Rural and Community-Based Cancer Cluster Research

Background: Researchers worked with a community to identify the key questions and methods, gather and analyze data, and disseminate findings regarding childhood and adolescent leukemia and osteosarcoma in the Fruithurst Elementary School. We explore the potential of community-based participatory research to inform a mixed-methods and interdisciplinary approach to rural community cancer cluster concerns. Methods: Between 2017 and 2021, public meetings and outreach directed the research process. Structured interviews and archival research informed soil and water sampling in 2017. A school district-wide survey of 515 households gathered data on cancer types and exposures, and then informed 2018 and 2019 sampling. Samples at 26 sites were analyzed for heavy metals; semivolatile and volatile organic compounds; and/or radon. Results: Archival research uncovered missing stormwater discharge reports for local industry and that the former town well system was shut down after failing to meet state water quality standards. Structured interviews with leukemia and lymphoma households identified well-water consumption and/or in vitro exposure and extended or immediate family occupational exposure to rubber. Some soil and water samples had elevated levels of contaminants, including carcinogenic bis(2-ethylhexyl) phthalate. Complete prevalence cancer rates in the survey were above the national rate for 16 cancers and indicated possible associations to well water and pesticide exposures. Discussion: For communities to achieve action through cancer cluster research, our project suggests integrating collaboration with verification; emphasizing more interaction and less control; utilizing flexible boundaries rather than imposed census ones; and approaching experience as significant. Limitations include comparative data and accurate geocoding in rural locations.