State of Wyoming Department of Health Tobacco-Related Cancers in Wyoming Data Brief The Tobacco-Related Cancers in Wyoming data brief is published by the Public Health Division Wendy E. Braund, MD, MPH, MSEd, FACPM State Health Officer and Senior Administrator, Public Health Division Additional information and copies may be obtained from: Elizabeth Mikesell Wyoming Comprehensive Cancer Control Program 6101 Yellowstone Road, Suite 510 Cheyenne, Wyoming 82002 307-777-8609 Fax: 307-777-2426 liz.mikesell@wyo.gov This document is available in alternative format upon request This publication was supported by Cooperative Agreement Grant # 5U58DP000801-04 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. 2
According to the National Cancer Institute, smoking is linked with increased risk of at least 15 types of cancer including: nasopharyngeal, nasal cavity, paranasal sinuses, lip, oral cavity, pharynx, larynx, lung, esophageal, pancreas, uterine, cervix, kidney, bladder, stomach and acute myeloid leukemia. This report focuses on the top three tobacco-related cancers in Wyoming lung cancer, bladder cancer and oral cancer. Incidence and Mortality of Cancers Related to Tobacco Use Lung Cancer Cancer of the lung and bronchus is the leading cause of cancer-related death in Wyoming and one of the top cancers diagnosed every year. In 2009, there were a total of 305 lung cancers diagnosed in Wyoming residents (175 men, 130 in women). In addition in 2009, there were 238 lung cancer related deaths in Wyoming (137 men, 101 women). Figure 1 illustrates the lung cancer incidence rate for Wyoming (in 3 year rolling averages) vs. the U.S. rate from 1998-2009. During this time period, Wyoming s rate is consistently lower than the U.S. rate. Figure 1 Lung Cancer Incidence Rate, 2009 Wyoming and U.S. 70 Rate per 100,000 population 60 50 40 30 20 10 0 98-00 99-01 00-02 01-03 02-04 03-05 04-06 05-07 06-08 07-09 Year (3-year average) Wyoming U.S. 3
This map shows lung cancer incidence rates by Wyoming county from 2005-2009. Darker shaded counties indicate higher rates, while lighter shaded counties had lower rates. 4
Figure 2 below shows lung cancer incidence by age and sex for Wyoming in 2009. Rates are higher among older people and the male rate is higher than the female rate for all age groups. Figure 2 Lung Cancer Incidence by Age and Sex, 2009 Wyoming 900 800 Rate per 100,000 population 700 600 500 400 300 200 100 0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age Group WY Male WY Female WY All Figure 3 shows lung cancer by stage of diagnosis. Here, stage refers to the extent the cancer has spread in the body at time of diagnosis. Over half of the lung cancer cases in 2009 were diagnosed at a distant stage. Figure 3 Lung Cancer by Stage of Diagnosis, Wyoming 2009 Unstaged 7% In situ <1% Local 17% Distant 52% Regional 24% 5
Bladder Cancer Cancer of the bladder is not always included in lists of tobacco related cancers, but there is a strong positive association between tobacco use and the risk of developing bladder cancer. In 2009, there were 147 cases of bladder cancer diagnosed in Wyoming (112 men, 35 women). In terms of mortality, there were 22 deaths due to bladder cancer in 2009 (15 men, 7 women). Figure 4 illustrates the bladder cancer incidence rate for Wyoming (in 3 year rolling averages) vs. the U.S. rate from 1998-2009. During this time period, Wyoming s incidence is slightly higher than the U.S. rate. Figure 4 Bladder Cancer Incidence Rate, 1998-2009 Wyoming and U.S. 30 Rate per 100,000 poulation 25 20 15 10 5 0 98-00 99-01 00-02 01-03 02-04 03-05 04-06 05-07 06-08 07-09 Year (3 year average) Wyoming U.S. 6
The map below shows bladder cancer incidence rates by Wyoming county from 2005-2009. Darker shaded counties indicate higher rates, while lighter shaded counties had lower rates. 7
Figure 5 below shows bladder cancer incidence by age and sex for Wyoming in 2009. Rates are higher among older people and the male rate is higher than the female rate for all age groups. Figure 5 Bladder Cancer Incidence by Age and Sex, Wyoming 2009 450 400 350 Rate per 100,000 population 300 250 200 150 100 50 0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age Group WY Male WY Female WY All Figure 6 shows bladder cancer by stage of diagnosis. A majority of bladder cancers diagnosed in Wyoming in 2009 were diagnosed at local or in situ stages. Figure 6 Bladder Cancer by Stage of Diagnosis, Wyoming 2009 Distant 4% Unstaged 1% Regional 8% In situ 43% Local 44% 8
Oral Cancer Oral cancer includes cancers of the lips, tongue, pharynx and mouth and is directly linked to all kinds of tobacco use including smoking, pipes, cigars, and smokeless tobacco. In 2009, there were 51 cases of oral cancer diagnosed in Wyoming residents (37 men, 14 women). Moreover, there were 13 deaths from oral cancer (8 men, 5 women). While it is not a leading cause of cancer death, oral cancer is a leading cause of disfigurement as treatment may include the removal of part of the jaw, lips, tongue, cheek or other facial features. Figure 7 illustrates the oral cancer incidence rate for Wyoming (in 3 year rolling averages) vs. the U.S. rate from 1998-2009. During this time period, Wyoming s rate is not appreciably different from the U.S. rate. Wyoming s rate is less stable, due to the small number of cases. Figure 7 Oral Cancer Incidence 1998-2009, Wyoming and U.S. 12 10 Rate per 100,000 8 6 4 2 0 98-00 99-01 00-02 01-03 02-04 03-05 04-06 05-07 06-08 07-09 Year (3 year average) Wyoming U.S. 9
The map below shows oral cancer incidence rates by Wyoming county from 2005-2009. Darker shaded counties indicate higher rates, while lighter shaded counties had lower rates. 10
Figure 8 shows oral cancer incidence by age and sex for Wyoming in 2009. Rates are higher among older people and the male rate is higher than the female rate for all age groups. Figure 8 Oral Cancer Incidence by Age and Sex, Wyoming 2009 180 160 140 Rate per 100,000 population 120 100 80 60 40 20 0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age Group WY Male WY Female WY All Figure 9 shows oral cancer by stage of diagnosis. A majority of oral cancers diagnosed in Wyoming in 2009 were diagnosed at local or regional stages. FIGURE 9 Oral Cancer by Stage of Diagnosis, Wyoming 2009 Distant 15% Unstaged 9% In situ 7% Regional 36% Local 33% 11
Other Related Cancers Aside from the three cancer sites discussed above, tobacco is a leading risk factor for at least 15 other types of cancer. Combined, these cancers accounted for 257 of the cancers diagnosed in 2009. Additionally, these cancers were responsible for a combined 145 cancer deaths in 2009. Tobacco as Risk Factor According to the Centers for Disease Control and Prevention (CDC), tobacco use, primarily cigarette smoking, is the leading cause of lung cancer with about 90% of all cases being related to cigarettes. According to the American Society of Clinical Oncology, smokers are four to seven times more likely to develop bladder cancer than non-smokers. According to the 2010 Wyoming Behavioral Risk Factor Surveillance System Survey, 19.5% of Wyoming adults currently smoke tobacco (16 th highest in the country). The map below shows current cigarette use by Wyoming County from 2005-2009 from the BRFSS survey. Use is highest in the darker shaded counties and lowest in the lighter shaded counties. 12
Figure 9 below shows the percent of Wyoming adults who reported current cigarette smoking from 1995-2010. In this time period, Wyoming smoking prevalence has not significantly decreased. The Healthy People 2020 goal is to have less than 12% of adults reporting current smoking; Wyoming has not met this goal. FIGURE 9 Current cigarette smoking, Wyoming 1995-2010 25% 20% Percent 15% 10% 5% 0% 2000 2002 2004 2006 2008 2010 WY Year HP2020 Target Current smoking among Wyoming adults in 2010 did not significantly differ by sex, with 20.2% of males and 18.9% of females reporting current smoking. Figure 10 shows the prevalence of current smoking by age group among Wyoming adults. Rates are similar across age groups with the exception of the 65 years and older group, where rates are significantly lower than any other age group. FIGURE 10 Current cigarette smoking by age, Wyoming 2010 Percent reporting current smoking 35% 30% 25% 20% 15% 10% 5% 0% 21.1% 24.6% 21.3% 21.9% 19.0% 9.1% 18-24 25-34 35-44 45-54 55-64 65+ Age Group 13
Among Wyoming adults, 8.2% said they currently use smokeless tobacco, which is the highest (1 st ) rate in the nation in 2010. Current smokeless tobacco use among Wyoming adults in 2010 was significantly higher among males compared to females, with 14.8% of males and 1.5% of females reporting current smokeless tobacco use. Figure 11 shows the prevalence of current smokeless tobacco use by age group among Wyoming adults. Rates are similar across age groups with the exception of the 65 years and older group, where rates are significantly lower than any other age group. FIGURE 11 Current smokeless tobacco use by age, Wyoming 2010 Percent reporting current smokeless tobacco use 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 11.0% 11.4% 10.7% 8.5% 5.2% 3.0% 18-24 25-34 35-44 45-54 55-64 65+ Age Group 14
The map below shows current smokeless tobacco use among adult males by Wyoming County from 2005-2009 from the BRFSS survey. Use is highest in the darker shaded counties and lowest in the lighter shaded counties. Hot Springs and Niobrara Counties are not included because of small sample sizes. 15
Program Information Wyoming Tobacco Prevention and Control Program The Wyoming Tobacco Prevention and Control Program implements evidence-based strategies to address nationally recognized goals to eliminate exposure to secondhand smoke, reduce tobacco initiation among youth, promote cessation and address populations that suffer disparately from the health or economic effects of tobacco. Activities directed toward the accomplishments of these goals are carried out by community-based prevention programs and the state s Wyoming QuitLine. Wyoming Comprehensive Cancer Control Consortium The Wyoming Comprehensive Cancer Control Consortium, through the Wyoming Cancer Control Plan 2011-2015, addresses tobacco prevention goals focused on reducing the impact of tobacco on the burden of cancer in Wyoming and providing programs and promoting policies and practices that protect residents from secondhand smoke. The Consortium s website has been designed to centralize a multitude of state and national resources and links to support these goals. Please visit www.fightcancerwy.com for more information. Definitions Incidence: the number of newly diagnosed cancer cases that occur in the population per unit of time, usually one year. Mortality: the number of deaths that occur in the population per unit of time, usually one year. Rate: the proportion of the population affected, usually defined as per 100,000 persons in a population. Stage of Diagnosis Unstaged: Extent of disease or primary site cannot be determined. Stage of Diagnosis In Situ: Cancer has not invaded the organ. Stage of Diagnosis Localized: Cancer has invaded the organ of origin. Stage of Diagnosis Regional: Cancer has invaded beyond the organ of origin by direct extension to adjacent organs and/or tissues and/or regional lymph nodes. Stage of Diagnosis Distant: Direct extension beyond adjacent organs or tissues or metastases to distant site(s) or distant lymph nodes. 16