Families Against Cancer & Toxics

Stop cancer before it starts

To: Carol Rubin, CDC

From: Terry Nordbrock

Subject: FACT requests JP-8 jet fuel exposure plan and methodology for the Sierra Vista leukemia cluster investigation

Cc: Julie Gerberding, CDC
Henry Falk, ATSDR
Thomas Sinks, CDC
Timothy Flood, Arizona Cancer Registry
David Engelthaler, Arizona State Epidemiologist
Diane C. Carper, Cochise County Health Dept
Gary Spivey, Cochise County Epidemiologist
Mary Belson, CDC
Robert L. Jones, CDC
Beverley Kingsley, CDC
John Florence, CDC
Benjamin Blount, CDC
David Ashley, CDC

Dear Dr. Rubin and the rest of the Sierra Vista Childhood Leukemia Cluster Investigative Team,

CDC will be taking biomonitoring samples next week in Sierra Vista, AZ, to measure the environmental chemicals in the bodies of the families that have a child with leukemia, as well as in comparison families. I am writing to ask for a copy of your study sampling plans, with special attention to the jet fuel sampling plans and methodologies.

In April 2004 our organization, Families Against Cancer & Toxics, sent you a memo calling for more definitive JP-8 jet fuel exposure testing in the Sierra Vista leukemia cluster investigation than was done in Fallon. That memo is below.

In May 2004 you responded that you did not choose to use the methods we suggested, but that CDC would "adapt the methods that were used in the Fallon study to include additional analytes that form the JP-8 chemical "signature", and anticipate that this method will be ready for use when the Sierra Vista
study begins." Your response is below.

When you and I spoke on the telephone on November 13, 2004, you stated that CDC's analytes have been in development, and that you plan to describe the methods openly and on the website once validated.

FACT's question:

May we have a copy of your study sampling plans, with special attention to the jet fuel sampling plans and methodologies? We would like to receive the study sampling plan before sampling begins, next week. We are hoping that your methodology, like the EPA methodology, creates results that can distinguish jet fuel exposure from similar contaminant sources, such as automotive exhaust. If you email the plans to me by Thursday, May 12, that would be helpful.

Thank you,

Mom of Henry and Linus, a 6-year-old Tucson kid with leukemia
Co-founder of FACT, Families Against Cancer & Toxics

At 2:22 PM -0400 5/13/04, Rubin, Carol wrote:
>Dear Terry,
>I am writing this response on behalf of all of the CDC co-investigators
>who are working with the Arizona Department of Health Services and the
>Cochise County Health Department to evaluate environmental exposures in
>Sierra Vista. We thank you for your thoughtful email and have carefully
>considered your comments and suggestions.
>As you know, real-life exposures are a competing mix of where you live,
>who you live with, where you work, what you eat, your general health
>status, etc. Ambient air sampling will tell you what is currently
>available for human inhalation. Breath samples will be a mixture of
>what has just been inhaled and chemicals that were recently inhaled and
>leave the body through the lungs; measuring blood and urine levels will
>tell you how a particular person metabolized and distributed that
>exposure throughout their body. The Division of Laboratory Sciences at
>the National Center for Environmental Health, CDC is the premier
>laboratory for measuring very small levels of chemicals in blood and
>urine. We are planning to measure volatile organic components in blood
>samples using state-of-the-art methods. We are currently working to
>adapt the methods that were used in the Fallon study to include
>additional analytes that form the JP-8 chemical "signature", and
>anticipate that this method will be ready for use when the Sierra Vista
>study begins. However in Sierra Vista, as in Fallon, the volatile
>organic measurements will only tell us what the exposure is at the time
>of sample collection.
>Your email refers to an EPA method for measuring JP-8 "signature"
>component ratios of chemicals in environmental and biological samples.
>Our chemists are familiar with this EPA research and agree that it is
>showing interesting results in occupational settings. The breath
>samples do indeed reflect what is in the ambient air samples when people
>are exposed to very high concentrations and in the absence of competing
>environmental volatile organic exposures. Human samples of exhaled air
>are positive for JP-8 in occupational settings with high JP-8 levels and
>minimal competing environmental volatiles. As the EPA scientists
>themselves agreed during conversations with CDC scientists, this
>methodology is not ready for use in a non-occupational exposure
>assessment. We believe that the breath analysis results would not be
>useful in defining community exposure in any meaningful way.
>Naphthalene, one component of JP-8 fuel, is found throughout our
>environment. It is discharged from a variety of incomplete combustion
>processes from industrial, domestic and natural sources (motor vehicle
>traffic, air traffic, residential heating with fossil fuels, gasoline
>burning, industrial plants, forest fires, tobacco smoke, etc.).
>Naphthalene from any of these sources can mask naphthalene from exposure
>to jet fuel fumes or exhaust, unless the JP8 exposure is significant and
>on-going (as was the case in the studies cited under a controlled
>environment). Environmental exposure to naphthalene will not be so
>controlled and predictable in an epidemiologic investigation, and will
>therefore be much more difficult for us to see against the substantial
>background levels from all of these other sources. Levels of
>naphthalene and its metabolites in the population will be very difficult
>to interpret in relation to a low level environmental exposure.
>As you are aware, exposures potentially related to leukemia probably
>occurred several years ago. Given that the case families are living
>over a fairly large geographic area it is highly unlikely that they
>selectively were exposed to transient levels of airborne volatiles that
>would be detected in the population selected for current biological
>sampling. Unfortunately no measurements taken now will definitively
>describe historical exposure to volatile compounds. It may make more
>sense to conduct continuous or periodic air sampling. Perhaps you might
>consider working with local authorities to request that EPA or a similar
>agency conduct the kind of ambient air sampling that you suggest
>recognizes the JP-8 signature.
>We are committed to performing the best possible exposure assessment
>using biological samples in community settings. Benzene is a known
>carcinogen whether it results from JP-8, gasoline or tobacco smoke; our
>assessment will define benzene and other volatile organic exposures,
>including naphthalene and its metabolites. However, the levels we
>measure will not explain the 12 children diagnosed with leukemia in
>Sierra Vista. The exposure assessment will tell us what kind of
>environmental exposures are currently affecting the community. As in
>Fallon, sample collection will likely happen over a period of time and
>will be representative of several weeks of air traffic operations at
>Libby Army Airfield and potential exposure.
>We appreciate your input. Please feel free to call me if you want to
>discuss this further.
>Sincerely yours,
>Please note new contact information!
>Carol Rubin, DVM, MPH
>Chief, Health Studies Branch
>Division of Environmental Hazards and Health Effects
>National Center for Environmental Health
>Centers for Disease Control and Prevention
>4770 Buford Highway, MS F-46
>Atlanta, GA 30341-3717
>voice 770-488-3406 fax 770-488-3450

>-----Original Message-----
>From: Terry Nordbrock
>Sent: Tuesday, April 20, 2004 11:51 PM
>To: Rubin, Carol; Belson, Martin; Jones, Robert L.; Kingsley, Beverly;
>Florence, John
>Cc: Timothy Flood; Bob England; Diane C. Carper; Gary Spivey
>Subject: FACT calls for more definitive JP-8 jet fuel exposure testing
>in the Sierra Vista leukemia cluster investigation than was done in
>Families Against Cancer & Toxins (FACT)
>PO Box 41285
>Tucson AZ 85717-1285
>Dear Sierra Vista Leukemia Cluster Investigation Team:
>It is the position of our group that it is imperative to test for
>JP-8 jet fuel exposure when the Center for Disease Control and
>Prevention (CDC) tests Sierra Vista residents for toxic body burden
>this summer, 2004. It is also necessary that the tests occur on a
>day with the average level of air traffic operations at Libby Army
>There are several lingering questions about CDC's investigation of
>the Fallon, Nevada, childhood leukemia cluster investigation -- most
>notably that they did not perform the definitive tests for JP-8 jet
>fuel exposure.
>JP-8 jet fuel is a concern because both Fallon and Sierra Vista have
>very active military aviation facilities. The Navy had moved their
>"Top Gun" training facility to Fallon in 1996, just before the rise
>in leukemia cases occurred, and the leukemia rates went down after
>they changed their flight path away from the community. Sierra
>Vista's Libby Army Airfield sees considerable numbers of "touch and
>goes," landing and takeoff training for pilots from Tucson's Davis
>Monthan Air Force base flying A-10s and C-130s.
>In Fallon, CDC checked blood BTEX levels (benzene, toluene, ethyl
>benzene, and xylene) in study participants. While these four
>volatile organic hydrocarbons (VOCs) are present in JP-8 jet fuel,
>they are also found in gasoline and diesel and are thus very common
>in the environment. Spot-checking case families' levels of one or two
>(or four) compounds cannot definitively prove or disprove exposure to
>jet fuel, particularly when the chemicals used are common in the
>environment, as is the case with BTEX.
>However, there are tests that can conclusively identify JP-8
>exposure. Jet fuel 8 contains over 2000 chemical compounds. What is
>distinctive and definitive about jet fuel chemistry is the RELATIVE
>amounts of these constituents, and more importantly, the relative
>amount of 9-carbon to 18 carbon hydrocarbon compounds. So jet fuel
>scientists use pattern-recognition techniques to study gas
>chromatograms of air, dust, breath, or whatever, to identify the
>presence of jet fuel.
>This approach allows the relative amounts of myriad chemical
>compounds to be assessed and matched to JP-8's very distinctive gas
>chromatogram chemical "signature." Please refer to the Liu and Pleil
>paper for an explanation of how to perform this test.
>Whereas the presence of BTEX chemicals alone could be due to
>gasoline, diesel, or even industrial solvents, the telltale
>chromatographic signature of JP-8 cannot be mistaken for anything
>else. It is very distinctive.
>It will not be necessary to quantify exposure levels. Recent studies
>show that even very low levels of jet fuel exposure, particularly for
>fetuses, can have serious cancer-risk-increasing effects. So the
>only question that needs to be tested, is whether or not the case
>families are being exposed--is jet fuel present in their breath or
>blood, or not? How much is there is irrelevant, and would depend
>mightily on when they were most recently exposed before testing, at
>any rate.
>Based on published studies, it appears that EPA has considerably more
>experience than CDC in testing for environmental exposures to this
>fuel, as they helped the Air Force conduct their occupational
>exposure study. FACT strongly recommends that CDC request EPA to
>perform the JP-8 analysis for Sierra Vista residents.
>FACT will be meeting with Dr. Bob England of the Arizona Department
>of Health Services on May 3, 2004. Please let us know before or on
>that date how CDC will test Sierra Vista residents for jet fuel
>Let me know if you have any questions,
>Terry Nordbrock
>Mom of Linus, a 5 year old Tucson kid with leukemia
>Co-founder of FACT, Families Against Cancer & Toxins
>Egeghy PP, Hauf-Cabalo L, Gibson R, Rappaport SM. Benzene and
>naphthalene in air and breath as indicators of exposure to jet fuel.
>Occup Environ Med. 2003 Dec;60(12):969-76. PMID: 14634191
>Liu S, Pleil JD. Optimized determination of trace jet fuel volatile
>organic compounds in human blood using in-field liquid-liquid
>extraction with subsequent laboratory gas chromatographic-mass
>spectrometric analysis and on-column large-volume injection. J
>Chromatogr B Biomed Sci Appl. 2001 Mar 5;752(1):159-71. PMID: 11254190
>Serdar B, Egeghy PP, Waidyanatha S, Gibson R, Rappaport SM. Urinary
>biomarkers of exposure to jet fuel (JP-8).Environ Health Perspect.
>2003 Nov;111(14):1760-4. PMID: 14594628
Families Against Cancer & Toxins


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