Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
R-03-0363
J-03-389 4/10/03 RESOLUTION NO. 03— 363 A RESOLUTION OF THE MIAMI CITY COMMISSION RELATED TO THE LEVELO POR LA VIDA EVENT, SPONSORED BY THE AMERICAN CANCER SOCIETY, TO BE HELD AT THE ORANGE BOWL STADIUM ON APRIL 26-27, 2003; AUTHORIZING THE ALLOCATION OF A CASH GRANT, IN AN AMOUNT NOT TO EXCEED, $6,933.50, FROM SPECIAL EVENTS ACCOUNT NO. 001000921054.6.289, TO BE TRANSFERRED TO THE BUDGET OF THE ORANGE BOWL STADIUM FOR THE WAIVER OF FACILITY FEES AND THE PROVISION OF POLICE AND FIRE -RESCUE SERVICES FOR SAID EVENT; CONDITIONING SAID AUTHORIZATIONS UPON THE SPONSORS: (1) OBTAINING ALL PERMITS REQUIRED BY LAW; (2) PAYING FOR ALL OTHER NECESSARY COSTS OF CITY SERVICES AND APPLICABLE FEES ASSOCIATED WITH SAID EVENT; (3) OBTAINING INSURANCE, TO PROTECT THE CITY IN THE AMOUNT AS PRESCRIBED BY THE CITY MANAGER; AND (4) COMPLYING WITH ALL CONDITIONS AND LIMITATIONS AS MAY BE PRESCRIBED BY THE CITY MANAGER. BE IT RESOLVED BY THE COMMISSION OF THE CITY OF MIAMI, FLORIDA: Section 1. The allocation of a cash grant, in an amount not to exceed, $6,933.50, from Special Events Account No. 001000921054.6.289, to be transferred to the budget of the CITY cornu ` om MEETIM OF APR 1 17_ttA3 Resolution No. 03- 363 Orange Bowl Stadium for the waiver of facility fees and the provision of police and fire -rescue services for the Levelo Por La Vida event, sponsored by the American Cancer Society, to be held at the Orange Bowl Stadium on April 26-27, 2003, is authorized. Section 2. The herein authorizations are conditioned upon the sponsors: (1) obtaining all permits required by law; (2) paying for all other necessary costs of City services and applicable fees associated with said event; (3) obtainina insurance to protect the City in the amount as prescribed by the City Manager or designee; (4) and complying with all conditions and limitations as may be prescribed by the City Manager. Section 4. This Resolution shall become effective immediately upon its adoption and signature of the Mayor.11 '-� If the Mayor does not sign this Resolution, it shall become effective at the end of ten calendar days from the date it was passed and adopted. If the Mayor vetoes this Resolution, it shall become effective immediately upon override of the veto by the City Commission. Page 2 of 3 03- 363 PASSED AND ADOPTED this 10th day of April , 2003. ATTEST: PRISCILLA A. THOMPSON CITY CLERK APPROVED AS TO FORM AND CORRECTNESS: i ALEJANDROlST / CITY ATTORNEY W7187:tr:AS:BSS Page 3 of 3 03- 363 DISTRICT 3 Alonso, Elvi G. COMMISSIONER SANCHEZ From: Wright, Steve Sent: Thursday, April 03, 2003 10:12 AM To: Alonso, Elvi G. Subject: 2 more blue pages for 4-10 Elvi, Commissioner Sanchez would like to add two personal appearances to the April 10 commission meeting Blue Pages. / 1) Lilliam Sanchez Martinez, chairperson of Hispanic Development Initiative Board of the American Cancer Society, to speak about an event on April 26 and 27 at the Orange Bowl. 2) Guarione M. Diaz, president of the Cuban American National Council, to speak about an event on May 3 at Jose Marti Park. Thank You. Steve Steve Wright Senior Policy Advisor Office of Commissioner Joe Sanchez 305 250-5382 03- 363 Puedo Salir Adelante (I Can Cope) es una serie de clases educativos para las personas con cancer, sus familiares y amigos. Hacerle frente al cancer presenta muchos retos, y este programa de la Sociedad Americana del Cancer ofrece informacion sobre tratamientos y efectos secundarios para ayudar a los pacientes a tomar decisiones basadas en la informacion. Puedo Salir Adelante provee apoyo en como aprender a sobrellevar el cancer. Hombre a Hombre (Man to Man) es un programa de educacion y apoyo que ayuda a los hombres y sus famihares a sobrellevar el cancer de la prostata. Hombre a Hombre provee un foro confidencial que estimula a los hombres y sus familiares a discutir sus inquietudes abierta y honestamente. 1.800.ACS.2345 www.cancer.org Hope. Progress.Answers. American Cancer Society 6049.10 Servicios para pacientes y familiares 03- 363 Nuesrros servicios a] paciente en ](I Florida incluyert: La /uente de informacion Inds itnportante sobre el cdncer: 1-800-227-2345 y touVln. cancer.oI-'q Albergues de esperanza — ubicados en Gainesville, Miami ), Tampa (2002) donde los pacientes clue no estan hospitalizado y sus fanriliares pueden permanecer gratis durante sus tratamientos contra el cancer. • Grupos de apoyo )' pmgramas educatirlos • Transports: en algunas romunidades hacia el lugai del tratamit'll to Programas de cancer infaritil: R.O.C.K. Camp (Reaching Out to Cancer Kids) para ninos con cancer Families" R.0.C.K. Weekend provee un refugio educativo y de desarollo de habilidadcs para los ninos coil cancer y sus farriilias College Scholarships provee betas a estudiantes con antecedentes de cdncer De todos los servicios que provee la Sociedad Americana del Cancer, los servicios al pa ciente son los que mas influyen en la vida y cora zones de los pacientes con cancer. La Sociedad Americana del Cancer es el primer lugar at que las personas Haman para obtener recursos, informacion y gula sobre el cancer, asf como ayuda practica de alguien que les escucha. A tan solo una Ilamada a la linea de asistencia 1-800- 227-2345 de la Sociedad Americana del Cancer se encuentran especialistas entrenados en informacion sobre el cancer que proveen informacion correcta y actualizada los siete dfas de la semana, las 24 horas del dfa. Es una linea directa a los programas de apoyo del cancer disponibles, servicios en la comunidad y asistencia persona a persona. Tambien puede visitar nuestra pagina en el Internet www.cancer.org Los amplios programas de servicios at paciente de la Sociedad Americana del Cancer ayudan con las necesidades emocionales. fisica s y psicologica s asociadas con el cancer. Recursos en la comunidad Con tan solo una Ila mada telefonica usted tiene acceso a una gran variedad de servicios de la Sociedad Americana del. Cancer en su comunidad. Le proveemos informacion sobre los recursos en su comunidad para ayudarle a sobrellevar su experiecia con el cancer. Si llama at 1-800-227 2345, puede recibir: Information para ayudarle a decidir sobre el diagnostico. tratamiento y recuperation Respuestas a preguntas sobre las causas del cancer, prevention, detection, sfntomas, y mas Recursos locales en la comunidad Programas de apoyo y educativos de la Sociedad Americana del Cancer Recuperation a su Alcance (Reach to Recovery) Su Sociedad Americana del Cancer provee apoyo a las mujeres que se enfrentan a los efectos emocionales y fisicos del cancer del seno. Las voluntarias visitan a las pacientes de cancer del seno para responder preguntas y compartir sus propias experiencias personales. Tambien hay apoyo temprano disponible para aquellas mujeres que hayan detectadouna masa en el seno. Las voluntarias de Recuperation a su Alcance son ejemplos positivos para pacientes, ademas son la prueba de que las mujeres pueden sobrevivir at cancer del sono. EI Camino a la Recuperation (Road to Recovery) Llegar a los centros do tratamiento contra el cancer puede ser un gran reto, especialmente para nuestra poblacion de edad avanzada en la Florida. Los voluntarios de Road to Recovery de la Sociedad Americana del Cancer son conductores que transportan a pacientes con cancer desde y hacia centros de tratamiento. Luzca Bien... Sientase Mejor (Look Good, Feel Better) ayuda a restablecer e1 balance emotional de los pacientes con cancer que hayan podido experimentar los cambios fisicos que pueden ocurrir como resultado de los tratamientos contra el cancer. Cosmetologos profesionales y estilistas ofrecen a sesora miento y consejos para sobrellevar la perdida del cabello ylos cambios en la piel. I Can Cope is a series of educational classes for people with cancer, their families and friends. Facing cancer has many challenges, and this American Cancer Society program offers information on treatments and side effects to help patients make informed decisions. I Can Cope provides support in learning to cope with cancer. Man To Man is an education and support program that helps men and their families cope with prostate cancer. Man To Man provides a confidential forum that encourages men and their families to discuss their concerns openly and honestly. 1.800.ACS.2345 www.cancer.org Hope. Prog ress.Answers. 6049.00FL 4/02 American Dancer �� Society IAmerican Cancer Society • 03- 363 fill►►rnri irrt/t othiIwIrn►»>1 !?rogra n►s. Transportation to treatment in sonic conununities. R.O.C.K. Programs (Reaching Out to Cancer Kids): R.O.C.K. Camp, a summer camp for children with a history of cancer. Families' R.O.C.K. Weekend, an educational and skill building retreat for children with cancer and their families. College scholarships, tuition assistance for students with a history of cancer. ru..aa.aal.J uilu wil.il families the most. I hP American Cancer Society is the first place people call for resources, information and guidance on cancer, as well as practical help from someone who listens. A phone call away on the American Cancer Society's 1 -800 -ACS - 2345 helpline are trained cancer information specialists who provide accurate, up-to-date information seven days a week, 24 hours a day. It's a direct line to available cancer support programs, community services, and one-on- one assistance. Or visit our website at www.cancer.org. The American Cancer Society's comprehen- sive patient services programs help with the Resources Althhoe lus�h one paa.,anae call you have access to a full range of American Cancer Society services located in your community. We provide information about resources within your community to help you through your cancer experience. By calling 1 -800 -ACS - 2345, you can receive: Information to help make informed decisions about your diagnosis, treatment and recovery. • Answers to questions about cancer, prevention, detection, symptoms and more. Local community resources. • American Cancer Society support and educational programs. physical effects of 11r st ca ncer. Volunteers visit breast rn nrpr nn tiPnfc answering questions and sharing their own personal experiences. Early support is also are norurive roue ononl- KAaf1 TA KGfA\/DY\/ Getting to cancer treat- ments can be a great challenge especially for our senior population in Florida. The American Cancer Society's Road To Recovery volunteers are drivers who trans- port cancer patients to and from treatments. Look Good ... Feel Better helps to restore the emotional balance of cancer patients who may have experienced the physical changes that can occur as a result of cancer treat- ments. Professional cosmetologists and hair stylists offer advice and tips for coping with hair loss and skin changes. Gilbert Baerga Senior Programs Director American Cancer Dade/Monroe unit 3901 NW 79 Avenue Suite 224 Miami FL 33166 t) 305. 594.4363 Ext. 230 f)305. 592.5140 gbaerga@cancer.org City of Miami fee wavier request itemized budget for Relevo por la vida 2003 Service Item Fee Description Orange Bowl $5,000 Facility Fee State Tax NA (Exempt/Non-profit Organization) Ticket Surcharge NA No Tickets Sold Stadium Employee $383.50 (1 employee @ $12.75 C 30 Hours) Police $600.00 (1 Police Officer @ $25 X 24 Hours) $150.00 (1 Police Officer @ $25 X 6 Hours) Fire Rescue $300.00 (1 Fire Rescue Unit @ $100 X 3 Hours) Stadium Maintenance $500.00 (24 hours/estimated attendance 2000) Total Expenses $6,933.50 03- 363 5 UN EVENT DE EQUiPO CONTRA EL CANCER You can be part of the ultimate community event and one of the largest special events in the world! Relay For Life, described as a "huge, compassionate support group," celebrates life in honor of those touched by cancer. It also raises funds for the American Cancer Society's programs of research, education, advocacy and service — programs that can reduce cancer deaths and cancer incidence, and improve the quality of life for cancer survivors. Created in 1985 by Oncologist Dr. Gordon Klatt, in Tacoma, Washington, Relay For Life has grown to become the American Cancer Society's national signature event and is the single largest non-profit event in the world. In 2000-2001, over 3,000 Relay For Life events held throughout the United States raised $212 million with over 2 million participants and over 400,000 cancer survivors walking the opening lap. In 2000-2001, Florida held 118 Relay For Life events that raised $9 million! In 2001-2002 Florida grew to 150 events and raised over $11 million. This year our goal is to host over 175 events and raise over $14 million! In addition, Miami will host the first ever Relevo Por La Vida in the United States, a Hispanic/Latino version of Relay For Life. Relay For Life is a true community developed, volunteer driven, team event where people of all ages and from all walks of life come together for a common cause. They walk, jog or run overnight in relay style around the tracks or pathways at school or community football fields, fairgrounds and parks. Friends, relatives, local businesses, hospitals, schools, churches, service clubs and other organizations organize teams of 10-15 people. Each team member is asked to raise a minimum of $100 from donors before the event. Food, music, fun and camaraderie are RW oethe Relay For Life experience. However, a more solemn aspect of the event is.the emotional candle -lighting ceremony to honor those who have survived cancer and to remember those w�have "iiet., ,This. powerful ceremony ties participants personally to the cause of fightng'canc_er 'arid fills` them with anticipation for the next year's event. 1 Relay For Life — it's all about the American Cancer Society providing Hope for the future, Progress toivards7a; cure, and Answers to cancer questions. 03- 363 Ll C This Is the American Cancer Society IAmerican Cancer c� Society- N C� 0 It can come at any time. The moment you become apart of a community you barely knew existed. No matter when it happens - no matter who you are - we can help. 4 C r child's life depends on ;nnovative new treatment. wish tomorrow's advances ld happen today. 're determined to end cancer ;ood. J II is is where to go for f "? Do you know anyone whose life has been saved w, by a bone marrow transplant? Or a Pap test? "MWAL "a What about drugs like tamoxifen or Gleevec? Perhaps you've heard of the latest discoveries - the secrets of the human genome unraveled, pills that attack cancer at its molecular level, genetic warning signs for certain cancers. These and almost all the scientific milestones in cancer research got their start with funding from the American Cancer Society. Thanks to our generous supporters, we have distributed nearly $2.5 billion to researchers since 1946. Of those investigators, 32 have gone on to win the Nobel Prize, proving our record of identifying the best and most promising research ideas. As the largest private, nonprofit source of research funding, we're committed to making the discoveries that could save your life or the life of someone you love. But we don't stop there. With the help of public health colleagues and volunteer advocates - people like you - we work with our elected leaders to ensure: • Greater government investments in cancer research and research application • Policies that allow every American, regardless of income level, access to lifesaving treatments • More access to innovative clinical trials that save lives as they advance our understanding of this disease If you've been touched by cancer, we can give you the opportunity to fight it in ways that will help you and others. 03- 363 �� o You don't have to have cancer to worry about it. Although cancer tops the list of Americans' health concerns, many people don't know they have the power to do something about it. The American Cancer Society's early detection guidelines are developed by leading medical and scientific experts to help you decide when and how to get tested for cancer. Thousands of lives have been saved each year thanks largely to greater use of early detection tests to find cancer at its earliest, most treatable stage. We know that everyday choices - such as diet, physical activity, tobacco use, and sun protection - make a big impact in preventing cancer. So we encourage healthy lifestyle decisions that could help avoid up to two-thirds of cancer deaths in our country. To help you make these life changes, we offer services such as smoking cessation tips and counseling. By collaborating with communities, corporations, physicians, and the media, we arm you with what you need to know to lower your cancer risk. And by working with public health partners, volunteers, and lawmakers, we help ensure every American has access to lifesaving cancer tests and can live, work, and play in a healthy environment. While our presence is nationwide, our approach is community-based. We work within each community to understand the barriers to health, determine how best to address those issues, and ultimately help lift the cancer burden. You want to help your family form healthier habits. You're ready to quit smoking You're wondering "Should I get tested?" This is where to go for �3_ 363 You're looking for the perfect way to celebrate the life of someone you love. You've survived cancer, and youd like to help others through it. Youd like to make your voice heard on the issues that matter. You want to leave a lasting legacy. This is where to go to make a While we've made great progress, we still have a lot to do. Too many people are diagnosed with cancer, too many suffer, and too many lose their lives. If you'd like to do something about it, please join us. Giving can be quick and easy. You can contribute conveniently through www.cancer.org or 1 -800 -ACS -2345 anytime. And we can walk you through how to leave a lasting legacy and perhaps enjoy significant tax benefits by giving through a will or trust. Giving can be fun - especially at our fundraising events. For example, Relay For Life" our signature activity, rallies communities to celebrate cancer survivors, remember loved ones lost, and raise funds to conquer cancer. Lasting overnight as team members take turns walking around a track, Relay inspires, entertains, and touches the hearts of all who participate. Giving can be rewarding. There are many ways to help make our mission happen. Writing letters, sending emails, or making phone calls to lawmakers can help shape important public policies. Helping cancer patients can put someone on the road to recovery. Sharing your cancer story can inspire others to get through their own struggle or to do something to lower their risk. Volunteering can lift your spirits and help others at the same time. If you have time or talents to share with those in need, call us to find out how you can help with what's happening in your community. 03- 363 You need the strength to make a confident decision. You want to meet someone who understands. You're ready to give back, and you have hope to spare. You'll do anything to find the cure. This is the American Cancer Society. This is where to go for 10 Call your American Cancer Society today at 1 -800 -ACS -2345 or visit wwwcancerorg. We'll give you information, support, and ways to get involved in the fight. Together, we will conquer cancer. Thank you for your continued support. 03- 363 The American Cancer Society New England Division, Inc. provides local services through (CT, ME, MA, NH, Rl, VT) more than 3,400 volunteer -led 30 Speen Street Units in communities across the Framingham, MA 01701-1800 country. Headquartered at the 508 270-4600 (0) National Home Office in Atlanta, 508 270-4699 (F) Georgia, the American Cancer Society has 17 chartered Divisions. Northwest Division, Inc. (AK, MT, OR, WA) Division Offices: 2120 First Avenue North Seattle, WA 98109-1140 California Division, Inc. 206 283-1152 (0) 1710 Webster Street 206 285-3469 (F) Oakland, CA 94612 Ohio Division, Inc. 510 893-7900 (0) 5555 Frantz Road 510 835-8656 (F) Dublin, OH 43017 Eastern Division, Inc. 614 889-9565 (0) (LI, NJ, NYC, NYS, Queens, 614 889-6578 (F) Westchester) Pennsylvania Division, Inc. 6725 Lyons Street (PA, Phil) I East Syracuse, NY 13057 Route 422 and Sipe Avenue 315 437-7025 (0) # 315 437-0540 (F) Hershey, PA 17033 0897 717 533-6144 (0) Florida Division, Inc. 717 534-1075 (F) 3709 West Jetton Avenue Rocky Mountain Division, Inc. y Tampa, FL 33629-5146 � 813 253-0541 (0) (CO, ID, ND, UT, WY) t' 1 813 254-5857 (F) 2255 South Oneida ` Denver, CO 80224 Puerto Rico, Inc. 303 758-2030 (0) Calle Alveno #577 303 758-7006 (F) Esquina Sargento Medina Southeast Division, Inc. Hato Rey, PR 00918 A 787 764-2295 (0) (GA, NC, SC) 787 764-0553 (F) 2200 Lake Boulevard Atlanta, GA 30319 cancenorg Great Lakes Division, Inc. 404 816-7800 (0) (MI, IN) 404 816-9443 (F) rmation, support1755 Abbey Road Southwest Division, Inc. East Lansing, MI 48823-1907 • • • • 517 332-2222 (0) (AZ, NM, NV) • • • 517 333-4656 (F) 2929 East Thomas Road Phoenix, AZ 85016 Heartland Division, Inc. 602 224-0524 (0) (KS, MO, NE, OK) 602 381-3096 (F) . • • 1100 Pennsylvania Avenue Texas Division, 5 Kansas City, MO 64105 816 842-7111 (0) Hawaii Pacific, Inc. -iing and planned 816 842-8828 (F) (TX, HI) 2433 Ridgepoint Drive Illinois Division, Inc. Austin, TX 78754 77 East Monroe Street 512 919-1800 (0) Chicago, IL 60603-5795 512 919-1844 (F) 312 641-6150 (0) 1`33.4673 Hawaii Pacific, Inc. 312 641-3533 (F) 2370 Nuuanu Avenue Mid -Atlantic Division, Inc. Honolulu, HI 96817 cancenorg(DC, DE, MD, VA, WV) 808 595-7500 (0) 8219 Town Center Drive 808 595-7502 (F) dvors Network" - recorded Baltimore, MD 21236-0026 410 931-6850 (0) • online supportgroups 410 931-6875 (F) Mid -South Division, Inc. (AL, AR, KY, LA, MS, TN) 1100 Ireland Way, Suite 300 Birmingham, AL 35205-7014 205 930-8860 (0) 205 930-8877 (F) Midwest Division, Inc. (IA, MN, SD, WI) 8364 Hickman Rd., Suite D Des Moines, IA 50325 515 253-0147 (0) 515 253-0806 (F) Would you like more information about us? Although our financial report is always sent free to anyone requesting a copy, certain States require us to advise you that a copy of our financial report is available from them. The American Cancer Society, Inc. ("ACS") is a New York not-for-profit corporation that is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives and diminishing suffering from cancer, through research, education, advocacy and service. The ACS national home office is located at 1599 Clifton Road, NE, Atlanta, GA 30329. The information enclosed describes one or more of ACS's or an American Cancer Society Division's activities. Your gift is very much appreciated and tax deductible as a charitable contribution to the fullest extent allowed by law. A copy of ACS's or an American Cancer Society Division's latest financial report may be obtained by writing to ACS, 1599 Clifton Road, NE, Atlanta, GA 30329 or by calling 1 -800 -ACS -2345. If you are a resident of the following states, you may obtain information directly by contacting: Florida: A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION OF ACS OR THE AMERICAN CANCER SOCIETY, FLORIDA DIVISION, INC. MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICE BY CALLING 1-800-435-7352, TOLL-FREE WITHIN THE STATE. THE ACS'S REGISTRATION NUMBER IN FLORIDA IS SC -07486. THE AMERICAN CANCER SOCIETY, FLORIDA DIVISION, INC.'S REGIS- TRATION NUMBER IS SC -00059. Maryland: Copies of documents and information submit- ted by ACS or the American Cancer Society, Mid -Atlantic Division, Inc. are available for the cost of copies and postage from the Secretary of State, Statehouse, Annapolis, MD 2140,1-410- 974-5534. Mississippi: The official registration and financial information of ACS and the American Cancer Society, Mid -South Division, Inc. may be obtained from the Mississippi Secretary of State's office by calling 1-888-236-6167. New Jersey: Information filed with the Attorney General concerning this charitable solicitation may be obtained from the Attorney General of the State of New Jersey by calling (973) 504-6215. New York: New York residents may obtain a copy of ACS's and the American Cancer Society, Eastern Division, Inc.'s annu- al report by writing to the Office of the Attorney General, Department of Law, Charities Bureau, 120 Broadway, New York, NY 10271. North Carolina: Financial information about ACS and the American Cancer Society, Southeast Division, Inc. and a copy of their licenses are available from the State Solicitation Licensi_nc_Branch_ at (919) 807-2214. Pennsylvania: The official registration and financial information of ACS and the American Cancer Society, Pennsylvania Division, Inc. may be obtained from the Pennsylvania Department of State by calling toll-free, within Pennsylvania, 1-800-732-0999. Virginia: A financial statement for the most recent fiscal year is available upon request from the State Division of Consumer Affairs, P.O. Box 1163, Richmond, VA 23209; 1-804-786-1343. Washington: You may obtain additional financial disclosure information by contacting the Secretary of State at 1 -800 -332 -GIVE. West Virginia: West Virginia residents may obtain a summary of the registration and financial documents from the Secretary of State, State Capital, Charleston, WV 25305. REGISTRATION WITH A STATE AGENCY DOES NOT CONSTITUTE OR IMPLY ENDORSEMENT, APPROVAL OR RECOMMENDATION BY THAT STATE. 02002, American Cancer Society, Inc. 02-50M-No.9520 The American Cancer Society is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service. For more information, contact us anytime, day or night, at 1 -800 -ACS -2345 or www.cancer.org. 1.800.ACS.2345 Cancer www.cancer.org Society �, Hope.Progress.Answers! City C1erkPriscilla Thompson 3500 Pan American Drive Miami, F133133 Dear City Clerk Thompson: IAmerican Cancer c) Society April 9, 2003 Sociedad Americana del Cancer'" The goals and objectives of the Hispanic Development Initiative of the American Cancer Society is to provide information on Cancer awareness and prevention through program and events such as: the "Mi Vida" media campaign which was launched in September of 2002 and focuses on Breast and Colorectal Cancer prevention, Aconseje A Su Amiga (Tell -A -Friend Adaptation for breast and cervical awareness), a Speakers Bureau for volunteer physicians and healthcare professionals to disseminate information to the general public on our guidelines for Cancer prevention and Relevo por la vida, a community event. On April 26`h, 2003 at the Orange Bowl in the City of Miami the American Cancer Society will host a community outreach event for over 2,000 participates called "Relevo por la vida" the focus of this event will be to educate our residents on Cancer prevention and awareness as well as the program services we can provide to Cancer patients and their families. We are pleased to say that we have the support and participation of Jackson Healthcare systems, Mercy Hospital, San Juan Bosco Clinic, the YWCA Health Breast Program and many other community organizations. The Jackson Mammo Van will screen medically underserved women for Breast Cancer. Other organizations have also joined us to provide information on other related health concerns such as lung disease and obesity in children. The Hispanic Broadcasting System and Univision who have sponsored the media campaign for this event will cover and promote the event for the general public from a healthcare perspective. Beginning the week of April 21st, Dr. Maritza Fuentes, the health anchor for Univision will devote her programs to Cancer Awareness. For your convenience, we have included in your packet materials on Cancer Facts and Figures and information on Relevo Por La Vida. It would be an honor and a privilege to have you join us on April 26'h, at the Orange in the fight against cancer as we seek to assist our Hispanic/Latinos of Miami and reach the medically underserved. Thank you in advance for your time and consideration. If there is additional information we can provide, please feel free to call us. Sincerely, .C'iffiam Sdnchzz .Madin" Lilliam Sanchez Martinez Chairperson Hispanic Development Initiative Miami -Dade, Monroe Area 3901 N.W. 79th Ave. Suite 224 Miami FL 33166 t) 305.594.4363 f) 305.592.5140 Cancer Information 1.800.ACS.2345 www.cancer.org Informad6n Sobre Cancer 1.800.227.2345 Gilbert Baerga Executive Director Hispanic Development Initiative 363 —� — �Evo 111.1kNi1 IIO`VI, Disenaoo por estudia rites de Diseno Grafico en Miami International University of Art 8 Design Para mas informacibn flame 305-779-3336 www.cancer.org AB R I L 26-27.2003 C -A WA MT 26,700 4,600 OR ( ID WY 17,300 I 5,500 2,300 CA 125,000 Ah NV 10,300 UT CO 6,200 15,200 AZ NM 23,300 7,400 I Q416.7 Aures FL \ 96,100 ^ vs �I':. =,. 1,334,100 -w HI PR El 9 4,900 N/A Rates are age-adjusted to the 2000 US standard population. Estimated number of new cancer cases for 2003, excluding basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Note: These estimates are offered as a rough guide and should be interpreted with caution. They are calculated according to the distribution of estimated cancer deaths in 2003 by state. State estimates may not add to US total due to rounding. AmeryCancecI Societ 03- 363 NH 6,000 3 ME ND VT 7,300 3,100 MN 3,100 21,900 MA 32,700 SD WI NY RI 3,900 25,800 85,900 5,800 MI CT 47,400 PA 16,600 NE I 70,800 NI 8,100 15,33 00 IN OH 42,300 IL 31,200 60,300 DE 59,900 MD 4,100 1,300 VA 24,400 KS MO 32,800 DC 12,600 29,500 2,700 22,100 NC TN 39,600 OK 30,500 17,700 AR SC 14,700 20,600 MS AL GA 14,900 23,600 33,400 TX 83,400 LA 22,600 FL \ 96,100 ^ vs �I':. =,. 1,334,100 -w HI PR El 9 4,900 N/A Rates are age-adjusted to the 2000 US standard population. Estimated number of new cancer cases for 2003, excluding basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Note: These estimates are offered as a rough guide and should be interpreted with caution. They are calculated according to the distribution of estimated cancer deaths in 2003 by state. State estimates may not add to US total due to rounding. AmeryCancecI Societ 03- 363 Cancer: Basic Facts 1 Age : Ad j i i sl cd Cancer Death Rates, Males by Site, US, 1930-1999' 2 \ge \dju,l cd Cancer Death Rates, Females by Site, US, 1930-1999' 3 I ,I inuiled New Cancer Cases and Deaths by Sex, US, 2003 4 I st i nail cd New Cancer Cases by Site and State, US, 2003* 5 I�1,I innil cd ( ancer Deaths for Selected Cancer Sites by State, US, 2003* 6 Cancer Incidence Rates by Site and State, US, 1995-1999 7 ( anter I)eal h Rates by Site and State, US, 1995-1999* 8 Selecled Cancers 9 beading Sites of New Cancer Cases and Deaths - 2003 Estimates* 10 I low to V'st imate Cancer Statistics Locally, 2003' 13 I'rohahil i I y of Developing Invasive Cancers Over Selected Age Intervals, by Sex, US, 1997-1999 14 F iv e -fear Relative Survival Rates by Stage at Diagnosis, 1992-1998" 17 'I rends in I ive Year Relative Survival Rates by Race and Year of Diagnosis, US, 1974-1998* 18 Special Section: Smoking Cessation 21 Cancer In Racial and Ethnic Minorities 29 Incidence and Mortality Rates by Site, Race, and Ethnicity, US, 1992-1999 29 The International Fight Against Cancer 30 Cancer ,Around the World, 2000* 30 Tobacco Use 32 Nutrition and Physical Activity 36 T,nvironmental Cancer Risks 38 The American Cancer Society 39 Sources of Statistics 46 Age Adjusl ment to the Year 2000 Standard 47 Screening Guidelines for the Early Detection of Cancer in Asymptomatic People* 48 bldicolcs o l"we or table I American Cancer Society® National Home Office: American Cancer Society, Inc., 1599 Clifton Road, NE, Atlanta, GA 30329-4251, (404) 320-3333 02003, American Cancer Society, Inc. All rights reserved, including the right to reproduce this publication or portions thereof in any form. For written permission, address the Legal Department of the American Cancer Society, 1599 Clifton Road, NE, Atlanta, GA 30329-4251. Cancer is a group of diseases characterized by uncon- trolled growth and spread of abnormal cells. If the spread is not controlled, it can result in death. Cancer is caused by both external factors (tobacco, chemicals, radiation, and infectious organisms) and internal fac- tors (inherited mutations, hormones, immune condi- tions, and mutations that occur from metabolism). Causal factors may act together or in sequence to initi- ate or promote carcinogenesis. Ten or more years often pass between exposures or mutations and detectable cancer. Cancer is treated by surgery, radiation, chemo- therapy, hormones, and immunotherapy. Can Cancer Be Prevented? All cancers caused by cigarette smoking and heavy use of alcohol could be prevented completely. The American Cancer Society estimates that in 2003 more than 180,000 cancer deaths are expected to be caused by tobacco use. Scientific evidence suggests that about one-third of the 556,500 cancer deaths expected to occur in 2003 will be related to nutrition, physical inactivity, obesity, and other lifestyle factors and could also be prevented. Certain cancers are related to infectious exposures, e.g., hepatitis B virus (HBV), human papillomavirus (HPV), human immunodeficiency virus (HIV), helicobacter, and others, and could be prevented through behavioral changes, vaccines, or antibiotics. In addition, many of the more than 1 million skin cancers that are expected to be diagnosed in 2003 could have been prevented by protection from the sun's rays. Regular screening examinations by a health care profes- sional can result in the detection of cancers of the breast, colon, rectum, cervix, prostate, testis, oral cavity, and skin at earlier stages, when treatment is more likely to be successful. Self-examinations for cancers of the breast and skin may also result in detection of tumors at earlier stages. Cancers that can be detected by screening account for about half of all new cancer cases. The 5 - year relative survival rate for these cancers is about 82%. If all of these cancers were diagnosed at a localized stage through regular cancer screenings, 5 -year survival would increase to about 95%. Who Is at Risk of Developing Cancer? Anyone. Since the occurrence of cancer increases as individuals age, most cases affect adults beginning in N middle age. About 77% of all cancers are diagnosed at ages 55 and older. Cancer researchers use the word risk in different ways. Lifetime risk refers to the probability that an individual, over the course of a lifetime, will develop cancer or die from it. In the US, men have a little less than 1 in 2 lifetime risk of developing cancer; for women the risk is a little more than 1 in 3. Relative risk is a measure of the strength of the relation- ship between risk factors and the particular cancer. It compares the risk of developing cancer in persons with a certain exposure or trait to the risk in persons who do not have this exposure or trait. For example, male smok- ers have a 20 -fold relative risk of developing lung cancer compared with nonsmokers. This means that they are about 20 times more likely to develop lung cancer than nonsmokers. Most relative risks are not this large. For example, women who have a first-degree (mother, sister, or daughter) family history of breast cancer have about a 2 -fold increased risk of developing breast cancer com- pared with women who do not have a family history. This means that women with a first-degree family his- tory are about two times more likely to develop breast cancer than women who do not have a family history of the disease. All cancers involve the malfunction of genes that control cell growth and division. About 5% to 10% of cancers are clearly hereditary, in that an inherited faulty gene pre- disposes the person to a very high risk of particular cancers. The remainder of cancers are not hereditary, but result from damage to genes (mutations) that occurs throughout our lifetime, either due to internal factors, such as hormones or the digestion of nutrients within cells, or external factors, such as tobacco, chemicals, and sunlight. How Many People Alive Today Have Ever Had Cancer? The National Cancer Institute estimates that approxi- mately 8.9 million Americans with a history of cancer were alive in January, 1999. Some of these individuals were cancer -free, while others still had evidence of cancer and may have been undergoing treatment. How Many New Cases Are Expected to Occur This Year? About 1,334,100 new cancer cases are expected to be diagnosed in 2003. Since 1990, over 17 million new cancer cases have been diagnosed. These estimates do not include carcinoma in situ (noninvasive cancer) of any site except urinary bladder, and do not include basal and squamous cell skin cancers. More than 1 million 03- 363 Cancer Facts & Figures 2003 1 -11 cases of basal and squamous cell skin cancers are detection and treatment of cancer, they do not represent expected to be diagnosed this year. the proportion of people who are cured permanently, since cancer can affect survival beyond five years after How Many People Are Expected to Die diagnosis. of Cancer This Year? This year about 556,500 Americans are expected to die of cancer, more than 1,500 people a day. Cancer is the second leading cause of death in the US, exceeded only by heart disease. In the US, 1 of every 4 deaths is from cancer. What Percentage of People Survive Cancer? The 5 -year relative survival rate for all cancers combined is 62%. After adjusting for normal life expectancy (fac- tors such as dying of heart disease, accidents, and diseases of old age), the 5 -year relative survival rate rep- resents persons who are living five years after diagnosis, whether disease-free, in remission, or under treatment with evidence of cancer. While 5 -year relative survival rates are useful in monitoring progress in the early Although these rates provide some indication about the average survival experience of cancer patients in a given population, they are less informative when used to pre- dict individual prognosis and should be interpreted with caution. First, 5 -year relative survival rates are based on patients who were diagnosed and treated at least five years ago and do not reflect recent advances in treat- ment. Second, information about detection methods, treatment protocols, additional illnesses, tumor spread at diagnosis, and behaviors that influence survival are not taken into account in the estimation of survival rates. (For more information about survival rates, see Sources of Statistics on page 46.) How Is Cancer Staged? Staging is the process of describing the extent or spread of the disease from the site of origin. It is essential in Age -Adjusted Cancer Death Rates,* Males by Site, US, 1930-1999 100 - -- - - -- -- Lung & bronchus 80 c 0 �a 3 CL 0 cL 60w E o / Stomach 0 o Prostate \ C; Colon 0 &rectum 40 CL w Oc m 20 — —-- — - PancreasOil! 11110 \ Leukemia Liver 0 L- - — 1930 1940 1950 1960 1970 1980 1990 1999 *Per 100,000, age-adjusted to the 2000 US standard population. Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the liver, lung & bronchus, and colon & rectum are affected by these coding changes. Source: US Mortality Public Use Data Tapes 1960-1999, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002. American Cancer Society, Surveillance Research, 2003 2 Cancer Facts & Figures 2003 C I determining the choice of therapy and: assessing prog- nosis. A cancer's stage is based on the primary tumor's size and location in the body and whether it has spread to other areas of the body. A number of different staging systems are used to classify tumors. The TNM staging system assesses tumors in three ways: extent of the pri- mary tumor (T), absence or presence of regional lymph node involvement (N), and absence or presence of dis- tant metastases (M). Once the T, N, and M are deter- mined, a "stage" of I, II, III, or IV is assigned, with stage I being early stage and IV being advanced. Summary stag- ing (in situ, local, regional, and distant) is useful for descriptive and statistical analysis of tumor registry data. If cancer cells are present only in the layer of cells where they developed and they have not spread, the stage is in situ. If cancer cells have spread beyond the original layer of tissue, the cancer is invasive. See Five - Year Relative Survival Rates by Stage at Diagnosis, 1992- 1998, page 17, for a description of the other summary stage categories. Nifflar-TWIT 4' A r The National Institutes of Health estimate overall costs for cancer in the year 2002 at $171.6 billion: $60.9 billion for direct medical costs (total of all health expenditures); $15.5 billion for indirect morbidity costs (cost of lost productivity due to illness); and $95.2 billion for indirect mortality costs (cost of lost productivity due to prema- ture death). Lack of health insurance and other barriers to health care prevent many Americans from receiving optimal health care. According to 2000 National Health Interview Survey data, about 17% of Americans under age 65 have no health insurance, and about 27% of persons 65 and over have only Medicare coverage. During 1999 and 2000, almost 18% of Americans aged 18 to 64 years reported not having a regular source of health care. Additionally, about 6% of 18- to 64 -year-old adults say cost was a barrier to obtaining needed health care in the previous year. Age -Adjusted Cancer Death Rates,* Females by Site, US, 1930-1999 c 0 .W M CL 0 CL d M E v 0 0 0 0 0 L d CL W r M oc M 0101111111 .q 40 20 v 1930 1940 1950 1960 1970 1980 1990 1999 *Per 100,000, age-adjusted to the 2000 US standard population. tUterus cancer death rates are for uterine cervix and uterine corpus combined. Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the liver, lung & bronchus, colon & rectum, and ovary are affected by these coding changes. Source: US Mortality Public Use Data Tapes 1960-1999, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002. American Cancer Society, Surveillance Research, 2003 is. 26 Cancer Fc & Figures A03 3 . 1 0 ex, US, 2003 Estimatei Both Sexes I nr- Estimated Deaths /tale Female Both Sexes Male Female 5,300 658,800 556,500 285,900 270,600 8,200 9,500 7,200 4,800 Am,s ,in, I (,r I'll & :n )i( n 4,x,00 2,400 Lrei ,x in'�,thsp.lic inl,, 11,300 1 (1,1 6,2D) 1,900 F,w( as 3 0, 70 0 1 011ic, dig.- lio, q,im, 4,500 1,400 Rispn r,1 v�slen 185,800 1C Bryn: 9,500 400 Lung A1):, 1) 1/1,900 C Otllcl w"pi"r,oi, OI ),n; 4,400 0,600 Bonw, k to nits 2,400 9,900 Soft 111"uc ( wludiuq h(I t� 8,300 9,000 Ski I (t>xclurlinn b,�„�I uln,irno. si 58,800 5,100 Mcl3uomd->k.ir 54,200 2 Other non npi�i,r)li,rl skin 4,600 9,000 Brea�)t 212,600 (wr) l )vs'ein 313,600 22 U'criie c�r✓ix 12,200 28,8001 Utrrire unpu 40,100 500 OVarp 25,400 1,700 Vulva 4,000 9,200 Vugmm & other m )ila 1( '1,+1e 2,000 3,700 Prost,itr 220,900 22 Ta�shs 7,600 30,000 Penis & o'l,(,r de 'stat, n',) 1,400 1,400 Unnare system 91,700 E Uriiwy blmlder 57,400 4 Kidne,t & wn,il ;>clvis 31,900 1 Urete &either Winary orq,rnr 2,400 3,800 Lye & ()rhil 2,200 1,800 Frain & otl er nervous syveur 18,300 1 Lndoaine ,yste,m 23,800 1,100 1 hyrold 22,000 700 Other endocrine 1,800 1,300 LyrnpIloina 61,000 4,500 Hodgkin 7,600 2,000 Non -Hodgkin lymphoin,i 53,400 2 ,lupi D �� m elotna I ✓ 14,6 00 3,600 Leukemia 30,600 1 Acute lymphocytic leukewl,< 3,600 2,400 Chronic lymphocytic leukeirria 7,300 1,500 Acuttt rny,1loid 10ukc11lia 10,500 211,300 Chronic myeloid leukemia 4,300 39,800 Other IeuKenii i t 4,900 56,300 Ocher unspecified prim V sitest 30,300 1 EXdud,s nasJl <110 ,11n,llfr :r ll J in I I I and in sii.i „ironornz umually, 31,(1 111 moma it It.r ,1.i0�II r au0xit 37,7('.1 rn .rises t More deaths Ilia r rasi)s s. 1,1 . I,r , . si), ticity in rec:r lino and I stirnates of new <i4 s ,vre )ayd rm W. W (E, sates from Ill,, N( I SE ihd �)l 14,300 ex, US, 2003 1 New Cases Estimated Deaths /tale Female Both Sexes Male Female 5,300 658,800 556,500 285,900 270,600 8,200 9,500 7,200 4,800 2,400 4,700 2,400 1,700 1,100 600 4,800 4,400 1,900 1,100 800 6,300 2,000 2,000 1,400 600 2,400 700 1,600 1,200 400 2,300 120,100 133,600 71,900 61,700 0,600 3,300 13,000 9,900 3,100 3,400 9,000 12,100 7,000 5,100 2,700 2,600 1,100 600 500 9,000 56,500 3,800 18,200 57,100t 28,3001 28,8001 1,700 2,300 500 200 300 1,700 5,600 14,400 9,200 5,200 3,100 3,700 3,500 1,300 2,200 4,900 15,800 30,000 14,700 15,300 1,400 3,100 1,900 700 1,200 2,200 83,600 163,700 93,400 70,300 7,100 2,400 3,800 3,000 800 1,800 80,100 157,200 88,400 68,800 3,300 1,100 2,700 2,000 700 1,300 1,100 1,300 700 600 4,500 3,800 3,900 2,000 1,900 2,300 26,500 9,800 6,200 3,600 9,900 24,300 7,600 4,700 2,900 2,400 2,200 2,200 1,500 700 1,300 211,300 40,200 400 39,800 9,900 83,700 56,300 29,500 26,800 12,200 4,100 4,100 40,100 6,800 6,800 25,400 14,300 14,300 4,000 800 800 2,000 800 800 0,900 28,900 28,900 7,600 400 400 1,400 200 200 3,300 28,400 25,100 16,400 8,700 2,200 15,200 12,500 8,600 3,900 9,500 12,400 11,900 7,400 4,500 1,600 800 700 400 300 1,100 1,100 200 100 100 0,200 8,100 13,100 7,300 5,800 6,600 17,200 2,300 1,100 1,200 5,700 16,300 1,400 600 800 - 900 900 -L 900 500 - 400 2,300 28,700 24,700 12,900 11,800 4,000 3,600 1,300 700 600 8,300 25,100 23,400 12,200 11,200 7,800 6,800 10,900 5,400 5,500 7,900 12,700 21,900 12,100 9,800 2,100 1,500 1,400 800 600 4,600 2,700 4,400 2,500 1,900 5,800 4,700 7,800 4,200 3,600 2,500 1,800 1,700 1,000 700 2,900 2,000 6,600 3,600 3,000 4,100 16,200 42,300 21,700 20,600 s except urinary bladder. Carcinoma in situ of the breast accounts for about 55,700 new cases annually. tEstimated deaths for colon & rectum cancers are combined. Aying causes of death on death certificate. -R Program, 1979 to 1999. ©2003, American Cancer Society, Inc., Surveillance Research �X Cancer Facts & Figures 2003 5 Estimated New Cancer Cases by Site and State, US, 2003* Non - Female Uterine Colon & Uterine Lung & Hodgkin Urinary State All Sites Breast Cervix Rectum Corpus Leukemia Bronchus Melanoma Lymphoma Prostate Bladder Alabama 23,600 3,400 200 2,200 600 500 3,300 900 800 4,700 800 Alaska 1,800 300 t 200 t t 200 100 100 200 100 Arizona 23,300 3,900 200 2,500 500 500 3,000 1,200 1,000 4,300 1,000 Arkansas 14,700 2,000 100 1,500 300 300 2,200 500 600 2,600 500 California 125,000 21,100 1,400 13,000 3,800 3,000 14,400 5,200 5,200 20,500 5,500 Colorado 15,200 2,500 100 1,600 400 400 1,600 800 700 2,600 600 Connecticut 16,600 2,600 100 1,900 500 400 2,000 600 700 2,800 800 Delaware 4,100 700 100 400 100 100 600 200 200 600 300 Dist. of Columbia 2,700 500 t 300 200 t 300 t t 600 100 Florida 96,100 13,500 900 10,200 2,500 2,200 13,200 4,100 3,900 15,800 4,500 Georgia 33,400 5,400 400 3,300 1,000 700 4,600 1,300 1,100 5,700 1,200 Hawaii 4,900 700 t 500 200 100 600 100 200 900 200 Idaho 5,500 1,000 t 600 100 100 600 300 200 1,100 300 Illinois 59,900 10,200 600 6,800 1,900 1,400 7,400 2,100 2,400 10,100 2,600 Indiana 31,200 4,700 300 3,500 900 700 4,400 1,400 1,300 5,000 1,300 Iowa 15,300 2,300 100 1,900 500 400 1,900 600 600 2,700 600 Kansas 12,600 2,100 100 1,300 300 300 1,700 600 500 2,100 500 Kentucky 22,100 3,200 200 2,400 500 400 3,500 1,000 800 3,300 900 Louisiana 22,600 3,800 200 2,600 600 500 3,000 700 800 3,600 800 Maine 7,300 1,000 t 800 200 100 1,000 300 300 900 400 Maryland 24,400 4,200 200 2,900 700 600 3,200 800 900 3,900 1,000 Massachusetts 32,700 4,700 200 3,700 900 700 4,100 1,500 1,300 5,500 1,700 Michigan 47,400 7,500 300 5,100 1,400 1,100 6,100 1,800 2,000 7,800 2,200 Minnesota 21,900 3,400 100 2,300 600 600 2,500 900 1,100 4,000 900 Mississippi 14,900 2,500 200 1,700 300 300 2,200 500 500 2,900 500 Missouri 29,500 4,100 200 3,300 900 700 4,200 1,300 1,100 4,500 1,100 Montana 4,600 600 t 500 100 100 600 200 200 800 200 Nebraska 8,100 1,100 100 1,100 300 200 1,000 300 400 1,400 300 Nevada 10,300 1,400 100 1,300 200 200 1,500 400 300 1,600 400 New Hampshire 6,000 800 t 700 100 100 800 300 300 900 300 New Jersey 42,300 7,400 400 4,800 1,600 1,000 5,000 1,700 1,800 6,600 2,200 New Mexico 7,400 1,300 100 800 200 200 800 300 300 1,400 300 New York 85,900 14,800 900 10,300 3,400 2,000 10,000 2,900 3,300 14,000 4,200 North Carolina 39,600 6,000 400 4,100 1,200 900 5,600 1,600 1,400 6,800 1,500 North Dakota 3,100 500 t 300 100 100 300 100 100 500 200 Ohio 60,300 9,900 500 6,900 1,900 1,400 8,000 2,300 2,600 9,400 2,800 Oklahoma 17,700 2,700 200 2,000 400 400 2,600 1,000 700 2,600 700 Oregon 17,300 2,600 100 1,700 500 400 2,300 800 700 3,200 800 Pennsylvania 70,800 11,100 600 8,600 2,300 1,600 8,700 2,700 3,000 12,000 3,400 Rhode Island 5,800 800 100 700 100 100 800 200 200 900 300 South Carolina 20,600 3,400 200 2,300 500 400 2,800 700 700 3,800 700 South Dakota 3,900 600 t 500 100 100 400 100 200 700 100 Tennessee 30,500 4,500 300 3,200 800 700 4,500 1,400 1,200 4,700 1,000 Texas 83,400 13,700 1,000 9,200 2,500 1,900 10,900 3,500 3,300 13,200 3,000 Utah 6,200 1,100 t 700 200 200 500 400 300 1,400 300 Vermont 3,100 500 t 400 100 100 400 200 100 300 100 Virginia 32,800 5,400 300 3,600 1,100 700 4,300 1,400 1,300 5,500 1,200 Washington 26,700 3,800 200 2,700 800 700 3,500 1,200 1,100 3,900 1,200 West Virginia 11,300 1,600 100 1,200 400 300 1,700 400 400 1,700 500 Wisconsin 25,800 3,900 200 2,900 800 700 3,000 1,100 1,200 4,500 1,200 Wyoming 2,300 300 t 300 100 100 300 100 100 400 100 United States 1,334,100 211,300 12,200 147,500 40,100 30,600 171,900 54,200 53,400 220,900 57,400 *Rounded to nearest 100. Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. tEstimate is 50 or fewer cases. Note: These estimates are offered as a rough guide and should be interpreted with caution. They are calculated according to the distribution of estimated cancer deaths by state in 2003. State estimates may not add to US total due to rounding. 02003, American Cancer Society, Inc. Surveillance Research --- r.9ill - �X Cancer Facts & Figures 2003 5 Brain/ Nervous Female State All Sites System Breast J ue,,:,.,,,�,. u� � rrdi,. I 5535 6 1 .I! 1. 'P its �. I '.SI 20 neer Sites by State, US, 2003* 2 Non - Colon & Lung & Hodgkin Tc itl.(1,. 9,200 2C EJC. Bronchus 9,100 200 JC Pv1ainr� 3,000I G0 20(' w1arylanu 10,200 200 80' v1assailur,�t'.. 13,600 300 9' ��ichi�lan 10,800 500 1,400 linnevrt: 9, 100 300 60L 1iss�ssip�,; 6,700 200 500 Mvl outi 12,300 3 0 C 800 Montan,s 1,900 100 100 Nehrask, 3,400 10C 200 Nevada 1,300 100 300 New, Ha itr,d w 2,50C 1CC 200 Nee Jersey 17,600 400 1,400 Ncvv Mea r o 7,100 100 200 New Yob 35,800 800 2,800 North Carolina 16,500 400 1,100 North Dakot,i 1,300 t 100 Ohio 25,200 600 1,900 Oklahon:,r 7,400 200 500 Oregon 7,2.00 200 50C Pennsylvania 29,600 600 2,100 Rhode Island 2,400 100 200 South "1 8,600 20C 600 South D,,kot,i 1,600 100 100 Tennesse^ 12,70C 30C 900 Texas 34,800 900 2,600 Utah 2,600 100 200 Vermont 1,300 t 100 Virginia 13,700 300 1,000 Washinq'.on 11,200 300 700 West Virginia 4,70C 100 300 Wisconsin 10,800 300 700 Wyoming 900 t 100 united States 556,500 13,100 39,800 'Rounded to -u,iu t '00_ LxcluCP" oa_,1I anrd sa,t.,mous 300 Note: St re may not add up to US total d tc roan Source: Us l l:�[taI ty Puolic Use Dasa ->pes, 1%0-2000, l 400 1,000 400 300 6 1 .I! 1. 'P its �. I '.SI 20 neer Sites by State, US, 2003* Non - Colon & Lung & Hodgkin Rectum Leukemia Liver Bronchus Lymphoma Ovary Pancreas Prostate 900 300 300 3,000 400 200 500 600 100 t t 200 t t t t 1,000 400 300 2,700 400 200 500 600 600 200 200 2,000 300 200 300 300 5,000 2,100 1,900 13,200 2,300 1,500 2,900 2,700 600 300 100 1,500 300 200 300 300 700 300 200 1,800 300 200 400 400 200 100 t 500 100 t 100 100 100 t t 300 t t 100 100 3,900 1,600 1,000 12,100 1,700 1,000 2,200 2,100 1,300 500 300 4,200 500 400 700 700 200 100 100 500 100 t 100 100 200 100 t 600 100 100 100 100 2,600 1,000 700 6,800 1,000 600 1,400 1,300 1,300 500 300 4,000 600 400 600 700 800 300 100 1,700 300 200 300 400 500 200 100 1,500 200 100 300 300 900 300 200 3,200 400 200 400 400 1,000 400 300 2,700 400 200 500 500 300 100 100 900 100 100 200 100 1,100 400 200 2,900 400 300 600 500 1,400 500 300 3,700 600 300 800 700 2,000 800 500 5,600 900 500 1,100 1,100 900 400 200 2,300 500 200 500 500 600 200 200 2,000 200 200 300 400 1,300 500 300 3,900 500 300 600 600 200 100 t 500 100 100 100 100 400 200 100 900 200 100 200 200 500 200 100 1,300 100 100 200 200 300 100 100 700 100 100 200 100 1,900 700 500 4,500 800 500 1,000 900 300 100 100 700 100 100 200 200 4,000 1,400 1,000 9,200 1,400 1,000 2,200 1,800 1,600 600 400 5,100 600 400 900 900 100 100 t 300 100 t 100 100 2,700 1,000 500 7,400 1,100 600 1,300 1,200 800 300 200 2,400 300 200 300 300 700 300 100 2,100 300 200 400 400 3,300 1,100 700 8,000 1,300 700 1,600 1,600 300 100 100 700 100 100 100 100 900 300 200 2,500 300 200 500 500 200 100 t 400 100 100 100 100 1,200 500 300 4,100 500 300 600 600 3,600 1,300 1,200 9,900 1,400 900 1,800 1,700 300 100 100 400 200 100 100 200 200 t t 400 100 t 100 t 1,400 500 300 3,900 500 300 700 700 1,000 500 300 3,200 500 300 600 500 500 200 100 1,600 200 100 200 200 1,100 500 300 2,800 500 300 600 600 100 t t 300 t t t 100 57,100 21,900 14,400 157,200 23,400 14,300 30,000 28,900 in cancers and in situ carcinomas except urinary bladder. tEstimate is 50 or fewer deaths. ling. ial Center for Health Statistics. 02003, American Cancer Society, Inc., Surveillance Research { Cancer Incidence Rates by Site and State, US, 1995-1999* Colon & Lung & Non -Hodgkin Urinary All Sites Breast Rectum Bronchus Lymphoma Prostate Bladder State Male Female Female Male Female Male Female Male Female Male Male Female Alabama (1999) 418.5 313.7 105.2 51.6 35.3 96.3 40.7 15.1 11.1 93.1 24.1 6.0 Alaska (1996-99) 527.2 443.6 135.9 61.2 51.0 87.4 65.3 22.1 17.2 152.2 38.8 10.2 Arizona# - Arkansas (1996-99) 488.8 347.8 113.2 55.5 41.2 110.4 50.9 18.8 13.7 130.5 31.1 6.9 Califomiat 526.3 411.4 133.2 59.4 43.5 77.0 50:6 22.9 14.9 154.3 34.0 8.6 Coloradot 512.3 395.0 132.6 56.3 41.9 69.3 41.6 20.7 16.1 156.9 34.2 9.1 Connecticutt 592.1 457.1 145.6 71.5 52.8 90.0 57.1 25.3 17.7 165.6 45.4 12.8 Delawaret 597.4 458.7 140.0 70.9 55.1 112.0 66.2 20.7 15.9 172.5 39.4 12.0 Dist. of Columbia 705.5 438.3 144.1 71.7 57.3 111.9 51.6 23.4 12.1 256.6 24.4 9.5 Florida# - - - - - - - - - - - Georgia 447.4 319.3 104.5 47.3 35.1 88.7 40.4 16.3 11.0 130.1 25.5 6.7 Hawaiit 476.8 384.2 130.0 67.0 44.5 72.1 37.5 19.4 12.9 124.1 21.6 6.0 Idahot 503.6 391.1 127.7 54.3 41.4 70.9 43.1 20.7 16.2 152.0 37.4 8.2 Illinoist 566.1 426.4 133.1 71.0 51.7 100.5 54.6 22.7 15.8 154.2 38.0 10.0 Indiana 498.4 391.4 124.3 66.1 48.3 102.1 52.1 19.8 14.8 120.3 35.6 9.5 lowat 557.5 420.7 130.7 75.8 55.3 95.8 47.3 22.6 i 17.0 152.1 38.3 8.4 Kansast - - - - - - - - - - - - Kentuckyt 593.7 425.6 122.2 70.7 53.2 141.3 68.5 21.9 15.3 141,5 36.2 9.3 Louisianat 597.9 391.7 120.2 71.1 47.8 119.4 54.0 20.7 14.9 170.4 33.4 8.5 Maine 572.8 434.0 126.9 68.4 50.9 103.5 62.9 22.8 15.4 147.2 45.5 12.5 Maryland 608.9 442.4 141.7 69.6 51.9 102.7 59.7 21.7 14.8 188.2 37.1 11.0 Massachusetts 591.6 444.5 144.1 72.5 51.1 90.3 57.1 23.0 16.4 174.6 45.2 12.9 Michigant 594.4 427.2 129.8 66.0 47.2 100.3 56.5 22.0 16.4 183.3 40.3 10.4 Minnesotat 544.1 409.6 136.6 62.9 46.7 74.1 43.6 25.2 17.4 174.0 37.1 9.7 Mississippi# - - - - - - - - - - - - Missouri (1996-99) 561.6 422.0 129.0 71.0 50.0 113.0 60.2 22.6 15.4 141.2 35.9 8.7 Montana 527.5 402.0 131.4 62.1 44.2 87.6 54.0 21.2 15.6 164.3 35.7 9.3 Nebraskat 546.6 405.2 129.7 70.8 48.9 89.2 43.9 23.1 16.3 161.5 34.6 8.1 Nevada 464.0 387.6 106.2 60.6 44.4 100.8 72.2 16.6 11.5 99.2 35.9 9.7 New Hampshire 551.8 428.4 137.7 68.2 49.2 90.3 59.1 20.3 14.4 150.2 45.3_ 12.5 New lerseyt 622.4 455.9 139.4 78.6 55.2 93.1 55.4 25.8 18.4 188.8 44.8 11.7 New Mexicot 473.2 363.3 120.3 51.7 36.0 63.7 37.2 17.8 12.3 147.0 27.0 8.2 New Yorkt 557.5 434.0 132.4 73.3 53.6 88.8 53.0 24.0 16.3 150.1 39.8 11.2 North Carolinat 522.4 369.7 122.0 57.5 42.0 106.8 47.6 18.7 13.2 146.5 33.2 8.2 North Dakota (1997-99) 537.7 369.6 123.8 69.8 46.4 73.6 38.5 22.8 12.9------179.5 39.9 8.9 Ohio (1996-99) 535.8 415.9 130.6 68.6 49.9 102.2 56.1 22.0 15.9 139.1 39.6 10.1 Oklahoma# - - - - - - - - - - - - Oregon (1996-99) 530.0 424.9 142.5 56.9 43.1 87.1 58.4 21.2 15.4 154.8 40.8 10.4 Pennsylvaniat 591.1 430.0 131.3 76.2 53.9 98.3 51.5 23.9 16.7 167.0 44.5 11.5 Rhode Islandt 640.9 470.3 136.6 76.1 57.3 108.7 63.6 26.4 19.3 172.2 51.8 13.5 South Carolina (1997-99) 580.9 385.7 124.4 66.3 44.9 107.3 47.4 18.5 13.1 177.5 33.9 7.8 South Dakota# - - - - - - - - - - - - Tennessee (1997) 461.1 354.0 114.4 58.9 40.5 106.0 49.7 17.4 14.1 106.6 28.6 7.1 Texas (1995-98) 536.7 380.0 117.2 61.4 43.1 102.7 51.1 20.7 14.4 148.9 30.0 7.5 Utaht 468.3 344.6 116.9 48.6 37.2 42.6 22.5 22.2 14.2 172.8 31.0 7.1 Vermont# - - - - - - - - - - Virginia 496.4 365.6 123.1 59.4 43.7 90.5 46.1 18.7 13.1 145.4 31.1 8.3 Washington 561.1 445.7 144.7 61.1 44.7 87.4 59.2 24.4 16.9 165.2 41.0 9.6 West Virginiat 569.2 424.0 118.1 69.5 51.4 126.8 65.5 21.2 16.4 138.0 40.3 11.6 Wisconsint 557.9 419.1 131.7 72.0 52.1 87.3 49.3 23.2 16.3 160.3 38.6 10.5 Wyomingt 527.6 388.8 120.9 60.2 43.4 74.2 46.9 18.1 14.8 168.0 38.1 10.1 United States 562.6 424.1 136.7 65.1 47.6 86.0 51.4 23.9 15.8 168.9 36.6 9.6 `Per 100,000, age-adjusted to the 2000 US standard population. Not all states submitted data for all years. t This state's registry has submitted five years of data and passed rigorous criteria for each year's data including completeness of reporting, non -duplication of records, percent unknown in critical data fields, percent of cases registered with information from death certificates only, and internal consistency among data items. *This state's registry did not submit incidence data to the North American Association of Central Cancer Registries (NAACCR) for 1995-1999. Sources: Cancer in North America: 1995-1999, Volume One: Incidence, North American Association of Central Cancer Registries. US Incidence: SEER Cancer Statistics Review, 1973-1999, Division of Cancer Control and Population Sciences, National Cancer Institute, 2002. American Cancer Society, Surveillance Research, 2003 03 63 Cancer Facts & Figures 2003 7 I� Cpl ii�►i I i �� ,ll Non -Hodgkin All Sit+rs FSrest Colon & Rectum Lung & Bronchus Lymphoma Pancreas Prostate State Mase FemjIe Female- Male Female Male Female i Male Female Male Female Male 24.1 16.9 101.8 38.1 1 9.9 6.3 13.0 9.4 41.9 1.3 18.6 71.2 46.2 10.4 6.3 13.6 10.2 22.6 22.4 15.6 68.5 39.0 10.3 71 11.1 8.4 29.9 25.2 18.5 109.4 43.5 11.5 7.1 13.1 9.5 37.4 r i 22.3 15.7 1 63.3 39.2 10.0 6.6 1 11.3 8.9 29.3 21.6 22.3 15.8 56.2 31.1 9-4 7.2 11.7 8.8 30.8 2 Vi 171 7_7-7 253 17.8 ( 693 40.6 10.6 7 7 12.8 10.2 31.0 .v . 7'3C << 97 8 3,? -6 28.4 20.8 94.6 51.1 9.7 7.1 12.8 9.5 38.8 isl of 32_- 19s 1 39-1 30.7 22.8 87.0 40.4 9.6 4.7 15.7 10.7 53.7 =nn 24>'E; 1E:='S 274 241 17.2 81.1 433 108 68 11.8 8.9 i 30.1 u g'„ 28 167 3 7-8.3 23.5 17.0 98.9 39.0 9.7 6.1 12.4 9.3 41.6 19"'_�1 13C 9 20.4 19.7 13.1 55.0 28.3 9.3 6.2 11.4 9.1 1 22.7 i 1+1ahc 22? 1 154 1 26.7 23.4 15.5 62.2 33.1 11.1 7.1 10.9 7.5 35.0 kinois 265 3 177 9 31 0 29.1 19.8 82.9 41.3 11.4 7.3 12.5 9.6 34.9 ur ana 278 3 18C 9 29,2 28.3 20.9 95.2 45.5 11.5- 7_7 12.5 9.0 35.9 - -- fi --- - ---- owa 244-8 160 4 27.5 27.6 19.6 77.1 36.1 1 10.8 7.9 , 11.4 8.6 33.1 Kansas 243 3 1600 26.5 24.6 17.1 j 78.8 37.7 10.4 7.3 12.1 9.1 31.6 Kentuc:y 304.3 183 6 28.1 29.7 20.1 116.1 51.4 11.3 7.4 12.6 8.8 35.2 Louisiana 314.7 187.5 30.8 30.3 19.9 104.9 44.1 11.1 7.6 I 15.1 10.5 42.1 Maine 2804 1894 28.8 28.5 21.4 ( 88.3 49.5 12 1 7.9 ' 13.2 10.0 33.4 Marylan i 278 5 184 9 31.4 29.5 20.7 86.4 46 1 10.7 6.6 1 13.2 10.0 38.2 Massacht.5eu. 267.9 179.7 30.4 29.6 20.4 76.8 43.5 11.5 7.4 12.6 9.9 33.0 Michig,in 259.5 173.8 29.5 27.1 18.3 81.6 42.3 11.1 7.8 12.0 9.5 34.7 Mlnnesotr 239 0 162.3 27.8 24.4 17.3 64.8 35.3 12.1 8.2 12.1 9.2 35.3 Mississippi 315.4 171.6 28.5 26.0 18.2 112.6 40.3 9.9 6.5 14.4 9.7 46.0 Missouri 2707 176.6 28.4 26.8 19.6 93.8 45.2 11.2 7.5 11.4 9.2 32.2 Montana 242.0 163.8 26.6 23.7 15.6 69.9 41.0 10.3 7.8 12.0 8.1 ( 36.0 Nebraska 237.5 157.2 27.1 28.4 19.2 73.6 34.0 10.8 7.1 11.5 7.9 29.2 Nevada 263.1 187.6 27.9 28.0 18.6 82.6 56.0 10.2 6.3 11.9 9.7 32.8 New ldamp) l,hw 270 2 187.0 29.7 28.2 21.8 797 47.4 11.7 7.5 13.4 9.6 32.9 New Jers� v 265.7 186.2 32.2 30.2 20.9 76.1 42.1 11.8 7.8 12.7 10.2 34.2 New Mex co 219.0 156.3 27.2 22.1 15.6 54.7 31.4 8.1 6.3 10.8 9.1 33.4 New York 248.1 174.2 31.5 28.7 20.0 70.6 38.6 11.0 7.1 13.1 10.0 32.2 North Camli m 283.7 167.9 28.7 25.8 18.2 98.5 38.4 I 10.0 6.6 12.9 9.3 39.9 North Dakota 236,8 156.8 27.2 26.8 17.5 65.1 31.3 10.6 7.6 10.8 8.8 35.5 Ohio 275.3 182.9 30.7 29.5 20.8 89.2 44.9 12.0 7.9 11.8 9.3 34.6 Oklahorn,j 267 9 169.1 27.7 25.0 17.9 96.9 44.0 10.8 7.5 11.5 8.6 31.2 Oregon 245 5 174.1 27.7 23.7 17.0 74.9 46.2 10.9 7.4 10.9 10.1 35.1 Pennsylvania 271 8 179.0 30.9 30.0 21.0 82.8 40.0 11.4 7.7 12.5 9.3 34.6 Rhode Island 2793 184.1 31.0 30.8 20.4 89.5 46.2 11.9 8.0 13.8 9.7 33.9 South Carolina 286.9 170.4 28.6 27.1 18.2 94.9 37.7 9.6 6.5 13.2 10.6 43.2 South Dakota 249.1 158.4 25.2 27.4 19.7 73.6 31.7 12.2 7.7 11.9 8.9 34.9 Tennessee 296.7 175.7 28.5 26.6 18.7 109.2 42.7 11.4 7.5 13.6 9.4 37.1 Texas 260.9 165.0 26.8 25.5 17.2 84.7 40.1 10.5 7.0 12.1 8.9 ( 34.3 Utah 188.3 128.8 24.5 18.8 15.1 35.9 17.6 10.0 6.6 9.4 6.5 37.0 Vermont 268.1 177.9 28.6 28.9 22.6 1 80.3 41.2 12.5 7.7 14.3 8.6 36.0 Virginia 277.3 175.6 29.5 25.9 19.2 90.9 41.9 10.0 7.0 12.4 9.0 39.1 Washington 239.2 171.1 27.1 22.8 16.5 72.2 45.7 10.7 7.4 12.0 9.6 30.4 West Virginia 289.1 186.0 27.6 28.3 20.8 104.7 50.1 10.7 7.4 11.6 7.5 31.9 Wisconsin 252.0 166.2 27.8 26.4 17.9 69.6 36.4 11.9 7.6 12.2 9.3 35.5 Wyoming 240.6 171.0 27.3 25.9 21.1 66.1 38.5 8.0 6.9 11.3 9.1 37.3 United States 259.1 171.4 28.8 26.3 18.5 81.2 41.0 10.8 7.2 12.2 9.3 33.9 *Per 100,000, aqe ac:j,i,,tod to the 2000 US standard population. Source: US Mortalty Puhlic Use Data Tapes 1960-1999, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002. American Cancer Society, Surveillance Research, 2003 8 Ca., :er Facts $, s 20(,1 Breast New cases: An estimated 211,300 new cases of invasive breast cancer are expected to occur among women in the United States during 2003. It is the most frequently diagnosed non -skin cancer in women. Breast cancer incidence rates have continued to increase since 1980, although the rate of increase slowed in the 1990s, com- pared to the 1980s. Furthermore, in the more recent time period, breast cancer incidence rates have increased only in those age 50 and over. About 1,300 new cases of breast cancer are expected in men in 2003. In addition to invasive breast cancer, 55,700 new cases of in situ breast cancer are expected to occur among women during 2003. Of these, approximately 85% will be ductal carcinoma in situ (DCIS). The increase in detec- tion of DCIS cases is a direct result of increased use of screening with mammography, which detects invasive breast cancers before they are palpable, that is, before they can be felt. Deaths: An estimated 40,200 deaths (39,800 women, 400 men) are anticipated from breast cancer in 2003. Breast cancer ranks second among cancer deaths in women. According to the most recent data, mortality rates declined by 1.4% per year during 1989-1995 and by 3.2% afterwards, with the largest decreases in younger women in both whites and African Americans. These decreases are probably the result of both earlier detec- tion and improved treatment. Signs and symptoms: The earliest sign of breast cancer is usually an abnormality that shows up on a mammo- gram before it can be felt by the woman or her health care provider. When breast cancer has grown to the point where physical signs and symptoms exist, these may include a breast lump, thickening, swelling, distor- tion, or tenderness; skin irritation or dimpling; and nip- ple pain, scaliness, ulceration, or retraction. Breast pain is commonly due to benign conditions and is not usually the first symptom of breast cancer. Risk factors: The risk of being diagnosed with breast cancer increases with age. Risk is higher in women who have a personal or family history of breast cancer, biopsy -confirmed atypical hyperplasia, increased breast density, a long menstrual history (menstrual periods that started early and ended late in life), obesity after menopause, recent use of oral contraceptives or post- K menopausal estrogens and progestin, who have never had children or had their first child after age 30, or who consume one or more alcoholic beverages per day. Vigorous physical activity and maintaining a healthy body weight are associated with lower risk. Most data indicate tamoxifen decreases breast cancer risk in women at increased risk, and preliminary data suggest another selective estrogen -receptor modulator, ralox- ifene, does also. The inherited susceptibility genes, BRCA1 and BRCA2, account for approximately 5% of all cases. General screening of the population for mutations of these genes is not recommended. However, screening of women with a strong family history is recommended when adequate counseling is available. Recent findings suggest that prophylactic removal of the breasts in BRCAI and BRCA2 carriers decreases the risk of breast cancer considerably. Recent studies also show that pre- ventive surgery to remove the ovaries and fallopian tubes in premenopausal BRCA1 and BRCA2 carriers reduces the risk of breast cancer. Early detection: Mammography is especially valuable as an early detection tool because it can identify breast cancer at an early stage, usually before physical symp- toms develop. Numerous studies have shown that early detection saves lives and increases treatment options. The declines in breast cancer mortality have been attrib- uted, in large part, to the regular use of screening mam- mography. The American Cancer Society recommends that women age 40 and older have an annual mammo- gram, an annual clinical breast examination by a health care professional (close to and preferably before the scheduled mammogram), and perform monthly breast self-examination. Women ages 20-39 should have a clin- ical breast examination by a health care professional every three years and should perform breast self-exami- nation monthly. When a woman has a suspicious lump or other abnormality on an initial mammogram, further mammographic testing can help determine whether additional tests are needed. Mammography alone does not provide a sufficient assessment. All suspicious lumps should be biopsied for a definitive diagnosis. Treatment: Taking into account the medical circum- stances and the patient's preferences, treatment may involve lumpectomy (local removal of the tumor), with removal of the lymph nodes under the arm if biopsy indicates cancer has spread to the nodes; mastectomy (surgical removal of the breast) and removal of the lymph nodes under the arm if cancer has spread to the nodes; radiation therapy; chemotherapy; or hormone 03- 363 Cancer Facts & Figures 2003 9 10 3ses and Deaths - 2003 Estimates* Estimated New Cases* Male P1,), tte 91,800 14 1t, olon & rectum 72,800!11 Urinary b'addcr 42,200 (6%i Mcl inoina of the skin 29,900 (4%) Nonlodgkin lymp,u>ma 28,300(4%) Kidney 19,500(3%) Oral cavity 18,200(3%) Leukemia 17,900(3%) Pancreas 14,900(2%) All sites ,I175,300 (100% Female Breast 211,300 (32%) ung & bronchus 80,100 (12%) Colon & rectum 74,700 (11%) Uterine corpus 40,100(6%) Ovary 25,400(4%) Nor Hodgkin lymphoma 25,100(4%) Melanoma of the skin 24,300(3%) Thyroid 16,300(3%) Pancreas 15,800(2%) Urinary bladder 15,200(2%) All sites 658,800 (100%) Male Estimated Deaths Female Lung & bronchus 88,400 (31%) Prostate 28,900 (10%) Colon & rectum 28,300 (10%) Pancreas 14,700(5%) Non -Hodgkin lymphoma 12,200(4%) Leukemia 12,100(4%) Esophagus 9,900(4%) Liver 9,200(3%) Urinary bladder 8,600(3%) Kidney 7,400(3%) All sites 285,900 (100%) Lung & bronchus 68,800 (25%) Breast 39,800 (15%) Colon & rectum 28,800 (11%) Pancreas 15,300(6%) Ovary 14,300(5%) Non -Hodgkin lymphoma 11,200(4%) Leukemia 9,800(4%) Uterine corpus 6,800(3%) Brain 5,800(2%) Multiple myeloma 5,500(2%) All sites 270,600 (100%) I - L , al and squamou ::ell ncers and in situ carcinoma except urinary bladder. g t, nay not total 10( t di )unding. 02003, American Cancer Society, Inc., Surveillance Research I Iwtupy. Often, two or more methods are used in combi- ❑nl i n. Numerous studies hove shown that, for early - ,I a'c disease, long-term su r\ ival rates after lumpectomy phi: radiotherapy are similar to survival rates after mod- ified radical mastectomy. 1'at ients should discuss possi- hie uptir;n'rs for the best management of their breast ,ant er kith their phvsici:ms. Significant advances in rctonstniction techniques provide several options for breast reconstruction immediately after mastectomy. While it: is controversial as I() whether ductal carcinoma I n si I u (DCIS) will progress a nd need to be treated, treat- ment options include lumpectomy and radiation ther- ,ipv with or without tom.oxifcn,and mastectomy with or wit hoLrt tamoxifen. Since doctors can't yet distinguish DCIS cancers that will progress from those that won't, I rent merit. of DCIS is recommended to prevent tumor progression. Future studies rising DNA microarrays will probably allow these distinct ions. Survival: The 5 -year relal ive survival rate for localized hreast. cancer has increased from 72% in the 1940s to O-, , 1� today. If the cancer has spread regionally, however, Is ,11 Figures 201 the rate is 78%, and for women with distant metastases the rate is 23%. Survival after a diagnosis of breast cancer continues to decline beyond five years. Survival at 10 years or more is also stage -dependent, with the best survival observed in women diagnosed with early- stage disease. For more information about breast cancer, please inquire about the American Cancer Society's Breast Cancer Facts & Figures 2001-2002 (8610.01) publication and Web site posting. Childhood Cancer New cases: An estimated 9,000 new cases are expected to occur among children aged 0-14 in 2003. Childhood cancers are rare. Deaths: An estimated 1,500 deaths are expected to occur among children aged 0-14 in 2003, about one-third of them from leukemia. Despite its rarity, cancer is the chief cause of death by disease in children between ages 1 and 14. Mortality rates have declined by about 47% since 1975. Early detection: Cancers in children often are difficult to recognize. Parents should make sure their children have regular medical checkups and should be alert to any unusual symptoms that persist. These include an unusual mass or swelling; unexplained paleness and loss of energy; sudden tendency to bruise; a persistent, local- ized pain or limping; prolonged, unexplained fever or ill- ness; frequent headaches, often with vomiting; sudden eye or vision changes; and excessive, rapid weight loss. Childhood cancers include: • Leukemia, which accounts for about 30% of cases in children ages 0-14 (see Leukemia). • Brain and spinal cord cancers (21%), which in early stages may cause headaches, nausea, vomiting, blurred or double vision, dizziness, and difficulty in walking or handling objects. • Neuroblastoma (7.3%), a cancer of the sympathetic nervous system which can appear anywhere but usu- ally occurs in the abdomen as a swelling. • Wilms tumor (5.9%), a kidney cancer which may be recognized by a swelling or lump in the abdomen. • Hodgkin disease (4.4%) and non-Hodgkin lymphoma (4.0%) involve the lymph nodes, but also may spread to bone marrow and other organs. These may cause swelling of lymph nodes in the neck, armpit, or groin. Other symptoms may include general weakness and fever. • Rhabdomyosarcoma (3.4%), the most common child- hood soft tissue sarcoma, can occur in the head and neck area, genitourinary area, trunk, and extremities. • Retinoblastoma (2.8%), an eye cancer, usually occurs in children under age 4. When detected early, cure is possible with appropriate treatment. • Osteosarcoma (2.7%), a bone cancer which may cause no pain at first, in which local swelling is often the first sign. • Ewing sarcoma (1.8%), another type of cancer that usually arises in bone. Treatment: Childhood cancers can be treated by a com- bination of therapies chosen based on the specific type and stage of the cancer. Treatment is coordinated by a team of experts including pediatric oncologists, pedi- atric nurses, social workers, psychologists, and others who assist children and their families. Survival: Five-year survival rates vary considerably, depending on the site: all sites, 77%; neuroblastoma, 69%; brain and central nervous system, 70%; bone and joint, 73%; acute lymphocytic leukemia, 85%; Wilms tumor (kidney), 90%; and Hodgkin disease, 94%. New cases: An estimated 105,500 colon and 42,000 rectal cancer cases are expected to occur in 2003. Colorectal cancer is the third most common cancer in men and women. Incidence rates declined by 1.8% per year during 1985-1995, but stabilized during 1995-99. Research suggests that these declines may in part be due to increased screening and polyp removal, preventing progression of polyps to invasive cancers. Deaths: An estimated 57,100 deaths are expected to occur in 2003, accounting for about 10% of cancer deaths. In contrast to incidence rates, which stabilized in the most recent time period, mortality rates contin- ued to decline for both men and women over the past 15 years, at an average of 1.7% per year. This decrease reflects the decreasing incidence rates from the mid- 1980s to the mid-1990s and improvements in survival. Signs and symptoms: In its early stages, colorectal cancer usually causes no symptoms. Rectal bleeding, blood in the stool, a change in bowel habits, and cramp- ing pain in the lower abdomen may signal advanced disease. Risk factors: The primary risk factor for colorectal cancer is age, with more than 90% of cases diagnosed in individuals over the age of 50. A personal or family his- tory of colorectal cancer or polyps or of inflammatory bowel disease increases colorectal cancer risk. Other risk factors include smoking, alcohol consumption, obe- sity, physical inactivity, high-fat and/or low -fiber diet, as well as inadequate intake of fruits and vegetables. Recent studies have suggested that estrogen (with or without progestin) replacement therapy and non- steroidal anti-inflammatory drugs, such as aspirin, may reduce colorectal cancer risk. Early detection: Beginning at age 50, men and women who are at average risk for developing colorectal cancer should have one of the following: fecal occult blood test (FOBT) annually; or flexible sigmoidoscopy every 5 years; or the combination of annual FOBT and flexible sigmoidoscopy every 5 years (this combination is preferred over either method alone); colonoscopy (if normal, repeat every 10 years), or double-contrast barium enema (if normal, repeat every 5 years). A digital rectal examination should be done at the same time as sigmoidoscopy, colonoscopy, or double-contrast barium 03- 363 Cancer Facts & Figures 2003 11 enema. These tests offer the best opportunity to detect colorectal cancer at an early stage when successful treat- ment is likely, and to prevent some cancers by detection and removal of polyps. People should begin colorectal cancer screening earlier and/or undergo screening more often if they have a personal history of colorectal cancer or adenomatous polyps, a strong family history of colo- rectal cancer or polyps, a personal history of chronic inflammatory bowel disease, or if they are a member of a family with hereditary colorectal cancer syndromes. Treatment: Surgery is the most common form of treat- ment for colorectal cancer. For cancers that have not spread, it is frequently curative. Chemotherapy or chemotherapy plus radiation is given before or after surgery to most patients whose cancer has deeply per- forated the bowel wall or has spread to the lymph nodes. A permanent colostomy (creation of an abdominal opening for elimination of body wastes) is very rarely needed for colon cancer and is infrequently required for rectal cancer. Among chemotherapy options, oxaliplatin in combination with 5 -fluorouracil (5 -FU) followed by leucovorin (LV) is a new treatment regimen for patients with metastatic carcinoma of the colon or rectum whose disease has recurred or progressed during or within six months of completion of first-line therapy with the combination of 5-FU/LV and irinotecan. Adjuvant chemotherapy for colon cancer is equally effective and no more toxic in otherwise healthy patients age 70 and older than in younger patients. Survival: The 1- and 5 -year relative survival rates for patients with colon and rectum cancer are 83% and 62%, respectively. When colorectal cancers are detected at an early, localized stage, the 5 -year relative survival rate is 90%; however, only 37% of colorectal cancers are discov- ered at that stage. After the cancer has spread regionally to involve adjacent organs or lymph nodes, the rate drops to 65%. The 5 -year survival rate for persons with distant metastases is 9%. Survival continues to decline beyond five years to 55% relative survival at 10 years after diagnosis. Leukemia New cases: An estimated 30,600 new cases are expected in 2003, approximately evenly divided between acute and chronic leukemia. Although often thought of as primarily a childhood disease, leukemia is diagnosed 10 times more often in adults than in children. Acute lym- phocytic leukemia accounts for approximately 2,200 of the leukemia cases among children. In adults, the most 12 Cancer Facts & Figures 2003 common types are acute myeloid leukemia (approxi- mately 10,500 cases) and chronic lymphocytic leukemia (approximately 7,300 cases). Incidence of leukemias decreased by 3.0% per year in males and 4.3% in females after the mid-1990s. Deaths: An estimated 21,900 deaths in 2003. Death rates from leukemias also decreased in the 1990s, though at a slower rate. Signs and symptoms: Fatigue, paleness, weight loss, repeated infections, bruising easily, and nosebleeds or other hemorrhages. In children, these signs can appear suddenly. Chronic leukemia can progress slowly with few symptoms. Risk factors: Leukemia affects both sexes and all ages. However, it more commonly occurs in males than in females. Causes of most leukemias are unknown. Persons with Down syndrome and certain other genetic abnormalities have higher incidence rates of leukemia. Myeloid leukemia is caused by cigarette smoking and by certain chemicals such as benzene, a chemical present in gasoline and cigarette smoke. Several types of leukemia are caused by excessive exposure to ionizing radiation. Leukemia also may occur as a side effect of cancer treatment. Certain leukemias and lymphomas are caused by a retrovirus, human T-cell leukemia/lym- phoma virus -I (HTLV-1). Early detection: Because symptoms often resemble those of other, less serious conditions, leukemia can be difficult to diagnose early. When a physician does sus- pect leukemia, diagnosis can be made using blood tests and bone marrow biopsy. Treatment: Chemotherapy is the most effective method of treating leukemia. Various anticancer drugs are used, either in combinations or as single agents. Gleevec (ima- tinib mesylate, formerly known as STI -571) is a highly specific new drug that has been approved by the FDA for the treatment of chronic myeloid (or myelogenous) leukemia, which affects about 4,300 people each year. Antibiotics and transfusions of blood components are used as supportive treatments. Under appropriate con- ditions, bone marrow transplantation may be useful in treating certain leukemias. Survival: Survival rates in leukemia vary by type, rang- ing from 5 -year survival rates of 18.7% for patients with acute myeloid leukemia to 73.1% for patients with chronic lymphocytic leukemia. Overall, the 1 -year rela- tive survival rate for patients with leukemia is 64%. How to Estimate Cancer Statistics Locally, 2003 *For female breast cancer multiply by female population, and for prostate cancer multiply by male population. Note: These calculations provide only a rough approximation of the number of people in a specific community who may develop or die of cancer. These estimates should be used with caution because they do not reflect the age or racial characteristics of the population, access to detection and treatment, or exposure to risk factors. State cancer registries count the number of cancers that occur in localities throughout the state. The American Cancer Society recommends using data from these registries, when it is available, to more accurately estimate local cancer statistics. Data source: DEVCAN Software, Version 4.2; NCI, Surveillance, Epidemiology, and End Results Program, 1973-1999, Division of Cancer Control and Population Sciences, National Cancer Institute, 2002. American Cancer Society, Surveillance Research, 2003 There has been a dramatic improvement in survival for patients with acute lymphocytic leukemia from a 5 -year relative survival rate of 38% in the mid-1970s to 63% in the mid-1990s. Survival rates for children with acute lymphocytic leukemia have increased from 53% to 85% over the same time period. Lung and Bronchus New cases: An estimated 171,900 new cases are expected in 2003, accounting for about 13% of cancer diagnoses. The incidence rate is declining significantly in men, from a high of 102.1 per 100,000 in 1984 to 81.1 in 1999. In the 1990s, the increase among women reached a plateau, with incidence at 52.4 per 100,000 in 1997 and 1998. Deaths: An estimated 157,200 deaths in 2003, account- ing for 28% of all cancer deaths. Lung cancer is the lead- ing cause of cancer death in men and women. Death rates have continued to decline significantly in men since 1990 by about 1.5% to 2.8% per year. After several decades of continuous increase, female lung cancer death rates have leveled off among white women during 1995-1999, but not among African American women. Since 1987, however, more women have died each year of lung cancer than breast cancer, which for the previous 40 years had been the major cause of cancer death in women. Decreasing lung cancer incidence and mortality rates most likely result from decreased smoking rates over the past 30 years. However, decreasing smoking patterns among women lag behind those of men. Declines in adult tobacco use have slowed, as have declines in lung cancer mortality in those under 45 years old. Tobacco use among youth increased considerably during the 1990s, although it declined after 1997. Signs and symptoms: Persistent cough, sputum streaked with blood, chest pain, and recurring pneumo- nia or bronchitis. Risk factors: Cigarette smoking is by far the most important risk factor in the development of lung cancer. Other risk factors include occupational or environmen- tal exposures to substances such as arsenic; some organic chemicals; radon and asbestos (particularly among smokers); radiation exposure from occupational, medical, and environmental sources; air pollution; tuberculosis; and for nonsmokers, environmental tobacco smoke. Early detection: Early detection has not yet been proven to improve survival. Chest x-ray, analysis of cells in sputum, and fiberoptic examination of the bronchial passages have shown limited effectiveness in early lung cancer detection. Newer tests, such as low-dose helical CT scans and molecular markers in sputum, can detect lung cancer earlier. The impact of these screening tests on survival is being evaluated. Treatment: Treatment options are determined by the type and stage of the cancer and include surgery, radia- tion therapy, and chemotherapy. For many localized cancers, surgery is usually the treatment of choice. Because the disease has usually spread by the time it is discovered, radiation therapy and chemotherapy are often needed in combination with surgery. Chemotherapy alone or combined with radiation is the treatment of choice for small cell lung cancer; on this regimen, a large percentage of patients experience remission, which in some cases is long lasting. Survival: The 1 -year relative survival rate for lung cancer has increased from 34% in 1975 to 42% in 1998, 02- 363 Cancer Facts & Figures 2003 13 Multiply community population by: Female Colon & To obtain the estimated number of... All Sites Breast* Rectum Lung Prostate* New cancer cases 0.0047 0.0015 0.0005 .0.0006 0.0016 Cancer deaths 0.0020 0.0003 0.0002 0.0006 0.0002 People who will eventually develop cancer 0.4085 0.1333 0.0580 0.0671 0.1661 People who will eventually die of cancer 0.2126 0.0309 0.0232 0.0542 0.0320 *For female breast cancer multiply by female population, and for prostate cancer multiply by male population. Note: These calculations provide only a rough approximation of the number of people in a specific community who may develop or die of cancer. These estimates should be used with caution because they do not reflect the age or racial characteristics of the population, access to detection and treatment, or exposure to risk factors. State cancer registries count the number of cancers that occur in localities throughout the state. The American Cancer Society recommends using data from these registries, when it is available, to more accurately estimate local cancer statistics. Data source: DEVCAN Software, Version 4.2; NCI, Surveillance, Epidemiology, and End Results Program, 1973-1999, Division of Cancer Control and Population Sciences, National Cancer Institute, 2002. American Cancer Society, Surveillance Research, 2003 There has been a dramatic improvement in survival for patients with acute lymphocytic leukemia from a 5 -year relative survival rate of 38% in the mid-1970s to 63% in the mid-1990s. Survival rates for children with acute lymphocytic leukemia have increased from 53% to 85% over the same time period. Lung and Bronchus New cases: An estimated 171,900 new cases are expected in 2003, accounting for about 13% of cancer diagnoses. The incidence rate is declining significantly in men, from a high of 102.1 per 100,000 in 1984 to 81.1 in 1999. In the 1990s, the increase among women reached a plateau, with incidence at 52.4 per 100,000 in 1997 and 1998. Deaths: An estimated 157,200 deaths in 2003, account- ing for 28% of all cancer deaths. Lung cancer is the lead- ing cause of cancer death in men and women. Death rates have continued to decline significantly in men since 1990 by about 1.5% to 2.8% per year. After several decades of continuous increase, female lung cancer death rates have leveled off among white women during 1995-1999, but not among African American women. Since 1987, however, more women have died each year of lung cancer than breast cancer, which for the previous 40 years had been the major cause of cancer death in women. Decreasing lung cancer incidence and mortality rates most likely result from decreased smoking rates over the past 30 years. However, decreasing smoking patterns among women lag behind those of men. Declines in adult tobacco use have slowed, as have declines in lung cancer mortality in those under 45 years old. Tobacco use among youth increased considerably during the 1990s, although it declined after 1997. Signs and symptoms: Persistent cough, sputum streaked with blood, chest pain, and recurring pneumo- nia or bronchitis. Risk factors: Cigarette smoking is by far the most important risk factor in the development of lung cancer. Other risk factors include occupational or environmen- tal exposures to substances such as arsenic; some organic chemicals; radon and asbestos (particularly among smokers); radiation exposure from occupational, medical, and environmental sources; air pollution; tuberculosis; and for nonsmokers, environmental tobacco smoke. Early detection: Early detection has not yet been proven to improve survival. Chest x-ray, analysis of cells in sputum, and fiberoptic examination of the bronchial passages have shown limited effectiveness in early lung cancer detection. Newer tests, such as low-dose helical CT scans and molecular markers in sputum, can detect lung cancer earlier. The impact of these screening tests on survival is being evaluated. Treatment: Treatment options are determined by the type and stage of the cancer and include surgery, radia- tion therapy, and chemotherapy. For many localized cancers, surgery is usually the treatment of choice. Because the disease has usually spread by the time it is discovered, radiation therapy and chemotherapy are often needed in combination with surgery. Chemotherapy alone or combined with radiation is the treatment of choice for small cell lung cancer; on this regimen, a large percentage of patients experience remission, which in some cases is long lasting. Survival: The 1 -year relative survival rate for lung cancer has increased from 34% in 1975 to 42% in 1998, 02- 363 Cancer Facts & Figures 2003 13 I.agely dne to iorpi-mcin ents in surgical techniques. I1mvever. Ilse 5 -year relative survival rate for all stages combined is only 15q(,. 't'hc survival rate is 49% for cases detected Nyhen the disease is still localized. Only 15% of lung cancers are diagnosed at this early stage. New cases: An estimated 61.000 new cases will occur in 2003. including 7.600 cases of' llodgkin disease and 53.x00 cases of non-Hodgkin lymphoma. Since the early 1970s, incidence rates for non-Hodgkin lymphoma (NI II.) have nearh, doubled. However, incidence rates stahilimcl in the 1990s due primarily to the decline in AIDS-related NI IL. Overall_ incidence rates for Hodgkin disease have declined significantly since the late 1980s at a rate of 0.91;b per year: Deaths: t1n estimated 21,700 deaths will occur in 2003 (non-Hodgkin Ivmphoma. 23,400; Hodgkin disease, Signs and symptoms: Enlarged lymph nodes, itching, fever, night sweats. fatigue. and weight loss. Intermittent fewer can last for several days or weeks. 14 l i; 1 !I l American Cancer Society, Surveillance Research, 2003 Risk factors: Risk factors are largely unknown but in part involve reduced immune function and exposure to certain infectious agents, as well as age. Persons with organ transplants are at higher risk due to altered immune function. Human immunodeficiency virus (HIV) and human T-cell leukemia/lymphoma virus -I (HTLV-I) are associated with increased risk of non- Hodgkin lymphoma. Other possible risk factors include occupational exposures to herbicides and perhaps other chemicals. In Africa, Burkitt lymphoma is partly caused by the Epstein-Barr virus. Treatment: Hodgkin disease: Chemotherapy alone or with radiotherapy is useful for most patients. Non - Hodgkin lymphoma: In the early stage, localized lymph node disease can be treated with radiotherapy. Patients with later -stage disease are treated with chemotherapy or with chemotherapy plus radiation depending on the specific type of non-Hodgkin lymphoma. New treatment programs using highly specific monoclonal antibodies directed at lymphoma cells and high -dose chemother- apy with bone marrow transplantation are being tested in selected patients who relapsed after standard treatment. ,lile Cancers Over Selected Age Intervals, by Sex, US, 1997-1999" Birth to 39 (%) 40 to 59 (%) 60 to 79 (%) Birth to Death (%) 1 in 72) 8.33 (1 in 12) 32.26 (1 in 3) 43.48 (1 in 2) .1 in 51) 9.09 (1 in 11) 22.22 (1 in 5) 38.46 (1 in 3) in 4,165) .41 (1 in 241) 2.33 (1 in 43) 3.45 (1 in 29) „ u,, in 9,367) .13 (1 in 769) .65 (1 in 154) 1.14 (1 in 88) •+ 1 in 228) 4.17 (1 in 24) 7.14 (1 in 14) 13.3 (1 in 8) in 1,617) .88 (1 in 114) 4.00 (1 in 25) 5.88 (1 in 17) - in 1,630) .69 (1 in 145) 3.03 (1 in 33) 5.56 (1 in 18) �> :1 in 639) .20 (1 in 496) .83 (1 in 121) 1.45 (1 in 69) .I in 794) .15 (1 in 687) .45 (1 in 224) 1.02 (1 in 98) in 3,347) 1.09 (1 in 92) 5.88 (1 in 17) 7.69 (1 in 13) in 3,187) .83 (1 in 120) 4.00 (1 in 25) 5.88 (1 in 17) in 791) 50 (1 in 202) .98 (1 in 102) 1.75 (1 in 57) 77 1 in 512) .39 (1 in 256) .51 (1 in 198) 1.23 (1 in 81) ' ( 1 in 658) .46 (1 in 218) 1.25 (1 in 80) 2.13 (1 in 47) 08 i''. in 1,250) .32 (1 in 316) .99 (1 in 101) 1.79 (1 in 56) Fr:ttr f.l,rr Oin 19,299) 2.22 (1 in 45) 13.70 (1 in 7) 16.67 (1 in 6) 17 ( 1 in 584) 32 (1 in 314) .28 (1 in 363) .81 (1 in 123) 01 (1 in 1,881) .73 (1 in 137) 1.59 (1 in 63) 2.70 (1 in 37) h I irterval. Based on cancer cases diagnosed during 1997-1999. 'I", percentage may not be equivalent due to rounding. 4 n cancers and In situ carcinomas except urinary bladder. t 1 1 , Iit .r -i ,s Source: 'L` - fJ, I A )(-d, )in(j or Dying of Cancer Software, Version 4.2. Feuer EJ, Wun LM, I.agely dne to iorpi-mcin ents in surgical techniques. I1mvever. Ilse 5 -year relative survival rate for all stages combined is only 15q(,. 't'hc survival rate is 49% for cases detected Nyhen the disease is still localized. Only 15% of lung cancers are diagnosed at this early stage. New cases: An estimated 61.000 new cases will occur in 2003. including 7.600 cases of' llodgkin disease and 53.x00 cases of non-Hodgkin lymphoma. Since the early 1970s, incidence rates for non-Hodgkin lymphoma (NI II.) have nearh, doubled. However, incidence rates stahilimcl in the 1990s due primarily to the decline in AIDS-related NI IL. Overall_ incidence rates for Hodgkin disease have declined significantly since the late 1980s at a rate of 0.91;b per year: Deaths: t1n estimated 21,700 deaths will occur in 2003 (non-Hodgkin Ivmphoma. 23,400; Hodgkin disease, Signs and symptoms: Enlarged lymph nodes, itching, fever, night sweats. fatigue. and weight loss. Intermittent fewer can last for several days or weeks. 14 l i; 1 !I l American Cancer Society, Surveillance Research, 2003 Risk factors: Risk factors are largely unknown but in part involve reduced immune function and exposure to certain infectious agents, as well as age. Persons with organ transplants are at higher risk due to altered immune function. Human immunodeficiency virus (HIV) and human T-cell leukemia/lymphoma virus -I (HTLV-I) are associated with increased risk of non- Hodgkin lymphoma. Other possible risk factors include occupational exposures to herbicides and perhaps other chemicals. In Africa, Burkitt lymphoma is partly caused by the Epstein-Barr virus. Treatment: Hodgkin disease: Chemotherapy alone or with radiotherapy is useful for most patients. Non - Hodgkin lymphoma: In the early stage, localized lymph node disease can be treated with radiotherapy. Patients with later -stage disease are treated with chemotherapy or with chemotherapy plus radiation depending on the specific type of non-Hodgkin lymphoma. New treatment programs using highly specific monoclonal antibodies directed at lymphoma cells and high -dose chemother- apy with bone marrow transplantation are being tested in selected patients who relapsed after standard treatment. Survival: Survival rates vary widely by cell type and stage of disease. The 1 -year relative survival rates for Hodgkin disease and non-Hodgkin lymphoma are 95% and 77%, respectively; the 5 -year rates are 84% and 55%. Ten years after diagnosis, the relative survival rates for Hodgkin and non-Hodgkin disease decline to 75% and 40%, and the 15 -year survival rates are 68% and 38%, respectively. Oral Cavity and Pharynx New cases: An estimated 27,700 new cases are expected in 2003. Incidence rates are more than twice as high in men as in women and are greatest in men who are over age 50. Incidence rates for cancer of the oral cavity and pharynx continued to decline in the 1990s in both African American and white males and females. Deaths: An estimated 7,200 deaths in 2003. Death rates have been decreasing since the late 1970s. Signs and symptoms: A sore that bleeds easily and does not heal; a lump or thickening; a red or white patch that persists. Difficulties in chewing, swallowing, or moving tongue or jaws are often late symptoms. Risk factors: Cigarette, cigar, or pipe smoking; use of smokeless tobacco; excessive consumption of alcohol. Early detection: Cancer can affect any part of the oral cavity, including the lip, tongue, mouth, and throat. Dentists and primary care physicians can identify abnormal changes in oral tissues and detect cancer at an early, curable stage. Treatment: Radiation therapy and surgery are standard treatments. In advanced disease, chemotherapy may be useful as an adjunct to surgery and/or radiation. Survival: For all stages combined, about 81% of oral cav- ity and pharynx cancer patients survive 1 year after diagnosis. The 5 -year and 10 -year relative survival rates are 56% and 41%, respectively. Ovary New cases: An estimated 25,400 new cases are expected in the United States in 2003. It accounts for nearly 4% of all cancers among women and ranks second among gynecologic cancers, following cancer of the uterine cor- pus. During 1989-1999, ovarian cancer incidence declined at a rate of 0.7% per year. Deaths: An estimated 14,300 deaths are expected in 2003. Ovarian cancer causes more deaths than any other cancer of the female reproductive system. Signs and symptoms: The most common sign is enlargement of the abdomen, which is caused by accu- mulation of fluid. Abnormal vaginal bleeding is rarely a symptom. In women over 40, vague digestive distur- bances (stomach discomfort, gas, distention) that per- sist and cannot be explained by any other cause may indicate the need for an evaluation for ovarian cancer, including a thorough pelvic examination. Risk factors: Risk for ovarian cancer increases with age and peaks in the late 70s. Women who have never had children are more likely to develop ovarian cancer than those who have. Pregnancy, tubal ligation, and the use of oral contraceptives appear to reduce the risk of develop- ing ovarian cancer, while the use of fertility drugs and hormone replacement therapy increases risk. Women who have had breast cancer or have a family history of breast or ovarian cancer are at increased risk. Mutations in BRCA1 or BRCA2 have been observed in these fami- lies. Recent studies suggested that preventive surgery to remove the ovaries and fallopian tubes can decrease the risk of ovarian cancers and other gynecologic cancers in women with BRCA1 and BRCA2 mutations. Another genetic syndrome, hereditary nonpolyposis colon cancer (HNPCC), also has been associated with endometrial and ovarian cancer. Incidence rates are highest in indus- trialized countries other than Japan. Early detection: Periodic, thorough pelvic exams are important. The Pap test, useful in detecting cervical cancer, rarely uncovers early ovarian cancer. Transvaginal ultrasound and a tumor marker, CA125, may help in diagnosis but are not used for routine screening in women at average risk. Research on specific patterns of proteins in the blood may develop more sensitive screening tests in the future, but these are not yet available for clinical use. Treatment: Surgery, radiation therapy, and chemother- apy are treatment options. Surgery usually includes the removal of the uterus (hysterectomy), and one or both ovaries and fallopian tubes (salpingo-oophorectomy). In some very early tumors, only the involved ovary will be removed, especially in young women who wish to have children. In advanced disease, an attempt is made to remove all intra-abdominal disease to enhance the effect of chemotherapy. Survival: Survival varies by age; women younger than 65 years old are about twice as likely to survive 5 years following diagnosis than women 65 and older, 65.8% and 33.2%, respectively. Overall, nearly 80% of new ovarian cancer patients survive 1 year after diagnosis; the 5 -year 03- 363 Cancer Facts & Figures 2003 15 relative survival rate for all stages is 53%. If diagnosed and treated while the disease is localized, the 5 -year survival rate is 95%; however, only about 25% of all cases are detected at the localized stage. Five-year relative survival rates for women with regional and distant disease are 81% and 31%, respectively. Pancreas New cases: An estimated 30,700 new cases in the United States in 2003. Over the past 15 to 25 years, rates of pancreatic cancer have declined slowly in men and women. Deaths: An estimated 30,000 deaths in 2003. The death rate from pancreatic cancer has continued to decline since the early 1970s in men, while it continued to increase in women. However, both the decrease in men and increase in women have slowed in recent years. Signs and symptoms: Cancer of the pancreas generally develops without early symptoms. If a cancer develops in an area of the pancreas near the common bile duct, its blockage may lead to jaundice (yellowing of the skin and eyes due to pigment accumulation). Sometimes this symptom allows the tumor to be diagnosed at an early stage. Risk factors: Cigarette and cigar smoking increase the risk of pancreatic cancer; incidence rates are more than twice as high for smokers as for nonsmokers. Risk also appears to increase with obesity, physical inactivity, chronic pancreatitis, diabetes, and cirrhosis. Pancreatic cancer rates are higher in countries whose populations eat a diet high in fat. Rates are slightly higher in males than in females. Early detection: At present, only biopsy yields a certain diagnosis. Because of the "silent" early course of the disease, the need for biopsy may become obvious only with advanced disease. Researchers are focusing on ways to diagnose pancreatic cancer before symptoms occur. Treatment: Surgery, radiation therapy, and chemother- apy are treatment options that can extend survival and/or relieve symptoms in many patients, but seldom produce a cure. Clinical trials with several new agents may offer improved survival and should be considered an option. Survival: For all stages combined, the 1 -year relative survival rate is 21%, and the 5 -year rate is about 4%. Even for those people diagnosed with local stage disease, the 5 -year relative survival rate is only 17%. 16 Cancer Facts & Figures 2003 Prostate New cases: An estimated 220,900 new cases will occur in the US during 2003. Prostate cancer incidence rates remain significantly higher in African American men than in white men. Between 1988 and 1992, prostate cancer incidence rates increased dramatically, due to earlier diagnosis in men without symptoms, using the prostate-specific antigen (PSA) blood test. Prostate cancer incidence rates subsequently declined and have leveled off, especially in the elderly. In ages under 65 years, however, rates have continued to increase at a less rapid rate. Rates peaked in 1992 among white men (236.4 per 100,00 persons) and in 1993 among African American men (333.6 per 100,000 persons). Deaths: An estimated 28,900 deaths in 2003, the second leading cause of cancer death in men. Although death rates have been declining among white and African American men since the early 1990s, rates in African American men remain more than twice as high as rates in white men. Signs and symptoms: Early prostate cancer usually has no symptoms. With more advanced disease, individuals may experience weak or interrupted urine flow; inability to urinate, or difficulty starting or stopping the urine flow; the need to urinate frequently, especially at night; blood in the urine; pain or burning on urination; or con- tinual pain in lower back, pelvis, or upper thighs. Most of these symptoms are nonspecific and are similar to those caused by benign conditions. Risk factors: The only well-established risk factors for prostate cancer are age, ethnicity, and family history of prostate cancer. More than 70% of all prostate cancer cases are diagnosed in men over age 65. African American men have the highest prostate cancer inci- dence rates in the world; the disease is common in North America and Northwestern Europe and is rare in Asia and South America. Recent genetic studies suggest that strong familial predisposition may be responsible for 5%-10% of prostate cancers. International studies suggest that dietary fat may also be a risk factor. Early detection: The prostate-specific antigen (PSA) test, a blood test used to detect a substance made by the prostate called prostate-specific antigen, and the digital rectal examination should be offered annually beginning at age 50 to men who have a life expectancy of at least 10 years. Men at high risk (African Americans and men who have a first-degree relative diagnosed with prostate cancer at a young age) should begin testing at age 45. *Rates are adjusted for normal life expectancy and are based on cases diagnosed from 1992-1998, followed through 1999. tThe rate for local stage represents local and regional stages combined. Local: An invasive malignant cancer confined entirely to the organ of origin. Regional: A malignant cancer that 1) has extended beyond the limits of the organ of origin directly into surrounding organs or tissues, 2) involves regional lymph nodes by way of lymphatic system, or 3) has both regional extension and involvement of regional lymph nodes. Distant: A malignant cancer that has spread to parts of the body remote from the primary tumor either by direct extension or by discontinuous metastasis to distant organs, tissues, or via the lymphatic system to distant lymph nodes. Source: Surveillance, Epidemiology, and End Results Program, 1973-1999, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, 2002. Patients should be given information about the benefits and limitations of testing so that they can make an informed decision about testing. Treatment: Depending on age, stage of the cancer, and other medical conditions of the patient, surgery and radiation should be discussed with the patient's physi- cian. Hormonal therapy, chemotherapy, and radiation (or combinations of these treatments) are used for metastatic disease. Hormone treatment may control prostate cancer for long periods by shrinking the size of the tumor, thus relieving pain and other symptoms. Careful observation without immediate active treat- ment ("watchful waiting") may be appropriate, particu- larly for older individuals with low-grade and/or early-stage tumors. Survival: Eighty-five percent of all prostate cancers are discovered in the local and regional stages; the 5 -year relative survival rate for patients whose tumors are diag- nosed at these stages is 100%. Over the past 20 years, the survival rate for all stages combined has increased from 67% to 97%. Relative survival after a diagnosis of prostate cancer continues to decline with longer follow- up. According to the most recent data, relative 10 -year survival is 79%, and 15 -year survival is 57%. MV, New cases: More than 1 million cases of highly curable basal cell or squamous cell cancers occur annually. The most serious form of skin cancer is melanoma, which is expected to be diagnosed in about 54,200 persons in American Cancer Society Surveillance Research, 2003 2003. During the 1970s, the incidence rate of melanoma increased rapidly at about 6% per year. Since 1981, how- ever, the rate of increase slowed to a little less than 3% per year. Melanoma is primarily a disease of whites, and rates are more than 10 times higher in whites than in African Americans. Other important forms of skin cancer include Kaposi sarcoma, which commonly occurred among patients with AIDS prior to the intro- duction of protease inhibitors, and cutaneous T-cell lymphoma. Deaths: An estimated 9,800 deaths this year, 7,600 from melanoma and 2,200 from other skin cancers. Melanoma mortality for the more recent period is increasing less rapidly in white men, while it has stabi- lized among white women. Signs and symptoms: Any change on the skin, espe- cially in the size or color of a mole or other darkly pig- mented growth or spot. Scaliness, oozing, bleeding, or change in the appearance of a bump or nodule; the spread of pigmentation beyond its border; a change in sensation, itchiness, tenderness, or pain. Risk factors: Excessive exposure to ultraviolet radiation from sunlight or tanning lamps; fair complexion; occu- pational exposure to coal tar, pitch, creosote, arsenic compounds, or radium; family history; and multiple or atypical nevi (moles). Prevention: Limit or avoid exposure to the sun during the midday hours (10 a.m.- 4 p.m.). When outdoors, wear a hat that shades the face, neck, and ears, and a long- 03- 363 Cancer Facts & Figures 2003 17 All Stages Local Regional Distant All Stages Local Regional Distant Site % % % % Site % % % % Breast (female) 86 97 78 23 Ovary 53 95 81 31 Colon & rectum 62 90 65 9 Pancreas 4 17 7 1 Esophagus 13 27 13 2 Prostatet 97 100 - 34 Kidney 62 90 60 9 Stomach 22 59 22 2 Larynx 64 82 51 38 Testis 95 99 95 74 Liver 7 15 6 2 Thyroid 96 99 95 44 Lung & bronchus 15 49 22 3 Urinary bladder 82 94 48 6 Melanoma 89 96 60 14 j Uterine cervix 71 92 51 15 Oral cavity 56 82 47 23 ( Uterine corpus 84 96 64 26 *Rates are adjusted for normal life expectancy and are based on cases diagnosed from 1992-1998, followed through 1999. tThe rate for local stage represents local and regional stages combined. Local: An invasive malignant cancer confined entirely to the organ of origin. Regional: A malignant cancer that 1) has extended beyond the limits of the organ of origin directly into surrounding organs or tissues, 2) involves regional lymph nodes by way of lymphatic system, or 3) has both regional extension and involvement of regional lymph nodes. Distant: A malignant cancer that has spread to parts of the body remote from the primary tumor either by direct extension or by discontinuous metastasis to distant organs, tissues, or via the lymphatic system to distant lymph nodes. Source: Surveillance, Epidemiology, and End Results Program, 1973-1999, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, 2002. Patients should be given information about the benefits and limitations of testing so that they can make an informed decision about testing. Treatment: Depending on age, stage of the cancer, and other medical conditions of the patient, surgery and radiation should be discussed with the patient's physi- cian. Hormonal therapy, chemotherapy, and radiation (or combinations of these treatments) are used for metastatic disease. Hormone treatment may control prostate cancer for long periods by shrinking the size of the tumor, thus relieving pain and other symptoms. Careful observation without immediate active treat- ment ("watchful waiting") may be appropriate, particu- larly for older individuals with low-grade and/or early-stage tumors. Survival: Eighty-five percent of all prostate cancers are discovered in the local and regional stages; the 5 -year relative survival rate for patients whose tumors are diag- nosed at these stages is 100%. Over the past 20 years, the survival rate for all stages combined has increased from 67% to 97%. Relative survival after a diagnosis of prostate cancer continues to decline with longer follow- up. According to the most recent data, relative 10 -year survival is 79%, and 15 -year survival is 57%. MV, New cases: More than 1 million cases of highly curable basal cell or squamous cell cancers occur annually. The most serious form of skin cancer is melanoma, which is expected to be diagnosed in about 54,200 persons in American Cancer Society Surveillance Research, 2003 2003. During the 1970s, the incidence rate of melanoma increased rapidly at about 6% per year. Since 1981, how- ever, the rate of increase slowed to a little less than 3% per year. Melanoma is primarily a disease of whites, and rates are more than 10 times higher in whites than in African Americans. Other important forms of skin cancer include Kaposi sarcoma, which commonly occurred among patients with AIDS prior to the intro- duction of protease inhibitors, and cutaneous T-cell lymphoma. Deaths: An estimated 9,800 deaths this year, 7,600 from melanoma and 2,200 from other skin cancers. Melanoma mortality for the more recent period is increasing less rapidly in white men, while it has stabi- lized among white women. Signs and symptoms: Any change on the skin, espe- cially in the size or color of a mole or other darkly pig- mented growth or spot. Scaliness, oozing, bleeding, or change in the appearance of a bump or nodule; the spread of pigmentation beyond its border; a change in sensation, itchiness, tenderness, or pain. Risk factors: Excessive exposure to ultraviolet radiation from sunlight or tanning lamps; fair complexion; occu- pational exposure to coal tar, pitch, creosote, arsenic compounds, or radium; family history; and multiple or atypical nevi (moles). Prevention: Limit or avoid exposure to the sun during the midday hours (10 a.m.- 4 p.m.). When outdoors, wear a hat that shades the face, neck, and ears, and a long- 03- 363 Cancer Facts & Figures 2003 17 White African American All Races Relative 5 -Year Survival Rate i I Relative 5 -Year Survival Rate i Relative 5 -Year Survival Rate M Site 1974-76 1983-85 1992-98i 1974-76 1983-85 1992-98 1974-76 1983-85 1992-98 SII 39 40 53t 50 — 52 62 27 32 40t 22-_-27 32t 5d 1,n I: 5;81- 63 63 73t 75 78 86t t 64 60 60 69 69 71t f 46 49 --� 53t 50 58 62t 86t 1 61 54 61 88 83 84t 15t 4 6 8t 5 8 13t 69 77 77t 71 79 84t K ���,, �� 2t 49 55 60t 52 56 62t 60 55 54- 66 67 64 -17t 31 34 38 34 41 46t 7f 1 4 4t 4 6 7t 1 15t 11 11 12t12 14 15t 89t 67t 74§ 66t 80 85 89t 3Ct 28 31 33 24 28 30t TS =1 56t 49 45 46 47 54 55t 59t 36 35 35 53 53 56t =1C 531 i 41 42 53t 37 41 53t P,1 - 4t 3 5 4 3 3 4t Pig ,t,tt„ �8 7( 98t 58 64 93t 67 75 97t E<:ung �q 5E1 62t 42 44 53t 49 55 62t Slrn,rl _ 1C 21t 17 19 20� 15 17 22t T, t i,, /9 9" 96t 76t 881 85 j 79 91 95t h,,,roui 97 97 96t ( 88 92 93 92 93 96t Unu11s hl,iddol 74 78 82t 48 60 65t 73 78 821 I.° .W A, 1 ISS � V to Ir, t n,_, ir, are based on cases diagnosed from 1974-76, 1983-85, and 1992-1998, and followed through t ,, i(_i is statistically significant (p <0.05). �n:km: _ .. . i ;I ,,t" i) C percentage points. s. , ' , of , I 11,11 ,s p i,c thou '0 percentage points. Source: i.; r i H,j in :6 rl, i � i t w Re iit� P ogrem, 1973-1999, Division of Cancer Control and Population Sciences, National Cancer Institute, slecved Sliirl and long pants. Wear sunglasses to protect the skin around the eves. 1'se a sunscreen with a sun prrrleCfiOn factor (SI'I) of 15 or higher. because severe sunburns in childhood mar greatly increase risk of melanonw in later life. children. in particular, should be prof ccicd 1) 0111 I he scut. Early deleclion: bccognition of changes in skin Ormolis or the appearance of new growths is the best vvav 10 find early slain Cancer. Adults Should practice skin sell-cVaminat ion regular N. Suspicious lesions shouldbe evalnal ed prompt Iv by a physician. basal and squamous cell slain cancers often Cake the Conn of a pale, waxlike, pearly nodule% or a red. scale. sharply outlined patch. A sudden or pr0tiressive change in a lesion's appearance should be, checked by a phvsician. wlelanomas often start as small, molcdil:c growths that increase in size 18 American Cancer Society Surveillance Research, 2003 and change color. A simple ABCD rule outlines the warning signals of melanoma: A is for asymmetry: one half of the mole does not match the other half, B is for border irregularity: the edges are ragged, notched, or blurred; C is for color: the pigmentation is not uniform, with variable degrees of tan, brown, or black; D is for diameter greater than 6 millimeters. Any sudden or pro- gressive increase in size should be of concern. Treatment: Treatment for basal cell cancer and squa- mous cell cancer includes surgical treatments in 90% of cases, such as electrodessication (tissue destruction by heat), cryosurgery (tissue destruction by freezing), and laser therapy for early skin cancer. Radiation therapy is also an option in some cases. For malignant melanoma, the primary growth must be adequately excised, and it may be necessary to remove nearby lymph nodes. Removal and microscopic examination of all suspicious moles is essential. Advanced cases of melanoma are treated with immunotherapy or chemotherapy. Survival: For basal cell or squamous cell cancers, cure is highly likely if detected and treated early. Melanoma can spread to other parts of the body quickly. When detected in its earliest stages and treated properly, however, it is highly curable. The 5 -year relative survival rate for patients with melanoma is 89%. For localized mela- noma, the 5 -year relative survival rate is 96%; survival rates for regional and distant stage diseases are 60% and 14%, respectively. About 82% of melanomas are diag- nosed at a localized stage. New cases: An estimated 57,400 new cases in 2003. Bladder cancer incidence rates declined from 1987 to 1999 in males, while they have stabilized for the last 25 years in females. Overall, bladder cancer incidence is nearly four times higher in men than in women, and 1.5 times higher in whites than in African Americans. Deaths: An estimated 12,500 deaths will occur in 2003. Mortality rates have continued to decrease since the 1970s among African Americans, while rates have stabi- lized since the late 1980s among whites. Signs and symptoms: Blood in the urine; usually asso- ciated with increased frequency of urination. Risk factors: Smoking is the greatest risk factor for bladder cancer. Smokers experience twice the risk of nonsmokers. Smoking is estimated to be responsible for about 48% of bladder cancer deaths among men and 28% among women. People living in urban areas and workers in dye, rubber, or leather industries also have a higher risk. Early detection: Bladder cancer is diagnosed by exami- nation of cells in the urine and examination of the blad- der wall with a cystoscope, a slender tube fitted with a lens and light that can be inserted through the urethra. Treatment: Surgery, alone or in combination with other treatments, is used in more than 90% of cases. Superficial, localized cancers may also be treated by administering immunotherapy or chemotherapy directly into the bladder. Chemotherapy alone or with radiation before cystectomy (bladder removal) has improved some treatment results. Survival: When diagnosed at a localized stage, the 5 - year relative survival rate is 94%; 74% of cancers are detected this early. For regional and distant stages, 5 - year relative survival rates are 48% and 6%, respectively. Beyond five years, survival continues to decline, with 76% of patients surviving 10 years after diagnosis, and 66% surviving 15 years. New cases: An estimated 12,200 cases of invasive cervi- cal cancer are expected to be diagnosed in 2003. Incidence rates have decreased steadily over the past several decades. In 1995-1999, the incidence rate in African American women (13.6 per 100,000) was higher than the rate in white women (8.1 per 100,000). As Pap screening has become more prevalent, pre -invasive lesions of the cervix are detected far more frequently than invasive cancer. Deaths: An estimated 4,100 cervical cancer deaths in 2003. Mortality rates have also declined sharply over the past several decades. Signs and symptoms: Symptoms usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue. When this happens, the most com- mon symptom is abnormal vaginal bleeding. Bleeding may start and stop between regular menstrual periods, or it may occur after sexual intercourse, douching, or a pelvic exam. Menstrual bleeding may last longer and be heavier than usual. Bleeding after menopause also may be a symptom of cervical cancer. Increased vaginal dis- charge is another symptom of cervical cancer. Risk factors: Cervical cancer risk is closely linked to sexual behavior and to sexually transmitted infections with certain types of human papilloma virus. Women who have sex at an early age, many sexual partners, or have partners who have had many sexual partners are at higher risk of developing the disease. Cigarette smoking increases cervical cancer risk. Early detection: The Pap test is a simple procedure that can be performed by a health care professional as part of a pelvic exam. A small sample of cells is collected from the cervix, transferred to a slide, and examined under a microscope. Screening should begin about three years after a woman begins having sexual intercourse, but no later than age 21. Screening should be done annually with regular Pap tests or every two years using liquid - based tests. For women age 30 and over who have had three tests in a row with normal findings, the Pap test may be performed every 2-3 years. However, doctors may suggest a woman get screened more often if she has certain risk factors, such as HIV infection or a weak immune system. Most women age 70 and older who Cancer Facts & Figures 2003 19 have had several recent normal Pap tests, and most women who have had a total hysterectomy, do not need to continue screening. Treatment: For preinvasive lesions, changes in the cervix may be treated by electrocoagulation (the destruction of tissue through intense heat by electric current), cryotherapy (the destruction of cells by extreme cold), or laser ablation, or by local surgery. Inva- sive cervical cancers generally are treated by surgery or radiation, or both, as well as chemotherapy in some cases. Survival: Survival for patients with preinvasive lesions is nearly 100%. Eighty-nine percent of cervical cancer patients survive 1 year after diagnosis, and 71% survive 5 years. When detected at an early stage, invasive cervi- cal cancer is one of the most successfully treatable cancers with a 5 -year relative survival rate of 92% for localized cancers. Whites are more likely than African Americans to have their cancers diagnosed at this early stage. Fifty-six percent of invasive cervical cancers among white women and 46% of cancers among African American women are diagnosed at a localized stage. Uterine Corpus (Endometrium) New cases: An estimated 40,100 cases of cancer of the uterine corpus (body of the uterus), usually of the endometrium or lining of the uterus, are expected to be diagnosed in 2003. After declining between the mid- 1970s and 1980s, incidence rates of endometrial cancer increased by about 0.6% per year from 1988 to 1999. Incidence rates are higher among white women (26.0 per 100,000) than African Americans (17.7 per 100,000) and every other racial/ethnic group. Deaths: An estimated 6,800 deaths in 2003. Although incidence rates are higher among white women than African American women, the relationship is reversed for mortality rates. African American women have mor- tality rates that are nearly twice as high as rates among white women (7.0 per 100,000 compared to 3.9 per 100,000). 20 Cancer Facts & Figures 2003 Signs and symptoms: Abnormal uterine bleeding or spotting is a frequent early sign. Pain and systemic symptoms are late symptoms. Risk factors: High cumulative exposure to estrogen is the major risk factor for endometrial cancer, the most common type of cancer of the uterine corpus. Factors that increase estrogen exposure include estrogen replacement therapy, tamoxifen, early menarche, late menopause, never having children, a history of failure to ovulate, and obesity. Progesterone plus estrogen replace- ment therapy (called hormone replacement therapy, or HRT) is believed to largely offset the increased risk related to HRT using only estrogen. Research has not implicated estrogen exposures in the development of the other types of uterine corpus cancer, which are more aggressive and have a poorer prognosis. Other risk fac- tors for uterine corpus cancer include infertility and hereditary nonpolyposis colon cancer (HNPCC). Pregnancy and the use of oral contraceptives appear to provide protection against endometrial cancer. Early detection: Most endometrial cancer is diagnosed at an early stage because of post -menopausal bleeding. All women are encouraged to report any unexpected bleeding or spotting to their physicians. Annual screen- ing for endometrial cancer with endometrial biopsy beginning at age 35 should be offered to women with or at risk for HNPCC. Treatment: Uterine corpus cancers are usually treated with surgery, radiation, hormones, and/or chemother- apy, depending on the stage of disease. Survival: The 1 -year relative survival rate for endome- trial cancer is 93%. The 5 -year relative survival rate is 96%, 64%, and 26%, if the cancer is diagnosed at local, regional, and distant stages, respectively. Relative sur- vival rates for whites exceed those for African Americans by about 15 percentage points at every stage. The devastating effects of tobacco use on the health and welfare of modern society are now widely recognized. 1, 2 In the United States, cigarette smoking alone causes approximately 30% of cancer deaths and a total of 440,000 premature deaths annually, most from lung and other cancers, ischemic heart disease, stroke, and chronic obstructive lung disease.3 An estimated $157 billion in annual health-related economic losses are also attributable to smoking.3 Less well recognized is that two parallel strategies can effectively prevent much of the current and future epi- demic of death from tobacco use. First, long-term suc- cess in ending the epidemic depends on reducing the uptake of smoking and other forms of tobacco use among adolescents through a variety of policy measures that are proving effective in states such as California, Massachusetts, Oregon, Arizona, and Florida.2, 4 Second, in the short term and for the 46.5 million Americans who are already addicted to tobacco, immediate efforts are needed to increase cessation and to help smokers quit at an earlier age. Many of the detrimental effects of smoking can be prevented or reversed by quitting smok- ing. Successful treatment of tobacco dependence has been proven to increase cessation rates and can, if widely implemented, substantially reduce tobacco - attributable deaths during the first half of the 21st century. To accomplish this and to meet the American Cancer Society's 2015 goals,5 vigorous support for tobacco cessation is critical. This special section discusses advances in our under- standing of tobacco dependence and treatment and current information on smoking cessation in the US. It presents various strategies and suggests policies that, if acted on appropriately, have the potential to increase smoking cessation rates and to prevent millions of pre- mature deaths from smoking. Its purpose is to stimulate concerted action on the part of individuals, clinicians, health care delivery systems, employers, and policy mak- ers, and to urge the integration of cost-effective treat- ment of tobacco dependence into standard medical practice. Individuals vary in the importance they place on dif- ferent benefits from quitting smoking or ending their dependence on other forms of tobacco. Motivating factors6 include: • Escaping the high cost of addiction ($1,800-$3,000 annually, assuming a pack-a-day habit) • Ending the embarrassment of being dependent • Living long enough to achieve certain ambitions and lifetime milestones • Avoiding abandonment of one's spouse and family because of premature death • Providing a positive example for children and others Figure 1. Probability of Dying Between Ages 35 and 69 by Smoking Status and Age at Quitting 100 100 Men Women 80 - 80 7- 60 60 ! Former smoker Former smoker Z M 0 40 40 CL 20 20 0 0 Never Quit age Quit age Quit age Quit age Continuing Never Quit age Quit age Quit age Quit age Continuing smoked <40 40-49 50-59 >_60 smoker smoked <40 40-49 50-59 z60 smoker Other cause of death - Lung cancer Note: CPS -II probabilities adjusted to 1990 US mortality. Lung cancer probabilities affected by other causes of death. 03- 363 Cancer Facts & Figures 2003 21 Al • Reducing the fear of the diseases caused by smoking • Eliminating tobacco exposure of the fetus during preg- nancy and of babies during early infancy People who quit smoking live longer than those who continue to smoke. Figure 1 compares the probability of dying from lung cancer or other causes during middle age (between 35 to 69 years of age) in current cigarette smokers, in former smokers who quit smoking at various ages, and in persons who have never smoked. More than one-third (38%) of men who continue to smoke will die during middle age compared with 22% of never smokers and 23% of former smokers who quit before age 40. A similar difference in the risk of death in middle age is seen when comparing women who currently smoke (25%) to those who have never smoked or quit before age 40 (15%). (See Figure 1, page 21.) People who stop smoking at younger ages experience the greatest health benefits from cessation; those who quit by age 35 avoid 90% of the risk attributable to tobacco.? However, even smokers who quit after age 50 substantially reduce their risk of premature death. The argument that it is too late to quit smoking because the damage is already done is untrue. For most tobacco users, addiction to tobacco is a true drug dependence, comparable in severity to the depend- ence caused by opiates, amphetamines, and cocaines Furthermore, tobacco dependence is a chronic, relaps- ing condition that warrants repeated clinical interven- tion, just as other addictive disorders do. Only about 5% of smokers who had smoked every day or some days were able to quit and maintain abstinence for 3-12 months.9 Consequently, repeated attempts, multiple approaches, and ongoing support are essential to achieving and maintaining abstinence. An estimated 44.3 million adults (24.7 million men and 19.7 million women) in the United States were former smokers in 2000.9 In 2000, 48.8% of US adults who ever smoked cigarettes had stopped smoking. Historically, the percentage of former smokers has been lower among blacks (37.3%), Hispanics (42.9%), persons aged 18 to 24 years (22.4%) and aged 25 to 44 years (34.8%), and those with less education, e.g., a GED diploma, (33.6%) than among whites, persons who are older, and those who have higher educational status (Table 1). 22 Cancer Facts & Figures 2003 Figure 2 (page 23) illustrates that the so-called "quit ratio" (percentage of ever smokers who have quit) has increased since 1965, especially among more educated smokers, and in persons aged 45 years and older. The quit ratio has historically been lower in women than in men, and in African Americans than in whites and Hispanics. However, as shown in Figure 2-13, the quit ratios in women and men have converged over time, so that about half of all persons who ever smoked regularly are now former smokers. Although these data indicate that quitting is possible, they also reveal that many smokers quit at older ages when the benefits are smaller. Further, it illustrates that cessation trends continue to lag among African Americans and those who are less educated. Table 1. Percentage of Ever Smokers' Who Quit - National Health Interview Survey, United States, 2000 Characteristic Percent Total 48.8 Sex 42.9 Male 50.0 Female 47.3 Race/ethnicity White, non -Hispanic 51.0 Black, non -Hispanic 37.3 Hispanic 42.9 American Indian/Alaska Nativet 40.9 Asiant# 44.7 Age groups 18-24 22.4 25-44 34.8 45-64 55.6 65 or greater 80.1 Education 0-12 years (no diploma) 47.1 High school equivalency test (GED) 33.6 12 years (diploma) 46.4 Associate degree 53.7 Some college 52.1 Undergraduate degree 64.0 Graduate degree 74.4 *Smoked >=100 cigarettes during their lifetime. t Estimates may be imprecise due to small sample size. #Does not include Native Hawaiians and other Pacific Islanders. Source: Data from National Health Interview Survey, 2000, National Center for Health Statistics, Centers for Disease Control and Prevention.9 Smoking cessation programs protide large health lmne- fits at a relatively lore cost and are cost eflectivc at the population level.10 :111 analysis of I:hce cost. eflectincncss C. By Education Level and Year D. By Race/Ethnicity and Year of implementing the 1996 Agency for Health Care Policy and Clinical Practice Guideline for Cessation$ revealed that cost per quality -adjusted -life -year saved ranged 6-om $1,108-$4,542.11 The cost is substantially less than the $61,744 for annual mammography for women aged 40-<19 years and $23,335 for hypertension screening in 40-vear-old men." These calculations do not take into accotmt. the higher costs of medical care and hospital- ization among smokers compared to nonsmokers. It has been estimated that the savings that result from reduced health care costs would more than pay for effec- tive cessation interventions within three to four years.12, 1� Moreover, studies of cost effectiveness tell us that the "cost. per quitter" for the most successful interventions (intensive counseling, with nicotine gum) are less than the "cost per quitter" of minimal interventions. Thus, growing evidence suggests that employer-sponsored and government -funded health plan coverage of coun- seling and pharmacotherapy to help patients quit smol:ina is beneficial from a cost, as well as a health, perspective.12,13 I ,e Treatments for Tobacco I 1 Jence Physician intervention: Even brief counseling by a ptniarr care physician or other health care professional during [lie course of a regular medical encounter can effectively encourage smokers to quit.14 Health care prm ider counseling may be as simple as advising a srnol,er to quit, or as complex as using computers to tailor the intervention to the individual smoker. The c�senlial features of individual smoking cessation kidv ice Iw health care providers are known as the 5 As: &'s-.._._. for Provider Interv�i in ng Cessation Ask I; )ut tobacco use Identify and document tobacco use status for every patient at every visit. Advise +o quit In a clear, strong, and personalized manner, urge every tobacco user to quit. Assess ,villingness During the visit, determine a quit attempt whether the tobacco user is willing to make a quit attempt this time. Assist i quit attempt For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help them. Arrange follow up Schedule follow-up contact, preferably within the first week after the quit date. 03- .3 Cancer Facts & Figures 2003 23 Therapy First line (FDA approved) Bupropion (Zyban(R)). i l , Nicotine gum: I b� iar; it e , than "'D to A'✓a ksbillw Ovi -i ; u h Nicotine inhaler: T d, Ic nicotineto re rroul r In'r>_ic ,1 oar tn to plas-i( carli.kjt Ivto,�; of tho rio)tine a✓ _.'.o J e iio, lh w, throal, whe a it i> ab,oi red thro,agh t[j,, n i.sx ^embiai r; Common side effects include throat arc ii Ili iiitatioi� ai d coughing. Anyone with bronchial problems should .tse vrith caution. Availability: Piescripton ony with a doctor consul ation Nicotine nasal spray: -the comes it a pump hottic containing nicotine that tobacco users can inhale when they have an urge to smoke. This product i no, recommended 101- People orpeople with nasal or sinus conditions, allergies, or asthma, nor is it recommended for young tobacco,asers. Availability Prescription only with a doctor consul.ation Nicotine patch: Patch supplies a steady ainount of nicotine to the body through the skin, and it is sold in varying strength; as an 8 -week smoking cessation treatment. Nicotine doses can be regularly lowered as the treatment progresses or given as a steady dose during treatment. The nicotine patch may not be a good choice for people with skin problems or allergies to adhesive tape. Availability: Either OTC or by prescription with a doctor consultation Second line (not FDA approved) Clonidine: Evidence suggests that clonidine is capable of improving smoking cessation rates. Although it may reduce craving for cigarettes after cessation, it does not consistently ameliorate other withdrawal symptoms. Side effects such as drowsiness, dizziness, or dry mouth may occur. Availability. Prescription only for both the patch and oral formulation Nortriptyline: Evidence suggests that this drug is effective in smoking cessation. However, this form of antidepressant may produce a number of side effects, including drowsiness and dry mouth. Availability: Prescription only with a doctor consultation Approx. _.stimated Abstinence Cost per Day Proportion* Duration. (in 2000) (95% C.Lt) 1 22.8 -t n 4, 29.2) 3-6 month $5. 0 f r,_ 30.5 12 do yes )i 8, 39.2) 4 viieeks; $=t 7_t 17.7 Tei- 2 wec1 s; 16.0, 19.5) then 2 weeks 8 weeks Sx 51 3-10 weeks $0.24 for 25.6 0.2 nut (oral (17.7, 33.6) torrnulation) S3-50 {o. a patch 12 vveeks $0.74 for 30.1 75 ilig (18,1, 41.6) *The estimated abstinence proportion was derived from a statistical wet „^v yis of publishes I ,t it ,H the le studies gar ,i s' I ve months of follow-up after the quit attempts and included a placebo group. tConfidence Interval (0): A range of possible values for the estimated i.jportion. A 95% CI , it n the t ea ,, uI 00 samples surveyed. A 95% Cl is commonly reported. Sources: This table contains brief descriptions and was adapted from pull shed medical artiO Pries , ,eie ba,ccl o t I t-,il I i, I,) ata national chain pharmacy located in Madison, Wisconsin, April 2000. 24 ;:r,lwic r Facts & Figures 2003 Physician counseling motivates individual smokers to consider the adverse effects of smoking and to become receptive to change. Most smokers cannot stop without more intensive help. Persons for whom physician coun- seling is most important in motivating cessation are heavy smokers who are at the greatest risk of smoking- related diseases. Because over 70% of smokers visit a physician each year, clinicians have repeated opportunities to influence their patients' tobacco dependence.15 However, many health care providers neglect these opportunities. Data from the 2000 National Health Interview Survey show that only 33% of all adults who talked to a doctor or health care professional within the previous year were asked if they smoked or used tobacco. Of current smokers or those who have quit smoking within the past 12 months, 51% were advised to quit smoking or encouraged to remain abstinent by their health care providers. Of those smokers who would like to quit and who have visited a health care provider within the past year, 58% were counseled on smoking cessation. Thus, low rates of appropriate tobacco cessation counseling by clinicians and other health care professionals are a continuing problem in primary health care. A Healthy People 2010 objective calls for increasing to 85% the proportion of primary care providers who counsel at -risk patients about tobacco cessation, physical activity, and cancer screening.16 Achieving this goal will require the further education of individual clinicians on effective treatment methods and dedication to tobacco dependence treat- ment.17 It will also require the commitment of health care administrators, insurers, and purchasers to institu- tionalize effective tobacco dependence treatment and a continued emphasis by medical organizations on improving effective tobacco dependence practices. (See the Role of the Health Care Delivery System in Smoking Cessation, next column.) Drug therapy: The treatment of tobacco dependence involves both effective pharmacological interventions and community/behavioral support. Although patients often relapse and require repeated interventions, effec- tive treatments can produce long-term abstinence. All patients attempting to quit should be encouraged to use effective pharmacotherapies except in the presence of specific contraindications.8 There are five first-line, FDA -approved drug therapies for tobacco dependence: sustained -release bupropion hydrochloride (Zyban®), nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patch (see Table 2). The evidence is strong and consistent that pharmacologic treatments for smoking Table Cessation Methods Current Former Smokers (%)* Smokers (%)* Followed recommended 15.1 6.8 therapy (drug therapy and/or counseling) Quit "cold turkey" or 82.4 91.4 slowly decreased amount smoked Other 2.5 2.1 *Weighted percents are age-adjusted; data for the analyses were derived from the National Health Interview Survey, 2000, National Center for Health Statistics, Centers for Disease Control and Prevention. cessation can help people to quit smoking.8, 18 Second - line treatments for smoking cessation, such as clonidine hydrochloride and nortriptyline hydrochloride, are recommended,8 but have not yet been approved by the FDA for this purpose.8,13 Counseling: Counseling and behavioral therapies that are especially effective in treating tobacco dependence include practical counseling in problem -solving skills and social support. Counseling can be provided by tele- phone and in individual or group settings. Behavioral counseling therapies achieve long-term abstinence in 12%-18% of smokers in a single quit attempt.19 Despite the availability of effective drug and behavioral therapies to facilitate smoking cessation, recent data show that these are substantially underutilized. Only 15% of current smokers and 6.8% of former smokers report using any of these recommended therapies at their last quit attempt. The majority of persons who attempt to quit smoking cite "will power" alone to decrease the number of cigarettes smoked, or they quit "cold turkey" (see Table 3). In addition, it appears that many smokers trying to quit by using over-the-counter cessation aids (i.e., nicotine patches and gums) are not using these products appropriately. This makes success- ful quitting more difficult.20 The Role of the Health Care Delivery System in Smoking Cessation There is increasing evidence that the success of treat- ment for tobacco dependence depends upon coordi- nated efforts by the health care system21 and not just on the individual efforts of doctors or patients. Recently, the US Surgeon General released recommendations for systems change to health care administrators, insurers, C"j- 363 Cancer Facts & Figures 2003 25 managed-care organizations, and purchasers. These rec- health promotion programs (including worksite cessa- ommendations include the following six strategies:22 tion programs) can improve a firm's profitability by • Every clinic should implement a tobacco -user identi- reducing health care costs, absenteeism, and other fication system, personnel costs.27 • All health care systems should provide education, resources, and feedback to promote provider interventions. • Clinics should dedicate staff to provide tobacco dependence treatment and assess the delivery of this treatment in staff performance evaluations. • Hospitals should promote policies that support and provide tobacco dependence services. • Insurers and managed care organizations (MCOs) should include tobacco dependence treatment (both counseling and pharmacotherapy) as paid or covered services for all subscribers or members of health insur- ance packages. • Insurers and MCOs should reimburse clinicians and specialists for delivery of effective tobacco depend- ence treatment and include these interventions among the defined duties of clinicians. fim '# - • ♦ • • LWWMMMSJA��� The two most effective measures that employers can adopt to encourage smoking cessation are to restrict or ban smoking in the workplace,L3 and to provide help to employees who want to quit. Recent survey data indi- cate that 69% of US workers employed indoors outside the home had smoke-free workplaces.24 While smoke- free workplaces protect nonsmokers, they also create environments that encourage smokers to cut back or quit.23, 25 Studies show that employees in workplaces with smoking bans have higher rates of smoking cessa- tion than employees in worksites where smoking is permitted.26 It is estimated that if all workplaces became smoke-free, the per -capita consumption of cigarettes across the United States would decrease by 4.5% per year.23 Employers can also support smoking cessation efforts by providing access to information and worksite cessa- tion programs on- or off-site. Employers could provide flexible work hours so that an employee who smokes could participate in ongoing worksite cessation pro- grams. Further, employers could ensure that tobacco dependence treatments are a covered benefit in their sponsored health plans. Growing evidence suggests that „,' sir �_ •'! 26 Cancer Facts & Figures 2003 e Tobaccot•Comprehensive Programs Reducing the toll of tobacco -related diseases is an important and feasible goal for the nation. The efforts of state and federal policy makers can facilitate action by health care providers, employers, and clinicians. A recent report from the Task Force on Community Preventive Services, an independent, nonfederal expert group, identified several measures that can be taken by communities and by health care systems to increase the number of tobacco users who attempt to quit and/or increase the success rates of individual cessation attempts.28 Recommendations at the community level are to: • Increase the tobacco excise tax. Raising tobacco excise taxes increases government revenues while decreasing tobacco consumption. A cigarette price increase of 10% decreases overall tobacco consumption by approximately 4%. The decrease in consumption is significantly higher among youth and people with low incomes. • Institute and sustain mass media campaigns com- bined with other interventions such as cessation. Effective counter -advertising and public education campaigns reduce initiation of smoking by adoles- cents and increase the motivation of addicted smokers to quit. Recommendations at the health care systems level are to: • Provide screening and counseling for tobacco cessa- tion by health care professionals. Clinicians and other health care professionals should be reimbursed for providing screening and counseling for tobacco dependence treatment, just as they are reimbursed for treating other chronic conditions. • Ensure access to pharmacological and counseling treatment of tobacco dependence in both public and private health care systems. Despite evidence of their effectiveness, formal treatment programs are used by relatively few smokers, and relapse rates are high. Barriers that discourage the use of such treatment programs should be removed. Corn munity-based resources such as centralized telephone quitlines and worksite cessation programs can increase access to effective treatment programs. + Reduce patients' out-of-pocket costs for cessation. Private and public health plans could reduce financial barriers to tobacco cessation by removing copayments and covering the cost of treatment. Tobacco control experts recognize that comprehensive tobacco control programs are needed to implement these measures effectively and to maximize their poten- tial benefit to health. Already, many communities and some states recognize the debilitating economic and health consequences of tobacco use. California, Massachusetts, Arizona, and Oregon have each allo- cated funding and have developed successful compre- hensive tobacco control programs. Tobacco is a public health hazard. More comprehensive tobacco control programs should be funded, and existing programs should be expanded in many more communities and states if we are to make progress toward achieving national public health goals in the 21st century. For more information: • American Cancer Society - 800 -ACS (227)-2345 www.cancer.org • Center for Tobacco Cessation - 202-585-3200 www.ctcinfo.org • American Lung Association - 800-586-4872 www.lungusa.org • Agency for Healthcare Research and Quality - 301-594-1364 www.ahrq.gov • Centers for Disease Control and Prevention Office of Smoking and Health - 800-232-1311 www.cdc.gov/tobacco • National Cancer Institute - 800-422-6237 www.cancer.gov + Office of the Surgeon General - www.surgeongeneral.gov/tobacco/default.htm • Office of the Surgeon General Tobacco Cessation Guidelines - www.surgeongeneral.gov/sgoffice.htm • Department of Health and Human Services - www.healthfinder.gov 1. US Department of Health and Human Services. The Health Benefits of Smoking Cessation. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1990. 2. US Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2000. 3. Centers for Disease Control and Prevention. Annual smoking - attributable mortality, years of potential life lost, and economic costs - United States, 1995-1999. MMWR Morb Mortal Wkly Rep. 2002; 51: 300-303. 4. National Cancer Policy Board. State Programs Can Reduce Tobacco Use. Institute of Medicine National Research Council, National Academy of Sciences; 2000. 5. Byers T, Mouchawar J, Marks J, et al. The American Cancer Society Challenge Goals: how far can cancer rates decline in the US by the year 2015? Cancer. 1999; 86: 715-727. 6. Ford BJ. Smokescreen: A Guide to the Personal Risks and Global Effects of the Cigarette Habit. North Perth, Australia: Halcyon Press; 1994. 7. Peto R, Darby S, Deo H, Silcocks P, Whitley E, Doll R. Smoking, smoking cessation, and lung cancer in the UK since 1950: com- bination of national statistics with two case -control studies. BMJ. 2000; 321: 323-329. 8. Fiore MC. The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives: a clini- cal practice guideline for treating tobacco use and dependence. A US Public Health Service Report. JAMA. 2000; 283(24): 3244- 3254. 9. Centers for Disease Control and Prevention. Cigarette smok- ing among adults - United States, 2000. MMWR Morb Mortal Wkly Rep. 2002; 51: 642-645. 10. National Cancer Institute. Population Based Smoking Cessa- tion: Proceedings of a Conference on What Works to Influence Cessation in the General Population. Smoking and Tobacco Control Monograph 12. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute. 2000; NIH Pub. No. 00-4892. 11. Cromwell J, Bartosch WJ, Fiore MC, Hasselblad V, Baker T. Cost-effectiveness of the clinical practice recommendation in the AHCPR guideline for smoking cessation. JAMA. 1997; 278(21):1759-1766. 12. Warner KE: The economics of tobacco: myths and realities. Tobacco Control. 2000; 9: 78-89. 13. US Public Health Service Report. A clinical practice guide- line for treating tobacco use and dependence. JAMA. 2000; 283: 3244-3254. 14. Silagy C, Ketteridge S. The Effectiveness of Physician Advice to Aid Smoking Cessation. The Cochrane Library, Database of Abstracts of Reviews of Effectiveness. Oxford: Update Software; 1998. 03- 363 Cancer Facts & Figures 2003 27 15. Centers for Disease Control and Prevention. Physician and other health-care professional counseling of smokers to quit - United States,1991. MM" Morb Mortal Wkly Rep. 1993; 42(44): 854-857. 16. US Department of Health and Human Services: Healthy People 2010. Available at: http://www.health.gov/ healthypeople2000. Accessed September 4, 2002. 17. Spangler JG, George G, Foley KL, Crandall SJ: Tobacco inter- vention training: current efforts and gaps in US medical schools. JAMA. 2002; 288:1102-1109. 18. Hopkins D, Briss P, Ricard C, et al. Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. Am JPrev Med. 2001; 20:16s -66s. 19. Rigotti N. Treatment of tobacco use and dependence. N Eng J Med. 2002; 346: 506-512. 20. Pierce JP, Gilpin EA. Impact of over-the-counter sales on effectiveness of pharmaceutical aids for smoking cessation. JAMA. 2002; 288:1260-1264. 21. Curry SJ. Building effective strategies to decrease tobacco use in a health maintenance organization: Group Health Cooperative of Puget Sound. Tobacco Control. 1998; 7(suppl): S21 -S23. 22. US Public Health Services. Treating Tobacco Dependence - A Systems Approach: A Guide for Health Care Administrators, Insurers, Managed Care Organizations, and Purchasers. Washington, DC: US Surgeon General; 2000. 28 Cancer Facts Oigures 2003 23. Fitchtenberg CM, Glantz SA. Effect of smoke-free work- places on smoking behavior: systematic review. BMJ. 2002; 325: 188-194. 24. Shopland DR, Gerlach KK, Burns DM, Hartman AM, Gibson JT. State -specific trends in smoke-free workplace policy cover- age: the current population survey of tobacco use supplement 1993 to 1999. J Occup Environ Med. 2001; 43: 680-686. 25. Chapman S, Borland R, Scollo M, Browson RC, Dominello A, Woodward S. The impact of smoke-free workplaces on declining consumption in Australia and in the United States. Am J Pub Health. 1999; 89: 1018-1023. 26. Longo DR, Johnson JC, Kruse RL, Brownson RC, Hewett JE. A prospective investigation of the impact of smoking bans on tobacco cessation and relapse. Tobacco Control. 2001; 10: 267- 272. 27. Pelletier KR. A review and analysis of the health and cost- effectiveness outcome studies of comprehensive health promo- tion and disease prevention programs at the worksite: 1993-1995 update. Am J Health Promotion. 1996; 10: 380-388. 28. Centers for Disease Control and Prevention. Strategies for reducing exposure to environmental tobacco smoke, increasing tobacco -use cessation, and reducing initiation in communities and health care systems: a report on recommendations of the Task Force on Community Preventive Services. MM" Morb Mortal Wkly Rep. 2000; 49 (RR -12). Overall, African Americans are more likely to develop and die from cancer than persons of any other racial and ethnic group. During 1992-1999, the average annual inci- dence rate for all cancer sites was 526.6 per 100,000 per- sons among African Americans, 480.4 per 100,000 for whites, 348.6 per 100,000 for Asian/Pacific Islanders, 329.6 per 100,000 in Hispanics, and 244.6 per 100,000 in American Indians/Alaska Natives. The death rate for all cancers combined is also about 30% higher in African Americans than white Americans. The average annual death rate (per 100,000) for all cancers combined from 1992-1999 was 267.3 for African Americans, 205.1 among whites, 129.2 among Hispanics, and 128.6 among both American Indians/Alaska Natives and Asian/ Pacific Islanders. Despite these high rates, mortality from all cancers com- bined decreased more among African American men than among other racial and ethnic groups between 1992-1999. During these same years, cancer incidence rates for men and women combined decreased by 1.6% per year among Hispanics, by 1.3% among African Americans, and by 0.9% among whites, while remaining relatively stable among American Indians/Alaska Natives and Asian/Pacific Islanders. Similarly, the death rate for all cancer sites decreased annually by 1.2% among African Americans, Asian/Pacific Islanders, and Hispanics, 0.9% among whites, and leveled off among American Indians/Alaska Natives. Incidence and Mortality Rates* by Site, Race, and Ethnicity, US, 1992-1999 African Asian/ American Indian/ Incidence White American Pacific Islander Alaskan Native Hispanict All Sites Males 568.2 703.6 408.9 277.7 393.1 Females 424.4 404.8 306.5 224.2 290.5 Total 480.4 526.6 348.6 244.6 329.6 Breast (female) _ 137.0 120.7 _ _ 93.4 59 4 82.6 Colon & rectum Males 64.4 70.7 58.7 40.7 43.9 Females 46.1 55.8 39.5 30.8 29.7 Total 53.9 61.9 47.9 35.2 35.7 Lung & bronchus Males 82.9 124.1 63.8 51.4 44.1 Females 51.1 53.2 28.5 23.3 22.8 Total 64.3 82.6 44.0 _35.4 31.5 Prostate 172.9 275.3 107.2 60.7 127.6 African Asian/ American Indian/ Mortality White American Pacific Islander Alaskan Native Hispanict All Sites Males 258.1 369.0 160.6 154.5 163.7 Females 171.2 204.5 104.4 110.4 105.7 Total 205.1 267.3 128.6 128.6 129.2 Breast (female) _ 29.3 _37.3_ 13.1 14.8 17.5__ Colon & rectum Males 26.7 34.8 16.5 14.6 16.6 Females 18.4 25.4 11.6 11.3 10.6 Total 21.9 29.1 _ 13.7 12.8 13.2 Lung & bronchus Males 81.7 113.0 42.3 49.3 38.2 Females 41.1 39.6 19.3 24.9 13.8 Total 57.9 68.9 29.3 35.5 24.1 Prostate _ 32.9 75.1 15.1 18.8 22.6 *Per 100,000, age-adjusted to the 2000 US standard population. Incidence rates obtained from SEER registries covering 10%-15% of the US population. Mortality data are from all states. tHispanics are not mutually exclusive from whites, African Americans, Asian/Pacific Islanders, and American Indian/Alaskan Natives. Source: Surveillance, Epidemiology, and End Results Program, 1973-99, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, 2002. American Cancer Society, Surveillance Research, 2003 03- 363 Cancer Facts & Figures 2003 29 I he hwarl (dI hc- Anncricait (ancer Socictv's niissioll is Icy mpe ant cancer. l ccausc cancer 1,11(ms nrr huundaries. IN,; missir�n cxlcnds around (lie vvtrrld. Beller prevcn- tirut. early del cction. and Uralment opt ions. as Krell as N improved immunization plans and sanitation, have helped some nations to lower incidence and death rates of cancers, such as cervix and stomach. Yet these and other cancers are still a problem in developing countries, and many other factors also contribute to an increasing overall cancer burden. For instance, Western lifestyle behaviors are becoming more common - including tobacco smoking, diets high in fat and low in fruits and Note: Figures in pamnthoses are order of rank within site aril sex group *Rates are age-adjusted to the World Health Organization world standard population 30 : - Facts 8'x 2003 er 100,000 Population for 45 Countries All Sites Oral Cavity Colon & Rectum Breast Prostate Country Male Female Male Female Male Female Female Male United States 161.8 (22) 116 4 (1C) 1.8 134) 0.8(17) 15.9 (27) 12.0 (20) 21.2 (12) 17.9 (18) Australia 150.9 (28) 103.2 (25) 2.2 (2.7) 0.900) 20.1 (12) 14.4 (12) 19.7 (18) 18.0 (17) Austria 168.6 (20) 113.8 (12) 3 7 (15) 0.8(18) 23.0(8) 14.9 (10) 23.3 (9) 18.9 (12) Azerbaijan 114.2 (41) 61.8 (45) 1 3 (41) 0.5 (42) 6.4(40) 4.8(42) 8.8(43) 4.3(43) Bulgaria 150.3 (29) 89.4 (35) 2.9 (21) 0.5 (43) 17.8 (20) 12.0 (21) 16.7 (31) 9.0(34) Canada 160.5 (23) 1167 (9) 2.3 (25) 0.8(19) 16.4(26) 11.6 (23) 22.7 (10) 17.1 (21) Chile 141.2 (34) 108.7 (18) 1.1 (45) 0.4(45) 7.0(39) 7.1 (37) 12.7 (37) 19.9(9) China 143.3 (33) 76.9 (43) 2.2 (28) 1.0(6) 7.2 (38) 5.3 (41) 4.5 (45) 1.0(45) Colombia 116.1 (40) 106.5 (19) 1,4(39) 1.0(7) 5.8(41) 6.1 (39) 10.6 (40) 15.1 (27) Croatia 230.1 (2) 105.4 (21) 7.2 (3) 0.8(20) 24.8(6) 13.0 (16) 19.9 (17) 15.3 (25) Cuba 141.0 (35) 104.0 (23) 4,0(12) 1.6(l) 11.4 (32) 12.4 (18) 15.6 (35) 22.1 (5) Czech Republic 222.2 (3) 127.6 (6) 4.4 (9) 0.8(21) 34.2 (1) 18.5(3) 21.0 (13) 15.7 (23) Denmark 184.9 (14) 144.0 (2) 3.0 (20) 1.2 (3) 23.8(7) 18.5(4) ( 29.2 (1) 23.1 (4) Estonia 201.5 (9) 104-8 (22) 5.3 (5) 1.0(8) 16.7 (24) 12.0 (22) 19.3 (19) 15.3 (26) Finland 145.8 (32) 92.5 (32) 1 7 (36) 0.9(11) 12.5 (30) 9.5 (32) 17.9 (26) 19.1 (11) France 2.01.5 (10) 98.0 (30) 4 4 (10) 0.8(22) 18.3 (17) 12.1 (19) 21.4 (11) 19.2 (10) Germany 176.6 (16) 116-9 (8) 3.2 (19) 0.8(23) 21.7 (11) 17.0(6) 23.7(8) 18.4 (15) Greece 149.5 (31) 81.8 (42) 1.5 (37) 0.5(44) 8.4(37) 6.7 (38) 16.7 (32) 10.7 (33) Hungary 272.3 (1) 147.4(l) 109 (1) 1.6(2) 33.5(2) 20.9(l) 25.3 (7) 17.9 (19) Ireland 170.2 (19) 127.8(5) 3 4 (17) 0.8(24) 22.6 (9) 15.4(8) 25.8 (6) 21.6(6) Israel 135.1 (38) 111.4 (15) 13 (42) 0.7 (33) 19.7 (13) 15.3 (9) 26.2 (4) 14.2 (30) Japan 159.5 (24) 83.1 (41) 2.0 (33) 0.8 (25) 17.6 (21) 11.0 (28) 7.7 (44) 5.5(40) Kazakhstan 201.9(8) 102.6 (27) 2-5 (22) 1.2 (4) I 12.2 (31) 8.6 (33) 13.3 (36) 5.2(41) Kyrgyzstan 185.6 (13) 112.6 (14) 2.1 (31) 0.7 (34) 10.9 (35) 7.9 (35) ( 17.0 (29) 6.4(39) Latvia 196.7 (11) 102.8 (26) 4.8(8) 0.7(35) 17.9 (19) 13.3 (15) 18.1 (24) 13.0 (31) Lithuania 195.9 (12) 97.0 (31) 5.0 (7) 0.8(26) 18.0 (18) 10.7 (29) 19.0 (20) 15.6 (24) Macedonia 140.1 (36) 85.5 (38) 21 (32) 0.7 (36) 11.2 (34) 7.8(36) 17.2 (28) 6.8(37) Mauritius 79.6 (45) 66.3 (44) 2.2 (29) 0.7 (37) 5.8(42) 3.9(45) 9.2 (41) 7.3 (36) Mexico 112.5 (42) 106.3 (20) 1.4(40) 0.7 (38) 4.7(44) 4.6(43) 12.2 (38) 16.6 (22) Netherlands 182.0 (15) 120.0 (7) 1.5(38) 0.8(27) 19.0 (14) 14.0 (13) 27.8(2) 20.0(8) New Zealand 167.2 (21) 131.1 (3) 2.3 (26) 0.9(12) 25.7(4) 20.2 (2) 25.9 (5) 21.2 (7) Norway 155.7 (27) 113.1 (13) 2.4(24) 0.903) 22.0 (10) 18.0(5) 20.7 (14) 26.8(3) Poland 205.2 (6) 111 A (16) 3.7 (16) 0.8(28) 16.6 (25) 11.6 (24) 16.8 (30) 11.2 (32) Portugal 157.1 (26) 89.1 (37) 3.9 (13) 0.6(41) 18.5 (16) 11.3 (26) 18.4 (22) 17.9 (20) Rep. of Moldova 157.8 (25) 89.4 (36) 6.7(4) 0.8(29) 15.8 (28) 10.6 (30) 18.5 (21) 5.0 (42) Romania 150.0 (30) 90.0 (34) 4.2(11) 0.9(14) 11.4 (33) 8.2 (34) 16.2 (34) 8.3 (35) Russian Fed. 211.2 (5) 100.6 (29) 5.3 (6) 0.8(30) 17.5 (22) 12.7 (17) 16.7 (33) 6.8(38) Slovakia 217.8(4) 108.8 (17) 9.5 (2) 1.0(9) 28.0(3) 16.1 (7) 18.4 (23) 14.3 (29) Slovenia 203.1 (7) 115.9 (11) 3,4(18) 0.7 (39) 25.1 (5) 14.6 (11) 20.3 (16) 18.8 (13) Spain 176.1 (17) 85.0 (40) 3,9(14) 0.8(31) 17.3 (23) 11.1 (27) 18.1 (25) 15.0 (28) Sweden 137.9 (37) 104.0 (24) 1.3 (43) 0.7(40) 14.4 (29) 11.5 (25) 17.5 (27) 27.3 (2) Trinidad & Tobago 103.5 (44) 101.9 (28) 2.5 (23) 1.1 (5) 8.5(36) 9.7 (31) I 20.6 (15) 32.3 (1) Turkmenistan 117.7 (39) 85.2 (39) 2.2 (30) 0.9(15) 4.7(45) 4.1 (44) 9.2 (42) 1.8(44) United Kingdom 171.0 (18) 128.0(4) 1.8 (35) 0.8(32) 18.7 (15) 13.8 (14) 26.8(3) 18.5 (14) Venezuela 104.1 (43) 91.8 (33) 1.3 (44) 0.9(16) 5.8(43) 6.1 (40) 11.6 (39) 18.2 (16) Note: Figures in pamnthoses are order of rank within site aril sex group *Rates are age-adjusted to the World Health Organization world standard population 30 : - Facts 8'x 2003 vegetables, and lack of exercise - leading to increased risk for cancers of the lung and colon, among others. (See also Worldwide Tobacco Use, page 34.) The Society collaborates with other cancer -related orga- nizations worldwide in the global fight against cancer, especially in the developing world where survival rates are low and resources are limited. Our international mission includes: • Capacity building with developing cancer societies • Tobacco control • Information exchange and delivery • Conferences and knowledge -sharing • Resource development and fundraising for interna- tional efforts 63 Lung & Bronchus Uterus Stomach Leukemia Country Male Female Cervix Corpus Male Female Male Female United States 53.2 (13) 27.2 (1) 1 3.3 (33) 2.0(32) 4.5(45) 2.3 (45) 1 6.6 (4) 4.2(5) Australia 36.2 (31) 14.0 (10) 2.4(41) 1.6(38) 6.1 (44) 3.0(44) 5.7 (14) 3.8(14) Austria 41.8 (25) 10.8 (16) 4.7(26) 2.8(19) 14.1 (24) 8.6(22) 5.0(25) 3.6(18) Azerbaijan 25.5 (37) 4.5(42) 1.9(44) 3.9(10) 24.7(8) 10.5 (10) ! 4.0(38) 2.7 (39) Bulgaria 43.7 (22) 7.1 (32) ; 7.4 (15) 3.2 (14) 17.8 (20) 9.0(20) 5.2 (21) 3.3 (24) ------- Canada -- 50.4 (14) 25.0(3) 2.8(39) - 1.8 (35) - ...-- 6.4(43) 3.2 (43) I 6.2 (8) 3.9(8) Chile 20.3 (40) 7.0(33) 10.6(8) 1.4(40) 1 30.1 (5) 12.7 (7) 4.0(39) 3.0(37) China 33.2 (32) 13.5 (11) 3.1 (35) 0.4(44) 27.0 (6) 13.0(6) 2.8(44) 2.0(44) Colombia 17.0 (43) 8.5(24) 13.7(4) 3.5 (13) 26.4(7) 16.4(2) 4./(31) 3.9(9) Croatia 70.3 (3) 9.4(20) 5.7 (21) 1.9(34) 21.7 (14) 9.1 (19) 5.8(12) 3.5 (20) Cuba 42.8 (23) 15.6(8) 10.6(9) 4.0(9) 8.4(38) 4.3 (38) 4.8(30) 3.6(19) Czech Republic 65.3 (5) 11.5 (14) 6.2 (20) 4.4(4) 13.5 (25) 7.5 (24) 6.7 (3) 4.4(3) Denmark 50.0 (15) 26.7 (2) 4.1 (28) 2.4(22) 7.5(40) 3.6(41) 5.8 (13) 3.9(10) Estonia 64.5 (6) 8.6(23) 9.7 (10) 2.9(17) 24.2 (11) 10.4 (11) 5.7 (15) 3.9(11) Finland 41.2 (26) 7.4(28) 1.3(45) 2.5 (21) 10.3 (30) 5.6(31) 4.7 (32) 3.3 (25) France 48.5 (19) 6.7 (35) 3.5(32) 2.1 (30) 8.0(39) 3.6(42) 6.1 (9) 3.9 (12) Germany 46.2 (20) 9.6 (18) 4.2 (27) 2.1 (31) 1 12.9 (27) 7.8(23) 5.7 (16) 3.9 (13) Greece 50.0 (16) 7.4(29) 2.2 (42) 1.1 (43) 1 8.5(37) 4.7(36) 6.3 (6) 3.8 (15) Hungary 86.2(l) 20.0 (5) 7.7(14) 4.1 (8) 21.0 (16) 10.1 (13) 7.6(l) 4.9(l) Ireland 38.3 (30) 17.3 (7) 3.9(29) L5 (39) 10.1 (31) 5.0(34) 5.4(19) 3.3 (26) Israel 27.5 (36) 9.3(21) 3.1 (36) 1.8(36) 9.3 (35) 5.6 (32) 6.5 (5) 4.5(2) Japan 33.1 (33) 9.6(19) 3.0(37) 1.2 (42) 31.2 (4) 13.8(4) 4.1 (36) 2.6(41) Kazakhstan 59.5(9) 8.3 (25) 8.1 (12) 2.4(23) 32.0(3) 13.8(5) j 3.3 (43) 2.5 (42) Kyrgyzstan 40.7 (27) 7.3 (30) 11.3(6) 4.9(2) 47.0(1) 18.9(l) 4.1 (37) 3.2 (30) Latvia 59.1 (10) 6.3 (37) 6.6(17) 4.3(6) 24.4 (10) 10.4 (12) ! 6.0(10) 4.0(6) Lithuania 56.5 (11) 5.5 (39) 8.8(11) 3.9(11) 24.5(9) 9.5 (17) 5.7 (17) 3.8(16) Macedonia 39.8 (28) 6.6(36) 6.3(18) 3.0(15) 21.9 (13) 9.5 (18) 4.3 (35) 2.7 (40) Mauritius Mexico 16.7 (44) 22.1 (39) 4.2(44) 8.2 (26) 13.6(5) 17.1 (1) 0.2 (45) 4.5(3) 10.6 (29) 13.2 (26) 5.7 (30) 9.8(15) 3.4 (41) 4.9 (27) 2.0(45) 4.0(7) Netherlands 59.7 (8) 14.8(9) 2.2 (43) 2.2 (26) 9.4(34) 4.6(37) 4.9(28) 3.2 (31) New Zealand 39.3 (29) 18.7(6) 3.9(30) 2.2 (27) 6.8(42) 4.0(39) 6.3 (7) 4.4(4) Norway 31.7 (34) 12.8 (12) 3.3 (34) 3.0(16) 9.6(33) 5.5(33) 4.6(33) 3.2 (32) Poland 71.5(2) 11.3 (15) 7.8(13) 2.9 (18) 19.2 (19) 7.3 (25) 5.6(18) 3.5(21) Portugal 29.5 (35) 4.8(40) 4.8(25) 2.3 (25) 22.2 (12) 10.9(8) 5.1 (23) 3.4(22) Rep. of Moldova (38) 2.2 (28) 9.0 (21) j _ _ - - __- --------------------- 5.2 (22) 3.3 (27) Romania _42.1___(_2_4_)______6.2 45.1 (21) ---7.0(16)--- 7.3 (31) 10.9(7) ------- 2.2 (29) _'20_.4__(1_7)____ 17.6(21) 7.0(27) 4.5(34) 3.0(38) Russian Fed. 68.2 (4) 6.8(34) 5.2 (24) 2.6(20) 35.6(2) 15.2 (3) 5.0(26) 3.4(23) Slovakia 60.7 (7) 7.8(27) 5.4(23) 5.2 (1) 16.9 (23) 7.3 (26) 7.1 (2) 3.7(17) Slovenia 55.3 (12) 10.1 (17) 1 5.6(22) 4.4(5) 20.2 (18) 9.6(16) 5.9 (11) 3.2 (33) Spain 49-4(17) 4.2 (45) 2.7(40) -------------- 2.4(24) 12.6 (28) 6.2 (29) 5.4(20) 3.2 (34) Sweden 22.6 (38) 12.6 (13) 2.9(38) 2.0(33) 7.4 (41) 4,0(40) 5.1 (24) 3.3 (28) Trinidad & Tobago 13.2 (45) 4.3 (43) 15.0(3) 4.3 (7) 8.7(36) 6.9(28) 3.4(42) 3.1 (36) Turkmenistan 18.9 (42) 4.6(41) 6.3 (19) 1.4(41) 21.1 (15) 10.8(9) 2.6(45) 2.4(43) United Kingdom- 48.6 (18) 21.1 (4) 3.9(31) 1.7 (37) 'i 10.1 (32) 4.8(35) 1 4.9 (29)- 3.3 (29) Venezuela 19.4 (41) 9.2 (22) 15.2 (2) 3.7 (12) I 17.5 (22) 10.0 (14) 3.9 (40) 3.2 (35) Source: GLOBOCAN 2000, Cancer Incidence, Mortality, and Prevalence Worldwide, Version 1.0. American Cancer Society, Surveillance Research, 2003 63 Snnd:in� is (11c mwd preventable cause of dral h. In 190:5. INN() million people in de%vlupcd counlriw died plana iurrly irom ,nu�kiu,�-related dise;ssc>..' _A=�I;roxinuitcl� li�cll of all Americans who contimu. io 'llwkc vvili die frog Iheil .uldi(lion.l In t! c tnitcd State, tol)acco nsc was wcsponsilflc loo ncal k ''lle n l i\ c dclai h; or au cslinuUed 1111.000 dcalhs icr Arai From 199.-,- 1999. Sorokin'. accounts for at Icast ")U' ( of all ccuurr deal hs and 87( "� of lung cancer deaths. hin- cancer moitalily rates are about 22 times higher I'm r currcnl male smoker, and 12 1imc< higher li0r current Icmale smokers compared with lifelonO neycr smokers., Smokin is also associated with increased risk iim cancers of I he mouth, nasal cayit ions. pharynx, larynx. esophagus. stomach, pancreas. liver. uterine cerrix. kidney. bladder, and mveloid leukemia. In addi- tion tocancer, snuil:ingis a major cause of hcarCdisease, stroke, chronic bronchitis. grid ernphysema, and is associated wit It Bast ric ulcers. Cigarette stooling among adults aged 18 and over declined 4094, between 1965 and 1990 — from 421%> to 2500,.6 Smoking prevalence among adults decreased by anavera ge of L%b per year from 1993 to 2000.% Between 1978 and 1995, cigarette smoking prevalence declined for whites (34% to 2690), !\6-ican Americans (370/c to 27°io), I Iispanics (301,%) to 19°io), and Asian and Pacific Islanders (24"x, to 1594)). Among American Indians and Alaska Natives, smoking prevalence did not change for men from 1983 to 1995 or for women from 1978 to :1995.8 Although cigarette smoking became prevalent among men before women, the gender gap narrowed in the raid -'1980s and has remained constant.`) Between 1983 and 1.999, smoking among college graduates decreased almost: 50% from 21 rb to I I %, but among adults without a high school education the percentage decreased only 22% from 41% to 32%.6 c. per capita consumption of cigarettes continues to decline. After peaking at 4,345 cigarettes per capita in 1963, consumption among Americans I8 years and older decreased 53% to an estimated 2,037 cigarettes per capita in 2001.10. l r u Current cigarette smoking among US high school students increased significantly from 28% in 1991.to a peakof"6% in 1997, and declined significantly to 29% 32 1:acts & Figures 2003 N in 2001. In addition, current frequent cigarette smok- ing among US high school students increased from 13% in 1991, peaked at 17% in 1997 and 1999, and declined significantly to 14% in 2001.12 • In 1997, nearly one-half (48%) of male students and more than one-third (36%) of female students reported using some form of tobacco - cigarettes, cigars, or smokeless tobacco - in the past month. The percent- ages declined to 39% for male students and to 30% for female students in 2001.13, 14 Over 80% of adult smokers surveyed in 1991 had begun smoking by age 18. In addition, 35% had become daily smokers by age 18.15 Among adults in 2000, national data showed:? • An estimated 46.5 million US adults were current smokers. • Men were more likely to smoke (26%) than women (21%). • Cigarette smoking was highest among American Indians and Alaska Natives (36%) and lowest among Asians (14%). • Adults with only a General Education Development (GED) diploma (47%) and high school dropouts (34%) have high percentages of cigarette smoking. Among US high school students in 2001, national data showed:14 • Nearly one-fourth (22%) smoked a whole cigarette before age 13. • Nearly two-thirds (64%) have ever tried cigarette smoking. • White (32%) and Hispanic (27%) students were more likely to be current cigarette smokers (smoked at least one cigarette in the past month) than African American (15%) students. • White (17%) students were more likely to smoke cigarettes frequently (on at least 20 of the 30 days pre- ceding the survey) than Hispanic (7%) and African American (5%) students. Among US middle school students in 2000, national data showed:16 • Eight percent smoked a whole cigarette before age 11. • Fifteen percent reported using some form of tobacco - cigarettes, cigars, smokeless tobacco, pipes, bidis, or kreteks - in the past month. • More than one-third (36%%) have ever tried cigarette smoking. • Eleven percent smoked cigarettes currently (smoked at least one cigarette in the past month). Smokeless Tobacco In 1986, the US Surgeon General concluded that the use of smokeless tobacco is not a safe substitute for smoking cigarettes or cigars, as these products cause various cancers and noncancerous oral conditions, and can lead to nicotine addiction.17 • Oral cancer occurs several times more frequently among snuff dippers compared with non -tobacco users.17 • The risk of cancer of the cheek and gums may increase nearly 50 -fold among long-term snuff users.17 • According to the US Department of Agriculture, US output of moist snuff has risen over 40% in the past decade from 48 million pounds in 1991 to an esti- mated 68 million pounds in 2001.11 • Among adults aged 18 and older, national data showed 6% of men and 1% of women were current users of chewing tobacco or snuff. Among men, American Indians and Alaska Natives (8%) and whites (7%) were more likely to use smokeless tobacco than African Americans (3%), Hispanics (2%), and Asian and Pacific Islanders (1%).8 • Nationwide, 15% of US male high school students currently used chewing tobacco, snuff, or dip in 2001. White male students (19%) were more likely to use smokeless tobacco than Hispanic (6%) and African American (3%) male students.14 • Nationwide, 6% of US male middle school students currently used chewing tobacco, snuff, or dip in 2000.16 Cigars The consumption of large cigars and cigarillos increased from 1993 to 1999. An estimated 3.8 billion large cigars and cigarillos were expected to be consumed in 2001. Small -cigar production increased from 1.5 billion pounds in 1997 to an estimated 2.4 billion pounds in 2001.11 • In 1998, the median percentage of adults aged 18 years and older who ever smoked cigars was 39%. More men than women had ever smoked cigars in all 50 states.ls • In 1998, the median percentage of adults aged 18 years and older who had smoked cigars in the past month was 5%. More men than women smoked cigars in the past month in all 50 states.ls a. • Nationwide, 15% of US high school students (grades 9 to 12) had smoked cigars, cigarillos, or little cigars on at least one of the past 30 days. Male students (22%) were more likely than female students (9%) to smoke cigars currently. White male students (24%) were significantly more likely than African American male students (16%) to report current cigar use.14 • Nationwide, 7% of US middle school students (grades 6 to 8) had smoked cigars on at least one of the past 30 days. Male students (10%) were more likely than female students (5%) to smoke cigars currently.16 In 2001, seven major cigar manufacturers provided five health warnings that rotated on labels on cigars sold in the US. The companies agreed to the warnings in June 2000 to settle a lawsuit brought by the Federal Trade Commission for failure to warn consumers of the dan- gers of cigar smoking. Cigar smoking has health conse- quences and hazards similar to those of cigarettes and smokeless tobacco such as:19 • Cancer of the lung, oral cavity, larynx, esophagus, and probably cancer of the pancreas. • Four to 10 times the risk of dying from laryngeal, oral, or esophageal cancers compared with nonsmokers. Smoking Cessation (See special section on pages 21-28.) Secondhand Smoke Secondhand smoke, or environmental tobacco smoke (ETS), contains numerous human carcinogens for which there is no safe level of exposure. Many scientific con- sensus groups reviewed the data on ETS, including a recent review by the International Agency for Research on Cancer (IARC) and the National Institute of Environ- mental Sciences' National Toxicology Program 24 Public policies to protect people from secondhand smoke are based on the following detrimental effects of ETS in the US: • Each year, about 3,000 nonsmoking adults die of lung cancer as a result of breathing secondhand smoke22 • ETS causes an estimated 35,000 to 40,000 deaths from heart disease in people who are not current smokers25 • ETS causes coughing, phlegm, chest discomfort, and reduced lung function in nonsmokers22 • Each year, exposure to secondhand smoke causes 150,000 to 300,000 lower respiratory tract infections (such as pneumonia and bronchitis) in US infants and children younger than 18 months of age. These infec- tions result in 7,500 to 15,000 hospitalizvo3s'ever}3 6 3 year.22 Cancer Facts & Figures 2003 33 • Secondhand smoke increases the number of asthma attacks and the severity of asthma in about 200,000 to 1 million asthmatic children 22 • Secondhand smoke contains over 4,000 substances, more than 40 of which are known or suspected to cause cancer in humans and animals and many of which are strong irritants22 Worldwide Tobacco Use While the prevalence of smoking has been slowly declin- ing in the United States and most other high-income countries over the past 20 years, smoking prevalence rates have been steadily rising in developing nations. • Smoking prevalence rates are increasing in developing nations at a rate of about 3.4% per year 26 • Smoking prevalence rates among men in developing countries are about 50%; rates among women are sub- stantially lower but increasing. • Based on current patterns, smoking-related diseases will kill about 500 million of the world's 1.2 billion smokers alive today27 • If current trends continue, tobacco -caused deaths are expected to increase from about 4 million per year today to about 10 million per year by 2030, with 70% of these additional deaths occurring in developing nations. By 2030, tobacco's annual death toll will be higher than the combined mortality due to malaria, pneumonia, tuberculosis, and diarrheal diseases. • In China, for example, where approximately two-thirds of the male population smokes, tobacco currently kills 800,000 people per year and will eventually kill 100 million of the 300 million Chinese males now aged 0- 29.28 • Today, about 8% of women in developing countries and 15% of women in developed countries smoke. It is predicted that by 2025 both figures will rise to 20%, with a global total of 532 million female smokers 29 • The first Global Youth Tobacco Survey (CYTS) found that among youth aged 13 to 15, current tobacco use prevalence ranged from 3.3% to 62.8%. Nearly 25% of youths who smoke reported smoking their first ciga- rette before age 10.30 To curtail the global tobacco pandemic, World Health Organization (WHO) member states have been negoti- ating since 1999 to promulgate the first global public health treaty, the Framework Convention on Tobacco Control (FCTC). The convention, to be adopted by May ja rt 34 Cancer Facts & Figures 2003 N, 2003, promises to address vital issues such as tobacco advertising and promotion, agricultural diversification, cigarette smuggling, and tobacco taxation.31 Costs of Tobacco in the US The number of people who prematurely die or suffer ill- ness from tobacco use results in substantial health- related economic costs to society. During 1995 to 1999, adult male and female smokers lost an average of 13.2 and 14.5 years of life, respectively, due to smoking.3 In addition:3 • Smoking causes approximately $157.7 billion in annual health-related economic costs, including adult mortality -related productivity costs, adult medical expenditures, and neonatal medical expenditures. • Mortality -related productivity losses in the US amounted to $81.9 billion annually during 1995 to 1999, or $1,760 in lost productivity per adult smoker in 1999. • Smoking-related medical costs totaled $75.5 billion in 1998 and accounted for 8% of personal health care medical expenditures. This translates to $1,623 in excess medical expenditures per adult smoker in 1999. • Smoking -attributable neonatal costs were $366 mil- lion in 1996, or $704 per maternal smoker. • From 1995 to 1999, the total economic costs per smoker per year were $3,391. • For each pack of cigarettes sold in 1999, $3.45 was spent on medical care due to smoking, with $3.73 in productivity losses, for a total cost of $7.18 per pack. • The impact of cigarette smoking on state Medicaid and Medicare budgets varied among states in 1993, ranging from $1.9 billion in New York to $11.4 million in Wyoming for Medicaid, and $1.5 billion in Califor- nia to $8 million in Alaska for Medicare.32, 33 References 1. Peto R, Lopez AD, Boreham J, Thun MJ, Heath CW Jr. Mortality from smoking in developed countries 1950-2000. New York, NY: Oxford University Press; 1994. 2. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993;270:2207-2212. 3. Centers for Disease Control and Prevention. Annual smoking - attributable mortality, years of potential life lost, and economic costs - United States, 1995-1999. MM" Morb Mortal Wkly Rep. 2002;51:300-303. 4. Doll R, Peto R. The Causes of Cancer. New York, NY: Oxford Press; 1981. L 5. US Department of Health and Human Services. Reducing the Health Consequences of Smoking - 25 Years of Progress: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1989. 6. National Center for Health Statistics. Health, United States, 2001 with Urban and Rural Health Chartbook. Hyattsville, MD: Public Health Service; 2001. 7. Centers for Disease Control and Prevention. Cigarette smok- ing among adults - United States, 2002. MMWR Morb Mortal Wkly Rep. 2002;51:642-645. 8. US Department of Health and Human Services. Tobacco Use Among US Racial/Ethnic Minority Groups - Africian Americans, American Indians, and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: AReport of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 1998. 9. US Department of Health and Human Services. Women and Smoking. A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2001. 10. Giovino GA, Schooley MW, Zhu BP, et al. Surveillance for Selected Tobacco Use Behaviors - United States, 1990-1994. MMWR Morb Mortal Wkly Rep CDC Surveill Sum. 1994;43 (SS -03). 11. US Department of Agriculture. Tobacco Situation and Outlook Report. Washington, DC: US Department of Agri- culture, Market and Trade Economics Division, Economics Research Service; April 2002. 12. Centers for Disease Control and Prevention. Trends in ciga- rette smoking among high school students - United States. MMWR Morb Mortal Wkly Rep. 2002;51:409-412. 13. Centers for Disease Control and Prevention. Tobacco use among high school students - United States, 1997. MMWR Morb Mortal Wkly Rep. 1998;47:229-233. 14. Centers for Disease Control and Prevention. Youth risk behavior surveillance - United States, 2001. MMWR Morb Mortal Wkly Rep CDC Surveill Summ. 2002;51(SS-4). 15. US Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1994. 16. Centers for Disease Control and Prevention. Youth tobacco surveillance - United States, 2000. MMWR Morb Mortal Wkly Rep CDC Surveill Summ. 2000;50(SS-4). 17. US Department of Health and Human Services. The Health Consequences of Using Smokeless Tobacco: A Report of the Advisory Committee to the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute; 1986. 18. Centers for Disease Control and Prevention. State -specific prevalence of current cigarette and cigar smoking among adults - United States, 1998. MMWR Morb Mortal Wkly Rep. 1999;48: 1034-1039. 19. Shanks TG, Burns DM. Disease Consequences of Cigar Smoking. In: Burns D, Cummings KM, Hoffman D, editors. Cigars - Health Effects and Trends, Monograph No. 9. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 1998. 20. US Department of Health and Human Services. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1990. 21. US Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2000. 22. US Environmental Protection Agency. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Washington, DC: US Environmental Protection Agency; 1992. EPA/600/6-90/006F. 23. California Environmental Protection Agency. Health Effects of Exposure to Environmental Tobacco Smoke: Final Report. Sacramento, CA: California Environmental Protection Agency, Office of Environmental Health Hazard Assessment; 1997. 24. National Institute of Environmental Sciences. 9th Report on Carcinogens. Research Triangle, NC: National Institute of Environmental Sciences, National Toxicology Program; 2000. 25. Steenland K. Passive smoking and the risk of heart disease. JAMA. 1992;267:94-99. 26. World Health Organization. The World Health Report 1999: Making a Difference. Geneva, Switzerland: World Health Organization; 1999. 27. World Health Organization. Confronting the Epidemic: A Global Agenda for Tobacco Control Research. Geneva, Switzerland: Research for International Tobacco Control and the World Health Organization; July 1999. Available at: http://www.who.int/toh/TFI/reseasrchritcwho.doc. 28. Liu BQ, Peto R, Chen ZM, et al. Emerging tobacco hazards in China: retrospective proportional mortality study of one million deaths. BMJ. 1998;317:1411-1422. 29. Samet JM, Yoon SY (eds). Women and the Tobacco Epidemic. Geneva, Switzerland: World Health Organization; 2001. 30. Global Youth Tobacco Collaborative Group. Tobacco use among youth: a cross country comparison. Tobacco Control. 2002;11:252-270. 31. Brundtland GH. Framework Convention on Tobacco Controll, Geneva, Switzerland: World Health Organization; May 2000. Available at: http://www5.who.int/tobacco/page.cfm?pid=40. 32. Miller LS, Zhang X, Novotny T, Rice DP, Max W. State esti- mates of Medicaid expenditures attributable to cigarette smok- ing, fiscal year 1993. Public Health Rep. 1998;113:140-151. 33. Zhang X, Miller LS, Max W, Rice DP. Costs of so to th� 3 Medicare program, 1993. Health Care Fin Rev. 199�P(79--196. Cancer Facts & Figures 2003 35 Scientific evidence suggests Ihat about one-third of the cancer deaths I haI occur in I he US etch year arc due to nuIriIion and phvsical itc•tiyiIv factors. includingobesity. For III(. majority of AIIWI_icans who do not use tobaCCo. dietary choices and phvsical act ivity arc the most impor- tant modifiable determinants of cancer risk. I'.vidcnce also inclicales that allhough inherited genes do inlluence cancer risk. heredity alone explains only a fraction of all cancers. Alost of the variation in cancer risk across populat ions c�uinot current Iv be explained by inhcriied factors: behavioral factors such as cigarette smoking. certain dietary patlerrns. and phvsical activity call subslaiihalk7 affect unc's risk of developing cancer. Phew fac(ors modify the risk of cancer at all stages of its deyelopmcnl. 'I he i ncric•an Cancer Society reviewed the scientific evidence and updated its nutrition and physical activity guiddincs in 2001. Changes frons the Society's 1996 guidelines include increased emphasis on Ilhe role of physical acl ivity cuicl weight control in reducing cancer risk and the addition ol'a phvsical activity recommen- dation for mullr due to increasing trends in ovenvcight and obesity in (his age group. Because healthful individ- ual behaviors arc most likely to occur when (here is social and cnvironmenlal support in communities, these 2001 guidelines inclucle for the first time an esplicil Cornmlolifyilctioratofacil- itate healthful food choices and opportunities for physi- cal activity in schools, worksitcs, and communities. "I he Society's rccornmendations arc consistent in princi- ple with 1 he 20tH) Dietary Guidelines for Americans, and rec•ommendaiions of other agencies for general health promotion and for the prevention of'' coronary heart disease. diabeles, and other diet. related chronic condi- tions. lUthongli no dict can guarantee full protection against any disease. the Society believes that the follow- ing recommendations offer the best: nutrition and physical activity information currently available to help Amcricarns reduce t heir risk of cancer. 36 I=a 1 II cI ,E KIQ lidivi4ij,71 Ctoices 1. Eat a variety of healthful foods, with an emphasis on plant sources. • Eat five or more servings of vegetables and fruit each day. • Choose whole grains in preference to processed (refined) grains and sugar. • Limit consumption of red meats, especially high-fat and processed meats. • Choose foods that help maintain a healthful weight. There is strong scientific evidence that healthy dietary patterns, in combination with regular physical activity, are needed to maintain a healthy body weight and to reduce cancer risk. Many epidemiologic studies have shown that populations that eat diets high in vegetables and fruit and low in animal fat, meat, and/or calories have reduced risk of some of the most common cancers. The scientific study of nutrition and cancer is highly complex, and many important questions remain unan- swered. It is not presently clear how single nutrients, combinations of nutrients, overnutrition and energy imbalance, or the amount and distribution of body fat at particular stages of life affect one's risk of specific cancers. Until more is known about the specific compo- nents of diet that influence cancer risk, the best advice is to emphasize whole foods and the consumption of a mostly plant -based diet. 2. Adopt a physically active lifestyle. • Adults: Engage in at least moderate activity for 30 minutes or more 5 or more days of the week; 45 min- utes or more of moderate to vigorous activity 5 or more days per week may further enhance reductions in the risk of breast and colon cancer. • Children and adolescents: Engage in at least 60 min- utes per day of moderate to vigorous physical activity at least 5 days per week. Scientific evidence indicates that physical activity may reduce the risk of certain cancers as well as provide other important health benefits. Regular physical activity contributes to the maintenance of a healthy body weight by balancing caloric intake with energy expenditure. Other mechanisms by which physical activity may help to prevent certain cancers may involve both direct and indirect effects. For colon cancer, physical activity accelerates the movement of food through the intestine, thereby reducing the length of time that the bowel lining is exposed to potential car- cinogens. For breast cancer, vigorous physical activity may decrease the exposure of breast tissue to circulating estrogen. Physical activity may also affect cancers of the colon, breast, and other sites by increasing metabolism and reducing circulating concentrations of insulin and related growth factors. Physical activity helps to prevent Type II diabetes, which is associated with increased risk of cancers of the colon, pancreas, and possibly other sites. The benefits of physical activity go far beyond reducing the risk of cancer. They include reducing the risk of heart disease, high blood pressure, diabetes, falls, osteoporosis, stress, and depression. 3. Maintain a healthful weight throughout life. • Balance caloric intake with physical activity. • Lose weight if currently overweight or obese. Overweight and obesity are associated with increased risk for cancers at several sites: breast (among post- menopausal women), colon, endometrium, adenocarci- noma of the esophagus, and kidney. The best way to achieve a healthful body weight is to balance energy intake (food intake) with energy expended (physical activity). Excess body fat can be reduced by restricting caloric intake and increasing physical activity. Caloric intake can be reduced by decreasing the sizes of food portions and limiting the intake of calorie -dense foods (e.g., those high in fat and refined sugars such as fried foods, cookies, cakes, candy, ice cream, and soft drinks). Such foods should be replaced with more healthful vegetables and fruit, whole grains, and beans. Because overweight in youth tends to continue throughout life, the increasing prevalence of overweight and obesity in pre -adolescents and adolescents may increase incidence of cancer in the future. For these reasons, efforts to establish a healthful weight and healthful patterns of weight gain should begin in childhood. 4. If you drink alcoholic beverages, limit consumption. People who drink alcohol should limit their intake to no more than 2 drinks per day for men and 1 drink a day for women. Alcohol consumption is an established cause of cancers of the mouth, pharynx, larynx, esophagus, liver, and breast. For each of these cancers, risk increases substantially with intake of more than 2 drinks per day. Alcohol consumption combined with tobacco use increases the risk of cancers of the mouth, larynx, and esophagus far more than the independent effect of either drinking or smoking. Regular consumption of even a few drinks per week has been associated with an increased risk of breast cancer in women. The mecha- nism for an effect of alcohol on breast cancer is not known with certainty, but may be due to alcohol - induced increases in circulating estrogens or other hormones in the blood, reduction of folic acid levels, or to a direct effect of alcohol or its metabolites on breast tissue. Some groups of people should not drink alcoholic bever- ages at all. These include children and adolescents; indi- viduals of any age who cannot restrict their drinking to moderate levels; women who are or may become preg- nant; individuals who plan to drive or operate machin- ery or who take part in other activities that require attention, skill, or coordination; and individuals taking prescriptions or over-the-counter medications that can interact with alcohol. Recommendation for Community Action Public, private, and community organizations should work to create social and physical environments that support the adoption and maintenance of healthful nutrition and physical activity behaviors. • Increase access to healthy foods in schools, worksites, and communities. • Provide safe, enjoyable, and accessible environments for physical activity in schools, and for transportation and recreation in communities. The American Cancer Society guidelines relate to individual choices regarding diet and physical activity patterns, but those choices occur within a community context that either facilitates or interferes with healthy behaviors. Therefore, this key recommendation for com- munity action accompanies the four guidelines for indi- vidual choices for nutrition and physical activity to reduce cancer risk. This recommendation for commu- nity action underscores the importance of community measures to support healthy behaviors by increasing access to healthful food choices and opportunities to be physically active. 03- 363 Cancer Facts & Figures 2003 37 I'm ironmenlal factors, defined hr()adIN to include smokin��. diet. and inic,chous diseases as Well as chenri- caIs;rnd radiation. cause an csIinurled tIIrecyuurters of all cauccrdcallis in the lniled Stales. .Arnow, I.hese fac- Iors, tohacco use. ohesily. and physical inact wily have a (,realer effect on individual cancer risk 1 hall do I race lev- els of pollutants in food. drinking \-valer. and air. I lowevcr, the degree of risk from pollnlnn(s depends on the conceulralion. intensity. and duration of exposure. Suhstantial increases in risk have been shotrn in settings Ndlere workers have been exposed to high concentra- tions of ionizing radiation. certain chemicals, metals, and other substances. as well as from radiation acci- dents, nuclear bombs, and patients treated with drugs or Iherapies later found to be carcinogenic. Fy,cn low-dose exposures that pose only a small rill: to indiv kraals cull still cause substantial ill heal) h across an entire population if the exposures are widespread. For example. secondhand tobacco smoke increases risk in lame numbers of people v0io do not smoke bill are exposed control and uttcntion to safe occupational practices. drug testing, and consumer product salelY play an important role in reducing risk of cancer from environmental exposures. ,Additional inlirrmation on environmental factors asso- ciated Nwith cancer risks can be round at several \V'eb sites. including www.atsdr.cdc.gov. www.epa.gov, ww�.nichs.nih.gov, xvw\-v.osha.gov. and www.who.int. Disk assessment evaloMICS both the cancer-causing potential of a substance as well as the levels of the sub- stance in the em-ironment and the extent to which people are actually exposed. However. the process is not perfect. For most potential carcinogens, data are onty available from high -dos(, experiments in animals or high]}' e.Xposed occupational groups. TO Use such infor- mation to set. human safety standards, regulators must extrapolate from animals to humans and from high - dose to low-dose conditions. Because both extrapola- tions involve nurch uncertainty, as does the effect of mixttnres of chemicals and ol' especially Susceptible sub- groups of the population, risk assessment, generally makes conservative assumptions to err on the side of safety. For cancer safety standards, acceptable risks are usually limited to those that increase risk by no more than one: case per Trillion persons over a lifetime. it ' J iFill I e38 Safety standards developed in this way for chemical or radiation exposures are the basis for federal regulatory activities at the Food and Drug Administration, the Environmental Protection Agency, and the Occupa- tional Safety and Health Administration. The applica- tion of laws and procedures by which standards are implemented and risks are controlled is called risk management. Chemicals Various chemicals (for example, benzene, asbestos, vinyl chloride, arsenic, aflatoxin) show definite evidence of causing cancer in humans; others are considered proba- ble human carcinogens based on evidence from animal experiments (for example, chloroform, dichloro- diphenyl-trichloroethane [DDT], formaldehyde, poly- chlorinated biphenyls [PCBs], polycyclic aromatic hydrocarbons). Often in the past, direct evidence of human carcinogenicity has come from studies of work- place conditions involving sustained, high -dose expo- sures. For some exposures (asbestos and radon), the risks are greatly increased when combined with tobacco smoking. Radiation The only types of radiation proven to cause human cancer are high -frequency ionizing radiation (IR) and ultraviolet (UV) radiation. Exposure to sunlight (UV radiation) causes almost all cases of basal and squamous cell skin cancer and is a major cause of skin melanoma. Disruption of the earth's ozone layer by pollution (the "ozone hole") may cause rising levels of UV radiation. Evidence that high -dose IR (x-rays, radon, etc.) causes cancer comes from studies of atomic bomb survivors, patients receiving radiotherapy, and certain occupa- tional groups, such as uranium miners. Virtually any part of the body can be affected by IR, but especially bone marrow and the thyroid gland. Diagnostic medical and dental x-rays are set at the lowest dose levels possi- ble to minimize risk without losing image quality and medical usefulness. Radon exposures in homes can increase lung cancer risk, and cigarette smoking greatly increases the effect of radon exposure on lung cancer risk. Fortunately, there are tests which can be used to detect high levels of radon. Remedial actions may be needed if radon levels are too high. Unproven Risks Public concern about cancer risks in the environment often focuses on unproven risks or on situations in which known carcinogen exposures Are at such low are greatly overshadowed by the health benefits of a levels that risks are negligible, for example: diverse diet rich in foods from plant sources. Pesticides. Many kinds of pesticides (insecticides, her- bicides, etc.) are widely used in agriculture in the pro- duction of the food supply. High doses of some of these chemicals have been shown to cause cancer in animals, but the very low concentrations found in some foods have not been associated with increased cancer risk. In fact, people who eat more fruits and vegetables, which may be contaminated with trace amounts of pesticides, generally have lower cancer risks than people who eat few fruits and vegetables. Workers exposed to higher levels of pesticides, in industry or farming, may be at higher risk of certain cancers. Environmental pollution by pesticides such as DDT, which is now banned but was used in agriculture in the past, degrade slowly and can lead to accumulation in body fat. These residues have been suggested as a possible risk factor for breast cancer, although study results have been largely negative. Continued research regarding pesticide use is essential for maximum food safety, improved food production through alternative pest control methods, and reduced pollution of the environment. In the meantime, pesti- cides play a major role in sustaining our food supply. When properly controlled, the minimal risks they pose In 1913, 10 physicians and five laymen founded the American Society for the Control of Cancer. Its stated purpose was to disseminate knowledge about the symp- toms, treatment, and prevention of cancer; to investi- gate conditions under which cancer was found; and to compile statistics about cancer. Later renamed the American Cancer Society, Inc., the organization now includes more than three million friends and volunteers working to conquer cancer. Organization: The American Cancer Society, Inc., con- sists of a National Society with 17 chartered Divisions throughout the country, and a local presence in most communities. Non -ionizing radiation. Electromagnetic radiation at frequencies below ionizing and ultraviolet levels has not been proven to cause cancer. Some studies suggest an association with cancer, but most of the now -extensive research in this area does not. Low -frequency radiation includes radiowaves, microwaves, and radar, as well as power frequency radiation arising from the electric and magnetic fields associated with electric currents, cellu- lar phones, and household appliances. Toxic wastes. Toxic wastes in dump sites can threaten human health through air, water, and soil pollution. Many toxic chemicals contained in such wastes can be carcinogenic at high doses, but most community expo- sures appear to involve very low or negligible dose levels. Clean-up of existing dump sites and close control of toxic materials in the future are essential to ensure healthy living conditions. Nuclear power plants. Ionizing radiation emissions from nuclear facilities are closely controlled and involve negligible levels of exposure for communities near the plants. Reports about cancer case clusters in such com- munities have raised public concern, but studies show that clusters do not occur more often near nuclear plants than they do by chance elsewhere. The National Society: A National Assembly provides basic representation from the Divisions and additional representation on the basis of population. The Assembly approves the charters for the 17 Divisions, approves the Society's strategic plan, and elects a volunteer Board of Directors. The Board of Directors sets strategic goals for the Society, ensures management accountability, and provides stewardship of donated funds. The National Society is responsible for overall planning and coordina- tion of the Society's programs for cancer information delivery, cancer control and prevention, advocacy, and resource development. The National Society also pro- vides technical help and materials for Divisions and local offices and administers its research program. The Divisions: These are governed by Division Boards of Directors comprised of both medical and lay volun- teers throughout the US and Puerto Rico. Thg S�cietyIs 363 Cancer Facts & Figures 2003 39 17 Divisions are responsible for program delivery in their regions. Local offices: Local offices are organized to deliver cancer control programs at the community level. Descriptions of some of the Society's major programs follow. Every day legislators make decisions that impact the lives of millions of Americans who have been touched by cancer. Laws and policies can fund cancer research, ensure access to care, offer screening and treatment to the medically underserved, and reduce suffering from tobacco -related illnesses. Advocacy can exponentially expand the Society's ability to fulfill its goals by ensuring lawmakers at every level of government adopt policies, laws, and regulations that will help people fight cancer. Advocacy Priorities Together with its research, education, service, and cancer control initiatives, the Society strives to advocate for and strengthen our nation's laws and regulations in a way that will: • Increase investments for cancer research, prevention, early detection, and care. • Increase access to quality cancer care, screening, prevention, and awareness efforts. • Reduce health disparities among minorities and the medically underserved. • Reduce and prevent suffering from tobacco -related illnesses. As the largest source of cancer research and application funding, the federal government provides billions of dollars for research, prevention, and early detection. But additional investments are needed to reach the next level of medical breakthroughs against cancer. A major- ity of Americans want the government to help marshal the resources dedicated to broadening our scientific knowledge and increasing our nation's capacity to pre- vent and treat this disease. At the same time, we need policy makers to support efforts that ensure that research advancements reach the public. Federal fund- ing is the foundation for the bridge between the lab room and the patient's room. The Society believes that urging legislators to fund research and its application moves our nation that much closer to our ultimate goal - defeating cancer. 40 Cancer Facts & Figures 2003 Expanded access to quality cancer care, screening, early detection, prevention, and awareness programs can be achieved through advocacy. Local, state, and federal gov- ernment leaders must help remove barriers that impede access to important cancer -fighting tools, such as early detection tests and clinical trials. Promoting policies that will improve the quality of life for people with cancer goes hand in hand with the Society's commit- ment to these issues. Reducing health disparities among minorities and the medically underserved is critical to reducing overall incidence and mortality. People who are poor, lack health insurance, have lower levels of education, or are members of racial or ethnic minorities are more likely to develop and die of cancer. Advocacy efforts can help improve these statistics by urging the government to raise awareness levels and better educate these commu- nities about cancer. Laws and policies that provide greater access to cancer care for these groups can be implemented. Support for creative interventions, more research, and culturally appropriate outreach are also needed to reach and serve these populations. Tobacco is responsible for nearly one-third of all cancer deaths. Federal, state, and local governments have a role to play in helping the Society reduce the nation's enor- mous tobacco -related cancer burden. Steps must be taken to help tobacco users quit and to keep children from using these deadly products, for example, through increased tobacco taxes, a proven means of reducing tobacco use, especially among youth. Policies that ensure all employees work in a smoke-free environment must be implemented. Effective local, state, and federal tobacco control programs must be sufficiently funded. Furthermore, the Society also believes the Food and Drug Administration (FDA) must be empowered with meaningful regulatory authority over tobacco products to ensure that tobacco is treated the same way as all other legal products. Advocacy Successes American Cancer Society advocacy initiatives rely on the combined efforts of a community-based grassroots network of cancer survivors and caregivers, Society volunteers and staff, health care professionals, public health organizations, and other collaborative partners. In the past year, the American Cancer Society, through its local, state, and federal efforts, has successfully influenced or supported policies, laws, and regulations that: • Secured continued investments for cancer research at the National Institutes of Health (NIH) and the National Cancer Institute (NCI), and funding for the new NIH Center on Minority Health and Health Disparities. • Improved our ability to apply research findings in cancer -related screening and early detection pro- grams provided by the Centers for Disease Control and Prevention (CDC). • Garnered significant bipartisan support in Congress for legislation that would help more Americans gain access to the full range of colorectal cancer screening tests. • Enacted laws in 16 states and the District of Columbia ensuring health care coverage for the full range of colorectal cancer screening tests to people over 50 or at a high risk for the disease. • Ensured that in 2003 more than 5.7 million more fed- eral employees and their dependents will have cover- age for the full range of colorectal cancer screening tools than in 2002. • Guaranteed the inclusion of strong patient protec- tions and access to clinical trials in the versions of the Patients' Bill of Rights passed by the House and the Senate, and passed access to clinical trials legislation in a total of 16 states. • Secured passage of tobacco excise tax increases in 22 states. • Developed and promoted landmark legislation to reduce barriers and expand access to ethnic minori- ties and medically underserved communities. • Led the way toward introduction of two comprehen- sive, bipartisan cancer bills. • Made major strides toward passage of meaningful FDA regulatory authority for tobacco products. In addition, on September 18 and 19, 2002, 3,000 Relay Community Ambassadors from every state and Con- gressional district and thousands of other Society volunteers came to Washington, DC, for the first ever Relay for Life® Celebration on the Hill to celebrate cancer survivorship and advocate for laws that help people fight cancer. Cancer Information Providing the public with accurate, up-to-date infor- mation on cancer anytime, day or night, is a priority for the American Cancer Society. Through our toll-free cancer information service at 1 -800 -ACS -2345, trained specialists answer calls in both English and Spanish, 24 hours a day, seven days a week. At our Web site www.cancer.org, visitors can find the latest cancer news, links to community resources and events, and available books. Cancer questions can be emailed to this Web site and are answered promptly. An online community of fel- low patients, survivors, and caregivers who understand and inspire is also available via the Cancer Survivors Network.'" National Cancer Information Center — 1 -800 -ACS -2345 People facing cancer need clear, reliable information in order to understand their disease and make informed decisions about their health. Trained cancer informa- tion specialists are available 24 hours a day, seven days a week to answer questions about cancer, link callers with resources in their communities, and provide informa- tion on local events. Cancer information specialists answer calls in both English and Spanish, and callers who speak languages other than English and Spanish can also be assisted through the translation services provided. The National Cancer Information Center includes an email response center staffed by cancer information specialists who reply to questions and com- ments submitted through the Society's Web site. American Cancer Society Web Site — www cancer.org The American Cancer Society's Web site is an important extension of the Society's mission to provide lifesaving information to the public. The user-friendly site includes an interactive cancer resource center contain- ing in-depth information on every major cancer type. Information is also available in Spanish. Through the Web site, visitors can order American Cancer Society publications, gain access to daily cancer -related articles, and find additional online and offline resources. Other useful sections on the Web site include a directory of medical resources, links to other sites organized by cancer type or topic, resources for media representa- tives, and information on the Society's research grants program, advocacy efforts, and special events. Publications The Society publishes a large number of patient educa- tion brochures and pamphlets, consumer books, and professional books and journals for patients, families, and health care professionals. These include books on specific cancer types, psychosocial, quality -of -life and caregiving issues, and prevention; cookboo and 63 0 Cancer Facts & Figures 2003 41 textbooks and other specialized cancer -related topics for health care professionals. The three clinical journals, Cancer, Cancer Cytopathology, and CA -A Cancer Journal for Clinicians, are also available. For more information, call 1 -800 -ACS -2345, or visit our online bookstore at www.cancer.org. Community Cancer Control Community cancer control encompasses activities at the local, state, regional, and national level which have a positive impact on the entire spectrum of prevention, early detection, effective treatment, survival, and quality of life related to cancer. Across the country, the Society seeks to fulfill its mission to save lives and diminish suf- fering from cancer through community-based programs aimed at reducing the risk of cancer, detecting cancer as early as possible, ensuring proper treatment, and empowering people facing cancer to cope with the disease and maintain the highest possible quality of life. Prevention Primary cancer prevention means taking the necessary precautions to prevent the occurrence of cancer in the first place. The Society's prevention programs focus pri- marily on tobacco control, the relationship between diet and physical activity and cancer, promoting coordinated school health, and reducing the risk of skin cancer. Programs are designed to help adults and children make health -enhancing decisions and act on them. The Society has joined other health, education, and social service agencies to promote comprehensive school health education and National School Health Education Standards. Comprehensive school health education is a planned health education curriculum for pre-school to grade 12. The standards describe for schools, parents, and communities how to create an instructional program that will enable students to become healthy and capable of academic success. The Society's school health education programs empha- size the importance of developing good health habits and can be an integral part of a comprehensive school health education curriculum. Specific programs that the Society has developed to strengthen schools' ability to teach cancer prevention include conducting a National School Health Coordi- nator Leadership Institute, creation of a series of social marketing campaigns on the benefits of school health, and coordinating the development of a Healthy Kids Network of parents and community members in support of school health and cancer prevention. 42 Cancer Facts & Figures 2003 The American Cancer Society works collaboratively with our national partners to implement comprehensive tobacco control programs. The Society advocates for social environmental change at the national, state, and community levels that prevents youth from starting to use tobacco and provides support for those who wish to stop smoking. Tobacco control efforts include: • Strong, meaningful FDA regulation of all tobacco products • Reduction of tobacco advertising and promotion directed at youth • Increased funding to support comprehensive tobacco control programs • Reduction of environmental tobacco smoke exposure • Support for coordinated school-based education programs • Accessible cessation programs for those who wish to quit • Tobacco tax increases to offset health care costs associated with tobacco use • Support for a global partnership to reduce tobacco - related death and disease The Society promotes its skin protection message through a variety of media and education activities, as well as through the 33 member organizations of the American Cancer Society Skin Protection Federation. This coalition includes nonprofit organizations, govern- ment agencies, and corporations that have a combined constituency of over 100 million adults and children. The purpose of the coalition is to accelerate promotion of the American Cancer Society's guidelines for skin cancer prevention, and to provide a forum for member organizations to share information and strategies that increase awareness about skin protection and encour- age more people to adopt skin protection behaviors. With possibly more than 60% of cancers preventable and due to lifestyle behaviors like smoking, sun exposure, and dietary habits that often begin in childhood, chil- dren and youth are an important audience for cancer prevention. The Society, together with the Centers for Disease Control and Prevention (CDC) and a host of other education, health, and social service agencies, has identified schools as a key system for impacting cancer prevention. By strengthening the 15,000 school districts in the US and helping them to deliver strong, coordi- nated school health programs and effective school EO health education, the American Cancer Society has the ability to impact over 45 million school children. Detection and Treatment The Society also seeks, through the dissemination of its early cancer detection guidelines and its cancer detec- tion and advocacy programs, to ensure that cancer is diagnosed at the earliest possible stage when there is the greatest chance of successful treatment. American Cancer Society guidelines for early cancer detection are reviewed annually to ensure that recommendations to the public and health care providers are based on the most current scientific evidence. Currently, the Society has early detection recommendations for cancers of the breast, cervix, colon and rectum, prostate, and endo- metrium, and general recommendations for a cancer - related checkup. (For more information, see Screening Guidelines, page 48.) The Society works in partnership with many public and private organizations in diverse settings to increase awareness about breast cancer and the importance of early detection, and to overcome the barriers to regular mammography use. The Society, in partnership with the CDC, is leading a national initiative to increase colorectal cancer screen- ing which is currently underutilized by adults. In addi- tion to public outreach campaigns and initiatives targeting health care providers, the American Cancer Society and the CDC have established the National Colorectal Cancer Roundtable, bringing leading govern- ment agencies, professional and medical organizations, and advocacy and patient groups together to identify collective strategies and opportunities to increase screening for colorectal cancer. Working with the Ad Council, the premier nonprofit communications organi- zation dedicated to stimulating action on public issues, the Society has been able to reach millions of people with the lifesaving colorectal cancer screening message: "Get the test. Get the polyp. Get the cure." Using a larger - than -life polyp character to grab attention, this cam- paign is designed to educate the public that screening tests can prevent this disease by removing polyps before they become cancerous. The availability of genetic testing for inherited risk for cancer has raised a complex set of questions about the medical, psychosocial, ethical, legal, policy, and quality - of -life implications about the use of genetic information. The Society is working with other national organiza- tions to address these issues through advocacy and edu- cational initiatives. As the delivery of health care continues to change, the Society is working with partners in all sectors of the health care system to ensure that all individuals are offered a full range of services to enable them to reduce their risk of getting cancer or to find their cancer at an early, treatable stage, and that persons with cancer receive the highest quality care. Patient Services The Society offers a range of practical and emotional support for patients, their families, their caregivers, and their community from the time of diagnosis throughout life. Cancer Survivors Networks": Created by and for cancer survivors and their families, this "virtual" com- munity offers unique opportunities and accessibility to survivors, caregivers, and all those touched by cancer. It is a welcoming, safe place for people to find hope and inspiration from others who have "been there." Services include radio talk show conversation and interviews, individual stories, personal Web pages, discussion forums, an Expression Gallery, and more - available online at www.cancer.org or by phone at 1-877-333-4673 (HOPE). I Can Cope®: Adult cancer patients and their loved ones learn ways to navigate the cancer experience while building their knowledge, coping skills, and positive attitude. In this series of educational classes, doctors and other health care professionals provide information, encouragement, and practical tips in a supportive environment. Hope Lodge®: This home -like environment provides free, temporary sleeping accommodations for cancer patients undergoing treatment and their family mem- bers. It makes the cancer treatment process a little eas- ier by providing a supportive environment and lifting the financial burden of an extended stay. "tic"TM: A magazine and catalog in one, "tic" supports women dealing with hair loss and other physical effects of cancer treatment. The magalog offers a wide variety of affordable products, such as wigs, hats, and prosthe- ses, through the privacy and convenience of mail order. Look Good ... Feel Better: Through this service, women in active cancer treatment learn techniques to restore their self-image and cope with appearance -related side effects. Certified beauty professionals provide tips on makeup, skin care, nail care, and head coverings. This program is a partnership among the American Cancer Society, the Cosmetic, Toiletry, and Fragrance Association Foundation, and the National Cosmetology Association. C3- 363 Cancer Facts & Figures 2003 43 9 r" 02 Road to Recovery": This service assists cancer patients and their families with transportation to and from treatment facilities. Volunteer drivers donate their time and resources to take patients to treatment appointments and return them to their homes. Reach to Recovery®: Breast cancer survivors provide one-on-one support and information to help individuals cope with breast cancer. Specially trained survivors serve as volunteers, responding in person or by phone to the concerns of people facing breast cancer diagnosis, treatment, recurrence, or recovery. Man to Man®: This comfortable, community-based set- ting for discussion and education provides men facing prostate cancer with support individually or in groups. Man to Man also offers men the opportunity to educate their communities about prostate cancer and advocate with lawmakers for stronger research and treatment policies. Children's camps: In some areas, the Society sponsors camps for children who have, or have had, cancer. These camps are equipped to handle the special needs of chil- dren undergoing treatment. Pain Control Cancer pain management is a serious public health problem and a major priority for the Society. Approximately 50%-70% of people with cancer experi- ence some degree of pain. Less than half of them get adequate relief from their pain, and this negatively affects their quality of life. Through service, collabora- tion, education, advocacy, and research, the Society is working aggressively to eliminate barriers to cancer - related pain relief across the survivorship continuum. Tools are being enhanced and expanded that educate the public, patients, families, and health care providers about the availability of treatments that effectively manage most cancer pain. Research The research program has three components: extramu- ral grants that fund researchers at universities, research institutes, and cancer centers throughout the US; intra- mural epidemiology and surveillance research; and the intramural behavioral research center. The intramural programs are dedicated to research conducted by the Society's own in-house scientists. As the largest source of private, nonprofit cancer research funds in the US, the Society dedicated more than $130 million to research and health professional training in 2001, with less than 5% of that amount going toward the operating ' k f 44 Cancer Facts & Figures 2003 0 expenses of the research program. Since 1946, when the Society awarded its first research grants, we have invested almost $2.5 billion in research. The investment has paid rich dividends: the 5 -year survival rate has almost tripled since 1946, and the new case rates and death rates from cancer have declined each year since 1990. Indeed, Society -supported researchers have con- tributed to most of the advances that, for the first time, make the conquest of cancer a feasible goal. Extramural Grants The American Cancer Society's extramural grants pro- gram supports the best research at more than 150 of the top US medical schools and universities across a wide range of health care disciplines critically important to the control of cancer. Grant applications solicited through a nationwide competition are subjected to a rigorous external peer review, ensuring that only the best research is funded, wherever it may be. The lion's share of our research budget is dedicated to funding investigators at the beginning of their research careers, a time when they are less likely to receive funding from the federal government. Strong emphasis is placed on research needs that are unmet by other funding organi- zations, such as our current targeted research area of cancer in the poor and underserved. The success of the Society's research program is exemplified by the fact that 32 Nobel Prize winners received grant support from the Society early in their careers. Epidemiology and Surveillance Research Intramural epidemiologic research at the American Cancer Society evaluates trends in cancer incidence and mortality, cancer risk factors, and cancer patient care, and Society epidemiologists study the causes and pre- vention of cancer in large prospective studies. In addi- tion to Cancer Facts E Figures, the department provides descriptive cancer statistics in several other publica- tions including Cancer Statistics, Breast Cancer Facts E Figures, and Cancer Facts E Figures for African Americans. Trends and patterns in cancer risk factors such as tobacco use, nutrition, and physical activity are presented in Cancer Prevention E Early Detection Facts Figures. This publication serves as a resource for the Society's 17 regional Divisions to assess progress toward the Society's goals. For the past five years, the depart- ment has collaborated with the National Cancer Institute, the Centers for Disease Control and Prevention, including the National Center for Health Statistics, and the North American Association of Central Cancer Registries to produce the annual Report to the Nation on progress related to cancer prevention and control in the United States. Internationally, the department collaborates with the World Health Organization to publish tobacco control country pro- files, a monograph on tobacco consumption, produc- tion, and trade in 197 countries. The department also analyzes patterns of cancer causa- tion in large prospective studies. Three such studies have been undertaken over the past 50 years: • Hammond -Horn (188,000 men studied from 1952- 1955) • Cancer Prevention Study I (1 million people studied from 1959-1972 in 25 states) • Cancer Prevention Study II (CPS -II, a continuing study of 1.2 million people enrolled in 1982 by 77,000 volun- teers in 50 states) About 130 scientific publications based on CPS -II have examined the contribution of lifestyle (smoking, nutri- tion, weight, etc.), family history, illnesses, medications, and environmental exposures to various cancers. Mortality follow-up of all CPS -II cohort members con- tinues. In addition, cancer incidence follow-up and peri- odic updating of exposure information occurs in the CPS -II Nutrition Cohort, a subgroup of 184,000 men and women. In 1998, the CPS -II LifeLink Study obtained blood sam- ples from approximately 40,000 surviving members of the CPS -II Nutrition Cohort residing in urban and sub- urban areas. An additional 67,000 buccal (check) cell samples were obtained, providing DNA specimens on over 100,000 cohort members. These blood and buccal cells samples are being stored in liquid nitrogen for future epidemiologic investigations, including the role of nutritional, hormonal, and genetic factors in the development of cancer and other diseases. Additional information about the Cancer Prevention Studies is available at www.cancer.org, including copies of ques- tionnaires and publication citations. Behavioral Research Center The Behavioral Research Center was established in 1995 to conduct original behavioral and psychosocial cancer research, provide consultation to other parts of the Society, and facilitate the transfer of behavioral and psy- chosocial research and theory to improve cancer control policies. Among the ongoing research projects of the center are: • An extensive nationwide, longitudinal study of adult cancer survivors to determine the unmet psychosocial needs of survivors and their caretakers, to identify factors that affect their quality of life, to evaluate pro- grams intended to meet their needs, and to examine late effects, including second cancers. • A cross-sectional national study of cancer survivors who are two, five, and 10 years from their initial diag- nosis and treatment. This study will evaluate the psy- chological needs, adjustment, and quality of life of cancer survivors and provide information now on longer-term cancer survivors. • Analysis of data from the health-related quality -of -life surveys conducted by the Department of Health and Human Services Centers for Medicare and Medicaid (formerly the Health Care Financing Administration, or HCFA). Data are being provided to the Behavioral Research Center to examine changes in quality of life of cancer survivors who receive Medicare -managed care. • A study to test the Patient/Provider/System Theoret- ical Model (PPSTM) for cancer screening in primary care centers. • A pilot study of cancer knowledge, attitudes, beliefs, and risk perceptions among African American college students. • Research to investigate the ethnic disparity in physical activity from a theory of planned behavior perspective, with the objective of providing information needed to develop ethnic -specific exercise interventions to increase physical activity and help reduce cancer risk. • Research to explore sedentary behavior patterns in an obese population. The objective is to identify key determinants of this population's behavior in order to increase their physical activity and reduce their cancer risk. • A survey of researchers in the field of psycho-oncology about their current research interests and opinions. • A study to examine prevalence rates of fruit and veg- etable consumption, physical activity, and smoking in cancer survivors and their influence on quality of life. • A study of the use of complementary therapies by breast and prostate cancer survivors, as well as a corresponding survey of physicians who treat cancer patients. The physicians' survey will explore physician -patient communications about comple- mentary therapies. 03- 363 Cancer Facts & Figures 2003 45 Cancer Deaths. the (',Iinulled ninnhers of 1 S cancer deaths arc caiculaled ht' IiIIin the nnmhof cancrr dcafIIs Ibr 1979 1hroti h'_'(IOU1o❑,fill istwill model\\hicklurcca,lsIIle nunthcrs of (('lith, thul arc led to occur in 2003. Mlle (stinuttcd nun11w), ofc;tncertical h>. fur ('itch ,late iue calculated ,inlilorlY. u,in Talc Icvel dilil. liar both the I''S and ,It11c c,Iintates. data on Ilio nunIlu,r,ufticiIII,ill oIIlain('d Irvin IIIc Nil llonil Ccnlcr for I IciliII Still i,lit, (\('I 1Sal the ( enter, lot I)iscasc Control ,111(1 lurevelllioll. \1c cli,coilrl(e the unc of our estimates to hired\ vcin-Io Year chiar_oc, in eonccr(1eal IIs h('cansc the nuIll hcr, can aIY consid- crnthh hom scar to vcar. pillicularhlilt- Ic,s common cancers anti for ,II1lIIIeI stole,. AlorlaliIX, rales reported h�v NCIIS are gencrn111t more infnrnuItke stali,tics to Ilse when Iracl<ing cancer Mot IitI e bends. 1101-talily Kates. NlurtallIX rales or death rates arc defined as IIIc nunthcr of people per 100.000 dying of it disease during a mcli war. In this publication. nwrtalih rates cure based on counts of cancer deolhs compiled by NCI IS for 1930 through 1999 and Imputation dila from the I.IS Bureau ol'tl'tc Census. pules, othervvi.,c indicated. death rates in this publication are agc-adjus(cd Io I he 2000 US ,stiuulard popltlil ion. to allow com- parisons across populations with different age distributions. These rates slLuuld only be compined to of her statistics Ihat are agc-adjnslcd to the I S 2000 standard population. New Cancer Cases. I he estimated numbers of new US cancer cases arc calculaled ba c,t imat ing I.he numbers of cancer cases that occurred each Year from 191-9 through 1999 and fitting [lies(, estimates to it s[atistical model which forecasts the Mlln- bers 011 eases that ar('eYpccted to occur i112003. I'.stimates ofthe numbers of cancer cases for 191-9 through L999 are used rather than actual case comas because case data are not available for all 50 slates. The estimated numbers of cases for 1979 through 1999 arc calculated using cancer incidence rates fi-om the regions of the I'nited Stales included in the National Cancer Institule's Surveillance, Fpidemiologyt and End Results (SEER) Program and population data collected by the US Bureau of the Census. State case estimates are calculated by apportioning the total US case esl iniatees for 2003 by state. based on the state distribution of estimated cancer deaths for 2003. Like th(, net hod used to calculate cancer deaths, the methods used to estimate new US and state cases f'or the upcoming year cern produ c numbers that; vary considerably from year to year, particularly for less common cancers and for smaller states. For this reason. we discourage the use of our estimates to track year -to -Year changes in cancer occurrence. Incidence rates reported by SElill are generally more informative statistics to use when tracking cancer incidence trends for the United States, and rales froln state cancer registries are useful for track- ing local trends. Incidence Rates. Incidence rates are defined as the number of people per 100,000 Lebo are diagnosed with cancers during a given time period. For this publication, incidence rates for the US were calculated using data on cancer cases collected by the SEEK Prograyn and population data collected by the US Bureau of the Census. State incidence rates presented in this publica- tion are published in the North American Association of Central Cancer Registries' publication Cancer Incidence in North America, 1995-1999. Incidence rates for the United States were originally published in SEER Cancer Statistics Review, 1973- 1999. This source is preferred because it provides incidence data by race/ethnicity. Unless otherwise indicated, incidence rates in this publication are age-adjusted to the 2000 US standard pop- ulation, to allow comparisons across populations that have dif- ferent age distributions. Note that because of delay in reporting cancer cases to the National Cancer Institute (NCI), cancer inci- dence rates for the most recent diagnosis years may be underes- timated. Cancers most affected by reporting delays are melanoma of the skin and prostate, which are frequently diag- nosed in nonhospital settings. Survival. Five-year relative survival rates are presented in this report for cancer patients diagnosed between 1992 and 1998, followed through 1999. Relative survival rates are used to adjust for normal life expectancy (and events such as death from heart disease, accidents, and diseases of old age). These rates are cal- culated by dividing observed 5 -year survival rates for cancer patients by 5 -year survival rates expected for people in the gen- eral population who are similar to the patient group with respect to age, sex, race, and calendar year of observation. All survival statistics presented in this publication were originally published in SEER Cancer Statistics Review, 1973-1999. Probability of Developing Cancer. Probabilities of developing cancer are calculated using DevCan (Probability of Developing Cancer Software) developed by the National Cancer Institute. These probabilities reflect the average experience of people in the United States and do not take into account individual behaviors and risk factors. For example, the estimate of 1 man in 13 developing lung cancer in a lifetime underestimates the risk for smokers and overestimates risk for nonsmokers. Additional Information. More information on the methods used to generate the statistics for this report can be found in the following publications: A. For information on data collection methods used by the National Center for Health Statistics: National Center for Health Statistics. Vital Statistics of the United States, 2000, Vol II, Mortality, Part A. Washington, DC: Public Health Service 2000, or visit the NCHS Web site at www.cdc.gov/nchs. B. For information on data collection methods used by the National Cancer Institute's Surveillance, Epidemiology and End Results Program: Ries LAG, Eisner MP, Kosary CL, et al. (eds). SEER Cancer Statistic Review, 1973-1999. National Cancer Institute. Bethesda, MD, 2002. Available at: http://seercancer. gov/csr/1973_1999/. Accessed October 24, 2002. C. For information on the methods used to estimate the num- bers of new cancer cases and deaths: Wingo PA, Landis S, Parker S, Bolden S, Heath CW. Using cancer registry and vital statistics data to estimate the number of new cancer cases and deaths in the United States for the upcoming year. J Reg Management. 1998;25(2):43-51. D. For information on the methods used to calculate the proba- bility of developing cancer: Feuer EJ, Wan L -M, Boring CC, et al. The lifetime risk of developing breast cancer. J Natl Cancer Inst. 1993; 85:892-897. o Age Adjustment to the Year 2000 Standard Epidemiologists use a statistical method called "age -adjustment" to compare groups of people with different age compositions. This is especially important when examining cancer rates, since cancer is generally a disease of older people. For example, without adjusting for age, it would be inaccurate to compare the cancer rates of the state of Florida, which has a large elderly population, to that of Alaska, which has a younger population. Without adjusting for age, it would appear that the cancer rates for Florida are much higher than Alaska. However, once the ages are adjusted, it appears their rates are similar. Starting with the publication of Cancer Facts E Figures 2003, we use the 2000 US population standard for age - adjustment. This is a change from statistics previously published by the American Cancer Society. Prior to this year, most age-adjusted rates were standardized to the 1970 census, although some were based on the 1980 census or even the 1940 census. This change has also been adopted by federal agencies that publish statistics. The new age standard applies to data from calendar year 1999 and forward. The change also requires a recalculation of age- adjusted rates for previous years to allow valid comparisons between current and past years. The purpose of shifting to the Year 2000 Standard is to more accurately reflect contemporary incidence and mor- tality rates, given the aging of the US population. On average, Americans are living longer because of the decline in infectious and cardiovascular diseases. Greater longevity allows more people to reach the age when cancer and other chronic diseases become more common. Using the Year 2000 Standard in age -adjustment instead of the 1970 or 1940 standards allows age-adjusted rates to be closer to the actual, unadjusted rate in the population. The effect of changing to the Year 2000 Standard will vary from cancer to cancer, depending on the age at which a particular cancer usually occurs. For all cancers combined, average annual age-adjusted incidence rate for 1995-99 will increase approximately 20% when adjusted to the Year 2000 compared to the Year 1970 Standard. For cancers, such as colon cancer, that occur mostly at older ages, the Year 2000 Standard will increase incidence by up to 25%, whereas for cancers such as acute lymphocytic leukemia, the new standard will decrease the incidence by about 7%. These changes are caused by the increased representation of older ages (for all cancers combined and colon cancer) or by the decreased representation of younger ages (for acute lymphocytic leukemia) in the Year 2000 Standard compared to the Year 1970 Standard. It is important to note that in no case will the actual number of cases/deaths or age-specific rates change, only the age -standardized rates which are weighted to the different age -distribution. C3- 363 Cancer Facts & Figures 2003 47 y - Site Recommendation Breast Women 40 and older should have an anneal mammogram, an annual clinical hreasi examination (CBE) by a health care professional. and Sluiuld perform monthly breast self-examinations (BSE). Ideally the CBI: should occur before the Scheduled mammogram. Women ages 20-31) should have a CBE by a health care professional every three years and Should perform BSF. moral hly. Colon & Beginning at age 50, men and women should follow one oft lie examination schedules below: rectum s A fecal occult blood test (FOBT) every year _ A flexible sigmoidoscopy (FSIG) every five years Annual fecal occult. blood test and flexible sigmoidoscopy every five years" o A double-contrast barium enema every five years 4 A colonoscopy every 10 years `°Combined testing is preferred over either an mol V'OBI: or FSK; every 5 years, alone. People it,ho are at moderate or high risk fi)r colorectal cancer should talk uiith a doctor about a different testing schedule. Prostate The PSA test and the digital rectal examination should be offered annually, beginning at age 50. to men who have a life expectancy of at least 10 years. Men at high risk (African American men and men with a strong family history of one or more first-degree relatives diagnosed with prostate cancer at an early age) should begin testing at age 45. For both men at average risk and high risk, information should be provided about what is known and what is uncertain about the benefits and lirnitations of early detec- tion and treatment of prostate cancer so that they can make an informed decision about testing. Uterus Cervix: Screening should begin approximately three years after a woman begins having vaginal inter- course, but no later than 21 years of age. Screening should be done every year wit h regular Pap tests or every two years using liquid -based tests. At or after age 30, women who have had three normal test results in a row may get screened every 2-3 years. However, doctors may suggest. a woman get screened more often if she has certain risk factors, such as HIV infection or a weak immune system. Women 70 years and older who have had three or more consecutive normal Pap tests in the last. 10 years may choose to stop cervical cancer screening. Screening after total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer: Endometrium: The American Cancer Society recommends that all women should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their physicians. Annual screening for endometrial cancer with endometrial biopsy beginning at age 35 should be offered to women with or at risk for hereditary nonpolyposis colon cancer (HNPCC). Cancer- For individuals undergoing periodic health examinations, a cancer -related checkup should include related health counseling, and depending on a persorfs age, might include examinations for cancers of the checkup thyroid, oral cavity, skin, lymph nodes, testes, and ovaries, as well as for some nonmalignant diseases. American Cancer Society guidelines for early cancer detection are assessed annually in order to identify whether there is new sci- entific evidence sufficient to warrant a re-evaluation of current recommendations. If evidence is sufficiently compelling to consider a change or clarification in a current guideline or the development of a new guideline, a formal procedure is initiated. Guidelines are formally evaluated every 5 years regardless of whether new evidence suggests a change in the existing recommendations. There are nine steps in this procedure, and these "guidelines for guideline development" were formally established to provide a specific methodology for science and expert judgment to form the underpinnings of specific statements and recommendations from the Society. 11wse procedures constitute a deliberate process to insure that all Society recommendations have the same methodolog- ical and evidence -based process at their core. This process also employs a system for rating strength and consistency of evidence that is similar to that employed by the Agency for Health Care Research and Quality (AHCRQ) and the US Preventive Services Task Force (USPSTP). 02003, American Cancer Society, Inc. 48 :e • Facts 8r Figures 2003 California Division, Inc. 1710 Webster Street Oakland, CA 94612 (510)893-7900 (0) (510) 835-8656 (F) Eastern Division, Inc. (Ll, NJ, NYC, NYS, Queens, Westchester) 6725 Lyons Street East Syracuse, NY 13057 (315) 437-7025 (0) (315) 437-0540 (F) Florida Division, Inc. (including Puerto Rico operations) 3709 West Jetton Avenue Tampa, FL 33629-5146 (813) 253-0541 (0) (813) 254-5857 (F) Puerto Rico, Inc. Calle Alverio #577 Esquina Sargento Medina Hato Rey, PR 00918 (787) 764-2295 (0) (787) 764-0553 (F) Great Lakes Division, Inc. (Ml, IN) 1755 Abbey Road East Lansing, MI 48823-1907 (517) 332-2222 (0) (517) 333-4656 (F) Heartland Division, Inc. (KS, MO, NE, OK) 1100 Pennsylvania Avenue Kansas City, MO 64105 (816)842-7111(0) (816) 842-8828 (F) Illinois Division, Inc. 77 East Monroe Street Chicago, IL 60603-5795 (312) 641-6150(0) (312) 641-3533 (F) Mid -Atlantic Division, Inc. (DC, DE, MD, VA, WV) 8219 Town Center Drive Baltimore, MD 21236-0026 (410)931-6850 (0) (410) 931-6875 (F) Mid -South Division, Inc. (AL, AR, KY, LA, MS, TN) 1100 Ireland Way Suite 300 Birmingham, AL 35205-7014 (205) 930-8860 (0) (205) 930-8877 (F) Midwest Division, Inc. (IA, MN, SD, WI) 8364 Hickman Road Suite D Des Moines, IA 50325 (515) 253-0147 (0) (515) 253-0806 (F) New England Division, Inc. (CT, ME, MA, NH, Rl, VT) 30 Speen Street Framingham, MA 01701-1800 (508) 270-4600 (0) (508) 270-4699 (F) Northwest Division, Inc. (AK, MT, OR, WA) 2120 First Avenue North Seattle, WA 98109-1140 (206) 283-1152 (0) (206) 285-3469 (F) Ohio Division, Inc. 5555 Frantz Road Dublin, OH 43017 (614)889-9565(0) (614) 889-6578 (F) Pennsylvania Division, Inc. (PA, Phil) Route 422 and Sipe Avenue Hershey, PA 17033-0897 (717) 533-6144 (0) (717) 534-1075 (F) Rocky Mountain Division, Inc. (CO, ID, ND, UT WY) 2255 South Oneida Denver, CO 80224 (303) 758-2030 (0) (303) 758-7006 (F) Southeast Division, Inc. (GA, NC, SC) 2200 Lake Boulevard Atlanta, GA 30319 (404) 816-7800 (0) (404) 816-9443 (F) Southwest Division, Inc. (AZ, NM, NV) 2929 East Thomas Road Phoenix, AZ 85016 (602) 224-0524 (0) (602) 381-3096 (F) Texas Division, Inc. (including Hawaii Pacific operations) 2433 Ridgepoint Drive Austin, TX 78754 (512) 919-1800 (0) (512) 919-1844 (F) Hawaii Pacific, Inc. 2370 Nuuanu Avenue Honolulu, HI 96817 (808) 595-7500 (0) (808) 595-7502 (F) 02003, American Cancer Society, Inc. No. 5008.03 i The American Cancer Society is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service. No matter who you are, we can help. Contact us anytime, day or night, for information and support. American ,~ Cancer c> society 1.800.ACS.2345 www.cancer.org Hope.Progress.Answers