| Community cancer clusters are viewed
quite differently by citizen activists than by epidemiologists.
Environmentalists and concerned local residents, for instance, might immediately
suspect environmental radiation as the culprit when a high incidence of cancer
cases occurs near a nuclear facility. Epidemiologists, in contrast, would be
more likely to say that the incidences were "inconclusive" or the result of pure
chance. And when a breast cancer survivor, Lorraine Pace, mapped 20 breast
cancer cases occurring in her West Islip, Long Island, community, her
rudimentary research efforts were guided more by hope that a
specific environmental agent could be correlated with the cancers than by
scientific method. When epidemiologists study clusters of cancer cases and other noncontagious conditions such as birth defects or miscarriage, they take several variables into account, such as background rate (the number of people affected in the general population), cluster size, and specificity (any notable characteristics of the individual affected in each case). If a cluster is both large and specific, it is easier for epidemiologists to assign blame. Not only must each variable be considered on its own, but it must also be combined with others. Lung cancer is very common in the general population. Yet when a huge number of cases turned up among World War II shipbuilders who had all worked with asbestos, the size of the cluster and the fact that the men had had similar occupational asbestos exposures enabled epidemiologists to assign blame to the fibrous mineral. Although several known carcinogens have been discovered through these kinds of occupational or medical clusters, only one community cancer cluster has ever been traced to an environmental cause. Health officials often discount a community's suspicion of a common environmental cause because citizens tend to include cases that were diagnosed before the afflicted individuals moved into the neighborhood. Add to this the problem of cancer's latency. Unlike an infectious disease such as cholera, which is caused by a recent exposure to food or water contaminated with the cholera bacterium, cancer may have its roots in an exposure that occurred 10 to 20 years earlier. Do all these caveats mean that the hard work of Lorraine Pace and other community activists is for nothing? Not necessarily. Together with many other reports of breast cancer clusters on Long Island, the West Islip situation highlighted by Pace has helped epidemiologists lay the groundwork for a well designed scientific study. |