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CANCER FACTS & FIGURES-1995 OE 3,800 AMERICAN VCANCER ? SOCIETY Estimated number of new cancer cases in 1995 by state, totai: 1,252,000 (excluding Puerto Rico}. 'Excluding basoi and squamous cell skin cancer and carcinoma in situ. PUERTO RICO 10,600 mately 7,000 cases) and chronic lymphocytic (approxi mately 7,800 cases). Mortality; An estimated 20,400 deaths in 1995. Signs and Symptoms: Fatigue, paleness, weight loss, seated infections, bruising easily, and nosebleeds or other .lemorrhages. In children, these signs can appear suddenly. Chronic leukemia can progress slowly and with few symptoms. Risk Factors: Leukemia strikes both sexes and all ages. Causes of most cases are unknown. Persons with Down syndrome and certain other genetic abnormalities have higher than normal incidence of leukemia. It has also been linked to excessive exposure to ionizing radiation and to certain chemicals such as benzene, a commercially used toxic liquid that is also present in lead-free gasoline. Certain forms of leukemia and lymphoma are caused by a retrovirus, HTLV-I (human T-cell leukemia/lymphoma virus-I). Early Detection: Because symptoms often resemble those of other, less serious conditions, leukemia can be difficult to diagnose early. When a physician does suspect leukemia, diagnosis can be made using blood tests and biopsy of the bone marrow. TVeatment: Chemotherapy is the most effective method of treating leukemia. Various anticancer drugs are used, either in combinations or as single agents. Transfusions of blood components and antibiotics are used as supportive treatments. To illuminate hidden cells, therapy of the central nervous system has become standard treatment, pecially in acute lymphocytic leukemia. Under appro priate conditions, bone marrow transplantation may be useful in the treatment of certain leukemias. Survival: The 5-year survival rate for patients with, leukemia is 38%, due partly to very poor survival of patients with some types of leukemia such as acute granulocytic. Over the last 30 years, however, there has been a dramatic improvement in survival of patients with acute lymphocytic leukemia; from a 5-year survival rate of 4% for people diagnosed in the early 1960s to 28% in the early 1970s to 52% in the mid-1980s. In children, the improvement has been from 4% to 73%. Lymphoma New Cancer Cases: An estimated 58,700 new cases in 1995, including 7,800 cases of Hodgkin's disease and 50,900 non-Hodgkin's lymphoma. Since the early 1970s, incidence rates for non-Hodgkin's lymphoma have increased over 65%. Incidence of Hodgkin's disease has declined over the same time period, especially among the elderly. Mortality: An estimated 24,150 deaths in 1995 (nonHodgkin's lymphoma, 22,700; Hodgkin's disease, 1,450). Signs and Symptoms: Hodgkin's disease: enlarged lymph jdes, itching, fever, night sweats, and weight loss. Fever 14 S & FIGURES 1995 can come and go in periods of several days or week Non-Hodgkin's lymphoma: enlarged lymph nodes, anemi weight loss, and fever. Risk Factors: Risk factors are largely unknown but part involve reduced immune function and exposure certain infectious agents. Persons with organ transplan are at higher risk due to altered immune function. Hum; immunodeficiency virus (HIV) and human T-cell leukemic lymphoma virus-I (HTLV-I) are associated with increasrisk of non-Hodgkin's lymphoma. Burkitt's lymphoma Africa is partly caused by the Epstein-Barr herpes vin Other possible risk factors include occupational exposur to herbicides and perhaps other chemicals. Treatment: Hodgkin's disease: chemotherapy and radi therapy are useful for most patients. Non-Hodgkii lymphoma: early stage, localized lymph node disease a be treated with radiotherapy. Patients with later sta disease often benefit from the addition of chemotheraj New programs using highly specific monoclonal antibodi directed at lymphoma cells, and improved techniques bone marrow preservation, are under investigation selected patients who relapse after standard treatment. Survival: Survival rates vary widely by cell type and sta of disease. The overall 5-year survival rate for Hodgki: disease is 79%. The overall 5-year survival for nc Hodgkin's lymphoma has steadily improved, and in t past 30 years has increased from 31% to 52%. Skin Cancer New Cancer Cases: Over 800,000 cases a year of higl curable basal cell or squamous cell cancers. They are m< common among individuals with lightly pigmented sk The most serious skin cancer is melanoma, which v be diagnosed in about 34,100 persons in 1995. Since 19' the incidence rate of melanoma has increased about per year. Incidence rates are over 10 times higher amc whites than blacks. An additional 16,000 invas nonmelanoma skin cancer cases will occur in 1995, mo: sarcomas, including Kaposi's sarcoma. Mortality: An estimated 9,300 deaths this year, 1,\ from malignant melanoma and 2,100 due to other s cancers. Signs and Symptoms: Any unusual skin conditi especially a change in the size or color of a mole or ot darkly pigmented growth or spot. Scaliness, oozi bleeding, or change in the appearance of a bump or nod the spread of pigmentation beyond its border, a cha in sensation, itchiness, tenderness, or pain. Risk Factors: Excessive exposure to ultraviolet radiat fair complexion; occupational exposure to coal tar, pit creosote, arsenic compounds, or radium. Prevention: The sun's ultraviolet rays are strong BFG 01391 CANCER F, Prevention Researchers estimate that if everything known about the prevention ofcancer was applied, up to two-thirds of cancers would not occur. The following are areas in which certain health choices might reduce an individual's risk of cancer. Smoking Cigarette smoking is responsible for 90% of lung cancers among men and 79% among women--about 87% overall. Smoking accounts for about 30% of all cancer deaths. Those who smoke two or more packs of cigarettes a day have lung cancer mortality rates 12 to 25 times greater than nonsmokers. (See Tobacco Use, p. 22.) Nutrition and Diet Research is showing the important role nutrition plays in preventing cancer. Evidence indicates that people may reduce their cancer risk by observing these nutrition guidelines: 1. Maintain a desirable weight Individuals 40% or more overweight have an increased risk of colon, breast, prostate, gallbladder, ovary, and uterus cancers. Physicians can recommend a suitable diet and exercise regimen to help maintain appropriate weight and body fitness. 2. Eat a varied diet A varied diet eaten in moderation offers the best hope for lowering the risk of cancer. 3. Include a variety of vegetables and fruits in the daily diet. Studies have shown that daily consumption of vegetables and fresh fruits is associated with a decreased risk of lung, prostate, bladder, esophagus, colorectal, and stomach cancers. 4. Eat more high-fiber foods such as whole grain cereals, breads, and pasta; and vegetables and fruits. High-fiber diets are a healthy substitute for fatty foods and may reduce the risk of colon cancer. 5. Cut down on total ht intake. A diet high in fat may be a factor in the development of certain cancers, particularly breast, colon, and prostate. 6. Limit consumption of alcohol, If you drink at all. Heavy drinking, especially when accompanied by cigarette smoking or smokeless tobacco use, increases risk of cancers of the mouth, larynx, throat, esophagus, and liver. 7. Limit consumption of salt-cured, smoked, and nitritecured foods. In areas of the world where salt-cured and smoked foods are eaten frequently, there is higher incidence of cancer of the esophagus and stomach. Modem methods of food processing and preserving appear to avoid the cancer-causing byproducts associated with older methods of food treatment. Sunlight Almost all of the more than 800,000 cases of basal and squamous cell skin cancer diagnosed each year in the US are sun-related (ultraviolet radiation). Epidemiologic evidence shows that sun exposure is a major factor in the development of melanoma and that incidence increases for those living near the equator. (See Selected Cancers: Skin Cancer, p. 15.) Alcohol Oral cancer and cancers of the larynx, throat, esophagus, and liver occur more frequently among heavy drinkers of alcohol especially when accompanied by smoking cigarettes or chewing tobacco. (See Selected Cancers: Oral Cancer, P-17.) Smokeless Tobacco Use of chewing tobacco or snuff increases risk of cancer of the mouth, larynx, throat, and esophagus and is a highly addictive habit. (See Selected Cancers: Oral Cancer, p. 17.) Estrogen Estrogen treatment to control menopausal symptoms can increase risk of endometrial cancer. However, including progesterone in estrogen replacement therapy helps to minimize this risk. Consultation with a physician will help each woman to assess personal risks and benefits. Continued research is needed in the area of estrogen use and breast cancer. (See Selected Cancers: Uterus [Cervix] Cancer, p. 12.) Occupational Hazards Exposure to several different industrial agents (nickel, chromate, asbestos, vinyl chloride, etc.) increases risk of various cancers. Risk of lung cancer from asbestos is greatly increased when combined with cigarette smoking. (See Environmental Cancer Risks, p. 20.) Ionizing Radiation Excessive exposure to ionizing radiation can increase cancer risk. Most medical and dental x-rays are adjusted to deliver the lowest dose possible without sacrificing image quality. Excessive radon exposure in homes may increase risk of lung cancer, especially in cigarette smokers. If levels are found to be too high, remedial actions should be taken. 19 CANCER FACTS & FIGURES 1995 BFG 01392