Cervical cancer Garfield County had the lowest incidence rates for cervical cancer among the comparison counties and the state, as a whole.

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1 15 CancerStatistics Cancer statistics for and the four comparison counties were obtained from the Department of Public Health and Environment, Central Cancer Registry, Prevention Services Division ( Jack Finch, (Statistical Analyst III) provided the most recently available data (through 25) for the most frequently observed cancersin,aswellasforseveralothercancersthatareofinterestbecauseoftheir potentiallinktoexposuretobenzeneortoradionuclides.forcancersthathavesufficiently highratesofoccurrencetoprovidemeaningfultrenddata,trendsinincidenceandmortality ratesareprovidedforthefourcomparisoncountiesfortheyears1992through25.(please see Appendix M for data tables.)table 23 (below) shows comparisons of selected cancer incidenceratestothestateincidenceratesforthesametimeperiods.blankcellsindicatethat therewasnosignificantdifferencefromthestaterate. Table 24 provides the same information for mortality rates.it is important to note that mortality rates more so than incidence rates may reflect differences in socioeconomic status and/or healthcare access (i.e., access to stateoftheart treatment), rather than differencesinriskfactorsfordevelopingcancer.thelattermayincludeanindividual sgenetic background, lifestyle choices, and/or exposures to a wide range of environmental toxins (chemical, biological, or radiological).one of the difficulties of observing relatively recent trendsincancerincidencestatisticsandtryingtodrawconclusionsaboutpossiblechangesin risk factors, is that, with respect to carcinogenic exposures, these trends reflect events that happened 1 2 years ago or are cumulative over a lifetime. Generally speaking, the appearance of clinical cancer has a lag time of up to two decades following initiation of carcinogenesis.(childhood cancers and some rare cancers are exceptions.)thus, with the exceptionofchangesincancerscreeningpracticesthatoftenartifactuallyinflatecancerrates, shortterm trends may not reflect changes in the potential for exposure to carcinogenic materials. Incidence and mortality trends among the comparison counties have also been portrayed graphically(seebelow).incidenceratesforallcancershavechangedlittleovertime,although cancerratesinmalesdroppedslightlyfor,,andcountiesforthemost recenttimeperiod.thereisrelativelylittledifferenceamongthecountiesforeithermaleor femalecancerincidenceratesacrossthedesignatedtimeperiods.inadditiontothecounty specific cancer statistics, the information on and National incidence rates and risk factors was obtained from the Cancer in report ( and Cancer Facts and Figures 28 (AmericanCancerSociety, Selectedcancers. Prostatecancer AlthoughCounty saverageannualincidenceratesfortheperiodof werehigherthanthoseof,andcounties,therehasbeena steadydownwardtrendinprostatecancerratesincounty.forthemostrecenttime period, prostate cancer rates were lower than those for the other three counties. It is importanttonotethatincidenceratesareareflectionof detection rates.changesinrates maybeanartifactofscreeningpractices(which,inturn,reflect standardsofpractice,health insurancecoverage,andpublicacceptance).

2 16 CommunityHealthRiskAnalysisofOilandGasIndustryImpactsinCounty FemaleBreastcancer Asimilardownwardtrendinfemalebreastcancerincidenceisseenfor County.Incidenceratesamongthecomparisoncountiesarenotsignificantlydifferent fromeachotherorfromthestaterate. Colorectalcancer ColorectalcancerratesinmalesforCountyhavedecreasedsince 1992,andarenowsimilartothoseinCountyandlowerthanthoseinand Counties and in the state, as a whole.female colorectal cancer incidence has been highly variable,andiscurrentlysimilartotheratesinandcountiesandinthestate,as awhole(whichareallhigherthanthemostrecentincidencerateforcounty). Lung cancer There has been a significant drop in the male lung cancer incidence rates in County over the most recent tracking period (2325). County has the lowestincidencerateamongthecomparisoncountiesandthestateofforthisperiod. FemalelungcancerratesinCountyhaveessentiallyremainedstablesince1992.The mostrecentratesaresimilartothestaterates,arehigherthanthoseforcounty,andare lowerthanthoseforandcounties. Bladdercancer BladdercancerincidencerateshavebeenhighlyvariableinCounty forbothmalesandfemales.allofthecomparisoncountiessawaspikeinmalebladdercancer incidenceforthe2122period(truealsoforfemalebladdercancer,withtheexceptionof County,forwhichnofemalebladdercancerswerereportedduringthisperiod).Themost recent tracking period showed decreases in the incidence rates for all counties, except County(continuedupwardtrendinmalebladdercancer)andCounty(increase infemalebladdercancer).staterateshaveremainedstableforbothmaleandfemalebladder canceroverthe199225timeperiod. Melanoma MelanomaratesforCountydonotdiffersignificantlyfromthoseinthe comparison counties or the state as whole.male melanoma rates have tended to decrease since1999,whilefemalerateshavebeenmorevariable,althoughrelativelylow. Leukemias The incidence rates for all male leukemias in County were lower than thoseinthecomparisoncountiesandthestateduring2325(theonlyperiodforwhich countyspecificdatawereavailable).femaleleukemiaincidenceratesforcountywere essentiallythesameasforthestate,asawhole,slightlylowerthanforcounty,and higherthanthoseforandcounties. Thyroid cancer In all cases, incidence rates for male thyroid cancer were lower than for thyroid cancer in females, during 2325, the only period for which countyspecific data were available.in County, male thyroid cancer rates were lower than in County and the state, but higher than in and Counties (No thyroid cancer was recordedformalesincounty).thyroidcancerratesforfemalesincountywere onlyhigherthantheratesforfemaleresidentsofcounty. Cervicalcancer Countyhadthelowestincidenceratesforcervicalcanceramongthe comparisoncountiesandthestate,asawhole.

3 17 TABLE23.COMPARISONOFCOUNTYRATESWITHSTATERATESINCIDENCE Male Prostate Lung Colo rectal Melan oma Bladder Leuke mias Thyroid All Cancers Female Breast Lung Colo rectal Melan oma *** Thyroid Leuke mias Bladder *** *** Cervix *** *** *** *** All Cancers Rate is significantly higher than rate. Rate is significantly lower than rate. ***Indicates fewer than 3 events in this category

4 18 CommunityHealthRiskAnalysisofOilandGasIndustryImpactsinCounty TABLE24.COMPARISONOFCOUNTYRATESWITHSTATERATESMORTALITY Male Prostate Lung Colo rectal *** Melan oma *** *** *** *** *** Bladder *** *** *** *** *** *** *** Leuke mias Thyroid *** *** *** *** All Cancers Female Breast Lung Colo rectal Melan oma *** *** *** *** *** *** *** *** *** *** Thyroid *** *** *** *** *** Leuke mias *** *** Bladder *** *** *** *** *** *** *** *** *** *** Cervix *** *** *** *** *** *** *** *** *** *** *** All Cancers *** Rateissignificantlyhigherthanrate. Rateissignificantlylowerthanrate. ***Indicatesfewerthan3eventsinthiscategory

5 All Cancers Incidence Trend Average Annual Rate - Males All Cancers Mortality Trend Average Annual Rate - Males Figures 4ad.In, the cummulative lifetime risk for developingcancerofanytypeis 1 in 2 for males and 2 in 5 for females.

6 All Cancers Incidence Trend Average Annual Rate - Females All Cancers Mortality Trend Average Annual Rate - Females 11

7 Prostate Cancer Incidence Trends Average Annual Rates Prostate Cancer Mortality Trends Average Annual Rates 111 Figures 41a and 41b.Prostate cancer is the most frequently diagnosed cancer in men. In,1in5malesislikelyto develop prostate cancer during their lifetime. The only well established risk factors for prostate cancer are age (>65 years), ethnicity (incidence rates are highest among African American men), and family history of the disease. Some studiessuggestthatadiethighin saturated fat may also be a risk factor.

8 112 CommunityHealthRiskAnalysisofOilandGasIndustryImpactsinCounty Female Breast Cancer Incidence Trends Average Annual Rates Figures 42a and 42b. Breast cancer is the most frequently diagnosed cancer in women.in, it is likely that 1 in 7 women develop breast cancer during their lifetime.age is the most important risk factor for femalebreastcancer.otherrisk factors include genetic background(inheritedmutations inthebrca1andbrca2genes;a personal or family history of breastcancer),andreproductive factorssuchasalongmenstrual history,neverhavingchildrenor having a first child after age 3, and recent use of oral contraceptives. Other factors suchasobesity,postmenopausal hormone therapy, physical inactivity and alcohol use may playaroleinthedevelopmentof breastcancer. Female Breast Cancer Mortality Trends Average Annual Rates

9 Colorectal Cancer Incidence Trends Average Annual Rates - Males Colorectal Cancer Mortality Trends Average Annual Rates - Males 113 Figures 43ad. Nationally, colorectal cancer is the third most common cancer in both men and women. In the lifetime risk for developing colorectal cancer is 1 in 14 for males and 1 in 18 for females. Risk factors for developing colorectal cancer include increasing age, certain genetic mutationsorapersonalorfamily history of colorectal cancer, polyps, or chronic inflammatory boweldisease.otherriskfactors include obesity, physical inactivity, smoking, alcohol consumption, and a diet high in red or processed meat and low infruitsandvegetables.

10 114 CommunityHealthRiskAnalysisofOilandGasIndustryImpactsinCounty Colorectal Cancer Incidence Trends Average Annual Rates - Females Colorectal Cancer Mortality Trends Average Annual Rates - Females

11 Lung Cancer Incidence Trends Average Annual Rates - Males Lung Cancer Mortality Trends Average Annual Rates - Males 115 Figures 44ad. Although the incidence rates for lung cancer aredeclining,itisstillthesecond most frequently diagnosed cancerinbothmenandwomen, and accounts for the most cancerrelated deaths. In,thelifetimeriskoflung canceris1in1formalesand1 in 15 for females. Cigarette smoking is by far the most important risk factor for developing lung cancer. Other risk factors include genetic background history of tuberculosisandoccupationalor environmental exposure to secondhand smoke, radon, asbestos,certainmetals,organic chemicals, and other air pollutants,andradiation.

12 116 CommunityHealthRiskAnalysisofOilandGasIndustryImpactsinCounty Lung Cancer incidence Trends Average Annual Rates - Females Lung Cancer Mortality Trends Average Annual Rates - Females

13 Bladder Cancer Incidence Trends Average Annual Rates - Males Bladder Cancer Incidence Trends Average Annual Rates - Females 117 Figures45aand45b.Nationally, bladder cancer incidence rates are nearly four times higher in men than in women. In, the lifetime risk for bladder cancer is 1 in 2 for males and 1 in 76 for females. Smoking is the most important riskfactorfordevelopingbladder cancer. Workers in the dye, rubber or leather industries and individuals who live in communities that have high levelsofarsenicintheirdrinking water are also at increased risk fordevelopingbladdercancer.

14 118 CommunityHealthRiskAnalysisofOilandGasIndustryImpactsinCounty Melanoma Incidence Trends Average Annual Rates - Males Figures46aand46b.Melanoma is the most common, serious form of skin cancer, and occurs primarily (although not exclusively)inwhites.themajor risk factors for melanoma are personal or family history and thepresenceoflargenumbersor atypicalmoles.otherriskfactors includeahistoryofexcessivesun orultravioletlightexposure;sun sensitivity (light or red hair and lightskin);diseasesthatsuppress the immune system; and occupational exposure to coal tar, pitch, creosote, arsenic compounds, or radiation. Melanoma Incidence Trends Average Annual Rates - Females

15 Leukemia Incidence by County for Average Annual Rates Leukemia Mortality by County for Average Annual Rates Male Female Male Female Figures 47a and 47b.Although leukemia is diagnosed 1 times more often in adults than in children,itisoftenthoughtofas primarily a childhood disease. The most common types of leukemiadiagnosedinadultsare acute myeloid leukemia and chronic lymphocytic leukemia. Leukemia occurs more frequently in males than in females. In, the lifetime risk of developing leukemiais1in45formalesand 1 in 79 for females.individuals with Down Syndrome and certain other genetic abnormalities have higher rates of leukemia.cigarette smoking andexposuretoradiationandto chemicals like benzene are also riskfactorsforleukemia.

16 12 CommunityHealthRiskAnalysisofOilandGasIndustryImpactsinCounty Thyroid Cancer Incidence by County for Average Annual Rates Cervical Cancer Incidence Rates by County for Average Annual Rates Male Female Figure48.Nationally,thyroidcancers occur about 3 times more often in women than in men, and they are more frequent in younger adults.in, the lifetime risk of developing thyroid cancer is 1 in 24 for males and 1 in 92 for females. Major risk factors for developing thyroidcancerareadietlowiniodine, exposure to radiation, and certain inheritedmedicalconditions. Figure49.Incidenceratesforcervical cancer have decreased significantly, and as Pap screening has become morecommon,cervicalcancerismore often detected before it becomes invasive.in,1in154women develop invasive cervical cancer over their lifetime.the primary cause of cervicalcancerisinfectionwithhuman papillomavirus (HPV). The ability of the infection to progress to cancer is related to factors such as suppressed immunity, having many children, cigarette smoking, and nutrition. Longtermuseoforalcontraceptivesis also associated with an increased risk ofcervicalcancer.