usphs scientific and training symposium university of maryland school of public health

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PHS Scientific and Training Sympos University of Maryland School of Public Health College Park, Maryland Track 2 - Clinical and Community Preventive Services Charles Carroll Room, Stamp Student Union Building Wednesday, 2:30 – 3:00 PM June 20, 2012 Cancer Assessment in Hinkley: the Real Problem John W. Morgan, DrPH, CPH 1,2 Mark E. Reeves, MD, PhD 2 1 Loma Linda University (LLU) School of Public Health Dept. Epidemiology, Biostatistics & Population Medicine 2 Loma Linda University Cancer Center

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Cancer Assessment in Hinkley : the Real Problem John W. Morgan, DrPH , CPH 1,2 Mark E. Reeves, MD, PhD 2 1 Loma Linda University (LLU) School of Public Health Dept. Epidemiology, Biostatistics & Population Medicine 2 Loma Linda University Cancer Center. USPHS Scientific and Training Symposium - PowerPoint PPT Presentation

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Page 1: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

USPHS Scientific and Training SymposiumUniversity of MarylandSchool of Public Health

College Park, MarylandTrack 2 - Clinical and Community Preventive ServicesCharles Carroll Room, Stamp Student Union Building

Wednesday, 2:30 – 3:00 PM June 20, 2012

Cancer Assessment in Hinkley:the Real ProblemJohn W. Morgan, DrPH, CPH1,2

Mark E. Reeves, MD, PhD2

1Loma Linda University (LLU) School of Public HealthDept. Epidemiology, Biostatistics & Population Medicine

2Loma Linda University Cancer Center

Page 2: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Background/Problem:

Since the mid-1990s, staff in the Desert Sierra Cancer Surveillance Program (DSCSP) have monitored cancer occurrence in the Hinkley Census Tract of San Bernardino County in response to concerns about a potential cancer excess.

Findings released by the DSCSP in 1997 and in 2000 failed to identify an excess in the occurrence of cancer in the Hinkley Tract.

Page 3: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Background/Problem:

“I would like to thank the academy … .”

Erin B.2000

In spite of the absence of evidence of a cancer excess in Hinkley …

Page 4: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Region 6(North)

Region 3(Sacramento)

Region 5(Desert Sierra)

Region 7(San Diego)

Region 4(Tri-County)

Region 1(Santa Clara)

Region 8(Bay Area)

Region 2(Central Valley)

Region 9 (Los Angeles)

Region 10 (Orange)

San Bernardino

Riverside

Regions forming the California Cancer Registry

Page 5: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

San Bernardino County

Page 6: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Hinkley

PG&E

Page 7: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

PG&E Hinkley Natural Gas Pumping Station

Page 8: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

PG&E Pumping Station Cooling Ponds

Page 9: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

PG&E Hinkley Natural Gas Pumping Station

Page 10: USPHS Scientific and Training Symposium University of Maryland School of Public  Health
Page 11: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Hinkley

PG&E

Page 12: USPHS Scientific and Training Symposium University of Maryland School of Public  Health
Page 13: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Inhaled Cr[VI] powder is accepted as a carcinogen, while the roleof aqueous Cr[VI]aq as a human carcinogen has been challenged. Aqueous Cr[VI]aq exists in equilibrium with Cr[III]aq, with the valence state determined by pH and other mineral ions.

Ingested CR[VI]ag is reduced to Cr[III]ag in saliva and blood. Cr[III] is essential for glucose metabolism and is an ingredient of multiple vitamin supplements that include minerals.

Page 14: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Hypothesis:

HA: The number of new invasive cancer cases inCensus Tract 119.00 (Hinkley) will exceed the number of cases expected for the demographic configuration of the

tract during 1996-2008.

Page 15: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Methods:

Page 16: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

The Standardized Incidence Ratio (SIR) was used to evaluate the ratio of Observed to Expected new cancer cases in census tract 119.00 for 1996-2008, balancing the effects of age, sex, race/ethnicity, and population size.

Observed CasesSIR = Expected Cases

Age Tract 119.00Sex measured inR/E 2000 CensusSize

Age DSCSPSex 1996-2008R/ESize

/ /Unique (Hinkley)

Average (DSCSP)

Age

Sex R/E Size

Age

Sex R/E Size

SIR > 1: Observed Count Greater Than Expected Count

Page 17: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

The Standardized Incidence Ratio (SIR) was used to evaluate the ratio of Observed to Expected new cancer cases in census tract 119.00 for 1996-2008, balancing the effects of age, sex, race/ethnicity, and population size.

Observed CasesSIR = Expected Cases

Age Tract 119.00Sex measured inR/E 2000 CensusSize

Age DSCSPSex 1996-2008R/ESize

/ /Unique (Hinkley)

Average (DSCSP)

Age

Sex R/E Size

Age

Sex R/E Size

SIR > 1: Observed Count Greater Than Expected Count

SIR = 1: Observed Count Same As Expected Count

Page 18: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

The Standardized Incidence Ratio (SIR) was used to evaluate the ratio of Observed to Expected new cancer cases in census tract 119.00 for 1996-2008, balancing the effects of age, sex, race/ethnicity, and population size.

Observed CasesSIR = Expected Cases

Age Tract 119.00Sex measured inR/E 2000 CensusSize

Age DSCSPSex 1996-2008R/ESize

/ /Unique (Hinkley)

Average (DSCSP)

SIR > 1: Observed Count Greater Than Expected Count

SIR = 1: Observed Count Same As Expected Count

SIR < 1: Observed Count Less Than Expected Count

Age

Sex R/E Size

Age

Sex R/E Size

Page 19: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Results:

Page 20: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Table 3. Numbers of observed and adjusted expected new invasive cancers, SIRs, and 95 percent confidence interval limits for SIRs for all cancers and for selected cancer types - Hinkley Tract 1996-2008.

Adjusted 95% CI Cancer Site Observed Expected SIR for SIR All cancer Sites (combined) 196 216.42 0.91 0.78, 1.04

Nasopharynx (nasopharyngeal ca) 0 0.21 <1 undefined Respiratory 38 32.97 1.15 0.82, 1.72Lung & bronchus 34 30.12 1.13 0.78, 1.58

Digestive 29 40.55 0.72 0.48, 1.03Pancreas 0 5.00 <1 undefined *

Cervix uteri 7 2.48 2.83 1.12, 5.86 *Childhood cancer (age <20) 5 2.44 2.05 0.65, 4.82

Esophagus & stomach 7 5.21 1.34 0.53, 2.79Hematopoetic system 20 16.86 1.19 0.72, 2.04

Thyroid gland <5 <5 0.34 <0.10, 1.97Oral cavity & oropharynx <5 >5 0.38 <0.10, 1.38Urinary bladder 5 9.25 0.54 0.17, 1.27Cutaneous melanoma 6 9.81 0.61 0.22, 1.34Brain & other nervous system <5 <5 0.68 <0.10, 2.49Liver & intrahepatic bile ducts <5 <5 0.74 <0.10, 2.73Breast 27 34.52 0.78 0.51, 1.14Intestine (SI, CRC, & R/S JX) 18 22.71 0.79 0.47, 1.26Kidney & renal pelvis 5 5.30 0.94 0.30, 2.22

Prostate gland 22 34.11 0.65 0.40, 0.98 *

Page 21: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

The SIR for colorectal cancer (CRC) cases was 0.87, although 33% of the cases in the Hinkley Tract were diagnosed at advanced stage, compared to 18% in the county, region, and statewide

Results continued:

Page 22: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Conclusions/Discussion:

Evidence of the need to promote screening for prevention and early detection of cancer of the: A. Cervix uteri B. Colon and Rectumin remote desert communities like Hinkley

No evidence of a generalized cancer excess was detected in the Hinkley Tract for 1996-2008. This is consistent with three previous cancer

assessments extending back to 1988 and is now enlarged toinclude childhood cancer and 18 cancer site groups

Evidence of deficits in the number of: A. digestive system cancers, including pancreatic cancer, and of B. prostate cancer

Page 23: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

The tragedy of Hinkley is that the $333 Million legal settlement distracted the world from the real cancer problem ; inadequate cancer screening in a poor and remote desert community.

Chasing phantoms is apoor substitute for cancer control.

Don Quixote

Page 24: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Thank YouFor Your Attention

I would like to thank the academyUSPHS

for the opportunity to present these findings.

USPHS

Page 25: USPHS Scientific and Training Symposium University of Maryland School of Public  Health
Page 26: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Aftermath

Page 27: USPHS Scientific and Training Symposium University of Maryland School of Public  Health
Page 28: USPHS Scientific and Training Symposium University of Maryland School of Public  Health

Authors of the Harvard Report on Cancer Preventionformed the following conclusions about the percentages

of cancer deaths among Americans attributable to various characteristics

Tobacco use

Poor nutrition

Sedentary lifestyle

Pollution, pesticides, herbicides, technology, etc. 2%

30%

30%

5%

Harvard Report on Cancer Prevention

Page 29: USPHS Scientific and Training Symposium University of Maryland School of Public  Health