She was diagnosed a couple of weeks after her 20th birthday. Later, after recuperating from surgery, she returned to her dorm room and discovered that her roommate had moved out, apparently unwilling to share space with a person who had cancer. Even now, 18 years later, the sight of a bare mattress can still move Sandra Steingraber to tears.
She can remember the diagnosis, the surgery, the empty room. But the roots of the cancer itself - the time and the place of it - are, of course, a mystery.You can't see your own cells mutating.
You can't see when or where cancer starts. Years can pass between exposure and symptoms, which is one reason why the epidemiology of cancer is so hard to pin down. But evidence is mounting, says Steingraber, that there is a deadly connection between the world we live in and the cancers we get.
Steingraber has a doctorate in biology and is a poet. Now she has written a scientific, lyrical, personal book called "Living Downstream: An Ecologist Looks at Cancer and the Environment." She'll read from her book at A Woman's Place bookstore, 1400 S. Foothill Drive, on Sunday, Oct. 12, at 2 p.m.
By Steingraber's assessment, we are all downwinders and downstreamers.
Nuclear fallout was only the most blatant of examples. Consider also, she says, trihalomethane, tetrachlorethylene and dioxin. Consider DDT and PCB and PCV, cyanizine, simazine and atrazine.
Yes, there are "cancer genes," says Steingraber. But fewer than 10 percent of all malignancies, she says, are believed to involve inherited mutations. Yes, Steingraber's own mother had breast cancer, an aunt had bladder cancer and several other relatives had colon cancer. But Steingraber herself is adopted.
"What runs in families does not necessarily run in blood," she writes. "And our genes are less an inherited set of teacups enclosed in a cellular china cabinet than they are plates used in a busy diner. Cracks, chips, scrapes accumulate. Accidents happen."
But which accident? Where? When?
The landscape of cancer is dotted with chemotherapy and support groups and hospices. But it is a landscape that may also begin with dirt and water and air.
Steingraber grew up in central Illinois, amid cornfields and soybeans, and also grain processing plants and chemical factories. A landscape, therefore, of pesticides and herbicides, dioxin and aromatic amines.
"Can I say cause and effect?" she asks about the link between her bladder cancer and toxic chemicals in the water she drank. "No. But I do believe we have enough evidence to say people shouldn't be drinking dry-cleaner fluid."
Here are some numbers:
- The incidence of cancer rose 49.3 percent in the United States between 1950 and 1991.
- There are 100 times as many synthetic chemicals produced today than there were just two generations ago.
- There are currently 40 possible carcinogens in our drinking water, 60 released by industry in to the ambient air, 66 routinely sprayed on our food as pesticides.
- The most conservative estimate of how many cancers are due to environmental causes is 2 percent. That's 30 funerals a day.
Not everyone agrees with Steingraber's conclusions or her interpretations of these numbers. Ray White, for example, who is executive director of the Huntsman Cancer Institute and chairman of oncological services at the University of Utah, notes that cancer deaths are down in the United States. The increase in cancer incidence may be due, in large part, he says, to better diagnostic techniques.
"It's very difficult to establish, for the most part, any direct relationship between chemicals and increases in cancer," he adds.
But waiting for the definitive proof may be too late, says Steingraber. Only between 1.5 and 3 percent of the 75,000 chemicals in use today have been tested for carcinogenicity. Most of those chemicals did not exist before World War II. We invented the first ones to help us fight a war. Then we found peacetime uses for them, without first finding out what their long-term effects would be on our health; the effects of making them, using them and later dumping or burning them.
Even those chemicals that have been banned haven't necessarily disappeared. They languish underground, says Steingraber. They show up in the fatty tissue of animals and humans. They are fed to babies in breast milk.
Chemicals don't stay put. Sprayed on a field, they evaporate, drift. They get caught in the jet stream. They dissolve in water, flow downhill, enter our ground water. Less than 0.1 percent of pesticides applied for pest control actually reach their target pests; 99.9 percent enter the general environment.
Sprayed on a lawn, they attach themselves to a shoe, get dragged indoors, get lodged in a carpet, touch the skin of a child. A 1995 Denver study found that children whose yards were treated with pesticides were four times more likely to have soft tissue cancers than children whose lawns were not sprayed.
Some synthetic organic chemicals interfere with our hormones, some attach themselves to our chromosomes, some cripple our immune systems, she says.
And no chemical lives in a vacuum. "Recent evidence," says Steingraber, "suggests that some of the major carcinogens in air are synthesized when organic chemicals released from various sources react with each other and are transformed into entirely new substances" - none of which have been tested.
So what can we do? "We can't shop our way out of this problem," says Steingraber. Drinking bottled water, for example, ignores the fact that a 10-minute shower can create a greater internal dose of volatile organic compounds (a reaction of chlorine and organic contaminants present in the water) than drinking a half gallon of tap water.
The answer, she says, is to travel way "upstream"; to stop the production and use of unhealthy chemicals and to find instead "the least toxic alternative." We should "shift the burden of proof," she says - instead of requiring consumers to prove that a substance is dangerous, require those who produce, import or use those substances to prove that they are safe.
We need to look toward the day, she says, when deliberately and routinely releasing chemical carcinogens into the environment "is as unthinkable as the practice of slavery."