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Epidemiology and Cancer Control |
Department of Human Genetics, University of California Los Angeles School of Medicine, Los Angeles, CA 90095-7088 (Z.F.); Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215 (M.K.); Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, CT 06030-6325 (D.I.G.); USA
2 Address correspondence to Martin Kulldorff, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA (Martin_Kulldorff{at}hms.harvard.edu).
Abstract
The Atlas of Cancer Mortality in the United States, 1950-94 (Devesa et al.) published in 1999 by the National Institutes of Health suggests that there are elevated rates of brain and other nervous system cancer in the northwestern, north central, and southeastern parts of the country. Being descriptive in nature, the atlas does not evaluate whether observed patterns are simply due to random variation or if they are reflective of true geographical differences in disease risk or treatment practices. To formally test for geographical clustering of disease, we analyzed U.S. brain cancer mortality data from 1986 to 1995 with Tango's Excess Events test, the Cuzick-Edwards k-Nearest-Neighbors test, and the spatial scan statistic. All tests revealed statistically significant geographical clustering for both adult men and women. The spatial scan statistic indicated that the most likely cluster of high mortality was in parts of Arkansas, Mississippi, and Oklahoma (relative risk [RR] = 1.22, P < 0.0001) for women and in parts of Tennessee and Kentucky (RR = 1.15, P < 0.0001) for men. Several secondary clusters were detected, but there were no statistically significant clusters of a very localized nature and a high RR. For childhood brain cancer, there were no statistically significant geographical clusters. It is reassuring that no local brain cancer mortality "hot spots" with very high RRs were found. While the causes of the large geographical clusters with modest RRs are unclear, the geographical pattern of brain cancer mortality provides valuable information that can help in formulating etiological hypotheses and in targeting high-risk populations for further epidemiological and health services research.
References
Besag, J., and Newell, J. (1991) The detection of clusters in rare diseases. J. R. Stat. Soc. Ser. A 154,143 -155.[CrossRef]
Bondy, M., Wiencke, J., Wrensch, M., and Kyritsis, A.P. (1994) Genetics of primary brain tumors: A review. J. Neurooncol. 18,69 -81.[CrossRef][Medline]
Breslow, N.E., and Day, N.E., Eds. (1987) Statistical Methods in Cancer Research, Volume II. The Design and Analysis of Cohort Studies (IARC Scientific Publication No. 82). Lyon, France: International Agency for Research on Cancer.
Brownson, R.C., Reif, J.S., Chang, J.C., and Davis, J.R.
(1990) An analysis of occupational risks for brain cancer.
Am. J. Public Health 80,169
-172.
Cuzick, J., and Edwards, R. (1990) Spatial clustering for inhomogeneous populations [with discussion]. J. R. Stat. Soc. Ser. B 52,73 -104.
Devesa, S.S., Grauman, D.J., Blot, W.J., Pennello, G.A., Hoover, R.N., and Fraumeni, J.F., Jr. (1999) Atlas of Cancer Mortality in the United States, 1950-94 (NIH Publication No. 99-4564). Bethesda, Md.: National Institutes of Health, National Cancer Institute.
Gittelsohn, A., and Senning, J. (1979) Studies on the
reliability of vital and health records: I. Comparison of cause of death and
hospital record diagnoses. Am. J. Public Health
69,680
-689.
Harrington, J.M., McBride, D.I., Sorahan, T., Paddle, G.M., and van Tongeren, M. (1997) Occupational exposure to magnetic fields in relation to mortality from brain cancer among electricity generation and transmission workers. Occup. Environ. Med. 54, 7-13.[Abstract]
HHS. U.S. Department of Health and Human Services (1980) The International Classification of Diseases, 9th revision, Clinical Modification: ICD-9-CM. Washington, D.C.: Government Printing Office
Hjalmars, U., Kulldorff, M., Wahlqvist, Y., and Lannering, B. (1999) Increased incidence rates but no space-time clustering of childhood astrocytoma in Sweden, 1973-1992: A population-based study of pediatric brain tumors. Cancer 85,2077 -2090.[ISI][Medline]
Inskip, P.D., Linet, M.S., and Heineman, E.F. (1995)
Etiology of brain tumors in adults. Epidemiol. Rev.
17,382
-414.
Jukich, P.J., McCarthy, B.J., Surawicz, T.S., Freels, S., and Davis, F.G. (2001) Trends in incidence of primary brain tumors in the United States, 1985-1994. Neuro-oncol. 3, 141-151.[Abstract]
Kuijten, R.R., and Bunin, G.R. (1993) Risk factors for childhood brain cancers. Cancer Epidemiol. Biomarker Prev. 2,277 -288.[ISI][Medline]
Kulldorff, M. (1997) A spatial scan statistic. Commun. Stat. Theory Methods 26,1481 -1496.[CrossRef]
Kulldorff, M., and Nagarwalla, N. (1995) Spatial disease clusters: Detection and inference. Stat. Med. 14,799 -810.[ISI][Medline]
Kulldorff, M., Rand, K., Gherman, G., Williams, G., and DeFrancesco, D. (1998) SaTScan v 2.1: Software for the spatial and space-time scan statistics. Bethesda, Md.: National Cancer Institute.
Kulldorff, M., Tango, T., and Park, P.J. (2003) Power comparisons for disease clustering tests. Comput. Stat. Data Anal. 42,665 -684.[CrossRef]
Kurtzke, J.F., and Stazio, A. (1967) Geographic distribution of brain cancer. Trans. Am. Neurol. Assoc. 92,253 -254.[Medline]
Kurtzke, J.F. (1969) Geographic pathology of brain tumors. 1. Distribution of deaths from primary tumors. Acta Neurol. Scand. 45,540 -555.[ISI][Medline]
Last, J.M., Ed. (2001) A Dictionary of Epidemiology, 4th ed. Oxford, England: Oxford University Press.
Lawson, A.B., and Kulldorff, M. (1999) A review of cluster detection methods. In Lawson, A.B., Biggeri, A., Böhning, D., Lesaffre, E., Viel, J.-F., and Bertollini, R., Eds. Disease Mapping and Risk Assessment for Public Health. New York: John Wiley & Sons, pp. 99-110.
Legler, J.M., Gloeckler Ries, L.A., Smith, M.A., Warren, J.L.,
Heineman, E.F., Kaplan, R.S., and Linet, M.S. (1999) Brain and
other central nervous system cancers: Recent trends in incidence and
mortality. J. Natl. Cancer Inst.
91,1382
-1390.
Marsh, G.M., Enterline, P.E., and McGraw, D. (1991) Mortality patterns among petroleum refinery and chemical plan works. Am. J. Ind. Med. 19,29 -42.[ISI][Medline]
Musicco, M., Sant, M., Molinari, S., Filippini, G., Gatta, G., and
Berrino, F. (1988) A case-control study of brain gliomas and
occupational exposure to chemical carcinogens: The risk to farmers.
Am. J. Epidemiol. 128,778
-785.
Preston-Martin, S., Pogoda, J.M., Mueller, B.A., Holly, E.A., Lijinsky, W., and Davis, R.L. (1996) Maternal consumption of cured meats and vitamins in relation to pediatric brain tumors. Cancer Epidemiol. Biomarker Prev. 5, 599-605.[Abstract]
Ries, L.A.G., Kosary, C.L., Hankey, B.F., Miller, B.A., Clegg, L.X., and Edwards, B.K., Eds. (1999). SEER Cancer Statistics Review, 1973-1996 (NIH Publication No. 99-2789). Bethesda, Md.: National Cancer Institute.
Ron, E., Modan, B., Boice, J.D., Jr., Alfandary, E., Stovall, M., Chetrit, A., and Katz, I. (1988) Tumors of the brain and nervous system after radiotherapy in childhood. N. Engl. J. Med. 319,1033 -1039.[Abstract]
Surawicz, T.S., McCarthy, B.J., Kupelian, V., Jukich, P.J., Bruner, J.M., and Davis, F.G. (1999) Descriptive epidemiology of primary brain and CNS tumors: Results from the Central Brain Tumor Registry of the United States, 1990-1994. Neuro-oncol. 1, 14-25.[Abstract]
Tango, T. (1995) A class of tests for detecting `general' and `focused' clustering of rare diseases. Stat. Med. 14,2323 -2334.[ISI][Medline]
Thomas, T.L., and Inskip, P.D. (1996) Brain and other nervous system. In Cancer Rates and Risks, 4th Ed. Bethesda, Md.: National Institutes of Health, National Cancer Institute, pp.114 -119.
U.S. Bureau of the Census. (1996) Statistical Abstract of the United States. Washington, D.C.: Government Printing Office.
Wilkins, J.R., 3rd, and Koutras, R.A. (1988) Paternal occupation and brain cancer in offspring—A mortality-based case-control study. Am J. Ind. Med. 14,299 -318.[ISI][Medline]
Wilkins, J.R., 3rd, and Sinks, T.H. (1990) Parental
occupation and intracranial neoplasms of childhood: Results of a case-control
interview study. Am J. Epidemiol.
132,275
-292.
WHO. World Health Organization (1975)International Classification of Diseases, Ninth Revision (ICD-9) . Geneva: World Health Organization.
Wu, J.K., and Naber, S.P. (1994) Molecular biology of brain tumors. Neurosurg. Clin. North Am. 5, 127-133.[Medline]
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