Camp Lejeune Cancer Incidence Study (CIS): A retrospective cohort study

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: 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?

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

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

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

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

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

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?