Success Rates for the Objectives of US State Cancer Control Plans: A First Look.

BACKGROUND: A well-designed cancer control plan is an important tool for a nation, state, or community to address the burden of cancer. Furthermore, it provides the opportunity to devise and implement measurable objectives. However, there has been little to no assessment of the success rates of such objectives. METHODS: I compared the success rate of objectives between US states' current plan and most recent past plan to determine the proportion of success in the United States overall. I also tested possible reasons for low success rates. RESULTS: The mean success rate was 20% for stringent successes (only exact matches between plans) and 28% for loose successes (exact and similar matches between plans). The magnitude of change in percentage between the baseline and target for loose objectives significantly predicted success (P = .0347). Higher change resulted in lower success. However, neither the number of objectives nor the level of overlap significantly predicted success rate. Nor was population size, region, or rural-urban status significantly related to success rate. The most successful states had high proportions of objectives that were measurable and a high number of overlapping objectives. CONCLUSION: I found that objective success rates were low for cancer control plans. To improve success rates, I suggest that future cancer control plans ensure each objective has a measurable baseline and realistically attainable target.

Brain cancer incidence rates and the presence of nuclear reactors in US states: a hypothesis-generating study.

BACKGROUND: The etiology of brain cancer is poorly understood. The only confirmed environmental risk factor is exposure to ionizing radiation. Because nuclear reactors emit ionizing radiation, we examined brain cancer incidence rates in the USA in relation to the presence of nuclear reactors per state. METHODS: Data on brain cancer incidence rates per state for Whites by sex for three age groups (all ages, 50 and older, and under 50) were obtained from cancer registries. The location, number, and type of nuclear reactor, i.e., power or research reactor, was obtained from public sources. We examined the association between these variables using multivariate linear regression and ANOVA. RESULTS: Brain cancer incidence rates were not associated with the number of nuclear power reactors. Conversely, incidence rates per state increased with the number of nuclear research reactors. This was significant for both sexes combined and for males in the 'all ages' category (ß = 0.08, p = 0.0319 and ß = 0.12, p = 0.0277, respectively), and for both sexes combined in the'50 and older' category (ß = 0.18, p = 0.0163). Brain cancer incidence rates for counties with research reactors were significantly higher than the corresponding rates for their states overall (p = 0.0140). These findings were not explicable by known confounders. CONCLUSIONS: Brain cancer incidence rates are positively associated with the number of nuclear research reactors per state. These findings merit further exploration and suggest new opportunities for research in brain cancer epidemiology.

Criterion Validity of Radon Test Values Reported by a Commercial Laboratory versus the Environmental Protection Agency.

Objective: Radon exposure is a proven cause of lung cancer and is a possible cause of other diseases. Recently, several ecologic studies explored the correlation of county-wide incidence rates for non-lung cancers with residential radon levels, using radon data reported by a commercial laboratory. However, the validity of the commercial radon data, i.e., whether they are an accurate representation of the radon levels in the counties from which they were drawn, is unknown. Methods: We compared county-wide radon data from the commercial laboratory with corresponding measurements from the same counties reported previously by the Environmental Protection Agency (EPA). Matching data were available for four states, Iowa, North Dakota, Texas, and Wisconsin, and were compared by paired t-tests. Criterion validity of the commercial tests, i.e., how well the commercial data predicted the EPA data, was tested using non-parametric methods, Kendall's tau, Lin's concordance, and Passing−Bablok regression. Results: The commercial and EPA data pairs from the four states were significantly positively correlated, although the size of the correlations was modest (tau = 0.490, Lin = 0.600). Passing−Bablok regression indicated that the commercial radon values were significantly higher than their EPA pairs and significantly overestimated radon at low levels (<4 pCi/L, p < 0.001). Conclusions: The commercial laboratory data were moderately predictive of EPA radon levels at the county level but were significantly biased upwards at low levels. The disagreement likely has several causes, including selection bias from homes that were tested voluntarily. Ecologic studies that employ radon data obtained from commercial laboratories should be interpreted with caution.

Lead service lines and Parkinson's disease prevalence in U.S. States.

INTRODUCTION: We recently showed that the prevalence of Parkinson's Disease (PD) in U.S. states is positively associated with the quantity of acid rain. Acid rain could play an etiologic role in PD by mobilizing metals, e.g., lead, from watersheds and pipes into drinking water. We assessed the correlation of PD with lead service lines, the underground pipes that connect homes to municipal water sources, which are a major aqueous source of lead. METHODS: We used multiple regression techniques to examine PD prevalence rates by state relative to the number of lead service lines. We included known or suspected aqueous risk factors, e.g., the Acid Precipitation Index (a measure of acid rain) and well water use. RESULTS: Age-, race-, and sex-adjusted prevalence rates for PD were significantly and positively correlated with the log number of lead service lines (p = 0.0004). The effect of lead service lines remained significant after adjusting for the effects of acid rain and well water use (p = 0.0019). CONCLUSION: These findings are consistent with a role for lead in the etiology of PD. Studies of lead service line exposure in relation to PD at the individual level are warranted.

Acid Precipitation and the Prevalence of Parkinson's Disease: An Ecologic Study in U.S. States.

Although the etiology of Parkinson's disease (PD) is unknown, potentially informative clues lie in its geographic distribution. PD prevalence rates within the U.S. are significantly higher in the Midwest and Northeast, a pattern that resembles the geographic distribution of acid precipitation ("acid rain"). Using linear and multivariable regression, we examined state-wide data on PD prevalence in relation to environmental factors including total precipitation, the acidity of precipitation, the use of well water, and industrial releases of sulfuric acid. In multivariate analyses, age-, race-, and gender-adjusted prevalence rates for PD were inversely correlated with well water use and positively correlated with industrial releases of sulfuric acid and with the quantity of acid precipitation (p < 0.0001). To our knowledge, this is the first report of an association between PD and acid rain. Because acid rain is known to leach metals from soils and pipes into drinking water, acid rain's association with PD prevalence adds support for a role for metals in the etiology of PD.

Cancer Mortality and Research Outcomes in a Rural State.

BACKGROUND: North Dakota is a rural state with high rates of cancer. Determining how various demographic, geographic, and funding factors contributed to cancer incidence on a state and county level helps improve cancer prevention and control. OBJECTIVES: We examined cancer incidence rate trends by demographic (sex and ethnicity) and geographic (county, population, rural/frontier status) factors. We also examined cancer funding and research output by year. METHODS: Cancer incidence rates were obtained from the North Dakota Cancer Registry and stratified by sex, ethnicity, and county. US cancer rates also were obtained for comparison. Generalized linear models were used to compare overall incidence rates and yearly trends. RESULTS: Male melanoma incidence rates increased faster than the US average across year P = 0.020). Incidence rates for prostate, lung, and colorectal cancer among American Indians/Alaska Natives (AI/AN) decreased faster than Whites across year (P < 0.001, P= 0.001, P < 0.001, respectively). Four counties-2 for breast cancer and 2 for prostate cancer-had differential trends compared to the North Dakota average across year (P = 0.011, P = 0.029; P= 0.046, P = 0.042). County-level lung cancer incidence rates were positively correlated with county population size, while rates for cervix/uteri were negatively correlated (P = 0.001, P = 0.023). Funding from the National Institutes of Health for North Dakota increased across year along with cancer papers published increased (P < 0.001, P < 0.001). CONCLUSIONS: Examining state and county data revealed several surprising trends and the need for a more fine-scale approach to cancer cause, control, and prevention.