INVESTIGATING CANCER CLUSTERS: COMMUNITY/HEALTH DEPARTMENT PERCEPTIONS

Abstract

ISEE-282 Introduction/Aim: Each year, state health departments receive between 1,100 and 1,650 calls about cancer clusters. Often, the callers are concerned that a few observed cancer cases may represent regional excess that could have been caused by environmental or other identifiable agents, and are a harbinger of worse things to follow. Responding to these calls is a difficult, expensive and resource intensive activity for health departments. Some require careful explanation of misinterpreted information to resolve community anxiety. Others require evaluation of existing data followed by communication of inconclusive technical information to members of the public confronted with these personal tragedies. And some result in the initiation of complex epidemiologic investigations. All of these situations can result in controversial and confrontational interactions. Methods: To develop a better understanding of this process that can generate these controversial and confrontational situations, we conducted a series of focus groups to explore perceptions and knowledge about cancer clusters. These were conducted separately for community residents and for health department staff. For communities, we examined how community members understand clusters, how they think about cancer, what additional information would be helpful to community members in understanding potential cancer cluster situations, and how they interpret data, especially when there is uncertainty. For health departments, we explored how they communicate with communities and how they evaluate their interactions. Results: This presentation will report results for one aim of this study in one community: the perceptions of how both health department staff and community residents felt health departments dealt with the community's concerns about their perception of a cluster in their community. Not surprisingly, preliminary analyses suggest that both groups felt misunderstood but the health department was more confident in the adequacy of the job they had done than was the community. We provide specific examples. Conclusion: Communities and health departments often have frustrating and acrimonious interactions over cancer clusters. In part, this is due to lack of appreciation of perceptions, knowledge and resource limitations of the other. By examining these issues, and tailoring messages and interactions to accommodate the sources of existing conflict, we believe more effective cluster response procedures can be developed which will lessen concerns and decrease cost.