PUBLIC HEALTH DIVISION

John A. Kitzhaber, MD, Governor

Public Health Division Investigation of West Salem Osteosarcoma Cluster

Thursday, March 13, 2014

In the fall of 2012, the news media reported on a possible cluster of childhood osteosarcoma cases that had occurred in the West Salem area over the preceding five-year period. These are the steps that Oregon Health Authoritys Public Health Division (PHD) has taken to investigate these cases. The PHDs Oregon State Cancer Registry (OSCaR) reviewed community reports and assessed cases that had been reported to the registry. The initial analyses, which focused on the entire populations of Marion and Polk Counties, did not identify an increased rate. Based on additional information from the community, OSCaR refined its earlier analysis of osteosarcoma cases in the area. These analyses focused specifically on geographic areas of concern that were identified by the community, and included the four contiguous census tracts that form the main catchment area for West Salem High School. OSCaR performed statistical analyses comparing rates of osteosarcoma during 2008-2012 for persons <25 years of age in the selected census tracts in the West Salem area to the expected rate in that area during the same time (reported as a Standardized Incidence Ratio or SIR). The SIR for the area of interest was found to be elevated at 14.29 (95% confidence interval 3.84, 36.57); however, because this is based only on a small number of cases, the precision of this estimate was found to be low (as reflected by the wide 95% C.I.). These results indicate that the rate of cases of osteosarcoma for the specified age group in the area of interest during 2008-2012 was higher than would be expected, based on the state rate (see attached report for details). In addition, OSCaR reviewed the literature to identify known causes of childhood osteosarcoma. While the exact causes of osteosarcoma are not known, incidence increases in teens (when bone growth is most intense), in children with other underlying bone diseases, and in those who have had radiation for other types of cancer. Currently, there are no known environmental contaminants associated with osteosarcoma. Community members concerns and a petition prompted the Region 10 Environmental Protection Agency to initiate an environmental assessment of the West Salem area in April 2013 to identify any potential environmental issues that might increase cancer risks and require environmental cleanup.

PHD Communications; 800 NE Oregon St. Suite 930, Portland, OR 97232; 971-246-9139; www.healthoregon.org

The EPA Preliminary Assessment report indicates that concentrations of contaminants identified in samples taken from sites in the West Salem area were well below levels considered unhealthy under Orego Oregon n Department of Environmental Quality standards. An outside investigator, Chris Neurath, Research Director for the American Health Studies Project (http://www.americanhealthstudies.org/aboutus http://www.americanhealthstudies.org/aboutus.html) ) contacted families of the affected children and offered to assess the situation. Using a specific set of assumptions, he concluded that the area in which these families live is experiencing a forty forty-fold fold increase in osteosarcoma rates compared to the he rest of Oregon. This analysis is based on different assumptions and is higher than the OHA calculations (which showed a fourteen fourteen-fold fold increase). However, both analyses concluded that the rates of osteosarcoma for the ages, years, and area of interest were higher than expected. Chris Neurath and Dr. Scott Burns (a geology professor from PSU) have proposed an ecologic study to examine osteosarcoma cases throughout the state of Oregon and their relationship to radon levels. This study has been approved by t the he OSCaR advisory committee and by the Public Health Division IRB to move forward. The Public Heath Division contacted an outside expert, Dr. Donald Austin, Professor at OHSU, to ask his advice as to next steps for communication with families and legislators, legisla particularly around the state of the science related to cancer clusters, and our ability (or inability) to find causes for these apparent clusters. Dr. Austin delineated that there are two distinct responses to cancer clusters: 1) a health hazard i investigation nvestigation to identify any possible carcinogenic contaminants in the environment; and 2) an in in-depth depth study to determine the causes of a particular type of cancer. Dr. Austin agrees with the State Health Officer and Public Health director that the PHD, in n conjunction with EPA, has completed the health hazard evaluation and exhausted all the investigative public health tools at their disposal. An in-depth in study into the causes of osteosarcoma would likely involve a multi multi-state state study with cases included from f around the country. Such a study is beyond the scope of the PHD and OSCaR. The PHD and OSCaR will continue, as always, to monitor cases of osteosarcoma in the West Salem area to determine any changes in rates, and address issues, should they arise. arise