Cancer From The Landfill?

In the first chapter we described several clusters of childhood cancers discovered by concerned residents of Woburn, Massachusetts, of Toms River, New Jersey, and of the Pelham Bay section of the Bronx, New York City. The residents in Pelham Bay blamed the cluster on a landfill nearby, in which hundreds of thousands of gallons of toxic chemicals, including waste oil sludges, metal plating wastes, lacquer, cyanides, ethyl benzene, toluene, and other organic solvents had been illegally dumped. This had been reported by an employee of the chemical company responsible, in testimony before a Congressional investigation of crime, and was never directly confirmed. Residents of the community had obtained a court order that stopped dumping in 1978, before the testimony about toxic wastes had been given. The story of this cancer cluster—both how it was discovered and what conclusions were reached about its causes—is typical of thousands of clusters reported each year to health authorities throughout the United States. After the alarm in Pelham Bay was sounded by the mother of a child with leukemia, ten years after dumping ceased, the New York City Department of Environmental Protection (NYCDEP) made measurements of hazardous chemicals in the air around the landfill, but found no significant amounts. The drinking water of the community came from the general New York City water supply system, so seepage from the landfill into the groundwater was not a possible route of exposure. It was concluded that by the time the measurements were made the landfill was no longer a threat to health. What the situation may have been in the past, during the time of dumping and just after, could no longer be known. After dumping had been stopped in 1978, the NYCDEP had covered the 150-foot-high mound of garbage, refuse, street sweepings, construction debris, and household and commercial waste, along with whatever may have been illegally dumped there, with a thin layer of soil. It was a hasty job, and it did not last. The soil cover cracked and eroded, washing away all the faster because of the steep slopes of the mound.

Introduction: What We Hope To Do

The movie Erin Brockovitch, starring Julia Roberts, opened in the spring of 2000 to excellent reviews and immediate popular success. Advertised as being “based on a true story,” it describes how an uneducated but feisty young woman discovers a cluster of diseases in a small California town, including uterine and breast cancer, Hodgkin’s disease, brain cancer, colon cancer, asthma, heart disease, and disorders of the immune system, which she attributes to contamination of the town’s drinking water with chromium, a toxic metal, due to negligent waste disposal practices of a large corporation. She then initiates a class-action lawsuit on behalf of the victims, which is settled for $333 million, the largest sum yet won in such a suit. The true story on which the case was based involved the Pacific Gas and Electric Corporation, which really did settle the lawsuit by paying out $333 million. Whether the willingness of the corporation to settle for this amount proves that the chromium did cause all the diseases claimed is an interesting question, which this book may shed some light on, but not directly answer. The movie is one of a number of recent films reflecting a widespread fear that the environment is being polluted by hazardous chemicals and harmful radiation that cause cancer and other diseases, and a need to identify and seek restitution from whoever is responsible. People living in the advanced industrialized countries of the world suffer from mixed feelings about their high standard of living. They are fully aware of its advantages, both for health and for the quality of life generally: greater freedom from infectious diseases, better medical care, longer life span, a higher standard of living, more choice in work and play. But there is a sense of disadvantages as well: concerns about a loss of community and of cultural diversity, about an obsession with material possessions, about pollution and destruction of the environment. In this book we will open only one of these Pandora’s boxes: the problem of environmental pollution and human health.

Asthma, Allergy, and Air Pollution

One night in early October 1997, Felipe G., a nine-year-old child of Dominican immigrants to New York City living in East Harlem, woke up struggling for breath. Felipe had had asthma attacks before, and his parents knew, or thought they knew, what to do: they called for an ambulance, which rushed him to the emergency room of Harlem Hospital nearby. But this time he stopped breathing on the way to the hospital, and could not be revived there. His younger sister Ana also has asthma, but so far has never had to go to the emergency room. The tenement building in which Felipe’s family lives is three blocks from the Harlem River Drive, a highway on which thousands of cars travel each workday, emitting, in spite of their catalytic converters, large quantities of oxides of nitrogen, carbon monoxide, and incompletely combusted gasoline. Several blocks north is a parking garage for the diesel trucks of the New York City Department of Sanitation. The drivers of the trucks that use the lot often keep their motors idling, so that great quantities of diesel exhaust particles are emitted to the surrounding area. The Harlem district of New York City, inhabited mainly by African-Americans and Hispanics, is shielded to a large extent from the prevailing west winds by higher areas on the west side of Manhattan. Hence, air pollution produced within Harlem—for example, by cars, diesel trucks, and buses, and by an electric power generating plant located there—tends to remain longer than in other areas of the city. The New York City Department of Environmental Protection operated a network of air monitoring stations from the 1940s to the 1970s, during which time Harlem was consistently found to be the most polluted area in the city. It had then, and still has, one of the highest rates of hospitalization for asthma in the city. In most countries, asthma is more common among children of higher social class. In the United States this pattern is reversed: people living in the inner cities of the United States, mostly low-income minorities, have higher rates of asthma than other Americans.

Power Lines, Magnetic Fields, and Cancer

We are old enough to have had iceboxes in our kitchens when we were children. Every few days an iceman came through our neighborhoods, in Jerusalem leading a donkey cart and in the Bronx in a truck, each full of blocks of ice. Housewives would put a sign in the window or call out to him to let him know how big a piece to leave. We were very proud of our first home refrigerators; not everyone in the neighborhood had one. Refrigerators were easier to use: we did not have to worry about missing the iceman, the food stayed fresh longer, and ice cream could be kept in the freezer compartment. We cannot imagine modern life without electric power, and not just for the convenience of keeping ice cream. When a study published in 1979 suggested that magnetic fields from the electric wiring in homes and from outside power lines might cause leukemia in children, it was taken seriously, and not only by scientists. Public awareness and concern grew rapidly as these results were publicized in the media, and today they are one of the more controversial suspected environmental hazards. On the one hand, claims have been made that they are responsible for clusters of various cancers, birth defects, and neurological disorders, which are covered up by power companies and government agencies. On the other hand, there have been contemptuous dismissals of such claims with the counterclaim that they could not possibly hurt anyone and that irresponsible journalists are creating a panic. Some examples of extreme positions give the flavor of the controversy. A series of articles written by the journalist Paul Brodeur for the New Yorker magazine, followed by two books, Currents of Death and The Great Power- Line Cover-up, describe health problems in a number of neighborhoods and schools in which there was reason to believe high magnetic fields were present.

Breast Cancer, Part 1: The Rise Of Activism and The Pesticide Hypothesis

The New York Post, a New York City daily, ran a sensational headline on the front page of its April 12, 2000, issue: “Breast Cancer Hot Spots”. The news story reported that statistics and maps of breast cancer rates just released by New York State health authorities showed unusually high rates of breast cancer on the Upper East Side of Manhattan, as well as on Long Island and several other areas in New York City and upstate. These high rates were described by the state authorities as “not likely due to chance.” The residents of the Upper East Side, one of the most affluent areas of the city, were understandably alarmed. One woman interviewed was considering whether to move elsewhere, but had not yet decided. A second demanded that the two major party candidates for the U.S. Senate state their positions on the high rate. A third noted that there were no obvious sources of pollution in the neighborhood, no pesticide spraying or toxic waste dumps, that could explain why the breast cancer rate was high. Many people believe that breast cancer is caused by toxic agents in the environment. Victims of breast cancer we have met at sessions of support groups have described vividly the pains and discomfort of chemotherapy, radiation, and radical surgery; the nagging anxiety about a possible recurrence, the sense of disfigurement, of mutilation; the ignorance and insensitivity of many of the so-far healthy; the strengthening or weakening of bonds to those close to them: husbands, sons, daughters, parents, who either grow in understanding and compassion or fall short. But there is one common thread that runs through their stories: each of them feels there must be a reason why she, at this particular point in her life, should have gotten this terrible disease. Why me? Lucia D., in her late thirties, remembers that as a child of eight or nine growing up in Panama she and other children used to run after the truck that periodically sprayed DDT in their neighborhood and dance around in the spray. She is convinced that this childhood exposure is the reason she has breast cancer at such an early age.

Summary: Lessons From A Disaster

We have told a number of stories in this book about environmental health hazards. To summarize the main messages, we will briefly tell another. There is one common pollutant, a product of human activity, that is responsible for many millions of deaths each year, most of them among small children. Human feces contaminating the water supply is the means by which cholera, dysentery, typhoid fever, and a number of parasitic diseases are spread. These diseases were killing people even in Western economically advanced countries throughout most of the nineteenth century, and are still among the most serious threats to the health of the majority of the people of the world. They can be prevented, as they are in the industrialized world, by rather simple measures, but measures that are beyond the economic resources of many of the less developed countries. Recently the United Nations has been providing funds and technological help in controlling them by improving access to uncontaminated drinking water. One such program in Bangladesh involved digging tube wells to get access to deep groundwater sources, so that the people would no longer have to drink surface water from ponds and streams contaminated by human and animal wastes. Bangladesh has had more than its share of misfortune. It is a low-lying country subject to floods and other natural disasters, which has not been spared disasters of human making as well. Originally part of Pakistan when British India was partitioned, it is cut off from the rest of Pakistan by a thousand miles of Indian territory. The people of Bangladesh, although Muslim in religion, were ethnically distinct and spoke a different language from the rest of Pakistan. Their attempts to gain greater autonomy for their region led to a brutal suppression by the Pakistan army in 1971, in which over 1 million people were killed. Indian military intervention led to the defeat of Pakistan and the creation of an independent country of about 150 million people, with the highest population density in the world and one of the lowest per capita incomes, under $300 a year.

Breast Cancer, Part 2: Testing The Pesticide Hypothesis

We do not yet know how much of the excess rates of breast cancer on Long Island or on Cape Cod will ultimately be explained by the known risk factors. We do know that pesticides have been sprayed in both these areas, and toxic chemicals carelessly disposed in them. Has breast cancer been increased by such exposures? The studies in progress on Long Island and Cape Cod are not the only ones that have tried to answer this question: a number of completed studies, carried out in other locations, have also done so, and we will describe them in this chapter. These studies rely to a considerable extent on recent discoveries in molecular biology. This rapidly advancing field has already contributed enormously to our understanding of cancer as well as other diseases, and it will contribute even more in the future. We have learned from it how to identify certain individuals who have genetic sensitivities to particular environmental agents. It may in some cases provide means to determine which environmental hazards have caused a particular case of cancer, from the genetic makeup of the cancer cells. With knowledge of that genetic makeup, physicians who treat cancer are helped to choose the most effective therapy in any given case of the disease, without having to go through a process of trial and error. Future research into the causes, prevention, and treatment of cancer and other diseases, whether in the clinic, the research laboratory, or in the epidemiological field study, will rely more and more on the perspectives and techniques of molecular biology. We will review briefly some of the basic concepts of this field before we describe the studies, completed or in progress, of environmental agents and breast cancer. In general, even when dramatic increases in the rate of some disease have been clearly linked to an environmental agent, only a fraction of the people exposed ever suffer the disease. Most people who survived the bombing of Hiroshima and Nagasaki have not suffered health effects from their radiation exposure. Cigarette smoking causes 90% of lung cancer today, but only 10% of heavy smokers will die of lung cancer.

Atomic Bombs, Nuclear Fallout, and Dental X-Rays

One of the first pictures made with X-rays by Wilhelm Roentgen, when he discovered them in 1895, was of the hand of a colleague of his, a Dr. von Koelliker. The bones of his hand and a ring he was wearing stand out clearly; the flesh appears as a faint halo around the bones. A glance at the photograph makes it obvious why the medical possibilities of X-rays were almost immediately recognized. X-rays were used first for diagnosis, and later for treatment of disease as well, but they were the first form of radiation shown also to cause disease. In the early years of radiology, radiologists used to hold the X-ray film in place close to the patient’s body, thus receiving intense exposures of their hands. There were unexpected difficulties in arranging for a celebratory dinner for the Society of Radiologists in Philadelphia on the twenty-fifth anniversary of the discovery of X-rays: so many of the members had lost fingers or hands that they found it too awkward to eat in public. The discovery of X-rays led in 1896 to the discovery of radioactivity by Henri Becquerel, who observed, almost by accident, that compounds of the metallic element uranium emitted a kind of radiation that like X-rays passed through the black paper photographic film was wrapped in and darkened the film. Marie and Pierre Curie, following up his work, found that the strongest sources of the radioactivity were impurities in the uranium compounds and were able to extract small quantities of other much more radioactive elements from them, including polonium and radium. Becquerel and the Curies were awarded the Nobel Prize in physics in 1903. At first, the energy given out steadily by radioactive substances could not be explained, and some scientists proposed that they might provide unlimited sources of energy. It was soon shown that radioactive substances, like any other fuel, are used up as energy is given out: the radioactive atoms are undergoing disintegration into other, different kinds of atoms. When an atom of uranium-238 emits alpha radiation, it changes at the same time into an atom of a rare element called thorium, also radioactive.

Radon In Your Basement

We once saw a science fiction movie in which a monster from outer space is first detected because it sets Geiger counters clicking furiously. We were reminded of that movie by the story of how radon in homes first came to wide public attention. A nuclear power plant was built in a town in Pennsylvania, and like all such plants was equipped with radiation detectors, both to protect the health of employees and to prevent anyone from removing nuclear fuel from the plant. A newly employed engineer at the plant registered a high radioactivity when he walked by the detectors. This was not only alarming but surprising: the plant was not yet operating, and there should not have been any radioactive material around. It was quickly established that the source of the radiation was not the plant but the engineer’s house in a nearby suburban community, which had levels of radioactivity almost a thousand times greater than federal standards permit in mines. The radioactivity came from radon gas seeping into the house from the ground. Cigarette smoking is responsible for about 90% of lung cancers, but 10% of the victims of this disease had never smoked. It was already known that miners exposed to radon gas in uranium mines suffered a high rate of lung cancer, and the question immediately arose: could radon gas in homes be another cause of lung cancer? Radon in homes is not a consequence of the atomic bomb or the building of nuclear power plants; it is one of the major sources of the natural background radiation we are all exposed to. It is present even in outdoor air, and at higher concentrations in homes, castles, peasants’ hovels, and caves as long as people have lived in them. It is a product of the decay of the element uranium. Uranium is present to some extent in all minerals, so we expect to find more radon in houses built of stone or mineral products like stone, concrete, and gypsum than in houses built of wood, and we expect to find more of it in basements than in attics.

Childhood Leukemia Near Nuclear Plants

In 1983 a television crew was making a documentary film about the health of the employees of a nuclear fuels reprocessing plant in England on the coast of the Irish Sea. This plant had previously been the site of a facility for the production of plutonium for nuclear weapons until it was converted to fuels processing after a fire in the reactor in 1957, during which there had been some release of radioactive material to the environment. The crew, filming in a town called Seascale 3 kilometers from the plant, where a number of the employees lived, was shocked to learn from the townspeople that there had been a surprising number of cases of leukemia among their children. Childhood leukemia is a rare disease, but in this small town there had been five cases in the preceding few years, ten times the number of cases that would have been expected from the average rate elsewhere in Great Britain. The focus of the film was changed from the health of the staff of the nuclear facility to the childhood leukemia in Seascale. Shown on television later that year, it aroused national attention and concern, making its points forcefully with shots of rapidly clicking Geiger counters in the neighborhood of the plant, claims that the coastline there is “the most radioactive environment on earth,” interviews with the anguished parents of sick or deceased children, reports of cows on neighboring farms born with malformations, and scenes of children playing on the beach with the smokestacks of the plant in the immediate background. It also reported that there had been some 300 other accidents at the plant in which radiation had been released, though the amounts were all of lesser magnitude than in the 1957 fire. The process for recovering plutonium from spent fuel from power plants does not recover all the plutonium, and some has to be disposed of as waste, along with other radioactive elements. Those responsible for the design of the plant had made the decision, based on both economic considerations and what was then known about the health hazards of radiation, to discharge much of this radioactive waste into the Irish Sea.