Tracking Cancer Hot Spots
An independent commission of health policy experts has recommended that President Bush establish a nationwide system for pinpointing areas where concentrations of cancer and other chronic conditions are occurring.
The Pew Environmental Health Commission, funded by the Pew Charitable Trusts through the Johns Hopkins School of Public Health, called for a major national initiative to be established within the U.S. Centers for Disease Control and Prevention.
In its final report, the commission noted that environmental health policy is currently divided among a dozen federal departments and agencies, thus impeding the nation’s ability to "respond aggressively to emerging health threats." It deemed the current tracking system of toxic chemicals and other environmental contaminants "woefully inadequate."
The report, released to coincide with the swearing in of the new administration, cited nearly 1,100 public requests to the government in 1997 alone for investigations of potential cancer clusters. "Environmental factors are always the leading suspect [of cancer clusters]," the report said. "The finger-pointing will only escalate until we have better public health information and action."
It called on Congress and the new president to immediately fund a nationwide health tracking network, focusing on "priority diseases" such as cancer, asthma and birth defects. It further cited a number of "priority pollutants" that should be closely monitored, including PCBs, dioxin, mercury, lead and pesticides.
The commission, which includes an independent panel of experts from the health industry, government, universities and environmental groups, was convened in May 1999 with the objective of developing practical recommendations for improving public health responses to environmental threats.
The national undertaking recommended by the commission would cost approximately $275 million annually and include five core components:
In addition to the above, the commission called on President Bush to name the U.S. Surgeon General as his point person on issues of disease prevention and environmental health. It called the Surgeon General "the only person with the ability and stature to command national attention and support the effort in the manner required."
While no national tracking program has yet been established, a number of local and statewide initiatives are already in place. For example, an ambitious effort to map cancer clusters in New York State got under way last year.
Reporting on the success of that effort at the Eighth Annual Congress on Women’s Health and Gender-Based Medicine, Dr. Mark Baptiste of the New York State Department of Health said the public response so far has been "mixed."
"The maps are a tool," he said. "We hope they can help us ask the right questions" to find out why there might be clusters of cancer around the state. But unfortunately, he cautioned, they cannot tell anyone why cancer cases are occurring.
Baptiste pointed out a number of high-cancer counties around his state that have had historically high industrial or agricultural activity. Yet early data from environmental testing shows no link between contaminated water and soil and breast cancer cases.
Other states have undertaken similar tracking programs, which also appear to have raised more questions than answers. The inherent weakness of such programs is that they can identify occurrences of cancer, but have not been able to take the next step of pinpointing causes.
Part of the problem may be a lack of statewide resources. Even more important, however, may be a lack of overall coordination among different agencies that could offer unique levels of expertise for addressing the problem. Often a state’s department of health is in charge of mapping cancer and disease outbreaks, but other agencies—commerce, environment, labor, etc.—are not asked to participate. In fact, these agencies are often undertaking their own independent programs, wasting valuable resources and dooming the effectiveness of the efforts.
And the same ineffective polyglot of initiatives exists on a national level.
Public opinion research shows that almost 90 percent of registered voters believe that the environment plays a significant role in their health, the Pew report noted. "But the majority of registered voters surveyed believe that their elected officials are not adequately responding to the threats at hand."
The commission added that better accountability on the local, statewide and national level was urgently needed "so environmental health problems can be quickly identified and strategies mobilized to fix and prevent diseases."
It is an extraordinarily daunting challenge, the panel acknowledged, but one with immense implications. It remains to be seen whether President Bush will share the same sense of urgency.
SOURCES:
"Transition Report to the New Administration: Strengthening our Public Health Defense Against Environmental Threats," The Pew Environmental Health Commission, Johns Hopkins School of Public Health, January 2001 (http://pewenvirohealth.jhsph.edu)
Eighth Annual Congress on Women’s Health and Gender-Based Medicine, June 5, 2000, Hilton Head, South Carolina
New York State Department of Health, Bureau of Chronic Disease Epidemiology and Surveillance (http://www.health.state.ny.us)
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