INTRODUCTION CONTENTS CALIFORNIA CANCER FACTS AND FIGURES 2006

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1 ACS by lithopmd 1 8/8/2, :32 PM

2 CONTENTS THE AMERICAN CANCER SOCIETY (ACS) IS THE NATIONWIDE COMMUNITY-BASED VOLUNTARY HEALTH ORGANIZATION DEDICATED TO ELIMINATING CANCER AS A MAJOR HEALTH PROBLEM BY PREVENTING CANCER, SAVING LIVES AND DIMINISHING SUFFERING FROM CANCER THROUGH RESEARCH, EDUCATION, ADVOCACY, AND SERVICE American Cancer Society Vision 21 Expected New Cases, Deaths, and Prevalence of Common Cancers in California, 26 California Report Card California Basic Cancer Data Expected New Cancer Cases and Deaths in California and by County, 26 Breast Cancer and Screening Colon and Rectum Cancer and Screening Nutrition, Obesity, Physical Activity, and Cancer Tobacco-Related Cancers and Tobacco Use Prostate Cancer and Screening Cervical Cancer and Screening Skin Cancer and Sun Avoidance Trends in Survival Stage at Diagnosis Cancer in Diverse Populations Cancer Risk and Causes ACS Cancer Guidelines Major Cancer Sites: Risk Reduction, Early Detection, Warning Signs, and Treatment ACS Outcome Measures for California ACS, California Division ACS, Research Program California Department of Health Services Data Sources CCR Acknowledgement and Disclaimer CCR Regional Cancer Registries ACS California Division, Regions, and Counties INTRODUCTION California has long been a world leader in cancer prevention and control, as evidenced by having some of the lowest rates of cancer and cancer mortality in the nation The American Cancer Society has played a pivotal role in establishing public awareness, advocacy, and cancer prevention and control programs and policies The data in California Cancer Facts and Figures demonstrate areas of cancer prevention, detection, treatment, and/or care that are succeeding The report also points out areas and populations where special attention is required, and can help focus further efforts in research, education, service and advocacy Many past discoveries that are being delivered today resulted from research that was championed by the American Cancer Society Yet, there are still gains to be realized by delivering proven discoveries in several areas In the area of prevention, we need to protect and develop physical and social environments as well as policies and practices that support health and healthy behaviors Through programs established by efforts of the American Cancer Society, working in partnership with the California Department of Health Services and others, success in tobacco prevention and control has been instrumental in bringing about the cancer reductions in recent decades Still, tobacco use, along with unhealthy diets, physical inactivity and overweight/obesity remain responsible for nearly two-thirds of the cases of cancer, and people who use tobacco want and need help to quit, including medications and counseling Likewise, programs established to increase breast and cervical cancer early detection and treatment have begun to make a dent in the disparities for low-income, underserved populations Effective methods exist to detect and remove polyps that progress to colorectal cancers and to detect early stage colorectal cancers at their most treatable stage, but they are sorely underutilized Finally, in the area of treatment, new approaches to interventions, including tailoring treatments to the individual and targeting treatments to the tumor s characteristics are rapidly emerging They warrant continued evaluation and development; for those that prove to be effective, education will be needed to help with dissemination and assurance of access to all who need them The American Cancer Society is proud to fulfill leadership roles in the areas of cancer information, patient services, research, and cancer prevention and early detection, working in collaboration with others who share our commitment to eliminate cancer as a major health problem California Cancer Facts and Figures, prepared in conjunction with the California Cancer Registry, provides essential data for these efforts With everyone working together we can fully realize the promises of existing and new discoveries to benefit all the people of California Our progress to conquer cancer continues through research, education, service and advocacy Thank you to everyone who is helping with this life-saving work Sincerely yours, Georjean Stoodt, MD, MPH, President 2 American Cancer Society, California Division, Inc All rights reserved, including the right to reproduce this publication or portions thereof in any form However, figures and tables produced by the California Department of Health Services, California Cancer Registry, may be reproduced without permission For written permission, address the American Cancer Society, California Division, 171 Webster Street, Oakland, CA Suggested Citation: American Cancer Society, California Division and Public Health Institute, California Cancer Registry California Cancer Facts and Figures 26 Oakland, CA: American Cancer Society, California Division, September 2 Cynthia LeBlanc, EdD, Chair of the Board Patricia M Felts, Chief Executive Officer American Cancer Society, California Division, Inc

3 3 AMERICAN CANCER SOCIETY VISION 21 8 Reduce cancer incidence by 2 percent 8 Reduce cancer mortality by percent 8 Improve the quality of life for cancer survivors EXPECTED INCIDENCE, MORTALITY, AND PREVALENCE OF COMMON CANCERS IN CALIFORNIA, 26 MALES Prostate Colon & Rectum Leukemia & Lymphoma Urinary Bladder All Cancers Combined New Cases Deaths Prevalence 22,29 9, 7,38,68 4,3 69,7 32% 13% 11% 8% 6% % 3,1 7,28 2,6 2, 86 27,48 11% 27% 1% 9% 3% % 11, 24,4 74, 36, 47, 42, 29% 6% 18% 9% 12% % FEMALES Breast Colon & Rectum Uterus & Cervix Leukemia & Lymphoma All Cancers Combined 22, 8,11 6,96,27 4,4 66,8 Source: California Cancer Registry, California Department of Health Services Excludes non-melanoma skin cancers and in situ cancers, except bladder Deaths include persons who may have been diagnosed in previous years These projections are offered as a rough guide, and should not be regarded as definitive Prevalence is the number of persons alive who have ever been diagnosed with cancer There are nearly 9, Californians alive today who have a history of cancer CALIFORNIA REPORT CARD 8 Cancer incidence rates in California declined by 12 percent from 1988 to 22 8 Over the same period, cancer mortality rates declined by 19 percent Mortality rates declined for all four major race/ethnic groups in the state 8 Tobacco-related cancers declined sharply, including cancers of the lung and bronchus, larynx, oral cavity, pancreas, stomach, and bladder California has experienced a much larger decrease in lung cancer incidence rates than the US, in large part, due to the success of the California tobacco control initiative 8 The breast cancer incidence rate in California has not increased since 1988, but the mortality rate has decreased by 29 percent 33% 12% 1% 8% 7% % Source: California Department of Health Services, Cancer Surveillance Section 4,16 6,38 2,62 1,11 1,97 26,8 16% 24% 1% 4% 7% % 22,2 18, 71, 9,9 31,9 47, 4% 3% 13% 18% 6% % 8 The prostate cancer incidence rate increased by percent from 1988 to 1992, but since then has declined to 199 levels The mortality rate has declined by percent since Colon and rectum cancer incidence and mortality rates are declining sharply in most racial/ethnic groups 8 Cancer incidence in California is about the same or somewhat lower than elsewhere in the US for most types of cancer 8 Despite these improvements, nearly one out of every two Californians born today will develop cancer at some point in their lives, and it is likely that one in five persons will die of the disease

4 4 CALIFORNIA BASIC CANCER DATA WHAT IS CANCER? Cancer is a large group of diseases characterized by uncontrolled growth and spread of abnormal cells If the spread is not controlled or checked, it results in death However, many cancers can be cured if detected and treated promptly, and many others can be prevented by lifestyle changes, especially avoidance of tobacco COULD MORE PEOPLE BE SAVED? All cancers caused by tobacco and heavy use of alcohol can be prevented completely The American Cancer Society estimates that in 26 over 18, lives will be lost to cancer in California because of tobacco use About 1,86 cancer deaths were related to excessive alcohol use, frequently in combination with tobacco use WHO GETS CANCER? Cancer strikes at any age It kills more children from birth to age 14 in California than any other disease Among adults it occurs more frequently with advancing age HOW MANY PEOPLE ALIVE TODAY WILL GET CANCER? About 1 million Californians now living will eventually be diagnosed with cancer, about two in five, according to present rates Over the years, cancer will strike approximately three of four families HOW MANY PEOPLE ALIVE TODAY HAVE EVER HAD CANCER? Nearly 9, Californians who are alive today have a history of cancer; nearly 9, were diagnosed five or more years ago Most of these prevalent cases, persons who were ever diagnosed with cancer, can be considered cured, while others still have evidence of cancer The term cured usually 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? In 26, about 136,87 Californians will be diagnosed as having cancer This estimate does not include non-melanoma skin cancer and carcinoma in situ for sites other than bladder This is equivalent to more than 1 new cases every hour of every day HOW MANY PEOPLE WILL DIE? In 26, about 4,34 people will die of the disease about 1 people a day Of every four deaths in California, one is from cancer HOW MANY PEOPLE ARE SURVIVING CANCER? In the early 19s, few cancer patients had any hope of long-term survival In the 19s, less than one in five was alive five years after treatment In the 194s it was one in four, and in the 196s it was one in three Today, more than 79, Californians who get cancer this year will be alive five years after diagnosis When normal life expectancy is taken into consideration (factors such as dying of heart disease, accidents, and diseases of old age), a relative fiveyear survival rate of 9 percent is seen for all cancers combined The relative survival rate is commonly used to measure progress in the early detection and treatment of cancer and estimates the proportion of cancer patients potentially curable Early diagnosis saves lives by identifying cancers when they are most curable Five-year relative survival rates for common cancers such as breast, prostate, colon and rectum, cervix, and melanoma of the skin are 9 to 9 percent if they are discovered before having spread beyond the organ where the cancer began Following American Cancer Society Cancer detection guidelines and encouraging others to do so can save your life or the lives of people you love CANCER AND OTHER DISEASES In California, cancer is the second-leading cause of death, accounting for 23 percent of all deaths in 22 Heart disease, the leading cause, accounted for 29 percent of deaths HOW DO CANCER INCIDENCE RATES IN CALIFORNIA COMPARE TO THE REST OF THE US? The Surveillance, Epidemiology, and End Results (SEER) Program registers cancer patients in geographic areas covering about 14 percent of the US population, including Los Angeles and the San Francisco Bay Area In , the overall cancer incidence rate in California compared to SEER areas other than in California was 11 percent lower for Asian/Pacific Islanders and three percent lower for African Americans Whites and Hispanics have higher rates by two percent and five percent, respectively Some of these differences may reflect differences in classifying the race/ethnicity of cancer cases and in population estimates However, it does not appear that Californians are at greater risk of developing cancer than other Americans HOW DO WE KEEP TRACK OF CHANGES IN CANCER RISK? This report and other ongoing activities that track cancer rates in California are only possible because of the existence of the California Cancer Registry (CCR) The CCR is a dynamic database of information on all cancers diagnosed in California since 1988, and is recognized as one of the leading cancer registries in the world The mission of the CCR is to protect the public by monitoring cancer rates, and to contribute to the search for cancer causes and cures

5 EXPECTED NEW CANCER CASES AND DEATHS IN CALIFORNIA 26 SITE All Sites Oral Cavity and Pharynx Digestive System Esophagus Stomach Small Intestine Colon excluding Rectum Rectum and Rectosigmoid Anus, Canal and Anorectum Liver Intrahepatic Bile Duct Gallbladder Other Biliary Pancreas Retroperitoneum Respiratory System Nasal Cavity, Middle Ear Larynx and Bronchus Pleura Bones and Joints Soft Tissue including Heart Melanomas of the Skin Other Non-Epithelial Skin Breast Female Genital System Cervix Uteri Corpus Uteri Uterus, NOS Ovary Vagina Vulva Male Genital System Prostate Testis Penis Urinary System Urinary Bladder Kidney and Renal Pelvis Ureter Eye and Orbit Brain and Other Nervous System Thyroid Gland Other Endocrine, Thymus Hodgkin s Disease Non-Hodgkin s Lymphomas Multiple Myeloma Leukemias Lymphocytic Leukemia Acute Lymphocytic Leukemia Chronic Lymphocytic Leukemia Myeloid and Monocytic Leukemia Acute Myeloid Leukemia Acute Monocytic Leukemia Chronic Myeloid Leukemia Ill Defined/Unknown EXPECTED NEW CASES Total* 136,87 3,22 2,8 1,2 2, 49 1,9 4, 48 1, , 1 18, , , ,1 8,9 1, 3,64 2, ,24 22,29 9 9,61,7 3, , 2,6 21 8, 1,49 3, 1, ,6 1, ,6 MALES 69,7 2,17 13,74 9 1,6 2,6 2, , ,62 1, , , ,24 22,29 9 6,7 4,3 2, , , , ,78 FEMALES 66,8 1,4 12, ,19 1, ,66 6 8, , , , 8,9 1, 3,64 2, ,7 1,4 1, , ,1 68 1, , Total* EXPECTED DEATHS 4, 89 14, 1,11 1, 11 4, , ,1 2 14, , ,2 2, , 6 3,7 3, ,46 1,24 1,1 4 1, ,14 1,6 2, , ,97 MALES 27,48 9 7, , , , 1 7,62 2 7, ,7 3, , ,19 6 1, ,4 FEMALES 26,8 31 6, , ,64 1 6, , ,16 2, , ,92 Source: California Cancer Registry, California Department of Health Services Excludes non-melanoma skin cancers and carcinoma in situ, except bladder Deaths include persons who may have been diagnosed in previous years These projections are offered as a rough guide, and should not be regarded as definitive * Male and female cases and deaths do not sum up to the total because of rounding of numbers

6 6 EXPECTED NEW CANCER CASES BY COUNTY 26 NEW CANCER CASES County All Breast Prostate Colon & Rectum Bladder Uterus & Cervix NHL* Melanoma Oral Leukemia Pancreas Alameda Alpine Amador Butte Calaveras Colusa Contra Costa Del Norte El Dorado Fresno Glenn Humboldt Imperial Inyo Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa Mendocino Merced Modoc Mono Monterey Napa Nevada Orange Placer Plumas Riverside Sacramento San Benito San Bernardino San Diego San Francisco San Joaquin San Luis Obispo San Mateo Santa Barbara Santa Clara Santa Cruz Shasta Sierra Siskiyou Solano Sonoma Stanislaus Sutter Tehama Trinity Tulare Tuolumne Ventura Yolo Yuba,7 24 1, ,41 1 2, , ,2 1 1, , ,36 1, ,9,3 1 6, 11, 3,78 2,2 1,29 3,24 1,82 6,1 1,4 1, , 2,21 1,7 8 1,3 44 3, , , , , , , , , , , , , , , , , , , , , Source: California Cancer Registry, California Department of Health Services Excludes non-melanoma skin cancers and carcinoma in situ, except bladder Only the total number of expected cases is shown for counties with 1 or fewer expected cases These projections are offered as a rough guide, and should not be regarded as definitive * NHL: non-hodgkin s lymphoma

7 EXPECTED CANCER DEATHS BY COUNTY 26 7 CANCER DEATHS County All Colon & Rectum Breast Prostate Pancreas NHL* Leukemia Stomach Ovary Bladder Uterus & Cervix Alameda Alpine Amador Butte Calaveras Colusa Contra Costa Del Norte El Dorado Fresno Glenn Humboldt Imperial Inyo Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa Mendocino Merced Modoc Mono Monterey Napa Nevada Orange Placer Plumas Riverside Sacramento San Benito San Bernardino San Diego San Francisco San Joaquin San Luis Obispo San Mateo Santa Barbara Santa Clara Santa Cruz Shasta Sierra Siskiyou Solano Sonoma Stanislaus Sutter Tehama Trinity Tulare Tuolumne Ventura Yolo Yuba 2, , , , , , ,97 2,24 2, 4,7 1, , , , , , , , Source: California Cancer Registry, California Department of Health Services Deaths include persons who may have been diagnosed in previous years These projections are offered as a rough guide, and should not be regarded as definitive Only the total number of expected deaths is shown for counties with 1 or fewer expected deaths * NHL: non-hodgkin s lymphoma

8 8 BREAST CANCER Breast cancer is the most common cancer among women in California, regardless of race/ethnicity Survival is excellent when diagnosed early If confined to the breast when discovered, five-year survival is over 9 percent Breast cancer Photo survival by stage at diagnosis and trends in survival from 1988 to 1999 can be found on page 19 Breast cancer incidence in California has been fairly stable since 1988 More cancers are being diagnosed at an early stage, and the rate of late-stage disease has declined About 68 percent of female breast cancers diagnosed in California in 22 were found at an early stage (see page 2) This shift to earlier-stage diagnoses reflects, in part, the successful efforts of the American Cancer Society and other organizations to increase the number of women who receive regular breast cancer screening (see next page) Breast cancer mortality in California has declined by more than 28 percent due to the combined effects of better treatment and earlier diagnosis While this is very good news for California women, breast cancer incidence rates may begin to rise in the next decade as the large number of women born after World War II reach the age where breast cancer becomes more common This group of women may be at higher risk of breast cancer than their mothers due to earlier menarche, smaller family size, delayed childbearing, and other factors This effect may already be seen in women of Asian/Pacific Islander ancestry Since 1988, the breast cancer incidence rate among this group of women has increased by 2 percent Although breast cancer mortality has been declining among non-hispanic white women for some time, declines are now statistically significant for African American and Hispanic women as well From 1988 to 22, breast cancer mortality declined by 17 percent among African American and 1 percent among Hispanic women, and by 27 percent among non-hispanic white women Mortality rates did not change Trends in Early-Stage Female Breast Cancer Incidence by Race/Ethnicity in California, Rate per, Non-Hispanic White African American Hispanic Asian/Pacific Islander Note: Rates are age-adjusted to the 2 US population Early-stage cancers are in situ or less than 2 cm in size with no lymph nodes involved Source: California Cancer Registry, California Department of Health Services Prepared by the California Department of Health Services, Cancer Surveillance Section among Asian/Pacific Islander women, despite the significant increase in incidence These trends may in part be attributed to earlier diagnosis due to more effective cancer screening Asian women, who commonly have low breast cancer incidence rates in their native countries, experience increasing rates upon migrating to the US and assimilating Research in Los Angeles County has found that breast cancer rates among Japanese-Americans are twice those of Chinese and Korean women and are quickly approaching rates of non-hispanic whites This increase can in part be explained by the Japanese being the first large Asian population migrating to Los Angeles County and who have adopted the Western lifestyle longer than any other Asian subgroup Breast cancer incidence rates may continue to increase in the future as more Asian subgroups adopt more Westernized lifestyles About 1 men are diagnosed with breast cancer each year in California, and about die of the disease annually Breast cancer in men is clinically very similar to the disease in women, but the prognosis is often poorer because men tend to be diagnosed at a later stage Trends in Female Breast Cancer by Race/Ethnicity in California, Rate per, Rate per, Mortality Non-Hispanic White Incidence African American Hispanic Asian/Pacific Islander Note: Rates are age-adjusted to the 2 US population Source: California Cancer Registry, California Department of Health Services Prepared by the California Department of Health Services, Cancer Surveillance Section

9 For reasons that are not completely understood, being welleducated and financially well-off are associated with a higher risk of developing breast cancer In each race/ethnic group in California, breast cancer incidence increases with socioeconomic status (SES) Non-Hispanic white women in the highest SES category are at highest risk Some geographic variation in breast cancer rates within California may be related to these factors In , the invasive female breast cancer incidence rate in California compared to SEER areas other than California was 1 percent lower among Asian/Pacific Islanders, five percent higher among African Americans, nearly identical among Hispanics, and ten percent higher among non-hispanic white women The Surveillance, Epidemiology, and End Results (SEER) Program registers cancer patients in geographic areas covering about 14 percent of the US population, including Los Angeles and the Bay Area BREAST CANCER SCREENING Early detection is the best defense against breast cancer A breast health program of clinical breast examination by a health provider every three years should begin at age 2, and annual mammograms and clinical breast examinations starting at age 4 Breast self-examinations are optional SCREENING CONTINUED Percent Screened within Last Year 9 Mammography Use Among Females Ages 4 and Older by Income in California, <$2, $2-, $, 6 Note: Data are weighted to the 199 California population Source: California Behavioral Risk Factor Survey Income categories are based on annual household income Data were not collected in 21 Prepared by the California Department of Health Services, Cancer Surveillance Section Mammography Use Among Female Ages 4 and Older by Race/Ethnicity, 24 Percent Screened In 24, 7 percent of women of screening age reported that they had a mammogram in the past year, compared to only 39 percent in 1987 Poor women have shown the largest increase in mammography use, especially in recent years Non-Hispanic white women were most likely to have been recently screened (9 percent) while screening among Hispanic, African American, and Asian women lagged behind (4 percent, percent, and 2 percent respectively) 4 2 Non-Hispanic White African American In Past Year Hispanic In Past 2 Years Asian/Pacific Islander Note: Data are age-adjusted to the 199 California population Source: California Behavioral Risk Factor Survey Prepared by the California Department of Health Services, Cancer Surveillance Section AMERICAN CANCER SOCIETY ACTIVITIES ON BREAST CANCER T he American Cancer Society is a leading advocate for the early detection of breast cancer Through community health education programs, the Society helps women learn about breast cancer screening and the importance of mammography Through a wide variety of materials, the number (1--ACS-234), and its Web site (wwwcancerorg), the Society provides answers to questions about the nature of breast cancer, its causes, and risk factors Reach to Recovery, Look Good Feel Better, and other services provide support, and help breast cancer patients to take action

10 1 COLON AND RECTUM CANCER Colon and rectum cancer is the third most common cancer in California among both men and women, and is the third most common cause of cancer-related death for each gender Although it is less common than either breast or prostate cancer, colon and rectum cancer has a poorer prognosis The five-year survival rates for breast and prostate cancers are 86 percent and 94 percent, respectively, whereas for colon and rectum cancer it is 62 percent NEW CASE SES, STAGE AT DIA IAGN GNOSI SIS, AND DEATHS FOR THREE COMMON CANCERS ANCERS,, CALIFORNIA ALIFORNIA,, 22 Trends in Invasive Colon and Rectum Cancer Incidence by Race/Ethnicity in California, Female Breast Prostate Colon and Rectum Cases Diagnosed 26,9 21,312 14,921 Early Stage 66% 7% 38% Total Deaths 4,116 3,49,27 6 Rate per, Note: Deaths include persons who may have been diagnosed in previous years Source: California Cancer Registry, California Department of Health Services Colon and rectum cancer risk has declined steadily in California over the last 1 years Colon and rectum cancer incidence rates declined by 8 and 11 percent among Hispanics and Asian/Pacific Islanders respectively The largest decline was among non-hispanic whites, and African Americans whose rates declined 26 and 27 percent respectively over the period Mortality rates decreased by 2 percent Among new cases, more of the decline in colon and rectum cancer rates has been among late-stage tumors The reasons for declining colon and rectum cancer rates are not clearly understood It has been suggested that increased use of endoscopic screening (sigmoidoscopy or colonoscopy) has resulted in the removal of benign polyps that would have progressed to cancer Among the other possible contributors to declining rates are increased use of aspirin to prevent heart disease, and dietary changes, including increased calcium intake In , the invasive colorectal cancer incidence rate in California compared to SEER areas other than California was 11 percent lower among Asian/Pacific Islanders, nearly identical among Hispanics, six percent lower among African Americans, and very similar among non-hispanic whites The Surveillance, Epidemiology, and End Results (SEER) Program registers cancer patients in geographic areas covering about 14 percent of the US population, including Los Angeles and the Bay Area Non-Hispanic White African American Hispanic Asian/Pacific Islander Note: Rates are age-adjusted to the 2 US population Source: California Cancer Registry, California Department of Health Services Prepared by the California Department of Health Services, Cancer Surveillance Section Trends in Colon and Rectum Cancer Incidence by Stage at Diagnosis in California, Rate per, Early Stage Late Stage Note: Rates are age-adjusted to the 2 US population Early-stage cancers are in situ or localized (ie, have not extended beyond the colon or rectum) Late-stage tumors have spread further Source: California Cancer Registry, California Department of Health Services Prepared by the California Department of Health Services, Cancer Surveillance Section

11 COLON AND RECTUM CANCER SCREENING Survival from colon and rectum cancer is nearly 9 percent when the cancer is diagnosed before it has extended beyond the intestinal wall Colon and rectum cancers are harder to detect when asymptomatic than breast and prostate cancer, and are less likely to be diagnosed at an early stage (in situ or localized) Sigmoidoscopy/Colonoscopy Use Among Persons Ages and Older by Annual Household Income in California, 24 Percent Screened Within Last Five Years <$2, $2-, $,+ Males Females Note: Data are weighted to the 2 California population Source: California Behavioral Risk Factor Survey Prepared by the California Department of Health Services, Cancer Surveillance Section 6 In 22, about 38 percent of colon and rectum cancers diagnosed in California were early-stage, compared to about 7 percent for prostate, and 66 percent for breast cancer The American Cancer Society recommends that both men and women begin routine screening for this cancer at age For more information on stage at diagnosis and screening guidelines for this cancer, refer to pages 21 and 27 In 24, only 43 percent of California adults ages and over reported having had sigmoidoscopy or colonoscopy within the past five years The proportion screened was even lower among persons in poverty (27 percent), and among Hispanics (31 percent) and Asian/Pacific Islanders/others (28 percent) In 24, 33 percent of Californians over age reporting having a fecal occult blood exam using a home kit in the past five years Those below poverty, Hispanics and African American were less likely to have had the exam (13 percent, 16 percent and 28 percent respectively) Sigmoidoscopy/Colonoscopy Use Among Persons Ages and Older by Race/Ethnicity in California, 24 Percent Screened Within Last Five Years 4 2 Non-Hispanic White African American Hispanic Asian/Pacific Islander Note: Data are weighted to the 2 California population Source: California Behavioral Risk Factor Survey Prepared by the California Department of Health Services, Cancer Surveillance Section AMERICAN CANCER SOCIETY ACTIVITIES ON COLON AND RECTUM CANCER T he American Cancer Society has launched an aggressive, multi-pronged initiative to reduce incidence and mortality from colon and rectum cancer Nationwide colorectal cancer education activities target the public men and women ages and over who need to get tested; physicians and other health care providers who need to recommend screening to their eligible patients; and health plans and health insurers who set policy and control payment for screening procedures The legislative advocacy campaign targets activities to increase funding to support research into the causes, cures, and care of colon and rectum cancer, and addresses legislation for programs to provide coverage for screening Programs such as the Colon Cancer Free Zone and the Mayors Campaign will be implemented to involve local communities in increasing awareness of the importance of colon cancer screening

12 12 NUTRITION, OBESITY, PHYSICAL ACTIVITY, AND CANCER The American Cancer Society recently published a study in the New England Journal of Medicine linking obesity with cancer The researchers document the association between Body Mass Index and death from most forms of cancer, concluding that 9, cancer deaths nationwide are related to weight The study proves that poor diet, obesity and lack of physical activity are critical pieces to the cancer puzzle, which is frightening considering a nationwide survey in 22 found that only 1% of Californians identified maintaining a healthful weight as a way to decrease cancer risk Poor diet, obesity, and physical inactivity may be responsible for one out of every three cancer deaths, just as many as smoking (see page 26) American Cancer Society guidelines on diet, nutrition, and cancer prevention emphasize a diet with a high proportion of plant foods (five or more servings of fruits and vegetables a day), limited amounts of meat, dairy, and other high-fat foods, and a balance of caloric intake and regular physical activity (see page 27) Helping Californians of all ages achieve healthy eating habits and enjoy a physically active lifestyle is critical to reducing the rate of new cancer by one-quarter by 21 Healthy eating means consuming at least five servings of fruits and vegetables each day for children, adults, and teen girls, and at least seven servings a day for teen boys Surveys conducted in 2 among year olds, and in 21 among children ages 9-11 and adults, found that only a minority of Californians met these recommendations (California Teen Eating Exercise and Nutrition Survey, 2; California Children s Healthy Eating and Exercise Practices Survey, 21) Twenty-nine percent of California adults ate five or more servings of fruits and vegetables in 24 Women were more likely then men to consume five or more servings (33 percent compared to 24 percent) Along with healthy eating, regular physical activity is one of the best ways to prevent chronic disease The American Cancer Society recommends moderate physical activity for minutes or more for adults and at least 6 minutes for children and adolescents on five or more days of the week California is far from reaching this goal In 23, only one out of three California adults reported being engaged in moderate physical activity for minutes or more at least five times a week Percent of California Adults Who Eat Five A Day, by Sex, * Percent Who Met Recommendations Both Sexes Males Females Note: Data are weighted to the 2 California population Source: California Behavioral Risk Factor Survey *21 included more types of fruits and vegetables Prepared by the California Department of Health Services, Cancer Surveillance Section Physical Activity Among Adults in California, 23 Percent with Moderate Activity or Vigorous Activity Non-Hispanic White African American Moderate Activity Hispanic Vigorous Activity Asian/Pacific Islander/Other Note: Data are age-adjusted to the 2 California population Source: California Behavioral Risk Factor Survey Prepared by the California Department of Health Services, Cancer Surveillance Section

13 13 The proportion of adults who are overweight in California is reaching alarming proportions Based on self-reported weight and height, 9 percent of California adults were considered overweight or obese in 24, compared to 4 percent in 1984, and nearly one out of every five (22 percent) California adults was obese In general, men are more likely to be overweight than women However, women are just as likely to be obese Excess weight (overweight) and obesity are associated with a wide range of negative health effects and increased risk for major chronic diseases, including cancer Trends in Adult Obesity and Adult Overweight in California, Using new guidelines released by the Centers for Disease Control and Prevention, the percentage of teenagers ages who are overweight is about 29 percent, nearly one out of every three Although this is lower than among adults, it is alarmingly high, especially among Hispanic males Overweight Among Youth Ages by Race/Ethnicity and Sex in California, Percent Obese or Overweight Percent Overweight Obese Overweight; includes obese Note: Data are weighted to the 2 California population Source: California Behavioral Risk Factor Survey Prepared by the California Department of Health Services, Cancer Surveillance Section 2 Non-Hispanic White Hispanic Other Males Females Note: Data are weighted to the 199 California population Overweight is based on Year 2 Guidelines for Youth Source: California Youth Tobacco Survey Prepared by the California Department of Health Services, Cancer Surveillance Section Adult Obesity and Adult Overweight by Race/Ethnicity and Sex in California, 24 Percent Obese or Overweight W AA H A W AA H A Males Females Obese Overweight Note: W=non-Hispanic white, AA=African American, H=Hispanic, A=Asian/Other Data are age-adjusted to the 2 California population Source: California Behavioral Risk Factor Survey Prepared by the California Department of Health Services, Cancer Surveillance Section AMERI MERICAN CAN ANCER SOCIET OCIETY ACTIVITIES ON NUTRITION EDU DUCATION AND PHY HYSI SICAL ACT CTIVIT IVITY T he Society partners with -A-Day Power Play! and the California Department of Education to promote Spring Into Health! which encourages fruit and vegetable consumption and physical activity to children and their caretakers Teenagers can participate in Generation Fit, a nutrition and physical activity advocacy program, which teaches leadership skills while engaging youth in community service Active for Life is a motivating 1-week program designed to promote physical activity in the workplace while boosting office morale and encouraging teamwork Meeting Well can be used to help plan healthy meetings and events and offers healthy vending machine options and nutrition snack suggestions Body and Soul is a dynamic week nutrition education program for the faith-based community designed to increase fruit and vegetable consumption

14 14 TOBACCO-RELATED CANCERS SMOKING TRENDS About 8 percent of lung cancer is caused by cigarette smoking cancer alone kills almost 14, Californians each year, more than prostate, breast, and colon and rectum cancers combined However, many other cancers are caused by tobacco as well Overall, one out of every three cancer deaths is due to tobacco cancer incidence rates in California decreased by 26 percent from 1988 to 22, while rates in SEER areas other than California dropped by only 6 percent (Non-California SEER areas include about 1 percent of the US population) Rates for other smoking-related cancers are declining as well These achievements are due, in large part, to the success of California tobacco control initiatives Smoking rates among California adults declined steadily among both men and women from 1989 to 24 In 24, 1 percent of California adults still smoked Overall smoking rates have declined for 12 to 17 year olds since 1994 During 24, approximately 1 percent of year olds reported smoking during the last days In California, year olds are smoking at an increasing rate and are now recognized as the fastest growing age group using tobacco Tobacco companies are targeting them in earnest as the smokers of the future The smoking rate for year olds was 18 percent in Trends in Cancer Incidence in California and SEER Areas Other than California, Rate per, Trends in Adult Smoking by Sex in California, Percent Current Smokers California SEER Note: Rates are age-adjusted to the 2 US population Source: California Cancer Registry, California Department of Health Services Prepared by the California Department of Health Services, Cancer Surveillance Section Males Females Note: Data are weighted to the 2 California population Source: California Behavioral Risk Factor Survey and California Adult Tobacco Survey Prepared by the California Department of Health Services, Cancer Surveillance Section Trends in the Incidence of Smoking- Related Cancers Other than Among Males in California, Trends in Smoking Among Youth Ages in California, Percent Smoked During Past Days Rate per, 4 Bladder Oral 1 Pancreas 1 Larynx 1 1 Esophagus Bladder Oral Pancreas Larynx Esophagus 12 to to 1 16 to to 24 Note: Data are weighted to the 199 California population Note: Rates are age-adjusted to the 2 US population Source: California Youth Tobacco Survey and California Behavioral Risk Factor Source: California Cancer Registry, California Department of Health Services Survey, and California Adult Tobacco Survey Prepared by the California Department of Health Services, Cancer Surveillance Section Prepared by the California Department of Health Services, Cancer Surveillance Section

15 KICKING THE HABIT 1 In 24, percent of adult smokers in California, or nearly three out of every five, reported that they tried to quit in the last year However, nicotine, the drug in tobacco, causes addiction, with pharmacologic and behavioral processes similar to those that determine addiction to cocaine and heroin Because of this, quitting can be a difficult challenge Nonetheless, millions of Californians have kicked the habit For those who do quit, the risk of lung cancer decreases over time After 1 years, the risk is only slightly higher than among persons who have never smoked, even among those who smoked more than a pack a day SECONDHAND SMOKE In 1992, the US Environmental Protection Agency declared that secondhand smoke, also called environmental tobacco smoke or ETS, is cancer-causing in humans Each year, about 3, non-smoking adults in the US die of lung cancer as a result of breathing the smoke of others cigarettes ETS can be particularly harmful to children In 24, more than percent of California households with children five years old or younger completely prohibited smoking in the home Effect of Smoking Cessation on Cancer Risk Among Males Relative Risk of Cancer Number Smoked Prior to Quitting 1-2/Day 21+/Day Adult Smoking by Annual Household Income and Sex in California, 24 < Number of Years Since Quit Source: Cancer Rates and Risks, 4th Edition National Cancer Institute, 1996 Prepared by the California Department of Health Services, Cancer Surveillance Section Non- Smoker < $2, $2-, $, Percent Current Smokers Male Female Note: Data are weighted to the 199 California population Source: California Behavioral Risk Factor Survey and California Adult Tobacco Survey Prepared by the California Department of Health Services, Cancer Surveillance Section AMERI MERICAN CAN ANCER SOCIET OCIETY ACT CTIVIT IVITIE IES ON TOBACCO CONTROL T he Society has long been a leader in preventing tobacco use and in assisting people to stop their use of tobacco products Our advocacy efforts to increase tobacco taxes, promote clean air legislation and decrease access to tobacco products have helped California become one of the most progressive states in the country for tobacco control Teens Kick Ash!, our teen-coordinated campaign, challenges the tobacco industry s efforts to hook new young tobacco users The Society provides important tobacco cessation support through referral to the California Smokers Helpline ( NOBUTTS)

16 16 PROSTATE CANCER Prostate cancer is the most common cancer among men in almost all race/ethnic groups in California The number of prostate cancers diagnosed each year rose dramatically in the early 199s when the prostate-specific antigen (PSA) test began to be widely used to detect this cancer (see next page) Incidence rates peaked in , and were 9-41 percent higher in 22 than in 1988 depending on race/ ethnicity These trends are consistent with the rapid introduction of a new, sensitive screening method African American men are at especially high risk for prostate cancer; they are over percent more likely to develop this disease than non-hispanic white men, nearly percent more likely than Hispanic men, and 1 times more likely than Asian/Pacific Islanders Unlike breast cancer, prostate cancer tends to be diagnosed late in life About 7 percent of prostate cancers are diagnosed among men ages 6 and older However, very little is known about the causes of prostate cancer Large international differences in prostate cancer risk indicate that lifestyle factors such as diet may be involved, and it is likely that diet interacts with hormonal status in complex ways The survival rate for prostate cancer is quite high (see page 19), especially when diagnosed early Prostate cancer mortality in California decreased significantly by percent after 1988, with declines among men in each race/ethnic group Nonetheless, it remains the second-leading cause of cancer-related mortality among men Trends in Prostate Cancer by Race/Ethnicity in California, Rate per, 9 Incidence Rate per, Mortality Non-Hispanic White African American Hispanic Asian/Pacific Islander Note: Rates are age-adjusted to the 2 US population Source: California Cancer Registry, California Department of Health Services Prepared by the California Department of Health Services, Cancer Surveillance Section In , the prostate cancer incidence rate in California compared to SEER areas other than California was 17 percent lower among Asian/Pacific Islanders, 12 percent lower among African Americans, eight percent lower among non-hispanic whites, and nine percent higher among Hispanics The Surveillance, Epidemiology, and End Results (SEER) Program registers cancer patients in geographic areas covering about 14 percent of the US population, including Los Angeles and the Bay Area

17 PROSTATE CANCER SCREENING 17 Percent Screened Within Last Year Unlike breast cancer, clinical trials have not clearly demonstrated a decrease in mortality following screening for prostate cancer, and many uncertainties remain surrounding the early detection of this disease One of the reasons for this is that, unlike many other cancers, prostate cancer often grows very slowly Because of this, many undiagnosed prostate cancers would never become life-threatening Although early diagnosis and treatment may help some men live longer, it may have no impact on the lifespan of other men Since testing for early detection of prostate cancer became common around 199, the prostate cancer death rate has dropped, but it has not been conclusively proven that this is a direct result of screening And, prostate cancer treatment can affect a man s quality of life Studies are underway which may resolve this issue ACS recommends that health care providers offer the PSA blood test and digital rectal examination annually, beginning at age, to men who have at least a ten-year life PSA and DRE Testing Among Men Ages and Older by Annual Household Income in California, 24 Percent Screened within Last Year < $2, $2-, $, + PSA DRE Note: Data are weighted to the 2 California population Source: California Behavioral Risk Factor Survey Prepared by the California Department of Health Services, Cancer Surveillance Section Percent Screened Within Last Year expectancy Men in high-risk groups, such as African Americans or those with brothers or fathers who have had prostate cancer, should begin screening at age 4 (see page 27) To assist men in making informed decisions about testing, physicians should inform their patients about and discuss with them the potential risks and benefits of early detection and treatment In 24, 7 percent of California men ages and over reported having had at least one PSA test while 82 percent reported having at least one DRE test Non-Hispanic white and African American men were more likely than Hispanic and Asian men to have been tested in the last year Men from households above poverty level were more likely to have had a prostate cancer screening test than men from households below poverty For information on stage at diagnosis by race/ethnicity, refer to page 2 Percent Screened within Last Year PSA and DRE Testing Among Men Ages and Older by Race/Ethnicity in California, 24 Non-Hispanic White African American Hispanic Asian/Pacific PSA DRE Islander Note: Data are weighted to the 2 California population Source: California Behavioral Risk Factor Survey Prepared by the California Department of Health Services, Cancer Surveillance Section AMERI MERICAN CAN ANCER SOCIET OCIETY ACT CTIVIT IVITIE IES ON PROSTATE CAN ANCER T hrough the Man To Man program, the Society makes information available about prostate cancer, especially early detection and treatment, and offers education and support programs for prostate cancer patients and their partners These programs provide men opportunities to share experiences, learn more about the disease, and to gain skills to meet individual needs following diagnosis The Society supports legislative activities to improve the availability of treatment for low-income prostate cancer patients, and research to help fight the disease Lets Talk About It, a collaboration of ACS and the Black Men of America, is aimed at educating African American men about prostate cancer In addition, the Society is a strong supporter of and participant in the California Prostate Cancer Coalition, formed to advocate for prostate cancer as a statewide public health issue

18 18 CERVICAL CANCER AND SCREENING In general, the risk of developing cancer is much lower for persons of Hispanic and Asian/Pacific Islander origin than for non-hispanic whites and African Americans However, this is not true for cervical cancer Hispanic women have the highest risk of developing cervical cancer, about twice as high as non-hispanic white women, African American and Asian/Pacific Islander women Cervical cancer is a major problem among many of the groups recently immigrating to California (see page 22) The American Cancer Society recommends that all women begin screening about three years after the start of vaginal intercourse but no later than 21 years of age, on an annual basis with conventional Pap tests, or every two years, using liquid-based Pap tests At or after age, women with three consecutive normal tests may be screened every two to three years Hispanic and Asian women are at greater risk of developing cervical cancer, but unfortunately, are less likely to receive routine screening than African American and non-hispanic white women In 24, the percent of women ages 18 and older in California who reported having a Pap smear in the previous three years was 94 percent, 86 percent, 84 percent, and 78 percent among African Americans, non-hispanic whites, Hispanics, and Asians, respectively Invasive Cervical Cancer Incidence by Race/ Ethnicity in California, SKIN CANCER AND SUN AVOIDANCE Skin cancer of all kinds is associated with exposure to the sun Melanoma of the skin is primarily a disease of non-hispanic white persons due to the increased susceptibility of fair-skinned people for this cancer In California, incidence rates of both in situ and invasive melanoma of the skin have increased in the past 1 years, but mortality rates have remained stable For information on survival and stage at diagnosis, refer to pages 19 and 21 To prevent skin cancer: Stay out of the sun between 1: in the morning and 4: in the afternoon; Wear protective clothing and a broad-brimmed hat; Use sun screens with SPF 1 or greater sun protection; and Protect children from sun exposure Trends in Melanoma Incidence and Mortality Among Non-Hispanic Whites in California, Rate per, Incidence, invasive Incidence, in situ Mortality Note: Rates are age-adjusted to the 2 US population Source: California Cancer Registry, California Department of Health Services Prepared by the California Department of Health Services, Cancer Surveillance Section Number of Sunburns in Past 12 Months in California, Rate per, Non-Hispanic White African American Hispanic Asian/Pacific Islander Note: Rates are age-adjusted to the 2 US population Source: California Cancer Registry, California Department of Health Services Prepared by the California Department of Health Services, Cancer Surveillance Section Percent Oldest Child < Zero 1 to 2 3 or more Note: Data are weighted to the 2 California population Children data from 23 California Behavioral Risk Factor Survey Source: California Behavioral Risk Factor Survey Prepared by the California Department of Health Services, Cancer Surveillance Section

19 TRENDS IN SURVIVAL Five-year relative survival has improved for many cancers in the past several decades Relative survival estimates the probability that an individual will not die from a given cancer during the specified time following diagnosis, after adjustment for the expected mortality from other causes % Trends in Five-Year Relative Survival for Selected Cancer Sites by Year of Diagnosis Percent Surviving 19 % 6% 4% 2% % Breast Prostate Colon & Rectum Note: Follow-up is through December 22 Source: California Cancer Registry, California Department of Health Services Prepared by the California Department of Health Services, Cancer Surveillance Section SURVIVAL BY STAGE AT DIAGNOSIS One of the strongest predictors of survival is the degree to which the cancer has spread when discovered, referred to as the stage at diagnosis Generally, the earlier the stage, the better the prognosis The following terminology is often used to summarize stage at diagnosis: In Situ Localized The tumor is at the earliest stage and has not extended through the first layer of cells (the basement membrane) in the area in which it is growing The tumor has broken through the basement membrane, but is still confined to the organ in which it is growing Five -Year Relative Survival by Stage at Diagnosis, California, Cancer Type All Stages Localized Regional Distant Female breast 86% 96% 77% 18% Cervix uteri 71% 91% 4% 16% Uterus 84% 9% 67% 19% Ovary 43% 9% 71% 27% Prostate 94% % 94% 33% Testis 94% 99% 9% % Oral & Pharynx 6% 76% 47% 2% Colon & Rectum 62% 89% 6% 8% Pancreas 4% 16% % 2% & Bronchus 1% 49% 19% 3% Melanoma 87% 93% 1% 13% Hodgkin's Disease 81% NHL* 2% Leukemia 44% Childhood (-19) 71% Adult (2+) 38% *NHL: Non-Hodgkin's Lymphoma Note: Follow-up is through December 22 Source: California Department of Health Services, Cancer Surveillance Section Prepared by the California Department of Health Services, Cancer Surveillance Section Regional Distant The tumor has spread to lymph nodes or adjacent tissues The tumor has spread to other parts of the body (metastasized)

20 2 STAGE AT DIAGNOSIS The percent of cancers diagnosed at an early stage (in situ or localized) is an indication of screening and early detection for the cancers listed below The fifteen most populous counties listed in the table account for percent of California s population The numbers are actual cases reported to the CCR for 22, while pages 6 and 7 show the expected number of cancers in 26 Percent of Cancer Diagnosed at Early Stage, California and Selected Counties, 22 California Alameda Contra Costa Fresno Kern Los Angeles Orange Riverside Sacramento San Bernardino San Diego San Francisco San Joaquin San Mateo Santa Clara Ventura California Alameda Contra Costa Fresno Kern Los Angeles Orange Riverside Sacramento San Bernardino San Diego San Francisco San Joaquin San Mateo Santa Clara Ventura California Alameda Contra Costa Fresno Kern Los Angeles Orange Riverside Sacramento San Bernardino San Diego San Francisco San Joaquin San Mateo Santa Clara Ventura Non-Hispanic White Total % Cases Early 19, ,89 1, , , ,698 1, , African American Total % Cases Early BREAST FEMALES PROSTATE MALES Total Cases Hispanic INVASIVE CERVIX FEMALES , , , , , , % Early Asian & Pacific Islander Total % Cases Early 2, , Source: California Cancer Registry, California Department of Health Services Data not shown if fewer than 1 cases were reported

21 STAGE AT DIAGNOSIS CONTINUED Percent of Cancer Diagnosed at Early Stage, California and Selected Counties, California Alameda Contra Costa Fresno Kern Los Angeles Orange Riverside Sacramento San Bernardino San Diego San Francisco San Joaquin San Mateo Santa Clara Ventura California Alameda Contra Costa Fresno Kern Los Angeles Orange Riverside Sacramento San Bernardino San Diego San Francisco San Joaquin San Mateo Santa Clara Ventura California Alameda Contra Costa Fresno Kern Los Angeles Orange Riverside Sacramento San Bernardino San Diego San Francisco San Joaquin San Mateo Santa Clara Ventura California Alameda Contra Costa Fresno Kern Los Angeles Orange Riverside Sacramento San Bernardino San Diego San Francisco San Joaquin San Mateo Santa Clara Ventura Non-Hispanic White Total % Cases Early, , , , , , African American Total % Cases Early Total Cases Hispanic COLON AND RECTUM MALES COLON AND RECTUM FEMALES % Early MELANOMA OF THE SKIN MALE MELANOMA OF THE SKIN FEMALES Source: California Cancer Registry, California Department of Health Services Data not shown if fewer than 1 cases were reported , Asian & Pacific Islander Total % Cases Early

22 22 CANCER IN DIVERSE POPULATIONS Five Most Common Cancers and Number of New Cases by Sex and Detailed Race/Ethnicity, California, Males Females African American American Indian South Asian Cambodian Chinese Filipino Hawaiian Hispanic Japanese Korean Laotian Non-Hispanic White Vietnamese 1 Prostate 9,1 Prostate 73 Prostate 8 49 Prostate 1,644 Prostate 1,91 Prostate 61 Prostate 13,82 Prostate Prostate, , Liver 4 1,83 1,164 4, Liver 46 34,929 Liver 398 Rank 3 2, , , Stomach ,213 Prostate NHL 77 Liver 26 NHL 8 Prostate 19 Liver 1 NHL 332 NHL 9 NHL 2,9 Stomach 219 Prostate 241 Lymphoma 2 Bladder 17, Kidney 689 Kidney 21 Leukemia 6 NHL 19 Stomach 371 Liver 277 Stomach 8 Leukemia 1,998 Bladder 186 Liver 217 Stomach 18 Melanoma 14,4 Stomach Breast 6,163 Breast 11 Breast 419 Breast 3 Breast 2,69 Breast 2,727 Breast 66 Breast 14,13 Breast 1,268 Breast 4 36 Breast 79,3 Breast , , , Breast 28 32,32 22 Rank 3 2,1 39 Uterus Uterus 21 3, Stomach 28 Cervix 2 2, Uterus 873 Uterus 2 Ovary 9 Thyroid 18 Uterus 4 Uterus 49 2 Cervix 3,99 Uterus Uterus 12,994 Cervix 14 Pancreas 634 Cervix 18 Thyroid 6 Cervix 17 Stomach 279 Thyroid 431 Pancreas 7 Uterus 2,17 Thyroid 2,12 Liver 11 Oral 13 Melanoma 9,893 Thyroid 137 Source: California Cancer Registry, California Department of Health Services Note: = colon and rectum; NHL = non-hodgkin s lymphoma The 2 Census counted 339 million Californians Of these, 47 percent were non-hispanic white, 32 percent Hispanic, 11 percent Asian/Pacific Islander, seven percent African American, and one percent American Indian or other race/ethnicity Another three percent of Californians reported that they were of more than one race This great diversity is further enhanced due to the fact that the Asian/Pacific Islander populations are composed of numerous nationalities, many of whom are recent immigrants Prostate cancer is a common cancer for males in most ethnic groups, but lung cancer is the most common among Korean, Cambodian, and Vietnamese males Breast cancer is the number-one cancer among women of all race/ethnic groups except Laotian women, for whom lung cancer is the most common

23 CANCER IN DIVERSE POPULATIONS 23 In general, the types of cancers that commonly develop are similar regardless of race/ethnicity In most race/ethnic groups in California, prostate, lung and bronchus, and colon and rectum cancer are among the top four cancers for males, while breast, lung and bronchus, and colon and rectum cancer are among the top four cancers for females (see previous page) And cancer is the second-leading cause of death among all race/ethnic groups Nonetheless, the risk of developing cancer varies considerably by race/ethnicity African American males have the highest overall cancer rate, followed by non-hispanic white males Among females, non-hispanic white women are the most likely to be diagnosed with cancer, but African Americans are more likely to die of the disease Cancer rates are considerably lower among persons of Asian/Pacific Islander origin and persons of Hispanic ethnicity than among other Californians However, both groups have substantially higher rates of certain cancers, such as liver and stomach cancer Asian/Pacific Islander and Hispanic women are also more likely to develop and die from cervical cancer Research indicates that cancer rates in populations immigrating to the US tend to increase over time The reasons for race/ethnic differences in cancer risk are not well understood It is likely that they result from a complex combination of dietary, lifestyle, environmental, occupational, and genetic factors Higher mortality rates among some populations are due in part to poverty, which may increase the risk of developing certain cancers and limit access to and utilization of preventive measures and screening Poor health among persons in poverty may also limit treatment options and decrease cancer survival Results from the 23 California Health Interview Survey show that over 6 million children and non elderly adults in California were uninsured for all or part of 23 Our challenge is to help improve the plight of those at risk, to identify the apparent protective cultural practices which explain lower incidence and mortality in some groups, and to assist other groups to adopt protective practices Rate per, Rate per, Cancer by Race/Ethnicity and Sex in California, 22 Males Males Non-Hispanic White Incidence Mortality African American Hispanic Females Females Asian/Pacific Islander Note: Rates are age-adjusted to the 2 US population Source: California Cancer Registry, California Department of Health Services Prepared by the California Department of Health Services, Cancer Surveillance Section

24 24 COMMON CANCERS BY AGE AND SEX Percent of New Cancers Diagnosed by Age and Sex, California, 22 Male Female -9 yrs 1% + yrs 16% 1-19 yrs 1% 2-29 yrs 1% -39 yrs 3% 4-49 yrs 7% -9 yrs 1% + yrs 17% 1-19 yrs 1% 2-29 yrs 1% -39 yrs % 4-49 yrs 12% -9 yrs 17% -79 yrs 28% -79 yrs 24% -9 yrs 19% 6-69 yrs 26% 6-69 yrs 2% Prepared by the California Department of Health Services, Cancer Surveillance Section Cancer risk varies considerably by age, with less than two percent of all cancers occurring before the age of 19, and about 6 percent occurring after age 6 In fact, nearly half of all cancers occur between ages -74, and more cancers occur after age 8 than before age Cancers occurring before the age of 2 are typically nonepithelial in origin, with the most common types being leukemias, tumors of the brain and central nervous system, and lymphomas Melanoma is a common cancer among both young adult males and females Kaposi s sarcoma is no longer among the top five cancers for males ages -44, due to recent dramatic decreases in this AIDSrelated cancer The introduction of highly active antiretroviral therapy (HAART) has resulted in a decrease in AIDS-related cancer incidence and improved survival Breast cancer is the most common cancer among adult women of all ages, while prostate cancer is the most common among males after age 4 and bronchus cancer is the second most common cancer among both men and women after age 4, followed closely by colon and rectum cancer Bladder cancer is common among elderly men, while cancer of the uterus is common among elderly women Bladder cancer is the fifth most commonly diagnosed cancer among those age 6 and older

25 CHILDHOOD CANCER More than 1, children and young adults under the age of 2 are diagnosed with cancer each year in California Of these, over 1, are under the age of 1 Although accidents kill about three times more children than cancer, an estimated one of every 34 children will develop some form of cancer before they are 2 years old these successful outcomes Clinical trials are available to help improve the outcome for all children with cancer, and must be considered in the evaluation of each child at the time of diagnosis 2 Trends in Five-Year Relative Survival Among Children Ages -14 by Year of Diagnosis Percent Number of Children and Young Adults Diagnosed with Cancer by Age at Diagnosis and Race/Ethnicity in California, 22 Non Hispanic White African American Hispanic Asian/Pacific Islander Source: California Cancer Registry, California Dept of Health Services Total Hodgkin s Wilms Soft Tissue NHL Leukemia Brain & CNS Note: Based on follow-up through 22 Source: SEER Cancer Statistics Review, National Cancer Institute, 2 Prepared by the California Department of Health Services, Cancer Surveillance Section In , the cancer incidence rate among children less than 1 years old was nearly identical in California than in SEER areas other than California The Surveillance, Epidemiology, and End Results (SEER) Program registers cancer patients in geographic areas covering about 14 percent of the US population, including Los Angeles and the Bay Area Cancer Incidence Among Children Ages -14 by Race/Ethnicity in California, 22 Non Hispanic White African American Hispanic Asian/Pacific Islander Cases Rate Rates are per, and age-adjusted to the 2 USstandard Source: California Cancer Registry, California Dept of Health Services Progress in the treatment of childhood cancer over the last years has been impressive The majority of children with cancer now grow to adulthood and lead productive lives Children with cancer must be treated at institutions that provide the intensive treatment, supportive care, and psychosocial services required to achieve AMERI MERICAN CAN ANCER SOCIET OCIETY ACTIVITIES ON CHILDHOOD CANCER T he California Division offers support programs, information, transportation and a variety of quality of life programs that help meet the needs of children with cancer and their families Recreational Opportunities for Cancer Kids (ROCK), Courageous Kids Day, ACS Summer Camps, and Relay For Life enable children with cancer and their families to enjoy time together for a day of fun at an amusement park, to spend a week among friends and families who face similar challenges and achievements, or to participate in a community celebration of the strength and courage of those affected by cancer The Young Cancer Survivor Scholarship Program awards college-bound or enrolled young cancer survivors scholarships of up to $, for college tuition and related costs for up to four years

26 26 CANCER RISK Lifetime risk of developing cancer is a frequently misinterpreted statistic The often-cited one-in-seven statistic for female breast cancer represents a newborn s likelihood of eventually being diagnosed with invasive breast cancer during her lifetime This statistic does not apply to women of all ages Risk of developing breast cancer in the next one or two decades of life may be considerably lower than the risk perceived by most women For example, the probability of being diagnosed with breast cancer over any 2-year period is much lower than commonly believed one out of 19 women will be diagnosed with breast cancer from ages 4 through 64 if cancer-free at age 4 For women cancer-free at 6, one out of 13 women will be diagnosed with breast cancer between the ages of 6 and 84 Probability of Being Diagnosed With Certain Cancers Over Selected Age Intervals 1, California, Birth to 19 2 to 44 4 to 64 6 to 84 Birth to Death One in: One in: One in: One in: One in: All Sites Male Female Breast Female * Colon and Rectum Male * Female * and Bronchus Male * 1, Female * 1, Prostate Male * 2, Assuming person is cancer-free at the beginning of the age interval * Probability is extremely small CAUSES OF CANCER CAUSES OF DEATH Approximately one-third of cancer deaths are caused by smoking, and another one-third by diet and obesity Effective prevention of many cancers is under your control by following the ACS guidelines on the next page While the successful treatment of cancer is cause for celebration, individual efforts to live a healthy life are extremely important Cancer is the second-leading cause of death in California, causing more than, deaths each year Smoking, poor diet, and obesity are key risk factors for diseases other than cancer, such as heart disease, cerebrovascular disease, chronic lung disease, and diabetes Following ACS guidelines for cancer prevention will also lower your risk for other diseases Risk Factors for Cancer Deaths in the United States Risk Factor Percent Tobacco % Diet/Obesity % Inactivity % Occupation % Family history of cancer % Viruses and other biologic agents % Perinatal factors/growth % Reproductive factors 3% Alcohol 3% Socioeconomic status 3% Environmental pollution 2% Ionizing/ultraviolet radiation 2% Prescription drugs 1% Salt/other food additives/contaminants 1% Total % Leading Causes of Death in California, 22 Cause Deaths Percent Heart Disease 68,387 29% Cancer 3,926 23% Cerebrovascular Disease 17,1 8% Chronic Disease 12,643 % Unintentional Injuries 9,882 4% Pneumonia and Influenza 8,98 4% Diabetes 6,783 3% Alzheimer's Disease,4 2% Chronic Liver Disease 3,72 2% Suicide 3,21 1% All Deaths 233,246 Source: Adapted from the Harvard Report on Cancer Prevention, 1996

27 ACS GUIDELINES ON NUTRITION, PHYSICAL ACTIVITY AND CANCER PREVENTION If you don t smoke, the most important risk factor that you control is a combination of diet and physical activity Introducing healthful diet and physical activity practices at any time from childhood to old age can promote health and reduce cancer risk Recently, the American Cancer Society updated its guidelines to include a recommendation for community action to ensure access to healthful foods and safe environments for physical activity The guidelines are as follows: 1 Don t smoke! Don t use any tobacco products 2 Eat a variety of healthful foods with an emphasis on plant sources 8 Eat or more servings of fruit and vegetables each day 8 Choose whole grains in preference to processed grains 8 Limit consumption of red meats, especially those processed and high in fat 8 Choose foods that maintain a healthful weight 3 Adopt a physically active lifestyle 8 Adults: Engage in at least moderate activity for minutes or more on or more days of the week CANCER SITE ITE 8 Children & Adolescents: Engage in at least 6 minutes of moderate to vigorous physical activity at least days per week 4 Talk to your doctor about cancer screening tests Maintain a healthful weight throughout life 8 Balance caloric intake with physical activity 8 Lose weight if currently overweight or obese 6 If you drink alcoholic beverages, limit consumption 7 Public, private, and community organizations should work to create social and physical environments that support the adoption and maintenance of healthful nutrition and physical activity behaviors 8 Increase access to healthful foods in schools, worksites and communities 8 Provide safe, enjoyable, and accessible environments for physical activities in schools, and for transportation and recreation in communities AMERI MERICAN CAN ANCER SOCIET OCIETY RECOMMEND MENDATIONS FOR THE EARL ARLY DET ETECT CTION OF CAN ANCER IN AVER VERAGE-RISK SK, ASYMP MPTOMATIC PEOPLE PLE POPUL ULATION TEST OR PROCEDURE Breast Women, age 2+ Clinical breast examination Colon and Rectum Men & Women, age + Mammography Breast self-examination One of these five testing schedules Fecal occult blood test (FOBT) or fecal immunochemical test (FIT) (For FOBT, the take-home multiple sample method should be used) Flexible sigmoidoscopy Annual FOBT or FIT plus flexible sigmoidoscopy every five years (this combination is preferred over either of these options alone) Double-contrast barium enema Colonoscopy FREQUENCY Every 3 years, ages 2-39 Annual, starting at age 4* Annual, starting at age 4 Optional, monthly, starting at age 2 Prostate Men, age + PSA blood test and digital rectal exam (DRE) The PSA test and the DRE should be offered to men annually starting at age Men in high-risk groups, such as African Americans or those with a family history of prostate cancer should begin screening at age 4 - Annual Every five years Every five years Every ten years 27 Cervix Women, age 21+ Pap test and pelvic examination Begin screening about 3 years after start of vaginal intercourse but no later than 21 years of age on an annual basis with conventional cytology smear Every 2 years with liquid-based cytology After age, if 3 consecutive normal tests, screening may be every 2-3 years Cancer-related check-up Men & women, age 2+ * Beginning at age 4, annual clinical breast examination should be performed prior to mammography H Flexible sigmoidoscopy together with FOBT is preferred compared with FOBT or flexible sigmoidoscopy alone - Information should be provided to men about the benefits and limitations of testing Examinations every 3 years from ages 2 to 39 years and annually after age 4 The cancer-related check-up should include examination for cancers of the thyroid, testicles, ovaries, lymph nodes, oral cavity, and skin, as well as health counseling about tobacco, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental and occupational exposures

28 28 MAJOR CANCER SITES CORE CANCERS RISK REDUCTION EARLY DETECTION (ED) & WARNING SIGNS (WS)* TREATMENT and Bronchus Colon and Rectum Avoid tobacco products in all forms; avoid second-hand smoke; follow workplace safety practices Removal of polyps; follow the ACS nutrition and physical activity guidelines; recent studies suggest certain drugs may reduce risk ED - Early detection tests are in clinical trial WS- Nagging cough, coughing up blood, unresolved pneumonia ED- Fecal occult blood test (FOBT); flexible sigmoidoscopy, colonoscopy, double-contrast barium enema WS- Rectal bleeding, change in bowel habits, blood in the stools Non-small cell: Surgery plus radiation therapy and/or chemotherapy for later stages Small-cell: Chemotherapy plus radiation therapy, and sometimes surgery, depending on prognostic factors Surgery plus radiation therapy and/or chemotherapy for later stages Prostate Prudent action would be to follow ACS nutrition and physical activity guidelines Clinical trials are underway to determine if vitamin E and selenium can reduce risk ED - Digital rectal examination Prostate specific antigen (PSA) WS- In most cases, there are no symptoms with early prostate cancer Difficulty with urinating or nagging pain in the back, hips or pelvis Surgery, radiation therapy, hormone manipulation, or watchful waiting, depending on stage Breast Follow ACS nutrition and physical activity guidelines; maintain normal weight; exercise 3 times per week Chemoprevention for high-risk women may be considered ED- Mammography; annual clinical breast examinations; breast self-examinations (optional) WS- Breast lump or a thickening; bleeding from nipple; skin irritation; retraction Surgery (breast conserving therapy with radiation, or mastectomy with or without radiation) plus chemotherapy and/or hormone therapy, depending on tumor size, spread to lymph nodes, and/or prognostic features OTHER CANCERS Bladder (Urinary) Avoid use of tobacco products; use workplace safety precautions if working in high-risk industry ED- Health-related checkups may identify early signs and symptoms WS- Blood in urine Surgery plus radiation therapy, immunotherapy, and/or chemotherapy for later stages Brain None known ED- Health-related checkups may identify early signs and symptoms WS- Headaches, convulsions, personality changes, visual problems, unexplained vomiting Surgery, radiation therapy, and/ or chemotherapy depending on tumor location Drugs are available to alleviate symptoms related to brain or other nervous system tumors Cervix Uteri Safe sex practices; avoid use of tobacco products ED- Pap smear and pelvic examination WS- Abnormal vaginal bleeding Surgery and/or radiation therapy Plus chemotherapy for later stages

29 MAJOR CANCER SITES 29 RISK REDUCTION EARLY DETECTION (ED) & WARNING SIGNS (WS)* TREATMENT Endometrium (Uterine Cancer) Hodgkin s Disease Lymphoma (Non-Hodgkin s) (NHL) Leukemia Melanoma (Skin) Oral Ovary Pancreas Stomach Testis When considering estrogen replacement therapy, benefits and risks must be considered by woman and her physician None known None known Use condoms to prevent HIV infection Reduce exposure to radiation and hazardous chemicals Avoid cigarette smoking Protect against sun exposure, especially in childhood; use protective clothing and sunscreens Avoid tanning lamps Avoid tobacco products in all forms and limit alcohol use Eat five servings of fresh fruits and vegetables Following ACS nutrition guidelines may be helpful Following ACS nutrition guidelines may be helpful Avoid use of tobacco products Avoid food high in nitrates; avoid use of tobacco products Eat a diet high in fresh fruits and vegetables None known ED- No screening examinations available for women without symptoms who are at average risk for endometrial cancer WS- Unusual bleeding, spotting, or abnormal discharge, especially if after menopause; Pelvic pain or mass; Unexplained weight loss Women should report warning signs to health care professional ED- Health-related checkups may identify early signs and symptoms WS- Night sweats, itching, unexplained fever, lymph node enlargement ED- Health-related checkups may identify early signs and symptoms WS- Lymph node enlargement, fever ED- Health-related checkups may identify early signs and symptoms WS- Fatigue, pallor, repeated infection, easy bruising, nose bleeds ED- Skin examinations by an experienced physician; monthly self-exams WS- A change in a mole or a sore that does not heal ED- Regular oral exams WS- Sore in mouth that does not heal; color change in an area of the mouth ED- Health-related checkups may identify early signs and symptoms WS- Often silent, abdominal symptoms, pain ED- Health-related checkups may identify early signs and symptoms WS- Vague abdominal symptoms, pain, and jaundice ED- Health-related checkups may identify early signs and symptoms WS- Indigestion ED - Testicular self-examination in young males has been suggested WS- Testicular mass or enlargement *Early cancer in most cases has no symptoms or warning signs Early detection guidelines should be followed Surgery plus radiation therapy, chemotherapy, or hormone therapy for later stages Chemotherapy and/or radiation therapy Bone marrow transplant for recurrent disease Chemotherapy and/or radiation therapy, plus stem cell transplant for advanced disease Chemotherapy, plus stem cell transplant depending on prognostic factors; Gleevec (imatinib mesylate) for treatment of chronic myeloid leukemia Surgery; immunotherapy for later stages Surgery and/or radiation therapy Plus chemotherapy for later stages Surgery, plus chemotherapy and sometimes radiation therapy for later stages Surgery, radiation therapy, and/ or chemotherapy depending on stage Surgery plus chemotherapy and radiation therapy for later stages Surgery plus radiation therapy and chemotherapy for later stages

30 ACS INTERIM OUTCOME MEASURES FOR CALIFORNIA The American Cancer Society s goals are to reduce cancer incidence by 2 percent, to reduce cancer mortality by percent, and to improve the quality of life for cancer survivors The California Division establishes interim outcome measures related to specific cancer control initiatives The table below shows some of the behaviors and outcomes being measured, ACS goals, and current data on achieving these goals in California ACS Outcome or Behavior Selected Populations 199 Percent Participating in California Interim Goals Breast Cancer Detection Annual mammogram when asymptomatic Women 4+ Women % 9% Diagnosed at early stage (in situ or localized) African American Asian/Pacific Islander Hispanic Non-Hispanic White % % % % Prostate Cancer Detection DRE Annual PSA (prostate specific antigen) test Men + African American males 4+ Men + African American males % % 9% 9% Colorectal Cancer Detection Sigmoidoscopy within five years Home blood stool past five years Diagnosed at early stage (in situ or localized) Men and women + Men and women + All % % % % Healthy Behaviors *Smoked during the last days Current smokers Youth years old Males 18+ Females % 1% 12% % % % Light to moderate exercise times/week for + minutes Eat -A-Day (fruits and vegetables) Adults 18+ Adults % 4% % 7% Source: Cancer Surveillance Section, California Department of Health Services Adult smoking rates are from the Behavioral Risk Factor Survey (BRFS) and the California Adult Tobacco Survey, combined Youth smoking rates are from the California Youth Tobacco Survey Cancer screening utilization, exercise, and diet information are from the BRFS Data on stage at diagnosis are from the California Cancer Registry N/A indicates data is not available *Weighted to the 2 California population AMERI MERICAN CAN ANCER SOCIET OCIETY ADVOC OCACY CY ACT CTIVIT IVITIE IES T he American Cancer Society has worked for over two decades to pass California laws to help cancer patients and improve cancer control ACS s Government Relations Office works with state legislators, their staff, state agency officials, cancer experts and ACS grassroots volunteers to advance the Society s mission to eliminate cancer as a major health problem Examples of past legislative victories include insurance coverage for breast reconstruction, prostheses, and screening mammography; state tobacco education and research programs created by Proposition 99, the landmark 2 cents a pack tobacco tax initiative; the smoking ban in enclosed workplaces, restaurants and bars; state breast cancer early detection, research and treatment programs; halting the illegal diversion of state tobacco education and research funds; insurance coverage for treatment in a cancer clinical trial; better pain management for cancer patients by eliminating a state prescription requirement; and enacting Patient Navigator legislation to assist underserved communities to access cancer information and treatment At the federal level, the California Division s Government Relations Office works closely with our National Government Relations Department in Washington, DC, Members of Congress and California ACS volunteers and staff to advocate for legislation that supports our cancer control mission Top federal legislative priorities include: increasing funding for the National Institutes of Health, the National Cancer Institute and the Centers for Disease Control and Prevention; and Food and Drug Administration regulation of tobacco The Society also works with local elected officials, ACS volunteers and allied groups to advocate for local policies that support our cancer control mission Examples of local advocacy efforts include smoke free-beaches, housing and entranceways; tobacco licensing ordinances; Colon Cancer Free Zones; nutrition and physical activity requirements for local schools; and campaigns targeted to mayors for cancer control priorities ACS has also established a new sister organization called ACS Cancer Action Network (CAN) to increase the scope of ACS s advocacy efforts ACS CAN hosts candidate forums and produces and distributes voter education guides to publicize candidates positions on cancer-related issues For more information on ACS CAN, or updated information on ACS s state and federal legislative efforts, visit wwwacscanorg ACS also operates an action network for those prepared to contact their legislators on important cancer related legislation Network members are kept informed of legislative activity in Sacramento and Washington DC, and receive inside information on which bills are moving, and when contacts to legislators are needed To join, call

31 AMERICAN CANCER SOCIETY, CALIFORNIA DIVISION 31 OUR MISSION 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, and diminishing suffering from cancer, through research, education, advocacy and service NO MATTER WHO OR WHERE YOU ARE THE AMERICAN CANCER SOCIETY CAN HELP In 26, an estimated 136,87 Californians will be diagnosed with cancer For these individuals and their loved ones, a cancer diagnosis is the beginning of a long journey through decision-making and treatment The American Cancer Society is the one place people can turn to every hour of every day for free, up-to-date, and unbiased information each step of the way Using Donated Money Wisely % California Cancer Control Programs Patient Support Prevention/ Risk Reduction Detection/ Treatment 39% Nationwide Program Support Research Patient Support and Education Supporting Services 22% Fundraising 4% Management and General More than $8 million was awarded to California research institutions Nationwide the American Cancer Society funds about $ million annually Regardless of where cancer research happens, the breakthroughs benefit us all Source: American Cancer Society California Division, Inc audited financial figures, 23-4 FINANCIAL SUPPORT The generosity of our donors is what allows us to battle cancer on so many fronts In 24, the California Division of the American Cancer Society received the following support: Contributions Special events Legacies and bequests In-kind contributions Other fundraising activities Total support from public $187 million $33 million $319 million $49 million $17 million $97 million VOLUNTEER ENGAGEMENT More than 16, Californians volunteer their time to help deliver programs and services, raise awareness and dollars, and provide hope The California Division is led by an unpaid volunteer Board of Directors, comprised of community leaders, health care professionals, survivors, and concerned citizens IMPACT OF THE AMERICAN CANCER SOCIETY IN CALIFORNIA COMMUNITIES Californians benefited from the American Cancer Society s free information, programs and services nearly 6 million times last year Californians in the Society s advocacy network made over 6, contacts with elected officials about cancer-related issues 6,97 people received 197,82 free rides to doctor and treatment appointments 13,727 calls were answered by American Cancer Society Information Specialists staffing the 24/7 tollfree phone line; thousands more visited the cancerorg Web site for the latest cancer information 6,427 people participated in our Reach to Recovery volunteer support program for women with breast cancer and our Man to Man education and support program for men with prostate cancer and their loved ones 1,82 new California users registered for the Cancer Survivors Network, the Society s Web-based network for cancer survivors and their caregivers 369,172 nine- to eleven-year-olds participated in our Spring Into Health! nutrition and physical activity awareness program

32 32 THE RESEARCH PROGRAM OF THE AMERICAN CANCER SOCIETY The Society s Research Program Was Created in 1946 The American Cancer Society is the largest non-profit non-government funder of cancer research in the United States Since our research program began in 1946, the ACS has devoted more than $28 billion to cancer research As the nation s largest private, not-for-profit source of funds for scientists studying cancer, the American Cancer Society focuses its funding on investigator-initiated, peer-reviewed proposals This process ensures that scientists propose projects that they believe are ready to be tackled with the available knowledge and techniques, rather than working on projects designed by administrators who are far removed from the front lines of research This intellectual freedom encourages discovery in areas that scientists believe are most likely to solve the problems of cancer MAJOR DEVELOPMENT IN CANCER RESE SEAR ARCH CH NFLAM AMMATION- CANCER LINK CH 24: INFL An ancient Greek physician noted a connection between wound healing in chronic or recurrent injuries and tumor growth, but it was not until 24 that scientists in the laboratory of ACS Research Professor Michael Karin, PhD, University of California, San Diego School of Medicine, found the first evidence of a direct molecular link between inflammation and cancer Untreated chronic inflammation is a hallmark of some cancers of the cervix, colon, and stomach Ironically, the process and signals that trigger inflammation needed for the healing and regeneration of injured tissues are also used by malignant cells to form tumors, including cancers affecting the liver, esophagus, stomach, large intestine, colon, prostate, pancreas, ovaries and urinary bladder Dr Karin and his colleagues deleted the pro-inflammatory gene IKKB in mice specially bred for susceptibility to colitis, an inflammation of the intestine In these mice, not only was inflammation reduced, but cancer incidence and tumor growth was decreased by nearly % These mechanisms may explain why anti-inflammatory drugs may reduce colorectal cancer risk The American Cancer Society s Cancer Prevention Trial II study, led by Michael Thun, MD, Vice President, Epidemiology and Surveillance Research, showed a lower risk of colon cancer among people who take anti-inflammatory drugs, namely aspirin, regularly While taking aspirin regularly to reduce colorectal risk is not recommended due to the serious side effects that can occur, several other drugs are currently being developed to thwart inflammation-induced carcinogenesis The causal relationship between inflammation and cancer is generally accepted; however, the contributions of Drs Karin, Thun and their colleagues are leading the way toward a better understanding of important signal pathways that permit the immune system to induce tumor development Their work exemplifies how crucial the Society s research investment is to solving the cancer puzzle and accomplishing the Society s mission FUNDING IN SELECTED PRIORITY AREAS*: EXPENDITURES IN FY Area of Research Cause/Etiology Psychosocial and Behavioral Treatment Prevention Prevention (Uncategorized) Nutrition Tobacco Control National Cancer Screening Trail Poor and Underserved Epidemiology Health Policy/Health Services Detection Environmental Carcinogenesis Childhood Cancer Major Organ Sites Breast Colon/rectum Leukemia ** Prostate Melanoma Lymphoma Brain and Nervous System Ovary Pancreas $ Awarded 23,497, 18,971, 16,31, 13,881, 7,, 3,749, 1,889, 693, 9,64,,17, 4,612, 4,376, 1,961, 1,6, 2,2, 1,277, 12,943, 1,73, 9,36, 8,6, 7,94, 6,77, 6,224, 2,613, *Not mututally exclusive categories ie, a grant that is both preventive and detection is counted twice, as is a grant that studies both breast and prostate cancers A grant emphasizing nutrition in breast and prostate cancer is counted in full in all three places Dollar amounts are rounded off to the nearest $1, **Includes dollar amounts from the, National Cancer Screening Trial (NLST)

33 ACS RESEARCH LEADERSHIP SOCIETY PROFESSORSHIPS The Society s Professorships are among the most prestigious individual awards given to researchers The highly competitive, peer-reviewed programs select some of the nation s most gifted scientists, freeing them of major administrative responsibilities and thereby enabling them to devote their work to cancer research RESEARCH PROFESSORS:! Inder Verma, PhD, Salk Institute for Biological Studies, San Diego! Douglas Hanahan, PhD, University of California, San Francisco, FM Kirby ACS Research Professor! Lewis Lanier, PhD, University of California, San Francisco! Cynthia J Kenyon, PhD, University of California, San Francisco CLINICAL RESEARCH PROFESSORS:! Patricia J Ganz, MD, University of California, Los Angeles Jonsson Comprehensive Cancer Center! Dennis Slamon, MD, PhD, University of California, Los Angeles Jonsson Comprehensive Cancer Center FRANK AND ELSE SCHILLING AMERICAN CANCER SOCIETY PROFESSORSHIPS:! Ronald Levy, MD, Stanford University, Stanford! Christine Guthrie, PhD, University of California, San Francisco! Tony Hunter, PhD, Salk Institute for Biological Studies, San Diego! Michael Karin, PhD, University of California, San Diego NOBEL PRIZE WINNERS The Society is proud of the 38 investigators that we supported before they went on to win the Nobel prize, considered the highest accolade any scientist can receive ACS HAS BEEN INVOLVED IN MANY OF THE MAJOR CANCER RESEARCH BREAKTHROUGHS OF THE CENTURY: percent -year survival rates for many childhood leukemias Pap smear crusade to detect cervical cancer Mammography to screen for breast cancer Lumpectomy + radiation for treatment of breast cancer PSA test for prostate cancer screening -FU (chemotherapy) for colon cancer Identification of smoking as cause of lung cancer Creation of recombinant DNA and gene cloning Discovery of cancer-causing oncogenes and tumor suppressor genes Discovery of genes for inherited breast and colon cancer Use of tamoxifen to reduce risk of second or first breast cancer Development of monoclonal antibodies to treat breast cancer (Herceptin) and lymphoma (Rituxan) Use of small molecule inhibitors to target genes that are at the root of cancer such as Gleevec for treatment of chronic myeloid leukemia CONTEMPORARY CANCER RESEARCH IS POISED TO MAKE GREAT ADVANCES IN THE COMING DECADE IN THE AREAS OF: Targeted drugs designed to attack the altered genes that are at the root of cancer, eg, anti-telomerase, pro-apoptosis, anti-angiogenesis, oncogene inhibitors Immunotherapy therapeutic vaccines and monoclonal antibodies; antibody-guided therapy of drugs or radioactive compounds attached to anti- tumor antibodies Chemoprevention selective estrogen receptor modulators (SERM), anti-inflammatory drugs (celecoxib), antioxidants (selenium, vitamin E, omega-3 oils) Gene therapy Gene-environment interactions leading to increased susceptibility to cancer Intensity-modulated radiation therapy (IMRT), using a radiation gun that focuses thousands of pinpoint, varying-intensity X-rays or proton beams on tumors that previously were not considered good targets for radiation therapy (prostate, nasopharyngeal) Imaging techniques to detect cancer at its earliest stages and to monitor the effectiveness of therapy Pharmacogenomics to identify the genetic signatures of patients to reduce toxicity and optimize therapy Tumor genomic profiling for better management of the disease and determination of the most effective therapy Proteomic techniques for early detection of cancer in blood samples CANCER AND THE ENVIRONMENT The American Cancer Society supports research to learn about the role of environmental factors in cancer causation While environmental factors have been definitely associated with certain cancers (examples: asbestos exposure with mesothelioma and lung cancer, especially in smokers and vinyl chloride exposure with certain liver cancers), the role of the environment and cancer is evolving The California Division has established a team of experts to assist in the development of approaches related to environmental issues based on research data Some of the topics that the team has reviewed are cancer clusters, arsenic in the state s drinking water, clean air school buses, integrated pest management policies for schools, diesel exhaust emissions, environmental justice and the built environment The team provides advice to the Division on environmental issues in the community and in the state legislative arena 33 SUMMARY OF RESEARCH GRANTS AND FELLOWSHIPS Awarded by the American Cancer Society (National and Division) during the fiscal year ending August 31, 2 # Total Amount California Institute of Technology Kaiser Foundation Research Institute Ludwig Institute for Cancer Research Northern California Institute for Research and Education Salk Institute for Biological Sciences Scripps Research Institute Stanford University University of California, Berkeley University of California, Davis $ $ $ $ $ $ $ $ $ 72, 827, 138, 138, 74, 1,621 1,7,1 94, 138, # Total Amount University of California, Irvine University of California, Los Angeles University of California, San Diego University of California, San Francisco $ $ $ $ 1,4, 2,99, 3,473, 3,164,9 1 University of Santa Cruz $ 9, 48 Total $16,671,66 Note: These awards represent multiple-year funding usually for grants to be carried out for three or four years

34 34 CALIFORNIA DEPARTMENT OF HEALTH SERVICES CANCER CONTROL ACTIVITIES NEED FOR COMPREHENSIVE CANCER CONTROL PLANNING (CCCP) ACTIVITIES The significant growth of cancer prevention and control programs within various health agencies has lead to the realization that improved coordination of cancer control activities is essential to maximize resources and achieve desired cancer control outcomes Comprehensive cancer control (CCC) results in many benefits to those states that undertake the process including increased efficiency for delivering public health messages and services to the public The Centers for Disease Control and Prevention (CDC) is advocating and building the knowledge base for comprehensive cancer control, which it defines as an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality through prevention, early detection, treatment, rehabilitation, and palliation While California has a number of individual programs focused on cancer control, there is a definite need to coordinate these activities into a single comprehensive plan Coordination of cancer control activities will help minimize duplication of efforts by the California Department of Health Services (DHS), the California Division of the American Cancer Society, and other organizations engaged in cancer prevention and control activities and help maximize resources dedicated to cancer control during these uncertain economic times in California This coordination will also presumably help the state more efficiently deliver cancer-related health services to the public Specifically, a comprehensive cancer control plan should help California expand its cancer prevention and control efforts in a strategic and planned fashion, as well as make the results of existing programs more available through regular evaluation The California Dialogue on Cancer (CDOC) was created to provide guidance for comprehensive cancer control activities in California CDOC is a coalition of cancer control leaders from throughout the state These leaders include members of state and local government, members of the public, non-profit organizations, health, medical, and business communities, the research community, and cancer survivors, caregivers, and advocates In March 23, CDOC convened more than 2 stakeholders who worked together to develop the California Comprehensive Cancer Control Plan (CCCCP) This plan represents the first formal attempt in over two decades to bring together all stakeholders to share resources and develop solutions to the burden of cancer in California The CCCCP will be implemented and administered by CDOC Development of a statewide plan is only the first step in an ongoing process of implementing comprehensive cancer control in California Development and adoption of a comprehensive plan will assist DHS in addressing existing gaps in cancer control, particularly those relating to disparities in cancer burden among ethnic minorities and the medically underserved Ultimately, adoption of the CCCCP will formalize current efforts and policies in the state into a document that should be endorsed by both the Legislature and the Governor, thus ensuring support for such activities far into the future As part of its mission to reduce the burden of cancer in California, CDOC determined colorectal cancer to be a top priority According to the American Cancer Society, colorectal cancer is the second leading cause of cancer-related death in the United States In California, colorectal cancer is the third most common cancer among both men and women and over,2 Californians are expected to die of this disease in 26 Given that several screening techniques exist for colorectal cancer, it is possible to reduce the number of deaths related to this disease by detecting and removing pre-cancerous polyps before invasive cancer develops CDOC will focus its efforts on raising awareness of colorectal cancer particularly in minority and medically underserved communities with the goal of increasing screening rates throughout the state TOBACCO CONTROL The strongest anti-tobacco legislation in the nation was passed by citizens of California in 1988 the Tobacco Tax and Health Promotion Act (Proposition 99) Since then, DHS has used funds from Proposition 99 taxes on tobacco products to launch an award-winning anti-smoking media campaign, to fund local prevention programs, and to monitor smoking prevalence and other use of tobacco products throughout the state cancer mortality rates are now falling faster in California than elsewhere in the US CANCER PREVENTION The Cancer Prevention and Nutrition Section was established in 1986 to develop technical capacity in DHS for implementing large-scale dietary improvement measures Its activities include the development and implementation of the a Day for Better Health! Campaign in 1988, California Dietary Practices Surveys starting in 1989, and the Nutrition Network for Healthy, Active Families Campaign and the Skin Cancer Prevention Program in 1998 BREAST, CERVICAL, AND PROSTATE CANCER DETECTION AND TREATMENT The largest public cancer screening program in the nation, DHS provides free breast and cervical cancer screening, diagnostic and treatment services to low-income women with no or limited health insurance Ten regional cancer detection partnerships assist in outreach and education to women, quality assurance and provider education Over 2, doctors and clinics provide clinical services Approximately 1, women were screened in fiscal year 7/1-6/2 More than 7% were women of color To determine eligibility for free screening, women can call Calls are accepted in English, Spanish, Mandarin, Cantonese, Vietnamese and Korean CANCER SURVEILLANCE Cancer rates among Californians are monitored by the Cancer Surveillance Section, DHS through the California Cancer Registry (CCR), which collects information on all cancers diagnosed in California since 1988 To date, the CCR has collected detailed information on over two million cases of cancer, with over 1, new cases added annually The database includes information on demographics, cancer type, extent of disease at diagnosis, treatment, and survival With this high quality data, leading cancer researchers are able to advance scientific knowledge about the causes, treatment, cures and prevention of cancer The CCR in conjunction with American Cancer Society produces California Facts and Figures Additionally, through annual and special-topic reports, the CCR keeps health professionals, policy-makers, cancer advocates, and researchers informed about the status of cancer in California CCR data is the cornerstone of cancer research in California SURVEILLANCE OF HEALTH-RELATED BEHAVIORS The DHS Survey Research Group (SRG) has collected information on health-related behaviors since 1984 More than 4,2 telephone surveys are conducted each year with a random sample of California adults to determine how many people are following cancer prevention and screening recommendations These data are used by other programs to assess need, target interventions, and measure success SRG also has ongoing surveys of teens, women, and smoking behavior

35 DATA SOURCES EXPECTED CASES AND DEATHS Expected cases and deaths were estimated by the California Cancer Registry (CCR), California Department of Health Services (CDHS) These estimates will differ from those published by the National American Cancer Society, which are based on rates from the Surveillance, Epidemiology, and End Results (SEER) program CANCER INCIDENCE AND MORTALITY Where not otherwise specified, cancer incidence data is from the most current data on the CCR The CCR is a legally mandated, statewide, population-based cancer registry, implemented in 1988 Cancer mortality data is from the CDHS Center for Health Statistics and is based on the underlying cause of death SURVIVAL TRENDS Survival trends are from the most current data on the CCR, and patient follow-up is through December 22 CALIFORNIA BEHAVIORAL RISK FACTOR SURVEY (BRFS), CALIFORNIA ADULT TOBACCO SURVEY (CATS), AND CALIFORNIA YOUTH TOBACCO SURVEY These surveys are conducted by the Survey Research Group (SRG), which is part of the CCR They are a collaboration between the Centers for Disease Control and Prevention, the Public Health Institute, and the CDHS To monitor key health behaviors, approximately 8, randomly selected adults and 2,4 youth ages are interviewed by telephone annually Not all questions are asked each year; the most recent data available is presented For more information on these and other SRG surveys, visit the SRG website at CCR ACKNOWLEDGEMENT AND DISCLAIMER All publications shall contain the following acknowledgment and disclaimer: The collection of cancer incidence data used in this study was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 1388; the National Cancer Institute s Surveillance, Epidemiology and End Results Program under contract N1-PC-136 awarded to the Northern California Cancer Center, contract N1-PC- 139 awarded to the University of Southern California, and contract N2-PC-11 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention s National Program of Cancer Registries, under agreement #U/CCR awarded to the Public Health Institute The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Health Services, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred CALIFORNIA CANCER REGISTRY EGISTRY: wwwc ccr crcalo alorg 1 Tribute Road, Suite, Sacramento, CA 981, (916) 779- FAX: (916) REGIONAL CANCER REGISTRIES Region 1/8: Northern California Cancer Center 221 Walnut Avenue, Suite, Fremont, CA 9438, (1) 68-, FAX (1) 68-9 Counties: Region 1: Santa Clara Region (Monterey, San Benito, Santa Clara and Santa Cruz Counties) Region 8: Bay Area Region (Alameda, Contra Costa, Marin, San Francisco and San Mateo Counties) Region 2: Cancer Registry of Central California,162 East Shaw Ave, Suite 1, Fresno, CA 9371, (9) 244-4, FAX (9) Counties: Central Region (Fresno, Kern, Kings, Madera, Mariposa, Merced, Stanislaus, Tulare and Tuolumne Counties) Region 3: Cancer Surveillance Program, 2 L Street, Suite 44, Sacramento, CA 9816, (916) , FAX (916) Counties: Sacramento Region (Alpine, Amador, Calaveras, El Dorado, Nevada, Placer, Sacramento, San Joaquin, Sierra, Solano, Sutter, Yolo and Yuba Counties) Region 4: Tri-Counties Cancer Surveillance Program 164 State Street, Suite C, Santa Barbara, CA 9311, () 7-121, FAX () Counties: Tri-County Region (San Luis Obispo, Santa Barbara and Ventura Counties) Region : Desert Sierra Cancer Surveillance Program,11368 Mountain View Ave, Suite C, Loma Linda, CA 924, (99) 8-61, FAX (99) Counties: Inland Empire Region (Inyo, Mono, Riverside and San Bernardino Counties) Region 6: Cancer Registry of Northern California 2 Jan Court, Suite 1, Chico, CA 9928, () , FAX () Counties: North Region (Butte, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Napa, Plumas, Shasta, Siskiyou, Sonoma, Tehama and Trinity Counties) Region 7/1: Cancer Surveillance Program of Orange County and San Diego Imperial Organization for Cancer Control, 224 Irvine Hall,University of California, Irvine, CA , (949) , FAX (949) Counties: Region 7: San Diego Region (Imperial and San Diego Counties) Region 1: Orange County Region 9: Cancer Surveillance Program, University of Southern California,14 Alcazar St, CHP-24, Los Angeles, CA 989, (323) 442-2, FAX (323) Counties: Los Angeles County CANCER WEB SITES Many of these Web sites have links to other sites and resources American Cancer Society wwwcancerorg CanSearch wwwcansearchorg California Cancer Registry wwwccrcalorg International Agency for Research on Cancer wwwiarcfr NCI CancerNet wwwcancergov NCI Cancer Trials wwwcancergov/ NCI Web site for Patients, Public, and Mass Media wwwcancergov OncoLink wwwoncolinkupennedu SEER Program www-seerimsncinihgov

36 CALIFORNIA DIVISION, REGIONS & COUNTIES California Division: 171 Webster Street, Oakland, CA 94612, (1) BS BORDER/SIERRA 26 Camino del Rio North, Suite San Diego, CA 9218 (619) Imperial County San Diego County 124 Palmyrita Avenue, Unit A Riverside, CA 927 (91) -12 Inyo County Mono County Riverside County San Bernardino County GBA GREATER BAY AREA/ REDWOOD EMPIRE 1 Webster Street Oakland, CA (1) East Bay Alameda County Contra Costa County Solano County Redwood Empire Del Norte County Humboldt County Lake County Mendocino County Napa County Sonoma County West Bay Marin County San Francisco County San Mateo County GC GOLD COAST 426 East Barcellus, Suite 4 Santa Maria, CA 9344 () San Luis Obispo County Santa Barbara County Ventura County GV GREAT VALLEY 176 Challenge Way, Suite 11 Sacramento, CA 981- (916) Alpine County Amador County Butte County Calaveras County Colusa County El Dorado County Glenn County Lassen County Modoc County Nevada County Placer County Plumas County Sacramento County San Joaquin County Shasta County Sierra County Siskiyou County Stanislaus County Sutter County Tehama County Trinity County Tuolumne County Yolo County Yuba County 2222 West Shaw Ave, Suite 21 Fresno, CA (9) Fresno County Kern County Kings County Madera County Mariposa County Merced County Tulare County LA LOS ANGELES 3333 Wilshire Blvd, Suite 9 Los Angeles, CA (213) Los Angeles County OC ORANGE COUNTY Alton Deere Plaza 194 East Deere Ave, Suite Santa Ana, CA 92 (949) Orange County SV SILICON VALLEY/ CENTRAL COAST 747 Camden Avenue, Suite B Campbell, CA 98 (48) Monterey County San Benito County Santa Clara County Santa Cruz County GBA SV GV GC The American Cancer Society is the only voluntary community-based organization fighting cancer on the local, state, and national levels Our programs of research, education, advocacy and patient services are financed by public contributions Thank you for your support LA OC BS For Information call 1--ACS- 234 wwwcancerorg Printed on recycled paper 64996