MEETING PACKET NOVEMBER 2015 Health Agent report November 2015
Announcements
• Public Health Nurse Erica Rimpila will begin her work as Public Health Nurse on
December P, 2015
• The Mayor had a joint breakfast meeting with the staff of the Health and Human Resources
Departments. The purpose of the meeting was to meet with staff in an informal manner.
• An Opiate awareness march was held on November 22°a with a gathering afterward at the
Salem Common. The march was in response to the death of a community member. The
Mayor, Police Chief, Senator Lovely and other community leaders made speeches at the
event.
Community Outreach
• Larry Ramdin met with a representative of the planned Bass River Community Kitchen
to discuss kitchen operations and options for secondary use.
Public Health Highlights
• There were 2 teleconferences with the DPH and MEMA on Highly Pathogenic Avian
Influenza(HPAI). There are no current cases but it is anticipated that it will eventually
present itself in Massachusetts. There is no indication of a shift from birds to humans.
The calls provided plans for response to cases of HPAI in large and small flocks and the
role of municipal departments in assisting in the outbreak
• All permit renewals for 2016 were mailed out.
Meetings and Trainings
• Larry Ramdin attended the integrated Foodborne Illness Response and Management
Conference. The conference focused on new tools for investigating illnesses and the role
of Environmental Health in foodborne illness response.
I
Inspections
Item Monthly Total YTD 2014 Total
i
Certificate of Fitness 32 499 559
Inspection
Certificate of Fitness 0 4 17
re-inspection
Food Inspection 6 261 384
Food Re-inspections 5 52 124
Retail Food 0 14 23
Inspections
Retail Food 0 1 7
re-inspection
General Nuisance 3 24 14
Inspections
Food— 0 0 1
Administrative
Hearings
Housing Inspections 15 171 183
Housing re- 8 36 39
inspections
Rodent Complaints 3 19 23
Court 0 6 10
Hearings/filings
Trash Inspections 19 123 218
Inspections
Item Monthly Total YTD 2014 Total
Certificate of Fitness 32 499 559
Inspection
Certificate of Fitness 0 4 17
re-inspection
Food Inspection 6 261 384
Food Re-inspections 5 52 124
Retail Food 0 14 23
Inspections
Retail Food 0 1 7
re-inspection
General Nuisance 3 24 14
Inspections
Food— 0 0 1
Administrative
Hearings
Housing Inspections 15 171 183
Housing re- 8 36 39
inspections
Rodent Complaints 3 19 23
Court 0 6 10
Hearings/filings
Trash Inspections 19 123 218
i
Orders served by 0 0 2
Constable
Tanning Inspections 0 3 1
Body Art 0 0 1
Swimming pools 0 17 23
Bathing Beach 0 106 100
Inspection/testing
Recreational Camps 0 12 14
Lead Determination 1 1 1
Septic Abandonment 0 0 1
Septic System Plan 0 0 1
Review
Soil Evaluation 0 0 1
Percolation tests 0 0 2
Total 92 1349 1739
i
CITY OF SALEM
BOARD OF HEALTH
MEETING MINUTES
' October 13, 2015
DRAFT
MEMBERS PRESENT: Dr. Shama Alam, Chair, Mark Danderson, Paul Kirby, &Dr. Jeremy Schiller
OTHERS PRESENT: David Greenbaum, Sr. Sanitarian, Suzanne Doty, Public Health Nurse, Joyce Redford, Dir.
NSTAPP &Heather Lyons-Paul Clerk of the Board
MEMBERS EXCUSED: Janet Greene
TOPIC DISCUSSION/ACTION
1. Call to Order 7:00pm
P. Kirby motioned to take the agenda out of order to
hear the subdivisions first. 2nd M Danderson. All in
favor. Motion passed.
2. Minutes of Last Meeting P. Kirby motioned to accept the minutes.Dr.
(Sept 8,2015) Schiller 2nd All in Favor. Motion Passed
3. Chairperson Announcements Jeremy Schiller has joined the board. Dr. Ledoux has
stepped down. This is Suzanne Doty's last meeting as
Public Health Nurse. She will be working a few hours
a week to help while the Board interviews candidates.
Mark Danderson is moving to Washington DC, and
has submitted his resignation to the Mayor. There is
. training held by MAHB certification program in
November for Board members. Dr. Schiller has
registered to go.
4. Monthly Reports-Updates
A. Public Health Nurse's Report Update on opiate meetings. The Salem Police
Department has applied for a grant for overdose
medication. Copy available at the BOH office
B. Health Agent'sP Copy Report Co available at the BOH office
C. Administrative Report Copy available at the BOH office
M. Danderson motioned to accept reports. P Kirby
nd
2 All in favor. Motion Passed
D. City Council Liaison Updates Excused
5. Subdivision approvals
A. Clark Street Plans for Clark Street were approved in 2008. There
are some changes to the street to provide better access.
P. Kirby motioned to revise the Board of
Health List of Conditions: #14 Change
"strongly recommend" to "required" for
radon mitigation kits and#15 Final
construction must comply with MA State
Sanitary Code M. Danderson 2"d All in
Favor. Motion passed
B.Almeda St Almeda Street will be extended by 80 feet. .
City water does not extend to this street.
Water supplied will be well water.
P. Kirby motioned to revise the Board of
Health List of Conditions as follows #14
Change"strongly recommend" to
"required" for radon mitigation kits #15
Final construction must comply with
State Sanitary Code, additionally a
potable water supply must be supplied to
the residence and must meet standards of
Department of Environmental Protection
water quality standards. 2"d Dr. Schiller
All in Favor. Motioned passed
6. Tobacco program policy and procedures *The tobacco training program that was
presented by Joyce Redford Director of provided for Salem establishments was
North Shore/Cape Ann Tobacco and moderately attended. The Board and J.
Alcohol Policy Program Redford noted that there is no policy for
mandatory training attendance.
*Part of the Tobacco Program Policy
includes, informing merchants of changes
to the regulations, providing signage,
unannounced inspections, pricing surveys •
that are sent to DPH for review, sending
youth in to do unannounced compliance
checks (16 & 17 year olds). In accordance
with DPH protocol the youth can ask for
any nicotine products. One full round of
checks is done on the DPH grant. The
second round is done on an FDA grant and
the youth can only ask for cigarettes.
The FDA Pilot program grant started back
in April 2014. At this time 25% of
enforcement is done on the DPH grant and
75%of enforcement done on the FDA grant
by one inspector. Both grants have the same
protocol for the youth. Youth training is
done online for the FDA grant and person
to person training is done by J. Redford on
the DPH grant. Part of the training is not
lying; no dressing like an adult, no IDs, and
no negotiation during compliance checks.
The type of fine given is a 21D civil
violation. Violators do not have the
opportunity to face their accuser. Youth are
aware that on rare occasions they might
have to testify in court. The safety of our
youths is a#1 priority of the department.
Dr. Alam asked J. Redford to provide
information about the FDA pilot program to
the Board and the City Solicitor's Office. In
the interim J. Redford will not provide a
violation under the FDA grant until she
meets with the Board next month. DJ
Wilson Tobacco Control Director at the
Mass. Municipal Association can also
provide more information about the FDA
pilot program.
J. Redford will be applying for the DPH
grant in December. If the DPH grant
funding is not approved, funding the FDA
program will be the only way to fine. Joyce
will provide data for fails and passes of
Salem establishments for the past 36
months at November's Board meeting.
7. Salem Grill Z Chicken—request to M. Danderson motioned that the Board
reinstate tobacco permit will not entertain another request to
reinstate Salem Grill Z Chicken's
tobacco permit. P. Kirby 2nd All in favor,
Motion passed
8.New Business/Scheduling of future agenda items Future agenda items: Continuation of Tobacco Control
policy and procedures and products that are being sold
on the market today.
1. MEETING ADJOURNED: P. Kirby motioned to adjourn the meeting.Dr.
Schiller 2Rd All in favor. Motion passed
8:57pm
Respectfully submitted,
Heather Lyons-Paul
Clerk of the Board
Next regularly scheduled meeting is November 10, 2015 at 7pm
At City Hall Annex, 120 Washington Street,Room 313 Salem.
•
Health Dept. Clerical Report FY 27M
Burial Permits permits Plan Reviews Certificate of Copies/ Fines Revenue Permit Fees
$25 Fitness $50
July-14 Food Service Est. <25 seats $140
$475.00 $2,210.00 $1,950.00 $4,635.00
August $700.00 $985.00 $1,500.00 $3,185.00 25-99 seats $28o >99 seats $420
September $1,475.00 $2,165.00 $4,300.00 $300.00 $8,240.00 Retail Food <l000sq' s7o
October $725.00 $3,295.00 $1,400.00 $5,420.00 l000-10,000 $28o >io,000 $420
November $0.00 Temp.Food 1-3 days s3oo
December $0.00 4-7days shoo >7days s
January-15 Example of>7 day temp food permit:
$0.00 14(da s)divided bY7=2 x shoo=s12oo
February $0.00 Frozen Desserts $25
March $0.00 Mobile Food $210
April $0.00 Plan Reviews New s18o
May $0.00
Remodel s90
June Catering $25 per eventl$200
$0.00 catering kitchen
Body Art Est. $315
Total $3,375.00 $8,655.00 $0.001 $9,150.00 $300.00 $21,480.00 Body Art Practitioner 135
Review Plans s18o
Fiscal Year Budget 2014 Suntan Est. $140
Rec.Day Camp $10
Salary Startinq Ending Expenses Ext.Paint Removal $35
Full Time $357,223.00 $245,426.75 Startinq Endinq Transport Off.Subst. slo5
Part Time $16,545.00 $13,210.00 $18,300.00 $13,249.89 Tobacco Vendors $135
Overtime $2,000.00 $593.25 Swimming Pools Seasonal $140
Balance $375,768.00 $259,230.00 Health Clinic Revolving Account Annual$210 Nonprofit$40
$6,022.99 Title V Review s18o
Well Application s18o
Disposal works $22Sli8o
i
�CN_ -7
The Commonwealth of Massachusetts
w w Executive Office of Health and Human Services
Department of Public Health
250 Washington Street, Boston, MA 02108-4619
o„M s�ev
CHARLES D.BAKER MARYLOU SUDDERS
Governor
Secretary
KARYN E.POLITO RECEIVED MONICA BHAREL,MD,MPH
Lieutenant Governor Commissioner
6 C 2 2015 www.m17-624-6000 ass.gov/dph
C"i ' C =SALEM
L30ARLD OF HEALTH
TO: Boards of Health
FROM: Susan T. Gershman, MPH, PhD, CTR
Director
Massachusetts Cancer.Registry
DATE: November 30, 2015
RE: Cancer Incidence in Massachusetts, 2007-2011, 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,
2007-2011, 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 December 7, 2015. 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 2007-2011 City and Town Supplement updates the 2006-2010 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
con't other side
The complete Internet version will be available at: www.mass.gov/dph/mcr y
The following reports have also been recently posted on the above website:
• Cancer Incidence and Mortality in Massachusetts 2008-2012: Statewide Report
• Data Brief Cancer Incidence in Massachusetts, 2009-2013—Preliminary Data .
• Data Brief.- Trends in Cancer Incidence (2003-2013) and Mortality (2003-2014)for
Four Major Cancers
If you have any trouble accessing this web site,please contact the MCR at (617) 624-5662.
Lastly, enclosed is a brochure with information about the Massachusetts Environmental Public .
Health Tracking System.
For further information, please contact the following at MDPH:
Massachusetts Cancer Registry (617) 624-5662
Bureau of Environmental Health (617) 624-5757
Massachusetts Comprehensive Cancer Prevention and Control Program(617) 624-5484
•
The complete Internet version will be available at: www.mass.gov/dph/mcr
The following reports have also been recently posted on the above website:
• Cancer Incidence and Mortality in Massachusetts 2008-2012: Statewide Report
• Data Brief Cancer Incidence in Massachusetts, 2009-2013—Preliminary Data
• Data Brief Trends in Cancer Incidence (2003-2013) and Mortality (2003-2014)for
Four Major Cancers
If you have any trouble accessing this web site,please contact the MCR at (617) 624-5662.
Lastly, enclosed is a brochure with information about the Massachusetts Environmental Public
Health Tracking System.
For further information,please contact the following at MDPH:
Massachusetts Cancer Registry (617) 624-5662
Bureau of Environmental Health (617) 624-5757
Massachusetts Comprehensive Cancer Prevention and Control Program(617) 624-5484
Salem
Observed and Expected Case Counts,with Standardized Incidence Ratios,2007-2011
Obs Exp SIR 95%CI Obs Ex SIR 95%CI
Bladder,Urinary Melanoma of Skin
Male 41 41.1 99.7 (71.5-135.2) Male 23 27.1 84.8 (53.8-127.3)
Female 19 16.4 115.8 (69.7-180.8) Female 23 24.2 95 (60.2-142.6)
Brain and Other Nervous System Multiple Mveloma
Male 10 8.2 122.3 (58.6-225) Male 2 7.4 nc (nc-nc)
Female 4 7.4 nc (nc-nc) Female 6 6.6 90.7 (33.1-197.5)
Breast Non-Hodgkin Lymphoma
Male 2 1.3 nc (nc-nc) Male 32 23.9 133.9 (91.6-189)
Female 197 173.5 113.5 (98.2-130.5) Female 22 21.6 101.9 (63.9-154.4)
Cervix Uteri Oral Cavity&Pharynx
Male 15 17.8 84.3 (47.2-139.1)
Female 5 6.4 77.8 (25.1-181.6) Female 9 8.6 104.9 (47.9-199.2)
Colon I Rectum Ovary
Male 53 46.7 113.5 (85-148.5)
Female 46 52.1 88.4 (64.7-117.9) Female 13 15.9 81.7 (43.5-139.7)
Esophagus Pancreas
Male 16 11 144.9 (82.7-235.3) Male 14 13.5 103.4 (56.5-173.4)
Female 4 3.3 nc (nc-nc) Female 20 15.9 126 (76.9-194.6)
Hodgkin Lymphoma Prostate
Male 4 3.7 nc (nc-nc) Male 164 153.2 107.1 (91.3-124.8)
Female 7 3.4 207.8 (83.2-428.2)
Kidney&Renal Pelvis Stomach
. Male 31 22 140.6 (95.5-199.6) Male 16 9.8 163.7 (93.5-265.9)
Female 14 13.9 100.4 (54.8-168.5) Female 6 6.4 94 (34.3-204.6)
Larynx Testis
Male 7 6 115.9 (46.4-238.8) Male 5 6.4 78.5 (25.3-183.1)
Female 4 2 nc (nc-nc)
Leukemia Thyroid
Male 22 16.2 135.7 (85-205.4) Male 13 10.1 129.1 (68.7-220.7)
Female 12 13.1 91.6 (47.3-160) Female 34 34.3 99.3 (68.7-138.7)
Liver and Intrahepatic Bile Ducts Uteri Corpus and Uterus.NOS
Male 14 12.9 108.9 (59.5-182.7)
Female 4 4.8 nc (nc-nc) Female 41 39.7 103.2 (74-140)
Lung and Bronchus All Sites I Types
Male 72 74.8 96.2 (75.3-121.2) Male 607 555.6 j1l)9.2 (100.7-118.3)
Female 83 84.2 98.6 (78.5-122.2) Female 613 601.5 101.9 (94-110.3)
• 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;
• nc=The SIR and 95%Cl were not calculated when Obs<5;
• 267
1
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 2007 through 2011. 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 hn://www.mass.gov/dph/mcr. 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, 6t"floor
Boston,MA 02108-4619
telephone 617-624-5642; fax 617-624-5695
The preceding report, Cancer Incidence in Massachusetts 2006-2010: City and Town Supplement,
included data for diagnosis years 2006 through 2010. This report contains data for the diagnosis years
2007 through 2011. There have been no changes in this report's format from the previous report.
1
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 2007-2011 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 36 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 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 2007-2011, 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 2007-2011 and reported to the MCR as of April 23,2015. These data
include some additional cases diagnosed in 2007-2010 that were not counted in the previous report,
Cancer Incidence in Massachusetts 2006-2010: City and Town Supplement. 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
2
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 2007-2011 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 36 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 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 2007-2011, 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 2007-2011 and reported to the MCR as of April 23, 2015. These data
• include some additional cases diagnosed in 2007-2010 that were not counted in the previous report,
Cancer Incidence in Massachusetts 2006-2010: City and Town Supplement. 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
2
i
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 2007-2011. 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 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 2007-2011, and the corresponding statewide average annual.age-speck incidence
rates. The population data for the 2007 to 2011 period was calculated by adding 2005 city and town
data with 2010 city and town data, dividing by two, and multiplying by five.
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.
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(Cl)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% 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% 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%CI(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
• 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 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%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
i maybe 100.0.
4
Example of Calculation of an SIR and Its Significance
• SIR__ OBSERVED CASES
X 100
EXPECTED CASES
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
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 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 aft(nc)("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 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
i
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 fmdings 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 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.
6
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.3 51 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
PP Y
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.
6
f
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 minimize such errors, cases from fifty geographic localities prone to city/town misassignment
are reviewed manually.
Y
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.
7
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s
i
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.mass.gov/dp
American Cancer Society: http://www.cancer.ora
Centers for Disease Control and Prevention
Home Page: http://www.cdc.M
Cancer Prevention and Control Program: http://www:cdc.gov/cancer
Fruits and Veggies More MattersTM Campaign(nutrition—formerly 5-A-Day Program):
http://www.FruitsandVeggiesMatter.gov
National Cancer Institute
' Information: http://www.cancer.gov
Cancer Literature in PubMed: http://www.cancer.gov/search/cancer_literature
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.upenn.edu
Cancerquest(Emory University—Winship Cancer Institute): www.cancerquest.org
Cancer News on the NOD(information on diagnosis and treatment for cancer patients and
their families): http://www.cancemews.com
National Coalition for Cancer Survivorship: http://www.canceradvocacy.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, 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/environmental health
Bureau of Substance Abuse Services,www.mass.gov/dph/bsas
Comprehensive Cancer Prevention and Control Program,www.mass. ovg /compcancer
Men's Health/Women's Health/Care Coordination Program
Tobacco Cessation and Prevention Program,www.mass.gov/dph/mtcp
Occupational Health Surveillance Program,www.mass.gov/dph/ohsp
Office of Healthy Aging,www.mass.gov/dl2h/healthyagina
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.mss.gov/dph/mcr.
366
APPENDIX III: 1VIDPH 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/enviromuental health
Bureau of Substance Abuse Services,www.mass.gov/dph/bsas
Comprehensive Cancer Prevention and Control Program,www.mass. ovg /compcancer
Men's Health/Women's Health/Care Coordination Program
Tobacco Cessation and Prevention Program,www.mass.gov/dph/mtcp
Occupational Health Surveillance Program,www.mass.gov/dph/ohsp
Office of Healthy Aging,www.mass.gov/dph/healthyagin
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.mss.gov/dph/mcr.
366
i
0
,� (MDPH/BEH) has been in the forefront of
BEH = _ environmental public health tracking by
analyzing information from statewide
disease registries and surveillance programs
.F to determine if exposure to environmental
Aw contaminants may be contributing to the high
rates of these chronic diseases in
Massachusetts.
M Different types of data are used to learn how
the environment affects people's health. The
MA EPHT website currently provides
In 2000, the Pew Environmental Health information about the following data:
Commission identified the lack of basic
information needed to link environmental Health Data:
hazards and chronic diseases. Chronic . Asthma Hospitalization
diseases—such as heart disease, stroke, . Birth Defects
cancer and diabetes—are among the most . Cancer
prevalent, costly, and preventable of all health . Carbon Monoxide Poisoning
problems. Massachusetts has one of the . Childhood Lead Poisoning
highest rates of chronic illness in the United Heart Attack Hospitalization
States, costing the state $34 billion a year. •
• Heat Stress
In response, the U.S. Centers for Disease Pediatric Asthma
Control and Prevention (CDC) developed the Pediatric Diabetes
National Environmental Public Health Tracking Reproductive Outcomes
(NEPHT) program to fund state and local health Environmental Data:
departments to build state-based environmental • Air Quality
public health tracking networks. Environmental • Climate Change
public health tracking is the ongoing collection, . Drinking Water Quality
integration, analysis, and interpretation of data . Radon
about environmental hazards, exposure to Inspection Data:
environmental hazards and the health effects . Food Protection
potentially related to exposure. • Mammography Inspection
Massachusetts has been part of the NEPHT On the MA EPHT website you can view maps,
Program since 2002 and launched the tables and charts to more closely examine the
Massachusetts Environmental Public Health
possible links between the environment and
Tracking website (MA EPHT) in 2009. chronic diseases both statewide and locally.
The Massachusetts Department of Public You can visit the MA EPHT website at
Health/Bureau of Environmental Health www.mass.gov/dph/matracking
MA Environmental Public Health Tracking: Cancer Did You Knwv `
Approximately 9%of all cancer deaths are thought to be
Cancer is not one disease, but a group of diseases. According to the related to environmental or occupational exposures
American Cancer Society, one in two men and one in three women
will develop cancer during his or her lifetime. Research has shown
that there are more than 100 different types of cancer, each with '
different causative (or risk) factors. A risk factor is anything that 9%
onw urw,r,
increases a person's chance of developing cancer and may include
hereditary conditions, medical conditions or treatments, lifestyle
factors, or environmental exposures. Cancer may be caused by
several factors acting together over time. In general, most adult .b—U.
cancers have a long period of development that can range from 10 to
40 years.
Cancer data available on the MA EPHT website:
Cancer incidence rates available on the MA EPHT website are calculated using data from the
Massachusetts Cancer Registry, a population-based surveillance program that has been monitoring
cancer incidence in the state of MA since 1982. Cancer data are presented on the website using two
different types of statistics:
Indirect Incidence Rates-referred to as Standardized Incidence Ratios (SIRs):An SIR is the
most appropriate statistic to examine cancer incidence in a small area, such as a community or
a census tract within a community. It is used to evaluate whether a community's or a census
tract's cancer incidence rate differs from that of the state as a whole.
Direct Incidence Rates-A direct incidence rate is the most appropriate statistic to use for
larger, more stable study populations such as a state or county. Because of the way it is
calculated, it may be used to compare cancer incidence in one relatively large area to another
relatively large area (such as one county to another).
For more information, visit the MA EPHT cancer webpage at: https:Hmatracking.ehs.state.ma.us/
Health-Data/Cancer/index.htmI
Massachusetts Department of Public Health ��SLSF1 or
A"46,
Bureau of Environmental Health
250 Washington Street,7th Floor
°Boston,MA 02108 ,/N
Phone:617-624-5757 1 Fax:617-624-5183 1 TTY:617-624-5286 m �V
WWW.Mass.gov/dph/environmental—health r�
MFM'OF PIJ
Massachusetts Department of Public Health
Bureau of Environmental Health
November 2015
MA Environmental Public Health Tracking: CancerI'll of an ►
Cancer is not one disease but a group of diseases. According to the `elMed to �"`"d�'"� exposu utobe
� related to environmental a occupatiaW e�owres.
American Cancer Society, one in two men and one in three women
will develop cancer during his or her lifetime. Research has shown
that there are more than 100 different types of cancer, each with
different causative (or risk) factors. A risk factor is anything that
increases a person's chance of developing cancer and may include
hereditary conditions, medical conditions or treatments, lifestyle
factors, or environmental exposures. Cancer may be caused by
several factors acting together over time. In general, most adult �.
cancers have a long period of development that can range from 10 to .a, .a..-
40 years.
Cancer data available on the MA EPHT website:
Cancer incidence rates available on the MA EPHT website are calculated using data from the
Massachusetts Cancer Registry, a population-based surveillance program that has been monitoring
cancer incidence in the state of MA since 1982. Cancer data are presented on the website using two
different types of statistics:
Indirect Incidence Rates- referred to as Standardized Incidence Ratios (SIRs):An SIR is the
most appropriate statistic to examine cancer incidence in a small area, such as a community or
a census tract within a community. It is used to evaluate whether a community's.or a census
tract's cancer incidence rate differs from that of the state as a whole.
Direct Incidence Rates-A direct incidence rate is the most appropriate statistic to use for
larger, more stable study populations such as a state or county. Because of the way it is
calculated, it may be used to compare cancer incidence in one relatively large area to another
relatively large area (such as one county to another).
For more information, visit the MA EPHT cancer webpage at: https://matracking.ehs.state.ma.us/
Health-Data/Cancer/index.htmI
Massachusetts Department of Public Health l�_-T"OF&U
Bureau of Environmental Health
Washington250 MA O2108treet,7th Floor
Boston,
Phone:617-624-57571 Fax:617-624-5183 1 TTY:617-624-5286
www.mass.gov/dph/environmental_health .�
F OF PUB�`G
Massachusetts Department of Public Health
Bureau of Environmental Health
November 2015
I
The Commonwealth of Massachusetts
w Executive Office of Health and Human Services
' Department of Public Health
.� 250 Washington Street, Boston, MA 02108-4619
io^M Sve„
CHARLES D.BAKER MARYLOU SUDDERS
Governor Secretary
KARYN E.POLITO MONICA BHAREL,MD,MPH
Lieutenant Governor Commissioner
Tel:617-624-6000
www.mass.gov/dph
November 30, 2015
This is a notification to inform you that an error was very recently discovered in the web
posting of last year's report Cancer Incidence in Massachusetts 2006-2010: City and Town
Supplement. Inadvertently two sets of statistics were posted for some cities and towns, and
each set had different statistics for females. The problem has been corrected and a new report
has been posted at http://www.mass.gov/dph/mcr (at this page click on Data&Statistics and
then City& Town Series). The corrected report will have 'run November 2015'in the title of
each city and town's statistics page.
We apologize for any inconvenience that this may have caused.
Sincerely,
The Massachusetts Cancer Registry Staff
s
Community Fact Sheet
Salem, Massachusetts Updated 03/07/14
Cigarette Smoking
of Adult Smokers �
An estimated 7,734 smokers live in Salem (18.9% of 40
adults, age 18+).
The adult smoking rate is 26% higher in Salem than 30
statewide (18.9% in Salem compared to 15% 18.9
statewide). 20 15
The rate of smoking during pregnancy in Salem is 10
about the same than statewide (7% in.Salem
compared to 7% statewide). o
JEL_
Salem MA
QuitWorks
From July 2009 to June 2013, 69 smokers enrolled in QuitWorks, a program for clinicians to refer
their patients to the Massachusetts Smokers' Helpline. In addition, 215 people from Salem called
and completed an intake with the Massachusetts Smokers' Helpline to quit smoking.
Illegal Tobacco Sales to Minors
The rate of illegal sales to minors (those under age 18) is 86% higher in Salem (20.6%) compared to
the state of Massachusetts (11.1%) based on date from fiscal years 2012 and 2013.
Health Effects of Smoking
Lung cancer incidence is 27% higher among males in Salem compared to the state of Massachusetts.
The age-adjusted lung cancer incidence (per 100,000) for males is 104.4 in Salem compared to 82.2 in
Massachusetts.
Lung cancer incidence is 8% lower among females in Salem compared to the state of Massachusetts.
The age-adjusted lung cancer incidence (per 100,000) for females is 60.5 in Salem compared to 65.5
in Massachusetts.
Mortality from lung cancer is 9% higher in Salem compared to Massachusetts.
OF
Massachusetts Department of Public Health
Tobacco Cessation and Prevention Program Make smoking history.
q1 yl `V (617) 624-5900 www.mass.gov/dph/mtcp FL=�
r
_I=JCommunity Fact Sheet
Salem, Massachusetts Updated 03/07/14
Data Sources
Smoking figures are small area estimates based on data from the 2009 Behavioral Risk Factor
Surveillance System,Massachusetts Department of Public Health.
Figures on smoking during pregnancy are based on 2006 to 2010 Births (Vital Records),
Massachusetts Department of Public Health.
The number of completed screeners from the QuitWorks program and calls to the Massachusetts
Smokers' Helpline is based on data collected by the Massachusetts Tobaccco Cessation and
Prevention Program from fiscal years 2009 to 2013.
The rate of illegal sales to minors is based on 107 compliance checks performed during fiscal year
2012 and 2013.
Rates of lung cancer incidence are based on age-adjusted rates from 2005 to 2009 Cancer Registry
maintained by the Massachusetts Department of Public Health.
Figures on lung cancer mortality are based on comparability modified age-adjusted rates for 2006
to 2010 (Vital Records), Massachusetts Department of Public Health.
cl
Massachusetts Department of Public Health
97, Tobacco Cessation and Prevention Program &a smoking history,
(617) 624-5900 www.mass.gov/dph/mtcp
Fti*OF �
I