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

Presentation Outline
•	Introduction and background
•	Methods
•	Results
•	Conclusions
•	Questions and Discussion

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

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

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

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

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

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

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

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
•	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

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

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

Statistical Methods
•	Standardized Incidence Ratio
•	95% Confidence Interval

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

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

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)

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

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

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

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
Known Smoking History: Lung Cancer
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

Known Smoking History: Lung Cancer

Attleboro CT 6317
Attleboro CT 6317
Attleboro CT 6317

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
Norton CT 6112
Norton CT 6112
Norton CT 6112

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

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

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)

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

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.

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.

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

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

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.

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

Questions and Answers

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, 7th floor
Boston, MA  02108

Telephone: (617) 624-5757
Fax:  (617) 624-5777
www.mass.gov/dph
Contact Information
The full report is available at:
http://www.mass.gov/dph/ceh