Printed on chlorine-free 100% PCW Recycled Paper, with soy-inks.
org
Excerpted from: The Falling Age of Puberty in U.S. Girls: What we Know,
What We Need to Know Continued From Page 7
increasing exercise and consumption of
fruits and vegetables. After two school
years, sixth-and-seventh grade girls in
the Boston area who attended schools
randomly selected for this curriculum had
lower average body mass indices, lower
body fat, higher levels of physical activity
and decreased screen time compared with
their counterparts at non-participating
schools. They were also 32 percent less
likely to have experienced menarche
during the 19-month study than girls in
control schools (Chavarro, 2005). Such
programs need to be replicated widely.
The success of school-based interventions
such as Healthy Planet can be carried out
to the community at large. Since 2005, there
has been a dramatic increase in efforts to
improve access to healthy foods in urban,
low-income areas through the creation of
farmers’ markets and community gardens
(Foxhall, 2006). Persuading schools,
neighborhood stores and convenience
markets to source with local, organic
farms is a grassroots campaign whose
efforts are relevant to protecting girls
from early sexual maturation.
Strategies to lower rates of preterm and
low-weight babies include eliminating
exposure to tobacco smoke and chemical
solvents as well as eliminating sources of
air pollution and mercury contamination.
Strategies to lower the pediatric body
burden of endocrine-disruptive chemicals
include phase-outs of chemicals such as
bisphenol A and phthlates, to which girls
have documented exposures. Supporting
organic agriculture not only lowers the
burden of hormonally active residues
in food, it protects watersheds from
contamination by pesticides, herbicides,
animal hormones and antibiotics, which
flow from farm, ranches and manure
lagoons into rivers and streams. Buying
organic thus protects drinking water,
12
another potential source of exposure.
Because it arises from a combination
of many different stressors in several
different aspects of the environment—
psychosocial, nutritional, behavioral,
chemical—early puberty in girls is not
a trend that will be reversed by single
actions by single-purpose agencies.
It is a multi-causal threat to the well-
being of girls and women that ultimately
requires a comprehensive, integrated,
unified response. The problem with health
issues that cross multiple environmental
media is that they fall between regulatory
and activist cracks. On the one hand,
addressing all of the root causes at the
same time raise the risk for programmatic
and regulatory fragmentation and leads to
inertia. On the other hand, addressing one
problem at a time does not begin to unknot
the tangle of its interrelated causes.
The environmental justice community, with
its long experience with cumulative risks
and impact, has many insights to offer
here. Any meaningful attempt to lessen
the problem of early sexual maturation
in girls must draw on the collective
wisdom of its leadership. Environmental
justice activists, for example, have
developed methods for responses that
are able to determine and alleviate multi-
media stressors swiftly. Built into their
analytical framework is the recognition
that health disparities, such as obesity
or low birth weight, are both an outcome
of and a contributor to vulnerability to
environmental toxicants. Know as “bias
for action,” this early identification and
response approach, which is community-
based and collaborative, holds much
promise for addressing the problem
of early puberty in U.S. girls (National
Environmental Justice Advisory Council,
2004).
www.environmentaloncology.
Center for Environmental Oncology
Fall 2007
Volume 2 • Number 1
Additional Fall 2007 • Volume 2 • Number 1 TABLE OF CONTENTS
Internet Resources UV Exposure Skin Cancer and The Case for
Beyond Pesticides Banning Tanning Beds
www.beyondpesticides.org John M Kirkwood, MD; Michelle L Meyer, BS;
Maryann Donovan, PhD, MPH;
Breast Cancer Fund Devra Lee Davis, PhD, MPH
www.breastcancerfund.org Page 4
Department of Environmental Quality The Falling Age of Puberty in U.S. Girls: What we
www.deq.state.mi.us/sid-web Know, What We Need to Know
Environmental Working Group Sandra Steingraber, PhD
www.ewg.org Page 6
Health Care Without Harm Environmental Safety of Toys
www.hcwh.org Jonathan Weinkle, MD
The Secret History of the
Page 8
Healthy Child, Healthy World
War on Cancer
www.healthychild.org Greening Indoor Air
Maryann Donovan, MPH, PhD.
OSHA
www.osha.gov My father, harry davis, as a toddler in the family-owned dry-cleaning and tailor shop in 1923,
Page 10
the year before he survived a massive explosion of benzene.
Perfectly Natural UPCOMING events
www.perfectlynatural.com by: Devra Lee Davis, PhD, MPH, Director, Center for Environmental Oncology of UPCI,
October 16, 2007, 12:00 - 1 PM
The Collaborative on Health and the Environment an excerpt from her new book, Chapter One. Lunch and Learn
www.healthandenvironment.org Jennifer Kloesz, MD, Neonatology
In 1973, out of every 100,000 men aged a massive explosion of benzene from the
The CDC “Environmental Teratogens”
fifty-five to fifty-nine, only five developed family dry cleaning shop underneath his
www.cdc.gov Children’s Hospital of Pittsburgh
multiple myeloma, a cancer of the bone home when he was a toddler surely added Room B213-214
The E-House Company
marrow. By 1983, that number had doubled to the lifelong burden on his ability to make Free Healthy Lunch Served
www.ehousecompany.com
and included my dad, a healthy middle- healthy blood. Maybe that accident in 1924 To pre-register, email Samantha at
The Green Guide malones@upmc.edu
aged man who never smoked or drank contributed to his death many decades
www.thegreenguide.com
much. He was one of about seven thou- later. We can’t say. Continued on page 2
The National Cancer Institute
www.nci.nih.gov/cancertopics sand people with the disease that year. Look around and it seems that cancer has
The Rachel Carson Homestead We can’t be sure why my dad’s bone mar- become the price of modern life. In Ameri-
www.rachelcarsonhomestead.org row stopped working. He lived through ca and England, one out of every two men
Safe 2 Use some remarkable encounters with agents and one out of every three women will de-
www.safe2use.com that affect the bones’ ability to produce velop cancer in their lifetime. In America Visit our New and
Susan G. Komen for the Cure
cms.komen.org/komen/index.htm
blood. Men who work with metal fumes
as machinists or welders, or with cutting
alone, there are currently more than 10
million cancer survivors. Cancer is the
Improved Website!
Venture Outdoors oils and solvents in steel mills, or who have leading killer of middle-aged persons, and, www.environmentaloncology.org
www.ventureoutdoors.org
had regular radiation exposures as part of after accidents, is also the leading killer of
frequent diagnostic checks in the military children.
– my dad did all of these things — suffer How did this happen? How did a disease Highmark Healthy Places, Healthy People
multiple myeloma cancer at higher rates that was once so atypical become so ordi-
Please share this newsletter and be than the rest of us. That he also survived nary? Are we simply talking more about an Funding for this newletter is provided by
sure it is recycled. the Highmark Foundation and the Heinz Endowments.
Continued on page 2
 www.environmentaloncology.org
UPCOMING events
Continued from page 1
November 3, 2007, 8:45 am - 1:45 pm
Stephen Grant, PhD
Talk for Gateway Health Plan
A Women’s Health Forum: Wellness in Mind and Body
“Environmental Health Risks for Breast Cancer”
Magee Womens Hospital
Forbes Avenue, Pittsburgh
November 10, 2007, 8:30am -12 noon
Health for Her & Living with Cancer present:
Greening your Life - Safeguarding your Health Day
Talk by Maryann Donovan, MPH, Ph.D.,
Scientific Director,
Center for Environmental Oncology
“Understanding the impact of environment on
incidence of breast cancer, infertility and
early puberty”
CCAC South Campus Auditorium
Building, B West Mifflin, PA 15122
November 28, 2007, 6- 8 PM
Talk by Maryann Donovan, MPH, Ph.D.
“Environmental Risks for Breast and Ovarian Cancer”
Gilda’s Club Western Pennsylvania
2816 Smallman Street
Pittsburgh, PA 15222
Light Refreshments Served
Please call Gilda’s Club to register: 412-338-1919
References for The Secret History of
the War on Cancer:
Amr S. Soliman, Melissa L. Bondy, Bernard Levin, Mohamed R.
Hamza, Kadry Ismail, Sohair Ismail, et al. “Colorectal Cancer in
Egypt Patients Under 40 Years of Age,” International Journal of
Cancer 71 (1997): 26-30.
David Biello, “Mixing It Up Harmless levels of chemicals prove
toxic together,” Scientific American, May 10, 2006.
Fall 2007
Volume 2 • Number 1
2 Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Helping to make prevention the cure for cancer. CEO-UPCI www.environmentaloncology.org
The Secret History of the War on Cancer Greening Indoor Air
Continued From Page 1 Continued From Page 10
illness that has always been around? Some by galloping growth in organs that have come aware of sources of toxic exposure, and prevent radon levels from increasing.
twenty-five-hundred years ago, the Greek just started a developmental spurt—their health effects, and strategies to reduce Have your home tested for radon and, if the
physician Hippocrates depicted a tumor bone marrow, brains and kidneys. These risk. levels are high, repair cracks and install
as a muddled, irritable cavity with spindly organs, which roughly double in size in the Smoking, car exhaust and chemicals ventilation systems to reduce radon gas
References for indoor
legs flaring out of control in all directions.first years of life, tend to get hit by cancer stored in attached garages all contribute to safe levels. When working with prod-
clean air plants:
Fascinated with its evil animal-like appear- when they begin to grow out of step dur- to indoor air pollution. Radon seeping ucts that contain volatile organic chemi-
cals (VOCs), such as paint, make sure that Wolverton, B. C., Foliage plants for improving indoor air quality,
ance, he termed it cancer, karkinoma, the ing their normal time of expansion. During through cracks in the house foundation is NASA Center: Stennis Space Center, 1988. Retrieved on 9/20/07.
there is cross ventilation and plenty of air
Greek word for crab. Like Hippocrates, we periods of fast growth, cells can double in of serious concern because it is the sec-
Wolverton, B.C., R. McDonald, and E. A. Watkins, Jr. Foliage
are drawn to objects of menacing beauty. size several times a day. The tiniest mis- ond leading cause of lung cancer. Bacte- exchange. Although water-based paints
Plants for Removing Indoor Air Pollutants from Energy-efficient
have fewer toxic chemicals these days,
All of us contain a remarkable array of take acquired when they were just being ria and mold can grow in wet areas and Homes. NASA Center: Stennis Space Center, 1984. Retrieved on
they still contain VOCs and these chemi- 9/20/07.
genes, proteins and enzymes that work to formed in early pregnancy or just after containers like walls, basements, ceilings
cals are what you smell while you paint
keep bad cells in check and tell danger- birth gets magnified over and over. roofs, and dropped ceilings; and humidi-
fiers and de-humidifiers that store water. and continue to smell for days after as the
ous ones to die. As we age, the vibrancy of To an epidemiologist like myself, such ex-
Combustion products from space heaters paint dries. Nowadays, many manufactur-
these repair systems and the rate at which planations of run-amok cancer processes
and gas and log-burning fireplaces also ers offer low VOC paint, and some even
they keep springing into action declines, address the how but not the why. They talk green this!
contribute toxins to the indoor air that we make paint without VOCs. Remember, if
just like a rubber band that eventually gives about how cells and organs behave when
breathe. Additionally, furniture made with you can smell the chemicals, then that is a greening your
out from overuse. But an aging population they spin out of control but say nothing
pressed wood and toxic glues can release good indication that you need to increase cleaning
does not explain why five times more men about what makes these things happen
solvents like formaldehyde into the air. the airflow in your home by opening a win- A New Book By
and women get brain cancer in America to specific groups of people located in a
The chemicals that we use in our arts and dow and, if possible, turning on a fan. Deirdre Imus, which
than in Japan. Nor do we understand why certain area at a certain time. Why have shows how easy it
rates of testicular cancer in men under age so many types of cancer, which are not crafts projects (like oil paints), to clean Finally, try to avoid using chemicals that
is to make “living
forty have risen 50 percent in one decade known to be tied with smoking, increased our homes (including air fresheners), and have warning labels including auto prod- green” your way of
in most industrial nations, why women of from decade to decade in industrial coun- to control insect pests and weeds can all ucts, pesticides, yard chemicals, home life
generation X are getting twice as much tries and in those areas of the developing affect air quality. Even our dogs and cats cleaning chemicals, air fresheners, “Most of us feel helpless when confronted with the ter-
can cause asthma if family members are bleach and home care products when- rifying realities of how our environment impacts our own
breast cancer as their grandmothers did, world that are becoming industrialized?
and our families’ health. “I’m here to tell you that we can
or why young black women get and die Why do one out of every three cases of allergic to fur and dander. These allergins, ever possible. Take the time to look for a
take action to improve this situation, and it’s much easier
from breast cancer in greater numbers colo-rectal cancer in Egypt occur in per- toxins, bacteria, and molds can trigger a less toxic alternative; these days there than you might think. As consumers, we have the power to
than their white counterparts do. sons under age forty, a rate that is nearly wide-range of health problems including are many less toxic and nontoxic options. control the level of toxins that enter our homes. With a little
asthma, allergies, chronic illness, and Keep your home dust-free to eliminate al- knowledge, we can give our families a much healthier life.”
Aging does not explain why so many more ten times higher than in the U.S? Why are
even cancer. lergens. Solid flooring—hardwood and
children have developed cancer. Can ag- so many people in their thirties and forties
tiles, for instance—is much easier to keep
ing be involved in growing cases of child- in many industrial countries coming down Importantly, there are some simple chang-
clean, while rugs can trap dirt, bacteria,
hood leukemia, kidney and brain cancer? with often fatal cancers of the bone mar- es that we can make to reduce the level of
and mold. To remove allergens, use a
In a strange way, yes. All of these can- row and pancreas—diseases that used to pollutants in our homes. We can change
vacuum with a high efficiency (hepa) fil-
cers come about because some part of occur only in those in their sixties or older? our cleaning routine by reducing or elimi- Citations for Greening Indoor Air:
ter, keep surfaces dusted, and wash bed
the body begins to act as though it were What can we do to reverse the trend? How nating toxic cleaning products and substi- 1. Leech JA, et al. J of Exposure Analysis
sheets and blankets frequently. Instead
much older, losing its ability to repair it- can we get better at keeping cancers from tuting safer, effective alternatives such as and Env. Epi. (12),427-432, 2002.
of tracking dust and germs in from the
self, as deformed cells take over. Normal happening in the first place? vinegar, baking soda, and fragrance-free 2. Whyatt, RM et al. Env. Health Perspectives
vegetable-based liquid soaps. Change the outdoors, leave your shoes at the door. 115:383-389, 2007
cells of healthy children have a spring-like We have all been told what we are sup-
water in humidifiers and de-humidifiers Indoor air quality will be improved if you
ability to recover from shocks, stay in or- posed to do to reduce the risk of cancer 3. Whyatt RM, et al. Env. Health
increase ventilation, reduce toxic chemi-
frequently and keep the containers clean Perspectives 112:1125-1132, 2004
der, stay in line, as though following some on our own. We are supposed to eat right
and free from mold and bacteria. Open cal use, reduce household dust, and keep
intelligent design. Children with cancer and exercise. Even prayer and meditation
windows in basements, use a dehumidi- moisture under control.
have lost their springs. They are overrun are touted as good things to do. Smoking, Fall 2007
fier, and seal cracks to control humidity Volume 2 • Number 1
Continued on page 3
Center for Environmental Oncology — University of Pittsburgh Cancer Institute 11
 www.environmentaloncology.org Helping to make prevention the cure for cancer. CEO-UPCI www.environmentaloncology.org

The Secret History of the War on Cancer

Continued From Page 2

of course, is forbidden. And we are cer- seed-corn fields of York County, Nebraska,
tainly not to drink much alcohol or engage are trying to tell us something: one in ev-
in dangerous sex. ery three exposed to mixtures of ordinary

indoor clean air plants But we all know people who lead perfectly chemicals in those fields die. The Secret History of
Plants can clean the air inside your home and office. The
clean, even exemplary lives and still get What causes cancer is a complicated mat- the War on Cancer
2-year study tested the following major indoor pollutants cancer. They take good care of themselves, ter of intense debate. Some of that debate
Devra Davis,
and found that most ornamental indoor plants can help and appear to be the very nicest of people, has been fostered and led by folks with
clean the air of at least one type of toxin, and some are PhD, MPH
yet somehow cancer hits. The first thing a strong interest in fanning uncertainties
able to remove all three of the following: Author of the National Book
most cancer patients, and their sometimes as a way to promote inaction. They have
Award Finalist
Formaldehyde unthinking friends ask—is what did I do argued that there’s only one proof that a
When Smoke Ran
Airborne Pollution Sources Plant Solutions to make this happen? The answer often given agent causes cancer in humans:
Like Water
Foam Insulation Corn Plant is—not a bloody enough people
Plywood / Particle Board Spider Plant thing. Sometimes with definite expo- www.basicbooks.com, For media inquiries related to the
Carpeting Philodendron species Greening Indoor Air cancer is due to a sures to a specific book, please contact: tim.brazier@perseusbooks.com
Furniture Bamboo Palm
by Maryann Donovan, MPH, PhD, Scientific Director, CEO of UPCI; Associate Director, genetic suscep- compound have to Now Available!
Paper Products Golden Pothos
Cleaners Chrysanthemum Research Services, UPCI; Assistant Professor, Department of Pathology, tibility that we have become sick The war on cancer was at first run by leaders of
University of Pittsburgh get from our fa- and died of the industries that made cancer-causing products, and
Benzene sometimes also profited from drugs and technologies
Researchers have reported that in the though some of the recent innovation thers or mothers, disease. They dis- for finding and treating the disease. Filled with
Airborne Pollution Sources Plant Solutions
United States, the average person, both has been beneficial, other developments but mostly it isn’t. miss experimental compelling personalities, and never-before-revealed
Tobacco Smoke Dragon Tree
young and old, spends 85% or more of may be contributing to poor indoor air We know that studies of cancer- information, The Secret History of the War on
Petroleum Products Dracaena
no matter how causing chemicals Cancer shows how we began fighting the wrong
Synthetic Fibers Potted Mum their time indoors and most of that time quality. Air quality is very important be-
war, with the wrong weapons, against the wrong
Plastics Gerbera Daisy (60-70%) is spent indoors at home. How cause the average person takes from careful anyone is conducted in rats enemies—a legacy that persists to this day.
Inks & Dyes Ribbon Plant about their good and mice. After
do we know that air contaminants in your 12-18 breaths/minute moving a large
Rubber Products English Ivy “A breathtaking, impeccably documented wake-up call
home affect your health? A recent study volume of air through their lungs. When and bad habits, all, we know we for what we should have done and what we must do!”
Detergents Peace Lily
conducted in New York City provides a the concentration of pollutants in the home where and when have to be differ- —Teresa Heinz Kerry, co-author of This Moment on Earth
Trichloroethylene
good example. Scientists showed that increases, exposure to airborne contami- we are born and ent from those “With the mastery of a great writer, Devra Davis
Airborne Pollution Sources Plant Solutions
pesticides that were used and stored in nants can become an important source what we work test rodents in takes the reader inside the successes, the failures,
Dry Cleaning Dragon Tree and play with laboratories. This and the ambiguity of research on cancer.”
homes could be detected both in the blood of exposure to toxic pollutants. What are
Inks & Dyes Potted Mum —Lorenzo Tomatis, MD, Former Director,
of pregnant women and in the air of their the possible sources of exposure and has a lot more to type of reasoning
Adhesives Peace Lily International Agency for Research on
Varnishes Gerbera Daisy homes. Could the scientists show a rela- what can we do? do with whether we get cancer than who is morally flawed and ignores one simple Cancer, World Health Organization
Lacquers & Paints Ribbon Plant tionship between pesticide exposure and our parents happen to be. fact: the same basic structure of DNA is
The American Lung Association has devel- “Devra Davis has written a brave and brilliant
health effects? Yes! Previous studies by Still, it defies common sense and basic bi- found in all mammals. If we cannot act to book.  It is a must-read for anyone who has ever
oped a very useful website to help you de-
Place one ornamental indoor plant per 100 square this same group reported that when chlo- ology to assume that just because a single protect or prevent exposures to suspected wondered why we’ve spent so much more effort
feet of office space. Select large leafy plants and mix
termine if there is evidence that your home treating cancer than preventing it.”
rpyrifos, an insecticide, was detected in agent looks all right when tested on its cancer causes based on solid experimen-
plant species to combat the full range of toxins. The has unhealthy air (www.healthhouse.org). —Lisa Heinzerling, Georgetown University Law
the umbilical cord blood at birth there was own, we can safely encounter hundreds of tal reasoning, and if we insist on proof that
recommendation of NASA is to use 15 to 18 good-sized On one page, they have a checklist to alert Center, and author of Priceless: On Knowing the
houseplants in six- to eight-inch diameter containers in a a significant association between high such materials all at once. You would never humans have already been harmed, then Price of Everything and the Value of Nothing
you to some common sources of house-
1,800 square-foot house. levels of insecticide and low birthweight take all the different pills in your medicine we are treating people like experimental All proceeds from sales of the book will go to the Devra
hold pollution and some common health
and small size. chest in one swallow, even though ingest- animals in a vast and largely uncontrolled Lee Davis Charitable Foundation, which supports the
effects that might suggest that the expo-
study. If the same people who oppose the work of the Center for Environmental Oncology of UPCI.
Our homes, especially homes that have sures are affecting household members. ing one or a few is fine. Why, then, should
we accept that there is no danger in being use of animal studies then go on to prevent
been built in the last 35 years, are much The Center for Environmental Oncology of
subjected to combinations of agents with- or suppress research on how environmen-
more air tight and contain many new University of Pittsburgh Cancer Institute
tal chemicals are affecting humans, the Fall 2007
Fall 2007 building products compared with homes (www.environmentaloncology.org) also out precedent in human history? Biologist
reasoning becomes morally indefensible. Volume 2 • Number 1
Volume 2 • Number 1 that were built 80 or more years ago. Al- has important information to help you be- Tyrone Hayes of the University of Califor-
Continued on page 11 nia at Berkeley thinks the tadpoles of the

10 Center for Environmental Oncology — University of Pittsburgh Cancer Institute Center for Environmental Oncology — University of Pittsburgh Cancer Institute 3
 www.environmentaloncology.org
Sunscreen primer
Sunscreen can provide a barrier to block the sun’s
damaging rays. The first sunscreens were developed
in the 1930s (11). Sunscreens today contain a mixture
of chemicals. A minimum SPF 15 is required to protect
against UVA and UVB exposure. Metal oxides, such
as titanium dioxide and zinc oxide, can contain
nanoparticles that absorb and reflect/scatter UV
rays (11). They offer protection against UVA and UVB
while being transparent on the skin. It is important to
reapply regularly and to use about an ounce of liquid
product for each application. Some information about
sunscreen ingredients can be found at www.ewg.org.
Table 1:
Self-identification catches two-thirds of melanoma
cases, so it is important to check your skin!:
• You should remember ENU: Evolving New and
Unusual moles
• Look for the ugly duckling: be suspicious of any mole
that is unlike the rest.
You should be aware of the ABCDE rule when checking
your skin:
A: asymmetry—one side of the mole differs from
the other
B: border irregularity—mole has ragged edges
C: color—mole is not the same color throughout
D: diameter—mole is larger than ¼ inch in diameter
E: evaluation—always seek medical advice for any
abnormality you find
Fall 2007
Volume 2 • Number 1
4 Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Helping to make prevention the cure for cancer.
UV Exposure Skin Cancer and The Case for
Banning Tanning Beds
by John M Kirkwood, MD, Director, UPCI Melanoma Program, Michelle L Meyer, BS,
Epidemiology Student, University of Pittsburgh Graduate School of Public Health, Maryann
Donovan, PhD, MPH, Scientific Director, Center for Environmental Oncology of UPCI, Devra
Lee Davis, PhD, MPH, Director, Center for Environmental Oncology of UPCI
Sunlight contains ultraviolet radiation A, B
and C (UVA, UVB, and UVC) and exposure
to UV radiation can cause skin cancer.
Since the 1930s, scientists have known
that excessive sunlight exposure—es-
pecially early in life—can cause cancer
in animals and humans. In fact, sunlight
is the main environmental risk factor for
skin cancer, although some solvents and
chemicals can sometimes play a role.
Sunlight is not the only source of UV expo-
sure. UV light from tanning beds is also a
dangerous source of skin cancer-causing
exposure that also increases the risk of
developing cataracts and other eye dis-
eases.
Skin cancer is the most common cancer
in the United States and one in five Ameri-
cans will have the disease in their lifetime
(1). Several types of skin cancer include:
basal cell cancer, squamous cell can-
cer, and melanoma. Basal cell cancers
are generally located in chronically sun-
exposed areas, such as the face, neck,
ears and arms. This common form of skin
cancer tends to grow slowly and gener-
ally remains localized for many months or
years. Squamous cell cancers are also
found in areas that are typically chroni-
cally exposed to the sun, and tend to prog-
ress more slowly than melanoma, but may
spread to other parts of the body. Melano-
ma is unique in that it begins in specialized
pigment-producing cells called melano-
cytes and can be very aggressive. Each
year melanoma affects 50,000 patients
and more than 8,000 patients will die from
the disease (3). It is very concerning that
melanoma incidence is rising rapidly. The
American Cancer Society recommends
checking monthly for changes in patterns
or shapes of moles and freckles using AB-
CDE (see Table 1).
Sun exposure is the major established
cause of skin cancer and risk is increased
with the number of sunburns in childhood.
About 80% of our lifetime sun exposure
occurs during childhood and this expo-
sure increases the chance of develop-
ing skin cancer later in life (4). Reducing
childhood exposures to sunlight could
lower the risk of skin cancer by more than
70% (2). Intermittent or recreational sun
exposure is a risk factor for melanoma,
while total sun exposure is a risk factor for
non-melanoma skin cancer (4). Although
cancer usually takes decades to develop,
at the UPMC Melanoma Clinic, we are
seeing melanoma in teenagers, some of
whom have used tanning beds for only
a few years. Melanoma, unfortunately,
can be fatal and UV rays are estimated to
cause nearly three out of every five cases
of melanoma.
Individuals vary more than 100-fold in sun
sensitivity, which is determined by genet-
ics and variations in skin color (10). Many
different risk factors can contribute to
any single case of skin cancer, including:
genetic susceptibility, UV exposure, and
possibly chemical exposure. Individuals
who have sun-sensitive skin that tends to
burn before tanning, and those who tan
poorly or freckle, are at the highest risk
for skin cancer. Ironically, these high-risk
individuals are often those who seek the
Continued on page 5
CEO-UPCI
Environmental Safety of Toys Continued From Page 8
proved Product)/CP (Certified Product)/HL
Health Label (Non-Toxic) (seals of the Arts
& Creative Materials Institute) can be cer-
tain to be up to current safety standards.
Products simply labeled “non-toxic” have
still been found to contain lead and other
harmful substances.
3. Chemicals called phthalates (actually
a group of chemicals, some of which are
known by the initials DEHP and DINP)
are often used as plasticizing agents in
vinyl, and leach out of the vinyl easily. In
animals, phthalates can harm the repro-
ductive system in males, interfere with
normal development, and cause cancer
of the liver and kidneys. Many of these
same effects are suspected (though not
yet proven) to occur in humans. In the U.S.
and Canada, phthalates are banned from
baby bottles, pacifiers, and plastic toys
aimed at infants and toddlers, but may
still be present in toys for older children,
and in shower curtains, plastic wraps, and
other vinyl or “PVC” items.
4. Outdoor play environments can also
pose health hazards. Pressure-treated
wooden play-sets containing arsenic can
leave residues of the metal on children’s
hands. Although the preservative copper
chromium arsenate in wood was phased
out of use at the end of 2003, many play-
grounds and sets still have this wood in
place. Older playground equipment may
have been painted with lead-based paint.
Grassy areas may have been sprayed with
pesticides. To ensure a safer environment
for children to play in, make sure painted
items are not peeling or rusting, avoid
Center for Environmental Oncology — University of Pittsburgh Cancer Institute 9
spraying pesticides where children play,
don’t allow them to play in grassy areas
where pesticides have been sprayed, and
replace arsenic-treated wood with newer
items. Clean up standing water to prevent
mosquitoes from breeding. Finally, always
remember to put UVA/UVB sun block on
children to protect them from damaging
sunburns.
Remember that environmental safety is
more than just avoiding toxic chemicals; it
is also about creating an environment that
is physically safe. Be aware of hazards
such as small marbles, latex balloons, and
other tiny parts that pose choking risks to
young children and keep such toys away
from children under three (or others who
still “mouth” toys). Stay alert for sharp
edges, electrical toys that heat up, projec-
tiles (like darts), and toys that make loud
noises. Make sure riding toys are kept
where they cannot accidentally roll down
stairs or off decks. Ensure that children
wear helmets when riding bicycles, skate-
boards, and scooters. Watch out for toys
with strings and cords that may strangle
infants and toddlers. Finally, pay attention
to the media environment, looking out for
age-inappropriate content in books, TV
shows, computer and video games, and
Internet sites.
We can never completely insulate our
children from risk, but by taking steps to
eliminate these hazards and by sharing
these recommendations with friends and
relatives, you can make playtime a much
safer time.
www.environmentaloncology.org
Are my pets at risk from lawn
care pesticides?
Dogs, cats, and other companion animals often come
into close contact with grass and, potentially, lawn care
pesticides that are harmful to them.
To reduce risk to you and your pets:
• Read the pesticide product label and follow all
instructions exactly. Pay attention to label warnings
for people and pets. After being applied, many
pesticides will break down by sun, air or water, with
time. Reduce exposures by waiting the appropriate
amount of time (according to the label) before allowing
your family or pets back into a treated area.
• If you use a professional lawn care service, ask to read
the label of the pesticide product being applied.
• Pay attention to small flags posted around turf and
lawn areas in your neighborhood, local park, and
other grassy areas. These flags often indicate a recent
application of pesticides and that people or pets should
stay away until flags are removed.
• Alternatively, look for other ways to control and
prevent pest infestations in your home and yard and
use chemical pesticides only as a last resort or not
at all. Integrated Pest Management (IPM) methods
provide a variety of chemical-free solutions. For more
information, go to: http://www.nysipm.cornell.edu/
or http://www.gardening.cornell.edu/lawn/. Or
http://envirocancer.cornell.edu/faq/answer.cfm
References for the Environ-
mental Safety of Toys article
Etzel RA and Balk SJ, eds. Pediatric Environmental Health, 2nd
Edition. Elk Grove Village, IL: American Academy of Pediatrics,
2003. Chapters on Child Care Settings, Arsenic, and Arts and
Crafts.
Draft of chapter on Toy Safety. Available at http://www.aap.org/
moc/toysafety.htm?CFID=1504452&CFTOKEN=57897971
Shea KM and Committee on Environmental Health. Pediatric Ex-
posure and Potential Toxicity of Phthalate Plasticizers. Pediatrics.
Vol. 111, No. 6 June 2003, pp. 1467-1474.
Websites of the American Academy of Pediatrics (www.aap.
org) and the U.S. Consumer Product Safety Commission (www.
cpsc.gov).
Fall 2007
Volume 2 • Number 1
 www.environmentaloncology.org Helping to make prevention the cure for cancer. CEO-UPCI www.environmentaloncology.org

Environmental Safety of Toys

by Jonathan Weinkle, MD Resident, Medicine-Pediatrics, UPMC Presbyterian-Shadyside
and Children’s Hospital of Pittsburgh

Nothing says “happy childhood” like a

Limit Your Child’s Intake of
Food Additives
Identify what your child eats. Keep a food diary
for a week, noting everything that is eaten—including
at school. At the end of the week, you should have a
good idea of your child’s exposure to food additives.
Food additives are largely present in processed and
packaged foods, candy, soda and other “junk” food, so
if you limit these foods, you’ll cut down considerably.
Adopt the New Green Diet. Eating a balanced diet of
fresh produce and whole grain foods will go a long way
towards keeping additives out of your child’s system.
Choose products that are labeled
“preservative-free.” Be wary of labels
that claim “no added preservatives..”
Read Labels. Particularly keep an eye out for the
following additives. Some of these cause allergy-
like symptoms or are suspected carcinogens.
• Butylated Hydroxyanisole (BHA) and
Butylated Hydroxytoluene (BHT)
• Propyl Gallate
• Sodium Nitrate/Nitrate
• Sulfites (Sulfur Dioxide, Sodium Sulfite,
Sodium and Potassium Bisulfite, Sodium
and Potassium Metabisulfite)
• Potassium Bromate
• FD&C Blue No. 1
• FD&C Blue No. 2
• FD&C Green No. 3
• FD&C Red No. 3 (Erythrosine)
• FD&C Yellow No. 5 (Tartrazine)
• FD&C Yellow No. 6
• Monosodium Glutamate (MSG)
• Acesulfame-K
Read the full article on the Healthy Child, Healthy
World Website: www.healthychild.org
Fall 2007
Volume 2 • Number 1
brand-new toy, a playground set, or
an afternoon of arts and crafts. Un-
fortunately, just like bubble baths and
pajamas, these items can contain
chemical or physical dangers
to children of which parents
need to be aware. Children’s
developing bodies and brains
are more vulnerable to physical and
chemical dangers in the environment than
adult bodies and brains. A product marked
“non-toxic” or “safe” may contain accept-
able levels of a chemical for an adult, but
these levels may be far beyond the levels
that are tolerable for a child.
One reason that children are so vulnerable
is that they are still growing and develop-
ing. This growth isn’t steady. It proceeds in
fits and starts with rapid growth in the first
year of life, slower growth during toddler
and school age years, and a surge forward
in adolescence, before it stops altogether.
Along the way, there are several critical
“windows”: growth spurts, various stag-
es of pre-puberty and puberty, and other
changes involving complex interactions of
hormones, nerve cells in the brain, nutri-
tion, and sleep, among other things. If this
process is interrupted or disturbed, there
can be serious repercussions for a child:
a lower IQ, a hormone-dependent cancer,
the development of asthma, or other chron-
ic health problems. When this delicate
balance is combined with a child’s greater
pound-for-pound intake of air, water, and
food, their hand-to-mouth behavior, and
greater proportion of time spent close to
the ground (where both airborne and solid
toxins collect), it’s easy to see why chil-
dren are at such an increased risk. With
these facts in mind, here is some advice
aimed
at making the
playtime environment a little safer:
1. While most painted wood toys are safe,
it helps to buy toys made in the United
States, Canada, or Europe, where stan-
dards are more strictly enforced. Some
toys made of painted wood and some
plastic toys, including toy jewelry items,
especially those made in China, have
high levels of lead. These products are
typically recalled when the problem is
discovered. The Consumer Product Safety
Commission (http://www.cpsc.gov/cp-
scpub/prerel/category/toy.html) posts
these recalls online, as does the website
www.recalls.gov. If a toy you own is re-
called, take it away immediately and fol-
low the company’s instructions on how to
get a safe replacement. As a fun, safer al-
ternative, buy natural wood toys and non-
toxic, lead-free paints and turn this into a
creative project with your child.
2. Paints and many other craft supplies
can contain a range of environmental haz-
ards, including heavy metals, solvents, and
dusts. To avoid exposures to these haz-
ards, children under 13 should never use
materials labeled “Keep Out of Reach of
Children” or which contain any sort of haz-
ard labeling or cautionary wording on the
label. Only products specifically labeled
“Conforms to ASTM (American Society for
Testing and Materials) D4236” and AP (Ap-
Continued on page 9
UV Exposure Skin Cancer and The Case for Banning Tanning Beds
Continued From Page 4
sun and spend considerable time at indoor use for those unusual skin diseases, like
tanning facilities. advanced psoriasis, where they can be of
Other risk factors for skin cancer includes therapeutic value.
family history, number of moles and freck-
les, history of sunburn (>3 before age 20),
sensitivity to sunburn, fair skin and light
hair color (1, 2, 5, 6). In some reports, in-
creased rates of melanoma have been
found in men and women who work with
chemicals such as arsenic, insecticides,
herbicides, ionizing radiation, polychlori-
nated biphenyls (PCBs), vinyl chloride, and
petrochemicals (5, 7, 8).
Tanning beds can provide more than five
times the exposure to UV that one would
receive from being outdoors for half an
hour. Despite the known risks of UV ex-
posure, tanning salons in the US are a
growing billion dollar-a-year industry, with
little standardization or control. The World
Health Organization considers UV to be
a proven cause of cancer in humans and
recommends that no children under the
age of eighteen use tanning beds. We be-
lieve that recreational tanning beds should
be banned, with an exception for medical
Good sun protection habits should be
started early and frequently reinforced
throughout life beginning in early child-
hood. Here are some things that you can
do:
• Avoid sun and recreational sunbathing
between the hours of 10 a.m. and
4 p.m., when UV radiation is at its
highest.
• Use physical barriers like umbrellas
or trees to provide shade and
block the sun reduces exposures.
• Wear protective clothing such as
wide-brimmed hats, sunglasses,
long sleeves and long pants, which
can provide an important
physical barrier.
• Finally, apply sunscreens containing
zinc oxide or titanium dioxide
micronized, to exposed skin,
as they provide an important
barrier as well (see Table 1).
Citations for UV Exposure and Skin
Cancer article:
(1) Cummins DL, Cummins JM, Pantle H, Silverman MA,
Leonard AL, Chanmugam A. Cutaneous Malignant Mela-
noma. Mayo. Clin. Proc. 2006. 81(4): 500-507.
(2) Geller AC, Colditz G, Oliveria S, Emmons K, Jorgensen
C, Aweh GN, Frazier L. Use of sunscreen, sunburning rates,
and tanning bed use among more than 10,000 US children
and adolescents. Pediatrics. 2002. 109:1009-1014.
(3) Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ.
Cancer statistics, 2007. CA Cancer J. Clin. 2007. 57:43-66.
(4) Abdulla FR, Feldman SR, Williford PM, Krowchuck D,
Kaur M. Tanning and skin cancer. Pediatric Dermatology.
2005. 22(6):501-512.
(5) Markovic SN, et al. Malignant melanoma in the 21st
century, part 1: epidemiology, risk factors, screening, pre-
vention, and diagnosis. Mayo. Clin. Proc. 2007. 82(3):364-
380.
(6) National Institutes of Health. What You Need to Know
About Skin Cancer; 2005. NIH Publication No. 05-1564.
Available at: http://www.cancer.gov/cancerinfo/wyntk/skin/
(7) Ward EM, Burnett CA, Ruder A, Davis-King K. Industries
and cancer. Cancer Causes and Control. 1997. 8:356-370.
(8) Gawkrodger DJ. Occupational skin cancers. Occupa-
tional Medicine. 2004. 54:458-463.
(9) Centers for Disease Control and Prevention. 2006/2007
Skin Cancer Prevention and Education Initiative Fact
Sheet. Available at: http://www.cdc.gov/cancer/skin/
basic_info/
(10) Rees JL. The genetics of sun sensitivity in humans. Am.
J. Hum. Genet. 2004. 75:739-751.
(11) Nash JF. Human safety and efficacy of ultraviolet filters
and sunscreen products. Dermatol. Clin. 2006. 35-51.
Fall 2007
Volume 2 • Number 1

8 Center for Environmental Oncology — University of Pittsburgh Cancer Institute Center for Environmental Oncology — University of Pittsburgh Cancer Institute 5
 www.environmentaloncology.org
Question:
Dear Center for Environmental Oncology,
I have a question regarding poultry:  My 10 year old
daughter eats a lot of chicken - almost 3-4 times
per week.  She turned 10 in November and prior to
that already showed signs of puberty. She is now
beginning to develop at a rapid pace.  I have also
noticed that she has a tendency to carry excess
weight around her belly.  I have heard that there
are a lot of hormones that are given to chickens
in order to produce a meatier piece of poultry and
wondered if these hormones could be the cause
of her early development and weight gain.  I have
asked her pediatrician, but he was not very help-
ful.  He indicated that they have found that young
girls are developing at an earlier rate than we did
as children.  I think I was in the 8th grade before
I even showed signs!  I am very concerned about
this and actually will be switching to organic.  When puberty arrives earlier, the window
Can I assume that organic chicken does not have
hormones in it?  Also, perhaps organic milk would
be best as well?  I would appreciate your input
and directing me to sites that I could view on the
website.  Thanks.
Answers on page 7 sidebar
Fall 2007
Volume 2 • Number 1
6 Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Helping to make prevention the cure for cancer.
Excerpted from: The Falling Age of
Puberty in U.S. Girls: What we Know, What
We Need to Know To view the entire article, please visit the Breast Cancer
Fund website: www.breastcancerfund.org
by: Sandra Steingraber, PhD
A Note from the Breast Cancer Fund
Executive Director: Over the past few
years, studies have revealed that girls as
young as two are entering puberty. The
reports and images are deeply disturbing.
For breast cancer advocates, there is
something else that is disturbing: early
puberty increases breast cancer risk.
of exposure to estrogen opens wider and
increases a girl’s risk of getting breast
cancer later in life.
Girls get their first periods today, on
average, a few months earlier than did girls
40 years ago, but they get their breasts one
to two years earlier. Over the course of a
few decades, the childhoods of U.S. girls
have been significantly shortened.
What does this mean for girls today and
their health in the future?
~ Jeanne Rizzo, R.N.
What We Know
In some respects, the falling age of
puberty appears to be part of a natural
process: humans, evolving in hunter-
gatherer societies, developed the ability
to reproduce at younger ages in response
to plentiful calories, and subsequent
environmental stimuli have simply
accelerated that trend. This remains
the best explanation for the falling age
of menarche in U.S. girls, as well as
European girls, from the mid-19th through
the mid-20th century. Increasing access to
food and less infectious diseases lowers
the age of the first menstrual period
(menarche). (Parent, 2003).
During the last 50 years, however,
additional forces seem to have been
at work. The evidence suggests that
children’s hormonal systems are being
altered by various stimuli and that early
puberty is the coincidental, non-adaptive
outcome. The intricate and naturally
reactive system that connects the adrenal
and pituitary glands to hormones is highly
vulnerable to disruption. Obesity is one
manifestation of endocrine disruption
and may lead to hyperinsulinism, leptin
(a hormone that has a central role in fat
metabolism) resistance and enhanced
aromatase (an enzyme involved in the
production of estrogen) activity. Preterm
birth and intrauterine growth restriction—
especially when followed by rapid weight
gain—is a second kind of endocrine
Continued on page 7
CEO-UPCI
Excerpted from: The Falling Age of Puberty in U.S. Girls: What we Know,
What We Need to Know Continued from page 6
disruptor that raises the risk for early
onset of puberty. The risk for obesity,
preterm birth and low birth weight, in turn,
are influenced by exposures to chemical
toxins. Chemical toxicants constitute a
third kind of endocrine disruptor when
they directly tamper with the development
of hormones. Chemical endocrine
disruption can lead to alterations in the
timing of puberty by several pathways. It
can interfere with the hormonal messages
received and sent out by the adrenal
and pituitary system, for example, or it
can alter their sensitivity to hormonal
messages. By either route, environmental
chemicals may contribute to early
puberty in girls. Indeed, stressors of many
sorts—nutritional, environmental and
psychosocial—all appear to interact in a
complex manner and contribute to early
sexual maturation in girls.
As such, early puberty is a phenomenon
best understood as an ecological disorder.
As described by physician Ted Schettler,
an ecological disorder does not result
from a single toxicant, or set of toxicants,
causing a single disease through a
single causal pathway. Rather, it is the
consequence of multiple and mutually
penetrating environmental stressors that
exist within a connecting web and can
thus be defined as an “ecological
manifestation of multiple changes in the
dynamic system in which people are
conceived, develop, live and grow old”
(Schettler, 2006). All of the stressors
identified here that appear to contribute
to early puberty in girls—obesity,
television viewing, lack of exercise,
family dysfunction, preterm birth, formula-
feeding, chemical exposures—are higher
in poor communities and communities of
color where poverty, racism, unemployment
Center for Environmental Oncology — University of Pittsburgh Cancer Institute 7
and toxic substance exposures are high
and access to nourishing food and safe
places to exercise is low. In particular,
U.S. black children are disproportionately
exposed to physical environmental
stressors (Hambrick-Dixon, 2002), and it
is also this group that reaches puberty
earliest among U.S. girls.
What We Can Do Now
There is sufficient evidence for the
contribution (direct or indirect) of body
mass to pubertal timing in girls to support
efforts that combat childhood obesity.
Any campaign to address this problem
should begin with the promotion of
breastfeeding. Breast milk safeguards
against obesity. At 12 months, breastfed
babies are leaner than formula-fed
babies, a difference that persists into later
childhood (Dewey, 1998; Mayer-Davis,
2006; Schack-Nielsen and Michaelsen,
2007). Breastfeeding is most important
for children born small for gestational
age or premature, for whom rapid weight
gain raises additional risks for obesity and
early puberty.
For older children, successful battles are
being waged at local and regional levels
even as national efforts remain mired. A
number of school districts around the
country have begun working to eliminate
sugary, high-calorie foods from cafeterias
and school events—and continue doing
so without federal funding or support from
the school lunch program (Foxhall, 2006).
Some school-based obesity-prevention
programs have already demonstrated an
ability to delay menarche. One is Planet
Health, a school-based intervention
designed to decrease among school
children television viewing and
consumption of high-fat foods while
Continued on page 12
www.environmentaloncology.org
Continued from page 6
Answer:
I’m sorry to tell you that your instincts are
correct.  We are seeing younger and younger girls
develop earlier.  This is not a good thing.  We don’t
know why this is happening, but certainly dietary
factors, and less exercise are among the things
we have good reason to be concerned about. One
of the causes could well be diets high in animals
and animal fat that can contain several approved
hormones in this country that are banned in Europe.
In the meantime, moderation in all things is advised. 
If you don’t want to go with organic chicken, then
you should diversify the diet to include beans and
grains, which combined, can provide a complement
of amino acids and proteins that are needed for the
growth of children.
~Devra Lee Davis, PhD, MPH
I, too, believe your instincts may be correct. There
are several theorized causes of earlier puberty--
hormones in meat and milk, xenoestrogens in the
environment, such as plastics that are used to wrap
and cook food in, as well as less exercise, and
more body fat overall. I do think that going organic
for meat and milk, adding in lots of other fruits and
vegetables, and minimizing use of plastics near
your food and in your microwave, may be helpful.
Of course, it could be none of these things, and just
what is normal for your daughter!
~Judith Balk, MD MPH, Assistant Professor,
Magee-Womens Hospital, University of Pittsburgh
Fall 2007
Volume 2 • Number 1
 www.environmentaloncology.org
Question:
Dear Center for Environmental Oncology,
I have a question regarding poultry:  My 10 year old
daughter eats a lot of chicken - almost 3-4 times
per week.  She turned 10 in November and prior to
that already showed signs of puberty. She is now
beginning to develop at a rapid pace.  I have also
noticed that she has a tendency to carry excess
weight around her belly.  I have heard that there
are a lot of hormones that are given to chickens
in order to produce a meatier piece of poultry and
wondered if these hormones could be the cause
of her early development and weight gain.  I have
asked her pediatrician, but he was not very help-
ful.  He indicated that they have found that young
girls are developing at an earlier rate than we did
as children.  I think I was in the 8th grade before
I even showed signs!  I am very concerned about
this and actually will be switching to organic.  When puberty arrives earlier, the window
Can I assume that organic chicken does not have
hormones in it?  Also, perhaps organic milk would
be best as well?  I would appreciate your input
and directing me to sites that I could view on the
website.  Thanks.
Answers on page 7 sidebar
Fall 2007
Volume 2 • Number 1
6 Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Helping to make prevention the cure for cancer.
Excerpted from: The Falling Age of
Puberty in U.S. Girls: What we Know, What
We Need to Know To view the entire article, please visit the Breast Cancer
Fund website: www.breastcancerfund.org
by: Sandra Steingraber, PhD
A Note from the Breast Cancer Fund
Executive Director: Over the past few
years, studies have revealed that girls as
young as two are entering puberty. The
reports and images are deeply disturbing.
For breast cancer advocates, there is
something else that is disturbing: early
puberty increases breast cancer risk.
of exposure to estrogen opens wider and
increases a girl’s risk of getting breast
cancer later in life.
Girls get their first periods today, on
average, a few months earlier than did girls
40 years ago, but they get their breasts one
to two years earlier. Over the course of a
few decades, the childhoods of U.S. girls
have been significantly shortened.
What does this mean for girls today and
their health in the future?
~ Jeanne Rizzo, R.N.
What We Know
In some respects, the falling age of
puberty appears to be part of a natural
process: humans, evolving in hunter-
gatherer societies, developed the ability
to reproduce at younger ages in response
to plentiful calories, and subsequent
environmental stimuli have simply
accelerated that trend. This remains
the best explanation for the falling age
of menarche in U.S. girls, as well as
European girls, from the mid-19th through
the mid-20th century. Increasing access to
food and less infectious diseases lowers
the age of the first menstrual period
(menarche). (Parent, 2003).
During the last 50 years, however,
additional forces seem to have been
at work. The evidence suggests that
children’s hormonal systems are being
altered by various stimuli and that early
puberty is the coincidental, non-adaptive
outcome. The intricate and naturally
reactive system that connects the adrenal
and pituitary glands to hormones is highly
vulnerable to disruption. Obesity is one
manifestation of endocrine disruption
and may lead to hyperinsulinism, leptin
(a hormone that has a central role in fat
metabolism) resistance and enhanced
aromatase (an enzyme involved in the
production of estrogen) activity. Preterm
birth and intrauterine growth restriction—
especially when followed by rapid weight
gain—is a second kind of endocrine
Continued on page 7
CEO-UPCI
Excerpted from: The Falling Age of Puberty in U.S. Girls: What we Know,
What We Need to Know Continued from page 6
disruptor that raises the risk for early
onset of puberty. The risk for obesity,
preterm birth and low birth weight, in turn,
are influenced by exposures to chemical
toxins. Chemical toxicants constitute a
third kind of endocrine disruptor when
they directly tamper with the development
of hormones. Chemical endocrine
disruption can lead to alterations in the
timing of puberty by several pathways. It
can interfere with the hormonal messages
received and sent out by the adrenal
and pituitary system, for example, or it
can alter their sensitivity to hormonal
messages. By either route, environmental
chemicals may contribute to early
puberty in girls. Indeed, stressors of many
sorts—nutritional, environmental and
psychosocial—all appear to interact in a
complex manner and contribute to early
sexual maturation in girls.
As such, early puberty is a phenomenon
best understood as an ecological disorder.
As described by physician Ted Schettler,
an ecological disorder does not result
from a single toxicant, or set of toxicants,
causing a single disease through a
single causal pathway. Rather, it is the
consequence of multiple and mutually
penetrating environmental stressors that
exist within a connecting web and can
thus be defined as an “ecological
manifestation of multiple changes in the
dynamic system in which people are
conceived, develop, live and grow old”
(Schettler, 2006). All of the stressors
identified here that appear to contribute
to early puberty in girls—obesity,
television viewing, lack of exercise,
family dysfunction, preterm birth, formula-
feeding, chemical exposures—are higher
in poor communities and communities of
color where poverty, racism, unemployment
Center for Environmental Oncology — University of Pittsburgh Cancer Institute 7
and toxic substance exposures are high
and access to nourishing food and safe
places to exercise is low. In particular,
U.S. black children are disproportionately
exposed to physical environmental
stressors (Hambrick-Dixon, 2002), and it
is also this group that reaches puberty
earliest among U.S. girls.
What We Can Do Now
There is sufficient evidence for the
contribution (direct or indirect) of body
mass to pubertal timing in girls to support
efforts that combat childhood obesity.
Any campaign to address this problem
should begin with the promotion of
breastfeeding. Breast milk safeguards
against obesity. At 12 months, breastfed
babies are leaner than formula-fed
babies, a difference that persists into later
childhood (Dewey, 1998; Mayer-Davis,
2006; Schack-Nielsen and Michaelsen,
2007). Breastfeeding is most important
for children born small for gestational
age or premature, for whom rapid weight
gain raises additional risks for obesity and
early puberty.
For older children, successful battles are
being waged at local and regional levels
even as national efforts remain mired. A
number of school districts around the
country have begun working to eliminate
sugary, high-calorie foods from cafeterias
and school events—and continue doing
so without federal funding or support from
the school lunch program (Foxhall, 2006).
Some school-based obesity-prevention
programs have already demonstrated an
ability to delay menarche. One is Planet
Health, a school-based intervention
designed to decrease among school
children television viewing and
consumption of high-fat foods while
Continued on page 12
www.environmentaloncology.org
Continued from page 6
Answer:
I’m sorry to tell you that your instincts are
correct.  We are seeing younger and younger girls
develop earlier.  This is not a good thing.  We don’t
know why this is happening, but certainly dietary
factors, and less exercise are among the things
we have good reason to be concerned about. One
of the causes could well be diets high in animals
and animal fat that can contain several approved
hormones in this country that are banned in Europe.
In the meantime, moderation in all things is advised. 
If you don’t want to go with organic chicken, then
you should diversify the diet to include beans and
grains, which combined, can provide a complement
of amino acids and proteins that are needed for the
growth of children.
~Devra Lee Davis, PhD, MPH
I, too, believe your instincts may be correct. There
are several theorized causes of earlier puberty--
hormones in meat and milk, xenoestrogens in the
environment, such as plastics that are used to wrap
and cook food in, as well as less exercise, and
more body fat overall. I do think that going organic
for meat and milk, adding in lots of other fruits and
vegetables, and minimizing use of plastics near
your food and in your microwave, may be helpful.
Of course, it could be none of these things, and just
what is normal for your daughter!
~Judith Balk, MD MPH, Assistant Professor,
Magee-Womens Hospital, University of Pittsburgh
Fall 2007
Volume 2 • Number 1
 www.environmentaloncology.org Helping to make prevention the cure for cancer. CEO-UPCI www.environmentaloncology.org

Environmental Safety of Toys

by Jonathan Weinkle, MD Resident, Medicine-Pediatrics, UPMC Presbyterian-Shadyside
and Children’s Hospital of Pittsburgh

Nothing says “happy childhood” like a

Limit Your Child’s Intake of
Food Additives
Identify what your child eats. Keep a food diary
for a week, noting everything that is eaten—including
at school. At the end of the week, you should have a
good idea of your child’s exposure to food additives.
Food additives are largely present in processed and
packaged foods, candy, soda and other “junk” food, so
if you limit these foods, you’ll cut down considerably.
Adopt the New Green Diet. Eating a balanced diet of
fresh produce and whole grain foods will go a long way
towards keeping additives out of your child’s system.
Choose products that are labeled
“preservative-free.” Be wary of labels
that claim “no added preservatives..”
Read Labels. Particularly keep an eye out for the
following additives. Some of these cause allergy-
like symptoms or are suspected carcinogens.
• Butylated Hydroxyanisole (BHA) and
Butylated Hydroxytoluene (BHT)
• Propyl Gallate
• Sodium Nitrate/Nitrate
• Sulfites (Sulfur Dioxide, Sodium Sulfite,
Sodium and Potassium Bisulfite, Sodium
and Potassium Metabisulfite)
• Potassium Bromate
• FD&C Blue No. 1
• FD&C Blue No. 2
• FD&C Green No. 3
• FD&C Red No. 3 (Erythrosine)
• FD&C Yellow No. 5 (Tartrazine)
• FD&C Yellow No. 6
• Monosodium Glutamate (MSG)
• Acesulfame-K
Read the full article on the Healthy Child, Healthy
World Website: www.healthychild.org
Fall 2007
Volume 2 • Number 1
brand-new toy, a playground set, or
an afternoon of arts and crafts. Un-
fortunately, just like bubble baths and
pajamas, these items can contain
chemical or physical dangers
to children of which parents
need to be aware. Children’s
developing bodies and brains
are more vulnerable to physical and
chemical dangers in the environment than
adult bodies and brains. A product marked
“non-toxic” or “safe” may contain accept-
able levels of a chemical for an adult, but
these levels may be far beyond the levels
that are tolerable for a child.
One reason that children are so vulnerable
is that they are still growing and develop-
ing. This growth isn’t steady. It proceeds in
fits and starts with rapid growth in the first
year of life, slower growth during toddler
and school age years, and a surge forward
in adolescence, before it stops altogether.
Along the way, there are several critical
“windows”: growth spurts, various stag-
es of pre-puberty and puberty, and other
changes involving complex interactions of
hormones, nerve cells in the brain, nutri-
tion, and sleep, among other things. If this
process is interrupted or disturbed, there
can be serious repercussions for a child:
a lower IQ, a hormone-dependent cancer,
the development of asthma, or other chron-
ic health problems. When this delicate
balance is combined with a child’s greater
pound-for-pound intake of air, water, and
food, their hand-to-mouth behavior, and
greater proportion of time spent close to
the ground (where both airborne and solid
toxins collect), it’s easy to see why chil-
dren are at such an increased risk. With
these facts in mind, here is some advice
aimed
at making the
playtime environment a little safer:
1. While most painted wood toys are safe,
it helps to buy toys made in the United
States, Canada, or Europe, where stan-
dards are more strictly enforced. Some
toys made of painted wood and some
plastic toys, including toy jewelry items,
especially those made in China, have
high levels of lead. These products are
typically recalled when the problem is
discovered. The Consumer Product Safety
Commission (http://www.cpsc.gov/cp-
scpub/prerel/category/toy.html) posts
these recalls online, as does the website
www.recalls.gov. If a toy you own is re-
called, take it away immediately and fol-
low the company’s instructions on how to
get a safe replacement. As a fun, safer al-
ternative, buy natural wood toys and non-
toxic, lead-free paints and turn this into a
creative project with your child.
2. Paints and many other craft supplies
can contain a range of environmental haz-
ards, including heavy metals, solvents, and
dusts. To avoid exposures to these haz-
ards, children under 13 should never use
materials labeled “Keep Out of Reach of
Children” or which contain any sort of haz-
ard labeling or cautionary wording on the
label. Only products specifically labeled
“Conforms to ASTM (American Society for
Testing and Materials) D4236” and AP (Ap-
Continued on page 9
UV Exposure Skin Cancer and The Case for Banning Tanning Beds
Continued From Page 4
sun and spend considerable time at indoor use for those unusual skin diseases, like
tanning facilities. advanced psoriasis, where they can be of
Other risk factors for skin cancer includes therapeutic value.
family history, number of moles and freck-
les, history of sunburn (>3 before age 20),
sensitivity to sunburn, fair skin and light
hair color (1, 2, 5, 6). In some reports, in-
creased rates of melanoma have been
found in men and women who work with
chemicals such as arsenic, insecticides,
herbicides, ionizing radiation, polychlori-
nated biphenyls (PCBs), vinyl chloride, and
petrochemicals (5, 7, 8).
Tanning beds can provide more than five
times the exposure to UV that one would
receive from being outdoors for half an
hour. Despite the known risks of UV ex-
posure, tanning salons in the US are a
growing billion dollar-a-year industry, with
little standardization or control. The World
Health Organization considers UV to be
a proven cause of cancer in humans and
recommends that no children under the
age of eighteen use tanning beds. We be-
lieve that recreational tanning beds should
be banned, with an exception for medical
Good sun protection habits should be
started early and frequently reinforced
throughout life beginning in early child-
hood. Here are some things that you can
do:
• Avoid sun and recreational sunbathing
between the hours of 10 a.m. and
4 p.m., when UV radiation is at its
highest.
• Use physical barriers like umbrellas
or trees to provide shade and
block the sun reduces exposures.
• Wear protective clothing such as
wide-brimmed hats, sunglasses,
long sleeves and long pants, which
can provide an important
physical barrier.
• Finally, apply sunscreens containing
zinc oxide or titanium dioxide
micronized, to exposed skin,
as they provide an important
barrier as well (see Table 1).
Citations for UV Exposure and Skin
Cancer article:
(1) Cummins DL, Cummins JM, Pantle H, Silverman MA,
Leonard AL, Chanmugam A. Cutaneous Malignant Mela-
noma. Mayo. Clin. Proc. 2006. 81(4): 500-507.
(2) Geller AC, Colditz G, Oliveria S, Emmons K, Jorgensen
C, Aweh GN, Frazier L. Use of sunscreen, sunburning rates,
and tanning bed use among more than 10,000 US children
and adolescents. Pediatrics. 2002. 109:1009-1014.
(3) Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ.
Cancer statistics, 2007. CA Cancer J. Clin. 2007. 57:43-66.
(4) Abdulla FR, Feldman SR, Williford PM, Krowchuck D,
Kaur M. Tanning and skin cancer. Pediatric Dermatology.
2005. 22(6):501-512.
(5) Markovic SN, et al. Malignant melanoma in the 21st
century, part 1: epidemiology, risk factors, screening, pre-
vention, and diagnosis. Mayo. Clin. Proc. 2007. 82(3):364-
380.
(6) National Institutes of Health. What You Need to Know
About Skin Cancer; 2005. NIH Publication No. 05-1564.
Available at: http://www.cancer.gov/cancerinfo/wyntk/skin/
(7) Ward EM, Burnett CA, Ruder A, Davis-King K. Industries
and cancer. Cancer Causes and Control. 1997. 8:356-370.
(8) Gawkrodger DJ. Occupational skin cancers. Occupa-
tional Medicine. 2004. 54:458-463.
(9) Centers for Disease Control and Prevention. 2006/2007
Skin Cancer Prevention and Education Initiative Fact
Sheet. Available at: http://www.cdc.gov/cancer/skin/
basic_info/
(10) Rees JL. The genetics of sun sensitivity in humans. Am.
J. Hum. Genet. 2004. 75:739-751.
(11) Nash JF. Human safety and efficacy of ultraviolet filters
and sunscreen products. Dermatol. Clin. 2006. 35-51.
Fall 2007
Volume 2 • Number 1

8 Center for Environmental Oncology — University of Pittsburgh Cancer Institute Center for Environmental Oncology — University of Pittsburgh Cancer Institute 5
 www.environmentaloncology.org
Sunscreen primer
Sunscreen can provide a barrier to block the sun’s
damaging rays. The first sunscreens were developed
in the 1930s (11). Sunscreens today contain a mixture
of chemicals. A minimum SPF 15 is required to protect
against UVA and UVB exposure. Metal oxides, such
as titanium dioxide and zinc oxide, can contain
nanoparticles that absorb and reflect/scatter UV
rays (11). They offer protection against UVA and UVB
while being transparent on the skin. It is important to
reapply regularly and to use about an ounce of liquid
product for each application. Some information about
sunscreen ingredients can be found at www.ewg.org.
Table 1:
Self-identification catches two-thirds of melanoma
cases, so it is important to check your skin!:
• You should remember ENU: Evolving New and
Unusual moles
• Look for the ugly duckling: be suspicious of any mole
that is unlike the rest.
You should be aware of the ABCDE rule when checking
your skin:
A: asymmetry—one side of the mole differs from
the other
B: border irregularity—mole has ragged edges
C: color—mole is not the same color throughout
D: diameter—mole is larger than ¼ inch in diameter
E: evaluation—always seek medical advice for any
abnormality you find
Fall 2007
Volume 2 • Number 1
4 Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Helping to make prevention the cure for cancer.
UV Exposure Skin Cancer and The Case for
Banning Tanning Beds
by John M Kirkwood, MD, Director, UPCI Melanoma Program, Michelle L Meyer, BS,
Epidemiology Student, University of Pittsburgh Graduate School of Public Health, Maryann
Donovan, PhD, MPH, Scientific Director, Center for Environmental Oncology of UPCI, Devra
Lee Davis, PhD, MPH, Director, Center for Environmental Oncology of UPCI
Sunlight contains ultraviolet radiation A, B
and C (UVA, UVB, and UVC) and exposure
to UV radiation can cause skin cancer.
Since the 1930s, scientists have known
that excessive sunlight exposure—es-
pecially early in life—can cause cancer
in animals and humans. In fact, sunlight
is the main environmental risk factor for
skin cancer, although some solvents and
chemicals can sometimes play a role.
Sunlight is not the only source of UV expo-
sure. UV light from tanning beds is also a
dangerous source of skin cancer-causing
exposure that also increases the risk of
developing cataracts and other eye dis-
eases.
Skin cancer is the most common cancer
in the United States and one in five Ameri-
cans will have the disease in their lifetime
(1). Several types of skin cancer include:
basal cell cancer, squamous cell can-
cer, and melanoma. Basal cell cancers
are generally located in chronically sun-
exposed areas, such as the face, neck,
ears and arms. This common form of skin
cancer tends to grow slowly and gener-
ally remains localized for many months or
years. Squamous cell cancers are also
found in areas that are typically chroni-
cally exposed to the sun, and tend to prog-
ress more slowly than melanoma, but may
spread to other parts of the body. Melano-
ma is unique in that it begins in specialized
pigment-producing cells called melano-
cytes and can be very aggressive. Each
year melanoma affects 50,000 patients
and more than 8,000 patients will die from
the disease (3). It is very concerning that
melanoma incidence is rising rapidly. The
American Cancer Society recommends
checking monthly for changes in patterns
or shapes of moles and freckles using AB-
CDE (see Table 1).
Sun exposure is the major established
cause of skin cancer and risk is increased
with the number of sunburns in childhood.
About 80% of our lifetime sun exposure
occurs during childhood and this expo-
sure increases the chance of develop-
ing skin cancer later in life (4). Reducing
childhood exposures to sunlight could
lower the risk of skin cancer by more than
70% (2). Intermittent or recreational sun
exposure is a risk factor for melanoma,
while total sun exposure is a risk factor for
non-melanoma skin cancer (4). Although
cancer usually takes decades to develop,
at the UPMC Melanoma Clinic, we are
seeing melanoma in teenagers, some of
whom have used tanning beds for only
a few years. Melanoma, unfortunately,
can be fatal and UV rays are estimated to
cause nearly three out of every five cases
of melanoma.
Individuals vary more than 100-fold in sun
sensitivity, which is determined by genet-
ics and variations in skin color (10). Many
different risk factors can contribute to
any single case of skin cancer, including:
genetic susceptibility, UV exposure, and
possibly chemical exposure. Individuals
who have sun-sensitive skin that tends to
burn before tanning, and those who tan
poorly or freckle, are at the highest risk
for skin cancer. Ironically, these high-risk
individuals are often those who seek the
Continued on page 5
CEO-UPCI
Environmental Safety of Toys Continued From Page 8
proved Product)/CP (Certified Product)/HL
Health Label (Non-Toxic) (seals of the Arts
& Creative Materials Institute) can be cer-
tain to be up to current safety standards.
Products simply labeled “non-toxic” have
still been found to contain lead and other
harmful substances.
3. Chemicals called phthalates (actually
a group of chemicals, some of which are
known by the initials DEHP and DINP)
are often used as plasticizing agents in
vinyl, and leach out of the vinyl easily. In
animals, phthalates can harm the repro-
ductive system in males, interfere with
normal development, and cause cancer
of the liver and kidneys. Many of these
same effects are suspected (though not
yet proven) to occur in humans. In the U.S.
and Canada, phthalates are banned from
baby bottles, pacifiers, and plastic toys
aimed at infants and toddlers, but may
still be present in toys for older children,
and in shower curtains, plastic wraps, and
other vinyl or “PVC” items.
4. Outdoor play environments can also
pose health hazards. Pressure-treated
wooden play-sets containing arsenic can
leave residues of the metal on children’s
hands. Although the preservative copper
chromium arsenate in wood was phased
out of use at the end of 2003, many play-
grounds and sets still have this wood in
place. Older playground equipment may
have been painted with lead-based paint.
Grassy areas may have been sprayed with
pesticides. To ensure a safer environment
for children to play in, make sure painted
items are not peeling or rusting, avoid
Center for Environmental Oncology — University of Pittsburgh Cancer Institute 9
spraying pesticides where children play,
don’t allow them to play in grassy areas
where pesticides have been sprayed, and
replace arsenic-treated wood with newer
items. Clean up standing water to prevent
mosquitoes from breeding. Finally, always
remember to put UVA/UVB sun block on
children to protect them from damaging
sunburns.
Remember that environmental safety is
more than just avoiding toxic chemicals; it
is also about creating an environment that
is physically safe. Be aware of hazards
such as small marbles, latex balloons, and
other tiny parts that pose choking risks to
young children and keep such toys away
from children under three (or others who
still “mouth” toys). Stay alert for sharp
edges, electrical toys that heat up, projec-
tiles (like darts), and toys that make loud
noises. Make sure riding toys are kept
where they cannot accidentally roll down
stairs or off decks. Ensure that children
wear helmets when riding bicycles, skate-
boards, and scooters. Watch out for toys
with strings and cords that may strangle
infants and toddlers. Finally, pay attention
to the media environment, looking out for
age-inappropriate content in books, TV
shows, computer and video games, and
Internet sites.
We can never completely insulate our
children from risk, but by taking steps to
eliminate these hazards and by sharing
these recommendations with friends and
relatives, you can make playtime a much
safer time.
www.environmentaloncology.org
Are my pets at risk from lawn
care pesticides?
Dogs, cats, and other companion animals often come
into close contact with grass and, potentially, lawn care
pesticides that are harmful to them.
To reduce risk to you and your pets:
• Read the pesticide product label and follow all
instructions exactly. Pay attention to label warnings
for people and pets. After being applied, many
pesticides will break down by sun, air or water, with
time. Reduce exposures by waiting the appropriate
amount of time (according to the label) before allowing
your family or pets back into a treated area.
• If you use a professional lawn care service, ask to read
the label of the pesticide product being applied.
• Pay attention to small flags posted around turf and
lawn areas in your neighborhood, local park, and
other grassy areas. These flags often indicate a recent
application of pesticides and that people or pets should
stay away until flags are removed.
• Alternatively, look for other ways to control and
prevent pest infestations in your home and yard and
use chemical pesticides only as a last resort or not
at all. Integrated Pest Management (IPM) methods
provide a variety of chemical-free solutions. For more
information, go to: http://www.nysipm.cornell.edu/
or http://www.gardening.cornell.edu/lawn/. Or
http://envirocancer.cornell.edu/faq/answer.cfm
References for the Environ-
mental Safety of Toys article
Etzel RA and Balk SJ, eds. Pediatric Environmental Health, 2nd
Edition. Elk Grove Village, IL: American Academy of Pediatrics,
2003. Chapters on Child Care Settings, Arsenic, and Arts and
Crafts.
Draft of chapter on Toy Safety. Available at http://www.aap.org/
moc/toysafety.htm?CFID=1504452&CFTOKEN=57897971
Shea KM and Committee on Environmental Health. Pediatric Ex-
posure and Potential Toxicity of Phthalate Plasticizers. Pediatrics.
Vol. 111, No. 6 June 2003, pp. 1467-1474.
Websites of the American Academy of Pediatrics (www.aap.
org) and the U.S. Consumer Product Safety Commission (www.
cpsc.gov).
Fall 2007
Volume 2 • Number 1
 www.environmentaloncology.org Helping to make prevention the cure for cancer. CEO-UPCI www.environmentaloncology.org

The Secret History of the War on Cancer

Continued From Page 2

of course, is forbidden. And we are cer- seed-corn fields of York County, Nebraska,
tainly not to drink much alcohol or engage are trying to tell us something: one in ev-
in dangerous sex. ery three exposed to mixtures of ordinary

indoor clean air plants But we all know people who lead perfectly chemicals in those fields die. The Secret History of
Plants can clean the air inside your home and office. The
clean, even exemplary lives and still get What causes cancer is a complicated mat- the War on Cancer
2-year study tested the following major indoor pollutants cancer. They take good care of themselves, ter of intense debate. Some of that debate
Devra Davis,
and found that most ornamental indoor plants can help and appear to be the very nicest of people, has been fostered and led by folks with
clean the air of at least one type of toxin, and some are PhD, MPH
yet somehow cancer hits. The first thing a strong interest in fanning uncertainties
able to remove all three of the following: Author of the National Book
most cancer patients, and their sometimes as a way to promote inaction. They have
Award Finalist
Formaldehyde unthinking friends ask—is what did I do argued that there’s only one proof that a
When Smoke Ran
Airborne Pollution Sources Plant Solutions to make this happen? The answer often given agent causes cancer in humans:
Like Water
Foam Insulation Corn Plant is—not a bloody enough people
Plywood / Particle Board Spider Plant thing. Sometimes with definite expo- www.basicbooks.com, For media inquiries related to the
Carpeting Philodendron species Greening Indoor Air cancer is due to a sures to a specific book, please contact: tim.brazier@perseusbooks.com
Furniture Bamboo Palm
by Maryann Donovan, MPH, PhD, Scientific Director, CEO of UPCI; Associate Director, genetic suscep- compound have to Now Available!
Paper Products Golden Pothos
Cleaners Chrysanthemum Research Services, UPCI; Assistant Professor, Department of Pathology, tibility that we have become sick The war on cancer was at first run by leaders of
University of Pittsburgh get from our fa- and died of the industries that made cancer-causing products, and
Benzene sometimes also profited from drugs and technologies
Researchers have reported that in the though some of the recent innovation thers or mothers, disease. They dis- for finding and treating the disease. Filled with
Airborne Pollution Sources Plant Solutions
United States, the average person, both has been beneficial, other developments but mostly it isn’t. miss experimental compelling personalities, and never-before-revealed
Tobacco Smoke Dragon Tree
young and old, spends 85% or more of may be contributing to poor indoor air We know that studies of cancer- information, The Secret History of the War on
Petroleum Products Dracaena
no matter how causing chemicals Cancer shows how we began fighting the wrong
Synthetic Fibers Potted Mum their time indoors and most of that time quality. Air quality is very important be-
war, with the wrong weapons, against the wrong
Plastics Gerbera Daisy (60-70%) is spent indoors at home. How cause the average person takes from careful anyone is conducted in rats enemies—a legacy that persists to this day.
Inks & Dyes Ribbon Plant about their good and mice. After
do we know that air contaminants in your 12-18 breaths/minute moving a large
Rubber Products English Ivy “A breathtaking, impeccably documented wake-up call
home affect your health? A recent study volume of air through their lungs. When and bad habits, all, we know we for what we should have done and what we must do!”
Detergents Peace Lily
conducted in New York City provides a the concentration of pollutants in the home where and when have to be differ- —Teresa Heinz Kerry, co-author of This Moment on Earth
Trichloroethylene
good example. Scientists showed that increases, exposure to airborne contami- we are born and ent from those “With the mastery of a great writer, Devra Davis
Airborne Pollution Sources Plant Solutions
pesticides that were used and stored in nants can become an important source what we work test rodents in takes the reader inside the successes, the failures,
Dry Cleaning Dragon Tree and play with laboratories. This and the ambiguity of research on cancer.”
homes could be detected both in the blood of exposure to toxic pollutants. What are
Inks & Dyes Potted Mum —Lorenzo Tomatis, MD, Former Director,
of pregnant women and in the air of their the possible sources of exposure and has a lot more to type of reasoning
Adhesives Peace Lily International Agency for Research on
Varnishes Gerbera Daisy homes. Could the scientists show a rela- what can we do? do with whether we get cancer than who is morally flawed and ignores one simple Cancer, World Health Organization
Lacquers & Paints Ribbon Plant tionship between pesticide exposure and our parents happen to be. fact: the same basic structure of DNA is
The American Lung Association has devel- “Devra Davis has written a brave and brilliant
health effects? Yes! Previous studies by Still, it defies common sense and basic bi- found in all mammals. If we cannot act to book.  It is a must-read for anyone who has ever
oped a very useful website to help you de-
Place one ornamental indoor plant per 100 square this same group reported that when chlo- ology to assume that just because a single protect or prevent exposures to suspected wondered why we’ve spent so much more effort
feet of office space. Select large leafy plants and mix
termine if there is evidence that your home treating cancer than preventing it.”
rpyrifos, an insecticide, was detected in agent looks all right when tested on its cancer causes based on solid experimen-
plant species to combat the full range of toxins. The has unhealthy air (www.healthhouse.org). —Lisa Heinzerling, Georgetown University Law
the umbilical cord blood at birth there was own, we can safely encounter hundreds of tal reasoning, and if we insist on proof that
recommendation of NASA is to use 15 to 18 good-sized On one page, they have a checklist to alert Center, and author of Priceless: On Knowing the
houseplants in six- to eight-inch diameter containers in a a significant association between high such materials all at once. You would never humans have already been harmed, then Price of Everything and the Value of Nothing
you to some common sources of house-
1,800 square-foot house. levels of insecticide and low birthweight take all the different pills in your medicine we are treating people like experimental All proceeds from sales of the book will go to the Devra
hold pollution and some common health
and small size. chest in one swallow, even though ingest- animals in a vast and largely uncontrolled Lee Davis Charitable Foundation, which supports the
effects that might suggest that the expo-
study. If the same people who oppose the work of the Center for Environmental Oncology of UPCI.
Our homes, especially homes that have sures are affecting household members. ing one or a few is fine. Why, then, should
we accept that there is no danger in being use of animal studies then go on to prevent
been built in the last 35 years, are much The Center for Environmental Oncology of
subjected to combinations of agents with- or suppress research on how environmen-
more air tight and contain many new University of Pittsburgh Cancer Institute
tal chemicals are affecting humans, the Fall 2007
Fall 2007 building products compared with homes (www.environmentaloncology.org) also out precedent in human history? Biologist
reasoning becomes morally indefensible. Volume 2 • Number 1
Volume 2 • Number 1 that were built 80 or more years ago. Al- has important information to help you be- Tyrone Hayes of the University of Califor-
Continued on page 11 nia at Berkeley thinks the tadpoles of the

10 Center for Environmental Oncology — University of Pittsburgh Cancer Institute Center for Environmental Oncology — University of Pittsburgh Cancer Institute 3
 www.environmentaloncology.org
UPCOMING events
Continued from page 1
November 3, 2007, 8:45 am - 1:45 pm
Stephen Grant, PhD
Talk for Gateway Health Plan
A Women’s Health Forum: Wellness in Mind and Body
“Environmental Health Risks for Breast Cancer”
Magee Womens Hospital
Forbes Avenue, Pittsburgh
November 10, 2007, 8:30am -12 noon
Health for Her & Living with Cancer present:
Greening your Life - Safeguarding your Health Day
Talk by Maryann Donovan, MPH, Ph.D.,
Scientific Director,
Center for Environmental Oncology
“Understanding the impact of environment on
incidence of breast cancer, infertility and
early puberty”
CCAC South Campus Auditorium
Building, B West Mifflin, PA 15122
November 28, 2007, 6- 8 PM
Talk by Maryann Donovan, MPH, Ph.D.
“Environmental Risks for Breast and Ovarian Cancer”
Gilda’s Club Western Pennsylvania
2816 Smallman Street
Pittsburgh, PA 15222
Light Refreshments Served
Please call Gilda’s Club to register: 412-338-1919
References for The Secret History of
the War on Cancer:
Amr S. Soliman, Melissa L. Bondy, Bernard Levin, Mohamed R.
Hamza, Kadry Ismail, Sohair Ismail, et al. “Colorectal Cancer in
Egypt Patients Under 40 Years of Age,” International Journal of
Cancer 71 (1997): 26-30.
David Biello, “Mixing It Up Harmless levels of chemicals prove
toxic together,” Scientific American, May 10, 2006.
Fall 2007
Volume 2 • Number 1
2 Center for Environmental Oncology — University of Pittsburgh Cancer Institute
Helping to make prevention the cure for cancer. CEO-UPCI www.environmentaloncology.org
The Secret History of the War on Cancer Greening Indoor Air
Continued From Page 1 Continued From Page 10
illness that has always been around? Some by galloping growth in organs that have come aware of sources of toxic exposure, and prevent radon levels from increasing.
twenty-five-hundred years ago, the Greek just started a developmental spurt—their health effects, and strategies to reduce Have your home tested for radon and, if the
physician Hippocrates depicted a tumor bone marrow, brains and kidneys. These risk. levels are high, repair cracks and install
as a muddled, irritable cavity with spindly organs, which roughly double in size in the Smoking, car exhaust and chemicals ventilation systems to reduce radon gas
References for indoor
legs flaring out of control in all directions.first years of life, tend to get hit by cancer stored in attached garages all contribute to safe levels. When working with prod-
clean air plants:
Fascinated with its evil animal-like appear- when they begin to grow out of step dur- to indoor air pollution. Radon seeping ucts that contain volatile organic chemi-
cals (VOCs), such as paint, make sure that Wolverton, B. C., Foliage plants for improving indoor air quality,
ance, he termed it cancer, karkinoma, the ing their normal time of expansion. During through cracks in the house foundation is NASA Center: Stennis Space Center, 1988. Retrieved on 9/20/07.
there is cross ventilation and plenty of air
Greek word for crab. Like Hippocrates, we periods of fast growth, cells can double in of serious concern because it is the sec-
Wolverton, B.C., R. McDonald, and E. A. Watkins, Jr. Foliage
are drawn to objects of menacing beauty. size several times a day. The tiniest mis- ond leading cause of lung cancer. Bacte- exchange. Although water-based paints
Plants for Removing Indoor Air Pollutants from Energy-efficient
have fewer toxic chemicals these days,
All of us contain a remarkable array of take acquired when they were just being ria and mold can grow in wet areas and Homes. NASA Center: Stennis Space Center, 1984. Retrieved on
they still contain VOCs and these chemi- 9/20/07.
genes, proteins and enzymes that work to formed in early pregnancy or just after containers like walls, basements, ceilings
cals are what you smell while you paint
keep bad cells in check and tell danger- birth gets magnified over and over. roofs, and dropped ceilings; and humidi-
fiers and de-humidifiers that store water. and continue to smell for days after as the
ous ones to die. As we age, the vibrancy of To an epidemiologist like myself, such ex-
Combustion products from space heaters paint dries. Nowadays, many manufactur-
these repair systems and the rate at which planations of run-amok cancer processes
and gas and log-burning fireplaces also ers offer low VOC paint, and some even
they keep springing into action declines, address the how but not the why. They talk green this!
contribute toxins to the indoor air that we make paint without VOCs. Remember, if
just like a rubber band that eventually gives about how cells and organs behave when
breathe. Additionally, furniture made with you can smell the chemicals, then that is a greening your
out from overuse. But an aging population they spin out of control but say nothing
pressed wood and toxic glues can release good indication that you need to increase cleaning
does not explain why five times more men about what makes these things happen
solvents like formaldehyde into the air. the airflow in your home by opening a win- A New Book By
and women get brain cancer in America to specific groups of people located in a
The chemicals that we use in our arts and dow and, if possible, turning on a fan. Deirdre Imus, which
than in Japan. Nor do we understand why certain area at a certain time. Why have shows how easy it
rates of testicular cancer in men under age so many types of cancer, which are not crafts projects (like oil paints), to clean Finally, try to avoid using chemicals that
is to make “living
forty have risen 50 percent in one decade known to be tied with smoking, increased our homes (including air fresheners), and have warning labels including auto prod- green” your way of
in most industrial nations, why women of from decade to decade in industrial coun- to control insect pests and weeds can all ucts, pesticides, yard chemicals, home life
generation X are getting twice as much tries and in those areas of the developing affect air quality. Even our dogs and cats cleaning chemicals, air fresheners, “Most of us feel helpless when confronted with the ter-
can cause asthma if family members are bleach and home care products when- rifying realities of how our environment impacts our own
breast cancer as their grandmothers did, world that are becoming industrialized?
and our families’ health. “I’m here to tell you that we can
or why young black women get and die Why do one out of every three cases of allergic to fur and dander. These allergins, ever possible. Take the time to look for a
take action to improve this situation, and it’s much easier
from breast cancer in greater numbers colo-rectal cancer in Egypt occur in per- toxins, bacteria, and molds can trigger a less toxic alternative; these days there than you might think. As consumers, we have the power to
than their white counterparts do. sons under age forty, a rate that is nearly wide-range of health problems including are many less toxic and nontoxic options. control the level of toxins that enter our homes. With a little
asthma, allergies, chronic illness, and Keep your home dust-free to eliminate al- knowledge, we can give our families a much healthier life.”
Aging does not explain why so many more ten times higher than in the U.S? Why are
even cancer. lergens. Solid flooring—hardwood and
children have developed cancer. Can ag- so many people in their thirties and forties
tiles, for instance—is much easier to keep
ing be involved in growing cases of child- in many industrial countries coming down Importantly, there are some simple chang-
clean, while rugs can trap dirt, bacteria,
hood leukemia, kidney and brain cancer? with often fatal cancers of the bone mar- es that we can make to reduce the level of
and mold. To remove allergens, use a
In a strange way, yes. All of these can- row and pancreas—diseases that used to pollutants in our homes. We can change
vacuum with a high efficiency (hepa) fil-
cers come about because some part of occur only in those in their sixties or older? our cleaning routine by reducing or elimi- Citations for Greening Indoor Air:
ter, keep surfaces dusted, and wash bed
the body begins to act as though it were What can we do to reverse the trend? How nating toxic cleaning products and substi- 1. Leech JA, et al. J of Exposure Analysis
sheets and blankets frequently. Instead
much older, losing its ability to repair it- can we get better at keeping cancers from tuting safer, effective alternatives such as and Env. Epi. (12),427-432, 2002.
of tracking dust and germs in from the
self, as deformed cells take over. Normal happening in the first place? vinegar, baking soda, and fragrance-free 2. Whyatt, RM et al. Env. Health Perspectives
vegetable-based liquid soaps. Change the outdoors, leave your shoes at the door. 115:383-389, 2007
cells of healthy children have a spring-like We have all been told what we are sup-
water in humidifiers and de-humidifiers Indoor air quality will be improved if you
ability to recover from shocks, stay in or- posed to do to reduce the risk of cancer 3. Whyatt RM, et al. Env. Health
increase ventilation, reduce toxic chemi-
frequently and keep the containers clean Perspectives 112:1125-1132, 2004
der, stay in line, as though following some on our own. We are supposed to eat right
and free from mold and bacteria. Open cal use, reduce household dust, and keep
intelligent design. Children with cancer and exercise. Even prayer and meditation
windows in basements, use a dehumidi- moisture under control.
have lost their springs. They are overrun are touted as good things to do. Smoking, Fall 2007
fier, and seal cracks to control humidity Volume 2 • Number 1
Continued on page 3
Center for Environmental Oncology — University of Pittsburgh Cancer Institute 11
 Printed on chlorine-free 100% PCW Recycled Paper, with soy-inks.
Excerpted from: The Falling Age of Puberty in U.S. Girls: What we Know,
What We Need to Know Continued From Page 7
increasing exercise and consumption of
fruits and vegetables. After two school
years, sixth-and-seventh grade girls in
the Boston area who attended schools
randomly selected for this curriculum had
lower average body mass indices, lower
body fat, higher levels of physical activity
and decreased screen time compared with
their counterparts at non-participating
schools. They were also 32 percent less
likely to have experienced menarche
during the 19-month study than girls in
control schools (Chavarro, 2005). Such
programs need to be replicated widely.
The success of school-based interventions
such as Healthy Planet can be carried out
to the community at large. Since 2005, there
has been a dramatic increase in efforts to
improve access to healthy foods in urban,
low-income areas through the creation of
farmers’ markets and community gardens
(Foxhall, 2006). Persuading schools,
neighborhood stores and convenience
markets to source with local, organic
farms is a grassroots campaign whose
efforts are relevant to protecting girls
from early sexual maturation.
Strategies to lower rates of preterm and
low-weight babies include eliminating
exposure to tobacco smoke and chemical
solvents as well as eliminating sources of
air pollution and mercury contamination.
Strategies to lower the pediatric body
burden of endocrine-disruptive chemicals
include phase-outs of chemicals such as
bisphenol A and phthlates, to which girls
have documented exposures. Supporting
organic agriculture not only lowers the
burden of hormonally active residues
in food, it protects watersheds from
contamination by pesticides, herbicides,
animal hormones and antibiotics, which
flow from farm, ranches and manure
lagoons into rivers and streams. Buying
organic thus protects drinking water,
12
another potential source of exposure.
Because it arises from a combination
of many different stressors in several
different aspects of the environment—
psychosocial, nutritional, behavioral,
chemical—early puberty in girls is not
a trend that will be reversed by single
actions by single-purpose agencies.
It is a multi-causal threat to the well-
being of girls and women that ultimately
requires a comprehensive, integrated,
unified response. The problem with health
issues that cross multiple environmental
media is that they fall between regulatory
and activist cracks. On the one hand,
addressing all of the root causes at the
same time raise the risk for programmatic
and regulatory fragmentation and leads to
inertia. On the other hand, addressing one
problem at a time does not begin to unknot
the tangle of its interrelated causes.
The environmental justice community, with
its long experience with cumulative risks
and impact, has many insights to offer
here. Any meaningful attempt to lessen
the problem of early sexual maturation
in girls must draw on the collective
wisdom of its leadership. Environmental
justice activists, for example, have
developed methods for responses that
are able to determine and alleviate multi-
media stressors swiftly. Built into their
analytical framework is the recognition
that health disparities, such as obesity
or low birth weight, are both an outcome
of and a contributor to vulnerability to
environmental toxicants. Know as “bias
for action,” this early identification and
response approach, which is community-
based and collaborative, holds much
promise for addressing the problem
of early puberty in U.S. girls (National
Environmental Justice Advisory Council,
2004).
www.environmentaloncology.org
Center for Environmental Oncology
Fall 2007
Volume 2 • Number 1
Additional Fall 2007 • Volume 2 • Number 1 TABLE OF CONTENTS
Internet Resources UV Exposure Skin Cancer and The Case for
Beyond Pesticides Banning Tanning Beds
www.beyondpesticides.org John M Kirkwood, MD; Michelle L Meyer, BS;
Maryann Donovan, PhD, MPH;
Breast Cancer Fund Devra Lee Davis, PhD, MPH
www.breastcancerfund.org Page 4
Department of Environmental Quality The Falling Age of Puberty in U.S. Girls: What we
www.deq.state.mi.us/sid-web Know, What We Need to Know
Environmental Working Group Sandra Steingraber, PhD
www.ewg.org Page 6
Health Care Without Harm Environmental Safety of Toys
www.hcwh.org Jonathan Weinkle, MD
The Secret History of the
Page 8
Healthy Child, Healthy World
War on Cancer
www.healthychild.org Greening Indoor Air
Maryann Donovan, MPH, PhD.
OSHA
www.osha.gov My father, harry davis, as a toddler in the family-owned dry-cleaning and tailor shop in 1923,
Page 10
the year before he survived a massive explosion of benzene.
Perfectly Natural UPCOMING events
www.perfectlynatural.com by: Devra Lee Davis, PhD, MPH, Director, Center for Environmental Oncology of UPCI,
October 16, 2007, 12:00 - 1 PM
The Collaborative on Health and the Environment an excerpt from her new book, Chapter One. Lunch and Learn
www.healthandenvironment.org Jennifer Kloesz, MD, Neonatology
In 1973, out of every 100,000 men aged a massive explosion of benzene from the
The CDC “Environmental Teratogens”
fifty-five to fifty-nine, only five developed family dry cleaning shop underneath his
www.cdc.gov Children’s Hospital of Pittsburgh
multiple myeloma, a cancer of the bone home when he was a toddler surely added Room B213-214
The E-House Company
marrow. By 1983, that number had doubled to the lifelong burden on his ability to make Free Healthy Lunch Served
www.ehousecompany.com
and included my dad, a healthy middle- healthy blood. Maybe that accident in 1924 To pre-register, email Samantha at
The Green Guide malones@upmc.edu
aged man who never smoked or drank contributed to his death many decades
www.thegreenguide.com
much. He was one of about seven thou- later. We can’t say. Continued on page 2
The National Cancer Institute
www.nci.nih.gov/cancertopics sand people with the disease that year. Look around and it seems that cancer has
The Rachel Carson Homestead We can’t be sure why my dad’s bone mar- become the price of modern life. In Ameri-
www.rachelcarsonhomestead.org row stopped working. He lived through ca and England, one out of every two men
Safe 2 Use some remarkable encounters with agents and one out of every three women will de-
www.safe2use.com that affect the bones’ ability to produce velop cancer in their lifetime. In America Visit our New and
Susan G. Komen for the Cure
cms.komen.org/komen/index.htm
blood. Men who work with metal fumes
as machinists or welders, or with cutting
alone, there are currently more than 10
million cancer survivors. Cancer is the
Improved Website!
Venture Outdoors oils and solvents in steel mills, or who have leading killer of middle-aged persons, and, www.environmentaloncology.org
www.ventureoutdoors.org
had regular radiation exposures as part of after accidents, is also the leading killer of
frequent diagnostic checks in the military children.
– my dad did all of these things — suffer How did this happen? How did a disease Highmark Healthy Places, Healthy People
multiple myeloma cancer at higher rates that was once so atypical become so ordi-
Please share this newsletter and be than the rest of us. That he also survived nary? Are we simply talking more about an Funding for this newletter is provided by
sure it is recycled. the Highmark Foundation and the Heinz Endowments.
Continued on page 2