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HEALTH CONSULTATION

CHILDHOOD CANCER INCIDENCE UPDATE:
A REVIEW AND ANALYSIS OF CANCER REGISTRY DATA, 1979-2000
DOVER TOWNSHIP, OCEAN COUNTY, NEW JERSEY


BACKGROUND AND STATEMENT OF ISSUES

This report is an update to the 1997 Childhood Cancer Incidence Health Consultation: AReview and Analysis of Cancer Registry Data, 1979-1995 for Dover Township (Ocean County),New Jersey1 assembled by the New Jersey Department of Health and Senior Services (NJDHSS)in cooperation with the federal Agency for Toxic Substances and Disease Registry (ATSDR). The results of the 1997 Health Consultation demonstrated that childhood cancer incidence forselected cancer groupings was significantly higher than expected for Dover Township and theToms River section of the Township. This was true for leukemia and brain and central nervoussystem (CNS) cancer, especially for female children under five years of age. These results, inconjunction with other Health Assessments and Consultations, which evaluated potentialexposure to environmental contamination in the community, provided the basis for the recentlycompleted case-control study to evaluate potential risk factors for childhood cancer in Dover Township.

This Health Consultation updates childhood cancer statistics for Dover Township. It wasa recommendation from the public comment draft of the report, Case-control Study of ChildhoodCancers in Dover Township (Ocean County), New Jersey2, to review an additional five years ofcancer incidence data (1996-2000) in order to determine if there are any changes in incidence rates or time trends in the Township.


DISCUSSION

METHODS

Study Time Period and Case Definition

The period evaluated for the updated Health Consultation was January 1, 1979, throughDecember 31, 2000, with a primary focus on the most recent five years of observation (1996-2000). Incidence data from 1979-1995 (the original Health Consultation time period) were alsore-evaluated using population census data from 1980, 1990 and 2000. State incidence rates wererecalculated to ensure the accuracy of the re-analysis. In addition, time trends were evaluatedover the 22 years of available State cancer information.

A "case" was defined as an individual diagnosed with a new primary cancer or reportablecondition during the evaluation period, who was under age 20 and was a resident of DoverTownship at the time of diagnosis.

Cancers to be Evaluated

All childhood cancers combined and groupings of selected childhood cancer types asdefined by the International Classification of Childhood Cancer3,4 using the InternationalClassification of Diseases for Oncology, Second Edition5 (ICD-O-2) were evaluated and include:total childhood cancer, brain and central nervous system (CNS) cancers, astrocytoma,sympathetic nervous system tumors, neuroblastoma, Wilms' tumor, malignant bone cancer, softtissue sarcomas, total leukemia, acute lymphocytic leukemia, lymphoma and otherreticuloendothelial neoplasms, Hodgkin's disease, and non-Hodgkin's lymphoma. A list of theICD-O-2 codes used for the groups can be found in the original Health Consultation1.

Cancer Incidence Data

Cancer cases were identified through the New Jersey State Cancer Registry (NJSCR). The NJSCR, operated by the NJDHSS, is a population-based cancer incidence registry coveringthe entire state of New Jersey. New Jersey regulations require reporting of all primary malignantand in-situ neoplasms, except for certain carcinomas of the skin and, since 1995, carcinoma in-situ of the cervix. The NJSCR collects and analyzes data in accordance with the standards set bythe North American Association of Central Cancer Registries and the National Cancer Institute. Reports are filed by hospitals, diagnosing physicians, dentists, and independent clinicallaboratories. In addition, the NJSCR has reporting agreements with the states of New York,Pennsylvania, Delaware, and Florida where information on New Jersey residents who arediagnosed in those states is supplied to the NJSCR. The Registry has been in operation since October 1, 1978.

The information collected by the NJSCR includes basic patient identification,demographic characteristics of the patient (date of birth, race, sex, age at diagnosis, address atdiagnosis), medical information on each cancer diagnosis (including anatomical site, histologicaltype and summary stage of disease), and annual follow-up status (alive/deceased). Information iscollected and defined in accordance with the National Cancer Institute's SEER (Surveillance,Epidemiology, and End Results) Program. These data, along with the date and underlying causeof death (where applicable) are incorporated into the basic source data set.

All records meeting case definitions for this analysis were verified by NJSCR staff foraccuracy and edited for errors using standardized edit routines provided by the North AmericanAssociation of Central Cancer Registries.

The NJSCR prepared a final data set of cases meeting the case definition and providedthat file to the Consumer and Environmental Health Services (CEHS). CEHS staff evaluated allOcean County cases to ensure accurate assignment to the appropriate municipality using countystreet maps. Dover Township cases were further geo-coded to their correct census tract (see Figure 1).

Data Analysis

Standardized Incidence Ratios (SIR) were used for the quantitative analysis of childhoodcancer incidence in the evaluation areas.6 The SIR is calculated by dividing the observed numberof cases (from the NJSCR) by an expected number for the study population over the time periodreviewed.

SIR = Observed cases รท Expected cases

SIRs were calculated for Dover Township and the Toms River section of the Township. Forpurposes of analysis, Toms River was defined as the population residing within four censustracts: 228, 231, 232, and 236 (see Figure 1). This designation of Toms River was developedprior to review of any cancer data, was meant to approximate the historical area of this section ofDover Township, and is identical to the area used to define Toms River in the 1997 HealthConsultation.

In order to parallel the earlier Health Consultation, SIRs were calculated for each cancergrouping by all age groups combined (0-19) and the youngest age group (0-4) separately. Inaddition, SIRs were calculated for males, females, and the total childhood population.

The expected numbers were calculated using average annual State of New Jersey age-sex-specific incidence rates for the cancer site groupings based on statewide NJSCR data from 1979to 1995, and from 1996 to 1999. At the time this analysis was initiated, these years of NJSCRdata were considered the most complete for calculation of State rates. The size and age structureof the population was estimated using U.S. Census data7-9 for each study area. Annual populationestimates for each of four 5-year age groups (0-4, 5-9, 10-14, and 15-19) were derived by linearinterpolation and extrapolation of the 1980, 1990, and 2000 population data. Person-timeestimates were made by summing the age-group specific populations over the 17-year (1979-1995) and 5-year (1996-2000) periods. The formula for deriving the expected number of cases isshown below.

mathematical equation

Evaluation of the observed and expected numbers was accomplished by interpreting the ratio (i.e., SIR) of these numbers. If the observed number of cases equals the expected number of cases, the SIR will equal one (1.0). When the SIR is less than one, we conclude that fewer cases were observed than expected. Should the SIR be greater than one, more cases than expected were observed.

Random fluctuations may account for some SIR deviations from 1.0. The statisticalsignificance of deviations from SIR=1.0 was evaluated using a 95% confidence interval9 (C.I.). The 95% C.I. was used to evaluate the probability that the SIR may be greater or less than 1.0due to chance alone. The upper and lower limits were calculated as follows using computationalformulas which accurately approximate the exact test for the Poisson distribution.10,11

Lower limit of the SIR:

mathematical equation

Upper limit of the SIR:

mathematical equation

If the 95% confidence interval includes 1.0, then the SIR is not considered to be significantlydifferent from 1.0. The analysis was facilitated using customized data management filesdesigned by NJDHSS for this application.

Variation in cancer incidence over time was also evaluated using three-year runningaverage rates calculated for all cancers combined, leukemia, and brain and central nervoussystem cancers. For comparison purposes, this analysis was also conducted for the State as awhole. Twenty three-year running average rates were computed for the State, Dover Township,and Toms River by dividing the number of cases by the person-time of observation in each three-year interval beginning with 1979-1981 and ending with 1998-2000.

RESULTS

According to the Census data (Appendix I), the total childhood population in DoverTownship remained stable in Dover Township from 1980 to 1990 (20,840 to 20, 857) andincreased ten percent (to 22,933) from 1990 to 2000. In the Toms River section of the Township,the total childhood population decreased over 16 percent from 1980 to 1990 (4,927 to 4,119) andthen increased nearly 12 percent (to 4,599) from 1990 to 2000. As a comparison, the New Jerseychildhood population decreased 11 percent from 1980 to 1990 (2,248,242 to 1,996,796) and thenincreased about 15 percent (to 2,284,107) from 1990 to 2000.

Person-year estimates by sex for Dover Township and Toms River are summed over thetwo evaluation periods (1979-1995 and 1996-2000) and presented in Table 1. The proportion ofToms River person-years remained similar over each of the study periods, representing about 20percent of the overall Dover Township study person-time.

Table 2 provides an enumeration of total childhood cancer incidence by year of diagnosisfor Dover Township and Toms River. The total number of incident cancers reported to theNJSCR for Dover Township during each time period, 1979-1995 and 1996-2000, was 87 (anaverage of 5.1 cases per year) and 25 (an average of 5.0 cases per year), respectively. The totalnumber of incident cancers reported for Toms River during each time period was 24 (an averageof 1.4 cases per year) and 5 (an average of 1.0 cases per year), respectively.

Table 3 provides an enumeration of total childhood cancer cases by age group, race, andsex for Dover Township and Toms River. Of note, for Dover Township the number of cases inthe youngest age group (0-4) dropped from 26 percent to 16 percent respectively for the 1979-1995 and the 1996-2000 time periods. The drop in cases in the youngest age group was morenotable for the Toms River section changing from 50 percent during the 1979-1995 period tozero in the most recent (1996-2000) time period. For each of the time periods, cases tended to be white and fairly evenly split by sex.

Dover Township SIR Analyses

Table 4 presents the Dover Township cases by cancer grouping and analysis period. Atotal of 87 cases of cancer (41 males and 46 females) were diagnosed for Dover Township duringthe 1979-1995 period. The most frequently diagnosed cancers for the Township over this periodinclude leukemia (21 total, including 17 acute lymphocytic leukemia), brain and CNS cancers(12 total, including 5 astrocytoma), and soft tissue sarcomas (7).

The 87 cases (Table 4) diagnosed for Dover Township over the 17-year period, 1979-1995, is three less than reported in the 1997 Health Consultation. The drop in case numbers wasdue to a subsequent change of status of four cases, two of which actually were diagnosed whileresident of another municipality and two of which were found to be over age 20 at the time oftheir diagnosis, and the addition of one case which was not identified in the earlier report.

Table 5 presents a summary of select SIRs for Dover Township during each period ofanalysis. For the 17-year period (1979-1995), the newly recalculated SIRs were virtually thesame as the those presented in the 1997 Health Consultation. Consequently, only these selectSIRs are presented in this report for comparison purposes. As in the earlier Health Consultation,all cancers combined for the total childhood population, all cancers combined in females, andacute lymphocytic leukemia in females were statistically elevated for the period 1979-1995 withSIRs ranging from 1.3 to 3.3.

For the 1996-2000 period of analysis, 25 cases of cancer (12 males and 13 females) werediagnosed for Dover Township (Table 4). The most frequently diagnosed cancers for theTownship over this period include leukemia (7 total, including 5 acute lymphocytic leukemia),brain and CNS cancers (4 total, including 3 astrocytoma), malignant bone cancer (3), and softtissue sarcomas (3).

Tables 6 and 7 present the results of the Dover Township SIR analysis for the time period1996-2000. While none of the SIRs for the most recent time period were statistically significant,several SIRs with more than one case were elevated two-fold or higher. For all ages combined,the elevated SIRs include astrocytoma in females (3 cases; SIR = 4.4; 95% CI = 0.88, 12.8), bonecancer in females (2 cases; SIR = 3.7; 95% CI = 0.42, 13.5), non-Hodgkin's lymphoma in males(2 cases; SIR = 3.0; 95% CI = 0.34, 10.8), Hodgkin's disease in females (2 cases; SIR = 2.1; 95%CI = 0.23, 7.42), and acute lymphocytic leukemia in females (3 cases; SIR = 2.0; 95% CI = 0.40,5.83). For children diagnosed under age five, acute lymphocytic leukemia in females waselevated more than two-fold (2 cases; SIR = 2.9; 95% CI = 0.32, 10.4).

A comparison between the statistically elevated SIRs for Dover Township for the 1979-1995 period and the SIRs for the 1996-2000 period shows that the SIRs have decreased. However, the magnitude of the SIRs are similar between the two periods, especially for acutelymphocytic leukemia in females (Table 5).

Toms River SIR Analyses

Table 8 presents the Toms River section of the Township cases by cancer grouping andperiod of analysis. A total of 24 cases of cancer (12 males and 12 females) were diagnosed forToms River during the 1979-1995 period. The most frequently diagnosed cancers over thisperiod include leukemia (6 total, including 5 acute lymphocytic leukemia) and brain and CNScancers (6 total, including 3 astrocytoma).

Table 9 presents a summary of select SIRs for Toms River during each period. For the17-year period, 1979-1995, the newly recalculated SIRs were virtually the same as the thosepresented in the 1997 Health Consultation. Consequently, only these select SIRs are presented inthis report for comparison purposes. As in the earlier Health Consultation, all cancers combinedfor the total childhood population, brain/CNS cancer in female children under age five,astrocytoma in the total childhood population under age five, and acute lymphocytic leukemia infemales under age five remained statistically elevated for the period 1979-1995 with SIRsranging from 1.7 to 11.3.

Tables 10 and 11 present the results of the Toms River SIR analysis for the time period1996-2000. While none of the SIRs for this time period were statistically significant, one SIRwith more than one case was elevated more than two-fold: all leukemia in males, all agescombined (2 cases; SIR = 3.4; 95% CI = 0.38, 12.2). As indicated in Table 11, no children underage five were diagnosed with cancer in Toms River for this time period.

A comparison between the statistically elevated SIRs for Toms River for the 1979-1995period and the SIRs for the 1996-2000 period shows a substantial decrease in the magnitude ofthe SIRs, primarily due to the drop in cases under age five (Table 9).

Census Tract SIR Analyses

Table 12 presents SIR results for all cancers combined by the 17 full census tracts of theTownship (see Figure 1) and the remainder of the population outside those census tracts,primarily Ortley Beach and Pelican Island. Although none of the individual tracts werestatistically elevated, census tract 228 (part of the Toms River section of the Township) had thehighest ratio (8 cases; SIR = 1.9; 95% CI = 0.82, 3.75). Census tract 227 had the most cases(19), 50 percent higher than expected (SIR = 1.5; 95% CI = 0.89, 2.30).

Time Trends

The three-year running average rates for all childhood cancers combined, leukemia, andbrain/CNS cancer are presented in Tables 13 through 15 and Figures 2 through 4. Forcomparison, similarly derived rates for the State are also presented. For all cancers combined,the State rate rose slightly over most of the 22 year period and then dropped slightly in the late-1990s (Table 13 and Figure 2). Dover Township rates begin rising above the State rates from the1985 midpoint through the 1995 midpoint. The Dover Township rates appear to again rise abovethe state rates in the late-1990s. The Toms River rates display the most variability over the 22years (due to the smaller number of cases) with the highest rates in the late-1980s.

Leukemia incidence (Table 14 and Figure 3) remained relatively constant for the Stateover the 22 year period. Because of the smaller numbers, leukemia rates in Dover Townshipdisplayed the most variability, with higher incidence during the mid to late 1980s and the mostrecent three-year period.

State brain and CNS cancer rates (Table 15 and Figure 4) rose slightly at the beginning ofthe study period, then remained stable through the rest of the time period. Dover Township againdisplayed much variability for brain and CNS cancer over the 22-year period with wide swings in the 3-year average rates above and below the state average rates.


CONCLUSIONS

Excess childhood cancer incidence over the earlier period of analysis (1979-1995) wasreconfirmed in Dover Township for all cancers combined and leukemia (specifically acutelymphocytic leukemia), and in Toms River for all cancers combined, brain and CNS cancer(including astrocytoma), and leukemia (specifically acute lymphocytic leukemia). The excesscases in Toms River occurred almost entirely in children under five years of age. Toms Riverhad a higher proportion of cases in younger children than all of Dover Township combined orOcean County.

While none of the SIRs for Dover Township were statistically significant during the laterperiod of analysis (1996-2000), the magnitude of those SIRs were similar to many of thestatistically elevated SIRs during the earlier study period (1979-1995). Because of the smallnumber of cases (25) diagnosed in the last five-year period, it is difficult at this time to determinewith a reasonable degree of accuracy whether or not the incidence of childhood cancer in theTownship is declining.

For the Toms River section of the Township during the 1996-2000 period, the smallnumber of childhood cancer cases (5, with no cases in children under age five) is an indicationthat childhood cancer incidence rates, especially for the youngest age group, may be declining.

The time trend analyses provide evidence of the variability in cancer incidence whenevaluated in relatively small populations. While cancer incidence rate peaks were found forDover Township during certain periods, especially the mid to late 1980s, it is not clear whetherthe elevation in the most recent three-year period (1998-2000) represents random variability orcontinued elevated risk. However, interpretation of these data should be done cautiously,especially because of the small number of cases diagnosed in any given year.


RECOMMENDATIONS

  1. The NJDHSS should continue its childhood cancer surveillance in Dover Township,updating this report when an additional five years of cancer incidence data (2001-2005) isavailable from the New Jersey State Cancer Registry.


  2. ATSDR and NJDHSS should continue their educational and outreach efforts in DoverTownship.

CERTIFICATION

This health consultation was prepared by the New Jersey Department of Health and SeniorServices (NJDHSS) under a cooperative agreement with the Agency for Toxic Substances andDisease Registry (ATSDR). It has been produced in accordance with approved methodology and procedures existing at the time the health consultation was begun.

Gregory V. Ulirsch
Technical Project Officer
Superfund Site Assessment Branch (SSAB)
Division of Health Assessment and Consultation (DHAC)
ATSDR


The Division of Health Assessment and Consultation, ATSDR, has reviewed this health consultation and concurs with its findings.

Gail Godfrey
for Roberta Erlwein
Chief, SPS, SSAB, DHAC
ATSDR


PREPARERS OF REPORT

Michael Berry, M.S.
Patricia Haltmeier
Jerald Fagliano, Ph.D.

New Jersey Department of Health and Senior Services
Division of Epidemiology, Environmental and Occupational Health
Consumer and Environmental Health Services


ATSDR Regional Representative:

Leah Escobar, R.S.
Associate Regional Representative


ATSDR Technical Project Officer:

Gregory V. Ulirsch, M.S.
Technical Project Officer
Superfund Site Assessment Branch
Division of Health Assessment and Consultation


REFERENCES

  1. Berry, M and Haltmeier, P: Childhood Cancer Incidence Health Consultation: A Reviewand Analysis of Cancer Registry Data, 1979-1995, for Dover Township (Ocean County),New Jersey. New Jersey Department of Health and Senior Services, Trenton, NewJersey, 1997.


  2. NJDHSS and ATSDR: Case-control Study of Childhood Cancers in Dover Township(Ocean County), New Jersey. Public Comment Draft Technical Report, Trenton, NewJersey, 2001.


  3. Kramarova, E., Stiller, C.A., Ferlay, J., Parkin, D.M., Draper, G.J., Michaelis, J., Neglia,J., Qureshi, S. (eds.): International Classification of Childhood Cancer 1996. IARCTechnical Report No. 29, International Agency for Research on Cancer, Lyon, 1996.


  4. Kramarova, E. and Stiller, C.A.: The International Classification of Childhood Cancer. Int. J. Cancer: 68, 759-765, 1996.


  5. World Health Organization: International Classification of Diseases for Oncology,Second Edition, 1990.


  6. Kelsey, J.L., Thompson, W.D., and Evans, A.S.: Methods in ObservationalEpidemiology, B. MacMahon, ed. Monographs in Epidemiology and Biostatistics Vol.10, Oxford University Press, Oxford, 1986.


  7. United States Department of Commerce, Bureau of the Census: Population CensusReport, General Population Characteristics, 1980.


  8. United States Department of Commerce, Bureau of the Census: Population CensusReport, General Population Characteristics, 1990.


  9. United States Department of Commerce, Bureau of the Census: Population CensusReport, General Population Characteristics, 2000.


  10. Breslow, N.E. and Day, N.E.: Statistical Methods in Cancer Research: Vol II-The Designand Analysis of Cohort Studies, E. Heseltine, ed. IARC Scientific Publication No. 82,International Agency for Research on Cancer, Lyon, 1987.


  11. Checkoway, H., Pearce, N.E., and Crawford-Brown, D.J.: Research Methods inOccupational Epidemiology, B. MacMahon, ed. Monographs in Epidemiology andBiostatistics Vol. 13, Oxford University Press, Oxford, 1989.

FIGURES

Dover Township and Toms River Section
Figure 1. Dover Township and Toms River Section (shaded)

3-Year Average Cancer Rates: All Cancer Combined
Figure 2. 3-Year Average Cancer Rates: All Cancer Combined

3-Year Average Leukemia Rates
Figure 3. 3-Year Average Leukemia Rates

3-Year Average Brain/CNS Rates
Figure 4. 3-Year Average Brain/CNS Rates


TABLES

TABLE 1. Person-years for the Time Periods 1979-1995 and 1996-2000
Dover Township and Toms River (Census Tracts 228, 231, 232, and 236)
Using 1980, 1990 and 2000 U.S. Census Bureau Data

 

Age Range

Dover Township

Toms River

1979-1995
Total:

0 - 4
5 - 9
10 - 14
15 - 19
Total

77,036
88,550
95,966
96,019
357,571

15,778
18,627
19,964
21,706
76,076

1979-1995
Male:

0 - 4
5 - 9
10 - 14
15 - 19
Total

38,561
44,308
48,164
47,945
178,978

7,930
9,286
10,004
10,804
38,023

1979-1995
Female:

0 - 4
5 - 9
10 - 14
15 - 19
Total

38,214
44,201
48,423
47,659
178,498

7,574
9,171
9,763
10,385
36,891

1996-2000
Total:

0 - 4
5 - 9
10 - 14
15 - 19
Total

24,604
28,382
30,523
29,080
112,589

5,005
5,673
5,844
5,993
22,515

1996-2000
Male:

0 - 4
5 - 9
10 - 14
15 - 19
Total

12,746
14,411
15,705
14,761
57,623

2,661
2,891
3,115
3,149
11,816

1996-2000
Female:

0 - 4
5 - 9
10 - 14
15 - 19
Total

11,858
13,971
14,818
14,319
54,966

2,344
2,782
2,729
2,844
10,699


TABLE 2. Childhood Cancer Incident Cases (0 to 19 Years)
Dover Township and Toms River (Census Tracts 228, 231, 232, and 236)
Year of Diagnosis 1979 Through 2000

  Dover Township Toms River (part of Dover)
Diagnosis Year:

1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995

Total

 

7
4
3
4
4
3
6
7
5
4
7
4
6
7
5
6
5

87

 

2
0
1
0
2
1
2
1
1
2
4
1
1
1
1
1
3

24

1996
1997
1998
1999
2000

Total

5
2
7
5
6

25

1
0
0
1
3

5


TABLE 3. Childhood Cancer Incident Cases (0 to 19 Years)
Dover Township and Toms River (Census Tracts 228, 231, 232, and 236)
Age Group, Race, and Sex
1979 Through 2000

  Dover Township Toms River (part of Dover)
Age Group (1979-1995):

0 - 4
5 - 9
10 - 14
15 - 19

 

23
13
14
37

 

12
4
2
6

Race (1979-1995):

White
Black
Other/Unknown

 

85
1
1

 

24
0
0

Sex (1979-1995):

Male
Female

 

41
46

 

12
12

Age Group (1996-2000):

0 - 4
5 - 9
10 - 14
15 - 19

 

4
2
8
11

 

0
1
2
2

Race (1996-2000):

White
Black
Other/Unknown

 

25
0
0

 

5
0
0

Sex (1996-2000):

Male
Female

 

12
13

 

4
1


TABLE 4. Dover Township Childhood Cancer Incident Cases (0 to 19 Years)

Disease Grouping 1979 - 1995 1996 - 2000
Male Female Male Female
Malignant Bone Tumors
Brain/Central Nervous System

(Astrocytoma)

Retinoblastoma
Sympathetic Nervous System

(Neuroblastoma)

Hodgkin's Disease
Non-Hodgkin's Lymphoma
Other Lymphomas
Leukemia

(Acute Lymphocytic Leukemia)

Melanoma
Skin
Hepatic Tumors
Renal Tumors

(Wilms' Tumor)

Thyroid
Nasopharyngeal Carcinomas
Soft Tissue Sarcomas
Germ Cell/Trophoblastic
Other Benign/Borderline
In Situ Cancers
Other/Unspecified

Total

3
8

(4)

0
3

(3)

4
3
2
8

(5)

0
0
0
1

(1)

1
1
3
3
0
0
1

41

1
4

(1)

0
1

(1)

2
2
0
13

(12)

3
0
0
2

(1)

2
0
4
2
1
5
4

46

1
1

(0)

0
0

(0)

0
2
1
3

(2)

0
0
0
0

(0)

0
1
2
1
0
0
0

12

2
3

(3)

0
1

(1)

2
0
0
4

(3)

0
0
0
0

(0)

0
0
1
0
0
0
0

13

Note: The parenthetical numbers are a subset of the rows directly above them.


TABLE 5. Dover Township: Summary of Select SIRs

Cancer Type

Age Group

Sex

Number Observed

Number Expected

SIR

95% C.I. Lower-Upper

Study Period: 1979-1995

All Types

All Types

All Types

0-19

0-19

0-4

Both

Female

Female

87

46

14

67.0

33.2

7.7

1.3*

1.4*

1.8

1.04 - 1.60

1.01 - 1.85

0.99 - 3.04

Acute Lymphocytic Leukemia

Acute Lymphocytic Leukemia

0-19

0-4

Female

Female

12

7

4.6

2.2

2.6*

3.3*

1.34 - 4.53

1.30 - 6.70

Study Period: 1996-2000

All Types

All Types

All Types

0-19

0-19

0-4

Both

Female

Female

25

13

3

20.6

9.4

2.2

1.2

1.4

1.4

0.78 - 1.79

0.74 - 2.37

0.28 - 4.02

Acute Lymphocytic Leukemia

Acute Lymphocytic Leukemia

0-19

0-4

Female

Female

3

2

1.5

0.7

2.0

2.9

0.40 - 5.83

0.32 - 10.4

* Statistically elevated, p < 0.05


TABLE 6. Dover Township Childhood Cancer Incident Cases (0 to 19 Years)
Standardized Incidence Ratios (SIR), 1996 Through 2000

Cancer Type

Sex

Number Observed

Number Expected

SIR

95% C.I. Lower-Upper

All Cancers Total
Male
Female
25
12
13
20.6
11.3
9.4
1.2
1.1
1.4
0.78 - 1.79
0.55 - 1.86
0.74 - 2.37
Bone Total
Male
Female
3
1
2
1.1
0.6
0.5
2.6
1.7
3.7
0.53 - 7.71
0.02 - 9.23
0.42 - 13.5
Brain/CNS Total
Male
Female
4
1
3
3.5
2.1
1.5
1.1
0.5
2.1
0.31 - 2.92
0.01 - 2.70
0.41 - 6.02

Astrocytoma

Total
Male
Female
3
0
3
1.5
0.8
0.7
2.0
-
4.4
0.39 - 5.73
-
0.88 - 12.8
Leukemia Total
Male
Female
7
3
4
4.9
2.9
2.0
1.4
1.0
2.0
0.57 - 2.94
0.21 - 3.04
0.53 - 5.06

Acute
Lymphocytic
Leukemia

Total
Male
Female
5
2
3
3.6
2.1
1.5
1.4
1.0
2.0
0.45 - 3.25
0.11 - 3.45
0.40 - 5.83
All Lymphoma Total
Male
Female
5
3
2
3.3
1.9
1.4
1.5
1.6
1.4
0.49 - 3.56
0.33 - 4.73
0.16 - 5.05

Hodgkin's

Total
Male
Female
2
0
2
1.8
0.8
1.0
1.1
-
2.1
0.13 - 4.11
-
0.23 - 7.42
Non-Hodgkin's
Lymphoma
Total
Male
Female
2
2
0
1.0
0.7
0.4
1.9
3.0
-
0.22 - 6.97
0.34 - 10.8
-
Soft Tissue Sarcomas Total
Male
Female
3
2
1
1.5
0.8
0.7
1.9
2.4
1.4
0.39 - 5.68
0.27 - 8.80
0.02 - 7.72
Sympathetic Nervous System Total
Male
Female
1
0
1
1.0
0.6
0.4
1.0
-
2.4
0.01 - 5.65
-
0.03 - 13.6

Neuroblastoma

Total
Male
Female
1
0
1
0.9
0.5
0.4
1.1
-
2.5
0.01 - 6.07
-
0.03 - 14.1
Wilms' Tumor Total
Male
Female
0
0
0
0.6
0.2
0.3
-
-
-
-
-
-


TABLE 7. Dover Township Childhood Cancer Incident Cases (0 to 4 Years)
Standardized Incidence Ratios (SIR), 1996 Through 2000

Cancer Type

Sex

Number Observed

Number Expected

SIR

95% C.I. Lower-Upper

All Cancers Total
Male
Female
4
1
3
5.5
3.3
2.2
0.7
0.3
1.4
0.20 - 1.88
0.00 - 1.69
0.28 - 4.02
Bone Total
Male
Female
0
0
0
0.0
0.0
0.0

-
-
-

-
-
-
Brain/CNS Total
Male
Female
0
0
0
0.9
0.6
0.3
-
-
-
-
-
-

Astrocytoma

Total
Male
Female
0
0
0
0.4
0.2
0.1
-
-
-
-
-
-
Leukemia Total
Male
Female
3
1
2
2.0
1.2
0.8
1.5
0.9
2.4
0.30 - 4.36
0.01 - 4.71
0.27 - 8.65

Acute
Lymphocytic
Leukemia

Total
Male
Female
3
1
2
1.6
0.9
0.7
1.9
1.1
2.9
0.38 - 5.50
0.01 - 6.16
0.32 - 10.4
All Lymphoma Total
Male
Female
0
0
0
0.3
0.2
0.1
-
-
-
-
-
-

Hodgkin's

Total
Male
Female
0
0
0
0.1
0.0
0.0
-
-
-
-
-
-

Non-Hodgkin's
Lymphoma

Total
Male
Female
0
0
0
0.1
0.1
0.0
-
-
-
-
-
-
Soft Tissue Sarcomas Total
Male
Female
0
0
0
0.4
0.2
0.2
-
-
-
-
-
-
Sympathetic Nervous System Total
Male
Female
1
0
1
0.8
0.4
0.4
1.3
-
2.8
0.02 - 6.93
-
0.04 - 15.6

Neuroblastoma

Total
Male
Female
1
0
1
0.8
0.4
0.4
1.3
-
2.8
0.02 - 6.93
-
0.04 - 15.6
Wilms' Tumor Total
Male
Female
0
0
0
0.4
0.2
0.2
-
-
-
-
-
-


TABLE 8. Toms River Childhood Cancer Incident Cases (0 to 19 Years)
Census Tracts 228, 231, 232, and 236

Disease Grouping 1979 - 1995 1996 - 2000
Male Female Male Female
Malignant Bone Tumors
Brain/Central Nervous System

(Astrocytoma)

Retinoblastoma
Sympathetic Nervous System

(Neuroblastoma)

Hodgkin's Disease
Non-Hodgkin's Lymphoma
Other Lymphomas
Leukemia

(Acute Lymphocytic Leukemia)

Melanoma
Skin
Hepatic Tumors
Renal Tumors

(Wilms' Tumor)

Thyroid
Nasopharyngeal Carcinomas
Soft Tissue Sarcomas
Germ Cell/Trophoblastic
Other Benign/Borderline
In Situ Cancers
Other/Unspecified

Total

0
3

(2)

0
1

(1)

2
0
1
2

(1)

0
0
0
0

(0)

0
0
2
1
0
0
0

12

0
3

(1)

0
1

(1)

0
0
0
4

(4)

1
0
0
0

(0)

1
0
0
0
0
0
2

12

0
1

(0)

0
0

(0)

0
0
0
2

(1)

0
0
0
0

(0)

0
0
1
0
0
0
0

4

0
0

(0)

0
0

(0)

0
0
0
1

(1)

0
0
0
0

(0)

0
0
0
0
0
0
0

1

Note: The parenthetical numbers are a subset of the rows directly above them.


TABLE 9. Toms River Census Tracts: Summary of Select SIRs

Cancer Type

Age Group

Sex

Number Observed

Number Expected

SIR

95% C.I. Lower-Upper

Study Period: 1979-1995

All Types

All Types

All Types

0-19

0-4

0-4

Both

Both

Female

24

12

10

14.4

3.4

1.5

1.7*

3.6*

6.5*

1.07 - 2.49

1.84 - 6.22

3.13 - 12.0

Brain/CNS

Brain/CNS

0-4

0-4

Both

Female

4

3

0.6

0.3

7.0*

11.3*

1.87 - 17.8

2.27 - 33.0

Astrocytoma

0-4

Both

2

0.2

8.9*

1.00 - 32.1

Acute Lymphocytic Leukemia

0-4

Female

4

0.4

9.4*

2.52 - 24.0

Study Period: 1996-2000

All Types

All Types

All Types

0-19

0-4

0-4

Both

Both

Female

5

0

0

4.2

1.1

0.4

1.2

-

-

0.39 - 2.81

-

-

Brain/CNS

Brain/CNS

0-4

0-4

Both

Female

0

0

0.2

0.1

-

-

-

-

Astrocytoma

0-4

Both

0

0.1

-

-

Acute Lymphocytic Leukemia

0-4

Female

0

0.1

-

-

* Statistically elevated, p < 0.05


TABLE 10. Toms River Childhood Cancer Incident Cases (0 to 19 Years)
Standardized Incidence Ratios (SIR), 1996 Through 2000

Cancer Type

Sex

Number Observed

Number Expected

SIR

95% C.I. Lower-Upper

All Cancers Total
Male
Female
5
4
1
4.2
2.3
1.8
1.2
1.7
0.6
0.39 - 2.81
0.46 - 4.39
0.01 - 3.04
Bone Total
Male
Female
0
0
0
0.2
0.1
0.1
-
-
-
-
-
-
Brain/CNS Total
Male
Female
1
1
0
0.7
0.4
0.3
1.4
2.4
-
0.02 - 7.93
0.03 - 13.2
-

Astrocytoma

Total
Male
Female
0
0
0
0.3
0.2
0.1
-
-
-
-
-
-
Leukemia Total
Male
Female
3
2
1
1.0
0.6
0.4
3.0
3.4
2.5
0.61 - 8.88
0.38 - 12.2
0.03 - 14.1

Acute
Lymphocytic
Leukemia

Total
Male
Female
2
1
1
0.7
0.4
0.3
2.8
2.3
3.4
0.31 - 9.99
0.03 - 13.0
0.04 - 18.9
AllLymphoma Total
Male
Female
0
0
0
0.7
0.4
0.3
-
-
-
-
-
-

Hodgkin's

Total
Male
Female
0
0
0
0.4
0.2
0.2
-
-
-
-
-
-

Non-Hodgkin's
Lymphoma

Total
Male
Female
0
0
0
0.2
0.1
0.1
-
-
-
-
-
-
Soft Tissue Sarcomas Total
Male
Female
1
1
0
0.3
0.2
0.1
3.2
5.9
-
0.04 - 17.9
0.08 - 32.6
-
Sympathetic Nervous System Total
Male
Female
0
0
0
0.2
0.1
0.1
-
-
-
-
-
-

Neuroblastoma

Total
Male
Female
0
0
0
0.2
0.1
0.1
-
-
-
-
-
-
Wilms' Tumor Total
Male
Female
0
0
0
0.1
0.0
0.1
-
-
-
-
-
-


TABLE 11. Toms River Childhood Cancer Incident Cases (0 to 4 Years)
Standardized Incidence Ratios (SIR), 1996 Through 2000

Cancer Type

Sex

Number Observed

Number Expected

SIR

95% C.I. Lower-Upper

All Cancers Total
Male
Female
0
0
0
1.1
0.7
0.4
-
-
-
-
-
-
Bone Total
Male
Female
0
0
0
0.0
0.0
0.0
-
-
-
-
-
-
Brain/CNS Total
Male
Female
0
0
0
0.2
0.1
0.1
-
-
-
-
-
-

Astrocytoma

Total
Male
Female
0
0
0
0.1
0.0
0.0
-
-
-
-
-
-
Leukemia Total
Male
Female
0
0
0
0.4
0.2
0.2
-
-
-
-
-
-

Acute
Lymphocytic
Leukemia

Total
Male
Female
0
0
0
0.3
0.2
0.1
-
-
-
-
-
-
AllLymphoma Total
Male
Female
0
0
0
0.1
0.0
0.0
-
-
-
-
-
-

Hodgkin's

Total
Male
Female
0
0
0
0.0
0.0
0.0
-
-
-

-
-
-

Non-Hodgkin's
Lymphoma

Total
Male
Female
0
0
0
0.0
0.0
0.0
-
-
-
-
-
-
Soft Tissue Sarcomas Total
Male
Female
0
0
0
0.1
0.0
0.0
-
-
-
-
-
-
Sympathetic Nervous System Total
Male
Female
0
0
0
0.2
0.1
0.1
-
-
-
-
-
-

Neuroblastoma

Total
Male
Female
0
0
0
0.2
0.1
0.1
-
-
-
-
-
-
Wilms' Tumor Total
Male
Female
0
0
0
0.1
0.0
0.0
-
-
-
-
-
-


TABLE 12. Dover Township Childhood Cancer Incident Cases By Census Tract
Standardized Incidence Ratios (SIR), 1979 Through 2000
All Race and Sex Groups Combined (0 to 19 Years)

CensusTract

NumberObservedNumberExpected SIR 95% C.I. Lower-Upper

220
221
222
223
224

7
2
0
5
11

6.9
3.1
0.4
4.4
10.7

1.0
0.6
-
1.1
1.0

0.41-2.10
0.07-3.32
-
0.37-2.65
0.51-1.84

225
226
227
228
229

0
5
19
8
7

0.8
4.0
12.9
4.2
4.8

-
1.2
1.5
1.9
1.5

-
0.40-2.89
0.89-2.30
0.82-3.75
0.59-3.04

230
231
232
233
234

8
7
11
11
3

7.0
4.0
8.1
7.7
3.0

1.1
1.8
1.4
1.4
1.0

0.49-2.25
0.71-3.65
0.68-2.42
0.72-2.57
0.20-2.92

235
236
Other

3
3
0

2.6
2.3
1.0

1.2
1.3
-

0.23-3.37
0.27-3.89
-

 

Note: Two cases lacked sufficient address information to code to a census tract.


TABLE 13. Average Annual Childhood Cancer Incidence Rates, All Cancers Combined Overlapping Three-year Periods, 1979-2000

Three-year Period New Jersey
(8,781)*
Dover Township
(112)*
Toms River
(29)*
1979-81 17.7 22 20
1980-82 17.4 18 6.9
1981-83 18.3 18 21
1982-84 18.9 18 21
1983-85 19.3 21 36
1984-86 18.8 26 30
1985-87 18.9 29 30
1986-88 18.6 26 31
1987-89 18.5 26 55
1988-90 19.3 24 56
1989-91 19.8 27 48
1990-92 20.2 27 24
1991-93 19.9 28 24
1992-94 20.1 28 24
1993-95 19.6 25 39
1994-96 19.4 24 38
1995-97 18.1 18 30
1996-98 18.6 21 7.5
1997-99 18.0 21 7.4
1998-00 17.1 26 29

Note: Rates are average annual number of cases diagnosed in the three-yearperiod per 100,000 children. Rates are more variable when based on fewer cases.

* - Total number of cases over the 22-years.


TABLE 14. Average Annual Childhood Cancer Incidence Rates, Leukemia Overlapping Three-year Periods, 1979-2000

Three-year Period New Jersey
(2,003)*
Dover Township
(28)*
1979-81 4.5 1.6
1980-82 4.4 3.2
1981-83 4.4 6.4
1982-84 4.3 6.4
1983-85 4.2 6.4
1984-86 3.9 3.2
1985-87 3.9 8.0
1986-88 3.9 8.0
1987-89 4.0 11
1988-90 4.2 6.4
1989-91 4.1 9.6
1990-92 4.2 4.8
1991-93 4.4 6.3
1992-94 4.5 1.6
1993-95 4.4 6.2
1994-96 4.5 6.1
1995-97 4.4 6.0
1996-98 4.6 4.5
1997-99 4.4 5.9
1998-00 4.1 8.8

Note: Rates are average annual number of cases diagnosed in the three-yearperiod per 100,000 children. Rates are more variable when based on fewer cases.

* - Total number of cases over the 22-years.


TABLE 15. Average Annual Childhood Cancer Incidence Rates, Brain/CNS Cancers Overlapping Three-year Periods, 1979-2000

Three-year Period New Jersey
(1,490)*
Dover Township
(16)*
1979-81 2.7 4.8
1980-82 2.7 3.2
1981-83 3.2 1.6
1982-84 3.3 3.2
1983-85 3.5 3.2
1984-86 3.3 4.8
1985-87 3.3 4.8
1986-88 3.2 3.2
1987-89 3.2 4.8
1988-90 3.3 3.2
1989-91 3.4 4.8
1990-92 3.4 3.2
1991-93 3.3 3.1
1992-94 3.2 1.6
1993-95 3.2 0
1994-96 3.4 1.5
1995-97 3.2 1.5
1996-98 3.4 1.5
1997-99 3.0 3.0
1998-00 3.0 4.4

Note: Rates are average annual number of cases diagnosed in the three-yearperiod per 100,000 children. Rates are more variable when based on fewer cases.

* - Total number of cases over the 22-years.


APPENDIX I: 1980, 1990, AND 2000 U.S. CENSUS BUREAU POPULATIONS
OCEAN COUNTY, DOVER TOWNSHIP, AND TOMS RIVER CENSUS TRACTS

Age Range

1980

1990

2000

Dover Township

Toms River

Dover Township

Toms River

Dover Township Toms River
Total:

0-4
5-9
10-14
15-19

Total

4,100
5,059
5,915
5,766

20,840

896
1,145
1,396
1,490

4,927

4,780
5,222
5,335
5,520

20,857

937
1,049
1,004
1,129

4,119

4,956
5,790
6,297
5,890

22,933

1,017
1,156
1,210
1,216

4,599

Male:

0-4
5-9
10-14
15-19

Total

2,107
2,554
2,967
2,948

10,576

450
593
719
786

2,548

2,362
2,591
2,589
2,741

10,283

497
523
503
581

2,104

2,596
2,955
3,279
3,005

11,835

541
592
653
642

2,428

Female:

0-4
5-9
10-14
15-19

Total

1,993
2,505
2,948
2,818

10,264

446
552
677
704

2,379

2,418
2,631
2,746
2,779

10,574

440
526
501
548

2,015

2,360
2,835
3,018
2,885

11,098

476
564
557
574

2,171

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