JAMA study finds increased cancer risk near St. Louis’s Coldwater Creek

Coldwater Creek was found to be contaminated with low-level radiation from improperly stored materials from uranium processing associated with the Manhattan Project. Since the 1990s, the U.S. Army Corps of Engineers has been cleaning up the creek and surrounding areas under the Formerly Utilized Sites Remedial Action Program.

According to the JAMA report, “Evidence suggested a positive association between living near Coldwater Creek in childhood and risk of cancer.”

The study: The JAMA study based its analysis on a cohort of more than 4,200 people who had participated in the St. Louis Baby Tooth–Later Life Health Study. From 1958 to 1970, individuals in that study donated their baby teeth to assess exposure to atmospheric nuclear weapons testing.

The study looked at participants who had lived within 1 kilometer or less of Coldwater Creek, more than 1 km to 5 km away, and 5 km to 20 km or more away from the area. A generalized linear model was used to examine the association between distance from the creek and the incidence of different types of cancer, including solid (colon, lung, kidney, etc.), radiosensitive (breast, thyroid, leukemia, etc.), and nonradiosensitive (endometrial, ovarian, prostate, etc.).

For all cancers, the study found that those living less than 1 km away from the creek had a 1.44 odds ratio for developing cancer, compared with 1.27 for those living 1–5 km away and 1.05 for those living 5–20 km or more away. Likewise, for radiosensitive cancers, the study found a 1.85 odds ratio for those living near the creek, compared with 1.25 and 1.10 for the other respective distances. Overall, those living closest to Coldwater Creek has a 29 percent increased risk of cancer, according to the study.

Different results: Previous studies conducted by the Missouri Department of Health and Senior Services (MDHSS) and the Agency for Toxic Substances and Disease Registry (ATSDR) found that risk of cancer for those living near Coldwater Creek was low and that the pattern of cancers was not consistent with exposure to radioactive contamination.

The authors of the JAMA study, however, said the MDHSS and ATSDR studies were limited. For example, they noted that the MDHSS study looked only at adults who lived near the creek at the time of the study and not at children who lived there prior to cleanup efforts. “This is an important distinction, as evidence shows that radiosensitivity is age dependent for several cancers,” the report states.

Likewise, the JAMA authors claimed that the ATSDR study “had a lot of room for error,” underestimating some of the ways radiological contamination could have been absorbed by residents and by “oversimplifying their methodology for estimating lifetime risks.”

Background: Beginning in 1946, residues and wastes from Mallinckrodt’s St. Louis uranium processing facility in downtown St. Louis were improperly stored on property near the St. Louis airport and another site near Coldwater Creek. The bulk of the waste, which consisted of low-level radioactive contamination commingled with metals from uranium processing activities, was removed in the past, but residual contamination lingers.

With the support of U.S. Sen. Josh Hawley (R., Mo.), the Radiation Exposure Compensation Act (RECA), which provides compensation to those who develop cancer or become ill due to government-caused nuclear contamination, was revived and expanded as part of the One Big Beautiful Bill Act that was signed into law on July 4. The bill reauthorizes RECA, which expired in June 2024, through the end of 2028 and expands its coverage to include more individuals living in Missouri.