(EHELP) Environmental Health Exposure Life Profile

Sample 2 January 10, 2012 by David Lincoln

SUMMARY Client is an 83 year old white female diagnosed with Alzheimers disease in her eighties. She has no history of previous chronic health problems and no history of chronic diseases (including cancer) in her family. She has never smoked and her parents never smoked, but she was subjected to secondhand smoke from her spouse for thirty years during late teens through middle age exclusively. It should be noted that her spouse died recently of Chronic Obstructive Pulmonary Disease (COPD) which could have partly been the result of decades of smoking, breathing Los Angeles area smog-filled air, or both. The subject only lived in three residences during her entire lifetime. Fortunately for her, the first residence was located on the outskirts of Oklahoma City in the western suburbs of Bethany OK. This location was essentially undeveloped during the 1930s and 40s. There is no indication of any significant toxic exposures from the pre-natal period through her teenage years with the possible exception of lead paint in the home. The prevalence of Alzheimers Disease in her large family could potentially be partly a result of eating lead paint flakes near the windows in early childhood. Parental lifestyle choices (non-smokers, non-drinkers, etc.) and no family history of cancer pre-disposed her to a relatively low risk of cancer. Low cancer risks for white females are present in Oklahoma County to this day. Despite this strong beginning, the next housing choice had the opposite characteristics and presents a higher risk for development of cancer and other chronic diseases. The house was located near a major freeway through the eastern suburbs of Los Angeles in the midst of the heavily developed post-WWII era housing boom. Moreover, the residence was ringed by a highly polluting petrochemical complex. Since the Norwalk, CA residence was at least two miles away from the nearest superfund site or toxic release facilities, soil and groundwater contamination are not significant issues in this area. However, air pollution was and is a real problem in the Norwalk area. Particulate matter and exhaust fumes from the nearby highway with 10% benzene and 50% formaldehyde releases from the refineries and factories in the vicinity could have had major health impacts. Benzene is a known human carcinogen and has been linked to leukemias (especially chronic myeloid leukemia) as has formaldehyde exposure. The latency period for the Benzene effects may be as long as 40 years. The highest risks of nasopharyngeal cancer were found for individuals with the highest formaldehyde exposure levels (assessed as cumulative exposure, exposure level, or exposure score). Risks were also significantly elevated for individuals with longer time since first exposure or who died at an older age. Risk was increased fourfold for individuals who died after the age of 68 and were probably exposed to high levels of formaldehyde for at least 20 years before death. In particular, the American Cancer Society recently found that people living in the smoggiest cities [like Los Angeles] for more than 20 years were 30 percent

more likely to have succumbed to lung diseases such as chronic bronchitis, emphysema and pneumonia. One of the major pollutants in Los Angeles in the post-war era was 1,3-Butadiene. Butadiene was primarily found in synthetic rubber in tires and is known to be a human carcinogen. Three studies have shown an association between occupational exposure to 1, 3-butadiene and excess mortality from cancer of the blood cells, especially leukemia. These occupational exposure studies are particularly relevant because the subject was employed by Firestone Tire And Rubber Company manufacturing tires for 5 years in the early 1960s. The client remembers working the night shift putting rims on tires and airplane fuel tanks while coping with strong odors with no masks. This represents the third chemical exposure associated with a higher risk of leukemia. Air pollution from local refineries in the Santa Fe Springs petrochemical complex consisted largely of Benzene, Toluene, Ethylbenzene and Xylene or BTEX chemicals. Both Benzene and Ethylbenzene have been associated with high risks for leukemia. One study concluded that the increased risk of leukemia from breathing Ambient BTEX could be as high as 3 in 10,000. Smoking is also thought to be the main cause in 14 percent of all United States adult leukemia cases, which amounts to about 3,600 cases per year. Secondhand smoke can contribute to and a 20% increase in risks of lung cancer and probably leukemia as well. In a recent Canadian study the risks of developing chronic lymphocytic leukemia were more than doubled for those with the longest exposures to secondhand smoke. Altogether during the Los Angeles period, exposure to the Benzene and Formaldehyde found in Los Angeles smog, the Ethylbenzene emitted from the local refinery, the occupational exposure to 1, 3-Butadiene and the secondhand smoke total five different chemical sources associated with higher risks for developing leukemia. In general, white females in Los Angeles during the past decade have experienced relatively higher mortality rates for All Malignant Cancers as well as stomach cancer, cervical cancer, liver, gallbladder and other biliary tract cancer. Given the long history of pollution in the Los Angeles area from petrochemical sources and vehicle emissions, there is no reason to expect that past trends for cancer would have been significantly less than current trends. Therefore, the subject who lived in this setting for 42 years should expect about the same cancer risks from environmental exposure as those who have lived in Los Angeles over the past two decades. Since 1988, the subject has lived in the presently pristine environment of Mountain Home in Baxter Co. Arkansas. Yet, there are two historical risk factors which should be considered.

The first chemical exposure is from the relatively high concentration of boat building operations in the area which have been emitting huge amounts of styrene in past decades. These emissions peaked at several hundred thousand pounds of styrene released into the air per year about five years after the subject moved here. Since Styrene has recently been declared a probable human carcinogen, these historical emissions take on greater significance than they would have warranted at the time of the pollution releases. It is impossible to determine from the available data what the levels of styrene might have been in the ambient air in the region during this period. However, we can examine the death rates in the counties nearest to the operations. While we do not know that the boat building industry in Arkansas is the cause of these high cancer rates, it is reasonable to assume that they may be a contributing factor. Baxter County over the past decade has shown elevated mortality rates for All Malignant Cancers for white females. These cancers included pancreatic cancer, lung cancer and ovarian cancer. The county also showed an elevated age adjusted death rate for stroke among white females. While there is little or no mortality data for bladder cancer among females in the region, the same mortality data for males shows that the county has some of the highest mortality rates in the country for bladder cancer. Recent studies have revealed that men are nearly 3-4 times more likely to develop bladder cancer than women. However, women present with more advanced disease and have worse survival. There is no reason to suspect that nationally these comparisons would not be consistent across counties. Therefore, it is certainly worth monitoring early symptoms of bladder cancer in white females in addition to males. The Second potential exposure source which much be evaluated in the Mountain Home residence is radon. The subject is advised that houses in the region near ledge or basement should be tested for indoor radon gas. If the gas tests are elevated, then the house should be treated and fixed to reduce risks of lung cancer. Other recommendations for the client involve the overall safety of the drinking water. The water well should be tested periodically to determine the levels of heavy metals, volatile organic compounds and pesticides. Given the changing levels of aquifer access, no water should be considered safe until it is thoroughly tested. Client should inform her doctor that she has likely been exposed to moderately high levels of benzene and formaldehyde during middle age. The doctor should be informed that the latency period for Benzene exposure can be up to 40 years and that she has been removed for 24 years after an exposure period of 42 years. Environmental Health tracking is most useful if used as a risk indicator. Obviously, if the subject plans to relocate, she is going to want an environmental assessment of the future residence. For past toxic exposures, she will need to work with her

doctor to assist in diagnosing chronic illnesses and determining the risks of treatment options. Our approach utilizes actual residences and proximity to Superfunds and toxic release sites. We analyze exposure based on the chemicals and amounts estimated at the time of residence. Based on this county exposure data we determine the relative risk of developing specific chronic diseases known to be associated with these chemicals at these levels of exposure in the latest medical journals. This is the only scientifically valid and defensible approach to assessing the risk of developing chronic disease from past exposure to environmental toxins.

EARLY YEARS Town: BETHANY OK. Years of Occupation: 1928-1945 Subject was born on May 18, 1928 where she spent her pre-natal period through to her teenage years (up to 1946) at 610 N Muller St.

Bethany Aerial Photo 1990 (Showing approx., location of 610 N. Muller St on oldest known air photo)

2011 Satellite Image of Bethany Address Expansion of School has resulted in new homes being built since client moved.

Satellite Image of Bethany OK and Toxic Release Sites

Bethany Area Toxic Release Sites Overlain by Death Rates for All Malignant Cancers for White Females (Green colors are lowest risk) Bethany Oklahoma has no superfund sites within 10 miles and no leaking underground storage tanks. The address has two Toxic Release sites within five miles but the chemicals are commonly less than 10,000 pounds/year. Two of these companies are emitters of Styrene to the air. The Athenian Marble Corp is located two miles from the residence, but was not established until 1969.

The other polluter in the area is Xerox Corp in Yukon OK just two miles from the residence. This company emits styrene and butadiene, but the date of first operation could not be determined. Based on a report by USA today called The Smokestack Effect, it appears the neither the subjects residence nor her schools were significantly impacted by these emissions. No adverse health effects would be anticipated. Between 2004 and 2009 the death rate for all cancers in the area was extremely low for white females compared to all US counties. Given the distance to older Superfund sites there is no reason to expect that cancer rates would have been higher in the past.

There is a very high rate of Alzheimers Disease in the subjects own large family. At least half of her 13 brothers and sisters developed Alzheimers Disease and many of them died from this progressive killer. This could simply be the result of genetics or it could be compounded by environmental exposure. On closer scrutiny, we find that both parents lived until about 90 with no accelerated signs of cognitive impairment. Furthermore, the youngest of the children suffered most from Alzheimers in old age; although they all lived in the same house. It turns out that the older children shared rooms in the basement while the younger childrens rooms were upstairs. This suggests an environmental cause within the house. Scientists dont yet know exactly how Alzheimers develops, but research is turning up important clues. For instance, researchers know that a protein called amyloidbeta is very important in Alzheimers prognosis. People with higher levels of this protein appear more likely to develop Alzheimers. While specific genes do influence how much amyloid-beta is in the brain, they arent the only factor. Studies show that certain chemicals, such as lead, can increase amyloid-beta accumulation in the brain. This frightening effect is worse when the exposure to lead happens early in life because the brain is less developed and thus more influenced by changes in the environment. Since lead paint was common at the time, and it was more likely to flake along the window sills on the upper floors; this is one possible source of exposure. The possible effect is magnified since only the younger children spent their earliest childhoods in that house. It could be informative to examine lead levels in teeth or bone to augment any genetic studies.

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CALIFORNIA Los Angeles County

Calif. Map of All Malignant Cancer Incidences Relative to US Counties (Higher incidences shown in darker brown color) Note that Los Angeles County in the Southwestern part of the state has some of the highest incidences of Malignant Cancer for white females in the US.

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Town: Norwalk CA Address: 11713 Arlee Ave Years of Occupation: 1946-1988

Norwalk CA Aerial Photo 1994 (Oldest known air photo available) As shown above, the Norwalk residence was located less than mile from the Santa Ana Freeway in Los Angeles County. The Santa Ana Freeway in Norwalk began as a part of the US Route 101 Bypass in 1941 which extended to Anaheim. Formal construction of the Santa Ana Freeway was initiated in 1947, but wasnt completed until 1956. Smoke and fumes have been known in the Los Angeles Area since the beginning of the 20th Century. However, smog first arrived in Los Angeles in 1943. The Los Angeles Times reported that a pall of smoke and fumes descended on downtown, cutting visibility to three blocks. Striking in the midst of a heat wave, the "gas attack" was nearly unbearable, gripping workers and residents with an eyestinging, throat-scraping sensation. It also left them with a realization that something had gone terribly wrong in their city, prized for its sunny climate. The following day, city officials pointed the finger at the Southern California Gas Co.'s. Aliso Street plant, which manufactured butadiene, an ingredient in synthetic 12

rubber. Public pressure temporarily shuttered the plant, but the gas attacks persisted, proving that it was not the prime culprit.

First recorded photo of smog in Los Angeles, 1943 (Photo courtesy of Los Angeles Times Collection, Department of Special Collections, UCLA Library). World War II dramatically increased the region's industrial base and resulting air pollution. The city's population and motor vehicle fleet grew rapidly as well. As a result, according to weather records, visibility declined rapidly from 1939 to 1943. Angelenos grew increasingly alarmed at the smoke that clouded their vision and the fumes that filled their lungs. In 1947, more than 300,000 backyard trash incinerators puffed out white plumes -- and black soot -- across the city. In October 1954, the heavy smog in Los Angeles was so bad that it shut down schools and industry for most of the month. More than a decade after the problem was first identified, trash collection programs were established and backyard incinerators were finally banned in 1958. Smog contains ground-level ozone, sulfur dioxide, nitrogen dioxide and carbon monoxide are especially harmful for senior citizens, children, and people with heart and lung conditions such as emphysema, bronchitis, and asthma. It can inflame breathing passages, decrease the lungs' working capacity, and cause shortness of breath, pain when inhaling deeply, wheezing, and coughing. It can cause eye and nose irritation and it dries out the protective membranes of the nose and throat and interferes with the body's ability to fight infection, increasing susceptibility to illness. A 2009 American Cancer Society study found that people living in the smoggiest cities for more than 20 years were 30 percent more likely to have succumbed to lung diseases such as chronic bronchitis, emphysema and pneumonia.

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In 2004, ScoreCard ranked Los Angeles as one of the Dirtiest Counties in the United States. With potentially serious health problems resulting from extremely high levels of ozone, particulates, oxides and volatile organic compounds such as formaldehyde. For the Norwalk area there are numerous sources of airborne emissions as shown below.

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Air Pollution and Air Emissions Sources In Relation to the Norwalk Residence In particular, samples of pollution in the area contain over 10% Benzene and more than 50 % formaldehyde. Long-term exposure to benzene can cause cancer of the blood-forming organs or bone marrow. This condition is called leukemia. Benzene is a known human carcinogen and has been linked to the following cancers and leukemias; Acute or Chronic Myelogenous Leukemia (AML/CML) Acute or Chronic Lymphocytic Leukemia (ALL/CLL) Chronic Myelogenous Leukemia (CML) Hairy Cell Leukemia (HCL) Non-Hodgkin's Leukemia (NHL) Multiple Myeloma Myelodysplastic Syndrome (MDS)

Benzene toxicity may present as an acute illness or as a chronic disease. There is a latency period associated with the effects of benzene exposure ranging from 7 to 40 years from the first exposure for the effects to show.

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On 10 June 2011, the US National Toxicology Program described formaldehyde as "known to be a human carcinogen" associated with nasal sinus cancer and nasopharyngeal cancer. Studies found the highest risks of nasopharyngeal cancer for individuals with the highest formaldehyde exposure levels (assessed as cumulative exposure, exposure level, or exposure score). Risks were also significantly elevated for individuals with longer time since first exposure or who died at an older age. Risk was increased fourfold for individuals who died after the age of 68 and were probably exposed to high levels of formaldehyde for at least 20 years before death. Recent studies have also shown a positive correlation between exposure to formaldehyde and the development of leukemia, particularly myeloid leukemia. One of the major pollutants in Los Angeles in the post-war era was 1, 3-Butadiene. Butadiene was primarily found in synthetic rubber in tires and is known to be a human carcinogen. Three studies have shown an association between occupational exposure to 1, 3-butadiene and excess mortality from cancer of the blood cells, particularly leukemia. These include an increased risk of lymphosarcoma and reticulosarcoma in workers who manufactured 1,3-butadiene monomer, a study of styrene-butadiene rubber workers in eight plants in the United States and Canada showing increased risk of leukemia among production workers, and a case-control study of styrene-butadiene rubber workers showing a large excess of leukemia associated with exposure to 1,3-butadiene. Occupational exposure to 1,3-butadiene may occur through inhalation and, to a lesser extent, dermal contact. The National Occupational Exposure Survey (conducted from 1981 to 1983) estimated that about 52,000 workers at 2,201 facilities, including 1,410 women, potentially were exposed to 1,3-butadiene. An earlier estimate of about 66,000 to 70,000 workers at 3,086 facilities was reported in the National Occupational Hazard Survey (conducted from 1972 to 1974). This suggests that workers exposed actually decreased from the 1970s to the 1980s. We can only suppose that even more women were exposed during the 1950s and 1960s. These occupational exposure studies are particularly relevant because the subject was employed by Firestone Tire And Rubber Company manufacturing tires

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for 5 years in the early 1960s. The client remembers working the night shift putting rims on tires and airplane fuel tanks while coping with strong odors with no masks. This represents the third chemical exposure associated with a higher risk of leukemia. The subject was married to a smoker in 1946 who smoked continually until the 1970s. While never a smoker herself, she was a victim of secondhand smoke for 25 years. The National Toxicology Program has found an overall increase in risk of lung cancer of 20% for exposure to environmental tobacco smoke from a spouse who smokes. Increased risk of lung cancer appears to be most strongly related to exposure to secondhand or environmental tobacco smoke from spousal smoking or exposure in an occupational setting. This is the fourth separate chemical exposure in Los Angeles which could increase the risks of leukemia

The Norwalk residence is surrounded by at least 10 toxic release sites and one Superfund Site as shown above. The Waste Disposal Inc. Superfund site is located over two miles from the subjects home and while it was in operation during her residence until the 1960s, it is mainly responsible for localized water and soil pollution.

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The Toxic Release sites form a ring around a petrochemical complex shown by the satellite image below.

Norwalk CA, Satellite Image from 2011 with Toxic Release Inventory Sites The largest of the Toxic Release sites is Cosby Oil Co Inc. in Santa Fe Springs. This company established in 1939 is a petroleum refiner, blender, distributer and trucking company. Its toxic BTEX emissions are typical of petrochemical companies in the area. In addition to Benzene, the site emits significant amounts of Toluene, Ethylbenzene and Xylene into the atmosphere. Ethylbenzene has been classified as a possible carcinogen while the other two chemical are not classifiable due to limited data. A 2010 study in Lisbon Portugal concluded that the increased risk of leukemia from breathing Ambient BTEX could be as high as 3 in 10,000.This is the fifth source of chemical exposure associated with higher risks of leukemia.

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Motor vehicles emit particulate matter < 2.5 m in diameter (PM2.5), and as a result, PM2.5 concentrations tend to be elevated near busy streets. A 2000 Canadian study found exposure to PM2.5 has a significant effect on hospital admission rates for a subset of respiratory diagnoses (asthma, bronchitis, chronic obstructive pulmonary disease, pneumonia, upper respiratory tract infection), with a relative risk of 1.24 (95% confidence interval, 1.051.45) for a log10 increase in exposure. In 2010, the Health Effects Institute in Boston, Massachusetts, summarized the available evidence on exposure to traffic generated air pollution and negative health effects. They find strong evidence for a causative role for traffic related air pollution and premature death, particularly from heart attacks and strokes. PM2.5 is emitted directly, and it is also produced by secondary formation, as sulfur dioxide (SO2) and nitrogen oxide (NOx) emissions contribute to the formation of sulfate and nitrate particles. Exposure to PM2.5 also causes other health effects such as asthma attacks, and other respiratory illnesses. They identified an exposure zone within a range of up to 300 to 500 m from a highway [approx. distance from Santa Ana Frwy to Norwalk residence] or a major road as the area most highly affected by traffic emissions (the range reflects the variable influence of background pollution concentrations, meteorological conditions, and season). The data presented may help to explain the relatively high rates of malignant cancer in Los Angeles County. The maps below present the mortality rates for specific cancers for white females in the Los Angeles area. 19

LOS ANGELES CO. STOMACH CANCER MORTALITY RATE FOR WHITE FEMALES (darker blue colors are higher mortality rates)

LOS ANGELES CO. LIVER CANCER MORTALITY RATE FOR WHITE FEMALES (darker blue colors are higher mortality rates)

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LOS ANGELES CO. CERVICAL CANCER MORTALITY RATE FOR WHITE FEMALES (darker blue colors are higher mortality rates)

Given the long history of pollution in the Los Angeles area from petrochemical sources and vehicle emissions, there is no reason to expect that past trends for cancer would have been significantly less than current trends. Therefore, the subject who lived in this setting for 42 years should expect about the same cancer risks from environmental exposure as those who have lived in Los Angeles over the past two decades.

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Town: Mountain Home Ark Address: 1391 Robinson Pt. Rd Date of Occupation: Jan 10, 1988 PRESENT The subject moved to the Mountain Home residence in Jan. 1988 when she was 60 years old and has lived there continuously for the past 24 years. The house is located at the peak of a recreational peninsula approx. 5 miles east of the town.

Robinson Point AR Aerial View 1994 (oldest known air photo available) The photo above shows the area essentially undeveloped with few residences nearby. As can be seen by the recent satellite image below little has changed to present day.

Mountain Home Satellite Image with Closest Toxic Release Sites in 2009 22

However, a larger view of the region paints a very different picture of the past environmental exposure.

MOUNTAIN HOME TOXIC RELEASE INVENTORY SITES As shown by the Toxmap above, the area is dominated by boat building operations and these comprise the three largest toxic release sources (especially styrene) on the map. While each of these companies has made substantial progress in reducing their styrene emissions in recent years, it is the peak volumes over the last two decades which determine the maximum environmental exposure. Since Styrene has recently been declared a probable human carcinogen and the boat companies have released remarkably high levels of styrene into the air, we will begin our investigation with these operations. Styrene inhalation over longer periods of time such as in the boat building occupations may cause central nervous system effects including headache, fatigue, weakness, and depression. Exposure may also damage peripheral nerves and cause changes to the kidneys and blood. The chart below shows the products in a boat building operation which contain styrene along with the percentage styrene content.

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Chart showing Hazardous Air Pollutant Styrene from the Boat Building Industry Ranger Boats is one of the largest Boat Builders in the region. The Toxic Release Inventory shows that nearly 95 % of their emissions are Styrene and they released about a quarter million pounds of styrene per year in 2008.

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In previous years Ranger Boats have released even more styrene as shown below (in red): This shows a peak styrene emissions rate of nearly 300,000 pounds/yr. in 1995 which made it one of the largest styrene emitters in the country. Over time this level of source pollution could have dispersed over large distances. Ranger Boats

Chemical 2008 2007 2006 2005 2004 2003 2002 2001 Methyl methacrylate 14,179 15,922.30 18,708.20 19,511 25,172 21,040 21,137.80 16,754 Styrene 238,967 296,685 293,008.90 273,195 247,802 245,278 230,683.20 215,431 Toluene 13,725 Chemical 1998 1997 1996 1995 1994 1993 1992 1991 Methyl methacrylate 5,121 4,974 8,416 Styrene 85,125 78,905 81,396 299,422 272,751 40,809 61,446 16,307 13,736 17,896 13,631 14,141 9,681 Ranger Boats Annual Toxic Emissions (pounds/yr.) Ranger Boats also submitted an emissions permit request in Arkansas in 2003 which stated, The major components of the laminations are styrene based resins and gel coats. The facility exceeds 100 tons per year of VOC [including styrene] and over 25 tons per year of combined hazardous air pollutants (HAPs).

Air dispersion modeling was performed on the estimated hourly emissions from sources, in order to predict ambient concentrations beyond the property boundary. The Presumptively Acceptable Impact Level (PAIL) for each compound was deemed by the Department to be one one-hundredth of the Threshold Limit Value, as listed by the ACGIH.

The chart below shows the amount of materials consumed at Ranger Boats.

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The use of over a half million pounds per month of resin which consists of more than 30% styrene suggests that even the high levels of styrene emissions reported at the plant may have understated the problem. Other Boat Builders in the area might also have underreported their styrene emissions. Bass Cat Boats shows a peak emissions rate of more than 50,000 pounds/yr. of styrene.

Bass Cat Annual Toxic Emissions (pounds/yr.) Legend Boats emissions history is similar although only about half the output is reported. The models indicate that the boat builders were aware of their emissions beyond their property boundaries and over the years they have installed equipment and adopted new processes and procedures to reduce those impacts. Yet for many, the damage has already been done.

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Therefore we have to ask, What have been the long term health impacts to these rural communities of the use of hundreds of thousands of pounds per month of toxic resins and gel coats by these facilities? One way to begin to answer this question is to examine the death rates in the counties nearest to the operations. While we do not know that the boat building industry in Arkansas is the cause of these high cancer rates, it is reasonable to assume that they may be a contributing factor,

BAXTER CO. ALL MALIGNANT CANCERS DEATH RATES FOR WHITE FEMALES (Higher death rates are in darker blue) Two surprising additional risks must be evaluated in the region. The first is Baxter Labs which has had remarkable success in recent years in reducing their total emissions.

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The TRI data above shows that Baxter Labs in the past emitted over 500,000 pounds per year of Freon and released about 100,000 pounds per year of ethylene oxide in 1988, through 1990. Then emissions were reduced dramatically. Ethylene oxide has been used for sterilization but it is a proven carcinogen. A 2003 study of 7,576 women exposed while at work in commercial sterilization facilities in the U.S. suggests ethylene oxide is associated with breast cancer incidence. Since ethylene oxide degrades in air within a few days it would not be expected to be a risk several miles away. However, occupational exposure for a large number of workers could potentially impact county breast cancer rankings. Another major pollutant from Baxter Labs is phthalate which peaked at nearly 100,000 pounds per year in 1991. The plasticizer Di-2-(ethylhexyl) phthalate, commonly abbreviated DEHP, is an organic compound which has been associated with birth defects in boys. Fortunately, it should be of little concern to a woman beyond child-bearing years.

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In 2002 Scorecard ranked Baxter Labs as one of the dirtiest facilities in the US in terms total waste and reproductive toxicants (like Phthalates). Phthalate is also the major pollutant at the last toxic release site investigated Mountain Home; Epoxyn Products LLC. Here the peak year of production was 1997 at nearly 20,000 pounds of phthalic anhydride per year. This plasticizer has similar health impacts to the previous one.

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This laboratory supply company also produced close to 20,000 pounds per year of 1-1-1 Trichloroethane until 1992. 1,1,1-trichloroethane, also known as methyl chloroform was used as a solvent and in PVC but has been phased out nationally as a greenhouse gas. Chloroform was recently declared to be reasonably anticipated to be a human carcinogen. One study in 2007 found a significantly elevated risk of urinary-bladder cancer associated with high levels of chloroform in drinking water. Although there is considerable distance between the Mountain Home residence and this toxic release site in town, there may be other sources and the groundwater recharge patterns are not well known. It would worthwhile to consider having the drinking water tested for Chloroform and other harmful substances.

Baxter County as a whole was evaluated in 2002 by ScoreCard and the cancer risks are shown below:

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In all of the Cancer Risk and Disease Risk maps below, the darker blue counties in Arkansas represent the highest risk for cancer relative to the rest of the counties in the US.

BAXTER CO STYRENE TOXIC RELEASE INVENTORY SITES BAXTER CO. ALL CANCERS MORTALITY FOR WHITE FEMALES (Higher death rates are in darker blue)

BAXTER CO. STROKE MORTALITY FOR WHITE FEMALES (Higher death rates are in darker blue) 31

BAXTER CO. PANCREATIC CANCER MORTALITY FOR WHITE FEMALES (Higher death rates are in darker blue)

BAXTER CO. OVARIAN CANCER MORTALITY FOR WHITE FEMALES (Higher death rates are in darker blue)

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BAXTER CO. LUNG CANCER MORTALITY FOR WHITE FEMALES (Higher death rates are in darker blue)

Finally, since Baxter Co is considered by the EPA to be at risk for radon gas further investigation is warranted.

N ARK RADON MAP

Radon Map Legend 33

The Radon Map above clearly shows Baxter County and surrounding counties in Northern Arkansas in Zone 2 indicating a moderately high radon level. Radon is the number one cause of lung cancer among non-smokers, according to EPA estimates. Overall, radon is the second leading cause of lung cancer. Radon is responsible for about 21,000 lung cancer deaths every year. About 2,900 of these deaths occur among people who have never smoked. On January 13, 2005, Dr. Richard H. Carmona, the U.S. Surgeon General, issued a national health advisory on radon. EPA recommends having homes tested because there is no known safe level of exposure to radon. EPA also recommends that Americans consider fixing their home for radon levels between 2 pCi/L and 4 pCi/L. The client would be wise to follow the EPA advice and have their home tested, especially due to the proximity to ledge or basement near the residence. If tests confirm moderate potential for lung cancer risk she should definitely have the house fixed professionally by having basement sealed against outgassing. In conclusion, the client is advised to have her well water tested for volatile organic compounds and heavy metals. She should inform her doctor that she has likely been exposed to moderately high levels of benzene and formaldehyde during middle age. The doctor should be informed that the latency period for Benzene exposure can be up to 40 years and that she has been removed for 24 years after an exposure period of 42 years. This places her at greater risk for Chronic Myeloid Leukemia or Chronic Lymphocytic Leukemia (CML/CLL). Proximity to a petrochemical complex emitting BTEX could increase the risk of leukemia from breathing the ambient air as high as 3 in 10,000. Prolonged exposure to styrene in her later years increases the risks of leukemia and lymphoma. She should have her blood tested regularly and any anomalous tests of blood cells should be considered cause for concern; not a fluke. Formaldehyde exposure at this time also adds to the risk of myeloid leukemia and nasal sinus cancer and nasopharyngeal cancer. These risks were significantly elevated for individuals with longer time since first exposure or who died at an older age. Risk was increased fourfold for individuals who died after the age of 68 and were probably exposed to high levels of formaldehyde for at least 20 years before death.

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In addition, prolonged exposure to high levels of smog during this period suggests that she is 30 percent more likely to succumb to lung diseases such as chronic bronchitis, emphysema and pneumonia. Upper chest congestion should be a cause for thorough testing. Living next to a major freeway during this period means exposure to particulate matter (especially PM2.5) which could increase susceptibility to respiratory infections including pneumonia. Recent studies have shown a relationship between traffic related air pollution and death from heart attack and stroke. The doctor should be informed that White Females in Los Angeles over the past decade have had an unusually high death rate from Stomach Cancer as well as Liver, Gallbladder and other Biliary Tract Cancer. Lung Cancer as a secondhand smoker cannot be ruled out and these chances are increased if it is determined that an unsafe level of radon is in the house. The U.S. Surgeon General estimates that living with a smoker increases a nonsmokers chances of developing lung cancer by 20 to 30 percent. No one knows what the risk is after smoking ceases. The doctor should definitely not rule out lung cancer as a likely possibility just because she has never smoked. The local doctor should already be aware that there is little or no mortality data for bladder cancer among females in the region However, the same mortality data for males shows that the county has some of the highest mortality rates in the country for bladder cancer. The doctor should also know that the region generally had an elevated mortality rate for all malignant cancers among females. This can partly be explained by the relatively high smoking rate and poor diet, but other environmental factors may also be involved. On the basis of mortality rates alone in the county, the doctor should be told to be on the lookout for early signs of stroke, pancreatic cancer, ovarian cancer and lung cancer. Environmental Health tracking is most useful if used as a risk indicator. Obviously, if the subject plans to relocate, she is going to want an environmental assessment of the future residence. For past toxic exposures, she will need to work with her doctor to assist in diagnosing chronic illnesses and determining the risks of treatment options. Environmental Health tracking is a fact-based, evidenced-based tool for assessing the risks of chronic disease over a persons lifetime. We use only toxic exposure data in the places of residence and estimate exposure only at the time of residence. We take into account the actual distance from the residences to the toxic sources and estimate amounts of discharge or emissions of specific chemicals known to be hazardous during the time of residence. Based on this exposure data we analyze the relative risk of developing specific chronic diseases known to be associated with these chemicals at these levels of exposure in the latest medical journals.

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Only epidemiological data appropriate to the gender and race of the subject is presented. All of this exposure information is compared directly to the relative mortality rates over the past decade for specific chronic conditions in the counties of residence. This is the only scientifically valid and defensible approach to assessing the risk of developing chronic disease from past exposure to environmental toxins. We do not claim that environmental exposures cause chronic diseases, only that it potentially contributes to the development of the diseases and therefore increases the risks of certain chronic diseases. Of course, multiple exposures to chemicals known to be associated with specific chronic diseases (as these historical investigations might reveal) increases the risks further. These relative risk assessments, in consultation with the subjects doctors, could aid in early diagnosis and treatment of chronic disease. If environmental tracking is applied to assess toxic risks at potential future residences or workplaces under consideration, it could also help to reduce the risks of future development of chronic diseases.

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