Breasts (23 page)

Do unto those downstream as you would have those upstream do unto you.

—WENDELL BERRY,
Citizenship Papers

E
VEN ITS NAME SOUNDS JAUNTY: CAMP LEJEUNE. SIGNS
posted along the Marine Corps base in coastal North Carolina pointed the way to archery and bowling. The Burger King on Holcomb Boulevard advertised frozen fruit drinks. I half expected to see a pickup game of Capture the Flag. For a moment, I thought it looked like summer camp, until I realized it’s the other way around. The traditional American summer camp model is based on the military. Think about it: the uniforms, mess hall, reveille, all those games of conquest.

People don’t live at Camp Lejeune, they live “aboard” it. Home to some 150,000 marines and sailors and their families, the base covers 236 square miles. In its outer reaches lies evidence of the more serious pursuits of the Second Marine Corps Division. There
is, for example, the (former) Live Hand Grenade Course, the Fortified Beach Assault Area, and, of course, the Flame Tank and Flame Thrower Range. (Don’t think that one will be coming to Camp Wigwam any time soon.) These sites may have helped keep America strong, but they have also helped keep it sodden with volatile organic compounds. All of these zones, plus dozens of others on the base, are currently marked on the Environmental Protection Agency’s National Priority List—otherwise known as Superfund.

Unfortunately, the base’s worst historic contamination overlay much of its drinking water supply for at least three decades, from the mid-1950s to the mid-1980s. Nicknamed “camp sloppy,” the base is made up of a big series of linked wetlands, aquifers, and the lazy New River flowing down the middle of it, all tilted toward the ocean. In one industrial area of the base known as Hadnot Point, fuel tanks silently dribbled or poured close to two million gallons of gasoline into the groundwater, forming a plume of petroleum now believed to be fifteen feet thick and half a mile wide. Atop it all sat well number 602, which in 1984 helped supply water to eight thousand people and yielded a reading of 380 parts per billion of benzene. This is seventy-six times the legal limit for benzene, a known human carcinogen.

Hadnot Point was known as a “fuel farm”—essentially the base’s gasoline depot—and it’s also where the Second Maintenance Battalion fixed tanks, jeeps, and other fleet vehicles. Beginning in the 1940s, it also held, in addition to gasoline, leaking storage tanks of industrial chlorinated solvents, notably trichloroethylene (TCE) and perchloroethylene (PCE) used for degreasing machinery. Up the road sat the base’s disposal yard, where these solvents and others were dumped or buried. Some wells were more contaminated than others,
but water from many wells was routinely mixed and then distributed to numerous houses and barracks from central water treatment plants.

The legal drinking water level for TCE and PCE, long considered probable carcinogens, is 5 parts per billion. That level, though, wasn’t established until 1989. Although the military knew there was a potentially hazardous contamination problem by 1982, it did not routinely check the levels here until late in 1984. At that time, analysis from one well revealed 1,600 parts per billion of TCE. Tap water at the elementary school contained 1,184 parts per billion. That is five times the levels recorded in the poster-child-city of water pollution, Woburn, Massachusetts, site of the book and film
A Civil Action.

Camp Lejeune, in addition to being the “home of the Marine expeditionary forces in readiness,” now enjoys distinction as having had the most contaminated public drinking water supply ever discovered in the United States. Over the decades, 750,000 people drank it, bathed and swam in it, and inhaled its vapors.

The base also happens to form the center of the largest cluster of male breast cancers ever identified. We know this thanks not to the U.S. Marine Corps or even the Agency for Toxic Substances and Disease Registry (ATSDR), an arm of the Centers for Disease Control and Prevention that is tasked with assessing the health effects of the contamination. We know this because of one man with the disease and an Internet connection, Michael Partain. He calls himself Number One.

Partain, a father of four and an insurance claims adjuster in Tallahassee, Florida, was diagnosed with cancer in his left breast in 2007, at the age of thirty-nine. He underwent a partial mastectomy and eight rounds of chemotherapy, and then developed “gonadal
failure,” or an inability to produce testosterone. This was tough business for the son of a marine. “I never even knew men could get breast cancer,” said Partain. “I kept thinking, what did I do to win this lottery? I never drank or smoked. I liked backpacking and Boy Scouts. There is no history of breast cancer in my family.”

Not long after Partain was diagnosed, his father called him and told him to turn on the TV. There was a news report about the pollution at Camp Lejeune and its possible links to leukemia and other diseases. It was the first either man had heard of the contamination. Partain had been conceived and born on the base. “I knew right away I’d been exposed. I figured if this was the cause of my cancer, I wouldn’t be the only one,” he said. Partain went public with his diagnosis in the local media. Soon after, he got a call from a preacher in Alabama. He’d lived as a child in the same neighborhood as Partain, and at the same time. The preacher became Number Two.

Partain started Googling around for male breast cancer, and soon he found a photo of another man with the disease in Michigan. “His chest was half gone,” recalled Partain, “and his Marines uniform was draped over his arm. I was like,
holy shit.”
Before long, he’d found twenty men with breast cancer and ties to Camp Lejeune. CNN ran a story on them and their conviction that their disease was linked to contaminated drinking water on the base. Overnight, twenty more men contacted Partain. Soon there were fifty.

As of this writing there are seventy-one of them, and the number goes up virtually every month. (There are also plenty of women around who lived on the base and have breast cancer, but what else is new?) Is there really a link between the men’s cancers and the drinking water at Lejeune? Although some two hundred chemi
cals have been found to make mammary tumors grow in lab animals, it’s been extremely difficult to link chemicals to the disease in humans. Many experts say there is only one proven environmental cause of breast cancer, and that’s radiation. If new insight emerges from studying men like Partain, it could profoundly alter the way we view environmental health, and breast cancer in particular.

In the Western world, the incidence of breast cancer has grown in both men and women between 1 and 2 percent a year since 1960 (with the exception of a short-lived dip in women’s rates in the last decade), although it is still very rare in men. For every one hundred women who get breast cancer, only one man does. But ironically, it may be the men who help solve the puzzle of this disease. In looking for a link between breast cancer and chemicals, it’s much simpler to study men than women. Men’s risk factors aren’t complicated by such things as age at puberty, reproductive life history, and hormone replacement therapy. They’re just guys with a very rare disease, and rare diseases are easier to trace to environmental exposures. This cluster, unlike so many others, could prove statistically significant.

“We stick out like a sore thumb,” said Partain.

FOR ALL THE PERSONAL TRAGEDY CAMP LEJEUNE MAY HAVE
caused an untold number of marines and their family members who have suffered from childhood cancers, birth defects, miscarriages, and adult diseases, the saga may prove a tremendous boon to scientists. Many of them gathered one recent summer day in Wilmington, North Carolina, for the twentieth meeting of the Community Action Panel, a committee of experts and local activists put together by ATSDR. The panel, one of several centered
on Superfund sites around the country, meets four times a year to discuss the state of the science and any concerns that community members have. Thanks to active public participants, researchers found out about the massive benzene plume. It’s also because of the participants that male breast cancer, along with a number of other health problems, is now being studied by the agency.

Partain sits on the community panel, and so does a former drill sergeant named Jerry Ensminger, whose daughter, Janey, died of leukemia in 1985 at the age of nine. Two other panelists were notably absent, one suffering from battle-related post-traumatic stress disorder and the other recently dead of parathyroid cancer. Ensminger, bullish and compact, plays Calvin to Partain’s more measured Hobbes. Ensminger and Partain were the two lead characters of a recent documentary titled
Semper Fi: Always Faithful,
about the former Lejeune residents and their battle against the military for truthful information and health-care benefits.

“You’re wearing cowboy boots,” Partain said to Ensminger as they walked across the local campus parking lot to the meeting.

“That’s for kicking some ass,” Ensminger replied.

After a round of introductory remarks, in which Ensminger lit into the U.S. Marine Corps for sending only a silent observer to the meeting, federal epidemiologist Perri Ruckart reviewed ATSDR’s work to date. One health study performed by the agency in 1998 pointed to an association between the drinking water and male babies born smaller than expected. But in light of new (and more damning) evidence of contamination, the findings are now being reanalyzed with updated water modeling data. Several other important studies are ongoing, said Ruckart. These include a study of birth defects and childhood cancers in children born on the base, an
overall mortality study of marines who lived there during the contamination, and a morbidity study that will canvass three hundred thousand former residents and base workers for illnesses. These studies will compare results with a similar but unexposed population from Camp Pendleton, a marine base in the state of Washington.

As Ruckart and her colleague Frank Bove had explained to me earlier, these are classic epidemiological studies, called case-control studies, which compare similar populations exposed to different things to see if one group is sicker. They’re not perfect because researchers must rely on high percentages of people to enroll in the studies. If only sick people from Lejeune choose to answer questionnaires, that’s called selection bias, and it can skew results. The ATSDR researchers won’t have to rely on participants to tell the truth, as they’ll laboriously confirm all medical diagnoses. These studies take years and cost tremendous amounts of money. The Lejeune studies will cost upward of $20 million. (Cleaning up the base is expected to cost more than $200 million.)

When they do work, health studies like these can be informative and (eventually) have a dramatic influence on public policy and medical practice. A case-control study is how researchers first reliably linked smoking to lung cancer. To date, the most revealing human cancer studies have been occupational ones, in which workers were known to be exposed to a particular chemical over a given length of time. Only a few general-population studies (as opposed to worker studies) have ever effectively proven a link between chemical exposures and cancer. Interestingly, though, two such studies also involved the solvents TCE and PCE, as well as other contaminants. In both Woburn (site of chemical and glue factories) and in Toms River, New Jersey (site of a dye-and-pigment plant), federal research
ers concluded that the towns’ high childhood leukemia rates were caused by contaminated drinking water, although they could not untangle one particular compound as the villain. In Woburn, an unusual number of male breast cancers also appeared, but the number was too small—only a handful—to be statistically meaningful.

That is why Ruckart and Bove are looking so hard at Camp Lejeune, where hundreds of thousands of men were exposed and already a high number with breast cancer have come forward. If nothing else, the numbers to work with are bigger, and that means more reliable. As ATSDR director Christopher Portier explained it to me after the meeting, “If I take a coin and flip it ten times and get seven heads, that could be biased by chance or not. But if I flip it one thousand times and get seven hundred heads, then I guarantee you there’s an association. If there are real effects [to be seen at Camp Lejeune], then they will pop out in these studies where they looked marginal in others. We will do distinctly new science here.”

At one point during the question-and-answer session, a local woman asked, “What can you tell this man here about the cause of his health problems?” Portier answered, simply, “Nothing.” Even if the studies show a leak-proof link between cancer and the base’s water, those conclusions would not apply to individuals, only to the risks faced by the population as a whole. Try telling that to Partain, though, who points out that the average age of onset for male breast cancer is seventy. “Over half the men I’ve identified are under fifty-six years old,” he said. “That’s not right. I know what caused my cancer.”

Human nature is such that many of us easily believe causal links where they may not exist, especially when it comes to personal or familial tragedies. But the Camp Lejeune cluster has certainly raised the interest of academics and clinicians. Richard Clapp is an epidemiologist recently retired from Boston University who is serving
as an outside expert on the community panel. He cautions that it may be years before the men get answers about the breast cancer. Even then the answers may be shrouded. While this is the largest cluster of male breast cancers ever found, there still might not be enough cases to get a strong signal in the data, he said. On the other hand, if an association does pan out, people will take notice. Most of Lejeune’s pollutants are not known to act as hormones, “so it would make it more of a pure chemical story, and you could say at least one type of breast cancer can be caused by chemicals,” said Clapp. “This should provide an opportunity to learn something. From an academic point of view, it’s good. For the men involved, it’s terrible.”