1. Camp Lejeune Cancer Incidence Study (CIS): A retrospective cohort study
Frank J. Bove, Sc.D, MS
Agency for Toxic Substances and Disease Registry (ATSDR)/
Centers for Disease Control and Prevention (CDC)
NAACCR/IACR Combined Annual Conference, June 13, 2019
Agency for Toxic Substances and Disease Registry

2. Researchers Principal Investigator: Contractor: Frank J. Bove, ScD, MS
Agency for Toxic Substances and Disease Registry (ATSDR) / Centers for Disease Control and Prevention (CDC)
Contractor:
Battelle Memorial Institute
Project Director: April Greek, PhD
Project Manager: Ruth Gatiba, MPH

3. Researchers Subcontractors:
North American Association of Central Cancer Registries
Assistant Project Director: Betsy Kohler, MPH, CTR
Recinda Sherman, MPH, PhD, CTR
Castine Clerkin, MS, CTR
Information Management Services, Inc. (IMS)
Donald Green, BS
William Howe, BS, BA
University of Southern California –Los Angeles
Rich Pinder, BA
Dennis Deapen, PhD

4. Objectives
Determine if exposures of marines and civilian workers to contaminated drinking water at Camp Lejeune were associated with increased risks of cancers.
Did Camp Lejeune marines and workers have higher incidence rates for cancers than comparison cohorts of marines and workers?
Within the Camp Lejeune cohorts, were there exposure-response relationships between cumulative exposures to the drinking water contaminants and increased incidence rates of cancers?
This is a “data-linkage” study. There was no contact with the people in the study. The Defense Manpower Data Center (DMDC) data were used to identify the Camp Lejeune and Camp Pendleton cohorts.

5. Cohorts Marine/Navy personnel, 1975 - 1987 (N=521,154)
Camp Lejeune = 241,513
Camp Pendleton = 256,697
New River Air Station = 22,944
Civilian employees, 1972 – 1987 (N=15,447)
Camp Lejeune = 8,024
Camp Pendleton = 7,423
We are conducting a retrospective cohort study using cancer incidence and cause of death data. The purpose of the study is to determine whether exposures to drinking water contaminants at Camp Lejeune are associated with increased risk of specific cancers. This is a data linkage study that does not involve contact with cohort members.
The study population of 536,631 cohort members consists of two cohorts at Camp Lejeune (Marines/Navy personnel and civilian employees) and comparison cohorts from Camp Pendleton. Those in the Camp Pendleton cohorts were never stationed or employed at Camp Lejeune during the period of drinking water contamination.
Quarterly personnel data from the Defense Manpower Data Center (DMDC) were used to identify the Camp Lejeune and Camp Pendleton cohorts. Unit information necessary to determine where the Marines/Navy personnel were stationed first became available from the DMDC database in the second quarter of For the civilian employees, DMDC data on Department of Defense (DOD) employment began in the last quarter of 1972.

6. Information Sources Defense Manpower Data Center personnel records
Social security number, name, date of birth, sex, race, unit code, base location
Camp Lejeune base family housing data
Locator firm (TransUnion), Social Security Administration (SSA) data, and the National Death Index (NDI)
Vital status, current address, state and date of death
Personally identifiable information (PII) from the DMDC database that includes social security number; first, middle, and last names which are available for most subjects; date of birth; sex, and race will be used to determine the vital status of cohort members as of December Additionally, a locator firm will be used to obtain the current address for those who are determined to be alive through 2017.
Cause of death information for all decedents, on both underlying and all contributing causes of death, will be obtained from the National Death Index (NDI).
Information on the areas served by each drinking water system, the areas where units were barracked, family housing records and location of worksites will be used to assign exposures.

7. Cancer registry data
Veterans Affairs Central Cancer Registry, Department of Defense Automated Central Tumor Registry, state and territorial cancer registries
Cancer incidence data linked to personal identifier information
Primary site
SEER summary stage-1977
Histologic type
Derived summary stage
Laterality
Sequence number
Behavior code
State of diagnosis
Grade
Age at diagnosis
Diagnostic confirmation
Date of diagnosis
SEER summary stage-2000
“DCO” case (y/n)
Data on all primary invasive cancers and in situ bladder cancers will be obtained via data linkage with federal (VACCR, DOD-ACTUR) and state cancer registries.
ATSDR will provide the cancer registries with the PII, vital status, current address for those alive in 2017, and multiple (underlying and contributing) cause of death data and state and date of death for decedents for matching with their database.
Each registry will be asked to provide cancer information to ATSDR linked to the cohort member’s PII used in the matching process. This table shows the data needed from each cancer registry.

8. Why national data?
Camp Lejeune and Camp Pendleton cohorts reside in all 50 states and U.S. territories
To minimize bias, registry data must be available for a high percentage (e.g., >90%) of both cohorts
Comprehensive case ascertainment necessary for adequate statistical power since many cohort members will be <65 years old at end of follow-up
To minimize bias, registry data must be available for a high percentage (e.g., >90%) of both cohorts – Camp Lejeune and Camp Pendleton Marines retire to different states
Median age of marines (both at CL and CP) will be 59 years by the end of About 90% of CL marines will be under 65 years of age by the end of (87% of CP marines).

9. Analyses Comparisons between Camp Lejeune and Camp Pendleton cohorts
January 1996 – December 2017
Comparisons internal to Camp Lejeune cohorts
As far back as registry has complete data or January 1973, whichever is later, through December 2017
The Marines/Navy cohorts will be analyzed separately from the civilian worker cohorts because their drinking water exposure experiences were different
Comparisons between CL and CP limited to because almost all of the cancer registries were collecting data in 1996
For internal comparisons of the CL cohort, we can start follow up as early as 1973 because it will minimize bias due to incomplete ascertainment (bias will not likely be related to exposure)

10. Progress to date Applications submitted to 51 cancer registries
Full approval received from 49 registries:
45 state registries
VACCR, D.C., Puerto Rico, Pacific Island Jurisdiction

11. Next steps Obtain study approvals from remaining registries
Obtain data security agreements and other materials from each registry prior to participation in the linkage
Finalize agreements with TransUnion, SSA, and NDI to obtain current address and vital status information
Each cancer registry performs linkage with cohort data

12. Questions?