UPDATE: On Thursday, June 30, the New York State Department of Health released information on its upcoming live webcast to present/discuss the cancer study findings described below and answer questions from the public. The meeting will be held Thursday, July 7, from 6:30-8:30pm at this link only. The public is invited to submit questions during the live webcast.
The results of a study launched in 2020 by the New York State Department of Health (NYSDOH) regarding cancer rates in the Northport-East Northport school district were released last week. The investigation was conducted after the finding of a significantly high number of leukemia cases among 2016 graduates of Northport High School. While the study was thorough, the NYSDOH was unable to determine why the statistically significant rates of cancer occurred.
Superintendent of Schools, Mr. Robert Banzer, sent out a district-wide email on Friday, June 24 summarizing the study findings.
“The district did not commission this study or hire any individuals to conduct the investigation,” Mr. Banzer told the Journal this week. “The summary, including the bullet points within my email last week, were written by the NYSDOH.”
Using data from the New York State Cancer Registry, a statistical analysis was formulated by comparing the occurence of cancer in the Northport-East Northport (NEN) school district to similar areas in the state during a 20-year period, from 1999 to 2018. The observed cancer cases were then compared to the expected rates in order to point out any statistically significant occurrences within the district. The study methodology, according to Mr. Banzer, was at the sole discretion of the NYSDOH and the district cooperated fully during the investigation.
As part of the study, separate analyses were done for the NEN school district as a whole, and for the Northport Middle School attendance district and the East Northport Middle School attendance district.
The NYSDOH report confirms that the number of leukemias diagnosed among the 2016 graduates was “statistically unusual.” Most of the cancers affecting this group were diagnosed in 2018 and 2019, and the number of cases of leukemia was significantly greater than the number expected (two or less cases), according to researchers. Not every diagnosed graduate attended Northport Middle School, according to the report, and because the observed number of cancer cases was less than six, the exact number is not reported to protect patient confidentiality, a privacy protocol followed by the NYSDOH.
The investigation did not identify any strong risk factors among the graduates that might account for their leukemia or other cancers individually, according to researchers. The report suggests that it is possible the elevated occurrence of leukemia among the graduates could be “related to factors not possible to uncover, including environmental exposures,” but it’s also possible that the elevation was “due to chance.”
The report indicates that because the leukemia diagnoses among the 2016 graduates do not appear to be part of a larger pattern of cancer occurrence within the district or even in Northport Middle School throughout the 20-year study period, the investigation was not able to suggest a hypotheses about specific types of blood cancers or specific types of exposures for additional investigation. “None of the blood cancers, including leukemia, lymphoma and multiple myeloma, were elevated among people of all ages living in the district,” according to the report.
In the analysis of overall cancer incidence within the NEN community, the DOH identified 4,593 cases of cancer among district residents, compared with 4,454 that would be expected. This 3% excess was statistically significant (because it’s above the 2.5% benchmark), meaning it was unlikely to occur by chance. The excess cases were made up of significant occurrences of pancreatic cancer, malignant melanoma of the skin, uterine (corpus) cancer, and prostate cancer.
The report also indicates that there were significantly fewer than expected numbers of cases of stomach cancer and lung cancer within the district as a whole. Numbers of cases of leukemia, other blood cancers (Hodgkin and non-Hodgkin lymphomas and multiple myeloma), and 13 other types of cancer examined separately were not significantly different from expected.
When the cancer rates among residents within the Northport Middle School (NMS) and East Northport Middle School (ENMS) districts within the 20-year study period were analyzed separately, data shows that the NMS area showed an approximate 7% excess (or 169 cases) in the total number of cancers, with 2,655 cases observed and 2,486 cases expected. This difference was statistically significant, with greater than expected numbers of cases of malignant melanoma and prostate cancer, and a lower-than-expected number of cases of stomach cancer.
For the East Northport Middle School area, the total number of cancer cases was not significantly different from the number expected, with 1,938 cases observed and 1,968 cases expected. When analyzed by specific types of cancer, there were higher than expected numbers of cancers of the esophagus and pancreas in the ENMS area, and lower than expected numbers of cases of lung cancer.
Cases of leukemia and lymphomas in young adults ages 15-24 were also examined separately. The cancer registry shows that between 1999 and 2018, seven young adults living in the school district were diagnosed with leukemia, which was significantly greater than the just under two that would be expected. This total includes some, but not all, of the members of the graduating class of 2016 that were reported, as well as other young people. If the members of the graduating class of 2016 were subtracted from this total, according to researchers, the number of young adults with leukemia would still be greater than the number expected, but the difference would not be statistically significant. The report indicates that numbers of cases in young adults were about the same in each middle school area.
Researchers were not able to hypothesize any common causes or risk factors for the elevated cancer types in the district, which includes pancreatic cancer, malignant melanoma of the skin, uterine cancer, prostate cancer and esophageal cancer. These cancers “have few known risk factors in common,” according to the report. “Some well established risk factors for these cancers include “smoking (pancreatic and esophageal cancers), fair skin and a history of severe sunburn (melanoma), and obesity and childbearing history (uterine cancer).” Few risk factors other than family history are known for prostate cancer, but prostate cancer incidence is closely related to the level of prostate cancer screening in an area, the report states.
Researchers did note some study limitations, including migration of NEN district residents over time. Cancer cases were identified among persons who resided in the study area when their cancers were diagnosed, therefore former residents who moved away prior to being diagnosed with cancer are not included, but persons who developed cancer shortly after moving into the area are included.
Cancer latency, or the time between when a cancer starts and when it’s diagnosed, is another possible limitation, according to researchers. “Cancer latency can range from five to 40 years, although it can be less in children or for some blood cancers. This is a limitation for almost all types of studies of cancer in individuals and communities,” the report notes.
Researchers indicate that it’s not possible with the current data to reconstruct information about the varied types of environmental exposures that may have occurred during the 20-year period and how these exposures would impact cancer latency.
Regarding potential environmental exposures within the NEN district, the NYSDOH explains in its report that in 2017, before this cancer investigation began, the NEN school district contacted them to assist with the interpretation of indoor air testing results in one of the wings of the Northport Middle School. “The testing results indicated the presence of chemicals in the indoor air that appeared to be associated with storage of various products used for repair and maintenance of the school grounds,” the report states. In response, the school removed all maintenance and repair products from the classroom buildings, and the NYSDOH and Suffolk County Department of Health Services provided technical advice on ways to improve the overall indoor air quality in the wing and in other areas of the school.
In 2019, in response to concerns about other locations at NMS, the district’s board of education engaged an environmental firm to conduct testing of soil, groundwater, injection wells, sub-slab vapor, and indoor air, and in June 2020, a final report entitled the “Comprehensive Investigation Report and the Soil and Materials Management Plan for the Northport Middle School,” was released to the community. The report states, “While some of the environmental test results led to recommendations for corrective actions, the Comprehensive Investigation Report did not identify sources and pathways for student exposures to hazardous chemicals at levels that posed a significant health risk.”
After review, the NYSDOH responded in January 2021 that the report addressed past and more recent environmental concerns at the school, and that the Soil and Materials Management Plan, if implemented, would be expected to mitigate against potential future exposures.
In response to the study results, Superintendent Banzer told the Journal that he cares deeply about the health and safety of all students and community members within the NEN district. “I am acutely aware of the devastating impact that cancer has on an individual and their family and loved ones, and take the results of the study very seriously,” he said.
At this time, the NYSDOH has not directed the district or community to do anything differently or make any changes based on their findings, according to Mr. Banzer. The NYSDOH will be holding a virtual public meeting, which will be conducted by the department itself, with the support of the district. Mr. Banzer said that they are currently in the process of finding a date and time that works for all parties, and will communicate this information as soon as possible.