Abstract Page
Abstract Page
The Cancer-Cluster Myth The New Yorker, February 8, 1999 P. 34

ANNALS OF MEDICINE about cancer clusters and public-health investigations... During the past two decades, reports of cancer clusters—communities in which there seems to be an unusual number of cancers—have soared. The place names and the suspects vary, but the basic story is nearly always the same... Mentions cancer clusters in McFarland, California, Los Alamos, New Mexico, West Islip and Levittown, Long Island, and the writer's own Newton, Massachusetts... In the late eighties, public-health departments were receiving between thirteen hundred and sixteen hundred reports of feared cancer clusters, or “cluster alarms,” each year. ...A community that is afflicted with an unusual number of cancers quite naturally looks for a cause in the environment—in the ground, the water, the air. And correlations are sometimes found: the cluster may arise after, say, contamination of the water supply by a possible carcinogen. The problem is that when scientists have tried to confirm such causes, they haven’t been able to. ...When public-health investigators fail to turn up any explanation for the appearance of a cancer cluster, communities can find it frustrating, even suspicious. After all, these investigators are highly efficient in tracking down the causes of other kinds of disease clusters. “Outbreak” stories usually start the same way: someone has an intuition that there are just too many people coming down with some illness and asks the health department to investigate. With outbreaks, though, such intuitions are vindicated in case after case. Consider the cluster of American Legionnaires who came down with an unusual lung disease in Philadelphia in 1976; the startling number of limb deformities among children born to Japanese women in the sixties; and the appearance of rare Pneumocystis carinii pneumonia in five young homosexual men in Los Angeles in 1981. All these clusters prompted what are called “hot-pursuit investigations” by public-health authorities, and all resulted in the definitive identification of a cause: namely, Legionella pneumonitis, or Legionnaires’ disease; mercury poisoning from contaminated fish; and H.I.V. infection. In fact, successful hot-pursuit investigations of disease clusters take place almost every day... Even when you've established a correlation between a specific cancer and a potential carcinogen, scientists have hardly any way to distinguish the "true" cancer cluster that's worth investigating from the statistical crowd of cluster impostors... Alan Bender, a Minnessota Department of Health epidemiologist, explained that "you can't just kiss people off" when they ask for an investiation... Writer explains that there are times when you cannot maintain public trust without acting on public concerns.

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Atul Gawande, a surgeon and public-health researcher, became a New Yorker staff writer in 1998.

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