In the United States today, one in two men and one in three women develop cancer. It's no exaggeration to say that we're in the midst of an epidemic. As of 2003, about 1.3 million people developed cancer each year, and 550,000 of them died of it.
In recent decades the number of Americans developing cancer has risen, while the ability to treat and cure most common cancers has remained pretty much the same.
National Cancer Institute and American Cancer Society: Criminal Indifference to Cancer Prevention and Conflicts of Interest, by Samuel S. Epstein, M.D., (Bloomington, Ind.: Xlibris, 2011, 189 pp., paper, $19.99) is a blistering polemic against those two venerable institutions. The ACS and NCI do good work, but they have a seamy side that Epstein exposes in the book.
Epstein is well qualified to critique the NCI and ACS. Professor emeritus of environmental and occupational medicine at the University of Illinois at Chicago School of Public Health and chair of the Cancer Prevention Coalition, he is also a former congressional consultant. Among his awards are the 1998 Right Livelihood Award and the 2005 Albert Schweitzer Golden Grand Medal.
"It is beyond dispute in the independent scientific community that environmental and occupational exposures to carcinogens [cancer-causing agents] are the primary cause of non-smoking related cancers."
He has written 270 scientific articles and 18 books on the causes, prevention and politics of cancer, including the groundbreaking Politics of Cancer Revisited (1998), Cancer-Gate: How to Win the Losing Cancer War (2005) and Healthy Beauty American Cancer Society: Criminal Indifference to Cancer Prevention and Conflicts of Interest(2010). Epstein is also an internationally known authority on avoidable causes of cancer in the air, water, consumer products and workplace.
President Richard Nixon initiated the War on Cancer in 1971, but, according to Epstein, it's a losing battle. He points out that the incidence of most cancers unrelated to smoking has escalated in the last 40 years. For example, from 2005 to 2008 the incidence of malignant melanoma, the most lethal form of skin cancer, rose 185 percent, while that of liver cancer rose 178 percent.
According to Epstein, the NCI's own figures from 1995 to 2000 reveal:
- "The overall burden [number of people with cancer] and incidence rates remained virtually unchanged, decreasing by under 1 percent.
- "There have been major increases in incidence rates of the following cancers: childhood kidney (43 percent), testicular (24 percent), thyroid (19 percent), prostate (5 percent), acute myeloid leukemia (5 percent), brain (3 percent) and breast (2 percent)."
Epstein argues that the cancer establishment, the NCI and ACS, focuses almost exclusively on damage control -- diagnosis and treatment and basic genetic research, paying little, if any, attention to cancer prevention research. It has failed to inform the public of the unintended exposures to the many environmental, avoidable causes of cancer.
"It is beyond dispute in the independent scientific community," says Epstein, "that environmental and occupational exposures to carcinogens [cancer-causing agents] are the primary cause of non-smoking related cancers."
Thus, he argues, cancer is largely preventable and avoidable. Carcinogens, he says, contaminate the air, water, soil, food and workplace, as well as consumer products such as personal care products, cosmetics, cleaners and pesticides. For example:
"Efforts at prevention should focus on primary prevention, stopping carcinogens at their industrial sources."
- Malignant melanoma: causes are use of sunscreens in childhood that fail to block long-wave ultraviolet light.
- Thyroid cancer: ionizing radiation from diagnostic X rays and nuclear facilities.
- Non-Hodgkin's lymphoma: use of phenoxy herbicides and phylenediamine hair dyes.
- Acute lymphocytic childhood leukemia: ionizing radiation, domestic pesticides, nitrite preservatives in meat (mainly hotdogs), parental exposures to occupation carcinogens.
- Testicular: pesticides, estrogen residues in meat.
- Breast: oral contraceptives, diagnostic radiation, routine premenopausal mammography.
- Ovary: genital use of talcum power.
Efforts at prevention should focus on primary prevention, stopping carcinogens at their industrial sources, Epstein argues.
Epstein is concerned about conflicts of interest and other forms of corruption in the NCI.
The more the cancer establishment spends on the War on Cancer, the more cancer Americans receive, Epstein argues. In 1971 the NCI had a budget of $220 million. In early 2011 that amount was projected to be $5.2 billion by the end of the year. Mortality rates have remained the same for decades.
Epstein quotes Nobel laureate Leland Hartwell, president of the Fred Hutchinson Cancer Control Center, who asserted in 2004, "Congress and the public are now paying NCI $5 billion a year, most of which is spent on promoting ineffective drugs for terminal disease."
The NCI's projected 2011 budget allocated less than 4.5 percent to prevention.
"The reason for losing the war against cancer is not a shortage of funds but their gross misallocation."
"The reason for losing the war against cancer," Epstein writes, "is not a shortage of funds but their gross misallocation. ... They have trivialized escalating cancer rates and explained them away as due to faulty lifestyle [such as smoking, lack of exercise and a fatty diet,] to the virtual exclusion of the major role of unwitting and avoidable exposures to industrial carcinogens in air, water, consumer products and the workplace."
Thus, the NCI blames the victim, Epstein says. The institute's attitude amounts to criminal indifference to cancer prevention.
In 2008 Harold Varmus, director of the NCI, received a salary of $2.7 million. Varmus eliminated any "price controls on cancer drugs made at the taxpayer expense," says Epstein.
The NCI is rife with conflicts of interest, according to Epstein, and operates a revolving door with polluting and cancer-drug industries.
For instance, in 1988 the late Frank Rauscher, whom Nixon appointed as NCI director in 1971 to spearhead the War on Cancer, became executive director of the Thermal Insulation Manufacturers Association, "which promotes the use of carcinogenic fiberglass and fights against its regulation," Epstein says.
Upon his resignation from the NCI as director from 1981 to 1995, Samuel Broder became chief scientific officer of Ivax and then chief medical officer of Celera Genomics. Both companies are manufacturers of cancer drugs.
In a 1998 Washington Post interview Broder "frankly admitted," Epstein says, "that 'the NCI has become what amounts to a government pharmaceutical company.'"
"With its every move, ACS reflects the interests of the major manufacturers of mammogram machines and films."
Epstein offers the cancer drug Taxol as a case in point. U.S. taxpayers funded its research and development for manufacturer Bristol-Myers. After expensive clinical trials were completed, the public, according to Epstein, "paid further for developing the drug's manufacturing process."
After the trials, "NCI gave Bristol-Myers the exclusive right to sell Taxol at an inflationary price of $5 per milligram, more than 20 times the cost of production."
Such events aren't isolated incidents but common practice, Epstein contends.
Further, the NCI has blocked funding for research and clinical trials on promising, nontoxic, low-cost and unpatentable alternative cancer treatments in favor of highly toxic and sometimes carcinogenic patented cancer drugs developed by Big Pharma, according to Epstein. The NCI backs pharmaceutical companies seeking approval "of their highly touted miracle drugs - drugs that have shown limited if any success over decades," he asserts.
The institute maintains no registry of known carcinogenic industrial carcinogens even though independent scientists (as opposed to industry-funded) have identified 700 carcinogens that cause cancer through periodic or regular exposure.
The NCI's silence on prevention, Epstein claims, sacrifices "citizens' health and welfare to powerful corporate interests."
At a Feb. 4, 1992, press conference, 68 leading, independent cancer prevention and public health experts, among them Epstein, presented the NCI with a program for reform. The institute never responded.
NCI doesn't need its "bloated budget" increased, Epstein contends. Rather, "drastic reforms are needed to explicitly re-orient its mission and priorities to cancer causes and prevention."
The ACS has long been recognized as the tail that wags the NCI dog, Epstein says. The two institutions are "locked at the hip" in terms of research and prevention policies, and their indifference to prevention from avoidable carcinogens.
The ACS is the world's wealthiest nonreligious, nonprofit organization.
However, with its familiar relays and other fundraising events, it perpetually cries poverty. In 1992 the Chronicle of Philanthropy, which Epstein describes as the nation's leading charity watchdog, "charged that 'the ACS is more interested in accumulating wealth than saving lives.'"
"Giant corporations -- which profited handsomely while they polluted air, water, the workplace and food with a wide range of carcinogens -- remain greatly comforted by the silence of the ACS [on prevention]."
The ACS has more than 500 industrial donors who each contribute more than $100,000 annually. Among them are drug and biotech, car, cosmetics and junk food companies and polluting corporations from the petrochemical and oil industries, Epstein charges.
In 1998 the ACS had a budget of $380 million, with cash reserves of nearly $1 billion. For every dollar it spent on direct services in 1992, $6.40 went to salaries and overhead. Many of the direct services to cancer patients, including driving them home from the hospital after chemotherapy, cost the ACS almost nothing because volunteers do much of that work, according to Epstein.
The ACS, despite its wealth, continues its aggressive public fundraising and complains about the dearth of money for research while ignoring the phasing out and banning of industrial carcinogens.
"Giant corporations -- which profited handsomely while they polluted air, water, the workplace and food with a wide range of carcinogens -- remain greatly comforted by the silence of the ACS [on prevention]," according to Epstein.
Mammography is a case in point. The ACS's National Breast Cancer Awareness Month (BCAM) promotes mammography for screening in premenopausal women, even though there's conclusive evidence that the procedure in young women can cause cancer, according to Epstein.
Mammography in premenopausal women also causes false negatives and misses tumors in young women, who have denser breast tissue than older women. False positives occur in one in four cases.
The United States is the only country that permits premenopausal mammography.
"The routine practice of taking four films annually for each breast results in approximately one rad (radiation absorbed dose) exposure, approximately 1,000 times greater than the dose from a single chest X-ray," Epstein says.
If a premenopausal woman undergoes mammography for 10 years, according to Epstein, she will have been exposed to roughly five rads, about the level of radiation to which Japanese women were exposed if they were a mile from where the bombs fell in Hiroshima and Nagasaki.
Mammography conflates prevention with screening for cancer that's already present. Though at least 90 percent of malignant breast tumors are detected by the patients themselves, as Epstein says the ACS admits, the organization goes out if its way to discredit breast self-examination (BSE) in favor of mammography. As an example Epstein offers the fact that the ACS opposed a congressional bill that would have mandated the teaching of BSE to high school students.
"With its every move," Epstein says, "ACS reflects the interests of the major manufacturers of mammogram machines and films."
Though the NCI finally came out in opposition to premenopausal mammography, the ACS continues to promote it.
"The cancer war is certainly winnable, given radical changes in its high command and priorities and given information on avoidable industrial causes of cancer is provided to the public and Congress."
Zeneca Pharmaceuticals is the only funder of BCAM and donates multimillions to the cause. A subsidiary of Imperial Chemical Industries, one of the world's largest manufacturers of chlorinated and other industrial chemicals, "including those incriminated as causes of breast cancer," Epstein says, Zeneca is also the only manufacturer of Tamoxifen, the world's top-selling drug for breast cancer prevention, with $400 million in annual profits. Tamoxifen isn't safe: it's a highly potent liver carcinogen and induces uterine cancer.
In other words, Imperial profits from the manufacture of breast cancer drugs while it profits from selling carcinogenic chemicals. BCAM, Epstein says, is a "masterful PR coup for Zeneca."
In catering to polluters, Epstein says, the ACS has opposed the Clean Air Act in deference to the auto industry; refused to testify on the cancer dangers of DES, a known carcinogen used in beef cattle; opposed regulating dark hair dyes and trivialized the relationship of recombinant bovine growth hormone (rBGH), administered to dairy cattle, to breast cancer even though the chemical is banned in other countries; and supported the Chlorine Institute in the continued manufacture of chlorinated, carcinogenic pesticides.
The ACS claims that exposures from pesticides in food, toxic waste dumps and nuclear facilities are so low as to be "negligible," even though such exposures are known to cause cancer, says Epstein.
The ACS conducts "highly biased ... witch-hunts against alternative practitioners [of anticancer treatments] in striking contrast to its extravagant and uncritical endorsement of conventional toxic chemotherapy," says Epstein. "This despite the absence of any objective evidence of improved survival rates or reduced mortality following chemotherapy for all but some relatively rare cancers."
The ACS is well known for favoring industry by sowing doubt in the public mind about the causes of cancer - much as climate-change deniers sow doubt about global warming - insisting that all the facts are not in and claiming that the causes of cancer are up for scientific debate.
In the case of rBGH, which has been linked to breast, colon and prostate cancer, ACS insists the exact nature of the links is still unclear and more study is necessary, Epstein says.
Epstein concludes, "Donors wanting to make contributions to a worthy cancer charity should think twice before selecting the ACS." Instead, he advocates donating to public interest and environmental organizations involved in primary cancer prevention, stopping cancer at the source.
"Only a grass-roots movement of activist citizens will convince politicians and presidential candidates of the need for drastic action."
"The cancer war is certainly winnable, given radical changes in its high command and priorities," Epstein concludes, "and given information on avoidable industrial causes of cancer is provided to the public and Congress."
But "only a grass-roots movement of activist citizens will convince politicians and presidential candidates of the need for drastic action" to prevent cancer and make cancer prevention a "top national priority."
One important flaw in the The National Cancer Institute and American Cancer Society is its repetitiousness. Self-published, the book seems not to have undergone an editor's efforts. Much of the book is taken up by news releases and Huffington Post blogs that not only repeat ideas but whole paragraphs verbatim. Condensation of this material would have made for a shorter and more readable book.
Linda Greene can be reached at .