Senator John McCain of Arizona. Senator Ted Kennedy of Massachusetts. Delaware Attorney General Beau Biden. All three men were diagnosed with glioblastoma, a rare and barely understood aggressive cancer of the brain. When the news first broke about John McCain’s diagnosis and the naming of other prominent Washington D.C. area figures who were afflicted with the disease, we thought it was odd that there were no discussions about the possible connection to environmental causes. So, we thought we would investigate this potential connection. We were then tangentially diverted when we discovered that Philadelphia Phillies baseball players Darren Daulton, Tug McGraw, John Vukovich, and Johnny Oates were also diagnosed with glioblastoma. Washington D.C. and Philadelphia are only 140 miles apart. Ken Brett – who played one season for the Phillies and two for the Kansas City Royals – was suspected to have died from glioblastoma. Indeed, another Kansas City Royal player Dan Quisenberry and manager Dick Howser also died from glioblastoma. Additionally, other major league baseball players Gary Carter and Bobby Murcer also died from the disease. Causes of Glioblastoma Current research suggests that only 5% of all glioblastomas are caused by hereditary conditions; the remaining 95% cannot be attributed to any specific cause. Glioblastoma cells have more genetic abnormalities than cells of the other types of astrocytoma brain cancer. As a result, researchers believe that several different genetic mutations are involved in the development of these cancers. This field of research inquiry is called epigenetics: the outside forces that trigger a genetic profile to mutate. These genetic mutations can be caused by: Diana Laverdure-Dunetz and I have written in our book, Canine Nutrigenomics: If you think certain people or animals are destined to get cancer as an unfortunate by-product of their inherited DNA, think again. Researchers estimate that only 5% to 10% of all cancer cases originate from genetic predisposition, while 90% to 95% are the result of lifestyle and environmental factors, such as exposure to pollution and toxins, obesity, lack of physical activity, infection, stress and diet. These factors create epigenetic changes that can turn off genes that suppress tumors and/or turn on oncogenes, a type of abnormal gene that predispose cells to develop into cancers. Demographics of Glioblastoma – What We Know Geographical Incidence of Brain and Other Central Nervous System Cancers Based on this, we ran a report on State Cancer Profiles, a website supported by the National Cancer Institute and Centers for Disease Control and Prevention. The parameters: Then, we compared it to the U.S. Census Bureau’s population data using the same parameters from the 2010 census to give us an estimate of incidence. Bear in mind, incidence rates (cases per 100,000 population per year) are age-adjusted to the 2000 US standard population. However, we double-checked our estimates to those of the State Cancer Profile’s and found out we were correct. Based on the report, the top 10 states with the highest incidence of brain and CNS cancers are: table, th, td { border: 1px solid black; border-collapse: collapse; } th, td { padding: 0px; } th, td { font-family: Arial, Helvetica, sans-serif; } th, td { text-align: left; } th, td { color: black; } td { vertical-align: center; } State Age-Adjusted Incidence Rate - cases per 100,000 - 2000 Census Bureau South Carolina 21.1 New Jersey 20.8 Vermont 20.6 Oregon 20.1 Alabama 19.7 Idaho 19.7 Maryland 19.7 Kansas 19.6 Kentucky 19.6 Nebraska 19.6 Washington D.C. had 19.5 cases per 100,000 people incidence rate, Maryland was slightly higher at 19.7, Pennsylvania came in at 18.9, and Virginia had 17.8. It should be noted that Delaware was in the bottom three states at 14.9. We did wonder where the incidences are reported: state of diagnosis or permanent state of residence? We wondered this because even though Senator John McCain was diagnosed in his home state of Arizona, what if he had been diagnosed at Walter Reed National Military Medical Center in Maryland? To answer this question, we reached out to State Cancer Profiles for clarification. The organization unequivocally stated residence. So, a diagnosis in Maryland would still be attributed to Arizona. To be clear, we think this standardization set by the national database is fine and necessary. Nevertheless, our hypothesis that glioblastoma is affected by something in the environment in the Mid-Atlantic region cannot be proven at this time. In regards to the major league baseball players, there is no definitive research conclusion. Some wonder if the astro turf used at both Veterans Stadium (the former Phillies stadium) and Kansas City may have harbored chemicals that increased the chance of brain cancer. According to The New York Times: Dr. Cory M. Franklin, a Chicago internist who has written about the cancer cases in baseball, said Major League Baseball and the players’ union should enlist epidemiologists and statisticians to examine whether the malignancies were workplace related. He also said that they should create an extensive registry of players and their causes of death. In this particular instance, we wanted to spotlight glioblastoma since it affected recognizable figureheads. The statistics we provided about brain cancer are facts. Unfortunately, they are potentially skewed facts because most medical research has only focused on white males for years which clearly does not accurately represent the entire population. This led us down another tangent: The All of Us Research Campaign. We encourage everyone to sign up for the campaign to enable scientists to have a better demographic and regional basis for research and study. According to the website: The All of Us Research Program is a historic effort to gather data over many years from one million or more people living in the United States, with the ultimate goal of accelerating research and improving health. Unlike research studies that are focused on a specific disease or population, All of Us will serve as a national research resource to inform thousands of studies, covering a wide variety of health conditions. Researchers will use data from the program to learn more about how individual differences in lifestyle, environment, and biological makeup can influence health and disease. Participants may be able to learn more about their own health and contribute to an effort that may advance the health of generations to come. Since South Carolina came in at the top of the list for white males over 50 years of age, we googled “South Carolina Brain Cancer”. To be fair, South Carolina is actually average in relation to the rest of the country for all populations. However, the Google results were too alarming not to mention and were certainly not what we suspected. In 2017, ABC 4 of Charleston, South Carolina ran a story about eleven children who lived relatively close to one another in Mt. Pleasant, South Carolina. All of these children were diagnosed with a rare pediatric brain tumor, diffuse intrinsic pontine glioma (DIPG), within a span of five years. This is disturbing. Bear in mind, only 300 children are diagnosed every year with DIPG in North America and Europe according to The International Diffuse Intrinsic Pontine Glioma Registry, a collaborative effort by physicians and researchers from North America, Europe, and Australia to centralize and standardize the collection of clinical and neuro-imaging data and tumor samples from DIPG patients. People in Mt. Pleasant wondered about air or water causes? Frustratingly, scientists do not know and cannot find any evidence at this point in time as to the cause. The official line by the registry about DIPG is, “Currently, there is no evidence that DIPG is caused by any environmental factor, such as exposure to chemicals or radiation. There is also no evidence that specific inherited genetic variations contribute to DIPG.” Compounding the frustration, the South Carolina Department of Health and Environmental Control states, “The results of the Community Cancer Assessments (CCA) conducted for children ages (0-19) and the population at large for the Mt. Pleasant area, using the Centers for Disease Control and Prevention guidelines, do not indicate a cancer cluster.” While the cause of glioblastoma and DIPG are unknown, researchers do know of other cancers associated with environmental exposure. Smoking, obesity and alcohol use are important environmental factors and are usually highlighted. We decided to focus on other causes and took an extensive excerpt from the booklet, Cancer and the Environment: What You Need to Know; What You Can Do, by the National Institutes of Health. Toxins from fungi – Aflatoxins are cancer-causing substances produced by certain types of fungi growing on food. Grains and peanuts are the most common foods on which these fungi grow. Meat, eggs, and milk from animals that eat aflatoxin-contaminated feed are other sources of exposure. Agricultural workers are potentially at risk if they inhale contaminated airborne grain dust. Exposure to high levels of aflatoxins increases the risk of liver cancer. Peanuts are screened for aflatoxin in most countries, including the United States, before processing. The risk of aflatoxin exposure is higher in developing countries where there is no screening for the fungus. Pesticides – Of the nearly 900 active ingredients in registered pesticides in the United States, about 20 have been found to be carcinogenic in animals, although not all have been tested. In the United States, a number of pesticides have been banned or their use has been restricted. These include ethylene oxide, amitrole, some chlorophenoxy herbicides, DDT, dimethylhydrazine, hexachlorobenzene, hexamethylphosphoramide, chlordecone, lead acetate, lindane, mirex, nitrofen, and toxaphene. Studies of people with high exposures to pesticides, such as farmers, pesticide applicators, crop duster pilots, and manufacturers, have found high rates of blood and lymphatic system cancers, cancers of the lip, stomach, lung, brain, and prostate, as well as melanoma and other skin cancers. So far, human studies do not allow researchers to sort out exactly which pesticides are linked to which cancers. Therefore, most of these pesticides are still listed in the Report on Carcinogens as likely to be cancer-causing, rather than as known carcinogens. Solvents – Several solvents used in paint thinners, paint and grease removers, and in the dry cleaning industry are known or suspected of being cancer-causing in animal studies. These include benzene, carbon tetrachloride, chloroform, dichloromethane (methylene chloride), tetrachloroethylene, and trichloroethylene. Human studies are suggestive, but not conclusive, except for benzene. Therefore, with the exception of benzene, these substances are listed as likely to be cancer-causing in humans. Benzene is known to cause leukemia in humans. It has widespread use as a solvent in the chemical and drug industries and as a gasoline component. After 1997, its use as an ingredient in pesticides was banned. Workers employed in the petrochemical industry, pharmaceutical industry, leather industry, rubber industry, gas stations, and in the transportation industry are exposed to benzene. Inhaling contaminated air is the primary method of exposure. Because benzene is present in gasoline, air contamination occurs around gas stations and in congested areas with automobile exhaust. It is also present in cigarette smoke. It is estimated that half of the exposure to benzene in the United States is from cigarette smoking. About half of the U.S. population is exposed to benzene from industrial sources, and virtually everyone in the country is exposed to benzene in gasoline. Fibers, fine particles, and dust – Exposures to various fibers, fine particles, and dust occur in several industrial settings and are associated with increased cancer risks. Exposure can also occur in nonindustrial settings. Asbestos fibers and all commercial forms of asbestos are human carcinogens. Increased rates of mesothelioma, a rare cancer of the lining of the lung and abdominal cavity, and cancer of the lung have been consistently observed in a variety of occupations involving asbestos exposure. Asbestos exposures account for the largest percent of occupational cancer, with the greatest risks among workers who smoke. Asbestos fibers are released into the environment from the use and deterioration of more than 5,000 asbestos products, including roofing, thermal, and electrical insulation; cement pipe and sheet; flooring; gaskets; plastics; and textile and paper products. Workers in asbestos insulation, brake maintenance and repair, and building demolition jobs are exposed to high levels of asbestos. The entire population may have been exposed to some degree because asbestos has been so widely used. Because the use of asbestos has been greatly restricted in the United States, exposure to the general population has decreased. Nonetheless, workers employed in construction trades, electricians, and carpenters can still experience high levels of asbestos exposures through renovations, repairs, and demolitions. Ceramic fibers are now used as insulation materials and are a replacement for asbestos. Because they can withstand high temperatures, they are used to line furnaces and kilns. These fibers cause lung cancer in experimental animals. Silica dusts are associated with an excess risk of lung cancer in humans and are found in industrial and occupational settings such as coal mines, mills, granite quarrying and processing, crushed stone and related industries, and sandblasting operations. Wood dust, associated with cancers of the nasal cavities and sinuses, is a known carcinogen for unprotected workers who are exposed regularly from sanding operations and furniture manufacturing. Diesel exhaust particles – The particles in diesel exhaust are suspected of being carcinogens because of the elevated lung cancer rates found in occupational groups exposed to diesel exhaust, such as railroad workers, mine workers, bus garage workers, trucking company workers, car mechanics, and people who work around diesel generators. Cancer risks from lower exposures in day-to-day living are not known. Metals – Arsenic compounds are associated with many forms of skin, lung, bladder, kidney, and liver cancers, particularly when high levels are consumed in drinking water. In addition, occupational exposure to inhaled arsenic, especially in mining and copper smelting, has been consistently associated with an increased risk of lung cancer. Arsenic is also used in wood preservatives, glass, herbicides, insecticides (ant killers), and pesticides, and it is a general environmental contaminant of air, food, and water. Beryllium compounds are known to cause lung cancer based primarily on studies of workers in beryllium production facilities. These compounds are used as metals for aerospace and defense industries; for electrical components, X-ray tubes, nuclear weapons, aircraft brakes, rocket fuel additives, light aircraft construction, and the manufacture of ceramics; and as an additive to glass and plastics, dental applications, and golf clubs. Industry is also increasingly using beryllium for fiber optics and cellular network communication systems. Workers can be exposed through jobs related to the above activities, as well as through recycling of computers, cell phones, and other high-tech products. Outside of these industries, beryllium exposure occurs primarily through the burning of coal and fuel oil. The general population can be exposed to trace amounts of beryllium by inhaling air and consuming food contaminated with beryllium residues. Small concentrations have been reported in drinking water, food, and tobacco. Studies of groups of workers show that cadmium metal and cadmium compounds are associated with an increased risk of lung cancer. Workers with the highest exposures are those involved in removing zinc and lead from minerals, producing cadmium powders, welding cadmium-coated steel, and working with solders that contain cadmium. Cadmium metal is primarily used to coat metals to prevent corrosion. Other uses are in plastic and synthetic products, in batteries, as stabilizers for polyvinyl chloride, and in fungicides. The industrial processes involved in making these products release cadmium into the air, surface water, ground water, and topsoil where it can be taken up by both land and water plants and, in turn, transferred to animals. Contaminated topsoil that allows uptake into tobacco plants may be indirectly responsible for the greatest nonoccupational human exposure to cadmium – smoking. Food is the main source of human exposure to cadmium for nonsmokers. Some chromium compounds are known to cause lung cancer. The steel industry is the major consumer of chromium. It is used for protection against corrosion of metal accessories, including automotive parts, as well as for electroplating, layering one metal over another. Electroplating converts chromium 6, the carcinogenic form, to a noncarcinogenic form of chromium. This means that workers who handle chromium 6 are at greater risk than the general population. Other uses include nuclear and high-temperature research; the textile and leather-tanning industry; pigments for floor covering products, paper, cement, and asphalt roofing; and creating an emerald color in colored glass. Chromium is widely distributed in the air, water, soil, and food, and the entire population is probably exposed to some of these compounds. The highest exposure occurs in occupations related to stainless steel production, welding, chrome plating, and leather tanning. Typical levels in most fresh foods are low. Lead acetate and lead phosphate are likely to be human carcinogens based on the evidence of kidney and brain tumors in animal studies. Lead acetate is used in cotton dyes; as a coating for metals; as a drier in paints, varnishes, and pigment inks; as a colorant in certain permanent hair dyes (progressive dyes); in explosives; and in washes to treat poison ivy. Lead phosphate is used as a stabilizer in certain plastics and specialty glass. Primary exposures are through skin contact, eating, and inhaling. Nickel and nickel compounds are associated with several kinds of cancers in rats and mice. Studies in human populations link nickel exposure to cancers of the nasal cavity, lung, and possibly the larynx (voice box). Nickel is used in steel, dental fillings, copper and brass, permanent magnets, storage batteries, and glazes. Because nickel is present in the air, water, soil, food, and consumer products in the United States, we are exposed through eating, breathing, and skin contact. Ionizing radiation – Ionizing radiation is invisible, high-frequency radiation that can damage the DNA or genes inside the body. Everyone is exposed to very small doses of ionizing radiation from cosmic rays (rays that enter the earth’s atmosphere from outer space). Radiation from this source may account for a very small percentage (about 1 percent) of our total cancer risk. Some homes have elevated levels of radon, a naturally occurring radioactive gas found at low levels in most soil. Radon is produced by the breakdown of uranium, which naturally releases low levels of ionizing radiation. Higher levels of radon can be found in certain types of rocky soil. The health effects of radon were first seen in the elevated levels of lung cancer found in underground uranium miners in the United States and around the world. Radon gas seeps into homes from the surrounding soil through cracks and other openings in the foundation. About 1 out of 20 homes has elevated levels of radon. Even though the cancer risks for radon exposure in the home are much lower than for radon-exposed miners, it is estimated that about 20,000 lung cancer deaths every year are caused by radon exposure in homes. There are various strategies for reducing residential radon exposure. Another source of ionizing radiation is the radioactive substances released by atomic bombs or nuclear weapons known as “fallout.” The doses of ionizing radiation received by the atomic bomb survivors in Japan resulted in increased risks of leukemia and cancers of the breast, thyroid, lung, stomach, and other organs. Radioactive substances were also released in the aboveground atomic bomb testing conducted by the U.S. Government in the late 1950s and early 1960s in Nevada. People exposed, especially as children, to one radioactive form of iodine, called Iodine-131 or I-131, which collects in the thyroid gland, may have an increased risk of thyroid disease, including thyroid cancer. Ultraviolet radiation – Ultraviolet (UV) radiation from the sun, sunlamps, or tanning beds causes premature aging of the skin and DNA damage that can lead to melanoma and other forms of skin cancer. The incidence of skin cancers is rapidly increasing. Dioxins – Dioxins are unwanted byproducts of chemical processes that contain chlorine and hydrocarbons (substances that contain both hydrogen and carbon). There are at least 100 different kinds of dioxins. They are not intentionally manufactured by industry. They are produced by paper and pulp bleaching; incineration of municipal, toxic, and hospital wastes; certain electrical fires; and smelters (plants where metal is extracted from ores). They are also found as a contaminant in some insecticides, herbicides, and wood preservatives. Dioxins are widespread environmental contaminants. They accumulate in fats and break down slowly. A particular dioxin that is likely to be carcinogenic to humans is called TCDD (2,3,7,8-tetrachlorodibenzo-pdioxin). TCDD is highly carcinogenic in animals, and, in highly exposed workers, increased overall cancer death rates have been reported. Fortunately, modifications of industrial processes such as bleaching and incineration have resulted in reduced dioxin emissions and have lowered dioxin levels in people. The general population is exposed to low levels of TCDD primarily from eating dairy products, fish, and meat, including poultry. Polycyclic aromatic hydrocarbons (PAHs) – A number of studies show increased incidence of cancer (lung, skin, and urinary cancers) in humans exposed to mixtures of polycyclic aromatic hydrocarbons (PAHs). The primary source of PAHs is from burning carbon-containing compounds. PAHs in air are produced by burning wood and fuel for homes. They are also contained in gasoline and diesel exhaust, soot, co*ke, cigar and cigarette smoke, and charcoal-broiled foods. In addition, they are the byproducts of open fires, waste incinerators, coal gasification, and co*ke oven emissions. Foods that contain small amounts of PAHs include smoked, barbecued, or charcoal-broiled foods, roasted coffees, and sausages. Vinyl chloride – Vinyl chloride, a colorless gas, is a human carcinogen associated with lung cancers and angiosarcomas (blood vessel tumors) of the liver and brain. It is used almost exclusively in the United States by the plastics industry in manufacturing many consumer products, including containers, wrapping film, electrical insulation, water and drain pipes, hosing, flooring, windows, and credit cards. Human exposure can occur primarily in workers in the plastic industry, not by using the end products such as vinyl siding or hosing. The major source of releases of vinyl chloride into the environment is believed to be from the plastics industries. People living near a plastics plant are exposed by breathing contaminated air, but the exposure of the general population away from the plant is essentially zero. Benzidine – Benzidine was one of the first chemicals recognized as being associated with increased cancer risk in humans. As early as 1921, increased cases of bladder cancer were reported to be associated with benzidine, a compound used in the production of more than 250 benzidine-based dyes for textiles, paper, and leather products. Human exposure to either benzidine or benzidine-based dyes is now known to be carcinogenic. The dyes break down into benzidine once inside the body. In most cases, dyes that metabolize to benzidine are hazards only in the vicinity of dye and pigment plants where wastes may escape or be discharged. W. Jean Dodds, DVMHemopet / NutriScan11561 Salinaz AvenueGarden Grove, CA 92843 References Background & Mission. DIPG Registry, http://www.dipgregistry.org/about/background-mission/. “Cancer and the Environment: What You Need to Know; What You Can Do.” National Institutes of Health, http://www.niehs.nih.gov/health/materials/cancer_and_the_environment_508.pdf. Dodds, W. Jean, and Diana Laverdure.Canine Nutrigenomics: The New Science of Feeding Your Dog for Optimum Health. Dogwise Publishing, 2015. Glioblastoma Causes. Moffitt Cancer Center, http://www.moffitt.org/cancers/glioblastoma/causes/. Heaton, Alex. “11 People Diagnosed with Rare Brain Tumor Live within Miles of Each Other.”WCIV, 26 June 2017, http://www.abcnews4.com/news/local/parents-of-kids-with-rare-brain-cancer-believe-mount-pleasant-cases-are-rising-linked. Longman, Jeré. “The Brain Cancer That Keeps Killing Baseball Players.”The New York Times, The New York Times, 14 Aug. 2017, http://www.nytimes.com/2017/08/14/sports/baseball/brain-cancer-phillies-daulton.html. Ostrom, Quinn T.Epidemiology of Glioma. The National Academies of Science, Engineering & Medicine, 30 Nov. 2017, http://www.nationalacademies.org/hmd/~/media/Files/Activity%20Files/Veterans/EleventhUpdate/Ostrom_Epidemiology%20of%20Glioma.pdf?la=en+.A Digression…
Back to the Topic at Hand…South Carolina and Brain Cancer
Other Environmental Causes of Cancers
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