Example 7

The New York Times

December 2, 1984, Sunday, Late City Final Edition

LEUKEMIA STRIKES A SMALL TOWN

By Paula DiPerna

Paula DiPerna is a New York-based freelance writer and editor.

A stiff morning breeze rolls a basketball from one yard to the next in a neighborhood of newly shingled homes with asphalt driveways just wide enough for one car. Inside a maroon ranch house, a bedroom door still bears the name ''Jim'' in black and gold metal letters. Anne Anderson, tall and blonde, with soft Norwegian features and smoky blue-gray eyes, sits in her son's room, reading in a deep velvet chair.

More often, though, she can be found downtown in Woburn, a commuter suburb 10 miles north of Boston, where she works in the storefront office of a volunteer organization called For A Cleaner Environment. Not far from her desk is a glossy street map spotted with blue plastic pushpins, 16 of them, each representing a child who has died of leukemia since 1969. One of those children was Jimmy Anderson.

According to the National Cancer Institute, the average incidence of leukemia is 3.74 cases per 100,000 children. In Woburn, a town of 36,000, in addition to the 16 blue pins on the map, there are eight red ones for children now ill with the disease. In Anne Anderson's neighborhood of East Woburn alone, there have been 12 cases, six within a few blocks of her home. The odds against six cases within a half-mile radius, according to the Centers for Disease Control, are 100 to 1.

Elsewhere on the map of Woburn are symbols representing lagoons of toxic arsenic, lead and chromium, some as deep as five feet. They sit on a 300-acre tract of poisonous wastes, left behind by chemical manufacturers and tanneries no longer operating in the area. The Environmental Protection Agency has listed this tract among the 10 most hazardous waste sites in the United States. And studies have shown that the children struck by leukemia in Woburn had only one relevant factor in common: They lived in a neighborhood that drew its water from two wells contaminated by toxic carcinogenic chemicals.

A clear case of cause and effect? A layman might assume so, but traditional medical epidemiology, the science of causes of epidemics, cannot prove what the map of Woburn suggests. All across the nation, outbreaks, or clusters, of cancer and other diseases have been reported in conjunction with evidence of environmental contamination. Yet firm proof of cause and effect remains elusive. The scope of the issue could be staggering. Millions of Americans have been exposed to air and water pollution released by the 18,000 hazardous toxic-waste sites around the country identified by the Environmental Protection Agency. And experts believe there are many more such sites still undiscovered - all potentially leaching poisons into the underground water supplies from which half the nation's population draws its drinking water.

The impact of toxic wastes on human health is ''gaining increasing public and regulatory concern,'' says Dr. Robert N. Hoover, head of the Environmental Epidemiology Studies Section of the National Cancer Institute, ''but in terms of buttressing that concern, science is at a very early stage.'' And this lag in scientific knowledge has posed a knotty public-policy problem: victims without a clearly identifiable culprit. Many are seeking redress in civil courts around the country. In fact, the Andersons and seven other plaintiffs have brought suit in Federal court in Massachusetts, charging that the waste-disposal practices of two companies led to the leukemia in their families.

The results of such ''toxic- tort'' suits have been mixed, though several - the Agent Orange case, for instance - have ended in multimillion- dollar settlements and awards. Congressional hearings were held last spring and summer on an amendment to Superfund, the Federal Comprehensive Environmental Response, Compensation and Liability Act, which provides funds for community efforts to clean up waste sites. Such an amendment, if passed, would compensate individual citizens.

The cancer branch offices of the Centers for Disease Control in Atlanta receive approximately one cancer-cluster report a week. It triggers a series of detective steps, from the analysis of computer readouts to the stalking of neighborhoods for physical clues. But there is a persistent twin frustration, described by Dr. Glyn G. Caldwell, an assistant director of the Chronic Diseases Division at the Atlanta centers: ''We can't tell the chance clusters from the causal ones and, among the causal ones, we can't tell the causes.''

Clusters pose basic, unanswered scientific questions: How do toxic chemicals circulate in the atmosphere or migrate through layers of the earth? Once inside the human body, how do they cause disease in general and cancer in particular?  Specifically, could a chemical in East Woburn water have sent normal white blood cells on a mad reproductive journey to become the one trillion leukemia cells that can be present in a victim at the time of death?

A recent investigation of the Woburn cluster by the Harvard University School of Public Health department of biostatistics represents a major breakthrough in the field. It showed that the more water from the two wells (known as G and H) to which a child was exposed, the likelier he or she was to have had leukemia, cleft palate, Down's syndrome or other childhood diseases. The Harvard study is believed to be the first in this country ever to correlate the distribution of contaminated water with an outbreak of childhood leukemia. ANNE M. AND Charles E. Anderson, a computer systems manager, and their daughter Christine moved to East Woburn in 1965. Chuck Anderson was born in 1966 and Jimmy, two years later. From time to time, Mrs. Anderson complained to town authorities about the neighborhood's foul-tasting tap water, but she says she was assured that it was safe.

In January 1972, samples of Jimmy's blood were sent to Boston's Massachusetts General Hospital for analysis; for weeks he had been unable to shake off a flu-like listlessness. ''In my whole life,'' Anne Anderson says, ''I'd known of only one case of leukemia.'' But the night before the diagnosis was due, she said she was kept awake by the premonition that Jimmy would be ''the one case of his generation.''  Acute lymphocytic leukemia, Jimmy Anderson's illness, strikes an average of 1,800 American children a year. It occurs when lymphocytes, white blood cells, fail to mature and thus do not perform their infection-fighting function and instead wildly reproduce.

Jimmy was being treated by Dr. John T. Truman, the hospital's chief of pediatric hematology and oncology. In the waiting room, Mrs. Anderson sat among other mothers with leukemic children. Afterward, she recognized some of them shopping in Woburn. She learned about an infant who had died of leukemia, then discovered that the child had lived somewhere in East Woburn. She noticed a woman putting trash out in front of a house down the street, and later saw the same woman at the hospital - waiting for a leukemic child.  ''I had heard of possible leukemia viruses,'' Anne Anderson recalls, ''and I wondered if the water could be carrying a germ or something. I never thought of chemicals at first.''

Charles Anderson was skeptical. His wife remembers his remarking, ''You can't tell me that if these cases were unusual, somebody somewhere wouldn't be keeping an eye on it.'' His wife did not report her fears to public-health authorities. ''I would not have known which to call,'' she admits. ''Nurses, even Jimmy's doctor, thought it was just chance I was hearing of other cases. I felt I would be dismissed as an emotionally involved mother the way the town dismissed my calls about the water. After awhile, I myself wondered if I was crazy.''   Federal Investigations of disease clusters usually start with a telephone call to the Centers for Disease Control, a series of long, low, barrack- style buildings off a busy four-lane highway

outside Atlanta. The man who fields those calls, note pad and maps ready in hand, is a bespectacled physician turned epidemiologist named Matthew M. Zack.

The caller may be an ordinary citizen, a local physician or a state health official, Dr. Zack says, and the message may range from a detailed, statistical report to a complaint as subjective as ''everyone in my neighborhood has cancer.'' About 90 percent of the callers, Dr. Zack estimates, cannot provide the information he needs - the number of ill people, the type of cancer involved, the geographical spread - and such complaints cannot be processed.

The remaining cluster reports are compared to national statistics for cancer mortality and diagnosis, using the Atlas of Cancer Mortality, published in 1975, and the U.S. Cancer Mortality by County, published in 1974, by the National Cancer Institute. These bound volumes show in maps and tables how many people died, by county, of what type of cancer, between 1950 and 1969.

Diagnosis figures are harder to come by. There is no standard system for collecting cancer diagnoses. The cancer institute extrapolates national rates from a sample of states and cities, and 22 states now require hospitals, physicians or laboratories to report current cancer diagnoses to a centralized, often computerized registry. Without such accurate and up-to- date diagnosis statistics, a cluster may not be detected until many years after it first began to form, and after most of the victims have died.

If a given cluster report shows a conspicuous excess in mortality or diagnosis beyond what epidemiologists would have expected, Dr. Zack says, ''the cluster is considered 'statistically significant.' '' The scientists' next step is to determine whether this rare event was produced by chance or by other factors.

When a coin is flipped, the laws of probability hold that it will land heads or tails a roughly equal number of times. When a particular coin lands heads up dozens of times in a row, there is a tendency to look for an explanation beyond probability.  Chance cannot be entirely ruled out, but science - and common sense - suggests that the coin is weighted.

''The problem with clusters,'' says Dr. Hoover of the National Cancer Institute, ''is that they are all, by definition, weird events. Some are more weird than others.'' But since leukemia is such a rare disease, a cluster of only six or seven extra cases can be very statistically significant. Dr. Caldwell of the Atlanta center explains: ''Depending on the size of the cluster, we can go as far as to say the odds are 100 to 1 that this cluster, this event, probably did not happen by chance, but we cannot say what it did occur by.'' If there is reason to suspect an environmental cause, Dr. Caldwell says, ''then we might interview families to search for a common factor, such as work exposure to carcinogens, hobbies, diet, medical history.''

Between 1960 and 1983, the Atlanta center, usually in cooperation with state health authorities, has conducted two-tier investigations of approximately 25 clusters, most of them leukemia clusters. The handful that have been conclusively linked to a specific environmental contaminant have almost all involved the place of work. An outbreak of a rare liver cancer among workers in a plastics plant in Kentucky, for example, was traced to vinyl chloride.

Tracking environmental contaminants outside the place of work poses special problems. ''If,'' says the stocky, crewcut Dr. Caldwell, ''everyone who ate a tuna- fish dinner Sunday evening got sick on Monday, you could test the dinner. But in cancer there is no one dinner but a whole menu of possible agents in the air and water to which a person might have been exposed.''

 Moreover, these agents are evasive, moving about in the environment. Since cancer symptoms may not appear in adults until as long as 40 years after exposure to a carcinogen, cluster research is always playing catch-up. The statistical studies call out, ''Hey, look over here,'' but the call may come many years after an environmental culprit has fled.

That's one reason childhood leukemia clusters attract research attention. Most victims develop symptoms between the ages of 3 and 6 years, which means there are fewer years in which the trail of evidence can grow cold.   In June 1975, after reviewing results of routine tests of the wells known as G and H, the Massachusetts Department of Health recommended that the Woburn Water Board take ''immediate action'' to remove the ''high concentrations'' of minerals and salts in the two wells or find alternate sources of water. But Woburn failed to act because of a budget crunch, town officials say. The filtering system proposed by a consultant was never installed, though in any event it would not have been effective against most toxic chemicals. ''They were playing with a different sheet of music then ,'' says Richard Chalpin of the Massachusetts Department of Environmental Quality Engineering. ''Nobody knew there could be toxic wastes in underground water.''

At about this same time, Charles Anderson had asked his pastor, the Rev. Bruce A. Young of Trinity Episcopal Church, to help Mrs. Anderson and convince her to forget her suspicions that East Woburn's water was to blame for the leukemia cases. ''I tried to talk Anne out of it,'' says Mr. Young, a soft-spoken man with a full, earnest face, ''by suggesting she actually count the cases.'' He assumed, he says, that there would not be any new ones.

Carl W. (Robbie) Robbins, 4 years old, was diagnosed in October 1976 - the second child with leukemia in Mr. Young's parish and the fifth or sixth on Anne Anderson's list. ''Even to me,'' Mr. Young says, ''it was beginning to seem weird, but I wondered if it wasn't like starting to see Volvos on the road after I had bought one.''

In May 1979, in a scrubby vacant lot abutting the Aberjona River, which flows through East Woburn, construction workers came upon several drums of polyurethane apparently abandoned by a midnight dumper. They phoned the police, who in turn called Mr. Chalpin at the state environmental agency.

Mr. Chalpin had not heard about the Woburn leukemia cases, but he knew all about the recent public concern over toxic contamination in Love Canal near Niagara Falls. By this time, as he would put it, the sheet of music had changed. Mr. Chalpin feared that wastes might also have been poured directly into the Aberjona. He decided to take samples from the two wells, G and H, which were thought to draw from the river.

Tests with a gas chromatograph mass spectrometer showed no sign of polyurethane. Instead, there were high concentrations of substances on the Federal E.P.A.'s list of priority toxic pollutants - among them, tetrachloroethylene and trichloroethylene (T.C.E.), both of which have caused cancers in laboratory animals. On May 12, the state ordered the wells shut down immediately.

Then, more happenstance. The next month, an E.P.A. official was driving past Woburn when he noticed bulldozers at work, filling in a marshy area near an industrial park called Industri- Plex. He suspected a wetlands zoning violation, and his report sent E.P.A. agents to the site. They found both surface and subterranean lagoons of arsenic, lead and chromium that were to become so prominent on the map of Woburn.

In September, the Daily Times Chronicle of Woburn reported the discovery of the toxic pools. At the same time, the Rev. Bruce Young placed a small advertisement in the newspaper, inviting anyone who knew of childhood leukemia cases in Woburn to attend a meeting at Trinity Church.

Afterward, Mr. Young recalls, he and Mrs. Anderson went over their new list of leukemia victims. ''We spread out a map of Woburn,'' he says. ''Anne called out the addresses and I marked them. Quadrant G4 and G5 kept coming up.'' There were six cases grouped tightly around the Anderson house, a total of 12 cases in East Woburn. But, as Mr. Young says, ''we still didn't know if 12 was a lot.'' He made an appointment with John Truman, the physician still treating Jimmy Anderson.

Dr. Truman credits the map with convincing him: ''Only when Bruce literally sat me down and said, 'Look at this,' was the significance of what Anne had been saying really impressed on my mind. I picked up the phone and called the C.D.C. in Atlanta.''

Now the momentum began to build. The first public recognition of the cluster came in December with a headline in the Times Chronicle: ''Child Leukemia Answer Sought.'' The next month, Mr. Young and Mrs. Anderson founded For A Cleaner Environment, drawing together about 20 concerned community members. And when Senator Edward M. Kennedy opened committee hearings on ''Health Effects of Hazardous Waste Disposal Practices'' that summer, Mr. Young and Mrs. Anderson were called to testify.

The first scientific investigation of the leukemia cluster in Woburn got under way during the week of June 23 - more than eight years after Jimmy Anderson's diagnosis. The study was conducted by John L. Cutler, an epidemiologist from the Centers for Disease Control, along with experts from the Massachusetts Department of Public Health. The first stage was an elaborate series of interviews with the families of leukemia victims, as well as with families making up the control group in which there was no incidence of leukemia.

Meanwhile, another kind of detective work was under way. The Senate hearings and meetings F.A.C.E. had arranged with state elected officials had galvanized several government agencies. Unprecedented appropriations from the state environmental agency and E.P.A. made it possible for scientists to start tracing the movement of underground water to try to determine how and when wells G and H had become contaminated. IN THE WINTER OF 1981, scientists began to swarm over the 300-acre Industri- Plex waste site. They drilled new wells to take water samples. And they set off small underground explosions and studied the movement of sound waves through the earth, seeking a profile of the underground layers.

The painstaking investigation has pinpointed two or possibly three separate streams, or ''plumes,'' of toxic seepage feeding the two wells. But to the scientists' surprise, the plumes do not seem to emanate from the heart of Industri-Plex. The studies have focused, instead, on two sites about a half-mile to the southeast. One is an empty lot behind an equipment-manufacturing plant operated by Cryovac; the other property is beside a tannery operated by the John J. Riley Company. In both places, T.C.E. was found in samples of the ground water. The scientists wonder whether the contaminated water could have traveled hundreds of yards, through layers of rock and soil, beneath parking lots and highways, and made its way to wells G and H.

Two elements of what might be a pattern of cause and effect were now in place - the wells serving East Woburn were known to be contaminated with toxins, and some possible sources of that contamination had been pinpointed - but a crucial third element remained uncertain: Could the chemicals found in the wells actually induce a leukemia cluster?

The solvent T.C.E. is used to clean septic tanks and remove grease from metal. In the laboratory, mice exposed to T.C.E. have developed cancer of the lymph nodes; these structures produce white blood cells, which run amok during leukemia.

But the mice did not develop leukemia. What's more, according to a review of research published by the National Academy of Science, no increased incidence of any kind of cancer, leukemia included, has been found among humans exposed to T.C.E. on their jobs.

Some authorities conclude that the solvent plays no role in the development of human cancer. Others, like Robert Hoover of the National Cancer Institute, are not so sure. ''On one hand,'' he says, '' we depend on laboratory data. On the other, just because we haven't yet seen T.C.E. cause leukemia doesn't mean it cannot do so.''

Many scientists are engaged in determining the mechanism whereby toxic chemicals such as T.C.E. could trigger cancer.  They assume a two-stage process, begun in a human cell by ''initiators'' and sparked by ''promoters.''

Dr. Frederica P. Perera, of Columbia University's School of Public Health, has a grant from the National Institutes of Health to research the effects of toxic chemicals on deoxyribonucleic acid (D.N.A.), which carries a cell's genetic instructions. She measures chemicals by the ''femtomole,'' roughly equivalent to a million billionths of a cubic inch of water.

According to Dr. Perera, a toxic substance can enter the cell and attach itself to a rung on the ladderlike structure of the D.N.A. She believes that this modified rung, known as an ''adduct,'' may prime the D.N.A. to deliver faulty instructions that turn a normal cell malignant. A promoter, perhaps another foreign substance or toxic chemical, would then encourage the transformation.

Dr. Perera emphasizes the tentative nature of her research. ''We don't know if the adducts actually do harm,'' she says, ''or why certain people might be more susceptible than others to their presence.'' Along with many researchers in the field, however, she believes that the developing cells of children, either in utero or after birth, could be ''especially vulnerable'' to genetic alteration. ON JAN. 18, 1981, AT THE AGE of 12 1/2, Jimmy Anderson died of internal bleeding made worse by aplastic anemia, a side effect of his antileukemia therapy. That same month, the Centers for Disease Control and the Massachusetts Department of Health confirmed an excess incidence of childhood leukemia in Woburn - about twice as large as what would be expected over all, and 7.5 times what would be expected within the half-mile radius of the Anderson home.  Several months later, Dr. Marvin Zelen, chairman of the department of biostatistics at Harvard University's School of Public

Health, heard Bruce Young and Anne Anderson describe the Woburn events at a seminar. He was ''very moved'' by the presentation, he says, but he was also intrigued by ''a fascinating intellectual problem. On the one hand, the kids, the leukemia, the wells. On the other, the legitimate possibility nothing more than chance was involved.''

Dr. Zelen wanted to study the whole public-health picture in Woburn. He reasoned that if the contaminated water caused leukemia, it would also have been likely to have produced other sickness. Beginning in April 1982, and working for close to a year, 300 volunteers organized by F.A.C.E. and trained by Dr. Zelen's staff interviewed 3,257 families.

The family medical histories were correlated with a statistical model of Woburn's municipal water-distribution system. The model developed by the Massachusetts environmental agency showed which Woburn neighborhoods and streets drew most of the water from the G and H wells.

Last February, more than 250 Woburn residents filled Walker Hall at Trinity Church to overflowing to hear the findings of the Harvard study. They were told of ''a consistent pattern of positive associations between availability of water from wells G and H and the incidence of childhood leukemia, perinatal deaths and some birth defects such as cleft palate and Down's syndrome.''

The linking of birth defects to the wells lent new weight to the suspicions about the leukemia cluster, since toxic chemicals have been clearly identified as capable of causing such reproductive effects.

The Harvard study showed that the children who developed leukemia received, on average, twice as much water from the wells as the general Woburn public. It also indicated that, conservatively, the probability of such an association - between the contaminated wells and the leukemic children - occurring by chance is 4 percent, or roughly 20 to 1. The Harvard group later pointed to another suggestive piece of evidence: After wells G and H were closed in 1979, the rate of birth defects dropped markedly.

After hearing Harvard's report, Anne Anderson admitted that she felt somewhat vindicated. But then, leaning her head back on the stone- cold cinder-block wall of the hall, she added: ''It is almost worse to know it was the wells than if they had had nothing to do with it. It means this did not have to happen.''

Despite the report, the case of Woburn is far from closed. For one thing, some experts have challenged the reliability of the model of Woburn's plumbing system and some of Dr. Zelen's research methods. But he stands by his report. ''The aggregate of evidence is overwhelming that the availability of water from these wells is positively associated with adverse health effects,'' Dr. Zelen told the Senate Superfund hearings in April. But even he acknowledges that epidemiological studies, by their nature, cannot categorically prove cause and effect.

It is too late, for example, for researchers to learn the exact quantity of contaminated water ingested or absorbed through the skin of the individual leukemia victims. Nor can scientists prove that T.C.E. or other toxic chemicals were present in wells G and H before the 1979 tests. Glyn Caldwell of the Atlanta center adds the ultimate standard of proof required by traditional science: ''It remains to be shown that if the wells had never existed, there would have been no leukemias.''

There is, however, a new and different approach to demonstrating a connection between toxic chemicals and human disease. Extensive blood tests have been conducted on Anne Anderson, her two living children and seven other East Woburn families. Preliminary results show evidence of unusual damage to the immunological system, weakening the body's ability to fight off disease. According to Dr. Alan S. Levin, an independent researcher working with Massachusetts General Hospital on the project, the Woburn results are consistent with other recent research that reveals similar immunological damage has been caused by some of the same toxic chemicals that appeared in wells G and H. He likens his findings to ''footprints in the snow.'' EACH YEAR, ALL across the country, new clusters crop up. Near San Jose, Calif., a cluster of congenital heart defects is being investigated for a potential relationship to a leaking underground toxic- solvent disposal tank. A brain-cancer cluster has been reported in south Texas near chemical and petrochemical complexes. And while scientists pursue their proofs, hundreds of families are filing lawsuits seeking financial compensation.

The suits are part of a growing national dilemma, the so-called ''toxic-tort'' cases. According to Frank P. Grad, the Columbia University Law School professor who wrote the report of a Congressionally authorized study group created by Superfund, the cases ''present challenges to the legal system for which it is wholly unprepared.'' The problem: How to apply the customary rules of evidence to slippery scientific concepts.

In the last year, two nationally significant toxic-tort cases have been resolved. A Federal district judge in Utah ruled that the Government had been negligent in conducting atomic tests; a settlement of at least $2.66 million was awarded to plaintiffs who claimed that radioactive fallout had led to their cancers. A $180 million settlement was reached in the suit brought by tens of thousands of Vietnam veterans and their families against several chemical companies that sold Agent Orange to the Government; the plaintiffs charged that exposure to the defoliant had led to birth defects, cancers and other illnesses.

In neither case could the plaintiffs demonstrate irrefutably a cause-and-effect relationship between fallout and defoliant, on the one hand, and disease, on the other. In his decision, Utah Judge Bruce S. Jenkins spoke to the difference between probability and fact. ''Dispute resolution,'' he said, ''demands rational decision, not perfect knowledge.''

In the suit brought by eight Woburn families, the defendants are Cryovac, a division of W. R. Grace, which manufactures food-packaging equipment in Woburn, and John J. Riley Company, which operates a tannery and was formerly a division of Beatrice Foods. The companies deny any liability.

Beatrice says that the T.C.E. found in a well on its former property could not have come from the tannery since T.C.E. was not used in the tanning process. Beatrice also insists that the well, where the T.C.E. was discovered, lies downstream from wells G and H and thus could not have polluted them.

W. R. Grace filed a motion to have the leukemia claim dismissed, which has been denied. Mark Stoler, Grace's counsel, says that, according to experts consulted by the company, ''there is absolutely no evidence of a connection between these chemicals and leukemia.'' He asks a crucial question:. ''Can we run a legal system on hypotheticals? If that is the basis of a claim, then everybody in the country has a claim if they incur a cancer.''

The Woburn case is not expected to come to trial until next year.

Meanwhile, several state legislatures, including those of New York and Massachusetts, are considering bills that would provide compensation for adverse health effects linked to toxic waste sites. And Congress continues to debate the establishment of a nationwide victims' compensation plan in connection with Superfund. The House failed to include victims' compensation when it voted last summer to extend the Superfund for five more years. The Senate is expected to continue its debate of Superfund provisions in its new session. Inevitably, discussion has focused on the difficulties of linking cause and effect. Sometimes, according to Senator Kennedy, a proponent of the compensation provision, ''common sense can substitute for a scientific study, and regulatory decisions need not await definitive proof before the anguish of whole communities is responded to.''

Scientists, too, may be responding to community concerns. ''It is out of the question to do a careful study on every waste site,'' says Dr. Zelen, ''but perhaps we can orchestrate a national strategy.'' Part of that strategy might be a turnaround of today's epidemiological approach. ''We may investigate toxic sites to look for clusters,'' says Dr. Caldwell, of the Centers for Disease Control, ''before clusters come looking for us.'' IN 1982, INTENSE LOBBYING by Anne Anderson, the Rev. Bruce Young and other members of For A Cleaner Environment led to the establishment of Massachusetts' first cancer registry. It requires every hospital in the state to report a cancer case within six months of diagnosis.  Prior to the registry, data on cancer incidence depended on death certificates. Jimmy Anderson's certificate reads ''pulmonary hemorrhage'' as primary cause of death. ''That is quite true,'' his mother agrees, fingering a file of papers on her desk, ''but it means that if the state had been counting leukemias in Woburn, Jimmy would never have been counted.''

The new registry attributes leukemia cases to a town only if the victim is living there at the time of diagnosis. Thus, some children who may have developed the disease while living in Woburn are now counted on the rolls of their new towns.  F.A.C.E. maintains that such cases are really Woburn cases. To reflect the cases in dispute, green pushpins are being added to the blue and the red pins on the map of Woburn.