7304_UpperPiedmontDHHSletter_DIN27018_20150528

North Carolina Department of Health and Human Services Division of Public Health

Pat McCrory Aldona Z. Wos, M.D. Governor Ambassador (Ret.)
Secretary DHHS
Daniel Stanley
Acting Division Director
www.ncdhhs.gov • www.publichealth.nc.gov
Tel [phone] • Fax [phone] Location: 5605 Six Forks Road • Raleigh, NC 27609
Mailing Address: 1931 Mail Service Center • Raleigh, NC 27699-1931 An Equal Opportunity / Affirmative Action Employer
May 28, 2015
Dear Director Clayton,
Thank you for your inquiry to the Central Cancer Registry regarding cancer cases in Person County. We receive many requests such
as yours for information about cancers in local areas throughout the state. The Central Cancer Registry compiles information on cancers across North Carolina and we monitor cancer rates for many types of cancer for each county annually to see if there appear to be areas of the state that need special attention.
Although much has been learned about cancer over the past couple of decades, there is still much that is not known about the causes of cancer. What we do know is that cancer is not one disease, but a group of diseases that behave similarly. We know that different
types of cancers are caused by different things. For example, cigarette smoking has been implicated in causing lung cancer, some
chemical exposures are associated with leukemia, and prolonged exposure to sunlight causes some types of skin cancer. Genetic research has shown that defects in certain genes result in a much higher likelihood that a person will get cancer. What is not known is how genetic factors and exposures to cancer causing agents interact.
Many people do not realize how common cancers are. It is estimated that one out of every two men and one out of every three women
will develop a cancer of some type during his or her lifetime. As a result, it is common to find what appear to be cancer cases clustering in neighborhoods over a period of years. This will occur in any neighborhood. As people age, their chance of getting cancer increases, and so as we look at a community, it is common to see increasing numbers of cancer cases as the people in the community age.
Cancers are diseases that develop over many years. As a result, it is difficult to know when any specific cancer began to develop, and
consequently, what the specific factor was which caused the cancer. Because people in our society move several times during their lives, the evaluation of clusters of cancer cases is quite challenging. One can never be certain that a specific cancer was caused by something in the community in which the person currently resides.
When clusters of cancer cases are investigated, we look for several things that are clues to likely associations with exposures in the community. These are:

1. Groups of cases of all the same type of cancer (such as brain cancer or leukemia). Because different things cause different types of cancer, cases of many different types of cancer do not constitute a cluster of cases. 2. Groups of cases among children, or ones with an unusual age distribution.
3. Cases diagnosed during a relatively short time interval. Cases diagnosed over a span of years do not constitute a cluster of cases unless there is consistency in the type of cancer. 4. Clusters of rare cancers. Because lung, breast, colon, and prostate cancers are so common, it is very difficult to find any association between them and exposures in a community.
This report is updated based on cases reported to the North Carolina Central Cancer Registry (CCR) as of April 2015, diagnosed
during 1990 - 2014, address at the time of diagnosis in North Carolina and diagnosis codes as reflected in the pathology and medical
reports reported from the hospitals and facilities. Further, cases diagnosed out of the state and country but may be receiving treatment in facilities in North Carolina are not included as they are not required to be reported. The CCR does not have real time data because it takes hospitals at least six months after the diagnosis of a malignancy to submit cancer diagnosis reports. The reason for this is that,
per General Statute 130A-209, CCR requires facilities to report complete first course of treatment data and many cases have an extended period of first course treatment. The patient may have surgery, followed by multiple courses of chemotherapy, followed by

radiation therapy. In order to obtain complete and accurate data from the facilities there is a lag time of at least six months. For some
cases, CCR receives multiple reports from different facilities, which are reviewed and consolidated on an ongoing basis. CCR continues to receive reports from the hospitals for cases diagnosed in 2013, 2014 and prior years. Therefore, all cases diagnosed in
2013 and 2014 may not be included in this report.
In order to evaluate the cancer risk in the county requested, all of the cases of cancer in our database diagnosed from 1990 to 2014 were identified. During this time a total of 4,583 cancer cases were diagnosed in Person County. Across the county, the four major
cancers - female breast, colon/rectum, prostate, and lung - comprised 57 percent of the cases. Pediatric cancers comprised less than 1 percent of the total number of cases and 86 percent of the cases were age 50 or older, when cancer diagnoses are quite common. These
cases were spread out over the 25 years, not concentrated in a short time period.
Further, we examined the age-adjusted cancer incidence rates in Person County for the 2008-2012 diagnosis years and found that the rates for colorectal, lung/bronchus, female breast and prostate cancers were similar to the state rates. Overall there were 1,205 cases
reported in Person County for this five year period.
In addition, we looked at cancers that have been shown to be associated with environmental risk factors (liver, pancreas, leukemia, brain, bladder, kidney, multiple myeloma and non-Hodgkin lymphoma) and identified a total of 870 cases for Person County between
1990 and 2014. These cases were spread out over the 25 years and not concentrated in any time period.
Concern was also expressed over the incidence of lung/bronchus and brain/other CNS cancers in Person County. Between 1990 and 2014, there were 763 cases (or about 17 percent of all cancer cases) of lung/bronchus cancer and 66 cases (about 1 percent of all
cases) of brain/other CNS cancer in Person County while there were 151,909 cases (or about 15 percent of all cancer cases) of lung/bronchus cancer and 13,484 cases (or about 1 percent of all cases) of brain/other CNS cancer statewide. Further analysis of the
age-adjusted cancer incidence rates in Person County for the 2008-2012 diagnosis years showed that the rates for lung/bronchus and brain/other CNS cancers were similar to the state rates.
Additionally, the area surrounding the landfill located at 9550 Oxford Road, Rougemont, NC was of particular interest. From 1990 to
2014, there were 473 cases reported in the 2-mile radius area around the site. The top four cancers comprised 55 percent of the cases. About 81 percent of the cases were diagnosed in people age 50 and older while 1 percent of the cases were pediatric cancers. Between
2010 and 2014, there were 127 cases reported in this area. Further analysis showed that there were 21 cases of lung/bronchus (17 percent of total) and no cases of brain/other CNS cancers reported in the area.
Overall, no consistent pattern of cases was observed other than those previously stated. It is possible that there is an environmental
risk for cancer in the area; however, we do not see a higher occurrence of cancers in the populations usually associated with environmental factors at this time or any evidence of a clustering of cancer cases in any of these areas.
On the CCR website (www.schs.state.nc.us/SCHS/data/cancer.cfm), there is additional North Carolina cancer information, including
the NC Cancer Profile and the Cancer Profile for Person County. There are also fact sheets regarding the leading cancers in the state. If you have questions regarding any of this information or you want additional resources about cancer, please do not hesitate to contact
me at [e-mail] or [phone].
Copies of neighborhood cancer evaluations are sent to local health department and the Office of Occupational and Environmental Epidemiology Branch.
Sincerely,
Gary Leung, PhD.
N.C. Department of Health and Human Services Statistician, North Carolina Central Cancer Registry, Division of Public Health
222 N. Dawson Street, Cotton Classing Building, Raleigh, NC 27603 (Office) 919-715-4559
[e-mail] http://www.schs.state.nc.us/schs/data/cancer.cfm

CC: Janet Clayton, Person County Health Department
Dr. Rick Langley, MD, MPH, Occupational and Environmental Epidemiology Branch