{"id":90668,"date":"2016-09-21T10:53:13","date_gmt":"2016-09-21T14:53:13","guid":{"rendered":"https:\/\/www.bu.edu\/sph\/?p=90668"},"modified":"2020-09-17T10:26:58","modified_gmt":"2020-09-17T14:26:58","slug":"toxic-legacy","status":"publish","type":"bu-article","link":"https:\/\/www.bu.edu\/sph\/news\/articles\/2016\/toxic-legacy\/","title":{"rendered":"The Cape Crusader"},"content":{"rendered":"\n
\n\t
\n\t\t\t\t\t
September 21, 2016<\/div>\n\t\t\n\t\t\t\t
\n\t\t\t\t\t<\/div>\n\t\t
\n\t\t\tTwitter<\/span><\/span>\n\t\t\tFacebook<\/span><\/span>\n\t\t\t<\/span>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n

\"ASCHENGRAU\"<\/h2>\n

This article originally appeared in BU Research<\/a>.<\/em><\/p>\n

In January 1992, Ann Aschengrau<\/a> stood in front of a packed auditorium in Falmouth, Massachusetts. Hundreds of people had gathered to hear her explain why the cancer rates on Cape Cod were so high.\u00a0According to the Massachusetts Department of Public Health, breast cancer in Barnstable was 41 percent higher than the state average, even after accounting for the town\u2019s older population. Colorectal cancer was 49 percent higher in Bourne, lung cancer was 79 percent higher in Falmouth. The atmosphere was tense; the crowd wanted answers.<\/p>\n

There were a few possible culprits: smoke from a coal-fired electric plant, leaking landfills, pesticides sprayed on cranberry bogs, the sprawling Massachusetts Military Reservation, and water pipes contaminated with a neurotoxin called PCE. Community groups had demanded that the state launch an investigation, and the task fell to Aschengrau, a Boston University School of Public Health (SPH) professor of epidemiology<\/a>, and her colleague David Ozonoff<\/a>, an SPH professor of environmental health<\/a>.<\/p>\n

The study, begun in 1988, became hugely politicized, with activists, cancer survivors, and the military pointing fingers, laying blame, demanding answers. By the evening of her presentation, Aschengrau feared an ugly confrontation. \u201cI was terrified of a scene with the activists, between the activists and the military people, all on TV and radio,\u201d she recalls.<\/p>\n

The study results, presented that night in Falmouth, pleased no one.<\/p>\n

There was no smoking gun. The scientists found an association between fumes from burning propellant bags on the military reservation and lung and breast cancer. They also found links between cranberry growing and brain cancer, and between PCE-laden drinking water and leukemia and bladder cancer.<\/p>\n

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.
\n\u201cI think we know a lot more now than we did three years ago,\u201d Aschengrau told the Cape Cod Times<\/em> after the meeting. \u201cA lot of things people were concerned about couldn\u2019t possibly have caused the cancer.\u201d The study noted, for instance, that groundwater contamination from the military reservation, the electric plant, or local landfills posed \u201cno increased cancer risk\u201d or \u201cdoubtful\u201d risk.Cape Cod residents\u2014at least those who spoke to reporters\u2014were unsatisfied. One young woman told a reporter, \u201cFor $500,000, we have a lot of maybes and that\u2019s not good enough.\u201d Deborah Queen, a 43-year-old resident of North Falmouth, told a television reporter, \u201cI expected to find some magic answer why I have breast cancer. That\u2019s why I came. I\u2019m disappointed.\u201dJoel Feigenbaum, a prominent community activist, called the work \u201cintellectually sloppy.\u201d\u201cThey said bad things about us in the newspaper; they yelled at us at the public meetings,\u201d recalls Ozonoff. \u201cAnd as somebody who\u2019s always been close to the community groups, it wasn\u2019t very happy or pleasant.\u201dAschengrau, who prides herself on meticulous, carefully constructed research, and who had made a concerted effort to involve community groups, was dismayed. \u201cI felt like I was true to myself and my principles,\u201d she says, \u201cbut for a while, it felt like I was pulling the daggers out of my back. It took a while to get over it.\u201dAs painful as the experience was, the study led her to the work that ultimately shaped her career: the unique and tragic case of the water pipes contaminated with PCE, a solvent still used at dry cleaners and machine shops. Over 25 years, Aschengrau has continued to make remarkable observations about the relationship between PCE\u2014a common but little-studied groundwater contaminant\u2014and not only cancer, but also effects as diverse as illicit drug use, bipolar disorder, and diminished color vision. The research, funded largely by the National Institute of Environmental Health Sciences<\/a>, has helped establish Aschengrau as one of the leading environmental epidemiologists in the world, while building a body of knowledge about PCE.<\/p>\n

\u201cThe PCE issue has probably not gotten the attention that it deserves,\u201d says Ed DeWitt<\/a>, executive director of the Association to Preserve Cape Cod<\/a>, an advocacy group focusing on water issues. \u201cI think the attitude is that we have professional people running our public water supplies, and we can trust and rely on them. And increasingly the evidence has been: Well, not so fast.\u201d<\/p>\n

Toxic Water<\/h3>\n

People love Cape Cod for the water: the beaches of Truro, with their windswept dunes; the muddy, rippled Brewster flats; the salt pools and freshwater ponds that shape so many childhood memories. Water is Cape Cod\u2019s lifeblood, its raison d\u2019\u00eatre\u2014and its Achilles\u2019 heel.<\/p>\n

All the drinking water on Cape Cod comes from one source: a huge underground aquifer. \u201cWe don\u2019t have any river bringing water in to us,\u201d says DeWitt. \u201cAll the fresh water comes from rain.\u201d And, because the Cape is basically a sand bar, anything spilled on the ground will eventually trickle down and contaminate the drinking water.<\/p>\n

When Cape Cod boomed after the mid-20th century\u2014its population swelled 400 percent between 1950 and 1990, from 47,000 to about 187,000 people\u2014companies installed hundreds of miles of pipe to send drinking water to new homes. Because the water supply is so vulnerable, drinking water on the Cape can spew from spigots with a variety of tastes, from metallic to mineral. In 1968, responding to residents\u2019 complaints about the funny flavors, some companies began lining their water pipes with vinyl. To do this, they mixed pellets of vinyl resin with a solvent called perchloroethylene<\/a>, or PCE, and then sprayed the slurry inside the pipes.<\/p>\n

PCE is a \u201cprobable\u201d carcinogen, according to the US Environmental Protection Agency<\/a>, and a known neurotoxin. \u201cIt\u2019s not a good chemical,\u201d says Aschengrau. After spraying the slurry, companies were supposed to allow time for the PCE to evaporate from the liner, leaving a harmless water pipe behind. That wasn\u2019t the case, says Aschengrau. \u201cWe came to believe that the pipes were not sufficiently cured.\u201d<\/p>\n

Water companies installed 660 miles of vinyl-lined water pipe in Massachusetts, along with additional pipe in Rhode Island and Vermont. There was no centralized communication; small water companies, which varied from town to town, installed the pipes as needed. As a result, people on one street could have a surge of PCE in their drinking water, while their neighbors next door\u2014with older or different pipes\u2014would have none. In 1976, the EPA discovered the contaminated water, first in Providence, Rhode Island, and then in other towns. But it took them four more years to find the source and order a remediation: flushing the pipes with fresh water over and over until the PCE levels dropped below 40 parts per billion, the EPA\u2019s established threshold at the time. The threshold now is much lower, 5 parts per billion.<\/p>\n

Though the contamination was removed, the damage had already been done: thousands of residents exposed, sometimes for years, to a neurotoxin and probable carcinogen in their drinking water.<\/p>\n

An (U<\/span>n)n<\/span>atural Experiment<\/h3>\n

\u201cThe PCE contamination is a tragedy for people on the Cape, but also a unique opportunity to learn because it created a natural experiment,\u201d says Julia Brody<\/a>, executive director and senior scientist at the Silent Spring Institute<\/a>, which conducts scientific research on the links between environmental chemicals and health, and has been actively studying the Cape Cod water supply. \u201cScientists could never intentionally expose people like this in a way where you can compare exposed and unexposed people with relatively high certainty.\u201d<\/p>\n

Aschengrau, presented with this remarkable opportunity, began the painstaking, careful work at the heart of epidemiological research: constructing a cohort. A cohort, in public health\u2013speak, is a group of people who have shared a particular experience during a particular time span\u2014in this case, people who lived on Cape Cod and were exposed to PCE in their drinking water between 1969 and 1983. Aschengrau narrowed the cohort further, restricting it to women who were pregnant and gave birth during this time.<\/p>\n

Building a cohort from scratch is arduous work. First, Aschengrau and her team gathered maps and data from water companies, trying to determine where companies had installed vinyl-lined pipe and which houses had been exposed. They gathered data about the age of each pipe, the size, which way the water flowed. Then, she and her students combed through 14,000 birth certificates by hand, looking for street addresses that matched exposed houses. They found about 2,000 births that matched exposure to PCE and 2,000 that didn\u2019t. They sent questionnaires to the mothers listed on the birth certificates, asking about birth weight, prematurity, miscarriage, birth defects, and learning disabilities.
\n\u201cThere were lots of different pieces to this thing, a tremendous number of moving parts that all had to be put together,\u201d says Ozonoff. \u201cAnd that\u2019s what Ann did.\u201dThe work suited Aschengrau, who is known for her careful nature and attention to detail. It\u2019s evident in the clarity of her writing\u2014she and her husband, George R. Seage III<\/a> (SPH\u201983, \u201991), coauthored the best-selling textbook in the field, Essentials of Epidemiology in Public Health<\/em><\/a>\u2014and in her personal habits, like compulsively straightening pictures hanging on the wall. \u201cSometimes we\u2019ll be watching TV, and she\u2019ll stand up and adjust a picture a quarter of an inch,\u201d says Seage. \u201cShe does the same thing in my office. It must really bug her.\u201d (\u201cIt really does bother me,\u201d confirms Aschengrau.) When she and Seage bought their house in Wayland, Aschengrau had her well water tested for 300 different chemicals. \u201cIt\u2019s fine,\u201d she says.The same meticulousness appears in her science. \u201cShe\u2019ll pore through a hundred old records just to get two more cases for the study,\u201d says Lisa Gallagher, an SPH research assistant professor of epidemiology who has worked with Aschengrau for years. \u201cBut that, to me, just seems like the way to conduct an accurate study. You explore all avenues you can, to collect the data that you need. And that way, when you get to the end and you do your analysis, you have confidence in what you\u2019re looking at, because you did a thorough job.\u201dCompiling all the data took years, but once Aschengrau had the cohort in place, she began the process of discovery. In her first study<\/a>, she found an association between PCE exposure and certain birth defects; namely, neural tube defects like spina bifida and oral clefts. In subsequent studies<\/a>, she questioned the children\u2014now adults\u2014and added neuropsychological testing, vision exams, and MRIs to look at things like motor skills, visual acuity, intelligence, and mood. She found surprising associations between PCE exposure and risk-taking behavior, such as cigarette smoking, alcohol consumption, and cocaine and heroin use. She also found links between PCE and bipolar disorder, diminished color vision, and decreased attention. Over the past two decades, she has published more than 20 papers on the neurotoxic effects of PCE, the largest body of research ever compiled on the subject.<\/p>\n

Modern Problems<\/h3>\n

PCE remains a major contaminant of groundwater, with US surveys detecting it in 11 percent of tested wells and 38 percent of surface water supplies. The solvent is still used by dry cleaners and in machine shops and small auto repair facilities. \u201cIt\u2019s mainly used to clean things, like you take greasy auto parts and you dip them in the stuff, and it dissolves all the grease and gunk that\u2019s on it,\u201d says Ozonoff. When dumped improperly (or illegally), it ends up in drinking water.<\/p>\n

Aschengrau\u2019s group is asking a new question: Are the current EPA levels protective enough, especially for vulnerable populations like pregnant women and young children? \u201cIf we keep finding that this chemical has harmful effects, maybe they\u2019re not,\u201d says Gallagher. \u201cAnd so, it\u2019s something that\u2019s relevant for people now.\u201d<\/p>\n

Aschengrau also continues her research with the original birth cohort, looking at social factors that may increase or decrease the effects of PCE. For example, people exposed to PCE early in life might be less resilient to neglect or bullying during childhood. This might make them more likely to engage in risk-taking behavior as compared to unexposed children. \u201cI\u2019ve become really interested in the interaction between environmental exposures and social stressors,\u201d says Aschengrau. \u201cAlcohol and drug use have enormous health, social, and economic costs, and I hope this novel approach will help unravel their complex causes.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Epidemiologist Ann Aschengrau has spent 25 years researching toxins in Cape Cod’s drinking water.<\/p>\n","protected":false},"author":8472,"featured_media":90698,"comment_status":"closed","ping_status":"open","template":"","meta":{"bu_prepress_billboard":"","_bu_prepress_primary_term":"","_bu_prepress_primary_term_manual":""},"tags":[1535],"bu-publication":[3516],"sphnews-article-category":[3519,3529,3530,3531,3540],"sphnews-topic":[],"bu_edition":[],"media_type":[],"profile_tax":[368,436],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/90668"}],"collection":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article"}],"about":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/types\/bu-article"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/users\/8472"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/comments?post=90668"}],"version-history":[{"count":12,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/90668\/revisions"}],"predecessor-version":[{"id":174086,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/90668\/revisions\/174086"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media\/90698"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media?parent=90668"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/tags?post=90668"},{"taxonomy":"bu-publication","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-publication?post=90668"},{"taxonomy":"sphnews-article-category","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-article-category?post=90668"},{"taxonomy":"sphnews-topic","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-topic?post=90668"},{"taxonomy":"bu_edition","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu_edition?post=90668"},{"taxonomy":"media_type","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media_type?post=90668"},{"taxonomy":"profile_tax","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/profile_tax?post=90668"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}