Health and the environment in the 1990s

Cancer and climate change

The acute impact of climate change on human health is receiving increased attention, but little is known or appreciated about the effect of climate change on chronic diseases, particularly cancer. This Review provides a synopsis of what is known about climate change and the exposures it generates relevant to cancer. In the context of the world's cancer burden and the probable direction we could expect to follow in the absence of climate change, this scoping review of the literature summarises the effects that climate change is having on major cancers, from environmental exposures to ultraviolet radiation, air pollution, disruptions in the food and water supply, environmental toxicants, and infectious agents. Finally, we explore the effect of climate change on the possible disruption of health systems that have been essential to cancer control practice. We conclude with potential responses and opportunities for intervention.

The Definition of Health: Towards New Perspectives

The definition of health is not just a theoretical issue, because it has many implications for practice, policy, and health services. The current definition of health, formulated by the WHO, is no longer adequate for dealing with the new challenges in health care systems. Despite many attempts to replace it, no alternative definition has reached a wide level of consensus. Assuming an epistemological perspective, the need for a unique definition has to be rejected in favor of a plural approach in which cannot exist the best definition of health but many different definitions, more or less useful depending on the scope of application. Nevertheless, it should be noted that not all potential definitions of health are fit to pursue clinical scientific goals. Based on recent scientific debate, one can maintain that each definition of health should have at least 9 features to work well within the clinical scientific field. Moving from this perspective, a new definition has been developed for pursuing health, especially in the fields of chronic patients and older people.

Redefining Health: The Evolution of Health Ideas from Antiquity to the Era of Value-Based Care

The current healthcare system in the United States (US) is characterized by high costs and poor patient outcomes. A value-based healthcare system, centered on providing the highest quality of care for the lowest cost, is the country's chosen solution for its healthcare crisis. As the US transitions to a value-based model, a new definition of health is necessary to clearly define what constitutes a healthy state. However, such a definition is impossible to develop without a proper understanding of what "health" actually means. To truly understand its meaning, one must have a thorough historical understanding of the changes in the concept of health and how it has evolved to reflect the beliefs and scientific understanding of each time period. Thus, this review summarizes the changes in the definition of health over time in order to provide a context for the definition needed today. We then propose a new definition of health that is specifically tailored to providers working in the era of value-based care.

Neighborhood epidemiological monitoring and adult mental health: European Quality of Life Survey, 2007-2012

Little is monitored on perceived neighborhood noise, quality of drinking water, air quality, rubbish, traffic, etc. at a continental scale. This study was aimed to examine the relationships of such neighborhood risks and mental health in adults and the very old in an international and population-based setting across Europe. Data were retrieved from the European Quality of Life Survey, 2007-2012 including demographics, living conditions, income and financial situation, housing and local environment, family, work, health, social participation and quality of social services. Adults aged 18 and above were included for statistical analysis (n = 79,270). Analysis included chi-square test, t test and logistic regression modeling. People who lived in town or city tended to indicate certain major problems for them such as noise (odds ratio (OR) 2.34, 95% confidence interval (CI) 2.17-2.53, P < 0.001), air quality (OR 2.76, 95% CI 2.54-3.00, P < 0.001), low quality of drinking water (OR 1.33, 95% CI 1.23-1.43, P < 0.001), crime and/or violence (OR 2.92, 95% CI 2.68-3.19, P < 0.001), rubbish (OR 3.68, 95% CI 3.41-3.97, P < 0.001) and traffic congestion (OR 2.64, 95% CI 2.45-2.85, P < 0.001). People who reported major problems on noise (OR 2.19, 95% CI 1.96-2.45, P < 0.001), air quality (OR 2.11, 95% CI 1.87-2.37, P < 0.001), low quality of drinking water (OR 2.40, 95% CI 2.14-2.68, P < 0.001), crime and/or violence (OR 2.13, 95% CI 1.88-2.41, P < 0.001), rubbish (OR 1.98, 95% CI 1.77-2.11, P < 0.001) and traffic congestion (OR 1.50, 95% CI 1.34-1.68, P < 0.001) were also classified as having depression. Perceived neighborhood conditions were associated with adult mental health across Europe. Future neighborhood monitoring research moving from the etiological to neighborhood management would be suggested.

[Inequalities in longevity and quality of life between Andalusia and Spain]

BACKGROUND

Because of the increase in life expectancy (LE) throughout the twentieth century, indicators providing information on quality of life and its distribution in distinct geographical areas are required. We describe LE and life expectancy without disability (LEWD) by age and sex and estimate the magnitude of inequalities between Andalusia and Spain.

MATERIAL AND METHOD

Mortality data from the Natural Population Movement, the Survey of Disabilities, Deficiencies and Health Status, and the populations of the National Institute of Statistics for Andalusia and Spain in 1999 were used. Abbreviated life tables were constructed and were used to calculate LEWD through Sullivan's method. LE and LEWD by age and sex were obtained for Andalusia and Spain.

RESULTS

LE was lower in Andalusia than in Spain in all age groups and in both sexes. At birth, LE was 73.9 years for men and was 80.9 years for women in Andalusia and was 75.0 years and 82.1 years in Spain respectively. Inequalities between Andalusia and Spain in LEWD were greater in all age groups both in men and in women: at birth LEWD was 66.0 years and 69.0 years for men and women in Andalusia and was 68.3 years and 72.0 years in Spain.

CONCLUSIONS

Longevity and quality of life are lower in Andalusia than the mean for Spain, especially in elderly women.

The global distribution and population at risk of malaria: past, present, and future

The aim of this review was to use geographic information systems in combination with historical maps to quantify the anthropogenic impact on the distribution of malaria in the 20th century. The nature of the cartographic record enabled global and regional patterns in the spatial limits of malaria to be investigated at six intervals between 1900 and 2002. Contemporaneous population surfaces also allowed changes in the numbers of people living in areas of malaria risk to be quantified. These data showed that during the past century, despite human activities reducing by half the land area supporting malaria, demographic changes resulted in a 2 billion increase in the total population exposed to malaria risk. Furthermore, stratifying the present day malaria extent by endemicity class and examining regional differences highlighted that nearly 1 billion people are exposed to hypoendemic and mesoendemic malaria in southeast Asia. We further concluded that some distortion in estimates of the regional distribution of malaria burden could have resulted from different methods used to calculate burden in Africa. Crude estimates of the national prevalence of Plasmodium falciparum infection based on endemicity maps corroborate these assertions. Finally, population projections for 2010 were used to investigate the potential effect of future demographic changes. These indicated that although population growth will not substantially change the regional distribution of people at malaria risk, around 400 million births will occur within the boundary of current distribution of malaria by 2010: the date by which the Roll Back Malaria initiative is challenged to halve the world's malaria burden.

Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world

OBJECTIVE

To analyse trends in mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD) over the period 1965 to 1998 in the European Union, other European countries, the USA, and Japan.

METHODS AND RESULTS

Data were derived from the World Health Organization database. In the European Union, CHD mortality in men rose from 146/100 000 in 1965-9 to 163/100 000 in 1975-9 and declined thereafter to 99/100 000 in 1995-8 (-39%). In women, the fall was from 70 to 45/100 000 (-36%). A > 55% decline in CVD was registered in both sexes. In eastern Europe, mortality from both CHD and CVD rose up to the early 1990s but has declined over the past few years in Poland and the Czech Republic. In the Russian Federation during 1995-8, mortality rates from CHD reached 330/100 000 men and 154/100 000 women and mortality rates from CVD were 203/100 000 men and 150/100 000 women-that is, they were among the highest rates worldwide. In the USA and Japan, long term trends were favourable for both CHD and CVD.

CONCLUSIONS

Trends in mortality from CHD and CVD were favourable in several developed areas of the world, but there were major geographical differences. In a few eastern European countries, mortality from CHD and CVD remains exceedingly high.

The effect of bacillus Calmette-Guérin immunization depends on the genetic predisposition to Th2-type responsiveness

The aim of this study was to investigate whether the effect of bacillus Calmette-Guérin (BCG) immunization on ovalbumin-induced allergic inflammation in a rat model depends on the genetic predisposition to react with a T helper cell (Th) 2-type cytokine response. This study was performed in an inbred Th2-predisposed "asthma prone" rat strain (brown Norway [BN]) and in an outbred nonpredisposed strain (Sprague Dawley [SD]), to differentiate between genetic and environmental factors. BCG decreased numbers of lung eosinophils and macrophages in the SD rat. This effect was not seen in the BN rat. In the BN rat, but not in the SD rat, BCG downregulated levels of total serum IgE. No significant differences were found with respect to frequencies of IFNgamma- or interleukin-4-producing cells in the lung in both rat strains. These results indicate that the degree and pathway of immunomodulatory effect of BCG in two genetically different rat strains is dependent on the genetic predisposition to develop a Th2-type response. Therefore, differences in genotype in relation to environment may result in difference in involvement of contributing pathogenic factors and thus different responsiveness to therapeutic strategies.

[Public and occupational health aspects related to municipal solid waste management]

Based on a literature review, the paper calls attention to public and occupational health problems related to poor municipal solid waste management resulting from a development model that views environmental protection, public health, and workers' health as secondary issues. The authors emphasize the need for research to support a new waste management model highlighting the importance of environmental preservation and protection of human health, in addition to suggesting measures to achieve such goals. The discussion aims to incorporate solid waste management into the public health agenda.

Life expectancy as an indicator of environmental health

Whether or not life expectancy at birth is related to the quality of life as expressed by global economical, environmental and nutritional measures is the primarily studied question in this article. Two models, set of independent variables and multivariate analysis was performed. An attempt to estimate the role of studied variables in overall life expectancy was done, too. A descriptive, ecological study design was used. The population of 156 countries have been taken into account, using data from published databases [7, 9]. Access to safe drinking water, per capita gross domestic product, literacy, calories available as percentage of needs and per capita public health expenditures were taken as exposure, and compared with life expectancy at birth. A linear regression model was used to estimate the role of different exposures on life expectancy at birth. A correlation matrix for all variables and life expectancy at birth is presented in the article. Literacy and access to safe drinking water are statistically significant variables (p < 0.001) also after fitting a linear regression model. The correlation coefficient for the linear model was 0.8823 (R2 = 0.7784). Shares of years of life from overall life expectancy attributed to studied variables were 28.06, 9.42, 2.04 and 1.93% for literacy, access to safe drinking water, GDP and calories available as percentage of needs, respectively.

The social class determinants of income inequality and social cohesion

The authors argue that Wilkinson's model omits important variables (social class) that make it vulnerable to biases due to model mis-specification. Furthermore, the culture of inequality hypothesis unnecessarily "psychopathologizes" the relatively deprived while omitting social determinants of disease related to production (environmental and occupational hazards) and the capacity of the relatively deprived for collective action. In addition, the hypothesis that being "disrespected" is a fundamental determinant of violence has already been refuted. Shying away from social mechanisms such as exploitation, workplace domination, or classist ideology might avoid conflict but reduce the income inequality model to a set of useful, but simple and wanting associations. Using a nonrecursive structural equation model that tests for reciprocal effects, the authors show that working-class position is negatively associated with social cohesion but positively associated with union membership. Thus, current indicators of social cohesion use middle-class standards for collective action that working-class communities are unlikely to meet. An erroneous characterization of working-class communities as noncohesive could be used to justify paternalistic or punitive social policies. These criticisms should not detract from an acknowledgment of Wilkinson's investigations as a leading empirical contribution to reviving social epidemiology at the end of the century.

Systemic mycobacterial infection inhibits antigen-specific immunoglobulin E production, bronchial mucus production and eosinophilic inflammation induced by allergen

As the burden of infectious diseases becomes reduced in many countries, a remarkable increase in the incidence of allergies has occurred. The basis for the rise in atopic disorders as a correlate of the decline in infectious diseases has not been defined. In the present study, we tested experimentally whether prior systemic infection with Mycobacterium bovis bacillus Calmette Guérin (BCG) had any effect on ovalbumin (OVA) Al(OH)3 (alum)-induced immunoglobulin E (IgE) production, airway mucus production and eosinophilic inflammation. The data showed that allergen-specific IgE production and OVA-induced eosinophilia and goblet cell development were significantly inhibited by prior infection with BCG. Correspondingly, following immunization with OVA alum, BCG-infected mice exhibited significantly higher levels of allergen-driven interferon-gamma (IFN-gamma) production than the mice without infection. The ratio of IFN-gamma: interleukin (IL)-4 production was higher in OVA-sensitized mice with prior BCG infection than in those without infection. The abrogation of OVA-induced mucus production and pulmonary eosinophilia in BCG-infected mice correlated with significantly decreased IL-5 production and increased IFN-gamma and IL-12 production. These data provide direct evidence that intracellular bacterial infection (i.e. BCG) can inhibit antigen-specific IgE and airway reactivity induced by environmental allergen. Furthermore, the results suggest that changes in cytokine-producing patterns of T lymphocytes and other cells may be the mechanism by which infections influence allergies.

Cancer mortality in Europe, 1990-1994, and an overview of trends from 1955 to 1994

Mortality data, abstracted from the WHO database, are presented in tabular form for 26 cancer sites or groups of sites, plus total cancer mortality, in 35 European countries during the period 1990-1994. Trends in mortality are also given in graphical form for 24 major countries over the period 1955-1994. In most western European countries total cancer mortality was--for the first time--moderately downwards in the early 1990s. Such favourable trends included some decline in lung cancer mortality for males, the persistent decline in stomach cancer for both sexes, and of cervical cancer for women, as well as some decline in breast and colorectal cancers, plus other neoplasms (testis, lymphoid neoplasms), whose treatment has further improved over the last few years. However, cancer mortality was still upwards in a few southern and eastern European countries, including Hungary and Poland, where total cancer mortality rates in middle-aged males are now the highest ever registered in Europe. The favourable trends in western Europe over the recent years are similar to those observed in the U.S.A.

Health impacts of climate change and ozone depletion: an ecoepidemiologic modeling approach

Anthropogenic climate changes and stratospheric ozone depletion affect human health in various ways. Current mainstream epidemiologic research methods do not appear well adapted to analyze these health impacts, which involve complex systems influenced by human interventions or simpler processes that will take place in the future. This paper discusses a different paradigm for studying the health impacts of global environmental changes and focuses on the development of integrated ecoepidemiologic models using three examples--the effect of climate change on vector-borne diseases, the effect of climate change on thermal-related mortality, and the effects of increasing ultraviolet levels because of ozone depletion on the rates of skin cancer.

Trends in mortality from major diseases in Europe, 1980-1993

Trends in age-standardized death certification rates from all causes, coronary heart disease (CHD), cerebrovascular diseases, all neoplasms and lung cancer were analysed over the period 1980-1993 in 20 major European countries. There were steady and substantial declines of overall mortality in all western European countries for both sexes, although appreciable geographic differences persisted. These favourable trends reflect a decline in CHD mortality in most western countries, besides a persisting fall in cerebrovascular disease, and a substantial stability (with some decline in a few northern and central European countries) in cancer mortality. In contrast, in eastern European countries appreciable rises were registered in mortality from major causes of death considered for males. For females, only moderate declines were observed in Eastern Europe. In the early 1990s, overall mortality was 30 to 100% higher for males and 20 to 100% higher for females as compared to Western Europe. As indicated by the trends in lung cancer death rates, this reflects a major impact of the tobacco-related disease epidemic in subsequent cohorts, as well as more unfavourable lifestyle factors (i.e. aspects of diet, other environmental factors), and a delayed control of hypertension in Eastern Europe, together with a substantial excess of suicides, (road) accidents, homicides and alcohol-related diseases, and the delayed introduction of rational treatment for some conditions. An indication of reversal of mortality trends was evident in the early 1990s only in Poland. In conclusion, there is ample scope for intervention on avoidable mortality in eastern European countries.

Anthroposophic perspectives in primary care

Anthroposophically Extended Medicine (AEM) is a truly integrative healing system. AEM represents an expansion, not an alternative to conventional medicine. Its unique understanding of the interplay among physiological, soul and spiritual processes in healing and illness serves to bridge allopathy with naturopathy, homeopathy, functional/nutritional medicine and other healing systems.

The inverse association between tuberculin responses and atopic disorder

Human immune responses are heterogeneous and may involve antagonism between T helper (TH) lymphocyte subsets and their cytokines. Atopy is characterized by immediate immunoglobulin E (IgE)-mediated hypersensitivity to agents such as dust mites and pollen, and it underlies the increasingly prevalent disorder asthma. Among Japanese schoolchildren, there was a strong inverse association between delayed hypersensitivity to Mycobacterium tuberculosis and atopy. Positive tuberculin responses predicted a lower incidence of asthma, lower serum IgE levels, and cytokine profiles biased toward TH1 type. Exposure and response to M. tuberculosis may, by modification of immune profiles, inhibit atopic disorder.

Disasters, the environment, and public health: improving our response

Natural and human-made disasters continue to adversely affect all areas of the world in both predictable and unpredictable ways. To highlight the importance of natural disasters, the United Nations declared the 1990s the International Decade for Natural Disaster Reduction. This paper considers the public health response to disasters. It highlights environmental health issues and approaches since disasters are extreme environmental events, and it reviews developments relating to capacity building, training, and collaboration. Although progress is noted, a comprehensive federal or academic approach is not evident in the United States and the proper linkage to environmental health is lacking. With the International Decade now half over, public health professionals and others involved with disaster management should reflect on progress made to date and goals for the future.

Tracking community sentinel events: breast cancer mortality and neighborhood risk for advanced-stage tumors in Denver

OBJECTIVES

The incidence of related sentinel events--breast cancer mortality and neighborhood-specific morbidity for advanced stage at diagnosis--were calculated for women likely to use a community health center in Denver, Colo.

METHODS

For the center's service area, neighborhoods (n = 37) were defined by program use. Mortality rates and proportional hazards regression models were estimated for 4189 breast cancer cases recorded between 1979 and 1990. Neighborhood-specific standard morbidity ratios of advanced-stage tumors were based on age-specific rates applied to the entire community.

RESULTS

Service area residents were more likely to present with advanced tumors (odds ratio [OR] = 1.4; 95% [CI] = 1.2, 1.5). After adjustment, advanced-stage disease and socioeconomic-demographic status, but not race-ethnicity, contributed significantly to survival. Two neighborhoods (6.5% of the population at risk) with standard morbidity ratios of 2.1 (95% CI = 1.3, 3.4) and 1.7 (95% CI = 1.2, 2.5) accounted for 42% of the excess cases of advanced-stage tumors between 1986 and 1990.

CONCLUSIONS

Neighborhood variation in advanced-stage cancer can serve as the basis for efforts to improve access to breast cancer screening.

A comparative study of mortality in agricultural and industrial areas in Spain

The three main causes of contamination in the industrialized world are energy production, and industrial and agricultural activities. The aim of the present study was to examine changes in cause of death in order to contrast causes of death between agricultural and industrial areas. To this effect we have selected four zones--two predominantly industrial and two mainly agricultural--within the Valencian Community. Mortality figures were gathered corresponding to the same period 1976-1989, published by the Conselleria de Sanitat i Consum of the Generalitat Valenciana (Valencian Community health authorities). Thirty large groups of causes of death were established for posterior analysis. Mortality rate was defined as the number of deaths per 100,000 inhabitants, standardizing the data by the direct method. A simple regression analysis was performed for each cause of death and in each health coverage area studied, to determine the tendencies characterizing each area in time. A statistical significance test was also carried out. A statistically significant increase (95% confidence interval) was observed for digestive cancer, respiratory cancer, benign tumors and non-specific neoplastic diseases in the industrial areas. In the agricultural areas, a significant decrease (95% confidence interval) was observed in tuberculosis and respiratory diseases and infections. Relative risk (RR) was calculated and thus, tuberculosis, mental and central nervous system disorders, respiratory infections and diseases, and male genital disorders were more frequent in agricultural areas.

Mortality, morbidity and drug consumption in a rural area (Spain)

A descriptive study was made of the health indicators in 5 rural municipalities of the province of Castellón (Spain), with a total of 1428 inhabitants. This population is characterized by its aging, 36.9% of all individuals being older than 65 years. A retrospective evaluation was made of the annual mortality rates between 1940 and 1990, and of morbidity and medications consumption for the period between June 1991 and May 1992. An increase in general mortality was observed during the study period, though the rates also diminished in relation to age groups, sex and cause of death. In addition, 59.45% of the study population made use of health-care services in the course of one year, an average of 2.59 drugs being prescribed per inhabitant in that same period. Morbidity in decreasing order of importance was attributed to acute respiratory disease, osteomuscular disorders, hypertension, depression and gastric pathology. Medications for the common cold and coughing were the most frequently used drugs, along with pain-killers, cardioactive agents, psycholeptics and non-sterioidal anti-inflammatory drugs (NSAIDs). Aging causes the mortality variations recorded, despite the socio-sanitary improvements observed in the zone during the study period. Aging may also be related to the important use of healthcare services and of drugs noted in the study. The highest morbidity rates and drug consumption levels corresponded to chronic diseases that deteriorate patient quality of life without actually increasing mortality.

[Emerging infectious diseases in the realm of complexity: implications for scientific and technological policies]

The current emergence and global dissemination of some new and resurgent infectious diseases have surpassed national frontiers, increasingly affecting developing and also developed countries. This study stresses that this outburst is affecting the predictability of dominant health transition approaches. This paper analyses, from epistemological and policy viewpoints, alternative approaches in order to confront these new global epidemiological trends.

Health and its determining factors in the Tokyo megacity

This study was designed to (i) analyze community health in post-industrial, densely populated Tokyo, and (ii) find a statistical-based prediction model for the health level of the communities from the environment. For this purpose, we compiled health-level indicators for each city-ward, and indicators for demography, infrastructure, land-use, amenities, education, working conditions, economics, and medical and welfare services. The health factors and the environmental factors were obtained by using weighted principal factor analysis; their relation was examined by weighted correlation analysis and weighted linear regression analysis. One to six environmental factors correlating significantly to health were found for each health-level indicator or factor. The prediction model explained up to 0.98 of the variance of the health-level factors and indicators. This analysis elicited health-determinant factors in various fields. The community health level was well reproduced by the present method; the model will be conducive to decision making pertaining to health policies.

Potential impact of global climate change on malaria risk

The biological activity and geographic distribution of the malarial parasite and its vector are sensitive to climatic influences, especially temperature and precipitation. We have incorporated General Circulation Model-based scenarios of anthropogenic global climate change in an integrated linked-system model for predicting changes in malaria epidemic potential in the next century. The concept of the disability-adjusted life years is included to arrive at a single measure of the effect of anthropogenic climate change on the health impact of malaria. Assessment of the potential impact of global climate change on the incidence of malaria suggests a widespread increase of risk due to expansion of the areas suitable for malaria transmission. This predicted increase is most pronounced at the borders of endemic malaria areas and at higher altitudes within malarial areas. The incidence of infection is sensitive to climate changes in areas of Southeast Asia, South America, and parts of Africa where the disease is less endemic; in these regions the numbers of years of healthy life lost may increase significantly. However, the simulated changes in malaria risk must be interpreted on the basis of local environmental conditions, the effects of socioeconomic developments, and malaria control programs or capabilities.

Equity and efficiency in health reform. A European view

Health care reform in both eastern and western Europe is on the agenda, and in both parts of Europe the importance of equity targets has been questioned. In the East, the previously strongly held equity goals were largely a facade, covering all sorts of privilege systems, something which has brought equity as a concept into disrepute. However, present developments mean that it is quite likely to be back on the agenda again soon. In the West, equity has been seen as inevitably linked to non-market systems of health care. In moving towards market solutions equity has come to be seen as conflicting with efficiency goals. This contra-positioning of equity and efficiency does not stand up to critical examination. It is based on confusing strategic goals with the implementation of those goals. Equity could be seen as a strategic goal in its own right. We may ask what are the most efficient ways of financing, managing and delivering medical services to achieve that goal. Clearly this has not been the question on the agenda. Cost containment has been imperative, and the consequences for general health, equity in health or the health and care for those suffering most, has been relegated to second place. The reduction of inequalities in health can be seen as an overall strategy for the improvement of a population's health, and as helpful in the maintaining and improvement of its human capital.(ABSTRACT TRUNCATED AT 250 WORDS)

Toxicological interactions between nickel and radiation on chromosome damage and repair

Carcinogenic nickel compounds are usually found to be weak mutagens; therefore these compounds may not exert their carcinogenic activity through conventional genotoxic mechanisms. On the other hand, the activities of many nickel compounds have not been adequately investigated. We evaluated the genotoxic activities of nickel acetate using conventional chromosome aberration and sister chromatid exchange assays and found that there was no increase of chromosome aberrations or sister chromatid exchanges, although the highest dose (1000 microM) caused mitotic inhibition. In addition, we investigated its effect on DNA repair using our challenge assay. In this assay, lymphocytes were exposed to 0.1 to 100 microM nickel acetate for 1 hr during the G0 phase of the cell cycle. The cells were washed free of the chemical and, 1.5 hr later, were irradiated with two doses of gamma-rays (75 cGy per dose separated by 60 min). A significant dose-dependent increase of chromosome translocations was observed (p < 0.05). The increase is more than expected based on additive effects from exposure to nickel or gamma-rays individually. In contrast to the increase of chromosome translocations, there was no increase in chromosome deletions, although there was a nickel dose-dependent reduction of mitotic indices. Our data suggest that pretreatment with nickel interferes with the repair of radiation-induced DNA damage and potentially cause mistakes in DNA repair. Furthermore, we suggest that nickel-induced abnormal DNA repair may be a mechanism for its carcinogenic properties. The DNA repair problems that we observed after exposure to low doses of nickel may be viewed as a type of adaptive response.(ABSTRACT TRUNCATED AT 250 WORDS)

Trends in cancer mortality in young adults in Europe, 1955-1989

Trends in mortality in the age group 20-44 years for the 16 most common cancers or groups of cancer in young adults are presented for 24 European countries (i.e. those with > or = 1,000,000 inhabitants). The largest (up to 9-fold) and most frequent increases were recorded for cancer of the mouth and pharynx (> or = 2-fold increase from 1955-1959 to 1985-1989 in 10 countries), and oesophagus (in eight countries) in males, and for cancer of the skin, chiefly of melanomatous type, in males and females (in nine and eight countries, respectively). Consistent declines were observed for cancer of the stomach and uterus (chiefly, cervix), and for Hodgkin's disease, most notably in northern European countries. Little change emerged in the last 30 years or so in young adult mortality rates for cancer of the colon-rectum, pancreas, non-Hodgkin's lymphoma, leukaemias and cancers of the breast and ovaries in women. More than 2-fold elevations in lung cancer mortality rates in men aged 20-44 years were found only in a few previously non-market economy countries, and in Spain and Portugal. In some northern European countries, favourable downward trends in young males were accompanied by more than 2-fold increases in lung cancer mortality rates in young women. Overall, total cancer mortality rates in women at aged 20-44 years have declined over the last 35 years by more than 20% in 12 countries, and have not increased anywhere. Total cancer mortality rates in young males showed similar decreases in nine northern European countries, but increases of the same magnitude were also observed in most formerly non-market economy countries, and in Spain and Portugal.

Income, race, and mortality

This study was undertaken to clarify the complex relationship between poverty and race with disease-specific mortality. Data from the 1987 National Health Interview Survey and the 1986 National Mortality Followback Survey were used to estimate standardized mortality ratios (SMRs) for various categories (all causes, all cancers, noncancerous medical causes, lung and breast cancers, ischemic heart disease, and cerebrovascular disease) associated with income below the poverty line and were compared with those with adequate or better than adequate income. All SMRs were substantially elevated. The SMRs were not appreciably affected by adjustments for confounding by alcohol consumption, occupation, or smoking. Sex-specific SMRs of blacks relative to whites with the exception of ischemic heart disease were significantly elevated for males but not for females with the exception of the SMR for all causes. However, when adjusted for per capita income within the family, black mortality never significantly exceeded that of whites. These results strongly support the conclusion that mortality differences between blacks and whites are due to differences in income and related factors. However, it is unclear why poverty should be associated with elevation in cancer relative risk.

Environmental carcinogenesis

It generally is accepted that approximately 80% of all cancers have an environmental component. However, although the cause and nature of certain human cancers are known, definitive preventative guidelines cannot be offered for many tumors attributed to life style, especially those of the digestive and genitourinary system. This has led to considerable public confusion and political controversy regarding cancer control strategies. Proponents of two divergent strategies for control have emerged: those who emphasize increased regulatory programs designed to control or eliminate minute quantities of pollutants in the ambient environment based on fairly rigid quantitative risk assessment; and those who believe in more intensive long-term research on the molecular biologic mechanisms with the objective of actively intervening in carcinogenic mechanisms. Current data indicate that the eliminatory approach, apart from more effort on certain already recognized exogenous agents, will have little additional impact on the cancer burden. The mechanistic approach, although complex and slow, represents the most logical alternative. Thus, there are increasing efforts directed to evaluating the application of more recent advances in molecular biology to human studies. However, such research strategies require a long-term investment, and no time frame can be offered. Informed scientists have an important role in ensuring that the public is made aware of current scientific views on carcinogenesis and priorities in preventative research.

Evaluation of the national cancer program and proposed reforms

A statement by some 68 prominent national experts in industrial medicine, carcinogenesis, epidemiology, and public health, released at a February 4, 1992 press conference in Washington, D.C., charged that the National Cancer Institute (NCI) has confused the public by repeated claims of winning the war against cancer. In fact, age standardized incidence rates have increased sharply over recent decades, while ability to treat and cure most cancers has not materially improved. Furthermore, the NCI has minimized evidence for increasing cancer rates which are largely attributed to smoking and to diet. In so doing, NCI trivializes the importance of occupational carcinogens as non-smoking-attributable causes of lung and other cancers, and ignores the tenuous and inconsistent evidence for the causal role of diet per se and also the important role of carcinogenic dietary contaminants. Reflecting this near exclusionary blame-the-victim theory of cancer causation, with support from the American Cancer Society and industry, the NCI discounts the role of avoidable involuntary exposures to industrial carcinogens in air, water, food, the home, and the workplace. The NCI has also failed to provide scientific guidance to Congress and regulatory agencies on fundamental principles of carcinogenesis and epidemiology, and on the critical need to reduce avoidable exposures to environmental and occupational carcinogens. Contrary to NCI, analysis of their $2 billion budget reveals very limited allocations for research on primary cancer prevention, and for occupational cancer which receives only $19 million annually, 1% of NCI's total budget. Problems of professional mindsets in NCI leadership--fixation on diagnosis, treatment, and basic research (much of questionable relevance) and the neglect of cancer prevention--are exemplified by the composition of the Executive President's Cancer Panel and the National Cancer Advisory Board. Contrary to the explicit mandate of the National Cancer Act, the Board is virtually devoid of recognized authorities in occupational and environmental carcinogenesis. These problems are further compounded by institutionalized conflicts of interest reflected in the composition of past Cancer Panels, and of the current Board of Overseers of the Memorial Sloan Kettering Cancer Center, NCI's prototype comprehensive cancer center, with their closely interlocking financial interests with the cancer drug and other industries. Comprehensive reforms of NCI policies and priorities are overdue. Implementation of such reforms is, however, unlikely in the absence of further support from industrial medicine professionals, which is here solicited, besides action by Congress and concerned citizen groups.

Underscoring the continued need for a sustained national HIV prevention and public education initiative

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Evaluation of the national cancer program and proposed reforms

A statement by 68 prominent national experts in cancer prevention, carcinogenesis, epidemiology, and public health, released at a February 4, 1992, press conference in Washington, D.C., charged that the National Cancer Institute (NCI) has misled and confused the public by repeated claims of winning the war against cancer. In fact, age-standardized incidence rates have escalated to epidemic proportions over recent decades, while the ability to treat and cure most cancers has not materially improved. Furthermore, the NCI has minimized evidence for increasing cancer rates, which are largely attributed to smoking, trivializing the importance of occupational carcinogens as non-smoking attributable causes of lung and other cancers, and to diet per se, in spite of tenuous and inconsistent evidence and ignoring the important role of carcinogenic dietary contaminants. Reflecting this near exclusionary blame-the-victim theory of cancer causation, with lockstep support from the American Cancer Society and industry, the NCI discounts the role of avoidable involuntary exposures to industrial carcinogens in air, water, food, the home, and the workplace. The NCI has also failed to provide any scientific guidance to Congress and regulatory agencies on fundament principles of carcinogenesis and epidemiology, and on the critical needs to reduce avoidable exposures to environmental and occupational carcinogens. Analysis of the +2 billion NCI budget, in spite of fiscal and semantic manipulation, reveals minimal allocations for research on primary cancer prevention, and for occupational cancer, which receives only +19 million annually, 1 percent of NCI's total budget. Problems of professional mindsets in the NCI leadership, fixation on diagnosis, treatment, and basic research, much of questionable relevance, and the neglect of cancer prevention, are exemplified by the composition of the National Cancer Advisory Board. Contrary to the explicit mandate of the National Cancer Act, the Board is devoid of members authoritative in occupational and environmental carcinogenesis. These problems are further compounded by institutionalized conflicts of interest reflected in the composition of past executive President's Cancer Panels, and of the current Board of Overseers of the Sloan-Kettering Memorial Cancer Center, the NCI's prototype comprehensive cancer center, with their closely interlocking financial interests with the cancer drug and other industries. Drastic reforms of NCI policies and priorities are long overdue. Implementation of such reforms is, however, unlikely in the absence of further support from industrial medicine professionals, besides action by Congress and concerned citizen groups.

Commentary: environmental disease--a preventable epidemic

Toxic environmental diseases are highly preventable causes of morbidity and mortality. Toxic diseases in the work environment cause an estimated 50,000 to 70,000 deaths and 350,000 new cases of illness each year in the United States; the asbestos pandemic will ultimately claim at least 300,000 lives; pediatric lead poisoning is epidemic, and an estimated 3 to 4 million US preschool children have blood lead levels above 10 micrograms/dl and could suffer long-term neuropsychological impairment. Prevention of environmental diseases can be achieved through legislation and regulation that control common-source exposures to chemical toxins. Modification of personal behaviors, such as tobacco and alcohol consumption, complements but does not replace control of toxic environmental exposures.