ML20133G247
| ML20133G247 | |
| Person / Time | |
|---|---|
| Site: | Salem, Three Mile Island, 05000000 |
| Issue date: | 09/30/1985 |
| From: | Digon E, Tokuhata G PENNSYLVANIA, COMMONWEALTH OF |
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| Shared Package | |
| ML18092A835 | List: |
| References | |
| NUDOCS 8510150291 | |
| Download: ML20133G247 (52) | |
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_ ENCLOSURE 1 CANCER MORTALITY AND MORBIDITY (INCIDENCE) AROUND TMI h
, s *. George K. Tokuhata, Dr.P.B., Ph.D.*
Edward Digon, M.P.H.**
j Division of Epidemiology Research Pennsylvania Department of Health i
September, 1985
- Dr. Tokuhata is Director, Division of Epid emiology Research; also Professor of Epidemiology anda Biost ti (adjunct), Graduate School of Public Health Pittsburgh stics
, University of 1
- Mr. Digen is Research Epidemiology Chief, special Studies Secti on, Division of We gratefully acknowledge the technical revi ew and comments Dr. Robert Miller and Dr. Charles Land, a ancer Nation Institute; Dr. Matthew Zack, Centers for Disease C Dr. Paul Sheehe, Upstate Medical Center ontrol;
, College of Ridge National Laboratory. Medicine, Syracuse, , Oak New York; a 0510150291 851009 DR ADOCK O 22
j I' Prologue and Summary CANCER MORTALITY AND MORBIDITY (INCIDENCE) AROUND TMI e-George K. Tokuhata, Dr.P.H., Ph.D.*
Edward Digon, M.P.H.**
Division of Epidemiology Research Pennsylvania Departmeht of Health September, 1985 l
- Dr. Tokuhata is Director, Division of Epidemiology Research; also Professor of Epidemiology and Biostatistics i (adjunct), Graduate School of Public Health, University of Pittsburgh
- Mr. Digen is Chief, special Studies section, Division of Epidemiology Research l
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More than six years have elapsed since the March 1979 accident at the Three Mile Island (TMI) nuclear facility. During this period, concerns about low level radiation as a possible cause of cancer have been a subject of considerable attention.
These concerns have been heightened by'a review of radiation dose assessment sponsored'by the TMI Public Health Fund and a survey of cancer mortality by a group of local volunteers in selected
,, communities near TMI.
The Pennsylvania Department of Health has conducted an epi-l demiological study to determine if there is evidence of unusual cancer mortality and morbidity in communities around TMI, and if ,
so, to determine if the findings are consistent with what is currently known about cancer caused by radiation.
Cancer caused by radiation generally has a long latency
- period before diagnosis can be made (10 to 20 years or more).
Even leukemia, which is known to have a relatively short latency -
period, is usually not detectable ear' lier than five years following radiation exposure.
t The present study examines both cancer mortality (deaths) and morbidity (incidence, i.e., the number of newly diagnosed cancer cases) and the results presented include: (a) comparison of the observed and expected numbers of cancer deaths, (b) com-parison of the observed and expected numbers of newly diagnosed cancer cases (incidence 1, and (c) followup of the incidence of cancer amone soecific oroues of mothers and fetuses presumably
, execsed te radiatioh as a result of the TMI accident.
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ANALYSIS OF CANCER MORTALITY IN TMI AREAS:
Direct comparison of cancer rates before and after the TMI accident would have been desirable. However, such comparisons
- require adjustments for population changes and for the influences of the age-sex compositions of area populations under study.
Because total an,d age-sex specific population data for the time prior to the accident are not available, such comparisons are not possible on a scientifically valid basis.
Under the circumstance, an observed vs. expected number method was used. The expected numbers of cancer deaths computed for the post-TMI period (1979-1983)a) are those which would have been anticipated, based on the 1980 population, if the communities under study had the same age-sex cancer mortality experience as Pennsylvania had during the 1979-80-81 period (average) . The observed numbers of cancer deaths for the period prior to TMI (1974-1978) have been included in the study to .
provide some indication of whether or not unusually high or low cancer mortality may have occurred in areas surrounding TMI prior to the accident. It should be noted that in areas of population increase, the expected numbers for the pre-TMI period would tend to be " overestimates" while fo.r the post-TMI period they would tend to be " underestimates."
a) For purposes of this report the post-TMI period is January 1, 1979 through December 31, 1983 and the pre-TMI period is .
January 1, 1974 through December 31, 1978. ]
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The reader should also be aware that one may expect to see more cancer cases, living or deceased, in the post-TMI period l
regardless of the accident because of the following:
- General increase in cancer cases in Pennsylvania and elsewhere.
- Population increases over time in many areas under study.
- Better cancer reporting system.
- Improved diagnostic techniques and opportunities.
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- Cancer patients now live longer than previously.
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- Increased longevity (older persons are more susceptible to cancer).
r ANALYSIS OF CANCER MORBIDITY IN TMI AREAS:
- In addition to analyzing the number of deaths due to can-cer, the Department also analyzed cancer morbidity (newly diag-
- nosed cases or incidence) in the TMI area. Incidence data are j
more useful than mortality data in assessing possible connections
- between radiation exposure and cancer.
It is well established that there is a long latency period -
- between radiation exposure and the diagnosis of cancer. There is f an even longer time lag between exposure and death from cancer.
Accordingly, if radiation exposure from TMI had resulted in any increase in the number of cancers, it will be observed in the incidence data long before being observed in mortality data.
Cancer morbidity (incidence) data used in this study were i
l obtained from the Pennsylvania Cancer Registry which became oper-ational in July 1982 for the TMI area. The data gap from the time of the accident through June 1982 is not considered serious in vie. cf the fact, as previcisly ncted, that radiocenic cance:r i .
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l are not expected to be observable within a few years post expo- j l
sure. These missing years, however, were well covered by the Department of Health's comprehensive analysis of the mortality data (see Summary of Major Findings).
ANALYSIS OF CANCER INCIDENCE AMONG MOTHERS AND FETUSES PRESUMABLY EXPOSED TO RADIATION FROM TMI:
The method of analyzing cancer incidence data in a given population as of-a given y. ear does not consider the fact that, since the accident, some individuals have moved out while others have moved into the study areas." In order to take this migration factor into account, a special analysis was conducted involving nearly 4,000 pregnant women living in the TMI area at the time of the accident.
Subsequent to the accident, pregnant women residing within 10 miles of TMI were entered into the Pennsylvania Department of Health Mother / Child Registry. The mothers and children they were
, _ carrying at that time have been monitored systematically to determine if they have experienced an unusual increase in cancer ,
incidence.
The analysis of cancer morbidity (incidence) among this group living in the area at the time of the accident complements the Department's analysis of ' cancer mortality data. The results of this special analysis are discussed in the Summary of Major Findings.
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ADDITIONAL CONSIDERATIONS / LIMITATIONS:
- 1. CORRECTION OF ERRORS IN PLACE OF RESIDENCE For selected small geographic areas, particularly ,
those located north, northwest, and west of the TMI facil-ity (down-wind during the early period of the accident), a special effort was made in this study to insure the accuracy of the place of. residence reported for each of the identi-fied cancer cases. Such care is necessary because mailing addresses are often incorrectly reported as residential addresses on mortality and cancer records.
l 2. FLUCTUATING STATISTICS FOR SMALL AREAS One should be aware that it is difficult to draw con-clusions based on small area statistics because of the inherent variability in the data and thus the increased probability of error in making inferences. In fact, mortal-ity and morbidity rates for small areas can and do fluctuate markedly from one area to another and from time to time within the same area. This normal fluctuation may create false impressions among lay observers about the importance of different rates from one time period to another or between one area and another.
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- 3. CANCER CLUSTERS
" Cancer Clusters" are frequently observed in community i
settings such as churches, schools, factories, or along !
certain streets. This is because cancer is a common disease
!. in the United States, with a life-time incidence of one case for every four to five people. With such a high frequency, it is not difficult to observe apparent " clustering" depend-L .
l ing upon how a geographic boundary is delineated or how the .
4 small area population at risk is identified and selected.
a.
l 4. CAUSE AND EFFECT RELATIONSHIPS It is tempting to attribute high cancer death rates or i an increase in cancer morbidity to those potential causative agents that would seem to be most apparent in a given place I
or time. The radiation releases from TMI are a case in 4
point. However, cancer can be caused by one or more of a variety of environmental and genetic factors such as: diet, .
tobacco, micro-organisms, radiation, food additives, occupa-l tional/ industrial exposures, host susceptibility, etc.
Because of the complexity of cancer etiology, one should not draw quick conclusions about cause and effect relationships.
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SUMMARY
OF MAJOR FINDINGS:
l 1. The results of moriality analyses provide no evidence that cancer mortality in the TMI area was significantly different 4 .
from expectation after the accident. On the contra'ry, the area covering a 20-mile radius from the plant was found to have had fewer cancer deaths than , expected during the 5-year period post-TMI,(7,924 observed versus 8,177 expected).
Analyses of data for several smaller geographic areas, regardless of distance and direction from the TMI facility, also showed no observed numbers significantly higher than expected. While in some instances the observed numbers of
- cancer deaths post-TMI were higher than expected, others were lower than expected, a sign of random variation.
- 2. TMI area cancer mortality data were also analyzed according to eight major anatomical site classifications. While recognizing the presence of random variations, there were no significant increases in any cancer sites, including leukemia and other radiogenic cancers. The nine leukemia j
deaths reported during the period January 1, 1979 through December 31, 1983 in four, selected MCDs (Fairview and Newberry Townships and Goldsboro and York Haven Boroughs),
compared to the three leukemia deaths of the pre-TMI period O
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might be viewed by lay persons to be of importance.
However, neither nine nor three deaths were significantly different from the expected number of six for the area. It i should be noted that one of the nine patients actually died before the accident and, of the remaining, two were diagnosed as having leukemia prior to the accident (in 1976 and 1978). 'In still another case,'the available clinical
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data suggest'that the. apparent onset of leukemia was noted by a physician well before the accident.
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- 3. In addition to analyzing deaths caused by cancers, the I Department also analyzed the number of newly diagnosed cases I
of cancer. According to Pennsylvania Cancer Registry data 1
for the July 1982-June 1984 period, there is no indication l
that the number of newly diagnosed cases of cancer was j significantly higher than expected for the four McDs. The differences between the observed and expected numbers of cases for these areas could have occurred by chance alone.
Furthermore, the total number of' radiogenic cancer cases
- observed in the four communities was not significantly greater than expected. In particular, leukemia, the most likely cancer that could'be detected as early as 5 to 6 years following exposure to radiation, was diagnosed in only two area residents while approximately four cases might have been expected. Again, these differences are not statis- l tically significant.
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- 4. The TMI Mother / Child Registry includes a study group of
, nearly 4,000 pregnant women who delivered between March 28, 1979 and March 27, 1980. These women were residing within a
- 10 mile radius of TMI and most of them were pregnant at the ,
time of the accident. This Registry is updated continuously and is linked to the Pennsylvania Cancer Registry file.
During the July 1982-December 1983 period, four of the 3,582 mothers (most of whom were residing in 14 southcentral ,
Pennsylvania counties) were diagnosed as having cancer. -
,, Based on the national cancer' registry data for females in the 10-44 year age group, 3.9 mothers might have been expected to be so diagnosed during this time period. Of the mothers' children, two were diagnosed with cancer, while one i
case was expected. Neither of these, differences is statistically significant. Thus, available information based on mothers and children presumably exposed to TMI m radiation gives no indication of a significant increase in cancer incidence at this time. -
CONCLUSIONS:
The results of our epidemiologic study, including both
- mortality and morbidity data,'do not present evidence of an increased risk of developing cancer by local residents living '
near the TMI nuclear facility.
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In view of the known long latency period from exposure to a cancer-causing agent and the development of cancer, however, and the persistent dispute over the amount of radiation releases from the damaged TMI nuclear reactor, it is prudent to continue epidemiologic surveillance of cancer around TMI. The Pennsylvania Department of Health established the mechanism for such an effort shortly after the 1979 decident and several long-term followup studies,of those who presumably were exposed to TMI radiation are in progress. .
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SUMMARY
OF EVALUATION OF THE AAMODT SURVEY:
i The results of a health survey conducted by a group of local !
residents (Aamodt survey) were made public on June 21, 1994. The Aamodt survey concluded that cancer mortality has markedly increased around TMI and implicated the 1979 nuclear accident at Three Mile Island (TMI) as being respon'sible. It covered three separate, small seographic. areas northwest of tha TMI facility, but provided little information regarding the survey design or
=- methodology. The demographic and cancer mortality data in the survey were very limited and incomplete.
Following its release, the Centers for Disease Control (CDC), U.S. Public Health Service, reviewed the Aamodt document at the request of the U.S. Nuclear Regulatory Commission. CDC identified a number of epidemiologic deficiencies in the data presented and concluded that the Aamodt survey does not present
" convincing evidence of increased cancer incidence; increased cancer mortality; or adverse pregnancy outcome in the TMI-area residents following the accident." In November, 1984, the Pennsylvania Department of Health was requested by the Advisory Panel for Decontamination of TMI Unit 2 to further evaluate cancer data presented in the Namodt Survey.
I The Division of Epidemiology Research of the Pennsylvania '
4 Department of Health was able to ascertain some additional infor-mation regarding the reported cancer cases. This enabled the Department to conduct a more thorough assessment of the Aamodt survey of cancer mortality.
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A re-analysis of the anta originally presented in the Aamodt '
survey, as well as additional data for the same general area procured by the State Health Department, does not support the l claim that' the TMI accident caused an increase in cancer deaths.
A number of methodological defects was noted in their survey.
l These defects and related comments are summarized as follows:
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- 1. The most import' ant and serious defect in the Aamodt survey is the selection bias which was introduced early in data .
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collection by the inclusion of only specific geographic
- areas (streets), households and individual residents while ignoring others equally qualified for inclusion. More
! specifically, there is evidence that such selection was influenced by the pre-existing knowledge of cancer deaths, j i.e., only those streets where cancer deaths were known to be present were chosen, ignoring other streets in the same area where no cancer deaths were reported. Because of this i selection bias, the results of the Aamodt analyses are .
invalid.
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- 2. The Aamodt survey claims a causal relationship between radiation resulting fromIthe March, 1979 accident at TMI and cancer in the areas they surveyed. This claim, however, is based on mortality data, which, by themselves, are of l limited value in establishing such a relationship. The l
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Aamodt survey provides very little information regarding q essential cancer incidence data.
- 3. The Aamodt survey differed with the concept of latency in radiogenic cancer. Yet, leukemia is probably the only cancer for which one reasonably could expect to see an l increased incidence within five or'six years post-TMI (even if the disputed' doses.of radiation releases were in fact high enough to cause it). Other forms of radiogenic cancers -
} ,, may not be observable for at' leant 10 to 20 years or more
- after the initial exposure to high doses of radiation.
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- 4. Existing epidemiologic studies indicate that certain speci-fic forms of cancer are more likely to occur following expo-sure to high-dose radiation. When many different types of cancer are observed, as is the case with the Aamodts' 4
reported cancer deaths, it suggests an absence of a single causal relationship. -
- 5. Age and sex distributions of the local populations under
- study are important factors to consider when evaluating
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cancer mortality. The Aamodts' survey did not take these sensitive factors into account.
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- 6. Unless supplemented by other data, cross-sectional mortality data are not adequate for establishing a causal relationship between cancer and TMI radiation because many people have moved out of and into the area since the accident. The former residents should be included, and the newcomers excluded in any scientific attempt to determine whether there is a ' connection between cancer mortality and the accident at'TMI. The.Aamodt survey did not address this problem.
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- 7. The expected numbers of cancer deaths presented in the Aamodt survey are for a five-year period. The 20 " actual cancer deaths" reported by the Aamodts, however, include persons who died during a five year ten and a half month time period - a discrepancy, which given the limited population survey could have had a significant impact on their claimed death rate.
- 8. The Aamodt survey attributed an alleged increase in cancer mortality to the TMI accident. Of the 20 originally reported deaths, one died before the accident in 1978; one who died of a cause other than cancer was apparently confused with a relative who died of cancer prior to the accident; six were diagnosed as having cancer prior to the accident; and two were long-term heavy smokers who died of i lung cancer. The remainder represented a variety of cancers normally found in any populatien group.
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_ TABLE OF CONTENTS CANCER MORTALITY AND MORBIDITY (INCIDENCE) AROUND PAGE I.
Introduction...................................'...... 1 II. Methods and III.
Materials................................ 3 Results.............................................. ,
7 A.
General Population Characteristics............... 7 B. Canc'er Mortality................................. 10
- 1. Overall Cancer Mortality by MCD:
20-Mile i c. Radius............................... 10 2
Site-Specific 10-Mile Cancer Mortality:
Radius............................... 11
- 3. Overall Cancer Mortality by Direction from TMI: MCD...................... 12 4
Four Selected Communities:
Downwind from i
TMI............................ 13 S.
TMI Census Enumeration Districs Downwind from TMI................(CED): . . . . ........ 15 C. Cancer Morbidity:
- Incidence...................... 16 D. TMI Mother / Child Re Cohort Follow-Up...gistry: -
.............................. 21 IV. Summary and Conclusions.............................. 23 i
AN ASSESSMENT OF A CANCER MORTALITY SURVEY IN THRE SELECTED BY LOCAL RESIDENTS NEAR TMI I.
Background........................................... 1 II.
III.
Methods..............................................
3 4
Results.............................................. 5 l A.
Demographic Characteristics...................... 5 I
- 1. Minor Civil Divisions: McDs.................. 5 4
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T5I Census Enumeration Districts: CEDs....... 6
- 3. Survey Areas selected by Local Residents.....
4 6 B.
Cancer Mortality in Three Selected Areas. . . . . . . . . 8 IV. Discussion, Evaluation and Critique..................
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CANCER MORTALITY AND MORBIDITY (INCIDENCE) ARO 7 I. _ INTRODUCTION j
More than six years have elapsed since the March 28, 1979 accident at the Three Mile Island (TMI) nuclear power plant.
- Since the accident, concerns about.the potential impact of radioactive substance releases on cancer incidence have been a subject of considerab1e' attention.
These concerns have been -
! fueled by a recent review of radiation dose assessment conducted i at the request of the TMI Public Health Fund and a survey of cancer mortality carried out by a group of citizens who focused on sections of communities near TMI. (1)
I Government reports published earlier of radioactive sub-stance releases and population exposures following the accident indicated that the radiation exposure of TMI area populations was very small and that future health effects would be minimal. With respect to the long-term health effect, it was projected that the number of cancer cases and genetic abnormalities over the life-,
time of the some 2,000,000 persons living within 50 miles of the plant would be too small to be detectable.(2)
The purposes of the present study are to determine if there is sufficient epidemiologic evidence to indicate that cancer t mortality and morbidity in communities around TMI show abnormal
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patterns recardless of the level of radiation releases, and that
' any substantial excess cancer cases, if observed, are consistent with the existing theory of radiation carcinogenesis.
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.. s-The Pennsylvania Department of Health monitors cancer mortality for the 2,580 minor civil divisions (MCDs) within the State and conducts epidemiologic investigations of potential problem areas.
Since the 1979 nuclear accident, the TMI area has been the subject of more intensive monitoring for several reasons including, (a) the continuing health concerns of area residents, (b) a general widespread interest in the situation ,
and (c) offi-cial requests by the Advisory Panel for Decontamination of TMI Unit 2 and the TMI Public Health Fund Advisory Group for further e.
evaluation of cancer mortality and morbidity in certain TMI area communities investigated by local residents.
Now that the minimum latency periods for certain forms of cancer, such as leukemia, might have been reached, it is reasonable to consider possible long-term health effects of the accident, particularly the incidence of cancer in the area.
Furthermore, it was only recently that the cancer incidence data .
necessary for an acceptable assessment of cancer problems in the area, became available from the Pennsylvania Cancer Registry which was instituted in south central Pennsylvania in July1982. ,
The present study covered both cancer mortality and morbid -
ity and the results presented include the following aspects:
(a) comparison of the observed and expected numbers of cancer deaths, (b) comparison of the observed and expected numbers of newly diagnosed cancer cases, and (c) assessment of the followup incidence (newly diagnosed cases) of cancer'within a defined population (cohort) presumably exposed to the TMI accident
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., s' radiation. Considered for the cohort analysis at this time.are pregnant women and their fetuses who were residing within the ;
i ten-mile area at the time of the accident for whom accurate cancer incidence data have been made available.
{ II. METHODS AND MATERIALS
- The routine monitoring of cancer mortality in the TMI area has focused on all 35 minor civil divisions (MCDs) within -
- ten miles of TMI. -
3 The data used in monitoring cancer mortality in MCDs in the j
TMI area include: (a) enumerated MCD populations by age, sex, and race from decennial United States censuses of populations (b) intercensal and postcensal population estimates (total popu-i lations only) developed by the Pennsylvania Department of Health i
and other governmental agencies; and (c) cancer mortality data by age, sex, race and site from the State Health Data Center, Pennsylvania Department of Health, which is responsible for the ,
state vital statistics registration system.
The time periods covered in this mortality study include a five-year pre-TMI period (1974-78), and a five-year post-TMI period (1979-83).a) Death rates (such as number of deaths per i
100,000 population) are not presented for individual geographic i
i areas because, when based on very small populations, as several l
are, single deaths can result in rates that,cannot be reasonably compared with normative rates based on large populations.
a)
! For purposes 1974 of this report the pre-TMI period is January 1, through December 31, 1978 and the post-TMI period is January 1, 1975 through December 31, 1983.
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Instead,
" expected" or theoretical numbers of deaths that would be expected under normal conditions were computed for com-parison with the observed numbers of deaths in each MCD. These include expected numbers for eight major cancer categories . The expected numbers of cancer deaths are those which would have been expected if the communities under study had the same age-sex-specific cancer mortality experiences as Pennsylvania as a whole during the 1979-81 period.
i More specifically, the expected numbers of cancer deaths are those which would have been expected if each age-sex population group in the communities under study had the same cancer mortality experiences as did the Pennsylvania population in that age-sex group between 1979 and 1981, and if the community's population remained the same in size (and in age-sex distribution) as it was at the time of the census in 1980.
It is important that the expected numbers be computed in this manner because cancer death rates vary according to age and sex.
The age-sex-specific population data needed to compute expected numbers of deaths specifically for the 1974-78 and 1979-83 periods were not available for the study populations .
Thus, period-specific expected numbers of deaths could not be
- computed.
Cancer morbidity data for a two-year period (July 1982-June j 1984) have recently beccme available for 14 counties in South l Central Pennsylvania, including the TMI areas.
i As in th.e i
mortality analysis, the expected numbers of new cancer cases were computed on the basis of 1980 U.S. Cencus population data and on normative cancer incidence data (1978-1981). frem the
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Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute. SEER data are used as the " standard" because Pennsylvania Cancer Registry data are not yet available for the State as a whole.
Population data developed from the special 1979 census, which included all households within an approximate five-mile radius of TMI, are also available for use in special investiga-tions.
These data' permit the assessment of cancer morbidity and mortality in Census Enumeration Districts (CEDs), smaller areas .
EO within each minor civil division under study.
These special census data have been supplemented by popula-tion data from the 1979 school census in certain minor civil divisions. While school census data do not provide the detailed information available from the special TMI Census, the informa-tion provided proved to be extremely valuable when the areas of interest lie beyond the five-mile limit of the TMI Census.
In order to utilize data from the TMI Census for studying areas which do not conform to the Census Enumeration Districts *
(CEDs),
field visits were necessary to determine the specific geographic boundaries of interest. This is particularly true when rural areas are involved and street addresses are not available. '
Mortality studies and investigations conducted in Pennsylvania, which are residence-specific, are complicated by
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the frequent incorrect reporting of actual residence on vital records.
This problem, of minor significance at the county ;
level, can, in many instances, be one of the most important 1
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i factors to be considered in evaluating the mortalit y and morbid-ity rates for specific MCDs.
j The problem, which tends to result L-in arti.ficially inflated rates for cities and borou h g s and l
reduced rates for townships, stems from a frequent s on of confu i I mailing address, by the persons providing information , with actual place of residence.
Since post offices are usually i located in cities or boroughs through which all mails are i
delivered, in' dividuals' associate mailing addressplace with of -
residence and report it as the place of residence on vital
, records.
The ascertainment and correction of incorrect ence r information, although difficult and time consumin i
g, is necessary in the assessment of health problems in small areas .
The statistical significance of the differences be tween i
observed and expected cancer morbidity and mortality essed was a by computing standardized mortality and morbidity rati os (SMRs) and testing for significant departures from unity using th e
Poisson model.
i As previously stated, the expected numbers of cancer eaths d !
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4 are based on the Pennsylvania cancer mortality experience i
1979-81, ,
by age and sex, and the distribution (agee s x) of the study populations at the time of the 1980 Census ofon. Populati Thus, the expected numbers of cancer deaths
! , based on normative
, data for the 1979-81 period can more appropriately be compared with observed numbers for the post-TMI period than for the pre-TMI period.
TheobservednumbersofcaEcerdeathsforthe pre-TMI period are provided for reference purposest however ,
i differences between the pre- and post-TMI observed ,
ures shocid fig i
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not automatically be attributed to TMI. As a matter of fact, the observed numbers for the pre-TMI period are likely to be lower '
j than the expected numbers. In contrast, the observed numbers for i
I the post-TMI period are likely to be higher than the ~ expected numbers for the following reasons:
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-- The population in many of the areas under study increased substantially over this time period. j
- L 1 -- There is a continuing in Penns'ylvania and elsewhere. general increase in cancer mortality !
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-- Diagnostic techniques and opportunities are improving. !
-- The population is aging and with age comes an increase in cancer incidence and, ultimately, mortality. 1 I !
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The expected numbers of new cancer cases (incidence) were i F
based on incidence data by cancer site, age, and sex from the i 4
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' Surveillance, Epidemiology and End Results (SEER) program ,
i (1978-81) of the National Cancer Institute and population data I .
from the 1980 census. i Since the observed numbers of new cancer !
cases in the study populations are for a later period, July 1982--June 1984, caution again must be exercised in interpreting
{ the data.
i Factors such as population growth or decline; improved j
cancer reporting systems; improved diagnostic techniques and- ,
opportunities; and aging populations, as well as actual changes '
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in cancer incidence can have an impact on the results.
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f i III. PESDLTS I
A. GENERAL POPULATION CHARACTERISTICS i
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i The TMI ten-mile area which includes 35 minor civil t divisions and portions ef five counties (Cumberland,
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Dauphin, Lancaster, Lebanon and York) had an enumerat e d
population of 289,930 in 1980 The TMI five-mile area, with a population of 64,897 in 1980 includes 13 minor c divisions in three counties (Dauphin, Lancaster
, and York).
The population of the TMI ten-mile area increased by t
7.3 percent from 270,306 in 1970 to 289,930 in 1980 (the '
population of Pennsylvania increased by 0.6 percent).The population .in the five-mile area, however, increased by 31.3 percent, from 49,410 to 64, 897, while the populati on
- in the five to nine mile band increased by only 1 9 per . -
centr from 220,896 to 225,033.
Only two of the 13 minor civil divisions in the five-mile area lost population during the decade and these were relatively minorses decrea in small boroughs (Royalton and Goldsboro) .
The popula-tions more of25seven than percent. of the 13 minor civil divisions e y in The population of East Manchester
' Township increased by 105.4 percent, from l',735 to 3,564, while Newberry Township's population increased by 68 1 .
percent, from 5,978 in 1970 to 10,047 in 1980 The popula-tion of seven of the 22 minor civil divisions ve in the to nine mile area decreased between 1970 and 1980 (six were boroughs, the other was Harrisburg City) but seven municipalities experienced population increases of 25 percent or more.
One, Conewago Township, increased by 119.8 percent, from 1,124 to 2,471. '
Lewisberry Borough experienced the greatest relative population decrease , 36.9 percent (from 490 to 309),
but Harrisburg City, whose
-p_
i 1 'F i
I population decreased by 21.7 percent, had the greatest absolute decline, 14,797 (from 68,061 to 53,264). The I i
population of the five to nine mile area, exclusive of Harrisburo, increased'by 12.4 percent between 1970 and j
- 1980s with Harrisburg, the increase was only 1.9 percent.
} In 1980, the median ages of the populations of the '
i l
i 35 minor civil divisions within ten miles of TMI ranged i from 27.3 years for Conewago Township to 40.0 years for ,
Paxtang Borough. Both are in Dauphin County.
l The median l ages of the populations of ten of the 13 minor civil i
! divisions in the five-mile TMI area and 17 of the 22 in .
the five to nine mile area increased between 1970 and i i
} 1980. Since cancer morbidity and mortality generally a
{
! increase with age, it might be expected that certain e 1
j increases in cancer morbidity and mortality during the decade of the 1970's would be. associated with the aging
- of the population. *
! L In 1970, 25,822 or 9.6 percent of the 270,306 residents i ,
i of the TMI ten-mile area were nonwhite. By 1980, the num-ber had increased to 33,627; the percentage to 11.6.- of !
j the 33,627 nonwhites in the area, 25,074 (74.6 percent) i i
resided in the City of Narrisburg; 2,079 (6.2 percent) in Lower Paxton Township; 1,833 (5.5 percent) in steelton
. i t
Borough; 1,619 (4.8 percent) in Swatara Township; 598 (1.8
(
percent) in Derry Township; and 571 (1.7 percent) in I
Middletown Borough. Thus, only about five percent of the ncnwhite population resided in the other 29 TMI ten-mile 4
1
. 1 l
. 5 area communities.
More than 47 percent of the population of Harrisburg City and 28 percent of the population of Steelton Borough were nonwhite in 1980 The only other communities in the area with nonwhite populations in excess of five percent were swatara Township (8.6 percent), Lower Paxton Township (6.0 percent), and Middletown Borough (5.6 percent). '
All are located in Dauphin County.
B. CAhCERMORTAL'ITY 1.
Overall cancer Mortality by Minor civil Division
- a. 1MCD): 20-Mile Radius The monitoring of cancer mortality in the TMI area by the Pennsylvania Department of Health, as previously stated, focuses on 35 minor civil divisions (MCDs) within ten miles of the nuclear facility, but periodi-cally includes communities in a 20-mile area. This monitoring includes an annual comparison of observed and expected numbers of cancer deaths, total and selected cancer sites, in individual a.nd grouped MCDs.
TABLE 1 shows the numbers of MCDs, the popula-tions, and the observed and expected average annual numbers of cancer deaths for Pennsylvania and geo-graphic areas at specified distances from TMI during a pre-TMI five-year period (1974-1978) and a post-TMI five-year period (1979-1983).
The grouped MCD data by distance from TMI provide no indication of excess cancer mortality in geographic areas up to 20 miles
- . . . , ~. .
distant from TMI. The similarity between the observed and expected numbers of deaths, particularly for the post-TMI period, is remarkable. The observed numbers for the pre-TMI period are somewhat lower than the expected numbers but are of no particular signifi-cance. The observed average annual number of cancer
- deaths in the 10-19 mile ring for the post-TMI (1979-1983) period was lower than expected, and the observed and expected numbers for the 5-9 mile band and
,, the five-mile radius areas were quite similar.
While the average annual number of cancer deaths among Pennsylvania residents increased by 8.5 percent from the 1974-78 period to the 1979-83 period, in-creases such as this are not limited to Pennsylvania.
i For example, the average annual number of cancer deaths of the United States increased by 12.1 percent during the same time periods. Such increases in the actual numbers of cancer in recent years are a reflection of' i
many factors, including environmental carcinogens in addition to size and characteristics, particularly aging, of the population. The potential influence of the various cance"r causing agents, however, are not accounted for in the observed-expected methodology used in this study.
- 2. Site-Scecific cancer Mortalitv Ten-Mile Padius TMI ten-mile area cancer mortality data for eight major cancer site classificatiens are presented in l
__ . __ ~- ~~ _. .-
, TABLE 2 P
The specified cancer sites are: buccal cavity and pharynx; digestive organs and peritoneum; I respiratory system; bone, connective tissue, skin and breast; genitourinary system; other and unspecified sites; leukemia; and other lymphatic and hematopoietic tissue.
The variations from expectation, higher or lower, in these site-specific data are nominal for both time periods under study and have no particular epidem-
. iologic importance.
3.
Overall Cancer Mortality by Direction from TMI:
Minor Civil Divisions It has been alleged that, because of the wind direction at the time of the major radioactivity j
release from TMI, cancer mortality has increased in the population to the northwest (downwind) of the facility.
TABLE _3_
shows cancer mortality data for TMI minor civil divisions grouped according to general direction quadrants from TMI.
For each quadrant, the observed '
average annual numbers of cancer deaths for both the pre-TMI and post-TMI periods approximate the expected numbers.
i The average annual numbers of deaths for Goldsboro and Highspire Boroughs are higher than t
expected both before and after the accident. On the other hand, the average numbers of deaths for other communities, such as Londonderry, West Donegal, Conewago, Newberry, Fairview, and Lower Swatara, are lower than expected both before and after the
.1-m,__ - , . _ . . ,_ - _ _ , - - _ , _ _ , - . -- - ___y..
accident. Such variations in mortality are commonly observed when the population bases under study are relatively s=all.
4.
Four Selected Communities: Downwind from TMI Following the release of results of the health survey conducted by local citizens, which reportedly show'ed excess. cancer mortality in selected areas within York County, availab1e cancer mortality data for four area minor civil divisions were reviewed to determine if there was any evidence of a cancer mortality problem ,
in these survey areas. Using 1979 TMI Population i
Census data, the actual place of residence of each post-TMI cancer decedent was determined. Presented in TABLE 4 are residence-corrected overall cancer mortality data pertaining to Fairview and Newberry Townships and Goldsboro and York Haven Boroughs for the post-TMI period. As shown in this table, the observed' average annual number of cancer deaths in each MCD was remarkably close to expectation when necessary corrections were made on residential addresses. The observed average annual number of deaths for Goldsboro Borough was 1.0 and the expected number was 0.9, while the respective observed and expected numbers for York Haven Borough were 1.0 and 1.2. dnannualaverageof 16.6 deaths was observed in Fairview Township, and
,-,n- , - ,.- - - - , , , . -
, , - , , . , - - _ ~ - - - . - - ,
16.5 was expected.
In Newberry Township, an average of t 12.2 deaths per year was reported, while 11.9 was expected. ,
a a
It was of further interest to examine how overall
!l cancer mortality fluctuated each year within these four i
selected communities. TABLE 5 shows the actual number i of resident cancer deaths 'for the selected communities I for ,each of the five years, beginning with 1979. These !
{
i numbers appear to reflect random-like variations in
- cancer mortality.
! TABLE 6, which provides data for the combined pop- l i
ulation of the same four MCD area according to cance:
site, includes grouped data for both the pre-TMI and i
post-TMI periods. As shown in this table, the site-i specific number of cancer deaths generally approximate i
expectation within the limits of random variation. The i
j numbers of site-specific deaths, even for an entire j
five-yearperiod,.aresometimesverysmailandone .
i should be aware that one or two deaths, more or less,
- can have a marked effect on mortality ratios, but be of i
} no particular significance. '
i '
The fact that- nine leukemia deaths were r eported during the five-year post-TMI period in the fcur l
- i. !
selected McDs, compared to three leukemia deatis in the .
l pre-TMI period, might appear to b of importance. How- I ever, neither nine nor three deaths are significantly l
i i
\
.,.-w,4-+---e---. ---- - ...--, -.-----,~---,,,--..-----3.---, -
,.m--,%.%,,,.--~~~----,,-,r------ . , . ~ - -
- ' ^^- -
different from the expected number of six for the area.
It should be noted that one of the nine patients actually died before the accident, and two others were diagnosed as having leukemia prior to the accident (in .
1976 and 1978),
and consequently, these deaths cannot be attributed to TMI. In still another case, the available clinical data s'uggest that the apparent onset of. leukemia was noted by a physician well before the accident. '
,o 5 TMI from Census TMI Enumeration Distriets (CED): Downwin_d The smallest geographic entities in the TMI area which can be studied with a reasonabir degree of Precision (in a statistical sense) are t.he Census Enumeration Districts (CEDs) delineated in the special i
1979 TMI Census which covered the entire population I residing within approximately five miles of TMI. There are 15 CEDs in Fairview and Newberry Townships, the downwind minor civil divisions of immediate concer .
Only two of these CEDs are in Fairview Township, the other 13 are in Newberry Township. TABLE 7 presents population data and average annual observed and expected numbers of cancer deaths for the post-TMI (1979-1963) period for these small geographic areas .
The CEDs are grouped to show data for the two township according to the directional qua'drants in which they
-1!-
lie.
The observed and expected average annual numbers J.
of cancer deaths for all 15 CEDs combined are quite comparable (10.8 observed and 11.6 expected).
Similarly, the deviations in the figures for the Northwest (7 CEDs) and Southwest (8 CEDs) quadrants are small and negligible. The mortality ratio for the i
, Newberry Township CEDs in each of the two quadrants is 0.85[thatis,'observedmortalitywaslessthan
. t i expected. The mortality ratio for the two Fairview l ,.
t Township CEDs,. which had a combined population of only r
710 residents, was 1.80 (nine deaths observed, an estimated five expected). None of these ratios is indicative of a significant departure from expectation.
In summary, the data analyzed thus far provide no indication that cancer mortality in Tni ar.s minor civil divisions, including much smaller area's within a
them, differed significantly from expectation during the five years following the March, 1979 accident at TMI.
B. CANCER MORBIDITY: INCIDENCE Population-based cancer incidence data were not. avail-able for Pennsylvania communities prior to July 1, 1982.
It was then that the Pennsylvania Cancer Registry became I
l i operatienal in South Central Pennsylvania, which includes the TMI area. While the Cancer Registry can now provide i
s ;
- morbidity data, there is a data gap from the time of the l
accident, March, 1979, through June, 1982. However, this Cata gap may not be considered serious in view of the fact that radiogenic cancers are not expected to be observable within a few years post exposure. Even leukemia, which is known to have a short latency period, is not likely to develop until at least five to six years following the initial e'xposure. Since six years have passed, early Registry data should be ex,amined for possible new cases of
- o cancer.
l The use of Pennsylvania Cancer Registry data in epi-demiologic investigations is relatively new. However, cancer incidence data for the four MCDs (Fairview and Newberry Townships and Goldsboro and York Haven Boroughs) were made available for special analysis.
The results of the'special analyses, which include the
~
period July 1, 1982 through June 30, 1984, are presented in
- TABLES 8, 9, and 10. The expected numbers of new cancer cases for this period are those which would have been i
expected if each age-sex population group in the communities under study had the same cancer incidence as did the SEER program population in that age-sex group during ,the years 1978-81, and if the community's population remained the sams in size (and age-sex distribution) as it was at the time of the 1980 census. $'n no instance did the i
observed numbers of newly diagnosed tancer cases shown in these tables significantly exceed the expected numbers,
(
, . . .. - - . - - - - -. __._.7 _
J
{
. [
{ i.e.,
the differences between the observed and expected numbers could have occurred by chance alone. Specifically, the observed number of newly diagnosed cancer cases among residents of the combined four MCD area during this ,
i two-year post-TMI period was 133 as compared with 121.4 i expected (TABLE 6) .
The observed number of new cases was less than expected for Fairview Township (61 observed and i
65.6 expected) and there was virtually no difference -
) between the observed and expected numbers for Goldsboro l Borough (4 observed and 3.9 expected). The observed and
'! i i
expected numbers of newly diagnosed cancer cases for York i
j 4
Haven Borough were 8 and 4.5, respectively, while the 4
j respective numbers for Newberry Township were 58 observed 1
{
1 and 47.8 expected. Again, these differences in the j
incidence of cancer are within the limits of random !
variation and not statistically significant at the 5 1
percent level. The exact place of residence of two cases ;
)
i .
could not be determined but they are included in the area total. i
- 1 4
TABLE 9 shows. for the same July, 1982 through June,
- 1984 period, observed and expected numbers of cancer cases I fe for 19 primary cancer sites (organ systems first affected)
, f 1
among residents of the total four minor civil division area ~
l j
and Fairview and Newberry Townships, combined and I l separately. The numbee of cancer cases of specific sites among residents of Goldsboro and York Haven Boroughs are i j
1 shown in the ' NOTES" section of the table. The expected
]
- - E-i 1
._- a e
. s numbers are not presented for these two boroughs because the numbers for specific primary cancer sites are too small
- for meaningful comparison. Of 19 different cancer sites considered, the observed numbers for the entire four minor civil division area were lower than expected for 11 sites, whereas the observed numbers were higher than expected for eight others. Among these eight cancer sites, the relative differenc'es between observed and expected were nominal and could be demonstrated in any set of random numbers
- o. subjected to multiple tests of significance. Similarly, the observed numbers for Fairview Township were lower than
, expected for 10 cancer sites and higher for nine others while for Newberry Township the observed numbers were higher for 12 sites and lower for seven others, some of the differences were very small and none was significantly different from expectation. The occurrence of specific
~
cancers among residents of Goldsboro and York Haven also appears to be randomly distributed. The 12 newly diagnosed cancer cases in these two communities include cr.ncers of 1
eight different primary sitos. The only cancer for which more than one new case was reported in either of these two boroughs was breast cancer. Three York Haven women were diagnosed as having breast cancer during the two year period; this was not significantly more than expected.
AnadditionalanalysiswasmadeEftenspecific radiogenic cancers (TABLE 10) . Thes'e are cancers, such
__ n , ~,
as leukemia, which are more susceptible to the injurious i '
l.
action of radiation. For purposes of this report, the following cancers were considered (although there is still some disagreement regarding degree of radiogenicity of certain of these): esophagus, stomach, colon, pancreas, lung, breast (female), thyroid,,non-Hodgkin's lymphomas, multiple myeloma, and leukemia. The number of such cancers that would have been expected to be diagnosed among i
residents of the four subject minor civil divisions during I '
the two-year period July 1982-June 1984 is 64.2 70 cases i
were actually diagnosed. Twenty-six residents of Newberry l Township were diagnosed as having these cancers; 25 were expected. The respective observed and expected figures for Fairview Township were 36 and 34.9. Goldsboro and York Haven Boroughs are too small in their populations for the computation of meaningful expected numbers of new cancers
~
{ by specific sites but overall, seven were observed and j about four to five were expected.< None of these differences was statistically significant. These data do not provide any consistent indication of a possible j radiation-related cancer problem. According to the j
i existing literature, leukemia is the most likely cancer to be detectable five to six years following exposure to high dose radiation. Two leukemia cases were diagnosed in the
~
j four minor civil division area and three to four were l expected. There was one case each in Fairview and Newberry Townships, but none in Goldsboro or Y,erk Haven Boroughs.
1
.f(
f l For some other forms of radiogenic cancer, more cases were reported than expected (e.g., colon, breast and non-Hodgkin's lymphomas) but for others there were fewer. ,
As already stated, these data are not indicative of a t
radiation related cancer problem in the area. Although the post-TMI observed number of newly identified cancer cases (133) is somewhat higher than the expected number (121.4)
~
. and although the observed number of radiogenic cancer cases (70) is somewhat higher than the expected number (64.2):
= - --
none of the differences, overall or for specific minor civil divisions or specific cancer sites, is statistically significant at the five percent level; leukemia, the type of cancer most apt to show any abnormal pattern the earliest, had in fact fewer cases observed than expected; there are several r'easons why the observed numbers are apt to be higher than the expected numbers, including general increases in cancer, population growth, better '
4 diagnostic techniques, improved cancer reporting, and an aging population.
D. TMI MOTHER /CRILD P GISTRY: COHORT FOLLOWUP The Mother / Child Registry includes a study group of nearly 4,000 pregnant women who delivered between March 28, 1979 and March 27, 1980. These womeh resided in the TMI l I
i I
ten-mile communities and were pregnant at the time of the accident or they became pregnant within a few months of the accident. The Mother / Child Registry also includes a com-parison (control) cohort of nearly 4,000 pregnant women i
who delivered one year after the study cohort, between March 28, 1980 and March 27, 1981. The Registry is updated continuously.to insure current information for each mother and child re~gistrant on a number of variables for use in -
a variety of followup studies. Linkages are being established with the Pennsylvania Cancer Registry, the Pennsylvania Mortality File, the National Death Index, and out-of-state cancer registries, to identify those regis-1 trants who have developed cancer since the 1979 accident.
During the period July 1, 1982 through December 31, 1983, four of the 3,582 mothers in the study group, most of whom resided in 14 South Central Pennsylvania counties, J .
were diagnosed as having cancer. Based on data from the .
Surveillance, Epidemiology, and End Results (SEER) program (1973-1977) for females in the 10-44 year age group, 3.9 j
i mothers might have been expected to be so diagnosed during
( this time period. The. primary cancer sites of these four patients were two colon, one brain, and one skin (trunk) .
During this same period, two of the study children i
under five ye:rs of age were diagnosed as having cancer; l
i about one case would have been expected en the basis of the SEER data; this small difference can occur by chance alone.
t .
12-
,, e- , -- ,w- a-r , , -,,,,,w-m ~, , -- e ,n -, ,--e n- - -e, - - - ,-,-- , - -- ,.,,---n n -m.mm--- +s - - -----eer,., - ----, ,
IV.
SUMMARY
AND CONCLUSIOES l
More than six years after the 1979 accident at TMI, both cancer mortality and morbidity were examined. Comprehensive analyses of the available data included comparisons of the observed numbers of cancer with the expected numbers for a series of geographic areas, from a 20-mile radius down to small Census Enumeration Districts around TMI. Because of the potential importance of wind direction and radioactive plume dispersion during the early days of the accident, data also were analyzed a.
with emphasis on the northwest and southwest quadrants. Also considered were the distribution by cancer sites for both living and deceased patients, as well as possible predilection for any radiogenic malignancies within expected latency periods.
Furthermore, the incidence of newly diagnosed cares of cancer was evaluated among those women who were pregnant a't the time of the accident and among their offspring.
While cancer mortality data are useful for certain pur-poses, they are severely limited when the time gap between 4
exposure and observation point is shorter than the time gap between initial diagnosis and death. In contrast, incidence data are far more appropriate in assessing possible linkage between environmental risk exposure and carcinogenesis. The most effec-tive method to be used in such an investigation is the prospec-tive cohort followup study of the population actually exposed to the specific environmental risk under study.
t h
I l . . , _ - _ - - _ . . ~ .. --- -. - - -- --
r The results of our epidemiologic study, including both mor-tality and morbidity data as well as cohort followup analysis, do not provide evidence of increased cancer risks to residents near the TMI nuclear facility.
In view of the known long latency of carcinogenesis and the persistent dispute over the amount of' radioactive releases from the damaged TMI. nuclear reactor, it is prudent to continue epi-demiologic surveillance around TMI. The Pennsylvania Department
,, of Health established the mechan' ism for such an effort shortly after the 1979 accident and several long-term followup studies are already in progress.
i i
1
_ .m . _ __
REFERENCES (1)Aamodt, M.M. and Aamodt, N.O. Aamodt' motions for investigation of licensee's reports of radioactive releases dur-ing the initial days of the TMI-2 accident and postponement of restart decision pending resolution of this investigation. Pre-sented to United States Nuclear Regulatory Commission, June 21, 1984.
(2)Ad Hoc Population Dose Assessment Group: Population dose and health impact of the accident at the Three Mile Island nuclear station. U.S. Government Printing Office, Washington, D.C., 1979, p.3. ,
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- TABLE 23 OBSERVED Am EXPECTED AVERA::E ANNUAL W M ERS OF CANCEA DEATHS BY KITE: TMI TDHCLE AREA, 1874-78 AND 1979-63 Average Annual Nueber of Cancer Deathe Mortality Retto Cancer Site I Observed!2) [0bserved/Espected)
(Ninth Revision, Internettonal Ctessif testion of Oteesses) Code hur.ber ExpectedIII 1974-78 1979-43 1874-78 1979-43 AlL S1tes 140-208 581.7' 557.5 578.4 0.98 0.99 Buccal Cavity and Pharynn 140-149 10.8 11.2 11.0 1.04 1.02 Dig stive Orgens and Perttonom 150-159 1 65.5 148.2 155.6 0.08 0.94
" hspiratory and Intratherecic Orgens 160-165 140.8 129.4 133.0 0.92 0.95 Sine, Connective Tissue. Skin & Breast 170-175 86.1 84.8 73.2 0.98- 1.11 G:nttourtnery Organs 179-169 R5.7 85.5 B0.4 1.00 1.05 Oth2r and Linspecified Sites 190-199 54.7 E8.4 84.2 1.08 0.99 Lsukente 204-2Ca 21.5 17.0 22.4 0.79 1.04 Oth2r Lyrphetic & Hematcpotetic Tissue 200-203 29.5 35.2 20.5 1.19 0.97
~
M:TES: III Espected nebers of concer doethe based on the age-sem distributtone of TMI Ten-Mile Aree einer etvit division populations,1980 U.S. Census of Population,
- and everage annust ege-ses specific concer doeth rates, Pennsylvente, 1979-41 The expected everage annual number of deaths for concer of ELL sites (581.7) does not equel the suenetton of espected doethe for specific sites (5B4.4) because the ett sites total wee computed on the beste of sweeery population date (by age-ses) l for the entire THI Ten-Mile Area, as ese done for other erees in Table 1, ohtte the espected numbers for specific sites were obtelnen by suneing the espected nebers for each of the 35 ainer civil divisione in the area.
i
- III Source of observed numbers of deaths
- State Health Data Center, Pennsylvente Department of Health. These date are not corrected for incorrect residence
- reporting on death certificates.
f f
i l
l i
i (TASLE 2 DATA ARI c2S USSEL ON PAGES 11 AC 12 cc THE TEXT.)
I s
. , , . , - . - ~ , - . _ . _ _ , - - _ . _ ._. -
._,.,_e
l
. ~
l
. 1 I
l TABLE 3: DSSERVED AND EXPECED AYERACE ANNt1AL htDeER OF RESIDENT CANCER DEATHS FOR '
TMI AREA MIM:R CIVIL DIVISIONS BY GENEAAL DIRECTION FROM TMI, 1974-78 AND 1879-93 Average Annuet Number of Cancer Deathe Mortality Retto ObservedI3I (Observed /Espected)
Eineret Direction from Pnpulation TWI/ Minor Civil Division 1980I13 Espectog(2) ggy4 78 1979-83 1974-73 1979-33 TMI Area MCDs 54,897 112.1 102.8 105.4 0.92 0.95 .
N2rthoest Quadrant 18.241 31.1 30.8 30.8 0.99 0.99 Londonderry T. (Deuphin Co.) 5,138 7.5 5.4 7.4 0.35 0.99
- Mideletown B. (Deuphin Co.) 10,122 21.5 2.2.4 21.8 1.02 1.00 Royetton 8. (Deuphin Co.) 981 1.7 2.0 1.8 1.18 0.94 Southeast Quadrant 11.481 27.9 24.0 27.4 0.98 0.98 Coney T. (Lancaster Co.) 2,309 3.7 3.3 3.8 1.03 1.03 rest Doneget T. [Lancaster Co.) 4,282 15.4 12.5 14.8 0.77 0.90 East Manchester T. (York Co.) 3,584 5.8 5.4 7.8 0.82 1.10 Yark Haven 5. (York Co.) 748 1.2 2.2 1.0 1.83 0.83 EIuthwest CA,edrent Conewego T. (York Co.) 4.979 7.5 S.2 5.4 0.83 0.72 SIuthweet/Northeest Quadrants heeberry T. (York Co.] 10.047 11.9 11.5 11.4
. - 0.97 0.98 l Northwest Quadrant 22.149 33.8 37.2 31.4 0.89 0.93 Fairview T. (York Co.) 11,941 16.5 11.4 18.2 0.69 0.98 G3tdsboro 8. (York Co.) 477 0.5 1.8 2.0 1.78 2.22 Highspire B. (Deuphin Co.) 2,959 5.9 8.0 S.8 1.38 1.15 8
Loser Senterc T. (Deuphin Co.) 5,772 10.5 9.2 8.4 0.0d l
0.C1 I
J NUTES: III Enmerated populations,1980 United States Census of Poputetton.
(2) Expected numbers of concer deaths based on the ege-sex distributton of the respective populations,1980 U.S. Censue of Population, and everage annuet ege-sex specific concer death retes, Pennsylvente, 1979-81.
I3I Source of cbserved nebers of deathsg State Heetth Data Center, Pennsylvanie l
Department of Neotth. These date are not corrected for incorrect residence-reporting on death certtricates. .
(TtJILE 3 DATA ARE DISC 12 SED CN PAGES 12 AND 13 0F THE TEXT.)
l
T CLE 4: POPULATION AM2 DBSERVED Am E)PECTD AVEM3E ANNUAL NUDEERS OF CANCER DEATks: FOUR TMI AREA MIPOR CIVIL DIVISIONS (FAIRVIEW AND NEWBERRY i TUw' CHIPS AND (CLDS80F0 AC YDRK HAVEN BC;0 UGHS),1979-40 Average Annual Number of Cancer Cesthe Mortality Retto Pinor Civil Divisions { MODS) PoputettonIll Observedl2) EspecteaI3I [0bserved/Espected)
Four Minor Ctvi1 Divisfon Tote 1 23,211 30.8 30.5 1.01 Feirvies/Nemberry Townships 21,988 28.8 28.4 1.01 Feirvlee Teenship 11,941 15.6 18.5 1.01 -
Newberry Teenship 10,047 -
12.2 11.9 1.03 e.
C:ltdsborcVYcrk Haven Boroughs 1,223 2.0 2.1 0.95 G31dsborc 8orough 477 1.0 0.9 1.11 Yark Haven Borough 748 1.C 1.2 0.83 NUTES: III Enmerated poputettons,1980 United States Census of Poputetton.
III Observed nebers of concea deaths obtained free death certificates provided by the State Hestth Date Center, Pennsylvente Department of Hestth. Numbers sheen for scoef fic hts soy not estch routinety reocrted nebers because of corrections of restcence reported on death certiftestes.
(3) Expected nebers of concer deaths based on ege-sex distributions of the respective poputettons,1980 U.S. Census of Population, and age-sex specific concer death rates for Penneytvente, 1979-81.
[TtJLE 4 DATA ARE DISCUSSED ON PAGES 13 AND 14 CF THE TEXT.]
l l
l
TABLE Us POPULATICM Am OSSERVED AND EXPECTED NtheERS CF CANCER DEATMS BY YEAR:
CERTAIN TMI AREA MDOR CIVIL DIVISIONS, 1879-63 ObservedIII Annual Number of Concer Deathe Expected Neber of Concer Deaths Minor Civil Divistens (HCOs) PoputettonI1) 1979 1980 1981 1982 1983 Per YearI3)
Fcur Mince Civil Division Tctet 23,211 22 33 30 36 33 30.5 Feirvies/Ne= berry Townships 21,199 22 29 28 34 31 28.4 Feirview Township 11,941 10 21 13 19 20 16.5 -
Newberry Township 10.047 12 8 15 15 11 11.9 e.
Goldsborn/ York Haven Boroughs 1,223 -
4 2 2 2 2.1 Goldshcro Barcugh 477 -
2 1 1 1 D.S Yarkhoven Borough 746 -
2 1 1 1 1.2 NOTES: III Enwereted populations,1980 United States Census of Poputetton.
(2) Cbserved numbers of concer deaths obtained from death certificates provided by the State Meetth Data Center, Pennsylvente Department of Health. Numbers shown for spectfic MCDs eay not match routinely reocrted numbers because of corrections of restcence reported on death certificates.
I3I Espected nebers of concer deaths based on ege-sex distributions of the respective poputettons,1980 U.S. Census of Poputetton, and age-ses specific concer death rates for Pennsylvente, 1979-81 (TASLE 5 CATA ARE D:S:t:ESED CN PAGE 14 0F THE TEXT.)
a
- = - - - - -
-- --- - - , -- ,y ,. . , . ~ - ,,y-
l l *
- TA'LE 6:
DBSERVED AM) DPECTID AVERAGE ANNUAL NLDEERS OF CANCER DEATHS BY' SITE IN SELECTED FCUR MIWR CIVIL DIVISION AREA (FAIRVIEW TCvNSHIP, EDLDS802 BOROUGH, NEY3ER tY TUwNSHIP, YORK HAVEN B0mu31),1974-78 AND 1979-50 Average Annual Number of Concer Deathe cancer Site Mortality Retto Observed (2) [0bserved/Espected)
(Ninth Revision, International -
Classifiestion of Diseases) Code Number Espectedlil 1974-78 1979-83 1874-78 1979-33 ALL Sites 140-208 30.5 28.8 30.8 0.88 1.01 Succel Cavity and Pharynn 140-149 0.8
- 0.8 0.4 1.33 0.87 Ofgsstive Organs and Peritonsum 150-159 8.2
- e. 5.8 7.2 0.71 0.L'8 Respiratory and Intrathoracic Organs 180-185 7.9 5.8 8.4 0.73 0.81 Bone, Connective Tissue, Skin & Breast 170-175 3.8 4.2 4.0 1.17 1.11 Ginitourtnery Organs 179-189 4.2 4.0 4.2 0.95 1.00 Oth2r end Unspecirted Sites 190-199 3.4 3.4 4.4 1.00 1.29 Leukeste 204-208 1.2 0.8 1.8 0.50 1.50 Other Lymphatic & Heretopoietic Tissue 200-203 1.8 2.2 2.4 1.38 1.50 NOTES: III Espected nurbers of cancer deaths based on the age-sea distribution of the
- respective populations,1980 U.S. Census of Population, and everege annual age-sez apect f tc concer death rates, Pennsylvente, 1979-81 III ';ource of observed numbers of deathsg State Health Data Center, Pennsylvente Department of Health. The 1974-78 date are not corrected for incorrect residence reporting on death certificates the 1579-83 date are corrected.
(TASLE 8 CATA ARE DISCUSSED ON PAGES 14 AND 15 0F THE TEXT.)
O I
l l
I l
TABLE 7: POPULATION APC 08 SERVED AJC EXPECTED AVERAGE ANNUAL NWEERS OF CANCER DEATHS FOR FAIRVIEW APC NEWBERRY TUWNSHIP CENSUS ENUMERATION DISTRICTS WITHIN FIVE MILES OF TMI BY GENERAL DIRECTION FFCN THI, 1979-43 i
i AvereCe Annual Number of Concer Deaths Conrus Enmeration Districts (CEDs)/ Population Mortality Retto Generet Direction from TMI 1979I1I ObservedI2I Espected(3) [0bserved/ Expected]
Newberry/Feirview Township CEDs in TMI Five Mile Area 8.118 10.9 11.8 9 0.93 Northwest Quadrant 3,075 4.0 3.8 1.11 Feirview Township (2 CEOs) 710 , 1.8 1.0 1.30 e.
Newberry Township (5 CEDs) 2,365 2.2 2.8 0.85 SIuthwest Guadrent 5,043 S.8 8.0 0.85 Neuberry Township (8 CEDs) 5,043 8.8 8.0 0.85 NOTES: l1I Enumerated populations,1980 United States Census of Population.
(2) Observed numbers of concer deaths obtained from death certificates provided by ~
the State Hestth Dete Center, Pennsylvanie Deporteent of Hestth. Incorrect residence inforwetion on death certificates has been corrected.
(3) Espected nebers of concer deaths based on ege-sex distributions of the '
respective populations,1983 U.S. Census of Population, erd age-sex specific concer death rates for Pennsylvania, 1979-41 (TtJLE 7 CATA ARE CISCUSSED CN PAGES 15 AND 16 0F THE TEXT.]
l l
- ~
. TtJLE 8:
- PCTPULATICN MC 08 SERVED AND EXPECTED NtmeERS OF DIADOSED CANOER CASE R)UR TMI AREA CIVIL DIVISICNS, FAIRVIEW MO hEYBERRY TUWNSHIPS AMd ECLDSBORO AND YORK HAVEN BOFOUCHS, JULY 1982 - JtmE 1984 New Cancer Cases PoputettonIII Retto Minor Civil Divisione (MCDs) Observed!2) EspectedI3) [0bse'rvevEspected)
Minsr Civit Division Totet 23,211 133 1 21 . 4 1.10 Fairvies/Neuberry Townships 21,988 119 113.4 1.05 Fairview Township 11,941 81 85.8 0.93 Nesberry Township 10,047 58 47.8 1 .21 Coldsborc/ York Haven Boroughs 1.223 12 8.0 1.50 Goldsboro Borouth 477 4 3.9 1.03 Ycrk Haven Borough 748 3 4.5 1.78 Unknown -
2 - -
NOTES: III Enumerated poputettons,1980 United States Census of Population.
(2) Observed numbers of diagnosed concer comes, Pennsylvania Cancer Registry, Pennsylvente Department of Hestth. Incorrect residence infomation on Cancer Registry Report Fems has been corrected.
- I3I Espected numbers of concer cases based on the ege-een distributions of the respective populations and ege-se specific incidence rates free the Survoittence. Epidseiology, and End Results (SEER) progree, 1978-81.
l (TABLE B DATA ARE DISCUSSED ON PAGES 17 AND 18 0F THE TEXT.)
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~ TABLE 10s DESERVED AMD EMPECTED IIUDGERS OF DIAGOSED HADIOCDf!C CANCE2 CASES
- BY PkMANr SITE IN A SELECTfD FOUH -
MIpen CIVIL CIVISION AREA 1 WITH SEPARATE DATA FOR FAIRVIEW AND NOSERiff *"
, TotnGIIPS, JUl.Y 1982 - JUNE 1984
___.__..___ ___ _ -- - ar.=mu.- ,
Att Areesi Felevieus/Ne= berry Top. Felrvlow Township Ne= berry Township 1
Rette liette Rette IIe t t o e e.
- e v f:l t a. Obs.2) g,,,3] [0be./ Esp.] Obe.II Esp.3I (Obs./ Esp.) Obs.2) g,,,3) (Obs./ Esp.] Obs.2) Esp.3] (Obs./ Esp.)
=--===~-----==.===.---.=====..-----.am....3a...
test 70 84.2 1.09 82 59.5 1.04 38 34.9 1.03 28 25.0 1.04 t t .. i .' g.. n * -
1.1 - -
1.0 - -
0.8 - -
0.4 -
- r e . -- e. 2 3.0 0.57 2 2.8 0.71 1 1.8 0.83 1 1.2 0.83 l s a s .. . 18 11.4 1.55 15 10.5 1.43 8 S.1 1.31 7 4.4 1.59 ,
1 ta-re-a= 1 3.0 0.33 1 2.7 0.37 1 1.0 0.53 -
1.1 -
f r- : 17 10.0 0.90 17 17.7 0.98 8 10.2 0.70 9 7.5 1.20
- s. . - - tr-ele] 21 16.0 1.27 17 15.0 1.09 11 0.2 1.20 8 8.4 0.94 t v i .n e .t* 1 1.0 0.58 1 1.7 0.59 1 1.3 1.00 -
D.7 -
to w. s'a.*nn tn's Lymphemeo 8 3.0 2.11 7 3.8 1.94 5 2.1 2'.30 2 1.5 1.33 i t*.sten sa Hyateme' -
1.1 - -
1.0 - -
0.5 - -
0.4 -
j e a..t .-. s - 2 3.4 0.58 2 3.3 0.61 1 1.9 0.53 1 1.4 0.71 i
- - - - - - - ,-c . _ . . _ ==_ _ _ _ _ . _
i e imirst III The four etnor cielt divlelen eree includes Goldebere end York Heven Boroughe end Feirvleu end Neoberry Toonohlpe. Data for Cotdebore end York Heven Boroughe are not presented in the tobte because the espected numbers for specific certer altos are too emett for seeningful comperleone. The , tee reported Getdebere coses include concere of the coton til end remete breest (1). The five reported York Haven coees include concere of the coton til, femete breast (3) and non-hodgkin's tymphones [1].
1he minor cIvit divlelen of reeldence of one concer case leeten) could not be determined.
l 12) Ohoorved nimbere of diagneeed concer cases, Penneytvente Concer Regletry, Penneytvente Department of Health. Incorrect
- reefdence Informatten on Concer Regletry Report Forse hee been corrected.
I3I Espected nassbere of cosee beoed on ege-een die'tributlen of the subject poputettene (1980) and ego-sea alte specifle incidence t
, retes from the Surveltlence Epidealetegy, and End Results (SEER l Progree, 1978-1981 The feltoelag altee (*) were not i
included in the SEER report for 1978-01, thus, date for the 1973-77 period were useds esophegue, thyreld, and multiple .
j myeleme.
i a
I (TABl.E 10 DATA ARE DISCUSSED ON PAGES 19, 20 AND 210F THE TEXT.]
I
)
4
_ _ _ - - - _. _ _