Will the products below increase your chances of getting cancer? Samuel Epstein thinks so. Ayala Ochert reports

Here is a sobering thought - on Monday morning, as you breakfast, shower and get ready for work, you could be exposed to more than a dozen avoidable carcinogens before you have even walked out the door.

From the pesticide residues in our cereal, to the preservatives in our shampoo, we continually receive small doses of chemicals that add up to a lifetime of significant health risks. That is the message from Samuel Epstein, professor of occupational and environmental medicine at the University of Illinois in Chicago, who has been campaigning to reduce such risks for more than 30 years.

"Cosmetics and toiletries are a witches' brew of undisclosed carcinogenic ingredients and contaminants," asserts Epstein, who in 1995 co-authored the Safe Shopper's Bible, a compendium of more than 4,000 consumer products, from shampoo to car wax to beef, detailing their potentially toxic ingredients.

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"It is not a Chicken Little, the-sky-is-falling-in sort of book," Epstein says. "There is as much emphasis given to the safe alternatives as there is to the mainstream products. The object of the book is to provide people with information so that they can reward responsible industries and punish reckless ones."

As with his latest book, The Breast Cancer Prevention Program, Epstein has gone directly to consumers with information on how they can protect themselves, bypassing government agencies. Both books represent a shift in tactics for Epstein, who has been a familiar face around Washington since the 1970s, lobbying to ban dangerous chemicals, with some successes over the years.

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Just last year, in recognition of his efforts, Epstein was awarded the Right Livelihood Award, the "alternative Nobel prize" for his "exemplary life of scholarship wedded to activism on behalf of humanity". But Epstein's campaigns have not always been appreciated, particularly by those industries and government agencies at the receiving end.

As you are running out the door, perhaps with children in tow, you may well feel that you have more important things to worry about than traces of chemicals in the milk you pour over your cereal. But when do we ever stop to tot up the columns of our chemical balance sheet, weighing up "convenience" against "acceptable" health risks? If we did, Epstein says, we would probably find ourselves heavily in the red.

Children who eat certain brands of hot dog 12 times a month have a fourfold greater risk of brain cancer and a sevenfold greater risk of leukaemia. Women who regularly dust their genital area with talcum powder are at three times greater risk of ovarian cancer.

Since the 1940s and the dawn of the petrochemical era, the lifetime risk of cancer has risen from one in four to one in three. Even taking into account an ageing population, between 1950 and 1998 the overall incidence of cancer jumped 54 per cent. In the more recent period from 1973 to 1994 there was an even sharper increase. Could all those "small doses" be adding up over time?

Statistics like these are a surprise to many of us, but Epstein has been drawing attention to them since 1978, when he published The Politics of Cancer. A damning indictment of the so-called "cancer establishment" - the government-funded National Cancer Institute and the charitable American Cancer Society - the book was a bombshell. Cancer had already become a political issue when, in 1971, President Nixon declared war on it. And with many millions to be made from new drugs to treat cancer, says Epstein, it had also become big business. This heady mixture of politics and high financial stakes was a recipe for conflicts of interest.

In a 1998 edition of the book, marking 20 years since the original publication, Epstein repeats his charge that the "cancer establishment" has squandered its resources, including more than $20 billion of US taxpayers' money since 1971, on "damage control" - diagnosis and treatment of the disease. Primary cancer prevention, meanwhile, was neglected. He also accuses the cancer establishment of misleading the public by suggesting that it has been winning the war against cancer. Rather, according to Epstein, it is losing, and badly. "The way the NCI reports the data is based on the assumption that if you survive for five years, you are not going to die from the cancer. But that is simply a short-term response to treatment. Mortality rates for certain cancers have not improved over the past few decades," Epstein says.

Cancer incidence has been steadily rising because of our unknowing and involuntary exposure to carcinogens in the air we breathe, the water we drink, in our homes and at work. Epstein characterises the NCI and ACS as taking a "blame-the-victim" approach. "Cancer is seen (by the establishment) as the expression almost exclusively of having chosen the wrong parents (genetics), or a high-fat diet, or smoking, and the other causes are trivial." Epstein, however, is outraged at this "not always benign" indifference to avoidable occupational and environmental risks.

Although some have tried to label Epstein a scaremonger, his strongest vindication came in 1992, when he was supported in his criticism of the cancer establishment by 64 leading public health experts, including several former directors of federal agencies.

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He is scathing in his criticism of the NCI, but it is not his only target. The US Food and Drug Administration and the Department of Agriculture, which are responsible for regulating food production and protecting public health, have also come in for criticism. In the 1970s, when Epstein helped expose corruption and malpractice in the FDA, heads rolled. Most recently he has been banging heads with them over the issue of sex hormones in beef.

It all began in 1989, when the European Union banned the use of natural sex hormones such as testosterone and estradiol in cattle and prevented the import of such beef from the United States and Canada. The North Americans brought the matter before the World Trade Organisation in 1997, arguing that the meat was completely safe and charging the Europeans with protectionism.

"The 1989 ban on meat was based on a European instinct not to go against mother nature," Epstein says. It was an instinct that he believes turned out to be reliable. While researching his Safe Shoppers Bible, Epstein went through reams of FDA documentation, and in the course of those investigations, he uncovered "extraordinary evidence".

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"What I found was that, contrary to FDA and industry assurances, there were marked elevations of natural hormones (in US cattle). For instance, estradiol levels could be 20 times the background level, while the FDA was maintaining that there were no excesses at all." These excesses were based on the legal method of injecting the hormones under the skin of the cow's ear, but in the late 1980s Epstein uncovered evidence that about 40 per cent of farmers were illegally injecting the hormones in the more accessible neck muscles, where hormones are absorbed at a higher rate. The European Commission invited Epstein as its lead public-health expert to deliver his evidence to the WTO hearings, where it was acknowledged that the European objections had some merit. Nonetheless, the WTO still ruled in favour of the Americans, giving the Europeans until 1999 to lift their ban.

Though natural, estradiol is a potent breast-cancer-causing agent and, according to FDA figures, 500 grammes of hormonal beef can contain more estradiol than an eight-year-old boy would produce in a day.

This May, the WTO challenge to the European ban came into effect, and two months later, with WTO approval, the US carried out its decade-long threat of sanctions against Europe, imposing tariffs on European imports ranging from Roquefort to canned tomatoes. Never one to be beaten, Epstein expects that a formal European risk assessment due at the end of the year will eventually reverse the WTO ruling.

Crucial to all Epstein's work is the Freedom of Information Act, which allows the American public to access official government documents. But Epstein also uses other, less conventional sources. As he explains, with a twinkle in his eye: "Some of this information arrives in unmarked envelopes." While he was investigating the effects of the hormone BGH (also known as BST), which is used to increase milk production, a box arrived one morning with a complete set of the files on BGH submitted by its manufacturer Monsanto to the FDA. The evidence, he says, showed clear FDA complicity in covering up the health effects of milk produced using this artificial hormone.

Epstein clearly relishes the cloak-and-dagger element of his work, and also seems to thrive on its eclectic nature. As a young man, he considered going into the foreign service or studying law, but chose medicine instead. In his role as scientist and activist he seems to have combined a little of all those professions. Part of what makes him formidable is his razor-sharp legal mind. Should anyone threaten to sue him, his eyes light up: "I'd be delighted."

It is hard to imagine that Epstein could ever have been "just a scientist", and he is disdainful of those who choose a narrow area and become blinkered to everything outside. "(There is) extraordinary fragmentation in science, (compounded by) the myopia of people who can spend a lifetime in a narrow subsection of a subsection of a subsection of a field, and not understand the impacts on public health," complains Epstein. It is not something that he could ever be accused of himself: "My critics will tell you I am all over the place and there is a lot of truth in that."

Epstein describes his father - the late Isadore Epstein, the rabbi and scholar who founded Jews College in London - as having a "fanatical obsession" with justice and human rights. Some of that clearly rubbed off on the younger Epstein, now 72. Early in life, he learned to stand up for what he believed in, no matter the cost. While still at school, he became a translator for the Zionist military wing, the Irgun, who were then fighting the British for an independent Jewish state. Later, as a young doctor, he broke into his boss's safe to uncover evidence of fraud, an episode that finally persuaded him to leave Britain for the US, where he hoped to find a more open society. But during the Vietnam conflict, Epstein became uncomfortable in his new home. In what he now calls a foolhardy endeavour, he travelled to Vietnam to bring back sick children for treatment in the US.

Eventually, Epstein found a cause to which he could devote himself entirely - the prevention of cancer and the elimination of toxic chemicals. "Cancer is in a sense a 'paradigm' of the impact of chemicals. It is the only way we have of measuring them," he concludes.

* Samuel Epstein's website:

RISKY PRODUCTS

Beef hotdogs (certain brands)

Whole milk (certain brands)

Talc (Johnson & Johnson)

Cover Girl Replenishing Natural Finish Make-up (Procter & Gamble)

Crest Tartar Control Toothpaste (P&G)

Alberto V05 conditioner (essence of neutral henna) (Alberto Culver)

Clairol Nice 'n Easy (permanent haircolour) (Clairol)

Ajax cleanser (Colgate-Palmolive)

(Ajax contains crystalline silica, though the manufacturer claims to have reduced silica levels since 1993 and no Ajax products in the UK contain silica.)

Zocliac cat and dog flea collar (Sandoz Agro)

Ortho Weed-B-Gon lawn weed killer (Monsanto)

List taken from Samuel Epstein's website. All the above contain carcinogens. The list refers to US products. UKproducts (pictured) are similar but may not be identical.

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