Dr. Jimmy Guidry, State Health Officer and Medical Director of the Louisiana Department of Health, gave the closing plenary at a recent conference I attended. He gave an inspiration speech, asking fellow colleagues to keep fighting the good fight in spite of obstacles. Dr. Guidry recounted a story of having to tell residents about the adverse effects of drinking from the local water supply, and that often when he gives news like that, people sometimes shift blame onto him.
Public health can be a thankless profession that way.
A Boston University article describes a situation in 1992 when Dr. Ann Aschengrau had to explain why cancer rates on Cape Cod were so much higher than the state average. Despite several linkages, there was no single answer much to the frustration of the local community. The article goes on to state:
“Epidemiology is a science of probabilities and estimates, maybes and maybe nots. No single epidemiological study can provide a definitive answer. Rather, research points to particular places or contaminants that, correlated, might bear further investigation.”
For former residents of Huntersville, NC and Auburn, AL, the investigation is still ongoing. In Huntersville, 18 people who spent a significant amount of time in the town since 2000 have received the same diagnosis of ocular melanoma, a rare eye cancer that typically only sees an incidences of around 5 people per every million. 33 people in Auburn who have lived or worked there between 1980 and the early 1990s have been diagnosed with the same cancer.
Each set of patients is sometimes described as a cluster. NCI defines a cancer cluster as “the occurrence of a greater than expected number of cancer cases among a group of people in a defined geographic area over a specific time period.” They can be challenging to investigate in part because of how long it takes cancer to develop and how often people can move in and out of a geographic area.
Furthermore, according to Dr. Marlana Orloff, an oncologist who specializes in this form of cancer, cases aren’t always picked up by cancer registries because “although these people lived in the state for that narrow window of time, they weren’t diagnosed there, so they’d fall out of the calculation.”
Ocular melanoma, or “OM” for short is a malignant tumor that ends up having a 50% mortality rate due to the development of metastatic cancer—growths of the tumor that have spread to other parts of the body. According to the National Cancer Institute (NCI), risk factors for OM include:
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