Summary Ratios of Cancer Incidence in Ten Areas around Rocky Flats, Colorado Compared to the Remainder of Metropolitan Denver, 1990-2014
Background •
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In 1998, the Colorado Central Cancer Registry (CCCR) at the Colorado Department of Public Health and Environment (CDPHE) prepared a report evaluating 1980-89 cancer incidence for a fairly large geographic area surrounding the Rocky Flats site. The overall conclusions of the 1998 report were that the incidence of all cancers combined and ten individual types of cancer in communities surrounding the Rocky Flats site were no different than expected based on cancer rates in the remainder of the Metro Denver area for the years 1980 through 1989. This new report, covering the years 1990-2014, uses the same methods to evaluate cancer incidence for the area surrounding the Rocky Flats site. The report uses data from the CCCR, which registers all cancers diagnosed in Colorado residents. The report evaluates the incidence of ten separate cancer types: esophagus, stomach, colon and rectum, liver, lung, prostate, bone, leukemias, lymphomas, and brain and central nervous system. These cancer types were selected in consultation with the 12-member Health Advisory Panel on Rocky Flats in 1998 because they are possibly linked with plutonium exposure or were of special concern to Panel members. The report compares the incidence of cancer in ten communities or Regional Statistical Areas (RSAs), which were selected for their proximity to Rocky Flats, to the incidence of cancer expected based on rates in the remainder of the Denver Metro area. (See Figure 1) These types of evaluations have been conducted frequently around communities adjacent to suspected environmental exposures since they are efficient, cost effective, and can be completed within a reasonable period of time. The intent of this report was to give Colorado’s citizens cancer incidence statistics for their communities in a way that they could compare their cancer experience to the remainder of the Metro Denver area during the 1990-2014 time period.
Overall Findings •
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The incidence of all cancers-combined for both adults and children was no different in the communities surrounding Rocky Flats than would be expected based on cancer rates in the remainder of the Metro Denver area for 1990-2014. The incidence for six of the ten types of cancer evaluated was no different in the communities surrounding Rocky Flats than would be expected based on cancer rates in the remainder of the Metro Denver area for 1990-2014. The types of cancer not elevated were stomach, liver, bone, leukemias, lymphomas, and brain and central nervous system. Data showed significant elevations of lung, esophagus, colorectal, or prostate cancer
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Summary Ratios of Cancer Incidence in Ten Areas around Rocky Flats, Colorado Compared to the Remainder of Metropolitan Denver, 1990-2014 in some of the communities surrounding Rocky Flats for 1990-2014.
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Lung cancer was elevated in both males and females in three of the communities and in males in four of the communities (Arvada, Adams-West, Adams-Clear Creek Valley (males only), and Northglenn-Thornton). More than 90% of the lung cancer cases in these areas had a history of smoking. These communities also have a higher rate of smoking among the general population (> 20%) compared to the remainder of the Metro Denver area (15.8%) based on more recent (2012-15) data.
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Colorectal cancer was elevated in men in two of the communities (Adams – West and Adams – Clear Creek Valley). More colorectal cancer cases in these communities (70%) were smokers compared to Metro Denver colorectal cancer cases (60%). These communities also have a higher rate of smoking among the general population (> 20%) compared to the remainder of the Metro Denver area (15.8%) based on more recent (2012-15) data.
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Esophagus cancer was elevated in women in one of the communities (Golden). Cases in this community had links to two major risk factors for esophagus cancer: (1) smoking in 90% of cases; (2) alcohol use in 80% of cases.
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Prostate cancer was elevated in one community (Boulder City – Periphery). Boulder County has historically had elevated prostate cancer incidence, which is often seen in higher income areas, possibly due to better participation in screening of blood samples for Prostate Specific Antigen (PSA) to detect prostate cancer.
Nearly all of the significantly elevated cancer findings in this evaluation involved cancer types (lung, colorectal and esophagus) known for having smoking as a primary risk factor. For more information on the Rocky Flats site and Rocky Flats cancer studies, please visit the CDPHE Rocky Flats webpage, available at: https://www.colorado.gov/pacific/cdphe/rocky-flats.
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Cancer is not a single disease, but a group of over 100 different diseases that share some common characteristics. Cancer is common; it is the second leading cause of death in the United States. Three of every five cancer deaths are due to tobacco use, being overweight, lack of physical activity, and poor nutrition. CDPHE recommends people adopt a healthy lifestyle that includes avoiding tobacco use, excessive alcohol consumption, and sun exposure. Increasing physical activity, maintaining a recommended body weight, eating a healthful and nutritious diet, and taking advantage of cancer screening will also reduce your risk. For more information about tobacco and cancer or quitting smoking, call 1-800-QUITNOW or visit https://www.coquitline.org
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Summary Ratios of Cancer Incidence in Ten Areas around Rocky Flats, Colorado Compared to the Remainder of Metropolitan Denver, 1990-2014
About the Colorado Central Cancer Registry •
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Monitoring of cancer incidence in Colorado is performed by the Colorado Central Cancer Registry (CCCR) at Colorado Department of Public Health and Environment (CDPHE). All cancers diagnosed in Colorado residents are reported to the CCCR with the exception of non-melanoma skin cancers. All Colorado hospitals, pathology labs, and outpatient clinics submit medicallyconfirmed cancer data to the CCCR. The registry is mandated by Colorado law [C.R.S. 25-1-107 (1) (z)] and by Colorado Board of Health regulation [6 CCR 1009-3]. All individual patient, physician, and hospital information is confidential as required by Colorado law [C.R.S. 25-1-122 (4)]. For other Colorado cancer statistics or more information on the CCCR, please visit: https://www.colorado.gov/pacific/cdphe/cancerregistry
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Summary Ratios of Cancer Incidence in Ten Areas around Rocky Flats, Colorado Compared to the Remainder of Metropolitan Denver, 1990-2014
Figure 1 – Study areas shaded in gray and comparison population (remainder of metro area)
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Ratios of Cancer Incidence in Ten Areas around Rocky Flats, Colorado Compared to the Remainder of Metropolitan Denver, 1990-2014 Prepared by: Colorado Central Cancer Registry Center for Health and Environmental Data (CHED) In collaboration with: Environmental Epidemiology, Occupational Health, and Toxicology Disease Control and Environmental Epidemiology Division
2016
Colorado Department of Public Health and Environment John Hickenlooper, Governor Larry Wolk, Executive Director
Dedicated to protecting and improving the health and environment of the people of Colorado 4300 Cherry Creek Dr. S. Denver, Colorado 80246-1530
Ratios of Cancer Incidence in Ten Areas around Rocky Flats, Colorado Compared to the Remainder of Metropolitan Denver, 1990-2014 Table of Contents List of Acronyms, List of Figures and Tables, and Metro Denver Map……………………… iii-ix Executive Summary ………....... . . . . . . . . . . ………. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2 Background and Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4 Study Design and Methods ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. 5-7 Findings and Analyses of Risk Factors ………………....................................... 8-12 Summary for Combined 10-RSA Region . . . . . . . . . . . . . . . . . . ………….... . . . . . . . . . . . . .. . . 8 Summary for 10 Individual RSAs ……………………………………………..….... 8 Detailed Sections for Six RSAs with Statistically High Cancer Ratios ........... 9-12 Discussion and Limitations .................................................................... 13-16 Summary and Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . …….... ... . 17-19 Figures and Tables ……………………………………………………………………. 20-65 Technical Appendices Appendix A - Observed/Expected Ratios ............................................ A.1 Appendix B – Maps and Geography . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .. . …….. . . . B.1-B.10
References
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List of Acronyms BMI - Body Mass Index uses height and weight to determine overweight and obesity BRCA1, BRCA2 - human genes that, when mutated, may lead to increased risk of cancer BRFSS - Behavioral Risk Factor Surveillance System CCCR - Colorado Central Cancer Registry CDPHE - Colorado Department of Public Health and Environment C.I. - confidence interval used in statistical testing DOE - U.S. Department of Energy DRCOG - Denver Regional Council of Governments GERD - gastroesophageal reflux disease FAP - familial adenomatous polyposis HNPCC - hereditary nonpolyposis colorectal cancer O/E - observed to expected ratio of cancer diagnoses P – probability of an event RSA - Regional Statistical Area
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List of Figures and Tables
Figure 1 (p.20) - Ten Regional Statistical Areas (RSAs) Combined in the Vicinity of Rocky Flats 1990-2014, Ratios of Observed to Expected Counts of Cancers by Sex Table 1a (p.21) - Ten Regional Statistical Areas (RSAs) Combined in the Vicinity of Rocky Flats 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Table 1b (p.22) - Ten Regional Statistical Areas (RSAs) Combined in the Vicinity of Rocky Flats 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Figure 2 (p.23) - "Boulder City - Periphery" Regional Statistical Area (RSA 103) 1990-2014, Ratios of Observed to Expected Counts of Cancers and 95% Confidence Intervals by Sex Table 2a (p.24) - "Boulder City - Periphery" Regional Statistical Area (RSA 103) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Table 2b (p.25) - "Boulder City - Periphery" Regional Statistical Area (RSA 103) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Figure 3 (p.26) - "Boulder – Tri-Cities" Regional Statistical Area (RSA 106) 1990-2014, Ratios of Observed to Expected Counts of Cancers and 95% Confidence Intervals by Sex Table 3a (p.27) - "Boulder – Tri-Cities" Regional Statistical Area (RSA 106) 19902014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Table 3b (p.28) - "Boulder – Tri-Cities" Regional Statistical Area (RSA 106) 19902014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females
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List of Figures and Tables - (continued)
Figure 4 (p.29) - "Standley Lake" Regional Statistical Area (RSA 202) 1990-2014, Ratios of Observed to Expected Counts of Cancers and 95 % Confidence Intervals by Sex Table 4a (p.30) - "Standley Lake" Regional Statistical Area (RSA 202) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Table 4b (p.31) - "Standley Lake" Regional Statistical Area (RSA 202) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Figure 5 (p.32) - "Arvada" Regional Statistical Area (RSA 203) 1990-2014, Ratios of Observed to Expected Counts of Cancers and 95% Confidence Intervals by Sex Table 5a (p.33) - "Arvada" Regional Statistical Area (RSA 203) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Table 5b (p.34) - "Arvada" Regional Statistical Area (RSA 203) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Figure 6 (p.35) - "Golden" Regional Statistical Area (RSA 204) 1990-2014, Ratios of Observed to Expected Counts of Cancers and 95% Confidence Intervals by Sex Table 6a (p.36) - "Golden" Regional Statistical Area (RSA 204) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Table 6b (p.37) - "Golden" Regional Statistical Area (RSA 204) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females
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List of Figures and Tables - (continued)
Figure 7 (p.38) - "Wheat Ridge" Regional Statistical Area (RSA 205) 1990-2014, Ratios of Observed to Expected Counts of Cancers and 95% Confidence Intervals by Sex Table 7a (p.39) - "Wheat Ridge" Regional Statistical Area (RSA 205) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Table 7b (p.40) - "Wheat Ridge" Regional Statistical Area (RSA 205) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Figure 8 (p.41) - "Adams - Northwest" Regional Statistical Area (RSA 301) 1990-2014, Ratios of Observed to Expected Counts of Cancers and 95% Confidence Intervals by Sex Table 8a (p.42) - "Adams - Northwest" Regional Statistical Area (RSA 301) 19902014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Table 8b (p.43) - "Adams - Northwest" Regional Statistical Area (RSA 301) 19902014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Figure 9 (p.44) - "Adams -West" Regional Statistical Area (RSA 304) 1990-2014, Ratios of Observed to Expected Counts of Cancers and 95 % Confidence Intervals by Sex Table 9a (p.45) - "Adams -West" Regional Statistical Area (RSA 304) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Table 9b (p.46) - "Adams -West" Regional Statistical Area (RSA 304) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females
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List of Figures and Tables - (continued)
Figure 10 (p.47) - "Adams - Clear Creek Valley" Regional Statistical Area (RSA 305) 1990-2014, Ratios of Observed to Expected Counts of Cancers and 95% Confidence Intervals by Sex Table l0a (p.48) - "Adams - Clear Creek Valley" Regional Statistical Area (RSA 305) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Table l0b (p.49) - "Adams - Clear Creek Valley" Regional Statistical Area (RSA 305) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Figure 11 (p.50) - "Northglenn - Thornton" Regional Statistical Area (RSA 306) 1990-2014, Ratios of Observed to Expected Counts of Cancers and 95% Confidence Intervals by Sex Table l1a (p.51) - "Northglenn - Thornton" Regional Statistical Area (RSA 306) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Table l1b (p.52) - "Northglenn - Thornton" Regional Statistical Area (RSA 306) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Table 12 (p.53) - "Boulder City - Periphery" Regional Statistical Area (RSA 103) 1990-2014, Ratios of Observed to Expected Counts of Prostate Cancers by Race/Ethnicity and by Age Figure 12 (p.54) - RSA Prostate Cancer Ratios (1990-2014) vs. RSA Average Household Income for 1999 Table 13 (p .55 ) - "Golden" Regional Statistical Area (RSA 204) 1990-2014, Ratios of Observed to Expected Counts of Esophagus Cancers by Race/Ethnicity and by Age – Females Table 14 (p . 56 ) - "Adams - West" Regional Statistical Area (RSA 304) 1990-2014, Ratios of Observed to Expected Counts of Colorectal Cancers by Race/Ethnicity and by Age – Males
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List of Figures and Tables - (continued)
Table 15 (p .57 ) - "Adams – Clear Creek Valley" Regional Statistical Area (RSA 305) 1990 - 2014, Ratios of Observed to Expected Counts of Colorectal Cancers by Race/Ethnicity and by Age – Males Figure 13 (p .5 8) - RSA Colorectal Cancer Ratios (1990-2014) vs. RSA Percentage Smokers for 2012-2015 Table 16 (p .59 ) - "Arvada" Regional Statistical Area (RSA 203) 1990-2014, Ratios of Observed to Expected Counts of Lung Cancers by Race/Ethnicity and by Age – Males and Females Table 17 (p .60 ) - "Adams - West" Regional Statistical Area (RSA 304) 1990-2014, Ratios of Observed to Expected Counts of Lung Cancers by Race/Ethnicity and by Age – Males and Females Table 18 (p .61 ) - "Adams – Clear Creek Valley" Regional Statistical Area (RSA 305) 1990-2014, Ratios of Observed to Expected Counts of Lung Cancers by Race/Ethnicity and by Age – Males and Females Table 19 (p .62 ) - "Northglenn - Thornton" Regional Statistical Area (RSA 306) 1990-2014, Ratios of Observed to Expected Counts of Lung Cancers by Race/Ethnicity and by Age – Males and Females Figure 14 (p .6 3) - RSA Lung Cancer Ratios (1990-2014) vs. RSA Percentage Smokers for 2012-2015 Table 20 (p .64 ) - RSAs 203, 304, 305, and 306 for 1990-2014, Number of Lung Cancer Diagnoses by Histologic Cell Type Compared to the Expected Number – Males and Females Table 21 (p .65 ) - RSAs 203, 304, 305, and 306 for 1990-2014, Number of Lung Cancer Diagnoses (Small Cell Carcinomas and Squamous Cell Carcinomas Only) Compared to the Expected Number – Males and Females
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“Executive -
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Background o Report entitled “Ratios of Cancer Incidence in Ten Areas around Rocky Flats, Colorado Compared to the Remainder of Metropolitan Denver, 1990-2014.” o Prepared by the Colorado Central Cancer Registry (CCCR), Colorado Department of Public Health and Environment (CDPHE), 2016. o The CCCR collects all cancers diagnosed in Colorado as it is mandated by Colorado law and by Colorado Board of Health regulation. Identification and registration of these cancer cases by the CCCR includes searching hospital medical charts, pathology laboratory records, and examining death certificate information for medically confirmed cancer diagnoses. o This new report contains 25 more years of data (1990-2014) since the last report which covered 1980-89; it uses the same geography and methodology. o Study geography includes ten Regional Statistical Areas (RSAs) selected for their proximity to Rocky Flats (within 12-16 miles south, southeast, east, northeast and north of the former plant). The ten RSAs are aggregates of a number of smaller U.S. Census areas called census tracts, which contribute population counts from 1990, 2000 and 2010 by race/ethnicity, age and sex. o Kinds of cancers evaluated: all cancers combined (all ages) and (children ages 0-14) and ten separate cancer categories (esophagus, stomach, colon and rectum, liver, lung, prostate, bone, leukemias, lymphomas, and brain and central nervous system). o Analysis method compared the number of diagnosed cancers for each sex during 1990-2014 in each RSA to the expected number of cancers based on the cancer rates by race/ethnicity, sex and age of the remainder of the Denver Metro area outside the 10-RSA region. Observed-to-expected ratios of cancer cases were then calculated to see if they were statistically significant.
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Findings: o For the entire 10-RSA region and the 10 individual RSAs, the incidence of all cancers combined for persons of all ages and for children during 1990-2014 was not higher than expected compared to the remainder of Metro Denver. o Also for the entire 10-RSA region, the incidence of nine of the ten selected kinds of cancer (esophagus, stomach, colon and rectum, liver, prostate, bone, leukemias, lymphomas, and brain and central nervous system) for persons of all ages was not higher than expected. 1
o Lung cancer incidence in the entire 10-RSA region was found to be about 5% higher than expected in men and 4% higher than expected in women; but six of the RSAs (103, 106, 202, 204, 205 and 301) had lung cancer incidence that was not higher. o This lung cancer elevation was mostly due to four RSAs (“Arvada” RSA 203 and three RSAs in Adams County: “Adams-West” RSA 304, “Adams-Clear Creek Valley” RSA 305, and “Northglenn-Thornton” RSA 306). These four RSAs had statistically higher lung cancer ratios (ranging from 1.11 to 1.47) that were linked with high rates of smoking (90+ %) among the cancer cases. Recent telephone survey data (2012-15) also indicates higher rates of smoking (20+ %) among the general population in three of these four RSAs compared to the comparison Metro Denver population (15.8%). o Additional evidence of the smoking link with these lung cancer findings is that the two cell types most linked with heavy smoking, small cell carcinomas and squamous cell carcinomas, were statistically higher in all four of these RSAs and over 95% of cancer cases with these two cell types were smokers. Further analysis of all10 RSAs showed higher lung cancer ratios in RSAs with higher rates of population smoking. o Esophagus cancer was statistically higher in RSA 204 (“Golden”) in women (12 cases compared to about five or six expected for a ratio of 2.08). Links to three known risk factors for esophagus cancer were seen in these cases: (1) smoking was evident in 90% of cases; (2) alcohol in 80% of cases; and (3) overweight or obesity was seen in 40% of the cases since 2011 when this data has been collected by the CCCR. o Prostate cancer was statistically higher (ratio of 1.22) in RSA 103 (“Boulder City – Periphery”). Boulder county has historically had elevated prostate cancer incidence, which is often seen in higher income areas, possibly due to better participation in screening of blood samples for Prostate Specific Antigen (PSA) to detect prostate cancer. This RSA had substantially higher household income and further analysis showed a strong relationship of higher household income with higher prostate cancer ratios among the 10 RSAs. o Colorectal cancer was statistically higher in men (ratios of 1.29 and 1.22) in two RSAs in Adams County (“Adams – West” RSA 304 and “Adams – Clear Creek Valley” RSA 305). There was a link to smoking as a known risk factor with 70% of cases being smokers compared to 60% among comparison Metro Denver colorectal cancer cases. Recent telephone survey data (2012-15) also indicates higher rates of smoking (20+ %) among the general population in these two RSAs compared to the comparison Metro Denver population (15.8%).
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Background and Introduction History of Rocky Flats and prior analyses. The Rocky Flats Nuclear Weapons Plant was established in 1952 in Jefferson County on a site 16 miles northwest of downtown Denver. For four decades, the Rocky Flats Plant produced nuclear weapons components for national defense. Radioactive materials, such as plutonium and uranium, as well as other hazardous materials associated with manufacturing, were used at the Plant. Over the course of its operating history, contaminants were released to the environment beyond the Plant boundaries through routine air emissions and accidents, such as fire and spills.1 The Plant’s production mission was terminated in 1992. The State of Colorado and the U.S. Environmental Protection Agency supervised the investigation and remediation of environmental contamination at the site. Remediation of the Rocky Flats Site was completed in 2005, and in 2007, jurisdiction of most of the site was turned over to the U.S. Fish and Wildlife Service to be operated as a wildlife refuge. For more information about the site’s history and remediation, see: https://www.colorado.gov/pacific/cdphe/rocky29 flats. In 1989, Colorado’s then-Governor Roy Romer and then-Department of Energy (DOE) Secretary James Watkins signed an Agreement in Principle to provide DOE funding for state oversight of Rocky Flats for increased environmental monitoring near the plant, more emphasis on the Plant’s compliance with environmental laws, speedier investigation and cleanup of site contamination, and research to identify past exposures and potential health risks.1 Also, during the 1980s, several studies of populations near Rocky Flats were done. In 1981, a study by Johnson2 used data from the National Cancer Institute's 1969-71 Third National Cancer Survey to examine the relation between cancer rates and plutonium soil sample data collected in 1970. This study concluded some cancers were increased in areas with higher soil plutonium levels. In 1982, Dreyer et. al.3, conducted a feasibility study for an epidemiologic study of persons who lived near the plant. The study concluded that estimated exposures were not high enough to be evaluated with statistical analyses in an epidemiologic study. In 1987, a study by Crump et. al. 4 , replicated the Johnson study design using 1969-71 and 1979-81 cancer diagnosis data. The study’s 1969-71 findings paralleled Johnson’s findings but the study could draw no conclusions about a relation between soil plutonium levels and cancer rates. The study also found no excess of cancers within 10 miles of Rocky Flats during either time period for total cancer, radiosensitive cancer or respiratory cancer. In other words, the study concluded that the number of cancers was not higher than expected. To address the limitations of previous studies2-4, the Rocky Flats Historical Exposure Studies1,5,6,30 were initiated to identify and assess past releases of radioactive materials and chemicals from the Site that may have led to exposure of the public. A 12-member Health Advisory Panel on Rocky Flats conducted the study, which was administered by the CDPHE. The independent panel consisted of scientists, physicians, health officials, and members of the 3
public. Besides estimating health risks to offsite individuals, the project included a citizen-led offsite soil sampling effort. For more information about the Rocky Flats Historical Exposure Studies, see https://www.colorado.gov/pacific/cdphe/rocky-flats-historical-public-exposure-studies In 1998, the CCCR at the CDPHE, in collaboration with other CDPHE staff, prepared the report “Ratios of Cancer Incidence in Ten Areas Around Rocky Flats, Colorado Compared to the Remainder of Metropolitan Denver, 1980-89 with an Update for Selected Areas, 1990-95.”8 In the 1998 report we evaluated observed/expected ratios of cancer for a fairly wide area located in the general vicinity of Rocky Flats. We found that cancer incidence in communities in the general vicinity of Rocky Flats during 1980-89 was comparable to the remainder of the Metro Denver area. We conducted an updated analysis for 1990-95 in the four areas where we saw statistically significant elevated rates of cancer in 1980-89. There was no evidence of any ongoing problem in two of those four areas, and in the other two areas, we observed continued lung cancer increases that were likely associated with high rates of smoking among the lung cancer cases. This new report, entitled “Ratios of Cancer Incidence in Ten Areas around Rocky Flats, Colorado Compared to the Remainder of Metropolitan Denver, 1990-2014” contains 25 more years of data since the last report was published. We used the same geographic area and the same methodology as the previous report for 1980-89. Colorado Central Cancer Registry. In Colorado, surveillance of cancer incidence is possible using data collected by the Colorado Central Cancer Registry (CCCR) at CDPHE. All cancers diagnosed in Colorado are reported to the CCCR with the exception of non-melanoma skin cancers. The registry is mandated by Colorado law [Colorado Revised Statutes 1989, Section 25-1-107 (1) (z)] and by Colorado Board of Health regulation [6 CCR 1009-3]. All Colorado hospitals, pathology labs, and outpatient clinics submit information to the CCCR; state Vital Records and some physicians also provide information to supplement cancer case reports. Pertinent data is registered on all malignant tumors, except basal and squamous cell carcinomas of the skin. All individual patient, physician, and hospital information is confidential as required by Colorado law [Colorado Revised Statutes 1989, Section 25-1-122 (4)]. This invaluable data allows the CCCR to effectively answer questions about cancer incidence in communities statewide.
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Study Design and Methods Cancer and general risk factors. Cancer is a general term applied to a wide variety of different diseases characterized by uncontrolled growth and spread of abnormal cells. These diseases are common within the population, and therefore remain at the forefront of public health concern. Over 25,000 new cases of cancer are registered annually in Colorado. Lifetime risk of developing cancer in Colorado is approximately one chance in two for men and two chances in five for women. Whether an individual develops a cancer during his or her lifetime may be greatly influenced by a variety of risk factors, many of which are not currently understood. We do know that the development of cancer is a complex, multistage, process that can involve both external (e.g. chemical, radiation, and viruses) and internal factors (e.g., hormones, immune conditions, and inherited mutations). Unfortunately, this complexity and its associated latencies, that is, the time period between the initiation of the cancer and subsequent diagnosis, have limited scientific efforts to identify causative factors or combinations of factors. We may, however, monitor incidence rates so as to be alert to significant deviation from the expected background rates. This in turn allows investigation of deviations with respect to potential environmental associations. Data sources. We obtained data from two primary sources for this study: (1) The CCCR provided cancer incidence data. It has maintained an incidence-based registry of all cancer cases reported at medical facilities in most parts of the state since the mid-1980s and complete state reporting has been available since 1988. Complete reporting has been available since1979 in the Denver Metro area. We queried the CCCR database to find all cases of cancer diagnosed between 1990 and 2014 in residents who lived in the study area at the time of diagnosis. The CCCR uses nationally recognized processes for identifying and registering cancer cases. We stratified the cancer incidence counts by age, race/ethnicity, and gender. (2) We obtained population count data by county, by census tract and by census block group (where necessary) for 1990, 2000 and 2010 from the Colorado Division of Local Governments (State Demographer’s Office) or from the U.S. Census16-20 website (www.census.gov). Population estimation between 1990 and 2000 was done by interpolation. Population estimation between 2001 and 2005 was done using interpolated values between 2000 and 2010. Population estimation for 2006-2014 used the 2010 Census as a mid-point so that 9 times this value was an estimate of the total person-years. All estimated population counts were stratified by age, race/ethnicity, and gender. Study area. The study protocol centered on ten areas of geography called Regional Statistical Areas (RSAs) which have been described in detail in the previous report.8 A map of the Denver Metro area with RSA boundaries is displayed on page ix. See Appendix B for a list of U.S. Census tracts contained in each RSA for the 1990, 2000 and 2010 Census years. We selected the ten RSAs primarily for their proximity to Rocky Flats (generally within 12-16 miles south, southeast, east, northeast and north of the Plant). We also determined that people residing
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in geographic areas beyond the boundaries of the ten RSAs (the remainder of the Metro Denver area) would likely be beyond the range or in the lower range, of any estimated or hypothesized health effects from Rocky Flats and would therefore provide a reasonable comparison population. RSAs named after cities or towns are not the same as the incorporated municipalities but may be used to generally locate particular geographic regions. The population of the entire 10-RSA area analyzed averaged about 578,000 residents during 1990-2014 and the population of the remainder of the Denver Metro area (outside the 10-RSA boundaries) averaged about 1.9 million residents. Kinds of cancer evaluated. As in the earlier study, we evaluated all cancers combined (all ages and children ages 0-14 separately) and ten separate cancer categories (esophagus, stomach, colon and rectum, liver, lung, prostate, bone, leukemias, lymphomas, and brain and central nervous system). Prior to the 1980-89 report, we had consulted data from several sources2,7,14,15 and discussed the choices of cancer types with the 12-member Health Advisory Panel on Rocky Flats, which also conducted the Historical Public Exposures Study. These specific types of cancer were recommended as either possibly linked with plutonium exposure or of special concern to panel members. Analysis approach. We compared the number of diagnosed cancers for each sex during the 1990-2014 time period in each RSA to the expected number of cancers based on the cancer rates by race/ethnicity, sex and age of a larger comparison population (in this case the remainder of the Denver Metro area outside the 10-RSA region). A cancer rate is the number of new cancer cases diagnosed per 100,000 population per year. The population in each RSA, stratified by age, gender, and race/ethnicity, was multiplied by the cancer rate for each age, gender, and race/ethnic group in the comparison population to produce the expected number of cancers. For this study we used the “Poisson method” or “observed/expected ratio technique” which evaluates the ratio of a Poisson variable to its expected value.13 The Poisson distribution provides a reasonably good approximation of the occurrence of many diseases including cancer. For each RSA we calculated a diagnosed-to-expected ratio by dividing the number of cancers diagnosed in the RSA by the number of expected cases. A ratio greater than 1 indicates that we observed more cancer cases than we expected in the area. For each ratio, we calculated a 95% confidence interval which has a lower number (minimum value) and a higher number (maximum value). It is common to use a 95% confidence interval which means that we are 95% sure that the true ratio is between the lower and higher values. If the ratio is greater than 1 but the confidence interval includes the number 1, then the ratio is within expected statistical limits. If the confidence interval does not include the number 1, then the ratio is statistically significant. A statistically significant elevated ratio means that there were more diagnosed cases than expected and that there is less than a 5 percent chance that this greater number is due to chance alone.
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As explained in Appendix A, for the entire 10-RSA combined region, we used an alternative12,22 to the standard method to calculate the expected number of cancers because the population for the combination of all 10 RSA areas represented about a quarter of the population in the seven Metro Denver counties. Consequently, the total expected count for the 10-RSA aggregate was not identical to the sum of the 10 individual RSA expected counts. When statistically significant elevations of diagnosed-to-expected ratios were observed, we further analyzed the data using age, race/ethnicity and other information recorded in the CCCR database such as cancer cell type, anatomical subsite, body mass index and smoking and alcohol history. These additional data elements helped to characterize potential other exposure and risk factor commonalities among the cancer cases. Smoking history data was available in the CCCR electronic database for most of the study period (1998-2014); and we excluded cancer cases with missing and unknown smoking status from calculations of smoking percentages in this analysis. We also used 2012-15 Colorado Behavioral Risk Factor Surveillance System24 (BRFSS) current smoking estimates and 2000 U.S. Census19 income data, where applicable, to help describe smoking and income characteristics of the RSA population and comparison Metro Denver population.
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Findings and Analyses of Risk Factors Our detailed findings are presented in figures and tables organized by geographic areas (RSAs), gender and cancer type. We also present additional tables displaying results of further in-depth analyses for selected cancers in selected RSAs. Summary for Combined 10-RSA Region For the entire 10-RSA region, the incidence of all cancers combined for persons of all ages and for children during 1990-2014 was not higher than expected compared to the remainder of the Denver Metro area. As can be seen in Figure 1 and the top lines of Tables 1a and 1b, there were fewer total cancers than expected for both men and women in the 10-RSA region; each gender had observed/expected ratios of 0.99 and 0.98, respectively. In the second line of these two tables the observed/expected cancer ratios for children age 0-14 are presented (0.95 for boys and 0.89 for girls), neither ratio being statistically high. Also for the entire 10-RSA region, the incidence of nine of the ten selected cancers (esophagus, stomach, colon and rectum, liver, prostate, bone, leukemias, lymphomas, and brain and central nervous system) for persons of all ages was not higher than expected. Figure 1 and Tables 1a and 1b show the observed/expected counts and ratios for the 10 kinds of cancer in men and the 9 kinds of cancer in women for the entire 10-RSA region. For the entire 10-RSA region, the incidence of all but one of the selected cancers (esophagus, stomach, colon and rectum, liver, prostate, bone, leukemias, lymphomas, and brain and central nervous system) for persons of all ages was within expected statistical limits. The one exception was lung cancer where the incidence in the entire 10-RSA region was found to be about 5% higher than expected in men (ratio of 1.05) and 4% higher than expected in women (ratio of 1.04). Not all individual RSAs in the region had higher lung cancer ratios, though. Six of the RSAs (103, 106, 202, 204, 205 and 301) had lung cancer incidence that was not higher than expected. We found that the lung cancer elevation was mostly due to four RSAs (203, 304, 305 and 306) with statistically higher lung cancer ratios and they are described in more detail below. Summary for 10 Individual RSAs For the 10 individual RSAs, the incidence of all cancers combined for persons of all ages and for children during 1990-2014 was not higher than expected compared to the remainder of the Denver Metro area. Figures 2 through 11 and the top lines of Tables 2a through 11b present the ratios of observed-to-expected numbers (O/E ratios) of all cancers combined for males and females for the 10 separate RSAs. These ratios ranged from 0.92 to 1.06 with none being statistically higher than expected. The second line of Tables 2a through 11b display similar data (all cancers combined) for children ages 0-14. None of these childhood O/E cancer ratios were statistically higher than expected, ranging from 0.36 to 1.18.
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For the 10 individual RSAs, Figures 2 through 11 and Tables 2a through 11b show the observed/expected ratios for the selected cancers for men and women for the individual RSAs. T he incidence of ten selected cancers (esophagus, stomach, colon and rectum, liver, prostate, bone, leukemias, lymphomas, and brain and central nervous system) for persons of all ages during 1990-2014 was not higher than expected compared to the remainder of the Denver Metro area, with the following exceptions where six RSAs had higher than expected cancer ratios for selected cancers: RSA 103 “Boulder City - Periphery” (prostate cancer); RSA 203 “Arvada” (lung cancer in males and females); RSA 204 “Golden” (esophagus cancer in females); RSA 304 “Adams - West” (lung cancer in males and females and colorectal cancer in males); RSA 305 “Adams - Clear Creek Valley” (lung cancer and colorectal cancer in males); and RSA 306 “Northglenn - Thornton” (lung cancer in males and females). These individual RSA findings are presented below. RSA 103 “Boulder City - Periphery” [Prostate Cancer] Figure 2 and Table 2a show that the ratio of 497 observed to about 408 expected prostate cancers in males in RSA 103, “Boulder City-Periphery” was statistically high at 1.22 (95% confidence interval of 1.11-1.33). Table 12 shows that we found statistically higher ratios in ages 65-74 and 75+ but not in younger ages. We also found statistically higher ratios in nonHispanic whites and Hispanics. Histologic cell types were 96.6 % adenocarcinomas as expected among prostate cancers. Boulder County has historically had higher prostate cancer incidence rates, which are often seen in higher income areas25, possibly due to higher participation in screening of blood samples with Prostate Specific Antigen (PSA) to detect prostate cancer. According to the 2000 U.S. Census,19 RSA 103 had an average household income of $94,832, substantially higher than the average household income of $67,851 seen in the comparison Metro Denver population. Figure 12 displays a graph of prostate cancer ratios compared to the average household income in each RSA in the study area (trend line significant p < 0.05). According to the American Cancer Society,21 prostate cancer is the most frequently diagnosed cancer in men apart from skin cancer, with incidence rates being 70% higher in blacks than in non-Hispanic whites. The only well-established risk factors for prostate cancer are increasing age, African ancestry, a family history of the disease and some inherited genetic conditions. Genetic studies suggest that strong familial predisposition may be responsible for 5%-10% of prostate cancers. Inherited conditions associated with increased risk include Lynch syndrome and BRCA1 and BRCA2 gene mutations. Studies suggest that obesity and smoking may increase the risk of aggressive prostate cancer.
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RSA 204 “Golden”
[Esophagus Cancer]
Figure 6 and Table 6b show that the ratio of 12 observed to about five or six esophagus cancers in females in RSA 204, “Golden”, was 2.08 (95% confidence interval of 1.07-3.63). If there had been one less case diagnosed, the O/E ratio would have been within statistical limits. Table 13 shows that there no statistically higher ratios in any particular age group and all 12 cases were non-Hispanic whites, resulting in that ratio being statistically high. Cell types were similar to the comparison Metro Denver distribution with over 80% being squamous cell carcinomas and adenocarcinomas. Tobacco and alcohol are risk factors for this esophagus cancer23, and among these 12 cases, 90% were smokers and 80% had a history of alcohol use according to CCCR abstract information. Obesity is another risk factor23, and per the CCCR Body Mass Index (BMI) information recorded on abstracts beginning in 2011, among the five cases diagnosed since 2011, 40% were overweight or obese which is the same percentage of overweight or obese found in comparison Metro Denver females esophagus cancer cases over that time period. Other risk factors for esophagus cancers include: increasing age, gastroesophageal reflux disease (GERD), and Barrett’s esophagus caused by long-term acid reflux damage to the inner lining of the esophagus.23 RSA 304 “Adams - West” and RSA 305 “Adams - Clear Creek Valley” [Colorectal Cancer] Figures 9 and 10 and Tables 9a and 10a show that the ratios of observed to expected colorectal cancers in males in RSA 304, “Adams - West”, (ratio of 1.29, C.I = 1.18 - 1.40) and RSA 305, “Adams - Clear Creek Valley”, (ratio of 1.22, C.I. = 1.06 - 1.38) were statistically high. Table 14 shows that statistically higher ratios were seen in the three age group categories 45-54, 55-64, and 65-74 in RSA 304 and in the age group 65-74 in RSA 305. Both of these RSAs had statistically higher ratios for non-Hispanic whites. Subsite anatomical distributions for the male colorectal cancers in both RSAs were similar to the comparison Metro Denver area. The right colon comprised 26%-28% of cases in the two RSAs compared to 31% of cases in Metro Denver comparison area; the transverse colon comprised about 6% of cases in the two RSAs compared to 5%-6% in comparison Metro Denver cases; the left colon comprised 27%-29% of cases in the two RSAs compared to 28% in comparison Metro Denver cases; the rectum and rectosigmoid colon comprised 33%-39% of cases in the two RSAs compared to 31% in comparison Metro Denver cases; and other subsites in the colon comprised 3%-4% of cases in the two RSAs compared to 5% in comparison Metro Denver cases.
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Smoking is a risk factor for colorectal cancer21 and RSA 304 and RSA 305 male colorectal cancer cases had a higher percentage of smokers than seen in comparison Metro Denver male colorectal cancer cases. Among RSA 304 male colorectal cases, 70% were smokers and among RSA 305 male colorectal cases, 72% were smokers. This compares to 60% of comparison Metro Denver male colorectal cancer cases being smokers. Recent smoking survey data from the 2012-15 Colorado Behavioral Risk Factor Survey24 (BRFSS) also shows that RSA 304 and RSA 305 have higher smoking rates (each 20.1%) in the general population than the 15.8% smoking rate in the comparison area of the remainder of Metro Denver. Figure 13 displays a graph of colorectal cancer ratios compared to the percentage of current smokers in each RSA in the study area (trend line significant p < 0.10). Other risk factors for colorectal cancer include21: increasing age, obesity, physical inactivity, long-term smoking, high consumption of red or processed meat, low calcium intake, moderate to heavy alcohol consumption, and very low intake of fruit and vegetables. Consumption of whole-grain fiber reduces risk. Hereditary and medical factors that increase risk include a personal or family history of colorectal cancer and/or polyps, certain inherited genetic conditions (e.g., Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer [HNPCC], and familial adenomatous polyposis [FAP]), a personal history of chronic inflammatory bowel disease (e.g., ulcerative colitis or Crohn’s disease), and type 2 diabetes21. RSA 203, “Arvada”, RSA 304, “Adams-West”, RSA 305, “Adams-Clear Creek Valley” and RSA 306, “Northglenn-Thornton” [Lung Cancer] Figures 5, 9, and 11 and Tables 5a, 5b, 9a, 9b, 11a and 11b show that the ratios of observed to expected lung cancers in males and females were statistically elevated in RSA 203, “Arvada”, (1.13 and 1.11 for males and females, respectively), RSA 304, “Adams-West”, (1.23 and 1.19), and RSA 306, “Northglenn-Thornton”, (1.47 and 1.35). Figure 10 and Table 10a shows the male lung cancer ratio (1.22) in RSA 305, “Adams-Clear Creek Valley”, was statistically high; and Figure 10 and table 10b shows that the female lung cancer ratio (1.09) was elevated, though within expected statistical limits. Age and race/ethnicity evaluations were done for lung cancers among males and females combined since the sex-specific ratios were all elevated in these four RSAs. Tables 16-19 show that age groups with statistically higher ratios (ranging from 1.21 to 1.75) were: RSA 203 age 55-64; RSA 304 age groups 55-64, 65-74 and 75+; RSA 305 age groups 55-64 and 65-74; and RSA 306 age groups 35-44, 45-54, 55-64 and 65-74. Each of these four RSAs had statistically high O/E lung cancer ratios for non-Hispanic whites ranging from 1.12 to 1.48. The RSA 306 lung cancer O/E ratio of 1.91 among the Other races group (comprised mostly of Asian Americans) was also statistically high (18 cases diagnosed compared to about 9 or 10 cases expected).
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Smoking is by far the leading risk factor for lung cancer.21 Among these four RSAs, according to CCCR abstract information, smoking percentages of the 1990-2014 lung cancer cases ranged from 90.4%-93.4%, slightly higher than the 89.7% smoker percentage seen in the Metro Denver comparison area lung cancer cases. Recent smoking survey data from the BRFSS24 (2012-15) also shows that three of the four RSAs (304, 305 and 306) have higher smoking rates (20.1%-20.6%) in the general population than the 15.8% smoking rate in the comparison area of the remainder of Metro Denver. Also, Figure 14 displays a strong linear relationship between 2012-15 RSA current smoker percentages and 1990-2014 RSA lung cancer ratios (trend line significant p < 0.01). Lung cancer histologic cell types were evaluated for these four RSAs compared to the Metro Denver standard area. Six categories of cell types were evaluated with their corresponding percentage of lung cancer cases, (1) 9.9% neoplasms, not otherwise specified; (2) 10.0% large cell carcinoma; (3) 14.0% small cell carcinoma; (4) 18.9% squamous cell carcinoma; (5) 34.9% adenocarcinoma; and (6) 12.2% other cell types. Table 20 displays the percentages of each lung cancer cell type category in the four RSAs and in the comparison Metro Denver area. Each of the four RSAs had a statistically significant difference from the Metro Denver distribution of cell types with two categories, small cell carcinomas and squamous cell carcinomas, the two cell types most linked with heavy smoking26-28, showing the most difference. Small cell carcinomas ranged from 16.2-17.8 % of lung cancer cases in the four RSAs vs. 14% in the Metro Denver comparison area and squamous cell carcinomas ranged from 18.2-22.2 % of lung cancer cases in the four RSAs vs. 18.9% in the Metro Denver comparison area. Table 21 shows further follow-up evaluations included calculating O/E ratios for each of these two cell types for each of the four RSAs resulting in statistically higher values ranging from 1.21 to 1.65. Smoking among the lung cancer cases with these two cell types in the four RSAs ranged from 95.9% to 100%, even higher than the 90.4%-93.4% smoking percentages seen among all cell types combined mentioned above.
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Discussion and Limitations The study design used in this analysis of observed and expected numbers of cancer cases among residents of ten RSAs in the general vicinity of the former Rocky Flats plant is descriptive and ecologic in nature.9 The descriptive element provides a numerical summary of disease frequency, whereas the ecological component examines entire communities or populations, rather than individuals. These types of studies have been conducted frequently around communities adjacent to suspected environmental exposures since they are efficient, cost effective, and can be completed within a reasonable period of time.10,11 This study’s intent was to give citizens cancer incidence statistics for their communities in a way that they could compare their cancer experience to the remainder of the Metro Denver area during 1990-2014, spanning the 25-year time period since the last publication covering 1980-89. A strength of this study is that we used data from a statewide incidence-based cancer registry. This approach provides several benefits compared to mortality-based data. Because incidence-based registries identify each case at the time a diagnosis of cancer is reported, rather than at the time of death, a more complete count of cancers that have occurred, regardless of survival, is available. Incidence data will not be affected by differences in survival across cancer types and sites, whereas mortality data are susceptible to bias from differences in treatment and access to health care. In addition, medical records used to compile incidence-based registry statistics typically have more detailed information on cancer diagnoses (e.g., pathology reports, etc.) than is collected on death certificates, which are used to compile mortality statistics. Ecological studies such as this one are usually viewed as exploratory and may generate hypotheses to be considered in additional studies, if appropriate. Studies of this kind are not expected to allow conclusions to be drawn about cause and effect relationships in individuals or at the community level. Another limitation of these studies is that information on potential causes of disease (for example, lifestyle behaviors, occupation, or genetic predisposition) is lacking or limited. For this study, the CCCR was able to use information in its database about smoking, drinking and obesity among some of the cancer patients. Another weakness of ecological studies is that, because potential exposure is not actually measured over time for each individual, a geographical area of residence is used as a substitute measure of exposure. The use of a geographical area raises the likelihood of exposure misclassification, which reduces the ability of the study to observe a statistically significant difference between groups. Lastly, the design of this cancer incidence analysis does not allow conclusions to be made about causal association between a potential environmental exposure and any single cancer or group of cancers. The study design and results only aid in determining whether the total number of cancers or certain types of cancers are greater or less than expected, and whether that difference is statistically significant, and whether future studies might be useful.
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This study design calls for observed/expected cancer ratios to be examined at the population group level (here the Regional Statistical Area), rather than at the level of individual persons. A weakness inherent in this study design is that information on potential confounders may be lacking and the data cannot be examined for these effects. In the approach taken here, use is made of individual age, gender and race/ethnicity data both at the census tract population level and the cancer case level. However, for critical exposure variables, such as actual human exposure estimates, in- and out-migration and length of residence, which can help assess misclassification bias in studies of this nature, there continues to be an absence of reliable data. An example of misclassification bias occurs when an area may have received exposure in a small section yet the disease rate for the entire area may not reflect it because many potentially unexposed individuals may dilute any health effect. Therefore, in this study design where exposure data is not measured or estimated directly, there is the possibility that health effects might not be detected. We used an approach that compares the number of diagnosed cancers to the expected number of cancers stratified by race/ethnicity, sex and age. This method assures that any differences found are not due to differences in demographic composition. For example, census tracts and RSAs with a higher proportion of elderly individuals would be expected to have higher cancer rates since incidence of most cancers increases dramatically with increasing age. RSAs, defined by the Denver Regional Council of Governments, were used because: (1) they are aggregates of census tracts for which the U.S. Census provided detailed population counts by race/ethnicity, sex and age (variables critical in determining expected cancer incidence); (2) they provide relatively stable, sub-county statistical units which are generally independent of shifting municipal boundaries over time, allowing for analysis of cancer data over many years and different decennial censuses; and (3) CCCR records contain a census tract code for each cancer case and, thus, can be aggregated to the RSA level. Because the estimate of expected cancers is based on the larger Denver Metro population, this estimate will be a central tendency, or average number, of expected cases for the time period, 1990-2014. Cancer rates for specific populations, such as in smaller cities, towns, or neighborhoods, will likely be either higher or lower than the “average expected.” Smaller populations tend to show greater variability. The variability of small populations is statistically reflected in the 95% confidence interval for the ratio of diagnosed to expected cases. Confidence intervals for small populations are wider than for large populations. When the expected number of cancer cases is small, slight increases can result in seemingly large diagnosed to expected ratios. For example, if only one case of cancer is expected in a small population in a given year, and two were actually diagnosed, the ratio would of course show a doubling of cases. But, in this situation, twice the number of expected cases would be within expected statistical limits. 14
Statistical testing was not done on ratios with less than three diagnosed cases because of the inherent variability in such small numbers. Also, individual-level data on potential confounders such as income and education were not available. Information on smoking was available in the CCCR database for many cases, but not all, since the items are not always present in medical records and thus not recorded by the CCCR. For the eleven statistically significant elevated O/E ratios found in this study, ten of them involved cancer types (lung, colorectal and esophagus) known for having smoking as a risk factor. The groups of cancer cases in the seven RSAs contributing to these higher O/E ratios all had substantially high smoking rates according to CCCR abstracts. For the higher esophagus cancer O/E ratio among women in RSA 204, “Golden”, 90% of the cases were smokers. For the higher colorectal cancer O/E ratios among men in RSA 304, “Adams-West” and RSA 305, “Adams-Clear Creek Valley”, smoking rates were 70% and 72%, respectively. For the higher lung cancer O/E ratios among residents of RSA 203, “Arvada”, RSA 304, “Adams-West”, RSA 305, “Adams-Clear Creek Valley”, and RSA 306, “Northglenn-Thornton”, smoking rates ranged from 90% to 93%. Figures 13 and 14 also document the linear relationship of recent (2012-15) smoking rates among the RSA population age 18+ and the RSA O/E ratios for colorectal and lung cancer showing that RSAs with higher smoking rates have higher O/E ratios for these cancers. When an excess of cancer cases is found for only one gender group in an area, as was seen in RSA 204 esophagus (female) and RSAs 304 and 305 colorectal (male) findings, the findings are weakened somewhat. This is because exposures which are found in or around the home should affect both genders, although one group may be preferentially affected if they spend more time in the area of interest. Conversely, excesses for a single gender may be associated with occupational exposures, gender confounding (e.g., smoking rates higher among males than females) or other gender-specific activities. In any study evaluating many cancers in a variety of population groups, there is the possibility of finding statistical elevations which are due to chance, commonly referred to as the “multiple comparisons problem.” For this study, we tested 190 observed/expected ratios (10 cancers for males and 9 cancers for females for each of 10 RSAs) with 95% confidence intervals. When using the standard 95% confidence interval, 5% of these ratios (about 10), with 5 higher and 5 lower, would be expected to be statistically significant simply due to chance variations. This means that even when there might be no actual difference between the RSAs and the comparison Metro Denver population, a small number of statistically significant ratios would still be expected to occur by chance. In the present analysis sixteen ratios were statistically lower, signaling some likely true lowered cancer risk is some of the RSAs. Eleven ratios were statistically higher, also suggesting some true elevated risk since only 5 statistically higher ratios might be expected simply by chance. As mentioned earlier in this section, though, we found that 10 of the 11 statistically higher ratios were likely associated with higher smoking rates found 15
among the cancer cases (esophagus, colorectal and lung cancers); and we also found higher general population smoking percentages in the more recent 2012-15 telephone survey data. These two findings, (1) high smoking rates among the individuals diagnosed with these cancers and (2) higher smoking percentages in the general population, suggest likely true increased risk of these three cancer types assuming past smoking rates were similar to the present in these RSAs. The histology or cell type of a cancer and the anatomic detail may offer clues to whether an elevated observed/expected cancer ratio is indicative of a possible association with something or more likely a chance occurrence. In this study we checked the distribution of cell types and/or anatomic locations in the RSAs with statistically higher ratios (seven lung cancer findings, two colorectal cancer findings, one prostate cancer finding and one esophagus cancer finding). All of these cancers, except lung cancer, had distributions similar to the distribution seen in the comparison Metro Denver area. Also, no unusual cell types or anatomic locations were noted. However, for the lung cancer elevations, we found that each of the four RSAs with statistically higher lung cancer ratios (seven in total) had a statistically significant difference from the comparison Metro Denver distribution of cell types. Two categories, small cell carcinomas and squamous cell carcinomas, the two cell types most linked with heavy smoking, showed the most difference. And, for these four RSAs, observed/expected lung cancer ratios for each of these two cell types were statistically higher, as well, ranging from 1.21 to 1.65.
16
Summary and Conclusions This report summarizes CCCR work completed regarding cancer incidence during 1990-2014 among residents of ten Regional Statistical Areas in the general vicinity of Rocky Flats compared to the remainder of Metropolitan Denver. Expected numbers of cancers were determined by applying race/ethnicity-sex-age-specific cancer rates from the remainder of the Denver Metro area to each RSA's estimated population. The study included all cancers combined for persons of all ages and for children, and ten selected cancers for persons of all ages. The ten cancers selected were: esophagus, stomach, colon and rectum, liver, lung, prostate, bone, leukemias, lymphomas, and brain and central nervous system. Conclusions for areas with diagnosed cancers not statistically higher than expected: (1) For the entire 10-RSA region, we found that the incidence of all cancers combined for persons of all ages during 1990-2014 was not higher than expected compared to the remainder of the Denver Metro area. This conclusion is based on the finding of observed/expected ratios less than 1.00 for total cancers for both men and women in the 10-RSA region. (2) For the entire 10-RSA region, we found that the incidence of all cancers combined for children during 1990-2014 was not higher than expected compared to the remainder of the Denver Metro area. This conclusion is based on the finding of observed/expected ratios less than 1.00 for total cancers for both boys and girls in the 10RSA region. (3) For the entire 10-RSA region, we found that the incidence of nine of the ten selected kinds of cancer (esophagus, stomach, colon and rectum, liver, prostate, bone, leukemias, lymphomas, and brain and central nervous system) for persons of all ages during 1990-2014 was not higher than expected. This conclusion is based on testing the applicable observed/expected ratios for these cancers and finding none higher than expected by chance. The one exception was lung cancer, where six of the 10 RSAs (103, 106, 202, 204, 205 and 301) had lung cancer incidence that was not higher than expected and four RSAs (203, 304, 305 and 306) had higher than expected lung cancer ratios. See (7) below for the lung cancer conclusion for the entire 10RSA region and the four RSAs with higher than expected lung cancer ratios. (4) For the 10 individual RSAs, we found that the incidence of all cancers combined for persons of all ages during 1990-2014 was not higher than expected compared to the remainder of the Denver Metro area. This conclusion is based on testing 20 observed/expected ratios for total cancers for both men and women in the individual RSAs and finding none higher than expected by chance. (5) For the 10 individual RSAs, we found that the incidence of all cancers combined for children during 1990-2014 was not higher than expected compared to the remainder of the Denver Metro area. This conclusion is based on testing 20 observed/expected ratios for total cancers for both boys and girls in the individual RSAs and finding none higher than expected by chance. 17
(6) For the 10 individual RSAs, we found that the incidence of six of the ten selected kinds of cancer (stomach, liver, bone, leukemias, lymphomas, and brain and central nervous system) for persons of all ages during 1990-2014 was not higher than expected compared to the remainder of the Denver Metro area. This conclusion is based on testing the applicable observed/expected ratios for these cancers and finding none higher than expected by chance. Conclusions for areas with diagnosed cancers statistically higher than expected: (7) For the entire 10-RSA region, we found lung cancer incidence to be about 5% higher than expected in men and 4% higher than expected in women during 1990-2014. This conclusion is based on observed/expected ratios of 1.05 and 1.04 testing statistically higher for men and women, respectively. (8) Four RSAs (“Arvada” RSA 203 and three RSAs in Adams County: “Adams-West” RSA 304, “Adams-Clear Creek Valley” RSA 305, and “Northglenn-Thornton” RSA 306) accounted for most of the lung cancer elevation seen in the 10-RSA region. We found that these four RSAs had statistically higher lung cancer ratios that were linked with high rates of smoking (90+ %) among the cancer cases. Recent BRFSS telephone survey data (2012-15) also indicated higher rates of smoking (20+ %) among the general population in three of these four RSAs compared to the comparison Metro Denver population (15.8%). We also found a strong relationship of higher smoking in the general population with lung cancer ratios among the 10 RSAs. We were able to present additional evidence of the smoking link with these lung cancer findings in that the two cell types most linked with heavy smoking, small cell carcinomas and squamous cell carcinomas, were statistically higher in all four of these RSAs and over 95% of cancer cases with these two cell types were smokers. (9) In RSA 204, “Golden”, esophagus cancer was statistically higher in women (12 cases compared to about five or six expected for a ratio of 2.08). We found links to three known risk factors for esophagus cancer among these cases: (1) smoking was evident in 90% of cases; (2) alcohol in 80% of cases; and (3) overweight or obesity was seen in 40% of the cases since 2011 when this data has been collected by the CCCR. (10) In RSA 103, “Boulder City – Periphery”, prostate cancer was statistically higher than expected (ratio of 1.22). The county has historically had elevated prostate cancer incidence, which is often seen in higher income areas, possibly due to better participation in screening of blood samples for Prostate Specific Antigen (PSA) to detect prostate cancer. This RSA had substantially higher household income and further analysis showed a strong relationship of higher household income with higher prostate cancer ratios among the 10 RSAs. (11) Two RSAs (“Adams - West” RSA 304 and “Adams - Clear Creek Valley” RSA 305) were found to have colorectal cancer ratios in men statistically higher than expected (1.22 and 1.29, respectively). We found a link to smoking as a known risk factor with 70% of cases being smokers compared to 60% among comparison Metro Denver colorectal cancer cases. Recent BRFSS telephone survey data (2012-15) also indicated higher rates of smoking (20+ %) among
18
the general population in these two RSAs compared to the comparison Metro Denver population (15.8%). In summary, we have presented updated cancer data to citizens in the vicinity of the former Rocky Flats plant since the original 1980-89 study released in 1998, so that they can compare their communities’ cancer statistics during 1990-2014 to the remainder of the Denver Metro area. As before, the information provided here is not intended to resolve the controversy surrounding possible health effects from Rocky Flats releases. For example, these analyses could not be based on actual past exposure data for individuals, but rather were focused on areas primarily due to their proximity to Rocky Flats. The data presented here do show that communities in the general vicinity of Rocky Flats had cancer incidence during 1990-2014 that was mostly comparable to the remainder of the Denver Metro area. For the specific RSAs where we found a total of eleven statistically higher O/E ratios in this study, ten of them involved cancer types (lung, colorectal and esophagus) known for having smoking as a risk factor. The groups of cancer cases in the seven RSAs contributing to these higher O/E ratios all had substantially high smoking rates and recent smoking estimates from telephone surveys revealed consistently higher current smoking in the neighborhoods affected than in the comparison Denver Metro area.
19
Figure 1. Ten Regional Statistical Areas (RSAs) in the Vicinity of Rocky Flats 1990-2014 Ratios of Observed to Expected Numbers of Cancers 2.00
Observed/Expected Ratios
Males
1.00
1.03
1.00
0.99***0.95
1.05**
1.02
0.98
0.86***
0.89
0.97
0.93
0.93
0.00 All
Child
Esoph Stom
Colon
Liver Lung Cancer Site
Prost
Bone
0.95
0.97
Leuk Lymph Brain
Observed/Expected Ratios
2.00
Females
1.00
0.98***
1.11 0.89*
0.97
1.02
0.97
1.04**
0.99
1.00
0.00 All
Child
Esoph
Stom
Colon Liver Lung Bone Leuk Lymph Brain Cancer Site Brain includes all brain and central nervous system tumors regardless of malignancy status. See Tables 1a and 1b for observed and expected cancer counts used to calculate O/E ratios. * p < .05, ** p < .01, *** p<.001 Source: Colorado Central Cancer Registry – Colorado Department of Public Health and Environment
20
Table 1a - Ten Regional Statistical Areas (RSAs) Combined in the Vicinity of Rocky Flats 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Cancers Cancers Diagnosed Diagnosed Expected /Expected Ratio1 All Cancers – 29200 29620.320 0.99*** All Ages All Cancers – 272 285.018 0.95 Age 0-14 Esophagus 393 394.440 1.00 Stomach
475
459.815
1.03
Colon and Rectum Liver
2776
2709.617
1.02
442
513.438
0.86***
Lung
3179
3042.600
1.05**
Prostate
8228
8371.043
0.98
69
77.599
0.89
963
989.756
0.97
Lymphomas
1393
1499.312
0.93**
Brain and CNS
1046
1123.183
0.93**
Bone Leukemias
1
*
Mantel-Haenszel Chi-Square statistic with one degree of freedom tests statistical significance of O/E ratios for the 10-RSAs combined. (Mantel and Haenszel, Journal of the National Cancer Institute, vol. 22, No. 4, p.719-748, April, 1959.) Ratios are not considered statistically high or low unless marked with asterisks. Ratios with asterisks are statistically significant at the specified probability (p-value) indicated. For example, p < .01 means there is less than 1% probability that the ratio is due to chance alone. p < .05, ** p < .01, *** p<.001
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
21
Table 1b - Ten Regional Statistical Areas (RSAs) Combined in the Vicinity of Rocky Flats 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Cancers Cancers Diagnosed Diagnosed Expected / Expected Ratio1 All Cancers – 31898 32495.210 0.98*** All Ages All Cancers – 209 234.576 0.89* Age 0-14 Esophagus 125 112.228 1.11 Stomach
256
262.770
0.97
Colon and Rectum Liver
2629
2586.610
1.02
219
226.488
0.97
Lung
2956
2840.731
1.04**
Bone
51
53.751
0.95
690
715.061
0.97
Lymphomas
1221
1233.000
0.99
Brain and CNS
1708
1714.034
1.00
Leukemias
1
Mantel-Haenszel Chi-Square statistic with one degree of freedom tests statistical significance of O/E ratios for the 10-RSAs combined. (Mantel and Haenszel, Journal of the National Cancer Institute, vol. 22, No. 4, p.719-748, April, 1959.) Ratios are not considered statistically high or low unless marked with asterisks. Ratios with asterisks are statistically significant at the specified probability (p-value) indicated. For example, p < .01 means there is less than 1% probability that the ratio is due to chance alone.
*
p < .05, ** p < .01, *** p<.001
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
22
Figure 2. “Boulder City – Periphery” Regional Statistical Area (RSA 103) 1990-2014 Ratios of Observed/Expected Counts of Cancers and 95% Confidence Intervals By Sex 5.00
Males
Observed/Expected Ratios
4.00
3.00
2.00
1.90
1.00
0.97
0.91
1.22
0.95
0.82
0.66
0.47
0.32
1.04
0.93 0.96
0.00 All
Child Esoph Stom Colon
Liver Lung Cancer Site
Prost
Bone
Leuk Lymph Brain
3.00
Observed/Expected Ratios
Females 2.00
1.06
1.00
1.21
1.08
1.15 0.96
0.86
0.72 0.51
1.01
1.04
0.49
0.00 All
Child
Esoph
Stom
Colon
Liver Lung Cancer Site
Bone
Leuk
Lymph
Brain
O/E Ratios with confidence intervals that include the value 1.00 are not considered statistically high or low. Brain includes all brain and central nervous system tumors regardless of malignancy status. See Tables 2a and 2b for observed and expected cancer counts used to calculate O/E ratios.
Source: Colorado Central Cancer Registry – Colorado Department of Public Health and Environment
23
Table 2a - "Boulder City - Periphery" Regional Statistical Area (RSA 103) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Cancers Cancers Diagnosed/ 95% C.I. Diagnosed Expected Expected for Ratio Ratio All Cancers – 1339 1381.488 0.97 0.92-1.02 All Ages All Cancers – 8 8.825 0.91 0.39-1.79 Age 0-14 Esophagus 6 18.772 0.32** 0.11-0.70 Stomach Colon and Rectum Liver Lung Prostate
16
19.629
0.82
0.47-1.32
115
121.181
0.95
0.78-1.14
10
21.230
0.47*
0.23-0.87
93
140.195
**
0.54-0.81
**
0.66
497
407.809
1.22
1.11-1.33
6
3.153
1.90
0.70-4.15
Leukemias
46
44.140
1.04
0.76-1.39
Lymphomas
63
67.882
0.93
0.71-1.19
Brain and CNS
49
51.144
0.96
0.71-1.27
Bone
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation)
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
24
Table 2b - "Boulder City - Periphery" Regional Statistical Area (RSA 103) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 1438 1359.094 1.06 1.00-1.11 All Ages All Cancers – 8 7.437 1.08 0.46-2.12 Age 0-14 Esophagus 3 4.169 0.72 0.15-2.11 Stomach
11
9.119
1.21
0.60-2.16
Colon and Rectum Liver
96
100.060
0.96
0.78-1.17
4
7.920
0.51
0.14-1.29
Lung
98
113.439
0.86
0.70-1.05
Bone
1
2.027
0.49
NC
Leukemias
32
27.954
1.15
0.78-1.62
Lymphomas
50
49.391
1.01
0.75-1.34
Brain and CNS
72
69.482
1.04
0.81-1.31
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation)
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
25
Figure 3. “Boulder – Tri-Cities” Regional Statistical Area (RSA 106) 1990-2014 Ratios of Observed/Expected Counts of Cancers and 95% Confidence Intervals By Sex 2.00
Observed/Expected Ratios
Males
1.17 1.00
1.11 0.97
0.96
0.94
1.00
0.90
0.95
0.88
0.91
0.68
0.66
0.00 All
Child
Esoph
Stom
Colon
Liver Lung Cancer Site
Prost
Bone
Leuk Lymph Brain
3.00
Observed/Expected Ratios
Females 2.00
1.00
0.99
0.95
0.95
1.24
1.09
1.04
0.87
1.04 0.85
1.05
0.79
0.00 All
Child
Esoph
Stom
Colon Liver Lung Cancer Site
Bone
Leuk
Lymph
Brain
O/E Ratios with confidence intervals that include the value 1.00 are not considered statistically high or low. Brain includes all brain and central nervous system tumors regardless of malignancy status. See Tables 3a and 3b for observed and expected cancer counts used to calculate O/E ratios.
Source: Colorado Central Cancer Registry – Colorado Department of Public Health and Environment 26
Table 3a - "Boulder – Tri-Cities" Regional Statistical Area (RSA 106) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 3493 3700.827 0.94** 0.91-0.98 All Ages All Cancers – 46 39.497 1.17 0.85-1.56 Age 0-14 Esophagus 47 49.206 0.96 0.70-1.27 Stomach
60
54.014
1.11
0.85-1.43
Colon and Rectum Liver
316
326.703
0.97
0.86-1.08
41
62.627
0.66**
0.47-0.89
Lung
326
361.931
0.90
0.81-1.00
1033
1034.064
1.00
0.94-1.06
7
10.304
0.68
0.27-1.40
Leukemias
110
124.905
0.88
0.72-1.06
Lymphomas
185
195.559
0.95
0.81-1.09
Brain and CNS
135
149.191
0.91
0.76-1.07
Prostate Bone
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
27
Table 3b- "Boulder – Tri-Cities" Regional Statistical Area (RSA 106) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 4082 4137.255 0.99 0.96-1.02 All Ages All Cancers – 32 33.566 0.95 0.65-1.35 Age 0-14 Esophagus 12 12.575 0.95 0.49-1.66 Stomach
33
30.209
1.09
0.75-1.54
Colon and Rectum Liver
320
307.453
1.04
0.93-1.16
23
26.323
0.87
0.55-1.31
Lung
283
332.461
0.85**
0.75-0.96
Bone
9
7.244
1.24
0.57-2.36
71
89.409
0.79
0.62-1.00
Lymphomas
160
153.514
1.04
0.89-1.22
Brain and CNS
228
218.000
1.05
0.91-1.19
Leukemias
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
28
Figure 4. “Standley Lake” Regional Statistical Area (RSA 202) 1990-2014 Ratios of Observed/Expected Counts of Cancers and 95% Confidence Intervals By Sex 2.00
Observed/Expected Ratios
Males
1.00
0.98
1.04
0.99
0.91
1.04
0.93
0.85
0.80
0.95
0.92
0.89
0.90
0.00 All
Child Esoph Stom Colon
Liver Lung Cancer Site
Prost
Bone
Leuk Lymph Brain
3.00
Observed/Expected Ratios
Females 2.00
1.22 1.00
0.99
0.95 0.77
0.69
1.13 0.94
0.90
0.88
1.00
0.67
0.00 All
Child
Esoph
Stom
Colon
Liver Lung Bone Leuk Lymph Brain Cancer Site O/E Ratios with confidence intervals that include the value 1.00 are not considered statistically high or low. Brain includes all brain and central nervous system tumors regardless of malignancy status. See Tables 4a and 4b for observed and expected cancer counts used to calculate O/E ratios. Source: Colorado Central Cancer Registry – Colorado Department of Public Health and Environment 29
Table 4a - "Standley Lake" Regional Statistical Area (RSA 202) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 3639 3729.221 0.98 0.94-1.01 All Ages All Cancers – 35 38.353 0.91 0.63-1.27 Age 0-14 Esophagus 49 49.512 0.99 0.73-1.31 Stomach
56
53.835
1.04
0.78-1.35
Colon and Rectum Liver
302
325.494
0.93
0.83-1.04
50
62.885
0.80
0.59-1.05
Lung
308
361.234
0.85**
0.76-0.95
1096
1053.298
1.04
0.98-1.10
10
10.553
0.95
0.46-1.74
Leukemias
114
124.523
0.92
0.75-1.10
Lymphomas
175
196.885
0.89
0.76-1.03
Brain and CNS
135
150.635
0.90
0.75-1.06
Prostate Bone
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
30
Table 4b - "Standley Lake" Regional Statistical Area (RSA 202) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 3924 4136.822 0.95** 0.92-0.98 All Ages All Cancers – 25 32.618 0.77 0.49-1.13 Age 0-14 Esophagus 15 12.298 1.22 0.68-2.01 Stomach
20
28.920
0.69
0.42-1.07
Colon and Rectum Liver
296
297.974
0.99
0.88-1.11
24
25.670
0.94
0.60-1.39
Lung
294
326.487
0.90
0.80-1.01
Bone
5
7.425
0.67
0.22-1.57
99
87.538
1.13
0.92-1.38
Lymphomas
135
152.780
0.88
0.74-1.05
Brain and CNS
218
217.215
1.00
0.87-1.15
Leukemias
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation)
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
31
Figure 5. “Arvada” Regional Statistical Area (RSA 203) 1990-2014 Ratios of Observed/Expected Counts of Cancers and 95% Confidence Intervals By Sex 3.00
Observed/Expected Ratios
Males 2.00
1.32
1.18
1.00
1.00
0.90
0.94
0.93
1.01
1.13
1.03
0.98
0.98 0.97
0.00 All
Child Esoph Stom Colon Liver Lung Cancer Site
Prost
Bone
Leuk Lymph Brain
2.00
Observed/Expected Ratios
Females
1.00
0.98
0.98
1.07 0.95
1.02
1.11
0.79
0.88
0.98
1.06
0.95
0.00 All
Child
Esoph
Stom
Colon Liver Lung Cancer Site
Bone
Leuk
Lymph
Brain
O/E Ratios with confidence intervals that include the value 1.00 are not considered statistically high or low. Brain includes all brain and central nervous system tumors regardless of malignancy status. See Tables 5a and 5b for observed and expected cancer counts used to calculate O/E ratios.
Source: Colorado Central Cancer Registry – Colorado Department of Public Health and Environment 32
Table 5a - "Arvada" Regional Statistical Area (RSA 203) 1990-2014 Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 4278 4259.000 1.00 0.97-1.03 All Ages All Cancers – 29 32.136 0.90 0.61-1.30 Age 0-14 Esophagus 54 57.724 0.94 0.70-1.22 Stomach
74
62.899
1.18
0.92-1.48
Colon and Rectum Liver
360
387.448
0.93
0.84-1.03
68
67.486
1.01
0.78-1.28
Lung
507
449.135
1.13*
1.03-1.23
1268
1237.382
1.03
0.97-1.08
13
9.884
1.32
0.70-2.25
Leukemias
137
140.540
0.98
0.82-1.15
Lymphomas
203
207.861
0.98
0.85-1.12
Brain and CNS
148
153.444
0.97
0.82-1.13
Prostate Bone
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
33
Table 5b - "Arvada" Regional Statistical Area (RSA 203) 1990-2014 Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 4642 4749.012 0.98 0.95-1.01 All Ages All Cancers – 26 26.496 0.98 0.64-1.44 Age 0-14 Esophagus 18 16.872 1.07 0.63-1.69 Stomach
31
39.163
0.79
0.54-1.13
Colon and Rectum Liver
380
402.138
0.95
0.85-1.05
33
32.249
1.02
0.70-1.44
Lung
494
443.643
1.11*
1.02-1.22
Bone
6
6.845
0.88
0.32-1.91
Leukemias
106
107.737
0.98
0.80-1.19
Lymphomas
193
182.062
1.06
0.92-1.22
Brain and CNS
232
245.268
0.95
0.83-1.08
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
34
Figure 6. “Golden” Regional Statistical Area (RSA 204) 1990-2014 Ratios of Observed/Expected Counts of Cancers and 95% Confidence Intervals By Sex 2.00
Observed/Expected Ratios
Males 1.21
1.13 1.00
1.06
0.98
0.92
0.90
0.83 0.85
0.66
0.58 0.36
0.00 All
Child Esoph Stom Colon
Liver Lung Cancer Site
0.00 Bone Leuk Lymph Brain
Prost
4.00
Observed/Expected Ratios
Females 3.00
2.08
2.00
1.00
0.98
1.08
1.19 0.86
1.04
0.93
0.78
0.92
0.89
1.07
0.00 All
Child
Esoph
Stom
Colon
Liver Lung Cancer Site
Bone
Leuk
Lymph
Brain
O/E Ratios with confidence intervals that include the value 1.00 are not considered statistically high or low. Brain includes all brain and central nervous system tumors regardless of malignancy status. See Tables 6a and 6b for observed and expected cancer counts used to calculate O/E ratios.
Source: Colorado Central Cancer Registry – Colorado Department of Public Health and Environment 35
Table 6a - "Golden" Regional Statistical Area (RSA 204) 1990-2014 Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 1800 1834.064 0.98 0.94-1.03 All Ages All Cancers – 4 11.282 0.36* 0.10-0.91 Age 0-14 Esophagus 28 24.879 1.13 0.75-1.63 15
25.951
0.58*
0.32-0.95
Colon and Rectum Liver
146
162.564
0.90
0.76-1.06
18
27.346
0.66
0.39-1.04
Lung
174
188.363
0.92
0.79-1.07
Prostate
567
533.939
1.06
0.98-1.15
0
4.572
0.00
NC
Leukemias
73
60.187
1.21
0.95-1.53
Lymphomas
76
91.508
0.83
0.66-1.04
Brain and CNS
58
67.945
0.85
0.65-1.10
Stomach
Bone
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
36
Table 6b - "Golden" Regional Statistical Area (RSA 204) 1990-2014 Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 1731 1772.805 0.98 0.93-1.02 All Ages All Cancers – 10 9.252 1.08 0.52-1.99 Age 0-14 Esophagus 12 5.775 2.08* 1.07-3.63 Stomach
15
12.630
1.19
0.66-1.96
Colon and Rectum Liver
119
138.514
0.86
0.71-1.03
11
10.595
1.04
0.52-1.86
Lung
146
156.691
0.93
0.79-1.10
Bone
2
2.577
0.78
NC
Leukemias
35
38.057
0.92
0.64-1.28
Lymphomas
59
65.974
0.89
0.68-1.15
Brain and CNS
97
90.637
1.07
0.87-1.31
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
37
Figure 7. “Wheat Ridge” Regional Statistical Area (RSA 205) 1990-2014 Ratios of Observed/Expected Counts of Cancers and 95% Confidence Intervals By Sex 3.00
Observed/Expected Ratios
Males 2.00
1.18 1.01
1.00
1.05
0.97
0.92
1.01
0.93
1.10
1.02
0.99
0.91
0.89
0.00 All
Child Esoph Stom Colon
Liver Lung Cancer Site
Prost
Bone
Leuk Lymph Brain
3.00
Observed/Expected Ratios
Females 2.00
1.47 1.00
1.12
0.98 0.80
0.87
1.26 0.97
0.96
1.05 0.88
0.83
0.00 All
Child
Esoph
Stom
Colon Liver Lung Cancer Site
Bone
Leuk
Lymph
Brain
O/E Ratios with confidence intervals that include the value 1.00 are not considered statistically high or low. Brain includes all brain and central nervous system tumors regardless of malignancy status. See Tables 7a and 7b for observed and expected cancer counts used to calculate O/E ratios.
Source: Colorado Central Cancer Registry – Colorado Department of Public Health and Environment 38
Table 7a - "Wheat Ridge" Regional Statistical Area (RSA 205) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 2223 2204.064 1.01 0.97-1.05 All Ages All Cancers – 14 11.840 1.18 0.65-1.98 Age 0-14 Esophagus 32 30.356 1.05 0.72-1.49 Stomach
31
33.613
0.92
0.63-1.31
Colon and Rectum Liver
201
208.042
0.97
0.84-1.11
35
34.780
1.01
0.70-1.40
Lung
227
243.037
0.93
0.82-1.06
Prostate
648
635.810
1.02
0.94-1.10
4
4.416
0.91
0.25-2.32
80
72.757
1.10
0.87-1.37
103
104.061
0.99
0.81-1.20
66
74.565
0.89
0.68-1.13
Bone Leukemias Lymphomas Brain and CNS
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
39
Table 7b - "Wheat Ridge" Regional Statistical Area (RSA 205) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 2531 2596.186 0.98 0.94-1.01 All Ages All Cancers – 8 10.008 0.80 0.34-1.57 Age 0-14 Esophagus 15 10.190 1.47 0.82-2.43 Stomach
21
24.193
0.87
0.54-1.33
Colon and Rectum Liver
271
242.316
1.12
0.99-1.26
24
19.073
1.26
0.81-1.87
Lung
256
262.877
0.97
0.86-1.10
Bone
3
3.129
0.96
0.20-2.80
54
61.416
0.88
0.66-1.15
Lymphomas
107
101.685
1.05
0.86-1.27
Brain and CNS
111
133.317
0.83
0.68-1.00
Leukemias
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
40
Figure 8. “Adams - Northwest” Regional Statistical Area (RSA 301) 1990-2014 Ratios of Observed/Expected Counts of Cancers and 95% Confidence Intervals By Sex 2.00
Observed/Expected Ratios
Males
1.00
0.92
0.90
0.92
0.90 0.77
1.03
1.02 0.89
0.85
0.82
0.81
0.79
0.00 All
Child Esoph Stom Colon
Liver Lung Cancer Site
Prost
Bone
Leuk Lymph Brain
3.00
Observed/Expected Ratios
Females 2.00
1.45 1.00
0.93 0.73
1.03
0.89 0.71
1.11 0.88
0.99
0.97
0.71
0.00 All
Child
Esoph
Stom
Colon
Liver Lung Cancer Site
Bone
Leuk
Lymph
Brain
O/E Ratios with confidence intervals that include the value 1.00 are not considered statistically high or low. Brain includes all brain and central nervous system tumors regardless of malignancy status. See Tables 8a and 8b for observed and expected cancer counts used to calculate O/E ratios.
Source: Colorado Central Cancer Registry – Colorado Department of Public Health and Environment
41
Table 8a - "Adams - Northwest" Regional Statistical Area (RSA 301) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 2462 2687.582 0.92** 0.88-0.95 All Ages All Cancers – 36 40.074 0.90 0.63-1.24 Age 0-14 Esophagus 31 34.611 0.90 0.61-1.27 Stomach
31
40.292
0.77
0.52-1.09
Colon and Rectum Liver
214
233.171
0.92
0.80-1.05
42
50.980
0.82
0.59-1.12
Lung
211
248.063
0.85*
0.74-0.97
Prostate Bone Leukemias
**
650
728.257
0.89
0.83-0.96
7
8.818
0.79
0.32-1.64
95
93.408
1.02
0.82-1.24 *
Lymphomas
122
151.084
0.81
0.67-0.96
Brain and CNS
121
117.696
1.03
0.85-1.23
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
42
Table 8b - "Adams - Northwest" Regional Statistical Area (RSA 301) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 2818 3034.004 0.93** 0.89-0.96 All Ages All Cancers – 25 34.039 0.73 0.47-1.08 Age 0-14 Esophagus 6 8.495 0.71 0.26-1.54 Stomach
31
21.389
1.45
0.98-2.06
Colon and Rectum Liver
184
205.879
0.89
0.77-1.03
14
19.713
0.71
0.39-1.19
Lung
228
220.562
1.03
0.90-1.18
Bone
7
6.334
1.11
0.44-2.28
57
65.146
0.88
0.66-1.13
Lymphomas
111
111.858
0.99
0.82-1.20
Brain and CNS
158
163.606
0.97
0.82-1.13
Leukemias
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
43
Figure 9. “Adams - West” Regional Statistical Area (RSA 304) 1990-2014 Ratios of Observed/Expected Counts of Cancers and 95% Confidence Intervals By Sex 2.00
Observed/Expected Ratios
Males 1.29
1.19 1.00
1.00
1.23
1.00
0.92
0.83
0.80
0.72
0.90
0.88
0.97
0.00 All
Child Esoph Stom Colon
Liver Lung Cancer Site
Prost
Bone
Leuk Lymph Brain
3.00
Observed/Expected Ratios
Females 2.00
1.00
0.99
1.12 0.86
1.09 0.90
1.19
1.21
0.94
0.87
1.02
0.95
0.00 All
Child
Esoph
Stom
Colon Liver Lung Cancer Site
Bone
Leuk
Lymph
Brain
O/E Ratios with confidence intervals that include the value 1.00 are not considered statistically high or low. Brain includes all brain and central nervous system tumors regardless of malignancy status. See Tables 9a and 9b for observed and expected cancer counts used to calculate O/E ratios.
Source: Colorado Central Cancer Registry – Colorado Department of Public Health and Environment
44
Table 9a - "Adams - West" Regional Statistical Area (RSA 304) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 4638 4643.067 1.00 0.97-1.03 All Ages All Cancers – 37 44.483 0.83 0.58-1.15 Age 0-14 Esophagus 61 61.086 1.00 0.76-1.28 Stomach
90
75.454
1.19
0.96-1.47
Colon and Rectum Liver
551
428.399
1.29**
1.18-1.40
67
92.961
0.72**
0.56-0.92
Lung
584
476.708
1.23**
1.13-1.33
1224
1327.946
0.92
**
0.87-0.98
10
12.499
0.80
0.38-1.47
Leukemias
135
154.102
0.88
0.73-1.04
Lymphomas
211
235.172
0.90
0.78-1.03
Brain and CNS
169
173.988
0.97
0.83-1.13
Prostate Bone
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
45
Table 9b - "Adams - West" Regional Statistical Area (RSA 304) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 4913 4972.703 0.99 0.96-1.02 All Ages All Cancers – 32 37.125 0.86 0.59-1.22 Age 0-14 Esophagus 19 16.999 1.12 0.67-1.75 Stomach
39
43.524
0.90
0.64-1.23
Colon and Rectum Liver
428
394.235
1.09
0.99-1.19
36
38.451
0.94
0.65-1.30
Lung
518
434.034
1.19**
1.09-1.30
Bone
10
8.245
1.21
0.58-2.23
Leukemias
96
109.449
0.87
0.71-1.07
Lymphomas
193
188.943
1.02
0.88-1.18
Brain and CNS
247
260.786
0.95
0.83-1.07
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
46
Figure 10. “Adams – Clear Creek Valley” Regional Statistical Area (RSA 305) 1990-2014 Ratios of Observed/Expected Counts of Cancers and 95% Confidence Intervals By Sex 2.00
Observed/Expected Ratios
Males 1.33 1.14 1.00
1.22 1.11
1.05
0.99
0.90
0.87 0.71
0.77
0.67 0.38
0.00 All
Child
Esoph
Stom
Colon
Liver Lung Cancer Site
Prost
Bone
Leuk Lymph Brain
3.00
Observed/Expected Ratios
Females 2.00
1.00
1.13
0.99
1.04
1.12
1.29
1.19
1.09 0.88
0.79
1.09 0.80
0.00 All
Child
Esoph
Stom
Colon Liver Lung Cancer Site
Bone
Leuk
Lymph Brain
O/E Ratios with confidence intervals that include the value 1.00 are not considered statistically high or low. Brain includes all brain and central nervous system tumors regardless of malignancy status. See Tables 10a and 10b for observed and expected cancer counts used to calculate O/E ratios.
Source: Colorado Central Cancer Registry – Colorado Department of Public Health and Environment 47
Table 10a - "Adams – Clear Creek Valley" Regional Statistical Area (RSA 305) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 1926 1946.614 0.99 0.95-1.03 All Ages All Cancers – 13 18.195 0.71 0.38-1.22 Age 0-14 Esophagus 29 25.492 1.14 0.76-1.64 Stomach
38
34.361
1.11
0.78-1.52
Colon and Rectum Liver
229
188.418
1.22**
1.06-1.38
46
44.000
1.05
0.77-1.40
Lung
271
204.083
1.33**
1.17-1.50
469
539.325
0.87
**
0.79-0.95
2
5.225
0.38
NC
Prostate Bone
**
Leukemias
44
65.498
0.67
0.49-0.90
Lymphomas
89
99.323
0.90
0.72-1.10
Brain and CNS
55
71.620
0.77
0.58-1.00
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
48
Table 10b - "Adams – Clear Creek Valley" Regional Statistical Area (RSA 305) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 2069 2088.237 0.99 0.95-1.03 All Ages All Cancers – 12 15.166 0.79 0.41-1.38 Age 0-14 Esophagus 9 7.957 1.13 0.52-2.15 Stomach
23
22.040
1.04
0.66-1.57
Colon and Rectum Liver
205
183.454
1.12
0.97-1.28
24
18.630
1.29
0.83-1.92
Lung
211
193.790
1.09
0.95-1.25
Bone
3
3.410
0.88
0.18-2.57
Leukemias
58
48.858
1.19
0.90-1.54
Lymphomas
66
82.382
0.80
0.62-1.02
121
111.045
1.09
0.90-1.30
Brain and CNS
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
49
Figure 11. “Northglenn - Thornton” Regional Statistical Area (RSA 306) 1990-2014 Ratios of Observed/Expected Counts of Cancers and 95% Confidence Intervals By Sex 2.00
Observed/Expected Ratios
Males 1.47 1.30 1.18
1.12 1.01
1.00
1.11
1.11 0.93
0.85
0.91
0.91 0.80
0.00 All
Child
Esoph
Stom
Colon
Liver Lung Cancer Site
Prost
Bone
Leuk
Lymph Brain
3.00
Observed/Expected Ratios
Females 2.00
1.35
1.27
1.00
0.98
0.83
0.94
1.10
0.93
0.88
0.99
1.09
0.67
0.00 All
Child
Esoph
Stom
Colon Liver Lung Cancer Site
Bone
Leuk
Lymph Brain
O/E Ratios with confidence intervals that include the value 1.00 are not considered statistically high or low. Brain includes all brain and central nervous system tumors regardless of malignancy status. See Tables 11a and 11b for observed and expected cancer counts used to calculate O/E ratios.
Source: Colorado Central Cancer Registry – Colorado Department of Public Health and Environment 50
Table 11a - "Northglenn - Thornton" Regional Statistical Area (RSA 306) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Males Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 3401 3353.145 1.01 0.98-1.05 All Ages All Cancers – 50 44.789 1.12 0.83-1.47 Age 0-14 Esophagus 56 43.218 1.30 0.98-1.68 Stomach
64
54.119
1.18
0.91-1.51
Colon and Rectum Liver
342
308.224
1.11
0.99-1.23
65
71.010
0.93
0.72-1.18
Lung
478
325.960
1.47**
1.34-1.60
776
912.116
0.85
**
0.79-0.91
10
10.992
0.91
0.44-1.67
Leukemias
129
116.580
1.11
0.92-1.32
Lymphomas
166
182.833
0.91
0.77-1.06
Brain and CNS
110
137.640
0.80*
0.66-0.96
Prostate Bone
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
51
Table 11b - "Northglenn - Thornton" Regional Statistical Area (RSA 306) 1990-2014, Ratios of Observed to Expected Counts of Cancers, All Cancers Combined (All Ages and Children 0-14) and Ten Selected Cancers (All Ages) - Females Cancers Cancers Diagnosed 95% C.I. for Diagnosed Expected / Expected Ratio Ratio All Cancers – 3749 3845.819 0.98 0.94-1.01 All Ages All Cancers – 31 37.458 0.83 0.56-1.18 Age 0-14 Esophagus 16 12.642 1.27 0.72-2.06 Stomach
32
33.953
0.94
0.64-1.33
Colon and Rectum Liver
330
300.253
1.10
0.98-1.22
26
29.592
0.88
0.57-1.29
Lung
428
317.470
1.35**
1.22-1.48
Bone
5
7.509
0.67
0.22-1.56
82
87.861
0.93
0.74-1.16
Lymphomas
147
148.707
0.99
0.84-1.16
Brain and CNS
224
206.096
1.09
0.95-1.24
Leukemias
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation) Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
52
Table 12 - "Boulder City - Periphery" Regional Statistical Area (RSA 103) 1990-2014, Ratios of Observed to Expected Counts of Prostate Cancers by Race/Ethnicity and by Age Cancers Cancers Diagnosed/ 95% C.I. Race/ Diagnosed Expected Expected for Ratio Ethnicity Ratio White Non482 392.662 1.23** 1.12-1.34 Hispanic Hispanic
13
5.366
2.42**
Black
0
5.032
0.00
NC
Other Age 0-44
2
4.749
0.42
NC
0
2.016
0.00
NC
45-54
38
40.768
0.93
0.66-1.28
55-64
148
141.074
1.05
0.89-1.23
65-74
193
151.450
1.27**
1.10-1.47
75+
118
72.501
1.63**
1.35-1.95
Total
497
407.809
1.22**
1.11-1.33
1.29-4.14
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation)
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
53
Figure 12. RSA Prostate Cancer Ratios (1990-2014) vs. RSA Average Household Income (1999) (In Excel a trend line is fit to the data points using the method of least squares; t-test with 8 degrees of freedom shows with p < .05 that there is less than a 5% chance that the true slope is zero) Source: 2000 U.S. Census and Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
RSA Prostate Cancer Ratio, 1990-2014 vs. Average Household Income, 1999 1.4 RSA 103
Prostate Cancer Ratio
1.2 RSA 205
1
RSA 305
0.8
RSA 203 RSA 304 RSA 306
RSA 204 RSA 202 RSA 106 RSA 301 RSA Prostate Cancer Ratio (trend line significant p<.05)
0.6 0.4 0.2 0 0
20000
40000
60000
80000
Average Household Income, 1999
54
100000
Table 13 - "Golden" Regional Statistical Area (RSA 204) 19902014, Ratios of Observed to Expected Counts of Esophagus Cancers by Race/Ethnicity and by Age - Females Cancers Cancers Diagnosed/ 95% C.I. Race/ Diagnosed Expected Expected for Ratio Ethnicity Ratio White Non12 5.494 2.19 1.13-3.82 Hispanic Hispanic
0
0.151
0.00
NC
Black
0
0.022
0.00
NC
Other Age 0-44
0
0.108
0.00
NC
0
0.131
0.00
NC
45-54
1
0.454
2.20
NC
55-64
4
1.320
3.03
0.83-7.75
65-74
3
1.723
1.74
0.36-5.09
75+
4
2.147
1.86
0.51-4.76
Total
12
5.775
2.08*
1.07-3.63
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation)
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
55
Table 14 - "Adams - West" Regional Statistical Area (RSA 304) 1990-2014, Ratios of Observed to Expected Counts of Colorectal Cancers by Race/Ethnicity and by Age - Males Cancers Cancers Diagnosed/ 95% C.I. Race/ Diagnosed Expected Expected for Ratio Ethnicity Ratio White Non448 334.598 1.34** 1.22-1.47 Hispanic Hispanic
82
72.663
1.13
0.90-1.38
Black
5
5.905
0.85
0.27-1.98
Other Age 0-24
16
15.233
1.05
0.60-1.70
0
1.215
0.00
NC
25-34
5
5.005
1.00
0.32-2.33
35-44
19
16.531
1.15
0.69-1.80
45-54
85
53.256
1.60**
1.28-1.97
55-64
136
98.234
1.38**
1.16-1.64
65-74
167
133.821
1.25**
1.07-1.45
75+
137
120.337
1.14
0.96-1.35
Total
551
428.399
1.29**
1.18-1.40
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation)
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
56
Table 15 - "Adams – Clear Creek Valley" Regional Statistical Area (RSA 305) 1990-2014, Ratios of Observed to Expected Counts of Colorectal Cancers by Race/Ethnicity and by Age - Males Cancers Cancers Diagnosed/ 95% C.I. Race/ Diagnosed Expected Expected for Ratio Ethnicity Ratio White Non182 131.903 1.38** 1.19-1.60 Hispanic 34
47.979
0.71*
0.49-0.99
Black
3
1.568
1.91
0.39-5.59
Other Age 0-24
10
6.968
1.44
0.69-2.64
0
0.534
0.00
NC
25-34
4
2.153
1.86
0.51-4.75
35-44
6
6.763
0.89
0.32-1.93
45-54
23
21.893
1.05
0.67-1.58
55-64
33
38.652
0.85
0.59-1.20
65-74
88
53.380
1.65**
1.33-2.03
75+
72
65.043
1.11
0.87-1.40
Total
229
188.418
1.22**
1.06-1.38
Hispanic
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation)
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
57
Figure 13. RSA Colorectal Cancer Ratios (1990-2014) vs. RSA Percentage Smokers (2012-15) (In Excel a trend line is fit to the data points using the method of least squares; t-test with 8 degrees of freedom shows with p < .10 that there is less than a 10% chance that the true slope is zero) Source: http://www.cohealthmaps.dphe.state.co.us/cdphe_community_level_estimates/ and Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
58
Table 16 - "Arvada" Regional Statistical Area (RSA 203) 1990-2014, Ratios of Observed to Expected Counts of Lung Cancers by Race/Ethnicity and by Age – Males and Females Cancers Cancers Diagnosed/ 95% C.I. Race/ Diagnosed Expected Expected for Ratio Ethnicity Ratio White Non936 835.842 1.12** 1.05-1.19 Hispanic Hispanic
48
38.455
1.25
0.92-1.66
Black
3
4.471
0.67
0.14-1.96
Other Age 0-24
14
14.009
1.00
0.55-1.68
0
0.674
0.00
NC
25-34
1
1.717
0.58
NC
35-44
14
10.871
1.29
0.70-2.16
45-54
72
60.692
1.19
0.93-1.49
55-64
216
169.353
1.28**
1.11-1.46
65-74
343
310.849
1.10
0.99-1.23
75+
355
338.622
1.05
0.94-1.16
Total
1001
892.778
1.12**
1.05-1.19
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation)
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
59
Table 17 - "Adams - West" Regional Statistical Area (RSA 304) 1990-2014, Ratios of Observed to Expected Counts of Lung Cancers by Race/Ethnicity and by Age – Males and Females Cancers Cancers Diagnosed/ 95% C.I. Race/ Diagnosed Expected Expected for Ratio Ethnicity Ratio White Non973 770.410 1.26** 1.18-1.34 Hispanic Hispanic
89
99.223
0.90
0.72-1.10
Black
13
11.130
1.17
0.62-2.00
Other Age 0-24
27
29.980
0.90
0.59-1.31
0
0.878
0.00
NC
25-34
2
2.621
0.76
NC
35-44
16
13.102
1.22
0.70-1.98
45-54
76
69.108
1.10
0.87-1.38
55-64
252
200.128
1.26**
1.11-1.43
65-74
422
348.990
1.21**
1.10-1.33
75+
334
275.915
1.21**
1.08-1.35
Total
1102
910.742
1.21**
1.14-1.28
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation)
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
60
Table 18 - "Adams – Clear Creek Valley" Regional Statistical Area (RSA 305) 1990-2014, Ratios of Observed to Expected Counts of Lung Cancers by Race/Ethnicity and by Age – Males and Females Cancers Cancers Diagnosed/ 95% C.I. Race/ Diagnosed Expected Expected for Ratio Ethnicity Ratio White Non391 315.304 1.24** 1.12-1.37 Hispanic Hispanic
72
65.912
1.09
0.86-1.38
Black
2
2.874
0.70
NC
Other Age 0-24
17
13.783
1.23
0.72-1.97
0
0.354
0.00
NC
25-34
1
1.130
0.88
NC
35-44
10
5.047
1.98
0.95-3.64
45-54
33
24.724
1.34
0.92-1.88
55-64
108
69.368
1.56**
1.28-1.88
65-74
178
137.932
1.29**
1.11-1.49
75+
152
159.318
0.95
0.81-1.12
Total
482
397.873
1.21**
1.11-1.32
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation)
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
61
Table 19 - "Northglenn - Thornton" Regional Statistical Area (RSA 306) 1990-2014, Ratios of Observed to Expected Counts of Lung Cancers by Race/Ethnicity and by Age – Males and Females Cancers Cancers Diagnosed/ 95% C.I. Race/ Diagnosed Expected Expected for Ratio Ethnicity Ratio White Non783 529.637 1.48** 1.38-1.59 Hispanic Hispanic
90
94.986
0.95
0.76-1.16
Black
15
9.392
1.60
0.89-2.64
Other Age 0-24
18
9.414
1.91*
1.13-3.02
0
0.836
0.00
NC
25-34
4
2.582
1.55
0.42-3.96
35-44
22
12.587
1.75*
1.09-2.65
45-54
89
57.144
1.56**
1.25-1.92
55-64
220
143.535
1.53**
1.34-1.75
65-74
341
218.599
1.56**
1.40-1.73
75+
230
208.147
1.11
0.97-1.26
Total
906
643.430
1.41**
1.32-1.50
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation)
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
62
Figure 14. RSA Lung Cancer Ratios (1990-2014) vs. RSA Percentage Smokers (2012-15) (In Excel a trend line is fit to the data points using the method of least squares; t-test with 8 degrees of freedom shows with p < .01 that there is less than a 1% chance that the true slope is zero) Source: http://www.cohealthmaps.dphe.state.co.us/cdphe_community_level_estimates/ and Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
63
Table 20 – RSAs 203, 304, 305, and 306 Males and Females Number of Lung Cancer Diagnoses by Histologic Cell Type Compared to the Expected1 Number, 1990-2014 Cell Type Neoplasm, nos Large Cell Carcinoma2 Small Cell Carcinoma Squamous Cell Carcinoma Adenocarcinoma All Other Types
RSA 203 Observed Expected 93 99.099
RSA 304 Observed Expected 106 109.098
RSA 305 Observed Expected 52 47.718
RSA 306 Observed Expected 88 89.694
84
100.100
84
110.200
45
48.200
93
90.600
174
140.140
196
154.280
78
67.480
154
126.840
205
189.189
208
208.278
107
91.098
165
171.234
348
349.349
351
384.598
132
168.218
276
316.194
97
122.122
157
134.444
68
58.804
130
110.532
1
Expected numbers were derived by applying the histologic cell type distribution of lung cancers in the comparison Metro Denver area
2
Large cell carcinoma category includes carcinoma, nos
Summary Chi-Squared χ 2 with d.f.5 = 17.27 (p<.005), RSA 203 Summary Chi-Squared χ 2 with d.f.5 = 24.23 (p<.001), RSA 304 Summary Chi-Squared χ 2 with d.f.5 = 13.86 (p<.025), RSA 305 Summary Chi-Squared χ 2 with d.f.5 = 14.64 (p<.025), RSA 306 Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
64
Table 21 – RSAs 203, 304, 305, and 306 Males and Females Number of Lung Cancer Diagnoses (Small Cell Carcinomas and Squamous Cell Carcinomas only ) Compared to the Expected Number, 1990-2014 Cancers Cancers Diagnosed/ 95% C.I. Diagnosed Expected Expected for Ratio Ratio Small Cell Carcinoma RSA 203
174
126.240
1.38**
1.18-1.60
RSA 304
196
132.287
1.48**
1.28-1.70
RSA 305
78
55.456
1.41**
1.28-1.76
RSA 306
154
93.121
1.65**
1.40-2.50
RSA 203
205
167.195
1.23**
1.06-1.41
RSA 304
208
172.563
1.21*
1.05-1.38
RSA 305
107
75.203
1.42**
1.16-1.72
RSA 306
165
119.902
1.38**
1.17-1.60
Squamous Cell Carcinoma
Note: 95% Confidence Interval means that the Diagnosed/Expected ratio is between the lower and upper values with 95% confidence. Diagnosed/Expected ratios that have a 95% Confidence Interval that include the value 1.00 are not considered statistically high or low. A ratio above 1.00 that is statistically significant means there were more diagnosed cases than expected and that there is less than a 5% chance that this higher number is due to chance alone. *
Ratio is statistically significant at p=0.05 level. (** p=0.01 level) NC = not calculated due to less than 3 diagnoses (see text for explanation)
Source: Colorado Central Cancer Registry, Colorado Department of Public Health and Environment
65
Technical Appendix A – Observed/Expected Ratios We compared the number of diagnosed (observed) cancers for each sex during the 19902014 time period in each Regional Statistical Area (RSA) to the expected number of cancers based on the cancer rates by race/ethnicity, sex and age of a larger comparison population (in this case the remainder of the Denver Metro area outside the 10-RSA region). A cancer rate is the number of new cancer cases diagnosed per 100,000 population per year. The population in each RSA, stratified by age, gender, and race/ethnicity, was multiplied by the cancer rate for each age, gender, and race/ethnic group in the comparison population to produce the expected number of cancers. For this study we used the “Poisson method” or “observed/expected ratio technique” which evaluates the ratio of a Poisson variable to its expected value.13 The Poisson distribution provides a reasonably good approximation of the occurrence of many diseases including cancer. For each RSA we calculated a diagnosed-to-expected ratio by dividing the number of cancers diagnosed in the RSA by the number of expected cases. A ratio greater than 1 indicates that we observed more cancer cases than we expected in the area. For each ratio, we calculated a 95% confidence interval which has a lower number (minimum value) and a higher number (maximum value). It is common to use a 95% confidence interval which means that we are 95% sure that the true ratio is between the lower and higher values. If the ratio is greater than 1 but the confidence interval includes the number 1, then the ratio is within expected statistical limits. If the confidence interval does not include the number 1, then the ratio is statistically significant. A statistically significant elevated ratio means that there were more diagnosed cases than expected and that there is less than a 5 percent chance that this greater number is due to chance alone. This standard test for determining how different the cancer counts are in a study population compared to the expected counts for the study population based on the rates in a control group, assumes that the control population is quite large compared to the study population, so that the variability in the former can be ignored. The populations in the ten RSA's taken separately are small enough compared to the remainder of the Denver Metro area to make this assumption reasonable. However, the population of the combined 10-RSA region comprises about a quarter of the population of the entire Denver Metro area. As a result, variability in both the 10-RSA total population and the remaining Denver Metro control population must be taken into account and the differences in rates evaluated by treating each of the 88 race/ethnicity-sex-age population groups (4 race/ethnicity groups, 2 sex groups and 11 age groups) as a stratum for the Mantel-Haenszel method 12 ,22 of comparing cancer occurrence in two groups. The numbers of cancer patients were counted as before and the numbers of non-cancer person years were estimated as: stratum population minus 12.5 times the number of cancer patients because on average the cancers occurred at the midpoints of the 25-year observation period and patients with cancer should be subtracted from t h e non-cancer population at time of diagnosis. The result of the Mantel- Haenszel test is a chi-square value with one degree of freedom.
A.1
Technical Appendix B – Maps and Geography
Page B.2 contains a map showing RSA boundaries for the Denver Metropolitan Area.
Pages B.3 and B.4 contain the community listing with RSA designations. It can be used to identify a particular community or portion of a community and look up the corresponding RSA used in the analysis.
Pages B.5 through B.9 contain the detailed description of each RSAs boundaries and aggregated census tracts. This can be used to locate RSA boundaries by street or other geographical landmarks.
B.1
B.2
Community Listing with Regional Statistical Area (RSA) Designations Community Description
RSA on Map
Arvada - east of Sheridan Blvd. -west of Ward Rd. and south of 64th Ave. -west of Ward Rd. and north of 64th Ave. - east of Ward Rd. , south of 80th Ave. and west of Sheridan Blvd.
RSA 305 RSA 204 RSA 202 RSA 203
Boulder City - Periphery - located in Boulder County generally between 4-6 miles immediately northeast, east, and southeast of Boulder city limits
RSA 103
Broomfield - north of 120th Ave. and west of Sheridan Blvd. - north of 120th Ave. and east of Sheridan Blvd. - south of 120th Ave.
RSA 106 RSA 301 RSA 202
Erie (portion in Boulder County)
RSA 106
Federal Heights
RSA 304
Golden (portion north and east of Hwy 6)
RSA 204
Lafayette
RSA 106
Louisville - east of McCaslin Blvd. - west of McCaslin Blvd.
RSA 106 RSA 103
Marshall - east of Hwy. 93
RSA103
Northglenn - west of 1-25 - east of 1-25 - north of 120th Ave.
RSA 304 RSA 306 RSA 301
B.3
Community Listing: with Regional Statistical Area (RSA) Designations (continued) Community Description
RSA on Map
Superior - east of McCaslin Blvd. - west of McCaslin Blvd.
RSA 106 RSA 103
Thornton - east of 1-25 and north of 120th Ave. - west of 1-25 - east of 1-25 and south of 120th Ave.
RSA 301 RSA 304 RSA 306
Westminster - west of Sheridan Blvd. -north of 120th Ave. - east of Sheridan Blvd., south of 120th Ave., and north of Denver-Boulder Turnpike -east of Sheridan Blvd. and south of Denver-Boulder Turnpike Wheat Ridge (excluding south of 32nd Ave. and west of Kipling)
B.4
RSA 202 RSA 301 RSA 304 RSA 305 RSA 205
Regional Statistical Areas RSA 103 - "Boulder City - Periphery" - located in Boulder County generally between 4-6 miles immediately northeast, east and southeast of Boulder City Limits (excludes mountain areas and northern half of county) includes: - Louisville west of McCaslin Blvd. - Marshall east of Hwy. 93 - Superior west of McCaslin Blvd. - 1990 Census Tracts: 127.01, 127.04, 127.05, 127.06, 127.07, 127.98 - 2000 Census Tracts: 127.01, 127.05, 127.07, 127.08, 127.09, 127.10, 131.06 (Block Group 1 only) - 2010 Census Tracts: 127.01, 127.05, 127.07, 127.08, 127.09, 127.10, 606 (Block Group 1 only) Boundaries:
Nebo Rd., 35th St., Nimbus Rd., 41st St., Oxford Rd., 67th St., Nimbus Rd. 73rd St., Niwot Rd., 71st St. By-pass, Diagonal Hwy. (Hwy. 119), Mineral Rd., 71st St. Lookout Rd. 95th St. Arapahoe Rd. (Hwy. 7) 75th. St., Baseline Rd., 76th St., S. Boulder Rd., McCaslin Blvd. Boulder-Jefferson County Line S. Foothills Hwy. (Hwy. 93), S. Boulder Creek, Denver Boulder Turnpike (Hwy. 36), Cherryvale Rd. (60th St.), Baseline Rd., 55th St. (Valley View Dr.), Valmont Rd., Airport Rd. , unnamed road parallel to west boundary of Boulder Airport, Independence Rd., Diagonal Hwy. (Hwy. 119), 28th St., North Foothills Hwy. (Hwy. 36)
B.5
Regional Statistical Areas ( continued) RSA 106- "Boulder- Tri Cities" - located generally in the extreme southeast comer of Boulder County includes: -Broomfield north of 120th Ave. and west of Sheridan Blvd. - Erie (portion in Boulder County) -Lafayette - Louisville east of McCaslin Blvd. - Superior east of McCaslin Blvd. - 1990 Census Tracts: 128.00, 129.02, 129.97, 129.98, 130.02, 130.98, 131.02 - 131.05 - 2000 Census Tracts: 128.00, 129.03 - 129.08, 130.03 - 130.07, 131.04, 131.06 (Block Groups 2 - 4 only), 131.07 - 131.11 - 2010 Census Tracts: 128.00, 129.03 - 129.05, 129.07, 130.03 - 130.06, 300, 301, 303, 304, 309, 311 (Block Group 1 only), 606 (Block Groups 2 and 3 only), 607 - 609, 613, 614, 98.01 - 98.03 Boundaries:
Lookout Rd., 115th St., Kenosha Rd. Boulder-Weld County Line Boulder-Jefferson County Line (W. 120th Ave.) McCaslin Blvd., S. Boulder Rd., 76th St., Baseline Rd., 75th St. Arapahoe Rd. (Hwy. 7) 95th St.
B.6
Regional Statistical Areas ( continued) RSA 202 - "Standley Lake" - located generally i n northern Jefferson County north of 64th Ave. and east of Hwy. 93 includes: - the Rocky Flats Site -Arvada west of Ward Rd. and N. of 64th Ave. -Arvada north of 80th Ave. - Broomfield south of 120th Ave. -Westminster west of Sheridan Blvd. - 1990 Census Tracts: 98.12, 98.14 - 98.21 - 2000 Census Tracts: 98.15, 98.22 - 98.41 - 2010 Census Tracts: 98.15, 98.23, 98.24, 98.27 – 98.41, 603 - 605, 302, 311 (Block Groups 2 and 3 only) Boundaries:
Jefferson-Boulder County line (W. 120th Ave.) Sheridan Blvd. (Adams-Jefferson County Line) W. 80th Ave. Sims W. 64th Ave., Yankee, W. 66th Ave., W. 68th Ave. Hwy. 93 (Foothills Rd.)
RSA 203- "Arvada" includes: - Arvada east of Ward Rd. , south of 80th Ave. and west of Sheridan B1vd. - 1990 Census Tracts: 102.04 - 102.09, 103.03 - 103.08, 104.02, 102.05, 102.06 - 2000 Census Tracts: 102.05, 102.06, 102.08 - 102.13, 103.03 - 103.08, 104.02, 104.05, 104.06 - 2010 Census Tracts: 102.05, 102.06, 102.08 - 102.13, 103.03 - 103.08, 104.02, 104.05, 104.06 Boundaries:
80th Ave. Sheridan Blvd. (Adams-Jefferson County Line) Denver-Jefferson County Line Clear Creek, 1-70 Ward Rd., 64th Ave., Sims
B.7
Regional Statistical Areas ( continued)
RSA 204 - "Golden" - located in Jefferson County generally south of 64th Ave, west of Ward Rd., west of 1-70, north and east of Hwy. 6, and east of Hwy. 93 includes: - Arvada west of Ward Rd and south of 64th Ave. - Golden north and east of Highway 6 - 1990 Census Tracts: 98.04, 98.05, 98.06, 99.00, 100.00, 101.00 - 2000 Census Tracts: 98.05, 98.06, 98.42, 98.43, 99.00, 100.00, 101.00 - 2010 Census Tracts: 98.06, 98.42, 98.43, 98.51, 98.52, 99.00, 100.00, 101.00
Boundaries:
W. 68th Ave. W. 66th Ave., Yankee, W. 64th Ave Ward Rd., 1-70, Indiana Hwy. 6, Clear Creek Hwy. 93 (Foothills Rd.)
RSA 205- "Wheat Ridge" includes: -Wheat Ridge except south of 32nd Ave. and west of Kipling - 1990 Census Tracts: 104.03,105.02,105.03, 106.03, 106.04, 107.01, 107.02 - 2000 Census Tracts: 104.03,105.02,105.03, 106.03, 106.04, 107.01, 107.02 - 2010 Census Tracts: 104.03,105.02,105.03, 106.03, 106.04, 107.01, 107.02
Boundaries:
1-70, Clear Creek, 1-70 Sheridan Blvd. W. 26th Ave., Kipling, W. 32nd Ave.
B.8
Regional Statistical Areas (continued) RSA 301 - "Adams - Northwest" - located generally in Adams County north of 120th Ave. and west of South Platte River includes: - Broomfield north of 120th Ave. and east of Sheridan Blvd. - Northglenn north of 120th Ave. - Thornton north of 120th Ave. and east of 1-25 - Westminster north of 120th Ave. and east of 1-25 - 1990 Census Tracts: 85.13, 85.15 - 85.19 - 2000 Census Tracts: 85.15, 85.16, 85.20, 85.21, 85.24 - 85.30 - 2010 Census Tracts: 85.24, 85.26, 85.29, 85.40, 85.41, 85.44 - 85.49, 305 - 308, 313, 314, 600 - 602, 612 Boundaries:
Adams-Weld County Line South Platte River Henderson Rd., Riverdale Rd., E. 128th Ave., Quebec E. 120th Ave. Boulder-Adams County Line
RSA 304- "Adams -West" -located generally in Adams County south of 120th Ave., west of 1-25, east of Sheridan Blvd. and north of Denver-Boulder Turnpike (Hwy. 36) includes: - Federal Heights - Northglenn west of I-25 - Thornton west of 1-25 - Westminster east of Sheridan Blvd., south of 120th Ave. and north of Denver-Boulder Turnpike (Hwy. 36) - 1990 Census Tracts: 93.04, 93.06 - 93.10, 93.13 - 93.18, 94.01, 94.03, 94.05 - 94.07 - 2000 Census Tracts: 93.04, 93.06 - 93.10, 93.16, 93.18 - 93.25, 94.01, 94.06 - 94.11 - 2010 Census Tracts: 93.04, 93.06 - 93.10, 93.16, 93.18 - 93.23, 93.25 - 93.27, 94.01, 94.06 - 94.11 Boundaries:
E. 120th Ave. 1-25 Denver-Boulder Turnpike (Hwy. 36) Sheridan Blvd. (Adams-Jefferson County Line) B.9
Regional Statistical Areas (continued) RSA 305- "Adams - Clear Creek Valley" - located generally in Adams County south of Denver-Boulder Turnpike, west of the South Platte River, east of Sheridan Blvd. and north of 52nd Ave. includes: - Arvada east of Sheridan Blvd. -Westminster east of Sheridan Blvd. and south of Denver-Boulder Turnpike (Hwy. 36) - 1990 Census Tracts: 89.52, 95.01, 95.02, 95.53, 96.03 - 96.06, 97.50 - 2000 Census Tracts: 89.52, 95.01, 95.02, 95.53, 96.03, 96.04, 96.06 - 96.08, 97.50 - 2010 Census Tracts: 95.01, 95.02, 95.53, 96.03, 96.04, 96.06 - 96.08, 97.51, 97.52, 150.00 (Block Group 2 excl. N. of Clear Creek) Boundaries:
Denver-Boulder Turnpike (Hwy. 36) 1-25, Clear Creek, South Platte River Adams-Denver County Line Sheridan Blvd. (Adams-Jefferson County Line)
RSA 306- "Northglenn - Thornton" - located generally in Adams County east of 1-25, south of 120th Ave. and west of South Platte River includes: - Northglenn east of 1-25 - Thornton east of 1-25 and south of 120th Ave. - 1990 Census Tracts: 85.05 - 85.08, 85.11, 90.01 - 90.03, 91.01, 91.02, 92.01 - 92.03 - 2000 Census Tracts: 85.05 - 85.08, 85.31, 85.33, 85.34, 90.01 - 90.03, 91.01, 91.03, 91.04, 92.02 – 92.05 - 2010 Census Tracts: 85.05 - 85.08, 85.33, 85.34, 85.50, 85.51, 90.01, 90.02, 91.01, 91.03, 91.04, 92.02 - 92.04, 92.06, 92.07, 150.00 (Block Group 2 N. of Clear Creek & Block Grp 1) Boundaries:
E. 120th Ave., Quebec, E. 128th Ave., Riverdale Rd., Henderson Rd. South Platte River Clear Creek 1-25 B.10
References
1
Health Advisory Panel’s Report to Colorado Citizens on the Phase I Study of the State of Colorado’s Health Studies on Rocky Flats, October, 1993. 2
Johnson, C.J. Cancer Incidence in an Area Contaminated with Radionuclides Near A Nuclear Installation. Ambio, 10(4), 176-182, 1981. 3
Dreyer, N.A., Loughlin, J.E., Fahey, F.H. and Harley, N.H. The Feasibility of Epidemiologic Studies of Cancer in Relation to the Rocky Flats Plant. Health Physics, 42(1), 65-68, 1982. 4
Crump, K . S . , Ng, T .H. and Cuddihy, R.G. Cancer Incidence Patterns in the Denver Metropolitan Area in Relation to the Rocky Flats Plant. American Journal of Epidemiology, 126(1), 127-135, 1987. 5
Technical Topics: Research on Adverse Health Effects Related to the Rocky Flats Plant, Rocky Flats Health Studies Unit, Colorado Department of Public Health and Environment, December, 1993. Draft Report: Assessing Risks of Exposure to Plutonium. Part of Task 3: Independent Analysis of Exposure, Dose and Health Risk to Offsite Individuals. Historical Public Exposure Studies on Rocky Flats, Phase II: Toxicity Assessment and Risk Characterization. Radiological Assessment Corporation, May, 1996.
6
7
Wilkinson, G.S., Tietjen, G.L., W i g g s , L.D., G a l k e , W.A., Acqua vel l a, J.F., R e y e s , M., Voelz, G.L. and Waxweiler, R.J. Mortality among Plutonium and Other Radiation Workers at a Plutonium Weapons Facility. American Journal of Epidemiology, 125(2), 231-250, 1987.
8
Ratios of Cancer Incidence in Ten Areas around Rocky Flats, Colorado Compared to the Remainder of Metropolitan Denver, 1980-89 with Update for Selected Areas, 19901995, a Report to the Health Advisory Panel on Rocky Flats, Colorado Central Cancer Registry, Colorado Department of Public Health and Environment, 1998. 9
Blumenthal, D.S. and Ruttenber, J. Introduction to Environmental Health, Revised Second Edition, Springer Publishing Company, 1995. 10
Fiore, B . J ., H a r a h a n , L. P . and Anderson, H.A. Public Health Response to Reports of Clusters. State Health Department Response to Disease Cluster Reports: A Protocol for Investigation. Am. J. Epidemiology, Vol. 132 (Suppl.1):S14-S22, 1990. 11
Warner, S . C . The Status of Cancer Cluster Investigations Undertaken by State Health Departments. American Journal of Public Health, Vol. 78, No. 3: 306-307, March, 1988.
References (continued) 12
Mantel, N. and Haenszel, W. Statistical Aspects of Data From Retrospective Studies of Disease, Journal of the National Cancer Institute, Vol. 22, No. 4, p. 719-748, April, 1959. 13
Bailar, J. and Ederer, F . Significance Factors for the Ratio of a Poisson Variable to its Expectation. Biometrics, Vol. 20, No. 3, p. 639-643, Sept., 1964. 14
Shleien, B., Ruttenber, J. and Sage, M., Epidemiologic Studies of Cancer in Populations near Nuclear Facilities, Health Physics, 61(6): December, 1991. 15
UPDATE: Historical Public Exposures Studies, Vol. 5, No. 1, Winter, 1995.
16
1990 Census of Population and Housing. Population and Housing Characteristics for Census Tracts and Block Numbering Areas. Denver-Boulder. CO CMSA (Part), Denver, CO PMSA, 1990 CPH-3-132B. (Section 1 of 2), U.S. Department of Commerce, Bureau of the Census, May, 1993. 17
1990 Census of Population and Housing. Population and Housing Characteristics for Census Tracts and Block Numbering Areas, Denver-Boulder, CO CMSA (Part), Denver, CO PMSA,1990 CPH-3-132B, (Section 2 of 2), U.S. Department of Commerce, Bureau of the Census, May, 1993. 18
1990 Census of Population and Housing. Population and Housing Characteristics for Census Tracts and Block Numbering Areas, Denver-Boulder. CO CMSA (Part), Boulder-Longmont, CO PMSA, 1990 CPH-3-132A, U.S. Department of Commerce, Bureau of the Census, April, 1993. 19
2000 U.S. Census www.census.gov
20
2010 U.S. Census www.census.gov
21
American Cancer Society. Cancer Facts & Figures 2016. Atlanta: American Cancer Society; 2016.http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf 22
Snedecor, G.W. and Cochran, W.G. Statistical Methods, Sixth Edition, Iowa State University Press, Ames, Iowa, 1967.
23
http://www.cancer.org/cancer/esophaguscancer/detailedguide/esophagus-cancer-risk-factors, American Cancer Society, 2016. 24
http://www.cohealthmaps.dphe.state.co.us/cdphe_community_level_estimates Behavioral Risk Factor Surveillance System (BRFSS), Colorado Department of Public Health and Environment.
References (continued) 25
Liu, L., Cozen, W, Bernstein, L., Ross, R.K., and Deapen, D. Changing Relationship between Socioeconomic Status and Prostate Cancer Incidence, Journal of the National Cancer Institute, Vol. 93, Issue 9, p. 705-709, 2001. 26
Seki, T., Nishino, Y., Tanji, F., Maemondo, M., Takahashi, S., Sato, I., Kawai, M., and Minami, Y. Cigarette Smoking and Lung Cancer Risk according to Histologic Type in Japanese Men and Women, Cancer Science, 104(11): 1515-22, Nov., 2013. 27
Jedrychowski, W., Becher, H., Wahrendorf, J., Basa-Cierpialek, Z. and Gomola, K. Effect of Tobacco Smoking on Various Histological Types of Lung Cancer, Journal of Cancer Research and Clinical Oncology, 118(4): 276-82, 1992. 28
Pesch, B., Kendzia, B., Gustavsson, P., et. al. Cigarette Smoking and Lung Cancer – Relative Risk Estimates for the Major Histological Types from a Pooled Analysis of Case-Control Studies, International Journal of Cancer, 131(5): 1210-1219, September 1, 2012. 29 30
Rocky Flats history https://www.colorado.gov/pacific/cdphe/rocky-flats
Rocky Flats Historical Exposure Studies https://www.colorado.gov/pacific/cdphe/rocky-flatshistorical-public-exposure-studies
