Why PCIST?
A Tool for Seeing Cancer as an Anthropogenic Disease in Every Community, For Every Community
Why PCIST?
Everyday Cumulative Impacts
According to the American Cancer Society (ACS), “…for the most part, cancer cases in the United States are spread randomly across the country…For most well-documented cancer clusters that have been found to be caused by a shared exposure, the exposure took place in the workplace, rather than in the communities where people lived….Even if the number of cases in an area is higher than expected, it still might not be caused by a single factor or exposure.”
The ACS’s explanation of the spatial distribution of cancer in the 21st century U.S. is hard to square with our lived experiences as Pennsylvanians and other state residents, however. As we look around us, the burden of cancer does not appear to be equally distributed among communities in our state. Even rudimentary maps of cancer incidence reveal striking spatial differences by state and county, and they do so for multiple cancer types.
In terms of making sense of these spatial variations, we also appreciate that none of us lives in a world of singular chemical exposures. Pennsylvania, for instance, has significant radon levels across large parts of the state. Radon is a colorless and odorless radioactive gas that is a natural byproduct of the decay of uranium and radium in the earth’s crust. A known carcinogen, specifically in relation to lung cancer, it seeps into many residents’ homes.
But also in Pennsylvania, highly radioactive substances like radium-226 (as well as heavy metals like lead and arsenic) are present in the oil and the gases that we extract from the ground in the western and northern regions of the state, that we burn and release into the air, and that we dump as petrochemical waste onto our soils and into our waterways.
Beyond radioactivity, our air, soil, water and foods are polluted with a wide and varying accumulation of man-made carcinogenic chemicals including pesticides, herbicides (such as glyphosate), phthalates and PFAS. Our air is also polluted with nitrogen oxides, sulfur oxides, polyaromatic hydrocarbons (such as napthalene), volatile organic chemicals (like benzene and toluene), particulate matter (ranging from large PM10 to tiny PM2.5) and persistent organic pollutants like dioxins and furans — all of which are released when we burn trash and fossil fuels, including “natural gas”.
Understandably, as we go about our daily lives, we cannot readily measure and disentangle the specific impact that any single chemical substance in our air, water and/or soil has on bodily health. But should real-world complexity justify erasing our everyday cumulative exposures in favor of “bad genes” and “lifestyle choices”?
At PCIST, we resist the epidemiological fallacy that cases of cancer are inherently random barring an “exceptional” exposure to a singular substance and the appearance of an “atypical” cancer cluster. Instead, we start from the recognition that none of us is separate from our environment — the air that we breathe, the water and substances that we drink, the foods that we ingest, the manufactured products that we routinely handle, and the soil that we cultivate and play on.
Simply put: we know full well that there is no “random” baseline of cancer incidence that stands outside of the countless, cumulative, everyday exposures that are inextricably tied to the specific environments in which we live. Our outsides are our insides — and our commitment is to making this visible.
Why PCIST?
Outsides and Insides
Cancer is not a single disease. All communities in Pennsylvania — as everywhere in the U.S. and the world — are affected by multiple types of cancer. As bodies age, our cellular machinery throughout tissues wears down, making the development of most types of cancer much more likely. Contracting particular viruses over the course of our lives can also contribute to the development of specific types of cancer.
But, as discussed in the previous section on cumulative impacts, there is much more to this story of cancer causation. Throughout our lives, all of us breathe, ingest, and absorb many carcinogenic substances. Once inside our bodies, these chemicals travel via our bloodstream to affect cells in multiple tissues and organs.
It is neither a mystery that — or how — cumulative chemical exposures contribute to cancer. But like the multiple pathways through which chemical pollutants enter our insides from our outsides, the processes are multiple and complex.
A voluminous scientific literature now solidly establishes the biochemical impacts that can turn a healthy cell into a malignant one. These include irradiation damage to DNA and cell structures; oxidative stress and tissue inflammation; immune suppression and altered function; cell signaling pathway changes and changes in gene transcription; endocrine (hormonal) disruption; mutations in nuclear and mitochondrial DNA; and epigenetic changes (that can be inherited) in the physical structure of our DNA that can turn tumor promoter genes on and turn tumor suppressor genes off.
Independently and together, these impacts can ultimately cause a given cell to turn malignant — shifting from its normal state of converting oxygen and water to produce ATP for energy to perform its required functions into a disordered state of energy production and consumption. In this disordered metabolic state, called glycolysis, the cell rapidly divides, grows into a tumor, and ultimately metastasizes.
Our bodies do eventually break down and eliminate most chemicals that circulate in our bloodstream via our livers. This limits the duration of many toxins’ direct impacts. However, the metabolites themselves can also be toxic. Additionally, as toxins are eliminated, new ones are constantly becoming part of our insides as we breathe, eat and drink.
Some organic pollutants –commonly known as POPs or “forever chemicals” — also cannot ever be broken down. These substances bio-accumulate inside our bodies throughout the course of our lives. Similarly, radioactive elements like radium-226 (which behaves like calcium and has a 1,600 year half-life) gets concentrated in oil and gas extraction and waste, as well as in our bones where it settles.
The multiple, complex processes by which the chemical pollutants specific to a community’s local environment enter residents’ bodies and potentially trigger a malignancy — and the years-long process and many parts of the body in which that malignancy might ultimately arises — make it challenging for us to document. What we need is a tool that empowers people to see the full spectrum of their community’s cancer incidence history.
Why PCIST?
Anthropogenic BiologieS
The cancerous consequences of how our society produces and consumes its fossil fuel energy, food, industrial goods and waste by-products affect us all — and increasingly so. Despite advancements in treatment, the rates of many types of cancer are on the rise in the U.S. This rising tide is also happening in ways that differently inundate and disproportionately burden some communities more than others — a reality of “sacrifice zones” that is invisible in analyses of cancer statistics conducted at the national, state and even most county-levels.
PCIST was created to capture the reality of “anthropogenic biologies” — how humans shape their own (as well as other living creatures’) biologies by documenting lived cancer experiences in context. PCIST does this by calculating local average annual crude cancer incidence rates for the municipalities, townships and boroughs in which people live and work. Given physiological differences in human bodies due to age and gender, PCIST generates these numbers for every community’s entire population; all females; all males; children aged 0-19; youth aged 0-29; and adults aged 20+.
Taking into account the wide range of potential impacts that multiple chemicals can have inside human bodies over long periods of time, PCIST also covers all twenty-three leading cancer types as defined by the CDC: Bladder and urinary tract; Blood (leukemia, myeloma, Hodgkin’s lymphoma and non-Hodgkin’s lymphoma); Brain and nervous system; Breast; Cervix;
Colon and rectum; Esophagus; Kidneys and renal tract; Larynx; Liver and bile duct system; Lung and bronchus; Mouth and pharynx; Ovaries; Pancreas; Prostate; Skin (melanoma); Stomach; Testes; Thyroid; and Uterus. Additionally, PCIST works with communities to identify and document other types of cancer that are emerging as “leading cancers” in their specific contexts.
Once these preliminary calculations are complete, PCIST determines its cancer signal values. These values represent a ratio of the community incidence rates in comparison with those for the state of residence and the entire US. Whenever there is a percent elevation in a community’s rate, it appears as a “cancer signal” on our original PCIST maps. Cancer signals vary in intensity from the mildly elevated (a 1-19% elevation) to the severely elevated (300%+).
In this way, PCIST enables residents to screen where their community’s relative cancer burden lies. In turn, residents are much better equipped to assess the cancerous consequences that the specific chemical exposures in their local environment have on their collective health. Publicly available cancer incidence maps are also in keeping with PCIST’s belief in dignity-based epidemiology — an approach that respects everyone as a knower of their own community’s health and as having the capability to act in thoughtful ways to mitigate collective cancer risks.
Project Sources
Cancer is a mandated, reportable disease in the United States. In running PCIST calculations, we use data obtained from the U.S. Center for Disease Control’s SEER and WONDER databases; from state cancer registries and departments of health; and from the US Census Bureau’s American Community Survey population data.
None of these source institutions is responsible for the cancer incidence data generated via the PCIST tool, or for any analyses and interpretations based upon the PCIST cancer incidence numbers that are communicated in its original CCSM (community cancer signal maps).
The PCIST project and its maps are intended as a free public informational resource. We expect to be acknowledged and cited for our work. However, we are not responsible for others’ interpretations of, responses to, and uses of our data and reports.
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