Addison-Wesley, 357 pp., including 62 pages of source notes plus index, $24
Reviewed by Nancy Evans
Had Rachel Carson lived longer, she might have written this book. The lucid, lyrical prose echoes that of Silent Spring as does the solid science that supports the premise: the urgent, imperative need for an “upstream” approach to cancer. As the author explains in her prologue:
“This image comes from a fable about a village along a river. The residents who live here, according to parable, began noticing increasing numbers of drowning people caught in the river’s swift current and so went to work inventing ever more elaborate technologies to resuscitate them. So preoccupied were these heroic villagers with rescue and treatment that they never thought to look upstream to see who was pushing the victims in.”
This book is a walk up that river.
It is difficult to do justice to the excellence, importance and timeliness of this book. Dr. Steingraber views cancer through several lenses: as biologist, cancer survivor, poet and activist. She draws together data on environmental contamination and cancer incidence to provide “a view of cancer’s trajectory through time and a map of its distribution across space.” But this is not a collection of statistics; it is a collection of stories, true stories told in a clear, compelling voice. The story of how the tallgrass prairie of America’s heartland was transformed by the chemicalization of agriculture after World War II. The story of the author’s own cancer journey which began at age 20 with a diagnosis of bladder cancer and the story of her friend Jeanie’s treatment for, and death from, a rare neurological cancer at age 36.
The stories of family members with cancer (a mother with breast cancer, uncles with prostate cancer and colon cancer, an aunt with bladder cancer), a family related only through marriage and adoption. Together these stories create a powerful picture of a nation, a people and a planet in peril.
The chapter titles tell a story of their own. In “Trace Amounts: Exposing the Euphemism Used by Polluters” (recently the newspaper reported “trace amounts” of radiation had been released in another “incident” at Three Mile Island), Steingraber reviews the evidence of pesticide contamination in Illinois, 89% of which is farmland, 99% of which receives 54 million pounds of pesticides annually. This story of a single state and its two major crops, corn and soybeans, illuminates the contamination of our food chain. “Corn syrup, corn gluten, cornstarch, dextrose, soy oil and soy proteins are found in almost every processed food from soft drinks to sliced bread to salad dressing. These are also the ingredients of the food we feed to the animals we eat. The molecules of water, earth and air that rearrange themselves to form these beans and kernels are the molecules that eventually become the tissues of our own bodies. You have eaten food that is grown here. You are the food that is grown here.”
In the chapter called “Silence,” the author describes the many kinds of silence that surround cancer issues, personal and political, individual and collective. The silence of scientists who fear loss of funding, the silence that fear imposes on people with cancer and those at risk. She suggests that Silent Spring shows us “how one kind of silence breeds another, how the secrecies of government beget a weirdly quiet and lifeless world.”
Three bodies of evidence linking cancer and the environment are explored in the chapter called “Time.” The first set of data is the increase of cancer incidence over time. Between 1950 and 1991, the incidence of cancer, excluding lung cancer, rose by 35 percent. The incidence has risen most swiftly in the last two decades, and it has affected all age groups, from infants to the elderly. The lifetime risk of cancer has risen from one in four in 1950 to today’s levels: one in three for women and one in two for men. The second line of evidence is the increase in cancer incidence among successive generations, and the third is the types of cancers increasing the most rapidly: melanoma of the skin, non-Hodgkin’s lymphoma and multiple myeloma.
There is general agreement that the increase in melanoma rates is related to increased exposure to ultraviolet light due to the hole in the ozone, in turn, related to the use of ozone depleting gases, such as chlorofluorocarbons (CFCs). Non-Hodgkin’s lymphoma seems to be associated consistently with exposure to a class of chemicals called phenoxy herbicides.
The best known of the phenoxy herbicides is Agent Orange, a combination of 2,4,5-T (eventually banned) and 2,4-D (marketed under many names such as Ded-Weed, Lawn-Keep, Weedone, Plantgard, Miracle, Demise). Incidence of non-Hodgkin’s lymphoma is highest among farmers and Vietnam veterans. Dogs whose owners use 2,4-D on their lawn are more likely to be diagnosed with canine lymphoma than dogs whose owners do not use chemicals.
In “Space,” Steingraber looks at geographic and occupational distribution of cancer. In this chapter we learn that, unlike the many U.S. scientists who denigrate the cancer-environment connection, the International Agency for Research on Cancer (IARC) has concluded that at least 80% of all cancer is attributable to environmental influences. Mapping across occupations again shows farmers to be at high cancer risk, as are “painters, welders, asbestos workers, plastics manufacturers, dye and fabric makers, firefighters, miners, printers and radiation workers.” Children of parents who are exposed to paint, petroleum products, solvents and pesticides are at higher than average risk of brain cancers and leukemias. This chapter also outlines the evidence linking vinyl chloride exposure and breast cancer, evidence based on a 1977 occupational study that has never been followed up.
The link between cancer and environmental factors has not been investigated in any systematic, exhaustive way during the past three decades, even though the levels of contamination have risen. In 1964, two scientists from the National Cancer Institute wrote: “Cancers of all types and all causes display even under already existing conditions, all the characteristics of an epidemic in slow motion.” They attributed this to “increasing contamination of the human environment with chemical and physical carcinogens and with chemicals supporting and potentiating their action.” Contrast that with the today’s cancer establishment that tells us to accommodate ourselves to degradation of the environment and the resulting increase in our cancer risk.
In “War,” the author explains two major fallacies still at work in today’s chemical age. First, many of the 75,000 chemicals now in use were developed “under emergency conditions and within the secretive atmosphere of wartime.” Thus, they were not fully tested for safety. Before adequate testing could take place, manufacturers developed peacetime markets for the chemicals. Second, the marketing strategies for these chemicals reflected wartime attitudes, and “the goals of conquest and annihilation were transferred from the battlefield to our kitchens, gardens, forests and farm fields.All life was caught in the crossfire.”
The narrative continues, fascinating, horrifying, through chapters called “Animals,” “Earth,” “Air,” “Water,” “Fire” and “Our Bodies, Inscribed.” In the final chapter, “Ecological Roots,” the author proposes a human rights approach to cancer. The first right-to know about carcinogens in the environment-involves a three-part inquiry: looking into past exposures, reassessing the present situation and imagining an alternative future. The reassessment demands admission that we do not all bear equal risks from chemicals. “Workers who manufacture carcinogens are exposed to higher levels as are those who live near the chemical graveyards that serve as their final resting place.”
The author examines the assumption of the most conservative scientists that only two percent of cancer deaths are due to environmental causes. If that were true (and, like IARC, she believes the percent is far greater), that would mean that “10,940 people in the U.S. die each year from environmentally caused cancer. This is more than the number of women who die each year from hereditary breast cancer-an issue that has launched multi-million-dollar research initiatives. This is more than the number of young people killed each year by firearms-an issue that is considered a matter of national shame. It is more than three times the number of nonsmokers estimated to die each year of lung cancer caused by exposure to secondhand smoke-a problem so serious it warranted sweeping changes in laws governing air quality in public places. It is the annual equivalent of wiping out a small city. It is thirty funerals every day.
“None of these 10,940 Americans will die quick, painless deaths. They will be amputated, irradiated and dosed with chemotherapy. They will expire privately in hospitals and hospices and be buried quietly. Photographs of their bodies will not appear in newspapers. We will not know who most of them are. Their anonymity, however, does not moderate this violence. These deaths are a form of homicide.”
Despite the powerful cancer establishment that continues to deny the importance of environmental factors and the vested interests dedicated to perpetuating that view, Steingraber remains hopeful that we can change this bleak picture. She proposes that imagining and creating a less toxic future, a future with declining cancer rates, will depend on the adoption of three principles: acting with precaution (based on evidence rather than proof of harm), reversing the onus (shifting the burden of proof from the public to the those who produce, import or use a particular substance) and choosing the least toxic alternative (not using toxics if there is another way of solving problems).
We all live downstream. But if enough of us walk up the river with Sandra Steingraber as our guide, future generations will need fewer rescuers on the bank.
Nancy Evans served as a source for some materials cited in Living Downstream.
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