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Role of Environment in development of Cancer

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Abstract

Many people wonder if the environment they live in " causes cancer " to answer such difficult questions, it is necessary first to make them understand what cancer is, how it develops and what environmental factors contribute to cancer. Cancer is the formidable disease of 21st century. It is frightening because it is unpredictable and indiscriminate action. The statistical analysis of epidemiological studies all over the world suggests that 80-90 % of cancers have an environmental etiology and therefore can be controlled. The objective of the paper is to educate ourselves on: what cancers is? What are the causes of cancer and how can we keep ourselves away from it. Cancer is an uncontrolled growth of cells that disrupts body tissues and organs. Cancer cells are not normal in their structure and functions. They grow and multiply to form tumors that invade local tissues and sometimes scatter throughout the body either by direct growth into the adjacent tissue or by implantation into distant sites by metastasis. The study of cancer is called Oncology. Cancer is caused by changes in a cell's DNA– its genetic " Blueprint ". Some of these changes may be inherited from our parents while others may be caused by outside exposures, which are often referred to as environmental factor. Environmental factors can include a wide range of exposures such as: Lifestyle factors (nutrition, tobacco use, physical activity etc.), Naturally Occurring Exposures (ultraviolet light, radon gas, infectious agents etc.), Medical treatments (chemotherapy, radiations, immune system suppressing drugs, etc.), Workplace exposures, Household exposures, Pollution.
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ISSN: 2349-2759
Abstract
Many people wonder if the environment they live in “causes cancer” to answer such difficult
questions, it is necessary first to make them understand what cancer is, how it develops and
what environmental factors contribute to cancer. Cancer is the formidable disease of 21st
century. It is frightening because it is unpredictable and indiscriminate action. The statistical
analysis of epidemiological studies all over the world suggests that 80-90 % of cancers have
an environmental etiology and therefore can be controlled. The objective of the paper is to
educate ourselves on: what cancers is? What are the causes of cancer and how can we keep
ourselves away from it.
Cancer is an uncontrolled growth of cells that disrupts body tissues and organs. Cancer cells
are not normal in their structure and functions. They grow and multiply to form tumors that
invade local tissues and sometimes scatter throughout the body either by direct growth into
the adjacent tissue or by implantation into distant sites by metastasis. The study of cancer is
called Oncology. Cancer is caused by changes in a cell’s DNA– its genetic “Blueprint”. Some of
these changes may be inherited from our parents while others may be caused by outside
exposures, which are often referred to as environmental factor. Environmental factors can
include a wide range of exposures such as: Lifestyle factors (nutrition, tobacco use, physical
activity etc.), Naturally Occurring Exposures (ultraviolet light, radon gas, infectious agents
etc.), Medical treatments (chemotherapy, radiations, immune system suppressing drugs,
etc.), Workplace exposures, Household exposures, Pollution.
Key words: DNA-Deoxy ribonucleic Acid, Carcenogens-Cancer promoter, Epidemiology-Scientific
study of spread and control of diseases, Endometrium-Uterine tissue lining, Etiology-the scientific
study of the causes of disease.
*Corresponding Author: M. J. A. Siddiqui, Dept. Environmental Science Integral University,
Dasauli, Kursi Road, Lucknow-226026, U.P., India.
1. Introduction
The study of cancer is called oncology. The
statistical analysis of epidemiological
studies all over the world suggest that 80-
90% of cancers have an environmental
etiology and therefore can be controlled
The science of epidemiology enables
researchers to determine causes of diseases
such as specific type of cancer, and also to
estimate or project number of deaths that
can be attributed to the cause on an annual
basis.
JIPBS
Review article
Role of environment in development of cancer
M. J. A. Siddiqui*, Amina Jafri, Rahila Rahman Khan
Dept. Environmental Science, Integral University, Dasauli, Kursi Road, Lucknow-226026, U.P., India.
M. J. A. Siddiqui et al., JIPBS, Vol 3 (2), 45-53, 2016
46
Originally, the term “environmental causes
of cancer’’ was used to refer all cancers that
were not caused by inherited factors. This
definition included all cancers caused due to
life style practices such as diet and tobacco
use, carcinogens present in the
environment etc. For the sake of
convenience, the term “environment’’ has
been further divided into two categories
“personal environment” and “external
environment”.
Causes of cancer related to an individual
personal environment includes life style
choices and other factors, which can keep a
person at high risk of cancer development.
Up to 85% of cancers is due to life style
choices made by individuals. For example
tobacco is directly related to more than
30% of cancer deaths. 500,000 deaths per
year are caused by tobacco alone.
The external environmental factors causing
cancer include environmental pollutants,
exposure to carcinogens in the work place,
household exposure etc.
What is cancer? How is it defined? No
oncologist so far has been able to give a
satisfactory definition of cancer. This is
because still there is lack of full knowledge
of cancer and also because there are variety
of cancers. However, J. Ewing a pathologist
defined it; cancer is a heritably altered,
relatively autonomous growth of cells.
The word “tumor” is now commonly used,
not just any localized swelling but
specifically a true neoplasm (new growth
synonymous with cancer). A tumor may
contain normal tissue but the major mass
consists of cancerous tissue.
Generally, cancer starts as growing lump,
which spreads in body through blood or by
other body fluids such as lymph. The
important feature of cancer is that the
cancer cell reproduces exactly its own kind,
which retains the capacity to multiply
defying the controls operating in the living
body.
Cancer is a cellular disease arising from
normal cells of any organ or tissue at any
age. A cell or cells not known how get
initiated and acquire capacity to multiply
unrestrictedly. The cells grow into a mass
called tumor and tend to become
nutritionally less dependent on the host.
The tumor cells may acquire mobility so
that they can move out of the tumor and
spread out in the body. The spreading of the
tumor is called metastasis meta means
change and stasis means position. When the
cancer cells are lodged in another organ or
tissue, they start growing there. These
tumors are called secondary. These
secondary growths develop into tumors
causing structural and functional damage to
the host organs. Metastasizing tumors are
therefore fatal. A metastasizing cancer may
be controlled but is difficult to cure.
For more than a century, researches are
working on finding ways and means to
eradicate or control cancer. Although there
is so far no discovery of target hitting drug
or any other method to cure cancer,
considerable advances have been made
during last several decades. The cure rate in
western countries is now 1 out of 3 which
was 1 out of 5 a few decades ago. It is
therefore thought that people must know
how the problem of malignancy is being
tackled by oncologist, scientists, the break-
through in the knowledge about the disease
the anticancer drugs and various
experimental systems being used to
understand cancer. The purpose of this
paper is to induce people to control
smoking, tobacco chewing, and alcohol
consumption and keep themselves
hygienically clean and away from life style
choices causing the disease.
Self-examination after guidance from a well
trained physician is the cheapest and easiest
M. J. A. Siddiqui et al., JIPBS, Vol 3 (2), 45-53, 2016
47
mode of screening for abnormal deviations
in the in the normal health in developing
countries [1].
2. Review of Literature
How many Cancers are caused by the
Environment? [1]
Some experts say a decade - old estimate
that six percent of cancers are due to
environmental and occupational
exposures is out dated and far too low.
More than 60% of U.S. cancer deaths are
caused by smoking and diet. But what
about the rest?
From womb to tomb, people around the
world are exposed to countless
carcinogens in their food, water, air and
consumers goods. The National Institute
of cancer has classified 54 compounds as
known human carcinogens. For example
Benzene, a known cause of human
leukemia, is a common pollutant in vehicle
exhaust. Radon a natural radioactive gas
found in many homes raises the risk of
cancer. Arsenic, linked to skin, liver,
bladder and lung cancer contaminates
some drinking water supplies. Other
known human carcinogens include
asbestos, hexavalent chromium, aflatoxins
and vinyl chloride.
Since 1981, agencies and institutes have
cited the same estimate when regulating
carcinogens in the workplace, air, water,
and consumers products. Roughly 4% of
cancer deaths or 20,000 deaths per year-
may be attributed to occupational
exposures and 2% or 10,000 deaths per
year- to environmental exposures.
In its new report, the panel appointed by
former president Bush, called that
estimate “woefully out of date” reporting
that the true burden of environmentally
induced cancers has been grossly
underestimated.
The role of environment in human health
is generally a subject only briefly touched
in medical school training. It wasn’t until I
attended the world Breast Cancer
Conference in 1997 that I first heard
discussion amongst a number of
prominent scientists, physicians and other
health professional about the growing
body of evidence linking environmental
contamination and cancer. [2] I became
very interested in this subject since I
developed breast cancer at the age of 37
with no risk factors and having breast fed
three children.
An obvious place to start looking for the
root causes of cancer is with substances
that are known to cause cancer in animal
models, that is carcinogens. One such class
of carcinogenic substances, the
organochlorines (OCs) are found all
around us. They are in our drinking water,
in much of our pesticide treated food in
many laundry detergents and cleaning
products as well. DDT a well known OC, is
persistent that its use has been banned in
North America for more than 25 years, it
is still found in detectable levels in the
tissues and blood of people living from
Florida to high Arctic. This ban
notwithstanding, OCs are still produced in
North America and exported abroad,
particularly to developing countries. As a
consequence imported fruits and
vegetables which end up back on our
dinning tables often have detectable levels
of substances known as human
carcinogens.
Aside from being potentially carcinogenic
some of these chemicals behave like much
weaker version of our own body’s
estrogen (hormone). Because these
estrogen like chemicals are outside the
body, they are classified as xenoestrogens,
“xeno” meaning foreign in Greek.
M. J. A. Siddiqui et al., JIPBS, Vol 3 (2), 45-53, 2016
48
The proposed link between chemical
xenoestrogen and breast cancer came
about by accident in 1991 when Tufts
University researchers noticed that breast
cancer cells, which need estrogen to
reproduce, were growing rapidly in plastic
dishes. They discovered that Nonlyphenol,
a chemical added to plastic to prevent
cracking was leaching out of the plastic
and triggering the growth of breast cancer
cells. In other words it was acting like
estrogen. The researchers then exposed
the other cancer cells to common
pesticides, detergents and plastics and
observed the same results. The
implications are disturbing, considering
how common these products are in our
lives.
Thus, I have discussed mainly the link
between pesticides and breast cancer
because that is my special interest but also
consider the following:
Farmers exposed to herbicides for more
than 20 days per year have been found to
have a six fold increase in non Hodgkin’s
lymphoma.
There is significant association between
yard treatment with pesticides and
pediatric soft tissue sarcomas, leukemia
and brain cancer.
The provincial and federal health
department reports that there are
instances where maximum allowable DDT
intake may be exceeded in breast fed
infants.
In the last 30 years the global average
human sperm count has decreased by
50%. Some argue that this is a result of
high exposure to xenoestrogens.
3. Experiences and Case Studies
Author’s Experience of Breast Cancer
His Wife Had:
I was on employment in a Gulf country
called Oman from 1992 to 2006. I was
working as Director of Education and my
wife (Naheed Jamal Siddiqui aged 52 at the
time of malignancy) had been a
homemaker with a daughter of teen age in
Oman and three grown up children in
India. We had very interesting days of life
full of joy, enthusiasm and a strong will to
live a long happy life.
In the month of March 2005, my wife told
me little pain in her left arm pit, later she
felt some hard swellings in her neck region
just above the collar bone. Consequently,
we visited a lady general physician Dr.
Fatima to get relief from the pain in the
knees and left arm pit of my wife. During
clinical check up Dr. Fatima advised us to
visit Oman Govt. hospital for investigation
about the hard parts in the neck region.
Within a week, the result came out after
fine needle aspiration test and the hard
parts were found malignant. The Sur
Hospital Oman provided the following
investigation report:
Impression: Suggestive of Carcinomatous
deposits in left axillary and supraclavicular
lymph node.
-FNAC breast- No significant pathology
seen.
-Primary in the breast could be a
possibility.
-Advised further work up.
Slides sent to Royal Hospital for opinion.
After a few days Royal hospital Oman
confirmed carcinomous tissues in the
lymph nodes. We were extremely shocked
(Paron Tale Zamin Khisak Gai),
immediately we decided to leave Oman
and come back to India for treatment.
We contacted the oncologists at Lucknow
as we are the residents of Lucknow, and
took the appointment of an oncologist Dr.
I.D. Sharma for 2nd April 2005. Dr. Sharma
(Professor of Oncology, K.G.M.C. Lucknow,
M. J. A. Siddiqui et al., JIPBS, Vol 3 (2), 45-53, 2016
49
retired now) advised for immediate
surgery of the patient. We agreed and after
so many tests such as mammography, fine
needle aspiration and blood test doctor
decided to operate my wife, the victim of
cancer on 5th April 2005. She entered the
Operation Theater with a smiling face.
After two hours duration surgical
operation Dr. Sharma called me inside the
O.T., I with a frightened heart entered the
O.T., Dr. showed me the left breast tissue
mass and 32 malignant lymph nodes he
had removed from the body of the patient.
He said you are too late; rest is in the hands
of Almighty God.
Table 1. List of Cigarette Smoke Carcinogens [3]
Chemical (carcinogens)
Amount(Per Cigarette)
Acetaldehyde
980 micrograms to 1.37 milligrams
Acrylonitrile
1-2 milligrams used as fumigant
4-Aminobiphenyl
0.2-23 nanograms per cigarette
0-Anicidine hydrochloride
Unknown
Arsenic
Unknown
Benzene
5.9-75 micrograms
Beryllium
0.5 nanograms
1,3 Butadine
152-400 micrograms
Cadmium
1.7 micrograms
1,1 Dimethylhydrazine
Unknown
Ethylene oxide
Unknown
Formaldehyde
Unknown
Furan
Unknown
Hetrocyclic amines
Unknown
Hydrazene
32 micrograms
Isoprene
3.1milligrams
Lead
Unknown
2-Napthylamine
1.5-35nanograms
Nitromethane
Unknown
N-Nitrosodiethanolamine
24-36 nanograms
N-Nitrosodimethylamine
5.7-43 nanograms
N-Nitrosodimethylamine
Up to 8.3nanograms
N-Nitrosodi-n-propylamine
1 nanogram
4-(Nitrosomethylamino)-1-(3-peridyl)-
1butanone
Upto 4.2 micrograms
N-Nitrsonornicotine
14 micrograms
N-Nitrosopiperidine
Unknown
N-Nitrosonitrosopyrrolidine
113 nanograms
N-Nitrososarcosine
22-460 nanograms
Polonium-210
Variable depending on soil & fertilizer used to
grow tobacco
Polycyclic aromatic hydrocarbons
28-100 milligrams
O-Toluidine
32 nanograms
Vinyl chloride
5.6-27 nanograms
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50
During the operation I had prayer time of
Asr, (third prayer of the day) at about 4:30
p.m., I went to a nearby mosque and
prayed for the life of my beloved wife and
requested all the people of the mosque for
the same.
With the grace of Allah she recovered from
the post operational heal up and was
advised to undergo 6 cycles and 5 cycles of
chemotherapy and radiotherapy
respectively. She had miserable days after
chemotherapy and radiotherapy due to
temporary side effects of the treatment.
But she could withstand all the side effects
bravely as a result of moral support given
by our children and myself. Further she
was advised for monthly clinical check up
and six monthly investigations. Thanks to
Almighty Allah, she is still surviving with
normal health and carries normal routine
work. She performs all the house hold
activities efficiently. I shall always remain
grateful first to Almighty Allah and then to
Dr. I.D. Sharma.
4. Techniques
The author has been highly interested in
finding out the real cause of cancers
specifically that of breast, since my wife
had breast cancer in the year 2005-6. The
review paper has been developed as a
result of reading and writing articles on
“Cancer an Enigma”. The paper could not
be materialized without the help of Google,
internet and books on cancer. Specifically
thorough reading of the book on cancer [4].
Google has been a source of knowledge on
various aspects of cancer. The author has
searched out a number of papers regarding
role of environment in development of
cancer.
Diagnosis and staging
Breast cancer is usually first detected as a
palpable mass or as a mammographic
abnormality, but it can also be manifested
initially by nipple discharge, breast skin
change, or breast pain. Suspicious palpable
and mammographic breast lesions are
investigated by biopsy. Most breast
masses, especially those that are found in
young premenopausal women are benign.
Most (75 to 85 percent) of the masses
found to be cancerous are invasive with the
remaining 15 to 25 percent in situ.
Carcinoma in situ is characterized by the
proliferation of malignant cells within the
ducts or lobules of the breast without
invasion of stromal tissue. The two major
subtypes are ductal carcinoma in situ
(DCIS) and lobular carcinoma in situ
(LCIS)[5].
LCIS, unlike DCIS, is microscopic and lacks
both clinical and mammographic signs.
LCIS is also more likely to have bilateral
involvement. The cells are grouped in a
small, solid mass and have small, uniform,
round to ovalnuclei [6].
All breast cancers are classified using a
scheme that encompasses all attributes of
the tumor that define its life history. The
American Joint Committee on Cancer
(AJCC) TNM classification is based on the
premise that cancers of the same anatomic
site and histology share similar patterns of
growth and extension. The system is based
on the size of the primary tumor (T),
regional lymph node involvement (N), and
distant metastasis (M) (Table 2). The
combination of the T, N, and M
classification indicates the extent of the
disease at the time of clinical evaluation
[7].
The stage grouping system is often used for
the purposes of tabulation and analysis
(Table 3). This grouping system was
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51
adopted to ensure, as far as possible, that
each group is more or less homogeneous
in respect of survival, and that the rates of
these groups for each are distinctive [8].
Notes:
1. T1 includes 1mic;
2. The prognosis of patients with pN1a is
similar to that of patients with pN0.
Treatment options
Effective means of treating breast cancer
are widely available and may be used alone
or in combination, depending on individual
circumstances. Surgery is the most
commonly used treatment for localized
breast cancer. The surgical procedures
most often used are lumpectomy with
axillary node dissection and modified
radical mastectomy. Lumpectomy with
axillary node dissection entails excision of
the tumor mass, including a clear margin of
normal breast around the tumor, along
with lymph nodes under the arm. Modified
radical mastectomy entails complete
removal of the breast, the underlying
pectoral fascia, and some of the axillary
nodes [9].
Table 2. The TNM system of staging of breast cancer [7].
Tumor Size T (LargestDiameter)
TX
T0
Tis
T1
T2
T3
T4
Nodal Involvement - N (Nodal Status)
NX
N0
N1
N2
N3
Metastases - M
M0
M1
The use of radiation therapy in the
management of breast cancer has been
increasing in recent years. For many early-
stage cancers, radiation of the breast is
used in combination with lumpectomy and
surgical examination of the axillary lymph
glands. In larger but still localized cancers,
the breast, axilla, and chest wall may be
irradiated following surgical treatment. A
number of complications due to the spread
of cancer to a distant site (e.g., pain) may
be successfully treated with radiation. In
these situations, hormone or drug
treatment may be given as well.
Surgery and radiotherapy are very
effective in removing or destroying
cancerous tissue if it is known exactly
where the cancer is and if adjacent normal
M. J. A. Siddiqui et al., JIPBS, Vol 3 (2), 45-53, 2016
52
organs and tissues can be preserved
without injury. Chemotherapy, on the
other hand, is distributed through the body
and is capable of destroying cancer cells
wherever they exist.
Table 3: Stage grouping system of staging of breast cancer: Conversion from TNM [5].
Stage
T
N
M
Stage 0
Tis
N0
M0
Stage I
T11
N0
M0
Stage IIA
T0
N1
M0
T11
N12
M0
T2
N0
M0
Stage IIB
T2T0
N1
M0
T3 1
N0
M0
Stage IIIA
T0 T4
N2
M0
T11
N2
M0
T2
N2
M0
T3
N1,N2
M0
Stage IIIB
T4
Any N
M0
Any T
N3
M0
Stage IV
Any T
Any N
M1
Chemotherapy is often used, as adjuvant
therapy where the primary tumor has been
controlled by surgery or radiotherapy but a
secondary tumor is known to exist. It is
also used in some situations where the
cancer is localized to one site. In a great
many cases the growth of breast cancers
has been shown to be dependent on the
hormonal environment provided by the
individual's body. Hormonal therapy
provides another approach to suppress the
growth of hormone-sensitive tumors.
Sometimes suppression of tumor growth is
achieved by reducing the level of
appropriate hormones in the body through
surgical removal or x-ray destruction of the
organ that normally produces those
hormones (such as the ovary or adrenal
gland). Drugs are now also available that
counteract the action of certain hormones.
Tumor suppression is sometimes achieved
by elevating the level of certain other
hormones by providing them in the form of
drugs [10].
5. Results and Discussions
The author has focused his study on breast
cancer since his wife had been a victim of
this fatal disease. After studying a number
of articles on breast cancer and based on
the self experience how his wife was saved
from the breast cancer, following
evaluating diagnostic tools have been
found effective:
Mammography: there was evidence that
mammography is more sensitive than
clinical examination diagnosing breast
cancer in women of all ages. There was
evidence that population based
mammography screening improves
survival in women aged 50 to 65.
Fine needle aspiration: the sensitivity is
generally high (over 90%) but the
specificity varies 78 to 95%. Both
sensitivity and specificity vary depending
on the placement of needle. In lesions more
than 1cm. core biopsy may be an
alternative to fine needle aspiration.
M. J. A. Siddiqui et al., JIPBS, Vol 3 (2), 45-53, 2016
53
Triple test: triple testing with
mammography, fine needle aspiration, and
clinical examination is more accurate than
any of the test alone.
Treatment and elimination of cancer is
possible through surgical operation,
chemotherapy and radiation. One has to be
optimistic of survival, adaptive to medical
advancement and technologies and strong
faith in almighty Allah.
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Article
Full-text available
Tobacco smoke is a toxic and carcinogenic mixture of more than 5,000 chemicals. The present article provides a list of 98 hazardous smoke components, based on an extensive literature search for known smoke components and their human health inhalation risks. An electronic database of smoke components containing more than 2,200 entries was generated. Emission levels in mainstream smoke have been found for 542 of the components and a human inhalation risk value for 98 components. As components with potential carcinogenic, cardiovascular and respiratory effects have been included, the three major smoke-related causes of death are all covered by the list. Given that the currently used Hoffmann list of hazardous smoke components is based on data from the 1990s and only includes carcinogens, it is recommended that the current list of 98 hazardous components is used for regulatory purposes instead. To enable risk assessment of components not covered by this list, thresholds of toxicological concern (TTC) have been established from the inhalation risk values found: 0.0018 μg day(-1) for all risks, and 1.2 μg day(-1) for all risks excluding carcinogenicity, the latter being similar to previously reported inhalation TTCs.
Nicole Bruinsma states: Cancer & Role of Environment
Nicole Bruinsma states: Cancer & Role of Environment: Nicole Bruinsma, M.D. Update Fall 2001.
Breast cancer and differential diagnosis of benign nodules
  • H B Muss
Muss, H.B., Breast cancer and differential diagnosis of benign nodules, in Cecil Textbook of Medicine, J.C.B. L. Goldman, Editor. W.B. Saunders: Philadelphia. 2000; 1373-1380.
Chapter 36: Cancer of the Breast: Section 2: Malignant tumors of the breast, in Cancer: Principles and Practice of Oncology
  • J Harris
  • M Morrow
  • L Norton
Harris, J., M. Morrow, and L. Norton, Chapter 36: Cancer of the Breast: Section 2: Malignant tumors of the breast, in Cancer: Principles and Practice of Oncology, V.T. DeVita Jr., S. Hellman, and S.A. Rosenberg, Editors. 1997, LippincottRaven Publishers: Philadelphia. 15571606.
Chapter 1: Purposes and Principles of Staging, in AJCC Cancer Staging Manual
American Joint Committee on Cancer, Chapter 1: Purposes and Principles of Staging, in AJCC Cancer Staging Manual., Lippincott-Raven Publishers: Philadelphia. 1997; 3-9