From fast food packaging with a grease-proof coating to cleaning products used in schools and daycares, chemicals are ubiquitous in modern life. In “A New War on Cancer: The Unlikely Heroes Revolutionizing Prevention,” environmental health journalist Kristina Marusic profiles doctors, researchers, and other advocates working in their respective fields to protect the public from chemicals in the environment that increase cancer risk. Marusic weaves the story of a cancer survivor through these examples of cancer prevention.
The Allegheny Front’s Kara Holsopple spoke with Kristina Marusic about the book.
LISTEN to their conversation
Kara Holsopple: You write that rates for certain types of cancer are up, and maybe most worryingly, for children. In the last 50 years, rates of childhood leukemia have increased by 35%. And this rise can’t be explained by genetics because it’s been very quick, or entirely by better disease diagnosis. Why should we look towards chemicals?
Kristina Marusic: One thing that has changed in the last 50 years is the number of chemicals that kids are exposed to on a daily basis and the number that the rest of us are exposed to too. In the last approximately 100 years, about 300,000 new manufactured chemicals have been invented. A lot of them are really helpful and have improved our lives in myriad ways, but most of them also never have been tested for safety. Among those that have been tested and have been found harmful, most of those are still on the market.
In the last 50 years, the United States has only removed five chemicals from U.S. markets because they’re found to be harmful.
In the last 50 years, the United States has only removed five chemicals from U.S. markets because they’re found to be harmful. And there are lots of carcinogens that we know are in the marketplace and in our products and in our food and water. That is the main thing that has shifted in the last 50 years while we’ve been watching these childhood cancer rates climb.
Kara Holsopple: This book is called “A New War on Cancer.” Why has the war on cancer thus far focused on treatments and a cure rather than on prevention?
Kristina Marusic: There are two main reasons for this, and the first one is money. There are huge market incentives for cancer treatments. The global oncology market is valued at around $330 billion right now, and that’s projected to grow to about $580 billion in 2050. Unfortunately, there’s no similar market projection for cancer prevention. No one stands to get super rich preventing cancer. So a drive for prevention will have to come from other places outside of the market, namely laws and regulations.
The other reason is that it’s harder to advocate for prevention. When you’re advocating for a cure for cancer or for better treatments, it’s really easy to put the face of a little girl who’s battling cancer on a T-shirt and on a Facebook page, and people empathize and they want to pitch in and they want to help join the fight and help that person. Right?
But when we talk about prevention, it ends up being really data-heavy. It’s a lot of statistics about long-term trends in cancer rates. It’s the nature of prevention that you don’t get to know whose cancer you’ve prevented. You don’t get to meet the person whose life you saved, and you don’t get to hear from a family who you spared from the heartache of receiving a childhood cancer diagnosis or having to endure surgery and the treatment process.
That’s the reason my book features profiles of people who are advocating for cancer prevention. I really wanted to find a way to humanize this story and make it easier to kind of connect emotionally with the humans who are driving this shift.
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Kara Holsopple: Yeah, the book is really focused on people who are looking for solutions, and the chapters go through some of the pathways of exposure to chemicals that are associated with cancer risk. Who are some of the people you profiled?
Kristina Marusic: One chapter focuses on a researcher whose work is focused on racial disparities in exposure to chemicals through personal care products, so things like makeup, lotion and shampoo. Another chapter is focused on schools and daycares.
We’ve talked about childhood cancer, and a lot of these chemicals are unfortunately present in many of the places where kids work and play, especially when they’re outside of our homes. I talked with the director of the Children’s Environmental Health Network, a Washington, DC-based organization that is working really hard to make schools and daycares safer for kids and reduce these kinds of exposures.
I also spoke with the founder of the Healthy Building Network. That organization has for 20 years tried to reduce the number of cancer-causing chemicals that are used in the materials we use to build our homes and office buildings and schools and daycares, too. They really work through market pressure, which is fascinating. They do work at the legislative level too, but they’ve been really successful in pressuring companies like Home Depot to switch from dangerous building materials to safer options. Once a really big producer of those products is doing it, a lot of smaller companies kind of have to follow suit.
Kara Holsopple: You also write about B. Braun, which manufactures medical supplies, and has worked to replace certain chemicals in things like I.V. bags and catheters with alternatives. What are some of the chemicals in these supplies and their possible impacts on patients who are mostly sick people using these products? And how hard is it to find safer solutions?
Kristina Marusic: Most of the bags and tubing contain phthalates, like DEHP. That’s the main one. That stands for Di-(2-ethylhexyl) phthalate, and DEHP is an endocrine-disrupting compound so it can disrupt the body’s hormonal processes, and interfere with reproduction. There’s increasing evidence that these endocrine-disrupting compounds also play a role in hormone-influenced cancers, like breast cancer and testicular cancer.
Research has found that patients can receive pretty high doses of these compounds when they’re getting an I.V. and that those doses can have a negative impact on their health. For example, a 2021 study found that among patients being treated for breast cancer, those with higher markers of exposure to DEHP were more likely to relapse following treatment, and patients who had a certain genetic marker who had higher markers for DEHP exposure were also more likely to die following treatment.
[E]veryone I spoke with for this book said over and over, this problem is so big, we cannot shop our way out of it.
You mentioned B. Braun, which is actually based in eastern Pennsylvania. They’re a company that is trying to replace these chemicals in I.V. bags and catheters and trying to phase out all of these chemicals in their products. And that’s proving much harder than you would think. It’s not like a quick, easy switch. There are very elaborate systems to create these products.
Unfortunately, on the consumer end, it’s tough to pick a hospital, for example, that’s using I.V. bags that don’t include these chemicals. It’s certainly something you can ask about. But to be honest, most physicians aren’t aware of this and don’t recognize it as a problem. So there is a role to play by sustainability directors and some hospital systems have started doing advocacy work around this. There’s an organization of nurses that is advocating for safer chemicals in these kinds of products.
Kara Holsopple: When it comes to a cancer diagnosis, a lot of patients think, you know, what could I have done to prevent this? And from your perspective, after writing this book, where does individual choice come in?
Kristina Marusic: Individual lifestyle choices, which include things like not smoking and diet and exercise, and if you’re really thinking about these issues, maybe things like eating organic and trying to minimize your exposure to these chemicals in your everyday life – that stuff is all meaningful. It’s important, it matters. There are lots of reasons, in addition to lowering your cancer risk, to eat healthy and exercise and not smoke cigarettes.
But everyone I spoke with for this book said over and over, this problem is so big, we cannot shop our way out of it. We’re exposed to these compounds on such a constant basis that even people who literally have a Ph.D. in the subject matter, know that they can’t just shop carefully enough to protect themselves and their families from these chemicals altogether. The only way we’re going to achieve that is through systemic change.
I think that sometimes people can feel really empowered by focusing on those things in their individual lives that they can control. But that’s also a lot of responsibility and it can feel really overwhelming. I spoke with one oncologist for the book, Dr. Margaret Kripke, who said you can risk blaming the victim if you only focus on those choices and you don’t also talk about the systems that contribute to increased cancer risk.
She shared a story about meeting a young man who had made all the healthy choices. He was a long-distance runner. He ate clean and organic. He had never smoked, and he was confused and then furious when he got diagnosed with cancer. He’d been led to believe that this was something he could entirely control through those choices. He felt like he had been lied to.
[I]n the U.S., you can just put something on the market directly without testing. If it’s proven unsafe ten or 20 years later, we turn to big class action lawsuits.
So I think a better alternative would be encouraging people to make healthy lifestyle choices, while also acknowledging that there are lots of factors beyond our individual control that increase our cancer risk and then empowering people to advocate for a healthier world while teaching people how to push for systemic changes that would protect everybody.
Kara Holsopple: You mentioned there are a lot of chemicals out there that no one’s ever really looked at how they impact us. You write that many people assume chemicals are really closely regulated like food and drugs, and that’s not the case. What is the state of regulation and what are some strides that have been made in the right direction?
Kristina Marusic: Chemical policy in the United States is weaker than in many other countries right now. There are a lot of reasons for that. One big factor is that our regulatory agencies, including the Environmental Protection Agency, have been underfunded, under-resourced and understaffed for decades. So they just quite literally cannot keep up with the pace of the industries that develop and use new chemicals in their products. Another driving force is an aggressively anti-regulation agenda being advanced by Republicans in the United States.
The European Union isn’t perfect, but they have a number of really comprehensive regulations aimed at protecting people from cancer-causing chemicals that the U.S. could certainly emulate. This is a big simplification, but what happens right now is that the EU requires companies that want to introduce new chemicals to the market to prove that they’re safe before doing so. Whereas in the U.S., you can just put something on the market directly without testing. If it’s proven unsafe ten or 20 years later, we turn to big class action lawsuits.
We have lots of examples of this related to things like asbestos and Johnson and Johnson baby powder, and now also things like PFAS or forever chemicals. Sometimes those lawsuits eventually result in new laws, but a lot of times they just kind of stand in for them. And by the time we get to that point, the damage has already been done.
You asked about things that are promising. I do think there are some really good reasons to be hopeful right now. For the first time ever, the proposed federal Cancer Moonshot plan includes some references to prevention. In the past, they framed prevention as early detection, which is not actually prevention. It’s just trying to catch the disease earlier rather than stopping it from happening. So lots of people are pushing to expand those references to prevention in the Moonshot Plan even further and include a more explicit focus on the environment and reducing our exposure to these chemicals.
The current head of the EPA, Michael Regan, actually lost his first son to neuroblastoma, which is a very rare childhood cancer, when he was just 15 months old. So this is an issue that he is both passionate about and aware of. And actually, just two weeks ago, I was invited to Washington, DC by the EPA’s Office of Children’s Health Protection to talk to them about these issues and about childhood cancer risk specifically.
So we’re at a really unique moment in time right now, I think, where we’re poised to take meaningful action on this, and that makes it a really great time to get involved and join the fight.
Journalist Kristina Marusic is the author of “A New War on Cancer: The Unlikely Heroes Revolutionizing Prevention,” published by Island Press.