Families agonize over cause of cancer cases
Sunday, September 17, 2006
BY DARRYL R. ISHERWOOD
The Trenton Times:
HAMILTON -- When Keith Hillman was diagnosed with
leukemia in March, one question tormented his family:
How did a 40-year-old man who had been healthy his
whole life suddenly get leukemia?

The answer? Nobody knows. What the Hillmans do know is
that Keith, who was a popular lieutenant in the West
Windsor Police Department, had grown up playing in the
woods and streams around the former Mercer Rubber
plant. Four months after the diagnosis he was dead.

Recent revelations about chemical contamination and
dumping from the former plant that operated in
Hamilton Square for 130 years have the Hillmans
wondering if they may have found an answer.

"It haunted Keith every day when we would go to the
hospital," said JoAnn Hillman, Keith's mother. "He
always wanted to know where he could have gotten
leukemia, but they could never give him an answer.
When we heard about the dumping, it was a big piece of
information that we never had."

The Hillmans are among hundreds of current and former
Hamilton residents asking such questions these days.
While stories about cancer in the neighborhood mount,
many wonder about the way state officials crunched
numbers from the state's cancer registry and came up
with the answer that the plant likely was not the
cause of elevated rates of two types of cancer. In 23
years, 1,141 cases of cancer were reported within
about a one-mile radius of the plant; many residents
contend that's too many to be coincidence.

Experts agree that the study methods are flawed but
maintain that their conclusions are accurate.

"I would say that cancer registries are perhaps the
best public health surveillance database available in
the country," said Betsy Kohler, director of Cancer
Epidemiology Services for the state health department.
"The cancer surveillance data are better than for
diabetes and heart disease."

CHEMICALS DUMPED
The Mercer Rubber plant operated from the mid-1860s
until 1993. Former employees of the now-closed factory
have told regulators that for years they dumped waste
chemicals from the plant onto the grounds that is now
Sayen Gardens park. Employees also told of a pipe that
ran from the plant into a nearby stream, turning the
water a milky white.

Residents, who for years whispered about the seemingly
high number of cancer cases in their neighborhoods,
asked health officials to investigate.

The resulting report of cancer incidence in
neighborhoods within about a mile of the defunct plant
used data from the state's cancer registry collected
between 1979 and 2001 to conclude that though some
forms of cancer were elevated above state averages, it
was likely not related to the plant's operations.
Families agonize over cause of cancer cases
Page 2

But since that report was released last month, dozens
of residents have surfaced with stories of friends,
relatives and former neighbors who, like Keith
Hillman, moved before their cancer diagnosis or were
stricken with the deadly disease before 1979, when the
state's cancer registry was formed.

"Keith died of exactly what they were studying and he
wasn't even included in the report," said Keith's
father, Hank Hillman. The Hillmans have since moved
from their Hughes Drive home, but continue to live in
Hamilton.

Many of these residents can't believe that though the
plant used several known carcinogens, including
benzene, which is a proven cause of leukemia, that
their illnesses are unrelated.

"It's a crock," said Kathy Schaible about the state
study. Schaible was diagnosed with leukemia and breast
cancer after moving from the Hamilton Square home
where she lived for several years. "I know that the
water I drank on Zieglers Lane gave me leukemia. I
have no doubt in my mind."

Schaible, who now lives in Maryland, said she knows of
several cases of acute myeloid leukemia near her
former Zieglers Lane home, including one young boy who
died from the disease in 1970.

Lisa Glodowski, whose daughter Jessica was diagnosed
with acute myeloid leukemia in 1998 at the age of 2,
also has difficulty believing that her daughter's
illness is unrelated to benzene from the former plant.

"Of course they can't say 100 percent what caused it,
but because of her age, that put up a huge red flag,"
she said. "My doctor told us that benzene is
definitely one of the environmental causes (of
leukemia)."

Glodowski also does not know if Jessica was included
in the report because she has no idea if her Estates
Boulevard home falls within the study area.

STUDY'S WEAKNESSES
Health officials acknowledge that there are some
weaknesses in the methods used to study the prevalence
of cancer in a given area.

Resources do not exist to determine the whereabouts of
everyone who lived in the neighborhood for the past
130 years, and there is no way to know which people in
the neighborhood were exposed to chemicals and which
were not, said Jerry Fagliano, program manager for
hazardous site health evaluation services for the
state health department.
Families agonize over cause of cancer cases
Page 3

The data on the effects of exposure to many chemicals
are also not complete, Fagliano said, and some
illnesses may have multiple causes.

Bad data can also be a problem, which is illustrated
in the report by the admission that some 187 cases of
cancer listed in the registry could not be included in
the study because of incomplete addresses.


Perhaps the most contentious issue, Fagliano said, is
determining what is a cause and what is a coincidence.

"Coming to a cause and effect is a very complicated
process that involves information from not only the
study you are doing but from other studies like
toxicological studies that may have been done,
occupational or workplace studies or other biological
data," he said.

But there are tremendous strengths in the cancer
registry as well, said Kohler. The database contains
more than 1.5 million entries dating back to 1978 and
has consistently been recognized as one of the best in
the country.

"I think one of the biggest strengths of our study is
the registry," Kohler said. "We have all the cases and
we have all ages, races and cancers. It's a complete
database."

And despite any issues with their data, both Fagliano
and Kohler said they are confident about the results
of their study. The 187 missing addresses likely have
little effect on the overall picture and the size of
the sample -- about 11,000 residents -- is adequate to
determine whether cancer is elevated in the area, they
said.

Fagliano said the department was exploring new ways to
look at the data, including studying a smaller group
of residents. Officials also have promised to meet
with community representatives to listen to their
ideas.

Environmental regulators have also acknowledged their
original study is incomplete and have vowed to
continue studying the area. Earlier this week, they
tested several private wells in the vicinity of the
former plant. In October they plan to test soil,
sediment and water in Sayen Gardens.

'WHY ME?'
But it's the difficulty in finding a cause that often
haunts residents, who are desperate to know what
caused their illness -- and that they are not just
unlucky.
Families agonize over cause of cancer cases
Page 4 of 4

'WHY ME?'
But it's the difficulty in finding a cause that often
haunts residents, who are desperate to know what
caused their illness -- and that they are not just
unlucky.

"People want an explanation," said Richard Clapp, a
professor in the Boston University School of
Environmental Science and a former head of the
Massachusetts cancer registry. "They want to know 'why
me?' Often they will seize on a pattern that looks
like a cluster. Their perception is often right, but
there is no scientific way to prove it."

Dan Wartenberg, a professor at the University of
Medicine and Dentistry of New Jersey and an expert on
disease cluster identification, also sees weaknesses
in the system that are a result of incomplete data or
lack of resources.

"Typically, for most instances that get called in,
from an epidemiological point of view, there is a
small number of individuals involved," he said. "This
makes it very hard to trust the results."

In addition, a weakness in the studies is that they do
not take into account people who have moved before a
diagnosis is made, Wartenberg said.

"Ideally, we need to have complete residential
histories for everybody," Wartenberg said. "That way,
when you see an excess (of cases) you can discount
people that just moved to the area, but also track
down people who have moved."

It is just those weaknesses in the study that drove
Sacramento, Calif., resident Dee Lewis to lead her
neighbors to conduct their own study of their
neighborhood after health officials declared that
three cases of a rare form of leukemia were unrelated
to the public water supply.

"Unfortunately, the information is not always
accurate," she said. "There are constraints that
agencies work under, and because of that they do not
always present an accurate picture."

Her door-to-door surveys uncovered two more cases of
leukemia that went unreported because of what she said
were glitches in California's registry. With her
cancer information and environmental data in hand,
Lewis was able to persuade officials to close down a
well that supplied water to her neighborhood. But the
road, she said, was too long and difficult.

After doing some research, Lewis found similar
concerns in several other areas of the country. As a
result, she helped form the National Disease Cluster
Alliance to help residents like those in Hamilton
Square who are not satisfied with the answers they are
receiving from the government.

But for residents like the Hillmans, it is too late to
help their son. What they want now are answers about
what may have caused Keith's terrible illness. Only by
determining what caused it can they be sure that more
parents do not go through the hell they have endured,
JoAnn Hillman said.

"All we want is to know the truth about the risks,"
she said.