Center for Environmental Oncology

Winter 2008 • Volume 2 • Number 2

TABLE OF CONTENTS
Pregnancy and Environmental Health Judith Balk, mD, mPH and michele ondeck, rN, mEd magee-Womens Hospital of UPmc PAGe 4 Pesticides and Breast cancer: a Wake Up call meriel Watts, PhD PAGe 6 creating Better Breathing space for asthmatics PAGe 9 the allegheny river stewardship Project: a call for Volunteers conrad Dan Volz, DrPH, mPH PAGe 10 additional internet resources PAGe 12

The Unrecognized risks of CT RadiaTion
Shaul Schwarz/Stringer/ News/Getty Images

by: Devra Lee Davis, PhD, MPH, Director, Center for Environmental Oncology of UPCI, Adapted from The Secret History of the War on Cancer.
Diagnostic radiation is a modern miracle we have come to depend on. In 1979, The Nobel Prize in Medicine and Physiology was awarded to Godfrey N. Hounsfield and Allen M. Cormack, the engineer and physicist who invented the system for creating three-dimensional images of the human body. Computerized imaging technology is now such a large, profitable industry that it has its own futures market. Seven times more CT scans are conducted today than just ten years ago. (1) The leading manufacturer, Cardinal Health, is one of the twenty largest companies in the world, with revenues of more than $81 billion a year. (2) New government regulations in the United States are shutting down what had been highly profitable ventures in which physicians would prescribe tests on machines they themselves owned. When offered a three-dimensional look inside an old set of knees or cranky stomach, a patient does not usually ask whether this remarkable test might increase her long-term risk of more serious ailments. When my then eleven-year-old daughter was given a CT scan of her abdomen to see if she had a ruptured spleen, I was just like most parents with a child in the emergency room. All I wanted to know was that she would be okay. But when I asked the young radiologist if there was a way to shield my daughter’s chest, she looked at me skeptically and asked, “Why? She doesn’t have any breasts.” I explained to her that we know that radiation exposure to the chests of girls before puberty increases the chances that breast cancer will develop later on. The woman looked at me as if I were slightly insane.
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UPCOMING EvENTS
February 13, 2008, 6:00 – 8:00 Pm Book reading and Discussion: “Not Just a Pretty Face— the Ugly side of the Beauty industry” maryann Donovan, m.P.H., PhD., scientific Director, center for Environmental oncology talk by author stacy malkan Magee-Womens Hospital of UPMC To register, call Magee’s education department at: 412-802-8299 or visit magee.upmc.com

Visit our New and

Improved Website!

www.preventingcancernow.org
HigHmark HEaltHy PlacEs, HEaltHy PEoPlE
Funding for this newsletter is provided by the Highmark Foundation and the Heinz Endowments.

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The Unrecognized Risks of CT Radiation Continued From Page 1
My colleague Dr. Dwight Heron, Vice Chairman for Clinical Affairs, Department of Radiology, University of Pittsburgh Cancer Institute and Chairman, Department of Radiation Oncology, UPMC Shadyside, spends his days diagnosing and treating cancer patients with the help of modern computerized diagnostic scanning systems. I asked him what he thought about the current enthusiasm for CT and PeT scans of healthy people. Heron says, “It’s a big problem. Radiologists appreciate that we could be creating more cancer in young people by what happens in emergency rooms all over the country today.” Heron referred me to the 2007 white paper on radiation in medicine, where the American College of Radiology (ACR) noted that in the past quarter century, the amount of radiation the U.S. population receives each year from medical imaging has increased fivefold. A single computerized scan of the stomach today can give half the dose that was shown to induce cancer in those who survived the atomic bomb blasts in Japan. The ACR advises that “the current annual collective dose estimate from medical exposure in the United States has been calculated as roughly equivalent to the total worldwide collective dose generated by the nuclear catastrophe at Chernobyl.” (3) around 500 Roentgen doses within several minutes of radiation from the Chernobyl explosion in 1986. Conservative estimates are that as a result of this massive explosion there will be 30,000 to 60,000 more cancer deaths that would not otherwise have occurred. (4) Concerns about unnecessary medical radiation in young children today are now ricocheting throughout the medical community. A group of Yale researchers, looking at current patterns, estimates that in one year, 700 people will die from cancers associated with head CTs and 1,800 will die from radiation-induced cancer from abdominal examinations carried out when they were infants. (5) Reduced brain function, learning problems and lowered IQ from such potentially unnecessary and inappropriate exams is not easily calculated, but it cannot be trivial.(1) Most physicians and the rest of us are unaware of the dangers shown in Table 15-2 (see page 3)

UPCOMING EvENTS
Continued from page 1 march 3, 2008, 4:30 - 6:00pm talk by arlene Blum, PhD “the Fire retardant Dilemma” Carnegie Mellon’ University 136A Baker Hall Pittsburgh, PA march 26, 2008, 7 Pm Dr. Devra Davis talk and Book signing the secret History of the War on cancer United Jewish Federation Phipps Conservatory Botany Hall march 27, 2008, 7:00 Pm - 8:30 Pm lecture and book signing by Devra Davis, PhD, mPH the secret History of the War on cancer’ South Park Library 2575 Brownsville Road South Park, PA 15129 Free event, open to the public Call 412-623-1175 for more information.

Winter 2008 Volume 2 • Number 2

To put these doses into perspective, even a properly calibrated CT scan of a child’s stomach can be equivalent to six hundred chest X-rays, while one of an infant’s head can be equivalent to a few thousand. Imagine a lifetime of emergency room visits, with repeated scans, and it becomes clear that these risks could create a major Let me translate this. Modern America’s cancer burden of the future. annual exposure to radiation from diag- emergency room physicians have not yet nostic machines is equal to that released gotten the message. A survey of emergenby a nuclear accident that spewed the cy room doctors at a major medical center equivalent of hundreds of Hiroshimas found that none of them was aware that across much of Russia and eastern eu- some of the diagnostic procedures they rope. In 2005, the Chernobyl Forum, an or- were ordering increased the risk of cancer ganization led by the International Atomic for their patients thirty years later. (1) energy Agency and the World Health Organization, estimated that about 6.5 million Of the more than 10 million cancer survipeople were exposed to 5.6 Roentgen per vors in this nation, those who underwent second (R/s). This is equivalent to 20,000 extensive radiation to treat or find their Roentgen per hour (R/h). A lethal dose is disease, like elizabeth edwards, wife of

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Sen. John edwards, and Tony Snow, former press secretary to the White House, or those who had the disease as young children, face lifetime risks of other cancers as a result. Other studies show that the risks of cancer from radiation in cancer patients treated for Hodgkin’s disease could even be greater than those of the atom bomb survivors. This apparently greater vulnerability of the weakened to the damaging effects of radiation is something that researchers like Alice Stewart and Rosalie Bertell warned about nearly half a century ago. (6) The world is catching up with them. Stewart’s work on the dangers of radiation in england was simple and powerful. She visited every county and county borough health department in the country, handing out questionnaires that asked mothers of children born between 1953 and 1955 about things that happened to them when they were pregnant. Within a year, she had determined that the mothers of leukemic children were three times more likely to have had routine x-rays of their abdomens during pregnancy. These results, published in the Lancet in 1956, flew in the face of assurances from obstetricians that the practice was harmless. Stewart’s findings also upset those advocating the continued use of nuclear weapons and testing. The year 1956 was the peak year for above-ground nuclear weapons and testing and radioactive fallout. Obstetricians and nuclear weapons advocates alike maintained that small doses of radiation were harmless. In fact, Stewart’s findings showed that a single dose of diagnostic x-rays early in pregnancy more than doubled the child’s risk of leukemia. (7) There is no question that in medical emergencies, CT scans save lives and eliminate exploratory surgery. But, experts increasingly agree (see sidebar) that the number of scans can be reduced without compromising the ability to deliver health care. For healthy individuals, and especially children, if a CT scan is recommended, it is important to consider whether another diagnostic tool, such as Magnetic Resonance Imaging or ultrasound, neither of which involves radiation, could be used instead.

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RECENT ExPERT WARNINGS ON ThE RISkS OF CT SCANS:
the american college of radiology calls for national standards for training and certification of ct technologists and improved medical education programs regarding risks and benefits of radiological procedures and non-radiological alternatives.
E. Stephen Amis, Priscilla F. Butler, Kimberly E. Appelgate, et al., “American College of Radiology White Paper on Radiation Dose in Medicine,” Journal of the American College of Radiology 4 (2007): 272-284. (www. devradavis.com/6%20-%20ACRWhitePaper.pdf)

current uses of ct scan are expected to increase the rates of radiation-related cancer, especially in children and young adults and should be reduced in non-emergency situations.
David J. Brenner, Eric J. Hall, “Computed Tomography— An Increasing Source of Radiation Exposure,” The New England Journal of Medicine 357:2277-2282 (November 29, 2007): Number 22 http://content. nejm.org/cgi/content/full/357/22/2277

Table 1 Radiation Risks of CT Scans
exam Type Machine Setting Relevant Organ Approx. equivalent Dose to Relevant Organ (mSv) 60 30 25 6 .01/.15 3 equivalency in Chest X-rays .15 - .01 mSv* 400-6000 200-3000 166-2500 40-600 .01-.15 20-300

References for The Unrecognized Risks of CT Scans:
Table 1. Davis, Devra. The Secret History of the War on Cancer. New York: Basic Books, 2007, p. 413. 1. Brenner, D. J., & Hall, E. J. (2007). Computed tomography — an increasing source of radiation exposure. N Engl J Med, 357, 2277-2282. <http://content.nejm.org/cgi/content/ full/357/22/2277> 2. “Cardinal Health Launches New PET Marketing Tools,” (2006). <http://nps.cardinal.com/nps/PETfoundations/currentNews.asp> 3. Amis, E. S., Butler, P. F., & Applegate, K. E., et al. (2007) American College of Radiology White Paper on Radiation Dose in Medicine. J Am Coll Radiol, 4, 272-284. See all references for The Unrecognized Risks of CT Scans on our website www.preventingcancernow.org

Pediatric Head CT Scan Pediatric Head CT Scan Ped. Abdominal CT Scan Ped. Abdominal CT Scan Chest X-ray (PA/lateral) Screening Mammogram

Unadjusted a Adjusted b Unadjusted Adjusted n/a n/a

Brain Brain Stomach Stomach Lung Breast

Source: Society for Pediatric Radiology and National Cancer Institute, “Radiation & Pediatric Computed Tomography: A Guide for Health Care Providers,” Summer 2002, http://www.cancer.gov/cancertopics/causes/radiation-risks-pediatric-CT a “Unadjusted” refers to using the same settings as for adults. b “Adjusted” refers to settings adjusted for body weight. *Chest-x-ray equivalency based on NCI estimates in this table

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Question:
Children, Playsets and Wood deCks: safety?
Dear Center for environmental Oncology, My deck and my children’s playset are made of pressure treated wood, which I’ve heard could be dangerous. What are my alternatives?

Pregnancy and Environmental Health

Answer:
For many years, more than 90 percent of all pressure treated wood contained chromium copper arsenic (CCA), an arsenic-laden wood preservative to prevent damage from rot, insects and fungi. Arsenic, a known human carcinogen, can leach to the surface of the wood and into surrounding soil, exposing children to unsafe levels. Tests have shown that even years after installation, arsenic continues to leach from pressure treated wood. In 2002, wood manufacturers agreed with the U.S. environmental Protection Agency to phase out CCA-treated wood by December 31, 2003. Alternatives to chemically treated wood include recycled plastic or naturally rot-resistant domestic woods like aromatic cedar and black locust. Playground equipment and decking materials may be available in these materials — check with the manufacturers directly. Taken from Healthy Child, Healthy World website: www.healthychild.org

by Judith Balk, MD, MPH, Magee-Womens Hospital of UPMC and Assistant Professor, University of Pittsburgh and Michele Ondeck, RN, Med, LCCE childbirth educator, Magee-Womens Hospital of UPMC
All parents want to have healthy children. In our industrialized world, women and men of childbearing age need to not only address issues of how to eat healthy and maintain fitness but also are confronted with environmental and workplace exposures that may impact their health and the health of their unborn child. A woman’s health before her pregnancy is the most significant determinant of a healthy pregnancy and baby. A preconception visit (a visit to a primary care doctor by a woman who could conceive before her next visit) may include counseling related to her workplace exposures and the need to achieve normal weight and establish an active lifestyle, as well as a recommendation that she take prenatal vitamins (this is good advice for all women of childbearing age.) Questions about fathers’ workplace exposures and good and bad habits are also relevant. It is important for a woman who is obese to lose weight before conceiving in order to reduce pregnancy complications and to reduce her body burden of environmental toxins that are stored in fat tissues. In this article, Magee-Womens Hospital of UPMC’s physician Dr. Judy Balk and childbirth educator, Michele Ondeck, answer some frequently asked questions from pregnant women around environmental health issues. i love to eat fish but the guidelines of what fish are safe to eat during pregnancy confuses me? eating a diet high in omega 3 fatty acids, found in salmon, for instance, is good for your cardiovascular health and is important for the fetus’ brain growth. Women of childbearing age should avoid eating fish high in methymercury (organic mercury). Methyl-mercury can permanently damage the brain of the developing fetus and can increase the chance that birth defects will occur. Organic mercury was used as a fungicide in agriculture in the 1960’s, and also released into water as a byproduct of the metals industry. The larger, older and fattier the fish, the more methylmercury and other contaminants it can contain. Methylmercury can especially accumulate in high levels in large or predatory fish, such

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as tuna, shark, king mackerel, swordfish, and tilefish. Children and pregnant women should not eat these fish. If a pregnant woman eats mercury-contaminated fish, the mercury travels from her bloodstream and across the placenta to the fetus. experts recommend that when a woman is preparing for pregnancy she should avoid fish high in mercury for 3 to 6 months. When pregnant, a woman should eat up to 12 ounces a week of a variety of fish and shellfish that are lower in mercury (such as salmon, canned light tuna, shrimp, pollock and catfish). Consumers also need to be aware of the source of their fish, as only a small percentage of fish are inspected. Check advisories about fish caught locally. The safest fish are wild caught or farmed in the United States by environmentally responsible operations. Next time you are shopping, consider buying a can of salmon that is not only low in mercury but also inexpensive and a good source of protein and omega 3 fatty acids. For more information: www.cfsan.fda.gov/seafood1; www.epa.gov/ost/fish; www.ewg.org a friend told me that i should not use make-up when i am pregnant. But, i look so much better in make-up. What can i use and still be safe? A teratogen is something that causes harm to a fetus, and there is no known way to predict if an individual fetus will be sensitive or not to a substance. It depends on the substance itself, how much exposure the pregnant woman/fetus had to it, and for how long and when, during the pregnancy, a woman is exposed. It is thought that the most vulnerable period for the fetus is within the first 57 days of pregnancy. There are many concerns about personal care products and cosmetics. An average woman uses about 12 products a day. That could mean she is applying well over 100 different chemicals to her skin, hair and nails in a single day. The Federal Drug Administration (FDA) does not regulate or require personal care product manufacturers to test products, so little or no data exists on most of the chemicals of concern. In the Unites States, we are guided by the principle of “prove harm” before regulating chemicals. In contrast, the european Union is guided by the “precautionary principle” and has banned most of these chemicals of concern. The best approach is prevention. Thankfully, now there is an on-line guide with safety ratings of more than 23,000 products at www.comesticsdatabase. com. Skin, hair and nail care products are rated for safety, depending on the chemicals they contain as well as other criteria. All women, pregnant or otherwise, should learn to always read product labels with the idea that fewer ingredients usually means a lower risk. It is also a good idea to avoid products with words like “fragrance,” “parabens,” or “ phthalates” on the label and to avoid nail polish with formaldehyde in it. Organic cosmetics and personal care products are a safer alternative, but there are still, as yet, no national standards established for using the words “natural” or “organic” in personal care products. Magee-Womens Hospital is hosting a book reading and discussion related to safe cosmetics about the new book by Stacy Malkan, entitled Not Just a Pretty Face-The Ugly Side of the Beauty Industry on Wednesday, February 13, 2008 from 6:00-8:00 pm. Dr. Maryann Donovan of the Center for environmental Oncology will also discuss these issues along with Mia Davis from the Safe Cosmetics Campaign. To register, call the education department
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PROTECT YOUR ChILdREN FROM hIddEN PESTICIdES IN YOUR hOME
Some pesticides have been shown to cause cancer in humans, especially when people are exposed at high levels. Children are at increased risk for pesticide poisoning because of their smaller size and because pesticides may be applied to surfaces that are easily accessed by children. aNtiBactErial soaPs aND DisiNFEctaNts: May contain any number of 275 different active ingredients classified by the ePA as pesticides. Frequent use of antibacterial soaps selects for more resistant bacteria. Alternative: Teach your children to wash their hands frequently with regular soap. motHBalls: Can cause serious health problems if ingested or by inhaling the fumes. 1,4 Dichlorobenzene, found in mothballs, may be reasonably anticipated to be a carcinogen. Alternative: Always keep mothballs out of reach of children. Use cedar balls or lavender sachets to ward off moths. syNtHEtic carPEts: May contain anti-mildew pesticides, as well as toxic adhesives. Many chemicals used on carpets are volatile organic compounds (VOCs), which may cause carcinogens to be released into the air. Alternatives: Choose alternative flooring: ceramic tiles, untreated hardwood, cotton or hemp rugs (with non-toxic adhesive and non-plastic backings.) PaiNt: Several brands contain anti-mildew pesticides and emit VOCs. Test paint chips from walls and windows for lead, which is very dangerous to children’s health. Alternatives: Choose “No-VOC” or natural milk paints. Keep children away from chipping and peeling paint; clean sills with a damp rag.

References:
National Cancer Institute: www.cancer.gov ATSDR: www.atsdr.cdc.gov

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Pesticides and Breast Cancer: A Wake Up Call
by Meriel Watts, PhD, a scientist with Pesticide Action Network (PAN) Asia and the Pacific, www.panap.net, and co-ordinator of PAN Aotearoa New Zealand, author of Ethical Pesticide Policy: Beyond Risk Assessment
PESTICIdE ACTION NETWORk (PAN) ASIA ANd ThE PACIFIC, PENANG MALAYSIA
www.panap.net panpa@panap.net Pesticide Action Network (PAN) is a global network working to eliminate the human and environmental harm caused by pesticides and to promote biodiversity based ecological agriculture. PAN Asia and the Pacific is committed to the empowerment of people especially women, agricultural workers, peasant and indigenous farmers.

Incidence of breast cancer continues to rise in most countries. even those countries that traditionally have been regarded as having relatively low rates, compared with countries like the USA and New Zealand—notably the developing countries of Asia—are beginning to catch up. Why? There is no easy answer. The factors involved in breast cancer genesis are many and complex, and still not fully understood. One potential factor, however, is frequently overlooked, and this is exposure to pesticides, which has escalated dramatically in developing countries over the last 20 years.

we find in household fly sprays, the herbicide atrazine which contaminates ground and drinking water in the US, New Zealand and other countries, the aerially applied herbicide 2, 4-D renowned for its ability to drift off-target over long distances, and organophosphate insecticides. Some pesticides—such as chlorpyrifos and diazinon—are found in the meconium, or first feces, of newborn children indicating exposure while still in the womb. Others are contaminating breast milk. This does not mean breastfeeding should be replaced by bottle-feeding. Despite the residues, breastfeeding confers overwhelming benPesticides and Breast Cancer: A Wake-Up efits on both mother and child. Call examines available experimental and The evidence considered in A Wake Up epidemiological evidence suggesting that Call includes epidemiological studies expesticides may contribute to the puzzling amining possible links between exposures growth of breast cancer. While this new to various pesticides and incidence of book focuses on pesticides used in the breast cancer; or body burdens of organoAsia Pacific region, the information it con- chlorine insecticides and incidence. It also tains applies to any country where they considers mammary tumors produced in are employed. It identifies 98 pesticide laboratory trials. These are the commonly active ingredients, one adjuvant and two acknowledged indicators of breast cancer contaminants of pesticide formulations risk. In fact, this is as far as most reviews that potentially affect the risk of breast go, and other indicators of a pesticide’s cancer. The pesticides identified include potential to cause breast cancer are geninsecticides, herbicides, fungicides and erally overlooked. fumigants. The capacity of pesticides to disrupt horIt would be nice to think of these substances as largely obsolete pesticides such as DDT, although the resurgence in use of this one in Africa is a real concern. But, in fact, the vast majority of pesticides covered in the book are still currently in use, particularly in developing countries. Some are also still widely used in the USA, europe and New Zealand. These include organochlorines like lindane used for head lice control, the synthetic pyrethroids that mones has been well documented. The role of estrogen in breast cancer is now well established and the potential role of estrogen-mimicking chemicals widely accepted. But what of the effects of pesticides on other hormones – androgens, progesterone, prolactin, melatonin and prostaglandins? These hormones also have a role to play in the development of breast cancer. And so may the pesticides that affect them.

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ExAMPLES OF PESTICIdES:
insecticides: organochlorines – endosulfan, lindane synthetic pyrethroids – permethrin, deltamethrin organophosphates – malathion, dichlorvos Herbicides: triazines – atrazine, simazine others – 2,4-D, paraquat Fungicides: mancozeb, captan

In addition, there are a number of other mechanisms by which pesticides might influence the onset and progression of breast cancer: through their influence on the immune systems’ Natural Killer T-cells, through interfering with cellular communication, or the function of enzymes on cell repair, or impeding the cell’s natural ability to cause tumor cells to die off. And there is evidence that a number of pesticides can adversly affect these mechanisms, raising the risk of breast cancer.

While the available evidence does not prove that pesticides are causing breast cancer in humans today, it does provide proof that they have the potential to influence its onset and development, and thus Table 2 (see page 8), adapted from the Sito raise the risk. lent Spring Institute, condenses informaSo what do we do, while we wait for tion on 216 different chemicals proven to evidence to accumulate? Continue using cause mammary tumors in animals. Some these pesticides despite the warnings? of these are found in pesticides, and none Hope for the best while we wait for ir- has ever been regulated for its potential to refutable proof? Or take a precautionary induce breast cancer. approach and drastically reduce the exposure of girls and women – especially pregnant women—because of the heightened vulnerability of the neonate to carcinogens and hormonally active chemicals?

We cannot rely solely on epidemiology to unravel the relationship between pesticides and breast cancer—not least because breast cancer can have such a long latency period, it may be virtually impossible to establish exposures in a meaningful way. The relevant exposures may have occurred very early in life or even at the fetal stage. The fetus is exquisitely sensitive to carcinogens and hormonally active substances. Recent studies covered in our report indicate that when pregnant rats are exposed to the fungicide vinclozolin, breast cancer incidence is elevated in each of the four succeeding generations (at least).

Fumigants: DBCP, ethylene dibromide adjuvants: nonylphenol contaminants: dioxin, 1,4-dioxane

For More Resources about Pesticide Safety Pesticides Environmental Protection agency (EPa): Home Page www.epa.gov/pesticides/ Pesticides Health and safety (EPa) Human Health issues www.epa.gov/pesticides/health/index.htm information on Pesticides Health issues center for Disease control and Prevention (cDc) Health studies www.cdc.gov/nceh/hsb/pesticides/links.htm

Our report calls for a systemic change in our thinking about pesticides in order to reduce the risk of breast cancer. Regulatory processes have to come to grips with the many different mechanisms that underlie breast cancer and how pesticides may influence these. The current paradigm in
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to purchase Pesticides and Breast Cancer: A Wake Up Call, order at Pesticide Action Network (PAN) Asia and the Pacific at panap@panap.net

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how safe is the Water We drink?
The Blue death
disease, disaster and the Water We drink
by Dr. Robert Morris “With the keen eyes of a scientist and the sensibilities of a seasoned writer, Dr. Robert Morris chronicles the fascinating and at times frightening story of our drinking water. His gripping narrative vividly recounts the epidemics that have shaken cities and nations, the scientists who reached into the invisible and emerged with controversial truths that would save millions of lives, and the economic and political forces that opposed these researchers in a ferocious war of ideas.” www.TheBlueDeath.com

Pesticides and Breast Cancer: A Wake Up Call
Continued From Page 7

many nations allows use of suspect pesticides to continue until proof of human harm, sufficient to persuade the regulators and the courts of law, can be collected. This places the onus on scientists who work in the public interest to try to achieve the impossible. We can only begin to pro-

tect women from breast cancer when we reject this approach, applying the precautionary principle and requiring substitution of less harmful methods of pest, weed and disease management in place of the suspect pesticides.

Table 2 Chemicals Shown to Cause Mammary Gland Tumors in Animal Studies and Produced at More than 1 Million Pounds Annually
Chemical Name Air Pollutant x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x In Consumer Products Food Additive Female Occup. exposed

Reference for Table 2:
Davis, Devra. The Secret History of the War on Cancer. New York: Basic Books, 2007, p. 288. Ruthann A. Rudel, Kathleen R. Attfield, Jessica N. Schifano, and Julia Green Brody, “Chemicals Causing Mammary Gland Tumors in Animals Signal New Directions for Epidemiology, Chemicals Testing, and Risk Assessment for Breast Cancer Prevention,” Cancer 109, S12 (2007): 2635-2666

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1,2-Dibromomethane 1,2-Propylene oxide 1,3-Butadiene 1,4-Dioxane 2,2-Bis(bromomethyl)-1,3-propanediol 4,4’-Methylene-bis (2-choloraniline) Acrylamide Acrylonitrile Benzene Chloropene ethylene oxide Hydrazine Nitrobenzene Nitromethane ortho-Nitrotoluene ortho-Toluidine Styrene Toluene diisocyanate mixtures vinyl chloride vinyl fluoride vinylidene choloride 1,2-dichloroethane 1,2,3-Trichloropropane 1,2-dichloropropane Carbon tetrachloride Methylene chloride Isoprene 3,3’-Dichlorobenzidene Amsonic acid

x x x x x x x x

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Create Better Breathing Space for Asthmatics
Checklist from Healthy Child, Healthy World: www.healthychild.org
minimize pet dander. “Cat dander is everywhere, even if you wash the cat,” Centers for Disease Control Dr. Ruth etzel says. “The only real solution is not to have the cat.” Or, wash the animal every two to three weeks, Los Angeles pediatrician Harvey Karp advises. No cigarette smoking in the home or car, or anywhere in asthmatics’ presence. Ventilation is crucial. “The building of tightly-sealed houses over the last two decades has made it much easier for moisture and dust to collect in homes,” Harvard professor Dr. Douglas Dockery notes. Many vapors trapped indoors, from perfumes and air fresheners to formaldehyde from particleboard, irritate asthmatics. When it’s fresh or even cold outside, keep windows open a crack to circulate air. On hot days, close windows and use air conditioners to ventilate and filter out smog. Don’t harbor dust mites. Microscopic dust mites and their droppings are a potent allergen and asthma trigger. One way to limit the amount of dust mites in your homes is to encase mattresses with impermeable covers. Eradicate cockroaches and keep clutter to a minimum. Piles of dirty clothes make a growth environment for mildews and mites; piles of paper attract cockroaches. Remember, you can eliminate household pests without using toxic pesticides. maintain humidity below 50 percent. “Dehumidifying is enormously important, as many asthmatics are highly allergic to mildews and molds,” says Harriet Burge, Ph.D., associate professor at Harvard School of Public Health. Furnace and heating duct filters should be replaced periodically as they collect dust and molds. Some businesses provide duct-cleaning services. keep asthmatics away from gas stoves. “Open the oven door and you get a blast of NO2,” says University of British Columbia professor emeritus Dr. David Bates. “The asthmatic child should not sit in the kitchen doing homework if the oven is being used.” Make sure that stoves are wellventilated, too. ask your pediatrician about allergenic foods. If there is a family tendency to allergy, Dr. Ruth etzel from the Centers for Disease Control says, parents might limit foods associated with allergies, such as cow’s milk, from the child’s diet in the first two years. She and other pediatricians recommend that mothers try to breastfeed their infants for at least the first year. check your local air quality index daily. Asthmatic children should not exert themselves outside in hot, smoggy weather, or when a dusty wind blows; smog counts tend to be highest between 3pm and 6pm. Air Now, a site provided by the U.S. environmental Protection Agency, allows you to check your local air quality, get ozone maps and more.
Continued on sidebar

Create Better Breathing Space for Asthmatics Continued
try air cleaning and purifying machines. Consumer Reports says a good air cleaner can help those allergic to dust and mold spores, citing the fan/filter models as most effective in removing airborne dust. The machine will help most in the asthmatic’s bedroom; but keep it at least six feet from the bed (it creates draft), and don’t place on carpet (it can kick up dust). But, “They can only help if you’ve gotten rid of the risk factors first, like dust mites, mold and danders,” Harvard School of Public Health associate professor Dr. Harriet Burge warns. ASThMA RESOURCES

RESOURCES FOR ChILdhOOd ASThMA the asthma center children’s Hospital of Pittsburgh www.chp.edu/clinical/03a_asthma asthma resources Us Environmental Protection agency (EPa) www.epa.gov/asthma/index.html(Asthma) www.epa.gov/iaq/index.html (Indoor Air Quality) For more resources about childhood asthma, visit our website at www.preventingcancernow.org

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The Allegheny River Stewardship Project: A Call For Volunteers
by Conrad Daniel Volz, DrPH, MPH
Project Background, results of Previous research WhAT CAN YOU dO TO hELP MAkE ThE ALLEGhENY STEWARdShIP PROjECT A SUCCESS?
Volunteer to catch fish during the sampling season. It will be fun! All gear and bait will be provided by Venture Outdoors. Just purchase a fishing license, which you can do online through the PA Fish and Boat Commission. You can also take a ride on or tour the RiverQuest Research vessel. Volunteer to give hair, toenail, and/or urine samples to researchers so we can gauge actual biomarkers of exposure to river contaminants. Contact Dr. Dan Volz, the project’s Principal Investigator at cdv5@pitt.edu.

The fish in our waterways are like canaries in the coal mines. Just as canaries are sensors for air quality, fish are sensors for water quality. Our river fish can anticipate the consequences of human exposure to environmental carcinogens, endocrineactive substances and metal, metalloid and elemental toxins. An initial study, the Pittsburgh Fish consumption study of 2005-07, showed results that indicate that extracts from the flesh and fat of catfish and white bass from the more contaminated Pittsburgh Pool surrounding the City of Pittsburgh proliferated the growth of estrogen-receptor positive breast cancer cells (MCF-7). These breast cancer cells multiply when exposed to human estrogen or to compounds that mimic estrogens (xenoestrogens.) When these same fish extracts were added to BT-20 breast cancer cells, which are estrogen receptor negative, no cell multiplication was observed. This led the research team to conclude that xenoestrogens produced by pharmaceutical wastes or chemicals found in our detergents and personal care products were bioaccumulating in the fish because of liquid wastes (effluents) from wastewater treat plants and sewer overflows.

twenty-three percent of samples from kittanning had mercury levels above the EPa human health standard of .3ppm. There are numerous coal burning power plants located on our rivers both above and below Kittanning, PA, and power plant emissions are a major source of mercury, selenium and arsenic that are found in our waterways. What is the allegheny river stewardship Project? The Allegheny River Stewardship Project is an effort by leading researchers at CeO-UPCI and the Graduate School of Public Health working with concerned citizens of the Alle-Kiski Valley river communities, to determine the specific sources and types of river pollutants. This is accomplished by monitoring the levels of pharmaceutical estrogens, xenoestrogens and heavy metals in the fish living in the river and are also present in wastewater, river water and river sediment. What are the goals of the allegheny river stewardship Project? The goals of the Allegheny River Stewardship Project are to: • Engage river community members to become involved in the stewardship of the Allegheny River;

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• Understand the concentrations of Also surprisingly, significantly higher levcontaminants in river fish species, els of the toxic elements—mercury, arseespecially those that people eat; nic, and selenium—were found in channel • Associate contaminants in fish catfish caught upstream on the Allegheny with potential pollution sources; River at Kittanning than in those caught in the Pittsburgh Pool near former steel • Identify human exposures to these contaminants; factories. The environmental Protection Agency’s Clean Water Act Human Health • Understand the risks to human health Ambient Water Quality Criterion for methand the environment from these ylmercury is based on levels in fish tissue. contaminants and pollution sources;

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Center for Environmental Oncology — University of Pittsburgh Cancer Institute

CEo-UPCi
• Obtain and share data with policymakers so that an action plan may be made to solve the identified problems, and; • Form strategic partnerships with stakeholder groups along the Allegheny River to help ensure ongoing stewardship activities. What are the expected outcomes of the allegheny river stewardship Project? • To engage river community members, anglers, recreational boaters and the general public (who generally obtain their drinking water from our rivers) in the planning, execution and data analysis portions of the projects. Specifically, this project will teach both interested adult and teenage community members the procedures associated with the catch and measurement, geographic positioning, gender identification, dissection, analysis and interpretation of results of the fish study; • To understand the different concentrations of contaminants, which are of significance to public health, and which are carcinogenic (able to cause cancer), estrogenic or toxic and have accumulated in the fish species along major sections of the Allegheny River; • To correlate the concentrations of contaminants in fish with proximity to the liquid wastes (effluents) from industrial facilities, power plants fallout or fly ash pile leeching into the waters, municipal sewer overflows, former industrial waste sites and/ or areas of environmental degradation • To identify human exposures to the contaminants found in fish either through drinking water and/or eating the fish; • To understand the risk posed to human or ecological health from these levels of contaminants in fish; • To obtain data, evidence, and other information that can inform policymakers in preparing for a regional approach to water management; • To form strategic partnerships with the CeO-UPCI, GSPH, RiverQuest, Venture Outdoors, The Rachel Carson Homestead, the Alle-Kiski Health Foundation, and the Heinz endowments, in order to galvanize the river communities, groups, schools, and individuals to become stewards of the river; • To raise awareness in this area of the importance of the river to the public’s health and well being, not only in the sense of drinking water or fish consumption but for aesthetic, cultural, historical and recreational values; Lessons learned from the project will be transformed into long-term community environmental and specific water quality goals, so that the footprint of the project widens and deepens with the passage of time. What is the duration of the allegheny stewardship Project? Community meetings, focus groups, and surveys to determine priority locations for actual river sampling are now being held and planned. Actual river fishing and water-and-sediment-sampling will occur at numerous locations on the Allegheny River on weekends from May through early June of 2008.Analysis of samples and report preparation will continue through the late fall of 2008. The project is expected to last until Spring 2009, when researchers will hold a series of community meetings on outcomes of the sampling results. At that time, strategy for community action to solve identified priority problems will be determined.

www.environmentaloncology.org

PERSONAL POLLUTION PROBLEM STATEMENT
Describe, name. and/or draw a current or past environmental pollution problem that you are aware of that may be affecting your community or the Allegheny River Watershed in general. Please be as specific as possible and try to tell us exactly where the problem(s) are occurring or has occurred. This may be an air, water, land, or mixed source pollution problem. This can also be mailed to Dr. Dan Volz at Bridgeside Point, 100 technology Drive, suite 564, BriDg, Pittsburgh, Pa 15219-3130. cdv5@pitt.edu

Winter 2008 Volume 2 • Number 2

Center for Environmental Oncology — University of Pittsburgh Cancer Institute

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www.environmentaloncology.org

Pregnancy and Environmental Health Continued From Page 5
at 412-802-8299 or register at www.magee.upmc.coml. i was so happy that i stopped smoking before i was pregnant. i asked my family to stop smoking, too, but they say it doesn’t matter. is that true? First of all, congratulations that you have stopped smoking! You have decreased the chances that your baby will be born prematurely or with a low birth weight. Your family is mistaken. Second-hand smoke does matter! Second-hand smoke or environmental tobacco smoke is a combination of smoke exhaled from the smoker and smoke from the burning cigarette. Cigarette smoke contains some 4000 chemicals, including carbon monoxide, ammonia, lead, and nicotine, which are known reproductive toxins that cross the placenta. If you and your unborn child are regularly exposed to second-hand smoke, you increase yours and your child’s chances of eventually developing lung cancer, heart disease, emphysema, allergies and asthma. Also, babies exposed to tobacco smoke have an increased risk of Sudden Infant Death Syndrome (SIDS) and are hospitalized more frequently with other health problems. So, keep your home and car smoke-free. At Magee-Womens Hospital, women are tested at the prenatal clinics for carbon monoxide. Carbon monoxide levels are higher in women who live with smokers compared to those who live in a smokefree environment. Share this information and encourage smokers in your family to consider a smoking cessation program. Knowing that this will protect your health and the health of your unborn child may be just the motivation they need to quit. i am working hard to eat a healthy diet now that i am pregnant. at work, i was heating my lunch in a plastic container, and someone said i was poisoning my baby. What should i do? Do not microwave in plastic, as this can release toxic contaminants from the plastic into foods. It is also important to pay attention to how you prepare and store your food. When food is stored in plastic containers, some of the chemicals in the plastic may leach into the food. Some of those chemicals are hormone-mimicking chemicals called endocrine disruptors which can have negative impacts on a fetus’ reproductive organs. For safety, it is recommended to store food in glass or ceramic containers, and only in plastic containers after foods have cooled. Never microwave in plastic containers or wrap, even those marked “microwave safe.” Again, a glass or ceramic bowl is recommended for use in the microwave. Discard any plastic containers that have started to break down. If you look on the bottom of plastic cups, bottles and containers, there is a triangle with a number in it. Plastics marked 1, 2 4 and 5 are “safer” plastics. Avoid plastics marked 3, 6 and 7 as they can leach harmful chemicals into your food or drink. Check children’s plastic sippy cups and their plastic baby bottles for unsafe numbers on them. This is also applicable to baby’s plastic toys. For instance, the bathtub rubber ducky toy can be made from an unsafe plastic called PVC. Magee-Womens Hospital’s intensive care unit for babies has eliminated the use of one of these plastics in medical equipment called DeHP. They have replaced intravenous tubes bringing baby’s blood, medicine or nutrition with a safer plastic. In addition, Magee’s nurses have been trained to be knowledgeable about some of these issues, and all new parents are given information about environmental health before they are discharged from the hospital.

Winter 2008 Volume 2 • Number 2
AddITIONAL INTERNET RESOURCES
Beyond Pesticides www.beyondpesticides.org Breast cancer Fund www.breastcancerfund.org Environmental Working group www.ewg.org www.comesticsdatabase.com Health care Without Harm www.hcwh.org Healthy child, Healthy World www.healthychild.org Perfectly Natural www.perfectlynatural.com the cDc www.cdc.gov the green guide www.thegreenguide.com the National cancer institute www.nci.nih.gov/cancertopics susan g. komen for the cure cms.komen.org/komen/index.htm Venture outdoors www.ventureoutdoors.org

STOP SMOkING RESOURCES
Pa Free Quitline 1-800-QUIT NOW UPmc Health Plan ready to Quit line 1-800-807-0751 Pittsburgh stoP (stop tobacco in Pregnancy) Program 412-551-8694

For more information: www.cdc.gov/tobacco

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