Health Consultation: Evaluation of Cancer Incidence in Census Tracts

of Attleboro and Norton, Massachusetts: 1982-2002

Suzanne K. CondonAssociate Commissioner

Jan Sullivan, DirectorCommunity Assessment Program

MA Department of Public HealthCenter for Environmental Health

January 2007

Presentation Outline

Introduction and background Methods Results Conclusions Questions and Discussion

Center for Environmental Health (CEH)

Protect the public health from a variety of environmental exposures

Respond to environmental health concerns and provide communities with epidemiologic and toxicological health assessments

Community Assessment Program (CAP)

Evaluate frequency and patterns of disease in the population

Respond to concerns about disease patterns or “clusters”

Investigate possible associations between environmental exposure and disease

ATSDR

Agency for Toxic Substances and Disease Registry

Within the U.S. Centers for Disease Control MDPH has a cooperative agreement with

ATSDR to conduct Health Consultations in MA

Reason for Investigation

Concerns about cancer incidence in Norton and Attleboro, particularly in neighborhoods near the Shpack Landfill

Requested by concerned residents

Background

1989: Preliminary Health Assessment of Shpack Landfill

1993: Site Review and Update 2001: Evaluation of Female Lung Cancer Incidence

and Radon Exposure in Attleboro for 1982-1994 2002: Phase I: Evaluation of Cancer Incidence in

Attleboro and Norton, 1994-1998 2006: Cancer Incidence in Census Tracts of

Attleboro and Norton: 1982-2002

Health Consultation (HC)

A review of available health outcome data (cancer incidence data) associated with a site where hazardous substances have been released.

Evaluation of Cancer Data

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

Evaluate geographic patterns of cancer in each town

Evaluate patterns of cancer in relation to Shpack Landfill

Evaluate available cancer risk factor information

Massachusetts Cancer Registry (MCR)

Population-based surveillance system established in 1982

Massachusetts law requires reporting of all newly diagnosed primary cancers in MA residents

Confidential database

MCR (cont’d)

At the time of this report, statewide and city/town data were complete through 2002– (Data for 2003 were recently released)

Diagnoses reported to the MCR after 2003 are available for review

13 Cancer Types Evaluated

Hodgkin’s disease Leukemia Non-Hodgkin’s lymphoma Multiple myeloma Cancers of the bladder, bone, brain and

central nervous system (CNS), breast, kidney, liver, lung, pancreas, and thyroid

Cancer data evaluated

Cancer rates for 4 time periods– 1982-1987– 1988-1993– 1994-1999– 2000-2002

Statistical Methods

Standardized Incidence Ratio

95% Confidence Interval

100#

#x

casesofExpected

casesofObservedSIR

Geographic Distribution Analysis

Map locations of residences reported at time of cancer diagnosis

Evaluate spatial patterns of cancer in neighborhoods within each community

Evaluate patterns of cancer in relation to Shpack Landfill

Risk Factor Information

Age Smoking Occupation

Other risk factors– Genetics, family history– Lifestyle factors

Summary of Community-Wide Findings

With some exceptions, the majority of cancer types occurred at or near expected rates in Attleboro and Norton during 1982-2002

Six of 13 cancer types occurred at or near expected rates in both towns and in their census tracts across all time periods (bone, kidney, leukemia, multiple myeloma, NHL, and pancreas)

Summary of Community-wide Findings

At some point in time, six of 13 cancer types were statistically significantly elevated either in Attleboro, Norton, or in one of their census tracts– In Attleboro: Hodgkin’s disease and cancers of

the bladder, breast, liver, and thyroid– In Norton: brain

Except for lung cancer, the elevations did not persist over time

Lung Cancer in Attleboro

Lung cancer was statistically significantly elevated in Attleboro females during 1988-1993 and in Attleboro males during 1994-1999

Lung Cancer Risk Factors

Age Smoking Second-hand smoke Occupation/environmental exposures

Review of Risk Factors: Lung Cancerin Attleboro Females 1988-1993

Age distribution did not appear unusual– 89% were age 50 or older– Average age was 66

Known Smoking History: Lung Cancer

Smoking History of Females with Lung Cancer in Attleboro, 1988-1993

88%

12%

0%

20%

40%

60%

80%

100%

Smoking History

% o

f ca

ses

wit

h

kn

own

sm

okin

g h

isto

ry

Current/Former Smoker Non-smoker

Review of Risk Factors: Lung Cancerin Attleboro Males 1994-1999

Age distribution did not appear unusual– 94% were age 50 or older– Average age was 67

Known Smoking History: Lung Cancer

Smoking History of Males with Lung Cancer in Attleboro, 1994-1999

89%

11%

0%

20%

40%

60%

80%

100%

Smoking History

% o

f ca

ses

wit

h

kn

own

sm

okin

g h

isto

ry

Current/Former Smoker Non-smoker

Attleboro CT 6317

Cancer Type

Rate < or About As Expected

Rate > Expected Rate Statistically Significantly > Expected

Bladder 1982-1987, 1994-1999, 2000-2002

1988-1993

Bone 1982-2002

Brain & CNS

1982-2002

Breast 1982-1987, 1994-1999, 2000-2002

1988-1993

Hodgkin’s 1982-2002

Kidney 1982-2002

Attleboro CT 6317

Cancer Type

Rate < or About As Expected

Rate > Expected Rate Statistically Significantly > Expected

Leukemia 1982-2002

Liver 1982-2002

Lung 1982-2002

Multiple Myeloma

1982-2002

Attleboro CT 6317

Cancer Type Rate < or About As Expected

Rate > Expected Rate Statistically Significantly > Expected

NHL 1982-1987, 1994-1999, 2000-2002

1988-1993

Pancreatic 1982-2002

Thyroid 1982-2002

Review of Breast Cancer Risk FactorsAttleboro CT 6317, 1988-1993

Age patterns were as expected– 82% were over 50 at diagnosis compared to 80%

statewide

Stage at diagnosis similar to statewide experience– 66% of Attleboro women were diagnosed at

earliest stage compared to 62% statewide

Norton CT 6112

Cancer Type Rate < or About As Expected

Rate > Expected Rate Statistically Significantly > Expected

Bladder 1982-2002

Bone 1982-2002

Brain & CNS 1982-1999 2000-2002

Breast 1982-2002

Hodgkin’s 1982-2002

Norton CT 6112

Cancer Type Rate < or About As Expected

Rate > Expected Rate Statistically Significantly > Expected

Kidney 1982-1987, 1994-1999, 2000-2002

1988-1993

Leukemia 1982-2002

Liver 1982-2002

Lung 1982-1987, 1994-1999, 2000-2002

1988-1993

Norton CT 6112

Cancer Type Rate < or About As Expected

Rate > Expected Rate Statistically Significantly > Expected

Multiple Myeloma

1982-2002

NHL 1982-1987, 1994-2002

1988-1993

Pancreatic 1982-1987, 1994-2002

1988-1993

Thyroid 1982-2002

Brain & CNS Cancer in Norton

Brain cancer occurred about as expected in males and females in all time periods except the most recent

In CT 6112 in 2000-2002, 5 diagnoses were observed in males versus 1 expected

Review of Brain Cancer Risk FactorsNorton CT 6112, 2000-2002

Age and gender patterns were as expected– More diagnoses among males, as expected– Average age at diagnosis was 66 years– 4 of 5 males were > 50 years old at diagnosis

The subtypes of brain cancer reported were as expected– 4 of 5 brain cancers were of glioma subtype, the

most common form of adult brain cancer

Within one-mile radius of Shpack Landfill

From 1982 to present, 35 different cancer types diagnosed among 208 individuals

Most common diagnoses (>60%) were lung & bronchus, breast, prostate, and colo-rectal cancer; consistent with statewide trends (54-58%)

Age pattern as expected (78% were age 50 or greater at diagnosis)

Within one-mile radius of Shpack Landfill

No unusual spatial or temporal patterns in cancer incidence or in types of cancer diagnosed within one-mile radius of Shpack Landfill

Within one-mile radius of Shpack Landfill

For those 74 individuals with a cancer type for which smoking is a risk factor and whose smoking history was reported, 62% were current or former smokers.

An evaluation of the spatial distribution of the nonsmokers’ residences did not show any unusual patterns.

Summary of Major Findings

Some elevations in cancer types occurred in some census tracts during certain time periods, in both Attleboro and Norton, but no consistent patterns were seen with respect to time with one exception.

Lung cancer was elevated in Attleboro over two time periods.

Risk Factor Analysis Summary

Age and gender patterns in both towns were similar to statewide and national patterns

Smoking likely played a role in the incidence of some cancer types in both communities

Summary of Spatial Patterns of Cancer

No apparent spatial patterns at the neighborhood level were seen that would suggest a common factor related to the cancer diagnoses

No unusual geographic concentrations of individuals diagnosed with cancer near Shpack Landfill

Recommendations

Exposure opportunities will be evaluated in the Public Health Assessment.

Cancer incidence can be further evaluated at that time to assess if any unusual patterns exist in relation to environmental exposure opportunities.

Upon request, MDPH’s Environmental Health Education and Outreach Program will prepare educational materials on cancer risk reduction.

Next Steps

30-day public comment period Response to public comments Release final Health Consultation

Questions and Answers

How to contact MDPH

Suzanne K. Condon, Associate CommissionerJan Sullivan, Director, Community Assessment Program

Massachusetts Department of Public HealthCenter for Environmental Health250 Washington Street, 7th floor

Boston, MA 02108

Telephone: (617) 624-5757Fax: (617) 624-5777www.mass.gov/dph

Contact Information

The full report is available at:

http://www.mass.gov/dph/ceh