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

  • Introduction and background

  • Methods

  • Results

  • Conclusions

  • Questions and Discussion


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Center for Environmental Health (CEH) Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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) Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

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

  • Requested by concerned residents


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Background Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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) Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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) Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 (cont’d) Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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


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Cancer data evaluated Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • Cancer rates for 4 time periods

    • 1982-1987

    • 1988-1993

    • 1994-1999

    • 2000-2002


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Statistical Methods Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • Standardized Incidence Ratio

  • 95% Confidence Interval


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Geographic Distribution Analysis Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • Age

  • Smoking

  • Occupation

  • Other risk factors

    • Genetics, family history

    • Lifestyle factors


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Summary of Community-Wide Findings Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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


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Lung Cancer in Attleboro Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • Age

  • Smoking

  • Second-hand smoke

  • Occupation/environmental exposures


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Review of Risk Factors: Lung Cancer Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002in 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002


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Review of Risk Factors: Lung Cancer Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002in 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002


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Attleboro CT 6317 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002


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Attleboro CT 6317 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002


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Attleboro CT 6317 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002


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Review of Breast Cancer Risk Factors Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002Attleboro 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002


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Norton CT 6112 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002


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Norton CT 6112 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002


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Brain & CNS Cancer in Norton Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Factors Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002Norton 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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 Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 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.


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Next Steps Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

  • 30-day public comment period

  • Response to public comments

  • Release final Health Consultation


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Questions and Answers Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002


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How to contact MDPH Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

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: (617) 624-5757

Fax: (617) 624-5777

www.mass.gov/dph


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Contact Information Census Tracts of Attleboro and Norton, Massachusetts: 1982-2002

The full report is available at:

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


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