Document b5obpkz7x4kZaLkpJLeGr3rbg

A -j 0 10 / r ; v - X \ OR] T 1 0 A L REVIEW OF CANCER IN TEXAS Witft Emphasis on Environmental and Occupational Exposures The University off Texas-Houston School of Public Health Southwest Center for Occupational and Ei nmental Health JULY 1994 BFG28117 A CRITICAL REVIEW OF CANCER IN TEXAS: WITH EMPHASIS ON ENVIRONMENTAL AND OCCUPATIONAL EXPOSURES Sharon P. Cooper, Ph.D. Lawrence Whitehead, Ph.D., GH Darwin Labarthe, M.D., Ph.D. Thomas Downs, PhX>. Sally Vernon, Ph.D. Margaret Spitz, M.D., M.P.H.1 Alice Sigurdson, M.S. Bonnie New, M.D. Keith Burau, Ph.D. The University of Texas Houston Health Science Center School of Public Health `The University of Texas M.D. Anderson Cancer Center July 1994 BFG28118 T " .....T This study was funded by a research agreement between The University of Texas Houston Health Science Center School of Public Health, and the Texas Institute for Advancement of Chemical Technology, Inc. (TIACT). Single copies of the report may be obtained at no charge from TIACT, Mail Stop 3125, Texas A & M University, College Station, Texas 77843-3125; telephone (409)845-3372; FAX (409)862-4202. The authors may be reached at The University of Texas-Houston School of Public Health, P.O. Box 20186, Houston, Texas 77225; telephone (713)792-7457. 238410^ BFG28119 Nature of Research Agreement and Acknowledgements This project was supported by a research agreement between The University of Texas Houston Health Science Center School of Public Health, and the Texas Institute for Advancement of Chemical Technology, Inc. (TIACT), a non-profit organization composed of industry and other private and public sector members. The contract encouraged and guaranteed the rights for independent publication by the investigators in the scientific literature. A study Steering Committee (see following list) composed of academic, government, and industry professionals advised TIACT as to scientific issues and study progress, and served as an optional resource to the study investigators in terms of identifying studies for review and accessing cancer mortality data, but were otherwise uninvolved in study proceedings. TIACT also engaged four outside epidemiologists; two early in the study to review study plans and the draft final report (Philip Cole, M.D., M.P.H.-Professor of Epidemiology, University of Alabama School of Public Health and Michael Greenberg, Ph.D~Professor, The State University of New Jersey, Rutgers), and two at the end of the study to serve as peer reviewers of the draft final report (Harvey Checkoway, Ph.D., Professor of Environmental Health, University of Washington; Donald Austin, M.D., M.P.H., Senior Medical Advisor, Chronic Disease Program, Oregon Health Division). In addition, Emily Untermeyer, M.P.H., Executive Director, Texas Cancer Council; and Jane Teta, Dr.P.H., Director of Epidemiology, Union Carbide, also reviewed and commented on the draft version of this final report The Steering Committee and outside reviewers made many constructive comments, many of which were addressed and incorporated into the final report. However, the comments were advisory in nature, and the authors take final responsibility for the content of this report The authors would also like to acknowledge the devoted contributions of the study staff to this project: Candiance Duplessis, B.A., for word processing and general study support activities, Deanna Fletcher, P.T., M.P.H., for computerized database searching, Young Kim, M.S., for cancer mortality graphing, and Erin Fletcher for article retrieval and database entry. Particular appreciation is also noted for the generous assistance with the cancer mortality data and analyses by the Cancer Registry Division of the Texas Department of Health, for database design by Charles Cooper, M.S., for cover design by Henry Fung and for printing advice and assistance by Earl Colvin at The University of Texas-Houston Printing Services, and for mapping graphics by Sharon Wells. BFG28120 H)OTb802 MEMBERS OF TIACT STEERING COMMITTEE David M. Baley, Ph.D., MJ>.H. Senior Epidemiologist Health Services Exxon Company, U.S.A. George Delclos, MD., M.P.H. Associate Professor Occupational Medicine University of Texas School of Public Health Robert Bernstein, MD. Texas Commissioner of Health (1980-1991) Member of the Board of Directors of The American Cancer Society Charles D. Holland, PhD. Chairman/President of TIACT and Professor Emeritus Texas A&M University Jean Brender, PhD., R.N. Director Noncommunicable Disease Epidemiology and Toxicology Division Texas Department of Health Geary Olsen, D.V.M., PhD. Research Associate in Epidemiology Health and Environmental Sciences Dow Chemical Company Sally K. Cowles, M.D., Dr.P.H. Medical Director AMOCO Chemical Company AMOCO Corporation Shan P. Tsai, PhD. Senior Epidemiologist Corporate Medical Department Shell Oil Company Paul F. Deisler, Jr,, PhD. Private Consultant Victor Vogel, MD. Assistant Professor of Medicine and Epidemiology M. D. Anderson Cancer Center Barbara Divine, PhD, Senior Coordinator - Epidemiology Programs Texaco Inc. Nancy Weiss, Ph.D., M.P.H. Cancer Epidemiologist Cancer Registry Texas Department of Health 23841005 TABLE OF CONTENTS LIST OF TABLES LIST OF FIGURES EXECUTIVE SUMMARY 1.0 INTRODUCTION 1.1 Background and Rationale 1.2 Specific Aims 1.3 Mortality Analyses: Data Sources and Analytic Methods 1.3.1 Texas vs. U.S. Cancer Mortality Rates 1.3.2 Cancer Mortality Trends in Texas, 1980-1990 1.3.3 Geographic Variation in Cancer Mortality 1.4 Critical Review of the Literature 1.4.1 Eligibility Requirements for Critical Review 1.4.2 Computerized Library Search 1.4.3 Other Sources of Unpublished Reports 1.4.4 Exclusion of Clinical Case Series and Cancer Cluster Investigations 1.4.5 Criteria for Evaluating Studies 1.5 Description of Studies Reviewed 2.0 CANCER MORTALITY IN TEXAS 2.1 Texas Cancer Mortality Rates Compared to the U.S. 2.2 Cancer Mortality Trends in Texas, 1980-1990 2.2.1 Overall Cancer Mortality Trends 2.2.2 Geographic Variation in Cancer Mortality Trends 2.3 Geographic Variation in Cancer Mortality Within Texas 3.0 SUMMARY OF STUDIES IN INDUSTRIAL SETTINGS 3.1 Historical Cohort Mortality Studies 3.2 Summary SMRs by Type of Plant and Cancer Type for Petrochemical Cohort Mortality Studies in Texas 3.3 Industry-based Case-Control Studies 3.4 Morbidity Studies 3.5 Proportionate Mortality Ratio (PMR) Studies in Labor Union Workers 3.6 Brain CanceryTumor Studies (other than PMR studies) 3.7 Colorectal Cancer Studies Page 1 7 7 8 8 9 10 11 12 12 13 13 13 14 15 17 17 17 17 22 25 27 27 35 56 57 58 59 62 BFG28122 Page 4.0 NON-INDUSTRY BASED STUDIES: SUMMARY OF POPULATION AND HOSPITAL-BASED STUDIES BY EXPOSURE AND CANCER TYPE 65 4.1 Environmental Studies 4.2 Lifestyle Studies 4.3 Genetic Studies 4.4 Childhood Cancer Studies 4.5 Occupational/Environmental Case-Control Studies of Specific Cancer Types 65 67 68 69 70 5.0 DISCUSSION 75 5.1 Summary of Occupational Risk Factors for Cancer in Texas 5.2 Summary of Non-occupational Risk Factors for Cancer in Texas 5.3 Impact of Risk Factors on Cancer in Texas 5.4 Occupational Attributable Risk for Lung Cancer 5.5 Smoking and Lung Cancer 5.6 Inferred Impact of Occupational and Environmental Causes of Cancer in Texas 75 76 76 76 77 78 6.0 LIMITATIONS OF AVAILABLE DATA 81 6.1 Lack of Statewide Cancer Incidence Data 6.2 Population Groups with Little or No Data 6.3 Incompleteness of Analysis from Brain and Leukemia Case-Control Studies 6.4 Limited Exposure Information 81 81 82 83 7.0 CONCLUSIONS 87 7.1 Aim 1: Mortality Analyses 7.2 Aim 2: Critical Review of Epidemiologic Literature 7.2.1 Studies in Industrial Settings 7.2.2 Other Studies 7.3 Aim 3: Major Data Gaps 7.3.1 Strengths and Limitations of Data Presently Available 7.3.2 Key Unsettled Issues 7.4 Other Considerations in Relation to Cancer in Texas 87 88 88 88 88 88 89 90 8.0 RECOMMENDATIONS FOR FUTURE RESEARCH 91 BIBLIOGRAPHY 97 23841007 BFG28123 APPENDIX A APPENDIX B APPENDIX C APPENDIX D APPENDIX E Overview of Epidemiologic Study Designs Ninth Revision ICD Mortality Categories Map and Listing of Counties within Texas Councils of Government (COGs) Time Trends in Age-Adjusted Cancer Mortality Rates in the U.S. and Texas by Race/Ethnicity and Sex, 1980-1990 Maps of Geographic Variation in Cancer Mortality in Texas: Excesses and Deficits Pace A-l B-l C-l D-l E-l 23841008 V BFG28124 TABLE NO. Table 1 Table 2 Table 3 Table 4 Table 5 Table 6 Table 7 Table 8 LIST OF TABLES TITLE Distribution of Reviewed Reports by Type of Exposure, Study Design, Source of Study, Publication Status, and Year of Report Average Annual Age-Adjusted Cancer Mortality Rates and Standard Errors for Selected Sites by Sex and Ethnicity in Texas, 1986 - 1990, and the U.S., 1986 - 1990 Average Annual Age-Adjusted Cancer Mortality Rates in Hispanics for Selected Sites by Sex in Texas, 1986 - 1990, and California, 1988 - 1990 Significant Trends in Texas Mortality Rates for Selected Cancer Sites by Ethnicity and Sex, 1980 to 1990 Selected Characteristics of Historical Cohort Mortality Studies Conducted in Industrial Populations in Texas Summary SMRs by Type of Plant and Cancer Type for 11 Non-Overlapping Petrochemical Plants in Texas Selected Characteristics of Non-Industry Based Occupational/Environmental Case - Control Studies of Cancer in Texas Leading Types of Cancer Deaths for Men and Women in Texas, 1992 PAGE 16 18 19 20 28 36 71 79 23641009 BFG28125 FIGURE NO. Figure 1 Figure 2 Figure 3 Figure 4 LIST OF FIGURES TITLE Age-adjusted Total Cancer Mortality in the U.S. and Texas by Race/Ethnicity and Sex, 1980 - 1990 Age-adjusted Lung Cancer Mortality in the U.S, and Texas by Race/Ethnicity and Sex, 1980 - 1990 Decreasing and Increasing Trends in Cancer Mortality in Texas by Council of Governments, 1976 - 1989 Summary SMRs by Cancer Type: 11 Plant Populations PAGE 21 23 24 55 23841010 BFG28126 EXECUTIVE SUMMARY Background and Study Questions In response to concerns regarding the possible contribution of environmental and occupational exposures to the burden of cancer in Texas, the Texas Institute for Advancement of Chemical Technology, a non-profit organization composed of industry and other private and public sector members, solicited proposals to review critically what is known about cancer in Texas, the second leading cause of death. The University of Texas-Houston School of Public Health was selected to conduct this project Although no new data were collected, this report constitutes the first attempt to assemble systematically and evaluate critically existing epidemiologic studies pertaining to cancer in Texas. The emphasis of the report on cancer mortality, rather than incidence, reflects the available data from the Texas Department of Health and specific studies. This review describes the magnitude, recent time trends, and geographic variation of cancer mortality in Texas as a framework in which to review the scientific literature about what is known regarding factors contributing to the occurrence of cancer in Texas. A further objective of this review is to identify important gaps in the evidence presently available and identify areas of study to improve cancer control and prevention in Texas. Mortality Analyses Available cancer mortality data from the Cancer Registry Division, Texas Department of Health, and published U.S. cancer mortality data were examined to describe the magnitude of cancer mortality and its variation over time and across geographic areas. California cancer mortality data (1988-1990) were used for Hispanic comparisons. (1) Cancer Mortality in Texas (1986-1990) For 17 selected cancers comprising nearly 80% of all cancer deaths in Texas, average annual age-adjusted mortality rates for Texas were compared to the U.S. for 1986-1990. In general, for most cancers, the rates in Texas were less than or nearly equal to the U.S. rates for non-Hispanic whites and blacks, and to California rates for Hispanics. The most notable statistically significant deficits were for colon and rectum cancer among white males and females, breast cancer among white females, and prostate cancer among black males. The most notable significant excesses were for liver cancer in all race/sex groups except black females and lung cancer in white males, white females, and Hispanic males. Further, total cancer mortality rates were higher for Texas Hispanic males and Hispanic females when compared to California rates. (2) Time Trends in Cancer Mortality Rates in Texas (1980-1990) Age-adjusted total cancer mortality rates over the years 1980-1990 were found to be significantly increasing for white males and females, Hispanic males, and black males in Texas, similar to the U.S. mortality experience. Most of this increase was accounted for by lung cancer. 1 23841011