Incidental Comparisons : Cance As an environmental activist and writer, I have tried for years to promote nationwide concern about the deteriorating state of our environment. The idea of writing about my own travails as an environmental victim had, however, never crossed my mind. But obviously, I could not have escaped what was and is happening all around me.

Facing a Silent SpringA young patient of cancer at New Delhi's All India Institute of Medical Sciences

Cancer is a frightening word. It means a terminal disease with periods of excruciating pain. And the treatment, full of poisons, is often as horrific as the disease itself.So how would you feel if you are told that you are suffering not just from cancer but from such an extremely rare form of it that there is hardly any treatment available? That it has already invaded both your eyesformed a small tumour in the centre of your brain so that it cannot even be surgically removed without cutting up the brain completely and has even reached your spinal cord? And that as the cancer grows in the eyes the mass of cancerous cells will pull out the retina in both your eyes and make you go permanently blind; the tumour in the brain will grow to put pressure on the brain and cause strokesamong other things; and the malignant cells in the spinal cord could affect the various nerve endings attached to the cord any time and cause you acute pain and/or irreversibly paralyse parts of your body? The end of all this suffering will of course be death. Maybe not more than a year later but a large part of that year could be spent in bed groping in darkness and pain.
What're lymphomas?Lymphomas are cancers that develop in the lymphatic system. They are parts of what are called lymphoid malignancies -- lymphomas and leukaemias. The most common type is called Hodgkin's disease; the rest are Non-Hodgkin's Lymphomas. The lymphatic system is part of the body's immune system consisting of lymphatic vessels carrying lympha watery fluid that contains infection-fighting white blood cells or lymphocytes.

Terrifying prospects as you will agree. These were the prospects I faced in early 1994 and they were enough to make me think how merciful was God to those whom he let die peacefully in their sleep.

Fluorescin angiogram of left eye before treatment (left) a cloud over the retina -- sheet of cancer cells -- hides it and makes the author blind in the left eye. Following chemotheropy vitrectomy and radiation treatment retina can be seen again making vision possible

In early 1994, I faced the prospects of blindness,neurological disorders and death

Failing to find even a diagnosis for the symptoms in my eyes -- black lines inside my left eye so that I could hardly see from it -- in India, I was finally referred to the National Eye Institute in USA whose scientists after diagnosing ocular and central nervous system Non-Hodgkin's Lymphoma (nhl), referred me to their prestigious sister institution, the National Cancer Institute (nci). I learnt that the black lines in my eyes were cancer cells which had formed a sheet in front of the retina.

Table 1 Placing Cancer
Age-adjusted cancer incidence rates (per 1000persons)

Urban centres

Rural centres

1991115.7144.6132.9130.8121.11131.4119.1137.1  55.567.3
M Males FFemales
Living in polluted cities more than doubles the chances of developing canceras comparedto living in rural areas

Fortunatelydoctors at NCI had an experimentalchemotherapy for the disease. They first pumped in fatal doses of a cancer drug so that itcould break past the blood-brain barrier and enter the otherwise well-protected centralnervous system and eyes in quantities sufficient to kill the cancer cells. They had toimmediately follow up with an antidote to save me from dying. The treatment gave me anyear’s blissful ‘remission’ (a period without measurable cancer). After anyearin late 1995the cancer cells returned. I was faced once again with the prospect ofblindnessneurological disorders and death.

Table 2 Placing NHL
Age-adjusted NHL incidence in India (per 1000people)

Urban centres

Rural centres

19913.  1.11.2
M Males FFemales
Delhi has the highest incidence of Non-Hodgkin’s Lymphoma (NHL)followed by Mumbai

The doctors said that this time they had caught the recurrence so early that they were sure the 1994 treatment would get me back in remissionbut they were also certain the remission would not last even a year. I needed something more definitesomething with a higher probability of cure -- "such that you can live till 70 or beyond till only old age kills you"as one of the doctors who was very fond of me put it. She and others knocked their heads together and came up with a solution medicos in Paris were experimenting with bone marrow transplants to cure nhl. "After we put you into remissionyou must immediately go in for this treatment" they recommended. Bone marrow transplant is one the most invasive medical procedures developed by modern science. I went through it in mid-1996 and hope that I have finally gotten rid of the disease. Thathoweveris something that only time will tell. MeanwhileI will keep praying that some medical scientist somewherewill continue to look for a simplerless horrifying and more definitive cure for this rare disease.

Mumbai    11.63%    13.53%33%37%
Madras38.07%15.05%    92%103%

Incidenceof Non-Hodgkin’s Lymphoma is rising faster than general cancer incidence. In Madrasit has doubled in 10 years

People as statistics
But why should this story of an individual cancer patient be of interest to anybody in a large and growing nation like India? Individuals areafter allmere statistics. My casehoweveris instructive because it represents today the scale of life-threatening and destructive processes that we are inflicting upon ourselves. My cancerlike most other cancersis deeply related to environmental pollution -- an issueon whichironicallyI have written numerous articles and booksgiven lectures and made films to increase public awareness of the threats we face. ThereforeI feel a sense of moral responsibility for going on.

My cancerlike most cancersis related to environmental pollution

The poornaturallysuffer more than the rich from environmental degradation. Howeverat least the powerful urban middle and upper classes -- we had thought -- were intelligent and self-indulgent enough to try and protect themselves and moderate the impact of environmental destruction on their own lives. That theory has proved to be a total chimaera. The elite of our nation have failed to internalise the ecological principle that every poison we put out into environment comes right back to us in our airwater and food. These poisons slowly seep into our bodies and take years to show up as canceras immune system disordersor as hormonal or reproductive system disorders -- affecting even the foetus.

One of every 10-15 people living in metros are potential cancer victims

Is itthereforenot imperative for a society to find a way that balances its urge for economic growth and material comforts with the requirements of its natural and human health? Isn't this some thing that we owe to ourselves and to our children?

Cancer as statistics
Although cancer statistics in India -- relatively poor -- probably understate the extent of the diseasewhat they tell us is terrifying. There are six hospital-based cancer registries in India -- five in BangaloreMumbaiMadrasDelhi and Bhopal and one in the rural area of Barsi near Pune -- which give us an idea of urban and rural cancer incidence in India (see Table 1). The data shows that age-adjusted cancer incidence rate per 1000people in the five urban centres varied between 101.2 (Bhopal) to 143.6 (Delhi) for women in 1990whereas for males it was between 107.5 (Bhopal) and 138.9 (Mumbai). This incidence was twice the incidence rate of 56.2 in Barsiwhich shows that living in our polluted urban centres more than doubles our chances of developing cancer.

Table 3 A lifetime ofdeath
Cumulative (lifetime) cancer incidence rates (0-64 years)


Bhopal6.70 7.79 



With their worsening environmental conditions Indian cities are headed the same way as their counterparts in developed nations

There is another way of looking at this data by asking the question what is the chance that I will be affected by cancer during my lifetime? The answer is stunning. If you are living in one of the four metros -- Bangalore, Mumbai, Madras or Delhi -- the chance of your catching cancer during a lifetime is as high as 7-11 per cent. In other words, one out of every 10-15 people living in these cities is going to become a cancer victim during his/her lifetime. Or, assuming an average household size of five, it means every second to third household in these metros will have a member falling victim to the disease. However, if you were living in Barsi, the chances of cancer in a lifetime would go down by half -- only one out of 20-36 persons will get cancer in their lifetime.

In industrialised nations like Britain or the us, the average lifetime cancer incidence rate in the late '70s was one out of every six to eight persons. With environmental conditions rapidly worsening here, there is no reason why Indian cities will not get there very soon.

But while cancer is an issue that impinges on national consciousness in the West, it does not do so in India. Experts in us argue that what is occurring in their country is nothing short of a 'cancer epidemic'. The concern for cancer shared by millions in the public has strongly fuelled environmental regulations for control of air and water pollution and toxic wastes. In India, cancer is still largely regarded as a relatively insignificant threat to public health. Yet one conservative estimate puts the total number of national cancer cases by the year 2001 at 8060. This figure, of course, does not include people who probably cannot even reach hospitals and get diagnosed, especially amongst the vast population of rural and urban poor.

In India, cancer is still largely regarded as a relatively insignificant threat to public health

Let me look at statistics about the cancer I am suffering from Non Hodgkin's Lymphoma. In 1990-91, nhl was listed amongst the eight most common forms of cancer in Delhi,Madras and Bangalore amongst males and in Delhi, amongst females, too. But there are less than 200 medically recorded cases worldwide where nhl has affected the eyes; I am probably the first case of ocular lymphoma diagnosed from India.

Causes of NHL
It is impossible to pinpoint why a particular individual gets cancer. Carcinogenesis can result from stress (which depresses the immune system)bad dietsenvironmental toxins like pesticidesair pollutants and industrial chemicalswaste products and even genes. While diet and stress are factors more associated with personal lifestyles, environmental contamination is a societal problem and, therefore, needs greater attention and regulation.

Risk of lymphatic cancers increases when the body's immune system gets affected

In the US, where nhl incidence has increased by over 65 per cent between 1973 and 1990 -- the second fastest increase in cancer incidence rates of all human cancers in the us in the last 15 years -- there is considerable effort to identify the causes and quantify their impact on the increase of nhl. Says Sheila Hoar Zahm of the nci"nhl is increasing not just in the us but in all industrialised countries. Overall, we may be making gains in cancerbut because nhl incidence is small compared to the mega-cancerssay breast cancer or lung cancerfigures for the latter cancers tend to swamp the overall cancer statistics."

In India, the meagre data collected by ncrp for different cities shows a steady increase. In Madras, there is literally a doubling of incidence in 10 years between 1982 and 1991 amongst both males and femalesbesides substantial increases in Mumbai and Bangalore. While the database for Delhi and Bhopal is too small to identify any trendthe statistics do show that Delhi has the highest incidence amongst both males and females followed by Mumbai. Interestingly, a comparison (see 'Incidental comparisons') clearly shows that nhl incidence is rising faster than overall cancer incidence; in Mumbai and Madras, the difference in increase is quite dramatic. Howeverin a conspiracy of silence, almost all specialists at the Tata Cancer Memorial Centre in Mumbai interviewed by Ambika Puria cse researcherreplied in the negative when asked if nhl was increasing in India.

Cancer experts believe that risk of lymphatic cancers including nhl increases when the body's immune system gets affected or suppressed. Says N K Mehrotrahead of the environmental carcinogenesis laboratory in the Industrial Toxicology Research Centre (ITRC)Lucknow"The causes of lymphoma are as yet unknownbut it mainly occurs due to cumulative effects of pollutants and reduced immunity in the body." A number of nhl cases in the us occur in people who have been affected by hivthe dreaded aids virus. In India toothe spread of hiv will definitely boost the incidence of nhl. But the nci does not believe that the hiv virusor cancer-causing viruses like human t-cell leukaemia virus-1 or the Epstein-Barr virusplay an important role in the increase of nhl. Neither do dietary factorsaccording to it.

The nci says that certain immunosuppressive genetic syndromes can play a role in causing nhlbut that they are too rare to bring about any major increase in cases. Similarly50increases in risk of nhl have been observed among organ transplant patientsbecause they receive powerful immunosuppressive drugs on a long-term basis; but againthese conditions affect very few people. A detailed statistical study in the us concludes that accuracy and completeness of diagnosisthe impact of hiv and occupational exposures leave unexplained an 80 per cent rise in incidence among white men. The nih study also argues that improved diagnostic facilities and recent reclassification of other cancers into lymphomas account for a tiny fraction of the increase in nhl.

The menace pesticides
The key factor which isthereforeattracting worldwide interest amongst epidemiologists is environmental pollution. Several studies carried out in CanadaSweden and the us have shown a strong correlation between the risk of nhl and use of pesticides.

Frequent use of herbicidesparticularly 24acid (24has been associated with a 200-800 per cent (two-eight times) increased risk of nhl in Sweden. According to one studythe association between nhl and phenoxy acid herbicides may be because of contamination by dioxina highly poisonous immunosuppressant. The nci study argues that though the number of people working in agriculture occupationally exposed to these and other pesticides is not large enough to explain the overall increases in nhlthe general population is also at a heightened risk because of the use of these pesticides in homeslawns and golf courses. Dogs whose owners have used 24for instancehave a heightened risk of contracting malignant lymphoma.

Pest controllers
Pesticides which cause lymphatic cancer in rats and mice
1. Toxaphene (organochlorinegeneral name Camphechlor)
2. Hexachlorocyclohexane (organochlorineused as gamaxine)
3. Trichlorophenol
4. Strobane (organochlorine)
5. Perthane
6. TCDD (Dioxin) (a chlorophenoxy herbicidewhich is often found as a contaminant in trichlorophenolhexachlorophene and 245)
7. Dieldrin (organochlorine)
8. DDT (organichlorine)
9. 12Dichloroethane (DDEbreakdown product of DDT)
10. Heptachlor
11. Picloram

This segment of population tends to have only a low-dosechronic exposurebut larger doses can be transmitted if the exposure is persistent and bioaccumulative. Persistent pesticides move through airsoil and waterfinding their way into living tissues where they can bioaccumulate up the food chain into human diets. Roughly 85-90 per cent of pesticides applied agriculturally never reach target organismsbut disperse through the airsoil and water. People who can be exposed to high levels of bioaccumulated pesticides include

habitual consumers of fishlivestock and dairy products;
foetuses and nursing infants whose mothers bodies have accumulated persistent pesticides; and
sick people who metabolise their fatty tissues (which contain bioaccumulated pesticides) while ill.

People in Delhi have one of the highest levels of DDT in their body fat

According to an itrc survey of studies on pesticide residueshigh levels of residues of bhclindaneheptachlorendosulphan and dieldrin have been found in just about everything necessary for life from food to water.

The list does not even include tea whose ddt residues are so high that Germany is refusing to import Indian tea.

How do these residue levels compare with residues in industrialised countries or with acceptable daily intake (adi) standards? Badlyat best. A report published in 1992 in the Journal of Agriculture and Food Chemistry by K Kannan and A Subramaniam concludes "Significantly high levels of food contamination with hchddtaldrin and dieldrin were evident throughout India...The average daily intake of hch and ddt...were higher than those observed in most of the developed nations. The dietary intakes of aldrin and dieldrin exceeded the acceptable daily intake recommended by who/fao...." Studies have shown that people in Delhi have one of the highest levels of ddt bioaccumulated in their body fat. Another study of 1991 on pesticide residues in Delhi by A Nair and M K K Pillai reports that ddt and hch residues were present in Delhi's watersoil and fauna. Human breast milk samples in Delhi show ddt and hch levels comparable to those found in Punjaban area of intensive farming. Infants ingesting this breast milk receive roughly 12 times the allowable daily intake of DDT.

Adding to the concern about carcinogenic effects of pesticides are the latest findings of a new discipline of science called immunotoxicitywhich studies substances with a negative impact on the immune system. A recent review of over 100 primary experimental studies of immunosuppressive nature of pesticides reports that the large majority of these studies reveal various types of immunosuppressive effects. Reduced immunity influences cancer incidence. A weak or devastated immune system allows cancerous cells to escape and form a tumour. One can only imagine the kind of havoc pesticides can play in a country where a large percentage of the population is malnourished andhencesuffers from immunodeficiency.

The maximum likelihood of exposure in my case is through food and water

Organic solvents and other industrial chemicals
According to nciexposure to organic solvents also leads to increased risk of nhl. According to Shiela Zahm"There is now a strong feeling amongst scientists that apart from pesticidesorganic solvents play an important role." Organic solvents are widely used in the paints industryin dry-cleaning and woodcraftsand large numbers of workers are potentially exposed to them. Among the solvents which are suspected carcinogens are chlorinated hydrocarbon solventsmethylene chloridetrichloroethylenechloroformformaldehyde and benzene. A Swedish study also lists styrenetrichloroethyleneperchloroethylene and chlorophenols as substances whose exposure heightens the risk of nhl. A British study shows heightened risk of nhl amongst those exposed to wood dust and expoxy glues.

Says Zahm"The general population is also exposed to these carcinogens through commercial products and contamination of drinking water sources." Enquiries in India conducted by researchers of cse reveal that no study of contamination of drinking water sources by these solvents has been conducted so far. Studieshoweverhave shown that the following solvents were present in effluents of the paint industry
246 Benzene
24 Chloroform
24 Methylene
46 Chloride
Pentachlorophenol Trichloroethylene

What is frightening is that not all these contaminants can be removed by existing wastewater treatment processes in Indiathus leading to the contamination of natural water sources which ultimately provide us with drinking water.

Eco-mandarins a no-show
The MEF is non-functional as far as controlling hazardous pesticides is concerned
What does the baby of environmental concern -- the much-hyped Union ministry of environment and forests (MEF) -- do to protect human beings from harmful pesticides? Precious littleit seems.The ministry has neither restricted the use of hazardous pesticides and monitored pesticide-induced pollution nor studied the health or overall environmental impact of pesticides. The agriculture ministry is responsible for approving pesticides. The MEFsays a senior officialacts only if an accident were to occur in a pesticide firma la Union Carbide in Bhopal.

Says R R Khanthe scientist in charge of MEF's technical unit dealing with safety aspects of pesticide use"We only have an advisory role. We offer advise to the ministry of agriculture regarding safe use of pesticides. We also conduct regular training programmes for pesticides industries as well as users." Period. This is the state of environmental governance in India. If the ministry closed down tomorrowit would make no difference to mine or your health. Then why should we pay taxes to this incompetent government?

Growing horde
The Indian pesticide industry today has an installed capacity of 1160tonnes (t) per annumof which about 700t is in the organised sectorwhereas the rest is in some 500-odd units belonging to the smallscale sector. It is doubtful that the smallscale sector has any appreciable control over contamination by pesticides. In 1994-95India produced almost all the pesticides it consumed -- some 830t in the agricultural sector alone. Imports are currently about 20t only. With liberalisationcontrols on creating additional capacity for pesticide formulations has been lifted and there is no restrictions excepting six pesticides (aluminium phosphidedimethoatequinalphoscarbarylphorate and fenitrothion) for which licensing is compulsory. A Planning Commission study has projected pesticide consumption by 2000 ad at 1180t -- 970t for agriculture and 210t for public health. It is interesting to note that most of the growth in the world pesticide industry is in developing nations. In value termsgrowth in the pesticide industry between 1987 and 1993 in Latin America and Asia (outside Japan) was more than twice the global average.

They throw, we use
Pesticides are good for you as long as you are an Indian
The Indiangovernment persists in allowing the production of a variety of deadly pesticidesevenafter many of them have been banned or severely
restricted abroad. In 1983the UN had produced a Consolidated List of Products WhoseConsumption and/or Sale Have Been BannedWithdrawnSeverely Restricted or Not Approvedby Governments. When Sunita Narain of the Centre for Science and Environment compared thepesticides listed in this report with those approved and used in Indiashe found that interms of tonnagean amazing 70 per cent of all pesticides used on Indian farms werebanned or severely restricted in Western countries and identified by the World HealthOrganization (WHO) as hazardous. The proportion of such pesticides used in public healthprogrammes was even higher.
In 1996even after a decade of environmental regulatory institutionsI found that thefigure in agriculture was 54.25 per cent 46826tonnes (t) of pesticides out of a totalof 86311t used in 1994-95 had been restricted or banned in the West. In public healththe figure was 94.5 per cent. Since I am still looking at the 1983 UN listthe figure islower as many restricted pesticides have not been included. If an updated list becomesavailableIndia’s extraordinary record in taking care of its people would plungefurther.
These pesticides includebesides DDTcarbofurandimethoateendosulphanlindanemethyl parathionmonocrotophosmancozeb and paraquat. A number of other pesticides whichare currently under special regulatory review on health grounds in the US — forinstancecarbamates like aldicarb and carbaryl — are widely used in Indianagriculture. A number of pesticides implicated in the causation of NHL are also in useincluding 2-4D (1200t in 1993-94about 15 per cent of total herbicides consumption inIndia).
The truthmaybeis that the Government of India is the most persistent pest in India forwhich we need a truly deadly pesticide.

Pesticidesbanned/restricted in the Westbut used in India (1994-95) (tonnes)

PesticideUse in agricultureUse in public health
DDT 8181.25
Dichlorvos (DDVP)1500 
Methyl parathion2600 
Total use of pesticides8631115327.25
Percentage of use consisting
of banned or severely restricted pesticides

Like the pesticides industrythe Indian paints industry has also been growing rapidly. Between 1950 and 1982production increased from 400t to 1900t (1070t in the organised sector and 830t in the smallscale sector) -- the smallscale sector increased production eight-fold compared to the organised sector's slightly over three-fold increase. The smallscale sector isparticularly notorious for its poor or non-existent waste-water treatment facilities. Following liberalisationa lot of hazardous paint and dyestuff industry has moved to India because of growing environmental controls in the West and inadequate controls in India. K R V Subramaniammanaging director of Colour Chema large paints companysaid in an interview to the Economic Times in 1993"Large Indian companies by and large meet pollution standards. But many otherswho contribute 40-50 per cent of our exportsdo not."

The MEF has no team working on the dangers posed by toxins like pesticides

More questions
There are countless questions that keep crossing my mind. Why did I get afflicted with this disease? How cancer-prone are we becoming as a nation? Who is responsible? What should we do about it? It is clear from the sum total of the evidence available that environmental contamination could have been a key cause of my cancer. As I am not an agricultural labourer or a farmer spraying pesticidesthe maximum likelihood in my case is of exposure through food and water.

My principal interest in writing this article is to inform the Indian people that they must not remain ignorant and nonchalant about the acute threats they face to their own health and to the health of their children. I find no concern in India about clean airwater or foodall of which are not just bacteriologically but also chemically contaminated today. At a seminar organised by a leading Delhi-based ngo on Delhi's drinking water supply system in 1995I had to point out that while there was so much talk about the inadequacy of water supplythere was almost none about its quality. What good is lots of water if it is so contaminated?

Bacteriological contamination shows up in acute epidemics and henceoften leads to a hue and cry amongst the public and in the media. But chemical contamination takes years to show up in the form of cancers or hormonal and reproductive disordersand hence unless there are good epidemiological studies carried out on a regular basis and a constant effort made by the medical profession and a vigilant media to inform the public about the health threats it facesthere will be no pressure whatsoever on the regulatory authorities to do anything to protect the environment.

Ignorance is bliss for the the politician and the bureaucrat. Apart from the influence of industrial lobbies which may operate underhandIndia's overt governance systems themselves are incompetent. An excellent illustration of this is the fact that the ministry of environment and forests has no team working on the dangers posed by toxins like pesticides that permeate the environment and food systems.

Summing upI can only say that had not fatefriends and well-wishers and committed scientists from various parts of the world not intervened to help in my caseit would have been a Silent Spring for me in the prime of life. I can only hope and wish that that no fellow citizen has to suffer the same fate. And that Indian civil society canone dayforce our misguidedgovernment to come to its senses.

(The author is grateful for inputs provided by Ambika PuriMadhumita DuttaAmbika SharmaMax Martin and Sunita Rainaand the time provided by Sheila Hoar Zahm)

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