127 people in a school suffered from brain cancer, the investigation results were unexpected

A high school student suffered from a "crowd cancer" incident, with 127 alumni suffering from brain tumors, which caused a sensation across the United States. This was a real incident that happened in New Jersey, USA last year, and it was also a typical case of suspected cancer clusters. However, the government investigation ultimately concluded that the "concentrated" incidence of brain cancer in the school was not statistically significant.

Written by | Qijun

Recently, the "collective cancer" incident at Zhongshan Second Hospital has sparked heated discussions. Some people believe that the research environment of the students involved is the key cancer-causing factor.

In fact, just last year, the United States also broke out a "crowd cancer" news of a much larger scale, and all of them were brain tumors. 127 alumni of a high school in New Jersey suffered from brain tumors. The school was close to the factory that processed uranium for the Manhattan Project. This incident caused a sensation in the United States, and the conclusion of the local government investigation was shocking.

The story begins in 1999.

That year, 27-year-old Al Lupiano was diagnosed with a benign brain tumor. However, Lupiano's misfortune was not over yet. 22 years later, in 2021, his wife Michele also had a benign acoustic neuroma in her left brain. Coincidentally, on the same day, his sister Angela was also diagnosed with a malignant tumor - glioblastoma, and died a year later.

Lupiano and his sister | From Al Lupiano

Even more surprising is that all three had attended the same high school, Colonia High School, in New Jersey. Lupiano felt something was fishy, ​​so he contacted alumni on Facebook and local news websites to ask if they had similar illnesses.

He was surprised to find that many of his former high school classmates also had brain tumors. In the list he had, there were 127 people with brain tumors. In the past 30 years, 15,000 people graduated from the school, most of whom graduated between 1975 and 2000. The brain tumors they suffered from included glioblastoma, acoustic neuroma, spinal cord angioreticuloma, and meningioma.

For example, Jason Wisinski's wife and sister-in-law also attended the high school and both died of malignant brain tumors.

In an interview, Lupiano said: "Something must be wrong." In his opinion, this "problem" is the so-called "collective cancer."

According to the Centers for Disease Control and Prevention, a cancer cluster occurs when the prevalence of a specific cancer in a population exceeds expected levels over a period of time.

The news caused a sensation in the United States after CBS reported on the incident. A related video on TikTok received 2.2 million views in just 24 hours.

Laymen were not the only ones shocked when the news broke. "This is an unusual situation," said Sumul Raval, a neuro-oncologist in New Jersey. He said an immediate investigation was warranted.

The local government also takes this matter very seriously. The city's mayor, John McCormac, once told the media: "Something may have really gone wrong, and our residents have the right to know if there is any danger."

Although incidents of more than a hundred people contracting cancer are rare, the history of epidemiology is filled with a variety of cluster cases, many of which have advanced human understanding of medicine.

For example, chimney sweeps in London in the 18th century often suffered from scrotal cancer. Women who painted watch dials with the radioactive element radium in the 20th century often developed osteosarcoma. And through the cluster of mesothelioma, humans realized that asbestos, which is often used as a building material and made into asbestos mesh for middle school chemistry experiments, is a carcinogen. And vaginal clear cell carcinoma is caused by exposure to the estrogen drug diethylstilbestrol during pregnancy.

In 1988, researcher LJ Kinlen also discovered that leukemia also has a clustering phenomenon. He noticed that leukemia clusters often occur in areas that were previously isolated but then suddenly received a large number of new populations. Based on this, he proposed the Population Mixing Hypothesis. Later, studies in countries and regions such as the United Kingdom, the United States, Hong Kong, Canada, and Croatia provided support for this hypothesis.

That being said, cancer cluster investigations rarely lead to definitive carcinogens.

According to a meta-study published in Critical Reviews in Toxicology in 2012, between 1,000 and 2,000 disease cluster investigations are initiated each year in the United States, and only a tiny fraction of these are ultimately proven to be statistically significant.

Of the more than 400 cluster investigations included in this meta-study, only three were considered likely to be related to carcinogen exposure, and only one had a conclusive cause of the disease.

The aforementioned cluster of mesothelioma (a tumor that grows on the lining of internal organs) occurred off the coast of South Carolina, and the carcinogens were linked to nearby shipyards. However, this investigation did not advance human understanding of the etiology of mesothelioma, because researchers had long known that nearby shipyards were associated with this malignancy.

In fact, as early as the 1980s, researchers realized that cluster surveys were almost always futile.

In 1989, the United States held a National Conference on Clustering of Health Events to discuss the research progress of disease clusters and related legal issues. The final summary of the conference host pointed out that overall, clusters have little effect on disease research, and the main reasons behind this are:

(1) Cluster samples are often too small;

(2) The diseases involved in the clusters usually lack consistency;

(3) Cluster sampling is actually a posterior estimation and therefore has defects;

(4) The pathogenic substances involved in the cluster are often vague;

(5) The public opinion generated by clusters makes unbiased sampling and surveys difficult or even impossible to conduct.

The Colonia High School “brain cancer cluster” investigation was not spared the same fate.

Lupiano once disclosed to the media that the school is less than 20 kilometers away from a uranium mining factory, which processed, packaged and transported uranium during the Manhattan Project. In addition, the school's scientific laboratory discovered a radioactive rock in 1997.

In order to screen for radioactive substances, the city council spent $221,000 to deploy 83 radon gas detection devices (radon gas is a carcinogen) near the high school in question and investigated local natural radioactive deposits.

Authorities are conducting a radioactive survey on the school's sports field | local media reports

The New Jersey Environmental Protection Agency also conducted an investigation, and the results showed that there was no problem with the groundwater used by the local water plant, and no violations of regulations on radioactive pollutants.

On May 26, 2022, the city's mayor, McCormac, and New Jersey environmental and public health officials held a press conference. Their investigation concluded that there was no evidence of a potential radioactive source at the site, and they would not conduct further investigations.

Moreover, calculations by the New Jersey Department of Public Health showed that the fact that more than 127 students and faculty had developed brain tumors since the school was founded in 1967 was not statistically abnormal.

Many local residents are not satisfied with the survey conclusions and statistical explanations, which is understandable because many people do not know that the probability of a person encountering carcinogens and developing cancer in their lifetime is far greater than imagined.

The American Cancer Society states that the chance of developing cancer in a person's lifetime is about 1 in 2, and the chance of dying from cancer is about 1 in 5.

Among the nearly 120 carcinogens published by the American Cancer Society, some are always with us, such as ultraviolet rays, car exhaust, and air pollution; others are closely related to lifestyle or cultural and economic levels, such as tobacco, alcohol, and processed meat.

Peter Shields, deputy director of the Ohio State University Comprehensive Cancer Center, told NBC News: "Pollutants are everywhere in the environment. It's difficult to prove that these low levels of pollutants are related to cancer because no students in other schools who were exposed to the same concentrations of pollutants developed brain cancer."

Tumors take a long time to develop, and tracing their origins many years later is difficult. Richard Clapp, an epidemiologist at Boston University, gave an analogy: "It's like looking for footprints in the beach after the tide has risen and fallen."

That’s why the National Cancer Institute notes on its website that “because cancer is a relatively common disease, cancer cases can appear to cluster even when they are not related to one another,” and that investigations confirm that “a specific environmental carcinogen is responsible for a cluster is very rare.”

However, the thousands of suspected disease clusters each year have indeed promoted judicial reforms in the United States.

For example, the U.S. federal government has passed the Strengthening Protections for Children and Communities from Disease Clusters Act, and some state governments have their own disease cluster laws, such as Maryland Senate Bill 574.

In 2016, Trevor Schaefer, a childhood brain cancer survivor involved in a suspected cancer cluster, made personal efforts to prompt the U.S. Congress to pass Trevor's Law, named after him.

The law requires the U.S. government to monitor and investigate possible cancer clusters, such as requiring regular updates to federal cluster investigation guidelines. In subsequent updates to the guidelines, the Centers for Disease Control and Prevention weakened the importance of statistical significance as a basis for judgment and incorporated other criteria, such as mortality rates, medical records, community cancer patterns, and even community-generated records of cancer patients.

Now in the U.S., people who suspect they are experiencing a cluster of disease can report it to local or state authorities, and the National Cancer Institute has created the Cancer Atlas, an online website where users can search and create maps of cancer-related demographics and risk factors.

Although most of the current disease cluster investigations are arduous and often "end in vain", and even have no academic significance in the eyes of experts, this does not mean that collective awareness of disease clusters has no social value. As Engels pointed out: "Once society has a technical need, this need will push science forward better than ten universities."

References and links

[1] Goodman, Michael, et al. "Cancer clusters in the USA: what do the last twenty years of state and federal investigations tell us?." Critical reviews in toxicology 42.6 (2012): 474-490.

[2] Herbst, Arthur L., Howard Ulfelder, and David C. Poskanzer. "Adenocarcinoma of the vagina: association of maternal stilbestrol therapy with tumor appearance in young women." New England journal of medicine 284.16 (1971): 878-881.

[3] Kinlen, LJ "An examination, with a meta-analysis, of studies of childhood leukaemia in relation to population mixing." British journal of cancer 107.7 (2012): 1163-1168.

[4] Otte, KE, TI Sigsgaard, and J. Kjaerulff. "Malignant mesothelioma: clustering in a family producing asbestos cement in their home." Occupational and Environmental Medicine 47.1 (1990): 10-13.

[5] https://www.nytimes.com/2022/08/05/opinion/cancer-cluster-colonia-woodbridge.html

[6] https://trevorstrek.org/trevors-law/testimony-trevor-schaefer/

[7] https://nypost.com/2022/04/14/why-nearly-100-people-at-nj-school-got-brain-tumors/

[8] https://www.today.com/health/health/107-cases-brain-tumors-lead-investigation-nj-high-school-rcna24973

[9] https://www.tiktok.com/@drjoe_md/video/7085859295929060650?is_copy_url=1&is_from_webapp=v1

[10] https://www.cancer.org/cancer/risk-prevention/understanding-cancer-risk/lifetime-probability-of-developing-or-dying-from-cancer.html

[11] https://www.cancer.org/cancer/risk-prevention/understanding-cancer-risk/known-and-probable-human-carcinogens.html

[12] https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/cancer-clusters-fact-sheet#r1

[13] https://gis.cancer.gov/canceratlas/

[14] https://www.cdc.gov/nceh/cancer-environment/about.html

This article is supported by the Science Popularization China Starry Sky Project

Produced by: China Association for Science and Technology Department of Science Popularization

Producer: China Science and Technology Press Co., Ltd., Beijing Zhongke Xinghe Culture Media Co., Ltd.

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