Evaluation of Childhood Cancer Incidence in Sandwich MA

Evaluation of Childhood Cancer Incidence in Sandwich, MA: 1995 - Present Massachusetts Department of Public Health Center for Environmental Health Community Assessment Program February 28, 2006

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 suspected disease patterns or “clusters” ¡ Investigate possible associations between environmental exposure and disease

Reason for Investigation ¡ ¡ Concerns about increased cancer incidence among children Requested by: Concerned resident from Sandwich ¡ A specific environmental concern was not reported to CAP ¡ ¡ Reports of more recent diagnoses of cancer among children

Steps in the Investigation ¡ Cancer evaluation Ø Ø Ø ¡ Calculate cancer incidence rate among children diagnosed during time period 1995 -2002 Review cancer types diagnosed (1995 – present) Evaluate geographic and temporal patterns of childhood cancer (1995 – present) Evaluate potential environmental concerns Ø Ø Public drinking water Location of groundwater plumes from MMR

Geographic Distribution ¡ Map locations of residence reported at time of diagnosis ¡ Evaluate spatial patterns of childhood cancer in neighborhoods within each community ¡ Evaluate patterns of childhood cancer in relation to environmental sources (e. g. MMR plumes)

Childhood Cancer Statistics ¡ ¡ 12, 158 children in the United States were diagnosed with cancer in 2002 267 children in Massachusetts were diagnosed with cancer in 2002

Cancer in Children Versus Cancer in Adults ¡ ¡ CHILDREN Different cancers may be more similar with respect to risk factors Little information is known about risk factors ¡ ¡ ADULTS Different cancers are different diseases Much is known about risk factors for a number of cancer types

Cancer in Children Versus Cancer in Adults (cont’d) Common Childhood Cancers Leukemia CNS tumors Bone tumors Common Adult Cancers Lung Colon Breast Prostate

Statistical Methods ¡ Standardized Incidence Ratio (SIR) SIR = ¡ Observed # of cases Expected # of cases 95% Confidence Interval X 100

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

MCR (cont’d) ¡ Statewide and city/town data are complete through 2002 Ø Data for 2003 being prepared for release soon ¡ Diagnoses reported to the MCR after 2002 are available for review ¡ Contacted treatment facilities and the Rhode Island cancer registry

Cape Cod Childhood Cancer: 1995 – 2002 Town Barnstable Observed Expected SIR 95% CI 14 14. 4 97 53 -163 Bourne 3 6. 2 NC NC Brewster 4 2. 9 NC NC Chatham 1 1. 3 NC NC Dennis 0 3. 8 NC NC Eastham 0 1. 3 NC NC Falmouth 9 9. 3 96 44 -183 Harwich 0 3. 1 NC NC Mashpee 7 4. 0 175 70 -361 Orleans 1 1. 2 NC NC Provincetown 0 0. 5 NC NC 10 7. 5 133 64 -245 Truro 1 0. 5 NC NC Wellfleet 2 0. 7 NC NC Yarmouth 6 5. 9 101 37 -220 Sandwich SIR and 95% CI not calculated when Observed is less than 5

Review of Cape Cod Childhood Cancer ¡ From 1995 -2002, the observed number of diagnoses was near or below the number of expected cases for the majority of towns on Cape Cod ¡ Preliminary review of more recent MCR data did not suggest patterns similar to those in SE Sandwich

Childhood Cancer Incidence in Sandwich, MA: 1995 -2002 Observed Expected SIR 95% CI Males 3 4. 0 NC NC Females 7 3. 5 200 80 -412 10 7. 5 133 64 -245 Total

Childhood Cancer Incidence in Sandwich Census Tracts: 1995 -2002 Census tracts Total Males Females OBS EXP SIR 95% CI 0133 1 0. 9 NC NC 0 0. 4 NC NC 1 0. 4 NC NC 0134 2 1. 3 NC NC 1 0. 7 NC NC 1 0. 6 NC NC 0135 5 2. 6 192 62 -449 1 1. 4 NC NC 4 1. 2 NC NC 0136 2 2. 7 NC 1 1. 4 NC NC 1 1. 2 NC NC Town 10 7. 5 133 64 -245 3 4. 0 NC NC 7 3. 5 200 80 -412 NC

Cancer Types Diagnosed 1995 -2002 Leukemia 3 children CNS Tumor 3 children Soft Tissue Sarcoma 2 children Lymphoma (Hodgkin’s Disease) 1 child Bone 1 child

Distribution of Childhood Cancer Diagnoses: 1995 - 2002

Cancer Types Diagnosed 2003 -2005 Leukemia 3 children CNS Tumor 2 children Bone 2 children

Distribution of Childhood Cancer Diagnoses: 2003 - 2005

What Do We Know About Childhood Cancer? Leukemia Ø Ø Ø Most common type among children Incidence highest in ages 2 -3 Pre-existing medical conditions (e. g. , Down’s syndrome) Treatment with ionizing radiation Exposure to drinking water contaminated with solvents and metals during pregnancy CNS Tumors Ø Ø Ø 2 nd most common type Ages 15 years and younger Pre-existing medical conditions (e. g. , Neurofibromatosis) Family history Treatment with ionizing radiation

What Do We Know About Childhood Cancer? Hodgkin’s Disease (HD) Ø Ø Ages 15 -19 Family history of HD Infection with Epstein Barr virus History of infectious mononucleosis Bone (Ewing’s) Ø Ø Ø Peak in incidence between ages 10 to 20 White children Other than race, no environmental factor or other characteristic has yet been shown to be a strong risk factor

What Do We Know About Childhood Cancer? Soft Tissue Sarcoma Ø Ø Ø Rhabdomyosarcoma is the most common soft tissue sarcoma in children Age less than 1 and children ages 15 -19 Pre-existing medical conditions (e. g. , Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome and Neurofibromatosis) Treatment with ionizing radiation Exposure to pesticides

Summary of Results 1995 -2002 ¡ Town-wide cancer incidence occurred more often than expected Ø Ø Incidence among males slightly less than expected Females were diagnosed more often than expected ¡ The number of diagnoses per year varied between 0 and 2 ¡ Age and cancer types diagnosed were consistent with literature

Summary of Results 1995 -2002 ¡ For 3 of 4 Sandwich CTs observed was close to the expected ¡ From 1996 -1999, 4 females residing in CT 0135 were diagnosed with cancer (versus 1. 2 expected) Ø Ø Ø 2 were diagnosed with leukemia 1 diagnosis of bone cancer 1 diagnosis of a soft tissue sarcoma

Summary of Results 2003 – 2005 ¡ From 2003 -2005, 7 children were diagnosed with cancer Ø Ø Ø ¡ 3 were diagnosed with leukemia 2 diagnoses of a CNS tumor 2 diagnoses of bone cancer Age and cancer types diagnosed were consistent with literature

Geographic Distribution 1995 - 2005 ¡ Two areas noted in CT 0135 Ø Ø 3 of the 6 children with leukemia lived in southeast Sandwich at the time of diagnosis 2 children diagnosed with bone cancer lived in fairly close proximity to one another in southern Sandwich

Environmental Review ¡ Distribution did not appear to correspond to areas potentially affected by MMR plumes ¡ Since 1993, no violations in Sandwich municipal drinking water (other than total coliform) ¡ % of housing units on public water (estimate)* Ø Ø CT CT 0133 0136 0134 0135 100% 90% 55% 36% *Source: 1990 US Census Data

Recommendations for Follow-up ¡ Conduct interviews with biological mother of children diagnosed with cancer in Sandwich from 1995 -present Ø Ø ¡ Pregnancy history Family medical history More complete residential history Parental occupational history Conduct interviews with mothers of children diagnosed with cancer from 1995 -present in Mashpee and Barnstable Ø Request MCR to contact treatment facilities

Recommendations for Follow-up (cont’d) ¡ ¡ Work with local health officials to obtain updated information on private well use To extent possible, review additional environmental factors of concern to community

Next Steps Approval of 24 A application (early March meeting) Mailing to parents with children diagnosed with cancer in Sandwich, Barnstable, and Mashpee during 1995 -present Obtain written consent from parents Schedule and conduct interviews; collect medical records; obtain available environmental data Data analysis Prepare summary report of findings Schedule public release

Contact Information The full report is available at: http: //www. mass. gov/dph/ceh. CAP staff can be reached at: Phone: (617) 624 -5757 Fax: (617) 624 -5777