First Statewide Cancer Maps Issued
More County Maps to Follow, as well as Small-area Analyses
Albany, December 9 – As part of New York's $4 million Cancer Surveillance Improvement Initiative, the State Health Department today issued the first in a series of maps that show the incidence of cancer across New York.
In 1998, Governor George E. Pataki directed the Department to produce the maps as part of an ongoing, comprehensive initiative that will help health officials to track the geographic distribution of cancer cases in New York State and respond to public concerns about possible unusual patterns of illness.
"Governor Pataki directed the State Health Department to develop easily understandable information that would address people's questions about the number of cancer cases in their communities," State Health Commissioner Antonia C. Novello, M.D., M.P.H. said."With the release of these maps, New York moves closer to its goal of improving cancer surveillance and becoming a national model for cancer mapping."
The Cancer Surveillance Improvement Initiative (CSII) is a comprehensive project which will enhance the State's ability to track the occurrence of cancer by improving the New York State Cancer Registry, and through the use of maps, charts and other graphic representations of the geographic pattern of cancer cases. The initiative also will increase public understanding of cancer, its known or suspected causes and risk factors, and will promote prevention and early detection.
"Maps are high-impact because a picture is worth a thousand words," Dr. Novello said. "We doctors lecture about how bad smoking is for you and why you should watch your diet. We rattle off statistics about serious illness and death. People don't like statistics so they don't always pay attention, but cancer maps are hard to ignore. It's right there in living color—cancer's terrible toll."
"I have discussed these maps with Dr. Novello and we look forward to receiving them and incorporating New York State's incidence data into our studies," said Richard D. Klausner, M.D., Director of the National Cancer Institute, which currently is conducting a $21 million study of breast cancer on Long Island. "We are eager to work with New York State health officials on future cancer research efforts."
Because cancer maps may suggest unusual patterns of cancer occurrence, State health officials believe that the comprehensive initiative will help in tracking new cases of cancer and may even suggest a focus for future research. The initiative, which will also include production of sub-county level maps and maps of cancer risk factors, may also indicate where specific health programs and services, such as mammography vans, colorectal screening and increased cancer education, should be enhanced.
These initial maps use color-coding to represent the rate of newly diagnosed cases of breast cancer among females; lung and bronchus cancers among males and females; and colorectal cancer among males and females for all counties in New York State. The Health Department produced the maps using Cancer Registry data for the years 1992-1996.
Maps based on zip code-level cancer data for the years 1993-1997 will follow within a few months. Sub-county level maps will incorporate state-of-the-art techniques to filter out statistical anomalies and better differentiate true cancer excesses from those caused by chance.
The maps are included in a booklet which explains the purposes of the CSII; general facts about cancer, its known causes and prevention; facts about the specific type of cancer that was mapped; and how to read the maps and accompanying bar graph. An advisory committee comprised of cancer activists, environmental advocates and national experts in cancer issues, geographic information systems and health risk communication is working closely with the Department to develop the maps and informational materials. Based on the committee's advice, these initial maps will be followed shortly by county maps representing eight more anatomic sites of cancer. Sub-county level maps and maps of selected cancer risk factors also are planned.
More county maps due shortly:
County maps to be issued shortly will show the geographic pattern of:
- Bladder cancer
- Brain and central nervous system cancer
- Kidney cancer
- Liver cancer
- Non-Hodgkin's lymphoma
- Prostate cancer
- Thyroid cancer
Selection of anatomic sites was based on criteria including overall prevalence of the disease, whether the incidence (number of new cases) is increasing, and whether the disease has known or suspected causes or risk factors (lifestyle, genetic or environmental associations).
Breast cancer was mapped because it is one of the most common cancers among women in New York State. Colorectal cancer and lung cancer, likewise, are common and deadly diseases. Colorectal cancer may be associated with a high-fat, low fiber diet and smoking is known to be the main cause of lung cancer.
Senator Kemp Hannon, Chairman of the State Senate Health Committee, said, "We are in a time of optimism, when public health strategies, early detection and more effective treatments can result in the decline of cancer in New York. Today's release of the comprehensive cancer incidence map is another useful tool available to all New Yorkers in their own fight against cancer."
Geri Barish, President of One in Nine, the Long Island Breast Cancer Coalition, said, "We're thrilled that cancer maps are being released. Breast cancer activists were the earliest and the strongest proponents of mapping. We look forward to working with the State Health Department and local health officials to help people look at the maps objectively and answer questions they may raise."
Robert A. Smith, Ph.D., Director of Cancer Screening for the American Cancer Society, and Chair of the New York State Cancer Surveillance Improvement Initiative Advisory Committee, said, "Today's release of the first State-wide incidence maps for breast, colorectal, and lung cancer represents a visible, and important milestone in progress towards the goals established by the New York State Department of Health's Cancer Surveillance Improvement Initiative. These maps, and those that will follow, offer the public, the media, policy makers, and researchers a new way of viewing the burden of cancer in New York. They also are a prelude towards the application of new geographic-information-system (GIS) analytic techniques to better identify localities in the State that may warrant epidemiologic investigation areas due to unusually high, or low, cancer incidence and/or mortality.
These maps can not explain why cancer rates are higher or lower than average; but maps generated by new techniques in geographic data analysis do provide us with powerful tool for determining where in the State citizens are experiencing a higher burden of disease. The New York State Department of Health is among a small number of States that are exploring new directions for cancer surveillance and epidemiology, and developing methods and protocols that are likely to be emulated by other States as they evolve."
Donald Distasio, Chief Operating Officer of the American Cancer Society of New York and New Jersey, said, "These maps will help us all better understand the burden of cancer among New Yorkers and can help the American Cancer Society target its resources for prevention and detection of cancer, patient services and advocacy efforts. They also will point us in the right direction for further epidemiological studies."
John A. Ostuni, M.D., President of the Medical Society of the State of New York, said, "We commend the Department of Health for publishing this important and useful health information that so clearly presents the many factors affecting an individual's cancer risk. This information is vitally important to all New Yorkers. We hope that patients will use this information and talk to their physicians about their own cancer risk and how to prevent cancer."
Limitations of cancer maps:
Health officials stress that neither the cancer maps released today nor those to be produced in the future will be able to demonstrate a cause and effect relationship between cancer risk factors, including suspected environmental carcinogens, and incidence of disease. This is partly due to the latency period, as well as the fact that cancer is not a single disease but more than 100 different diseases. What causes a lung cell to change into lung cancer is not the same as what changes a breast cell into breast cancer, or a blood cell into leukemia. In the case of environmental factors, the presence of a known or suspected cancer-causing agent, by itself, does not prove whether any individuals were exposed. Without exposure, there is no increased risk.
Exposure assessment, as well as other critical individual details such as family history of cancer, residential and occupational histories, and behavioral factors such as smoking, diet and amount of physical activity, are determined through the science of epidemiology, the study of disease. State health officials believe that cancer maps might help guide the direction of future scientific studies, should unusual disease patterns emerge.
The Breast Cancer map:
The statewide map of female breast cancer shows a consistent pattern of the disease throughout New York. The vast majority of counties (60 of 62) fall within 20 percent below or 20 percent above the annual State rate of 101.6 cases of 100,000 women. One county (Hamilton) is more than 20 percent below the State rate. Because Hamilton County averages fewer than 20 cases of breast cancer annually, its rate is considered unstable. One county (Rockland) is 29 percent above the State rate. State health officials have examined Cancer Registry data representing Rockland County breast cancer cases, including a calculation of the proportion of cases diagnosed at an early stage of disease and the age of women when they were diagnosed with breast cancer. There were no unusual findings as a result of this analysis.
Rockland County may have a higher prevalence of known breast cancer risk factors. Like other areas of the northeastern United States, Rockland County may share similarities in demographic make up of the population that research has shown to be associated with increased rates of breast cancer in the community. These factors include higher median income level, higher education levels, smaller family size, later age at first childbirth, and higher proportion of women of Jewish ethnicity. As with other areas of New York, the State has devoted resources to provide mammograms, breast exams and diagnostic tests to medically under-served women in Rockland County, in order to reduce the disease burden on the community.
Nassau and Suffolk counties, which are the focus of the ongoing $21 million dollar breast cancer case control study by the National Cancer Institute, have breast cancer rates that are, respectively, 16 percent and 11 percent above the State rate. Because of its size and scientific design, the Long Island research will provide important information about breast cancer that will benefit all women in New York State.
Breast cancer prevention and early detection has been a top priority of the Pataki administration. The State Health Department has supported Healthy Women Partnerships that serve every county and bring breast cancer screening to women who otherwise could not afford it. Since 1997, nearly 135,000 breast cancer screenings have been provided to under-served women. As a result, 443 cases of invasive breast cancer and 140 cases of in situ breast cancer were detected. Many were found at an early stage when treatment is most promising.
The Department also has purchased, equipped and funded staff for mobile mammography units around the State. These vans are bringing breast cancer screening services to women in rural areas, inner city neighborhoods and other locations with limited access to screening opportunities.
Lung Cancer maps:
Three counties (Jefferson, Yates and Greene) have the highest lung cancer rates among both males and females. Although they do not all fall within the highest category, many counties in the northern part of New York State, along the Vermont and Canadian borders, have higher lung cancer rates. These counties have relatively smaller populations, and rates in small counties tend to fluctuate. Since smoking is the cause of the vast majority of lung cancers, the higher rates probably reflect past tobacco use by county residents. The current smoking pattern of people who live in those counties would not affect the lung cancer rate, since the disease has a latency period of ten to twenty years, or longer. This means that it usually takes decades between the time that persons begin smoking and when they develop lung cancer, although damage to the body begins at once.
Among the counties that comprise New York City, Richmond (Staten Island) is the only one that has a lung cancer incidence rate more than 20 percent above the State rate. Demographically, Staten Island is more like the remainder of New York State than are the other New York City boroughs, which have low lung cancer rates compared to the rest of the State. Past smoking patterns of Staten Island residents would be associated most closely with a higher rate of lung cancer.
Colorectal Cancer maps:
Montgomery County is the only county which has a colon and rectal cancer rate for both males and females more than 20 percent above the State rate. Known risk factors for colorectal cancer include physical inactivity, obesity and a low fiber, high fat diet. Persons with certain inherited diseases also are more likely to get colorectal cancer. At present, there is no county-specific data that would demonstrate if these risk factors are more pronounced in Montgomery County than elsewhere in New York State.
For further information:
Booklets containing county maps and related information about breast cancer, lung cancer and colorectal cancer are available free-of-charge from the State Health Department, Box 2000, Empire State Plaza, Albany, New York 12237. Electronic versions of the maps are available online, along with interactive features and detailed information including to cancer resources, from the Health Department's Cancer Surveillance Improvement Initiative web site (www.health.state.ny.us).