Sarah Gonzalez: Last month, President Biden announced he wanted to boost funding for research on cancer and other diseases.

President Biden: So many of us have deceased sons, daughters, and relatives who died of cancer. I can think of no more worthy investment. I know of nothing that is more bipartisan. Let's end cancer as we know it. It's within our power. [applause] It's within our power to do it.

Sarah Gonzalez: Experts say the fight against cancer is unwinnable if there isn't also a focus on preventing the disease by regulating carcinogens. The Environmental Protection Agency has historically been slow to act on known carcinogens, and much more research is needed to find out exactly which toxins are making us sick. What would it actually take to win the war on cancer? Here to explain is Diana Zuckerman, president of the National Center for Health Research. Diana, welcome to The Takeaway.

Diana Zuckerman: Thanks so much for having me.

Sarah Gonzalez: Okay, first, what kinds of carcinogens are we talking about here, carcinogens in products sold in stores, and in food? Are we talking about environmental exposures?

Diana Zuckerman: Well, unfortunately, it's all of the above. There are so many chemicals and other substances that we know can cause cancer, or know that it does cause cancer. Some of them are in our environment and some of them are in our home environment. Some of them are in our backyards. We really need to have that comprehensive view of what is causing cancers and doing something about it.

Sarah Gonzalez: What do you make of President Biden's plan? He said he wants to eradicate cancer. What does that realistically look like?

Diana Zuckerman: Clearly, he is very heartfelt on this issue, but his focus has really been on treatments. That's why he wants to do a new agency within the National Institutes of Health, that would focus on cancer but focus on it as a treatment. That's what NIH does. They do look at causes, but they're not looking so much at prevention, and that's what's been missing always. That's rather typical of political leaders.

Sarah Gonzalez: Okay, so there's more of a focus on treating cancer versus preventing cancer. Can you tell us what has the so-called war on cancer looked like in the past?

Diana Zuckerman: So far, the war on cancer has looked at what is called prevention, but is actually early diagnosis. You hear a lot about screening, there's a lot of interest in screening for all kinds of cancers where that's possible. That is effective at diagnosing early but it isn't really prevention usually, but most kinds of screening, whether it's mammograms or other kinds of screening that people are most knowledgeable about, really is about finding an early cancer, but the cancer is already there. That's why the war on cancer has always been very limited, because it's focused on the cancer once it started rather than looking at how can we prevent it, to begin with.

Sarah Gonzalez: Biden did mention prevention in his speech, he talked, I think, more specifically about screening for cancer. What are your thoughts on that approach?

Diana Zuckerman: It's a good approach as far as it goes, but it is not the way to really end cancer. If we want to end cancer, we've got thousands and thousands of chemicals that were being exposed to many of us every day. These chemicals are in our bodies. The various federal agencies have studied them, and they know that we have them in our bodies. What we don't know usually is how high those levels have to be to cause cancer, and that's always going to be different for different people.

If you want to end cancer as we know it, you would want to have much more information about what are these levels, which are the chemicals, what are the combination of chemicals, and who are the people who are most vulnerable, most likely to develop cancer if they are exposed to particular chemicals and other substances.

Sarah Gonzalez: Diana, public health experts who have spent their careers examining environmental causes of cancer say it may not be possible to truly stop cancer without the EPA stepping in. What is President Biden's strategy?

Diana Zuckerman: We haven't heard about a strategy pertaining to EPA, although his administration has already started to make some corrections of where EPA has been going in the last couple of years. I should just say that at the end of the Obama administration, an amendment to what's called the Toxic Substances Control Act, or TOSCA, an amendment was made, that was a bipartisan effort. It was a very big deal at the time of a compromise between what new chemicals and what old chemicals would finally be studied, and perhaps, in some cases, taken off the market, in exchange for giving states less control over what they did. For example, states like California tended to have much higher standards than other states.

The purpose of this compromise legislation was to put everybody on a more similar level playing field. What happened in the last four years was that these new regulations that were supposed to take place, these new reviews, and these new efforts to get carcinogenic chemicals off the market just stopped. They stopped because they stopped doing the right kind of research, they stopped looking at the right kind of research, and so hundreds of new chemicals went on the market that were potentially dangerous but weren't being studied.

The Biden administration has started reversing that, and that's great, but there are thousands of chemicals out there that we still know very little about, but we do know in many cases they have the possibility of causing cancer.

Sarah Gonzalez: What is the role of regulation here? How is the EPA falling short in terms of the regulation of carcinogens?

Diana Zuckerman: EPA is supposed to look at the new chemicals, as they are ready to go on the market and not allow them on the market if they show signs of being carcinogenic, and instead requiring that they be studied. There's still thousands of old chemicals that have already been on the market, and so there's this huge backlog. EPA needs to look at those as well.

EPA was supposed to find the chemicals that were most likely to cause cancer. By that I mean, ones that probably we already know cause cancer, but we just don't know under what conditions they cause cancer. That was what the EPA was supposed to be doing the last few years and stopped doing. Under the Biden administration, some of these policies have been reversed back to what the law is supposed to require, which is reviewing and then taking action.

Sarah Gonzalez: They just stopped reviewing whether certain products sold in stores are carcinogenic, or potentially carcinogenic. It's interesting, every time I see a warning on a product that says this is potentially carcinogenic, I'm like, "Why do we even allow this to be sold in stores then if it's possibly carcinogenic?"

Diana Zuckerman: That's such a good question. By the way, just in the last couple of days, there have been new reports about new evidence. I'll just very briefly mention what they are. The Inspector General of EPA came out saying that EPA need to do a better job. That's a good step in the right direction, where they're saying, "Oops, there are certain chemicals that we should be looking at more carefully that we haven't looked at yet."

In addition to that, a new study came out showing that PFAS, which are these chemicals known as forever chemicals, they've been in the news a lot lately, do cause kidney cancer and that was in a journal called the Journal of the National Cancer Institute. It was already assumed or thought that PFAS could cause kidney cancer or testicular cancer, but now we have a new study showing that people who have more PFAS in their bodies, in their blood, are much more likely to be diagnosed with kidney cancer.

Sarah Gonzalez: Where do we find this chemical PFAS?

Diana Zuckerman: Well, unfortunately, it's everywhere. It's in our homes, definitely. It's in stain-proof carpeting. It can be in our nonstick cookware. It's also outside as well. This is something that has been in the news a bit lately, but I think a lot of people are still not aware of. You have all of these different chemical abbreviations, the PFAS, the PFOA. People do get confused and for good reason. We're now finding very clear evidence that these chemicals not only cause cancer, but they accumulate and they don't go away. That's why they're called forever chemicals because they last for many, many years.

Sarah Gonzalez: Okay. How much is the White House focusing on environmental causes of cancer?

Diana Zuckerman: It seems not much. Another new study that came out about air pollution found that, not surprisingly, that air pollution can cause lung cancer, breast cancer, liver cancer, and pancreatic cancer. We really need at least a two-pronged approach if we want to end cancer. Treatment is very important, screening is very important. We need to look inside our homes, as well as air pollution and other emissions outside our homes.

Sarah Gonzalez: The timing of this announcement is interesting. It seems like the scramble to research and treat COVID-19 moved some of our attention and funding away from cancer research, but it also seems like the success of the COVID vaccines have also shown us what can happen when we put a bunch of resources into trying to solve a big health problem.

Diana Zuckerman: That's absolutely true. We've certainly realized that if you throw a lot of money at a problem under certain circumstances, with a lot of motivation, you can achieve what seemed absolutely impossible. It is true that it's been hard to get attention to cancer issues when COVID has really taken over, not just our lives but our news cycles.

Sarah Gonzalez: Diana Zuckerman is the president of the National Center for Health Research. Diana, thank you so much.

Diana Zuckerman: Thank you.

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