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WATER GREMLIN PUBLIC HEALTH ASSESSMENT Usefulness and Limitations of Community Cancer Rates in Addressing Environmental Cancer Concerns The MCRS is a vital tool for examining cancer rates and trends in Minnesota and MCRS data are extremely useful in facilitating epidemioiogic studies of specific cancers, quality of care studies,. evaluating screening and prevention programs, and many other purposes. While community cancer rates have a high degree. of statistical uncertainty and must be. interpreted cautiously, such data are also very useful in. addressing public concerns over cancer rates.in a county or a community by providing a more Complete and accurate profile of cancer occurrence. However, for many reasons, analyses of community cancer rates are rarely useful, in documenting potential cancer risks from low levels of environmental pollutants. Cancer is not a single disease. but a group of more than 100 different diseases. Cancers differ in their rates of occurrence, risk factors; treatment, and survivorship. Unfortunately, cancer is not.a rare disease, especially when considered in. terms of Iifetime'risk. Not including the most. common forms. of skin cancer, the average lifetime risk of developing some type of cancer (in situ or malignant). is approximately 44% among males and 41%.among females (National Cancer Institute. The Cancer Ciuery System). _ On average then, almost one in two people will have a diagnosis of cancer. during their lifetimes. For any individual, of course, the lifetime risk will be dependent on many personal factors such as smoking history, obesity, alcohol use, family history, and other risk factors. The time period for the development of cancer (latency period) is typically several decades, such that many cancers diagnosed today are due to exposures. and lifestyle experiences that began or occurred many years ago. Unfortunately, it is often.not possible to know when and to what extent newly identified contarnants would have created the potential for exposure in a community. Furthermore, due to the high. mobility of our population, rnany residents in a community may not reside there for more. than five years prior to their diagnosis of cancer. Thus, community cancer rates are frequently comprised of individuals who differ in their residential histories in the community, their personal risk factors for cancer, as well as in their potential exposures to environmental contaminants. While we have no control over risk factors. such as age, race, family history,. and .genetics, much of our cancer risk is strongly influenced by lifestyle factors that we can control. 5uch lifestyle risk factors include cigarette smoking, obesity, alcohol consumption, ionizing and solar radiation, certain infectious agents (e.g., .hepatitis viruses), occupation, and physical inactivity (Figure 3). Those factors account about 60% of cancer deaths in the U.S.. Other lifestyle factors that increase risk include reproductive patterns, sexual behavior; and medications. However, even when no modifiable risk factors are known that can reduce the risk of developing a cancer, screening and early diagnosis.may prevent or reduce the risk of death. Sl