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Public Health concerns regarding unhealthy drinking water and its possible relationship to a cancer cluster study in Palm Beach County Florida Sharon Pardo PUBH-8165-10 Environmental Health Target Audience: Acreage Florida Residents Final Presentation Project for Environmental Health Course Walden University Department of Public Health PhD Program January 23, 2010 There is currently an on-going investigation regarding the existence of a cancer cluster in a specific area of Palm Beach County, Florida known as the acreage. Specifically, the incidence of pediatric brain tumors is under epidemiological investigation One possible cause being investigated for the occurrence of cancer in the acreage is contaminated well water Florida Department of Health (2009) Learn about Water quality and safety and possible health effects (such as cancer) secondary to unsafe or contaminate water Discuss what prevention measures such as regulatory controls Discuss what a cancer cluster study involves and how one is proven to be true Discuss the current status of the acreage cancer cluster study in Palm Beach County Florida Groundwater * upper water table or deeper reservoirs Surface Water * lakes, reservoirs, rivers (Moeller, 2005, p. 161) There is no such thing as naturally pure water Some of these impurities occur naturally Others can come from man-made sources (U.S. Environmental Protection Agency, 2009) U.S. EPA – categorizes water contaminants into the following categories: - microorganisms * Giardia Lamblia - disinfectants * chlorine - disinfection by products - inorganic chemicals * arsenic - organic chemicals *benzene - radionuclides * radium U.S. Environmental Protection Agency (2010). At the Federal Level : Safe Drinking Water Act (SDWA P.L. 95-523) Purpose of SDWA is to ensure public water supplies are free from potentially harmful materials and that supplies meet federal standards for public health However, keep in mind the SDWA does not provide protection for small water systems and / or private well use (U.S. Environmental Protection Agency ,2008). At the state and local level: Florida Safe Drinking Water Act Specifically sets drinking water standards for over 100 chemical compounds, microorganisms, and radionuclides considered health risks (again this does not pertain to private well consumers) In order to provide some legislature for private well water consumers the state legislature passed the Florida Statutes Chapter 64E-8 Drinking Water Systems to provide standards for well setback and well construction A cancer cluster is a greater than expected number of cancer cases occurring within a group of people in a specific geographic area over a specific period of time (Centers for Disease Control , 2009) A true cancer cluster should have the following characteristics: Several cases of a rare type of cancer Lager than expected numbers of a more common type of cancer Type of cancer not usually seen in this type of people (children with adult type cancer) (American Cancer Society , 2010) According to the American Cancer Society more that 1,000 suspected cancer clusters are reported to State Health Departments each year Cancer is the cause of death for 1 out of every 5 Americans Specifically for children in 2007, 10,400 children under age 15 were diagnosed with cancer, making it the leading cause of death by disease among US children 1-14 years of age (American Cancer Society 2010a) Many researchers are skeptical of cancer clusters for the following reasons: People tend to treat random events as though they are not random (clustering illusion) Cancer is not just one disease; it is actually an umbrella term for at least 100 different but related diseases Each type of cancer has certain known and/or suspected risk factors associated with it. Cancer is almost always caused by a combination of factors that interact in ways that are not yet fully understood. (American Cancer Society, 2010b) Model used by epidemiologists that states that no one factor is the sole cause for a disease or chronic condition, rather for a disease such as cancer several factors predetermine the disease and these factors all interrelate with each other (Krieger, N. 1994) May 13 2009: Florida Department of Health Bureau of Epidemiology received request from concerned citizen to investigate possible high occurrence of pediatric brain tumors for acreage residents The Florida Department of Health then launched a Level 1 investigation Data gathering: review of health statistics for acreage area for time period of 1995-2007. Existing data from Florida Cancer Data System and 2000 US census data was used Level 1 study can not link causality, it is just to determine if an increase incidence of pediatric brain tumors does exist (Palm Beach County Health Department, 2009) Florida Department of Environmental Protection in conjunction with Florida Department of Health sampled 50 wells for a variety of contaminants Preliminary findings showed that water form residential wells met drinking water standards (Florida Department of Environmental Protection, 2009). Total Cancer rates may be elevated in the acreage, not specifically for pediatric cases However, is the data a true representation of recent population since population data used was from 2000 Level II investigation is occurring to recalculate rates with more recent population estimates, verify if pediatric brain tumor rates are greater than expected, and further examine residence histories and additional risk factors for pediatric brain cancers Florida Department of Environmental Protection has concluded its involvement at this time American Cancer Society (2010). Cancer Clusters. Retrieved on January 20 2010, from http://www.cancer.org/docroot/PED/content/PED_1_3x_Cancer_Clusters.asp?sitearea=PE D. American Cancer Society (2010) . Childhood Cancer. Retrieved on January 23 2010, from http://www.cancer.gov/cancertopics/factsheet/Sites-Types/childhood. Centers for Disease Control (2010) Cancer Clusters. Retrieved on January 20 2010 from http://www.cdc.gov/nceh/clusters/about.htm. Florida Department of Environmental Protection (2009). Retrieved on January 20 2010, from http://www.dep.state.fl.us/secretary/news/2009/files/2009_11_report.pdf. Krieger, N. (1994). Epidemiology and the web of causation: has anyone seen the spider? Soc. Sci Med Oct;39(7), 887-903. Retrieved on January 29 2010, from http://www.ncbi.nlm.nih.gov/pubmed/7992123. Moeller, D.W. (2005). Environmental Health Third Edition. Cambridge, MA:Harvard University Press. Palm Beach County Health Department (2009). Acreage Cancer Cluster Review and Findings. Retrieved on January 20 2010, from http://www.pbchd.com/pdfs/environmental/acreage_cancer_cluster_review.pdf. Palm Beach Post (2009) . Palm Beach Post News. Retrieved on January 20, 2010, from http://www.palmbeachpost.com/news/new-tests-in-acreage-cancer-study-to-focus167987.html. U.S. Environmental Protection Agency (2009). Ground Water and Drinking Water What Contaminants may be found in Drinking Water. Retrieved on January 23 2010, from http://www.epa.gov/safewater/dwh/contams.html. U.S. Environmental Protection Agency (2010). Drinking Water Contaminants. Retrieved on January 22 2010, from http://www.epa.gov/safewater/contaminants/index.html. United States Environmental Protection Agency (2008). Safe Drinking Water Act (SDWA) Basic Information. Retrieved on December 30 2009, from http://www.epa.gov/safewater/sdwa/basicinformation.html (2008) Chapter 64E-8 Drinking Water Systems http://www.myfloridaeh.com/water/manual/pdfs/64E-8.pdf.