Fear and frustration

Fuel for solving the Ewing sarcoma mystery

Fear and frustration are understandable, expected and warranted among residents of the region including the Canon-McMillan School District where Ewing sarcoma and other rare cancers have been diagnosed in children.

A recent community meeting at the Washington County school district did little to ease the emotional turmoil of those wanting to know whether pollution exposure from shale gas development could be responsible for the diagnoses which have been documented by Post-Gazette reporters David Templeton and Don Hopey.

Public health experts have not made that link to date.

State Department of Health officials and a UPMC Ewing sarcoma physician/researcher presented the audience with a statistical analysis that shows, from an epidemiological standpoint, why a Ewing sarcoma cluster does not exist within the school district — this, despite empirical evidence to the commonsensical contrary.

In March, the PG documented six Ewing sarcoma cases within Canon-McMillan (comprising Cecil and North Strabane townships and Canonsburg) as well as an additional nine Canon-McMillan preschoolers and students who during the 2018-2019 school year had cancer. Those cases include two cases each of osteosarcoma (bones) and leukemia (blood), and one case each of liposarcoma (connective tissue), rhabdomyosarcoma (soft tissue), neuroblastoma (nerve cells), liver cancer and Wilms (kidney) tumor. Additionally, a teenage student died in February from astrocytoma, a brain and spinal cord cancer.

Particularly confounding to those at the recent public meeting was the fact that the Health Department used only three of the six cases identified by the PG within the boundaries of the school between 2005 through 2017 to conclude that the number of diagnoses is higher than would be expected but not an official “cluster.” The answer to “Why?” boils down to proper scientific protocol. It is an unsatisfying answer — an answer that feels outrageous — but it is one that comports with standard scientific practice.

Sharon Watkins, the director of the Health Department’s Bureau of Epidemiology, has said the department will do additional analysis of state cancer registry data for an area including Washington, Westmoreland, Fayette and Greene counties.

This must happen. It must happen expeditiously. And it must happen in a way that produces good science.

The rub is this: Good science does not happen expeditiously.

So parallel tracks must be created. One track: Researchers should use accepted, if oblique, standards and practices to produce data solid enough to create reliable guideposts in our understanding of the burgeoning shale gas industry and its potential health impacts.

A second track: Analysis driven by common sense should be undertaken. Public health officials should activate a boots-on-the-ground team to verify the sick, where they live now, where they formerly lived, and the exact nature of their illness.

The Post-Gazette’s investigation has unearthed enough evidence to warrant dual approaches to this potential public health crisis.

Good science most often must wait. But parents of sick children cannot be asked to exercise such patience in the face of peril.

Pennsylvania must move forward with its own continuing research. Gov. Tom Wolf and our state lawmakers also must bring pressure to bear on federal stakeholders: Congress, the Centers for Disease Control and Prevention and the National Institutes of Health. Mr. Wolf would be wise to enlist the aid of other states where suspicions simmer of a lethal connection with natural gas production, places like Colorado, North Carolina and Georgia. Research universities should link hands in the effort.

Fear and frustration must be harnessed as the fuel for purposeful and effective strategy.