REDACTED OH DEPT OF HEALTH REPORT - CANCER …Division o-f Epidemiology, Ohio Department o-f Health...

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HANGER SURVEILLANCE IN THE POPULATION IN CLOSE PROXIMITY TO THEFIELDS BROOK HAZARDOUS WASTE SITE

ASHTABULA COUNTY, OHIOFINAL REPORT

Robert U. Indian, M.S.Vickie Hundlev, M.S.

Chronic Disease and Special Studies UnitDivision of Epidemiology

The Ohio Department of HealthJune, 1987

Case Report No. 850801

Copy and -further information requests to Chronic Disease and Special Studies UnitDivision of Epidemiology, Ohio Department of Health, P.O. Box US, Columbus, Ohio,43266-0118, telephone (614) 466-0281 (Robert Uf. Indian).

Division of Epidemiology, Ohio Department of HealthFinal Report - Cancer Surveillance, Fields Brook Site

Case Log No. 850801; June 1987

ACKNOULEDGMENTS

I would like to take this opportunity to thank Raymond Saporito, B.S., M.P.H.;

Health Commissioner, Ashtabula County Health Department and his staff for their warm

support, cooperation and assistance in the conduction of the household cancer survey

in the Ashtabula community. Their warm support and faith made this study possible.

A special thank you also to Barbara Teresk, R.N., M.P.H.j Health Commissioner,

Ashtabula City Health Department and her staff for assistance in the cancer survey

interviewing process.

A special thanks also to the staff of the Environmental Unit and the Infectious

Disease Unit in the Division of Epidemiology for their extensive efforts to complete

the cancer survey interviewing process. Sincere appreciation is also extended to

Sharon Parmenter, Chronic Disease and Special Studies Unit for her painstaking

efforts in preparation of this manuscript. Thank you also to other members of the

Division of Epidemiology for their efforts in reviewing and commenting on the

contents of this report.

• <*- / \MA*vlRobert W. Indian, M.S.Epidemiology Investigation SupervisorChronic Disease and Special Studies UnitDivision of EpidemiologyOhio Department of HealthJune 15, 1987



TABLE QF CONTENTS

I. INTRODUCTION

A. Overview

B. Initiation of Action

C. Objectives of the Action

D. Review of Cancer Mortality in Ashtabula County, Ohio, 1979-1983

II. THE FIELDS BROOK HAZARDOUS WASTE SITE

A. Site Visit

8. Brief Description of the Site and Potential Exposures

C. Previous Ohio Department of Health Actions in the Fields Brook/Ash tabu laArea.

I I I . METHODS

A. Cancer Incidence Household Survey

1. Defining of study area and population at greatest potential exposure.

2. Study period defined.

3. Sample size determination

4. Survey instrument

5. Case definition

6. Notification of residents

7. Interviewer training

8. Case ascertainment

9. Person years of observation

10. Data analysis

11. Statistical power

i i

Division o-f Epidemiology, Ohio Department o-f HealthFinal Report - Cancer Surveillance, Fields Brook Site


B. Cancer Mortality Surveillance

1. Study area and study population de-fined

2. Study period defined

3. Case definition


5. Data analysis


C. Time Frame -for Action

IV. RESULTS


1. Residence survey response

2. Person years o-f observation



5. Standardized Incidence Ratios




3. Standardized Mortality Ratios

y. DISCUSS I ON

VI. CONCLUSIONS

VII. RECOMMENDATIONS

11 1


Case Log No, 850801; June 1987

INTRODUCTION

A. Overview

Surveillance of cancer in a de-fined population in close proximity to the

Fields Brook Hazardous Waste Site in Ashtabula County, Ohio was conducted.

This surveillance consisted of a comparison of cancer incidence and cancer

mortality to Ohio and national data. This surveillance revealed that brain

and other central nervous system cancer incidence and mortali tv is

significantly higher (p < 0.05) when compared to Ohio -and the U.S. The risk

factors for cancer in general and brain cancer in particular are discussed.

Recommendations for further action are presented.

6. Initiation of Action

This action was initiated in 1985 -as part of .an effort to increase cancer

surveillance of populations in Ohio at potential exposure to carcinogens

and/or where local concern has been express?? regarding a perceived Higher

than expected rate or clustering of cancer. A review o-f the Final Remedial

Investigation Report and the Remedial Action Master ?'£:• issued by :re V.S,

Environmental Protection Agency reveals that the Fields Brook site is

located in Ashtabula County, Ohio near the City of Ashtabula in one of the

area's largest industrial complexes (1,2). The Fields Brook has

historically been the principal receiving stream for industrial discharges,

Many of these industrial discharges have been hazardous and have contained

carcinogens.



Consultations with Raymond Saporito, M.F.H., Health Commissioner of

Ashtabula County and Barbara Teresk, M.P.H., Health Commissioner, City o-f

Ash tabu lai and Robert U). Indian, M.S., Epidemiology Investigation

Supervisor, Division o-f Epidemiology, Ohio Department of Health, revealed

that there was apparent widespread concern by local residents regarding a

perceived higher than expected rate o-f cancer. Both agreed that there was a

need to establish the cancer burden in the community and pu* the situation

into perspective. It was also discussed that since Ohio does not have a

population based cancer incidence reporting system, any attempt to establish

the burden o-f cancer in the area would nave to include a residential survey

of cancer incidence as we11 as a death certificate review of cancer

mortality. At that time Robert Indian recommended that this ascertainment

include the following:

1) The defining o-f a study population;

2) The defining of a study period (years);

3) The conduction of a door-to-docr survey to estimate cancer incidence and

to compare this burden to an appropriate reliable referent populations

and

4) To ascertain the cancer mortality burden and to compare this burden to

an appropriate, reliable referent population.

The Ashtabula County Health Department pledged their f u l l support and

resources- to these proposals. The C i t y of Ash*aouia Hea'-th Department

agreed in p r i n c i p l e to the pr coos*.1 = byt because c^ scarce resources c:<u''d

Division of Epidemiology, Ohio Department of HealthFinal Report - Cancer Surveillance, Field? Brook Site


pledge only minimal assistance in the actual conduction of the work. The

Division of Epidemiology agreed to provide a study protocol, interviewer

training, interviewer personnel, questionnaires, data abstraction and

coding, death and birth certificate reviews, statistical analysis, and a

-final report. It was agreed that it would be advantageous to initiate this

surveillance as relatively soon as possible. However, because of other

commitments of resources in other- parts of the State, the Division of

Epidemiology would not be able to i n i t i a t e the surveillance u n t i l November,

1986.

C. Objectives of the Action

Consultation with epidemiology and medical staff at the Ohio Department of

Health identified five main objectives of this action:

1 .> To define a study area and population at greatest potential exposures'

2) To define a study period;

3) To estimate cancer incidence in the study pcpu-ation and compare this

burden to an appropriate, reliable referen* population:

4) To ascertain the cancer mortality burden in the study population and

compare this burden to an appropriate, reliable referent population: and

5) To make recommendations for further action <if any),

These activities were pursued under sections 3701.14, 3701.06, 3701.14, and

3701.262 of the Ohio Revised Code,

The Bureau of Environmental Health, the Office of Legislative Relations, and

the Office of Public Relations at the Oh:c Depa-'t^ent o- Health: the = >:B"!IC

Division o-f Epidemiology, Ohio Department of HealthFinal Report - Cancer Surveillance, Fields Brook Site


Interest Center at the Ohio Environmental Protection Agency <£PA); the U.S.

EPA/Centers for Disease Control <CDC) Liaison in Region V of the U.S. ERA;

and the Cancer Control Consortium of Ohio were notified of this action.

D. Review of Cancer Mortality in Ashtabula County, 1979-1983.

in order to gain some perspective of the cancer burden in Ashtabula County,

the Chronic Disease and Special Studies Unit (CDSSU), Division of

Epidemiology, examined population based computerized records of death from

the Division of Vital Statistics at the Ohio Department of Health for

Ashtabula residents for the years 1979-1983. The death records revealed an

estimated 1,052 cases of which the underlying cause of death was determined

to be a primary malignant neoplasm, International Classification of Disease

Codes 140-208<3). The average annual age-adjusted mortality for all cancer

sites/types combined is 175.46 per 100,000 persons which is not

significantly different <p < 0.05) than the Ohio rate of 1-80.72 per 100,000

persons. No significant difference vp < 0.05) between Ashtabula County and

Ohio was observed for the major s-i tes/ t>T5= of cancer mortality :n:"udino

brain and other central nervous system: breast; prostate: 1iuer, gal 1

bladder, and bile ducts; stomach; kidney; leukemia; and respiratory,

including lung. A significantly lower rate <p < 0.05) was observed for

bladder cancer deaths when compared to Ohio, as indicated in Table 1.



TABLE 1

Number of cancer.100,000 populationtotal population .

************#*#***#•

deaths, average annual age-adjusted cancer m o r t a l i t y rates per, and 95X confidence intervals, Ashtabula County, Ohio, 1979-83,

Ashtabula County State o-f Ohio* Site Deaths

A l l sites

Brain/CNS

Breast

Bladder

Prostate

Liver , g a l l bladder& bi le ducts

Stomacn

Kidney-

Leukemia

Respiratory

1052

31

78

16

69

28

42

17

43

263

Rate

175.46

5.56

13.67

2.58

10.38

4.77

6.76

3.07

7.32

44.61

<95X CI)

<165. 14-185. 78)

< 3.59-

< 10.63-

< 1.35-

< 8.11-

< 3.02-

< 4.76-

C 1.59-

< 5.14-

< 39.24-

7.54)

16.71)

3.82)

12.65)

6.53")

8.76)

4.54)

9.50)

49.99)

Deaths

106,242

2,410

9.652

2,656

5.717

2,524

3,252

2,093

4,075

28,040

Rate

180.72

4.28

16.68

4.37

9.30

4.24

5.42

3.60

6.96

48.33

(95X CI)

<179. 68-181. 77)

( 4.11- 4.45)

•; U.3c- 17.01)

< 4.21- 4.53)

( 9.0?- 9.53)

\ 4 .OS- « . *o.)

< 5,24- 5.60)

>; 3.45- 3.75)

< 6.75- 7.17)

< 47.77- 48.5'9>

Age-adjusted to the U.S. 1970 Census;"Data compilation and calculations by Division o-f Epidemiology, Ohio Department ofHealth, 1966.



II. THE FIELDS BROOK HAZARDOUS WASTE SITE

A. Site Visit

In October, 1986, Robert Indian, M.S., and Deborah Gray, M.S., Epidemiology

Investigation Supervisor, Environmental Unit, Division of Epidemiology made

a visit to the Fields Brook Site. This visit revealed that the site is

bounded by the shoreline of Lake Erie, on the north and the Ashtabula River

and the City of Ashtabula on the west. The eastern most part o-f the site is

heavily industrialized, and is sparsely populated while the western and

southern boundaries o-f the site are bounded by relatively dense residential

housing. A tour of the site and the immediate environs revealed/

approximately 1.600 households within an approximate one mile radius o-f the

approximate geographic center o-f the site,

B. Brief Description of the Site and Potential Exposures

The Fields Brook site is in the City o-f Ashtabula and Ashtabula Township in

Ashtabula County in northeast Ohio. The Fields Brook drains a 5.6 square-

mile watershed, with the eastern portion draining Ashtabula Township and the

western portion draining the eastern section o-f the City of Ashtabula (1,2).

The 3.5 mile channel begins immediately south o-f U.S. Highway 20, about one

mile east of State Highway 11. The stream then -flows northwesterly under

U.S. Highway 20 and Cook Road to immediately north of Middle Road. The

stream then -flows westerly to its confluence with the Ashtabula River, From

Cook Road downstream to State Highway 13, the stream -flows through what has

been described as - "one o-f the largest and most diversified concentrations

of chemical plants in Oh:: -;i-2:". Ne*r i*s confluence with the Ashtabula

Division of Epidemiology, Ohio Department o-f HealthFinal Report - Cancer Surveillance, Fields Brook Site

Case Log No. 850801\ June 1987

River, downstream -from State Route 11, the brook flows through a residential

area in the City o-f Ashtabula. The Ashtabula River empties into Lake Erie

at about 8,000 -feet downstream o-f the Fields Brook.

The Fields Brook site has been determined by the United States Environmental

Protection Agency <U.S. EPA) and the Ohio Environmental Protection Agency

(Ohio EPA) to contain contaminated sediment resulting -form industrial

discharges to the brook over a number o-f years (1,2). In consideration'o-f

the possibility o-f direct contact with the brook's sediments, movement of

the contaminant* into the public water supply o-f the City o-f Ashtabula, and

the possibility of uncontrolled releases of hazardous materials from the

sediment, the site was included by the U.S. EPA on the National Priorities

List of uncontrol1ed hazardous waste si te= under the Comprehensive

Environmental Response, Compensation, and Liability Act of 1980 (CERCLA).

The U.S. EPA reports that various industrial sources are believed to have

contaminated the sediment in the Fields Brook with a tread spectrum cf

organic and heavy metal pollutants, many cf which are carcinogenic <1,2).

The carcinogens reported in the sediment samples include, but are not

limited to - 1,1,2, 2-tetrachloroethanej tetrachloroethene; gamma-

hexachlorocyclohexane; hexachlorobenzene; polychlorinated biphenyls (PC6s)\

hexachloroethane; hexachlorobutadiene; arsenic; heptachlor; and beryllium.



Past analyses o-f tissue -from fish caught in the Ashtabula River and the

Fields Brook also indicate the presence of various organic compounds and

heavy metals, several of which are carcinogenic (1,2). The carcinogens

reportedly found in the fish samples include but are not limited to - 1,1,2,

2-tetrachloroethane; tetrachloroethene; trichloroethene; hexachlorobenzene,

PCBs, arsenic; and beryllium.

The U.S. ERA has identified seven environmental media pathways that present

potential exposure to humans from the Fields Brook site (1,2):

1) Sediment, through ingest ion, dermal absorption, or

inhalation;

2) Surface water, through dermal absorption or ingestionj

3) Fish through ingest ion;

4) Groundwater through ingestic-n, dermal absorption or vapor

inhalation;

5) Air, through inhalation o-f vapors;

6) Local vegetation and w i l d l i f e through ingestion; and

7) Contaminated facilities, through contact and/or absorption of

releases from facilities.

It is imperative to note that in order to have human health effects,

significant human contact with contaminated media <i.e., surface water,

sediment, edible fish, etc.) must occur (1,2). Contamination is defined as

1evels of consti tuents above standards, cri teria* and/or background.

Contamination by itself does not necessarily imply that a hazard to hum-an

8


Case Log No. 850801i June 1987

health exists. The U.S. EPA has presented estimates of oossibl e excess

lifetime cancer risks, assuming lifetime exposure to the environmental media

under a "No Action Alternative". These elements include the -following:

1) Residential sediment ingest ion resulting in an excess-21ifetime risk of 5 x 10 ;

2) Surface water "dermal absorption of carcinogens could result-4in an excess lifetime cancer risk o-f -as high as 1 x 10 : and

3) Fish ingestion could result in an excess lifetime cancer risk

of 1 x 10~3.

C. Previous Ohio Department of Health Actions in the Fields Brook/Ashtabula

Area.

It should be noted that the Ohio Department o-f Health has taken previous

actions regarding environmental chemica' p o l l u t i o n in the Fields

Brook/Ashtabula area;

1) In March, 1983 the Ohio Department of Health and the Ohio Environmental

Protection Agency issued a joint statement advising persons not tc eat

fish caught in an approximate two m i l e section of the Ashtabula River

<4>. This advisory was in response to information provided by the U.S.

Environmental Protection Agency that relatively high levels of

hazardous/toxic chemicals had been found in bottom feeding fish in this

section of the river, many of which are suspected of causing cancer.

The advisory extended from the confluence of the Ashtabula River with

Lake Erie including the harbor and extending upstream to the 24th Street«•

bridge.

Division o-f Epidemiology• Ohio Department o-f HealthFinal Report - Cancer Surveillance, Fields Brook Site


2> In April, 1985 the Division o* Epidemiology issued a Final Report

reviewing the toxicologic properties o-f contaminants -found in the

sediments o-f the Ash tabu la River (5). These contaminants were -found by

analysts o-f river sediments taken by a contractor -for the U.S. Army

Corps o-f Engineers in 1782-1983 (6). Several of the chemicals found are

known or suspected carcinogens (7,8). Several others are -fat soluble

and have great potential -for entering the -food chain and eventual

exposure to humans , particular! v through con sump t i o* o* •f|*&=hm**pr -fish

•from the Ashtabula River. These analyses rein-forced the policy which

initiated the advisory not to consume -fish caught in a segment o-f the

Ashtabula River in 1983. As a result o-f these analyses an additional

advisory was issued advising persons to avoid any direct contact with

the sediments, such as swimming or wading.

III. METHODS


1. De-fining of study area and population at greatest potential exposure.

Consultation with Ashtabula County Health Commissioner Ray Saporito and

Ashtabula City Health Commissioner Barbara Teresk resulted in a decision

to conduct the cancer survey in the population within a one mi l e radius

o-f the approximate geographic center o-f the Fields Brook Site. This was

based on the assumption that these households had the greatest potential

•for environmental exposure to airborne toxins -from the heavily

industrialized area. It WAS -also thought that this area re-fleeted the

area o-f concern -for 1 ocal res-i dents that had expressed concern reoarainQ

iO



a perceived high rate o-f cancer* Thus, "exposure" was relatively

crudely de-fined, consisting o-f having residence within the one m i l e

radius o-f the approximate geographic center o-f the site.

Based on these assumptions the Study Area was de-fined as that area o-f

the City o-f Ash tabu la and Ash tabu la Township bounded on the north by

Lake Erie and Lake Shore Park; on the east by an area approximately mid-

way between State Road and Cook Road; on the south by U.S. Route 20 and

Schenley Avenue; and on the west by the Ashtabuta River, an area of

approximately three square miles as indicated on Map 1.

The 1984 Polk Ashtabula City Directory <9) and a review of city and

township maps revealed that there are approximately 1,596 households in

the Study Area. Approximately 839 households are in Ashtabula City

w h i l e approximately 757 households are in Ashtabula Township. The 1980

Census o-f Population (10) indicates an average o-f 2.84 persons per

household in Ashtabula County. Thus, the total study population is

estimated to consist of Approximately 4,574 persons.

2. Study period de-fined.

Consultation with epidemiology and medical sta-f-f resulted in a decision

to de-fine an approximate ten year study period, January 1, 1977 through

June 30, 1986. This time period was selected as it would represent the

most recent, relevant information concerning the cancer incidence burden

in the study population as well as render sufficient numbers o* cases

for meaningful analysis.

11

HEALTH STUDY AREAFIELDSBftOOK HAZARDOUS WASTE SITE

ASHTABULA COUNTY, OHIOOHIO DEPARTMENT OF HEALTH, 1987



3. Sample size determination.

Consultation with epidemiology and medical sta-f-f at the Ohio Department

o-f Health resulted in a decision to determine a sample of the households

-for the cancer incidence household survey. It was -further decided that

this sample should be o-f su-f-ficient size to determine at least a two-

fold risk o-f total cancer incidence when compared to U.S. cancer

incidence data (11,12) with at least 90 percent power and a one-tailed

alpha (increased risk only) o-f 0.05.

Based on these parameters the method o-f Col ton (13) was used to

determine the number o-f person-years o-f observation and consequently,

the number o-f persons needed to sample -from the total study population,

These calculations result in a sample size o-f 3,651 person years. The

1980 Census o-f Population <10) indicates that approximately <f-0 percent

o-f Ashtabula County residents have live: -for -five years or more at the

same residence. Using the ten year study period and the 1980 Census o-f

Population (10) in-formation on length of residence, the estimated t:-tai

potential p-erson years is 31,120. Based on the determined sample size

o-f 3,651 person years (approximately 12 percent), an estimated 550

persons or 193 households (550 persons/2.86 persons per household) were

needed -for the household survey. Assuming a 10 percent re-fusal rate,

the sample size was increased to 215 households. Thus, the study

population was de-fined to be 215 households. Dividing the total number

o-f households by 215 provided the nth household with which to randomize

the sample throughout the Study Area. Sampling every seventh household

13

Division of Epidemiology, Ohio Department of HealthFinal Report - Cancer Surveillance, Fields Brooi< Site

Case Log No. 850801s June 1987

<1,596/215) resulted in 116 sampled households in the City o-f Ashtabula

and 106 sampled households in Ashtabula Township.

4. Survey instrument,

A Neighborhood Questionnaire was designed by CDSSU personnel. This

questionnaire consists o-f two main parts: a household roster including

name, birthdate, race, sex and length o-f time in the household; and a

history o-f cancer in members o-f the household. This questionnaire is ^ L

included as Appendix 1.

Data from the questionnaires were coded, abstracted and placed on

magnetic tape -for analysis using a SAS computer program <14) developed

in the Division o-f Epidemiology at the Ohio Department of Health.

5. Case definition

Cases were de-fined as Study Area residents wi th newl y diagnosed

malignant neoplasms while in residence in the Study Area for at least

six months during the time period January 1, 1977 through June 30, 1986.

For the purposes o-f this surveillance study, cases were not verified by

medical record review. This was based on the assumption that many of

the reported cases would have medical records in hospitals outside of

Ohio and the process of obtaining and reviewing out-of-state medical

records would add an unacceptable amount of time needed to complete the

surveillance. However, it was decided that if a particular cancer

site/type was found at -a s i g n i f i c a n t l y elevated rate, then any foUow-up

action would include a medics." record review of the cases.

14



6. Notification of residents

The surnames o-f the selected study area households were identified

through the Polk Directory <9). An introductory letter was sent to each

identified household on Ohio Department of Health letterhead. These

letters were signed by Robert Indian and Health Commissioner Ray

Saporito for those households in Ash tabu la Township and by Robert Indian

and by Deborah Grayp Division of Epidemiology, for those households in

the City of Ashtabula. The letter* to Ashtabula Township households

were mailed August 5, 1984 -and the letters to City of Ashtabula

residents mailed on November 14, lc'84. These letters explained the

purpose of the survey; indicated that they would be contacted by either

Ashtabula County, City of Ashtabul*, or Ohio Department o-f Health

personnel.at their homes! stressed the confidentiality o-f the data: and

provided a telephone number to call at the Ashtabula County Health

Department and the City of Ashtabula Health Department if they had any

comments or questions regarding the study. Copies of these letters .are

provided as Appendix 2 and 3.

7. Interviewer training.

The training of interviewers from the Ashtabula County Health Department

and the Ashtabula City Health Department was conducted by Robert Indian

and Vickie Hundley, Division of Epidemiology. This training reiterated

the objectives of the study, identified anticipated common questions,

and stressed the importance of identifying the total number of residents.

in the sample, their length of residence and the burden of cancer in the

study area.

15



8. Case ascertainment.

Cases were ascertained by a door-to-door survey using the Neighborhood

Questionnaire. Interviews were conducted by trained interviewers from

the Ashtabula County Health Department, the City of Ashtabula Health

Department, and the Ohio Department of Health. Household interviews

were initiated August 10, 1984 in Ashtabula Township by Ashtabula County

Health Department and continued through September 1, 1986. Intensive

household interviewing in the City of Ashtabula was conducted by the

Ohio Department of Health on November 18 and 19, 1986. City of

Ashtabula Health Department interviewers conducted extensive follow-up

of residents not found at home on those two days. There were at least

three attempts on three different days to contact each of the households

in the study area.

9. Person years of observation.

A SAS computer program <14) was used to calculate the age-tiT.e-speci-Mc

person-years for the study population for the time interval January 1,

1977 - June 30, 1986, based on each individual's age and residence in

the Study Area from year to year. Persons with residence less than six

months did not enter the study file. Person years of observation were

calculated for 18 age groups by five year age intervals starting with

less than five years and ending with age 85 years and over.

16

Division of Epidemic!OQX, Ohio Department of HealthFinal Report - Cancer Surveillance, Fields Brook Site


10. Data analysis - Standardized Incidence Ratios.

An analysis of the data was conducted to determine if the Fields Brook

Study Area population is experiencing statistically significant greater

cancer incidence than would be expected based on comparison to the

populations in the designated population-based cancer registries in the

Surveillance, Epidemiology and End Results Program (SEER) as used by the

National Cancer Institute (12).

Expected values for cancer incidence in the Study Area population were

generated by applying the age-specific incidence rates of the SEER

populations (12) to the study population using 18 different age groups

starting with persons under five years of age -and ending with persons

over age 85 years. These were then used to compute Standardized

Incidence Ratios <SIRs) based on the cancer incidence of the comparison

populations controlling for age where:

Observed cases in the Field* Brook Study AreaSIR = ——————————————————————————————————————————

Expected cases in the Fields Brook Study Area

If this incidence ratio is greater than one, i\ indicates that more

cases are observed than would be expected based on the age-specific

rates in the comparison population. If the ratio is less than one,

fewer cases are observed than expected. SIRs were computed from the

SEER comparison populations for total cancer incidence and for site/type

- specific cancer incidence where the observed values were three or

more. The ratios of the observed to the expected numbers were tested

for significance at the p < 0.05 levei in the manner described by Bailar

and Ederer <15 s.

17



The reported cancer sites and types were coded in the manner o-f the

International Classification of Diseases, Injuries, and Causes of Death

(l.C.D.) Codes (3), grouped in the same manner used by SEER <12), and

cross-tabulated by reported age at diagnosis using 18 age groups by five

year age intervals starting with less than five years and ending with

age 85 years and over.

11. Statistical power.

The power of detecting a significantly elevated risk of at least two-

fold was calculated in the manner described by Beaumont and Ereslow

"K14>. » Power was calculated with a"one-sided aT^ha~<for elevated risk'

only) fixed at 0.05 using the Standardized Incidence Ratio as an

estimate of the relative risk of the residents developing cancer during

the study period.

6. Cancer Mortality Surveillance

1. Study area and population defined.

The defined SVjdy Area of a one mile radius from the approximate

geographic center of the Fields Brook Site and the approximately 1,596

households with an estimated 4,576 persons were used for an analysis of

cancer mortali ty.

2. Study period defined

A six year study period, 1980-1985, was defined for cancer mortality

surveillance. This time period was selected as it would represent the

most recent, relevant data concerning the cancer mortality burden in the

Study Area.

18



3. Case definition

Cases were defined as deceased Study Area residents with the underlying

cause of death attributed to malignant neoplasms, I.C.D. Codes 140-208

(3) with the xear o-f death in the de-fined study period 1980-1985.


Death certificate numbers were generated from the computerized mortality

records of the Ohio Department of Health for 1980-1985 by year- for

I.C.D. Codes 140-208 (3) for decedents in the City of Ash tabu la and the

unincorporated areas of Ashtabula Count/. These Death Certificates were

then examined in the archives of the Ohio Department of Health and the

underlying cause of death, age, sex, and exact geographic residence at

the time of death recorded. Deaths were classified by residence as

either within or outside the Study Area.

5. Data analysis

An analysis of the data was conducted to determine if the Fields Brook

Study Area population is experiencing st a t i s t i c a l l y significant greater

cancer mortality than would be expected based on comparison to the SEER

populations (12) and the State of Ohio (17). Expected values for cancer

mortality in the Study Area Population were generated by applying the

age-specific mortality rates of the SEER populations U2> and the Ohio

population (17) to the 18 different age groups used in the SIR

calculations. These were then used to compute Standardized Mortality

Ratios CSMRs) based on the cancer mortali ty of the comparison

populations controlling for age where:

19



Observed cancer deaths in the Fields Brook Study AreaSMR * ——————————————r———————————————————————————-

Expected cancer deaths in the Fields Brook Study Area

The SMR is similar to the SIR in that if the ratio is greater than one,

more deaths are observed than expected based on the comparison

population. If the ratio is less than one it indicates that -fewer

deaths are observed than expected. SMRs were computed -from the SEER and

Ohio comparison populations -for total cancer mortality and -for

si te/type-specif ic cancer mortality where the observed values were -five

or more. The ratios of the observed to the expected numbers were tested

•for significance at p < 0.05 le'.-el in the manner described by Bailar and

Ederer (15).

The cancer sites/types were grouped in the manner used by SEER <12> and

cross-tabulated by age at death (years) using 18 age groups- by -five year

age intervals starting with less *hsr. five year-s and erring with *ge 85

years and over.


The power of detecting a significantly elevated risk of at least two-

fold was calculated in the manner described by Beaumont and Breslow

(16). Power was calculated with a one-sided alpha (elevated risk only)

fixed at 0.05 using the SMR as an estimate of the relative risk of the

residents dying of cancer during the study period.

D i v i s i o n of Epidemiology, Ohio Department o-f HealthFinal Report - Cancer Surveillance, Fields Brook Site


RESULTS


1. Residence survey response

Of the 222 targeted households, 12 were -found to be unoccupied at the

time of the survey <5.4 percent). 04 the remaining 210 households,

seven (3.3 percent) could not be contacted despite at least three

separate attempts, whi 1 e -four households (1.9 percent) re-fused to

p a r t i c i p a t e . There-fore, of the 210 households that p o t e n t i a l l y c o u l d

have entered the study, 199 actually did, for a p o s i t i v e response rate

of 94.8 percent as indicated in Table 2.

2. Person years of observation

Examination of the questionnaire data for each year in the study period

and adjusting for each persons changing age d u r i n g his/her residency

revealed -a total of 3,937.03 person years of observation for the

residents in the study sample. This total and the age-specific year* of

observation ranged from 72.4? in the 85 years and older age group to

326.92 in the 15-19 years of age group as indicated in Table 3. Male

residents in the study sample contributed 1,952.58 person years w h i l e

female residents contributed 1,984.45 person years as indicated in Table

3.

21



TABLE 2

Residence survey response -for cancer incidence, Fields Brook Study Area, Ashtabuia,Ohio, 1986.

No. ('/.)

Total residences in study area 222Unoccupied residences 'at time o-f survey) 12 ',5.4)

Total occupied residences 210Residents that couln't be reached 7 (3.3)

(three separate attempts)Resident re-fusals 4 ',1.9)

Total completed interviews 39? <94.8)(among the occupied residences)

Data compiled by the Division ot Epidemioiooy, Ohio Department o* Health,1987.



Person years of observation by age,Fields Brook Study Area, Ash tabu la,

TABLE 3

sex,. January 1, 1977 - June 30, 1986,Ohio.

Age <Years) Male Female Total

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4750-5455-5960-6465-6970-7475-7980-84

85*

84.25121.16138.00195.09165.99134.17136.50143.00108.4284.67

101.08135.92146.53

91.3454.8342.1632.6736.75

1952.58

103.41119.84118.25131.83147.60133.93124.2593.6796.17

107.42146.3?174.00163.00128.3470.6741.5048.5035.74

1984.45

187.6624! .00256.25326.92313.59268.10260.75236.67204.59192.09247 .41309.9230*. 5821 9.68125.5083.6681.1772.49

3937.03

1Data1987.

compiled by the Division o-f Epidemiology, Ohio Department of Health

23


Case Log No. 850801) June 1987

3. Power considerations

Given the 3,937.03 age-specific person years of observation, an

estimated 19.59 cases of cancer would be expected in the study

population based on SEER data (12). Assuming a one sided alpha of 0.05,

the calculated power of detecting at least a two-fold increased risk if

over 90 percent. This power is quite good and provides a high degree of

confidence in the ability of the study techniques to detect at least a

two-fold increased risk of cancer in the residents.


Nineteen residents reported that they had been diagnosed with cancer

within the defined study period of January l, 1977 through June 30,

1986. The anatomical primary sites/types of these 19 cases include the

stomach, mesentery tract, prostate, brain, colon, lung, 1iver, skin,

breast, cervix, and Hodgkin's Disease. The age at diagnosis ranged from

14 to 86 years. A listing of these cancers by age at diagnosis and year

of diagnosis is provided in Table 4. The only site/type specific

cancers that had sufficient numbers for separate analyses were brain

cancer (n=3) and lung cancer <n-3>.

24



TABLE 4

Reported cancers by anatomical site/type, sex, age and year o-f diagnosis,Janury 1, 1977 - June 30, 1984, Fields Brook Study Area, Ashtabula, Ohio.

Site/Type Age at diagnosis (Years) Year of diagnosis

Males

(!) stomach 68 1980(2) mesentery tract 54 197?<3> prostate 45 1978(4) prostate 49 1986(5) brain 44 1978(4) brain 31 1981(7) colon 84 1979<8) Hodgkins disease 14 1985(9) lung 45 1980

(10) lung 62 1985(11) liver 80 1982

Females

<\2> stomach 50 1982<13) brain 55 1983(14) colon 65 1982(15) lung 73 1985(14) skin 47 1978(17) cervix 53 1977(18) breast 52 1984(19) breast 88 1979

Data compiled by the Division o-f Epidemiology, Ohio Department of Health, 1987

D i v i s i o n of Epidemiology, Ohio Department of HealthFinal Report - Cancer Surveillance, Fields Brook Site


5. Standardized Incidence Ratios (SIRs)

The comparisons of cancer incidence -for the residents to the SEER

populations <12) are summarized in Table 5. The calculated SIRs were

not s i g n i f i c a n t l y elevated -for reported total cancer in males, -females,

the total population, or for lung cancer in the total p o p u l a t i o n .

However, brain and other central nervous sytem cancer was significantly

elevated for the total population. The detai1ed calculations and

comparisons o-f cancer i n c i d e n c e for the study area residents arrd the

SEER populations are presented in A p p e n d i x Tables 1-5.

The age-specific t o t a l cancer incidence reates in the SEER populations

i n d i c a t e that 19.5?, 30.40 and 9.19 cases would be expected in the

total, male, and female study sample pop u l a t i o n respectively. Nineteen,

11 and e i g h t cases were reported in the respective populations. The

calculated SIRs are 0.97 (95 percent confidence interval 0.5S-1.51);

1.06 (95 percent confidence interval 0.53-1.90): and 0.87 <95 percent

confidence interval 0.38-1.71; respectively which are not s t a t i s t i c a l l y

significantly different from that expected at p < 0.05.

The age-specific lung cancer incidence rates in the SEER populations

indicate that 3.00 cases would be expected in the study samp* e

population. Three cases were actually reported. The calculated SIR is

1.00 (95 percent confidence interval of 0.21-2.92 which is not

s t a t i s t i c a l l y different from that expected at p < 0.05.

26



TABLE 5

Summary of Standardized Incidence Ratios - reported cancer incidence, January 1, 1977- June 30, 1984, Fields Brook Study Area, Ashtabula County, Ohio .

Total cancer

Total population

Males

Females

Observed

19

11

8

Standardized to SEER. 1973-1981*

Expected SIR 95X confidence interval

19.59 0.97 0.58-1.51

10.40 1.06 0.53-1.90

9.19 0.87 0.38-1.71

Lung cancer

Total population 3.00 1.00 0.21-2.92

Brain & other centralnervous system cancer

Total population 0.2? 10.34 * 2.13-30.23

Data compilation and calculations by Division o-f Epidemiology, Ohio Department ofHealth, 1986.

Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in thein the United States, 1973-1981. National Cancer Institute. NIH Publication No. 83-1837, November, 1984.

*Significantly higher than expected at p < 0.05.



The age-specific brain and central nervous cancer incidence rates in the

SEER populations indicated that 0.29 cases would be expected in the

study sample population. Three cases were actually reported. The

calculated SIR is 10.34 (95 percent confidence interval of 2.13-30.23)

which is significantly higher than that expected at p < 0.05.



Given the extimated 4.576 persons in the study area population, an

estimated 67.7 cancer deaths would be expected in the study population

based on SEEP data <12). Assuming a one-sided alpha of 0.05, the

calculated power of detecting at least a two-fold increased risk is over

99 percent. With an estimated 74.7 cancer deaths expected based on Ohio

data (17) and again assuming a one-sided alpha of 0.05, the calculated

power is again over 99 percent. This power is quite good and provides a

high degree of confidence in the ability of the mortality surveillance

to detect at least a two-fold increased risk of cancer in the study

population.


The review of Ohio Certificates of death for the years 1979-1985

revealed that 80 study area residents had an underlying cause of death

attributed to a malignant neoplasm. Thirty-nine of these deaths were

male, while 41 were female. The age at death ranged from 11 to 92 years.

These 80 deaths included a broad spectrum of cancer sites/types. The

only site/type specific cancers that had sufficient numbers for separate

28



analyses were brain and central nervous system cancer in the total

population <n»8); males (n=4); and -females <n=4>; breast cancer in

•females (n=8); colon cancer in the total population <n=5); and lung

cancer in the total population <n=18)j males <n=10); and females <n=8).

3. Standardized Mortality Ratios (SMRs)

The comparisons of cancer mortality -for the study population to the SEER

(12) and Ohio < 17) populations are s-ummar ized in Table 6. The

calculated SMRs are not significantly elevated -for total cancer in

males, -females or the total population; -for breast cancer in -females;

for colon cancer in the total population; or -for lung cancer in the

total population, males, or -females. However, mortality -form brain and

other central nervous system cancer was significantly elevated for the

total population for males and for females. The detailed calculations

and comparisons for the study area population, SEER and Ohio populations

are presented in Appendix Tables 6-27.

The age-specific total cancer mortality reates in the SEER pop'jlaticns

indicat that 67.66, 32.65 and 32.95 deaths would be expected in the

total, male, and female study area populations respectively. Eighty,

39, and 41 were observed in the respective populations. The calculated

SMRs are 1.18 <95 percent confidence interval 0.87-1.56)j 1.20 <95

percent confidence interval 0.83-1.67); and 1.24 (95 percent confidence

interval 0.89-1.69) respectively which are not statistically

significantly different from the expected at p < 0.05.

29



TABLE 6

Summary of Standardized Mortality Ratios — cancer mortality, 1979-84, Fields BrookStudy Area, Ashtabula County, Ohio

Total cancerTotal pop.

MaleFemale

80 74.739 34.94i 35.8

Standardized toOhio 1979-84*

SMR

1.07

95X CI

0.85-1.331.06 0.74-1.471.15 0.82-1.57

80 47.739 32.641 33.0

Standardized toSEER 1973-81

SMR 95XCI

1.18 0.94-1.471.20 0.83-1.671.24 0.89-1.49

Brain/CNSTotal pop.

MaleFemale

8 1.54 0.794 0.75

5.14 2.22-10.15*5.06 1.38-12.94*5.33 1.45-13.43*

8 1.4 5.63 2.43-11.08*4 0.75 5.33 1.45-13.63*4 0.65 6.15 1.68-15.72*

BreastFemale 8 6.6 1.21 0.52-2.36 5.9 1.36 0.59-2.68

Colontotal pop 9.1 0.55 0.18-1.29 7.8 0.64 0.21-1.50

Lung cancerTotaJ popMaleFemale

IS 19.4108

13.15.5

0.93 0.55-1.470.76 0.37-1.401.45 0.63-2.85

IB 15.710 10.38 4.5

1.15 0.68-1.620.97 0.47-1.781.78 0.77-3.50

Data compilation and calculations by Division of Epidemiology, Ohio Department o-fHealth, 1986.2Cancer mortality in Ohio, 1979-1984, Unpublished data. Division o-f Epidemiology,Ohio Department o-f Health, 1984.3National Cancer Institute, Surveillance, Epidemiology and End Results: Incidence andMortality Data, 1973-1981, N1H Publication No. 85-1837, November, 1984.

*Significantly higher than expected at p < 0.05,

30



The age-specific total cancer mortality rates in Ohio indicates that

74.65, 36.93 and 35.80 deaths would be expected in the total, male, and

•female study populations respectively. Eighty, 39, and 41 cancer deaths

were observed in the respective populations. The calculated SMRs are

1-.07 <95 percent con-f idence interval 0.85-1.33); 1.06 (95 percent

confidence interval. 0.74-1.47)? and 1.15 (95 percent confidence interval

0.82-1.57) respectively which are not statistical ly significantly

different from the expected at p < 0.05.

The age-specific brain and other c e n t r a l nervous system cancer mortality

rates in the SEER and Ohio popylatior= indicates that 1.42 and i.55

deaths would be expected in the total study population respectively.

Eight deaths were actually observed. The calculated SMRs are 5.63 (95

percent confidence interval 2.43-11.08:' j.nd 5.16 (95 percent confidence

interval 2.22-10.15) respectively which are statistically significantly

higher than expected at p < 0.05. Male brain and other central nervous

system cancer mortality rates indicate that 0.75 and 0.79 deaths would

be expected in the male study population. Four deaths were actually

observed. The calculated SMRs. are 5.33 <95 percent confidence interval

1.45-13.63) and 5.06 (95 percent confidence interval 1.38-12.94)

respectively which are statistically significantly higher than expected

at p < 0.05. Female brain and other central nervous 'system cancer

mortality rates in the comparison populations indicate that 0.65 and

0.75 deaths would be expected in the female study population. Four-

death* were actually observed, The calculated ?Mfr* are 6.15 (95 percent

31



confidence interval 1.68-15.72) and 5.33 <95 percent confidence interval

1.45-13.63) which are again statistically significantly higher that

expected at p < 0.05. There-fore, the number o-f brain and other central

nervous system cancer deaths was signi-ficantly higher for the total

population, males, and females (p <0.05) when compared to the Ohio and

SEER populations.

The age-specific breast cancer mortality rates in the female SEER and

Ohio populations indicate that 5.89 and 6.57 deaths would be expected in

the female st.udy population respectively. Eight deaths were actually

observed. The calculated SMR* are 1.36 <95 percent confidence interval

0.59-2.68) and 1.21 (95 percent confidence interval 0.52-2.38)

respectively which are not statistically significantly different from

that expected at p < 0.05.

The age-specific colon cancer mortality rates in the SEER and Ohio

populations indicate that 7.77 and 9.07 deaths would be expected in the

total study population respectively. Five deaths were -actually

observed. The calculated SMRs are 0.64 (95 percent confidence interval

0.21-1.50) and 0.55 <95 percent confidence intervals 0.18-1.29)

respectively which are not statistically significantly different from

the expected at p < 0.05.

The age-specific lung/trachea/bronchus cancer mortality rates in the

SEER and Ohio populations indicate that 15.74 and .19.41 deaths would be

expected in the total study population. Eighteen deaths were actually

observed. The calculated SMRs are 1.15 *;95 percent confidence interval

32



0.68-1.82) and 0.93 (95 percent con-fidence interval 0.55-1.47) which are

not statistically significantly different from the expected at p < 0.05.

Similar rates for males in the SEER and Ohio populations indicate that

10.33 and 13.11 deaths would be expected in the male study population.

Ten deaths were actually observed. The calculated SMRs are 0.95 <95

percent confidence interval 0.47-1.78) and 0.74 (95 percent confidence

interval 0.37-1.40) which are not statistically significantly different

from the expected at p < 0.05. Age-specific mortality rates for femalesV - i'.j

in the SEER and Ohio populations indicate that -1.76 and 4.45 deaths

would be expected in the female study population. Eight deaths were

actually observed. The calculated SMRs are 1.78 (95 percent confidence

interval 0.77-3.50) and 1.45 (95 percent confidence interval 0.63-2.85)

which are not statistically significantly different from the expected at

p < 0.05. Therefore, the mortality due to lung/trachea/bronchus cancer

in the total, male, and female study populations does not differ

significantly•< p < 0.05) from the SEER and Ohio populations.

DISCUSSION

.The analysis indicates that total cancer incidence and mortality in the study

area does not differ significantly (p < 0.05) from the U.S. and Ohio experience.

However, brain and other central nervous system cancer incidence and mortality

was found to be significantly higher than that expected (p < 0.05) even though

the number- of cases was relatively small.

33



This study should be viewed within certain perspectives. One concerns residents

that left the study area and subsequently developed cancer. These were not

included in the case definition for two main reasons: (a) It was not possible to

trace every former resident and ascertain their current health status; and (b)

This process would have rendered the population based cancer incidence

registries ineffective as comparison populations. These population based

registries ascertain cases for as long as the person lives in the designated

study area. However, if they leave the study area and are subsequently

diagnosed with cancer,, they are not counted as a case. Tracing former residents

in this study would have created an "apples and oranges" situation which would

have been misleading at best. Thus, the study populations1' cancer experience

should be viewed as a representative sample of the total cancer experience.

Cancer has ceased to be a rare disease. For a child born in 19S~, the

probability at birth of eventually developing cancer (excluding nonmelanotic

skin cancers) is about 33 percent, and the probability .of eventually dying of

cancer is about 20 percent U8). Cancer is actually a group of many different

diseases, some with a relatively long latency period. Many of these are

influenced by multiple environmental and host factors (19). Factors such as

high fat diets, excessive exposure to sunlight, tobacco use, infections, certain

reproductive and sexual practices, certain occupations, exposure to selected

chemicals and radiation, and excessive alcohol use are risks associated with

more than 80 percent of all cancer <!?).

This cancer study has indicated a statistically significantly higher than

expected burden of brain and other central nervous system cancer in the study

34



population when compared to the Ohio and U.S. experience. The risk factors -for

brain and other central nervous system neoplasms have been relatively well

de-fined, although the exact carcinogenesis mechanisms have yet to be elucidated

(20). These include genetic -factors, exposure to certain viruses and chemicals,

radiation exposure, and history of head trauma. It is not known, at this point

in time, what role (if any) potential exposures from the Fields Brook site may

have played in this increased burden. As previously noted, the U.S. EPA has

identified environmental media pathways that present potential exposure to

humans from the site as well as estimates of increased lifetime cancer risks,

assuming lifetime exposure to the environments! media <1,2>. It is imperative

to note that this increased risk is entirely dependent upon exposures to the

contaminants. However, exposure in this cancer study was only crudely defined

as being a resident in close proximity to the site. Additional action w i l l be

needed to attempt to identify risk factors, including potential exposures from

the site, for this increased burden. However, it would o^-y seem pruder* -fo^

the U.S. EPA to take all reasonable steps in *= timely a rr-r.^er *.= pos = :r'» tc

facilitate a clean-up or other action at the Fields Brook Site to minimize or

eliminate the potential exposure to environmental carcinogens and other toxins.

The primary objective of this action was to estimate the cancer burden in the

study population, to compare this burden to reliable referent populations and

make recommendations for further action, if any. The finding of a significantly

higher than expected number of brain and other central nervous system neoplasms

indicates clearly that further action is warranted. This excess burden is not

reflected in brain and central nervous system cancer m o r t a l i t y rates for the



county since the Ashtabula County and Ohio rates of 5.56 and 4.28 per 100,000

persons respectively do not differ significantly at p < 0.05. Thus it would

seem prudent that a study of these cancer cases be conducted to further define

the problem and ascertain what risk factors may have played a role in the

increased burden. This action should include: a) A detailed medical record

review of the cases to verify the diagnoses* to identify the specific type of

brain or other central nervous system cancer; as well as to ascertain the

physician's impressions of what factors may have played a role in the disease

process; and b) comprehensive interviews with the cases and/or their families

to ascertain possible risk factors for the disease, including familial history

of disease; viral, chemical and radiation exposures; occupational and

residential histories, etc. This action should be'completed in as timely a

manner as possible.

It should also be noted that exposure to various toxic agents can incrase the

risk of adverse reproductive outcomes, e.g. fetal death, low birthweight, and

birth defects <21>. Furthermore, the latency period between exposure and

reproductive damage is potentially short, so that surveillance of adverse

reproductive outcomes may provide earlier evidence of toxic effects that can

chronic diseases such as cancer. In view of the identified potential pathways

of exposure to toxic agents from the site, and the apparent high rate of be*in

and other central nervous system cancer, it would seem prudent to conduct at

least a preliminary analysis of fetal deaths, low birthweight, and birth defects

in the study population using the existing vital record system at the Ohio

Department of Heatlh. This analysis should also be conducted in as timely a

manner as possible.

36



Cancer is a very real problem in Ohio, as well as the U.S. Approximately one

person in three born in 1987 w i l l develop cancer in their lifetime. While

government agencies have a responsibility to minimize or eliminate potential

unavoidable exposures to carcinogens, there are also cri tical steps that

individuals may take to minimize their risk o-f developing cancer. Preventive

measures <e.g. stopping cigarette smoking, changing dietary habits, breast and

cervical cancer screening) can reduce the total cancer incidence and mortality

burden <22). It is clear that Ashtabula County residents should take positive

and proactive steps to work with their physicians and public health officials to

minimize their risk of cancer. These steps include, but are not limited to:

a) elimination or minimization of tobacco arid alcohol use; b) decreasing

dietary fat consumption and incresing dietary intake of fresh fruit, vegetables,

whole grains, and fiberj c) becoming aware of potential chemical or radiation

exposures in both the occupational and home environments, and following strict

guidelines to minimize or eliminate the exposure; and d) establishing regular

care and check-ups with a physician to detect cancer at its earliest stages to

maximize the probability of longevity and survival.

VI. CONCLUSIONS

A, Total cancer incidence and mortality in the population in close proximity to

the Fields Brook Hazardous Waste Site does not differ significantly

(p < 0.05) from the U.S. and Ohio experience.

B. Brain and other central nervous system cancer incidence <n=3) and mortality

(n=8) in the population in close proximity to the Fields Brook Hazardous

Waste Site is significantly higher < p < 0.05) when compared to the U.S. and

37

Division of Epidemiology, Ohio Department oi HealthFinal Report - Cancer Surveillance, Fields Brook Site


Ohio. It is not known if potential exposures from the site have played a

role in this burden.

VII. RECOMMENDATIONS

A. The U.S. Environmental Protection Agencx should take all reasonable steps in

as timely a manner as possible to -facilitate the clean-up or other action at

the Fields Brook site to minimize or eliminate the potential exposure to ^^

environmental carcinogens and other toxins.

8. The Division of Epidemiology at the Ohio Department of Health should conduct

a study of the brain and other central nervous system cancer cases to

further define the problem and attempt to ascertain what risk factors may

have piayed a role in the increased burden. This should be completed with a

Final Report by December 31, 1987.

C. The Division of Epidemiology at the Ohio Department of Health should conduct ^^

a preliminary analysis of adverse reproductive outcomes, i.e. fetal deaths,

low birthweight, and birth defects in the study population using existing

vital records. This should be completed with a Final Report by December

31, 1987.

D. The final report of this study should be made available within the community

for residents to review.

38

Division of Epidemiology, Ohio Department of HealthFinal Report - Cancer Survei1 lance. Fields Brook Site


E. The residents o-f Ashtabula County should take pos'itive, proactive steps to

identify lifestyle factors, e.g. tobacco use and dietary habits that put

them at greater risk of cancer and take appropriate steps to minimize the

r i sk.

Respectfully submitted,

Robert W. Indian, M.S.Epidemiology Investigation SupervisorChronic Disease & Special Studies UnitDivision of EpidemiologyOhio Department of HealthP.O. Box 118Columbus, Ohio 43266-0118<614> 466-0281

I (fa0Vickie Hundley, M.S

Ep identic*! ogy InvestigatorChronic Disease & SpecialDivision of EpidemiologyOhio Department of HealthP.O. Box 118Columbus, Ohio 43266-0118• ; 6 1 4 > 466-0285

I I IStudies Unit

C:fieldsbr

39



REFERENCES

1. United States Environmental Protection Agency. Final Remedial InvestigationReport; Fields Brook Site. Ash tabu la, Ohio. March 28, 1985.

2. United States Environmental Protection Agency. Preliminary Draft FeasibilityStudy: fields Brook Site. AshtabuU, Ohio. May 13, 2985.

3. World Health Organization. Manual o-f the International StatisticalClassification o-f Diseases, Injuries and Causes of Death 9th Revision; Geneva,Switzerland, 1977.

4. Press Release - Fish Advisory on the Ashtabula River, Ashtabula, Ohio, March 1,1983. The Ohio Department of Health; The Ohio Environmental Protection Agency.

5. Gray DL, Indian RW, Rao RA, and Hoitzhauer F. Toxicologic Properties ofChemical Contaminants Found in the Sediments o-f the Ashtabula River, Ashtabula,Ohio. Division of Epidemiology, Ohio Department o-f Health, Case Log Number850401, April 5, 1985.

6. Analysis of Sediment from the Ashtabula River, Ashtabula, Ohio. TechnicalReport No. 60072-02. Prepared by Floyd Brown Associates Limited (Aqua Tech) -forBuffalo District Corps of Engineers, June, 1983.

7. Si ttig M (Edi tor), Handbook of Toxic and Hazardous Chemicals. NoyesPublications, New Jersey, 1981.

8. Doull J, Klassen CD, Andur MD. Toxicology - The Basic Science o-f Poisons, 2ndEdition. MacMi11ian Publishing, Incorporated, New York, 1980.

9. Ashtabula, Ohio Ci ty Directory. RL Pol k -and Compar-y Put"; ishers: Ta^-e- ,Michigan, 1986.

10. 1980 Ohio Census of Population. General Population Characteristics. Vol. 1,Parts 37. U.S. Department of Commerce, Washington, D.C,, 1982.

11. National Cancer Institute. Surveillance, Epidemiology and End Results!Incidence and Mortality Data, 1973-1977. Monograph No. 57, Washington, D.C.,1981.

12. National Cancer Institute. Survei1 lance, Epidemiology, and End Results:Incidence and Mortality Data, 1973-1981. NJH Publication No. 85-1837, November,1984.

13. Colton T. Statistics in Medicine. Little, Brow and Companyf Boston, 1974.

14. SAS User's Guide: Basics, Version 5 Edition. SAS Institute Incorporated, Gary,North Carolina, 1985.

40


Case Log No. 850801; June 198?

References (continued)

15. Bailar JC, Ederer F. Significance factors for the ratio of a poisson variableto its expectation. Biometrics 1964; 20: 639-643.

16. Beaumont JJ, Breslow NE. Power considerations in epidemiologic studies of vinylchloride workers. American Journal of Epidemiology 1981; 114: 725-734.

17. Cancer mortality in Ohio, 1979-1984. Unpublished data. Division ofEpidemiology, Ohio Department of Health, 19S7.

18. Seidman H, Mushinski MH, Geld SK, Silverberg E. Probabilities of eventuallydeveloping or dying of cancer - United States, 1985. Ca-A Cancer Journal forClinicians. 1985; 35: 36-56.

19. Doll R, Peto R. The causes of cancer: quantitative estimates of avoidable risksof cancer in the United States today. Journal of the National Cancer Institute.1981; 66: 1191-3198.

20. Schoenberg BS. Nervous System <cancer) IN: Schottenfeld D, Fraumeni JF(Editors). Cancer Epidemiology and Prevention, pp, 968-983. W.B. SaundersCompany, Philadelphia, 1982.

21. Mattison DR (Edi tor). Reproductive Toxicology. Pregnancy Research Branch,National Institute of C h i l d Health and Human Development, National Institutes ofHealth, Bethesd-a, Maryland.

22. Foege WH, Arnler RUI, White CC. Closing the gap: Report of the Carter Centerhealth policy consultation, Journal of the American Medical Association !985;254: 1355-1358.

41



APPENDIX TABLES



APPENDIX 1

Standardized Incidence Ratio - total cancer incidence, total population.1977-June 30, 1986, Fields Brook Study Area, Ashtabula, Ohio, and SEER ' ,

January 1

Age(years)

0*45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-4465-6970-7475-7980-8485+

SEER 1973-81average-annual age-spec i -fie

mortality rate (per 100,000 persons)

18.610.410.519.229.546.770.2

109.8185.3309.2488.5717.8

1061.1141.3177.3

2060.22251.92358.9

Personyears

187.66241.00256.25326.92313.59248.10260.75236.67204.59192.09247.41309.9230?. 58219,65125.5083.6681.1772.4?

Expected *o-f cases

0.0340.0250.0260.0620.0920.1250.1830.25?0.37?0.5931.2082.2243.2843.1042.2251 .7231.8271 .70?

Observed ftof cases

1

1

32261

12

TOTALS 3937.03

Observed 19

19,594 1?

Standardized Incidence Ratio = Expected = 19.5? = 0.97

The 95X confidence interval is 0.58-1 .51 ; there-fore, there is no significantdifference at p < 0.05.

Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.?"Data compilation and calculations by Division o-f Epidemic! ogy, Ohio Department ofHealth, 1987.

43



APPENDIX 2

Standardized Incidence Ratio - total cancer incidence, males,. January 1, 1977-June30, 1986, Fields Brook Study Area, Ash tabuU, Ohio, and SEER ' .

Age(years)

0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

SEER 1973-81average-annual agt-specific

mortality rate (.per 100,000 persons)

18.311.211.620.329.540.652.271.9126.6238.3432.3729.71167.73730.62377.12937.63380.93622.1

Personyears

84.25121.16138.00195.09165.99134.17136.50143.00108.4284.67101.08135.92146.5891 .3454.8342.1632.6736.75

Expected 41o-f cases

0.0150.0130.0160.0390.0480.0540.0710.1020.1370.2010.4360.9911.711i .5901.3031 .2381.1041 .331

Observed Hof cases

1

1

124

11

TOTALS 1952.58

Observed 11

10.400

J M

11

Standardized Incidence Ratio » Expected = 10.400 = 1.06

The 495X confidence interval is 0.53-1.90 j there-fore, there is no significantdifference at p < 0.05.1Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.

"Data compilation and calculations bv Division of Epidemiology, Ohio Department ofHealth, 1987.



APPENDIX 3

Standardized Incidence Ratio - total cancer incidence, females,30, 1986, Fields Brook Study Area, Ashtabula, Ohio, and SEER ' ,

January 1, 1977-June

SEER 1973-81Age average-annual age-specific Person

(years) m o r t a l i t y rate (per 100,000 persons) years

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5940-4465-4970-7475-7980-8485+

19.09.59.3

18.229.452.988. 3

147.9243.4378.4542.3704.8945.71155.81341 .11524.41677.31819.2

103.41119.84118.25131.8S147.60133.93124.2593.4794.17107.42144.33174.00143.00128.3470.4741.5048.5035.74

Expected Itof cases

0.0190.0110.0100.0230.0430,0700.1090.1380.2340.4060.7931.2291.5741.4830.9470.6320.8130.650

Observed ttof cases

31*>1

1

TOTALS 1984.45 9.194

Observed 8Standardized Incidence Ratio = Expected = 9.19 « 0.87

The 95X confidence interval is 0.38-1.71 ; there-fore, there is no significantdifference at p < 0.05.1Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.

Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987.

Division of Epidemiology) Ohio Department o-f HealthFinal Report - Cancer Surveillance, Fields Brook Site


Standardized1977-June 30,

APPENDIX 4

Incidence Ratio - lung cancer incidence, total population*1986, Fields Brook Study Area, Ash tabu la, Ohio, and SEER ' .

January 1

SEER 1973-81Age average-annual age-spec i fie Person

(years) mortality rate (per 100,000 persons) years

0-45-9

10-1415-1920-2425-2?30-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

0.00.00.00.10.10.51.46.618.544.587.9137

205.9265.2293

280.8232.6172.1

187.66241

256.25326.92313.59268.10260.75236.67204.59392.09247.41309.92309.58239.68125.5083.6681 .3772.49

Expected *of cases

0.0000.0000.0000.0000.0000.0010.0030.0150.0370.0850.2170.4240.6370.5320.3670.2340.1880.124

Observed fto-f cases

1i1

TOTALS 3937.03 3.005

Observed 3Standardized Incidence Ratio » Expected = 3.00 = 1.0

The 95X confidence interval is 0.21-2.92; there-fore, there is no significantdifference at p < 0.05.

'Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.>"Data compilation and calculations by Division of EpidemioloQX, Ohio Department ofHealth, 1987.

Standardized1, 1977-June



APPENDIX 5

Incidence Ratio - brain/CNS cancer incidence, total populatioa, January30, 1986, Fields Brook Study Area, Ashtabula, Ohio, and SEER ' .

SEER 1973-81Age average-annual age-specific Person

<years) mortality rate "(per 100,000 persons) years

0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

3.32.52.31.72

2.53.14.34.87.210.312.815.119.419.617.616.36.2

187.66241.00256.25326.92333.59268.10260.75236.67204.59192.09247.41309.92309.58239.68125.5083.6681 .1772.49

Expected ftof cases

0.0060.0060.0050.0050.0060.0060.0080.0100.0090.0130.0250.0390.0460.0420.0240.0140.0130.004

Observed ttof cases

1

11

TOTALS 3937.03 0.291

Observed 3Standardized Incidence Ratio = Expected = 0.29 = 10.34

The 95X confidence interval is 2.13-30.23; there-fore, there is a significantdifference at p < 0.05.1Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.>"Data compilation and calculations by Division o-f Epidemiology, Ohio Department ofHealth, 1987.

47


Case LOQ No. 850801; June 1987

APPENDIX 6

Standardized Mortality Ratio - total cancer mortalit>Fields Brook Study Area, Ash tabu la, Ohio, and SEER '

total population, 1979-85,

Age(years)

0-45-910-2415-1920-2425*2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

SEER 1978-81average-annual age-specific


4.34.64.05.26.69.516.231.463.4123.3217.2333. 2510.5697.2918.81139.51362.21588.9

StudyArea

population

3623713623844354073112291831882242382292011821337364

Expected tto-f deaths

0.1080.1190.1010.1390.2000.2700.3520.5030,8121.6223.4055.6348.1839.80911.70510.6086.9607.118

Observed Ito-f deaths

2

11

123291299

11117

TOTALS 4576

Observed 80

67.658 80

Standardized Mortality Ratio = Expected * 67.7 =1.18


Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUpited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.2Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987.

48



APPENDIX 7

Standardized Mortalitx Ratio - total cancer mortality,Study Area, Ashtabula, Ohio, and SEER '

males, 1979-85, Fields Brook

Age(years)

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8465+



4.65.24.86.18.1

11.115.827.058.6121.5228.2373.4608.5885.31260.11637.12031.52394.8

StudyArea

population

1761892052141791841621311091091181161058563382017

Expected ftof deaths

0.0560.0680.0680.0910.1010.1420.1790.2470.4470.9271 .8843.0844.4725.2675.5574.3542.8442.849

Observed ttof deaths

2

122

5745353

TOTALS 222; 32.645 39

ObservedStandardized Mortality Ratio = Expected = 32.6 = 1.20

The 95X confidence interval is 0.83-1.67; there-fore, there is no significantdifference at p < 0.05.1Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.I"Data compilation and calculations by Division of Epidemiology, Ohio Department o-fHealth, 1987.

49



APPENDIX 8

Standardized Mortal!tx Ratio - total cancer mortality, -females, 1979-85, Fields BrookStudy Area, Ash tabula, Ohio, and SEER1'^

SEER 1978-81 StudyAge average-annual age-specific Area

(years) mortality rate (per 100,000 persons) population

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84

85+

4.04.03.24.35.07.9

16.635.768.1

125.0206.8305.8422.9543.2668.2826.5

1014.51238.7

186182157170256223149987479

1061201241U119955347

Expected 41o-f deaths

0.0520.0500.035

,0.0510.0890.1230.1730.2440.3520.6911.5342.5683.6704 .4105.5665.4?63.763 .4.075

Observed tto-f deaths

2

11

124554864

TOTALS 2354 32.950 41

Observed 41Standardized Mortality Ratio = Expected = 33.0 = 1.24

The 95X confidence interval is 0.89-1.69j therefore, there is no sign if leantdifference at p < 0.05.1Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.>"Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987.



APPENDIX 9

Standardized Mortality Ratio - total cancer mortality, toJFields Brook Study Area, Ashtabula County, Ohio, and Ohio *'

population, 1979-85,

Age(years)

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Ohio 1979-84average-annual age-specif ic

mortality rate <per 100,000 persons)

4.64.74.05.36.6

10.318.136.769.7

136.6323.0372.7576.1797.81030.51275.01429.11646.5

StudyArea

population

36237136238443540731122918318822423822?2011821337364

Expected *o-f deaths

0.1180.1220.1020.1430.2020.2930.3960.5880.8931.7983.6386.2109.235

11 .22513,1291 1 .8707.3027.376

Observed tto-f deaths

2

11

123291299

11117

TOTALS 4576

Observed 80

74.650 80

Standardized Mortality Ratio = Expected » 74.7 = 1.07

The 95X confidence interval is 0.85-1 .33; there-fore, there is no sign if icantdifference at p < 0.05.1Ohio 1979-84 cancer mortality data compilation and calculations by Division ofEpidemiology, Ohio Department of Health, 1985.

'Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987.

51



APPENDIX 10

Standardized Mortality Ratio - total cancer mortality,Study Area, Ashtabula, County, Ohio, and Ohio '

males, 1979-85, Fields Brook

Age(years)

0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Ohio 1979-84average-annual age-specific


5.05.34.56.28.010.916.330.964.3133.3250,5436,5701,41038.71449.71900.02164.02465.4

StudyArea

population

1761892052141791841621311091091181181058563382017

Expected Hof deaths

0.0610.0710.0640.0940.1010.1410.1850.2830.4911.0372.0693.6055.1556.1806.3935.0543.0292.933

Observed ftof deaths

2

122

5745353

TOTALS 2222

Observed 39

36.934

Standardized Mortality Ratio = Expected = 36.9 = 1.06

The 95X confidence interval is 0.74-1.47; therefore, there is no significantdifference at p < 0.05.1Ohio 1979-84 cancer mortality data compilation and calculations by Division ofEpidemiology, Ohio Department of Health, 1985.

>'Data compilation and calculations by Division of Epidemiology* Ohio Department ofHealth, 1987.



APPENDIX 11

Standardized Mortality Ratio - total cancer mortality, -females, 1979-85,Study Area, Ashtabula County, Ohio, and Ohio *

Fields Brook

Age(years)

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

i B = —— B=«a JBM BBS5BS«»S 5=S « Sm Sf fSWfSm «B»» •SS.—ifa— — — — =S



4.34.03.54.35.29.6

19.942.174.7

139.8214.9315.8467.5607.9739.1910.11063.81306.4

StudyArea

population

136182157170256223149987479106120124116119955347

Expected 41of deaths

0.0560.0510.0390.0520.0940.15!0.2080.2890.3870.7731.5942.6524.0584 . 9366.1566.0523.9464.298

Observed flof deaths

2

11

124554864

TOTALS 2354 35.798 41

Observed 41Standardized Mortality Ratio = Expected = 35.8 =1.15

The 95X confidence interval is 0.82-1.57; there-fore, there is no significantdifference at p < 0.05.1Ohio 1979-84 cancer mortality data compilation and calculations by Division ofEpidemiology, Ohio Department of Health, 1985.?"Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987.

Division of Epidtmiology, Ohio Department o-f HealthFinal Report - Cancer Surveillance, Fields Brook Site


APPENDIX 12

Standardized Mortality Ratio - brain/CNS cancer mortality,Fields Brook Study Area, Ash tabula, Ohio, and SEER ' .




0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

0.8i.l0.80.80.71.01.42.03.34,57.59.711.415.816.114.612.55.0

3623713623844354073112291831882242382292011821337364

Expected ttof deaths

0,0200.0280.0200.0210.0210.0280.0300.0320.0420.0590.1170.1610.1820.2220.2050.1350.0630.022

"Bgg=aaBB«jES


11

12

111

TOTALS 4576

Observed 8

1.416

Standardized Mortality Ratio « Expected » 1.4 = 5.63

The 95X confidence interval it 2.43-11,08; there-fore, there is a significantdifference at p < 0.05.

'Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.>"Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987.

Division of Epidemiology, Ohio Department o-f HealthFinal Report * Cancer Surveillance, Fields Brook Site


APPENDIX 13

Standardized Mortality Ratio - brain/CNS cancer mortal ity,Fields Brook Study Area, Ash tabu U County, Ohio, and Ohio '


Ohio-1979-84 StudyAge average-annual age-specific Area

(years) mortality rate <per 100,000 persons) population

0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

1.31 .30.90.70.71.21.72.93.24.67.4

10.113.416.315.916.314.85.9

3623713623844354073112291831882242382292011821337364


0.0330.0340.0230.0200.0240.0340.0370.0470.0410.0600.1170.1680.2150.2300.2030.1520.0760.026

Observed Kof deaths

11

12

111

TOTALS 4576 1.545


The 95X confidence interval is 2.22-10.15; there-fore, there is a significantdifference at p < 0.05.1Ohio 1979-84 cancer mortality data compilation and calculations by Division o-fEpidemiology, Ohio Department of Health, 1985.

Data compilation and calculations by Division o-f Epidemiology, Ohio Department ofHealth, 1987.



APPENDIX 14

Standardized Mortality Ratio - brain/CNS cancer mortality,Brook Study Area, Ash tabuU, Ohio, and SEER ' ..

rnal es, 1979-85, Fi el ds



0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485*

0.91.00.90.90.81.41.72.34.45.68.9

11.714.118.919.719.616.38.0

1761892052141791841621311091091181181058563382017


0.0120,0130.0120.0130.010o.oie0.0190,0210.0330.0420,0730.0960.1030.1120.0860.0520.0220.009

Observed Ito-f deaths

l"1

2

TOTALS 2222

Observed

0.753

Standardized Mortality Ratio = Expected - 0.75 = 5.33

The 95X confidence interval is 1,45-13.63; there-fore, there is a significantdifference at p ( 0.05.1Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1337,November, 1984.s"Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987.



APPENDIX 15

Standardized Mortality Ratio - brain/CNS cancer mortality, males, 1979-85, FieldsBrook Study Area, Ash tabu la County, Ohio, and Ohio ' .

Ohio 1979-84 StudyAge average-annual age-specific Area


0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5940-4445-4970-7475-7980-8485+

1.21.21.00.90.81.72.24.03.95.39.0

11.914.319.118.421.417.77.5

1741892052141791841421313093093181181058543382017

Expected tto-f deaths

0.0150.0140.0150.0140.0110.0220.0250.0340.0300.0400.0740.0990.1050.1130.0820.0570.0240.008

Observed flo-f deaths

31

2

TOTALS 2222

Observed

0.794


The 95X confidence interval is 1.38-12.94; therefore, there is a significantdifference at p < 0.05.1Ohio. 1979-84 cancer mortality data compilation and calculations by Division ofEpidemiology, Ohio Department of Health, 1985.

>"Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987.



APPENDIX 16

Standardized Mortality Ratio - brain/CNS cancer mortality, -females, 1979-85, FieldsBrook Study Area, Ashtabula, Ohio, and SEER ' .



0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-4465-4970-7475-7980-8485+

0.71.30.60.70.50.61.01.72.23.46.37.99.013.113.511.410.53.6

186182157170256223149987479106120124116119955347

Expected #of deaths

0.0090.0160.0040.0080.0080.0090.0100.0110.0110.0180.0460.0660.0780.1060.1120.0750.0380.011

Observed Itof deaths

1

111

TOTALS 2354 0.647

QbservedStandardized Mortality Ratio * Expected = 0.65 = 6.15

The 95X confidence interval is 1.68-15.72; there-fore, there is a significantdifference at p < 0.05.1Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981, National Cancer Institute. N1H Publication No. 85-1837,November, 1984.




APPENDIX 17

Standardized Mortality RatioBrook Study Area, Ash tabula,

- brain/CNS caocOhio, and Ohio '

ar mortali ty, females, 1979-85, Fields

OHIO 1979-84 StudyAge average-annual age-specific Area

(years) mortality rate <per 100,000 persons) population

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

1.31.30.70.60.70.71.21.92.4'3.86.08.412.614.114.013.313.45.2

186182157170256223149987479106120124116119955347

Expected *tof deaths

0.0170.0170.0080.0060.0320.0110.0120.0130.0120.0210.0450.0700.1090.1140.1170.0880.0490.017

Observed flof deaths

1

111

TOTALS 2354 0.749


The 95X confidence interval is 1.45-13.63; there-fore, there is a significantdifference at p < 0.05.

Ohio 1979-84 cancer mortality data compilation and calculations by Division o-fEpidemiology, Ohio Department of Health, 1985.2Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987.



APPENDIX 18

Standardized Mortality Ratio - breastBrook Study Area, Ashtabula, Ohio, and SEER

cancer, mortality,* »* females, 1979-85, Fields

SEER 1978-81 Study -Age average-annual age-specific Area


0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5?60-6465-6970-7475-7980-8485 +

0.00.00.00.00.10.75.0

11.723.239.058.178.089.197.9

110.0112.1144.7170.4

186182157170256223149987479106120124116119955347


0.0000.0000.0000.0000.0010.0100.0520.0300.1200.2150.4310.6550.7730.7940.9160.7450.5360.560

Observed Mo-f deaths

1

21112

TOTALS

ObservedStandardized Mortality Ratio = Expected

2354

5.9 = 1.36

5.894

The 95X confidence interval is 0.59-2.68; therefore, there is no significantdifference at p < 0.05.

Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.2Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987,

60



APPENDIX 19

Standardized Mortality Ratio - breast cancer mortality,Brook Study Area, Ash tabuU County, Ohio, and Ohio ' .

females, 1979-85, Fields

Age(years)

0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+



0.00.00.00.00.01.36.313.926.243.160.177.897.0309.4126.9142.7144.1192.3

StudyArea

populat i on

186182157-170256223149987479106120124U6119955347

Expected M Observed ftof deaths of deaths

0.0000,0000,0000.0000,0030.0230.0660.0950.1350.238 10.4460.6540.8420.888 21.057 30.949 30.534 10.632 2

TOTALS 2354 6.565

Observed 8Standardized Mortality Ratio = Expected = 6.6 =3.21

The 95X confidence interval is 0.52-2.38; therefore, there is no significantdifference at p < 0.05.2Data compilation and calculations by Division of Epidemiology., Ohio Department ofHealth, 1987.

61



APPENDIX 20

Standardized Mortality Ratio - colon cancer mortality,Fields Brook Study Area, Ashtabula, Ohio, and SEER ' .


SEER 1978-81 StudyAge average-annual age-spec i lie Area


0-45-9

10-14 .15-1920-2425-2930-3435-3940-4445-4950-5455-5940-4445-6970-7475-7980-8485+

0.00.00.00.00.10.51.12.04.08.4

14.430.149.273.4

108.2150.7201.8253.7

3423713423844354073112291831882242382292031821337344


0.0000.0000.0000.0000.0030.0140.0230.0320.0510.1100.2570.5010.7881 .0351.3781.4031.0311,134

Observed Ko-f deaths

1

1

111

TOTALS 4574

Observed

7.767

Standardized Mortality Ratio » Expected ~ 7.8 ~ 0.44


Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.>'Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987.

62


Cast Log No. 850801; June 1987

APPENDIX 21

Standardized Mortality Ratio - colon cancer mortality,Fields Brook Study Area, Ash tabu la County, Ohio, and Ohio


Age(years)

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7JJ75-7980-8485 +

Ohio 1979-84average-annual age-spec i -fie


0.00.00.00.00.20.61.12.15.1

10.117.533.156.1 ,88.5128.8178.6230.1296.3

StudyArea

population

3623713623844354073112291831682242382292011821337364

Expected tt Observed *of deaths of deaths

0.0000.0000.0000.0000.0060.0180.0230.0340.0650.1340.2750.553 10.9001.245 11 .6421.663 11.176 11.327 1

TOTALS 4576

Observed

9.067



Ohio 1979-84 cancer mortality data compilation and calculations by Division ofEpidemiology, Ohio Department of Health, 1985.2Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987.

63



APPENDIX 22

Standardized Mortality Ratio - lung/trachea/bronchus cancer mortalitypopulation, 1979-85, Fields Brook Study Area, Ashtabula, Ohio, and SEER ' .

total

Age< years)

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

SEER 1978-81average-annual age-spec i -fie


0.00.00.00.10.10.31.14.613.232.065.1101.0155.1199.5236.5236.3212.5166.5

StudyArea

population

3623713623844354073112291831882242382292011821337364

Expected Ko-f deaths

0.0000.0000.0000.0020.0030.0080.0230.0730.1690.4211.0201.6822.4862.8063.0132.1991.0850.745

Observed fto-f deaths

1

11442212

TOTALS 4576

Observed

15.743 18

Standardized Mortality Ratio » Expected = 1$.7 = 1.15

The 95X confidence interval is 0.68-1.82; there-fore, there is no significantdifference at p < 0.05.1Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.

"Data compilation and calculations by Division of Epidemiology, Ohio Department o-fHealth, 1987.

64

Division 6f "^Epidemiology, Ohio Department of HealthFinal Report - Cancer Surveillance, Fields Brook Site


APPENDIX 23

Standardized Mortality Ratio - lung/trachea/bronchus cancer rnorfa^population

Age(years)

0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

, 1979-85, Fields Brook Study Area, Ashtabula, Ohio,



0.00.00.00.00.00.31.05.2

15.139.175.4128.8193.1

, 256.9292.4292.9240.3191.4

StudyArea

population

3623713623844354073112291831882242382292011821 337364

and Ohio '


0.0000.0000.0000.0010.0020.0090.0230.0840.1940.5151.1822.1453.0963.6153.7262.7271.2280.857

ity total•


1

11442212

TOTALS 4576 19.411 18

Observed 18Standardized Mortality Ratio = Expected * 19.4 * 0.93


Ohio 1979-84 cancer mortality data compilation and calculations bx Division ofEpidemiology, Ohio Department of Health, 1985.2Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987.



APPENDIX 24

Standardized Mortality Ratio - luno/trachea/bronchys.cancer mortality males, 1979-85,Fields Brook Study Area, Ash tabu la, Ohio, and SEER ' .

Age(years)

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+



0.00.00.00.10.10.41.15.5

17,342.191.0

145.4236.4325.6421.6465.3459.7366.5

StudyArea

population

1761892052141791841621311091091.181181058563362017

Expected «of deaths

0.0000.0000.0000.0010.0010.0050.0120.0500.1310.3210.7511.2011.7371 .9371.6591.2370.6430.436

Observed ttof deaths

1

2221

2

TOTALS 2222

Observed 10

10.328 10

Standardized Mortality Ratio « Expected = 10.3 » 0.97

The 95X confidence interval is 0.47-1.78; therefore, there is no significantdifference at p < 0.05.1Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.


66



APPENDIX 25

Standardized Mortality Ratio -Fields Brook Study Area, Ashtabula County, Ohio, and

lung/trachea/bronchus cancer-mortality males, 1979-85,Ohio1'*.

Age< years)

0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Ohio 1979-84average-annual age-specif ic


0.00.00.00.00.00.31.36.419.951.2107.5195.6299.2425.0540.4605.3527.2434.8

StudyArea

population

1761892052141793841621311091091181181058563382017

Expected *of deaths

O.DOO0.0000.0000.0000.0010.0050.0150.0590.1520.3910.8883.6152.1992.5292.3831.6100.7380.517

Observed fto-f deaths

1

2221

2

TOTALS 2222

Observed II

13.106



Ohio 1979-84 cancer mortality data compilation and calculations' by Division ofEpidemiology, Ohio Department of Health, 1965.2Data compilation and calculations by Division of Epidemiology, Ohio Department cfHealth, 1987.

67



APPENDIX 26

Standardized Mortality Ratio - lung/trachea/bronchus cancer mortality females, 1979-85, Fields Brook Study Area, Ashtabula, Ohio, and SEER ' .

Age(years)

0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6445-6970-7475-7980-8485+



0.00.10.00.10.16.21.13.79.222.340.360.182.596.3100.692.384.179.5

StudyArea

population

186182157170256223149987479106120124116119955347

Expected Hof deaths

0.0000.0010.0000.0010.0010.0030.0110.0250.0470.1230.3020.5040.7160.7810.8370.6130.3120.261

Observed «of deaths

1

122

11

TOTALS 2354

Observed 8

4.546



Surveillance, Epidemiology and End Results: Cancer Incidence and Mortality in theUnited States. 1973-1981. National Cancer Institute. NIH Publication No. 85-1837,November, 1984.

"Data compilation and calculations by Division of Epidemiology, Ohio Department ofHealth, 1987.

68



APPENDIX 27

Standardized Mortality Ratio - luno/trachea/bronchus cancer mortality femal85, Fields Brook Study Area, Ashtabula County, Ohio, and Ohio * .

es, 1979-

Age< years)

0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6445-6970-7475-7980-8485+

Ohio 1979-84average-annual age-spec

mortality rate (per 100,000

0.00.00.00.00.00.20.74.210.727.845.569.1

101.2124.3120.0no. 697.790.4

Studyi-fic Areapersons) population

186182157170256223149987479106120124116119955347

Expected tf Observed ftof deaths of deaths

0.0000.0000.0000.0000.0010.004 10.0080.0280.0550.1540.338 10.580 20.878 21.0101.000 10.735 10.3620.297

TOTALS 2354 5.45?

Observed 8Standardized Mortality Ratio = Expected = 5.5 = 1.45

The 95X confidence interval is 0.63-2.85; there-fore, there is no sign if icantdifference at p < 0.05.

Ohio 1979-84 cancer mortality data compilation and calculations by Division ofEpidemiology, Ohio Department of Health, 1985.2Data compilation and calculations by Division o-f Epidemiology, Ohio Department ofHealth, 1987.

fieldsbr

69

246 N High StreetPost OH ice Box MSColumbus. Ohic 43266-01 '8

Telephone (614| 466-3543

RICHARD F. CELESTEGovernor

August 5* 1986

Resident

Ashtabuia/ Ohio 44004

Dear Community Member:

As you nay already be aware, the Ohio Department of Health and the AshtabulaCounty Health Department have been requested to determine the cancer burden in thepopulation in close proximity to the Fieldsbrook Hazardous Waste Site in Ashtabulaand Ashtabula Township.

The main objective of our investigation is to determine the number of new cancercases in the community from January 1* 1977 through June 30* 1986. To facilitateour efforts we are asking the support of the residents to supply some vitalinformation concerning age, sex* race* length of residence* and history of cancer,All information will be kept strictly confidential. Only summary figures will bepresented for the entire community.

The success of the investigation greatly depends upon accurate and promptresponses by everyone in the community. Therefore we respectfully request yourparticipation in this survey. Within the next few weeks a representative fromeither the Ohio Department of Health or the Ashtabula County Health Departmentwill be stopping by your household to request a short interview. This interviewwill take approximately 20 minutes to complete. Your participation is bothencouraged and greatly appreciated. Please remember that this information will beheld strictly confidential.

If you have any questions or comments regarding this study please feelcall the Ashtabula County Health Department at 576-6010.

Sincerely/

free to

Robert W. Indian/ M.S.Epidemiology Investigation SupervisorChronic Disease and Special Studies UnitDivision of EpidemiologyOhio Department of HealthP.O. Box 118Columbus/ Ohio 43266-0118(614) 466-0281

RWI/RS/spfieldlet

Ray Sapor ito/ H.P.H.Health CommissionerAshtabula County Health DepartmentOld CourthouseJefferson/ Ohio 44047(216) 576-6010

246 N H.9* Suect f£gLlg*l<BiJ>:L\ RICHARD F. CELESTEPost OH.ce Bo, 118 lar~-^^q= GovernorColumbus, Oh.o 43266-0118 l V •-" '-=^ J governor

Telephone iSUl 466-3543

November 14, 1986

Current ResidentEast 1st Street

Ashtabula, Ohio 44004

Dear Community Member!

As you may already be aware, the Ohio Department o-f Health has been reouetted todetermine the cancer burden in the population in close or oximi ty to theFieldsbrook Hazardous Waste Site in Ashtabula and Ash tabu la Townshic-.

The main objective o-f our investioation is to determine the number of new cancercases in the community -from January 1, 1977 throuoh June 30. 1986. To facilitateour efforts we are askino the support of the residents to su:o'> s?me vita 1

information concernina aoe, sex, race, lenoth of residence, and histo rv c* cancer.Information reoardino personal identifiers w i l l not be released. Only summaryfioures w i l l be presented for the entire corwnuru tv.

The success of the investioation greatly depends upon accurate and orcrotresponses by everyone in the community. Therefore we respectful"? y reouest yourparticipation in this surve*. Within the next -*ew days a ^eorese-<t-ati ve fro~the Ohio Department of Health w i l l be stoppino by your home to r-ecue*t *interview. This interview will take approximate' y 20 minutes to cornp1ete.participation is both encouraoed and oreatly appreciated.

If you have any questions orcontact us at 1-800-282-0546.

Sincerely.

comments reoardino tM« stud? pie=» = i

Robert Ul. Indian, M.S.Epidemiology Investigation SupervisorChronic Disease and Special Studies UnitDivision o-? EpidemiologyOhio Department of HealthP.O. Box 118Columbus. Ohio 43266-0118(614) 466-0281

Deborah L. Gray, M.S.Epidemiology Investigation SupervisorEnvironmental UnitDivision of EpidemiologyOhio Department of HealthP.O. Box 118Columbus, Ohio 43266-0118<614> 466-5972

RWI/DLG/sp

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