The way I now see it, I’ve spent 16 years trying to help families avoid pediatric cancer. I do this mostly through writing books (my first was The Complete Organic Pregnancy) and articles.
I chose this work because we live in an increasingly toxic world. Also, I’m a mom. Children are uniquely vulnerable to exposures to potentially harmful substances: pesticides, flame retardants, and even ingredients in baby powder, toys, and cleaning products. Chemicals in the United States are allowed on the market until proven harmful. This is not the case in many other countries. This infuriates me, so I’ve been trying to raise awareness.
My work gave me a false sense of security. Despite doing everything “right”—we eat organic, use safer products, minimize indoor air pollution, etc.—my youngest daughter, now nine, was diagnosed with Wilms Tumor in 2021. I don’t know why she developed kidney cancer, though my family has gone through extensive genetic testing. I may never know.
I do know that my baby is now at risk for other diseases—including future cancers—as a result of the hideously toxic treatment that saved her life. In all of my years of environmental health work, I never specifically considered how pediatric cancer patients are even more vulnerable than the general population. Maybe it was too painful to imagine, until I had no choice.
My daughter is out of active treatment. Her energy is up, and her hair is pushing in. She has frequent follow-up scans and will for many years, if we’re lucky. We’re currently clawing our way through insurmountable emotional trauma. In clearheaded moments, I find myself searching for colleagues or friends—anyone, really—specifically doing prevention work with cancer survivors in mind. I have a fantasy I can go work for them. It has not been a fruitful endeavor.
But then, attending a conference on cancer and the environment, I found Dr. Judy Y. Ou PhD, MPH. She’s a research scientist at the Huntsman Cancer Institute in Utah, studying how pollution presents higher health risks for … childhood cancer survivors! I think she might be a goddess.
I called her. She shares my frustration with the lack of collaboration between oncology and environmental health experts. “It was a pretty duh moment, learning about all of the treatment-related complications that cancer survivors had,” she says, noting that her background in cumulative risk helps her work.
“A lot of cumulative risk is rooted in environmental justice. We know minority and low-income communities are historically overexposed to industrial pollution. But no one has thought to think of having a disease as a source of vulnerability,” she says.
Once she left her office in pollution so thick it was visible, so she wore a mask. But cancer patients were being wheeled through the pollution unmasked. “No one is telling them… This seems like an obvious thing people should be educating people about.”
While asthma and heart disease have traditionally been considered risks, “cancer itself has not been thought of as a risk in the same way. Honestly it takes an out-of-the-box thinker to connect the dots.”
To be clear, it’s not the oncologists’ fault. “That’s part of the issue with medical training in the United States. There is this huge gap in physician training about environmental health. They don’t ever talk about air pollution at length in their medical school.”
When doctors aren’t trained in environmental health, of course they don’t think to ask about home environments or consider if a patient lives next to a freeway.
“When I first started, a senior person flat out said, You are not going to find anything. Only treatment matters. Air pollution doesn’t.” Actually, Ou’s research has revealed just how much air pollution matters—more than she even imagined.
Some doctors avoid discussing home environment because they don’t know how to have a positive impact. Few patients have the means to move homes. Some interventions can be cost prohibitive, especially for families struggling with medical bills.
Ou contends an all or nothing mentality is a “fatalist perspective.” There are simple and inexpensive steps that anyone can take to minimize exposure. Phones can monitor air quality and N95 masks can be worn. HEPA filters can be installed. Ou mentions a Chinese dietary intervention study involving a detoxing broccoli sprout beverage. “There are a lot of different ways. Small increases in PM2.5 have big effects, so small reductions should also have big positive effects.” (PM2.5 is also known as fine particulate matter air pollution.)
One time, I asked a beloved nurse practitioner for enviro health advice. I wasn’t sure it would be safe for my daughter, who had lung radiation, to socialize near an outdoor fire pit. It was a pickle, because due to Covid-19, gathering outside is one of our only safe social options. My question was met with silence; she didn’t understand it, even though concerns about wood smoke are well-known.
“There are no existing recommendations that would give a nurse practitioner confidence to say you should be avoiding air pollution,” Ou says. “It’s a complete gap. For me it’s the Grand Canyon, and people are like, Where do you see this gap in recommendations?”
I also feel it’s the Grand Canyon. It’s oddly relaxing to be understood. Ou has lofty dreams. “At conferences, I hear people talk about precision medicine and looking at human genome and gene specific therapies for people. But we know the environment is a huge contributor to gene risk. It seems obvious to integrate environment here.”
She envisions environmental questions on intake forms like, Do you live near a superfund site or a freeway? Do you have a private well? Do you test your well water for nitrogen and heavy metals? “We do this for domestic violence, smoking, alcohol. Why don’t we do this for other factors too? It makes sense to target people who are already sick. They are most susceptible.”
Beyond intake, survivorship clinics would also be a useful place for environmental health education. Their guidelines could incorporate the fact that chemotherapy can be a cause of vulnerability to pollutants.
“We are on the cusp of something. These are new ideas; it’s going to take a few for people to get comfortable. We are so focused on genes and therapy and treatment, and we ignore the other 80% of people’s lives.”
She adds, “I’d love to see air pollution added to Children’s Oncology Group (COG) and American Cancer Society’s survivor guide.”
Me too. So badly. Maybe I can even write the words to add.