The Cancer and the Environment Stakeholder Group: Cancer and the Environment in Ontario

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The Cancer and the Environment Stakeholder
Group Cancer and the Environment in Ontario

• 2007 alPHa Annual Conference
• June 11, 2007
• Deb Keen, Cancer Care Ontario
• John Wellner, Ontario Medical Association

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Outline

• Definitions
• Challenges to work in this area
• Building a case for action
• The Cancer and the Environment Stakeholder group
  and its activities
• Results of the gap analysis
• Findings and directions for future policy
  development

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Definitions What is a carcinogen?

• A carcinogen is any substance or agent that can
  produce or incite cancer1
• Included among carcinogens are chemical
  substances (such as vinyl chloride), physical
  agents (such as asbestos), and biological agents
  (such as viruses or bacteria)

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Definitions What are environmental carcinogens?

• In a broad sense, Environmental carcinogens can
  include tobacco smoke, alcohol, and sunlight
• Here, we are looking at carcinogens that can be
  found in the air, water and soil

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Challenges Carcinogens and the Environment2

• The percentage of cancers related to the
• environment is not known.
• There are measurement issues
• Small exposures
• Difficult to isolate cause due to long lag time
• Susceptibility to carcinogens varies among
  individuals
• Exposure can take place over different lengths of
  time
• Risk is confounded by other exposures, e.g.,
  smoking

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Cancer is an Important Issue

• While we do know what causes many cancers, we
  still dont know what causes about 172
• Across the globe, incidence of cancer is on the
  rise
• In Canada, 38 of women and 44 of men will
  develop cancer at some point in their lives3
• Every day in Ontario 150 new cancer cases are
  diagnosed and 67 die of cancer3

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A Call to Action on Environmental Carcinogens

• A number of cancers may be affected by
  environmental exposures2
• The public is concerned about cancer and the
  environment

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Support for Action

• The provinces action plan for cancer
• prevention and detection, Cancer 2020
• (CCS and CCO, 2003)
• Acknowledges the uncertainty around the issue
• Considers environmental exposure to be a source
  of risk that can be controlled
• Recommends surveillance and precautionary action
  on environmental exposures

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Support for Action

• Cancer 2020 set targets on environmental
• exposures
• Reduced exposures to THMs in drinking water
• Reduced exposures to particles
• 0 of Ontarians exposed to carcinogens above 1 in
  1 million benchmark

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Support for Action

• In 2005 the CCS and CCO also released an
• Insight on Cancer Environmental Exposures
• and Cancer, which found
• An association between cancer and environmental
  exposure to air pollution, arsenic, asbestos,
  water disinfection byproducts, extremely low
  frequency electromagnetic fields, solar radiation
  and radon

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Cancer and the Environment Stakeholder Group

• Purpose
• To develop and support an
• environmental cancer prevention strategy for
  Ontario.
• Primary work has focused on building a scientific
  case to inform action of the environment

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Cancer and the Environment Stakeholder Group

• 34 Stakeholders including representatives from
  labour, NGOs, local public health, universities,
  professional organizations and environmental
  groups
• The Canadian Cancer Society
• Cancer Care Ontario
• The Ontario Medical Association
• The Canadian Environmental Law Association
• The Ontario Federation of Labour
• Registered Nurses Association of Ontario
• Ontario Public Health Association
• Environmental Defence
• Toronto Public Health
• Additional Resources
• Ministry of Health and Long Term Care
• Ministry of the Environment

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Activities of the Cancer and the Environment
Stakeholder Group

• Defined environmental carcinogens
• Identified toxic use reduction as their framework
  for carcinogen use reduction
• Reviewed literature on environmental carcinogens
  in Ontario and selected approaches for reduction

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Activities of the Cancer and the Environment
Stakeholder Group

• Environmental Carcinogen Use Reduction
• Symposium (2007)
• 85 individuals representing provincial,
  national, and international organizations and
  government departments met to discuss key
  priorities and recommendations for the reduction
  of environmental carcinogen use in Ontario.
• Key Objective
• To provide input for the cancer and the
  environment strategy by working on current
  recommendations

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Guiding Principles

• Include
• Precautionary principle
• Strategic use of resources, priorities pay
  attention to vulnerable populations
• Alignment with the Cancer 2020 action plan goals
  and targets

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Environmental Carcinogen Definition by Group

• A substance found in the environment to which the
• public can be expected to be exposed as the
  result
• of human activity
• Known or likely to be in the Ontario environment
• Classified by the International Agency for
  Research on Cancer (IARC) as a group 1 (known) or
  group 2A (probable) carcinogen, or identified in
  the U.S. National Toxicology Program Report on
  Carcinogens as known or reasonably anticipated to
  be a human carcinogen
• Not a biological agent or used solely as a
  pharmaceutical

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Toxic Use Reduction Approach

• Focuses on the overall use of less toxic
  substances
• Approach is a good starting place, avoids
  disagreement over specific carcinogens

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Toxic Use Reduction

• Environmental carcinogen use reduction based on
  the toxic use reduction platform
• Can include elements such as
• Right-to-know
• Purchasing policies
• Prohibition of certain substances
• Substitution requirements
• Pollution prevention planning

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Gap Analysis Report

• Under guidance of Scientific Working Group
• (subgroup of Stakeholder Group), identified
• and reviewed
• Federal, provincial, and municipal laws and
  regulations
• International approaches
• Europe (Denmark, Sweden, REACH)
• US (California, Massachusetts, New Jersey)

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Gap Analysis Findings and Conclusions, Ontario

• In Ontario (and Canada)
• No overarching framework to reduce release and
  exposure to environmental carcinogens
• Carcinogens are controlled on a chemical by
  chemical basis
• Pollution prevention is encouraged through a
  voluntary approach

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Gap Analysis Findings and Conclusions,
International

• Recognized international programs emphasize
• Substituting toxic chemicals with less toxic
  chemicals reformulation, comparative assessment
• Placing greater responsibility on producers or
  users of toxic products, have them prove products
  are necessary, etc.
• Pollution prevention planning, replacing toxic
  chemicals, or lowering the need for their use
• Providing companies with technical assistance in
  making changes

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Directions for Future Policy Development Guiding
principles

• That the precautionary principle be adopted in
  relation to environmental carcinogens
• Margins of safety should be established to take
  into account the greater vulnerability of some
  groups to environmental carcinogens, e.g.,
  children

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Directions for Future Policy Development (draft)

• General
• 1.1 That an arms length Ontario Carcinogen Use
  Reduction Institute (OCURI) be established and
  fully funded, mandated by law, to
• Research substitutes
• Assist industry in switching to chemicals of
  lower toxicity (through training, knowledge
  transfer and direct assistance)
• Collect and report annually on the use of
  carcinogens
• Follow up with industry

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Directions for Future Policy Development (draft)

• General
• 1.2 That a comprehensive, integrated,
  provincial environmental toxics use reduction
  strategy be developed, involving government, key
  stakeholders and municipalities, focusing on
  goals and caps for carcinogen use reduction.

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Directions for Future Policy Development (draft)

• Surveillance
• 2.1 That OCURI develop an environmental
  carcinogen surveillance strategy (including
  environmentally-related cancer cases and deaths,
  residential and occupational history, and
  tracking environmental carcinogen trends) that
  easily links into federal information gathering
  databases.

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Directions for Future Policy Development (draft)

• Surveillance
• 2.2 That OCURI annually report on regional and
  provincial trends on environmental carcinogens
  (those with a known presence in Ontario, and
  classified by IARC as being a known or probable
  carcinogen, or classified as being a known or
  reasonable human carcinogen according to the
  U.S. NTP) in the air, water and soil.

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Directions for Future Policy Development (draft)

• Policies and Programs
• 3.1 That users, manufacturers and importers of
  new or existing substances be required to
  demonstrate, to the responsible Minister, that a
  substance does not pose an environmental or
  health risk, before it is permitted for import,
  manufacture or use.

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Directions for Future Policy Development (draft)

• Policies and Programs
• 3.2 That comparative assessments and chemical
  substitution be adopted as the means of
  achieving carcinogen use reduction in Ontario,
  and that tax incentives, professional assistance
  and the scientific assessment of safe
  alternatives be provided to chemical users and
  manufacturers in the province.

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Directions for Future Policy Development (draft)

• Policies and Programs
• 3.3 That an accelerated assessment and approval
  process be developed for chemicals known to be
  of low risk, so that they may quickly move
  through the processes of obtaining permission
  for import, manufacture or use, and through
  comparative assessment.

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Directions for Future Policy Development (draft)

• Policies and Programs
• 3.4 That the list of substances in the federal
  National Pollutant Release Inventory be amended
  to include environmental carcinogens (presence
  in Canada, and classified by IARC as being a
  known or probable carcinogen, or classified as
  being a known or reasonable human carcinogen
  according to the U.S. NTP), and that this list
  be assessed annually and revised when necessary.

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Directions for Future Policy Development (draft)

• Policies and Programs
• 3.5 That the label on all consumer products
  sold in Ontario (including pesticides) clearly
  indicate the presence of carcinogens (presence
  in Ontario, classified by IARC as being a known
  or probable carcinogen, or classified as being
  a known or reasonable human carcinogen according
  to the U.S. NTP), with an easily recognized
  symbol.

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Directions for Future Policy Development (draft)

• Policies and Programs
• 3.6 That public health standards include
  carcinogen use reduction, including
  community-based programs, policies and
  education.

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References

• Tabers Cyclopedic Medical Dictionary, 1985.
• Canadian Cancer Society and Cancer Care Ontario.
  Targeting Cancer An action plan for cancer
  prevention and detection. Cancer 2020 Background
  report. Toronto, 2003.
• Canadian Cancer Society/National Cancer Institute
  of Canada. Canadian Cancer Statistics 2006.
  Toronto, Canada, 2006.
• Canadian Cancer Society and Cancer Care Ontario.
  Insight on Cancer Environmental Exposures and
  Cancer. Toronto, Canada, 2005.

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Considerations for the Future

• Are we going in the right direction?
• Who do you trust with this issue?
• Does this help/hinder your work?
• Is there a role for local PHUs?
• If so, what might that be?