Health Consultation: Evaluation of Cancer Incidence in Census Tracts of Attleboro and Norton, Massac

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Health Consultation Evaluation of Cancer
Incidence in Census Tracts of Attleboro and
Norton, Massachusetts 1982-2002

• Suzanne K. Condon
• Associate Commissioner
• Jan Sullivan, Director
• Community Assessment Program

MA Department of Public Health Center for
Environmental Health January 2007
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Presentation Outline

• Introduction and background
• Methods
• Results
• Conclusions
• Questions and Discussion

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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

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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

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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

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Reason for Investigation

• Concerns about cancer incidence in Norton and
  Attleboro, particularly in neighborhoods near the
  Shpack Landfill
• Requested by concerned residents

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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

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Health Consultation (HC)

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

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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

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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

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MCR (contd)

• 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

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13 Cancer Types Evaluated

• Hodgkins disease
• Leukemia
• Non-Hodgkins lymphoma
• Multiple myeloma
• Cancers of the bladder, bone, brain and central
  nervous system (CNS), breast, kidney, liver,
  lung, pancreas, and thyroid

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Cancer data evaluated

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

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Statistical Methods

• Standardized Incidence Ratio
• 95 Confidence Interval

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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

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Risk Factor Information

• Age
• Smoking
• Occupation
• Other risk factors
• Genetics, family history
• Lifestyle factors

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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)

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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 Hodgkins disease and cancers of
  the bladder, breast, liver, and thyroid
• In Norton brain
• Except for lung cancer, the elevations did not
  persist over time

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Lung Cancer in Attleboro

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

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Lung Cancer Risk Factors

• Age
• Smoking
• Second-hand smoke
• Occupation/environmental exposures

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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

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Known Smoking History Lung Cancer
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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

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Known Smoking History Lung Cancer
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Attleboro CT 6317
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Attleboro CT 6317
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Attleboro CT 6317
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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

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Norton CT 6112
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Norton CT 6112
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Norton CT 6112
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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

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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

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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)

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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

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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.

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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.

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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

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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

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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, MDPHs Environmental Health
  Education and Outreach Program will prepare
  educational materials on cancer risk reduction.

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Next Steps

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

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Questions and Answers
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How to contact MDPH

• Suzanne K. Condon, Associate Commissioner
• Jan Sullivan, Director, Community Assessment
  Program
• Massachusetts Department of Public Health
• Center for Environmental Health
• 250 Washington Street, 7th floor
• Boston, MA 02108
• Telephone [phone]
• Fax [phone]
• www.mass.gov/dph

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Contact Information

• The full report is available at
• http//www.mass.gov/dph/ceh