This past Thursday evening, the New York State Department of Health (NYSDOH) held a virtual public webinar to provide information regarding the investigation of cancer incidence in the Northport-East Northport district and answer questions from community members. Meeting attendees were able to submit questions via email, many of which were then answered by Aura Weinstein, the Director of the Cancer Surveillance Program at the NYSDOH, and her colleagues at the Centers for Environmental Health.
“We do investigations in cancer incidence in communities throughout New York State and we were called on to look into cancer occurrence in the Northport-East Northport School District,” Ms. Weinstein explained before providing a summary of the study background, objective and findings.
The source of the data for the study was the New York State Cancer Registry. “All healthcare providers are required by law to report any cases of cancer that come under their care to the state department, and these reports go into the New York State Cancer Registry,” Ms. Weinstein said. The statistical analysis was based on a comparison of observed vs. expected number of cancer cases.
There were several questions from residents during the webinar, all of which can be rewatched here. Some of the questions and answers are transcribed below:
Q. Why did the data for the study stop in 2018?
A. At the time we did the analysis, data was official only through 2018. Data for 2019 are complete and official, they were just made official this past April; the analysis had been completed by then. But we did look at data from later years, for 2019 and 2020, and we didn’t see anything unusual among the children or young adults. No further cases among older teenagers and people under 24. There were a few cancers in children under 15. In the investigation, we started with a 20-year time frame and I didn’t think the addition of another year would have made a difference and we wanted to release the investigation to the public.
Q. Is it common for increases in cancer populations like Northport in other areas on Long Island?
A. We spent a lot of time looking at cancers in different areas and populations, and when you look at an entire area like a school district or a county, it’s not uncommon to find elevations in certain kinds of cancers and also deficits of certain types of cancers. We’ve done this for a long time and we were taking an average over the comparison areas, an average over all of New York State, outside of New York City. So generally, with an average, expect to see some places where cancer is high and some where cancer is low.
Q. There were seven cases of leukemia and lymphoma, but less than two cases were expected. Observed cases were more than three times higher than expected. You’ve recognized that this is statistically significant, but you say there is no cause for alarm and no follow up is needed. Is there some threshold beyond statistical significance that would trigger great alarm?
A. We did look at statistical significance, it’s important, but we looked a little further than statistical significance. We looked at the characteristics of the young people diagnosed with leukemia, we looked at the type of leukemia they had, we looked at where they went to middle school, we looked at some things among their medical history…we looked at other types of blood cancers. They lived in different areas of the school district and it was statistically significant, but still it was a very small number and we didn’t think that any further investigation would be useful.
Q. Is there going to be any follow-up?
A. We do not plan to conduct any follow-up at this time. We don’t have a basis for any hypothesis that we would need to follow if we were going to do a follow-up. There wasn’t enough information to show to do a follow-up that would provide useful information.
Q. Exposure to benzene and petrochemicals are known causes of blood cancers. These chemicals were found at Northport Middle School. What are the chances that three years of exposure to students at NMS could have contributed or caused the 2016 graduates’ illnesses?
A. I just want to point out that not all 2016 graduates attended Northport Middle School…The exposures to benzene and petrochemicals when the K wing was investigated in 2017 initially, the levels of volatile organic chemicals that were measured were generally at levels that are similar to what it often found in background, but there were some that were higher than we’d like to see. Our goal is always to minimize exposures, so actions were taken to do that. We often say when we release reports like this that we can’t rule out environmental exposures having contributed to the cancers that were observed and so I would say that again here. However, we didn’t see an overall increase in leukemia in higher ages. The analysis saw it in the 2016 graduates as a group, but we didn’t see it as an overall pattern. And again, not all young people in the graduating class had gone to the Northport Middle School, but of course, that doesn’t mean exposures couldn’t have affected some of the people who ended up getting leukemia. So I can’t say a definite “no” to exposures being important, but the exposures we saw were not at a level where we’d expect to see a measurable increase in cancer. The other issue is latency and one of the frustrations with these cancer studies is that we don’t know what people were exposed to many years prior, from birth onwards. And in this case, we don’t know how long those chemicals may have been an issue in that storage room. So we don’t have a way to answer the question as it’s asked.
Q. Based on the fact that there’s an elevated cancer rate in the area, do they plan on checking things like water, air, etc.?
A. What we found doesn’t point to any one particular contaminant or more material that might be related, so at this point we really don’t have any place to start with any hypothesis to pursue in that way. It’s more what we know about the cancers that we’ve already confirmed and what causes them. And unfortunately, a lot of the causes of cancers are still unknown. We know some causes of leukemia, but we certainly haven’t identified every cause and I think at this point it’s just not a useful thing to do, to go looking into everything.
Q. Is it accurate to say that our community has an elevated cancer rate above other Long Island communities?
A. It was our finding that the total numbers of cancers in the whole school district were above expected, that is the conclusion, that there is a higher cancer rate. But it’s only by 3%, which is not a large amount…slightly elevated I’d characterize it as…We compared [the cancer rate] with all of New York State, outside of New York City. I’m not really sure where Long Island falls compared to other counties or regions in New York State regarding cancer. Usually there will be higher rates of one type of cancer and lower rates of another type of cancer.
Q. Can it be explained why the cancer cases in Northport Middle School are significantly higher than expected and why East Northport Middle School would not be affected equally?
A. I think we are talking about the Northport Middle School district…in the whole district, we saw a 7% higher rate than what would be expected. It can be attributed to a number of different types of cancer. In Northport Middle School [district], there were high numbers of cases of Melanoma of the skin and prostate cancer – that probably accounted for a good portion of the excess and then you look at the risk factors for those. For prostate cancer, I did look a little more closely at cases of prostate cancers in the Northport Middle School area and looked at what we call the stage distribution, that is the percentage of the cancers that were diagnosed at different stages, early or late stage. We did see a higher percentage of prostate cancers that were diagnosed at an early stage in the Northport Middle School area compared to the comparison population and also the East Northport Middle School area. So that’s telling me there may be a higher level of prostate screening among men in the Northport Middle School area. The risk factors of melanoma of the skin are related to skin tone and sun exposure. I think it’s more useful to look at the individual types of cancers and these things do vary from place to place, [depending on] how much screening is going on or how many people are at higher risk.
The full webinar can be viewed here. Questions and requests regarding the study can be sent to the New York State Department of Health at firstname.lastname@example.org. The NYSDOH report can be viewed here. More information on the NYS Cancer Registry and Cancer Statistics can be viewed here.