Canary in a Coal Mine

The Mystery of Camp Lejeune

They keel over like canaries in coal mines filled with poison gas, long before robust types realize that any danger is there. – Kurt Vonnegut

Ugh. It was complicated, I thought. I didn’t know if I could find an answer but wanted to try. I owed this effort to the part of my brain that kept searching for why my healthy husband developed male breast cancer, an exceedingly rare disease. He didn’t have any genetic mutations known to confer an increased risk for breast cancer and so we were left with the lingering question of why lightning had struck him.

The doctor in Boston had mentioned Camp Lejeune, a U.S. Marine Corps base in North Carolina, as a good place to begin learning about causes of male breast cancer that didn’t involve genetic mutations. The drinking water was heavily contaminated at Camp Lejeune for decades before the problem was discovered.

I sat down at my computer in a big sweater and pajamas to dig into the mystery. These were the clothes I wore when I was writing a grant, and they sent a signal to my brain that I would be sitting motionless at the computer for a long, long time.

Camp Lejeune was an ideal base for the Marine Corps because the long Atlantic coastline allowed soldiers to practice amphibious assaults. Tens of thousands of soldiers and their families were stationed at the Camp, which functioned like a small city. The well water system was constructed using groundwater in the 1940’s. A dry-cleaning business opened about two miles from the base in 1964. Toxic chemicals from the dry cleaner made their way into the groundwater and polluted one of the major wells on the base. Another well became polluted from several industrial sources and leaking fuel storage tanks on the military base. Altogether, approximately one million military personnel and their families were estimated to have been exposed to contaminated water while living at Camp Lejeune.

A cluster of more than 80 male breast cancer cases in the residents of Camp Lejeune had been discovered with survivors finding each other and then working together to uncover more cases. One man was diagnosed with breast cancer when he was 39 years old. He didn’t smoke, didn’t drink, and had no genetic risk factors. He was just a baby when lived at Camp Lejeune. His mother made his baby formula with water from the tap.

I swallowed hard. This was the type of toxic exposure that I wondered might have resulted in my husband’s breast cancer. Perhaps the cause of his cancer was a silent toxic exposure from a well or the drinking water in Eastern Europe, I thought. The physician in me knew that this type of searching for a reason that a cancer would never pan out. Cancer was complicated and lots of genetic and environmental factors played a role. Bad luck also played a role, but I didn’t want to hear this.  

The U.S. Agency for Toxic Substances and Disease Registry concluded that exposure to contaminated drinking water at Camp Lejeune was likely to have increased the risk of breast cancer, esophageal cancer, kidney cancer, lung cancer, bladder cancer, certain kidney and liver diseases, and adverse birth outcomes.

Canary in a coal mine, I thought. The death of a canary in a coal mine was a warning sign to miners of toxic gases that they could neither smell nor see. The coal mine was the contaminated water at Camp Lejeune. The canary was the unexpected cluster of male breast cancer cases. A sign of toxins or pollutants in a community.

I sat down at the kitchen table with an egg sandwich that I made and began to eat. In silence, I cursed to myself that my husband had this rare cancer. I was frustrated that there were no national guidelines recommending mammograms for men that had a family history of breast or ovarian cancer, or that had high exposure to similar toxins through their work or military service.

I had a thought and did a quick search on my phone. One of the contaminants at Camp Lejeune was benzene from leaking fuel tanks. After ten seconds, I got the answer I was looking for. Yes, car mechanics had a higher rate of male breast cancer. And fire fighters, exposed to smoke from burning cancer-causing substances and toxins also had a higher rate of male breast cancer. There was even a cluster of male breast cancer cases thought to be linked to Agent Orange and inhalation of toxins from the smoky ruins of Ground Zero in New York City after 9/11.

I started to wonder if cases of male breast cancer could be used to discover toxins in the environment, if an unexpected geographic cluster of cases emerged. One would need a national registry of male breast cancer patients to figure this out. Someone would need to recognize that they are a canary in the coal mine.

What if tracking cases of male breast cancer would expose risk factor for cancer that might be responsible for female breast cancer as well? Female breast cancer rates were already so high, it would be more difficult to find a geographic spike in cases and hunt down a possible toxin.

Hell hath no fury like a woman scorned, I thought, repeating the words of the English playwright, William Congreve. The stinging injustice of his diagnosis was an affront to our family and to me personally. I wanted to know what was responsible and track it down. This deep dive was an exercise in revenge, to be honest. A line of thinking that I am nearly positive the grief therapist and primary care provider would have thought unhealthy.

Next, I turned back to my phone and did another quick search for the American Cancer Society webpage for male breast cancer. Worse than I thought! The website said that men at a high risk for breast cancer should discuss how to manage their risk with their doctor.

How was a man supposed to know that he was at high risk so that he could discuss it with his doctor? Most men don’t even know that they can get breast cancer, because no one talks about it. Do fire fighters or car mechanics think to discuss their risk for male breast cancer with their doctors?  Without a recommendation from the American Cancer Society that doctors ask about a man’s exposure to these kinds of toxins and cancers to determine if he should be screened for breast cancer, nothing would change.

Men with breast cancer are hidden and forgotten, I thought angrily as I got up to put my plate in the dishwasher. The hidden cases of male breast cancer make the men and their families feel alone. So the problem stays buried. There is no impetus for any national organization to take a stance on it. Because no one wants to discuss the problem.

Fuming, I walked back to my home office. As I left the kitchen, my thoughts returned to the wind-swept beach along the Atlantic that I had seen when searching for images of Camp Lejeune. Large amphibious assault vehicles dotted the beach and hundreds of Marines were practicing beach landings. Then, the men turned into small yellow birds before they disappeared entirely.