Comprehensive Cancer Center Cancer Concerns Workgroup

Dashboard · Concerns · CCW-2026-0142 · Decision Making

Decision Making Form

Step 8 of 17 · Examining Unusual Patterns of Cancer and Environmental Concerns. Completed by the Workgroup during the meeting.

All fields are required unless (optional) appears next to the label.

Section 1 — Number of cancer cases and rate of cancer in the area of concern

  1. 1. For the cancer(s) of concern, is the observed number of cases more than the expected number of cases?
    Criterion 1 response
  2. 2. Is the difference (in cases or rates) between the area of interest and the comparison area statistically significant?
    Criterion 2 response
  3. 3. Is there an individual year or group of years responsible for an elevated rate suggesting a temporal cluster, and/or has the rate of that cancer increased over time?
    Criterion 3 response
  4. 4. Are the number or pattern of cancer deaths (as shown in mortality/vital statistic data) elevated or unusual in the area of concern? CCW does not complete this question
    Criterion 4 (omitted)
  5. 5. Considering the geographic distribution of cancer cases, are cases concentrated in any area suggesting a spatial cluster?
    Criterion 5 response
  6. 6. Do the cancers of concern share similar causes / risk factors and are they elevated in the area of concern or neighboring areas (regardless of geopolitical boundaries)?
    Criterion 6 response

Section 2 — Environmental risk factors

  1. 7. Has an environmental concern been raised as potentially being related to the pattern of cancer in the area of concern?
    Criterion 7 response
  2. 8. Is there a plausible pathway of exposure between the suspected environmental contaminants and the cancer(s) of concern in terms of disease etiology?
    Criterion 8 response
  3. 9. Does the scientific literature suggest that exposure to environmental contaminants may play a role in the development of the cancers of concern?
    Criterion 9 response
  4. 10. What is the latency period for the cancer of concern, and is it consistent with the contaminant exposure timeframe?
    Criterion 10 response

Outcome guidance (from CDC/ATSDR)

If ALL answers in Sections 1 and 2 are “No”

  • No further assessment needed at this time.
  • Summarize collected information in a written report or letter; provide summary to the inquirer / community point of contact.
  • Continue routine monitoring as appropriate; plan to include this cancer and area in routine evaluations.

If answer to question 1 is “Yes,” AND any other question in Section 1 is “Yes”

Further assess the cancer pattern. May include consultation/referral to a cancer prevention and control program, additional information gathering (e.g., case series analysis, defining geographic area or time frame using spatial/temporal methods).

If answer to any question in Section 2 is “Yes”

Consider information from Section 2 (environmental data and environmental risk factors) during the additional assessment, and/or refer to or collaborate with another agency (e.g., local water department, state environmental regulatory agency, ATSDR).

Step 9 — Determine Response Type

Workgroup decision
Is additional analysis needed?
Refer to another agency for further investigation? (rare)
Cancel

Reference: Guidelines for Examining Unusual Patterns of Cancer and Environmental Concerns · CDC/ATSDR.