The Ramazzini Institute
for Occupational and Environmental Health Research   

Who Are We?

     On May 16-17 the Institute of Medicine held a roundtable titled Cancer and the Environment: Gene-Environment Interactions. The roundtable featured sessions on the general links between environmental factors and the development of cancer as well as discussion of risk factors for specific cancer types. Dr. Samuel Wilson of the NIEHS noted that the purpose was to “clarify issues related to environmental health” and discussed how the “new scientific tool box” of genomic technology could further disease prevention. Wilson emphasized the need to identify research strategies and methods that will facilitate interventions, promote environmental prevention, and be sensitive to community needs for flexible approaches. Dr. Frank Mirer of the United Auto Workers emphasized the need to focus on the occupational environment because about one-third of our time is spent there.
     ABC-TV’s Sam Donaldson, in the keynote address, emphasized the need for scientists to reach broad agreement on issues related to the environment and health. While he acknowledged that it is unlikely to achieve 100% agreement on issues, he cited examples, CFCs and above-ground weapons testing, where scientists came together in an “action that promoted health.”
     Dr. Kari Hemminki** reported on his study, published in the New England Journal of Medicine (2000,343:78-85) of monozygotic [identical twins from a single fertilized egg] and dizygotic [fraternal] twins. Using an epidemiologic model, he and his colleagues at the Karolinska Institute in Sweden used cancer registry data to explain what proportion of cancer can be explained by genetic effects. They studied twins in Sweden, Denmark and Finland to evaluate the contribution of genetic and environmental factors to cancer. Their overall findings suggest that the twins “non-shared” environment has the greatest impact on cancer risk. The study concluded generally that the “non-shared” environment accounts for a major proportion of cancers, but genetic effects appeared important for colon, breast and prostate cancers.
     Dr. Curtis Harris offered some insight into how new scientific tools could further disease prevention. He described research that utilized new scanning technologies that can detect 1 “hot spot” in 5 million normal cells. The technology has been used to identify mutations in p53, tumor suppressor, genes, and has promise to characterize mutational spectra associated environmental exposures. Increased throughput could enable better detection of biomarkers of exposure and early effect in workers and other populations exposed to suspect agents. However, Dr. Lovell Jones and other speakers on the vulnerable populations panel reminded participants that medical services and protection against harm, social and economic, are not in place for such biomarked individuals. Thus the audience was reminded of the promise and peril of the new genetic technologies.
     The cancer-specific topics focused on how environmental factors impact disease incidence and outcome. However, due to limitations in exposure assessment, the vast majority of studies are limited to the impact of smoking, alcohol or dietary patterns. Consequently, participants were advised of the risks from red meat, smoking, alcohol, certain herbal remedies and the benefits of fruits, green vegetables, and soy. Such studies provide further mechanistic insight into the disease process, and also highlight the protective role of specific nutrients. A number of presenters acknowledged that there is a need for better data on more routine low-level environmental exposure and more systematic workplace exposure data in order to address involuntary risks posed by chemical or physical agents. To underscore the importance of good exposure data for genetic epidemiology studies, a number of presenters provided quantitative examples of how misclassification can skew results.
     In a more sobering moment, former Illinois representative John Porter provided a perspective from Capitol Hill. Mr. Porter expressed concern that there appears to be sentiment on the Hill to relax environmental standards for energy production. In addition, the budget figures proposed by the House of Representatives will squeeze new research initiatives. Also, there are no new initiatives to address the information needs described in the roundtable. Mr. Porter called upon the scientific community to “engage” their elected officials on these issues.
     Overall, the roundtable did provide new research strategies to facilitate interventions and prevention among specific groups. For the moment these interventions appear limited to identified groups who are identified as high-risk. These groups include cancer patients, former smokers, and individuals with a family history of cancer. The interventions are largely frequent screening and monitoring, with the exception of possible immune stimulation therapy. For those individuals concerned about primary prevention, who are anxious to identify methods of evaluating environmental agents for control and remediation, progress is limited. In addition, for those concerned about occupational disease prevention, there is an ongoing need to push researchers to develop practical approaches for workplace surveillance. In another bright note, presenters acknowledged the need to pursue research that leads to the development of upstream interventions. There was a strong emphasis on the need for community-based solutions.
     The Roundtable on Environmental Health Sciences, Research, and Medicine will continue its deliberations. Details and updates may be found at <http://www.iom.edu>

* Geoffrey Lomax, MPH, is an industrial hygienist at the University of California, Berkeley. He is currently exploring ethical methods for using genetic tests in the workplace.

** Dr. Kari Hemminki heads the Unit of Molecular Epidemiology at Sweden’s Karolinska Institute, where he is an international leader in establishing how chemical pollutants cause cancer by reacting with DNA to form adducts.

Future Profiles

     Genetic Profiles will be amplified to create a catalog of "ecological" profiles. I.e., they will include social, economic, demographic, psychological, biomedical, and environmental data. Each of the affected populations face special problems, but share common research, legislative, employment, insurance, and health care needs. There may also be unexplored environmental questions that need to be highlighted, not only in terms of causation, but also in terms of protection as a population especially vulnerable to contaminated environments. Some members of each population are likely to have “membership” in other populations, creating an overlap of biomedical and environmental research and protection needs.