Action needed on toxic substances that put Alaskans at risk

We arrived in Alaska just as the bloom was beginning to pop: two nurses with the privilege to be invited to visit Alaska and speak on preventing breast cancer by avoiding cancer-causing chemicals in the environment and our everyday lives. We came at the invitation of Alaska Community Action on Toxics, through a grant awarded by the Alaska Run for Women. The lecture series, held to commemorate Nurses' Week, was co-sponsored by the Alaska Nurses Association, Citizens for Clean Air, the YWCA and Planned Parenthood.

Our presentation was titled "Nursing the Earth back to health: Preventing breast cancer at the individual, institutional, and community levels." Although both of us have worked on issues around environmental exposure throughout our nursing careers, we consulted the scientific literature as we prepared for our talks, to see if there were exposures or certain vulnerabilities that would be important to highlight for our Alaskan audiences.

Two things jumped out at us from our reading. First was the concept of the circumpolar north being a hemispheric "sink" for persistent bioaccumulative toxic substances. These are chemicals that break down slowly in the environment, accumulating in humans and other species. Exposures can have a variety of negative health effects such as cancer, neurological toxicity and reproductive toxicity.

These toxic substances may be released intentionally, such as when pesticides are used in agriculture, or unintentionally, such as in the exhaust from our cars or manufacturing byproducts. Some PBTs can travel long distances in a series of "hops" known as the grasshopper effect. The chemicals evaporate out of the soil in the warmer climates where they are used, then travel to cooler climates through the atmosphere. When they come in contact with cooler temperatures, they condense and fall back to earth. Through these "hops," these chemicals can travel thousands of miles and eventually accumulate in cold regions such as the Arctic. This makes the concentration of pollutants — including PBTs — much greater in Alaska than in the Lower 48, and highlights the need for national and global efforts to eliminate them in order to protect the health of Alaskans.

Another deeply concerning issue was emerging evidence of the extensive contamination caused by per- and poly-fluorinated chemicals in the drinking water of people living in Fairbanks. Poly-fluorinated alkyl substances are human-made chemicals used in products found in the home, in stain- and stick- resistant products such as pots and pans, furniture and carpets, clothing and food packaging. They are also used for industrial purposes. They are so widely used they are found in more than 95 percent of Americans. These chemicals have been linked to a number of health effects, including cancer, changes in breast development, difficulty becoming pregnant, low birth weight and impacts on the endocrine system that have been implicated in breast and other cancers.

The groundwater contamination in Fairbanks was caused by the dispersion of aqueous firefighting foams into groundwater from Eielson Air Force Base, the Regional Fire Training Center and, most recently, the Fairbanks International Airport. PFAS chemicals are very persistent in the environment and can travel long distances in water and air. During our talks, we heard from affected residents that local, state, and federal officials are doing little to protect health or prevent further harm.

ACAT, the Alaska Nurses Association and the other organizations hosted four public forums in Fairbanks and Anchorage. We believe nurses are key to educating the public on chemical and environmental risks. We emphasized the everyday exposures linked to breast cancer: pesticides, herbicides, paints, chemicals in our cosmetics, soaps, fragrances, toothpaste and sun screens, as well as in cleaning products, stain-resistant fabrics, the linings of canned food and coatings of fast food containers (the latter may contain PFAS chemicals). By avoiding exposure and advocating for policies that prevent carcinogens from being used in these products in the first place, we have an opportunity to decrease the risk of developing breast cancer.

Little did we know that the issue of PFAS would be front-page news within a week of our visit.

Just two days after we returned home to San Francisco and Washington DC (respectively), on May 14, Politico reported that the U.S. Environmental Protection Agency Administrator Scott Pruitt, the White House, and the Department of Defense sought to block the release of a study of PFAS chemicals compiled by the Department of Health and Human Services Agency for Toxic Substances and Disease Control, which showed that these chemicals were harmful at exposure levels 10 times lower than what the EPA had called safe. Once the word of the study being quashed became public, senators across the country whose states are dealing with PFAS water contamination, called on Mr. Pruitt to establish health protective regulatory standards for drinking water. However, Alaska's senators, Sen. Lisa Murkowski and Sen. Dan Sullivan, have not yet weighed in.

Mr. Pruitt went ahead with a previously scheduled two-day leadership summit in Washington, D.C. to address PFAS contamination on May 22 and 23. However, media and affected community representatives were largely excluded.

Among the promises Pruitt made at the summit was to "initiate steps to evaluate the need" for setting a legal limit for PFAS chemicals under the federal Safe Drinking Water Act. He also said the EPA will officially designate PFAS chemicals "hazardous substances," which could make it easier for the agency to clean up hazardous sites contaminated with the chemicals. Nurses and other health care professionals can play a crucial role in advocating for health protective limits. We encourage Alaska's health professionals to be active participants in ensuring this public health crisis is addressed.

Thanks to Alaska Community Action on Toxics for their continued efforts to protect all Alaskans and to the Alaska Run for Women for recognizing the importance of this education about preventing breast cancer.

Catherine Dodd, Ph.D., RN, is a health consultant with Breast Cancer Prevention Partners.

Katie Huffling, MS, RN, CNM, is a member of the Alliance of Nurses for Healthy Environments.

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