bans and thus the continuation of the status quo. “The tobacco industry and the chemical industry…were heavily involved in running the beginning of the war on cancer…Of course they weren’t too interested in figuring out how to control asbestos or benzene,” Davis said in an interview with the Pittsburgh City Paper.
Since the 1976 Toxic Substances Control Act (TSCA), only a few hundred of the more than 80,000 chemicals in the TSCA inventory have been tested and only five banned—asbestos, chlorofluorocarbons, dioxin, hexavalent chromium, and polychlorinated biphenyls (PCBs)—with the asbestos ban being overturned by the Supreme Court to allow for some continued uses, although new uses remain prohibited.
According to the Environmental Protection Agency (EPA), “Anyone who intends to manufacture (including import) a new chemical substance for a non-exempt commercial purpose is required to submit a pre-manufacture notice (PMN) at least 90 days prior to the manufacture of the chemical.” But prior toxicity testing is not required by the TSCA, and the EPA only has 90 days after a PMN is submitted to take action; otherwise, the new chemical can be introduced into the marketplace for public consumption through commercial use.
“We know enough [about PFASs] that we should be very concerned.”
—Professor Joseph Allen
A Renewed Focus on an Old Problem
What was generally missing from the conversation has been a spotlight on another category of dangerous chemicals called “perfluorinated or polyfluorinated substances” (PFAS). These carcinogens and toxic compounds enter the bodies of humans and animals and stay there, without fully degrading, lasting “millennia” according to Professor Joseph Allen of Harvard University’s School of Public Health, who named them “Forever Chemicals” in a 2018 article in The Washington Post. “We know enough [about PFASs] that we should be very concerned,” Professor Allen has stated.
They are defined by the National Institutes of Health (NIH) as “a large, complex, and ever-expanding group of manufactured chemicals” used to make an array of items for everyday use. The EPA has identified them in stain and water-repellant cookware, carpets, and furniture; manufacturing facilities that make fire extinguishing foam, chrome plating, electronics, paper, and textiles; the soil at or near waste sites; public and private sources of drinking water; dairy products made from PFAS-exposed livestock and fish caught in PFAS-contaminated water; food packaging using grease-resistant coatings such as microwave popcorn bags, pizza boxes, and candy wrappers; personal care merchandise and cosmetics; building materials like paints, varnishes and sealants; and fabrics used for everything from curtains to clothes. Even the dust that accumulates on these objects and is then inhaled can be tainted with PFAS.
Because children consume more food, water, and air per pound of body weight than adults, they are especially vulnerable; the EPA therefore cautions against kids crawling on the floor and putting things in their mouths that have touched PSAF-exposed surfaces including hardwood floor tiles, carpets, and toys and warns that mothers can pass on PFAS to infants through their breast milk.
PFAS appear in the blood of people worldwide (over 98 percent in the U.S.) and contribute to a long list of cancers, especially of the prostate, testicular, and kidney, and thus, a new front in the War on Cancer has been opened by an emerging coalition of activists and legislators at all levels of government.
One coalition in Maryland crossed party lines in 2022 to pass the George “Walter” Taylor Act, named after a fireman who died of cancer at the age of 46 after many years wearing protective gear and using firefighter foam made with PFAS.
The Taylor Act comprised two bills cross-filed in the State Senate (SB0273) and the House of Delegates (HB0275) sponsored by Democrats Heather Bagnall, Pam Beidle, Brian Crosby, Sarah Elfreth, Terri Hill, Carl Jackson, Marc Korman, Clarence Lam, Mary Lehman, Robbyn Lewis, Sara Love and Mike Rogers along with Republicans Jack Bailey (representing Taylor’s district) and Jerry Clark.
“I care deeply about this issue for a variety of reasons. not the least of which is the fact that in my Annapolis district, issues connected to the environment poll the highest in terms of public importance.”
—Sarah Elfreth
“I care deeply about this issue for a variety of reasons,” Elfreth says, “not the least of which is the fact that in my Annapolis district, issues connected to the environment poll the highest in terms of public importance.”
Elfreth has a history of tackling big problems, first as a Towson University student representative on the University System of Maryland’s Board of Regents; then as an employee of the Johns Hopkins University’s Office of Government and Community Affairs while earning a public policy master’s degree; and now as a legislator who has passed laws and held committee assignments related to everything from cleaning up the Chesapeake Bay and investing in state parks to ending homelessness, increasing rape victim services, and improving pensions.
In her first legislative session (2019), she led all newcomers with an 80 percent bill-to-law efficiency. In her second (2020), she and two Democratic members of the House of Delegates, Sara Love and Pat Young, succeeded in banning the use of PFAS-laden firefighting foam during training after documented incidents of drinking water contamination. In her third (2021), after Maryland passed a ban on cosmetics that contain specific chemicals, including thirteen known PSAS—similar to what California has done—Elfreth reported that the Maryland Department of the Environment would collect 1,000 drinking water samples and oysters in order to evaluate the presence of PFAS. Elfreth’s goal in co-sponsoring the Taylor Act was to implement a comprehensive strategy to ban over 9,000 PFAS connected to as many products containing these chemicals as possible.
Other states have also taken action; since 2020, seventeen states have passed close to thirty laws regulating PFAS including Alaska, California, Colorado, Connecticut, Indiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New York, Ohio, Vermont, Washington, and Wisconsin, with Rhode Island and Virginia getting ready to join them.
At the federal level, last October, the administration of President Joe Biden announced an intention to confront PFAS. In addition to the eight federal agencies already involved, such as the EPA and their “PFAS Strategic Roadmap,” a three-year action plan to “research, restrict, and remediate” their prior, present, and future use, Biden’s “Environmental Justice Plan” mentions setting “enforceable limits for PFAS” under the 1974 Safe Water Drinking Act. Although the ability of the federal government to effectively regulate PFAS remains uncertain.
An Unknowable Future
There have been some notable victories, most famously lawsuits against the chemical giant DuPont from 1998 to 2017 related to PFAS used to produce Teflon. DuPont has spent hundreds of millions of dollars to settle thousands of cases brought by farmers, corporate employees, and the general public. These lawsuits brought to light that DuPont knew as far back as 1961 that a particular PFAS—perfluorooctanoic acid (PFOA)—had been discovered in the local water supply and in the dust pouring out of factory chimneys (since 2013, DuPont no longer makes Teflon with this PFOA).
The DuPont litigation demonstrated how long it can take for specific actions to take effect. Vermont, for example, won’t see full implementation of its PFAS laws until this year, the same year the European Union’s ban on over 200 PFAS subgroups (like PFOA) takes effect. The Food and Drug Administration’s voluntary phasing out of PFAS from food packaging won’t happen until 2024. California’s legislation won’t kick in completely until 2025.
In the meantime, new PFAS are on the way; according to Professor Allen at Harvard in his Post article, “It may get even worse. In every chemical with a carbon-hydrogen bond (the fundamental unit of organic chemistry), you can theoretically replace the ‘H’ with an ‘F,’ creating a Forever Chemical. Thus, the number of Forever Chemicals that can be made is close to infinite. Scientists could study these indefinitely and not make any progress. It’s job security that I don’t want.”
Thankfully, Senator Sarah Elfreth does, and so do an increasing number of political leaders and activists in a growing number of states and countries. Diamonds may not last forever, but if the War on Cancer is ever going to end, the industrial and commercial use of all carcinogens and toxic substances, including Forever Chemicals, must stop as soon as possible.
Mark Croatti, who teaches courses on Public Policy and Comparative Politics at the University of Maryland, the United States Naval Academy, and The George Washington University, has covered state and local politics since 2004. Prior to teaching, after serving as the consultant to the International Program at the Howard Hughes Medical Institute, he worked at the journal Science.
