Fallon’s cluster was an exception. A nurse reported it to state health officials in July 2000 after only five cases had emerged. At that point, officials decided it was worth investigating. They drew their study plot along county lines, including a population more than twice the size of Fallon’s. Then more cases appeared, all of them in Fallon or close by. After 11 diagnoses, officials determined there was a one-in-232 million chance that the cluster was coincidental. Odder still was how quickly it arose, with diagnoses only weeks apart, as though the children had caught an infectious disease. The cluster looked like something that could be stopped. It also looked, one researcher told me, like “the perfect opportunity to determine the environmental cause of pediatric leukemia.”
Other scientists had more modest expectations. Despite its significance, the cluster was small. Still, most agree that there had never been a case quite like Fallon’s: An outbreak in an isolated patch of desert, its origins confined to a certain space and span of time, and in a community willing, at least at first, to undergo scientific scrutiny.
Fallon’s potential as a test case prompted the Nevada State Health Division to dedicate its epidemiologist, Randall Todd, to it almost full-time. For guidance, the agency assembled a panel of experts, including Thomas Sinks, associate director for science at the National Center for Environmental Health, and Malcolm Smith, head of pediatrics for the National Cancer Institute. Early in 2001, when it was clear the state could not tackle the problem alone, the Centers for Disease Control and Prevention agreed to investigate—the first time it had probed a cancer cluster in 20 years. The CDC was encouraged, in part, by new technology. Prior investigations relied heavily on interviews to find common exposures. Now, investigators could detect trace contaminants in blood, urine, and fat at levels lower than before. They planned to gather samples from leukemia patients, their families, and healthy residents and compare them to each other and to national averages. The Nevada Department of Environmental Protection and the Agency for Toxic Substances and Disease Registry, meanwhile, would search for sources of toxic exposure.
National politicians took interest, including senators Clinton and Harry Reid, a Nevada Democrat. At a hearing in Fallon before the investigation began, Clinton ventured that “advances in determining how to prevent cancer could really be attributed to the extraordinary response in this community.” For that, she said, “I think the entire country and maybe even the world will be grateful to Fallon.”
These were lofty words, aimed less at parents, whose desperation had little to do with scientific advancement, than at residents who might have seen the scrutiny as too great a sacrifice. Still, they reflected a real and collective hopefulness at the time that answers would be found—that the investigation would yield something more than an enduring sense of uncertainty.
* * *
From downtown Fallon, it is not far in any direction before alfalfa turns to sand and rabbitbrush. The desert is everywhere. In the spring, ditch water takes on the color of the earth. The water comes from the Carson River, dammed in 1915. Before that, Fallon was a string of ranches tied to the river’s scanty offering. The town has never counted on water, but it can always count on wind and sand. On windy days, residents say, “Real estate is really moving.” One told me that Fallon is a “sharing” community: “You get a little of your neighbor’s property. They get a little of yours.”
The June day that I walked Briggs Lane, where the Brunes once lived, the wind had scoured the road and deposited small dunes along a livestock fence. A light was on in a nearby house. I knocked, and a man came to the door. I asked if he knew of any cancer in the neighborhood. Two men had lived in the house before him, he replied; one died of liver cancer, the other of leukemia. Next door, an elderly woman waved me into the yard. Someone on the corner had breast cancer, she said. Then she eyed me curiously. Had I heard of the leukemia cluster? Those were “separate cases,” she explained. “Not the same family or church group. Not much to make a deal about.”
Most people I met spoke casually of disease: “Sure is a lot of cancer here,” or, “Seems about everyone I know has some kind of cancer.” Until recently, there was no reliable tally of diagnoses in Nevada. Most western Nevadans suspected of having cancer were sent to hospitals in California, and their cases counted toward the California Cancer Registry. Fallon residents heard of new cases by word of mouth, including the case of two middle school boys diagnosed with leukemia in the fall of 2012. Since the cluster investigation closed in 2004, at least five children have developed leukemia, but the boys’ diagnoses earned the most attention. Though each had a different kind of leukemia and officials said the cases were unrelated, suspicion arose that the cluster had returned.
Peoples’ guesses as to what caused the cancer vary. Some say the cluster was a media myth, or that “all the new people coming to Nevada” prompted the spike in cases. An elderly woman, whose nephew is an epidemiologist, told me, “If you throw up a handful of rocks, you’re going to end up with clusters of rocks.” When I asked if she thought there might be something in the water, she said, “No, honey. I think we pretty much come with what we get.” Others attribute it to “something at the Navy base”; a pipeline leak; pesticides; radiation from an atomic bomb test site 20 miles to the southeast. Some believe that whatever caused the cluster lingered; they bathe their children in bottled water. One mother said she feeds her sons extra vitamins “to counter whatever it is that’s doing it.” Many people simply rolled or averted their eyes at mention of the cluster.
“There are a lot in Fallon that want it all behind them,” Jeff Braccini, whose son survived leukemia, told me in July. “The mayor—if he could pay to have the Internet slicked, I know he would.” Braccini has a chiseled face and small blue eyes. He had just returned from the Navy base, where he is an aircraft mechanic. We sat on his porch, watching geese turn circles in a pond. “I don’t think it’s the kind of thing you can just shove away,” he said. “Kids died from this. And there’s still kids getting sick.”
His son was diagnosed in December 2001. The CDC had nearly finished collecting samples from study participants but would not release its results for another year. Braccini initially believed the investigation would find answers, but his confidence waned when he joined Fallon Families First, a program founded by the mayor’s wife to offer emotional and financial support to cluster families. At meetings, parents criticized investigators for their slow progress. It had taken the CDC a year to prepare equipment and get permission to study human subjects. By the time investigators collected samples, most children had finished treatment, and some had died.