State Health Department Announces Cancer Mapping "Follow-Up Investigation" in Suffolk County

Albany, May 20, 2002 – Based on results from the cancer mapping component of its ongoing Cancer Surveillance Improvement Initiative, the New York State Department of Health has begun an investigation to explore why there appears to be an elevated incidence of breast cancer in the Coram/Mt. Sinai/Port Jefferson Station area of Suffolk County, State Health Commissioner Antonia C. Novello, M.D., M.P.H., Dr.P.H., announced today.

"This is the first of many investigations arising from our Cancer Surveillance Improvement Initiative that will consider ways in which environmental factors or other risk factors may contribute to unusual disease patterns," Dr. Novello said. "Throughout the course of the Coram/Mt. Sinai/Port Jefferson Station area investigation, we will work closely with local officials and area residents who may be able to provide knowledge of environmental concerns in their communities."

Two public information sessions have been scheduled for June 5 at Comsewogue Public Library in Port Jefferson Station to provide area residents with details of the follow–up study, discuss issues of environmental concern and provide information about locally–available cancer services. An afternoon session will be held between 2 and 4 p.m., and an evening session is scheduled between 6 and 9 p.m. Residents are encouraged to stop in anytime during either session.

At the direction of Governor George Pataki, the State Health Department (the Department) developed the Cancer Surveillance Improvement Initiative (CSII) to address questions about high cancer rates in various parts of the State. The comprehensive, multi–stage project includes the creation of cancer incidence and cancer risk factor maps to help focus further cancer research and target necessary health resources, along with the production of educational materials to increase public awareness of cancer prevention and early detection. As a result of the initiative, the Department is enhancing its ability to identify unusual patterns of cancer and to address community concerns.

A total of 17 separate cancer maps have been produced to date, including maps illustrating newly diagnosed cases of breast cancer, lung cancer, colorectal cancer and prostate cancer in ZIP Codes throughout New York State. In preparation for risk factor mapping, the Department also has evaluated 50 data sets of cancer risk factors, including environmental contaminants, socio–demographic characteristics, behavioral and nutritional factors, and medical conditions (such as history of related disease and certain genetic conditions) associated with a higher risk for cancer.

CSII Follow–up Protocol

The Coram/Mt. Sinai/Port Jefferson Station area of Suffolk County was selected as the first area to be investigated using a "follow–up protocol" developed for the Cancer Surveillance Improvement Initiative. The protocol includes as many as five steps; how many are used will depend on the results of the first few steps. The Department is selecting areas for further investigation from those "areas of elevated incidence," which are designated by hatch marks on the maps, and are parts of the State in which excess cancer incidence is least likely to be due to chance.

The Coram/Mt. Sinai/Port Jefferson Station area was selected based on data from the breast cancer map–the first ZIP Code map to be issued. This area was well defined, limited geographically, and the only area on the map with a 50 percent excess in breast cancer. The follow–up will focus on seven ZIP Codes: 11727, Coram; 11733, East Setauket; 11764, Miller Place; 11766, Mt. Sinai; 11776, Port Jefferson Station; 11777, Port Jefferson; and 11789, Sound Beach.

Department scientists also have reviewed cancer incidence data from the Coram/Mt. Sinai/Port Jefferson Station area and have concluded that the excess incidence of breast cancer cannot be explained by screening (routine testing in patients with no symptoms, which can increase the number of cases diagnosed during a specific time period), nor by a large number of seasonal residences (which can distort incidence rates).

State Health Department scientists also are compiling and reviewing environmental information including public water supply data, hazardous waste sites data and air pollution emission data. During this phase of the investigation (step two of the follow–up protocol) the Department is working closely with the Suffolk County Department of Health Services and the New York State Department of Environmental Conservation.

During the third step of the investigation, the Department will seek input on environmental concerns from members of the local community. As the investigation proceeds, information supplied by the community, along with existing data about hazardous waste sites, landfills, industrial facilities and other possible sources of environmental contaminants will be evaluated to assess the potential for exposure. Scientists will also review the scientific literature to investigate what substances in the environment might contribute to the development of breast cancer. This review will include substances that are already known or suspected to cause the disease, as well as previously unexplored factors that may play a potential role in the development of breast cancer.

Once the investigation has progressed to this point (step four), the Department will determine what further actions should be taken. Areas that need specific environmental interventions to reduce the community's contact with contaminants may be identified and may need to be addressed. If no increased exposures or environmental factors are identified, these areas will be referred to the Department's Cancer Surveillance Program for review of possible non–environmental factors that could be contributing to the excess cancer rate. However, if further environmental and epidemiological investigation is indicated, the Department will determine whether there are sufficient data available and enough residents who are willing to participate in a study, which would be step five.

Should this final step be indicated, the State Health Department will recruit community participants, develop a study protocol and conduct the study. If a study does not at first appear feasible, it may still be possible to improve the exposure data (for instance, by conducting environmental sampling) and/or to increase the size of the population to be studied.

At the conclusion of the follow–up investigation, a report detailing its findings will be produced and shared with members of the community.

"This Coram/Mt. Sinai/Port Jefferson Station area investigation fulfills one of our original objectives for the Cancer Surveillance Improvement Initiative–namely, to focus further scientific scrutiny on parts of the State where cancer incidence is unexpectedly high," Dr. Novello said. "We recognize that many New Yorkers have concerns about cancer in their communities, and we want to address them as best we can."

About the public information sessions

Residents who have questions about the Public Information sessions, or who have special needs may call 1–800–458–1158, extension 27530. People who cannot attend the sessions but would like to share issues of specific concern may call the toll–free number or send e–mail to ceheduc@health.state.ny.us Information about cancer mapping is available on the State Health Department's website: www.health.state.ny.us.

5/20/02–50 OPA