Carcinogenic risk as the basis for fish advisories: A critique

Fish advisories are important tools in public health practice and are primarily used to translate fish contaminant levels into consumption recommendations for consumers. Even when a targeted advisory is issued, it may alter broad food consumption patterns among the public, including diminishing intake of fish‐based protein and polyunsaturated fatty acids. Such alterations may have both positive (e.g., reduced exposure to contaminants) and negative (e.g., loss of health benefits or cultural traditions associated with consuming fish) consequences. Currently, a fish advisory may be based on the potential for either noncarcinogenic or carcinogenic endpoints. Consumption recommendations based on a cancer outcome are likely to be highly restrictive, potentially diminishing opportunities for the recognized health benefits associated with a fish‐rich diet. This possibility causes us to raise 3 arguments against using cancer risk as the basis for fish consumption advisories. First, the benefits of fish consumption are widely recognized. Second, the standard methodology to predict cancer risk is likely to overestimate actual risk, often by orders of magnitude. Third, the public's real and perceived concerns about cancer may result in unintended consequences, such as avoidance of fish altogether. As an alternative to cancer‐based advisories, we suggest that future advisories incorporate a multidisciplinary public health framework focused on avoiding noncarcinogenic health outcomes and encouraging the public to consume a balanced diet rich in fish. We also suggest that decision makers need to 1) understand which elements of the advisory process are science and which are implicit or default policy, 2) consciously consider whether these policy elements are appropriate for their particular situation, and 3) if not, be willing to make and defend alternative policy choices. Integr Environ Assess Manag 2010; 6:180–183. © 2009 SETAC