Invisible Threat, Inequitable Impact
The commonwealth of Puerto Rico bears a disproportionate burden of EtO pollution from commercial sterilizers. Only California and Texas, the two most populous states, have more sterilizers, even though Puerto Rico has roughly one-tenth the population of Texas and 1 percent of its land area.
Puerto Rico has seven commercial sterilizers. The EPA has identified four as contributing to elevated cancer risks: Edwards Lifesciences Technology SARL in Añasco, Customed in Fajardo, Steri-Tech in Salinas, and Medtronic in Villalba (EPA 2022i; EPA 2022j; EPA 2022k; EPA 2022l). All four sterilize medical equipment.
The maximum excess cancer risk levels from facility-specific EtO emissions range from 800 to 6,000 cases per 1 million people. The sterilizers in Añasco and Salinas have the highest excess cancer risk levels from EtO emissions (5,000 and 6,000 cases per 1 million, respectively) among all 23 elevated-risk sterilizers identified by the EPA. In 2021, the Añasco and Salinas sterilizers reported releasing 1,089 and 547 pounds of EtO, respectively. Indeed, EtO emissions from these sterilizers contribute to a high overall air toxics cancer risk in these communities. In the census tracts where the Añasco and Salinas sterilizers are located, the air toxics cancer risks are 200 and 400 cases per 1 million people, respectively. EtO emissions account for 96 and 91 percent of the overall cancer risk in these respective census tracts (AirToxScreen 2022).
In all, the seven sterilizers are within five miles of more than 413,000 Puerto Ricans (roughly 13 percent of the commonwealth's population) and nearly 300 schools and childcare centers (US Census Bureau 2020). Puerto Rico has a very high proportion of Latino residents, with people of color making up 99 percent of the population within five miles of these sterilizers.