Appendix 1.

North Carolina Depart ment of H ealth and
Division of Publi c H ealth

H1m 1rui

Services

PatMcCroiy
Governor

AldouaZ. Wos, M.D.
Ambassador(Rel.)
Sro-elal}' DllliS
Daniel Staley

Aeling DivisionDirector
November 14, 2013
Dear JI.fr.ug g:
Tbanl.:you for your inquiry to weCeotr:i.lCa.acerRegistry (CCR) reg3rding cancer cases in MecklenburgCounty. We meh·e many reque;ts
suc.has yours for infonwtion about cancers in local areas throughout the state. The CCR compiles infonuation on c:uicus across North
Carolina and we mooitor cancer rates for many types of cancer for each county onnuollyto see if tliere appear to be areas of tl,e state that
ueed special attention.
Although WU(b !Ms been leaiued about cancer over tbe p><tcouple of decades, there u still much that is not mown about the causes of
cnncer. \Vhat we ookoow is that cnncer is not one disease, but a g[oup of di"a se9 that bilia~•esimilarly. We know tbot different l}pes of
cnncers a[e caused by different things. For e"-8.lllple
, cig,uette swol:iog has b~n implicatedin causing lung ca.acer,sowe chemical expo,ures
are associate<!with leukemia, :i.odprolonged expos11
re to suuligbt causes sorue types of sl.:iticancer. Genetic research has shown that defects
in cutain genes result in a wuch higher lil:elilioodthat a person will get canctt . Whal is not bl own is bow generic faclor; and ex-poS11res
to
ca.acer causing ageals interact.

w

Many people do uot realize how comruon cancers are. It i~ wim.lred that 2M our of evey
men and~ out of every~
womtn will
develop a cnncer of some twe during his or her lifetime. As a r<rult, ii is couwion to &d what appear to be cancer ca:es clusterin~ill
neighborhoods o,·er • period of years. 1ws will occur in nny neighborhood. As people cge,lheir ch:ioceof getting cancer increase,, and ,o
os we loo!.:at B coDlDlua.ity,
it is coUlUlonto see iucrea•iug numbers of c11Ucer
case~ as the people in the commuoityage.
Cancers are diseases that develop o,-er fll.lfly years. As a result, it is difficult lo know wheo :ioy specific cancer began to develop, and
consequently, what the specific factor was which caused the cancer. Because people in ocr societyu10,·eseveral times during their li,es, Ille
e\'aluarion of cluster, of cancer cases is quite cbaUeoging. One cau never be certain that a specific ca.ncerwas camed by somethini in Ille
coOlDluni
ly ic wli.id1the persou cum~ntly re~des.
When clusters of cancer case, are ian stigated, we loo!.::for ><Vtral things that ate dues to likely associatioM with exposures in Ille
community. These are:
I.

GToups of cases of all the sODlel}-peof c:uicer (ouch as braiu cancer or leukemia).Bee•~• differentthings cause di.ffereot l}pe•
of cancer, cases of 01aoy differC1lltypes of cancer do 110 1 coastirute a cluster of co,eo.
2. Groups of cases among childr~ or oues \\ilb an unusual age distribution.
3. Cases diagnosed dtlring a relati.e ly short tiu.teinterval. Cases cJi3gnosed over • spo\flof yem do uot constitute a cluster of ca1e1
uruess there is consistency iu the l)pe of cance[.
4. Clusters of rare c:i.ocers. Because lung, breast, colon, and prostate cancers are so common, it is very difficult to find any
associarioo behveeo them and exposures in a community.
Tltis report is updated based on cases repo11edto the North Carolina Central C:11.D
cer Registry (CCR) as of October J, 2013, diagoosed during
1990 - 2012, address 31the tUlll!of diagnosis in No,th Carolinaaod diagnosis codes as reflected in th~ pllb.ology and Dle<lical
reports reported
from the hospitals and facilities. Furthtr, cases diagnosed out of the state and country b~t may be receiving tlea!llleol in facilities in North
Co.rolina:ue not included as they are ool required to be reported. The CCR does not havereal tiwe data because it takes hospitals at least sis
mouths a1\e,-t1Jediagnosis of a malignancy to submit cancer diagnosis reports. Tue m ,on for thfo is tha:, per Geneml Statute 130A-209,
CCR ,equires facilities lo report coroplete first coune of treatment dala and = y case, Ii.we an e>,1endedperiod of first course treatmenl.
The patient ru..iyhave s1ir~ecy, followed by multiple coursesof cheuiotherapy, followed by udiatiou therapy. In order lo obtain complete aud
acrnrale data fi:ow the facilities there is a log time of al least six ruooths. for soD1ecases, CCR re~eins ru,~tiple reports fi:oDldiffenal

I\Wl\'.ncdhhs.gov• www.publicl.lealth.nc
.gov • W\IW.
schs.state.nc.us
Tel 919-733-4728• Fax 919-733-8485
Location: 222 NorthDawsonStreet • Raleigh.NC
27603
tvlailingAddress: 1908 Mail Smice Center· Raleigh,NC 27699-1908
AnEqualOpportunityI AffirmativeActionEruploy(f"

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 focilitie., which are reviewed and consolidated on an ongoing basfo. CCR continues torecei,•erepo1ts from the hospitals for cases diagnosed
in 2011, 20 I 2 and prioryi,an. Case.; diagnosed in 2013 are beginning to be proce~1ed.

In order to evalu,te the cancer risk in the area requested, all of the cases of cancer in oUt database diagnosed froru 1990 to 2012 were
ideutified. During this time a total of 64,364 cancer cases were diagnosed in Mecklenburg County. Across the county, the four major cancers
• female breast, colon and rectuw, prostate, and lung and bronchus • cOOlprised57 percent of the 64,364 cases. Pediatric cancers corupri1edI
percent of the total number of cases and 80 perceut of the cases were age 50 or older, when cancer diagnoses are quite commou. Thesecases
were spread out over the 23 years, not concentrated in a short time period.
F011her,we looL:edat the age-adjusted incidence rates for Mecklenbwg County for the 2006-2010 diagnosis year,;and found that prostate and
female breast were relatively higher than the state rates; and colon md rectum and Jungand bronclms mies were lower than the slate rates.
Ch-erallthere wm 17,741 case.srepo11edin 1-!ecl.:lenburgCounty for this five }"'ar pericd.
Concern was expressed about cancer incideuce in Huntersville. Fron11990 to 2012, lheie were 2,688 cases in this town. The top four cancers
compri~d 57 pen-ent oflhe,..e cases. At least 76 perceut of the cases were age 50 or older,in which caJ1cerdiagnoses are quite coOlOlooand 1
pm:ent of the cases were pediatric. Further, we looked at cao.cers that have beeu shown to be associated with environmental risk factors
(liver, pancreas, leukemia, l>raio,bladder, kidney, multiple 111yelomaand non -Hodgkill lywphon1a)and identified a total of 448 cases in this
town foethe 23 }"'ar period. These cases were spread out over the 23 years and not concentratedin any time period.
There were two particular areas in HuntersviUe that were of interest. We looked at cases within two miles of the nuclear station and found
205 ca:es in the area between 1990 and 201 I. The fo1trmajor caucen comprised 52 percent of cases. Eighty percent of cases were age 50 or
older and 2 percent of thecases were pediatric. We also looked at cases within a two mile radius of the high school of interest. Frow 1990to
2011, there were 289 cases reported in the region. The top fo1trcancers comprised 54 perceut of the c11Ses.Al.most three-fourths of the cases
were diagnosed in people age 50 011dolder while l perceut of the cases were diagnosed iu pediatric1.
Fu11her,concern wa', also expressed o,·er the incidence of ocular melanoma (&lined as primaiy site: C69 will! histology code.;: 8720-8780).
Between 1990 and 2012, there were 77 cases (or 0.12% of all cancer cases) of ocular mdanoma in Mecklenburg County while there 1\"ere
1,232 cases (or 0.14-%of all cancer cases) statewide. There were !es~than 5 ca:es ofocularwelanoma in Hunter1villein the time period. Tue
number of cases is fairly consistent over the time period for Mecklenburg County, and the cases were spread out over the 23 )"'aa, not
concentrated in a short time period.

0, erall no consistent pattern of cases, was obse1wd other than those previously ~lated. It is possible !hat there is an ern•iroDlllental1ilk for
cancer in the area; however, we do not see a higher occurrence of caoceViin the populationsustl3.l.lyassociated with enviro0111entalfactor; at
this time or any e,idellce of a clustering of cancer cases in any of these areas.
0

On the CCR website (www.schs.state.nc.us/data/cancer.cfiu), there is additional North Carolinaemcee info1mation,including rhe NC Cancer
Profile and the Cancer Profile for Mecklenburg Colillly. There are al10 fuel sheets regarding Ute leading cancers in the state. If you have
questious regarding any of this information or yon want additional resources about cancer,please do not hesitate to contact the CCR at (919)
715-7289.
At the request of the No,111Carolina Senate, House of Representatives nnd local health depalf111et1ts,
copies of neighborhood cancer
evaluations are also seut to those who represent and serve the area oftbo state beingeval\l-'lled.

Sincerely,

JtMb,
p))'#<,

Jordan Bostic, Ph.D.
Statistician
NC Central Cancer Registry
State Center for Health Statistics
(919) 715-2887
Katlirju.llostic@dbbs .nc.gov
CC:

Representative Charle; Jeter
Senator Jeif Tarte
MicheUeLancaster-Sandlin, Mecklenburg County Interim Health Director
Dr. luckL:ingley, !liD, MPH, Occupational and Environmental Epidemiology Branch
Dr. Chao.drib Rao, Director, Nortb Carol.in.aCetltral Cancer Re~try

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