Based on its conclusions, the Panel recommends:
1. A precautionary, prevention-oriented approach should replace current reactionary approaches to environmental contaminants in which human harm must be proven before action is taken to reduce or eliminate exposure.
Though not applicable in every instance, this approach should be the cornerstone of a new national cancer prevention strategy that emphasizes primary prevention, redirects accordingly both research and policy agendas, and sets tangible goals for reducing or eliminating toxic environmental exposures implicated in cancer causation. The proposed Kid Safe Chemicals Act introduced in the 110th Congress, or similar legislation, has the potential to be an important first step toward a precautionary chemicals management policy and regulatory approach to reducing environmental cancer risk. Optimally, it should shift the burden of proving safety to manufacturers prior to new chemical approval, in mandatory post-market studies for new and existing agents, and in renewal applications for chemical approval.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
President/Administration
Congress
Environmental Protection Agency (EPA)
Department of Labor (DOL)/Occupational Safety and Health Administration (OSHA)
Department of Health and Human Services (HHS):
Food and Drug Administration (FDA)
National Institutes of Health (NIH)
Department of Agriculture (USDA)
State governments
Industry
2. A thorough new assessment of workplace chemical and other exposures is needed to quantify current health risks. Previous estimates of occupational cancer risk are outdated and should no longer be used by government or industry.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
Congress
National Academy of Science/ Institute of Medicine
National Science Foundation (NSF)
General Accountability Office
Other multidisciplinary group appointed for this task
HHS/National Institute for Occupational Safety and Health (NIOSH) DOL: OSHA
Mine Safety and Health Administration (MSHA)
3. In large measure, adequate environmental health regulatory agencies and infrastructures already exist, but agencies responsible for promulgating and enforcing regulations related to environmental exposures are failing to carry out their responsibilities.
The following are needed:
A more integrated, coordinated, and transparent system for promulgating and enforcing environmental contaminant policy and regulations, driven by science and free of political or industry influence, must be developed to protect public health.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
EPA
HHS/FDA
USDA
DOL:
OSHA
MSHA
Better concordance of exposure measures and standards is needed to facilitate interagency and international regulatory policy and enforcement and to identify research needs.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
HHS/National Institute of
Environmental Health Services
(NIEHS)
EPA
DOL/OSHA
The United States should carefully consider the potential impact on consumers and commerce of the Globally Harmonized System for classifying carcinogens.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
President/Administration
Congress
Information sharing among the public, researchers, regulatory agencies, industry, and other stakeholders must be a bedrock component of the environmental health regulatory system mission.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
EPA
DOL: OSHA
MSHA
HHS: FDA
Center for Disease Control and Prevention (CDC)
USDA
Department of Defense (DoD)
Department of Energy (DOE)
Environmental and cancer research communities
Industry
Media
Environmental and public health advocates should be included in developing the environmental cancer research and policy agendas and in information dissemination.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
Advocates
EPA
HHS: FDA
CDC
DOE
4. Epidemiologic and hazard assessment research must be continued and strengthened in areas in which the evidence is unclear, especially research on workplace exposures, the impact of in utero and childhood exposures, and exposures that appear to have multigenerational effects. Current funding for federally supported occupational and environmental epidemiologic cancer research is inadequate.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
Congress
EPA
HHS: National Cancer Institute (NCI)
NIEHS
National Institute for Child Health and Human Development
NIOSH
EPA
NSF
Nongovernmental research funders
5. Measurement tool development and exposure assessment research, including the development of new research models and endpoints, should be accelerated to enable better quantification of exposures at individual, occupational, and population levels. High-throughput screening technologies and related data interpretation models should be developed and used to evaluate multiple exposures simultaneously. It may be possible to screen apparently similar suspect chemicals together and regulate these as a group as indicated by findings.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
HHS
NIEHS
NIOSH
NSF
DoD/Applied Research Projects
Agency
Industry
Methods for long-term monitoring and quantification of electromagnetic energy exposures related to cell phones and wireless technologies are urgently needed given the escalating use of these devices by larger and younger segments of the population and the higher radiofrequencies newer devices produce.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
DOE
HHS/NIOSH
EPA
National Council on Radiation Protection and Measurements (NCRP)
6. The cancer risk attributable to residential radon exposure has been clearly demonstrated and must be better addressed.
The following are needed:
The Environmental Protection Agency (EPA) should consider lowering its current action level (4 pCi/L) for radon exposure, taking into account data on radon-related cancer risk developed since the existing action level was established.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
EPA
Public and health care provider education should be developed and broadly disseminated to raise awareness of radon-related cancer risk.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
HHS
Health care provider professional
organizations
Media
Improved testing methods for residential radon exposure and better methods for assessing cumulative exposure should be developed. Tax deductions or other incentives should be implemented to encourage radon mitigation retrofitting of existing housing. Building code changes should be made to require radon reduction venting in new construction.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
Industry
Congress
Internal Revenue Service
State and local governments
All schools, day care centers, and workplaces should be tested at regular intervals for radon. Radon level data must be made available to the public. Buildings found to have levels in excess of the EPA action level should be mitigated.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
State and local governments
7. Actions must be taken to minimize radiation exposure from medical sources.
Specifically:
Health care providers, radiology technicians, and the public must be informed about the extent of radiation exposure from commonly used imaging and nuclear medicine examinations and the potential health risks of these procedures.
Referring physicians are responsible for discussing with the patient the balance of benefit and risk associated with each imaging or nuclear medicine procedure being recommended. An educational/ decision-making tool that considers each patient’s cumulative lifetime radiation exposure should be developed to facilitate these provider-patient communications.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
Physicians and other health care providers
Health professional organizations Advocates
Media
HHS: Agency for Healthcare Research and Quality
NCI
The estimated effective radiation dose of all imaging and nuclear medicine tests performed should be a required element in patient records and should be a core data element in all electronic health records systems. In addition, patients should be assisted to reconstruct an estimate of the total medical radiation dose they have received.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
Joint Commission for Accreditation of Healthcare Organizations (JCAHO)
HHS: FDA
Centers for Medicare and
Medicaid Services (CMS)
CDC
Health Resources and Services Administration (HRSA)
Indian Health Service (IHS)
Office of the National Coordinator for Health Information Technology (ONCHIT)
Department of Veterans Affairs (VA)
DoD
Physicians and other health care providers
Radiation dose-lowering techniques must be implemented consistently and to the maximum extent feasible.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
Physicians and other health care providers
Inspection of radiation-emitting medical equipment and pharmaceuticals must become more stringent, and uniform credentialing of technicians who administer scans is needed.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
JCAHO
Radiation technologist professional organizations
HHS/FDA
8. The unequal burden of exposure to known and suspected carcinogens must be addressed. Individuals exposed to nuclear fallout and other nuclear contamination by biologically important radionuclides must be provided all available information on these exposures. A system must be developed to enable affected individuals to reconstruct and add radiation doses received so that they can adequately assess their cumulative exposure and potential health risks, including cancer.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
DoD
DOE
Nuclear Regulatory Commission
HHS/NCI
VA
NCRP
The Advisory Committee on Energy-related Epidemiologic Research (ACERER) should be rechartered, or a similar body convened, to enable individuals exposed to nuclear testing fallout and other nuclear exposures to participate in policy making and other decisions that will affect their access to health care and compensation related to those exposures.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
DOE
Geographic areas and vulnerable populations (including but not limited to children, migrant and other farm workers, and residents of high-poverty areas and cancer "hot spots") should be studied to determine environmental influences on cancer risk; identified risks must be remediated to the maximum extent possible.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
EPA
HHS/NIEHS
DoD
USDA
The U.S. Government should honor and make payments according to the judgment of the Marshall Islands Tribunal.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
President/Administration
Congress
9. Physicians and other medical personnel should routinely query patients about their previous and current workplace and home environments as part of the standard medical history. This information will increase the likelihood that environmental factors in cancer and other illnesses are considered and will strengthen the body of information on environmental exposures and disease. Data on workplace and home environmental history should be incorporated into existing and developing automated medical records systems.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
Physicians and other health care providers
HHS: ONCHIT
NCI: Surveillance, Epidemiology, and End Results Program
CDC: National Program of Cancer Registries
CMS
HRSA
IHS
DoD: TRICARE
VA: Veterans Health Information System and Technology Architecture
Private insurer patient databases
10. “Green chemistry” initiatives and research, including process redesign, should be pursued and supported more aggressively, but new products must be well- studied prior to and following their introduction into the environment and stringently regulated to ensure their short- and long-term safety.
RESPONSIBLE AGENCIES, STAKEHOLDERS, AND OTHER ENTITIES
HHS/NIEHS
EPA
NSF
11. Public health messages should be developed and disseminated to raise awareness of environmental cancer risks and encourage people to reduce or eliminate exposures whenever possible.
HHS: FDA
CDC
HRSA
CMS
USDA
DOE
Federal Communications Commission
Advocates
Media
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