Mike Partain (left) and Teddy Richardson in the Art beCAUSE breast cancer calendar (David Fox)So why might a bunch of macho middle-aged guys be such a gold mine for researchers hoping to reveal the secrets of what is generally regarded as a women's disease? Like women, men have mammary glands, a vestige of our evolutionary past. Structures called milk lines take shape early in human embryonic development, before our genes throw the switch that differentiates males from females. But men are far simpler to study than women. Their risk of developing breast cancer isn't complicated by sex-specific factors such as age of first menstruation, reproductive history, years of breastfeeding, and hormone replacement therapy. And because the disease is so rare in men, a spike in cases is easier to spot. While it's too early to say anything definitive, Frank Bove, the ATSDR senior epidemiologist leading the Lejeune studies, is impressed both by the number of men on Partain's list and by their relative youth—the average age of diagnosis is 56.
Last summer I ventured to Wilmington, North Carolina, for a meeting of the ATSDR's Community Assistance Panel, an advisory committee where experts such as Clapp serve alongside nonscientists like Partain and his friend Jerry Ensminger, a former drill instructor whose daughter, Janey, was raised at Lejeune and died of leukemia at age nine. In 2008, when Congress finally ponied up funding for federal scientists to investigate the illnesses, it was thanks in large part to activists like Partain and Ensminger stirring up holy hell in the media and the halls of government.
Partain and Ensminger fault the military for shutting down tainted wells too late, failing to disclose the extent of the pollution, and denying benefits to sick Marines.
Bullish and compact, Ensminger plays Calvin to Partain's measured Hobbes—though he prefers to say that he and Partain are Meathead to the Marine Corps' Archie Bunker. "If this is a family, it's dysfunctional," he told me. The two men were featured in Semper Fi: Always Faithful, a documentary that aired recently on MSNBC about the Lejeune residents' battle with the military for health benefits and information about the pollution.
The armed forces, of course, have a long history of making their uniformed ranks sick. There was ionizing radiation from various nuclear detonations, Agent Orange in Vietnam, Gulf War Syndrome, and, most recently, burn pits spewing dioxin and other toxins in the Iraqi outback. In each case, Congress has had to compel the Department of Defense to study the resulting illnesses and offer redress to the troops. At Lejeune, Partain and Ensminger fault the military for shutting down its tainted wells too late, failing to disclose the full extent of the pollution, and denying benefits to sick Marines. To date, Lejeune vets have filed more than 2,100 medical claims, many for illnesses like non-Hodgkin's lymphoma, kidney and bladder cancer, and cirrhosis of the liver, which have known or suspected links to the solvents found in Lejeune's wells. The Veterans Administration has approved only 25 percent of the claims it has reviewed.
As the three of us walked through the University of North Carolina campus to the room where the panel was meeting, Partain commented on Ensminger's cowboy boots. "That's for kicking some ass," Ensminger shot back.
True to form, during introductory remarks, Ensminger lit into the Marine Corps for sending only a silent observer to the meeting. Then federal epidemiologist Perri Ruckart rose to deliver a status report: An earlier birth-weight study was being reworked based on new—and more damning—pollution data. Another study was examining the rates of birth defects and cancers among children born at Lejeune between 1968 and 1985. Also in the works was a morbidity study of 300,000 former base residents and workers, focusing on cancer and other illnesses that might be related to the water.
The worst of the chemicals found in Lejeune's water remain in wide use: TCE is no longer a pet food additive, but it is still an industrial degreaser.
While tens of thousands of women have lived or worked at Lejeune over the years, the extent of breast cancer among them remains a mystery. The morbidity study could reveal whether the numbers—both male and female—are truly out of the ordinary. It is a classic case-control study, comparing a population researchers are interested in with a demographically similar group—in this case, former residents and workers at California's Camp Pendleton—to determine which group is sicker.
It's not as easy as it sounds. To get reliable results, you have to enroll huge numbers of people. If only the sick sign up, you've got a problem known as selection bias, which skews the results. The Lejeune researchers won't merely rely on study participants to tell the truth; they'll laboriously confirm the medical diagnoses.
When these kinds of studies pan out, they can have a major impact on public policy and medical practice. It was case-control studies, for instance, that first reliably linked smoking to lung cancer, resulting in warning labels, class-action suits, and public health campaigns. The Lejeune studies will take years and cost north of $20 million. Cleaning up the base will likely run about 15 times that.
From top: Allen Ray (left) lived at Lejeune as a child in the 1970s and 1980s, and died of pancreatic cancer at age 38; Lance Cpl. Ariel Cintron was stationed there in the '70s; Cintron (left) with cancer-stricken comrade Julio Medina, who was also was based at Lejeune, shortly before his death; Cintron at Medina's funeral; Jerry Ensminger with daughter Janey, who died of leukemia at nine; Ensminger testifying at a House committee hearing.
The most worrisome chemicals found in Lejeune's water have been used by industries of all stripes. TCE was once a pet food additive, a coffee decaffeinating solution, a wound disinfectant, and an obstetrical anesthetic. And while those uses were banned by the Food and Drug Administration in 1977, the volatile chemical is still employed as an industrial degreaser. Estimates vary, but TCE is thought to contaminate between 9 and 34 percent of the nation's local water supplies. PCE, with a very similar chemical structure, is still used by most dry cleaners—having replaced TCE for that purpose in the 1950s—and benzene is still added to gasoline, even though long-term exposure is known to "cause cancer of the blood-forming organs," according to the ATSDR.
Within the past 12 months, after more than a decade of opposition by the military, the Environmental Protection Agency labeled TCE and PCE, respectively, as known and likely human carcinogens. The agency is now in the process of revising its drinking-water standards for TCE, citing toxic effects in the brain, liver, and immune system, not to mention developmental defects, reproductive effects, and kidney cancer.
The little we know about the environmental causes of breast cancer comes from relatively small studies of workers exposed to specific chemicals on the job. And those, it must be said, are all over the map. One of the few general-population studies ever to prove a link between chemicals and cancer came out of Woburn, where researchers concluded that high childhood leukemia rates were caused by TCE and PCE in the water. The number of male breast-cancer cases in Woburn was also unusual, but not large enough to be statistically meaningful.
That's why scientists are looking so intently at the Lejeune cluster, which continues to grow. "If I take a coin and flip it 10 times and get seven heads, that could be biased by chance or not," explains ATSDR director Christopher Portier. "But if I flip it 1,000 times and get 700 heads, then I guarantee you it's not due to random chance. If there are real effects, then they will pop out in these studies where they looked marginal in others. We will do distinctly new science here."
For regulators, industries, and anyone who has been exposed, the stakes couldn't be higher. The American Cancer Society currently attributes just 6 percent of all cancers to environmental exposure, but that 30-year-old estimate is based on limited occupational studies. And while major breast cancer organizations concede that there's no clear evidence that chemicals cause the disease in humans, known nonchemical risk factors account for only about half of all breast cancers. The role of chemicals has been "grossly underestimated," noted the authors of a recent state-of-the-science report.
"A lot of data do suggest chemicals cause tumors in mammalian systems," Portier told me. "We have good studies now, for example with identical twins, that suggest the numbers could be as high as 75 percent [of all cancers], if you look at environmental factors broadly to include smoking and nutrition." Not counting those things, Portier adds, he believes it's closer to 20 to 25 percent, and not the 4 to 10 percent one sees in the literature. Marion Kavanaugh-Lynch, director of the California Breast Cancer Research Program, is also troubled by the existing evidence in animals and humans. "If we can identify these chemicals now, we can more easily avoid them," she says.