Cancer

Healthy Kansans 2010

Steering Committee Meeting

May 12, 2005

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Description of the Problem Cancer will affect one of every three individuals

during their lifetime. About 13,000 Kansans were diagnosed with cancer

last year. Cancer accounts for approximately 22 percent of all

deaths in Kansas. 5,285 Kansans died of cancer in 2003. Cancer is the second leading cause of death in our

state. Minorities die of cancer at a greater rate than white

Kansans. Kansas spends $1.6 billion annually on cancer.

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16.017.6

15.316.9 17.6

37.8 37.8 37.7

40.940.0

2.1 2.3 3.01.5 1.3

26.425.4

28.3

22.2

26.4

2.3 1.8 2.0 2.8 2.4

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

1998 1999 2000 2001 2002

C olorectal

Lung & Bronchus

Skin M elanoma

Breast

C ervix

Age-Adjusted Cancer D eath Rates By Site Am ong Fem ale R esidents in K ansas (1998 -2002)

Y ear

Age

-Ad

just

ed D

eath

Rat

e (P

er 1

00,0

00 P

opu

lati

on)

Rates are per 100,000 Female Population and age-adjusted to the 2000 U .S. Standard Population. D ata Source: Kansas V ital Statistics database, Center for Health and Environm ental Statistics, Kansas Departm ent of Health & Environm ent.

In 2002, age-adjusted cancer death rate (all sites) among females in Kansas was 160.5/100,000 population, lower than that of the US 163.1/100,000 population.1

Lung cancer is the leading cause of death among females as well as males Kansans.2

1. US DHHS/CDC/NCHS, Compressed Mortality File compiled from 1999-2002 on CDC Wonder on-line Database; 2. Kansas Annual Summary of Vital Statistics –2003, Kansas Department of Health and Environment.

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Age-Adjusted Cancer Death Rates By Site Among Male Residents in Kansas (1998-2002)

23.124.7

22.524.8 23.5

76.0 76.974.5

76.7

71.1

31.228.5 28.6 28.0

4.5 4.2 3.4 4.3 2.9

27.2

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1998 1999 2000 2001 2002

Colorectal

Lung & Bronchus

Prostate

Skin Melanoma

Age

-Ad

just

ed D

eath

Rat

e (P

er

100,

000

Pop

ula

tion

)

YearRates are per 100,000 Male Population and age-adjusted to the 2000 U.S. Standard Population. Data Source: Kansas Vital Statistics database, Center for Health and Environmental Statistics, Kansas Department of Health & Environment.

In 2002, age-adjusted cancer death rate (all sites) among males in Kansas was 231.8 per 100,000 population, higher than that of female counterparts but lower than that of the United Stated male residents (238.9 per 100,000).1

Colon cancer is the third leading cause of death in men as well as in women in Kansas. The same trend is observed in the United States.2

1. US DHHS/CDC/NCHS, Compressed Mortality File compiled from 1999-2002 on CDC Wonder on-line Database; 2. Kansas Annual Summary of Vital Statistics- 2003, Kansas Department of Health and Environment.

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Age-Adjusted Mortality Rates of Cancer (All Sites) Among White and Black Kansans, 1993-2003.

196.4 202.6 197.0 196.2 191.4 184.5 190.7 187.6 189.7 184.6 183.9

259.8 254.7275.0 271.0

241.5

280.0262.5 269.8

288.5274.1

241.0

0

50

100

150

200

250

300

350

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Whites African-Americans

1. United Cancer Statistics: 2001 Incidence and Mortality, DHHS/CDC/NCI 2004

Ra

tes

pe

r 1

00

,00

0 p

op

ula

tio

n

Year

Similar to national trend, African American Kansans have a higher age-adjusted cancer death rate (all sites). In the United States, cancer deaths for men are highest in blacks, followed by whites, Hispanics, and Asian/Pacific Islanders 1.

Adjusted to 2000 US Population. Source: Kansas Information for Communities. Center for Health and Environmental Statistics, KDHE

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Age-Adjusted Invasive Cancer Incidence Rates By Primary Site Among Female Residents in Kansas (1997-2002)

122.0

128.6132.2 131.8 134.1

126.4

9.0 9.4 9.0 9.1

11.3 12.5 12.2 13.5 13.5 12.5

45.7

46.340.7 42.2

45.045.844.4

47.7 45.344.5

42.142.2

6.27.60

20

40

60

80

100

120

140

1997 1998 1999 2000 2001 2002

Colorectal

Lung & Bronchus

Breast

Cervical

Skin Melanoma

Age

-Ad

just

ed I

nci

den

ce R

ate

(Per

100

,000

P

opu

lati

on)

Year

Rates are per 100,000 Female Population and age-adjusted to the 2000 U.S. Standard Population. Data Source: Kansas Cancer Registry

Invasive cancer age-adjusted incidence rate (all sites) among females in Kansas was essentially stable during 1997 to 2002 (424/100,000 in 2001).1 This incidence rate was higher than that of females in the United States (405/100,000 in 2001).2

Among female Kansans, breast cancer was the most frequently diagnosed cancer (126.4/100,000 in 2002), but represented the second leading cause of death.1 1. Kansas Cancer Registry Annual Reports, Cancer Incidence and Mortality in Kansas, 1997-2002. University of Kansas Medical Center;

2. United Cancer Statistics: 2001 Incidence and Mortality, DHHS/CDC/NCI 2004

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Age-Adjusted Invasive Cancer Incidence Rates By Primary Site Among Male Residents in Kansas (1997-2002)

60.164.2 64.6 61.8 62.5

54.4

82.3 81.5 82.4 79.5 79.871.8

164.0160.2 163.8 161.9

154.3 151.0

19.8 18.3 21.1 19.2 17.1 20.3

0

20

40

60

80

100

120

140

160

180

1997 1998 1999 2000 2001 2002

Colorectal

Lung & bronchus

Prostate

Skin Melanoma

Age

-Ad

just

ed I

nci

den

ce R

ate

(Per

10

0,00

0 P

opu

lati

on)

YearRates are per 100,000 Male Population and age-adjusted to the 2000 U.S. Standard Population. Data Source: Kansas Cancer Registry

Invasive cancer age-adjusted incidence rate (all sites) among males in Kansas was also stable during 1997 to 2002 (449/100,000 in 2001).1 In 2001, this incidence rate was lower than that of all males in the United States (544.8/100,000).2

African American Kansans experience a higher age-adjusted incidence rate of prostate cancer (221/ 100,000 male population) compared to White Kansans (153/100,000 male population).2

1. Kansas Cancer Registry Annual Reports, Cancer Incidence and Mortality in Kansas, 1997-2002. University of Kansas Medical Center;

2. United Cancer Statistics: 2001 Incidence and Mortality, DHHS/CDC/NCI 2004

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Breast Cancer in Kansas The most frequently diagnosed cancer among women in

Kansas. Second leading cause of cancer death among women. Most common among women ages 65 to 74 years White females are more often diagnosed with invasive

breast cancer than African-American women. Women living in household with an income of $20,000

or less, women of Hispanic origin, and women living in rural areas are at a higher risk for not having a mammogram within the past 2 years. (KS BRFSS 2001-2002).

From 1997 to 2002, breast cancer has shown a slight increase in incidence (from 122.0 to 126.4 cases per 100,000 female population).

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Cervical Cancer in Kansas Cervical cancer accounts for about 2% all

cancers. From 1997 to 2001, 599 new cases of invasive

cervical cancer were diagnosed. Death rates for cervical cancer is low due to early

detection and screening. However, women of Hispanic origin are less

likely than others to report that they have received a Pap smear within the past 2 years.

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Colorectal Cancer in Kansas

Third leading cause of death among male and female Kansans.

From 1997-2001, 7,466 Kansans were diagnosed with colorectal cancer and 2,790 died.

During the same period higher incidence of the disease was seen among Whites.

African Americans die of the disease at a higher rate compared to Whites (30.5/100,000 vs. 19.8 cases per 100,000, age-adjusted).

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Lung Cancer in Kansas

Lung cancer is the leading cause of cancer death among both sexes.

From 1997-2001, 8,479 persons were diagnosed with the disease and 7,401 individuals in Kansas during that same period died from the disease.

The prognosis for lung cancer is poor; only 14% of persons with the disease will be alive five years after diagnosis. Therefore, prevention of lung cancer is very important.

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Lung Cancer in Kansas - Cont’d

Tobacco smoking is estimated to account for 87% of all lung cancer cases and an additional 2% are attributed to exposure to second hand smoke. Therefore, tobacco use prevention and control is very important to reduce lung cancer morbidity and mortality.

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Prostate Cancer in Kansas Invasive prostate cancer is found mainly among

men age 50 or older. From 1997-2001, about 9,500 persons were

diagnosed with the disease and about 300 individuals die of the disease yearly.

A decline has been seen in the incidence of prostate cancer, from 164/100,000 male population in 1997 to 151/100,000 in 2002.

African American men are at a higher risk of dying of the disease than Whites.

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Skin Cancer in Kansas As many as 12,000 new cases of skin cancer are

diagnosed each year. Data regarding skin cancer are limited. (some

cancers are not reported in registries). From 1997 to 2001, 2,117 cases of invasive

melanoma were reported. During the same period, nearly 400 persons died from the disease. However, melanoma rates remained steady during the same period (16/100,000 population, age-adjusted).

Young individuals are at high risk for developing the disease.

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How Are We Addressing This Issue in Kansas Now? Kansas Cancer Partnership Early Detection Works Cancer Registry Patient Navigator Project Outreach to Minority Groups

4-Tribes Wellness Coalition Project. Heartland American Indian Cancer Coalition. Witnessing the Heartland Project among African

American women. American Indian Survey Project (BRFSS).

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How Are We Addressing This Issue in Kansas Now? – Cont’d

Kansas Cancer Partnership Goal: reduce the burden of cancer in Kansas. Focus: cancer issues across a continuum of care. First step: a comprehensive cancer control plan. Current activities: planning for implementation of

strategies recommended in the comprehensive cancer

plan.

Cancer control has impact on most of the 10 leading indicators as physical activity, overweight and obesity, tobacco use, responsible sexual behavior, mental health, environmental quality, and access to health care.

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Kansas’ Assets for Improving This Health Issue

The comprehensive cancer control plan. Strong data systems and ability to expand

Kansas Cancer Registry, BRFSS, Vital Statistics (mortality data), Hospital Discharge data.

Access to cancer information via: www.preventionworkskansas.com, Tobacco quit line: 1-866-KAN-STOP.

Screening services through Early Detection Works (KDHE) and Susan B. Komen Breast Cancer Foundation.

Local Health Departments: preventive services, support groups. Numerous partnerships including: Kansas Medical Society, Mid-

America Healthcare Coalition, American College of Surgeons, KU Med Center, K-State, ACS, Susan B. Komen, and others.

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Barriers or Liabilities That Are Limiting Progress in Kansas

Data gaps and linkage problems. Lack of awareness among the public. Lack of funding. Unequal access to prevention and treatment

leading to disparities. Quality of care needs attention.

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Barriers or Liabilities That Are Limiting Progress in Kansas – Cont’d

High prevalence of risk behaviors in the population.

Incomplete, hard to find, difficult to understand sources of cancer information.

Screening guidelines are not consistent across different organizations (USPSTF, ASC, NCI, etc.).

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Recommendations

Need for more support, more backing, and more assistance throughout the implementation process of the comprehensive cancer control plan.

Strengthen existing partnerships and develop new ones.

Strong coordination between health professionals/ organizations (clinical and public health), policy makers and other partners to address cancer issues in Kansas.

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Gary Doolittle, MD Chair,Kansas Cancer Partnership