Childhood Leukemia: An Ounce of Prevention

Written by Mark Miller MD, MPH; Catherine Metayer, MD, PhD; and Gary Dahl, MD

Mark Miller, MD, MPH
Catherine Metayer, MD, PhD

This post was originally published on the website of Physicians for Social Responsibility. It is posted here with permission of the authors. CHE is hosting a teleconference call on January 22nd on this topic as part of the launch of A Story of Health. The call features Dr. Miller and Dr. Metayer, the first two authors of this post.

The nearly miraculous news is that great strides have been made in the treatment of childhood acute lymphocytic leukemia, and now nearly 90% of children are cured. The dark side, however, is that the incidence of childhood leukemia (age 0-14 years) in the United States has increased an average of 0.7 percent per year since 1975.[1] During the 35 years between 1975 and 2011, there has been a 55% increase in the number of children diagnosed annually (per capita, age adjusted) with this most common form of cancer in childhood. Though a cure is now expected for most children, side effects both short and long-term and secondary cancers later in life are common. The emotional and financial costs for these children and families is considerable.

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A Story of Health Launches

written by Elise Miller, MEd
Director

If your holidays were like mine, you gathered with extended family to celebrate. Mixed with the sharing of good cheer, you may have also learned that your cousin has been suffering severe asthma attacks or your young niece was diagnosed with childhood leukemia or your grandson is having difficulty learning and relating to peers. Unfortunately, these stories seem to be woven more thickly into the fabric of our family conversations as various chronic health challenges increasingly dominate the landscape of our lives.

Why is this happening? Are there actions we can take as individuals and as a society so that we more often get to share stories of good health with our family and friends, rather than so many about chronic disease and disability?

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Top 10 Selections: 4th quarter 2014

We present CHE’s picks of the most important environmental health stories from the last quarter of 2014.

  1. Air pollution and autism
    A growing body of evidence implicates air toxics as potential contributors to autism spectrum disorders, with four studies published in rapid succession this quarter:

    1. Environmental chemical exposures and autism spectrum disorders: a review of the epidemiological evidence.
    2. University of Pittsburgh study correlates autism with air pollution: Preliminary results from the study show that children with autism spectrum disorders were more likely to have been exposed to higher levels of certain air toxics during their mothers’ pregnancies and their first two years of life compared with children without the condition. The study: The association of national air toxics assessment exposures and the risk of childhood autism spectrum disorder: a case control study.
    3. Air pollution exposure in pregnancy linked to autism in study: Women who are exposed to high levels of air pollution during their third trimester of pregnancy may be twice as likely to have an autistic child. The study: Autism spectrum disorder and particulate matter air pollution before, during, and after pregnancy: a nested case–control analysis within the Nurses’ Health Study II cohort.
    4. Fourth study finds traffic pollution may cause autism: The more traffic pollution a pregnant woman is exposed to — especially during her third trimester — the greater chance her child will develop autism. The study: In utero exposure to toxic air pollutants and risk of childhood autism.
  2. Phthalates’ effects on health
    A proposed rule by the Consumer Product Safety Commission was mandated by the Consumer Product Safety Improvement Act of 2008 and is now open for public comment: Prohibition of children’s toys and child care articles containing specified phthalates. Research continues to bring fuller understanding of the potential for harm from several phthalates:

    1. Prenatal exposure to household chemical linked to reduced IQ, study says: Children who were exposed in utero to high levels of phthalates went on to have lower IQ levels than their peers who were exposed to lower levels, a new study from the Mailman School of Public Health at Columbia University found. The study: Persistent associations between maternal prenatal exposure to phthalates on child IQ at age 7 years.
    2. A birth cohort study to investigate the association between prenatal phthalate and bisphenol A exposures and fetal markers of metabolic dysfunction: Associations between maternal exposure to chemicals and markers of metabolic function appear potentially to be sex specific.
    3. Plastics chemical linked to changes in boys’ genitals: Boys exposed in the womb to high levels of a chemical found in vinyl products are born with slightly altered genital development, according to research published today. The study of nearly 200 Swedish babies is the first to link the chemical di-isononyl phthalate (DiNP) to changes in the development of the human male reproductive tract. The study: Prenatal phthalate exposures and anogenital distance in Swedish boys.
    4. How household plastics could ruin your sex life: Phthalates are being linked to, among other things, a decrease in libido in women. The study: Environmental exposure to di-2-ethylhexyl phthalate is associated with low interest in sexual activity in premenopausal women.
  3. Sugar and other sweeteners
    The impact of sugar and other sweeteners on health has been getting more attention lately. In addition to the launch of SugarScience, a new website touted as an authoritative source for evidence-based, scientific information about sugar and its impact on health, the nation’s first soda tax passed in Berkeley, California. Proponents of the tax say it will curb the consumption of sodas, energy drinks and sweetened teas which are contributing to the country’s obesity epidemic and Type 2 diabetes. Meanwhile, research is uncovering health effects of sugar and other sweeteners that go beyond obesity and diabetes:

    1. This is your teenager’s brain on soda: Researchers at the University of Southern California recently published a study showing a connection between sugar consumption and memory problems. The study: Effects of sucrose and high fructose corn syrup consumption on spatial memory function and hippocampal neuroinflammation in adolescent rats.
    2. Intake of energy-dense foods, fast foods, sugary drinks, and breast cancer risk in African American and European American women.
    3. Soda and cell aging: associations between sugar-sweetened beverage consumption and leukocyte telomere length in healthy adults from the National Health and Nutrition Examination Surveys.
  4. Climate change
    The biggest climate story this quarter was that the US and China announced important new actions to reduce carbon pollution. The Climate Change 2014: Synthesis Report from the Intergovernmental Panel on Climate Change also reiterated that the situation requires immediate and substantial action or the Earth will face “further warming and long-lasting changes in all components of the climate system, increasing the likelihood of severe, pervasive and irreversible impacts for people and ecosystems.” While the connection to human health is not always mentioned in reports on climate change, the health impacts are substantial. For example, in Chemically mediated behavior of recruiting corals and fishes: a tipping point that may limit reef recovery, there’s an understated repercussion of the loss of reefs: devastating impacts on sources of food, and especially protein, for much of the world’s human population. Other stories highlighting other aspects of climate change include these:

    1. From bar fights to wars, climate change will make us more violent: The hotter it gets, the more likely we are to kill each other. Murder rates go up in heat waves; in some countries, civil war is also more likely. In training exercises in hot weather, police are more likely to pull out a gun and fire. The paper: Climate and conflict.
    2. Climate change affects national security: After close examination of the science, the Military Advisory Board, a group of 16 retired flag-level officers, conclude that, “The national security risks of projected climate change are as serious as any challenges we have faced.”
  5. NY health and environmental chiefs: no to fracking
    New York Governor Andrew Cuomo’s administration has moved to prohibit fracking in the state, citing unresolved health issues and dubious economic benefits of the widely used gas-drilling technique. This is the first US state to take such a stand. The report from the New York State Department of Health: A Public Health Review of High Volume Hydraulic Fracturing for Shale Gas Development and another recent report: Warning Signs: Toxic Air Pollution Identified at Oil and Gas Sites.
  6. BPA and its replacements
    While more research mounts on health concerns from exposure to BPA, the Food and Drug Administration maintains that “the available information continues to support the safety of BPA for the currently approved uses in food containers and packaging”, as reported in Bisphenol A is safe for approved uses in food containers, packaging, FDA says. In a conflicting decision, a California court upheld the state scientists’ finding that BPA is known to cause reproductive health problems: Court upholds BPA health warning. Recent research on BPA and replacements include these studies:

    1. Kids exposed to BPA before birth at risk of wheeze: study: Young kids who were exposed to Bisphenol A before birth are more likely than others to have a wheeze before age five, according to a new study that found no connection to BPA exposure after birth.The study: Bisphenol A exposure and the development of wheeze and lung function in children through age 5 years.
    2. Prenatal bisphenol A exposure and maternally reported behavior in boys and girls: These results suggest that prenatal exposure to BPA may be related to increased behavior problems in school age boys, but not girls.
    3. The leaching of BPA into skin from cash receipts is enhanced by using sanitizers: Touching cash register receipts while using sanitizers can dramatically increase your body’s absorption of BPA, researchers report. The study: Holding thermal receipt paper and eating food after using hand sanitizer results in high serum bioactive and urine total levels of bisphenol A (BPA).
    4. BPA exposure by infants may increase later risk of food intolerance: This research involving rats suggests that early life exposure at a dose significantly below the current human safety limit set by the FDA affects developing immune systems, predisposing offspring to food intolerance in adulthood. The study: Food intolerance at adulthood after perinatal exposure to the endocrine disruptor bisphenol A.
    5. That takeout coffee cup may be messing with your hormones: A new study suggests that whole classes of BPA-free plastics — including the kind in styrofoam — release estrogenic chemicals. The study: Estrogenic chemicals often leach from BPA-free plastic products that are replacements for BPA-containing polycarbonate products.
  7. New study charts the fate of chemicals affecting health and the environment
    In a new study, Rolf Halden, PhD, a researcher at Arizona State University’s Biodesign Institute, examines the trajectory of chemicals appearing as emergent threats to human or environmental health. His research offers a highly instructive analysis of how long it takes chemicals of concern to become recognized and acted on — and why. The review: Epistemology of contaminants of emerging concern and literature meta-analysis.
  8. 16 major companies and agencies say no to chemical flame retardants
    The Center for Environmental Health, which helped encourage a rewrite of California’s regulations regarding safety standards in furniture manufacturing, announced in mid December that 16 major furniture manufacturers have now “sworn off” chemical flame retardants. This is a prime example of how environmental health science can be effectively translated into regulations that better protect health. The CEH press release including the list: Major producers eliminating flame retardant chemicals as major buyers are demanding flame retardant-free furniture.
  9. National Institutes of Health ends longitudinal children’s study
    The US National Institutes of Health has cancelled its plan for an ambitious, multi-decade study of environmental influences on children’s health known as the National Children’s Study, agency director Francis Collins announced on December 12th. The study was originally approved by a bipartisan Congress in 2000 but was fraught with scientific and political challenges over the last 14 years. See also an analysis: How the US government botched its multibillion-dollar plan to beat childhood disease.
  10. Theo Colborn: Honoring the work of an environmental health giant
    Theo Colborn, PhD, passed away on December 14th at age 87, leaving an extraordinary legacy of careful and determined environmental health research and advocacy. She was particularly recognized for her seminal work on endocrine disrupting chemicals and fracking.

    1. A brief biography by Elizabeth Grossman.
    2. Theo’s CV.
    3. Comments and stories from those who knew Theo.
    4. Remembering the genius who got BPA out of your water bottles, and so much more, one of many media reports on Theo’s death.

Cancer, Stem Cells, and Bad Luck

written by Ted Schettler, MD, MPH
Science Director

Ted SchettlerThe new year got off to a fast start in cancer-related research with a paper published in the January 2nd issue of the prestigious journal Science titled “Variation in cancer risk among tissues can be explained by the number of stem cell divisions”, co-authored by C. Tomasetti and B. Vogelstein of Johns Hopkins University.  The authors “show that the lifetime risk of cancers of many different types is strongly correlated (0.81) with the total number of divisions of the normal self-renewing cells [stem cells] maintaining that tissue’s homeostasis.”

They based this conclusion on a comparison of lifetime risk of cancer in various tissues (expressed logarithmically) with an estimate of total lifetime stem cell divisions in those tissues for which there is some agreement about stem cell mass and dynamics. Breast and prostate cancers were not included because of lack of consensus around stem cell properties.

The paper says they included 31 tissue types, but actually it was fewer since the authors double counted lung, liver, head and neck, duodenum, and colorectal, each of which they evaluated with and without known links to cancer (smoking, hepatitis C virus, human papillomavirus, and familial adenomatous polyposis, respectively). For the tissues evaluated, the correlation between lifetime cancer risk and total number of stem cell divisions was quite strong. And, by separating smokers from non-smokers, the analysis clearly shows that lifetime lung cancer risk is much higher in smokers, assuming a similar number of lung stem cell divisions in the two groups. So far so good.

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