The Cancer Burden in California. Janet Bates MD MPH California Cancer Registry California Department of Public Health April 25, 2012
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1 The Cancer Burden in California Janet Bates MD MPH California Cancer Registry California Department of Public Health April 25, 2012
2 Goals Introduce you to the California Cancer Registry (CCR) Provide an overview of California s cancer burden Highlight cancers associated with overweight/obesity and lack of sufficient physical activity Present data on California s cancer burden compared to that of the U.S.
3 The California Cancer Registry The mission of the California Cancer Registry is to serve the public by collecting statewide data, and conducting surveillance and research into the causes, controls, and cures of cancer, and communicating results to the public.
4 The California Cancer Registry Established by state law passed in 1985 The CCR has collected information on all new cancer cases and deaths for the entire state of California since 1988 Hospitals and physicians are required to report cancer cases to the CCR
5 The California Cancer Registry We receive over 200,000 cancer case reports each year After weeding out duplicate reports, we end up with about 170,000 new cases added to the database each year We now have over 4 million cases diagnosed from 1988 forward in our database
6 Cancer Surveillance Terms Incidence = number of new cancers diagnosed in a population during a specific time period Mortality = number of cancer-related deaths in a population during a specific time period Incidence Rate or Mortality Rate = number of new cancers or cancer-related deaths occurring in a population during a specific time period, divided by the population at risk (often expressed as the number of new cancers or deaths per 100,000 population at risk)
7
8 The Cancer Burden: Objective #1 By 2015, decrease the overall cancer incidence rate in California by 5%, from a baseline rate of 431 per 100,000 in 2009 to a target rate of 409 per 100,000 in 2015
9 The Cancer Burden: Objective #1
10 Cancer Incidence in California Cancer incidence rates in California declined by 7% from 1988 to 2009 This decrease was driven by declines in lung, prostate, colon and rectum, and bladder cancers among men and breast, colon and rectum, and lung cancers among women Despite these improvements, nearly one out of every two Californians born today will develop cancer at some point in their lives
11 Five Most Common Types of Cancer Incidence among Men Cancer Site 2009 Count 2009 Rate 1 Prostate 20, Lung and Bronchus 8, Colon and Rectum 7, Urinary Bladder 4, Melanoma of the Skin 4, Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. Source: California Cancer Registry, June 2011
12 Five Most Common Types of Cancer Incidence among Men Age-Adjusted Rate per 100, Trends in the Five Most Common Types of Cancer Incidence among Men, California, All Cancers (APC1 = 3.9*, APC2 = -4.0, APC3 = -0.7*) Prostate (APC1 = 16.1*, APC2 = -11.1, APC3 = 0.9, APC4 = -2.2*) Lung & Bronchus (APC = -2.3*) Colon & Rectum (APC = -1.6*) Urinary Bladder (APC = -0.5*) Melanoma (APC1 = 0.1, APC2 = 8.3, APC3 = 1.9*) Year of Diagnosis *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
13 Five Most Common Types of Cancer Incidence among Men 250 Trends in the Five Most Common Types of Cancer Incidence among Men, California, Age-Adjusted Rate per 100, Prostate (APC1 = 16.1*, APC2 = -11.1, APC3 = 0.9, APC4 = -2.2*) Lung & Bronchus (APC = -2.3*) Colon & Rectum (APC = -1.6*) Urinary Bladder (APC = -0.5*) Melanoma (APC1 = 0.1, APC2 = 8.3, APC3 = 1.9*) Year of Diagnosis *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
14 Five Most Common Types of Cancer Incidence among Women Cancer Site 2009 Count 2009 Rate 1 Breast 23, Lung and Bronchus 8, Colon and Rectum 6, Corpus and Uterus, NOS 4, Thyroid 3, Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. Source: California Cancer Registry, June 2011
15 Five Most Common Types of Cancer Incidence among Women 450 Trends in the Five Most Common Types of Cancer Incidence among Women, California, Age-Adjusted Rate per 100, All Cancers (APC1 = -0.4, APC2 = 0.8, APC3 = -1.1*, APC4 = 0.2) Breast (APC1 = 0.5*, APC2 = -3.9, APC3 = 0.9) Lung & Bronchus (APC1 = 0.1, APC2 = -1.3*) Colon & Rectum (APC1 = -2.1*, APC2 = 1.1, APC3 = -1.8*) Corpus & Uterus, NOS (APC1 = -0.4, APC2 = -2.0*, APC3=1.9*) Thyroid (APC1 = 3.0*, APC2 = 6.4*) 50 0 Year of Diagnosis *The annual percent change (APC) is significantly different from zero.
16 Five Most Common Types of Cancer Incidence among Women 150 Trends in the Five Most Common Types of Cancer Incidence among Women, California, Age-Adjusted Rate per 100, Breast (APC1 = 0.5*, APC2 = -3.9, APC3 = 0.9) Lung & Bronchus (APC1 = 0.1, APC2 = -1.3*) Colon & Rectum (APC1 = -2.1*, APC2 = 1.1, APC3 = -1.8*) Corpus & Uterus, NOS (APC1 = -0.4, APC2 = -2.0*, APC3=1.9*) Thyroid (APC1 = 3.0*, APC2 = 6.4*) 0 Year of Diagnosis *The annual percent change (APC) is significantly different from zero.
17 Five Most Common Types of Cancer Incidence among Women 75 Trends in the Five Most Common Types of Cancer Incidence among Women, California, Age-Adjusted Rate per 100, Lung & Bronchus (APC1 = 0.1, APC2 = -1.3*) Colon & Rectum (APC1 = -2.1*, APC2 = 1.1, APC3 = -1.8*) Corpus & Uterus, NOS (APC1 = -0.4, APC2 = -2.0*, APC3=1.9*) Thyroid (APC1 = 3.0*, APC2 = 6.4*) 0 Year of Diagnosis *The annual percent change (APC) is significantly different from zero.
18 Cancer Incidence by Race/Ethnicity and Sex Five-Year, Age-Adjusted Cancer Incidence Rates by Race/Ethnicity and Sex, California, African American Non-Hispanic White Hispanic Asian/PI Rate per 100, Source: California Cancer Registry, February 2012 Male Female
19 Cancer Incidence by Asian Subgroup and Sex Five-Year, Age-Adjusted Cancer Incidence Rates by Asian Subgroup and Sex, California, Korean Vietnamese Filipino Japanese Chinese South Asian Rate per 100, Source: California Cancer Registry, February 2012 Male Female
20 Cancer Incidence Trends, California vs. United States Trend in Age-Adjusted Cancer Incidence Rates, California vs. United States*, United States (APC1 = 2.8^, APC2 = -2.3, APC3 = 1.1, APC4 = -0.5^) California (APC1 = 2.0, APC2 = -0.6^) Rate per 100, Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb and SEER*Stat Database: Incidence, SEER 9 Reg Research Data Nov
21 The Cancer Burden: Objective #2 By 2015, decrease the overall cancer mortality rate in California by 5%, from a baseline rate of 158 per 100,000 in 2009 to a target rate of 150 per 100,000 in 2015
22 The Cancer Burden: Objective #2 Trend in Age-Adjusted Cancer Mortality Rate, California, All Cancer Deaths (APC1 = -0.7*, APC = -1.5*) Target Rate Rate per 100, Year of Death *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
23 Cancer Mortality in California Cancer mortality rates in California declined by 23% from 1988 to 2009 Mortality has declined for all four major racial/ethnic groups in the state Despite these improvements, cancer is the second leading cause of death among Californians and nearly one in five Californians will die of a cancer
24 Five Most Common Types of Cancer Mortality among Men Cancer Site 2009 Count 2009 Rate 1 Lung and Bronchus 6, Prostate 3, Colon and Rectum 2, Pancreas 1, Liver and Intrahepatic Bile Duct (IBD) 1, Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. Source: California Cancer Registry, June 2011
25 Five Most Common Types of Cancer Mortality among Men 300 Trends in the Five Most Common Types of Cancer Mortality among Men, California, Age-Adjusted Rate per 100, All Cancers (APC1 = -1.0*, APC2 = -1.6*) Lung & Bronchus (APC1 = -2.0*, APC2 = -2.7*) Prostate (APC1 = 1.4, APC2 = -5.1*, APC3 = -2.4*) Colon & Rectum (APC = -2.2*) Pancreas (APC = -0.1) Liver & IBD (APC = 2.8*) 0 Year of Death *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
26 Five Most Common Types of Cancer Mortality among Men 90 Trends in the Five Most Common Types of Cancer Mortality among Men, California, Age-Adjusted Rate per 100, Lung & Bronchus (APC1 = -2.0*, APC2 = -2.7*) Prostate (APC1 = 1.4, APC2 = -5.1*, APC3 = -2.4*) Colon & Rectum (APC = -2.2*) Pancreas (APC = -0.1) Liver & IBD (APC = 2.8*) 10 0 Year of Death *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
27 Five Most Common Types of Cancer Mortality among Women Cancer Site 2009 Count 2009 Rate 1 Lung and Bronchus 6, Breast 4, Colon and Rectum 2, Pancreas 1, Ovary 1, Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. Source: California Cancer Registry, June 2011
28 Five Most Common Types of Cancer Mortality among Women Age-Adjusted Rate per 100, Trends in the Five Most Common Types of Cancer Mortality among Women, California, All Cancers (APC1 = -0.4, APC2 = -1.4*) Lung & Bronchus (APC1 = 1.4*, APC2 = -1.0*, APC3 = -2.4*) Breast (APC = -2.0*) Colon & Rectum (APC = -2.2*) Pancreas (APC = 0.1) Ovary (APC1 = -0.3, APC2 = -2.7*) Year of Death *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
29 Five Most Common Types of Cancer Mortality among Women 50 Trends in the Five Most Common Types of Cancer Mortality among Women, California, Age-Adjusted Rate per 100, Lung & Bronchus (APC1 = 1.4*, APC2 = -1.0*, APC3 = -2.4*) Breast (APC = -2.0*) Colon & Rectum (APC = -2.2*) Pancreas (APC = 0.1) Ovary (APC1 = -0.3, APC2 = -2.7*) 0 Year of Death *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
30 Cancer Mortality by Race/Ethnicity and Sex Five-Year, Age-Adjusted Cancer Mortality Rates by Race/Ethnicity and Sex, California, African American Non-Hispanic White Hispanic Asian/PI Rate per 100, Male Female Source: California Cancer Registry, February 2012
31 Cancer Mortality by Asian Subgroup and Sex 250 Five-Year, Age-Adjusted Cancer Mortality Rates by Asian Subgroup and Sex, California, Korean Japanese Filipino Chinese Vietnamese South Asian Rate per 100, Male Female Source: California Cancer Registry, February 2012
32 Cancer Mortality Trends, California vs. United States
33
34 Cancers Associated with Excess Weight & Lack of Sufficient Physical Activity Esophageal (adenocarcinomas) Colon & Rectum Pancreatic Kidney Postmenopausal breast cancer Endometrial (uterine)
35 Trend in Esophageal Cancer, California vs. United States Trend in Age-Adjusted Incidence Rates of Adenocarcinoma of the Esophagus, California vs. United States*, United States (APC1 = 6.6^, APC2 = 1.6^) California (APC1 = 5.4^, APC2 = 1.1^) 3 Rate per 100, Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb and SEER*Stat Database: Incidence, SEER 9 Reg Research Data Nov
36 Trend in Colorectal Cancer, California vs. United States Trend in Age-Adjusted Incidence Rates of Colorectal Cancer, California vs. United States*, United States (APC1 = -1.9^, APC2 = 1.3, APC3, -1.6^, APC4 = -3.1^) California (APC1 = -1.9^, APC2 = 0.5, APC = -1.9^) Rate per 100, Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb and SEER*Stat Database: Incidence, SEER 9 Reg Research Data Nov
37 Trend in Pancreatic Cancer, California vs. United States 14 Trend in Age-Adjusted Incidence Rates of Pancreatic Cancer, California vs. United States*, United States (APC1 = 0.1, APC2 = 1.2^) California (APC1 = -0.9^, APC2 = 0.7^) Rate per 100, Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb and SEER*Stat Database: Incidence, SEER 9 Reg Research Data Nov
38 Trend in Kidney Cancer, California vs. United States Trend in Age-Adjusted Incidence Rates of Kidney Cancer, California vs. United States*, Rate per 100, United States (APC = 2.1^) California (APC1 = 0.9^, APC2 = 3.6^) Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb and SEER*Stat Database: Incidence, SEER 9 Reg Research
39 Trend in Postmenopausal Breast Cancer, California vs. United States Trend in Age-Adjusted Incidence Rates of Postmenopausal Breast Cancer, California vs. United States*, United States (APC1 = 0.9^, APC2 = -4.7, APC3 = 0.6) California (APC1 = 0.7^, APC 2 = -4.8, APC3 = 0.8) 400 Rate per 100, Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb and SEER*Stat Database: Incidence, SEER 9 Reg Research Data Nov
40 Trend in Endometrial Cancer, California vs. United States Trend in Age-Adjusted Incidence Rates of Corpus Uteri Cancer, California vs. United States*, United States (APC1 = 3.7, APC2 = -0.9, APC3 = 1.2, APC4 = -0.4, APC5 = 3.4^) California (APC1 = -0.4, APC2 = -2.0^, APC3 = 1.9^) 30 Rate per 100, Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb and SEER*Stat Database: Incidence, SEER 9 Reg Research Data Nov
41 Summary In general, cancer incidence and mortality rates in California are lower than the rest of the United States Overall cancer incidence and mortality rates in California are declining but disparities by race/ethnicity still exist The decline in California s cancer incidence is being threatened by an obesity epidemic
42 Summary California adults and teens have a high prevalence of excess weight and insufficient physical activity Cancers associated with excess weight and lack of sufficient physical activity are on the rise in California
43 Summary The CCR is a rich resource for cancer information in California This information supports cancer control efforts and cancer research that are vital to winning the war on cancer We hope that this information will be helpful to you all, and welcome the opportunity to work with you again
44 Acknowledgement The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section ; the National Cancer Institute s Surveillance, Epidemiology and End Results Program under contract HHSN C awarded to the Northern California Cancer Center, contract HHSN C awarded to the University of Southern California, and contract HHSN C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention s National Program of Cancer Registries, under agreement #1U58 DP awarded to the Public Health Institute.
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