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The Lake Effect by Nancy Nichols

By the time the PCB problem was isolated in January 1976, the Illinois Environmental Protection Agency believed that Outboard Marine was delivering approximately nine to ten tons of PCBs to the harbor each day. The PCB content of the sludge at the bottom of the harbor ranged from 240,000 to 500,000 parts per million depending on when and where the sample was taken. That means that either one in two or one in four grains of sand or silt at the bottom of the harbor was not actually sand or silt, but was a PCB instead. page 43

Waukegan would take its turn on the national stage two years later, in 1984,when a U.S. Environmental Protection official, Rita Lavelle, was accused of secretly meeting with lakefront polluters in an effort to strike a cleanup deal that heavily favored industry… In the aftermath of the scandal, the full extent of Waukegan’s chemical contamination was revealed… Eventually, three separate Superfund sites, named after the 1980 federal legislation that allocated funds to clean them up, were designated in Waukegan. Two of the sites are adjacent to the lake… In addition, more than a dozen other sites form what federal and state regulators call an expanded study area, which stretches along the lakefront from one end of town to the other. These smaller sites contain the waste products from a tannery, a steel company, a paint factory, a pharmaceutical company, and a scrap yard. Together these sites contain not just PCBs, but an alphabet soup of pollutants. “Just about every chemical we know to be dangerous to human health is in one of those sites,” Says Margaret Quinn, a professor at the University of Massachusetts, Lowell, who specializes in human exposure assessment. In addition to PCBs, these chemicals include benzene and other volatile organic compounds, arsenic. lead, asbestos, polycyclic aromatic hydrocarbons (PAHs), dioxins, vinyl chloride, and ammonia. Various chemicals among these have been associated with reproductive diseases, learning and attention deficits in children, birth defects, immune system deficiencies, and some forms of cancer.

Was there a relationship between my sister’s cancer and the toxins of our childhood? My sister certainly thought so. And many other people have suspected, often correctly, that elements in their environment have had an effect on their health. Yet because of the long time it takes for a cancer to develop and because of relative mobility of our lives today, it can be challenging to establish a casual link between a disease and its origin.

pages 5 -6

“Ovaries are approximately three centimeters long by one and one-half centimeters wide by one centimeter thick,” writes Ethel Sloan in, “The Biology of Women.”… Whichever edition you consult will tell you that the ovary is about the size of an almond and that it produces the female hormone estrogen. During the monthly menstrual cycle, each ovary forces an egg through a wall of tissue and afterward repairs that rupture in a process called ovulation. “The ovary is no beauty,” writes Natalie Angier in “Woman: An Intimate Geography, “It is scarred and pitted, for each cycle of ovulation leaves behind a blemish where an egg follicle has been emptied of its contents. The older the woman, the more scarred her ovaries will be. It is this continual bursting and repairing–part and parcel of the ovarian life cycle–that makes the ovary vulnerable to cancer.

Scientists have long theorized that as cells multiply each month to repair the breach in the ovarian wall, more opportunities are created for mistakes in the DNA copying process, which in turn increases the chances of a malignant mutation. More ovulations, in other words, mean more chances for mistakes.

Risk factors for the disease therefore include never giving your ovaries a break by being pregnant or having a child. The other risk factor is having a close relative with the disease. That would be my sister, of course, and that would bring our story back home….

Doctors at this hospital and elsewhere have long speculated that there were significant environmental factors associated with ovarian cancer. The vagina provides a runway to the ovaries not simply for sperm but for many other substances as well. Significantly, women who have their tubes tied experience a lower rate of ovarian cancer than those who do not. Some have theorized that this may be because the pathways to the ovaries has been blocked, keeping outside agents at bay.

For example, some researchers have found a link between talcum powder and ovarian cancer–though several other studies have produced conflicting results. Some early forms of talcum may have contained asbestos and thus given researchers their positive findings. Indeed, at least one retrospective study found a much higher disease rate among women who used talc prior to 1960 than those who used is after–giving at least some credence to the idea that the use of asbestos-laden talc increases a woman’s risk of ovarian cancer.

My sister speculated that asbestos had contributed to her illness. A group of naturally occurring fibrous materials that are fire-resistant, asbestos has been thought to cause adverse health effects since the first century. Yet, as writer Paul Brodeur tells us in his book on asbestos, Outrageous Misconduct, its role in causing the disease asbestosis, a noncancerous condition in which the lungs scar so badly that they won’t expand and contract properly, was not well established in medical literature until the 1970s.

In the years before my sister died, when I was an editor for the Harvard Business Review, I worked on a piece written by Bill Sells, the man who had run the Johns-Manville plants in Waukegan in the early 1970s–a time when deaths from asbestosis and other asbestos-related diseases were beginning to occur in the workforce at an alarming rate. After noting that his job included the unenviable task of visiting his sick and dying employees at the local hospital, he offered this description of his first visit to the factory: “The plant lay at the back of a sprawling complex built in the 1920s. Its view of Lake Michigan was obscured by a landfill several stories high. A road wound through this mountain of asbestos-laden scrap, and as I drove through it for the first time I stopped to watch a bulldozer crush a 36-inch sewer pipe. A cloud of dust swirled around my car.” Inside the plant, he said, he found “asbestos-laden dust coating almost every visible surface.”

An EPA official charged with overseeing the cleanup of the Johns-Manville plant, Brad Bradley, has a similar recollection. Standing at the edge of the 350-acre Superfund site that overlooks Lake Michigan, Bradley recalled his first visit there in 1982. He remembers asking an asbestos expert where he thought they would find the fibers. “I think they are everywhere,” said the expert. Indeed, virtually anywhere on the site that Bradley scuffed the ground with his boot, he found the telltale fibers.

People are more likely to connect the fiber with asbestosis than with ovarian cancer. However, a thirty-year study of nearly two thousand women who worked with asbestos while manufacturing gas masks during World War II showed these women to be seven times more likely to die from ovarian cancer than a control group. My sister’s medical history seems to tell a different story, though, and the link between asbestos and ovarian cancer in general does not appear to be a strong one. The ovarian cancer specialist I saw at the clinic was quick to point out that my sister’s record indicated that her cancer was preceded by endometriosis.

The phrase “painful periods” does not begin to describe the torture that my mother and sister endured during menstruation. White and sweating, doubled over with pain, they retreated to the bed or the couch until the pain and the bleeding passed. When I recounted my mother’s experience, the ovarian cancer specialist suggests that my mother also likely suffered from endometriosis.

Endometriosis is a once rare disease that is now common. When the disease was first named and discovered in 1921 by a New York physician, there were only twenty reports of the illness in the medical literature. Today, the National Institutes of Health estimates that roughly 5.5 million women suffer from the disease in the United States, and as many as 89 million women may have it worldwide. An exact number is hard to come by, since the disease can only properly be diagnosed during surgery. Still, about one-third of women of childbearing age suffer some symptoms–including pelvic pain and infertility–and in the United States at least, the average age of onset has been declining…

Endometriosis is a complex condition, and no one is certain what causes it. Some scientists believe it is an immune system disorder. Others believe that women with endometriosis lack the ability to shed cells that have migrated and are growing where they should not be. Other scientists have focused on a genetic component of the disease since it can run in families. A woman with a sister or mother with endometriosis, for example, is three to seven times more likely to get the disease.

The mechanisms of endometriosis are not that different from those that create cancer: they involve cell proliferation, the migration of cells, and a change in their cellular nature. Endometriosis grows unchecked and invades surrounding tissues, and the body’s immune system fails to rid itself of the misplaced lesions. In the same way, the body fails to rid itself of cancerous lesions.

It is often but not always the case that the kind of cancer my sister suffered from, ovarian clear-cell adenocarcinoma, is preceded by endometriosis, and many believe that there is a relationship between the two diseases. Some scientists believe that endometriosis–in certain cases–is a kind of precancerous condition, and others believe that the two diseases spring forth in unison. Other experts theorize that the endometrial cells themselves drive the proliferation of cancer once it has started by producing their own estrogen. Each lesion is capable of increasing the local production of estrogen, so that once the disease takes hold it is capable of feeding itself.

In my sister’s case, cancerous growths arose within her endometrial lesions. Whatever the exact mechanism of disease development, women with the type of ovarian cancer that my sister suffered from have higher rates of endometriosis that the general female population. In one study, about 70 percent of the women with clear-cell ovarian cancer also had endometriosis.

Scientists have long suspected that chemicals of the type found in Waukegan–dioxins, PCBs, and polycyclic aromatic hydrocarbons (PAHs)–play a role in human endometriosis.

pages 75 – 81

Carson died in 1964, but her work and her life serve as a warning to everyone who struggles with cancer. “As we pour millions into research and invest all our hopes in vast programs to find cures for established cases of cancer,” she wrote, “we are neglecting the golden opportunity to prevent, even while we seek to cure.”

Carson’s favorite quote, from Abraham Lincoln, can be found snuggled into her almost daily letters to Freeman, where she explains what keeps her going through her treatments and on to finish her groundbreaking book. It reads: “To sin by silence when they should protest, makes cowards of men.”

page 122

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