New study finds higher cancer rates near mountaintop removal sites along Coal River Valley

July 27, 2011 by Ken Ward Jr.

Coal River Mountain as seen from nearby Kayford Mountain. Photo courtesy of Coal River Mountain Watch.

There’s another new study out from West Virginia University’s Michael Hendryx, this one reporting, based on a community survey in the Coal River area of Boone and Raleigh counties:

Self-reported cancer rates were significantly higher in the mining versus non-mining areas after control for respondent age, sex, smoking, occupational history and family history.

Mountaintop mining is linked to increased community cancer risk. Efforts to reduce cancer and other health disparities in Appalachia must focus on mountaintop mining portions of the region.

The study, “Self-Reported Cancer Rates in Two Rural Areas of West Virginia with and without Mountaintop Coal Mining,” (subscription required)  was published online in the Journal of Community Health.

Hendryx co-authored the paper with Leah Wolfe and Juhua Luo of the WVU Department of Community Medicine. Also listed as a co-author is Bo Webb, a Coal River resident and activist who has long been concerned about the health impacts of mountaintop removal.

The new study is based on 773 interviews with local residents, in a community survey that the researchers designed, in part to try to investigate the health concerns that Bo and other residents have been raising for years. As the paper explains:

Local residents in mountaintop mining areas of West Virginia identified the problem based on their personal experiences and the experiences of their neighbors. They witnessed, for example, the explosions at the mining sites and the dust that subsequently settled over their porches, windows and gardens. They collected bottles of well water from their kitchen taps that were black with impurities from coal treatment settling ponds. Concerns about the health impacts from these conditions led them to contact a university researcher for assistance. The researcher and community members worked together to identify the study focus, develop the approach, plan the logistics, recruit interviewers for a door–door survey, conduct the survey, collect and analyze the data, and report the results. Throughout the process, the importance of maintaining objectivity and using the best possible survey instruments and methods was emphasized by all parties.

The actual interviews were done in March and were conducted by undergraduate students from several local colleges and universities who volunteered to conduct the work as a service project during their spring break week. Interviews were conducted along the Coal River Valley in an area roughly stretching from the Seth-Prenter communities down to Rock Creek. Separate interviews were conducted in Pocahontas County, which was used as a comparison community.

The interviews revealed a cancer rate in the Coal River communities of 14 percent, compared to a rate of 9 percent in Pocahontas County. Researchers controlled for various other potential factors, including age, sex, smoking, occupational exposure and family cancer history (but not for obesity) — and found “Coal River subjects reported significantly higher odds of cancer”:

The odds for reporting cancer were twice as high in the mountaintop mining environment compared to the non-mining environment in ways not explained by age, sex, smoking, occupational exposure, or family cancer history.

While this study does not include data for exposure to any mining pollution, it does outline possible impacts:

Environmental pollution contributes to cancer risk, and many chemicals that are present in coal, coal strata and coal processing activities are established or possible carcinogens.

Arsenic, for example, is an impurity present in coal that is implicated in many forms of cancer including that of skin, bladder and kidney. Cadmium is linked to renal cancer. Diesel engines are widely used at mining sites, and diesel fuel is used for surface mining explosives, coal transportation and coal processing; diesel exhaust has been identified as a major environmental contributor to cancer risk.

The paper continues:

Previous research on Appalachian health disparities has tended to focus on health care access problems, or behavioral risks such as poor diet and smoking, as the causal factors driving poor health outcomes. A recent study in Virginia, for example, identified higher cancer rates among Appalachian compared to non-Appalachian residents, and discussed the need for better health care in Appalachia. However, Appalachian Virginia also has mountaintop coal mining, and the environmental, social and economic impacts of coal mining are often overlooked in Appalachian health research. Mountaintop coal mining is damaging to the environment, and contributes to the area’s chronic economic problems; these areas have the highest poverty rates and highest unemployment rates in the region. Poor economic conditions are one of the most powerful predictors of poor public health outcomes.

Map of study areas. Cross-hatched areas indicate the approximate locations of survey activities

The paper is not without its limitations. The authors explained:

Study limitations include those relating to survey sampling procedures and the extent of questions asked. Contact attempts at most households occurred only once, and survey times did not include late evenings and weekends because of the logistical and cost difficulties involved in transporting and housing the student volunteers. This could result in survey respondents in both locations that are not necessarily representative of the entire populations. Survey procedures, however, were comparable in both communities and so would not be expected to result in an overestimate of cancer in Coal River relative to Pocahontas. Asking people if they have ever had cancer limits the cancer experience to survivors. Information on persons who died from cancer was not collected, which may explain why some cancer types such as lung cancer were observed rarely in the sample. In other research, higher lung cancer mortality in coal mining portions of Appalachia has been documented.

In addition:

The survey included limited information on covariates. The preference among the community research partners was to keep the survey brief so that as many surveys as possible could be collected in a short time. There were concerns expressed by community partners that if the time spent per survey was prolonged, such that fewer surveys could be completed/day and more time had to be spent in Coal River to collect an adequate sample size, word about the survey taking place would reach the coal industry, and community residents would be instructed or pressured by industry representatives not to take part. Limited covariate data precluded investigating the possible impacts of such variables as obesity or health care access on cancer.

After data collection the research partners convened to discuss how the study process could be improved for possible replication in other communities. There was agreement that future efforts should attend to data collection during weekend and evening times, and how some additional data would have been worth the extra survey time to collect. In addition to extra covariates such as obesity, community partners expressed the importance in future studies of collecting cancer data not just on biologically-related family members but on spouses, as they knew of cases where a husband or wife had recently died of cancer, but these data were not collected in the survey. These discussions illustrate the utility of the community-based participatory model in helping both parties (academic researchers and community residents) learn from each other to make research efforts more practical and effective.

The paper concludes:

There are 1.2 million people who live in mountaintop coal mining counties in central Appalachia based on 2010 US Census data. If the rates found in this study represent the region, a 5% higher cancer rate (14.4% vs. 9.4%) translates to an additional 60,000 people with cancer in central Appalachian mountaintop mining counties. On a national level, the difference between 11.2 and 3.9% (the rates in the Coal River sample and the US, respectively, not including non-melanoma skin cancers) translates to an additional 87,600 people with cancer in central Appalachian mountaintop mining areas compared to national rates. Although, these projections are uncertain, they illustrate the large numbers of people who are potentially impacted by mountaintop mining environments.

The people of Appalachia constitute a nationally recognized priority population for the elimination of health disparities. The results of this study and others previously cited on coal mining populations demonstrate that health disparities are concentrated in mountaintop mining areas of the region; clearly, the national goal to eliminate Appalachian health disparities will not be achieved unless disparities are eliminated in mountaintop mining areas.

28 Responses to “New study finds higher cancer rates near mountaintop removal sites along Coal River Valley”

  1. Bob Kincaid says:

    60,000+ expendable people. Sixty.Thousand. More than the population of Beckley, or of Huntington, or Morgantown. Think about a Mountaineer football game. Imagine every.single.person there having cancer. That’s what mountaintop removal is doing to Appalachia.

    If you live in Southern West Virginia, look around you. Numbers like that are extremely likely to touch someone you love, just as the birth defects do. How, in any culture, is such a thing tolerable, let alone acceptable?

    How will coal magnates like Joe Manchin and apologists like Rockefeller, Rahall, Moore-Capito and McKinley (not to mention Rogers, McConnell, Paul, Warner and Webb) respond to this? Will they respond at all?

    I wonder if the lawyers at CrowellMoring in D.C. will see this as another opportunity to accuse us of being inbred.

  2. bluecanary says:

    Let’s not be hasty. I think we need 20-30 more studies about the studies that examine the studies showing that MTR is killing tens of thousands of people.

  3. Vernon says:

    I suspect the responses from those folks Bob mentioned will be much like Acting Gov. Tomblin’s: “There’s reports every day on something causing some kind of illness.” Or wring their hands like Rahall and not know what Congress can do.

  4. Ken Ward Jr. says:


    Just to clarify on this figure that you cite from the study — 60,000 cancer cases.

    I know that Jeff Biggers is leading his commentary on this study this way:

    Headline: Breaking: New Study Links Mountaintop Removal to 60,000 Additional Cancer Cases

    “Among the 1.2 million American citizens living in mountaintop removal mining counties in central Appalachia, an additional 60,000 cases of cancer are directly linked to the federally sanctioned strip-mining practice.”

    But that’s really quite a leap from what the study reported, and totally ignores the context in which the study authors mentioned that figure.

    With all due respect to my friend Jeff Biggers, it’s just not correct to say that the study found “an additional 60,000 cases of cancer are linked directly” to mountaintop removal. Saying that lead people to believe there is a level of certainty in this science that Dr. Hendryx specifically says in the study just isn’t there.

    The abstract of the paper does indeed say:

    “Mountaintop mining is linked to increased community cancer risk.”

    The 60,000 cancer cases figure, though, is discussed in a different context from that statement.

    The specific section of the study on this matter said:

    “If the rates found in this study represent the region, a 5% higher cancer rate (14.4% vs. 9.4%) translates to an additional 60,000 people with cancer in central Appalachian mountaintop mining counties.”

    Note that word “if” at the beginning of the sentence.

    That same paragraph ends with this statement:

    “Although these projections are uncertain, they illustrate the large numbers of people who are potentially impacted by mountaintop removal environment.”

    Note the words “uncertain”, “illustrate” and “potentially”.

    The study doesn’t support your most definitive statement:

    “That’s what mountaintop removal is doing to Appalachia.”

    The study is powerful enough as it is, and Dr. Hendryx deserves to have it quoted accurately and talked about in the context in which he wrote it.


  5. John says:

    I work on a strip job have been all my life I am 46 years old if this is the case if the study is right wouldn’t the workers have a higher rate of cancer but we don’t have so how can you link that to MTR

  6. Ralphieboy says:

    bluecanary has hit the nail right on the head. Study after study points to the same conclusions; that MTR is causing serious heath catastrophes to the residents living in their shadow. I submit that if something similar were happening in Washington or New York, there would be an immediate moratorium put in place on the cause. But because we are just dumb, inbred mountain trash, we are expendable. Justice has become just another purchasable commodity and we hillbillies can’t afford it.

  7. Soyedina says:

    John I don’t think your question was asked in this study. It would be interesting to compare those sorts of health outcomes in surface miners but i don’t think anyone has those data.

  8. Bill Howley says:

    Thanks, Ken, for asking everyone to calm down. The emotions surrounding MTR are so great that we will hear all kinds of exaggerations of Hendryx’s results.

    Science and research are not about getting definitive “answers” or providing absolute causes. Hendryx’s epidemiological studies are the initial statistical studies that point the direction for future research. Competent scientists always point to the weaknesses in their own studies, as does Dr. Hendryx, and suggest areas for future research. That is all we can expect from a single study.

    Hendryx and his collaborators have turned up a lot of interesting correlations between living near MTR sites and bad health effects. That is all he has done. He has not identified MTR as the cause of these effects. It will be up to others to provide further research.

    My question is whether politicians and business leaders will support that further research, given that they have failed to address the results of Dr. Hendryx’s studies. Scientific study requires money. Grants require support from business and government leaders.

    One thing is clear from the studies to date — we need more research. Will Mr. Tomblin and Mr. Rahal and Mr. Manchin come out publicly and support that research?

  9. PJD says:


    One explanation is that the surface mine workers are not regularly drinking, cooking and bathing with well or surface water obtained from the mine’s watershed. In fact, one striking thing I notice about coal mining these days (surface or underground), is that the miners seem to rarely live near the mines in which they work – most commute from a couple counties away. I have suspected that this is a deliberate hiring policy the mine operators use to make union organizing more difficult, but maybe it might have a health benefit.

  10. Bob Kincaid says:


    So you contest 60,000.

    Would you contest 30,000? 15,000? 5,000?

    Is ANY increased community cancer risk worth the outcome? Let’s say Dr. Hendryx is off by a factor of 12. What if there are only 5,000 additional cancers from Mountaintop Removal? Is that lower number somehow more acceptable? Ken, that’s what you seem to assert. That’s roughly one cancer for each mountain remover in West Virginia. Is each mountain remover family in West Virginia entitled to the life of one of his fellow West Virginians?

    These are hard questions, but they MUST be answered, and I know what my answer is. ONE is one too many. No amount of profit is equal to the value of a human life.

  11. Frank says:

    MTR areas are sacrifice zones.

  12. Ken Ward Jr. says:


    Thanks for reading and for your comment.

    With all due respect, you are misstating my point, and I would appreciate if if you would take more care in the future and not do so.

    My point is that it is important to understand exactly what Dr. Hendryx said in this study — and what he didn’t say.

    He most definitely did not say “an additional 60,000 cases of cancer are directly linked to” mountaintop removal. His study didn’t say that, and he has not said that.

    Saying so is a very convenient rhetorical effort by my good friend Jeff Biggers to catch the attention of his many readers and to provide a nifty soundbite to the movement against mountaintop removal. Jeff is a powerful writer, an important culture historian, and his work has brought much important commentary and research to coal-related issues not only here in Appalachia, but across the country and around the globe.

    But on this point, I don’t believe — I’m very confident in fact — that he didn’t get it right. Any fair and reasonable reading of the latest work by Dr. Hendryx will conclude this to be the case.

    As I wrote above, and as I’m sure you really know, the study at issue here did indeed say that mountaintop mining “is linked” to an increase risk of cancer. That quote comes from the abstract, and in context, what it means is that the survey results show that, after adjusting for some (but not all) other relevant factors, the odds of having cancer are significantly higher (twice as high) in the mountaintop mining area compared to the non-mining area.

    The 60,000 figure is an extrapolation made far later in the paper, to provide some context as to what perhaps — possibly, maybe — the extent of the population that could be impacted could be. Dr. Hendrxy, careful and thoughtful scientist (and very straight-forward writer) that he is, makes it clear that this 60,000 figure is simply not definitely proven (directly linked) by his paper when he writes:

    “Although these projections are uncertain, they illustrate the large numbers of people who are potentially impacted by mountaintop removal environment.”

    Again — projections, uncertain, illustrate, potentially — all very important words here.

    As Bill Howley explained clearly above, this and the other papers by Dr. Hendryx don’t prove mountaintop removal is killing people. They don’t prove causation — in large part because that’s not what this type of study sets out to do or is designed to do.

    What these studies do provide is clear evidence that there’s something going on here, something that needs further investigation — and they certainly provide strong ammunition for activists who want to make the public understand that mountaintop removal is not just about salamanders or mayflies. As Dr. Hendryx has said to me, this is not something that should be ignored.

    Activists are free to use their own websites, Facebook pages and whatever other outlets they want to say whatever they want … But on this blog, we’re going to try to be clear, honest and factual about the science. You’ve very carefully changed the subject that I raised in response to your earlier comment, Bob, and that’s fine — you very forcefully advocate in this and other forums for what you believe to be the right thing to do about mountaintop removal. I welcome your contributions to Coal Tattoo in that regard.

    But let’s try not to misstate what the science in a report like this says. It’s a very strong study, as have been others by Dr. Hendryx, and I just can’t for the life of me see what anyone feels the need to overstate what it discovered, and how it informs us about this important issue

    Frankly, I regret even pointing out the problem with the way Jeff Biggers wrote up this study — it’s unfortunately deflected the attention and efforts of a number of people (including myself) from the very important findings that this study does make.

    So, unless someone really can explain how this study actually does prove that there are 60,000 additional cancer cases directly linked to mountaintop removal, let’s just move on, or rather move back — and talk about what the study does say … I’ll have another blog post in the morning about what a couple of our favorite political leaders have to say, or rather don’t have to say, about these issues.


  13. Bob Kincaid says:


    I appreciate your response. My query is: if this is causing cancer for anyone in Appalchia or, as you suggest, even contributing to those cancers, how, in what mindset, by what process, do we rationalize and accept it? I think I know the Industry response. I’m most concerned with Appalachian people who live their lives unconnected to coal and yet still have a spot in the stew. There are obvious historical analogies here that I won’t bother making, save to say that regret and remorse are the salt and pepper of a very bitter dish served in a sad and sorry future.

    Like you, I’ve been listening to the chorus of crickets coming from our elected representatives. Cynic that I am, I expected nothing more and expect they’ll try to give this study the same ostrich treatment they’ve given others, at least until the Industry proffers more direction.

  14. Ken Ward Jr. says:


    I don’t know about accepting it … but as for rationalizing, it seems that perhaps a very important step toward doing anything is to have an open and honest discussion of what’s going on regarding mountaintop removal and any public health impacts.

    Of course, as a reporter I try to foster that kind of discussion with stories in the newspaper, posts on this blog and this very active comments section (which takes up an increasing amount of my time).

    The first step there, it seems to me, is to actually discuss what the science is telling us in an honest way — rather than an overstated manner fueled by overheated rhetoric.

    What Dr. Hendryx has done here is really at once both routine and remarkable. It’s routine because he’s done exactly what PUBLIC health experts and advocates are supposed to do. It’s remarkable because it’s something that a great many powerful forces would have rather seen not be done.

    What is it he’s done? First, he listened to the people … People like Bo Webb, who talks about what he’s seen happen in his community and to his neighbors. And then Dr. Hendryx set out to work with Bo and others to investigate, in a scientific fashion, what Bo knew from his own observations was going on — to see if using public health tools like this survey he could articulate and put numbers on the problem. He’s done that in a thoughtful study in a peer-reviewed journal.

    I’m going to keep writing about this research, and people like yourself who care about their families and their neighbors should keep talking about it — but talking about it in as accurate (and yet straight-forward) a manner as possible.

    While I’m not sure what you mean by rationalizing it … anybody who doesn’t want to “accept it” needs to first be accurate about what it is. Anything that gives the industry or political officials the ability to discount what you’re saying as not being strictly backed up by the science undermines your efforts.


  15. Casey says:

    Did the Hendyrix study control for the amounts of raw sewage in these watersheds?

    This study states “fecal coliform, an indicator of human disease-carrying pathogens in fecal matter, is often 10 to 100 times beyond clean water standards”.

    Not controlling for obesity seems to be a deficiency in the study since there are many studies that link the amount of abdominal fat to disease.

    The cause and effect is not being researched in the plethora of Hendyrix studies.

  16. Ken Ward Jr. says:


    I’m curious if you actually read this particular study by Hendryx, et al., because your comments suggest you haven’t — and that’s been the case in the past when you’ve criticized them.

    A couple of things to remember, in your effort to discredit this research:

    1. These studies are not designed to determine cause and effect — there are different sorts of studies. Much of his previous work has been “environmental” or “ecological” in method — using data examining a broader set of data, while this particular study uses more specific “person-level” data collected from the surveys.

    A study aimed at examining cause and effect is much more difficult, more more time-consuming and much more expensive — it requires far more data about exposures, which means more specific data about kinds and amounts of pollutants, and where people live, etc. As we’ve seen, coal industry regulators have been careful not to collect enough of this sort of data over the years to easily allow this sort of study — WVU reported this in its slurry injection study a year ago.

    It’s prudent to do the sort of work Dr. Hendryx is doing now before embarking on these more expensive studies, as doing the sort of examinations his has done to date help point researchers in the direction of potential problems, so that precious research resources can be best spent on the most important areas.

    Criticizing the “plethora of Hendryx studies” for not looking at cause and effect is simply not fair, because it shows a lack of understanding of how science works.

    2. On the issue of raw sewage, with this type of study, you would not “control for” raw sewage, because it’s not a study that looks at different pollutant exposures … in a sort of next-step study, you would probably try to look at those exposures and determine what may have influenced things, what the exposures were, etc.

    Also, I’m not sure that the sewage problem would be an issue here — the public health concerns for these exposures would be other than cancer, I think. With that type of pollution, you would be more concerned about gastrointestinal illness. I’m not suggesting raw sewage in the water isn’t a concern in many of these communities — it is — but simply that it’s not necessarily a potential cause of cancer.

    3. Regarding obesity — if you read the study, you’ll see that Hendryx and his coauthors outline this as a potential weakness in their study, as any good scientist does. There is no perfect study, and one major test of whether a study is good or not is whether the authors clearly outline the limits of their work.

    However, that said, Dr. Hendryx told me in an interview that the obesity numbers for Boone-Raleigh and Pocahontas counties weren’t that different. So, not controlling for this wouldn’t make that big of a difference. What I mean is: the comparison here was between the Coal River Valley and Pocahontas County. If their obesity rates are similar, then not controlling for that doesn’t impact your results in this study much. If, for example, Pocahontas County had a far better obesity rate than the Coal River Valley, then not controlling for that might give you bad results. That wasn’t the case here.

    I ask again — have you actually read the study?

    Thanks, Ken.

  17. john says:

    when did he start his study and how did he do it where are the names of the people that he did study on

  18. Ken Ward Jr. says:


    The methods are spelled out in the paper, which is linked to in this post.

    The door-to-door interviews, as noted, were conducted in March 2011.

    As any reasonable person would understand, the study does not include the names of the people surveyed, because do publish that would be a pretty significant invasion of their privacy.


  19. coalfire says:

    I won’t even try to argue this point because I fully believe it. I really do. I do think that mining and cancer go hand in hand. That is why the State needs to invest in municipal water systems for these areas.

  20. Observer says:

    “Criticizing the “plethora of Hendryx studies” for not looking at cause and effect is simply not fair, because it shows a lack of understanding of how science works.” How does science work?? Do you continue to sit in the back row and scream fire?? I would challege Hendryx to put some meat on the bone. With no cause and effect all Hendryx is doing is stiring emotions.

  21. Ken Ward Jr. says:


    I believe if you had bothered to read any of Dr. Hendryx’s studies, you would see that he has suggested — and is working on — further studies of just the sort that others have said are needed.


  22. Observer says:

    You assume too much Ken. I have read them.

    It just seems like there is a study every other week. At some point don’t you move to searching for cause and effect.

  23. Ken Ward Jr. says:


    As mentioned in response to Casey above, those sorts of studies are much more expensive, time-consuming and difficult to conduct … and as you’ve seen, that is the direction Dr. Hendryx is heading.

    I look forward to reading that you’ve made a personal financial contribution to the WVU medical school to further this research.


  24. Ralphieboy says:

    Further studies into cause and effect are a necessity; however, enough evidence has already been provided by these studies to show that something is horribly wrong in areas where MTR is practiced and that alone should be reason enough to place a moratorium on MTR until further studies are completed. If cause and effect is proven through further study, then the practice should be outlawed forever.

  25. Ken Ward Jr. says:


    The report you quoted from concerning the New River also states:

    Historic and current coal mining operations have also
    left their mark on the watershed. Of the 93 stream
    miles impaired by poor biological conditions, nearly
    70 percent are also impaired by acid mine drainage¬-
    related parameters, which is usually reflected in low
    pH and high concentrations of metals (mostly iron,
    aluminum, and manganese). Abandoned mine lands
    (AMLs)14 comprise over 2,500 acres in the Lower
    New River watershed and are considered a significant
    source of metals and pH impairments throughout
    the watershed.


  26. Observer says:

    There you go again Ken. You assumed that that I have enough money to make a donation.

    I think I get your point. Quit throwing stones. Fair enough.

    My biggest issue with the studies is how do you square up all the data out there. A quick look at the National Cancer Institute web site shows the cancer incidence rate in Pocahontas County as being higher than both Raleigh and Boone.

  27. Ken Ward Jr. says:


    I didn’t say a “big” donation … any little bit would probably help.

    Regarding the National Cancer Institute, please provide a direct link to the data you’re referencing so we can all check it out.

    However, to be clear: The study in question here looked at certain parts of Boone and Raleigh counties identified as being near mountaintop removal operations … and at only a certain portion of Pocahontas County — it did not look at county-wide data.


  28. Ken Ward Jr. says:

    OK folks … we are starting to repeat ourselves and to get posts that are little more than inflammatory, so I’m going to close out the comments on this one. Thanks to all who contributed reasoned, polite discussion points. Ken.