55 unique chemical compounds used for fracking are known as probable or possible human carcinogens

Unconventional oil and gas development and risk of childhood leukemia: Assessing the evidence

2017 Study Highlights

  • Concerns exist about carcinogenic effects of unconventional oil & gas development.
  • We evaluated the carcinogenicity of 1177 water pollutants and 143 air pollutants.
  • These chemicals included 55 known, probable, or possible human carcinogens.
  • Specifically, 20 compounds had evidence of leukemia/lymphoma risk.
  • Research on exposures to unconventional oil & gas development and cancer is needed.

Abstract

The widespread distribution of unconventional oil and gas (UO&G) wells and other facilities in the United States potentially exposes millions of people to air and water pollutants, including known or suspected carcinogens. Childhood leukemia is a particular concern because of the disease severity, vulnerable population, and short disease latency. A comprehensive review of carcinogens and leukemogens associated with UO&G development is not available and could inform future exposure monitoring studies and human health assessments.

The objective of this analysis was to assess the evidence of carcinogenicity of water contaminants and air pollutants related to UO&G development.

We obtained a list of 1177 chemicals in hydraulic fracturing fluids and wastewater from the U.S. Environmental Protection Agency and constructed a list of 143 UO&G-related air pollutants through a review of scientific papers published through 2015 using PubMed and ProQuest databases.

We assessed carcinogenicity and evidence of increased risk for leukemia/lymphoma of these chemicals using International Agency for Research on Cancer (IARC) monographs.

The majority of compounds (> 80%) were not evaluated by IARC and therefore could not be reviewed. Of the 111 potential water contaminants and 29 potential air pollutants evaluated by IARC (119 unique compounds), 49 water and 20 air pollutants were known, probable, or possible human carcinogens (55 unique compounds). A total of 17 water and 11 air pollutants (20 unique compounds) had evidence of increased risk for leukemia/lymphoma, including benzene, 1,3-butadiene, cadmium, diesel exhaust, and several polycyclic aromatic hydrocarbons.

Though information on the carcinogenicity of compounds associated with UO&G development was limited, our assessment identified 20 known or suspected carcinogens that could be measured in future studies to advance exposure and risk assessments of cancer-causing agents.

Our findings support the need for investigation into the relationship between UO&G development and risk of cancer in general and childhood leukemia in particular.

Les liens entre les industries agroalimentaire et pharmaceutique

Interview de Vandana Shiva, Brut, Février 2019

Selon Vandana Shiva, des multinationales s’enrichissent en vendant des médicaments pour soigner des maladies qu’elles ont elles-mêmes provoquées.

L’écologiste Vandana Shiva dénonce le “cartel du poison”, Brut, Février 2019.

How can risks from nanotechnology be managed ?

The Essential Elements of a Risk Governance Framework for Current and Future Nanotechnologies

Currently laws and regulations governing nanotechnology are fragmented and do not take account of the unique properties of nanomaterials, the effect of which on humans and the environment are not yet fully understood, argue researchers in a new study.

In the study, a network of European researchers propose a new universal regulatory framework that deals specifically with nanomaterials. The framework should help policymakers, organisations and researchers evaluate the risks of any existing materials and new nanomaterials entering the market. It should also help SMEs and large companies use safer products and processes, limit the potential adverse effects of nanomaterials on workers and consumers, reduce the cost of insurance and reduce the risk of governments having to pay out money in the future due to unforeseen accidents or diseases.

2018 Study Abstract

Societies worldwide are investing considerable resources into the safe development and use of nanomaterials. Although each of these protective efforts is crucial for governing the risks of nanomaterials, they are insufficient in isolation. What is missing is a more integrative governance approach that goes beyond legislation. Development of this approach must be evidence based and involve key stakeholders to ensure acceptance by end users. The challenge is to develop a framework that coordinates the variety of actors involved in nanotechnology and civil society to facilitate consideration of the complex issues that occur in this rapidly evolving research and development area. Here, we propose three sets of essential elements required to generate an effective risk governance framework for nanomaterials.

  1. Advanced tools to facilitate risk-based decision making, including an assessment of the needs of users regarding risk assessment, mitigation, and transfer.
  2. An integrated model of predicted human behavior and decision making concerning nanomaterial risks.
  3. Legal and other (nano-specific and general) regulatory requirements to ensure compliance and to stimulate proactive approaches to safety.

The implementation of such an approach should facilitate and motivate good practice for the various stakeholders to allow the safe and sustainable future development of nanotechnology.

Disinfection by-products in drinking water : an emerging health concern

Evaluating gas chromatography with a halogen-specific detector for the determination of disinfection by-products in drinking water

DBPs come in many classes and are chemically diverse, making them challenging to monitor. Swedish researchers have evaluated a new method for the simultaneous determination of a broader range of DBPs than typically possible using other available techniques. The method uses gas chromatography (a laboratory technique that separates and analyses vaporisable compounds in a mixture), together with a halogen-specific detector (XSD). Having been tested in real water samples from two municipal waterworks in Sweden, the method has been optimised for the simultaneous determination of a wide range of neutral DBPs.

2018 Study Abstract

The occurrence of disinfection by-products (DBPs) in drinking water has become an issue of concern during the past decades. The DBPs pose health risks and are suspected to cause various cancer forms, be genotoxic, and have negative developmental effects. The vast chemical diversity of DBPs makes comprehensive monitoring challenging. Only few of the DBPs are regulated and included in analytical protocols. In this study, a method for simultaneous measurement of 20 DBPs from five different structural classes (both regulated and non-regulated) was investigated and further developed for 11 DBPs using solid-phase extraction and gas chromatography coupled with a halogen-specific detector (XSD). The XSD was highly selective towards halogenated DBPs, providing chromatograms with little noise. The method allowed detection down to 0.05 μg L−1 and showed promising results for the simultaneous determination of a range of neutral DBP classes. Compounds from two classes of emerging DBPs, more cytotoxic than the “traditional” regulated DBPs, were successfully determined using this method. However, haloacetic acids (HAAs) should be analyzed separately as some HAA methyl esters may degrade giving false positives of trihalomethanes (THMs). The method was tested on real water samples from two municipal waterworks where the target DBP concentrations were found below the regulatory limits of Sweden.

Evaluating the Strength of the Association Between Industry Payments and Prescribing Practices in Oncology

Doctor payments drove scripts for cancer drugs from Pfizer, Novartis and more: study

New study showed that physicians who received payments over three consecutive years and tied to a specific drug boosted their prescriptions of that product.

Abstract

Background
Financial relationships between physicians and the pharmaceutical industry are common, but factors that may determine whether such relationships result in physician practice changes are unknown.

Materials and Methods
We evaluated physician use of orally administered cancer drugs for four cancers: prostate (abiraterone, enzalutamide), renal cell (axitinib, everolimus, pazopanib, sorafenib, sunitinib), lung (afatinib, erlotinib), and chronic myeloid leukemia (CML; dasatinib, imatinib, nilotinib). Separate physician cohorts were defined for each cancer type by prescribing history. The primary exposure was the number of calendar years during 2013–2015 in which a physician received payments from the manufacturer of one of the studied drugs; the outcome was relative prescribing of that drug in 2015, compared with the other drugs for that cancer. We evaluated whether practice setting at a National Cancer Institute (NCI)‐designated Comprehensive Cancer Center, receipt of payments for purposes other than education or research (compensation payments), maximum annual dollar value received, and institutional conflict‐of‐interest policies were associated with the strength of the payment‐prescribing association. We used modified Poisson regression to control confounding by other physician characteristics.

Results
Physicians who received payments for a drug in all 3 years had increased prescribing of that drug (compared with 0 years), for renal cell (relative risk [RR] 1.81, 95% confidence interval [CI] 1.58–2.07), CML (RR 1.22, 95% CI 1.08–1.39), and lung (RR 1.69, 95% CI 1.58–1.82), but not prostate (RR 0.97, 95% CI 0.93–1.02). Physicians who received compensation payments or >$100 annually had increased prescribing compared with those who did not, but NCI setting and institutional conflict‐of‐interest policies were not consistently associated with the direction of prescribing change.

Conclusion
The association between industry payments and cancer drug prescribing was greatest among physicians who received payments consistently (within each calendar year). Receipt of payments for compensation purposes, such as for consulting or travel, and higher dollar value of payments were also associated with increased prescribing.

Implications for Practice
Financial payments from pharmaceutical companies are common among oncologists. It is known from prior work that oncologists tend to prescribe more of the drugs made by companies that have given them money. By combining records of industry gifts with prescribing records, this study identifies the consistency of payments over time, the dollar value of payments, and payments for compensation as factors that may strengthen the association between receiving payments and increased prescribing of that company’s drug.

Press release.

FIGO Cancer Report 2018

Presention of the management of gynecological cancers

The FIGO Committee for Gynecologic Oncology is pleased to present the third edition of the FIGO Cancer Report. Since 2012, this report has been presented triennially in the current format, which aims to present the state of the art management of gynecological cancers in our endeavor to ensure women worldwide receive an acceptable standard of care. The excellent readership of the previous edition encouraged us to produce an updated edition. A series of carefully reviewed and presented articles covers each of the gynecologic cancers. Chapters on pathology, targeted therapy, psychosexual health, and end‐of‐life care have been updated. New chapters have been added on surgical anatomy in gynecologic oncology, essential surgical skills for gynecologic oncologists, enhanced recovery after surgery, role of imaging in endometrial cancer, and cancer in pregnancy. This edition is Open Access to ensure wide dissemination. The 2015 edition of the Cancer Report was translated into Portuguese and Spanish, and the 2018 edition will also be translated to ensure greater readership.

Undeniably, this does not do away with the need for data. The situational analysis done during the tenure of the previous committee had indicated the need to position dedicated data entry managers to get good quality data from low‐ and middle‐income countries (LMICs). However, this project could not find funding. It is apparent that in these days of widespread internet use and mobile health, new methods will have to be found. The Committee initiated a survey to understand changing practices, the results of which will be presented at the XXII FIGO World Congress, held in Rio de Janeiro, Brazil, October 14–19, 2018. It is hoped that increased use of these techniques will bring more insights.

In the last three years, FIGO Gynecologic Oncology Committee members have been actively engaged in organizing and participating in several educational activities including conferences, workshops, and training programs in various countries. They have developed educational aids including handbooks and slide sets. An e‐learning course in collaboration with the Catalan Institute of Oncology (ICO) has been implemented. Cadaver training programs have been initiated for skills development in open and laparoscopic surgery. A smartphone mobile application (free to download and use ofline) for staging and resource‐based management of gynecologic cancers was developed in collaboration with the International Atomic Energy Agency (IAEA).

One of the major objectives of the Committee has been to work with governments to inform policy regarding the implementation of the HPV vaccine program. Members have been engaged in advising various governments during this period. The Committee has collaborated with international and nongovernmental organizations to support this cause in different regions.

By far one of the most challenging tasks undertaken by the Committee was the revision of the staging of cervical cancer. Hitherto staged by clinical methods only, it was insensitive to the advances in technology that had improved the quality of imaging and brought in minimally invasive surgery to facilitate access. However, being a disease largely confined to LMICs, there was widespread belief that a revision would not be applicable where it was needed most. Various rounds of discussions, extensive literature review, interaction, face‐to‐face meetings with the major gynecologic oncology societies internationally, in collaboration with the International Union for Cancer Control (UICC) and the American Joint Commission on Cancer (AJCC), finally resolved the impasse and the 2018 revision now allows the use of imaging and pathology in a way that can be practiced at all levels of resources. The revised staging has been endorsed by the FIGO Executive Board and will be published in the International Journal of Gynecology and Obstetrics (IJGO).

The members of the FIGO Committee for Gynecologic Oncology during this term were: Neerja Bhatla (Chair), India; Kanishka Karunaratne (Co‐Chair), Sri Lanka; Lynette Denny (Immediate Past Chair), South Africa; Seija Grenman (Vice President FIGO, Ex officio member), Finland; Jonathan Berek, USA; Mauricio Cuello Fredes, Chile; Sean Kehoe, UK; Ikuo Konishi, Japan; Alexander Olawaiye, USA; Jaime Prat, Spain; Rengaswamy Sankaranarayanan, France.

Going forward, the Committee will continue its work on FIGO staging, the next cancer to be updated will be cancer of the vulva. FIGO also hopes to work closely with WHO in response to the call for elimination of cervical cancer. Collaboration with the International Agency for Research on Cancer (IARC) will help to gain insights on incidence and survival statistics from different regions to understand the inequities and direct our efforts to promote appropriate education and skills training as we work together to lessen the burden of gynecologic cancers.

Reference. FIGO Cancer Report 2018.

Impact of upstream oil extraction and environmental public health : A review of the evidence

There are approximately 40,000 oil fields globally and 6 million people that live or work nearby

Highlights

  • Identifies 63 studies on the exposure and health risks related to oil extraction
  • Examines the human health effects of oil drilling
  • Discusses potential exposure pathways via include air, soil, water and waste fluids

Abstract

Upstream oil extraction, which includes exploration and operation to bring crude oil to the surface, frequently occurs near human populations. There are approximately 40,000 oil fields globally and 6 million people that live or work nearby. Oil extraction can impact local soil, water, and air, which in turn can influence community health. As oil resources are increasingly being extracted near human populations, we highlight the current scope of scientific knowledge regarding potential community health impacts with the aim to help identify scientific gaps and inform policy discussions surrounding oil drilling operations.

In this review, we assess the wide range of both direct and indirect impacts that oil drilling operations can have on human health, with specific emphasis on understanding the body of scientific literature to assess potential environmental and health risks to residents living near active onshore oil extraction sites. From an initial literature search capturing 2236 studies, we identified 22 human studies, including 5 occupational studies, 5 animal studies, 6 experimental studies and 31 oil drilling-related exposure studies relevant to the scope of this review.

The current evidence suggests potential health impacts due to exposure to upstream oil extraction, such as cancer, liver damage, immunodeficiency, and neurological symptoms. Adverse impacts to soil, air, and water quality in oil drilling regions were also identified. Improved characterization of exposures by community health studies and further study of the chemical mixtures associated with oil extraction will be critical to determining the full range of health risks to communities living near oil extraction.

Exposure to Glyphosate-Based Herbicides and Risk for Non-Hodgkin Lymphoma

A Meta-Analysis and Supporting Evidence, Mutation Research/Reviews, February 2019

Abstract

Glyphosate is the most widely used broad-spectrum systemic herbicide in the world. Recent evaluations of the carcinogenic potential of glyphosate-based herbicides (GBHs) by various regional, national, and international agencies have engendered controversy.

We investigated whether there was an association between high cumulative exposures to GBHs and increased risk of non-Hodgkin lymphoma (NHL) in humans. We conducted a new meta-analysis that included the most recent update of the Agricultural Health Study (AHS) cohort published in 2018 along with five case-control studies.

Using the highest exposure groups when available in each study, we report the overall meta-relative risk (meta-RR) of NHL in GBH-exposed individuals was increased by 41% (meta-RR = 1.41, 95% CI, confidence interval: 1.13–1.75). For comparison, we also performed a secondary meta-analysis using high-exposure groups with the earlier AHS (2005), and we determined a meta-RR for NHL of 1.45 (95% CI: 1.11–1.91), which was higher than the meta-RRs reported previously. Multiple sensitivity tests conducted to assess the validity of our findings did not reveal meaningful differences from our primary estimated meta-RR. To contextualize our findings of an increased NHL risk in individuals with high GBH exposure, we reviewed available animal and mechanistic studies, which provided supporting evidence for the carcinogenic potential of GBH. We documented further support from studies of malignant lymphoma incidence in mice treated with pure glyphosate, as well as potential links between GBH exposure and immunosuppression, endocrine disruption, and genetic alterations that are commonly associated with NHL.

Overall, in accordance with evidence from experimental animal and mechanistic studies, our current meta-analysis of human epidemiological studies suggests a compelling link between exposures to GBHs and increased risk for NHL.

 

Reference. Image credit gmwatch.

Financial toxicity: cancer treatment’s side effect

The shock and anxiety of a cancer diagnosis can be followed by a second jolt: the astronomical price of cancer drugs

Presented by Arjun Rajagopalan,
uploaded on SlideShare. Watch it full screen.

The mechanism by which a drug’s market price is fixed is opaque and mostly arbitrary. Medical research, particularly new drug discovery, is a very expensive endeavour; the drug industry uses this argument to price new drugs at levels that are breathtakingly high. With the backing of currently enforced patent protection laws, drug companies can insulate themselves against market forces that are operational in most other consumer markets where competition assures reasonable prices. The Indian drug industry which used to pride itself on its ability to reverse engineer and deliver generics substitutes at low prices, can no longer indulge in this tactic.

Cancer treatment is a large area of interest for drug research. Unlike other noncommunicable diseases like hypertension, diabetes and the like, patients with a diagnosis of cancer are usually keen to seek the best available treatments. Newer generations of cancer drugs are priced at astounding figures. Treatment costs can exceed 100,000 US dollars a year. Even for those in wealthy, developed nations, the burden can lead to far reaching domains: a complication that has been labeled as “financial toxicity”.

Quand le prix élevé et insupportable des médicaments devient un effet secondaire du cancer

Très chères minutes de vie, Luc Perino, 2018

Publié par Luc Perino, médecin généraliste, humeur du 22/10/2018

En cancérologie de l’adulte, la chirurgie et la radiothérapie ont permis de prolonger la vie de certains patients. On a longtemps et honnêtement pensé que la pharmacologie pourrait encore améliorer les choses. Mais depuis une vingtaine d’années, les études indépendantes montrent l’inefficacité globale des anticancéreux anciens ou modernes.

Pour évaluer l’action des anticancéreux lors des essais cliniques, on utilise principalement trois critères :

  1. les biomarqueurs (analyses biologiques),
  2. l’amélioration clinique
  3. et la survie sans progression tumorale.

Il s’agit de critères dits « intermédiaires ». Le seul critère important pour le patient et ses proches étant celui de la survie globale assortie ou non d’une qualité de vie acceptable. Les critères intermédiaires ne sont que des leurres. Certes la baisse d’un biomarqueur ou la diminution du volume tumoral à l’imagerie sont une grande source de satisfaction pour les patients et les médecins, mais elles ne sont pas corrélées à une augmentation de la quantité-qualité de vie.

Il peut paraître cruel de dire les choses aussi brutalement, mais peut-on vraiment faire progresser la médecine sans admettre les faits cliniques ?

Par rapport aux anciens antimitotiques, les nouvelles thérapies ciblées, et plus récemment, les immunothérapies, ont trois caractéristiques nouvelles :

  1. un support théorique séduisant,
  2. des tests de surveillance auto-satisfaisants
  3. et un coût faramineux.

Hélas, à une ou deux fragiles exceptions près, elles ne prolongent la vie que de quelques mois ou semaines.

Ces coûts exorbitants et injustifiés ont deux effets pervers inattendus.

  1. D’une part, ils deviennent la plus importante part de l’effet placebo,
  2. d’autre part, en politisant le sujet, ils majorent les revendications des associations de patients.

« Le cancer est un fléau » et « la vie n’a pas de prix » sont devenus des arguments indirects bougrement efficaces qui détournent l’attention hors de l’examen objectif des résultats. Les lobbyistes de l’industrie ont bien compris la puissance de ces arguments indirects et ils misent diaboliquement sur la détresse des patients en utilisant leurs associations pour faire pression sur les ministères. Ils savent aussi que les élus sont piégés par l’électoralisme et la démagogie et que les médias sont à l’affut de leurs moindres ambiguïtés.

Enfin, la validation de ces supercheries par les agences du médicament soulève inévitablement la question de la corruption.

Quand bien même certaines thérapies feraient gagner quelques minutes de vie, aucune société, quel que soit son niveau de richesse, de compassion ou de solidarité, ne peut supporter les coûts indécents de chacune de ces minutes, sans se mettre toute entière en péril.

Il est difficile d’expliquer ceci à des patients en détresse et à leurs proches, mais ce n’est pas une raison pour laisser de séduisantes théories renouer avec l’obscurantisme médical des siècles d’antan.

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