Steingraber - Living downstream: an ecologists personal investigation of cancer and the environment

Table of Contents

This book is a walk up that river.

Thirty years ago, in between my sophomore and junior years of college, I was diagnosed with bladder cancer. Those are amazing words to write: Thirty years ago I had cancer. I had just turned twenty. I was hoping that I would live long enough to have sex with someone; I hadnt done that yet. I could not have imagined, while lying in my hospital bed, exhaling anesthesia, that someday I could write, Thirty years ago I had cancer.

Last September, on a sunny afternoon, the phone rang while I was trying to meet a writing deadline. It was the nurse in my urologists office. She was calling to say that the pathologist had found, in the urine collected from my last cystoscopic check-up, abnormal cell clusters. And traces of blood.

After I hung up, I looked out the window of my small house where the sun still shone on the last of the marigolds. I looked down at my computer screen where the cursor still blinked on the same paragraph. I noticed the crayons on the floor, cast aside in the morning rush for the school bus, and could hear in the kitchen the tomatoes still bobbing in the stockpot that was steaming away on the stove. The world was still the same, but it felt to me a suddenly altered place.

I provided a second urine sample for further testing, and based on the results of that, a third sample that was sent out for genetic analysis. I began living within that period of time known as watchful waiting. This is a familiar place to me. Watch means screening tests, imaging, blood work, self-advocacy, second opinions, and hours logged in hospital parking garages. Wait means you go back to your half-finished essay, to the tomatoes on the stove. You lay plans and carry on within the confines of ambiguity. You meet deadlines and make grocery lists. And sometimes you jump when the phone rings on a sunny afternoon. Bladder cancer recurs in 50-70 percent of patients. There are evidence-based reasons for feeling jumpy.

Ten days later, I got a call from the urology nurse. The results were normal. A few months later I had a second cystoscope and a renal ultrasound. Normal. No explanation for the blood. It might mean nothing. Lets look again in six months.

Thirty years ago I had cancer. When I left the hospital, I went back to my college dormitory, resumed my life as a biology major with a side interest in poetry, and began mucking around in the medical literature. I was curious about a series of questions my young, new-to-the-area urologist had asked me a few days after my surgery. Had I ever worked in a tire factory? Any exposure to textile dyes? What about employment in the aluminum industry? As I lay there, still tethered to catheter tubes, these queries had seemed surreal to me. I was the clean-living winner of the local Elks Club scholarship, a high-achieving college student with plans for graduate research. Of course I wasnt out vulcanizing tires or smelting aluminum. But why had he asked?

It didnt require many hours in the university library to learn that bladder cancer is considered a quintessential environmental cancer, meaning that more evidence exists for a link between toxic chemical exposure and bladder cancer risk than for almost any other kind of cancer, with data going back a hundred years. I also learned that the identification of bladder carcinogens does not preclude their ongoing use in commerce. Just because researchers discover, through careful scientific study, that a chemical contributes to cancer doesnt mean its automatically banished from our economy.

On all these fronts, not much has changed in the three decades since my diagnosis. Of the 80,000 synthetic chemicals now in use, only about 2 percent have been tested for carcinogenicity and, since 1976, exactly five have been outlawed under the Toxics Substances Control Act. Our environmental regulatory system requires no rigorous toxicological testing of chemicals as a precondition for marketing them. It promulgates legal limits on chemical releases, largely overlooking that we are all exposed to trace amounts of many contaminants, and not just one at a time. It is still no ones job to make sure that the total burden of toxic exposures is not too much for any one of us.

A 2007 investigation published by the American Cancer Society identified 216 chemicals known to cause breast cancer in animals. Of these, 73 are found in food or consumer products; 35 are air pollutants; and 29 of them are produced in the United States in large amounts every year.

In 1981, I went off to graduate school, pursuing first a degree in creative writing and then another in field biology. Both offered opportunities to travel far from my hometown in central Illinois. Wherever I was, I dutifully submitted to cancer check-ups. I also started a collection of pamphlets on bladder cancer, gathered from the various waiting rooms and hospitals where I spent time. I noticed that they seldom contained the words carcinogen or environment. (More on these in Chapter Twelve.) Nor were these words used anymore in conversations I had with my various health care providers. There seemed to be a disconnect between the evidence that medical researchers had compiled about the environmental origins of bladder cancer and what patients heard about that evidence. To judge by the medical intake forms, the more relevant variable was genetics: I was asked again and again about my family medical history. I was happy enough to provide it. There is a lot of cancer in my family. My mother was diagnosed with breast cancer at age 44. I have uncles with colon cancer, prostate cancer, stromal cancer. My aunt died of the same kind of bladder cancertransitional cell carcinomathat I had.

But heres the punch line to my family story: I am adopted.

And when I looked at the literature on cancer among adoptees, I learned that, in fact, the chance of an adopted person dying of cancer is more closely related to whether or not her adoptive parents had died of cancer and far less related to whether or not her biological parents had met such a fate. What runs in families does not necessarily run in genes. And while knowledge of ones genetic history is important for understanding health risks, so too is knowledge about ones environment. (More on this in Chapter Eleven.)

The environmental questions posed by my first urologist became the seeds of this book. The research it required began in the stacks of the Harvard Medical School Library, where I spent a postdoctoral year, and continued in my Midwestern hometown. As a biologist, my goal with this book was to bring together two categories of informationdata on environmental contamination and data on cancerto see what patterns might exist, to identify questions for further inquiry, and to urge precautionary action, even in the face of incomplete answers. To explore the extent to which toxic chemicals, including cancer-causing agents, have trespassed into our air, food, water, and soil, I drew heavily upon databases available under federal right-to-know laws. Cancer registry data provided a view of cancers trajectory through time and its distribution across space. Various published studies, gathered from far-flung corners of the biological and medical literature, offered other glimpses of the connection between cancer and the environment. Informing my discussion throughout this book, these range from reports on pesticides, river sediments, and trash incinerators to surveys of farmers, sport anglers, and nursing mothers. They include investigations of laboratory animals, wildlife, and pets, as well as examinations of human tissues and cellular machinery. They range from atmospheric science to neuroendocrinology.