Unlocking the Secrets in Our Cells (Part 5)

  • Dr. Madhuri Kakarala looking at stem cells from human breast tissue. Women voluntarily donate their tissue after various breast surgeries for research. (Photo by Mark Brush/Michigan Radio)

There have been breakthroughs in treating cancer, but what about preventing it in the first place?

In 1970, the nation launched a “War on Cancer.” The goal was to cure it in 25 years, but back then, researchers didn’t know what we know now. That cancer is a disease of our genes… “a distorted version of our normal selves” as Nobel Prize winner Dr. Harold Varmus said.

In the final part of our week-long series, I visited some researchers at the University of Michigan's Comprehensive Cancer Center who are looking deep into our cells for answers.


When I visited Dr. Madhuri Kakarala, she had me peek through a microscope in her lab.

“Just describe for me what you see here, and I’ll tell you what it is,” said Kakarala.

The last time I peered through a microscope was in a high school biology class. Those images were typically a hazy outline of something… maybe green… and with a hair in it.

But what I was seeing here was crystal clear. Tiny white spots on a gray background, and several spots had clumped together in the center.

“That looks kind of like a circular ball, right? A three dimensional sphere. That is a mammosphere,” said Kakarala.

I’m looking at stem cells from human breast tissue donated by women who have undergone some type of breast surgery.

They’re analyzing these cells to see how they react to a chemical many of us are exposed to – bisphenol A, or BPA.

BPA is used in plastic food containers, water bottles, and the linings of metal food cans. It’s even on money and some paper receipts.

Scientists at the National Toxicology Program at the Department of Health and Human Services say this about BPA:

In the case of BPA, the NTP and our expert panel expressed “some concern” for potential exposures to the fetus, infants and children. There are insufficient data from studies in humans to reach a conclusion on reproductive or developmental hazards presented by current exposures to bisphenol A, but there is limited evidence of developmental changes occurring in some animal studies at doses that are experienced by humans. It is uncertain if similar changes would occur in humans, but the possibility of adverse health effects cannot be dismissed.

It’s “uncertain,” so the researchers in this lab are gathering more data.

They want to know how this estrogenic compound affects breast cells. Kakarala says BPA can promote progenitor cell growth, and they want to know if it promotes the growth of some kinds of breast cancers.

This is just one experiment in this lab. It’s one puzzle they’re working on.

They’re also looking at how some spices, like turmeric and pepper, might keep cells from turning cancerous – how some foods and anti-inflammatory drugs might also help.

“What we are trying to do is look at those individuals that we know have an increased risk of developing cancer, and intervene with those people before they already have cancer,” said Kakarala.

Much of the research they do here falls under the umbrella term of cancer prevention research.

Cancer prevention can be cell biology research like this, or developing vaccines, or it can mean educating the public about the things that can reduce cancer risk – things like maintaining a healthy weight, reducing emotional stress, eating the right foods, and exercising (the Mayo Clinic lists 7 tips for  reducing your cancer risk).

Some cancer rates are rising, but if you look at all cancers combined the overall rates have been ticking downward since 2001.

More people have quit smoking, and that’s led to a drop in lung cancer rates.

More people are getting screened, and that’s led to a drop in colon cancer rates.

Dr. Dean Brenner heads up the lab where Dr. Kakarala works. He said the lesson is that cancer prevention works.

“That’s why it’s so important to think of dealing with cancer as a process that starts long before one sees the bad endpoint, which is the disease that everybody calls cancer and treats with chemotherapy, but rather that the whole process that we intervene early than that because we already know that when you intervene early, we see a reduction in mortality,” said Brenner.

The complex puzzle remains. Can researchers find the things that increase our cancer risk?

There are around 80,000 chemicals in our lives today. Only a fraction of them have been well studied.

Many health professionals say more needs to be done.

But all this research takes money, and today more money is spent on treating the disease than preventing it.

The National Cancer Institute is the biggest funder of research in the U.S. The government agency has an annual budget of more than $5 billion.

When we looked at the programs aimed at prevention, around 13 percent of their 2011 budget went toward this kind of research.

In an e-mail, an NCI official told us they spent closer to 27 percent of the 2011 budget on prevention. And they said much of the research they fund focuses on basic cell biology, which can lead to breakthroughs in treatment and prevention.

Dr. Kakarala said no matter what her funding situation, she’ll keep looking for answers.

In her first year of medical school she was diagnosed with an advanced thyroid cancer.

She said living through that experience has helped her. And it helps today when she’s in the lab or with her patients.

“It makes me really understand the suffering that they’re going through, because I’ve been in that bed.  And in the lab, it’s a huge motivator. You may or may not get your next grant, but I’m not giving up on this, because this is a mission. It’s not just a career.”

Dr. Kakarala said she feels like her experience drives her to solve these complex genetic puzzles – to learn ways to keep our cells from mutating out of control.

Suing Over Cancer (Part 4)

  • Kathy Henry's property was contaminated by Dow Chemical with a chemical called dioxin. The EPA says it's likely to cause cancer. (Photo by Kathy Henry)

This is the Environment Report. I’m Rebecca Williams.

As part of our week-long series on cancer and the environment… we’re talking about going to court. Some people turn to the courts because they think pollution has made them sick, and they think they know who’s to blame. But, the courts aren’t always the best place to turn with these kinds of cases. Sarah Alvarez explains:

Kathy Henry lived along a river in the Midland area that Dow Chemical contaminated with a chemical called dioxin. The EPA says dioxin is likely to cause cancer. Henry’s property had high levels of the chemical. So she and a group of other people sued Dow. She was more than a little nervous that first day in court.

“I was a little overwhelmed, just really Interested in watching the proceedings.”

But what does she feel like now?

”We’re just frustrated to the point where I have no respect for the process anymore.”

Henry’s frustrated because her case started nine years ago. Their case isn’t over yet, but it’s not looking good for them.

“We just wanted the courts to force Dow to basically buy our house so we could leave. And we couldn’t afford to just pack up and leave on our own.”

Henry’s group has not been successful in getting Dow to pay for any moves, or for medical monitoring to look out for future health problems.

Let’s just say here that these cases aren’t easy for the companies being sued either. They take up a lot of time and resources.

Sara Gosman teaches toxic torts classes at the University of Michigan Law School. She says Kathy Henry’s experience is not uncommon.

“A toxic tort is a lawsuit for personal injury. These cases are complex, they’re difficult to prove, they’re very expensive.”

Let’s say, for example, there’s a case where people say a company released a chemical into their water-and now some of them have cancer. Sara Gosman says it’s going to get complicated right away.

“I think a lot of the difficulty comes from the lack of scientific knowledge about how people get cancer.”

And there’s one other thing.

“And since cancers don’t typically show up until 20 to 30 years after the exposure, you have to reconstruct after a great length of time what actually happened. That is the big issue around toxic torts.”

Sometimes the system works for plaintiffs. When it does they can win a lot of money and really change how companies act. But that doesn’t happen often. Sara Gosman says maybe the courts aren’t the best place for these kinds of fights, but that people keep ending up there anyway. Why? Because the laws that should protect people from toxic substances in the first place-and keep them out of court-are weak.

“Right now, the federal law governing these substances, the main federal law governing it which is called the toxic substances control act, TSCA, is widely seen as a failure. It doesn’t actually protect people’s health.”

In fact, that law… it’s basically been locked in a drawer. Gosman says the EPA hasn’t even tried to use it to regulate any toxic substances-at all-in over 20 years.

So what are people supposed to do? Well, there are alternatives to the court system. Like the 9-11 Health Compensation Act. People who got certain diseases from dust after the twin towers collapsed got some money automatically to pay for certain health problems. But that’s not happening on a wide scale. Until there are more alternatives people will still turn to the courts if they think the environment is making them sick.

And what advice does Kathy Henry, the woman who is suing Dow right now, have for those people?

“So all you can do is try. I wish them luck.”

For the Environment Report, I’m Sarah Alvarez.

Tomorrow, in the final part of our series, we take a look at cancer prevention research and what we know about avoiding cancer before it starts.

That’s the Environment Report. I’m Rebecca Williams.

Investigating Rare Childhood Cancer Cluster (Part 3)

  • Danielle Williams with her daughter Erika. Williams suspects something in the water or air is making kids sick. Health officials say at the moment, there's no clear connection. (Photo courtesy of Danielle Williams)

This is the Environment Report. I’m Rebecca Williams.

This week, we’re bringing you a series of stories on cancer and the environment.

Today, in the third part of our series, we’re going to St. Clair County.

The state of Michigan has confirmed a cancer cluster in the county. Since 2007, eight young children – and a possible ninth – have been diagnosed with a rare kidney cancer called Wilms tumor.

Health officials ran a statistical analysis and found there are more cases of Wilms tumor in kids in the county than you’d expect to find.

Danielle Williams’ (no relation to Rebecca Williams) daughter Erika was the first to be diagnosed. She was seven years old.

“My daughter was playing soccer and she came home that night and we noticed she had a protruding lump on the side of her belly, and to the touch it was hot.”

An ultrasound revealed what looked like a six inch mass in Erika’s kidney. Erika had surgery to remove her left kidney … and that’s when the doctors discovered the tumor was the size of a football.

“In the hospital, she quit… she didn’t speak. She didn’t really know what was going on but she knew it was serious. Because they’re so little they don’t know the serious(ness) of it, but her seeing me so broken, she just sat there in silence all the time and didn’t talk.”

Williams says after Erika’s surgery, she went through radiation and a year of chemotherapy. Erika is in remission now. Officials with the Centers for Disease Control say more than 90 percent of kids diagnosed with Wilms tumor survive.

A few months after Erika’s diagnosis, another child in the county was diagnosed with Wilms tumor. And then more kids got sick. The youngest was a 6 month old baby girl.

“If children are getting cancer, you know there’s something wrong. There’s something wrong.”

Williams lives in Marine City, on the St. Clair River. It’s downstream from Sarnia, Ontario. That area is nicknamed Chemical Valley because of the complex of petrochemical plants on the river. There have been hundreds of spills in the past two decades. Several cities – including Marine City – pull their drinking water from the river.

Danielle Williams suspects something in the water or the air is making the kids sick.

But health officials say right now… there is no clear connection between any environmental factor and Wilms tumor.

Tom Sinks is with the CDC’s National Center for Environmental Health. He says it’s believed Wilms tumor could stem from something that happens before a baby is born.

“So if you translate that into doing an epidemiologic study you have to try to recreate what environmental exposures or what the conditions may have been for the mother during pregnancy or possibly before pregnancy .”

The St. Clair County Health Department has been following the Wilms cases for a few years.

Dr. Annette Mercatante is the medical health officer with the health department. She says they’re developing detailed survey questions for the families in the cancer cluster.

“Where did they live? What did they eat? Their medical history, their work exposure history, we’re just going to try and be very comprehensive.”

They’re also going to try to track down the placentas of the children. Hospitals often save placentas when babies are born. There’s a research team at the University of Michigan that’s hoping to study the placental tissue to see if they can find any clues about the Wilms tumor cluster.

Dr. Mercatante says it will be difficult to figure out why these kids are getting sick.

“I need to be honest. And the honest answer is we don’t know and we very well may not know for a long time to come, if ever. Especially in something as rare as this.”

But she says this cluster of children with cancer deserves a very close look.

Our series on cancer and environment continues tomorrow. We’ll hear the story of some people who turn to the courts when they think pollution could make them sick.

That’s the Environment Report. I’m Rebecca Williams.

Mapping Cancer Cases in a Small Town (Part 2)

  • Claire Schlaff and her daughter-in-law Polly were motivated by the loss of their son and husband, Doug, to start a cancer mapping project. They're trying to piece together information about cancer cases in White Lake, a resort community in West Michigan. (Photo by Sarah Alvarez)

This is the Environment Report. I’m Rebecca Williams.

All this week we’re bringing you a special series on cancer and the environment.

Sometimes a whole community can be affected by cancer. In the second part of our series, Sarah Alvarez visits one town in west Michigan where families are trying to find out why their loved ones got sick:

Cancer is a scary enough word, and cancer cluster can sound even scarier. That term describes a place where more people have cancer than you’d expect to find in the rest of the population. But finding out if a cluster really exists and then getting something done about it is hard, really hard.

Claire Schlaff doesn’t know if there’s a cancer cluster in her small resort community around White Lake, Michigan. She says she just wanted to know more about what might have caused her son, Doug to get cancer and die three years ago.

“He went to two major medical facilities and was even in a clinical trial. They were focused on treatment. They weren’t about doing research into what causes Ewing’s Sarcoma.”

Claire’s daughter-in-law Polly was also looking for answers to what had caused the disease. She’s Doug’s widow and the mother of his three boys.

“He was diagnosed when he was 33 and he passed away when he was 35. We were high school sweethearts. He was a high school counselor; he was a high school basketball coach. He was an athlete.”

Polly started a Facebook group called Cancer in White Lake to gather stories of people around the lake affected by cancer. She and Claire had a hunch there was more cancer around White Lake than in other places. They collected more than a hundred stories from people with lots of different cancers. Claire and Polly thought it might have something to do with past pollution. This is Claire again:

“In 1985 we were listed as one of the great lakes area of concern because of contamination from Hooker chemical, the tannery, DuPont and maybe some others.”

White Lake has been cleaned up. It’s expected to come off the list of polluted places this year. The local health department doesn’t have any data to show there’s more cancer around White Lake than anyplace else.

Claire and Polly and some dedicated volunteers want to get the health department more data. The state keeps track of cancer rates by county, but not by town. And there are lots of types of cancers they don’t keep track of.

So Claire and Polly turned their Facebook group into something else.

“It’s a voluntary, self-reporting mapping project.”

They’re trying to map all the people in their community who’ve had cancer in hope of getting their health department interested in looking into this. They’re finding, then calling and surveying about 1000 people.

Terry Nordbrock runs the nonprofit National Disease Cluster Alliance. She says regular people are not usually successful in discovering a cancer cluster.

“There’s hundreds and hundreds of times where people have a concern-they’re observing harmful effects in their community and they can’t get anyone to listen to them. So that is actually the more common outcome: massive frustration for all involved.”

Terry Nordbrock says cancer clusters just don’t get enough attention from the government. She says that’s why people like Claire and Polly Schlaff often have to do the work themselves if they want to see it done.

“Communities deserve to have confidence that their concerns will be adequately addressed. We’re not there yet.”

Claire Schlaff says she doesn’t expect answers about what caused her son’s cancer.

“I don’t think we’ll ever figure out what caused Doug’s cancer. I feel like we might figure out why somebody got cancer.”

They do hope their work is useful and can provide answers for somebody, some day.

For the Environment Report, I’m Sarah Alvarez.

Our cancer and environment series continues tomorrow. We’ll hear about a confirmed cancer cluster in St. Clair County, where a number of young children have been diagnosed with a rare kidney cancer. That’s the Environment Report. I’m Rebecca Williams.

Our Murky Understanding of Cancer and Chemicals (Part 1)

  • Corinna Borden was diagnosed with Hodgkin's lymphoma six years ago. She wrote a book about her experience - "I Dreamt of Sausage." (Photo courtesy of Corinna Borden)

According to the latest numbers from the National Cancer Institute, roughly 41 percent of us will be diagnosed with some type of cancer in our lifetimes.

But “cancer” is not just one type of disease.

There are more than 100 different kinds with different personalities and causes. And the causes are not all that well understood.

This week, we’re taking a closer look at cancer and environmental pollutants.

It’s a subject researchers are trying to learn more about, but the picture of how the chemicals in our everyday lives interact with our bodies’ cells is far from clear.


What it's like to hear the word "cancer"

Six years ago, Corinna Borden woke up in the middle of the night with a shooting pain under her right rib cage. It was the kind of pain that made her want to crawl out of her skin.

Months went by and the pain got worse. Doctors were stumped.

She was taking two Vicodin pills every four hours for relief. The medical tests continued, and they eventually found the problem.

Hodgkin’s lymphoma – cancer.

She was 29 years old when she got the news.

“I basically shut down,” said Borden. “Like I was totally blown apart and terrified, and I couldn’t think of anything but that I was going to die and that this was really unfair. And then there was a small part of me that was happy that the pain was not totally in my head, and hadn’t been… And then [I was] angry that nobody had found it. So there was a lot going on. There’s that great line with Paul Simon, ‘when you lose love, it’s like everyone can see into your heart.’ It’s the same feeling, you've just been stripped…. every boundary you have is just laid open. It’s a really emotionally horrible feeling. ”

Doctors reassured Borden that Hodgkin’s lymphoma is treatable, and a week later, she started chemotherapy.

But after months of treatment, it didn’t work. Her scans still showed a spot where cancer might be lurking.

“To be honest my anger with the western establishment of not having the chemotherapy help me was also coupled with the anger [that] I’ve been poisoned by whatever that’s been going on… I mean I have no idea what it is I’ve been actually eating, or drinking, or every cosmetic, they don’t have list all of the ingredients or the 'natural flavors' – that is an umbrella that can mean anything,” said Borden.

How could this have happened?

It’s a common question after being diagnosed. People ask, “How could this have happened to me – or to my sister, my uncle, my mom, my neighbor?”

There are many factors that can lead to cancer. There are the genes we have inherited. There are viruses. There are naturally occurring things like sun exposure, arsenic in water, and radon.

All these factors can interplay with our genes and cause the cells in our body to grow out of control.

And then there are the man-made chemicals in our lives. How these impact cancer can be tough to figure out.

The National Toxicology Program of the U.S. Department of Health and Human Services publishes a list of substances that could cause cancer “to which a significant number of persons residing in the United States are exposed.”

The list is published every two years, and the most recent edition lists 240 substances that can lead to cancer.

  • 54 of these substances are listed as “known to be human carcinogens,”
  • and 186 substances are listed as “reasonably anticipated to be human carcinogens.”

The President's Cancer Panel calls for more action

Each year a panel of scientists appointed by the President takes stock of the nation’s strategy to fight cancer.

In 2010, a panel appointed by former President George W. Bush issued a report that said quote – “the true burden of environmentally induced cancer has been grossly underestimated.”

Chair of the President’s Cancer Panel Dr. LeSalle Leffall said that only a fraction of the 80,000 chemicals in use today are tested for safety.

“The health effects of many of these chemicals have not been studied or they’ve been understudied and the chemicals really remain unregulated,” said Leffall.

Leffall said the panel recommended more research and more action.

“We think that the government needs to take action to eliminate carcinogens from our workplaces, our schools, and our homes, and that action needs to start now,” said Leffall.

The President’s Cancer Panel report, “Reducing Environmental Cancer Risk,” talked about reducing exposure to things such as toxic substances in drinking water, pesticides, medical x-rays, car exhaust, and plastic food containers.

It was criticized by the American Cancer Society. They say only about 6% of cancer deaths are caused by occupational exposure and environmental pollutants.

From the ACS’ report “Cancer Facts & Figures 2012”:

Exposure to carcinogenic agents in occupational, community, and other settings is thought to account for a relatively small percentage of cancer deaths – about 4% from occupational exposures and 2% from environmental pollutants (man-made and naturally occurring).

They said the President’s Cancer Panel report put too much emphasis on these potential environmental risks to the detriment of other known risks – bigger risks – things like smoking, diet, and lack of exercise.

How can we know?

Dr. Richard Clapp is an environmental epidemiologist at Boston University.

He said the 6% number is outdated.

“This is a thirty-year old estimate. I think it was wrong 30 years ago and it’s wrong now. I don’t know what the real percentage is. I don’t think anyone knows what the real percentage is because things interact,” said Clapp.

He said right now, we simply don’t know enough.

“It’s not like environmental or occupational exposures cause 70% or 80%, we don’t know that,” said Clapp. “Anyone that claims they know that is making it up. There’s no way to prove that. But we do know that there are people getting exposed to stuff that causes cancer; why would we want to have that continue?”

Clapp says if there’s a chemical that looks like it might be linked to cancer, it’s wise to get rid of it.

He points to the falling rates of lung cancer as evidence of how we should approach the problem.

“It’s good news that lung cancer, especially in males, has begun to come down, and probably is beginning to come down in females. So that’s a story that needs repeating…  We don’t exactly know  the mechanism, we don’t know exactly what happens to an individual cell, from even whether it’s benzo[a]pyrene in the cigarette smoke, or something else in it, there’s lots of carcinogens in cigarette smoke. So we don’t know the exact details of how that works. But we know if we prevent that exposure it’s going to have a benefit for people’s health.”

Moving from a "reactionary principle" to a "precautionary principle"

Clapp said the U.S. should move toward the European model of chemical regulation. The REACH program (Registration, Evaluation, Authorization, and Restriction of Chemical substances) was adopted in Europe in 2007. It “places greater responsibility on industry to manage the risks from chemicals and to provide safety information on the substances.”

A similar, precautionary approach to chemical regulation has been introduced in the U.S. Congress.

The Safe Chemicals Act (S.847) was introduced by Senator Frank R. Lautenberg (D-NJ), and hearings on the bill were held last November.

And the National Institute for Occupational Safety and Health (NIOSH) is working on a new carcinogens policy expected later this year that could move toward a more precautionary approach to chemical regulation in the workplace.

Making changes, but trying not to be consumed by them

Corinna Borden doesn’t know what caused her cancer, but she has changed her life.

Soon after her diagnosis, she got rid of the chemicals in her house, she began filtering her tap water, and she changed what she eats.

But she tries not to be consumed by these choices. She say she still has to live.

“I’ve been in a position where I didn’t want to get out of bed, because I was so afraid of dying,” said Borden.  “And that’s not how we should live. Life is precious and beautiful and I really feel that you need to go out and experience it.  And going out and being a little closer to the edge is… what choice do we have?”

It’s been almost six years since Borden first heard the word cancer, and she doesn’t know yet if her cancer is in remission. (Borden keeps a blog about her experiences and life lessons, and she's also written a book, "I Dreamt of Sausage.")

For those who get the disease these days – fewer are dying from it because of advances in treatment and screening.

But researchers continue to work on one of the biggest puzzles – what makes our cells turn cancerous in the first place?

Tomorrow, as part of our week-long series on cancer and the environment, Sarah Alvarez will take us to White Lake, Michigan. Some families there are trying to figure out where cancer in their community might come from.