Remarks for Cancer Mapping Press Conference - April 11, 2000, 2:30 P.M. - Antonia C. Novello, M.D., M.P.H.

(Cancer Surveillance Improvement Initiative Graphic on Screen)

  • As you may know, Governor Pataki directed the Department to undertake the initiative to address people's questions about the incidence of cancer in their communities. The Governor has provided $4 million for this initiative.
  • We are the first State in the nation to produce maps like this and today we are using the most recent data available - 1997. The Governor should be commended for his support of this groundbreaking project.
  • This comprehensive project has enhanced the State's ability to track the occurrence of cancer by improving the New York State Cancer Registry, and by creating maps and other graphic representations of the geographic pattern of cancer cases.
  • The initiative is also designed to increase public understanding of cancer, its known or suspected causes, and, as a consequence, to promote prevention and early detection.
  • In order to work on the initiative, the Health Department recruited an expert panel representing some of the best minds in the fields of science, academia and cancer control, as well as cancer activists and environmental advocates.
  • I am pleased to tell you that the State Health Department today has issued ZIP Code level maps that show the incidence of breast cancer in communities across the State.
  • Breast cancer was mapped because it is one of the most common cancers among women in New York State. About 12,000 women are diagnosed with breast cancer every year in the State, and more than 3,500 die from the disease.
  • 1 in 3 people are diagnosed with cancer at some time in their lives. In New York 1 in 4 deaths are due to cancer.
  • Nationally, breast cancer is the leading cause of cancer deaths between ages 15 to 54. 1 out of 8 women will develop cancer in their lifetime.

(Graphic of County Level-Beige-Breast Cancer Map)

  • As you recall, in the recent past and as part of the initiative, the Health Department issued maps several months ago showing the county level incidence for 11 different types of cancer, including breast cancer.
  • Those county maps showed a higher incidence of breast cancer in Rockland County. We suspected that as we mapped smaller areas we would find other unusual patterns of disease, and that has turned out to be the case.
  • The second phase was to produce sub-county maps utilizing ZIP Codes. Today we are doing just that.

The ZIP Code level maps:

(Projection of State Map on Screen)

  • The ZIP Code level breast cancer maps, seen here, are color-coded in shades of purple, green and gray to indicate how the actual incidence of breast cancer within a particular ZIP Code compares to the expected incidence-that is, how many women living in that ZIP Code would be expected to contract the disease within a given time period.
  • Specifically, the Zip Code level maps show whether the number of new cases of breast cancer diagnosed within each particular Zip Code during the years 1993-1997 is higher, lower or about the same as the expected incidence.
  • The various colors represent different categories; for instance, light purple represents 15 to 49 percent above the expected incidence.
  • Medium purple represents 50 to 100 percent above the expected incidence," and dark purple shows Zip Codes that are more than 100 percent above what was expected.
  • Gray indicates ZIP Codes that were about the same as expected; green is lower than expected incidence.
  • The categories were determined using a statistical technique that finds natural breaks in the data. These breaks were then rounded off to be easily understood and meaningfu to people.
  • For example, 100 percent above expected means that twice as many cases occurred as were expected.
  • The maps also use slanted or crossed lines, called cross-hatching, to identify groups of Zip Codes which comprise areas where cancer incidence is believed to be elevated - not likely due to chance or randomness.
  • You'll notice that not all individual Zip Codes within the cross-hatched areas have higher than expected incidence. Despite these variations, the cancer pattern for an entire region of elevated incidence is considered to be statistically significant.

(Projection of Albany County Map, on Screen)

  • Along with the State map, we have produced county level maps showing cancer incidence by Zip Code.
  • Here, for instance, is the map of Albany County.
  • You'll notice, one Zip Code in Albany County is dark purple. Because this area is so small and the incidence of breast cancer totaled 10 versus the expected rate of 4.6 incidents - the Zip Code (Berne area) was not determined to be statistically significant.

(Projection of Zip Code Index, on Screen)

  • The maps are accompanied by an index which lists Zip Codes in numerical order by county and which provides the actual as well as expected incidence of breast cancer for each Zip Code shown.
  • In order to protect patient confidentiality some Zip Codes (those with very few total cancer cases) were combined with a neighboring Zip Code before being mapped.
  • Again, if you look at the index - you will see Berne (ZIP Code 12023) with 10 incidents of breast cancer vs. 4.6 expected.

(List of Areas of Elevated Incidence on Screen)

Areas of elevated incidence:

  • Using a formula called the spatial scan statistic, the following regions have been identified as having an elevated incidence of breast cancer.
  • Again, as I've stated previously, the maps use slanted or crossed lines, called cross-hatching, to identify groups of ZIPCodes which comprise areas where cancer incidence is believed to be elevated - not likely due to chance or randomness.
  • Those areas of elevated incidence are:
    • Northwestern Erie/Southwestern Niagara counties
    • Eastern Monroe/Western Wayne counties
    • Mid/Southern Rockland and Western Westchester counties
    • Southern Westchester County
    • Southeastern Staten Island
    • Manhattan (on the Eastern side of the Central Park area)
    • Southern Brooklyn
    • Northern Nassau County
    • Southwestern Nassau County
    • Southeastern Nassau County/Southwestern Suffolk County
    • Eastern Suffolk County -- (the communities of Mount Sinai, Port Jefferson and Coram).

(State Map Projection on Screen)

  • I think it is important to spend some time describing what we mean by "areas of elevated incidence" and how they were identified, since people obviously will have some concerns.
  • The "areas of elevated incidence" identified on the maps are groups of ZIPCodes in which the combined incidence of breast cancer is higher than the rate of breast cancer for the State as a whole (102.1 per 100,000).

(Map of Western New York on Screen)

  • For instance, here is the map of western New York.
  • Using the spatial scan statistic, Health Department scientists have determined that the higher than expected incidence of breast cancer in areas of elevated incidence is less likely to be due to chance or a random occurrence.
  • Note that you will see ZIPCodes shaded green or gray in areas of elevated influence. That means the pattern of breast cancer in the particular ZIP Code was not significant, but the overall pattern in the larger area that includes the ZIP Code was significant.
  • You'll also see a light gray area that demonstrates an area of very sparse data-where fewer than five cases of breast cancer were expected to occur and where the actual incidence was within one case of the expected number.

(Downstate New York Map on Screen)

  • Now, let's look at the map for downstate.
  • You'll see a number of areas of elevated incidence.
  • You will see ZIP Codes that are shaded dark purple that are not included in areas of elevated incidence. Again, this indicates a finding that was not statistically significant.

Limitations of cancer maps:

  • While we firmly believe that this is a vital initiative, and one that will have national implications, I also must continue to stress that cancer maps do have limitations.
  • Our expert panel of scientists has told us 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 and incidence of disease.
  • The maps alone will not give us the answers, but they will suggest the proper questions to ask.

What is causing the increase?

(Graphic of Personal Risk Factors)

  • Because so many things contribute to cancer risk including age, heredity, lifestyle factors, and exposures to cancer-causing agents, the reasons for the increased number of breast cancer cases in areas of elevated incidence are not known.
  • Like other areas of the northeastern United States with a high breast cancer incidence, these areas 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.
  • Some of these factors include higher median income level, higher education levels, smaller family size, and later age at first childbirth.

(Projecton of State Map on Screen)

Other Issues:

  • I am pleased to tell you that the New York State Cancer Registry currently meets all standards of the North American Association of Central Cancer Registries at either the gold or silver levels!
  • Our data are complete through the year 1997-even the National Cancer Institute's "Surveillance Epidemiology and End Results Registry" (Also known as SEER) is only reporting through 1996-and SEER is considered the Gold Standard of Cancer registries.

(CSII Graphic on Screen)

  • Where do we go from here?
  • I have met with breast cancer activists and I know how deeply they are concerned.
  • We will address those concerns.
  • Cancer maps can do many things. They can show us the pattern of cancer incidence across the State, help health officials plan services and programs, and suggest areas for more research. They cannot, by themselves, tell us what causes cancer.
  • Health Department staff are preparing a protocol for further research in areas of elevated incidence. We will work with our expert Advisory Committee to refine the protocol.
  • We will begin by selecting areas for further study based on the strength of the evidence that an unusual disease pattern has occurred.
  • Working with the affected community, Health Department scientists will then conduct in-depth studies to examine various possibilities for the increased cancer incidence using the Department's Division of Epidemiology, Center for Environmental Health, Wadsworth Laboratory resources and other state agencies.
  • These maps can also help us enhance our breast cancer screening program - called the Healthy Women Partnerships. Recently, the Governor added $2 million dollars to this program, bringing it to $11.2 million - the highest level of funding in State history.
  • Now, I will be happy to take your questions.