Cancer and Cancer and Jefferson CountyJefferson County

Prepared by the University of Louisville, School of Public Health Depts. of Epidemiology and Clinical Investigation Sciences and Occupational and Environmental Health, and the Lung Cancer Project

A Presentation

Should I be concerned? We all should be concerned about air

quality and look for ways to reduce emissions of chemicals, especially air toxics

And we should keep the risks in perspective

“Good surveillance does not necessarily ensure the making of right decision, but it reduces the chances of the wrong ones.”

Alexander Langmuir, MD, MPH; Director of Epidemiology for CDC from 1949-1969

Problem Chemicals & Community Concerns

Butadiene Sources: Vehicles, 3 manufacturers (plans in place to

reduce) Chromium

Sources: Electricity generation, boilers, plating Acrylonitrile

Sources: 2 manufacturers (plans in place to reduce)

Understanding cancer risk “one-in-a-million”

Cancer risk is enormous “Everybody wants to go to heaven, but

nobody wants to die” – Aging is a critical factor in cancer increase & risk

Environmental risk is incredibly small 1/1,000,000 is an enormous prevention

goal, NOT a useful thing to fear

Region 4 Air ToxicsRanked Risk Screening

Analysis

11/1000

0.001/1000

WF AAF WM AAM

Age 70

Age 70 + Ever0

5

10

15

20

25

Cancer Risk to Age 70 and Ever: Breast Cancer for Women, Prostate Cancer for Men

African-American men’s risk for prostate cancer rises from 1:8 until age 70 and then to 1:5 ever (lifetime) risk.

Cancer Risk to Age 70, Ever, and Environmental Increase

21.5

21.5

18.3

18.3

15 20 25 30 35 40 45 50

males

one-yr

females

one-yr To 70EverEnv.

….

Risk to age 70 is 215,000/1,000,000; environmental protection aims to keep that to 215,001/1,000,000

Data Monitoring in Rubbertown

EPA monitoring identified Jefferson County as having the highest health risk posed by air quality, in the Southeastern US.

State funding permitted follow-up air monitoring studies to be performed in the Rubbertown area during 2001

Disease risk is also able to be assessed for asthma and cancer.

Treatment [First Course]

3.8

15.4

30.8

6.7

33.3

6.6

23.1

26.926.7 26.7

0

5

10

15

20

25

30

35

None Surg RadTx Chem/Rtx All Other

Perc

ent

WFAfrAmF

Stage at Diagnosis

65.4

26.9

7.7

26.7

4033.3

0

10

20

30

40

50

60

70

Earlier IV Unstaged

Perc

ent

WF

AAF

Considerable Stage Difference

Comparisons by Race for Stage, Treatment, Payor

No Trtx and ‘all Other’ varies

Method of Payment is quite different by race, and from the Overall Hospital Pattern

Payment Pattern Uof L [All Admissions] vs Adencocarcinoma of the Lung 1999-2001

37

17.1

7.311.7 12

2326.9

7.74

40

6.7 7.3

19.414.9

19.2 19.213.313.3

05

1015202530354045

Med

icai

d

Med

icar

e

Com

mer

cial

Priv

ate

Wel

fare

All O

ther

% P

ayin

g

All UofL

AdenoLung wfAdenoLung bf

University of Louisville and BCC Lung Cancer, Adenocarcinoma for Females: 1999-2000

00.10.20.30.40.50.60.70.80.9

1

0 6 mos. 1 Yr. 18 mo. 2 Yrs. 30 mo. 3 Yrs.

Perc

ent

Sur

vivi

ng

WF

AAF

“The reason for collecting, analyzing, and disseminating information on a disease is to control that disease. Collection and analysis should not be allowed to consume resources if action does not follow.”Foege, Hagan, Newton: International

Journal of Epidemiology, 5: 29-37. 1976.

Michael R. Hicks, MAVoice: 502-852-4061 Fax: 502-852-3294E-mail: michael.hicks@louisville.edu

Fairouz Saad, MPHVoice: 502-852-4061 Fax: 502-852-3294E-mail: fssaad01@louisville.edu

Tim E. Aldrich, Ph.D., MPHVoice: 502-852-3006 Fax: 502-852-3294E-mail: tealdr01@gwise.louisville.edu

University of Louisville School of Public Health and Information SciencesDept. Epidemiology and Clinical Investigation Sciences Louisville, Kentucky 40202

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