Matilda Lee: Can you briefly explain the idea behind your book and film Living Downstream?

Sandra Steingraber: It represents my best attempts as a biologist to summarise the state of the evidence for the link between cancer and the environment. At the same time, as a cancer patient myself, it tells my own story of my diagnosis, aged 20, with bladder cancer, which has known links to the environment.

It's a personal memoir, and interwoven between the scientific analysis is a story about my return home as a woman in my 30s, a biologist investigating the environmental toxins in her home town. You see the story of my family, who still farm in Illinois and still use some toxic pesticides; the story of the industrial chemicals that leaked into the drinking water wells there. I really went in search of my own ecological roots and became an environmental detective.

I discover that there is a cancer cluster where I grew up and I'm one data point in that cluster. But I also care for the other people who live there, and I care for the river and the farm fields. It's a kind of love story between me and this place, but at the same time it's a scientific analysis.

ML: How strong are the links between chemicals and cancer?

SS: The evidence is quite compelling. It's my impression as a cancer patient that there is a disconnect between what we in the scientific community know about the evidence for the link, which is quite a lot, and what cancer patients are told when they talk to their doctors about it, which is very little. This discontinuity was my motivating force for writing the book. I decided that I wanted to bring the evidence that I knew as a biologist to other cancer patients and have my own life serve as a kind of bridge.

ML: Why aren't we told about all the evidence for the link between cancer and the environment?

SS: For one, there is a double standard: the evidence for the link between, say, hereditary factors and cancer is actually not that strong, and we freely talk about the importance of family history to cancer patients.

We know there is a link between lifestyle factors, such as diet, and cancers such as colon cancer. But for breast cancer, the data are contradictory, yet we feel free to tell women to change their diet as a way of preventing breast cancer, even though the evidence is not very good. At the same time, we have equally good if not better evidence for a link between air pollution and breast cancer.

To talk about that, the ‘cease and desist’ order would have to be directed at industry, or our energy sector, rather than individuals. Cancer is a disease that makes you feel helpless. I think there is an intent to make people feel that they have control over their future, so they give them all kinds of tips about what to do in their individual lives. The idea that air pollution and breast cancer are related doesn't really offer an individual cancer patient advice on what to do – we leave it out.

Maybe that is rightfully so. Who needs to be told that the air they breathe is contributing to the disease that they are now trying to fight with chemotherapy and radiation? Maybe that would make cancer patients feel helpless, when we want them to have a fighting spirit. But then comes the silence. Then we don't turn around and tell industry that we have evidence that combustion byproducts such as polycyclic aromatic hydrocarbons are contributing to breast cancer, so we need to stop and get off fossil fuels. That message never gets played out.

I think there is a cultural willingness to tell individual cancer patients what to do, and a cultural taboo about telling industry and agriculture that their practices need to change to prevent cancer.

Another reason is the medical education of physicians. Having taught in the medical and pre-medical programmes at universities myself, I would say that the doctors that are training are not getting a good background in environmental health. It's not part of their curriculum.

The evidence has become much more rigorous in the past decade, and there have been many breakthroughs. Epigenetics shows how environmental signals alter the expression of genes in a way that can place cells on the path way to tumour-formation. If a physician, like an oncologist or cancer doctor, has not graduated recently, they may not have had that information.

ML: Why is there so little money given to researching prevention (rather than cure) in the major cancer charities?

SS: I don't know. It's a mystery to me as well. In the US, the latest report by the president's cancer panel, part of the National Cancer Institute, was about the link between cancer and the environment. The panel that reviewed the literature, in the same way that I did, and came to many of the same conclusions that I did, also heard testimony from some 40 experts on the issue of cancer and the environment.

The panel became so persuaded of the strength of the evidence, and so alarmed at how little attention has been given to this, that they took the unusual step of accompanying their report with a letter to the president that said the ‘burden of environmental cancer has been grievously underappreciated’ and urged the president to use the power of his office to remove carcinogens from the air, food and water.

Yet we did not see our cancer charities rally around this report. In fact, the American Cancer Society immediately moved to downplay the report. I find it mysterious and distressing. The data are there, and we have the opportunity to prevent all kinds of suffering and save lives before cancer even gets started. Our treatments aren't that good. Half of all cancer patients go on to die from it; this hasn't changed very much. I can only speculate about why more money is directed to look at new treatments rather than to prevention.

ML: What has been the response of the chemicals industry to your book?

SS: I haven't heard from them, so I don't know.

ML: What do you want people to do after becoming aware of the link between cancer and the environment?

SS: The bulk of the chemicals that cause cancer are derived from fossil fuels, petrochemicals. Moving our economy away from fossil fuels is already something we need to do because of climate change. Even though the environment and cancer seems like this big, overwhelming and depressing problem, in fact its root causes are the same as the causes that are killing the planet.

I often use a metaphor: we are all musicians in this great human orchestra. It really is time now to play the ‘save the world’ symphony. None of us has to play solo, but we do have to know which instrument we hold and play it as well as we can. Everyone has some expertise to bring to this huge human-rights issue: people who are chefs can source from local, organic farmers. I work with young girls who are trying to promote non-toxic makeup and nail varnish. Architects can design more energy-efficient buildings and find substitutes to materials such as polyvinyl chloride, which causes cancer in workers. Athletes can promote organic playing fields and golf courses; fashion designers can take on the dry-cleaning industry and source organic fabrics. We all have a role to play. Cancer patients have a role to play, too: we don't give up easily; we fight – I want us to bring that same fighting spirit to cancer-prevention.

ML: The US premiere of Living Downstream took place in your home town. Have things there changed for the better?

SS: I have been delighted to learn that now there is a thriving, organic farm culture instead of endless fields of soy and corn, which were very intensively farmed and used for ethanol production, animal feed or snack food. Now there are famers' markets.

At the same time, in the area where the cancer rates are high, there is a plan to build a mega-hog-farm operation. There are so many chemicals used to raise animals in that way, my concern will be drinking-water contamination. It's the last thing that community needs.

The second edition of Sandra Steingraber's book Living Downstream: An ecologist's personal investigation of cancer and the environment (Da Capo press, March 2010) is available in North America.

The European premiere of Living Downstream takes place tonight in Brussels. Sandra Steingraber will be speaking at the European Parliament on behalf of HEAL, a non-profit that advocates greater protection from exposure to environmental chemicals, including carcinogens.

Matilda Lee is the Ecologist's Community Affairs Editor

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