Post on 27-Dec-2015
Health Consultation: Evaluation of Cancer Incidence in Census Tracts
of Attleboro and Norton, Massachusetts: 1982-2002
Suzanne K. CondonAssociate Commissioner
Jan Sullivan, DirectorCommunity Assessment Program
MA Department of Public HealthCenter for Environmental Health
January 2007
Presentation Outline
Introduction and background Methods Results Conclusions Questions and Discussion
Center for Environmental Health (CEH)
Protect the public health from a variety of environmental exposures
Respond to environmental health concerns and provide communities with epidemiologic and toxicological health assessments
Community Assessment Program (CAP)
Evaluate frequency and patterns of disease in the population
Respond to concerns about disease patterns or “clusters”
Investigate possible associations between environmental exposure and disease
ATSDR
Agency for Toxic Substances and Disease Registry
Within the U.S. Centers for Disease Control MDPH has a cooperative agreement with
ATSDR to conduct Health Consultations in MA
Reason for Investigation
Concerns about cancer incidence in Norton and Attleboro, particularly in neighborhoods near the Shpack Landfill
Requested by concerned residents
Background
1989: Preliminary Health Assessment of Shpack Landfill
1993: Site Review and Update 2001: Evaluation of Female Lung Cancer Incidence
and Radon Exposure in Attleboro for 1982-1994 2002: Phase I: Evaluation of Cancer Incidence in
Attleboro and Norton, 1994-1998 2006: Cancer Incidence in Census Tracts of
Attleboro and Norton: 1982-2002
Health Consultation (HC)
A review of available health outcome data (cancer incidence data) associated with a site where hazardous substances have been released.
Evaluation of Cancer Data
Calculate cancer rates for each town and by smaller areas (census tracts)
Evaluate geographic patterns of cancer in each town
Evaluate patterns of cancer in relation to Shpack Landfill
Evaluate available cancer risk factor information
Massachusetts Cancer Registry (MCR)
Population-based surveillance system established in 1982
Massachusetts law requires reporting of all newly diagnosed primary cancers in MA residents
Confidential database
MCR (cont’d)
At the time of this report, statewide and city/town data were complete through 2002– (Data for 2003 were recently released)
Diagnoses reported to the MCR after 2003 are available for review
13 Cancer Types Evaluated
Hodgkin’s disease Leukemia Non-Hodgkin’s lymphoma Multiple myeloma Cancers of the bladder, bone, brain and
central nervous system (CNS), breast, kidney, liver, lung, pancreas, and thyroid
Cancer data evaluated
Cancer rates for 4 time periods– 1982-1987– 1988-1993– 1994-1999– 2000-2002
Statistical Methods
Standardized Incidence Ratio
95% Confidence Interval
100#
#x
casesofExpected
casesofObservedSIR
Geographic Distribution Analysis
Map locations of residences reported at time of cancer diagnosis
Evaluate spatial patterns of cancer in neighborhoods within each community
Evaluate patterns of cancer in relation to Shpack Landfill
Risk Factor Information
Age Smoking Occupation
Other risk factors– Genetics, family history– Lifestyle factors
Summary of Community-Wide Findings
With some exceptions, the majority of cancer types occurred at or near expected rates in Attleboro and Norton during 1982-2002
Six of 13 cancer types occurred at or near expected rates in both towns and in their census tracts across all time periods (bone, kidney, leukemia, multiple myeloma, NHL, and pancreas)
Summary of Community-wide Findings
At some point in time, six of 13 cancer types were statistically significantly elevated either in Attleboro, Norton, or in one of their census tracts– In Attleboro: Hodgkin’s disease and cancers of
the bladder, breast, liver, and thyroid– In Norton: brain
Except for lung cancer, the elevations did not persist over time
Lung Cancer in Attleboro
Lung cancer was statistically significantly elevated in Attleboro females during 1988-1993 and in Attleboro males during 1994-1999
Lung Cancer Risk Factors
Age Smoking Second-hand smoke Occupation/environmental exposures
Review of Risk Factors: Lung Cancerin Attleboro Females 1988-1993
Age distribution did not appear unusual– 89% were age 50 or older– Average age was 66
Known Smoking History: Lung Cancer
Smoking History of Females with Lung Cancer in Attleboro, 1988-1993
88%
12%
0%
20%
40%
60%
80%
100%
Smoking History
% o
f ca
ses
wit
h
kn
own
sm
okin
g h
isto
ry
Current/Former Smoker Non-smoker
Review of Risk Factors: Lung Cancerin Attleboro Males 1994-1999
Age distribution did not appear unusual– 94% were age 50 or older– Average age was 67
Known Smoking History: Lung Cancer
Smoking History of Males with Lung Cancer in Attleboro, 1994-1999
89%
11%
0%
20%
40%
60%
80%
100%
Smoking History
% o
f ca
ses
wit
h
kn
own
sm
okin
g h
isto
ry
Current/Former Smoker Non-smoker
Attleboro CT 6317
Cancer Type
Rate < or About As Expected
Rate > Expected Rate Statistically Significantly > Expected
Bladder 1982-1987, 1994-1999, 2000-2002
1988-1993
Bone 1982-2002
Brain & CNS
1982-2002
Breast 1982-1987, 1994-1999, 2000-2002
1988-1993
Hodgkin’s 1982-2002
Kidney 1982-2002
Attleboro CT 6317
Cancer Type
Rate < or About As Expected
Rate > Expected Rate Statistically Significantly > Expected
Leukemia 1982-2002
Liver 1982-2002
Lung 1982-2002
Multiple Myeloma
1982-2002
Attleboro CT 6317
Cancer Type Rate < or About As Expected
Rate > Expected Rate Statistically Significantly > Expected
NHL 1982-1987, 1994-1999, 2000-2002
1988-1993
Pancreatic 1982-2002
Thyroid 1982-2002
Review of Breast Cancer Risk FactorsAttleboro CT 6317, 1988-1993
Age patterns were as expected– 82% were over 50 at diagnosis compared to 80%
statewide
Stage at diagnosis similar to statewide experience– 66% of Attleboro women were diagnosed at
earliest stage compared to 62% statewide
Norton CT 6112
Cancer Type Rate < or About As Expected
Rate > Expected Rate Statistically Significantly > Expected
Bladder 1982-2002
Bone 1982-2002
Brain & CNS 1982-1999 2000-2002
Breast 1982-2002
Hodgkin’s 1982-2002
Norton CT 6112
Cancer Type Rate < or About As Expected
Rate > Expected Rate Statistically Significantly > Expected
Kidney 1982-1987, 1994-1999, 2000-2002
1988-1993
Leukemia 1982-2002
Liver 1982-2002
Lung 1982-1987, 1994-1999, 2000-2002
1988-1993
Norton CT 6112
Cancer Type Rate < or About As Expected
Rate > Expected Rate Statistically Significantly > Expected
Multiple Myeloma
1982-2002
NHL 1982-1987, 1994-2002
1988-1993
Pancreatic 1982-1987, 1994-2002
1988-1993
Thyroid 1982-2002
Brain & CNS Cancer in Norton
Brain cancer occurred about as expected in males and females in all time periods except the most recent
In CT 6112 in 2000-2002, 5 diagnoses were observed in males versus 1 expected
Review of Brain Cancer Risk FactorsNorton CT 6112, 2000-2002
Age and gender patterns were as expected– More diagnoses among males, as expected– Average age at diagnosis was 66 years– 4 of 5 males were > 50 years old at diagnosis
The subtypes of brain cancer reported were as expected– 4 of 5 brain cancers were of glioma subtype, the
most common form of adult brain cancer
Within one-mile radius of Shpack Landfill
From 1982 to present, 35 different cancer types diagnosed among 208 individuals
Most common diagnoses (>60%) were lung & bronchus, breast, prostate, and colo-rectal cancer; consistent with statewide trends (54-58%)
Age pattern as expected (78% were age 50 or greater at diagnosis)
Within one-mile radius of Shpack Landfill
No unusual spatial or temporal patterns in cancer incidence or in types of cancer diagnosed within one-mile radius of Shpack Landfill
Within one-mile radius of Shpack Landfill
For those 74 individuals with a cancer type for which smoking is a risk factor and whose smoking history was reported, 62% were current or former smokers.
An evaluation of the spatial distribution of the nonsmokers’ residences did not show any unusual patterns.
Summary of Major Findings
Some elevations in cancer types occurred in some census tracts during certain time periods, in both Attleboro and Norton, but no consistent patterns were seen with respect to time with one exception.
Lung cancer was elevated in Attleboro over two time periods.
Risk Factor Analysis Summary
Age and gender patterns in both towns were similar to statewide and national patterns
Smoking likely played a role in the incidence of some cancer types in both communities
Summary of Spatial Patterns of Cancer
No apparent spatial patterns at the neighborhood level were seen that would suggest a common factor related to the cancer diagnoses
No unusual geographic concentrations of individuals diagnosed with cancer near Shpack Landfill
Recommendations
Exposure opportunities will be evaluated in the Public Health Assessment.
Cancer incidence can be further evaluated at that time to assess if any unusual patterns exist in relation to environmental exposure opportunities.
Upon request, MDPH’s Environmental Health Education and Outreach Program will prepare educational materials on cancer risk reduction.
Next Steps
30-day public comment period Response to public comments Release final Health Consultation
Questions and Answers
How to contact MDPH
Suzanne K. Condon, Associate CommissionerJan Sullivan, Director, Community Assessment Program
Massachusetts Department of Public HealthCenter for Environmental Health250 Washington Street, 7th floor
Boston, MA 02108
Telephone: (617) 624-5757Fax: (617) 624-5777www.mass.gov/dph
Contact Information
The full report is available at:
http://www.mass.gov/dph/ceh