Cancer incidence in a population potentially exposed to radium-226 at Dalgety Bay, Scotland

Investigating reports of cancer clusters in Canada: a qualitative study of public health communication practices and investigation procedures

INTRODUCTION:

Public health officials provide an important public service responding to community concerns around cancer and often receive requests to investigate patterns of cancer incidence and communicate findings with citizens. In this study, we identified procedures Canadian public health officials followed when investigating reports of cancer clusters, and explored the challenges officials faced conducting risk communication with communities.

METHODS:

Thirteen interviews were administered by telephone with 15 officials across Canadian jurisdictions and analyzed using thematic analysis. A content analysis of procedural documents received from five provinces was also undertaken.

RESULTS:

A third of provinces/territories in this study did not use any consistent guidelines to investigate reports of cancer clusters, a third used their own guidelines and a third used guidelines from other countries. Each Canadian jurisdiction identified a different agency or individual responsible for investigating cluster inquiries. Officials in most interviews considered public education to be the primary objective of risk communication during an investigation. Officials in only 4 of 13 interviews cited an overall positive response from the public after investigating reports of a cancer cluster.

CONCLUSION:

Differences in practices used to investigate suspected cancer clusters by public health officials were revealed in this work. Establishing pan-Canadian cancer cluster guidelines could improve procedural consistency across jurisdictions and offer enhanced opportunities to compare cluster responses for evaluation. A reporting system to track reported clusters may improve information sharing between federal, provincial/territorial and local investigators. During formal investigations, face-to-face participatory communication approaches should be explored to improve citizen engagement and manage community concerns.

Analysis of the spatial variation of hospitalization admissions for hypertension disease in Shenzhen, China

In China, awareness about hypertension, the treatment rate and the control rate are low compared to developed countries, even though China's aging population has grown, especially in those areas with a high degree of urbanization. However, limited epidemiological studies have attempted to describe the spatial variation of the geo-referenced data on hypertension disease over an urban area of China. In this study, we applied hierarchical Bayesian models to explore the spatial heterogeneity of the relative risk for hypertension admissions throughout Shenzhen in 2011. The final model specification includes an intercept and spatial components (structured and unstructured). Although the road density could be used as a covariate in modeling, it is an indirect factor on the relative risk. In addition, spatial scan statistics and spatial analysis were utilized to identify the spatial pattern and to map the clusters. The results showed that the relative risk for hospital admission for hypertension has high-value clusters in the south and southeastern Shenzhen. This study aimed to identify some specific regions with high relative risk, and this information is useful for the health administrators. Further research should address more-detailed data collection and an explanation of the spatial patterns.

Evaluating airborne and ground based gamma spectrometry methods for detecting particulate radioactivity in the environment: a case study of Irish Sea beaches

In several places, programmes are in place to locate and recover radioactive particles that have the potential to cause detrimental health effects in any member of the public who may encounter them. A model has been developed to evaluate the use of mobile gamma spectrometry systems within such programmes, with particular emphasis on large volume (16l) NaI(Tl) detectors mounted in low flying helicopters. This model uses a validated Monte Carlo code with assessment of local geochemistry and natural and anthropogenic background radiation concentrations and distributions. The results of the model, applied to the example of particles recovered from beaches in the vicinity of Sellafield, clearly show the ability of rapid airborne surveys conducted at 75 m ground clearance and 120 kph speeds to demonstrate the absence of sources greater than 5 MBq (137)Cs within large areas (10-20 km(2)h(-1)), and identify areas requiring further ground based investigation. Lowering ground clearance for airborne surveys to 15m whilst maintaining speeds covering 1-2 km(2) h(-1) can detect buried (137)Cs sources of 0.5MBq or greater activity. A survey design to detect 100 kBq (137)Cs sources at 10 cm depth has also been defined, requiring surveys at <15m ground clearance and <2 ms(-1) ground speed. The response of airborne systems to the Sellafield particles recovered to date has also been simulated, and the proportion of the existing radiocaesium background in the vicinity of the nuclear site has been established. Finally the rates of area coverage and sensitivities of both airborne and ground based approaches are compared, demonstrating the ability of airborne systems to increase the rate of particle recovery in a cost effective manner. The potential for equipment and methodological developments to improve performance are discussed.

Multiple myeloma: A review of the epidemiologic literature

Multiple myeloma, a neoplasm of plasma cells, accounts for approximately approximately 15% of lymphatohematopoietic cancers (LHC) and 2% of all cancers in the US. Incidence rates increase with age, particularly after age 40, and are higher in men, particularly African American men. The etiology is unknown with no established lifestyle, occupational or environmental risk factors. Although several factors have been implicated as potentially etiologic, findings are inconsistent. We reviewed epidemiologic studies that evaluated lifestyle, dietary, occupational and environmental factors; immune function, family history and genetic factors; and the hypothesized precursor, monoclonal gammopathies of undetermined significance (MGUS). Because multiple myeloma is an uncommon disease, etiologic assessments can be difficult because of small numbers of cases in occupational cohort studies, and few subjects reporting exposure to specific agents in case-control studies. Elevated risks have been reported consistently among persons with a positive family history of LHC. A few studies have reported a relationship between obesity and multiple myeloma, and this may be a promising area of research. Factors underlying higher incidence rates of multiple myeloma in African Americans are not understood. The progression from MGUS to multiple myeloma has been reported in several studies; however, there are no established risk factors for MGUS. To improve our understanding of the causes of multiple myeloma, future research efforts should seek the causes of MGUS. More research is also needed on the genetic factors of multiple myeloma, given the strong familial clustering of the disease.

Spatial epidemiology: current approaches and future challenges

Spatial epidemiology is the description and analysis of geographic variations in disease with respect to demographic, environmental, behavioral, socioeconomic, genetic, and infectious risk factors. We focus on small-area analyses, encompassing disease mapping, geographic correlation studies, disease clusters, and clustering. Advances in geographic information systems, statistical methodology, and availability of high-resolution, geographically referenced health and environmental quality data have created unprecedented new opportunities to investigate environmental and other factors in explaining local geographic variations in disease. They also present new challenges. Problems include the large random component that may predominate disease rates across small areas. Though this can be dealt with appropriately using Bayesian statistics to provide smooth estimates of disease risks, sensitivity to detect areas at high risk is limited when expected numbers of cases are small. Potential biases and confounding, particularly due to socioeconomic factors, and a detailed understanding of data quality are important. Data errors can result in large apparent disease excess in a locality. Disease cluster reports often arise nonsystematically because of media, physician, or public concern. One ready means of investigating such concerns is the replication of analyses in different areas based on routine data, as is done in the United Kingdom through the Small Area Health Statistics Unit (and increasingly in other European countries, e.g., through the European Health and Environment Information System collaboration). In the future, developments in exposure modeling and mapping, enhanced study designs, and new methods of surveillance of large health databases promise to improve our ability to understand the complex relationships of environment to health.

Mapping health in the Great Lakes areas of concern: a user-friendly tool for policy and decision makers

The role of the physical environment as a determinant of health is a major concern reported by the general public as well as by many policymakers. However, it remains one of the health determinants for which few available measures or indicators are readily available. This lack of data is compounded by the fact that evidence for direct cause-and-effect relationships in the literature is often equivocal, leading to feelings of uncertainty among the lay public and often leading to indecision among policymakers. In this article we examine one aspect of the physical environment--water pollution in the Great Lakes Areas of Concern (AOCs)--and its potential impacts on a wide range of (plausible) human health outcomes. Essentially, the International Joint Commission, the international agency that oversees Great Lakes water quality and related issues, worked with Health Canada to produce a report for each of the 17 AOCs on the Canadian side of the Great Lakes, outlining a long list of health outcomes and the potential relationships these might have with environmental exposures known or suspected to exist in the Great Lakes basin. These reports are based solely on secondary health data and a thorough review of the environmental epidemiologic literature. The use of these reports by local health policymakers as well as by public health officials in the AOCs was limited, however, by the presentation of vast amounts of data in a series of tables with various outcome measures. The reports were therefore not used widely by the audience for whom they were intended. In this paper we report the results of an undertaking designed to reduce the data and present them in a more policy-friendly manner, using a geographic information system. We do not attempt to answer directly questions related to cause and effect vis-à-vis the relationships between environment and health in the Great Lakes; rather, this work is a hypothesis-generating exercise that will help sharpen the focus of research into this increasingly important area of public health concern.

Community health profile of Windsor, Ontario, Canada: anatomy of a Great Lakes area of concern

The rates of mortality, morbidity as hospitalizations, and congenital anomalies in the Windsor Area of Concern ranked among the highest of the 17 Areas of Concern on the Canadian side of the Great Lakes for selected end points that might be related to pollution in this relatively highly industrialized city. Mortality and morbidity rates from all causes were higher than in the rest of the province. Anomalously high rates of diseases included various cancers; endocrine, nutritional, metabolic, and immunity disorders; diseases of the blood and blood-forming organs, nervous system and sense organs, circulatory and respiratory systems, digestive system, genitourinary system, skin and subcutaneous tissue, musculoskeletal system and connective tissues; congenital anomalies, and infant mortality. Of particular concern was the early onset of the elevated rates of many of these diseases and conditions. Comparison of these incident rates with those in Hamilton, another industrial municipality in southern Ontario, suggested that in addition to a variety of local sources of industrial pollution from automobile manufacturing and use, transboundary air and water pollution from Detroit, Michigan, should be investigated as potentially important causes of these health outcomes in the Windsor Area of Concern. Some of the institutional and political trends of the past decade may need to be reversed before effective remedial programs are implemented for cleaning up contaminated sediments and for containment of leaking hazardous waste sites. This pilot project would seem to be a useful preliminary method of integrating human health concerns and of priority setting for the administration of the Great Lakes Water Quality Agreement and the Canada-United States Air Quality Agreement.