ORRHES Meeting Minutes
October 22, 2002
Kowetha Davidson reviewed the agenda dated October 8, 2002.
No correspondence has been received since the last ORRHES meeting.
Lunch order announcement.
Kowetha Davidson referred to the minutes of the August 27, 2002 ORRHES meeting, previously distributed to the Subcommittee members. A motion was received, and seconded, to approved the August 27, 2002 meeting minutes, with minor edits regarding page 21 provided by Don Box. A vote was taken by voice with none opposed. The minutes of the August 27, 2002 ORRHES meeting were declared approved.
The table listing the status of action items has been distributed to the Subcommittee members. The table of action items was reviewed. No comments were made regarding the action items.
Jerry Pereira commented that he has been meeting with Dr. Falk, who has requested monthly status updates regarding ORRHES progress. Dr. Falk has an increased interest in the Subcommittee’s actions and places full responsibility and authority for the work in Oak Ridge on Jerry Pereira.
Regarding future resource needs, Jerry Pereira plans to report, in detail, what has been done thus far with current resources, and, if additional resource needs are identified, will define why desired goals can not be achieved and what is needed to achieve those goals. Jerry Pereira will require legitimate reasons to support resource requests brought to Dr. Falk. Given those legitimate reasons, Jerry Pereira believes that he can get the resources to accomplish what the Subcommittee needs to accomplish. At the December 3rd ORRHES meeting Jack Hanley will present the project plan, including dates and milestone activities. In monthly reports to Dr. Falk the status of those milestones will be updated.
Jerry Pereira and Bill Murray have recently interviewed a candidate for the administrative position in the field office (SEEP employee program). ATSDR plans to have this person begin to work as soon as arrangements can be made.
Kowetha Davidson reported that Dr. Falk plans to attend an ORRHES meeting after January 1, 2003.
James Lewis reported on a recommendation concerning performance issues. In March of 2000, ORRHES requested that ATSDR develop a project plan to outline outstanding PHA issues. Lacking completion of the project plan, several Subcommittee members and some members of the public developed a recommendation to identify weaknesses. The recommendation summarizes issues and focuses on meeting the goals of the Subcommittee. Evaluation of contaminants of concern is behind schedule, for example regarding iodine and mercury. The recommendation is generated to expedite PHA progress and get back on schedule. Currently, only a draft of the project plan has been developed. The recommendation includes an organizational chart depicting Subcommittee members’ understanding of ATSDR staff responsibilities on the project. ORRHES members feel that the PHA process lacks a project manager with the authority and responsibility to see that tasks were performed in a timely manner.
LC Manley, Susan Kaplan, Al Brooks, and James Lewis met with Dr. Falk as private citizens rather than representatives of the Subcommittee. Donna Mosby and Pete Malmquist were unable to attend. The reason for the meeting was to inform Dr. Falk of issues and concerns of the Subcommittee. The following issues were presented:
- The key issue concerned the performance of the ATSDR/PHA process.
Two documents were presented to Dr. Falk. The first document was a PHA
- Milestone Chart (Schedule) listing incomplete milestones. The second document presented was the ATSDR/PHA Guidance Manual. The ATSDR//PHA Guidance Manual, Section 2.5.1, presents the following points for conducting the process:
- Perform initial site documentation and agency activity scoping review,
- Define roles and responsibilities of team members (internal and external),
- Establish communication mechanisms (internal and external),
- Develop a site-specific PHA strategy (establish aggressive, but
realistic, time lines).
- The second issue concerned what could be done to recover from the
schedule delays, and complete the PHA process in the next 18-24 months.
Dr. Falk indicated that this issue would have to be evaluated, but appeared
to be a reasonable goal.
- The third issue concerned the assignment of authority to control the
project. Jerry Pereira has just clarified in this meeting that Dr. Falk
has given him full responsibility and authority for the work in Oak
- The fourth issue concerned field office operations, ensuring that staff with the proper skill sets are provided in the field office to help the Subcommittee and work groups manage meetings.
After listening to the all of the issues presented, Dr. Falk committed to looking further into the issues and responding to the Subcommittee at the December 3rd ORRHES meeting.
Al Brooks concurred with James Lewis’ presentation about the meeting with Dr. Falk, and commented that the most important point concerns lines of authority in the project. Jerry Pereira has given the Subcommittee reassurance on this issue today.
Jerry Pereira commented that after the meeting Dr. Falk asked him to contact Kowetha Davidson about what was discussed. Dr. Falk confirmed that any response from ATSDR would be made to the Subcommittee at the December 3rd ORRHES meeting. Dr. Falk also confirmed that he viewed the visitors as members of the local community.
James Lewis added that if members of the Subcommittee have issues or questions regarding the discussions in the meeting with Dr. Falk, those issues or questions should be compiled for presentation to Dr. Falk.
LC Manley commented that he is concerned about ATSDR follow-up, after compiling and evaluating data in the PHA, to help the community. Currently the ORRHES and the ATSDR/PHA process have a negative image in the community.
Bob Craig inquired about the status of the Gantt chart. Jerry Pereira responded that members should have a copy of the chart before next ORRHES meeting, with milestone dates.
Elmer Akin inquired whether there was a way to report any outcomes of the meeting with Dr. Falk to the community other than through the ORHHES. Al Brooks responded that there was unanimous agreement that any actions taken in response to the meeting with Dr. Falk would be reported through the ORHHES.
AGENDA WORK GROUP PRESENTATION
Barbara Sonnenburg stated that there were no meetings of the Agenda Work Group and had nothing to report.
GUIDELINES AND PROCEDURES WORK GROUP
Karen Galloway stated that there were no meetings of the Guidelines and Procedures Work Group and had nothing to report.
HEALTH EDUCATION NEEDS ASSESSMENT WORK GROUP
Theresa NeSmith provided an update on the Health Education Needs Assessment by telephone.
The Needs Assessment flow chart was presented. Key resource interviews were completed in September 2001. Theresa NeSmith pointed out that in the original plan focus groups were to precede telephone surveys. George Washington University changed the Needs Assessment design to convene the focus groups after telephone surveys. The telephone surveys were completed in January 2001. The Needs Assessment is currently at Step 6, “focus groups,” in the flow chart. The focus groups are currently being formed, and recruiting of participants is ongoing. Weekly updates are provided to the Health Education Needs Assessment Work Group chairpersons. The next steps of the Needs Assessment include:
- Continue focus group recruitment
- Finalize Needs Assessment report
- Develop follow-up Health Education and Health Promotion Plan based on the findings of the Needs Assessment
The current projected schedule for the Needs Assessment is:
- Focus groups completed by January 2003
- Needs Assessment document finalized by Spring 2003
- Additional Health Education and promotion activities (dependent upon Needs Assessment recommendations, PHA, and other public health activities)
- I-131 Health Education Program completed by Spring/Summer 2003 (dependent upon PHA recommendations and other public health activities).
Iodine-131 studies are being performed at many DOE sites (e.g. Hanford, Savannah River, etc.). The American College of Preventive Medicine (ACPM) is conducting a project with ATSDR to develop I-131 health education materials. Health education materials developed through that project could be modified for use for Oak Ridge. Representatives from the ACPM project could be brought to the Subcommittee to make a presentation about health education.
Bob Craig asked why focus group recruitment has been delayed. Theresa NeSmith replied it was due to change in design, switching the focus groups from Step 5 to step 6. In addition, there have been difficulties recruiting people.
James Lewis asked how many focus groups have been developed and their titles. James Lewis also asked how many focus groups have met and when upcoming focus group meetings are scheduled to meet. Theresa NeSmith responded that the names of focus groups are being kept confidential. Typically the names of focus groups are not shared. Theresa NeSmith agreed to check into the confidentiality requirement. The projected schedule for completing the focus group process is January 2003.
James Lewis questioned the necessity of keeping the names of the focus groups confidential. Subcommittee members expected to have some idea of the titles of the focus groups. Theresa NeSmith again committed to check into the confidentiality requirement.
Jerry Periera asked what number of focus group meetings have been conducted. Theresa NeSmith responded that no focus group meetings have been conducted. Eight focus groups will be conducted. Recruiting for the focus groups is ongoing. All of the focus groups will be formed and then conducted simultaneously. Theresa NeSmith confirmed that one group has been formed and is ready for its meeting.
Barbara Sonnenburg asked if the work group chairpersons have been provided with Needs Assessment updates. Theresa NeSmith clarified that the two chairpersons of the Health Education Needs Assessment Work Group receive updates on the Needs Assessment.
Barbara Sonnenburg commented that the Subcommittee feels strongly that the types of focus groups should be limited to titles similar to those recommended by the Subcommittee. If the Subcommittee knew the titles of the focus groups the Subcommittee could assist in recruiting participants. Theresa NeSmith responded that the input of the Subcommittee (focus group titles and potential participants) was used.
Barbara Sonnenburg inquired whether the information could be shared with Subcommittee members via e-mail prior to the next ORRHES meeting. Theresa NeSmith replied that the information would be sent out if there are no restrictions on releasing the information. Theresa NeSmith encouraged Subcommittee members to ask people to call and volunteer to participate in the focus groups.
Herman Cember (new ORRHES member) asked about the subject of the focus groups. Kowetha Davidson asked ATSDR to provide new ORRHES members with information about the Needs Assessment and focus groups from the ORRHES meeting minutes from April 2001. Jerry Pereira informed the Subcommittee that ATSDR staff will present a brief update of agency activities two hours before the December 3, 2002 ORRHES meeting.
Al Brooks asked if the findings from previous county studies of health concerns in the Oak Ridge area will be reconciled with new information that is generated from the current Needs Assessment. Theresa NeSmith replied that information from previous studies in the Oak Ridge area has been considered in the Needs Assessment.
James Lewis asked whether ATSDR has performed a Needs Assessment for any of the other DOE sites, and whether ATSDR has a document that describes the end product expected from the Needs Assessment. Burt Cooper responded that a Needs Assessment is not performed at most sites.
COMMUNICATIONS AND OUTREACH WORK GROUP
James Lewis stated that there were no meetings of the Communication and Outreach Work Group and had nothing to report.
PUBLIC HEALTH ASSESSMENT WORK GROUP
Bob Craig stated that several recommendations are brought to ORRHES from the Public Health Assessment Work Group.
The first recommendation states:
If ATSDR determines that there is unavoidable delay in completion of the I-131 evaluation, the evaluation of one or more other contaminants of concern should be expedited and presented before the I-131 Public Health Assessment.
The second recommendation states:
The ORRHES requests a copy of a detailed Gantt chart from ATSDR as soon as possible. The detailed Gantt chart should reflect the steps in the ORRHES flow sheet. (The flow sheet includes dates of presentations made to the work groups and the Subcommittee).
James Lewis emphasized the need for the Public Health Assessment Work Group to be prepared to address contaminants of concern that may be expedited in advance of I-131.
Presentation by Paul Charp “Radiation Screening Level”
- Background information regarding dose-based screening
- The ATSDR Minimal Risk Level (MRL)
- Screening Protocol Rationale
February 11, 2002 ORRHES meeting:
- ATSDR presented a screening value for radiation exposure of 5,000 millirem (mrem) in a lifetime (70 years, excluding thyroid exposures to I-131)
- Screening value presents no apparent public health concern
- Screening value is partially based on worker studies
- Separate thyroid radiation screening value is to be determined
ATSDR Minimal Risk Level (MRL):
- MRL is a daily radiation dose not expected to cause any adverse health effects (non-cancerous health effects)
- MRL is based on epidemiological studies of exposed persons
- MRL incorporates multiple uncertainty factors
- Refer to: “ATSDR Minimal Risk Levels and Worksheets”
- Two ATSDR MRLs: chronic external radiation exposure (100 mrem/year above background) and acute external radiation exposure (400 mrem/year above background)
- Chronic external - exposure for a period of time greater than one year, MRL = 0.3 x background (or: MRL = 1.3 x background)
- Acute external - exposure over a short period of time, usually less than 14 days, MRL = NOAEL x CF/UF = 0.3 x (1/25) / 3 = 400 mrem/year.
Components of Background Radiation:
- Natural background radiation includes contributions from soil, water, air (including radon gas), and cosmic radiation.
- Typical dose levels of background radiation (not including contributions
from medical exposures, consumer products, fallout):
Inhaled (mostly radon)
- Natural background radiation levels vary with geographic location and elevation (for example: Southeast U.S. versus Rocky Mountains).
- Average radon gas levels indoors in Tennessee by county:
- Anderson = 3 pCi/L
- Knox =2.6 pCi/L
- Loudon = 2.8 pCi/L
- Morgan = 1.5 pCi/L
- Roane = 7.1 pCi/L
ATSDR Screening Value Compared to Background Radiation:
- 5,000 mrem/lifetime divided by 70 years = 71 mrem/year
- Average background in the U.S. = 360 mrem/year
- 71 mrem divided by 360 mrem = 20%
- Annualized screening value represents 20% of average background
- Proposed ICRP (International Commission on Radiological Protection)
harmonization of radiation dose to level of health concern:
Level of Concern
>100 x background
>10 x background
<0.1 x background
- MRL = 1.3 x background
ATSDR Exposure and Dose Assessment Flow Chart:
- Source terms contribute external exposures and internal exposures.
- External and internal exposures are used to estimate whole body and organ doses (Effective Dose and Committed Effective Dose Equivalents).
- Effective Dose and Committed Effective Dose Equivalents are combined to produce a total dose estimate.
- Total dose estimate is compared to MRL to determine either:
- No apparent health concern, or
- Public Health Advisory, or
- Health hazard.
- “No apparent concern” is defined by the ATSDR Public Health Assessment Guidance Manual as exposure to a site contaminant that may have occurred in the past, or is still occurring, but the exposures are not expected to cause adverse health effects.
- Bone seeking radionuclides or radionuclides distributed
throughout the body would be individually evaluated by ATSDR for their potential to cause health effects. (e.g. strontium, radium, plutonium).
Herman Cember asked what action would be taken regarding a dose estimate greater than the screening value. Paul Charp responded that exposure pathways would be looked at more closely. Herman Cember commented that 5000 mrem is small and not likely to cause an effect, and suggested that perhaps the screening level is too low to identify health effects caused by that dose. Paul Charp responded that the MRL screening value is a cut-off point below which dose estimates are not of concern, and above which pathways are evaluated more closely.
Peggy Adkins asked if dose assessments could be performed for people with manifest health effects to estimate their exposures. Paul Charp responded that such a process is an epidemiological process. Elmer Akin added that epidemiologists start with a disease endpoint and then look for a common exposure, and they compare incidence of the disease with incidence in a control community.
Jack Hanley commented that ATSDR’s PHA health assessment process focuses on estimating exposures rather than measuring health outcomes of exposures, which is the focus of epidemiological studies. Jack Hanley also commented that individuals with existing health problems could seek assistance at an AOEC clinic (Association of Occupational and Environmental Clinics). This information is contained in the Environmental and Occupational Medical Resources fact sheet developed by the Subcommittee.
Jeff Hill commented that the ATSDR screening value seems reasonable and was presented clearly.
Kowetha Davidson commented that establishing a cause and effect in individuals is very difficult because many diseases are associated with multiple types of exposures. Certain diseases are associated with exposures to particular substances. (E.g. asbestosis associated with exposure to asbestos)
Bob Peele commented that the proposed ATSDR screening value is inappropriate, and that the MRL concept is inappropriate for carcinogens. Radiation exposure, which can cause cancer, is regulated based on the proportionality of exposure to risk of cancer. Bob Peele believes that the ATSDR screening value is too high, and the ATSDR MRL corresponds to an excess cancer risk of 0.3%. This level of risk is of concern, particularly if groups of people are exposed at this level. Bob Peele suggested that the Subcommittee not endorse the ATSDR screening value, and pointed out that the EPA clean-up program goals are 1/30th of the exposure value.
Constance Jones, EPA project manager of the Scarboro Sampling Program provided an update on the status of activities of that program. The Sampling Report is available for public comment through November 22, 2002, at the Scarboro Community Center, DOE Information Center, and the Oak Ridge Public Library. Two public availability sessions are scheduled for November 14, 2002 from 11:00 AM to 1: 00 PM in the Oak Ridge Mall, and at the Scarboro Community Center from 6:30 PM to 8:30 PM. The report is also available on the EPA Region IV website.
Barbara Sonnenburg asked other Subcommittee members for comments about Bob Peele’s comment that the ATSDR radiation screening value is too high.
Jeff Hill compared the ATSDR screening value to the occupational dose limits as a radiation worker (2 rem/year administrative limit). Jeff Hill asked what percentage of the population (non-occupational) might be exposed to 71 mrem/year for 70 years.
Paul Charp replied that the annualized dose limit of 71 mrem/year corresponds to an estimated risk of 35 per million per year of exposure. Paul Charp also stated that the Committed Effective Dose Equivalent concept conservatively assigns the entire committed dose (future internal dose) to the year of intake.
Herman Cember clarified that the cancer risk versus radiation dose model is unverifiable, assumes no threshold, and is based on acute exposures while environmental exposures are typically chronic and at lower levels. Bob Peele added that a threshold could exist within the range of background radiation exposure levels.
Paul Charp displayed a graph of cancer risk versus acute dose from the General Accounting Office review of radiation standards. The graph shows that health effects are known to occur above 10 rem, that it is unknown whether health effects occur between 5 rem and 10 rem, and that it has not been possible to verify health effects below 5 rem. Below 5 rem a linear risk versus dose model is typically assumed, although other models have also been proposed. Elmer Akin added that the risks of non-radioactive carcinogens at low doses are also unverifiable and that model assumptions must similarly be made.
Barbara Sonnenburg expressed concern that the combined impacts of background radiation releases to the air from sources impacting Oak Ridge have not been evaluated (e.g. releases from Oak Ridge Reservation, Kingston Power Plant, Nevada Test Site).
Bob Craig pointed out that background radiation exposure for 70 years (i.e. 360 mrem/year x 70 years) is well over 10 rem on the General Accounting Office graph displayed during the presentation.
Dr. Toni H. Bounds
Director, Office of Cancer Surveillance, Tennessee Department of Health
Dr. Bounds is the Program Director of the Tennessee Cancer Registry. Toni Bounds described the Tennessee Cancer Registry for the Subcommittee.
What is a Cancer Registry?
- A cancer registry collects information about new cancer cases, which represent cancer incidence over a specified period of time. The time period for the Tennessee (TN) Cancer Registry is the calendar year (cases diagnosed January 1 through December 31 each year).
- General types of cancer registries:
- Hospital-based registry
- Special registry
- Population-based registry
- Hospital-based registries cover only that particular facility. Oaks Ridge Hospital has a hospital-based cancer registry on the cases of cancer diagnosed and treated in that hospital. Those case data are reported to the TN Cancer Registry. Internally, hospitals use their cancer registry to help care for cancer patients.
- Hospital cancer registries are either:
- ACOS (American College of Surgeons) approved, or
- ACOS not approved
- The ACOS provides approved standards for hospital registries. ACOS approved hospitals have a “tumor board” of doctors who review cancer cases, make recommendations, and perform special studies of particular cancer sites.
- Special registries collect particular information on a specific area / cancer site (e.g. brain cancer, childhood cancer).
- A population-based (central) registry collects all defined cancer cases within a population. The TN Cancer Registry is an example of a population-based registry.
- General Information and history about the TN Cancer Registry:
- Located in Nashville within the TN Department of Health
- Housed in the Office of Cancer Surveillance, Bureau of Health Informatics
- Developing TN Cancer Plan – a program for cancer prevention and control
- 1983 TN Cancer Reporting Act passed (controversial law)
- 1986 statewide reporting began (first few years data reporting was voluntary)
- 1997 CDC grant awarded to the state to include data from outpatient and diagnostic clinics because of a trend of people using these facilities as alternatives to hospitals.
- 2000 state law amended to include all national regulations for cancer registries
- 2002 rules and regulations of the TN Cancer Registry passed
- TN Cancer Registry estimates that they receive data for 80% of all actual cases in the state. The goal is 95% complete reporting.
Types of data collected by the TN Cancer Registry:
- Definition of each case: identifies each form of invasive cancer diagnosed (excluding basal and squamous cell skin carcinoma and carcinoma of the cervix, which are too numerous to include in the registry).
- Patient information: name, address, gender, date of birth, family history, tobacco and alcohol use history, occupation/industry exposures.
- Cancer information: cancer site, stage of tumor progression, first course of treatment administered.
- Management information: reporting facility, name of person abstracting data, date of diagnosis. Management information is used to help facilities correct reporting procedures if data are not properly reported.
Facilities reporting information include all healthcare facilities and practitioners who diagnose or treat cancer patients. This includes hospitals, laboratories, and outpatient facilities. Healthcare practitioners do not report if the cancer case is reported by a healthcare facility.
Data reported is abstracted from patient medical records by staff trained in “case finding procedures”. Colleges have training programs available (e.g. Roane State, Walter State). Software packages are available to assist in abstracting data from medical records. The data are required to be reported within 6 months of the date of diagnosis. Six months is allowed in order for the patient and caregiver to establish a course of treatment.
National Cancer Registry history:
- North American Association of Central Cancer Registries (NAACCR) was established in the late 1980’s. The NAACCR established working relationships with statewide registries, and adopted national standards for cancer registries.
- 1992 National Cancer Registries Act passed to create a National Program of Cancer Registries (NPCR) so that data may be shared between states. It is managed by CDC. The TN Cancer Registry is part of the NPCR.
- NPCR, NAACCR and CDC provide monetary support, training and set standards for registries.
- Data exchange agreements allow information to be exchanged with other states regarding patients who choose to be treated or diagnosed outside of their home state.
There are four major areas of NAACR standards:
- Data Completeness: 95% complete reporting, and less than 3% death certificate cases, required within 24 months.
- Data Timeliness:
- Data Quality: 99% of cases pass edits within 24 months. In Tennessee, 30,000 cases are reported each year, and about 8,000 are duplicates, which must be edited appropriately.
- Data Confidentiality: must maintain confidentiality. Data are used by citizens, researchers, students, the Department of Health, and other cancer registries.
Cancer statistics for the state of Tennessee:
- Highest cancer rate in males is 91.9 per 100,000 for prostate cancer.
- Highest cancer rate in females is 95.0 per 100,000 for breast cancer.
- Next highest cancer rate in males and females is lung cancer.
- Lung cancer is the most common type of cancer in Tennessee, overall.
Limitations of the cancer registry data:
- Incomplete reporting
- Not receiving data from ambulatory centers, laboratories, physicians
- Not yet performing death certificate clearances
Strengths of the data:
- Extensive data edits are applied to the TN Cancer Registry
- The TN Cancer Registry has certified tumor registrars
- Education and training of tumor registrars is ongoing
- Identity security must be maintained
- Health Insurance Portability and Accountability Act specifies identity security requirements.
- The data are population-based and do not correspond to incidence in individuals.
- The data inherently follow geographical-political boundaries.
- There are multiple risk factors for cancer. Certain cancers are associated with specific risk factors. (e.g. smoking and lung cancer).
- Exposures to individuals are difficult to estimate.
Toni H. Bounds, Ph.D., MPH
Director, Office of Cancer Surveillance
TN Department of Health
Cordell Hull Bldg., 6 North
425 Fifth Ave. North
Nashville, TN 37247
Discussion (following Toni Bounds presentation):
Barbara Sonnenburg asked whether two different cancers in a single person are counted as separate cases, and requested copies of the TN Cancer Registry maps presented by Toni Bounds. Toni Bounds responded that the different cancers are counted separately, and the data will be sent to the Subcommittee.
Charles Washington asked which region, county, and city in Tennessee has the highest rate of cancer. Toni Bounds responded that she would have to examine the data in order to determine an answer.
Susan Kaplan asked whether thyroid cancers are included in the registry, and if follow-up questions may be submitted if time does not allow for all questions during the Subcommittee meeting. Toni Bounds replied that all cancers are included in the registry and follow-up questions are welcome.
Tony Malinauskas asked the meaning of “age adjustment” in cancer incidence presentations. Toni Bounds explained that it compensates for the confounding variable of age, which is the greatest risk factor for cancer (cancer incidence increases with age).
Toni Bounds explained that cancer incidence statistics for one year are unstable, they are often based on small numbers, and may also change considerably from year to year. One-year cancer incidence rates are based on small numbers, which contributes to their instability.
Bob Peele asked for a calculation sheet that shows how the age adjustment is calculated. Toni Bounds replied that she would provide a calculation sheet, and that it is important to understand which age-adjustment standards are used when looking at cancer incidence statistics. Some mortality rates are adjusted to the 1940 standard, but statistics from the newer data are adjusted to the 2000 standard. The TN Cancer Registry is changing all statistics to the year 2000 standard.
Elmer Akin asked for which years the TN Cancer Registry has achieved 80% reporting, and if the data would help the Subcommittee determine what counties are impacted by the Oak Ridge facilities, particularly thyroid cancer. Toni Bounds responded that the early and mid-1990’s have achieved 80% reporting, and that the TN Cancer Registry could be used to make estimates of the incidences of specific cancers.
Peggy Adkins asked who initially opposed the establishment of the TN Cancer Registry. Toni Bounds replied that some health agencies hesitated to support the formation of the TN Cancer Registry because of concerns about extra work involved in reporting cancer cases. The registry staff have helped to relieve those concerns by providing training and software for reporting. There is not a problem with facilities providing the data today. Peggy Adkins expressed concern that people who lived in the Oak Ridge area in the 1950’s were deceased by the 1970’s, and would have been missed by the registry. Toni Bounds responded that state mortality data date back to the 1930’s in Tennessee, and it would be possible to go back to those records to collect some cancer information.
Kowetha Davidson commented that any further questions could be submitted in writing, and will be collected by Bill Murray, for a later response from Toni Bounds.