Many people are getting rare cancers in a small Georgia town
atlantamagazine.com
atlantamagazine.com
https://statecancerprofiles.cancer.gov/map/map.withimage.php...
Actually, I see that the stat is age adjusted. So not sure what effect that would have on the comparison that I described
See also: Bayesian Data Analysis, Gelman et al., 2nd edition, section 2.8.
I don't understand how it continues unchecked. Sometimes I'd spend as little as an hour breathing the stuff and my nose and throat would be sore for days afterwards.
My assumption is the residents are too poor so they lack representation and likely are employed by the same companies behind the pollution. The government should be more actively monitoring these industrial activities and protecting its citizens from their negligence.
Local and state politicians don’t want to be seen as killing industrial jobs. The Federal government really needs to take action here, but this is obviously a non starter in the current administration.
Pittsburgh’s air (while still f’ed up) is infinitely better than it was 30 or 40 years ago, largely because of EPA regulations.
Profit and lack of regulation and lack of effective penalties
https://www.npr.org/sections/krulwich/2012/10/02/162163801/o...
Not that they are related- but the mysterious & provoking bands evoke eachother.
The outline of the Ohio-Mississippi river valleys is particularly clear.
https://statecancerprofiles.cancer.gov/map/map.withimage.php...
Put the maps side-be-side, or toggle them:
Incidence: https://statecancerprofiles.cancer.gov/map/output/ScpMapImg_...
Mortality: https://statecancerprofiles.cancer.gov/map/output/ScpMapImg_...
Evidence against jurisdictional effects.
That said, I didn't do the math and it's entirely possible that the rates in Waycross are way above what one might expect by chance.
There seem to be about 1500 towns in the US with populations between 10000 and 25000: https://www.statista.com/statistics/241695/number-of-us-citi...
There seem to be about 200 defined types of "rare cancer" (where rare is defined as affecting less than 1 in 100000 people[3]): https://www.macmillan.org.uk/information-and-support/audienc...
My programming is better than my math[1], so I brute forced it as a simulation. Using 2000 towns, each with a population of 10000, and testing for 200 different types of cancer with a prevalence of 1 in 100000, I got this distribution:
1: 36393
2: 1831
3: 63
4: 1
[1] What's the right way to calculate this mathematically?
[2] My slow Perl code took about 10 minutes to run while I was writing this, and I committed to showing the numbers generated regardless of what they came out as.
[3] Oops, reading more closely I now see that the linked article is distinguishing between "rare" and "very rare".
Assuming independence between diseases and towns (not a terrible assumption but definitely not true) we have:
2000x200x3.77x10^-6 ~= 1.5
Which agrees with your simulation [1].
[1] My slow brain and calculator took 2 minutes to calculate this ;)
EDIT: Changed asterisks to x to avoid formatting.
EDIT 2: Here are the numbers for all the cases you have:
0: 361934.8
1: 36913.8
2: 1809.5
3: 60.3
4: 1.5
First, I'm not sure this is true for all forms of cancer and all types of carcinogens. While it's true that tobacco smoke contains a wide variety of carcinogens and causes a wide variety of cancers, it doesn't seem impossible that some particular chemical might cause an increase in rhabdomyosarcomas without producing a general increase. For example, I don't think that asbestos exposure leads to an across the board increase in all cancers, just an increase in lung cancer and mesothelioma. What makes you so sure that there cannot exist a more focused carcinogen that causes just rhabdomyosarcoma?
Second, you seem to be assuming that just because the article focuses on one particular type of cancer, that the town does not have elevated levels of other cancers. Do you have outside evidence that makes you so sure of this that you conclude that the increased rate of once type of cancer "must be a statistical artifact" rather than evidence of a greater underlying problem that merits further research?
Yes it is possible for some specific rare cancers to have some single specific cause (mesothelioma and asbestos are probably the best known example), but this is not what is seen with nearly all other carcinogens.
The reason is two fold:
1) Almost all carcinogens are not localised to a precise body location (asbestos is a rare example). Once inside a person the carcinogen is distributed everywhere. This is why exposure to tobacco smoke for example gives rise to cancers in distant locations to the lung.
2) Carcinogenic pollutants are almost never just a single chemical, but a wide range of compounds.
Cancer is not like infectious disease where you have one causative agent that gives rise to a distinct set of symptoms. The nature by which cancer arise (loss of cellular replication control), by its very nature rarely proceeds down the same path - expose one person to a specific carcinogen and they might get liver cancer and lung cancer in a different person.
I was partly confused by one of the links from the article[1], which says "These cancers are derived from similar cellular lineage; therefore, these sarcomas are closely related in cellular composition. It is biologically plausible that a common exposure exists." Is there a way in which this might make sense? Are they suggesting that it might be biologically contagious rather than chemically induced?
And the second question? When you conclude that the prevalence of this particular must be a statistical artifact rather than a reproducible effect, do you have reason to believe that there are not elevated levels of other cancers in the area? Or is this not actually necessary to show?
[1] https://www.facebook.com/notes/jason-c-spencer/response-to-w...
I would be far more likely to believe that a large number of unrelated cancers in an area were caused by pollutant carcinogens, than a small number of rare cancers.
I don't know if there is an elevated rate of cancer in this area, but I assume not since it would be the first thing that anyone looking at this rare cancer cluster would look for.
Your point of there being more than two types of rare cancer and that any selection of outliers over all the types would give rise to the same sentiment is totally correct.
I did the quick mental calculation with one in a million. As you see in your simulation the difference between 1e-5 and 1e-6 makes all the difference here.
"This" == "a possibility", not "this" == "Waycross cancer rate". What matters is what the probabilities/frequencies are.
Whoa. :-)
36,000 people in Ware County, GA.
3 cases of RMS, 1 of Ewing's.
327,000,000 people in the US.
400-500 cases of RMS in the US per year.
Chance of a case: 0.0000015
Chance of 4 cases: 5.5e-24
...in Ware County: 2.0e-19
...in any Ware County-sized population: 1.8e-15 [edit; I'm an idiot] [think I was right the first time]
Bonus: number of cases in US based on Ware Cty: 36,000 (weird, eh?) or about 73× more common.
The probability of you randomly selecting a sample of people who happen to have a high rate of cancer is very low.
The probability of you EVENTUALLY selecting a sample of people who have a high rate of cancer after selecting many samples is actually very high.
The probability of you eventually selecting a sample of people who happen to have a high rate of cancer AND happen to live in the same town AND happen to have cancers that are classified as rare is very very low.
There is no doubt this is an anomaly by every logical measure and not a statistical quirk.
This is an example of where your gut notion of a cancer cluster actually trumps the statistical logic. While logic is always correct and the logic you were using was technically wrong, this is a good example of how your intuitive gut feeling of what a cluster is, trumps your logical mind. Don't ignore your gut feelings, don't ignore your intuitions. The logical part of the human mind is just as flawed as your intuitions and it can build an incorrect scaffold of compositions that support an incorrect conclusion.
When your logic collides with your intuitions, do not automatically assume that logic trumps all. Evaluate both.
There are events that contain so much information that the probability of the event occurring due to entropy are basically impossible. The event fitting those 3 conditions I mentioned is one example.
Let me add one more conditional to the cancer-cluster event: Happening within the same time-frame.
> In late 2015, the Georgia Department of Public Health said it could find no link among the children’s cancer cases. Then it backtracked and said more investigation was needed. In December, the federal government stepped in. The Agency for Toxic Substances and Disease Registry, an arm of the Centers for Disease Control and Prevention, said it would work alongside state officials in evaluating contamination at the railroad yard as well as an Atlanta Gas Light property that once held a power plant, which was torn down after closing 60 years ago.
The author heavily focuses on pollution in the area being a possible cause, and points out inadequacy in investigation performed on and arguments against pollution being the cause. But all her evidence is anecdotal.
The point isn't to assert that she is certain of the cause, it's to provide a spotlight on evidence which she has seen which has not been given adequate examination and the resulting suffering from what could possibly be preventable.
The title is appropriate, not clickbait.
"Pollution suspected of causing rare cancers in Waycross, GA"
Otherwise, it's not all that bad - just clever headline choice. (The point of headlines has always been to intrigue prospective readers, after all.)
Since this article is a substantial piece of journalism that remains interesting if you know the tl;dr, rather than an insubstantial chunk of #content, I don't think it really counts as clickbait.
Did this change at some point? Or is this just tabloid practices infecting journalism in the era of maximizing clicks? I find the old model infinitely better especially as people tend not to read past headlines in most cases.
Which would have been a better headline on, say 9/11?
A: “U.S. Attacked - Hijacked Jets Destroy Twin Towers”
B: “Something Awful Happened in NYC Today. Click here to find out what!”
That's arguably worse than clickbait. It actually discourages people from reading the article who might find it interesting.
It suffers from being both too specific and too general at the same time.
It's too specific because Waycross, GA, is a town of under 14k people and as far as I can see there is no reason to expect that many people outside of Georgia to have ever heard of it. Naming it in the headline suggests that the story is aimed at those people who do recognize it.
It's too general because of course it is pollution. The other things that cause cancer don't tend to cause cancer spikes in small areas.
Both the town and the cause are actually incidental to this story. The interesting aspects of the story are how the various parties reacted when some started noticing there might be a cancer cluster.
Also: A town newspaper did not cover this, and the head editor as well as the mayor believes this is a case of "Facebook moms" and overly-concerned parents using personal griefs to wreck Waycross's tenuous economic bounce back.
That's a pretty big exclusion. It's not as if pollution gives a damn about political boundaries.
so why insist on only counting local diagnoses?
EDIT: perhaps there are regulations that mandate doctors to diagnose similar percentages, to prevent overdiagnosis... and perhaps this is being weaponized against discovering localized exposure to carcinogens?
Charitably, I guess the researchers just don't have resources to locate patients more accurately than by their diagnosing hospitals location. It's a huge amount of noise on top of patients actual location history, which would seem to make their survey only capable of detecting persistent hotspots that span the location of many hospitals.
Either it's on the cancer cluster question, but then you contact and ascertain the accurate patient location history.
Or the data never was on the cancer cluster question...
I would be floored if they did this. I'm a statistician who reports on cancer rates for another state, and the universal standard for assigning locations to cases is the patient's residential address. Looking at Georgia's 2016 report[1], they mention using the SEER*Stat software provided by SEER[2]. I have the same software, and I've never seen it offer any information about the reporting facility beyond a general category ("hospital", "lab", etc). They would've had to work outside the well-worn paths using a custom extract from the cancer registry. Not impossible, but also not reasonable.
It's true that epidemiologists, or whoever looked into the clusters, could've been a separate unit from the statisticians behind the annual reports. And maybe they're not used to cancer epidemiology and didn't ask about best practices. But I'd be surprised if they messed up this basic thing.
Also, I've heard of the study mentioned in the article where only one out of 428 cluster investigations proved true. But the way it was portrayed at a cancer registry conference, the low rate is a combination of small sample sizes and over-reporting of "clusters." Cancer's a rare and frightening event, which are two things people have trouble seeing rationally.
The first half of the article also calls out multiple toxic organic chemical contaminants from several operations including a railroad and a waste-processing plant ... severe enough to require Superfund remediation.
In that era ('Better things for better living through chemistry') most people were unaware of the dangers of industrial chemicals in the air, water and soil. They got little press, at least until 'Silent Spring'.
[1] https://marginalrevolution.com/marginalrevolution/2010/09/th...
However, coal contains (depending on the source), mercury, sulfur, radioactive elements, tars, rare earth elements.
Some of these are volatile when burned. Some become ash.
A plant running anthracite is naturally very clean.
The plant has to have scrubbers to remove the volatile ones.
Especially the yellow smoke (likely sulfur)
However, a one time emission of sulfur is likely insignificant.
Finally you mentioned it could be natural gas. Natural gas, mostly methane, is also colorless except it releases water vapor. Given the right conditions, you might see plumes of white smoke coming out - that’s harmless water vapor.
> On the cancer cluster question, ATSDR cites data from the Georgia Comprehensive Cancer Registry to make the case that there isn’t one. GCCR data from the past decade shows childhood cancer incidence has been below the state average here. GCCR’s Waycross-area data, however, doesn’t include people who are diagnosed at hospitals in other cities, as Lexi, Harris, Gage, and Raylee all were.
My blood boils.
>On the cancer cluster question, ATSDR cites data from the Georgia Comprehensive Cancer Registry to make the case that there isn’t one. GCCR data from the past decade shows childhood cancer incidence has been below the state average here. GCCR’s Waycross-area data, however, doesn’t include people who are diagnosed at hospitals in other cities, as Lexi, Harris, Gage, and Raylee all were.
I’m a Georgia native but from Atlanta. I’ve never been to Waycross. I lived in South Georgia for about a year a couple hours away.
For anyone who read the Vidalia Onion article on the front page it’s about 1.5 hours north of here. There’s a beautiful college in Valdosta an hour away. The region is nice because it transitions into more of a Florida type of landscape.
So flat as a pancake and hotter than Hades? :) The Gulf cloudscapes, though, are something to behold.
And compared to say Venus, FL's pretty comfortable!
I wonder how much of these findings are liability protection for large lobbying corporations that operate in these towns.