Workshop report: environmental exposures and cancer prevention. (Workshop Report).The Workshop on Environmental Exposures and Cancer was held by Cancer Care Ontario (CCO (Chief or Corporate Compliance Officer) The executive person in charge of compliance issues, regulatory requirements, internal controls and managing audits within an enterprise or organization. ) 25-26 April 2001. An expert panel convened to achieve consensus on a list of important environmental exposures, priority environmental exposures in Ontario, and recommendations for CCO in the areas of surveillance, research, and prevention activities to address these environmental exposures. Panel members developed a working definition of environmental exposure and criteria to prioritize pri·or·i·tize v. pri·or·i·tized, pri·or·i·tiz·ing, pri·or·i·tiz·es Usage Problem v.tr. To arrange or deal with in order of importance. v.intr. the identified exposures. The process followed in the workshop provided CCO with important direction for its surveillance, research, and prevention activities to address environmental exposures and cancer. It is hoped that the environmental exposures and the opportunities identified through this workshop process will guide policy makers, program personnel, and researchers interested in and struggling with the challenges associated with surveillance, research, and prevention of environmental exposures. Key words: cancer control, environment, exposure, prevention, research, risk, surveillance. Environ en·vi·ron tr.v. en·vi·roned, en·vi·ron·ing, en·vi·rons To encircle; surround. See Synonyms at surround. [Middle English envirounen, from Old French environner Health Perspect 111:105-108 (2003). [Online 9 December 2002] doi: 10.1289/ehp.5384 available via http://dx.doi.org/ ********** Cancer is the second leading cause of death in Ontario after cardiovascular diseases Cardiovascular disease Disease that affects the heart and blood vessels. Mentioned in: Lipoproteins Test cardiovascular disease . The National Cancer Institute of Canada estimates that in Ontario 50,200 men and women will be diagnosed with, and 23,800 people will die from, cancer in 2001 (1). As the population grows and ages, and as techniques to detect cancer in its early stages are more systematically applied and improved, the number of people diagnosed with cancer will continue to rise. It has been estimated that, if current trends continue, the number of new cancer cases will increase by 40% by the year 2010 (2). Unless mortality rates for cancer decline as significantly as they have for cardiovascular diseases, cancer will likely become the leading cause of death in Ontario within a few decades. Given the challenges that exist in treating cancer effectively (3), prevention strategies represent an essential part of cancer control. Effective prevention initiatives can decrease cancer incidence and mortality by [greater than or equal to] 50% (4). The potential benefits of prevention initiatives are underscored by the knowledge that most cancers are caused by "environmental" (i.e., nongenetic) factors. The majority of such cancers are attributed to behavioral and lifestyle factors, viral agents, occupational exposures, and dietary factors. The proportion of cancers attributable to agents found in our physical environment (e.g., environmental pollutants environmental pollutants, n.pl the substances and conditions, including noise, that adversely affect the health and well-being of the people within a community. , ionizing and nonionizing radiation) has been estimated to be relatively small, < 5% of all cancers (5). This comparatively low estimate of attributable risk attributable risk Epidemiology Any factor which ↑ the risk of suffering a particular condition. See Relative risk, Risk factor. Cf Nonattributable risk Statistics The rate of a disorder in exposed subjects that is attributable to the exposure derived from should be interpreted with caution, however, in light of the methodologic problems of epidemiologic studies epidemiologic study A study that compares 2 groups of people who are alike except for one factor, such as exposure to a chemical or the presence of a health effect; the investigators try to determine if any factor is associated with the health effect in assessing the impact of environmental exposures and cancer risk--most notably problems in exposure measurement and identification of adequate control populations (6). The attributable risk of some environmental exposures will also be greater among some segments of the population, including those with gene polymorphisms that may leave them more susceptible to exposure effects. Moreover, the health risks of environmental contaminants are not limited to cancer risk. Despite their seemingly seem·ing adj. Apparent; ostensible. n. Outward appearance; semblance. seem  ing·ly adv. low impact on the overall burden of cancer,
environmental contaminants and ionizing and nonionizing radiation are a
source of great concern to the general public. In a 1992 survey by
Health Canada Health Canada (French: Santé Canada) is the department of the government of Canada with responsibility for national public health.Health Canada's goal is to improve Canadian life by improving Canadian longevity, lifestyle and use of public healthcare. (7), > 90% of respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. believed that the air, water, and land were more contaminated contaminated, v 1. made radioactive by the addition of small quantities of radioactive material. 2. made contaminated by adding infective or radiographic materials. 3. an infective surface or object. than ever before, and > 75% responded that strict environmental regulation should continue. Survey respondents indicated a high level of concern over chemical products, pollution, nuclear waste, and ozone depletion Ozone depletion describes two distinct, but related observations: a slow, steady decline of about 4 percent per decade in the total amount of ozone in Earth's stratosphere since around 1980; and a much larger, but seasonal, decrease in stratospheric ozone over Earth's polar regions and an unwillingness to accept some health risks to aid the economy. Much of the public concern regarding environmental exposures focuses on the cancer burden, and the combination of pollution and cancer is, in the mind of the public, explosive. Spurred in part by public interest and in part by an acknowledgment acknowledgment, in law, formal declaration or admission by a person who executed an instrument (e.g., a will or a deed) that the instrument is his. The acknowledgment is made before a court, a notary public, or any other authorized person. that reduction of environmental exposure must be a component of a comprehensive cancer control strategy, the strategic plan of Cancer Care Ontario (CCO) recognizes the importance of environmental exposures vis-a-vis cancer in Ontario. Thus, CCO undertook the task of identifying its role concerning environmental exposures and cancer risk, with respect to the potential areas of surveillance, research, and prevention. The process involved key informant informant Historian Medtalk A person who provides a medical history interviews with research scientists active in the area of environment and cancer, followed by a 2-day workshop with a group of experts. The goal of the workshop was to develop consensus on priorities and recommendations for CCO regarding surveillance, research, and prevention. Key Informant Interviews to Identify Important Environmental Exposures We conducted key informant interviews (8) with 14 scientists working in government, academia, and cancer control agencies in Canada, the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , and Europe. The scientists, identified through a process of networking with individuals conducting research in the broad area of environmental exposures and health, represented the disciplines of human physiology Human physiology is the science of the mechanical, physical, and biochemical functions of humans in good health, their organs, and the cells of which they are composed. The principal level of focus of physiology is at the level of organs and systems. , toxicology toxicology, study of poisons, or toxins, from the standpoint of detection, isolation, identification, and determination of their effects on the human body. Toxicology may be considered the branch of pharmacology devoted to the study of the poisonous effects of drugs. , epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause , environmental biology, occupational hygiene Occupational Hygiene is both a technical field of study and a profession. The term Occupational Hygiene (used in the UK and Commonwealth Countries as well as much of Europe) is synonymous with Industrial Hygiene , environmental health, risk assessment, public health, and radiation biology Radiation biology The study of the action of ionizing and nonionizing radiation on biological systems. Ionizing radiation includes highly energetic electromagnetic radiation (x-rays, gamma rays, or cosmic rays) and particulate radiation (alpha particles, beta . The key informant questionnaire (Table 1) was a semi-structured telephone interview, which asked respondents to identify the 10 most important environmental exposures. All interviews were conducted by two of us, and the extensive notes were written in narrative form immediately after the interview. This procedure yielded more than 30 exposures, grouped into the following 13 areas (listed in alphabetical order): asbestos asbestos, mineral asbestos, common name for any of a variety of silicate minerals within the amphibole and serpentine groups that are fibrous in structure and more or less resistant to acid and fire. , combustion by-products, electromagnetic fields electromagnetic field Property of space caused by the motion of an electric charge. A stationary charge produces an electric field in the surrounding space. If the charge is moving, a magnetic field is also produced. A changing magnetic field also produces an electric field. , endocrine disruptors Endocrine disruptors are exogenous substances that act like hormones in the endocrine system and disrupt the physiologic function of endogenous hormones. Studies have linked endocrine disruptors to adverse biological effects in animals, giving rise to concerns that low-level , environmental tobacco smoke environmental tobacco smoke (ETS/passive smoke), n the gaseous by-product of burning tobacco products, including but not limited to commercially manufactured cigarettes and cigars; contains toxic elements harmful to the health of adults and children , medical/dental radiation, outdoor air pollution, persistent organic pollutants Persistent organic pollutants (POPs) are organic compounds that are resistant to environmental degradation through chemical, biological, and photolytic processes.[1] , pesticides, radio frequency waves, radon, ultraviolet An invisible band of radiation at the upper end of the visible light spectrum. With wavelengths from 10 to 400 nm, ultraviolet starts at the end of visible light and ends at the beginning of X-rays. The primary source of ultraviolet light is the sun. radiation, and water disinfection disinfection, n the process of destroying pathogenic organisms or rendering them inert. disinfection, full oral cavity, n a procedure used to reduce active periodontal disease, usually completed within a certain short time frame. by-products. This list provided the basis upon which workshop participants could discuss, clarify, augment aug·ment v. aug·ment·ed, aug·ment·ing, aug·ments v.tr. 1. To make (something already developed or well under way) greater, as in size, extent, or quantity: , and set priorities for CCO's work relating to relating to relate prep → concernant relating to relate prep → bezüglich +gen, mit Bezug auf +acc environmental exposures. In this article we describe the results and recommendations of the workshop. The Workshop The Workshop on Environmental Exposures and Cancer, held in Toronto on 25-26 April 2001, convened an expert panel of five scientists from academia and government in Ontario and Quebec, Canada, the United States, and Germany. Two of the panel members had participated in the earlier key informant interview process. Four scientists from within CCO were invited to attend as observers (Appendix 1). Goal and Objectives of the Workshop The workshop's objectives were to achieve full consensus on a list of important environmental exposures, priority environmental exposures in Ontario, and recommendations for CCO in the areas of surveillance, research, and prevention activities to address these environmental exposures. Consensus was not difficult' to achieve once the definition and assessment criteria were agreed upon Adj. 1. agreed upon - constituted or contracted by stipulation or agreement; "stipulatory obligations" stipulatory noncontroversial, uncontroversial - not likely to arouse controversy . Workshop materials, structure, and agenda. Before the workshop, participants were sent an agenda, a list of fellow participants, and copies of some relevant background reading (1,3-5). The preworkshop package also included a questionnaire containing the list of the potentially important environmental exposures in Ontario that derived from the key informant interviews. The questionnaire asked participants to make a professional assessment of the important exposures relevant to the role of CCO as a provincial cancer control agency, with respect to surveillance, research, and prevention. Specifically, participants were asked to a) review and, if necessary, add to the list of environmental exposures provided by key informants that are a priority for Ontario; b) prioritize the list of exposures (and any exposures they added) in terms of their importance; and c) give their opinions regarding the next steps for action (surveillance, research, and prevention) for each of the priority environmental exposures. Participants were asked to submit their completed questionnaires before the workshop so that the responses could be collated for presentation early in the discussion. The workshop agenda called for a full day to discuss and review the list of environmental carcinogens Carcinogens Substances in the environment that cause cancer, presumably by inducing mutations, with prolonged exposure. Mentioned in: Colon Cancer, Rectal Cancer and to begin to develop a consensus on the list of priority exposures. The second day was reserved to complete the consensus process and to develop specific recommendations concerning the role of CCO to address surveillance, research, and prevention regarding environmental exposures and cancer. Results of Workshop The workshop opened with a presentation on the context and rationale for CCO hosting a workshop on environmental exposures and cancer prevention. This was followed by a summary of the results of the preworkshop survey and general discussion of the list of environmental carcinogens generated through the key informant interviews. It became clear in this discussion that workshop participants needed to establish a working definition of environmental exposures before the participants could develop a list of exposures to discuss. Workshop participants also identified the need to develop criteria to be used to prioritize the exposures. Defining "environmental exposures." The panel of experts agreed to define "environmental exposures," for the purpose of the workshop, as "natural and anthropogenic an·thro·po·gen·ic adj. 1. Of or relating to anthropogenesis. 2. Caused by humans: anthropogenic degradation of the environment. chemical and physical hazards in air, water, soil, foods (i.e., food contaminants Food contamination refers to the presence in food of harmful chemicals and microorganisms which can cause consumer illness. This article addresses the chemical contamination of foods, as opposed to microbiological contamination, which can be found under Foodborne illness. , not natural food toxins), consumer products, and our climate to which people may be exposed, usually involuntarily in·vol·un·tar·y adj. 1. Acting or done without or against one's will: an involuntary participant in what turned out to be an argument. 2. because of the need to eat, drink, and breathe in Verb 1. breathe in - draw in (air); "Inhale deeply"; "inhale the fresh mountain air"; "The patient has trouble inspiring"; "The lung cancer patient cannot inspire air very well" inhale, inspire order to live" (9). The working definition allowed for the inclusion of food contaminants such as pesticides applied to fruits and vegetables, but excluded diet itself. Lifestyle factors (smoking and physical activity), iatrogenic iatrogenic /iat·ro·gen·ic/ (i-a´tro-jen´ik) resulting from the activity of physicians; said of any adverse condition in a patient resulting from treatment by a physician or surgeon. exposures (e.g., medical and dental radiation), and infectious agents infectious agent Pathogen, see there were also excluded from the definition. Identifying important environmental exposures. Based on the working definition of environmental exposures described above, consensus was achieved on the list of important exposures to be prioritized; Table 2 lists these exposures. Prioritizing environmental exposures. A key discussion was the establishment of criteria to enable prioritization of the important environmental exposures. These criteria would subsequently be applied to the exposure list to derive relative rankings around which would revolve re·volve v. re·volved, re·volv·ing, re·volves v.intr. 1. To orbit a central point. 2. To turn on an axis; rotate. See Synonyms at turn. 3. the discussion concerning recommendations. The panel first identified potential criteria for prioritizing the environmental exposures. Workshop participants subsequently discussed these criteria to derive a framework to prioritize the environmental exposures. The framework rested on deriving answers to four key questions: * How strong is the evidence of an association between the environmental exposure and the occurrence of cancer? * How large is the problem relating to the exposure (e.g., prevalence of exposure, incidence of outcome, and magnitude of effect)? * Is there public concern or pressure for a response regarding control of exposure levels? * How does this apply to Ontario? These key questions were answered for each of the environmental exposures identified in Table 2 to produce a list of exposures, prioritized for further consideration: ultraviolet radiation; environmental tobacco smoke; polycyclic aromatic hydrocarbons polycyclic aromatic hydrocarbon n. Any of a class of carcinogenic organic molecules that consist of three or more rings containing carbon and hydrogen and that are commonly produced by fossil fuel combustion. , other outdoor air pollutants pollutants see environmental pollution. , and other combustion by-products; asbestos; water disinfection by-products; electromagnetic fields; endocrine disruptors; radon; pesticides; radio frequency waves; dump site contaminants; and heavy metals heavy metals, n.pl metallic compounds, such as aluminum, arsenic, cadmium, lead, mercury, and nickel. Exposure to these metals has been linked to immune, kidney, and neurotic disorders. . Other exposures listed in Table 2 were deleted Deleted A security that is no longer included on a specified market. Sometimes referred to as "delisted". Notes: Reasons for delisting include violating regulations, failing to meet financial specifications set out by the stock exchange and going bankrupt. from further consideration during the prioritization process. Recommendations for surveillance, research, and prevention activities. Recommendations were framed as either generic to any environmental exposure or specific to a particular exposure or group of exposures. The generic recommendations for surveillance initiatives were to a) identify and become knowledgeable about existing surveillance initiatives and databases (e.g., water quality, environmental tobacco smoke, emissions, dump sites) and b) design and implement new surveillance initiatives targeting exposures that are not currently monitored (e.g., radon, asbestos, dump sites, electromagnetic fields, pesticides, and heavy metals). These new initiatives might be as simple as adding relevant questions to existing population surveys. The generic recommendations for research were to a) conduct literature reviews to determine the strength of the evidence regarding specific environmental exposures and to identify opportunities for further research and b) monitor research in the areas of electromagnetic fields, endocrine disruptors, and radio frequency waves. The generic recommendations for prevention were to a) develop partnerships with organizations with common interests and objectives; b) assist with the evaluation of environmental exposure prevention programs implemented by other organizations; c) identify and communicate new evidence about environmental exposures and cancer to other organizations and stakeholder stakeholder n. a person having in his/her possession (holding) money or property in which he/she has no interest, right or title, awaiting the outcome of a dispute between two or more claimants to the money or property. groups; and d) provide technical support to organizations and stakeholder groups, as required. Specific recommendations also arose, tailored to the needs around particular exposures and focused on surveillance, research, or prevention. These recommendations are shown in Table 3. Discussion The main result of the workshop on environmental exposure and cancer prevention was to provide concrete guidance for CCO on how to focus its attention productively on important environmental exposures. Workshop participants were invited to make recommendations in the context of surveillance, research, and prevention initiatives, recognizing that CCO must determine, based on its resources and capacity, the extent to which it can develop and implement these initiatives. Workshop participants were able to identify important environmental exposures possibly associated with cancer risk in Ontario. In order to do so, they developed a working definition of environmental exposures. It is important to acknowledge that this definition may be incomplete or may not be acceptable to all scientists, policy makers, and program personnel working in the field of environmental exposures and cancer (e.g., early in the process, some key informants had identified high-fat diet high-fat diet A diet rich in fats, often saturated–animal or tropical oils—fats Adverse effects Arthritis, CA, vascular disease, DM, HTN, obesity, stroke. See Fat, Fatty acids, Saturated fat acis, Cf Low-fat diet. and sexual activity as "environmental" exposures). Finally, different criteria than those identified by the workshop participants might be used to rank environmental exposures and cancer risk. This process has enabled a substantial reduction of the number of environmental exposures requiring consideration by a cancer control agency. Professional assessment and consensus, rather than quantitative meta-analysis, is a highly efficient and effective means of directing attention to a) a limited (and manageable) number of high-priority exposures, among the myriad possible "contenders," and b) the activity (surveillance, research, prevention) required at present for each of the exposures. Given finite public health resources, it is necessary for a public agency to follow a somewhat restricted path, one that offers the greatest probability of yielding new knowledge and new public policy. It is interesting that the literature has been rather silent on these issues, even as public agencies, including those devoted to cancer control as well as those more broadly involved with public health, struggle to identify important exposures and actions to reduce their impact. The priority environmental exposures that emerged from the workshop passed a test of "face validity face validity (fāsˑ v  ·liˑ·di·tē),n ," and consensus was obtained from this diverse group of scientists. As new evidence emerges, the list of environmental exposures may (and likely will) change, precipitating pre·cip·i·tate v. pre·cip·i·tat·ed, pre·cip·i·tat·ing, pre·cip·i·tates v.tr. 1. To throw from or as if from a great height; hurl downward: renewed discussion of the emphasis placed on these exposures with respect to the activities of surveillance, research, and prevention. Thus, there is a need to establish a process by which CCO may identify new carcinogens, rather than to assume that a one-time workshop can provide all the answers. The incidence of cancer is increasing in Ontario, and there is substantial public concern over the extent to which the environment plays a role in the onset of cancer. A number of community-based organizations have adopted position statements for public education on environmental contaminants and cancer risk (10,11). The process followed in the workshop provided CCO with important direction for its surveillance, research, and prevention activities to address environmental exposures and cancer, as the beginning of a multistage mul·ti·stage adj. 1. Functioning in more than one stage: a multistage design project. 2. Relating to or composed of two or more propulsion units. project. Activities are under way within CCO to review the literature on the identified environmental exposures and cancer risk, with a view to focusing more closely on specific opportunities for activities in surveillance, research, and prevention in conjunction with other interested agencies. It is hoped that the environmental exposures and the opportunities identified through this workshop process will guide policy makers, program personnel, and researchers interested in and struggling with the challenges associated with surveillance, research, and prevention of environmental exposures. Appendix 1. Participants of the Environmental Exposures and Cancer Prevention Workshop, Cancer Care Ontario, 25-26 April 2001. Expert Panel Aaron Blair Occupational Epidemiology Branch Division of Cancer Epidemiology and Genetics National Cancer institute Rockville, Maryland Rockville is the county seat of Montgomery County, Maryland, United States. According to the 2006 census update, the city had a total population of 59,114, making it the second largest city in Maryland. , USA John Eyles School of Geography and Geology McMaster University McMaster University, at Hamilton, Ont., Canada; nondenominational; founded 1887. It has faculties of humanities, science, social sciences, business, engineering, and health sciences, as well as a school of graduate studies and a divinity college. Hamilton, Ontario, Canada Anthony Miller Anthony Miller may refer to:
Jack Siemiatycki INRS-Institut Armand-Frappier Level, Quebec, Canada Don Wigle (a) Cancer Bureau Population and Public Health Branch Health Canada Ottawa, Ontario, Canada Observers Nancy Kreiger (b) Division of Preventive Oncology oncology /on·col·o·gy/ (ong-kol´ah-je) the sum of knowledge regarding tumors; the study of tumors. on·col·o·gy n. Cancer Care Ontario Toronto, Ontario, Canada Loraine Marrett (b) Division of Preventive Oncology Cancer Care Ontario Toronto, Ontario, Canada Mark Purdue (b) Division of Preventive Oncology Cancer Care Ontario Toronto, Ontario, Canada Terry Sullivan Terry Sullivan was a fictional character in the British Soap opera Brookside, played by Brian Regan. Terry first appeared a few episodes after the series made its debut in 1982. Division of Preventive Oncology Cancer Care Ontario Toronto, Ontario, Canada Facilitator Fred Ashbury (b) PICEPS Consultants, Inc. Whitby, Ontario Whitby (2006 population 111 184) is a town located east of Toronto on the north shore of Lake Ontario, and is the seat of Durham Region, Ontario, Canada. History , Canada (a) Key informant interview participant. (b) Member, workshop organizing committee.
Table 1. Key informant questionnaire.
I. From your perspective as a scientist, what are the ten most
important environmental exposures which are known or may be causes of
cancer in Ontario? These are exposures where you feel that someone
should be generating * ACTION and/or RESEARCH and/or PREVENTION
activities. [This last sentence was modified in later interviews to ask
about "generating * RESEARCH and/or SURVEILLANCE and/or
ACTION/PREVENTION activities."] Consider air, water, food, and dermal
routes of exposure to humans as well as level and geographic extent of
exposure, bioaccumulation, latent effects, potential for health effects
in Ontario which may or may not be confirmed links in cancer aetiology.
1.--
2.--
3.--
4.--
5.--
6.--
7.--
8.--
9.--
10.-
II. (a) Roughly, how would you rank these and why do you think these
areas are important, specifically in relation to Ontario?
(b) Where ACTION is appropriate, what level(s) of action would you
suggest for these areas?
III. What other agencies or groups are you aware of that might be
doing this kind of investigation/prioritizing?
IV. Can you suggest other scientists with whom we should speak?
Table 2. Consensus on important environmental
exposures (in alphabetical order).
Asbestos
Benzene
Dioxins
Dump site contaminants
Electromagnetic fields
Endocrine disruptors
Environmental tobacco smoke
Fossil fuel radiation
Heavy metals
Other organic pollutants
Pesticides
Phthalates
Polycyclic aromatic hydrocarbons (a)
Radio frequency waves
Radon
Ultraviolet radiation
Volatile organic compounds (excluding benzene)
Water disinfection by-products (including
trihalomethanes)
Working/living near nuclear power plants
(a) Plus other outdoor air pollutants and other combustion
by-products.
Table 3. Exposure-specific recommendations to Cancer Care Ontario
concerning surveillance, research, and prevention of environmental
exposures and cancer.
Cancer
Environmental prevention
exposure Surveillance Research activity
Ultraviolet Collect more Work with Health
radiation data on Canada, Environ-
sun-protective ment Canada, the
behaviors, Canadian Cancer
outcomes (e.g., Society, school
nonmelanoma skin boards, and
cancer), and municipalities
markers (e.g., to deliver sun
nevi in safety programs
children) and evaluate sun
safety programs
Monitor temporal Communicate/
trends in disseminate
ultraviolet scientific
index evidence to
professionals
Environmental Support existing Conduct Advocate for the
tobacco smoke surveillance surveillance banning of
initiatives at using exposure environmental
the local, biomarkers such tobacco smoke in
regional, and as cotinine the workplace;
national levels levels in the communicate to
general partners/
population stakeholders
regarding
successful
initiatives
Polycyclic Estimate the Develop Advocate for
aromatic number of cancer improved cleaner engines
hydrocarbons deaths exposure
attributable to estimation
polycyclic
aromatic
hydrocarbons
Asbestos Support workers
and businesses
in building
trade to reduce
exposure;
support initia-
tives to
identify
buildings with
asbestos
Water Monitor water Advocate for
disinfection quality at improvements to
by-products treatment plants the Ontario
Drinking Water
Surveillance
Program
Radon Communicate
information
regarding risk
of cancer from
exposure to
radon to
partners,
stakeholders,
and the public
concerning areas
in Ontario with
higher natural
radon levels
Pesticides Monitor Communicate
pesticide use results of
studies
regarding the
risk of cancer
from exposure to
pesticides to
partners,
stakeholders,
and the public
Dump site Link point-
contaminants source
exposures from
dump sites to
cancer registry
data
Heavy metals Work with the
Ministry of
Labour and other
stakeholder
groups to
monitor exposure
in industrial
sites
REFERENCES AND NOTES (1.) NCIC NCIC National Crime Information Center NCIC National Cancer Institute of Canada NCIC North Carolina Industrial Commission NCIC National Cartographic Information Center NCIC National Cancer Information Center (American Cancer Society) . Canadian Cancer Statistics 2001, Toronto, Ontario, Canada:National Cancer Institute of Canada, 2001. (2.) Marrett L, Theis B, Ashbury F, and an expert panel. Workshop report: physical activity and cancer prevention, Chronic Dis Can 21(4):143-149 (2000). (3.) Bailar JC, Gornik H. Cancer undefeated. N Engl J Med 336:1569-1574 (1997). (4.) Miller AB. Canadian contributions to cancer control. Can J Oncol 4:238-342 (1994). (5.) Anonymous. Harvard report on cancer prevention. Cancer Causes Control 7(suppl):53-59 (1996). (6.) Ontario Task Force on the Primary Prevention of Cancer. Recommendations for the Primary Prevention of Cancer. Toronto, Ontario, Canada:Ontario Ministry of Health, 1995. (7.) Health Canada. Health Risk Perception in Canada. Ottawa, Ontario, Canada:Health Protection Branch, Environmental Health Directorate, 1993. (8.) Gilchrist V. Key informant interviews. In: Doing Qualitative Research Qualitative research Traditional analysis of firm-specific prospects for future earnings. It may be based on data collected by the analysts, there is no formal quantitative framework used to generate projections. (Crabtree B, Miller D, ads). Newbury Park, CA: Sage Publications This article or section needs sources or references that appear in reliable, third-party publications. Alone, primary sources and sources affiliated with the subject of this article are not sufficient for an accurate encyclopedia article. , 1992. (9.) Wige D. Personal communication. (10.) Cahow ca·how n. An earth-burrowing, nocturnal bird (Pterodroma cahow), once abundant in Bermuda but now nearly extinct, with a hooked black beak, brown and white plumage, and a gray underside. Also called Bermuda petrel. K. The cancer conundrum conundrum A problem with no satisfactory solution; a dilemma . Environ Health Perspect 103:898-1004 (1995). (11.) Canadian Cancer Society The Canadian Cancer Society is a volunteer-based organization which seeks to eradicate cancer and to enhance the quality of life of those suffering from it. The Society . Environmental Contaminants and Cancer. Toronto, Ontario, Canada:Canadian Cancer Society, 2000. Nancy Kreiger, (1,2) Fredrick D. Ashbury, (3,4,5) Mark P. Purdue, (1) and Loraine D. Marrett (1,2) (1) Division of Preventive Oncology, Cancer Care Ontario, Toronto, Ontario, Canada; (2) Department of Public Health Sciences, University of Toronto Research at the University of Toronto has been responsible for the world's first electronic heart pacemaker, artificial larynx, single-lung transplant, nerve transplant, artificial pancreas, chemical laser, G-suit, the first practical electron microscope, the first cloning of T-cells, , Toronto, Ontario, Canada; (3) PICEPS Consultants Inc., Whitby, Ontario, Canada; (4) Department of Oncology, McGill University McGill University, at Montreal, Que., Canada; coeducational; chartered 1821, opened 1829. It was named for James McGill, who left a bequest to establish it. Its real development dates from 1855 when John W. Dawson became principal. , Montreal, Quebec, Canada; (5) optx Corporation, Denver, Colorado, USA Address correspondence to N. Kreiger, Division of Preventive Oncology, Cancer Care Ontario, 620 University Avenue, Toronto, Ontario M5G 2L7 Canada. Telephone: (416) 971-9800 ext. 1239. Fax: (416) 971-7554. E-mail: nancy.kreiger@ cancercare.on.ca We thank the scientists who made up the expert panel, whose guidance and recommendations will assist those working in cancer prevention. We also thank J. Macey for all her input and L. Larmand for her assistance. This study was funded by the Division of Preventive Oncology, Cancer Care Ontario. Received 5 December 2001; accepted 28 May 2002. |
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