In mid-January 2011, 16-year-old Jacob Peters developed a bad cough.
Doctors initially diagnosed him with an upper respiratory infection. But when Jacob didn't get better, his father, Gary Peters, said they started feeling around his son's neck.
“They then ordered a chest X-ray and found a three-inch tumor just below his collarbone that was compressing his trachea,” she said.
Gary remembers Jacob as an active, healthy teenager who played many sports. So he was shocked when his son was diagnosed with an aggressive type of cancer. He died less than a year later while undergoing chemotherapy.
“He fought hard for 290 days,” Gary said. “And actually, in the end, the chemotherapy is what killed him. He died of sepsis and multiple organ failure because his body just couldn't take it anymore.”
The Peters family lives in Aurora, Nebraska, a small farming community in the central part of the state.
In the years following Jacob's illness, several children in Aurora were also diagnosed with cancer, Gary said. It's a disturbing coincidence, given childhood cancer incredibly rare. The American Cancer Society predicted that 9,910 children under the age of 15 will be diagnosed with cancer this year.
“The average class size at Aurora is probably 95 – 90 to 100 kids, somewhere around there,” Gary said. “And when you have seven kids at the same time who have cancer, that's a big deal.”
It is not clear what made the children sick. Gary says it was probably a number of factors.
But one possibility keeps nagging at him: What if it's something in the water?
“There's no scientific causation. There's no evidence that anything in the water is causing this, but it's terribly suspicious,” he said.
“Maybe that 10 isn't such a great idea”
About a decade ago, a team of researchers at the University of Nebraska Medical Center began looking into the possibility of a link between water quality and pediatric cancer.
Nebraska has it higher rate of childhood cancer in the Midwest.
Eleanor Roganpublic health researcher for the ongoing study at UNMC, said the center began looking at Nebraska's rural watersheds and found a correlation between childhood cancer and higher levels of nitrates, which come from farm fertilizers, as well as a herbicide called Atrazine.
Watersheds associated with higher cancer rates often had nitrate levels below US Environmental Protection Agency levels current safe pollutant level 10 parts per million.
“That's what leads us to say, 'Well, maybe that 10 isn't such a good idea. It really should be lower,” Rogan said. “And other people have found the same thing.”
The nitrate standard was which was raised decades ago to prevent methemoglobinemia, also known as blue baby syndrome. Even so, it is common to rural communities throughout the Midwest have elevated nitrate levels that still meet federal standards.
Recent studies have linked nitrates with other health issues such as colon cancer and thyroid disease.
But Mary Warda senior researcher at the National Institutes of Health and a leading expert on nitrates, said it's still too early to draw firm conclusions.
“We really need more ongoing studies to study this connection between nitrates and health, including specific cancers and adverse reproductive outcomes,” he said.
The EPA has begun looking into the matter. Nitrate is is scheduled for a health reassessment which could lead to a lower level.
The agency originally planned for this study in 2017, but eventually postponed it.
Additional obstacles mean progress is slow
Some environmental health experts worry that officials are not acting fast enough.
“I will say that I'm very concerned, like if in 15, 20 years, the evidence becomes more convincing and we realize that things like nitrates cause cancer for sure,” he said. Dave Cwiertny, the executive director of the Center for Health Effects of Environmental Pollution at the University of Iowa. “We're going to feel really bad about how long we've had an idea and haven't acted on it.”
But creating the comprehensive studies needed to gather definitive evidence about the potential health effects of nitrates can be really difficult and complicated, Cwiertny said.
“You need access to water quality data or people who will allow you to take samples and test their water quality,” he said. “You need access to public health data. A lot of it is often protected.”
Another aspect of concern to experts is that meeting the current EPA nitrate standard is already difficult for many communities. Reverse osmosis systems that filter nitrates from water are incredibly expensive.
“Whether the nitrate problem is at 10 parts per million, or if the EPA decides to bring it down to eight parts per million or six parts per million, that problem will then be sent to these small communities. They will have to absorb the cost,” he said Don Coulterpediatric oncologist at the University of Nebraska Medical Center, who is involved in the ongoing nitrate study.
Coulter said that's why it's important that officials dedicate resources to helping rural communities and farmers make drinking water safer.
