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  • Cancer Clusters












  • Cancer Clusters

    Scenario

    The information below addresses cancer clusters in general and shows how this type of information would be used to respond to this scenario.

    Cancers often appear to occur in clusters, which scientists define as an unusual concentration of cancer cases in a defined area or time. A cluster also occurs when the cancers are found among workers of a different age or sex group than is usual. The cases of cancer may have a common cause or may be the coincidental occurrence of unrelated causes. Although the occurrence of a disease may be random, the distribution of that disease may not be uniform, and clusters of disease may arise by chance alone. When cancer in a workplace is described, it is important to determine the primary site of the cancer.

    What do we look for when evaluating a cancer cluster?

    Because cancer is a common disease, cancer can be found among people at any workplace. In the United States, one in two men and one in three women will develop cancer over the course of their lifetime. These figures show the unfortunate reality that cancer occurs more often than many people realize. Disease or tumor rates are very variable in small populations and rarely match the overall rate for a larger area, such as the state, so that for any given time period some populations have rates above the overall rate and others have rates below the overall rate. So, even when there is an excess, this may be completely consistent with the expected random variability.

    Cancer clusters thought to be related to a workplace exposure usually consist of the same types of cancer. When several cases of the same type of cancer occur and that type is not common in the general population, it is more likely that an occupational exposure is involved. When the cluster consists of multiple types of cancer, without one type predominating, an occupational cause of the cluster is less likely.

    In our example, four types of cancer were diagnosed among the elementary school staff.

    When a known or suspected cancer-causing agent is present and the types of cancer occurring have been linked with these exposures in other settings, we are more likely to make the connection between cancer and a workplace exposure. We also look to see whether cancer is occurring among employees in particular jobs or areas of the workplace. This can help to identify exposures.

    School environments do not typically contain significant hazardous exposures. Asbestos can be a concern in older buildings, but while it is known to cause lung cancer and mesothelioma, it is not known to cause the types of cancer reported among this group of employees.

    The time between first exposure to a cancer-causing agent and clinical recognition of the disease is called the latency period. Latency periods vary by cancer type, but usually are 15 to 20 years, or longer. Because of this, past exposures are more relevant than current exposures as potential causes of cancers occurring in workers today. Often, these exposures are hard to document.

    The average time from first employment in the school to the diagnosis of cancer among staff members in the elementary school in our example was 5.7 years.

    Conclusions for the scenario above

    This scenario illustrates the key questions that are answered in response to cancer cluster inquiries. Historical experience at NIOSH has shown that most reports of cancer clusters indicate the coincidental occurrence of cancer in workforce members. In most situations, particularly in non-industrial work environments, it is not possible to link the cancers to exposures at work.



    This information came from an
    NIOSH online article.

    *** Any law, statute, regulation or other precedent is subject to change at any time ***

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