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It Would Break Your HeartChristopher Myers

"It Would Break Your Heart" (continued)

This is a story about the collision of personal experience, data, science and the hundreds of diseases known as cancer.

 Each year in the U.S., cancer cluster concerns prompt more than 1,000 investigation requests. As people see neighbors and loved ones getting sick or dying from cancer, they naturally want to know the cause.

“Cancer clusters are perhaps one of the most difficult things I’ve ever done,” says Thomas Burke, PhD, MPH, a former New Jersey deputy health commissioner who has led several cluster investigations. “These are real people, real lives, real lost loved ones. And that’s the emotion that charges these investigations, and it makes it very difficult.”

A lack of data doesn’t mean there wasn’t an issue at Fort Detrick, says Jennifer Peppe Hahn.

The CDC defines a cluster as “a greater-than-expected number of cancer cases that occurs within a group of people in a geographic area over a period of time.” However, the public often sees it differently. They may hear of several cases of cancer in their neighborhood and think it’s a cluster. It’s probably not, says Burke, now associate dean for Public Health Practice and Training. First, different cancers are actually different diseases (likely with different causes), he says. Melanoma, for example, is quite different from leukemia or lung cancer. Second, cancer risk increases with age and occurs all too frequently among older people. The American Cancer Society estimates about one in two men and one in three women will develop an invasive cancer in their lifetimes.

When investigating a possible cluster, experts analyze data to uncover unusual cancer patterns. Do cases cluster in time and space? Are there more cases of a rare cancer than expected? Are cancers striking the young or otherwise healthy? Are there known carcinogens in the area? It’s a difficult task: Consider that it can take 20 or 30 years for cancer to develop after exposure. In the interim, an individual encounters innumerable other chemicals in water, air, their diet, the workplace and so on. “We’re starting at a scientific disadvantage,” says Burke. “For instance, if we have an outbreak of a foodborne disease, you can go to the refrigerators of people and see what they ate the night before. That’s not the case for 30 years ago when there may have been environmental exposure… that would lead to increased cancer incidence in a community.

"The difficulty involved is borne out in the scientific literature. Of the more than 400 investigations of perceived cancer clusters since 1990, only 13 percent found a statistically significant increase in the cancer rate, according to a 2012 article in Critical Reviews in Toxicology. And only one investigation found a clear cause. (That investigation found that “an excess in pleural cancers” in coastal South Carolina was due to asbestos-exposed shipyard workers.) And a CDC review of 108 investigations of perceived cancer clusters from 1961 to 1982 found that none could identify a cause, according to a 1990 American Journal of Epidemiology article.

Such long odds mean little to people like Carroll Rice, whose family, with deep roots in Frederick, has been decimated by cancer. Fourteen immediate family members have developed a rare form of leukemia, erythroleukemia. Thirteen have died from it. “In my way of thinking, if you’re part of our Rice clan, you gonna die with cancer,” Rice says. “It’s no question because all of the others have—with the exception of one. He had a heart attack.”

Rice says that the family’s cancer victims all descend from his grandfather, Charles “Tuff” Rice. They believe he developed the genetic mutation that’s been passed down through the family because he worked at Fort Detrick. Given the devastation visited upon his family, Rice is incredulous that the existence of a cluster is questioned, much less denied.

“Dammit, my family alone is a cluster,” he says.

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Frederick Voices

Frederick Voices

People from Frederick, Md. and public health professionals talk about a possible cancer cluster and whether it can be linked to nearby Fort Detrick.

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