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Carcinogenicity assessments: WHO decides?
Editorial
A column in the New York Times in September, 2012, drew attention to an attempt by the American Chemistry Council (ACC), a body representing the interests of the chemical industry in the USA, to put funding for the National Toxicology Program’s (NTP) 13th Report on Carcinogens on hold. The ACC wrote a letter to congress in April, 2012, contesting the change of listing in the 12th version of the report about formaldehyde, which is widely used in manufactured products, from “reasonably anticipated to be a human carcinogen” to “known to be a human carcinogen”, citing inconsistencies between various bodies in their methods of carcinogen reporting. They state that some aspects of a similar classification by an Environmental Protection Agency (EPA) report was not found to be scientifically justified by a government commissioned review. The ACC proposes that the NTP’s methods and purpose should be subject to similar scrutiny before publishing its 13th Report on Carcinogens. This justification, based on inter-departmental inconsistencies, raises a wider question about the duplication of work by different organisations and who the reporting bodies should be accountable to. In their letter, the ACC describe flawed science and duplicative procedures that they claim lead to confusing messages. The EPA report that listed formaldehyde as a carcinogen was reviewed by a panel from the National Academy of Sciences who, according to the ACC, found that the EPA had not justified its conclusion that formaldehyde causes leukaemia. The ACC claim that the NTP failed to take the National Academy’s findings into consideration and repeated that mistake. The NTP’s 12th report has an addendum acknowledging the review, but state that the National Academy had not been tasked to do an independent hazard assessment and their findings had restricted applicability to the 13th Report on Carcinogens. In September, 2012, 76 occupational and health scientists wrote a letter to congress to point out that WHO’s International Agency for Research into Cancer (IARC) monograph on carcinogens also describes formaldehyde as a human carcinogen, thus supporting the EPA and NTP reports. The ACC expresses concerns about the redundancy in a system that they claim has overlapping reporting of substances (with different assessment methods) between the NTP, EPA, Centers for Disease Control and Prevention, and Agency for www.thelancet.com/oncology Vol 13 November 2012
Toxic Substances and Disease Registry—all of which are under the control of different federal agencies. On this matter, however, they could have a valid point. Any methodological or report discrepancies can be exploited by lobbyists like the ACC and because these agencies are all housed within US Government agencies, they are vulnerable to lobbying organisations who can garner political influence, in this case, to suppress fundings. The amount of duplicative reporting in the USA can be amplified across the world. Several organisations review the same scientific evidence to generate reports on toxicity and carcinogenicity of chemicals. Although carcinogen research should certainly be undertaken by different institutions around the world, the review of carcinogen status only really needs to be done by a single international organisation with standardised, robust methods. Such an organisation should be independent of political influence and thus out of the reach of lobbyists. After all, if the report is a rigorous review of scientific evidence there should only be a single, unequivocal finding. It is notable that the 76 scientific experts supporting the EPA and NTP reports emphasised the IARC monograph on carcinogens as definitive evidence that the NTP’s report is scientifically robust and in accordance with global authoritative bodies. This comes at a time when WHO is reforming itself to better define its role in the world and is actively engaging with the global community to shape its future through a consultation process. The Lancet is supporting WHO and UNICEF in this venture and is seeking ideas for the shape of the organisation in the future. Perhaps global responsibility for carcinogen reporting should be ceded to IARC, under a revised remit for WHO, and then government policy on cancer risk from substances can focus on how to safeguard health and not whether the method of the assessment was sound. This centralisation of carcinogen assessment would sit logically within a strengthened prevention brief for non-communicable diseases within a post-2015 WHO. Closer international cooperation is essential to improve cancer prevention and treatment. Combining, rather than duplicating, scientific efforts in an environment independent from policy and industry lobbyists, should be a future aspiration in which WHO could take a central and leading role. ■ The Lancet Oncology
Laguna Design/Science Photo Library
Carcinogenicity assessments: WHO decides?
For the NTP’s 12th report on carcinogens see http://ntp. niehs.nih.gov/ntp/roc/twelfth/ profiles/formaldehyde.pdf For the ACC letter see http:// www.americanchemistry.com/ Policy/Regulatory-Reform/ ACC-Letter-to-House-ScienceCommittee-Regarding-JointHearing-on-the-Report-onCarcinogens.pdf For the addendum to the NTP’s 12th report see http://ntp.niehs. nih.gov/ntp/roc/twelfth/ Addendum.pdf For the IARC monograph on carginogens see http://www. iarc.fr/en/publications/pdfsonline/monographs/index.php For more on WHO and UNICEF’s consultation see Comment Lancet 2012; 380: 1214
1063
A column in the New York Times in September, 2012, drew attention to an attempt by the American Chemistry Council (ACC), a body representing the interests of the chemical industry in the USA, to put funding for the National Toxicology Program’s (NTP) 13th Report on Carcinogens on hold. The ACC wrote a letter to congress in April, 2012, contesting the change of listing in the 12th version of the report about formaldehyde, which is widely used in manufactured products, from “reasonably anticipated to be a human carcinogen” to “known to be a human carcinogen”, citing inconsistencies between various bodies in their methods of carcinogen reporting. They state that some aspects of a similar classification by an Environmental Protection Agency (EPA) report was not found to be scientifically justified by a government commissioned review. The ACC proposes that the NTP’s methods and purpose should be subject to similar scrutiny before publishing its 13th Report on Carcinogens. This justification, based on inter-departmental inconsistencies, raises a wider question about the duplication of work by different organisations and who the reporting bodies should be accountable to. In their letter, the ACC describe flawed science and duplicative procedures that they claim lead to confusing messages. The EPA report that listed formaldehyde as a carcinogen was reviewed by a panel from the National Academy of Sciences who, according to the ACC, found that the EPA had not justified its conclusion that formaldehyde causes leukaemia. The ACC claim that the NTP failed to take the National Academy’s findings into consideration and repeated that mistake. The NTP’s 12th report has an addendum acknowledging the review, but state that the National Academy had not been tasked to do an independent hazard assessment and their findings had restricted applicability to the 13th Report on Carcinogens. In September, 2012, 76 occupational and health scientists wrote a letter to congress to point out that WHO’s International Agency for Research into Cancer (IARC) monograph on carcinogens also describes formaldehyde as a human carcinogen, thus supporting the EPA and NTP reports. The ACC expresses concerns about the redundancy in a system that they claim has overlapping reporting of substances (with different assessment methods) between the NTP, EPA, Centers for Disease Control and Prevention, and Agency for www.thelancet.com/oncology Vol 13 November 2012
Toxic Substances and Disease Registry—all of which are under the control of different federal agencies. On this matter, however, they could have a valid point. Any methodological or report discrepancies can be exploited by lobbyists like the ACC and because these agencies are all housed within US Government agencies, they are vulnerable to lobbying organisations who can garner political influence, in this case, to suppress fundings. The amount of duplicative reporting in the USA can be amplified across the world. Several organisations review the same scientific evidence to generate reports on toxicity and carcinogenicity of chemicals. Although carcinogen research should certainly be undertaken by different institutions around the world, the review of carcinogen status only really needs to be done by a single international organisation with standardised, robust methods. Such an organisation should be independent of political influence and thus out of the reach of lobbyists. After all, if the report is a rigorous review of scientific evidence there should only be a single, unequivocal finding. It is notable that the 76 scientific experts supporting the EPA and NTP reports emphasised the IARC monograph on carcinogens as definitive evidence that the NTP’s report is scientifically robust and in accordance with global authoritative bodies. This comes at a time when WHO is reforming itself to better define its role in the world and is actively engaging with the global community to shape its future through a consultation process. The Lancet is supporting WHO and UNICEF in this venture and is seeking ideas for the shape of the organisation in the future. Perhaps global responsibility for carcinogen reporting should be ceded to IARC, under a revised remit for WHO, and then government policy on cancer risk from substances can focus on how to safeguard health and not whether the method of the assessment was sound. This centralisation of carcinogen assessment would sit logically within a strengthened prevention brief for non-communicable diseases within a post-2015 WHO. Closer international cooperation is essential to improve cancer prevention and treatment. Combining, rather than duplicating, scientific efforts in an environment independent from policy and industry lobbyists, should be a future aspiration in which WHO could take a central and leading role. ■ The Lancet Oncology
Laguna Design/Science Photo Library
Carcinogenicity assessments: WHO decides?
For the NTP’s 12th report on carcinogens see http://ntp. niehs.nih.gov/ntp/roc/twelfth/ profiles/formaldehyde.pdf For the ACC letter see http:// www.americanchemistry.com/ Policy/Regulatory-Reform/ ACC-Letter-to-House-ScienceCommittee-Regarding-JointHearing-on-the-Report-onCarcinogens.pdf For the addendum to the NTP’s 12th report see http://ntp.niehs. nih.gov/ntp/roc/twelfth/ Addendum.pdf For the IARC monograph on carginogens see http://www. iarc.fr/en/publications/pdfsonline/monographs/index.php For more on WHO and UNICEF’s consultation see Comment Lancet 2012; 380: 1214
1063