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CHILD CANCER SURVEY

Help Us Investigate Environmental Causes for Common Cancers Affecting Children
These include Brain Cancer, Neuroblastoma, Leukemia, Lymphoma,
Aplastic Anemia and Others

By Wayne Sinclair, M.D.
Richard W. Pressinger, M.Ed.

Allergy, Asthma & Immunology, Vero Beach, Florida
email: chem-tox@adelphia.net

As there is extensive research showing cancers such as brain cancer, neuroblastoma, lymphomas, aplastic anemia and leukemia can result from exposure to man-made chemicals, please complete the form below to help us investigate major contributing causes.

We are especially interested with acquiring information regarding any cancers affecting children. Information is being compiled by the office of Dr. Wayne Sinclair, M.D. Allergy, Asthma & Immunology, Vero Beach, Florida.  This survey has been developed to gain insight toward the  increases being observed in the U.S. and other countries in cancers that affect the brain, nervous system and blood.  Your survey answers can then be sent to us by pressing the "SEND-SURVEY" button at the end of the survey.

Sometimes the cause of cancer can be illusive, as many chemicals can be involved that could be adding to genetic damage. Researchers now agree that cancer results from what is called a multi-stepped process in which several biological changes must occur before the cancer can develop. These can include:
  

  1. Damage to the genes that control the growth of the cells.
    Of the 100,000+ genes inside every cell in our body, some genes have been identified which have the job of starting the growth of cells (which occurs normally after we get a cut or injury to the body). Other genes have been found which function as policemen and tell the cells to "stop growing". If these "start growing" or "stop growing" genes can no longer function properly because of repeated insults by one or a variety of modern chemicals, the cells within our body will then grow without proper regulation – the result being an uncontrolled growth of cells, known as cancer.

  2. Damage to the genes that control the immune system
    It has been reported that all of us develop cancer cells daily. However, if the individual has a properly functioning immune system, the immune system cells will locate and destroy any cancer cells it detects (since cancer cells are genetically different from normal cells).

    It has been reported in several peer review medical journals that individuals with the cancer neuroblastoma have defects in immune system function (this is explained in detail under our neuroblastoma heading). It must also be considered that modern chemicals are being shown to cause serious weaknesses to a person's immune system. Defects than can result from exposure to these chemicals can result in the following:

Although anyone with cancer or a representative for someone with cancer can complete this form, we are especially concerned with the increasing incidence rates of child and adult brain and nervous system cancers being detected over the past 40 years in all industrialized countries. Researchers agree this increase is not just the result of better detection or an increase in the numbers of older individuals.

Individuals completing this form will receive an immediate "thank-you" email giving you the address to our highly informative website on child brain and nervous system cancers which outlines the major ongoing research linking exposure to many modern day chemicals with child cancers. This information is invaluable to families who wish to insure the maximum likelihood of remission by removing certain environmental factors that have only recently been found to cause child cancers.


  Environmental Cancer Survey Form

PLEASE HELP US IDENTIFY CAUSES OF CHILD CANCERS BY
COMPLETING THE FOLLOWING INFORMATION

Send completed information at end of form by pressing SEND SURVEY button   After processing your responses, you will receive an email showing current findings among respondents and detailed information to why specific questions were asked. Environmental circumstances appearing elevated for your questionnaire will be discussed.

Note: Not all questions below imply a possible causation factor but need to be investigated when looking for possible interactions.   Completing this survey will take about 10 minutes for the 60 questions - Thank you.

Type of cancer originally diagnosed
Age of individual when cancer was diagnosed
Sex of the person with cancer
Age of mother when child was born
Age of father when child was born

Answer the following questions to the best of your recollection for the period 3 months prior to conception (the time period required for male sperm development) and for the period following birth. It may take 10 minutes to complete this form but the information is extremely important to help identify  which chemicals may be interacting together to result in the increased incidence of child and nervous system cancers being observed.   

Question 

Answers should be for the time period only from 3 months before conception to the time of cancer diagnosis
How close was home to currently active agriculture/farming areas -
(such as citrus groves, etc)?
Please be specific.

If answer is yes to above question,
What type of agriculture was patient close to?
If no agriculture areas are currently close to the home, was there ever any agriculture conducted in the past around your home?
If the cancer affects an adult? Did the person ever follow  mosquito spray trucks
(as children often did on their bicycles)
when there was a thick fog plume?
If yes, how often.
Was professional pest control used inside the home for roaches, ants, etc. 
If yes, how often?
Did you or family members ever apply pesticides inside the home yourselves –
such as roach sprays etc? If yes, list type of chemical, how often and how applied.
Were lawn pesticides ever applied? If yes, how often and by which company?
Were shrubbery pesticides ever applied?
If yes, how often and by which company?
Were termite treatments ever applied while in the home? Explain.
Did the mother consume diet drinks containing aspartame (nutra-sweet) during pregnancy.
If yes, how often?
Did father consume diet drinks prior to conception? If yes, how often?
Were flea bombs (aerosol or smoke vapor) ever used in the home?
If yes, type and how often?
Were liquid or powder flea treatments ever applied to the interior of the home – these are where the pesticide is usually sprayed over the entire carpet and/or couches?
What type of laundry detergent was used?
Was any fabric softener used? 
If yes – what type of product - 
Brand Name – liquid or sheets?
How often was bleach used as a cleaning or disinfecting agent in the home?
How often was pine cleaner used in the home?
Were any fragrance products (such as plug-ins – or aerosols) ever intentionally used to add fragrance to the household air? 
Year home was built?
Was home wood or concrete block construction?
Type of flooring – carpet – tile etc? Explain if different for different rooms?
Was new carpet ever installed during the three months before conception up until  cancer diagnosis - if yes, when?
Was new paint ever applied? 
If yes, was latex or oil paint used? Also, if you recall the brand name, please list –
Benjamin Moore, Walmart, Glidden etc.
What type of pet was in the home?
How often was the pet treated for fleas with chemical flea treatments?
How often did mother use perfume?
What type if known?
How often did father use colognes?
What type if known?
Type of deodorant used by the mother?
If none, please state 
Type of deodorant used by the father?
Type of shampoo used by the mother?
Type of hair creme-rinse used by the mother?
How often was finger nail polish applied by the mother? Was this done in a salon or at home?
How often were hair permanents done?
Did the mother color her hair? 
If yes, what type and what color?
Did the mother use a face
"foundation" base-make up?
What type? Creme, powder, etc.
How often was hair spray applied by the mother?  What type?
Did the father ever use any type of hair coloring, creme, tonic or hair spray? Explain
Job occupation of mother?
Job occupation of father?
How often and how long did the patient use a pacifier as a child?
List type of x-rays taken of cancer patient prior to cancer diagnosis.
Did mother receive anesthesia during pregnancy (dental, etc.) (not counting during child delivery). Please explain.
What type of anesthesia procedure was used when child was born? local, spinal block, general anesthesia, etc.? Please be as specific as possible
Were you conscious when your child was born?
Was any remodeling done in the home? Painting? Drywall, wall paper, etc. – Please detail
How often were moisturizing skin creams applied over the body? What type?
How often was suntan lotion used by mother? If you know the SPF number please list.
How often was suntan lotion put on child before cancer diagnosis? - List SPF number.
Do you know how close the nearest trash incinerator was to your residence? 
Was the flavor enhancer ACCENT' ever used on foods? If yes, how often?
Are you aware of any foods eaten regularly which contained monosodium glutamate (MSG)?  These often include flavored potato chips, cheetos type snacks, frozen pizza, soups, etc.
How much did the cancer patient's
mother drink alcohol during pregnancy?
How much did the father
drink alcohol 3 months prior to conception?
How much did the patient’s mother smoke during pregnancy?
How much did the patient’s father smoke 3 months prior to conception?
If the patient reached school age, was the patient ever enrolled in special education classes - if yes, which type?
Email address for sending cancer survey results

May we contact you via email if we feel it would help to get more detail on your answers?
yes, I would like to help further   no

Thank you, for completing this form,
this information will help in further understanding the many environmental risk factors
that are coming together which can result in cancer among children. 
Once we compile your results with the first 100 other families who will be completing this survey, we will email you a summary of previous results as well as the latest research on the
environmental causes of child cancers. 

Thank you,
Dr. Wayne Sinclair, M.D.
Richard W. Pressinger, M.Ed.
Allergy, Asthma, Immunology
Cancer Research Project
Vero Beach, Florida
email: chem-tox@adelphia.net

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