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Author Notes:

Corresponding author: Michael Goodman, MD, Associate Professor, Department of Epidemiology, Emory University School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, USA. Tel: +404 727 2734. Fax: +404 727 8737. Email: mgoodm2@sph.emory.edu

The authors are grateful to the state representatives who took the time to both speak with us and to search their records for available reports of cluster investigations.

We could not have conducted this research without their assistance.

ACC was not involved in the design, collection, management, analysis, or interpretation of the data; or in the preparation or approval of the manuscript.

The authors’ affiliations are as shown on the cover page.

The authors have sole responsibility for the writing and content of the paper. J.S.L. and M.G. consult to both government and industry.


Research Funding:

This research was supported by the Chlorine Chemistry Division of the American Chemistry Council (ACC). ACC was not involved in the design, collection, management, analysis, or interpretation of the data; or in the preparation or approval of the manuscript.


  • Cancer cluster investigation
  • state health department
  • CDC
  • environmental agent
  • infectious agent

Cancer clusters in the USA: What do the last twenty years of state and federal investigations tell us?


Journal Title:

Critical Reviews in Toxicology


Volume 42, Number 6


, Pages 474-490

Type of Work:

Article | Final Publisher PDF


Background: Cancer clusters garner considerable public and legislative attention, and there is often an expectation that cluster investigations in a community will reveal a causal link to an environmental exposure. At a 1989 national conference on disease clusters, it was reported that cluster studies conducted in the 1970s and 1980s rarely, if ever, produced important findings. We seek to answer the question: Have cancer cluster investigations conducted by US health agencies in the past 20 years improved our understanding of cancer etiology, or informed cancer prevention and control? Methods: We reviewed publicly available cancer cluster investigation reports since 1990, obtained from literature searches and by canvassing all 50 states and the District of Columbia. Investigations were categorized with respect to cancer type(s), hypothesized exposure, whether perceived clusters were confirmed (e.g. by elevated incidence), and conclusions about a link between cancer(s) of concern and hypothesized environmental exposure(s). Results: We reviewed 428 investigations evaluating 567 cancers of concern. An increase in incidence was confirmed for 72 (13%) cancer categories (including the category “all sites”). Three of those were linked (with variable degree of certainty) to hypothesized exposures, but only one investigation revealed a clear cause. Conclusions: It is fair to state that extensive efforts to find causes of community cancer clusters have not been successful. There are fundamental shortcomings to our current methods of investigating community cancer clusters. We recommend a multidisciplinary national dialogue on creative, innovative approaches to understanding when and why cancer and other chronic diseases cluster in space and time.

Copyright information:

© 2012 Informa Healthcare USA, Inc. This is an open access article distributed under the Supplemental Terms and Conditions for iOpenAccess articles published in Informa Healthcare journals, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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