PLATZ

From the sandy beaches of the Atlantic Ocean on our Eastern Shore to the Appalachian Mountains of western Maryland and everything in between, Maryland’s geography is as diverse as our citizens. Our shores, mountains, the Chesapeake Bay, Baltimore’s Inner Harbor and other natural resources frame our history — the agricultural and manufacturing industry that thrived, the rural and urban towns and communities that emerged, and a unique impact on cancer rates.

The entire Johns Hopkins enterprise is very much a part of this history. It was discoveries by our own School of Public Health in the late 19th and early 20th centuries that revealed the carcinogenic effects of asbestos in our shipbuilding industry. Decades later, other School of Public Health researchers revealed that arsenic was seeping into the groundwater supply on the Eastern Shore from chicken manure as a result of farming.

GROOPMAN

In the 1970s and early 1980s, much of the cancer prevention and control focus was focused on toxic exposures in the workplace. It was estimated that 20% of U.S. cancer cases were linked to toxic exposures on the job. Researchers, like Morton Corn, director of the School of Public Health division of environmental engineering introduced ideas, such as air cleaning systems and worker education. Cleaning up the workplace costs money, he pointed out, but not cleaning it up costs too, in the illness it causes to the workforce.

Later, researchers, including Timothy Buckley, Ph.D., and Timothy Burke, Ph.D., began to look at environmental toxins, such air pollution. They began evaluating the geography of environmental carcinogens and death rates, looking at air, dust, soil and other environmental exposures. They looked at inhalation of environmental carcinogens as well as the consumption in food and absorption through skin.

VISVANATHAN

In 1985, the Kimmel Cancer Center established the Cancer Prevention and Control Program and began a collaboration with the state that continues today and includes leadership positions on the Maryland State Council on Cancer Control and the Maryland Cigarette Restitution Fund. These efforts were targeted to and positively impacted cancer rates and disparities.

These efforts are making a difference as Maryland, which had the highest cancer death rates in the nation in 1985, is now ranked below the national average, at 34th among states.

TALALAY

Elizabeth Platz, Sc.D., co-director of the Cancer Center’s Cancer Prevention and Control Program says, “In population science, we try to figure out what causes cancer. We look in large groups of people. What do they do? What do they eat? How much do they exercise? We may take measurements in blood or other body fluids that tell us about exposures and risks.”

Platz’s own research is focused on prostate cancer prevention. Her colleague and co-director John Groopman, Ph.D., linked environmental exposures to liver cancer.

Cancer is considered a genetic disease, but Groopman points out that most of the gene mutations that characterize cancer are caused by lifestyle not heredity. Where do the bad genes come from? The societal burden is lopsided toward behavioral issues, he says. Often, it is through our own behaviors. Cigarette smoking, virus exposure, sunburns, poor and unbalanced diets, and obesity are a few of the most common culprits.

Groopman and Platz both agree that obesity is currently the leading cancer prevention concern and, without intervention, one expected to have impact long into the future.

PALLER

“Intervention is individual and societal,” Platz points out. Addressing health inequities in primary prevention—identifying and eliminating cancer causing exposures and education about behavioral changes that can reduce cancer risk—early detection and diagnosis, and improving the quality of life and life expectancy of cancer survivors is also urgent, she adds.

“Calorie balance versus inactivity is likely the cause of about 14 cancers, including a higher risk of fatal prostate cancer,” says Platz. Groopman who estimates that more than 60% of Americans are overweight, calls obesity a U.S. epidemic and one of the nation’s most consequential health concerns.

“The effect of this epidemic of obesity on cancer statistics over the next decades remains to be seen but it will certainly have an impact,” says Groopman, but, he adds, “we can and need to do a better job of identifying and eliminating exposures earlier. There are things we can do to tilt the odds in our favor.”

He points out, however, that cancer development is not a foregone conclusion. Many cancers, he says, stem from things we do that start at an early age.

“We can and need to do a better job of identifying and eliminating exposures earlier says,” says Groopman. “There are things we can do to tilt the odds in our favor.”

Looking forward into the next decades, Platz says cancer prevention science will benefit from the mountains of data that are currently being generated. Technologies to gather and mine this data will help reveal new associations to cancer that can be studied.

She says that measuring exposure and classifying people with respect to their exposures helps reveal what is causing cancer on a population level. However, she says,3 things we know about—smoking, obesity and physical activity—only explain about 50 percent of cancers in the population. We will begin to understand the causes of the other 50% and ways to translate what we’ve learned about prevention into behavior changes so that we reduce the risk of cancer on a population scale and create healthier survivorship.

“Data will be powerful tool,” says Platz, “and we need to start thinking about how we will analyze it and what questions we need to ask to get meaningful results that will impact cancer prevention.”