The Cancer Conundrum

The disease remains a large public health issue in Delaware. The state is making efforts at improving detection and mortality rates. But it’s up to us, too.

Illustration by Revelation StudiosWhen the story “Eight cancer clusters discovered in Delaware” appeared in The News Journal on April 24, 2008, readers looked at the map of locations and held their breath. Some were relieved to learn their homes weren’t near a cluster. Others weren’t so fortunate.

About four in 10 Delawareans live in an area where cancer rates are 10 percent to 45 percent higher than the state average. As Governor Jack Markell and his team prepared to take office in January, addressing the issue was a priority. Their plan was to reduce environmental causes of cancer, increase enforcement of environmental regulations, promote healthy living among the citizenry and work closely with the Cancer Consortium to reduce cancer rates in Delaware. But we need to play a part, too.

Controlling Industrial Polluters

Though the cancer clusters are near known toxin-emitting plants and factories, it’s difficult to establish a cause-and-effect relationship. “One of our most important areas of focus has been looking at our energy and ways to reduce emissions,” says Collin O’Mara, secretary of the Department of Natural Resources and Environmental Control.

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Some of the big plants include the DuPont Company pigment plant and Conectiv power-generating plant east of Wilmington; the Valero oil refinery, Metachem Products and Formosa Plastics near Delaware City; and NRG’s Indian River power plant near Millsboro. But proving cancer is caused by a smokestack isn’t easy.

“I think there’s a constant process of trying to define the environmental causes of cancer,” says Lieutenant Governor Matt Denn. “They are difficult to measure, particularly in a small state, because environmental pollutants travel, whether in the air or the water.

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“The other challenge is that we have a fair number of people who come from other places where they may have been exposed to carcinogens,” Denn says. “The problem is that we don’t know conclusively. What we do know is that we have facilities that are releasing known carcinogens, so we should be trying to minimize the carcinogens in our environment now. Further studies are important, but they will not delay what needs to be done.”

Citing the Environmental Protection Agency’s 2008 Toxic Release Inventory, The News Journal reported in August about some significant drops in toxic releases during 2008. The decrease in toxins from General Motors and Chrysler were due to the plants closing, while the DuPont Edge Moor plant showed a 45 percent one-year drop in dioxins and a 90 percent one-year drop in PCBs due to a $25 million upgrade.

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Others showed decreases, too. Conectiv’s Edge Moor generating complex reduced toxic emissions by 20 percent, and Valero had decreased emissions by an unspecified amount.

But with Formosa Plastics showing a 33 percent increase in emissions and NRG showing a decrease of only 10 percent, there is still much work to be done. NRG remains the state’s largest source of toxic pollution.

O’Mara says that’s going to change with a consent decree by NRG.

“If enacted, the consent decree will take the NRG plant from being the worst polluter in the state to being one of the cleanest coal plants in the country,” O’Mara says. “Two of the four towers will come off-line, and the other two will have a half-billion dollars in new controls.”

Environmental activist Alan Muller of Green Delaware says retrofitting of the NRG plant will be a major improvement that will reduce particulate pollutants, including sulfur dioxide and mercury, by 80 percent to 90 percent. 

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“There are also new regulations being finalized for the Integrated Resource Plan,” O’Mara says, a document that examines the total cost of electricity to society, including long-term impacts on the environment and public health. “The process will be the first of its kind in the country, and will have impacts on air and water quality.”

“I give Markell credit for that,” says Muller, because Markell directed DNREC to intervene on behalf of the Public Service Commission, which regulates utilities such as electric provider Delmarva Power. “DNREC has submitted some good comments that I think are making a difference. If the governor hadn’t told them to get involved, they wouldn’t have. And that’s a positive development.

“There’s tremendous potential benefit if we can get the true cost of power plant pollution on the books,” he says. “We need to stop burning coal as soon as possible. Not only is it making us sick, but it’s also the single biggest cause of global warming.”

Another step toward reducing environmental pollutants is Senate Bill 106, the Energy Conservation and Efficiency Act of 2009. Signed by Governor Markell on July 30, the law mandates that state utilities reduce their energy consumption 15 percent by 2015. Before a utility company proposes a new energy supply to the state, it must show it has exhausted energy efficiency measures and that renewable energy sources are considered and deployed before fossil fuels.

Muller is concerned the bill may contain loopholes. For example, a working group seems to be able to change the requirements, but the bill doesn’t specify who appoints the members. “There isn’t any question that Bill 106 is good,” Muller says, “but can we get it done when the utilities are so powerful?”

New regulations lead to more enforcement, and that’s good. Yet Denn and Muller agree that limits of emissions are not strict enough. One plant, for example, is permitted to dump up to 38,000 pounds of oil and industrial waste into the Delaware River each day, Muller says.

“As situations arise where facilities violate state pollution regulations, we’re going to need to be vigilant about how we deal with those,” Denn says. “That has an impact not just on cancer, but on a variety of health conditions.”

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Promoting Healthy Living

As DNREC works toward a healthier environment, the Division of Public Health works to promote healthy living.

“The issues of proper nutrition and fitness are linked to cancer, so DPH is emphasizing both,” says public information officer Heidi Truschel-Light.

The American Cancer Society reports, “It is estimated that obtaining recommended cancer screening tests and adopting healthy behaviors such as good nutrition, reasonable body weight and regular physical exercise could eliminate at least 50 percent of cancer deaths.”

The report also states that tobacco use accounts for nearly 90 percent of lung cancer deaths and about 30 percent of cancer deaths.

To address these issues, the state has several programs and campaigns to promote healthy living and cancer screening. The Get Up and Do Something campaign encourages physical activity and offers information about ways to keep active in Delaware.

The Lieutenant Governor’s Challenge is a 12-week program aimed at developing or improving good exercise and fitness habits. More than 43,000 people have taken the challenge since it started in 2002.

The ban on indoor smoking was also a positive step. Delaware was an early adopter of the Clean Indoor Air Act in November 2000, which has reduced the health risk of second-hand smoke for Delawareans.

In addition, the state offers individuals help with smoking cessation through Quitline, free telephone or personal counseling for adult smokers, and Quitnet, an online resource for smokers of all ages. 

Delaware residents who meet eligibility requirements may receive free cancer screening through Screening for Life and, if needed, free cancer treatment is available for up to two years through the Delaware Cancer Treatment Program. Both programs were developed by the Cancer Consortium, a taskforce formed to create a cancer control and prevention program based on guidelines from the Centers for Disease Control.

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“The Cancer Treatment Program is significant because there is a proven difference between the treatment people get with insurance as compared to those without,” says Denn, a member of the Cancer Consortium. “We have been very vigilant about the state’s cancer programs, and we’re proud of maintaining prevention and treatment efforts at a time when a lot of state programs had to be cut dramatically because of the state and national budget crisis. We’ve begun to see some pretty striking results from the programs that have been in place for a few years.”

Delaware has experienced an increase in cancer screenings and has been making major strides in early cancer detection. According to the 2008 Behavioral Risk Factor Surveillance System, Delaware has surpassed the national rate for colorectal cancer screening. Seventy-four percent of Delawareans age 50 and over report having a sigmoidoscopy or colonoscopy, as compared to 62 percent nationally. Seventy-two percent of residents did so as part of a routine health exam, showing that Delawareans are being proactive about their health.

According to the 2008 Cancer Incidence and Mortality Report released by the Division of Public Health, cancer incidence and mortality rates have decreased in Delaware. Comparing data from 1991 through 1995 and 2001 through 2005, the all-site cancer incidence rate decreased by 5 percent in the state, while the national rate fell 4 percent.

Mortality rates in Delaware have dropped 17 percent for all-site cancers, as compared to the national decrease of 11 percent. The state’s incidence rates for colorectal, cervical and female breast cancers are now comparable to U.S. rates for years 2001 through 2005. Delaware saw a decrease of 20 percent in lung cancer incidence rates among males from 1991 through 1995 to 2001 through 2005, but a 2.5 percent increase among females.

Efforts to increase screening have impacted breast cancer, with 82 percent of women in Delaware ages 40 and older reporting having had a mammogram in the past two years. Early diagnosis of female breast cancer has increased from 42 percent to 64 percent since the period 1980 through 1984.

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Our Own Next Steps

O’Mara says DNREC is “working closely with the Cancer Consortium to get another study of environmental factors and cancer. We’re looking at federal, state and private sources to fund the study.”

What can individuals do as the Markell administration continues its fight against cancer in Delaware? “I think they should hold us accountable,” Denn says.

But we also need to hold ourselves accountable as individuals, however, to ask ourselves “What am I doing about it?”

First and foremost, be an advocate for your own health and for the health of your family. Eat right, exercise, don’t smoke, and get regular cancer screenings. If you have health insurance, use it. If you don’t have insurance, call the (800) 464-HELP to find out more about the programs and services that may be available to you.

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