THE BURDEN OF Cancer - Department of Health Home · The Pennsylvania Cancer Registry (PCR) is the statewide data system established by the Pennsylvania Cancer Prevention, Control

THE BURDEN OF

Cancer IN PENNSYLVANIA

Calculating Costs

Understanding Impacts

Exploring Interventions

Dear Reader:

The Burden of Cancer in Pennsylvania provides information about the incidence, mortality, behavioral risks and the cost

of cancer; the disease that continues to be the second leading cause of death among Pennsylvanians. While the death

rates for cancer are declining, Pennsylvania is still above the national rates for mortality in most cancers. There are many

areas for improvement in screening, lifestyle modifi cation and tobacco cessation that can prevent Pennsylvanians from

getting cancer.

This report shows how cancer affects different genders, ethnic and racial groups across Pennsylvania. The collection

and reporting of cancer statistics allows resources to be targeted to populations or communities of Pennsylvania most in

need for public health interventions and to evaluate the impact of cancer interventions.

This report addresses the cancers of bladder, breast, cervical, colorectal, lung, melanoma, prostate, and thyroid. These

cancers were selected due to their impact on the overall burden of cancer and the fact that screenings/preventative

measures exist for them. Researchers seeking information on other cancers or additional analyses are directed to

www.health.state.pa.us/stats for a comprehensive list of Pennsylvania-related health statistics.

Our appreciation to the members of the Data Advisory Committee of the Pennsylvania Cancer Control, Prevention and

Research Advisory Board whose hard work made this report possible.

Sincerely,

Joel Noumoff, MD.

Chairman, Pennsylvania Cancer Control, Prevention and Research Advisory Board

Bureau of Health Promotion & Risk Reduction | Room 1008 H&W Building | 625 Forster Street | Harrisburg, PA 17120-0701

DATA ADVISORY COMMITTEE (DAC)

As a committee of the Pennsylvania Cancer Control, Prevention and Research Advisory Board, the mission of the DAC

is to facilitate the use of cancer surveillance data to evaluate the impact of cancer interventions and identify target

populations and communities where interventions should be focused.

Pennsylvania Department of Health, Bureau of Epidemiology

Marshal Ma, MD, MPH, Epidemiologist, DAC Co-Chair

Ron Tringali, PhD, RN, Epidemiologist

Gene Weinberg, PhD, Epidemiologist Manager

Pennsylvania Department of Health, Bureau of Health Statistics and Research

Michelle Esterly, Pennsylvania Cancer Registry

Alan Fleegal, Statistical Analyst Supervisor

Diane Kirsch, Statistical Registries Director

Robin Otto, Pennsylvania Cancer Registry Manager

Brian Wright, Statistical Support Division Chief

Pennsylvania Department of Health, Division of Cancer Prevention and Control

Joe Burkhart, Operations and Evaluation Section Chief

Sharon Sowers, Plan and Policy Development Section Chief

Joanna Stoms, Cancer Plan Manager, DAC Co-Chair, Editor in Chief

Jeremy Zuckero, Data Manager

CONTENTS Executive Summary 1

Demographic Profi le of Pennsylvania 5

Data Notes 6

Modifi able Risk Factor Behaviors 8

Smoking 8

Obesity 10

Physical Inactivity 13

Preventive Activities 16

Colorectal Cancer Screening 19

Breast and Cervical Cancer Screening 22

Cancer Burden 25

All Cancers 25

Lung and Bronchus Cancer 30

Colorectal Cancer 38

Female Breast Cancer 46

Cervical Cancer 52

Prostate Cancer 59

Melanoma of the Skin 66

Urinary Bladder Cancer 74

Thyroid Cancer 82

Appendix 90

1

EXECUTIVE SUMMARYCancer is the second leading cause of death in Pennsylvania, exceeded only by heart disease. In 2011, over 77,000 people had a diagnosis of an invasive cancer and approximately 28,500 died of cancer. Beyond the number of lives lost and new diagnoses each year, cancer also imposes a great fi nancial and emotional burden on cancer patients and their families. According to the Centers for Disease Control and Prevention (CDC), cancer cost Pennsylvania an estimated $7.3 billion in medical costs and lost productivity in 2010.

More than 30% of cancer could be prevented, mainly by not using tobacco, having a healthy diet, being physically active and moderating the use of alcohol. Screening increases the chances of detecting certain cancers early, when they are most likely to be curable. Screening procedures such as mammography, colonoscopy/sigmoidoscopy and Pap testing can detect precancerous conditions or increase the likelihood of discovering cancer in an early stage where the chance of effective treatment and survival is higher.

Purpose of the Report

The purpose of the Pennsylvania Cancer Burden Report is to provide a general description of cancer incidence, mortality, hospitalization and selected risk factors to help policy makers, program administrators, business and industry leaders and the citizens of the Commonwealth understand the true cost of cancer in Pennsylvania and to target interventions to certain geographic regions or populations experiencing cancer-related health disparities.

The Pennsylvania Cancer Burden report supports the epidemiology and surveillance requirement and provides information to stakeholders involved in cancer control. The report informs decision makers, helps managers allocate resources and helps reach those most in need. It is a comprehensive analysis of cancer in Pennsylvania and it illustrates the true cost of this disease to the Commonwealth and its over 12 million citizens.

Statewide Cancer Control Efforts

Even though cancer death rates are at their lowest since 1990, Pennsylvania continues its commitment to provide a comprehensive approach to cancer control. The Cancer Control, Prevention and Research Advisory Board (CAB) is a legislatively mandated board that advises the Secretary

of Health on cancer control and prevention-related issues in Pennsylvania; approves the statewide cancer plan; and reports annually to the Governor and General Assembly on cancer control activities. The CAB has four committees to carry out its mission: the Stakeholder Leadership Team (SLT), functioning as the statewide cancer coalition; the Breast and Cervical Cancer Medical Advisory Committee and the Colorectal Cancer Advisory Committee, both to provide clinical expertise for screening programs; and the Data Advisory Committee to coordinate the enhancement of data sharing with internal and external organizations and act as an advisory group to the Pennsylvania Cancer Registry.

The 2013-2018 Pennsylvania Cancer Control Plan was created by the SLT coalition, approved by the CAB, and now serves as a blueprint for all sectors of Pennsylvania, setting the stage for the major issues to be addressed, along with potential actions for implementation. The Plan is based on improving health through a range of policy, system and environmental approaches commonly referred to as the Chronic Disease Prevention and Health Promotion Domains established by CDC:

Epidemiology and Surveillance—using data to target services to those at higher risk for developing cancer and the factors contributing to cancer

Policy Systems and Environmental Approaches—promoting access to affordable and quality health care in schools, worksites, and communities

Health System Interventions—improving how prevention services and cancer treatment are delivered

Community Clinical Linkages—linking community resources with health care delivery systems to improve the prevention, management, and survival of cancer

The Pennsylvania Department of Health (Department) is responsible for the planning, implementation, and evaluation of efforts to prevent and manage cancer, funded in part by state appropriations and the Centers for Disease Control and Prevention (CDC). The overarching goal of the Department is to eliminate the burden of cancer for Pennsylvanians. To achieve this, the Department established the s goals of reducing the rate of cancer mortality and increasing screening rates to detect breast, cervical, and colorectal cancer.

executive summary

2 executive summary

Within the Department, the Division of Cancer Prevention and Control is responsible for statewide cancer control planning, including staff support to the CAB, the SLT coalition and its workgroups. The Division manages program oversight for the Pennsylvania HealthyWoman Program which provides low-income, uninsured and underinsured women access to timely breast and cervical cancer screening, diagnostic and patient navigation services. The Division oversees the PA Colorectal Cancer Control Program which provides screening, diagnostic and follow-up services in Philadelphia County.

The Pennsylvania Cancer Registry (PCR) is the statewide data system established by the Pennsylvania Cancer Prevention, Control and Research Act to collect information on all new cases of cancer diagnosed or treated in Pennsylvania. The PCR has collected a complete statewide data summary of patient history, diagnosis, treatment and status since 1985. The PCR has earned Gold Certifi cation from North American Association of Central Cancer Registries (NAACCR) for 14 years.

The Pennsylvania Department of Health’s Bureau of Health Statistics and Research collects and disseminates data to assist in planning, administering and evaluating the health status of Pennsylvania residents and the quality and quantity of health services within Pennsylvania. The Bureau provides technical assistance, statistical analysis, and training to other program areas. The Department’s Data Driven Management Program is also the responsibility of the Bureau.

The Pennsylvania Cancer Control, and Prevention and Research Act established as one of its priorities cancer epidemiology and statistics. The Pennsylvania Department of Health has a dedicated Epidemiologist that focuses on the causes, distribution and control of cancer. The Epidemiologist’s work is instrumental in developing the cancer incidence and mortality reports as well as providing comprehensive analysis of the risk factors and disparities associated with cancer.

Report Design

First, selected modifi able risk factor behaviors and preventive activities associated with cancer diagnosis are described. Data presented in this section includes prevalence rates from 2000-2010, prevalence by gender and race/ethnicity, prevalence by age group and prevalence by income and education. Geographic information from the 2010-2012 Behavioral Risk Factor Surveillance System (BRFSS) Survey is also presented.

Eight cancers were selected for study: Cervix uteri, colon and rectum, female breast, lung and bronchus, prostate,

malignant melanoma, thyroid and urinary bladder. These cancers were selected due to their impact on the overall burden of cancer and the fact that screenings/preventative measures exist for them.

Summary of Findings

Modifi able Risk Factors Behaviors

The rate of adult smoking is currently down to 18% in 2010 from 24% in 1995. Smoking rates peaked in 2003 at 25% but have been slowly declining. It is worth noting that in 2002 Pennsylvania imposed a signifi cant excise tax on cigarettes and in 2008, Pennsylvania instituted the Clean Indoor Air Act. Although smoking rates have declined over the years, Pennsylvania’s rates in all categories are slightly higher than the national rates.

Pennsylvanians who identifi ed themselves as multiracial had the highest rates of smoking followed by blacks and Hispanics; males are more likely to smoke than females. Rates of smoking were inversely proportional to income and education, with those having less than a high school education and making less than $15,000 having the highest rates of smoking.

Obesity rates in Pennsylvania follow national trends and have increased from 16% in 1995 to 29% in 2010. Overall, obesity rates for Pennsylvania are marginally higher than the national rates. Females tend to be slightly more obese than males and Hispanics show the highest rate of obesity at 36% followed by blacks at 34%. Citizens belonging to the age group 55-64 have the highest rates of obesity at 33%, and those who are poorest and least educated have the highest rates of obesity. Geographically, several south central counties exhibit rates of obesity that are 6-7 % higher than the state average.

“Physically inactive” can be defi ned as not having engaged in a physical activity other than regular job activities within the past month. The level of physical activity for Pennsylvania peaked in 1998 but has remained somewhat steady for the time period studied. Pennsylvania rates are, as with other factors, slightly above the national average. The state 2012 rate for all age groups is 23%; those 55-64 years old are the most inactive at 35.8% far surpassing the national rate of 25.9% for this indicator. This trend does correspond with the above mentioned increased obesity rate for this age category. Not surprisingly, the rates of physical inactivity are highest with those citizens at the lowest income and education levels. The southwest corner of the state and Philadelphia County show the highest rates of physical inactivity statewide.

3 executive summary

Preventive Activities

From 1995 to 2010, the number of people without health care coverage in Pennsylvania increased slightly from 12% to 14%, and the state continues to be below the national average in almost all categories. Males, Hispanics, followed by blacks, make up the greatest number of uninsured. Younger adults, ages 25-34, have less health care coverage than other age groups. Those making $15,000-$25,000, along with those having less than a high school education are most likely to be uninsured. The northeast corner of the state, four south central counties and Philadelphia County have the highest rates of no health coverage. However, with the addition of the Affordable Care Act and Healthy PA an increase in health care coverage rates can be expected.

Colonoscopy/sigmoidoscopy rates in Pennsylvania for adults ages 50 years and older have increased steadily and currently stand at a rate of 68%. Overall rates for colonoscopy/sigmoidoscopy are nearly the same or slightly better than national rates in all categories. Males and females are screened at approximately the same rates. Hispanics have the lowest rates of screening at 57%. Adults 50-59 years of age show the lowest rate of screening at 59%. Once again, those with the least amount of education and annual income exhibit the lowest rates of screening. The southwest area of the state has the lowest rate of colonoscopy/sigmoidoscopy at 60%. A less invasive, but less utilized type of colorectal cancer screening is a blood stool kit known as known as the FOBT (fecal occult blood test) or the FIT (fecal immunochemical fecal occult blood test). The current rate for this method of screening is 9% statewide. The lowest rate of screening occurs in the northeast at 7%.

Mammogram screening rates for women 40 years of age and older have increased from 63% in 1995 to 74% in 2010. Pennsylvania’s rate at 73.9% is slightly lower than the national average.at 75.2%. Women ages 40-49 have the lowest screening rate at 65.3% and women who have less than a high school education and make less than $15,000 are also the least likely to receive a mammogram. Geographic areas of the state that show lower rates of screening than the state average are the: northeast, southwest and Allegheny County.

The Papanicolaou test (Pap test) is a method to detect cervical cancer. The rate of women who received a Pap test in the past three years is 73%. The southwest and north central regions of the state are 3 to 5% below the state average, of 73%. Philadelphia County has the highest rate for adult females who received a Pap test at 78%.

Cancer Incidence

In 2011 approximately 78,000 cases of invasive cancer were diagnosed in Pennsylvania. Nearly all non-female specifi c cancers, except breast cancer and thyroid cancer, males have higher incidence and mortality rates than females. For many types of cancers, racial disparities regarding incidence and mortality are also highly evident, and with few exceptions, black male incidence and mortality rates are the highest in all race/sex/ethnicity categories.

Disparities between gender and races can be noted. Black males had an overall age-adjusted cancer incidence rate of 625.7 per 100,000 in 2011, compared to 542.0 for white males, and approximately 460 for females of both races.

Lung and bronchus, female breast, and prostate cancer are the three most commonly diagnosed invasive cancers with over 10,000 cases each.

Lung and bronchus cancer is the most common invasive cancer in Pennsylvania as of 2011 with a total of 10,568 cases diagnosed, female breast cancer at 10,561 cases and prostate cancer at 10,235 cases. The rate of lung cancer in males is signifi cantly higher than in females. However, male lung cancer incidence rates have declined slightly over the past decade, while female incidence rates increased until 2007 and currently appear to be holding steady.

Cancer Mortality

In 2011, more than 28,500 Pennsylvanians died from cancer. The highest number of deaths, by a substantial margin, was lung and bronchus cancer, with 7,600 deaths. Colorectal cancer, with 2,600 deaths, and female breast cancer, with 2,000 deaths are the second and third leading causes of cancer death in both males and females.

Stage Distribution at time of Diagnosis

Approximately half of all cancers are diagnosed at early stages (e.g., local or in situ) and less than 25 percent are diagnosed at the distant stage. The exception to this trend is lung and bronchus cancer. Over 50% of lung and bronchus tumors are diagnosed as distant and therefore much less treatable. Some variation exists among the race/ethnic groups represented in the fi gure, but overall rates are relatively close.

4 executive summary

Geographic Information

The overall cancer incidence rates for males and females in Pennsylvania are higher than the national rate. Counties which have a statistically signifi cant higher rate occurred in both very urban and very rural areas. The distribution of counties with statistically signifi cant higher or lower incidence rates for females is slightly different than for males, but the largely urban and rural pattern remains.

The national and Pennsylvania mortality rates for males and females, in contrast to incidence rates, are fairly close. For both sexes, the distribution of counties with signifi cantly higher and lower rates also differs from incidence. Two of the counties in the Philadelphia Metropolitan Statistical Area (MSA), specifi cally Philadelphia and Delaware counties, have signifi cantly higher mortality rates compared to the state for both males and in females.

Hospitalization Data

The data source for this section of the report is from the 2001-2011 Pennsylvania Health Care Cost Containment Council (PHC4) inpatient discharge data. PHC4 is an independent state agency charged with collecting, analyzing and reporting information that can improve the quality and restrain the costs of health care in the state.

The following table shows select hospitalization data for high burden cancers in Pennsylvania.

Consistent with the incidence and mortality data, lung cancer had the highest number of hospitalization admissions at 6,921 in 2011. Except for thyroid cancer, admissions decreased from 2001 to 2011. However, hospitalization charges have increased substantially in the same time period. Colorectal cancer had the highest charges by primary payer at a cost of $311 million to Medicare, followed closely by lung cancer at $306.6 million. It is worth noting that charges for prostate cancer almost tripled from 2001 to 2011, with commercial insurance assuming a majority of the costs. An analysis of the data also shows that non-Hispanic blacks and Hispanics are hospitalized at a disproportionate rate as compared to other racial and ethnic groups.

Select Data from Cancer Hospitalization Report 2001-2011

Cancer Type YearTotal Number of Hospital Admissions

Total Hospitalization Charges by Primary Payer type (millions)

Age Adjusted Hospital rate by race/ethnicity

Lung and Bronchus

2001 7821 $167.8 Medicare 82.2% non-Hispanic black


Colorectal2001 8726 $222.3 Medicare 73.9% Hispanic


Female Breast2001 5370 $39.6 Commercial 42.4% Hispanic

2011 3373 $82.6 Commercial 33.7% non-Hispanic black

Prostate2001 4801 $46.6 Commercial 44.9% non-Hispanic black

2011 4291 $125.7 Commercial 34.2% non-Hispanic black

5 demographic profi le of pennsylvania

DEMOGRAPHIC PROFILE OF PENNSYLVANIAPennsylvania ranks as the sixth largest state in United States, with an estimated population of 12.8 million in 2013. Two major cities—Philadelphia and Pittsburgh—anchor each side of the state with a total population of 1.55 and 0.31 million respectively. However, Pennsylvania ranks third in the nation with 16.4% of its citizens at 65 years of age or older.1

Pennsylvanians reside in 67 counties with 2,575 municipalities; 31 of the 67 counties have total populations over 100,000, while the other 36 counties have populations less than 100,000.2

The Center for Rural Pennsylvania defi nes a county “rural” if the population density is lower than the population density of the state. For Pennsylvania, counties with population density of less than 284 persons per square mile are “rural.” Forty-eight of Pennsylvania’s 67 counties meet this defi nition; nineteen counties do not and are considered urban. In 2013, over 3.5 million or 27 percent of the population of Pennsylvania lived in a rural county.3

The Pennsylvania Department of Health is organized into six community health districts, 60 state health centers, as well as 10 county or municipal health departments. The state is also served by more than 200 Federally Qualifi ed Health Centers serving over 700,000 patients in Pennsylvania. They are located in 45 out of 67 counties and serve both urban (60%) and rural (40%) populations.4

Race and Ethnicity

Pennsylvania is becoming more racially and ethnically diverse, as is the United States. In 2000, the U.S. Census Bureau calculated that 16 percent of Pennsylvania residents belonged to a minority group. Ten years later, the agency found 20 percent of the state’s population belonged to a minority group. During the same time period, the percentage of people belonging to at least one minority group increased from 31 percent to 36 percent nationwide.

Minority residents comprise a greater percentage of the population in urban areas (25 percent) than in rural areas (8 percent) of Pennsylvania. Urban counties include Allegheny, Beaver, Berks, Bucks, Chester, Cumberland, Dauphin, Delaware, Erie, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Montgomery, Northampton, Philadelphia, Westmoreland and York.5

Table 1 (Appendix) shows the 2000 and 2010 population 1 (United States Census, 2014) 2 (United States Census, 2014) 3 (Center for Rural Pennsylvania, 2014) 4 (Pennsylvania Association for Community Health Centers, 2014) 5 (Center for Rural Pennsylvania, 2014)

totals for Pennsylvania counties by race/ethnicity. Counties with the greatest population of black residents, in descending order, are Philadelphia, Allegheny, Delaware, Montgomery and Dauphin. The majority of Hispanic residents live in Philadelphia, Berks, Lehigh, Lancaster and Luzerne counties. The Hispanic population has shown the most growth in Luzerne County, which increased almost 500 percent from 2000 to 2010. Population change in Forest County is due in large part to the opening of a prison in that county in 2004. In addition, the populations of people who identify as Asian/Pacifi c Islander or Hispanic have increased, especially in eastern counties.

Socioeconomic Status

According to the Centers for Disease Control (CDC), a person’s socioeconomic status impacts his or her ability to obtain health care.6 Areas that have a higher unemployment rate, higher eligibility for medical assistance, less education, less per capita income or less education typically exhibit poorer health coutcomes among its inhabitants.

Income

According to US Census, the Pennsylvania median household income for 2008-2012 was $52,267 compared to $53, 046 for the United States. The largest employment sector in the state is educational services, health and social assistance, followed by manufacturing and retail trades.

Poverty

According to US Census, about 13.1 percent of Pennsylvanians lived below the poverty level during 2008-2012, which was lower than the national rate of 14.9 percent. The Pennsylvania poverty rate among black residents was 28 percent, compared to 34 percent for Hispanics and only 11 percent for whites during the above time period.

Education

According to the US Census Bureau’s American Community Survey 2012, 11.1 percent of Pennsylvania’s population 25 or over has less than a high school educations, 36.8 percent has a high school diploma or equivalent, 16.6 percent have some college education, 7.9 percent have attained An Associate’s degree and 27.9 percent have a Bachelor’s degree or higher.7

6 (Centers for Disease Control, 2014) 7 (U. S. Census Bureau American Community Survey, 2012)

6 data notes

DATA NOTES

Demographic Data:

Socioeconomic and demographic data and tables were taken in part from the Pennsylvania State Health Assessment 2013.

Incidence Data:

Cancer abstracts collected by the Pennsylvania Cancer Registry (PCR) are the source for Pennsylvania cancer incidence data shown here. Data from the PCR were used to project the expected number of cancer cases listed in this report. Primary cancer sites or types follow the defi nitions used by the National Cancer Institute’s SEER Program and are therefore comparable. Currently, 2011 is the latest year of available incidence data for the commonwealth.

Unless noted, in situ cases for sites other than urinary bladder cancer are not included in any calculation or projection contained in this report. Cancer cases were coded using the International Classifi cation of Diseases for Oncology—Third Edition (ICD-O-3) and staged according to the “SEER Summary Staging Manual” categories.

Mortality Data:

Pennsylvania’s Certifi cate of Death is the source document for Pennsylvania cancer mortality data. The actual numbers of Pennsylvania cancer deaths reported were used to forecast the expected number of cancer deaths listed in this report. Currently, 2011 is the latest year of available mortality data for the commonwealth.

Incidence and Mortality Projections:

The projections of new cancer cases in this report were obtained by producing a regression line using the method of least squares. This approach utilized the actual number of cases reported to the PCR with a diagnosis year of 2006 through 2010. This method constructed the regression line that minimizes the sum of the squared residuals. A residual is the difference between each data point (actual or observed event) and the regression line (predicted event). Once a regression line has been computed, the population standard error of the estimate is computed. This estimate measures the variability of the line.

The population standard deviation of the dependent variable (year of diagnosis) is also computed. This is a

measure of the variability of projected cancer cases based on the arithmetic mean of cancer cases for the fi ve years of 2006 through 2010. The population standard error of the estimate was then compared to the population standard deviation of the mean to identify which method had less variability. If the population standard deviation was lower, then the arithmetic mean for the fi ve-year period was used as the projected number of cancer cases. This same method was applied to projecting the number of cancer deaths. However, since the cancer mortality fi le is more current, the fi ve-year period of 2007 through 2011 was used to project the number of cancer deaths.

Precision of Projections:

Estimates of new cancer cases and new cancer deaths have been rounded to the nearest whole fi ve. The projected fi gures should be used cautiously. Considerable variation may occur, particularly with estimates of small numbers.

Age-Adjusted Rates (Direct Method):

Age-specifi c rates for a selected population are applied to a standard population (in this report, the 2000 U .S. standard million population for 18 age groups) in order to calculate what rate would be expected if the selected population had the same age distribution as the standard. The total of these expected events divided by the total of the standard population and multiplied by 100,000 yields the age-adjusted rate per 100, 000. It is important to use the same standard population in the computation of each age-adjusted rate to allow comparability. Age-adjusted rates should never be compared with any other type of rate or be used as absolute measurements of vital events. All state population fi gures used for calculating rates are estimates produced jointly by the U.S. Census Bureau and the Pennsylvania State Data Center of Penn State at Harrisburg.

Cancer Hospitalization:

The data source for this section of the report is the 2001 to 2011 Pennsylvania Health Care Cost Containment Council (PHC4) inpatient discharge data. PHC4 is an independent state agency charged with collecting, analyzing and reporting information that can be used to improve the quality and restrain the cost of health care in the state. PHC4 collects comprehensive inpatient and outpatient

7 data notes

records—nearly 5 million patient records per year—from Pennsylvania’s 246 hospitals and 271 ambulatory surgery centers. The data is collected on a quarterly basis and verifi ed by PHC4 staff. Only inpatient records with primary diagnosis of cancer were used in this report. Patient with cancer as secondary diagnoses without primary diagnosis of cancer were excluded.

Total length of hospitalization stay represents the sum of all number of days a patient stayed in the hospital for that particular cancer as a primary diagnosis. Average length of stay by sex is calculated using total length of stay/total hospital admissions by sex. How long a patient stays in the hospital may refl ect upon the success of the treatment.

Age-adjusted hospitalization rate is the rate per 100,000 general population using 2000 U.S. standard population, not the population with the specifi c condition. Hospitalization rate is based on the number of hospitalizations, not the distinct patients. A patient who is hospitalized more than once in the time period will be counted multiple times in the rate calculation.

Payer type is determined by primary payer type at discharge. Charges are round to the millions and are not the actual payment reimbursed. Hospitalization charge in this report is the submitted charge amount and not the actual reimbursement amount, which is usually less than the submitted charges.

8 modifi able risk factor behaviors | smoking

MODIFIABLE RISK FACTOR BEHAVIORSA small set of common modifi able risk factors are responsible for most of the main chronic diseases, including most cancers. These risk factors are the same in men and women: smoking, obesity and lack of physical activity. The major modifi able risk factors, in conjunction with the non-modifi able risk factors of age and heredity, are associated with the majority of new events of chronic respiratory diseases and some types of cancer. Promoting healthy behaviors and limiting exposures to potential cancer risks such as tobacco can reduce a person’s risk of being diagnosed with cancer.

SMOKING

FIGURE A1

The current rate of smoking among adults in Pennsylvania decreased from a high of 25.4 percent in 2003 to 18.4 percent in 2010. Nationwide, the highest rate of adult smoking was 24.2 percent in 1996 and decreased to 17.3 percent in 2010. Pennsylvania was slightly above the nationwide median for the time period shown. Both rates began to decline in 2003-2004 and are at their lowest rates ever in 2010.

FIGURE A2

This graph shows that, in 2012, 23.2 percent of smokers in Pennsylvania were male, while 19.7 percent were female. Multiracial smokers represented the highest ethnic group at 30.9 percent, followed by blacks at 27.5 percent and Hispanics at 25.5 percent. Smoking rates in all categories were above the nationwide median for Pennsylvania.

0

5

10

15

20

25

30

2010200920082007200620052004200320022001200019991998199719961995

Current smokers among adults, 1995-2010

Year

PER

CEN

T ( %

)

PennsylvaniaNationwide Median

Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Pennsylvania percentages are shown with their 95% confidence intervals.

0

5

10

15

20

25

30

35

40

45

MultiracialOtherHispanicBlackWhiteFemaleMale

Current smokers among adults, by sex and race/ethnicity, 2012

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T ( %

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Sex and Race/Ethnicity


Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Pennsylvania percentages are shown with their 95% confidence intervals. “Other” includes Asian, American Indian, Alaskan Native, some other mentioned race, or “Other race.”

9 modifi able risk factor behaviors | smoking

FIGURE A3

Figure A-3 depicts the current rate of adults who smoke in 2012. The Pennsylvania rate for all smokers is listed at 21.4 percent, higher than the national rate of 19.6 percent. Smoking in Pennsylvania is highest in the 25-34 age group at 32.8 percent followed by the 35-44 age group at 26.9 percent. Pennsylvania is above the national median for each group of current smokers except 65+, the greatest disparities being evident in the 25-34 and 35-44 age groups.

FIGURE A4

Figure A-4 shows the effect of household income and education on smoking adults. Smoking rates at both the state and national levels are highest with those who have the least education and the least household income. In Pennsylvania, smoking rates for citizens making less than $15,000 per year and having less than a high school education are 38.5 percent and 38.9 percent respectively. Conversely, smoking rates are lowest among those with the highest education levels and household income.

Current smokers among adults, by age group, 2012

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All adults and age groups



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Current smokers among adultsby household income and education, 2012


Collegegraduate

Some post-H.S.

H.S. orG.E.D.

Less thanH.S.

$50,000+$35,000-49,000

$25,000-34,999

$15,000-24,999

Less than$15,000

Household income and education


10 modifi able risk factor behaviors | smoking | obesity

FIGURE A5

The Behavioral Risk Factor Surveillance System (BRFSS) data from 2010-2012 in shows twelve counties in the Northwest corner of the state that have a signifi cantly higher percentage of smokers at 24 percent as compared to the Pennsylvania average of 18 percent. The counties include: Crawford, Lawrence, Mercer, Venango, Forest, Elk, Cameron, Clearfi eld, Jefferson, Clarion and McKean and Warren. Conversely, Cumberland, Perry, Chester and Montgomery exhibit percentages that are signifi cantly lower than the Pennsylvania average.

OBESITY

FIGURE A6

Following the national trend, the obesity prevalence among adults in Pennsylvania has increased steadily from 1995 to 2010. Figure A-6 shows that 16.4 percent of Pennsylvanians were considered obese in 1995. In 2010, the statewide rate jumped almost 13 points to 29.2 percent, as compared to the national rate which was 27.5 percent. Over time, Pennsylvania’s obesity rates have shown to be close to, but slightly higher than, US obesity rates, except for 2006 when the rate dropped one point below the national median.

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201020092008200720062005200420032002

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Obesity prevalence among adults, 1995-2010

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Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data.Obesity is defined as having a Body Mass Index (BMI) of 30 or more. Pennsylvania percentages are shown with their 95% confidence intervals.

Erie23%

Butler,Beaver17%

Allegheny18%

Fayette, Greene,Washington

21%

Indiana, Cambria,Somerset, Armstrong

21%Bradford, Blair, Huntington,

Juniata, Mifflin17%

Adams, FranklinFulton21%

Cumberland, Perry12%

York18%

Lancaster14%

Dauphin, Lebanon16%

Berks, Schuylkill19%

Lackawanna,Luzerne, Wyoming

23%

Pike, Monroe,Susquehanna,

Wayne20%

Carbon, Lehigh,Northhampton

20%

Chester10%

Montgomery 14%

Centre, Columbia, Montour,Northumberland, Snyder, Union

17%

Bradford, Sullivan, TiogaLycoming, Clinton, Potter

21%Forest, Elk, Cameron,

Clearfield, Jefferson, Clarion,McKean, Warren

24%

Crawford, Lawrence,Mercer, Venango

24%

Bucks15%

Delaware18%

Westmoreland18%

Philadelphia20%

Significant differences between BRFSS region and Pennsylvania current smokers*Pennsylvania adults, 2010-2012

Source: Pennsylvania Behavioral Risk Factor Surveillance System (BRFSS). Starting in 2010, Pennsylvania began collecting data by eight different strata consisting of the six Pennsylvania health districts and both Allegheny and Philadelphia Counties. In 2011, the BRFSS added cell phone numbers and introduced a new weighingmethodology to the survey. Therefore, single-year measures should be re-benchmarked at the 2011 estimate values, and not compared to BRFSS estimates fromprevious years. Three-year summaries can still be compared to previous years since they will continue to be weighed using the post-stratification methologyuntil 2011-2013 data is available.*Excludes missing, don’t know, and refused†Includes adults who smoke cigarettes every day or some days

Significantly lowerSignificantly higherPennsylvania: 18% Not significantly different

11 modifi able risk factor behaviors | obesity

0

5

10

15

20

25

30

35

40

45


Obesity prevalence among adults, by sex and race/ethnicity, 2012

PER

CEN

T ( %

)

Sex and race/ethnicity


Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Obesity is defined as having a Body Mass Index (BMI) of 30 or more. Pennsylvania percentages are shown with their 95% confidence intervals. “Other” includes Asian, American Indian, Alaskan Native, some other

FIGURE A7

Figure A-7 shows the prevalence of obesity among adults by gender and race/ethnicity in 2012. In Pennsylvania, females were slightly more obese at 29.2 percent than males at 28.9 percent. Hispanics showed the highest rate of obesity at 36.1 percent followed by 34.6 percent of blacks. Pennsylvania rates were higher than national rates in almost all categories, the exceptions being blacks and Other (Asian, Pacifi c Islander, Native American) categories.

FIGURE A8

In Figure A-8, the prevalence of obesity by age group for all Pennsylvania adults is depicted at 29.1 percent. Most Pennsylvania rates are at or above the corresponding national rates by age group. Residents in middle age show the highest rates of obesity; the rate for the 55-64 age group stands at 33.3 percent while the 45-54 age group rate peaks at 32.9 percent. The 18-24 age group rate is signifi cantly lower at a rate of at 18.5 percent, but is almost four percentage points higher than the national rate of 14.7.

Obesity prevalence among adults by age group, 2012


PER

CEN

T ( %

)


Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data.“Physical inactive” is defined as not having engaged in a physical activity other than their regular job within the past month. Pennsylvania percentages are shown with their 95% confidence intervals.

0

5

10

15

20

25

30

35

40

65+55-6445-5435-4425-3418-24All

12 modifi able risk factor behaviors | obesity

FIGURE A9

Figure A-9 shows that Pennsylvania adults with a household income of less than $15,000 and those with High School diploma or G.E.D are most likely to be obese at a rate of 35.4 percent and 31.1 percent respectively. College graduates and those with income over $50,000 show the least tendency towards obesity. Again, the Pennsylvania rates for obesity by household income and education are, as a rule, higher than the national rates.

FIGURE A10

The BRFSS data in fi gure A-10 shows that citizens in Indiana, Cambria, Somerset Armstrong counties possess a 34 percent regional rate of obesity. Residents of Bedford, Blair, Huntingdon, Juniata, Miffl in counties post a regional rate of 33 percent. Both areas show rates that are signifi cantly higher than the Pennsylvania average obesity rate of 27 percent. Chester and Montgomery counties are below the state average at 20 and 21 percent respectively.

Obesity prevalence among adultsby household income and education, 2012


Collegegraduate

Some post-H.S.

H.S. orG.E.D.

Less thanH.S.

$50,000+$35,000-49,000

$25,000-34,999

$15,000-24,999

Less than$15,000

PER

CEN

T ( %

)


0

5

10

15

20

25

30

35

40


Erie24%

Butler,Beaver27%

Allegheny25%

Westmoreland25%


29%



Juniata, Mifflin33%



York28%

Lancaster27%

Dauphin, Lebanon32%



28%


Wayne27%


29%

Chester20%

Montgomery 21%


26%




29%


30%

Bucks22%

Delaware20%

Philadelphia20%

Significant differences between BRFSS region and Pennsylvania Percent who are obese (body mass index of 30 or more) Pennsylvania adults, 2010-2012

Source: Pennsylvania Behavioral Risk Factor Surveillance System (BRFSS). Starting in 2010, Pennsylvania began collecting data by eight different strata consisting of the six Pennsylvania health districts and both Allegheny and Philadelphia Counties. In 2011, the BRFSS added cell phone numbers and introduced a new weighingmethodology to the survey. Therefore, single-year measures should be re-benchmarked at the 2011 estimate values, and not compared to BRFSS estimates fromprevious years. Three-year summaries can still be compared to previous years since they will continue to be weighed using the post-stratification methologyuntil 2011-2013 data is available.


13 modifi able risk factor behaviors | physical inactivity

PHYSICAL INACTIVITY

FIGURE A11

Physical inactivity is defi ned by the CDC as not having engaged in a physical activity other than your regular job within the past month. Overall, Pennsylvania’s level of physical inactivity has remained relatively the same from 1996-2010 (Figure A-11). It was at its highest in 1998 at 32.7 percent but has remained somewhat stable for the last 14 years. Pennsylvania trends are similar to the national rates for the above time period.

FIGURE A12

In Figure A-12, Pennsylvania’s physically inactive adults who are categorized as Other (Asian, Pacifi c Islander, and Native American) show the highest rate of physical inactivity at 29.5 percent, followed by Hispanics at 28.1 and blacks at 26.8 percent. Those who identify as white are the least inactive at a rate of 22.5 percent. In Pennsylvania, males are more active than females, with inactivity rates of 21.2 and 25.6 respectively. Overall, Pennsylvania rates for physical inactivity are similar to national rates, with the exception of the Other category rate which is markedly higher than the national rate.

Physically inactive adults, by sex and race/ethnicity, 2012


0

5

10

15

20

25

30

35

40

PER

CEN

T ( %

)



Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data.“Physically inactive” is defined as not having engaged in a physical activity other than their regular job within the past month. Pennsylvania percentages are shown with their 95% confidence intervals. “Other” includes Asian, American Indian, Alaskan Native, some other mentioned race, or “Other race.”

0

5

10

15

20

25

30

35

40

2010200920082007200620052004200320022001200019981996

Year

Physically inactive adults, 1996-2010


PER

CEN

T ( %

)

Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. “Physically inactive” is defined as not having engaged in a physical activity other than their regular job within the past month. Pennsylvania percentages are shown with their 95% confidence intervals.


FIGURE A13

Overall, 23.5 percent of Pennsylvanians consider themselves inactive. (Figure A.13) Pennsylvanians between 55 and 64 years of age are the most physically inactive of all age groups. This rate is ten percentage points higher than the national rate of 25.9 percent for the same age group. Adults 18 to 25 years old in Pennsylvania show the least amount of physical inactivity at 15.5 percent. Pennsylvania’s rates in all age groups are above the national median.

FIGURE A14

Pennsylvanians making $15,000 or less, and having less than a high school education, possess the Commonwealth’s highest levels of physical inactivity. In direct contrast, the inactivity level of Pennsylvanians with incomes of $50,000 or more and those who are college educated, are the lowest in Pennsylvania. The lowest two income categories in Pennsylvania have inactivity rates that are substantially higher than corresponding national rates.

Physically inactive adults, by age group, 2012

PER

CEN

T ( %

)




0

5

10

15

20

25

30

35

40

45

PER

CEN

T ( %

)

Physically inactive adults by household income and education, 2012


Collegegraduate

Some post-H.S.

H.S. orG.E.D.

Less thanH.S.

$50,000+$35,000-49,000

$25,000-34,999

$15,000-24,999

Less than$15,000

Household income and educationSource: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data.“Physical inactive” is defined as not having engaged in a physical activity other than their regular job within the past month. Pennsylvania percentages are shown with their 95% confidence intervals.


FIGURE A15

Figure A-15 depicts Bedford, Blair, Huntingdon, Juniata, Miffl in and Philadelphia Counties as the counties showing the highest rates of physical inactivity at a rate of 31 percent. Montgomery County is the most active with a rate of 19 percent. The remainder of Pennsylvania is within the range of the state average for physical inactivity of 25 percent.

Erie27%

Butler,Beaver25%

Allegheny24%

Westmoreland25%


29%



Juniata, Mifflin31%



York21%

Lancaster21%

Bucks21%Dauphin, Lebanon

24%



29%


Wayne27%


28%

Montgomery 19%


21%




29%


24%

Chester19%

Delaware20%

Philadelphia31%

Significant differences between BRFSS region and Pennsylvania Percent who had no leisure time physical activity in past month Pennsylvania adults, 2008-2010



16 preventive activities | health care coverage

PREVENTIVE ACTIVITIES

The number of new cancer cases can be reduced, and many cancer deaths can be prevented by engaging in preventive activities. Research shows that screening for cervical and colorectal cancers as recommended helps prevent these diseases by fi nding precancerous lesions so they can be treated before they become cancerous. Screening for cervical, colorectal, and breast cancers also helps fi nd these diseases at an early, often highly treatable stage. The access to health care coverage can also play a part in a person’s ability to engage in preventive activities and therefore plays an important role in the discussion of cancer care and prevention.

HEALTH CARE COVERAGE

FIGURE B1

Figure B-1 highlights the percentage of adults between the ages of 18 and 64 who do not have health care coverage. For 1995 as well as each subsequent year until 2010, Pennsylvania has a lower percentage of individual adults who are without health care coverage as compared to the national average. The percentage of uninsured Pennsylvanians was highest in 2004, when 14.5 percent of adults were without health care coverage. This can be compared to the national rate which reached its highest point in 2010 with a rate of 17.8 percent.

FIGURE B2

Figure B-2 illustrates the percentage of adults between the ages of 18 and 64 who do not have health care coverage, based on gender, and race and ethnicity. Both nationally and statewide, Hispanics had the highest percentage of adults without health care coverage at 26.9 percent, and males were less likely to be insured than females.

0

2

4

6

8

10

12

14

16

18

20

Adults, aged 18-64, without health care coverage, 1995-2010

Year

PER

CEN

T ( %

)



20102009200820072006200520042003200019991998199719961995

0

5

10

15

20

25

30

35

40

45


Adults, aged 18-64, without health care coverageby sex and race/ethnicity, 2012

PER

CEN

T ( %

)





FIGURE B3

Figure B-3 shows the number of uninsured adults aged 18-64 for 2012. Overall, the Pennsylvania rate is 16.2 percent compared to the national rate of 20.4 percent. In Pennsylvania, adults 25-34 are most likely to be uninsured at a rate of 24.7 percent. Nationally, the rate for this age group is also the highest at 27.2 percent. In all age groups, Pennsylvania rates are lower than the national averages.

FIGURE B4

The number of adults aged 18-64 without health care coverage, by income and education, is displayed in Figure B-4. Pennsylvanians who make between $15,000-24,999 are most likely to be without health care coverage at a rate of 35.1 percent. Nationally, the highest rate of not having health care coverage occurs within the same income group, at a rate of 41.8 percent. Adults having less than a high school education exhibit the highest rates of no health care coverage at 33.8 percent statewide and 42.7 percent nationally. Comparatively, those with the highest levels of income and education are much more likely to be insured. In Pennsylvania, only 5.1 percent of those earning 50,000 or more and 6.4 percent of those with a college education are without health care coverage.

Adults, aged 18-64, without health care coverage, by age group, 2012

PER

CEN

T ( %

)




0

5

10

15

20

25

30

35

40

45

PER

CEN

T ( %

)

Adults aged 18-24, without health care coverage,by household income and education, 2012


Collegegraduate

Some post-H.S.

H.S. orG.E.D.

Less thanH.S.

$50,000+$35,000-49,000

$25,000-34,999

$15,000-24,999

Less than$15,000



FIGURE B5

The map in Figure B-5 displays the percent of adults who do not have health insurance by region for 2010-2012. In Pennsylvania, the Southcentral area comprised of Adams, Franklin, and Fulton counties had the highest rate in the state at 22 percent, followed by Lancaster County at 21 percent, Pike Monroe, Susquehanna and Wayne counties at 20 percent and Philadelphia County at 18 percent. Chester County had the lowest rate of adults who did not have insurance at six percent.

Erie14%

Butler,Beaver12%

Allegheny11%

Westmoreland11%


16%



Juniata, Mifflin13%



York13%

Lancaster21%

Bucks12%Dauphin, Lebanon

10%



14%


Wayne20%


10%

Montgomery 11%


14%




15%


14%

Chester6%

Delaware13%

Philadelphia18%

Significantly higher Significantly lower Not significantly different

Significant differences between BRFSS region and Pennsylvania Percent who do not have health insurance (age 18-64) Pennsylvania adults, 2010-2012


19 preventive activities | colorectal cancer screening

COLORECTAL CANCER SCREENING

FIGURE B6

The number of adults, age 50 and older, who have ever had a colonoscopy or sigmoidoscopy, is illustrated in Figure B-6. In 1999, 39.7 percent of Pennsylvanians 50 years and older had colonoscopy/sigmoidoscopy compared to the lowest national rate in 1997 at 40.2 percent. Rates steadily increased from 1997 to 2010 and were at their highest in 2010 with 68 percent of Pennsylvanians participating in screening as compared to the national rate which was slightly lower at 65.2 percent.

FIGURE B7

Figure B-7 shows national and statewide rates of adults age 50 and over who had a colonoscopy/sigmoidoscopy, by gender and race/ethnicity. In Pennsylvania, females had a slightly higher rate of screening than males. In 2012, females had a screening rate of 69.6 percent, while males had a screening rate of 67.8 percent. Whites had a screening rate of 69.7 percent followed closely by blacks at a rate of 68.6 percent. Those that consider themselves multiracial were lowest at 54.4 percent. Statewide, rates were similar if not higher than national rates in most categories of sex/race/ethnicity.

Adults, aged 50+, who have ever had acolonoscopy or sigmoidoscopy, 1997-2010


PER

CEN

T ( %

)

2010200820062004200219991997

Year

0

10

20

30

40

50

60

70

80


0

10

20

30

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50

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70

80

90


Adults, aged 50+, who have ever had a colonoscopy or sigmoidoscopy, by sex and race/ethnicity, 2012

PER

CEN

T ( %

)





FIGURE B8

The rate of adults aged 50 and over who ever had a colonoscopy or sigmoidoscopy is shown in Figure B-8. Overall, the rate for Pennsylvania is 68.8 percent while the rate for the US is slightly lower at 67.3 percent. Both rates fall short of the Healthy People 2020 goal of 70.5 percent. Adults 65 years of age and older had the highest screening rates statewide and nationally, 75.8 percent for Pennsylvania and 77.4 percent nationally.

FIGURE B9

As with other activities, those citizens with the highest levels of income and education exhibit the highest rates of colonoscopy/sigmoidoscopy. Conversely, Pennsylvania adults aged 50 and older having less than $15,000 in annual income and less than a high school education had the lowest colonoscopy or sigmoidoscopy rates at 56.8 percent and 57.0 percent respectively. Pennsylvania rates in all categories are equal to or slightly higher than the national rates.

PER

CEN

T ( %

)

Adults, aged 50+, who have ever had acolonoscopy or sigmoidoscopy,by household income and education, 2012


Collegegraduate

Some post-H.S.

H.S. orG.E.D.

Less thanH.S.

$50,000+$35,000-49,000

$25,000-34,999

$15,000-24,999

Less than$15,000


0

10

20

30

40

50

60

70

80

90


Adults, aged 50+, who have ever had acolonoscopy or sigmoidoscopy, by age group, 2012

PER

CEN

T ( %

)



0

10

20

30

40

50

60

70

80

90

65+60-6450-59All



FIGURE B10

The map in Figure B-10 shows the percentage of adults who had a colonoscopy or sigmoidoscopy in the past 10 years. The Southwest corner of the state, except for Allegheny County, had a screening rate of 60 percent which was signifi cantly lower than the overall Pennsylvania rate of 65 percent. The Southeast corner of the state exhibits the highest rate of colonoscopy/ sigmoidoscopy at a rate of 68 percent.

FIGURE B11

Figure B-11 shows rates of colorectal screening using the at home blood stool kit, known as a FOBT (fecal occult blood test) or the FIT (fecal immunochemical fecal occult blood test). These are fecal-based colorectal cancer screening tests that allow patients to procure samples in the comfort of their own homes. This screening test is not widely used in Pennsylvania. The state rate for such testing is nine percent with the Northeast area having the lowest rate of testing at seven percent.

Southwest 60%(CI: 56%–63%)

Northwest 63%(CI: 59%–66%)

North Central 67%(CI: 64%–70%)

South Central 64%(CI: 61%–67%)

Southeast 68%(CI: 65%–72%)

Northeast 65%(CI: 62%–69%)

Philadelphia 65%(CI: 61%–69%)

Allegheny 65%(CI: 61%–68%)

61% to 65%60%Pennsylvania: 65%(CI: 64% – 66%)

66%

Percentage of adults (age 50+) in 2012 who had a colonoscopy or sigmoidoscopy in the past 10 years

Source: Behavioral Health Risks of Pennsylvania Regions – 2012. Included with each percentage is its 95% confidence interval (CI).Percentages in RED are statistically significantly lower than the percentage for Pennsylvania.









8%7%Pennsylvania: 9%(CI: 8% – 10%)

9% 10% 11%

Percentage of adults (age 50+) in 2012 who had a blood stool test using a home kit in the past year

Source: Behavioral Health Risks of Pennsylvania Regions – 2012. Included with each percentage is its 95% confidence interval (CI).

22 preventive activities | breast and cervical cancer screening

BREAST AND CERVICAL CANCER SCREENING

FIGURE B12

Figure B-12 illustrates the percent of women, aged 40 and over, who had a mammogram in the past two years. This rate was at it is lowest, both nationally and statewide in 1995, and in Pennsylvania reached its peak in 2000 at 77.8 percent. Nationally, the highest rate was recorded in 2006 at 76.5 percent. Overall, the rate of mammography for 2010 is 73.9 percent for Pennsylvania and 75.2 percent for the United States.

FIGURE B13

Figure B-13 shows the percent of females 40 years and over who had a mammogram in the past two years, by race/ethnicity. Black women 40 years and over had the highest rate of mammography in 2012 at a rate of 80.5 percent for Pennsylvania and 78.3 percent nationally. Multiracial women showed the lowest screening rates at 49.6 percent for Pennsylvania and 60.1 percent nationally.

Year

Females, aged 40+, who have had a mammogram in the past two years, 1995-2010


PER

CEN

T ( %

)

Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Pennsylvania percentages are shown with their 95% confidence interval.

0

10

20

30

40

50

60

70

80

90

20102008200620042002200019991998199719961995 20102008200620042002200019991998199719961995

Race/ethnicity

Females, aged 40+, who have had a mammogram in the past two years, by race/ethnicity, 2012


PER

CEN

T ( %

)

Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Pennsylvania percentages are shown with their 95% confidence interval. “Other” includes Asian, American Indian, Alaskan Native, some other mentioned race, or “Other race.”

0

10

20

30

40

50

60

70

80

90

MultiracialOtherHispanicBlackWhite


FIGURE B14

Figure B-14 shows the percent of females, aged forty and over, who had a mammogram in the past two years by age group. The overall rate of mammograms for women aged 40 years and older was 74.7 percent for Pennsylvania and 74 percent nationwide. Women in the 50-59 year old category exhibited the highest screening for Pennsylvania at 78.7 percent. Almost identical to that rate, was the rate for the 60-64 year old age group in Pennsylvania which had a screening rate of 78.6 percent. Nationally, the highest screening rates were exhibited by women in the 60-64 year old age group with a rate of 79.2 percent.

FIGURE B15

Figure B-15 shows that women having $15,000 or less in household income and having less than a high school education had lower mammogram rates than other income and educational groups. In Pennsylvania, the lowest rate of mammogram screening was found in women with less than a high school education at 63.8 percent, and those making less than $15,000, at 65.0 percent. Nationally, the rate for women with the lowest level of education was 62.7 percent and 60.4 percent for those with the least amount of annual income.


Females, aged 40+, who have had a mammogram in the past two years, by age group, 2012


PER

CEN

T ( %

)


0

10

20

30

40

50

60

70

80

90

65+60-6450-5940-49All

PER

CEN

T ( %

)

Females, aged 40+, who have had a mammogram in the past two years, by household income and education, 2012


Collegegraduate

Some post-H.S.

H.S. orG.E.D.

Less thanH.S.

$50,000+$35,000-49,000

$25,000-34,999

$15,000-24,999

Less than$15,000


0

10

20

30

40

50

60

70

80

90



FIGURE B16

The map in Figure B-16 shows the percentage of Pennsylvania women, 40 years and older, who in the past year, received a mammogram in 2012.The statewide average is 60 percent; however, three areas of Pennsylvania (Northeast at 58 percent, Southwest at 56 percent and Allegheny County at 57 percent) are lower than the statewide average. Philadelphia County has the highest percentage of mammography at 64 percent.

FIGURE B17

The Papanicolaou test (Pap test) is a method of screening to detect cervical cancer. In Pennsylvania, the rate of women who received a Pap test in the past three years is 73 percent. The Southwest at 70 percent and the Northcentral at 68 percent, are 3 to 5 percent below the state average. Philadelphia County has the highest rate of cervical cancer screening at 78 percent.









59% to 60%56 to 58%Pennsylvania: 60%(CI: 58% – 61%)

61% to 62% 63% to 64%

Percentage of adults females (age 40+) in 2012 who had a mammogram in the past year










71% to 72%68 to 70%Pennsylvania: 73%(CI: 72% – 74%)

73% to 74% 75% to 76%

Percentage of adults females in 2012 who had a Pap test in the past 3 years


25 cancer burden | all cancers

0

200

Year

All cancers, age-adjusted incidence rates by sex and race, Pennsylvania residents, 2000-2011

White Male Black Male White Female Black Female

NOTES: Age-adjusted rates are computed by the direct method using the 2000 U.S. standard million population. Incidence rates are based on invasive (and in situ urinary bladder) cancers. Rates based on less than 10 events are considered statistically unreliable and are not displayed. Cancer primary site/type groupings follow the definitions used by the National Cancer Institute’s SEER program.

400

600

800

1000

201120102009200820072006200520042003200220012000

PER

100

,000

CANCER BURDENCancer is the most visible chronic disease affl icting Pennsylvanians. One of the directives that the Cancer Advisory Board is charged with, accomplished through the Stakeholder Leadership Team, is being data-driven. Thus, cancer plan implementation decisions must proceed from an understanding of the cancer data. This report on the burden of cancer in Pennsylvania will provide an overview of cancer incidence and mortality, cancer hospitalizations, cancer risk factors, and cancer prevention/health outcomes for cancer within the Commonwealth. The burden report uses the most recent available data at time of report creation, and the data can be used to inform where cancer disparities are, thus providing leadership with the tools necessary for a data-driven approach, and identifying potential areas for further inquiry.

For all non-female specifi c cancers, except breast cancer and thyroid cancer, males have higher incidence and mortality rates than females. For most types of cancers, racial disparities in incidence and mortality are also highly evident, and with few exceptions, black male incidence and mortality rates are the highest of all race/sex/ethnicity categories.

ALL CANCERS

Incidence

In 2011, there were approximately 78,0008 new cases of invasive cancer9 diagnosed among Pennsylvania residents. Lung and bronchus, female breast, and prostate cancer are the three most commonly diagnosed invasive cancers with over 10,000 cases each, and seven of the eight cancers covered in this report are among the most common cancers affecting the lives of Pennsylvanians. The cancers covered in this report10 were chosen because of a combination of their overall impact on the overall burden of cancer and the fact that screenings/preventative measures exist for them. Figure 1-1 depicts the incidence rates for all cancers since 2000.

8 Incidence and Mortality counts in this report are rounded to the nearest thousand or hundred as appropriate 9 Also including new in situ Urinary Bladder Cancer cases 10 Lung and Bronchus, Female Breast, Cervical, Colorectal, Prostate, Melanoma, Urinary Bladder, and Thyroid

FIGURE 11

Clear differences between males and females, and black males and white males can be noted. Black males had an overall age-adjusted cancer incidence rate of 625.7 per 100,000 in 2011, compared to 542.0 for white males, and approximately 460 for females of both races.


Mortality

In 2011, more than 28,500 Pennsylvanians died from cancer. The highest number of deaths, by a substantial margin, was lung and bronchus cancer, with 7,600 deaths. Colorectal cancer, with 2,600 deaths, and female breast cancer, with 2,000 deaths are the second and third leading causes of cancer death. Figure 1-2 shows mortality by sex and race, since 2000.

FIGURE 12

Racial and sex disparities in cancer mortality are again evident. Black males had a mortality rate of 274.6 per 100,000 in 2011, compared to white females with a mortality rate of 149.2 in the same year, almost twice as high. The black male mortality rate has declined since 2,000 by 32.4 percent, moving closer to the other the other race/sex combinations, but still remains the highest.

Age and Summary data

Cancer is primarily a disease of the aged, and as age increases, so do rates of both incidence and mortality. This is the case for all cancers taken together, as seen in Figure 1-3.

FIGURE 13

Cancer incidence begins rising sharply with the onset of middle age, with mortality lagging behind slightly but also increasing steadily with age. Incidence rates peak in the early 80’s, while mortality rates continue to rise across all age brackets.

0

50

Year

All cancer deaths, age-adjusted rates by sexand race, Pennsylvania residents, 2000-2011


NOTES: Age-adjusted rates are computed by the direct method using the 2000 U.S. standard million population. Rates based on less than 10 events are considered statistically unreliable and are not displayed. Cancer primary site/type groupings follow the definitions used by the National Cancer Institute’s SEER program.

100

150

200

250

300

350

400

201120102009200820072006200520042003200220012000

PER

100

,000

0

Age Group

All cancers, age-specific incidence and death rates, Pennsylvania residents, 2009-2011

Incidence Deaths

NOTES: Incidence rates are based on invasive cancers. Rates based on less than 10 events are considered statistically unreliable and are not displayed. Cancer primary site/type groupings follow the definitions used by the National Cancer Institute’s SEER program.

500

1000

1500

2000

3000

2500

PER

100

,000

85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-1405-0900-04


FIGURE 14

Three year summary data for all cancers, both incidence and mortality rates, including additional racial and ethnic groups appears in Figure 1-4. Black males have the highest incidence and mortality of all sex and race/ethnicity groups followed by white males, then black females.

FIGURE 15

Note that approximately half of all cancers are diagnosed in early stage.11 Some variation exists among the race/ethnic groups represented in the fi gure, but the rates are all relatively close.

Geographical Data

Great interest exists in analyzing county and local level sub state health data whenever it is available. Mapping cancer rates by county provides a powerful way of visualizing cancer incidence and mortality in Pennsylvania. Figures 1-6 through 1-9 below illustrate cancer incidence and mortality, by sex, for all counties in Pennsylvania for which data exists. Counties that have signifi cantly higher or lower rates are indicated on the map, as well as a comparison of the overall United States rate to the applicable Pennsylvania rate.

11 (In situ and Local)

All cancers, age-adjusted incidence and death rates* by sex and race/ethnicity, Pennsylvania, 2009-2011

Incidence Deaths

*Three-year average annual rates are per 100,000 and age-adjusted to the 2000 U.S.standard population.

0 100 200 300 400 500 600 700

Asian/PI females

Hispanic females

White females

Black females

Asian/PI males

Hispanic males

White males

Black males

PER 100,000

Stage distribution of all cancers at time of diagnosis by race/ethnicity, Pennsylvania, 2009-2011*

PER

CEN

T TO

TAL

CASE

S


In Situ Local Regional Distant Unknown

*Rates are three-year average annual percentages and based of SEER Summary Stage definitions.

HispanicAsian/PIBlackWhite0

10

20

30

40

50


FIGURE 16

Note that Pennsylvania’s overall cancer rate for males is higher than the United State (US) rate, and the counties which have a statistically signifi cant higher rate tend to be very urban or very rural.

FIGURE 17

The distribution of counties with statistically signifi cant higher or lower incidence rates for females is slightly different than for males, but the largely urban and rural pattern remains. The overall female cancer rate for Pennsylvania is also higher than the US rate.

Significantly higher Not significantly different Significantly lower

Male all cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates

The symbol, , represents the number of invasive cancers. A larger circle indicates a larger amount of cases.Note: Age-adjusted rates are per 100,000 and computed by the direct method using the 2000 U.S. standard million population. Rates based on less than 20 events are considered statistically unreliable.

U.S. Rate—(2007–2011) 536.1 Pa. Rate—(2007–2011) 571.7

Erie529

Crawford552.8

Venango556.9

Mercer610.5

Lawrence590.8

Beaver527.4

Allegheny570

Washington557.9

Greene552.6

Fayette596.6

Westmoreland547.2

Armstrong518.9

Indiana516.1

Somerset521.1

Clarion621.8

Warren588.3

McKean552.1

Potter541

Tioga593.9

Bradford562.9

Susquehanna532.4

Forest498.8 Elk

641.1

Jefferson575.7

Clearfield580.4

Cambria587.6

Bedford593.6

Blair569.6

Huntington486.7

Centre527.4

Clinton593.9

Cameron662.8

Lycoming584.9

Sullivan649.2

Mifflin551.2 Juniata

446.1

Fulton545.8

Franklin554.8

Perry541.9

Snyder549.6

Union545.2

Northumberland585.1

Lebanon548.8

Dauphin516.7

Cumberland502

Adams502

York549.4

Lancaster521.3

Berks558.7

Schuylkill561.1

Luzerne581.5

Wyoming602.7

Lackawanna572

Wayne491.1

Pike490.8

Monroe533.1

Carbon610

Northampton624.4Lehigh

574.7

Bucks574

Montgomery 575.2

Chester567.3

Delaware629

Philadelphia652.3

Columbia 614.5

Montour583.8Butler

609

Female all cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates

The symbol, , represents the number of invasive cancers. A larger circle indicates a larger amount of deaths.Note: Age-adjusted rates are per 100,000 and computed by the direct method using the 2000 U.S. standard million population. Rates based on less than 20 events are considered statistically unreliable.

U.S. Rate—(2007–2011) 420.1 Pa. Rate—(2007–2011) 455.9

Erie452.4

Crawford445.4

Venango447.6

Mercer462.9

Lawrence473.7

Beaver437.4

Allegheny478.2

Washington450.8

Greene482.5

Fayette438.6

Westmoreland449.3

Armstrong428.2

Indiana382.1

Somerset425.8

Clarion473.9

Warren425.3

McKean458.6

Potter422.6

Tioga452.4

Bradford478

Susquehanna395.1

Forest492.1 Elk

450

Jefferson440

Clearfield437.6

Cambria445.4

Bedford431.8

Blair427.5

Huntington394.2

Centre416.9

Clinton489.3

Cameron503.2

Lycoming494.2

Sullivan453.6


425.7

Fulton379

Franklin434.9

Perry455.8

Snyder410.1

Union430.5

Northumberland426.3

Lebanon434.4

Dauphin437.5

Cumberland456.2

Adams445.8

York646.4

Lancaster417.6

Berks437.7

Schuylkill474.7

Luzerne489.2

Wyoming511

Lackawanna464.7

Wayne391.9

Pike424.2

Monroe443.8

Carbon452.9

Northampton482Lehigh

448.6

Bucks463.3

Montgomery 457.7

Chester464.9

Delaware475

Philadelphia470

Columbia478.2

Montour432Butler

463.8


FIGURE 18

The US and Pennsylvania mortality rates for males, in contrast to incidence rates, are fairly close. The distribution of counties with signifi cantly higher and lower rates also differs from incidence. For example, three of the counties in the Philadelphia Metropolitan Statistical Area (MSA) have signifi cantly lower mortality rates compared to the state as a whole, where Philadelphia itself and Delaware county are signifi cantly higher.

FIGURE 19

The overall female cancer mortality rate in Pennsylvania, like the male rate, is relatively close to the US mortality rate, though both are slightly higher. In this case, the distribution of signifi cantly higher and signifi cantly lower mortality rates appears to be roughly similar to the male rates. A similar pattern emerges in the MSA, for example.


Male all cancer deaths, 2007–2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S.Rate—(2007–2011) 215.3 PA. Rate—(2007–2011) 225.1

Erie230

Crawford236

Venango240.1

Mercer234.9

Lawrence246.9

Beaver227.6

Allegheny230.8

Washington237.7

Greene242.3

Fayette266.8

Westmoreland229.1

Armstrong209.5

Indiana192.6

Somerset196.1

Clarion220.5

Warren227

McKean225.5

Potter215.2

Tioga217

Bradford228.3

Susquehanna240.3

Forest259.7 Elk

241.9

Jefferson224

Clearfield237.2

Cambria221.2

Bedford209.4

Blair251.2

Huntington215.1

Centre196

Clinton240.1

Cameron219.1

Lycoming210.7

Sullivan234.5


230.1

Fulton201.6

Franklin206.5

Perry264.4

Snyder205.6

Union198.4

Northumberland235.8

Lebanon228.3

Dauphin225.5

Cumberland196.1

Adams206.7

York214.8

Lancaster209.6

Berks208.1

Schuylkill236.1

Luzerne235.7

Wyoming252.5

Lackawanna234

Wayne215.4

Pike154.7

Monroe229

Carbon247.4


217.7

Bucks205.4

Montgomery 203.3

Chester202.6

Delaware236.5

Philadelphia268.2

Columbia261.4

Montour184.3Butler

215.8


Female all cancer deaths, 2007–2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S.Rate—(2007–2011) 149.7 PA. Rate—(2007–2011) 154.8

Erie162.2

Crawford161.9

Venango168.5

Mercer167.4

Lawrence154.3

Beaver157.1

Allegheny160.3

Washington165.9

Greene166.5

Fayette163.9

Westmoreland154.7

Armstrong157.3

Indiana140.1

Somerset137.1

Clarion139

Warren151.9

McKean163.7

Potter181.8

Tioga137.1

Bradford169.4

Susquehanna151.6

Forest173.9 Elk

152.2

Jefferson145.7

Clearfield156.3

Cambria146.9

Bedford145.5

Blair147.8

Huntington160.9

Centre126

Clinton157.5

Cameron151.5

Lycoming157.7

Sullivan136.3


139.1

Fulton139.6

Franklin139.9

Perry163.8

Snyder135.1

Union129.8

Northumberland147.5

Lebanon150.5

Dauphin146.6

Cumberland135.1

Adams144.2

York151.5

Lancaster143.4

Berks142.7

Schuylkill168.2

Luzerne155.1

Wyoming150

Lackawanna152.3

Wayne136.7

Pike124.9

Monroe151.1

Carbon144.3


142.6

Bucks149.3

Montgomery 148.3

Chester150

Delaware166.3

Philadelphia180.5

Columbia149.4

Montour136.8Butler

148.4

30 cancer burden | lung cancer

LUNG AND BRONCHUS CANCER

Incidence

Lung cancer12 is the most common invasive cancer in Pennsylvania as of 2011, with female breast cancer and prostate cancer close behind. In 2011, 10,600 cases of lung cancer were diagnosed. The rate of lung cancer in males is signifi cantly higher than in females, and while male lung cancer incidence rates have declined slightly over the past decade, the incidence rate in females is holding steady. Substantial racial disparities in incidence rates exist as well—the age adjusted incidence rate for black males was 106.6 per 100,000, in 2011, in comparison to a rate of 78.6 per 100,000 for white males in the same year.

12 (Lung cancer incidence is defi ned using ICD-O-3 codes C340-C349, excluding ICD-O-3 histologies 9590-9989. Lung cancer mortality is defi ned as ICD-10 code C34)

FIGURE 21

Figure 2-1 demonstrates some of the disparities among sex and white and black racial groups for lung cancer incidence. Since 2000, black male and white male incidence rates have declined 15.8 percent and 14.8 percent, respectively. In contrast, the white female incidence rate has held steady, while black female incidence has actually edged upwards.

0

Year

Lung and bronchus cancers, age-adjusted incidence rates by sex and race, Pennsylvania residents, 2000-2011


NOTES: Age-adjusted rates are computed by the direct method using the 2000 U.S. standard million population. Incidence rates based on invasive cancers. Rates based on less than 10 events are considered statistically unreliable and are not displayed. Cancer primary site/type groupings follow the definitions used by the National Cancer Institute’s SEER program.

20

40

60

80

100

120

140

201120102009200820072006200520042003200220012000

PER

100

,000


Mortality

Lung cancer has the highest mortality rate of any cancer in Pennsylvania, by a large margin. In 2011, 7,600 lung cancer deaths were reported. The overall trend across the past decade for mortality mirrors the trend in incidence rates. Male mortality rates have declined, rather steeply in the case of black males, but have remained stagnant for females, as show in Figure 2-2 below.

FIGURE 22

Age-adjusted black male mortality rates have fallen 42.8 percent since 2000, though black males retain the highest mortality of any group for lung cancer. There has been little net movement across the decade in female mortality rates.

Year

Lung and bronchus cancer deaths, age-adjusted rates by sex and race, Pennsylvania residents 2000-2011

White male Black male White female Black female


201120102009200820072006200520042003200220012000

PER

100

,000

0

20

40

60

80

100

120


Age and Summary data

The effects of aging on lung cancer incidence and mortality are similar to those of overall cancer incidence and mortality, as seen in Figure 2-3. Invasive lung cancer diagnoses start increasing steeply by the early 50s, and peak around 80. Lung cancer deaths begin increasing rapidly starting around age 60. Three year summary data for eight sex and race combinations, for both lung cancer incidence and mortality, are show in Figure 2-4. Figure 2-5 depicts stage distribution for lung cancer also using three year aggregate data.

FIGURE 23

As with most cancers, incidence and mortality for lung cancer both rise with age, peaking around 80 years of age.

FIGURE 24

Figure 2-4 demonstrates that the incidence and mortality rates for lung and bronchus cancers are highest for black males, followed by white males.

0

Age Group

Lung and bronchus cancers, age-specific incidence and death rates, Pennsylvania residents, 2009-2011

Incidence Deaths


100

200

300

400

500

PER

100

,000

85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-1405-0900-04

Lung and bronchus, age-adjusted incidence and death rates,* by sex and race/ethnicity, Pennsylvania, 2009-2011

Incidence Deaths

*Three-year average annual rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.

0 20 40 60 80 100 120

Asian/PI females

Hispanic females

White females

Black females

Asian/PI males

Hispanic males

White males

Black males

PER 100,000


FIGURE 25

Unfortunately, in marked contrast to the other more screen-able cancers in this report, a distinct majority of lung cancers are diagnosed in late stage.13 Similar to overall cancer incidence, the lung cancer incidence stage distribution breakdown is relatively close across the four race/ethnic groups for which data exists.

13 (Regional and Distant)

Stage distribution of lung and bronchus cancers at time of diagnosis by race/ethnicity, Pennsylvania, 2009-2011*

PER

CEN

T TO

TAL

CASE

S

Stage of Disease

In Situ Local Regional Distant Unknown

*Rates are three-year average annual percentages and based of SEER Summary Stage definitions.NOTE: ND indicates the data were not displayed due to low frequency counts <10.

HispanicAsian/PIBlackWhite0

NDND ND ND ND

10

20

30

40

50

60

70


Geographical Data

Figures 2-6 through 2-9 below depict lung cancer incidence and mortality rates by sex, in Pennsylvania, using four year summary data.

FIGURE 26

Male lung cancer incidence rate in Pennsylvania is substantially higher than the US rate. Clustering of signifi cantly higher than average incidence rates occurs in the Northeastern, Southeastern, and Southwestern areas of the state.

FIGURE 27

Female lung cancer incidence rate for Pennsylvania is slightly higher than the US rate. The distribution of signifi cantly higher or lower than average counties is roughly similar to that of males.


Male lung cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2007–2011) 69.6 Pa. Rate—(2007–2011) 83.8

Erie79.5

Crawford89.1

Venango105.5

Mercer91.7

Lawrence94.6

Beaver87.8

Allegheny90.2

Washington86.5

Greene91.6

Fayette110.7

Westmoreland89.9

Armstrong77.2

Indiana65.2

Somerset63

Clarion89.5

Warren59.5

McKean77.2

Potter73

Tioga87.8

Bradford78.4

Susquehanna87.1

Forest102 Elk

86.9

Jefferson86.5

Clearfield84.5

Cambria74.5

Bedford77

Blair88.5

Huntington79.9

Centre75.4

Clinton93.6

Cameron

Lycoming83.9

Sullivan100.4

Mifflin91.4 Juniata

67.9

Fulton83.9

Franklin80.8

Perry110

Snyder75.5

Union68.1

Northumberland92.8

Lebanon79.1

Dauphin81.6

Cumberland72.7

Adams67.9

York82.2

Lancaster70.2

Berks74.8

Schuylkill88.4

Luzerne92.5

Wyoming99.7

Lackawanna92.8

Wayne76.5

Pike77.8

Monroe92.4

Carbon107


80.6

Bucks77.4

Montgomery 69.7

Chester64.4

Delaware89.3

Philadelphia100.4

Columbia97.9

Montour50.6Butler

81.1

Significance not determined – less than 20 observed cases

Female lung cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2007–2011) 51.0 Pa. Rate—(2007–2011) 57.3

–

Erie58

Crawford60.6

Venango64.3

Mercer52.1

Lawrence56.3

Beaver55.7

Allegheny68.7

Washington55.7

Greene67.6

Fayette63.7

Westmoreland56.9

Armstrong48.5

Indiana38.9

Somerset36.2

Clarion47.4

Warren61.2

McKean74

Potter74.4

Tioga60.7

Bradford59.2

Susquehanna50.5

ForestElk61.9

Jefferson56.4

Clearfield46.5

Cambria41

Bedford38.9

Blair47.2

Huntington44.1

Centre42.1

Clinton72.1

Cameron

Lycoming60.5

Sullivan

Mifflin64 Juniata

47

Fulton Franklin46.8

Perry52.9

Snyder33

Union49.1

Northumberland52.9

Lebanon51.3

Dauphin55.3

Cumberland51.9

Adams53.9

York57.3

Lancaster44.3

Berks51.4

Schuylkill56.2

Luzerne57.7

Wyoming52.4

Lackawanna54.9

Wayne48.4

Pike56

Monroe64.6

Carbon48.8


50.9

Bucks57.5

Montgomery 52

Chester51.5

Delaware65.7

Philadelphia72.8

Columbia49.5

Montour56.9Butler

49


FIGURE 28

Mirroring the trend for overall cancer deaths, the Pennsylvania mortality rate for males is similar to the US rate. The distribution of counties differing signifi cantly from average in mortality is roughly similar to the distribution for incidence.

FIGURE 29

Female lung cancer mortality rates in Pennsylvania are also similar to the US rate. However, the distribution of signifi cantly higher than average mortality rates differs from female incidence and male incidence and mortality, with a cluster of signifi cantly higher than average mortality in Northwestern Pennsylvania.

Male lung cancer deaths, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2006–2010) 63.5 Pa. Rate—(2006–2010) 64.7

–

Erie65.4

Crawford67.3

Venango74.6

Mercer69.5

Lawrence78.5

Beaver69.6

Allegheny68.4

Washington72.2

Greene71.5

Fayette87.2

Westmoreland68.8

Armstrong67.3

Indiana49.6

Somerset53.5

Clarion68

Warren53.1

McKean66.2

Potter59.1

Tioga60.1

Bradford60.5

Susquehanna72.8

Forest87.7 Elk

74

Jefferson69.4

Clearfield67

Cambria58.3

Bedford63.7

Blair72.8

Huntington67.2

Centre58.6

Clinton69.5

Cameron

Lycoming63.2

Sullivan93.3

Mifflin66.4 Juniata

66.2

Fulton69.1

Franklin64.9

Perry92.7

Snyder62.7

Union54.9

Northumberland72.8

Lebanon71.5

Dauphin62.9

Cumberland53.6

Adams55.3

York61.5

Lancaster55.9

Berks56.5

Schuylkill75.8

Luzerne65.3

Wyoming65.9

Lackawanna64

Wayne62.8

Pike39.6

Monroe77.3

Carbon76


58.4

Bucks56

Montgomery 52.6

Chester53.8

Delaware69.4

Philadelphia75.8

Columbia78.1

Montour36.8Butler

71.3

–

Female lung cancer deaths, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2006–2010) 39.2 Pa. Rate—(2007–2011) 39.1

Erie43.5

Crawford48.5

Venango43.1

Mercer42.1

Lawrence35.9

Beaver40.6

Allegheny43.7

Washington42.4

Greene41.8

Fayette42.7

Westmoreland39.5

Armstrong38.8

Indiana33.4

Somerset22

Clarion24.6

Warren48.5

McKean51.9

Potter53.2.2

Tioga37.5

Bradford41.2

Susquehanna41.4

ForestElk39.2

Jefferson29.8

Clearfield39.5

Cambria32.4

Bedford33.3

Blair32.3

Huntington34.8

Centre32

Clinton54.3

Cameron

Lycoming42.4

Sullivan

Mifflin38.2 Juniata

32.1

Fulton Franklin32.2

Perry31.6

Snyder24.1

Union35.7

Northumberland37.7

Lebanon38

Dauphin35.6

Cumberland33.1

Adams34.9

York39.4

Lancaster31.6

Berks34

Schuylkill38.8

Luzerne37.7

Wyoming31.7

Lackawanna 37

Wayne37

Pike25.8

Monroe41.7

Carbon29.5


32.4

Bucks37.9

Montgomery 36.4

Chester37.4

Delaware45.6

Philadelphia49.4

Columbia35

MontourButler

36


Hospitalization Data14

FIGURE 210

There were 3,532 male and 3,389 female lung cancer hospitalizations in 2011. The total number of lung cancer hospitalizations decreased from 4,308 in 2001 to 3,532 in 2011 for male, an 18.0% decrease. The number of lung cancer hospitalizations for female decreased a mere 3.5%, from 3,513 in 2001 to 3,389 in 2011. The gaps in the number of lung cancer hospitalizations between male and female decreased over the years from 2001 to 2011.

FIGURE 211

Total hospitalization charges for lung cancer to Medicare were the highest from 2001 to 2011, followed by commercial insurance and Medicaid. The total charges to Medicare for lung cancer in 2011 were $306.6 million, about 3 times of that to commercial insurance ($122.1 million) and about 5 times of that to Medicaid ($56.5 million). The total hospitalization charges for lung cancer in 2011 were almost two times of that in 2001 ($167.8 million) for Medicare. Hospitalization charges for lung cancer to Medicaid increased 197.9% from $19.0 million in 2001 to $56.6 million in 2011, while commercial insurance charges increased 58.6% from $77.0 million in 2001 to $122.1 million in 2011.

14 (The data source for all hospitalization data in this report is the 2001 to 2011 Pennsylvania Health Care Cost Containment Council (PHC4) inpatient discharge data.)

Hospital admissions for lung cancer by sex inPennsylvania, 2001-2011

NUM

BER

OF

HO

SPIT

AL

AD

MIS

SIO

NS

Year

Male Female

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

20112010200920082007200620052004200320022001

Hospitalization charges for lung cancer by primary payer type in Pennsylvania, 2001-2011

MIL

LIO

N D

OLL

AR

S

Year

20112010200920082007200620052004200320022001

Commercial Medicaid Medicare Other Uninsured

0

50

100

150

200

250

300

350


FIGURE 212

The male age-adjusted lung cancer hospitalization rate was consistently higher than the rate for females from 2001 to 2011. The male age-adjusted lung cancer hospitalization rate consistently decreased yearly from 69.4 per 100,000 in 2001 to 50.0 per 100,000 in 2011, a 28.0% decrease. The female lung cancer age-adjusted hospitalization rate decreased 11.4% from 43.8 per 100,000 in 2001 to 38.8 per 100,000 in 2011.

FIGURE 213

Non-Hispanic black had the highest age-adjusted lung cancer hospitalization rates over the years of 2001 to 2011. Non-Hispanic black had the highest age-adjusted lung cancer hospitalization rate in 2011 (66.64 per 100,000) followed by non-Hispanic white (41.59 per 100,000) and Hispanic (15.56 per 100,000). The age-adjusted lung cancer hospitalization rate decreased from 2001 to 2011 among non-Hispanic white, non-Hispanic black and Hispanic. Hispanic age-adjusted hospitalization rate had the largest decrease from 2001 to 2011 followed by non-Hispanic black and non-Hispanic white.

Year

Age-adjusted lung cancer hospitalization rate by sex in, Pennsylvania, 2001-2011

Male Female

PER

100

,000

10

20

30

40

50

60

70

80

020112010200920082007200620052004200320022001

PER

100

,000

Year

NHW NHB Hispanic

Age-adjusted lung cancer hospitalization rate by race/ethnicity in Pennsylvania, 2001-2011

0

10

20

30

40

50

60

70

80

90

100

20112010200920082007200620052004200320022001

38 cancer burden | colorectal cancer

COLORECTAL CANCER

Incidence

Colorectal cancer15 is the fourth most commonly diagnosed invasive cancer in Pennsylvania, with over 7,000 diagnoses in 2011. Racial disparities in incidence are not as pronounced for colorectal cancer as they are for most other types. The black male incidence rates are higher than white male rates, but not dramatically so. Similarly, the black female incidence rates across the past decade are on average slightly higher than the white female rates, but the two rates are fairly close.

15 (Colorectal cancer incidence is defi ned using ICD-O-3 codes C180-C289 and C260, excluding ICD-O-3 histologies 9590-9989. Colorectal cancer mortality is defi ned as ICD-10 codes C18-20, C260)

0

20

Year

Colon and rectum cancers, age-adjusted incidence rates by sex and race, Pennsylvania residents, 2000-2011


NOTES: Age-adjusted rates are computed by the direct method using the 2000 U.S. standard million population. Incidence rates are based on invasive cancers. Rates based on less than 10 events are considered statistically unreliable and are not displayed. Cancer primary site/type groupings follow the definitions used by the National Cancer Institute’s SEER program.

40

60

80

100

201120102009200820072006200520042003200220012000

PER

100

,000

FIGURE 31

All four race and sex combinations trended down since 2000 as seen in Figure 3-1, and the largest decline was the white male incidence rate, which decreased 49.0 percent.


Mortality

Though trailing lung cancer deaths by several thousand, the second leading killer among all cancer types was colorectal cancer, with 2,600 deaths in 2011 among Pennsylvanians. Since 2000, colorectal mortality has declined among each of the race/sex groups. While the incidence rate gap between black and white males is fairly small, the mortality rate gap is quite marked, as seen in Figure 3-2 below.

FIGURE 32

There is a large spike in the black male mortality rate for 2006. The reason or reasons for this, if it is not just noise in the data, are unknown. The overall trend is more important than one individual outlying year. Substantial racial disparity in mortality exists for colorectal cancer. In 2011, the black male incidence rate was 54.9 percent higher than the white male rate. The black female incidence rate in the same year was 46.5 percent higher than the white female rate.

0

10

Year

Colon and rectum cancer deaths, age-adjusted death rates by sex and race, Pennsylvania residents, 2000-2011



20

30

40

50

201120102009200820072006200520042003200220012000

PER

100

,000


Age and Summary Data

For colorectal cancer, incidence rates do not start climbing steeply until around age sixty, as seen in Figure 3-3. Though increasing with age, death rates lag behind incidence rates, possibly because colorectal cancer often develops slowly in comparison to other cancers.

FIGURE 33

Note that colorectal incidence rates level off around age eighty, while mortality rates continue to increase steadily.

FIGURE 34

Figure 3-4 demonstrates that both incidence and death rates for black males and black females are the highest among all race/ethnicity and sex combinations.

0

Age Group

Colon and rectum cancers, age-specific incidence and death rates Pennsylvania residents, 2009-2011

Incidence Deaths


50

100

150

200

300

350

250

PER

100

,000

85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-1405-0900-04

Colon and rectum cancers, age-adjusted incidence and death rates* by sex and race/ethnicity, Pennsylvania, 2009-2011

Incidence Deaths

*Three-year average annual rates are per 100,000 and age-adjusted to the 2000 U.S.standard population.Note: ND indicates the data were not displayed due to low frequency counts < 10.Hispanics can be of any race.

PER 100,0000 10 20 30 40 50 60 70

Asian/PI males

Hispanic males

White males

Black males

Asian/PI females

Hispanic females

White females

Black females


FIGURE 35

Some racial disparities emerge in stage distribution for colorectal cancer. Interestingly, for both black males and black females, in situ cases are higher than for whites of the same sex. While white and black males have approximately equal early and late stage diagnoses, a larger portion of the late stage diagnoses for black males is distant.

PER

CEN

T TO

TAL

CASE

S

Stage of Disease

In situ Local Regional Distant Unknown

Stage distribution of colon and rectum cancer at time of diagnosis by sex and race, Pennsylvania, 2009-2011*

0

10

20

30

40

50

Black femalesWhite femalesBlack malesWhite males

*Rates are three-year average annual percentages and based on SEER Summary Stage definitions.


Geographical Data

As with overall cancer and lung cancer, Pennslyvania’s colorectal incidence rates for males and females are higher than the respective US rates, while mortality rates are fairly close. Note that for cancers other than lung, female breast, and prostate, larger numbers of white colored signifi cance not determined counties will appear in the maps, due to lower absolute numbers of incidences and deaths.

FIGURE 36

Relatively few counties show a signifcant difference from the overall Pennsylvania rate for colorectal cancer. No immediately clear pattern of signifi cantly higher or lower counties presents itself.

FIGURE 37

Similarly, only ten counties out of sixty-seven show either a signifi cantly higher or lower female incidence rate compared to Pennsylvania’s overall rate. Again, these counties are distributed fairly widely across the state.

Male colorectal cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2007–2011) 48.9 Pa. Rate—(2007–2011) 55.0

–

Erie50.2

Crawford53.9

Venango51.2

Mercer56.9

Lawrence53

Beaver52

Allegheny54.4

Washington58.3

Greene59.2

Fayette64.8

Westmoreland56.1

Armstrong46.3

Indiana56.5

Somerset58.1

Clarion54.7

Warren49.1

McKean60.2

Potter48.1

Tioga61

Bradford58.9

Susquehanna46.5

ForestElk56.3

Jefferson52.5

Clearfield60.6

Cambria70.7

Bedford54.4

Blair62.6

Huntington55.3

Centre41.9

Clinton60.8

Cameron

Lycoming61.9

Sullivan

Mifflin57.8 Juniata

64.7

Fulton Franklin56.6

Perry52.7

Snyder49.2

Union50.3

Northumberland54

Lebanon51.9

Dauphin50.9

Cumberland53.4

Adams55.1

York56

Lancaster49.9

Berks59.1

Schuylkill63.3

Luzerne61.6

Wyoming55 Lackawanna

56

Wayne45.4

Pike49.3

Monroe50.2

Carbon52.3


50.1

Bucks47.9

Montgomery 47.8

Chester46.3

Delaware59.9

Philadelphia64.6

Columbia55.6

Montour41.4Butler

59.4

Female colorectal cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2007–2011) 37.9 Pa. Rate—(2007–2011) 41.2

Significantly higher Not significantly different Significantly lowerSignificance not determined – less than 20 observed cases

Erie34.5

Crawford42.7

Venango45.9

Mercer47.7

Lawrence41.6

Beaver36.1

Allegheny40.1

Washington43.5

Greene44.2

Fayette41.7

Westmoreland43.7

Armstrong37.9

Indiana41.6

Somerset36.7

Clarion55.3

Warren40.7

McKean44.3

Potter42.5

Tioga37.1

Bradford46.4

Susquehanna35.1

ForestElk41

Jefferson44

Clearfield47.1

Cambria44.1

Bedford34.1

Blair44.9

Huntington41.5

Centre38.4

Clinton43

Cameron

Lycoming49.2

Sullivan

Mifflin38.7 Juniata

39.3

Fulton Franklin43.7

Perry38.7

Snyder51.2

Union36

Northumberland35

Lebanon38.6

Dauphin43.2

Cumberland44.2

Adams41.7

York40.9

Lancaster39.5

Berks41.1

Schuylkill52.5.

Luzerne43.9

Wyoming36.9 Lackawanna

44.8

Wayne43.7

Pike40.1

Monroe42.1

Carbon39.7


36

Bucks38.9

Montgomery 38.3

Chester39.8

Delaware43.5

Philadelphia43.3

Columbia42.7

Montour31.8Butler

36.8


FIGURE 38

However, comparing incidence to mortality for males shows that Luzerne, Delaware, and Philadelphia county have evelvated rates of both incidence and mortality.

FIGURE 39

For females, the only counties that have signifi cantly higher or lower mortality rates are part of the Philadelphia MSA, and Philadelphia has both a signifi cantly higher incidence and mortality rate among females.

Male colorectal cancer deaths, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2006–2010) 19.6 Pa. Rate—(2007–2011) 21.0

–

Erie20.8

Crawford23.5

Venango19.1

Mercer25.4

Lawrence17.6

Beaver20.3

Allegheny21.3

Washington22.6

Greene24.4

Fayette25.5

Westmoreland21.8

Armstrong20.1

Indiana22.7

Somerset19.7

Clarion24.5

Warren25.5

McKean22.4

Potter Tioga20.6

Bradford19.7

Susquehanna19.6

ForestElk21.7

Jefferson29.7

Clearfield25.8

Cambria22.8

Bedford

Blair22.6

Huntington20.6

Centre15.2

Clinton31

Cameron

Lycoming16.1

Sullivan

Mifflin20.2 Juniata

35

Fulton Franklin16.6

Perry24.9

Snyder

Union

Northumberland21.5

Lebanon20.1

Dauphin18.2

Cumberland17.7

Adams20.8

York20.1

Lancaster20.7

Berks19.8

Schuylkill23.3

Luzerne25.3

WyomingLackawanna23.6

Wayne17.7

Pike13.7

Monroe19.9

Carbon17.1


18.6

Bucks17.3

Montgomery 17

Chester19.5

Delaware24.2

Philadelphia26.8

Columbia26.7

MontourButler14.7

Female colorectal cancer deaths, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates

The symbol, , represents the number of cancer deaths. A larger circle indicates a larger amount of deaths.Note: Age-adjusted rates are per 100,000 and computed by the direct method using the 2000 U.S. standard million population. Rates based on less than 20 events are considered statistically unreliable.

U.S. Rate—(2006–2010) 13.9 Pa. Rate—(2007–2011) 14.6

–

Erie14.7

Crawford16.6

Venango19

Mercer18.3

Lawrence14.5

Beaver14.4

Allegheny14.6

Washington15.6

GreeneFayette15.8

Westmoreland14.9

Armstrong18.4

Indiana12.6

Somerset15.2

Clarion13.5

Warren14.8

McKean13.4

Potter Tioga15.8

Bradford18.3

Susquehanna

ForestElk19.5

Jefferson13.8

Clearfield18.1

Cambria12.3

Bedford16.5

Blair16.5

Huntington15.3

Centre12.7

Clinton

Cameron

Lycoming14.9

Sullivan

MifflinJuniata

Fulton Franklin14.5

Perry14.8

Snyder17.2

Union

Northumberland11.5

Lebanon15.3

Dauphin14.5

Cumberland12.7

Adams13.1

York14.1

Lancaster15.2

Berks13

Schuylkill16.7

Luzerne15.5

Wyoming Lackawanna14.4

Wayne14.7

Pike

Monroe13.1

Carbon13.8


13

Bucks13.2

Montgomery 12.7

Chester13.9

Delaware16.5

Philadelphia16.2

Columbia11.3

MontourButler13.6



FIGURE 310

There were 3,191 male and 3,188 female colorectal cancer hospitalizations in 2011. The total number of colorectal cancer hospitalizations decreased consistently from 2001 to 2011 for both male and female. The total number of colorectal cancer hospitalizations decreased 24.9% for male, from 4,247 in 2001 to 3,191 in 2011, and 28.8% for female, from 4,479 in 2001 to 3,188 in 2011.

FIGURE 311

Medicare had the largest colorectal cancer hospitalization charges from 2001 to 2011, followed by commercial insurances and Medicaid. The total hospitalization charges for colorectal cancer reached $311.0 million for Medicare, a 39.9% increase comparing to 2001 ($222.3 million). The total hospitalization charges for colorectal cancer in 2011 reached $40.7 million for Medicaid, almost a 190.7% increase from $14.0 million in 2001. Hospitalization charges for colorectal cancer to Medicare were the highest over the years from 2001 to 2011, followed by commercial insurance and Medicaid.

Hospital admissions for colorectal cancer by sex in Pennsylvania, 2001-2011

NUM

BER

OF

HO

SPIT

AL

AD

MIS

SIO

NS

Year

Male Female

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

20112010200920082007200620052004200320022001

Hospitalization charges for colorectal cancer by primary payer type in Pennsylvania, 2001-2011

MIL

LIO

N D

OLL

AR

S

Year


0

50

100

150

200

250

300

350

400

20112010200920082007200620052004200320022001


FIGURE 312

Age-adjusted colorectal cancer hospitalization rates for male were consistently higher than the rates for female from 2001 to 2011. The age-adjusted colorectal cancer hospitalization rate decreased from 70.0 per 100,000 in 2001 to 45.8 per 100,000 for male, and from 51.9 per 100,000 in 2001 to 35.8 per 100,000 in 2011 for female.

FIGURE 313

Non-Hispanic black had the highest age-adjusted colorectal cancer hospitalization rate in 2011 (47.5 per 100,000) followed by non-Hispanic white (39.5 per 100,000) and Hispanic (21.4 per 100,000). The age-adjusted hospitalization rate decreased from 2001 to 2011 among non-Hispanic white, non-Hispanic black and Hispanic. Hispanic age-adjusted hospitalization rates had the largest decrease from 2001 to 2011 followed by non-Hispanic white and non-Hispanic black.

Year

Age-adjusted colorectal cancer hospitalization rate by sex in, Pennsylvania, 2001-2011

Male Female

PER

100

,000

10

20

30

40

50

60

70

80

020112010200920082007200620052004200320022001

PER

100

,000

Year

NHW NHB Hispanic

Age-adjusted colorectal cancer hospitalization rate by race/ethnicity in Pennsylvania, 2001-2011

0

10

20

30

40

50

60

70

80

90

20112010200920082007200620052004200320022001

46 cancer burden | female breast cancer

FEMALE BREAST CANCER

Incidence

Female16 breast cancer,17 along with lung and bronchus and prostate cancer, is one of the three most commonly diagnosed invasive cancers in Pennsylvania. In 2011, nearly 10,600 women were diagnosed with invasive breast cancer. Because there are no male and race combinations to depict, fi gures 4-1 and 4-2 below include Asian/Pacifi c islander and Hispanic18 females. Note that due to the racial and ethnic makeup of Pennsylvania, the data for those two categories are sparse and sometimes unavailable.

16 (While males can develop breast cancer; it is extremely rare. Male breast cancer data is therefore typically not available or reported.) 17 (Breast cancer incidence is defi ned using ICD-O-3 codes C50.0-C50.9, excluding ICD-O-3 histologies 9590-9989. Breast cancer mortality is defi ned

as ICD-10 code C50) 18 (Prior to 2002, no Hispanic incidence data for any cancer was collected in Pennsylvania. All incidence graphs depicting Hispanic incidence will

therefore show no data prior to 2002.)

FIGURE 41

Across the past decade, female breast cancer incidence rates have shown little difference between black and white females. Since 2000, incidences rates for all women have held steady overall.

0

75

50

25

Year

Female breast cancers, age-adjusted incidence rates by race/ethnicity, Pennsylvania residents, 2000-2011

Asian/PI Female Hispanic FemaleWhite Female Black Female

NOTES: Age-adjusted rates are computed by the direct method using the 2000 U.S. standard million population. Incidence rates are based on invasive cancers. Rates based on less than 10 events are considered statistically unreliable and are not displayed. Cancer primary site/type groupings follow the definitions used by the National Cancer Institute’s SEER program. Hispanics can be of any race and are only available for 2000+. Prior to 2002, Hispanics were classified as white

100

125

150

201120102009200820072006200520042003200220012000

PER

100

,000


Mortality

In 2011, more than 2,000 women died of breast cancer in Pennsylvania, more than any other cancer group except lung and bronchus.

FIGURE 42

In contrast to incidence rates, black and white female death rates differ substantially. In 2011, for black and white females respectively, mortality rates were 31.9 and 22.3 per 100,000: a 43.0 percent difference. Very slight net declines in mortality rates can be noted since 2000, but the trend is fairly level.


For female breast cancers, the gap between incidence and mortality rates is quite pronounced, as seen in Figure 4-3. Incidence begins to rise rapidly around age thirty-fi ve. In contrast, mortality does not begin to rise sharply until approximately age seventy. Three-year aggregate data for female breast cancer show minimal difference in incidence rates between black and white females but does demonstrate a substantial disparity in mortality rates.

FIGURE 43

The increase in female breast cancer incidence slows around age sixty-fi ve, peaking around age eighty, while mortality continues to rise with age.

Year

Female breast cancer deaths, age-adjusted rates by race/ethnicity, Pennsylvania residents, 2000-2011

NOTES: Age-adjusted rates are computed by the direct method using the 2000 U.S. standard million population. Rates based on less than 10 events are considered statistically unreliable and are not displayed. Cancer primary site/type groupings follow the definitions used by the National Cancer Institute’s SEER program. *Insufficient date to include Asian/Pacific Islanders and Hispanics.

201120102009200820072006200520042003200220012000

PER

100

,000

Asian/PI Female Hispanic FemaleWhite Female Black Female

0

10

20

30

40

50

Age Group

Female breast cancers, age-specific incidence and death rates, Pennsylvania females, 2009-2011

Incidence Deaths


PER

100

,000

0

100

200

300

400

500

85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-1405-0900-04


FIGURE 44

Three-year data for Asian/Pacifi c islander and Hispanic females are more reliable than single-year data and may possibly indicate signifi cantly lower rates of incidence and mortality of breast cancer in those groups. However, the vast majority of absolute incidence and mortality totals of breast cancer in Pennsylvania are among black and white females, and making inferences regarding the rates for the other two groups should be approached with caution.

FIGURE 45

Stage distribution across the four race/ethnicity categories is roughly similar. Early stage diagnoses comprise the majority for all groups. However, some disparity exists; 71.6 percent of the diagnoses for white females are early stage, while 66.2 percent are early stage for black females.

Female breast cancers, age-adjusted incidence and death rates,* by sex and race/ethnicity, Pennsylvania, 2009-2011

Incidence Deaths

*Three-year average annual rates are per 100,000 and age-adjusted to the 2000 U.S.standard population.Hispanics can be of any race.

PER 100,0000 20 40 60 80 100 120 140 160

Hispanic females

Asian/PI females

White females

Black females

All females

PER

CEN

T TO

TAL

CASE

S

Stage of Disease


Stage distribution of female breast cancers at time of diagnosis by race/ethnicity, Pennsylvania, 2009-2011*

*Rates are three-year average annual percentages and based on SEER Summary Stage definitions.Note: ND indicates the percentages were not displayed due to low frequency counts <10.

0

10

20

30

40

50

60

Hispanic femalesAsian/PI femalesBlack femalesWhite females

ND ND


Geographical Data

In contrast to the cancers previously discussed, female breast cancer rates for both incidence and mortality are very similar to the U.S. rates.

FIGURE 46

For female breast cancer incidence, incidence rates signifi cantly higher than the state rate appear to center around the Pittsburgh and Philadelphia areas, though interestingly, Philadelphia itself has an incidence rate not signifi cantly different from the state.

FIGURE 47

Note that, for female breast cancer mortality, the Philadelphia rate is signifi cantly higher than the state rate, in contrast to its incidence rate.

Female breast cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2007–2011) 128.5 Pa. Rate—(2007–2011) 127.4

–

Erie131.9

Crawford115.5

Venango131.2

Mercer134.6

Lawrence130.5

Beaver126.1

Allegheny134

Washington125.5

Greene127.4

Fayette111.3

Westmoreland127.7

Armstrong113.9

Indiana106.8

Somerset102.1

Clarion121.2

Warren111.2

McKean116

Potter110.6

Tioga109.9

Bradford126.7

Susquehanna100.5

Forest156.9 Elk

117

Jefferson107

Clearfield111.5

Cambria115.4

Bedford127.9

Blair115

Huntington91.5

Centre127.3

Clinton124.6

Cameron137.5

Lycoming138.7

Sullivan93.2


114

Fulton99.1

Franklin118.2

Perry127

Snyder111.2

Union120

Northumberland107

Lebanon116.2

Dauphin126.2

Cumberland132.9

Adams119.2

York126.9

Lancaster122.2

Berks125.3

Schuylkill117.6

Luzerne122.6


123.6

Wayne102.1

Pike110.9

Monroe122.6

Carbon118.1


126.8

Bucks132

Montgomery 138.2

Chester135.7

Delaware137.8

Philadelphia128.4

Columbia121.4

Montour124.1Butler

136.8

Female breast cancer deaths, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2006–2010) 22.6 Pa. Rate—(2007–2011) 23.5

–

Erie24.4

Crawford18.9

Venango23.8

Mercer27.8

Lawrence23.9

Beaver25.1

Allegheny24.1

Washington27.3

Greene24.2

Fayette26.2

Westmoreland24.2

Armstrong18.6

Indiana25.2

Somerset18.9

Clarion20.5

Warren23.5

McKean25.7

Potter Tioga18.5

Bradford21

Susquehanna21.9

ForestElk22.8

Jefferson23.7

Clearfield18.7

Cambria23.4

Bedford19.7

Blair24.6

Huntington19.1

Centre18.3

Clinton16.9

Cameron

Lycoming18.2

Sullivan

Mifflin21.1 Juniata

25.2

Fulton Franklin19.6

Perry23.9

Snyder22.7

Union14

Northumberland21.2

Lebanon23

Dauphin24.9

Cumberland18.5

Adams21.7

York21.4

Lancaster23.6

Berks21.9

Schuylkill28.1

Luzerne20.5


19

Wayne21.5

Pike22.8

Monroe20.6

Carbon22.3


22.3

Bucks24.4

Montgomery 22.6

Chester22.8

Delaware25.3

Philadelphia28.6

Columbia21.2

MontourButler24.5



FIGURE 48

There were 3,373 female breast cancer hospitalizations in 2011. This was a 37.2% decrease from 5,370 in 2001.

FIGURE 49

Commercial insurances had the largest female breast cancer charges from 2001 to 2011, followed by Medicare and Medicaid. Total female breast cancer hospitalization charges to Medicare were $51.4 million in 2011. The total Medicaid charges in 2011 were $18.8 million, a 261.5% increase from $5.2 million in 2001.

Hospital admissions for female breast cancer in Pennsylvania, 2001-2011

NUM

BER

OF

HO

SPIT

AL

AD

MIS

SIO

NS

Year

Female

0

1000

2000

3000

4000

5000

6000

20112010200920082007200620052004200320022001

Hospitalization charges for female breast cancer by primary payer type in Pennsylvania, 2001-2011

MIL

LIO

N D

OLL

AR

S

Year


0

10

20

30

40

50

60

70

80

90

20112010200920082007200620052004200320022001


FIGURE 410

The age-adjusted female breast cancer hospitalization rate decreased from 71.0 per 100,000 in 2001 to 42.5 per 100,000 in 2011. Greater decreases were observed from 2001 to 2007 with a slight increase from 2007 to 2008 and then a slight decrease from 2008 to 2011.

FIGURE 411

Non-Hispanic blacks had the highest age-adjusted female breast cancer hospitalization rate in 2011, followed by non-Hispanic whites and Hispanics. The Hispanic female breast cancer hospitalization rate had the greatest decreases from 2001 to 2011, followed by the non-Hispanic white and non-Hispanic black rates. Non-Hispanic blacks consistently had the highest rate over the years from 2002 to 2011.

Year

Age-adjusted female breast cancer hospitalization rates in Pennsylvania, 2001-2011

PER

100

,000

10

20

30

40

50

60

70

80

20112010200920082007200620052004200320022001

0PE

R 1

00,0

00

Year

NHW NHB Hispanic

Age-adjusted female breast cancer hospitalization rate by race/ethnicity in Pennsylvania, 2001-2011

0

5

10

15

20

25

30

35

40

45

50

20112010200920082007200620052004200320022001

52 cancer burden | cervical cancer

CERVICAL CANCER

Incidence

Cervical Cancer19 is a relatively rare female-specifi c cancer with 552 invasive cases diagnosed in 2011. It is included in this report because it is the only cancer that is almost wholly preventable through use of the Human Papilloma Virus (HPV) vaccine. As shown in Figure 5-1, the cervical cancer incidence rate has been higher for black females than white females.

19 (Cervical cancer incidence is defi ned using ICD-O-3 codes C53.0-C53.9, excluding ICD-O-3 histologies 9590-9989. Cervical cancer mortality is defi ned as ICD-10 code C53. In situ stage data for cervical cancer is unavailable because that data is not collected by the PA Cancer Registry.)

FIGURE 51

The 2011 year-over-year comparison shows that the black female incidence rate is 58.4 percent higher than the white female incidence rate. Note that the absolute incidence, the number of cases, for black females is quite low even state-wide, and therefore the true difference between the two rates may not be that large. The net trend since 2000 has held steady for both races.

Year

Cervical cancers, age-adjusted incidence rates by race, Pennsylvania females, 2000-2011

White Female Black Female

NOTES: Age-adjusted rates are computed by the direct method using the 2000 U.S. standard million populationIncidence rates are based on invasive cancers. Rates based on less than 10 events are considered statistically unreliable and are not displayed. Cancer primary site/type groupings follow the definitions used by the National Cancer Institute’s SEER program.

5

0

10

15

201120102009200820072006200520042003200220012000

PER

100

,000


Mortality

In 2011, 180 cervical cancer deaths were recorded in Pennsylvania, approximately 25 of which were black females. Because the absolute mortality totals are so low, it can be diffi cult to infer much information in terms of trends over time.

FIGURE 52

Again, due to the low absolute numbers, the black female cervical cancer death rate has a high degree of variability over time. However, the net trend over the past decade for the black female mortality rate, like the trend for the white female rate, shows little movement.

Year

Cervical cancer deaths, age-adjusted rates by race, Pennsylvania residents, 2000-2011

White Female Black Female

NOTES: Age-adjusted rates are computed by the direct method using the 2000 U.S. standard million population. Rates based on less than 10 events are considered statistically unreliable and are not displayed. Cancer primary site/type groupings follow the definitions used by the National Cancer Institute’s SEER program. *Insufficient data to include Asian/Pacific Islanders and Hispanics.

201120102009200820072006200520042003200220012000

PER

100

,000

0

1

2

3

4

5

6



In contrast to most cancers, cervical cancer incidence peaks in early middle age, and declines as women age and pass through menopause. Mortality rises, albeit slowly, as age increases, as seen in Figure 5-3. In Figure 5-4, three year aggregate data for incidence and mortality more reliably indicate a disparity between white and black female incidence and mortality rates for cervical cancer.

FIGURE 53

Cervical cancer incidence rises sharply from around age twenty up through approximately age forty, declining steadily as age increases thereafter. Mortality lags substantially behind incidence, and peaks around age sixty-fi ve, leveling off around that point.

FIGURE 54

White females make up the overwhelming majority of cervical cancer incidence and mortalities, and the total incidence and mortality rates refl ect that. However, black female incidence and mortality rates appear to be substantially higher than rates for white women. For example, the mortality rate for black females appears to be double that of white females. With such low absolute incidence and mortality counts, even across three years, it is diffi cult to infer that the true difference is necessarily that high, but there does appear to be a signifi cant difference of some kind.

Age Group

Cervix uteri cancers, age-specific incidence and death rates, Pennsylvania females, 2009-2011

Incidence Deaths


PER

100

,000

0

4

8

12

16

20

85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-1405-0900-04

Cervix uteri cancers, age-adjusted incidence and death rates* by race/ethnicity, Pennsylvania, 2009-2011

Incidence Deaths

*Three-year average annual rates are per 100,000 and age-adjusted to the 2000 U.S.standard population.Note: ND indicates the data were not displayed due to low frequency counts <10. Hispanics can be of any race.

PER 100,000

0 2 4 6 8 10 12

White females

Asian/PI females

Hispanic females

Black females

All females

ND


FIGURE 55

Stage distribution is similar across each racial or ethnic group. While the number of in situ cervical cancers is not known, the cases collected show that late-staged cancers made up the majority among both white and black females.

PER

CEN

T TO

TAL

CASE

S

Stage of Disease

Local Regional Distant Unknown

Stage distribution of cervix uteri cancers at time of diagnosis by race/ethnicity, Pennsylvania, 2009-2011*

*Rates are three-year average annual percentages and based on SEER Summary Stage definitions.Note: ND indicates the percentages were not displayed due to low frequency counts <10.

0

10

20

30

40

50

60

Hispanic femalesAsian/PI femalesBlack femalesWhite females

ND ND ND ND


Geographical Data

The sub state geographical data for cervical cancer are very limited due to the low incidence and mortality of the cancer. Overall, the US and Pennsylvania incidence and mortality rates do not appear to differ widely.

FIGURE 56

The Philadelphia MSA once again shows interesting rate disparities, possibly refl ecting racial makeup and access issues, with Philadelphia county showing a signifi cantly higher cervical incidence rate, while the three outer MSA counties show a signifi cantly lower rate.

FIGURE 57

Philadelphia has a signifi cantly higher cervical cancer mortality rate compared to the state rate, as well as a signifi cantly higher incidence rate.

Female cervical cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2007–2011) 6.8 Pa. Rate—(2007–2011) 7.9

–

Erie6.8

Crawford11.3

Venango

Mercer9.8

Lawrence

Beaver5.9

Allegheny6.4

Washington10.1

GreeneFayette

6.6

Westmoreland7

Armstrong

Indiana

Somerset13.8

Clarion

Warren McKean Potter Tioga Bradford Susquehanna

ForestElk

Jefferson

Clearfield9.3

Cambria6.7

Bedford

Blair6.9

Huntington

Centre

Clinton

Cameron

Lycoming8.3

Sullivan

MifflinJuniata

Fulton Franklin9.7

Perry

Snyder

Union

Northumberland10.2

Lebanon10.1

Dauphin8

Cumberland6.7

Adams8.7

York7.3

Lancaster7.8

Berks6.6

Schuylkill10.8

Luzerne10.3

Wyoming Lackawanna8.6

Wayne

Pike

Monroe9.7

Carbon


7.8

Bucks6.5

Montgomery 6.1

Chester5.9

Delaware7.5

Philadelphia12.6

Columbia

MontourButler6.7

Female cervical cancer deaths, 2007–2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2006–2010) 2.4 Pa. Rate—(2007–2011) 2.2

–

Erie

Crawford

Venango

Mercer

Lawrence

Beaver

Allegheny1.9

Washington

GreeneFayette

Westmoreland1.8

Armstrong

Indiana

Somerset

Clarion


ForestElk

Jefferson

Clearfield

Cambria

Bedford

Blair

Huntington

Centre

Clinton

Cameron

Lycoming8.3

Sullivan

MifflinJuniata

Fulton Franklin

Perry

Snyder

Union

Northumberland

LebanonDauphin

Cumberland

Adams York2.9

Lancaster2.3

Berks1.8

Schuylkill

Luzerne3

Wyoming Lackawanna

Wayne

Pike

Monroe4.6

Carbon

Northampton

Lehigh

Bucks1.9

Montgomery 1.3

Chester

Delaware1.8

Philadelphia3.3

Columbia

MontourButler



FIGURE 58

There were 391 cervix uteri cancer hospitalizations in 2011. This was a 30.4% decrease from 562 hospitalizations in 2001.

FIGURE 59

Medicaid led the cervix uteri cancer hospitalization charges in 2011 with $9.3 million, followed by commercial insurance ($7.9 million) and Medicare ($5.7 million). Before then, cervix uteri cancer hospitalization charges were the highest to commercial insurance from 2001 to 2010. Total hospitalization charges to Medicaid increased 97.9 percent, from $4.7 million in 2001 to $9.3 million in 2011, while the total hospitalization charges to Medicare increased 111.1 percent, from $2.7 million in 2001 to $5.7 million in 2011.

Hospital admissions for female cervix uteri cancer in Pennsylvania, 2001-2011

NUM

BER

OF

HO

SPIT

AL

AD

MIS

SIO

NS

Year

Female

0

100

200

300

400

500

600

20112010200920082007200620052004200320022001

Hospitalization charges for cervix uteri cancer by primary payer type in Pennsylvania, 2001-2011

MIL

LIO

N D

OLL

AR

S

Year


0

2

4

6

8

10

12

20112010200920082007200620052004200320022001


FIGURE 510

The age-adjusted cervix uteri cancer hospitalization rate decreased from 8.4 per 100,000 in 2001 to 5.6 in 2011.

FIGURE 511

Non-Hispanic blacks consistently had the highest age-adjusted cervix uteri cancer hospitalization rate from 2001 to 2011 except in 2006, when surpassed by Hispanic. Non-Hispanic white rates were consistently lower than among non-Hispanic blacks and Hispanics except in 2003 and 2011, when the Hispanic rate was the lowest. Non-Hispanic blacks and Hispanics had greater decreases in their age-adjusted cervix uteri hospitalization rates than non-Hispanic whites from 2001 to 2011.

1

2

Year

Age-adjusted female cervix uteri cancer hospitalization rates in Pennsylvania, 2001-2011

3

4

5

6

7

9

0

8

20112010200920082007200620052004200320022001

PER

100

,000

PER

100

,000

Year

NHW NHB Hispanic

Age-adjusted cervix uteri cancer hospitalization rate by race/ethnicity in Pennsylvania, 2001-2011

0

1

2

3

4

5

6

7

8

9

10

20112010200920082007200620052004200320022001

59 cancer burden | prostate cancer

PROSTATE CANCER

Incidence

Prostate cancer20 is one of the three most commonly diagnosed cancers in Pennsylvania, trailing only slightly behind lung and bronchus and female breast cancer. In 2011, 10,235 men were diagnosed with invasive prostate cancer. Because this is a male-specifi c cancer, Asian/Pacifi c islander and Hispanic males are depicted in Figure 6-1. Additionally, because prostate cancer is very common in comparison to female-specifi c cervical cancer, the Asian/Pacifi c islander and Hispanic data may be considered more reliable.

20 Prostate cancer incidence is defi ned as ICD-O-3 code C61.9, excluding ICD-O-3 histologies 9590-9989. Prostate cancer mortality is defi ned as ICD-10 code C61. )

FIGURE 61

Prostate cancer incidence rates have been holding steady or declining for all races and ethnicities since 2000, with black male incidence declining markedly. The black male incidence rate in 2000 was 252.2 per 100,000, 30.0 percent higher than the 2011 rate of 194.0. However, though the gap has narrowed slightly, the 2011 black male incidence rate for prostate cancer was still 58.4 percent higher than the 2011 white male incidence rate.

Year

Prostate cancers, age-adjusted rates by race/ethnicity, Pennsylvania residents, 2000-2011

White male Black male Asian/PI male Hispanic male

NOTES: Age-adjusted rates are computed by the direct method using the 2000 U.S. standard million population. Rates based on less than 10 events are considered statistically unreliable and are not displayed. Cancer primary site/type groupings follow the definitions used by the National Cancer Institute’s SEER program. Hispanics can be of any race and are only availabe for 2002+. Prior to 2002, Hispanics were classified as white.

201120102009200820072006200520042003200220012000

PER

100

,000

50

100

150

200

250

300

0


Mortality

Though prostate cancer has a very high incidence count, it has a relatively low mortality count in comparison to other cancers, such as female breast cancer. In 2011, 1,364 men died of prostate cancer. Figure 6-2 below illustrates the large disparity in mortality rates between black males and white or Hispanic males.

FIGURE 62

Over the past decade, prostate cancer death rates have shown a net decline in black and white males, while the Hispanic male rate has held steady or possibly declined slightly. However, the mortality rate gap is even more dramatic than the incidence rate gap. In 2011, the black male rate (52.1 per 100,000) was 175.7 percent higher than the white male rate (18.9)

Year

Prostate cancer deaths, age-adjusted rates by race/ethnicity, Pennsylvania males, 2000-2011

Hispanic maleWhite male Black male

NOTES: Age-adjusted rates are computed by the direct method using the 2000 U.S. standard million population. Rates based on less than 10 events are considered statistically unreliable and are not displayed. Cancer primary site/type groupings follow the definitions used by the National Cancer Institute’s SEER program. *Insufficient data to include Asian/Pacific islanders.

201120102009200820072006200520042003200220012000

PER

100

,000

0

20

40

60

80



FIGURE 63

Incidence rates for prostate cancer rise rapidly starting around age forty-fi ve, and peak around age sixty-fi ve. In contrast, mortality rates do not become substantial until approximately seventy-fi ve years of age, and rise rapidly after that. The three-year aggregate data also demonstrate the markedly higher incidence and mortality rates among black males in comparison to all other races and ethnicities.

FIGURE 64

Black males are by far most affected by prostate cancer. Black males exhibit the highest incidence and mortality rates among all racial groups. Although the incidence of prostate cancer is substantial, its mortality rate is lower in comparison to other high incidence cancers.

Age Group

Prostate cancers, age-specific incidence and death rates, Pennsylvania males, 2009-2011

Incidence Deaths


PER

100

,000

0

200

400

600

800

1000

85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-1405-0900-04

Prostate cancers, age-adjusted incidence and death rates* by race/ethnicity, Pennsylvania, 2009-2011

Incidence Deaths

*Three-year average annual rates are per 100,000 and age-adjusted to the 2000 U.S.standard population.Note: ND indicates the data were not displayed due to low frequency counts <10. Hispanics can be of any race.

PER 100,0000 50 100 150 200 250

Asian/PI males

Hispanic males

White males

Black males

All males


FIGURE 65

A large majority of prostate cancers, over 75 percent for all races, are diagnosed in early stage. This may contribute to the lower mortality rate of prostate cancers as compared to other high incidence cancers.

PER

CEN

T TO

TAL

CASE

S

Stage of Disease


Stage distribution of prostate cancers at time of diagnosis by race/ethnicity, Pennsylvania, 2009-2011*

0

20

40

60

80

100

Hispanic malesAsian/PI femalesBlack malesWhite males

ND ND ND ND ND


Geographical Data

Prostate cancer shows somewhat distinctive clustering of high or low incidence rates in comparison to other cancers. In contrast to most other Pennsylvania cancers which are typically at a similar or higher incidence rate than the U.S., the Pennsylvania prostate cancer rate is lower than the U.S. rate.

FIGURE 66

Interestingly, the Southwest, Southcentral, and Northeast regions of the state show signifi cantly lower rates of prostate cancer incidence in comparison to the Pennsylvania rate. The Southeast and Northwest regions of the state have a preponderence of signifi cantly higher rates.

FIGURE 67

The county level prostate cancer mortality data do not show nearly the same range of differences in death rates. Some of the counties with a signifi cantly lower incidence rate retained a signifi cantly lower mortality rate, and Philadelphia retained a signifi cantly higher mortality rate.

Male prostate cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2007–2011) 154.2 Pa. Rate—(2007–2011) 144.6

–

Erie144.8

Crawford152.9

Venango128

Mercer173.8

Lawrence135.5

Beaver105.7

Allegheny137.6

Washington132.7

Greene100.2

Fayette126.8

Westmoreland124.8

Armstrong137.2

Indiana132.1

Somerset135.2

Clarion175.4

Warren193.1

McKean124.5

Potter144.3

Tioga161.5

Bradford143.5

Susquehanna137.4

Forest136 Elk

208.4

Jefferson168.1

Clearfield143.4

Cambria147

Bedford173.9

Blair113

Huntington109.1

Centre143.2

Clinton149.4

Cameron207.8

Lycoming135.8

Sullivan140.9

Mifflin130 Juniata

85.8

Fulton135

Franklin142.5

Perry79.5

Snyder135.1

Union146.3

Northumberland153

Lebanon143.8

Dauphin106.6

Cumberland93.7

Adams106.8

York125.5

Lancaster134.2

Berks138.3

Schuylkill119.7

Luzerne120.1


119

Wayne99

Pike123.6

Monroe134.6

Carbon124.7


141.7

Bucks154.6

Montgomery 162.8

Chester162.6

Delaware172.3

Philadelphia184.6

Columbia148.5

Montour174.7Butler

182.6

Male prostate cancer deaths, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2006–2010) 23.0 Pa. Rate—(2007–2011) 22.4

–

Erie25.4

Crawford26.5

Venango22.1

Mercer19.9

Lawrence23

Beaver22.1

Allegheny20.6

Washington22.2

GreeneFayette23.3

Westmoreland21.8

Armstrong20.5

Indiana25.4

Somerset19.1

Clarion

Warren21.1

McKean19.9

Potter Tioga21

Bradford24.5

Susquehanna27.1

ForestElk23

Jefferson20.1

Clearfield21.4

Cambria20.7

Bedford22.2

Blair23

Huntington19.5

Centre16.6

Clinton

Cameron

Lycoming24.3

Sullivan

Mifflin14.8 Juniata

Fulton Franklin13.1

Perry26

Snyder32.8

Union21.7

Northumberland20.9

Lebanon21.5

Dauphin20.5

Cumberland21.1

Adams18.3

York20.5

Lancaster21.1

Berks18.8

Schuylkill23.8

Luzerne20


22.2

Wayne20.8

Pike22.8

Monroe21.9

Carbon24.3


21.2

Bucks20.3

Montgomery 23

Chester22.1

Delaware23.7

Philadelphia32.5

Columbia25.9

MontourButler19.3



FIGURE 68

There were 4,291 prostate cancer hospitalizations in 2011. This was a 10.6 percent decrease from 4,801 in 2001. The number of hospitalizations decreased from 2001 to 2004, then increased from 2004 to 2007, and stayed level from 2007 to 2009. The total prostate cancer hospitalizations decreased from 2009 to 2010 then increased again from 2010 to 2011.

FIGURE 69

Total hospitalization charges for prostate cancer to commercial insurance were the highest of all insurance types from 2001 to 2011, followed by Medicare and Medicaid. The total charges to Medicare for prostate cancer in 2011 were $66.4 million, an 82.4 percent increase from $36.4 million in 2001. The total hospitalization charges to Medicaid increased 236.4 percent from $3.3 million in 2001 to $11.1 million in 2011.

Hospital admissions for prostate cancer in Pennsylvania, 2001-2011

NUM

BER

OF

HO

SPIT

AL

AD

MIS

SIO

NS

Year

0

1000

2000

3000

4000

5000

6000

20112010200920082007200620052004200320022001

Hospitalization charges for prostate cancer by primary payer type in Pennsylvania, 2001-2011

MIL

LIO

N D

OLL

AR

S

Year


0

20

40

60

80

100

120

140

20112010200920082007200620052004200320022001


FIGURE 610

The age-adjusted prostate cancer hospitalization rate decreased greatly from 77.3 per 100,000 in 2001 to 53.5 in 2004 and then remained steady.

FIGURE 611

Non-Hispanic blacks had the highest age-adjusted prostate cancer hospitalization rates from 2001 to 2011, except in 2002, when Hispanics exhibited the highest rate. The rate in 2011 for non-Hispanic blacks was 43.0 percent higher than that of non-Hispanic whites and 171.0 percent higher than that of Hispanics. The rate saw a net decrease from 2001 to 2011 among non-Hispanic whites, non-Hispanic blacks and Hispanics. The Hispanic age-adjusted hospitalization rate had the largest decrease over this period, followed by the non-Hispanic black and non-Hispanic white rates.

Year

Age-adjusted prostate cancer hospitalization rates in Pennsylvania, 2001-2011

PER

100

,000

10

20

30

40

50

60

70

80

90

020112010200920082007200620052004200320022001

PER

100

,000

Year

NHW NHB Hispanic

Age-adjusted prostate cancer hospitalization rate by race/ethnicity in Pennsylvania, 2001-2011

0

10

20

30

40

50

60

20112010200920082007200620052004200320022001

66 cancer burden | melanoma of the skin

MELANOMA OF THE SKIN

Incidence

In 2011, 3,200 invasive cases of melanoma21 were diagnosed in Pennsylvania, which places it among the ten most commonly diagnosed invasive cancers in Pennsylvania. Additionally, melanoma of the skin is one of the few common cancers for which incidence rates have been steadily rising, as shown in Figure 7-1 below. The only other cancer in this report showing growth in incidence is thyroid cancer. The presence of substantial quantities of melanin in the skin greatly mitigates the risk of developing melanoma; therefore, almost all cases develop in white males and females. The fi gures in this section depict categories for white males and white females only, unless otherwise indicated.

21 (Melanoma of the skin incidence is defi ned using ICD-O-3 codes C440-C449, with the ICD-O-3 histologies 8720-8790. Melanoma of the skin

mortality is defi ned as ICD-10 code C43.)

FIGURE 71

As is typical for cancers affecting both sexes, incidence rates are substantially higher for males than for females. In 2011, for example, the male melanoma incidence rate was 48.9 percent higher than the female melanoma rate. Most notable, however, is the fact that for both males and females, incidence has increased steadily since 2000. Incidence of melanoma has risen 48.0 percent for males and 57.1 percent for females across this time period.

Year

Melanoma skin cancers, age-adjusted incidence rates by sex, Pennsylvania residents, 2000-2011

Male Female


201120102009200820072006200520042003200220012000

PER

100

,000

0

10

20

30


Mortality

Melanoma of the skin is typically highly treatable when diagnosed at an early stage, and mortality rates relative to incidence rates are fairly low. Additionally, despite the increase in incidence since 2000, mortality rates have held relatively steady, as seen in Figure 7-2 below.

FIGURE 72

Year

Melanoma skin cancer deaths, age-adjusted rates by sex and race, Pennsylvania residents, 2000-2011

White male White female


201120102009200820072006200520042003200220012000

PER

100

,000

0

1

2

3

4

5

6



Incidence and mortality rates for melanoma of the skin rise overall with age, as with many cancers. However, melanoma is unusual in that the incidence rate is high enough to be measurable below approximately thirty-fi ve years of age. The three-year aggregate data for white males and females demonstrates the same disparities of incidence and mortality apparent in Figures 7-1 and 7-2.

FIGURE 73

Aside from the earlier onset, melanoma of the skin shows a typical cancer incidence and mortality growth pattern. Incidence peaks around age eighty and mortality levels off at that point as well. The mortality rate in general is much lower than the incidence rate, and increases rather slowly with age.

FIGURE 74

The death rate among males appears to be more than double that of females. However, because the absolute mortality counts are so low, the true difference may be less.

Age Group

Melanoma skin cancers, age-specific incidence and death rates, Pennsylvania residents, 2009-2011

Incidence Deaths


PER

100

,000

0

20

40

60

80

100

85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-1405-0900-04

Melanoma skin cancers, age-adjusted incidence and death rates* by sex, Pennsylvania, 2009-2011

Incidence Deaths

*Three-year average annual rates are per 100,000 and age-adjusted to the 2000 U.S.standard population.

PER 100,0000 5 10 15 20 25 30

White females

White males


FIGURE 75

For both white males and females, more than 80 percent of melanoma skin cancer is diagnosed in early stage.

PER

CEN

T TO

TAL

CASE

S

Stage of Disease


Stage distribution of melanoma skin cancers at time of diagnosis by sex, Pennsylvania, 2009-2011*


0

10

20

30

40

50

60

White femalesWhite males


Geographical Data

County level data for melanoma of the skin demonstrates some overall clustering of incidence rates signifi cantly higher and lower than the Pennsylvania rate. Due to the very low absolute mortality counts, signifi cance was unable to be determined for most counties in the mortality rate maps.

FIGURE 76

For male incidence, some clustering of signifi cantly higher incidence rates occur in the Southcentral and Southeastern portions of the state, with signifi cantly lower rates in the Northwest, Southwest, and Northeastern portions. Additionally, Pennsylvania’s melanoma of the skin incidence rate for white males is lower than the US rate. Interestingly, and in contrast to almost all other cancers, Philadelphia has a signifi cantly lower rate of melanoma incidence for both males and females. This likely refl ects the racial makeup of the county.

FIGURE 77

Similar to male melanoma cancer incidence, female melanoma incidence shows similar signifi cantly higher rate clustering in Southcentral and Southeastern Pennsylvania. In addition, there appears to be a cluster of signifi cantly higher incidence rates in Northcentral PA. In contrast to male incidence rates, only the Southwestern portion of the state shows a cluster of signifi cantly lower rates.

Male melanoma of the skin cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2007–2011) 29.0 Pa. Rate—(2007–2011) 24.0

–

Erie19

Crawford17.1

Venango24.4

Mercer15

Lawrence22.8

Beaver15.8

Allegheny19.3

Washington17.6

Greene17.6

Fayette13.6

Westmoreland16.4

Armstrong19.4

Indiana21.5

Somerset18.6

Clarion27.2

Warren29.6

McKean25.5

Potter Tioga32.4

Bradford23.1

Susquehanna20.3

ForestElk

Jefferson17.4

Clearfield25.8

Cambria19.5

Bedford27.5

Blair24.5

Huntington21

Centre34.7

Clinton25.1

Cameron

Lycoming29.3

Sullivan

Mifflin23.8 Juniata

Fulton Franklin32.9

Perry29.8

Snyder26.7

Union25.9

Northumberland24.1

Lebanon25.3

Dauphin29.2

Cumberland35.9

Adams30.5

York29.5

Lancaster24.9

Berks26

Schuylkill21.2

Luzerne22.8


20.5

Wayne15.3

Pike13.3

Monroe13.8

Carbon27.4


29.2

Bucks31.4

Montgomery 30.2

Chester35

Delaware34.1

Philadelphia13

Columbia38.8

MontourButler24.1

Female melanoma of the skin cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2007–2011) 18.6 Pa. Rate—(2007–2011) 16.5

–

Erie15.1

Crawford17

Venango13.9

Mercer17.4

Lawrence17.1

Beaver15

Allegheny13.7

Washington13.4

GreeneFayette

6.6

Westmoreland12.2

Armstrong14.4

Indiana11.9

Somerset16.1

Clarion27.9

Warren18.1

McKean18

Potter Tioga22.8

Bradford23.5

Susquehanna20.3

Forest

Elk

Jefferson28.1

Clearfield21.3

Cambria17.8

Bedford16.4

Blair15.2

Huntington18.5

Centre22.9

Clinton21.7

Cameron

Lycoming22.4

Sullivan

Mifflin19.9 Juniata

Fulton Franklin23.5

Perry19.7

Snyder25.7

Union30.3

Northumberland20.9

Lebanon18.3

Dauphin18

Cumberland25.1

Adams20.7

York25.5

Lancaster15.8

Berks18.3

Schuylkill17.2

Luzerne14


14.7

Wayne12.5

Pike16.1

Monroe14.8

Carbon19.1


19.4

Bucks20.7

Montgomery 18.9

Chester23.5

Delaware20.5

Philadelphia7.1

Columbia20.8

MontourButler16.7


FIGURE 78

Because of the low mortality counts, it is diffi cult to infer much geographically about either male or female mortality for melanoma of the skin.

FIGURE 79

Pennsylvania and U.S. rates for melanoma mortality appear to be similar. Interestingly, Philadelphia County is lower than the state average, while neighboring Delaware County is higher than the state average. A majority of the state had less than 20 observed deaths from melanoma and its signifi cance was not determined.

Male melanoma of the skin cancer deaths, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2006–2010) 4.1 Pa. Rate—(2007–2011) 4.4

–

Erie5

Crawford

Venango

Mercer

Lawrence

Beaver5

Allegheny3.7

Washington3.6

GreeneFayette

Westmoreland4.4

Armstrong

Indiana

Somerset

Clarion


Forest

Elk

Jefferson

Clearfield

Cambria

Bedford

Blair

Huntington

Centre

Clinton

Cameron

LycomingSullivan

MifflinJuniata

Fulton Franklin5.2

Perry

Snyder

Union

Northumberland

LebanonDauphin4

Cumberland4.7

Adams York4.2

Lancaster5.6

Berks4.9

Schuylkill

Luzerne5.1


Wayne

Pike

Monroe

Carbon


5

Bucks2.2

Montgomery 4.6

Chester5.6

Delaware5.2

Philadelphia3.1

Columbia

MontourButler4.7

Female melanoma of the skin cancer deaths, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2006–2010) 1.7 Pa. Rate—(2007–2011) 1.9

–

Erie

Crawford

Venango

Mercer

Lawrence

Beaver

Allegheny1.6

Washington

GreeneFayette

Westmoreland

Armstrong

Indiana

Somerset

Clarion


Forest

Elk

Jefferson

Clearfield

Cambria

Bedford

Blair

Huntington

Centre

Clinton

Cameron

LycomingSullivan

MifflinJuniata

Fulton Franklin

Perry

Snyder

Union

Northumberland

LebanonDauphin

Cumberland

Adams York2.1

Lancaster2

Berks1.8

Schuylkill

Luzerne2.1

WyomingLackawanna

Wayne

Pike

Monroe

Carbon

Northampton

Lehigh2.4

Bucks2.2

Montgomery 1.6

Chester2.5

Delaware3.1

Philadelphia1.2

Columbia

MontourButler



FIGURE 710

There were 86 male and 56 female melanoma hospitalizations in 2011. The total number of melanoma hospitalizations decreased from 129 in 2001 to 86 in 2011 for males, a 33.3% decrease. The total number of melanoma hospitalizations for females decreased 41.7% from 96 in 2001 to 56 in 2011.

FIGURE 711

Total hospitalization charges for melanoma from 2001 to 2011 were highest for Medicare followed by commercial insurance and Medicaid. The total charges to Medicare for melanoma in 2011 were $3.0 million, about 1.5 times of that to commercial insurance ($2.1 million) and about 4 times that to Medicaid ($0.7 million). The total hospitalization charges for melanoma in 2011 were about 50% higher than in 2001 ($2.1 million) for Medicare. Hospitalization charges to Medicaid increased 133.3% from 0.3 million in 2001 to 0.7 million in 2011 while charges to commercial insurance increased 16.7% from 1.8 million in 2001 to 2.1 million in 2011.

Hospital admissions for melanoma by sex in Pennsylvania, 2001-2011

NUM

BER

OF

HO

SPIT

AL

AD

MIS

SIO

NS

Year

Male Female

0

20

40

60

80

100

120

140

20112010200920082007200620052004200320022001

Hospitalization charges for melanoma by primary payer type in Pennsylvania, 2001-2011

MIL

LIO

N D

OLL

AR

S

Year


0

1

2

3

4

5

20112010200920082007200620052004200320022001


FIGURE 712

Males had consistently higher melanoma hospitalization rates than females from 2001 to 2011. Both age-adjusted melanoma hospitalization rates for males and females decreased from 2001 to 2011. Age-adjusted melanoma hospitalization rates decreased from 2.1 per 100,000 in 2001 to 1.3 per 100,000 for males and from 1.2 per 100,000 in 2001 to 0.7 per 100,000 in 2011 for females.

FIGURE 713

Non-Hispanic whites had higher age-adjusted melanoma hospitalization rates than non-Hispanic blacks from 2001 to 2011. The age-adjusted hospitalization rate decreased from 1.37 per 100,000 in 2001 to 1.01 per 100,000 in 2011 for non-Hispanic whites and from 0.32 per 100,000 in 2001 to 0.29 per 100,000 in 2011 for non-Hispanic blacks. Hispanic age-adjusted hospitalization rates were unstable due to small counts from 2001 to 2011.

PER

100

,000

Year

NHW NHB Hispanic

Age-adjusted melanoma hospitalization rate by race/ethnicity in Pennsylvania, 2001-2011

0.0

0.5

1.0

1.5

2.0

2.5

20112010200920082007200620052004200320022001

Year

Age-adjusted melanoma hospitalization rate by sex in, Pennsylvania, 2001-2011

Male Female

PER

100

,000

20112010200920082007200620052004200320022001

0.5

1.0

1.5

2.0

2.5

0

74 cancer burden | urinary bladder cancer

URINARY BLADDER CANCER

Incidence

Urinary bladder cancer22 is the fi fth most commonly diagnosed cancer in Pennsylvania. Because of some of the unique features of this cancer, incidence for bladder cancer includes newly diagnosed invasive and in situ cases. For all other cancers, incidence includes only invasive diagnoses. In 2011, 4,100 new cases were diagnosed. In addition to being a common cancer, urinary bladder cancer is also notable for its unusual racial incidence pattern. For almost all cancers, black males suffer from the highest incidence and mortality rates, often higher, by a large margin, than the other race and sex combinations. In marked contrast, the highest incidence rates for urinary bladder cancer are found among white males. In general, males have a larger than usual share of the urinary bladder cancer incidence.

22 (Urinary bladder cancer incidence is defi ned using ICD-O-3 codes C670-C679, excluding ICD-O-3 histologies 9590-9989. Urinary bladder cancer mortality is defi ned as ICD-10 code C67.)

FIGURE 81

As noted above, white males have the highest incidence rates for urinary bladder cancer. In 2011, the white male incidence rate was 78.7 percent higher than the black male rate. For all race/sex combinations, the net trend across the previous decade has been fl at.

Year

Urinary bladder cancers, age-adjusted incidence rates by sex and race, Pennsylvania residents, 2000-2011


NOTES: Age-adjusted rates are computed by the direct method using the 2000 U.S. standard million population.Rates based on less than 10 events are considered statistically unreliable and are not displayed. Cancer primary site/type groupings follow the definitions used by the National Cancer Institute’s SEER program.

201120102009200820072006200520042003200220012000

PER

100

,000

10

20

30

40

50

60

0


Mortality

Though the absolute incidence counts for urinary bladder cancer are high, the absolute mortality counts for the cancer are fairly low. As expected, white males do have the highest mortality rate, as seen in Figure 8-2 below.

FIGURE 82

The black male mortality rate shows substantial variability, likely due to low mortality counts. It is interesting to note that in 2011, white male mortality was 39.0 percent higher than black male mortality, a substantially narrower gap than for incidence. This may suggest a disproportionately high mortality rate among black males. Due to the variability of the black male mortality rate, caution should be observed before making such an inference. Since 2000, the net trend for all race and sex combinations has held steady.

Year

Urinary bladder cancer deaths, age-adjusted rates by sex and race, Pennsylvania residents, 2000-2011



201120102009200820072006200520042003200220012000

PER

100

,000

2

4

6

8

10

12

0



As is typical for cancer in general, urinary bladder cancer incidence rates and mortality rates increase with age. For urinary bladder cancer, mortality rates are fairly low and, even in advanced age, the mortality rate rise lags behind the incidence rate rise.

FIGURE 83

Urinary bladder cancer incidence rates begin to increase steeply around age fi fty-fi ve, rising rapidly and peaking around age eighty. Urinary bladder cancer mortality rates rise slowly, only beginning to increase rapidly around age seventy-fi ve.

FIGURE 84

The three year aggregate data necessarily includes higher mortality counts than single year data and as such can typically be considered more reliable. However, for urinary bladder cancer, even three year mortality data for groups other than white males is sparse. The data suggests much greater incidence and mortality rates in white males compared to those of black males.

Age Group

Urinary bladder cancers, age-specific incidence and death rates Pennsylvania residents, 2009-2011

Incidence Deaths


PER

100

,000

50

100

150

200

250

085+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-1405-0900-04

Urinary bladder cancers, age-adjusted incidence and death rates* by sex and race/ethnicity, Pennsylvania, 2009-2011

Incidence Death

*Three-year average annual rates are per 100,000 and age-adjusted to the 2000 U.S.standard population.Note: ND indicates the data percentages were not displayed due to low frequency counts <10.Hispanics can be of any race.

PER 100,000

0 10 20 30 40 50

Asian/PI females

Black females

Hispanic females

White females

Asian/PI males

Hispanic males

Black males

White males

ND

ND

ND


FIGURE 85

For all race and sex groups, a large majority of all urinary bladder cancers are diagnosed in early stage. With the possible exception of black females, the stage distribution is consistent across the sex and race combinations.

PER

CEN

T TO

TAL

CASE

S

Stage of Disease


Stage distribution of urinary bladder cancers at time of diagnosis by sex and race, Pennsylvania, 2009-2011*


0

10

20

30

40

50

60



Geographical Data

Urinary bladder cancer is rare enough in females that the female incidence map contains numerous counties for which incidence rate signifi cance could not be determined. Absolute mortality counts, even among males, are low enough that signifi cance could not be determined for many counties on the mortality maps.

FIGURE 86

As with most other cancers covered in this report, the male and female Pennsylvania incidence rate is higher than the US rate. Urinary bladder cancer incidence rates for males are signifi cantly higher than the Pennsylvania rate in Eastern and Southwestern Pennsylvania, while Southcentral Pennsylvania has the most counties with signifi cantly lower incidence rates. Again, unusually, Philadelphia has a signifi cantly lower incidence rate of urinary bladder cancer, possibly refl ecting the local racial demographics.

FIGURE 87

Little can be gleaned from the female urinary bladder cancer incidence map. As with males, the Southcentral portion of the state contains most of the counties showing signifi cantly lower incidence rates, compared to the Pennsylvania rate.

Male urinary bladder cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2007–2011) 37.2 Pa. Rate—(2007–2011) 44.7

–

Erie40.4

Crawford44.3

Venango47

Mercer47.5

Lawrence51.4

Beaver50

Allegheny46.8

Washington51.1

Greene45.8

Fayette53.7

Westmoreland47.4

Armstrong41.5

Indiana44.2

Somerset38.5

Clarion51.8

Warren55

McKean44.7

Potter36.1 Tioga

40.2

Bradford12.9

Susquehanna45

Forest

Elk46.3

Jefferson43.3

Clearfield37.1

Cambria53.3

Bedford53.6

Blair49.6

Huntington38.8

Centre35.9

Clinton54.1

CameronLycoming

50.4

Sullivan

Mifflin50.4 Juniata

28.9

Fulton Franklin35.9

Perry39.8

Snyder40.8

Union30.8

Northumberland40.5

Lebanon45.2

Dauphin36.3

Cumberland39.7

Adams41

York44.2

Lancaster41.1

Berks47.6

Schuylkill42.7

Luzerne42.3


48

Wayne40.6

Pike39.6

Monroe39.1

Carbon55.9


47.8

Bucks47.9

Montgomery 46.8

Chester46.1

Delaware41.4

Philadelphia39.2

Columbia46.6

Montour 39.8Butler

46.7

Female urinary bladder cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2007–2011) 9.0 Pa. Rate—(2007–2011) 11.1

–

Erie9.7

Crawford7.1

Venango11.5

Mercer9.2

Lawrence12.1

Beaver13.7

Allegheny11.4

Washington11.7

GreeneFayette10.3

Westmoreland12.6

Armstrong9.9

Indiana11

Somerset15

Clarion

Warren McKean Potter Tioga Bradford12.9

Susquehanna

Forest

Elk17.7

Jefferson

Clearfield9.5

Cambria14.5

Bedford14.4

Blair9.9

Huntington

Centre7.4

Clinton

CameronLycoming

10

Sullivan

Mifflin13.7 Juniata

Fulton Franklin12.2

Perry

Snyder

Union

Northumberland8.4

Lebanon10.9

Dauphin7.3

Cumberland11.2

Adams10.3

York8.6

Lancaster9.3

Berks9.4

Schuylkill15.5

Luzerne12.8


Wayne10.6

Pike

Monroe11.7

Carbon10.7


11.6

Bucks11.9

Montgomery 11.1

Chester10.8

Delaware12.2

Philadelphia11.4

Columbia14.1

Montour

Butler10.2


FIGURE 88

The Pennsylvania death rate is numerically larger than the US death rate, for male urinary bladder cancer. However, the absolute mortality counts are low, and the two rates are close. Therefore, it cannot be said with reasonable certainty that the true Pennsylvania death rate is higher than the US rate. No clear pattern emerges, though again, some signifi cantly lower mortality rates appear in Southcentral Pennsylvania.

FIGURE 89

Very little data can be depicted for female urinary bladder cancer deaths. It is interesting to note, that Philadelphia has a signifi cantly higher female mortality rate than the state as a whole.

Male urinary bladder cancer deaths, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2006–2010) 7.7 Pa. Rate—(2007–2011) 8.7

–

Erie10.3

Crawford12.1

Venango

Mercer8.7

Lawrence10.1

Beaver10.7

Allegheny8.9

Washington12.3

GreeneFayette

5.7

Westmoreland8

Armstrong

Indiana

Somerset

Clarion


Forest

Elk

Jefferson

Clearfield8.8

Cambria10.2

Bedford

Blair10

Huntington

Centre9.3

Clinton

CameronLycoming

9.4

Sullivan

MifflinJuniata

Fulton Franklin6.2

Perry

Snyder

Union

Northumberland8.4

Lebanon8.8

Dauphin8.4

Cumberland4.4

Adams9.8

York9.4

Lancaster8.2

Berks9.1

Schuylkill7.2

Luzerne8.3


Wayne

Pike

Monroe7.6

Carbon15.7


7.9

Bucks10.3

Montgomery 7.8

Chester8.4

Delaware8.2

Philadelphia8.3

Columbia12.2

Montour

Butler7.1

Female urinary bladder cancer deaths, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates

The symbol, , represents the number of cancer deaths. A larger circle indicates a larger amount of cases.Note: Age-adjusted rates are per 100,000 and computed by the direct method using the 2000 U.S. standard million population. Rates based on less than 20 events are considered statistically unreliable.

U.S. Rate—(2006–2010) 2.2 Pa. Rate—(2007–2011) 2.4

–

Erie10.3

Crawford12.1

Venango

Mercer8.7

Lawrence10.1

Beaver10.7

Allegheny8.9

Washington12.3

GreeneFayette

5.7

Westmoreland8

Armstrong

Indiana

Somerset

Clarion


Forest

Elk

Jefferson

Clearfield8.8

Cambria10.2

Bedford

Blair10

Huntington

Centre9.3

Clinton

CameronLycoming

9.4

Sullivan

MifflinJuniata

Fulton Franklin6.2

Perry

Snyder

Union

Northumberland8.4

Lebanon8.8

Dauphin8.4

Cumberland4.4

Adams9.8

York9.4

Lancaster8.2

Berks9.1

Schuylkill7.2

Luzerne8.3


Wayne

Pike

Monroe7.6

Carbon15.7


7.9

Bucks10.3

Montgomery 7.8

Chester8.4

Delaware8.2

Philadelphia8.3

Columbia12.2

Montour

Butler7.1



FIGURE 810

There were 1,413 male and 455 female urinary bladder cancer hospitalizations in 2011. The number of urinary bladder cancer hospitalizations in Pennsylvania decreased 22.2% for males from 1,818 in 2001 to 1,413 in 2013 and 29.7% for females from 647 in 2001 to 455 in 2011.

FIGURE 811

The total hospitalization charges for urinary bladder cancer reached $84.2 million for Medicare in 2011, almost a 100% increase compared to 2001 ($42.2 million). The total hospitalization charges for urinary bladder cancer reached 8.2 million for Medicaid in 2011, about a 187% increase compared to 2001 ($2.9 million). The total charges to commercial insurance payers increased 78% from $14.0 million in 2001 to $24.6 million in 2011. Charges to Medicare were the highest over the years from 2001 to 2011, more than twice the charges to commercial payers.

Hospital admissions for urinary bladder cancer by sex in Pennsylvania, 2001-2011

NUM

BER

OF

HO

SPIT

AL

AD

MIS

SIO

NS

Year

Male Female

0

500

1000

1500

2000

20112010200920082007200620052004200320022001

Hospitalization charges for urinary bladder cancer by primary payer type in Pennsylvania, 2001-2011

MIL

LIO

N D

OLL

AR

S

Year


0

10

20

30

40

50

60

70

80

90

20112010200920082007200620052004200320022001


FIGURE 812

Age-adjusted urinary bladder cancer hospitalization rate for males were 4 times higher than the rates for females from 2001 to 2011. Age-adjusted urinary bladder cancer hospitalization rates decreased from 2001 to 2011 for both males and females.

FIGURE 813

Non-Hispanic white and non-Hispanic blacks had much higher age-adjusted urinary bladder cancer hospitalization rates than the rate for Hispanics from 2001 to 2011. The age-adjusted rate for non-Hispanic whites and non-Hispanic blacks increased from 2001 to 2011 while the age-adjusted hospitalization rate for Hispanics decreased from 2001 to 2011.

Year

Age-adjusted urinary bladder cancer hospitalization rate by sex in Pennsylvania, 2001-2011

Male Female

PER

100

,000

20112010200920082007200620052004200320022001

5

10

15

20

25

30

35

0

PER

100

,000

Year

NHW NHB Hispanic

Age-adjusted urinary bladder cancer hospitalization rate by race/ethnicity in Pennsylvania, 2001-2011

0

2

4

6

8

10

12

14

16

20112010200920082007200620052004200320022001

82 cancer burden | thyroid cancer

THYROID CANCER

Incidence

Thyroid cancer23 is a relatively common cancer, with 2,800 new invasive cases diagnosed in 2011. It also presents a very unusual and atypical burden for many reasons. Almost none of the typical cancer patterns of incidence and mortality hold for thyroid cancer. In contrast to all other non-female specifi c cancers,24 incidence rates for females are substantially higher than male incidence rates. Furthermore, white females have a higher incidence rate than black females, another oddity. Finally, in marked contrast to all other cancers covered in this report, other than melanoma of the skin, incidence rate has risen rather sharply over the past decade for females.

23 (Thyroid cancer incidence is defi ned using ICD-O-3 codes C739, excluding ICD-O-3 histologies 9590-9989. Thyroid cancer mortality is defi ned as ICD-10 code C73.)

24 (Excepting breast cancer – breast cancer is technically not female specifi c. Males can develop breast cancer, though this is rare.)

FIGURE 91

The 2011 incidence rates for black and white females, respectively, are 110.6 percent and 99.2 percent higher than the 2000 rates. Male incidence rates are low and have held steady or increased slightly since 2000. Unusually, white male incidence rates are slightly higher than black male incidence rates.

Year

Thyroid cancers, age-adjusted incidence rates by sex and race, Pennsylvania residents, 2000-2011



201120102009200820072006200520042003200220012000

PER

100

,000

5

10

15

20

25

30

35

0


Mortality

Despite thyroid cancer being a relatively common cancer, mortality rates are extremely low. In 2011, only 77 people in Pennsylvania died of thyroid cancer. The mortality rates for thyroid cancer are so low, that it is diffi cult to make any inferences from the mortality data. Insuffi cient data exists to depict mortality rates over time for any race/ethnicity and sex combinations other than white males and females.

FIGURE 92

It appears the mortality rate of thyroid cancer for white males and females is fairly similar, and that not much change has occurred in mortality rates for whites of either sex across the past decade.

Year

Thyroid cancer deaths, age-adjusted rates by sex and race, Pennsylvania residents, 2000-2011

White male White female

NOTES: Age-adjusted rates are computed by the direct method using the 2000 U.S. standard million population. Rates based on less than 10 events are considered statistically unreliable and are not displayed. Cancer primary site/type groupings follow the definitions used by the National Cancer Institute’s SEER program. *Insufficient data for black males and females.

201120102009200820072006200520042003200220012000

PER

100

,000

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7



Due to the low mortality counts, even three year aggregate data does not reveal much in regard to mortality disparities, though it does support the trend line data showing a large incidence disparity between females and males of all races. Though the racial breakout by sex has limited data to report, it appears white males and white females have the highest incidence rates of all racial and ethnic groups as seen in Figure 9-4. The incidence rate distribution across age groups is also highly unusual.

FIGURE 93

Thyroid incidence age group distribution shows measurable incidence rates for individuals as young as ten, which is atypical for cancer. The incidence rate rises steadily until approximately age forty-fi ve, at which point it stays relatively steady until approximately age seventy, when incidence declines steeply. Mortality rates are not measurably high for individuals under age fi fty, after which rates rise slowly, peaking in the highest age groups.

FIGURE 94

Age Group

Thyroid cancers, age-specific incidence and death rates, Pennsylvania residents, 2009-2011

Incidence Deaths


PER

100

,000

0

10

20

30

40

50

85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-1405-0900-04

Thyroid cancers, age-adjusted incidence and death rates* by sex and race/ethnicity, Pennsylvania, 2009-2011

Incidence Death

*Three-year average annual rates are per 100,000 and age-adjusted to the 2000 U.S.standard population.Note: ND indicates the data were not displayed due to low frequency counts <10.Hispanics can be of any race.

0 5 10 15 20 25 30 35

Hispanic females

Black females

Asian/PI females

White females

All females

Hispanic males

Black males

Asian/PI males

White males

All males

ND

ND

ND

ND

ND

PER 100,000


FIGURE 95

Most thyroid cancers are diagnosed in early stage, as high as 84.8 percent for black females. White males may have a disproportionately high late stage diagnosis rate, though the paucity of data makes that diffi cult to infer.

PER

CEN

T TO

TAL

CASE

S

Stage of Disease


Stage distribution of thyroid cancers at time of diagnosis by sex and race, Pennsylvania, 2009-2011*

*Rates are three-year average annual percentages and based on SEER Summary Stage definitions.Note: ND indicates the data were not displayed due to low frequency counts <10.

0

20

40

60

80

100


ND ND ND ND ND ND ND


Geographical Data

The one area in which thyroid cancer appears to comply with the typical trend of the cancers explored in this report is that the incidence rates for males and females in Pennsylvania is higher than the US rates. Some geographical patterns emerge for male and female incidence at the county level, but mortality is so low the mortality maps are almost devoid of usable data.

FIGURE 96

For males, the west central portion of the state contains three of the four counties with a signifi cantly higher incidence rate than the PA rate. Philadelphia shows a signifi cantly lower incidence rate, which again possibly refl ects local demographics.

FIGURE 97

More data is available for the female thyroid cancer incidence map. Clusters of counties with signifi cantly higher incidence rates for females occur in West Central and Northeastern portions of the state. A cluster of counties with signifi cantly lower incidence rates occurs in Southcentral Pennsylvania.

Male thyroid cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2007–2011) 6.7 Pa. Rate—(2007–2011) 9.6

–

Erie10

Crawford

Venango

Mercer12.6

Lawrence16.1

Beaver8.7

Allegheny11.9

Washington7.8

GreeneFayette12.3

Westmoreland11.3

Armstrong

Indiana

Somerset9.7

Clarion


Forest

Elk

Jefferson

Clearfield

Cambria8.6

Bedford

Blair6

Huntington

Centre7.8

Clinton

CameronLycoming

13

Sullivan

MifflinJuniata

Fulton Franklin6.3

Perry

Snyder

Union

Northumberland7.2

Lebanon8.9

Dauphin7.8

Cumberland8.2

Adams11.7

York11.5

Lancaster8.6

Berks8.6

Schuylkill8.2

Luzerne8.4


Wayne

Pike

Monroe7.2

Carbon11.9


9.6

Bucks10.9

Montgomery 9.5

Chester11.8

Delaware8.4

Philadelphia7.6

Columbia

Montour

Butler15.7

Female thyroid cancer incidence, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2007–2011) 20.5 Pa. Rate—(2007–2011) 28.8

–

Erie32.8

Crawford34.3

Venango21.7

Mercer33.1

Lawrence46.2

Beaver31.1

Allegheny37.7

Washington26.5

Greene37.6

Fayette30.7

Westmoreland29

Armstrong30.9

Indiana33.1

Somerset33.7

Clarion29.1

Warren23.3

McKean21.8

PotterTioga26

Bradford14.4

Susquehanna18.8

Forest

Elk35.2

Jefferson20.8

Clearfield20.2

Cambria31.2

Bedford33.6

Blair19.1

Huntington25

Centre23

Clinton33

CameronLycoming

36

Sullivan

Mifflin36.7 Juniata

Fulton Franklin23.7

Perry29.8

Snyder25.3

Union34

Northumberland22.1

Lebanon23

Dauphin21.1

Cumberland25.1

Adams34.8

York35.6

Lancaster23

Berks24.7

Schuylkill20.5

Luzerne39.4


39.8

Wayne36

Pike22

Monroe17.3

Carbon32


29.7

Bucks28.3

Montgomery 27

Chester33.1

Delaware24.9

Philadelphia21.9

Columbia32

Montour

Butler45


FIGURE 98

The only county in Pennsylvania with enough male deaths to calculate signifi cance was Philadelphia, which appears to not have a signifi cantly different death rate than the state as a whole. Mortality rate for males in Pennsylvania appears to be similar to the US rate.

FIGURE 99

Even for female thyroid death cancer rates, the only county with enough deaths to calculate signifi cance was again Philadelphia, which does not appear to differ signifi cantly from the state as a whole in mortality rate. Female thyroid mortality in Pennsylvania also appears to be similar to the US mortality rate.

Male thyroid cancer deaths, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2006–2010) 0.5 Pa. Rate—(2007–2011) 0.5

–

Erie

Crawford

Venango

Mercer

Lawrence

Beaver

Allegheny

Washington

GreeneFayette

Westmoreland

Armstrong

Indiana

Somerset

Clarion


Forest

Elk

Jefferson

Clearfield

Cambria

Bedford

Blair

Huntington

Centre

Clinton

CameronLycoming

Sullivan

MifflinJuniata

Fulton Franklin

Perry

Snyder

Union

Northumberland

LebanonDauphin

Cumberland

Adams York

Lancaster

Berks

Schuylkill

Luzerne

WyomingLackawanna

Wayne

Pike

Monroe

Carbon

Northampton

Lehigh

Bucks

Montgomery

Chester

Delaware

Philadelphia0.7

Columbia

Montour

Butler

Female thyroid cancer deaths, 2007-2011Significant differences between Pennsylvania county and state age-adjusted rates


U.S. Rate—(2006–2010) 0.5 Pa. Rate—(2007–2011) 0.5

–

Erie

Crawford

Venango

Mercer

Lawrence

Beaver

Allegheny

Washington

GreeneFayette

Westmoreland

Armstrong

Indiana

Somerset

Clarion


Forest

Elk

Jefferson

Clearfield

Cambria

Bedford

Blair

Huntington

Centre

Clinton

CameronLycoming

Sullivan

MifflinJuniata

Fulton Franklin

Perry

Snyder

Union

Northumberland

LebanonDauphin

Cumberland

AdamsYork

Lancaster

Berks

Schuylkill

Luzerne

WyomingLackawanna

Wayne

Pike

Monroe

Carbon

Northampton

Lehigh

Bucks

Montgomery

Chester

Delaware

Philadelphia0.7

Columbia

Montour

Butler



FIGURE 910

There were 454 male and 1,164 female thyroid cancer hospitalizations in 2011. Females had approximately three times the thyroid cancer hospitalizations than males from 2001 to 20011. The total number of female thyroid cancer hospitalizations increased from 1,138 in 2001 to 1,229 in 2009 then decreased from 2009 to 2011. The total number of thyroid cancer hospitalizations for males increased 34.3 percent from 338 in 2001 to 454 in 2011.

FIGURE 911

Total hospitalization charges for thyroid cancer to commercial insurance were the highest from 2001 to 2011 followed Medicare and Medicaid. The total charges to Medicare for thyroid cancer in 2011 were $18.3 million, about 3 times of the total charges in 2001 ($66 million). The total hospitalization charges for thyroid cancer to Medicaid also increased 3 times from $1.8 million in 2001 to $6.5 million in 2011.

Hospital Admissions for Thyroid Cancer by Sex in Pennsylvania, 2001-2011

NUM

BER

OF

HO

SPIT

AL

AD

MIS

SIO

NS

Year

Male Female

0

200

400

600

800

1000

1200

1400

20112010200920082007200620052004200320022001

Hospitalization charges for thyroid cancer by primary payer type in Pennsylvania, 2001-2011

MIL

LIO

N D

OLL

AR

S

Year


0

5

10

15

20

25

30

35

40

20112010200920082007200620052004200320022001


FIGURE 912

Age-adjusted thyroid cancer hospitalization rates for females were consistently about 3 times higher than the rates for males from 2001 to 2011. Age-adjusted thyroid cancer hospitalization rates increased from 5.5 per 100,000 in 2001 to 6.5 per 100,000 in 2011 for females while male thyroid cancer age-adjusted hospitalization rates stayed the same in 2001 and in 2011.

FIGURE 913

Non-Hispanic whites had the highest age-adjusted thyroid cancer hospitalization rate in 2011 (12.14 per 100,000) followed by non-Hispanic blacks (11.84 per 100,000) and Hispanics (3.67 per 100,000). The age-adjusted hospitalization rate increased from 2001 to 2011 for non-Hispanic whites and non-Hispanic blacks but not for Hispanics. The Hispanic age-adjusted hospitalization rate decreased 12.2 percent from 4.18 per 100,000 in 2001 to 3.67 per 100,000 in 2011 while age-adjusted rates for non-Hispanic whites and non-Hispanic blacks increased 24.5 percent and 18.2 percent, respectively.

Year

Age-adjusted thyroid cancer hospitalization rate by sex in, Pennsylvania, 2001-2011

Male Female

PER

100

,000

20112010200920082007200620052004200320022001

5

10

15

20

0

PER

100

,000

Year

NHW NHB Hispanic

Age-adjusted thyroid cancer hospitalization rate by race/ethnicity in Pennsylvania, 2001-2011

0

2

4

6

8

10

12

14

16

20112010200920082007200620052004200320022001

90 appendix

APPENDIX

Table 1. Population by Race and Ethnicity, Pennsylvania, 2000 and 201025

2000 2010

White BlackAsian/ Pacifi c Islander

Hispanic White BlackAsian/ Pacifi c Islander

Hispanic

Pennsylvania 10,484,203 1,224,612 223,230 394,088 10,406,288 1,377,689 352,741 719,660

Adams* 87,088 1,105 469 3,323 94,979 1,561 766 6,115

Allegheny 1,080,800 159,058 22,051 11,166 997,295 161,861 34,368 19,070

Armstrong* 71,173 592 102 308 67,565 553 159 366

Beaver 167,890 10,811 482 1,315 155,561 10,676 764 1,998

Bedford* 49,253 178 150 263 48,782 238 115 450

Berks 329,460 13,778 3,862 36,357 342,148 20,143 5,513 67,355

Blair* 126,059 1,535 482 662 122,238 2,129 735 1,230

Bradford* 61,471 251 289 398 61,035 311 346 702

Bucks 552,588 19,495 13,791 14,005 557,647 22,376 24,182 26,782

Butler* 170,302 1,367 1,032 1,016 177,605 2,021 1,888 1,941

Cambria* 146,183 4,322 610 1,352 135,206 5,222 758 2,006

Cameron* 5,904 21 10 34 5,000 13 14 19

Carbon* 57,520 353 203 858 62,519 976 338 2,145

Centre* 124,134 3,544 5,467 2,243 137,625 4,638 8,034 3,690

Chester 386,745 27,040 8,608 16,126 426,707 30,623 19,457 32,503

Clarion* 40,998 329 144 172 38,873 484 199 245

Clearfi eld* 81,218 1,239 230 471 77,912 1,862 405 1,907

Clinton* 37,264 197 160 205 37,860 625 215 437

Columbia* 62,602 516 355 609 64,227 1,246 578 1,349

Crawford* 87,653 1,437 277 537 85,448 1,547 422 823

Cumberland 201,716 5,048 3,655 2,883 213,934 7,527 7,137 6,448

Dauphin 194,158 42,580 5,013 10,404 194,910 48,386 8,658 18,795

Delaware 442,449 79,981 18,203 8,368 405,233 110,260 26,422 16,537

Elk* 34,746 52 137 142 31,469 89 102 183

Erie 255,282 17,202 1,990 6,126 247,569 20,155 3,167 9,518

Fayette* 141,657 5,223 341 564 127,418 6,325 429 1,049

Forest* 4,745 110 7 60 5,937 1,389 13 418

Franklin* 123,279 3,016 757 2,268 137,674 4,700 1,339 6,438

Fulton* 14,012 94 17 52 14,450 151 20 123

Greene* 38,665 1,585 96 357 36,584 1,282 120 465

25 (Pennsylvania Department of Health, 2014)

91 appendix

2000 2010



Hispanic

Huntingdon* 42,544 2,342 98 524 42,470 2,392 186 727

Indiana* 86,796 1,407 673 457 84,360 2,434 784 947

Jefferson* 45,457 59 102 188 44,446 157 95 275

Juniata* 22,376 85 96 369 23,845 151 88 623

Lackawanna 206,160 2,793 1,624 2,958 197,296 5,423 3,699 10,682

Lancaster 430,456 12,993 6,960 26,742 460,171 19,035 10,024 44,930

Lawrence* 89,894 3,416 267 529 85,484 3,501 380 931

Lebanon 113,662 1,548 1,110 5,969 121,566 2,885 1,569 12,410

Lehigh 271,590 11,097 6,668 31,881 276,286 21,440 10,373 65,615

Luzerne 308,476 5,408 1,907 3,713 290,943 10,767 3,192 21,491

Lycoming* 112,737 5,189 521 799 107,573 5,203 696 1,559

McKean* 44,312 860 150 485 41,661 1,046 196 757

Mercer* 112,031 6,318 513 803 106,890 6,726 744 1,248

Miffl in* 45,803 226 137 263 45,531 300 175 534

Monroe* 122,342 8,343 1,585 9,195 131,162 22,348 3,563 22,288

Montgomery 648,510 55,969 30,446 15,300 649,021 69,351 51,861 34,233

Montour* 17,628 185 234 167 17,408 256 328 324

Northampton 243,639 7,400 3,737 17,868 256,895 14,986 7,301 31,179

Northumberland* 91,803 1,439 227 1,041 90,156 1,921 345 2,253

Perry* 42,964 189 70 301 44,779 296 183 588

Philadelphia 683,267 655,824 68,383 128,928 626,221 661,839 97,149 187,611

Pike* 43,109 1,513 288 2,315 50,856 3,322 613 5,173

Potter* 17,729 52 95 103 17,128 67 46 181

Schuylkill* 145,249 3,147 644 1,671 140,013 3,967 736 4,080

Snyder* 36,768 307 158 368 38,476 428 220 657

Somerset* 77,938 1,275 178 532 74,603 1,863 256 840

Sullivan* 6,266 144 10 72 6,163 168 20 92

Susquehanna* 41,621 128 98 285 42,510 156 135 564

Tioga* 40,589 250 128 214 40,852 333 187 437

Union* 37,496 2,878 460 1,622 39,414 3,324 546 2,346

Venango* 56,208 626 143 298 53,390 571 208 478

Warren* 43,286 90 126 151 41,031 149 169 305

Washington* 193,297 6,606 769 1,170 195,657 6,757 1,358 2,366

Wayne* 46,160 757 183 811 49,759 1,644 259 1,816

92 appendix

2000 2010



Hispanic

Westmoreland 357,325 7,446 1,984 1,869 348,182 8,562 2,766 3,179

Wyoming* 27,598 149 79 187 27,545 208 98 437

York 354,103 14,095 3,389 11,296 385,135 24,344 5,530 24,397

Note: Hispanic origin can be of any race. White, black, and Asian in this chart include those of Hispanic origin. Asterisk (*) indicates rural counties, per Center for Rural Pennsylvania defi nition.

Documents

THE BURDEN OF Cancer - Department of Health Home · The Pennsylvania Cancer Registry (PCR) is the statewide data system established by the Pennsylvania Cancer Prevention, Control