FAQs regarding the Acreage cancer cluster investigation

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FLORIDA DEPARTMENT OF HEALTH & FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
The Acreage Frequently Asked Questions
Updated March 5, 2010

ABOUT THE AGENCIES    Updated 03/09/2010
pdf version

What does the Florida Department of Health do?
• The Florida Department of Health (DOH) is the lead agency in Florida for public health services. DOH’s mission is to promote, protect and improve the health of all people in Florida. Each Florida county has a public health unit that works in conjunction with the Tallahassee DOH Headquarters.

What is DOH’s role?
• DOH provides scientific expertise to determine if a cluster, or an unexpected increase or grouping of cancers is present in a community. Collaborating with our state and federal partners, DOH seeks sources or causes for these increases.

What does the Florida Department of Environmental Protection do?
• The Florida Department of Environmental Protection (DEP) is the lead agency in Florida for environmental management. DEP’s mission is to protect, conserve and manage Florida’s environment and natural resources. There are six DEP regulatory district offices throughout the state. DEP’s Southeast District Office is located in West Palm Beach, and serves Okeechobee, St. Lucie, Martin, Palm Beach, Broward and Miami-Dade counties.

What is DEP’s role?
• While DOH is the lead in public health issues, DEP is responsible for environmental issues. DEP has conducted environmental assessments to determine if contamination is present in groundwater or soil in The Acreage. DEP has sampled private drinking water wells, tap water, the Seminole Improvement District’s supply wells and collected soil samples.
 

ABOUT ENVIRONMENTAL SAMPLING

Where and when did DEP’s initial water sampling take place?
• During the week of August 4-8, 2009, DEP collected samples from about 50 residential drinking water wells, a child care facility and the Seminole Improvement District water treatment plant in a 36 square mile area.

• The well testing divided the 36 square mile area into six zones. Samples were collected at five to 10 separate locations within each zone to achieve wide coverage that is proportional to population density.

• On August 26 and 27, after reviewing the preliminary findings of the sampling, DEP conducted additional water quality sampling. The additional samples included all five water supply wells and two treated water locations at the Seminole Improvement District water treatment plant (only one of the five water supply wells was sampled in the preliminary round), 10 private residential drinking water wells and nearby canals in the area. With this additional sampling, DEP had tested all wells providing raw (pre-treated) water to the Seminole Improvement District water treatment plant as well as the finished treated water that is distributed to customers. The water treatment plant is in compliance with DEP’s regulatory requirements.

• The additional August 26 and 27, testing focused on radionuclides, specifically radium 226/228, due to a minor exceedance found in a sample of pre-treated water from the first supply well at the Seminole Improvement District water treatment plant.

• On October 1, 2009, results for the sampling were released and can be viewed in The Acreage Sampling Report.

What is radium?
• Radium is a naturally occurring radioactive metal found at low levels in virtually all rock, soil, water, plants, and animals.

• Radionuclides that occur in groundwater above federal and state standards can be easily treated to meet these standards.

Where and when did DEP’s second round of water sampling take place?
• February 12-14, 2010, DEP collected samples from 23 homes of untreated ground water from drinking water wells and samples from water that passed through a water treatment system or water softener, if the resident owns a treatment system. The homes included residences where cases of pediatric brain cancer have been identified as well as a number of other nearby homes to serve as a control group.

• DEP also collected treated water from the Seminole Improvement District water treatment plant and four homes as a follow-up to the first round of sampling.

What will DEP test for during the second round of water sampling?
• As before, the laboratories will analyze the water for a wide array of contaminants that are associated with industrial (metals and organic solvents) and agricultural (herbicides and pesticides) chemicals used now and in the past.

• While the tests will look for more than 200 individual chemicals, most fall into one of the following groups: petroleum, solvents, pesticides, herbicides, wood treating chemicals, metals, nutrients, polychlorinated biphenyls (PCBs) and radionuclides.

How does the laboratory process work and who will analyze these samples?
• Except for radionuclide samples, all samples taken will be transported to the DEP Central Laboratory in Tallahassee and analyzed for the industrial and agricultural chemicals mentioned above. Some samples will be sent to a contract laboratory, for radionuclide testing – gross alpha, gross beta and radium 226/228.

• At the laboratory, each sample will be logged-in and the chain-of-custody paperwork checked again. Laboratory technicians will prepare the samples for analysis, depending on the chemical group to be analyzed. For some groups of chemicals, the water can be injected directly into laboratory instruments for testing after minimal preparation. For other groups of chemicals, several hours of preparation may be necessary before the testing can begin. Also, the time to complete an analysis is different for each chemical group.

• As the testing instruments produce results for each sample, technicians and chemists will review the data and compare it to quality control tests to be sure that the instruments are producing results that are accurate and complete for each sample.

When will results be available?
• Because the preparation and analytical time for the chemical groups are different, it will take about four weeks, early April, for DEP to have the final test results for all residences.
• When the results are ready, all homeowners will be contacted to set up a time when DEP and someone from DOH can come to their residence to deliver the results, explain what the results mean and answer any questions.

When will soil sampling begin?
• On March 2, 2010, DEP sampling teams will begin sampling soils at most of the homes where water samples were collected during the February 12-14, 2010 sampling event. Having both water and soil samples will allow DEP to evaluate environmental data from homes where cases of pediatric brain cancer exist as well as additional nearby homes which are serving as a control group.

Will DEP be coordinating with DOH on the sampling?
• Yes, the agencies are working together. However, DEP’s investigation is focused on an environmental assessment, including the presence of contaminants in water or soil in The Acreage. These are slightly different criteria from the specific areas of concern that are under review by DOH for its epidemiological study.

Why is the state testing water and soil if risk factors for pediatric brain cancer are unclear?
• DOH is casting a wide net for sources and causes to ensure its investigation is as complete as possible. Both agencies have had discussions with federal partners including the Centers for Disease Control (CDC), National Cancer Institute and the United States Environmental Protection Agency regarding environmental testing strategies. Broad testing of well water and soil will allow the state to assess if there are contaminants present in the environment in The Acreage.

How can I get my water tested?
• There are several qualified commercial testing services available in the area. DOH has a list of qualified laboratories available online at www.pbchd.com. Residents who are interested in having their water tested should consult with these commercial testing services for their pricing.

• If the water is commercially tested, DOH recommends that samples be taken from the kitchen tap to represent the water actually consumed. It is also recommended that residents request analyses for gross alpha (as a measure of radionuclides) and semi-volatiles (525 EPA method – to scan for organic chemicals including some pesticides) and heavy metals including arsenic and lead. DOH is available to go over the commercial lab results, explain any findings, and answer questions residents may have about their water testing reports.

ABOUT THE INTERVIEWS CONDUCTED

Who did the Palm Beach County Health Department interview?
• The Palm Beach County Health Department (PBCHD) interviewed 13 families that have had a child diagnosed with a pediatric brain cancer while living in The Acreage. These interviews were designed in consultation with the CDC and other federal experts.

• The interview included questions related to how long the families have lived at various addresses, schools attended, health of the child, and the parent’s occupations and hobbies. The interview also included questions related to diet and life style, family history of illness, immunizations, and many other questions related to potential exposures. Interviews with all 13 families have been completed.

What happens now that those interviews have been completed?
• The PBCHD is now contacting neighboring families to serve as comparison controls and that would be willing to provide answers to the same interview questions. Identification of these control families and completion of control interviews may take a number of weeks.

• After all interviews are complete, the response will be analyzed and commonalities among case families will be assessed as well as differences between case and control families. DOH will use these interviews to better understand behaviors, exposures and risk factors in The Acreage community.

ABOUT PEDIATRIC BRAIN CANCER

Is it possible to find a cause for the increase in pediatric brain cancers in The Acreage?
• DOH cannot guarantee finding a specific cause but is using its available resources to continue the investigation. In addition, DOH has asked for help from the CDC and several national research centers that specialize in brain cancer.

Does DOH plan to do additional analysis such as on other types of childhood cancers or on adult cancers?
• After conducting its initial investigation, DOH determined that there is no elevation of total cancers among children or in adult brain cancer rates in The Acreage.

• The DOH study was in response to a citizen concern involving pediatric brain cancers. As part of the initial analysis, total or all pediatric cancer rates as a group were calculated. DOH noted 15 cases of any type of cancer in a child (0-19 years of age) during 2000-2007 diagnosed in the Acreage This number is similar and what would be expected when compared to county and state rates.

• The initial analysis also looked at adult rates of brain cancer in The Acreage residents. DOH noted 12 cases of brain and other central nervous system tumors in Acreage adults (20 years of age or older) during the period 2000-2007 which again is similar to county or state rates.

• Based on the findings, DOH is focusing its study efforts on pediatric brain cancers.

How many cases of pediatric brain cancer have been identified?
• There are 13 cases of pediatric brain cancers diagnosed among children living in the Acreage during the years 1994-2008. Cases occurring in 2009-2010 have not yet been verified in the state cancer registry. DOH will continue to review the registry for cases as well as verify any cases that are reported directly to the PBCHD.

• Although some facilities do take longer, hospitals, physicians and laboratories have six months from diagnoses to report to the Florida Cancer Data System (FCDS). Once reported, the registry must verify the information which may take months. For this reason, cases reported in mid to late 2009 may not yet appear in FCDS records.

What if I know of a case of pediatric brain cancer that is not in the registry?
• The analyses and study includes cases of pediatric brain cancer that were diagnosed between 1994 and 2008 among children living in he Acreage. Children who were diagnosed before they moved in or after they left The Acreage were not included. Children who live outside of The Acreage are also not part of the study.
• Please contact the Palm Beach County Health Department if there are any families with children who have pediatric brain cancer that meets these criteria and that have not been contacted by the Department.

There have been reports of at least 50 or as many as 80 adult brain cancers in the community. Why are DOH numbers for adult brain cancer lower?
• DOH numbers are based on verified diagnosis of primary adult brain cancers that occurred in residents living in The Acreage. Considering benign, borderline and malignant brain cancers between 2004 and 2007, 18 cases have been verified.

• Several factors can lead to differences between state counts and community counts. For example, the community counts may include:

• cases diagnosed within a different time frame,
• individuals who were not diagnosed while living in The Acreage (former residents or new residents who moved in with the diagnosis),
• brain cancers that are a result of metastasis from other cancers,
• diagnoses of other brain conditions that are not considered cancer, or
• benign and borderline brain cancers diagnosed before 2004 (the year the state began collecting data on these types).

What are the causes of pediatric brain cancer and why can’t the state begin testing for specific causes?
Current medical science does not provide clear environmental causes for most types of pediatric brain cancers. A few factors are known to be related and these include the presence of an inherited syndrome and therapeutic radiation of the head. Experimental evidence exists to suggest a relation between pediatric brain cancers and ingestion of cured meats (N-nitroso compounds) and exposure to polyoma viruses although these have not been fully supported by epidemiologic studies.

• Living on a farm or having a parent that does farm work has also been shown to be associated with an increase in pediatric brain cancers but the set of factors that contributes to this is not known.

• Factors such as epilepsy, brain injury, electromagnetic fields, maternal factors, immunizations, childhood illnesses and other potential risk factors have been mentioned in research papers but have not consistently shown an association.

PRATT & WHITNEY

Why isn’t DEP more closely scrutinizing the nearby Pratt & Whitney facility?
• The Pratt & Whitney facility is currently in compliance with all DEP hazardous waste regulations. The facility has a hazardous waste permit that includes operational requirements for a hazardous waste storage area and requirements for the continuation of corrective actions regarding past contamination. As part of the oversight there are more than 400 groundwater monitoring wells at this facility to demonstrate compliance with current permits and to detect whether contamination has the potential to spread beyond its current location.

Has contamination spread beyond the Pratt & Whitney property boundary?
• There are a number of wells along the southern boundary of the Pratt & Whitney property that are monitored semi-annually to demonstrate that no contamination has migrated from the property.

• Those monitoring wells have shown the migration of a chemical called 1,4-dioxane in the groundwater beyond the property boundaries onto the J.W. Corbett Wildlife Management Area (WMA). All other chemicals being monitored in the groundwater are confined within the property boundaries of Pratt & Whitney. Monitoring wells installed on the WMA indicate the 1,4-dioxane had migrated approximately 1,000 feet south of the Pratt & Whitney property line. The facility is actively working to demonstrate to DEP that this is the extent of contamination migration and to ensure that there is no risk to human health or the environment.

WHAT YOU CAN DO TO PROTECT YOUR FAMILY’S HEALTH

What can I do to protect my family during this testing period?
• Since everyone has a unique health profile, it is important that specific health questions about family members be discussed with the primary health care provider. This includes reporting any unusual signs or symptoms such as severe headaches, changes in vision, lack of balance, changes in speech patterns, or any other symptoms of concern.

• Pediatricians and family practice physicians have been advised that DOH is looking into an increase in pediatric brain cancers. DOH will continue to update area physicians on the progress of the investigation.
 

CONTACTS & MORE INFORMATION

Whom can residents contact at DOH for more information?
• For additional questions, residents can contact the Palm Beach County Health Department at 800 Clematis Street, West Palm Beach, FL 33401. Visit the website www.pbchd.com, or call the main telephone number for information (561)840-4500.

Whom can residents contact at DEP for more information?
• For additional questions about environmental issues, residents can contact DEP’s Southeast District Office Outreach Coordinator, Cristina Llorens, at (561) 681-6605 or Cristina.Llorens@dep.state.fl.us.

How can I keep up-to-date on The Acreage investigation?
• DOH is opening a resident’s resource office in The Acreage and will be sending regular updates to you by email. In addition, DOH is updating The Acreage webpage at www.pbchd.com as new information becomes available.

• DOH is adding a function to the Palm Beach County Health Department so you can sign up for email alerts that will alert you when new information is posted.

What has been DEP’s public outreach effort to inform the public?
• DEP has developed a web site, www.dep.state.fl.us, dedicated to The Acreage that houses relevant information to keep the public apprised.

• Staff members are also available to answer questions about The Acreage and DEP’s environmental assessment projects.
 
 

• Soil Testing Labs
• Well water testing labs
• Acreage Investigation Cancer Study Area (map)
• CDC Acreage Cancer Letter  24kb
• Acreage SIR Recalculation Population Estimate Methods and Results
• CDC REVIEWED DOH POPULATION RECALCULATION PEDIATRIC BRAIN AND CNS CANCERS REMAIN ELEVATED
• FAQs regarding the Acreage cancer cluster investigation
   

 

This website will be updated regularly by the Palm Beach County Health Department.

The link below will take you to the complete report on the Level 1 cancer review.

Review

• DOH & DEP ANNOUNCE INITIAL FINDINGS IN CANCER REVIEW INVESTIGATION FOR THE ACREAGE COMMUNITY
• Acreage Cancer Cluster Review    08/28/2009

CANCER INFORMATION FOR YOUR REVIEW

• Radium Fact Sheet
• Understanding Cancer
• www.cancer.gov
• www.cdc.gov - Q & A
• www.doh.state.fl.us
• www.doh.state.fl.us pdf
• Florida Department of Environmental Protection Acreage investigation
• Palm Beach County Commissioners - Video Links
• www.theacreagecancerstudy.com
• Palm Beach Post