1. 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

2. Presentation Outline Introduction and background Methods Results Conclusions Questions and Discussion

3. Center for Environmental Health (CEH) Protect the public health from a variety of environmental exposures Respond to environmental health concerns and provide communities with epidemiologic and toxicological health assessments

4. Community Assessment Program (CAP) 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

5. ATSDR 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

6. Reason for Investigation Concerns about cancer incidence in Norton and Attleboro, particularly in neighborhoods near the Shpack Landfill Requested by concerned residents

7. Background 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

8. Health Consultation (HC) A review of available health outcome data (cancer incidence data) associated with a site where hazardous substances have been released.

9. Evaluation of Cancer Data 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

10. Massachusetts Cancer Registry (MCR) Population-based surveillance system established in 1982 Massachusetts law requires reporting of all newly diagnosed primary cancers in MA residents Confidential database

11. MCR (cont’d) 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

12. 13 Cancer Types Evaluated 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

13. Cancer data evaluated Cancer rates for 4 time periods – 1982-1987 – 1988-1993 – 1994-1999 – 2000-2002

14. Statistical Methods Standardized Incidence Ratio 95% Confidence Interval

15. Geographic Distribution Analysis 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

17. Risk Factor Information Age Smoking Occupation Other risk factors – Genetics, family history – Lifestyle factors

18. Summary of Community-Wide Findings 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)

19. Summary of Community-wide Findings 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

20. Lung Cancer in Attleboro Lung cancer was statistically significantly elevated in Attleboro females during 1988- 1993 and in Attleboro males during 1994- 1999

21. Lung Cancer Risk Factors Age Smoking Second-hand smoke Occupation/environmental exposures

22. Review of Risk Factors: Lung Cancer in Attleboro Females 1988-1993 Age distribution did not appear unusual – 89% were age 50 or older – Average age was 66

23. Known Smoking History: Lung Cancer

24. Review of Risk Factors: Lung Cancer in Attleboro Males 1994-1999 Age distribution did not appear unusual – 94% were age 50 or older – Average age was 67

25. Known Smoking History: Lung Cancer

27. Attleboro CT 6317 Cancer Type Rate < or About As Expected Rate > ExpectedRate Statistically Significantly > Expected Bladder1982-1987, 1994- 1999, 2000-2002 1988-1993 Bone1982-2002 Brain & CNS 1982-2002 Breast1982-1987, 1994- 1999, 2000-2002 1988-1993 Hodgkin’s1982-2002 Kidney1982-2002

28. Attleboro CT 6317 Cancer Type Rate < or About As Expected Rate > ExpectedRate Statistically Significantly > Expected Leukemia1982-2002 Liver1982-2002 Lung1982-2002 Multiple Myeloma 1982-2002

29. Attleboro CT 6317 Cancer TypeRate < or About As Expected Rate > ExpectedRate Statistically Significantly > Expected NHL1982-1987, 1994-1999, 2000-2002 1988-1993 Pancreatic1982-2002 Thyroid1982-2002

30. Review of Breast Cancer Risk Factors Attleboro 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

31. Norton CT 6112 Cancer TypeRate < or About As Expected Rate > ExpectedRate Statistically Significantly > Expected Bladder1982-2002 Bone1982-2002 Brain & CNS1982-19992000-2002 Breast1982-2002 Hodgkin’s1982-2002

32. Norton CT 6112 Cancer TypeRate < or About As Expected Rate > ExpectedRate Statistically Significantly > Expected Kidney1982-1987, 1994- 1999, 2000-2002 1988-1993 Leukemia1982-2002 Liver1982-2002 Lung1982-1987, 1994- 1999, 2000-2002 1988-1993

33. Norton CT 6112 Cancer TypeRate < or About As Expected Rate > ExpectedRate Statistically Significantly > Expected Multiple Myeloma 1982-2002 NHL1982-1987, 1994-2002 1988-1993 Pancreatic1982-1987, 1994-2002 1988-1993 Thyroid1982-2002

34. Brain & CNS Cancer in Norton 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

35. Review of Brain Cancer Risk Factors Norton 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

37. Within one-mile radius of Shpack Landfill 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)

38. Within one-mile radius of Shpack Landfill No unusual spatial or temporal patterns in cancer incidence or in types of cancer diagnosed within one-mile radius of Shpack Landfill

39. Within one-mile radius of Shpack Landfill 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.

40. Summary of Major Findings 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.

41. Risk Factor Analysis Summary 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

42. Summary of Spatial Patterns of Cancer 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

43. Recommendations 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.

44. Next Steps 30-day public comment period Response to public comments Release final Health Consultation

45. Questions and Answers

46. How to contact MDPH Suzanne K. Condon, Associate Commissioner Jan Sullivan, Director, Community Assessment Program Massachusetts Department of Public Health Center for Environmental Health 250 Washington Street, 7 th floor Boston, MA 02108 Telephone: (617) 624-5757 Fax: (617) 624-5777 www.mass.gov/dph

47. Contact Information The full report is available at: http://www.mass.gov/dph/ceh