Counting Cancer Cases Among Alumni

January 26, 2009

The alumni database typically isn’t used for public health purposes. Yet, spurred by a March 2007 investigation by the Harrisburg-based Patriot-News into a possible cancer cluster among young alumni of Susquehanna University, the Pennsylvania Department of Health went about cross-referencing 20 years of alumni listings against state cancer registries. While it found that cancer rates for former students were 56 percent higher than for the general Pennsylvania population, it did not find any evidence of an environmental link or cause associated with the graduates' time at Susquehanna.

Specifically, the higher incidences were only statistically significant for two types of cancer, malignant melanoma and testicular cancer. “[T]he types of cancer responsible for the excess identified cases have known alternative explanations or are not ones associated with known environmental toxic exposures,” states the Department of Health report, released Friday. Among other factors, both melanoma and testicular cancer are more prevalent among Caucasians; Susquehanna’s alumni population ranged from between 90 and 97 percent white in the years studied, compared to 82 percent for the state of Pennsylvania (while investigators controlled for age in the study, they lacked the data to also control for race).

The report also notes that cancer rates for residents of the town of Selinsgrove, where Susquehanna is located, were actually 10 percent lower than expected, and points out that, in a separate investigation, the state environmental department did not identify hazardous elements in the area.

"What we are trying to address is whether or not there was a health risk, particularly an environmental health risk, associated with attending Susquehanna University. And the analysis that we did, based on all of the evidence together, including the results of the [alumni] study, the environmental sampling that was done, and the community cancer experience analysis, didn’t suggest that was the case,” said Stephen M. Ostroff, director of the Bureau of Epidemiology at the Pennsylvania Department of Health.

“However, we are cognizant of the fact that there is more cancer there [among alumni] than would be anticipated. And that they are the types of cancers that one wouldn’t necessarily conclude would be linked to having gone to that university. There are two possibilities there. One is that in some way, shape or form, our methodology, in terms of counting the expected [cancer rates] wasn’t done properly and so our expected numbers are too low.… We use some very conservative estimates to determine what the expected cases ought to be and we may have low-balled that.

"On the other hand, it may be that this population does certain things or doesn’t do certain things in terms of prevention, especially with a cancer like melanoma.... What we don't know is if I was to have done the same study at another university in Pennsylvania or some other location, whether or not the data would look the same. In general, I don't think people do sub-analyses of cancer data to see who was a college student and who wasn't a college student."

To conduct the study, the Pennsylvania Department of Health drew from 13,097 entries in Susquehanna’s alumni database for the classes of 1985 through 2004. Agency staff checked these names against cancer registries in the six states where 77.1 percent of alumni live – Pennsylvania, New Jersey, New York, Maryland, Virginia and Massachusetts -- and made statistical adjustments for the remaining 23 percent of alumni (assuming that cancer rates and types were similar among alumni living elsewhere). In cases where it was unclear whether the alumni database listing matched a cancer registry listing, Department of Health staff did detective work of sorts, resolving each case individually.

“We’re concerned about the fact that families suffer losses,” said Gerald Cohen, assistant vice president for communications at the university. “What we’re more than reasonably confident of, because of these two exhaustive studies, is that it had nothing to do with their time here at Susquehanna.

"This should resolve any lingering questions about the alleged environmental menace that exists in this community," Cohen said.

The state Department of Health has concluded its investigation into this matter. However, "should new information become available regarding additional illness or health risks, the investigation can be re-opened at any future date."

“I’m glad they’ve investigated, but it’s strange. I don’t know any way other way to describe it,” said Marisa Donati, a 1992 Susquehanna graduate whose breast cancer has metastasized to her liver. “I don’t know what else could be done, but it just seems -- I don’t think they’ve answered the question really… [Which is] why so many students have such aggressive cancers. I know that they believe they’ve answered the question. It still seems very suspicious to me.”

Linda Kadel, whose son, Patrick, graduated from Susquehanna in 1997 and died of osteosarcoma in 2002, originally compiled a database of Susquehanna alumni with cancer. Reached on Friday, she said, "I’m very happy that the state took it seriously and did the study; I’m very happy that they did that. But I feel that some concern should be warranted that it’s [56] percent higher – I mean, I don’t think that can be discounted. How is that supposed to make anyone feel good?”

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