A TOXIC CONVERSATION

My very good friend Andrea Ravinette Martin—-the charismatic founder of the Breast Cancer Fund--used to say, "The only way I will know I have really survived breast cancer is when I die of something else."

She did: when she was fifty-six, a new and unrelated malignancy of the brain turned her into a breast cancer survivor.

Three years before a tangled web of glioblastoma multiforme invaded her brain, Andrea was in excellent health. As part of a pilot research study of the Environmental Working Group, she was tested for chemical contaminants. She had never worked in a factory. She had no chemically intensive hobbies like boatbuilding or oil painting.

Yet it turned out that Andrea was a walking toxic waste site. Her body contained nearly one hundred different chemical residues, half of which caused cancer when tested in experimental animals.

Many of these toxins didn't exist when she was born in the middle of the past century. Had they played any role in causing either her breast or brain tumors? Did her frequent use of those clunky first-generation cell phones have anything to do with it? It is sad that we don't know. It is appalling that we can't find out.

Look around and it seems like cancer has become the price of modern life. In America, one out of every two men and one out of every three women will develop cancer in their lifetime. In America alone, there are currently more than 10 million cancer survivors.

Cancer is the second leading killer of Americans, and the leading cause of disease related deaths among children. Yes, deaths have dropped, chiefly because fewer are smoking and more are surviving colorectal, prostate and breast cancer. But more new cases of cancer are arising that have nothing to do with smoking, aging or screening.

How did this happen? How did a disease that was once so atypical become so ordinary? Are we simply talking more about an illness that has always been around?

Some twenty-five hundred years ago, the Greek physician Hippocrates depicted a tumor as a muddled irritable cavity with spindly legs flaring out of control in all directions. Fascinated with its evil animal-like appearance, he termed it cancer, karkinoma, the Greek word for crab. Like Hippocrates, we are drawn to things of menacing beauty.

To an epidemiologist like myself, the explanations of run-amok cancer processes that routinely capture Nobel Prizes and promising headlines address the how but not the why of cancer. They can tell us about how cells and organs behave when they spin out of control, but say nothing about what makes these things happen to specific groups of people located in a certain area at a certain time.

Why have so many types of cancer not known to be tied with smoking increased from decade to decade in industrial countries and in those areas of the developing world that are becoming industrialized? Why do one fifth of all colorectal cancers in Egypt occur in persons under age thirty, a rate that is ten times higher than in the U.S?

Why are so many people in their thirties and forties in many industrial countries coming down with often fatal cancers of the bone marrow and pancreas—diseases that used to occur only in those in their sixties or older?

What can we do to reverse the trend? How can we get better at keeping cancers from happening in the first place? Despite impressive progress in finding and treating some forms of the disease, more than half of all those diagnosed with cancer will not last a decade.

We have all been told what we are supposed to do to reduce the risk of cancer on our own. We are supposed to eat right and exercise. Even prayer and meditation are touted as good things to do. Smoking, of course, is forbidden. And we are certainly not to drink much alcohol or engage in unprotected sex.

But we all know people who lead perfectly clean, even exemplary lives, like my dear friend Andrea, and still get cancer. They take good care of themselves, and appear to be the very nicest of people, yet somehow cancer hits.

The first thing most cancer patients and their sometimes unthinking friends ask is: What did I do to make this happen? Often, the answer is not a bloody thing.