The Cancer Burden in California Janet Bates MD MPH California Cancer Registry California Department of Public Health April 25, 2012
Goals Introduce you to the California Cancer Registry (CCR) Provide an overview of California s cancer burden Highlight cancers associated with overweight/obesity and lack of sufficient physical activity Present data on California s cancer burden compared to that of the U.S.
The California Cancer Registry The mission of the California Cancer Registry is to serve the public by collecting statewide data, and conducting surveillance and research into the causes, controls, and cures of cancer, and communicating results to the public.
The California Cancer Registry Established by state law passed in 1985 The CCR has collected information on all new cancer cases and deaths for the entire state of California since 1988 Hospitals and physicians are required to report cancer cases to the CCR
The California Cancer Registry We receive over 200,000 cancer case reports each year After weeding out duplicate reports, we end up with about 170,000 new cases added to the database each year We now have over 4 million cases diagnosed from 1988 forward in our database
Cancer Surveillance Terms Incidence = number of new cancers diagnosed in a population during a specific time period Mortality = number of cancer-related deaths in a population during a specific time period Incidence Rate or Mortality Rate = number of new cancers or cancer-related deaths occurring in a population during a specific time period, divided by the population at risk (often expressed as the number of new cancers or deaths per 100,000 population at risk)
The Cancer Burden: Objective #1 By 2015, decrease the overall cancer incidence rate in California by 5%, from a baseline rate of 431 per 100,000 in 2009 to a target rate of 409 per 100,000 in 2015
The Cancer Burden: Objective #1
Cancer Incidence in California Cancer incidence rates in California declined by 7% from 1988 to 2009 This decrease was driven by declines in lung, prostate, colon and rectum, and bladder cancers among men and breast, colon and rectum, and lung cancers among women Despite these improvements, nearly one out of every two Californians born today will develop cancer at some point in their lives
Five Most Common Types of Cancer Incidence among Men Cancer Site 2009 Count 2009 Rate 1 Prostate 20,746 126.0 2 Lung and Bronchus 8,419 55.7 3 Colon and Rectum 7,498 47.1 4 Urinary Bladder 4,688 31.4 5 Melanoma of the Skin 4,203 25.9 Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. Source: California Cancer Registry, June 2011
Five Most Common Types of Cancer Incidence among Men Age-Adjusted Rate per 100,000 650 600 550 500 450 400 350 300 250 200 150 100 50 0 Trends in the Five Most Common Types of Cancer Incidence among Men, California, 1988-2009 All Cancers (APC1 = 3.9*, APC2 = -4.0, APC3 = -0.7*) Prostate (APC1 = 16.1*, APC2 = -11.1, APC3 = 0.9, APC4 = -2.2*) Lung & Bronchus (APC = -2.3*) Colon & Rectum (APC = -1.6*) Urinary Bladder (APC = -0.5*) Melanoma (APC1 = 0.1, APC2 = 8.3, APC3 = 1.9*) Year of Diagnosis *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
Five Most Common Types of Cancer Incidence among Men 250 Trends in the Five Most Common Types of Cancer Incidence among Men, California, 1988-2009 Age-Adjusted Rate per 100,000 200 150 100 50 0 Prostate (APC1 = 16.1*, APC2 = -11.1, APC3 = 0.9, APC4 = -2.2*) Lung & Bronchus (APC = -2.3*) Colon & Rectum (APC = -1.6*) Urinary Bladder (APC = -0.5*) Melanoma (APC1 = 0.1, APC2 = 8.3, APC3 = 1.9*) Year of Diagnosis *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
Five Most Common Types of Cancer Incidence among Women Cancer Site 2009 Count 2009 Rate 1 Breast 23,404 121.7 2 Lung and Bronchus 8,077 42.2 3 Colon and Rectum 6,894 35.2 4 Corpus and Uterus, NOS 4,626 23.5 5 Thyroid 3,166 17.0 Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. Source: California Cancer Registry, June 2011
Five Most Common Types of Cancer Incidence among Women 450 Trends in the Five Most Common Types of Cancer Incidence among Women, California, 1988-2009 400 Age-Adjusted Rate per 100,000 350 300 250 200 150 100 All Cancers (APC1 = -0.4, APC2 = 0.8, APC3 = -1.1*, APC4 = 0.2) Breast (APC1 = 0.5*, APC2 = -3.9, APC3 = 0.9) Lung & Bronchus (APC1 = 0.1, APC2 = -1.3*) Colon & Rectum (APC1 = -2.1*, APC2 = 1.1, APC3 = -1.8*) Corpus & Uterus, NOS (APC1 = -0.4, APC2 = -2.0*, APC3=1.9*) Thyroid (APC1 = 3.0*, APC2 = 6.4*) 50 0 Year of Diagnosis *The annual percent change (APC) is significantly different from zero.
Five Most Common Types of Cancer Incidence among Women 150 Trends in the Five Most Common Types of Cancer Incidence among Women, California, 1988-2009 Age-Adjusted Rate per 100,000 100 50 Breast (APC1 = 0.5*, APC2 = -3.9, APC3 = 0.9) Lung & Bronchus (APC1 = 0.1, APC2 = -1.3*) Colon & Rectum (APC1 = -2.1*, APC2 = 1.1, APC3 = -1.8*) Corpus & Uterus, NOS (APC1 = -0.4, APC2 = -2.0*, APC3=1.9*) Thyroid (APC1 = 3.0*, APC2 = 6.4*) 0 Year of Diagnosis *The annual percent change (APC) is significantly different from zero.
Five Most Common Types of Cancer Incidence among Women 75 Trends in the Five Most Common Types of Cancer Incidence among Women, California, 1988-2009 Age-Adjusted Rate per 100,000 50 25 Lung & Bronchus (APC1 = 0.1, APC2 = -1.3*) Colon & Rectum (APC1 = -2.1*, APC2 = 1.1, APC3 = -1.8*) Corpus & Uterus, NOS (APC1 = -0.4, APC2 = -2.0*, APC3=1.9*) Thyroid (APC1 = 3.0*, APC2 = 6.4*) 0 Year of Diagnosis *The annual percent change (APC) is significantly different from zero.
Cancer Incidence by Race/Ethnicity and Sex Five-Year, Age-Adjusted Cancer Incidence Rates by Race/Ethnicity and Sex, California, 2005-2009 700 African American Non-Hispanic White Hispanic Asian/PI Rate per 100,000 600 500 400 300 200 608 548 394 342 408 438 310 303 100 0 Source: California Cancer Registry, February 2012 Male Female
Cancer Incidence by Asian Subgroup and Sex Five-Year, Age-Adjusted Cancer Incidence Rates by Asian Subgroup and Sex, California, 2004-2008 450 Korean Vietnamese Filipino Japanese Chinese South Asian Rate per 100,000 400 350 300 250 200 150 394 375 370 350 313 267 267 296 304 310 258 250 100 50 0 Source: California Cancer Registry, February 2012 Male Female
Cancer Incidence Trends, California vs. United States 520 510 Trend in Age-Adjusted Cancer Incidence Rates, California vs. United States*, 1988-2009 United States (APC1 = 2.8^, APC2 = -2.3, APC3 = 1.1, APC4 = -0.5^) California (APC1 = 2.0, APC2 = -0.6^) Rate per 100,000 500 490 480 470 460 450 440 430 420 Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb. 2012 and SEER*Stat Database: Incidence, SEER 9 Reg Research Data Nov. 2011.
The Cancer Burden: Objective #2 By 2015, decrease the overall cancer mortality rate in California by 5%, from a baseline rate of 158 per 100,000 in 2009 to a target rate of 150 per 100,000 in 2015
The Cancer Burden: Objective #2 Trend in Age-Adjusted Cancer Mortality Rate, California, 1988-2009 All Cancer Deaths (APC1 = -0.7*, APC = -1.5*) Target Rate 210 200 Rate per 100,000 190 180 170 160 150 140 Year of Death *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
Cancer Mortality in California Cancer mortality rates in California declined by 23% from 1988 to 2009 Mortality has declined for all four major racial/ethnic groups in the state Despite these improvements, cancer is the second leading cause of death among Californians and nearly one in five Californians will die of a cancer
Five Most Common Types of Cancer Mortality among Men Cancer Site 2009 Count 2009 Rate 1 Lung and Bronchus 6,979 46.9 2 Prostate 3,093 22.4 3 Colon and Rectum 2,660 17.5 4 Pancreas 1,807 11.7 5 Liver and Intrahepatic Bile Duct (IBD) 1,659 10.1 Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. Source: California Cancer Registry, June 2011
Five Most Common Types of Cancer Mortality among Men 300 Trends in the Five Most Common Types of Cancer Mortality among Men, California, 1988-2009 250 Age-Adjusted Rate per 100,000 200 150 100 50 All Cancers (APC1 = -1.0*, APC2 = -1.6*) Lung & Bronchus (APC1 = -2.0*, APC2 = -2.7*) Prostate (APC1 = 1.4, APC2 = -5.1*, APC3 = -2.4*) Colon & Rectum (APC = -2.2*) Pancreas (APC = -0.1) Liver & IBD (APC = 2.8*) 0 Year of Death *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
Five Most Common Types of Cancer Mortality among Men 90 Trends in the Five Most Common Types of Cancer Mortality among Men, California, 1988-2009 80 Age-Adjusted Rate per 100,000 70 60 50 40 30 20 Lung & Bronchus (APC1 = -2.0*, APC2 = -2.7*) Prostate (APC1 = 1.4, APC2 = -5.1*, APC3 = -2.4*) Colon & Rectum (APC = -2.2*) Pancreas (APC = -0.1) Liver & IBD (APC = 2.8*) 10 0 Year of Death *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
Five Most Common Types of Cancer Mortality among Women Cancer Site 2009 Count 2009 Rate 1 Lung and Bronchus 6,071 31.1 2 Breast 4,386 22.2 3 Colon and Rectum 2,473 12.2 4 Pancreas 1,861 9.4 5 Ovary 1,564 7.9 Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. Source: California Cancer Registry, June 2011
Five Most Common Types of Cancer Mortality among Women Age-Adjusted Rate per 100,000 180 170 160 150 140 130 120 110 100 90 80 70 60 50 40 30 20 10 0 Trends in the Five Most Common Types of Cancer Mortality among Women, California, 1988-2009 All Cancers (APC1 = -0.4, APC2 = -1.4*) Lung & Bronchus (APC1 = 1.4*, APC2 = -1.0*, APC3 = -2.4*) Breast (APC = -2.0*) Colon & Rectum (APC = -2.2*) Pancreas (APC = 0.1) Ovary (APC1 = -0.3, APC2 = -2.7*) Year of Death *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
Five Most Common Types of Cancer Mortality among Women 50 Trends in the Five Most Common Types of Cancer Mortality among Women, California, 1988-2009 Age-Adjusted Rate per 100,000 40 30 20 10 Lung & Bronchus (APC1 = 1.4*, APC2 = -1.0*, APC3 = -2.4*) Breast (APC = -2.0*) Colon & Rectum (APC = -2.2*) Pancreas (APC = 0.1) Ovary (APC1 = -0.3, APC2 = -2.7*) 0 Year of Death *The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, February 2012
Cancer Mortality by Race/Ethnicity and Sex Five-Year, Age-Adjusted Cancer Mortality Rates by Race/Ethnicity and Sex, California, 2005-2009 African American Non-Hispanic White Hispanic Asian/PI 300 250 283 Rate per 100,000 200 150 100 207 157 146 186 151 120 102 50 0 Male Female Source: California Cancer Registry, February 2012
Cancer Mortality by Asian Subgroup and Sex 250 Five-Year, Age-Adjusted Cancer Mortality Rates by Asian Subgroup and Sex, California, 2004-2008 Korean Japanese Filipino Chinese Vietnamese South Asian 200 203 Rate per 100,000 150 100 174 160 160 158 112 132 103 111 93 50 70 66 0 Male Female Source: California Cancer Registry, February 2012
Cancer Mortality Trends, California vs. United States
Cancers Associated with Excess Weight & Lack of Sufficient Physical Activity Esophageal (adenocarcinomas) Colon & Rectum Pancreatic Kidney Postmenopausal breast cancer Endometrial (uterine)
Trend in Esophageal Cancer, California vs. United States Trend in Age-Adjusted Incidence Rates of Adenocarcinoma of the Esophagus, California vs. United States*, 1988-2009 4 United States (APC1 = 6.6^, APC2 = 1.6^) California (APC1 = 5.4^, APC2 = 1.1^) 3 Rate per 100,000 2 1 0 Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb. 2012 and SEER*Stat Database: Incidence, SEER 9 Reg Research Data Nov. 2011.
Trend in Colorectal Cancer, California vs. United States Trend in Age-Adjusted Incidence Rates of Colorectal Cancer, California vs. United States*, 1988-2009 70 United States (APC1 = -1.9^, APC2 = 1.3, APC3, -1.6^, APC4 = -3.1^) California (APC1 = -1.9^, APC2 = 0.5, APC = -1.9^) 65 60 Rate per 100,000 55 50 45 40 35 30 Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb. 2012 and SEER*Stat Database: Incidence, SEER 9 Reg Research Data Nov. 2011.
Trend in Pancreatic Cancer, California vs. United States 14 Trend in Age-Adjusted Incidence Rates of Pancreatic Cancer, California vs. United States*, 1988-2009 United States (APC1 = 0.1, APC2 = 1.2^) California (APC1 = -0.9^, APC2 = 0.7^) 12 10 Rate per 100,000 8 6 4 2 0 Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb. 2012 and SEER*Stat Database: Incidence, SEER 9 Reg Research Data Nov. 2011.
Trend in Kidney Cancer, California vs. United States Trend in Age-Adjusted Incidence Rates of Kidney Cancer, California vs. United States*, 1988-2009 Rate per 100,000 18 16 14 12 10 8 6 4 2 0 United States (APC = 2.1^) California (APC1 = 0.9^, APC2 = 3.6^) Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb. 2012 and SEER*Stat Database: Incidence, SEER 9 Reg Research
Trend in Postmenopausal Breast Cancer, California vs. United States Trend in Age-Adjusted Incidence Rates of Postmenopausal Breast Cancer, California vs. United States*, 1988-2009 450 United States (APC1 = 0.9^, APC2 = -4.7, APC3 = 0.6) California (APC1 = 0.7^, APC 2 = -4.8, APC3 = 0.8) 400 Rate per 100,000 350 300 250 200 Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb. 2012 and SEER*Stat Database: Incidence, SEER 9 Reg Research Data Nov. 2011.
Trend in Endometrial Cancer, California vs. United States Trend in Age-Adjusted Incidence Rates of Corpus Uteri Cancer, California vs. United States*, 1988-2009 United States (APC1 = 3.7, APC2 = -0.9, APC3 = 1.2, APC4 = -0.4, APC5 = 3.4^) California (APC1 = -0.4, APC2 = -2.0^, APC3 = 1.9^) 30 Rate per 100,000 25 20 15 10 Year of Diagnosis *U.S. rates are estimated using SEER 9 data (excluding California). ^The annual percent change (APC) is significantly different from zero. Source: California Cancer Registry, Feb. 2012 and SEER*Stat Database: Incidence, SEER 9 Reg Research Data Nov. 2011.
Summary In general, cancer incidence and mortality rates in California are lower than the rest of the United States Overall cancer incidence and mortality rates in California are declining but disparities by race/ethnicity still exist The decline in California s cancer incidence is being threatened by an obesity epidemic
Summary California adults and teens have a high prevalence of excess weight and insufficient physical activity Cancers associated with excess weight and lack of sufficient physical activity are on the rise in California
Summary The CCR is a rich resource for cancer information in California This information supports cancer control efforts and cancer research that are vital to winning the war on cancer We hope that this information will be helpful to you all, and welcome the opportunity to work with you again
Acknowledgement The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute s Surveillance, Epidemiology and End Results Program under contract HHSN261201000036C awarded to the Northern California Cancer Center, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention s National Program of Cancer Registries, under agreement #1U58 DP000807-01 awarded to the Public Health Institute.