1 / 23

Screening for increased cancer risk near toxic waste sites

Screening for increased cancer risk near toxic waste sites. Recinda Sherman, MPH CTR Florida Cancer Data Systems NAACCR Annual Meeting, June 2008. Background:. Cluster detection & surveillance. Routine surveillance versus reactive cluster investigations

jirons
Download Presentation

Screening for increased cancer risk near toxic waste sites

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Screening for increased cancer risk near toxic waste sites Recinda Sherman, MPH CTR Florida Cancer Data Systems NAACCR Annual Meeting, June 2008

  2. Background:

  3. Cluster detection & surveillance • Routine surveillance versus reactive cluster investigations • No a priori assumptions of boundary location • Ho = even distribution of dx by geography • Increases likelihood of identifying a true cluster • Targeted prevention activities • Cluster concern response more thorough, timely, consistent and scientific • Active versus Passive • Rapid intervention

  4. Cluster detection & surveillance • Develop new cluster detection surveillance model for Florida • Investigate technology • SaTScan, ClusterSEER • Quantify methodological limitations • Systematic framework for identifying communities at risk

  5. Disparities in breast cancer • Entire cancer continuum • Education, Poverty • Race/ethnicity surrogate? • Geography • Pacific NW, Marin County, Long Island • Demographic driven?

  6. Risk factors for breast cancer • Immutable • Age, sex, genetics • Modifiable • Hormone replacement • Motherhood • Age, parity, breastfeeding • Alcohol use • Obesity/Physical activity Environmental ??

  7. Methods:

  8. Florida Cancer Data Systems Inception date 1981 1981 Hospital data 1995 CDC-NPCR enhancement Physician office, death certificates, freestanding radiation, pathology 2nd largest in nation 95,000 incidence cases per year Operated by University of Miami Miller Medical School Under DOH contract NAACCR Gold

  9. Florida breast cancer data • 1998-2002 • Straddle census 2000 • 77,729 cases • 88% geocoded • 70% exact street level match • 5% imprecise street level match • 8% bg/tract centroid/st intersection • 3% zipcode centroid

  10. Environmental data • EPA NPL sites • National priorities among the known releases or threatened releases of hazardous substances, • Guide EPA in determining which warrant further investigation • 39 NPL Sites • Potential breast cancer carcinogens • benzene, cadmium, chromium, polycyclic aromatic hydrocarbons (PAHs), pesticides, and vinyl chloride

  11. Focused test • Lawson & Waller Test • ClusterSEER • Detect clustering around a suspected point source • Evaluates the pattern of disease frequency the closer to a specific location • Multiple geographic areas scored for difference between the O/E and weighted by distance from the point of interest

  12. Results:

  13. Hazard scores • Hazard ranking system • Used to place waste sites on NPL • Assess potential for threat to human health or environment • Hazard score for sites with identified clusters higher • 43.99 versus 45.99 • range 30.19-59.81

  14. Potential carcinogens

  15. Potential exposure routes

  16. Income gradient

  17. EPA assessments • Public health assessment • Health consultation • Conducted when there is a specific exposure question • None of the sites with statistically higher risk had a health consultation performed • This may indicate low levels of advocacy concerning these sites

  18. Methodological limitations

  19. RegistryImplications:

  20. Future Focus • Proactive surveillance by registry • “Screening” tool for areas for further focus/epi investigation • Hypothesis generating • Collaboration between Registry and Environmental Health, others • Community partnership

  21. Data, data everywhere & not a thought to think • Underlying demographics • Artifact? Residential Segregation? Contagion? • Primary assumption – denominator problem • Rule out • Release of cluster data • Communicate Risk • Prioritize • Ability to follow up with intervention • External partners

  22. Questions? Thank you to our funders: Thank you to my colleagues: Dr. David Lee UM, Miami, FL Dr. Greg Kearny FL DOH, Tallahassee, FL D. Jennifer Hu UM, Miami, FL Dr. Geoffrey Jacquez TerraSEER, Inc, Ann Arbor, MI Dr. Lora Fleming UM, Miami, FL 23

More Related