E. J. Holowaty and P. Brown Division of Preventive Oncology Cancer Care Ontario Dec 8, The Ontario Health and Environment Information System (OHEIS) P.E.I. Potato farms a hotbed of cancer debate From The Cancer Blog, Mar 27, Breast cancer more likely in farm workers: From CTV News Oct 12, 2006.

From the UK Black Enquiry, 1984

Small Area Health Statistics Unit and the Rapid Inquiry Facility (RIF) n Spatial mapping and risk assessment n Funding proposal submitted to GeoConnections n Modeled on EUROHEIS in European Union and Natl Environmental PUBLIC Health Tracking Network in USA n Starting point for further R&D at CCO n Spatio-temporal models n Continuous spatial variation n Screening and mortality

Surveillance Question n Do known population characteristics (RFs, SES, demographics) fully explain cancer incidence, or –Is the variability between areas higher than we would expect if each area had an identical cancer risk? –Do neighbouring areas tend to have similar cancer incidence rates?

A Spatial Model

Maps and Exceedence Probabilities

Aim of OHEIS Project n To design, implement and test an enhanced spatial surveillance system to improve our understanding of the association between environmental exposures, health outcomes and confounding risk factors. n Integrated information systems (GIS) for mapping and risk ass’t n Rapid assessment (3-6 mos. <1 week) n Scientifically sound, robust, understandable and transparent n Easily export data to more sophisticated spatial analysis systems – WINBugs; SATScan n To deploy data, software and/or results to PH partners thru web- based portal and/or stand-alone, secure PC application.

Environmental and geographic data Roads, Railways, Rivers Road Traffic Chemical Release Radiation release or exposure Locations of refineries, incinerators, dumps Water supplies Oracle/Access, GIS Cancer Deaths Births Hospital admissions Congenital anomalies Stillbirths and perinatal deaths Health event data Oracle/Access Census data (1976,1981, 1986,1991, 1996, 2001) Deprivation Census geography Area classification Oracle/Access, GIS Postcode EA, CT Link data Postcode – EA/DA Street Address - EA CSD, CD boundaries …. etc.. …. Vectors, polygons Integrated Information Systems airborne waterborne foodborne soil Pathway Analysis and Exposure Modelling Name? Street address Postal code Municipality Historic Pop’n Files Smoking Screening Confounders

A Study of the Association Between Cancer Rates and TCE Ground Water Contamination in Communities Surrounding Hill Air Force Base, Utah from

Exposure Data n Graphic plume boundaries –5-10 ug/l TCE – sampling period n Limited pathway data –Indoor air intrusion –Plant sampling

Exposed population : Utah

Select Shape Files, Popn Centroids and Test for Homogeneity

Tests for Homogeneity and Linear Trend

Routine Tabular Output

Time Advantage of Utah test

Export Functionality

Next Steps n Feasibility Phase 3 mos. n Privacy issues; public and stakeholder acceptability - Users surveys; Focus groups; privacy impact ass’t n Preparation of detailed scientific protocol n Submission to GeoConnections n External scientific review n REB Review

Next Steps n Feasibility Phase 3 mos. n DB design; software acquisition n Creation of “test” cohort and comparison cohort n Develop record linkage strategies n Review of methods of Pathway Analysis and exposure estimation - point/line/area source n Statistical issues - minimizing random var.; adjusted estimates; multilevel, multivar. Modelling

Next Steps n Implementation and Enhancements –4 mos. n Testing and Deployment – 6-7 mos n Final Report – 1-2 mos