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Carol S. Rubin,¹ Adrianne K. Holmes,¹ Martin G. Belson,¹ Robert L. Jones,² W. Dana Flanders,² Stephanie M. Kieszak,¹ John Osterloh,² George E. Luber,¹ Benjamin C. Blount,¹ Dana B. Barr,² Karen K. Steinberg,¹ Glen A. Satten,¹ Michael A. McGeehin,¹ and Randall L. Todd²

¹National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ²Nevada State Health Division, Carson City, Nevada, USA

Abstract
Background. Sixteen children diagnosed with acute leukemia between 1997 and 2002 lived in Churchill County, Nevada, at the time of or before their illness. Considering the county population and statewide cancer rate, fewer than two cases would be expected.

Objectives. In March 2001, the Centers for Disease Control and Prevention led federal, state, and local agencies in a cross-sectional, case-comparison study to determine if ongoing environmental exposures posed a health risk to residents and to compare levels of contaminants in environmental and biologic samples collected from participating families.

Methods. Surveys with more than 500 variables were administered to 205 people in 69 families. Blood, urine, and cheek cell samples were collected and analyzed for 139 chemicals, eight viral markers, and several genetic polymorphisms. Air, water, soil, and dust samples were collected from almost 80 homes to measure more than 200 chemicals.

Results. The scope of this cancer cluster investigation exceeded any previous study of pediatric leukemia. Nonetheless, no exposure consistent with leukemia risk was identified. Overall, tungsten and arsenic levels in urine and water samples were significantly higher than national comparison values ; however, levels were similar among case and comparison groups.

Conclusions. Although the cases in this cancer cluster may in fact have a common etiology, their small number and the length of time between diagnosis and our exposure assessment lessen the ability to find an association between leukemia and environmental exposures. Given the limitations of individual cancer cluster investigations, it may prove more efficient to pool laboratory and questionnaire data from similar leukemia clusters.

Key words: ALL, AML, Churchill County, cancer cluster, environment, Fallon, leukemia, tungsten. Environ Health Perspect 115:151–157 (2007) . doi:10.1289/ehp.9022 available via http://dx.doi.org/ [Online 30 November 2006]

This article is part of the mini-monograph "Cancer Cluster Activities at the Centers for Disease Control and Prevention."

Address correspondence to C.S. Rubin, CDC, NCEH, 4770 Buford Hwy. NE, Building 101, Room 1156, Atlanta, GA 30341 USA. Telephone: (770) 488-3406. Fax: (770) 488-3450. E-mail: crubin@cdc.gov

We thank K. Service, J. Najima, J. Ryan, M. Candreia, B. Goetsch, D. Henahan, J. Wamsley, D. Wollin, D. Reissman, A. Wolkin, R. Sabogal, K. Schmeichel, J. Mutter, D. Ashley, D. Paschal, M. Gallagher, S. O'Connor, R. Boneva, L. Levy, K. Tedford, and the entire City of Fallon for their support of and contributions to this investigation.

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the CDC.

The authors declare they have no competing financial interests.

Received 18 January 2006 ; accepted 15 June 2006.