Burden of Cancer in California

Transcription

1 Burden of Cancer in California California Cancer Reporting and Epidemiologic Surveillance Institute for Population Health Improvement UC Davis Health August 22, 2018

2 Outline 1. Incidence and Mortality 2. Trends 3. Risk Factors 4. Stage at Diagnosis 5. Cancer Control Plan Progress Summary 6. Survival 7. Childhood Cancer 2

3 Most Common Types of Cancer Incidence and Prevalence among California Males, 2015 Rank Cancer Type New Cases Incidence Rate Existing Cases 1 Prostate 17, ,895 2 Lung 8, ,847 3 Colon and Rectum 7, ,210 4 Melanoma of the Skin 5, ,709 5 Urinary Bladder 5, ,479 6 Non-Hodgkin Lymphoma 4, ,405 7 Kidney 3, ,911 8 Oral Cavity and Pharynx 3, ,053 9 Leukemia 2, , Liver 2, ,847 Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. 3

4 Most Common Types of Cancer Mortality among California Males, 2015 Rank Cancer Type Count Rate 1 Lung 6, Prostate 3, Colon and Rectum 2, Pancreas 2, Liver 2, Leukemia 1, Non-Hodgkin Lymphoma 1, Urinary Bladder 1, Esophagus 1, Brain and Other Nervous System 1, Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. 4

5 Most Common Types of Cancer Mortality among California Males, 2015 Rank Cancer Type Count Rate 2 1 Lung 6, Prostate 3, Colon and Rectum 2, Pancreas 2, Liver 2, Leukemia 1, Non-Hodgkin Lymphoma 1, Urinary Bladder 1, Esophagus 1, Brain and Other Nervous System 1, Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. 5

6 Most Common Types of Cancer Incidence and Prevalence among California Females, 2015 Rank Cancer Type New Cases Incidence Rate Existing Cases 1 Breast 26, ,370 2 Lung 8, ,534 3 Colon and Rectum 6, ,634 4 Uterus 5, ,154 5 Thyroid 3, ,083 6 Melanoma of the Skin 3, ,236 7 Non-Hodgkin Lymphoma 3, ,169 8 Ovary 2, ,981 9 Pancreas 2, , Kidney 2, ,286 Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. 6

7 Most Common Types of Cancer Mortality among California Females, 2015 Rank Cancer Type Count Rate 1 Lung 5, Breast 4, Colon and Rectum 2, Pancreas 2, Ovary 1, Liver 1, Uterus 1, Leukemia Non-Hodgkin Lymphoma Brain and Other Nervous System Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. 7

8 Most Common Types of Cancer Mortality among California Females, 2015 Rank Cancer Type Count Rate 2 1 Lung 5, Breast 4, Colon and Rectum 2, Pancreas 2, Ovary 1, Liver 1, Uterus 1, Leukemia Non-Hodgkin Lymphoma Brain and Other Nervous System Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. 8

9 Average Annual Percent Change, Males, Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<0.05 9

10 Average Annual Percent Change, Males, Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<

11 Average Annual Percent Change, Males, Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<

12 Average Annual Percent Change, Males, Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<

13 Average Annual Percent Change, Females, Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<

14 Average Annual Percent Change, Females, Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<

15 Average Annual Percent Change, Females, Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<

16 Average Annual Percent Change, Females, Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<

17 Outline 1. Incidence and Mortality 2. Trends 3. Risk Factors 4. Stage at Diagnosis 5. Cancer Control Plan Progress Summary 6. Survival 7. Childhood Cancer 17

18 Trends in California Incidence: Mortality: Breast Prostate Colorectal Lung 18

19 Age-Adjusted Rate / 100,000 Age-Adjusted Rate / 100,000 Breast Cancer Incidence Trends, CA Invasive In Situ APC 4.9*

20 Interpreting trends: Invasive breast cancer Slow increase in incidence until 2000: not well understood, probably multi-factorial Rapid decrease in 2002 after drop in hormone replacement therapy use (women s health study) Rates stable after 2004 (still lower than in 1988) Asian/Pacific Islanders: only group with steady increase in incidence 20

21 Interpreting trends: In Situ breast cancer Fast increase in rates: screening Increase no longer significant after

22 Age-Adjusted Rate / 100,000 Breast Cancer Mortality Trends: CA,

23 Interpreting Trends: Mortality Mortality: 36% decrease since 1986 Decrease in all racial/ethnic groups Treatment + early detection 23

24 Age-Adjusted Rate / 100,000 Age-Adjusted Rate / 100,000 Prostate Cancer Trends: CA, INCIDENCE 40 MORTALITY APC 2.1*

25 Interpreting prostate cancer trends Incidence peak in early 90s consistent with introduction of screening (PSA) in population with high prevalence of undetected tumors Since early 2000: almost 50% decrease in incidence (all groups) Since early 90s, mortality decreased by almost 50%: treatment, early-detection 25

26 Age-Adjusted Rate / 100,000 Age-Adjusted Rate / 100,000 Colorectal Cancer Trends: CA INCIDENCE 35 MORTALITY Male Female Male Female APC -2.3*

27 Colorectal Cancer Trends Incidence decreased by about 40% (M and F) Sharper decrease in mortality (after mid 80s ): rates now 50% lower than in 1984 Exception: Hispanic men! Trends consistent with screening effect : decrease in incidence + shift to earlier stage at diagnosis 27

28 Age-Adjusted Rate / 100,000 Age-Adjusted Rate / 100,000 Lung Cancer Trends: California, INCIDENCE 90 MORTALITY Male Male AAPC -2.8* (87-14) Female AAPC -1.9* (98-14) Female

29 Interpreting lung cancer trends Female lung cancer declined in mid-late 90s, faster decline after 2010 (CA earlier than rest of US) Male lung cancer incidence and mortality declining, tide changed in mid 80s Decline in adult smoking prevalence in CA: 23.7% in 1988 to 11.7% in 2016 CA: state with highest smoking in the 60s-70s BUT: SES & racial/ethnic disparities in smoking 29

30 Outline 1. Incidence and Mortality 2. Trends 3. Risk Factors 4. Stage at Diagnosis 5. Cancer Control Plan Progress Summary 6. Survival 7. Childhood Cancer 30

31 Body Mass Index Trends for California Adults 50.0% 45.0% 43.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 35.5% 19.3% 35.4% 34.8% 27.9% Underweight Normal Overweight Obese 10.0% 5.0% Source: CHIS 2.2% 1.9% 0.0%

32 Body Mass Index Trends for California Adults 50.0% 45.0% 43.0% 40.0% 35.0% 30.0% 25.0% 35.5% 35.4% 34.8% 27.9% 62.7% Underweight Normal Overweight or Obese 20.0% 19.3% Overweight Obese 15.0% 10.0% 5.0% Source: CHIS 2.2% 1.9% 0.0%

33 Percentage Use of colorectal screening tests by race/ethnicity, adults ages 50-75, U.S Hispanic White Black Asian Source: NHIS 33

34 Smoking Status Trends Among California Adults 70.0% 66.6% 60.0% 58.1% 50.0% 40.0% 30.0% 24.9% Current Smoker Former Smoker Never Smoked 20.0% 10.0% 17.1% 21.7% 11.7% 0.0% Source: CHIS

35 35% 30% Cigarette smoking by race/ethnicity among U.S. adults, % 25% 25.2% 20% 15% 16.5% 16.6% 10% 9.0% 10.7% 5% 0% American Indian/Alaska Native Asian Black Hispanic Multiple Race White Source: CDC 35

36 Cigarette smoking by education among U.S. adults, % 40.6% 40.0% 35.0% 30.0% 25.0% 24.1% 20.0% 19.7% 18.9% 16.8% 15.0% 10.0% 7.7% 5.0% 4.5% 0.0% Less than high school GED High school graduate Some college Associate degree Undergraduate degree Graduate degree Source: CDC 36

37 30.0% Cigarette smoking by poverty level among U.S. adults, % 25.3% 20.0% 15.0% 14.3% 10.0% 5.0% 0.0% Below poverty level At or above poverty level Source: CDC 37

38 Outline 1. Incidence and Mortality 2. Trends 3. Risk Factors 4. Stage at Diagnosis 5. Cancer Control Plan Progress Summary 6. Survival 7. Childhood Cancer 38

39 Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic Non-Hispanic White Breast Cervical Colorectal Melanoma 0 Breast Cervical Colorectal Melanoma Early stage=in situ or localized 39

40 Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic Non-Hispanic White Breast Cervical Colorectal Melanoma 0 Breast Cervical Colorectal Melanoma Early stage=in situ or localized 40

41 Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic Non-Hispanic White Breast Cervical Colorectal Melanoma 0 Breast Cervical Colorectal Melanoma Early stage=in situ or localized 41

42 Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic Non-Hispanic White Breast Cervical Colorectal Melanoma 0 Breast Cervical Colorectal Melanoma Early stage=in situ or localized 42

43 Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic Non-Hispanic White 10 0 Oropharyngeal Lung Oropharyngeal Lung Early stage=in situ or localized 43

44 Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic Non-Hispanic White 10 0 Oropharyngeal Lung Oropharyngeal Lung Early stage=in situ or localized 44

45 Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic Non-Hispanic White 10 0 Oropharyngeal Lung Oropharyngeal Lung Early stage=in situ or localized 45

46 Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic 30 Non-Hispanic White Prostate Colorectal Melanoma 0 Prostate Colorectal Melanoma Early stage=in situ or localized 46

47 Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic 30 Non-Hispanic White Prostate Colorectal Melanoma 0 Prostate Colorectal Melanoma Early stage=in situ or localized 47

48 Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic 30 Non-Hispanic White Prostate Colorectal Melanoma 0 Prostate Colorectal Melanoma Early stage=in situ or localized 48

49 Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic 30 Non-Hispanic White Prostate Colorectal Melanoma 0 Prostate Colorectal Melanoma Early stage=in situ or localized 49

50 Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic 10 Non-Hispanic White 5 0 Oropharyngeal Lung Oropharyngeal Lung Early stage=in situ or localized 50

51 Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic 10 Non-Hispanic White 5 0 Oropharyngeal Lung Oropharyngeal Lung Early stage=in situ or localized 51

52 Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California African American Asian/Pacific Islander Hispanic 10 Non-Hispanic White 5 0 Oropharyngeal Lung Oropharyngeal Lung Early stage=in situ or localized 52

53 90 Percent of cancer cases diagnosed at late stage, by socioeconomic status (SES), California Females, Lowest SES Highest SES Breast Cervical Colorectal Melanoma Oropharyngeal Lung Late stage=regional or distant 53

54 Percent of cancer cases diagnosed at late stage, by socioeconomic status (SES), California Males, Lowest SES Highest SES Prostate Colorectal Melanoma Oropharyngeal Lung 5 Late stage=regional or distant 54

55 Outline 1. Incidence and Mortality 2. Trends 3. Risk Factors 4. Stage at Diagnosis 5. Cancer Control Plan Progress Summary 6. Survival 7. Childhood Cancer 55

56 California s Comprehensive Cancer Control Plan, Did we meet our targets? Objective Target for The Cancer Burden: Objective 1 Decrease combined cancer incidence The Cancer Burden: Objective 2 Decrease combined cancer mortality Incidence and mortality rates are per 100,000 56

57 Age-adjusted rate/100,000 Five-year, age-adjusted incidence rates by race/ethnicity and sex, all cancers Non-Hispanic White Non-Hispanic Black Hispanic Asian/Pacific Islander Male Female Decreases in all groups since , more pronounced in males 57

58 Age-adjusted rate/100,000 Five-year, age-adjusted mortality rates by race/ethnicity and sex, all cancers Non-Hispanic white Non-Hispanic black Hispanic Asian/Pacific Islander Male Female Decreases in all groups since

59 California s Comprehensive Cancer Control Plan, Did we meet our targets? Objective Target for Reduce the breast cancer mortality rate Reduce the cervical cancer incidence rate Reduce the colorectal cancer mortality rate Reduce the incidence of melanoma Reduce the mortality rate due to melanoma Reduce the mortality rate of ovarian cancer Decrease the mortality rate for prostate cancer Decrease the mortality rate for prostate cancer among African American males Rates are per 100,000 59

60 California s Comprehensive Cancer Control Plan, Did we meet our targets? Objective Target for Breast Cancer: Objective 2: Increase early diagnoses of breast cancer (in situ and localized) 89% 72.1% Colorectal Cancer: Objective 2: Decrease late-stage diagnoses of CRC (Regional and Distant)-including in situ in the total 40% 56.1% Colorectal Cancer: Objective 3: Decrease late-stage diagnoses of CRC for African Americans and Asian/Pacific Islanders-including in situ in the total AA-41.2% API-41.4% AA-55.7% API-56.4% Melanoma: Objective 1: Decrease late-stage diagnoses of melanoma (regional and distant)- including in situ in the total 5.2% 6.1% Ovarian Cancer: Objective 1: Decrease distant-stage diagnoses of ovarian cancer 55.4% 52.9% Excluded unstaged cases 60

61 Outline 1. Incidence and Mortality 2. Trends 3. Risk Factors 4. Stage at Diagnosis 5. Cancer Control Plan Progress Summary 6. Survival 7. Childhood Cancer 61

62 Five-year Relative Survival (%), California, , All Cancers Race Age Stage SES SES Stage Age Race All Cases 65 5 (Highest) (Lowest) 54 IV 19 III 57 II 88 I Asian/Pacific Islander 63 Hispanic 64 Non-Hispanic black 60 Non-Hispanic white

63 Change in Five-Year Relative Survival by Race/Ethnicity: All Cancers 63

64 Five-year Relative Survival (%), California, , Female Breast Cancer Race Stage SES All Cases 90 5 (Highest) 95 SES (Lowest) 82 IV 28 Stage III II I 100 Asian/Pacific Islander 92 Race Hispanic Non-Hispanic black Non-Hispanic white

65 Change in Five-Year Relative Survival by Race/Ethnicity: Female Breast Cancer 65

66 Five-year Relative Survival (%), California, , Cervical Cancer Race Stage SES All Cases 68 5 (Highest) 74 SES (Lowest) 64 IV 18 Stage III II I 92 Asian/Pacific Islander 69 Race Hispanic Non-Hispanic black Non-Hispanic white

67 Change in Five-Year Relative Survival by Race/Ethnicity: Cervical Cancer 67

68 Five-year Relative Survival (%), California, , Colorectal Cancer Race Stage SES Sex Sex SES Stage Race All Cases 63 Female 63 Male 63 5 (Highest) (Lowest) 56 IV 12 III 67 II 81 I 91 Asian/Pacific Islander 65 Hispanic 63 Non-Hispanic black 56 Non-Hispanic white

69 Change in Five-Year Relative Survival by Race/Ethnicity: Colorectal Cancer 69

70 Race Stage SES Sex Five-year Relative Survival (%), California, , Lung Cancer Sex SES Stage Race All Cases 17 Female 20 Male 14 5 (Highest) (Lowest) 12 IV 4 III 15 II 36 I 60 Asian/Pacific Islander 20 Hispanic 16 Non-Hispanic black 15 Non-Hispanic white

71 Change in Five-Year Relative Survival by Race/Ethnicity: Lung Cancer 71

72 Five-year Relative Survival (%), California, , Melanoma Race Stage SES Sex Sex SES Stage Race All Cases 89 Female 92 Male 87 5 (Highest) (Lowest) 76 IV 17 III 60 II 77 I 100 Asian/Pacific Islander 71 Hispanic 81 Non-Hispanic black 75 Non-Hispanic white

73 Change in Five-Year Relative Survival by Race/Ethnicity: Melanoma 73

74 Five-year Relative Survival (%), California, , Oropharyngeal Cancer Race Stage SES Sex Sex SES Stage Race All Cases 64 Female 66 Male 63 5 (Highest) (Lowest) 51 IV 53 III 66 II 76 I 87 Asian/Pacific Islander 66 Hispanic 61 Non-Hispanic black 52 Non-Hispanic white

75 Change in Five-Year Relative Survival by Race/Ethnicity: Oropharyngeal Cancer 75

76 Five-year Relative Survival (%), California, , Prostate Cancer Race Stage SES All Cases 97 SES 5 (Highest) (Lowest) 90 IV 45 Stage III II I Race Asian/Pacific Islander Hispanic Non-Hispanic black Non-Hispanic white

77 Change in Five-Year Relative Survival by Race/Ethnicity: Prostate Cancer 77

78 Outline 1. Incidence and Mortality 2. Trends 3. Risk Factors 4. Stage at Diagnosis 5. Cancer Control Plan Progress Summary 6. Survival 7. Childhood Cancer 78

79 Distribution of Cancer Types among children ages 0-14, California, % 34% 6% 6% 8% Leukemias CNS^ Lymphomas Neuroblastoma Soft tissue All other cancers 24% Includes myelodysplastic syndromes and benign brain/cns tumors. ^Includes miscellaneous intracranial and intraspinal neoplasms. Includes other extraosseous sarcomas. 79

80 Distribution of Cancer Types among Adolescents ages 15-19, California, % 20% CNS^ 14% Other malignant epithelial neoplasms Lymphomas 19% Leukemias 15% Germ cell Includes myelodysplastic syndromes and benign brain/cns tumors. ^Includes miscellaneous intracranial and intraspinal neoplasms. Includes melanomas. Includes trophoblastic tumors and neoplasms of gonads. 18% All other cancers 80

81 Rate per 1,000,000 Age-Adjusted Incidence Trends for children ages 0-14 by Sex, California, Year of Diagnosis All Children (APC=0.1) Males (APC=0.1) Females (APC=0.2) Excludes myelodysplastic syndromes and benign brain/cns tumors. *The annual percent change (APC) is significantly different from zero at p <

82 Rate per 1,000,000 Age-Adjusted Incidence Trends for adolescents ages by Sex, California, Year of Diagnosis All Children (APC=1.2*) Males (APC=2.0*) Females (APC=0.3) Excludes myelodysplastic syndromes and benign brain/cns tumors. * The annual percent change (APC) is significantly different from zero at p <

83 Summary Good news: Overall decrease in cancer incidence and mortality Overall increase in 5 year survival Bad news: Significant disparities by race/ethnicity and SES Cervical cancer: no increases in survival, decreases in early stage diagnosis for blacks and Asians 83

84 Thank you! Contact information: Fran Maguire: 84

85 Questions 85