In many places around Western Pennsylvania residents see clusters of death and clusters of people sickened by cancer or heart and lung diseases.
And, like Lee Lasich, a Clairton resident, they're frustrated that government health and environmental agencies don't see them too, don't do something about the problems and don't take a tougher stance on enforcement of air pollution regulations.
Ms. Lasich, whose husband worked in U.S. Steel Corp.'s Clairton Coke Works and died after suffering from lung, prostate and throat cancers in 2004 when he was 53, is typical. She uses all the fingers of her right hand to tick off the names of friends who have died from brain cancer in her Constitution Circle neighborhood. She uses her left hand to count "a whole family that's got pancreatic cancers."
"They're on our street and near where we live and they're not that old," said Ms. Lasich, a leader of the local grassroots group Residents for a Clean Healthy Mon Valley. "It's too coincidental, and there's too much there. This is a scary time to live here. People are starting to notice that something is going on; that something just isn't right."
The Pittsburgh Post-Gazette's analysis of Pennsylvania Department of Health mortality data from 2000 through 2008 found that 14,636 more people died from heart and respiratory disease and lung cancer in 14 Western Pennsylvania counties than national rates would predict, or 12,833 after adjusting for excess smoking in the region. And the yearlong investigation found numerous people throughout the region who talked about what seemed like unnatural and unexplained clusters of illnesses and death in their communities.
This overlap of high mortality rates and pollution raises questions about whether there is a causal relationship. The question has not been definitively answered, but for the people who live among these clusters, the connection seems clear.
• In Lincoln, across the Monongahela River from Clairton, Stacy Beisler can quickly count the names of a dozen residents who either have some form of cancer or have died from it recently. There's a half dozen more in her neighborhood who have lung disease or have died from it.
• In LaBelle, Fayette County, Gary Kuklish is one of several residents who point to nine cases of cancer in the 18 homes on Sauerkraut Hill.
• In Clearfield County, the United Methodist Church's Greater Shawville Parish has numerous cases of cancer and respiratory disease, according to former pastor Jennifer Heikes. There's hardly a family in the church that hasn't been touched by cancer, said Leslie Shaw, a parishioner.
• Street maps hand-drawn by George Simo of his Jefferson Hills neighborhood, on top of a ridge along the Mon, are crowded with names and scribbled notations about fatal cancers, heart and respiratory disease at more than three dozen homes.
The U.S. Centers for Disease Control and Prevention defines a "cluster" as an unusual number of illnesses or deaths grouped together in the same time frame or location and reported to a public health agency. Cluster investigations seek to confirm cases of a single disease; establish whether the reported cases represent an unusually high occurrence of the disease; and explore potential causes when possible.
Epidemiologists say it is almost impossible to verify with scientific certainty reports of environmental disease and death clusters. But for the residents the clusters seem real and they raise real concern.
"In 36 houses on Silverdale and Silver roads I identified 17 cases of heart disease, three cases of lung disease, 17 cancers and five cases of dementia or Alzheimer's," Mr. Simo said.
Known around the neighborhood as "the cat man," or "animal man," Mr. Simo takes in stray animals. As he did with his neighbors, he's kept records of death rates of those animals.
"People drop off live animals here all the time, but they're dying young," he said, pointing to the front of his 2 1/2-acre yard where homemade wooden markers adorn weedy graves of more than 60 cats, 280 birds and 13 dogs. "These dogs should have died of old age out on the farm but they're dying here between young and middle age. What's happening?"
It's a question that hangs in the air in many communities. One is Greene Township, Beaver County, which has a mortality rate 44 percent above the national average for the three diseases reviewed by the Post-Gazette.
"There seems to be a lot of heart problems and a high rate of cancer around here, and it's been around a while. Just about every road you go on I can name two or three people with cancer who lived there," said Russell Morgan, board of commissioners chairman in Greene Township, home to FirstEnergy Corp.'s sprawling, 1,300-acre Little Blue Run coal-ash impoundment for the Bruce Mansfield power plant in nearby Shippingport.
"We should be looking at doing a study of the higher [mortality] rates," said Mr. Morgan, whose father died of a heart attack there at age 56.
And upwind from highly industrialized Neville Island is Avalon, where each individual disease category -- heart and respiratory disease and lung cancer -- is above the adjusted national average and the total three-disease mortality risk rate is 18 percent higher. Janet Strahosky, a long-time Avalon activist, lamented the public apathy despite the community's knowledge of the eight women with breast cancer and the dead-end street in neighboring Ben Avon where there are five people with cancers.
"I've canvassed all of these communities door-to-door and people know what's happening, but they don't speak out," she said. The Allegheny County Health Department "needs to expand the chemical pollutants it tests for. There's lots of stuff coming out of local industries that we don't test for and don't measure or monitor or connect them to health effects."
A committee appointed by the Health Department board is working on new guidelines to regulate the emissions of air toxics by local industries. The board tabled a proposal in July 2009 that would have covered 300 hazardous chemicals, including all of the 187 hazardous air pollutants -- many of them dangerous carcinogens -- listed in the federal Clean Air Act. The county's existing air toxic guidelines, which date to 1988, have never been updated.
The Pennsylvania Department of Health gets 50 or more requests to investigate reported "clusters" every year -- including calls from towns around Neville Island, from Shaler and Washington County -- but hasn't identified the environmental cause of any.
"They're anecdotal, so we look at the mortality rates and try to get some sort of objective measure of what's happening," said Gene Weinberg, head of the department's Bureau of Epidemiology. "As to clusters, well, we've seen some unusual rates. But discovering the factor causing them is rare."
Even though it gets approximately 1,000 citizen referrals or reports a year, the Agency for Toxic Substances and Disease Registry in the CDC has never issued an environmental cause finding for a community "cluster" of death or disease in the United States.
The ATSDR, the principal non-regulatory federal public health agency responsible for addressing health effects associated with toxic exposures, works in cooperation with state health departments, which almost always act as the lead investigating agencies.
While such collaborations haven't identified community clusters, the ATSDR has made determinations of a number of "occupational clusters," including asbestos-related cancers and diseases related to W.R. Grace Co.'s mining of vermiculite in Libby, Mont. Even though that cluster is classified as occupational, the agency said, it caused health problems, disease and cancers for many women and children in Libby who never worked for W.R. Grace.
The CDC, working with the Council of State and Territorial Epidemiologists, is updating its 20-year-old cancer cluster investigation guidelines to incorporate new epidemiological survey and computer tools and best practices.
But those 1990 guidelines and any eventual updates of them are only advisory, which creates problems due to inconsistent investigations in different states, said Terri Nordbrock, executive director of the National Disease Clusters Alliance and an environmental health scientist.
"There's also a lot of pressure not to declare a 'cluster' exists because it's a controversial thing that takes a lot of work and attracts media attention," Ms. Nordbrock said. "Many states don't have the resources to do such investigations and any cluster findings can get them into a lot of trouble with not a lot of payback."
In a written statement about the Post-Gazette's ecological mortality study, Dr. Weinberg said the state Department of Health "recognizes that environmental pollution has health consequences." Although associations may appear, he cautioned against attributing the mapped findings to any factor or combination of factors.
According to the ATSDR, the state health department has conducted 129 public health assessments and health consultations for the registry since 1994 and found no environmental cause for any cluster.
"It is important to understand that clusters, or elevated rates in time and space, can be identified," said Beth Abrams, a spokeswoman for the ATSDR, "but that does not mean that those diseases necessarily share the same cause or an environmental cause."
Daniel Wartenberg, an epidemiologist, professor and director of the Division of Environmental Epidemiology at UMDNJ-Robert Wood Johnson Medical School in New Brunswick, N.J., said he's concerned that state health departments and the CDC are missing legitimate clusters.
"Some of the pollutants cause multiple types of cancer and even multiple diseases," he said. "To say that a state health department will look at only one type of cancer or one disease when considering a cluster is crazy. It's like calling a doctor when you don't feel good and he treats your cold symptoms but not your broken leg."
Dr. Wartenberg, who is on the board of the National Disease Clusters Alliance and also a member of the CDC committee working to update cluster investigation guidelines, said there's better science, computer techniques and years of experience that states should be applying to cluster investigations that will make them work better for communities and the states.
There's also a better way to approach such investigations, including analyzing death and disease data and pinpointing problem areas, he said.
"Now the health departments wait until they are called up or approached by individuals or communities about a perceived problem. The state doesn't go out and look for these clusters. It's passive." he said.
In Clairton, Rex Cole Jr., a lifelong resident, has seen family members -- uncles, aunts, father, grandparents -- die of some form of cancer or heart disease in their 60s along with many neighbors. It's the way of life and death in the mill town dominated by the world's biggest coke plant.
"What you did was, you went to high school, then got a job at U.S. Steel," said Mr. Cole, 28, who is leading a faith-based effort to attract alternative energy industries and jobs to Clairton. "The neighbors said everybody on the street basically died of cancer ... Sometimes the smell is so thick you can taste it. But most people are more worried about putting food on the table than the long-term effects of lung or heart diseases."
U.S. Steel declined to comment on the Post-Gazette's study and its findings, or comment on whether its emissions have affected the health of residents in the Mon Valley. It did outline its ongoing $1.2 billion replacement and upgrade of its operations in Clairton, including new coke batteries and three new coke quenching towers.
Pollution in the Liberty-Clairton region has exceeded federal health standards for airborne particles since 1995. The coke works is the largest local contributor of airborne particles. It is operating under a county consent order and agreement designed to reduce those emissions.