1941-44 were obtained from the State Registrar, Oregon State Board of Health, Portland. Washington .... (4) Hill, A. B.: Principles of medical statistics. Ed. 7.
A
Reappraisal
Oregon Malignancy Pattern and Radioisotope Storage JOHN C. BAILAR III, M.D., and JOHN L.
AN INCREASED mortality rate for cancer, leukemia particularly, among near the south bank of the residents Oregon Columbia River or along the Pacific Coast was reported recently by Fadeley (1). This would be an important observation if it were con¬ firmed, because there is an increase in the radio¬ active content of water which flows through or past the Hanford (Washington) Atomic Stor¬ age Preserve before it is carried downstream past the areas which Fadeley reported to have high mortality rates. Because of the following features of his report, however, we have re-examined the question. 1. Several inland counties were omitted with¬ out explanation in the analysis. 2. Basic data (numbers of deaths) were not reported, and random variations of rates cal¬ culated on the small numbers of deaths occur¬ ring in single counties were not considered. 3. Although the age and sex structure of the population varies from one county to another, the rates were neither age adjusted nor sex
_r\_ including
adjusted.
4. The fact that throughout the United States and in many other countries cancer mortality rates are higher in cities than in rural areas (2,3) was not mentioned. The river and Pacific counties generally are more densely populated than the inland counties, and, on this basis, they might be expected to have higher rates. 5. No study was made of cancer mortality data from earlier years to determine if the re-
The authors are with the Biometry Branch, National Cancer Institute, Public Health Service. Vol. 81, No. 4,
April 1966
YOUNG, Jr., M.P.H.
ported excess risk was present before the Han¬ ford Atomic Energy Facility started operation. 6. No study was made of cancer mortality rates along the north bank of the Columbia River, which is in the State of Washington. Method of Analysis Total cancer mortality rates and leukemia mortality rates for groups of counties in Ore¬ gon and Washington from 1934 through 1963 were adjusted by the indirect method (4>~6) f°r differences between counties in the age and sex composition of the population (table 1 and fig. 1). The 1950 observed mortality rates for all forms of cancer and for leukemia in the U.S.
white population (7) were taken as standard. For the years prior to 1949, the rates include a small adjustment for differences in cause-ofdeath assignments in the fourth, fifth, and sixth revisions of the International Classification of Diseases (5, 9). Because the 1960 nonwhite populations were rather small in Oregon (2.1 percent) and Wash¬ ington (3.6 percent), no adjustment was made for race. The numbers of deaths on which the rates in table 1 are based are shown in table 2. Table 3 lists the counties included in each area, and figure 2 shows the boundaries of the counties and county groups. Counties in the Metropolitan Portland area were considered separately from the other river counties because of the different cancer risk between urban and rural areas in general (2,3). The age-sex-adjusted mortality rates for all forms of cancer and the numbers of deaths upon which these rates were based for Oregon 311
and Washington are shown by county in tables 4 and 5. We did not include a similar tabula¬ tion of leukemia mortality in this report be¬ cause the numbers of deaths in most counties were quite small. Results
Several trends are clear from figure 1. First,
mortality rates in Oregon and have been consistently lower than Washington the average rate for the U.S. white population. In contrast, leukemia mortality rates in both States have been above average for as long as data by county are available (1940 in Oregon and 1934 in Washington). Although the rates total
cancer
Table 1.
in both States have increased rapidly in recent years, the increase has been about the same as in the rest of the United States. Interestingly,
the excess in leukemia mortality existed before the Hanford Preserve began operation in 1945. Second, total cancer mortality rates in the Portland region of Oregon have remained es¬ sentially unchanged since 1935. Mortality in the river counties has increased up to the State average, but remains substantially below that for the entire United States, and mortality in the ocean counties has actually declined. In Washington total cancer mortality in the river counties has been consistently lower than in other parts of the State. Mortality rates for
Mortality rates * per 100,000 population for all forms of cancer and for leukemia in the United States, Oregon, and Washington, in various time periods Area
1934-37
1938-42
1943-47
1948-52
All forms of
1953-57
1958-63
cancer
Total United States 2
144.9 130.5 131.4 123.8 138. 1 122.6 139.3 125.0 127.2 128. 1 142.0
Oregon_ River counties_
Ocean counties_ Portland countiesInland countiesWashingtonRiver countiesOcean counties_ Portland counties_ Inland counties_
3
141. 9
132.5 133.7 121.8 142.4 123.8 138.5 128.9 133.7 137.5 139.7
Leukemia Total United States 2
6.8
Oregon_ River counties_
7.4 7.3 8. 1 7.5 7.0
Washingtoncounties-
6.9 6. 1 4.8 6.7 7.2
Ocean countiesPortland counties_ Inland counties_ River
Ocean countiesPortland counties_ Inland counties-
in
3
7.0 7.6
7.9 6.2 8.3 7.3 7.4 6. 1 7. 1 7.4 7.6
1 Rates age and sex by the indirect method, taking U.S. 1950 observed rates for males and females adjusted for as standard. age groups 10-year 2 Rates for white population only. 3 Rates for 1958-62. * Rates for 1935 only. 8 Rates for 1939-42. 8 Leukemia deaths by county not available for these years. 7 Rates for 1940-42. 8 Rates based on leukemia deaths in 1935 and 1937 only. Leukemia deaths not available by county for 1934
and 1936.
312
Public Health
Reports
mortality rates per 100,000 population for all forms of leukemia, United States, Oregon, and Washington, 1935.60
1. Annual
Figure
ALL FORMS OF CANCER
200 r- OREGON
cancer
and for
WASHINGTON
}50\.%_.
. -_.___¦
.. .
*»-_«v^^
^
100 LEUKEMIA a o a
o o
o" o v
6
5h>
4h
3h
-L 1935
± 1940
1945
Note : Available leukemia
Vol.
81, No. 4, April 1966
1950
1955
1960
1935
1940
1945
Year
1950
1955
1960
mortality data for 1935-40 are shown in tables 1 and 2.
313
the ocean counties have also been generally low. Trends in mortality rates for leukemia are somewhat less clear-cut than trends for total cancer because of the small numbers of deaths in some areas. In Oregon leukemia mortality increased at about the national average in the Portland area, slightly faster in river counties, and even faster in the inland counties. Kates for the ocean counties have fluctuated widely,
but in the most recent period (1958-63) they were the lowest in the State. In Washington leukemia mortality rates in the river counties increased rapidly before 1950, but they have actually decreased since that time while rates in other parts of the State and in the total United States were rising. Leukemia mortality rates in the ocean counties also have increased rapidly since 1934, but the increase
Table 2. Numbers x of deaths from all forms of cancer and from leukemia in the United States, Oregon, and Washington, in various time periods Area
1934-37
1938-42
1943-47
1948-52
All forms of Total United States2
Oregon_ River counties-
Ocean counties_ Portland counties_ Inland counties_
Washington_ River counties_
Ocean counties_ Portland counties_ Inland counties-
527, 601 1,4 229
100 173 606 350
733, 045 8 5,5 845
8,644
521 754 2, 786 1, 784 12, 127
7,270
1,080 345 10, 109
4 4 4
415 755 204
6
6 8
593
824, 849 8,659 682 1,119 4,298 2,560 13, 690 648 1,221 434 11,387
1953-57
1958-63
1, 102, 279 11, 641 992 1,746 5,495 3,408 19, 130 1,068 1,448 590 16, 024
1, 200, 361 15, 832 1,314 2,368 7,528 4,622 25, 352 1,501 1,970 857 21, 024
cancer
969, 037 10, 229 878 1,456 4,994 2,901 16, 462 843 1,421 541 13, 657
Leukemia Total United States 2
Oregon_ River counties_
Ocean counties_ Portland counties_ Inland counties_
Washington_ counties_
River Ocean counties_ Portland counties_ Inland counties_
13, 796
22, 985
30, 246
41, 476
51, 036
58, 260
96 10 91 9 81
14 32 8 311
354 30 44 199 81 573 31 39 25 478
M84 38 79 234 132 745 59 50 32 604
648 54 121 280 193 941 56
873 74 127 408
98
170 16 30 84 40 365
(6) (6) (6) (6) (6)9 9
7
7 7 7 7
52 31 802
264
1,342 75 99 45
1,123
1 Numbers which were reported. Before the rates were calculated for table 1, comparability ratios were to adjust for differences in cause-of-death assignments between the 4th, 5th, and 6th revisions of the applied International Classification of Diseases. 2 White population only. 8 Data for 1958-62. 4 Data for 1935 only. 8 Data for 1939-42. 6 Data not available by county. 7
Data for 1940-42. Total includes one with county of residence unknown. Data for 1935 and 1937 only. Leukemia deaths not available by county for 1934 and 1936. Sources: Oregon leukemia deaths by county for 1940-57 and deaths due to all forms of cancer by county for 1941-44 were obtained from the State Registrar, Oregon State Board of Health, Portland. Washington leukemia deaths by county for 1935 and 1937-57 and deaths due to all forms of cancer for 1934, 1936-38, and 1941-44 were obtained from the State Registrar, Washington State Board of Health, Olympia. The remainder of the data were obtained from annual volumes of Vital Statistics of the United States. 8
9
314
Public Health
Reports
has been no greater than that of the State as a whole. No significant trends were observed in individual counties in either Washington or Oregon. Summary
Because of recent concern over possible contamination of the Columbia River by radioactive products from the Hanford (Washington)
Figure 2. Counties in Oregon and Washing ton, by geographic category
Hanford works Columbia Riv-r
WSIGO
Table 3. Counties in Oregon and Washington, by geographic category Area
Total
Area
counties
Total counties
Portland OREGON
Oregon -36 River -8 Clatsop Columbia Gilliam Hood River Morrow Sherman Umatilla Wasco Ocean -6 Coos Curry Douglas Lane Lincoln Tillamook
Metropolitan PortlandClackamas Multnomah Washington Inland Baker Baker
Benton Crook Deschutes Grant
Harney
Jackson Jefferson Josephine Klamath Lake Linn Malheur Marion Polk
Pnolk Wallowa
Union
Wheeler Yamhill
3
19
Washington_ River-
39 7
Benton Cowlitz
oPortland ERiver IlMOcean
Franklin
Klickitat Skamania Wahkiakum Walla Walla OceanClallam Grays Harbor Island Jefferson Pacific San Juan
7
Whatcom
Metropolitan PortlandClark I'nland Adams
Asotin ~~~~Chelan Columbia Douglas Ferry
Garfield Grant
King Kitsap
Kittitas Lewis Lincoln Mason Okanogan Pend Oreille Pierce Skagit
SSnohomish Spokane Stevens Thurston Whitman Yakima
Vol. 81, No. 4, April 1966
1 24
EjInlond
Atomic Storage Preserve, an independent study was undertaken to determine cancer trends in Washington and Oregon from 1934 to 1963. For the analysis, the counties within the two States were divided into four categories: river, ocean, Metropolitan Portland, and inland. Results of the study revealed that in both States mortality rates for all forms of cancer combined have been consistently below the mortality rate for the U.S. white population. Both States have had a consistent excess in leukemia mortality, but the excess was present before the Hanford Preserve began operation. No important mortality trends were observed in individual counties in either State. No evidence was found that persons living downstream from the Hanford Preserve or along the Pacific coast of Oregon have had an excess risk of death from cancer in general or from leukemia in particular. REFERENCES
(1) FPadeley, R. C.: Oregon malignancy pattern physiographically related to Hanford Washington radioisotope storage. J Environ Health 27: 883-897, May-June 1965. (2) Levin, M. L., et al.: Cancer incidence in urban and rural areas of New York State. J Nat Cancer Inst 24: 1243-1257, June 1960.
315
(8) Haenszel, W., Marcus, S. C., and Zimmerer, E. G.: Cancer morbidity in urban and rural Iowa. PHS Publication No. 462 (Public Health Monograph No. 37). U.S. Government Printing Office, Washington, D.C., 1956. (4) Hill, A. B.: Principles of medical statistics. Ed. 7. Oxford University Press, London, 1961. (5) Linder, F., and Grove, R. D.: Vital statistics rates
in the United States, 1900-1940. U.S. Government Printing Office, Washington, D.C., 1947. (6) Spiegelman, M.: Introduction to demography. The Society of Actuaries, Chicago, 1955. (7) Gordon, T., Crittenden, M., and Haenszel, W.: Cancer mortality trends in the United Statem. Nat Cancer Inst Monogr 6. U.S. Government Printing Office, Washington, D.C., 1961.
Table 4. Mortality rates per 100,000 population and numbers of deaths for all forms of cancer by county, in various time periods, Oregon Numbers
Rates
County 1935 1939- 1943- 1948- 1953- 195863 57 52 47 42
1935
193942
194347
194852
195357
195863
130. 5 Clatsop119. 8 Columbia Gilliam -80. 3 Hood River- 102.6 Morrow -124.3 85.6 Sherman100. 0 Umatila101.2 WascoOcean: Coos -130. 8
132.9 112. 3 89. 1 112. 5 113. 8 77.9 128. 1 143.7
116. 6 101. 0 113. 1 99. 8 133. 1 64.8 116. 9 123.6
137.8 129. 1 118.1 86. 8 149. 0 125.3 127. 5 129.3
154. 0 117.5 102. 1 129.7 122.8 127.8 127. 6 126.5
141. 3 142.8 144.6 139.2 119. 4 121.3 126. 3
126.7
26 20 2 9 5 2 24 12
125 88 10 48 20 8 143
163 110 16 58 31 8 199 97
225 156 17 55 37 15 258 115
269 150 15 92 32 16 291
127
315 230 26 131 39 19 384 170
139. 6 81. 0 97.8 122.2 112.5 143.2
119. 5 87.2 110.9 111. 6 112.6 129.8
133. 8 136.6 117.8 123. 5 103.7 111. 0
147. 5 92.4 125.8 120.2 112.0 120. 5
121. 9 87.1 119.2 124.4 121.0 131. 8
32 5 31 79 12 14
162 14 117 328 66
200 24 209 485 108 93
256 46 270 665 124 95
325 43 334 776 155 113
364 62 431 1,122 228 161
108. 5 144. 1 122. 3
121. 3 149. 7 106. 6
122. 4 146. 2 121. 5
120. 5 143. 1 123. 4
131. 8 147. 8 117. 4
465 557 642 274 67 493 2, 302 3, 549 4, 047 4, 367 486 390 284 46 210
965 5, 906 657
127.4 121. 9 105. 6 121.0 125. 4 73. 8 127.8 121. 1 104. 5 118. 8 97.1 132. 0 85. 6 131. 5 122. 1 114. 5
128.5 107.6 144. 0 129.6 91. 7 121. 6 120.3 44. 2 104. 3 126.3 91. 3 117. 5 103. 7 122. 4 122.0 127.9 104.3 126.7
120.6 95. 2 88.3 117.4 134.2 105. 6 119.8 105. 3 127. 9 113. 0 112. 7 123.4 115. 7 116. 6 111.8 135. 5 118. 7 147. 5
125.4 104. 0 149.1 111.8 112. 7 124. 6 133.0 95. 6 113. 4 116. 9 131. 1 122. 1 124.2 119. 3 110.8 136.6 115. 2 150. 8 143. 5
107.5 115. 6 109.6 122.6 125. 8 128. 1 120.4 115. 8 138. 7 132.4 141. 3 119. 7 131. 8 126. 9 113.3 115. 6 135.1 122. 0 124. 8
River:
Curry -143.3
Douglas -121.8 Lane -142.9 Lincoln -106.7 Tillamook- 143. 0 Portland: Clackamas Multnomah -
Washington
127. 4 147. 1 128. 1
Inland: Baker -131.3 Benton -125. 2 Crook -115. 9 Deschutes - 108.9 Grant -167. 5 Harney-46. 3 101. 8 Jackson59. 1 Jefferson156. 7 Josephine 98. 3 KlamathLake -46.3 Linn -127. 1 94.4 MalheurMarion -113. 8 Polk -101.6 Union -112. 6 Wallowa -97. 3 Wheeler -89. 7 110. 3 Yamhill -
132.2 100. 1 118. 0
141. 1
132. 8
21 20 4 13 9 2 36 1 25 21 2 36 10 79 17
17 6 2 29
79
67
94 92 18 72 30 14 211 9 84 125 20
173 47 432 95 78 37
10 143
119 118 38 110 30 31 313 6 128 185 25 236 84 593 134 120 37 16 237
113 120 28 113 48 29 379 19 187 184 33 296 109 656 138 140 43 19 247
126 150 56 128 43 37 501 21 192 219 42 330 132 780 152 148 44 19 288
138 225 57 195 61 49 630 36 320
336
59 431 187 1, 131 205 157 65 18 322
SOURCES: Oregon deaths due to all forms of cancer for the years 1941-44 by county were obtained from the State Registrar, Oregon State Board of Health, Portland. The remainder of the data were obtained from respective volumes of Vital Statistics of the United States.
316
Public Health Reports
(8) Dunn, H. L., and Shackley, W.: Comparison of cause of death assignments by the 1929 and 1938 revisions of the international list: deaths in the United States, 1940. Vital StatisticsSpecial Reports 19, June 1944, p. 14.
(9) Faust, M. M., and Dolman, A. B.: Comparability ratios based on mortality statistics for the fifth and sixth revisions. United States, 1950. Vital Statistics-Special Reports 51, February 1964, p. 3.
Table 5. Mortality rates per 100,000 population and numbers of deaths for all forms of cancer by county, in various time periods, Washington Numbers
Rates
County 193437
193842
194347
194852
195357
1958- 1934- 1938- 1943- 1948- 1953- 195863 52 57 47 42 37 63
79.2 137.0 106. 4 99.9 114. 2 93.3 150.2
110. 0 119. 3 101. 5 106. 3 101. 8 118. 8 140.5
63.7 109.2 128.9 95.1 85. 2 94. 5 129.3
101. 7 127.7 142. 5 123. 0 102. 4 60. 4 108. 0
113. 4 129.3 141. 6 134. 1 100.7 91. 1 128.2
126.4 140.0 125. 5 127.9 97. 1 163. 9 120. 4
34 131 21 36 15 12 166
67 175 30 56 21 21 223
67 197 51 54 20 19 240
153 274 71 75 27 13 230
208 326 96 89 28 20 301
328 486 129 110 34 44 370
Ocean: 139.9 Clallam133. 0 Grays HarborIsland-131.3 136.7 Jefferson117.3 Pacific118.5 San Juan 118.3 WhatcomPortland: Clark-- 123. 9
121. 1 141.3 112.8 112.3 109.7 104. 6 125.9
108. 4 138.5 97. 4 129.5 136.8 95. 2 131. 7
118.7
150.7 161. 3 114. 6 122.2 113. 9 133.5
104 9 139.1 117.2 159. 6 146.3 120.2 119. 4
134 6 151.9 124.1 110.9 107. 7 111. 0 131. 6
89 229 37 17 281
112 346 48 47 84 21 422
118 375 49 60 117 20 482
149 448 94 58 116 25 531
152 444 83 86 146 29 508
265 621 124 76 135 35 714
139. 4
134. 1
134. 9
128. 1
137. 5
204
345
434
541
590
857
108. 5 111. 4 115. 8 100.1 119. 4 126.9 125. 5 126. 4 104. 4 83.8 105. 9 160.2 77.3 117. 0 89.8 82.4 114. 6 121. 7 72. 0 105. 5 138.3 86. 6 110. 9 65. 0 164.1 146. 5 142.3 145. 6 143.9 137.8 Kitsap154. 0 117. 9 127.7 Kittitas144 9 144. 6 125. 4 Lewis - 133. 0 129.7 135. 6 Lincoln -150.7 154. 8 128.4 MasonOkanogan - - 123.8 104. 9 117.7 130. 2 127.3 107. 7 Pend Oreille 146. 1 142. 6 134.8 Pierce - 118. 3 140. 1 126.4 Skagit - Snohomish -- 142. 5 128. 0 127.6 Spokane -- 151. 6 137.3 125.3 93. 7 143.4 128.1 Stevens-Thurston -- 114. 8 126. 2 134. 0 Whitman -- 170. 2 136. 7 122. 0 Yakima -- 136. 8 131. 2 120. 5
85. 7 114. 1 123.4 159. 6 94. 0 119. 5 131. 3 103.4 149.8 146. 0 124.9 129.9 100. 3 97. 1 117.0 104. 9 130. 9 109. 6 134. 0 131. 3 136. 5 133. 5 118.3 124. 8
125. 3 114.3
96. 5 121. 9 133.4 104. 2 103. 9 108.6
23 32 125 34 21 12 9 24
31 53 188 25 46 25 18 52
35 73 179
28
47
49 129 376 41 83 25 35 177 8,833 714 196 489 102 151 226 57 2,807 418 1,457 2,506 158 533 227 1, 235
River: ---BentonCowlitz-_ Franklin Klickitat------SkamaniaWahkiakumWalla Walla
Inland: Adams -Asotin- Chelan -Columbia -Douglas - Ferry- Garfield d GrantKing
41 61
81 240 49 45
91
267 124.2 38 32 119. 6 53 39 92.6 27 25 26 134 5 24 25 25 124.9 150.7 122 40 79 111. 1 103. 0 153. 6 148.7 2,926 3,967 4,677 5,809 6,784 511 548 392 135. 2 129. 4 208 317 136 141 130 107 94 117. 2 137.4 144. 4 140.3 210 305 295 338 398 62 75 80 73 56 116. 2 126. 5 72 132 81 81 52 156. 5 133.3 151 149 127 82 105 111.4 131.3 41 68 40 32 45 167. 0 112. 4 966 1,397 1, 564 1,760 2,096 140. 4 142.8 328 293 303 298 171 112. 9 111. 3 850 1,038 708 610 455 138. 2 140. 0 955 1,271 1,368 1, 655 1,960 138.2 132.6 130 144 96 127 101 120. 9 120. 5 372 318 282 231 141 137.3 146. 5 195 171 167 177 161 131. 0 123. 6 944 628 771 380 560 136. 0 133. 8
SOURCES: Washington deaths due to all forms of cancer for the years 1934, 1936-38, and 1941-44 by county were obtained from the State Registrar, Washington State Board of Health, Olympia. The remainder of the data were obtained from respective volumes of Vital Statistics of the United States.
Vol. 81, No. 4, April 1966
317
