Brewster A-Wing Updates

Published Dec 01, 2021 by
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Brewster A-Wing Health Hazard Evaluation Updates

The purpose of this page is to provide the campus community with information regarding health hazard evaluations conducted at Brewster A-wing in response to employees concerns that cancer diagnosis could be related to indoor environmental quality and environmental exposures in the building. An internal assessment conducted by EH&S and an external assessment conducted by NCDHHS were conducted with no evidence identified associating the reported cancer cases with building-related exposures.  Detailed information regarding those assessments is provided below.

The University also requested the National Institute for Occupational Safety and Health (NIOSH) to conduct a health hazard evaluation (HHE) of Brewster A-wing. The full final report, dated April 17, 2023, is attached for review. NIOSH found no evidence that cancers reported by ECU employees working in Brewster A-wing were associated with a common workplace exposure.  Here is the full Conclusions excerpt from the report (see page 15 of attached NIOSH report):

“We found no evidence that the cancers reported by ECU employees working in the Brewster A-wing are associated with a common workplace exposure. No significant hazardous exposures were identified, and employees are unlikely to have any exposure or concerning levels of exposure to cancer-causing substances in the workplace. The distribution of cancer types reported by ECU employees is not unusual and there does not appear to be an excess of cancer. We do not believe further case finding or investigation would lead to the identification of a cluster or unusual pattern of cancer among employees.

We encourage ECU management to communicate the results of this HHE with all ECU employees. Acknowledging employees’ concerns, focusing on transparency, and increasing communication including receiving and responding to questions from all potentially affected employees will provide a consistent and reliable source of information about the safety of the workplace and may reduce occupational health and safety concerns over time.”

NIOSH recommendations were also offered as part of the evaluation report and are provided on pages 16 through 18 of the attached report. See attached memorandum to the campus community dated April 27, 2023 for response to those recommendations.

Receipt of the NIOSH final report concludes the health hazard evaluation for Brewster A-wing. Although findings did not indicate any building-related environmental risks, EH&S staff will continue to monitor indoor environmental quality and post any updates on our website. EH&S has taken the proactive measure of developing a response and communication protocol for suspected disease clusters that includes consultation with faculty experts and local and state health representatives. Protecting the health, safety, and well-being of our campus community remains a top priority of East Carolina University.

Discussion for cancer concerns included in the report is provided below.

If you have any questions or concerns, please do not hesitate to contact EH&S at 328-6166 or safety@ecu.edu.

 

 

Evaluation of Cancer Concerns (excerpt from NIOSH Health Hazard Evaluation Report pages 8 through 11)

Understanding cancer and its occurrence in the general population

Cancer is a group of different diseases that have the same feature, the uncontrolled growth and spread of abnormal cells [CDC 2022; NCI 2020a]. As a group of diseases, cancer is very common and has a major impact on society and on the individuals and families it affects [NCI 2020b]. Approximately 40% of men and women will be diagnosed with cancer at some point during their lifetimes [ACS 2020]. The most common cancers diagnosed during 2020 (excluding non-melanoma skin cancer) were breast cancer, lung and bronchus cancer, prostate cancer, colon and rectum cancer, melanoma of the skin, bladder cancer, non-Hodgkin lymphoma, kidney and renal pelvis cancer, endometrial cancer, leukemia, pancreatic cancer, thyroid cancer, and liver cancer [NCI 2020b]. Most cancers are caused by a combination of multiple factors and each different type of cancer has its own set of contributing causes. Some of these factors include personal characteristics (e.g., age, sex, family history of cancer); personal habits (e.g., diet, smoking, alcohol consumption); underlying medical conditions; and exposure to cancer-causing agents in the environment, including the work environment. These factors may act together or in sequence to cause cancer. Although some risk factors for certain types of cancer are known, the causes of many types of cancer remain unknown. In many cases, people with no known risk factors develop cancer.

What is a cancer cluster and how do we determine if cancer could be related to a common exposure?

NIOSH receives many requests to evaluate workplaces regarding concerns related to cancer clusters. These concerns are understandable, as it can be alarming when employees in the same workplace report developing cancer. However, this does not necessarily mean that the cancer was caused by a workplace exposure. Cancer often appears to occur in clusters. Scientists define a cancer cluster as “a greater than expected number of the same or etiologically related cancer cases that occurs within a group of people in a geographic area over a defined period of time” [CDC 2022]. A cluster can also occur when groups of individuals who are not expected to develop a particular cancer become ill. In many workplaces, the number of cancer cases is relatively small. This makes detecting a possible common cause difficult, especially when there are no apparent cancer-causing exposures.

Many factors need to be considered when we assess whether cases of cancer among employees could be related to workplace exposure(s), including:

  • Potential for exposure to cancer-causing agents
  • Types of cancer reported
  • Number of cancer cases reported
  • Timing of the cancer diagnosis in relation to the exposure

Cancer clusters potentially related to a workplace exposure usually need to consist of the same type of cancer or etiologically related cancers, because this makes it more likely that a common causal pathway from exposure to disease exists. When several cases of the same type of cancer occur and that cancer is either uncommon in the general population or uncommon in the group of people developing it (for example, breast cancer in men), it is more likely that a workplace exposure may be involved. These issues are discussed below in a series of questions that relate to the evaluation of a reported cancer cluster.

Was exposure to a specific chemical substance or physical agent known or suspected of causing cancer occurring in the Brewster Building A-wing?

In our review of past sampling results and IEQ assessments performed in the Brewster A-wing, we did not identify any exposures to known or suspected carcinogens at sufficiently high levels to cause cancer. In the scientific literature, the relationship between some chemical and physical agents and certain cancers has been well established. For other agents and cancers, the evidence is not definitive, but a suspicion exists. When a known or suspected cancer-causing agent is present and the type of cancer occurring has been linked with that agent in other settings, we are more likely to suspect a connection between the workplace exposure and cancer diagnoses.

Do employees working in the Brewster Building A-wing have an unusual distribution of types of cancer?

Occupational exposure-related cancer is more likely when the same type of cancer has been diagnosed in employees and that type of cancer is not common in the general population. When a group of observed cancers includes multiple types of cancer or multiple cases of a common type of cancer, occupational causes of the observed cancers are less likely. The distribution of cancer among employees working in the Brewster Building A-wing does not appear unusual, because it includes eight different types of cancer and most of them are commonly diagnosed in the United States (including breast, lung, kidney, pancreas, and liver cancer).

Do employees working in the Brewster Building A-wing have more cancer than people who do not work there?

Cancer is a common disease and can be found among people at any workplace. When multiple cases of cancer occur in a workplace, they may be part of a true cluster if the number is greater than we expect compared to the number in other groups of people similar in age, sex, and race. However, small populations can have highly variable disease or tumor rates that rarely match the overall rate for a larger area, such as the state. At any given time, some populations can have rates above or below the overall rate. Even when high rates do occur, it may still be consistent with the expected random variability. Calculations like this make many assumptions that may not be appropriate for every workplace. Comparing rates without adjusting for age, sex, or other population characteristics assumes that such characteristics are the same in the workplace as in the larger population, which may not be true. It was not possible to calculate a crude incidence rate for cancer among Brewster A-wing employees. This is because we were not able to obtain the total number of employees who have worked in the Brewster A-wing over the same timeframe as the individuals with cancer. This is a common limitation of occupational investigations of cancer concerns, and it is especially challenging to obtain these workforce numbers when the reference timeframe includes an approximately 50-year period, as it does in this investigation. Moreover, it was not possible to obtain age-, sex-, and race-adjusted incidence calculations for this employee population. Therefore, comparisons between employees and the overall North Carolina population were not possible and may not be appropriate.

In the United States, approximately 40% of people will develop some type of invasive cancer in their lifetime [ACS 2020]. Therefore, 21 reported cancer diagnoses among current and former employees does not appear excessive. Additionally, approximately 1%–2% of people in the United States will develop pancreatic cancer in their lifetime [ACS 2020] and pancreatic cancer has a low 5-year relative survival rate (12%) [ACS 2022a]. Of the eight reported deaths from pancreatic cancer, we were able to confirm with HR that five had an address of record in the Brewster A-wing and 6 died from pancreatic cancer according to NC DHHS death certificate records. However, we could only link three of the pancreatic cancer deaths among employees with a work address in the Brewster A-wing. Even if the number of pancreatic cancer deaths among employees who have worked in the Brewster A-wing ranged from 3–8, that does not appear to be an excessive amount over an approximately 50-year timeframe. Although we cannot calculate a crude incidence rate because the total number of employees over the same timeframe was unavailable, we can estimate that the maximum of 8 pancreatic cancer deaths would not be excessive as long as 400 people have worked in the building over the past 50 years (8/400 =.02 or 2%). It is likely that there is increased awareness of the pancreatic cancer diagnoses among employees because the survival rate for pancreatic cancer is low, especially when compared to other common types of cancer. It is also likely that more employees have been diagnosed with other types of cancer than those whose information was provided by employee representatives. As employees age, more cases of cancer are expected and will occur, including more cases of pancreatic cancer over time. For more information about pancreatic cancer, see Appendix A.

Has enough time passed since a potential exposure began for excess cancer rates to be observed in ECU employees working in Brewster Building A-wing?

Latency is the time between first exposure to a cancer-causing agent and clinical recognition of the disease. Latency periods vary by cancer type but are usually a minimum of 10–12 years for solid tumors [Rugo 2004]. Because of this, exposures in the distant past are more relevant than recent or current exposures when determining potential causes of cancers occurring today. The median number of years between hire at ECU and the reported cancer diagnoses among Brewster A-wing employees is unknown. However, consideration of latency is not of primary concern in this evaluation because there are no apparent cancer-causing exposures in the workplace.

 

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