by Pia K. Hansen and Ann M. Colford
The asbestos contamination that is now killing people in Libby, Mont., is a stark reminder of how vulnerable we are to contaminants in our environment. Every day we breathe the air, drink the water, eat the food and play on the soil. Some of us get sick. Some of us develop allergies and asthma. Many of us get cancer. Allergies have taken on a whole new dimension, where today any responsible parent throwing a birthday party not only asks for an RSVP but also for any food or pet allergies. People cough, sneeze and complain. There's something in the water. Then there's mining waste, the incinerator, diesel fumes, radon, the smoke from the wood stoves. So what's really going on? Is Spokane really bad for you? We looked at a few areas of the community's health -- and the news is not all bad.
CANCER - by Pia K. Hansen
There are many known reasons some people develop cancer; there are even more that are unknown. The chilling fact is that one in four of us stand a good chance of developing the sometimes-deadly disease at some point in our lives. The good news is that early treatment and newly developed surgical techniques allow many cancer patients to live to tell the story. The bad news is that many of us fail to take simple preventive measures or to get adequately screened for some of the more common types of cancer.
People have protested the Waste-To-Energy plant for years, saying that dioxins in its emissions will elevate cancer rates here, yet the health study completed last year concluded there was no need to worry. But as the only incinerator left in Washington state, the Spokane plant, perched just above the city, is under pressure to burn questionable items, from pharmaceuticals to meth-making chemicals. In past years, the WTE plant was even accepting waste considered hazardous in Canada. A vigilant public is needed to continue monitoring what is being burned there. At least one local environmental group continues to push to get the plant shut down because of the dioxin it produces.
Now there's growing concern that the by-products of the mining the region is so rich in, such as lead and arsenic, may cause people to develop cancer at a higher rate as well. The infamous releases of radioactive waste from Hanford have been linked to a higher level of thyroid cancer in Eastern Washington.
And Spokane and Kootenai counties have among the nation's highest natural occurrence of radon -- one of the leading causes of lung cancer in the nation. Radon is a kind of radiated gas that seeps through the rock many homes are built on, and although it isn't linked to any specific lung cancer, it is considered a risk factor. Homeowners can have their homes tested and, if necessary, get a radon removal system installed.
There seem to be plenty of reasons people in Spokane could get cancer at a rate higher than in other places.
The Washington State Department of Health (DOH) is home to the Washington State Cancer Registry (WSCR). Keeping track of cancer occurrences is not as simple a task as it sounds, since some cancer patients may be accurately diagnosed, yet choose never to undergo treatment. Other cancer patients are never treated -- it's only after they die that it's discovered they had cancer. Of those cared for, some are treated in hospitals, while many others are treated at individual doctors' offices and at health clinics.
So what is the truth about Spokane? Do people really get cancer at a higher rate here than in the rest of the state?
"Gosh, you know, I wish I had a dime for every time I've been contacted by people who think their county has the highest cancer rate in the state," says Joe Campo, research investigator with the chronic diseases assessment/cancer program of the DOH. Based on data reviewed for thyroid, colorectal, breast and lung cancer (some of the most common types), Spokane is at or just below the average rate for the rest of the state. Campo knows of no spikes in other types of cancer.
In other words, no, Spokane is not a carcinogen on its own.
"If you look at the numbers for colorectal cancer, the age-adjusted rate for the state is 44.4 [out of 100,000 people] and it's 42.2 for Spokane. That is not a significant difference," says Campo. "The thing is, cancer is becoming a very common disease, and as people see friends and family come down with it, it's easy to jump to the conclusion that more and more people in one's area of living are getting sick." About one-fourth of all deaths are attributed to cancer, he adds, and though some cancers are prevalent among children, cancer remains a disease of the aging population -- a fact WSCR's age-adjusted cancer rates take into consideration.
When asked why people get cancer, Campo launches a missile right at our clouded health consciousness.
"Genetics play a role, but beyond anything else lifestyle choices are the major cancer causes," says Campo. "Like not eating your five servings of fruits and vegetables a day, or not exercising, or continuing to smoke. Compared to anything that we are exposed to in our daily living environment, any chemical or anything like that, I'd say lifestyle choices is the main carcinogen."
The area's notoriously high rates of naturally occurring radon -- among the highest in the nation -- have yet to be officially linked to specific types of lung cancer. The main cause of lung cancer remains cigarette smoke.
So is it fair and accurate to compare cancer rates, when trying to determine the cancer risk in a certain area?
"I'd say it's more interesting to look at cancer screening and at what point of the disease people come in," says Campo. "There's a new focus on the value of screening and on what stage of the disease people first get into treatment. The state as a whole has far too many late-stage colorectal cancers, for instance." "Late-stage" means the cancer has either spread to the region around the initial site or has metastasized to distant sites in the body.
"Generally, survival rates decrease -- often dramatically -- once the cancer has spread," says Campo.
Of the more common types of cancer -- such as colorectal, breast cancer and melanoma of the skin -- there's broad agreement that screening and early detection pays off.
"Of those three, Spokane has an appreciably higher percentage of late-stage colorectal cancers compared to the rest of the state," says Campo. In Spokane, 64 percent of the colorectal cancers are late-stage when discovered, compared to 57 percent in the rest of the state.
Early detection is a matter of life and death. Campo says nationally the five-year survival rate for colorectal cancer is 64 percent when the disease is "regional" (only in the area where it started). If it has already spread to other parts of the body, that rate drops to 9 percent.
"That means only 9 percent of people diagnosed with distant colon cancer survive for five years," says Campo. "We have the tools to do these screenings, but people are still uncomfortable talking about these things. Though there have been some questions about other cancer screenings, with colorectal at least we can say for sure that screenings save lives."
AIR -- by Ann M. Colford
We've all seen headlines about the problems with Spokane's poor air quality and heard the health warnings regarding exposure to carbon monoxide and particulate matter. Anecdotal stories abound about increased rates of asthma and other respiratory ailments in our region. And, of course, the most visible air quality issue -- field burning by local grass farmers -- clouds the horizon late every summer and remains a political hot potato all year round.
With all of the dire stories, should asthma and allergy sufferers consider a mass exodus? Dr. Michael Kraemer of the Spokane Allergy & amp; Asthma Clinic sees plenty of patients with respiratory problems. But based on his experience in the clinic, he says conditions for allergy sufferers in the Inland Northwest are not as bad as the headlines may lead us to believe.
"For an allergy patient, Spokane is generally a good place to be," says Kraemer. "My impression is that, globally, we're doing pretty well here. Depending on what you're allergic to, it's not bad, unless you live near the grass burning."
It turns out that our region has a relatively low volume of airborne allergens overall when compared to some other areas of the country, says Kraemer.
"We don't have heavy industrial sources of air pollution. We have dust, which is endemic in the West due to our low humidity levels. Here, the dust is made up of loess, which is volcanic ash, and tilling, from the agricultural areas." Some may not agree with Kraemer's assessment of industrial air pollution in the area: Kaiser Aluminum was fined for continuously violating state air standards, and the Waste-to-Energy plant just recently cleared the long-awaited health assessment study.
Kraemer says the low humidity that contributes to our dust problems mostly means good news for allergy sufferers.
"We have no ragweed, no mold and no dust mites, and there's minimal pollen because we have no vast deciduous forests."
Higher levels of particulate matter in the air due to smoke is a problem in the summer months, but there are multiple sources for the smoke.
"We have forest fires plus naturally occurring grass fires plus the set grass burning," says Kraemer. "All of these contribute toward smoke levels, and all are worse in Spokane than in some other areas."
Asthma on the Rise
Although Spokane may not be a bad place for asthma sufferers, the number of people dealing with the chronic condition has doubled in the past 15 years, according to the Spokane Regional Health District. Both the Washington Department of Health and the American Lung Association of Washington (ALAW) indicate that asthma is approaching epidemic proportions.
"One in nine adults and one in 10 children in Washington have been diagnosed with asthma at some time in their lives," says Cindy Thompson, the Spokane Branch Director of the ALAW. The numbers in Washington reflect a national trend, she adds, so Spokane is not necessarily an asthma-provoking city.
The cause of asthma is unknown, but it's well-known that exposure to some pollutants makes asthma symptoms worse.
But even when factoring in the effects of summer smoke, Kraemer says outdoor air is not the biggest problem facing allergy and asthma patients on a daily basis.
"Indoor cigarette smoke and other pollutants in today's tighter homes is a far bigger issue," he says.
Thompson says the ALAW agrees with Kraemer's emphasis on indoor air quality. The organization has research showing that American adults now spend about 90 percent of their time indoors. Homes and workplaces have become more tightly insulated over recent years, so concentrations of pollutants indoors may be even higher than outdoors. In addition to environmental tobacco smoke (secondhand smoke), the ALAW has identified several other indoor air hazards: radon; combustion products stemming from sources such as stoves, furnaces, fireplaces and heaters; biologicals such as pet dander, pollen, molds and dust mites; the volatile organic compounds present in paints, cleaners, pesticides, copiers, printers, glues and adhesives; lead dust from old, lead-based paints; and asbestos.
Clearing the Air
The ALAW continues to follow the ambient air quality in the Spokane region as a partner agency with the Spokane County Air Pollution Control Authority, or SCAPCA, in the region's AirWatch program.
In the mid-'90s, Spokane County was designated by the Environmental Protection Agency (EPA) as a serious non-attainment area for carbon monoxide (CO), and a moderate non-attainment area for particulate matter (PM). As a result, Spokane ended up on the nation's list of cities with the worst air quality -- alongside more notorious offenders like Los Angeles.
Since then, thanks to a broad community effort and SCAPCA's AirWatch program, the region's ambient air quality has improved tremendously. In a statement issued in November, SCAPCA Director Eric Skelton said that Spokane is getting close to achieving five years without a violation.
"Efforts are well underway toward demonstrating that Spokane is attaining the federal standard for CO," he says. "Our ultimate goal is official recognition by EPA that we have attained the standard. However, we still have plenty of work to do if we are to continue this progress, and reducing invisible carbon monoxide continues to be one of our biggest challenges."
The Lung Association estimates that 57 percent of air pollution in Washington comes from motor vehicles, and motor vehicles are the primary source of CO.
"If motorists reduce drive-alone commutes and eliminate unnecessary car trips -- especially during periods of clear, cold and calm weather conditions -- then Spokane might well be on its way to successfully achieving five years of back-to-back air quality within the federal health-based air quality standards," says Skelton.
To help prod commuters out of their cars, the Spokane Transit Authority -- another AirWatch partner -- offers four Free Bus Ride Days each winter and sponsors several commute reduction programs with large employers in the area. The final free ride day for this season is coming up on February 13.
A Burning Question
Following the guidelines of the EPA, SCAPCA measures three categories of pollutants: carbon monoxide (CO), particulate matter (PM) and ozone. Particulate matter is further subdivided into two categories: PM10, particles up to 10 microns in diameter; and PM2.5, fine particles with a diameter up to 2.5 microns. These are the tiny particles that can work their way into fragile lung tissues and trigger asthma and other chronic lung ailments.
The health threat caused by PM10 and PM2.5 in grass field smoke has led the Idaho Medical Association to partner with the American Lung Association of Idaho/Nevada and the grassroots organization, SAFE (Safe Air For Everyone) in a major effort to put an end to grass field burning in Idaho.
A number of studies, including local efforts led by the Spokane Regional Health District, have shown that increases in fine particulates can lead to higher rates of hospitalization and death from asthma. Based on the scientific data and on their own experience with patients, 85 percent of the physicians in Sandpoint signed a letter calling for a ban on grass field burning. SAFE has already become a significant presence in the 2002 Idaho legislative session.
Grass burning in Washington has been substantially reduced since new regulations were put into place by the state Department of Ecology in 1996. Acres burned in Spokane County have dropped from more than 30,000 in 1989 to just 143 in 2000. Since 1997, SCAPCA has noted no violations of the air quality standards for either CO or PM10.
All in all, mostly good news about the air we breathe, but continued diligence is very important to keep the lungs of today and tomorrow healthy.
"The lungs' constant interaction with the environment makes the health impacts of air pollution inescapable, and poor air quality is particularly hard on children, the elderly and people who suffer from respiratory disease," says the ALAW's Thompson. "But even healthy people can be affected when air pollution levels are elevated."
MULTIPLE SCLEROSIS -- by Pia K. Hansen
Here's an ongoing health mystery if we ever saw one. Multiple Sclerosis (MS) has no cure, and there's great uncertainty about what causes it. While most MS sufferers are mildly affected, the worst cases of the disease leave sufferers unable to walk or speak, sometimes slowly wasting away over decades.
Often diagnosed in younger adults -- primarily in female Caucasians -- the disease causes inflammation of the central nervous system and destruction of myelin, the matter that insulates nerve cell fibers in the brain and spinal cord, and conducts the transmission of electrochemical messages between the brain and the rest of the body. As the nervous system gradually breaks down, the patient can become more and more debilitated. And here's the real kicker: Spokane has the highest MS rate in the entire nation. So the obvious question remains: Is there something in the water or air here that causes multiple sclerosis?
"Anyone you talk to in our community knows somebody," says Robert Hansen, chapter president of the Inland Northwest Chapter of the national MS Society. "It's a high incidence. It tends to run in a family, but you can't predict it."
In most areas of the United States, the MS rate is about 185 cases per 100,000 people. In Spokane and Lincoln counties, that rate is 211. These numbers are all based on sufferers who self-report to the MS Society.
There are four major theories as to what causes MS:
* An immunologic explanation: MS involves an autoimmune process in which the body's own immune system attacks the central nervous system. Researchers are currently looking for ways to stop this attack without ruining the immune system's ability to respond to other diseases.
* An environmental cause: this one involves migration patterns, socioeconomic reasons and genetic factors. Research has shown that people who are born in an area with a high risk of developing MS, but move to an area with a low risk before they reach adolescence, acquire the risk of their new home region. This may point to the presence of an environmental factor, or trigger, in high-risk areas. No one seems to know what this factor may be.
* A viral cause: it is possible that certain viruses may trigger MS, including the Epstein-Barr virus (EBV), which causes mononucleosis. In a recent study of more than 62,000 women conducted at Harvard University, researchers found 18 women with MS had a higher EBV antibody level compared to the women without MS. Still, very few people infected with EBV (a virus 90 percent of the population is exposed to) actually develop MS -- so there have got to be other factors involved.
* A genetic cause: MS is not hereditary, but having a first-degree relative like a parent or a sibling with MS increases an individual's risk of developing the disease by several fold. The disease is also more common in the Northern Hemisphere, especially in northern Europe.
So the question 'Why Spokane?' remains unanswered. Hansen offers a few ideas, mainly that the population here is only about 5 percent non-Caucasian, and that many local families can trace their ancestry to northern Europe and areas of Britain, Scotland and Ireland with high levels of MS.
The area's whiteness plays a big role in the high rates, since MS attacks mostly Caucasians.
"That means we have 95 percent of the population susceptible to the disease," he says. Locally, many have tried pinning the high MS-rates on Hanford or the mining waste in the water, but neither theory seems to hold up to scrutiny.
"People say it's Hanford, but we found that doesn't hold water because there was a lot of MS reported here before [Hanford was built] in 1945," says Hansen. Other theories include the water in certain creeks and inoculations against smallpox, but none have been verified.
Hansen says the symptoms of MS -- numbness, paralysis and fatigue -- can be similar to those of lead poisoning, but today's diagnostic methods are close to 99 percent accurate.
"The neurologists are fairly certain of the diagnosis these days," says Hansen. "With MRI scanning, MS can be definitely diagnosed."
Hansen seems to support the idea that some combination of the four mentioned theories is what's really going on with MS.
"People move up here from California and see our ads about our [fundraising] walks and say 'Do we need to move back?' " he explains. "The [scientists] know it's based on where you spent the first 12 years of your life. If you grew up here, and you're white Anglo-Saxon, northern European extract, you're at a higher risk than your brother who grew up in Texas."
But why? Doesn't that show that MS has got to be exacerbated by something in Spokane's immediate environment? Sadly, no one is certain about anything when it comes to MS.
WATER -- by Pia K. Hansen
People are exposed to many different environmental factors every day. Of all of them, water and air are probably the ones with the largest impact on our health.
When health warning signs went up along the upper Spokane River between State Line and Plantes Ferry Park last year, the area got a big wake-up call. An environmental study had found high levels of lead and arsenic in the sand along the shoreline of the river and some lead and PCB contamination in the fish in the river. The signs asked people to limit their intake of fish caught in the river, and to make sure, especially, that children and their beach toys are cleaned after a visit to the water's edge. Decades of mining activities in North Idaho have left some area rivers and lakes contaminated with lead and arsenic from mine tailings, and some of the heavy metals had begun migrating down the river.
Michael LaScuola is an environmental health specialist and chemical/physical hazards advisor with the Spokane Regional Health District. He says the concern about river contamination comes down to two things: heavy metals such as lead, and PCBs (polychlorinated biphenyls, an industrial waste product).
Generally, he says, fish contaminated with heavy metals are not a significant health risk unless they are prepared in a way that incorporates the gut, bone and nervous system of the fish.
PCBs, however, are accumulated in the fatty tissue of the fish, so they are much more likely to be ingested by local fishers. PCBs are suspected carcinogens.
Children are at much higher risk for exposure to lead, which may cause brain damage and learning disabilities, because they are more likely to be playing in the sand on the river banks and putting toys -- with soil on them -- in their mouths.
People should limit their intake of fish caught in the river, especially rainbow trout, white fish and large-scale suckers.
To this date, however, no one has filed a report of arsenic or lead problems in either children or adults stemming from the Spokane River. Does this mean things are looking better for the river?
"With any luck in the next five or 10 years, we may be able to reset those advisories," says LaScuola. "We are just asking people to use good judgement."
Spokane gets all of its drinking water from the Spokane aquifer, a unique underground flood plain that stretches beneath the Spokane Valley out to the Rathdrum Prairie. As any water source located in an area with lots of farming and high-density urban developments, the aquifer is likely to be affected by the nitrates in fertilizer, excess phosphorous stemming from septic systems and industrial pollutants that have seeped through the topsoil.
But Spokane's aquifer so far has passed all tests with flying colors. One contaminant that has been in the headlines a lot lately, however, is arsenic. The highest level of arsenic in drinking water the EPA allows for is 10 ppb (parts per billion). In Spokane, the highest level detected is 4 ppb.
"The level now set at 10 is making a lot of communities treat their water because the standard used to be 50," says Brad Blegen, director of Spokane's water services department. "If for some reason the standard was lowered again, perhaps to 5 ppb, we'd be getting close."
The maximum level of nitrate allowed by the EPA is 10 ppm (parts per million) and the highest measurement in Spokane comes in at 4 ppm.
Because of the area's mining history, many are concerned about lead not only in the river water, but also in the drinking water. Lead does not have a maximum allowance, but several factors together form a basis for what's called an "action level" -- the point at which action is taken to clean lead out of the drinking water. Lead's action level is 15; the highest level of lead found in Spokane's water is six.
"The water quality is excellent," says Ty Wick of the Spokane Aquifer Joint Board. "The only nuisance is high minerals, but this doesn't affect the taste of the water -- you only notice that with laundry and such. We are below all the National Contamination Levels as established by the Environmental Protection Agency."
The challenge, it seems, is to keep things this way. The aquifer is not a bottomless well of magically clean water. Industrial developments such as Burlington Northern's refueling depot and the proposed Cogentrix power plant, which will be pumping millions of gallons of cooling water straight from the aquifer, are threats to our clean water. The Department of Ecology tries to educate business and property owners located on top of the aquifer, helping them deal with potential hazardous waste in a manner that won't destroy the water source for about 400,000 residents in this area.