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HEALTH CONSULTATION

Health Outcome Data Evaluation

KELLY AIR FORCE BASE
SAN ANTONIO, BEXAR COUNTY, TEXAS


APPENDIX D

Additional Cancer Analysis

In order to examine cancer incidence in other areas surrounding Kelly Air Force Base, ATSDRrequested that the CRD evaluate incidence data for cancer of the liver, lung, cervix, bladder,kidney, and leukemia in the zip code areas 78201, 78204, 78205, 78207, 78221, 78224, 78225,78226, 78227, and 78242, during the period 1990-1994 (Tables D1-D10).

In zip code area 78201, the number of cases observed for cancer of the lung, bladder, kidney, andleukemia was close to the number expected among males and females (Table D-1). However, asignificant excess of liver cancer was observed among the male residents in this zip code area. Inzip code area 78204 (Table D-2), 78224 (Table D-6), and 78225 (Table D-7) the number of casesobserved for cancer of the lung, bladder, kidney, and leukemia was close to the number expectedamong males and females. The number of cases of cancer of the cervix was also close to thenumber expected for females in these three zip code areas for the time period 1990-1994.

In zip code area 78205 (Table D-3), a significant excess of liver cancer was observed amongmales during this time period and in zip code 78207 (Table D-4) a higher than expected numberof liver cancer cases was observed among males and females, although the excesses were ofborderline statistical significance. In zip code area 78221 (Table D-5), a significant excess oflung and kidney cancer was observed among males, as well as a significant excess of kidneycancer among females. A higher than expected number of liver cancer cases was observed amongfemales in this zip code area, although the excess was of borderline statistical significance.

A significant excess of leukemia was observed among males in zip code area 78226 (Table D-8)during this time period. In zip code area 78227 (Table D-9), a significant excess of liver cancer,bladder cancer, and leukemia were observed among males, and a significant excess of lung cancerwas observed among females. A higher than expected number of bladder cancer cases was alsoobserved among females in this zip code area, although the excess was of borderline statisticalsignificance. In zip code area 78242 (Table D-10), a significant excess of lung and kidney cancer was observed about males during this time period.


Table D-1.

Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78201, 1990-1994
MALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Bladder
Kidney
Leukemia

16
74
18
16
17

7.9
63.5
18.2
12.1
10.8

2.0*
1.2
1.0
1.3
1.6

1.3-3.3
0.9-1.5
0.6-1.6
0.8-2.1
0.9-2.5

FEMALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Cervix
Bladder
Kidney
Leukemia

8
40
16
6
15
9

5.5
46.7
17.6
9.4
10.2
10.7

1.5
0.9
0.9
0.6
1.5
0.8

0.6-2.9
0.6-1.2
0.5-1.5
0.2-1.4
0.8-2.4
0.4-1.6

Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided bythe number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidencerates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

CI: confidence interval
* Significantly higher ( at the 5% level) than expected


Table D-2.

Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78204, 1990-1994
MALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Bladder
Kidney
Leukemia

6
19
2
5
2

3.2
16.0
4.5
3.8
2.8

1.9
1.2
0.4
1.3
0.7

0.7-4.1
0.7-1.9
0.1-1.6
0.4-3.1
0.1-2.6

FEMALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Cervix
Bladder
Kidney
Leukemia

3
12
3
0
3
2

2.1
9.3
5.2
2.2
2.9
2.2

1.4
1.3
0.6
0.0
1.0
0.9

0.3-4.2
0.7-2.3
0.1-1.7
0.0-1.7
0.2-3.0
0.1-3.3

Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided bythe number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidencerates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

CI: confidence interval


Table D-3.

Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78205, 1990-1994
MALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Bladder
Kidney
Leukemia

3
7
1
2
0

0.4
4.8
1.4
0.8
0.7

7.5*
1.5
0.7
2.5
0.0

1.5-21.9
0.6-3.0
0.0-4.0
0.3-9.0
0.0-5.3

FEMALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Cervix
Bladder
Kidney
Leukemia

0
3
1
0
0
0

0.3
3.4
0.7
0.7
0.6
0.6

0.0
0.9
1.4
0.0
0.0
0.0

0.0-12.3
0.2-2.6
0.0-8.0
0.0-5.3
0.0-6.1
0.0-6.1

Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided bythe number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidencerates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

CI: confidence interval
Bold type indicates an excess of borderline statistical significance
* Significantly higher ( at the 5% level) than expected


Table D-4.

Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78207, 1990-1994
MALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Bladder
Kidney
Leukemia

23
69
12
19
10

14.0
65.0
17.1
15.6
12.7

1.6
1.1
0.7
1.2
0.8

1.0-2.5
0.8-1.3
0.4-1.2
0.7-1.9
0.4-1.4

FEMALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Cervix
Bladder
Kidney
Leukemia

15
32
24
4
16
9

8.8
35.6
23.2
8.5
11.8
9.6

1.7
0.9
1.0
0.5
1.4
0.9

1.0-2.8
0.6-1.3
0.7-1.5
0.1-1.2
0.8-2.2
0.4-1.8

Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided bythe number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidencerates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

CI: confidence interval
Bold type indicates an excess of borderline statistical significance


Table D-5.

Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78221, 1990-1994
MALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Bladder
Kidney
Leukemia

7
66
11
16
7

5.3
43.8
11.9
8.7
7.7

1.3
1.5*
0.9
1.8*
0.9

0.5-2.7
1.2-1.9
0.5-1.7
1.1-3.0
0.4-1.9

FEMALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Cervix
Bladder
Kidney
Leukemia

7
24
12
9
17
7

2.8
27.6
12.3
4.7
6.1
6.3

2.5
0.9
1.0
1.9
2.8*
1.1

1.0-5.2
0.6-1.3
0.5-1.7
0.9-3.6
1.6-4.5
0.4-2.9

Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided bythe number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidencerates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

CI: confidence interval
Bold type indicates an excess of borderline statistical significance
* Significantly higher ( at the 5% level) than expected


Table D-6.

Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78224, 1990-1994
MALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Bladder
Kidney
Leukemia

2
14
2
2
2

1.9
10.6
2.9
2.6
2.5

1.1
1.3
0.7
0.8
0.8

0.1-3.8
0.7-2.2
0.1-2.5
0.1-2.8
0.1-2.9

FEMALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Cervix
Bladder
Kidney
Leukemia

1
7
3
1
2
0

1.0
6.3
4.8
1.2
1.9
2.2

1.0
1.1
0.6
0.8
1.1
0.0

0.0-5.6
0.4-2.3
0.1-1.8
0.0-4.6
0.1-3.8
0.0-1.7

Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided bythe number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidencerates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

CI: confidence interval


Table D-7.

Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78225, 1990-1994
MALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Bladder
Kidney
Leukemia

6
19
3
3
3

3.7
19.7
5.6
4.5
2.0

1.6
1.0
0.5
0.7
1.5

0.6-3.5
0.6-1.5
0.1-1.6
0.1-1.9
0.3-4.4

FEMALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Cervix
Bladder
Kidney
Leukemia

3
10
11
3
7
3

1.9
10.7
6.0
2.3
3.3
2.8

1.6
0.9
1.8
1.3
2.1
1.1

0.3-4.6
0.4-1.7
0.9-3.3
0.3-3.8
0.9-4.4
0.2-3.1

Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided bythe number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidencerates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

CI: confidence interval


Table D-8.

Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78226, 1990-1994
MALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Bladder
Kidney
Leukemia

2
9
0
4
5

1.3
6.4
1.6
1.6
1.3

1.5
1.4
0.0
2.5
3.8*

0.2-5.6
0.6-2.7
0.0-2.3
0.7-6.4
1.2-9.0

FEMALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Cervix
Bladder
Kidney
Leukemia

2
4
2
0
1
3

0.5
3.0
2.5
0.5
1.0
1.0

4.0
1.3
0.8
0.0
1.0
3.0

0.5-14.4
0.4-3.4
0.1-2.9
0.0-7.4
0.0-5.6
0.6-8.8

Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided bythe number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidencerates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

CI: confidence interval
Bold type indicates an excess of borderline statistical significance
* Significantly higher ( at the 5% level) than expected


Table D-9.

Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78227, 1990-1994
MALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Bladder
Kidney
Leukemia

11
61
23
15
18

4.4
51.5
12.7
8.9
8.7

2.5*
1.2
1.8*
1.7
2.1*

1.2-4.5
0.9-1.5
1.1-2.7
0.9-2.8
1.2-3.3

FEMALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Cervix
Bladder
Kidney
Leukemia

4
50
8
10
11
10

2.1
30.7
13.6
4.6
5.9
7.1

1.9
1.6*
0.6
2.2
1.9
1.4

0.5-4.9
1.2-2.1
0.3-1.2
1.0-4.0
0.9-3.3
0.7-2.6

Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided bythe number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidencerates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

CI: confidence interval
Bold type indicates an excess of borderline statistical significance
* Significantly higher ( at the 5% level) than expected


Table D-10.

Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78242, 1990-1994
MALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Bladder
Kidney
Leukemia

4
38
10
9
7

2.0
19.6
4.6
3.8
4.1

2.0
1.9*
2.2
2.4*
1.7

0.5-5.1
1.4-2.7
1.0-4.0
1.1-4.5
0.7-3.5

FEMALES
SiteObservedExpectedSIR95% CI
Liver
Lung
Cervix
Bladder
Kidney
Leukemia

2
11
11
3
3
3

0.8
10.4
6.6
1.4
2.3
3.2

2.5
1.1
1.7
2.1
1.3
0.9

0.3-9.0
0.5-1.9
0.8-3.0
0.4-6.3
0.3-3.8
0.2-2.7

Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided bythe number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidencerates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

CI: confidence interval
Bold type indicates an excess of borderline statistical significance
* Significantly higher ( at the 5% level) than expected


APPENDIX E

Health Outcome Data Addendum

In August 1999, the Agency for Toxic Substances and Disease Registry (ATSDR) released Phase1 of the public health assessment for Kelly Air Force Base. In this document, several types ofhealth outcomes were evaluated, including several types of cancer, birth defects, and low birth weight. ATSDR made the following recommendations.

  1. Include additional years of information to update such health outcomes as cancer,birth defects, and low birth weight.

  2. Continue to monitor liver cancer incidence and mortality as more years of databecome available.

  3. Continue monitoring heart and circulatory system defects using vital statisticinformation and data from the Texas Birth Defects Monitoring Division as itbecomes available.

  4. Continue monitoring the number of low birth weight babies reported as additionaldata becomes available.

  5. Determine whether data are available to address community concerns regardinglupus, hearing problems, asthma, allergies, hepatitis, and diabetes in the area.

This addendum will address part of the first recommendation by using additional years ofinformation to update the cancer rates in the area. The Texas Department of Health will continueto monitor rates of liver cancer, birth defects, and low birth weight babies, which addresses thefirst four recommendations. ATSDR will continue to attempt to locate data related to the fifthrecommendation, but, to date, very limited, if any, information has been found. No data has beenfound regarding hearing loss. To determine whether an individual had decreased hearing ability, itwould be necessary to test hearing function. This, however, is beyond the scope of the publichealth assessment. As additional documents are completed by ATSDR regarding base drinkingwater, East Kelly, and current and past air emissions on the base, additional health outcome data may be evaluated.

Cancer Data

In Phase 1, the Texas Department of Health Cancer Registry Division conducted an investigationof the occurrence of cases of cancer in selected zip code areas of San Antonio, Texas. The CancerRegistry Division evaluated the incidence and mortality data for cancer of the liver, lung, bladder,kidney, cervix, and leukemia in zip codes 78211, 78228, and 78237 for the periods of 1990-1994(for incidence) and 1991-1995 (for mortality). The current analyses extend the previous studyperiods to include data for 1990-1996 (incidence) and 1990-1997 (mortality).

Texas Cancer Incidence Rates

The analysis of incidence data showed several statistically significant excesses in the San Antonioareas of zip codes 78211, 78228, and 78237 during the period 1990-1996 (Tables E1-E3).

Among male residents, the rate of liver cancer was significantly higher than expected in the 78228and 78237 zip codes. The number of males with lung cancer in zip code 78228 was significantlylower than expected.

Among female residents, the number of kidney cancer cases was significantly higher in the 78211zip code. A statistically significant excess of cervical cancer cases was observed in the 78237 zipcode. A higher than expected number of females with kidney cancer was observed in zip code78237, and a lower than expected number of females with lung cancer was observed in zip codearea 78228, although these results were not statistically significant.

Texas Cancer Mortality Rates

The analysis of mortality data showed several statistically significant elevations for selectedcancer sites in zip code areas 78211, 78228, and 78237 during 1990-1997 (Tables E4-E6).Among the male residents, the number of liver cancer deaths was significantly higher thanexpected in all three zip code areas. A significantly lower than expected number of deaths due tolung cancer in males was observed in zip code 78228. A higher than expected number of leukemiadeaths for males was observed in zip code area 78237, although these results were not statistically significant.

Among female residents, the number of deaths from liver cancer was significantly higher thanexpected in the 78211 and 78237 zip code areas, and a significantly lower number of deaths fromcervical cancer was observed in zip code area 78228. A higher than expected number of cervicalcancer deaths was observed in zip code 78211, although this result was not statistically significant.

Discussion

Using the additional years of information available, the analysis of cancer incidence datacontinued to show statistically significant elevations in several cancer sites. The differences fromthe initial analysis include a statistically significant excess of cases of kidney cancer in females inzip code area 78211; no excess of cases of kidney cancer in males in zip code 78228; a lower thanexpected number of cases of lung cancer in females in zip code 78228; and no excess cases ofleukemia in females in zip code 78237. The analysis of cancer mortality data using additionalyears information continued to show statistically significant excess in several cancer sites and alsoshowed a few differences from the initial analysis. These differences include a significant excessof cases of liver cancer in males and an excess of cases of cervical cancer in females in zip codearea 78211 and a significant decrease of cases of cervical cancer in females in zip code area78228.

The reasons for the elevations of rates of cancer in these zip code areas are not known. The dataavailable to the Texas Cancer Registry regarding individuals who have been diagnosed withcancer are limited and does not include information about known risk factors for specific types ofcancer. In regard to liver cancer, it should be noted that elevated rates of liver cancer are generallyhigh throughout Texas. Increased rates have been observed nationally as well.

Additional Analysis of Leukemia Data

In Phase 1, leukemia incidence was elevated in females in zip code area 78237, and leukemiamortality was elevated in males in the same zip code area. Using additional years of information,the analysis showed a continuation of the elevated rates of leukemia mortality in males in zip codearea 78237.

Leukemias are generally classified as lymphocytic or myelocytic, depending upon the cell type,and into acute or chronic, depending upon the degree of aggressiveness and rate of progression.Thus there are four basic types of leukemia: acute lymphocytic (ALL), chronic lymphocytic(CLL), acute myeloid (AML), and chronic myelogenous (CML). Further analysis was conductedexamining the different types of leukemia in the three zip code areas to determine if there wereelevations in specific types of leukemia or in specific age groups. Although data were requestedfrom the Cancer Registry Division by cell type, age, and sex, they are presented by cell type only due to reasons of confidentiality.

Leukemia Incidence Data

From 1990-1996, a total of 84 cases of leukemia was reported in zip code areas 78211, 78227,and 78237 (Table E-7). The cases occurred with similar frequency in males and females (52% and48% respectively). Of the 84 cases, nearly one-quarter (n=23; 27%) could not be classified intoone of the four basic types of leukemia and were listed as "other." Of the 61 that were classifiedby cell type, approximately one-quarter (n=17; 28%) were ALL; one-fifth were CLL (n=12; 20%);one-third were AML (n=20; 33%); and one-fifth were CML (n=12; 20%).

Thirteen of the total number of leukemia cases occurred in children less than 19 years of age. Ofthese, two cases were not able to be classified and were listed as "other." When examined by celltype, the majority of the childhood leukemia cases that were classified were ALL (n=8; 73%).Two cases of AML (18%) and one case of CML (9%) were reported in children, while no cases ofCLL were reported. Among children, the expected distribution for the different subtypes ofleukemia is 20% AML, 5% CML, and 75% ALL. Even with the small number of leukemia casesthat occurred in children less than 19 years of age, the distribution of leukemia types wasconsistent with what is expected in this age group based on national data [1].

In adults, 71 cases of leukemia cases were reported. Of these, nearly one-third could not beclassified (n=21; 30%). Of the 50 cases that were classified, nearly one-fifth were ALL (n=9;18%), nearly one-quarter were CLL (n=12; 24%), more than one-third were AML (n=18; 36%),and more than one-fifth were CML (n=11; 22%). In adults, the expected rates are 54% AML, 15%CML, 6% ALL, and 25% CLL. When we compare the observed incidence rates in adults from thethree zip code areas, we found a higher than expected proportion of ALL and CML types and alower than expected proportion of AML cell type. In adults, however, it is difficult to drawconclusions from the subtypes of leukemia observed due to the large number of "other" types ofleukemia reported which represents a significant proportion (30% or 21/71) of the reported adultleukemias.

Leukemia Mortality Data

From 1990-1997, a total of 70 deaths from leukemia was reported for zip code areas 78211,78227, and 78237 (Table E-8). Approximately two-thirds were in males (n=44; 63%), and one-third were in females (n=26; 37%). Of the 70 deaths, more than one-third (n=27; 39%) could notbe classified as one of the four basic types of leukemia and were listed as "other." Of the 43 thatwere classified by cell type, approximately one-fifth (n=9; 21%) were ALL, less than one-fifthwere CLL (n=6; 14%), one-third were AML (n=14; 33%), and one-third were CML (n=14; 33%).

Seven of the reported deaths from leukemia occurred in children less than 19 years of age. Ofthese, three were unclassified and listed as "other." When examined by cell type, the majoritywere classified as ALL (n=3; 75%); one was classified as CML (n=1; 25%). No cases of CLL orAML were reported. Due to the small number of deaths reported from leukemia, it is not possibleto draw conclusions from the subtypes of leukemia observed in children less than 19 years of age.

In adults, a total of 63 deaths from leukemia was reported. Of these, more than one-third wereunclassified and listed as "other" (n=24; 38%). Of the thirty-nine that were classified, less thanone-fifth (n=6; 15%) were ALL; less than one-fifth were CLL (n=6; 15%); more than one-thirdwere AML (n=14; 36%); and one-third were CML (n=13; 33%). In adults, the expected rates are54% AML, 15% CML, 6% ALL, and 25% CLL . When we compare the observed mortality ratesin adults from the three zip code areas, we found higher rates of CML and ALL and lower rates ofAML and CLL. In adults, however, there was a large number of "other" types of leukemiareported. This represents a significant proportion of the adult leukemias reported and makes itdifficult to draw conclusions from the subtypes of leukemia observed in adults.

Discussion

This purpose of this analysis was to examine the different types of leukemia that were reported inthree zip code areas in San Antonio to determine if there were elevations in specific types ofleukemia or in specific age groups. If a leukemia case could not be classified into one of the foursubtypes, it was classified as "other." Unfortunately, the fact that the "other" category represents asignificant proportion of the leukemias reported makes it impossible to draw any conclusions fromthis information.

According to data from the National Cancer Institute, ALL is the most common type of childhoodleukemia, while AML is the most common type of adult leukemia [1]. CLL and CML are morecommon among adults. Rates for all types of leukemia are higher among males than amongfemales, and, with the exception of CML, rates are higher among whites than blacks [2].

We do not know the cause of the cases of leukemia in these areas. The risk factors for leukemiaare varied and include diet, heredity, radiation, smoking, treatment with chemotherapeutic agents,and viral infections. Occupational exposures to chemicals are also suspected of influencing the development of leukemia.

Conclusions

1. In zip code area 78211, an elevation of kidney cancer cases was observed among females. Elevations of liver cancer deaths among males and females were also observed, as well as cervicalcancer deaths among females.

2. In zip code 78228, elevations of liver cancer cases and liver cancer deaths were observedamong males.

3. In zip code 78237, an elevation of liver cancer cases was observed among males and elevationsof cancer of the cervix and kidney cancer was observed among females. Elevation of liver cancerdeaths were observed among males and females, as well as an elevation of leukemia deaths amongmales.

4. The distribution of the different subtypes of leukemia that occurred in children less than 19years of age was consistent with what is expected in this age group based on national data.

5. No conclusions can be made from the distribution of the different subtypes of leukemia inadults due to the large number of "other" types of leukemia reported.

Recommendations

1. The Texas department of Health will continue to monitor liver cancer incidence and mortalityas more years of data become available.

2. ATSDR will continue to work with researchers from the Texas Department of Health, BaylorSchool of Medicine, and Texas A & M to try and address the higher rates of liver cancer in Texas.

References

  1. U.S. National Institutes of Health. Leukemia. Report No. 94-329. Bethesda, MD: National Cancer Institute, 1993.

  2. U.S. National Institutes of Health. Cancer Rates and Risks. 4th Edition, Report. No. 96-691. Bethesda, MD: National Cancer Institute, 1996.


Table E-1.

Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78211, 1990-1996
Males
Site Observed Expected SIR 95% CI
Liver 15 9.3 1.6 0.9-2.7
Lung 39 43.2 0.9 0.6-1.2
Bladder 8 11.3 0.7 0.3-1.4
Kidney 9 11.7 0.8 0.4-1.5
Leukemia 10 8.8 1.1 0.5-2.1
Females
Site Observed Expected SIR 95% CI
Liver 7 4.6 1.5 0.6-3.1
Lung 13 20.7 0.6 0.3-1.1
Cervix 19 15.6 1.2 0.7-1.9
Bladder 4 3.8 1.1 0.3-2.7
Kidney 15 7.8 1.9* 1.1-3.2
Leukemia 10 6.9 1.4 0.7-2.7
Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided bythe number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidencerates for Texas during the years 1992 and 1995 combined. The SIR has been rounded to the firstdecimal place.

CI: confidence interval
* Significantly higher (at the 5% level) than expected



Table E-2.

Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78228, 1990-1996
Males
Site Observed Expected SIR 95% CI
Liver 33 16.2 2.0* 1.4-2.9
Lung 91 120.2 0.8 0.6-0.9
Bladder 29 32.4 0.9 0.6-1.3
Kidney 31 24.5 1.3 0.9-1.8
Leukemia 23 19.9 1.2 0.7-1.7
Females
Site Observed Expected SIR 95% CI
Liver 10

8.8

1.1 0.5-2.1
Lung 60

73.9

0.8 0.6-1.0
Cervix 24

31.1

0.8 0.5-1.1
Bladder 10

12.2

0.8 0.4-1.5
Kidney 21

17.8

1.2 0.7-1.8
Leukemia 15

17.5

0.9 0.5-1.4
Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases dividedby the number of expected cases. The later is based on race-, sex-, and age-specific cancerincidence rates for Texas for the years 1992 and 1995 combined. The SIR has been rounded to thefirst decimal place.

CI: confidence interval
Bold type indicates an excess of borderline statistical significance
* Significantly higher (at the 5% level) than expected
Significantly lower (at the 5% level) than expected


Table E-3.

Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78237, 1990-1996
Males
Site Observed Expected SIR 95% CI
Liver 32 12.1 2.6* 1.8-3.7
Lung 60 56.0 1.1 0.8-1.4
Bladder 10 13.4 0.7 0.4-1.4
Kidney 18 14.3 1.3 0.7-2.0
Leukemia 12 11.0 1.1 0.6-1.9
Females
Site Observed Expected SIR 95% CI
Liver 11 6.8 1.6 0.8-2.9
Lung 26 29.4 0.9 0.6-1.3
Cervix 33 21.4 1.5* 1.1-2.2
Bladder 9 5.5 1.6 0.7-3.1
Kidney 18 11.2 1.6 1.0-2.5
Leukemia 14 9.2 1.5 0.8-2.6
Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases dividedby the number of expected cases. The later is based on race-, sex-, and age-specific cancerincidence rates for Texas for the years 1992 and 1995 combined. The SIR has been rounded to thefirst decimal place.

CI: confidence interval
* Significantly higher (at the 5% level) than expected
Bold type indicates an excess of borderline statistical significance


Table E-4.

Number of Observed and Expected Cancer Deaths and Race-Adjusted Standardized Mortality Ratios, Selected Sites, San Antonio, Texas, Zip Code 78211, 1990-1997
Males
Site Observed Expected SMR 95% CI
Liver 18 9.5 1.9* 1.1-3.0
Lung 45 41.8 1.1 0.8-1.4
Bladder 5 2.8 1.8 0.6-4.2
Kidney 6 5.3 1.1 0.4-2.5
Leukemia 10 6.7 1.5 0.7-2.7
Females
Site Observed Expected SMR 95% CI
Liver 12 4.7 2.6* 1.3-4.5
Lung 18 17.7 1.0 0.6-1.6
Cervix 11 5.4 2.0 1.0-3.6
Bladder 2 1.2 1.7 0.2-6.0
Kidney 5 3.4 1.5 0.5-3.4
Leukemia 6 4.8 1.3 0.5-2.7
Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SMR (standardized mortality ratio) is defined as the number of observed deathsdivided by the number of expected deaths. The later is based on race-, sex-, and age-specificcancer incidence rates for Texas during the period 1992-1997. The SMR has been rounded to thefirst decimal place.

CI: confidence interval
* Significantly higher (at the 5% level) than expected
Bold type indicates an excess of borderline statistical significance


Table E-5.

Number of Observed and Expected Cancer Deaths and Race-Adjusted Standardized Mortality Ratios, Selected Sites, San Antonio, Texas, Zip Code 78228, 1990-1997
Males
Site Observed Expected SMR 95% CI
Liver 37 16.9 2.2* 1.5-3.0
Lung 86 116.2 0.7 0.6-0.9
Bladder 8 7.7 1.0 0.4-2.0
Kidney 8 11.3 0.7 0.3-1.4
Leukemia 19 16.1 1.2 0.7-1.8
Females
Site Observed Expected SMR 95% CI
Liver 14 9.6 1.5 0.8-2.4
Lung 61 66.6 0.9 0.7-1.2
Cervix 3 10.8 0.3 0.1-0.8
Bladder 1 4.1 0.2 0.0-1.4
Kidney 7 7.9 0.9 0.4-1.8
Leukemia 11 13.4 0.8 0.4-1.5
Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SMR (standardized mortality ratio) is defined as the number of observed deathsdivided by the number of expected deaths. The later is based on race-, sex-, and age-specificcancer incidence rates for Texas during the period 1992-1997. The SMR has been rounded to thefirst decimal place.

CI: confidence interval
* Significantly higher (at the 5% level) than expected
Significantly lower (at the 5% level) than expected


Table E-6.

Number of Observed and Expected Cancer Deaths and Race-Adjusted Standardized Mortality Ratios, Selected Sites, San Antonio, Texas, Zip Code 78237, 1990-1997
Males
Site Observed Expected SMR 95% CI
Liver 47 12.4 3.8* 2.8-5.0
Lung 63 54.7 1.2 0.9-1.5
Bladder 2 3.3 0.6 0.1-2.2
Kidney 8 6.7 1.2 0.5-2.4
Leukemia 15 8.2 1.8 1.0-3.0
Females
Site Observed Expected SMR 95% CI
Liver 20 7.0 2.9* 1.7-4.4
Lung 30 25.5 1.2 0.8-1.7
Cervix 12 7.8 1.5 0.8-2.7
Bladder 2 1.9 1.1 0.1-3.8
Kidney 8 4.9 1.6 0.7-3.2
Leukemia 9 6.7 1.3 0.6-2.6
Data provided by the Cancer Registry Division of the Texas Department of Health.

Note: The SMR (standardized mortality ratio) is defined as the number of observed deathsdivided by the number of expected deaths. The later is based on race-, sex-, and age-specificcancer incidence rates for Texas during the period 1992-1997. The SMR has been rounded to thefirst decimal place.

CI: confidence interval
* Significantly higher (at the 5% level) than expected
Bold type indicates an excess of borderline statistical significance


Table E-7.

Distribution of Leukemia Cases in Zip Code Areas 78211, 78228, and 78237 by Cell Type, San Antonio, Texas, 1990-1996
Zip Code Leukemia Cell Type  
ALL CLL AML CML Other Total
78211 7 1 4 2 6 20
78228 6 9 10 4 9 38
78237 4 2 6 6 8 26
Total 17 12 20 12 23 84
Data provided by the Cancer Registry Division of the Texas Department of Health.

ALL: acute lymphocytic leukemia
CLL: chronic lymphocytic leukemia
AML: acute myeloid leukemia
CML: chronic myelogenous leukemia


Table E-8.

Distribution of Leukemia Deaths in Zip Code Areas 78211, 78228, and 78237 by Cell Type, San Antonio, Texas, 1990-1997
Zip Code Leukemia Cell Type  
ALL CLL AML CML Other Total
78211 2 2 4 4 4 16
78228 3 3 5 5 14 30
78237 4 1 5 5 9 24
Total 9 6 14 14 27 70
Data provided by the Cancer Registry Division of the Texas Department of Health.

ALL: acute lymphocytic leukemia
CLL: chronic lymphocytic leukemia
AML: acute myeloid leukemia
CML: chronic myelogenous leukemia


PREPARERS OF THE REPORT

Dhelia Williamson, M.S.
Epidemiologist
Health Investigations Branch
Division of Health Studies

Barry Wilson
Epidemiologist
Cancer Registry Division
Texas Department of Health

Judy Henry, M.S.
Epidemiologist
Environmental Epidemiology and Toxicology Division
Texas Department of Health

Matthew Garabedian, M.P.H.
Epidemiologist
Environmental Epidemiology and Toxicology Division
Texas Department of Health

John Villanacci, Ph.D.
Toxicologist
Environmental Epidemiology and Toxicology Division
Texas Department of Health


Regional Representative

Jennifer Lyke
ATSDR Region VI
Regional Operations



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