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Cluster of cancer cases concerns parents

Cluster of cancer cases concerns parents
The Braun family. Front row, from left, Todd, Michael, 8, and Yvonne. Back row, from left, Nathan, 12, Jeff, 20, and Ben, 14.

KASSON — "Cancer" is one of the most frightening words a parent can hear about a child's health.

Too often during the past two years, that has been the diagnosis for children from a small area in the Kasson-Mantorville school district.

Cancer dates to ancient Egypt when physicians "treated patients for several forms," according to the National Cancer Institute. But in all that time, the causes of many childhood cancers remain elusive.

Yvonne Braun, of Kasson, says she believes her son Nathan, now 12, was the first child in a group of kids diagnosed with acute lymphocytic leukemia and other cancers.

Braun says six individuals have been affected:


• Her son in 2009.

• A girl near his age diagnosed with acute lymphocytic leukemia in 2010.

• A child younger than 6 with the same type of leukemia.

• A toddler with a tumor found in spring 2011.

• Another toddler in fall 2011 diagnosed with leukemia.

• Late this year, a child diagnosed with a brain tumor.

Of the six children, Braun said, four have been diagnosed within the past nine months.

The Minnesota Department of Health gathers similar data, but statistics for 2011 haven't been compiled yet. If Braun's description represents an accurate summary, "that is more than you'd expect — quite a bit more," said John Soler, an epidemiologist at the Minnesota Department of Health. 


For pediatric cancers — those that happen from birth to age 19 — the expected number of cancers for a population the size of Kasson-Mantorville, based on the 2000 census, would be four or five children affected every 10 years, Soler said. Instead, four have happened in nine months, and all of the cases in the past two years were among kids 10 or younger.

Soler said health officials can't give much reassurance to families. That's because studies of pediatric cancer clusters nationwide that have reviewed soil, water, air and blood samples have not pinpointed a root cause of pediatric cancers.

"The best we can determine, there isn't a common link," Soler said.

By the numbers

Logan Spector, associate professor in the division of epidemiology and clinical research at the University of Minnesota Department of Pediatrics, said there are about 12,000 pediatric cancers per year in the U.S.

"You need a lot of cases to be able to detect difference in exposures with statistical confidence," Spector said. "When there is a group occurring close together in time and place, although the number is very noticeable to a community, it usually only amounts to under 10 cases." 

He likens pediatric cancers to grains of rice, each grain representing a child with cancer. Drop 12,000 grains on a map of the United States.

"Some will surely appear to end up closer to each other randomly," Spector said. 


If the cause isn't known, there's no way to tell parents what to do to protect siblings and classmates — or even if there's a need to since it's not clear if such cancers are naturally occurring spikes in the statistics.

Soler notes that there's a downside to publicizing cancer clusters; it can bring unnecessary worry to unaffected families and might make affected families believe answers will be forthcoming. 

It's hard to put seemingly "cold, harsh" lack of answers in print when parent's won't benefit as a result, Soler said, and he agonizes because he pursued epidemiology so that he could provide such answers. Knowledge and techniques haven't progressed as fast as needed to find them.

It's important to know, Soler said, that "there has not been a situation where a cluster started and just kept going and going and going, knock on wood."

Statistical anomalies

The Kasson cases might be a random occurrence, Soler said. He said that Kasson had a period of six years in a row during the past 30 years with no pediatric cancers.

Such statistical anomalies happen on a fairly regular basis in Minnesota and nationwide, Soler said. He gets about 100 calls each year from people worried about potential clusters. Most are related to adult diagnoses. But the calls include a disproportionate number that relate to kids affected by cancer.

"I actually get a fair number from school districts," Soler said.

When a child is affected, a family's path forward can be heart-wrenching, exhaustive and financially disruptive, and he understands that.

The types of cancer recorded is another issue, according to Spector. Leukemia, lymphoma and brain cancer are the three most common types of childhood cancer. Different cancers are unlikely to have the same cause, Spector said, suggesting chance occurrence rather than a single cause in Kasson.

Dr. Shakila Khan, a pediatric oncologist at Mayo Clinic in Rochester, also said that the Kasson cancers involve different types. Research is ongoing as to why some children nationally get acute lymphocytic leukemia and some don't. The risk for siblings of an affected child is about the same as for the general population, Khan said, though more than one child in a family can develop acute lymphocytic leukemia. 

Khan said it's still not clear there's anything abnormal about the number of kids affected in the Kasson area. 

"Unless you do a proper epidemiological study, it's hard to get anything out of it," she said. Can you protect classmates and siblings of affected kids? The hard answer is no, because there's no scientific evidence about ways to decrease cancer risk in kids.

Khan said, though, that common sense suggests you'll do no harm by living a healthy lifestyle. The good news, she said, is that medical success is becoming more common for treatment of childhood cancers.

"I would say about 80 percent get better and cured," she said.

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