Living Downstream is a 1997 book (updated in 2010) by Sandra Steingraber, a biologist and poet who is also a survivor of bladder cancer. Primarily a data-based examination of the link between environmental contamination and cancer, the book is also an autobiographical account of Steingraber’s experience with the subject matter in rural Illinois. The book reflects several themes: The Paradox of Silence, Personalizing Scientific Research through Memoir, and War as a Backdrop for Environmental Contamination.

While the book was first published in 1997, the second edition, published in 2010—on which this guide is based—reflects the rapid growth in the medical understanding of bladder cancer. The 2010 documentary Living Downstream, produced by the People’s Picture Company, is based on Steingraber’s book.

Summary

At age 20, while a biology major at Illinois Wesleyan University, Steingraber was diagnosed with bladder cancer. After reading numerous medical reports and pamphlets about bladder cancer, she identified a disconnect in the information she read: The medical pamphlets she collected from medical offices didn’t address environmental toxins. Doctors suggested that the cancer was genetic. However, although Steingraber’s family has a history of cancer, she was adopted. The literature on cancer among adoptees, Steingraber reveals, suggests that the chances of an adoptee dying of cancer relates more closely to the occurrence of cancer in the adoptive than biological parents and family. Steingraber concludes that health risks are as much a result of one’s environment as family genetics.

Steingraber’s goal in this book is to examine and understand the data linking environmental contamination to incidences of cancer. The book is based on information from published right-to-know laws, medical papers, surveys, and case studies. As a memoir, Steingraber’s story centers on her Illinois community and the environmental impact of industrial and agricultural development on the area following World War II.

The book includes 12 chapters. In Chapter 1 (“Trace Amounts”), Steingraber examines the sharp increase in pesticide use since 1950 in her native rural Illinois. Chapter 2 (“Silence”) recalls the impact of Rachel Carson’s 1962 book Silent Spring on the environmental movement and on Steingraber’s personal battle with cancer. In Chapter 3 (“Time”), the author discusses how changes in data collection methodologies and cancer incidence present challenges in compiling and interpreting information—and notes the urgency of environmental action.

Chapter 4 (“Space”) considers land use, population densities, and how data reflects the stories of populations. In Chapter 5 (“War”), Steingraber explores the increase in production of highly toxic chemicals during wartime, particularly World War II, and the lasting residual impact of those chemicals. Chapter 6 (“Animals”) examines data on the effects of chemicals on animals, both in laboratories and the environment.

Chapters 7 (“Earth”), 8 (“Air”), 9 (“Water”), and 10 (“Fire”) look at how and where chemicals are released into the environment, how they can combine, and the corresponding health effects. In Chapter 11 (“Our Bodies Inscribed”), the author considers the “body burden” of chemical exposure. Chapter 12 (“Ecological Roots”) examines how environmental differences can alter genetics and cites data on sampling within geographically dispersed families.

The author notes the many research drawbacks she encountered. Databases that published right-to-know information on industrial pollutants scaled back in the 2000s. Many facilities linked to environmental pollution were no longer required to report information about their toxins. As of 2009, many laws were reinstated, but the information contained in the reports is much less comprehensive. Additionally, Steingraber lists six challenges to understanding the link between environmental toxicity and cancer:

1. Genes, lifestyle, and environment aren’t independent of each other.
2. Bad or damaged genes through inheritance aren’t the only causes of cancer.
3. The endocrine system can’t distinguish between a normal hormone and an environmental chemical acting like one.
4. Ancient toxicology reports suggest that the amount of a toxin to which we’re exposed dictates its danger—but when we were exposed is just as important.
5. Chemical mixtures may have a different reaction and effect on human health than just one chemical by itself.
6. Not acting before definitive proof is available may hinder the ability to avoid unknown, irreversible damage.

The evidence to suggest that the environment plays a role in the incidence of cancer is good news because we can do something about it. We can choose green solutions to combat toxins from industry.