The People’s Cancer Incidence Screening Tool (PCIST):Because Cancer is Not Our Destiny

Ever wonder about cancer rates in your community but struggle to get answers?  PCIST is the People’s Cancer Incidence Screening Tool, a newly developed public health resource for Pennsylvania residents.  It was first created in January 2025 as a partnership between Lauren Minsky, an environmental health historian at Haverford College, and organized groups of concerned citizens in southeastern Delaware county.  In this environmental justice region, community members – led by Zulene Mayfield and Nolan Fontaine at Chester Residents Concerned for Quality Living (CRCQL), and joined by Echo Alford, Thom Nixon and Lora Snyder at Marcus Hook Area Neighbors for Public Health (MHANPH) – were seeking information about cancer incidence in their local municipalities, townships, and boroughs. They had valid concerns that multiple pollutant exposures – stemming from major oil and gas refineries, waste incinerators, and chemical plants – were causing cancers to become more prevalent among their families and neighbors, including their children and youth.  However, they kept hearing that “there is no local cancer data” or “that’s impossible data to get” or “things like that come down to random chance”.

After working over the course of several months to develop and refine the PCIST tool, our project formally launched in June 2025 with the power to generate an accurate history of crude cancer rates for all of Pennsylvania’s cities, towns, and boroughs. The PCIST tool covers primary invasive cancers in twenty-three leading sites in the body: bladder and urinary tract; blood (leukemia, myeloma, Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma); brain and nervous system; breast; cervix; colon and rectum; esophagus; kidney and renal; larynx; liver and bile duct system; lung and bronchi; mouth and pharynx; ovaries; pancreas; prostate; skin (melanoma); stomach; testes; thyroid; and uterus. We include all sites in every analysis because narrowing down the cancer types can prevent us from seeing unexpectedly significant “cancer signals” in a single community, as well as common signals among communities with shared air and drinking water sources and/or pollutant exposures.

With PCIST, we generate average annual crude cancer incidence rates over a twenty-year period, from 2002-2021. We work with this long interval of time because cancer takes years to develop.  In small towns and boroughs, there are also significant fluctuations in the annual case counts of rarer types of cancer, which makes it important to calculate average annual incidence rates over many years. By producing cancer rates over a twenty-year period, we are also able to identify which cancers are stable, lessening, or growing as problems for a given community. Additionally, we run our calculations for each community’s total population, as well as broken down by gender and age.  We prioritize these demographics because age and gendered differences in physiology, as well as exposure to pollutants, affect cancer incidence.  

Our final and most important step is to swiftly release the results of our calculations in Community Cancer Incidence Reports (CCIR).  Our priority at PCIST is “experiential significance”.  We always share what actually happened.  We never a priori suppress, or explain away, cancer data on the grounds that it fails to meet abstract standards of “statistical significance”.  Our CCIR reports detail any elevations greater than 10% in a community’s cancer numbers as compared with the corresponding US, PA, and all-county figures. By using multiple reference populations – national, state and county – we provide a nuanced perspective on each community’s relative crude cancer incidence.  For environmental justice areas, we additionally produce a regional report that combines the cancer rates of contiguous towns. All of our CCIR reports are freely downloadable on our project website, where we also offer a more detailed explanation of our project rationale, our approach and sources, and a step-by-step guide to aid interpretation of our reports: https://pcist.net.  

When launching PCIST this summer, we began in Delaware and Washington counties at either end of southern Pennsylvania’s fossil fuel pipelines. As evident in our CCIR reports, the “cancer signals” for both of these heavily-polluted counties are striking – and, sadly, often devastating.  This is especially the case for communities located in areas of active fossil fuel mining, drilling, fracking, refining, and waste processing.  PCIST data strongly substantiates residents’ concerns about the cumulative effects of pollutant exposures on their rates of many types of cancer, including among their children and youth.  PCIST data also reveals that all communities experience some elevated cancer rates – a reality that is not surprising, but is perhaps underappreciated by many residents. Air blows and water flows from heavily polluted sources to locations far and wide. Cancerous pollution also takes many forms, including widespread residential and recreational pesticide and herbicide use.  The elevated cancer rates in many communities also strongly suggest the significance of legacy pollution. Prior industries – from mills to quarries and mines – frequently leave behind soil, water, workers, and residents contaminated by carcinogenic substances that do not readily break down, including persistent organic pollutants, heavy metals, and radioactive waste.  

At PCIST, we share common cause with everyone working at the intersection of cumulative impacts, environmental health, and climate change.  At present, our team finds purpose in seeing how our CCIR reports are already proving useful as informative aids for educating, organizing, connecting, and empowering communities across southern Pennsylvania. We are also grateful to be working with a growing network of experienced and skilled partner organizations in the fields of environmental health and environmental justice, now including Physicians for Social Responsibility.  As we look to the future, we are committed to bringing PCIST to all Pennsylvanian communities, as well as to communities in Delaware, New York, New Jersey, Ohio, and West Virginia as our neighbors in the Delaware and Ohio river basins.  We believe that every community, every family, and every case of cancer is significant and “counts”. 

Ultimately, we hope that our rigorous, historically-grounded approach to generating local cancer data and analyses – soon to include layered maps – will continue to shine a spotlight on the “self-devouring” consequences of how our society produces and consumes its fossil fuel energy, food, industrial goods and waste by-products.  We will also use our rapidly expanding database of community cancer rates to support any researchers and epidemiologists who want to undertake specialized studies of the historical relationship between specific chemical exposures and types of cancer.  Perhaps someday, our PCIST database will even be useful for physicians who want to assess and to mitigate their patients contextualized cancer risks – approaching the practice of oncology and cancer prevention from a community environmental health, as much as from a genetic and behavioral, perspective.  

Cancer is not our destiny.  As PCIST looks to the future, we warmly welcome all feedback, collaboration, and support.  Please visit us at https://pcist.net to learn more and join our effort.