17
Additionally, several data sources are used to describe the burden of risk factors (e.g., obesity) and cancer screen-ing rates among Indiana residents. The Behavioral Risk Factor Surveillance System (BRFSS) is the main source utilized to do this because it provides yearly data that can be used to generate Indiana-speci�c estimates for a large number of cancer risk and preventative factors. These �ndings can then be tracked over time and compared to other states to evaluate how Indiana is progressing in those areas.
Additional local, state, and national data resources can be found in the Indiana Community Health Information Resource Guide (www.indianactsi.org/chep/resourceguide).
ReferencesAmerican Cancer Society. Heredity and Cancer. [Online] Jul 2009. Accessed at www.cancer.org/Cancer/CancerCauses/GeneticsandCancer/heredity-and-cancer on Nov 15, 2011.American Cancer Society. Cancer Facts & Figures 2011. Atlanta, GA. 2011. Accessed at www .cancer.org/Research/CancerFactsFigures/index on Nov 23, 2011.Indiana Behavioral Risk Factor Surveillance System. Accessed at www.in.gov/isdh/25194.htm on Nov 23, 2011Harvard University. Harvard Report on Cancer Prevention, Vol 1: Causes of Human Cancer. [Online] April 2009. Accessed at www.health.harvard.edu/newsletters/Harvard_Mens_Health_Watch/2009/April/The-10-commandments-of-cancer-prevention on Nov 15, 2011. Howlader N et al. SEER Cancer Statistics Review, 1975–2008. National Cancer Institute. Bethesda, MD, [Online] Nov 2010. Accessed at www.cancer.gov/csr/1975_2008 on Nov 15, 2011.American Cancer Society. Infectious Agents and Cancer. [Online] Sept 2011. Accessed at www.cancer.org/Cancer/CancerCauses/OtherCarcinogens/InfectiousAgents/InfectiousAgentsandCancer/infectious-agents-and-cancer -intro on Nov 23, 2011.De-Navas-Walt C, Proctor B, Smith J. Income, Poverty, and Health Insurance Coverage in the United States: 2010. [Online] September 2011. Accessed at www.census.gov/prod/2011pubs/p60-239.pdf on Nov 15, 2011.American Cancer Society. What is Cancer? [Online] Mar 2010. Accessed at www.cancer.org/Cancer/CancerBasics/what-is-cancer on Nov 15, 2011.Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2010. Accessed at apps.nccd.cdc.gov/BRFSS on Nov 23, 2011.American Cancer Society. Economic Impact of Cancer. [Online] Aug 2011. Accessed at www.cancer.org/Cancer/CancerBasics/economic-impact-of-cancer on Nov 23, 2011.DeVol R, Bedroussian A. An Unhealthy America: The Economic Burden of Chronic Disease. Milken Institute. [Online] Oct 2007. Accessed at www.milkeninstitute.org/publications on Oct 26, 2011.
Common Questions about Cancer
Table 2. Indiana Cancer Incidence Rates by County, 2004–2008*
DENOTE IF COUNTY RATE IS SIGNIFICANTLY DIFFERENT THAN STATE RATE†
= higher = lower “blank” = no di�erence
18
Common Questions about Cancer
Table 2. Indiana Cancer Incidence Rates by County, 2004–2008*
DENOTE IF COUNTY RATE IS SIGNIFICANTLY DIFFERENT THAN STATE RATE†
= higher = lower “blank” = no di�erence
*Rates are per 100,000 people and age-adjusted to the 2000 U.S. Standard Population†“ ” symbols denote whether the county’s rate is signi�cantly di�erent than the Indiana rate based on the 95% con�dence interval overlap method (see Page 4 for description). Because of limitations of this method, some of the counties without symbols could still have signi�cantly di�erent rates than the state. “x” Rate and comparison to state rate is suppressed if fewer than 20 cases occurred because rate is considered unstable. Source: Indiana State Cancer Registry
19
Common Questions about Cancer
DENOTE IF COUNTY RATE IS SIGNIFICANTLY DIFFERENT THAN STATE RATE†
= higher = lower “blank” = no di�erence
Table 3. Indiana Cancer Mortality (Death) Rates by County, 2004–2008*
20
Common Questions about Cancer
DENOTE IF COUNTY RATE IS SIGNIFICANTLY DIFFERENT THAN STATE RATE†
= higher = lower “blank” = no di�erence
Table 3. Indiana Cancer Mortality (Death) Rates by County, 2004–2008*
*Rates are per 100,000 people and age-adjusted to the 2000 U.S. Standard Population†“ ” symbols denote whether the county’s rate is signi�cantly di�erent than the Indiana rate based on the 95% con�dence interval overlap method (see Page 4 for description). Because of limitations of this method, some of the counties without symbols could still have signi�cantly di�erent rates than the state. “x” Rate and comparison to state rate is suppressed if fewer than 20 deaths occurred because rate is considered unstable; counts <5 are suppressed to maintain con�dentiality. Source: Indiana State Cancer Registry
21
Map 1. Incidence Rates for All Cancers Combined by County—Indiana, 2004–2008
*Signi�cantly di�erent (higher or lower) than state rate (P<.05)Technical note: This map presents age-adjusted county incidence rates using a smoothed interpolated surface and is intended to provide a generalized depiction of rate variability throughout the state.Source: Indiana State Cancer Registry
Common Questions about Cancer
Ohio485.3
Cass455.9
Knox483.5
Owen468.7
Rush465.4
Scott442.6
Noble470.2
Wayne492.9
Parke445.7
White507.4
Allen477.4
Floyd452.9
Perry458.5
Miami444.8
Porter479.1
Wabash450.5
Martin473.3
Monroe476.4
Orange436.7
Tipton438.8
Starke465.5
Shelby464.3
Putnam501.4
Newton459.2
Morgan475.8
Benton503.8
Whitley479.3
Pulaski507.9
Carroll496.6
Madison463.2
Johnson473.4
Hancock477.1
Decatur475.9
De Kalb497.5
Steuben485.5
Clinton461.2
Daviess454.3
Fayette457.6
Sullivan465.6
Marshall482.7
Delaware491.7 Randolph
493.0Fountain500.8
Crawford484.9
Jennings462.8
LaPorte483.0
Lawrence469.3
Blackford495.0
Jefferson502.0
Huntington470.4
Tippecanoe484.2
Washington439.8
Verm.500.4
Bartholomew458.7
Jay519.9*
Vigo525.7*
Pike395.2*
Lake502.5*
Clay533.1*
Grant531.3*
Henry512.0*
Brown397.1*
Wells433.1*
Adams430.2*
Posey404.5*
Boone422.1*
Clark532.7*
Union283.5*
Marion490.8*
Jasper548.4*
Howard499.8*
Ripley517.5*
Warren384.9*
Fulton528.9*
Gibson395.9*
Dubois419.4*
Greene435.8*
Jackson522.8*
Spencer425.3*
Elkhart455.3*
Warrick406.6*
Dearborn562.6*
Franklin353.9*
Harrison439.7*
LaGrange373.2*
Hamilton408.2*
Kosciusko439.1*
Hendricks451.2*
St. Joseph503.6*
Montgomery439.8*
Vander-burgh435.9*
Switzerland562.4*
Lower Rates
Higher Rates
*Age-adjusted†Based on age-speci�c rates for children ages 0–19‡ The incidence of cancer among Indiana children ages 0–19 during 2004–2008 (19.6 cases per 100,000 children) was slightly higher than the reported national rate of 17.1 cases per 100,000 children. However, there appears be some underreporting of the U.S. data, as the source used to obtain the U.S. rate listed the Indiana rate as 17.5, not 19.6, cases per 100,000 children. Based on this other source of data, the Indiana rate is only 2.3% higher than the national rate.
Note: symbols denote whether Indiana’s rate is signi�cantly di�erent than the U.S. rate based on the 95% con�dence interval overlap method (see Page 4 for description). = signi�cantly higher; = signi�cantly lower.
Sources: Indiana State Cancer Registry (Indiana data); U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2008 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2011. Accessed at wonder.cdc.gov on Dec 21, 2011. (U.S. data)
22
Map 2. Incidence Rates for Selected Cancer Types by County—Indiana, 2004–2008
*Signi�cantly di�erent (higher or lower) than state rate (P<.05) Technical note: This map presents age-adjusted county incidence rates using a smoothed interpolated surface and is intended to provide a generalized depiction of rate variability throughout the state.Source: Indiana State Cancer Registry
Lung Cancer Colon & Rectum Cancer
Breast Cancer Prostate Cancer
Common Questions about Cancer
Lower Rates Higher Rates
99.2
#
131.8
146.4
119.1
153.1
157.4
129.9
136.5
145.8
121.9
114.8
145.3
112.2
113.0
120.9
108.2
156.5
154.7
131.7
111.5
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104.1
123.8
148.6
132.5
135.4 129.1
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127.7
125.4
118.3
109.9
111.5
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116.1
150.8
143.5
138.9
151.1
119.4
120.7
132.3
112.4
108.1
123.1
127.2
133.1
144.5
179.2
135.2
127.2
146.7
121.4
118.5
133.4
130.4
131.8
135.7
122.7
113.9
141.6
180.6
169.3
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96.0*96.6*
80.3*
98.3*
78.7*
93.1*
99.6*
99.2*
78.4*
78.9*
99.4*
200.5*
161.7*
160.4*
100.6*
158.2*
159.7*
167.3*
156.0*
173.0*
153.8*
155.8*
115.2*
175.8*
103.5*
111.8*
92.0*
75.4
98.5*
75.2
92.1
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73.1
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80.0
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78.5
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74.3
90.5
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71.275.8
68.2*
84.9
78.8
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75.7
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96.4*
88.8*
83.6
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73.4
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71.6
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89.4
84.8
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88.9
66.3*
77.0
92.2
88.4
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56.5*
65.3*
87.9
69.3*
73.3
55.2*
65.5
70.2
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71.9
91.8
78.3
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84.9
86.1
79.0
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89.5
91.8
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77.9
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82.3
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49.0*
107.1*
100.3*
102.8*
105.5*
103.5*
50.0
52.2
52.9
47.1
54.066.3
60.0
57.8
59.8
47.2
56.3
57.4
48.7
54.4
65.9
42.9
46.2
59.4
51.9
53.8
56.8
61.8
57.5
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48.7
54.5
45.3
49.1
51.2
47.9
50.0
44.8
48.5
45.1
50.7
49.1
65.4
57.5
54.4
57.7
49.3
42.4
57.1
47.6
46.9
46.1
47.5
51.4
50.1
55.3
56.6
50.6
50.9
54.9
48.2
45.5
48.4
46.5
55.6
46.9
59.3
51.0
53.6
50.3
45.4
49.5
48.5
49.8
53.3
63.9
53.8
29.6
68.0*
67.8*
68.2*
31.3*
43.2*
64.1*
43.2*
35.4*
43.7*
67.1*
64.3*
35.2*
63.8*
83.7*
40.5*
36.9*
59.0*
61.4*
37.8*
73.9*
96.8
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92.6
94.9
93.8
97.0
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87.3*
94.8
98.7
97.3
80.2*
69.3
116.8
127.1
104.7
102.4
103.5
115.4
138.6*
125.8
139.7*
110.1
117.3
103.5
114.1
113.4
112.5
121.3
124.7
114.5
122.7
111.0
112.6
113.4
104.0
118.1
118.1
103.6
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114.5
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128.7
113.5
101.0
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117.4
117.2
100.3
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112.4
117.7
126.9
122.1
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107.9
116.8
129.9
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121.5
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124.5
115.4
105.2
116.2
117.6
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132.0
107.0
104.8
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110.7
120.3
120.2
115.4
132.9
118.7
100.0
111.2
104.2
128.6
#
#
#
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