Document b5Kd4MZjKGq3LK2zmK33OOdwy

CANCER FACTS & FIGURES-1994 PUERTO RICO 9,400 AMERICAN iVCANCER SOCIETY' Estimated number of new cancer cases in 1994 by state, total: 1,208,000 (excluding Puerto Rico].' 'Excluding bosal and squamous cell skin cancer and corcmcma in situ. R&S 144807 Contents CANCER: BASIC FACTS........................................................................ 1 RESEARCH, PREVENTION, DIAGNOSIS AND TREATMENT........ Cancer Death Rates by Site, Males, US, 1930-1990 ....................... Cancer Death Rates by Site, Females, US, 1930-1990 ................... 30-Year Trends in Cancer Death Rates per 100,000 Population, 1958-60 to 1988-90 ..................................................... Estimated New Cancer Cases and Deaths, US, 1994 ...................... Estimated New Cancer Cases, by State--1994 ................................ Cancer Mortality, by State--1994 ....................................................... 2 4 4 5 6 7 8 SELECTED CANCERS........................................................................... 9 Lung Cancer............................................................................................ 9 Colon and Rectum Cancer..................................................................... 9 Breast Cancer............................................................................................10 Prostate Cancer........................................................................................ 10 Leading Sites of Cancer Incidence and Death--1994 Estimates................................................................................................ 11 How to Estimate Cancer Statistics Locally..........................................12 Pancreas Cancer....................................................................................... 12 Uterus (Cervix) Cancer............................................................................ 12 Percentage of Population (Probability) Developing Invasive Cancers at Certain Ages........................................................13 Uterus (Endometrial) Cancer.................................................................. 13 Cancer in Children................................................................................... 13 Leukemia................................................................................................... 14 Lymphoma.................................................................................................14 Tables are indicated in bold print. Ovary Cancer............................................................................................ 15 Five-Year Relative Survival Rates by Stage at Diagnosis...................16 Bladder Cancer.........................................................................................16 Oral Cancer.............................................................................................. 16 TYends in Cancer Survival, by Race......................................................17 CANCER IN MINORITIES...................................................................... 18 Number of Cancer Deaths for Black, American Indian, Chinese, Japanese, and Hispanic Persons, US, 1990...................... 18 PREVENTION...........................................................................................19 Environmental Cancer Risks.................................................................. 20 EARLY DETECTION................................................................................21 TOBACCO USE............................................................... 22 THE AMERICAN CANCER SOCIETY................................................... 24 Research................................................................................................... 24 Public Education..................................................................................... 24 Professional Education........................................................................... 25 Patient Services....................................................................................... 25 Public Issues............................................................................................ 25 COSTS OF CANCER................................................................................26 THE DISADVANTAGED..........................................................................26 Allocation of ACS Funds, 1992.............................................................26 Summary of Research Grants and Fellowships................................... 27 Cancer Around the World...................................................................... 28 Cancer Centers.........................................................................................29 Chartered Divisions of the ACS............................................. Back Cover Sources of Statistics Incidence. Since there is no nationwide cancer registry, there is no way of knowing exactly how many new cases of cancer are diagnosed each year. The American Cancer Society (ACS) estimates cancer incidence for the upcoming year using the best available data sources at the time. Estimates of cancer incidence in Facts and Figures editions prior to 1974 were based on rates from two state cancer registries, the Connecticut Tumor Registry and the New York State Tumor Registry. The issues from 1974 to 1978 used information from the National Cancer Institute's Third National Cancer Survey (1969-1971) of nine major areas of the United States. In 1973, the NCI began the Surveillance, Epidemiology and End Results (SEER) program to collect ongoing data on cancer incidence and patient survival. The SEER deaths are based on cancer mortality data from 1984 through 1990. Beginning with the 1981 edition of Facts and Figures, age-adjusted mortality rates per 100,000 are standardized to the 1970 census population distribution. Age-adjustment or age-standardization is a method used to make valid statistical comparisons among rates by assuming the same age distribution occurs among the different groups being compared. Death rates by state: Since 1990, actual age-adjusted mortality rates, based on reported deaths in a recent 5-year period, have been presented. State mortality rate estimates from earlier Facts and Figures are not comparable. Cancer Around the World: International mortality rates were calculated from data made available by the World Health Organization,' and are adjusted to program includes data from nine population-based cancer registries, covering the old world population standard. about 1096 of the US population. Beginning with the 1979 edition of Facts and Figures, estimates of cancer incidence have been based on incidence rates obtained through the SEER program, applied to the US Census estimates of the population for the current year. Estimates of new cancer cases include invasive cancers only, excluding in situ tumors except for cancers of the urinary bladder. Basal and squamous cell skin cancers are also excluded. Probability of Developing Cancer. The probabilities of developing cancer are based on incidence rates for first primary cancers for that site, as reported to the NCI SEER program for 1988 through 1990. SEER area mortality rates for 1988-1990 were used to calculate survival into each age interval. Detailed methodology is available from the Applied Research Branch, National Cancer It is not appropriate or accurate to evaluate cancer incidence and mortality Institute. trends using only ACS estimates of cases and deaths, since these numbers are projected before the year begins, using data that are several years old. Survival. Cancer survival statistics are usually reported as 5-year relative survival The numbers are presented to give the best available measure of the scope rates. In this edition, we present survival statistics for cases diagnosed in of the disease in the US at the time of publication. Comparable incidence the period 1983-1989, as reported from the SEER program and followed through rates are available for 1973 through 1990 from the National Cancer Institute's 1990. The relative survival rate is the ratio of the observed survival rate for SEER program to evaluate cancer trends. the patient group to the expected survival rate for persons in the general The estimates of total US cancer cases diagnosed in 1994 are based on population similar to the patient group with respect to age, sex, race and age-specific incidence rates from the SEER program for 1988-1990 applied calendar year of observation. Because there is a certain lag time required to the 1994 Census population projections. Some adjustment is made for sites in measuring survival, these rates may not reflect the most recent treatment with recently increasing or decreasing rates. Estimated new cases by state advances. are calculated according to the distribution of estimated 1994 cancer deaths by state for each primary cancer site. SEER Report. The NCI SEER program is the source of specific data components for Cancer Facts & Figures 1994, including incidence rates and survival rates. Mortality. Mortality statistics are derived from underlying cause of death data These and other data are available in the SEER Cancer Statistics Review: 1973- reported by the Division of Vital Statistics, National Center for Health Statistics, 1990, National Cancer Institute. NIH Pub. No. 93-2789, 1993. Department of Health and Human Services. The 1994 estimates of cancer c 1994, American Cancer Society, Inc All rights reserved, including the right to reproduce this publication or portions thereofin any for R&S 144808 For written permtipon, address the American Cancer Society, J599 Clifton Road, A . Atlanta, CA 30329-4251. Cancer: Basic Facts What is cancer? 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. What causes cancer? Cancer is caused by both external (chemicals, radiation, and viruses) and internal (hormones, immune conditions, and inherited mutations) factors. Causal factors may act together or in sequence to initiate or promote carcino genesis. Ten or more years often pass between exposures or mutations and detectable cancer. Can cancer be prevented? Yes, about 90% of the 700,000 skin cancers that will be diagnosed in 1994 could have been prevented by protection from the sun's rays. All cancers caused by cigarette smoking and heavy use of alcohol could be prevented completely. The ACS estimates that in 1994, about 165,000 lives will be lost to cancer because of tobacco use. About 17,000 cancer deaths will be related to excessive alcohol use, frequently in combination with cigarette smoking. Regular screening and self-exams can detect cancers of the breast, tongue, mouth, colon, rectum, cervix, prostate, testis, and melanoma at an early stage, when treatment is more likely to be successful. These sites include nearly half of all new cases. Of these cases, about two-thirds of all patients currently survive five years. With early detection, about 90% would survive. This means that of those persons diagnosed with these cancers in 1994, about 100,000 more would survive if their cancers had been detected in a localized stage and treated promptly. How is cancer treated? By surgery, radiation, radioactive substances, chemicals, hormones, and immunotherapy. Who gets cancer? Anyone. Since incidence rises with age, most cases affect adults in mid-life or older. Among children ages 1-14, cancer causes more deaths in the US than any other disease. In the 1980s there were over 4.5 million cancer deaths, almost 9 million new cancer cases, and some 12 million people under medical care for cancer. How many people alive today have ever had cancer? Over 8 million Americans alive today have a history of cancer, 5 million diagnosed five or more years ago. Most of these 5 million can be considered cured, while others still have evidence of cancer. "Cured" means that a patient has no evidence of disease and has the same life expectancy as a person who never had cancer. How many new cases will there be this year? About 1,208,000 new cancer cases will be diagnosed. This estimate does not include carcinoma in situ and basal and squamous cell skin cancers. The incidence of these skin cancers is estimated to be over 700,000 cases annually. How many people will die? This year about 538,000 will die of cancer--over 1,400 people a day. One out of every five deaths in the US is from cancer. What is the national cancer death rate? There has been a steady rise in the cancer mortality rate in the US in the last half-century. The age-adjusted rate in 1930 was 143 per 100,000 population. It rose to 157 in 1950, to 163 in 1970, and was 174 in 1990. The major cause of this increase has been lung cancer. Death rates for many major cancer sites have leveled off or declined over the past 50 years (see page 5). If lung cancer deaths were excluded, cancer mortality would have declined 14% between 1950 and 1990. How many people are surviving cancer? In the early 1900s, few cancer patients had any hope of long-term survival. In the 1930s, less than one in five was alive five years after treatment. In the 1940s, it was one in four, and in the 1960s, it was one in three. About 483.000 Americans, or 4 of 10 patients who get cancer this year, will be alive 5 years after diagnosis. The gain from 1 in 3 in the 1960s to 4 in 10 now represents over 85.000 persons each year. This 4 in 10, or about 40% is called the "observed" survival rate. When adjusted for normal life expectancy (factors such as dying of heart disease, accidents, and diseases of old age), a "relative" 5-year survival rate of 53% is seen for all cancers. The relative survival rate is commonly used to measure progress in the early detection and treatmen of cancer. R&S 144809 1 CANCER FACTS l FIGURES 1994 Research, Prevention, Diagnosis, & Treatment The vocabulary of cancer is ever increasing, as knowledge about the disease mounts. In the past decade, words such as oncogenes, retinoids, and growth factors have become standard. Indeed, our knowledge of the genetics of cancer has soared, and it is now possible to envision the day when the genetic basis of individual cancers will be known, along with mechanisms to correct the problem. In addition to looking to the future, we can enjoy some successes now. Some cancers that only a few decades ago had a very poor outlook are often cured today: acute lymphocytic leukemia in children, Hodgkin's disease, Burkitt's lymphoma, Ewing's sarcoma (a form of bone cancer), Wilms' tumor (a kidney cancer in children), rhabdomyosarcoma (a cancer in certain muscle tissue), testicular cancer, and osteogenic (bone) sarcoma. This section highlights some developments in cancer research, prevention, diagnosis, and therapy, and indicates the directions of current and future research. Oncogenes, which play a role in normal cell growth and differentiation, can mutate and cause the runaway cell growth associated with cancer. The ras oncogene is mutated in 50% of colon cancers and 90% of pancreatic cancers. The presence of certain oncogenes is being used to predict which tumors are likely to recur after surgery and/or to identify family members at risk. Suppressor genes, which exist in normal cells to control cell growth, also play a role in cancer. Some cancers are caused when mutations occur in these genes, allowing uncontrolled cell growth. For example, the p53 suppressor gene frequently is altered in many types of cancer, including breast and lung. In one familial syndrome, where family members have high rates of cancer, about 90% of those who inherit the abnormal p53 gene get cancer by the age of 50. Family members can now be screened for this genetic abnormality before cancer develops. Through genetic engineering, researchers may be able to correct or modify hereditary susceptibility by transplanting normal copies of genes into cells that have mutated copies of those genes. Growth factors can be used to stimulate normal bone marrow cells to withstand very high doses of chemother apeutic drugs. A genetic fusing of cancer cells with normal cells can produce disease-fighting monoclonal antibodies (specific antibodies tailored to seek out chosen targets on cancer cells). Their potential in the diagnosis and treatment of cancer is under study, and they are showing promise for carrying cancer-killing radiation and drugs to a precise location. Researchers are understanding how cancer cells spread to healthy tissues, a process called metastasis. Cell mutations can cause increased production of destructive enzymes that allow them to invade surrounding tissues and penetrate blood vessels to travel to other parts of the body. A powerful enzyme inhibitor, TIMP-2 is showing promise for abolishing the metastatic potential of tumor cells. A metastasis suppressor gene, NM23, has also been identified. New ways have been found to treat early breast and colon cancers postoperatively with drugs. This "adjuvant" treatment may eradicate cancer cells remaining after surgery and increase cure rates. Neoadjuvant chemotherapy (giving chemotherapy to shrink the cancer and then removing it surgically) has been tried against various types of cancers. This is a prom ising new treatment approach. Understanding the causes of pain in cancer patients has increased the options for controlling pain. Regular use of orally administered pain medicines, infusions or injections of analgesics, and procedures to interrupt pain pathways are among the effective approaches available for the majority of patients with pain from cancer. Researchers are examining synthetic retinoids (cousins of vitamin A) and other substances to see if recurrences of certain cancers can be prevented and if these agents can reduce cancer in high-risk groups. The cancer prevention capabilities of many other compounds are also being researched. In clinical trials, taxol, an agent obtained currently from the bark of Pacific yew trees, has been effective in treating ovarian cancer. Research efforts are underway to synthesize this scarce drug in the laboratory and the synthesized taxol will be tested for efficacy in all types of cancer. New approaches to drug therapy use combinations of chemotherapeutic drugs, or chemotherapy plus surgery or radiation. New classes of agents are being tested for their effectiveness in treating patients whose disease is resistant to drug therapies now in use. Understanding the basis of drug resistance and developing counterattacks are major areas of research today. Many patients with primary bone cancer now are treated successfully by removing and replacing a section of bone rather than by amputating the leg or arm. Drugs and radiation therapy are being used effectively after bon cancer surgery, resulting in dramatic improvement i survival. 2 CANCER FACTS & FIGURES 1994 R&S 144810 mew nign-tecnnoiogy ui^uuslu; imaging Leuiiuques have replaced exploratory surgery for some cancer patients. Magnetic resonance imaging (MRI) is one example of such technology. In MRI, a huge electromagnet is used to detect hidden tumors by mapping the vibrations of the various atoms in the body on a computer screen. Computerized tomography (CT) scanning uses x-rays to examine parts of the body. In both of these painless, noninvasive pro cedures, cross-section pictures can show a tumor's shape and location more accurately than is possible with conventional x-ray techniques. For patients undergoing radiation therapy, CT scanning may enable the therapist to pinpoint the tumor more precisely, and thus provide more accurate radiation dosage while sparing normal tissue. Positron emission tomography (PET) is another imaging technique. One of the advances in the area of imaging combines two or three different types of images (e.g., MRI and PET) in a computer to create a threedimensional picture that can be rotated on the screen. This technology is currently used in some medical centers to help plan for surgery and radiation therapy in areas such as the brain. Immunotherapy holds the hope of enhancing the body's own disease-fighting systems to help control cancer. Interferon (a naturally occurring body protein capable of killing cancer cells or stopping their growth), interleukin2 (a growth factor that stimulates cells of the immune system to fight cancer), and other biologic response modifiers are under study. Recently, interferon was made available to all doctors as the treatment for hairy cell leukemia, a rare blood cancer of older Americans. Interleukin-2 is under active research in the treatment of kidney cancer and melanoma. Gene therapy is the newest approach to stimulating immune cells to fight cancer. Vaccines against several types of cancer are also being developed. Many cancers develop in a two-stage process through exposure to substances known as initiators and promoters. Research scientists are exploring ways to interrupt this process. Ongoing research into new drug development will result in compounds that are less toxic to normal cells, and more potent against tumor cells. New drugs will also allow physicians to circumvent the problem of drug resistance that many cancer cells develop. Along that same line of research, genes responsible for cancer cell resistance to chemotherapy have recently been discovered. New technologies have made it possible to use bone marrow transplantation as an important treatment option in select patients with leukemia and lymphoma. Bone marrow transplantation for breast cancers and other malignant tumors is under study. Because disruption of UUiic munufv luiiv-uou o a oiuv yi ouiiii. treatments, researchers are evaluating autologous bone marrow transplants, in which a portion of the patient's own marrow is removed before treatment, saved, and later restored. This procedure eliminates the problems of matching a donor with the recipient patient, and may make it possible for the patient to tolerate larger doses of anticancer drugs or radiation therapy. * Improvements in cancer treatment have made possible more conservative management of some early cancers. In early cancer of the larynx, many patients are now able to retain the larynx and voice; in colorectal cancer, fewer permanent colostomies are needed; in many cases, the surgery for breast cancer is often more limited; and special nerve-sparing surgery now commonly used for prostate cancer could enable men to maintain normal penile function. * Prostatic ultrasound (a rectal probe using ultrasonic waves to produce an image of the prostate) is currently being investigated as a potential means to increase the early detection of occult (not clinically suspected) prostate cancer. Recently, prostatic ultrasound has been combined with a blood test for prostate-specific antigen to aid in early detection of prostate cancer. * A large clinical trial is underway to evaluate the usefulness of an estrogen-blocking drug called tamoxifen. Commonly used to treat women when they have breast cancer, this large study hopes to see if tamoxifen can also be used to prevent breast cancer in women who are at high risk. * With medical progress producing longer survival periods for many cancer patients, clinical concerns are expanding to include not only patients' physical well-being, but also their psychosocial needs. The response of both patient and family to the disease, the patient's sexual concerns, employment and insurance needs, and ways to provide psychosocial support have emerged as important areas of research and clinical care. * Psychosocial and behavioral research is showing much promise as evidence mounts that lifestyle (tobacco, diet) and environmental factors influence a person's general health and chances of developing cancer, as well as the mental ability to cope with cancer if it occurs. Research on behavioral modification is having a significant impact on symptoms of cancer and its treatment, such as pain, nausea, and vomiting. Other research deals with stress during treatment and during recovery after surgery or radiation treatment. A number of investigations concentrate on breast cancer, specifically on how women can be motivated to make use of mammography screening, and how to adjust to surgery, if such intervention becomes necessary. R&S 144811 3 CANCER FACTS & FIGURES 1994 Cancer Death Rates by Site, Males, United States, 1930-90 Rotes ore per 100,000 and ore age-adjusted to the 1970 US census population. Cancer Death Rates by Site, Females, United States, 1930-90 Available on reproduction sheet (5005.94) Rates are per 100,000 and are age-odjusted to the 1970 US census population. 4 CANCER FACTS & FIGURES 1994 Available on reproduction sheet (5005.94) R&S 144812 30-Year Trends in Cancer Death Rates* per 100,000 Population, 1958-60 to 1988-90 Sites All Sites Oral Esophagus Stomach Colon & rectum Colon Rectum Liver^ Pancreas Larynx Lung Melanoma of skin Other skin Breast Cervix uteri Other uterus Ovary Prostate Bladder ,, Kidney Brain Non-Hodgkin's lymphoma Hodgkin's disease Multiple myeloma Leukemia Sex Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Female Female Female Male Male Female Male Female Male Female Male Female Male Female Male Female Male Female 1958-1960 180.9 136.8 6.0 1.6 4.8 1.2 17.5 9.0 25.2 22.8 17.0 17.4 8.2 5.4 5.7 5.9 10.1 6.2 2.7 0.3 36.4 5.5 1.4 1.0 1.7 0.8 0.3 25.7 9.4 6.6 8.8 20.5 7.2 2.7 3.8 2.0 4.0 2.7 4.8 3.2 2.2 1.3 2.0 1.4 8.9 5.7 1988-1990 218.0 140.8 4.6 1.7 5.9 1.5 6.9 3.1 23.5 16.1 20.0 14.1 3.5 2.0 5.2 3.2 9.9 7.1 2.5 0.5 74.2 30.6 3.0 1.5 1.3 0.4 0.2 27.4 3.0 3.5 7.9 25.3 5.6 1.7 5.1 2.4 5.1 3.4 7.7 5.0 0.7 0.4 3.6 2.5 8.2 4.8 Percent Changes 21% f -22% 9% 23% 25% -61% -65% - 7% -30% 17% -19% -58% -63% - 8% -45% f 14% - 6% 87% 104% 452% 120% 48% -25% -56% -33% 7% -68% -47% -10% 23% -22% -38% 35% 16% 26% 27% 62% 58% -67% -68% 85% 76% - 7% -16% Number of Deaths 1960 143,498 124,084 4,668 1,507 3,832 1,083 13,085 7,774 19,127 20,265 13,010 15,527 6,117 4,738 4,566 5,828 7,982 5,693 2,201 225 31,257 5,163 1,194 989 1,156 670 215 23,755 8,487 5,929 8,046 14,452 5,440 2,425 3,145 1,794 3,700 2,484 4,015 2,839 1,877 1,198 1,687 1,342 7,371 5,354 Number of Deaths 1990 268,283 237,039 5,636 2,769 7,213 2,506 8,336 5,737 28,635 28,895 24,385 25,325 4,250 3,570 6,557 5,811 12,199 12,883 2,977 733 91,091 50,194 3,844 2,576 1,556 614 272 43,391 4,627 6,052 12,762 32,378 6,910 3,431 6,271 4,042 6,339 5,291 9,795 8,806 956 676 4,561 4,373 10,192 8,382 'Adjusted to the oge distribution of the 1970 US Census population. fPercent changes not listed because they are not meaningful. ^Primary ond non-specified. Note: Even though death rates declined or remained stable, the number of deaths increased because the population has become larger and older. The US population increased 38% from 1960 to 1990. R&S 144813 5 CANCER FACTS & FIGURES 1994 Estimated New Cancer Cases and Deaths, United States--1994* Estimated New Cases Both Sexes Male Female Estimated Deaths Both Sexes Male Female All sites 1,208,000 632,000 576,000 538,000 283,000 255,000 Buccal cavity & pharynx (Oral) Lip Tongue Mouth Pharynx 29,600 3,300 6,000 11,100 9,200 19,800 2,800 3,800 6,600 6,600 9,800 500 2,200 4,500 2,600 7,925 5,150 75 50 1,750 1,100 2,100 1,200 4,000 2,800 2,775 25 650 900 1,200 Digestive organs Esophagus Stomach Small intestine Large intestine \ Rectum S .. . ,, . . (Colon-Rectum) Liver and biliary passages Pancreas Other and unspecified digestive 233,300 11,000 24,000 3,600 107,000 42,000 16,100 27,000 2,600 123,100 8,000 15,000 2,000 52,000 23,000 8,800 13,000 1,300 110,200 3,000 9,000 1,600 55,000 19,000 7,300 14,000 1,300 121,450 10,400 14,000 950 49,000 7,000 13,200 25,900 1,000 64,550 7,800. 8,400 500 24,000 3,800 7,200 12,400 450 56,900 2,600 5,600 450 25,000 3,200 6,000 13,500 550 Respiratory system Larynx Lung Other & unspecified respiratory 189,000 12,500 172,000 4,500 112,800 9,800 100,000 3,000 76,200 2,700 72,000 1,500 158,200 3,800 153,000 1,400 97,900 3,000 94,000 900 60,300 800 59,000 500 Bone 2,000 1,100 900 1,075 600 475 Connective tissue 6,000 3,300 2,700 3,300 1,600 1,700 Melanoma of skin 32,000 17,000 15,000 6,900 4,300 2,600 Breast 183,000 1,000 182,000 46,300 300 46,000 Genital organs Cervix uteri 1 ... . Corpus & unspecified J (UterUS> Ovary Other & unspecified genital, female Prostate Testis Other & unspecified genital, male 283,400 15,000 31,000 24,000 5,300 200,000 6,800 1,300 208,100 -- -- -- -- 200,000 6,800 1,300 75,300 15,000 31,000 24,000 5,300 -- -- -- 63,725 4,600 5,900 13,600 1,100 38,000 325 ' 200 38,525 -- -- -- 38,000 325 200 25,200 4,600 5,900 13,600 1,100 -- --, -- Urinary organs Bladder Kidney & other urinary 78,800 51,200 27,600 55,000 38,000 17,000 23,800 13,200 10,600 21,900 10,600 11,300 13,800 7,000 6,800 8,100 3,600 4,500 Eye 1,750 950 800 250 125 125 Brain & central nervous system 17,500 9,600 7,900 12,600 6,800 5,800 Endocrine glands Thyroid Other endocrine 14,450 4,150 10,300 1,725 750 13,000 3,400 9,600 1,025 400 1,450 750 700 700 350 975 625 350 Leukemia Lymphocytic leukemio Granulocytic leukemia Other & unspecified leukemia 28,600 12,500 11,400 4,700 16,200 7,300 6,200 2,700 12,400 5,200 5,200 2,000 19,100 5,700 7,500 5,900 10,500 3,300 4,100 3,100 8,600 2,400 3,400 2,800 Other blood & lymph tissues Hodgkin's disease Non-Hodgkin's lymphoma Multiple myeloma 65,600 7,900 45,000 12,700 35,900 4,400 25,000 6,500 29,700 3,500 20,000 6,200 32,550 1,550 21,200 9,800 17,100 900 11,200 5,000 15,450 650 10,000 4,800 All other & unspecified sites 43,000 24,000 19,000 41,000 21,000 20,000 'Excludes basol ond squomous cell cancers and in situ carcinomas except bladder. Carcinoma in situ of the uterine cervix accounts for about 55,000 new cases annually, corcinoma in situ of the female breast accounts for about 25,000 new cases annually, ond melanoma carcinoma in situ accounts for about 8,000 new cases annually. Overall, obout 100,000 new cases of corcinoma in situ of all sites of cancer ore diagnosed each yeor. Bosal cell and squomous cell skin cancers account for more than 700,000 new cases onnually. About 2,300 nonmelonoma skin cancer deaths will occur in 1W4. Incidence estimates ore based on rates from NCI SEER program 1988-90. R&S 144814 6 CANCER FACTS & FIGURES 1994 Estimated New Cancer Cases, by State--1994* All State Sites Alabama 21,000 Alaska Arizona 1,300 17,500 Arkansas 14,000 California 124,000 Colorado 12,000 Connecticut 16,200 Delaware 3,800 Dist. of Columbia 4,000 Florida 82,000 Georgia 28,000 Hawaii 4,100 Idaho 4,200 Illinois 57,000 Indiana 27,000 Iowa 14,200 Kansas 12,300 Kentucky 20,000 Louisiana 20,500 Maine 6,900 Morylond 23,500 Massachusetts 31,000 Michigan 43,500 Minnesota 19,300 Mississippi 13,200 Missouri 27,500 Montano 3,900 Nebraska 7,700 Nevoda 5,900 New Hampshire 5,200 New Jersey 42,000 New Mexico 5,800 New York ^ 88,000 North Carolina 33,000 North Dokota 3,300 Ohio Oklohoma 55,000 15,700 Oregon 14,500 Pennsylvania 69,000 Rhode Island 5,700 Sooth Corolina 16,500 South Dakota 3,300 Tennessee 25,500 Texas 66,000 Utah 4,800 Vermont 2,600 Virginia 28,000 Washington 22,000 West Virginio 10,600 Wisconsin 24,000 Wyoming 2,000 United States 1,208,000 Puerto Rico 9,400 Female Breast 2,800 150 2,500 1,900 19,000 1,900 2,500 600 600 11,500 4,200 475 600 8,800 4,200 2,200 1,900 2,600 2,900 900 3,300 4,900 6,800 3,100 1,700 4,100 550 1,300 800 900 6,800 850 15,000 4,800 425 8,800 2,100 1,900 11,000 900 2,300 475 3,500 9,200 750 425 4,400 3,300 1,400 3,700 300 182,000 1,300 Colon & Rectum 2,200 150 2,000 1,700 14,000 1,500 2,300 500 500 10,200 3,000 550 500 7,600 3,300 2,100 1,700 2,400 2,200 850 2,900 4,400 5,400 2,600 1,400 3,200 500 900 600 650 5,600 650 12,500 4,000 425 7,000 1,700 1,600 9,400 800 1,800 450 3,200 7,500 500 275 3,100 2,300 1,200 3,000 200 149,000 1,100 Lung 3,100 250 2,500 2,300 17,000 1,500 2,100 550 450 13,000 4,200 500 550 7,600 4,100 1,900 1,700 3,500 3,300 1,000 3,400 3,900 6,000 2,300 2,100 4,200 500 1,000 1,000 700 5,400 700 11,500 5,000 350 8,000 2,500 2,200 9,300 750 2,500 425 4,200 10,000 375 350 4,200 3,200 1,800 2,800 250 172,000 650 Skin Oral Uterus Prostate Melanoma Pancreas Leukemia 550 850 3,200 500 450 425 50 60 150 40 25 30 350 550 3,100 550 400 450 250 600 2,600 325 325 325 3,300 5,000 18,000 4,000 2,900 3,100 275 450 2,600 475 300 275 400 500 2,500 400 375 400 125 125 600 125 60 75 150 225 800 40 100 75 2,500 3,000 16,000 2,500 1,800 1,900 900 900 4,700 750 600 650 100 125 650 60 100 80 100 150 1,000 125 100 125 1,400 2,200 9,400 1,300 1,200 1,400 500 1,000 4,000 600 600 600 300 450 2,600 450 300 375 300 475 2,100 400 250 325 375 800 2,800 500 400 400 500 750 3,100 400 500 450 150 175 1,200 200 150 125 600 800 3,800 550 500 475 950 950 4,600 950 700 650 950 1,700 7,100 850 950 1,100 350 650 4,000 500 450 550 350 500 2,500 275 300 275 450 1,000 4,300 650 550 650 125 100 850 100 90 80 175 300 1,400 250 175 150 100 225 800 150 125 125 150 200 850 150 100 100 1,000 1,700 6,800 1,100 900 850 150 225 1,000 150 125 175 2,300 3,600 13,000 2,200 2,100 2,000 900 1,400 6,300 1,000 750 800 70 100 950 70 60 100 1,200 2,300 8,600 1,300 1,100 1,400 350 650 2,600 425 300 400 350 500 2,600 400 325 400 1,400 2,800 11,400 1,800 1,500 1,500 125 200 850 150 125 100 600 700 3,000 400 400 350 60 100 650 90 75 80 500 950 4,000 700 600 600 yoo 2,500 10,000 1,600 1,600 1,800 60 275 1,200 175 100 125 60 75 600 70 60 70 650 1,100 4,800 750 650 600 500 650 3,800 550 500 550 275 375 1,500 325 225 250 550 900 4,700 550 600 650 25 90 350 30 30 60 29,600 46,000 200,000 32,000 27,000 28,600 425 425 1,800 75 225 225 'Does not include carcinoma in situ or basal and squamous cell skin cancers. These estimates are offered os a rou jh guide and should not be regarded os definitive. They are calculated according to the distribution of estimated 1994 cancer deoths by state. JO & w K 00 tn 7 CANCER FACTS & FI GURES 1994 Cancer Mortality by State--1994 . _, Estimated Number of Deaths State Death Rate per 100,000' All Sites Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevoda New Hampshire New Jersey New Mexico ' New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dokota Tennessee Texos Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 179 175 157 176 166 146 170 195 230 166 176 138 150 180 178 158 157 188 190 184 193 179 176 156 178 174 160 159 184 179 185 146 176 173 155 181 169 167 180 181 175 152 178 164 124 175 180 164 180 165 154 9,400 500 7,800 6,200 52,000 5,400 7,200 1,600 1,700 37,700 12,300 1,800 1,900 25,400 12,100 6,300 5,500 9,100 9,100 3,100 10,500 13,800 19,500 8,600 5,900 12,300 1,700 3,400 2,600 2,300 18,700 2,600 39,000 15,200 1,400 24,700 7,000 6,500 31,000 2,500 7,400 1,500 11,300 31,000 2,000 1,100 12,500 9,600 4,700 10,800 800 United States Puerto Rico 172 538,000 129 4,500 Female Breast 700 50 600 475 4,600 475 600 150 150 3,000 1,000 125 175 2,200 1,100 600 500 650 750 225 850 1,200 1,700 800 425 1,000 150 325 200 225 1,700 225 3,900 1,200 125 2,200 550 500 2,800 225 600 125 900 2,300 200 125 1,100 850 350 950 75 46,000 325 Colon & Rectum 850 50 750 650 5,100 550 800 200 200 3,800 1,100 200 175 2,900 1,200 800 600 900 850 325 1,100 1,700 2,100 1,000 550 1,300 175 325 250 225 2,100 250 4,500 1,500 150 2,600 650 600 3,500 300 700 175 1,200 2,900 200 100 1,200 900 475 1,200 75 56,000 425 Lung 2,800 175 2,200 2,100 14,500 1,200 1,900 500 400 11,500 3,800 425 475 6,800 3,700 1,700 1,500 3,100 2,900 900 3,100 3,600 5,400 2,100 1,800 3,800 450 900 850 600 4,900 600 10,200 4,600 325 7,200 2,200 2,000 8,300 700 2,300 ' 350 3,700 9,000 325 300 3,600 2,900 1,500 2,600 225 153,000 600 Oral 150 20 100 70 900 80 100 40 40 650 200 30 30 400 125 75 75 100 150 40 175 225 250 90 90 125 25 40 25 40 275 40 600 250 20 325 90 90 375 30 150 20 125 475 20 20 175 150 75 150 10 7,925 175 Uterus 200 10 125 150 1,100 100 100 30 50 700 200 30 30 500 225 100 100 175 150 40 175 200 400 150 125 250 30 80 50 50 400 50 850 300 25 500 125 100 650 50 175 30 225 600 50 20 250 175 80 200 20 10,500 150 Prostate 600 25 600 500 3,600 450 450 100 150 3,000 850 125 175 1,800 750 500 375 500 600 225 700 850 1,400 750 450 800 175 275 150 175 1,300 175 2,600 1,200 175 1,600 475 475 2,200 150 550 125 750 1,900 225 125 900 700 300 900 75 38,000 450 Skin Melanoma 100 10 125 70 900 100 80 30 10 500 150 20 30 275 125 90 80 100 80 40 125 225 175 125 60 150 25 50 30 30 225 40 475 225 15 275 100 80 375 30 90 20 150 350 40 20 150 125 70 125 10 6,900 25 Pancreas 425 25 375 300 2,800 275 350 60. 100 1,800 550 100 100 1,200 550 300 250 375 500 150 475 650 900 450 300 500 90 175 125 100 850 125 2,000 700 60 1,100 300 325 1,400 125 375 75 600 1,500 100 60 600 475 200 550 30 25,900 200 Leukemia 300 20 300 225 2,000 200 250 50 50 1,300 425 60 90 900 400 250 225 300 300 90 325 425 750 375 200 450 50 125 80 60 550 125 1,300 550 70 900 275 275 1,000 75 225 50 400 1,200 90 50 400 350 175 425 40 19,100 150 'Average annual mortality rate for 1986-1990, adjusted to the age distribution of the 1970 US Census Population. R&S 144816 8 CANCER FACTS & FIGURES 1994 Lung Cancer Incidence: An estimated 172,000 new cases in 1994. The incidence rate, which had been increasing steadily in men and women for several decades, has declined in men, from a high of 87 per 100,000 in 1984 to 80 in 1990. The incidence rate in women continues to increase to 41 per 100,000 in 1990. Mortality: An estimated 153,000 deaths in 1994. Since 1987, more women have died of lung cancer than breast cancer, which, for over 40 years, was the major cause of cancer death in women. Signs and Symptoms: Persistent cough, sputum streaked with blood, chest pain, recurring pneumonia or bronchitis. Risk Factors: Cigarette smoking; exposure to certain industrial substances, such as arsenic, certain organic chemicals and asbestos, particularly for persons who smoke; radiation exposure from occupational, medical, and envi ronmental sources. Radon exposure may increase risk, especially in cigarette smokers. Exposure to sidestream cigarette smoke increases the risk for nonsmokers. Early Detection: Because symptoms often don't appear until the disease is in advanced stages, early detection is very difficult. In smokers who stop smoking at the time of early precancerous cellular changes, damaged bronchial lining tissues often return to normal. Smokers who persist in smoking may form abnormal cell growth patterns that lead to cancer. Chest x-ray, analysis of the types of cells contained in sputum, and fiberoptic examination of the bronchial passages assist diagnosis. Treatment: Determined by the type and stage of the cancer. Options include surgery, radiation 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. In small cell cancer, chemotherapy alone or combined with radiation has replaced surgery as the treatment of choice; on this regimen, a large percentage of patients experience remission, which in some cases is long-lasting. Survival: The 5-year relative survival rate is only 13% in all patients, regardless of stage at diagnosis. The rate is 46% for cases detected when the disease is still localized, but only 16% of lung cancers are discovered that early. Colon and Rectum Cancer Incidence: An estimated 149,000 new cases in 1994, including 107,000 of colon cancer and 42,000 of rectum cancer. Mortality: An estimated 56,000 deaths (49,000 from colon cancer, 7,000 from rectum cancer) in 1994. Mortality from colorectal cancer has fallen 30% for women and 7% for men over the last 30 years. Signs and Symptoms: Rectal bleeding, blood in the stool, change in bowel habits. Risk Factors: Personal or family history of cancer or polyps of the colon or rectum; inflammatory bowel disease. High-fat and/or low-fiber diet may be associated with increased risk. Early Detection: Digital rectal examination, stool blood test, and proctosigmoidoscopy are recommended by the American Cancer Society to detect colon or rectum cancer in asymptomatic patients. Digital rectal examination is performed by a physician during an office visit. The American Cancer Society recommends that this examination be performed annually after age 40. The stool blood test is a simple method to test feces for hidden blood. The specimen is obtained by the patient at home and returned to the physician's office, a hospital, or a clinic for analysis. The Society recommends annual testing after age 50. In proctosigmoidoscopy, the physician uses a hollow lighted tube or a fiberoptic sigmoidoscope to inspect the rectum and lower colon. To detect cancers higher in the colon, longer, flexible instruments are being used. The American Cancer Society recommends sigmoidoscopy, preferably flexible, every 3 to 5 years after age 50. If any of these tests reveal possible problems, more extensive Studies, such as colonoscopy (examination of the entire colon) and barium enema (an x-ray procedure in which the intestines are viewed), may be needed. Treatment: Surgery, at times combined with radiation, is the most effective method of treating colorectal cancer. The role of chemotherapy in treating advanced cases is under study. Combinations of chemotherapy and immu nologic agents have recently been described as beneficial in postoperative patients with cancerous lymph nodes. Colostomy (creation of an abdominal opening for elim ination of body wastes) is seldom needed for colon cancer and is infrequently required for rectal cancer. The American Cancer Society has a patient assistance program for those who do have permanent colostomies (see p. 25). 9 CANCER FACTS l FIGURES 1994 R&S 144817 Survival: When colorectal cancer is detected in an early, localized stage, the 5-year survival rates are 92% for colon cancer and 85% for rectal cancer. After the cancer has spread regionally, to involve adjacent organs or lymph nodes, the survival rates drop to 61%,and 51%, respectively. Survival rates for persons with distant metastases are less than 7%. Breast Cancer Incidence: An estimated 182,000 new cases among women in the United States during 1994. About 1,000 new cases of breast cancer will be diagnosed in men in 1994. Breast cancer incidence rates for women increased about 2% a year since 1980, but recently have leveled off at about 108 per 100,000. Most of the recent rise in rates is believed to be due to marked increases in mammography utilization, allowing the detection of early stage breast cancers, frequently before they would become clinically apparent. Other reasons for a longer-term increase in breast cancer are not yet understood. Mortality: An estimated 46,300 deaths (46,000 women, 300 men) in 1994; in women, the second major cause of cancer death. Although incidence rates are increasing, early detection and improved treatment have kept mortality rates fairly stable over the past 50 years. Signs and Symptoms: Breast changes that persist, such as a lump, thickening, swelling, dimpling, skin irritation, distortion, retraction, scaliness, pain, tenderness of the nipple, or nipple discharge. Risk Factors: Over age 40, increases with age; personal or family history of breast cancer; early age at menarche, late age at menopause, never had children or late age at first live birth, and higher education and socioeconomic status. International variability in cancer incidence rates correlate with variations in diet, especially fat intake, although a causal role for dietary factors has not been firmly established. Breast cancer risk factors appear to be more useful in providing clues to the development of cancer than in identifying prevention strategies. Since adult women may not be able to alter their personal risk factors in any practical sense, the best opportunity for reducing mortality is through early detection. Many women will have one or more risk factors for breast cancer. How ever, most risks are at such a low level that they only partly explain the high frequency of the disease in the population. Early Detection: The Society recommends that women have a screening mammogram by age 40; women 40 to 49 should have a mammogram every 1-2 years; asymp tomatic women age 50 and over should have a mammogram every year. In addition, a clinical physical examination of the breast is recommended every three years for women 20 to 40, and every year for those over 40. The Society also recommends monthly breast self-examination as a routine good health habit for women 20 years or older. Most breast lumps are not cancer, but only a physician can make a diagnosis. Besides its effectiveness in screening asymptomatic women, mammography is recognized as a valuable diag nostic technique for women who have findings suggestive of breast cancer. Once a breast lump is found, mammog raphy can help determine if there are other lesions too small to be felt in the same or opposite breast. Since a small percentage of breast cancers may not be seen on a mammogram, all suspicious lumps should be biopsied for a definitive diagnosis, even when current or recent mammography findings are described as normal. Treatment: Taking into account the medical situation and the patient's preferences, treatment may require lumpectomy (local removal of the tumor), mastectomy (surgical removal of the breast), radiation therapy, chemo therapy, or hormone manipulation therapy. Often, two or more methods are used in combination. Patients should discuss with their physicians possible options for the best management of their breast cancer. New techniques in recent years have made breast reconstruction possible after mastectomy, and the cosmetic results usually are good. Reconstruction has become an important part of treatment and rehabilitation. Survival: The 5-year survival rate (which includes all women living five years after diagnosis, whether the patient is in remission, disease-free, or under treatment) for localized breast cancer has risen from 78% in the 1940s to 93% today. If the cancer has spread regionally at the time of diagnosis, however, the 5-year survival rate is 72%, for persons with distant metastases at the time of diagnosis, the 5-year survival rate is 18%. From current data, based on women diagnosed in the early 1970s, the long-term breast cancer survival rate is about 50%. Prostate Cancer Incidence: An estimated 200,000 new cases in the United States during 1994. Prostate cancer incidence rates are 30% higher for black men than white men. Between 1980 and 1990, prostate cancer incidence rates increased 50%, largely due to improved detection. Further increased incidence is expected with widespread use of serum screening tests. Mortality: An estimated 38,000 deaths in 1994, the second leading cause of cancer death in men. Signs and Symptoms: 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; continuing pain in lower back, pelvis, or upper thighs. 10 CANCER FACTS & FIGURES 1994 R&S 144818 Leading Sites of Cancer Incidence and Death--1994 Estimates Cancer Incidence by Sife and Sex* Male Female Cancer Deaths by Site and Sex Male Female ; Prostate 200,000 s?lung |100,000 . blorti. Rectum* 38,000 .yinphoma 'f%!Oral' /=< 19,800 * "Melanoma of the Skin ^17.000 /^Kidney -'1/17,000 Leukemia ' / 16,200 r,l Stomach ; 15,000 , Pancreas 13,000 fkf Larynx ` .9,800 - Breast j 182,000 Colon & Rectum .rym($Si Lung ' 72,000,- fejpi tf;' -24,000 ' Lymphoma 23,500 `.itiS,; Melanoma of the Skin 1 ,y$ : .05,000 ' Pancreas . 14,000 ./.Bladder 13,200 Leukemia : 12,400 Kidney , 10,600 /Oral r =,9,800 All Sites 632,000 All Sites 576,000 'Excluding basal and squamous cell skin cancer ond corcinoma in situ. : _ -Lung 94,000 Prostate . - i'ij'! 38,000 on & Rectum 27,800 'ancreas 42,400 ,,=*. fv7Jymphoma -I ^#12,KX) 4| // Leukemia Stomach /i F^:8;400 :yt Esophagus 7.800 //':/ Liver ; '.7,200 .'1... Bladder ' -.7,000 ' Brain 6.800 Kidney v'*: 6,800 V V, All Sites 283,000 /'lung ,}59,000 'if Breast 46.000. .#$t-Gol6n & Rectum / /f -Sfoo onrT-. - ,)/5or^ ^0^0,500-' ` j|/j)^iieukemia .'/Xl / ^mmrnw -^MfByoin B^SJoq- illlomach ' 115.600 Multiple Myeloma "nei,l80o`"!'-jj All Sites 255,000 Available on reproduction sheet (5005.94) Most of these symptoms are nonspecific and may be similar to those caused by benign conditions such as infection or prostate enlargement. Risk Factors: Incidence increases with age; over 80%. of all prostate cancers are diagnosed in men over age 65. The disease is more common in northwestern Europe and North America. It is rare in the Near East, Africa, Central America, and South America. For reasons not currently known, black Americans have the highest incidence rate in the world. There is some familial association, but it is unclear whether this is due to genetic or environmental factors. International studies suggest that dietary fat may be a factor. Early Detection: Every man 40 and over should have a digital rectal examination as part of his regular annual physical checkup. In addition the American Cancer Society recommends that men 50 and over have an annual prostate-specific antigen blood test. If either result is suspicious, further evaluation in the form of transrectal ultrasound should be performed. TVeatment: Surgery, radiation, and/or hormones and anticancer drugs, are treatment options. Hormone treat ment and anticancer drugs may control prostate cancer for long periods by shrinking the size of the tumor, thus relieving pain. Survival: Fifty-eight percent of all prostate cancers are discovered while still localized; the 5-year relative survival rate for patients whose tumors are diagnosed at this stage is 92%. Survival rates for all stages combined have steadily improved, and in the past 30 years have increased from 50% to 78%. 11 CANCER FACTS & FIGURES 1994 R&S 144819 How to Estimate Cancer Statistics Locally Estimated number of... Number per Multiply community 100,000 population by Special Notes New cancer cases, 1994 Cancer deaths, 1994 400 200 Cancer survivors, 1994 2,000 Cancer cases under care, 1994 1,600 People who will eventually develop cancer People who will eventually die of cancer People who will be saved from cancer in 1994 40,000 20,000 200 0.004 0.002 0.020 0.016 0.400 0.200 0.002 Estimated cases and deaths will not reflect the age and ethnic characteristics of the population, access to detection and treatment, and varying risk factors. Actual data from a population-based tumor registry will allow more accurate estimates. Represents the number of people who were diagnosed over 5 years ago and are still living today. Represents the number of people diagnosed in 1994 and within the previous 5 years. All are assumed to be under treatment or follow-up care. If current incidence and mortality rates remain the same, about 40% will develop cancer before they die. If current mortality rates remain the same, about 1 in 5 people living today will die of cancer. Based on 5-year relative survival rate of 53%. Notet The figures ore only a rough approximation of oduol doto for a community and should be used with caution. Numbers moy vary according to the age distribution of the local population. Pancreas Cancer Incidence: An estimated 27,000 new cases in the United States in 1994. The disease is more common in men, and occurs more frequently in black Americans than in white Americans. Mortality: An estimated 25,900 deaths in 1994. Pan creatic cancer incidence and mortality rates have been fairly stable since the early 1970s, except among black women, whose rates have increased slightly. Signs and Symptoms: Cancer of the pancreas is a "silent" disease, one that occurs without symptoms until it is in advanced stages. Risk Factors: Very little is known about what causes the disease or how to prevent it. Risk increases after age 50, with the most cases occurring between ages 65 and 79. Smoking is a risk factor; incidence is more than twice as high for smokers as nonsmokers. Some studies have suggested associations with chronic pancreatitis, diabetes, or cirrhosis. In countries where the diet is high in fat, pancreatic cancer rates are higher. Early Detection: At present, only a biopsy yields a certain diagnosis, and because of the "silent" course of the disease, the need for biopsy is likely to be obvious only after the disease has advanced. Researchers are focusing on ways to diagnose pancreatic cancer before symptoms occur. Ultrasound imaging and computerized tomography scans are being tried. Treatment: Surgery, radiation therapy, and anticancer drugs are treatment options, but have had little influence on the outcome. Diagnosis is usually so late that none of these is used. Survival: Only 3% of patients live more than 5 years after diagnosis. Uterus (Cervix) Cancer Incidence: An estimated 15,000 invasive and 55,000 carcinoma in situ cases will be diagnosed in 1994. The rate of invasive cervical cancer has decreased steadily over the last several decades, but has increased in recent years in women under 50. Cervical carcinoma in situ, a precancerous condition, is now more frequent than invasive cancer, especially in women under 50. Mortality: An estimated 4,600 deaths from cervical cancer in 1994. The mortality rate is more than twice as high for black women as for white women. Signs and Symptoms: Abnormal uterine bleeding or spotting; abnormal vaginal discharge. Pain and systemic symptoms are late manifestations of the disease. Risk factors: Early age at first intercourse, multiple sex partners, cigarette smoking, and infection with certain types of human papillomavirus. Early Detection: The Pap test is a simple procedure that can be performed at appropriate intervals by health care professionals as part of a pelvic examination. A small sample of cells is swabbed from the cervix, transferred to a slide, and examined under a microscope. This test should be performed annually with a pelvic examination in women who are, or have been, sexually active or who have reached age 18 years. After three or more consecutive annual examinations with normal findings, the Pap test 12 CANCER FACTS & FIGURES 1994 R&S 144820 Percentage'of Population (Probability) Developing Invasive Cancers at Certain Ages Birth to 39 40 to 59 60 to 79 Ever (Birth to Death) All sites Breast Colon & rectum Prostate Lung Male Female Female Male Female Male Male Female 1.68 (1 in 60) 1.91 (1 in 52) 0.45 (1 in 222) 0.06 (1 in 1,667) 0.05 (1 in 2,000) Less than 1 in 10,000 0.04 (1 in 2,500) 0.03 (1 in 3,333) 7.51 (1 n 13) 9.29 (1 nil) 3.78 (1 n 26) 0.91 (1 n 110) 0.73 (1 n 137) 0.78 (1 n 128) 1.60 (1 n 63) 1.07 (1 n 93) 32.27 (1 in 3) 23.06 (1 in 4) 6.78 (1 in 15) 4.45 (1 in 22) 3.34 (1 in 30) 10.71 (1 in 9) 6.69 (1 in 15) 3.49 (1 in 29) 42.52 (1 n 2) 38.88 (1 n 3) 12.20 (1 n 8) 6.12 (1 n 16) 5.96 (1 n 17) 13.05 (1 n 8) 8.43 (1 n 12) 5.02 (1 n 20) Note: This chart shows the risks of being diagnosed with the most common cancers over certain age intervals. These risks are calculated for persons free of the specified cancer at the beginning of the age interval. Risk estimates do not assume all persons live to the end of the age interval or to any fixed age. Risk estimates ore presented to give an approximate measure of the burden of cancer to society. Measures are based on population level rates and do not take into occount individual behaviors and risk factors. For example, lung concer is rare omong nonsmokers or persons not heavily exposed to environmental tobacco smoke, so the risk for a nonsmoking man getting lung cancer in his lifetime is much lower than 8.4%, ond it is much higher for a smoker. It is dear that the risk of developing concer increoses with age. For prostate cancer, the risk before age 60 is very low, but between age 60 and 80,1 in 9 men will be diagnosed with prostate cancer. Source of data: Applied Research Branch, National Cancer Institute Available on reproduction sheet (5005.94) may be performed less frequently at the discretion of the physician. Treatment: Cervix cancers generally are treated by surgery or radiation, or by a combination of the two. In precancerous (in situ) stages, changes in the cervix may be treated by cryotherapy (the destruction of cells by extreme cold), by electrocoagulation (the destruction of tissue through intense heat by electric current), or by local surgery. Survival: The 5-year survival rate for cervical cancer patients is 67%. For women diagnosed with localized disease the survival rate is 90%. Uterus (JEndometrial) Cancer Incidence: An estimated 31,000 cases of cancer of the corpus (body) of the uterus, usually of the endometrium (lining). Endometrial cancer is most frequently diagnosed in women over age 50. Mortality: An estimated 5,900 deaths in 1994. Signs and Symptoms: Abnormal uterine staining or bleeding, especially postmenopausal. Pain and weight loss occur late in the disease. Risk Factors: Early menarche, late menopause, history of infertility, failure to ovulate, tamoxifen or unopposed estrogen therapy, obesity. During menopause, the level of hormones (estrogens) normally produced by the ovaries declines. This causes symptoms such as "hot flashes" or painful sexual inter course due to thinning of the vaginal lining. To control these symptoms, estrogen replacement therapy may be given to women during and after menopause. This therapy may increase the risk of endometrial cancer, therefore, the benefits and risks of such treatment should be discussed by the woman and her physician. Early Detection: The Pap test, highly effective in detecting early cancer of the uterine cervix, is only partially effective in detecting endometrial cancer. Women 40 and over should have an annual pelvic exam by a health professional. Women at high risk of developing endometrial cancer should have an endometrial tissue sample evaluated at menopause. TVeatment: Uterine cancers are usually treated with surgery, radiation, hormones, and/or chemotherapy depending on the stage of disease. Survival: The 5-year survival rate for endometrial cancer is 83% overall, 94% if discovered at an early stage, and 69% if diagnosed in a regional stage. Cancer in Children Incidence: An estimated 8,200 new cases in 1994; as a childhood disease, cancer is rare. Common sites include the blood and bone marrow, bone, lymph nodes, brain, nervous system, kidneys, and soft tissues. Mortality: An estimated 1,600 deaths in 1994, about onethird of them from leukemia. Despite its rarity, cancer is the chief cause of death by disease in children between the ages of 1 and 14. Mortality rates have declined 60% since 1950. Early Detection: Cancers in children often are difficult to recognize. Parents should see that 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, localized pain oi limping; prolonged, unexplained fever or illness; frequenl headaches, often with vomiting; sudden eye or vision ^ go w 13 CANCER FACTS 4 FIGURES 1994 OO ro changes; and excessive, rapid weight loss. t Some of the main childhood cancers are: Leukemia, below. Osteogenic sarcoma and Ewing's sarcoma are bone cancers. These may cause no pain at first, and swelling in the area of the tumor is often the first sign. Neuroblastoma can appear anywhere but usually in the abdomen, where a swelling occurs. Rhabdomyosarcoma, the most common soft tissue sarcoma, can occur in the head and neck area, genito urinary area, trunk, and extremities. Brain cancers in early stages may cause headaches, blurred or double vision, dizziness, difficulty in walking or handling objects, and nausea. Lymphomas and Hodgkin's disease are cancers that involve the lymph nodes, but also may invade bone marrow and other organs. They may cause swelling of lymph nodes in the neck, armpit, or groin. Other symptoms may include general weakness and fever. Retinoblastoma, an eye cancer, usually occurs in children under age four. When detected early, cure is possible with appropriate treatment. Wilms' tumor, a kidney cancer, may be recognized by a swelling or lump in the abdomen. Treatment: Childhood cancers can be treated by a combination of therapies. Treatment is coordinated by a team of experts including oncologic physicians, pediatric 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, 68%; bone cancer, 58%; neuroblastoma, 57%; brain and central nervous system, 60%; Wilms' tumor (kidney), 88%; Hodgkin's disease, 88%; and acute lymphocytic leukemia, 72%. Leukemia Incidence: An estimated 28,600 new cases in 1994, approximately evenly divided into acute leukemia and chronic leukemia. Although often thought of as primar ily a childhood disease, leukemia will strike many more adults (26,000 this year) than children (2,600 this year). Acute lymphocytic leukemia accounts for approximately 2,000 of the cases of leukemia among children. In adults, the most common types are acute granulocytic (approxi mately 7,000 cases) and chronic lymphocytic (approxi mately 8,500 cases). Mortality: An estimated 19,100 deaths in 1994. 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 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. Treatment: 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, especially 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 72%. Lymphoma Incidence: An estimated 52,900 new cases in 1994, including 7,900 cases of Hodgkin's disease and 45,000 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 22,750 deaths in 1994 (nonHodgkin's lymphoma, 21,200; Hodgkin's disease, 1,550). Signs and Symptoms: Hodgkin's disease: enlarged lymph nodes, itching, fever, night sweats, and weight loss. Fever can come and go in periods of several days or weeks. Non-Hodgkin's lymphoma: enlarged lymph nodes, anemia, weight loss, and fever. Risk Factors: Risk factors are largely unknown but in part involve reduced immune function and exposure to certain infectious agents. 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's lymphoma. Burkitt's lymphoma in 14 CANCER FACTS & FIGURES 1994 R&S 144822 Africa js partly caused by the Epstein-Barr herpes virus. Other possible risk factors include exposures to herbicides, industrial solvents, and vinyl chloride. Treatment: Hodgkin's disease: chemotherapy and radio therapy are useful for most patients. Non-Hodgkin's lymphoma: early stage, localized lymph node disease can be treated with radiotherapy. Patients with later stage disease often benefit from the addition of chemotherapy. New programs using highly specific monoclonal antibodies directed at lymphoma cells, and improved techniques in bone marrow preservation, are under investigation in selected patients who relapse after standard treatment. Survival: Survival rates vary widely by cell type and stage of disease. The overall 5-year survival rate for Hodgkin's disease is 78%. The overall 5-year survival for nonHodgkin's lymphoma has steadily improved, and in the past 30 years has increased from 31% to 52%. Skin Cancer Incidence: Over 700,000 cases a year of highly curable basal cell or squamous cell cancers. They are more common among individuals with lightly pigmented skin. The most serious skin cancer is melanoma, which will be diagnosed in about 32,000 persons in 1994. Since 1973, the incidence rate of melanoma has increased about 4% per year. Incidence rates are over ten times higher among whites than blacks. An additional 10,000 invasive nonmelanoma skin cancers will occur in 1994, mostly sarcomas, including Kaposi's sarcoma. Mortality: An estimated 9,200 deaths this year, 6,900 from malignant melanoma and 2,300 due to other skin cancers. Signs and-Symptoms: Any unusual skin condition, especially a change in the size or color of a mole or other darkly pigmented 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; fair complexion; occupational exposure to coal tar, pitch, creosote, arsenic compounds, or radium. Prevention: The sun's ultraviolet rays are strongest between 10 a.m. and 3 p.m. Exposure at these times should be avoided, and protective clothing should be worn. Sunscreens should be used. These come in various strengths, ranging from those facilitating gradual tanning to those that allow practically no tanning. Because of the possible link between severe sunburns in childhood and greatly increased risk of melanoma in later life, children, in particular, should be protected from the sun. Early Detection: Early detection is critical. Recognition of changes in skin growths or the appearance of new growths is the best way to find early skin cancer. Adults should practice skin self-examination once a month, and suspicious lesions should be evaluated promptly by a physician. Basal and squamous cell skin cancers often take the form of a pale, waxlike, pearly nodule, or a red, scaly, sharply outlined patch. A sudden or progressive change in a mole's appearance should be checked by a physician. Melanomas often start as small, mole-like growths that increase in size, change color, become ulcerated, and bleed easily from a slight injury. 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 uni form. D is for diameter greater than 6 millimeters. Any sudden or progressive increase in size should be of special concern. Treatment: There are four methods of treatment: surgery (used in 90% of cases), radiation therapy, electrodessication (tissue destruction by heat), or cryosurgery (tissue destruction by freezing) for early skin cancer. 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 according to the characteristics of the case. Survival: For basal cell or squamous cell cancers, cure is highly likely if detected and treated early. Malignant melanoma can spread to other parts of the body quickly; however, when detected in its earliest stages, and with proper treatment, it is highly curable. The overall 5-year survival rate for patients with malignant melanoma is 84%. The 5-year survival rate for localized malignant melanoma is 92%; survival rates for regional and distant disease are 55% and 14%, respectively. About 82% of melanomas are diagnosed in a local stage. Ovary Cancer Incidence: An estimated 24,000 new cases in the United States in 1994. It accounts for 4% of all cancers among women. Mortality: An estimated 13,600 deaths in 1994. Although ovarian cancer ranks second in incidence among gyne cological cancers, it causes more deaths than any other cancer of the female reproductive system. Signs and Symptoms: Ovarian cancer is often "silent," showing no obvious signs or symptoms until late in its development. The most common sign is enlargement of the abdomen, which is caused by the accumulation of fluid. Rarely will there be abnormal vaginal bleeding. In women over 40, vague digestive disturbances (stomach discomfort, gas, distention) that persist and cannot be explained by any other cause may indicate the need for a thorough evaluation for ovarian cancer. 15 CANCER FACTS i FIGURES 1994 R&S 144823 Five-Year Relative Survival Rates by Stage at Diagnosis* Site All Stages % Local % Oral Colon-rectum Pancreas Lung Melanoma Female breost Cervix uteri Corpus uteri Ovary Prostate Bladder Kidney 53 78 58 89 38 13 46 84 92 79 93 67 90 83 94 39 88 77 92 79 91 55 86 'Adjusted for normal life expectancy. This chart based on cases diagnosed in 1983-87, followed through 1990. Source: Cancer Statistics Branch, Notional Cancer Institute Regional % 42 58 4 13 55 72 52 69 36 82 46 57 Distant % 19 6 2 1 14 18 13 27 17 28 9 10 Available on reproduction sheet (5005.94) Risk Factors: Risk for ovarian cancer increases with age. Women who have never had children are more likely to develop ovarian cancer than those who have. Increased number of pregnancies and the use of oral contraceptives, appear to be protective against ovarian cancer. Women who have had breast cancer or have a family history of ovarian cancer are at increased risk. Certain rare genetic disorders are associated with increased risk. With the exception of Japan, the highest incidence rates are reported from the more industrialized countries. Early Detection: Periodic, thorough pelvic examinations are important.The Pap test, useful in detecting cervical cancer, does not reveal ovarian cancer. Women over the age of 40 should have a cancer-related checkup every year. Treatment: Surgery, radiation therapy, and drug therapy are treatment options. Surgery usually includes the removal of one or both ovaries (oophorectomy), the uterus (hys terectomy), and the fallopian tubes (salpingectomy). In some very early tumors, only the involved ovary will be removed, especially in young women. In advanced disease, an attempt is made to remove all intraabdominal disease, to enhance the effect of chemotherapy. Survival: Overall, the 5-year survival rate for ovarian cancer is 41%. If diagnosed and treated early, the relative survival rate is 88%; however, only about 23% of all cases are detected at the localized stage. Survival rates for women with regional and distant disease are 36% and 17%, respectively. Bladder Cancer Incidence: An estimated 51,200 new cases in 1994; 38,000 in men, 13,200 in women. Overall, the incidence rate of bladder cancer is four times greater among men than among women, and is higher in whites than in blacks. Mortality: An estimated 10,600 deaths in 1994. Signs and Symptoms: Blood in the urine. Usually associated with increased frequency of urination. Risk Factors: Smoking is the greatest risk factor in bladder cancer, with smokers experiencing twice the risk of nonsmokers. Smoking is estimated to be responsible for approximately 47% of the bladder cancer deaths among men and 37% among women. People living in urban areas and workers exposed to dye, rubber, or leather also are at higher risk. Early Detection: Bladder cancer is diagnosed by exam ination of the bladder wall with a cystoscope, a'slender tube fitted with a lens and light that can be inserted into the tract through the urethra. Treatment: Surgery, alone or in combination with other treatments is used in over 90% of cases. Preoperative chemotherapy alone or with radiation before cystectomy (bladder removal) has improved some treatment results. Survival: When detected at an early stage, the 5-year survival rate for bladder cancer is 91%. For regional and distant disease, the survival rates are 46% and 9%, respectively. Oral Cancer Incidence: An estimated 29,600 new cases in 1994. Incidence is more than twice as high in men as in women, and is most frequent in men over age 40. Mortality: An estimated 7,925 deaths in 1994. Signs and Symptoms: A sore that bleeds easily and doesn't heal; a Jump or thickening; a red or white patch that per sists. Difficulty in chewing, swallowing, or moving tongue or jaws are often late changes. 16 CANCER FACTS & FIGURES 1994 R&S 144824 Trends jn Cancer Survival, by Race Cases Diagnosed in 1960-63,1970-73,1974-76,1977-79,1983-89 White Black Relative 5-Year Survival % Relative 5-Year Survival % Site 1960-63' 1970-73' 1974-76' 1977-79' 1983-fiV? 1960-63' 1970-73' 1974-76' 1977-79' 1983-89' All sites 39 43 50 51 55* 27 31 39 39 39 Oral cavity & pharynx 45 43 55 54 54 36 36 33 Esophagus Stomach 4 4 5 6 10* 11 13 14 16 17* 1 4 4 3 7* 8 13 16 15 18 Colon 43 49 50 53 60* 34 37 46 48 49* Rectum 38 45 49 50 58* 27 30 42 38 45 Liver 2 3 4 3 6* -- -- 1 6 5 Pancreas 1 2 3 2 3* 1 2 2 4 5* Larynx 53 62 66 68 68 -- -- 59 55 54 Lung & bronchus 8 10 12 14 13* 5 7 11 11 11 Melanoma of skin 60 68 80 82 84* 69f 52* 72f Female breast 63 68 75 75 81* 46 51 63 63 64 Cervix uteri 58 64 69 69 69 47 61 63 62 57* Corpus uteri 73 81 89 86 85* 31 44 60 58 56 Ovary 32 36 36 38 40* 32 32 41 40 40 Prostate 50 63 68 72 79* 35 55 58 62 64* Testis 63 72 79 88 93* -- -- 76f -- 84f Urinary bladder 53 61 74 76 80* 24 36 48 55 61* Kidney & renal pelvis 37 46 52 51 56* 38 44 49 52 51 Brain & nervous system 18 20 22 24 26* 19 19 27 28 31 Thyroid gland 83 86 92 92 94* -- -- 87 92 92 Hodgkin's disease 40 67 72 73 79* 69 73 74 Non-Hodgkin's lymphoma 31 41 48 48 52* 48 50 44 Multiple myeloma 12 19 24 25 27* 27 34 29 Leukemia 14 22 35 37 39* -- -- 31 30 30 Source: Cancer Statistics Branch, Notional Cancer Institute 'Rates are based on End Results Group data front a series of hospital registries and one population-based registry. 'Rotes are from the SEER Program. They are based on data from population-bosed registries in Connecticut, New Mexico, Utoh, Iowa, Hawaii, Atlonta, Detroit, Seattle-Puget Sound, and Son froncisco-Ooklond. Rates ore based on follow-up of patients through 1990. 'The difference in rotes between 1974-76 and 1983-89 is statistically significant (p <0.05). fThe stondord error of the survivol rate is between 5 ond 10 percentage points. fThe stondord error of the survivol rate is greater thon 10 percenloge points. --Valid survivol rate could not be calculated. Risk Factors: Cigarette, cigar, or pipe smoking; use of smokeless tobacco; excess use 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 have the opportunity, during regular checkups, to see abnormal tissue changes and to detect cancer at an early, curable stage. Treatment: Principal methods are radiation therapy and surgery. Chemotherapy is being studied as an adjunct to surgery in advanced disease. Survival: Five-year survival rates vary substantially, depending on the site. Rates range from 25% for cancer of the hypopharynx to 90% for lip cancer. Overall, 5-year survival for oral cancer patients is about 52%. R&S 144825 17 CANCER FACTS & FIGURES 1994 Cancer in Minorities In 1994, about 1,208,000 cancers will be diagnosed in the United States. About 120,000 of these cancers will be among black Americans and 35,000 among other minority Americans. Cancer incidence and mortality rates are generally higher for black Americans than for whites. In 1990, the incidence rates were 423 per 100,000 for blacks and 393 for whites, about a 6% difference. In 1990, the mortality rates were 230 for blacks and 170 for whites. Cancer sites for which blacks have significantly higher incidence and mortality rates include esophagus, uterine cervix, stomach, liver, prostate, larynx, and multiple myeloma. Rates for esophageal cancer are over three times higher among blacks than whites. The 5-year survival rate for cancer in blacks diagnosed from 1983 through 1989 was about 39% compared with 55% for whites. A considerable part of this difference in survival can be attributed to late diagnosis. Many cancers are more frequently diagnosed in a localized stage among whites than among blacks. Most of these sites represent cancers for which screening tests are available or which present symptoms early in the disease process. Early detection and timely treatment can increase survival. Incidence and mortality rates for other minority groups such as Hispanics are often lower than those for white or black Americans. Because cancer risk is strongly associated with lifestyle and behavior, differences in ethnic and cultural groups can provide clues to factors involved in the development of cancer such as dietary patterns, alcohol use, and sexual and reproductive behaviors involved in the development of cancer. Cultural values and belief systems can affect attitudes about seeking medical care or following screening guidelines (see p. 21). Socioeco nomic factors such as lack of health insurance or transportation can impede access to care, and lead to late diagnosis and poor survival. Number of Cancer Deaths for Black, American Indian, Chinese, Japanese, and Hispanic Persons, United States, 1990 Cancer Site Black Males Black Females American Indian Chinese Japanese Hispanic* All sites Oral cavity Esophagus Stomach Colon & rectum Liver Mother biliary Pancreas Lung (mole) Lung (female) Melanoma of skin Breast (female) Cervix uteri Other uterus Ovary Prostate Bladder Kidney Brain & CNSf Lymphoma Leukemia Multiple myeloma 31,995 1,000 1,433 1,341 2,898 757 1,442 10,632 -- 51 ~ -- -- -- 5,181 466 563 372 747 854 745 25,082 311 541 917 3,169 615 1,581 -- 4,512 55 4,659 972 899 975 -- 381 382 319 573 737 708 1,275 23 19 67 117 . 68 52 205 117 9 89 47 12 34 59 9 39 21 50 52 39 1,527 60 45 117 166 168 65 238 145 2 88 22 15 29 42 21 12 35 47 47 15 1,122 14,003 23 232 32 233 132 811 168 1,414 66 769 77 795 148 1,824 75 787 3 89 79 1,246 12 296 14 168 22 385 56 728 12 210 14 355 14 376 42 688 27 735 6 273 "Persons classified as of Hispanic origin on death certificotes moy be of any race. Hispanic origin reporting, however, moy be incomplete on deoth certificates in some states. These numbers ore believed to include over 90% of concer deaths in Hispanics in 1990. fCNS = Central nervous system. Available on reproduction sheet (5005.94) 18 CANCER FACTS & FIGURES 1994 R&S 144826 Prevention Smoking Cigarette smoking is responsible for 90% of lung cancer 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.) 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 increase their 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 fat 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. Modern 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 700,000 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.) 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.) 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.) 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 and Cervix Cancer). 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.) 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. R&S 144827 19 CANCER FACTS & FIGURES 1994 Environmental Cancer Risks The environmental causes of cancer include exposures in the community or workplace settings, as well as exposures determined by individual lifestyle choices (smoking, diet, medications, etc.). The degree of cancer hazard posed by such risks depends on the concentration or intensity of the carcinogen in the environment and the exposure dose a person receives. These factors in combination create a range of risk. For example, in situations where high levels of carcinogen are present and where exposures are extensive, significant hazards may exist, but where concentrations are low and exposures limited, hazards are often negligible. Risk Assessment To protect people against unsafe exposures, risks should be assessed so that appropriate environmental standards can be set. Risk assessment is a two-step process: identifying the toxic properties of potential oncogenic hazards and measuring the extent of human exposure. The first step, hazard identification, evaluates the chemical or physical nature of hazards and their onco genicity in observed clinical and epidemiologic studies and in laboratory tests using animals or cell systems. Special attention is given to any evidence suggesting that cancer risk may increase with dose (dose-response relationships). The second step, exposure measurement, determines the levels of hazards in the environment (air, water, food, etc.) and the extent to which people are actually exposed (how much they eat of a particular food, use a particular water source, etc.). Knowledge of how the body absorbs, metab olizes, and excretes chemicals or is exposed to radiation sources is essential to determine accurately the actual carcinogenic dose delivered to humans. Unfortunately, evidence of risk for most potential car cinogens usually rests on the results of high-dose animal experiments or on human observations where high-dose exposures have occurred. To use such information in setting human safety standards, scientists must extrapolate from animals to humans and from high-dose to low-dose conditions. Both extrapolations involve much uncertainty; therefore conservative assumptions are used so that risk assessment will err on the side of safety. For cancer safety standards, only increased risks of one case or less per million persons over a lifetime are usually accepted. 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 Occupational Safety and Health Administration. The application of laws and procedures by which standards are implemented and risks are controlled is called risk management. Chemicals and Radiation Not all chemicals or all forms of radiation cause cancer. Only a limited number of chemicals (for example, benzene, asbestos, vinyl chloride, arsenic, aflatoxins) show definite evidence of human carcinogenicity or are probable human carcinogens based on animal experiments (for example, chloroform, dichlorodiphenyltrichloroethane [DDT], for maldehyde, polychlorinated biphenyls [PCBs], polycyclic aromatic hydrocarbons). The only forms of radiation proven to cause human cancer are ionizing radiation (for example, x-rays, radon, cosmic rays) and ultraviolet radiation (principally UV-B radiation). Unproven Risks Public concern about environmental cancer risks often focuses on risks for which no carcinogenicity has been proven or on situations where known carcinogen exposures are at such low levels that risks are negligible. For example: 1. Non-ionizing radiation. Electromagnetic radiation at frequencies below ionizing and ultraviolet levels has not been shown to cause cancer. While some epidemiologic studies suggest associations with cancer, others do not, and experimental studies have not yielded reproducible evidence of carcinogenic mechanisms. 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 (often called ELF or extremely low frequency radiation). 2. Pesticides. Many kinds of pesticides (insecticides, herbicides, etc.) are widely used in producing and marketing our food supply. While some of these chemicals cause cancer at high doses in experimental animals, the very low concentrations found in some foods are generally within established safety levels. Environmental pollution by slowly degraded pesticides such as DDT, a result of past agricultural practices, can lead to food chain bioaccumulation and to persistent residues in body fat. Such residues have been suggested as a possible risk factor for breast cancer; concentrations in tissue are low, however, and the evidence is not conclusive. 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. At the same time, banning any man-made chemicals with carcinogenic potential (as required for processed foods under the 1958 Delaney Amendment of the Food and Drug Act) is unrealistic, given the very low concentrations involved and the value of pesticides in sustaining our food supply. Scientists and consumer groups stress the important health benefits of a diet which includes many fruits and vegetables in contrast to the minimal risks associated with pesticide residues. 3. Toxic wastes. Toxic wastes in dump sites can threaten 20 CANCER FACTS & FIGURES 1994 14*828 Ft&S human health through air, water, and soil pollution. Although many toxic chemicals contained in such wastes can be carcinogenic at high doses, most community exposures appear to involve very low or negligible dose levels. Clean-up of existing dump sites and close control of toxic materials in the future is essential to ensure healthy living conditions in our industrialized society. 4. Nuclear power plants. Ionizing radiation emissions from nuclear facilities are closely controlled and involve negligible levels of exposure for communities near such plants. Although reports about cancer case clusters in such communities have raised public concern, studies show that clusters do not occur more often near nuclear plants than they do by chance elsewhere in the population. Early Detection Each person should be aware of the cancer early detection guidelines that pertain to them. To understand the role of the cancer-related checkup, the ACS adopted the following definitions. Screening is the search for disease in persons without symptoms. Once a person has had a positive screening test, or once signs or symptoms have been identified, further tests are considered diagnostic. Detection is the discovery of an abnormality in a person with or without symptoms. Diagnostic evaluation is the evaluation of a patient who has signs or symptoms suggestive of disease to determine the actual existence and nature of the disease. The following recommendations are for the early detection of cancer in asymptomatic persons on an individual basis. The recommendations are intended to help individual providers and their patients determine the most appropriate early cancer detection tests to meet their individual needs. Guidelines for the early detection of cancer in people without symptoms are recommended by the American Cancer Society as follows: A cancer-related checkup by a physician every three years for persons aged 20-39 and annually for-those aged 40 and over. Some persons at particular risk for certain cancers may need tests more often and should discuss this with their doctor. The checkup should always include health counseling (how to quit smoking, etc.) and exams for cancer of the breast, uterus, cervix, colon, rectum, prostate, mouth, skin, testes, thyroid, and lymph nodes. In 1989 and 1990, Congress passed legislation mandating Medicare coverage for cervical and breast cancer screening, respectively. For women over age 65, Medicare currently covers a Pap smear once every three years and a mam mogram every two years. Although this policy does not strictly conform to ACS screening recommendations, it does begin to address the benefits of early detection. Breast The American Cancer Society recommends that screening mammography begin by age 40. Women aged 4049 should have a mammogram every 1-2 years, depending on physical and mammographic findings. Women aged 50 and older should have mammograms yearly. The ACS recommends the monthly practice of breast self-exam (BSE) by women 20 years and older as a routine good health habit. Examination of the breast by a health care professional should be done every three years from ages 2040 and then every year. Colon and Rectum The American Cancer Society recommends three tests for the early detection of colon and rectum cancer in people without symptoms. A digital rectal examination by a physician during an office visit should be performed every year after the age of 40; the stool blood test is recommended every year after age 50; and sigmoidoscopy, preferably flex ible, should be performed every 3 to 5 years. Uterus For cervical cancer, women who are or have been sexually active, or have reached age 18, should have an annual Pap test and pelvic examination. After a woman has had three or more consecutive satisfactory normal annual examinations, the Pap test may be performed less frequently at the discretion of her physician. Women at high-risk for endometrial cancer (those who have a history of infertility, obesity, failure to ovulate, abnormal uterine bleeding, or unopposed estrogen or tamoxifen therapy) should have an endometrial tissue sample taken at menopause and thereafter at the discretion of the physician. Prostate Men who have reached 50 years of age and older should have a digital rectal examination (DRE) annually. Annual prostate-specific antigen blood testing should be performed on men age 50 and older. 21 CANCER FACTS & FIGURES 1994 R&S 144829 Smoking is the most preventable cause of death in our society. Tobacco use is responsible for nearly one in five deaths in the United States. Based upon data from the American Cancer Society's Cancer Prevention Study II, it is estimated that smoking is related to about 419,000 US deaths each year. Although the number of cardiovas cular deaths are declining, smoking-related cancer deaths continue to rise. According to the World Health Orga nization approximately 3 million people die worldwide each year as a result of smoking. Smokers lose an average of 15 years of life. The risks of dying of lung cancer are 22 times higher for male smokers and 12 times higher for female smokers than for people who have never smoked. In addition to being responsible for 87% of lung cancers, smoking is also associated with cancers of the mouth, pharynx, larynx, esophagus, pancreas, uterine cervix, kidney, and bladder. Smoking accounts for 30% of all cancer deaths, is a major cause of heart disease, and is associated with conditions ranging from colds and gastric ulcers to chronic bronchitis, emphysema, and cerebrovascular disease. Trends in Smoking The National Health Interview Survey (NHIS) reports that cigarette smoking among adults aged 18 and over declined from 42% in 1965 to 25% in 1991. The NHIS data from 1974.to 1991 show: Smoking among women decreased from 33% to 24%. Smoking among men dropped from 43% to 28%. Rates for college graduates declined from 28% to 14%. Rates for persons without a high school education decreased slightly from 44% to 37%. Data from the 1991 NHIS indicate that the decline in cigarette smoking among adults has begun to level off. Between 1990 and 1991, smoking rates rose for the first time in nearly 20 years due to increased smoking among blacks and women. Contributing to this rise may be the growth in discount cigarette products and the recent surge in the tobacco industry's domestic advertising and pro motion expenditures. According to the 1989 Surgeon General's Report, decisions to quit or not to start through 1985 will postpone or prevent an additional 2 million smoking-related deaths between 1986 and the year 2000. Per capita cigarette consumption dropped 37% from 1973 to 1992 (4,148 to 2,640). This is the lowest per capita cigarette consumption since 1942. Profile of Smokers In 1991, the number of current smokers in the US: 46 million. The prevalence of smoking is highest among people who live below poverty level: men 39%; women 29%. Smoking rates are highest in the age group 25-44. Approximately 50% of smokers start smoking regularly before age 18. More than 3,000 teenagers become regular smokers each day in the United States. According to the Centers for Disease Control and Prevention's 1991 Youth Risk Behavior Survey: 70% of all students in grades 9-12 reported ever trying cigarettes. About 13% of high school students reported frequent cigarette use. Cost of Tobacco The 1992 Surgeon General's Report estimates that the total lifetime excess medical care costs for smokers exceed those for nonsmokers by $501 billion. The US Congress Office of Technology Assessment estimates that cigarettes cost Americans $68 billion annually in tobacco-related health care costs and lost productivity. The cost of treating smoking-related diseases and lost productivity amounts to $2.59 for each pack of cigarettes sold in the US. For every 10% increase in the price of tobacco products, it is estimated that tobacco consumption would decline 4%. Cigarette Exports US cigarette exports have increased due to aggressive marketing by tobacco companies and expanding foreign markets. A September 1993 tobacco report of the US Department of Agriculture estimates: US cigarette exports have increased about 275% since 1985. US cigarette exports to Japan have increased almost 800%, from 6.5 billion in 1985 to 56 billion in 1993. Exports to South Korea have grown from 1.3 billion in 1987 to 4 billion in 1993. Exports to the countries that formerly comprised the Soviet Union have increased from 4.6 billion in 1991 to 13.6 billion in 1993. US cigarette output from July 1992 to June 1993 was 702 billion. Even though domestic consumption has dropped, this recent increase in output is the result ol R&S 144830 22 CANCER FACTS & FIGURES 1994 foreign demand of US tobacco leaf and US manufacturers offering discounted cigarettes and lower prices on premium brands. Nicotine Addiction Tobacco smoke contains over 4,000 chemical compounds including at least 43 different carcinogenic substances. The 1988 Surgeon General's Report on Nicotine Addiction concluded: Cigarettes and other forms of tobacco are addicting. Nicotine is the drug in tobacco that causes addiction. The pharmacologic and behavioral processes that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine. Nicotine is found in substantial amounts in tobacco. It is absorbed readily from tobacco smoke in the lungs and from smokeless tobacco in the mouth or nose and is rapidly distributed throughout the body. Smoking Cessation By 1991, almost 44 million Americans had quit smoking cigarettes, nearly half of all living adults who ever smoked. In September 1990, the Surgeon General outlined the benefits of smoking cessation: People who quit smoking, regardless of age, live longer than people who continue to smoke. Smokers who quit before age 50 have half the risk of dying in the next 15 years compared with those who continue to smoke. Quitting smoking substantially decreases the risk of lung, laryngeal, esophageal, oral, pancreatic, bladder, and cervical cancers. Benefits of cessation include risk reduction for other major diseases including coronary heart disease and cardiovascular-disease. A 1989 Gallup Survey reported that the following people want to quit smoking: 57% of smokers 50 and older 67% of smokers aged 30-49 68% of smokers aged 18-29. Environmental Tobacco Smoke In December 1992, the Environmental Protection Agency concluded that widespread exposure to environmental tobacco smoke (ETS) presents "a serious and substantial" public health problem in the United States. Each year about 3,000 nonsmoking adults die of lung cancer as a result of breathing the smoke of other's cigarettes. The risk of dying of lung cancer is 30% higher for a nonsmoker living with a smoker compared with a nonsmoker living with a nonsmoker. It is estimated that ETS causes 35,000 to 40,000 excess heart disease deaths among people who are not current smokers. ETS contains essentially all of the same carcinogens and toxic agents that are inhaled by the smoker. ETS can result in aggravated asthmatic conditions, impaired blood circulation, bronchitis, and pneumonia. ETS poses additional health hazards for unborn and young children. According to the 1988 NHIS, about 10 million children under the age of six are exposed to ETS by a household member. Children exposed to secondhand smoke have increased risks of respiratory illnesses and infections, impaired development of lung function, and middle ear infections. Infants born to women who smoked during pregnancy are more likely to die of Sudden Infant Death syndrome. Smokeless Tobacco There has been a resurgence in the use of all forms of smokeless tobacco--plug, leaf, and snuff--but the greatest cause for concern centers on the increased use of "dipping snuff." In this practice, tobacco that has been processed into a coarse, moist powder is placed between the cheek and gum, and nicotine, along with a number of carcinogens, is absorbed through the oral tissue. Dipping snuff is highly addictive, and exposes the body to levels of nicotine equal to those of cigarettes. In 1986, the US Surgeon General concluded that the use of smokeless tobacco "is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous oral conditions and can lead to nicotine addiction and dependence." Oral cancer occurs several times more frequently among snuff dippers compared with non-tobacco users. The excess risk of cancer of the cheek and gum may reach nearly fiftyfold among long-term snuff users. The use of smokeless tobacco is increasing among male adolescents and young male adults. According to the US Department of Agriculture, US output of moist snuff has risen 83% from about 30 million pounds in 1981 to an estimated 55 million pounds in 1993. About 5 million US adults use smokeless tobacco. The Centers for Disease Control and Prevention's 1991 Youth Risk Behavior Survey reported that 19% of male high school students used smokeless tobacco. Industrial Hazards Industrial workers are especially susceptible to lung diseases due to the combined effects of cigarette smoke and exposure to certain toxic industrial substances, such as fumes from rubber and chlorine, and dust from cotton and coal. Exposure to asbestos in combination with cigarette smoking increases an individual's lung cancer risk nearly 60 times. Smoking also enhances lung cancer ris in underground miners exposed to radon. R&S 144831 23 CANCER FACTS & FIGURES 1994 In 1913, 10 physicians and five laymen founded the American Society for the Control of Cancer. Its stated purpose was to "disseminate knowledge concerning the symptoms, treatment, and prevention of cancer; to inves tigate conditions under which cancer is found; and to compile statistics in regard thereto." Later renamed the American Cancer Society, Inc., the organization now con sists of over 2 million Americans working to conquer cancer. Organization: The American Cancer Society, Inc., consists of a National Society, 57 Divisions, and over 3,400 Units. The National Society: A 285-member Board of Directors provides representation from the 57 Divisions. The National Society is responsible for overall planning and coordination, providing technical help and materials to Divisions and Units, administering programs of research, medical grants and clinical fellowships, and performing public and professional education at the national level. The 57 Divisions: Located in all states plus five metropolitan areas, the District of Columbia, and Puerto Rico, the Divisions are governed by members of Divisional boards of directors. The Units: These are organized to cover the counties in the United States. There are thousands of community leaders who direct the Society's programs at this level. Descriptions of some of the Society's major programs follow. Research The American Cancer Society is the largest private source of cancer research funds in the United States, second only to the federal government's National Cancer Institute in total dollars spent. In fiscal year 1993, the Society invested approximately $100 million in research--slightly over 26% of its budget. To date, the Society has invested more than $1.5 billion in cancer research. The research program consists of two components: extramural grants and awards, and intramural epidemiology research. The extramural program supports investigatorinitiated projects taking place in leading centers across the country. Applications for grants are subjected to a rigorous external peer review which ensures that only the highest quality applications receive funding. The success of the Society's research program is exemplified by the fact that 26 Nobel Prize winners received grant support from the Society early in their careers. Epidemiology The Society supports an active program of epidemiologic research at its National office. This program analyzes trends in cancer occurrence and has conducted three large pro spective studies of cancer risk in Americans over the past 40 years. The Hammond-Horn study demonstrated the effects of smoking on mortality and cancer risk in 188,000 men observed from 1952-1955. Cancer Prevention Study I, conducted from 1959 through 1972, encompassed 1 million men and women in 25 states and examined potential cancer risk factors related to the environment and to individual lifestyles. Cancer Prevention Study II (CPS II), was launched in 1982 and is still in progress, examining the habits and exposures of more than 1 million Americans. Causes of death among these people over subsequent years are being studied to learn how lifestyles and environmental factors affect the development of cancer. Over 77,000 volunteers enrolled the men and women in CPS II. These volunteer researchers distributed ques tionnaires to participants who were asked about their lifestyles. Another questionnaire was sent in October 1992, to 160,000 households participating in CPS II. This ques tionnaire seeks additional dietary information to gain more specific knowledge about how diet impacts disease. Public Education The Society's Public Education programs focus on tobacco control, the relationship between diet and cancer, comprehensive school health education and early detection. The programs are divided into two audiences: adult and youth. Adults are reached through the worksites, healthsites, and the community. Volunteers are recruited and trained both to promote and to deliver programs. Examples of adult education include Taking Control, which identifies 10 steps to a healthier lifestyle; Smart Move, a single-session stop-smoking program; SelfDefense, which explains how a person can work with a health care provider to become familiar with cancer tests and examinations; and Special Touch, which explains breast cancer and early detection techniques. The Society has joined with other health, education, and social service agencies to promote comprehensive school health education. The best way to ensure good cancer education in the schools, comprehensive school health 24 CANCER FACTS i FIGURES 1994 R&S 144832 education is the means of delivering a planned health edu cation curricula from pre-school to grade 12. ' The Society's education programs emphasize the impor tance of developing good health habits. Beginning in pre school, students learn about the dangers of tobacco use with Starting Free: Good Air for Me. Other tobacco pre vention programs include: An Early Start to Good Health (grades K-3), and Health Myself (grades 7-9). Changing the Course curricula help elementary and secondary stu dents make good dietary choices that will reduce their risk of developing a number of diseases, including cancer. High school students can also learn in-depth about cancer through Right Choices. Professional Education The Society's Professional Education Department pro vides health care professionals with the latest information on developments in cancer prevention, early detection, and treatment through: National conferences and workshops (The Society is accredited by the Accreditation Council for Continuing Medical Education) Materials (videotapes, slide programs, audiotapes, textbooks, proceedings of conferences and workshops, and booklets on key issues are examples, in addition to two national journals for health care professionals) Clinical awards, professorships, and scholarships (Clinical Oncology Fellowships, Clinical Oncology Career Development Awards, Oncology Social Work Awards, Cancer Control Career Development Awards). Over the past 40 years, Clinical Fellowships and Junior Faculty Clinical Fellowships have supported the education of more than 9,600 individuals. Nursing-programs (a newsletter, scholarships, and professorships) Information on questionable methods of cancer management. Patient Services In 1993, approximately 745,141 cancer patients were reached through the service and rehabilitation programs of the American Cancer Society. Service Programs Community Connection: Resources, Information, and Guidance: provides information about Society services and other resources in the community to meet the practical, social, psychological, and other support needs of cancer patients and their families. Transportation: Trained volunteer drivers provide trans portation that enables patients to get to and from treatment. Home Care Items: offers supplies and equipment to care for the patient at home. Rehabilitation Programs Reach to Recovery: This one-on-one visitation program provides information and support to women with experience with breast cancer; additional information for husbands, children, and friends of breast cancer patients is available. Laryngectomy Rehabilitation: Spearheaded by the International Association of Laryngectomees, this program provides pre- and/or postoperative support for patients by laryngectomee visitors. Look Good...Feel Better: In partnership with the Cosmetic, Toiletry and Fragrance Association and National Cosmetology Association, this program is an opportunity for people undergoing cancer treatment to develop skills to cope with appearance changes. CanSurmount: A short-term program for cancer patients and their families. Trained volunteers who have experienced the same type of cancer offer support through one-to-one visits. Ostomy Rehabilitation: In cooperation with the United Ostomy Association and enterostomal therapists, trained volunteers who have experienced the same type of surgery as the patient offer help on a one-to-one basis. Children's Camps: Many Divisions offer camps for chil dren who have or have had cancer. These camps can cope with the special needs of children undergoing treatment. Patient and Family Education Programs Group and individual programs designed to help patients of all ages and their families understand the complexities of cancer. I Can Cope: offers information on cancer treatments, nutrition, resources, and other issues to patients and families. Group Support Programs Offered to patients, families and friends, these programs vary according to each Division's needs and resources. Public Issues Cancer has become a political, as well as a medical, social, psychological, and economic issue. Policy makers at all levels of government make decisions which impact the lives of more than 8 million Americans with a history of cancer, their families, and millions of potential cancer patients. Therefore, the Society's Public Issues program educates policy makers about cancer and how it affects the indi viduals and families they represent. The Society is orga nized to advocate for public policy initiatives which relate to and affect: 25 CANCER FACTS & FIGURES 1994 R&S 144833  the welfare of the cancer patient and his/her family risks'to and protection of the potential cancer patient cancer research The Society supports increased federal funding and pro vides direction for the federal government's cancer research program run by the National Cancer Institute. The Public Issues program also supports the work of the Society's cancer education and service programs by influencing public policy on tobacco control, access to health care, employment discrimination against cancer patients, environmental cancer issues, and other issues affecting cancer survivors and their families. Among the major public policy changes that the Society has advocated are: smoking ban on airlines. restricted tobacco advertising. expanded access to screening mammography and Pap tests. Costs of Cancer reduces suffering and saves lives if cancer is detected at' an earlier, treatable stage. The current debate on health care reform highlights these figures in a new way. An estimated $900 billion will be spent on health care this year in the United States, yet 34 million Americans do not have any health insurance. The number of uninsured, moreover, does not take into account the tens of millions of Americans now living with disease or disability who daily encounter problems with our health care system, including 8 million Americans who have had cancer. The American Cancer Society's Statement of Principles on Health Care System Reform calls for: high quality cancer care for all Americans; expanded support for basic and clinical cancer research; comprehensive school health education as a key cost saving primary prevention strategy; and, an increase of at least $2.00 in the federal cigarette excise tax and a comparable increase for other tobacco products to prevent death and disease from smoking. The financial costs of cancer are great both for the individual and for society as a whole. Cancer accounts for about 10% of the total cost of disease in the US and its share of the total cost of premature deaths was about 18% of all causes of death in 1985. The National Cancer Institute estimates overall costs for cancer at $104 billion; $35 billion for direct medical costs, $12 billion for morbidity costs (cost of lost productivity), and $57 billion for mortality costs. Over half of the direct medical costs are due to treatment of breast ($6 billion), lung ($5 billion), and prostate ($5 billion) cancers. The cost of cancer screenings, including mammograms, Pap smears, and colorectal exams adds another $3 to $4 billion to overall cancer costs, but S Since 1988, the Society has funded over 100 community demonstration projects to provide cancer education mes sages and programs (cancer screening and education, trans portation, and patient service support) to the poor and underserved of our country. Overall, approximately 10 to 12 million adults in socioeconomically disadvantaged pop ulations are reached annually with public education programs. In addition, the Society currently has over $2 million in research grants in effect in this area. Allocation of American Cancer Society Funds Based on Total 1992-1993 Budget-$376,381 Management & General Community Services $27,405 7.3% *The Society's cancer prevention, detection, and treatment programs ore carried out through these areas. Figures taken from 1992 Annual Report (in thousands). 26 CANCER FACTS & FIGURES 1994 J3 CO 00 CO 4* CANCER FACTS 4 FIGURES 1994 to 30 fto CO 00 co in Summary of Research Grants & Fellowships Awarded by the American Cancer Society {National and Division) During the Fiscal Year Ending August 31,1993 {Subjectto Audit) Albany Medico 1 College, Albany, NY Albert Einstein College of Medicine, Bronx, NY American Assn, for Cancer Research, Philadelphia, PA Amerkon Health Foundation, NewYorV, NY Baylor College of Medicine, Houslon, TX Beth Israel Hospital, Boston, MA Boslon City Hospital, Boston, MA Bosloa College, Cheslnul Hill, MA Boslon Unk, Bos loo, MA Bowman Gray Sch. of Medicine, Winston-Salem, NC Brandeis llniv., Woltham, MA Brigham & Women's Hospifal, Boslon, MA Brigham Young Llniv., Provo, UT Brown Univ., Providence, fil California Inst, of Biological Res., La Jolla California Inst, of Technology, Posodena Carle Foundation Hospital, Urbana, 11 Carnegie Inslllullon of Washinglon, Boflimore, MD Case Western Reserve Univ., Cleveland, OH CKicogo Medical School, North Chicago, IL Children's Hospilol, Boslon, MA Children's Hospilol of Los Angeles, Los Angeles, CA City of Hope Nalionol Medical Ctr., Doarle, CA Cold Spring Horbor Lab., Cold Spring Horbor, NY Colorado Slate Univ,, Fort Collins Columbia Univ., New York, NY Cornell Univ., New York, NY Dana-Forber Cancer Institute, Boston, MA Dartmouth College, Hanover, NH Dartmoiilh-Hilchcoclt Medical Center, lebonon, NH Drexel Univ., Philadelphia, PA Duke Univ., Durham, NC Eleanor Roosevelt Inst, for Cancer Res., Denver, CO Eastern Virginia Medical School, Norfolk Emory Univ., Allanto, GA European Mot. Biol, loborolory, Heidelberg, Germony Foundation for Biomedical Research, Washinglon, DC Fox Chase Cancer Center, Philadelphia, PA Fred Hutchinson Concer Res. Center, Seatlle, WA Georgelown Univ., Washinglon, DC Georgia tnsf. ol Technology, Atfanla, GA Hahnemann University, Phildelphra, PA Harrington Concer Center, Amarillo, TX Harvand Univ. Medico! School, Boston, MA Harvard Univ., Cambridge, MA Henry Ford Hospital, Detroit, Ml Hunter College CUNY, New York, NY Imperial Cancer Research Fund, London, England Indiana Univ., Indianapolis Indiana Univ., Bloomington Inti. Union Agoinsl Cancer, Geneva, Switzerland Iowa State Unk, Ames Jockson Loborolory, Bar Horbor, ME Johns Hopkins Univ,, Baltimore, MD Kaiser Permonente Health Research, Portland, OR Konsas Slate Univ., Manhattan La Jolla Concer Research Foundation, La Jolla, CA la Jolla Inst. Allergy and Immunology, Lo Jolla, CA Louisiona State Univ. Med. Clr., Shreveport, LA Lonkenou Medical Research Center, Wynnewood, PA Loyolo Univ. of Chkogo, Maywood, IL Massachusetts General Hospital, Charlestown Massachusetts Inst, of Technology, Cambridge Map Clink Foundation, Rochester, MN McLaughlin Research Inst., Great Falls, MT Medkal Biology Inslilufe, La Jolla, CA Medkol College of Ohio, Toledo 1 3) 1 3) 1 1| ( 3) ( ?) ( 3) ( '} ( 1) ( 31 t 3} 1h3i1 11) (3) (1| 1 7] I 1) ( 3] I | 2) [3) [31 1 3) 1 5) Ml |!3) 13) I?) 1 '1 1J1 11] (18) ( 1) 13) 1 5) 1 11 1 'I ( 8) Ml 1 4) 1 1) 1 1) I 1) 113) (5) ( 1) 1 1) 1 1) 1 4) 13) ID 1 1) (411 (38) Ml (3) (4) M) (3) (3) ( 1) (8) (?) M) Ml 1 3) Ml Note: Numbers in parenTheses indicate numbers of grants per institution. $ 333,000 707,000 140,000 141,000 1,000,000 171,380 90,500 90,500 458,000 410,000 171,000 701,000 115,000 316,000 186,000 616,400 15,000 154,190 406,000 181,000 173,500 190,000 364,000 430,075 50,190 1,915,600 315,000 835,000 75,000 310,000 180,000 1,917,000 105,000 194,000 474,000 79,500 10,000 911,000 747,970 638,000 180,000 B,313 100,000 1,310,150 491,500 60,000 115,000 79,000 506,500 371,300 705,000 105,000 698,000 3,538,000 90,000 184,000 511,000 110,000 170,000 300,500 98,000 731,000 871,010 78,000 105,000 134,194 80,000 Medkol College of Virginia, Richmond Medkal College of Wisconsin, Milwaukee Medical Foundation of Buffalo, Buffalo, NY Medkal Univ. of South Carolina, Charleston Mem6ial Sloan-Kettering Cancer Clr., New York, NY Mkhi|an State Unk, East Lansing Montana State Univ., Bozeman Montefiore Medical Center, Bronx, NY MRC Lob. of Mol. Biology, Cambridge, England Mt. Sinoi Medkal Center, New York, NY Nall. Jewish Hospital & Research Ctr., Denver, CO New England Medical Center Hospitals, Boston, MA New Jersey Medical School, Newark New York Medical College, Yofhalla New York Unk, NYC National Institutes of Health, Belhesda, MD North Carolina Stole Univ., Raleigh North Dakota State Univ., Fargo Norlhweslem Univ., Chicago, IL Oak Ridge Assoc, Univ, of Tennessee, Ook Ridge Oberlln University, Oberlin, OH Ohio State Univ., Columbus Oklahoma Medkal Res. Fdn., Oklahoma City Oregon Health Science Link, Portland Oregon State Unk, Corvallis Pennsykonia Stole Unk, Hershey Pennsylvania Stale Univ., University Park Philadelphia Coll. Pharm, l Science, Philadelphia, PA Pkower Institute Med. Research, Manhasset, NY Pittsburgh Cancer Research Institute, PA Princeton Unk, Princeton, NJ hblk Health Jtes. Jnst. of New York, NYC Purdue Univ., West Lofayelte, IN Reed College, Portland, OR Rockefeller Univ., New York, NY Roger Willioms General Hospital, Providence, Rl Roswell fork Memorial Institute, Buffalo, NY Rush Presbyterian-St Luke's Med. Clr., Chkogo, IL Rutgers, Stale Unk of New Jersey, Piscotowoy Stale Univ. of New York (SUNY) ol Stony Brook Stole Univ. of New York [SUNY] at Syracuse Salk Institute, lo Jolla, CA Scrippt Clink & Research Foundation, La Jolla, CA Southwest Foundation Biomed, Res., Son Antonio, TX St. Jude's Children's Research Hospital, Memphis, TN St, John's Unk, Jamaica, NY St. Louis Univ., St. Louis, MO Stanford Univ., Stanford, CA Texas A & M Univ., College Station, TX Thomas Jefferson Unk, Philadelphia, PA Tufts Univ., Boslon, MA University Hospitals of Cleveland, Cleveland, OH UMDNJ-Robert Wood Johnson Medkal School, NJ Unk of Alabama, Birmingham Unk of Arizona, Tucson Unk of Arkansas for Med. Science, Little Rock Unk of California ol Berkeley Univ. of Californio at Davis Univ. of California ot Irvine Univ. of Californio at Los Angeles Unk of California ot Riverside Univ. of California at Santa Barbara Univ. of California al San Francisco Univ. of California al Son Diego Univ. of California ot Santa Cruz Univ. of Chicago, IL Univ. of Cincinnati, OH (3) $ 113,000 Unk of Colorado Hlth. Sci. Center, Denver 111 63,000 Unk of Coforodo, Boulder M) 180,000 Unk of Conned kut, Formington (!) 79,000 Unk of Delaware, Newark (19) $1,150,500 Univ. of Florida, Gainesville Ml 110,000 Unk of Georgia, Athens (!) 118,000 Univ. of Hawaii, Honolulu Ml 51,000 Univ. of Houston, TX (1) 80,000 Univ. of Iowa, Iowa City (4) 369,300 Univ. of Kansas, Lawrence Ml 100,000 Univ. of Kentucky, Lexington 13) 306,000 Untv. of Illinois, Chicago Ml 100,000 Unk of Illinois, Urbcma 1 3) 161,000 Univ. of Maryland, Baltimore Ml 1,109,000 Unk of Maryland, College Park 1 3) 118,000 Univ. of Massachusetts Med. Center, Worcester ( 1) 31,000 Univ. of Miami, FI (1) 115,500 Univ. of Mkhigon, Ann Arbor (7) 960,500 Unk of Minnesota, Minneapolis 111 118,000 Unk of Nebraska Med. Center, Omaha M) 76,000 Unk of Nebraska, Lincoln Ml 1,001,000 Univ. of NewMexko, Albuquerque |l) 48,000 Univ. of New Orleans, LA 1 3) 188,000 Univ. of North Carolina, Chapel Hill (!) 95,000 Univ. of Oklahoma, Oklahoma City (!) 410,000 Univ. of Oregon, Eugene Ml 147,300 Unk of Oxford, Oxford, England Ml 71,000 Univ. of Pennsylvania, Philadelphia ID 140,000 Unk. of Pittsburgh, PA (3) 563,000 Unk. of Rochester, NY (?) 1,079,000 Unk of South Carolina, Columbia (3) 354,000 Unk of South Florida, Tompo (3) 111,000 Unk. of Southern California, Los Angeles Ml 93,000 Univ. of Tennessee, Knoxville 1 n 180,000 Univ. of Tennessee, Memphis Ml 115,000 Univ. of Texas MD Anderson Ca. Ctr., Houston 1 4) 444,000 Unk. of Texas, Austin 1 3] 115,000 Unk. of Texas Med. Br., Galveston Ml 605,000 Unk. of Texas Southwestern Med. Ctr. al Dallas (11) 1,138,000 Unk of Texas Hlth. Sci. Ctr. at Houston (i) 90,000 Unk. of Texas Hlth. Sci. Ctr. at Son Antonio (?) 515,500 Unk, of Texas Health Ctr., Tyler Ml 106,810 Univ. of Utoh, Salt lake City 111 88,000 Univ. of Vermont, Burlington Ml 354,000 Univ. of Virginia, Charlottesville Ml 194,000 Univ. ol Washington, Seattle ( 3] 364,000 Unk. of Wisconsin, Madison (37] 1,358,451 Link of Wisconsin, Milwaukee (!) 181,000 Unk. of Wyoming, Laramie (7) 931,500 Utah Stole Unk, Logan (?) 468,000 Vanderbilt Univ., Nashville, TN (3) 190,000 Virginia Polytechnic Inst., Blacksburg 1 3) 190,000 W. Alton Jones Cell Sci. Ctr., Lake Placid, NY (5| 688,500 Washington State Univ., Pullman Ml 836,000 Washington Univ., St Louis, MO ( 4) 410,000 Wayne Stole Unk, Detroit, Ml (?) 800,000 Wesleyan Unk., Middletown, CT (?) 381,500 West Virginia link, Morgantown (11) 963,100 Whitehead Institute, Cambridge, MA Ml 1,515,500 Wichita State University, Wichita, XS (1) $ 110,000 William Patterson College, Wayne, NJ 1 <1 174,000 Wistar Institute, Philadelphia, PA (23) 1,564,000 Yafe Univ.. New Haven, CT (HI 1,314,600 Subtotal (11 113,000 Division Research Grants |7| 730,500 111 $ 48,000 Grand Total ini 1 ) (!) (2) ( 1) (1) (1) (1) (4) Ml 1 1) 1 4) (2) (4) (11 (7) (5) (16) (10) ( 4) ( !| (3) Ml |1S| Ml (?1 (i) (") (8) (8) (1) (1) 13) Ml 13] (11) 1 1) Ml (14) (1) (3) (1) ( ?! (5) (10) 111) (13) (1) ( 1) ( 1) (7) (1) (!) (2) Ml (5) (31 (2) (4) (1) M) ( 4) (27) (847) 1,488,500 898.900 111,1)00 171,000 100,000 88,000 100,000 106,000 395,000 141,000 90,000 314,000 146,500 336,000 85,500 836,471 681,000 1,000,500 1,047,000 441,000 89,000 89,115 73,000 1,591,000 413,000 1,011,000 78,000 1,098,850 891,000 703,383 191,000 135,000 1,190,000 61,000 345,000 1,516,000 50,000 50,000 1,649,000 90,500 193,000 180,000 486,000 749,000 1,413,000 1,117,670 1,357,000 99,000 166,000 90,000 991,000 117,000 400,000 195,000 495,670 443,000 179,500 106,000 141,500 59,000 105,000 407,500 1,915,174 $95,838,887 $ 3,91 B,015 $99,756,903 Cancer Centers The institutions listed have been recognized as Cancer Centers by the National Cancer Institute. These centers have been rigorously reviewed by the National Cancer Advisory Board. They receive financial support from the National Cancer Institute, the American Cancer Society and many other sources. ALABAMA University of Alabama at Birmingham* Comprehensive Cancer Center (205) 934-5077 ARIZONA University of Arizona* Arizona Cancer Center (602) 626-6372 CALIFORNIA The Kenneth Norris, Jr, Comprehensive Cancer Center* University of Southern California (213) 226-2370 Jonsson Comprehensive Cancer Center* University of California at Los Angeles 1-800-825-2631 La Jolla Cancer Research Foundation (619) 455-6480 University of California at San Diego Cancer Center (619) 543-6178 City of Hope Beckman Research Institute (818) 359-8111 Armand Hammer Center for Cancer Biology Salk Institute (619) 453-4100 COLORADO University of Colorado Cancer Center University of Colorado Health Sciences Center (303) 270-3007 CONNECTICUT Yale University* Comprehensive Cancer Center 1-8004-CANCER DISTRICT OF COLUMBIA Lombardi Cancer Research Center* Georgetown University Medical Center (202) 687-2192 FLORIDA Sylvester Comprehensive Cancer Center* University of Miami Medical School (305) 545-1000 ILLINOIS University of Chicago Cancer Research Center (312) 702-6180 Lurie Cancer Center Northwestern University (312) 908-5250 INDIANA Purdue University Cancer Center (317) 494-9129 MAINE The Jackson Laboratory (207) 288-3371 MARYLAND The Johns Hopkins Oncology Center* (410) 955-8800 Indicates Comprehensive Cancer Center. MASSACHUSETTS Dana-Farber Cancer Institute* (617)632-3000 Worcester Foundation for Experimental Biology (508) 842-8921 Massachusetts Institute of Technology Center for Cancer Research (617) 253-6421 MICHICAN Meyer L. Prentis Comprehensive Cancer Center of Metropolitan Detroit (313) 7454329 University of Michigan Comprehensive Cancer Center* (313) 936-9583 MINNESOTA Mayo Comprehensive Cancer Center* (507) 284-3413 NEBRASKA Eppley Institute University of Nebraska Medical Center 1-800-999-5465 NEW HAMPSHIRE Norris Cotton Cancer Center* Dartmouth-Hitchcock Medical Center (603) 650-5000 NEW YORK Cold Spring Harbor Laboratory (516) 367-8397 Memorial SIoan-Kettering Cancer Center* 1-800-525-2225 Roswell Park Cancer Institute* 1-800-ROSWELL Albert Einstein College of Medicine Cancer Research Center (718) 9204826 Columbia University Comprehensive Cancer Center (212) 305-6921 Kaplan Comprehensive Cancer Center* New York University Medical Center (212) 263-6485 University of Rochester Cancer Center (716) 2754911 Nelson Institute for Environmental Medicine New York University Medical Center (212) 263-5280 American Health Foundation (212) 953-1900 NORTH CAROLINA Duke University Comprehensive Cancer Center* (919)684-2748 Lineberger Cancer Research Center* University of North Carolina (919) 966-3036 Wake Forest University* Comprehensive Cancer Center Bowman Cray School of Medicine (919) 7164464 OHIO Ohio State University* Comprehensive Cancer Center Arthur C. James Cancer Hospital 1-800638-6996 Case Western Reserve University Ireland Cancer Center (216) 844-5432 PENNSYLVANIA Foz Chase Cancer Center* (215)728-2570 University of Pennsylvania Cancer Center* (215)662-6364 Wistar Institute Cancer Center (215)898-3926 Fels Research Institute Temple University School of Medicine (215) 2214000 Pittsburgh Cancer Institute* University of Pittsburgh 1400537-4063 RHODE ISLAND Brown University Roger Williams Cancer Center (401) 456-2071 TENNESSEE Drew-Meharry-Morehouse Consortium Cancer Center (615) 327-6927 St. Jude Children's Research Hospital (901) 522-0306 TEXAS M.D. Anderson Cancer Center* University of Texas (713) 792-3245 San Antonio Cancer Institute (210) 677-3850 UTAH Utah Cancer Center University of Utah School of Medicine (801) 5814048 VERMONT Vermont Cancer Center* University of Vermont (802) 6564414 VIRGINIA Massey Cancer Center Medical College of Virginia/VCU (804)371-5116 University of Virginia Cancer Center (804)924-5811 WASHINGTON Fred Hutchinson Cancer Research Center* (206) 667-5000 WISCONSIN Comprehensive Cancer Center* University of Wisconsin (608) 2634600 McArdle Laboratory for Cancer Research University of Wisconsin Medical School (608) 262-2177 R&S 144836 Cancer Around the World, 1988-1991, Death Rates per 100,000 Population for 46 Countries > o m PO ~n >O -H ^ K -- O m crj *o 'O 3 (* CO _|. 4* 00 CO -g COUNTRY United Slates Argentina! AusIrafiaS Austria Bulgaria Conodaf Chi lef China'! Costa fijca^ Cubaf Czechoslovak raf Denmark Ecuodor England A Wales Finland Froncef Germony, Fed fl Greecef Hong Kong! Hungary Iceland Irelandf Israel! Ilalyt Japan Luxembourg Molto Mauritius Wexicof Netherlands! New Zealand! North Ireland Norwayf Poland Portugal Puerto Rico! Romania Scotland Singapore! Spain! Sweden! Swilzerland Uruguay! USSR! Venezuela! Yugoslavtof ALL sms Male Female 164.4(24) 151.8(79} 164.0 PS) 172.3(18) 1390(37) 170.8(21) 140 3(36) 154.1(27) 166.6(22) 129.8(39) 232.8( 2) 179 5(11) 83.6(45) 179.2(12) 154,1(28) 200.7 ( 5) 177.9(13] 144.3(34] 175.1(16) 246.5( 1] 147.6(32] 174.9(17) 115.5(42) 192.3(10] 150.2(30] 1976( B] 144.0(35) 85.0(44) 83.5(46] 195.3 ( 9] 171.9(19] 176.6(14] 148.2(31] 203.5( 4) 145.9(33) 125.5(41) 135.3 (38) 198.5( 6] 175.3 (15) 166.3(33) 129.4(40] 171.1(20) 204.7 ( 3) 198.3( 7) 92.7(43) 158.4 pi) 110.6(11) 97.6(26) 102.2(22) 106.9(19) 84.2(38) 110.6(12) 109.4(14) 87.3(35) 108.6(16) 95.6(28) 1210 ( 8) 139.8 ( 1) 85 2(37) 125.7 ( 6) 90.6(32) 83.1 (34) 108.3(17) 77.5(43) 91.0(31) 131.5( 3) 114.6(10) 127.5 ( 4) 98.7(24) 99.2(23) 76.7(44) 109,4(15) 92.5(30) 623(46] 797(42) 109.8(13] 126.8( 5) 1223 ] 7] 102.2(21] 107.8(18) 86.6(36) 75.1 (45) 83.8(39) 137.1 ( 2) 103.9 (70) 80.8(41] 98.1 (25) 97.2(27) 116.6( 9) 94.5(29) 83.7(40) 90.2(33) ORAL Male Female 37 (29) 4.0(26) 4.7(20) 5.9(16) 3.8(28) 4.4(22) 23 (39) 25(36) 3.2(31) 5.6(19) 9.0( 6) 4 0p7) 0.7(46) 2.9(33) 2.3|40| 13.6 ( 3) 6.3(13) 1.6(44) !4.5| 2) 14.7( 1) 2.1(42) 4.4(24) 10(45) 63(11) 23(41) 10.1| 5) 3.6(30] 4.6(21) 2.0(43) 2.8(35) 43(25) 2.8(34) 3.1(32) 6.2(14) 5.7(18) 7.9(7) 5.7(17) 4.4(23) 12.9 ( 4) 6.3(12) 2.4(38) 6.6(10) 6.0(151 7.4(8) 2.4(37) 6.9(9) 1.3(12) 0.9(35) 1.3(13) 0.9(33) 0.6(45) 1.3(14) 0.6(44) 1.2(17) 1-0(35} 2.0 (3) 1.0(26) 1.4(9) 0.7(40) 12(18) 0.8(39) 1.3(15) 1.0(33) 0.6(46) 4.4(2) 1.7(5] 1.0P7) 1.0(38) 0.7(42) 1.0(23) 0.6 (43) 1.4(10] 1.6 [ 6] 1.81 4] 0.7(41] 1.0(32] 1.41 8] 1.0(31] l.i po; 1.0(24) 0.8(37) 1.4(7) 1.0(29) 1.3(11) 4-4( 1) 0.8(38) 0.8(36) 1.2(16) 0.9(34) 1.0(30) 1.1(19) i.opt) COLON A RECTUM Male Female 16.7 (20) 137 pi) 21.5 ( 9) 22.4 ( 6) 15.1(25) 17.8(17) 7.0(40) 7.9(3?) 6.8(42) 10.2(36) 30.7( 1) 23.8( 5) 2.7(46) 20.2(12) 12.2(35) 17.3(19) 21.1(10] 6.8(41) 14.8(39] 29.0 ( 2] 14.9(37} 23.2 ( 4) 14.4(30) 15.6(21) 15.1 P4) 21.6| 7) 13.5(32] 5.0(44) 3.3(45] 17.9(16) 25.7 ( 3) 21.5( 8) 20.0(13) 74.9 (36) 15.3 P2) 9.6(38] 9.7P7) 20.6(11) 19.1(14) 13.2(34) 14.9(28) 18.2(15) 17.7(18) 15.2(23) 5.7(43) 13.4(33) 11.4(19) 93(33} 14.7(9) 14.2(11) 10.7(36) 12.0(17) 6.0(41) 6.5(40) 67 (39) 11.4 PO) 17.0( 4) 17.5 ( 3) 4.1(45) 137(14) 8.6(36) 10.3(37} 15.2( 6) 5.5(43) 107 P5) 18.1(2) 10.BP4) 15.1) 7) 11.9(18) 103(28) 9.7(32) 12.4(16) 10.0(31) 4.1(44] 3.1(46] 13.3(15) 20.5 ( 1) ]4.B( 8) 14.2(10) 10.2(29) 10.1(30) M P7) 7.2(38} 15.2| 5) 14.0(13) 9.2(35) 11.1 pi) 10.9(23) 14.1(12) 10.9(22) 5.2(43) 9.3(34) PROSTATE Mole 16.8(17) 13.1 (29) 17.2(15) 167(18) 7.8(39) 16.9(16) 13.)(28) 19.6( 5) 18.7( 7) 13.6(26) 18.1 (10) 11.1(32) 16.6(20) 17.5(12) 17.3(13) 15.9|21) 8.1(33) 2.6(45) 15.7(22) 19.4| 6) 17.6(11) 8.6(37) 11.5(31) 3.B (44) 16.6(19) 9.1(35) 5.3(42) 10.6(33) 18.3 ( 9) 187( 8) 15.4(23) 21.7| 2} 9.8 P4| 14.5(25) 17.3(14) 7.1(40) 14.9(24) 4.2(43) 12.9(30) 20.4(3) 22.5( 1) 19.9 ( 4) 6.3(41) 133(27) 8.9(3*) LUNG Male Female 57.1(10) 39.2(30) 45.1 P5| 45.1 (24) 403 (29) 57.3) 9) 21.1(40) 34.0(33) 17.5(43] 39.0(32) 74.4) 2) 51.9(15) 6.9(46) 57.0(11) 47.8(21) 46.8(22) 487(19) 49.8(17) 54.2(14) 76.4 ( 1) 30.8(34) 47.9(20) 24.5 PB) 58.9 ( B) 30.1(36) 62.9 ( 7) 42.2(28) 18.9(42) 16.5(45) 71.2| 4) 44.4(27) 55.4(12) 30.3(35) 70.4 ( 5) 26.0(37) 19.5(41) 39.1(31) 71.3 ( 3) 50.6(16) 45.2(23) 23.4(39} 44.9(26} 55.0(13) 63.6(6) 16.5(44) 48.9(18) 24.7| 2) 5.8(38) 12.8(15] 9.0 (20) 63 (36} 20.6| 6) 5.8(39) 14.5(13) 6.4(34) 143(14) 83(22) 23.91 3) 2.8(46) 20.5| 7) 6.6(33) 5.0(41) 7.B (26) 6.9(32) 23.3( 5) 14.9(12) 23.8| 4) 19.2| 8) 7.9 (24} 7.3(28) 8.0(23) 8.8(21) 37(44) 5.1(40) 5.9 P7) 10.2(17) 17.3(11) 17.8 ( 9) 10.3(16) 97(19) 4.4(43) 7.0(31) 6.4 P5) 28.3 (1) 17.5(10) 3.4(45) 9.9(18) 7-2(29) 4.6(42) 7.1 P0) 7-9(25) 73(27) NOTE: Figures in parentheses ore order of rank within siteond sex group. Rotes ore oge-odiusted to the WHO world standard population. 'Oral cancer roles include nasopharynx only* | IV8S-1990 only. | I9B8-1989 only. 6 l9$l only. 81989-1990 only. BREAST Female 22.4(16) 20.9(19] 20.7(21) 22.0(17) 15.6(31) 23.9(12) 12.5(39) 4.6(46) 12.9(38) 14.8(33) 19.8(22} 777{ 4) 5.6(46) 287) 1) 17.0 pB} 39.7(23} 21.9 (IB) 15.2(32) 8.6(41) 22.6(15) 23.7(13) 27.B| 3) 23.0(14) 20.8(20) 6.3(44) 25.4(10) 2B.1 ( 2) 6.7(43) 8.1(42) 26.8( 7) 27.0( 6) 26.5{ Bj 19.2 P4) 15.7(30) 17.8(26} 14.2(35) 14.8(34) 27.1(5) 12.9(37) 17.1 (27) 18.2(25) 24.3(11) 26.4 ( 9) 13.6(36) 9.6(40) 15.9(29) UTERUS Cervix Other 2.6 p3] 4.6(16) 3.1(29} 2.9(30) 1.1(32) 2.3(37) 12.5 (2) 4.2 pi) 10.4 ( 3) 6.2(9) 5.6(11) 5.3(12) 5.8(10) 4.4(18) 17(43) 1.8(40) 3.6(25) 1.3(45) 3.9(23} 6.8(7) 2.6(34} 3.2(27) 1.4(44] 09(46) 1.8(41) 3.2 (28) 1.9 p9) 3.6(24} 15.9 ( 1) 3.5 PS) 4.5(17) 3.5(26) 40(19] 7.? ( 6) 2.3(36) 2.6(32) 10.3 ( 4) 4.6(15) 6.4(8) 17(42) 2.2(38) 2.6(33) 4.7(14) 5.2(13) 97(5) 4.2(20) 2.6(33) 6.5(5) 17(44) 5.1(9) 6.0(7) 2.5(35) 2.4(38) 3.5(22) 70(4) 57(8) 3.5(23) 137 ( 1) 2.5(34) 2.6 pi) 4.0(17) 3.2(25) 3.0(26) 1.4(45) 5.0(11) 1.8(42) 2.9(27) 2.2(39) 5.1(10) 2.4(37) 4.5(14) 3.8 P0) 7.4(3) 2.6(32) 2.5 (36) 2.8(28) 2.0(41) 2.8(29) 4.0(16) 4.9(12) 3-5(21) 3.9(18) 2.1(40) 1.8(43} 3.8(19) 27(30) 3.3P4) 6.4 ( 6) 4.4(15| 4.6(13) STOMACH Male Female 5.2(46) 12.8(26) 8.4(41) 167(19) 19.8(11) 8.0(42) 350( 3) 32.6 {5) 547{ 1) 7-3(45) 197(12) 7.8(43) 26.9( 6) 12.5(29} 13.0(25} 9.1 PB) 14.9(21) 9.6(36) 11.5(31) 24.0{ 8) 18.1(15) 12.0(30) 77(44) 18.2(14) 34.9( 4) 11.3(32) 14.9(22) 127(27) 10.5(35) 13.1 (23) 8.8(40) 12.6(28} 11.0(34) 211 ( 9) 24.9 (7) 11.0P3) 18.2(13) 13.1(24) 20.3(10| 15.0(20) 8.9(39) 9.6(37) 17.0(18) 36.8(2) 17.1(17) 18.0(16) 20(46) 56(29) 3.6(44) 8.2|15| 10.7 ( 9) 3.4(45) 13.6| 6] 157(4) 228 ( 1) 3.8(42) 8.9(12) 4.2(41) 19.2 ( 2) 5.1(31) 7,0(23) 3.6(43) 77)17) 4.9(34) 50(30] 10.2(10) 77(18) 5-9(27} 4.2(40) 8.6(13) 15.5 ( 5) 4.3(38) 6.1 (26) 7.2(21) 76(19) 5.0(33) 47 (35) 45-7(25} 5.0(32) 8.2(14) 12.0) 7) 4.5(36) 7-1(22) 5.9(28) 10.8( 8) 6.9 (24) 4.5P7) 4.2(39) 70 (20) 16.0 (3) 90(11) 7.8(16) t LEUKEMIA Male Female 60 ( 8) 4.6(33) 6.1(11) 5.4 pi) 4.5 (36) 6.2(10) 3.9(42] 4.1(40) 60(9) 4.6(32) <5-71 4) 6.8 ( 3) 37(45) 5.3(24) 5.2(25) 6.1(13) 5.9(14) 57(16) 3.8(43) ( D 4.9(29) 6.1(12) 6.4(7) 6.7(5) 40(38) 67 ( 6) 5.4(2!) 3.5(46] 3.8(44) 5.6(18) 7.2(2) 4.5(34) 4.9(28) 5.8(15) 5.0 P7) 4.0(30) 4-5(35) 4-4 (37) 4.2(39) 5.3(23) 5.1 (26) 5.6(17) 5.5(20) 5.5(19) 4.0(41} 4-7(31) 3.3 ( 9) 3.3(28) 3.8(10) 3.5(24) 2.9(43) 3.9 ( 8) 30(32) 30 P7) 4-9( 1) 3.6(16) 40 ( 4) 4.1(5) 3.2(33) 3.3(31) 3.0 (38) 37(15] 37(13) 3-4(55) 5.7(45} 4.6 ( 2) 3.1(37) 37(12) 4-5 ( 3) 40(7) 2.8(44) 3.6(21) 3.6(17) 2.3(46) 3.0(401 3.5(23) 4.11 6) 3.2(34) 3.3(30) 3.6(18) 37(14) 3.5(22) 3.0(39) 3.1 (35) 3.0(41) 3.4(26) 3.3(29) 3.6(20) 3.8(11) 3.6(19) 3.1(36) 3.0(42) ^ Alabsmi Division, Inc. S04 Brookwood Boulevard Homewood, Alabama 35209 (205) 879-2242 Alula Division, Inc. 406 West Fireweed Lane Anchorage, Alaska 99503 (907) 277-8696 Arizona Division, Inc. 2929 East Thomas Road Phoenix, Arizona 85016 (602) 224-0524 Azinnias Division, Inc, 901 North University Little Rock, Arkansas 72203 (501) 664-3480 California Division, Inc. 1710 Webster Street Oakland, California 94612 (510) 893-7900 Colorado Division, Inc. 2255 South Oneida Denver, Colorado 80224 (303)758-2030 Connecticut Division, Inc. Barnes Park South 14 Village Lane Wallingford, Connecticut 06492 (203) 265-7161 Delaware Division, Inc. 92 Read's Way New Castle, Delaware 19720 (302) 324-4227 District of Columbia Division, Inc. 1875 Connecticut Avenue, N.W. Washington, DC 20009 (202) 483-2600 Florida Division, Inc. 3709 West Jetton Avenue Tampa, Florida 33629-5146 (813) 253-0541 Georgia Division, Incr 2200 Lake Blvd. Atlanta, Georgia 30319 (404) 816-7800 Hawaii Pacific Division, Inc. Community Services Center Bldg. 200 North Vineyard Boulevard Honolulu, Hawaii 96817 (808) 531-1662 Idaho Division, Inc. 2676 Vista Avenue Boise, Idaho 83705-0836 (208) 343-4609 Illinois Division, Inc. 77 East Monroe Chicago, Illinois 60603-5795 (312) 641-6150 Indiana Division, Inc. 8730 Commerce Park Place Indianapolis, Indiana 46268 (317) 872-4432 Iowa Division, Inc. 8364 Hickman Road Des Moines, Iowa 50325 (515) 253-0147 Kansu Division, Inc. 1315 SW Arrowhead Road Topeka, Kansas 66604 (913) 273-4114 Kentucky Division, Inc. 701 West Muhammad Ali Blvd. Louisville, Kentucky 40203-1909 (502) 584-6782 Louisiana Division, Inc. 2200 Veteran's Memorial Blvd. Suite 214 Kenner, Louisiana 70062 (504) 469-0021 Maine Division, Inc. 52 Federal Street Brunswick, Maine 04011 (207) 729-3339 Maryland Division, Inc. 8219 Town Center Drive Baltimore, Maryland 21236-0026 (410) 931-6868 Massachusetts Division, Inc. 247 Commonwealth Avenue Boston, Massachusetts 02116 (617) 267-2650 Michigan Division, Inc. 1205 East Saginaw Street Lansing, Michigan 48906 (517) 371-2920 Minnesota Division, Inc. 3316 West 66th Street Minneapolis, Minnesota 55435 (612) 925-2772 Mississippi Division, Inc. 1380 Livingston Lane Lakeover Office Park Jackson, Mississippi 39213 (601)362-8874 Missouri Division, Inc. 3322 American Avenue Jefferson City, Missouri 65102 (314) 893-4800 Montana Division, Inc. 17 North 26th Billings, Montana 59101 (406) 252-7111 Nebraska Division, Inc, 8502 West Center Road Omaha, Nebraska 68124-5255 (402) 393-5800 Nevada Division, Inc. 1325 East Harmon Las Vegas, Nevada 89119 (702)798-6857 New Hampshire Division, Inc. 360 Route 101, Unit 501 Bedford, New Hampshire 03110-5032 (603) 472-8899 New Jersey Division, Inc. 2600 US Highway 1 North Brunswick, New Jersey 089020803 (908) 297-8000 New Mexico Division, Inc. 5800 Lomas Blvd., NE Albuquerque, New Mexico 87110 (505) 260-2105 New York State Division, Inc. 6725 Lyons Street East Syracuse, New York 13057 (315) 437-7025 Long Island Division, Inc. 75 Davids Drive Hauppauge, New York 11788 (516) 436-7070 New York City Division, Inc. 19 West 56th Street New York, New York 10019 (212) 586-8700 n Queens Division, Inc. 112-25 Queens Boulevard Forest Hills, New York 11375 (718) 263-2224 o Westchester Division, Inc. 30 Glenn Street White Plains, New York 10603 (914) 949-4800 North Carolina Division, Inc. 11 South Boylan Avenue Raleigh, North Carolina 27603 (919) 834-8463 North Dakota Division, Inc. 123 Roberts Street Fargo, North Dakota 58102 (701)232-1385 Ohio Division, Inc, 5555 Frantz Road Dublin, Ohio 43017 (614) 889-9565 Oklahoma Division, Inc. 4323 63d, Suite 110 Oklahoma City, Oklahoma 73116 (405) 843-9888 Oregon Division, Inc. 0330 SW Curry Portland, Oregon 97201 (503) 295-6422 Pennsykaola Division, Inc. Route 422 & Sipe Avenue Hershey, Pennsylvania 17033-0897 (717) 533-6144 Philadelphia Division, Inc. 1422 Chestnut Street Philadelphia, Pennsylvania 19102 (215) 665-2900 Puerto Rico Division, Inc, Calle AJverio *577 Esquina Sargento Medina Hato Rey, Puerto Rico 00918 (809) 764-2295 Rhode Island Division, Inc. 400 Main Street Pawtucket, Rhode Island 02860 (401) 722-8480 South Carolina Division, Inc. 128 Stonemark Lane Columbia, South Carolina 29210-3855 (803) 750-1693 South Dakota Division, Inc. 4101 Camegie Place Sioux Falls, South Dakota 57106-2322 (605)361-8277 Tennessee Division, Inc* 1315 Eighth Avenue, South Nashville, Tennessee 37203 (615) 255-1227 Texas Division, Inc. 2433 Ridgepoint Drive Austin, Texas 78754 (512)928-2262 Utah Division, Inc. 941 East 3300 S. Salt Lake City, Utah 84106 (801) 483-1500 Vermont Division, Inc. 13 Loomis Street Montpelier, Vermont 05602 (802) 223-2348 Virginia Division, Inc. P.O. Box 6359 Glen Allen, Virginia 23058-6359 (804) 527-3700 Washington Division, Inc. 2120 First Avenue North Seattle, Washington 98109-1140 (206) 283-1152 West Virginia Division, Inc. 2428 Kanawha Boulevard East Charleston, West Virginia 25311 (304) 344-3611 Wisconsin Division, Inc. P.O. Box 902 Pewaukee, Wisconsin 53072-0902 (414) 523-5500 Wyoming Division, Inc. 2222 House Avenue Cheyenne, Wyoming 82001 (307) 638-3331 THERE'S NOTHING MIGHTIER THAN THE SWORD AMERICAN V CANCER f SOCIETY FOR MORE INFORMATION CALL THE AMERICAN CANCER SOCIETY TOLL FREE: 1-800-ACS-2345 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 from cancer, and diminishing suffering from cancer through research, education, and service. R&S 144838 National Headquarters: American Cancer Society, Inc., 1599 Clifton Road N.E., Atlanta, CA 30329-4251 c1994, American Cancer Society, Inc 94-375M-NO. 5008.94