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SPONSOR: |
Regensberg |
DATE TYPED: |
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HB |
717 |
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SHORT TITLE: |
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SB |
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ANALYST: |
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APPROPRIATION
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Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
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FY03 |
FY04 |
FY03 |
FY04 |
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$1,000.0 |
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Non-Recurring |
General
Fund |
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(Parenthesis
( ) Indicate Expenditure Decreases)
Responses
Received From
Department
of Health (DOH)
Health
Policy Commission (HPC)
Synopsis
of Bill
House Bill 717 appropriates $1,000,000
from the general fund to the Department of Health to fund a study of the
frequency and locations of occurrence of cancer cases in
Significant
Issues
HB
717 aims to study “cancer clusters.” In general, the term “cancer cluster”
implies that a greater number of cancer cases have occurred in a specific
geographic region or in a specific time period than what would be expected.
Typically, the public perception is that the cancers are caused by some common
exposure, such as an environmental contaminant, and this is the rationale for
studying them.
Cancer
cluster reports present great challenges to public health departments
nationwide. In the vast majority of cases, the cancer “clusters” do not turn
out to be clusters at all. A survey of
41 state health departments in 1996 showed that, of the 1,900 cancer cluster inquiries
logged, less than 10% showed a true excess of cancer. Of that small percentage,
only a handful led to discoveries of preventable causes of cancer.
Response to cancer cluster concerns
requires collaboration with state and local agencies. Within state health
departments, both environmental epidemiology and comprehensive cancer programs
need to be involved. Expertise on
occupational exposures and disease is often required. Population-based cancer
registries are also an essential tool to address cancer cluster concerns. .
FISCAL IMPLICATIONS
The appropriation of
$1,000.0 contained in this bill is a non-recurring expense to the general fund.
Any unexpended or unencumbered balance remaining at the end of FY 04 shall
revert to the general fund.
At this stage, an appropriation may be premature. DOH
suggests that an investigation should begin by determining whether reported
cancer clusters are in fact clusters. This could be accomplished for a fraction
of the amount requested in the bill, perhaps on the order of $10.0 to $20.0.
Depending on the results of such an initial investigation, a major study of
possible causes, and ways to ameliorate or prevent them, might be
warranted.
ADMINISTRATIVE IMPLICATIONS
The
approval/establishment of 1.0 FTE would be necessary to provide oversight if HB
717 is passed, and if epidemiological assessment determines such a study is
warranted.
OTHER SUBSTANTIVE ISSUES
The Office of Epidemiology, of the New
Mexico Department of Health and the New Mexico Tumor Registry (NMTR) at the
University of New Mexico Health Sciences Center formed
a Cancer Incidence Review Group five years ago to pool resources and coordinate
activities when responding to cluster inquiries. The group reviewed materials
and recommendations from other health departments and the Centers for Disease
Control and Prevention, and developed cluster response materials and protocols.
The
group meets as needed to review cancer inquiries. The group leaders are the Deputy and
Assistant Deputy State Epidemiologist, and the Chronic Disease Medical
Epidemiologist. The NMTR provides
expertise acquired over 25 years of tracking and studying cancer in
The
group works closely with community health leaders to identify concerns and
gather initial information. It
communicates progress and findings to the community,
and can call on other agencies as needed. It aims to be responsive to
communities’ concerns, allaying fears and taking the opportunity to educate on
the best practices for identifying and preventing cancer.
DOH
states that an initial investigation would identify the specific types of
cancers that have occurred. In some cases, a “cluster” turns out to include
cancers of several different types, known to have different causes. An initial
investigation would also examine the numbers and the patterns of occurrence of
the cancer, in relation to what might be expected by chance alone. Only then
could it be determined whether there is actually a cluster, and thus a need to
follow up with a major study. Even if no cluster can be identified, follow-up
with the community would be essential to educate community members and explain
the results.
Scientific investigations of cancer
clusters may take years to complete, and the findings are often inconclusive.
These investigations occasionally identify important public health problems,
but unless the disease is extremely rare, highly unusual in a particular group,
or previously unknown, determining a clear cause and effect is very rare.
Nevertheless, the perception that there
is a cancer cluster can have a devastating impact on individuals, families, and
communities. From a public health perspective, this perception may be as
important as, or more important than, an actual cluster. Public concern increases
quickly when people think there is a cancer cluster in their community and that
they and/or their children will be harmed. These situations deserve prompt and
effective public health attention.
Regardless of outcome, the investigation process can provide
opportunities for public education for cancer risks and prevention. It is also
a chance to build community support for public health efforts.
According
to DOH, the one-year timeframe specified by HB717 would be too short to develop
and complete a major, in-depth study such as HB717 would call for. However, one
year would most likely be adequate for a more modest, initial investigation.
The
HPC provided the following information pertaining to cancer cases in the San
Miguel county area:
·
According
to the NM Tumor Registry at the
o
6,000
new cancer cases diagnosed in NM per year
o
16
new cases per day
o
2,600
cancer deaths per year
o
7
cancer deaths per day
·
From
1991-2000, according to the Tumor Registry, there were an average of 92 new
cases of cancer per year in
o
o
Grant,
pop. 30,159 = 134 new cases per year
o
·
According to 2001 Hospital
Inpatient Discharge Data (HIDD) collected by the Health Policy Commission, the
·
From
1998 to 2000, the rate of hospitalization per 1,000 people for cancer was:
|
Year |
San
Miguel |
|
|
1998 |
4.5
per 1,000 |
4.8
per 1,000 |
|
1999 |
4.9
per 1,000 |
4.7
per 1,000 |
|
2000 |
5.2
per 1,000 |
4.6
per 1,000 |
(HPC 2000 HIDD Report)
·
The differences between the
HIDD data and the Tumor Registry data are likely in the methods that hospitals
use to classify and report hospital discharges to the Health Policy Commission. In addition, HIDD data reflects hospital
utilization – many people with cancer utilize a variety of non-inpatient care
options.
·
Residents
of
o
Community
activists, in the area surrounding the diesel generator, have counted 52 cases
of cancer.
o
No
official studies have been performed to document the incidence or causes of cancer
in relationship to the generator.
o
Neighborhood
complaints about the PNM generator also include noise nuisance levels.
o
Cancer
concerns are based on particulates and waste gasses emitted during the diesel
combustion process. According to the Journal article, information obtained from
the Environmental Protection Agency permit process for the generator shows that
its by-products include 2.7 tons of nitrogen oxides and 3 tons of particulates
per day of operation.
o
The
generator, built in 1972 and operated by Public Utilities of New Mexico (PNM),
is not the primary source of electricity for the
·
According
to the US Public Interest Research Group, diesel combustion emits a mixture of gases and fine particles that contain some 40
chemicals, including benzene, butadiene, dioxin, and mercury compounds. Fine
diesel particulates may increase the risk of cancer.
·
A
1999 study conducted by the Department of Health found that there were no
increased levels of cancer among employees of
BD/yr