Case Studies in Earth & Environmental Science Journalism

Cancer Clusters and the Toms River / Ciba-Geigy Site


Questions to Ponder and Discuss

  1. What is a cancer cluster?

  2. What is a statistically significant difference in cancer rates? Does it coincide with your 'gut feeling' about what an abnormal cancer incidence rate is?

  3. What is necessary to establish that a cluster of cancer cases is attributable to a particular source? What are the special challenges in attempting to prove cancer causation in "geographical clusters," where the cases are related simply by occurring in close geographical proximity?

  4. With so many potential causes of cancer, does it even make sense to try to identify a single cause in a place like Toms River? Do we have the statistical power necessary to identify a single cause? If the cause is neither necessary nor sufficient, should a polluting company be held liable?

  5. Consider the entire collection of materials on Toms River. Do you believe Toms River has a "cancer cluster"? Why or why not? If so, do you believe it is linked to pollution? Why or why not?

  6. Why do you think parallels with Woburn, MA ("A Civil Action") were not drawn earlier in the coverage of Toms River? Would they have been appropriate?

  7. What are some major similarities between Toms River and Woburn (if you are familiar with that case)? What are some major differences? How do you think this influenced coverage of the story in the two locations?

  8. Critique Glen Martin's article on McFarland, CA from the San Francisco Chronicle.

  9. Looking through the Toms River coverage, at what point did reporters stop referring to the cluster as "suspected" or "alleged" and begin referring to it as a fact. Was this justified?

  10. Throughout these materials, there seems to be a divergence between what lay people's "common sense" says about cancer in Toms River and what experts say. How do the journalists deal with this divergence?

  11. How can a cluster that seems so clear to residents be statistically insignificant?

  12. The Toms River cancer cluster has not received the national press attention of the Woburn case ("A Civil Action"). Why do you think this is?

  13. Consider the personalities involved in the Toms River cancer cluster story. How is Linda Gillick portrayed? How is she 'used' by journalists covering the story? Would there even have been a "Toms River cancer cluster" story without Linda Gillick?

  14. What are some metaphors used by journalists to explain the probability theory behind "clusters"? Which ones work? Why? What makes it so hard to wrap one's mind around the apparent contradictions in cluster analysis?

  15. What are some of the biases evident in the different sources of information in the Toms River stories? How can journalists filter out these biases? Do you think the Asbury Park Press reporters were successful in doing so?

  16. Look at the Asbury Park Press articles from March, 1996. The report they cover found 54 cases of brain or central nervous system cancers in Ocean County children, 15 more than the 39 cases that would be expected based on statistics. How much of an increase over expected rates is this? Do you think the community response was appropriate? How did media coverage influence community response? If you lived in Toms River, would you be concerned?

  17. What role did politics play in the way the Toms River story developed, and in the way it was covered? Do you think politicians "used" the cancer cluster for their political ends? If so, is it appropriate to cover such use? Can you find examples in the articles where this was done?

  18. What role did the fact that children were developing cancer in Toms River play in the way the story was covered? Would the articles have sounded the same if the victims had been old black men in South Carolina?

  19. The New York Times article from February 7, 1999 stated that the deadline for negotiations between the Toms River Families and Ciba-Geigy would be August, 1999. What happened in August?

  20. What responsibility does a journalist have to assess the scientific "truth" of public claims? What responsibility does he or she have to consider the potential for his or her coverage to create or enhance misperceptions? Did the reporters for the Asbury Park Press do these things?

  21. What are some of the possible causes of childhood cancer in Toms River that were considered when the story was first breaking? Which ones of these were borne out by research? Do they seem reasonable? How did attention finally focus on Ciba-Geigy (and to a lesser extent Reich Farm)?

  22. When is enough enough? What kind of proof of no cancer cluster should be required for public concerns to be quelled?

  23. Consider Alan Bender's statement from Atul Gawande's New Yorker article: "The reality is, that they're an absolute, total, and complete waste of taxpayer dollars." Do you think the residents of Toms River would agree? Do you think you would agree if you lived in an area of elevated cancer incidence rates?

  24. Think about the responses of Ciba-Geigy and Union Carbide. How should companies respond to charges that their pollution is killing people? How do you think Union Carbide did?

  25. Look at the Asbury Park Press article from June 2, 1996. The article attempts a comprehensive review of the evidence and science of cancer clusters. Do you think it succeeds? Is there another article in the reader that does a better job?

  26. What are some other angles to the Toms River story that you don't see among these articles? If you were writing for a national publication, how would you make this story relevant outside Ocean County?

  27. How could the reporters have better handled the underlying science (statistics and medicine)? Did they make an attempt to do so? How would you have written about the scientific underpinnings of cluster research? Who would you have interviewed?

  28. Look at the last two articles from February 28, 2000 and February 29, 2000. How does the local paper's coverage (and headline) differ from the Associated Press's coverage (and headline)? Are they talking about the same report?

  29. Which is the best article in the group? Which is the worst? Why?



Background information:

Rothman, K.J. and C. Poole. 1996. Causation and causal inference. In: Cancer Epidemiology and Prevention. Schottenfeld, D. and J.F. Fraumeni, eds. Oxford: Oxford University Press, 2nd ed., 1996, pp. 3-10

Trichopoulos, D., F.P. Li, and D.J. Hunter. 1996. What causes cancer? Scientific American, September, 1996: 80-87.

Braus, P. 1996. Why does cancer cluster? American Demographics, March 1996, pp. 36-41.

EPA Website. "National Priority Site Fact Sheet: Ciba-Geigy Corp."

Ciba-Geigy Website. "Toms River Federal Superfund Site."


Scientific and Technical Papers:

Alexander, F.E. Clusters and Clustering of Childhood cancer: a review. European Journal of Epidemiology, 15: 847-852, October 1999.

Grufferman, S. Methodologic Approaches to Studying Environmental Factors in Childhood Cancer, Environmental Health Perspectives, Vol 106, Supplement 3, June 1998, 881-886.

Kulldorf, M., E.J. Feuer, B.A. Miller and L.S. Freedman, Breast Cancer Clusters in the Northeast United States: A Geographic Analysis, American Journals of Epidemiology, Vol 146, No. 2, 1997, 161-170.

Timander, L.M. and S. Mclafferty, Breast Cancer in West Islip, NY: a Spatial Clustering Analysis with Covariates, Social Science and Medicine, Vol 46, No 12, 1998, p 1623-1635.

Pavlova, M.T. Superfund and One Community Program, American Journal of Industrial Medicine, Vol 23. 1993, 183-189.

New Jersey Department of Health and Senior Services Website. "Citizens' Guide to the Ciba-Geigy Public Health Assessment Public Comment Draft: February 29-April 28, 2000."


Popular Articles - Toms River, NJ:

Associated Press. 1996. "Cancer cluster in kids reported; brain tumor rate is three times over normal." Bergen Record, March 11, 1996, p. A8.

Willis, D. P., and the Associated Press. 1996. "Cancer cluster cause puzzling; Ciba-Geigy denies role in child illnesses." Asbury Park Press, March 11, 1996, p. A1.

Sheehan, N.A. 1996. "'Cancer cluster' a catchy term, but definition has catches to it." Asbury Park Press, March 12, 1996, p. A6.

Sheehan, N.A., and L.L. Colangelo. 1996. "Childhood cancer scare grips Toms River area; Health agencies vow a thorough study of data." Asbury Park Press, March 12, 1996, p. A1.

Sheehan, N.A. 1996. "Incidence of cancer called not out of line." Asbury Park Press, March 13, 1996, p. A1.

Williams, C.G. 1996. "Pressure builds on state for in-depth study." Asbury Park Press, March 14, 1996, p. A10.

Williams, C.G. 1996. "Tracking down a cause: Lawmakers pledge fund to better assess child cancer cluster." Asbury Park Press, March 19, 1996, p. B1.

Williams, C.G. 1996. "Searching for cause of a cancer cluster, but hopes are slim." Asbury Park Press, March 20, 1996, p. A1.

Sullivan, J. 1996. "Search for cause of a cancer cluster yields fear and doubt." New York Times, April 20, 1996, p. 27.

Bates, T.B. and R. McEnery. 1996. "Clearing the air on water; Toms River study finds no links to cancer rates." Asbury Park Press, May 9, 1996, p. A1.

Moore, K. and T.B. Bates. 1996. "Pollution and cancer: the elusive link." Asbury Park Press, June 2, 1996, p. C1.

Williams, C.G. 1996. "GOP says cancer cluster devoid of politics." Asbury Park Press, June 22, 1996, p. A4.

Williams, C.G. 1996. "Ciba: It's 'premature' to discuss site's future." Asbury Park Press, August 27, 1996, p. A1.

Bromery, K. "No evidence links nuclear plant to childhood cancers." Asbury Park Press, September 4, 1996, p. A9.

Miller, P.A. and K. Moore. 1996. "Dover officials vow to go after dumper of waste." Asbury Park Press, November 2, 1996, p. A1.

Miller, P.A. 1996. "Dover cancers called disproportionate; Boston researcher screens data on child cases." Asbury Park Press, November 26, 1996, p. B1.

Miller, P.A. 1996. "Registry finds more cancer cases." Asbury Park Press, December 10, 1996, p. B1.

Miller, P.A. 1996. "Carbide vows to continue sharing information." Asbury Park Press, December 11, 1996, p. B2.

Mikle, J. 1997. "Cancer cluster study's pace fuels anxieties." Asbury Park Press, January 26, 1997, p. A1.

Curran, J. 1997. "Childhood cases no coincidence; cancer cluster confirmed; state seeks cause in Dover Township." Bergen Record, April 8, 1997, p. A3.

Mikle, J. 1997. "No quick cancer answers." Asbury Park Press, August 26, 1997, p. A1.

Miller, P.A. 1998. "Five more Dover children may have cancer." Asbury Park Press, May 14, 1998, p. A1.

Torricelli, R.G. 1998. "Cuts will harm study; disease registry needs more money for work on cancer clusters." Asbury Park Press, May 31, 1998, p. C3.

Asbury Park Press. 1998. "Ocean diary." Asbury Park Press, June 7, 1998, p. AA4.

Miller, P.A. 1998. "Panel fears cancer study delay; Epidemiologist quits state health post." Asbury Park Press, June 26, 1998, p. B1.

Sachs, S. 1998. "Public clamor puts focus on 'clusters' in cancer research." New York Times, September 21, 1998, p. A1.

Mikle, J. 1998. "Third Toms River well has traces of pollutants." Asbury Park Press, September 10, 1998, p. A1.

Moore, K. 1998. "Well's water free of taint." Asbury Park Press, October 6, 1998, p. A1.

Mikle, J. 1998. "Official tallies new cancer cases." Asbury Park Press, December 15, 1998, p. D1.

Associated Press. 1998. "State prepares local health officials for fallout from Travolta film." Associated Press, December 31, 1998, AM cycle.

Mansnerus, L. 1999. "Dover Township's cancer cluster." New York Times, February 7, 1999, section 14, p. NJ6.

Lautenberg, F.R. 1999. "New Jersey should err on side of water safety in complying with new federal law." Asbury Park Press, February 9, 1999, p. A11.

Stier, J. 1999. "Letters: 'Cancer clusters' link to Superfund unproven." New York Times, February 21, 1999, section 14, p. NJ17.

Mikle, J. 1999. "Toxicity testing may take 5 to 8 years." Asbury Park Press, May 11, 1999, p. A2.

Associated Press, 1999. "Reports: Toxic waste sites contaminated Dover Township water." Associated Press, July 30, 1999, AM cycle.

Mikle, J. 1999. "Past pollution is documented; Dover dump, Reich Farm cited." Asbury Park Press, August 1, 1999, p. A1.

Moore, K. 1999. "Group told of new cancer cases." Asbury Park Press, September 21, 1999, p. B1.

Associated Press. 1999. "State says Toms River water supply is OK now, but studies continue." Associated Press, November 16, 1999, AM cycle.

Miller, P.A. 1999. "'Cluster' meaning debated." Asbury Park Press, November 17, 1999, p. A1.

Gannon, A. 1999. "Students study 'cancer cluster'." Asbury Park Press, December 11, 1999, p. A5.

Curran, J. 1999. "Interim report cites drinking water, electric blankets as potential factors." Associated Press, December 13, 1999, AM cycle.

Associated Press. 2000. "State: Ciba-Geigy Corp. site is no hazard anymore." Associated Press, February 28, 2000, AM cycle.

Moore, K. 2000. "Cancer probe's Ciba data out; Toxic exposures may date to 1960s." Asbury Park Press, February 29, 2000, p. A1.


Popular Articles: General

Jenkins, J. 1997. "The cluster and the fluster." The Guardian (Manchester, England), June 17, 1997, P. 2:16.

Martin, G. 1998. "Cluster: random or environmental?" San Francisco Chronicle, October 4, 1998, p. S1.

Perez-Pena, R. 1999. "Critics question overdue plan to track cancer and pollution." New York Times, January 18, 1999, p. B6.

Gawande, Atul. 1999. "The cancer-cluster myth." New Yorker, February 8, 1999, p. 34.

Perez-Pena, R. 1999. "New York is first state with cancer-rate maps." New York Times, December 10, 1999, p. B5.


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