Governor's Cancer Research Initiative – Warren County Cancer Incidence Report

Executive Summary
This report summarizes cancer patterns and trends for Warren County, NY. New York State
Department of Health (DOH) researchers investigated Warren County because it had the
highest rate of all cancers combined in NYS based on 2011-2015 data. This investigation was
conducted as part of Governor Cuomo’s Cancer Research Initiative announced in October 2017,
which examined cancer trends and the potential causes of cancer in four regions of the state
that have higher cancer rates, based on 2011-2015 data.
During the Warren County Investigation, DOH obtained input from interested members of the
community. Researchers met with community members to present the design, goals, and
approaches of the investigation. Community members and stakeholders provided input at
meetings and emailed additional feedback.
DOH will use these findings to work with partners to enhance community cancer prevention,
recommend appropriate screening efforts, and support access to appropriate high-quality
health care.

What was Evaluated
Sociodemographic Data
DOH researchers examined data about the population, such as race, ethnicity, age, education,
and income, to see if these factors could be related to higher cancer rates.
Behavioral, Healthcare and Occupational Data
DOH researchers reviewed available data about behavioral, healthcare and occupational factors
known to be related to cancer. These included available information about smoking, obesity,
alcohol use, diet, physical activity, occupation, and medical care access and practices.
Environmental Data
DOH researchers worked with the Department of Environmental Conservation (DEC) to review
available environmental data to look for unusual patterns or trends in Warren County. Data
included outdoor air pollutants, radon concentrations in indoor air, drinking water
contaminants, industrial and inactive hazardous waste disposal sites, and traffic density.
Cancer Data
DOH researchers applied a two-step selection process to Cancer Registry data and chose nine
types of cancer for in-depth examination. Oral cancer, colorectal cancer, laryngeal cancer, lung
cancer, brain and other nervous system cancer, and thyroid cancer were selected because their
overall or sex-specific incidence rates were statistically significantly higher in Warren County
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 Governor's Cancer Research Initiative – Warren County Cancer Incidence Report
than in NYS excluding NYC. Esophageal cancer, melanoma of the skin, and leukemia were added
to the target list because their overall or sex-specific incidence rates were significantly higher
than the NYS rates and the excess was at least 40%. For each type of cancer, the evaluation
included cancer trends over time; age and gender of patients diagnosed with cancer; and
characteristics of the cancer, such as type of cells that were cancerous, tumor size, and stage of
disease at the time of diagnosis.

Findings
Sociodemographic Factors
Review of population data showed that the sociodemographic makeup of Warren County more
closely resembles that of NYS excluding NYC than that of NYS. Thus, NYS excluding NYC is the
more appropriate comparison area for Warren County. However, the lack of racial and ethnic
diversity, as well as the low prevalence of foreign nativity, distinguishes Warren County from
NYS excluding NYC.
Behavioral, Healthcare and Occupational Factors
Behavior and Lifestyle. Behavioral surveillance data indicate that compared to NYS excluding
NYC, Warren County residents were more likely to be current smokers, engage in leisure time
physical activity, and have health care coverage. Furthermore, a significantly higher percentage
of women in Warren County were overweight or obese. Overall, Warren County was ranked
relatively low with respect to a multi-element composite measure of health behaviors,
indicating less healthy lifestyles.
Healthcare System. Using information on various healthcare-related metrics, Warren County
was placed in the top tier among the 57 counties of NYS excluding NYC in a national county
ranking program.
Occupation. Results from survey data on occupations showed that compared to NYS excluding
NYC, a slightly higher percentage of residents in Warren County were engaged in occupations
associated with a higher probability of workplace exposures. However, the percentages in
Warren County were based on a small number of respondents and therefore these differences
may not be meaningful. In addition, analysis of asbestosis hospitalization rates indicates that
past exposure to asbestos is unlikely to have been elevated in Warren County.
Environmental Factors
Outdoor Air Pollution. Historical monitored air quality data for 1973-1996 indicated that
outdoor air in Warren County met national air quality standards. Evaluation of model-predicted
cancer risks associated with inhalation exposure to hazardous air pollutants that are known or
likely human carcinogens generally found low risk of cancer. Additionally, estimated inhalation
cancer risks associated with outdoor air pollution in Warren County were similar or lower than
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in NYS excluding NYC and in NYS.
Radon in Indoor Air. Radon is the second leading cause of lung cancer after smoking. Average
radon concentrations in Warren County were lower in comparison to both NYS excluding NYC
and in NYS. Radon is unlikely to explain the excess lung cancer risk in Warren County.
Drinking Water Quality. Researchers evaluated routine sampling data from 31 active public
water systems in Warren County. Results showed that in general these water systems met safe
drinking water standards and were in compliance. However, contaminant standards were
exceeded at two public water systems. These violations were time-limited and quickly resolved.
Furthermore, the contaminants that were involved are not associated with the cancers under
study. Review of available data related to sampling for unregulated contaminants, based on the
United States Environmental Protection Agency’s (USEPA’s) Unregulated Contaminant
Monitoring Rule program, showed public water systems tested in Warren County had levels
below USEPA reference concentrations.
Industrial and Inactive Hazardous Waste Disposal Sites. Researchers reviewed information for
22 sites in Warren County, including sites that were of concern to the public. This evaluation
found no evidence suggesting that contamination from these remedial sites is causing
widespread exposures in Warren County.
Traffic. Information from the traffic monitoring program was used to estimate the number of
people living within 500 meters of roads with various traffic volumes. The proportion of Warren
County residents living in proximity to heavily trafficked roads was considerably smaller than in
NYS excluding NYC and in NYS.
Elevation in Cancer Incidence
Oral (Mouth and Throat) Cancer. The five-year rates of oral cancer were statistically
significantly above the rates for NYS excluding NYC in the 2001-2005, 2006-2010 and 2011-2015
time periods. During the 2011-2015 period, the excess was observed in people aged 50-64
years, with regional-stage tumors, and with squamous cell carcinomas.
According to the scientific literature, oral cancer is associated with all forms of tobacco use,
including smoking, snuff, and chewing tobacco. Most oral cancer patients in Warren County
were current or former tobacco users.
Alcohol consumption is another important risk factor for oral cancer. People who are heavy
users of both tobacco and alcohol are at highest risk. Population-level survey results also
support that alcohol consumption, both independently and in conjunction with smoking, may
account for some of the Warren County excess in oral cancer.
Infection with the human papillomavirus (HPV) is another risk factor for oral cancer. Rates for
both HPV and non-HPV related squamous cell tumors were higher in Warren County than in
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NYS excluding NYC in 2011-2015. However, data were insufficient to evaluate the contribution
of HPV infection to the oral cancer excess, particularly because those cancers associated with
HPV are also associated with alcohol and tobacco use.
Results from the environmental investigation did not show any unusual environmental
exposures that could explain the county-wide excess in oral cancers in Warren County.
Esophageal Cancer. In 2011-2015 the incidence rate of esophageal cancer for Warren County
was comparable to the rate for NYS excluding NYC, but significantly higher than the rate for
NYS. These rates and analyses are based on a relatively small number of cases diagnosed each
year in Warren County. The excess was fully attributable to men, regional-stage tumors, and
squamous cell tumors.
According to the literature, smoking and alcohol use account for as much as 90% of squamous
cell esophageal cancers. Most of the elevation in esophageal cancer was of the squamous cell
carcinoma type, and most Warren County men diagnosed with this cancer were current or
former smokers. Population-level survey results also support that alcohol consumption, both
independently and in conjunction with smoking, may account for some of the Warren County
excess in esophageal cancer.
Colorectal (Colon and Rectum) Cancer. Since 1999, the rates of colorectal cancer in Warren
County and NYS excluding NYC have been declining. However, the incidence rate among
women in Warren County in 2011-2015 was statistically significantly higher than in NYS
excluding NYC. The marked excess was in women aged 20-49 years. Most colorectal cancers in
women aged 20-49 were treatable, local-stage tumors indicating extensive clinical care for
young symptomatic patients.
The literature estimates that up to half of early-onset colorectal cancers may be related to
hereditary cancer syndromes or familial colorectal cancer. However, data were insufficient to
evaluate the contribution of genetic factors to the excess of colorectal cancer.
According to the literature, colorectal cancer is also associated with smoking, heavy alcohol use,
and physical inactivity. Studies also suggest diet may be a risk factor, particularly a diet
consisting heavily of red or processed meats and low on fruits, vegetables and fiber. People
who are overweight or obese also have a greater risk of developing colorectal cancer.
Population-level survey results for Warren County also support that alcohol consumption, both
independently and in conjunction with smoking, and obesity may account for some of the
Warren County excess in colorectal cancer.
Results from the environmental investigation did not show any unusual environmental
exposures that could explain the county-wide excess of colorectal cancers in Warren County.
Laryngeal (Larynx, Voice Box) Cancer. Rates of laryngeal cancer in Warren County were
statistically significantly higher than in NYS excluding NYC in 2006-2010 and 2011-2015. The
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excess in laryngeal cancer is because rates for NYS excluding NYC have been decreasing, not
because rates in Warren County have been increasing. The excess cancers in Warren County
were observed mainly in men and were almost entirely limited to those under age 65. Nearly all
excess cancer cases were diagnosed at a localized stage.
According to the literature, the strongest risk factor for laryngeal cancer is smoking. In Warren
County, almost all laryngeal cancer patients were current or former tobacco users.
Laryngeal cancer is also strongly associated with alcohol use. Population-level survey results
support that alcohol consumption, both independently or synergistically with smoking, may
account for some of the Warren County excess in laryngeal cancer.
Researchers considered occupational exposures to sulfuric acid and asbestos, known risk
factors for laryngeal cancer, because both mining and pulp production use these chemicals in
small quantities in their operations and these industries used to operate in Warren County.
Data were insufficient to examine directly. Indirect evidence based on asbestosis hospitalization
rates suggests that past exposure to asbestos in Warren County was not elevated relative to
NYS excluding NYC. Therefore, the impact of higher occupational exposure to asbestos on the
excess of laryngeal cancer in Warren County would probably be minor.
Lung Cancer. Lung cancer rates in Warren County were statistically significantly higher than in
NYS excluding NYC between 2011 and 2015. This excess is because rates for NYS excluding NYC
have been decreasing, not because the rates in Warren County have been increasing. The
excess of lung cancer in Warren County is mainly associated with men, and all adults under age
65. The highest elevation in rates was observed for individuals 20-49 years of age.
Rates of the three major subtypes of lung cancer that are strongly associated with smoking
were significantly elevated (i.e., squamous cell, small cell, and large cell carcinomas). An
overwhelming majority of lung cancer patients in Warren County had a history of tobacco use
at some time in their life, with the highest percentages among patients with small cell
carcinoma and squamous cell carcinoma, the two subtypes most strongly related to cigarette
smoking.
Researchers examined the rates of people diagnosed with lung cancer in Warren County who
had a prior history of cancer, because radiation exposure is another key risk factor for lung
cancer and cancer patients are frequently treated with radiation. The results did not show a
significant difference between Warren County and NYS excluding NYC. Thus, it is unlikely that
the excess in lung cancer incidence in Warren County can be attributed to radiation treatment
for a prior tumor.
Exposure to air pollutants has been associated with lung cancer. Review of the modeled data
showed that cancer risks from inhalation exposure to hazardous air pollutants were lower or
similar to levels in NYS excluding NYC. Furthermore, the proportion of residents who live in
proximity to high traffic roads was lower in Warren County. Therefore, available data on
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outdoor air quality indicate that air pollution is unlikely to explain the elevated lung cancer
rates in Warren County.
Radon is an important environmental risk factor for lung cancer. In-home radon testing results
show that average radon concentrations in Warren County were generally lower than in NYS
excluding NYC. Although radon may be contributing to lung cancer risk in a limited number of
localities, it is unlikely to explain the lung cancer excess in Warren County.
In the literature, elevated lung cancer rates have also been seen in communities with high
levels of arsenic in drinking water. Also, beryllium, cadmium, and nickel are chemicals
associated with lung cancer risk. These substances were monitored during routine water quality
tests, but no violations were ever issued for them. The substances for which water violations
were issued (e.g., total trihalomethanes) have not been associated with lung cancer. Therefore,
contamination in drinking water is unlikely to be related to the excess in lung cancer in Warren
County.
Warren County has a somewhat greater proportion of people working in occupations with a
higher probability of workplace exposures to elevated levels of hazardous substances than NYS
excluding NYC. However, there were insufficient data available to evaluate the possible
contributions of specific occupations to the lung cancer excess in Warren County. Indirect
evidence based on asbestosis hospitalization rates indicates that past exposure to asbestos in
Warren County was unlikely to have been elevated compared to NYS excluding NYC.
Melanoma of the Skin. Historically, rates of melanoma in Warren County have been higher
than those for NYS and NYS excluding NYC. For the 2011-2015 period, the incidence rates for
Warren County and NYS excluding NYC were statistically equivalent but the rate for Warren
County was 42% higher than the rate for NYS, a statistically significant difference.
The most important risk factor for melanoma is having a light skin complexion, which is a
common trait among non-Hispanic whites. When comparing data for non-Hispanic whites in
NYS, NYS excluding NYC, and Warren County, rates in Warren County were not statistically
different. The rates of melanoma in Warren County were elevated when race/ethnicity was not
considered because Warren county residents are almost exclusively non-Hispanic white (95%),
while only 76% of the population of NYS excluding NYC and 58% of the population of NYS are
non-Hispanic white.
Brain Cancer. The rates of cancers of the brain and other nervous system (ONS) in Warren
County are based on small numbers since these cancers are relatively rare. They did not differ
significantly from NYS excluding NYC until the 2011-2015 period. Rates in this timeframe were
statistically significantly elevated among females, and among individuals under 20 years of age
when both sexes were combined. Examination by cell type showed that the rate of pilocytic
astrocytoma among individuals 0-19 years of age was almost five times higher in Warren
County than in NYS excluding NYC. However, this rate was only based on four cases.
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Pilocytic astrocytomas accounted for 75% of the excess in brain and ONS cancers in the under
20 age group in Warren County.
Researchers examined the rates of people diagnosed with brain cancer in Warren County who
had a prior history of cancer because radiation exposure is a key risk factor for brain and ONS
cancer and cancer patients are frequently treated with radiation. The results did not show a
significant difference between Warren County and NYS excluding NYC.
Results from the environmental investigation did not show any unusual environmental
exposures that could explain the county-wide excess in brain and ONS cancers in Warren
County.
Thyroid Cancer. Thyroid cancer rates in Warren County and in NYS excluding NYC have been
increasing for decades. The five-year rate in Warren County was 30% higher than in NYS
excluding NYC in 2011-2015. Thyroid cancer is more common in women than in men and
becomes more common among people 30 years of age or older. Although rates in Warren
County were elevated in women of all ages, the elevation was statistically significant only
among women aged 65 and older.
Papillary carcinoma is the most common type of thyroid cancer in NYS and Warren County.
Papillary carcinoma was responsible for nearly all the increase in cancers in Warren County and
in NYS excluding NYC. This cancer is slow growing and rarely fatal. Nearly all the increase in
Warren County thyroid cancers has been for tumors small enough to be considered subclinical,
meaning they were small enough to cause no symptoms.
According to the scientific literature, the primary risk factor for thyroid cancer is medical system
practices. These include the use of diagnostic imaging, cancer screening, and cancer diagnoses
occurring post-surgery. Increases in thyroid cancer correspond directly to an increase in routine
diagnostic imaging – specifically, diagnostic imaging with a neck ultrasound, or another form of
imaging in the absence of symptoms. According to an article in the New England Journal of
Medicine, 70-80% of female thyroid cancer cases and 45% of male thyroid cancer cases
diagnosed in the US fall into this category. Researchers attempted to measure the volume of
diagnostic imaging in New York and Warren County, but data were insufficient. Survey data
showed that a higher proportion of adults in Warren County had health care coverage than
those in NYS excluding NYC. Additionally, in recent years, Warren County has been ranked high
on a composite metric of access to care and quality of care. Thus, high healthcare utilization in
Warren County may be contributing to higher thyroid cancer rates.
Researchers examined the proportion of female thyroid cancer patients in Warren County who
had a prior history of cancer because radiation exposure is a key risk factor for thyroid cancer
and cancer patients are frequently treated with radiation. The results did not show a significant
difference in rates between Warren County and NYS excluding NYC. There is also evidence that
an excess in body fat is associated with thyroid cancer, although the increase in risk is modest,
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and its contribution based on population-level survey results for Warren County would be
minor.
Results from the environmental investigation did not show any unusual environmental
exposures that could explain the county-wide excess in thyroid cancers in Warren County.
Leukemia. Leukemia was selected for study based on an excess of over 40% among females in
Warren County relative to females in NYS. Leukemia incidence rates vary markedly by
race/ethnicity. Virtually all leukemia cases in Warren County were non-Hispanic white. When
the analysis was limited to non-Hispanic white females, the leukemia rate for women in Warren
County was elevated during 2011-2015, but this rate was not statistically different from the
rate for women in NYS excluding NYC. Most of the observed excess was attributable to an
excess in chronic lymphocytic leukemia (CLL). However, the CLL incidence rates for nonHispanic white females in Warren County and in NYS excluding NYC were also not statistically
different.
CLL is the most common type of leukemia in adults. Family history is a strong risk factor, but
other causes of CLL are uncertain. CLL can be detected by routine blood testing, before
symptoms appear. Cancer data do not suggest that the excess could be due to greater reporting
by either physician practices or independent clinical laboratories in the study area. The
observed excess may in part be attributed to greater contact with the medical care system
among Warren County residents.
Researchers observed a statistically significant excess in the CLL rate for women 20-49 years of
age in Warren County compared to NYS excluding NYC. They also observed a deficit in the CLL
incidence rate for females 50-64 years of age. This pattern suggests a shift toward earlier
diagnosis for some CLL cases.
Survey data suggest that a greater proportion of Warren County residents under age 65 had
health care coverage, which would improve access to medical care. This may in part explain the
elevation in the CLL rate among women 20-49 years of age.
Given the lack of a statistically significant excess in leukemia among non-Hispanic white females
in Warren County, and the highly variable annual leukemia incidence rates, it is likely that the
excess observed for 2011-2015 represents an anomaly. Examination of 2012-2016 cancer data
supports this conclusion.

Conclusions
•

•

It is likely that a higher proportion of current and former tobacco use contributed to the
elevated rates of lung, laryngeal, esophageal, and oral cancers in Warren County, which are
four cancers most strongly associated with tobacco use. In 2011-2015, the elevations in the
rates for these cancers were more often observed in men.
Alcohol consumption, independently or through a synergetic effect with tobacco use, might
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 Governor's Cancer Research Initiative – Warren County Cancer Incidence Report

•
•
•
•
•

•

have contributed to the excess of oral, esophageal, and laryngeal cancers in Warren County,
particularly among men.
HPV infection could also have contributed to the oral cancer excess.
Most of the elevation in thyroid cancer rates among women in Warren County is likely due
to increased detection of small papillary tumors by medical imaging and other diagnostic
techniques.
The higher proportion of overweight or obese women in Warren County could also have
contributed to the excess in female thyroid cancer incidence as well as the excess in female
colorectal cancer incidence.
The excess in leukemia rates among women in Warren County may represent a time-limited
anomaly.
The investigation found no factors that might account for the elevated incidence of cancers
of the brain and ONS among females in Warren County. There were also no factors that
might explain the higher incidence of pilocytic astrocytoma tumors among individuals less
than 20 years of age. DOH will continue to monitor the incidence of brain and ONS cancers
in Warren County.
Results from the environmental investigation did not show any unusual environmental
exposures that could explain the elevated cancer incidence rates in Warren County.

Recommendations
The recommendations below are divided into two main sections: 1) recommended actions to
address the specific cancers that were elevated in the Warren County Study Area, and 2)
recommended actions to address all cancer types throughout New York State. Many of the
recommended activities are aligned with two existing State plans that address cancer
prevention and control, the New York State 2018-2023 Comprehensive Cancer Control Plan, and
the New York State Prevention Agenda 2019-2024.
Recommended Actions Based on Specific Cancers Elevated in the Warren County
Study Area
Health Promotion and Cancer Prevention
Tobacco Prevention
Recommendation: Prevent initiation of tobacco use, including combustible tobacco and
electronic vaping products by youth and young adults.
Recommendation: Promote tobacco use cessation, especially among populations
disproportionately affected by tobacco use including: low socioeconomic status; frequent
mental distress/substance use disorder; lesbian, gay, bisexual and transgender; and
disability.
Recommendation: Eliminate exposure to secondhand smoke and exposure to secondhand
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aerosol/emissions from electronic vapor products.
Alcohol Use
Recommendation: Implement environmental approaches, including reducing alcohol
access, implementing responsible beverage services, reducing risk of drinking and driving,
and restricting underage alcohol access.
Recommendation: Collaborate with partners and key stakeholders to educate the public,
including youth and young adults, on cancer risk related to alcohol usage.
Recommendation: Provide personalized feedback about the risks and consequences of
excessive drinking through the use of electronic screening and behavioral counseling
interventions in healthcare settings, schools, and emergency rooms.
Recommendation: Among persons meeting the diagnostic criteria for alcohol dependence,
promote the use of alcohol misuse screening and brief behavioral counseling interventions
via traditional (face to face) or electronic means, and referrals to specialty treatment.
Healthy Nutrition and Physical Activity
Recommendation: Promote healthy eating and food security by:
• Increasing access to healthy and affordable foods and beverages,
• Increasing skills and knowledge to support healthy food and beverage choices,
• Increasing food security, and
• Increasing awareness of DOH sportfish advisories to promote healthier fish
consumption choices while reducing chemical exposures
(https://www.health.ny.gov/environmental/outdoors/fish/health_advisories/).
Recommendation: Increase physical activity by:
• Improving community environments that support active transportation and
recreational physical activity for people of all ages and abilities,
• Promoting school, child care, and worksite environments that support physical
activity for people of all ages and abilities, and
• Increasing access, for people of all ages and abilities, to safe indoor and/or outdoor
places for physical activity.
HPV Vaccination
Recommendation: Develop and implement educational campaigns targeted to adolescents
and adults regarding the benefits and risks of HPV vaccine.
Recommendation: Maximize use of the New York State Immunization Information System
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(NYSIIS) and the Citywide Immunization Registry (CIR) for vaccine documentation,
assessment, decision support, reminders and recall.
Recommendation: Adopt local HPV policies which support HPV vaccination in adolescents
and expand vaccine availability to new venues such as more healthcare settings and
schools.
Exposure to Ultraviolet (UV) Radiation
Recommendation: Promote educational initiatives that stress sun safety messages and
provide clear information about the cancer risk associated with indoor tanning to decrease
exposure to UV radiation for people of all ages, especially initiatives that target children,
adolescents, young adults, parents, healthcare providers, and summer camp instructors.
Recommendation: Implement environmental changes for sun protection in outdoor
settings such as access to shade and sunscreen in playgrounds, schools, summer camps, and
other outdoor recreational settings, and increase the availability of sun protection in
occupational settings for outdoor workers.
Recommendation: Promote awareness of, and compliance with, NYS’s tanning law
restricting minors from the use of indoor tanning facilities.
Cancer Screening and Early Detection
Lung Cancer Screening
Recommendation: Educate men and women who meet the criteria for lung cancer
screening about the benefits and risks of screening to help them make informed decisions.
Recommendation: Healthcare providers need tools and support to engage with patients
who may benefit from screening, and facilities adopting lung cancer screening programs
should be following national guidelines for a quality program.
Colorectal Cancer Screening
Recommendation: Educate men and women who meet the criteria for colorectal cancer
screening about the benefits and risks of screening to help them make informed decisions.
Recommendation: Educate providers and the public that there are many testing options for
colorectal cancer screening including take-home tests.
Recommendation: Reduce cost-related barriers to screening by educating providers and the
public that health insurance plans in New York State are required to cover screening, and
for those who are uninsured, the New York State Cancer Services Program (CSP) provides
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free colorectal cancer screening to men and women age 50 and older.
Recommendation: Support primary care practices and staff to implement evidence-based
strategies outlined in the Guide to Community Preventive Services such as the use of
patient and provider screening reminders.
Thyroid Cancer Screening
Recommendation: The U.S. Preventive Services Task Force recommends against screening
for thyroid cancer in asymptomatic adults. Educate the public and healthcare providers
about recommendations against thyroid cancer screening in average risk, asymptomatic
adults.
Healthy and Safe Environment
Radon Testing and Mitigation
Recommendation: Improve the public’s awareness about the relationship between indoor
radon exposure and lung cancer by conducting outreach and education about building
testing and remediation. Promote the DOH’s free and low-cost radon test kit programs,
provision of test kits at half price to schools and daycares, and free test kits as part of the
DOH’s Healthy Neighborhoods Program and other grant-funded programs.
Recommendation: Explore local level policy and/or code adoption to require radon
resistant construction in high radon areas.
Recommendation: Increase the number of physicians that ask their patients if they have
had their homes tested for radon and refer them to the DOH, as needed. Add radon testing
questions to routine electronic medical questionnaires.
Radiation from Medical Imaging
Recommendation: Increase awareness of such programs as NYS’s “Image Gently” and the
national “Image Wisely” campaigns that educate physicians and the public about potential
radiation exposure from CT scans and X-rays in both children and adults.
Safety in the Workplace
Recommendation: Develop targeted occupational safety and health training programs for
employers and workers in high-risk jobs.
Recommendation: Incorporate industry and occupation into electronic health records and
other patient-oriented databases.
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Recommended Actions to Reduce the Burden of All Cancers Statewide
Below are highlights of what individuals can do and what DOH and its partner organizations are
doing. For more information on activities, by type of organization, that New Yorkers can do to
help reduce the burden of cancer, see:
https://www.health.ny.gov/diseases/cancer/consortium/docs/20182023_comp_cancer_control_plan.pdf#page=62.
For All New Yorkers
The following are things that all individuals can do to reduce their risk of cancer:
• If you use tobacco, quit. If you don’t use tobacco, don’t start.
• Eat nutritious meals that include fruits, vegetables and whole grains.
• Get moving for at least 30 minutes a day on five or more days each week.
• Use sunscreen, monitor sun exposure and avoid tanning salons.
• Limit alcohol use.
• Get cancer-preventive vaccines such as hepatitis B and HPV.
• Learn your family health history (if possible) and discuss with your healthcare provider
whether genetic counseling might be right for you.
• Discuss what cancer screening tests might be right for you with your healthcare provider.
• Test your home for radon.
• For women of child-bearing age, know the benefits of breastfeeding and, if possible, breastfeed infants exclusively for at least the first six months of life.
For NYS Department of Health and Partner Organizations
Cancer Surveillance: The New York State Cancer Registry (NYSCR) was designated by the CDC
(Centers for Disease Control and Prevention) as a Registry of Excellence and has achieved Goldlevel certification since 1998. In 2018, the NYSCR became a member of the National Cancer
Institute's Surveillance, Epidemiology and End Results Program (SEER), the nation's preeminent
source of population-based cancer data.
Recommendation: Continue to meet the highest cancer registry standards for timeliness,
completeness and quality of data, and make these data available to researchers, clinicians,
public health officials, legislators, policymakers, community groups and the public.
Environmental Health: DOH’s Center for Environmental Health (CEH) works collaboratively with
other agencies including the NYS Department of Environmental Conservation, the federal
Environmental Protection Agency (EPA), the Centers for Disease Control and Prevention (CDC),
and the Agency for Toxic Substance and Disease Registry (ATSDR). CEH programs evaluate
health effects associated with environmental exposures, develop policies, and maintain a
variety of programs to reduce and eliminate exposures.
Recommendation: Continue to identify and assess potential exposures throughout the
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state and take action to reduce those exposures. NYS will continue to support programs to
promote and maintain clean air, clean water and reduce human exposures to
environmental hazards, with particular attention to the needs of environmental justice
communities.
Recommendation: Promote awareness of programs and initiatives to reduce environmental
hazards in our communities.
Statewide Initiatives: The overarching goals of cancer prevention and control efforts in New
York State are detailed in two State plans, the New York State 2018-2023 Comprehensive
Cancer Control Plan, and the New York State Prevention Agenda 2019-2024.
Recommendation: Continue to work with partners to implement cancer-related initiatives.
• More details about the NYS Comprehensive Cancer Control Plan can be found at:
https://www.health.ny.gov/diseases/cancer/consortium/index.htm.
• More details about the NYS Prevention Agenda can be found at:
https://www.health.ny.gov/prevention/prevention_agenda/2019-2024/.

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