Bureau of Environmental Health Assessment Massachusetts Department of Public Health February 13,...

Bureau of Environmental Health AssessmentBureau of Environmental Health Assessment

Massachusetts Department of Public HealthMassachusetts Department of Public Health

February 13, 2002February 13, 2002

Public Meeting:MDPH Activities in South Weymouth

and Neighboring Communities

Public Meeting:MDPH Activities in South Weymouth

and Neighboring Communities

Bureau of Environmental Health AssessmentBureau of Environmental Health Assessment

Massachusetts Department of Public HealthMassachusetts Department of Public Health

February 13, 2002February 13, 2002

Assessment of Cancer Incidence in Rockland, Weymouth, Abington,

and Hingham, MA 1982-1998

Assessment of Cancer Incidence in Rockland, Weymouth, Abington,

and Hingham, MA 1982-1998

Massachusetts Department of Public Health, Bureau of

Environmental Health Assessment3

Reason for InvestigationReason for Investigation

Concerns about increased cancer near Concerns about increased cancer near the NASthe NAS

Requests by: Requests by: Senator Michael Morrissey, Senator Michael Morrissey, Weymouth Board of Health, andWeymouth Board of Health, and Concerned residents in Rockland, Concerned residents in Rockland,

Weymouth, Abington, and HinghamWeymouth, Abington, and Hingham



Community Cancer ConcernsCommunity Cancer Concerns

Suspected increases in cancer in the four Suspected increases in cancer in the four townstowns

Possible link to environmental Possible link to environmental contamination present at NAScontamination present at NAS

Suspected increases in cancer in other areas Suspected increases in cancer in other areas of the four towns unrelated to NASof the four towns unrelated to NAS



Investigative ApproachInvestigative Approach

Calculate cancer rates for each town and by Calculate cancer rates for each town and by smaller areas (census tracts) smaller areas (census tracts)

Evaluate available cancer risk factor Evaluate available cancer risk factor informationinformation

Evaluate geographic patterns of cancer in each Evaluate geographic patterns of cancer in each towntown

Evaluate patterns of cancer in relation to Evaluate patterns of cancer in relation to environmental sources (particularly NAS)environmental sources (particularly NAS)



Massachusetts Cancer RegistryMassachusetts Cancer Registry

Population-based surveillance system Population-based surveillance system established in 1982established in 1982

Massachusetts law requires reporting of all Massachusetts law requires reporting of all newly diagnosed primary cancers in Mass. newly diagnosed primary cancers in Mass. residentsresidents

Confidential databaseConfidential database



Eight Cancer Types EvaluatedEight Cancer Types Evaluated

BladderBladder BrainBrain KidneyKidney LeukemiaLeukemia LiverLiver

LungLung Non-Hodgkin’s Non-Hodgkin’s

Lymphoma (NHL)Lymphoma (NHL) PancreasPancreas



Cancer Data Evaluated Cancer Data Evaluated

1982-1998 1982-1998

Three smaller time periods Three smaller time periods 1982-1986 1982-1986 1987-19941987-1994 1995-19981995-1998



Statistical MethodsStatistical Methods

Standardized Incidence RatioStandardized Incidence Ratio

Observed # of casesObserved # of casesSIR = SIR = x 100 x 100

Expected # of casesExpected # of cases

95% Confidence Interval95% Confidence Interval



Summary of Major FindingsSummary of Major Findings

The majority of cancer types evaluated occurred at The majority of cancer types evaluated occurred at or near the expected rates in the four towns and in or near the expected rates in the four towns and in their census tractstheir census tracts

Lung cancer was statistically significantly Lung cancer was statistically significantly elevated in three of the four townselevated in three of the four towns



Summary of Major FindingsSummary of Major Findings

In Weymouth, leukemia and pancreatic cancer In Weymouth, leukemia and pancreatic cancer were statistically significantly elevated in some were statistically significantly elevated in some time periodstime periods

Some isolated elevations in cancer types occurred Some isolated elevations in cancer types occurred in some census tracts during certain time periodsin some census tracts during certain time periods



Statistically Significant FindingsStatistically Significant Findings

Lung cancer elevated in Weymouth, Lung cancer elevated in Weymouth, Abington, and RocklandAbington, and Rockland

Lung cancer lower than expected in Lung cancer lower than expected in HinghamHingham

Pancreatic cancer elevated in Weymouth Pancreatic cancer elevated in Weymouth during 1982-1986during 1982-1986

Leukemia elevated in Weymouth during Leukemia elevated in Weymouth during 1987-19941987-1994



Lung Cancer Incidence in Weymouth, MA

Lung Cancer Incidence in Weymouth, MA

Lung Cancer SIRs in Weymouth by Time Period

134*

115*115

90

100

110

120

130

140

150

1982-1986 1987-1994 1995-1998

Time Period

SIR



Lung Cancer Incidence inRockland, MA

Lung Cancer Incidence inRockland, MA

Lung Cancer SIRs in Rockland by Time Period

179*

11798

65

85105

125

145

165185

205

225

1982-1986 1987-1994 1995-1998

Time Period

SIR



Lung Cancer Incidence inAbington, MA

Lung Cancer Incidence inAbington, MA

Lung Cancer SIRs in Abington by Time Period

119111

138*

85

105

125

145

165

185

1982-1986 1987-1994 1995-1998

Time Period

SIR



Lung Cancer Incidence inHingham, MA

Lung Cancer Incidence inHingham, MA

Lung Cancer SIRs in Hingham by Time Period

69*77*

95

45

55

65

75

85

95

105

115

125

1982-1986 1987-1994 1995-1998

Time Period

SIR



Factors ConsideredFactors Considered

Cancer may be caused by one or many Cancer may be caused by one or many different factors different factors

Review of MCR data on cancer risk factors Review of MCR data on cancer risk factors age/genderage/gender smoking historysmoking history occupationoccupation



Lung Cancer Risk FactorsLung Cancer Risk Factors

AgeAge Smoking Smoking Second-hand smokeSecond-hand smoke Occupation/environmental exposuresOccupation/environmental exposures



Review of Risk Factors:Lung Cancer

Review of Risk Factors:Lung Cancer

Age and gender patterns did not appear Age and gender patterns did not appear unusualunusual

Workplace exposures may have played a Workplace exposures may have played a role in some diagnosesrole in some diagnoses

Majority of those with lung cancer were Majority of those with lung cancer were current or former smokerscurrent or former smokers



Smoking History: Lung CancerSmoking History: Lung Cancer

Smoking History of Individuals with Lung Cancer in Weymouth, 1982-1998

74%

5%

21%

0%

10%20%

30%

40%50%

60%

70%80%

Smoking History

% o

f al

l cas

es

Current/Former Smoker Non-smoker Unknown




Smoking History of Individuals with Lung Cancer in Weymouth, 1982-1998

94%

6%0%

20%

40%

60%

80%

100%

Smoking History

% o

f ca

ses

wit

h kn

own

smok

ing

hist

ory

Current/Former Smoker Non-smoker




Smoking History of Individuals with Lung Cancer in Rockland, 1982-1998

74%

3%

23%

0%

10%20%

30%

40%50%

60%

70%80%

Smoking History

% o

f al

l cas

es





Smoking History of Individuals with Lung Cancer in Rockland, 1982-1998

96%

4%0%

20%

40%

60%

80%

100%

Smoking History

% o

f ca

ses

wit

h k

now

n

smok

ing

his

tory

Current/Former Smoker Non-smoker



Cancer Rates by Census TractCancer Rates by Census Tract

SIRs were also calculated for the census SIRs were also calculated for the census tracts that subdivide each of the four townstracts that subdivide each of the four towns 8 CTs in Weymouth8 CTs in Weymouth 3 CTs in Abington3 CTs in Abington 3 CTs in Hingham3 CTs in Hingham 2 CTs in Rockland2 CTs in Rockland

Lung Cancer Incidence1982-1986

rate = or < expected

rate > expected

rate statistically significantly > expected



rate > expected




Pancreatic Cancer Incidence in Weymouth, MA

Pancreatic Cancer Incidence in Weymouth, MA

Pancreatic Cancer SIRs in Weymouth by Time Period

149*

72101

45

6585

105

125

145165

185

205

1982-1986 1987-1994 1995-1998

Time Period

SIR

Pancreatic Cancer Incidence1982-1986


rate > expected




Review of Risk Factors:Pancreatic Cancer

Review of Risk Factors:Pancreatic Cancer

Age patterns were as expectedAge patterns were as expected More women than men were diagnosed More women than men were diagnosed

with pancreatic cancer with pancreatic cancer Workplace exposures possibleWorkplace exposures possible Smoking may have played an important Smoking may have played an important

role for some individualsrole for some individuals



Smoking History: Pancreatic CancerSmoking History: Pancreatic Cancer

Smoking History of Females with Pancreatic Cancer in Weymouth, 1982-1986

42%

29% 29%

0%

10%

20%

30%

40%

50%

Smoking History

% o

f al

l cas

es




Leukemia Incidence in Weymouth, MALeukemia Incidence in Weymouth, MA

Leukemia SIRs in Weymouth by Time Period

87

149*

104

50

70

90

110

130

150

170

190

1982-1986 1987-1994 1995-1998

Time Period

SIR

Leukemia Incidence1987-1994


rate > expected




Review of Risk Factors: LeukemiaReview of Risk Factors: Leukemia

Age and gender patterns did not appear Age and gender patterns did not appear unusualunusual

A variety of different leukemia subtypes A variety of different leukemia subtypes were reportedwere reported

Workplace exposures may have played a Workplace exposures may have played a role in some diagnosesrole in some diagnoses



Evaluation of Geographic Distribution

Evaluation of Geographic Distribution

Place of residence at time of diagnosis was Place of residence at time of diagnosis was mapped for each individual mapped for each individual

Patterns of individuals diagnosed with Patterns of individuals diagnosed with cancer were evaluated spatiallycancer were evaluated spatially

Other factors that may indicate a cluster Other factors that may indicate a cluster were consideredwere considered



Community Environmental Concerns

Community Environmental Concerns

Naval Air StationNaval Air Station Potentially hazardous waste sites (21E sites)Potentially hazardous waste sites (21E sites) Weymouth Neck LandfillWeymouth Neck Landfill Specific community environmental Specific community environmental

concerns in Weymouth and Hinghamconcerns in Weymouth and Hingham Suburban Auto and two landfills in Suburban Auto and two landfills in

RocklandRockland



Sources of Environmental Information

Sources of Environmental Information

ATSDR Public Health AssessmentATSDR Public Health Assessment Environmental Baseline StudyEnvironmental Baseline Study ATSDR Private Well SurveyATSDR Private Well Survey Modeled Flight Track PatternsModeled Flight Track Patterns Recent Investigations in NW corner of NASRecent Investigations in NW corner of NAS



Summary of Geographic Distribution Analysis

Summary of Geographic Distribution Analysis

With the exception of lung cancer, no consistent With the exception of lung cancer, no consistent spatial patterns were observed in any one area of spatial patterns were observed in any one area of the four townsthe four towns

The geographic pattern of cancer did not show a The geographic pattern of cancer did not show a clear pattern suggesting a common environmental clear pattern suggesting a common environmental exposure related to the NASexposure related to the NAS

Patterns of cancer near other areas of community Patterns of cancer near other areas of community environmental concern were not atypicalenvironmental concern were not atypical



rate > expected




ConclusionsConclusions

Majority of cancer types occurred at or near the Majority of cancer types occurred at or near the expected rates in the four towns between 1982-1998expected rates in the four towns between 1982-1998

Lung cancer is increasing in Weymouth and Rockland, Lung cancer is increasing in Weymouth and Rockland, particularly in CTs near the NASparticularly in CTs near the NAS

Evaluation of risk factors showed smoking likely played Evaluation of risk factors showed smoking likely played a role in increased lung cancer ratesa role in increased lung cancer rates

Occupation also played a role in lung cancer for some Occupation also played a role in lung cancer for some individualsindividuals



Conclusions (cont.)Conclusions (cont.)

With the exception of lung cancer, patterns by census With the exception of lung cancer, patterns by census tract showed no consistent elevations of cancer over tract showed no consistent elevations of cancer over timetime

The geographic pattern of cancer did not show a clear The geographic pattern of cancer did not show a clear pattern suggesting a common environmental exposure pattern suggesting a common environmental exposure related to the NASrelated to the NAS



MDPH RecommendationsMDPH Recommendations

The MDPH should further investigate the pattern The MDPH should further investigate the pattern of lung cancer with respect to length of residence, of lung cancer with respect to length of residence, particularly among non-smokers, to determine if a particularly among non-smokers, to determine if a clearer pattern of this cancer emergesclearer pattern of this cancer emerges

Results should be considered by town Boards of Results should be considered by town Boards of Health when planning future prevention or Health when planning future prevention or intervention strategies in the four townsintervention strategies in the four towns



MDPH Recommendations (cont.)MDPH Recommendations (cont.)

Tobacco control efforts should be focused Tobacco control efforts should be focused accordingly in the towns of Weymouth, Abington, accordingly in the towns of Weymouth, Abington, and Rocklandand Rockland

Cancer incidence will continue to be monitored in Cancer incidence will continue to be monitored in these four towns through the use of the MCRthese four towns through the use of the MCR

Weymouth Health Needs AssessmentWeymouth Health Needs Assessment

February 2002February 2002



Weymouth Health Needs Assessment


Weymouth Board of Health SponsoredWeymouth Board of Health SponsoredPurpose to identify health needs of Purpose to identify health needs of

Weymouth residentsWeymouth residentsPurpose to design programs to improve Purpose to design programs to improve

the health of residentsthe health of residents





Confidential mailed survey to 5000 Confidential mailed survey to 5000 Weymouth residentsWeymouth residents

Survey conducted by JSI Research and Survey conducted by JSI Research and Training Institute of BostonTraining Institute of Boston





Identify respiratory problems in the Identify respiratory problems in the householdhousehold

Identify risk factors for heart disease in Identify risk factors for heart disease in the householdthe household

Identify health care services needsIdentify health care services needs Identify possible environmental health Identify possible environmental health

outcomes outcomes





Questions designed to address specific Questions designed to address specific arsenic and SWNAS concernsarsenic and SWNAS concerns





Identify the occurrence of Multiple Identify the occurrence of Multiple Sclerosis and other types of Sclerosis and other types of neurodegenerative diseasesneurodegenerative diseases

Identify the occurrence of Lupus Identify the occurrence of Lupus Erythematosus and other types of Erythematosus and other types of autoimmune diseasesautoimmune diseases





Identify the occurrence of aplastic Identify the occurrence of aplastic anemia and myelodysplastic syndromeanemia and myelodysplastic syndrome

Identify the occurrence of diseases of Identify the occurrence of diseases of the kidneythe kidney

Identify the occurrence of birth defectsIdentify the occurrence of birth defects





The environmental health outcome The environmental health outcome component of the survey will tell us if component of the survey will tell us if these outcomes occur at rates greater these outcomes occur at rates greater than would be expected or if they occur than would be expected or if they occur more often in certain areas of the more often in certain areas of the community.community.



How to Contact BEHAHow to Contact BEHA

Massachusetts Department of Public HealthMassachusetts Department of Public HealthBureau of Environmental Health AssessmentBureau of Environmental Health Assessment

250 Washington Street, 7250 Washington Street, 7 thth floor floorBoston, MA 02108Boston, MA 02108

Telephone: (617) 624-5757Telephone: (617) 624-5757Fax: (617) 624-5777Fax: (617) 624-5777

www.state.ma.us/dph/behawww.state.ma.us/dph/beha

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