The Columbus Dispatch

Columbus, Ohio — State health leaders are working on a written policy for responding to concerns about potential cancer clusters, the director of the Ohio Department of Health said last week.

That plan will guide how department employees respond to inquiries about cancer incidence in a community, Dr. Ted Wymyslo said.

It will address how the department works with local health officials and researchers outside government, including those at universities, he said.

Word of the policy work came after The Dispatch reported that Robert Indian, the department’s top cancer-control expert, said he wants to avoid working on cluster investigations whenever possible.

Wymyslo said he doesn’t want Ohioans to think his department isn’t interested in responding when people believe there is something unusual going on in a community.

At a minimum, the state always will provide data to put the cancer incidence into perspective and help determine whether there are higher-than-normal rates, he said.

And regardless of what the data says, the department has a responsibility to listen to and address public concerns, Wymyslo said.

Robert Jennings, a spokesman for the department, said the state’s policies will be discussed with Indian, Jennings said.

Over the past few years, Indian repeatedly has said that cluster investigations are almost always fruitless and that resources are better used in prevention and early detection of disease.

Last week, he cited a recent investigation in Clyde as more evidence that years of work in a community with higher-than-normal cancer rates usually leads to no answers. In Clyde, a small farming town in Sandusky County, 35 children were found to have cancer in a 15-year period.

It’s notoriously difficult to link a single cause to a cluster of cancer cases. But many public-health experts and advocates say authorities should work hard to uncover links between environment factors, including industrial contaminants, and illness.

“I’ve always had a problem with how they do cluster investigations,” said Teresa Mills, the Ohio organizer for the Center for Health, Environment and Justice.

“I was in Clyde, Ohio, when (Indian) stood up there and said, ‘We’re not likely to find anything’ before they ever started,” Mills said.

“Maybe we don’t need ODH to be doing our cancer-cluster investigations, if that’s the attitude they take from the very beginning.”

Mills and others have asked the legislature to take up a bill that would make several changes, including requiring detailed and frequent online reporting of cancer incidence by county and census tract.

The proposal also would require a written response from the state Health Department within two months of a request for an investigation. In that response, the state would have to provide details of its investigation plan along with a timeframe for completing the work.

It also outlines steps that should be taken if the state finds that cancer cases in a community appear linked in some way.

mcrane@dispatch.com

<,a href="http://www.dispatch.com/content/stories/local/2012/06/18/state-to-set-cancer-cluster-policy-after-health-officials-comment.html">Columbus Dispatch

By Misti Crane
The Columbus Dispatch

When the state’s four-year cancer plan was introduced last month, there was no mention made of looking into suspected cancer clusters — geographical pockets of higher-than-expected cases.

That’s for good reason. The man in charge wants to avoid spending time on those investigations whenever possible.

Robert Indian, chief of the state’s comprehensive cancer-control program at the Ohio Department of Health, said cancer-cluster investigations “use a lot of resources, raise expectations, and you find nothing.”

Working on boosting prevention and early detection of disease are better ways to serve the people of Ohio, he said.

“We want to focus on primary prevention. We want to promote people not smoking. … We want them to be aware of chemicals in the workplace,” he said. “There’s more payoff in that, and it does more good than continuing to pursue these will-o’-the-wisp things.”

Instead, he said, the department will take a “very 21st-century” approach to cancer.

In the past, during cancer-cluster investigations, “People have worked in good faith and expended (a) great amount of resources, and it hasn’t borne much fruit.”

The state does not track the hours expended on cancer-cluster investigations, and health officials said they could not provide an estimate of the cost of that work.

Indian said the state will continue to provide cancer incidence data to communities that request it, “but this is not a research institution.”

Robert Jennings, Ohio Department of Health spokesman, said the state’s involvement in potential investigations will be considered on a case-by-case basis, as it has been in the past.

Typically, they’re led and started by local health officials, he said, and the state will continue to partner with them when it’s appropriate.

“I personally think that a public-health organization like a state health department has an obligation to investigate clusters, even perceived clusters,” said John Wilkins, a professor of epidemiology in Ohio State University’s College of Public Health.

“The majority of them don’t lead to anything, but once in a great while, you find something,” he said.

For example, a cluster of rare vaginal and cervical cancers pointed scientists to the link between DES, a synthetic estrogen, and risks for daughters of women who took the compound during pregnancy.

Naturally, people in communities with cancer clusters can become frustrated when science doesn’t provide an answer to what is sickening them or their children, Wilkins said.

But, “If you don’t do them, the consequences are much, much worse.”

In the past seven months, the Ohio Department of Health has responded to 17 calls of concern about potential clusters, most of them from individual residents or from local health departments.

The state has no open investigations now, Jennings said.

In most cases where the state Health Department investigates at all, it compares the number of known cancer cases with what would be expected and determines there’s nothing going on out of the ordinary.

Sometimes, the agency provides some guidance to local health departments or goes to a community to help educate residents about the data.

In rare cases, investigations get much more involved and stretch on for years, such as in Clyde, a small farming town south of Lake Erie where 35 children were found to have cancer in a 15-year period.

That investigation involved multiple agencies, including the Ohio Department of Health and the Ohio Environmental Protection Agency. The Health Department, which began its work on the cluster in 2006, issued a report last spring that said the state had found no known cause for the higher-than-normal cancer incidence there.

The work included consultation with parents (families of 21 children agreed to participate) a geographic analysis and investigations into possible environmental exposures.

Like almost all of these investigations, it drew no conclusions.

An investigation of 83 leukemia cases in Marion County ended after five years in 2001 without determining a cause. Many parents suspected that the cancers sprang from toxic waste buried at River Valley schools.

Despite not finding a cause, River Valley students still were moved to new schools in 2003.

Cancer clusters are notoriously difficult to prove outside of occupational settings — where exposure to certain chemicals is known to increase cancer risk — for several reasons.

Cancer is a complex disease, brought on by a variety of factors including genetics and lifestyle choices. And the time between an exposure to something dangerous and the diagnosis of cancer could be decades.

“Cancer clusters rarely pan out with an environmental cause, but it is an ill-advised health official who dismisses all of them without at least a bit of a look,” said Dr. Richard J. Jackson, chairman of environmental health sciences at the University of California, Los Angeles.

At the least, officials should do some data analysis when a cluster is suspected, Jackson said in an email.

The Columbus Dispatch