Cancer Wars: How Politics Shape What We Know and Don't Know about Cancer by Robert N. Proctor

From the Publisher

Cancer Wars explains why we still don't have straight answers to questions such as these: Why do rates from some cancers appear to have risen and others fallen? What are the relative risks of polluted water, radon in homes, and the natural toxins in peanut butter? Is it dangerous to use a cellular phone or to live near high-voltage wires? Are there "thresholds" of exposure to radiation or chemical toxins? If cigarettes cause up to 30 percent of all cancer, why has so little been done to discourage their production? And why does the National Cancer Institute spend only 3 percent of its budget on antitobacco efforts? After an overview of the history of attempts to understand cancer, the book introduces two of the foremost twentieth-century advocates of the environmental view of cancer: the little-known Wilhelm Hueper and his famous disciple, Rachel Carson. Proctor then moves to the 1970s, when claims that a large percentage of cancers could be caused by exposure to industrial pollutants gained currency, and then to the backlash during the Reagan era, when environmental and occupational health factors were downplayed. Proctor discusses the lobbying efforts of industrial research bodies and trade associations representing tobacco, asbestos, meat, coffee, and other special interest groups. He considers the debate over Bruce Ames's argument that "natural carcinogens" in foods pose a far greater threat than industrial pollutants or pesticides, and chronicles the political history of dose-response curves: Can a single molecule of a carcinogen cause cancer? A fascinating chapter on the history of radiation and cancer draws on censored information about uranium-mine concentration camps in Czechoslovakia. The author also discusses genetic factors and differential susceptibility to cancer. Finally, Proctor suggests how we might actually win the war on cancer.

Publishers Weekly

Proctor estimates that former Presidents Reagan and Bush, by dismantling and defunding occupational, environmental and consumer product safety agencies, may have caused 600,000 additional cancer deaths in the nation over 12 years. Professor of the history of science at Pennsylvania State University, he mounts a devastating critique of trade associations of the tobacco, meat, chlorine and asbestos industries, which, in his view, co-opt scientific research to create and exploit uncertainty over the carcinogenic risks of their products. Next he disputes the notion, popularized by Berkeley biochemist Bruce Ames, that natural carcinogens in foods pose a far greater health hazard than industrial pollutants or pesticides. Noting that the National Cancer Institute spends less than 3% of its budget on anti-smoking efforts, even though 30% of cancer deaths result from cigarettes, this forceful, scholarly study urges greater efforts to encourage cancer prevention, including a halt to tobacco subsidies, stiffer supervision of pesticides and federal support for alternatives to petrochemical agriculture. First serial to Sciences. (Mar.)

Library Journal

Science historian Proctor discusses not only the war fought against cancer but especially the several wars fought over cancer. He notes several prominent, disturbing facts: despite 20 or more years of heavily funded and widely proclaimed cancer research, cancer has become the second-most frequent cause of death in the United States and other developed nations; the five-year survival rates for most cancers have not changed since 1972; and, alas, the incidence of some cancers has increased. Despite widespread recognition that the principal causal agents of cancer are environmental, conflicts over the causes and prevention of cancer persist among scientists, between industrial corporations and regulatory agencies, and between environmentalists and manufacturers. The origin, persistence, and effects of these conflicts form the central questions examined here. Proctor holds that cancer research is often subtly and sometimes overtly affected by politics. Why, he asks, has the so-called cancer establishment devoted far more time and money to investigating the mechanisms of cancer than to its prevention? This fascinating but well-documented book should be profitably read by all informed readers.-James D. Haug, East Carolina Univ. Lib., Greenville, N.C.

What People Are Saying

Dorothy Nelkin
"A brilliant history of the social biases, economic interests, and political stakes that have long entered debates over the causes, prevention, and treatment of cancer...The book reflects Proctor's superb scholarship, but is also lucid and interesting."

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"Nearly every medical man is assailed at frequent intervals with the question, Why has cancer increased so much?"
—Arthur Newsholme, 1899

"For every Ph.D. there's an equal and opposite Ph.D."
—Gibson's Law

More than a thousand people die of cancer every day in the United States. For every American alive today, one in three will contract the disease and one in five will die from it. Cancer is the plague of the twentieth century, second only to heart disease as a cause of death in the United States and most other First World nations. While most other diseases are on the decline, cancer is on the rise. The trend has been building for some time: Roswell Park, a New York physician, noted as early as 1899 that cancer was "now the only disease which is steadily upon the increase." That year, cancer claimed about 30,000 U.S. lives. In 1994, cancer will kill more than fifteen times that many: 538,000, according to American Cancer Society projections. If present trends continue, cancer will become the First World's leading cause of death sometime in the twenty-first century. It has already reached that status in Japan. This year alone, cancer will kill nearly twice as many Americans as were killed in all of World War II.

The tragedy is magnified by the fact that the causes of cancer are largely known—and have been for quite some time. Cancer is caused by chemicals in the air we breathe, the water we drink, and the food we eat. Cancer is caused by bad habits, bad working conditions, bad government, and badluck—including the luck of your genetic draw and the culture into which you're born.

Cancer is primarily a disease of the elderly, which is why death rates are generally presented as "age-adjusted" figures. Florida, for example, has a much higher annual cancer death rate than Alaska (250 per 100,000 versus 80 per 100,000) due to the fact that Floridians are, on average, significantly older than Alaskans. Adjusting for age, one finds that Floridians actually have a slightly lower cancer mortality rate than Alaskans (163 per 100,000 compared with 184 per 100,000). See the American Cancer Society's Cancer Facts & Figures—1992 (New York, 1992), p. 7. The failure to age-adjust was usually the single greatest flaw of early cancer registries—the otherwise impressive registry of fin de siŠcle Hungary, for example. See Juraj K”rbler, "Die grosse ungarische Krebsstatistik aus der Zeit der Jahrhundertwende," Krebsarzt 14 (1959): 224-27.

Much of what is known about the disease stems from its distinctive political geography. The World Health Organization estimates that about one-half of all cancers occur in the most industrialized one-fifth of the world's population. Even industrialized nations, though, suffer dramatically different kinds of cancer. The leading cancer killer in the United States (for both males and, since the 1980s, females) is lung cancer; in Japan, it is stomach cancer. Mouth cancer is nearly ten times as common among French males as among Israeli males; women in England and Wales are more than five times as likely to die of breast cancer as women in Japan. Global comparisons show that cancer incidence rates may vary dramatically from one nation to another. African Americans in Atlanta are 28 times more likely than Japanese in Osaka to suffer cancer of the prostate. Czechoslovakia has the highest colon cancer death rate on record (41 per 100,000), but its breast cancer rate is only about one-third that of the United States. Queensland, Australia, is the skin cancer capital of the world, an unhappy consequence of the migration of light-skinned Britons to a region of intense and unrelenting sun.

Cancer rates can also vary substantially within a given nation. In certain parts of China, esophageal cancer is 600 times more common than in other parts of that country. Cancer atlases published by the National Cancer Institute indicate that industrialized states such as New Jersey and New York have higher rates of cancer than rural states such as Kansas or Arizona. Nonsmoking Iowans have one of the lowest recorded rates of lung cancer mortality. Americans who live in the Sunbelt states are more likely to develop skin cancer than Americans who live in the North. Blacks suffer significantly higher rates of death from nearly every form of cancer than do whites (skin cancer being the only notable exception), though studies have shown that it is poverty rather than race that is the root cause of the difference. Samuel Broder, director of the National Cancer Institute, put it bluntly: "Poverty is a carcinogen." And cancer may in turn produce poverty: Daniel M. Hayes at the University of Southern California has found that people who survive childhood cancer tend to earn less money, have more difficulty getting life insurance, and be less likely to marry than people who never had the disease. Cancer, even if cured, casts a long shadow.

Occupation, diet, and lifestyle are linked with the disease. Asbestos workers suffer cancers of the lungs and pleural lining; dye workers suffer cancers of the bladder and stomach. Liver cancer can be caused by exposure to vinyl chloride, lung cancer by work with arsenic, uranium, or beryllium. Bowel cancer is rare in countries where meat is not a regular part of the diet and where large amounts of fiber are consumed. (This is true even after adjusting for the fact that people tend to die younger in Third World nations, leaving fewer people to reach the ages at which colon cancer is common.) Mormons, whose religious beliefs forbid them to smoke or to drink alcohol, coffee, or tea, have 20 percent lower cancer death rates than non-Mormons. In China, esophageal cancer has been traced to diets that include particular kinds of moldy bread. In France, esophageal cancer has been linked to the consumption of home-brewed alcoholic beverages (maps of alcoholism and esophageal cancer rates are almost perfect matches). The Japanese vulnerability to stomach cancer probably derives from their consumption of large amounts of pickled, burned, and high-salt foods such as seaweed and shellfish, and other foods cooked with soybean pastes and sauces. Cancer of the mouth is common among the peoples of India who chew betel nuts and tobacco leaves. Liver cancer is especially common among the Bantu (in Africa) and in Guam, where foods are often contaminated with aflatoxin, a potent fungal toxin. In China, correlations have been found between women's risk for lung cancer and the cooking fuel they use; how frequently they cook with oil and even the kinds of oil they use have also been implicated (canola [rapeseed] oil vapors appear to be particularly hazardous). In the United States and elsewhere, correlations have been found (and disputed) between fat consumption and breast cancer. Pesticides and PCBs (polychlorinated biphenyls), for example, collect in fatty tissues, and this may explain the link. Fat alone, though, may be the more important offender.

Sexual practices are also involved. Cervical cancer is rare in nuns, but common in prostitutes. A sexually transmissible virus may be the culprit, but perhaps some other environmental agent is at work. Age of childbirth is tied to risk of breast cancer: having children early tends to lessen a woman's risk, and having children later in life—or not having any children—seems to heighten the risk. Nuns, though they have low rates of cervical cancer, have high rates of breast cancer. Physical exercise seems to help prevent breast cancer: Susan Love, author of Dr. Susan Love's Breast Book, suggests that support for women's athletics may be one way to diminish the disease.

We also know there is no greater cause of cancer than tobacco. C. Everett Koop, the U.S. surgeon general under Ronald Reagan, estimated in the mid-1980s that cigarettes alone accounted for between 300,000 and 400,000 American deaths yearly—an annual death toll six or seven times higher than the number of American lives lost in all twelve years of the Vietnam War. Oxford's Richard Doll and Richard Peto argue that tobacco is the single most important carcinogen in the modern world: "Indeed, were it not for the effects of tobacco, total U.S. death rates would be decreasing substantially." Two-pack-a-day smokers increase their risk of lung cancer by a factor of twenty and shorten their life expectancy by about eight years. And cigarette smoking has been found to endanger not just the smoker but anyone in the vicinity: the Environmental Protection Agency estimates that more than 3,000 nonsmoking Americans are killed each year by "secondhand" or "environmental" tobacco smoke. A 1991 report in the official journal of the American Heart Association places the figure as high as 50,000.