Breast cancer, dizziness, headaches: El Paso residents ask if a warehouse’s toxic emissions are to blame

Maria was ecstatic when Cardinal Health, a leading medical device manufacturer, employed her as an accountant in 2014. As her first position after graduating, securing a job with a multinational organization was a significant achievement. For the subsequent year, she operated in the firm’s El Paso warehouse, where sterilized medical supplies were received and distributed to hospitals nationwide. 

Upon moving on to a role at a prominent accounting firm, she cherished her time at Cardinal. Her colleagues were warm and encouraging, and she appreciated the company for launching her career. Throughout the next decade, as she relocated to Seattle and advanced in her corporate role, she remained unaware that she had been exposed to ethylene oxide, a hazardous chemical used for sterilizing medical devices, during her tenure at the Cardinal warehouse.

While extensive peer-reviewed studies have associated ethylene oxide with breast and lung cancers, pinpointing individual cancer cases to this exposure remains challenging. Nevertheless, a Grist investigation modeling self-reported emissions from Cardinal Health’s El Paso warehouses revealed that at least one facility had emissions surpassing legal limits. The findings suggested that these warehouses expose roughly 90% of the local population to a cancer risk greater than 1 in 1 million — the figure the Environmental Protection Agency aims to keep most people below — while individuals nearest the warehouses might face risks of up to 1 in 5,000.

In February 2023, nearly ten years after her departure from Cardinal, Maria discovered a lump in her breast. Alarmed, she promptly consulted her gynecologist, leading to a mammogram, ultrasound, and biopsy. These tests revealed stage 3 triple-negative breast cancer. The aggressive nature of her cancer indicated it might have been developing for a significant period, posing a mystery as she had no family history of the disease and was also tested negative for BRCA gene mutations, which typically signify a lower risk.

The cause of her illness haunted her and remained uncertain, dramatically altering her life. Over the subsequent months, she underwent chemotherapy and immunotherapy, including 15 rounds of radiation. By the fall of 2023, she had a unilateral mastectomy. Throughout her journey, she struggled to understand how a healthy woman in her early 30s without any family history of breast cancer could be facing such an aggressive diagnosis. Initially, she blamed herself, recalling a moment in a grocery store when she broke down after choosing unsalted almonds to manage her sodium levels. 

“I thought, ‘What good did that do me?’ I got sick anyway,” she reflected. “It was truly difficult — realizing that I tried to prioritize my health, and it still happened.”

Earlier this year, her partner discovered the Grist article and shared it with her. For the first time, Maria learned about the dangerous chemical, now believing there might be a connection to her illness. She found out that following her departure from Cardinal, as new scientific studies emerged, the federal Environmental Protection Agency had revised its toxicity assessments, concluding that ethylene oxide was 30 times more toxic to adults than previously recognized. The agency linked the chemical to cancers of the breast and lungs. 

“It was an ‘Oh my gosh’ moment,” Maria recalled, “Obviously, we can’t know for certain, but prior to this, we were completely in the dark about the cause. Now I feel like a light has been shone on it — this could indeed be the reason.” (Maria requested that only her middle name be used.)

Richard Peltier, a researcher in environmental health at the University of Massachusetts Amherst, noted, “While there’s no direct causality established, Maria’s exposure at an ethylene oxide-emitting facility aligns with the profile one might anticipate from such exposure.”

“Witnessing triple-negative breast cancer in a 30-year-old is an extreme outcome for a generally healthy individual,” he added.

Approximately 90 medical sterilization facilities in the U.S. use ethylene oxide to process medical devices. After products leave these sites, they emit some residual ethylene oxide. As they linger in storage awaiting transit to hospitals, they continue to release the chemical. Consequently, thousands of workers in sterilization, warehousing, and trucking, along with residents in nearby communities, face some level of exposure to this toxic substance. 

Many individuals are left questioning if the cancer incidents within their communities have ties to ethylene oxide exposure. In Illinois, residents near sterilization plants have filed lawsuits against companies for air pollution, winning multimillion-dollar judgments and settlements. In Georgia, a jury granted $20 million to a truck driver for unknowingly being exposed to ethylene oxide. In Puerto Rico’s Salinas, researchers have initiated a longitudinal study to investigate potential links between elevated cancer rates in neighborhoods and emissions from nearby sterilization facilities.

In El Paso, many residents on John Phelan Drive, located directly behind another one of Cardinal Health’s warehouses, were largely unaware of the ethylene oxide emissions a few hundred feet from their homes. A Grist analysis indicated that these residents face a cancer risk of 2 in 10,000, meaning if 10,000 individuals were exposed to the emissions, two might develop cancer. The EPA’s acceptable threshold is 1 in 10,000, and experts contend that even this level might be excessively lenient.

Numerous homeowners on John Phelan Drive informed Grist and El Paso Matters that they have developed allergies and respiratory issues in recent years, frequently experiencing headaches and dizziness, yet it remains unclear if these symptoms are due to ethylene oxide emissions or other factors.

Maria Garcia, a 63-year-old resident on John Phelan Drive since 2001, reported persistent headaches and dizziness over the past year and is uncertain of the cause. Despite seeking treatment for symptoms potentially linked to women’s health concerns, she suspects that the facility behind her home may be a contributing factor. 

“I always thought I was very healthy. I donate blood and try to take care of myself. However, I have experienced increased dizziness lately, in the past year or so,” said Garcia. 

The middle-class neighborhood on the eastern side of El Paso overlooks a major business park filled with logistics companies, but Cardinal Health’s warehouse stands as one of the closest structures to their residences. It’s a tranquil area with a close-knit community; Garcia has participated in the neighborhood watch, and her children used to help erase graffiti from the rock walls at nearby McCarthy Park.

Garcia mentioned that taking walks around the neighborhood with her neighbor has become difficult; often, they find themselves turning back due to headaches that set in after just a few minutes outdoors.

“The dizziness is very concerning,” she expressed.

Another resident on the same street, Fernando Hernandez, reported developing allergy-like symptoms over the past few years. He is curious if the ethylene oxide emissions from the facility are responsible for respiratory issues among neighbors or harming backyard plants, as trees and grass have withered in multiple backyards adjacent to the warehouse. 

“I want answers, because I’ve been experiencing allergies every morning,” Hernandez remarked.

Other residents have echoed similar stories, reporting headaches or feelings of dizziness. While exposure to EtO might lead to such symptoms, they are contingent on the intensity of exposure, according to Susan Buchanan, a clinical associate professor of environmental and occupational health sciences at the University of Illinois Chicago. 

“They could experience symptoms if the exposure levels are sufficiently high,” Buchanan stated in an interview, adding that she hasn’t previously encountered ethylene oxide exposure at levels severe enough to prompt significant reactions in communities near facilities employing EtO. “Typically, it’s the workers who experience the highest exposure,” she noted. She also expressed concerns that the emission allowances for EtO in many states are outdated compared to contemporary medical insights concerning exposure risks.

“Numerous facilities are permitted to emit levels that pose risks to local residents,” Buchanan emphasized. “Exposure to ethylene oxide is associated with an increased cancer risk.”

Richard Richter, a spokesperson for the Texas Commission on Environmental Quality, stated that Cardinal’s warehouses have state permits, ensuring that “off-property impacts from ethylene oxide were assessed to confirm compliance with all state and federal regulations that protect human health and the environment.” Facilities operating within these guidelines “should not adversely affect health or welfare through exposure to emitted chemicals,” he added.

Cardinal Health did not respond to multiple requests for comment.

The Environmental Protection Agency, under President Joe Biden, enacted a 2024 rule compelling sterilization facilities nationwide to significantly curtail ethylene oxide emissions through the installation of pollution controls. However, this regulation did not apply to off-site warehouses like those utilized by Cardinal Health in El Paso, yet represented initial steps toward regulating ethylene oxide emissions from the medical sector. 

In July, however, President Trump allowed sterilization firms an additional two years to adhere to the rule, arguing that the Biden administration’s regulation would impose “severe burdens” on such companies and threaten the supply chain of medical equipment.

An EPA spokesperson noted that the Clean Air Act authorizes presidential exemptions for facilities lacking available technology for implementing standards, and if such exemptions align with national security interests. The agency is reassessing sterilization regulations.

One facility potentially affected by stricter regulations was Sterigenics in Santa Teresa, New Mexico, which lies just west of El Paso. New Mexico’s attorney general filed a lawsuit against the company in 2020, claiming excessive ethylene oxide emissions affecting surrounding areas.

Aaron Szabo, whom Trump appointed to lead the EPA’s air quality office, previously lobbied for the sterilization industry.

“Their focus is on minimizing standard enforcement,” Buchanan stated concerning the Trump administration’s stance. “It is evident they prioritize economic development over environmental protection.”

With federal protections lacking, residents and workers have sought legal remedies. In the case of Gary Walker, a truck driver in Georgia who succeeded in a lawsuit against a sterilization company, the jury recognized that his ethylene oxide exposure while transporting sterilized goods linked him to non-Hodgkin lymphoma. Walker’s attorney, Michael Geoffroy, noted that they carefully select cases where scientific research supports the claims of clients who have experienced cancer types linked to ethylene oxide.

“We have established minimum exposure criteria,” remarked Geoffroy. “Countless clients have developed cancers known to be associated with ethylene oxide, yet we refrain from taking on cases when we cannot definitively ascertain the exposure amounts or provide sufficient evidence for scientists to support that ethylene oxide contributed meaningfully to their cancers.”

Maria, the former accountant at Cardinal Health, is currently in remission following her mastectomy. While she fears a recurrence of cancer, she finds solace in having at least one plausible explanation for her diagnosis. Her newfound awareness of the ethylene oxide emissions from the facility has “tainted” what was otherwise a hopeful experience. “It’s a complex mix of emotions,” she said.

We have produced an informational resource — available in English and Spanish — alongside community organizations, nonprofits, and residents advocating for more stringent EtO regulations for years. This guide includes crucial facts about EtO, strategies for engaging local authorities regarding emissions, legal resources, and additional information. You can view, download, print, and share it here.

If you are a local journalist or community member interested in understanding our investigative approach to this issue and exploring how you can identify potential EtO-emitting warehouses in your area, read this.