1999...CANCER IN NEW HAMPSHIRE, 1999 2 New Features in this Report The use of 2000 US standard population as a reference group for age-adjusted rates. Unlike previous publications

1 9 9 9CANCER IN NEW HAMPSHIRE, 1999

AN ANNUAL REPORT ON CANCER INCIDENCE AND MORTALITY

New Hampshire Department of Health and Human Services

Office of Community and Public Health

Division of Epidemiology and Vital Statistics

Bureau of Health Statistics and Data Management

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CANCER IN NEW HAMPSHIRE, 1999An annual report on cancer incidence and mortality

Jeanne Shaheen, Governor

Donald L. Shumway, CommissionerDepartment of Health and Human Services

Kathleen A. Dunn, DirectorOffice of Community and Public Health

A Publication of theNew Hampshire Department of Health and Human ServicesOffice of Community and Public HealthDivision of Epidemiology and Vital StatisticsBureau of Health Statistics and Data Management

6 Hazen Drive, Concord, NH 03301-6527(603)271-5926 or 1-800-852-2964 Ext. 5926TDD Access 1-800-735-2964Email: [email protected]: www.dhhs.state.nh.us/healthstats

June 2002

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CANCER IN NEW HAMPSHIRE, 1999An annual report on cancer incidence and mortality

PREPARED BY:

Chun-Fu Liu, MSc, MPH, Cancer EpidemiologistBureau of Health Statistics and Data Management

ACKNOWLEDGEMENTS:

Incidence Data: New Hampshire State Cancer Registry

E. Robert Greenberg, MD, Interim DirectorBruce L. Riddle, PhD, Network and Computer AdministratorJanice Gregoire, CTR, Senior RegistrarMaria O. Celaya, RHIT, CTR, Senior RegistrarMarcia D. Berry, RHIA, CTR, Registrar

Mortality Data: Bill Bolton, Registrar, Bureau of Vital Records

GIS Mapping:

Janet L. Horne, Planning Analyst, Bureau of Health Statistics and Data Management

BRFSS Data:

Josephine B.J. Porter, MPH, BRFSS Coordinator, Bureau of Health Statistics and DataManagement

Reviewers:(Bureau of Health Statistics and Data Management)

Jennifer A. Taylor, MPH, ChiefAndrew Chalsma, Senior Management AnalystJosephine B.J. Porter, MPH, BRFSS Coordinator/EpidemiologistJanet L. Horne, Planning AnalystDavid L. Reichel, MPH, Planning AnalystAnn Benett, Program Assistant

E. Robert Greenberg, MD, Interim DirectorBruce L. Riddle, PhD, Network and Computer Administrator

Andrew Pelletier, MD, MPH, Chronic Disease EpidemiologistSusan Knight, MPH, Epidemiologist

Jesse F. Greenblatt, MD, MPH, State Epidemiologist and Director, Division of Epidemiology and Vital Statistics

Margaret S. Murphy, Director, NH Breast and Cervical Cancer ProgramJohn D. Bonds, Planning Coordinator, Office of Planning and ResearchRebecca Cowens, MPH, American Cancer Society

*Special thanks to Poshen Wang for layout and cover design.

This work was supported in part by grant number U75/CCU118722-01 from the Centers for Disease Control.

(New Hampshire State Cancer Registry)

(Tobacco Control Program)

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Understanding the burden of cancer in New Hampshire would not be possible without theenormous contribution of its Tumor Registrars (who identify, register, and maintain records ofall cancer patients and report the information to the Cancer Registry). The Department ofHealth and Human Services would like to acknowledge the Registrars’ commitment to com-pleteness, accuracy, and integrity of cancer data. Without the dedication of these individuals,the pursuit of cancer control and prevention would be greatly compromised.

Tumor Registrar

Marilyn Thorson, BS, CCSBrigitte Lannan, HRA, CTRRichard Clark, CTR Claire Davis, CTRJudy Spahr, MLS, MED, CTRRosemary Couch, CTRAlberta Fraser, RHIT, CCSLaura Sims-Larabee, BS, CTRDarlene Austin, CTRAmanda TimlakeMary St.Jean, CTRMarjorie Moulton, RHITCynthia Dreyer, CTRAnn WigginSusan McGarryAnn Wiggett, RNDr. Gehr GeraldNancy Mason, RN, CCSDoreen Martin, RHITWenda White, CCSBetty McGannDebbie Dalton, CTRSimone Boudle, CTRJoyce Gosselin, CTRLisa LemieuxTracy StopyraBarbara SnyderMarie Munro, CTR, CCS Cindy Wright, CMTDebbie Rivet, RHIT, CTRHeather Placey, RHITLinda FullamCarrie MarshallJennifer Bolduc, CTR

Hospital

Alice Peck Day Memorial Hospital Androscoggin Valley Hospital Catholic Medical Center Cheshire Medical Center Concord Hospital

Cottage Hospital Dartmouth Hitchcock Medical Center

Exeter Hospital Franklin Regional Hospital Frisbie Memorial Hospital Huggins Hospital Lakes Region General Hospital Littleton Hospital Manchester VA Medical Center Memorial Hospital Monadnock Community Hospital New London Hospital

Elliot Hospital

Parkland Medical Center Portsmouth Regional Hospital Southern NH Regional Medical Center Speare Memorial HospitalSt. Joseph Hospital Upper Connecticut Valley Hospital Valley Regional Hospital Weeks Memorial Hospital Wentworth Douglas Hospital

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Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Frequently Asked Questions . . . . . . . . . . . . . . . . . . . 8 Summary of All Primary Sites. . . . . . . . . . . . . . . . . 11 Bladder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Brain and Other Central Nervous System. . . . . . . . 22 Breast (Female) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Cervix Uteri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Colon and Rectum . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Corpus Uteri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Hodgkin’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Kidney and Renal Pelvis . . . . . . . . . . . . . . . . . . . . . 39 Larynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Leukemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Lung and Bronchus . . . . . . . . . . . . . . . . . . . . . . . . . 47 Melanomas of the Skin . . . . . . . . . . . . . . . . . . . . . . 50 Multiple Myeloma . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Non-Hodgkin’s Lymphomas . . . . . . . . . . . . . . . . . . 55 Oral Cavity and Pharynx . . . . . . . . . . . . . . . . . . . . . 58 Ovary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Stomach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Testis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Thyroid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

TABLE OF CONTENTS

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SUMMARY TABLES AND FIGURES

Table 1. New Cases and Deaths by Sex and Primary Site, New Hampshire, 1999 . . . . . . .11Table 2. New Cases and Age-adjusted Incidence Rates by Sex and Primary Site,

New Hampshire, 1995-1999, US (SEER) White 1997 Comparison Rates . . . . . . . .12Table 3. Deaths and Age-adjusted Mortality Rates by Sex and Primary Site,

New Hampshire, 1995-1999, 1997 U.S. White Comparison Rates . . . . . . . . . . . . .13Table 4. Male Age-adjusted Incidence and Mortality Rates for Selected Primary Sites,

New Hampshire, 1995-1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14Table 5. Female Age-adjusted Incidence and Mortality Rates for Selected Primary Sites, . .

New Hampshire, 1995-1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15Table 6. Distribution of Cancer Incidence and Mortality by Site and Sex,

New Hampshire, 1995-1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Table 7. New Cases by Sex, Age, and Primary Site, New Hampshire, 1999 . . . . . . . . . . . .17Table 8. Deaths by Sex, Age, and Primary Site, New Hampshire, 1999 . . . . . . . . . . . . . . .18

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INTRODUCTION

Cancer is a heterogeneous group of diseases characterized by uncontrolled growth and spreadof abnormal cells1. In 1999, there were 5,377 new cases of cancer diagnosed in NewHampshire. The various forms of cancer were responsible for 2,407 deaths among NewHampshire residents in 1999, comprising approximately 26% of all deaths. In 1998, cancer (alltypes combined) was the most common cause of death among adults 35 to 74 years and thesecond leading cause across all age groups in New Hampshire2.

Morbidity and mortality due to cancer are increasingly preventable through two types of strate-gies. Primary prevention strategies aim to reduce, usually through lifestyle change, the likeli-hood that a healthy individual will develop cancer. Alternatively, secondary prevention isaccomplished by screening asymptomatic people to diagnose cancers at an early, more readilytreatable stage3.

This report includes New Hampshire cancer incidence and mortality data from 1999 and a sum-mary of incidence and mortality rates for the state covering the five years from 1995 through1999. The report provides information on cancer of all types combined and the 23 cancer sitesmost frequently diagnosed in New Hampshire residents using incidence data acquired by theNew Hampshire State Cancer Registry (NHSCR) and mortality data from the New HampshireBureau of Vital Records. For comparison purposes, national incidence rates are presented fromthe National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER)Program, SEER Cancer Incidence Public-Use Database, 1973-1998 using SEER Stat; and USwhite mortality rates are presented from the National Mortality Data Base (NMDB) using CDCWONDER provided by the National Center for Health Statistics. This information can be used atthe state and county level to identify the burden of morbidity and mortality associated witheach type of cancer. Combined with information on cancer prevention, early detection, andtreatment, it is useful for program planning and policy development aimed at reducing the bur-den of cancer.

This report is organized into three major sections: an executive summary (included as a sepa-rate document in the inside front cover pocket), the main report, and appendices. The execu-tive summary is a smaller version of the report, summarizing the overall cancer burden in NewHampshire, and is intended to stand on its own as a synopsis of the main report. The mainreport includes the information provided within the executive summary and provides moredetail about each of the 23 main cancer sites. Each primary site is presented using incidenceand mortality data and age-adjusted rates where appropriate. Information from the NCI and theAmerican Cancer Society (ACS) on risk factors, age of onset, early detection and screening, andother relevant facts are also included when available. Results from statistical tests at the countylevel have been included when data are available and reliable. Within each of the 23 primarysite summaries, there are icons identifying other data sources that provide information relatedto that specific cancer.

The last section of this report contains appendices to provide the reader with technical assis-tance regarding cancer coding, population weights, data quality, stage definitions, other consid-erations relevant to using cancer data, and sources for more cancer information. The implica-tions on two most important changes in this report including the adoption of the 2000 US stan-dard population for age-adjusted rates and the use of ICD-10 (International Classification ofDisease, Tenth Revision) for 1999 mortality data are also provided in the appendix.

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New Features in this Report

The use of 2000 US standard population as a reference group for age-adjusted rates. Unlikeprevious publications which were age-adjusted to the 1970 US standard population, therates in this report are age-adjusted to the 2000 US standard population.

A comparison of the weights for different age groups between 1970 and 2000 US standardpopulation is provided in appendix for comparison purposes. Methods used to calculateage-adjusted rates are also provided.

Unlike the use of ICD-9 coding for 1995-1998 mortality data, ICD-10 coding was used for1999 mortality data.

A comparison table of site codes including topography and morphology codes of ICD-O2 forsite grouping in incidence and ICD-9 (1995-1998) and ICD-10 (1999) in mortality.

A section on cancer prevention to illustrate the importance of prevention at different levelsto reduce cancer burdens. Information on corresponding programs in each level is incorpo-rated.

Information from the New Hampshire Breast and Cervical Cancer Program (BCCP) is includ-ed to provide information about screening program for these two cancers.

The use of SEER Cancer Incidence Public-Use Database, 1973-1998 for SEER incidence ratethrough SEER Stat; and the use of National Mortality Data Base (NMDB) for national mortali-ty rate through CDC WONDER.

The objectives from Healthy New Hampshire (HNH) 2010 were incorporated in the mortalitytrends whenever applicable.

Trends of late stage diagnosis for female breast cancer over years were included to show theeffectiveness of screening and early detection programs.

Geographic Information System (GIS) mapping was used to illustrate rate differencesbetween counties and the state as a whole for female breast and prostate cancers.

A section for sources of additional information is included in the appendices.

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The Bureau of Health Statistics and Data Management (BHSDM)

The Bureau of Health Statistics and Data Management analyzes records of newly diagnosedcases of cancer (incidence data) and Vital Records death files and distributes statistical informa-tion from these records to community organizations, government agencies, and the generalpublic. This information may be used to plan and evaluate public health programs and toassess cancer risk.

The tables and graphs in this report provide significant insight into the information availablefrom records of both cancer incidence and mortality. The information presented is based on aconsideration of data users’ needs and a desire to provide information that is useful to themajority of readers. However, because of concerns about statistical reliability, the same detailcannot be presented for each of the primary sites described in this report. For instance, datafor less common sites do not support reporting rates at the county level.

To request more detailed analysis of New Hampshire cancer data, or to obtain additional copiesof this report, contact the Bureau of Health Statistics and Data Management, Department ofHealth and Human Services, 6 Hazen Drive, Concord, NH 03301, (603) 271-5926 or (800) 852-3345, Ext. 5926, or e-mail [email protected]. Further information, as well as anelectronic version of this report, is available on the BHSDM web site:www.dhhs.state.nh.us/healthstats.

Data Sources

IncidenceStatistical information on newly diagnosed primary cancers is reported to the New HampshireState Cancer Registry (NHSCR). The NHSCR database is comprised of abstract information onreportable cancers from New Hampshire acute care hospitals and their tumor registries, med-ical records departments, oncology departments, physicians, and private pathology laborato-ries. The Registry has reciprocal agreements for exchange of case information withMassachusetts, Maine, Vermont, Rhode Island, Connecticut, New York, and Florida. The figuresin this report are for newly diagnosed primary tumors, and not people newly diagnosed withcancer. It is possible that a single person could be represented multiple times in this report ifthey were diagnosed with more than one primary (non-metastasis) tumor. Health care facilitiesin New Hampshire are required to report all cancer cases that are seen for diagnosis or treat-ment under the "Chronic Disease Prevention, Assessment and Control Act", RSA 141-B: 1, 1985.

The data tables and figures in this report are based on invasive* cancers only, with the excep-tion of bladder cancer (nationally, the invasiveness of bladder cancer is determined inconsis-tently by physicians; as a result, the convention is to analyze all diagnoses together, includingin situ cases). The tables and figures describing stage information are based on both invasiveand in situ tumors. Cancer cases include all neoplasms covered by ICD-O2 (InternationalClassification of Diseases for Oncology, 2nd edition) codes C00-C80. For more informationregarding the ICD-O2 topography and morphology codes, please refer to Appendix A of thisreport.

* Those tumors that have penetrated the basement membrane of the surrounding tissue, as opposed to in situ (“in place”),where penetration has not occurred.

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Data are available 24 months after the close of the calendar year. For example, data for 1999became available in January, 2002. The annual report is usually released 6 months after thedata are available. Occasionally, problems with data acquisition and data management areencountered that delay the report’s publication.

MortalityStatistical information on deaths of New Hampshire residents is reported to the State Bureau ofVital Records (BVR) which collects records of all vital events that occur in New Hampshire. BVRalso obtains copies of out-of-state records involving New Hampshire residents. For this report,death records were analyzed with an underlying cause of death coded as cancer as defined byICD-9 codes 140-208 for years 1995-1998 and ICD-10 codes C00-C95 for year 1999.

Confidentiality of all of these records is of utmost concern and is protected by state statute.Strict rules have been adopted to protect the privacy of individuals, yet allow for analysis ofthese records and publication of statistical reports, which empower public health decision making.

Survival StatisticsSurvival analyses on cancer involve a collection of statistical procedures for data analysis forwhich the outcome variable of interest is time until the case dies. This information is importantfor planning of cancer control activities and policy making because it provides the basis forevaluation of program effectiveness.

New Hampshire has not been collecting complete cancer incidence and mortality data for along enough period to present reliable state-specific cancer survival data. Instead, this reportpresents national cancer survival statistics from SEER program. In the future, when enoughdata are available, New Hampshire specific data will be reported.

The New Hampshire State Cancer Registry (NHSCR)

The National Cancer Institute (NCI), the American Cancer Society (ACS), and the Centers forDisease Control (CDC) indicate that overall cancer incidence rates appear to be decreasing.However, this estimate is based on SEER, which bases its estimates on a sample of 14% of thenational population that does not include New Hampshire. The ACS estimates that the totalnumber of cancer cases in New Hampshire will increase to over 5,800 in 2002. Without a cen-tral cancer registry, it would be impossible to determine if reductions in cancer rates occur inNew Hampshire and if resources are being directed appropriately. Cancer surveillance is thekey to a unified scientific and public health approach to fighting cancer. Data collected throughthe NHSCR, New Hampshire’s statewide, population-based cancer registry, provide a basis foridentification of cancer trends and patterns within the state. Since 1987, the NHSCR has beenoperated out of the Norris Cotton Cancer Center under a contract between the State andDartmouth Medical School.

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In 1984, nationaI mortality statistics revealed that the number of cancer deaths in NewHampshire were above what was expected and above the national average each year from1950-1979. As a consequence, individuals and organizations, including the New HampshireDepartment of Health and Human Services and the ACS, helped create the Coalition AgainstCancer. The efforts of this group subsequently lead to the promulgation of the State’s ChronicDisease Prevention and Control Act, the establishment of the Governor’s Advisory Panel onCancer and Chronic Disease, and the designation of cancer as a reportable disease in the state.

In 1995, the NHSCR began to make enhancements to the registry infrastructure and to caseascertainment and quality assurance processes through their participation in the first round ofthe CDC’s National Program for Cancer Registries (NPCR). The NPCR program was started toensure that all states would have sufficient funding to establish and/or enhance cancer reg-istries that met national standards. National central cancer registry standards are a compositeof several cancer surveillance initiatives: the NCI SEER program, the American College ofSurgeons Commission on Cancer (COC), and the NPCR program requirements. Data quality inNHSCR has made a significant improvement since 1995, due to CDC funding. The NorthAmerican Association of Central Cancer Registries (NAACCR), in collaboration with these threeprograms, derives and publishes standards for timeliness, completeness, and quality of cancerregistry data. In addition, NAACCR evaluates and certifies the quality of central cancer registrydata for registries in North America, including most state registries in the US and all provin-cial/territorial registries in Canada. The NHSCR achieved the second highest, “silver” level ofcertification from the NAACCR for diagnosis year of 1999.

Disparities on Race and Ethnicity

The Department of Health and Human Services (DHHS) is committed to presenting its data byrace and ethnicity whenever possible. Race specific statistics are not provided in this report,because too few cases were reported to allow reliable analysis. Less than 1% of all newly diag-nosed cancers and deaths due to cancer occurred among non-whites (this is consistent with thepercentage of the non-white population in New Hampshire in the older age groups most affect-ed by cancer). DHHS will continue to monitor the burden of cancer on minority populationsand, if the numbers reliably support analysis by race and ethnicity, future reports will presentthose results. More information on racial/ethnic patterns of cancer can be found in the NCI pub-lications4.

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Cancer Prevention

Several types of cancer can be prevented and the prospects for surviving cancer continue toimprove. Cancer prevention is based on the natural history of the cancer development and canbe regarded as having three levels.

Primary prevention – is to limit the incidence of cancer by controlling exposure to risk fac-tors or increasing individuals’ resistance to them (e.g., by vaccination or chemoprevention).Clearly, the first step is to identify the relevant exposures and to assess their impact on the riskof developing disease in the population. For example, lung cancer is largely attributable tosmoking. Excess body fat and alcohol consumption can contribute to breast cancer.Consuming less dietary fat, while increasing fruit and vegetable consumption, can reduce therisk of contracting colorectal cancers. Physical activity and weight control also can contributeto cancer prevention. This report includes information from the 2000 NH Behavioral Risk FactorSurveillance System whenever possible and appropriate.

It indicates data from the 2000 New Hampshire Behavioral Risk FactorSurveillance System (BRFSS), a telephone survey of residents assessing riskbehaviors and attitudes pertinent to health. Most data in this report are fromthe 2000 BRFSS findings unless otherwise specified.

Secondary prevention – refers to detection of cancer at an early stage, when treatment ismore effective than at the time of usual diagnosis and treatment. With such measures it is pos-sible to prevent the progression of the disease and its complications (including death).Screening represents an important component of secondary prevention. Screening involvestests to asymptomatic subjects in order to classify them as being likely or unlikely to have thedisease that is the object of the screen. For example, sigmoidoscopic/colonoscopic exam canbe used to detect colorectal cancer, and mammography and Pap smears are effective tools todetect female breast and cervical cancers. This report includes information from the NH Breastand Cervical Cancer Program whenever possible and appropriate.

It indicates information from the NH Breast and Cervical Cancer Program(BCCP). The goal of BCCP is to reduce morbidity and mortality from these dis-eases in New Hampshire by providing regular free screening services tounderserved women, case management through definitive diagnosis, qualityassurance for every aspect of the program, and professional education.Because women over the age of 50 are least likely to seek screening and mostlikely to be diagnosed at later stages of breast and cervical cancer, free screen-ing services are prioritized for women age 50-64.

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Tertiary prevention – aims at improving the prognosis and quality of life of affected individ-uals by offering them the best available treatment and rehabilitation programs.

The ultimate goal of cancer prevention is to reduce the morbidity and mortality as a result ofcancers. It is important to set up long-term objectives for achieving these goals through variouscancer control activities. Objectives from the Healthy New Hampshire 2010 are included in thisreport whenever possible and appropriate.

It indicates goals of the Healthy New Hampshire 2010 (HNH 2010), NewHampshire’s first disease prevention and health promotion agenda.

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FREQUENTLY ASKED QUESTIONS

I am interested in looking at cancer rates by year, but when I read the report, I find only 5-year rates. Why?

Rates need to be calculated with at least 20 events in the numerator. Calculating a ratebased on less than 20 events in the numerator creates an unstable estimate that is not sta-tistically reliable and varies greatly from year to year by chance alone. Therefore, generat-ing rates based on small numbers can lead to misinterpretation. For this reason, 5 years ofdata are aggregated to create a more stable rate that can be used to compare cancer bytype or by another variable of interest.

I would like to see the different types of cancer in my town, but cannot find this information in the report.Why doesn’t this report show town-level data and where can I find this information?

New Hampshire is a small state with 234 cities and towns. In a given year, the numberof newly diagnosed cancers or cancer deaths is too small to generate meaningful results ona town level. However, data are summarized by county to provide information that is moredetailed than state level data. For information on a town level, please contact the Bureau ofHealth Statistics and Data Management at 603-271-5926.

I notice that in 1999 pancreatic cancer caused 128 deaths and 124 new cancer diagnoses. Are these eventsthe same people? If so, can I make conclusions about the lethality of a certain type of cancer based on adeath to new cases comparison?

Some of the deaths may be the same as the people diagnosed in the current year andsome may have been diagnosed in previous years. Pancreatic cancer is usually not diag-nosed until an advanced stage. Comparisons between the number of new cases diagnosedand the number of deaths can be used as a rough illustration of the lethality of a cancertype, given the typical stage of diagnosis, but should not be used as the sole source ofmortality or survival rates for any cancer type.

I have noticed a lot of cancer cases on my street and in my town. Who can I contact at the state if I wantthis investigated further?

One out of every three Americans will develop some form of cancer in their lifetimeand it is therefore not uncommon to see the occurrence of the disease in a neighborhood.However, there are rare circumstances where cancer clusters are observed. Please contactthe Bureau of Health Statistics and Data Management (603-271-5926) for concerns on non-environmental cancer clusters. For environmentally related cancer cluster investigations,please contact the Bureau of Health Risk Assessment (603-271-4664) for advice and furtherinvestigation.

Where can I get more detailed information on cancer treatment, prevention, and research?

The Breast and Cervical Cancer Program (BCCP) can be reached at 603-271-4931 forinformation regarding female breast and cervical cancers. The National Cancer Institute is agood general resource for all types of cancer and can be reached at 1-800-4CANCER orhttp://www.cancer.gov, as well as the American Cancer Society at 1-800-ACS-2345 orhttp://www.cancer.org.

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How is cancer defined in this report?

Cancer rates and case reports included in this report are invasive and malignant,except for bladder cancer where in situ cases are included (bladder cancer staging is diffi-cult to determine and is performed inconsistently nationwide, therefore the convention isto analyze all cases). Data presented on the stage at which the cancer was diagnosed doinclude in situ cases where those cases are required to be reported. In New Hampshire, insitu cases of melanoma and cervical cancer are not reportable.

All of the rate information for the total population is identified as "age-adjusted." What does this meanand why is it done?

To compare groups where proportions of age groups are different, an adjustmentneeds to be made to make the age groups comparable. For example, the rate of lung can-cer in New Hampshire may look higher than that of the United States. However, if NewHampshire has fewer younger people than the United States as a whole, its rate willappear higher. Once the two rates are adjusted to control for the differences in age distri-bution, the rates may not look different at all.

Throughout the report, SEER is mentioned. What is SEER?

The Surveillance, Epidemiology, and End Results (SEER) Program of the NationalCancer Institute collects and publishes cancer incidence and survival data from 11 popula-tion-based cancer registries and three supplemental registries covering approximately 14percent of the U.S. population. Geographic areas were selected for inclusion in the SEERProgram based on their ability to operate and maintain a high quality population-basedcancer reporting system and for their epidemiologically significant population subgroups.The population covered by SEER is comparable to the general U.S. population with regardto measures of poverty and education. The SEER population tends to be somewhat moreurban and has a higher proportion of foreign-born persons than the general U.S. popula-tion. SEER is used as the reference for national estimates of cancer diagnosis. NH dataare not included in the SEER program.

I am interested in bone cancer, but I do not see mention of it in this report. Why? How do I get this infor-mation?

Bone cancer is a very rare condition and therefore is not included in the 23 primarycancer sites. Many other rare cancers are also excluded from this report because the num-bers are too small for meaningful tabulations. If you would like analysis on any of thesecancers, please contact the Bureau of Health Statistics (603-271-5926) for assistance.

This report summarizes data from 1999. It is now 2002. Why is there such a long time between dataacquisition and publication?

Data are available 24 months after the close of the calendar year. For example, datafor 1999 became available in January 2002. The annual report is usually released 6 monthsafter the data are available. Cancer is a disease that tends to require many years to devel-op. For example, lung cancer typically is not diagnosed until at least 20 years after an indi-vidual starts smoking. Because of the long time period required for cancers to form, cancerincidence rates tend to change only slightly from one year to the next.

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Staff in the NHSCR and of the reporting facilities communicate with each other to completeeach case’s reporting in a timely manner. However, delays in diagnosis, treatment, or out-of-state case submission can greatly affect a complete and accurate dataset being available.The BHSDM and NHSCR are committed to improving the timeliness of case reporting. Thedata included in this report are the most recently available data at the time of publication.

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SUMMARY OF ALL PRIMARY SITES

All Sites

BladderBrain and other CNSBreast (Female)Cervix UteriColon and RectumCorpus UteriEsophagusHodgkin’s DiseaseKidney and Renal PelvisLarynxLeukemiasLiverLung and BronchusMelanomas of the SkinMultiple MyelomaNon-Hodgkin’s LymphomasOral Cavity and PharynxOvaryPancreasProstateStomachTestisThyroid

Total

5,377

29178

591

6441

11156

13645

79424453

202121

124

73

69

Male

2,713

21046

285

482269437332

42012433

10081

64764473925

Total

2,407

6662

269

756

43169151

66640338928

128

44

6

Male

1,247

3933

137

556

23105432

37820164917

721192631

Female

1,160

2729

18513

1322520

206

3719

288201740116056

18

5

(includes sites notgrouped below)

Table 1 – New Cases and Deaths by Sex and Primary Site, New Hampshire, 1999

New Cases Diagnosed Deaths

In 1999, there were 5,377 total cases of invasive cancer reported in New Hampshire (throughoutthe report, except for bladder cancer as explained in the Introduction, in situ cases are notincluded, except where staging is discussed). As shown in the above table, the most commonforms of cancer are breast (32% of female cancers), lung (15% of all cancers), prostate (28% ofmale cancers), and colorectal (12% of all cancers). These four groups account for 56% of totalcancers diagnosed.

The number of deaths due to cancer totaled 2,407 in 1999. Variation in early detection andtreatment among cancer types results in deaths being more broadly distributed than diag-noses. Lung cancer was the most frequent cause of cancer death among both men (30%) andwomen (25%). Among other common forms of cancer, breast (16% of female cancer deaths),colorectal (11% of all cancer deaths), and prostate (10% of male cancer deaths), caused a lowerproportion of deaths than the proportion diagnosed.

Female

2,664

8132

84841

306158161942136313

37412020

102408760

26

44

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

12

Table 2 – New Cases and Age-adjusted Incidence Rates by Sex and Primary Site, New Hampshire, 1995-1999, US (SEER) White 1997 Comparison Rates

All Sites


NHCases

26,171

1,445409

3,145

319187550306635198

3,9281,011

266939598

589

360

278

NHRate

477.3

26.4

7.3

57.6

5.9

3.110.05.6

11.5

3.6

72.0

17.84.9

17.0

10.9

10.8

6.5

4.7

1997 US(SEER)

472.8

21.77.0

53.8

4.32.9

10.73.9

12.54.4

62.918.85.3

19.611.0

10.6

7.5

6.8


TotalNH

Cases

13,333

1,056231

1,599

233102339243353137

2,166567151496401

2863,601

24517879

NHRate

552.4

45.2

8.7

68.7

9.6

3.413.510.0

14.6

5.790.3

22.56.3

20.3

16.2

12.1150.1

10.35.62.7

1997 US(SEER)

543.4

38.28.3

64.3

7.13.2

14.77.0

16.46.6

78.723.26.6

23.816.3

12.1158.911.16.13.7

MaleNH

Cases

12,938

389178

4,091249

1,5467878685

21163

28261

1,762444115443197508303

115

199

NHRate

427.9

12.5

6.0137.7

8.249.0

26.92.7

2.87.02.1

9.21.9

58.9

14.63.7

14.5

6.617.09.8

3.6

6.5

1997 US(SEER)

428.3

9.65.9

139.69.0

46.026.61.92.77.51.59.72.7

51.715.84.4

16.16.7

17.59.3

4.8

9.9

Female

Note: Rates are per 100,000 population and age-adjusted to the 2000 US standard population. New Hampshire rates inbold type are significantly different from the SEER rates at the 95% confidence interval.

Rates in New Hampshire are significantly higher compared to national (SEER) estimates for thefollowing primary sites:• Overall Population: Bladder, Colorectal, Esophageal, Larynx, Lung• Male: Bladder, Colorectal, Esophageal, Larynx, Lung • Female: Bladder, Colorectal, Esophageal, Larynx, Lung

Rates in New Hampshire are significantly lower compared to national (SEER) estimates for thefollowing primary sites:• Overall Population: Leukemia, Liver, Non-Hodgkin’s Lymphoma, Stomach, Thyroid• Male: Leukemia, Non-Hodgkin’s Lymphoma, Prostate, Thyroid• Female: Liver, Multiple Myeloma, Non-Hodgkin’s Lymphoma, Stomach, Thyroid

SU

MM

AR

Y O

F A

LL

PR

IMA

RY

SIT

ES

13

Table 3 – Deaths and Age-adjusted Mortality Rates by Sex and Primary Site, New Hampshire, 1995-1999, 1997 US White Comparison Rates

All Sites


NHDeaths

11,965

306314

1,348

31635

25878

430225

3,291171189519200

614

236

17

NHRate

218.7

5.6

5.6

24.7

5.8

0.64.71.47.84.1

60.3

3.13.59.53.7

11.3

4.3

-

1997 US Rate

202.2

4.65.0

21.2

4.00.64.61.37.93.3

58.03.13.69.32.8

10.3

4.4

0.5


TotalNH

Deaths

6,150

195179

642

23621

14660

249146

1,855103101276128

313652153103

NHRate

269.5

9.07.0

28.3

9.9

0.96.22.5

10.96.3

79.44.34.3

11.95.5

13.432.56.8

--

1997 US Rate

251.9

7.86.1

25.7

7.10.66.52.4

10.64.9

80.24.44.6

11.44.2

12.031.16.30.30.5

MaleNH

Deaths

5,815

11113591874

7061498014

11218

18179

1,4366888

24372

296301

83

14

NHRate

185.8

3.3

4.529.52.4

21.8

4.7

2.5

-3.6

-5.72.5

47.1

2.22.77.52.3

9.69.5

2.5

-

1997 US Rate

170.0

2.44.2

28.02.8

17.92.01.60.53.10.56.12.0

42.12.13.07.71.79.38.9

3.0

0.5

Female

Note: Rates are per 100,000 population and age-adjusted to the 2000 US standard population.Rates are not displayed if fewer than 20 events were reported (noted as -).

New Hampshire rates in bold type are significantly different from the National rates at the 95% confidence interval.

Rates in New Hampshire are significantly higher compared to national rates for the followingprimary sites:• Overall Population: Bladder, Brain, Colorectal, Esophageal, Liver, Lung, Oral Cavity, Pancreas• Male: Colorectal, Esophageal, Liver, Oral Cavity• Female: Bladder, Colorectal, Corpus Uteri, Esophageal, Lung, Oral Cavity

New Hampshire is not significantly lower in cancer mortality rates for any site when comparedto national rates.

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

14

Note: The site groups above are those with 20 or more events over the five-year period.

Table 4 – Male Age-adjusted Incidence and Mortality Rates for Selected Primary Sites, New Hampshire, 1995-1999

Stomach

Prostate

Pancreas

Oral Cavity and Pharynx

Non-Hodgkin’s Lymphomas

Multiple Myeloma

Melanomas of the Skin

Lung and Bronchus

Liver

Leukemias

Larynx

Kidney and Renal Pelvis

Esophagus

Colon and Rectum

Brain and other CNS

Bladder

0 20 40 60 80 100 120 140 160

Incidence Mortality

Age-adjusted Rate/ 100,000

SU

MM

AR

Y O

F A

LL

PR

IMA

RY

SIT

ES

15

Table 5 – Female Age-adjusted Incidence and Mortality Rates for Selected Primary Sites, New Hampshire, 1995-1999

Stomach

Pancreas

Ovary

Oral Cavity and Pharynx

Non-Hodgkin’s Lymphomas

Multiple Myeloma

Melanomas of the Skin

Lung and Bronchus

Liver

Leukemias

Kidney and Renal Pelvis

Esophagus

Corpus Uteri

Colon and Rectum

Cervix Uteri

Breast

Brain and other CNS

Bladder

0 20 40 60 80 100 120 140 160

Incidence Mortality

Age-adjusted Rate/ 100,000

Note: The site groups above are those with 20 or more events over the five-year period.

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

16

Table 6 – Distribution of Cancer Incidence and Mortality by Site and Sex, New Hampshire,1995-1999

Incidence

Male(n=13,333)

Mortality

Males(n=6,150)

Other Sites29% Prostate

27%

Lung andBronchus

16%Colorectal

12%

Bladder8%

Melanomasof the Skin

4%

Non-Hodgkin’sLymphomas

4%

Prostate11%

Lung andBronchus

30%

Colorectal10%

Pancreas5%

Non-Hodgkin’s

Lymphomas4%

Other Sites36%

Leukemias4%

Females(n=12,938)

Females(n=5,815)

Other Sites30%

Non-Hodgkin’s

Lymphomas3%

Ovary4%

CorpusUteri6%

Colorectal12%

Lung andBronchus

14%

FemaleBreast31%

Other Sites33% Female Breast

16%

Lung andBronchus

25%

Colorectal12%Pancreas

5%Ovary

5%

Non-Hodgkin’s

Lymphomas4%

SU

MM

AR

Y O

F A

LL

PR

IMA

RY

SIT

ES

17

25-34

34308113017032100

124

54

1161130910201

200414016

66

35-39

5030310101411211273

43

22

316510230105

100302217

90

40-44

334219121

111616525183

89

21

758540121424

140415209

151

45-49

64

11223053

10101890

12421

108

13

7966

11011020

1015163

1231

10

176

50-54

145

23208554

21162

1373

56213

198

44

932

2223003340

26172

1059814

250

55-59

153

15519484

421168

131093500

271

84

1024

2033003150

2881844501

251

60-64

184

32718964

57917

115

113200

309

63

951

2316607320

5083757320

256

65-69

366

391228

1055

71129

1288

138804

417

104

985

32191051

121

7332

106

14410

316

70-74

365

388086

223

87122

109

10171

903

460

84

902

40170261

102

6572

1259942

317

75-79

311

54705346

6910479

11103

601

362

113

771

4817414163

5466

1458933

308

80-84

232

31106352

3961

1629

49611

225

140

554

519206264

3251

1238760

243

85+

202

31203140

1195343

23200

132

140

471

525311041

2672

1014860

220

Total

21046

285482269437332

42012433

1008164

764473925

2,713

8132

84841

306158161942136313

37412020

1024087602644

2,664

Table 7– New Cases by Sex, Age, and Primary Site, New Hampshire, 1999

<15

0600100200002000000

16

010000010040000100000

9

15-24

0110300100104000082

29

020010010010000111002

11

(including sites notgrouped above)

Primary Site Group

MaleBladderBrain and other CNSColorectalEsophagusHodgkin's DiseaseKidney and Renal PelvisLarynxLeukemiasLiverLung and BronchusMelanomas of the SkinMultiple MyelomaNon-Hodgkin's LymphomasOral Cavity and PharynxPancreasProstateStomachTestisThyroid

Male Total of All Sites

FemaleBladderBrain and other CNSBreast (Female)Cervix UteriColorectalCorpus UteriEsophagusHodgkin's DiseaseKidney and Renal PelvisLarynxLeukemiasLiverLung and BronchusMelanomas of the SkinMultiple MyelomaNon-Hodgkin's LymphomasOral Cavity and PharynxOvaryPancreasStomachThyroid

Female Total of All Sites (including sites notgrouped above)

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

18

Table 8 – Deaths by Sex, Age, and Primary Site, New Hampshire, 1999

25-34

0320000100001000010

8

010110000000100001000

7

35-39

0300000001202010000

9

004030000000100000200

11

40-44

003100001

12101101010

25

027212002021420202000

36

45-49

026230022

11202010200

38

02

13140001012910103010

41

50-54

219605321

20024232110

75

13

18253101111

1631115310

73

55-59

127205062

32235092300

91

24

221

104000021

2021432200

87

60-64

326801145

45011293000

106

03

120

102501041

2631016201

89

65-69

37

118032

104

56425175200

158

04

152

142102231

4832308501

128

70-74

65

201301187

673041

1419401

195

54

25193301123

6203308851

163

75-79

113

33812245

692475

1223300

219

53

211

225502133

441280

131130

168

80-84

52

25513073

3833

102

1125700

167

41

191

1820051

104

2734726

1311

152

85+

83

15213182

2711635

39400

151

101

291

352505072

3023

1146

1071

202

Total

3933

137556

23105432

3782016491772

1192631

1,247

2729

18513

13225200

206

3719

288201740116056185

1,160

Primary Site Group

Male

BladderBrain and other CNSColorectalEsophagusHodgkin's DiseaseKidney and Renal PelvisLarynxLeukemiasLiverLung and BronchusMelanomas of the SkinMultiple MyelomaNon-Hodgkin's LymphomasOral Cavity and PharynxPancreasProstateStomachTestisThyroid

Male Total of All Sites

Female

BladderBrain and other CNSBreast (Female)Cervix UteriColorectalCorpus UteriEsophagusHodgkin's DiseaseKidney and Renal PelvisLarynxLeukemiasLiverLung and BronchusMelanomas of the SkinMultiple MyelomaNon-Hodgkin's LymphomasOral Cavity and PharynxOvaryPancreasStomachThyroid

Female Total of All Sites

<15

0000000200001000000

5

010000000010000000000

2

15-24

0000000000000000000

0

000000000010000000000

1



BL

AD

DE

R

19

BLADDER

Bladder cancer is the most common location for malignancies in the urinary tract. About 90percent of bladder cancers are transitional cell carcinomas; these are cancers that begin in thecells lining the bladder.

Facts

Age Most Often Affected: 60+Gender Most Often Affected: MaleSurvival Information: Survival dependsgreatly on the stage at which the canceris discovered; with early diagnosis, 5-year survival rates are 95%. However, 5-year survival rates for later diagnosis ofbladder cancer with distant metastasesare 10-15%.

Known Risk Factors

Smokers are more than twice as likely to get bladder cancer compared to non-smokers.Occupational exposures to some aromaticand organic chemicals; for example textileindustries, painters, chemical workers, andhairdressers.

Age-adjusted Incidence Rate/100,000 Age-adjusted Mortality Rate/100,000

1995-1999 New Hampshire

1997 SEER U.S. White


1997 U.S. White

Male 210 45.2 38.2 39 9.0 7.8Female 81 12.5 9.6 27 3.3 2.4

Total 291 26.4 21.7 66 5.6 4.6

1999 NHDeaths

1999 NHNew Cases

Note: New Hampshire rates in bold type are significantly different from national rates at the 95% confidence interval.

Incidence Mortality

350

300

250

20

150

100

50

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

350

300

250

200

150

100

50

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

Note: Rates plotted in gray are based on 10 to 19 events; they are presented to provide continuity and allow some interpretation, butshould be relied upon with caution.

25% (95% CI:23.0-27.7) of NH adultsare current smokers.

Bladder: Incidence and Mortality Rates by Age and Sex, 1995-1999

CA

NC

ER

IN N

EW

HA

MP

SH

IRE

, 199

9

20

CountyBelknapCarrollCheshireCoosGraftonHillsboroughMerrimackRockinghamStraffordSullivan

State Total

141295

16602742187

210

84333

25101383

81

2216128

198537552610

291

22255

100

1012

39

3122332344

27

53478

132

1356

66

New Cases Deaths

Bladder: Stage at Diagnosis, 1999

Localized35%

In Situ50%

Unknown5%

Distant4%

Regional6%

FemaleMale Total FemaleMale Total

Bladder: New Cases and Deaths by County, 1999

Bladder: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases30

1021253890

113148220248227170132

Incidence Mortality

Rate---

3.74.99.0

27.447.376.3

108.7138.2158.8173.8156.2

Cases206

1614315783

12717418316911480

Rate-----

14.534.669.9

135.6182.6230.4285.0313.8348.4

Cases1045

117

3330214665585652

Rate------

20.125.020.942.965.069.391.084.5

Deaths000005

1312133154615166

Rate---------

15.330.142.752.178.1

Deaths000002

107

122636443127

Rate---------

27.345.374.285.3

117.6

Deaths0000033515

18172039

Rate------------

32.563.4

TotalMale Female TotalMale Female


BLA

DD

ER

21

Bladder: Age-adjusted Incidence and Mortality Rates by Sex and County, 1995–1999


State Total

Cases91659145

10439618228712360

1,444

Incidence Mortality

Rate29.326.125.021.026.525.930.326.425.526.3

26.5

Cases6541693075

2881282268450

1,056

Cases2624221529

10854613910

388

Rate14.617.610.6

-13.012.314.710.214.1

-

12.5

Deaths16201724287921523118

306

Rate-

7.9-

10.7

7.05.23.4

5.06.5

-

5.6

Deaths10138

17174911382012

195

Rate-----

9.0-

8.910.5

-

9.0

Deaths6797

11301014116

111

Rate-----

3.2----

3.3


Note: Rates are per 100,000 population and age-adjusted to the 2000 US standard population. Rates in bold type are significantly different from the state rate at the 95% confidence interval.Rates are not displayed if fewer than 20 events were reported (noted as -).

Rate47.535.643.433.844.446.149.948.540.950.2

45.3

14.0

12.0

10.0

8.0

6.0

4.0

2.0

0.0

Ag

e-ad

just

ed R

ate/

100,

000

1980

-81

1982

-83

1984

-85

1986

-87

1988

-89

1990

-91

1992

-93

1994

-95

1996

-97

1998

-99

Bladder: Age-adjusted Mortality Rate Trends by Sex, 1980-1999

MaleFemale

US White MaleUS White Female

Note: Rates are two year averages and are age-adjusted to the 2000 US standard population. Neither the male nor female mortality rates are significantly different at the 95% confidence interval between the start and end of theperiod shown.

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

22

These cancers include tumors of the brain and spinal cord. Brain cancer is the second mostcommon cause of cancer after leukemia in children.

Facts

Age Most Often Affected: All ages Survival Information: Brain and CNS tumorsare not staged like other types of cancer andsurvival rates depend on type of tumor.Survival time for patients with low-gradeastrocytomas or oligodendrogliomas isapproximately 6 to 8 years. Survival forpatients with anaplastic astrocytomas isapproximately 3 years. Survival for patientswith glioblastomas is approximately 12 to18 months.





1997U.S. White

Male 46 8.7 8.3 33 7.0 6.1Female 32 6.0 5.9 29 4.5 4.2

Total 78 7.3 7.0 62 5.6 5.0

1999 NHDeaths

1999 NHNew

Note: New Hampshire rates in bold type are significantly different from national rates at the 95% confidence interval

Brain and other CNS: Incidence Rate and Mortality by Age and Sex, 1995-1999

Mortality

30

25

20

15

10

5

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

1999 NHDeaths

1999 NHNew Cases

BRAIN AND OTHER CENTRAL NERVOUS SYSTEM

Known Risk Factors

Working in oil refining, rubber manufactur-ing, and drug manufacturing Possible hereditary component

30

25

20

15

10

5

0

Dea

ths

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

Male Female

Incidence

Note: Actual number of events are plotted in place of rates for mortality, there were not enough reliable rates available to produce ameaningful chart.

Total

23

BelknapCarrollCheshireCoosGraftonHillsboroughMerrimackRockinghamStraffordSullivan

State Total

40212

135

1441

46

12112

106801

32

52324

23112242

78

3041394423

33

0203294522

29

32445

188945

62

New Cases Deaths


Brain and other CNS: New Cases and Deaths by County, 1999

Brain and other CNS: Age-specific Incidence and Mortality Rates by Sex, 1995–1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases462224242327413634453825204

Incidence Mortality

Rate3.73.02.64.24.56.4

12.515.117.522.221.217.520.4

-

Cases221118111415292222271413112

Rate3.5

-----

17.618.523.528.3

----

Cases24116

139

1212141218241292

Rate4.0

---------

24.0---

Deaths123

191117212732284034312811

Rate-----

5.08.2

13.414.419.818.921.728.6

-

Deaths62

108

1212202017261117135

Rate------

12.116.8

-27.3

----

Deaths6193597

1211142314156

Rate----------

23.0---



BR

AIN

AN

D O

TH

ER

CE

NT

RA

L N

ER

VO

US

SY

ST

EM

County

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

24

BREAST (FEMALE)

Breast cancer is the most common type of cancer among women in New Hampshire and thesecond leading cause of cancer death after lung cancer in women. Early detection of breastcancer is the most effective approach to reduce mortality from this disease.

Facts

Age Most Often Affected: 40+ Survival Information: The 5-year relative sur-vival rate for localized breast cancer hasincreased from 72% in the 1940s to 96%today. If the cancer has spread regionallyhowever, the survival rate is 77%, and forwomen with distant metastases, the rate is21%. Seventy-one percent of women diag-nosed with breast cancer survive 10 years,and 57% survive 15 years.

Known Risk Factors

Family history of breast cancerEarly menarche and/or late menopauseNever pregnant or having first live birth at a late age

Screening and Early Detection

Monthly self-examinationsRegular clinical breast examsMammograms as appropriateFor women with a family history of breastcancer, some physicians and researchersrecommend screening for changes inBRCA1 or BRCA2 genes. (* See BCCP screening guidelines on page 27).



1997SEER U.S. White


1997 U.S. White

Female 848 137.7 139.6 185 29.5 28.0

1999 NHDeaths

1999 NHNew Cases

600

500

400

200

200

100

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

18% (95% CI:14.4-22.1) of NH women age50+ had not had a clinical breast exam andmammogram in the past 2 years.

600

500

400

200

200

100

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

Breast (Female): Incidence and Mortality Rates by Age, 1995-1999

Incidence Mortality

FE

MA

LE

BR

EA

ST

25

County

7136402167

23691

1886731

848

131166

17382941159

185

New Cases Deaths

Breast (Female): New Cases andDeaths by County, 1999

Breast (Female): Age-specific Incidenceand Mortality Rates, 1995–1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Incidence Mortality

Cases00

63154296434498405382464487379273256

Rate--

13.553.8

116.5207.9303.1337.7380.7432.9486.7453.1443.8416.0

Deaths006

21346774756395

12988

103163

Rate---

7.313.432.145.062.562.888.6

128.9105.2167.5264.9

Breast (Female): Stage at Diagnosis, 1999

In Situ19%Regional

21%

Unknown2%

Distant4%

Localized54%

Breast (Female): Late Stage Diagnosis Trends,1995–1999

6

5

4

3

2

1

0

Year of Diagnosis

1995 1996 1997 1998 1999

% L

ate

Sta

ge

Dia

gn

osi

s

* See appendix for definition of late stage diagnosis.

Note: Rates are per 100,000 population and age-adjusted to the2000 US standard population. Rates are not displayed if fewer than 20 events were reported(noted as -).


State Total

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

26

220

200

180

160

140

120

100

80

60

40

20

0

Inci

den

ce R

ate/

100,

000

Bel

knap

Car

roll

Che

shire

Coo

s

Gra

fton

Hill

s-bo

roug

h

Mer

rimac

k

Roc

king

ham

Str

affo

rd

Sul

livan

Breast (Female): Age-adjusted Incidence Ratesby County with 95% Confidence Intervals,1995–1999

Note: Rates are age-adjusted to the 2000 US standard population.Represents 95% confidence interval. The confidence interval bars

can be used to compare the rates in different counties. If the barsoverlap at any point, the rates are not statistically different. The abovechart shows that there are statistically meaningful differences betweenCoos (lower than some) and Belknap (higher than some) and some ofthe other counties.

Breast (Female): Age-adjusted Incidence andMortality Rates by County, 1995–1999


State Total

Incidence Mortality

Cases275179243114310

1,221424868324133

Rate184.8

146.7125.7108.7

155.1140.1130.4139.6123.5115.2

Deaths5231503166

2561111948146

918

Rate31.323.323.225.830.828.532.231.229.138.1

Note: Rates are per 100,000 population and age-adjusted to the2000 US standard population. Rates in bold type are significantly different from the state rate atthe 95% confidence interval.

State Rate = 137.9(95% CI: 133.7,142.2)

Breast (Female): Age-adjusted IncidenceRates by County, 1995–1999

FE

MA

LE

BR

EA

ST

27

45.0

35.0

30.0

25.0

20.0

15.0

10.0

5.0

0.0

Ag

e-ad

just

ed R

ate/

100,

000

1980

-81

1982

-83

1984

-85

1986

-87

1988

-89

1990

-91

1992

-93

1994

-95

1996

-97

1998

-99

Breast (Female): Age-adjusted Mortality Rate Trend, 1980–1999

Note: Rates are two year averages and are age-adjusted to the 2000 US standard population. The mortality rates are significantly different at the 95% confidence interval between the start and end of the period.

Screening Guidelines for Women of Different Ages

Age Recommendation Benefit

< 40

40 – 49

50 – 74

> 75

Breast exam by doctor

Breast exam by doctorMammogram every 1 to 2years



No data

May reduce chances ofdying from breast can-cer by 17%.

May reduce chances ofdying from breast can-cer by 30%.

No data

For more information about breast and cervical cancer screeningservices in New Hampshire, contact:The NH DHHS’s “Let No Woman Be Overlooked” program at 1-800-852-3345 ext. 4931 (in NH) or 603-271-4931.

26.0

New Hampshire

US White

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

28

CERVIX UTERI

Cells on the surface of the cervix sometimes appear abnormal but are not cancerous. Theseabnormal changes in cells on the cervix can be the first step in a series of slow changes thatcan lead to cervical cancer years later. Most precancerous conditions of the cervix can bedetected through regularly scheduled Pap tests. If detected, these precancerous conditions canbe treated before cancer develops. Also, any invasive cancer that does occur would likely befound at an early, curable stage.

Facts

Age Most Often Affected: 20+Survival Information: Eighty-nine per-cent of invasive cervical cancer patientssurvive one year after diagnosis, and70% survive five years. When detectedat an early stage, invasive cervical can-cer is one of the most successfully treat-able cancers with a 5-year relative sur-vival rate of 91% for localized cancers.

Age-adjusted Mortality Rate/100,000


1997U.S. White

1999 NHDeaths

Age-adjusted Incidence Rate/100,000


1997SEER U.S. White

Female 41 8.2 9.0 13 2.4 2.8

1999 NHNew Cases

10% (95% CI: 7.7-12.1) of adultNH women have not had a Paptest in the last 3 years.

25

20

15

10

5

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

30

25

20

15

10

5

0

Dea

ths

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

Cervix Uteri: Incidence Rates and Mortality by Age, 1995-1999

MortalityIncidence

Known Risk Factors

Genital human papillomavirus (HPV) infection(especially types 16, 18, 31, 45)Sexual intercourse before age 18Multiple sexual partnersSmoking

Screening and Early DetectionRecommended Pap tests.(* See BCCP screening guidelines on page 29).

Note: Actual number of events are plotted in place of rates for mortality, there were not enough reliable rates available to produce ameaningful chart.

CE

RV

IX U

TE

RI

29

County

21213

125933

41

1100211223

13

New Cases Deaths

Cervix Uteri: Stage at Diagnosis, 1999

Localized49%

Distant11%

Unknown5%

Regional54%

Cervix Uteri: New Cases and Deaths byCounty, 1999

Cervix Uteri: Age-specific Incidence andMortality Rates, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Incidence Mortality

Cases03

363326322820162165

176

Rate--

7.711.510.215.317.016.7

-19.6

----

Deaths008476

1352771

104

Rate--------------

Begin with the onset of sexual activity orage 18.

Continue less frequently at the discretion ofthe doctor and patient after three or moreannual tests have been normal.

Screening Guidelines

For more information about breast and cer-vical cancer screening services in NewHampshire, contact:The NH DHHS’s “Let No Woman BeOverlooked” program at 1-800-852-3345 ext.4931 (in NH) or 603-271-4931.



State Total

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

30

COLON AND RECTUM

Colorectal cancer is the fourth leading cause of cancer and the second leading cause of cancerdeath in New Hampshire. Over 95% of colorectal cancers are adenocarcinomas which are can-cers that line the inside of the colon and rectum. Early detection of colorectal cancer andimproved therapy are proven means to reduce mortality from this disease.

Facts

Age Most Often Affected: 65+Survival Information: When colorectal can-cers are detected in an early, localized stage,the 5-year relative survival rate is 90%, how-ever only 37% of colorectal cancers are dis-covered at this stage. If the cancer hasspread regionally, the rate drops to 65%.The 5-year survival rate for persons withdistant metastases is 8%.

Known Risk Factors

Family history of colorectal cancerIntestinal adenomatous polyps Inflammatory bowel diseaseObesity and physical inactivity


Colonoscopy/flexible sigmoidoscopyFecal occult blood testDouble-contrast barium enema

600

500

400

300

200

100

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group



1997SEER U.S. White


1997U.S. White

Male 285 68.7 64.3 137 28.3 25.7Female 306 49.0 46.0 132 21.8 17.9

Total 591 57.6 53.8 269 24.7 21.2

1999 NHDeaths

1999 NHNew Cases


MaleFemale

600

500

400

300

200

100

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

53% (95% CI:48.0-58.3) of NH adults age 50+ have never had a sigmoidoscopic orproctoscopic exam (1999).

Colorectal: Incidence and Mortality Rates by Age and Sex, 1995-1999

MortalityIncidence


CO

LO

N A

ND

RE

CT

UM

31


State Total

912167

267736493616

285

16171816238633513214

306

2529342349

16369

1006830

591

8875

12341625148

137

31066

12352422104

132

11181311246940472412

269

New Cases Deaths


Colorectal: New Cases and Deaths by County,1999

Colorectal: Age-specific Incidence and Mortality Rates by Sex, 1995–1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases04

23246493

185205292427475534443376

Incidence Mortality

Rate--

2.54.2

12.522.056.285.9

150.5210.9264.7373.6452.8445.0

Rate----

13.227.169.295.2

192.2264.5324.9426.7506.5548.8

Cases019

1430357192

112175217281259250

Rate----

11.816.843.276.7

111.6163.3216.9335.9421.1406.3

Deaths0289

13396373

107155190234201254

Rate-----

9.219.130.655.276.6

105.9163.7205.4300.6

Deaths0254

102336385889

1061129366

Rate-----

10.721.932.061.993.4

133.5188.9256.0287.4

Deaths00353

162735496684

122108188

Rate------

16.429.248.861.684.0

145.9175.6305.5


Distant17%

Regional38%

Unknown5%

Localized30%

Colorectal: Stage at Diagnosis, 1999

In Situ10%

Cases03

14103458

114113180252258253184126


CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

32

Colorectal: Age-adjusted Incidence and Mortality Rates by Sex and County, 1995–1999


State Total

Cases147168191134229887358629277124

3,144

Incidence Mortality

Rate48.867.851.162.258.958.258.058.158.355.5

57.6

Cases83819062

12145517233114261

1,598

Cases6487

10172

10843218629813563

1,546

Rate38.261.046.655.548.948.749.449.148.748.2

49.1

Deaths63777858

11037416424211567

1,348

Rate21.131.121.026.928.224.626.422.724.529.2

24.7

Deaths3532453055

18270

1115329

642

Rate29.428.428.932.531.730.427.823.9

31.429.2

28.3

Deaths2845332855

19294

1316238

706

Rate16.332.216.119.824.020.924.521.321.727.3

21.8


Note: Rates are per 100,000 population and age-adjusted to the 2000 US standard population.Rates in bold type are significantly different from the state rate at the 95% confidence interval.

Rate63.072.656.568.470.372.268.269.076.362.6

68.7

45.0

35.0

30.0

25.0

20.0

15.0

10.0

5.0

0.0

Ag

e-ad

just

ed R

ate/

100,

000

1980

-81

1982

-83

1984

-85

1986

-87

1988

-89

1990

-91

1992

-93

1994

-95

1996

-97

1998

-99

Colorectal: Age-adjusted Mortality Rate Trends by Sex, 1980–1999


US White Male

US White Female

Male

Female

21.0

33

CO

RP

US

UT

ER

I

Cancer of the uterus is the most common cancer of the female reproductive tract. It is alsocalled endometrial cancer because the site of cancer is usually the endometrium or lining of theuterus. Nationally, incidence rates are higher among white women than black women, but therelationship is reversed for mortality—the mortality rate for black women is nearly twice ashigh as for white women.

Facts

Age Most Often Affected: 50+Survival Information: The 1-year relative sur-vival rate for endometrial cancer is 93%. The5-year relative survival rate is 95% if the can-cer is discovered at an early stage and 64% ifdiagnosed at a regional stage.





1997 U.S. White

Female 158 26.9 26.6 25 4.7 2.0

1999 NHDeaths

1999 NHNew


1009080706050403020100

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

1999 NHDeaths

1999 NHNew Cases

CORPUS UTERI

Known Risk Factors

Exposure to estrogen, including estro-gen replacement therapy; early menar-che, and late menopauseDiabetes and hypertensionGallbladder diseaseObesityColorectal or breast cancer

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

1009080706050403020100


Corpus Uteri: Incidence and Mortality Rates by Age, 1995-1999

MortalityIncidence

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

34

Corpus Uteri: New Cases and Deaths byCounty, 1999

Corpus Uteri: Age-specific Incidence andMortality Rates, 1995–1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Incidence Mortality

Cases00

13172953

105114938991765354

Rate----

11.425.463.995.092.783.090.990.986.287.8

Deaths0010345

12121322261932

Rate----------

22.031.1

-52.0

Note: Rates are per 100,000 population and age-adjusted to the2000 US standard population. Rates are not displayed if fewerthan 20 events were reported (noted as -).

Distant7%

Regional15%

Unknown5%

Localized69%

In Situ4%

Corpus Uteri: Stage at Diagnosis, 1999

County

77

104

10421141169

158

1122172900

25

New Cases Deaths


State Total

35

ES

OP

HA

GU

S

Esophageal cancer in New Hampshire and the U.S. is relatively rare; however, it is the fifthleading cause of cancer death worldwide. Esophageal cancer is almost three times more com-mon among men than among women and three times more common among AfricanAmericans than among whites.

Facts

Age Most Often Affected: 60+ Gender Most Often Affected: Male Survival Information: Survivability foresophageal cancer depends greatly on stageat diagnosis; earlier detection leads to muchhigher survival rates. Five-year survival ratesfor cancers detected at early stage are 75%,50% for localized ones, 20% for regional, andless than 1% for distant.

ESOPHAGUS

Known Risk Factors

Use of tobacco productsChronic or heavy alcohol usePersistent acid reflux (heartburn)


Age-adjusted Incidence Rate/100,000 Age-adjusted Mortality Rate/100,0001995-1999

New Hampshire1997SEER U.S. White


1997 U.S. White

Female 16 2.7 1.9 20 2.5 1.6

Total 64 5.9 4.3 75 5.8 4.0

1999 NHDeaths

1999 NHNew Cases


25% (95% CI: 23.0-27.7) of NHadults are current smokers.5% (95% CI: 3.2-6.6) of NH adultsare chronic drinkers of alcohol(60+ drinks/month) (1999).

60

50

10

30

20

10

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

60

50

10

30

20

10

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

Esophagus: Incidence and Mortality Rates by Age and Sex, 1995-1999

MortalityIncidence

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

36


State Total

64702

145721

49

2100141331

16

85703

186

1052

65

71600

196853

55

1120142432

20

82801

238

1285

75

New Cases Deaths

Esophagus: Stage at Diagnosis, 1999

Localized19%

In Situ1%

Unknown24%

Distant23%

Regional33%


Esophagus: New Cases and Deaths by County, 1999

Esophagus: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases0012

108

2726506348352326

Incidence Mortality

Rate------

8.210.925.831.126.724.523.530.8

Cases001187

2424414734231310

Rate------

14.620.243.849.342.838.8

--

Cases000121329

1614121016

Rate--------------

Deaths002076

2820494949453031

Rate------

8.58.4

25.324.227.331.530.736.7

Deaths002055

2617403639332013

Rate------

15.8-

42.737.849.155.755.1

-

Deaths000021239

1310121018

Rate--------------



County

37

HO

DG

KIN

’S D

ISE

AS

E

Hodgkin’s Disease is a type of cancer of the lymphatic system. Hodgkin's disease is an uncom-mon lymphoma, and accounts for less than 1 percent of all cases of cancer in New Hampshire.

Facts

Age Most Often Affected: Young adulthood(15-34) and 60+Gender Most Often Affected: MaleSurvival Information: The 1-year relative sur-vival rate for Hodgkin’s Disease is 93%, 82%for 5-year, and 72% for 10-year.

25

20

15

10

5

0

New

Cas

es

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

HODGKIN’S DISEASE

Known Risk Factors

Family history of Hodgkin’s Disease.Exposure to Epstein-Barr virus

Note: Actual number of events are plotted in place of rates, there were not enough reliable rates available to produce a meaningfulchart.

Age-adjusted Incidence Rate/100,000 Age-adjusted Mortality Rate/100,0001995-1999

New Hampshire1997SEER U.S. White


1997U.S. White

Female 19 2.8 2.7 0 - 0.5

Total 41 3.1 2.9 6 0.6 0.6

1999 NHDeaths

1999 NHNew Cases

MaleFemale

25

20

15

10

5

0

Dea

ths

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

Hodgkin’s Disease: Incidence and Mortality by Age and Sex, 1995-1999

MortalityIncidence

Note: Rates are not displayed if fewer than 20 events were reported (noted as -).

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

38


State Total

0010092730

22

0011283400

19

00212

175

1130

41

1001110200

6

0000000000

0

1001110200

6

New Cases Deaths


Hodgkin’s Disease: New Cases and Deaths byCounty, 1999

Hodgkin’s Disease: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases7

424232171176352373

Incidence Mortality

Rate-

5.84.65.6

----------

Cases2

2222219754250021

Rate-

6.04.87.3

----------

Cases5

2020118422102352

Rate-

5.54.3

-----------

Deaths02643411121145

Rate--------------

Deaths02131311011124

Rate--------------

Deaths00512100110021

Rate--------------



County

39

KID

NE

Y A

ND

RE

NA

L P

ELV

IS

Several types of cancer can develop in the kidney; the most common form of kidney cancer inadults is renal cell cancer. Cancers of the kidney account for one third of all urinary tract neo-plasms. The incidence of this cancer has continued to rise over the past decade, and it is twiceas common in males as females.

Facts

Age Most Often Affected: 50+ Gender Most Often Affected: MaleSurvival Information: Survival is greatly dependenton the stage at which the cancer is diagnosed. Forthose cancers discovered at the local stage, the 5-year survival rate is 88%, for regional it is 61%.However for those diagnosed at a distant stage the5-year survival rate is less than 10%.

KIDNEY AND RENAL PELVIS

Known Risk Factors

SmokingObesityOccupational exposures to coalfumes




1997SEER U.S. White


1997 U.S. White

Female 42 7.0 7.5 20 3.6 3.1

Total 111 10.0 10.7 43 4.7 4.6

1999 NHDeaths

1999 NHNew Cases

80706050403020100

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

80706050403020100

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

25% (95% CI: 23.0-27.7) of NH adults arecurrent smokers.

Kidney and Renal Pelvis: Incidence and Mortality Rates by Age and Sex, 1995-1999

MortalityIncidence

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

40


State Total

14056

272

1752

69

01420

155

1320

42

15476

427

3072

110

1011273521

23

0101093510

20

11122

166

1031

43

New Cases Deaths

Kidney and Renal Pelvis: Stage atDiagnosis, 1999

Localized52%

In Situ3%Unknown

6%

Distant19%

Regional20%


Kidney and Renal Pelvis: New Cases and Deathsby County, 1999

Kidney and Renal Pelvis: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases60

111432314959677880545217

Incidence Mortality

Rate----

6.37.3

14.924.734.538.544.637.853.2

-

Cases5067

1921364443504829247

Rate-----

9.821.937.145.952.560.448.966.1

-

Cases1057

13101315242832252810

Rate--------

23.926.132.029.945.5

-

Deaths00136

101625303036294527

Rate-------

10.515.514.820.120.346.032.0

Deaths000235

112115212019218

Rate-------

17.7-

22.025.2

-57.8

-

Deaths00113554

159

16102419

Rate------------

39.0-



County

41

LA

RY

NX

Cancer of the larynx or voice box is a relatively rare disease. The risk factors for laryngeal can-cer are similar to those for other cancers of the mouth and throat.

Facts

Age Most Often Affected: 60+Gender Most Often Affected: MaleSurvival Information: 88% of laryngeal cancer patientssurvive one year after diagnosis. The majority of casesare diagnosed while still localized having an 81% 5-yearsurvival rate. For all stages combined, the 5-year relativesurvival rate is 65% and the 10-year rate is 53%.

LARYNX

Known Risk Factors

Use of tobacco productsChronic or heavy alcohol useExposure to asbestos, nickel,mustard gas, wood dust

Note: Rates plotted in gray are based on 10 to 19 events; they are presented to provide continuity and allow some interpretation, butshould be relied upon with caution. Actual number of events are plotted in place of rates for mortality, there were not enough reliablerates available to produce a meaningful chart.



1997SEER U.S. White


1997 U.S. White

Female 13 2.1 1.5 6 - 0.5

Total 56 5.6 3.9 16 1.4 1.3

1999 NHDeaths

1999 NHNew Cases

Note: New Hampshire rates in bold type are significantly different from national rates at the 95% confidence interval.Rates are not displayed if fewer than 20 events were reported (noted as -).

25

20

15

10

5

0

Dea

ths

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

25% (95% CI: 23.0-27.7) of NH adults are current smokers.5% (95% CI: 3.2-6.6) of NH adults are chronic drinkers of alcohol (60+ drinks/month)(1999).

700

600

500

400

300

200

100

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleTotal

Larynx: Incidence Rates and Mortality by Age and Sex, 1995-1999

MortalityIncidence

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

42


State Total

4311493

1242

43

3100040311

13

74114

133

1553

56

3010021300

10

0001010202

6

3011031502

16

New Cases Deaths

Larynx: Stage at Diagnosis, 1999

Localized61%

In Situ4%

Unknown2%

Distant5%

Regional28%


Larynx: New Cases and Deaths by County, 1999

Larynx: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases00237

142733545448351910

Incidence Mortality

Rate------

8.213.827.826.726.724.5

--

Cases00124

11192944473527159

Rate-------

24.447.049.344.145.5

--

Cases00113384

107

13841

Rate--------------

Deaths00001464

1314141354

Rate--------------

Deaths00001351

1010111144

Rate--------------

Deaths00000113343210

Rate--------------



County

43

LE

UK

EM

IAS

Leukemia is a cancer in which the body produces large numbers of abnormal blood cells. Inmost types of leukemia, the white blood cells are affected. Leukemia cells usually appear dif-ferent from normal blood cells and do not function properly, impairing the body’s ability tofight infection. Although it is often thought of as a childhood disease, leukemia affects manymore adults than children each year.

Facts

Age Most Often Affected: All agesGender Most Often Affected: Both gendersSurvival Information: The 1-year relative survival rate forpatients with leukemia is 64%. Survival drops to 43%five years after diagnosis, primarily due to the poor sur-vival rates of particular types of leukemia, such as acutemyelocytic Leukemia. There has been a dramaticimprovement in survival for patients with acute lympho-cytic leukemia—from a 5-year relative survival rate of38% in the mid-1970s to 59% in the early 1990s. Survivalrates for children have increased from 53% to 81% overthe same period.

LEUKEMIAS

Known Risk Factors

Exposure to radiationSome genetic conditions,such as Down’s syndromeLong term exposure to ben-zene




1997SEER U.S. White


1997 U.S. White

Female 63 9.2 9.7 37 5.7 6.1

Total 136 11.5 12.5 91 7.8 7.9

1999 NHDeaths

1999 NHNew Cases


140

120

100

80

60

40

20

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

140

120

100

80

60

40

20

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

Leukemias: Incidence and Mortality Rates by Age and Sex, 1995-1999

MortalityIncidence

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

44


State Total

53844

159

1357

73

62539

176933

63

115

137

133215228

10

136

31432

144

1355

54

6020276833

37

91634

21102188

91

New Cases Deaths


Leukemias: New Cases and Deaths by County,1999

Leukemias: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases42111814302541565371

102626743

Incidence Mortality

Rate3.4

---

5.95.9

12.523.527.335.156.843.468.550.9

Cases23585

14143136353055374020

Rate3.6

-----

18.830.337.431.569.362.4

110.187.1

Cases196

109

16111020184147252723

Rate-------

16.7-

38.347.029.943.937.4

Deaths115

1249

169

32314868527360

Rate-------

13.416.023.737.936.474.671.0

Deaths72813

107

21153343314127

Rate-------

17.7-

34.654.152.3

112.9117.6

Deaths4343662

11161525213233

Rate----------

25.025.152.053.6



County

45

LIV

ER

Liver cancer is the fifth most common cancer worldwide. Rates in developing countries aremuch higher than in the United States.

Facts

Age Most Often Affected: 50+Gender Most Often Affected: MaleSurvival Information: Because symptoms ofliver cancer often do not appear until the dis-ease is advanced, only a small number of livercancers are found in the early stages and canbe removed through surgery. Less than 30%of the patients having explorative surgery areable to have their cancer completely removedby surgery. The overall 5-year relative sur-vival rate from liver cancer is about 10%.

30

25

20

15

10

5

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

LIVER

Known Risk Factors

Hepatitis B or C infectionCirrhosis of the liverExposure to aflatoxin, vinyl chloride,thorium dioxide, anabolic steroids, orarsenicChronic alcohol consumption

Note: Actual number of events are plotted in place of rates; there were not enough reliable rates available to produce a meaningfulchart.



1997SEER U.S. White


1997 U.S. White

Female 13 1.9 2.7 19 2.5 2.0

Total 45 3.6 4.4 51 4.1 3.3

1999 NHDeaths

1999 NHNew Cases


MaleFemale

8% (95% CI: 5.1-11.7) of NH adultmales are chronic drinkers of alco-hol (60+ drinks per month) (1999).

30

25

20

15

10

5

0

Dea

ths

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

Liver: Incidence and Mortality by Age and Sex, 1995-1999

MortalityIncidence

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

46


State Total

2042352931

32

1101230211

13

3143582

1152

45

3021484721

32

2211460210

19

52328

144931

51

New Cases Deaths

Liver: Stage at Diagnosis, 1999

Localized13%

Unknown46% Distant

19%

Regional22%FemaleMale Total FemaleMale Total

Liver: New Cases and Deaths by County, 1999

Liver: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases4132788

15183132312117

Rate---------

15.317.821.721.5

-

Cases3122566

1313222518138

Rate---------

23.131.5

---

Cases10102222597

1389

Rate--------------

Deaths1111866

15313634362326

Rate--------

16.017.818.925.223.530.8

Deaths10115439

242724221213

Rate--------

25.628.330.237.1

--

Deaths0100323679

10141113

Rate--------------


Incidence Mortality


County

47

LU

NG

AN

D B

RO

NC

HU

S

Lung cancer is the second most commonly diagnosed type of cancer in both men and womenin New Hampshire and is the leading cause of cancer death. Cancers that begin in the lungsare divided into two major types, non-small cell lung cancer, and small cell lung cancer. Non-small cell lung cancer is more common than small cell lung cancer, and it generally grows andspreads more slowly. Small cell lung cancer grows more quickly and is more likely to spreadto other organs in the body. Because symptoms often do not appear until the lung cancer ofeither type is advanced, early detection is difficult.

Facts

Age Most Often Affected: 60+Gender Most Often Affected: Males, although thegap with females has been narrowing over the last20 years (following increased female smoking rates)Survival Information: The 1-year relative survivalrates for lung cancer have increased from 34% in1975 to 41% in 1995, largely due to improvements insurgical techniques. The 5-year relative survival ratefor all stages combined remains very low, at 14%.The survival rate is 49% for cases detected when thedisease is still localized, but only 15% of cases arediscovered this early.

LUNG AND BRONCHUS

Known Risk Factors

SmokingOccupational exposure to asbestos,chloromethyl ethers, chromium,nickel, radiation, or second-handsmokingExposure to radon




1997SEER U.S. White


1997 U.S. White

Male 420 90.3 78.7 378 79.4 80.2Female 374 58.9 51.7 288 47.1 42.1

Total 794 72.0 62.9 666 60.3 58.0

1999 NHDeaths

1999 NHNew Cases


25% (95% CI: 23.0-27.7) of NHadults are current smokers.51% (95% CI: 46.1-55.5) of NHpeople have had their hometested for radon.

700

600

500

400

300

200

100

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

700

600

500

400

300

200

100

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

Lung and Bronchus: Incidence and Mortality Rates by Age and Sex, 1995-1999

MortalityIncidence

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

48


State Total

2720322321

10943883918

420

1713361718

10632813914

374

4433684039

21575

1697832

794

2120302019

10127823523

378

1312218

167726692817

288

3132512835

17853

1516340

666

New Cases Deaths

Lung and Bronchus: Stage atDiagnosis, 1999

Localized17%

Distant46%

Unknown12%

Regional25%


Lung and Bronchus: New Cases and Deaths byCounty, 1999

Lung and Bronchus: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases005

2985

139267333490717727597353186

Incidence Mortality

Rate---

5.016.632.981.1

139.5252.6354.2405.1417.7360.8220.1

Cases003

104776

14716827640042534018292

Rate----

18.335.589.2

141.5294.7419.9535.2573.4510.0400.7

Cases002

193863

12016521431730225717194

Rate----

15.030.273.0

137.6213.3295.8301.8307.2278.0152.8

Deaths002

165899

192237381530644513372247

Rate----

11.323.458.499.3

196.4261.8358.8358.9380.2292.3

Deaths0007

3149

114135216308374291206124

Rate----

12.022.969.2

113.7230.6323.3470.9490.8567.1540.0

Deaths0029

275078

102165222270222166123

Rate----

10.623.947.585.0

164.4207.1269.9265.4269.9199.9



County

49

LU

NG

AN

D B

RO

NC

HU

S

Lung and Bronchus: Age-adjusted Incidence and Mortality Rates by Sex and County, 1995–1999


State Total

Cases219161300152234

1,085392819386178

3,926

Incidence Mortality

Rate73.864.981.7

71.260.2

70.466.675.680.3

79.7

72.1

Cases12190

15794

13759922344420596

2,166

Cases9871

1435897

48616937518182

1,760

Rate63.255.870.8

49.546.5

56.552.463.867.767.7

59.0

Deaths181154221130213899330681315166

3,291

Rate59.761.959.860.154.758.855.263.465.973.2

60.3

Deaths9984

12984

12650619836817091

1,855

Rate75.271.781.787.374.979.678.778.784.989.8

79.4

Deaths8270924687

39313231314575

1,436

Rate50.254.244.538.340.844.938.753.153.560.3

47.1


Note: Rates are per 100,000 population and age-adjusted to the 2000 US standard population.Rates in bold type are significantly different from the state rate at the 95% confidence interval.

Rate89.776.297.198.379.890.986.291.799.893.3

90.3

100.0

90.0.

80.0

70.0

60.0

50.0

40.0

30.0

20.0

10.0

0.0

Ag

e-ad

just

ed R

ate/

100,

000

1980

-81

1982

-83

1984

-85

1986

-87

1988

-89

1990

-91

1992

-93

1994

-95

1996

-97

1998

-99

Lung and Bronchus: Age-adjusted Mortality Rate Trends by Sex, 1980–1999

Note: Rates are two year averages and are age-adjusted to the 2000 US standard population. The female mortality rates are significantly different at the 95% confidence interval between the start and end of the period.

MaleFemale


CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

50

Melanoma occurs when pigment cells (melanocytes) of the skin become malignant. Melanomacan occur on any skin surface. In men, melanoma is often found on the trunk (the area fromthe shoul-ders to the hips) or the head and neck. In women, melanoma often develops on thelower legs. In the United States, the number of new cases of melanoma has more than dou-bled in the past 20 years.

Facts

Age Most Often Affected: All ages, most commonly 50+Gender Most Often Affected: More men than womenSurvival Information: The 5-year relative survival rate forpatients with malignant melanoma is 88%. For localizedmalignant melanoma, the 5-year relative survival rate is95%; survival rates for regional and distant disease are58% and 13%, respectively. About 82% of melanomasare diagnosed at a localized stage.

MELANOMAS OF THE SKIN

Known Risk Factors

Exposure of the skin to ultravi-olet light (sunlight, tanninglights, etc.), especially in child-hood.Family history of melanomaDysplastic nevus syndrome


Regular self and physicianexaminations of the skin.




1997SEER U.S. White


1997 U.S. White

Male 124 22.5 23.2 20 4.3 4.4

Total 244 17.8 18.8 40 3.1 3.1

1999 NHDeaths

1999 NHNew Cases

25

20

15

10

5

0

Dea

ths

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

42% (95% CI: 38.3-44.9) of NH adults had a sunburn within the past 12 months, andamong those, 32% (95% CI: 26.3-36.7) had 3 or more sunburns.

140

120

100

80

60

40

20

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

Melanomas of the Skin: Incidence Rates and Mortality by Age and Sex, 1995-1999

MortalityIncidence

51

ME

LAN

OM

AS

OF

TH

E S

KIN


State Total

14292

1728172365

124

45

102

1425192688

120

187

194

315336491412

244

0020262530

20

1121043332

20

11412

105862

40

New Cases Deaths

Melanomas of the Skin: Stage atDiagnosis, 1999

Localized64%

In Situ27%

Unknown4%

Distant2%

Regional3%


Melanomas of the Skin: New Cases and Deaths byCounty, 1999

Melanomas of the Skin: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases0

1887819176

10896929484756247

Incidence Mortality

Rate--

9.414.117.818.032.840.247.446.446.852.563.455.6

Cases08

293346416465596057453030

Rate--

6.411.417.919.138.854.763.063.071.875.982.6

130.7

Cases0

10584845354431333427303217

Rate--

12.416.817.716.826.825.832.931.727.035.952.0

-

Deaths0129

10151315191814171919

Rate--------------

Deaths00167889

14121198

10

Rate--------------

Deaths011337565638

119

Rate--------------



County

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

52

Melanomas of the Skin: Age-adjusted IncidenceRates by Sex and County, 1995-1999


State Total

Cases79337629

1062451451926145

1,011

Incidence

Rate28.6

14.521.116.127.7

14.7

23.4

15.812.1

21.8

17.8

Cases4918521163

13678

1082923

567

Cases3015241843

10967843222

444

Rate21.0

-12.7

-21.4

12.120.1

12.011.821.1

14.5

TotalMale Female

Note: Rates are per 100,000 population and age-adjusted to the 2000US standard population.Rates in bold type are significantly different from the state rate at the95% confidence interval.Rates are not displayed if fewer than 20 events were reported (notedas -).

Rate37.3

-32.1

-36.4

18.4

28.7

20.513.6

22.8

22.4

50

40

30

20

10

0

Inci

den

ce R

ate/

100,

000

Bel

knap

Car

roll

Che

shire

Coo

s

Gra

fton

Hill

s-bo

roug

h

Mer

rimac

k

Roc

king

ham

Str

affo

rd

Sul

livan

Melanomas of the Skin: Age-adjusted IncidenceRates by Sex and County with 95% ConfidenceIntervals, 1995–1999

Note: Rates are age-adjusted to the 2000 US standardpopulation.*Indicates where rates are not displayed because therewere fewer than 20 cases reported.

Represents 95% confidence interval. The confidence interval barscan be used to compare the rates in different counties and the rates ofeach sex within each county. If the bars overlap at any point, the ratesare not statistically different. The above chart shows that there are sta-tistically meaningful differences between Belknap (higher than some)and Stratford (lower than some) and some of the other counties

Male Female

* * **

6.0

5.0

4.0

3.0

2.0

1.0

0.0

Ag

e-ad

just

ed R

ate/

100,

000

1980

-81

1982

-83

1984

-85

1986

-87

1988

-89

1990

-91

1992

-93

1994

-95

1996

-97

1998

-99

Melanomas of the Skin: Age-adjusted Mortality Rate Trends by Sex, 1980–1999


MaleFemale


53

MU

LTIP

LE

MY

EL

OM

A

Multiple myeloma is a malignancy of plasma calls, usually originating in bone marrow andmainly affecting the skeleton. The disease is characterized by abnormal accumulations of plas-ma cells in bone marrow. Multiple myeloma is associated with anemia, hemorrhages, weak-ness, and infections. Multiple myeloma is a rare disease that accounts for about 1% of all can-cers. Age is the most significant risk factor for multiple myeloma. Only 2% of cases are diag-nosed in people younger than 40. The average age at diagnosis is about 70.

Facts

Age Most Often Affected: 50+Gender Most Often Affected: Male Survival Information: The 1-year relative sur-vival rate for multiple myeloma is 72%, 28%for 5-year, and 12% for 10-year.

MULTIPLE MYELOMA

Known Risk Factors

AgeFamily member with multiple myeloma



1997SEER U.S. White


1997 U.S. White

Male 33 6.3 6.6 16 4.3 4.6Female 20 3.7 4.4 17 2.7 3.0

Total 53 4.9 5.3 33 3.5 3.6

1999 NHDeaths

1999 NHNew Cases


30

25

20

15

10

5

0

New

Cas

es

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group


MaleFemale

30

25

20

15

10

5

0

Dea

ths

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

Multiple Myeloma: Incidence and Mortality by Age and Sex, 1995-1999

MortalityIncidence

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

54


State Total

2222154

1032

33

2010172331

20

42322

126

1363

53

1311122131

16

3322454352

33

2011332221

17

New Cases Deaths


Multiple Myeloma: New Cases and Deaths byCounty, 1999

Multiple Myeloma: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases004268

1722255041412723

Incidence Mortality

Rate-------

9.212.924.722.828.727.627.2

Cases0042559

15143422161510

Rate---------

35.727.7

---

Cases00001387

111619251213

Rate-----------

29.9--

Deaths0011249

148

2731343226

Rate---------

13.317.323.832.730.8

Deaths0011245

104

191518157

Rate--------------

Deaths0000004448

16161719

Rate--------------



County

55

NO

N-H

OD

GK

IN’S

LY

MP

HO

MA

S

Lymphoma is a general term for cancers that develop in the lymphatic system. Hodgkin's dis-ease is one type of lymphoma. All other lymphomas are grouped together and are called non-Hodgkin's lymphoma. The incidence of non-Hodgkin's lymphoma has increased dramaticallyover the last two decades. This disease has gone from being relatively rare to being the fifthmost common cancer in the United States. Reasons for this increase are not fully understood,but lymphomas occuring in patients with AIDS are partially responsible.

Facts

Age Most Often Affected: All ages, incidenceincreases with ageGender Most Often Affected: Male Survival Information: The 1-year survival ratefor Non-Hodgkin’s lymphoma is 70%, 51% for5-year, and 41% for 10-year.

NON-HODGKIN’S LYMPHOMAS

Known Risk Factors

Acquired immune disordersExposures to herbicides and chemicalsused in agriculture and forestryExposure to Human T-lymphotropic virustype I (HTLV-1) and Epstein-Barr virus



1997SEER U.S. White


1997 U.S. White

Male 100 20.3 23.8 49 11.9 11.4Female 102 14.5 16.1 40 7.5 7.7

Total 202 17.0 19.6 89 9.5 9.3

1999 NHDeaths

1999 NHNew Cases



140

120

100

80

60

40

20

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

140

120

100

80

60

40

20

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

Non-Hodgkin’s Lymphomas: Incidence and Mortality Rates by Age and Sex, 1995-1999

MortalityIncidence

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

56


State Total

4295

1323151874

100

54569

30112543

102

96

141122532643117

202

10424

1910540

49

32514

107521

40

42938

29171061

89

New Cases Deaths


Non-Hodgkin's Lymphomas: New Cases andDeaths by County, 1999

Non-Hodgkin's Lymphomas: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases10174425415178729196

1311248970

Incidence Mortality

Rate--

4.84.38.0

12.123.730.246.947.473.086.791.082.8

Cases5

10241221304244565670524628

Rate--

5.3-

8.214.025.537.159.858.888.187.7

126.6121.9

Cases57

201320213628354061724342

Rate--

4.3-

7.910.121.923.334.937.361.086.169.968.3

Deaths558

1112192137355169897879

Rate------

6.415.518.025.238.462.379.793.5

Deaths33378

111825213040443924

Rate-------

21.122.431.550.474.2

107.4104.5

Deaths2254483

12142129453955

Rate---------

19.629.053.863.489.4



County

57

NO

N-H

OD

GK

IN’S

LY

MP

HO

MA

S


State Total

Cases4836694591

2531141797331

939

Incidence Mortality

Rate15.915.819.021.623.8

16.219.215.614.914.4

17.0

Cases2322352551

13057964017

496

Rate17.423.022.027.330.2

18.721.618.319.1

-

20.3

Cases2514342040

12357833314

443

Rate15.1

-16.617.818.713.917.313.512.1

-

14.5

Deaths2714382332

15464

1004720

519

Rate9.0

-10.410.98.39.9

10.49.39.98.6

9.5

Deaths126

221518833154278

276

Rate--

13.9--

12.812.711.713.4

-

11.9

Deaths158

168

147133462012

243

Rate-----

7.89.07.56.8

-

7.5


Non-Hodgkin's Lymphomas: Age-adjusted Incidence and Mortality Rates by Sex andCounty, 1995-1999

Note: Rates are per 100,000 population and age-adjusted to the 2000 US standard population.Rates in bold type are significantly different from the state rate at the 95% confidence interval.Rates are not displayed if fewer than 20 events were reported (noted as -).

14.0

12.0

10.0

8.0

6.0

4.0

2.0

0.0

Ag

e-ad

just

ed R

ate/

100,

000

1980

-81

1982

-83

1984

-85

1986

-87

1988

-89

1990

-91

1992

-93

1994

-95

1996

-97

1998

-99

Non-Hodgkin's Lymphomas: Age-adjusted Mortality Rate Trends by Sex, 1980–1999


MaleFemale


CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

58

Oropharyngeal cancers include those that occur in the lip, tongue, salivary gland, floor of themouth, and back of the throat (nasopharynx, oropharyngx and hypopharynx). The majority ofcases are diagnosed on the tongue, lips, and floor of the mouth. During regular check-ups,dentists and primary care physicians can check for abnormal tissue in order to detect oral can-cer at early stages.

Facts

Age Most Often Affected: Over age 40Gender Most Often Affected: Male Survival Information: 83% of oropharyn-geal cancer patients survive one year afterdiagnosis. For all stages of disease com-bined, the 5-year relative survival rate is53% and the 10-year rate is 46%.

ORAL CAVITY AND PHARYNX

Known Risk Factors

Use of tobacco productsExcessive consumption of alcohol

Screening and Detection

Visual inspection through regular dentalcheck-ups and annual physician visits.



1997SEER U.S. White


1997 U.S. White

Male 81 16.2 16.3 17 5.5 4.2Female 40 6.6 6.7 11 2.3 1.7

Total 121 10.9 11.0 28 3.7 2.8

1999 NHDeaths

1999 NHNew Cases



9080706050403020100

Dea

ths

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

28% (95% CI: 24.6-30.5) of NHadults had not visited a dentist inthe past year (1999).

9080706050403020100

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

Oral Cavity and Pharynx: Incidence Rate and Mortality by Age and Sex, 1995-1999

MortalityIncidence

59

OR

AL

CA

VIT

Y A

ND

PH

AR

YN

X


State Total

42705

308

1744

81

12523

106911

40

54

1228

40142655

121

1000331801

17

2110030040

11

3110361841

28

New Cases Deaths


Oral Cavity and Pharynx: New Cases and Deathsby County, 1999

Oral Cavity and Pharynx: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases33

141028465468767584663635

Incidence Mortality

Rate----

5.510.916.428.539.237.046.846.236.841.4

Cases2186

20374047544761421719

Rate----

7.817.324.339.657.749.376.870.8

--

Cases126489

1421222823241916

Rate-------

17.521.926.123.028.7

--

Deaths003158

1118233325271927

Rate--------

11.916.313.918.9

-32.0

Deaths00215789

152218161213

Rate---------

23.1----

Deaths001001398

117

117

14

Rate--------------



Oral Cavity and Pharynx: Stage atDiagnosis, 1999

Localized38%

In Situ2%

Distant5%

Regional47%

Unknown8%County

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

60

Overall, ovarian cancer is considered a relatively uncommon type of cancer, however it is theleading cause of death from gynecological cancers in this country. Most ovarian cancers formon the surface of the ovaries. Because no effective screening method is available, periodic,thorough pelvic exams are important.

Facts

Age Most Often Affected: 60+, but found in all age groupsSurvival Information: 78% of ovarian cancer patients sur-vive one year after diagnosis; the 5-year relative survivalrate for all stages is 50%. If diagnosed and treated early,the survival rate is 95%; however, only about 25% of allcases are detected at the localized stage. Five-year rela-tive survival rates for women with regional and distantdisease are 79% and 28%, respectively. .

OVARY

Known Risk Factors

Family history of ovarian can-cerCancer of colon, rectum, orbreastChildlessnessFertility drugs



1997SEER U.S. White


1997 U.S. White

Female 87 17.0 17.5 60 9.6 9.3

1999 NHDeaths

1999 NHNew Cases

9080706050403020100

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group


9080706050403020100

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

Ovary: Incidence and Mortality Rates by Age, 1995-1999

MortalityIncidence

61

Localized31%

OVA

RY

County


State Total

52766

259

1854

87

55525

175

1132

60

New Cases Deaths

Ovary: New Cases and Deaths by County, 1999

Ovary: Age-specific Incidence and MortalityRates, 1995–1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Incidence Mortality

Cases1

11262326485537535464484121

Rate--

5.68.0

10.223.033.530.852.850.464.057.466.734.1

Deaths00546

112124254444433930

Rate------

12.820.024.941.144.051.463.448.8


Ovary: Stage at Diagnosis, 1999

Distant38%

Regional25%

Unknown6%

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

62

Located behind the stomach, the pancreas is responsible for the production of insulin (to con-trol blood sugar) and digestive juices. It is composed of 2 different types of glands: theexocrine and the endocrine. About 95% of cancers of the exocrine pancreas are adenocarcino-mas; these are cancers that grow in the cells lining certain organs. Tumors of the endocrinepancreas are much less common. Cigarette smokers develop this disease two to three timesmore often than nonsmokers.

Facts

Age Most Often Affected: 60+Gender Most Often Affected: Both gendersSurvival Information: For all stages combined, the 1-yearrelative survival rate is 19%; the 5-year rate is 4%.

PANCREAS

Known Risk Factors

Tobacco useDiet high in fatObesityDiabetes





1997 U.S. White

Male 64 12.1 12.1 72 13.4 12.0Female 60 9.8 9.3 56 9.5 8.9

Total 124 10.8 10.6 128 11.3 10.3

1999 NHDeaths

1999 NHNew Cases



25% (95% CI:23.0-27.7) of NH adultsare current smokers.

9080706050403020100

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

1101009080706050403020100

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

Pancreas: Incidence and Mortality Rates by Age and Sex, 1995-1999

MortalityIncidence

63

PAN

CR

EA

S


State Total

15764

137

1371

64

40328

152

1844

60

55

108

12289

31115

124

53887

186

1151

72

30326

156

1713

56

83

11101333122864

128

New Cases Deaths

Pancreas: Stage at Diagnosis, 1999

Localized8%

Unknown26%

Distant41%

Regional25%


Pancreas: New Cases and Deaths by County, 1999

Pancreas: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases0016

16264062537193907754

Incidence Mortality

Rate-----

6.112.226.027.335.151.863.078.763.9

Cases00129

132039304337492617

Rate------

12.132.832.045.146.682.671.6

-

Cases00047

132023232856415137

Rate------

12.219.222.926.156.049.082.960.1

Deaths0005

101827585874

105958579

Rate------

8.224.329.936.658.566.586.993.5

Deaths00025

131637325056473223

Rate-------

31.234.252.570.579.388.1

100.2

Deaths000355

1121262449485356

Rate-------

17.525.922.449.057.486.291.0



County

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

64

Cancer of the prostate is the most common cancer in men. Between 1989 and 1992, prostatecancer incidence rates increased dramatically, probably due to earlier diagnosis in men withoutsymptoms through better screening, using the PSA blood test.

Facts

Age Most Often Affected: 65+Survival Information: Seventy-nine percent of all prostatecancers are discovered in the local and regional stages;the 5-year relative survival rate for patients whosetumors are diagnosed at these stages is 100%. Over thepast 20 years, the survival rate for all stages combinedhas increased from 67% to 92%. Survival after a diagno-sis of prostate cancer continues to decline beyond fiveyears. According to the most recent data, 67% of mendiagnosed with prostate cancer survive 10 years and52% survive 15 years.

PROSTATE

Known Risk Factors

Possibly a diet high in fatFamily history of prostate can-cerRace (African American menhave the highest prostate can-cer incidence rates in theworld.)

Screening and DetectionDigital rectal exam of theprostate glandProstate-specific antigen (PSA)blood test



1997SEER U.S. White


1997 U.S. White

Male 764 150.1 158.9 119 32.5 31.1

1999 NHDeaths

1999 NHNew Cases

100900800700600500400300200100

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group


100900800700600500400300200100

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

23% (95% CI: 17.5-29.2) of NH males 50 yearsor older have never had the PSA test.

Prostate: Incidence and Mortality Rates by Age, 1995-1999

MortalityIncidence


65

PR

OS

TAT

E

County

4331482643

25490

1485229

764

1010989

2412141310

119

New Cases Deaths

Prostate: New Cases and Deaths byCounty, 1999

Prostate: Age-specific Incidence andMortality Rates, 1995–1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Incidence Mortality

Cases0001

1363

197346570739744554248126

Rate-----

29.4119.6291.4608.6775.7936.8934.3682.7548.8

Deaths0000218

10265987

151145163

Rate--------

27.861.9

109.5254.7399.2709.9

Prostate: Stage at Diagnosis, 1999

Unknown8%

Localized76%

Regional 10%

Distant6%



State Total

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

66

180

160

140

120

100

80

60

40

20

0

Inci

den

ce R

ate/

100,

000

Bel

knap

Car

roll

Che

shire

Coo

s

Gra

fton

Hill

s-bo

roug

h

Mer

rimac

k

Roc

king

ham

Str

affo

rd

Sul

livan

Prostate: Age-adjusted Incidence Rates byCounty with 95% Confidence Intervals,1995–1999

Note: Rates are age-adjusted to the 2000 US standard population.Represents 95% confidence interval. The confidence interval bars

can be used to compare the rates in different counties. If the barsoverlap at any point, the rates are not statistically different. The abovechart shows that there are statistically meaningful differences withGrafton and Sullivan lower than Hillsborough, Rockingham, andStratford Counties.

Prostate: Age-adjusted Incidence andMortality Rates by County, 1995–1999


State Total

Incidence Mortality

Cases181153223130214

1,091406754324125

3,601

Rate133.4128.9138.3133.6122.3

166.6

159.2154.3156.6117.7

150.2

Deaths4634483544

15965

1166540

652

Rate38.232.333.040.329.330.628.130.237.244.7

32.5

Note: Rates are per 100,000 population and age-adjusted to the2000 US standard population. Rates in bold type are significantly different from the state rate atthe 95% confidence interval.

State Rate = 150.2(95% CI: 145.4,155.3)

Prostate: Age-adjusted Incidence Rates byCounty, 1995–1999

133.6

122.3

128.9

133.4

117.7

159.2

154.3

156.6

138.3 166.6

PR

OS

TAT

E

67

45.0

35.0

30.0

25.0

20.0

15.0

10.0

5.0

0.0

Ag

e-ad

just

ed R

ate/

100,

000

1980

-81

1982

-83

1984

-85

1986

-87

1988

-89

1990

-91

1992

-93

1994

-95

1996

-97

1998

-99

Prostate: Age-adjusted Mortality Rate Trend, 1980–1999


New Hampshire

US White

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

68

Stomach cancer incidence and death rates have fallen dramatically in the last 60 years in theUS. Early stomach cancer causes few symptoms; which makes early diagnosis difficult. Only10%-20% of stomach cancers in the U.S. are detected in the early stage when survival rates arehighest.

Facts

Age Most Often Affected: 50+Gender Most Often Affected: MaleSurvival Information: The 5-year survivalrate is greater than 90% in stages 0 and I,about 50% in stage II, 15% or less in stageIII, and about 3% in stage IV. Most patientsdiagnosed with stomach cancer in theUnited States have stage III or stage IV can-cers.

STOMACH

Known Risk Factors

Diet high in smoked or salted foods con-taining nitrates and nitrites and low infresh fruits and vegetables, especially vita-mins A and CSmokingStomach ulcers



1997SEER U.S. White


1997 U.S. White

Female 26 3.6 4.8 18 2.5 3.0

Total 73 6.5 7.5 44 4.3 4.4

1999 NHDeaths

1999 NHNew Cases


74% (95%CI: 71.6-76.1) of NH adultsdid not eat five servings of fruits orvegetables a day.


60

50

10

30

20

10

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

60

50

10

30

20

10

0

Rat

e/10

0,00

0

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

Stomach: Incidence and Mortality Rates by Age, 1995-1999

MortalityIncidence

Total Total

ST

OM

AC

H

69


State Total

2551381

1642

47

3051061631

26

55

1023

142

2273

73

2221170722

26

3031140321

18

52522

110

1043

44

New Cases Deaths

Stomach: Stage at Diagnosis, 1999

In Situ3%

Unknown21%

Distant31%

Regional34%


Stomach: New Cases and Deaths by County, 1999

Stomach: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases003

106

141635234970504935

Incidence Mortality

Rate-------

14.712.424.239.035.050.141.4

Cases00175

111431154048253216

Rate-------

26.1-

42.060.442.288.1

-

Cases0023132489

22251719

Rate----------

22.029.9

--

Deaths0004399

19102745294041

Rate---------

13.325.120.340.948.5

Deaths0002278

189

2129132420

Rate---------

22.036.5

-66.187.1

Deaths0002121116

16161621

Rate-------------

34.1



Localized11%County

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

70

Testicular cancer represents only one percent of all cancers and about five percent of genitalcancers in males. However, it is the most common cancer in young males. Testicular cancerrisk has more than doubled among white Americans in the past 40 years but has remained thesame for African-Americans.

Facts

Age Most Often Affected: 15-35Survival Information: Studies show that the curerate exceeds 90% in all stages combined. The 5-year survival rate for stage I and stage II testicularcancer is more than 95%. The 5-year survival ratefor stage III disease, in which cancer has spreadbeyond local lymph nodes, is 75%.

TESTIS

Known Risk Factors

Undescended testicleCongenital abnormalities of the testi-clesMaternal exposure to DES beforebirth

Screening and Detection

Self-exams and regular exams by aphysician



1997SEER U.S. White


1997 U.S. White

Male 39 5.6 6.1 3 - 0.3

1999 NHDeaths

1999 NHNew Cases

80

70

60

50

40

30

20

10

0

New

Cas

es

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group


80

70

60

50

40

30

20

10

0

Dea

ths

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

9% (95% CI: 6.4-11.3) of NH adult males had no health insurance; 31% (95% CI: 27.7-35.7) of NH males did not have a routine physical checkup in the past year.

Testis: Incidence and Mortality by Age, 1995-1999

MortalityIncidence

Note: Rates are not displayed if fewer than 20 events were reported (noted as -).

TE

ST

IS

71

Distant13%

County

10114

127

1120

39

0000020100

3

New Cases Deaths

Testis: New Cases and Deaths by County, 1999

Testis: Age-specific Incidence and MortalityRates, 1995–1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Incidence Mortality

Cases0

217035261650202010

Rate-

5.715.412.110.1

---------

Deaths00431020000000

Rate--------------


Testis: Stage at Diagnosis, 1999

Regional11%

Localized75%

Unknown1%


State Tota

CA

NC

ER

IN

NE

W H

AM

PS

HIR

E,

19

99

72

Thyroid cancer is the most common cancer of the endocrine system and accounts for about 1percent of all cancers. About 10 percent of thyroid nodules (lumps) are cancerous. Most earlythyroid cancers are found when patients ask their doctors about nodules they have noticed, butsome are also detected by health care providers during routine checkups.

Facts

Age Most Often Affected: All agesGender Most Often Affected: FemaleSurvival Information: More than 90% of patientstreated for papillary or follicular thyroid carcinomawill live for 15 years or longer after diagnosis. Formedullary thyroid cancer, over 80% of patients live atleast 10 years after surgery. Anaplastic thyroid carci-noma has a much less favorable prognosis: between3% and 17% of these patients survive five years afterdiagnosis.

THYROID

Known Risk Factors

Exposure to ionizing radiation,especially during childhoodHistory of goiterDiet either very low or very high iniodineHereditary factors

Screening and DetectionSelf-examination and regularannual physician visits



1997SEER U.S. White


1997 U.S. White

Male 25 2.7 3.7 1 - 0.5Female 44 6.5 9.9 5 - 0.5

Total 69 4.7 6.8 6 - 0.5

1999 NHDeaths

1999 NHNew Cases

Note: New Hampshire rates in bold type are significantly different from national rates at the 95% confidence interval.Rates are not displayed if fewer than 20 events were reported (noted as -).

454035302520151050

New

Cas

es

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

Note: Actual number of events are plotted in place of rates; there were not enough reliable rates available to produce a meaningful chart.

MaleFemale

20% (95% CI: 17.3-22.5) of NH women did not havea routine medical checkup during the past year.

454035302520151050

Dea

ths

<15

15-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+Age Group

MaleFemale

Thyroid: Incidence and Mortality by Age and Sex, 1995-1999

MortalityIncidence

TH

YR

OID

73


State Total

01113

111610

25

11406

165731

44

12519

276

1341

69

0000010000

1

0000111110

5

0000121110

6

New Cases Deaths

Thyroid: Stage at Diagnosis, 1999

Distant5%

Regional29%


Thyroid: New Cases and Deaths by County, 1999

Thyroid: Age-specific Incidence and Mortality Rates by Sex, 1995-1999

Age Group<1515-2425-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Cases3

185241362423167

15181762

Incidence Mortality

Rate--

5.67.17.05.77.0

-------

Cases15

12138863188510

Rate--------------

Cases2

1340282816171367

101252

Rate--

8.69.8

11.0---------

Deaths00000010116233

Rate--------------

Deaths00000000002100

Rate--------------

Deaths00000010114133

Rate--------------



Localized61%

Unknown5%County

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1. CHANGE IN STANDARD POPULATION FOR AGE-ADJUSTED RATES Unlike the 1970 US standard population that was used for age-adjusted rates previously, the2000 US standard population was used for age-adjusted rates in this report. The 2000 standardpopulation has a higher percentage of individuals in the middle and older age groups than inthe 1970 standard population. Because increased age is the greatest risk factor in developingcancer, age distribution in the 2000 standard population better reflects the current age struc-ture. Therefore the age-adjusted rates in this report are expected to be higher and cannot becompared to those in the previous reports.

2. TRANSITION FROM ICD-9 TO ICD-10 IN MORTALITY CODINGVital records departments were required to switch from ICD-9 to ICD-10 for recording cause ofdeath in 1999. ICD-10 is far more detailed than ICD-9 with approximately 3,000 additional codesand is more compatible with the ICD-Oncology (ICD-O) system. Basically, the number of overallcancer deaths using the ICD-9 and the ICD-10 systems are the same. However, causes of deathare moved among different categories.

The most notable change in coding of cancer mortality is for lung cancer deaths. Lung cancer isclassified as secondary to some other cancers by ICD-10. Therefore, some of the lung cancerdeaths classified by ICD-9 were moved to other primary sites in ICD-10. The result is a lowerrate of cancer deaths attributed to lung cancer and cannot be concluded as fewer deaths ascompared to previous reports.

3. DEFINITION OF CANCER TERMSCase: an incident of a reportable primary site of cancer. (Note: a cancer patient may developmultiple primary cancers; therefore, the number of cases in this report refers to the number ofreported primary sites, not the number of cancer patients.)

Site: the primary organ or tissue of origin for the malignancy. Microscopic examination,endoscopy, radiology, or clinical examination determines the place of origin.

Stage of disease: the extent to which the disease has spread from the site of origin at thetime of diagnosis. The New Hampshire State Cancer Registry uses the Summary StagingGuide of the Cancer Surveillance, Epidemiology, and End Results Reporting (SEER) Program ofNCI. The American College of Surgeons sanctions this guide. It is divided into four generalcategories that provide a measure of the stage of disease at the time the cancer is first diag-nosed. The groupings are general enough so that nearly every case can, with careful consider-ation, be fitted into one of the groups. These stage categories are defined as follows:

In situ: a noninvasive neoplasm, a tumor that has not penetrated the basement membraneof the epithelial tissue involved.Localized: an invasive neoplasm confined entirely to the organ of origin. Regional: a neoplasm that has extended beyond the limits of the organ of origin directlyinto surrounding organs or tissues and/or into regional lymph nodes by way of the lym-phatic system.Distant: a neoplasm that has spread to other parts of the body remote from the primarytumor either by direct extension or by discontinuous metastasis. A cancer case diagnosedin this stage is classified as late stage diagnosis.

APPENDIX A: TECHNICAL NOTES

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DEFINITION OF PRIMARY SITE CATEGORIES

a. Morphology Group Type 1: M-9590-9989. b. Morphology Group Type 2: M-9530-9539. c. Morphology Group Type 3: M-9650-9667. d. Morphology Group Type 4: M-9800-9941. e. Morphology Group Type 5: M-8720-8790. f. Morphology Group Type 6: M-9731-9732. g. Morphology Group Type 7: M-9590-9595 & M-9670-9717.

*International Classification of Diseases for Oncology, 2nd Ed. (1990) for incidence data**International Classification of Diseases, Nineth Revision, Clinical Modification (1980) for 1995-1998 mortality dataand Tenth Revision, Clinical Modification (2000) for 1999 mortality data.

Primary Sites

BladderBrain & other CNS

Breast

Cervix UteriColon/Rectum

Corpus Uteri & Uterus,NOS

EsophagusHodgkin’s DiseaseKidney & Renal PelvisLarynxLeukemia

Liver & IntrahepaticBile DuctsLung & BronchusMelanoma of the SkinMultiple Myeloma

Non-Hodgkin’sLymphoma

Oral Cavity & PharynxOvaryPancreasProstateStomachTestisThyroid

C670-C679C700-C729

C500-C509

C530-C539C180-C189C199,C209C260C540-C549C559

C150-C159C000-C809C649,C659C320-C329C000-C809

C220,C221

C340-C349C440-C449C000-C809

C000-C809

C000-C148C569C250-C259C619C160-C169C620-C629C739

Exclude Type 1a

Exclude Type 1 & 2b

Exclude Type 1

Exclude Type 1Exclude Type 1

Exclude Type 1

Exclude Type 1Type 3c

Exclude Type 1Exclude Type 1Type 4d

Exclude Type 1

Exclude Type 1Type 5e

Type 6f

Type 7g

Exclude Type 1Exclude Type 1Exclude Type 1Exclude Type 1Exclude Type 1Exclude Type 1Exclude Type 1

188.0-188.9191.0-192.9

174.0-174.9175180.0-180.9153.0-153.9154.0,154.1159.0179182.0-182.1182.8150.0-150.9201.0-201.9189.0,189.1161.0-161.9202.4,203.1204.0-208.9155.0,155.2

162.2-162.9172.0-172.9203.0203.2-203.8200.0-200.8202.0-202.2202.8-202.9140.0-149.9183.0157.0-157.9185151.0-151.9186.0-186.9193

C670-C679C700-C729

C500-C509

C530-C539C180-C189C19,C20C26C540-C549C55

C150-C159C810-C819C64,C65C320-C329C910-C959

C220-C229

C340-C349C430-C439C900-C902

C820-C859

C000-C148C56C250-C259C61C160-C169C620-C629C73

Incidence Mortality

ICD-O2Morphology

ICD-O2*Topography

ICD-9** ICD-10**

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4. DATA QUALITYData quality is directly related to the completeness and accuracy of the information reported.Registry data tabulated in this report are based on information received and edited by theNHSCR as of January 2002 and reflect at least 95% of the true cancer incidence rate for thestate. Delays in reports from out of state hospitals and incomplete medical records account forthe balance of the cases.

The NHSCR follows standard procedures for ensuring the accuracy of data. A comprehensiveset of standard national edits are applied to all case reports received by the NHSCR prior toincluding those cases in the central database. New case reports are then merged with old casereports to ensure that only primary incident tumors are included. The NHSCR tumor registrarscontact registrars at reporting institutions to resolve any outstanding edits. In addition to thesequality assurance activities for case processing, the NHSCR conducts quarterly case reabstrac-tion reviews to ensure that professional standards for case abstraction are consistently metacross all reporting institutions. To ensure complete case reporting, the NHSCR performs quar-terly independent audits of pathology and cytology reports at hospitals, free standing labs, andselected out of state laboratories performing microscopic reviews for physician offices. In addi-tion, the NHSCR performs death clearance by linking incident cancer cases with vital statisticsdeath certificates and follows up on all deaths with cancer as a diagnosis that were not previ-ously reported to the cancer registry.

5. DATA CONFIDENTIALITYAll individuals working with the Registry database are governed by the confidentiality policyimplemented under the New Hampshire Rules and Regulations governing the Registry.Release of confidential cancer data for research or other purposes is governed by RSA 141B.Data or data analysis may be requested through the Bureau of Health Statistics and DataManagement.

6. DATA SOURCES - U.S. INCIDENCE AND MORTALITYSEER incidence are derived from National Cancer Institute’s SEER Program: SEER CancerIncidence Public-Use Database, 1973-1998 using SEER Stat.Statistical information on cancer deaths for the US white population was obtained from theNational Mortality Data Base (NMDB) using CDC WONDER provided by the National Center forHealth Statistics.

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7. POPULATION WEIGHTSState and county population estimates for New Hampshire are based on data from theU.S. Bureau of the Census. For comparison purposes, the 2000 U.S. standard population weights used in calculatingage-adjusted rates in this report and the 1970 U.S. standard population weights used inprevious publications are shown below.

Age Group 1970 weight 2000 weight

0-4 0.0844 0.06915-9 0.0982 0.072510-14 0.1023 0.073015-19 0.0938 0.072220-24 0.0806 0.066525-29 0.0663 0.064530-34 0.0562 0.071035-39 0.0547 0.080840-44 0.0590 0.081945-49 0.0596 0.072150-54 0.0546 0.062755-59 0.0491 0.048560-64 0.0424 0.038865-69 0.0344 0.034370-74 0.0268 0.031875-79 0.0189 0.027080-84 0.0112 0.017885+ 0.0074 0.0155All Ages 1.0000 1.0000

8. AGE-ADJUSTED RATES Age-adjusted rates refer to the number of events that would be expected per 100,000 per-sons in a selected population if that population had the same age distribution as a stan-dard population. For this report, the standard population used is the U.S. 2000 standardpopulation. Age-adjusted rates allow for comparisons of different population groups bycontrolling for the effects of differences in age between populations. Age-adjusted rateswere calculated using the direct method as follows

where,m = number of age groupsdi= number of events in age group iPi= population in age group iSi= proportion of the standard population in age group iThis is a weighted sum of Poisson random variables, with the weights being (Si /pi)

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* Reliability of RatesSeveral important notes should be kept in mind when examining rates.

Rates based on small numbers of events can show considerable variation (e.g. less than20 events). This limits the usefulness of these rates in comparisons and estimations offuture occurrences. Unadjusted rates are not reliable for drawing definitive conclusions when making com-parisons, because they do not take factors such as age distribution among populationsinto account. Age-adjusted rates offer a more refined measurement when comparingevents over geographic areas or time periods.When a difference in rates appears to be significant, care should be exercised in attribut-ing the difference to any particular factor or set of factors. Many variables may influencerate differences. Interpretation of a rate difference requires substantial data and exactinganalysis.

9. GRAPHSGraphs have varying scales depending on the range of the data displayed. Therefore, cautionshould be exercised when comparing such graphs.

10. STANDARD ERRORSThe standard errors (S.E.) of the rates were calculated using the following formula:

where, = fraction of the standard population in age category= number of cases in that age category= person-years denominator

11. CONFIDENCE INTERVALS (CI)The standard error can be used to evaluate the statistical significance between two rates by cal-culating the confidence interval. If the interval produced for one rate does not overlap theinterval for another, the probability that the rates are statistically different is 95% or higher.(This test can be inaccurate for rates based on fewer than 10 events.) The formula used is:

R z (SE)

where,R=age-adjusted rate of one populationz = 1.96 for 95% confidence limitsSE= standard error as calculated above

S.E.=

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APPENDIX B: SOURCES OF ADDITIONAL INFORMATION

For more information on cancer, risk factors or prevention strategies please refer to thefollowing resources:

1-800-4CANCER: A cancer information service of the National Cancer Institute.

American Cancer Society: http://www.cancer.org/American College of Surgeons Commission on Cancer: http://www.facs.org/National Cancer Institute: http://cancer.gov/National Program of Cancer Registries: http://www.cdc.gov/cancer/npcr/Surveillance, Epidemiology, and End Results program: http://seer.cancer.gov/National Cancer Registrars Association: http://www.ncra-usa.org/North American Association of Central Cancer Registries: http://www.naaccr.org/International Agency for Research on Cancer, World Health Organization:http://www.iarc.fr/International Union Against Cancer: http://www.uicc.org/New Hampshire Behavioral Risk Factor Surveillance System: 603-271-4671Healthy New Hampshire 2010: 603-271-4551 or http://www.healthynh2010.org/New Hampshire Breast and Cervical Cancer Program: 603-271-4931 orhttp://www.dhhs.state.nh.us/commpublichealth/bccancer.nsf/vMain?OpenviewBureau of Health Risk Assessment, New Hampshire Department of Health andHuman Services: 603-271-4664 orhttp://www.dhhs.state.nh.us/CommPublicHealth/RiskAssess.nsf/vMain?OpenViewBureau of Health Statistics and Data Management, New Hampshire Department ofHealth and Human Services: 603-271-5926 or http://www.dhhs.state.nh.us/healthstats

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REFERENCES

1 Tannock IF, Hill RP (1998). The Basic Science of Oncology (3rd ed.) USA:McGraw-HillCompanies, Inc.

2 New Hampshire Vital Statistics Report, 1998, New Hampshire Department of Health andHuman Services.

3 IARC Publications (1999): Cancer Epidemiology: Principles and Methods, Lyon, France:International Agency for Research on Cancer.

4 NIH Publications (1996): National Cancer Institute’s Racial/Ethnic Patterns of Cancer in theUnited States, 1988-1992, Bethesda, MD: National Cancer Institute.

5 Healthy New Hampshire (HNH) 2010, New Hampshire Department of Health and HumanServices.

6 Findings from the Behavioral Risk Factor Surveillance System (BRFSS), 2000, NewHampshire Department of Health and Human Services.

Documents

1999...CANCER IN NEW HAMPSHIRE, 1999 2 New Features in this Report The use of 2000 US standard population as a reference group for age-adjusted rates. Unlike previous publications