Vilma Moran seemed an unlikely candidate for cirrhosis of the liver, which her doctor said explained her swollen abdomen and yellowing eyes. In her 60 years of life, she had consumed probably 10 alcoholic beverages. She didn't smoke, didn't have hepatitis. She was diabetic, which is a risk factor. But when it was found later that she had liver cancer, the surgeon asked if she'd ever worked in a chemical plant. The type of cancer she had suggested a chemical exposure, he said. No, she told him, she worked with special education children at Lowell Middle School.
Then she and her husband recalled a letter they had received four years earlier, inviting them to a neighborhood meeting to discuss a plume of contaminated groundwater linked to the shuttered Kelly AFB. They had ignored the invitation. She had lived near Kelly almost all her life. Her father had maintained the base golf course.
In February 2006, Moran attended another neighborhood meeting from her wheelchair. She listened as Tim Aldrich of East Tennessee State University, an expert in cancer clusters, announced he had been hired to look into reports of elevated liver cancer in neighborhoods surrounding Kelly.
Last month, Aldrich's report was quietly released to the San Antonio City Council. A planned meeting to announce the results to people living in those neighborhoods never was held.
The report noted that while 14 ZIP codes that roughly encompass the plume of polluted groundwater indeed did have high rates of liver cancer, so did all of Bexar County. In fact, when adjusted for age differences, the liver cancer rates in those 14 ZIP codes over several years actually were lower than for the county as a whole.
"Whatever is the process for Bexar County to think about its liver cancer risk, in my opinion they must keep in mind that they have more communities with elevated liver cancer risk than just the one near" Kelly, Aldrich said by phone.
Despite those findings, the high rates in those 14 ZIP codes fit the definition of a cancer cluster, Aldrich said. Examine them over shorter periods of time, or in other ways, and they do stand out. That justifies a more in-depth look comparing the cases in those ZIP codes with a comparison group somewhere else.
The ZIP codes are 78201, 78204, 78205, 78207, 78211, 78214, 78221, 78224, 78225, 78226, 78227, 78228, 78237 and 78242.
Local, state and federal health officials have criticized the report and its conclusions. Although they agree the rates in those neighborhoods are high compared with the state and the nation, they disagree with Aldrich that a major study of liver cancer cases in those 14 ZIP codes is feasible — noting only five survivors were willing to be interviewed.
And they strongly disagree with one particular statement in the report: that after statistically excluding the other possible causes — hepatitis, alcohol-related cirrhosis, smoking and diabetes — 11.5 percent of the liver cancers in those 14 ZIP codes "may be attributable to residing over the Kelly ... plume."
A cancer puzzle
For years, experts have puzzled over Bexar County's high rates of liver cancer, particularly the large number of cases that plague the modest neighborhoods to the south and west of downtown. Between 1999 and 2002, Bexar ranked no lower than seventh each year in liver cancer death rates among all 254 Texas counties, for both men and women, according to the Texas Cancer Registry. Hispanics ranked no lower than fourth. Only much smaller counties had higher rates.
There was good reason for concern. No cancer drug is FDA-approved for liver cancer. Most patients are diagnosed with advanced disease, when surgical options — including a liver transplant — often have a poor prognosis.
Worldwide, liver cancer is the fourth biggest cancer killer, with 80 percent of new cases taking place in developing countries. The most common causes in those countries are hepatitis B and food-borne toxins — primarily aflatoxin, a mold that grows on corn, peanuts and other grains.
In fact, while rates for many cancers have declined, liver cancer rates have gone up in the United States and other wealthy nations, fueled instead by hepatitis C, alcohol consumption and diabetes.
Some experts warn the worst lies ahead.
"That's the way we view it," said Dr. Melanie Thomas, assistant professor of gastrointestinal medical oncology at the University of Texas MD Anderson Cancer Center in Houston. In a 2005 paper, she and a co-author described liver cancer as "a looming epidemic for which the medical oncology community is largely unprepared."
The federal Agency for Toxic Substances and Disease Registry first identified liver cancer as a major concern in 1999 after studying the neighborhoods around the base at the request of the late U.S. Rep. Frank Tejeda.
Residents had a laundry list of health complaints that many blamed on contamination from the base. A number of studies since then have confirmed high rates in those neighborhoods and countywide.
Health officials have argued the polluted shallow aquifer beneath the neighborhoods wasn't used for drinking or watering lawns, and people weren't exposed. They noted the lag time between exposure and cancer can be decades.
Aldrich points out that the 14 ZIP codes in his study share another characteristic besides the plume. Nearly half of Bexar County's Hispanic population lives in them. Across the country, Hispanics — particularly Hispanic men — are more prone to liver cancer than other groups.
Hispanics are slightly more likely to have hepatitis C, and some research has shown the virus progresses more rapidly in Hispanics. Diabetes, an epidemic in the Hispanic community, causes a condition known as fatty liver disease, which can progress to a form of cirrhosis called NASH — non-alcoholic steatohepatitis — and liver cancer. Having diabetes doubles the risk of liver disease and liver cancer.
Then there's the question of alcohol use. A 2004 study in the American Journal of Public Health, which looked at survey data from the late 1990s, found San Antonio had the highest percentage of binge drinking among 120 U.S. cities. Twenty-four percent of adults here — and more than a third of all men — had consumed five or more alcoholic beverages in one occasion within 30 days of being asked. Nationwide, the median was 14.5 percent. Those researchers found no statistically significant differences between racial or ethnic groups. Those with lower education levels were slightly more likely to be binge drinkers.
With funding from the Air Force, the Metropolitan Health District commissioned a feasibility study through HealthCare Resolution Services Inc. of Laurel, Md., which hired Aldrich as a consultant. The study was to examine rates of primary liver cancer — cancer that began in the liver, excluding cancer that might have begun in another part of the body and spread to the liver — in those 14 ZIP codes to see if a large, comprehensive study might be justified.
With the help of Metro Health staff, the study grew beyond its initial scope — including a survey of neighborhood veterinarians to see if they had diagnosed liver cancer in dogs, which might suggest an environmental cause. They hadn't.
In his report, Aldrich estimates that when you apply Bexar County's rates of hepatitis, smoking, diabetes and other causes to those ZIP codes, that still would leave 11.5 percent of cases unexplained. He's unapologetic for stating those cases "may be" related to living over the plume, saying the report was written to guide the health department as it considers studying the matter further.
"I'm trying to explain to the health department, if they do a study, how many of the people they've studied will they be able to say, it looks like your liver cancer was the result of living over this plume," Aldrich said. "Their study should be designed to find this many cases."
"We do not agree," said Dr. James Wittmer, a local environmental health consultant to the Metropolitan Health District. "It's a firm conclusion of all the people who have read this report, the professionals and the reviewers, that this is an unfounded statement."
Other possible causes
In any case, health officials are looking at other causes. A still-unpublished study of 800 liver cancer death certificates between 1996 and 2005 by the health district and University of Texas Health Science Center researchers found little they didn't already know. Hepatitis was more common in Hispanics than in Anglos, but about the same as in blacks. Diabetes — probably the least understood cause of liver cancer — was much more common in Hispanics who died of liver cancer. "Was diabetes a contributing factor in the progression to cirrhosis? We couldn't make that conclusion," said Roger Sanchez, an epidemiologist with the health district.
In 2004, Houston researchers published the strongest evidence to date on diabetes and liver cancer involving more than 800,000 VA hospital patients.
They estimated diabetes doubles the risk of liver disease and liver cancer. While the link had been known, some had questioned whether diabetes caused liver disease, or the other way around.
Under way is still another study, and perhaps the biggest long shot yet. Some researchers looking at the high Hispanic rates have wondered whether food-borne toxins might play a role, as they do in other parts of the world.
Aflatoxin and fumonisins contaminate corn, peanuts and other grains. Contamination levels can rise and fall depending on seasonal weather patterns that put stress on plants — drought in particular. And South Texas is drought prone.
Hispanics might consume more corn, the theory goes, and they might buy less expensive corn products, which might be more prone to contamination.
A lot of mights. Researchers at Texas A&M and Texas Tech universities, together with the health district, are targeting three ZIP codes with some of the highest liver cancer rates — 78207, 78228 and 78237, which lie north of U.S. 90 on the West Side. The researchers have sophisticated tests that can detect byproducts of the toxins in blood and urine going back a year from ingestion.
The study is hoping to recruit 500 residents — a number that would provide the strongest statistical evidence of a cause. About 100 have volunteered so far. To learn more about the study, call (210) 434-0077.
For Vilma Moran, it's less important to find what caused her own liver cancer than it is to prevent it from developing in someone else.
"I've already gone through it, however bad it was," she said. "But maybe it will be helpful for someone else. I'm concerned for my son and the other people in the area."
SWU-YLO went to Bill Millers on September 27, 2007 to submit petition and to request yet again another sit down meeting with the senior management. The petition had 1,157 signatures from San Antonio residents that agree on Bill Miller shall pay a starting wage of $9.00/hr to all your workers, regardless of location. We have been asking Bill Millers to have a sit down face to face meeting to talk about the pay discrepancies and to attempt to reach a resolution in starting wages at the restaurant base in 
the office because everyone was out to lunch. How can a chain of restaurants run if no one is in the office? According to her she could not take anything from anyone especially the petition. “You can leave them here but, I can’t accept them” continued Cynthia the receptionist. We decided to take the petition with us. Not sure if she would turn them in or just trash them. Later I went back in and gave her the second letter that was written that was going to be attached with the petitions. On the letter it was requesting another sit down face to face meeting with a senior manager. She accepted the letter and told me she’ll see what box she’ll put it in. 
d pressuring the company in way there is a pay disparity between locations. We also found out that the loyal customers of Bill Millers have also been sending in the post card that Southwest Workers Union made. They been keeping everything they receive in file. They also researched the union web site and the YLO myspace. “We [Bill Miller’s] are very aware of who you guys are.” said Cynthia.
National Guard soldiers and 
