Bynum Cancer Rate (Long Version)

Tom, what was the first suspicion you have of Hall River? It's fairly simple and basic that there are dischargers upstream and people are drinking water downstream. We wanted to know as much as possible about the quality of water and also to know what the health effects of drinking that water were over a long period of time. What was the matter? Why did you suspect anything? Well, I've come from an industrial city Cleveland, Ohio and I know how messed up the Kaya Haga River is. There were some sensational events there when the river caught on fire. In other words, I'm coming from a place that had a polluted river. I began to see that the types of illnesses in America were changing and cancer was increasing and I'm not a doctor, I'm a landscaper.

So I really know nothing more than just basic logic, but I began to suspect that there was a possibility that the water would have an influence. There were chemicals in the river. We knew that and therefore began the study and the drinking water survey published in July of 85 and we found that the treated water actually changed those chemicals into chemicals in the same class of synthetic organics which were hazardous to human health. But in such small traces that we really didn't know if there was a human health effect. From these early suspicions then you founded with your colleagues in concern the Hau River Assembly which was a stream watch organization and also a Sherlock Holmes investigation unit or what.

Really it had a pretty broad charter. We were concerned about water quality, the land use around the river, recreation and safety on the river and preservation of wildlife. But very soon we got into the more scientific aspect of water quality and the stream watch began after we were founded but I can say that all the canoeists who go down the Hau River are stream watch people. We also noted a particular side effect of falling in the river after canoeing or while canoeing and that was something that was identified as a reaction like chemical pneumonia or meningitis. That first-hand experience and just some rather deductive logic led us into the drinking water survey. Is there indeed meningitis coming from that or was it a remarkable similarity? There's a similarity.

I don't know that anybody has actually gone to a doctor and had it analyzed at the moment that we're feeling the symptoms. What are they? Slightly higher than normal temperature, irritation in the nasal passages and throat and upper chest inflammation in the nasal passages mouth throat and a rather peculiar yellow fluid that comes out of the nasal passages, something I've never seen general malaise and listlessness. How long did that kind of reaction last? You were from two days to five days, seven days in that range, enough to get them to the next weekend to canoe again. Yep. Are you canoeers? You just won't give up with it. You could be the disease of stupidness of falling in the river. Let's go on then from this kind of suspicion.

You launched an investigation in the beginning parts of the drinking water survey, someone with whom I worked in in Pittsburgh came to me and said that she had over the years collected notes of the people who have died and were gotten sick and by them and when she explained them to them and we tallied the figures up, it just seemed remarkably high. We were in the middle of the drinking water survey and looking for a continuation of that effort because in a study of medical literature about the human health effects of the chemicals that we found in the drinking water supply, we really came to a dead end. Your drinking water survey, if I recall, said that the water did meet the standards established across the country and probably were the equal of other cities, right?

Yes. At least statistics compiled on the biennum population, what did you do with them? Well we sensibly knocked on a lot of doors and tried to find somebody who would be interested in continuing the study or carrying it out. We're again not qualified scientists or doctors but saw the possibility that this may have implications about the water and very fortunately Dr. Shy expressed an interest in it and we are very fortunate that he has continued, I mean, taken the study on as a project and is interested in more or in further water projects, water quality projects. Charles Shy is professor of epidemiology in the School of Public Health in Chapel Hill, the UNC.

I guess also fortunate Dr. Shy that there is a School of Public Health so close, pick up the story. What happened then? Well, the first thing we had to try to evaluate was whether indeed there was a demonstrable excess of cancer among the residents of biennum, one possibility was that since the biennum community is growing older and as people age they tend to get more cancer that perhaps what they were simply observing was a phenomenon of more cancer with older age. So we said well first we need to verify who did die of cancer and then compare the proportion of deaths associated with cancer with a similar proportion for the state of North Carolina by time interval. And so we went to the Chatham County Records Office where all the death certificates for the residents are filed and started with 1947 went through 1985 and identified all deaths

in Chatham County that had listed on them biennum as a usual residence. And then we identified the cause of death listed on that death certificate and calculated what proportion of all deaths were cancers. Normally at the present time you would expect somewhere from 18 to 20 percent of deaths to be attributable to cancer. What we did is divided the time period 1947-85 into five year intervals and compared biennum's proportion of deaths associated with cancer with the state of North Carolina's proportion. Those data are available in published final statistics for the state. We found that from 1947 to 1964 the state of North Carolina and biennum had about the same proportion of cancer deaths roughly 10 percent.

Beginning in 1965 at the state of North Carolina has had a steady but slow increase in the proportion of deaths that are cancers going from 10 percent up to 20 percent at the present time. However, biennum went from 10 percent to nearly 60 percent over that same time interval in 1965 to 85 and the last 10 years the community of biennum has had 55 to 60 percent of their deaths due to cancer whereas the state of North Carolina has about 20 to 22 percent attributable to cancer. In making this comparison we always compared the same ages of the two groups so that we weren't comparing a lot of young people in North Carolina with old persons in biennum. You had three areas of concern, water, environment, smoking. Yes. Occupational environment, water, and smoking.

Yes. Those are, I've concerned now, our original study just demonstrated that there indeed appears to be a significant excess of cancer deaths. We don't know the reason for that excess at the present time but our suspicion is that smoking might be a possible factor because it accounts for excesses of cancer in the whole respiratory tract all the way from the mouth to the pharynx, the lung, even bladder and possibly pancreas cancers are in excess in smokers. Occupation we considered not because it's known to cause cancer that is work in textile mills is not known to cause cancer, it's known to be associated with a risk of what we call brown lung disease or bisonosis which is a nonmalignant scarring of the lung but not associated with cancer. Other existing studies of textile workers failed to show an excess of cancers in them.

So, we don't think that work in the textile mill necessarily caused the cancer but since it was such a common experience, work experience of the residents of Bynum, we decided we better investigated. Water was considered because the whole river is known to have a lot of upstream discharges from textile plants, industrial sources and the towns of Greensboro and Burlington. Some of those discharges are synthetic organic chemicals, some of them are likely to be carcinogens, not all have been proven to be carcinogens but they're analogs of carcinogens. And we know that some of them are dissolved in the water and are not necessarily removed by the sedimentation filtration process that's are nearly used to prepare water for distribution to for drinking purposes.

So treatment in itself doesn't remove synthetic organics in order to do so requires an expensive process called activated charcoal filtration and that process called tertiary treatment is not ordinary to use because of its high cost. So there are two things to say here. One is that the water Bynum received from 1947 to 1977 was not treated in the same way that communities normally treat their water supply. That water as we understand it was essentially pumped directly out of the hall, river into a large holding tank and was manually chlorinated. It did not receive prior sedimentation or filtration apparently. That would result in chemical reactions different than those you would tend to get with a modern water treatment facility. Since 1977 Bynum has changed from that source of water to the Pittsburgh water treatment

plant, which while it still gets water from the hall river does practice modern treatment type of operations on the water. So major difficulty for us if we do find that the cancer excess is associated with the water intake from the so-called mill water is to know whether what that water contained. That was water that existed from 1947 to 1977. Much of that time period preceded the Clean Water Act which controls discharges into water waste. So Clean Water Act came into being a 1972 prior to that time there was little control over dischargers into main water waste. Since 1972 there has been considerably more in the way of control of discharges. Then Bynum's water system was quite different than Pittsburgh, another which participated in the Pittsburgh water system services.

Yes. Bynum's water from 1947 to 1977 was their own water supply pumped by the mill up into the holding tank of the town and then distributed to the members after manual chlorination. Was that a water system owned by the mill itself? Yes it was. The mill incidentally is no longer an operation. What kind of cancers were being discovered in the Bynum population were they one of a kind or were they? They were not one of a kind, they were distributed somewhat as you would expect in the general population. The dominant cancers were gastrointestinal, lung or respiratory tract and some genital urinary cancers that accounts for more than about 75% of all the cancers. It's not a terribly different distribution than you would get in a large population. You were away when the announcement of the Phase I cancer study was announced, did the

publicity and uproar surprise you? Well you never know how to predict these things. I guess that we didn't anticipate quite as much local interests but then again now as you look at it it's understandable because that part of Chatham County is growing rapidly and growth means requirements for water and sores and they're talking about expanding the water treatment capacity of Pittsburgh in order to supply the growth in northern Chatham County. Naturally people are concerned that they get good water for their homes. When you return you had a readjustment of the goals I think with a meeting with the Hall River Assembly and that was just this past week. What did you say to those people? Well before and even the newspapers published all this we felt it important to meet with the residents of BINOM to let them know what we found and to encourage them to participate

in some cancer screening programs and we're working on making those available through the Health Department of Chatham County. As a BINOM the Hall River Assembly is concerned we're continuing to work with them to expand the study to get more information directly from residents about their work habits, smoking habits, their use of water and perhaps other exposures they may have had that could contribute to increased risk of cancer. We're also looking into studying other communities that may have been using either that water or downstream water supplies for more than 10 to 15 years. We found that there are several communities downstream beyond the Jordan Lake that are using the Cape Fear River water, which the Cape Fear River is formed by the confluence of the Hall River with the deep river below Jordan Lake. Those communities have been using that water for more than 15 to 20 years as their water

supply and we'll see if they show any evidence of any cancer access. I should think that some of the places upstream where there's more textile mill activity in the past probably had the same kind of water systems that the BINOM mill town did. Or am I starting to spread the alarm once again? I had the same assumption you did. And I thought there would be upstream communities we could investigate and it turns out none of them have drawn their water directly out of the Hall River. They all get their water from feeder creeks which don't have the same mainstream contamination to them. They're often relatively unpolluted side stream creeks. After saying phase one, a short time ago that would indicate there must be another phase in which you were involved, not phase two. What's that? Well, phase two is essentially an expansion of the study to first get more detailed information on exposure factors among the BINOM residents.

This will involve in large part interviews with the residents of BINOM and asking questions about their exposures. It also involves, as I mentioned, investigating other communities that are downstream and are using that water for their water supply. If you demonstrate, for instance, that other communities show a cancer excess when they're on that water supply, it certainly confirms this suspicion that maybe something with water. We also are going to do some studies examining the chemical constituents of the water as it might have existed in BINOM 15-20 years ago. We can't really obtain those water samples, but we can take the present water and treat it the way they treated it, use raw water and hand chlorinated and see what kind of reaction products one gets from that form of treatment.

But I'll be the devil's advocate here, but textile activity upstream has changed quite a bit, where the closing of textile mills and the discharge is less, the sample won't be the same one. No, the sample will not be the same, and we can't do anything about that. We're actually trying to find out if residents kept water samples in that, of course, one reason or other, they might have stored, and there's some preliminary suggestions that there might be some of these samples available. But then again, it depends what they're stored in, whether they're airtight, whether they might have reacted with the storage container itself, so there's a lot of doubt that we can possibly recreate a water sample of 20 years ago. No, we'll be the angel's advocate, is it far enough over the horizon to ask you about phase three? Oh, there undoubtedly will be enough interest to consider a phase three. That could be an even more extensive study of the entire K-Fear river basin, which extends

all the way to Wilmington. It could entail much more chemical characterization of the synthetic organic, or even the natural organic reactions between chlorine and the organic materials that are in the water already. There's some suspicion that chlorinating water causes a reaction that could lead to products that are harmful to health. We chlorinate to protect our health, and yet at the same time, we may chlorinate and cause health problems. What happens with Hall River Assembly, Tom? Where do you go from here? Are the professionals taking a hand? What about the assembly? Well, we just want to know that what's really happening with the water and the people are drinking it. If there's no conclusive evidence to points to the water, we still feel there's enough question that people who draw water from the river ought to get together and encourage people upstream to clean up their discharges, encourage the state to tighten the discharge

regulations, and certainly to fund the departments, which are in charge of water quality, so that they can actually do their job, and this is not the case now. We just want to know the facts and encourage people to consider the river as a living organism as part of all of life on the earth, not as a dumping ground, to feel a connection with the river, which is real. But there's something else in the future that concerns the Hall River Assembly. Here's the threat of landfills and the leachate from landfills, which gets into surface water. The threat of a landfill old or new is close to a perpetual motion pollution machine as we have in this society today.

The input into the landfills is not monitored. One who is a generator of toxic and hazardous waste has to produce over a certain quota or quantity in order to be regulated so that they have to trace the movement of the chemicals that they use. It's just as easy for a small generator to put a couple barrels of something in the back of a truck, dump them in the landfill or disguise them with a little paper and brush, and put it in the landfill, which has no monitoring at the gates. To the effect that that chemical would get into an anaerobic situation combined with other leachates or other anaerobic products and get into the surface water, the assembly has tested the water emanating from the present Alamance County landfill and has found that it is a virtual chemical soup and although we haven't identified that those chemicals

we've found are the same as that we're found in the 83WRI study or the Drinking Water Survey study, we have a suspicion that some of them are the same and that placing a landfill on the river because the leachate that comes out to the surface needs to be diluted, I think really needs to be rethought. That is one of the standards for landfill construction in North Carolina, by the way, but to place this Alamance County landfill with a one mile front to John the Hall River and a one mile front to John Hall Creek is simply asking Pittsburgh to drink more chemical soup. Dr. Shy, those facts of the Phase 2 study, is there a date at which you've set the goal for completion?

We're hoping to complete the study in a one year time interval and that should give us a much more in the way of evidence to say whether this needs to become a more intensive study and I think one year is a reasonable time. Dr. Shy, Professor Epidemiology in the School of Public Health, thank you very much. I'm Tom Glendinning, co-founder of the Hall River Assembly, thank you.