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9 Health Considerations in the Cape Cod population
Pages 139-175

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From page 139...
... Frnally the committee presents a geographical correlation study of health effects associated with exposure to the PAVE PAWS radar in the upper Cape Cod region surrounding the Massachusetts military reserve where PAVE PAWS is located. The population characteristics of Cape Cod are important in interpretation of observed health effects and evaluation of epidemiological studies and are described briefly here.
From page 140...
... For those without children, the corresponding numbers are 2.2% and 2.1%. Population Growth Census data from 1980 and 1990 Indicate that the growth of the state overall was 1.049% during this decade and for Barnstable County (Cape Cod)
From page 141...
... and a specific health effect. By definihon, hypothesis-testing epidemiologic research specifies the exposure and outcome of interest as well as the direction of effect (i.e., increase of risk or protective effect)
From page 142...
... deaths per 100,000 persons ages 0-74, after adjustment to the age distribution of the 2000 census. The premature-mortality rates for towns on upper Cape Cod are summarized in Table 9-1.
From page 143...
... Massachusetts Department of Pubbc Health (Premature Mortality 2001, wow state.ma.us/dph bhsR/death 2001 pRlmmnal2001 Off) Cancer 143 From the inception of the Massachusetts Cancer Registry and the initial analysis of cancer incidence by towns, there has been concern that the rates of cancer are elevated in the Cape Cod population.
From page 144...
... The study consisted of incident cancer of lung, n = 251, breast, n = 265, colon and rectum, n = 315, bladder, n = 62, hdney, n = 35, pancreas, n = 37, leukemia, n = 36, brain, n = 37, and liver, n = 4, as reported by the Massachusetts Cancer Registry in the years 1983 to 1986. Since many mdividuals were deceased by the start of the study, the living and deceased upper Cape residents were selected as controls (n = 1285)
From page 145...
... An association was also observed for brain cancer among those who ever swam m Johns Pond and leukemia among those ever swimmmg in local ponds. A comparison of the calculated SIR for 5 categories consisting of total cancers, breast, colon, lung, and prostate cancer during 1987-1994 versus 19951999 for 5 towns in upper Cape Cod (see Table 9-2)
From page 146...
... 146 Cal ~ 2 o ._ ~ o ~ o o C ~ -c 2 .N :a C e o ~ o a ~ ~ 1 0
From page 147...
... MASSACHUSETTS MILITARY RESERVATION Ryan and colleagues (MDPH 2002) employed extensive analytic techniques to explore the possible associations between the Massachusetts Military Reservation and health among upper Cape Cod residents.
From page 148...
... The Silent Spring study looked in substantial detail at the potential envrrommental contamination that may relate to nsk of breast cancer, focusing on envrrommental estrogens, PCE exposure, DDT exposure, and the role of the Massachusetts Military Reservation as potential sources of exposure. The investigation concluded that breast-cancer rates on Cape Cod do not appear to be fully explained by the individual characteristics of the women (including, for example, age, family history, reproductive history, alcohol consumption, smoking, and age at onset of menstruation and menopause)
From page 149...
... Thus the expected number of cases was estimated using stamdard approaches, within age-specific strata, of age, and then summed across age groups, to provide the overall expected number of cases for each town. The descriptive analysis of cancer-incidence data for the upper Cape towns addressed 23 specific cancer types as well as total cancer incidence for the upper Cape as a whole, for each of the five towns, and for each of the 30 census tracts that compose the upper Cape.
From page 150...
... . TABLE 9-3 Cancer Cases Diagnosed on Upper Cape Cod, 1986-1994, and Standardized Incidence Rate Ratios (SIR)
From page 151...
... The Massachusetts Department of Public Health updated information of cancer incidence and mortality with its report "Cancer Incidence and Mortality in Massachusetts 1996-2000." Through 2000, total cancer-mortality rates declined significantly while incidence rates varied according to cancer site. The City and Town Supplement reports the cancer data for towns and is most recently available for the penod 1995-1999.3 Data for upper Cape Cod towns are summarized in Table 9-4.
From page 152...
... The purpose of the evaluation was to discuss the types of cancer that were occurnug among Cape Cod children and to identify areas with a greater than expected occurrence of childhood cancer. Like other health evaluations, this investigation was initiated at the request of Cape Cod citizens who were concerned that childhood cancer might be a problem on Cape Cod.
From page 153...
... CNS 17 21.3 80(46-128) Upper Cape Cod Leukemia 12 13.0 92 (48-192)
From page 154...
... 12% of the residents in upper Cape Cod reside in a location that results in exposure to the sidelobes of the PAVE PAWS radar beam, (3) the population size and composition of upper Cape Cod is that obtained for the 2000 U.S.
From page 155...
... Surnmanzed in Table 9-6 is the diagnosis-specific power calculation for the upper Cape Cod population. Highlighted are those cancer-specific groups where power would be considered sufficient to detect a modest level of risk (i.e., less them twofold)
From page 157...
... STATISTICAL ANALYSES Introduction To characterize challenges inherent in the epidemiological assessment of the health effects associated with exposure to the PAVE PAWS radar, we conducted a geographical correlation study within the upper Cape Cod region surrounding the Massachusetts Military Reservation (MMR) where PAVE PAWS is located.
From page 158...
... Overall we estimated that in 1990, 11.~% of the population living in upper Cape Cod was exposed to the PAVE PAWS radar beam. Percentages of the total population exposed to the PAVE PAWS radar beam by age and gender are presented in Table 9-7.
From page 159...
... HEALTH CONSIDERATIONS IN THE CAPE COD POPULATION Digital elevation model i_ _~ MAP 2 Digital elevation model. Data from GeoCosmn international Com, oration.
From page 160...
... ~:5-~ ;~\' .vLAP 5 117 Census block groups within 30 Census tracts in 1990.
From page 161...
... 161 ~ ~ ~3 3 e :~ ~ ~ _ 0 = ~ 3 mo ~ §' ~ ~ ~ _ $= ~ ~ .g ~ §' ~ = At, CC ~ vo ~ ~ ~ ~ Cat Cat V)
From page 162...
... The changes in population distribution in the past decade had little effect on the proportion of population living under the line of sight from the PAVE PAWS radar. Average and Peak Power-Density Assessment Because cancer-incidence data was made available to us only at census-tract level, to carry out a geographic correlation study and to estimate association between cancer incidence and exposure to the PAVE PAWS radar beam, we needed to estimate average and peak power density at each census tract.
From page 163...
... it: of. MAP 7 MITRE average power densities.
From page 164...
... 164 ASSESSMENT OF POTENTIAL IIEALTII EFFECTS FROM PA VE PAWS 1~ r MAP 8 BSL average power densities MAP 9 Population densities at census block level.
From page 165...
... In the upper Cape Cod cancer-incidence re
From page 166...
... For example, if one type of cancer has a higher detection rate in a population with high socio-economic status due to better access to health care and one supposes that a wealthy population lives in upper Cape Cod, then one should expect to see more cancer diagnosed m upper Cape Cod. Failing to adjust for this higher than expected number of cancer incidences will over-estimate the SIR.
From page 167...
... Because of data unavailability for indirect SES adjustment on cancer-incidence ratios, we explored the potenhal associahon of SES and cancer SIR using data from the "Upper Cape Cod Cancer Incidence Review, 1986-1994" and SES data from the Census Bureau. Since 62% of all cancer incidences in upper Cape Cod dunug that penod were one of the four major cancer types (colo-rectal, breast, lung, prostate cancer)
From page 168...
... Besides colo-rectal cancer, our analyses of cancer incidence on upper Cape Cod demonstrated little association between socioeconomic factors and the standardized incidence ratio of three major cancer types (see Table 9-~)
From page 169...
... . For each of the four major cancer types, the cancer Incidence data revealed little evidence of association with our estimated exposure and we determmed that controlling for SES did not lead to qualitative changes in the relative rate estimates (Figure 9-5)
From page 170...
... M = male, F = female. C 40% o o 20% ~ ~ ~ 0% ._ ~ =° -20% o E o A, ~ c -40%o ~ -60 To o -80% ~ ~ T I i' ~ I T ~ r I T I Ci F ~ ~ L: LIP ~ FIGURE 9-7 Association between BSL average density exposure and cancer incidence.
From page 171...
... Findings of the National Research Council committee's geographical correlation study by census tract of exposure to PAVE PAWS radar and cancer incidence should be interpreted with caution. First, because of the lack of sufficient health-related statistics and confounders at a geographical resolution smaller than a census tract, our results could be affected by ecological and confounding bias.
From page 172...
... · Because of the limited population of upper Cape Cod, it will not be
From page 173...
... Exposure to power frequency magnetic fields md risk of breast cancer in the UpperCape Cod Cancer Incidence Study. Arch Environ Health 53:359-367.
From page 174...
... Osborne, eds. Philadelphia: Lippincott Williams & Wi kms, ANNEX 9-1: DATA SOURCES · CanCer incidence data from 1986 to 1994 for 24 CanCer types in 30 cenSUs tracts in upper Cape Cod (Upper Cape Cod Car~cer Ir~cider~ce Revich 19861994[31)
From page 175...
... HEALTH CONSIDERATIONS IN THE CAPE COD POPULATION ANNEX 9-2: GEOBUGS CODE Model a~ciationbetweencarcer imideme ard MIRE p~ak ex~sure cortrollirg for SES 1 # X ex~sure # S SES for (i in1 N)


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