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HomeMy WebLinkAboutMINUTES - 01061987 - IO.1 0. TOBOARD OF SUPERVISORS , FROM: INTERNAL OPERATIONS COMMITTEE Contra December 22, 1986 Costa DATE'. County Prospective Study of the Incidence of Cancer SUBJECT: in Contra Costa County SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1 . Authorize the Health Services Director to submit funding proposals to foundations or other sources for the purpose of funding one or more of the following elements of a prospective cancer study with the understanding that no general funds of the County will be committed to such studies without prior approval of the Board of Supervisors. a. Utilization of AB 2185 data base to provide data allowing a comprehensive health evaluation of selected establishments and a determination of whether there may be workplace exposure to carcinogenic materials. ( $133,000) b. Testing several methodologies for collecting occupational and smoking history from tumor cases in order to determine the most effective means of incorporating such information into the Bay Area Surveillance Epidemiology End Results Program ( SEER) of the National Cancer Institute. ( $62,000) C. Linking existing industry maintained employee health data with the tumor registry. ( $218,000) d. Undertake the detailed planning for a prospective cancer study. ( $140,000) 2 . Refer this matter to the 1987 Internal Operations Committee and direct the Health Services Director to report to the -1987 Internal Operations Committee by July 1 , 1987 on the progress made in the implementation of the above funding proposals. 3 . Reemphasize to the Health Services Director and Director of Community Development the need for close cooperation on planning decisions so as to reduce the potential of allowing residential and industrial developments in such proximity to each other as to increase public health dangers. CONTINUED ON ATTACHMENT; X YES SIGNATURE: _ RECOMMENDATION OF COUNTY ADMINISTRATOR X RECOMMENDATION OF BOARD COMMITTEE X APPROVE OTHER ,(p SIGNATURE s ancv C. Fanden Sunne 14. Mc Peak ACTION OF BOAR ON January 6. 1987 APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS 1 HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. CC: County Administrator ATTESTED ____;January Health Services Director PHIL BATCHELOR, CLERK OF THE BOARD OF Communitv Development Director SUPERVISORS AND COUNTY ADMINISTRATOR 1987 Internal Onerations Committee BY DEPUTY M382/7-83 Page 2 4. Request the Health Services Director to include in one or more of his grant applications the development of a mechanism for including medical . information as well as occupational history in the records of the tumor registry (see recommendations 1b and lc above) . 5 . Request the Health Services Director to work with the Technical Advisory Committee on Occupational and Environmental Health in an effort to reach agreement on how the necessary data bases can be defined and assembled. 6 . Request the Health Services Director to incorporate into the AB 2185 data base the extensive information available from the Bay Area Air Quality Management District' s Air Toxics Emissions Inventory data base. 7 . Remove this item as a referral to the 1986 Internal Operations Committee. BACKGROUND: Our Committee has been working with the Health Services Department throughout the past year on the development of the design for a prospective study of the incidence of cancer in Contra Costa County. The attached report from the Health Services Director, which provides excellent background on the need for such a study and how efforts might be undertaken to begin such a study, outlines three pilot programs and a planning process which need to be undertaken in order to move ahead with a major, long-term prospective study. In our review of the attached report and conversations with the Health Services Director and Assistant Health Services Director for Public Health, we have added several recommendations which we feel are critical to the overall success of such a study. ( See recommendations three through six. ) CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT sr c6ux'� Internal Operations Committee Supervisor Sunne McPeak December 18, 1986 To: Supervisor Nancy Fanden Date: Mark Finucane, Director PROSPECTIVE OCCUPATIONAL From: Health Services Department �v�Subject: CANCER PROPOSAL By: Wendel Brunner, M.D. , MPH Assistant Health Services Director Public Health At the direction of the Board of Supervisors, the Health Services Department has prepared the enclosed proposal for the implementation of a Prospective Cancer Study in Contra Costa County. This proposal forms the basis for developing letters of intent to funding sources and outlines a stepped program for investigating occupational cancer. A Prospective Cancer Study will involve the following cohorts numbering tens of thousands over a period of several decades. The cost of such a program will run into millions of dollars. The County Health Services Department does not have the resources to develop a detailed grant funding proposal to submit to a single agency for a comprehensive prospective cancer study. Instead we have developed a proposal .which would involve the incremental implementation of the full study and is prepared in four sec- tions, each of which could be funded independently. The implementation of each section will provide a necessary part of the full prospective cancer study, and will form the basis for developing further funding sources. There are three pilot programs and a planning process described in this Prospective Cancer Proposal . The first proposal involves the utilization of the AB2185 Hazardous. Materials Data Base to identify occupational cohorts and to begin to collect exposure and medical data. The second proposal is to - incorporate occupational history into the data base of the existing population-based tumor registry serving Contra Costa County. The third pro- posal will develop procedures to link existing occupational and employment records from industry with the data base of the tumor registry. Finally, a planning process is described which would build on the pilot programs and develop a detailed grant proposal for the Prospective Cancer Study. The total budget described in this proposal includes $413,000 for the pilot projects and $140,000 for the planning process. These figures are in each case minimal estimates which will allow us to proceed with the various pha- ses of the project. Letters of intent based on this proposal have been prepared and we are in the process of contacting a variety of funding sources. MF:WB:cbc Enc. (Cal2) A-41 3181 - f • PROPOSAL TO DEVELOP A PROSPECTIVE CANCER STUDY IN CONTRA COSTA COUNTY At the direction of the Board of Supervisors, the Health Department is working to implement a prospective study of occupational cancer in Contra Costa County. This proposal outlines a strategy for planning and funding such a study and serves as the basis for developing letters of intent to foundations and other potential funding sources. A prospective study of occupational cancer that could be expected to uncover occupational carcinogens will require following large cohorts over a period of decades. Such a study will require millions of dollars and the assurance of stability of both the funding source and the investigating institution over the period of the study. The detailed planning of such a grant proposal in a form that could be submitted to an agency such as the National Cancer Institute with an expectation of consideration for funding is beyond the scope and existing resources of the local health department. Instead, with the assistance and con- sultation of the Technical Advisory Committee on Occupational and Environmental Health, we have developed a step-wise proposal which can lead to the implemen- tation of a full-scale prospective cancer study. . We are currently seeking funding for various of the segments described in this proposal . Those segments, when implemented, will provide essential pilot programs or data bases which would be utilized in the full scale prospective cancer study. In addition, each of the segments would be useful Public Health programs in themselves, and the implementation of these various aspects of the project has been recommended by the Health Department 's Technical Advisory Committee on Occupational and Environmental Health. NEED FOR AN OCCUPATIONAL CANCER STUDY IN CONTRA COSTA COUNTY - Over the last several decades there has been increasing concern among the public that the three hundred-fold increase in the use of industrial chemicals since World War II has had an adverse health impact on the general population. In particular there is anxiety that chemicals that find their way into the environment may cause an increase in the rate of cancer in the general popula- tion. This concern has been shared by -Epstein (1 ) and others who argue that a substantial amount of cancer is caused by the distribution of industrial chemi - cals in the environment, particularly into the air and water, and of exposure to chemicals in the work place. This concern is mitigated somewhat by the obser- vation that the age adjusted cancer death rates over the last 50 years in the United States have remained remarkably constant (2) . The increase in the -2- general distribution of industrial chemicals in the United States has not been followed by a major increase in the incidence of cancer. There is, in fact, no _- cancer epidemic. The two significant exceptions to the general constant cancer trend are the rate for stomach cancer, which has declined remarkably since 1930, and the lung cancer rate, which has climbed dramatically since around 1940. The cause of the decline in stomach cancer is largely unknown; however, the increase of lung cancer is clearly associated with increase of smoking in the population. There is also reason to suspect that a portion of the increase in lung cancer is associated with second-hand smoke and industrial activity. There are several caveats to our reassurance about the general cancer rates, however. Cancer usually has a long latency period between exposure and the development of tumor, often decades. The major chemical exposures of the popula- tion may have been more recently than World War II , and their effects may appear in the future. In addition we know that occupational exposure to some chemicals does cause cancer. There are approximately 25 chemicals proven to be car- cinogenic in humans, and a substantially larger number of suspected human car- cinogens. Many of the listed proven human carcinogens have very large cancer risks associated with them, which is how they were detected. Asbestos exposure carries a five to fifty-fold increase risk for lung cancer; bis-chloromethylether, identified as an occupational carcinogen in the 701s, has an even larger rela- tive risk. Some of these worst chemicals are generally well controlled in the workplace; there remains the concern that other exposure, not yet identified as carcinogenic, are less well monitored. During the 1970' s, there- were wide ranges of estimates of the contribution of occupational and environmental chemical exposure to the total cancer burden in the population. In 1982 the epidemiologist Doll made a careful review of the attributable causes of cancer (3) . In that work, Doll assigned approxima- tely .5% of all cancer to occupational causes. Doll 's figure is currently generally accepted by occupational epidemiologists, including those who are associated with industry, academic institutions, and occupational health organi- zations. Occupational cancer has importance that far exceeds its relatively small contri - bution to the total cancer burden, however. Occupational cancer should be almost totally preventable by public policy measures and is therefore an impor- tant target for public health intervention. More important, occupational cancer serves as an early warning system for the community at large. If the population is at risk from industrial chemical contamination in the environment, then those risks will be most easily detected among populations that are most heavily exposed. The greatest exposure to industrial chemicals occurs in the workplace, and if general environmental contamination does lead to environmentally-induced cancer, then that effect will be most easily detected as occupational cancer occurring in the workplace. In that manner occupational cancer and other occu- pational illness serve as an early warning for potentially environmentally induced disease. There have been a number of epidemiological studies investigating occupationally or environmentally induced cancer involving Contra Costa County. In 1977 a report by Blot et al appeared in Science (4) which identified 39 U.S. counties with major petroleum industries as having excess rates of cancer, including Contra Costa. In particular, cancer of the stomach, nasal cavity, lung and all -3- sites were significantly elevated. The Blot Study suggested that a more speci - fic investigation into the relationship between petrochemical air pollution and cancer would be appropriate. Kaldor et al (5) undertook such an investigation in Contra Costa. Those authors found a significant gradient of increased cancer incidence for white males across geographical areas of increased marker for petrochemical air emissions, for cancer of the stomach, lung, kidney, buccal- pharyngeal , and all sites combined. For white females the gradient was signifi - cant only for buccal-pharyngeal and bladder cancer and not for all combined sites. Those authors implied that the results show a causal relationship bet- ween exposure to markers of petrochemical industrial pollution and a variety of cancers at least for white men. A similar study undertaken out of Kaiser Hospitals in Contra Costa County using a somewhat different methodology (6) concluded, however, that there was no connection between air pollution markers and cancer incidence. In 1982 Austin from the California State Health Services Department released a case controlled study of lung cancer and air pollution in Contra Costa County (7) . Austin concluded from his investigation that there was no demonstrable association between lung cancer incidence and air pollution, and that the geographical distribution of lung cancer in the County was accounted for by the geographical distribution of smoking. A followup study released by Austin in 1983 of occupation and lung cancer in Contra Costa County also failed to iden- tify any occupational factors. Both of these Austin studies suffer from a lack of statistical power, that is, the ability to detect the hypothesized effect assuming that it is present, because of inadequate numbers of cases in the study. The Austin and Kaldor studies were reviewed by Smith and Waller (8) at the request of the Contra Costa County Health Services Department. Smith and Waller disagreed with Austin' s conclusion; they felt that cigarette smoking did not account for all of the geographical distribution of lung cancer in the county. This variety of studies in Contra Costa County with their contradictory results has suggested the value of designing a comprehensive, large scale, prospective study of occupational cancer in the County. Such a study, if carefully insti- gated and extensively funded, could both identify occupational carcinogens and determine the relative risk to the population at large of industrial pollution in the environment. A prospective cancer differs from the other studies described in Contra Costa in that a prospective study would identify a popula- tion or cohort and follow that group into the future to observe the various - cancer incidences. The advantage of a prospective design is that it would allow the investigators to define and measure the actual chemical exposures of the cohort which would then be followed. Observed cancer rates could then be corre- lated with accurately measured and recorded exposure histories to identify any causal relationships. Since cancer has the previously mentioned long latency period, a prospective study requires following a cohort and keeping records of its various chemical exposures for a period of decades. The previous studies described in Contra Costa County have all been retrospec- tive studies; that is, they identified a group of cases and then looked backward in time to attempt to determine the previous exposures. The advantage of a retrospective study are that results can be obtained without waiting many years and a much smaller sample size is required because one is collecting data only on actual cases. The major disadvantage of a retrospective study is that there -4- is usually no accurate records from which to determine exposure data. A prospective study on the other hand, would focus on maintaining careful quan- titative exposure data for the entire cohort. One of the significant problems with the .previous studies in Contra Costa County has been the lack of statistical power to detect an environmental or occupa- tional affect if one should occur. For a variety of reasons (9,10) we would predict a relative risk of cancer from occupational or environmental exposure of perhaps 1 .1 . Such a relative risk would require a study of several thousands of cases to detect (11 ) . A prospective study requires following a cohort, most of whom will not develop occupationally-associated tumors. Determining the precise size of the required cohort would be part of the comprehensive planning process to be described below. The actual cohort size required depends on a number of factors including the incidence of the tumor in the population; however, a use- ful prospective cancer study would require following a cohort of at least some tens of thousands (11 ) . DESCRIPTION OF CONTRA COSTA COUNTY AS A SITE FOR A PROSPECTIVE OCCUPATIONAL CANCER STUDY Contra Costa County is located in the San Francisco Bay Area and is bordered on the west by San Pablo Bay and on the north by the Carquinez Strait and the Sacramento River. Contra Costa has a population of 720,000 with 9.2% black, 81 .5% white, and 9.3% other. The County is the site of a major concentration of petrochemical industry, with five oil refineries and three major chemical fac- tories, as well as a large number of associated and related petrochemical industries, transportation facilities, and storage sites. The County Health Services Department planning process has identified 8 - 12,000 establishments . suspected of handling hazardous materials. There are 2 worksites with over 1 ,000 employees, 4 sites with over 500 employees, 12 sites with over 250 employees and 38 sites with over 100 employees. There are an estimated 30,000-60,000 persons employed in Contra Costa County in establishments which use, handle, or store hazardous materials. This work group would form the popu- lation from which occupational coharts could be identified and followed. The County is served by a comprehensive population-based tumor registry, the Surveillance Epidemiology End Results Program of the National Cancer Institute. This tumor registry is believed to identify and catalog into a computerized data base more than 95% of the cancers which develop in the 5 bay area counties,. This registry would be a key part of' any prospective cancer study and would greatly facilitate its implementation. The County is also in close proximity to two major campuses of the University of California, the Berkeley campus with its School of Public Health and the San Francisco campus with its School of Medicine. These two campuses can provide academic and technical consultation in the fields of epidemiology and occupational medicine. In addition the Northern California Occupational Health Center based at U.C. Berkeley, U.C. San Francisco, and U.C. Davis provide coordination of academic resources for the study of occupational environmental health problems. Finally, the Contra Costa County Board of Supervisors is very supportive of the idea of implementing a Prospective Occupational Cancer Study and would work with County Industrial Associations to obtain the cooperation of industry in such an endeavor. -5- DESCRIPTION OF REQUESTING AGENCY, CONTRA COSTA' COUNTY HEALTH SERVICES DEPARTMENT The Contra Costa County Health Services Department is a local county health agency responsible for providing a continuum of health service's to county resi- dents. County government provides both medical and preventions services in the County as well as environmental and public health programs that protect the well being of the entire community. The Health Services Department works cooperati- vely with Federal and State Health Services and the private sector to assure comprehensive health care at the local level. To carry out its mission, the Health'.Services Department. is organized into five divisions encompassing the continuum of services. Those divisions are Alcohol/Drug Abuse/Mental Health, Merrithew Memorial Hospital , Contra Costa Health Plan, Environmental Health and Public Health. Studies and programs relating to occupational cancer` are coordinated out of the Public Health Division. Public Health Division incorporates the complete range of Public Health Services including Public Health Nursing, Public Health Laboratory, Communicable Disease Control , Comm.unity Prevention, and Maternal and Child Health . Technical staff available to participate. in coordinating and directing the occupational disease investigation programs currently consist of the Public Health Director, who is a t"rained, physi,cian epidemiologist who spe- cializes in environmental epidemiology.- In ,addition, the Public Health Division has assembled a Technical Advisory Committee on Occupational and Environmental Health which consists of epidemiologists, toxicologists, and occupational medi - cine physicians from the University of California, industry and the private com- munity. NEED FOR DESIGNATED FUNDING FOR FURTHER PLANNING ACTIVITIES The current resources available within the Health Services Department are inade- quate to design a detailed, comprehensive proposal for a prospective occupa- tional cancer study which could be submitted to a major funding source as a complete proposal with an expectation of receiving long-term funding. The Technical Advisory Committee has communicated that they are "very enthusiastic about developing appropriate scientific methods for determining the contribution occupation to cancer incidence". However, they point out that "design of a spe- cific -study methodology requires a more extensive out evaluation for these data bases than the advisory committee can conduct at this time" (see attachment) . The Health Department ' s physician epidemiologist is unable to devote more than part time to the occupational cancer issue, as he has extensive other commit- ments including directing the Department's Public Health Division and programs. In order to complete the planning process, a substantial amount of professional epidemiologist time must be employed. In addition, there will be required some specific consultation in a variety of technical fields. The Department 's physi- cian epidemiologist can direct the overall planning process, and the Technical Advisory Committee will continue to provide assistance. However, the epide- miologist and consultant time must be procured. A proposal for specific funding of the prospective cancer planning process is included below. -6- PLAN FOR SEQUENTIAL IMPLEMENTATION OF A PROSPECTIVE CANCER STUDY The total cost for a long-term prospective study of occupational cancer in Contra Costa County, and perhaps the neighboring counties, will run into millions to tens of millions of dollars. To estimate these costs, we can con- sider related studies in the Bay Area. The Austin Study of Lung Cancer in Contra Costa involved a single retrospective evaluation of 273 cases of lung cancer undertaken over a period of one year. The total direct cost of the Austin Study, not including the occupational health component was $700,000. The State Health Services Department two years ago implemented a 1 year examination of birth defects in Santa Clara County and their possible association with chemical contamination of the public water supply. Although that study was funded through the regular Health Services Department budget, the direct cost asso- ciated with that project were estimated at approximately $400,000. We feel that it is unlikely we can interest a funding source in committing millions of dollars for a project or ev.en hundreds of thousands for a planning process, until there is demonstrated a more concrete ability to implement such a program in the County. We have therefore divided the prospective cancer study proposal into four segments, three pilot and data development projects and one planning proposal . These four segments can be separately and sequentially implemented, and funding for each of them can be sought independently of the development of the others. At the same time, each of these segments is an essential part of the Prospective Cancer Studyaand their implementation will serve as the basis for developing funding proposals for the 20 year project. PILOT PROJECTS FOR A PROSPECTIVE OCCUPATIONAL CANCER STUDY I. Utilization of the AB2185 County Data Base Under the legislation enacted in California, the Contra Costa County Health Services Department is developing a computerized data base which will list all the establishments within the County that produce, use, or store hazardous materials. Included in the data base will be an inventory of the - type and quantity of hazardous materials located on each premise. The data base will be funded by fees charged to the handlers of hazardous materials and will be available to the Health Services Department for a variety of uses. Other provisions of AB2185 call for onsite inspections of premises handling hazardous materials to insure compliance with business plans and to evaluate potential adverse health impacts of the hazardous materials either in the community or in the work place. These inspections will likewise be funded by fees on the user base. Planning for the development of the hazardous materials data base has already included projected public health uses, and we are anticipating having the ability to query the data base as to the location and distribution of specific hazardous materials throughout the County. We propose to utilize the AB2185 data base to identify establishments which are handling occupational carcinogens and where there may be occupational exposure. Such establishments would be a source of cohorts for a prospective occupational cancer study. -7- Once sites are identified which handle, use, or store occupational carcinogens,. the AB2185 inspections of these sites would be keyed to specifically evaluating for the actual use of these carcinogens in- a work setting. If the initial inspection indicates further evaluation, there would be a followup visit with a certified industrial hygienist to make a comprehensive health evaluation of the establishment and to determine if there may be actual work place exposure. A master 's level epidemiologist would also be involved in the project. The role of the epidemiologist would be to followup on recommendation #1 of the Technical Advisory Committee (see attachment) that is, identify the nature and extent of existing occupational exposure and work history data. We would look at company personnel records, CAL OSHA data, etc. The joint activity of the epidemiologist and the industrial hygienist would identify occupational cohorts in Contra Costa County and begin establishing a data base for exposure and medical history for the cohort. An occupational medicine physician consultant would be utilized in this project to evaluate medical history records and to make recommendations about appropriate ongoing medical monitoring. The identification of cohorts and the establishment of exposure and medical data bases would be a major step towards implementing a prospective cancer study. In addition, this project would serve an immediate public health role in the county by identifying potential health problems and assisting industry to establish safe industrial hygiene practices and appropriate medical monitoring. This assistance would be particularly valuable for the smaller establishments handling hazardous materials, as they seldom have the inhouse industrial hygiene and occupational medical expertise which is available in the larger industries in the .County. Proposed budget including salary and benefits: Industrial Hygienist 0.5 FTE - $ 25,000 ° Master ' s Level Epidemiologist 0.5 FTE - 18,000 ° Occupational Physician Consultant 0.2 FTE - 15,000 ° Data Processing and Support Costs - 75,000 Total Costs: $133,000 Possible funding sources: Kellogg Foundation, Industry. -8- INCORPORATE WORK HISTORY INTO CURRENT..TUMOR .REGISTRY DATA BASE The existing SEER tumor registry is a comprehensive population-based cancer registry covering the 5 Bay Area counties. Information on more than 95% of all the tumors which develop in the Bay Area region is maintained on a computerized data base, which contains type of tumor, date of diagnosis, and basic infor- mation on the patient including place of residence, age, sex and race. There is currently no information included in the tumor registry on occupation of the patient. Other population-based tumor registries have included occupa- tional data, and that information has been used to investigate occupational cancer. The tumor registry covering Los Angeles County includes usual occupa- tional and that data base has been used for a number of studies in occupational cancer (12) . The SEER registry in Michigan also collects extensive data on occupation in its registry area. In addition, the Michigan registry develops occupational and other data for a sample of the general population in Michigan to serve as a control group for epidemiological purposes. It would be inva- luable in investigating occupation cancer in Contra Costa County for the Bay Area Tumor Registry to include occupational history in its data base. The proposed project to incorporate occupational history into the tumor registry would be implemented in two phases. The pilot phase involves a program to test several methodologies for collecting occupational and smoking history from tumor cases. All tumors diagnosed during a three month period in four Contra Costa County Hospitals will be evaluated, and data will be collected on occupational and smoking history from the patients. Each patient will be contacted, with the cooperation of the primary care physician, and will be questioned to obtain the detailed occupational history. In addition to interviewing patients, the pilot test hospitals will begin a program to collect information on at least the usual occupation, if not a more detailed occupational history, from all hospital admissions during the testing phase. The routine collection of occupational history in our hospitals would greatly facilitate the inclusion of that data on an ongoing basis in the tumor registry. The four hospitals in Contra Costa involved are Merrithew Memorial , Mt. Diablo, the VA Hospital in Martinez, and Kaiser -Walnut Creek. Representatives from each of these institutions have , agreed to participate as co-investigators. On the basis of this pilot project, an appropriate methodology will be selected for incorporating occupational data into the Bay Area Tumor Registry. Further funding will then be sought to implement the more extensive program. Budget for Phase I: ° Physician Epidemiologist 0.2 FTE - $ 15,000 ° Research Assistant 1 FTE - $ 24,000 ° Travel and Supplies - $ 3,000 ° Data Processing - $ 20,000 Total : $ 62,000 -9- Possible Funding Sources: ° National Institute for Occupational Science -and Health, State Health Services Department. Phase II involves incorporating occupational data into the ongoing work of the registry throughout the Bay Area. Phase II will follow on Phase I, and is dependent upon obtaining ongoing funding sources. Costs estimates are currently being developed by staff at the Bay Area SEER registry for use in more detailed grant proposals to the National Cancer Institute ad the American Cancer Society. These costs will run several hundred thousand dollars per year. Possible funding source, Phase II : - National Cancer Institute - American Cancer Society LINKAGE OF INDUSTRY-MAINTAINED OCCUPATIONAL RECORDS WITH TUMOR REGISTRY Recommendation #3 of the Advisory Committee on Occupational and Environmental Health (see appendix) suggests investigating the feasibility of industry employee record linkages with the tumor registry data base. The Advisory Committee has determined that at least some of the larger industries in Contra Costa County maintain relatively extensive health surveillance records on employees and may also have maintained some kinds of exposure data. Much of that data is or can be computerized. .Linking existing employee data with the tumor registry provides a very cost- effective way to follow occupational cohorts for the development of occupational cancer. Using existing data allows the development of a historical prospective or historical cohort study design. Such a design shares the advantages of a prospective cohort strategy in that ongoing medical and exposure data is available. The historical cohort approach, however, adds the advantage of dra- matically reducing the amount of time required to produce the results from the study. In addition to using the 2185 data base and inspections to identify potential worksites for record linkages, a direct approach should be made to the refining and large chemical industries in the County to link their extensive work records to the tumor registry. Most worksites which maintain medical records or expo- sure data will not have that information computerized. Those industries which we know do maintain computerized occupational records undoubtedly all use widely different formats, hardware, and data elements. Developing working data linka- ges with the tumor registry will involve considerable staff time and a major data processing commitment. -10- Budget: ° Masters Epidemiologist 1 FTE - $ 43,000 ° Clerical/Data Entry 1 FTE - $ 25,000 ° Data Processing/Development - $150,000 Total : $218,000 Possible funding sources: ° Industry (some inkind contribution) ° National Institutes of Health ° Private Foundations PLANNING PHASE FOR PROSPECTIVE CANCER STUDY In conjunction with developing one or more of these pilot projects, the detailed planning of a prospective cancer study can commence. The Health Services Department does not have the resources or the kinds of personnel needed to carry out such an extensive planning process. The current Technical Advisory Commitee is willing to assist in this endeavor but has clearly stated that the design of a specific study methodology requires a more extensive evaluation than the advi- sory committee can conduct itself. We are proposing a planning budget for the Prospective Cancer Study. We will seek to fund this planning component on the basis of implementation of one or more of the above programs. The planning budget will require funding for a senior epidemiologist and a substantial amount of money to be paid for technical consultants to work on various aspects of the plan. The Technical Advisory Committee for occupational and environmental health will be willing to assist in this planning process, but their expertise can be utilized more effectively if staff time and technical assistance is provided them. Proposed budget: ° Epidemiologist PHD Level - $ 55,000 ° Consultants - $ 40,000 ° Technica Advisory Committee Staff - $ 10,000 ° Meeting costs (8 12 day meetings) - $ 4,000 ° Travel - $ 7,000 ° Technical Staff - $ 1 ,500 ° Direct Department Support 0.1 Time - $ 9,800 ° Secretary 0.5 FTE - $ 11 ,000 ° Mailing/Supplies - $ 2,000 Total : $140,300 Cancer REFERENCES 1 ) Epstein S, Swartz JB:Fallacies of lifestyle cancer theories. Nature 289:127-30, 1981 2) Silverberg E: Cancer statistics. Ca 35:19-34, 1985 3) Doll R, Peto R: The causes of cancer:: quantitative estimates of avoidable risks of cancer in the United States today. JNCI 66: 1193-1308, 1981 4) Blot WJ, Brinton LA, Fraumen JF et al : Cancer mortality in U.S. counties with petroleum industries. Science 198: 51-53, 1977 5) Kaldor J, Harris JA, Glazer E, et al : Statistical associations between cancer incidence and major-cause mortality, and estimated residential exposure to air emissions from petroleum and chemical plants. Environ- mental Health Perspectives 54: 319-332, 1984 - 6) Heary CD, Ury H, et al : Lack of association between cancer incidence and residence near petrochemical industry in San Francisco Bay Area. J. Natl . Cancer Inst. 64: 1295-1299, 1980 7) Austen, DF : Epidemiological study of the incidence' of cancer as related to industrial air emissions in Contra Costa County, California. Final Report to the Environmental Protection Agency, 1982 8) Smith AH, Waller K: Air pollution and cancer incidence in Contra Costa County; review and recommendations. Published by Contra Costa Dept. of Health Services, California, 1985 9) Friberg L, Cederlor R: Late effects of air pollution with special references to lung cancer. Environmental Health Perspectives 22:45-66, 1978 10) Hanes MM, Staviraky KM, Fowler JL: Cancer mortality in oil refinery workers. J. Occ. Med 21 : 167-174, 1979 11 ) Schlesselman JJ: Case-Control Studies, Oxford University Press, 1982 12) Pike MC, Jing JS, Rosario TP et al : Occupation: Explanation of an apparent air pollution related localized excess of lung cancer in Los Angeles County. In: Breslow N and Whatemer A eds: Proceedings of the SIAM - SIMS Conference, 1978, SIAM, Philadelphia, 3-16, 1979 STATE OF CALIFORNIA—HEALTH AND WELFARE AGENCY GEORGE DEUKMEJIAN, Govemoi DEPARTMENT OF HEALTH SERVICES OCCUPATIONAL HEALTH SURVEILLANCE s AND EVALUATION PROGRAM (OHSEP) 2151 BERKELEY WAY.ROOM 504 BERKELEY.CA 94704 (415)540 3141 October 17, 1986 William B. Walker, M.D. Contra Costa County Health Department 2500 Alhambra Avenue Martinez, CA 94553-3191 Dear Dr. Walker: As members of the County Health Department Advisory Committee, we would like to express our appreciation for the continued interest of the Health Department in the important areas of occupational and environmental health. The intent of this letter is to comment on the recent Board of Supervisors' mandate to your department to facilitate a prospective study of occupational cancer in Contra Costa County. We are very enthusiastic about developing appropriate scientific methods for determining the contribution of occupation to cancer incidence. At our last meeting, we identified a variety of potential sources of information and data which could be used in such studies. These include the Northern California Tumor Registry, industry surveillance systems, union records, and hospital data. Design of a specific study methodology requires a more extensive evaluation for these data bases than the Advisory Committee can conduct at this time. Therefore, we would strongly recommend that the County Health Department find a feasibility study which would address several issues: 1. What is the nature and extent of existing occupational exposure and work history data? (e.g. , company personnel records, Cal/OSHA data, etc.) 2. Can this information be used to identify potentially at-risk populations? What are the options for evaluating these populations after identification? 3. How can an adequate work history best be incorporated into tumor registry data? What types of record linkages with the tumor registry are feasible? We would be glad to continue to serve in an advisory capacity to provide input in carrying out a feasibility study of this type. We feel that such a study is really the first step before any more comprehensive studies can be carried out. We would also like to remind you that there are potentially many other significant health outcomes besides cancer which may be associated with r- r William B. Walker, M.D. -2- October 17, 1986 occupational and environmental exposures, and which merit further attention. Respiratory problems are an example that has come to the attention of the _ committee. We would hope that the feasibility study, although focused on cancer, could also begin to address the possibility of evaluation of some of - these other concerns as well . Sincerely, Linda Rudolph, M.D. Public Health Medical Officer William J. Bailey, M.D. Senior Epidemiologist Chevron Corporation LR:mk