BONNER COUNTY CANCER PROFILE

BONNER COUNTY CANCER PROFILE A fact sheet from the Cancer Data Registry of Idaho, Idaho Hospital Association. Cancer Incidence 2010-2014 Cancer Mortality 2011-2015 BRFSS 2011-2015 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 http://www.idcancer.org National Cancer Institute Cancer Information Services 1-800-4CANCER https://www.cancer.gov/contact/contact -center American Cancer Society 2676 South Vista Avenue Boise, ID 83705 208-343-4609 http://www.cancer.org 1

CANCER INCIDENCE 2010-2014 During the five-year period 2010-2014, 37,621 cases of invasive cancer were diagnosed among residents of the state of Idaho, 1,321 among Bonner County residents. It is estimated that almost one in two Idahoans will develop cancer during their lifetime. Cancer Incidence 2010-2014 Bonner County State of Idaho All Sites/Types 1,321 37,621 Female Breast 182 5,295 Prostate 179 5,187 Lung & Bronchus 168 4,338 Colorectal 116 3,049 The table, CANCER INCIDENCE 2010-2014, COMPARISON BETWEEN BONNER COUNTY AND THE REMAINDER OF THE STATE OF IDAHO, shows for Bonner County the number of observed cases, person-years, crude rates, age and sexadjusted 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, personyears, 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 Bonner County was 646.3 cases per 100,000 person-years for the years 2010-2014. Compared with the crude incidence rate for the remainder of Idaho (465.7), this gives an estimate of the burden of disease in Bonner County. The age- and sex-adjusted incidence rate of invasive cancer in Bonner County, all sites combined, was 464.9 cases per 100,000 persons per year for the years 2010-2014. There were fewer cases of cancer in Bonner County (1,321) than expected (1,323.3) 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 2011-2015 In 2008 cancer became the leading cause of death in Idaho. From 2011-2015, 13,470 persons in Idaho died from cancer, 541 in Bonner County. The majority of cancer deaths are from five primary sites: lung, colon, pancreas, female breast, and prostate. Mortality 2011-2015 Bonner County State of Idaho All Deaths 2,047 62,050 Cancer Deaths % of All Deaths 541 26% 13,470 21.7% Lung & Bronchus 132 3,169 Colorectal 49 1,143 Pancreas 30 984 Female Breast 45 942 The table, CANCER MORTALITY 2011-2015, COMPARISON BETWEEN BONNER COUNTY AND THE REMAINDER OF THE STATE OF IDAHO, shows for Bonner County the number of observed deaths, person-years, crude rates, age and sexadjusted 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, personyears, 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 Bonner County, all sites combined, was 186.1 deaths per 100,000 persons per year for the years 2011-2015, compared with 164.1 for the remainder of the state. There were statistically significantly more cancer deaths in Bonner County (541) than expected (477.0) based upon rates in the remainder of the state (p=.004). Prostate 40 861 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 2010-2014 COMPARISON BETWEEN BONNER COUNTY AND THE REMAINDER OF THE STATE OF IDAHO Bonner 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 1,321 204,387 646.3 464.9 1,323.3 0.965 36,300 7,794,421 465.7 All Sites Combined Male 715 102,347 698.6 474.0 729.0 0.620 18,864 3,902,933 483.3 All Sites Combined Female 606 102,040 593.9 449.9 603.5 0.929 17,436 3,891,488 448.1 Bladder Total 72 204,387 35.2 24.7 67.3 0.599 1,802 7,794,421 23.1 Bladder Male 57 102,347 55.7 37.2 55.8 0.905 1,422 3,902,933 36.4 Bladder Female 15 102,040 14.7 10.8 13.5 0.754 380 3,891,488 9.8 Brain - malignant Total 18 204,387 8.8 6.9 16.5 0.785 497 7,794,421 6.4 Brain - malignant Male 12 102,347 11.7 9.0 10.2 0.653 299 3,902,933 7.7 Brain - malignant Female 6 102,040 5.9 4.7 6.4 1.000 198 3,891,488 5.1 Brain and other CNS - non-malignant Total 26 204,387 12.7 9.9 29.5 0.592 878 7,794,421 11.3 Brain and other CNS - non-malignant Male 7 102,347 6.8 5.3 10.3 0.392 301 3,902,933 7.7 Brain and other CNS - non-malignant Female 19 102,040 18.6 14.8 19.1 1.000 577 3,891,488 14.8 Breast Total 185 204,387 90.5 65.4 187.1 0.918 5,156 7,794,421 66.1 Breast Male 3 102,347 2.9 2.0 1.7 0.463 43 3,902,933 1.1 Breast Female 182 102,040 178.4 132.7 180.2 0.914 5,113 3,891,488 131.4 Breast - in situ Total 46 204,387 22.5 16.5 35.9 0.117 1,000 7,794,421 12.8 Breast - in situ Male - 102,347 - - 0.1 1.000 2 3,902,933 0.1 Breast - in situ Female 46 102,040 45.1 33.7 35.0 0.085 998 3,891,488 25.6 Cervix Female 6 102,040 5.9 5.1 7.3 0.819 239 3,891,488 6.1 Colorectal Total 116 204,387 56.8 40.8 106.9 0.403 2,933 7,794,421 37.6 Colorectal Male 58 102,347 56.7 38.6 59.8 0.883 1,554 3,902,933 39.8 Colorectal Female 58 102,040 56.8 43.1 47.7 0.164 1,379 3,891,488 35.4 Corpus Uteri Female 36 102,040 35.3 25.4 37.3 0.918 1,024 3,891,488 26.3 Esophagus Total 22 204,387 10.8 7.5 14.2 0.065 378 7,794,421 4.8 Esophagus Male 20 102,347 19.5 13.1 12.2 0.051 313 3,902,933 8.0 Esophagus Female 2 102,040 2.0 1.5 2.3 1.000 65 3,891,488 1.7 Hodgkin Lymphoma Total 10 204,387 4.9 4.8 5.2 0.083 197 7,794,421 2.5 Hodgkin Lymphoma Male 3 102,347 2.9 2.7 3.1 1.000 111 3,902,933 2.8 Hodgkin Lymphoma Female 7 102,040 6.9 7.3 2.1 0.012 >> 86 3,891,488 2.2 Kidney and Renal Pelvis Total 39 204,387 19.1 13.7 46.7 0.288 1,277 7,794,421 16.4 Kidney and Renal Pelvis Male 21 102,347 20.5 14.0 31.3 0.068 815 3,902,933 20.9 Kidney and Renal Pelvis Female 18 102,040 17.6 13.2 16.1 0.706 462 3,891,488 11.9 Larynx Total 9 204,387 4.4 3.0 7.3 0.617 188 7,794,421 2.4 Larynx Male 7 102,347 6.8 4.4 6.3 0.898 157 3,902,933 4.0 Larynx Female 2 102,040 2.0 1.4 1.2 0.647 31 3,891,488 0.8 Leukemia Total 38 204,387 18.6 14.1 44.6 0.363 1,293 7,794,421 16.6 Leukemia Male 28 102,347 27.4 19.9 26.5 0.825 736 3,902,933 18.9 Leukemia Female 10 102,040 9.8 7.8 18.5 0.048 << 557 3,891,488 14.3 Liver and Bile Duct Total 25 204,387 12.2 8.4 20.4 0.356 536 7,794,421 6.9 Liver and Bile Duct Male 17 102,347 16.6 11.1 14.9 0.656 379 3,902,933 9.7 Liver and Bile Duct Female 8 102,040 7.8 5.7 5.7 0.425 157 3,891,488 4.0 Lung and Bronchus Total 168 204,387 82.2 56.8 158.3 0.463 4,170 7,794,421 53.5 Lung and Bronchus Male 97 102,347 94.8 62.3 84.7 0.202 2,124 3,902,933 54.4 Lung and Bronchus Female 71 102,040 69.6 50.3 74.2 0.770 2,046 3,891,488 52.6 Melanoma of the Skin Total 71 204,387 34.7 26.1 75.3 0.676 2,158 7,794,421 27.7 Melanoma of the Skin Male 43 102,347 42.0 29.5 47.3 0.594 1,268 3,902,933 32.5 Melanoma of the Skin Female 28 102,040 27.4 22.1 29.0 0.949 890 3,891,488 22.9 Myeloma Total 10 204,387 4.9 3.4 18.7 0.043 << 498 7,794,421 6.4 Myeloma Male 3 102,347 2.9 1.9 12.5 0.003 << 314 3,902,933 8.0 Myeloma Female 7 102,040 6.9 5.1 6.5 0.951 184 3,891,488 4.7 Non-Hodgkin Lymphoma Total 51 204,387 25.0 18.1 54.6 0.684 1,511 7,794,421 19.4 Non-Hodgkin Lymphoma Male 30 102,347 29.3 20.3 32.3 0.765 853 3,902,933 21.9 Non-Hodgkin Lymphoma Female 21 102,040 20.6 15.6 22.7 0.821 658 3,891,488 16.9 Oral Cavity and Pharynx Total 47 204,387 23.0 16.3 37.3 0.139 1,010 7,794,421 13.0 Oral Cavity and Pharynx Male 29 102,347 28.3 19.5 26.3 0.646 688 3,902,933 17.6 Oral Cavity and Pharynx Female 18 102,040 17.6 13.2 11.3 0.081 322 3,891,488 8.3 Ovary Female 28 102,040 27.4 20.7 16.8 0.015 >> 482 3,891,488 12.4 Pancreas Total 42 204,387 20.5 14.4 39.1 0.686 1,047 7,794,421 13.4 Pancreas Male 29 102,347 28.3 19.0 21.0 0.112 536 3,902,933 13.7 Pancreas Female 13 102,040 12.7 9.4 18.2 0.266 511 3,891,488 13.1 Prostate Male 179 102,347 174.9 112.6 204.0 0.082 5,008 3,902,933 128.3 Stomach Total 21 204,387 10.3 7.3 14.8 0.147 400 7,794,421 5.1 Stomach Male 14 102,347 13.7 9.1 10.4 0.325 264 3,902,933 6.8 Stomach Female 7 102,040 6.9 5.2 4.7 0.391 136 3,891,488 3.5 Testis Male 6 102,347 5.9 6.8 5.3 0.879 236 3,902,933 6.0 Thyroid Total 16 204,387 7.8 6.7 38.4 0.000 << 1,253 7,794,421 16.1 Thyroid Male 5 102,347 4.9 3.8 9.5 0.177 284 3,902,933 7.3 Thyroid Female 11 102,040 10.8 9.5 28.9 0.000 << 969 3,891,488 24.9 Pediatric Age 0 to 19 Total 7 46,769 15.0 15.1 7.8 0.971 390 2,321,637 16.8 Pediatric Age 0 to 19 Male 4 23,922 16.7 17.0 4.3 1.000 219 1,187,931 18.4 Pediatric Age 0 to 19 Female 3 22,847 13.1 13.2 3.4 1.000 171 1,133,706 15.1 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 2011-2015 COMPARISON BETWEEN BONNER COUNTY AND THE REMAINDER OF THE STATE OF IDAHO Bonner 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 2,047 205,329 996.9 752.8 2,071.2 0.604 60,003 7,877,423 761.7 All Causes of Death Male 1,064 102,601 1,037.0 752.6 1,111.1 0.161 31,002 3,944,607 785.9 All Causes of Death Female 983 102,728 956.9 747.4 969.8 0.680 29,001 3,932,816 737.4 All Malignant Cancers Total 541 205,329 263.5 186.1 477.0 0.004 >> 12,929 7,877,423 164.1 All Malignant Cancers Male 308 102,601 300.2 202.0 271.4 0.031 >> 7,019 3,944,607 177.9 All Malignant Cancers Female 233 102,728 226.8 167.7 208.8 0.105 5,910 3,932,816 150.3 Bladder Total 18 205,329 8.8 6.3 12.4 0.159 344 7,877,423 4.4 Bladder Male 12 102,601 11.7 8.1 9.9 0.578 262 3,944,607 6.6 Bladder Female 6 102,728 5.8 4.4 2.8 0.132 82 3,932,816 2.1 Brain and Other Nervous System Total 18 205,329 8.8 6.3 15.4 0.569 426 7,877,423 5.4 Brain and Other Nervous System Male 12 102,601 11.7 8.3 10.1 0.618 273 3,944,607 6.9 Brain and Other Nervous System Female 6 102,728 5.8 4.3 5.5 0.928 153 3,932,816 3.9 Breast Total 46 205,329 22.4 16.1 32.7 0.033 >> 904 7,877,423 11.5 Breast Male 1 102,601 1.0 0.7 0.3 0.452 7 3,944,607 0.2 Breast Female 45 102,728 43.8 32.6 31.5 0.027 >> 897 3,932,816 22.8 Cervix Female 3 102,728 2.9 2.3 2.4 0.880 72 3,932,816 1.8 Colorectal Total 49 205,329 23.9 17.0 40.1 0.189 1,094 7,877,423 13.9 Colorectal Male 30 102,601 29.2 19.8 23.3 0.207 607 3,944,607 15.4 Colorectal Female 19 102,728 18.5 13.8 17.0 0.694 487 3,932,816 12.4 Corpus Uteri Female 6 102,728 5.8 4.2 3.8 0.358 104 3,932,816 2.6 Esophagus Total 15 205,329 7.3 5.1 13.6 0.764 362 7,877,423 4.6 Esophagus Male 14 102,601 13.6 9.1 11.2 0.482 288 3,944,607 7.3 Esophagus Female 1 102,728 1.0 0.7 2.6 0.527 74 3,932,816 1.9 Hodgkin Lymphoma Total 1 205,329 0.5 0.4 0.8 1.000 25 7,877,423 0.3 Hodgkin Lymphoma Male - 102,601 - - 0.4 1.000 11 3,944,607 0.3 Hodgkin Lymphoma Female 1 102,728 1.0 0.8 0.5 0.729 14 3,932,816 0.4 Kidney Total 12 205,329 5.8 4.1 13.0 0.922 351 7,877,423 4.5 Kidney Male 10 102,601 9.7 6.5 9.2 0.889 236 3,944,607 6.0 Kidney Female 2 102,728 1.9 1.5 4.0 0.473 115 3,932,816 2.9 Larynx Total 4 205,329 1.9 1.3 2.1 0.329 56 7,877,423 0.7 Larynx Male 3 102,601 2.9 2.0 1.9 0.576 48 3,944,607 1.2 Larynx Female 1 102,728 1.0 0.7 0.3 0.518 8 3,932,816 0.2 Leukemia Total 21 205,329 10.2 7.5 19.0 0.701 535 7,877,423 6.8 Leukemia Male 15 102,601 14.6 10.2 11.5 0.375 309 3,944,607 7.8 Leukemia Female 6 102,728 5.8 4.5 7.7 0.714 226 3,932,816 5.7 Liver and Bile Duct Total 21 205,329 10.2 7.0 17.9 0.528 471 7,877,423 6.0 Liver and Bile Duct Male 13 102,601 12.7 8.2 12.4 0.936 309 3,944,607 7.8 Liver and Bile Duct Female 8 102,728 7.8 5.7 5.8 0.458 162 3,932,816 4.1 Lung and Bronchus Total 132 205,329 64.3 44.1 115.3 0.136 3,037 7,877,423 38.6 Lung and Bronchus Male 80 102,601 78.0 50.7 65.0 0.080 1,626 3,944,607 41.2 Lung and Bronchus Female 52 102,728 50.6 36.6 51.0 0.926 1,411 3,932,816 35.9 Melanoma of the Skin Total 10 205,329 4.9 3.5 10.9 0.945 301 7,877,423 3.8 Melanoma of the Skin Male 7 102,601 6.8 4.7 7.5 1.000 197 3,944,607 5.0 Melanoma of the Skin Female 3 102,728 2.9 2.2 3.6 1.000 104 3,932,816 2.6 Myeloma Total 4 205,329 1.9 1.4 9.9 0.063 267 7,877,423 3.4 Myeloma Male - 102,601 - - 6.3 0.004 << 162 3,944,607 4.1 Myeloma Female 4 102,728 3.9 2.9 3.7 0.995 105 3,932,816 2.7 Non-Hodgkin Lymphoma Total 19 205,329 9.3 6.6 18.9 1.000 520 7,877,423 6.6 Non-Hodgkin Lymphoma Male 12 102,601 11.7 7.9 11.5 0.950 297 3,944,607 7.5 Non-Hodgkin Lymphoma Female 7 102,728 6.8 5.2 7.7 0.995 223 3,932,816 5.7 Oral Cavity and Pharynx Total 9 205,329 4.4 3.1 7.4 0.637 198 7,877,423 2.5 Oral Cavity and Pharynx Male 5 102,601 4.9 3.3 5.6 1.000 144 3,944,607 3.7 Oral Cavity and Pharynx Female 4 102,728 3.9 2.9 1.9 0.245 54 3,932,816 1.4 Ovary Female 14 102,728 13.6 9.8 13.1 0.883 363 3,932,816 9.2 Pancreas Total 30 205,329 14.6 10.1 35.8 0.379 954 7,877,423 12.1 Pancreas Male 20 102,601 19.5 12.8 20.4 1.000 516 3,944,607 13.1 Pancreas Female 10 102,728 9.7 7.1 15.6 0.184 438 3,932,816 11.1 Prostate Male 40 102,601 39.0 27.0 30.8 0.127 821 3,944,607 20.8 Stomach Total 9 205,329 4.4 3.1 7.0 0.534 192 7,877,423 2.4 Stomach Male 5 102,601 4.9 3.3 5.0 1.000 131 3,944,607 3.3 Stomach Female 4 102,728 3.9 2.9 2.1 0.324 61 3,932,816 1.6 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, 2015. 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 2015 to CDRI staff, who performed the analyses reported in these County Profiles. Analysis weights were poststratified to 2015 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. Access to Care Cancer Screening and Risk Factor Prevalence Estimates, 2011-2015 State of Idaho HD 1 HD 2 HD 3 HD 4 HD 5 HD 6 HD 7 Cancer Screening Bonner County Access to Care Health Insurance, Age <65 (2014-2015) 81.4% 81.1% 86.1% 74.2% 86.1% 72.6% 83.8% 82.5% 79.3% Not See Doctor Due to Cost Past Year (2014-2015) 14.5% 13.3% 11.8% 21.1% 13.5% 15.3% 11.8% 13.1% 14.7% Cancer Screening Mammogram Past 2 Years, Age 50-74 (2012, 2014) 69.7% 72.5% 69.8% 62.1% 73.9% 68.6% 67.2% 68.2% 66.9% Pap Test Past 3 Years, Cervix Intact Age 21-65 (2012, 2014) 76.4% 77.2% 80.8% 67.2% 80.9% 75.1% 75.9% 74.9% 78.6% Colorectal Cancer Screening, Age 50-75 (2012, 2014) 61.9% 60.6% 65.3% 56.4% 67.8% 57.9% 59.5% 60.6% 52.1% Tobacco Use Current Smoker (2013-2015) 15.6% 18.1% 15.0% 18.9% 14.3% 17.8% 13.5% 11.2% 17.2% Current Smokeless Tobacco User, Males (2012-2015) 9.3% 10.0% 15.2% 10.9% 8.0% 10.3% 6.6% 7.5% 5.3% Other Cancer-Related Sunburn in Previous 12 Months (2014) 50.2% 45.9% 52.0% 45.4% 53.2% 47.8% 52.1% 53.9% 49.3% Artificial Tanning Appliance Use (2011, 2014) 5.1% 6.6% 3.9% 3.9% 3.4% 5.4% 6.6% 8.2% 5.2% Weight Classification by Body Mass Index (2013-2015) 32.6% 33.6% 35.7% 26.4% 35.9% 30.1% 32.6% 32.3% 37.7% Meet Physical Activity Guidelines (2011, 2013, 2015) 21.5% 21.1% 18.2% 19.1% 25.6% 19.1% 20.7% 19.6% 19.6% Home Ever Tested for Radon (2012, 2014) 15.7% 22.8% 9.8% 11.0% 15.3% 14.0% 17.5% 18.2% 17.7% Health Insurance 2014-2015 Statewide, 81.4% of adults aged 18-64 reported having health care coverage. Health care coverage differed significantly by race/ethnicity, with 84.0% of white non-hispanics, compared to 63.8% of Hispanics and 85.7% of Native Americans, having health insurance. Spanish-speaking respondents were significantly less likely to be insured (36.7%) than Englishspeaking respondents (83.0%). Health care coverage differed significantly by age of respondent, with 77.0% of persons aged 18-29, and 86.4% of persons aged 50-64, having health insurance. Health care coverage differed significantly by county, with a range of 61.0% (Jerome County) to 90.1% (Elmore County) having health insurance. Not See Doctor Due to Cost Past Year 2014-2015 Statewide, 14.5% 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 (13.4% of white non-hispanics, 23.8% of Hispanics, and 13.2% of Native Americans). Inability to see a doctor due to cost differed significantly by annual household income (30.2% for less than $15,000, 7.2% for greater than $50,000). Inability to see a doctor due to cost differed significantly by county, with a range of 7.0% (Elmore County) to 23.1% (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. Mammogram 2012, 2014 Statewide, 69.7% 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 (73.4% versus 39.2%). Mammography rates differed significantly by county, with a range in screening of 55.1% (Gem County) to 79.5% (Nez Perce County). In 2014, Idaho ranked 50 th among states and the District of Columbia for mammography screening rates among women aged 40+ and 50-74. Pap Test 2012, 2014 Statewide, 76.4% 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 (78.5% versus 69.4% screened in the past 3 years). Pap screening differed significantly by county, with a range of 63.4% (Madison County) to 90.6% (Nez Perce County). In 2014, Idaho had the lowest Pap screening rate among states and the District of Columbia. Colorectal Cancer Screening 2012, 2014 Statewide, 61.9% 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 2014, 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 2013-2015 Statewide, 15.6% of adults aged 18 and older were current smokers. Smoking prevalence differed significantly by age of respondent, with 20.2% of persons aged 30-39, and 7.9% of persons aged 65 and older, reporting current smoking. Smoking prevalence was lower among white non-hispanics (15.3%) than among Native Americans (36.1%). Smoking prevalence differed significantly by county, with a range of 4.2% (Madison County) to 30.0% (Elmore County). Counties with higher rates of current smoking had higher rates of lung cancer. Smokeless Tobacco Use, Males 2012-2015 Statewide, 9.3% of males aged 18 and older were current users of smokeless tobacco. Smokeless tobacco use differed significantly by age group, ranging from 13.3% 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 1.0% (Franklin County) to 22.0% (Owyhee County). Other Cancer-Related Sun Exposure 2014 Statewide, 50.2% of adults aged 18 and older reported having sunburn in the past 12 months. Sunburn rates were higher for white non-hispanics (52.7%) than for Hispanics (37.7%) or Native Americans (37.6%). Males (54.2%) were more likely than females (46.2%) to have had sunburn in the past 12 months. Sunburn rates differed significantly by age group, with 70.7% of persons aged 18-29 and 19.4% of persons aged 65 and older having sunburn in the past 12 months. Sunburn rates differed significantly by county, with a range of 33.5% (Lemhi County) to 68.8% (Latah County) having sunburn in the past 12 months. Artificial Tanning Appliance Use 2011, 2014 Statewide, 5.1% of adults aged 18 and older reported using an artificial tanning appliance, such as a tanning bed, in the past 12 months. Females (7.8%) were significantly more likely than males (2.4%) to have used an artificial tanning appliance in the past 12 months. Tanning appliance use differed significantly by age group, with 10.6% of persons aged 18-29 and 1.0% 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% (Gem and Power Counties) to over 9% (Fremont and Madison Counties) using an artificial tanning appliance in the past 12 months. Weight Classification by Body Mass Index 2013-2015 Statewide, 32.6% 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 25.4% of Hispanics and 25.1% of Native Americans, being in the healthy weight range. Males (25.9%) were significantly less likely to be in the healthy weight range than females (39.4%). BMI differed significantly by age of respondent, with 44.6% of persons aged 18-29, and 26.6% of persons aged 50-64, being in the healthy weight range. BMI differed significantly by county, with a range of 17.9% (Gem County) to 49.5% (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=.004). 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 7.5% (Oneida County) to 29.7% (Blaine County). Home Radon Testing 2012, 2014 Statewide, 15.7% of adults have ever tested their house for radon. Radon test usage varied significantly by race/ethnicity, with 16.8% of white non-hispanics, 6.0% of Hispanics, and 15.9% 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 4.7% (Lewis County) to 44.2% (Blaine County). 6