Since mass production of plastics are available in 1940s, they have been widely used in various industries because they benefit a reasonable price, lightness, durability, flexibility and stability properties (Thompson et al., 2009). Although plastics contributed to many commercial and medical advantages, they are proved to be an inducing-factor behind increasing rate of cancer. However, most studies in plastic-induced cancer have only been conducted in some countries. Gaza, which has been encountering with military action from Israel, requires specific protocol to cope with this complicated situation. This study aims to propose possible solutions to handle plastic-induced cancer problem, and this article is divided into four parts: the first section will describe plastics-related situation in Gaza; the second section focuses on relationship between plastic product cycle and carcinogen discharge; the third part aims to proposes potential resolution; and the final part dedicates to discussion about possibility of each solution.
Although the growth of private economic sector in Gaza are restricted by Egypt-Israel blockade, plastic industries still play an important role in Gaza economic. According to Portland Trust (2010), plastic manufacturing is the second most resilient sector, in other words, Gaza plastic industry were relatively less impacted by the blockade than other economic sectors. Simultaneously, Gaza strip has been experiencing with drastic increase of cancer prevalence especially breast cancer in Gaza woman. The Information Center at the Ministry of Health in Ramallah revealed that cancer is accounted for 10.8% of the total fatality in Palestine in 2010, and this percentage was increased to 12.4% in 2011. Moreover, due to Egypt-Israel sanction and public health service insufficiency, 5-year survival rate of cancer patients in Gaza was accounted for only 40% comparing to 71% and 80% in Israel and Australia respectively, thereby, prevention of cancer should be implemented to reduce cancer prevalence (Shaheen et al., 2011). There is a considerable number of research that reported the positive relationship between plastic products and cancer prevalence (Brandt-Rauf et al., 2012). In order to understand carcinogen discharge mechanism, plastic product cycle should be divided into three stages: manufacturing, using (as a product package) and waste management process (Kogevinas et al., 1998; Li et al., 2001; Brandt-Rauf et al., 2012).
First, while plastic is being manufacturing, different carcinogens are discharged from plastic plants. For instance, Di (2-ethylhexyl) phthalate (DEHP), a plasticizer, that is used and emitted during Polyvinylchloride (PVC) softening procedure. Hepatocarcinogenic effects of DEHP has been reported in humans and rodents (Rusyn and Corton, 2012). Several studies which aim to investigate other carcinogens emitting during plastic manufacturing, such as 1-3-butadiene, styrene and di-butyl phthalate (DBP), were reported (Rustagi et al., 2011; Sathiakumar et al., 2015). These carcinogens could cause not only cancer, but also long-term health problems of plastic industry workers. Second, carcinogens have been found to be released from plastic package and may be ingested by consumers. An example of this is the research conducted by Chapa-Martínez et al., (2016) in which Polyethylene terephthalate (PET), a material using in drinking water bottle, leaches antimony (Sb) into water. This reaction generally be accelerated by high temperature (>80 Cº) and sunlight exposure (Westerhoff et al. 2008, cited in Chapa-Martínez et al., 2016). Carcinogenic activity of Sb was confirmed in laboratory animal by International Agency for Research on Cancer (IARC), and it also lead to other health problems (Boffetta, 1993). Besides PET, bisphenol A (BPA) is also included in plastic bottle production and is likely to release estrogenic chemical which is acts as estrogen hormone (Yang et al., 2011). As a consequence of prolonged estrogenic consumption, breast cancer is reported to be induced by this behaviour (ibid.). In addition, this could explain that why cancer was accounted for the highest prevalence cancer in Gaza ladies in 2010 (Shaheen et al., 2011). Third, plastic waste management that are traditionally conducted in two major methods which are incineration and landfill methods. Various plastic carcinogenic precursors, such as PVC, polypropylene (PP) and High-density polyethylene (HDPE), were studied and found to be emitted during incineration process (Li et al., 2001).
In order to improve cancer situation in Gaza, two pragmatic resolutions should be applied: (1) adopting re-usable package; and (2) establishment of cancer self-examination scheme. The former resolution, re-using, will decrease plastic demand which in turn reduce carcinogen emission. There is a slowly drop in using refilling bottle in several countries due to complicated process regarding to distribution and collection point requirement (Institute for Local Self-Reliance, 2002). Nevertheless, this method has been reconsidered and become a potential solution as plastic waste management developed to a public health concern (Hopewell et al., 2009). Sapphire (1994) suggested that to succeed in implementing re-usable package requires three strategies: (a) compulsory deposit is essential and the deposit will be refunded after returning the package; (b) 5-10% discount on products that are consumed at a collection site; and (c) simplified and unique distribution system. Besides these strategies, other approaches could be employed including promotion public awareness, financial motivation to participated companies and disposal container prohibition (Platt and Rowe, 2002). Gaza local government should directly responsible for providing a unique distribution and collection system. The latter resolution, cancer self-examination scheme, will enhance the possibility that cancer will be early diagnosed regardless of diagnosis equipment accessibility and financial affordability. To establish this programme, local government could initiate as a preliminary project for the highest incidence rate cancer in Gaza women (i.e. breast cancer) (Shaheen et al., 2011). In most cases cancer patients were diagnosed in late stage of the disease, various types of malignant tumour are a treatable tumour, nonetheless successful cancer treatment required early stage diagnosis(ibid.). A study in the United States of America (USA) carried out by Roth et al. (2011) found that breast cancer detection by means of self-reported method was 43%, while mammography combined with clinical breast examination were 56%. This means breast cancer self-examination remain to be important for early diagnosis of cancer. In Gaza strip, only 4 mammography units are available for 1.4 million (700,000 women), in addition women in Gaza were concerned by safety issues to reach medical services. Thereby, this project could promote early self detection amongst Gaza women and enhance 5-year survival rate (Shaheen et al., 2011).
On account of Gaza strip circumstance, marine and terrestrial accessibility has been restricted. Intervention in plastic manufacturing and plastic waste management are not expected to be straightforward. Prior studies that have shown benefits of potential strategies, for instance biodegradable plastic, bio-filter material and salted-modified plastic (Ammala et al., 2011; Abbott et al., 2012 ; and Pérez Gil et al., 2015), however these demand cutting-edge manufactures and superior raw materials. Thus, factors such as affordability, technological availability and raw material approachability are considerable aspects. Reusable package could reduce not only carcinogen emission, but government expenditure for plastic waste management as well. The Joint Service Council has been founded by partnership amongst 13 municipalities in Gaza strip, aim to operate household waste management (HWM). Annually, 3.6 million New Israeli Shekel (NIS) has been spent for HWM, but only 38% of total budget is covered by household waste fees which is collected at 10 NIS per household per month and the remainders are acquired from international financiers (United Nations Development Programme, 2012). This cost is possibly lowered by adopting reusable package scheme, due to plastic is a dominant portion of municipal solid waste in Gaza (ibid.). However, as a result of economic role of plastic industries in Gaza strip, immediate application of reusable package may exacerbate a poverty issue and induce other economic problems. Further studies of advantages and disadvantages of the policy are necessary. Moreover, because of most cancers are multi-factor diseases, reducing of cancer incidence after adopting this solution is not guaranteed. The second possible solution, establishment of cancer self-detection scheme, does not rely on high technology instruments or high quantity of government expenditure. The limited mammography devices and medical staff in Gaza will not be overburdened by high women population/mammography devices ratio (175,000:1) (Shaheen et al., 2011). This solution would be an applicable strategy, if proper media are provided to deliver a useful self-examination protocol. Though establishment of this solution does not expect to reduce cancer incidence, this may extend 5-year survival rate of the patients in Gaza.
In this study, the aim is to propose potential solutions for plastics-cancer concern in Gaza. This article found that carcinogens are proved to be released during most stage of plastic product cycle. However, direct intervention in plastic industries, which show a valuable contribution toward Gaza economic system, seems to be a difficult challenge. Therefore, two conventional approaches, including adopting reusable package and establishment of cancer self-examination scheme, could provide an effective result due to hi-technology equipment and high amount of money are not required.