1. Bureau of Environmental Health Assessment Massachusetts Department of Public Health February 13, 2002 Public Meeting: MDPH Activities in South Weymouth and Neighboring Communities

2. Bureau of Environmental Health Assessment Massachusetts Department of Public Health February 13, 2002 Assessment of Cancer Incidence in Rockland, Weymouth, Abington, and Hingham, MA 1982-1998

3. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 3 Reason for Investigation ä Concerns about increased cancer near the NAS ä Requests by: Q Senator Michael Morrissey, Q Weymouth Board of Health, and Q Concerned residents in Rockland, Weymouth, Abington, and Hingham

5. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 5 Community Cancer Concerns ä Suspected increases in cancer in the four towns ä Possible link to environmental contamination present at NAS ä Suspected increases in cancer in other areas of the four towns unrelated to NAS

6. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 6 Investigative Approach ä Calculate cancer rates for each town and by smaller areas (census tracts) ä Evaluate available cancer risk factor information ä Evaluate geographic patterns of cancer in each town ä Evaluate patterns of cancer in relation to environmental sources (particularly NAS)

7. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 7 Massachusetts Cancer Registry ä Population-based surveillance system established in 1982 ä Massachusetts law requires reporting of all newly diagnosed primary cancers in Mass. residents ä Confidential database

8. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 8 Eight Cancer Types Evaluated ä Bladder ä Brain ä Kidney ä Leukemia ä Liver ä Lung ä Non-Hodgkin’s Lymphoma (NHL) ä Pancreas

9. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 9 Cancer Data Evaluated ä 1982-1998 ä Three smaller time periods Q 1982-1986 Q 1987-1994 Q 1995-1998

10. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 10 Statistical Methods ä Standardized Incidence Ratio Observed # of cases Observed # of cases SIR = x 100 Expected # of cases Expected # of cases ä 95% Confidence Interval

11. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 11 Summary of Major Findings ä The majority of cancer types evaluated occurred at or near the expected rates in the four towns and in their census tracts ä Lung cancer was statistically significantly elevated in three of the four towns

12. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 12 Summary of Major Findings ä In Weymouth, leukemia and pancreatic cancer were statistically significantly elevated in some time periods ä Some isolated elevations in cancer types occurred in some census tracts during certain time periods

13. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 13 Statistically Significant Findings ä Lung cancer elevated in Weymouth, Abington, and Rockland ä Lung cancer lower than expected in Hingham ä Pancreatic cancer elevated in Weymouth during 1982-1986 ä Leukemia elevated in Weymouth during 1987-1994

14. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 14 Lung Cancer Incidence in Weymouth, MA

15. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 15 Lung Cancer Incidence in Rockland, MA

16. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 16 Lung Cancer Incidence in Abington, MA

17. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 17 Lung Cancer Incidence in Hingham, MA

18. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 18 Factors Considered ä Cancer may be caused by one or many different factors ä Review of MCR data on cancer risk factors Q age/gender Q smoking history Q occupation

19. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 19 Lung Cancer Risk Factors ä Age ä Smoking ä Second-hand smoke ä Occupation/environmental exposures

20. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 20 Review of Risk Factors: Lung Cancer ä Age and gender patterns did not appear unusual ä Workplace exposures may have played a role in some diagnoses ä Majority of those with lung cancer were current or former smokers

21. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 21 Smoking History: Lung Cancer

22. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 22 Smoking History: Lung Cancer

23. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 23 Smoking History: Lung Cancer

24. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 24 Smoking History: Lung Cancer

25. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 25 Cancer Rates by Census Tract ä SIRs were also calculated for the census tracts that subdivide each of the four towns Q 8 CTs in Weymouth Q 3 CTs in Abington Q 3 CTs in Hingham Q 2 CTs in Rockland

30. Lung Cancer Incidence 1982-1986 rate = or < expected rate > expected rate statistically significantly > expected

31. Lung Cancer Incidence 1987-1994 rate = or < expected rate > expected rate statistically significantly > expected

32. Lung Cancer Incidence 1995-1998 rate = or < expected rate > expected rate statistically significantly > expected

33. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 33 Pancreatic Cancer Incidence in Weymouth, MA

34. Pancreatic Cancer Incidence 1982-1986 rate = or < expected rate > expected rate statistically significantly > expected

35. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 35 Review of Risk Factors: Pancreatic Cancer ä Age patterns were as expected ä More women than men were diagnosed with pancreatic cancer ä Workplace exposures possible ä Smoking may have played an important role for some individuals

36. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 36 Smoking History: Pancreatic Cancer

37. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 37 Leukemia Incidence in Weymouth, MA

38. Leukemia Incidence 1987-1994 rate = or < expected rate > expected rate statistically significantly > expected

39. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 39 Review of Risk Factors: Leukemia ä Age and gender patterns did not appear unusual ä A variety of different leukemia subtypes were reported ä Workplace exposures may have played a role in some diagnoses

40. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 40 Evaluation of Geographic Distribution ä Place of residence at time of diagnosis was mapped for each individual ä Patterns of individuals diagnosed with cancer were evaluated spatially ä Other factors that may indicate a cluster were considered

41. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 41 Community Environmental Concerns ä Naval Air Station ä Potentially hazardous waste sites (21E sites) ä Weymouth Neck Landfill ä Specific community environmental concerns in Weymouth and Hingham ä Suburban Auto and two landfills in Rockland

43. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 43 Sources of Environmental Information ä ATSDR Public Health Assessment ä Environmental Baseline Study ä ATSDR Private Well Survey ä Modeled Flight Track Patterns ä Recent Investigations in NW corner of NAS

47. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 47 Summary of Geographic Distribution Analysis ä With the exception of lung cancer, no consistent spatial patterns were observed in any one area of the four towns ä The geographic pattern of cancer did not show a clear pattern suggesting a common environmental exposure related to the NAS ä Patterns of cancer near other areas of community environmental concern were not atypical

48. Lung Cancer Incidence 1995-1998 rate = or < expected rate > expected rate statistically significantly > expected

49. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 49 Conclusions ä Majority of cancer types occurred at or near the expected rates in the four towns between 1982-1998 ä Lung cancer is increasing in Weymouth and Rockland, particularly in CTs near the NAS ä Evaluation of risk factors showed smoking likely played a role in increased lung cancer rates ä Occupation also played a role in lung cancer for some individuals

50. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 50 Conclusions (cont.) ä With the exception of lung cancer, patterns by census tract showed no consistent elevations of cancer over time ä The geographic pattern of cancer did not show a clear pattern suggesting a common environmental exposure related to the NAS

51. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 51 MDPH Recommendations ä The MDPH should further investigate the pattern of lung cancer with respect to length of residence, particularly among non-smokers, to determine if a clearer pattern of this cancer emerges ä Results should be considered by town Boards of Health when planning future prevention or intervention strategies in the four towns

52. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 52 MDPH Recommendations (cont.) ä Tobacco control efforts should be focused accordingly in the towns of Weymouth, Abington, and Rockland ä Cancer incidence will continue to be monitored in these four towns through the use of the MCR

53. Weymouth Health Needs Assessment February 2002

54. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 54 Weymouth Health Needs Assessment ä Weymouth Board of Health Sponsored ä Purpose to identify health needs of Weymouth residents ä Purpose to design programs to improve the health of residents

55. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 55 Weymouth Health Needs Assessment ä Confidential mailed survey to 5000 Weymouth residents ä Survey conducted by JSI Research and Training Institute of Boston

56. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 56 Weymouth Health Needs Assessment ä Identify respiratory problems in the household ä Identify risk factors for heart disease in the household ä Identify health care services needs ä Identify possible environmental health outcomes

57. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 57

58. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 58

59. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 59 Weymouth Health Needs Assessment ä Questions designed to address specific arsenic and SWNAS concerns

60. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 60 Weymouth Health Needs Assessment ä Identify the occurrence of Multiple Sclerosis and other types of neurodegenerative diseases ä Identify the occurrence of Lupus Erythematosus and other types of autoimmune diseases

61. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 61 Weymouth Health Needs Assessment ä Identify the occurrence of aplastic anemia and myelodysplastic syndrome ä Identify the occurrence of diseases of the kidney ä Identify the occurrence of birth defects

62. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 62 Weymouth Health Needs Assessment ä The environmental health outcome component of the survey will tell us if these outcomes occur at rates greater than would be expected or if they occur more often in certain areas of the community.

63. Massachusetts Department of Public Health, Bureau of Environmental Health Assessment 63 How to Contact BEHA Massachusetts Department of Public Health Bureau of Environmental Health Assessment 250 Washington Street, 7 th floor Boston, MA 02108 Telephone: (617) 624-5757 Fax: (617) 624-5777 www.state.ma.us/dph/beha