1. Environmental Issues and Cancer Prevention Strategies

2. Environmental Factors in the Development of Cancers Development of cancer is a multi-stage process influenced by a variety of environmental factors. Categories: radiation infections chemicals

3. Environmental Factors in the Development of Cancers The largest environmental contributors appear to be: tobacco smoke diet

4. Environmental Factors in the Development of Cancers Other environmental contributors: infections natural and manmade chemicals in foods, drinking water, indoor air (home and occupation), outdoor air

5. Strategies for Preventing Cancers Prevention of exposure to environmental agents through: education programs directed at avoiding or reducing exposures regulations that decrease environmental levels

6. Key Issues and Recommendations

7. Issue 1: Exposure information is limited and not easily accessible Recommendations: Improve accessibility and utility of environmental monitoring data by computerizing databases and geo-coding data Support development of a state environmental health tracking system

8. Issue 1: Exposure information is limited and not easily accessible Recommendations: Find ways to enhance Maryland’s regulatory data collection efforts Increase the capacity of the State to test for environmental agents and other biomarkers of exposure in urine, blood, and other tissues

9. Issue 1: Exposure information is limited and not easily accessible Recommendations: Explore ways to capture more information about commercial and non-commercial pesticide use Explore ways to increase ambient air toxics monitoring Support the development of a strategy for comprehensive, private well monitoring

10. Issue 2: Assessment of current control programs is inadequate Recommendation: Support efforts to measure the effectiveness of existing pollution control programs and policies, including their impact on toxic exposures and cancer

11. Issue 3: Limited information exists for occupational risk factors Recommendation: Explore opportunities for matching employee databases with the State’s cancer database to investigate Maryland’s occupational cancer burden

12. Issue 3: Limited information exists for occupational risk factors Recommendation: Establish an interdisciplinary task force to develop recommendations for occupational cancer surveillance in Maryland

13. Issue 4: Need collaboration between state and academic institutions Recommendations: Develop formal and adequately funded linkages between academia and government to bring teaching, research and practice agendas closer together Promote training of physicians and environmental scientists in occupational and environmental cancer research

14. Issue 4: Need collaboration between state and academic institutions Recommendations: Develop resources for responding to citizen’s concerns regarding cancer clusters that includes contact persons throughout local universities

15. Issue 5: Recognize and address infections that enhance cancer risk Recommendations: Encourage screening for HPV and support efforts to develop vaccine Promote immunization for Hepatitis B virus

16. Issue 5: Recognize and address infections that enhance cancer risk Recommendations: Encourage physicians to test for and treat Helicobacter pylori infection Support stronger efforts to control blood borne infections

17. Issue 6: Different cancer rates between communities of different socio-economic status and ethnicity Recommendations: Develop a public participation and involvement plan to support State cancer control initiatives Develop community health profiles to support decision making & priority setting Undertake comparative research to better understand differences in cancer rates

18. Issue 6: Different cancer rates between communities of different socio-economic status and ethnicity Recommendations: Support community health centers in local communities to increase screening & awareness of environmental health issues Make healthcare more culturally acceptable and appropriate

19. Final Recommendation Primary prevention needs to be an ongoing focus of Maryland’s Cancer Council planning process to ensure that environmental issues receive appropriate attention