E. J. Holowaty and P. BrownDivision of Preventive Oncology

Cancer Care OntarioDec 8, 2006.

The Ontario Health and Environment Information

System (OHEIS)P.E.I. Potato farms a hotbed of cancer debate

From The Cancer Blog, Mar 27, 2006.

Breast cancer more likely in farm workers:

From CTV News Oct 12, 2006.

From the UK Black From the UK Black Enquiry, 1984Enquiry, 1984

Small Area Health Statistics Small Area Health Statistics Unit and the Rapid Inquiry Unit and the Rapid Inquiry

Facility (RIF)Facility (RIF)

Spatial mapping and risk assessmentSpatial mapping and risk assessment Funding proposal submitted to Funding proposal submitted to

GeoConnectionsGeoConnections Modeled on EUROHEIS in European Union and Modeled on EUROHEIS in European Union and

Natl Environmental PUBLIC Health Tracking Natl Environmental PUBLIC Health Tracking Network in USANetwork in USA

Starting point for further R&D at CCOStarting point for further R&D at CCO Spatio-temporal modelsSpatio-temporal models Continuous spatial variationContinuous spatial variation Screening and mortalityScreening and mortality

Surveillance QuestionSurveillance Question

Do known population characteristics Do known population characteristics (RFs, SES, demographics) fully (RFs, SES, demographics) fully explain cancer incidence, orexplain cancer incidence, or– Is the variability between areas higher Is the variability between areas higher

than we would expect if each area had than we would expect if each area had an identical cancer risk?an identical cancer risk?

– Do neighbouring areas tend to have Do neighbouring areas tend to have similar cancer incidence rates?similar cancer incidence rates?

A Spatial ModelA Spatial Model

Maps and Exceedence ProbabilitiesMaps and Exceedence Probabilities

Aim of OHEIS ProjectAim of OHEIS Project To design, implement and test an enhanced spatial To design, implement and test an enhanced spatial

surveillance system to improve our understanding of the surveillance system to improve our understanding of the association between environmental exposures, health association between environmental exposures, health outcomes and confounding risk factors.outcomes and confounding risk factors.

Integrated information systems (GIS) for mapping and risk Integrated information systems (GIS) for mapping and risk ass’tass’t

Rapid assessment (3-6 mos. <1 week)Rapid assessment (3-6 mos. <1 week)

Scientifically sound, robust, understandable and transparentScientifically sound, robust, understandable and transparent

Easily export data to more sophisticated spatial analysis Easily export data to more sophisticated spatial analysis systems – WINBugs; SATScansystems – WINBugs; SATScan

To deploy data, software and/or results to PH partners thru To deploy data, software and/or results to PH partners thru web-based portal and/or stand-alone, secure PC application.web-based portal and/or stand-alone, secure PC application.

Environmental andgeographic data

Roads, Railways,Rivers

Road TrafficChemical Release

Radiation release or exposure

Locations of refineries, incinerators, dumps

Water supplies

Oracle/Access, GIS

CancerDeathsBirthsHospital admissionsCongenital anomaliesStillbirths and perinatal deaths

Healtheventdata

Oracle/Access

Censusdata

(1976,1981,1986,1991,1996, 2001)

DeprivationCensus geographyArea classification

Oracle/Access, GIS

PostcodeEA, CT

Link dataPostcode – EA/DAStreet Address - EACSD, CD boundaries…. etc.. ….

Vectors, polygons

Integrated Information Integrated Information SystemsSystems

airbornewaterbornefoodbornesoil

Pathway Analysisand

Exposure Modelling

Name?Street addressPostal codeMunicipality

Historic Pop’nFiles

SmokingScreening

Confounders

A Study of the Association Between A Study of the Association Between Cancer Rates and TCE Ground Water Cancer Rates and TCE Ground Water

ContaminationContaminationin Communities Surrounding Hill Air Force in Communities Surrounding Hill Air Force

Base, Utah from 1973 - 2001Base, Utah from 1973 - 2001

Exposure DataExposure Data

Graphic plume boundariesGraphic plume boundaries– 5-10 ug/l TCE 5-10 ug/l TCE – 2001-2002 sampling 2001-2002 sampling

periodperiod

Limited pathway dataLimited pathway data– Indoor air intrusionIndoor air intrusion– Plant samplingPlant sampling

Exposed population : UtahExposed population : Utah

Select Shape Files, Popn Centroids Select Shape Files, Popn Centroids and Test for Homogeneityand Test for Homogeneity

Tests for Homogeneity and Linear Tests for Homogeneity and Linear TrendTrend

Routine Tabular OutputRoutine Tabular Output

Time Advantage of Utah Time Advantage of Utah testtest

Export FunctionalityExport Functionality

Next Steps Next Steps

Feasibility Phase 3 mos.Feasibility Phase 3 mos. Privacy issues; public and stakeholder Privacy issues; public and stakeholder

acceptability - Users surveys; Focus acceptability - Users surveys; Focus groups; groups; privacy impact ass’tprivacy impact ass’t

Preparation of detailed scientific protocolPreparation of detailed scientific protocol Submission to GeoConnectionsSubmission to GeoConnections External scientific reviewExternal scientific review REB ReviewREB Review

Next StepsNext Steps

Feasibility Phase 3 mos.Feasibility Phase 3 mos. DB design; software acquisitionDB design; software acquisition Creation of “test” cohort and comparison Creation of “test” cohort and comparison

cohortcohort Develop record linkage strategiesDevelop record linkage strategies Review of methods of Pathway Analysis and Review of methods of Pathway Analysis and

exposure estimation - point/line/area sourceexposure estimation - point/line/area source Statistical issues - minimizing random var.; Statistical issues - minimizing random var.;

adjusted estimates; multilevel, multivar. adjusted estimates; multilevel, multivar. ModellingModelling

Next StepsNext Steps

Implementation and Implementation and EnhancementsEnhancements

– 4 mos.4 mos.

Testing and DeploymentTesting and Deployment– 6-7 mos6-7 mos

Final ReportFinal Report– 1-2 mos1-2 mos