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HomeMy WebLinkAboutCancer Incidence in Mansfield -2006-2015CHARLES D. BAKER Governor KARYN E. POLITO Lieutenant Governor TO.: FROM: DATE: RE The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health 250 Washington Street, Boston, MA 02108-4619 MARYLOU SUDDERS Secretary MONICA BHAREL, MD, MPH Commissioner Tel: 617-624-6000 m anass.govldph Boards of Health Susan T. Gershman, MPH, PhD, CTR Director Massachusetts Cancer Registry January 25, 2019 Cancer Incidence in Massachusetts, 2010-2014, City and Town Supplement Cancer hncidence in Massachusetts, 2011-2015, City and Town Supplement I am writing to inform you that the Massachusetts Cancer Registry (MCR) of the Massachusetts Department of Public Health (MDPH) is releasing two reports: Cancer Incidence in Massachusetts, 2010-2014, City and Town Supplement, and Cancer Incidence in Massachusetts, 2011-2015, City and Town Supplement. Please note that these reports will be published in an electronic version only and will be posted on the Department of Public Health's web site at www.mass,gov/dpli/mcr on February 8, 2019. If you are interested in farther supplement data prior to the posting, please contact the registry directly at the telephone number listed below. Please note that there is no embargo on these data and they may be released prior to the web posting date. The 2010-2014 City and Town Supplement and the 2011-2015 City and town Supplement are updates to the City and Town Supplement series. For each city and town, these reports provide expected case counts, observed case counts, standardized incidence ratios, and confidence intervals for 23 types of cancer and for all cancers combined. The confidence intervals indicate if there is a statistically significant difference (excess or deficit) between the observed and expected counts. We are providing you with the following pieces of information in advance of the reports' Internet release. 1. The introduction to the report, including an explanation of standardized incidence ratios. over 2. The cancer incidence data for your town (i.e. for 23 cancer types and all cancers combined) for the two time periods: 2010-2014 and 2011-2015. 3. Appendix II includes selected resources for information on cancer. 4. Appendix III includes MDPH Cancer Prevention and Control Initiatives. For cancer risk factors, please check the following websites: American Cancer Society: www.cancer.org; National Cancer Institute: www.cancer.gov. The complete Internet version will be available at: www.mass.gov/dpl>/mcr on February 8, 2019. If you have any trouble accessing this web site, please contact the MCR at (617) 624-5642. For further information, please contact the following at MDPH: Massachusetts Cancer Registry (617) 624-5642 Bureau of Environmental Health (617) 624-5757 Massachusetts Comprehensive Cancer Prevention and Control Program (617) 624-5484 INTRODUCTION Content The purpose of this report is to provide an estimate of cancer incidence for each of the 351 cities and towns of Massachusetts for the five-year time period 2011 through 2015. For each city and town, Standardized Incidence Ratios (SIRs) are presented for twenty-three types of invasive cancer and for all invasive cancer types combined. These ratios compare the cancer incidence experience of each city or town with the cancer experience of the state as a whole. The method involves comparing the number of cases that were observed for a city or town to the number of cases that would be expected if the city or town had the same cancer rates as the state as whole. The report is organized into the following sections: AIETHODS provides a detailed explanation of the data collection, data processing, and statistical techniques employed in this report. TABLES present data for selected types of cancer by city/town and sex. APPENDIX I provides a listing of International Classification of Diseases for Oncology codes used in the preparation of this report. APPENDIX II provides selected resources for information on cancer. APPENDIX HI describes the Massachusetts Department of Public Health's current cancer control initiatives, and provides links to bureaus within the department that address some aspect of cancer. Links to resources for publications are also provided. Comparison with Previous Reports This report updates previous annual reports published by the Massachusetts Cancer Registry (MCR). It is available on line at http://Nvww.mass.gov/dphhner. For questions about the report, contact the MCR at: Massachusetts Cancer Registry Office of Data Management and Outcomes Assessment Office of Population Health Massachusetts Department of Public Health 250 Washington Street, 6"' floor Boston, MA 02108-4619 telephone 617-624-5642; fax 617-624-5695 The preceding report, Cancer Incidence in Massachusetts 2010-2014: City and Town Supplement, included data for diagnosis years 2010 through 2014. This report contains data for the diagnosis years 2011 thorough 2015. There have been no changes in this report's format from the previous report. METHODS Data Sources Cancer Incidence The MCR collects reports of newly diagnosed cancer cases from health care facilities and practitioners throughout Massachusetts. Facilities that reported the 2011-2015 diagnoses that comprise this report include 69 Massachusetts acute care hospitals, 20 independent laboratories, 10 surgical centers, 5 radiation/oncology centers, 10 medical practice associations, 4 endoscopy centers, and approximately 500 private practice physicians. The MCR signed the modified National Data Exchange Agreement on March 28, 2013. This is a single agreement that allows participating states to exchange data on cases diagnosed or treated in other areas. Together with states participating in the agreement, and states with individual agreements, the MCR now has reciprocal reporting agreements with 42 states and with the District of Columbia, the Virgin Islands, Puerto Rico and Guam to obtain data on Massachusetts residents diagnosed out of state. Currently the MCR collects information on in situ and invasive cancers and benign tumors of the brain and associated tissues. The MCR does not collect information on basal and squamous cell carcinomas of the skin. The MCR also collects information from reporting hospitals on cases diagnosed and treated in staff physician offices when this information- is available. Not all hospitals report this type of case, however, some hospitals report such cases as if the patients had been diagnosed and treated by the hospital directly. Collecting these types of data makes the MCR's overall case ascertainment more complete. Some cancer types that may be reported to the MCR in this manner are melanoma, prostate, colon/rectum, and oral cancers. In addition, the MCR identifies previously unreported cancer cases through review of death certificate data to further improve case completeness. This process is referred to as death clearance and identifies cancers mentioned on death certificates that were not previously reported to the MCR. In some instances, the MCR obtains additional information on these cases through follow-up activities with hospitals, nursing homes, hospice residences, and physicians' offices. In other instances, a cancer -related cause of death recorded on a Massachusetts death certificate is the only source of information for a cancer case. Thus these "death certificate only" cancer diagnoses are poorly documented and have not been confirmed by review of clinical and pathological information. Such cases are included in this report, but they comprise less than 3% of all cancer cases. All case reports that provided the basis for this report were coded following the International Classification of Diseases for Oncology, 777ird Edition (ICD-0-3), which was implemented in North America with cases diagnosed as of January 1, 2001. (1) Please see Appendix A for the classification of cancers by ICD-03 codes. Each year, the North American Association of Central Cancer Registries (NAACCR) reviews cancer registry data for quality, completeness, and timeliness. For 2011-2015, the MCR's annual case count was estimated by NAACCR to be more than 95% complete for each year. The MCR has achieved the gold standard for this certification element as well as for six other certification elements for each case year since 1997. The Massachusetts cancer cases presented in this report are primary cases of cancer diagnosed among Massachusetts residents during 2011-2015 and reported to the MCR as of June 26, 2018. These data include some additional cases diagnosed in 2010-2014 that were not counted in the 2 previous report, Cancer Incidence in Massachnsetts 2010-2014: City and Town Snppiernernt. The lag time between this report and the annual statewide report of 2011-2015 cancer cases is due to the fact that data for this city and town report needed to be cleaned for accuracy of residence within Massachusetts. The statewide report presented data at the state level and did not require such accuracy of city and town of residence. The numbers presented in this report may change slightly in future reports, reflecting late reported cases or corrections based on subsequent details from the reporting facilities. Such changes might result in slight differences in numbers and rates in future reports of MCR data, reflecting the nature of population -based cancer registries that receive case reports on an ongoing basis. Massachusetts cancer cases presented in this report are primary cases of cancer diagnosed among Massachusetts residents during 2011-2015. The Massachusetts data presented include invasive cancers only (except cancer of the urinary bladder, where in situ cancers are also included). Invasive cancers have spread beyond the layer of cells where they started and have the potential to spread to other parts of the body. In situ cancers are neoplasms diagnosed at the earliest stage, before they have spread, when they are limited to a small number of cells and have not invaded the organ itself. Typically, published incidence rates do not combine invasive and in situ cancers due to differences in the biologic significance, survival prognosis and types of treatment of the humors. Cancer of the urinary bladder is the only exception, due to the specific nature of the diagnostic techniques and treatment patterns. Presentation of Data Each city and town in Massachusetts is listed alphabetically in the TABLES section. Tine observed number of cases, the expected number of cases, the standardized incidence ratios, and 95% confidence intervals are presented for twenty-three main types of cancer and for all cancer types combined. The "all cancers combined" category includes the twenty-three main types presented in this report and other malignant neoplasms. This category is meant to provide a summary of the total cancer experience in a community. As different cancers have different causes, this category does not reflect any specific risk factor that may be important for this community. observed and Expected Case Counts The observed case count (Obs) for a particular type of cancer in a city/town is the actual number of newly diagnosed cases among residents of that city/town for a given time period. A city/town's expected case count (Exp) for a certain type of cancer for this time period is a calculated number based on that city/to population distribution (by sex and among eighteen age groups) for the time period 2011, 2015, and the corresponding statewide average annual age- specifrc incidence rates. The source of tine city and town population data for the 2011-2015 period was the US Census American Community Survey (ACS), an ongoing national survey that provides demographic estimates on a yearly basis. 3 Standardized hrcidenee Ratios A Standardized Incidence Ratio (SIR) is an indirect method of adjustment for age and sex that describes in numerical terms how a city/town's cancer experience in a given time period compares with that of the state as a whole. • An SIR of exactly 100 indicates that a city/town's incidence of a certain type of cancer is equal to that expected based on statewide average age -specific incidence rates. • Au SIR of more thait 100 indicates that a city/town's incidence of a certain type of cancer is higher than expected for that type of cancer based on statewide average annual age - specific incidence rates. For example, an SIR of 105 indicates that a city/town's cancer incidence is 5% higher than expected based on statewide average annual age -specific incidence rates, • An SIR of less than 100 indicates that a city/town's incidence of a certain type of cancer is lower than expected based on statewide average age -specific incidence rates. For example, an SIR of 85 indicates that a city/town's cancer incidence is 15% lower than expected based on statewide average annual age -specific incidence rates. Statistical Significance and lateupretation ofSlRs The interpretation of tile SIR depends on both how large it is and how stable it is. Stability in this context refers to how much the SIR changes when there are small increases or decreases iu the observed or expected number of cases. Two SIRS may have the same size but not the same stability. For example, an SIR of 150 may represent 6 observed cases and 4 expected cases, or 600 observed cases and 400 expected cases. Both represent a 50 percent excess ec observed cases. However, in the first instance, one or two fewer cases would change the SIR a great deal, whereas in the second instance, even if there were several fewer cases, the SIR would only change minimally. When the observed and expected numbers of cases are relatively small, their ratio is easily affected by one or two cases. Conversely, when the observed and expected numbers of cases are relatively large, the value of the SIR is stable. A 95 percent confidence interval (CI) has been presented for each SIR in this report (when the observed number of cases is at least 5), to indicate if the observed number of cases is significantly different from the expected number, or if the difference is most likely due to chance. A confidence interval is a range of values around a measurement that indicates the precision of the measurement. In this report, the 95% confidence interval is the range of estimated SIR values that has a 95% probability of including the true SIR for a specific city or town. If the 95% confidence interval range does not include the value 100.0, then the number of observed cases is significantly different from the expected number of cases. "Significantly different" means there is at most a 5% chance that the difference between the number of observed and expected cancer cases is due solely to chance alone. If the confidence interval does contain the value 100.0, there is no significant difference between the observed and expected numbers. Statistically, the width of the interval reflects the size of the population and the number of events; smaller populations and smaller observed numbers of cases yield less precise estimates that have wider confidence intervals. Wide confidence intervals indicate instability, meaning that small changes in the observed or expected number of cases would change the SIR a great deal. Exam101.6 - ples: 0 180.6) — the confidence interval does not include 100.0 and the S= 137.0; 95 /n CI ( that the number of observed cases is statistically IR interval is above 100,,0atttthe expe ted number. eignif candy hig herthi SIR = 71.0; 9 5% CI (56.2 - 88.4) - the confidence interval does not include 100.l and the interval is below 100.0,t�� etexpected nun tiertnber of observed cases is statistically indicating signif cantly lower that 0 71.0-159.4) —the confidence intervaltDOE y cliff der t fro n what Is • SIR =108.895/o CI( that the number of observed cases is NOT statistically srgt f expected, and the difference is likely due to chance. I ben the interval includes 100.0, then the tree SIR may be 100.0. Example of Calculation of an SIR and Its Significance OBSERVED CASES X l00 SIR = EXPECTED CASES yp othetical town for one type The followindgone sexInc illustr theratesyeafile 07 t20 if calculation for a ht of cancer an To_ Town — Town$ Sty �I Expected Obs d I Cases ,kge populaflot Age -Specific Incidence Rate Cases (C)=(A)x(B) (D) Group(A) (B 7.47 11 74,657 0.0001 26.99 25 00-04 134,957 0.0002 27.23 30 05-09 0.0005 40 10-14 54,463 0.0015 37.70 30 15-19 25,136 0.0018 30.62 20-24 17,012 8 UP TO 6,337 0.0010 6.34 144 85+ Total: 136.35 144 - X 100 ;� 106 (column X 100 = 136.35 Observes X 100 = (column C total) ecte SIR= Expd Cases for this typ statewide average incidence for this cancer. Thus the SIR e of cancer in Town X is 106, indicating that the incidence of this cancer TI calculation not shown) in Town X is 6% higher othe 95% confidence interval g9,1-124.3) ( since the range However, the rang indicates that the true value maybe as low as 89.1 or as high as 124.3 Also, includes the value 100, it means that the observed number of cases is rzotstatisticallysi zi r higlzer or• lower than what is expected. St fcarztly Whenever the number of observed cases is less than five calculated nor tested for statistical significance, However, the the corresponding SIR is neither number of observed and ex Tlns is indicated with an no expected cases is show in these circwnstar cOt calculated"). Notes about Data huterpretation The SIR is a useful indication of the disease categories given community. These statistics, that have relatively starting point for further research and investi should be used with care. y high or low rates for a by themselves continn or den gation into Such statistics Provide a unrelated to disease causati deny existence of a a possible health problem, but the Particular health problem Man y do not changes in diagnosticy contribute to an elevated SIR y factors techniques, and changes in data collection omeooidingrnethods over time, as well as the natural variation if]es disease ages ence. g demographic factors, CUI When reviewing the data tables it is i observed cancer incidence in a particular c nt to kee particular comtnun[ p m mind that e SIR compares the statewide average amoral age -specific incidence rates. t3 with the expected incidence based on only be made benneerz a conrmzazit This CANNor and SHOULD* Y aird the state as a whole. Sly that valid conaparisorzs cart NOT be corn cored to each other•, or• di ererrt cities arzd totvizs would be valid only if there were no differences ill the age be tween two communities, populations.) and sex distributions ofthertwo nities Another point to keep in mind when reviewing being performed in this report For each of the 351 citiethose s and Iowis the ans cancer that can occur ill both males and females, 3 large ruueval of statistical tests that occur only in males, resultin in 41 types that occur onl e evaluate 18 tyPCs of calculations (351 cities and towns gender/cancer categories. This felual 14 391 types categories with less than 5 observed cases rarernot evaluated for statistical si gorier , � Possible actual numbers oftests is sli ) Note thatgendesults in er/cancer when multiple significance tests are wer than 14,391. This is important for significance, so tile because performed chance alone. Based on the number of calculations ill this re some will result in a significant finding due to findings to he due to chance alone. Half of these port, we expect 720 significant would be significant deficits 360 , would be significant excesses (360 ( ) There are statistical techniques that call be used to reduce this number, however use of these techniques leads to the oppositep ) and half differences that may be missed. We choose to err on tile side of caution and identify significant results, krrowin hue significant g that some will be due to chance alone. more Data Limitations It should be emphasized that apparent increases or reflect changes in diagnostic methods or case reporting decreases in cancer incidence over tune might incidence. Four other limitations must be considered rather than hue changes ill cancer Massachusetts cities and towns; under -re when interpreting cancer incidence data for reporting for cancers that In under -reporting hng nt sedareas olose to neighboring cities/towns; and standardized inci enoe ratios in based on s Hall a renbe being of ca s state.; assigned to incorrect 6 Border Areas and Neigh boring States but this may be due to loss of Some areas of Massachusetts appear to have low cancer incidence, nosed in neighboring or other states and not reported to Massachnsetts resident cases a es. Who al e dinging agreements with 42 states and with the District of the MCR• The ]vl in Islands, Puerto Rico, and Guam. Columbia, the Virg Cases Diagnosed ill NowHospital Settings the MCP-' primary information source for most eriod coveted by this report, when this ation During the time p offices, newly diagnosed cases of cancer was d rand treated ton staff physician tologiists and de nat patholotgy reporting hospitals on cases diagnoseSome types of cancer in this reportivat rnay enerallaboratory, private physicians, p' information was au istsb e. Other re Bing sources include P are diagnosed P' center's that escape identification laboratories, uOrted radiotherapy be under -reported because they anizationsI nosed or treated outside of as not he laboratories, health maintenance organ, es o f cancer diagnose systems used by hospitals. The most common . neat majority of cases statewide hospital include melanoma and prostate cancer. The exact extent of this under -reporting been determined, but cases included in this report represent the g' and provide an essential basis for evaluating statewide cancer incidence patterns. Cite/Town Misassignntettt registry toc0dures, each case reported to the MC diagnosis, In accordance with standard central cancer rn ic p ractice, however, a patient may ideally should be assigned to the al GE own in which the patient lived at the time of drag based on rite adtile dress provided by the reporting hospital. In p' a post office box locatedOn e patient is a business address; atempor'ary address ( •g• provide tee hospital with his/her mailing address (e.g•> , treatment and reports the relative's address a B� his/her patient's city/town of residence); staying with a relative while receiving ,Chestnut Hill" rathet'nosed,han Btloe hospital may report or a locality or post office name (e.g•, and own); if a patient has moved since being diagnosed, or "Newton")• in addition, large number of cases reported to the MCRents are the patient's current address. Because of tee ct /town case assig egg lay compute" rocess. TiWile" l ennlviCR staff hero net awarenOf such Performed because data are reported to the MCIZ via electronic media, most ct c performed by an automated comp P some cases based ou lire reported locality na in Order to minimize such errors, misassig /town misassigmnent are reviewed manually. nments, they manually correct tee errors. Furthermore, cases from fifty geographic localities prone to city Smolt Nwnbers of Cases ry elation of a city or town is small or if the Standardized incidence ratioostbai)d when ti1etpopbers of cases are r to calculated when the s result ill estimates that are e unstable. This situation is particular cancer type is .are SIRS and statistical significano number• of observed cases fora specific category is less than five. hn these instances, the observed and expected cases are presented hi tee tables or c ctalitative coot arison onl . 7 T11is page intentionally left blank APPI INFORMAT ON ONCAANCFRSOURCES FOR This Appendix contains a listing of selected resources for additional information on cancer. Cancers are complex diseases, many of which have multiple factors that may contribute to their development. evention, you may wish to contact the following: For information on cancer risk factors or Pr Cancer information Service (National Cancer Institute): 1 800-AC�) 345 (1 800 227 2345) Cancer Response Line (American Cancer Society): In addition, the following selected Internet websites provide information on cancer. Many of these also provide links to other sites (not listed) which may be of interest. Massachusetts Department of Public Health: httu•//www mass nov/duh American Cancer Society: httu'www cancer.org Centers for Disease Control and Prevention Horne Page: t ttp://� oov Cancer Prevention and Control Program: -h-t-tg'./—/'NVW,cdo.gov/caiceI Fruits and Veggies More Mattergu Campaign (nutrition — formerly S-A-Day Program): lrtt//www figitsandde iesmoretmatters org/ National Cancer Institute Information: httu'//www canc0r.90v Cancer Literature in PubMed: htts://www.ncor,uau.,,, .. �., Surveillance, Epidemiology, and End Results (SEER) Program data: httu'//seer cancer ov Center at Barnes -Jewish hospital and Washington You' Cancer Risk (Siteman Cancer rmerly, at Harvard Center for Cancer Prevention): University School of Medicine; to bttp,j/www.yourdise serisk.wtistl.cdu oncoLink (Abramson Cancer Center of the University of penmsylvania): l,tt,2://www.olirolitik.oi*g Cancerquest (Emory University — Winship Cancer hnstitute)! www cancerguest.org National Coalition for Cancer Survivorship: httu //www canceradvocacv org 365 "PE NDT%III: MDPH CANCER PRI,;vENTION AND CONTROL INITIATIVL, 8 The Massachusetts Department of Public Health is working to reduce the incidence and mortality Of cancer in the Commonwealth. Partnerships between MDPH programs, researchers, healthcare Providers and nonprofit organizations collect information about cancer, lead quality improvement projects, coordinate evidenced -based workshops for managing living with chronic disease (including cancel), provide education for health professionals and brig shared messages to the public. Our collaborated efforts focus on reducing cancer nrisk, incidence and mortality through healthy lifestyles, early diagnosis, and increased access to care. The Department's programs address -the impact of tobacco, alcohol, nutrition, and physical activity on cancer prevention, along with environmental and occupational hazards for cancer, Tluoughout all of our efforts there is an emphasis on reducing disparate health outcomes and unequal access to cancer care. MDPH Bureaus and Programs: Bureau of Environmental Health, wcvw.mass. ov/d h/etivironmental health Bureau of Substance Abuse Services, www.mass eov/dph/bsas Comprehensive Cancer Prevention and Control Program, www.mass go Men's Health/Wonien's Health/Care Coordination Program Tobacco Cessation and Prevention Program, www.mass Occupational Health Surveillance ProgLVWw.mass.gov/dpbtoW ram, tvhsu Office of Elder Affairs www mass UVdelders/ Oral Healtli Program, www Massu�o y/dnh/o_ r_ a�health Division of Prevention and Wellnesswww.mass.eov/dnb/healthnromotion MDPH publications on cancer prevention and screening are available at the Massachusetts Health Promotion Clearinghouse, www.maclearinahouse.com. Massachusetts Cancer Registry Publications are available through the Massachusetts Cancer Registry, telephone: 617-624-5642 and on the web at www.mass ov/dnh/mcr. 366 Mansfield Observed and Expected Case Counts, with Standardized Incidence fia10.2014 Ohs E� SIR 95%CI �Obs--� EXg SIR 95% CI Bladder Urinary Melanoma of Skin Male 24 16.7 143.3 (91.8-213.2) Male 25 12.2 205.5 (132.9-303.3) Female 0 5.8 no (no-nc) Female 21 10.3 203.9 (1262-311.8) Brain and Other Nervous System Multiple Mveloma Male 8 4.2 189.3 (61.5-373.0) Male 5 3.8 131.9 (42.5-307.8) Female 6 3.4 178.9 (65.3-389.3) Female 1 2.8 no (nc-no) Breast Non -Hodgkin Lymphoma Male 2 0.6 no (nc-no) Male 13 11.0 118.4 (63.0-202.5) Female 93 83.6 111.3 (89.8-136.3) Female 3 9.1 no (no -no) Cervix Uteri Oral Cavity & Pharvnx Male 10 9.9 101.0 (48.4-185.8) Female 1 3.2 no (nc-no) Female 1 4.0 no no-nc) Colon f Rectum Ovary Male 25 20.6 121.3 (78.4-179.0) Female 27 19.0 142.4 (93.8-207.1) Female 8 7.0 114.7 (49.4-226.0) Esophagus Pancreas Male 1 4.8 no (nc-no) Male 5 6.4 77.8 (25.1-181.5) Female 1 1.2 no (no-nc) Female 6 5.9 101.3 (37.0-220.5) Hodgkin Lymphoma Prostate Male 0 1.8 no (no -no) Male 60 59.3 101.1 (77.2-1302) Female 1 1.4 no (no-nc) Kidney & Renal Pelvis Stomach Male 13 11.4 114.5 (60.9-195.8) Male 5 4.4 114.7 (37.0-267.8) Female 5 6,2 81.2 (262-189.4) Female 4 2.5 no (nc-no) Larynx Testis Male 0 2.8 no (no-nc) Male 8 3.5 231.6 (99.7-456.4) Female 1 0.8 no (nc-nc) Leukemia ThyroidMale 6 7.8 76.6 (28.0-166.8) Male 15 5.9 254.9 (142.64120.5) Female 11 5.4 202.7 (101.0-362.6) Female 17 18.1 93.7 (54.6-150.0) Liver and Intrahepalic Bile Ducts Uteri Corpus and Uterus NOS Male 9 6.9 131.0 (59.8-248.7) Female 3 2.1 no (no -no) Female 11 18.0 61.2 (30.5-109.5) Lung and Bronchus All Sites i Types Male 35 30.6 114.5 (79.7-159.2) Male 284 243.5 416.6 (103A-131.0) Female 34 30 107.4 (74.4-150.1) Female 282 260.5 108.2 (96.0-121.6) Ohs = observed case count; Exp = expected case count; SIR = standardized incidence ratio ( (Ohs / Exp) X 100); 95% Cl = 95% confidence intervals, a measure of the statistical significance of the SIR; Shading indicates the statistical significance of the SIR at 95% level of probability; no = The SIR and 95% Cl were not calculated when Ohs < 5; 176 Mansfield //^\ )Exp Observed and Expected Case Counts, with Standardized Incidence Ratos, 20i 11-2015Obs E�x SIR 95%CI Obs_SIR Bladder, Urinary Melanoma of Skin Male 23 17.3 132.7 (84.1-199.2) Male 20 12.5 160.4 Female 1 5.9 no (no -no) Female 20 10.7 187.1. Brain and Other Nervous System Multiple Mveloma Male 8 4.2 192.5 (82.9-379.3) Male 5 3.9 128.4 Female 6 3.5 170.7 (62.3-371.6) Female 1 2.9 no Breast Non -Hodgkin Lymphoma Male 2 0.7 _ no (nc-nc) Male 14 11.2 125.5 Female 99 87.5 113.1 (91.9-137.7) Female 3 9.2 no Cervix Uteri Oral Cavity & Pharvnx Male 7 10.1 69.4 Female 0 3.3 no (no -no) Female 3 4.3 no Colon I Rectum - Ovary Male 24 20.6 116.E (74.7-173.5) Female 27 19.1 141.6 (93.3-206.1) Female 10 7.2 138.0 Esophagus Pancreas Male 1 4.8 no (nc-no) Male 5 6.9 72.8 Female 2 1.2 no (nc-nc) Female 4 6.1 no Hodgkin Lymphoma Prostate Male 0 1.8 no (no-nc) Male 62 58.7 105.5 Female 2 1.5 no (nc-no) Kidney & Renal Pelvis Stomach Male 11 12.1 91.1 (45.4-163.1) Male 2 4A no Female 4 6.4 no (no-nc) Female 4 2.6 no Larynx Testis Male 0 2.8 no (nc-no) Male 8 3.7 216.9 Female 1 0.9 no (no -no) Leukemia Thyroid Male 8 7.9 101.1 (43.5-199.2) Male 13 6.2 208.9 Female 8 5.6 143.8 (61.9-283.4) Female 15 19.5 77.1 Liver and Intrahepatic Bile Ducts Uteri Corpus and Uterus, NOS Male 10 7.0 142.2 (68.1-261.6) Female 3 2.2 no (no -no) Female 12 18.7 64.1 Lung and Bronchus All Sites I Types Male 37 30.9 119.6 (84.2-164.8) Male 276 246.5 112.0 Female 28 32.3 86.6 (57.6-125.2) Female 279 269.9 103.4 • Obs = observed case count; Exp = expected case count; • SIR = standardized incidence ratio ( (Obs I Exp) X 100); • 95% Cl = 95% confidence intervals, a measure of the statistical significance of the SIR; • Shading indicates the statistical significance of the SIR at 95% level of probability; • no = The SIR and 95% CI were not calculated when Ohs < 5; 176 95% CI (97.9-247.8) (114.2-288.9) (41.4-299.8) (nc-no) (68.5-210.5) (nc-no) (27.8-142.9) (no -no) (66.1-253.8) (23.5-169.9) (no-nc) (80.9-135.3) (no -no) (no-nc) (93.4-427.4) (111.1-357.2) (43.1-127.2) (33.1-112.0) (99.1-126.0) (91.6-116.2) CHARLES D. BAKER Governor KARYN E. POLITO Lieutenant Governor TO: I13ZULTAE DATE: RE: The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health 250 Washington Street, Boston, MA 02108-4619 MARYLOU SUDDERS Secretary MONICA BHAREL, MD, MPH . Commissioner Tel: 617-624-6000 w .mass.ilov/dph Boards of Health Susan T. Gershman, MPH, PhD, CTR S44-- Director Massachusetts Cancer Registry May 15, 2017 Cancer Incidence in Massachusetts, 2009-2013, City and Town Supplement I am writing to inform you that the Massachusetts Cancer Registry (MCR) of the Massachusetts Department of Public Health (MDPH) is releasing its report Cancer Incidence in Massachusetts, 2009-2013, City and Town Supplement. Please note that this report will be published in an electronic version only and will be posted on the Department of Public Health's web site at www.mass.goy/dpb/mer on May 24, 2017. If you are interested in further supplement data prior to the posting, please contact the registry directly at the telephone number listed below. Please note that there is no embargo on these data and they may be released prior to the web posting date. The 2009-2013 City and Town Supplement updates the 2008-2012 City and Town Supplement. For each city and town, this report provides expected case counts, observed case counts, standardized incidence ratios, and confidence intervals for 23 types of cancer and for all cancers combined. The confidence intervals indicate if there is a statistically significant difference (excess or deficit) between the observed and expected counts. We are providing you with the following pieces of information in advance of the report's Internet release. 1. The introduction to the report, including an explanation of standardized incidence ratios. 2. The cancer incidence data for your town (i.e. for 23 cancer types and all cancers combined). 3. Appendix II includes selected resources for information on cancer. 4. Appendix III includes MDPH Cancer Prevention and Control Initiatives. 5. For cancer risk factors,.please check the following websites: American Cancer Society: www.cancer.org; National Cancer Institute: www.cancer.gov. over The complete Internet version will be available at: www.mass. aov/dpb/mcr The following reports have also been recently posted on the above website: Data Brief: Cancer Incidence in Massachusetts 2010-2014 —Preliminary Data Cancer Incidence and Mortality in Massachusetts 2009-2013: Statewide Report If you have any trouble accessing this web site, please contact the MCR at (617) 624-5642. For further information, please contact the following at MDPH: Massachusetts Cancer Registry (617) 624-5642 Bureau of Environmental Health (617) 624-5757 Massachusetts Comprehensive Cancer Prevention and Control Program (617) 624-5484 INTRODUCTION Content The purpose of this report is to provide an estimate of cancer incidence for each of the 351 cities and towns of Massachusetts for the five-year time period 2009 through 2013. For each city and town, Standardized Incidence Ratios (SIRS) are presented for twenty-three types of invasive cancer and for all invasive cancer types combined. These ratios compare the cancer incidence experience. of each city or town with the cancer experience of the state as a whole. The method involves comparing the number of cases that were observed for a city or town to the number of cases that would be expected if the city or town had the same cancer rates as the state as whole. The report is organized into the following sections: METHODS provides a detailed explanation of the data collection, data processing, and statistical techniques employed in this report. TABLES present data for selected types of cancer by city/town and sex. APPENDIX I provides a listing of International Classification of Diseases for Oncology codes' used in the preparation of this report. APPENDIX 11 provides selected resources for information on cancer. APPENDIX III describes the Massachusetts Department of Public Health's current cancer control initiatives, and provides links to bureaus within the department that address some aspect of cancer. Links to resources for publications are also provided. Comparison with Previous Reports This report updates .previous annual reports published by the Massachusetts Cancer Registry (MCR). It is available on line at hgp://www.mass.gov/dl2h/me . For questions about the report, contact the MCR at: Massachusetts Cancer Registry Office of Data Management and Outcomes Assessment Massachusetts Department of Public Health 250 Washington Street, 6h floor. Boston, MA 02108-4619 telephone 617-624-5642; fax 617-624-5695 The preceding report ancer I eidence in Massachusetts 20081-2012. City and Town Supplement, included data for diagnosis years 2008 through 2012. This report contains data for the diagnosis years 2009 through 2013. There have been no changes in this report's format from the previous report. ME, THODS Data Sources Cancer Incidence The MCR collects reports of newly diagnosed cancer cases from health care facilities and practitioners throughout Massachusetts. Facilities that reported the 2009-2013 diagnoses that'comprise this report include 0 Massachusetts acute care hospitals, 18 independent laboratories, 10 surgical centers, 5 radiation/oncology centers, 5 medical practice associations, 4 endoscopy centers, and approximately 500 private practice physicians. The MCR signed the modified National Data Exchange Agreement on March 28; 2013. This is a single agreement that allows participating states to exchange data on cases diagnosed or treated in other areas. Together with states participating in the agreement, and states with individual agreements, the MCR now has reciprocal reporting agreements with 43 states and with Puerto Rico and Guam to obtain data on Massachusetts residents diagnosed out of "state. Currently the MCR collects information on in situ and invasive cancers and benign tumors of the brain and associated tissues. The MCR does not collect information on basal and squamous cell carcinomas of the skin. The MCR also collects information from reporting hospitals on cases diagnosed and treated in staff physician offices when this information is available. Not all hospitals report this type of case, however, some hospitals report such cases .as if the patients had been diagnosed and treated by the hospital directly. Collecting these types of data makes 'the MCR''s overall case ascertainment more complete. Some cancer types that maybe reported to the MCR in this manner are melanoma, prostate, colon/rectum, and oral cancers. In addition, the MCR identifies previously unreported cancer cases through review of death certificate data to further improve case completeness. This•process is referred to as death clearance and identifies cancers mentioned on death certificates. that were not previously reported to the MCR. In some instances, the MCR obtains additional information on these cases through follow-up activities with hospitals, nursing homes, hospice residences, and physicians'. offices. In othef instances, a cancer - related cause of death recorded on a Massachusetts death certificate is the only source of information for a cancer case. Thus these "death certificate only" cancer diagnoses are poorly documented and have not been confirmed by review of clinical and pathological information. Such cases are included in this report, but they comprise less than 3% of all cancer cases. All case reports that provided the basis for this report were coded following the International Classification of Diseases for Oncology, Third Edition (ICD-0-3), which was implemented in North America with cases diagnosed as of January 1, 2001. (1) Please see Appendix A for the classification of cancers by ICD-03 codes. Each year, the North American Association of Central Cancer Registries (NAACCR) reviews cancer registry data for quality, completeness, and timeliness. For 2009-2013, the MCR's annual case count was estimated by NAACCR to be more than'95% complete for each year. The MCR has achieved the gold standard for this certification element as well as, for six other certification ele}nents for each case year since 1997. The Massachusetts cancer cases presented in this report are primary cases of cancer diagnosed among Massachusetts residents during2009-2013 and reported to the MCR as of December 1, 2016. These data include some additional cases diagnosed in 2008-2012 that were not counted in the previous report, Cancer Incidence in Massachusetts 2008-20I2: 'City and Torvn Supplement The lag time between this report and the annual statewide report of 2009-2013 cancer cases is due to the fact that data for this city and town report needed to be, cleaned for accuracy of residence within Massachusetts. The statewide report presented data at the state level and did not require such accuracy of city and 2. town of residence. The numberspresented in this report may change slightly in future reports, reflecting late reported cases or corrections based on subsequent details from the reporting facilities. Such changes might result in slight differences in numbers and rates in future reports of MCR data, reflecting the nature of population -based cancer registries that receive case reports on an ongoing basis. Massachusetts cancer cases presented in this report are primary cases of cancer diagnosed among Massachusetts residents during 2009-2013." The Massachusetts data presented include invasive cancers only (except cancer of the urinary bladder, where in situ cancers are also included). Invasive cancers have spread beyond the layer of cells where they started and have the potential to spread to other parts of the body. In situ cancers are neoplasms diagnosed at the earliest stage, before they have spread, when they are limited to a small number of cells and have not invaded the organ itself. Typically, published incidence rates do not combine invasive and in situ cancers due to differences in the biologic significance, survival prognosis and types of treatment of the tumors. Cancer of the urinary bladder is the only exception, due to the specific nature of the diagnostic,techniques and treatment patterns. Presentation of Data Each city and town in Massachusetts is listed alphabetically in the TABLES section. The observed number of cases, the expected number of cases, the standardized incidence ratios, and 95% confidence intervals are presented for twenty-tluee main types of cancer and for all cancer types combined. The "all cancers combined" category includes the twenty-three main types presented in this report and other riralignant neoplasms. This category is meant to provide a summary of the total cancer experience in a community. As different cancers have different causes, tbis.categmy does not reflect any specific risk factor that may be important for this community. Observed and Expected Case Counts The observed case count (Ohs) for a particular type of cancer in a city/town is the actual number of newly diagnosed cases among residents. of that city/town for a given time period. A city/town's expected case count (Exp) for a certain type of cancer for this time period is a calculated number based on that city/town's population distribution (by sex and among eighteen age groups) for the time period 2009-2013, and the corresponding statewide average annual age -specific incidence rates. The source of the city and town population data for the 2009-2013 period was the US Census American Community Survey (ACS), an ongoing national survey that provides demographic estimates on a yearly basis? Standardized Incidence Ratios A Standardized Incidence Ratio (SIR) is an indirect method of adjustment for age and sex that describes in numerical terms how a city/town's cancer experience in a given time period compares with that of the state as a whole. • An SIR of exactly 100 indicates that a city/town's incidence of a certain type of cancer is equal to that expected based on statewide average age -specific incidence rates. • An SIR of more than 100 indicates that a city/town's incidence of a certain type of cancer is higher than expected for that type of cancer based on statewide average annual age -specific incidence rates. For example, an SIR of 105 indicates that a city/town's cancer incidence is 5% higher than expected based on statewide average annual age -specific incidence rates. 3. An SIR of less than 100 indicates that a city/town's incidence of a certain type of cancer is lower than expected based on statewide average age -specific, incidence rates, For example, an SIR of 85 indicates that a city/town's cancer incidence is 15% lower than expected based on statewide average annual age -specific incidence rates. Statistieal Sign fcance and Interpretation of SIRs The interpretation of the SIR depends on both how large it is and how stable it is. Stability in this context refers to how much the SIR changes when there are small increases or decreases in the observed or expected number of cases. Two SIRS may have the same size but not the same stability. For example, an SIR of 150 may represent 6 observed cases and 4 expected cases, or 660 observed cases and 400 expected cases. Both represent a 50 percent excess of observed cases. however, in the first instance, one or two fewer cases would change the SIR a great deal, whereas in the second instance; even if there were several fewer cases, the SZR would only change minimally: When the observed and expected numbers of cases are relatively small, their ratio is easily affected by one or two cases. Conversely, when the observed and expected numbers of cases are relatively large, the value of the SIR is stable. A 95 percent confidence interval (CI) has been presented for each SIR in this report(when the observed number of cases is at least 5), to indicate if the observed number of cases is significantly different from the expected number, or if the difference is most likely due to chance. A confidence interval is a range of values around a measurement that indicates the precision of the measurement. In this report, the 95% confidence interval is the range of estimated SIR values that has a 95% probability of including the true SIR for a specific city or town. If the 95% confidence interval range does not include the value 100.0, then the number of observed cases is significantly different from the expected number of cases. "Significantly different" means there is at most a 5% chance that the difference between the number of observed and expected cancer cases is due solely to chance alone. If the confidence interval does contain the value 100, there is no significant difference between the observed and expected numbers. Statistically, the width of the interval reflects the size of the population and the number of events; smaller populations and smaller observed numbers of cases yield less precise . estimates that have wider confidence intervals. Wide confidence intervals indicate instability, meaning that small changes in the observed or expected number of cases would change the SIR a. great deal. Examples: • SIR = 137.0; 95% CI (101.6 - 180.6) —the confidence interval does not include 100.0 and the interval is above 100.0, indicating that the number of observed cases is statistically significantly higher than the expected number. • SIR = 71.0; 95% *CI (56.2 — 88.4) —the confidence interval does not include 100.0 and the interval is below 100.0, indicating that the number of observed cases is statistically significantly lower than the expected number. • SIR = 108.8 95% Cl (71.0-159.4) — the confidence interval DOES include 100.0 indicating that the number of observed cases is NOT statistically significantly different from what is expected, and the difference is likely due to chance. When the interval includes, 100.0, then the true SIR maybe 100.0. 4 Exaihple of Calculation of an SIR and lis Significance OBSERVED CASES EXPECTED CASES X 100 The following example illustrates the method of calculation for a hypothetical town for:one type of cancer and one sex for the years 2007-2011: Town X State Town X Town X Age Age -Specific Expected Observed Group Population Incidence Rate Cases Cases (A) (B) (C)= (A) x (B) (D) 00-04 74,657 0.0001 7.47 11 05-09 134,957 0.0002 26.99 . 25 1044 54,463 0.0005 27.23 30 15-19 25,136 0.0015 37.70 40 20-24 17,012 0.0018 30.62 30 UP TO 85+ 6,337 0.0010 6.34 8 Total: 136.35 144 Observed Cases (column D total) 144 SIR Expected Cases X 100 = (column C total) X 100 = 136.35 X 100 106 Thus the SIR for this type of cancer in Town X is 106, indicating that the incidence of this cancer in Town X is 6% higher than the corresponding statewide average incidence for this cancer. However, the range for the 95% confidence interval (89.1-124.3) (calculation not shown) indicates that the true value may be as low as 89.1 or as high as 124.3 Also, since the range includes the value 100, it means that the observed number of cases is not statistically significantly higher or lower than what is expected. Whenever the number of observed cases is less than five, the corresponding SIR is neither calculated nor tested for statistical significance. This is indicated with an (no) ("not calculated"). However, the number of observed and expected cases is shown in these circumstances. Notes about Data Interpretation The SIR is a useful indication of the disease categories that have relatively high or low rates for.a given community. These statistics, however, should be used with care. Such statistics provide a starting point for further research and, investigation into a possible,health problem, but they do not by themselves confnui or deny the existence of a particular health problem. Many factors unrelated.to disease causation may contribute to an elevated SIR, including demographic factors, changes in diagnostic techniques, and changes in data collection or recording methods over time, as well as the natural variation in disease occun'ence. 5 When reviewing the data tables, it is important to keep in mind that an SIR compares the observed cancer incidence in a particular community with the expected incidence based on statewide average annual age -specific incidence rates. This means that valid comparisons can only be made between a community and the state as a whole. SZRs for different cities and towns CANNOT and SHOULD NOT be compared to each other. (Comparisons between two communities would be valid only if there were no differences in the age and sex distributions of the two communities' populations.) Another point to keep in mind when reviewing these data is the large number of statistical tests being performed in this report. For each of the 351 cities and towns, we evaluate 18 types of cancer that can. occur in both males and females, 3 types that occur only in females and 2 types that occur only in males, resulting in 41 gender/cancer categories. This results in 14,391 possible calculations (351 cities and towns x 41 gender cancer categories). Note that gender/cancer categories with less than 5 observed cases are not evaluated for statistical significance, so the actual numbers of tests is slightly lower than 14,391. This is important for the reader because when multiple significance tests are performed, some will result in a significant finding due to chance alone. Based on the number of calculations in this report, we expect 720 significant findings to be due to chance alone. Half of these would' be significant excesses (360) and half would be significant deficits (360). There are statistical techniques that can be used to reduce this number, however use of these techniques leads to the opposite problem —hue significant differences that may be missed. We choose to err on the side of caution and identify more significant results, knowing that some will be due to chance alone. Data Limitations It should be empbasized that apparent increases or decreases in cancer incidence over time might reflect changes in diagnostic methods or case reporting rather than true changes in cancer incidence. Your other limitations must be considered when interpreting cancer incidence data for Massachusetts cities and towns: under -reporting in areas close to neighboring states; under -reporting for cancers that may not be diagnosed in hospitals; cases being assigned to incorrect cities/towns; and standardized incidence ratios based on small numbers of cases. .. Border Areas and Neighboring States Some areas of Massachusetts appear to have low cancer incidence, but this may be due to loss of Massachusetts resident cases who are diagnosed in neighboring or other states and not reported to the MCR. The MCR has reciprocal reporting agreements with 29 states and with Puerto Rico. Cases Diagnosed in Non Hospital Settings During the time period covered by this report, the MCR's primary information source for most newly diagnosed cases of cancer was hospitals. In addition the MCR collected information from reporting hospitals on cases .diagnosed and treatedin staff physician offices, when this information was available. Other reporting sources include dermatologists and dermatopathology laboratories, urologists' offices and a general laboratory. Some types of cancer in this report may be under -reported because they are diagnosed primarily by private physicians, private laboratories, health maintenance organizations, radiotherapy centers that escape identification systems used by hospitals. The most common types of cancer diagnosed or treated outside of the hospital include melanoma and prostate cancer. The exact extent of this under -reporting has not been determined, but cases included in this report represent the great majority of cases statewide and provide an essential basis for evaluating statewide cancer incidence patterns. City/Town Misassigninent In accordance with standard central cancer registry procedures, each case reported to the MCR ideally should be assigned to the city/town in which the patient lived at the time of diagnosis, based on the address provided by the reporting hospital. In practice, however, a patient may provide the hospital with his/her mailing address (e.g., a post office box located outside the patient's city/town of residence); a business address; a temporary address (e.g., the patient is staying with a relative while receiving treatment and reports the relative's address as his/her own); or a locality or post office name (e.g., "Chestnut hill' rather than "Boston," `Brookline," or "Newton"). In addition, if a patient has moved since being diagnosed, the hospital may report the patient's current address. Because of the large number of cases reported to the MCR, and because data are reported to the MCR via electronic media, most cityltown case assignments are performed by an automated computer process. This simplified matching process may misassign some cases based on the reported locality name. When MCR staff become aware of such misassignments, they manually correct the errors. Furthermore, in order to minimize such.errors, cases from fifty geographic localities prone to city/towri misassignment are reviewed manually. Small Numbers of Cases Standardized incidence ratios based on small numbers of cases result in estimates that are very unstable. This situation is common when the population of a city or town is small or if the particular cancer type is rare. SIRS and statistical significance are not calculated when the number of observed cases for a specific category is less than five. In these instances, the observed and expected cases are' presented in the tables for qualitative comparison onlx. Mansfield Observed and Expected 2009-2013 Case Counts, with Standardized Incidence R7_00` Ohs Exp 95% Cl s E� SIR Bladder, Urinary Melanoma of Skin Male 20 15.6 128.2 (78.3-197.9) Male 26 11.6 223.6 Female 0 5.6 no (no -no) Female 20 10.3 193.6 Brain and Other Nervous System Multiple Myeloma Male 8 4.1 193.7 (83.4-381.6) Male 3 3.5 no Female 7 3.3 214.9 (86.1-442.8) Female 1 2.7 no Breast Non -Hodgkin Lymphoma Male 2 0.6 no (nc-nc) Male 14 10.6 132.6 Female 89 80.2 110.9 (89.1-136.5) Female 4 8.8 no Cervix Uteri Oral Cavity & Pharynx Male 11 9.2 119.5 Female 1 3.2 no (no -no) Female 1 3.8 no Colon / Rectum Ovary Male 27 19.3 140.0 (92.2-203.7) Female 28 18.5 151.6 (100.7-219.2) Female 7 6.9 102.0 Esophagus Pancreas Male 3 4.6 no (nc-no) Male 4 5.8 no Female 0 1.1 no (nc-nc) Female 9 5.5 162.E Hodgkin Lymphoma Prostate Male 0 1.8 no (nc-no) Male 57 58.5 97.4 Female 2 1.4 no (nc-no) Kidney & Renal Pelvis Stomach Male 14 10.5 132.9 (72.6-222.9) Male 6 4.0 150.6 Female 9 5.9 153.6 (70.1-291.6) Female 3 2.3 no Larynx Testis Male 0 2.7 no (nc-nc) Male 6 3.5 170.0 Female 1 0.8 no (no-nc) Leukemia Thyroid Male 9 7.4 121.6 (55.5-230.8) Male 16 5.6 284.1 Female 10 5.3 188.5 (90.2-346.7) Female 19 17.9 106.3 Liver and Intrahepatic Bile Ducts Uteri Corpus and Uterus NOS Male 6 6.5 92.4 (33.7-201.2) Female 3 1.9 no (nc-nc) Female 14 17.4 80.3 Lung and Bronchus All Sites /Types Male 32 28.6 112.1 (76.6-158.2) Male 279 231.9 1203 Female 38 30.2 125.8 (89.0-172.7) Female 290 251.3 115.4 • Ohs = observed case count; Exp = expected case count; • SIR = standardized incidence ratio ( (Ohs / Exp) X 100); • 95% Cl = 95% confidence intervals, a measure of the statistical significance of the SIR; • Shading indicates the statistical significance of the SIR at 95% level of probability; • no = The SIR and 95% Cl were not calculated when Ohs < 5; 176 95% Cl (146.0-327.6) (118.2-299.1) (no-nc) (nc-nc) (72.5-222.6) (no -no) (59.6-213.9) (no-nc) (40.8-210.1) (nc-no) (74.2-308.6) (73.7-126.1) (55.0-327.8) (nc-nc) (62.1-370.1) (162.3-461.4) (64.0.166.0) (43.9-134.7) (106.6-135.3) (102.5-129.5) APPENDIX IT: SELECTED RESOURCES FOR INFORMATION ON CANCER This Appendix contains a listing of selected resources for additional information on cancer. Cancers are complex diseases, many of which have multiple factors that may contribute to their development. For information on cancer risk factors or prevention, you may wish to contact the following: Cancer Information Service (National Cancer Institute): 1-800-4-CANCER (1-800-422-6237) Cancer Response Line (American Cancer Society): 1-800-ACS-2345 (1-800-227-2345) In addition, the following selected Internet websites provide information on cancer. Many of these also provide links to other sites (not listed) which may be of interest. Massachusetts Department of Public Health: http://www.mass.goy/dph American Cancer Society: http://www.cancer.org Centers for Disease Control and Prevention Home Page: http://www.cdo.gov Cancer Prevention and Control Program: http:/Iwww.edc.gov/cancer Fruits and Veggies More MattersTM Campaign (nutrition — formerly S-A-Day Program): ift://www.fiaitsandveggiesinorematters.or National Cancer Institute Information: http://www.cancer.gov Cancer Literature in PubMed: litti2s://www,nebi.nhn.nili. oy/pubined?cmd current=Limits&pmfilter Subsets=Cancer Surveillance, Epidemiology, and End Results (SEER) Program data: http://seer.cancer.gov Your Cancer Risk (Siteman Cancer Center at Barnes -Jewish Hospital and Washington University School of Medicine; formerly at Harvard Center for Cancer Prevention): http://www.yourdiseaserisk.wustl.edu OncoLink (Abramson Cancer Center of the University of Pennsylvania): http://www,oncolink.org Cancerquest (Emory University — Winship Cancer Institute): www.cancerquest.org National Coalition for Cancer Survivorship: http://www.canceradvocagy.org APPENDIX III: MDPH CANCER PREVENTION AND CONTROL INITIATIVES The Massachusetts Department of Public Health is working to reduce the incidence and mortality of cancer in the Commonwealth. Partnerships between MDPH programs, researchers, healthcare providers and nonprofit organizations collect information about cancer, lead quality improvement projects, coordinate evidenced -based workshops for managing living with chronic disease (including cancer), provide education for health professionals and bring shared messages to the public. Our collaborated efforts focus on reducing cancer risk, incidence and mortality through healthy lifestyles, early diagnosis, and increased access to care. The Department's programs address the impact of tobacco, alcohol, nutrition, and physical activity on cancer prevention, along with environmental and occupational hazards for cancer. Throughout all of our efforts there is an emphasis on reducing disparate health outcomes and unequal access to cancer care. MDPH Bureaus and Programs: Bureau of Environmental Health, www.mass.gov/dph/onvironmental health Bureau of Substance Abuse Services, www.mass:gov/dph/bsas Comprehensive Cancer Prevention and Control Program, www.mass.gov/compcancer Men's Health/Women's Health/Care Coordination Program Tobacco Cessation and Prevention Program, www.mass.gov/dph/mtep Occupational Health Surveillance Program, www.mass.goy/dph/ohsp Office of Elder Affairs www.mass.gov/elders/ Oral Health Program, www.mass.gov/dph/oralhealth Division of Prevention and Wellness www.mass.gov/dph/healthpromotion MDPH publications on cancer prevention and screening are available at the Massachusetts Health Promotion Clearinghouse, www.maclearinghouse.com. Massachusetts Cancer Registry Publications are available through the Massachusetts Cancer Registry, telephone: 617-624-5642 and on the web at www.mas§.gov/dph/mcr. CHARLES D. BAKER Governor KARYN E. POLITO Lieutenant Governor TO FROM: The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health 250 Washington Street, Boston, MA 02108-4619 Boards of Health Susan T. Gershman, MPH, PhD, CTR Director Massachusetts Cancer Registry DATE: June 21, 2016 MARYLOU SUDDERS Secretary MONICA BHAREL, MD, MPH Commissioner Tel: 617-624-6000 w .mass.gov/dph RE: Cancer Incidence in Massachusetts, 2008-2012, City and Town Supplement I am writing to inform you that the Massachusetts Cancer Registry (MCR) of the Massachusetts Department of Public Health (MDPH) is releasing its report Cancer Incidence in Massachusetts, 2008-2012, City and Town Supplement. Please note that this report will be published in an electronic version only and will be posted on the Department of Public Health's web site at www.mass.gov/dph/mcr on July 6, 2016, 2016. If you are interested in further supplement data prior to the posting, please contact the registry directly at the telephone number listed below. Please note that there is no embargo on these data and they may be released prior to the web posting date. The 2008-2012 City and Town Supplement updates the 2007-2011 City and Town Supplement. For each city and town, this report provides expected case counts, observed case counts, standardized incidence ratios, and confidence intervals for 23 types of cancer and for all cancers combined. The confidence intervals indicate if there is a statistically significant difference (excess or deficit) between the observed and expected counts. We are providing you with the following pieces of information in advance of the report's Internet release. 1. The introduction to the report, including an explanation of standardized incidence ratios. 2. The cancer incidence data for your town (Le, for 23 cancer types and all cancers combined). 3. Appendix II includes selected resources for information on cancer. 4. Appendix III includes MDPH Cancer Prevention and Control Initiatives. 5. For cancer risk factors, please check the following websites: American Cancer Society: www.cancer.ora; National Cancer Institute: www.cancer.gov. aver The complete Internet version will be available at: www.mass.gov/dph/mcr The following report has also been recently posted on the above website: Cancer Incidence and Mortality in Massachusetts 2009-2013: Statewide Report If you have any trouble accessing this web site, please contact the MCR at (617) 624-5642. For further information, please contact the following at MDPH: Massachusetts Cancer Registry (617) 624-5642 Bureau of Environmental Health (617).624-5757 Massachusetts Comprehensive Cancer Prevention and Control Program (617) 624-5484 INTRODUCTION Content The purpose of this report is to provide an estimate of cancer incidence for each of the 351 cities and towns of Massachusetts for the five-year time period 2008 through 2012. For each city and town, Standardized Incidence Ratios (SIRS) are presented for twenty-three types of invasive cancer and for all invasive cancer types combined. These ratios compare the cancer incidence experience of each city or town with the cancer experience of the state as a whole. The method involves comparing the number of cases that were observed for a city or town to the number of cases that would be expected if the city or town had the same cancer rates as the state as whole. The report is organized into the following sections: METHODS PROVIDES a detailed explanation of the data collection, data processing, and statistical techniques employed in this report. TABLES present data for selected types of cancer by city/town and sex. APPENDIX I provides a listing of International Classification of Diseases for Oncology codes used in the preparation of this report. APPENDIX H provides selected resources for information on cancer. APPENDIX III describes the Massachusetts Department of Public Health's current cancer control initiatives, and provides links to bureaus within the department that address some aspect of cancer. Links to resources for publications are also provided. Comparison with Previous Reports This report updates previous annual reports published by the Massachusetts Cancer Registry (MCR). It is available on line at http://www.mass.eov/dph/mcr. For questions about the report, comact.the MCR at: Massachusetts Cancer Registry Office of Data Management and Outcomes Assessment Massachusetts Department of Public Health 250 Washington Street, 6t° floor Boston, MA 02108-4619 telephone 617-624-5642; fax 617-624-5695 The preceding repork Cancer Incidence in Massachusetts 2007-2011: City and Town Supplement, included data for diagnosis years 2007 through 2011. This report contains data for the diagnosis years 2008 through 2012. There have been no changes in this report's format from the previous report. METHODS Data Sources Cancer Incidence The MCR collects reports of newly diagnosed cancer cases from health care facilities and practitioners throughout Massachusetts. Facilities that reported the 2008-2012 diagnoses that comprise this report include 69 Massachusetts acute care hospitals, 5 radiation/oncology centers, 2 endoscopy centers, 2 surgical centers, 10 independent laboratories, 3 medical practice associations, and approximately 500 private practice physicians. The MCR signed the modified National Data Exchange Agreement on March 28, 2013. This is a single agreement that allows participating states to exchange data on cases diagnosed or treated in other areas. Together with states participating in the agreement, and states with individual agreements, the MCR now has reciprocal reporting agreements with 37 states and with Puerto Rico and Guam to obtain data on Massachusetts residents diagnosed out of state. Currently the MCR collects information on in sitzr and invasive cancers and benign tumors of the brain and associated tissues. The MCR does not collect information on basal and squamous cell carcinomas of the skin. _ The MCR also collects information from reporting hospitals on cases diagnosed and treated in staff physician offices when this information is available. Not all hospitals report this type of case, however, some hospitals report such cases as if the patients had been diagnosed and treated by the hospital directly. Collecting these types of data makes the MCR's overall case ascertainment more complete. Some cancer types that may be reported to the MCR in this manner are melanoma, prostate, colon/rectum, and oral cancers. In addition, the MCR identifies previously unreported cancer cases through review of death certificate data to further improve case completeness. This process is referred to as death clearance and identifies cancers mentioned on death certificates that were not previously reported to the MCR. In some instances, the MCR obtains additional information on these cases through follow-up activities with hospitals, nursing homes, hospice residences, and physicians' offices. In other instances, a cancer - related cause of death recorded on a Massachusetts death certificate is the only source of information for a cancer case. Thus these "death certificate only" cancer diagnoses are poorly documented and have not been confirmed by review of clinical and pathological information. Such cases are included in this report, but they comprise less than 3% of all cancer cases. All case reports that provided the basis for this report were coded following the International Classification of Diseases for Oncology, Third Edition (ICD-0-3), which was implemented in North America with cases diagnosed as of January 1, 2001, (1) Please see Appendix A for the classification of cancers by ICD-03 codes.. Each year, the North American Association of Central Cancer Registries (NAACCR) reviews cancer registry data for quality, completeness, and timeliness. For 2008-2012, the MCR's annual case count was estimated by NAACCR to be more than 95% complete for each year. The MCR has achieved the gold standard for this certification element as well as for six other certification elements for each case year since 1997. The Massachusetts cancer cases presented in this report are primary cases of cancer diagnosed among Massachusetts residents during 2008-2012 and reported to the MCR as of December 18, 2015. These data include some additional cases diagnosed in 2008-2011 that were not counted in the previous report, Cancer Irrciderace irr Massaclnrsetls 2007--207I: City and Torvn Srgrplemen1. The lag time between this report and the annual statewide report of 2008-2012 cancer cases is due to the fact that data for this city and town report needed to be cleaned for accuracy of residence within Massachusetts. The statewide report presented data at the state level and did not require such accuracy of city and town of residence. The numbers presented in this report may change slightly in future reports, reflecting late reported cases or corrections based on subsequent details from the reporting facilities. Such changes might result in slight differences in numbers and rates in future reports of MCR data, reflecting the nature of population -based cancer registries that receive case reports on an ongoing basis. Massachusetts cancer cases presented in this report are primary cases of cancer diagnosed among Massachusetts residents during 2008-2012. The Massachusetts data presented include invasive cancers only (except cancer of the urinary bladder, where in sitar cancers are also included). Invasive cancers have spread beyond the layer of cells where they started and have the potential to spread to other parts of the body. In situ cancers are neoplasms diagnosed at the earliest stage, before they have spread, when they are limited to a small number of cells and have not invaded the organ itself. Typically, published incidence rates do not combine invasive and in situ cancers due to differences in the biologic significance, survival prognosis and types of treatment of the tumors. Cancer of the urinary bladder is the only exception, due to the specific nature of the diagnostic techniques and treatment patterns. Presentation of Data Each city and town in Massachusetts is listed alphabetically in the TABLES section. The observed number of cases, the expected number of cases, the standardized incidence ratios, and 95% confidence intervals are presented for twenty-three main types of cancer and for all cancer types combined. The "all cancers combined" category includes the twenty-three main types presented in this report and other malignant neoplasms. This category is meant to provide a summary of the total cancer experience in a community. As different cancers have different causes, this category does not reflect any specific risk factor that may be important for this community. Observed and Expected Case Counts The observed case count (Obs) for a particular type of cancer in a city/town is the actual number of newly diagnosed cases among residents of that city/town for a given time period. A city/town's expected case count (Exp) for a certain type of cancer for this time period is a calculated number based on that city/town's population distribution (by sex and among eighteen age groups) for the time period 2008-2012, and the corresponding statewide average amoral age -specific incidence rates. The city/town level population data for the 2008 to 2012 period in this report was calculated by multiplying 2010 city and town data by five (2). Standardizedlneldence Ratios A Standardized Incidence Ratio (SIR) is an indirect method of adjustment for age and sex that describes in numerical terms how a city/town's cancer experience in a given time period compares with that of the state as a whole. • An SIR of exactly 100 indicates that a city/town's incidence of a certain type of cancer is equal to that expected based on statewide average age -specific incidence rates. J • An SIR of more than 100 indicates that a city/town's incidence of a certain type of cancer is higher than expected for that type of cancer based on statewide average annual age -specific incidence rates. For example, an SIR of 105 indicates that a city/town's cancer incidence is 5% higher than expected based on statewide average annual age -specific incidence rates. An SIR of less than 100 indicates that a city/town's incidence of a certain type of cancer is lower than expected based on statewide average age -specific incidence rates. For example, an SIR of 85 indicates that a city/town's cancer incidence is 15% lower than expected based on statewide average annual age -specific incidence rates. Statistical Significance and Interpretation of SIRS The interpretation of the SIR depends on both how large it is and how stable it is. Stability in this context refers to how much the SIR changes when there are small increases or decreases in the observed or expected number of cases. Two SIRs may have the same size but not the same stability. For example, an SIR of 150 may represent 6 observed cases and 4 expected cases, or 600 observed cases and 400 expected cases. Both represent a 50 percent excess of observed cases. However, in the first instance, one or two fewer cases would change the SIR a great deal, whereas in the second instance, even if there were several fewer cases, the SIR would only change minimally. When the observed and expected numbers of cases are relatively small, their ratio is easily affected by one or two cases. Conversely, when the observed and expected numbers of cases are relatively large, the value of the SIR is stable. A 95 percent confidence interval (CI) has been presented for each SIR in this report (when the ' observed number of cases is at least 5), to indicate if the observed number of cases is significantly different from the expected number, or if the difference is most likely due to chance. A confidence interval is a range of values around a measurement that indicates the precision of the measurement. In this report, the 95% confidence interval is the range of estimated SIR values that has a 95% probability of including the true SIR for a specific city or town. If the 95% confidence interval range does not include the value 100.0, then the number of observed cases is significantly different fiom the expected number of cases. "Significantly different" means there is at most a 5% chance that the difference between the number of observed and expected cancer cases is due solely to chance alone. If the confidence interval does contain the value 100, there is no significant difference between the observed and expected numbers. Statistically, the width of the interval reflects the size of the population and the number of events; smaller populations and smaller observed numbers of cases yield less precise estimates that have wider confidence intervals. Wide confidence intervals indicate instability, meaning that small changes in the observed or expected number of cases would change the SIR a great deal. Examples: • SIR = 137.0; 95% Cl (101.6 - 180.6) — the confidence interval does not include 100.0 and the interval is above 100.0, indicating that the number of observed cases is statistically significantly higher than the expected number. • SIR = 71.0; 95% Cl (56.2 — 88.4) — the confidence interval does not include 100.0 and the interval is below 100.0, indicating that the number of observed cases is statistically significantly lower than the expected number. • SIR = 108.8 95% Cl (71.0-159.4) — the confidence interval DOES include 100.0 indicating that the number of observed cases is NOT statistically significantly different from what is expected, and the difference is likely due to chance. When the interval includes 100.0, then the true SIR maybe 100.0. 11 Example of Calculation of an SIR and Its Signficance OBSERVED CASES EXPECTED CASES X 100 The following example illustrates the method of calculation for a hypothetical town for one type of cancer and one sex for the years 2008-2012: Town X State Town X Town X Age Age -Specific Expected Observed Group Population Incidence Rate Cases Cases (A) (B) (C)=(A)x(B) (D) 00-04 74,657 0.0001 7.47 11 05-04 134,957 0.0002 26.99 25 10-14 54,463 0.0005 27.23 30 15-19 25,136 0.0015 37.70 40 20-24 17,012 0.0018 30.62 30 UP TO 85+ 6,337 0.0010 6.34 8 Total: 136.35 144 Observed Cases (column D total) 144 S1R Expected Cases X 100 = (colunm C total) X 100 = 136.35 X 100 106 Thus the SIR for this type of cancer in Town X is 106, indicating that the incidence of this cancer in Town X is 6% higher than the corresponding statewide average incidence for this cancer. However, the range for the 95% confidence interval (89.1-124.3) (calculation not shown) indicates that the true value may be as low as 89.1 or as high as 124.3 Also, since the range includes the value 100, it means that the observed number of cases is not statistically significantly higher or lower than what is expected. Whenever the number of observed cases is less than five, the corresponding SIR is neither calculated nor tested for statistical significance. This is indicated with an (nc) ("not calculated"). However, the number of observed and expected cases is shown in these circumstances. Notes about Data Interpretation The SM is a useful indication of the disease categories that have relatively high or low rates for a given community. These statistics, however, should be used with care. Such statistics provide a starting point for further research and investigation into a possible health problem, but they do not by themselves confirm or deny the existence of a particular health problem. Many factors unrelated to disease causation may contribute to an elevated SIR, including demographic factors, changes in diagnostic techniques, and changes in data collection or recording methods over time, as well as the natural variation in disease occurrence. 5 When reviewing the data tables, it is important to keep in mind that an SIR compares the observed cancer incidence in a particular community with the expected incidence based on statewide average annual age -specific incidence rates. This means that valid comparisons can only be made betiveen a comrmunity and the state as a whole. SIRS for different cities and towns CANNOT and SHOULD NOT be compared to each other. (Comparisons between two communities would be valid only if there were no differences in the age and sex distributions of the two communities' populations.) Another point to keep in mind when reviewing these data is the large number of statistical tests being performed in this report. For each of the 351 cities and towns, we evaluate 18 types of cancer that can occur in both males and females, 3 types that occur only in females and 2 types that occur only in males, resulting in 41 gender/cancer categories. This results in 14,391 possible calculations (351 cities and towns x 41 gender cancer categories). Note that gender/cancer categories with less than 5 observed cases are not evaluated for statistical significance, so the actual numbers of tests is slightly lower than 14,391. This is important for the reader because when multiple significance tests are performed, some will result in a significant finding due to chance alone. Based on the number of calculations in this report, we expect 720 significant findings to be due to chance alone. Half of these would be significant excesses (360) and half would be significant deficits (360). There are statistical techniques that can be used to reduce this number, however use of these techniques leads to the opposite problem — true significant differences that may be missed. We choose to err on the side of caution and identify more significant results, knowing that some will be due to chance alone. Data Limitations It should be emphasized that apparent increases or decreases in cancer incidence over time might reflect changes in diagnostic methods or case reporting rather than true changes in cancer incidence. Four other limitations must be considered when interpreting cancer incidence data for Massachusetts cities and towns: under -reporting in areas close to neighboring states; under-reporting.for cancers that may not be diagnosed in hospitals; cases being assigned to incorrect cities/towns; and standardized incidence ratios based on small numbers of cases. Border Areas and Neighboring States Some areas of Massachusetts appear to have low cancer incidence, but this may be due to loss of Massachusetts resident cases who are diagnosed in neighboring or other states and not reported to the MCR. The MCR has reciprocal reporting agreements with 37 states and with Puerto Rico and Guam. Cases Diagnosed in Non -Hospital Settings During the time period covered by this report, the MCR's primary information source for most newly diagnosed cases of cancer was hospitals. In addition the MCR collected information from reporting hospitals on cases diagnosed and treated in staff physician offices, when this information was available. Other reporting sources include dermatologists and dermatopathology laboratories, urologists' offices and a general laboratory. Some types of cancer in this report may be under -reported because they are diagnosed primarily by private physicians, private laboratories, health maintenance organizations, radiotherapy centers that escape identification systems used by hospitals. The most common types of cancer diagnosed or treated outside of the hospital include melanoma and prostate cancer. The exact extent of this under -reporting has not been determined, but cases included in this report represent the great majority of cases statewide and provide an essential basis for evaluating statewide cancer incidence patterns. C. City/Toivu Misassignrnent In accordance with standard central cancer registry procedures, each case reported to the MCR ideally should be assigned to the city/town in which the patient lived at the time of diagnosis, based on the address provided by the reporting hospital, hn practice, however, a patient may provide the hospital with his/her mailing address (e.g., a post office box located outside the patient's city/town of residence); a business address; a temporary address (e.g., the patient is staying with a relative while receiving treatment and reports the relative's address as his/her own); or a locality or post office name (e.g., "Chestnut Hill" rather than "Boston," `Brookline," or "Newton"). In addition, if a patient has moved since being diagnosed, the hospital may report the patient's current address. Because of the large number of cases reported to the MCR, and because data are reported to the MCR via electronic media, most city/town case assignments are performed by an automated computer process. This simplified matching process may misassign some cases based on the reported locality name. When MCR staff become aware of such misassigmnents, they manually correct the errors. Furthermore, in order to minimize such errors, cases from fifty geographic localities prone to city/town misassignment are reviewed manually. Small Numbers of Cases Standardized incidence ratios based on small numbers of cases result in estimates that are very unstable. This situation is common when the population of a city or town is small or if the particular cancer type is rare. SIRS and statistical significance are not calculated when the number of observed cases for a specific category is less than five. In these instances, the observed and expected cases are presented in the tables for qualitative comparison only. Mansfield Observed and Expected Case Counts, with Standardized Incidence R t os2012 SIR 95% CI Qbss SIR Bladder, Urinary Melanoma of Skin -- Male 18 16.9 106.7 (63.2-168.6) Male 22 12.5 175.6 Female 1 6.0 no (nano) Female 18 10.7 167.7 Brain and Other Nervous System Multiple Mveloma Male 5 4.2 120.0 (38.7-280.1) Male 3 3.5 no Female 8 3.4 238.2 (102.6-469.5) Female 1 2.7 no Breast Non -Hodgkin Lymphoma Male 3 0.6 no (no -no) Male 12 11.2 107.5 Female 88 62.8 106.3 (85.3-131.0) Female 3 9.0 no Cervix Uteri Oral Cavity & Pharynx Male 11 9.7 113A Female 1 3.3 no (nc-no) Female 2 3.9 no Colon I Rectum Ovary Male 27 20.9 129.0 (85.0-187.7) Female 27 19.8 136.1 (89.7-198.1) Female 9 Esophagus Pancreas Male 4 5.0 no (nc-nc) Male 3 Female 0 1.2 no (nc-no) Female 8 Hodgkin Lymphoma Prostate Male 0 1.9 no (no -no) Male 60 Female 3 1.5 no (nc-nc) Kidney & Renal Pelvis Stomach Male 13 11.1 117.2 (62.3-200.4) Male 6 Female 8 6.1 132.0 (56.8-260.0) Female 2 Larynx Testis Male 0 2.8 no (nc-no) Male 6 Female 1 0.9 no (nc-nc) Leukemia Thyroid Male 8 7.7 104.1 (44.8-205.1) Male 15 Female 8 5.5 144.4 (62.2-284.5) Female 19 Liver and Intrahepatic Bile Ducts Uteri Corpus and Uterus, NOS Male 4 6.8 no (nc-nc) Female 3 2.0 no (nc-nc) Female 10 Lung and Bronchus All Sites I Types Male 30 31.3 95.8 (64.6-136.7) Male 270 Female 41 32.3 127.0 (91.1-172.3) Female 285 • Obs = observed case count; Exp = expected case count; • SIR = standardized incidence ratio ( (Ohs I Exp) X 100); • 95% Cl = 95% confidence intervals, a measure of the statistical significance of the SIR; • Shading indicates the statistical significance of the SIR at 95% level of probability; • no = The SIR and 95% Cl were not calculated when Ohs < 5; 176 7.2 124.5 6.1 no 5.8 136.9 67.6 88.8 4.3 140.3 2.4 no 3.4 177.8 5.8 258.7 18.0 105.7 17.9 55.8 251.8 107.2 261.5 109.0 95% CI (110.0-265.8) (99.4-265.1) (no -no) (no -no) (55.5-187.8) (nc-no) (56.5-202.9) (no -no) (56.8-236.4) (no -no) (59.0-269.8) (67.7-114.2) (51.2-305.4) (nc-nc) (64.9-386.9) (144.7A26.7) (63.6-165.1) (26.7-102.6) (94.8-120.8) (96.7-122.4) APPENDIX H: SELECTED RESOURCES FOR INFORMATION ON CANCER This Appendix contains a listing of selected resources for additional information on cancer. Cancers are complex diseases, many of which have multiple factors that may contribute to their development. For information on cancer risk factors or prevention, you may wish to contact the following: Cancer Information Service (National Cancer Institute): 1-800-4-CANCER (1-800-422-6237) Cancer Response Line (American Cancer Society): 1-800-ACS-2345 (1-800-227-2345) In addition,.the following selected Internet websites provide information on cancer. Many of these also provide links to other sites (not fisted) which may be of interest. Massachusetts Department of Public Health: http://www.mass.gov/dph American Cancer Society: litti)://Nvmv.caiicer.org Centers for Disease Control and Prevention Home Page: http://Nvww.cdc.gov Cancer Prevention and Control Program: littp://w-,vw.cdc.gov/cancet- Fruits and Veggies More MattersTM Campaign (nutrition — formerly 5-A-Day Program): hftp://NvNvw.Fj-uitsaiidVeggiesMafter.gov National Cancer Institute Information: http://www.cancer.gov Cancer Literature in PubMed: http://wA"y.cancer.goy/scarcli/cancer literature Surveillance, Epidemiology, and End Results (SEER) Program data: hftl2://seer.caiicei-.gov Your Cancer Risk (Siteman Cancer Center at Barnes -Jewish Hospital and Washington University School of Medicine; formerly at Harvard Center for Cancer Prevention): http://www.youi-diseaserisk.Nvitstl.edii OncoLink (Abramson Cancer Center of the University of Pennsylvania): littp://wwNv.oiicoliiik.tipeiin.edu Cancerquest (Emory University — Winship Cancer Institute): www.cancer uq est.org Cancer News on the Net® (information on diagnosis and treatment for cancer patients and their families): http://www.caucernews.com National Coalition for Cancer Survivorship: http://www.cauceradvocac�org 365 APPENDIX III: MDPH CANCER PREVENTION AND CONTROL INITIATIVES The Massachusetts Department of Public Health is working to reduce the incidence and mortality of cancer in the Commonwealth. Partnerships between MDPH programs, researchers, healthcare providers and nonprofit organizations collect information about cancer, lead quality improvement projects, coordinate evidenced -based workshops for managing living with chronic disease (including cancer), provide education for health professionals and bring shared messages to the public. Our collaborated efforts focus on reducing cancer risk, incidence and mortality through healthy lifestyles, early diagnosis, increased access to care, and improved quality of life for cancer survivors. The Department's programs address the impact of tobacco, alcohol, nutrition, and physical activity on cancer prevention, along with environmental and occupational hazards for cancer. Throughout all of our efforts there is an emphasis on reducing disparate health outcomes and unequal access to cancer care. MDPH Bureaus and Programs: Bureau of Environmental Health, www.mass.gov/dph/environmental health Bureau of Substance Abuse Services, www.mass.gov/dph/bsas Comprehensive Cancer Prevention and Control Network, www.mass ovg /compcancer Cancer Care Coordination Program, www.mass.gov/dph/cccp Tobacco Cessation and Prevention Program, wNvw.mass.gov/dphhntcp Occupational Health Surveillance Program, www.mass.g_ov/dph/ohsp Office of Healthy Aging; www.mass.gov/dph/liealtiiyasin Oral Health Program, www.mass.gov/dph/oralliealth Division of Prevention and Wellness www.mass.gov/dph/healtlipromotiol MDPH publications on cancer prevention and screening are available at the Massachusetts Health Promotion Clearinghouse, www.niaclearinghouse.com. Massachusetts Cancer Registry Publications are available through the Massachusetts Cancer Registry, telephone: 617-624-5642 and on the web at www.mss.gov/dpli/inor. 366 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH WILLIAM A. HINTON STATE LABORATORY INSTITUTE Diagnostic Microbiology Laboratories 305 South Street, Jamaica Plain, MA 02130, (617) 983-6600 Report Date: 06/20/2016 Accession#16EN4285 MANSFIELD BOARD OF HEALTH SIX PARK ROW MANSFIELD, MA 02048 FINAL REPORT Salmonella species was not found, Patient Name: TAARIN T HAGGARD Provider Patient ID: UN3373 DOB: 09/06/1982 Sex: F Collection Date: 06/14/2016 Received Date: 06/15/2016 Contact: Source: Stool Source Description: ORIG STOOL Specimen Type: Original Mansfield Observed and Expected Case Counts, with Standardized Incidence R(tios, 2007.2011 Obs Exp SIR 95%CI Obs Bladder, Urinary Melanoma of Skin Male 17 15.5 109.4 (63.7-175.2) Male 18 Female 2 5.4 no (nc-no) Female 18 Brain and Other Nervous System Multiple Mveloma Male 2 4.2 no (nc-nc) Male 2 Female 7 3.2 216.2 (8&6445.4) Female 1 Breast Non -Hodgkin Lymphoma Male 3 0.5 no (nc-nc) Male 13 Female 75 74.4 100.8 (79.3-126.3) Female 4 Cervix Uteri Oral Cavils & Pharynx Male 10 Female 2 3.2 no (nc-nc) Female 2 Colon 1 Rectum Ovary Male 27 19.8 136.6 (90-198.7) Female 27 18.4 146.4 (96.5-213) Female 6 Esophagus Pancreas Male 5 4.6 109.3 (35.2-255.1) Male 2 Female 0 1.1 no (no -no) Female 10 Hodgkin Lymphoma Prostate Male 0 2 no (Re -no) Male 59 Female 3 1.5 no (no-nc) Kidney & Renal Pelvis Stomach Male 10 10.3 97.5 (46.7-179.3) Male 6 Female 8 5.5 146.7 (63.1-289) Female 0 Larynx Testis Male 2 2.6 no (no-nc) Male 4 Female 0 0.8 no (nc-no) Leukemia Thyroid Male 8 7.1 112.9 (48.6-222.5) Male 13 Female 7 5.2 135.9 (54.4-280) Female 22 Liver and Intrahepatic Bile Ducts Uteri Corpus and Uterus, NOS Male 6 5.8 103.5 (37.8-225.2) Female 2 1.7 no (no -no) Female 11 Lung and Bronchus - All Sites / Types Male 25 28.9 86.4 (55.9-127.6) Male 250 Female 44 28.8 152.7 (110.9-204.9) Female 272 • Obs = observed case count; Exp = expected case count; • SIR = standardized incidence ratio ( (Obs / Exp) X 100); • 95% Cl = 95% confidence intervals, a measure of the statistical significance of the SIR; • Shading indicates the statistical significance of the SIR at 95% level of probability; • no = The SIR and 95% Cl were not calculated when Obs < 5; 176 n SIR 11.9 151.6 10.3 174 3.1 no 2.3 no 10.5 123.5 8 no 8.5 118 3.4 no 6A 93.7 5.3 no 5.2 192.4 64.5 91.5 4 150 2.2 no 3.5 no 5.3 245.7 17.4 126,5 16.1 68.4 235.3 106.3 237.9 114.3 95% CI (89.8-239.6) (103.1-275.1) (nc-no) (nc-nc) (65.7-211.2) (nc-nc) (%5-217) (nc-no) (34.2-204) (nc-no) (92.1-353.9) (69.7-118.1) (54.8-326.5) (nc-nc) (no-nc) (130.7A20.1) (79.2-191.5) (34.1-122.4) (93.5-120.3) (101.1-128.7) DEVAL L. PATRICK GOVERNOR JOHN W.POLANOWICZ SECRETARY CHERYLBARTLETT COMMISSIONER TO: FROM: DATE: RE: The Commonwealth of Massachusetts Executive Office of Health and Human Services. Department of Public Health 250 Washington Street, Boston, MA 02108-4619 Tel:617-624-6000 Fax:617-624-5206 wvvw.mass.gov/dph Boards of Health . Susan T. Gershman, MPH, PhD, CTR Director Massachusetts Cancer Registry November.18, 2014 Cancer Incidence in Massachusetts, 2006-2010, City and Town Supplement I am writing to infMm you that he Massar.,husetts Cancer Registry (MCR)'0F1the Massac setts rff Department of Public Health,MPH) is rIbleasing its report Cancer Incidence.in MassacYittsetts, 2006-2010, City and�Towri Supplement: Please note that this report will b6'j3ubIished in an electronic version,only and will be posted on the Department of Public Health..,s.web sile at www.mass.goy/d�ll/i- t December 1, 2014. If you are interested in further supplement data prior to the posting, please contact the registry directly at the telephone number listed below. Please note that there is no embargo on these data and they may be released prior to the web posting date. The 2006-2010. City and Town Supplement updates the 2005-2009 City and Town Supplement. For each city and town, this report provides expected case counts, observed case counts, standardized incidence ratios, and confidence intervals for 23 types of cancer and for all cancers combined. The confidence intervals indicate if there is a statistically significant difference (excess or deficit) between the observed and expected counts. We are providing you with the following pieces of information in advance of the report's Internet• release. 1. The introduction to the report, including an explanation of standardized incidence ratios. 2. The cancer incidence data for your town (i.e. for 23 cancer types and all cancers combined). 3. Appendix II includes selected resources for information on cancer. 4. Appendix III includes MDPH Cancer Prevention and Control Initiatives. 5. For cancer risk factors, please check the following websites: American Cancer Society: www.eancer,ertt;National Cancer Institute: www.caneer.go The'complete Internet version will be available at: www.mass&y/d h/mcr The following report has also been recently posted on the above website: Cancer Incidence. and Mortality in Massachusetts 2006-2010. Statewide Report If you have any trouble accessing this web site, please contact the MCR at (617) 624-5642. For further information, please contact the following at MDPH: Massachusetts Cancer Registry (617) 624-5642 Bureau of Environmental Health (617) 624-5757 Massachusetts Comprehensive Cancer Prevention and Control Program (617) 624-5484 I INTRODUCTION Content The purpose of this report is to provide an estimate of cancer incidence for each of the 351 cities and towns of Massachusetts for the five-year time period 2006 through 2010. For each city and town, Standardized Incidence Ratios (SIRS) are presented for twenty-three types of invasive cancer and for all invasive cancer types combined. These ratios compare the cancer incidence experience of each city or town with the cancer experience of the state as a whole. The method involves comparing the number of cases that were observed for a city or town to the number of cases that would be expected if the city or town had the same cancer rates as the state as whole. The report is organized into the following sections: METHODS provides a detailed explanation of the data collection, data processing, and statistical techniques employed in this report. TABLES present data for selected types of cancer by city/town and sex. APPENDIX d provides a listing of -International Classification of Diseases for Oncology codes used in the preparation of this report. APPENDIX H provides a listing of risk factors for selected cancer types and a listing of the individuals who reviewed the risk factor list.. APPENDIX IH describes the Massaelmsetts Department of Public Health's current cancer c;introl initiatives and provides links to bureaus witliiir the de `di tment that address some aspect ". of cancer. Links to resources for publications ai a Aso provided. Comparison nvith Previous Reports' "yr• "� This report updates previous annual reports published by the Massachusetts Cancer Registry (MCR). It is available on line at http://www.iTass,gov/dph/nncr. For questions about the report, contact the MCR at: Massachusetts Cancer Registry Office of Data Management and Outcomes Assessment Massachusetts Department of Public Health 250 Washington Street, 6`h floor Boston, MA 02108-4619 telephone 617-624-5642; fax 617-624-5695 The preceding report Cancer Incidence in Massachusetts 2005-2009: City and Toavu Supplement, included data for diagnosis years 2005 through 2009. This report contains data for the diagnosis years 2006 through 2010. There have been no changes in this report's format fi•om the previous report. METHODS Data Sources Cancer Incidence The MCR collects reports of newly diagnosed cancer cases from health care facilities and practitioners throughout Massachusetts. Facilities that reported the 2006-2010 diagnoses that comprise this report include 69 Massachusetts acute care hospitals, 5 radiation/oncology centers, 2 endoscopy centers, 2 surgical centers, 10 independent laboratories, 3 medical practice associations, and approximately 500 private practice physicians. The MCR signed the modified National Data Exchange Agreement on March 28, 2013. This is a single agreement that allows participating states to exchange data on cases diagnosed or treated in other areas. Together with states participating in the agreement, and states with individual agreements, the MCR now has reciprocal reporting agreements with 29 states and with Puerto Rico to obtain data on Massachusetts residents diagnosed out of state. Currently the MCR collects information on in situ .and 'invasive cancers and benign tumors of the brain and associated tissues. The MCR does not collect information on basal and squanrous cell carcinomas of the skin. The MCR also collects information from reporting hospitals on cases diagnosed and treated in staff physician offices when this information is available. Not all hospitals report this type of case, however, some hospitals report such cases as if the patients had been diagnosed and treated by the hospital directly. Collecting these types of data makes the MCR's overall case ascertainment more complete. Some cancer types that may be reported to the MCR in this manner are melanoma, prostate, colon/rectum, and oral cancers. In ar[4{ilon, the MCR identifies previously unreported cancer casegAr ough review of death certificate Js . data to further improve case completeness. This process is referred to as death clearance and identifies cancers mentioned. on death certificates that were not previously reported to the MCR. In some instances, the MCR obtains additional information on: these cases through follow-up activities with hospitals, nursing homes, hospice. residences, and physicians' offices. In other instances, a cancer - related cause of death recorded on a Massachusetts death certificate is the only source of information for a cancer case. Thus these "death certificate' only" cancer diagnoses are poorly documented and have not been confirmed by review of clinical and pathological information. Such cases are included in this report, but they comprise less than 30/o of all cancer cases. All case reports that provided the basis for this report were coded following the International Classification of Diseases for Oncology, Third Edition (ICD-0-3),'which was implemented in North America with cases diagnosed as of January 1, 2001. (1) Please see Appendix A for the classification of cancers by ICD-03 codes. Each year, the North American Association of Central Cancer Registries (NAACCR) reviews cancer registry data for quality, completeness, and timeliness. The NAACCR certification results for the MCR for diagnosis years 2006-2010 are presented in Table A. For 2006-2010, the MCR's annual case count was estimated by NAACCR to be more than 95% complete for each year. The MCR has achieved the gold standard for this certification element as well as for six other certification elements for each case year since 1997. (See Table A.) The Massachusetts cancer cases presented in this report are primary cases of cancer diagnosed among Massachusetts residents during 2006-2010 and reported to the MCR as of August 1, 2014. These data include some additional cases diagnosed in 2006-2009 that were not counted in the previous report, Cancer Incidence in Massachusetts 2005-2009: City and Town Supplement. The lag time between this report and the annual statewide report of 2006-2010 cancer cases is due to the fact that data for this city and town report needed to be cleaned for accuracy of residence within Massachusetts. The statewide report presented data at the state level and did not require such accuracy of city and town of 2 residence.The numbers presented in this report may change slightly in future reports, reflecting late reported cases or corrections based on subsequent details from the reporting facilities. Such changes might result in slight differences in numbers and rates in future repoits of MCR data, reflecting the nature of population -based cancer registries that receive case reports on an ongoing basis. Massachusetts cancer cases presented in this report are primary cases of cancer diagnosed among Massachusetts residents during 2006-2010. The Massachusetts data presented include invasive cancers only (except cancer of the urinary bladder, where in situ cancers are also included). Invasive cancers have spread beyond the layer of cells where they started and have the potential to spread to other parts of the body. In situ cancers are neoplasms diagnosed at the earliest stage, before they have spread, when they are limited to a small number of cells and have not invaded the organ itself. Typically, published incidence rates do not combine invasive and in situ cancers due to differences in the biologic significance, survival prognosis and types of treatment of the tumors. Cancer of the urinary bladder is the only exception, due to the specific nature of the diagnostic techniques and treatment patterns. Presentation of Data Each city and town in Massachusetts, is listed alphabetically in the TABLES section. The observed number of cases, the expected number of cases, the standardized incidence ratios, and 95% confidence intervals are presented for twenty-three main types of cancer and for all cancer types combined. The "all cancers combined" category includes the twenty-three main types presented in this report and other malignant neoplasms. This category is meant to provide a summary of the total cancer experience in a community. As different cancers have different causes; this category does not reflect any specific risk• fa,tuiAhat maybe important for this community. §r{ Observed and Exp .cted Case Counts The observed case count (Ohs) for a particular type of cancer in a city/town is the actual number of newly diagnosed cases among residents of that city/town for a given time period. A city/town's expected case count (> xp) for a certain type of cancer for this time period is a calculated number based on that city/town's population distribution2 (by sex and among eighteen age groups) for the time period 2006-2010, and the corresponding statewide average annual age -specific incidence rates. The population data for the 2006 to 2010 period was calculated by adding 2005 city and town data with 2010 city and town data, dividing by two, and multiplying by five. Standardizedlncidence Ratios A Standardized Incidence Ratio (SIR) is an indirect method of adjustment for age and sex that describes in numerical terms how a city/town's cancer experience in, a given time period compares with that of the state as a whole. • An SIR of exactly 100 indicates that a city/town's incidence of a certain type of cancer is equal to that expected based on statewide average age -specific incidence rates. • An SIR of more than 100 indicates that a city/town's incidence of a certain type of cancer is higher than expected for that type of cancer based on statewide average annual age -specific incidence' rates. For example, an SIR of 105 indicates that a city/town's cancer incidence is 5% higher than expected based on statewide average annual age -specific incidence rates. 3 An SIR of less than 100 indicates that a cityltown's incidence of a certain type of cancer is lower than expected based on statewide average age -specific incidence rates. For example, an. SIR of 85 indicates that a city/town's cancer incidence is 15% lower than expected based on statewide average annual age -specific incidence rates. Statistical Significance andlnterpretation ofSIRs The interpretation of the SIR depends on both how large it is and how stable it is. Stability in this context refers to how much the SIR changes when there are small increases or decreases in the observed or expected number of cases. Two SIRS may have the same size but not the same stability. For example, an SIR of 150 may represent 6 observed cases and 4 expected cases, or 600 observed cases and 400 expected cases. Both represent a.50 percent excess of observed cases. However, in the first instance, one or two fewer cases would change the SIR a great deal, whereas in the second instance, even if there were several fewer cases, the SIR would only change minimally. When the observed and expected numbers of cases are relatively small, their ratio is easily affected by one or two cases. Conversely, when the observed and expected numbers of cases are relatively large, the value of the SIR is stable. A 95 percent confidence interval (CI) has been presented for each SIR in this report (when the observed number of cases is at least 5), to indicate if the observed number of cases is significantly different from the expected number, or if the difference is most likely due to chance. A confidence interval is a range of values around a measurement that indicates the precision of the measurement. In this report, the 95% confidence interval is the range of estimated SIR values that has a 95% probability of including the true SIR for 'specific city or town. If the 95% confidence interval.range dw-s not include the value,10d%t, then Re nurnber of observed cases is significantly differsuttom the expected number of cases. "Significantly different" means there is at most a'3"W61u ncertlfattlie difference between,the numdler of observed and expected cancer cases is due solely to elrar;se alone. If the confidence interval does contain the value 100, there is no significant difference between the observed and expected numbers. Statistically, the width of the interval reflects the size of the population and the number of events; smaller populations and smaller observed numbers of cases yield less precise estimates that have wider confidence intervals. Wide confidence intervals indicate. instability, meaning that small changes in the observed or expected number of cases would change the SIR a great deal. Examples: ® SIR= 137.0; 95% Cl (101.6 - 180.6)—tlre confidence interval does not include 100.0 and the interval is above 100.0, indicating that the number of observed cases is statistically significantly higher than the expected number. • SIR = 71.0; 95% Cl (56.2 — 88.4) —the confidence interval does not include 100.0 and the interval is below 100.0, indicating that the number of observed cases is statistically significantly lower than the expected number. • SIR=108.8 95% Cl (71.0-159.4) —the confidence interval DOES include 100.0 indicating that the number of observed cases is NOT statistically significantly different from what is expected, and the difference is likely due to chance. When the interval includes 100.0, then the true SIR maybe 100.0. n Example of Calculation of an SIR and Its Significance OBSERVED CASES SIR _ -EXPECTED CASES X 100 The following example illustrates the method of calculation for a hypothetical town for one type of cancer and one sex for the years 2004-2008: Town X State Town X Town X Age Age -Specific Expected Observed Group Population Incidence Rate Cases Cases (A) (B) (C)—(A)x(B) (D) 00-04 74,657 0.0001 7.47 11 05-09 134,957 ' 0.0002 26.99 25 10-14 54,463 0.0005 27.23 30 15-19 25,136 0.0015 -37.70 40 20-24 17,012 0.0018 30.62 30 UP TO 85+ 6,337 0.0010 6.34 8 Total: 136.35 144 < < Observed Cases (column D total) 144 "^ SIR X 100 = X 100 = X 100 106 Expected Cases (column C total) 136.35 Thus the SIR for this type of cancer in Town X is 106, indicating that the incidence of this cancer in Town X is 6% higher than the corresponding statewide average incidence for this cancer. However, the range for the 95% confidence interval (89.1-124.3) (calculation not shown) indicates that the true value may be as low as 89.1 or as high as 124.3 Also, since the range includes the value 100, it means that the observed number of cases is not statistically significantly higher or lower than what is expected. Whenever the number of observed cases is less than five, the corresponding SIR is neither calculated nor tested for statistical significance. This is indicated with an (ne) ("not calculated"). However, the number of observed and expected cases is shown in these circumstances. Notes about Data Interpretation The SIR is a useful indication of the disease categories that have relatively high or low rates for a given community. These statistics, however, should be used with care. Such statistics provide a startirig point for further research and investigation Into a possible health problem, but they do not by themselves confirm or deny tine existence of a particular health problem. Many factors unrelated to disease causation may contribute to an elevated SIR, including demographic factors, changes in diagnostic techniques, and changes in data collection or recording methods over time, as well as tine natural variation in disease occurrence. ' 4� When reviewing the data tables, it is important to keep in mind that an SIR compares the observed cancer incidence in a particular community with the expected incidence based on statewide average annual age -specific incidence rates. This means that valid comparisons can only be made between a community and the state as a whole. SIRS for different cities and towns CANNOT and SHOULD NOT be compared to each other. (Comparisons between two communities would be valid only if there were no differences in the age and sex distributions of the two communities' populations.) Another point to keep in mind when reviewing these data is the large number of statistical tests being performed in this report. For each of the 351 cities and towns, we evaluate.18 types of cancer that can occur in both males and females, 3 types that occur only in females and 2 types that occur only in males, resulting in 41 gender/cancer categories. This results in 14,391 possible calculations (351 cities and towns x 41 gender cancer categories). Note that gender/cancer categories with, less than 5 observed cases are not evaluated for statistical significance, so the actual numbers of tests is slightly lower than 14,391. This is important for the reader because when multiple significance tests are performed, some will result in a significant finding due to chance alone. Based on the number of calculations in this report, we expect 720 significant findings to be due to chance alone. Half of these would be significant excesses (360) and half would be significant deficits (360). There are statistical techniques that can be used to reduce this number, however use of these techniques leads to the opposite problem — true significant differences that may be missed. We choose to err on the side of caution and identify more significant. results, knowing that some will be due to chance alone. . Data Limitations It should be emphasized that apparent increas�& or decrgases in cancer incidence over time might r. as•' reflect changes in diagnostic methods crease reporting rather than true changes in cancer incidence. Four other limitations must be4considered when interpreting cancer incidence data for Massachusetts cities and towns: under-reporting+in are as to neighboring states; under -reporting for cancors that' may not be diagnosed in hospitals; cases being assigned to incorrect cities/towns; and standardized incidence ratios based on small numbers of cases. Border Areas and Neighboring Stafes Some areas of Massachusetts appear to have low cancer incidence, but this may be due to loss of Massachusetts resident cases who are diagnosed in neighboring or other states and not reported to the MCR. The MCR has reciprocal reporting agreements with 29 'states and with Puerto Rico. Cases Diagnosed in Non -Hospital Settings During the time period covered by this report, the MCR's primary information source. for most newly diagnosed cases of cancer was hospitals. In addition the MCR collected information from reporting hospitals on cases diagnosed and treated in staff physician offices, when this information was available. Other reporting sources include dermatologists and dermatopathology laboratories, urologists' offices and a general laboratory. Some types of cancer in this report may be under -reported because they are diagnosed primarily by private physicians, private laboratories, health maintenance organizations, radiotherapy centers that escape identification systems used by hospitals. The most common types of cancer diagnosed or treated outside of the hospital include melanoma and prostate cancer. The exact extent of this under -reporting has not been determined, but cases included in this report represent the great majority of cases statewide and provide an essential basis for evaluating statewide cancer incidence patterns. City/Town Misassignment In accordance with standard central cancer registry procedures, each case reported to the MCR ideally should be assigned to the city/town in which the patient lived at the time of diagnosis, based on the address provided by the reporting hospital. In practice, however, a patient may provide the hospital with his/her mailing address (e.g., a post office box located outside the patient's city/town of residence); a business address; a temporary address (e.g., the patient is staying with a relative while receiving treatment and reports the relative's address as his/her own); or a locality or post office name (e.g., "Chestnut Hill" rather than "Boston," `Brookline," or "Newton"). In addition, if a patient has moved since being diagnosed, the hospital may report the patient's current address. Because of the large number of cases reported to the MCR, and because data are reported to the MCR via electronic media, most city/town case assignments are performed by an automated computer process. This simplified matching process may misassign some cases based on the reported locality name. When MCR staff become aware of such misassignments, they manually correct the errors. Furthermore, in order to minnnize such errors, cases from fifty geographic localities prove to city/town nrisassigmnent are reviewed manually. Small Numbers of Cases Standardized incidence ratios based on small numbers of cases result in estimates that are very unstable. This situation is common wlren the population,of a city or town is small or if the particular cancer type is rare. SIRS and statistical significance are not calculated when the number of observed cases for a specific category is less than five. In these instances, the observed and expected cases are presented in the tables Lor qualitative comparison only. 7 APPENDIX H: SELECTED RESOURCES FOR INFORMATION ON CANCER This Appendix contains a listing of selected resources for additional information on cancer. Cancers are complex diseases, many of which have multiple factors that may contribute to their development. For information on cancer risk factors or prevention, you may wish to contact the following: Cancer Information Service (National Cancer Institute):1-800-4-CANCER (1-800-422-6237) Cancer Response Line (American Cancer Society): 1-800-ACS-2345 (1-800-227-2345) In addition, the following selected Internet websites provide information on cancer. Many of these also provide links to other sites (not listed) which may be of interest. Massachusetts Department of Public Health: http://www.inass,goy/dph American Cancer Society: http:/ mmeancer.org Centers for Disease Control and Prevention Home Page: httn://www.cde.gov Cancer Prevention and Control Program: http;//www,edc;gov/cancer Fruits and Veggies More Matterg"i Campaign (nutrition — formerly 5-A-Day Program): hgp://www.FruitsandVeggiesMatter.gov t i ai t"si , i NY tid,md Cancer Institute Information: http://vvww.caiider.gov ar Cancer Literature in PubMed: li*://www.cancer,gov/searell/dancer• literature Surveillance, Epidemiology, and End Results (SEER) Program data: http://seer,caileer.gov' . Your Cancer Risk (Siteman Cancer Center at Barnes -Jewish Hospital and Washington University School of Medicine; formerly at Harvard Center for Cancer Prevention): •/ttp, /www,yourdiseaserisk.wustt,g& OncoLink (Abramson Cancer Center of the University of Pennsylvania ): http://www.oncolink.upenn.edu CaucerqueA (Emory University —Winship Cancer Institute): www.cancei uest,org Cancer News on the NetO (information on diagnosis and treatment for cancer patients and their families): tt ://Nvww.caileem6ws.coni National Coalition for Cancer Survivorship: http://www.canceradyocac}�org 365 APPENDIX HI: MDPH CANCER PRE'VI;NTION AND CONTROL INITIATIVES The'Massachusetts Department of Public Health is working to reduce the incidence and mortality of cancer in the Commonwealth. Partnerships between MDPH programs, researchers, healthcare providers and nonprofit organizations collect information about cancer, lead quality improvement projects, coordinate evidenced -based workshops for managing living with chronic disease (including cancer), provide education for health professionals and bring shared messages to the public. Our collaborated efforts focus on reducing cancer risk, incidence and mortality t1nough healthy lifestyles, early diagnosis, and increased access to care. The Department's programs address the impact of tobacco, alcohol, nutrition, and physical activity on cancer prevention, along with environmental and occupational hazards for cancer. Throughout all of our efforts there is an emphasis on reducing disparate health outcomes and unequal access to cancer care. MDPH Bureaus and Programs: Bureau of Environmental Health, www.mass, ovp /duh/environmental health Bureau of Substance Abuse Services, www,mass,gov/dph/bsas Comprehensive Cancer Prevention and Control Program, www.mass.gov/conipcancer Men's Healtli/Women's Health/Care Coordination Program Tobacco Cessation and Prevention Program, www.nfass.gov/dJ)l1/1ntcP. Occupational Health Surveillance Program, www,mass,goy/dph/ohsp Office of Healthy Aghig, www.mass.gov/dplr/healthyaaina Oral Health Program, wwry,ma8s.gov/dph/omlhealth Division of Prevention and Wellness www,mass,Foy/dpli/healthpromotiol MDPH publications on cancer prevention Mid screening are available at the Massachusetts Health t0 . Promotion Clearinghouse, g y iaclearinghouse,cont. r, Massachusetts Cancer Registry Publications are available through theiMassachusetts Caitcer'0 Registry, telephone: 617-624-5642 and on the web At www.mss.gov/di)li/iner. 366