We won't give up, says Ingo Karstens, trying to sound like he's ready for a fight. Still, his words seem more helpless than anything. Sometimes he feels "like Don Quixote," he says, his shoulders drooping a little. It almost seems as if he were worried that fighting would be futile.
A map is lying on Karstens' table. It depicts the Wilstermarsch, a completely flat, barren stretch of land on the north bank of the Elbe River, in northwestern Germany. On it, you can also see the 14 municipalities that make up the district, including Wewelsfleth, of which Karstens is the mayor.
The color scale on the map ranges from dark gray to dark red. Gray signifies that everything is alright, while red means that something is wrong. The large, orange area on the eastern end of the Wilstermarsch is Wewelsfleth. The map illustrates the incidence of cancer in the region. People living in Wewelsfleth are 50 percent more likely to have cancer than people in other communities in the northern German state of Schleswig-Holstein. Between 1998 and 2008, some 142 new cases were reported in Wewelsfleth, as compared with the 95 cases that would have been expected based on state averages. This is what statisticians call "significant."
Searching for Possible Causes
Wewelsfleth is a village with a population of 1,500 people, a supermarket, a brass band and the Alfred Döblin House, which is relatively well known since the German writer Günter Grass lived and wrote there for many years. Karstens has been the mayor of Wewelsfleth for 14 years.
Karstens moved to the village from a neighboring community in 1967. A decade ago, his wife died of lung cancer at only 61. Since Karstens knew other Wewelsfleth residents who had also died of cancer at a relatively young age, he turned to the state government for answers. He wanted to know whether there was a reason for his wife's early death. After all, it's presumably easier to cope with death when one knows what caused it.
Three nuclear power plants stand in Wewelsfleth's immediate vicinity. One is in the neighboring community of Brokdorf, four kilometers (2.5 miles) to the west, the direction from which the wind usually blows. The Brunsbüttel Nuclear Power Plant lies on the bank of the Elbe River, a few kilometers downstream. The third plant is in Stade, on the other side of the river. One might think that having three nuclear power plants nearby is the obvious answer to the question of why cancer rates are so high in the region. But that wasn't the case.
A study conducted by researchers at the nearby University of Lübeck searched for anomalies related to a number of factors, including age and gender distribution. The study cites cases of esophageal cancer, stomach cancer, lung cancer and a few other types of cancer in Wewelsfleth. The experts examined possible causes, such as the proximity of the nuclear power plant in Brokdorf, the shipyard in Wewelsfleth, where toxic spray paints were once used, asbestos and the use of pesticides in farming. It also looked into whether Wewelsfleth residents were particularly heavy smokers. The study returned no clear findings, no probable cause, nothing.
Of course, since they are more afraid of cancer, it's possible that people in Wewelsfleth are also just more likely to get tested for cancer. This is called the "screening effect," and it describes how people searching for certainty often end up creating more uncertainty.
Karstens opens the door to a small balcony and walks outside. His office window looks out over green meadows and, farther off, the Brokdorf cooling towers. There is apparently no evidence that nuclear power is to blame for cancer. Nevertheless, is there any evidence that it isn't?
After the disaster at Japan's Fukushima nuclear power plant in March 2011, even the German government decided to phase out all nuclear energy by 2022 because it couldn't guarantee that nuclear power wasn't dangerous. Since then, the Brunsbüttel and Stade plants have been shut down. But some wonder whether the Brokdorf plant shouldn't be shut down more quickly.
For Karstens, the situation presents two major questions: How much uncertainty can a politician be held responsible for? And how much uncertainty can people tolerate?
Karstens can cite a case of cancer corresponding to every house on his street. Indeed, in Wewelsfleth, the "Why me?" question every cancer patient asks himself has become "Why us?" The disease no longer appears to be brought on by fate. These days, it feels more like a curse.
Of course, the residents of Wewelsfleth can change things by moving or modifying their behavior. But doing so would, of course, first require knowing what they're supposed to change. Then again, one could also eliminate all factors as a precaution: nuclear power, smoking, alcohol, the shipyard.
Impotent to Act
A few days ago, Karstens and some other village residents drove to Kiel, the state capitol, to deliver a petition. They had an appointment at the state health ministry, where they were greeted with expressions of concern.
But then there was silence -- because the officials didn't know what to say.
Karstens and his neighbors want another study to be conducted, one that specifically focuses on Wewelsfleth. But experts say that 142 cancer cases aren't enough to make the results of a study statistically significant. In other words, the people of Wewelsfleth will have to get used to the idea that a highly localized incidence of disease could also just be a coincidence -- and that there's nothing logical or fair about this disease.
After his wife died, Karstens decided to stay in Wewelsfleth. People who grow up in the area tend to not move away. A few years later, he met another woman.
In early December 2009, this woman was also diagnosed with cancer. In fact, it was so advanced that she wasn't even allowed to leave the hospital.