INVESTIGATION OF MULTIPLE MYELOMA IN THE AREA OF WAPPINGERS FALLS, ZIP CODE 12590, DUTCHESS COUNTY, NEW YORK

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1 INVESTIGATION OF MULTIPLE MYELOMA IN THE AREA OF WAPPINGERS FALLS, ZIP CODE 12590, DUTCHESS COUNTY, NEW YORK Prepared by the Cancer Surveillance Program Bureau of Chronic Disease Epidemiology and Surveillance New York State Department of Health with the assistance of the New York State Cancer Registry and the Bureau of Environmental Exposure Investigation For further information contact: Aura L. Weinstein, M.P.H. Director, Cancer Surveillance Program 10/10

2 INVESTIGATION OF MULTIPLE MYELOMA IN THE AREA OF WAPPINGERS FALLS, ZIP CODE 12590, DUTCHESS COUNTY, NEW YORK Background The Cancer Surveillance Program of the New York State Department of Health, Bureau of Chronic Disease Epidemiology and Surveillance, responds to concerns about cancer in communities throughout New York State. In September 2007, a nurse who worked at a physician=s office in Wappingers Falls contacted the Cancer Surveillance Program and reported what they believed to be an unusual number of cases of multiple myeloma diagnosed in adult patients they had treated. These patients all lived in the same small neighborhood and were diagnosed between 2003 and The Cancer Surveillance Program reviewed the information provided by the nurse and attempted to confirm the reported diagnoses through available information sources. One of these sources was the New York State Cancer Registry, which contains information on all cases of cancer diagnosed or treated in New York State, as required by law. Medical records were also obtained to further confirm the precise diagnoses for all the patients reported by the nurse. This review showed that not all of the patients reported by the nurse were actually diagnosed with multiple myeloma (exact numbers are not provided in order to protect patient confidentiality). The actual number of patients who were confirmed was relatively small, so that the occurrence of the cancers close together in space and time could easily have been the result of chance. However, given the size of the neighborhood and the time period over which the cancers were diagnosed, the number of confirmed cases still appeared unusual. It was therefore decided to conduct a study to learn more about the occurrence of multiple myeloma in the Wappingers Falls area. Follow-up activities included 1) a search of Cancer Registry files for additional cases of multiple myeloma and other blood cancers among residents of the Wappingers Falls area to evaluate whether the confirmed cases of multiple myeloma were part of any larger patterns; 2) a review of the medical records for all of the patients who had been reported by the nurse; and 3) a review of available environmental information to identify any potential for unusual environmental exposures in the area. This report presents the results of these follow-up activities. Search for unusual patterns Methods The source of information on blood cancers among residents of the Wappingers Falls area was the New York State Cancer Registry. As noted in the background section, the Cancer Registry contains information on all cases of cancer diagnosed or treated in New York State, as

3 mandated by law. One person can be hospitalized many times, at different hospitals, over a period of years for the same cancer. Each separate hospital admission is reportable to the Cancer Registry. As multiple reports on the same cancer are received, they are combined with existing information to continuously update Cancer Registry files to reflect the fullest and most accurate information available. At the time this follow-up began, cancer incidence data were considered official through 2007, with information on cancer cases updated through March Variation in cancer incidence among different geographic areas reflects not only true differences in cancer occurrence, but also differences in how cancer is diagnosed, treated, and recorded in different areas of the state. The completeness and accuracy of the Cancer Registry depend upon reporting from hospitals, laboratories, managed care organizations and other sources. The Cancer Registry has been certified as more than 95% complete by the North American Association of Central Cancer Registries. In addition, the Cancer Registry has received gold certification from the Association for the past seven years, the highest certification given to central cancer registries (1). Multiple myeloma, leukemia and lymphoma are all cancers of the blood or blood-forming system. While their patterns of spread within the body are different, multiple myeloma, lymphomas, and the lymphocytic types of leukemia involve the same class of white blood cell (2). Since it is plausible that these diseases may have similar causes, all three classes of blood cancers were examined as a first step to determine whether the confirmed cases of multiple myeloma might be part of a larger pattern. To identify additional blood cancers diagnosed among residents of the Wappingers Falls area, we looked at ZIP Code (Wappingers Falls) including point ZIP Codes (Castle Point), (Chelsea) and (Hughsonville), all located in Dutchess County (see map). ZIP Code was chosen because it is a larger area that contains the neighborhood of concern. Point ZIP Codes have residential post office boxes but no associated delivery area. They were included in the study because a person with a point ZIP Code likely lives somewhere in the area. Cancer Registry records were searched for people living in these ZIP Codes who were diagnosed with multiple myeloma, leukemia or lymphoma since Findings A total of 180 blood cancers were identified among residents of the ZIP Code and point ZIP Codes during the 13-year study period for which data were official, The 180 blood cancers diagnosed in the 13 years of the study translates to an average of 13.8 diagnoses per year. Table 1 shows that numbers of blood cancers diagnosed in any one year during the time period of the study ranged from seven to 20. The total numbers of blood cancers diagnosed showed no apparent trends, but varied from year to year for most of the time period of the study. There were also somewhat more cases in the second half of the time period, which is consistent with an aging population. 2

4 Multiple myeloma, leukemia and lymphoma cases diagnosed in 2008 were not included in the analysis because data for that year were not yet official. However the data that were available for 2008 were examined and the numbers and characteristics of these blood cancers were found to be consistent with data from previous years. For multiple myeloma, as of March 2010, there were no additional cases diagnosed in 2008 in the neighborhood of concern. In the study area during the time period of the study, blood cancers accounted for approximately 8.6% of all diagnosed cancers (a total of 2,117 cancer diagnoses). In New York State, exclusive of New York City, blood cancers accounted for approximately 8.8% of all diagnosed cancers during the same time period (a total of 785,774 cancer diagnoses). This indicates that there does not appear to be an unusual number of blood cancers in the study area. The number of cancers that would be expected in the study area was calculated by applying cancer incidence rates by age and sex for a reference area to the estimated population of the study area by age and sex. The reference area selected for this investigation was New York State, exclusive of New York City. The population of the study area for was estimated using data from Claritas, a commercial vendor that provides demographic estimates and projections based on United States Census data and geography. For this investigation, a total of 180 blood cancers were observed and a total of 193 blood cancers were expected, a difference that is not statistically significant. This indicates that there does not appear to be an unusual number of blood cancers in the study area. Specific types of blood cancers diagnosed in the ZIP Codes between 1995 and 2007 included 25 multiple myelomas, 51 leukemias, and 104 lymphomas (see Table 2). Multiple Myeloma There were 25 cases of multiple myeloma identified in the study area with 25 cases expected. Multiple myeloma is most commonly found in adults 65 years of age or older (3). In this study, about 60 percent of the cases were age 65 or older at the time of their diagnosis and there were no cases younger than 35 years of age. The age at diagnosis ranged from early forties to early nineties with an average age of 69 years. Sixty percent of the cases were diagnosed in males. Over 90% of the cases were white. The number of cases of multiple myeloma diagnosed during the time period of the study for any one year ranged from zero to five, with an average of 1.9 per year. The number of cases diagnosed was fairly stable over the time period. The street address at the time of diagnosis for each individual diagnosed with multiple myeloma was plotted on a map of the study area. Except for the neighborhood of concern, which is located in a portion of ZIP Code that is in the Town of Poughkeepsie, the addresses generally followed the distribution of the population, with several cases in the more 3

5 densely populated areas within the Town of Wappinger and other addresses widely scattered in the more rural areas. There were no cases of multiple myeloma identified in the neighborhood of concern other than those reported by the nurse. Leukemias There were 51 leukemias identified in the study area and 61 cases were expected. The number of cases of leukemia diagnosed ranged from zero to 11 per year with an average of 3.9 cases per year. The number of cases diagnosed was stable except for an almost doubling of cases, from six to eleven, between 2004 and After 2005, the number of people diagnosed with leukemia decreased to fewer than six per year, which is what was observed annually between 1995 and The 51 diagnoses of leukemia were separated into the following most common types and then examined; acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML) and chronic myeloid leukemia (CML). ALL is the most common type of leukemia in children. It also affects adults, especially those age 65 and older. CLL most commonly affects adults over the age of 55 and rarely occurs in children. AML occurs in both adults and children and is sometimes called acute non-lymphocytic leukemia. CML occurs mainly in adults, but a small number of children also get this form of leukemia. There were 11 diagnoses of ALL. Individuals diagnosed with ALL ranged in age from early childhood to late adulthood with a majority of the cases being male. The number of cases diagnosed in any given year ranged from zero to three, with an average of 0.8 per year. There were 10 diagnoses of CLL occurring in people who were in their early fifties and older, with a majority in their early sixties and older. The average age at diagnosis was 69 years. Slightly more females than males were diagnosed with CLL. The number of cases diagnosed annually ranged from zero to four with an average of 0.8 per year. AML was diagnosed in 17 people ranging in age from early childhood to the elderly. A majority of the cases were older than 40 years of age. The average age at diagnosis was 61 years. Slightly more females than males were diagnosed with this particular type of leukemia. The number of cases diagnosed annually ranged from zero to four with an average of 1.3 per year. CML was identified in six people, ranging in age from young adults to the elderly. The average age at diagnosis was 53 years which is younger than what is usually seen (average age is usually around 66 years); the number of cases, however, was small. The number of cases diagnosed was either zero or one in any given year with an average of 0.5 per year. Seven people were identified as having other specified or unspecified types of leukemia. The ages ranged from the middle-aged to the elderly. The average age at diagnosis was 67 years. Lymphomas There were 104 lymphomas identified in the study area, with 105 cases expected. The number of lymphomas diagnosed annually in the study area ranged from four to 12 with an 4

6 average of 8.0 cases per year. The number of cases diagnosed was fairly stable during the time period of the study. Lymphomas include Hodgkin lymphoma (formerly referred to as Hodgkin=s disease), and various other types known collectively as the non-hodgkin lymphomas. As is usually observed, lymphomas were the most frequently identified class of blood cancer in people of all ages in the study area. Of these, 23 were cases of Hodgkin lymphoma and 81 were non-hodgkin lymphoma. Residents of the study area diagnosed with Hodgkin lymphoma ranged in age from the teens to the elderly, although, as is typically seen, the majority were young adults. The average age at diagnosis was 39 years. Slightly more females than males were diagnosed with this cancer. The number of cases diagnosed in any one year during the time period ranged from zero to three with an average of 1.8 per year. There were 81 cases of non-hodgkin lymphoma diagnosed. These occurred among people ranging from young children to the elderly, with a majority over the age of 60. The average age at diagnosis was 64 years. Typically 50% of people diagnosed with non-hodgkin lymphoma are age 65 and older. More females than males were diagnosed with this cancer. The number of cases diagnosed in any one year ranged from two to nine with an average of 6.2 per year. Additional Blood Cancers - Other and Unspecified There were an additional six blood cancers, consisting of three different types of blood cancers, diagnosed in the study area that did not fall under any of the specific categories above. When the characteristics of these cancers were examined more closely, nothing unusual was found. The average age at diagnosis for these cancers was in the mid-60s. They were excluded from the results of the study. Medical records Medical records were requested and received for all of the patients who were reported by the nurse to have been diagnosed with multiple myeloma. As was previously mentioned, not all of the patients reported were actually diagnosed with multiple myeloma. Of those that were confirmed, very little information was available regarding their histories. Some information sought from the medical records included information on exposure to radiation, family history of multiple myeloma, working in a petroleum-related industry, being overweight or obese, or having other plasma cell diseases. These are all risk factors that may increase one=s chance of being diagnosed with multiple myeloma (3). None of the medical records reviewed mentioned whether any of the patients had any exposure to radiation. Only one of the medical records stated that there was no family history of multiple myeloma. One medical record mentioned a family history of other cancers (liver, breast and non-hodgkin lymphoma). None of the medical records listed a current or previous 5

7 occupation. One patient was stated to be obese, another may have been overweight but no height was given to make that determination. There was also no mention of any of the patients having other plasma cell diseases. Given the limited information available from the medical records on these patients, it is not possible to determine whether any individual characteristics may have played a role in the diagnoses. Environmental review Methods Staff from the New York State Department of Health, Bureau of Environmental Exposure Investigation, examined several readily available environmental databases to identify any potential sources of unusual environmental exposures to people in the neighborhood of concern, which is located in ZIP Code in the Town of Poughkeepsie. These included databases on inactive hazardous waste sites, Toxics Release Inventory (TRI) facilities and other facilities that could be sources of environmental exposures (environmental facilities). Areas served by public water supplies were also examined. Findings Three Star Anodizing was the only inactive hazardous waste site identified in the area of the neighborhood of concern. It is located within the Market Street Industrial Park in the Village of Wappingers Falls on the south bank of Wappingers Creek. The site had been used for textile dyeing operations, as a manufactured gas plant, as a metal plating facility and for some other smaller industrial activities. Upon review of the remedial investigation report (4) and its environmental sampling results, no evidence was found to suggest ongoing exposures to the general public. Public access to building remnants and former plating vats is prevented by fencing. The former manufactured gas plant property is wooded and heavily overgrown, which limits the potential for exposure to surface soil. No one uses groundwater at the site for any purpose (i.e., drinking, cooking, bathing). Therefore, the potential for exposure to any siterelated contaminants is low. Two facilities were identified that are required to report chemical releases to the TRI. They are the Hess Corporation Roseton Terminal and Roseton Generating Station, both located across the Hudson River and southwest from the study area in Newburgh, Orange County. The Hess Terminal is a petroleum receiving and storage facility and the Roseton Generating Station has both coal and oil storage facilities. Chemical emissions to air from both TRI facilities could impact the study area, but there is no evidence of unusual environmental exposures that are specific to the neighborhood of concern. In addition to the facilities that store/use petroleum products, there are petroleum storage facilities, gasoline stations, dry-cleaners and asphalt plants in the area. People may be exposed to fuel-related chemicals from motor vehicles, boats and gas stations. Exposure to these chemicals could occur via inhalation of the chemicals in the general outdoor air or while pumping gasoline. However, there is no reason to believe that people's exposure to motor 6

8 vehicle-related fuels is any different in this area as compared to other populated areas of Dutchess County or New York State. Also, we are not aware of any leaking fuel storage tanks that could be a possible source of chemical transport into homes in the area of concern via soil vapor intrusion. The neighborhood of concern has been on public water since being developed. Review of the results of public water supply testing did not show any detection of any bacteriologic or chemical contamination at levels above health standards for any of the public water supplies in the area (5). Discussion Multiple Myeloma Multiple myeloma is a cancer of the plasma cells. Plasma cells are a type of white blood cell and are part of the immune system. They are found in the bone marrow, the soft tissue found inside some hollow bones. The plasma cells can become cancerous and produce a tumor called a plasmacytoma which usually develops in a bone but can also be found in other tissue. Multiple myeloma is diagnosed when many plasma cell tumors are found throughout the bones. Multiple myeloma is a relatively uncommon cancer, accounting for about 1.2% of all diagnosed cancers in New York State, exclusive of New York City, during the time period of the study. In the study area, multiple myeloma accounted for about 1.2% of all diagnosed cancers during the same time period. It is most often seen in adults age 65 and older. Less than one percent of cases are seen in people less than 35 years of age. In the study area, about 60 percent of the cases were age 65 or older and there were no cases younger than 35 years of age. Men are slightly more likely than women to be diagnosed with this disease. African- Americans are almost twice as likely as white Americans to be diagnosed with multiple myeloma (3). As was mentioned previously, there are a few other risk factors that may increase one=s chance of developing multiple myeloma: exposure to radiation (accounting for a very small number of cases), family history of multiple myeloma, working in a petroleum-related industry, being overweight or obese, or having other plasma cell diseases (monoclonal gammopathy of undetermined significance [MGUS] or solitary plasmacytoma) (3). Leukemia Leukemias are cancers of the cells in the bone marrow that give rise to the various types of blood cells. The leukemias can be classified according to the course of the disease (acute or chronic), and the type of blood cell affected (lymphocytic or non-lymphocytic). Acute lymphocytic leukemia (ALL) is the most common type of leukemia in children, but also affects adults, particularly the elderly. Acute non-lymphocytic leukemia, also called acute myeloid leukemia (AML), occurs in both adults and children. Chronic lymphocytic leukemia (CLL) most 7

9 commonly affects adults over age 55 and rarely occurs in children. Chronic myeloid leukemia (CML) occurs mainly in adults, but has been known to affect children. Although it is often thought of as a disease of children, most cases of leukemia occur in older adults. Leukemia accounted for approximately 2.8% of all diagnosed cancers in New York State, exclusive of New York City during the time period of the study. In the study area, leukemia accounted for about 2.4% of all diagnosed cancers during the same time period. There was a total of 51 leukemia diagnoses in the study area. The ages of the cases ranged from young children to the elderly. Of the four types of leukemia that were examined separately, only CML had an average age that was younger that what would normally be seen. There were, however, only six cases of this type of leukemia. More people diagnosed with CML in the study area would be needed to be able to conclude that this result truly reflects an unusual finding. Other than the younger than average age of those diagnosed with CML, there was nothing unusual when the leukemias were examined separately. At this time, scientists do not know what causes most cases of leukemia. Different types of leukemia have been found to have different, but overlapping, sets of risk factors. Since it has not always been possible to look at different types of leukemias separately, much of what is known about leukemia risk factors comes from studies where all the leukemias are looked at as a group. In addition, not all risk factors identified for adults are applicable to children, and certain risk factors identified for children do not hold for adults. Most types of leukemia have been associated with exposure to high doses of ionizing radiation, such as atomic bombs or radiation treatments for other forms of cancer. People with Down syndrome and certain other genetic abnormalities are known to develop leukemia more frequently. Certain unusual forms of leukemia are caused by a rare virus. Long-term exposures to certain chemicals found in the workplace, such as benzene, have also been linked to leukemia, and people treated with certain anti-cancer drugs are known to be at higher risk. Recent research suggests that leukemia, especially the myeloid types, is associated with cigarette smoking (6, 7). Lymphomas Lymphoma is the name for cancers that develop in the lymphatic system, a part of the body=s immune system. The lymphatic system helps the body fight infection and diseases. It is made up of thin tubes, similar to blood vessels, that branch into tissue throughout the body. These tubes carry a watery, colorless fluid, called lymph, which contains infectionsfighting cells. These cells are called lymphocytes. Along the network of tubes are small, oval-shaped organs called lymph nodes. Groups of lymph nodes are found in the armpits, neck, chest, abdomen and groin. Other parts of the lymphatic system are the thymus, spleen, tonsils and bone marrow. Lymphatic tissue is also found in the stomach, skin and intestines and other body parts. Lymphomas are often divided into two groups: Hodgkin lymphoma and non-hodgkin lymphoma. Non-Hodgkin lymphoma occurs more frequently than Hodgkin lymphoma. 8

10 The lymphomas accounted for approximately 4.7% of all diagnosed cancers in New York State, exclusive of New York City during the time period of the study. In the study area, the lymphomas accounted for about 4.9% of all diagnosed cancers during the same time period. Non-Hodgkin lymphoma occurs more frequently in men than in women. It also occurs more frequently in whites than in African-Americans. Although children can get non-hodgkin lymphoma, the risk of getting lymphoma increases with age. Approximately 70% of people diagnosed with lymphoma are age 50 and older. Almost 50% are age 65 and older. Hodgkin lymphoma occurs slightly more often in males than in females. It can occur in both children and adults and is most common in early adulthood (ages 15 to 40) and in late adulthood (after age 55). It is rare before the age of five. Approximately 10%-15% of cases are diagnosed in children and teens. There was nothing unusual found when the cases of the lymphomas were examined in the study area. The ages at diagnoses were what would be expected and there were no years of significant increase in the number of cases diagnosed. At this time, scientists do not know exactly what causes non-hodgkin or Hodgkin lymphoma. People with depressed immune systems, such as those who have had organ transplants and individuals with HIV/AIDS, have an increased risk of getting non-hodgkin lymphoma. Research studies among farmers and other occupations also suggest that exposure to herbicides, pesticides and certain other chemicals may be associated with the development of non-hodgkin lymphoma (8, 9). Risk factors associated with Hodgkin lymphoma include having had infectious mononucleosis, age (ages and after age 55), a family history of Hodgkin lymphoma and having a higher socioeconomic status (10, 11). Study findings This study identified a total of 180 blood cancers among residents of the study area during the 13-year study period. Of those blood cancers, 25 were identified as multiple myeloma, 51 were leukemias, and 104 were lymphomas. All of the blood cancers were examined further both as a whole and by specific blood cancer. When all of the blood cancers were examined, no unusual patterns were found. The total number of blood cancers that was diagnosed was not statistically different than the number of blood cancer diagnoses expected. The numbers of cases diagnosed in any one year fluctuated with no particular year or years standing out as having significantly more cases than another. There was a slight increase in the number of cases diagnosed over time which is consistent with the aging of the population. Cancer cases diagnosed in 2008, where data were not yet official, were also examined and were found to be consistent with data from previous years. As of March 2010, there were no additional cases of multiple myeloma diagnosed in the neighborhood of concern in Following initiation of this study, the nurse from the physician=s office called to report another case of multiple myeloma, but after review it was found that the patient actually lived more than five miles away from the neighborhood of concern, in another ZIP Code. 9

11 The blood cancers were examined individually by looking at the number of cases diagnosed in each year, the age at which the diagnosis was made, and the gender. For multiple myeloma only, the street addresses at the time of diagnosis were plotted on a map of the study area and examined for any unusual patterns. There was nothing unusual found when examining the characteristics of the cases of multiple myeloma in the study area as a whole. A majority of the cases were found in adults age 65 and older, which is when multiple myeloma is most frequently found. Most of the cases were male. The average number of cases diagnosed in any one year was 1.9. The numbers of cases diagnosed in any one year fluctuated from year to year but there was no obvious pattern. Other than the apparently unusual number of cases originally confirmed in the neighborhood of concern, there was no unusual geographic pattern found when street addresses at the time of diagnosis were plotted on a map, and there were no additional cases in the neighborhood of concern other than the ones that were originally confirmed. Multiple myeloma accounted for about 1.2% of all diagnosed cancers in the study area, similar to the percentage in New York State, exclusive of New York City, during the time period of the study. The number of cases diagnosed was the same as the number of cases that was expected. For the remaining blood cancers, an increase in the number of leukemia cases was found in 2005 which was primarily accounted for by CLL and AML. For both cancers, the number of cases decreased to average levels the following year. The average age at diagnosis was 53 years for the cases of CML, which is younger than what would usually be seen but there were only six cases. There was nothing else unusual that was found when examining the leukemia and lymphoma cases. Environmental considerations For any substance to have an effect on human health, people have to come into contact with it. This is what is known as exposure. People may be exposed to a chemical substance by breathing it in (inhalation), consuming it in food or water (ingestion), or getting it on their skin (dermal exposure). Even with exposure, not all substances cause cancer. The risk of developing cancer upon exposure to a cancer-causing substance depends on how exposure occurs, the amount of the substance people are exposed to, the length of time they are exposed to it, and how often they are exposed to it. To assess the potential for exposure to known chemical contaminants, the following available environmental databases were examined: hazardous waste sites, Toxics Release Inventory, environmental facilities and public water supply. There was no evidence that the one inactive hazardous waste site in the area of the neighborhood of concern would result in any exposures to any part of the study area. There was also no evidence of unusual environmental exposures that are specific to the neighborhood of concern from the two facilities in or near the ZIP Code that were required to report chemical releases to the Toxics Release Inventory, or from other environmental facilities. The neighborhood of concern has been on public water 10

12 since being developed with no detection of any contamination at levels above health standards. Interpretation The present investigation was conducted to follow up on an apparently unusual number of confirmed cases of multiple myeloma in a small neighborhood in ZIP Code When the ZIP Code was looked at as a whole, the study did not confirm any unusual patterns of multiple myeloma, or any other blood cancer, in the Wappingers Falls area at any time during the 13- year study period. There were also no additional cases of multiple myeloma (other than the cases reported by the physician s office) identified in the neighborhood of concern. Given the limited information available from the medical records on the patients with multiple myeloma who were reported by the physician=s office, it is not possible to determine whether any individual characteristics may have played a role in the diagnoses of these patients. The area does not stand out as unusual in terms of possible environmental exposures. The information available does not suggest any single cause or combination of causes that might account for the multiple myelomas. Although this apparently unusual occurrence may be related to factors it has not been possible to identify, it is also possible that it occurred by chance. 11

13 Table 1. Blood cancer 1 diagnoses by year, ZIP Code (Wappingers Falls) and Point ZIP Codes (Castle Point), (Chelsea), (Hughsonville), Dutchess County, New York, Year Number of diagnoses Total Includes multiple myeloma, leukemias, and lymphomas 2 Source of data: New York State Cancer Registry 12

14 Table 2. Blood cancer 1 diagnoses by type and sub-type, ZIP Code (Wappingers Falls) and point ZIP Codes (Castle Point), (Chelsea), (Hughsonville), Dutchess County, New York, Number of diagnoses Percent of All Cancers (Study Area) Percent of All Cancers (NYS exc. NYC) Multiple myeloma % 1.2% Leukemias % 2.8% Acute myeloid leukemia (AML) 17 Chronic lymphocytic leukemia (CLL) 10 Chronic myeloid leukemia (CML) 6 Acute lymphocytic leukemia (ALL) 11 Other and unspecified leukemias 7 Lymphomas % 4.7% Hodgkin lymphoma 23 Non-Hodgkin lymphomas 81 TOTAL BLOOD CANCERS % 8.8% 1 Includes multiple myeloma, leukemias, and lymphomas 2 Source of data: New York State Cancer Registry 13

15 References 1. Wu XC, McLaughlin CC, Lake A et al., (eds). Cancer in North America, , Springfield, IL: North American Association of Central Cancer Registries, Inc. May 2007 (Appendix D). 2. Fritz A, Percy C, Jack A, et al., (eds.) International Classification of Diseases for Oncology Third Edition U.S. Interim Version Geneva: World Health Organization, American Cancer Society, Multiple Myeloma, from website accessed May O Brien and Gere, Three Star Anodizing Site, Wappingers Falls, New York. Remedial Investigation NYSDEC Site , Final Report. Prepared for the New York State Department of Environmental Conservation, Dutchess County Department of Health, personal communication. 6. Linet MS, Devesa S, Morgan GJ, The leukemias, in Schottenfeld D, and Fraumeni JF Jr. (eds.), Cancer Epidemiology and Prevention, 3 rd Ed., New York: Oxford University Press; Sandler DP and Ross JA, Epidemiology of acute leukemia in children and adults, Seminars in Oncology 24(1):3-16, Hartge P, Wang SS, Bracci PM et al., Non-Hodgkin lymphoma, in Schottenfeld D, and Fraumeni JF Jr. (eds.), Cancer Epidemiology and Prevention, 3 rd Ed., New York: Oxford University Press; American Cancer Society, Non-Hodgkin lymphoma, from website accessed July Mueller NE and Grufferman S, Hodgkin lymphoma, in Schottenfeld D, and Fraumeni JF Jr. (eds.), Cancer Epidemiology and Prevention, 3 rd Ed., New York: Oxford University Press; American Cancer Society, Hodgkin disease, from website accessed July

16 ZIP CODE WAPPINGERS FALLS STUDY AREA WAPPINGERS FALLS, DUTCHESS COUNTY LaGrange Town Poughkeepsie Town ZIP CODE Sheafe Rd Channingville Rd Myers Corners Rd Wappinger Town East Fishkill Town US Highway Old Hopewell Rd Route 9D Fishkill Town Legend ZIP Code Boundaries Town Boundaries 0 1 Miles 2 ( Point ZIP Codes