TWIN FALLS COUNTY CANCER PROFILE

TWIN FALLS COUNTY CANCER PROFILE A fact sheet from the Cancer Data Registry of Idaho, Idaho Hospital Association. Cancer Incidence 2011-2015 Cancer Mortality 2012-2016 BRFSS 2011-2016 CANCER Cancer is a group of more than 100 different diseases, each characterized by uncontrolled growth and spread of abnormal cells. Cancer risk increases with age and varies by gender and race. As the average age of the population increases, the incidence of cancer will increase as well. It is generally accepted that 65-80% of all cancers are related to personal lifestyle or environmental factors, such as smoking and diet, and are therefore preventable. Other factors such as age, gender, and family history of specific cancers are also associated with cancer and aid in the identification of people at high risk. For some cancers, effective treatment is available. For these cancers, early detection can save lives. For example, there is convincing evidence that screening for colorectal cancer reduces mortality in adults aged 50 to 75 years. Through improved prevention, early detection, and treatment, opportunities exist to lessen the burden of cancer in Idaho. RISK FACTORS AND INTERVENTIONS Aging: Because the population is aging, the number of new cancer cases and cancer deaths that occur each year will continue to increase unless the trend is reversed by significant improvements in prevention, early detection, and treatment. Smoking: Smoking and the use of smokeless tobacco are responsible for the majority of all cancers of the lung, trachea, bronchus, larynx, pharynx, oral cavity, and esophagus. Smoking is the leading cause of preventable death in the United States. Diet: The U.S. Department of Agriculture recommends the following dietary guidelines for managing a healthy diet: eat a variety of foods; maintain a healthy weight; choose a diet with plenty of fruits, vegetables, and whole-grain products; limit the use of sugar, sodium (salt), solid fats, and refined grains; and minimize alcoholic beverage consumption. Screening: Early detection is extremely important for those cancers that can be cured and which can be discovered early. FOR MORE INFORMATION Cancer Data Registry of Idaho 615 N. 7 th Street P.O. Box 1278 Boise, ID 83701 208-489-1380 https://www.idcancer.org National Cancer Institute Cancer Information Services 1-800-4CANCER https://www.cancer.gov/contact/contact -center American Cancer Society 2676 S. Vista Avenue Boise, ID 83705 208-343-4609 https://www.cancer.org 1

CANCER INCIDENCE 2011-2015 During the five-year period 2011-2015, 38,676 cases of invasive cancer were diagnosed among residents of the state of Idaho, 1,950 among Twin Falls County residents. It is estimated that almost one in two Idahoans will develop cancer during their lifetime. Cancer Incidence 2011-2015 Twin Falls County State of Idaho All Sites/Types 1,950 38,676 Female Breast 282 5,487 Prostate 239 5,021 Lung & Bronchus 219 4,493 Colorectal 166 3,151 The table, CANCER INCIDENCE 2011-2015, COMPARISON BETWEEN TWIN FALLS COUNTY AND THE REMAINDER OF THE STATE OF IDAHO, shows for Twin Falls County the number of observed cases, person-years, crude rates, age and sex-adjusted rates, expected number of cases based upon age and sex-specific rates in the remainder of Idaho, and p-values for tests comparing the number of observed and expected cases. The table also shows the number of observed cases, person-years, and crude rates for the remainder of the state of Idaho. Comparisons were made for all cancers combined, 23 invasive cancer types, in situ breast cancer, non-malignant brain and other central nervous system tumors, and pediatric cancer. Separate comparisons for males, females, and both sexes combined are included. As the table shows, the crude rate of invasive cancer incidence in Twin Falls County was 488.3 cases per 100,000 personyears for the years 2011-2015. Compared with the crude incidence rate for the remainder of Idaho (478.3), this gives an estimate of the burden of disease in Twin Falls County. The age- and sex-adjusted incidence rate of invasive cancer in Twin Falls County, all sites combined, was 479.0 cases per 100,000 persons per year for the years 2011-2015. There were more cases of cancer in Twin Falls County (1,950) than expected (1,947.2) based upon rates in the remainder of the state, but the difference was not statistically significant. There are many reasons why cancer incidence rates differ by county, related to smoking, other personal behaviors, socioeconomic status, and other factors. CANCER MORTALITY 2012-2016 In 2008 cancer became the leading cause of death in Idaho. From 2012-2016, 13,799 persons in Idaho died from cancer, 734 in Twin Falls County. The majority of cancer deaths are from five primary sites: lung, colon, pancreas, female breast, and prostate. Mortality 2012-2016 Twin Falls County State of Idaho All Deaths 3,665 63,430 Cancer Deaths % of All Deaths 734 20.0% 13,799 21.8% Lung & Bronchus 155 3,135 Colorectal 58 1,165 Pancreas 50 1,025 Female Breast 61 965 The table, CANCER MORTALITY 2012-2016, COMPARISON BETWEEN TWIN FALLS COUNTY AND THE REMAINDER OF THE STATE OF IDAHO, shows for Twin Falls County the number of observed deaths, person-years, crude rates, age and sex-adjusted rates, expected number of deaths based upon age and sex-specific rates in the remainder of Idaho, and p-values for tests comparing the number of observed and expected deaths. The table also shows the number of observed deaths, person-years, and crude rates for the remainder of the state of Idaho. Comparisons were made for all deaths, all cancer deaths, and 21 specific cancer types. Separate comparisons for males, females, and both sexes combined are included. The age- and sex-adjusted cancer mortality rate for Twin Falls County, all sites combined, was 174.4 deaths per 100,000 persons per year for the years 2012-2016, compared with 168.1 for the remainder of the state. There were more cancer deaths in Twin Falls County (734) than expected (707.5) based upon rates in the remainder of the state, but the difference was not statistically significant. Prostate 43 881 Statistical Note: Rates and percentages based upon 12 or fewer cases or deaths (numerator) should be interpreted with caution. Data Note: Mortality data may differ slightly from published official statistics from the Bureau of Vital Records and Health Statistics. 2

CANCER INCIDENCE 2011-2015 COMPARISON BETWEEN TWIN FALLS COUNTY AND THE REMAINDER OF THE STATE OF IDAHO Twin Falls County Remainder of Idaho Cancer Observed Person Crude A.A.I. Expected Observed Person Crude Site/Type Sex Cases Years Rate (1) Rate (1,2) Cases (3) P-Value (4) Cases Years Rate (1) All Sites Combined Total 1,950 399,312 488.3 479.0 1,947.2 0.955 36,726 7,679,113 478.3 All Sites Combined Male 989 197,110 501.8 496.9 981.3 0.814 18,981 3,849,938 493.0 All Sites Combined Female 961 202,202 475.3 464.5 958.7 0.950 17,745 3,829,175 463.4 Bladder Total 104 399,312 26.0 24.8 97.6 0.544 1,789 7,679,113 23.3 Bladder Male 78 197,110 39.6 38.3 74.0 0.673 1,398 3,849,938 36.3 Bladder Female 26 202,202 12.9 12.2 21.8 0.425 391 3,829,175 10.2 Brain - malignant Total 24 399,312 6.0 6.0 28.6 0.452 546 7,679,113 7.1 Brain - malignant Male 15 197,110 7.6 7.6 17.0 0.740 332 3,849,938 8.6 Brain - malignant Female 9 202,202 4.5 4.4 11.4 0.597 214 3,829,175 5.6 Brain and other CNS - non-malignant Total 45 399,312 11.3 11.1 47.5 0.794 900 7,679,113 11.7 Brain and other CNS - non-malignant Male 15 197,110 7.6 7.5 15.8 0.982 305 3,849,938 7.9 Brain and other CNS - non-malignant Female 30 202,202 14.8 14.6 32.0 0.813 595 3,829,175 15.5 Breast Total 283 399,312 70.9 70.7 273.3 0.575 5,245 7,679,113 68.3 Breast Male 1 197,110 0.5 0.5 2.1 0.766 40 3,849,938 1.0 Breast Female 282 202,202 139.5 138.6 276.6 0.760 5,205 3,829,175 135.9 Breast - in situ Total 43 399,312 10.8 11.0 51.5 0.260 1,013 7,679,113 13.2 Breast - in situ Male - 197,110 - - 0.2 1.000 3 3,849,938 0.1 Breast - in situ Female 43 202,202 21.3 21.7 52.2 0.224 1,010 3,829,175 26.4 Cervix Female 15 202,202 7.4 7.6 11.6 0.389 226 3,829,175 5.9 Colorectal Total 166 399,312 41.6 40.4 159.5 0.630 2,985 7,679,113 38.9 Colorectal Male 85 197,110 43.1 42.7 80.6 0.655 1,561 3,849,938 40.5 Colorectal Female 81 202,202 40.1 38.3 78.6 0.812 1,424 3,829,175 37.2 Corpus Uteri Female 69 202,202 34.1 34.5 54.4 0.063 1,043 3,829,175 27.2 Esophagus Total 14 399,312 3.5 3.4 21.0 0.141 396 7,679,113 5.2 Esophagus Male 12 197,110 6.1 6.0 16.8 0.290 326 3,849,938 8.5 Esophagus Female 2 202,202 1.0 0.9 3.9 0.519 70 3,829,175 1.8 Hodgkin Lymphoma Total 7 399,312 1.8 1.8 10.3 0.393 199 7,679,113 2.6 Hodgkin Lymphoma Male 5 197,110 2.5 2.6 5.8 0.971 114 3,849,938 3.0 Hodgkin Lymphoma Female 2 202,202 1.0 1.0 4.5 0.347 85 3,829,175 2.2 Kidney and Renal Pelvis Total 66 399,312 16.5 16.3 70.9 0.608 1,347 7,679,113 17.5 Kidney and Renal Pelvis Male 42 197,110 21.3 21.3 44.1 0.831 860 3,849,938 22.3 Kidney and Renal Pelvis Female 24 202,202 11.9 11.6 26.3 0.744 487 3,829,175 12.7 Larynx Total 9 399,312 2.3 2.2 10.0 0.905 192 7,679,113 2.5 Larynx Male 9 197,110 4.6 4.6 8.1 0.829 158 3,849,938 4.1 Larynx Female - 202,202 - - 1.8 0.344 34 3,829,175 0.9 Leukemia Total 68 399,312 17.0 16.4 71.0 0.785 1,314 7,679,113 17.1 Leukemia Male 37 197,110 18.8 18.4 39.3 0.791 751 3,849,938 19.5 Leukemia Female 31 202,202 15.3 14.6 31.2 1.000 563 3,829,175 14.7 Liver and Bile Duct Total 40 399,312 10.0 10.0 30.8 0.125 590 7,679,113 7.7 Liver and Bile Duct Male 27 197,110 13.7 13.9 21.1 0.247 419 3,849,938 10.9 Liver and Bile Duct Female 13 202,202 6.4 6.2 9.3 0.294 171 3,829,175 4.5 Lung and Bronchus Total 219 399,312 54.8 52.6 231.6 0.429 4,274 7,679,113 55.7 Lung and Bronchus Male 101 197,110 51.2 49.9 116.9 0.149 2,224 3,849,938 57.8 Lung and Bronchus Female 118 202,202 58.4 55.5 113.9 0.726 2,050 3,829,175 53.5 Melanoma of the Skin Total 104 399,312 26.0 25.8 117.5 0.226 2,239 7,679,113 29.2 Melanoma of the Skin Male 67 197,110 34.0 33.8 66.5 0.984 1,291 3,849,938 33.5 Melanoma of the Skin Female 37 202,202 18.3 18.3 50.2 0.064 948 3,829,175 24.8 Myeloma Total 25 399,312 6.3 6.0 27.8 0.684 513 7,679,113 6.7 Myeloma Male 16 197,110 8.1 8.0 16.1 1.000 308 3,849,938 8.0 Myeloma Female 9 202,202 4.5 4.2 11.6 0.567 205 3,829,175 5.4 Non-Hodgkin Lymphoma Total 85 399,312 21.3 20.6 83.4 0.890 1,553 7,679,113 20.2 Non-Hodgkin Lymphoma Male 48 197,110 24.4 24.0 45.9 0.794 882 3,849,938 22.9 Non-Hodgkin Lymphoma Female 37 202,202 18.3 17.5 37.0 1.000 671 3,829,175 17.5 Oral Cavity and Pharynx Total 73 399,312 18.3 18.3 51.8 0.006 >> 996 7,679,113 13.0 Oral Cavity and Pharynx Male 48 197,110 24.4 24.7 34.4 0.032 >> 681 3,849,938 17.7 Oral Cavity and Pharynx Female 25 202,202 12.4 12.0 17.1 0.085 315 3,829,175 8.2 Ovary Female 26 202,202 12.9 12.7 26.0 1.000 485 3,829,175 12.7 Pancreas Total 58 399,312 14.5 14.0 59.5 0.919 1,102 7,679,113 14.4 Pancreas Male 34 197,110 17.2 17.0 31.1 0.655 600 3,849,938 15.6 Pancreas Female 24 202,202 11.9 11.2 28.0 0.516 502 3,829,175 13.1 Prostate Male 239 197,110 121.3 121.7 243.9 0.787 4,782 3,849,938 124.2 Stomach Total 22 399,312 5.5 5.3 22.7 0.998 421 7,679,113 5.5 Stomach Male 10 197,110 5.1 5.0 14.8 0.255 284 3,849,938 7.4 Stomach Female 12 202,202 5.9 5.7 7.6 0.170 137 3,829,175 3.6 Testis Male 11 197,110 5.6 5.6 12.8 0.751 252 3,849,938 6.5 Thyroid Total 53 399,312 13.3 13.5 62.4 0.255 1,222 7,679,113 15.9 Thyroid Male 12 197,110 6.1 6.2 14.1 0.695 280 3,849,938 7.3 Thyroid Female 41 202,202 20.3 20.7 48.7 0.299 942 3,829,175 24.6 Pediatric Age 0 to 19 Total 20 119,888 16.7 16.7 21.3 0.885 400 2,249,881 17.8 Pediatric Age 0 to 19 Male 8 61,049 13.1 13.1 11.4 0.400 214 1,151,557 18.6 Pediatric Age 0 to 19 Female 12 58,839 20.4 20.4 10.0 0.597 186 1,098,324 16.9 Notes: 1. Rates are expressed as the number of cases per 100,000 persons per year (person-years). 2. Age and sex-adjusted incidence (A.A.I.) rates for county use age and sex-specific crude rates for the remainder of the state as standard. 3. Expected cases are based upon age and sex-specific rates for the remainder of the state of Idaho (compare to observed). 4. P-values compare observed and expected cases, are two tailed, based upon the Poisson probability distribution. "<<" denotes significantly fewer cases observed than expected, ">>" denotes significantly more cases observed than expected (p=.05). Statistical Note: Rates based upon 12 or fewer cases (numerator) should be interpreted with caution. 3

CANCER MORTALITY 2012-2016 COMPARISON BETWEEN TWIN FALLS COUNTY AND THE REMAINDER OF THE STATE OF IDAHO Twin Falls County Remainder of Idaho Cause of Death Observed Person Crude A.A.M. Expected Observed Person Crude Cancer Site/Type Sex Deaths Years Rate (1) Rate (1,2) Deaths (3) P-Value (4) Deaths Years Rate (1) All Causes of Death Total 3,665 404,776 905.4 846.1 3,330.7 0.000 >> 59,765 7,772,646 768.9 All Causes of Death Male 1,892 199,792 947.0 909.7 1,654.2 0.000 >> 30,999 3,897,310 795.4 All Causes of Death Female 1,773 204,984 864.9 790.6 1,664.7 0.009 >> 28,766 3,875,336 742.3 All Malignant Cancers Total 734 404,776 181.3 174.4 707.5 0.328 13,065 7,772,646 168.1 All Malignant Cancers Male 400 199,792 200.2 195.7 370.1 0.130 7,059 3,897,310 181.1 All Malignant Cancers Female 334 204,984 162.9 155.1 333.7 1.000 6,006 3,875,336 155.0 Bladder Total 29 404,776 7.2 6.7 19.7 0.059 353 7,772,646 4.5 Bladder Male 25 199,792 12.5 11.9 14.1 0.011 >> 261 3,897,310 6.7 Bladder Female 4 204,984 2.0 1.8 5.3 0.784 92 3,875,336 2.4 Brain and Other Nervous System Total 26 404,776 6.4 6.4 22.9 0.564 440 7,772,646 5.7 Brain and Other Nervous System Male 14 199,792 7.0 7.1 14.3 1.000 282 3,897,310 7.2 Brain and Other Nervous System Female 12 204,984 5.9 5.9 8.4 0.278 158 3,875,336 4.1 Breast Total 61 404,776 15.1 14.7 48.8 0.102 912 7,772,646 11.7 Breast Male - 199,792 - - 0.4 1.000 8 3,897,310 0.2 Breast Female 61 204,984 29.8 28.7 49.5 0.126 904 3,875,336 23.3 Cervix Female 5 204,984 2.4 2.5 3.7 0.637 72 3,875,336 1.9 Colorectal Total 58 404,776 14.3 13.8 59.8 0.882 1,107 7,772,646 14.2 Colorectal Male 33 199,792 16.5 16.3 31.8 0.876 611 3,897,310 15.7 Colorectal Female 25 204,984 12.2 11.6 27.7 0.696 496 3,875,336 12.8 Corpus Uteri Female 5 204,984 2.4 2.4 6.6 0.713 121 3,875,336 3.1 Esophagus Total 17 404,776 4.2 4.1 20.6 0.509 386 7,772,646 5.0 Esophagus Male 10 199,792 5.0 5.0 15.9 0.162 308 3,897,310 7.9 Esophagus Female 7 204,984 3.4 3.3 4.3 0.287 78 3,875,336 2.0 Hodgkin Lymphoma Total - 404,776 - - 1.3 0.536 25 7,772,646 0.3 Hodgkin Lymphoma Male - 199,792 - - 0.6 1.000 12 3,897,310 0.3 Hodgkin Lymphoma Female - 204,984 - - 0.7 1.000 13 3,875,336 0.3 Kidney Total 17 404,776 4.2 4.1 18.1 0.917 336 7,772,646 4.3 Kidney Male 10 199,792 5.0 5.0 11.5 0.807 222 3,897,310 5.7 Kidney Female 7 204,984 3.4 3.2 6.4 0.928 114 3,875,336 2.9 Larynx Total 3 404,776 0.7 0.7 3.1 1.000 58 7,772,646 0.7 Larynx Male 3 199,792 1.5 1.5 2.4 0.872 47 3,897,310 1.2 Larynx Female - 204,984 - - 0.6 1.000 11 3,875,336 0.3 Leukemia Total 24 404,776 5.9 5.6 29.9 0.327 544 7,772,646 7.0 Leukemia Male 19 199,792 9.5 9.2 16.8 0.663 318 3,897,310 8.2 Leukemia Female 5 204,984 2.4 2.3 12.8 0.024 << 226 3,875,336 5.8 Liver and Bile Duct Total 27 404,776 6.7 6.6 27.0 1.000 515 7,772,646 6.6 Liver and Bile Duct Male 18 199,792 9.0 9.1 17.4 0.943 344 3,897,310 8.8 Liver and Bile Duct Female 9 204,984 4.4 4.2 9.3 1.000 171 3,875,336 4.4 Lung and Bronchus Total 155 404,776 38.3 36.9 161.0 0.670 2,980 7,772,646 38.3 Lung and Bronchus Male 75 199,792 37.5 36.9 84.0 0.355 1,609 3,897,310 41.3 Lung and Bronchus Female 80 204,984 39.0 37.1 76.2 0.695 1,371 3,875,336 35.4 Melanoma of the Skin Total 28 404,776 6.9 6.7 15.0 0.003 >> 280 7,772,646 3.6 Melanoma of the Skin Male 22 199,792 11.0 11.0 9.1 0.000 >> 177 3,897,310 4.5 Melanoma of the Skin Female 6 204,984 2.9 2.8 5.7 1.000 103 3,875,336 2.7 Myeloma Total 15 404,776 3.7 3.5 15.8 0.967 287 7,772,646 3.7 Myeloma Male 8 199,792 4.0 3.9 8.9 0.942 168 3,897,310 4.3 Myeloma Female 7 204,984 3.4 3.1 6.9 1.000 119 3,875,336 3.1 Non-Hodgkin Lymphoma Total 34 404,776 8.4 7.9 28.8 0.372 517 7,772,646 6.7 Non-Hodgkin Lymphoma Male 20 199,792 10.0 9.7 15.4 0.292 289 3,897,310 7.4 Non-Hodgkin Lymphoma Female 14 204,984 6.8 6.2 13.2 0.903 228 3,875,336 5.9 Oral Cavity and Pharynx Total 14 404,776 3.5 3.4 10.1 0.279 188 7,772,646 2.4 Oral Cavity and Pharynx Male 9 199,792 4.5 4.5 6.6 0.445 129 3,897,310 3.3 Oral Cavity and Pharynx Female 5 204,984 2.4 2.3 3.3 0.489 59 3,875,336 1.5 Ovary Female 12 204,984 5.9 5.7 21.4 0.040 << 393 3,875,336 10.1 Pancreas Total 50 404,776 12.4 12.0 52.3 0.816 975 7,772,646 12.5 Pancreas Male 31 199,792 15.5 15.5 27.4 0.535 532 3,897,310 13.7 Pancreas Female 19 204,984 9.3 8.8 24.8 0.287 443 3,875,336 11.4 Prostate Male 43 199,792 21.5 20.1 45.9 0.738 838 3,897,310 21.5 Stomach Total 14 404,776 3.5 3.3 10.5 0.346 193 7,772,646 2.5 Stomach Male 8 199,792 4.0 3.9 6.6 0.681 125 3,897,310 3.2 Stomach Female 6 204,984 2.9 2.8 3.8 0.371 68 3,875,336 1.8 Notes: 1. Rates are expressed as the number of cases per 100,000 persons per year (person-years). 2. Age and sex-adjusted mortality (A.A.M.) rates for county use age and sex-specific crude rates for the remainder of the state as standard. 3. Expected cases are based upon age and sex-specific rates for the remainder of the state of Idaho (compare to observed). 4. P-values compare observed and expected cases, are two tailed, based upon the Poisson probability distribution. "<<" denotes significantly fewer cases observed than expected, ">>" denotes significantly more cases observed than expected (p=.05). Statistical Notes: Rates based upon 12 or fewer cases (numerator) should be interpreted with caution. Mortality statistics presented differ from BVRHS official statistics due to differences in methodology. Data Source: Bureau of Vital Records and Health Statistics (BVRHS), Division of Public Health, Idaho Department of Health and Welfare, 2017. 4

Cancer Screening and Risk Factors The Bureau of Vital Records and Health Statistics (BVRHS), Division of Public Health, Idaho Department of Health and Welfare, under a cooperative agreement with the Centers for Disease Control and Prevention, has conducted telephone Behavioral Risk Factor Surveys (BRFS) since 1984 of random samples of adult Idahoans to measure population prevalences of risk factors for the major causes of death, including cancer. The BVRHS provided data sets containing Behavioral Risk Factor Surveillance System (BRFSS) data from 2011 through 2016 to CDRI staff, who performed the analyses reported in these County Profiles. Analysis weights were poststratified to 2016 population estimates by age group, sex, and county, beginning with the BRFSS raked weights. Not all questions were asked in all years. A minimum of 50 respondents was required to generate county-level statistics. Results may differ from IDHW reports due to differences in methods. The cancer screening and risk factor measures were selected to assist in monitoring Comprehensive Cancer Alliance for Idaho objectives. Wald log-linear chi-square statistics were used to test for independence of the selected measures and other variables such as age and race, taking into account the complex survey design. Cancer Screening and Risk Factor Prevalence Estimates, 2011-2016 State of Idaho HD 1 HD 2 HD 3 HD 4 HD 5 HD 6 HD 7 Twin Falls County Access to Care Health Insurance, Age <65 (2014-2016) 81.4% 80.1% 84.9% 73.9% 86.5% 73.3% 83.4% 83.5% 76.3% Not See Doctor Due to Cost Past Year (2014-2016) 14.3% 14.0% 10.9% 19.0% 13.2% 14.7% 13.0% 13.8% 12.6% Cancer Screening Mammogram Past 2 Years, Age 50-74 (2014, 2016) 67.0% 66.4% 69.7% 64.0% 71.3% 61.8% 63.1% 67.8% 67.3% Pap Test Past 3 Years, Cervix Intact Age 21-65 (2012, 2014, 2016) 75.2% 75.8% 80.1% 69.0% 78.9% 72.9% 75.7% 72.0% 73.3% Colorectal Cancer Screening, Age 50-75 (2012, 2014, 2016) 62.3% 62.4% 65.4% 57.8% 66.5% 59.2% 59.7% 61.0% 63.4% Tobacco Use Current Smoker (2014-2016) 14.7% 17.5% 14.8% 18.8% 12.1% 17.5% 14.2% 10.1% 20.2% Current Smokeless Tobacco User, Males (2012-2016) 9.6% 10.2% 15.4% 11.3% 8.6% 10.1% 7.8% 7.3% 11.4% Other Cancer-Related Sunburn in Previous 12 Months (2016) 24.4% 25.6% 24.6% 18.6% 21.9% 26.4% 29.6% 30.8% 26.0% Artificial Tanning Appliance Use (2011, 2014, 2016) 4.4% 5.6% 3.3% 3.3% 3.5% 4.2% 5.7% 6.8% 4.3% Weight Classification by Body Mass Index, Age 20+ (2013-2016) 32.7% 34.1% 35.5% 26.6% 36.5% 29.5% 31.1% 32.2% 27.8% Meet Physical Activity Guidelines (2011, 2013, 2015) 21.5% 21.1% 18.2% 19.0% 25.7% 19.1% 20.6% 19.6% 19.8% Home Ever Tested for Radon (2014, 2016) 18.6% 25.5% 13.7% 12.6% 20.2% 16.1% 20.4% 18.5% 10.7% Access to Care Health Insurance 2014-2016 Statewide, 81.4% of adults aged 18-64 reported having health care coverage. Health care coverage differed significantly by race/ethnicity, with 84.3% of white non-hispanics, compared to 61.3% of Hispanics and 87.1% of Native Americans, having health insurance. Spanish-speaking respondents were significantly less likely to be insured (34.5%) than Englishspeaking respondents (83.2%). Health care coverage differed significantly by age of respondent, with 77.8% of persons aged 18-29, and 86.6% of persons aged 50-64, having health insurance. Health care coverage differed significantly by county, with a range of 63.7% (Jerome County) to 94.3% (Caribou County) having health insurance. Not See Doctor Due to Cost Past Year 2014-2016 Statewide, 14.3% of adults aged 18+ reported they needed to see a doctor but could not because of cost sometime in the past 12 months. Inability to see a doctor due to cost differed significantly by race/ethnicity (13.3% of white non-hispanics, 22.9% of Hispanics, and 15.9% of Native Americans). Inability to see a doctor due to cost differed significantly by annual household income (29.1% for less than $15,000, 7.1% for greater than $50,000). Inability to see a doctor due to cost differed significantly by county, with a range of 3.9% (Butte County) to 21.0% (Jerome County). ** Current for colorectal cancer screening means a blood stool test in the past year, sigmoidoscopy in the past 5 years and blood stool test in the past 3 years, or a colonoscopy in the past 10 years. Cancer Screening Mammogram 2014, 2016 Statewide, 67.0% of women aged 50-74 reported having a mammogram in the past 2 years. Insured women were about twice as likely to have had a mammogram in the past 2 years (70.4% versus 32.8%). Mammography rates differed significantly by county, with a range in screening of 62.7% (Bingham County) to 76.0% (Nez Perce County). In 2016, Idaho ranked 50 th among states and the District of Columbia for mammography screening rates among women aged 50-74 and 51 st among ages 40+. Pap Test 2012, 2014, 2016 Statewide, 75.2% of women aged 21-65 (with intact cervix) reported having a Pap test in the past 3 years. Women with health insurance were significantly more likely to have timely Pap screening than uninsured women (78.0% versus 64.9% screened in the past 3 years). Pap screening differed significantly by county, with a range of 59.6% (Madison County) to 89.5% (Nez Perce County). In 2016, Idaho ranked 50 th among states and the District of Columbia for Pap screening rate. Colorectal Cancer Screening 2012, 2014, 2016 Statewide, 62.3% of adults aged 50-75 reported receiving colorectal cancer screening based on the most recent guidelines.** Persons with health insurance were over twice as likely to be current for colorectal cancer screening. In 2016, Idaho ranked 44 th among states and the District of Columbia in the percentage of adults aged 50-75 and older who reported being current with colorectal cancer screening recommendations. 5

Cancer Screening and Risk Factors Tobacco Use Current Smoking 2014-2016 Statewide, 14.7% of adults aged 18 and older were current smokers. Smoking prevalence differed significantly by age of respondent, with 19.0% of persons aged 30-39, and 8.2% of persons aged 65 and older, reporting current smoking. Smoking prevalence was lower among white non-hispanics (14.8%) than among Native Americans (28.3%). Smoking prevalence differed significantly by county, with a range of 3.8% (Madison County) to 32.6% (Washington County). Counties with higher rates of current smoking had higher rates of lung cancer. Smokeless Tobacco Use, Males 2012-2016 Statewide, 9.6% of males aged 18 and older were current users of smokeless tobacco. Smokeless tobacco use differed significantly by age group, ranging from 13.4% of males aged 30-39 to 4.2% of males aged 65 and older. Smokeless tobacco use differed significantly by county, with a range of 2.2% (Franklin County) to 24.5% (Custer County). Counties with higher rates of smokeless tobacco use had higher rates of oral cavity & pharynx cancer. Other Cancer-Related Sun Exposure 2016 Statewide, 24.4% of adults aged 18 and older reported having sunburn in the past 12 months. Sunburn rates were higher for white non-hispanics (26.1%) than for Hispanics (12.3%) or Native Americans (19.4%). Sunburn rates differed significantly by age group, with 38.3% of persons aged 18-29 and 6.0% of persons aged 65 and older having sunburn in the past 12 months. Sunburn rates differed significantly by county, with a range of 11.8% (Jerome County) to 47.0% (Minidoka County) having sunburn in the past 12 months. Weight Classification by Body Mass Index 2013-2016 Statewide, 32.7% of adults aged 20 and older were in the healthy weight range as measured by body mass index (BMI 18.5-24.9). BMI differed significantly by race/ethnicity, with 33.4% of white non-hispanics, compared to 25.9% of Hispanics and 27.0% of Native Americans, being in the healthy weight range. Males (25.8%) were significantly less likely to be in the healthy weight range than females (39.5%). BMI differed significantly by age of respondent, with 43.5% of persons aged 18-29, and 27.2% of persons aged 50-64, being in the healthy weight range. BMI differed significantly by county, with a range of 21.0% (Gem County) to 46.9% (Blaine County) of adults being in the healthy weight range. Counties with higher percentages of adults in the healthy weight range had significantly lower rates of colorectal cancer (p=.011). Physical Activity 2011, 2013, 2015 Statewide, 21.5% of adults aged 18 and older met aerobic and strength physical activity guidelines during the past month or week. Physical activity differed significantly by age of respondent, with 25.2% of persons aged 18-29, and 18.8% of persons aged 50-64, meeting guidelines. The percentage of adults meeting physical activity guidelines differed significantly by county, with a range of 7.6% (Oneida County) to 29.8% (Blaine County). Home Radon Testing 2014, 2016 Statewide, 18.6% of adults have ever tested their house for radon. Radon test usage varied significantly by race/ethnicity, with 20.2% of white non-hispanics, 4.9% of Hispanics, and 23.2% of Native Americans having ever tested their house for radon. Radon test usage was higher for persons aged 50-64 than for younger persons. Home radon testing differed significantly by county, with a range of 6.9% (Cassia County) to 50.2% (Blaine County). Artificial Tanning Appliance Use 2011, 2014, 2016 Statewide, 4.4% of adults aged 18 and older reported using an artificial tanning appliance, such as a tanning bed, in the past 12 months. Females (6.8%) were significantly more likely than males (2.1%) to have used an artificial tanning appliance in the past 12 months. Tanning appliance use differed significantly by age group, with 8.7% of persons aged 18-29 and 0.9% of persons aged 65 and older, using an appliance in the past 12 months. Tanning appliance use differed by county, with a range of less than 1% (Oneida, Power, and Valley Counties) to over 9% (Bear Lake, Fremont, and Madison Counties) using an artificial tanning appliance in the past 12 months. 6