Meeting Addresses Polycythemia Vera Epidemic

Officials with a host of federal and state agencies gathered in Pottsville on Friday to discuss plans to study the area's high incidence rate of polycythemia vera, a rare blood cancer. The meeting was convened by the Agency for Toxic Substances and Disease Registry, a division of the Centers for Disease Control and Prevention. Three scientists from ATSDR's Atlanta headquarters—Vince Seaman, Aisha Jumaan and Mohammed Uddin—flew in for the occasion. Also in attendance were officials with the Pennsylvania Department of Health and the state Department of Environmental Protection.

ATSDR held the meeting at the Schuylkill County Ag Center to gather more information from local physicians about the incidence of p. vera and other cancers. However, the only local physician in attendance was Dr. Pete Baddick, who has been pressing state and federal officials to investigate possible contamination of the Still Creek Reservoir, which supplies drinking water to the Hometown-Tamaqua area, from the nearby McAdoo Associates Superfund site. ATSDR, PADOH and PADEP deny that there is any widespread contamination of the local drinking water supply based on tests conducted by the Tamaqua Water Authority.

Press reports prior to the meeting characterized it as a "closed-door session." However, I attended along with Shawn Hessinger of the Pottsville Republican, who reported on the event in today's paper.

The meeting opened with a presentation by Dr. Gene Weinberg of PADOH on the Tamaqua Area Cancer Incidence Study released by his agency earlier this year. That study found dramatically elevated rates of p. vera in Schuylkill and Luzerne counties compared to the state, which is elevated compared to the nation. Weinberg also presented data that had not been shared with the public before showing p. vera rates for specific communities in Carbon, Luzerne and Schuylkill counties. Among the Schuylkill County communities with dramatically elevated rates of the disease are Frackville, Mahanoy City and Tremont.

One of the problems discussed at length was the disparity between the numbers of p. vera cases being reported to the state cancer registry and the numbers reported anecdotally by Baddick and other local environmental health advocates. For example, Baddick says one local oncology practice serving Carbon, Luzerne and Schuylkill counties reports that it is currently treating 70 active cases of p. vera, while another local practice reports treating 19 active cases—numbers far higher than those collected by the registry. ATSDR wants to explore ways of ensuring that local physicians are reporting cases appropriately.

Baddick talked about his experience as a general internist who has observed unusual local incidence rates of cancers, especially myelodysplastic syndromes including p. vera, leukemia and multiple myeloma. He and Hometown resident Joe Murphy also presented information on the severity of the toxic contamination at the McAdoo Associates site gathered as the result of research for a possible lawsuit against the site’s responsible parties. The firm working on that suit, Locks Law of Philadelphia, recently concluded after a year and a half of work that it does not have a legal basis for proceeding with an action for civil damages at this time due to a lack of evidence that poisons dumped at the site have migrated to nearby wells or the reservoir. Baddick and Murphy are among those pressing for further testing of the reservoir in order to establish that evidence.

I also spoke at the meeting, questioning Baddick's and Murphy's single-minded focus on the Still Creek Reservoir. While acknowledging the severe contamination at McAdoo Associates, I noted that given the elevated rates of p. vera throughout the entire region, it doesn't seem likely that the Still Creek Reservoir is the primary source of the p. vera problem. After all, people from Frackville, Mahanoy City and Tremont are not drinking from that reservoir. I did note, however, that one of the characteristics shared by those towns along with the Ben Titus Road area and other communities with elevated p. vera rates is the presence nearby of waste coal-fired power plants. I asked the ATSDR officials to keep an open mind about all possible toxic culprits, which they said they were planning to do.

Werner of ATSDR's Philadelphia office said that the agency is approaching this problem differently than usual. Normally the agency begins with a known toxic exposure and then examines health effects. But in this case, the agency will look at the cases of p. vera and try to find a common exposure—much like epidemiologists approached the recent outbreak of E. coli sickness that was eventually traced to bagged spinach from a California processing plant.

"We accept the fact that there have been serious environmental issues here," said ATSDR's Seaman. "The goal of this meeting is to ensure that the cases are in the registry so we can find possible connections."

Tamaqua Passes Anti-Sludge Ordinance

Tamaqua last night became the first borough in Schuylkill County to approve an ordinance restricting land application of sewage sludge, the Pottsville Republican reports. Borough council members passed the ordinance unanimously after it was modified to address some members' concerns. Rush Township, where Hometown is located, will soon advertise its own version of the ordinance, the paper reports.

Airborne Metal Pollution Linked to Lung Cancer

Airborne metal particles from industrial pollution may lead to lung cancer, researchers at the University of Texas Southwestern Medical Center have found. That's troubling news for residents of the Hometown area and surrounding Schuylkill County, where metal pollution from waste-coal-burning power plants and other industrial facilities is a major problem.

The groundbreaking study, published last week in the Journal of Thoracic Oncology, compared incidence rates of lung cancer for all 254 Texas counties from 1995 to 2000 with industrial air releases of metals reported to the U.S. Environmental Protection Agency in the previous eight to 13 years. It found that lung cancer rates were highest in counties with the highest levels of industrialization.

The study offers a possible explanation for the occurrence of lung cancer in the 10 to 15 percent of patients who have never smoked cigarettes. It could also help explain why some cigarette smokers get lung cancer and others do not.

"There is concern that other environmental carcinogens may be interacting with cigarette smoking or alone may be influencing the current trends for lung cancer incidence and mortality," said Dr. Yvonne Coyle, associate professor of internal medicine and the study's senior author.

Coyle explained the carcinogenic effect of airborne metals: "There is some evidence that metals can interfere with a biochemical process called methylation that inactivates genes that normally suppress tumor growth.

"Although the study is not conclusive, it provides new information suggesting that airborne metals, including those that are essential human nutrients, such as zinc and copper, play an important role in lung carcinogenesis," she added.

Among the metals the study considered were chromium, copper and zinc. According to the EPA's 2004 Toxic Release Inventory, industrial facilities in Schuylkill County released to the air 1,024 pounds of chromium and chromium compounds, 242 pounds of copper and copper compounds, and 128 pounds of zinc and zinc compounds.

The county's biggest airborne chromium polluter is Goulds Pumps of Ashland, which released 352 pounds of the metal to the air in 2004, according to the TRI. Northeastern Power Co. north of Hometown ties for second place, having released 255 pounds to the air in 2004 , according to TRI. NEPCO is tied with the St. Nicholas Cogeneration Project 14 miles west of Hometown near the borough of Shenandoah; that facility that released 255 pounds of chromium to the air in 2004, along with 10 pounds of copper and another 10 pounds of zinc.

Meanwhile, both of those waste-coal-burning facilities are also dumping an enormous amount of these potentially health-impairing metals into nearby mine-reclamation landfills, leading to possible air pollution via dust. NEPCO dumped 14,500 pounds of chromium into its nearby "Big Gorilla" mine-reclamation landfill, while St. Nicholas dumped into a mine-reclamation landfill near that facility 52,984 pounds of chromium, 23,037 pounds of copper and 28,412 pounds of zinc.

EPA Plans Cutbacks

In news that could spell trouble for residents of Hometown and other communities plagued with toxic pollution, the Environmental Protection Agency plans to close labs, cut its scientific staff and reduce regulatory oversight, according to news reports.

The proposed budget cuts were detailed in an internal memo dated June 8 and obtained by Public Employees for Environmental Responsibility, a government watchdog group. Lyons Gray, the EPA's chief financial officer, was the memo's author.

"The decisions we make will be critical, difficult and will have long-term consequences," Gray wrote.

There are several EPA-managed Superfund toxic waste sites in the Hometown area: McAdoo Associates north of the village, Eastern Diversified Metals off of Lincoln Avenue, and Tonolli east of the village near Nesquehoning.

Earlier this year, the EPA announced plans to cap the EDM site, where a now-shuttered metal-reclamation facility left behind an enormous pile of plastic waste contaminated with heavy metals, PCBs, dioxin and other dangerous pollutants. The plan is widely opposed by local residents, who wanted the material removed to a properly lined landfifll.

Local residents are also pressing federal and state officials to take another look at the McAdoo site, where some fear that contamination may be migrating from the area and affecting groundwater.

'Less Propaganda and More Research'

Federal and state authorities are distributing pamphlets in the Hometown area assuring residents that the Still Creek Reservoir is safe and free from contamination related to the nearby McAdoo Associates Superfund site.

The pamphlet -- available online at My McAdoo Home under the heading "EPA gives new meaning to the term Junk Mail!" -- is drawing fire from environmental health advocates. Army for a Clean Environment Director Dante Picciano took the agencies to task in an editorial letter he distributed today, printed here in full:

To the editor:

We recently became aware of a mailed brochure from four government agencies in regard to some of the problems that we are experiencing in this area with toxic exposures and chemicals. The four government agencies are the U.S. Environmental Protection Agency (EPA), the Agency for Toxic Substances and Disease Registry (ATSDR), the Pennsylvania Department of Environmental Protection (PA DEP) and the Pennsylvania Department of Health (PA DOH). The brochure is entitled "Seven Facts You Should Know About the McAdoo Associates Superfund Site."

After reading the brochure, we must conclude that the information presented is, at best, incomplete and misleading. For example, the brochure states, "Only a single sample of untreated surface water from the [Still Creek] reservoir in 2004 detected an elevated level of lead (76 parts per billion, or ppb)." The brochure fails to mention that a sediment sample taken at the same time revealed 93.5 parts per million (ppm) of lead and 200 ppm of methyl ethyl ketone. 93.5 ppm of lead is more than 1,000 times the concentration of lead found in the water. Other samples showed 67.7 and 63.1 ppm of lead in the sediment. The brochure also fails to mention the recent findings of elevated levels of iron, manganese and zinc in the water. There is more but we need not get into too much detail at this time. We have reported most of the relevant data that we have compiled to the ATSDR.

Furthermore, the information about polycythemia vera, a rare blood cancer, is just as incomplete and misleading. The brochure states, "Unfortunately, we don't know what causes polycythemia vera. No one has yet been able to establish any links between this disease and exposure to any particular chemical or chemicals." However, a report from the Mayo Clinic states, "No strong evidence supports disease association with environmental exposure, although an excess risk has been suggested in embalmers and funeral directors, as well as in persons exposed to benzene, petroleum refineries, and low doses of radiation." A. Tefferi, Polycythemia Vera: A Comprehensive Review and Clinical Recommendations, Mayo Clinic Proceedings 78: 174-194, 2003.

Finally, a reporter, Sue Sturgis, from North Carolina has reviewed the PA DOH’s data of reported cases of polycythemia vera by county for the years 2001 through 2003 and suggests a possible association between polycythemia vera and power plants that burn waste coal (www.hometownhazards.com). It is amazing to us that a reporter from North Carolina has done more investigating into the basis of our problems than the combined efforts of four government agencies.

We would respectfully submit that the EPA, ATSDR, PA DEP and PA DOH have spent more money publishing and mailing this brochure than the agencies have spent investigating the problems that we are experiencing with toxic exposures and chemicals. We need less propaganda and more research.

Dante J. Picciano, Ph.D.
Army for a Clean Environment
Tamaqua, PA

Polycythemia Vera and Age

I heard from Dr. Samuel Lesko, medical director of the Northeast Regional Cancer Institute in Scranton, Pa., regarding yesterday's post on polycythemia vera and waste-coal-fired power plants:

This is a potentially interesting observation. However, the incidence figures are for unadjusted rates (crude rates); age-adjusted rates would be more appropriate. The risk of p. vera increases dramatically with age and many of the high risk counties on the map are also home to many older residents. So, age cannot be ruled out as a possible explanation for the high rates in these counties. If a similar pattern was observed for a map showing age-adjusted incidence rates, it would make a more compelling case that something is going on. There may be other confounders as well, but age can't be ignored.

Indeed, epidemiologists commonly adjust for age in their disease incidence analyses. After all, counties with a higher proportion of older residents will typically show a higher incidence of diseases related to aging. And while polycythemia vera usually occurs within the age range of 20 to 80, its mean age of onset is 60, so it is generally a disease affecting older people. That certainly needs to be taken into consideration before any firm conclusions are to be drawn about the disease's distribution.

Unfortunately, the Pennsylvania Department of Health does not make it easy for an ordinary citizen like me to calculate age-adjusted incidence rates for polycythemia vera. When I requested numbers on the disease from PADOH, staff informed me that they would provide me with only the crudest data -- the count of cases by county. They declined even to break down the count by gender. (Polycythemia vera is slightly more common in men than in women.) Anything above and beyond that, they said, would require significant work on their part -- and significant cost on my part. Since I do not receive any funding for this Web site, and since I am not a person of independent means, I took what they would give me for free and did the best I could with it.

It's true that Pennsylvania has a higher proportion of elderly residents than the nation as a whole. And the four counties where I identified the very highest polycythemia incidence rates -- at least double the state’s rate -- are also among the state's oldest counties. To consider just one measure, 15.3 percent of Pennsylvania’s population is over 65 compared to 12.4 percent of the U.S. population, according to the latest figures from the U.S. Census Bureau. And the populations of the four counties with the most dramatically elevated polycythemia rates are even older than the state in general. The percent of the population over 65 is 19.1 percent in Cambria County, 18.9 percent in Schuylkill County, 18.7 in Luzerne County and 17.3 in Blair County.

Perhaps age could partly explain the dramatically elevated polycythemia vera incident rates in those counties and in the state as a whole. But could it completely account for a state rate that's somewhere between nine and 23 times the national rate? (The U.S. incidence rate is between 0.6 and 1.6 cases per million people, while in Pennsylvania for the years 2001 and 2002 there were 14 cases per million people, according to PADOH and the federal Agency for Toxic Substances and Disease Registry.) Could age completely account for county rates that are more than double the state's already elevated rate?

I'm skeptical. But perhaps those agencies with the means and ability to conduct more refined analyses than I -- PADOH? ATSDR? NRCI? -- would be willing to take a look at this.

Could Pennsylvania's Polycythemia Vera Epidemic Be Linked to Waste-Coal Burning?

Like many people in the Hometown area, I have been puzzling over the unusually high number of polycythemia vera cases reported among local residents. Seeking clues, I recently contacted the Pennsylvania Department of Health and requested their statewide data on polycythemia vera cases reported to the cancer registry*.

My analysis of that data suggests a possible association between the rare blood cancer and power plants that burn culm and gob, the waste produced by anthracite and bituminous coal processing operations. I discovered that populous Pennsylvania counties with the highest incidence rate of polycythemia vera -- at least double the state's rate -- tend to be located near such plants.

Using PADOH's count of reported polycythemia vera cases by county for 2001 through 2003, I calculated the general incidence rate over that period for each county by dividing the total number of cases in the county by the county population according to 2000 census data. I excluded from my analysis those counties with populations of less than 100,000, since a difference of one or two cases there would skew the rate dramatically.

In the thirty-odd counties I considered, there were four -- Schuylkill, Luzerne, Cambria and Blair -- that had a polycythemia incidence rate that was more than double the state's rate. And Pennsylvania's polycythemia rate is already elevated compared to the nation's, according to a June 2006 information sheet from PADOH and the federal Agency for Toxic Substances and Disease Registry distributed as part of the agencies' controversial program to educate local physicians about the disease. (The program was an outgrowth of PADOH's local cancer study released earlier this year.) Titled "Health Professional Update: Tamaqua Area Environmental Community Health Concerns," the information sheet states:

"The incident rate nationally is between 0.6 - 1.6 cases per million people. In Pennsylvania for the years 2001 and 2002, there were 14 cases per million people."

That means Pennsylvania's polycythemia vera rate is somewhere between nine and 23 times the nation's rate.

Why is there so much polycythemia vera in Pennsylvania?

My initial hypothesis was that the elevated incidence rate might be related to the Three Mile Island disaster, since researchers have linked polycythemia vera to radiation exposure. I made a map of Pennsylvania showing counties with elevated (as well as lower-than-expected) polycythemia vera rates. But as it turns out, the counties immediately downwind of TMI don't show a higher incidence rate of polycythemia vera. And neither do the counties downwind of the state's five nuclear power plants, another potential source of radiation exposure.

So then I decided to look at the disease's distribution in relation to the state's waste-coal plants. Of the 18 such plants currently operating in the United States, 14 are in Pennsylvania, and five are in Schuylkill County, which has more than any other county in the nation, according to the Energy Justice Network. Northeast Schuylkill's Ben Titus Road community -- where the Army for a Clean Environment has counted as many as eight cases of polycythemia -- is next to Northeastern Power Co., a co-generation plant that burns culm as its primary fuel and diesel or fuel oil as a secondary fuel, according to EJN.

After marking the waste-coal facilities on my map, I immediately saw a pattern: Of the 10 waste-coal power plants located in the 33 Pennsylvania counties with populations big enough to figure into my analysis, nine were in -- or right on the border of -- the four counties with the most dramatically elevated polycythemia vera rates (click on small map for readable image):



  


Burning waste coal releases a large amount of toxic pollutants to the environment, including hydrochloric acid, a suspected immunotoxicant; lead, a recognized carcinogen and suspected blood toxicant; manganese, a suspected liver and nerve toxicant; and mercury, a suspected blood toxicant. Pennsylvania gob has 3.5 times more mercury than bituminous coal, while culm has 19 percent more mercury than anthracite, according to EJN.

Waste-coal plants also emit polycyclic aromatic hydrocarbons, which are suspected carcinogens and blood toxicants, as well as so-called "products of incomplete combustion," the potential toxicity of which is uncertain.

As I noted, Schuylkill County is home to five such waste-coal plants: NEPCO; Gilberton Power in Frackville, which also reportedly burns a mix of culm and diesel or fuel oil; Schuylkill Energy Resource's St. Nicholas cogen near Shenandoah, which burns culm; Waste Management's Wheelabrator plant near Frackville, which burns culm and diesel or fuel oil; and WPS Westwood Generation plant near Tremont, another culm and diesel or fuel oil facility. In 2001 alone, those five plants combined released more than 139,000 pounds of toxins to the air and another 937,000 pounds to landfills -- in many cases, nearby abandoned mine pits that drain into the area's groundwater and streams. (For EJN's list of waste-coal-ash landfills, click here.)

NEPCO sits on the border of Luzerne County, which is also home to another waste-coal-burning plant -- the Hunlock Power Station west of Nanticoke. That facility burns anthracite coal as its primary fuel and culm as a secondary fuel. In the south-central part of the state, Cambria County has three waste-coal facilities: Cambria Cogen and Ebensburg Power, gob-burning plants in Ebensburg, and the Colver Power Project in Colver, which also burns gob. The Ebensburg facilities are located about 10 west of the Blair County border.

I am not claiming that waste-coal-burning plants are causing polycythemia vera. I recognize that an association between two phenomena is not the same thing as a causal relationship. Other factors may be at play, and I welcome feedback from anyone who has thoughts on what it those might be. But given Pennsylvania's unusually high rate of polycythemia vera, and the striking distribution pattern I found through my mapping effort, it seems that the public health authorities need to look at what sort of impact these facilities are having on local communities' health.


* A message from PADOH: "These data were provided by the Bureau of Health Statistics and Research, Pennsylvania Department of Health. The Department specifically disclaims responsibility for any analyses, interpretations or conclusions."