DEQ-CFW_00021894

2015, and Comparison to Statewide Rates
Background and Summary
This summary was prepared to answer questions about cancer rates in four counties that have arisen
during the ongoing investigation of GenX in the Cape Fear River. Central Cancer Registry data do not
include information about causes of cancer or associations with specific exposures; therefore, no
conclusions can be drawn about the association between GenX or other exposures and the cancer rates
described here.
The North Carolina Department of Health and Human Services (NC DHHS) examined data from the North
Carolina Central Cancer Registry to determine how rates of certain cancers in four counties compared
with state-wide cancer rates during 1996-2015. The incidence of pancreatic, liver, uterine, testicular and
kidney cancers were examined in Bladen, Brunswick, New Hanover, and Pender Counties. The incidence
rates were compiled for the entire ZU-yearperiod and separately for each 5'yearinterval therein (1996-
2DOO,2DD1-2UO5,2UU6-2OlUand 2U11-2Ul5).
Overall, cancer rates inthe four counties were similar tostate rates. There were two exceptions where
the county incidence rates were higher than the state and four where the incidence rates were lower:
Higher
New Hanover County had a higher 20-year rate of testicular cancer during 1996-2015 and a
higher 5-year rate of liver cancers during 2006-2010 compared with the state. Rates ofboth
cancers were similar tothe state rates during the most recent period (2011'2015).
Lower
* Brunswick County had a lower 20-year rate of pancreatic cancer during 1996-2015; a lower 5-
yearrateofuterinecancerdurin8JOO6—Z01U;anda|ovver5-yearrateofpancreadccancer
during 2011-2D1Scompared with the state.
* Bladen County had a lower 20-year rate of kidney cancer during 1996-2015 compared with the
state.
During the most recent five-year interval (2011-2015), no county -specific cancer rates examined were
significantly higher than state rates.
Although the information in this summary describes cancer rates in these counties over time, only
comprehensive research study can provide information about whether a specific exposure is associated
with increased rates of cancer.
It should be noted that liver cancer incidence rates have increased in North Carolina and in the United
States during the period of 1996-2015. State and national increases in liver cancer are due in part to the
aging of the baby boomer population (persons born between 1945 and 1965). This population is at least
five times more likely to have hepatitis C (a leading cause of liver cancer) as compared to other ad UltS.2
The overall increasing liver cancer rate in New Hanover County during the period examined might also
be related to the increasing proportion of the population >65 years of age in that county- from 12.8% in
2000to16.296in2015.3
Epidemio|ogstsatNCDHH8examinedaBe'adjustedcancerincidencerates(reportedcasesper1OOOOO
population) during 1996-2015 for the state of North Carolina and specifically for Bladen, Brunswick,
New Hanover, and Pender counties. Rates were age -adjusted to the US Census 2000 population. Data
OEQ-CFVV_00021894

were provided bythe North Carolina Central Cancer Registry. We focused on cancers ofthe liver,
pancreas, testes, and uterus due to findings reported in laboratory animals during GenX exposure
studies. Kidney cancer was examined because epiclemiologic studies of exposure to perfluorooctanoic
acid (PFOA) have found associations with increased occurrence of kidney cancers.'
For each cancer type, we examined the overall 20-year rate (1996-2015). To describe trends over time,
we also looked at rates in 5-year intervals during the same period. We compared county -specific rates to
the state rate by determining if the 95Y6 confidence intervals (Cis) around the county -specific rate
overlapped with the 95Y6 Os around the state rate for the same period. If no overlap occurred, the rates
were considered significantly different.
Findings
Z&-yearIates
All 20-year (1996-2015) county -specific incidence rates were similar to state rates except as noted
* The 20-year rate of testicular cancer in New Hanover County was greater than the state rate.
Rates were not significantly different from the state rate when examined for any of the
individual S'yearperiods.
w The 20-year rate of pancreatic cancer in Brunswick County and the 20-year rate of kidney cancer
in Bladen County were lower than the state rates
Trends over time
All 5-year county -specific incidence rates were similar to state rates except as noted below:
* The liver cancer rate in New Hanover County was significantly higher than the state liver cancer
rate during ZOU6—IO1O,but was similar tuthe state rate in1996—ZOUU ZOO1—IOOS,and ZU11—
ZO1S.
* The Brunswick County uterine cancer rate during 2006-2010 and the Brunswick County
pancreatic cancer rate during 2011-2015 were significantly lower than the state rates during the
same periods.
The county -specific cancer rates examined here were not significantly higher than state rates, with the
exceptions of testicular and liver cancers in New Hanover County during specific periods. During the
most recent five-year interval (2011-2015), no county -specific cancer rates examined were significantly
higher than state rates. Although the information in this summary describes cancer rates in these
counties over time, only a comprehensive research study can provide information about
whether any specific exposure is associated with increased rates of cancer.
1. Viral Hepatitis and Liver Cancer. CDC Fact Sheet:
z. U5Census Bureau. Quick Facts. New Hanover County, North Carolina:
Envirnnmpnta|ProtpcdnnAgency.DrinkinDwaterhea|thadvisoryforperf|ouronctannicacid(PFOA).PWay
2016:health advisory final-
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OEQ-CFVV_OOO218Q5

Table 1. Twenty-year age -adjusted incidence rates (cases per 100,000 population) for selected cancers
in Bladen, Brunswick, New Hanover, and Pender Counties and North Carolina (1996-2015).* Rates were
age adjusted to the US 2000 Census. Rates significantly different from state-wide rates are highlighted.
Cancer Site Population
Cases
95% CI
Liver 8|aden
36
4.5
3.1 ,
6]
Brunswick
146
5.4
4.5 ,
6.5
New Hanover
258
6.3
5.6 ,
72
Pender
66
EO
4.5 ,
7.4
NORTHCARO
Pancreas 8|aden
77
9.9
7.8 ,
12.4
Brunswick
266
9.6
8.4 ,
10.9
New Hanover
421
10.4
9.5 ,
11.5
Pender
122
10.8
9.0 ,
13.0
NORTHCAR{JL|NA
20,835
11.3
11.2 ,
11.5
Testes B|aden
lZ
4.2
2.2 ,
7.3
Brunswick
27
3.5
2.3 ,
5.1
New Hanover
118
6.2
52 ,
7.5
Pender
22
5.0
3.2 ,
7.6
NOBTHCAROL|NA
4,108
4.7
4.6
4.9
Kidney B|aden
94
11.9
9.6 ,
14.6
Brunswick
420
15.4
13.8 ,
17.1
New Hanover
584
14.5
13.4 ,
15.8
Pender
130
lSJ
13.4 ,
13.2
NORTHCAROLINA
2
Uterus 8|aden
92
20.9
16.8 ,
25.8
Brunswick
319
21.4
18.9 ,
24.1
New Hanover
499
22.2
ZU] ,
243
Pender
135
21.8
18] ,
25.9
NOBTHCAROL|NA
23,090
22.4
22.1 ,
22.7
Rates were produced by the NC Central Cancer Registry (June 20I7); numbers are subject to change
asfiles are
updated. Amodified gamma interval was used to calculate the
confidence intervals;
Vintage2OI5 bridged -race
postcensal population estimates were obtained from the National
Center for Health
Statistics
OEQ-CFVV_00021896

Table 2. Five-year age -adjusted incidence rates (cases per 100,000 population) for selected cancers for Bladen, Brunswick, New Hanover, and Pender Counties
and North Carolina (1996-2015).* Rates were age adjusted to the US 2000 Census. Rates significantly different from state-wide rates are highlighted.
Cancer Site
Population
Cases
Rate
95%
Cl
Cases
Rate
95%
CI
Cases
Rate
95% CI
Cases
Rate
95% CI
Rates were oroduced bv the
NC Central Cancer Reeistry (June 2017):
numbers
are subiect to chanee as files
are uodated. A modified
eamma interval
was used to calculate
the
confidence intervals; Vintage 2015 bridged -race postcensal population estimates were obtained from the National Center for Health Statistics
t Counts fewer than 5 are suppressed; no rate was estimated.
OEQ-CFVV_00021897