St.
Pius X
Facilites Environmental Committee
SCHOOL ENVIRONMENTAL CONCERNS UPDATE
Several weeks ago we informed you of concerns that some school parents brought to us regarding 3 cases of Hodgkin's disease, diagnosed in the last 3 years, involving former St. Pius X students. We would like to update you on the steps we have taken and what information we have to date. (View discussion on causes of Hodgkin's.)
- June 8, 2004 Concerns of some school parents regarding 2 recent cases of Hodgkin's disease, and 1 case in 2001, were brought to parish business office.
- June 10, 2004 Research on internet, and decision to form a school environmental committee to further research and form a plan of fact finding, testing, and communication.
- June 12 - 18, 2004 Calls to potential committee members; Committee formed and first meeting set.
- June 23, 2004 Environmental committee met to do whatever they can to help assure the school families that St. Pius X School is a safe environment. Committee decides to contact state epidemiologist for information and advice. Facilities committee representative explains efforts already underway since early spring to improve the school ventilation system. Committee decides to expand on the testing that is already done annually, to further assure safety.
- June 24-July 2, 2004 Contact made with families of Hodgkin's patients; pulpit announcement made to inform parish of concerns; communication with Indiana State Department of Health's epidemiologist; communication with environmental testing companies.
- July 8, 2004 Risk factors for Hodgkin's info received from State Department of Health, as well as a letter stating they have little data on causes and it is difficult to distinguish between random excess and excess due to a specific cause. Advised that environmental audit St. Pius is having done is a good idea.
- July 13, 2004 Thorough environmental testing to be done at St. Pius School; Results may take up to 3 weeks.
- July 25, 2004 Update to parishioners circulated in Sunday Bulletin.
We will continue to keep you informed as we have new information. For more details return to our website at www.spxparish.org
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Dear St. Pius Parishioners,
We wanted to take this opportunity to further update you on actions we have taken this summer to assure a safe environment for our children at St. Pius X School.
As noted in previous communications, when concerns were brought to us regarding recent Hodgkin's cases, and the questions as to whether our school could be linked as a cause, we immediately acted. Our first step was to form a committee of parishioners who are knowledgeable about cancer, quality of the environment, and the history of the St. Pius school building. We came up with a plan for research, further professional help, testing, and communication. We spoke with the families involved, one with a daughter diagnosed in 2001, and two with daughters diagnosed this spring of 2004. All three families have stated that their doctors do not feel there is any reason to suspect the school as source, and these families reassured us that they would not hesitate to return their children to St. Pius. Several lengthy conversations followed with the Indiana State Department of Health epidemiologist. He was given the types of cancer, dates diagnosed, and ages of all the cancer patients that we have knowledge of over the last 15 years. He said these cases would not be considered a cluster. There are 5 different cancer types that we know of and he said this is not what would be expected if there were an environmental issue.
On July 13, 2004, Micro Air, Inc. conducted testing in our school. They sampled for mold, bacteria, carbon monoxide, carbon dioxide, temperature, relative humidity, hydrogen sulfide, and methane in 6 locations in the building and 2 locations outside the building. They also sampled for nitrates in the drinking water, and did sampling for airborne asbestos and radon in the building. Some of these tests will be repeated once the children have returned to school. Limited research conducted by Micro Air, Inc. indicates that there is no definitive known cause of Hodgkin's disease, therefore Micro Air has approached the study in terms of ensuring that the building is a healthy learning and work environment. The results of the tests may take three weeks or more to complete.
Also on July 13, 2004, we met with Peine Engineering, who has been contracted to work on our ventilation system in the school, to reduce the humidity. This project was underway well before the current cancer concerns came to light. Also meeting with us was an indoor air specialist from the Marion County Health Department. She inspects many of the public schools. She approved of the work we are doing and she also did a walk through with us of our school building. She has offered to meet with teachers to give them ways to help with the quality of the environment, and she will also join us for our parish meeting on August 4th.
We appreciate your patience as we sift through all the research and work in order to ensure environmental safety. If you have questions, please feel free to ask them. The Environmental Committee member names and phone numbers are listed below and they would be happy to field your questions and try to get you the answers. We all have the same goal - to assure a safe environment in the school.
Sharon Wagner; Jim Bastnagel; Roland Gamache; Bud Watts; Susan Tsangaris; Ellen Farrell; Nick Fohl (see parish directory for individual phone numbers).
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Letter From State Epidemiologist
Dear Ms. Wagner:
This letter is in response to your telephone report of an excess of cancer among students at Saint Pius X School. You stated that in the last several years there have been 8 cases of cancer among current and previous students and that these 8 cases were represented by 5 different cancer types. Your major concern centered on Hodgkin’s disease.
The following information might help put the parish’s cancer concerns in perspective:
- Cancer is a common disease, even among children. One third of us will get cancer some time in our life. Cancer is the second most important cause of death among children from 1 to 14 years of age.
- Cancer is not a single disease, but actually hundreds of different diseases, each with its own causes, progression, and outcome.
- Except for a few types of cancer (e.g., lung cancer) we have very little data on what causes cancer.
- The general consensus among researchers is that most cancers are caused by lifestyle factors (e.g., smoking, diet, lack of exercise, etc.). Genetics and viruses can also play a role. Far less than 5% of cancers are thought to be caused by environmental toxins.
- If a group of cancers were to be caused by an environmental toxin, we would expect all of the cancers to be of the same type.
- Cancer does not occur in a regular pattern in the population. Like most natural phenomena, cancer occurs more or less randomly, resulting in an excess number of cases in some areas and a below average number of cases in others.
This last point is very important in attempting to understand the situation at Saint Pius X School. Because cancer is so common, sometimes people become concerned when they notice how many cases are occurring around them even when no excess is present. In other instances, people notice when random variation produces an excess of cases in some readily identifiable population (e.g., a neighborhood, workplace, school, etc.). It is very difficult to distinguish between a random excess and an excess due to a specific cause. In fact, the lack of success in discovering the cause of localized excesses of cancer has led CDC to stop investigating perceived cancer clusters except for very special cases.
So where does that leave Saint Pius X School? Although the number of cases that you have compiled seems higher than would be expected, the fact that the cases occurred in both current and graduated students means that the population at risk is greater than the 450 student enrollment of the school. That is to say, by counting ex-students, the population from which the cases arose is larger than just the current enrollment. This could explain at least some of the apparent excess. Another fact that needs to be considered is that the 8 cases include 5 different cancer types. This is not what would be expected if there were an environmental cause at work in the school. I think the environmental audit of the school that you have commissioned is a very good idea because it should identify any toxins or other hazards in the school that might be putting students at risk. At this point, I think this is the most that can be done.
Please keep me informed if other cases come to your intention. In the meantime, if you have further questions please don’t hesitate to ask.
Sincerely,
Robert Teclaw DVM, PHD, MPH
State Epidemiologist
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Minutes From
School Environmental Committee Meeting
Wednesday, June 23, 2004
In attendance: Jim Bastnagel, Ellen Farrell, Susan Tsangaris, Nick Fohl, Roland Gamache, Bud Watts, and Sharon Wagner (SPX Business Manager).
The purpose of this group is to research the concerns, communicate the issues, the facts and the findings, and determine the method of investigation and testing.
Concerns have been brought to the parish staff and shared among school families regarding the fact that 3 young women, who attended St. Pius grade school, have been diagnosed with Hodgkin's disease within the last 3 years. There have also been 5 other cases, which we know about, of different types of cancer in other former students since 1989.
Christi Bastnagel, whose daughter Erin was diagnosed in 2001, spoke with Erin's physician regarding the 3 Hodgkin's cases. His response was reassuring and he indicated that he would not hesitate to send his children to St. Pius.
This committee wants to make sure we do everything we can to determine that St. Pius school is a safe environment. This is not about protecting St. Pius, but about protecting the children. Fr. Jerry (who could not attend due to a prior commitment) has said we will do whatever we need to do and we will find the money to do it. This committee needs to provide the correct info to the parish, help the rumor mill spread TRUE information.
Bud Watts from the Facilities Committee explained the efforts already underway to improve the school ventilation system and handle the humidity. Work has already been approved by the Facilities Committee and the Finance Committee and will begin in July. The changes will dehumidify the school without the need for additional units placed in the hallways. This system will bring in outside air to circulate. It will also treat the area with oxygenated air at night to "clean" the air. The company St. Pius is working with, and the Marion County Health Dept. have both praised St. Pius for the aggressive efforts they have taken and the money spent to stay on top of issues and make changes.
This committee feels we should progress as follows:
§ Contact the families of the 3 Hodgkin's patients. Let them know what we are doing; ask if they are okay with use of their info for investigation.
§ Contact the Indiana State Dept. of Health and talk with an epidemiologist. This person will look at anything unusual. The epidemiologist will try to determine if this group of Hodgkin's diagnoses, in this time frame, indicates environmental exposure as a cause. This person will probably need names, ages, date of onset, types on cancer, and contacts for all the patients we know about.
§ Communicate to the parish from the pulpit this Sunday, that concerns have been expressed and that we are acting on these concerns.
§ Set up website communication with Mike Coffey.
§ Get list of possible cancer causing carcinogens from the Dept. of Health in order to have some focus to the testing.
§ Set up testing with Dept. of Health, ACT (company we have used before), and possibly another company (Microaire was recommended by Peine) and have tests done ASAP.
§ Communicate results to parish in various forms - pulpit, pastor's bulletin letter, mass mailing to school families, website.
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Announcement June 26 - 27, 2004 from Fr. Jerry:
I would like to let you know that 2 young women in our parish have recently been diagnosed with Hodgkin's disease and are under their doctors' care. A third young woman was diagnosed with Hodgkin's in 2001 and has been disease free since her first cycle of treatment. Due to the fact that all three of these parishioners attended St. Pius grade school, some school parents have brought questions and concerns to the staff about the school environment.
I want to let you know that we have formed a committee of parents including physicians, a nurse, a St. Pius facilities committee representative, and a State Department of Health, Public Health Director, and we are investigating these concerns. We want to make sure that you have the correct information, rather than bits and pieces of the rumors that are circulating.
If there is an environmental risk in our school, we will find it and fix it. I will see to that.
We
will move quickly and thoroughly in this investigation and will communicate
all results to you as they are received. We will be adding information
as we have it to our website at www.spxparish.org . After accessing the
home page, hit the "facilities" tab and find a link to current environmental
concerns. We appreciate your support and understanding as we address these
concerns.
Thank you, Fr. Jerry
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Email Discussion Re: Causes of Hodgkin's Disease
From: Robert Teclaw [Rteclaw@isdh.state.in.us]
Sent: Wednesday, July 07, 2004 4:38 PM
To: Sharon Wagner
Subject: Causes of Hodgkin's disease
Here are various possible causes of Hodgkin's
from various sources
separated by *************.
The bottom line is that no one really knows what causes it.
Thanks.
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Hodgkin's Disease Risks
Researchers worldwide have yet to establish
a specific cause or
dominant susceptibility factor for Hodgkin's disease (HD). Recent
findings from several studies and clinical trials, however, have
highlighted a number of potential risk factors for developing HD,
including:
Age:
The likelihood of developing Hodgkin's disease increases in young
adults, particularly males in their mid-20s. Risk decreases in middle
age, but then increases again from the age of fifty on.
Reduced immunity: Individuals with a lowered immune response, for
whatever reason, are more likely to develop HD. For example, a link has
been established with the increasing number of occurrences of acquired
immune deficiency syndrome (AIDS) and the onset of HD.
Drugs:
Immunosuppressive drugs, such as those used for the treatment of
rheumatoid arthritis, or drugs administered routinely following an organ
transplant, have been shown to increase the likelihood of developing the
disease.
Infection:
Individuals who have had glandular fever (infectious
mononucleosis), an infection caused by the Epstein-Barr virus, may be
at
increased risk.
Exposure to environmental carcinogens:
Pesticides, herbicides, viruses,
bacteria and various other environmental factors may increase the risk.
Genetics:
Some studies have revealed a genetic susceptibility in
identical twins. The identical twin of an affected individual appears
to
have a greater risk than a random individual of developing HD in young
adulthood. However, more research is required to link genetics with an
increased susceptibility to developing Hodgkin's disease.
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There is reasonable evidence suggesting occupational
exposure to
phenoxy herbicides could result in both Hodgkin's and non Hodgkin's
lymphoma. These compounds act as growth regulators and cause destructive
proliferation of tissues in plants.
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WHAT ARE THE RISK FACTORS FOR HODGKIN'S DISEASE?
About 7,400 new cases of Hodgkin's disease
are diagnosed in the US each
year. Experts believe that the malignant process leading to Hodgkin's
disease is triggered by a combination of environmental and genetic
factors along with a susceptible immune system. The exact triggers,
however, are unknown.
Gender
Hodgkin's disease is more common in males.
In the last few years,
however, the incidence of HD has increased dramatically in young women.
This rise is associated with an increase in incidence in nodular
sclerosis Hodgkin's disease. One possible explanation for this trend is
that after pregnancy, a woman gains protection against nodular sclerosis
Hodgkin's. Such protection may be delayed now because women tend to wait
longer until they bear children. Women who get Hodgkin's disease appear
to have a slightly lower risk for relapse after treatment than men do.
Age
Initial Risk by Age Group.
Hodgkin's disease is the most common
malignancy in people ages 10 to 30. The average age for developing
Hodgkin's is about 28 years old. There are two periods of peak incidence
in HD over a lifetime. The major peak occurs in young people between the
ages of 15 and 24, with a lesser peak after age 55. The disease can,
however, occur at all ages, even in children.
A 2001 Scandinavian study reported an increase
in cases among young
people. The rate of the disease in older people has declined, however,
possibly because better diagnostic procedures are identifying elderly
people with non-Hodgkin's lymphomas who would previously have been
diagnosed with Hodgkin's.
Prognosis by Age Group.
Studies suggest that children with Hodgkin's
disease have a better outlook than adults -- particularly elderly
adults. One 2000 study suggested, however, that the reason is due to
better HD treatments in pediatric medical centers than in adult centers.
In support of this, another 2000 study reported
that when elderly
patients were treated successfully for relapse they did as well as
younger people. (In any case, unrelated illness would affect treatment
complications and outlook in elderly people.)
Family Factors
Hodgkin's disease runs in families in about
5% of cases. Siblings have
a threefold higher risk than the general population. Studies suggest,
however, that such family clusters are more likely to be due to
environmental than genetic factors.
Epstein Barr Virus
Infections appear to play some role and to
support the theory of an
infectious agent. Researchers have noted that the first symptoms of
Hodgkin's disease peak in winter, when viral infections are also at
their highest level.
A higher than normal rate of Hodgkin's disease
occurs in people who
have had infectious mononucleosis, which is caused by the Epstein-Barr
virus (EBV). EBV has been detected within the abnormal Reed-Sternberg
cells in many (but not all) Hodgkin's patients. Some experts believe
that the virus may actually protect the Reed-Sternberg cell from normal
cell death (apoptosis) and from the immune response of killer T-cells,
which would ordinarily destroy these abnormal cells.
EBV most likely plays a role in only about half of HD cases. It appears
to have a higher incidence in Hodgkin's patients with the subtype mixed
cellularity and a lower incidence in patients with nodular sclerosis.
In
fact, there have been reports of a decline in Epstein-Barr associated
HD
coinciding with a increasing incidence of nodular sclerosis HD. Studies
suggest the EBV-associated Hodgkin's disease is more severe in the
elderly (although possibly not in younger people) than other forms of
HD.
It should be further noted that the virus
is a very common infection in
the general public, and in the great majority of cases only causes a
mild infection that has no long term significance. Some evidence
suggests that ethnic differences may account for a lower or higher
susceptibility to Hodgkin's disease after an Epstein-Barr infection,
with Northern Europeans being at higher risk than other groups.
Exposure to Chemicals
Although high exposure to industrial chemicals
has been linked to
non-Hodgkin's lymphomas, it is not clear if this is a major risk factor
in HD. In a 1999 analysis of studies on the subject, woodworking posed
the most consistent risk, although no specific chemical was implicated
and not all studies reported a risk. In a 2000 study, automobile workers
exposed to cutting oil had a much higher incidence of HD as well as
cancers of the lung and testis. Dioxin may also be associated with a
higher risk for HD.
Other Risk Factors
The following are groups that have a slightly
higher than normal risk
for HD:
People who are from small families, have
higher educational levels, and
are from homes with good hygiene.
Geographically, people living in developed
countries have the highest
incidence of Hodgkin's disease. Hodgkin's disease is very uncommon in
people who live in Eastern Asia and the Pacific Islands.
People who are HIV-positive are at increased
risk for Hodgkin's and the
incidence is increasing.
Some studies have reported an association
between inflammatory bowel
disease (ulcerative colitis or Crohn's disease) and HD. (One study
suggested that this relationship may be due to Epstein-Barr virus, which
could play causal role in both disorders.)
********************************************************
What causes Hodgkin's disease?
The cause of Hodgkin's disease is unknown
but certain factors may
predispose to this condition.
Patients with certain genetic immunodeficiency
disorders may be more
susceptible to the disease.
Environmental factors such as the presence
of nitrates in water, and
the use of herbicides and insecticides in farmers.
*********************************************************
What causes Hodgkin's disease?
Risk factors are anything that can increase
the chance of developing a
disease. They may be lifestyle-related, genetic (inherited) or
environmental. The risk factors that a relate to other cancers such as
diet, smoking and unprotected sun or pesticide exposure are not related
to Hodgkin's disease. In fact, there are few risk factors that link
directly to the development of Hodgkin's disease.
Age/Sex:
The disease occurs more often in males in
the primary age categories,
early adulthood (15-40) and late adulthood (after 55).
Genetic:
Brothers and sisters of Hodgkin's disease
patients have an
above-average chance of developing the disease but the significance of
the family relationship as the primary cause is not known.
Infection:
The Epstein-Barr virus (EBV), which causes
mononucleosis, may be linked
to an increase in the risk of developing Hodgkin's. EBV is a virus that
infects B-lymphocytes, causing them to grow and live longer. If the
body's T-cell production is compromised, then the B-cells continue to
accumulate, increasing the chance for the disease to develop. However,
more than half of all Hodgkin's patients have no evidence of a previous
EBV infection so a definitive relationship is still unclear.
Medical Conditions:
People with compromised immune systems are
at greater risk for
Hodgkin's disease but Hodgkin's disease is less common than other
cancers such as NHL in these patients.
Human immmunodeficiency virus (HIV or AIDS virus) infection poses a
risk factor for developing Hodgkin's disease
Organ transplant patients undergo drug therapy that suppress their
immune system (T-cells) to keep it from attacking the new organ(s).
Depending on the drugs used, this intentional suppression poses a
significant risk to the patient of developing Hodgkin's disease.
Unfortunately, the bottom line is that most
patients with Hodgkin's
disease have no known risk factors, therefore the true cause of
Hodgkin's disease is still unknown. However, it is important to note
that Hodgkin's is NOT contagious so patients pose no health risk to
others at any time and possessing a risk factor does not mean a person
will develop Hodgkin's disease.
******************************************************************
Which cancers affect children most often?
Leukemia is the most common childhood cancer,
representing 31.5 percent
of cases in children under 15. Next most common are central nervous
system cancers including brain cancer (20.2 percent), lymphomas
including Hodgkin's disease and non-Hodgkin's lymphoma (10.7 percent),
neuroblastoma and other cancers of the nerves (7.8 percent), soft tissue
sarcomas (7 percent), kidney cancers (6.3 percent) and cancer of the
bones (4.5 percent).
The patterns of these cancers vary by age.
For infants, neuroblastoma
is the most common form, accounting for 28 percent of cases. Leukemia
(17 percent), central nervous system cancers (13 percent),
retinoblastoma (12 percent) and Wilms tumor (9 percent) are the next
most common. For children up to 15 years, the most common cancers are
leukemia, brain and central nervous system cancers, lymphoma, soft
tissue sarcomas, kidney tumors and cancer of the bones.
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Is childhood cancer caused by genetic or environmental factors?
Childhood cancer doesn't usually run in families,
and there is little
evidence for a strong genetic predisposition. Evidence does exist,
however, for environmental links with childhood cancer. But it will most
likely turn out that both genetic and environmental factors are
involved. For example, some children may have genetic predispositions
toward cancer that are triggered by environmental exposures, or they may
be less able to tolerate exposure to a toxic or cancer-causing chemical.
This may explain why some children who are exposed to hazardous
substances develop cancer, while many others do not.
*********************************************************************
What are the links between pesticides and childhood cancer?
Numerous research studies have uncovered
links between pesticide
exposure and childhood cancer. Most of the research has focused on
leukemia and brain tumors, and the majority of the studies have found
connections with pesticides. However, there are many uncertainties. For
example, not all studies identified a link with pesticides, and the
studies that did find a link were usually unable to identify the
particular chemical that might have been responsible; instead, they
found links with insecticide use generally, or with working on a farm.
It also remains unclear if there are certain people who are more
susceptible, and if there are certain times of life during which
children are most vulnerable. Because of these uncertainties, it is
difficult to be sure what to protect children from. The best course is
to decrease or eliminate any unnecessary pesticide exposures.
**********************************************************************
What other environmental exposures may cause childhood cancer?
Research has linked childhood cancer to numerous
environmental factors.
Some of these may occur before the child is even born. For example,
parents who were exposed to solvents (such as paint thinners,
degreasers, glues or gasoline) on the job are more likely to have
children who develop leukemia or brain tumors. A few studies have found
possible links between exposure to electromagnetic fields and childhood
leukemia, although these results are contradicted by several good
studies that found no such link. Ionizing radiation (such as that
produced by nuclear bombs, nuclear power plants, and X-rays) is a known
cause of childhood cancer. Other likely links include cigarette smoke
and radon gas.
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This is Bob Teclaw again. I think you get
the idea that there are no
smoking guns identified. I think the best goal for your environmental
audit is to be able to say that no toxic substances were found or that
the few toxins found have been removed and that there is no strong
scientific evidence linking them to childhood cancer in general nor
Hodgkin's in particular. Please let me know if you need more or
different information.
Bob Teclaw
Robert
F. Teclaw DVM, PhD, MPH
State Epidemiologist
Indiana State Department of Health
2 N. Meridian, 3D
Indianapolis, IN 46204
317/233-7807
FAX 317/234-2812
rteclaw@isdh.state.in.us
END
