New substances added to HHS Report on Carcinogens

The U.S. Department of Health and Human Services today added eight substances to its Report on Carcinogens, a science-based document that identifies chemicals and biological agents that may put people at increased risk for cancer.

The industrial chemical formaldehyde and a botanical known as aristolochic acids are listed as known human carcinogens. Six other substances — captafol, cobalt-tungsten carbide (in powder or hard metal form), certain inhalable glass wool fibers, o-nitrotoluene, riddelliine, and styrene — are added as substances that are reasonably anticipated to be human carcinogens. With these additions, the 12th Report on Carcinogens now includes 240 listings. It is available at 12th Report on Carcinogens.

“Reducing exposure to cancer-causing agents is something we all want, and the Report on Carcinogens provides important information on substances that pose a cancer risk,” said Linda Birnbaum, Ph.D., director of both the National Institute of Environmental Health Sciences (NIEHS) and the National Toxicology Program (NTP). “The NTP is pleased to be able to compile this report.”

John Bucher, Ph.D., associate director of the NTP added, “This report underscores the critical connection between our nation’s health and what’s in our environment.”

The Report on Carcinogens is a congressionally mandated document that is prepared for the HHS Secretary by the NTP. The report identifies agents, substances, mixtures, or exposures in two categories: known to be a human carcinogen and reasonably anticipated to be a human carcinogen. A listing in the Report on Carcinogens does not by itself mean that a substance will cause cancer. Many factors, including the amount and duration of exposure, and an individual’s susceptibility to a substance, affect whether a person will develop cancer.

Once a substance is nominated by the public or private sector and selected for consideration, it undergoes an extensive evaluation with numerous opportunities for scientific and public input. There were at least six opportunities for public input on each substance. The NTP used established criteria to evaluate the scientific evidence on each candidate substance under review. The NTP drew upon the scientific expertise of several federal agencies, including the National Institutes of Health, Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry, U.S. Food and Drug Administration, U.S. Environmental Protection Agency, U.S. Consumer Product Safety Commission, and Occupational Safety and Health Administration.

“The strength of this report lies in the rigorous scientific review process,” said Ruth Lunn, Dr.P.H., director of the NTP Office of the Report on Carcinogens. “We could not have completed this report without the significant input we received from the public, industry, academia, and other government agencies.”

A detailed description of each substance listed in the Report on Carcinogens is included in the new report.

Two known human carcinogens:

Aristolochic acids have been shown to cause high rates of bladder or upper urinary tract cancer among individuals with kidney or renal disease who consumed botanical products containing aristolochic acids. Aristolochic acids are a family of acids that occur naturally in some plant species. Despite a warning issued in 2001 by the U.S. Food and Drug Administration that advised consumers to discontinue use of any botanical products containing aristolochic acids, they can still be purchased on the Internet and abroad, and may be found as a contaminant in herbal products used to treat a variety of symptoms and diseases, such as arthritis, gout, and inflammation.

Formaldehyde was first listed in the 2nd Report on Carcinogens as a substance that was reasonably anticipated to be a human carcinogen, after laboratory studies showed it caused nasal cancer in rats. There is now sufficient evidence from studies in humans to show that individuals with higher measures of exposure to formaldehyde are at increased risk for certain types of rare cancers, including nasopharyngeal (the nasopharnyx is the upper part of the throat behind the nose), sinonasal, as well as a specific cancer of the white blood cells known as myeloid leukemia. Formaldehyde is a colorless, flammable, strong-smelling chemical that is widely used to make resins for household items, such as composite wood products, paper product coatings, plastics, synthetic fibers, and textile finishes. Formaldehyde is also commonly used as a preservative in medical laboratories, mortuaries, and some consumer products, including some hair straightening products.

Six substances reasonably anticipated to be human carcinogens:

Captafol was found to induce cancer in experimental animal studies, which demonstrated that dietary exposure to captafol caused tumors at several different tissue sites in rats and mice. Captafol is a fungicide that had been used to control fungal diseases in fruits, vegetables, ornamental plants, and grasses, and as a seed treatment. It has been banned in the United States since 1999, but past exposures may still have an effect on health.

Cobalt-tungsten carbide (in powder and hard metal form) showed limited evidence of lung cancer in workers involved in cobalt-tungsten carbide hard metal manufacturing. Cobalt-tungsten carbide is used to make cutting and grinding tools, dies, and wear-resistant products for a broad spectrum of industries, including oil and gas drilling, as well as mining. In the United States, cobalt-tungsten hard metals are commonly referred to as cemented or sintered carbides.

Certain inhalable glass wool fibers made the list based on experimental animal studies. Not all glass wool or man-made fibers were found to be carcinogenic. The specific glass wool fibers referred to in this report have been redefined from previous reports on carcinogens to include only those fibers that can enter the respiratory tract, are highly durable, and are biopersistent, meaning they remain in the lungs for long periods of time. Glass wool fibers generally fall into two categories for consumers: low-cost, general purpose fibers, and premium, special purpose fibers. The largest use of general purpose glass wool is for home and building insulation, which appears to be less durable and less biopersistent, and thus less likely to cause cancer in humans.

o-Nitrotoluene is listed because experimental animal studies showed tumor formation at many different tissue sites in rats and mice. o-Nitrotoluene is used as an intermediate in the preparation of azo dyes and other dyes, including magenta and various sulfur dyes for cotton, wool, silk, leather, and paper. It is also used in preparing agricultural chemicals, rubber chemicals, pesticides, petrochemicals, pharmaceuticals, and explosives. Workers in the United States are likely exposed to o-nitrotoluene through the skin or from breathing it during production and use. o-Nitrotoluene has also been detected in air and water near facilities that produce munitions, and near military training facilities.

Riddelliine has been found to cause cancer of the blood vessels in rats and mice, leukemia and liver cancer in rats, and lung tumors in mice. This botanical should not be confused with the drug Ritalin, prescribed for the treatment of attention deficit hyperactivity disorder. Riddelliine is found in certain plants of the genus Senecio, a member of the daisy family, grown in sandy areas in the western United States and other parts of the world. Some common names for Senecio plants are ragwort and groundsel. Riddelliine-containing plants are not used for food in the United States, and have no known commercial uses. However, at least 13 Senecio species have been identified that are used in herbal medicines or possibly as food in other parts of the world. Exposure in humans could result from eating or drinking herbal medicine or teas, honey, or foods contaminated by parts of Senecio plants or after consuming products from animals that have fed on the plants.

Styrene is on the list based on human cancer studies, laboratory animal studies, and mechanistic scientific information. The limited evidence of cancer from studies in humans shows lymphohematopoietic cancer and genetic damage in the white blood cells, or lymphocytes, of workers exposed to styrene. Styrene is a synthetic chemical used worldwide in the manufacture of products such as rubber, plastic, insulation, fiberglass, pipes, automobile parts, food containers, and carpet backing. People may be exposed to styrene by breathing indoor air that has styrene vapors from building materials, tobacco smoke, and other products. The greatest exposure to styrene in the general population is through cigarette smoking. Workers in certain occupations may potentially be exposed to much higher levels of styrene than the general population.

The Report on Carcinogens, Twelfth Edition, is prepared by the National Toxicology Program, an interagency program headquartered at the National Institute of Environmental Health Sciences, part of the National Institutes of Health.

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The NTP was established in 1978. The program was created as a cooperative effort to coordinate toxicology testing programs within the federal government, strengthen the science base in toxicology, develop and validate improved testing methods, and provide information about potentially toxic chemicals to health, regulatory, and research agencies, scientific and medical communities, and the public. The NTP is headquartered at the NIEHS. For more information about the NTP, visit http://ntp.niehs.nih.gov.

NIEHS supports research to understand the effects of the environment on human health and is part of NIH. For more information on environmental health topics, visit  http://www.niehs.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases.

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New National Study Finds Decrease in Pediatric Injuries Associated with Household Cleaners Children younger than 6 years still at high risk of poisoning

Every year in the United States, there are more than 1.2 million poison exposures among children younger than 6 years. In recent decades, household cleaning products have consistently been one of the leading sources of pediatric poisoning. A new study conducted by the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital found that from 1990-2006, an estimated 267,269 children younger than 6 years were treated in U.S. hospital emergency departments for injuries attributable to household cleaning products. During the 17-year study period, researchers noted a 46 percent decrease in the number of injuries.

Data from the study, being released online August 2 and appearing in the September issue of Pediatrics, show that most of the household cleaner-related injuries were poisonings, with children ages 1-3 years accounting for the majority (72 percent) of the injuries. Bleach was the cleaning product most commonly associated with injury (37.1 percent). While approximately one-third of the injuries occurred through contact with the cleaning product, the more frequent means was ingestion (62.7 percent), and spray bottles were the most common storage container (40.1 percent).

“Interestingly, spray bottles were the only major storage source that increased over the study period,” said study lead author Lara McKenzie, PhD, principal investigator at the Center for Injury Research and Policy at Nationwide Children’s Hospital. “Although rates of household cleaner-related injuries from regular bottles and original containers decreased during the study period, spray bottle injury rates remained constant. This area is worthy of further research.”

The good news is that the number of injuries decreased almost by half during the study period, but the bad news is that there were still nearly 12,000 children younger than 6 years who suffered injuries from household cleaning products in 2006.

“Young children are curious about their surroundings and tend to explore their environment by putting things in their mouths,” said Dr. McKenzie, also a faculty member of The Ohio State University College of Medicine. “This general sense of inquisitiveness, combined with increased mobility, the ubiquitous nature of household cleaning products and the ease of accessibility, place young children at high risk of injury.”

Parents and caregivers must do their part to prevent childhood poisonings. According to Heath Jolliff, DO, associate medical director of the Central Ohio Poison Center at Nationwide Children’s Hospital, parents should store poisonous substances in locked cabinets, out of sight and reach of children.

“It’s important to only purchase cleaners with child-resistant packaging, keep all products in their original containers and properly dispose of leftover or unused products,” Dr. Jolliff, also a faculty member at OSU College of Medicine, said.

Parents should also know what to do if they suspect their child has come in contact with a poison. Dr. Jolliff advises to immediately contact the Poison Center at 1-800-222-1222 (this national number will direct callers to their local Poison Center), unless the child is unconscious, not breathing, or having seizures, in which case parents should call 9-1-1.

This is the first published study using nationally representative data to examine poisonings from household cleaning products among children younger than 6 years for an extended time period. Data for this study were collected from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. The NEISS dataset provides information on consumer product-related and sports and recreation-related injuries treated in hospital emergency departments across the country.

Reference:

Nationwide Children’s Hospital, New National Study Finds Decrease in Pediatric Injuries Associated with Household Cleaners Children younger than 6 years still at high risk of poisoning, Columbus, OH – 8/2/2010.

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Further Articles about Children’s Health:

• Oil Spill: Kids in the Gulf
• Pesticides in kids linked to ADHD- Attention-Deficit/Hyperactivity Disorder, study finds
• Our Planet – Our Children – How are your Children doing?
• EPA releases Guide to help Scientists understand Children Exposure to Pollutants
• Common Plastics Chemicals linked to ADHD Symptoms

The European Food Safety Authority (EFSA) has published an analysis of the levels of dioxins and related substances in food and animal feed. The report, which was prepared by EFSA’s Data Collection and Exposure unit, is based on over 7,000 samples collected by 21 European countries between 1999 and 2008. EFSA was asked by the European Commission to evaluate dioxin contamination levels in relation to maximum levels which have been set for different categories of food and feed in the EU in order to protect consumers.

Dioxins and similar compounds, such as dioxin-like polychlorinated biphenyls (PCBs), include a range of toxic substances which are formed by burning – e.g. through waste incineration or forest fires – and some industrial processes. Their presence in the environment has declined since the 1970s, following concerted efforts at the EU level.

Dioxins are found at low levels in many foods. They do not cause immediate health problems, but long-term exposure to high levels of dioxins has been shown to cause a range of effects, including cancer. Their persistence and the fact that they accumulate in the food chain, notably in animal fat, therefore continues to cause some safety concerns.

The highest average levels of dioxins and dioxin-like PCBs in relation to fat content were observed for liver and liver products from animals. The highest average levels in relation to total product weight were for fish liver and products derived from fish liver. In animal feed, the highest average levels were found in fish oil.

Overall, 8% of the samples exceeded the different maximum levels set out in EU legislation. However, some of these samples clearly originated from targeted sampling during specific contamination episodes. There were also large variations between different groups of food and feed in terms of the proportion of samples which exceed maximum levels.

The report concludes that no clear trend can be established regarding changes in background levels of dioxins and related substances in food and feed over time, as there were increases in some categories but decreases in others. Furthermore, occasional contamination episodes and a lack of information on which samples resulted from targeted or random sampling make it difficult to assess such trends.

The current EU method for measuring overall dioxin levels is based on toxicity values for different types of dioxins recommended by the World Health Organisation (WHO) in 1998. EFSA was also asked to assess the impact on total dioxin levels of using toxicity values set out in WHO recommendations from 2005, which downgraded the relative toxicity of certain types of dioxins. The report finds that using the new values would reduce overall dioxin levels by 14%, although the extent of this reduction was very different across food and feed categories.

Finally, the report recommends continuous random testing of a sufficient number of samples in each food and feed group to ensure accurate assessments of the presence of dioxins and dioxin-like PCBs.

Author; EFSA, EFSA publishes European overview of dioxin levels in food and feed, March 31, 2010

• Full Report
• Results of the monitoring of dioxin levels in food and feed
• European Commission – Food Contaminants – Dioxins and PCBs

WASHINGTON – The U.S. Environmental Protection Agency today released a user-friendly document to help risk assessors understand how children are exposed to pollution. The document, titled “Highlights of the Child-Specific Exposure Factors Handbook” serves as a quick-reference guide to the more comprehensive “Child-Specific Exposure Factors Handbook” published by EPA in 2008. It will serve as an additional resource for those who work on children’s health issues, which the agency has been highlighting during Children’s Health Month.

EPA developed the reference guide to provide important information necessary for answering questions about exposure through drinking water, breathing, and eating foods, such as:

• How much exposure to environmental pollutants might children get if they live or play near contaminated sites?
• How much dirt from a child’s hands might s/he inadvertently eat?
• How much of a child’s exposure to various pollutants might come from skin contact?
• Which age groups (childhood life stages) may inhale or ingest the most and thus may be at higher risks?

More information on the documents:

• http://www.epa.gov/childexpfactors/highlights
• http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=200445

Reference: EPA Releases Guide to Help Scientists Understand Children’s Exposure to Pollutants, Release date: 10/27/2009

This article aims to describe essential conditions and starting-points for the monetary evaluation of environmentally attributable diseases. Furthermore, a cost calculation within a scenario analysis is conducted for Germany. 

To calculate the costs of environmental health effects we chose a disease-specific perspective. The national statistics of the Federal Statistical Office and the World Health Report burden of disease estimates were used to identify the most important disease categories for Germany. Based on an extensive literature research in computerized databases and the publications of national and international institutions, available costs of illness studies for Germany as well as environmental attributable fractions (EAFs) were identified. Based on these data environmental health costs were calculated with a top-down approach. 

Direct and indirect environmental costs of illness add up to 15-62 billion euro (2006) per year depending on the specific scenario. From our results a tentative scheme is deduced of how the monetary environmental burden of specific diseases is composed and how it can be assigned to major environmental exposures and economic sectors which can be used in setting intervention priorities and evaluating intervention efficiency. 

Within this article, we were able to calculate environmental health costs for Germany based on available, easy to access data and deduce implications for environmental policy decision-making. However, there are restrictions in data quality, as the aetiology of some diseases with respect to environmental impacts is not very well documented and data has not been collected particularly for Germany. 

Reference:   Haucke F, Brückner U., First approaches to the monetary impact of environmental health disturbances in Germany, Helmholtz Zentrum München – German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Germany, Health Policy. 2009 Sep 8.