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HomeMy WebLinkAboutMINUTES - 12191989 - IO.6 I.O.-6 TO: BOARD OF SUPERVISORS Contra .Y^. FROM: Costa •( ',• INTERNAL OPERATIONS COMMITTEE County DATE: °srA December 11, 1989 c'uri SUBJECT: STATUS REPORT ON THE PROSPECTIVE STUDY OF THE INCIDENCE OF CANCER IN CONTRA COSTA COUNTY SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOVRY ENDATIONS 1 , Acknowledge receipt of the attached report from the Health Services Director on this subject and commend the staff of the Health Services Department, and particularly Dr. Wendel Brunner, for the substantial progress which has been made in this area. 2 . Request The Health Services Director to include in the protocol for gathering essential background information on cancer patients, information on the individual' s occupational history, environmental history, and medical history including nutritional patterns, alcohol consumption and wellness behavior. 3 . Request the Health Services Director to prepare an outline of what would be included in a proposal to the National Institute of Cancer to fund a prospective study of the incidence of cancer in Contra Costa County and the approximate cost of preparing' such a proposal and report this information back to the 1990 Internal Operations Committee by February 15 , 1990 and for this purpose refer this item to the 1990 Internal Operations Committee. 4. Request the Health Services Director to approach the American Cancer Society and American Medical Association about their willingness to fund the writing of a detailed proposal to- the National Cancer Institute for a prospective study of the incidence of cancer in Contra Costa County and CONTINUED ON ATTACHMENT: Yes YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BO RD COMMITTEE APPROVE OTHER � SIGNATURE(S): TOM 1DOW"ERS gTTNNP, WRTCHT Mr_PRAK ACTION OF BOARD ON - ni-e-t'ICl}' pr 1-91 1_q$c) APPROVED AS RECOMMENDED X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS(ABSENT I ) 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: ATTESTED— PHIL TTESTED PHIL BATCHELOR,CLERK OF THE BOARD OF County Administrator SUPERVISORS AND COUNTY ADMINISTRATOR Health Services Director Director of Public Health 0,/" ��l-� M382 (10/88) BY DEPUTY report the results of his conversations to the 1990 Internal Operations Committee at the time the outline of the proposal is considered by the Committee. 5. Request the Health Services Director to schedule a presentation before the Bay Area. Air Quality Management District' s Advisory Board regarding the proposed prospective study of the incidence of cancer in Contra Costa County, seek their endorsement of the study and then make a similar presentation to the Bay Area Air Quality Management District ' s Board of Directors. 6. Request the Health Services Director to utilize the Conference of the California Coalition on the Future of Public Health in April, 1990 as an opportunity to seek endorsements and funding for the prospective study of the incidence of cancer in Contra Costa County. 7 . Concur with the membership of the Prospective Cancer Study Review Committee formed by the Health Services Director which will review and comment on the outline for the proposal to the National Cancer Institute, if possible before the study outline is presented to the 1990 Internal Operations Committee. 8 . Remove this item as a referral to our Committee. BACKGROUND: . On June 27 , 1989 the Board of Supervisors requested the Health Services Director to prepare a report to our Committee on an outline of how a prospective study of the incidence of cancer in Contra Costa County should be conducted and present it to our Committee on December 11 ,--1989. On December 11 , 1989 our Committee reviewed the attached report which outline the type of study methodology which would be followed in such a prospective study. The next step which is necessary is to prepare an outline of a study proposal which would go to the National Cancer Institute, have the study outline reviewed by the professional study review committee which has been formed, review the study outline with the 1990 Internal Operations Committee, obtain funding for the preparation of the proposal to the National Cancer Institute and then undertake the preparation of the actual proposal. The above recommendations came out of our discussions with Mr. Finucane and Dr. Brunner on December 11, 1989 and will assist in moving this process forward. We noted that while a good deal of occupational history will be obtained from cancer patients, the methodology does not include nutritional information and information on the consumption of alcohol, both of. which are important elements which should be included. It is our hope that a full-blown funding proposal for a prospective study of the incidence of cancer in Contra Costa County can be submitted to the National Cancer Institute by the end of 1990. t CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT December 6, 1989 TO: Supervisor Sunne McPeak Supervisor Tom Powers Internal Operations Committee FROM: Wendel Brunner, M.D. 0, & Director of Public Health RE: Status Report on the Prospective Study of the Incidence of Cancer in Contra Costa County We were asked to report to the Internal Operations Committee with an outline of the methodology on how a prospective study on the incidence of cancer in Contra Costa County should be conducted. We were also asked to involve the Bay Area Cancer Coalition (BACC) in the concept of a prospective study of cancer incidence and to then follow-up with the Bay Area Air Quality Management District's (BAAQMD) Advisory Committee and thereafter with the BAAQMD Board of Directors. OUTLINE OF STUDY METHODOLOGY Population Based Tumor Registry The population based Tumor Registry which currently covers the seven Bay Area counties forms a major part of the database that is necessary for a prospective study of occupational and environmental cancerThis Tumor Registry forms the basis for: ( 1) identifying cases for case/control studies of cancer (2) screening populations for occupational cancer associations (3) providing linkages between occupational cohorts and tumor databases(2) . The Tumor Registry maintains information on age, race, sex, type of tumor, and census tract, and is believed to be over 98% complete in the. Bay Area. The registry identifies. some 43,000 cancer cases in the Bay Area per year. There are a number of major essential components of this registry, ; however, which are missing for an occupational cancer study. First -of all, while the data is quite complete and available on tape, there are currently no staff in place to analyze the cancer incidence data, or even publish it on a regular basis. This lack of staff is partly due to the recent disruption of the tumor registry by its move to Sacramento, but also reflects the situation that existed when the registry was administratively based in the Bay Area. Several additional FTE's would be required to utilize the Tumor Registry database in conjunction with a prospective cancer study. Perhaps more important, the registry database does not contain occupational history on the persons diagnosed with tumors . Lack of occupational history makes the registry of limited use for occupational cancer epidemiology. Occupational History Reports on Cancer Cases It is essential to develop occupational histories for the cancer cases identified in the Tumor Registry, in order to implement the prospective cancer study. A key requirement for the prospective cancer study is to put in place a mechanism to link occupational history with tumor cases . Death certificate information available from vital statistics databases does include some information on "usual occupation" , and can be linked, with difficulty, to the Tumor Registry database(3) . It is generally accepted, however, that the occupational information on death certificates is so poor as to be nearly useless for occupational mortality studies(4) . The prospective cancer study will have to include an extensive component for identifying occupation of diagnosed cancer cases. Occupational history will have to be identified by survey of cancer cases as they are diagnosed. A methodology for ascertaining occupational history and linking that with the Bay Area Tumor Registry database has been piloted by Drs . Glazer, Hiatt, and Brunner under a grant funded by the National Institute of Occupational Safety and Health (NIOSH)(5) This methodology involves administering to patients at the initial admission to the hospital, or subsequently if the patient is unable to respond at the admission, a simple questionnaire designed to elicit information on current and usual occupation and smoking habits . During the pilot study a .5 FTE research assistant administered the questionnaire to 250 persons diagnosed with cancer, and included the occupational information in the Bay Area Tumor Registry database. The fact that this was a pilot program designed to test the survey instrument and procedure minimized the productivity of the research assistant, although other professional staff were also involved in implementing this project. Nonetheless, it is evident that a major commitment of resources would be required to incorporate accurate occupational information on the 43,000 annual cases entered into the Tumor Registry. 2 Exposure Surveillance In addition to identifying disease outcomes through the Tumor Registry, it is essential to monitor in a prospective manner the workplace exposures that are being experienced in Contra Costa County and the Bay Area. In fact, it is through the combined efforts of both hazard and disease surveillance that provides the potential for discovery of causes of occupational disease(6) . Fortunately, an extensive methodology for occupational exposure surveillance has been developed by NIOSH, and it is not necessary to reinvent this wheel" . NIOSH instituted the National Occupational Exposure Survey (NOES) in 1980, which identified occupational exposures through extensive surveying, industrial hygiene assessment, and toxic monitoring in a variety of representative industries. NIOSH then developed this NOES information into a job-exposure matrix (JEM) to facilitate its use in epidemiologic applications . These kind of job-exposure matrices can be applied to individual occupational histories to estimate occupational exposures. Unfortunately, it will be impossible to apply the existing NIOSH JEM's to Contra Costa and Bay Area cancer cases with occupational histories to obtain meaningful exposures . The NOES survey was conducted between 1976 and 1980, and the industry base is not representative of either Contra Costa County or the Bay Area. The NIOSH Task Force on Occupational Surveillance recommended that NIOSH conduct periodic national surveys, but this recommendation was not implemented. For the Contra Costa and Bay Area prospective cancer study, it would be appropriate to conduct a special purpose survey which would be representative of Contra Costa and Bay Area industry and worksites(8) . This survey should be repeated periodically, probably every five years, during the course of the prospective study, and could be carried out under existing NIOSH guidelines for such surveys(9) . Population Survey In addition to case identification, occupational history, and exposure surveillance, data needs to be compiled on the general working population which identifies workers' perception of occupational risk, and the prevalence of behavioral risk factors such as smoking and diet for specific occupational groups and segments of industry. This attitude and behavioral data specific for the Bay Area population is essential to identify factors such as smoking which confound the supposed occupational or environmental association with cancer. This survey data also collaborates the occupational history survey techniques which are used to develop the occupational linkages for the Tumor Registry cases . 3 Much of the methodology appropriate for these surveys has been developed by NIOSH as a supplement to the National Health Interview Survey (NHIS) conducted by the National Center for Health Statistics . This special NHIS modification focuses on the specific factors involved in occupational health epidemiology design(lo) . The appropriate population sampling, survey instrument design, survey administration, and analysis of data could be performed in the Bay Area by the Survey Research Center at U. C. Berkeley, or one of several other survey centers in the Bay Area. Typical costs for such a survey run $200 to $300 per individual surveyed, not counting the cost of designing the survey instrument and technique. Preliminary Sample Size and Power Calculations We have performed in consultation with several statisticians some very preliminary sample size and power calculations, which give estimates of the numbers of cases, persons surveyed, and worksites which need to be evaluated to identify occupational cancer incidence in the Bay Area. - Number of cases entered into the Bay Area Tumor Registry annually -- approximately 43,000. - Number of cases needed for case control design. In order to detect a 10% increase in cancer due to occupation, if such an increased cancer risk were present in 10% of worksites, approximately 20,000 to 30,000 cases would need to be identified, and matched with corresponding controls for good population data�ll� . - Number of persons to be sampled in population behavior and attitude survey -- 500 to 1, 000 minimum. - Exposure surveillance -- a representative sample of the Bay Area's industrial and non-industrial worksites could be selected. Identifying such a sample would be a task of the exposure surveillance team, and would be a significant undertaking in itself . The following individuals have agreed to review the proposed methodology and provide advice to the Contra Costa County Health Services Department about its implementation. This assistance offered, while quite significant and valuable, does not imply a commitment on the part of these individuals to implement the methodology or prepare extensive grant applications.. Don Austin, MD, MPH, Chronic Disease Branch, Department of Health Services (DOHS) Eva Glazer, MD, MPH, formerly Tumor Registry, DOHS 4 Peggy Reynolds, PhD, Environmental Epidemiology Section, DOHS Lynn Goldman, MD, MPH, Environmental Epidemiology Section, DOHS Michael Lipsett, MD, Air Toxics Section, DOHS, and BAAQMD Public Health Advisory Board Robert Hiatt, PhD, MD, Northern California Cancer Center Joan Bloom, PhD, U.C. Berkeley School of Public Health Survey Design PARTICIPATION OF THE BAY AREA CANCER COALITION IN THE PROSPECTIVE CANCER STUDY We were directed to ask the Bay Area Cancer Coalition (BACC) to participate in the prospective cancer study and report on the concept to the BAAQMD Advisory Committee, and thereafter to the BAAQMD Board of Directors . The Bay Area Cancer Coalition formed a research committee in September, to evaluate and implement research projects that could be undertaken by BACC. I approached key members of the BACC research committee with a request to consider and facilitate the Bay Area prospective cancer study. These members are interested, and willing to evaluate the study, but proposed that we consider it after the first of the year. The BACC research committee is currently deeply involved in responding to an extensive National Cancer Institute Research proposal on breast and cervical cancer detection and prevention (see attached Board Order) which was due to the NCI December 11 . This NCI proposal stands a significant chance of being funded, and would establish a track record for BACC with the National Cancer Institute which would allow us to be seriously considered for an unsolicited research proposal, such as the prospective cancer study would be. Consideration of the prospective cancer study, therefore, was deferred by BACC until 1990. I have proceeded to contact Dr. Michael Lipsett from the BAAQMD Advisory Board and DOHS, and requested that he participate with the group listed above that will evaluate the prospective cancer methodology., Most of the members of that group are currently deeply involved in preparing the BACC NCI grant application and have requested that we consider the specifics of the prospective cancer study after the first of the year. The mechanisms are now in place for a professional review of the methodology proposed, and an assessment by the BAAQMD Advisory Board. Subsequent to that assessment, we will be forwarding the proposal to the BAAQMD Board of Directors and the cities and counties for endorsement. WB:rm Attachment 3.prospect.ca 5 REFERENCES (1) Swanson, G.M. et al: Population Based Occupational Cancer Incidence Surveillance JOM 27 (6 ) : 439-447, 1985 . (2) Wharton, MD et al: Feasibility of Identifying High Risk Occupations Through Tumor Registries . JOM 25: 657-660, 1983 . (3) National Center for Health Statistics: Guidelines for Reporting Occupation and Industry on Death Certificates. Hayettsville, Md. : National Center for Health Statistics, 1988. (4) Steenland, R. , Beaumont, J: The Accuracy of Occupation and Industry Data on Death Certificates. JOM, 26 : 228-296, 1984 . (5) Glazer, E.R. , Hiatt, R.A. , Brunner, W. C. : Feasibility Study for an Occupational Cancer Program, Manuscript in Preparation. (6) Sundin, D.S. , Frazier, T.M. , Hazard Surveillance at NIOSH, AJPH 79 : 32-37 1989 . (7 ) Sundin, D.S . : National Occupational Hazards Survey (NOES II) . In: Proceedings of the First NCI/EPA/NIOSH Collaborative Workshop: Progress on Joint Environmental and Occupational Cancer Studies. May 6-8 1980. (8) Halperin, W.E. , Frazier, T.M. : Effect of Workplace Exposures in Breslow) Ed: Annual Reviews Public Health 6 :419-430, 1980-432, 1985. (9) National Institute for Occupational Safety and Health: National Occupational Hazards Survey - Vol. 1 Survey Manual. NIOSH Pub. No. 74-127 May, 1974 (10) Rovar, M.G. , Roe, G.S. : The National Health Interview Survey Design, 1973-1984, and Procedures, 1975-1983 . National Center for Health Statistics: Vital and Health Statistics, Series 1, No. 18 DHHS Pub. No. 85-1320, 1985. (11) Schlesselman, J.J. : Case Control Studies, Oxford University Press, 1982 3.Prospect.CA1 PROSPECTIVE CANCER STUDY REVIEW COMMITTEE Don Austin, MD, MPH, Chronic Disease Branch, Department of Health Services (DOHS) Eva Glazer, MD, MPH, formerly Tumor Registry, DOHS Peggy Reynolds, PhD, Environmental Epidemiology Section, DOHS Lynn Goldman, MD, MPH, Environmental Epidemiology Section, DOHS Michael Lipsett, MD, Air Toxics Section, DOHS, and BAAQMD Public Health Advisory Board Robert Hiatt, PhD, MD, Northern California Cancer Center Kathleen Lamborn, PhD. , Statistical Consultant Northern California Cancer Center Joan Bloom, PhD, U.C. Berkeley School of Public Health Survey Design Peggy Boyd, PhD, California Public Health Foundation Survey Design Linda Rudolph, MD, MPH - Occupational Health - DOHS George Kaplan, PhD, Human Populations Laboratory, Public and Environmental Health Advisory Board