title: Cancer clusters in the USA: what do the last twenty years of state and federal investigations tell us?
abstract: 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.
authors.affiliation: Department of Epidemiology, Emory University School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, USA. mgoodm2@sph.emory.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Naiman
authors.forename: Dina
authors.initials: D
authors.lastname: Goodman
authors.forename: Judy S
authors.initials: JS
authors.lastname: LaKind
mesh_terms: D016000:Cluster Analysis; D004781:Environmental Exposure / Q000009:adverse effects*; D015340:Epidemiologic Research Design; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology