Document z3kQJQYr89nEXjaaM31kZXQ6

ABD00003011 CANCER FACTS & FIGURES-1994 vAAAERICAN CANCER * SOCIETY E^.rr.c'ed nurber c; ne j ccnccr cc.'es in 194 by stcie, toiol I 208 000 (e/dudmg Puerlo Rico] * 'c*;ijc' '0 betel and saian-.ous cell stm cancer crd cc c none m situ ABD00003012 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 m 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 m 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 m 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 m 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 m five was alive five years after treatment In the 1940s, it was one in four, and m 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 m 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 treatment of cancer 1 CANCER FACTS & FIGURES 1994 ABD00003013 Contents * CANCER BASIC FACTS 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 SELECTED CANCERS Lung Cancer Colon and Rectum Cancer Breast Cancer Prostate Cancer Leading Sites of Cancer Incidence and Death --1994 Estimates How to Estimate Cancer Statistics Locally Pancreas Cancer Uterus (Cervix) Cancer Percentage of Population (Probability) Developing Invasive Cancers at Certain Ages Uterus (Endometrial) Cancer Cancer m Children Leukemia Lymphoma Skin Cancer Tables are indicated in bold print 1 Ovary Cancer 2 Five-Year Relative Survival Rates by Stage at Diagnosis 4 Bladder Cancer 4 Oral Cancer TYends in Cancer Survival, by Race 15 16 16 16 17 5 CANCER IN MINORITIES 18 6 Number of Cancer Deaths for Black, American Indian, 7 Chinese, Japanese, and HispanicPersons, US, 1990 18 8 PREVENTION 19 9 Environmental Cancer Risks 20 9 EARLY DETECTION 9 TOBACCO USE 10 10 THE AMERICAN CANCER SOCIETY Research 21 22 24 24 11 Public Education 12 Professional Education 12 Patient Services 12 Public Issues COSTS OF CANCER 24 25 25 25 26 13 THE DISADVANTAGED 13 Allocation of ACS Funds, 1992 13 Summary of Research Grants andFellowships 14 Cancer Around the World 14 Cancer Centers 15 Chartered Divisions of the ACS 26 26 27 28 29 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 vear 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 Wk 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 surma! The SEER program includes data irom nine population based cancer registries, covering about 10% of the US population Beginning with the 1979 edition of Facts and Figures, estimates or cancer incidence have been based on incidence rates obtained through the SEER program, applied to the US Census estimates of the population tor the current vear 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 It is not appropriate or accurate to evaluate cancer incidence and mortalitv trends using only ACS estimates ot cases and deaths, since these numbers are proiected before the vear begins using data that are several vears old The numbers are presented to give the best available measure of the scope of the disease in the US at the time of publication Comparable incidence rates are available for 1973 through 1990 from the National Cancer Institutes SEER program to evaluate cancer trends The estimates of total US cancer cases diagnosed in 1994 are based on age-specific incidence rates from the SEER program tor ]9S8 1990 applied to the 1994 Census population projections Some adjustment is made for sites with recently increasing or decreasing rates Estimated new cases by state are calculated according tc the distribution of estimated 1994 cancer deaths b\ state tor each primary cancer site Mortality Mortality statistics are derived from underlvmg cause of death data reported bv the Division oi \ ital Statistics National Center for Health Statistics, Department of Health and Human Services The 1994 estimates of cancer deaths are based on cancer mortalitv 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 the old world population standard 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 Institute Survival Cancer survival statistics are usually reported as 5 vear relative survival rates In this edition, we present survival statistics for cases diagnosed in the period 1983 1989, as reported from the SEER program and followed through 1990 The relative survival rate is the ratio of the observed survival rate for the patient group to the expected survival rate for persons in the general population similar to the patient group with respect to age, sex, race and calendar year of observation Because there is a certain lag time required in measuring survival, these rates may not reflect the most recent treatment advances SEER Report The NCI SEER program is the source of specific data components for Cancer Facts <* Figures 1994, including incidence rates and survival rates These and other data are available in the SEER Cancer Statistics Review 19731990, National Cancer Institute N1H Pub No 93-2789,1993 f iyi,4 Am^-ican Cancer Foe,xtv Ire 4// nahts rvrerved including the right to reproduce this publication or portions thereof in cry fom For u--nen permission address the American Cancer Society 1599 Chiton Ft>od V F Atlanta CA 3039^-4351 ABD00003014 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 m 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 m 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 m 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 bone cancer surgery, resulting in dramatic improvement in survival 2 CANCER FACTS & FIGURES 1994  New high-technology diagnostic imaging techmqu^BDOD(M)30il#row Junction is a side eftect of some cancer nave replaced exploratory surgery for some cancer patients treatments, researchers are evaluating autologous bone ' Magnetic resonance imaging (MRI) is one example of such marrow transplants, in which a portion of the patient's echnology In MRI, a huge electromagnet is used to detect own marrow is removed before treatment, saved, and later mdden tumors by mapping the vibrations of the various restored This procedure eliminates the problems of atoms in the body on a computer screen Computerized matching a donor with the recipient patient, and may make tomography (CT) scanning uses x-rays to examine parts it possible for the patient to tolerate larger doses of of the body In both of these painless, noninvasive pro anticancer drugs or radiation therapy cedures, cross-section pictures can show a tumor's shape Improvements in cancer treatment have made possible and location more accurately than is possible with more conservative management of some early cancers In conventional x-ray techniques For patients undergoing early cancer of the larynx, many patients are now able radiation therapy, CT scanning may enable the therapist to retain the larynx and voice, in colorectal cancer, fewer to pinpoint the tumor more precisely, and thus provide permanent colostomies are needed, in many cases, the more accurate radiation dosage while sparing normal surgery for breast cancer is often more limited, and special tissue Positron emission tomography (PET) is another nerve-sparing surgery now commonly used for prostate imaging technique One of the advances in the area of cancer could enable men to maintain normal penile imaging combines two or three different types of images function (e g , MRI and PET) in a computer to create a three- Prostatic ultrasound (a rectal probe using ultrasonic dimensional picture that can be rotated on the screen waves to produce an image of the prostate) is currently This technology is currently used in some medical centers being investigated as a potential means to increase the to help plan for surgery and radiation therapy in areas early detection of occult (not clinically suspected) prostate such as the brain cancer Recently, prostatic ultrasound has been combined rmmunotherapy holds the hope of enhancing the body's with a blood test for prostate-specific antigen to aid in own disease-fighting systems to help control cancer early detection of prostate cancel Interferon (a naturally occurring body protein capable of A large clinical trial is underway to evaluate the killing cancer cells or stopping their growth), interleukin- usefulness of an estrogen-blocking drug called tamoxifen. 2 (a growth factor that stimulates cells of the immune Commonly used to treat women when they have breast system to fight cancer), and other biologic response cancer, this large study hopes to see if tamoxifen can also modifiers are under study Recently, interferon was made be used to prevent breast cancer in women who are at available to all doctors as the treatment for hairy cell high risk leukemia, a rare blood cancer of older Americans With medical progress producing longer survival Interleukin-2 is under active research in the treatment of periods for many cancer patients, clinical concerns are kidney cancer and melanoma Gene therapy is the newest expanding to include not only patients' physical well-being, approach to stimulating immune cells to fight cancer but also their psychosocial needs. The response of both Vaccines against several types of cancer are also being patient and family to the disease, the patient's sexual developed concerns, employment and insurance needs, and ways to Many cancers develop in a two-stage process through provide psychosocial support have emerged as important exposure to substances known as initiators and promoters. areas of research and clinical care Research scientists are exploring ways to interrupt this Psychosocial and behavioral research is showing much process promise as evidence mounts that lifestyle (tobacco, diet) Ongoing research into new drug development will and environmental factors influence a person's general result in compounds that are less toxic to normal cells health and chances of developing cancer, as well as the and more potent against tumor cells New drugs will also mental ability to cope with cancer if it occurs Research allow physicians to circumvent the problem of drug on behavioral modification is having a significant impact resistance that many cancer cells develop Along that same on symptoms of cancer and its treatment, such as pain, line of research, genes responsible for cancer cell resistance nausea, and vomiting Other research deals with stress to chemotherapy have recently been discovered during treatment and during recovery after surgery or New technologies have made it possible to use bone radiation treatment A number of investigations concentrate marrow transplantation as an important treatment option on breast cancer, specifically on how women can be in select patients with leukemia and lymphoma Bone motivated to make use of mammography screening, and marrow transplantation for breast cancers and other how to adjust to surgery, if such intervention becomes malignant tumors is under study Because disruption of necessary 3 CANCER FACTS & FIGURES 1994 ABD00003016 Cancer Death Rates by Site, Males, United States, 1930-90 Rotes ore per 100,000 ond ore oge adjusted to the 1970 US census populotion Cancer Death Rates by Site, Females, United States, 1930-90 Available on reproduction sheet (5005 94) Rotes ore per 100,000 and ore oge od|usted to the 1970 US census populotion 4 CANCER FACTS & FIGURES 1994 AvoJoble on reproduction sheet (5005 94) ABD00003017 30-Year Trends in Cancer Death Rates* per 100/000 Population, 1958-60 to 1988-90 oites 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 Femole Male Femole Mole Femole Mole Femole Mole Femole Mole Femole Mole Female Mole Femoie Male Femole Mole Female Mole Femole Mole Female Mole Female Mole Femole Femole Femoie Femoie Mole Male Femole Male Femole Mole Femole Male Femole Mole Femole Mole Femole Mole Femole 1958-1960 180 9 136 8 60 16 48 12 175 90 25 2 22 8 170 174 82 54 57 59 101 62 27 03 36 4 55 14 10 17 08 03 25 7 94 66 88 20 5 72 27 38 20 40 27 48 32 22 13 20 14 89 57 1988-1990 218 0 140 8 46 17 59 15 69 31 23 5 16 1 20 0 14 1 35 20 52 32 99 71 25 05 74 2 30 6 30 15 13 04 02 274 30 35 79 25 3 56 17 51 24 51 34 77 50 07 04 36 25 82 48 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 populohon fPercent chonges not listed because they are not meoningful ^Primory and non specified Note Even though oecth roles declined or remomed stoble, the number of deaths mcreosed because the population hos become larger and older The US population increased 38% from 1960 to 1990 5 CANCER FACTS & FIGURES 1994 ABD00003018 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 Buccol covity & 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 75 1,750 2,100 4,000 5,150 50 1,100 1,200 2,800 2,775 25 650 900 1,200 Digestive organs Esophogus Stomoch Small intestine Lorge intestine \ Rectum 5 r. 0 . , (Colon-Rertum) Liver and biliary passoges Pancreas Other ond 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 Respirotory system Lorynx 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 Melonomo of skin Breast 32,000 183,000 17,000 1,000 15,000 182,000 6,900 46,300 4,300 300 2,600 46,000 Gemtol orgons Cervix uteri 1 Corpus & unspecified i ^ ' Ovary Other & unspecified genitol, femole Prostote Testis Other 1 unspecified genitol, mole 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 -- ___ -- Urmory orgons Bladder Kidney & other urmory 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 & centrol nervous system 17,500 9,600 7,900 12,600 6,800 5,800 Endocrine glands Thyroid Other endocrine 14,450 13,000 1,450 4,150 3,400 750 10,300 9,600 700 1,725 1,025 700 750 400 350 975 625 350 leukemio lymphocytic leukemio Granulocytic leukemio Other & unspecified leukemio 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 5 diseose Non Hodgkin s lymphoma Multiple myelomo 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 bcsal ond squcmous cell ccncers end in situ ccrcmomos except bladder Carcinoma m situ of the uterine cervix occounts for obout 55,000 new coses onnually, corcinomo in situ of the femole b'ecst occounts for cbout 25,000 new coses onnuoily, ond melcnomo ccrcmomo in situ occounts for about 8,000 new coses onnuclly Overoll, obout 100,000 new coses of corcmoma m situ of ail sites of concer ore diognosed eoch yeor Bosol cell ond squamous cell skin ccncers cccounl for more thon 700 000 new coses onnuoily About 2,300 nonmelonomo skm concer deaths will occur in 1994 Incidence estimates ore besed on rotes from NCI SEER progrom 1988 90 6 CANCER FACTS l FIGURES 1994 Estimated New Cancer Cases, by State--1994* ABD00003019 State All Sites Alobama Alosko Arizono Arkonsos California Colorodo Connecticut Deloware Dist of Columbio Florida Georgia Howan Idoho Illinois Indiona lowo Konsos Kentucky Louisiono Moine Morylond Mossochusetts Michigan Minnesota Mississippi Missouri Montona Nebrosko Nevodo New Hampshire New Jersey New Mexico New York . North Corolino North Dokota Ohio Oklohomo Oregon Pennsylvomo Rhode Island South Carolina South Dakota Tennessee Texas Uloh Vermont Virgmio Washington West Virgmio Wisconsin Wyoming 21,000 1,300 17,500 14 000 124,000 12,000 16,200 3,800 4,000 62,000 28,000 4,100 4,200 57,000 27000 14,200 12,300 20,000 20,500 6,900 23,500 31,000 43,500 19,300 13 200 27,500 3,900 7,700 5,900 5,200 42,000 5,800 88,000 33,000 3,300 55 000 15,700 14 500 69,000 5,700 16,500 3,300 25,500 66,000 4,800 2,600 28,000 22,000 10,600 24 000 2,000 United Stoles Puerto Rico 1 208 000 0,400 Femole 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 2,00 900 3,300 4 900 6,800 3100 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 3100 2,300 1,200 3 000 200 K9 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 Oral 550 50 350 250 3,300 275 400 125 150 2,500 900 100 100 1,400 500 300 300 375 500 150 600 950 950 350 350 450 125 175 100 150 1,000 150 2,300 900 70 1,200 350 350 1,400 125 600 60 500 1,700 60 60 650 500 275 550 25 29,600 425 Uterus 850 60 550 600 5,000 450 500 125 225 3,000 900 125 150 2,200 1,000 450 475 800 750 175 800 950 1,700 650 500 1,000 100 300 225 200 1,700 225 3,600 1,400 100 2,300 650 500 2,800 200 700 100 950 2,500 275 75 1,100 650 375 900 90 46,000 425 Prostate 3,200 150 3,100 2,600 18,000 2,600 2,500 600 800 16,000 4,700 650 1,000 9,400 4,000 2,600 2,100 2,800 3,100 1,200 3,800 4,600 7,100 4,000 2,500 4,300 850 1,400 800 850 6,800 1,000 13,000 6,300 950 8,600 2,600 2,600 11,400 850 3,000 650 4,000 10,000 1,200 600 4,800 3,800 1,500 4,700 350 200,000 1,800 Skin Melanoma 500 40 550 325 4,000 475 400 125 40 2,500 750 60 125 1,300 600 450 400 500 400 200 550 950 850 500 275 650 100 250 150 150 1,100 150 2,200 1,000 70 1,300 425 400 1,800 150 400 90 700 1,600 175 70 750 550 325 550 30 32,000 75 Pancreos 450 25 400 325 2,900 300 375 60 100 1,800 600 100 100 1,200 600 300 250 400 500 150 500 700 950 450 300 550 90 175 125 100 900 125 2,100 750 60 1,100 300 325 1,500 125 400 75 600 1,600 100 60 650 500 225 600 30 27000 225 Leukemia 425 30 450 325 3,100 275 400 75 75 1,900 650 80 125 1,400 600 375 325 400 450 125 475 650 1,100 550 275 650 80 150 125 100 850 175 2,000 800 100 1,400 400 400 1,500 100 350 80 600 1,800 125 70 600 550 250 650 60 28,600 225 'Does not include ccrcmo-no m situ or bosol ond squomous cell skin concers These estimates ore offered os o rough ouide ond should not be regarded os definitive They ore calculated according to the distribution of estimated 1994 cancer deoths by stote 7 CANCER FACTS d FIGURES 1994 ABD00003020 Cancer Mortality by State--1994 State Estimated Number of Deaths Reported __________________________________________________________________________ Death Rote Female Colon & per 100,000* All Sites Breast Rectum Lung Oral Uterus Prostate Alabama Alasko Arizona Arkonsos Coliformo Colorodo Connect cut Deiowore Dist of Columbio Florido Georgio Hawon Idaho Illinois Indiona IqwO Konscs Kentucky Louisiana Maine Maryland Massachusetts Michigon Minnesota Mississippi Missouri Montono Nebrosko Nevoda New Hampshire New Jersey New Mexico ' New York North Carolina North Dokoto Ohio Ok la homo Oreqon Pennsylvania Rhode Islond South Corolmo South Dakota Tennessee Texos Utoh Vermont Virginia Washington West Virgmio Wisconsin Wyoming 179 175 157 176 166 U6 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 9100 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 10,800 800 700 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 75 850 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 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 2,600 225 150 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 10 200 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 20 600 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 United Stotes Puerto Rico 172 538 000 46,000 56,000 153,000 7,925 10,500 38,000 129 4,500 325 425 600 175 150 450 Skm Melanoma Pancreas 100 425 10 25 125 375 70 300 900 2,800 100 275 80 350 30 60 10 100 500 1,800 150 550 20 100 30 100 275 1,200 125 550 90 300 80 250 100 375 80 500 40 150 125 475 225 650 175 900 125 450 60 300 150 500 25 90 50 175 30 125 30 100 225 850 40 125 475 2,000 225 700 15 60 275 1,100 100 300 80 325 375 1,400 30 125 90 375 20 75 150 600 350 1,500 40 100 20 60 150 600 125 475 70 200 125 550 10 30 6,900 25 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 onnuol mortality rate (or 1986 1990, adjusted to the oge distribution of the 1970 US Census Population 8 CANCER FACTS & FIGURES 1994 ABD00003021 Selected Cancers 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 i 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 m 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 industnal substances, such as arsenic, certain organic chemicals and asbestos, particularly for persons who smoke, radiation exposure from occupational, medical, and envilonmental 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 ceil cancer, chemotherapy alone or combined with radiation has replaced surgery as the treatment ot choice, on this regimen, a large percentage of patients experience remission, which in some cases is long-lasting Survival: The 5-vear 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 stiil localized, but onl> 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 & FIGURES 1994 Survival* When colorectal cancer is detected in an eart?0003^? recommends monthly breast self-examination as a 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, scahness, 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 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 TVeatment: 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 m 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, 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 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 ABD0Q003023 .eading Sites of Cancer Incidence and Death --1994 Estimates Cancer Incidence by Site and Sex' Male Female Cancer Deaths by Site and Sex Male Female Prostate 200,000 - Lung 100,000 Colon & Rectum 75,000 Bladder 38,000 Lymphoma 29,400 Oral 19,800 Melanoma of the Skin 17,000 Kidney 17,000 leuxemio lo,200 Siomoch 15,000 Pancreas 13,000 larynx 9,800 Breast 182,000 Colon & Rectum 74,000 lung 72,000 Uterus , 46,000 ' Ovary 24,000 lymphoma 23,500 Melonoma of the Skin 15,000 Pancreos 14,000 Blodder 13,200 leukemio 12,400 Kidney 10,600 Oral 9,800 All Sites o32 000 All Sites 576 000 ! LC'-al cr: ssjo-'Cj1 ce'l sim ccncer end ccrcmomo m <i.j lung \ 94,000 --Prostate 38,000 Colon & Rectum 2^800 Pancreas 12,400 Lymphomo 12,100 leukemia 10,500 Siomoch 8,400 Esophogus 7,800 liver 7,200 Blodder 7,000 Brom 6,800 Kidney 6,800 All Sites 283000 lung 59,000 - -Breast s 46.000 Colon & Rectum 28,200 Ovary `' 13,600 Poncreos 13,500 lymphomo 10,650 Uterus 10,500 Leukemia 8,600 liver '6,000 Brom * 5,800 Stomach ' 5,600 Multiple Myeloma . 4,800 All Sites 255,000 Avoilobfe 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 m 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: Everv man 40 and over should have a digital rectal examination as part of his regular annual physical checkup In addition the Amencan 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 Treatment: 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 m the past 30 years have increased from 50% to 78% 11 C A C r R FACTS FIGURES 19 9 4 ABD00003024 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 Concer survivors, 1994 400 200 2,000 0 004 0 002 0 020 _ Estimoted coses ond deoths will not reflect the oge ond ethnic characteristics of the population, occess to detection ond treotment, ond varying risk factors Actual data from o population-based tumor registry will ollow more accurate estimates Represents the number of people who were diagnosed over 5 yeors ogo ond are still living today Cancer cases under care, 1994 1,600 0 016 Represents the number of people diognosed in 1994 ond within the previous 5 yeors All ore assumed to be under treotment or follow up core People who will eventually develop cancer 40,000 0 400 If current incidence ond mortolity rotes remain the some, about 40% will develop concer before they die People who will eventually die of concer 20,000 0 200 If current mortality rotes remom the some, about 1 in 5 people living today will die of concer People who will be saved from concer in 1994 200 0 002 Based on 5 year relative survival rote of 53% Note; The figures ore only o rough approximation of octuol dofo for o community and should be used with coution Numbers moy vary according to the oge distribution of the locol population Pancreas Cancer Incidence: An estimated 27,000 new cases in the United States in 1994 The disease is more common m men, and occurs more frequently in black Americans than in white Americans Mortality: An estimated 25,900 deaths m 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 m 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 ABD00003025 rcentage of Population (Probability) Developing invasive Cancers at Certain Ages Birth to 39 40 to 59 60 to 79 Ever (Birth to Death) sites ost Ion edum stole '9 Male Female Female Mole Female Male Male Female 1 68 (1 in 60) 1 91 (1 m 52) 0 45 (1 in 222} 0 06 (1 m 1,667) 0 05 (1 m 2,000) Less than 1 in 10,000 0 04 [1 in 2,500) 0 03 (1 m 3,333) 751 (1 m 13) 929 (1 mil) 3 78 (1 m 26) 0 91 (1 in 110) 0 73 (1 in 137) 0 78 (1 in 128) 1 60 (1 in 63) 1 07 (1 m 93) 32 27 (1 m3) 23 06 (1 in 4) 6 78 (1 in 15) 4 45 (1 in 22) 3 34 (1 m 30) 10 71 (1 in 9) 6 69 (1 in 15) 3 49 (1 m 29) 42 52 (1 m2) 38 88 (1 in 3) 12 20 (1 m 8) 6 12 (1 in 16) 5 96 (1 m 17) 13 05 (1 m 8) 8 43 (1 in 12) 5 02 (1 m 20) te: Thu chort shows the risks of being diognosed wilh the most common concers over certain age intervals These risks are calculated for persons free of the specified concer ne beginning of the oge intervol Pisk estimates do not assume oil persons live to the end of the oge interval or to ony fixed oge Risk estimotes ore presented to give on sroximote meosure of the burden of cancer to society Measures are based on population level rotes and do not take into occount individual behaviors end risk foctors For mple, lung concer is rore omong nonsmokers or persons not heavily exposed to environmental tobocco smoke, so the risk for o nonsmoking mon getting lung concer in his lifetime uch lower than 6 4%, ond it is much higher for a smoker It is clear thot the risk of developing concer increases with oge For prostote concer, the risk before oge 60 is very low, between oge 60 ond 80, 1 in 9 men will be diognosed with prostate concer rce of doto Applied Research Branch, Notionai Concer Institute Avoiloble 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 m the cervix may oe 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 (Endometrial) 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 m 1994 Signs and Symptoms: Abnormal uterine staining or bleeding, especially postmenopausal Pain and weight loss occur late m 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 Treatment: 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 or limping, prolonged, unexplained fever or illness, frequent headaches, often with vomiting, sudden eye or vision 13 CANCER FACTS & FIGURES 1994 ABD00003026 changes, and excessive, rapid weight loss 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 m 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 sy mptoms 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: 4n estimated 28,600 new cases m 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 19,300 deaths m 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-1) 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 ceils, therapy of the central nervous system has become standard treatment, especially m 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 m 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 i FIGURES 1994 ABD00003027 Africa is partly caused by the Epstein-Barr herpes virus Other possible risk factors include exposures to herbicides, industrial solvents, and vinyl chloride Treatment: Hodgkin'sTfisease 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 m 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 nonHodgkm'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 m the size or color of a mole or other darkly pigmented growth or spot Scalmess, 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 am and3pm 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 m 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 m 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 m 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 m 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 m 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 PACTS & FIGURES 1994 ABD00003028 Five-Year Relative Survival Rates by Stage at Diag nosis* Site All Stages % Local % Oral Colon rectum Poncreos lung Melanomo Femole breost Cervix uteri Corpus uteri Ovary Prostote 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 chort bosed on coses diagnosed in 1983-87, followed through 1990 Source Cancer Statistics Branch, National Concer 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 m 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 lump 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 ABD00003029 Trends in Cancer Survival, by Race Coses 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' 1974-761 1977-79' 1983-89' 1960-63' 1970-73* 1974-763 1977-79' 1983-89' All siles 39 43 50 51 55* 27 31 39 39 39 Oral cavity & pharynx 45 43 55 54 54 -- -- 36 36 33 Esophogus 4 4 5 6 10* 1 44 3 7* Stomoch 11 13 14 16 17* 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 Poncreas 2 3 4 3 6* -- -- 1 6 5 1 2 3 2 3* 1 22 4 5* Larynx 53 62 66 68 68 -- -- 59 55 54 lung & bronchus 8 10 12 14 13* 5 7 11 11 11 Melonoma of skin 60 68 80 82 84* -- -- 69f 52* 72f Female breost 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 Ovory 32 36 36 38 40* 32 32 41 40 40 Prostote 50 63 68 72 79* 35 55 58 62 64* Testis 63 72 79 88 93* -- -- 76f -- 84* Urinary bladder 53 61 74 76 80* 24 36 48 55 61* Kidney & renol pelvis 37 46 52 51 56* 38 44 49 52 51 Broin & nervous system 18 20 22 24 26* 19 19 27 28 31 Thyroid glond 83 86 92 92 94* -- -- 87 92 92 Hodgkin's disease 40 67 72 73 79* -- _ 69 73 74 Non Hodgkins lymphomo 31 41 48 48 52* -- -- 48 50 44 Multiple myeloma 12 19 24 25 27* -- -- 27 34 29 leukemio 14 22 35 37 39* -- -- 31 30 30 Source Concer Statistics Bronch, Notionol Concer Institute 'Rotes ore based on End Results Group doto from o senes of hospital rer -stnes ond one populotion-bosed registry 'Rotes ore from the SEER Program They ore bosed on doto from populo on based registries in Connecticut, New Mexico, Utah, lowo, Howon, Atlanta, Detroit, Seottle Puget Sound, and Son Francisco Oakland Rates are based on follow up of patients thi ugh 1990 'The difference m rotes between 1974 76 ond 1983-89 is statistically sign,* "nt fp <0 05) |The standard error of the survivol rote is between 5 and 10 percentage points JThe standard error of the survival rote is greoter than 10 percentage poir --Valid survivol rote could not be calculated Risk Factors: Cigarette, cigar, or pipe smoking, '.se of smokeless tobacco, excess use of alcohol. Early Detection: Cancer can affect any part of the oral cavity, including the lip, tongue, mouth, and tiroat 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%. 17 CANCER FACTS & FIGURES 1994 ABD00003030 Cancer in Minorities , , r ' .. 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 m 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 Orol covity Esophagus Stomach Colon & rectum Liver & other btliory Poncreas lung (male) lung (femole) Melonomo of slcm Breast (femole) Cervix uteri Other uterus Ovory Prostote Blodder Kidney Brain & CNSf Lymphoma Leukemia Multiple myelomo 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 23 32 132 168 66 77 148 75 3 79 12 14 22 56 12 14 14 42 27 6 Cc Ov r-s 14,003 232 233 811 1,414 769 795 1,824 787 89 1,246 296 168 385 210 355 376 688 735 273 'Persons classified as of Hispomc origin on death certificates moy be of ony roce Hispanic origin reporting, however moy be incomplete on deoth certificates in some states These numbers ore believed to include over 90% of concer deoths u\ Hispanics m 1990 fCNS = Centrol nervous system Available on reproduction sheet (5005 94) 18 CANCER FACTS t FIGURES 1994 ABD00003031 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 colan 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 m 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 m homes may increase risk of lung cancer, especially in cigarette smokers If levels are found to be too high, remedial actions should be taken 19 CANCER FACTS & FIGURES 1994 ABD00003Q32. f Chemicals and Radiation Environmental Cancer Risks Not all chemicals or all forms of radiation cause cancer The environmental causes of cancer include exposures Only a limited number of chemicals (for example, benzene, in the community or workplace settings, as well as asbestos, vinyl chlorider arsenic, aflatoxins) show definite exposures determined by individual lifestyle choices evidence of human carcinogenicity or are probable human (smoking, diet, medications, etc ) carcinogens based on animal experiments (for example, The degree of cancer hazard posed by such risks depends chloroform, dichlorodiphenyltrichloroethane [DDT], for on the concentration or intensity of the carcinogen in the maldehyde, polychlorinated biphenyls [PCBs], polycyclic environment and the exposure dose a person receives aromatic hydrocarbons) The only forms of radiation proven These factors in combination create a range of risk For to cause human cancer are ionizing radiation (for example, example, in situations where high levels of carcinogen are x-rays, radon, cosmic rays) and ultraviolet radiation present and where exposures are extensive, significant (principally UV-B radiation) hazards may exist, but where concentrations are low and exposures limited, hazards are often negligible Unproven Risks Public concern about environmental cancer risks often Risk Assessment focuses on risks for which no carcinogenicity has been To protect people against unsafe exposures, risks should proven or on situations where known carcinogen exposures be assessed so that appropriate environmental standards are at such low levels that risks are negligible For example can be set Risk assessment is a two-step process 1. Non-ionizing radiation. Electromagnetic radiation at identifying the toxic properties of potential oncogenic frequencies below ionizing and ultraviolet levels has not hazards and measuring the extent of human exposure been shown to cause cancer While some epidemiologic The first step, hazard identification, evaluates the studies suggest associations with cancer, others do not, chemical or physical nature of hazards and their onco and experimental studies have not yielded reproducible genicity in observed clinical and epidemiologic studies and evidence of carcinogenic mechanisms Low frequency in laboratory tests using animals or cell systems Special radiation includes radiowaves, microwaves, and radar, as attention is given to any evidence suggesting that cancer well as power frequency radiation arising from the electric risk may increase with dose (dose-response relationships) and magnetic fields associated with electric currents (often The second step, exposure measurement, determines the called ELF or ex'tremely low frequency radiation) levels of hazards in the environment (air, water, food, etc ) 2. Pesticides Many kinds of pesticides (insecticides, and the extent to which people are actually exposed (how herbicides, etc ) are widely used in producing and much they eat of a particular food, use a particular water marketing our food supply While some of these chemicals source, etc ) Knowledge of how the body absorbs, metab cause cancer at high doses in experimental animals, the olizes, and excretes chemicals or is exposed to radiation very low concentrations found m some foods are generally sources is essential to determine accurately the actual within established safety levels. Environmental pollution carcinogenic dose delivered to humans by slowly degraded pesticides such as DDT, a result of Unfortunately, evidence of risk for most potential car past agricultural practices, can lead to food chain cinogens usually rests on the results of high-dose animal bioaccumulation and to persistent residues in body fat experiments or on human observations where high-dose Such residues have been suggested as a possible risk factor exposures have occurred To use such information in setting for breast cancer, concentrations in tissue are low, however, human safety standards, scientists must extrapolate from and the evidence is not conclusive animals to humans and from high-dose to low-dose Continued research regarding pesticide use is essential conditions. Both extrapolations involve much uncertainty, for maximum food safety, improved food production therefore conservative assumptions are used so that risk through alternative pest control methods, and reduced assessment will err on the side of safety. For cancer safety pollution of the environment At the same time, banning standards, only increased risks of one case or less per million any man-made chemicals with carcinogenic potential (as persons over a lifetime are usually accepted required for processed foods under the 1958 Delaney Safety standards developed in this way for chemical or Amendment of the Food and Drug Act) is unrealistic, given radiation exposures are the basis for federal regulatory the very low concentrations involved and the value of activities at the Food and Drug Administration, the pesticides in sustaining our food supply Scientists and Environmental Protection Agency, and the Occupational consumer groups stress the important health benefits of Safety and Health Administration The application of laws a diet which includes many fruits and vegetables in contrast and procedures by which standards are implemented and to the minimal risks associated with pesticide residues risks are controlled is called risk management. 3. Toxic wastes. Toxic wastes in dump sites can threaten 20 CANCER FACTS i FIGURES 1994 human health through i y * r-> r-i 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 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 tn 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 m people without svmptoms 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-4hose 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 addiess the benefits of early detection Breast The American Cancer Society recommends that screening mammography begin by age 40 Women aged 40-49 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 20-40 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 ABD00003034 Tobacco Use 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 m 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 m 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 m 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 m 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 m output is the result of 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 cardiovasculajs-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 * contains essentially ail 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 risk in underground miners exposed to radon 23 CANCER FACTS FIGURES 1994 ABD00003036 The American Cancer Society 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 m 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 m 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 & FIGURES 1994 education is the means of delivering a planned health emP^^rRmite'Care Items: offers supplies and equipment to care cation curricula from pre-school to grade 12 for the patient at home 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 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 dents make good dietary choices that will reduce their risk of developing a number of diseases, including cancer International Association of Laryngectomees, this program provides pre- and/or postoperative support for patients by High school students can also learn m-depth about cancer through Right Choices laryngectomee visitors Look Good...Feel Better: In partnership with the Cosmetic, Toiletry and Fragrance Association and National Professional Education Cosmetology Association, this program is an opportunity for people undergoing cancer treatment to develop skills The Society's Professional Education Department pro to cope with appearance changes vides health care professionals with the latest information CanSurmount: A short-term program for cancer patients on developments in cancer prevention, early detection, and and their families Trained volunteers who have experienced treatment through the same type of cancer offer support through one-to-one National conferences and workshops (The Society is visits accredited by the Accreditation Council for Continuing Ostomy Rehabilitation: In cooperation with the United Medical Education) Ostomy Association and enterostomal therapists, trained Materials (videotapes, slide programs, audiotapes, volunteers who have experienced the same type of surgery textbooks, proceedings of conferences and workshops, and as the patient offer help on a one-to-one basis booklets on key issues are examples, m addition to two Children's Camps: Many Divisions offer camps for chil national journals for health care professionals) Clinical awards, professorships, and scholarships dren who have or have had cancer These camps can cope with the special needs of children undergoing treatment (Clinical Oncology Fellowships, Clinical Oncology Career Development Awards, Oncology Social Work Awards, Patient and Family Education Programs Cancer Control Career Development Awards) Over the past Group and individual programs designed to help patients 40 years, Clinical Fellowships and Junior Faculty Clinical of all ages and their families understand the complexities Fellowships have supported the education of more than of cancer 9,600 individuals I Can Cope: offers information on cancer treatments, Nursing-programs (a newsletter, scholarships, and nutrition, resources, and other issues to patients and professorships) families Information on questionable methods of cancer management Group Support Programs Offered to patients, families and friends, these programs Patient Services vary according to each Division's needs and resources In 1993, approximately 745,141 cancer patients were reached through the service and rehabilitation programs of the American Cancer Societv 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 Public Issues Cancer has become apolitical, 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  the welfare of the cancer patient and his/her famiTv 000038S:es suifcring and saves lives if cancer is detected at 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 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 m 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 The Disadvantaged 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-5376,381 Fundraising $64, 17 Professional Education* $35,791 95% Management & General S26,600 71% Patient Services $52,479 Community Services $27,405 73% Public Education $69,531 18 5% 'The Society s cancer prevention, defection, ond treatment progroms ore corned out through these oreos Figures token from 1992 Annuol Report (m ihousonds) Research $100,243 26 6% 26 CANCER FACTS & FIGURES 1994 ABD00003039 "cocTcST- - -- -- =T^-p7^-=-cr5:r o=* -- FT -- 2" FT ST =-^-So-S3-;s?fTF?^ -- - E.S" Z.Z. ---- 1 J llU^Jl Ig> I- la Hi{H!4J|!Ij JilUli ! 1 J|l : x J? g ,4| || f!, II11 If}i 11| I ii 111111 fItif11 IllllijIllllJJllJljlllJIllllllIlttlltllll1-I I|11llti|ljll4c 'o'o'5~o'c'o'5'3'o''5'o'o'o'o'5'o'o'o'5'5''5'o o "5 ~ "5 "o 'o o'o'o'o'o o*o o o "5 o o o o *3 o S > IlllllllJlllllllliilllllJJilillillllllllllllllllll 5 TOC3 "oc5 zD ?r-- -- -- ^ - FT=T - ^T- FT" FT TFT -- -- =T^ =r.FT FTFT (=?"=-.F?Tf=rFT~- - f! 512 C! -- ^^L~ Z.^.K ^ " *xow /o) co co <_> CkJ! <_ a> t >*, _Q O Il l^s0 S. g o' oT --' < * f?c~ftstf?:=-:=-f? =" > * < cn cc 2:f o l5 Eo aO _ So *s V* r* =E OC ' yi) |o =t-ftftftft:f--- g-sr =-?==-s-=-<=70=r=- -- *> *------ ^ --- -- ^ r- := FT ^-= f? fC-- ST---r- 27 CANCER FACTS * FIGURES 1994 irxJxole numbers ol gronlj per ABD00003040 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* Umvcrsitv of California at Los Angeles 1 800 825 2631 U 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 Universitv of Colorado Cancer Center University of Colorado Health Sciences Center (303) 270 3007 CONNECTICUT Yale University* Comprehensive Cancer Center 1 800 4 CANCER DISTRICT OF COLUMBIA Lombardi Cancer RfSCarch Center* Georgetown Universitv Medical Center (202) 687-2192 FLORIDA Sylvester Comprehensive Cancer Center* Universitv 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 Universitv 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 MICHIGAN Mever L Prentis Comprehensive Cancer Center of Metropolitan Detroit (313) 745-4329 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 Sloan Kettering Cancer Center* 1-800 525 2225 Roswell Park Cancer Institute* 1 800-ROSWELL Albert Einstein College of Medicine Cancer Research Center (718) 920-4826 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) 275-4911 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 2 748 Lmeberger Cancer Research Center* University of North Carolina (919) 966 3036 Wake Forest Universitv* Comprehensive Cancer Center Bowman Cray School of Medicine (919)716 4464 OHIO Ohio State University* Comprehensive Cancer Center Arthur C James Cancer Hospital 3-800-638 6996 Case Western Reserve University Ireland Cancer Center (216) 844 5432 PENNSYLVANIA Fox Chase Cancer Center* (215) 728 2570 University of Pennsylvania Cancer Center* (215) 662 6364 Wistar Institute Cancer Center (215)898 3926 Pels Research Institute Temple University School of Medicine (215) 221 4000 Pittsburgh Cancer Institute* University of Pittsburgh 1-800-537 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 (601) 581 4048 VERMONT Vermont Cancer Center* University of Vermont (802) 656 4414 V1RCINIA Massey Cancer Center Medical College ofVirginia/VCU (804) 371 5116 Universitv of Virginia Cancer Center (804) 924 5811 WASHINGTON Fred Hutchinson Cancer Research Center* (206) 667 5000 WISCONSIN Comprehensive Cancer Center* University of Wisconsin (608) 263 8600 McArdle Laboratory for Cancer Research University of Wisconsin Medical School (608) 262 2177 ABD00003041 CANCER FACTS & FIGURES 1994 Cancer Around the World, 1988-1991, Death Rates per 100,000 Population fo r 46 Countries NOTE Figures in porenlhcses ore order of rank wilhm site ond sex group Kales ore oge adjusted lo the W H O world sfandord population "Orol cancer roles include nosophorynx only }I988-I9?0 only {1980-1989 only 1988 only #1989-1990 only ABD00003042 Chartered Divisions of the American Cancer Society, Inc. Alabama Division, Inc 504 Brookwood Boulevard Homewood Alabama 35209 (205) 879 2242 Alaska Division, Inc 406 West Fireweed Lane Anchorage, Alaska 99503 (907) 277 8696 Arizona Division, Inc 2929 East Thomas Road Phoenix, Arizona 850)6 (602) 224 0524 Arkansas Division, Inc 901 North University Little Rock Arkansas 72203 (501)664 3480 California Division, Inc 1710 Webster Street Oakland California 946)2 (510) Sy3 7900 Colorado Division, Inc 2255 South Oneida Denver Colorado 80224 (303) 758 2030 Connecticut Division, Inc Barnes Park South 14 \ illage Lane Wallingford Connecticut 06492 (203) 265 7161 Delaware Division, Inc 92 Reads Way New Castle Delaware !Q720 (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 5)46 (8)3) 253 0541 Georgia Division, Inc2200 Lake BKd Atlanta, Ceorgia 30319 (404) 816 7800 Hawaii Pacific Division, Inc Community Services Center Bldg 200 North \ mevard Boulevard Honoblu Hawaii 968)7 (808) 531-1662 Idaho Division Inc 2676 \ ista Avenue Boise Idaho 83705 0836 (208)343 4609 Illinois Division, Inc 77 East Monroe Chicago Illinois 60603 5795 (3)2) 641-6150 Indiana Division, Inc 8730 Commerce Park Place Indianapolis Indiana 46268 (317)8724432 Iowa Division, Inc 8364 Hickman Road Des Moines Iowa 50325 (515) 253 0147 Kansas Division, Inc 13) 5 SW Arrow head Road Topeka, Kansas 66604 <913)273 4114 Kentucky Division, Inc 701 West Muhammad All Bivd Louisville, Kentucky 40203 1909 (502)584 6782 Louisiana Division, Inc 2200 Veterans Memorial BKd Suite 214 Kenner Louisiana 70062 (504)469 0021 Maine Division, Inc 52 Federal Street Brunswick Maine 04011 (207)729 3339 Manland Division, Inc 8219 Town Center Drive Baltimore, Maryland 21236 0026 (4)01931 6868 Massachusetts Division, Inc 247 Commonwealth Avenue Boston, Massachusetts 02116 (6)7)267 2650 Michigan Division, Inc 1205 East Saginaw Street Lansing Michigan 48906 (517) 371 2920 Minnesota Drvision, Inc 3316 West 66th Street Minneapolis, Minnesota 55435 (6)2)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 65)02 (314)8934800 Montana Division, Inc 37 North 26th Billings Montana 59)01 (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 10), Unit 501 Bedford New Hampshire 03)10 5032 (603) 472-8899 New Jersey Division, Inc 2600 US Highway 1 North Brunswick, New Jersey 08902 0803 (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 a Long Island Division, Inc 75 Davids Drive Hauppauge, New \ork 13788 (516) 436-7070 o New York City Division, Inc 19 West 56th Street New York, New Vork 100)9 (212) 586-8700 0 Queens Division, Inc 112 25 Queens Boulevard Forest Hills, New York 11375 (718) 263 2224 Westchester Division, Inc 30 Glenn Street White Plains, New Vork 10603 (914)9494800 North Carolina Division, Idc 1) 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 Citv, Oklahoma 73116 (405)843 9888 Oregon Division, Inc 0330 SW Curry Portland, Oregon 97201 (503)295-6422 Pennsylvania Division, Inc Route 422 & Sipe Avenue Herehey, Pennsylvania 17033 0897 (717)533 6)44 Philadelphia Division, Inc 1422 Chestnut Street Philadelphia Pennsylvania 19102 (215)665 2900 Puerto Rico Division, Inc Calle Alveno *577 Esquina Sargento Medina Hato Rev, Puerto Rico 00918 (809) 764 2295 Rhode Island Division, Inc 400 Main Street Pawtucket, Rhode Island 02860 (401) 722 8480 South Caroltoa Division, Inc 128 Slonemark Lane Columbia, South Carolina 29210-3855 (803) 750 1693 South Dakota Division, Inc 4101 Carnegie Place Sioux Falls, South Dakota 57106 2322 (605) 361 8277 Tennessee Division, Inc 1315 Eighth Avenue South Nashville Tennessee 37203 (615) 255 1227 Texas Divimoq Inc 2433 Ridgepomt 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 PO Box 6359 Glen Al'en, Virginia 23058-6359 (804)527 3700 Washington Division, Inc 2)20 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 PO Box 902 Pewaukee Wisconsin 53072 0902 (414)523 5500 Wyoming Division, Inc 2222 House Avenue Chevenne, Wvoming 82001 (307)638 333) THERE'S NOTHING MIGHTIER THAN THE SWORD AMERICAN VCANCER 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, educution, and service National Headquarters American Cancer Society, !nc , 1599 Clifton Road N E , Atlanta, CA 30329-4251 <19Q4 American Cancer Societv inc 94 375M No 5008 94