Commentary: New Hampshire-sponsored pediatric cancer study misses the mark

A new study published by Rees, et al misses critical points about youth cancers in New Hampshire. In June of 2018, the CDC determined that New Hampshire’s pediatric cancer rate (ages 0 to 19) was the highest in the nation between 2003 and 2014. New Hampshire children are the proverbial “canaries in the coal mine.” However, rather than defining and addressing small area effects (i.e., environmental impacts of contaminated drinking water in towns or zip code areas), this new study directs state resources to assess regional issues. In our opinion, it mistakenly deflects public attention and resources from inspecting internal surveillance, policies and regulations that should be used as tools to prevent environmental exposures contributing to cancers.

In 2019, the state directed $400,000 “to bring in renowned experts to get to the bottom of this public health crisis without any preconceived notions.” When one of our authors personally thanked the governor for taking steps to address this important issue, the governor replied that he did not think that the New Hampshire pediatric cancer rates were the highest in the nation contrary to the CDC’s determination. Instead of funding a study that implies pediatric cancer is a regional issue rather than a New Hampshire concern, funds would be more appropriately spent to address the problem which is costing the state and families untold amounts of stress and health care costs.

In 2018, the CDC found, averaged over the entire state, 205.5 New Hampshire children per 100,000 were diagnosed with new cancers between 2003 and 2014; the highest rates of new childhood cancers in the nation. That means that some towns or areas of the state are likely to have exceptionally high rates of children diagnosed with cancer. We know this is true in New Hampshire because the state found significantly higher rates of two extremely rare and devastating cancers (rhabdomyosarcoma and pleuropulmonary blastoma) in children in five Seacoast New Hampshire towns in 2016.

Unlike the Seacoast of New Hampshire, most of the time, when a member of the public reports what they perceive to be a cancer cluster, that agency does not conclude that the cancers meet the definition of a CDC-defined cancer cluster. Cancer cluster determinations are exceedingly rare. A 2012 study determined that over the preceding 20 years, only 72 of the 576 reported cancer cluster investigations conducted met a cancer cluster definition. Only three of the 72 cancer clusters were linked to environmental exposures (asbestos, contaminated drinking water, industrial air, and water pollution). Only one cancer cluster was linked to a clear cause. The authors called upon scientists to create “a multidisciplinary national dialogue on creative, innovative approaches to understanding when and why cancer and other chronic diseases cluster in space and time.”

Since the bar is high and rare for a cancer cluster determination, the occurrence in the Seacoast of New Hampshire underscores the need “to get to the bottom of this public health crisis without any preconceived notions.” It requires government transparency and investigation of small area effects (i.e., geospatial distribution of adult and childhood cancers and environmental factors by town, census tract, and/or zip code) to prevent more children and families from devastating, life-changing diagnoses and death. The U.S. Department of Health and Human Services estimated that at least two-thirds of all cancer cases could be prevented by minimizing environmental causes.

In addition to the Seacoast, the most widespread environmental tragedy in New Hampshire history is unfolding in southern New Hampshire. Adults and possibly children are experiencing higher than expected rates of at least four types of cancer, known to be associated with environmental exposures when compared to other similar towns in New England and national cancer incidences. It is important to strengthen and enforce regulation and hold industrial polluters like Saint Gobain Performance Plastics in Merrimack accountable for the damage they have caused. A full and transparent assessment of the environmental and public health damage is an essential step in that process.

We sincerely hope that in the future, precious state resources will be directed to studies that are more useful in determining potential root causes to minimize exposure and prevent cancer and chronic disease in children and adults in New Hampshire.

“When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause-and-effect relationships are not fully established scientifically.” ~ Wingspread Statement

Mindi Messmer, PG CG; NH House Rep. Dr. Gary Woods; NH House Rep. Dr. William Marsh; NH House Rep. Dr. Jeff Salloway; Dr. Ben Locwin; NH State Senator David Watters

This article originally appeared on Portsmouth Herald: Commentary: NH-sponsored pediatric cancer study misses mark