[CPEO-MEF] Small town leukemia cases a mystery

[CPEO Moderator <cpeo@cpeo.org>]

Nevada
CNN.COM
Small town leukemia cases a mystery
Saturday, December 13, 2003 Posted: 1809 GMT ( 2:09 AM HKT)

FALLON, Nevada (AP) -- Maybe the first person to realize something
terrible was happening to the children of Fallon was a nurse who gives
chemotherapy at the community hospital.

It was the summer of 2000, and Dr. James Hockenberry had recently
diagnosed two cases of childhood leukemia. As it happened, his son
Timothy, also a family practitioner, had seen another. These are the
tragedies doctors encounter even in small towns, and neither man put
them together.

Then one day Tim Hockenberry was working in the emergency room, and the
infusion nurse, Barbara de Braga, stopped to see him.

"She came walking in and closed the door behind her," Hockenberry says.
"I thought, 'Oh, gee. Now what.' She said, 'I'm concerned. I think we
may have a cancer cluster going on.' I remember the blood drained out of
my face and just thinking, 'Oh, my God."'

She counted them up: The Hockenberrys' three cases plus one more, all in
the past year. Soon calls were made. By the time state health officials
got to the hospital, there was a fifth case. Then quickly a sixth. And a
seventh. All in Fallon.

"People were starting to feel panicky, even the health care
professionals," remembers de Braga. "Everyone was looking at children
and saying, 'Are they pale? Do they have bruises?"' Possible signs of
leukemia.

One thing seemed certain. This could hardly be a coincidence. Childhood
leukemia is a rare disease. In a town the size of Fallon, just one case
would be expected in five years. And during the 1990s, that is exactly
what happened: one case in 1992 and one in 1999.

But that 1999 case -- a 3-year-old boy named Dustin Gross with acute
lymphocytic leukemia -- was the start of an incredible spike. Through
2001, 11 cases were diagnosed in Fallon and surrounding Churchill
County. Eventually, another five were found between 1997 and 2002 among
children who once lived there but had moved away.

Little is known for certain about what causes this disease. Some think
exposure to radiation in the womb or early childhood can contribute. But
for most cases, there is no clear answer.

Without doubt genes are involved, as in all kinds of cancer. Often young
leukemia victims are born with genetic defects that put them at risk,
but it probably takes several more to get cancer. Perhaps some
environmental toxin causes these. Or maybe they accumulate through an
unlucky series of random errors when cells copy their genetic material
as they divide.

During the 1960s and '70s, the Centers for Disease Control and
Prevention investigated 108 cancer clusters around the United States,
most of them childhood leukemia, in hope of proving that a virus, a
chemical or some other contaminant caused the disease.

In the end, they found nothing. If the cases in any single place shared
a source, it could not be detected with the tools medical investigators
had at the time. Maybe they were just random flukes after all.

In the decades since then, the source of these cancer outbreaks remained
as much a mystery as ever. In fact, not a single geographic cluster was
ever solved to scientists' satisfaction.

Still, the Fallon outbreak was especially sudden and large. State health
officials decided an inquiry was essential, if only to make sure no
awful contaminant was seeping unseen through the community. The first
step, decided that day when the state visited the hospital, was to
interview all the victims' families to see what they had in common.

And so began the most intensive investigation ever conducted into a
cancer cluster. By the time it was over, hundreds of experts from at
least seven state and federal agencies would be involved, spending
millions, all to answer one question: What is causing Fallon's leukemia?

Except for its sprinkling of small casinos and the legal brothel outside
town, Fallon at first glance could be a modest farming community
anywhere. Its 8,200 residents live on the high desert about an hour east
of Reno. Along U.S. 50, the main drag, miles of emerald irrigated
alfalfa fields dead-end in brown, rocky scrub that undulates to the
horizon.

Were farm chemicals to blame for the cancer? The drinking water? Or
could it somehow have come from the town's real claim to fame, the
Fallon Naval Air Station? All day, planes roar and bank overhead,
reminder of the base's busy fighter jet training program, including the
Navy's Top Gun school.

This article can be viewed at:
http://edition.cnn.com/2003/HEALTH/12/13/cancer.mystery.ap/

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