1. GM Monawar Hosain State Cancer Epidemiologist Bureau of Public Health Statistics and Informatics NH Division of Pubic Health Services

2. Cancer in NH Cancer has been the #1 leading cause of death in New Hampshire since 2005 It is the cause of approximately 25% of all deaths in New Hampshire Lifetime risk of developing cancer: 1 in 2 male, 1 in 3 female >75% of cancers occur after age 55 years

4. NH is the 4th oldest in USA This increased longevity may create the impression that cancer is becoming much more common even though an increase in the number of cancer cases is partly related to the aging population Median Age of NH: 41.1 + 0.1years Median age of Andover: 48.6 + 2.6 years

5. Total number of invasive cancer cases in NH during 2005-2011 time period: N= 52,474 The total number invasive cancer cases in Andover during the same period: N= 96 (only Breast, Prostate, Lung, Colorectal, Melanoma and Uterus had 5 or more cases)

6. A cancer cluster is the occurrence of a greater than expected number of cases of a particular cancer within a group of people within a geographic area, or within a period of time Definition of a Cancer Cluster

7. A suspected cancer cluster is more likely to be a true cluster, if it involves: A large number of cases of a similar type of cancer, rather than several different types A rare type of cancer, rather than common types, and An increased number of cases of a certain type of cancer in an age group that is not usually affected by that type of cancer

8. Analysis The common occurrence of a cancer increases the potential for cancer cases to appear to cluster in a neighborhood. This is why we conduct statistical analyses to see whether local cancer rate are within the normal range of variations

9. The standardized incidence ratio (SIR) is a measure that compares the cancer rate in a town with the state/country, taking into account differences in age in the different communities Standard Incidence Ratio (SIR)

11. This report was prepared based on data from the NH State Cancer Registry, 2005- 2011 Only invasive cancers were included: Malignant cases (localized, regional, distant stage) of all cancer sites and In-situ cancers of urinary bladder only

12. GenderExpectedObservedSIRlower CLUpper CL Male54.8621.130.871.45 Female43.5340.780.541.09 Both96.7960.990.801.21 All cancers

13. GenderExpectedObservedSIRlower CLUpper CL Female13.1120.910.471.60 Breast Cancer (Female)

14. GenderExpectedObservedSIRlower CLUpper CL Male15.8130.820.441.41 Prostate Cancer

15. GenderExpectedObservedSIRlower CLUpper CL Male7.4101.350.652.48 Female6.150.820.261.91 Both13.3151.130.631.86 Lung Cancer

16. GenderExpectedObservedSIRlower CLUpper CL Both8.0111.380.692.47 Colorectal Cancer

17. GenderExpectedObservedSIRlower CLUpper CL Both5.161.170.432.55 Melanoma

18. GenderExpectedObservedSIRlower CLUpper CL Female3.251.570.513.67 Uterus

19. Our results suggest that various cancer rates are within the range of what is expected in comparable populations in New Hampshire Statistical estimates are not exact, but these numbers do not look outside of the normal range of variability

20. These results are reassuring, as they suggest that the most likely explanation for these observations is random chance and not due to environmental factors These analyses do not prove absolutely that there is no issue in your community, but the information does not lead us to believe there is a specific environmental concern causing cancer in your community

21. It is unfortunate when any adult or child develops cancer, regardless of data and statistics, and We appreciate that you brought it to our attention, and We will continue to monitor cancer rates in the future.

22. Any Questions?? Thank you.