USPHS Scientific and Training Symposium University of Maryland School of Public Health
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Transcript of USPHS Scientific and Training Symposium University of Maryland School of Public Health
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USPHS Scientific and Training SymposiumUniversity of MarylandSchool of Public Health
College Park, MarylandTrack 2 - Clinical and Community Preventive ServicesCharles Carroll Room, Stamp Student Union Building
Wednesday, 2:30 – 3:00 PM June 20, 2012
Cancer Assessment in Hinkley:the Real ProblemJohn W. Morgan, DrPH, CPH1,2
Mark E. Reeves, MD, PhD2
1Loma Linda University (LLU) School of Public HealthDept. Epidemiology, Biostatistics & Population Medicine
2Loma Linda University Cancer Center
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Background/Problem:
Since the mid-1990s, staff in the Desert Sierra Cancer Surveillance Program (DSCSP) have monitored cancer occurrence in the Hinkley Census Tract of San Bernardino County in response to concerns about a potential cancer excess.
Findings released by the DSCSP in 1997 and in 2000 failed to identify an excess in the occurrence of cancer in the Hinkley Tract.
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Background/Problem:
“I would like to thank the academy … .”
Erin B.2000
In spite of the absence of evidence of a cancer excess in Hinkley …
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Region 6(North)
Region 3(Sacramento)
Region 5(Desert Sierra)
Region 7(San Diego)
Region 4(Tri-County)
Region 1(Santa Clara)
Region 8(Bay Area)
Region 2(Central Valley)
Region 9 (Los Angeles)
Region 10 (Orange)
San Bernardino
Riverside
Regions forming the California Cancer Registry
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San Bernardino County
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Hinkley
PG&E
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PG&E Hinkley Natural Gas Pumping Station
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PG&E Pumping Station Cooling Ponds
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PG&E Hinkley Natural Gas Pumping Station
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Hinkley
PG&E
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Inhaled Cr[VI] powder is accepted as a carcinogen, while the roleof aqueous Cr[VI]aq as a human carcinogen has been challenged. Aqueous Cr[VI]aq exists in equilibrium with Cr[III]aq, with the valence state determined by pH and other mineral ions.
Ingested CR[VI]ag is reduced to Cr[III]ag in saliva and blood. Cr[III] is essential for glucose metabolism and is an ingredient of multiple vitamin supplements that include minerals.
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Hypothesis:
HA: The number of new invasive cancer cases inCensus Tract 119.00 (Hinkley) will exceed the number of cases expected for the demographic configuration of the
tract during 1996-2008.
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Methods:
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The Standardized Incidence Ratio (SIR) was used to evaluate the ratio of Observed to Expected new cancer cases in census tract 119.00 for 1996-2008, balancing the effects of age, sex, race/ethnicity, and population size.
Observed CasesSIR = Expected Cases
Age Tract 119.00Sex measured inR/E 2000 CensusSize
Age DSCSPSex 1996-2008R/ESize
/ /Unique (Hinkley)
Average (DSCSP)
Age
Sex R/E Size
Age
Sex R/E Size
SIR > 1: Observed Count Greater Than Expected Count
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The Standardized Incidence Ratio (SIR) was used to evaluate the ratio of Observed to Expected new cancer cases in census tract 119.00 for 1996-2008, balancing the effects of age, sex, race/ethnicity, and population size.
Observed CasesSIR = Expected Cases
Age Tract 119.00Sex measured inR/E 2000 CensusSize
Age DSCSPSex 1996-2008R/ESize
/ /Unique (Hinkley)
Average (DSCSP)
Age
Sex R/E Size
Age
Sex R/E Size
SIR > 1: Observed Count Greater Than Expected Count
SIR = 1: Observed Count Same As Expected Count
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The Standardized Incidence Ratio (SIR) was used to evaluate the ratio of Observed to Expected new cancer cases in census tract 119.00 for 1996-2008, balancing the effects of age, sex, race/ethnicity, and population size.
Observed CasesSIR = Expected Cases
Age Tract 119.00Sex measured inR/E 2000 CensusSize
Age DSCSPSex 1996-2008R/ESize
/ /Unique (Hinkley)
Average (DSCSP)
SIR > 1: Observed Count Greater Than Expected Count
SIR = 1: Observed Count Same As Expected Count
SIR < 1: Observed Count Less Than Expected Count
Age
Sex R/E Size
Age
Sex R/E Size
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Results:
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Table 3. Numbers of observed and adjusted expected new invasive cancers, SIRs, and 95 percent confidence interval limits for SIRs for all cancers and for selected cancer types - Hinkley Tract 1996-2008.
Adjusted 95% CI Cancer Site Observed Expected SIR for SIR All cancer Sites (combined) 196 216.42 0.91 0.78, 1.04
Nasopharynx (nasopharyngeal ca) 0 0.21 <1 undefined Respiratory 38 32.97 1.15 0.82, 1.72Lung & bronchus 34 30.12 1.13 0.78, 1.58
Digestive 29 40.55 0.72 0.48, 1.03Pancreas 0 5.00 <1 undefined *
Cervix uteri 7 2.48 2.83 1.12, 5.86 *Childhood cancer (age <20) 5 2.44 2.05 0.65, 4.82
Esophagus & stomach 7 5.21 1.34 0.53, 2.79Hematopoetic system 20 16.86 1.19 0.72, 2.04
Thyroid gland <5 <5 0.34 <0.10, 1.97Oral cavity & oropharynx <5 >5 0.38 <0.10, 1.38Urinary bladder 5 9.25 0.54 0.17, 1.27Cutaneous melanoma 6 9.81 0.61 0.22, 1.34Brain & other nervous system <5 <5 0.68 <0.10, 2.49Liver & intrahepatic bile ducts <5 <5 0.74 <0.10, 2.73Breast 27 34.52 0.78 0.51, 1.14Intestine (SI, CRC, & R/S JX) 18 22.71 0.79 0.47, 1.26Kidney & renal pelvis 5 5.30 0.94 0.30, 2.22
Prostate gland 22 34.11 0.65 0.40, 0.98 *
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The SIR for colorectal cancer (CRC) cases was 0.87, although 33% of the cases in the Hinkley Tract were diagnosed at advanced stage, compared to 18% in the county, region, and statewide
Results continued:
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Conclusions/Discussion:
Evidence of the need to promote screening for prevention and early detection of cancer of the: A. Cervix uteri B. Colon and Rectumin remote desert communities like Hinkley
No evidence of a generalized cancer excess was detected in the Hinkley Tract for 1996-2008. This is consistent with three previous cancer
assessments extending back to 1988 and is now enlarged toinclude childhood cancer and 18 cancer site groups
Evidence of deficits in the number of: A. digestive system cancers, including pancreatic cancer, and of B. prostate cancer
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The tragedy of Hinkley is that the $333 Million legal settlement distracted the world from the real cancer problem ; inadequate cancer screening in a poor and remote desert community.
Chasing phantoms is apoor substitute for cancer control.
Don Quixote
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Thank YouFor Your Attention
I would like to thank the academyUSPHS
for the opportunity to present these findings.
USPHS
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Aftermath
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Authors of the Harvard Report on Cancer Preventionformed the following conclusions about the percentages
of cancer deaths among Americans attributable to various characteristics
Tobacco use
Poor nutrition
Sedentary lifestyle
Pollution, pesticides, herbicides, technology, etc. 2%
30%
30%
5%
Harvard Report on Cancer Prevention
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