^ CHRISTINE TODD WHITMAN GOVERNOR LEN FISHMAN COMMISSIONER OF HEALTH



August 31, 1995

Steve Jones
Regional Representative ATSDR/EPA Region 2
290 Broadway
New York City, New York 10007-1866

Dear Mr. Jones:

As requested, this is an analysis completed by Environmental Health Services staff regarding concerns of childhood cancer in residents of Toms River, Ocean County.

In 1994, the New Jersey Department of Health released a report on childhood (under 15 years of age) cancer titled Childhood Cancers-in New Jersey: 1980-1988, In that report, Ocean County was found to have higher rates of cfiildhood.cancer (all sites combined) than the state as a whole. Additionally, Ocean County had a significantly higher rate of childhood brain and central nervous sys t em ( CNS ) cancer, nearly 70%7 above state rates. Since Ocean County childhood cancer has been documented to be higher than the state, we have indluded updated childhood cancer statistics for the county in this investigation,

To take a systematic look at the evidence of cancer incidence, we have utilized data from the New Jersey State Cancer Registry, a population-based registry whdre all newly diagnosed cases of cancer are reported by law. Using the Registry allows us .to evaluate whether the number of reported cases was higher than expected over a 13-year period, 1979 through 1991 This time period represents all complete years of data available for analysis.

Since Toms River is a section of Dover Township, data was collected and evaluated for the entire Township. In addition, a subset of the municipality representing the Toms River section of the town was analyzed separately. For purposes of analysis, Toms River was defined as the population residing within four census tracts: 228, 231, 232, and 236 as defined in the 1980 U.S. Census. Although the Toms River mailing area is larger than the designated census tracts, the accuracy of this definition of Toms River was confirmed by Ocean County Health Department staff. All addresses

were assigned a census tract aft- checking with a county road map.

A total of 56newly diagnosed malignant childhood (under 20 years of age) cancer cases (31 male and 25 female) have been reported to the Cancer Registry for the 13-year survey period for Dover Township. Of these, 14 cases (8 male and 6 female) were residents of the Toms River section of Dover. Table 1 presents a description of the numbers and types of cancer found for the town. During this same time period, 230 Ocean County children were diagnosed with cancer (a detailed breakdown not provided in table) .

Analysis of cancer was completed using Standardized Incidence Ratios (SIR). The SIEZ is calculated by dividing the observed number of cases by the expected number. The expected number of cases is based on the assumption that average annual cancer incidence rates for the whole State of New Jersey from 1986 through 1988 would prevail in the population surveyed.

Evaluation of the SIR is by how much it deviates from one. When the SIR is less than one, we conclude that we have observed fewer cases than we expected. Should the SIR be greater than one, then we have observed more cases than we expected. The 95% confidence interval is the statistical test used to evaluate the significance of the difference between the observed and expected numbers . If the c onf idence interval includes 1.0, then the observed and expe ct ed numbers are not considered to be significantly different from each other, using conventional definitions of "statistical significance.

Table 2 presents our findings. Toms River had a moderately elevated SIR for all cancers combined (49% higher) and leukemia (80% higher) However, neither of these SIRs were statistically significant. Brain and CNS cancer was more than three times higher than expected for children under 20. For Toms River children under five, Brain and CNS cancer incidence was significantly elevated, over seven times higher than expected.

All SIRs' calculated for Dover Township were higher than expected. Brain and CNS cancer in children under five was more than two and one - half t imes higher than expected, though not statistically significant, When Dover Township brain and CNS cancer incidence was reanalyzed without the Toms River cases (or population) the observed number of cases approached the expected number .

Ocean County had a slight though not statistically significant elevation for all childhood cancers combined and leukemia. Brain and CNS cancer was significantly elevated.in Ocean County. The elevation was particularly evident in children under five who had a 75% higher incidence than expected. When brain and CNS cancer was reanalyzed without Toms River cases, Ocean County rates were still significantly elevated, especially in children under 5.

Brain and CNS cancer is the second most common childhood cancer in New Jersey and the United States repre s ent ing approximately 21% and 20% of all childhood cancer respectively. According to the National Cancer Institute, malignant brain and CNS cancer incidence in children has increased by about 50% nationally from 1973 to 1990. Very little is known about the causes of childhood brain and CNS cancer, although studies have linked them with occupational, environmental, viral, and genetic factors. Potential environmental risks include high dose X-rays, organic solvents, pesticides, and electromagnetic fields (EMF). Other factors that may be related to brain and CNS cancer include consumption of sodium nitrate (a corronon meat preservative) and exposure to other N-nitroso compounds, halomethanes in drinking water, and the use of barbiturates by pregnant women and children,

Because of the small number of cases included in this analysis, it is not possible to conduct studies to determine possible causes at the municipality or even county level. There are several on-going epidemiologic studies being carried out on a State and national scale to better elucidate the risk factors for childhood cancer, so that effective preventive measures can be developed. If you have any further questions concerning these findings, please write, or call me at (609) 633-2043.

Sincerely, ~4~
Michael Berry
Research Scientist Environmental Health Service

c: Assistant Commissioner's Office, DEEOHS
New Jersey State CancerRegistry
Herbert Roeschke, HealthOfficer, Ocean County Health Dept.


Note: The following raw data is in the process of being processed. TABLE 2 NJDOH, ENVIRONMENTAL HEALTH SERVICES STANDARDIZED INCIDENCE RATIOS (SIR) COMPARISON OF OBSERVED AND EXPECTED CANCER INCIDENCE CHILDHOOD CANCER DOVER TOWNSHIP AND TONS RIVER, OCEAN COUNTY 1979 -1991 Cancer Type OCEAN COUNTY: All Cancers Brain/CNS Leukemia DOVER TOWNSHIP: All Cancel Brain/CNS Leukemia TOMS RIVER (Census Tracts 2281 231, 232, and 236): All Cancers Brain/CNS Leukemia Age Group 0-19 0-19 0- 4 0-19 P: 0-19 0-19 0- 4 0-19 e~nsus 'I 0-19 0-19 0- 4 0-19 Observed I Cases 230 54 21 60 56 11 5 16 'racts 2281 14 5 3 4 ~pected Cases 215.5 38.8 12.0 53.4 42.7 7.6 1.9 10.2 31, 232, ~ 9.4 1.6 0.4 2.2 SIR 'It 1.07 1.39 @ 1.75 ~ 1.12 1,31 1.45 2.64 1.58 and 236): 1.49 3.05 7.14 @ 1.80 95% C.I. "" Lower - Upper --------'---'------- 0.93 -1.21 1.05 - 1.82 1.08 - 2.68 0.86 - 1.45 0.99 - 1.70 0.72 - 2.60 0.85 - 6.17 0.90 -2.56 0.81 - 2.50 0.98 -7.11 1.44 -20.87 0.48 - 4.61 '---'------------------ '--^'--"--'--------'-'----'-----'-'----'-----^---'----------'-- SIR - Standardized Incidence Ratio of Observed and Expected Number of Cancers (Age Standardized). ** 95% Confidence Interval (C.I.). The;e is only 5% likelihood that the.SIR is actually outside of this inte~val. If the C.I. includes 1.0, then the SIR is not considered to he significantly different from 1.0 using conventional definitions of "statistical significance. @ Statistically elevated, p ~ 0.05 TABLE 1 NJDOII, ENVIR6NMENTAL HEALTH SERVICES CHILDHOOD CANCER INCIDENCE (AGES 0-19) DOVER MWNSHIP AND MMS RIVER, OCEAN COUNTY 1979 -1991 ------~iIS============LZ Cancer Type -"-"---------------------"'-----'----------------- DOVER TOWNSHIP: Bone and Joint Brain/Central Nervous SL Endocrine Eye Hodgkin's Disease Leukemia Oralpharynx Other Digestive Other Respiratory Ovary Non-Hodgkin's Lynrphoma Prostate Renal Skin Soft Tissue Testis TOMS RIVER (Census Tracts 228, 231, 232, and 236): Brain/Central Nervous System Endocrine Eye Hodgkin's Disease Leukemia Other Respiratory I--------- Male 2 8 1 0 2 8 1 0 1 4 1 0 1 1 I 31 232, and 236 3 1 0 I 2 1 8 -Cases--- Female 1 3 1 1 1 8 0 1 1 2 0 2 1 3 25 2 1 I 0 2 0 6 Total 3 11 2 I 3 16 I 1 2 2 4 1 2 2 4 I 56 5 2 1 1 4 I 14 n of sodium nitrate (a corronon meat preservative) and exposure to other N-nit 0.98 -7.11 1.44 -20.87 0.48 - 4.61 '-----'-'----'----