Download Screening for increased cancer risk near toxic waste sites

Screening for increased cancer
risk near toxic waste sites
Recinda Sherman, MPH CTR
Florida Cancer Data Systems
NAACCR Annual Meeting, June 2008
Background:
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Cluster detection & surveillance
• Routine surveillance versus reactive cluster
investigations
– No a priori assumptions of boundary location
• Ho = even distribution of dx by geography
– Increases likelihood of identifying a true cluster
• Targeted prevention activities
– Cluster concern response more thorough, timely, consistent
and scientific
• Active versus Passive
– Rapid intervention
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Cluster detection & surveillance
• Develop new cluster detection surveillance
model for Florida
– Investigate technology
• SaTScan, ClusterSEER
– Quantify methodological limitations
– Systematic framework for identifying communities
at risk
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Disparities in breast cancer
• Entire cancer continuum
• Education, Poverty
– Race/ethnicity surrogate?
• Geography
– Pacific NW, Marin County, Long Island
– Demographic driven?
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Risk factors for breast cancer
• Immutable
– Age, sex, genetics
• Modifiable
– Hormone replacement
– Motherhood
• Age, parity, breastfeeding
– Alcohol use
– Obesity/Physical activity
Environmental ??
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Methods:
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Florida Cancer Data Systems
• Inception date 1981
– 1981 Hospital data
– 1995 CDC-NPCR enhancement
• Physician office, death certificates, freestanding radiation,
pathology
• 2nd largest in nation
– 95,000 incidence cases per year
• Operated by University of Miami Miller Medical
School
– Under DOH contract
• NAACCR Gold
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Florida breast cancer data
• 1998-2002
– Straddle census 2000
• 77,729 cases
• 88% geocoded
– 70% exact street level match
– 5% imprecise street level match
– 8% bg/tract centroid/st intersection
– 3% zipcode centroid
Environmental data
• EPA NPL sites
– National priorities among the known releases or
threatened releases of hazardous substances,
– Guide EPA in determining which warrant further
investigation
• 39 NPL Sites
– Potential breast cancer carcinogens
• benzene, cadmium, chromium, polycyclic aromatic
hydrocarbons (PAHs), pesticides, and vinyl chloride
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Focused test
• Lawson & Waller Test
– ClusterSEER
• Detect clustering around a suspected point
source
– Evaluates the pattern of disease frequency the
closer to a specific location
– Multiple geographic areas scored for difference
between the O/E and weighted by distance from
the point of interest
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Results:
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Hazard scores
• Hazard ranking system
– Used to place waste sites on NPL
– Assess potential for threat to human health or
environment
• Hazard score for sites with identified clusters
higher
– 43.99 versus 45.99
– range 30.19-59.81
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Potential carcinogens
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Potential exposure routes
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Income gradient
Table 3.
Distance from sites with
identified clustering
Household Income
Median
Mean
5 Miles
40,684
52,070
3 Miles
34,607
43,019
1 Mile
30,392
37,865
Florida Average
42,111
53,547
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EPA assessments
• Public health assessment
• Health consultation
– Conducted when there is a specific exposure
question
– None of the sites with statistically higher risk had a
health consultation performed
– This may indicate low levels of advocacy
concerning these sites
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Methodological limitations
Registry
Implications:
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Future Focus
• Proactive surveillance by registry
– “Screening” tool for areas for further focus/epi
investigation
– Hypothesis generating
• Collaboration between Registry and
Environmental Health, others
• Community partnership
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Data, data everywhere & not a thought to
think
• Underlying demographics
– Artifact? Residential Segregation? Contagion?
– Primary assumption – denominator problem
• Rule out
• Release of cluster data
– Communicate Risk
– Prioritize
– Ability to follow up with intervention
• External partners
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Questions?
Thank you to our funders:
Thank you to my colleagues:
• Dr. David Lee
– UM, Miami, FL
• Dr. Greg Kearny
– FL DOH, Tallahassee, FL
• D. Jennifer Hu
– UM, Miami, FL
• Dr. Geoffrey Jacquez
– TerraSEER, Inc, Ann Arbor,
MI
• Dr. Lora Fleming
– UM, Miami, FL
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