Two Boys From Brooklyn

by: Ronald B. Herberman, MD, Director, UPCI and UPMC Cancer Centers

My older brother Harvey and I mostly grew up in Brooklyn, New York, where coal heated and lighted our apartment buildings. For a few years, we also lived in the San Fernando Valley of California, where we played in pesticide-sprayed fields. Both of us Brooklyn boys became physicians at a time when premed and medical students routinely worked in laboratories without protective equipment or fans, using various preservatives and cleaning compounds like formaldehyde, urethane, acrylamide, and benzene—compounds now known to cause cancer. (1)

I am the shorter of the two boys seen in this wintertime photo of Cropsey Avenue Park in the Bensonhurst section of Brooklyn, where in warmer seasons we built and crashed model airplanes.

My interest in cancer spans more than four decades, beginning when I first conducted research as a young medical student at New York University in 1961. Recent events have made that interest much more personal. Even though not a single one of our relatives before or since has developed the disease, Harvey and I each came down with chronic lymphocytic leukemia (CLL) —a cancer of one component of the immune system, B lymphocytes, that is usually asymptomatic or slowly progressive in older adults. (2) Harvey died a year and a half ago from complications associated with a somewhat related type of cancer of the immune system, Hodgkin’s lymphoma. Fortunately, I remain in good health more than five years after my diagnosis. When two members of the same family develop the same disease at similar ages and there is no record of other such cases in the family, one has to ask whether this was just a coincidence. Is it possible that something that happened to us as we were growing up could explain why we each developed the same illness?

Science can only occasionally answer the question of why two members of the same family develop the same tumor. We know that the chances any person in the entire country will have CLL are about 1 in a million per year. (3) So, unless there is an inherited risk of the disease, the odds that two brothers will come down with the same form of the disease are about 1 in a billion. Perhaps there is something about the job of becoming a physician that actually increases the chance the disease will develop. Maybe something else in our early environment played a role. Scientists combine information from experiments with animals and also study patterns of cancer in groups with distinct exposures to identify factors that cause cancer. But, determining whether what happened to Harvey and me was just a random coincidence or something else is not easily resolved.

From studies of highly exposed workers, we know that more than fifty different industrial exposures—including asbestos, vinyl chloride and cadmium—cause cancer in humans. (1) Each one of these known human cancer causes also produces cancer in animals when adequately studied. (4) For this reason, a number of national and international policy groups consider that evidence for an agent causing cancer in experimental animals serves as an indication that this same agent may increase cancer risk in humans. At this time, there are more than 400 different chemicals proven to induce cancer in experimental animals.

What about complex childhood or young adult exposures, whether pesticides or coal smoke or the solvents in airplane glue, like those my brother and I went through? People who work with certain solvents and some pesticides are at increased risk of CLL. (5) Modern life truly is a mixture, and science also has shown that children are not simply tiny adults. Whether animal or human, for all mammals, susceptibility to a toxic condition is much greater at those times when cells grow most rapidly and immune systems are less mature. Experimental and public health studies show that exposures to chemicals or radiation that take place during pregnancy affect the chances that cancer and other diseases will occur years later. Infants, whose mothers were irradiated or took certain hormones early in pregnancy, have higher rates of either childhood leukemia or reproductive defects as young adults. Children, whose parents work with some pesticides or solvents before conception or during pregnancy, are more likely to develop childhood cancer. (6)

Exposures that occur after birth and during early childhood can also be especially important determinants of adult health. The brain doubles in the first years of life. (7) The faster cells are growing, the greater the chance they can be damaged and pass that damage on. The skull does not reach its adult thickness until high school age—something that many parents instinctively understand. This means that the rapidly growing and not fully protected brains of children can be more sensitive to a variety of toxic exposures.

Because a recent report from French Telecom researchers indicates that electromagnetic fields from cell phones penetrate the brains of children more than adults, our Cancer Institute recently joined with national authorities and expert advisors in England, France, Sweden, India, Israel, and Germany in advising that children only use cell phones for emergencies. (8) In addition, we have recommended several simple precautions to reduce exposure to all cell phone users from direct bodily contact. We make these recommendations based on a review of experimental evidence and on some preliminary reports that cell signals can lower sperm counts, alter blood chemistry, and possibly increase the risk of brain tumors and cause other damage to the body. We believe that it is important to reduce exposures because we understand the unique vulnerability of the young and are concerned about the possible risks to all cell phone users from long term, frequent use of cell phones directly held against the ear or other parts of the body.

Because of actions long-delayed and finally taken to discourage it, smoking related cancers are declining. (9) The recent major funding by the Gates and Blumberg Foundations of more programs to discourage smoking is a welcome advance. But, several types of cancers not tied with smoking continue to increase and efforts to identify and prevent the use and exposure of things that cause them remain poorly funded. The National Cancer Institute reports that most cases of cancer are not inherited. (10) So efforts to identify preventable causes of the disease should receive much higher priority.

In truth, the capacity to study the environment is limited by three fundamental challenges. First of all, the environment presents a messy and complicated array of factors, many of which are not well described or measured. Second, people seldom are aware of all the potentially important environmental exposures they have undergone in their lifetimes. Finally, public resources to study these questions are more limited today than at any other time in recent history.

Recognizing the importance of basic research to identify and control avoidable causes of cancer, UPCI established the Center for Environmental Oncology to provide a focused set of research activities that would address environmental contributions to the growing importance of cancers not explained by tobacco. We have been pleased by the broad acceptance of the Center’s efforts to date, including our warnings about the need for taking precautions with cell phones and appropriate use of diagnostic radiation in children. These efforts have been entirely supported by Pittsburgh’s generous philanthropic community and by our colleagues at Magee-Womens Hospital of UPMC and others throughout our institution. We are especially delighted that our developing program is joined by a distinguished group of international experts in various aspects of environmental oncology, and we are gratified to learn that a number of countries share in these concerns. Elmer Huerta, MD, President of the American Cancer Society, has also recently provided notice of the need to take precautions in the use of cell phones throughout Latin America through his blog and appearances on radio and television, including CNN Spanish.

Working with colleagues from around the world, the Center brings together basic researchers, epidemiologists, engineers, and educators all of whom share a commitment to learning how daily life affects our health. With officials throughout UPMC, we are also working to translate what we know about health risks—ranging from the well-understood dangers of tobacco, overeating, and excessive use of diagnostic radiation—to the need to reduce reliance on industrial hazards like asbestos and heavy metals and promote the use of safer, less toxic materials throughout the health care system. I trust that the Center’s motto—helping to make prevention the cure for cancer—will resonate strongly with all of you.

Questions about the links between the environment and cancer are capturing the interest of growing numbers of researchers around the world, including the President’s Cancer Panel. We established the Center for Environmental Oncology at Pittsburgh precisely because we recognized the need to improve our ability to predict and prevent cancer for ourselves, our children and grandchildren—a need that growing numbers of international groups are endorsing.

References

1. International Agency for Research on Cancer (IARC). “Agents Reviewed by the IARC Monographs: Volumes 1-99.” (2008). Available at: http://monographs.iarc.fr/ENG/Classification/Listagentsalphorder.pdf.
2. American Cancer Society. “What Is Chronic Lymphocytic Leukemia?” Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_Is_Chronic_Lym....
3. Surveillance Epidemiology and End Results (SEER) Database. “Chronic Lymphocytic Leukemia.” Available at: http://seer.cancer.gov/statfacts/html/clyl.html?statfacts_page=clyl.html....
4. IARC. “Scientific Review and Evaluation: Studies of cancer in experimental animals.” (2006). Available at: http://monographs.iarc.fr/ENG/Preamble/currentb3studiesanimals0706.php
5. ACS. “What Are the Risk Factors for Chronic Lymphocytic Leukemia?” Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_Are_the_Risk_F....
6. The Breast Cancer Fund. “State of the Evidence 2008.” Available at: http://www.breastcancerfund.org/site/pp.asp?c=kwKXLdPaE&b=206137
7. Gale C, Walton S, Martyn C. Foetal and postnatal head growth and risk of cognitive decline in old age. Brain. 126(10):2273-2278, October 2003.
8. Wiart J, Hadjem A, Wong M, Bloch I. Analysis of RF exposure in the head tissues of children and adults. Phys. Med. Biol. 53 (2008).
9. University of Pittsburgh Cancer Institute (UPCI). “The Case for Precaution in the Use of Cell Phones.” July 2008. Available at: http://www.environmentaloncology.org/node/201.
10. National Cancer Institute (NCI). “Understanding Cancer Series: Cancer: Most Cancer Is NOT Inherited.” (2006). Available at: http://www.cancer.gov/cancertopics/understandingcancer/genetesting/Slide....