Analysis of Cancer Risks in Populations Near Nuclear Facilities Phase 1 (2012) / Chapter Skim
Currently Skimming:
4 Epidemiologic Studies
4 Epidemiologic Studies
Pages 143-252
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 143... ...
Nuclear Regulatory Commission (USNRC) -licensed nuclear facilities.
|
From page 144... ...
and the increasing acceptance of the limitations of epidemiologic studies of lowdose radiation exposures, mainly owing to their limited statistical power. The study designs described in this chapter can provide clues for potential associations between cancer and living near a nuclear facility.
|
From page 145... ...
, assigning statistical significance to a reported cluster requires clear definitions of the populations, regions, and/ or time periods under consideration, often a challenging undertaking. 4.1.2 Ecologic Studies An ecologic study (sometimes referred to as a geographic study or correlation study)
|
From page 146... ...
One of the causes of ecologic fallacy is that average levels of potential confounding variables across the geographic units may be subject to considerable measurement error, so trying to adjust for the geographically estimated confounding variables fails to control for confounding. This was illustrated in a study of the association of average county radon levels with lung cancer rates, with an attempt to characterize smoking levels by county (Cohen, 1995, 1997)
|
From page 147... ...
4.2 STUDY DESIGNS CONSIDERED Choosing from among different possible study designs to assess cancer risks in populations near nuclear facilities, or even deciding against mak
|
From page 148... ...
Section 4.3 provides a summary of data sources for population counts, health outcomes, and other information required for the execution of the studies considered and recommended. 4.2.1 Issues Affecting Several Epidemiologic Study Designs In any of the studies considered, population sizes, estimated doses, and resulting risk estimates may be too low to demonstrate statistically significant increased cancer risks near nuclear facilities.
|
From page 149... ...
Outcome Incidence/ Theoretical GU-based rates Individual level Individual level Individual level Individual level Mortality Time period Past, current or Past and current Fairly recent past Recent past and Future Fairly recent past and future and current current current Number of N/A Large, depending Limited to Limited to recent Limited to future Limited to cases Cases on availability relatively recent cases (and those cases and subject that are successfully of aggregated cases, depending that are alive) , to length of linked via birth cancer incidence on available birth successfully traced, follow-up period records and mortality record and cancer and willing to data incidence data participate Cancer Types All All Limited, primarily Limited to one or a Limited to a few Limited, primarily suitable for few types relatively common suitable for childhood cancers types depending childhood cancers or or those due to on follow-up early exposures early exposures period Age All ages All ages Best for childhood Targeted ages All or targeted Best for childhood; cancers; limited for ages limited for adult adults 149 continued
|
From page 150... ...
Nondiseased N/A Census Requires selection Requires selection Participants would Participants would comparison denominators and study of a and study of a be nondiseased at be nondiseased at group comparison group comparison group entry, and number entry, and number of individuals of individuals developing disease developing disease during study during study period period would be would be determined determined Exposure Dosimetry GU-based GU-based Individual location Individual Individual Individual location at birth locations at birth Lifetime Can be Approximate, Limited primarily Complete lifetime Complete lifetime Lifetime exposure constructed for without to exposure at time residential history residential history residential history hypothetical information of birth derived from derived from derived from records, individuals based about residential interview data interview data but realistically will on residential changes be limited primarily history to exposure at time of birth
|
From page 151... ...
Temporality Can fully Can fully Restricted to Restricted to Can include all Restricted to utilize historical utilize historical exposure at birth exposure prior to exposure prior exposure at birth variations in plant variations in location; limited diagnosis, limited to diagnosis, but location, dependent exposure levels plant exposure because must use because must use does not address on how far back in prior to each year levels prior to relatively recent recent cases only the higher past time birth records of interest diagnosis dates cases exposures with adequate information are available Potential Confounders Natural GU-based GU-based Residence based Residence based Residence based Residence based background and direct and direct radiation measurements measurements possible possible Socioeconomic GU-based GU-based Individual Individual level via Individual level Individual status level through questionnaires via questionnaires level through socioeconomic socioeconomic proxies insofar as proxies insofar as available in records available in records Urban/rural/ GU-based GU-based Individual level at Individual level Individual level Individual level at mixed birth complete history complete history birth residence Medical GU-based GU-based GU-based for Individual level via Individual level GU-based for exposures approximations approximations individual questionnaire via questionnaire individual birthplace birthplace Other risk GU-based GU-based Limited to Individual Individual Limited to factors information exposures and exposures and information available available on birth risk factors via risk factors via on birth records records interviews interviews 151 continued
|
From page 152... ...
Biases Selection bias In- and In- and Out-migration Out-migration, Lost to follow-up, Out-migration and out-migration out-migration and unsuccessful unsuccessful study dropouts unsuccessful linkage linkage linkage, and unlocatable study subjects Nonparticipation None None None Likely Likely None Response None None None Possible over or Possible over or None underreporting underreporting Assessment of N/A Requires Considered Considered Considered Considered causality confirmation using another study design NOTE: GU, geographic unit such as census tract; N/A, not applicable.
|
From page 153... ...
Routine releases from the operating facilities have been far greater than those reported to the USNRC, or B Sensitivity to radiation as characterized in most or all generally accepted risk models is either inappropriately low or simply irrel evant to the populations living near nuclear facilities in the United States.
|
From page 154... ...
A plausible cause-effect relationship between radioactive releases from nuclear facilities and cancer cannot be established solely by examining risks in populations living near nuclear facilities through any of the study designs considered. Direct epidemiologic investigation of the exposures in populations near nuclear facilities is limited by small numbers, the presence of unmeasured risk factors and potential confounders, and/or uncertainty in the exposure estimation.
|
From page 155... ...
A mortality study of thyroid cancer would have restricted statistical power in testing increases in risk at a certain time and interpretation because most of the incident cases in a year would not be captured in the mortality statistics for that year, and many of the deaths in the mortality data for a given year would have been diagnosed many years earlier. On the contrary, for highly fatal cancers such as lung and pancreatic cancers, mortality data would reflect cancer incidence quite accurately.
|
From page 156... ...
, although such studies would be limited to the states or regions covered by these registries and would not cover all areas near nuclear facilities. For the reasons mentioned above, incidence and mortality studies provide complementary data, and both could provide potentially useful information.
|
From page 157... ...
Epidemiologic studies that aim to link exposure to radiation and cancer often use a 2-year minimum latency period for leukemia and a 10-year minimum latency period for solid5 cancers (Boice et al., 2011)
|
From page 158... ...
An epidemiologic investigation of cancer risks due to radiation exposure is complicated by the lack of diagnostic tests, clinical or molecular, that can determine the cause of cancer in an individual. For this reason, it is important to collect, where possible, information on other risk factors 6 Thestudies discussed in this report focus on first cancers only.
|
From page 159... ...
Given the strong smoking effect, analyzing lung cancer data in relation to low-dose radiation exposure would be fraught with potential problems that would be difficult or impossible to address without accurate historical smoking data for individuals in the study population. For other cancers, however, such as those of childhood, established risk factors that include specific genetic syndromes, prenatal exposure to ionizing radiation, infections, and demographic characteristics such as race/ethnicity, gender, and high birth weight collectively can explain only a small fraction of cases.
|
From page 160... ...
Table 4.2 lists several definitions of exposure in the literature of radiation epidemiology on health risks of populations living near nuclear facilities. Using examples, the definitions are ranked from a less-defined to a better-defined characterization of exposure.
|
From page 161... ...
Established zones of 20-km radius centered on the nuclear facilities, further subdivided into 0-5, 5-10, 10-15, and 15-20 km zones were used for analysis of cancer incidence in populations residing near the facilities (White-Koning et al., 2004)
|
From page 162... ...
As demonstrated above, studies of cancer risks near nuclear facilities use differing estimates of exposure and commonly suffer from several weaknesses by not accounting for: 1. Prevailing wind directions and speeds or terrain factors, which may appreciably alter exposures to gaseous effluents.
|
From page 163... ...
The same methodology could be used to estimate the doses received by the individuals in a record-linkage-based case-control or cohort study. This implies that each individual is assigned the calculated dose for the census tract within which he or she resides.
|
From page 164... ...
An analysis based on residence at time of death is the most likely to be affected by migration bias. Individual dose reconstruction for members of a large case-control or cohort study could be time consuming, especially when the investigator wants to incorporate information on residential history of each individual if this is available through interviews or questionnaires.
|
From page 165... ...
Instead of statistical power to detect an effect, an investigator may want to set bounds on the magnitude of risk. In that case, two different purposes need to be distinguished: FIGURE 4.2 Size of a cohort exposed to different radiation doses, which would be required to detect a statistically significant increase in cancer mortality in that Figure 4.2.eps cohort, assuming lifetime follow-up.
|
From page 166... ...
As a result, precise computations of statistical power based on risks due to the expected doses would have little meaning; therefore, computations of statistical power are focused on the population sizes required to "rule out" larger risks. Arguably, the power calculations presented here are based on risks tied to exposures that are on the order of 0.5-1.0 Sv, which are much higher than those expected from the releases of nuclear facilities.
|
From page 167... ...
. The latter could approximate the matching ratio of cases and controls of a large cohort study or an ecologic study; as is generally true for rare diseases, far more controls are available than cases in these two study designs.
|
From page 168... ...
. A 40 percent risk increase can be detected with about 3,800 cases for a 1:1 case-control study and about 1,800 with a case control or a cohort and ecologic study designs of 1:100 matching.
|
From page 169... ...
There are approximately 3,000 childhood acute lymphoblastic leukemia cases diagnosed per year in the entire United States (http://www.cancer.gov/cancertopics/ pdq/treatment/childALL/HealthProfessional) , 15 percent of which (450)
|
From page 170... ...
. However, since the mean doses received by the populations near nuclear facilities are expected to be low and the associated risks, if any, are expected to be small, very large numbers of cases and controls would still be required in order for the study to be informative and useful.
|
From page 171... ...
A substantial amount of data supports the concept of greater radiation cancer risks after exposure in childhood than after exposure in adulthood. For example, the Japanese atomic bombing survivors data suggest this age differential for cancer mortality or incidence for total solid cancer, leukemia, and cancers of the stomach, breast, colon, bladder, thyroid, skin (nonmelanoma)
|
From page 172... ...
For example, an epidemiologic hypothesis may be that cancer (all types together or a specific type) occurs more often in populations that live near nuclear facilities than in populations that live further away.
|
From page 173... ...
Accompanying that is often the common human tendency to focus on the "statistically significant" risks, which means that the false-positive results with large imputed risks get undue attention. The multiple comparison issue would be particularly limiting in the interpretation of the results of an ecologic study in which multiple cancers are examined for individual facilities as well as combinations of facilities, different time periods, and different age groups.
|
From page 174... ...
Issues of confounding are important in all epidemiologic studies with no exception, and they are particularly important in low-dose radiation
|
From page 175... ...
Studies of health effects associated with high levels of radiation exposure usually are not affected by major confounders, because confounding by other exposures or risk factors tends to be considerably smaller than the radiation effects in question. However, with low-dose studies in which the size of the radiation effect is expected to be small, the magnitude of potential confounding effects may be as large, or larger than the size of the radiation effect.
|
From page 176... ...
Still, any of the study designs considered would attempt to demonstrate very small radiation effects, if any, associated with low doses, 9 There are other methods of controlling for confounding at the design phase such as restriction, or at the analysis phase by standardization, stratification, and multivariate analysis.
|
From page 177... ...
Inability to retrieve information on residential history and duration of residence at each location is a major source of uncertainty in the epidemiologic investigation of cancer risks near nuclear facilities. In most such studies investigators estimate the exposure of the individuals or the populations based on one time point: place at time of diagnosis, or at time of death (and the equivalent for controls)
|
From page 178... ...
. Arguably, a study of the cancer risks of populations near nuclear facilities (especially of the older populations)
|
From page 179... ...
Similar to the "noise" on baseline cancer risk that arises from the variability of risk factors such as those discussed above, variability in exposure to other sources of radiation is difficult to measure with accuracy. An increasing source of radiation dose to the popu lation in the United States is from exposure to medical diagnostic procedures, which accounts for almost half of the annual dose that the population receives (NCRP, 2009)
|
From page 180... ...
are often used to measure frequency of infection in children. These proxies have been used by a recent study of risks in populations near nuclear facilities (Spycher et al., 2011)
|
From page 181... ...
Risk-projection models would involve using dose data related to the exposures of individuals living near nuclear facilities and quantifying the risk by transferring that observed in other exposed populations. Data from the Japanese atomic bombing survivors' cohort are most often used for the purposes of assessing the risks arising from exposure to radiation.
|
From page 182... ...
The excess relative risk of breast cancer incidence in the Japanese atomic bombing survivors, however, is significantly higher than that of medical radiation patients in the study in the United States (Little and Boice, 1999) and the best estimate of the ratio of the excess relative risk coefficients for the Japanese and U.S.
|
From page 183... ...
. The NCI reported an ecologic study of cancer mortality across all nuclear facilities that began operations prior to 1982 and for cancer incidence for two states (Jablon et al., 1991)
|
From page 184... ...
. This context is important when considering the role of dosimetry based on reported radiation releases and monitored values from nuclear facilities, especially since the reported doses in recent years fall well below exposures that have been directly shown to cause cancer.
|
From page 185... ...
There was very little follow-up time beyond a presumed minimum latency period of 10 years for most solid cancers. (Only with the passage of some years from the year that a facility started operation is it expected that populations living near the facility have accumulated sufficient exposure to develop cancers because of the releases from these facilities.)
|
From page 186... ...
, calendar year, age, gender, and race/ethnicity. For example, cancer registration of a 50-year-old African American woman, diagnosed with breast cancer in 2005, living in census tract X at the time of diagnosis, would contribute a case count to the cell which records the number of African American women in tract who in 2005 were 50 years old.
|
From page 187... ...
Investigators of the 1990 NCI study who based their analysis primarily on a pre- versus post-facility-operation comparison of risks in counties with or without a nuclear facility were able to interpret and communicate the appearance of false-positive findings rather effectively. Data were presented in support of the fact that many statistically "significant" increases in risk in relation to nuclear facilities were found for the period before facilities started operation; these risks could not possibly be attributed to releases from the facilities but are rather statistical effects (Jablon et al., 1990, 1991)
|
From page 188... ...
. A cohort study of the future cancer outcome of individuals near nuclear facilities would involve enormous logistical problems in order to follow individuals for decades into the future.
|
From page 189... ...
The committee carefully considered the feasibility of a retrospective cohort study of cancer incidence in and around states with nuclear facilities. For the reasons outlined below, only studies of childhood cancers were considered for such a study.
|
From page 190... ...
Associations of childhood cancer risk and radiation releases from nuclear facilities, if any, are probably less affected by co-carcinogens compared to adults, where smoking, occupational exposure, and other established lifestyle risk factors play an important role. Nevertheless, there may be still some risk factors and potential confounders in the development of a cancer during early years of life that are presently unknown.
|
From page 191... ...
and would require approximately 4 years of incidence data. For example, if all childhood cancers among children aged 0-14 diagnosed in the 4-year time period 2006-2009 were to be targeted in the study (a time when almost all states have working cancer registries)
|
From page 192... ...
4.2.2.4 Population-Based Case-Control Studies A case-control approach may be appropriate if efforts are directed to selecting just one or two major diseases that may appear in populations around nuclear sites or are restricted to a specific age group. For example, it may be relevant to focus efforts on studying the risks associated with pediatric cancers developing in young residents close to nuclear facilities or more specifically look at risk factors involved in childhood leukemia developing in this group.
|
From page 193... ...
The information for cases and controls must be collected by the same approach in order to limit bias related to quality of information or extent of detail of the data collected in different administrative files or medical records, or due to differential interviewing. Residential history, socioeconomic characteristics of the parents, infections, exposure to radiation in utero or as a child, and parental smoking are some of the factors previously associated with childhood leukemia and such information, if available, can be included.
|
From page 194... ...
Rather than considering (for example) all of the 3,000 childhood leukemia cases per year that are expected nationwide for linkage to birth registry information for all states with or proximal to nuclear facilities, cases would be identified from state cancer registries with or near facilities, and linkages would occur only within the respective states as opposed to between states.
|
From page 195... ...
It must be kept in mind, however, that as further restrictions for selecting eligible cases apply, the potential for loss of study power increases if large numbers of cases were excluded from consideration. Additionally, as the design does not rely on follow-up of the controls to establish if they also remained at the 50-km zone from birth to the time that the cases were diagnosed, the potential for selection bias increases and false relationships between case status and distance could appear if the probability of moving versus staying within the same region is inhomogeneous with respect to distance from nearest nuclear facility.
|
From page 196... ...
Regarding these issues, in a five-state pooled analysis study of parental age (available from birth records) and risk of childhood cancer (Johnson et al., 2009)
|
From page 197... ...
However, given the rarity of childhood cancers (about 4.8 per 100,000 children will be diagnosed by age 15 with leukemia or brain cancers, the two most common cancers in children) , this issue should have essentially no effect on the power of a study, but might nevertheless have some unknown potential to introduce bias, since controls but not cases may have migrated from the state and such migration might reflect socioeconomic or other differences that affect childhood cancer risk.
|
From page 198... ...
Children with cancer would be traced through the treating institution as identified from cancer registration files or other means and they and/or their parents contacted in order to obtain additional information regarding residential history and a list of known or putative risk factors for childhood cancer. If the identified cases who were children at diagnosis and are adults at the time of interview are those providing the information, their responses may differ from those of the parent, and many now-adults may not know answers to questions about childhood residential history or early life care.
|
From page 199... ...
Telephone interviewing may be a better approach than interviews in person, especially when questions touch on sensitive matters such as possible exposures during pregnancy. In a study of childhood leukemia the questionnaire is likely to contain details on lifestyle, socioeconomic status, residential history, occupational exposure of parents at the time of conception of the child and during pregnancy, medical radiation exposure during pregnancy and early childhood, infectious diseases during early childhood, contact with other children during first years of life, nursery care, birth order, and number of children in the family as well as questions specific to milk consumption to better estimate individual exposure.
|
From page 200... ...
Building on Existing Studies As discussed earlier in this section, it may be possible to partner with investigators who are already using linkages between cancer registration and birth records to perform the record-linkage-based case-control study. As these linkages exist in at least six states, representing more than 30 percent of the U.S.
|
From page 201... ...
The possibility of using an existing study to build a contact-based case-control study was not considered further, since no known studies that would meet the necessary criteria were identified. 4.2.3 Recommended Studies Of the several studies considered, two epidemiologic study designs were judged by the committee as suitable to have scientific merit and address the nonscientific issues that they must deal with for assessing cancer risks in populations near nuclear facilities: the ecologic and record-linkage-based case-control studies.
|
From page 202... ...
The question such a study can answer Are observed cancer incidence and/or mortality rates higher in census tracts with higher estimated exposures (as estimated from reported releases from the nuclear facility)
|
From page 203... ...
in states that have or have had a nuclear facility or are within a fixed distance (for example, 50 km) of a nuclear facility are linked to the birth records of the respective states to identify those children that developed cancer and were born within a fixed distance from the facility (for example 50 km)
|
From page 204... ...
c. Can be considered an objective study as it does not rely on contact of individuals or interviews and therefore is not subject to selection or possible information bias related with subject participation and collection of information on risk factors.
|
From page 205... ...
4.2.3.2 Approaches for Conducting the Recommended Studies The recommended studies are complementary in that each addresses different aspects of cancer risks: • The ecologic study would provide an assessment of risks for a variety of cancer types over longer operational histories of nuclear facilities for which effluent release and cancer mortality and inci dence data are available. • The record-linkage-based case-control study would provide an assessment of cancer risks for childhood exposures to radiation during more recent operating histories of nuclear facilities.
|
From page 206... ...
The spatial size of the census tract also varies widely across the country. Census tracts were not fully defined until the 1980 Census.
|
From page 207... ...
While geographic areas are associated with ZIP codes, these areas rarely match block, block-group, or census-tract boundaries and, at times, even cross county and state boundaries. Compared to census tracts, ZIP codes are not only typically larger but also less homogenous aggregate units.
|
From page 208... ...
To appreciate the size of the populations residing near the nuclear facilities, the committee estimated the number of individuals that reside within the census tracts at 0-8- and 0-50-km radii around currently operating nu
|
From page 209... ...
highlight different challenges that need to be considered when evaluating the risks of the populations around the nuclear facilities and these are discussed here. The population size residing near (e.g., within 50 km of)
|
From page 210... ...
An example describing such a situation is the conversion facility in Metropolis, Illinois, operated by Honeywell International, Inc., and the uranium enrichment facility in Paducah, Kentucky, operated by USEC Inc. These two types of facilities are in such close proximity that there is an almost complete overlap of the exposed population within the 50-km zone (Figure 4.4c)
|
From page 211... ...
Figure 4.4d illustrates some of the many power plants whose populations in close proximity reside not only in the state where the plant is located but also in neighboring states. For example, the populations living within 50 km of the Vermont Yankee plant in Vermont reside in Vermont, Massachusetts, and New Hampshire.
|
From page 212... ...
Such information is needed for any incidence- or mortality-based ecologic study, any cohort study that compares cancer rates in different areas, or a case-control study that estimates associations. It takes time, typically 1-2 years after the occurrence of the cancer, to get registry files that are virtually complete.
|
From page 213... ...
population, respectively. SEER currently collects and publishes cancer incidence from 15 population FIGURE 4.5 Cancer registration coverage within the United States.
|
From page 214... ...
Although the studies considered here focus on the risks of developing first cancers only, this paragraph describes the registries' regulations of recording multiple cancers, mostly to clarify that second or multiple cancers of an individual are recorded separately from the first. The SEER rules for classifying multiple primary cancers are followed by all registries in the United States (that is from all SEER and NPCR registries)
|
From page 215... ...
. This finding is in agreement with previous studies of childhood cancers, which have implicated initial therapy and genetic susceptibility as major risk factors for cancers later in life (Neglia et al., 2011)
|
From page 216... ...
NAACCR develops and promotes uniform data standards for cancer registration; provides education and training; certifies population-based registries; and aggregates and publishes data from central cancer registries. Data down to county level are released by NAACCR beginning in 1995, when NPCR started.
|
From page 217... ...
Only cancer registries that demonstrated that cancer incidence data were of high quality are included in the data set. The criteria for USCS publication are also presented in Table 4.5.
|
From page 218... ...
publishes cancer incidence data from populations all over the world for which good quality data are available. The purpose of the publication is to compare rates of cancer incidence from different populations and draw conclusions on differences between and changes in cancer patterns by geographic area and formulate hypotheses about causes of cancer.
|
From page 219... ...
TABLE 4.6 Summary of State Cancer Registries' Data Quality by NAACCR Certification Methods State 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Alabama U U U U U S S G S G G G G G Alaska U U C G G G G G G G G G S G Arizona C G C G U S S S U U U U S S Arkansas U U U U U U S U S S S G G G California C G C G G/S G/S G/S/U G/S G G G G/S G G Colorado C G C G G G S G G G G G G G Connecticut C G C G G G U G G G G G G G Delaware U U C S G U U S G G G G G G District of Columbia U U C G G G G S G S U S S U Florida U U C S S G G G G G G G G G Georgia C/U G/U C/U S/U G/U G G G G G G G G/S G Hawaii C G C G S G G G G G G G G G Idaho U G C G G G G G G G G G G G Illinois U G C G G G G G G G G G G G Indiana U U U U U S G G S G S G G G Iowa C G C G G G G G G G G G G G Kansas U U C S S G G U G G G G G G Kentucky C G C G G G G G G G G G G G Louisiana C S C G G G G G G G G G G G Maine U U U U U U G G G G G G G G Maryland U U C G G G U G G U U U G G Massachusetts U U C G G G G G G G G G G G Michigan C/U G C G/S G G G G G G G G G G Minnesota U S C U G G G G G U G G G G Mississippi U U U U U U U U U S S G G G Missouri U U U S S G S G G G G G G G 219 continued
|
From page 220... ...
TABLE 4.6 Continued 220 State 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Montana U U C S S S S S G G G S S G Nebraska C G C G G G G G G G G G G G Nevada U U U U U G G G G G G G U G New Hampshire U U C G S G G G S G G G G G New Jersey C G C G G G G G G G G G G G New Mexico C G C G S S S G U S G S S S New York U U C G G G G G G G G G G G North Carolina U U C G S G S S S G S G G G North Dakota U U U G G S U G G G G G G G Ohio U G U S S S S S U S U U S S Oklahoma U U U U U U G G G G G G G G Oregon U G C G S G G G G G G G G G Pennsylvania U U C G G G U G G G G G G G Rhode Island U G C G G G G G G G G G G G South Carolina U U C G G S S G G G G G G S South Dakota U U U U U U U U G S G S G G Tennessee U U U U U U U U U U G G G G Texas U U U U U U U U G G G G G G Utah C G C G G S G G S G G G G G Vermont U U U U U U U U S G G G G G Virginia U U U U U U U U S S G G G U Washington C/U G C G/S G G G G G G G G G G West Virginia C S C G G G G G G G G G G G Wisconsin C G C G G G G G G U U U S U Wyoming U U C G G G S U U U G G S G NOTE: C, certified; S, silver; G, gold; U, uncertified; multiple certifications if more than one registries exist within the state.
|
From page 221... ...
TABLE 4.7 Geographic Coverage in the Nine Successive Volumes of IARC's Cancer Incidence in Five Continents Vol.
|
From page 222... ...
TABLE 4.7 Continued 222 Vol.
|
From page 223... ...
Indiana 1998-2002 Iowa 1969-71 1973-77 1978-82 1983-87 1988-92 1993-97 1998-2002 Kentucky 1998-2002 Louisiana 1998-2002 Black 1998-2002 White 1998-2002 Louisiana, Central Region: Black 1988-92 1993-93 White 1988-92 1993-97 Louisiana, New Orleans Black 1974-77 1978-82 1983-87 1988-92 1993-97 1998-2002 White 1974-77 1978-82 1983-87 1988-92 1993-97 1998-2002 Maine 1998-2002 Massachusetts 1998-2002 Michigan 1998-2002 Black 1998-2002 White 1998-2002 Michigan, Detroit: 1998-2002 Black 1969-71 1973-77 1978-82 1983-87 1988-92 1993-97 1998-2002 White 1969-71 1973-77 1978-82 1983-87 1988-92 1993-97 1998-2002 Missouri 1998-2002 Black 1998-2002 White 1998-2002 Montana 1998-2002 Nevada 1959-66 New Jersey 1998-2002 Black 1993-97 1998-2002 White 1993-97 1998-2002 223 continued
|
From page 224... ...
TABLE 4.7 Continued 224 Vol.
|
From page 225... ...
1998-2002 Asian and Pacific Islander 1998-2002 Black 1998-2002 Hispanic White 1998-2002 Non-Hispanic White 1998-2002 South Carolina 1998-2002 Black 1998-2002 White 1998-2002 Texas 1998-2002 Black 1998-2002 White 1998-2002 Texas, El Paso Latin 1960-66 1968-70 Other than Latin 1960-66 1968-70 Utah 1966-70 1973-77 1978-82 1983-87 1988-92 1993-97 1998-2002 Vermont 1998-2002 Washington 1998-2002 Washington, Seattle 1974-77 1978-82 1983-87 1988-92 1993-97 1998-2002 West Virginia 1998-2002 Wisconsin 1998-2002 SOURCE: IARC's Cancer Incidence in Five Continents, Volume IX.
|
From page 226... ...
To better understand what data are available in individual cancer registries for the immediate need of this study, the committee requested information regarding cancer incidence from the states that have or have had a nuclear facility. A letter template is presented in Appendix K
|
From page 227... ...
227 EPIDEMIOLOGIC STUDIES TABLE 4.8 Availability of Cancer Incidence and Mortality Data of States that Have or Have Had a USNRC-Licensed Nuclear Facility Information Received from First Year Data Are Available and: Census Tract M=mortality In Electronic I=incidence Address Is Complete Is Present Vital Format Present Cancer Statistics State Registry Office M 1991 1991 -- 1991 ✓ Alabama I 1996 1996 -- 1996 ✓ M 1970 1989 1975 1970 Arizona I 1995 1990 1995 1990 M Arkansas I 1997 1997 1997 1997 ✓ M 1988 1988 1988 1988 ✓ California I 1988 1988 1988 1988 ✓ M 1975 1975 1990 1975 ✓ Colorado I 1988 1988 1995 1988 ✓ M Connecticut I M 1970 1970 1991 1970 ✓ Florida I 1981 1981 1981 1981 ✓ M 1980 1980 1995 1980 ✓ Georgia I 1998 1998 1998 1998 ✓ M 1950 2008 1979 1970 Illinois I 1986 1986 -- 1986 ✓ M Iowa I 1973 1973 1990 1973 ✓ ✓ M 1995 -- 1995 ✓ Kansas I M Kentucky I 1995 1995 1995 1995 ✓ M 1969 1969 1969 ✓ Louisiana I 1988 1988 1995 1988 ✓ M Maine I 1995 1995 -- 1983 ✓ M 1970 1987 1995 1970 ✓ Maryland I 1992 1992 2000 1995 ✓ M ✓ Massachusetts I 1982 1982 1982 1982 ✓ M 1970 2000 2000 1970 Michigan I 1985 1985 1985 1985 ✓ M Minnesota I 1988 1988 1988 1988 ✓ M Mississippi I continued
|
From page 228... ...
228 ANALYSIS OF CANCER RISKS TABLE 4.8 Continued Information Received from First Year Data Are Available and: Census Tract M=mortality In Electronic I=incidence Address Is Complete Is Present Vital Format Present Cancer Statistics State Registry Office M Missouri I M Nebraska I 1995 1987 1990 1995 ✓ M Nevada I 1995 1995 -- 1979 ✓ M New Hampshire I 1990 1990 1990 1990 ✓ M 1979 1979 1979 ✓ New Jersey I 1979 1979 1979 ✓ M 1965 1980 2006 1980 New Mexico I 1973 1966 1973 1966 M New York I 1976 1995 1995 1976 ✓ M 1913 2000 2001 1956 North ✓ Carolina I 1990 1990 1990 1990 ✓ M ✓ Ohio I 1996 1996 1996 1996 ✓ M 1971 2006 2007 1989 ✓ Oregon I 1996 1996 1996 1996 ✓ M 1959 1979 -- 1959 Pennsylvania I 1985 1985 2000 1985 M South ✓ Carolina I 1996 1996 1996 1996 ✓ M South Dakota I M Tennessee I M Texas I 1995 1995 1995 1995 ✓ M 1985 2008 -- 1985 ✓ Vermont I 1994 1994 2001 1994 ✓ M Virginia I 1999 1990 1998 1990 ✓ M 1980 ✓ Washington I 1992 1992 1992 1992 ✓ M Wisconsin I SOURCE: Based on responses to the letter shown in Appendix K
|
From page 229... ...
This change is important for the interpretation of cancer incidence statistics. The extent of the effect for each cancer site depends on the sitespecific probability of multiple primaries.
|
From page 230... ...
However, if justified by research needs, address information from the Illinois cancer registry may be released upon review and approval of the application. Interestingly, although generally census-tract data exist for cancer registries, mortality data have not been routinely geocoded.
|
From page 231... ...
Table 4.9 summarizes the information on approval requirements for cancer registries (document Cancer Registry Data Access for Research was created January 11, 2012, by CDC)
|
From page 232... ...
232 ANALYSIS OF CANCER RISKS TABLE 4.9 Cancer Registry Research Approval Process Pediatric Level of Special Timeframe Complexitya State Approval Requirements Fee (months) 3 AK GROUP Yes Yes Varied 3 AL CR Director/Group/CR IRB Yes Yes Varied <2 1 AR Epidemiologist/Group 2 AZ CR IRB Varied <2 3 CA CR IRB Yes Yes 3 CO CR IRB 2-6 <2 2 CT CR IRB <2 2 DC CR IRB 2 DE Epidemiologist/Group/CR IRB 2-6 <2 1 FL Group/CR IRB Yes <2 3 GA CR IRB <2 3 HI Group/CR IRB Yes <2 1 IA Epidemiologist/CR IRB/Group <2 3 ID Group Yes Yes 2 IL CR IRB Yes Varied <2 1 IN Group 2 KS Group/CR IRB/CR IRB/Group Yes Varied <2 1 KY Group Yes <2 3 LA Group/CR IRB Yes 2 MA Group/Commissioner Varied 2 MD CR Director/Officials/CR IRB/Dept Varied Health Sec 3 ME CR Director/Group/CR IRB Yes Yes 2-6 3 MI Group/Group/Dept Health Director Yes Yes 2-6 3 MN Group/Group Yes Yes 2-6 3 MO Group/CR IRB/CR IRB Yes 2-6 <2 1 MS Group Yes <2 1 MT Group/Bureau Chief/Admin/Group Yes <2 1 NC Group/Group Yes 2 ND Group/Group 2-6 <2 3 NH Group/CR IRB Yes 2 NJ Group/CR IRB Yes Varied 3 NM CR Director/CR IRB Yes Varied 2 NY Group/CR IRB Yes 2-6 3 NV CR Biostatistician/CR Manager/ Yes Yes 2-6 Bureau Chief 2 OH Group/CR IRB 2-6 2 OK CR/CR IRB/Commissioner Varied 3 OR CR Director/CR IRB/Group Yes Yes 2-6 <2 1 PA Group Yes 3 PR CR Director&Coord/CR IRB/ Yes 2-6 Group 3 RI CR Director/CR IRB Yes 2-6
|
From page 233... ...
233 EPIDEMIOLOGIC STUDIES Required Physician/Patient Auth by Human Patient Subject Contact Limit Protection Studies Number of Sponsorship Training Allowed CR Researcher Studies No N/A N/A Physician Yes Pt Physician Pt Yes Physician Yes Physician Pt Yes Pt Yes Physician/Pt Yes Yes Pt Yes Pt Physician/Pt Pt Physician Yes Pt Pt Yes Yes Yes Pt Pt Physician Yes Physician/Pt Physician/Pt Yes Pt Yes Pt Pt Physician Pt Yes Pt Yes Yes Physician/Pt Physician/Pt Yes Physician/Pt Physician/Pt Pt Yes Physician Pt continued
|
From page 234... ...
Pediatric cancer incidence can be derived for any site or age group from individual state cancer registry data and from SEER. Unlike the situation
|
From page 235... ...
. The CCRN potentially could provide a resource for identification of cases for an epidemiologic study.
|
From page 236... ...
NCHS then summarizes the mortality data and documents the health status of the population in the United States. NCHS provides access to its data but does not release data for geographic units smaller than county; the vital records office of each state needs to be contacted for access to more geographically precise data.
|
From page 237... ...
The lack of address information accompanying cancer death registration is problematic for a study of cancer risks in populations near nuclear facilities as investigators are unable to assess risks related to the early operational years of the nuclear facilities, for example, the 1960s (when cancer registration efforts were nonexistent in the majority of the states)
|
From page 238... ...
As a result, DMV records would not be useful for a study of childhood cancers. Alternative control identification methods such as use of a friend, neighborhood, family, or school controls have limitations that affect their appropriateness in a study of cancer risks in populations near nuclear facilities, including a high risk of overmatching on exposure and geographic location.
|
From page 239... ...
to obtain addresses or tabulations by census tract or other smaller geographic units. In an effort to identify the release criteria of birth registration data and the potential of linkage of birth records with cancer registries within and across states, the committee sent a letter to the 38 states that have or have had a nuclear facility.
|
From page 240... ...
. Common record linkages in epidemiology are between birth records and state cancer registries to identify individuals who developed the disease of interest or with mortality data to determine who has died.
|
From page 241... ...
One example is the Hanford Thyroid Disease Study conducted in the 1990s, a retrospective cohort study of the effects of exposure to atmospheric radioactive releases from the Hanford Nuclear Site in southeastern Washington State in the 1940s-1950s (Davis et al., 2008; study is discussed in Appendix A)
|
From page 242... ...
An extensive effort was required before a cohort member was declared "unlocated" by the team of supervisory staff. Another example of a study with satisfactory response rate of 75 percent used 14 sources to locate 230 parents of sudden infant death syndrome infants and 255 parents of healthy living infants in Southern California (Klonoff-Cohen, 1996)
|
From page 243... ...
In 2007, participation rates for the survey were 68 percent. As noted above, the goal of the NHIS is to collect summaries of health at the national, and perhaps state level, not at the fine geographic scale of census tracts.
|
From page 244... ...
However, the data are not sufficient to support design-based estimates at the census-tract level. 4.3.6.4 Health Care Surveys NCHS performs the National Health Care Survey to answer questions on the use and quality of health care, the impact of medical technology, and disparities in health care services provided to population subgroups in the
|
From page 245... ...
The National Hospital Discharge Survey (NHDS) is briefly described here as an example to demonstrate the relation of the different health care surveys and the potential for linkage with other national data sets.
|
From page 246... ...
Based on this assessment, the committee finds that: 1. The statistical power of an epidemiologic study of cancer risks in populations near nuclear facilities is likely to be low because (a)
|
From page 247... ...
, two studies be carried out to assess cancer risks in populations near nuclear facilities: (a) an ecologic study of multiple cancer types that would provide an assessment of cancer incidence and mortality in populations living within approximately 50 km of nuclear facilities and (b)
|
From page 248... ...
. Cancer incidence in municipalities near two for mer nuclear materials processing facilities in Pennsylvania.
|
From page 249... ...
. Cancer in populations living near nuclear facilities.
|
From page 250... ...
. Comparison of breast cancer incidence in the Mas sachusetts tuberculosis fluoroscopy cohort and in the Japanese atomic bomb survivors.
|
From page 251... ...
. Solid cancer incidence in atomic bomb survivors: 1958 1998.
|
From page 252... ...
. Childhood cancer and nuclear power plants in Swit zerland: A census-based cohort study.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.