High Incidence of Chronic Myelogenous Leukemia in Kitsap County and Puget Sound Naval Shipyard

First authored in 1996

I am writing this because of the concern I have over what I perceive to be a very high rate of Chronic Myelogenous Leukemia (CML) in Kitsap County (pop approx. 207,800) and the Puget Sound Naval Shipyard (12,000 workers - 1990 to 1993). In February of 1993, I was diagnosed with CML. In September of 1993, I had a bone marrow transplantation (BMT) at the Fred Hutchinson Cancer Research Center, Seattle, WA. (CML is not cured except with a BMT). Since then, I have belonged to a local cancer support group. There are five of us post BMT CML survivors in my support group (Al McFarland (diagnosed 12/90; BMT 7/91), Terri (BMT 1/93), Heather, Jan (BMT 2/93) and Bob Farmer- me (diagnosed 2/93; BMT 9/93). Three of us live within a mile radius of each other. Terri lives one block from me and Al lives about two miles away.

Printed in the June 4, 1998
Center News
Fred Hutchinson Cancer Research Center

The following are the reasons and logic behind my concern:

• I do not believe I should know so many local CML BMT survivors. The diagnosed disease rate for the whole State of California for CML is 1.3 per 100,000 per year for CML. The rate of all leukemias together is 9.8 per 100,000, Ref. (a). The national rate for CML is 1.4 per 100,000 per NIC report on leukemia, Ref. (b). The newly diagnosed cases per year are 5,000, Ref. (c) . There are slightly over 1000 Allogeneic BMT for CML in USA for 1995 per graph. Ref. (d).
• Three of the five of us (Al, Terri, and I) were Puget Sound Naval Shipyard workers when diagnosed with CML. Puget Sound Naval Shipyard had approximately 12,000 employees during that period. Assuming that I know 20% of the total CML cases in the Navy Yard, the rate would be 68.9 times the national average. If I know 100% of the CML cases and 100% were leukemia free survivors (LFS), the Navy Yard rate would still be 8.3 times the national average.
• In the Public Works Group, I have been informed that there were three diagnosed cases of leukemia in 1993 for 600 employees. This would be a rate of 500 per 100,000 for leukemia. We were exposed to heavy exhaust fumes. Most vehicles were operated and serviced inside of our building without being connected to the external ventilation system. Another problem like this is the main engineering building (known as Building 850, The Henry Jackson Engineering Building) air intake is from the carport at the front entrance. This has been a continuing problem discussed at meeting between unions and management since it was built.
• Only about 30 to 40 percent of CML patients have a sibling donor. The rest of them have to use an unrelated donor. Heather and Terri (of the five of us) had unrelated donors. Many people do not receive a BMT because of other health problems, expense or because they do not want to do it. There must be many more than the five of us that were diagnosed during the roughly two-year period (26 months) we were all diagnosed. We should be like the tip of an iceberg. There should be about 41 CML cases in Kitsap County in that same period, if the data in Ref. (c) and Ref. (d) is valid. Roughly 20 percent of CML victims have a bone marrow transplant -  Ref. (c)  divided by Ref. (d).  Roughly 50 to 70 percent of patients survive a BMT for CML per Ref. (e) if done in the chronic stage (much less in the accelerated or blast stage). The bottom line is only about 20% of CML patients finally have a BMT and less than 60% of them survive leukemia free 3 to 6 years post BMT.
• I sense there is resistance to know or study problems like this because of the possible negative economic effects and community morale. Kitsap County has much to be concerned about with all of the Naval Activities in the area (Puget Sound Naval Shipyard, Bangor Sub Base, and Keyport Torpedo Naval Station). No place wants to be known as the Love Canalers or Down-winders of Western Washington.
• Early in my illness, I submitted a workers compensation claim and asked my health care provider to support my claim as occupational. I was told there was no evidence to support my claim and my claim was denied with these words: "The evidence of file supports the fact that the claimed events, incidents or exposures occurred at the times, places and in the manners alleged. However, a medical condition resulting from the accepted trauma or exposure is not supported by the medical evidence of file. Therefore, an injury within the meaning of the FECA is not demonstrated." In October of 1996, I appealed my workers compensation claim based upon new information and presented it to my health care provider. I was provided with an attending physicians report that strongly supported my claim, however my claim was denied with these words: "Your claim for compensation has been denied as it did not meet the guidelines for timeliness, as required by the Federal Employees’ Compensation Act." If I received the same support for my first claim in 1993, my BMT (approx. $225,000) and wages would have been paid from workers comp. I would not have lost 50% of my salary and significant out-of-pocket expenses. I have not been able to return to work because of the downsizing of the Navy. It angers me to have been deliberately or negligently exposed to cancer causing environments and agents while employed and to have no legal recourse or remedy.
• I have delayed mentioning these facts and concerns, in order to present my case objectively, accurately, and not distorted or exaggerated by my personal experience with CML. I am concerned that the media will put this off as paranoia. I know that I am not a statistician and it will be expensive to do a research study, but I believe it should not take a "rocket scientist" to be concerned.

Robert F. Farmer

Bremerton, WA

Calculations using the reference data assumptions.

Table 1. Incidence of CML in Puget Sound Naval Shipyard, Dec 1991 to Feb 1993 with 20% of known survivors with a 60% leukemia free survival (LFS) rate.

This is 2.75 to 3.4 times worse than Hiroshima and Nagasaki

Atomic bomb survivors after the explosion of Hiroshima and Nagasaki had a 20-25 fold increase in the incidence of leukemia.

Table 2. Incidence of CML in Puget Sound Naval Shipyard, Dec 1991 to Feb 1993 with 100% of known survivors with a 100% leukemia free survival (LFS) rate.

Table 3. Incidence of CML in Kitsap County, Dec 1991 to Feb 1993 with 20% known survivors with a 60% leukemia free survival (LFS) rate.

References:

(a) California rate for CML is 1.3 per 100,000 per year for CML

Source:

Table 1. Average Annual Age-Adjusted (1970 US Standard) Invasive Cancer Incidence Rates per 100,000 Population by Primary Site, Race/Ethnicity and Sex

http://cedr.lbl.gov/~houser/cancer/calif94/t1.html

(b) National rate for CML is 1.4 per 100,000 (4,200 per yr)

Source:

National Cancer Institute

NIH Publication Number 94-329

Revised November 1993

Table 2. Leukemia Statistics

NCI/PDQ Cancer News: - Modified

 

(c ) Total per year in USA aprox 5,000 year

Source:

BMT Newsletter story on BMT for Leukemia
January 1995
Issue # 28 - BMTs for Chronic Myelogeneous Leukemia

http://nysernet.org/bcic/bmt/march1995/lead-story.html

(d) Slightly over 1000 Allogeneic BMT for CML in North America for 1995

Source:

International Bone Marrow Transplant Registry

http://www.biostat.mcw.edu/IBMTR/slides.html

Slide 4: Indications for blood and marrow transplants in North America, 1995

http://www.biostat.mcw.edu/IBMTR/gifs/Slide_4.GIF

 

(e) Other

Slide 8: Probability of Leukemia-free Survival after HLA-identical Sibling BMT for Chronic Myelogenous Leukemia, 1989-1995

http://www.biostat.mcw.edu/IBMTR/gifs/Slide_8.GIF

I welcome your comments and suggestions.
Bob Farmer - robert.farmer@comcast.net

Last Updated on 05/25/04