Download Understanding cancer risk “one-in-a-million”

Cancer and
Jefferson County
A Presentation
Prepared by the University of Louisville, School of
Public Health Depts. of Epidemiology and Clinical
Investigation Sciences and Occupational and
Environmental Health, and the Lung Cancer Project
Should I be concerned?


We all should be concerned about air
quality and look for ways to reduce
emissions of chemicals, especially air
toxics
And we should keep the risks in
perspective
“Good surveillance
does not necessarily
ensure the making
of right decision,
but it reduces the
chances of the
wrong ones.”
Alexander Langmuir, MD,
MPH; Director of
Epidemiology for CDC
from 1949-1969
Problem Chemicals & Community Concerns

Butadiene


Chromium


Sources: Vehicles, 3 manufacturers (plans in place to
reduce)
Sources: Electricity generation, boilers, plating
Acrylonitrile

Sources: 2 manufacturers (plans in place to reduce)
Understanding cancer risk
“one-in-a-million”




Cancer risk is enormous
“Everybody wants to go to heaven, but
nobody wants to die” – Aging is a critical
factor in cancer increase & risk
Environmental risk is incredibly small
1/1,000,000 is an enormous prevention
goal, NOT a useful thing to fear
Region 4 Air Toxics
Ranked Risk Screening
Analysis
Cancer Risk to Age 70 and Ever: Breast Cancer for
Women, Prostate Cancer for Men
25
11/1000
20
15
10
0.001/1000
5
0
Age 70 + Ever
WF
AAF
Age 70
WM
AAM
African-American men’s risk for prostate cancer rises
from 1:8 until age 70 and then to 1:5 ever (lifetime) risk.
Cancer Risk to Age 70, Ever, and Environmental Increase
one-yr
18.3
females
18.3
To 70
Ever
Env.
….
one-yr
21.5
males
21.5
15
20
25
30
35
40
45
50
Risk to age 70 is 215,000/1,000,000; environmental
protection aims to keep that to 215,001/1,000,000
Data Monitoring in Rubbertown



EPA monitoring identified Jefferson County
as having the highest health risk posed by air
quality, in the Southeastern US.
State funding permitted follow-up air
monitoring studies to be performed in the
Rubbertown area during 2001
Disease risk is also able to be assessed for
asthma and cancer.
Comparisons by Race for Stage, Treatment, Payor
Stage at Diagnosis
70
 Considerable Stage Difference
65.4
60
WF
50
AAF
Percent
40
40
33.3
26.9
30
26.7
Treatment [First Course]
20
10
33.3
30.8
35
7.7
30
0
IV
Unstaged
Percent
Earlier
26.7
25
No Trtx and ‘all Other’ varies 
15.4
15
5
6.7
6.6
3.8
0
None
40
37
Surg
RadTx
Chem/Rtx
All Other
All UofL
AdenoLung wf
23
AdenoLung bf
19.4
19.2
13.3
13.3 11.7
7.76.7
Commercial
Medicare
7.3
14.9
12
7.3
Welfare
17.1
Private
19.2
4
All Other
26.9
Medicaid
% Paying
45
40
35
30
25
20
15
10
5
0
26.9
23.1
AfrAmF
20
10
Payment Pattern Uof L [All Admissions] vs
Adencocarcinoma of the Lung 1999-2001
26.7
WF
 Method of Payment is quite
different by race, and from the
Overall Hospital Pattern
University of Louisville and BCC Lung Cancer,
Adenocarcinoma for Females: 1999-2000
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
Percent
Surviving
WF
AAF
0
6 mos.
1 Yr.
18 mo.
2 Yrs.
30 mo.
3 Yrs.
“The reason for collecting, analyzing, and
disseminating information on a disease is
to control that disease. Collection and
analysis should not be allowed to consume
resources if action does not follow.”
Foege, Hagan, Newton: International Journal of
Epidemiology, 5: 29-37. 1976.
‘Its amazing what you can see when you look...”
Yogi Berra
Michael R. Hicks, MA
Voice: 502-852-4061 Fax: 502-852-3294
E-mail: [email protected]
Fairouz Saad, MPH
Voice: 502-852-4061 Fax: 502-852-3294
E-mail: [email protected]
Tim E. Aldrich, Ph.D., MPH
Voice: 502-852-3006 Fax: 502-852-3294
E-mail: [email protected]
University of Louisville
School of Public Health and Information Sciences
Dept. Epidemiology and Clinical Investigation Sciences
Louisville, Kentucky 40202