One night in May 2008, in a modest ranch house in central Nevada, Ryan Brune woke with a headache. He had complained about the pain earlier that week, but his doctor said it was migraines. This time, he couldn’t sleep, and so his mother, April, drove him to the hospital in Fallon, a farming town of 8,200 where the family had lived for most of Ryan’s 10 years. He was an otherwise healthy boy, with fleshy cheeks and sandy blond hair, but a CT scan revealed a chestnut-sized mass in his brain. By morning, he was flown to Palo Alto, California, and the tumor was removed. Ryan had glioblastoma multiforme, a brain cancer that rarely afflicts children. His likelihood of survival was 1 percent.
The next summer, when Ryan returned to Fallon to spend his last months at home, his hospice doctor mentioned that a friend, Alan Levin, “might know something” about his illness. Levin, who phoned April in September, struck her as “a very smart man.” He was both an immunologist and a lawyer, and in the 1980s, he had served as an expert witness in a high-profile lawsuit that accused two chemical companies of polluting drinking water and causing dozens of cases of childhood leukemia in Woburn, Massachusetts. (The suit inspired the book and film, A Civil Action.)
Levin thought Fallon bore an unsettling resemblance to Woburn. From 1997 to 2002, Fallon had also suffered a high incidence of acute lymphoblastic leukemia among children; 16 cases were diagnosed, an alarming number for a small town. Health officials declared it the most significant childhood cancer cluster on national record and launched an investigation unprecedented in cost and scope. They never found the cause.
Levin suspected corporate negligence: He had evidence that a pipeline transporting jet fuel to the Fallon Naval Air Station had leaked underneath E.C. Best Elementary, where Ryan attended preschool. Levin believed both the leukemia cluster and Ryan’s condition could be traced to fuel exposure. He based this theory on scientific findings that certain people, due to genetic variations, are less able to detoxify their bodies, and the buildup of contaminants can damage their DNA and cause cancerous growth. In his words, “Jet fuel selected out the susceptible children and gave them cancer.”
Levin’s claims horrified April. She had asked Ryan’s doctors if his illness had anything to do with the leukemia cluster, but they told her that the cluster’s cause was still unknown. Why hadn’t she heard of the pipeline leak? At the time, she worked at the local airport, where she sometimes overheard people guessing at the cancer’s cause. She became curious herself, when, in 2001, Senator Hillary Clinton, came to Fallon for a hearing, and April was tasked with refueling her plane. She brought her children to meet Clinton and handed her a letter. “I asked her to not forget about us,” she recalled. “I said, ‘My children are my life, and I need to know if we need to move out of Fallon.’ ” April heard nothing more. “I didn’t really think about it again until my son got sick.”
Ryan died on October 2, 2009. Afterward, April spent sleepless nights on the Internet, searching “jet fuel,” “cluster,” and “glioblastoma” in various combinations. One night, she discovered a tally of cancer cases in Nevada and thought the numbers for Churchill County (which contains Fallon) seemed high. On Briggs Lane, where she and a dozen other families lived, she knew five people with cancer. She thought it odd that at the end of the lane, the pipeline ran beneath the irrigation ditch where her kids often played. “I was putting everything together,” she said, but not all the pieces fit. There were many theories about what caused the cancer, some discounting the pipeline. She wrote the mayor; he never replied. She posted a query on an online forum, and a local woman, who had a brain tumor, invited her to lunch but asked to remain anonymous; her husband, who came from “a prominent Fallon family,” would disapprove of their meeting. There did seem to be a lot of cancer in Fallon, she agreed, but she didn’t know why.
In March 2010, Levin named April the plaintiff in a wrongful death suit against Kinder Morgan Energy Partners, the pipeline operator; ExxonMobil, the fuel manufacturer; and the city of Fallon. The suit also accused the Brunes’ employers of contributing to Ryan’s illness by exposing his parents to jet fuel without proper safeguards. A judge dismissed the city from the case. The employers settled, and the Brunes used the money to buy a house in Reno that summer. April remained only minimally involved in the case against Kinder Morgan and ExxonMobil, but, in November 2012, agreed to a local television interview. In Fallon, her story was greeted coldly. The Churchill County School District sent an automated phone message to Fallon residents, advising, “The pipeline has not and does not pose a public health hazard. We object to those who take advantage of the sensitive nature of this topic by providing inaccurate or misleading information.”
It was clear to April that few in Fallon were willing to admit the possibility that the same agents that caused the cancer cluster may have had lingering effects. Around this time, she noticed a comment online: “It said that everyone lost a lot when the leukemia cluster happened. ‘Do you really think we need to revisit this?’ I felt sick. I lost this battle with my son, and I want to know why he got this cancer.”
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State health departments collectively receive thousands of cancer cluster reports from citizens each year, but of more than 400 investigations since 1990, only three—including Woburn’s—found a link between an environmental contaminant and a cluster. Epidemiologists have long doubted the value of such investigations. In a seminal speech to the 1989 National Conference on Clustering of Health Events, Kenneth Rothman, founder of the journal Epidemiology, announced that, “With very few exceptions, there is little scientific or public health purpose to investigate individual disease clusters at all.” Since scientists don’t know what causes most cancers, linking a cluster of cases to the same origin often involves guesswork. (Linking two different kinds, such as leukemia and brain cancer, is even more challenging.) As a result, cluster investigations are thought to be fraught with error. Some scientists even dismiss clusters as matters of happenstance, or, as Atul Gawande wrote for The New Yorker in 1999, in “The Cancer-Cluster Myth,” “the result of almost irresistible errors in perception”—of the human tendency to see coincidence as cause for alarm.
When alerted to a suspicious rise in cancer cases, epidemiologists must first determine if the numbers are indeed unusually high, or “statistically significant.” If they are, investigators then catalog the things that distinguish the sick from the healthy and ask if any of those variables could have caused the disease. These comparisons require more statistical tests, and to achieve a significant result, a large sample size. Often, clusters are so small that studies result in false negatives, finding no significant link between a toxic substance and disease even when one could exist.
“It’s a huge source of frustration for everyone, scientists and communities alike,” said Rachel Morello-Frosch, a professor of public health and environmental science at the University of California-Berkeley. “By the time you see a relationship between environmental exposure and a health concern”—when enough cases have piled up to draw the link with any certainty—“you’re basically doing a body count.”