Living with Cancer
by Susan Steingraber, PhD

In the summer between my sophomore and junior years in college, I was diagnosed with a type of bladder cancer called transitional cell carcinoma. It is something I have in common with at least one beluga whale in the St. Lawrence River.

The St. Lawrence slants through the Canadian province of Quebec and flares open like a trumpet as it pours itself into the North Atlantic. The neck of the Gulf of St. Lawrence is one of the world's deepest, longest estuaries. About 500 beluga whales, a remnant of the thousands that once lived here, inhabit this transition zone between river and ocean.

Belugas are small, toothed whales. Their skin is pure white. Transitional cell carcinoma among the belugas was first discovered during an autopsy of a carcass that washed ashore in 1985. It was a particularly provocative finding because workers in nearby aluminum smelters, which release their wastes into the St. Lawrence, had also been found to have an elevated incidence of this type of bladder cancer.

Gross hematuria, or noticeable blood in the urine, is the usual way bladder cancer presents itself. In my case, gross hematuria arrived as I was finishing a morning shift at a truck-stop diner. After making my final rounds with the ketchup bottles and syrup dispensers, I stopped in the restroom. Turning to flush, I froze. My urine looked like cherry Kool-Aid. I stood there a long time.

Whales and Cancer

Bladder cancer is only one of several cancers striking the beluga population of the St. Lawrence. Aluminum smelters and other industries lining the river basin have contaminated the region's waters with benzo[a]pyrene, a potent carcinogen.

In 1988, a team of veterinarians found tumors in the bodies of four dead whales that had washed up over a period of ten months along a polluted stretch of the river. The immature breast ducts of one young female showed an abnormal proliferation called ductal hyperplasia - a condition considered a strong risk factor for breast cancer in women.

To date, cancers identified in the beluga include bladder, stomach, intestinal, salivary gland, breast and ovarian. The prevalence of intestinal cancer is especially high. Of 73 stranded whales autopsied since 1983, 15 had cancerous tumors somewhere in their bodies, and one-third were intestinal tumors. No cases of cancer have been reported in belugas inhabiting the less-contaminated Arctic Ocean.

Even though belugas have been protected from hunting since the 1970s, their numbers have failed to rebound. Chemical analyses of their blubber have detected PCBs, DDT, chlordane and toxaphene - at some of the highest levels ever recorded in a living organism. All four chemicals are endocrine disrupters, as well as probable carcinogens. All were banned decades ago. All are very persistent.

Chlordane and Toxaphene

Unlike PCBs and DDT, chlordane and toxaphene do not have a history of use in the St. Lawrence basin. And yet these two chemicals are found in the waters and sediments of the estuary, presumably because they are carried into the seaway by winds blowing up from the southern US, where both were once used heavily. The St. Lawrence basin drains a 500,000-square-mile area and any contaminant that rains down within its vast perimeter is, sooner or later, flushed into the estuary.

There is another route of exposure. Beluga whales love to eat eels, which run through the deep Lawrentian channel on their autumn migration from Lake Ontario to the warm waters of the Sargasso Sea.

The eels may be the reason the belugas are contaminated with Mirex, a now-banned organochlorine pesticide that was once used against fire ants. There is no Mirex in the water of the lower St. Lawrence nor in its sediments and hardly any in the bodies of the estuary's other marine mammals. But there is Mirex in the flesh of St. Lawrence eels.

There are two sources of Mirex: a pesticide-manufacturing plant near Niagara and a river called the Oswego, where Mirex was once accidentally spilled. The eels are the apparent courier between these contaminated sites and the beluga whales living 600 miles away.

Staring Cancer in the Eye

Bathed in a brilliant yellow-green light, they look like bats floating in a perfectly round pond. I have seen many micrographs of cancerous tissue - reproduced neatly in atlases of human tumor cell lines or in the shiny pages of medical journals - but never before have I stared at living cancer cells.

"Now compare that one to this one."

The first petri dish is removed and replaced by another, and I look again through the microscope. In this second watery landscape, the cells look more like fallen leaves some drift together in large masses, others in smaller clusters.

"Okay, here's dish number three."

Now they are everywhere. A mosaic of islands and jutting peninsulas. Pieces of a crazy quilt tossed into a lake. A raft of vines tangled with shards of crockery. There is no one way to describe them.

These three different petri dishes contain estrogen-sensitive breast cancer cells derived from a human cell line called MCF-7. The first dish is the control: It contains no estrogen. The third dish was inoculated with estradiol, the most potent known form of human estrogen. It is also the dish with the most luxuriant growth.

It is the second dish, the one with the intermediate growth rate, that reveals the significant finding. Its culture medium has been laced with trace amounts of endosulfan, an organochlorine pesticide. These three dishes are part of a series of experiments showing that endosulfan - introduced in 1954 and now widely used on salad crops - is estrogenic. Like the hormone it mimics, endosulfan stimulates breast cancer cells to divide and multiply.

Studies have shown that endosulfan can act in concert with other xenoestrogens - chemicals foreign to the body that act like estrogens. Like raindrops eroding a boulder, quantities of weakly estrogenic chemicals too small to exert observable effects on their own, have a significant impact when combined. Furthermore, some xenoestrogens may have the ability to interact with naturally occurring estrogens and amplify their effect. If confirmed, this would imply that "safe" levels of exposure to individual estrogen-mimicking chemicals may not exist.

Toxaphene: Banned but Unbound

Using MCF-7 cells, Boston-based cell biologists Ana Soto and Carlos Sonnenschein have identified estrogenic activity in a variety of pesticides. Some, like endosulfan, are still in use. Others, such as dieldrin and toxaphene, are now banned.

That toxaphene - fat-soluble and stubbornly persistent - should prove estrogenic is particularly frightening. Identified as an animal carcinogen in 1979 and banned in 1982, toxaphene was once the most heavily used US insecticide. It was used in extraordinary quantities against boll weevils in cotton fields. In 1950, northern Alabama cotton fields received an average of 63 pounds per acre.

Rachel Carson denounced toxaphene as an indiscriminate killer of fish and, in Silent Spring, she detailed the die-offs of crappies, bass and sunfish in southern streams and farm ponds. Ironically, toxaphene rose to even greater popularity after DDT fell into disfavor.

When field researchers linked toxaphene to reproductive damage in seals and documented its ongoing accumulation in the muscle fat of Arctic and Baltic salmon, Soto and Sonnenschein decided to test its effects on human breast cancer cells. Not only does toxaphene cause MCF-7 cells to proliferate, the pair discovered, but it does so at levels well within the range of concentrations now found in the flesh of some salmon.

Remarkably, changes in the growth rate of breast cancer cells in a Boston laboratory may help elucidate the reasons for reproductive failures among sea mammals living thousands of miles away. And this evidence, in turn, may provide reasons for rising cancer rates among humans.

Cancer Dreams

Like breast cancer, bladder cancer can recur at any time. After lying quiescent for years - sometimes decades - it can reappearing inexplicably. "Once a year for life" is the National Cancer Institute's guideline regarding cystoscopic examination of the bladder in patients, beginning five years after diagnosis.

After five years, my checkups became annual and I was no longer tethered so tightly to the medical system. This change was almost unnerving - as though it were normal to think of the interior landscape of one's body as a study site that required constant data collection.

I accepted a fellowship in Costa Rica, where I be came involved in a field study of ghost crabs - delicate creatures that occupy burrows along the Pacific beaches at the edge of the rainforest. At the study's conclusion, the night before we were to fly out, I had a vivid dream:

I am walking by the ocean and discover a pale orange crab, big as a whale, washed up on the beach. It is dying. I lie down next to it and slowly it wraps a great, clawed arm around me. Reaching my arm over its carapaced body, I return the embrace. I am not afraid. As if in the final frame of a movie scene, giant letters appear in the sky above us, spelling out a single word - G-R-A-C-E.

Among those of us who had spent days out in the tropical sun trying to monitor the movements of these reclusive, lightning-fast animals, the dream was hugely funny. ("Sleep with any arthropods last night, Steingraber?") Not until I returned home did I connect the dream to the end of five intense years of monitoring the possible movements of cancer. Ghost crabs.

I mean to say two things here. First, even if the cancer never comes back, one's life is utterly changed. Second, in all the years I have been under medical scrutiny, no one has ever asked me about the environmental conditions where I grew up, even though bladder cancer in young women is highly unusual.

I was once asked if I had ever worked with dyes or had ever been employed in the rubber industry. (No and no.) Other than these two questions, no doctor, nurse, or technician has ever shown interest in probing the possible causes of my disease - even when I have introduced the topic. From my conversations with other cancer patients, I gather that such lack of curiosity in the medical community is the norm.

Risky Lifestyles or Chemical Inevitability?

In 1990, at the International Forum for the Future of the Beluga, the conservationist Leone Pippard of the Canadian Ecology Advocates asked the following questions:

Tell me, does the St. Lawrence beluga drink too much alcohol and does the St. Lawrence beluga smoke too much and does the St. Lawrence beluga have a bad diet… is that why the beluga whales are ill?… Do you think you are somehow immune and that it is only the beluga whale that is being affected?

Steadily increasing in incidence, bladder cancer is associated with a few lifestyle habits - especially cigarette smoking - as well as with more than a few occupations including dyeworkers, tiremakers, janitors, mechanics, miners, printers, hairdressers, painters, truck drivers, drill press operators and machinists.

Among US males, bladder cancer is significantly higher in counties with chemical-manufacturing plants. In 1984, bladder cancer was found in excess among inhabitants of Clinton County, Pennsylvania, where a 46-acre toxic waste site is contaminated with aromatic amines and benzene. In Massachusetts, bladder cancer has been linked to exposure to perchloroethylene from drinking-water pipes. In Taiwan, an investigation of bladder cancer deaths among children and adolescents found that almost all those afflicted lived within a few miles of three large petroleum and petrochemical plants.

As a woman with cancer who grew up in a county with 15 hazardous waste sites, several carcinogen-emitting industries and public water wells that, from time to time, showed detectable levels of toxic chemicals, I am less concerned about whether the cancer in my community is more directly connected to the dump sites, the air emissions, the occupational exposures, or the drinking water.

I am more concerned that the uncertainty over details is being used to call into doubt the fact that profound connections do exist between human health and the environment. I am more concerned that uncertainty is too often parlayed into an excuse to do nothing until more research can be conducted.

As a survivor of cancer and as a member of the most poisoned generation to come of adult age, I am more concerned that cooler heads did not prevail in the calm prosperity of peacetime, when careful consideration and a longer view on public health were once again permissible and necessary.

I am sorry that no one asked, "Is this the industrial path we want to continue along? Is this the most reasonable way to rid our dogs of fleas and our trees of gypsy moths? Is this the safest material for a baby's pacifier or for a tub of margarine?" And I am sorry that those who did ask such questions were not heard.

Sandra Steingraber, Ph.D., is a professor of biology and the co-author of The Spoils of Famine. She also serves on the National Action Plan on Breast Cancer. Excerpted from Living Downstream: An Ecologist Looks at Cancer and the Environment ©1997 by Sandra Steingraber. Reprinted by permission of Addison-Wesley Longman. All Rights Reserved.

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