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Landfills aren't known to cause pancreatic cancer, but that doesn't mean they don't

If I lived near the White Street Landfill, I would be none too happy hearing about the higher-than-expected number of pancreatic cancer cases among my neighbors.

However, that number by itself does not show that the landfill causes the disease.

What does? Here are some very basic answers to the question from the Sol Goldman Pancreatic Cancer Research Center at Johns Hopkins University School of Medicine.

You'll notice that the first sentence contains this key phrase: "it is virtually impossible to tell what caused a specific person to develop pancreatic cancer ..."

Among the risk factors it lists are:

cigarette smoking

race (it is more common among African Americans)

chronic pancreatitis

diabetes

obesity

diet (a lot of meat and fried foods)

and genetics.

Did the people with pancreatic cancer have some or all of these risk factors? If so, how could anyone determine there was some other cause?

Another complication is that, for purposes of this study, researchers looked at the individual's address at the time of diagnosis. Is that where the person lived when the disease first developed? Unknown.

"It is recognized that this may not be the relevant address in terms of etiology for a disease with a long latent period that is causally related to environmental exposures, especially given the mobility of many populations."

The report says, "Additional study would be needed before statements can be made about the connection between potential contaminants associated with the landfill and cancer rates in the study area."

At a minimum, you would have to know what contaminants were present; how exposure occurred, and at what levels; and whether it is reasonable to conclude, based on medical evidence, that this exposure caused the specific disease in the particular individual -- and not some other cause.

The state report seems to rule out exposure via water or air, but it's always possible that additional investigation could come up with something that's been missed so far.

Years of additional investigation.

It's foolish to jump to conclusions. If I lived near the landfill, I would be uneasy but hardly convinced I were living under a pancreatic cancer death sentence.

At the same time, I'd like to see a lot more information.

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Posted by Doug Clark on Friday, November 13, 2009 at 12:26 pm

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scharrison

November 14, 2009 - 11:58 am EST

We at least agree on one thing, Doug—much more information is needed.

I will say this, though: I've spent hundreds of hours doing research on environmental pieces I've written, and I've noticed that people are quick to explain away atypical/above average incidences of cancer or other diseases, when they're near suspected environmental hot-spots. It's often many years later that 2 and 2 are finally added together to get 4, all the while people are being exposed to dangerous contaminants. And it always makes the officials who claimed "results are inconclusive" look like negligent idiots.

If the number of cases had been merely "slightly higher than expected", it would warrant a closer look. But when the number of cases is "twice as high as expected", writing it off to demographics or an unlucky combination of various natural causes is simply dangerous thinking.

Doug

November 14, 2009 - 9:07 pm EST

I hear what you're saying, Steve, but there's no easy way to arrive at conclusions here. If there were known environmental triggers of pancreatic cancer, it would be one thing. You could test for the presence of that substance and make a good guess about likely exposures. But, apparently, there are not.

But there are other known risk factors, so ignoring them seems foolish. Could you examine the population for prevalence of known risk factors and combine that finding with the occurrences of pancreatic cancer? What if there are twice the expected number of people with those risk factors? Then your expectation of the occurrence of pancreatic cancer would change.

scharrison

November 15, 2009 - 1:01 am EST

Check these out and tell me if they don't sound familiar:

http://www.nhpr.org/node/27595

http://74.125.93.132/search?q=cache%3A8MTBP6GA4BUJ%3Ahazwastework.doh.st...

http://www.rutlandherald.com/article/20090504/NEWS01/905040285/1004/NEWS...

http://suburban.gmnews.com/news/2007/0601/Front_page/001.html

http://www.acereport.org/statistics.html

Doug

November 15, 2009 - 8:08 am EST

It does sound familiar, but experience in other places under different circumstances doesn't necessarily pertain to the situation here. This requires scientific, logical evaluation.

What we have in hand so far is lacking in many respects. Our follow-up story today (apparently not posted online yet) speaks to the point I made here yesterday: the state analysis was not normed to account for the makeup of the population in the study area. In a population with a high number of African Americans, the "expectation" of pancreatic cancer is higher. So, in fact, it's probably not accurate after all to say that the number of cases observed was twice the expectationl. But there ought to be a community meeting with state and county health officials to explain all this and put it in context.

As for environmental causes, it's my understanding you have to evaluate potential exposure. It can occur basically in three ways: ingestion, inhalation or absorption. Can something be found in the food/water, air or soil that can be linked to pancreatic cancer?

In the meantime, a general evacuation might be an overreaction.

scharrison

November 15, 2009 - 12:05 pm EST

"experience in other places under different circumstances doesn't necessarily pertain to the situation here."

That's true, but my point in posting those links was to demonstrate that higher rates of cancer for those living in proximity to landfills is a conundrum that other communities are faced with, and their attempts to explain these elevated numbers (very often) mirror what's happening in Greensboro. Not enough detailed information, officials promise to investigate further, plus all these other things could have caused it, etc. The end result from that is enough "reasonable doubt" is generated so that dedicating the proper resources (money) to conclusively detect causality becomes low-priority. Meaning it doesn't happen.

The thing about cancer clusters (if officials are even brave enough to make that determination) is that they still only impact a small percentage of the population. Cancer overall is a huge problem, but the extra few dozen from a cluster doesn't generate much public concern, if you catch my drift. Unless you live in the cluster zone, of course, but even then our natural inclination is towards denial. If you read the comments on Amanda's piece, you'll see the majority of commenters hanging on any statement that will allow them to write this off. If you took a poll (or referendum) on whether we should spend taxpayer money to find out what we really should know, you'll find out that most people think we know enough already. And that's a shame.

Just a little slightly off-topic observation on denial: When discussing landfills/municipal solid waste, each of us is responsible for throwing away a little under 1,500 lbs. of garbage every year. It's not somebody else that's doing it, we're doing it. And we know it. But there's a huge disconnect between what we're doing and the personal responsibility for what we're doing. So when a story like this surfaces, we are psychologically predisposed to finding and nourishing doubt. And we'll always find that doubt, because we're in this together, from the morons all the way up to the credentialed scientific geniuses. It's not an inhuman response, it's deeply and undeniably human. And wrong, but don't expect a consensus on that opinion.

Doug

November 15, 2009 - 12:35 pm EST

To your last point, I agree will all throw away much too much stuff.

But relating that to the possibility of landfill-related cancer presumes we're including cancer-causing substances in what we discard ... which would also mean this is stuff we use in our own households -- a much closer source of exposure and contamination.

If that were the case, we'd all be at high risk for pancreatic and other cancers. But, by and large, I don't think that's the case. Much more likely, the culprit -- if there is one at the landfill -- would be industrial waste of some kind, not household trash.

scharrison

November 15, 2009 - 6:35 pm EST

I wish that were true, Doug. There are numerous household goods that are (relatively) safe to handle before they're thrown away, but become toxic sources after being dumped. Electronics, even little cordless phone sets and such, are composed of all kinds of nasty elements, like lead, mercury and cadmium. As the casing and protective coating degrade, these toxins are released to leach into the groundwater. Then there's seemingly empty bottles of household cleaners that get tossed. But right now, the worst culprits are batteries. People use and throw away around 84,000 tons of D, AA, AAA, etc,.alkaline batteries every year, and those little dudes are leaking mercury like crazy.

Industrial waste is nasty, but it's also monitored much more closely than what you and I carry out to the curb weekly.

Dogwood

November 16, 2009 - 1:21 pm EST

Amanda and Jason did the best they could to figure out the state report. This is a state normal confusion report.
I can walk 400-800 yards and know how far I am. I can use a caliper. I know northeast Greensboro. I know White Street. I could not figure out how 400-800 yards from the landfill property exploded 1990-2006 with the two most deadly incurable cancers. Overpopulation may be the leading cause of cancer for all I know.Mercury kills and so does clorax. How far away did the report travel address by address? Cloudy, cloudy state reports are common.