Transcript of Bladder Cancer and Environmental Exposure

Voice over:

This is Bladder Cancer Matters, the podcast for bladder cancer, patients, caregivers, advocates, and medical and research professionals. It’s brought to you by the Bladder Cancer Advocacy Network, otherwise known as BCAN. BCAN works to increase public awareness about bladder cancer, advances bladder cancer research, and provides educational and support services for bladder cancer patients and their loved ones. To learn more, please visit bcan.org.

Rick Bangs:

Hi, I’m Rick Bangs, the host of Bladder Cancer Matters, a podcast for, by and about the bladder cancer community. I’m also a survivor of muscle invasive bladder cancer, the proud owner of a 2006 model year neobladder, and a patient advocate supporting cancer research at the Bladder Cancer Advocacy Network, or as many call it, BCAN, producers of this podcast. This podcast is sponsored by Merck, Bristol-Meyers Squibb, and Genentech.

Today we’re going to talk about bladder cancer and environmental exposure. Like me, when many patients are told that they have bladder cancer, their first question is how did I get it? There are some known causes like smoking, but there are others that people might not be aware of. To help sort this out, I’m excited to have two guests joining me today. First up is Dr. Stella Koutros, an investigator at the occupational and environmental epidemiology branch of the National Cancer Institute, also called the NCI. Among other things, Dr. Koutros has an interest in pesticide exposures and cancer risk, as well as occupational and environmental exposures associated with risk of bladder cancer.

Our second guest is Molly Jacobs, an environmental epidemiologist who focuses on exposure reduction. Molly is a senior research associate and project manager at the Lowell Center for Sustainable Production with over 20 years of experience in public health research and practice. Dr. Koutros, I’m so excited to have you join me today to discuss potential causes of bladder cancer beyond smoking, which we know as the most common cause.

Dr. Stella Koutros:

Hi, Rick, it’s a pleasure to talk with you and Molly today and feel free to call me Stella. And yes, about 50% of all bladder cancer is attributable to smoking in men and women. And occupational exposures or workplace exposures have also been recognized as an important contributor and have been estimated to be responsible for up to 25% of bladder cancer among men, and about 11% among women. And we also know that exposures that occur outside the work setting in our environment play a role.

Rick Bangs:

Molly, I’m so pleased to have you join us in this discussion with a focus on the actions that we can take against these other causes of bladder cancer.

Dr. Molly Jacobs:

Well, thank you so much, Rick. I’m really thrilled to be here with you both. I’m a big fan of Stella’s research and, yes, because there are indeed actions that we can take to prevent bladder cancer. Those of you, Rick, like yourself and your listeners that have gone through this disease, are critical champions for educating friends and colleagues and family and the general public about what we know about causes of the disease, but also what we can do about it. And my whole professional career has been focused on the premise that prevention is possible for so many cases of this disease and other types of cancer.

Rick Bangs:

OK, and I’m really looking forward to hearing more about that, but let me start with Stella. So most people have heard about linkages between smoking and bladder cancer, but a large portion of us and myself included, never smoked and wonder what other possibilities there might be. So we can make the link between liquids and urine, so what we drink and eat might be higher on our list of suspects than other things would be. But what categories of things might have caused our bladder cancer?

Dr. Stella Koutros:

So we know a lot from the literature of smoking about the relationship between the carcinogens in tobacco smoke. And when they are inhaled, they interact with the cells in the lining of the bladder, and those carcinogens can lead to the development of bladder cancer. So we know that there’s also the possibility for other things that we eat and breathe and drink and inhale in our environment also have the potential to have an effect once they reach the bladder. And we also know that for bladder cancer, it has a long latency. So that just means that the things that you were exposed to many, many years ago all add up over time to influence your future risk of bladder cancer.

Rick Bangs:

Yeah. I’ve heard some doctors talk about 15, 20 years as being normal and on the low end of that exposure. [crosstalk 00:05:19] have any thoughts on that.

Dr. Stella Koutros:

Yeah, so we know that it could be that latent period could be between 15 and 20 years on average for many cancers. And it also can be exposure for specifics. So for some bladder carcinogens, they’ve been shown to have a latent period of up to 40 years even. So you think about those exposures that happened up to four decades prior could still impact your risk.

Rick Bangs:

Wow. All right. Let’s talk about some specific causes. Stella, what does your research or research done by others tell us about these other causes?

Dr. Stella Koutros:

One of the areas that I work in is obviously in occupational and environmental causes with cancer at the National Cancer Institute. So I thought that maybe we could talk about some of the environmental causes that we know about first.

Rick Bangs:

Yeah, let’s do it. Let’s start with arsenic because I know that that is sometimes found in well water and can lead to bladder.

Dr. Stella Koutros:

Yes. In the general population, a few environmental exposures in drinking water have been pretty well studied as risk factors for bladder cancer, and arsenic is really one of the big ones. It’s a well established bladder carcinogen, and people can be exposed to arsenic in their drinking water depending on where they live and their water source. In some places, private wells can be more likely to be contaminated with arsenic, depending on the region’s geology and other factors.

Rick Bangs:

And arsenic is naturally occurring, right?

Dr. Stella Koutros:

Correct. It’s part of the land’s geology, but also the levels that are present in some private wells also can depend on the type and depth of the wells in the particular regions. And Molly, I know that this is an area you’re quite knowledgeable about as well.

Dr. Molly Jacobs:

Yeah. Also, an additional factor to that, and correct me if I’m wrong, Stella, but the legacy use. Decades ago we used to use pesticides that were arsenic based. We don’t use them any anymore. They’ve been banned, but is that also a contributor to what’s landing in people’s wells?

Dr. Stella Koutros:

That’s correct. So the region’s natural geology as well as a historical use of arsenical pesticides are really the main historical source of arsenic contamination in drinking water.

Rick Bangs:

Now are there other water contaminants that people should be aware of, other environmental exposures?

Dr. Stella Koutros:

Yeah. So there are also other drinking water exposures that have been studied and suspected to be related to bladder cancer. The evidence for these is not as strong as it is for arsenic, but the evidence is definitely accumulating. So drinking water also contains disinfection byproducts, so sometimes you’ll see that abbreviated as DVPs. And these are formed when chlorine and other disinfectants react with compounds in source water, and elevated levels have been detected in public water supplies. And research studies over the last decade or so have identified trihalomethanes, or THMs, which is the most common of the DBP that have been associated with an increased risk of bladder cancer. In addition to the DBPs, another contaminant of interest in drinking water is nitrate. And this has also been associated with historical use of nitrogen fertilizers in predominantly agricultural regions. But for arsenic and nitrate, private wells tend to have higher levels of these because they’re not regulated in the same way as public water supplies.

Rick Bangs:

And now what about outdoor air pollution? Is that a cause?

Dr. Stella Koutros:

So that’s a really interesting area of research at the moment. We are starting to understand more and more about the health effects associated with outdoor air pollution. In the context of bladder cancer, we’re still trying to understand what components of pollution might be really important. So air pollution is a really complex mixture of chemicals, but one of those constituents is diesel exhaust, and diesel exhaust is something that I studied quite a bit in relation to bladder cancer risk. And we know that there is starting to be a much stronger link now between diesel exhaust exposure, which is part of the air pollution as a risk factor for bladder cancer as well.

Rick Bangs:

And it probably makes sense to our listeners because smoke is something that you’re inhaling and you’re breathing. And so air pollution make sense, even though it’s not something you’re eating or drinking.

Dr. Stella Koutros:

Absolutely. I think that obviously, we’re all exposed to outdoor air pollution. And so I think we are going to be learning a lot more about the health effects associated with diesel exhaust and probably lots of other components of air pollution in the coming years.

Rick Bangs:

So there’s also occupational exposure and that’s a factor for bladder cancer, second only to smoking. So can you tell us about some of the occupations which are higher than normal risk for bladder cancer, how strong the evidence for that occupation might be, and why people in these occupations face increased risk? So Stella, let’s start with the three, for which I understand there’s actually the most evidence. First is dye manufacturing and hairdressers. Second is rubber manufacturing, which includes tires, and the third are painters and dry cleaners.

Dr. Stella Koutros:

Yes, during the second half of the 20th century, many studies identified certain groups of workers with increased rates of bladder cancer. And I think the most famous example is the elevated rates of bladder cancer in dyestuff workers, and dye users. Those are people who were working in dye manufacturing and more recently who are hairdressers, who are using dyes. These workers are exposed to specific chemicals called aromatica means, and these are very well known and described to cause direct damage to those cells of the bladder that we were talking about earlier. And so workers who inhale or have dermal exposure to these chemicals are at an increased risk for bladder cancer.

Rick Bangs:

Yeah, so they’re both breathing it. And they’re also, particularly if they’re not wearing gloves, they’re having exposure on the skin.

Dr. Stella Koutros:

Correct. We also know that people who have worked in the rubber manufacturing industry have a very steadily observed increased risk of bladder cancer. In this setting, there are so many varied chemical exposures that it’s really been hard to pinpoint a specific chemical that would explain the risk, but it’s clear that group of workers have greater rates of bladder cancer.

Rick Bangs:

And what about our painters and dry cleaners?

Dr. Stella Koutros:

Right. So other occupational groups that are associated with increased risk of bladder cancer include these painters and dry cleaners. Both of these groups have inhaled and dermal exposures to solvents, some which are known bladder carcinogens, and some are suspected. We still need more research on some of these solvents to fully understand which additional solvents really contribute to risk. But these group of workers also are exposed to a range of products, but we think that some solvents in particular might be important here.

Rick Bangs:

Okay, so we’ve talked about the three for which there’s the most evidence, and I’m curious about others where the evidence is mounting. I understand one that I think might surprise our listeners is truck drivers.

Dr. Stella Koutros:

Yeah, so drivers of trucks and other motor vehicles have an increased risk of bladder cancer. This is linked to inhaled exposure to diesel engine exhaust. So we talked about that as a component of outdoor air pollution, but truck drivers have as part of their occupation, a continuous stream of exposure to diesel engine exhaust. This exhausts itself is a complex mixture. And we know that it’s already a well established lung carcinogen, but the evidence is really mounting now with more recent studies where we can look at that question more carefully in the context of smoking. So that is taking smoking into account and exposure to diesel exhaust into account that the links with bladder cancer are becoming more clear.

Rick Bangs:

So Stella, are there any others?

Dr. Stella Koutros:

Sure. So one other part of my research is actually really dedicated to pesticide exposures and cancer risk. I’ve done a lot of this work by studying farmers because they use a lot of pesticides. So this gives us an advantage for our research studies because their exposures are really high. And exposure to Agent Orange, which is a mixture of two herbicides, has also been of interest for bladder cancer, because a contaminant in Agent Orange called dioxin, or TCDD, is a known carcinogen. Agent Orange was sprayed during the time of Vietnam War to remove various plants, and because of the way it was sprayed, exposure probably occurred through many different routes, but it’s clear that many veterans and people in the area where it was sprayed were exposed. And this exposure has been clearly linked to certain blood cancers, and there’s also evidence to suggest there’s an association with bladder cancer. As a result, the VA now includes bladder cancer under its list of presumptive conditions eligible for disability compensation.

Another occupational group of interest is firefighters clearly also have exposure to inhaled smoke and a wide variety of other potential carcinogens. The research in firefighters and bladder cancer is still a little bit limited, but what’s really interesting is at coming up over the next year or so I believe, the international agency for research on cancer, IARC, which is part of the WHO, the World Health Organization, is going to be doing a review of all the literature, looking at the relationship between working as a firefighter and cancer. I’m really going to be looking forward to that summary of the literature and the evidence for that group of firefighters from the WHO.

Rick Bangs:

So Stella, I know you’re leading some large studies of bladder cancer to identify occupational exposures that might influence risk. Can you talk about your work in a patient friendly way?

Dr. Stella Koutros:

Sure. One of the studies that I work on is called the New England Bladder Cancer Study. It was a study that was designed to study why there were some observed increases in the incidents of bladder cancer in New England. The study was conducted in Maine, Vermont, New Hampshire, and the study was focused on looking at the effect of occupational and environmental exposures in particular, also looking at arsenic because a lot of the people in that area of the country use private wells for their drinking water, but also other drinking water contaminants.

Then occupational exposures were also evaluated because people were asked about their entire of lifetime occupational history. And so this study is called a case control study, and you start with a bunch of people who have bladder cancer and match them to controls who are the same age. They’ve been asked a series of really detailed questions to try to evaluate whether these environmental and occupational exposures are causing the bladder cancer risk. And so we published several papers, like I said, on arsenic and disinfection byproduct exposures, nitrate exposures in drinking water, but also on diesel exhaust and other occupational exposures as well.

Rick Bangs:

That sounds like exciting work.

Dr. Stella Koutros:

Thank you. In addition to the work on occupation environment, we do also have biological samples that were collected to look at genetic factors. So we and others have shown that people who have a family history of bladder cancer, that is a first degree relative with bladder cancer, have two times the risk of bladder cancer compared to those who don’t have a family history. We’re also conducting large studies to identify what some of the common specific genetic markers are that increased risk. For example, one of the genetic markers that’s been identified is related to our ability to break down and get rid of the cancer causing chemicals in tobacco smoke. There’s a gene called NAT2 and some people have changes in this gene that make it harder to eliminate the toxins from cigarette. This is known as a gene environment interactions. It’s one of the most famous in cancer, and it results in an increased risk for bladder cancer, specifically amongst smokers.

Rick Bangs:

So this could explain why some people who smoke get it and other people who also smoke, even if it’s the same amount, don’t get it.

Dr. Stella Koutros:

Well, the amounts that you smoke definitely makes a difference as well.

Rick Bangs:

Yep.

Dr. Stella Koutros:

Clearly there is genetic variation that contributes to the differences. Absolutely.

Rick Bangs:

Right. Right. Okay. So now we’re going to pivot. We’re going to pivot from causes to the possibilities of reducing risks that are underlying these same causes. We’re going to look at both the individual and the local level. Molly, can you first describe the type of work that you do and generically, how do you approach reducing risk?

Dr. Molly Jacobs:

Sure. I just want to say, thank you, Stella. What a great summary of the science related to these risk factors for bladder cancer. Like Stella, I was trained as an environmental epidemiologist. I started my career conducting health studies in Massachusetts, where we had a disease cluster, more stock on this as a cancer cluster, and where we had concerns that the elevated rates may have a common environmental exposure. It was during these studies that I found myself feeling really frustrated that the same chemicals responsible for cancers and other diseases were still in use, still causing contamination, still exposing workers and communities. I just couldn’t understand why we hadn’t acted on the science of harm that Stella and other researchers have discovered and often discovered many decades ago.

So I found myself wanting to really move upstream and work less on studying the problem and focusing more on preventative solutions. So at my research institute at the University in Massachusetts Lowell, we work directly with individuals to educate them about preventative options that they have at their disposal. We work with governments to help design stronger policies that better protect us both by limiting allowable exposures and wherever possible, to support industries in transitioning to safer alternatives.

We also work more directly with businesses to help phase out their use of carcinogens. Again, showcasing the availability of options and alternatives for them to move towards, and support innovation in the development of safer and more sustainable chemicals. Lastly, we try to link all of these entities together, individuals, NGOs, governments, and businesses, to really scale the change that’s needed, realizing that prevention requires action by a range of actors and sectors at multiple levels, the individual, the institutional, which includes businesses and also governments.

Rick Bangs:

So you’re trying to make sure all the stakeholders are playing a role.

Dr. Molly Jacobs:

What’s the saying? It takes a [crosstalk 00:23:12] It takes a village. It really does. It absolutely does. No one action alone … I mean, bladder cancer, like all cancers, they’re multifactorial. And so we really need to attend to solutions at so many different levels in order to really make gains on prevention.

Rick Bangs:

So true. Molly, can you give us some examples of successes where in which you or your counterparts can be really proud, and which our audience might be able to relate?

Dr. Molly Jacobs:

Sure. Let me start at the local level. I think one example that for me is really compelling is transitioning dry cleaners to professional wet cleaning. So as Stella mentioned, dry cleaners are one of the occupations where we’re seeing elevated rates of increased risk of bladder cancer and due to exposure to certain solvents that are used in those cleaning operations. I’m going to name a name there. The chemicals called perchloroethylene. I’ll call it perch, so these are types of businesses that line our main streets across our cities and towns, but we’ve learned that we don’t have to use the solvent to do the job of cleaning our clothes. So even though the labels of my wool sweater or my silk blouse says dry clean only, they don’t have to be dry cleaned. They can be cleaned through a process that’s called wet cleaning.

Professional wet cleaning is effective, and it’s a clearly safer alternative to dry cleaning. It uses what’s called computer controlled washers and dryers and soap and water, and a special drying process that uses tensioning equipment. There’s no toxic solvents involved at all. So we worked directly with a dry cleaner in a Boston neighborhood called Jamaica Plane to help make this transition. It was an immigrant owned facility. We hooked them up with our colleagues at the Massachusetts Toxic Use Reduction Institute who were running demonstration events where a wet cleaner shares their experience, shows interested colleagues and other shops how the technology works and answers their questions. The Institute also provided the shop with a small grant to offset some of the cost related transition.

For me, this is a really great story because the son of that particular now professional wet cleaning shop is super excited to take over the business. He feels that it’s so much safer to work there and is part of a small business that is really making healthier changes for the community as a whole. There are over a dozen or so wet cleaners now in Massachusetts, but there’s still about 500 dry cleaners. So this is still a very niche industry, despite the existence of safer technology, so it requires education. It also requires consumer support to utilize consumer purchasing powers, to help businesses and support businesses that are making these healthier choices for all of us. And to really scale the change, it will require more policy level intervention to better incentivizing these types of businesses in our communities.

Rick Bangs:

So this is an industry in transition then.

Dr. Molly Jacobs:

I hope so. There are definitely policies dotted around the country that are severely restricting or phasing out the use of perchloroethylene. The problem is that many of them are going to other types of toxic solvents rather than an inherently safer technology like wet cleaning. So those that are using the wet cleaning technology are literally leapfrogging over potentially future problems associated with health effects from the new solvents that they’re adopting. So yes, this is an industry in transition, and there’s definitely safer alternatives for them to be using.

Dr. Stella Koutros:

What a wonderful success story, taking what we have learned in the research world and really putting it to action. That was an amazing story. Thank you for sharing that moment.

Dr. Molly Jacobs:

Oh, well, thank you. Yeah. It’s a definitely a story of using the science and moving towards going down preventative paths. But it brings me to want to mention, I have two other success stories to share with you from my perspective. Well, I guess next I want to focus on the issue of policy and I have to ask, why a chemical perchloroethylene, the solvent that’s used under dry cleaning, isn’t more tightly regulated in the United States. The United States Environmental Protection Agency, the EPA, has issued rules to more tightly regulate the dry cleaning industry. But in general, I have to say we really don’t have an effective federal regulatory system that is protecting workers and consumers from health risks associated with toxic chemicals.

So many chemicals were grandfathered into being approved without adequate safety testing when our main law, which is called the Toxic Substances Control Act, was established in the 1970s. The result is that our EPA bears the responsibility for making findings of significant harm, of significant risk in order to more strictly regulate specific chemicals. So, as you can imagine, such an effort is highly political and goes beyond just the science and the politics really dominate the discussion. We only address one chemical at a time.

So I just want to say you regulation is absolutely a key driver for progress, but I want to elevate, I guess, a success that we’re seeing at the state level. I have to say that we’re seeing a lot more advances on prevention being made at the state level. For example, I work closely with an institute, which I mentioned before, the Massachusetts Toxic Use Reduction Institute, and it was formed as part of a law in Massachusetts to help businesses reduce their use of toxic chemicals. The law requires that Massachusetts companies which use or manufacture large quantities of one of nearly about 1500 listed toxic chemicals, they require them to report their use and releases every year, to undergo a planning process that identifies options to reduce their use of toxics, and to pay an annual fee that supports state programs that are tasked to provide assistance to businesses, to help them implement the options, the toxics reduced options that they identified.

And so TURI, the Toxic Use Reduction Institute, has conducted research on alternatives for toxic chemicals that are used in an array of applications. I mentioned the dry cleaning example, but perchloroethylene, which is the solvent used in dry clean, is also used in a number of industries, such as those that use the solvent to clean metal parts. But what I want to focus on is the real gains that this law has made. We conducted an analysis a few years back, that software example, and 96% reduction and the use of that solvent, perchloroethylene, that’s used dry cleaning and metal parts cleaning, et cetera.

We also saw a decline of a class of air pollutants called poly aromatic hydrocarbons that have also been linked to bladder cancer, a 97% decline in these substances. SO the lesson here is that when businesses realize that there are safer options, which are all also economically preferable, because it reduces their liabilities and regulatory costs, industries do make the switch. And so this type of policy, one that pairs planning with support to transition, to provide substitution assistance is highly effective to support cancer prevention. But I have to say, unfortunately, there are only a few states that have such a policy.

Rick Bangs:

So Massachusetts, I’m guessing, is more on the leading edge. California, we probably would all recognize is maybe the leader at the top, Massachusetts pretty close?

Dr. Molly Jacobs:

Well, having been a former Massachusetts resident and still employed by Massachusetts, yes, I do think it’s leading, especially in this place of understanding what it takes to move towards safer options, to move towards safer chemicals, to phase out problematic, hazardous, carcinogenic compounds and what it takes to do so. It takes policy, but it also takes a range of other programs to support industry actors to make these shifts.

Rick Bangs:

Along with good science, right?

Dr. Molly Jacobs:

Along with good science.

Dr. Stella Koutros:

Absolutely.

Rick Bangs:

Molly, our audience is always going to be interested in taking action that might benefit themselves or people they know. So you heard Stella talk about bladder cancer risks. What kinds of interventions might a person or a group of people consider to specifically reduce the risk of bladder cancer for themselves or for others?

Dr. Molly Jacobs:

Well, let’s talk with arsenic and drinking water, as Stella has really highlighted this as a notable risk for bladder cancer. As she said, the risk is more unique in terms of the solutions. It doesn’t play out the same way I just described. We can’t put pressure on industry to make the change. This compound, as we said, is naturally occurring in many parts of the country and also a legacy pollutant from the use of arsenic based pesticides decades ago. So I live in Vermont, which is an area of focus in Stella’s New England bladder cancer study, so I also just want to state that it’s really well water, private well water that we’re talking about with regard to risk.

If you get your water from a public utility, a municipal water authority, they have to follow national regulations to ensure safe levels of arsenic. But when it comes to private wells, and I have a private well, it’s up to the owner to test the well. We’re responsible for understanding the risks and treating them. So what we can do if you own a private well, and if you live in an area or concerned about arsenic in your drinking water, you need to use an accredited lab. You need to actually test your water. If results come back and they show levels that need to be mitigated, don’t fret because they can be fixed. There are an array of filtration options that remove arsenic to levels that no longer cause health problems.

Experts, for example, you suggest using what’s called a point of use filtration options. So this is a filter that’s installed at the faucet versus installing the filter at the water intake for your home, which could also be more expensive. I say that, but for some homes, depending on what else might be in your water, it also will depend on what treatment is necessary. If you’ve got radon or manganese or nitrate for that matter, you need to be thoughtful about what’s in your water. There’ll be a conversation with experts about the right filtration option. Just to say, filtration costs are quite broad. They could be $150 up to a few thousand dollars depending on the technology.

Unfortunately, I have to say I haven’t seen too many states helping residents to support or subsidize the purchasing of these filters, but I really encourage people to call their state drinking water authority. There’s often programs available to offset the cost of these for people that are having trouble affording the filtration. Also just to say, I don’t think it’s the best long term solution, but many counter pitchers that you can purchase say at Walmart or Target, many can effectively remove arsenic, not all. We’ve got to look at the label and the statements about the filtration that they offer, but this is a low cost option. But just want to advise listeners that if they do have to use a counter pitcher to filter the water, they should use that pitcher for everything, which includes cooking, not just for drinking.

Rick Bangs:

Good point.

Dr. Molly Jacobs:

I guess the other area just where we can talk about what solutions are out there, again, given that Stella focused on the issue of diesel exhaust is that I think that does open up this other avenue of what types of prevention are needed. This is beyond what us as individuals can do alone, but there are options. So for us to avoid diesel exhaust exposures at an individual level, we can choose, for example, where we decide to walk or to bike. I would advise not doing these type of activities in areas that are high traffic corridors, where you often see driving down the road are diesel powered buses and construction equipment or long, diesel powered train tracks. These are just areas that, if there’s other places to avoid getting outside and enjoying exercise and what have you, try to avoid those areas to reduce exposure.

But the real solution, in my opinion, lies really at the policy change level, the policies that are needed to improve admission standards, to stop, for example, the idling of diesel vehicles. I think, we’ve all gone by areas where construction equipment is just spewing out diesel, and it’s just idling for hours, also trucks and buses. In many states, there’s no idling laws, again, to reduce exposure to this exhaust to all of us. There’s a need for policies to improve public transportation infrastructure and to change zoning ordinances, so that schools and residences are not located near high traffic corridors.

But, unfortunately policy change means politics, and so it gets messy. It does matter who we vote for. We definitely need more politicians that will fight for our health and support legislation that reduces bladder cancer risks in our environment. So yeah, I’ll leave it at that. I don’t know, Stella, if you have other ideas about prevention pathways, especially at the policy level related to diesel exhaust and air pollutants associated with bladder cancer that are coming down the pike.

Dr. Stella Koutros:

Well, from a cancer prevention perspective, if we’re talking about bladder cancer, yeah, I have to say the number one thing is really to stop smoking, but our goals, when we talk about the occupational and environmental bladder carcinogens that are out there from the research perspective, is that we do the studies to provide the data that’s needed to make any subsequent policy change. That’s what we try to do at the NCI is our work is really trying to provide the highest quality research studies showing what and to what extent these occupational and environmental exposures are influencing bladder cancer risks. It was really interesting that you highlighted obviously the importance of taking action to decrease arsenic in private wells, if it’s there. Also, I appreciate just from a personal perspective, these thoughts about how to reduce your exposure to air pollution and emissions, because sometimes I think people feel like, well, what can I do about that? So I appreciate hearing that from a personal perspective as well.

Rick Bangs:

I think, if I’m not mistaken, there’s some additional funding or some additional focus on prevention in the most recently announced Biden Cancer [inaudible 00:39:15] right? Has he done an announcement in the last couple weeks?

Dr. Stella Koutros:

I actually have no idea, but I know that president Biden is quite interested in supporting cancer research and that’s a good thing for all of us.

Dr. Molly Jacobs:

Agreed, agreed.

Rick Bangs:

Right. All right. Now, Molly, we’ve got many folks, some of whom may be on this call, that they can’t leave their jobs, even though they might have concerns about potential exposure. So what do you say to someone in that situation?

Dr. Molly Jacobs:

Yeah, this is definitely a sensitive and complicated situation. For many individuals, this is a real dilemma. We need to work and I have to say, no worker should fall ill simply from showing up to work and doing the job that’s being asked of them. If the person feels comfortable, I think they need to be an advocate for their own health. Although I know there is fear of what an employer might do if concerned is raised. However, if they don’t feel comfortable, most states have a coalition, a council, a center for occupational safety and health, which are often nonprofit organizations with the mission to protect workers. So I would encourage those that are having concerns in the workplace about what they’re being exposed to reach out to them for support and advice.

But there’s also generic tools that we could all learn from, if you will, to reduce exposures in our workplace. Let’s take diesel exhaust in those that are working in an auto body shop. We need to make sure that there’s appropriate ventilation to reduce those exposures. Workers could limit the time an engine is idling. In the case of an auto body shop, as well as every other industry out there that uses chemicals, to look at the safety data sheets to know what chemicals you are working with. So these reveal known hazards that are associated with a chemical, including chemicals and specific products. And your employer must make these available to you by law and should be on site for every chemical or chemical product that’s being used at your place of employment.

I think workers can also start a dialogue with coworkers about whether their work process could be done differently. What are safer options? What are different ways of achieving the same end that could be safer? And just encourage, again, people to use engineering controls to limit exposures as well as personal protective equipment as needed. I don’t know. Stella, would you add anything else to this question?

Dr. Stella Koutros:

No, I think this is excellent information that you’ve provided, particularly for the workplace setting. And I know that there are often industrial hygienists on site in many workplaces, and seeking out that advice to limit exposure is also a huge source of valuable information.

Dr. Molly Jacobs:

Yeah, absolutely.

Rick Bangs:

Well, Stella and Molly, thanks so much for your time today and giving us a better understanding of some non-smoking causes of bladder cancer and equally as important, what we as the bladder cancer community can do about them.

Dr. Molly Jacobs:

Thanks so much, Rick. It’s been a pleasure to be with both you and Stella.

Dr. Stella Koutros:

No, thank you very much for having me and it was a pleasure talking with you both.

Rick Bangs:

Our pleasure indeed. So in case people wanted to get in touch with you, can you share your email or a Twitter handle or other information that you would like people to have? Let’s start with Stella, Dr. Koutros.

Dr. Stella Koutros:

Sure. My Twitter handle is @stellakoutros, S-T-E-L-L-A, K-O-U-T-R-O-U-S.

Rick Bangs:

All right. Molly, how about you?

Dr. Molly Jacobs:

Well, I am a social media Luddite and so you’re going to have to find me through our university’s website, and feel free to email me. That is molly_jacobs@uml, like University of Massachusetts Lowell,.edu.

Rick Bangs:

There’s still a way to get ahold of you, so you’re not as big a Luddite as you’re claiming to be.

Dr. Molly Jacobs:

Yeah. If I could turn off email too, I probably would.

Rick Bangs:

Well, wouldn’t we all? All right. So just a reminder, if you’d like more information about bladder cancer, you can contact the Bladder Cancer Advocacy Network at (188) 901-2226. That’s all the time we have today. Thanks for listening and we’ll be back with another interesting episode of Bladder Cancer Matters. Thanks again, Stella and Molly.

Dr. Stella Koutros:

Thank you.

Dr. Molly Jacobs:

Thank you, everyone.

Announcer:

Thank you for listening to Bladder Cancer Matters, a podcast by the Bladder Cancer Advocacy Network, or BCAN. BCAN works to increase public awareness about bladder cancer, advanced bladder cancer research, and provide educational and support services for bladder cancer patients. For more information about this podcast and additional information about bladder cancer, please visit bcan.org.