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San Sebastian et al1 reported an overall excess for all cancers in San Carlos, Ecuador (standardised incidence ratio (SIR) 2.26; 95% CI 0.97 to 4.46 for males), and an increased mortality due to cancers in males (standardised mortality ratio (SMR) 3.6; 95% CI 1.31 to 7.81). The authors concluded that there was an excess of cancer cases among the villagers linked to environmental pollutants stemming from oil production activities.
Since clusters present many epidemiological biases, the Centers for Disease Control issued a set of guidelines2 in 1990 to investigate clusters. Under those guidelines, we reviewed the cluster of cancer …
Competing interests: AA and FA are partners of Risk Management Resources that provides consultancy to Chevron, an oil Production Company with business in Ecuador in the past.
Risk Management Resources has a contractual agreement in which Risk Management Resources has complete control of the content of the publication as well as of the journal of choice for submission. AA and FA have read and approved all versions of the manuscript, its content and its submission to this journal.