FacebookTwitterRedditEmail

Cancer Clusters in Florida: the Silence of the State

This is a story about pediatric cancer clusters in Florida. It begins in Durham, North Carolina at Duke University where Dr. David Banks is a professor in the Department of Statistical Science.

In 2013 Dr. Banks was the new editor of Statistics and Public Policy, a journal of the American Statistical Association. In early February, Banks gave a speech to the Florida Chapter of the ASA at the University of West Florida in Pensacola. There, he met with Dr. Raid Amin, a distinguished statistics professor at the university.

Three years earlier, a team led by Dr. Amin had published a paper, “Epidemiological Mapping of Florida Childhood Cancer Clusters.”

Dr. Amin’s statistical analysis of pediatric cancers in Florida – from the years 2000 to 2007 – concluded that there are significant cancer clusters in two large areas of Florida: the southern region of Florida and in northeast Florida. That struck one of the most sensitive nerves in state government.

Its publication was lightly reported in the press, but to state officials charged with monitoring public health, it followed in the highly publicized wake of two claims of pediatric cancer clusters, one in Port St. Lucie in the 1990’s and another in an unincorporated area of West Palm Beach called the Acreage in 2009. Even today, reading the plaintive cries for help from aggrieved parents is heart wrenching.

Although the causes of pediatric cancer are poorly understood, the incidence of its most common forms – leukemia, cancers of the brain and nervous system, and lymphoma – are rising around the United States, according to the CDC. As the incidence rises, so do public calls for some sort of accountability. In Florida, that particular responsibility falls to the State Department of Health.

In both Florida instances, Port St. Lucie and West Palm Beach, the Department of Health – the agency charged with registering data and investigating claims of cancer clusters – emphasized to the public that there was no identifiable cause and effect. As in the case of most claims about cancer clusters, the angst and public outcry generated media attention then blew out like a passing storm.

Cancer strikes like lightning. It doesn’t matter if it is adult or pediatric cancer, although the very mention of pediatric cancer makes me nauseous. According to the CDC, cancer is the leading cause of death by disease among children. For most people, when cancer strikes, it instantly becomes a full time occupation – from flights of hope, tumbles to despair and every step between where the mind can rest. There are no part time victims of cancer.

In the midst of battling cancer, it rarely occurs – or seems irrelevant if it does – that one’s personal or family catastrophe ought to be weighed as 1) a deviation from a statistical norm or 2) that there is something in the external environmental that caused the cancer, unless one begins to hear about other rare cancers in the neighborhood. Then, alarm bells go off like no others. (A cancer cluster is where a greater than expected number of cancer malignancies occur within a group, a geographic area, or a period of time.)

Dr. Banks and Dr. Amin are not in the cause and effect end of cancer. Statistics is the practice or science of collecting and analyzing numerical data in large quantities. The idea is that you take a big soup of numbers, strain it, analyze what’s in the numbers and infer proportions from a representative sample. It is a practice that can be applied over any kind of dataset – from growing nuts to assembly of microchips.

In an interview, Dr. Banks told me that after visiting the University of West Florida, he was intrigued. Are there cancer clusters in Florida or not?

The 2010 report, covering data from 2000 – 2007, states that  “… during this time, there were 4,591 cases of pediatric cancer diagnosed, of which 1,254 (27%) had leukemia, 839 (18%) had brain/central nervous system (CNS) cancer, and 252 (5.5%) had lymphoma.”

“In south Florida, the cluster encompasses the southwest, south central and southeast regions where “… compared with the state, there is a statistically significant 36% increased risk of childhood cancer.”  Also, “In the northeast Florida cluster, there were 466 and 375 observed and expected cases, respectively. This region appears to be smaller in size, although it may represent a more densely populated area. … In addition, a third overall childhood cancer cluster was identified in a small area of central Florida in which the observed number of cases was 31 as compared to 11 expected cases. The rates were statistically significantly higher in this area relative to the state … which implies that compared with the state of Florida, those in this area are almost three times as likely to be diagnosed with childhood cancer.”

PastedGraphic-2

“Epidemiologic Mapping of Florida Childhood Cancer Clusters” Raid Amin, PhD,1,2* Alexander Bohnert,1 Laurens Holmes, PhD, DrPH,2,3 Ayyappan Rajasekaran, PhD,2 and Chatchawin Assanasen, MD2,4** , Pediatric Blood Cancer 2010;54:511–518

Following its publication, in March 2010 Dr. Amin and his colleagues were invited to Tallahassee by the Surgeon General of Florida, state health officials, and the CDC to discuss their findings. In an interview, Dr. Amin told me, “It was a chilly meeting.” At the time, a state health official told the Palm Beach Post that the report’s analysis methods were “relatively new and untested” and that “independent researchers will use this report to identify areas that require additional study using more traditional methods.”

A few weeks later, the Florida Department of Health told Dr. Amin said that the agency’s data sets including pediatric cancers did not match the Florida researchers’. According to Amin, “They promised to share their data if we gave them ours. We gave them our data, and they never gave us theirs.”

For the ensuing three years, after the publication of their paper in Pediatric Blood Cancer, silence.

Fast forward to February 2013 when Duke professor David Banks met professor Raid Amin at the University of West Florida.

“Since I had just started as the publication editor, we were looking for interesting projects,” Dr. Banks told me in an interview. During the meeting Dr. Banks and Dr. Amin discussed a study Amin and colleagues had recently completed on clusters of adolescent and young adult thyroid cancers in Florida counties.

Banks said it would be an interesting idea to update the earlier 2010 study and have other statisticians review the data and conclusions. In other words, apply independent methodologies on the same data to ask the question: are there cancer clusters in Florida?

Amin said he would need to check if he could share the data, and a few weeks later informed Banks it would be okay to proceed. Banks “started to contact some of the statisticians (he) knows who are prominent and work in epidemiological statistics. Some were busy and declined, others were interested in the experiment of having multiple papers on the same data, and eventually I obtained five papers (one by Dr. Amin). These all went through peer review, and after revision were ultimately published. To the best of my knowledge, there were no previous peer reviewed papers comparing different methods on the same data.”

On May 29, 2014 Dr. Amin and colleagues published their updated paper reviewing pediatric cancer data covering the 11year period from 2000-2010. Dr. Amin’s report identifies two pediatric clusters – in the Miami metro area and an area nearby, west of the Everglades around the southern portion of Lake Okeechobee. The cluster analysis results for the three cancer types and the total cancer rates are similar to what Amin and colleagues had concluded in 2010.  “The three most widely recorded pediatric cancer types all occur in a geographical area that is close to Miami and to Lake Okeechobee. The relative risk values are not small, indicating cancer rates that are higher than what is found in other parts in Florida by 35%–52%.”

A year later, on April 17, 2105 the American Statistical Association published its review of the same data. “The process followed the usual academic path. It takes a long time to do,” Dr. Banks said. “Each of the five teams that took on this project, submitted drafts to peer review. Each paper had two referees to review the work, and some of the papers went through a few rounds of revisions. It is the first time we had done something like this.”

Five separately conducted methodological assessments, summarized by Dr. Lance Waller, a biostatics professor specializing in spatial epidemiology at Emory University in Atlanta, confirmed Dr. Amin and colleagues’ findings: “The five author groups find some consistent results: there seem to be local areas where the observed cancer rate is statistically significantly higher than we would expect and the different methods tend to identify a few common areas. As noted above, the clusters themselves are not identical, but they do overlap …”

For Dr. Amin, five years have passed since he and his team alerted the state to the presence of cancer clusters in Florida, but the memory is still vivid.

Not as vivid, of course, as the memory of anyone who suffered through a child’s cancer.

In 2010, when the state of Florida contested Dr. Amin’s data, a state health officer recommended that Amin and his colleagues contact the journal in which the paper had been published. Amin was troubled. “We saw no errors (in our data), and we suggested to them that research is not done that way. If you (the state) think you found errors, then you write the editors and you provide the correct data and results. They never did.”

I recently submitted two questions to the Florida Department of Health: 1) In a recent journal of the American Statistical Association, Dr. Lance Waller summarized the results of five independent statistical analyses of cancer data in Florida. What is the DOH response to that report? 2) Pediatric Blood Cancer 2010 published an earlier study, “Epidemiological Mapping of Florida Childhood Cancer Clusters”. What was the DOH response to that article, at the time and has the position of DOH changed or is it the same?

In response, I received the following statement: “The Florida Department of Health cannot comment on the two studies mentioned as we have not had adequate time to review.”

This August in Seattle, at the upcoming meeting of the American Statistical Association, Dr. Amin will discuss his research in a special session titled, “Are there cancer clusters in Florida?”

(Writer’s note: for ongoing reporting on these issues, if you would like to contact the author with new information, he can be reached at: afarago@bellsouth.net)

Alan Farago is president of Friends of the Everglades 

More articles by:

Alan Farago is president of Friends of the Everglades and can be reached at afarago@bellsouth.net

bernie-the-sandernistas-cover-344x550
Weekend Edition
February 21, 2020
Friday - Sunday
Anthony DiMaggio
Election Con 2020: Exposing Trump’s Deception on the Opioid Epidemic
Joshua Frank
Bloomberg is a Climate Change Con Man
Jeffrey St. Clair
Roaming Charges: Billion Dollar Babies
Paul Street
More Real-Time Reflections from Your Friendly South Loop Marxist
Jonathan Latham
Extensive Chemical Safety Fraud Uncovered at German Testing Laboratory
Ramzy Baroud
‘The Donald Trump I know’: Abbas’ UN Speech and the Breakdown of Palestinian Politics
Martha Rosenberg
A Trump Sentence Commutation Attorneys Generals Liked
Ted Rall
Bernie Should Own the Socialist Label
Louis Proyect
Encountering Malcolm X
Kathleen Wallace
The Debate Question That Really Mattered
Jonathan Cook
UN List of Firms Aiding Israel’s Settlements was Dead on Arrival
George Wuerthner
‘Extremists,’ Not Collaborators, Have Kept Wilderness Whole
Colin Todhunter
Apocalypse Now! Insects, Pesticide and a Public Health Crisis  
Stephen Reyna
A Paradoxical Colonel: He Doesn’t Know What He is Talking About, Because He Knows What He is Talking About.
Evaggelos Vallianatos
A New Solar Power Deal From California
Richard Moser
One Winning Way to Build the Peace Movement and One Losing Way
Laiken Jordahl
Trump’s Wall is Destroying the Environment We Worked to Protect
Walden Bello
Duterte Does the Right Thing for a Change
Jefferson Morley
On JFK, Tulsi Gabbard Keeps Very Respectable Company
Vijay Prashad
Standing Up for Left Literature: In India, It Can Cost You Your Life
Gary Leupp
Bloomberg Versus Bernie: The Upcoming Battle?
Ron Jacobs
The Young Lords: Luchadores Para La Gente
Richard Klin
Loss Leaders
Gaither Stewart
Roma: How Romans Differ From Europeans
Kerron Ó Luain
The Soviet Century
Mike Garrity
We Can Fireproof Homes But Not Forests
Fred Baumgarten
Gaslighting Bernie and His Supporters
Joseph Essertier
Our First Amendment or Our Empire, But Not Both
Peter Linebaugh
A Story for the Anthropocene
Danny Sjursen
Where Have You Gone Smedley Butler?
Jill Richardson
A Broken Promise to Teachers and Nonprofit Workers
Binoy Kampmark
“Leave Our Bloke Alone”: A Little Mission for Julian Assange
Wade Sikorski
Oil or Food? Notes From a Farmer Who Doesn’t Think Pipelines are Worth It
Christopher Brauchli
The Politics of Vengeance
Hilary Moore – James Tracy
No Fascist USA! Lessons From a History of Anti-Klan Organizing
Linn Washington Jr.
Ridiculing MLK’s Historic Garden State ‘Firsts’
L. Michael Hager
Evaluating the Democratic Candidates: the Importance of Integrity
Jim Goodman
Bloomberg Won’t, as They Say, Play Well in Peoria, But Then Neither Should Trump
Olivia Alperstein
We Need to Treat Nuclear War Like the Emergency It Is
Jesse Jackson
Kerner Report Set Standard for What a Serious Presidential Candidate Should Champion
ADRIAN KUZMINSKI
Home Sweet Home: District Campaign Financing
Kollibri terre Sonnenblume
The Latest BLM Hoodwinkery: “Fuel Breaks” in the Great Basin
Wendell Griffen
Grace and Gullibility
Nicky Reid
Hillary, Donald & Bernie: Three Who Would Make a Catastrophe
David Yearsley
Dresden 75
FacebookTwitterRedditEmail