1. ENVIRONMENTAL AND OCCUPATIONAL

2. DOMESTIC/HOUSEHOLD

3. MEDICAL

• Radiation: diagnostic X-rays in late pregnancy; high-dose radiation CAT scans of infants and children

• Pediatric prescription drugs: Lindane shampoos; Ritalin, for treatment of attention deficit disorder

• Drugs prescribed during pregnancy: the estrogenic DES; the anti-epileptic Dilantin

NCI's silence on such causes of childhood cancer violates the charge of the 1971 National Cancer Act, launching President Nixon's War Against Cancer, "to disseminate cancer information to the public." This silence is also contrary to NCI's 1998 Congressional testimony that it had developed a public registry of avoidable carcinogens. Not surprisingly, the media remain as uninformed as the public. An April 1, 2003 New York Times article, "Success Stories Abound in Efforts to Prevent and Control Cancer," stated that while amazing progress has been made in treating childhood cancers, "their causes remain a mystery."

Besides the NCI and ACS silence on avoidable causes of childhood cancer, they have failed to provide scientific guidance to regulatory agencies, as reflected in their inconsistent and questionable policies. This is illustrated in the well-intentioned current proposal of the Scientific Advisory Board of the Environmental Protection Agency to develop new guidelines for regulating risks "from Early-Life Exposure to Carcinogens." These proposals, however, are based on attempting to quantify risks from individual carcinogens in air and water, without any recognition of their unpredictable additive or multiplicative effects. These proposals also ignore additional risks from a wide range of other carcinogens, such as those in food and cosmetics, regulated by the Food and Drug Administration, and such as household products including pesticides, regulated by the Consumer Product Safety Commission. Furthermore, EPA's proposals are flawed by unscientific assumptions, such as that safe levels of exposure to carcinogens can be theoretically quantified, and that risks based on evidence from rodent tests should be downgraded unless their mechanism of action can be shown to be the same as in humans.

The minimal priorities of the NCI and ACS for research and providing the public with information on avoidable causes of childhood cancers reflect imbalanced policies, and not lack of resources. NCI's annual budget has increased some 30-fold, from $220 million to $4.6 billion, since passage of the 1971 National Cancer Act. NCI expenditures on prevention of avoidable causes of cancer have been estimated as under 4% of its budget, while ACS has allocated less than 1% of its $800 million revenues, apart from $1 billion reserves, to "environmental carcinogenesis."

Clearly, the time for open public debate, and Congressional oversight of national cancer policy is long overdue.

For further details, see the February 2003 "Stop Cancer Before It Starts Campaign" report at www.preventcancer.com ; the report has been endorsed by over 100 scientific experts in cancer prevention, and representatives of environmental, consumer, and other activist groups.

Samuel S. Epstein, M.D., Chairman, Cancer Prevention Coalition, and Professor emeritus Environmental and Occupational Medicine, University of Illinois at Chicago School of Public Health, 312-996-2297; epstein@uic.edu.  5/8/03