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New study in New Brunswick links cancer hotspots in communities to pollution, pesticides, heavy metal contamination

By Jake Cole

The Conservation Council of New Brunswick (CCNB) has released the results of a study investigating the cancer-environment connection in New Brunswick communities. This type of report has never been published before in Canada. While it is generally understood that areas with higher pollution rates make for higher cancer rates, no one has formally made the connection, at least not in this country. Among the startling results was this one: high rates of lung cancer in Saint John were more likely linked to occupational and environmental exposure to pollutants than to smoking.

Prevent Cancer Now (PCN) interviewed the study’s lead author to get a bit of an insider’s report and its implications for those of us trying to prevent cancer. Inka Milewski (photo) is the CCNB’s science advisor and director of its Health Watch program. She has a 34-year background in science and (marine) ecology and has worked with government agencies, universities and non-profit research, conservation and community organizations at local, provincial, national and international levels. She is the author and co-author of several peer-reviewed and popular science publications. Her most recent research examined cancer rates in fourteen urban and rural areas in New Brunswick (1989-2005). The results of that research were recently published in a two-part series titled “Cancer in New Brunswick communities: investigating the environmental connection”

Here is the interview:

PCN: Can you tell us a little about your organization, the Conservation Council of New Brunswick? Why did you carry out this study?

IM: The Conservation Council of New Brunswick was established in 1969 making it one of Canada’s oldest environmental organizations. Over the past four decades the organization and its staff have been honoured with provincial, national and international awards including the United Nations. Currently we have five program areas: forest conservation; marine conservation; freshwater conservation and protection; green energy future; and environment justice. The work I do through Health Watch falls into the latter category.

This study evolved from my many years of working with communities who believed their health and environment were being affected by industrial pollutants. I kept hearing people say things like “we have high rates of cancer in our community” or “ten people on my street have died of cancer”. I began looking for data that would either verify or refute these claims. The only published information I could find were in provincial cancer report, but those cancer rates were only for the province’s seven health regions. That search for data led me to a three-year research project that culminated in the publication of two reports.

PCN: What were the main results of the study?

IM: I found that communities exposed to industrial and/or natural-occurring carcinogens such as arsenic in well water and radon gas in homes were more likely to have higher rates of cancer than communities with little or no contamination. The study also found hotspots of specific, less common, cancer types which may be linked to specific contaminants. For example, rates of non-Hodgkin’s lymphoma, ovarian and brain cancers among women in the Upper Miramichi area were 50% above provincial rates. Studies done elsewhere have linked these cancers to exposure to certain pesticides. The Upper Miramichi area of the province was part of the longest and most extensive aerial pesticide spray program to control spruce budworm in the world.

One limitation of this study was that community-level smoking and other risk factor data were not available and, therefore, their impacts on cancer rates could not be assessed. Across Canada, this data is available only at the provincial and health region level and, beginning in 2000, selected census metropolitan areas (CMA). However, smoking rates among the seven health regions that encompassed the communities in this study were not significantly different from the provincial rate. While overall smoking rates among New Brunswickers, and all Canadians for that matter, were higher 30 years ago compared with rates in 2000 and 2005, the relatively small variation in rates among health regions suggests that differences in smoking behaviour alone may be insufficient to explain the significantly higher rates of lung and bladder cancer types in some communities. Moreover, smoking was a key risk factor for only four (lung, bladder, pancreatic and kidney) of the fourteen cancers examined by this study, and experts at the World Health Organization estimate that collectively smoking, alcohol consumption, low fruit and vegetable intake, along with overweight,obesity and physical inactivity account for only 37% of all cancers. If smoking accounts for approximately one-third of all cancers, what accounts for the other 63% of cancers?

PCN: Why makes this study so unique?

IM: Studies that examine and compare cancer rates in and among communities in Canada are rare. When studies are done, they rarely surprise and always confirm the suspicions local residents have about high cancer rates in their community. This was the case in Sarnia, centre of Canada’s petrochemical industry, in the Alberta tar sands community of Fort Chipewyan, in the lead smelter community of Belledune, New Brunswick, and in the community of Sydney, Nova Scotia, home to the notorious and toxic tar ponds. In all four communities, studies found higher cancer rates than expected. To my knowledge, our study is the first to examine and compare cancer rates among several communities within a province.

PCN: Does this same information exist for other provinces or territories in Canada?

IM: One or two studies have examined cancer rates across provincial health regions, but not communities. A recent Ontario study (Holowaty et al., 2010) examined cancer risks at the neighbourhood level within a public health unit and found two cancer clusters.

The geographic location of each cancer diagnosed is recorded using Statistics Canada’s census subdivision codes (CSD). This is a much smaller geographic scale than a health region or public health unit and often encompasses a single community. I used these CSDs to obtain cancer counts for fourteen urban and rural communities between 1989 and 2005 for fourteen primary cancer sites for males and females from the New Brunswick Cancer Registry Database. Some provincial cancer agencies record cancer and other health data at even smaller geographic scales such as postal code level. This is the case in Ontario and Nova Scotia and perhaps other provinces, but, historically not New Brunswick. At the very least, cancer rates can be calculated for every CSD code in Canada. Cancer counts and year and age at diagnosis by CSD code should be freely available from provincial health agencies and perhaps statistics Canada. Maps with provincial and territorial CSD codes can be found on Statistics Canada’s website.

PCN: What are people saying about the study? What are the people saying who are living in some of the communities with high cancer rates? Has there been an outcry for action?

IM: Despite sending dozens of letters and copies of our cancer reports to numerous provincial health agencies, research institutes, professional health associations, unions, and the mayors of communities in our study, I received only one letter of acknowledgment and four requests for presentation. One representative of a provincial health agency wrote to say that it would not be appropriate to make a presentation to their group because “planning, designing and implementing cancer service in New Brunswick was the role of the New Brunswick Cancer Network” and suggested I make a presentation to the NB Cancer Network. I did, and their response was similar to that of provincial health officials – they were studying the recommendations. That was two years ago.

As for the public’s response, I did receive several e-mails, letters, and phone calls thanking me for identifying and drawing public attention to the health issues in their community. In general, however, there was a lack of media, public and political response to these reports. One reason may be that the health department’s official response to the reports was neutral and uncontroversial. They did not contradict or challenge the study’s findings and therefore the media lost interest in the story.

A more pernicious reason for what can only be characterized as indifference to our reports is the sense of fatalism or inevitability about cancer among the public and health officials. Most people, including health officials, appear resigned to rising cancer rates. The numbers are indeed staggering. One in two males and one in three females will experience some form of cancer in their lifetime. And it’s not just older people that are affected. Several types of cancer are on the rise in children and younger people. Just about everyone knows someone who has survived or died from cancer. This statistical nightmare has created a sense of fatalism about cancer.

Most people, health officials included, appear resigned to rising cancer rates, and the annual reporting of provincial and national statistics just reinforces the doom.

Missing from national and provincial cancer reports is the fact that cancer rates are not evenly distributed across cities, towns or even neighbourhoods. If cancer is an inevitable disease, why do some communities have higher rates of cancers than other communities?

This brings me to another possible reason why our reports did not generate more response and why cancer and other disease rates are not reported at the community level. Drawing attention to communities with higher rates of cancer or other diseases is not welcome attention for a community. Being known as a community with high cancer rates could create a stigma that hampers a community’s social and economic development. However, I view it a bit differently. The reason why all provinces track unemployment rates in communities is to identify problem areas so that the wide-range of social and economic development tools available to provincial government can be directed to those communities. By reporting cancer and other health information at the community level, residents can become more aware of disease trends in their community, public disease prevention policies and programs can more effectively target the most vulnerable populations, and community-based participatory research can increase public awareness and action on public health and environmental policy issues.

PCN: What do you think should be done with the results of your work?

IM: We made several simple recommendations in our reports: 1) the province’s cancer network needs to start reporting cancer rates at the community level and it needs to expand its cancer prevention outreach and education programs to include occupational and environmental risk factors ; 2) departments of health and environment need to work together to require industries to eliminate carcinogen releases from their operations; and 3) government and non-government research groups need to start work with communities to raise aware of cancer trends in their community and help them engaged in, and advocate for, appropriate risk-reduction programs and health and environmental policies. I would make these recommendations to all provincial and territorial health and cancer agencies.

PCN: Do you think we’ll find a cure for cancer soon?

IM: In the early1960′s, Wilhelm Hueper, considered the founder of modern-day environmental and occupational cancer epidemiology, was asked by Rachel Carson, author of Silent Spring, why the war on cancer was concentrated largely on trying to find a cure rather than reducing and eliminating the cancer-producing agents into the environment. He replied by saying “the goal of curing the victims of cancer is more exciting, more tangible, more glamorous and rewarding than prevention.”

In Hueper’s view, any attempt to wrestle down the cancer epidemic by focusing solely on trying to find a cure would fail because the massive amounts of carcinogens that have been released and are still being released into the environment would claim new victims faster than finding any cure. He was right.

Like Hueper and many other cancer epidemiologists of their time, Carson believed cancer could be reduced significantly if only the same amount of effort was put into identifying environmental causes and eliminating them as in trying to find a cure. She wrote, “For those in whom cancer is already a hidden or a visible presence, efforts to find cures must of course continue. But for those not yet touched by the disease and certainly for the generation as yet unborn, prevention is the imperative need.” I couldn’t agree more.

Study Highlights:

  1. Health information reported by geographically large public health units can cover up high cancer risks at the community level.
  2. Communities with higher overall levels of industrial emissions have higher overall rates of cancer.
  3. Smoking rates did not explain the higher rates of lung cancer among some communities.
  4. Communities with high rates of specific cancers also had high rates of environmental and occupational exposure to pollutants known to be linked to those cancer types.

For a look at the complete study, go to:

Also in this issue on An Ounce …