See http://www.dhss.delaware.gov/dhss/dph/dpc/files/irrpt071707.pdf
9/22/07 - Cancer cluster study set for Sussex
Health officials try to pinpoint cause of high number of cases in 6 ZIP codes, By AARON NATHANS, The News Journal
A study of lung cancer patients in the Indian River area will cost about $100,000, as state officials try to rule out whether tobacco exposure was the culprit.
The study, developed by the Division of Public Health, will begin in November, pending approval by the Delaware Cancer Consortium next month, a division official said Friday.
In July, the division identified a cluster of cancer cases in the six ZIP codes around NRG Energy's Indian River power plant, the state's worst polluter.
The study showed the age-adjusted rate of cancer cases in the area is 17 percent higher than the national average, including an increased incidence in lung cancer among older residents.
But the study did not identify a cause. Area environmentalists suspect emissions from the power plant, but public health specialists say they first need to investigate one likely culprit: smoking.
Alisa Olshefsky, the division's chronic disease bureau chief, noted that more than 80 percent of lung cancer cases are attributable to tobacco exposure.
She added that there are a large number of new arrivals in the area. The study will help determine whether those factors can explain the higher rate of lung cancer in the area, she said.
The Delaware Cancer Consortium's environmental committee will discuss the study's methodology at its meeting on Oct. 10. If the full consortium approves the study, it could begin in November,and run through June, Olshefsky said.
The $100,000 study, twice the cost of the original estimate, will be paid for by a combination of state funds and tobacco settlement money.
The Office of Management and Budget identified the state funds, which are available for evaluation of issues and state programs, said Lt. Gov. John Carney, who sought the funding. The Division of Public Health still has to formally request the funding.
"I'm very confident we have the funds available to do this study," Carney said. "It may be that it just gives rise to additional questions, but at least we'll be making progress," he added.
The survey will study four populations: residents of the Indian River area who have been diagnosed with lung cancer since 2004; those in that area with no cancer; residents of Sussex County diagnosed with lung cancer since 2004; and residents of Sussex County
Researchers will attempt to speak with victims of lung cancer and the "first-degree relatives," mainly spouses, of those who have died.
Olshefsky said researchers hope to find at least 150 people in each category. They will use the state's central cancer registry, as well as registries at Beebe Medical Center and Nanticoke Memorial Hospital
The survey will seek respondents' demographic information, occupations, risk behaviors such as smoking and exposure to toxins, and length of residency in the area.
The Indian River area, as defined by this survey, will include the following six ZIP codes: 19939 (Dagsboro), 19945 (Frankford), 19947 (Georgetown
Contact Aaron Nathans at 324-2786 or anathans@delawareonline.com.
Delaware
See http://www.dhss.delaware.gov/dhss/dph/dpc/files/irrpt071707.pdf
9/22/07 - Cancer cluster study set for
Health officials try to pinpoint cause of high number of cases in 6 ZIP codes, By AARON NATHANS, The News Journal
A study of lung cancer patients in the
The study, developed by the Division of Public Health, will begin in November, pending approval by the Delaware Cancer Consortium next month, a division official said Friday.
In July, the division identified a cluster of cancer cases in the six ZIP codes around NRG Energy's
The study showed the age-adjusted rate of cancer cases in the area is 17 percent higher than the national average, including an increased incidence in lung cancer among older residents.
But the study did not identify a cause. Area environmentalists suspect emissions from the power plant, but public health specialists say they first need to investigate one likely culprit: smoking.
Alisa Olshefsky, the division's chronic disease bureau chief, noted that more than 80 percent of lung cancer cases are attributable to tobacco exposure.
She added that there are a large number of new arrivals in the area. The study will help determine whether those factors can explain the higher rate of lung cancer in the area, she said.
The Delaware Cancer Consortium's environmental committee will discuss the study's methodology at its meeting on Oct. 10. If the full consortium approves the study, it could begin in November,and run through June, Olshefsky said.
The $100,000 study, twice the cost of the original estimate, will be paid for by a combination of state funds and tobacco settlement money.
The Office of Management and Budget identified the state funds, which are available for evaluation of issues and state programs, said Lt. Gov. John Carney, who sought the funding. The Division of Public Health still has to formally request the funding.
"I'm very confident we have the funds available to do this study," Carney said. "It may be that it just gives rise to additional questions, but at least we'll be making progress," he added.
The survey will study four populations: residents of the Indian River area who have been diagnosed with lung cancer since 2004; those in that area with no cancer; residents of
Researchers will attempt to speak with victims of lung cancer and the "first-degree relatives," mainly spouses, of those who have died.
Olshefsky said researchers hope to find at least 150 people in each category. They will use the state's central cancer registry, as well as registries at
The survey will seek respondents' demographic information, occupations, risk behaviors such as smoking and exposure to toxins, and length of residency in the area.
The Indian River area, as defined by this survey, will include the following six ZIP codes: 19939 (Dagsboro), 19945 (Frankford), 19947 (
Contact Aaron Nathans at 324-2786 or anathans@delawareonline.com.
Delaware
Study finds higher rate near
Posted Sun,
For years, residents in the small towns around the Indian River power plant have noticed friends and relatives falling sick in greater numbers than they thought normal.
Years after citizen activists first asked the state for data to establish a pattern, the Division of Public Health has finally confirmed what they suspected: There's a cluster of cancer cases near the coal burning plant -- the state's worst polluter.
According to the state's own study, the rate of cancer cases in the area is 17 percent higher than the national average.
But the Division of Public Health says it is unlikely to study the matter further, citing a lack of resources and the historical difficulty of pinning down an environmental cause.
Now resident activists are pushing a state panel to fund further studies to determine whether there is a link with the plant.
"We are saying, you need to spend the money and do it right," said Pat Gearity, spokeswoman for Citizens for Clean Power. Her group has worked to document higher-than-normal health problems in the area.
Gearity said the responsibility for investigating whether there is a link between the plants and the high rate of cancer lies with the state, not private citizens.
NRG Energy Inc.'s Indian River complex, located in Millsboro, ranks as the state's top source of toxic and smog-forming pollution. The state last year passed pollution control rules that would reduce emissions from the
Duane Lynch, 72, said she lives with the memory of friends and loved ones who have died over the years of cancer at young ages. She recalled one couple whose cars mysteriously chipped paint, and clothes on the clothesline collected debris. The man died of liver cancer in his early 40s about 25 years ago; and his wife died around that same time of an infection.
"I think that power plant has a lot to do with their deaths," Lynch said. "I'd like to have more research done, knowing that the cancer is so much greater in my area."
Further conclusions unlikely
The state study was released to Lt. Gov. John Carney on July 17, who had requested the report; he then passed it along to the citizen activists who had come to him for help. It shows an incidence of 553.9 cancer cases per 100,000 residents of a six ZIP code area around
That amounts to a cancer cluster, the division determined. Public health officials adjusted the figures for age to compensate for the larger number of retirees in the area. The highest incidence of cancer was lung cancer, which accounted for 19.5 percent of the cases.
The Centers for Disease Control and Prevention defines a cancer cluster as a greater-than-expected incidence of the disease within a geographic area. The Division of Public Health gets complaints about alleged cancer clusters "every couple of months," said Paul Silverman, the division's associate deputy director. But the division never found a definitive link with an environmental contaminant for any of the cases, he said.
The CDC has launched scores of cancer cluster investigations over the years, and has helped focus public attention on certain cases, like the incidence of childhood leukemia amid corporate contamination of the groundwater in
The CDC reported that few cases have resulted in definitive links with environmental causes. That's the reason
"Are we likely to reach any further conclusions by outlaying the cost and devoting the time to studying these further?" Silverman said, noting that studying carcinogens in the air would be expensive. "There's a balance between whether there's something to be gained versus the resources necessary to go that next step."
NRG's spokeswoman, Lori Neuman, said in an e-mail that the company "is fully committed to reducing emissions from our
Coal-burning power plants in
Kim Furtado, a member of Citizens for Clean Power, is a naturopathic physician based in
Furtado, a Millsboro resident, said the state should be interviewing cancer victims and their survivors, and performing tests to find the levels of contaminants in their urine and blood.
In 2002, she asked the Division of Public Health for cancer data. She argued her findings showed a higher incidence of cancer in the area. But it wasn't until earlier this year, when the Lewes-based Citizens for Clean Power and the grassroots anti-pollution group Citizens for a Better Sussex kept pushing, that the division undertook a study. The two groups got the attention of Carney, who formally requested the study.
"It's one thing to say we can't get it," Furtado said, referring to seeking further information about the cause of the cancers. "But don't refuse to do the work and say we can't get it."
At the division's suggestion, citizen advocates on Aug. 13 are taking their case to the environmental committee of the Delaware Cancer Consortium in hopes it will perform a more detailed study.
No clues to cluster's origin
In the report, the division said it's not sure whether the higher incidence of lung cancer could have been caused by tobacco use, the culprit in 85 percent of all lung cancers nationwide. The cancers may have also been caused by people having moved into the area from a different environment, the report argued.
The cases could also be an example of random variation, Silverman said. The six areas examined in the report were Dagsboro, Frankford,
The high percentage of lung cancer cases around
The 61-70 age group was the largest group of lung cancer patients in the area, with 36.6 percent of all cancer cases, compared to 32.3 statewide.
The report said the absence of unusual cancers or cancers striking young people "provides no clues as to the origin of this cluster and suggests that further investigation is unlikely to be fruitful."
The report also said new state rules intended to reduce emissions "are a major step forward in providing a clean environment," and would be enhanced by putting more air quality monitors in the area.
The state study found that the
But the biggest exception by far was lung cancer, which affected 19.5 percent of cancer patients in the
The other was breast cancer, which had a 2.7 percent lower incidence among cancer patients in the area than the state's population at large.
In the
No one from the Delaware Cancer Consortium's environment committee was willing to be interviewed for this article. One member, John Hughes, the state's environmental secretary, said through a spokeswoman that he had not yet read the report.
Carney, a member of the consortium's advisory council, said he didn't have an opinion on whether the consortium should proceed with a more in-depth study. He said it might suffice to take actions "that would address whatever potential problems might exist," like reducing emissions at the plant and funding smoking cessation programs.
Residents left to wonder
Lynch noted that her first husband died of cancer of the thymus gland in 1966 at the age of 33. Her second husband, who was a heavy smoker but has since quit, has been treated for lung cancer. She is a survivor of breast cancer. "It's strange three people lived in this house all had cancer," she said.
Lynch, a patient of Furtado, said elevated levels of metals like aluminum have been found in her blood. She wonders whether that contributed to her osteoporosis.
"I still think it needs to be investigated more," Lynch said.
Copyright ©2007, The News Journal.
Officials urge further cancer cluster study
Establishing cause will be difficult
By AARON NATHANS, The News Journal
Posted Tuesday,
Lt. Gov. John C. Carney Jr. and lawmakers on Monday urged the state to take a deeper look into a cancer cluster in the area around the Indian River Power Plant.
The Division of Public Health recently confirmed a cancer cluster in the six ZIP codes around the NRG Energy Inc. plant -- the state's worst polluter -- but said it is unlikely to study the matter further.
On Monday, Carney said the state has "a responsibility to do more study on this. It's incumbent upon us to do everything we can to determine what the cause of the cluster is, if that's possible to do."
The Division of Public Health has said it didn't have enough information to determine whether emissions from the coal-burning plant caused the cluster. Its study shows the rate of cancer cases in the area is 17 percent higher than the national average, including an increased incidence in lung cancer among older residents.
In an interview last week, Carney questioned the value of spending resources on investigating the cancer cluster that might instead be spent on cancer care coordinators, treatment of those with cancer and anti-smoking programs.
But Monday he said further investigation would be worth the investment.
The environmental committee of the Delaware Cancer Consortium meets next week in
Independent public health specialists warned that even if the matter is studied further, it will be difficult to establish an environmental cause.
Calls for research
Carney, a member of the cancer consortium's advisory committee said he agreed with the division's finding that the Department of Natural Resources and Environmental Control should install air quality monitors in the area.
He said it would be especially valuable to get information about two other factors that could be responsible for the cancer cases: tobacco use and people moving into the area.
State Sen. Gary Simpson, R-Milford, said a deeper investigation can give impetus to cleaning up the Indian River Power Plant. Even if investigators could rule out smoking and migration into the area as potential causes of the cluster, that could be worthwhile, he said.
"There's a lot of good reasons to study it further," said Simpson, whose district includes parts of
State Rep. Gerald W. Hocker, R-Ocean View, said it would be valuable to know whether the people suffering from cancer were longtime residents of the area or relatively new arrivals.
"For a study to mean anything to me, they need to find out where these people are coming from," Hocker said. "If they're going to blame it on one thing, they have to spend more money and effort and determine once and for all if it's the power plant or not the power plant."
Study can reap some benefit
Public health officials adjusted their findings for age to compensate for the high number of retirees in the area. The study found the highest incidence of cancer was lung cancer, accounting for 19.5 percent of the cases.
Coal-burning plants release several chemicals that can cause cancer or linger in human tissue or the environment, according to federal health and environment agencies.
But communities that go into cancer cluster investigations looking for definitive links between environment and disease are bound to be disappointed, said Tom Burke, professor at Johns Hopkins Bloomberg School of Public Health. Such "smoking guns" are rare, Burke said.
But the studies can identify risk factors, increase residents' awareness of their environment, and provide a more thorough understanding of an area's health profile, he said.
Louise Ryan, professor of biostatistics at the Harvard School of Public Health, said the elevated level of cancer in the
"This kind of situation is almost doomed to get everyone quite frustrated," Ryan said.
That echoes the state Division of Public Health's comment in its report on the cancer cluster that "further investigation is unlikely to be fruitful" due to the lack of abnormal forms of cancer or disproportionate cases among young people.
Carney wrote a letter Monday to the National Cancer Institute, asking the organization to comment on that argument.
He also asked the institute to identify what additional research is needed.
Ryan suggested testing the air for pollutants, and asking if residents were suffering from other respiratory problems, like wheezing and bronchitis.
Copyright ©2007, The News Journal.
From: Maryann McGonegal
Members of the Environmental Committee of the
Dear members:
I am Maryanne McGonegal and I was diagnosed with stage 3 multiple myeloma/leukemia in June, 2006. Multiple myeloma is caused, in part, by exposure to environmental toxins, such as benzene, dioxins, and PCBs. Despite never having smoked, having only an occasional glass of wine, drinking bottled water, eating organic food, practicing yoga, walking over five miles every day, I am suffering with a cancer that is very expensive to treat.
I am very fortunate and thankful to have health care underwritten by the state of
I am here today to ask you to consider the cost of my treatment, only one cancer patient, and ask how can you possibly compare the cost of expanding the review of cancer data to analyze data for the entire state. I am concerned that the issue of cancer clusters has become politicized. We are a small state and various areas should not be pitted against one another in an attempt to discern why
I do not accept that the first step in an analysis is to look for personal blame. The time is far past the 'blaming the victim' mentality. State officials, including Consortium members, must enlarge their vision to offer citizens meaningful ways to live in our industrialized state, especially the toxic areas of Wilmington/Edgemoor, which is home to a large, mostly ignored, minority population.
I offer the cost of my treatment for each month to show that a more comprehensive study of possible cancer clusters would be cost effective for the state.
Chemo pills over $6,000 for 21-day supply. Other daily medicines amount to $890.00/month. Monthly infusion $5,000. This approximately $12,000/monthly cost does not include the cost of CAT scans; x-rays, radiation, etc. I have those figures; for instance, a 6-day stay at Christiana Care for diagnosis was $10,819.38 and does not include thousands of dollars in tests and doctors' hospital visits. I have had 5 hospitalizations in the past year, including one for a hospital-acquired sepsis infection from which I nearly died. I also did not include the cost of a stem-cell transplant, which failed and cost over $100,000.
I join everyone who has asked for additional study of cancer issues. We need to stand together to fight this terrible scourge that is putting a burden on our families and destroying the lives of our citizens.
Thank you,
Maryanne McGonegal, 506
302-588-0310