31888 Federal Register / Vol. 87, No. 101 / Wednesday, May 25, 2022 / Notices 

related to banking and permissible for 

bank holding companies. Unless 

otherwise noted, these activities will be 

conducted throughout the United States. 

The public portions of the 

applications listed below, as well as 

other related filings required by the 

Board, if any, are available for 

immediate inspection at the Federal 

Reserve Bank(s) indicated below and at 

the offices of the Board of Governors. 

This information may also be obtained 

on an expedited basis, upon request, by 

contacting the appropriate Federal 

Reserve Bank and from the Board’s 

Freedom of Information Office at 

https://www.federalreserve.gov/foia/ 

request.htm. Interested persons may 

express their views in writing on the 

question whether the proposal complies 

with the standards of section 4 of the 

BHC Act. 

Unless otherwise noted, comments 

regarding the applications must be 

received at the Reserve Bank indicated 

or the offices of the Board of Governors, 

Ann E. Misback, Secretary of the Board, 

20th Street and Constitution Avenue 

NW, Washington DC 20551–0001, not 

later than June 8, 2022. 

A. Federal Reserve Bank of Atlanta 

(Erien O. Terry, Assistant Vice 

President) 1000 Peachtree Street NE, 

Atlanta, Georgia 30309. Comments can 

also be sent electronically to 

Applications.Comments@atl.frb.org: 

1. Capital City Bank Group, Inc., 

Tallahassee, Florida; through its 

subsidiary bank, Capital City Bank, 

Tallahassee, Florida, to indirectly 

acquire an equity interest in SOLCAP 

2022–1 LLC, Las Vegas, Nevada, and 

thereby engage in extending credit and 

servicing loans pursuant to section 

225.28(b)(l) of the Board’s Regulation Y. 

Board of Governors of the Federal Reserve 

System. 

Michele Taylor Fennell, 

Deputy Associate Secretary of the Board. 

[FR Doc. 2022–11189 Filed 5–24–22; 8:45 am] 

BILLING CODE P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[Docket No. CDC–2022–0070] 

Draft Guidelines for Examining 

Unusual Patterns of Cancer and 

Environmental Concerns 

AGENCY: Centers for Disease Control and 

Prevention (CDC), Department of Health 

and Human Services (HHS). 

ACTION: Notice with comment period. 

SUMMARY: The Centers for Disease 

Control and Prevention (CDC), within 

the Department of Health and Human 

Services (HHS), announces the opening 

of a docket to obtain comment on the 

Draft Guidelines for Examining Unusual 

Patterns of Cancer and Environmental 

Concerns (2022 Draft Guidelines). The 

2022 Draft Guidelines provide updates 

to the 2013 publication, Investigating 

Suspected Cancer Clusters and 

Responding to Community Concerns: 

Guidelines from the CDC and the 

Council of State and Territorial 

Epidemiologists (CSTE) (2013 

Guidelines). The updates provide state, 

tribal, local, and territorial health 

departments guidance for a revised and 

expanded approach to evaluating 

concerns about unusual patterns of 

cancer in communities, including those 

associated with local environmental 

concerns. The 2022 Draft Guidelines 

provide recommendations only; 

compliance with these 

recommendations is voluntary. 

DATES: Written comments must be 

received on or before July 25, 2022. 

ADDRESSES: You may submit comments, 

identified by Docket No. CDC–2022– 

0070, by either of the methods listed 

below. 

• Federal eRulemaking Portal: http:// 

www.regulations.gov. Follow the 

instructions for submitting comments. 

• Mail: Division of Environmental 

Health Science and Practice, National 

Center for Environmental Health, 

Centers for Disease Control and 

Prevention, Attn: Docket No. CDC– 

2022–0070, 4770 Buford Highway NE, 

Mailstop S–106–6, Atlanta, GA 30341. 

Instructions: All submissions received 

must include the agency name and 

docket number. All relevant comments, 

including any personal information 

provided will be posted without change 

to http://regulations.gov. Do not submit 

comments by email. CDC does not 

accept comments by email. For access to 

the docket to read background 

documents or comments received, go to 

http://www.regulations.gov. 

FOR FURTHER INFORMATION CONTACT: 

Alisha Etheredge, Centers for Disease 

Control and Prevention, National Center 

for Environmental Health, Division of 

Environmental Health Science and 

Practice, 4770 Buford Highway NE, 

Mailstop S–106–6, Atlanta, GA 30341; 

Telephone: 770–488–4024; Email: 

CCGuidelines@cdc.gov. 

SUPPLEMENTARY INFORMATION: 

Public Participation 

Interested persons or organizations 

are invited to participate by submitting 

written views, recommendations, and 

data related to the 2022 Draft 

Guidelines. In addition, CDC invites 

comments specifically on the following: 

1. Please comment on the strengths 

and limitations of the enhanced 

approach for routine, proactive 

evaluation of cancer patterns. 

2. Please comment on the strengths 

and limitations of the recommendations 

for enhancing communications and 

engagement with communities. 

3. Please comment on the strengths 

and limitations of the enhanced phased 

approach for responding to community 

inquiries. 

4. Please comment on the strengths 

and limitations of the new criteria for 

suggesting continued assessment of a 

report of an unusual pattern of cancer 

and addressing environmental concerns. 

5. Please comment on the strengths 

and limitations of the revised definition 

of a cancer cluster. 

6. Please comment on the strengths of 

the 2022 Draft Guidelines and provide 

suggestions to address weaknesses. 

7. Please comment on whether the 

language in the 2022 Draft Guidelines is 

sufficiently clear for both the general 

public and state, tribal, local, and 

territorial public health agency staff, in 

terms of comprehension of the 

investigative process and 

recommendations. 

8. Please provide any additional 

comments about the document. 

CDC will carefully consider all 

comments submitted in preparation of 

the final Guidelines for Examining 

Unusual Patterns of Cancer and 

Environmental Concerns and may revise 

the final document as appropriate. 

Please note that comments received, 

including attachments and other 

supporting materials, are part of the 

public record and are subject to public 

disclosure. Comments will be posted on 

https://www.regulations.gov. Therefore, 

do not include any information in your 

comment or supporting materials that 

you consider confidential or 

inappropriate for public disclosure. If 

you include your name, contact 

information, or other information that 

identifies you in the body of your 

comments, that information will be on 

public display. CDC will review all 

submissions and may choose to redact 

or withhold submissions containing 

private or proprietary information such 

as Social Security numbers, medical 

information, inappropriate language, or 

duplicate or near duplicate examples of 

a mass-mail campaign. Do not submit 

comments by email. CDC does not 

accept comment by email. 


lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 87, No. 101 / Wednesday, May 25, 2022 / Notices 31889 

Background 

CDC/ATSDR develops guidance for 

state, tribal, local, and territorial (STLT) 

public health departments on how to 

respond to cancer cluster concerns. The 

current 2013 Guidelines provide a 

rationale and tool to assist STLT public 

health agencies in applying a systematic 

approach when responding to inquiries 

about suspected unusual patterns of 

cancer in residential or community 

settings. Since publication of the 2013 

Guidelines, there have been technical 

and scientific advancements in areas 

such as data availability and analytic 

and geospatial methods. 

In the 2022 Draft Guidelines, CDC/ 

ATSDR has updated and expanded the 

2013 Guidelines to provide STLT public 

health agencies and other interested 

parties with access to information about 

current scientific tools and approaches 

to assess and respond to unusual 

patterns of cancer in communities. CDC/ 

ATSDR plans to update the evidence 

base to include final reports associated 

with several of the inputs gathered to 

inform the 2022 Draft Guidelines. 

CDC/ATSDR developed the 2022 

Draft Guidelines using input from a 

variety of stakeholders including STLT 

public health agencies, subject matter 

experts from academia and nongovernmental organizations, an internal 

CDC/ATSDR steering committee, public 

comments received from a previous 

announcement in the Federal Register 

(84 FR 21786, Docket No. CDC–2019– 

0045), and focus groups conducted with 

community members and organizations 

that have been involved with cancer 

concerns in their communities. CDC/ 

ATSDR also gathered input from a 

literature review and media scan and 

evaluated advances in the field of 

environmental epidemiology (e.g., 

geospatial methods) and community 

engagement strategies. An 

Environmental Media Scan Report, 

CSTE Workgroup Report (https://

cdn.ymaws.com/www.cste.org/resource/ 

resmgr/environmentalhealth/CSTE_

Cancer_Cluster_Guidelin.pdf) and STLT 

Survey and Focus Group Report 

(https://www.cdc.gov/nceh/clusters/ 

survey-report.html) have been 

developed or are in the process of being 

developed and will be published on the 

CDC Cancer Clusters website (https://

www.cdc.gov/nceh/clusters/ 

guidelines.htm) once available. 

As a result of these inputs, key themes 

emerged: 

1. The need for enhanced and 

improved engagement with 

communities; 

2. The need to deemphasize reliance 

on statistical significance so that 

statistical significance is not the 

deciding factor when evaluating the 

criteria to address cancer rates and 

environmental concerns; 

3. The need for routine, proactive 

evaluation of cancer data; and 

4. The need for tools and templates 

for standardized information collection 

and data evaluation. 

The 2022 Draft Guidelines address 

each of these themes in the following 

ways. 

• Theme 1: Throughout the 2022 

Draft Guidelines, the importance of 

communication and community 

engagement are addressed. 

Additionally, a section and one of the 

new recommended phases are devoted 

to communicating with and engaging 

communities, including identification of 

a community point of contact. These 

parts of the guidelines highlight and 

reinforce the need for establishing clear 

and ongoing communication channels 

about activities and challenges 

associated with the evaluation of 

unusual patterns of cancer and 

environmental concerns. 

• Theme 2: The four-step approach to 

evaluate patterns of cancer and identify 

factors of concern to the community 

recommended in the 2013 Guidelines 

has been replaced with ten new criteria 

to clarify additional efforts that may be 

required. Statistical significance of the 

estimates for cancer rates is one among 

these criteria; however, the 2022 Draft 

Guidelines recommend that statistical 

significance alone should not be the 

deciding factor when evaluating the 

patterns of cancer. Further assessment 

and suggested actions are provided to 

include consideration of health equity 

and environmental justice issues when 

responding to community inquiries. 

• Theme 3: The 2022 Draft Guidelines 

propose an approach for identifying and 

investigating unusual patterns of cancer 

as part of routine surveillance activities. 

The updates introduce a new section 

encouraging proactive evaluation of 

cancer registry data on a routine basis to 

monitor cancer trends and identify 

unusual patterns. The 2022 Draft 

Guidelines also suggest that state health 

officials conduct routine monitoring of 

cancer data in an area of concern in 

situations when the criteria do not 

suggest further action at that time. 

• Theme 4: New standardized data 

collection templates are provided to 

assist with the uniform collection of 

information during an inquiry from the 

community. Data collected and 

electronically transmitted will also 

enable CDC/ATSDR to have a clearer 

understanding of types of cancer and 

environmental concerns nationally. 

Other tools and resources included 

providing guidance regarding how to 

evaluate the new criteria. For example, 

decision trees are included to assist 

with understanding the new phases, the 

flow of activities, and reinforcing the 

proactive approach for routine 

evaluation of cancer surveillance data. 

A new tool for evaluating standardized 

incidence ratios (SIR) is also described. 

The SIR is a ratio of the number of 

observed cancer cases in the study 

population compared to the number that 

would be expected if the study 

population experienced the same cancer 

rates as a selected reference population 

(typically the state as a whole is used as 

a reference population). This tool will 

be available on the National 

Environmental Public Health Tracking 

Network (https://ephtracking.cdc.gov/). 

It will provide SIR estimates by county 

to enable review of cancer data by the 

public and STLT partners. 

In addition to these updates, other 

proposed changes in the 2022 Draft 

Guidelines include the following: 

• Changing the name of the 

guidelines to reflect consideration of 

environmental concerns as a factor 

when investigating a community 

inquiry about unusual patterns of 

cancer; 

• Revising the definition of a cancer 

cluster; 

• Including specific and standardized 

approaches to better engage community 

members; 

• Explaining how to use a 

standardized template to better 

document the nature and extent of 

cancer and environmental concerns; and 

• Enhanced appendices describing 

statistical and geospatial methods 

supporting the evaluation of unusual 

patterns of cancer. 

For more information about the 

process of developing the 2022 Draft 

Guidelines, please visit https://

www.cdc.gov/nceh/clusters/ 

guidelines.htm. 

Supporting and Related Material in the 

Docket 

The 2022 Draft Guidelines can be 

found in the Supporting Materials tab of 

this docket. 

Angela K. Oliver, 

Executive Secretary, Centers for Disease 

Control and Prevention. 

[FR Doc. 2022–11237 Filed 5–24–22; 8:45 am] 

BILLING CODE 4163–18–P 


lotter on DSK11XQN23PROD with NOTICES1