Burden of Cancer in California

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

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

Most Common Types of Cancer Incidence and Prevalence among California Males, 2015 Rank Cancer Type New Cases Incidence Rate Existing Cases 1 Prostate 17,159 84.4 271,895 2 Lung 8,248 44.7 18,847 3 Colon and Rectum 7,518 38.9 62,210 4 Melanoma of the Skin 5,586 29.2 51,709 5 Urinary Bladder 5,049 27.7 43,479 6 Non-Hodgkin Lymphoma 4,034 21.2 32,405 7 Kidney 3,896 19.8 26,911 8 Oral Cavity and Pharynx 3,010 14.9 22,053 9 Leukemia 2,721 14.5 20,428 10 Liver 2,944 14.1 6,847 Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. 3

Most Common Types of Cancer Mortality among California Males, 2015 Rank Cancer Type Count Rate 1 Lung 6,478 35.5 2 Prostate 3,314 19.4 3 Colon and Rectum 2,791 15.0 4 Pancreas 2,163 11.6 5 Liver 2,207 11.1 6 Leukemia 1,380 7.8 7 Non-Hodgkin Lymphoma 1,214 6.7 8 Urinary Bladder 1,155 6.6 9 Esophagus 1,058 5.5 10 Brain and Other Nervous System 1,017 5.3 Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. 4

Most Common Types of Cancer Mortality among California Males, 2015 Rank Cancer Type Count Rate 2 1 Lung 6,478 35.5 1 2 Prostate 3,314 19.4 3 3 Colon and Rectum 2,791 15.0 4 Pancreas 2,163 11.6 10 5 Liver 2,207 11.1 9 6 Leukemia 1,380 7.8 6 7 Non-Hodgkin Lymphoma 1,214 6.7 5 8 Urinary Bladder 1,155 6.6 9 Esophagus 1,058 5.5 10 Brain and Other Nervous System 1,017 5.3 Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. 5

Most Common Types of Cancer Incidence and Prevalence among California Females, 2015 Rank Cancer Type New Cases Incidence Rate Existing Cases 1 Breast 26,514 119.8 321,370 2 Lung 8,397 36.9 25,534 3 Colon and Rectum 6,901 30.6 61,634 4 Uterus 5,855 25.5 61,154 5 Thyroid 3,951 19.2 49,083 6 Melanoma of the Skin 3,750 17.0 45,236 7 Non-Hodgkin Lymphoma 3,295 14.7 29,169 8 Ovary 2,530 11.5 19,981 9 Pancreas 2,382 10.4 3,388 10 Kidney 2,235 10.1 17,286 Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. 6

Most Common Types of Cancer Mortality among California Females, 2015 Rank Cancer Type Count Rate 1 Lung 5,829 25.3 2 Breast 4,441 19.4 3 Colon and Rectum 2,628 11.3 4 Pancreas 2,061 8.9 5 Ovary 1,582 6.9 6 Liver 1,135 4.9 7 Uterus 1,123 4.8 8 Leukemia 958 4.3 9 Non-Hodgkin Lymphoma 943 4.1 10 Brain and Other Nervous System 793 3.5 Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. 7

Most Common Types of Cancer Mortality among California Females, 2015 Rank Cancer Type Count Rate 2 1 Lung 5,829 25.3 1 2 Breast 4,441 19.4 3 3 Colon and Rectum 2,628 11.3 9 4 Pancreas 2,061 8.9 8 5 Ovary 1,582 6.9 6 Liver 1,135 4.9 4 7 Uterus 1,123 4.8 8 Leukemia 958 4.3 7 9 Non-Hodgkin Lymphoma 943 4.1 10 Brain and Other Nervous System 793 3.5 Rates are per 100,000 and age-adjusted to the 2000 U.S. Standard Population. 8

Average Annual Percent Change, Males, 2005-2014 Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<0.05 9

Average Annual Percent Change, Males, 2005-2014 Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<0.05 10

Average Annual Percent Change, Males, 2005-2014 Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<0.05 11

Average Annual Percent Change, Males, 2005-2014 Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<0.05 12

Average Annual Percent Change, Females, 2005-2014 Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<0.05 13

Average Annual Percent Change, Females, 2005-2014 Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<0.05 14

Average Annual Percent Change, Females, 2005-2014 Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<0.05 15

Average Annual Percent Change, Females, 2005-2014 Cancer Incidence Cancer Mortality *Percent change is significantly different from zero at p<0.05 16

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

Trends in California Incidence: 1988-2014 Mortality: 1970-2014 Breast Prostate Colorectal Lung 18

Age-Adjusted Rate / 100,000 Age-Adjusted Rate / 100,000 Breast Cancer Incidence Trends, CA 1988-2014 Invasive In Situ 140 129.6 35 120 119.3 30 29.2 100 80 25 20 APC 4.9* 60 15 16.25 40 10 20 5 0 1990 1993 1996 1999 2002 2005 2008 2011 2014 0 1990 1993 1996 1999 2002 2005 2008 2011 2014 19

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

Interpreting trends: In Situ breast cancer Fast increase in rates: screening Increase no longer significant after 2000 21

Age-Adjusted Rate / 100,000 Breast Cancer Mortality Trends: CA, 1970-2014 40 35 33.7 30 25 20 19.8 15 10 5 0 1970 1974 1979 1984 1989 1994 1999 2004 2009 2014 22

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

Age-Adjusted Rate / 100,000 Age-Adjusted Rate / 100,000 Prostate Cancer Trends: CA,1988-2014 24 250 INCIDENCE 40 MORTALITY 35 200 150 165.4 APC 2.1* 30 25 29.4 100 87.3 20 15 19.1 50 10 5 0 1990 1993 1996 1999 2002 2005 2008 2011 2014 0 1970 1974 1979 1984 1989 1994 1999 2004 2009 2014

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

Age-Adjusted Rate / 100,000 Age-Adjusted Rate / 100,000 Colorectal Cancer Trends: CA 1988-2014 26 80 INCIDENCE 35 MORTALITY 32.3 70 67.5 30 60 50 40 30 47.7 Male Female 40.9 30.3 25 20 15 24.9 Male Female APC -2.3* 15.2 20 10 11.0 10 5 0 1990 1993 1996 1999 2002 2005 2008 2011 2014 0 1970 1974 1979 1984 1989 1994 1999 2004 2009 2014

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

Age-Adjusted Rate / 100,000 Age-Adjusted Rate / 100,000 Lung Cancer Trends: California, 1988-2014 100 INCIDENCE 90 MORTALITY 90 80 80 70 Male 70 60 Male AAPC -2.8* (87-14) 60 50 50 40 30 Female AAPC -1.9* (98-14) 40 30 Female 20 20 10 10 0 1990 1993 1996 1999 2002 2005 2008 2011 2014 0 1970 1974 1979 1984 1989 1994 1999 2004 2009 2014

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

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

Body Mass Index Trends for California Adults 50.0% 45.0% 43.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 35.5% 19.3% 35.4% 34.8% 27.9% Underweight Normal Overweight Obese 10.0% 5.0% Source: CHIS 2.2% 1.9% 0.0% 2001 2003 2005 2007 2009 2011 2012 2013 2014 2015 2016 31

Body Mass Index Trends for California Adults 50.0% 45.0% 43.0% 40.0% 35.0% 30.0% 25.0% 35.5% 35.4% 34.8% 27.9% 62.7% Underweight Normal Overweight or Obese 20.0% 19.3% Overweight Obese 15.0% 10.0% 5.0% Source: CHIS 2.2% 1.9% 0.0% 2001 2003 2005 2007 2009 2011 2012 2013 2014 2015 2016 32

Percentage Use of colorectal screening tests by race/ethnicity, adults ages 50-75, U.S. 70.0 60.0 65.6 60.3 50.0 52.1 47.4 40.0 30.0 20.0 35.7 29.7 21.7 20.6 Hispanic White Black Asian 10.0 0.0 2000 2003 2005 2008 2010 2013 2015 Source: NHIS 33

Smoking Status Trends Among California Adults 70.0% 66.6% 60.0% 58.1% 50.0% 40.0% 30.0% 24.9% Current Smoker Former Smoker Never Smoked 20.0% 10.0% 17.1% 21.7% 11.7% 0.0% Source: CHIS 2001 2003 2005 2007 2009 2011 2012 2013 2014 2015 2016 34

35% 30% Cigarette smoking by race/ethnicity among U.S. adults, 2016 31.8% 25% 25.2% 20% 15% 16.5% 16.6% 10% 9.0% 10.7% 5% 0% American Indian/Alaska Native Asian Black Hispanic Multiple Race White Source: CDC 35

Cigarette smoking by education among U.S. adults, 2016 45.0% 40.6% 40.0% 35.0% 30.0% 25.0% 24.1% 20.0% 19.7% 18.9% 16.8% 15.0% 10.0% 7.7% 5.0% 4.5% 0.0% Less than high school GED High school graduate Some college Associate degree Undergraduate degree Graduate degree Source: CDC 36

30.0% Cigarette smoking by poverty level among U.S. adults, 2016 25.0% 25.3% 20.0% 15.0% 14.3% 10.0% 5.0% 0.0% Below poverty level At or above poverty level Source: CDC 37

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

Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 100 90 93 94 85 95 88 80 70 60 50 40 30 75 72 67 65 48 46 45 42 39 40 41 41 75 74 67 67 47 47 4344 424343 30 74 African American Asian/Pacific Islander Hispanic Non-Hispanic White 20 10 0 0 Breast Cervical Colorectal Melanoma 0 Breast Cervical Colorectal Melanoma Early stage=in situ or localized 39

Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 100 90 93 94 85 95 88 80 70 60 50 40 30 75 72 67 65 48 46 45 42 39 40 41 41 75 74 67 67 47 47 4344 424343 30 74 African American Asian/Pacific Islander Hispanic Non-Hispanic White 20 10 0 0 Breast Cervical Colorectal Melanoma 0 Breast Cervical Colorectal Melanoma Early stage=in situ or localized 40

Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 100 90 93 94 85 95 88 80 70 60 50 40 30 75 72 67 65 48 46 45 42 39 40 41 41 75 74 67 67 47 47 4344 424343 30 74 African American Asian/Pacific Islander Hispanic Non-Hispanic White 20 10 0 0 Breast Cervical Colorectal Melanoma 0 Breast Cervical Colorectal Melanoma Early stage=in situ or localized 41

Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 100 90 93 94 85 95 88 80 70 60 50 40 30 75 72 67 65 48 46 45 42 39 40 41 41 75 74 67 67 47 47 4344 424343 30 74 African American Asian/Pacific Islander Hispanic Non-Hispanic White 20 10 0 0 Breast Cervical Colorectal Melanoma 0 Breast Cervical Colorectal Melanoma Early stage=in situ or localized 42

Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 60 50 40 41 44 49 53 40 42 51 50 African American 30 20 18 20 22 24 24 20 21 27 Asian/Pacific Islander Hispanic Non-Hispanic White 10 0 Oropharyngeal Lung Oropharyngeal Lung Early stage=in situ or localized 43

Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 60 50 40 41 44 49 53 40 42 51 50 African American 30 20 18 20 22 24 24 20 21 27 Asian/Pacific Islander Hispanic Non-Hispanic White 10 0 Oropharyngeal Lung Oropharyngeal Lung Early stage=in situ or localized 44

Females Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 60 50 40 41 44 49 53 40 42 51 50 African American 30 20 18 20 22 24 24 20 21 27 Asian/Pacific Islander Hispanic Non-Hispanic White 10 0 Oropharyngeal Lung Oropharyngeal Lung Early stage=in situ or localized 45

Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 100 90 80 70 60 77 75 74 75 67 74 90 72 73 72 73 93 82 78 African American 50 40 41 43 40 43 45 45 41 44 Asian/Pacific Islander Hispanic 30 Non-Hispanic White 20 10 0 0 Prostate Colorectal Melanoma 0 Prostate Colorectal Melanoma Early stage=in situ or localized 46

Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 100 90 80 70 60 77 75 74 75 67 74 90 72 73 72 73 93 82 78 African American 50 40 41 43 40 43 45 45 41 44 Asian/Pacific Islander Hispanic 30 Non-Hispanic White 20 10 0 0 Prostate Colorectal Melanoma 0 Prostate Colorectal Melanoma Early stage=in situ or localized 47

Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 100 90 80 70 60 77 75 74 75 67 74 90 72 73 72 73 93 82 78 African American 50 40 41 43 40 43 45 45 41 44 Asian/Pacific Islander Hispanic 30 Non-Hispanic White 20 10 0 0 Prostate Colorectal Melanoma 0 Prostate Colorectal Melanoma Early stage=in situ or localized 48

Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 100 90 80 70 60 77 75 74 75 67 74 90 72 73 72 73 93 82 78 African American 50 40 41 43 40 43 45 45 41 44 Asian/Pacific Islander Hispanic 30 Non-Hispanic White 20 10 0 0 Prostate Colorectal Melanoma 0 Prostate Colorectal Melanoma Early stage=in situ or localized 49

Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 35 30 25 25 29 31 23 26 33 31 23 20 15 19 13 15 14 18 16 18 16 African American Asian/Pacific Islander Hispanic 10 Non-Hispanic White 5 0 Oropharyngeal Lung Oropharyngeal Lung Early stage=in situ or localized 50

Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 35 30 25 25 29 31 23 26 33 31 23 20 15 19 13 15 14 18 16 18 16 African American Asian/Pacific Islander Hispanic 10 Non-Hispanic White 5 0 Oropharyngeal Lung Oropharyngeal Lung Early stage=in situ or localized 51

Males Percent of cancer cases diagnosed at early stage, by racial/ethnic group, California 2012 2015 35 30 25 25 29 31 23 26 33 31 23 20 15 19 13 15 14 18 16 18 16 African American Asian/Pacific Islander Hispanic 10 Non-Hispanic White 5 0 Oropharyngeal Lung Oropharyngeal Lung Early stage=in situ or localized 52

90 Percent of cancer cases diagnosed at late stage, by socioeconomic status (SES), California Females, 2015 80 78 70 71 60 61 58 54 53 53 50 47 Lowest SES 40 33 Highest SES 30 24 20 10 12 4 0 Breast Cervical Colorectal Melanoma Oropharyngeal Lung Late stage=regional or distant 53

Percent of cancer cases diagnosed at late stage, by socioeconomic status (SES), California Males, 2015 90 80 78 82 75 70 68 60 58 55 50 40 Lowest SES Highest SES 30 28 25 20 14 10 0 Prostate Colorectal Melanoma Oropharyngeal Lung 5 Late stage=regional or distant 54

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

California s Comprehensive Cancer Control Plan, 2011-2015 Did we meet our targets? Objective Target for 2015 2015 The Cancer Burden: Objective 1 Decrease combined cancer incidence 392.4 384.0 The Cancer Burden: Objective 2 Decrease combined cancer mortality 148.6 142.1 Incidence and mortality rates are per 100,000 56

Age-adjusted rate/100,000 Five-year, age-adjusted incidence rates by race/ethnicity and sex, all cancers 482.4 500 2011-2015 428.2 395.7 348.4 309.2 299.1 298.1 Non-Hispanic White Non-Hispanic Black Hispanic Asian/Pacific Islander Male Female Decreases in all groups since 2008-2012, more pronounced in males 57

Age-adjusted rate/100,000 Five-year, age-adjusted mortality rates by race/ethnicity and sex, all cancers 229.7 2011-2015 184.6 148.1 132.5 137.2 168.4 109.9 95.4 Non-Hispanic white Non-Hispanic black Hispanic Asian/Pacific Islander Male Female Decreases in all groups since 2008-2012 58

California s Comprehensive Cancer Control Plan, 2011-2015 Did we meet our targets? Objective Target for 2015 2015 Reduce the breast cancer mortality rate 19.3 19.4 Reduce the cervical cancer incidence rate 7.0 7.0 Reduce the colorectal cancer mortality rate 12.0 12.9 Reduce the incidence of melanoma 22.2 22.3 Reduce the mortality rate due to melanoma 2.3 2.2 Reduce the mortality rate of ovarian cancer 6.9 6.9 Decrease the mortality rate for prostate cancer 19.5 19.4 Decrease the mortality rate for prostate cancer among African American males 46.4 43.4 Rates are per 100,000 59

California s Comprehensive Cancer Control Plan, 2011-2015 Did we meet our targets? Objective Target for 2015 2015 Breast Cancer: Objective 2: Increase early diagnoses of breast cancer (in situ and localized) 89% 72.1% Colorectal Cancer: Objective 2: Decrease late-stage diagnoses of CRC (Regional and Distant)-including in situ in the total 40% 56.1% Colorectal Cancer: Objective 3: Decrease late-stage diagnoses of CRC for African Americans and Asian/Pacific Islanders-including in situ in the total AA-41.2% API-41.4% AA-55.7% API-56.4% Melanoma: Objective 1: Decrease late-stage diagnoses of melanoma (regional and distant)- including in situ in the total 5.2% 6.1% Ovarian Cancer: Objective 1: Decrease distant-stage diagnoses of ovarian cancer 55.4% 52.9% Excluded unstaged cases 60

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

Five-year Relative Survival (%), California, 2004-2015, All Cancers Race Age Stage SES SES Stage Age Race All Cases 65 5 (Highest) 74 4 68 3 63 2 59 1 (Lowest) 54 IV 19 III 57 II 88 I 91 75+ 47 65-74 65 55-64 69 45-54 74 20-44 81 Asian/Pacific Islander 63 Hispanic 64 Non-Hispanic black 60 Non-Hispanic white 66 0 10 20 30 40 50 60 70 80 90 100 62

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

Five-year Relative Survival (%), California, 2004-2015, Female Breast Cancer Race Stage SES All Cases 90 5 (Highest) 95 SES 4 3 89 92 2 86 1 (Lowest) 82 IV 28 Stage III II 75 93 I 100 Asian/Pacific Islander 92 Race Hispanic Non-Hispanic black 81 88 Non-Hispanic white 91 0 10 20 30 40 50 60 70 80 90 100 64

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

Five-year Relative Survival (%), California, 2004-2015, Cervical Cancer Race Stage SES All Cases 68 5 (Highest) 74 SES 4 3 68 72 2 66 1 (Lowest) 64 IV 18 Stage III II 54 67 I 92 Asian/Pacific Islander 69 Race Hispanic Non-Hispanic black 56 71 Non-Hispanic white 67 0 10 20 30 40 50 60 70 80 90 100 66

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

Five-year Relative Survival (%), California, 2004-2015, Colorectal Cancer Race Stage SES Sex Sex SES Stage Race All Cases 63 Female 63 Male 63 5 (Highest) 70 4 65 3 63 2 59 1 (Lowest) 56 IV 12 III 67 II 81 I 91 Asian/Pacific Islander 65 Hispanic 63 Non-Hispanic black 56 Non-Hispanic white 64 0 10 20 30 40 50 60 70 80 90 100 68

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

Race Stage SES Sex Five-year Relative Survival (%), California, 2004-2015, Lung Cancer Sex SES Stage Race All Cases 17 Female 20 Male 14 5 (Highest) 23 4 19 3 17 2 15 1 (Lowest) 12 IV 4 III 15 II 36 I 60 Asian/Pacific Islander 20 Hispanic 16 Non-Hispanic black 15 Non-Hispanic white 17 0 10 20 30 40 50 60 70

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

Five-year Relative Survival (%), California, 2004-2015, Melanoma Race Stage SES Sex Sex SES Stage Race All Cases 89 Female 92 Male 87 5 (Highest) 94 4 91 3 87 2 83 1 (Lowest) 76 IV 17 III 60 II 77 I 100 Asian/Pacific Islander 71 Hispanic 81 Non-Hispanic black 75 Non-Hispanic white 90 0 10 20 30 40 50 60 70 80 90 100 72

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

Five-year Relative Survival (%), California, 2004-2015, Oropharyngeal Cancer Race Stage SES Sex Sex SES Stage Race All Cases 64 Female 66 Male 63 5 (Highest) 76 4 68 3 64 2 57 1 (Lowest) 51 IV 53 III 66 II 76 I 87 Asian/Pacific Islander 66 Hispanic 61 Non-Hispanic black 52 Non-Hispanic white 66 0 10 20 30 40 50 60 70 80 90 100 74

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

Five-year Relative Survival (%), California, 2004-2015, Prostate Cancer Race Stage SES All Cases 97 SES 5 (Highest) 4 3 2 100 98 96 94 1 (Lowest) 90 IV 45 Stage III II I 100 100 100 Race Asian/Pacific Islander Hispanic Non-Hispanic black Non-Hispanic white 95 95 95 97 0 10 20 30 40 50 60 70 80 90 100 76

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

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

Distribution of Cancer Types among children ages 0-14, California, 2011-2015 22% 34% 6% 6% 8% Leukemias CNS^ Lymphomas Neuroblastoma Soft tissue All other cancers 24% Includes myelodysplastic syndromes and benign brain/cns tumors. ^Includes miscellaneous intracranial and intraspinal neoplasms. Includes other extraosseous sarcomas. 79

Distribution of Cancer Types among Adolescents ages 15-19, California, 2011-2015 14% 20% CNS^ 14% Other malignant epithelial neoplasms Lymphomas 19% Leukemias 15% Germ cell Includes myelodysplastic syndromes and benign brain/cns tumors. ^Includes miscellaneous intracranial and intraspinal neoplasms. Includes melanomas. Includes trophoblastic tumors and neoplasms of gonads. 18% All other cancers 80

Rate per 1,000,000 Age-Adjusted Incidence Trends for children ages 0-14 by Sex, California, 2005-2014 175 170 165 160 155 150 145 140 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year of Diagnosis All Children (APC=0.1) Males (APC=0.1) Females (APC=0.2) Excludes myelodysplastic syndromes and benign brain/cns tumors. *The annual percent change (APC) is significantly different from zero at p < 0.05 81

Rate per 1,000,000 Age-Adjusted Incidence Trends for adolescents ages 15-19 by Sex, California, 2005-2014 270 250 230 210 190 170 150 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year of Diagnosis All Children (APC=1.2*) Males (APC=2.0*) Females (APC=0.3) Excludes myelodysplastic syndromes and benign brain/cns tumors. * The annual percent change (APC) is significantly different from zero at p < 0.05. 82

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

Thank you! Contact information: Fran Maguire: fbmaguire@ucdavis.edu 84

Questions 85