ATSDR/CDC Northeast PA Polycythemia Vera (PV) Investigation Projects Update

Background

In 2004, using state cancer registry records, the Pennsylvania Department of Health (PADOH) found a PV cluster in northeast Pennsylvania. PV is part of a disease group called myeloproliferative neoplasms (MPN), which is a group of slow-growing blood cancers where the bone marrow makes too many red blood cells, white blood cells, or platelets.

In 2006, ATSDR was asked to help study PV patterns in the area. From 2007-2008, ATSDR reviewed medical records, conducted genetic testing, and confirmed this PV cluster.

In 2009, Congress funded ATSDR to continue this investigation. ATSDR is overseeing 18 projects with PADOH, the Pennsylvania Department of Environmental Protection, and various universities and private organizations. These projects are based on recommendations from an expert panel. The panel identified four areas for investigation; epidemiology, genetics, toxicology, and environmental studies.

As of October 1, 2013, all of the contracts for the 18 projects have ended.  The last to end was the tissue bank contract, which closed for recruitment of new tissue donations from the PA tri-county study area in May 2014.  At this time, no new samples will be added from the tri-county study area, but the geographically identified (but de-identified in terms of personal information) donations from the tri-county study area will continue to be available for researchers to access via this national tissue bank established at the Myleloproliferative Disease Research Consortium (MPD-RC).  You can continue to follow the work of the overall MPD-Research Consortium on their website at: http://www.mpd-rc.org/home.php.

Status

The graphic with this email provides this summary as of August 2014.  I’ve attached this graphic both as a “snapshot” in the body of this email, as well as a pdf attachment.  Projects highlighted in “green” in the attached graphic have work complete and a final product available (if applicable).  Projects highlighted in “yellow” have final products in progress and undergoing clearance.  Projects highlighted in “red” have final products that are anticipated but not yet started.

As of August 5, 2014, work is complete and a final product is available (if applicable) for 6 projects.  We are happy to announce that one new project (#16/17, PADEP’s environmental testing) moved from yellow to green since my May update; we now have a factsheet and final ATSDR health consultation report evaluating an initial set of radiological environmental sampling results from the study area.  At the request of ATSDR, PADEP collected and analyzed environmental samples within the tri-county area and ATSDR evaluated the possible health effects of exposure to the radiological elements in the samples.  Environmental samples from the cluster area were collected as a component of the overall research investigation into the PV disease cluster:

• Indoor air was analyzed for radon.
• Soil, sediment and water samples were analyzed for metals, organic compounds, and radioactive substances.

This ATSDR public health report focuses on an initial set of the radiological environmental sampling information.  Additional reports evaluating other environmental and health information from the PV investigation will be released at a later date.

The ATSDR report found:

• Some houses in the study area had elevated levels of radon gas in indoor air. Radon gas was also found in the private well water of some homes.
• Soils from the study area had slightly elevated levels of radium.
• Without additional information, ATSDR cannot determine if the cluster of cases of PV disease in the tri-county area is related to the radiological exposures observed in the environmental sampling information.

 

In this report, ATSDR recommends:

• All residents in the study area should have their homes tested for radon gas. Houses with elevated radon levels should be retested. If a home is retested and elevated radon levels continue, residents should contact the state of Pennsylvania radon program hotline at 1-800-237-2366 and request additional information on how to reduce the radon levels in the home.
• People in homes with high levels of radon in their drinking water should contact the PADEP Radon Program for assistance. Home water supplies can be treated to reduce radon levels.
• ATSDR recommends that in those areas where radium in soils seems to be elevated, additional sampling may be helpful to further understand this exposure pathway. ATSDR will discuss the potential for a future collaboration with the U.S. Geological Survey to further evaluate levels of radiological contaminants in environmental media in the study area.

 

These documents are available at:

http://www.atsdr.cdc.gov/HAC/pha/PolycythemiaVera/Polycythemia%20Vera%20Investigation%20in%20PA_HC_07-22-2014%20FINAL.pdf

http://www.atsdr.cdc.gov/HAC/pha/PolycythemiaVera/PV%20(Still%20Creek)%20Tri%20County%20-%20FINAL%20Fact%20Sheet%20-%20Review%20of%20Radiological.pdf

Final products for another 9 projects are still in progress and remain coded as yellow.  Final products for 2projects are anticipated but not yet started and remain coded as red.

For more information:

Visit ATSDR’s web page on PV: http://www.atsdr.cdc.gov/sites/polycythemia_vera/index.html

Call ATSDR’s toll-free PV information line: 866-448-0242 or email jcx0@cdc, which will connect you to Dr. Elizabeth Irvin-Barnwell, ATSDR Division of Toxicology and Human Health Sciences.

Contact Lora Siegmann Werner, ATSDR Region 3, by phone at 215-814-3141 or by email at lkw9@cdc.gov.

 

Other Resources

1. Radiological Testing and Screening – http://www.water-research.net/index.php/radiological-contaminants

2. Radiological – Testing Parameters – Radon

3. Radon in Water