Eastern Idaho - SiteSpecific Data - Statistical Data

Background

Citizen requests led to the evaluation of brain cancer rates in eastern Idaho. Results of the evaluation revealed an elevated rate of brain cancer in the six-county area of Bingham, Bonneville, Butte, Clark, Jefferson, and Madison Counties compared to the rest of the state for the period 1985 through 1994. In response to the elevated rate in the six-county area, an investigation by the Cluster Analysis Work Group (CAWG) was undertaken in May 1997.

Participants:

Persons diagnosed with brain cancer during 1978* through 1996 who were residing in Bingham, Bonneville, Butte, Clark, Jefferson, or Madison counties at the time of their diagnosis were identified through the Cancer Data Registry of Idaho (CDRI).

Using the registry, 180 eligible participants were identified; addresses for them or their next-of-kin were available for 108. Of the 108 surveys sent, 14 of these were returned as undeliverable to the address; therefore, 94 surveys were successfully delivered.

Response rate:

Fifty-six of 94 (60% of successfully delivered) surveys were received back from study participants or their next-of-kin.

County of residence of brain cancer patients at diagnosis:

County	Number of persons with brain cancer listed in CDRI	Number of persons responding to survey
Bingham	48	17
Bonneville	97	28
Butte	3	0
Clark	2	0
Jefferson	17	6
Madison	13	4
Bannock	n/a	1**
Total	180	56

** Residence listed in study area in the CDRI, but self-reported Bannock County on survey.

* The first year complete and reliable information was available from the CDRI.

Results
Note: Data on the following pages are based only on surveys that were completed and returned; no data are presented on persons who did not respond. All results such as residence and exposures refer to the peron with brain cancer, who was not always the person who actually completed the survey.

Demographic Information

Total respondents:	56
Sex:	32 (57% male), 24 female
Ethnicity:	all non-Hispanic
Race:	55 white, 1 Native American/Alaska Native
Age at diagnosis:
Range:	2-86
Median:	45
Children:	12 persons were under 18
Adults:	44 persons were 18 or over

Relatives with cancer

Nine persons (16%) reported a family member, including distant relatives, with brain cancer.

Twenty-seven persons (48%) reported a first-degree relative with some type of cancer other than brain or skin cancer. A first-degree relative was defined as a brother, half-brother, sister, half-sister, mother, father, or child. A total of 44 relatives were reported with other types of cancer. The reported cancers in relatives were:

Cancer Type	Number of Relatives listed
Bladder	1
Bone	2
Breast	9
Carcinoma, unspecified	1
Colon	2
Kidney	2
Liver	3
Lung	3
Lymphoma/leukemia	4
Ovary	1
Pancreas	1
Prostate	5
Skin (melanoma)	1
Stomach	2
Throat	1
Thyroid	1
Tumor in back/shoulder blade	2
Uterus	3
Total	44

Residence Information

Pesticide use at residence

Among residences at the time of diagnosis, 24 respondents indicated no pesticides were ever used in the house. Of those who indicated some pesticide use, 14 used pesticides annually; 1 monthly; 1 weekly; 1 daily; 6 reported other patterns of use; 1 did not indicate use pattern and 8 indicated use frequency was unknown.

Among all residences lived in during the cancer patients' lifetimes ( a total of 183), pesticides were reportedly never used in 67 of them; in 65 homes, it was unknown how often pesticides were used; in 28 of homes pesticides were used yearly; in 6 homes, pesticides were used monthly; in 2 homes, pesticides were used weekly; in 1 home, pesticides were used daily, and in 14 homes, other patterns of use were listed.

Amount of time in area [Note: "Area" refers to the six-county survey area.]

Time in the area prior to diagnosis ranged from 1-86 years. The average amount of time spent in the area prior to diagnosis was 26 years.

Percent of life spent in area

The percent of life spent in the area prior to diagnosis ranged from 2% to 100%. The average percent of life spent in the area prior to diagnosis was 60%. Some respondents did not include all prior residences in their response, so for some persons, the amount of time spent in the area may be greater than that reported.

Amount of time on a farm or ranch

The amount of time spent on a farm or ranch in the area ranged from 0 - 49 years. The average amount of time was 9 years. This represented an average of 27% of their lifetime and ranged from 0 - 100% of their lives.

Water source while in the area

At the time of diagnosis, 61% of cancer patients were using city water, and 39% were on well water.

The most common source of drinking water for persons during their lives in the area was city water. An average of 16 years prior to diagnosis had been spent using city water. An average of 10 years had been spent using well water, and an average of less than one year was spent using other sources of water such as bottled water.

Job / Occupation / Career Information

The following information is a list of all jobs reported by respondents, including part-time jobs.

Job Activity	Number of persons reporting job activity*
Administrative and selling	1
Auto parts ordering/selling	1
Bagging groceries/deli/stocking shelves	2
Baking/cooking	2
Bartending	1
Bookkeeper, accountant, office manager/worker	7
Child care provider	1
Cleaning grain elevators	1
Cleaning/designing flowers, sales	1
Clothing sales	3
Cooking and cleaning	1
Crop dusting chemical mixing	1
Defense plant loading shells	1
Driving/loading/unloading/hauling	4
Electrical/concentrator	1
Electrical/mechanical repair	1
Engineer/maintenance	1
Engineer, electric or unspecified	4
Farm work	5
Field work/research at Nevada Test Site	1
Finishing hardwood floors	1
Fixing machines	1
Framing	1
Grounds/building maintenance	1
Health insurance analyst	1
Health care of elderly	1
Housewife	1
Lab research with high power laser, fiber optics	2
Lawn/tree chemical care	1
Maintenance/installing lines	1
Manufacture	1
Marble installing	1
Nurse	6
Operations, engineer	1
Optometry	3
Pick and shovel	1
Pipe mover	1
Reactor operator, operations physicist	1
Rad/Con. technician	1
Repairing and servicing televisions	1
Retreading tires	1
Running youth programs	1
Secretary/clerical	3
Shepherding	1
Sorting potatoes	1
Survey	1
SWAT	1
Teaching	4
Teletype operator	1
Teller	3
Treating and diagnosing	1
Trim line sorter	3
Waitress/Waiter	2
Walking a beat/surveillance	1
Warehouse inventory	1
* Some persons reported more than one job.

Chemical and Radiation Exposure at Work

Among adults, 7 (16%) reported wearing a protective badge during some previous job.

Among adults, 14 (32%) wor protective clothing during some previous job.

Among adults, 16 (36%) had a previous job where they may have been exposed to chemicals. The chemicals reported were:

Chemical	Number of persons reporting exposure*
Acetone	2
Aluminum nitrate	2
Cleaning supplies / household cleaners	4
Copy machine toner / office supplies	2
Floral leaf shine	1
Formaldehyde	1
Garage solvents	1
Grease	1
Herbicide / pesticide	1
Lye / oil / chlorine / solvents	1
Methanol	1
Nitric acid	1
Potato processing chemicals	1
Resins	1
Rubber adhesives	1
Spray paint	1
Trichloroethylene (TCE)	1
Trisulfate	1
"W4-W6- Dinitro thimet Dasanett Disiston"	1
Unsure	1
* Some persons reported more than one exposure.

Among adults, 15 (34%) held jobs previously that might have exposed them to chemical vapors, fumes, or dust. The reported fumes/vapors/dusts were:

Fume / Vapor / Dust	Number of persons reporting exposure*
Acetone, methanol, trichloroethylene (TCE)	1
Ammonia, chlorine, other cleaning chemicals	1
Chemical plant fumes in Henderson, Nevada	1
Copy machine toner, whiteout	1
Dust / insecticides on potatoes	2
Dust inside television sets	1
Grain dust	1
Herbicides, pesticides	1
Nitric acid	1
Potato processing fumes	1
Rubber dust	1
Secondhand cigarette smoke	1
Trisulfate and formaldehyde/spray paint/leaf shine	2
Varnish / paint thinner	2
Wood dust, turpentine	1
* Some persons reported more than one exposure.

Among adults, 7 (16%) held jobs previously in which they used radioactive materials.

Radioactive Exposure	Number of persons reporting exposure
"Contained sources"	1
Dose of radiation, unspecified	1
Nevada Test Site	1
Picture tubes in TV sets	1
Uranium fuel	1
Unsure	2

Military Experience

Among adults, 12 (27%) reported military experience.

Type of military experience	Number of persons reporting military experience
Air Force	1
Destroyer in US Navy	1
Fort Bragg	1
Fort Lewis Wash, 1947	1
Fort Ord	1
Military 1942-45 (was wounded)	1
National Guard	2
USA 7	1
Blank (no specifics listed)	3

Schools

Of the 12 persons under age 18 when diagnosed, 3 were too young to ever have attended school. These 3 children resided in Bingham (1 child) and Bonneville (2 children) Counties at the time of diagnosis. The remaining 9 children attended schools in the following counties in the area:

County of School	Number of children attending
Bingham	5
Bonneville	1
Jefferson	2
Madison and Bonneville	1

Other Exposures

Crop Dusting

Among the 56 respondents, 27 (48%) indicated that the cancer patient had at some time lived near crop dusting. Among the 27, 22 reported that crop dusting had occurred within 2 miles or "around the area". The frequency of crop dusting was reported as during the summer months (8 respondents), yearly (6 respondents), 2-3 times per year (4 respondents), during crop season (3 respondents), once every (3 respondents), once every 3 years (1 respondent), and routinely (2 respondents).

Medical radiation exposure

No medical radiation exposure was reported, except as part of cancer diagnosis or treatment in 26 persons; recurrent brain cancer in one person, and diagnosis of pneumonia in one person.

Body site exposed / reason for medical radiation	Number of persons reporting exposure	Reason for radiation
Adenoids	0
Cancer Treatment	26	All 26 related to diagnosis or treatment for brain cancer
Nasopharnynx (nose or throat)	0
Skin or scalp	0
Thymus (gland in upper chest)	0
Thyroid	0
Tonsils	0
Tuberculosis (TB)	0
Other sources of medical radiation	2	1 recurrent brain cancer; 1 lung cancer/x-rays for pneumonia

Hobbies

Among respondents, 26 persons wrote "none" for hobbies that may have caused chemical exposure; 14 left the question blank; 2 wrote "unknown".

Hobbies were reported by 14 persons:

Hobby	Number of persons listing hobby*
Ceramics	1
Fishing	2
Fixing or working on cars and trucks	2
Gardening	1
Golf	2
Hunting	1
Painting	4
Remodeling / house construction	1
Smoking	1
Sports	1
Woodworking	1
* Some persons reported more than one hobby.

Comments / Additional Remarks

A page was given for the survey respondents to fill in individual remarks. Following is a summary of those remarks. Responses were edited and paraphrased to remove personal and identifying information, but retain concerns regarding possible causes or factors related to the person's brain cancer.

OCCUPATIONAL EXPOSURES
Cement dust
Aerial camera repair work.
TV picture tubes
Working at INEL; brought home contamination
Stress / stressful job
Working at Nevada Test Site
RESIDENTIAL/MEDICATION/LIFESTYLE
High aspirin use
Smoking (2 persons)
House painting
Wild game consumption
Another resident of same home with brain cancer; neighbor with cancer
COMMUNITY EXPOSURES
Lived near mosquito abatement zone
Lived near dump site
Hunting / fishing
Lived whole life near Rexburg
CHEMICAL EXPOSURES
Golf course pesticides (2 persons)
Cleaning chemicals
Crop dusting / pesticide chemical exposure
Strong smells; chlorine gas; paint remover, and amonia
Used household chemicals and insect sprays
Used paints with hobby
GENETIC/MEDICAL CONDITIONS
Autism
Past electric shock (2 persons)
Past trauma to the head (3 persons)
Runs in the family / genetic (3 persons)
Seizures / medication
Past multiple x-rays
Possibly born with brain cancer (2 persons)

One respondent wondered why we did not inquire about brain cancer type on the survey. The CDRI has information on brain cancer type already.

Summary, Conclusions, and Plans

This study was undertaken in response to concerns about increased rates of brain cancer in a six-county area in Idaho. Analysis had revealed that 182 cases of brain cancer were reported in the six-county area from 1975 to 1994, in contrast to 152 cases expected during the same time period based on the rate in the remainder of Idaho. Following is a brief summary of the findings, conclusions, and our future plans.

The majority of respondents indicated they were white, and non-Hispanic.

Age of those diagnosed with brain cancer ranged from 2 - 86.

Sixteen percent of respondents had another relative with brain cancer, and 48% of respondents had a relative with some type of cancer other than brain or skin cancer.

Home pesticide use varied widely among respondents, from daily to never, but some persons also reported exposure to crop dusting chemicals which is difficult to quantify. Job chemical exposure was reported by 36% of respondents. When specific chemicals were named, the type of chemical varied greatly among respondents. Sixteen percent of respondents reported some type of radiation exposure at work, and one person may have been exposed to frequent medical radiation prior to brain cancer diagnosis.

Exposure to fumes, vapors or dusts at work were reported by 34% of respondents, but the types of specific exposures reported varied widely.

Military experience was reported by 27% of adults, but the type and location of military experience was not the same among most respondents.

Among children, age of diagnosis varied greatly. Residence and school attendance included 4 of the 6 counties; no children were living in Butte or Clark Counties at diagnosis. Two of the children were very young at diagnosis, suggesting that they may have been born with brain cancer.

Hobbies involving possible exposure to chemicals were reported by 25% of respondents; the most common hobby reported was painting.

Upon reviewing the results, we found that a wide variety of life experiences, occupations, and exposures were represented. No common factors were identified that clearly linked the cases, and individuals expressed varying concerns about possible exposures or causes for brain cancer.

The survey was designed by members of the Cluster Analysis Work Group at the Idaho Department of Health and Welfare and the Cancer Data Registry of Idaho (CDRI) to gather more information about possible exposures among persons with brain cancer in the area with elevated rates. The survey was not designed to investigate causes of individual cases of brain cancer, or to compare exposures and behaviors among residents of the area with brain cancer to residents of the area without brain cancer.

The results of this survey will be shared with other members of the public health community with particular expertise in brain cancer investigations. We anticipate guidance from them on whether further investigation is likely to be helpful in determining a possible cause for the elevated rates of brain cancer in the area. Further, the CDRI will continue to collect information on the numbers and types of brain cancer throughout the state and the survey area, and the data will continue to be analyzed for trends.

This report will be made available to persons interested in brain cancer, including educators, researchers, scientists, and the media, after those involved in the survey have had the opportunity to review and comment on it. Questions and comments are welcomed and should be addressed to:

Christine Hahn, MD
State Epidemiologist
Idaho Department of Health and Welfare
450 W. State St.
Boise, Idaho 83720-0036
Ph 208-334-5939