ALBERT

Description: Background Examining spatial patterns of DLBCL incidence has identified of areas of elevated and decreased risk (Bulka, Cancer 2013). Examining the relationships between DLBCL clusters and residential exposures to potential carcinogens can provide insight about potential environmental and socio-demographic risk factors. Methods In order to investigate the spatial patterns of DLBCL incidence among adults (≥ 20 years), we linked and geocoded cancer incidence data for the period 1999-2008 from the Georgia Comprehensive Cancer Registry (a CDC-supported a statewide population-based cancer registry) with population data from the 2000 U.S. Census, and the EPA toxic release inventory. DLBCL cases were aggregated to the census tract level. DLBCL incidence in Georgia was standardized indirectly by age, sex, and race to national rates obtained from SEER*Stat software. Choropleth maps were created to depict the ratio of observed to expected incidence (standardized incidence ratios [SIR]) by census tract using ArcGIS. Spatial Empirical Bayes smoothing was performed on the SIR values. To assess spatial correlation of SIRs, we conducted global and local cluster analyses by calculating global Moran’s I and Local Indicators of Spatial Autocorrelation [LISA] values. Cluster analyses were repeated, stratifying by age (20-59 years, ≥60 years), sex, and race (Caucasian and African American). The Lawson-Waller Score test was used to individually assess each of the release sites for focal clustering of DLBCL. We adjusted our alpha level using the Bonferroni correction. Poisson regression models were constructed under the assumption that the number of observed incident cases for each census tract had a Poisson distribution that was dependent on the number of expected cases for that census tract, based on its age, sex, and race demographics, and the explanatory variable of mean distance from the toxic release sites. Median year moved into residence was also assessed as a potential confounder and/or effect modifier. Results Between 1988 and 1998, facilities in Georgia reported release of: 1,3 butadiene (3 sites), 2,4-D (1 site), benzene (19 sites), ethylene oxide (7 sites), formaldehyde (60 sites), pentachlorophenol (5 sites), styrene (86 sites), tetrachloroethylene (33 sites), and trichloroethylene (40 sites). Total releases, calculated as the sum of fugitive air releases, stack air releases, and surface water discharges between 1988 and 1998 for each site ranged from 52 to 3,830,097 pounds of benzene, 171,437 to 216,659 pounds of 1,3 butadiene, 250 pounds of 2,4-D, 4,220 to 581,077 pounds of ethylene oxide, 5 to 872,835 pounds of formaldehyde, 164 to 3,845 pounds of pentachlorophenol, 2 to 4,472,334 pounds of styrene, 5 to 1,575,644 pounds of tetrachloroethylene, and 5 to 3,730,069 pounds of trichloroethylene. 3,851 incident DLBCL cases occurred among adults residing in Georgia between 1999 and 2008. Clustering of high SEB-smoothed SIRs appears to be located in the metro-Atlanta area for Caucasians and African Americans. All 9 toxic release exposures showed some evidence for focal clustering. The Lawson-Waller score test identified significant focal clustering of higher than expected DLBCL incidence around: 86% of ethylene oxide, 68% benzene, 48% of tetrachloroethylene, 29% of styrene, 23% of formaldehyde, 20% of trichloroethylene, and 20% of all release sites. No statistically significant Poisson coefficients emerged for the interaction term between mean distance to toxic release site and time in residence. Conclusions We identified spatial clustering of DLBCL and associations between excess DLBCL incidence and residential proximity to EPA-designated toxic release sites. Confirmatory studies using geospatial mapping in other locations and epidemiological studies can aid in identifying risk factors for the development of DLBCL. Disclosures: Flowers: Genentech BioOncology: Consultancy; Millennium/Takeda: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Spectrum: Research Funding; Sanofi: Research Funding; Janssen: Research Funding; Abbott: Research Funding.

Description: Abstract 2710 Background: Increased risk of Non Hodgkin Lymphoma (NHL) has been observed in persons occupationally exposed to benzene, but the risk among persons living near benzene release sites has been less studied. Methods: In order to investigate the spatial patterns of NHL incidence and the association between NHL incidence and distance to benzene release sites, we linked cancer incidence data for the period 1999–2008 from the Georgia Comprehensive Cancer Registry (a CDC-supported a statewide population-based cancer registry collecting all cancer cases diagnosed among Georgia residents since 1995) with population data from the U.S. Census, and with Environmental Protection Agency's Toxics Release Inventory data on the locations of benzene release sites in Georgia between 1988–1998. NHL cases were aggregated by census tract. Descriptive spatial analysis was performed using ArcGIS. Choropleth maps were created to depict the standardized incidence ratios (SIRs) by census tract for NHL and NHL subtypes, and locations of benzene release sites were overlayed upon SIR maps. Spatial Empirical Bayes smoothing was performed on the SIR values using GeoDa 1.01. To assess spatial correlation in SIRs, we conducted global, local, and focal spatial analyses. The global Moran's I and a local Moran's I (also termed Local Indicators of Spatial Autocorrelation [LISA]) were calculated for SIR patterns of NHL and NHL subtypes. The Lawson-Waller Score test was used to individually assess each of the 19 benzene release sites for focal clustering of NHL with Bonferroni correction for the 19 comparisons. We performed Poisson regression on NHL incidence rates, using the mean distance between the tracts centroids and release sites as a marker of exposure. Results: 12,716 incident NHL cases occurred among adults residing in Georgia during this period. There was a positive spatial autocorrelation for cases of NHL, B-cell NHL, T-cell NHL and for diffuse large B-cell lymphoma indicating that cases NHL in Georgia were geographically clustered (all global Moran's p-values 〈 0.05). LISA cluster maps of SEB-smoothed SIRs (Figure) show the locations of “hot-spots” (high-high clusters) and “cold-spots” (low-low clusters). High SIRs were clustered in the metro-Atlanta area for NHL and NHL subtypes, while low SIRs were mostly in the southern region of the state. The Lawson-Waller test scored each census tract for the difference between the observed and expected NHL incidence, weighted by inverse distance to the sites. Results were statistically significant at the á= 0.0026 level (Bonferroni correction) for 15 of the 19 benzene release sites. All sites located within the metro-Atlanta area had significant focal clustering, with greater incidence rates observed in the tracts near these sites than expected. Mean distance from benzene release site had a protective effect with a 0.4% decrease in the incidence rate of NHL for every mile the mean distance increased. Conclusions: Clusters of NHL were significantly spatially associated with benzene release sites located in the metropolitan Atlanta area, but not with release sites in other areas of the state. Populations living in a census tract ≥100 miles away from all benzene release sites in Georgia have approximately a 40% decrease in the expected incidence of NHL when compared to populations living in a census tract adjacent to a benzene release site. While the overall incidence of NHL in Georgia is low (17.4/100,000 individuals in the population/year), this represents a significant change in incidence pattern. Additional studies are needed to identify factors that modify this risk. Disclosures: Flowers: Genentech/Roche (unpaid): Consultancy; Millennium (unpaid): Consultancy; Celgene: Consultancy; Celgene: Research Funding; Spectrum: Research Funding; Millennium: Research Funding; Gilead: Research Funding; Janssen: Research Funding.

Description: Background Exploring spatial patterns of disease incidence allows for the identification of areas of elevated or decreased risk. For chronic lymphocytic leukemia and small lymphocytic leukemia (CLL/SLL), which have poorly understood etiologies, identifying spatial patterns through cluster analysis may provide insight about potential environmental and socio-demographic risk factors. Methods In order to investigate the spatial patterns of CLL/SLL incidence among adults (≥ 20 years), we linked cancer incidence data for the period 1999-2008 from the Georgia Comprehensive Cancer Registry (a CDC-supported a statewide population-based cancer registry collecting all cancer cases diagnosed among Georgia residents since 1995) with population data from the 2000 U.S. Census. CLL/SLL cases were aggregated to the census tract level. CLL/SLL incidence in Georgia was standardized indirectly by age, sex, and race to national rates obtained from SEER*Stat software. Choropleth maps were created to depict the ratio of observed to expected incidence (standardized incidence ratios [SIR]) by census tract using ArcGIS. Spatial Empirical Bayes smoothing was performed on the SIR values using GeoDa 1.01. To assess spatial correlation of SIRs, we conducted global and local cluster analyses by calculating global Moran’s I and local Moran’s I (also known as Local Indicators of Spatial Autocorrelation [LISA]) values. Cluster analyses were repeated, stratifying by age (20-59 years, 60+ years), sex, and race (Caucasian and African American). P-values less than 0.01 were considered statistically significant. Results 765 incident CLL/SLL cases occurred among adults residing in Georgia between 1999 and 2008 (Table 1). There was a positive spatial autocorrelation for cases of CLL/SLL age 60 and older indicating these cases were geographically clustered (p = 0.0010) (Table 2). The LISA cluster map of the smoothed standardized incidence ratios shows the locations of “hot-spots” (high-high clusters) and “cold-spots” (low-low clusters) with clustering of high smoothed SIRs was found in the metro-Atlanta area, Albany, Macon, and outside of Augusta while cold-spots were mostly in the southern region of the state. Conclusions Despite the low number of cases of CLL/SLL in Georgia during the 10-year period studied, we found evidence of spatial clustering among adults 60 years and above. Hot-spots of smoothed SIRs were located in the metro-Atlanta area, Albany, Macon, and near Augusta, but these varied when stratified by age, sex, and race, suggesting confounding or effect modification that warrants further investigation. Disclosures: Flowers: Spectrum: Research Funding; Celgene: Consultancy, Research Funding; Millennium/Takeda: Consultancy, Research Funding; Genentech BioOncology: Consultancy; Sanofi: Research Funding; Janssen: Research Funding; Abbott: Research Funding.