Remarks for Dr. Novello and Mark Baptiste Cancer Mapping News Conference

Good afternoon. I am pleased to be here to announce the progress of a major new initiative that the Department of Health is undertaking to improve cancer surveillance in New York. Today I am releasing the first in a series of maps that will give all New Yorkers a clear, concise picture of the incidence of cancer across the State.

I am here today because I know full well that people all across the State are very concerned about cancer in their communities.

They fear that breast cancer is taking a huge toll on their mothers, sisters, wives and daughters, and that rates for other kinds of cancer are also much higher than they should be.

They feel especially vulnerable to environmental risk factors–and they are worried that something about the air they breathe, the water they drink, or the place they live, is affecting their health.

They want to fight back, and they believe that cancer maps will help them to do that.

To answer their concerns, Governor Pataki directed the Health Department to develop a comprehensive Cancer Surveillance Improvement Initiative and has dedicated $4 million dollars to the effort.

This ambitious endeavor, which includes cancer mapping, already has improved New York's Cancer Registry and enhanced the State's ability to track cancer incidence. New York is the first State to undertake such a comprehensive cancer mapping project.

Cancer maps will have many different uses. They may help scientists determine where to focus future cancer research. Because they will show the pattern of where cancer is occurring, they will guide prevention and early detection campaigns. And we are providing useful health information along with the maps to make people more aware of the known and suspected causes of cancer, and what they can do to reduce their risk.

Things like stopping smoking, avoiding over-exposure to sunlight and being careful about what they eat.

But they won't be able to show that something in their community, such as a landfill, is causing an increase in cancer there.

Maps alone cannot prove a cancer cause and effect. Cancer develops slowly in people and appears five to 40 years after exposure to a cancer causing agent. That is why it is so difficult to determine what causes cancer in humans. We must also factor in that people move during this time, making it hard to link exposure to a cancer causing agent.

And why is this important? It is due, in part, to the long latency period, or the time that it takes for cancer to develop. It is also due to 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.

And, the presence of a known or suspected cancer-causing agent, by itself, does not prove whether any individuals were exposed.

Your cancer risk depends on many factors including your lifestyle, whether you smoke, your diet, your family history and the contact you may have with cancer causing substances such as sunlight, x-rays or tobacco smoke.

New York State Rates Compared to National Rates

We're often asked how New York State cancer incidence rates compare with those of other states.

As you can see from this chart, our rates are not so very different from those of our neighboring states, and other large states.

For instance, the breast cancer incidence rate is 117.3 cases per 100,00 women in Connecticut... 110.6 in Massachusetts... 115.0 in New Jersey and 108.7 in Pennsylvania.

California's rate is 108.3; Florida's is 103.2 and Virginia's is 92.9.

New York's breast cancer incidence rate is 101.1.

You can see from the similar comparisons for lung cancer and colorectal cancer on this chart that the cancer knows no geographic boundaries.

Nonetheless, we believe our initiative, and the cancer maps we produce, will help New York State to improve cancer surveillance.

The County-Level Cancer Maps

Even though they cannot show us what is causing cancer in our communities, the country-level maps and graphs that we are releasing today are designed to increase public understanding of cancer. They are also intended to promote prevention and early detection.

In a moment I will describe how to read these maps and what they show us, but first allow me to offer you some background on how the Department approached this major undertaking.

But first, I want to mention our next steps.

Within a few months, we expect to release maps based on zip code-level cancer data for the years 1993-1997. 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.

We are also making provisions to share the data we generate with the National Cancer Institute and other experts.

Selecting an Expert Advisory Committee

Due to the complicated and multi-faceted nature of the initiative, we have assembled an Advisory Committee of nationally recognized experts to guide the Department through this process. The Committee comprises cancer activists, environmental advocates and national experts in cancer control, geographic information systems and health risk communication.

Joining us on the telephone right now is Dr. Robert Smith, of the national office of the American Cancer Society. Dr. Smith, Director of Cancer Screening for the American Cancer Society, is also an expert in health communications, and serves as our Advisory Committee Chair. Dr. Smith, would you like to comment on the initiative?

(Dr. Smith makes brief statement)

Improving the State Cancer Registry

Thank you Dr. Smith.

When we began this initiative, our first priority was to improve the timeliness, accuracy and completeness of New York State's Cancer Registry. Resources were made available to new reporting facilities, such as hospitals and managed care organizations, in meeting reporting requirements. The Department provided staff training, help in geocoding addresses, and upgrades to computer software.

As a result, the Department has made significant progress in improving the Registry, particularly in the area of timeliness. Data for 1996 was finalized so that we could produce maps and graphs using data for years 1992-1996.

These First Maps

I'd like to explain the maps to you which are contained in these booklets. These are the first in a series of maps that we will be releasing and they 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.

We chose to first map cancer incidence by county for lung, breast and colorectal cancer because they are among the most common cancers affecting New Yorkers. We also have effective ways of preventing deaths due to these cancers. For example, with lung cancer, the most effective way to reduce deaths is through smoking prevention and cessation programs. For colorectal and breast cancers, we can prevent deaths through early detection.

In the future we will produce maps of cancer incidence by county for several other anatomic sites. (Mark Baptiste to list later) Each county has been color-coded to indicate where it stands in relation to the state lung cancer incidence rate:

  • White indicates 20% below the state rate
  • Beige indicates a county is within 20% below and 20% above the state rate.
  • Light Brown indicates 20 - 29% above the state rate and;
  • Dark Brown means the county is 30% above the state rate or more.

For example: Hamilton County is the only county that falls well below the State Rate for lung cancer in men. While Chenango, Fulton, Greene, Jefferson, Sullivan and Yates counties are above the state rate by 30% or more.

The Map

If you refer to the map, you can see that Hamilton County is the only county that falls below the state rate and that the counties with the highest rates appear in the dark brown.

Because cancer rates are different in males and females the booklet contains two maps – one for each sex.

I would now like to turn to Mark Baptiste, of the New York State Department of Health's Center for Community Health to highlight what the individual maps showed us.

Script for Mark Baptiste

Thank you Commissioner Novello.

Now, if you refer to the second to last page of the booklet for Lung and Bronchus Cancer, I will describe how you go about reading these maps and graphs. Each booklet contains a similar bar graph and a map and they are each read the same way.

The Bar Graphs

The bar graphs show the age–adjusted incidence of cancer for either males or females for each county for 1992–1996. This particular graph shows the age–adjusted incidence rate of lung and bronchus cancer for males.

This means we produced the rate in a way that lets us compare one county to another by taking into account the ages of the people in each county. The vertical line represents the rate or the number of people per 100,000 individuals in New York State who get this type of cancer.

For example: the graph shows that the New York State Rate for Lung and Bronchus Cancer is 75.4 cases per 100,000 men. Now, let's take a look at the maps for breast cancer, lung cancer and colorectal cancer.

Breast Cancer Maps

  • The Breast Cancer map shows a consistent pattern of the disease throughout New York with the vast majority of counties. Sixty of the 62 counties fall within 20 percent below or 20 percent above the annual State rate of 101.6 cases of 100,000 women.
  • Rockland County is the only county that is 29 percent above the State rate.

The Health Department has examined Cancer Registry Data for Rockland County and discovered no unusual findings. It may be that Rockland County has 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 that research has shown to be associated with increased rates of breast cancer such as: higher median income level, higher education levels, smaller family size, later age at first childbirth, and higher proportion of women of Jewish ethnicity.

  • In Nassau and Suffolk Counties, which are the focus of an ongoing $21 million dollar breast cancer case control study by the National Cancer Institute, breast cancer rates are 16 percent and 11 percent respectively, above the State rate. We expect this research to provide important information about breast cancer that will ultimately benefit all women in New York State.

Lung Cancer Maps

For Lung Cancer, the Maps showed that:

  • Three counties, Jefferson, Yates and Greene have the highest lung cancer rates among both males and females. Although they are not among 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, since the disease has a latency period of ten to twenty years, or longer.

  • Among New York City Counties, Richmond or 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 than the other city boroughs, which have low lung cancer rates compare to the rest of the state.

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. At present, there is no county–specific data that would demonstrate if the know risk factors such as physical inactivity, obesity and low fiber, high fat diets are more pronounced in Montgomery County than elsewhere in the state.

I'd like to remind you that county maps will be issued shortly to show the geographic pattern of:

  • Bladder cancer
  • Brain and central nervous system cancer
  • Kidney cancer
  • Leukemia
  • Liver Cancer and;
  • Non–Hodgkin's lymphoma

The cancer maps are available through the Department of Health and are on the Department's website at www.health.state.ny.us.

Now, I will turn the podium back to Commissioner Novello.

Accomplishments and Next Steps

Breast cancer

As you know, breast cancer prevention and control has been a top priority of Governor Pataki's administration and this Department.

We have supported Healthy Women Partnerships that serve every single county and bring breast cancer screening to women who could not otherwise afford it.

In the past three years, nearly 135,000 breast cancer screenings have been provided to under–served women.

As a result of these screenings, 443 cases of invasive breast cancer and 140 cases of in situ breast cancer were found–many at an early stage, when treatment is likely to be most successful.

We've also purchased, equipped and funded staff for new mobile mammography units around the State. These vans bring screening services to women in rural areas, inner city areas and other locations where improved access is vital.

And, the Governor has signed important protections for cancer patients into law, including putting an end to "Drive by" mastectomies.

Colorectal Cancer

The Department also is conducting a colorectal cancer screening project in 17 sites across the State. In the past three years, more than 8,500 people received vital health education about prevention and control of colorectal cancer, and 4,800 were screened.

More than two dozen cases of colorectal cancer or pre–cancerous conditions were discovered.

Lung Cancer

As you know, lung cancer takes a devastating toll on New Yorkers.

Because the vast majority of lung cancer cases are caused by tobacco use, New York State has engaged in an unprecedented tobacco control effort, focusing on youth.

A total of $20 million has been dedicated to tobacco control.

I'm sure you've seen our youth smoking prevention mass media campaign, which most recently has been bolstered by the addition of new "in–your–face" billboards.

We've worked with youth tobacco partnerships on a variety of projects, notably, the extremely successful vender compliance checks.

We conducted 28,000 compliance checks last year to determine whether retailers were selling tobacco products to minors. That's a 700 percent increase!

And, as I recently announced, the Department's Medicaid program will underwrite the cost of smoking cessation products for Medicaid recipients who want to kick the habit.

Next Steps

Obviously, there's more work to do.

I firmly believe that the county–level maps we are releasing today are an important step in the process of informing New Yorkers about cancer; what we know about its causes and risk factors, as well as critical information about prevention and early detection.

Having these maps will help the public health community make decisions about where to focus additional health education and cancer screening programs.

And we expect they will get more people thinking about cancer rates and risks, and what they can do as individuals to reduce their chances of getting the disease.

Earlier, I referred to cancer mapping as a "process." That's exactly correct. Even as we release these county–level maps, we are working on sub–county level maps that will use zip code data.

Those maps will be the next step in this project and they may eventually suggest a new research focus or prompt health interventions.

We're working with our expert Advisory Commitee on the best way to present sub–county level cancer data so that it is understandable and useful, and helps to address people's legitimate concerns.

I'll let you know when we have those maps finalized. Right now, I'd like to take some questions from the reporters present, then we'll go to the telephone...