DHHS: Dartmouth pilot study moving through IRB; cancer‑registry reanalysis with VA cases underway

Michelle Robersch, bureau chief for public health protection at the New Hampshire Department of Health and Human Services, briefed the commission on April 11 about the Merrimack cancer investigation and related work by Dartmouth and UNH researchers.

The update matters because the pilot study and registry reanalysis will guide whether a larger epidemiologic study is feasible and what hypotheses could be pursued regarding apparent excesses of kidney cancer in Merrimack and the nine‑town study area.

Robersch said the study has four main components: community engagement studios (complete), cancer‑registry data analysis, a UNH feasibility survey, and a Dartmouth‑led pilot study. She told the commission that Dartmouth’s team requested a reanalysis that adds VA‑reported cancer cases to the New Hampshire State Cancer Registry dataset; DHHS is conducting that reanalysis to ensure consistent time frames and to include all available VA cases for diagnosis years 1995–2021.

Robersch said the inclusion of VA cases and an additional reanalysis caused some project delays but that Dartmouth’s investigators (including Dr. Salas and Dr. Romano) have presented preliminary results to legislative study groups in March. She said the Clinical Cancer Review Committee approved a required assessment on April 9 and that Dartmouth is in the institutional review board (IRB) process; an expedited IRB review is expected now that committee approval has been received.

On the pilot study, Robersch said the primary purpose is feasibility: "The pilot study... will not provide definitive information about the causes of excess kidney cancer in Merrimack, but rather will serve as preliminary data useful to support a grant application to fund this larger study." The pilot is intended to test recruitment strategies, instruments and sampling methods that would inform a future larger study; it is not designed to be definitive on causation.

Robersch reported that Dartmouth and UNH have revised survey instruments and that Dartmouth has pursued community outreach: the research coordinator attended local events in Bedford and Merrimack and the live community feedback form remains active. The study team is aiming to recruit roughly 70–100 pilot participants; Robersch said Dartmouth is finalizing recruitment strategies and that the team will report on progress at upcoming commission meetings.

DHHS said the pilot and feasibility work were funded with state general funds (a one‑time appropriation in the current legislative session, approximately $500,000). Robersch said DHHS will update the commission when the registry reanalysis that incorporates VA data is complete, and that the department is preparing an expanded appendix of other cancer types for the previously issued Merrimack incident report, using registry data through 2021.

Commission members raised questions about why Dartmouth’s recent analysis focused on kidney tumors in the way it did; Robersch said Dartmouth investigators would be asked to return with clarifying comments for the commission and community. Members also asked about timelines: Robersch suggested an October timeframe as reasonable for a follow‑up presentation and said the team will report recruitment progress at the May meeting so commissioners can assess whether outreach needs to be intensified.

Robersch said the pilot’s results will be used to support grant applications for a larger, definitive study if warranted; the pilot itself is not intended to provide causal conclusions.