Download Wisconsin Cancer Facts and Figures, 2011

Wisconsin
Cancer Facts
& Figures 2011
Table of Contents
Welcome Letters…………………………………………………………………………………………………………………1
Cancer: Basic Facts………………………………………………………………………………………………………………3
Understanding Cancer Incidence and Mortality Rates…………………………………………………………………………
5
Data Sources………………………………………………………………………………………………………………………
7
Wisconsin Cancer Incidence and Mortality Data………………………………………………………………………………8
Trends in Cancer Incidence and Mortality in Wisconsin………………………………………………………………………
14
Lung & Bronchus Cancer/Tobacco Control in Wisconsin……………………………………………………………………16
Colorectal Cancer in Wisconsin…………………………………………………………………………………………………
20
Female Breast Cancer in Wisconsin……………………………………………………………………………………………23
Prostate Cancer in Wisconsin…………………………………………………………………………………………………26
Melanoma/Skin Cancer in Wisconsin…………………………………………………………………………………………28
Cervical Cancer in Wisconsin……………………………………………………………………………………………………
30
Childhood Cancer in Wisconsin………………………………………………………………………………………………32
Nutrition, Physical Activity, Obesity, Alcohol and Cancer……………………………………………………………………33
Cancer in Diverse Populations……………………………………………………………………………………………………
39
Cancer Survivorship and Quality of Life………………………………………………………………………………………42
Wisconsin Comprehensive Cancer Control Plan…………………………………………………………………………… 44
Wisconsin Well Woman Program…………………………………………………………………………………………… 46
Wisconsin Cancer Incidence and Mortality by County………………………………………………………………………47
Glossary of Terms………………………………………………………………………………………………………………56
Acknowledgements
Special thanks for their contributions and assistance go to:
Wisconsin Cancer Reporting System
Mary Foote, M.S.
Laura Stephenson, B.A.
Wisconsin Office of Health Informatics
Anne Ziege, Ph.D.
Wisconsin Comprehensive Cancer Control Program
Amy Conlon, M.P.H.
American Cancer Society
Beth Brunner, B.S.
Wisconsin Well Woman Program
Gale Johnson, M.P.A.
The American Cancer Society saves lives and is creating a world with more birthdays. Due – in
large part – to our lifesaving work, the five-year survival rate for all cancers is now 68 percent.
Every day, we are creating more than 350 more birthdays.
The American Cancer Society has helped save countless lives. Yet, lives are still being lost to
cancer. Until cancer is eliminated, we will continue to fight for every cancer, in every community
by helping people:
• Stay well – Nearly 65% of Wisconsin women over the age of 40 receive an annual mammogram
to aid in the detection of breast cancer when it is most treatable.
• Get well – The American Cancer Society is here around the clock to guide cancer patients,
survivors and caregivers through every step of a cancer experience. In fiscal year 2009-2010,
we provided information, day-to-day help, and emotional support to nearly 8,000 individuals in
Wisconsin.
• Find cures – Since 1946, the American Cancer Society has invested more than $3.4 billion
to better understand, prevent and cure cancer. Currently, we are funding 10 research grants in
Wisconsin, totaling more than $5 million.
• Fight back – We work with lawmakers to pass laws to defeat cancer and rally communities
to join our fight. Thanks to the thousands of American Cancer Society volunteers who
advocated for the right to breathe smoke-free air, in July, Wisconsin joined nearly 80% of the
U.S. population protected by smoke-free laws.
The information presented in Wisconsin Cancer Facts and Figures 2011 is intended to help
demonstrate our progress and guide informed decision-making. For cancer patients, this
publication can provide important details about their disease. Health care and public health
professionals can use this book to monitor and better understand cancer trends. Also, policymakers, media outlets and others looking for detailed, easy-to-read information about the
cancer burden in Wisconsin should find this publication useful.
Too many lives are still being lost to cancer. Every day, we are making progress. Every day, we are
making more birthdays possible. With your ongoing support and dedication to our cause, our
mission will be achieved.
Sincerely,
Jari Johnston-Allen
Chief Executive Officer
American Cancer Society, Midwest Division
Wisconsin Cancer Facts and Figures 2011
1
DIVISION OF PUBLIC HEALTH
1 WEST WILSON STREET
P O BOX 2659
MADISON WI 53701-2659
Jim Doyle
Governor
Karen E. Timberlake
Secretary
State of Wisconsin
Department of Health Services
608-266-1251
F A X : 6 0 8 - 2 67 - 2 83 2
TTY: 888-701-1253
dhs.wisconsin.gov
Dear Colleague:
The Wisconsin Cancer Reporting System (WCRS) in the Wisconsin Division of Public Health is pleased to join
with the American Cancer Society (ACS) in presenting this new report, the third edition, Wisconsin Cancer Facts
and Figures 2011. The WCRS greatly appreciates this opportunity to work with the Midwest Division of ACS to
make this report available to our partners working on cancer control in Wisconsin.
Progress in cancer control demands accurate, timely, and complete data. This report contains the most recent
data available on cancer incidence and mortality in Wisconsin. It includes county-specific rates for the most
commonly diagnosed cancers and those for which public health interventions exist to reduce the cancer burden
in Wisconsin. Equally important are the data provided for behaviors such as tobacco use, diet, physical activity, as
well as rates for some types of cancer screening. These data help focus our efforts where they are most needed and
are instrumental in measuring the impact of current cancer control programs. Information from ACS on screening
recommendations is also provided to help professionals with preventive tools implement Healthiest Wisconsin
2020 (the state health plan) and the Wisconsin Comprehensive Cancer Control Plan 2010-2015.
Much of this data would not be available were it not for the dedication of hospital cancer registrars and reporters,
physicians and staff, and the many other people who make the Wisconsin Cancer Reporting System work. We
thank everyone for their participation in our cancer registry and other services that made this report possible.
We hope the Wisconsin Cancer Facts and Figures 2011 is a valuable resource for everyone interested in reducing the
cancer burden in Wisconsin. Please visit the WCRS Web site http://dhs.wisconsin.gov/wcrs/index.htm to view
this and other cancer-related reports, and offer your comments and suggestions. Join us in the Healthiest Wisconsin
2020 vision of “Everyone Living Better Longer” by using this report to help prevent and treat cancer more effectively.
Sincerely,
Henry Anderson, MD
State Health Officer
Division of Public Health
Department of Health Services
2
Wisconsin Cancer Facts and Figures 2011
Figure 2. Estimated Percentage and Number of Cancer
Deaths in Wisconsin, 2010
Cancer: Basic Facts
Brain/Nervous System
2% (n = 270)
Female Breast
6% (n = 690)
What is Wisconsin Cancer Facts and Figures?
Wisconsin Cancer Facts and Figures is a publication designed
to provide state and local cancer statistics along with cancer
information and risk factors to individuals interested in cancer
issues, community members, and public health and medical
professionals.
Other
32% (n = 3,670)
Colon & Rectum
8% (n = 900)
Leukemia
4% (n = 490)
Ovary
3% (n = 290)
What is Cancer?
Cancer is a group of diseases characterized by uncontrolled
growth and spread of abnormal cells. If the spread is not controlled,
it can result in death. Cancer is caused by both external factors
(tobacco, chemicals, radiation and infectious organisms) and
internal factors (inherited mutations, hormones, immune
conditions and mutations that occur from metabolism). These
causal factors may act together or in sequence to initiate or
promote the development of cancer. Ten or more years often
pass between exposures to external factors and detectable
cancer. Cancer is treated by surgery, radiation, chemotherapy,
hormone therapy, biological therapy and targeted therapy. Many
cancers can be cured if detected early and treated promptly.
Figure 1. Estimated Percentage and Number of New
Cancer Cases in Wisconsin, 2010
Non-Hodgkin Lymphoma
5% (n = 1,340)
Prostate
16% (n = 4,670)
Other
27% (n = 7,990)
Lung & Bronchus
26% (n = 2,940)
Pancreas
6% (n = 720)
Liver
3% (n = 330)
Non-Hodgkin Lymphoma
4% (n = 410)
Source: U.S. Mortality Data, National Center for Health Statistics, Centers for
Disease Control and Prevention, 2010. 2010 American Cancer Society, Inc.,
Surveillance and Health Policy Research
Who is at Risk of Cancer?
Anyone can develop cancer but the risk of developing cancer
increases as people age. More than 78% of all cancers are diagnosed in persons 55 and older. In the United States, men have
about a 1 in 2 chance of developing cancer during the course of
a lifetime; for women the risk is about 1 in 3.
How Many New Cases of Cancer are Expected
This Year?
Urinary Bladder
5% (n = 1,510)
In 2010, approximately 29,610 Wisconsin residents will be diagnosed
with cancer. This means each day 81 people in Wisconsin will
hear the words “you have cancer” (Figure 1).
Melanoma
4% (n = 1,050)
How Many Cancer Deaths are Expected This Year?
Lung & Bronchus
13% (n = 3,990)
Uterine Corpus
3% (n = 1,040)
Leukemia
3% (n = 940)
Prostate
5% (n = 600)
Female Breast
14% (n = 4,120)
Colon & Rectum
9% (n = 2,760)
In 2010, approximately 11,310 Wisconsin residents will die of
cancer, which amounts to more than one person every hour
(Figure 2).
Uterine Cervix
1% (n = 200)
Source: 2010 American Cancer Society, Inc., Surveillance and Health Policy Research
Wisconsin Cancer Facts and Figures 2011
3
How Many People Survive Cancer?
Impact of Stage at Diagnosis on Survival
It is estimated that approximately 18,965 or 68% of Wisconsin
residents who were diagnosed with cancer in 2006 survived five
years after diagnosis. Nationwide, the five-year relative survival rate
for all cancers diagnosed between 1999-2006 is 68%, up from
50% in 1975-1977.
Generally, the earlier the cancer is diagnosed, the better the
prognosis for length of survival. The National Cancer Institute’s
Surveillance, Epidemiology and End Results (SEER) program
developed a summary classification. The stages from earliest to
latest are: in situ, localized, regional and distant (see glossary,
page 56).
Could More Lives be Saved?
More lives could be saved through lifestyle changes such as
eliminating tobacco use, increasing physical activity, improving
dietary habits and obtaining appropriate cancer screenings. All
cancers caused by cigarette smoking and heavy use of alcohol
could be prevented. Scientific evidence also suggests that about
one-third of cancer deaths are related to overweight or obesity,
physical inactivity, and poor nutrition. In addition, regular
cancer screening by a health care professional can result in early
detection of many cancers, when treatment is more likely to
be effective.
Causes of Cancer in the United States
Estimated percentage of total cancer deaths attributable to established cause of cancer
Tobacco…………………………………………30%
Reproductive factors……………………………3%
Adult diet/obesity………………………………30%
Alcohol……………………………………………3%
Sedentary lifestyle………………………………5%
Socioeconomic status……………………………3%
Occupational factors……………………………5%
Environmental pollution…………………………2%
Family history of cancer…………………………5%
Ionizing/ultraviolet radiation……………………2%
Viruses/other biologic agents……………………5%
Prescription drugs/medical procedures…………1%
Perinatal factors/growth…………………………5%
Salt/other food additives/contaminants…………1%
Source: Cancer Causes & Control, Harvard Report on Cancer Prevention, 1996.
4
Wisconsin Cancer Facts and Figures 2011
Understanding Cancer
Incidence and Mortality Rates
Cancer rates in this document represent the number of new
cases of cancer per 100,000 population (incidence) or the number
of cancer deaths per 100,000 population (mortality) during a
specific time period. Cancer incidence and mortality rates can
be adjusted for demographic variables such as race, age and sex.
The most commonly used adjustment for cancer rates is age.
Age-Adjusted Rates
Older age groups generally have higher cancer rates than younger
age groups. For example, more than 75% of new cancer cases occur
in those aged 55 and older. As a result, if one county’s cancer
incidence rate is higher than another, the first question asked is
whether the county with a high rate has an older population.
To address this issue, all incidence and mortality rates presented
in this booklet have been age-adjusted. This removes the disparity
of different age distributions between populations and allows
for direct comparison of those populations. Age-adjustment
also allows for the comparison of rates within a single population
over time.
All incidence and mortality rates in this publication, provided
by the Wisconsin Cancer Reporting System, were age-adjusted
using the direct method. The direct standardization method
weights the age-specific rates for a given gender, race, or geographic area by the age distribution of the standard population.
The 2000 United States standard million population was used
for all rates provided in this booklet.
There are three major components used to calculate age-adjusted
rates: the number of cases or deaths being reported, the population
being reported and a “standard” population. The rate (new cases
or deaths per 100,000 population) is first computed for each
age group, then weighted by multiplying it by the proportion
of the 2000 U.S. standard population for that same age group.
The results from each age group are added to arrive at the ageadjusted rate for the total population.
An age-adjusted rate should only be compared with another
age-adjusted rate using the same U.S. standard population.
Starting with all 1999 data, the National Center for Health
Statistics (NCHS) and the National Cancer Institute (NCI)
began using the year 2000 U.S. standard million-population age
distribution reported by the Census Bureau. Cancer incidence
increases with age and because the 2000 population was older
than the 1970 population, the change to the 2000 U.S. standard
population resulted in apparent higher rates for many cancers.
Caution should be used when comparing the data in this report
with cancer incidence rates adjusted to standard populations
other than the 2000 U.S. standard population.
The 2010 Census continued the option first started in the 2000
Census of allowing respondents the option of identifying themselves as more than one race. The priority of reducing disparities
in cancer prevention and control means that states need to report
long-term trends for each race. NCHS and the Census Bureau
developed bridged 2000 population estimates as implemented
in NCI SEER* Stat software used in this report. Documentation
of the modifications made by NCI to Census Bureau estimates is
available at www.seer.cancer.gov/popdata/methods.html.
Age-adjusted incidence and mortality rates are grouped by primary
cancer site or the site of origin per 100,000 population. For
cancers that occur only in one sex (prostate, uterine, cervical,
female breast), sex-specific population denominators are used to
calculate incidence and mortality rates. Incidence rates are for
invasive cancers unless otherwise specified. The only exception
is the incidence rate for urinary bladder, which includes both in situ and invasive cancers. Cancer incidence rates may include
multiple primary cancers that occur in single patients; each
cancer is counted as a separate case if a patient has more than
one primary cancer.
Limitations and Caveats
To accurately represent the burden of cancer in Wisconsin, it
is important that all newly diagnosed cancer cases be reported
annually to the Wisconsin cancer registry, Wisconsin Cancer
Reporting System (WCRS). The North American Association of
Central Cancer Registries (NAACCR) certification process indicated
that Wisconsin state data was at least 95% complete for every
year represented in this report. This national standard for
completeness is one measure of data quality. However, incidence
data for certain sites and counties in 1998-2007, the years widely
represented in this report, are not necessarily 95% complete.
Data for cancers diagnosed and treated at non-hospital settings
(such as melanoma, leukemia and prostate cancers) are probably
less complete than cancers primarily treated in hospitals (lung
and colorectal cancers).
The primary reason for incomplete data is that there are some
hospitals, laboratories and out-patient diagnostic and treatment
facilities that are not reporting their cancer cases to the WCRS
or are not reporting cases in a timely manner. Incomplete and
late reporting of cancer data may underestimate the true burden
of cancer in Wisconsin and Wisconsin counties.
Geographic Boundaries
Two major factors affect interpretation of geographic location
tabulations. First, many Wisconsin counties have a very small
number of new cancer diagnoses or deaths in a year, resulting
Wisconsin Cancer Facts and Figures 2011
5
in site-specific frequencies in the single digits. Such small
numbers may easily double or triple (or decrease by equivalent
amounts) from year to year. When years of data or primary
sites are combined to produce larger number of events, the
rates become more stable. County data in this report are averaged
over the five years to provide more stable rates. Even with multiple
years of data, however, the numbers may still be small and some
random fluctuation is expected. To provide guidance in assessing
the stability of rates, all county tables show the upper and lower
limits of the confidence interval for each rate, which will include
the true value 95% of the time. A large confidence interval indicates
high variability of the “true” rate, while a small confidence interval
indicates greater stability of the rate.
Second, reporting completeness and/or timeliness may vary by
region. The largest reporting variations relate to out-of-state
diagnosis and treatment of patients who live in the sparsely
populated counties along the Wisconsin/Minnesota border
and are seen in Minnesota hospitals. Reporting by Minnesota
hospitals to WCRS is a voluntary process (established through
memoranda of understanding that protect patient confidentiality)
and is not covered under Section 255.04, Wisconsin Statutes.
Therefore, the number of reports sent to WCRS from Minnesota
can vary greatly from year to year.
Patient Race and Ethnicity
Historically, differences among facilities in recording patient
race (information not required in medical chart, entered by
proxy, or patient self-reporting) have led to a number of ambiguous or unknown race codes. As training and expanded codes have
been introduced in recent years, the number of incidence cases
reported with unknown race has decreased. Data in this report
reflect American Indian cases reported by facilities and also
those identified through the linkage with the U.S. Indian Health
Service.
For this report, the NAACCR Hispanic/Latino Algorithm Identification
Algorithm (NHIA) assigned Hispanic/Latino ethnicity to cases,
using variables of birthplace, marital status, gender, race and
surname to increase the number of cases identified as Hispanic
in the registry during the years covered in this report. For a
complete description of NHIA, and other updates to reporting
guidelines, visit the following web site: http://www.naaccr.org/.
The application of the NHIA increased the number of Hispanic
cancer cases beyond the number identified by reporting facilities.
The NHIA was developed and tested by NAACCR and endorsed
by the Centers for Disease Control and Prevention to correct
for documented under-reporting of Hispanic/Latino cases
by facilities. Caution should be used when comparing rates
for Hispanics/Latinos with the rates for race groups because
ethnicity and race are not mutually exclusive categories in this
report. Hispanics/Latinos who identify themselves as white or
any other racial group are included in the race category as well
as in the Hispanic category.
6
Wisconsin Cancer Facts and Figures 2011
Changes in Multiple Primary Rules
Starting with 2007 cases, all central state cancer registries
received new rules and guidelines for counting and coding cases
as primary tumors. For a complete discussion of the new rules,
please see the web page: http://training.seer.cancer.gov/rules/
changes/.
Wisconsin Population Characteristics
The census population estimate for Wisconsin in 2009 was
5,654,774. Wisconsin’s population increased by 5.4% from 2000
to 2009 compared to the national 9.1% increase. While Wisconsin
has experienced increased racial and ethnic diversity, the state’s
minority populations are smaller than national proportions. Of
the state’s 5.6 million residents, more than 14.9% are racial or
ethnic minorities, compared to 34.4% nationally. Wisconsin’s
population is comprised of 6.1% African Americans and 5.1%
Hispanics, compared to U.S. proportions of 12.8% and 15.4%,
respectively. By age, Wisconsin’s population is similar to the
nation with 13.3% of the population over 65 years old compared
to 12.8% nationally. Economically, Wisconsin has a lower poverty
rate than the U.S., 10.5% compared to 13.2%, and the almost
the same median household income as the nation, $52,103
compared to $52,029. Approximately one third of Wisconsin
residents live in rural locations compared to one fifth of the
national population. However, the rural population in Wisconsin
has decreased by approximately 10% during the last decade.
Data Sources
Estimated Cases and Deaths, 2010
The National Home Office of the American Cancer Society
publishes these estimates, which are based on incidence data
from the Surveillance, Epidemiology and End Results (SEER)
Program and the Center for Disease Control and Prevention’s
National Program of Cancer Registries. Estimated deaths are
based on mortality data are from the National Center for Health
Statistics (NCHS), Centers for Disease Control and Prevention.
Report available at: www.cancer.org
Wisconsin Cancer Incidence and Mortality
Cancer incidence data are from the Wisconsin Cancer Reporting System (WCRS), part of the Office of Health Informatics,
Division of Public Health, Department of Health Services. The
WCRS was established in 1976 to collect cancer incidence data
on Wisconsin residents as mandated by chapter 255.04, Wisconsin Statutes. In 1994 WCRS became part of the National
Program of Cancer Registries (NPCR) authorized and funded by
the Centers for Disease Control and Prevention. Cancer mortality data are from the NCHS and are based on the underlying
cause of death. The WCRS staff prepared all data for the cancer
incidence and mortality rates per 100,000 age-adjusted to the
2000 U.S. standard population. The SEER*Stat software package, from the National Cancer Institute, was used to calculate
both incidence and mortality rates.
Wisconsin cancer publications available at: www.dhs.wisconsin.gov/wcrs
Control and Prevention (CDC) and is part of the Behavioral Risk
Factor Surveillance System (BRFSS), which is conducted in all
50 states and four U.S. territories.
Available at: www.dhs.wisconsin.gov/stats/brfs.htm
Youth Smoking/Behavioral Risk Data
The 2009 Wisconsin Youth Risk Behavior Survey (YRBS) was
conducted as part of the national survey efforts by CDC. The
survey was designed to provide national, state and local prevalence
estimates on health risk behaviors, such as tobacco use, unhealthy
dietary behaviors and physical inactivity among youths who
attend public and private schools. The YRBS is a biennial survey,
which began in 1993. Available at: www.dpi.state.wi.us/sspw/yrbsindx.html
Burden of Tobacco in Wisconsin Data
The 2010 Burden of Tobacco in Wisconsin Report was developed in partnership by the American Cancer Society, the
Wisconsin Division of Public Health, within the Department of
Health Services, and the UW Carbone Cancer Center’s Surveillance and Evaluation Program. The Burden of Tobacco Report
measures tobacco’s impact on Wisconsin, including the number
of deaths from tobacco use and health care costs related to tobacco. Available at: www.dhs.wisconsin.gov/tobacco/informationData.htm
National Cancer Data and Survival Trends
National cancer data and survival data are from the Surveillance, Epidemiology and End Results (SEER) Program of the
National Cancer Institute. National incidence rates are based on
nine SEER registries reporting from geographic areas covering
about 10% the population. National mortality rates are from the
SEER*Stat public-use database for mortality (www.seer.cancer.
gov/seerstat), with underlying mortality data provided by NCHS
(www.cdc.gov/nchs). The SEER registry program is considered
an authoritative source of cancer incidence and mortality in the
United States. Available at: www.seer.cancer.gov
Behavioral Risk Factor Data
The Wisconsin Office of Health Informatics, Division of Public
Health, annually conducts the Behavioral Risk Factor Survey
through telephone interviews of randomly selected adults in
Wisconsin. Respondents are asked to provide information about
their health risk behaviors and health monitoring activities.
The survey is done in cooperation with the Centers for Disease
Wisconsin Cancer Facts and Figures 2011
7
Wisconsin for 2003-2007. For additional county-level information, such as the number of newly diagnosed cases and ageadjusted rates for specific cancer sites, refer to the supplemental
Table A, pages 48-51.
Wisconsin Cancer Incidence
and Mortality Data
Cancer Mortality
Cancer Incidence
Lung cancer is the leading cause of cancer deaths among both
males and females in Wisconsin, with a yearly (2003-2007) average
of 1,590 men and 1,260 women dying from the disease (Table 2,
page 11).
Figure 3 displays the leading cancer sites among males in
Wisconsin by percentage of new cases and cancer deaths.
Prostate cancer is the most frequently diagnosed cancer among
Wisconsin males, representing 28% of all cancers diagnosed
between 2003 and 2007. Figure 4, page 9 shows that breast cancer
remains the most frequently diagnosed cancer in Wisconsin
women, representing 28% of all female cancer diagnoses. Overall, lung cancer continues to be the most frequently diagnosed cancer in Wisconsin for both genders combined.
Prostate cancer ranks as the second leading cause of cancer
death for men (Figure 3), accounting for 11% of male cancer
deaths, while breast cancer ranks as the second leading cause of cancer death for women at 14% (Figure 4).
Map 2, page 13 presents total mortality rates for all cancer in
Wisconsin by county for 2003-2007. More detailed data on the
number of deaths and the age-adjusted rates are provided in the
supplemental Table B, pages 52-55.
Map 1, page 12 shows total cancer incidence for all counties in
Figure 3. Leading Cancer Sites: Percentage of New Cases and Deaths Among Males in Wisconsin,
2003-2007
Cases
Deaths
Prostate 28%
11%
L ung & Bronchus
14%
Colon & Rectum
28%
10%
9%
Ur i nar y B l adder
7%
4%
Non-Hodgkin Lymphoma
5%
4%
Kidney & Renal Pelvis
4%
3%
Melanoma of the Skin
4%
2%
Oral Cavity & Pharynx
3%
2%
Leukemia
3%
Pancreas
5%
3%
6%
Percent New Cases
30
20
Percent Cancer Deaths
10
0
10
20
30
Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Wisconsin Department of Health Services, and
National Center for Health Statistics, 2010.
8
Wisconsin Cancer Facts and Figures 2011
in
Colorectal cancer is the second leading cause of cancer death in
Wisconsin residents for males and females combined (Table 2).
Wisconsin males have a higher mortality rate from colorectal
cancer than do females (19.9 and 14.0, respectively).
Table 1, page 10 provides average annual new cases and ageadjusted incidence rates for 23 common cancers by gender with
national comparisons. The lung cancer incidence rate for 20032007 was 76.8 per 100,000 for Wisconsin men, marginally higher
than the national lung cancer incidence rate for men of 74.5 per
100,000.
Figure 4. Leading Cancer Sites: Percentage of New Cases and Deaths Among Females in Wisconsin,
2003-2007
Cases
Deaths
Breast 28%
14%
Lung & Bronchus
13%
Colon & Rectum
24%
10%
Corpus & Uterus, NOS
10%
7%
3%
Non-Hodgkin Lymphoma
4%
Ovary
4%
4%
6%
Mel anoma of the Ski n
3%
1%
Thyroid
3%
0.4%
Pancreas
3%
Ur i nar y bl adder
6%
3%
2%
Percent New Cases
30
20
Percent Cancer Deaths
10
0
10
20
30
Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Wisconsin Department of Health Services, and
National Center for Health Statistics, 2010.
Wisconsin Cancer Facts and Figures 2011
9
10
Wisconsin Cancer Facts and Figures 2011
14,378
265
–
1,415
–
293
–
104
538
186
462
213
2,001
509
170
674
479
–
379
3,992
238
200
128
1,007
542.9
9.8
–
54.5
–
10.9
–
3.8
19.9
6.9
17.7
7.8
76.8
18.8
6.5
25.5
17.2
–
14.5
148.3
9.2
7.3
4.6
39.6
Males
WI Rate
541.7
7.6
–
54.6
–
8.1
–
3.3
18.7
5.9
16.4
10.1
74.5
25.8
7.1
24.6
15.5
–
13.5
163.1
10.6
5.7
5.4
37.2
U.S. Rate
13,511
220
189
1,408
884
88
3,808
98
329
48
342
111
1,713
416
135
605
237
482
361
–
150
–
367
373
WI Cases
Sources: Wisconsin Cancer Reporting System and the Surveillance, Epidemiology and End Results (SEER) Program, 2010.
Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.
All Cancer
Brain and Other Nervous System
Cervix Uteri
Colon and Rectum
Corpus and Uterus, NOS
Esophagus
Female Breast
Hodgkin Lymphoma
Kidney and Renal Pelvis
Larynx
Leukemia
Liver and Intrahepatic Bile Duct
Lung and Bronchus
Melanoma of the Skin
Myeloma
Non-Hodgkin Lymphoma
Oral Cavity and Pharynx
Ovary
Pancreas
Prostate
Stomach
Testis
Thyroid
Urinary Bladder
WI Cases
425.2
7.3
6.6
42.1
27.9
2.7
121.7
3.5
10.3
1.5
10.7
3.4
53.7
13.9
4.1
18.7
7.5
15.3
10.8
–
4.5
–
12.9
11.1
Females
WI Rate
411.1
5.5
6.8
41.5
24.5
2.0
124.9
2.6
9.9
1.3
9.9
3.5
52.2
17.3
4.6
17.0
6.2
12.9
10.5
–
5.1
–
15.9
9.3
U.S. Rate
473.7
8.5
–
47.6
–
6.4
–
3.6
14.7
3.9
13.8
5.5
63.4
15.9
5.2
21.7
12.0
–
12.5
–
6.6
–
8.8
23.3
202
867
234
804
323
3,714
925
306
1,279
716
–
739
–
388
–
496
1,379
Total
WI Rate
27,889
485
–
2,824
–
380
–
WI Cases
11.9
–
7.5
–
10.7
21.1
2.9
13.9
3.3
12.7
6.6
61.6
20.8
5.7
20.3
10.5
–
464.9
6.5
–
47.3
–
4.7
–
U.S. Rate
Average Annual Number of Cases and Age-Adjusted Incidence Rates by Sex, Wisconsin and U.S., 2003-2007
Primary Cancer Site/Type
Table 1
Wisconsin Cancer Facts and Figures 2011
11
5,633
149
–
496
–
240
–
14
163
52
281
182
1,590
95
113
234
98
–
323
632
120
4
12
199
223.5
5.6
–
19.9
–
9.2
–
0.5
6.3
2.0
11.3
6.8
62.3
3.6
4.6
9.3
3.6
–
12.6
27.1
4.7
0.1
0.5
8.3
Males
WI Rate
225.4
5.2
–
21.2
–
7.8
–
0.5
5.9
2.2
9.7
7.7
68.8
4.0
4.4
8.7
3.9
–
12.3
24.7
5.3
0.2
0.5
7.5
U.S. Rate
5,235
120
58
504
157
65
757
11
101
1.4
208
101
1,260
57
98
213
49
314
325
–
74
–
20
96
WI Deaths
Source: National Center for Health Statistics, Surveillance, Epidemiology, and End Results (SEER) Publice-Use Mortality Files, 2010.
Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.
All Cancer
Brain and Other Nervous System
Cervix Uteri
Colon and Rectum
Corpus and Uterus, NOS
Esophagus
Female Breast
Hodgkin Lymphoma
Kidney and Renal Pelvis
Larynx
Leukemia
Liver and Intrahepatic Bile Duct
Lung and Bronchus
Melanoma of the Skin
Myeloma
Non-Hodgkin Lymphoma
Oral Cavity and Pharynx
Ovary
Pancreas
Prostate
Stomach
Testis
Thyroid
Urinary Bladder
WI Deaths
154.5
3.8
1.9
14.0
4.6
1.9
22.6
0.3
3.0
0.4
6.0
2.9
38.5
1.7
2.9
6.0
1.5
9.5
9.4
–
2.1
–
0.6
2.6
Females
WI Rate
155.4
3.5
2.4
14.9
4.1
1.7
24.0
0.3
2.7
0.5
5.4
3.2
40.6
1.7
2.9
5.5
1.4
8.6
9.4
–
2.7
–
0.5
2.2
U.S. Rate
182.0
4.6
–
16.5
–
5.1
–
0.4
4.4
1.1
8.2
4.7
48.5
2.6
3.6
7.4
2.5
–
10.9
–
3.2
–
0.5
4.8
–
1,000
–
305
–
25
265
66
489
282
2,851
152
212
447
147
–
649
–
193
–
32
295
Total
WI Rate
10,868
269
WI Deaths
–
0.5
4.3
10.7
–
3.8
0.4
4.1
1.2
7.2
5.2
52.5
2.7
3.6
6.9
2.5
–
4.4
–
–
17.6
–
183.8
4.3
U.S. Rate
Average Annual Number of Deaths and Age-Adjusted Mortality Rates by Sex, Wisconsin and U.S., 2003-2007
Primary Cancer Site/Type
Table 2
Map 1. Cancer Incidence Rates for All Cancer by County in Wisconsin, 2003-2007
Douglas
383.5
Bayfield
389.1
Ashland
483.5
Burnett
346.3
Sawyer
435.8
Washburn
462.8
Polk
372.8
St. Croix
288.6
Dunn
385.5
Pierce
305.8
Pepin
411.9
Vilas
475.5
Lincoln
505.3
Taylor
423.0
Chippewa
486.2
Eau Claire
389.7
Marathon
456.7
Clark
512.1
Buffalo Tremp
409.0 ealeau
Wood
498.2
Jackson
512.1
475.5
Monroe
La
Crosse
487.1
503.6
Vernon
500.5
Juneau
524.4
Sauk
434.7
Crawford
Grant
391.3
Iowa
346.2
Lafayette
391.6
Forest
442.5
Marinette
463.8
Langlade
464.2
MenomOconto
inee
623.2 485.2
Door
Shawano
531.9
481.3
Waupaca
463.1
OutaBrown Kewaunee
Portage 503.4
gamie
468.8
414.1
487.9
Adams
391.0
Richland
546.7 409.3
Florence
370.8
Oneida
555.4
Price
471.6
Rusk
456.0
Barron
431.3
Iron
423.9
WinneCalu- Manitowoc
met 487.8
bago
411.5
493.7
Waushara
459.6
MarGreen
quette Lake Fond du Lac
604.7 494.8
Columbia
487.3
Dane
431.6
Green
468.1
Washington
Dodge
424.6
Jefferson
469.0
Rock
499.0
Sheboygan
526.7
523.1
504.2
Waukesha
520.3
Walworth
506.8
Ozaukee
497.3
Milwaukee
492.7
501.7 Racine
484.3 Kenosha
County Cancer Incidence
Wisconsin State Average - 473.7
Below or Equal to State Average
Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.
Above State Average
Rate is statistically significant above or
below the state rate
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
12
Wisconsin Cancer Facts and Figures 2011
Map 2. Cancer Mortality Rates for All Cancer by County in Wisconsin, 2003-2007
Douglas
208.7
Bayfield
176.6
Ashland
193.9
Burnett
184.1
Washburn
188.3
Polk
193.8
Barron
184.2
St. Croix
173.6
Dunn
151.5
Pierce
176.2
Pepin
191.1
Sawyer
190.6
Iron
211.9
Price
206.6
Lincoln
171.8
Taylor
154.0
Chippewa
190.8
Eau Claire
166.2
Marathon
159.9
Clark
161.3
Jackson
192.6
Florence
192.3
Oneida
199.8
Rusk
183.1
Buffalo
169.3 Tremp
ealeau
171.3
Vilas
175.0
Wood
163.6
Forest
208.5
Marinette
187.5
Langlade
213.8
Menominee
Oconto
299.2
176.4
Shawano 175.6
OutaPortage Waupaca gamie
168.0 191.6
173.5
Brown
168.2
Door
156.3
169.7
Kewaunee
Calu- Manitowoc
Waushara Winnemet 165.7
bago
Adams
195.8
La
185.9 164.5
228.2
MarCrosse Monroe
quette Green Fond du Lac
177.5 186.7 Juneau
Lake
Sheboygan
229.0
184.2
221.7 200.6
180.8
Vernon
163.1
WashColumbia
Sauk
Richland
Ozaukee
Dodge ington
183.3
183.8
175.2
208.8 181.4
210.0 159.9
Crawford
Grant
188.5
Iowa
161.5
Lafayette
190.7
Dane
167.5
Green
174.9
Jefferson Waukesha
183.6
Rock
196.1
175.5
Walworth
183.1
Milwaukee
195.8
182.3 Racine
194.7
Kenosha
County Cancer Mortality
Wisconsin State Average - 182.0
Below or Equal to State Average
Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.
Above State Average
Rate is statistically significant above or
below the state rate
Source: National Center for Health Statistics, Surveillance, Epidemiology and End Results (SEER) Public-Use Mortality Files, 2010.
Wisconsin Cancer Facts and Figures 2011
13
Table 4 displays the mortality rates and shows that female breast
cancer mortality declined 20% during the 1997-2007 period.
Also, cervical cancer mortality rates decreased by 36% during
this same time.
Trends in Cancer Incidence
and Mortality in Wisconsin
1997-2007 Trends
Overall, the cancer mortality rates for both males and females in
Wisconsin have declined from 1997 to 2007 (Figure 5). Incidence
rate for all cancers declined 14% for males from 1997 to 2007.
Females also experienced a decline of 7% in the overall incidence
rate during this same time period (Table 3, page 15).
Both males and females experienced lower mortality rates in
colorectal cancer in 2007 than in 1997, with mortality rates
declining by 32% and 29% respectively. However, lung cancer
mortality rates parallel the incidence rates and show a gender
disparity; male mortality dropped by 10% while female mortality
increased by 4%.
Displayed in Table 3, the cancer incidence rates have increased
most dramatically for melanoma. For the period shown, male
melanoma rates increased by approximately 42% while female
rates increased by 45%. The other major trends in incidence
rates are found for colorectal cancer, declining by approximately
35% for males and 31% for females and lung cancer declining 22%
for men. Unfortunately, women have experienced an increase in
lung cancer incidence by 3%, largely attributable to increased
smoking.
The positive side, however, is that overall cancer mortality rates
for both males and females have declined approximately 11%
and 8%, respectively (Table 4, page 15). This decline in mortality
is attributed to an increase in early detection, better treatments
and increased awareness of risk reduction behaviors.
Figure 5. Trends in Wisconsin Cancer Incidence and Mortality Rates for All Cancer Sites, 1997-2007
700
600
Incidence Total
500
Rates
Incidence Male
Incidence Female
400
Mortality Total
300
Mortality Male
Mortality Female
200
100
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services and National Center for Health Statistics, 2010.
1. Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.
2. Rates are single-year rates.
14
Wisconsin Cancer Facts and Figures 2011
Table 3. Trends for Leading Cancers: Incidence Rates in Wisconsin by Gender, 1997-2007
All Sites
Lung
Colorectal
Melanoma
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Female Breast
Cervical
Prostate
1997
1999
2001
2003
2005
2007
PC*
485.8
583.0
421.5
66.8
91.8
49.0
60.4
71.5
52.1
11.4
13.5
10.0
133.7
8.8
174.5
490.8
584.0
428.6
66.1
89.0
49.6
60.3
74.3
49.4
12.1
14.9
10.1
139.1
9.2
174.4
499.8
584.7
441.7
67.0
84.2
54.9
55.8
66.7
47.6
15.2
18.2
13.1
139.8
6.8
177.3
479.0
553.3
428.8
66.3
83.0
54.4
54.7
63.2
48.1
14.3
16.2
13.0
123.4
6.7
153.0
487.1
551.2
443.3
64.0
74.1
56.9
47.8
53.9
43.1
16.9
19.5
15.3
124.4
7.2
148.1
440.3
504.4
393.5
59.4
71.4
50.5
40.6
46.4
35.8
16.4
19.2
14.5
116.8
5.4
142.7
-9.4
-13.5
-6.6
-11.1
-22.2
3.1
-32.8
-35.2
-31.3
43.6
42.1
44.8
-12.6
.
-38.5
-18.2
Source: Wisconsin Cancer Reporting System, Office of Public Health Informatics, Division of Public Health, Department of Health Services, 2010.
Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.
PC*: Percent Change based on 1997-2007 difference.
Table 4. Trends for Leading Cancers: Mortality Rates in Wisconsin by Gender, 1997-2007
All Sites
Lung
Colorectal
Melanoma
Female Breast
Cervical
Prostate
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
1997
1999
2001
2003
2005
2007
PC*
195.9
245.0
164.7
50.1
68.5
37.3
21.5
26.4
18.1
2.5
3.5
1.6
25.9
2.7
33.5
195.1
249.2
160.1
48.6
66.7
35.8
21.1
26.7
17.0
2.6
3.8
1.7
26.6
2.4
32.7
190.8
237.9
159.9
49.2
65.1
37.8
19.7
25.1
16.0
2.7
3.8
1.7
25.7
1.8
29.1
183.2
228.3
154.0
47.4
63.9
36.1
18.3
22.2
15.2
2.4
3.1
1.8
23.7
1.8
29.5
183.4
222.8
156.8
48.5
61.2
39.6
16.4
19.8
13.9
2.9
3.7
2.3
22.7
1.9
26.9
178.2
218.1
151.2
48.6
61.4
38.9
15.1
18.0
12.9
2.6
3.8
1.6
20.8
1.7
26.3
-9.1
-11.0
-8.2
-3.0
-10.3
4.1
-29.6
-31.8
-28.5
3.8
8.7
-2.5
-19.6
-36.4
-21.4
Source: National Center for Health Statistics, 2010.
Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.
PC*: percent change is based on 1997-2007 difference.
Wisconsin Cancer Facts and Figures 2011
15
Lung & Bronchus Cancer/
Tobacco Control in Wisconsin
Overview
According to the report The Burden of Tobacco in Wisconsin,
2010, each year approximately 15% of all deaths in Wisconsin
are attributable to smoking. Cigarette smoking causes 79% of all
lung cancer deaths and 14% of deaths from cardiovascular disease in
Wisconsin. Lung cancer was the leading cause of cancer deaths
and killed more than 2,900 Wisconsin residents in 2007. Stopping
the use of tobacco could eliminate most lung cancer. Quitting
smoking reduces an individual’s risk significantly, although
former smokers remain at greater risk than those who never
smoked.
Prevention/Screening/Early Detection
Lung cancer is the most preventable cancer. Tobacco use is
responsible for 87% of lung cancers. Most people with early lung
cancer do not have any symptoms. Only 19% of all lung cancers
in Wisconsin were found at an early stage in 2007.
Currently, screening for early lung cancer detection has not been
proven to reduce mortality. Chest x-ray, analysis of cells contained in sputum and fiber optic examination of the bronchial
passages have all shown limited effectiveness in reducing lung
cancer deaths. Newer tests, such as low-dose helical CT scans
and molecular markers in sputum, have produced promising
results in detecting lung cancer at earlier, more operable stages
in high-risk patients, but have not yet been shown to reduce
lung cancer deaths.
Cancer Burden
More people die from lung cancer than from breast, prostate
and colorectal cancers combined. In Wisconsin, lung cancer
• Cigarette smoking is the most important risk factor killed an average of 2,851 residents per year during the five-year
for lung cancer. Lung cancer mortality rates are about period 2003 through 2007, and an average of 3,714 new cases of
23 times higher for current male smokers and 13 times lung cancer were diagnosed each year.
higher for current female smokers compared to people Nationally, the incidence rate for men during the period of 2003-2007
who have never smoked.
averaged 74.5 per 100,000 population. For Wisconsin men, the
• Exposure to secondhand tobacco smoke.
lung cancer incidence rate for that same period was higher –
• Environmental or occupational exposure to radon, 76.8 per 100,000 population. The national incidence rate for
asbestos (particularly among smokers), certain metals women during the 2003-2007 period was 52.2 per 100,000. The
(chromium, cadmium, arsenic), some organic Wisconsin incidence rate for women during that period was
chemicals, radiations, air pollution, and a history of 53.7 per 100,000. (Table 1, page 10).
tuberculosis.
• Genetic susceptibility plays a contributing role in the The national lung cancer mortality rates for 2003-2007 were
68.8 for men and 40.6 for women, per 100,000 population. The
development of lung cancer, especially in those who Wisconsin 2003-2007 mortality rates were lower – 62.3 for men
develop the disease at a younger age.
and 38.5 for women, per 100,000 population (Table 2, page 11).
For the past 15 years, more women have died each year of lung
Groups at High Risk for Smoking: U.S. Adults
cancer than breast cancer.
• Adults living below the poverty level are more likely to smoke than adults with higher incomes.
Both gender and race are factors in lung cancer incidence and
mortality rates. Lung cancer incidence and mortality rates are
• Adults without a high school degree are three times significantly higher among Wisconsin males than Wisconsin
more likely to smoke than those with a college degree.
females. Wisconsin males have an average of 1,590 deaths from
• American Indian, Alaskan Natives are more likely lung cancer each year, compared to an average of 1,260 deaths
than other races/ethnicities to smoke cigarettes.
for Wisconsin females during 2003-2007 (Table 2). While men
traditionally experienced higher lung cancer rates, the difference
Groups at High Risk for Smoking: U.S. Youth
has decreased in recent years, largely as the result of continuing
• White, non-Hispanic students are the most likely to smoking rates among women. In Wisconsin, between 1997 and
smoke cigarettes, followed by Hispanic students, then 2007, deaths from lung cancer among women increased by 4%,
African-American students.
compared to a 10% decrease among men.
• High school boys are much more likely than girls to African Americans and American Indians in Wisconsin are
use smokeless tobacco, cigars, pipes and bidis.
more likely than other races to die from lung cancer. The Wisconsin
• White high school students are more likely than mortality rate for African Americans with lung cancer for the African -American high school students to report current cigar use.
Risk Factors
16
Wisconsin Cancer Facts and Figures 2011
years of 2003-2007 was 78.9 per 100,000, similar to the mortality
rate for American Indians of 73.1. The mortality rate for whites
was 47.6, and Asian/Pacific Islanders had the lowest mortality
rate of 16.5 per 100,000 (Table 6, page 41).
Trends in Tobacco Use
Secondhand Smoke
The devastating effects of tobacco use in the health and welfare
of society are now widely recognized. Tobacco use is the single
largest preventable cause of disease and premature death in the
United States.
In 2006, the U.S. Surgeon General published a report titled,
The Health Consequences of Involuntary Exposure to Tobacco
Smoke. Secondhand smoke contains numerous carcinogens
for which there is no safe level of exposure. It is estimated that
more than 126 million nonsmoking Americans are exposed to
secondhand smoke.
Tobacco use accounts for about one-third of all cancer deaths
and 87% of lung cancer deaths each year in the U.S. The best
way to avoid lung cancer is to not start using tobacco or to quit
if you do use it. Cigarette smoking also causes cancers of the
mouth, nasal cavities, larynx, pharynx, esophagus, stomach,
colorectum, liver, pancreas, kidney, bladder, uterine cervix and
ovary, and myeloid leukemia. Cigar smoking increases the risk
of cancers of the lung, oral cavity, larynx, esophagus and probably
pancreas.
The prevalence of smoking in Wisconsin has declined since
2000, but 19% of adults age 18 and older report current (2009)
cigarette smoking. Figure 6, page 18 depicts tobacco use by
gender in Wisconsin in 2000-2009. It shows the prevalence of
smoking in 2000 was 24% for both genders, but by 2009 had
declined to 17% among women and 20% among men. In 2008,
for both sexes combined, the 25 to 34-year-old age group had the
highest percentage of smokers, followed by the 18-24 year-olds
(Figure 7, page 18). The large number of younger adults smoking
will cause a rise in lung cancer mortality in 20-30 years, unless
smoking cessation efforts intervene.
According to the Wisconsin Youth Risk Behavior Survey (YRBS)
for 2009, approximately 18% of male high school students and
16% of female high school students in Wisconsin reported
smoking (Figure 8, page 19). The YRBS also reports a decline
in the percentage of all high school students who are current
smokers (smoked a cigarette at least one day out of the prior 30
days) from 38% in 1999 to 17% in 2009.
Burden of Tobacco Dependence
Quitting tobacco use substantially decreases the risk of cancer
and cardiovascular disease. Smokers who quit, regardless of age,
live longer than people who continue to smoke. Once smoking
rates begin to decline in a population, it takes 20-30 years to see
a decrease in lung cancer rates.
• According to the report The Burden of Tobacco in Wisconsin, an estimated $2.8 billion in health care costs were paid in 2007 in Wisconsin as a result of diseases caused by smoking.
• In Wisconsin almost 7,000 people die annually from illnesses directly related to smoking. and approximately 750 die from illnesses and fires indirectly related to smoking, for a total of 7,750 annual deaths.
Increasing smoke-free environments leads to fewer youth
beginning to smoke and more teens and adults quitting. Studies
have shown that smoking is not merely a bad habit but is an
addiction, a chronic condition that may need treatment over an
extended period of time.
• 3,400 lung cancer deaths occur annually in the U.S. in nonsmoking adults as a result of breathing secondhand smoke.
• Secondhand smoke contains over 4,000 substances, more than 50 of which are known or are suspected to cause cancer in humans and animals.
Stage at Diagnosis
Lung cancer in Wisconsin is most often (49% of new cases in
2007) diagnosed at the distant stage, which negatively impacts
the length of survival (Figure 9, page 19). Five-year probability of
survival is highest if lung cancer is diagnosed early, with a 55%
five-year survival rate for lung cancers diagnosed at the local stage.
However, only 19% of lung cancers in Wisconsin were diagnosed
at this stage in 2007.
Quitting Smoking in Wisconsin
There are a number of treatments that can help tobacco
users quit and thus reduce the incidence of lung and
bronchus cancer. Tobacco users who are ready to quit can
consult their physicians, who will conduct an intervention
and prescribe an appropriate medication.
Medication combined with practical, individualized
counseling provides effective nicotine dependence treatment.
The counseling component can be obtained by calling
the Wisconsin Tobacco Quit Line (1-800-QUIT-NOW). The
Quit Line conducts an assessment and provides ongoing,
practical advice on the process of quitting tobacco use. A
number of local programs are also available in Wisconsin.
Information can be obtained on local programs by calling
the Quit Line.
Wisconsin Cancer Facts and Figures 2011
17
Figure 6. Trends in Prevalence of Adult Current Cigarette Smoking by Sex in Wisconsin, 2000-2009
35
30
25
Males
Percent
20
Females
15
10
5
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
Source: Wisconsin Behavior Risk Factor Surveillance System, 2000-2009, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
1. Current cigarette smoking: persons who reported smoking at least 100 cigarettes in their lifetime and currently smoke every day or some days.
Figure 7. Trends in Prevalence of Adult Current Cigarette Smoking by Age in Wisconsin, 2000-2009
40
35
30
18-24
Percent
25-34
25
35-44
45-54
20
55-64
65+
15
10
5
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
Source: Wisconsin Behavior Risk Factor Surveillance System, 2000-2009, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
1. Current cigarette smoking: persons who reported smoking at least 100 cigarettes in their lifetime and currently smoke every day or some days.
2. Data for 18-24 year olds were unavailable for 2009.
18
Wisconsin Cancer Facts and Figures 2011
Figure 8. Trends in Prevalence of Current Cigarette Smoking Among High School Students by Sex in Wisconsin,
1999-2009
45
40
Percent
35
Males
30
Females
25
20
15
10
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
Source: 2009 Wisconsin Youth Risk Behavior Survey, 1999-2009, Department of Public Instruction, 2009.
1. Cigarette Smoking: High school students who reported smoking at least once a day for the past thirty days.
Figure 9. Trends in Lung Cancer Stage at Diagnosis in Wisconsin, 1997-2007
1997
1999
50
2001
2003
50
2005
2007
40
Percent
40
30
30
20
20
10
10
0
0
Localized
Distant/Systemic
Regional
Unknown/Unstaged
Stage at Diagnosis
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
1. Refer to page 57 for glossary of terms with definition of stage of disease at diagnosis.
Wisconsin Cancer Facts and Figures 2011
19
Colorectal Cancer
in Wisconsin
Colon and rectal cancers have many features in common and
are referred to as colorectal cancer. Cancer can develop in any
part of the colon or rectum.
Overview
Colorectal cancer develops slowly over a period of several years.
Before cancer develops there are usually precancerous growths
called polyps. Screening tests offer a powerful opportunity for the
prevention, early detection and successful treatment of colorectal
cancers. While people cannot change their genetic makeup or
family health history, most people can reduce their risk of colorectal
cancer by following screening guidelines, eating a healthy, low-fat,
high-fiber diet and increasing their level of physical activity.
Modifiable factors for reducing the risk of colorectal cancer include healthy eating, regular physical activity, maintaining suggested body weight and avoiding smoking.
The American Cancer Society recommends screening beginning
at age 50 for women and men who are at average risk for developing colorectal cancer. Screening can result in the detection
and removal of colorectal polyps before they become cancerous.
Screening can also find colorectal cancer early, when treatment
can be most effective.
Colorectal cancers can almost always be cured if detected early.
There is a 91% chance of survival five years after diagnosis if a
patient is diagnosed at the earliest stage. Therefore, it is important for all adults aged 50 and older (at average risk) to follow
the American Cancer Society’s screening guidelines. Individuals
at increased risk of colorectal cancer should begin screening
before age 50 and should discuss their screening options with
their healthcare provider.
Risk Factors
Several risk factors may contribute to the development of colorectal cancer. They include:
• Age (91% of colorectal cancers are diagnosed in
individuals age 50 and over)
• Race (African Americans are more likely than other racial and ethnic groups to develop colorectal cancer)
• A family history of colorectal cancer or a personal history of colorectal cancer, colon polyps, or inflammatory bowel disease
• Inherited genetic mutations (familial adenomatous polyposis [FAP] and hereditary non-polyposis colorectal cancer [HNPCC], also known as Lynch syndrome)
• Studies have also found an association between diabetes and colorectal cancer
Modifiable risk factors
• Being sedentary or not physically active
• A diet that is high in fat (especially from red meat) or low in fruits and vegetables
• Obesity, particularly excess fat around the waist, increases the risk
• Long-term smoking
Signs and Symptoms of Colorectal Cancer
• Alcohol, especially heavy use
• Bleeding from rectum
Prevention/Screening/Early Detection
Screening tests that detect and remove adenomatous polyps are
the most reliable method of preventing colorectal cancer.
20
Wisconsin Cancer Facts and Figures 2011
• Blood in stool or in the toilet after a bowel movement
• A change in bowel habits
• Cramping pain in lower abdomen
Cancer Burden
In Wisconsin, colorectal cancer is the second most common
cancer diagnosed in both men and women combined (Table 1,
page 10).
cancer mortality rate was 16.5 per 100,000, with a rate of 19.9
per 100,000 for males and 14.0 per 100,000 for females. The colorectal mortality rate has dropped from 21.5 per 100,000 in 1997
to 15.1 per 100,000 in 2007 (Table 4, page 15).
From 2003-2007, an annual average of 2,824 Wisconsin residents
were diagnosed with colorectal cancer and 1,000 residents died
of the disease (Tables 1 and 2, pages 10 and 11). The incidence
rate for both genders combined was 47.6 per 100,000 (20032007). Males had a higher incidence rate than females, 54.5
compared with 42.1, respectively. The Wisconsin colorectal Increased use of sigmoidoscopy or colonoscopy, which in turn
has increased benign polyp removal, has been largely credited
for the decline in colorectal cancer incidence rates. Mortality
rates for colorectal cancer continue to decrease, due in part
to the decline in colorectal cancer incidence and to improved
cancer treatments.
Figure 10. Trends in Persons Aged 50 Years and Older Who Have Ever Had a Sigmoidoscopy or Colonoscopy
in Wisconsin, 1997-2007
75
70
Percent
65
60
55
50
45
40
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Source: Wisconsin Behavioral Risk Factor Surveillance System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
American Cancer Society Screening Recommendations for Colorectal Cancer
Beginning at age 50, men and women at average risk should follow one of the examination schedules below:
Tests that find polyps and cancer:
When to get one:
• Flexible sigmoidoscopy**, or
• Colonoscopy, or
• Double-contrast barium enema (DCBE)**, or
• CT colonography (virtual colonoscopy)** • Every five years, starting at age 50
• Every 10 years, starting at age 50
• Every five years, starting at age 50
• Every five years, starting at age 50
Tests that mainly find cancer:
When to get one:
• Fecal occult blood test (FOBT)*,** with at least 50% test sensitivity for cancer, or
• Fecal immunochemical test (FIT)*,** with at least 50% test sensitivity for cancer, or
• Stool DNA test (sDNA)**
• Annually, starting at age 50
• Annually, starting at age 50
• Interval uncertain, starting at age 50
*For FOBT or FIT used as a screening test, the take-home multiple sample method should be used. A FOBT or FIT done during a digital rectal exam in the doctor’s office is not adequate for screening.
**Colonoscopy should be done if test results are positive.
Wisconsin Cancer Facts and Figures 2011
21
Figure 11. Trends in Colorectal Cancer Stage at Diagnosis in Wisconsin, 1997-2007
1997
1999
50
2001
2003
50
2005
2007
40
Percent
40
30
30
20
20
10
10
0
0
Localized
Distant/Systemic
Regional
Stage at Diagnosis
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
1. Refer to page 57 for definitions of stage at diagnosis.
Stage at Diagnosis
Survival from colorectal cancer is more than 91% when the cancer
is diagnosed before it has extended beyond the intestinal wall. In
2003-2007, about 40% of invasive colorectal cancers diagnosed in
Wisconsin were at an early (localized) stage. Figure 11 displays
stages at diagnosis for colorectal cancer and shows an increase
in the percent of colorectal cancers detected early in Wisconsin
from 1997 to 2007.
22
Wisconsin Cancer Facts and Figures 2011
Unknown/Unstaged
Female Breast Cancer
in Wisconsin
The majority of breast cancers can be treated successfully if
detected early. An annual mammogram starting at age 40 is the
most effective way to detect breast cancer at an early, curable
stage. The American Cancer Society also recommends that
women at increased risk of developing breast cancer (family history, genetic predisposition, history of the disease) may
benefit from starting early detection practices at a younger
age or having additional tests or more frequent examinations.
These women should talk to their health care provider about
the benefits and limitations of beginning screening at an earlier
age, and then make a decision about breast cancer screening.
Specific guidelines for clinical breast exams and breast examinations are also provided based on both age and level of risk.
Risk Factors
Several risk factors may contribute to the development of breast
cancer. They include:
• Increasing age
• Personal or family history of breast cancer and inherited genetic mutations in the breast cancer susceptibility genes BRCA1 and BRCA2 (These mutations account for approximately 5%-10% of all breast cancer cases.)
• History of noncancerous breast disease
• Long menstrual history (menstrual periods that start early and end late in life)
Modifiable risk factors:
Overview • Weight gain after age 18
• Being overweight or obese (postmenopausal breast cancer)
• Use of combined estrogen and progestin MHT
• Physical inactivity
• Alcohol consumption, especially two or more drinks daily
• Never having children or having the first child after age 30
• Recent use of oral contraceptives
Prevention/Screening/Early Detection
Some breast cancer risk factors, such as family history, cannot
be changed. However, a woman’s risk of developing breast cancer
may be reduced by staying physically active, avoiding obesity
and limiting alcohol use. Management of risk factors may help
some women decrease their chances of being diagnosed with
breast cancer. For women at high risk for breast cancer, two
medications, tamoxifen and raloxifene, have been approved to
reduce breast cancer risk.
Mammography can detect breast cancer at an early stage, when
treatment is more effective and a cure is more likely. Steady
declines in breast cancer mortality among women since 1990
Figure 12. Trends in Prevalence of Mammography Screening Among Women Aged 40 Years and Older
in Wisconsin, 1998-2008
95
90
85
Percent
Ever had mammogram
Had mammogram in past 2 years
80
75
70
65
60
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
Source: Wisconsin Behavioral Risk Factor Surveillance System, 1998-2008, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
Wisconsin Cancer Facts and Figures 2011
23
have been attributed to a combination of early detection and
improvements in treatment.
Figure 12, page 23 displays the upward trend in mammography
rates in both having a mammogram during the past two years,
which increased from 71% in 1998 to 76% in 2008, and ever having had a mammogram, which increased from 85% in 1998 to
92% in 2008. Improved mammography screening to detect breast
cancer early, along with better treatment options, have made
breast cancer a more curable disease than it was 30 years ago.
Cancer Burden
Breast cancer is the most common cancer among women in
Wisconsin regardless of race. Breast cancer accounts for nearly
one-third of all cancers diagnosed among women. During 20032007, the age-adjusted incidence rate for female breast cancer
was 121.7 per 100,000 population, representing more than
19,000 newly diagnosed breast cancers. Only lung cancer accounts for more cancer deaths in women. The mortality rate for
breast cancer in Wisconsin females during 2003-2007 was 22.6
per 100,000 population. This represents 3,784 deaths from breast
cancer during this time period. (Tables A & B, pages 48, 52).
The risk of developing breast cancer increases with age. Nationally, 95% of new cases and 97% of breast cancer deaths occur
in women aged 40 and older. In Wisconsin, during the five year
period from 2003 to 2007, approximately 95% of women who developed breast cancer were aged 40 and over, and 79% of
women diagnosed with breast cancer were aged 50 and over. Of women who died from breast cancer in Wisconsin, 98% were over age 40 and 89% were aged 50 and older.
Earlier diagnosis and treatment have resulted in a reduction in
mortality from breast cancer. Breast cancer mortality declined
significantly from the 1997 rate of 25.9 per 100,000 population to
the 2007 rate of 20.8 per 100,000 (Table 4, page 15).
Nationwide, after increasing from 1994 to 1999, female breast
cancer incidence rates decreased from 1999 to 2006 by 2.0%
each year. This decrease may reflect reductions in the use of
menopausal hormone therapy (MHT), previously know as
hormone replacement therapy, following the publication of
results from the Women’s Health Initiative in 2002, which linked
combined estrogen plus progestin MHT use to increase risk
of breast cancer and coronary heart disease. In Wisconsin, the
female breast cancer incidence rates has dropped from 133.7 per
100,000 population in 1997 to 116.8 per 100,000 population in
2007 (Table 3, page 15). Each year, about 50 men are diagnosed
with breast cancer in Wisconsin and approximately 1,900 men
are diagnosed with the disease nationally. Clinically, breast
cancer in men is very similar to breast cancer in women, but
the prognosis is often worse for men because they tend to be
diagnosed at a later stage than women.
Stage at Diagnosis
The national five-year relative survival rate for women diagnosed
with breast cancer at the local stage is 98%. Nationally, during
1999-2006, 60% of invasive breast cancer cases were diagnosed
early, or at the local stage. In Wisconsin, 61% of invasive female
breast cancers during that same period were diagnosed at the
local stage.
Figure 13, page 25 shows both pre-invasive and invasive breast
cancers in Wisconsin. It illustrates the percentage of diagnoses
at the pre-invasive, or in situ stage, increased from approximately 16% in 1997 to 20% in 2007. This increase in pre-invasive breast cancer largely reflects a rise in mammography use. Early detection through mammography screening provides the best chance of discovering breast cancer at an early stage and increasing survival.
American Cancer Society Screening Recommendations for Breast Cancer Women at average risk should follow the examination schedules below:
• Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health
• Clinical breast exams (CBE) should be part of a periodic health exam, preferably at least every three years for women in
their 20s and 30s and every year for women 40 and older
• Breast self-exam (BSE) is an option for women starting in their 20s and women should report any breast change promptly to their health care providers
• Women at increased risk (family history, genetic tendency, history of breast cancer) should talk with their health care provider about the benefits and limitations of starting mammography screening earlier, having additional tests (breast, ultrasound or MRI) or having more frequent exams
A mammogram is able to detect the earliest sign of breast cancer before it can be seen or felt physically.
24
Wisconsin Cancer Facts and Figures 2011
Figure 13. Trends in Breast Cancer Stage at Diagnosis in Wisconsin, 1997-2007
55
1997
1999
50
2001
2003
45
2005
2007
50
40
35
40
Percent
30
25
20
15
10
10
5
0
0
In Situ
Localized
Regional
Distant/Systemic
Unknown/Unstaged
Stage at Diagnosis
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
1. Refer to page 57 for definitions of stage at diagnosis.
Wisconsin Cancer Facts and Figures 2011
25
Prostate Cancer
in Wisconsin
Overview Prostate cancer is the most commonly diagnosed cancer among
men, excluding skin cancer. It is estimated that about 1 in 6 men
in the U.S. will be diagnosed with prostate cancer during their
lifetime. Prostate cancer is typically a disease found among
older men and often is a relatively slow growing cancer. When
prostate cancer is diagnosed at the localized or regional stage,
the 5-year survival rate approaches 100%.
Risk Factors
Although a specific cause is unknown, the American Cancer
Society recognizes that several risk factors may contribute to
the development of prostate cancer. They include:
• Increasing age
• Race (African-American men have higher incidence and mortality rates than other races. Their mortality rate from prostate cancer is twice as high as white men.)
• Family history (Having a father or brother with prostate cancer can double a man’s risk of developing this disease.)
• Diet (Diets high in fat and red meat and low in fruits and vegetables may increase the chance of developing prostate cancer.)
Prevention/Screening/Early Detection
Three of the four main risk factors for prostate cancer are not
preventable (age, race, family history), but maintaining a healthy
body weight and being physically active may reduce the risk of
developing aggressive prostate cancer and improve outcomes
following treatment.
Most prostate cancers are diagnosed before symptoms develop
through prostate specific antigen (PSA) screening or a digital
rectal exam (DRE). The American Cancer Society recommends
that asymptomatic men who have at least a 10-year life expectancy
should have an opportunity to make an informed decision with
their health care provider about screening for prostate cancer,
after receiving information about the uncertainties, risks and
potential benefits associated with prostate cancer screening.
Men at average risk should receive this information beginning at
age 50. Men at higher risk, including African-American men and
men with a first-degree relative (father or brother) diagnosed
with prostate cancer before age 65, should receive this information
beginning at age 45.
Cancer Burden
Prostate cancer is the most commonly diagnosed cancer and
the second leading cause of cancer death among men. In Wisconsin from 2003-2007, the average number of newly diagnosed
prostate cancers per year was 3,992 (age-adjusted rate of 148.3
cases per 100,000 population) and the average number of deaths
per year was 632 (27.1 deaths per 100,000 population). Nationally,
the incidence rate was higher for that same period, 163.1 per
100,000. However, the national death rate, 24.7 per 100,000, was
lower than Wisconsin’s rate (Tables 1 and 2, pages 10 and 11).
Stage at Diagnosis
The majority of prostate cancers were diagnosed at the local
stage (Figure 14, page 27). In Wisconsin, the percent of prostate
cancer diagnosed at the local stage increased from 77% in 1997
to 81% in 2007. However, in Wisconsin and nationally, AfricanAmerican men were more likely to be diagnosed at a distant
stage than men of other races. The national five-year survival
rate, all races combined, for locally and regionally diagnosed
prostate cancers was 100%. However, the survival rate for prostate
cancer diagnosed at the distant stage dropped to 30%.
American Cancer Society Screening Recommendations for Prostate Cancer
Asymptomatic men who have at least a 10-year life expectancy should have an opportunity to make an informed
decision with their health care provider about screening for prostate cancer, including the prostate specific antigen (PSA) screening and digital rectal examination (DRE), after receiving information about the uncertainties,
risks and potential benefits associated with prostate cancer screening.
• Men at average risk should receive this information beginning at age 50.
• Men at higher risk, including African-American men and men with a first-degree relative (father or brother) diagnosed with prostate cancer before age 65, should receive this information beginning at age 45.
• Men at appreciably higher risk (multiple family members diagnosed with prostate cancer before age 65) should receive this
information beginning at age 40.
26
Wisconsin Cancer Facts and Figures 2011
Figure 14. Trends in Prostate Cancer Stage at Diagnosis in Wisconsin, 1997-2007
1997
1999
90
2001
2003
50
2005
2007
70
Percent
40
50
30
20
30
10
10
0
0
0
Localized
Distant/Systemic
Regional
Unknown/Unstaged
Stage at Diagnosis
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
1. Refer to page 57 for definitions of stage at diagnosis.
Wisconsin Cancer Facts and Figures 2011
27
Melanoma/Skin Cancer
in Wisconsin
Overview
The number of melanoma cases in the United States, as well
as Wisconsin, is increasing. From 1997 to 2007, the number of
melanomas diagnosed in Wisconsin increased from 602 to 973.
Although melanoma accounts for only 4% of all skin cancers,
it causes 79% of skin cancer deaths. Fortunately melanoma is
often curable if detected and treated at early stages.
Skin Cancer Definition
Skin cancer is the most common form of cancer in the United
States. Most skin cancers are classified as nonmelanoma (basal
cell or squamous cell) and develop on sun-exposed areas of the
body. Although these cancers are highly curable if detected and
treated early, basal cell and squamous cell carcinomas can cause
considerable damage and disfigurement if left untreated.
Melanoma is a skin cancer that develops in melanocytes, the
cells that produce our skin color. This type of cancer can spread
quickly to other parts of the body. Even though melanoma is
very curable when detected in its early stages, melanoma is far
more dangerous than other skin cancers.
Signs and Symptoms of Skin Cancer
Key warning signs of melanoma include changes in size, shape,
or color of a skin lesion or the appearance of a new growth on
the skin. Basel cell carcinomas may appear as growths that are
flat, or as small, raised, pink or red, translucent, shiny areas that
may bleed following minor injury. Squamous cell cancer may
appear as growing lumps, often with a rough surface, or as flat,
reddish patches that grow slowly. Another sign of basal and
squamous cell skin cancers is a sore that doesn’t heal.
The American Cancer Society recommends
the following for the prevention of skin cancer:
• Limit or avoid sun exposure during the midday hours (10 a.m. – 4 p.m.)
• Wear a hat that shades the face, neck and ears, as well as a long-sleeved shirt and long pants.
• Wear sunglasses to protect the eyes.
• Use sunscreen with a sun protection factor (SPF) of 15 or higher.
• Avoid indoor tanning booths and sunlamps
• Sunburn protection should be emphasized in children; severe sunburns in childhood greatly increase the risk of melanoma in later life.
Risk Factors
Several risk factors may contribute to the development of melanoma.
They include:
• Personal or family history of melanoma
• Presence of atypical or numerous moles (more than 50)
Risk factors for the development of all types of skin cancer:
• Sun sensitivity (sunburning easily, difficulty tanning, natural blond or red hair color)
• A history of excessive sun exposure, including sunburns
• Use of tanning booths
• Personal history of skin cancer
• Diseases that suppress the immune system
Prevention/Screening/Early Detection
Skin should be protected from intense sun exposure by covering with clothing or a hat and applying sunscreen that has a
sun protection factor (SPF) of 15 or higher to uncovered skin.
Children in particular should be protected from the sun because
severe sunburns in childhood may greatly increase risk of melanoma
in later life.
In order to detect skin cancer early, it is important to recognize
changes in skin growths or the appearance of new growths. A
new or unusual lesion should be evaluated promptly by a physician.
28
Wisconsin Cancer Facts and Figures 2011
Early Detection of skin cancer:
A simple ABCD rule outlines the warning signals of
melanoma:
A is for asymmetry: one half of the mole does not match the other half.
B is for border irregularity: the edges are ragged, notched, or blurred.
C is for color: the pigmentation is not uniform, with variable degrees of tan, brown or black.
D is for diameter greater than six millimeters: any sudden or progressive increase in size should be of concern.
Figure 15. Trends in Melanoma Stage at Diagnosis in Wisconsin, 1997-2007
1997
1999
90
2001
2003
50
2005
2007
70
Percent
40
50
30
20
30
10
10
0
0
Localized
Distant/Systemic
Regional
Unknown/Unstaged
Stage at Diagnosis
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
1. Refer to page 57 for definitions of stage at diagnosis.
Cancer Burden
Every year, approximately 925 Wisconsin residents were diagnosed with melanoma, and 152 died from the disease between
2003 and 2007. Since 1997 the incidence rate has increased by
almost 44%, from 11.4 to 16.4 per 100,000. The Wisconsin incidence rate for 2003-2007 was 15.9, lower than the national rate
of 20.8 per 100,000. The Wisconsin mortality rate has remained
stable at around 2.6 per 100,000, close to the national rate of 2.7
(for 2003-2007) (Tables 1 and 2, pages 10 and 11). Approximately
63% of the melanoma deaths occurred in men and 37% of the
deaths occurred in women. Due to historical lower reporting for
this cancer site (often diagnosed at clinic and outpatient settings), the reader should use some caution in making inferences
from Wisconsin incidence data for melanoma.
invasive melanomas in the U.S. are diagnosed at the local stage.
In Wisconsin, 79% of invasive melanomas were diagnosed at the
local stage in 2007.
Figure 15 shows trends in stage at diagnosis of invasive melanomas in Wisconsin. The percent of melanomas diagnosed in
Wisconsin at the localized stage has remained high during 19972007, ranging from 71% to 81% each year.
Stage at Diagnosis
Melanoma can spread to other parts of the body quickly, but is
highly curable if detected early. The five-year national survival
rate for patients with melanoma is 91%. For localized melanoma, the national five-year survival rate is 98%. About 84% of
Wisconsin Cancer Facts and Figures 2011
29
protect against established infections, nor do they protect
against all HPV types. To be most effective, the HPV vaccine
should be given before a person becomes sexually active.
Cervical Cancer
in Wisconsin
Overview
Screening tests offer a powerful opportunity for the prevention,
early detection and successful treatment of cervical cancer.
National cervical cancer incidence and mortality rates decreased
50% over the past three decades with most of the reduction
attributed to the Pap test. Approximately 95% of Wisconsin
women have had a Pap test at some time in their lives.
Risk Factors
The primary cause of cervical cancer is infection with certain
types of Human Papilloma Virus (HPV). Factors that increase a
woman’s risk for cervical cancer and HPV infection include:
• Women who begin having sex at an early age
• Women who have many sexual partners, however, a woman may be infected with HPV even if she has had only one sexual partner
• Long term use of oral contraceptives
Prevention/Screening/Early Detection
Cervical cancer is closely linked to sexual behavior and to sexually
transmitted infections with certain types of Human Papilloma
Virus (HPV). The Food and Drug Administration (FDA) has
approved two vaccines for the prevention of the most common
HPV infections that cause cervical cancer. The vaccines cannot
Screening can prevent cervical cancer by detecting precancerous
lesions. As screening has become more common, pre-invasive lesions of the cervix are detected far more frequently than invasive
cancer. Cervical cancer can be cured if detected early.
Invasive cervical cancer has decreased significantly during the
past 25 years due to increased screening with Pap tests. Since
2001, the percentage of Wisconsin women who reported having
had a Pap test during the past three years has declined (Figure 16). In 2001, 90% of Wisconsin women aged 18 and older
reported having had a Pap test in the past three years. In 2008,
83% of adult women reported comparable Pap tests within that
time frame.
American Cancer Society Screening Recommendations for Cervical Cancer
Cervical cancer screening should begin approximately three
years after a woman begins having vaginal intercourse, but no
later than 21 years of age. Screening should be done every year
with conventional Pap tests or every two years using liquidbased Pap tests. At or after age 30, women who have had three
normal test results in a row may get screened every two to three
years with cervical cytology (either conventional or liquid-based
Pap test) alone, or every three years with an HPV DNA test plus
cervical cytology. Women 70 years of age and older who have
had three or more normal Pap tests and no abnormal Pap tests
in the past 10 years and women who have had a total hysterectomy may choose to stop cervical cancer screening.
Figure 16. Trends in Prevalence Among Women Aged 18 Years and Older Who Have Had a Pap Smear Within
Past Three Years in Wisconsin, 1998-2008
100
Percent
95
90
85
80
1998
1999
2000
2001
2002
2004
2006
Year
Source: Wisconsin Behavioral Risk Factor Surveillance System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
1. BRFS data for this figure are available for years: 1998, 1999, 2000, 2001, 2002, 2004, 2006, 2008.
30
Wisconsin Cancer Facts and Figures 2011
2008
Cancer Burden
In an average year, 189 Wisconsin women develop invasive
cervical cancer and 58 women die of the disease (Tables 1 and 2,
pages 10 and 11). The incidence rate of cervical cancer in Wisconsin from 2003-2007 was 6.6 per 100,000 population and the
mortality rate was 1.9 per 100,000 population. The national incidence rate for those same years was 6.8 per 100,000 population
and the national mortality rate was 2.4 per 100,000 population.
Stage at Diagnosis
Early detection through Pap screening provides the best chance
of discovering cervical cancer at a local stage. Early stage invasive
cervical cancer is one of the most successfully treatable cancers.
In Wisconsin, from 1997-2007, the percent of invasive cervical
cancers diagnosed at the local stage decreased from 51% to 48%
(Figure 17). Nationally, during 1999 to 2006, 49% of cervical cancer
cases were diagnosed early (at a local stage), and the relative
survival rate for women diagnosed at the local stage was 91%.
Figure 17. Trends in Cervical Cancer Stage at Diagnosis in Wisconsin, 1997-2007
90
1997
1999
2001
2003
50
70
2005
2007
40
Percent
50
30
30
20
10
00
0
Localized
Regional
Distant/Systemic
Unknown/Unstaged
Stage at Diagnosis
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
1. Refer to page 57 for definitions of stage at diagnosis.
Wisconsin Cancer Facts and Figures 2011
31
in Wisconsin were leukemia (38%), brain cancer (23%), and
lymphoma (6%).
Childhood Cancer
in Wisconsin
Trends in Childhood Cancer
Figure 18 shows the trends in childhood cancer during 1995-2007
for Wisconsin and the U.S.
Overview
The types of cancers that occur in children vary greatly from
those seen in adults. Leukemia, brain and other nervous system
tumors, lymphoma (lymph node cancer), bone cancer, soft tissue sarcoma, and kidney cancer are the most common cancers
of children. Because of significant advances in therapy, 80%
of these children will survive five years or more, an increase of
40% since the early 1970s. Despite its rarity and the impressive
improvements in treatment, cancer is still the leading cause of
death from disease in children under 15, and is second only to
accidents in most age groups. Encouragingly, childhood cancer
mortality rates in the U.S. declined 53% from 1975-2007; mortality for all childhood cancer was 4.9 per 100,000 population in
1975 compared with 2.3 per 100,000 in 2007.
The incidence rate for all childhood cancer in Wisconsin has
varied more than the national rate, in part due to the relatively
small number of cases each year. Wisconsin’s childhood mortality rates were similar to U.S. mortality rates, but showed more
variation from year to year.
Burden of Childhood Cancer in Wisconsin
An estimated 175 children under the age of 15 in Wisconsin
were diagnosed with cancer in 2007, and 25 children died from
the disease. That year, the age-adjusted incidence rate for childhood cancer in Wisconsin was 16.1 per 100,000 population and
the cancer mortality rate that year was 2.3 per 100,000 population. In 2007, the most frequently diagnosed childhood cancers
Figure 18. Childhood Cancer in Wisconsin and U.S., 1995-2007
20
Rate per 100,000
15
Wisconsin Incidence Rate
U.S. Incidence Rate
10
Wisconsin Mortality Rate
U.S. Mortality Rate
5
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services and Surveillance, Epidemiology,
and End Results (SEER) Program, National Cancer Institute, 2010.
1. Rates are per 100,000 population and age-adjusted to the U.S. standard population.
32
Wisconsin Cancer Facts and Figures 2011
Nutrition, Physical Activity,
Obesity, Alcohol and Cancer
Overview Approximately one-third of the cancer deaths that occur in the
U.S. each year are due to poor nutrition and physical inactivity,
including excess weight. For the majority of people, next to not
smoking tobacco, healthy dietary choices and physical activity
are the most important choices they can make to reduce their
cancer risk. Excessive caloric intake combined with inadequate
physical activity leads to obesity. Being overweight and obese
are clearly associated with increased risk for developing many
cancers, including cancers of the breast in postmenopausal
women, colon, endometrium, kidney, and adenocarcinoma of
the esophagus. Evidence is highly suggestive that obesity also
increases risk for cancers of the pancreas, gallbladder, thyroid,
ovary, and cervix, as well as for myeloma, Hodgkin lymphoma
and aggressive forms of prostate cancer. At the same time that
evidence connecting excess weight to increased cancer risk has
been accumulating, the rates of overweight and obesity have
been increasing.
Physical activity indirectly reduces the risk of developing the
many types of obesity related cancers because of its role in
helping to maintain a healthy weight. Being active is thought to
reduce cancer risk largely by improving energy metabolism and
reducing circulating concentrations of estrogen, insulin, and
insulin-like growth factors.
Recommendations for Community Action
Public, private and community organizations should work to
create social and physical environments that support the adoption
and maintenance of healthy nutrition and physical activity
behaviors.
• Increase access to healthful foods in schools, work
sites and communities.
• Provide safe, enjoyable and accessible environments for physical activity in schools and for transportation and recreation in communities.
Reducing the Risk of Cancer
Factors that influence the risk of cancer such as age, gender, or
family history cannot be modified and are classified as nonmodifiable risk factors. Lifestyle factors that influence cancer
risk, such as dietary and physical activity level and exercise
habits, are modifiable. By changing these modifiable aspects of
their lifestyle, people may reduce their risk of cancer.
Consuming Fruits and Vegetables
There is large gap between the current dietary recommendations (five or more fruits and vegetables daily) and actual
consumption patterns. Less than one in four adults in the
U.S. reported eating five or more servings of vegetables and
fruits daily in 2009. Similarly, only 23% of Wisconsin residents
reported eating five or more servings of fruits and vegetables per
day in the 2009 Wisconsin Behavioral Risk Factor Surveillance
System (BRFSS).
Below are the groups that reported the highest percentage of
“Consumed Fewer than Five Fruits and Vegetables Daily”:
• Adults aged 18 to 34 – 82%
• Adults with annual household income under $15,000 – 86%
• High school graduates, or less than high school education – 82%
• Hispanics* – 80%
* for combined years 2007-2009
American Cancer Society Guidelines on Nutrition
and Physical Activity for Cancer Prevention
Maintain a healthful weight throughout life.
• Balance caloric intake with physical activity.
• Avoid excessive weight gain throughout life.
• Achieve and maintain a healthy weight if currently
overweight or obese.
Adopt a physically active lifestyle.
• Adults: engage in at least 30 minutes of moderate to vigorous physical activity, above usual activities, on five or more days of the week; 45 – 60 minutes of intentional physical activity is preferable.
• Children and adolescents: engage in at least 60 minutes per day of moderate to vigorous physical activity at least five days per week.
Consume a healthy diet, with an emphasis on plant sources.
• Choose foods and beverages in amounts that help achieve and maintain a healthy weight.
• Eat five or more servings of a variety of vegetables and fruits each day.
• Choose whole grains in preference to processed (refined) grains.
• Limit consumption of processed and red meats.
If you drink alcoholic beverages, limit consumption.
• Consume no more than one alcoholic beverage per day for women or two per day for men.
Wisconsin Cancer Facts and Figures 2011
33
To improve dietary habits, both individual and community
actions are important. Consumers should ask for nutritional information when it is not available and request healthy changes
to menu items in restaurants. Community programs are needed
to support educational programs that promote nutritional quality in food selections and to ensure quality meals are offered in
public schools and other settings away from the home.
Physical Activity
Many Wisconsin adults live relatively inactive lifestyles. Regular
physical activity can lower cancer risk by maintaining a healthy
weight, since obesity is a risk factor for many types of cancer.
Insufficient physical activity is defined as adults having less than
30 minutes of moderate physical activity five or more days per
week, or vigorous physical activity for at least 20 minutes three
or more times per week. Almost one-half, or 47%, of Wisconsin
adults reported less than moderate or vigorous physical activity.
In 2009, the highest percentage of insufficient physical activity
was reported by following the groups of Wisconsin adults:
• Adults age 65 and older – 52%
• Adults with an annual household income of less than $15,000 – 58%
• Adults with high school education, or some college – 50%
• American Indian* – 52%
* for combined years 2007-2009
Increased opportunities for physical activity require individual
and community efforts to provide social support, environmental
opportunity and political policies promoting more accessible
recreational facilities. Community programs need to include
walking and bicycling trails, walking groups in malls, as well as
incentives for physical activity during the workday at places of
employment.
From an extensive array of activities (whether gardening,
dancing, pushing a stroller, sports or walking) everyone should
engage in physical activities that are fun, easy, practical and appropriate in relation to any health conditions.
Obesity
Obesity has reached epidemic proportions in the United States
and in Wisconsin. The percentage of overweight and obese
adults has increased dramatically in Wisconsin over the last
decade. Being overweight is defined as a body mass index (BMI)
of 25.0-29.9 kg/m2 and obesity is defined as a BMI equal to or
greater than 30 kg/m2. According to the Wisconsin 2009 BRFSS,
36% of Wisconsin adults are overweight and 29% are obese. The percentage of obesity is highest among:
34
• Adults aged 50-64 – 34%
Wisconsin Cancer Facts and Figures 2011
• Adults with an annual household income less than $15,000 – 41%
• Adults with less than a high school education – 37%
• African Americans* – 43%
* for combined years 2007-2009
Current behaviors such as eating meals away from home,
reduced physical activity, longer work hours and the increased
availability of electronic entertainment contribute to lifestyles
highly conducive to weight gain. If the environments where
people live, work, go to school and enjoy leisure time are not
oriented to improve their eating and activity habits, efforts to
decease obesity will have limited success. Community strategies
are needed to create environments that support healthy dietary
and physical activity behaviors. Strategies range from work site
policies and benefit packages that support health promotion
activities to school-based physical education programs that
reward physical activity achievements.
Alcohol Consumption
Alcohol consumption increases the risk of cancers of the
mouth, pharynx, larynx, esophagus, liver and breast. For each
of these cancers, risk increases substantially with the intake
of more than two drinks per day. The combination of alcohol
and tobacco significantly multiplies the risk for cancers of the
mouth, larynx and esophagus more than either alcohol or tobacco
use alone. The American Cancer Society recommends people
who drink alcohol should limit their intake to no more than two
drinks per day for men and one drink a day for women.
According to the BRFSS, 2009, Wisconsin had one of the highest
rates of heavy drinking among all states. Heavy drinking was
defined as when adults on average consume two or more drinks
per day, or 60 or more alcoholic drinks a month for men and
one or more drinks per day or 30 or more drinks a month for
women. In Wisconsin, 8% of adults reported heavy drinking
compared to 5% of the adults nationwide. The percentage of heavy drinking was highest among:
• Adults aged 18-34 – 10%
• Adults with annual household incomes of $15,000 - $24,999 – 10%
• Adults with a high school education – 10%
• American Indians* – 11%
* for combined years 2007-2009
Figure 19. Prevalence of Obesity, Nutrition, Sedentary Lifestyle and Heavy Drinking Among Adults
Aged 18 and Older, by Age, in Wisconsin, 2009
50
18-34
80
35-49
50-64
65+
40
Percent
60
30
40
20
20
00
0
Obesity
Fewer than 5 Fruits/Veg
Insufficient Physical Activity
Heavy Drinking
Risk Factors
Source: Wisconsin Behavioral Risk Factor Surveillance System, 2009, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
Notes: Obesity is defined as Body Mass Index = 30.0-99.8.
Insufficient Physical Activity is less than 30+ minutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ minutes three or
more days per week.
Heavy drinking is defined as 2 or more drinks per day for men and one or more drinks per day for women.
Wisconsin Cancer Facts and Figures 2011
35
Figure 20. Prevalence of Obesity, Nutrition, Sedentary Lifestyle and Heavy Drinking Among
Adults Aged 18 and Older, by Race/Ethnicity, in Wisconsin, 2007 and 2009*
80
White
70
Black
American Indian
50
Hispanic
60
40
Percent
50
40
30
20
20
10
00
0
Obesity
Fewer than 5 Fruits/Veg
Insufficient Physical Activity
Heavy Drinking
Risk Factors
Source: Wisconsin Behavioral Risk Factor Surveillance System, 2009, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
Notes: Obesity is defined as Body Mass Index = 30.0-99.8.
Insufficient Physical Activity is less than 30+ minutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ minutes three or
more days per week.
Heavy drinking is defined as 2 or more drinks per day for men and one or more drinks per day for women.
*For combined years 2007 and 2009.
36
Wisconsin Cancer Facts and Figures 2011
Figure 21. Prevalence of Obesity, Nutrition, Sedentary Lifestyle and Heavy Drinking Among
Adults Age 18 and Older, by Income, in Wisconsin, 2009
< $15,000
80
$15,000-$24,999
$25,000-$34,999
$35,000-$49,999
$50,000+
40
Percent
60
40
20
20
00
0
Obesity
Fewer than 5 Fruits/Veg
Insufficient Physical Activity
Heavy Drinking
Risk Factors
Source: Wisconsin Behavioral Risk Factor Surveillance System, 2009, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
Notes: Obesity is defined as Body Mass Index = 30.0-99.8.
Insufficient Physical Activity is less than 30+ minutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ minutes three or
more days per week.
Heavy drinking is defined as 2 or more drinks per day for men and one or more drinks per day for women.
Wisconsin Cancer Facts and Figures 2011
37
Figure 22. Prevalence of Obesity, Nutrition, Sedentary Lifestyle and Heavy Drinking Among Adults
Aged 18 and Older, by Education, in Wisconsin, 2009
Less than High School
80
High School Grad
40
Some College
College Graduate
Percent
60
40
20
20
00
0
Obesity
Fewer than 5 Fruits/Veg
Insufficient Physical Activity
Heavy Drinking
Risk Factors
Source: Wisconsin Behavioral Risk Factor Surveillance System, 2009, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
Notes: Obesity is defined as Body Mass Index = 30.0-99.8.
Insufficient Physical Activity is less than 30+ minutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ minutes three or
more days per week.
Heavy drinking is defined as 2 or more drinks per day for men and one or more drinks per day for women.
38
Wisconsin Cancer Facts and Figures 2011
Cancer in Diverse
Populations
According to the U.S. Census Bureau, the Wisconsin population
increased by 9% from 2000 to 2009 and reached more than 5.6
million in 2009. Approximately 11% of Wisconsin residents are
racial minorities: 6% African American, 1% American Indian, 2%
Asian, with 1% multiple race. Including all races, more than 5%
are of Hispanic or Latino ethnicity. In 2008, cancer was one of
the two leading causes of death among all Wisconsin residents
and accounted for 23.9% of deaths; only heart disease caused
more deaths, at 24.2%. However, cancer was the leading cause
of death among African Americans, American Indians, and Asian
residents, while heart disease was the leading cause among
whites.
The risk of developing and dying from cancer varies by race.
During 2003-2007, Wisconsin’s age-adjusted incidence rate
was 473.3 per 100,000 population. However, when examined by
racial group, the incidence rates ranged from 293.3 for Asians
to 556.6 for African Americans (Table 5, page 40). The same pattern was reflected in cancer mortality. The state mortality rate
was 182.0 per 100,000 population, but the rates by racial group
ranged from 98.1 for Asian/Pacific Islanders to 253.8 for African
Americans (Table 6, page 41). Hispanics/Latinos of any race
experienced the lowest rate of cancer mortality, 90.1 per 100,000
population.
For all cancer combined, incidence rates among African Americans were higher than the state average and highest of all racial
groups during 2003-2007 (Figure 23, page 40). African Americans also had the highest incidence rates of the lung, colorectal
and prostate cancers. Mortality rates were also higher for all
cancers combined and the major cancers profiled in this report
(Figure 24, page 41). The largest disparity between white and
African-American mortality rates occurs for prostate and lung
cancers (African-American rates being 80% and 66% higher
than the white rates, respectively).
Prostate Cancer
During 2003-2007, African-American males experienced higher
prostate cancer incidence and mortality rates than whites (243.7
cases per 100,000 and 48.4 deaths per 100,000 African-American
males as compared to 142.6 cases per 100,000 and 26.7 deaths
per 100,000 for white males).
Lung Cancer
Lung cancer rates among African-American males were almost
twice as high (141.5 incidence rate and 117.8 mortality rate, per
100,000 population) as rates among white males (73.7 incidence
rate and 60.9 mortality rate). American Indian males also experienced
high incidence and mortality rates of lung cancer (97.6 and 87.9,
respectively, per 100,000 population) that exceeded comparable
rates for white males.
Colorectal Cancer
African Americans and American Indians in Wisconsin experienced
higher colorectal incidence rates than whites (61.8 and 57.6
compared with 46.5, respectively, per 100,000 population) and
higher colorectal mortality rates than whites (23.1 and 20.4
compared with 16.3, respectively, per 100,000 population).
The reasons behind the incidence and mortality disparities
between racial and ethnic groups are not clearly defined.
Explanations vary from problems with accurate reporting of
racial information on incidence reports and death certificates
to differences among socioeconomic, lifestyle, environmental,
genetic, occupational and dietary factors. Access to care and
timing of diagnoses (late stage diagnoses reduce treatment
options and chances of long-term survival) are also important
aspects in determining reasons for the disparities.
Female Breast Cancer
While African-American women in Wisconsin are less likely to
be diagnosed with breast cancer than white women (116.8 cases
per 100,000 African-American women compared to 121.7 cases
per 100,000 white women), they are more likely to die from the
disease (26.5 per 100,000 African-American women compared
to 22.6 per 100,000 white women). This may be due to diagnoses
at later stages of the disease for African Americans and a higher
frequency of more aggressive tumors.
Wisconsin Cancer Facts and Figures 2011
39
Table 5. Age-adjusted Cancer Incidence Rates, by Race/Ethnicity and Sex, in Wisconsin, 2003-2007
Site
All Races
White
African
American
Asian American/
Pacific Islander
All sites
Male and Female
Male
Female
473.7
542.9
425.3
465.9
530.1
421.5
556.6
710.2
450.2
293.3
306.2
293.8
Lung & Bronchus
Male & Female
Male
Female
63.4
76.8
53.7
61.3
73.7
52.5
99.4
141.5
70.3
Colon & Rectum
Male and Female
Male
Female
47.6
54.5
42.1
46.5
53.2
41.1
Breast
Female
Hispanic/
Latino
American Indian
429.8
470.5
408.0
340.7
356.2
334.3
31.8
35.6*
30.4*
85.4
97.6
77.2
35.9
36.3
35.3
61.8
71.2
55.8
28.6
34.4*
25.6*
57.6
66.3*
52.3*
36.1
41.9
30.8
116.8
74.8
87.0
92.4
11.1*
13.6*
15.3*
121.7
121.7
Cervical
6.6
6.1
12.9
Prostate
148.3
142.6
243.7
73.5
102.4
97.0
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
1. Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.
2. Hispanic/Latino category includes all races.
3. * Rate based on small number (fewer than 20 cases) for the five-year period.
Figure 23. Age-Adjusted Cancer Incidence Rates by Race and Ethnicity in Wisconsin, 2003-2007
600
All Races
White
African American
American Indian
500
Asian/Pacific Islander
Hispanic/Latino
Rate per 100,000
400
300
200
100
0
0
All Sites
Lung & Bronchus
Colon & Rectum
Female Breast
Cancer Site
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
1. Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.
2. Hispanic/Latino category includes all races.
40
Wisconsin Cancer Facts and Figures 2011
Prostate
Table 6. Age-adjusted Cancer Mortality Rates, by Race/Ethnicity and Sex, in Wisconsin, 2003-2007
Site
All Races
White
African
American
Asian American/
Pacific Islander
All Malignant Cancers
Male and Female
Male
Female
182.0
223.5
154.5
179.8
220.4
152.9
253.8
340.5
198.5
98.1
98.5
97.4
229.4
276.1
201.1
Lung & Bronchus
Male & Female
Male
Female
48.5
62.3
38.5
47.6
60.9
38.1
78.9
117.8
52.5
16.5*
21.9*
13.4*
73.1
87.9
64.4
17.9
24.5*
11.8*
Colon & Rectum
Male and Female
Male
Female
16.5
19.9
14.0
16.3
19.6
13.7
23.1
28.6
19.6
9.0*
5.9*
10.8*
20.4*
34.8*
12.1*
7.5*
7.1*
7.7*
Breast
Female
22.6
22.6
26.5
7.6*
25.4*
7.3*
1.9
1.6
4.5*
4.5*
2.4*
27.1
26.7
5.0*
32.0*
6.0*
Cervix Uteri
Prostate
5.2*
48.4
Hispanic/
Latino
American Indian
90.1
109.0
73.6
Source: National Center for Health Statistics.
1. Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.
2. * The number of deaths used to calculate the rate was less than 10 deaths per year and the rate may be subject to great variability.
Figure 24. Age-Adjusted Cancer Mortality Rates by Race and Ethnicity in Wisconsin, 2003-2007
300
All Races
White
African American
American Indian
250
Asian/Pacific Islander
Hispanic/Latino
Rate per 100,000
200
150
100
50
00
All Sites
Lung & Bronchus
Colon & Rectum
Female Breast
Prostate
Cancer Site
Source: National Center for Health Statistics.
1. Rates are per 100,000 population and are age-adjusted to the 2000 U.S. standard population.
2. Hispanic/Latino category includes all races.
Wisconsin Cancer Facts and Figures 2011
41
normal life expectancy (factors such as dying of heart disease,
accidents and diseases of old age). Although five-year survival
rates are useful in monitoring progress in detection and treatment of cancer, they do not represent the proportion of people
who are cured or permanently free of cancer.
Cancer Survivorship and
Quality of Life
What Percentage of People Survive Cancer?
The five-year relative survival rate for all cancers in the U.S. diagnosed during 1999-2006 was 68%, up from 50% in 1975-1977.
The National Cancer Institute estimates there are more than 11
million cancer survivors in the United States. The survival rate is
different for different types of cancer, as cancer sites vary in the
rate of growth and likelihood of early detection. The five-year
relative survival rate represents persons who are living five years
after diagnosis whether disease free, in remission, or under
treatment with evidence of further cancer, after adjusting for
The five-year relative survival rates for major cancer sites decline with the advance of the disease at the time of diagnosis.
Cancer is staged at the time of diagnosis based on the extent of
the disease from the site of origin. Summary staging (in situ, local, regional and distant) is used by cancer registries for analysis
relevant to diagnosis, treatment and survival statistics. See
Glossary on page 57 for definitions of each summary stage.
The five-year relative survival rates for major cancer sites in the
United States are shown in Table 7.
Table 7. Five-Year Survival Rates for Major Invasive Cancers by Stage at Diagnosis, United States, 1999-2006
Site
Female Breast
All Stages
Local
Regional
Distant
%
%
%
%
%
%
89.0
98.0
23.4
57.9
100.0
83.6
Unstaged
Cervix
70.2
91.2
57.8
Colon & Rectum
65.0
94.0
69.5
17.0
Esophagus
17.0
37.4
18.8
3.2
12.1
Kidney
68.8
90.3
62.7
10.6
37.8
Lung & Bronchus
15.8
52.9
24.0
3.5
8.7
Melanoma
91.4
98.0
62.1
15.9
76.0
Ovary
27.2
11.6
58.1
38.3
45.6
93.5
73.4
27.6
Pancreas
5.6
22.5
8.8
1.9
5.0
Prostate
99.1
100.0
100.0
30.2
75.0
Stomach
26.0
62.5
27.0
3.4
17.3
Thyroid
97.3
99.8
97.1
58.1
89.7
Uterine
82.7
95.5
67.5
17.1
55.5
Urinary Bladder
79.3
73.3
36.1
5.6
55.3
Source: Surveillance, Epidemiology, and End Results Program, SEER Cancer Statistics Review 1975-2007, National Cancer Institute, 2010.
1. In Situ cases are not included in the "all stages" group.
2. Refer to page 57 in the glossary for definitions of stage at diagnosis.
42
Wisconsin Cancer Facts and Figures 2011
In Situ
96.6
Quality of Life Factors
From the time of diagnosis, the quality of life for every cancer patient and survivor is affected in some way.
Lung - People with lung cancer tend to be distressed about their physical appearance, including weight loss, the social stigma
and guilt associated with a history of tobacco use and end of life issues due to the low survival rate for this cancer.
Colon and Rectal - People with colorectal cancer are often concerned with bowel dysfunction and the associated social
stigma, as well as the effects of chemotherapy and radiation.
Female Breast - Women with breast cancer often feel uncertainty about treatment options and have concerns about their
fatigue, sexuality and body image.
Melanoma of the Skin - People with skin cancer may have a fear of possible disfigurement, and concern about
protecting their skin from the sun may greatly increase.
Cervical - Women with cervical cancer also are often concerned about whether they will be able to get pregnant.
The American Cancer Society supports programs that empower cancer patients, survivors and their families to
seek and recognize ongoing sources of support within their community.
Comprehensive cancer information and access to community based support are available 24-hours a day, seven
days a week, by calling 1.800.227.2345 or visiting www.cancer.org.
Wisconsin Cancer Facts and Figures 2011
43
Wisconsin Comprehensive
Cancer Control Plan
The Wisconsin Comprehensive Cancer Control Plan 2010-2015
(WI CCC Plan) was developed in collaboration with partners
across Wisconsin. Strategies and action steps across the cancer
continuum are presented throughout the WI CCC Plan for organizations to implement over the next five years to reduce
the burden of cancer in the state.
Here are a few examples of strategies and action steps from the
plan that could be implemented by you and/or your organization.
In no way is this list exhaustive of all the possible ways you or
your organization might work to reduce the burden of cancer
in Wisconsin over the next five years. Refer to the complete WI
CCC Plan 2010-2015 for all the proposed strategies and action
steps. The WI CCC Plan 2010-2015 can be accessed at www.wicancer.org.
• Seek and apply for accreditation by the American College of Surgeons.
• Increase the availability of culturally appropriate patient navigation systems within your health system.
• Practice shared decision making between providers, patients and family at your health system.
• Put survivorship best practice models into practice system wide.
• Promote advanced directives conversations with providers, patients and families.
• Ensure all cancer cases are reported as mandated to the Wisconsin Cancer Reporting System.
If you are a Health Care Provider:
• Ask all your patients if they smoke and provide tobacco cessation interventions to patients who do smoke.
• Screen patients for obesity and work with those that are receiving treatment.
How Can You Use the Wisconsin Comprehensive
Cancer Control Plan 2010-2015?
• Encourage patients to get their recommended cancer screenings.
If you are a Community Based Organization:
• Follow nationally validated practice guidelines when treating a cancer patient.
• Decrease youth tobacco use in your community through programs and policy.
• Provide cancer patients with a written synopsis of their coordinated care plan.
• Create a local level action plan to eliminate barriers to cancer screenings.
• Provide community based educational forums to address specific and unique needs of cancer survivors. • Work with health systems to improve health literacy resources for patients.
If you are a Advocacy Organization:
• Inform cancer patients that quality symptom management is an expected part of their cancer care.
• Advocate for full funding of the Wisconsin Tobacco Prevention & Control Program.
• Advocate for regulation of tanning beds.
• Support legislation to provide insurance coverage and funding for recommended cancer screenings.
• Advocate for legislation to increase funding for survivorship services, research and surveillance.
• Advocate for the completion of advance care documents for all cancer patients.
• Advocate for full funding of the Wisconsin Cancer Reporting System.
If you are a State or Local Public Health Agency:
• Decrease youth tobacco use in your community through programs and policy.
• Promote physical activity and healthy balanced diets to those living in your community.
• Promote programs that cover recommended screenings for the underinsured or uninsured.
• Promote the use of existing cancer-related data and relevant reports.
• Collect data to measure emerging needs identified within the chapters of WI CCC Plan.
If you are a Health Care System:
44
• Implement office based reminders that identify patients due for cancer prevention and screening services.
Wisconsin Cancer Facts and Figures 2011
• Pursue continued education to increase understanding of survivor needs and available best practices.
• Talk with your patients about the benefits of palliative care.
If you are a Legislator:
• Support full funding of the Wisconsin Tobacco Prevention & Control Program.
• Support the regulation of tanning beds.
• Support legislation that provides full insurance coverage and funding for recommended cancer screenings.
• Support legislation to improve funding for survivorship services, research and surveillance.
• Train professionals on how to address cancer survivorship issues.
• Support full funding of the Wisconsin Cancer Reporting System.
• Identify indicators and useful sources of data for monitoring quality symptom management.
• Collect data to measure emerging needs identified within the chapters of WI CCC Plan.
• Create a database to capture data on Wisconsin survivors.
If you are a Professional Organization:
• Inform professional members of the importance and benefits of providing cancer clinical trials.
• Educate professional members on survivor needs and available best practices.
• Support policy changes and increase funding for survivorship services.
• Train professional members on standard cancer symptom management.
• Partner with other professional organizations to provide cancer risk assessments and counseling.
If you are a Insurance Company or Payer:
If you are a Educator or School:
• Promote healthy lifestyles behaviors to students and staff.
• Provide information on return to school transition issues to survivors and those in their school environment.
If you are a Survivor:
• Share your experience to help educate the public about the needs of survivors and co-survivors.
• Mentor survivors and co-survivors to be active participants in their medical decision making teams.
• Encourage employers or schools to provide information on transition issues to survivors and others.
• Provide full coverage for tobacco addiction treatments.
• Reimburse for nutrition and physical activity counseling and interventions.
• Provide full coverage for HPV vaccination services.
• Provide incentives to members who get recommended cancer screenings.
• Provide full coverage for recommended cancer screenings.
If you are a Wisconsin Resident:
• Reimburse providers for their time to discuss the importance of advance directives with patients.
• Incorporate healthy lifestyles for you and your family.
• Provide full coverage for cancer risk assessments and genetic testing.
• Get and follow recommended cancer screenings.
• Complete an advance directive.
• Consider joining an advocacy group or organization working to improve survivors’ experiences.
If you are a Business and/or Employer:
• Provide a smoke-free work environment and access to tobacco addiction treatment for employees.
• Encourage employees to be physically active and eat a healthy balanced diet.
• Provide sun-protective gear or products to those working outside.
• Provide full coverage for recommended cancer screenings and time off for employees to get screened.
• Implement a cancer screening event at the workplace.
• Provide information on return to work transition issues to survivors and their co-workers.
WI Comprehensive Cancer Control Website
www.wicancer.org
If you are an Academic or Research Institution:
• Assess possible environmental issues as they relate to cancer.
• Increase awareness of the connection between alcohol consumption and cancer risk.
Wisconsin Cancer Facts and Figures 2011
45
Wisconsin Well Woman
Program
The Wisconsin Well Woman Program (WWWP) was established
in 1993 as a state component of the Centers for Disease Control
and Prevention’s (CDC) National Breast and Cervical Cancer
Early Detection Program (NBCCEDP). The WWWP is located
with the other chronic disease programs, in the Wisconsin
Division of Public Health’s (DPH) Bureau of Community Health
Promotion.
The program’s primary goal is to reduce mortality from breast
and cervical cancers by increasing the number of low-income
women who are routinely screened, and by improving the quality
of screening, referral and follow-up.
The primary population targeted by the WWWP is women ages
45-64 with low incomes. Women must have a gross household
income at or below 250% of the current federal poverty level.
A woman who is age and income eligible must be uninsured
or underinsured. The program also has some exceptions to
the age eligibility criteria for women 65 and older who are not
eligible for Medicare or who cannot afford Medicare Part B. The
program also has exceptions for women ages 35-44 referred
from the Medicaid Family Planning Waiver or women in this age
group who have breast symptoms.
The majority of breast cancers can be treated successfully, if
detected early. Early stage invasive cervical cancer is one of the
most successfully treatable cancers. Early detection with Pap
tests at appropriate intervals provides the best chance of discovering
cervical cancer at a local stage.
Breast and cervical cancer screening rates among underserved
populations are lower than the general population due to many
barriers. Access to affordable screening services is a major barrier
for some populations.
The WWWP has been providing breast and cervical cancer
screening services since June 1, 1994. To date, more than 58,450
women have received screening services. On average, the
WWWP has provided screening services to 9,900 women for
each of the last three program years.
In calendar year 2009, the program provided screening services
to 9,944 women. The majority of these women, 6,617, were ages
50-64. More than 7,400 were white, 553 African American and
1,815 were Hispanic. Program records indicate that 168 American
Indian and 95 Asian women also received program screening
services. During calendar year 2009, 52 women enrolled in the
WWWP were diagnosed with invasive breast cancer and 11
were diagnosed with invasive cervical cancer.
46
Wisconsin Cancer Facts and Figures 2011
The WWWP is a decentralized statewide screening program,
with local coordinating agencies covering the state’s 72 counties
and 11 tribes. The local coordinating agencies include local
health departments, tribal agencies, family planning agencies
and other community-based organizations. Each local coordinating
agency has a designated coordinator, who is responsible for
implementing local WWWP activities. These activities include
recruitment, public education and outreach; eligibility determination and enrollment; case management including follow-up
for clients with abnormal screening results; provider support;
and assisting women with their treatment needs. The local coordinators are the first line of contact for women accessing
the WWWP through the 83 local coordinating agencies.
It has always been the goal of the WWWP to have provider
agreements with health care providers across the state so that
eligible women have access to screening services within a 50
mile radius of their residence. The WWWP works with mobile
providers in some areas in order to improve access to screening
services.
The WWWP currently has a statewide network of 995 provider
sites. These providers include family planning clinics, hospitals,
independent laboratories, mammography facilities, federally
qualified health centers, medical clinics, and tribal health clinics.
There is at least one screening provider in each of the 72 counties.
There are 53 screening providers in the Milwaukee metropolitan
area.
In order to maximize resources, coordinate activities and provide services to as many women as possible, the WWWP has
partnered with a variety of groups and organizations during its
16-year screening history. These partnerships include nursing
schools, community-based organizations, public service organizations and other public health programs.
Wisconsin Well Woman Program website:
www.dhs.wisconsin.gov/womenshealth/wwwp
Phone number: 608-266-8311
Wisconsin Cancer Incidence
and Mortality, by County,
2003-2007
The following tables present Wisconsin cancer incidence and
mortality data from 2003-2007 by county. The number of cases/
deaths listed for each county is the total number of cancer cases
or deaths, for that county, for the entire 5-year period represented
in these tables. Five year age-adjusted rates are also included in
the tables; the rates represent the average number of cases or
deaths, per 100,000 population, weighted to reflect the 2000 U.S.
standard population. Due to wide variances in county populations, rates are included to allow comparisons between counties.
However, the number of cases/deaths should not be directly
compared across counties.
The 95% confidence intervals (95% CI) are also included in the
tables to facilitate county comparisons. The range between the
lower and upper limits of the confidence interval defines where
the “true” age-adjusted rate for the county or state actually falls,
within 95% probability.
Comparing two sets of confidence intervals can be equated
to statistical significance testing of county rate differences. A
narrow confidence interval (more common with larger populations) implies that the rate has been more accurately estimated
whereas a wider interval implies less certainty that the calculated
rate is the “true” rate for that respective county.
Wisconsin Cancer Facts and Figures 2011
47
Table A: Cancer Incidence, Total Number of Cases and Averaged-Annual
Age-Adjusted Rates by County, 2003 - 2007
County
Statistic
All Sites
Colon &
Rectum
Lung &
Bronchus
Female
Breast
Prostate
All Counties
Cases
Rate
(95% CI)
139,391
473.5
(471.0 - 476.0)
14,113
47.6
(46.8 - 48.4)
18,558
63.3
(62.4 - 64.2)
19,037
121.7
(120.0 - 123.5)
19,957
148.2
(146.1 - 150.3)
Adams
Cases
Rate
(95% CI)
577
391.0
(359.0 - 425.5)
56
35.8
(26.9 - 47.2)
125
81.4
(67.4 - 97.8)
50
74.0
(54.0 - 99.7)
60
77.6
(59.0 - 101.1)
Ashland
Cases
Rate
(95% CI)
456
483.5
(439.5 - 530.8)
49
50.5
(37.2 - 67.2)
86
90.7
(72.4 - 112.4)
66
140.5
(108.1 - 179.7)
54
123.9
(93.0 - 162.0)
Barron
Cases
Rate
(95% CI)
1,225
431.3
(407.1 - 456.6)
125
43.6
(36.1 - 52.1)
161
55.8
(47.4 - 65.3)
164
113.0
(96.0 - 132.4)
163
123.2
(105.0 - 143.8)
Bayfield
Cases
Rate
(95% CI)
387
389.1
(350.4 - 431.2)
55
53.7
(40.4 - 70.6)
48
103.6
(75.3 - 139.8)
51
96.8
(71.9 - 128.8)
Brown
Cases
Rate
(95% CI)
5,317
468.8
(456.2 - 481.7)
538
47.8
(43.8 - 52.1)
63
62.9
(48.2 - 81.2)
599
54.5
(50.2 - 59.0)
757
123.1
(114.4 - 132.3)
763
147.6
(137.1 - 158.7)
Buffalo
Cases
Rate
(95% CI)
358
409.0
(367.3 - 454.5)
36
39.1
(27.4 - 54.7)
44
50.2
(36.4 - 67.9)
36
83.7
(57.8 - 117.9)
64
149.0
(114.7 - 191.1)
Burnett
Cases
Rate
(95% CI)
Cases
Rate
(95% CI)
420
346.3
(313.0 - 382.5)
841
411.5
(383.8 - 440.6)
39
30.1
(21.3 - 42.0)
97
49.9
(40.3 - 60.9)
68
52.5
(40.7 - 67.4)
67
32.9
(25.4 - 41.9)
57
103.4
(76.8 - 136.9)
133
122.7
(102.5 - 145.6)
60
96.0
(73.0 - 125.2)
147
150.9
(127.0 - 178.0)
Chippewa
Cases
Rate
(95% CI)
1,577
486.2
(462.4 - 511.0)
175
53.5
(45.8 - 62.1)
219
67.4
(58.7 - 77.0)
199
116.3
(100.5 - 133.9)
253
168.4
(148.2 - 190.7)
Clark
Cases
Rate
(95% CI)
983
512.1
(480.1 - 545.7)
86
43.6
(34.8 - 54.1)
94
48.4
(39.1 - 59.5)
129
131.7
(109.1 - 157.6)
170
187.5
(160.3 - 218.0)
Columbia
Cases
Rate
(95% CI)
1,520
487.3
(462.9 - 512.6)
163
51.9
(44.2 - 60.7)
236
74.5
(65.3 - 84.8)
210
130.5
(113.2 - 149.9)
213
Crawford
Cases
Rate
(95% CI)
577
546.7
(502.2 - 594.2)
58
53.4
(40.4 - 69.6)
95
86.6
(69.9 - 106.3)
49
92.7
(68.0 - 123.9)
94
180.0
(145.3 - 221.0)
Dane
Cases
Rate
(95% CI)
8,823
431.6
(422.4 - 440.9)
778
39.4
(36.7 - 42.4)
1,063
55.1
(51.7 - 58.5)
1,406
123.9
(117.4 - 130.7)
1,235
132.7
(125.1 - 140.6)
Dodge
Cases
Rate
(95% CI)
2,034
424.6
(406.3 - 443.6)
221
45.4
(39.6 - 51.9)
280
58.5
(51.8 - 65.8)
272
110.8
(97.9 - 125.0)
274
122.4
(108.2 - 137.9)
Door
Cases
Rate
(95% CI)
1,105
531.9
(500.3 - 565.3)
125
58.1
(48.2 - 69.7)
132
60.6
(50.7 - 72.3)
161
156.5
(132.5 - 184.2)
160
160.5
(136.5 - 188.0)
Douglas
Cases
Rate
(95% CI)
951
383.5
(359.3 - 409.0)
83
32.3
(25.7 - 40.3)
151
60.5
(51.2 - 71.1)
110
84.5
(69.3 - 102.3)
139
124.7
(104.7 - 147.6)
Dunn
Cases
Rate
(95% CI)
748
385.5
(358.1 - 414.5)
81
40.8
(32.3 - 50.8)
93
50.0
(40.3 - 61.3)
112
112.1
(92.0 - 135.3)
96
111.4
(90.0 - 136.2)
Calumet
48
Wisconsin Cancer Facts and Figures 2011
147.6
(128.3 - 169.1)
Table A: Cancer Incidence, Total Number of Cases and Averaged-Annual
Age-Adjusted Rates by County, 2003 - 2007 (continued)
County
Statistic
All Sites
Colon &
Rectum
Lung &
Bronchus
Female
Breast
Prostate
Eau Claire
Cases
Rate
(95% CI)
1,858
389.7
(372.0 - 408.1)
190
38.3
(33.0 - 44.2)
246
52.3
(45.9 - 59.3)
271
106.8
(94.2 - 120.5)
271
128.5
(113.5 - 145.0)
Florence
Cases
Rate
(95% CI)
355
64.3
(57.7 - 71.4)
11
64.2
(31.6 - 122.4)
394
135.1
(121.8 - 149.4)
21
113.9
(70.2 - 180.1)
Cases
Rate
(95% CI)
6
14.8
(5.4 - 36.9)
320
55.8
(49.7 - 62.3)
20
59.5
(36.0 - 94.9)
Fond du Lac
126
370.8
(307.5 - 445.0)
2,889
523.1
(504.0 - 542.8)
Forest
Cases
Rate
(95% CI)
308
442.5
(393.2 - 496.9)
44
61.3
(44.0 - 83.9)
57
77.3
(58.3 - 101.3)
25
72.5
(46.2 - 109.6)
37
113.8
(79.9 - 158.6)
Grant
Cases
Rate
(95% CI)
1,121
391.3
(368.3 - 415.3)
118
38.9
(32.1 - 46.9)
163
55.4
(47.1 - 64.7)
124
81.2
(66.9 - 97.8)
164
122.9
(104.8 - 143.4)
Green
Cases
Rate
(95% CI)
938
468.1
(438.3 - 499.4)
122
58.6
(48.5 - 70.2)
110
54.4
(44.7 - 65.7)
120
113.8
(94.1 - 136.7)
102
112.3
(91.4 - 136.7)
Green Lake
Cases
Rate
(95% CI)
632
494.8
(456.1 - 536.2)
71
53.1
(41.2 - 67.6)
87
64.0
(51.1 - 79.5)
62
101.0
(76.5 - 131.4)
85
143.2
(114.3 - 177.6)
Iowa
Cases
Rate
(95% CI)
441
346.2
(314.4 - 380.4)
47
37.2
(27.3 - 49.7)
44
35.3
(25.6 - 47.5)
66
100.2
(77.3 - 127.9)
79
134.4
(106.0 - 167.9)
Iron
Cases
Rate
(95% CI)
216
423.9
(366.8 - 488.9)
29
51.7
(34.3 - 77.5)
47
90.3
(66.0 - 123.0)
21
91.5
(55.4 - 146.1)
18
68.8
(40.7 - 114.7)
Jackson
Cases
Rate
(95% CI)
569
512.1
(470.7 - 556.3)
62
53.7
(41.1 - 69.0)
80
71.2
(56.4 - 88.8)
74
135.1
(105.6 - 170.7)
94
174.9
(141.1 - 214.4)
Jefferson
Cases
Rate
(95% CI)
1,908
469.0
(448.0 - 490.7)
208
51.2
(44.4 - 58.7)
249
62.6
(55.0 - 71.0)
245
112.4
(98.6 - 127.6)
273
146.7
(129.6 - 165.5)
Juneau
Cases
Rate
(95% CI)
829
524.4
(489.0 - 561.9)
84
52.4
(41.7 - 65.1)
150
94.0
(79.5 - 110.5)
85
104.3
(82.9 - 129.8)
113
149.9
(123.5 - 180.6)
Kenosha
Cases
Rate
(95% CI)
3,691
484.3
(468.7 - 500.3)
371
48.9
(44.0 - 54.2)
598
79.8
(73.5 - 86.5)
485
117.1
(106.8 - 128.1)
535
156.2
(143.0 - 170.3)
Kewaunee
Cases
Rate
(95% CI)
549
463.1
(424.7 - 504.1)
58
47.4
(35.8 - 61.6)
70
57.6
(44.8 - 73.2)
72
118.6
(92.5 - 150.2)
87
153.9
(123.1 - 190.2)
La Crosse
Cases
Rate
(95% CI)
2,813
503.6
(485.0 - 522.7)
260
45.7
(40.2 - 51.6)
354
63.9
(57.4 - 71.0)
390
129.7
(117.0 - 143.5)
477
191.4
(174.5 - 209.5)
Lafayette
Cases
Rate
(95% CI)
377
391.6
(352.8 - 433.8)
41
42.7
(30.6 - 58.3)
44
44.8
(32.5 - 60.4)
44
89.5
(64.9 - 120.9)
45
99.8
(72.7 - 134.0)
Langlade
Cases
Rate
(95% CI)
641
464.2
(428.2 - 502.6)
66
45.5
(35.1 - 58.4)
94
66.2
(53.3 - 81.4)
69
102.9
(79.5 - 131.6)
79
117.8
(93.2 - 147.5)
Lincoln
Cases
Rate
(95% CI)
951
505.3
(473.2 - 539.0)
106
52.6
(43.0 - 64.0)
139
71.8
(60.3 - 85.1)
137
142.4
(119.0 - 169.4)
130
145.5
(121.5 - 173.1)
Manitowoc
Cases
Rate
(95% CI)
2,398
487.8
(468.2 - 508.0)
236
46.6
(40.8 - 53.0)
260
51.2
(45.2 - 58.0)
293
113.5
(100.6 - 127.8)
335
148.6
(133.0 - 165.6)
419
168.7
(152.8 - 185.8)
Wisconsin Cancer Facts and Figures 2011
49
Table A: Cancer Incidence, Total Number of Cases and Averaged-Annual
Age-Adjusted Rates by County, 2003 - 2007 (continued)
50
County
Statistic
All Sites
Colon &
Rectum
Lung &
Bronchus
Female
Breast
Prostate
Marathon
Cases
Rate
(95% CI)
3,181
456.7
(440.8 - 473.0)
294
41.4
(36.8 - 46.5)
360
52.0
(46.7 - 57.7)
483
131.5
(119.9 - 144.0)
509
158.1
(144.5 - 172.6)
Marinette
Cases
Rate
(95% CI)
1,315
463.8
(438.6 - 490.2)
129
42.4
(35.3 - 50.6)
182
62.0
(53.2 - 72.0)
165
113.8
(96.6 - 133.6)
218
159.4
(138.9 - 182.4)
Marquette
Cases
Rate
(95% CI)
627
604.7
(557.0 - 655.7)
56
51.0
(38.3 - 67.1)
131
122.5
(102.1 - 146.3)
72
156.3
(120.2 - 200.1)
82
157.0
(124.6 - 196.1)
Menominee
Cases
Rate
(95% CI)
121
623.2
(511.1 - 752.1)
21
117.3
(69.3 - 184.1)
19
94.9
(56.4 - 149.9)
17
167.9
(96.7 - 271.8)
18
196.1
(109.9 - 320.4)
Milwaukee
Cases
Rate
(95% CI)
23,074
492.7
(486.3 - 499.2)
2,392
50.6
(48.6 - 52.7)
3,383
73.3
(70.8 - 75.8)
3,132
119.8
(115.6 - 124.1)
2,959
150.3
(144.8 - 155.8)
Monroe
Cases
Rate
(95% CI)
1,118
487.1
(458.8 - 516.8)
134
57.8
(48.4 - 68.5)
144
60.9
(51.3 - 71.8)
152
130.1
(110.0 - 152.8)
187
168.4
(144.9 - 194.7)
Oconto
Cases
Rate
(95% CI)
1,059
485.2
(456.2 - 515.6)
99
44.5
(36.1 - 54.3)
170
76.7
(65.5 - 89.2)
92
85.2
(68.6 - 104.9)
199
180.6
(156.2 - 208.0)
Oneida
Cases
Rate
(95% CI)
1,457
555.4
(526.6 - 585.5)
152
54.7
(46.3 - 64.4)
243
87.2
(76.6 - 99.2)
175
132.7
(113.2 - 154.9)
203
153.6
(133.1 - 176.9)
Outagamie
Cases
Rate
(95% CI)
4,042
487.9
(472.8 - 503.3)
412
50.0
(45.3 - 55.1)
416
52.2
(47.3 - 57.5)
594
131.9
(121.4 - 143.0)
595
160.0
(147.2 - 173.6)
Ozaukee
Cases
Rate
(95% CI)
2,431
497.3
(477.4 - 517.9)
222
45.1
(39.3 - 51.5)
255
52.5
(46.2 - 59.4)
412
158.1
(143.0 - 174.5)
378
156.9
(141.2 - 174.0)
Pepin
Cases
Rate
(95% CI)
183
411.9
(353.5 - 477.6)
20
43.4
(26.1 - 68.4)
24
54.0
(34.4 - 81.2)
15
67.4
(37.1 - 113.7)
31
143.5
(97.4 - 204.9)
Pierce
Cases
Rate
(95% CI)
512
305.8
(279.3 - 334.0)
53
32.9
(24.5 - 43.2)
66
41.5
(31.9 - 52.9)
81
89.7
(71.0 - 111.9)
69
93.3
(71.9 - 118.7)
Polk
Cases
Rate
(95% CI)
959
372.8
(349.3 - 397.4)
115
43.7
(36.0 - 52.6)
134
51.1
(42.8 - 60.7)
92
71.6
(57.4 - 88.3)
133
112.0
(93.6 - 133.0)
Portage
Cases
Rate
(95% CI)
1,350
414.1
(392.1 - 437.1)
119
37.2
(30.8 - 44.6)
172
54.5
(46.6 - 63.3)
192
110.0
(94.8 - 126.9)
190
120.0
(103.2 - 138.6)
Price
Cases
Rate
(95% CI)
496
471.6
(430.0 - 516.6)
49
45.6
(33.4 - 61.3)
84
78.0
(62.0 - 97.4)
63
112.4
(85.9 - 145.8)
67
130.0
(100.7 - 166.3)
Racine
Cases
Rate
(95% CI)
5,068
501.7
(487.9 - 515.8)
504
50.1
(45.8 - 54.7)
694
69.5
(64.4 - 74.9)
757
138.5
(128.7 - 148.8)
750
163.8
(152.1 - 176.1)
Richland
Cases
Rate
(95% CI)
462
409.3
(372.1 - 449.5)
65
56.5
(43.4 - 72.5)
65
55.5
(42.8 - 71.2)
41
64.9
(45.6 - 90.2)
36
66.2
(46.3 - 92.3)
Rock
Cases
Rate
(95% CI)
4,095
499.0
(483.8 - 514.6)
412
50.5
(45.7 - 55.6)
636
77.4
(71.5 - 83.7)
509
115.9
(105.9 - 126.5)
474
124.7
(113.6 - 136.6)
Rusk
Cases
Rate
(95% CI)
443
456.0
(413.6 - 502.0)
43
42.8
(30.8 - 58.5)
69
69.5
(54.0 - 88.6)
48
94.8
(69.1 - 127.9)
56
119.3
(90.0 - 155.8)
Wisconsin Cancer Facts and Figures 2011
Table A: Cancer Incidence, Total Number of Cases and Averaged-Annual
Age-Adjusted Rates by County, 2003 - 2007 (continued)
County
Statistic
All Sites
Colon &
Rectum
Lung &
Bronchus
Female
Breast
Prostate
St. Croix
Cases
Rate
(95% CI)
952
288.6
(270.1 - 307.9)
89
27.0
(21.6 - 33.3)
119
38.1
(31.4 - 45.7)
112
61.0
(50.0 - 73.6)
120
87.4
(71.9 - 105.0)
Sauk
Cases
Rate
(95% CI)
1,423
434.7
(412.2 - 458.2)
187
55.4
(47.7 - 64.1)
183
55.9
(48.0 - 64.7)
225
132.0
(115.0 - 150.9)
187
125.1
(107.7 - 144.5)
Sawyer
Cases
Rate
(95% CI)
501
435.8
(397.9 - 476.6)
47
42.7
(31.1 - 57.5)
75
63.0
(49.4 - 79.5)
63
114.8
(87.6 - 148.3)
89
150.0
(120.3 - 185.6)
Shawano
Cases
Rate
(95% CI)
1,225
481.3
(454.4 - 509.5)
142
53.4
(44.9 - 63.1)
172
65.8
(56.2 - 76.5)
147
115.9
(97.6 - 136.9)
174
141.2
(121.0 - 164.0)
Sheboygan
Cases
Rate
(95% CI)
3,321
526.7
(508.8 - 545.1)
399
62.1
(56.1 - 68.6)
356
56.9
(51.1 - 63.1)
417
126.3
(114.3 - 139.3)
511
178.6
(163.3 - 194.9)
Taylor
Cases
Rate
(95% CI)
476
423.0
(385.4 - 463.4)
45
39.0
(28.4 - 52.6)
52
46.3
(34.5 - 61.0)
60
98.5
(74.1 - 128.8)
69
126.2
(98.1 - 160.0)
Trempealeau
Cases
Rate
(95% CI)
789
475.5
(442.4 - 510.6)
94
51.3
(41.2 - 63.3)
84
51.5
(41.0 - 64.0)
113
137.3
(112.6 - 166.0)
142
178.3
(150.0 - 210.5)
Vernon
Cases
Rate
(95% CI)
883
500.5
(467.5 - 535.2)
84
45.1
(35.8 - 56.1)
101
56.4
(45.8 - 68.8)
121
137.0
(113.0 - 164.9)
154
184.3
(156.3 - 216.2)
Vilas
Cases
Rate
(95% CI)
837
475.5
(442.2 - 510.9)
81
44.0
(34.6 - 55.7)
140
74.2
(62.0 - 88.5)
125
149.5
(123.1 - 180.7)
115
127.1
(104.6 - 154.0)
Walworth
Cases
Rate
(95% CI)
2,613
506.8
(487.5 - 526.7)
261
50.2
(44.3 - 56.7)
359
70.0
(62.9 - 77.7)
332
123.5
(110.5 - 137.8)
339
142.3
(127.4 - 158.4)
Washburn
Cases
Rate
(95% CI)
525
462.8
(422.8 - 505.9)
47
39.1
(28.5 - 52.8)
82
69.6
(55.2 - 87.0)
66
116.0
(89.0 - 149.5)
78
133.5
(105.4 - 167.8)
Washington
Cases
Rate
(95% CI)
3,261
504.2
(486.9 - 522.0)
311
49.0
(43.6 - 54.8)
394
62.3
(56.2 - 68.8)
475
135.3
(123.3 - 148.1)
506
164.8
(150.4 - 180.2)
Waukesha
Cases
Rate
(95% CI)
10,744
520.3
(510.4 - 530.3)
963
47.3
(44.3 - 50.4)
1,289
62.8
(59.4 - 66.4)
1,602
143.4
(136.4 - 150.7)
1,725
180.2
(171.5 - 189.1)
Waupaca
Cases
Rate
(95% CI)
1,603
503.4
(478.8 - 529.0)
173
52.9
(45.2 - 61.5)
191
59.3
(51.1 - 68.4)
178
114.2
(97.8 - 132.8)
278
180.7
(160.1 - 203.4)
Waushara
Cases
Rate
(95% CI)
745
459.6
(426.7 - 494.5)
74
46.5
(36.3 - 58.9)
137
80.9
(67.9 - 96.0)
80
102.3
(80.6 - 128.6)
86
103.2
(82.4 - 128.1)
Winnebago
Cases
Rate
(95% CI)
4,074
493.7
(478.5 - 509.2)
404
48.4
(43.7 - 53.4)
534
65.9
(60.4 - 71.8)
590
134.7
(123.9 - 146.1)
520
138.7
(126.9 - 151.3)
Wood
Cases
Rate
(95% CI)
2,272
498.2
(477.6 - 519.4)
217
45.6
(39.7 - 52.3)
300
64.1
(57.0 - 71.9)
292
123.1
(109.1 - 138.5)
350
164.3
(147.5 - 182.6)
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.
1. Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.
2. Cases and rates include invasive cancers only.
Wisconsin Cancer Facts and Figures 2011
51
Table B Cancer Mortality: Total Number of Deaths and Age-Adjusted Rates
by County in Wisconsin, 2003-2007
County
Statistic
All Sites
Colon &
Rectum
Lung &
Bronchus
Female
Breast
Prostate
All Counties
Deaths
Rate
(95% CI)
54,340
182.0
(180.5 - 183.6)
5,000
16.5
(16.0 - 17.0)
14,254
48.5
(47.7 - 49.3)
3,784
22.6
(21.9 - 23.4)
3,161
27.1
(26.1 - 28.0)
Adams
Deaths
Rate
(95% CI)
343
228.2
(204.3 - 254.5)
28
18.3
(12.1 - 27.1)
106
66.3
(54.2 - 80.8)
15
20.0
(11.1 - 34.8)
22
33.2
(20.5 - 51.5)
Ashland
Deaths
Rate
(95% CI)
197
193.9
(167.3 - 223.8)
27
25.1
(16.4 - 37.1)
60
60.9
(46.3 - 78.9)
18
32.0
(18.4 - 52.6)
10
23.2
(11.1 - 43.0)
Barron
Deaths
Rate
(95% CI)
556
184.2
(169.0 - 200.5)
50
16.8
(12.4 - 22.4)
140
47.8
(40.2 - 56.6)
32
20.8
(14.1 - 29.7)
44
33.7
(24.5 - 45.4)
Bayfield
Deaths
Rate
(95% CI)
179
176.6
(151.4 - 205.2)
21
21.0
(13.0 - 32.8)
48
47.3
(34.9 - 63.4)
Brown
Deaths
Rate
(95% CI)
1,870
168.2
(160.6 - 176.1)
169
14.8
(12.7 - 17.3)
469
42.9
(39.0 - 47.0)
9
19.8
(8.6 - 39.7)
123
19.8
(16.4 - 23.7)
10
22.5
(10.8 - 42.5)
100
25.0
(20.3 - 30.4)
Buffalo
Deaths
Rate
(95% CI)
155
169.3
(143.5 - 198.8)
17
18.2
(10.6 - 29.8)
32
35.7
(24.3 - 51.0)
7
14.3
(5.6 - 31.6)
11
27.4
(13.6 - 49.8)
Burnett
Deaths
Rate
(95% CI)
Deaths
Rate
(95% CI)
232
184.1
(160.9 - 210.3)
325
164.5
(146.9 - 183.6)
14
10.8
(5.8 - 19.0)
36
18.4
(12.9 - 25.5)
74
57.2
(44.8 - 72.6)
77
38.9
(30.6 - 48.7)
14
23.8
(12.4 - 42.3)
24
21.2
(13.5 - 31.7)
17
31.3
(18.2 - 51.4)
12
15.6
(8.0 - 26.8)
Chippewa
Deaths
Rate
(95% CI)
632
190.8
(176.2 - 206.4)
45
13.7
(10.0 - 18.4)
169
51.5
(44.0 - 60.0)
51
29.3
(21.7 - 38.8)
44
32.7
(23.7 - 43.8)
Clark
Deaths
Rate
(95% CI)
343
161.3
(144.3 - 179.8)
31
13.9
(9.4 - 20.1)
77
38.6
(30.4 - 48.4)
17
13.2
(7.4 - 22.3)
19
19.1
(11.5 - 30.1)
Columbia
Deaths
Rate
(95% CI)
51
15.7
(11.6 - 20.7)
152
47.3
(40.1 - 55.6)
30
15.6
(10.4 - 22.8)
33
26.1
(18.0 - 36.7)
Crawford
Deaths
Rate
(95% CI)
589
183.3
(168.7 - 198.9)
233
210.0
(183.6 - 239.5)
26
24.7
(16.0 - 36.6)
72
65.5
(51.2 - 83.0)
10
15.8
(7.5 - 30.9)
13
27.1
(14.4 - 46.9)
Dane
Deaths
Rate
(95% CI)
3,223
167.5
(161.7 - 173.5)
274
14.3
(12.6 - 16.1)
771
40.9
(38.1 - 44.0)
270
24.1
(21.3 - 27.2)
193
27.9
(24.0 - 32.1)
Dodge
Deaths
Rate
(95% CI)
1,035
208.8
(196.2 - 222.1)
109
21.3
(17.5 - 25.8)
259
53.5
(47.2 - 60.5)
72
26.9
(20.9 - 34.2)
65
31.9
(24.6 - 40.7)
Door
Deaths
Rate
(95% CI)
347
156.3
(140.2 - 174.1)
43
19.4
(14.0 - 26.5)
86
38.8
(31.0 - 48.4)
22
16.9
(10.4 - 27.0)
13
14.2
(7.5 - 25.0)
Douglas
Deaths
Rate
(95% CI)
532
208.7
(191.1 - 227.5)
51
18.6
(13.8 - 24.7)
145
58.0
(48.9 - 68.4)
29
20.7
(13.6 - 30.3)
49
48.9
(36.2 - 64.7)
Dunn
Deaths
Rate
(95% CI)
299
151.5
(134.6 - 169.9)
25
11.6
(7.5 - 17.3)
70
37.2
(29.0 - 47.1)
16
14.2
(8.0 - 23.5)
22
27.2
(17.0 - 41.0)
Calumet
52
Wisconsin Cancer Facts and Figures 2011
Table B Cancer Mortality: Total Number of Deaths and Age-Adjusted Rates
by County in Wisconsin, 2003-2007 (continued)
County
Statistic
All Sites
Colon &
Rectum
Lung &
Bronchus
Female
Breast
Prostate
Eau Claire
Deaths
Rate
(95% CI)
816
166.2
(154.8 - 178.2)
73
14.1
(11.0 - 17.8)
212
44.6
(38.8 - 51.2)
51
19.5
(14.4 - 25.8)
62
32.3
(24.7 - 41.4)
Florence
Deaths
Rate
(95% CI)
Fond du Lac
Deaths
Rate
(95% CI)
68
192.3
(149.0 - 246.5)
1,061
184.2
(173.1 - 195.8)
^
^
(^ - ^)
116
20.1
(16.5 - 24.1)
20
59.3
(35.9 - 94.7)
266
47.8
(42.2 - 54.0)
^
^
(^ - ^)
86
26.8
(21.2 - 33.4)
8
49.0
(21.0 - 102.3)
70
30.9
(24.0 - 39.0)
Forest
Deaths
Rate
(95% CI)
155
208.5
(176.3 - 245.5)
16
20.8
(11.6 - 35.4)
43
58.1
(41.9 - 79.3)
9
22.5
(9.8 - 46.6)
8
24.8
(10.7 - 50.8)
Grant
Deaths
Rate
(95% CI)
574
188.5
(173.2 - 204.9)
61
19.3
(14.7 - 25.0)
151
50.9
(43.0 - 59.8)
33
20.6
(13.9 - 29.6)
37
29.7
(20.9 - 41.0)
Green
Deaths
Rate
(95% CI)
370
174.9
(157.3 - 193.9)
49
22.1
(16.3 - 29.5)
91
44.7
(35.9 - 55.0)
22
18.1
(11.2 - 28.1)
18
20.9
(12.3 - 33.1)
Green Lake
Deaths
Rate
(95% CI)
280
200.6
(177.3 - 226.5)
26
16.8
(10.9 - 25.4)
69
48.9
(37.9 - 62.6)
16
23.0
(12.5 - 39.4)
9
14.8
(6.7 - 29.0)
Iowa
Deaths
Rate
(95% CI)
205
161.5
(140.0 - 185.4)
23
17.8
(11.2 - 26.9)
47
37.7
(27.6 - 50.2)
17
26.3
(15.2 - 42.4)
12
22.6
(11.6 - 39.4)
Iron
Deaths
Rate
(95% CI)
121
211.9
(174.3 - 257.1)
12
18.6
(9.5 - 36.8)
31
56.2
(37.7 - 83.2)
4
15.3
(4.1 - 47.8)
8
31.0
(13.4 - 68.2)
Jackson
Deaths
Rate
(95% CI)
221
192.6
(167.9 - 220.1)
28
23.9
(15.9 - 34.8)
57
49.8
(37.7 - 64.8)
18
32.2
(18.7 - 52.0)
11
22.9
(11.4 - 41.0)
Jefferson
Deaths
Rate
(95% CI)
752
183.6
(170.6 - 197.3)
74
17.4
(13.6 - 21.8)
177
44.4
(38.1 - 51.5)
40
16.8
(11.9 - 23.1)
43
26.4
(19.0 - 35.4)
Juneau
Deaths
Rate
(95% CI)
376
229.0
(206.3 - 253.6)
33
20.0
(13.8 - 28.4)
129
78.6
(65.6 - 93.6)
18
20.3
(11.9 - 33.0)
22
31.3
(19.5 - 47.6)
Kenosha
Deaths
Rate
(95% CI)
1,464
194.7
(184.7 - 205.0)
131
17.5
(14.6 - 20.7)
463
62.7
(57.1 - 68.8)
97
22.2
(18.0 - 27.2)
74
26.2
(20.5 - 32.8)
Kewaunee
Deaths
Rate
(95% CI)
215
169.7
(147.4 - 194.5)
24
18.2
(11.5 - 27.5)
44
36.3
(26.3 - 49.0)
15
22.9
(12.6 - 39.0)
11
20.2
(10.1 - 36.4)
La Crosse
Deaths
Rate
(95% CI)
1,013
177.5
(166.6 - 188.9)
102
17.0
(13.9 - 20.8)
288
52.0
(46.1 - 58.4)
95
30.2
(24.3 - 37.2)
49
22.3
(16.5 - 29.5)
Lafayette
Deaths
Rate
(95% CI)
189
190.7
(164.3 - 220.5)
28
27.3
(18.1 - 39.8)
45
45.8
(33.4 - 61.6)
14
27.3
(14.7 - 47.1)
9
20.3
(9.2 - 39.1)
Langlade
Deaths
Rate
(95% CI)
320
213.8
(190.6 - 239.3)
24
15.2
(9.7 - 23.3)
88
60.6
(48.5 - 75.1)
14
15.6
(8.3 - 28.2)
12
18.0
(9.3 - 32.3)
Lincoln
Deaths
Rate
(95% CI)
340
171.8
(153.8 - 191.5)
34
17.0
(11.7 - 24.1)
101
51.7
(42.0 - 63.1)
23
22.9
(14.3 - 35.2)
29
33.7
(22.6 - 48.8)
Manitowoc
Deaths
Rate
(95% CI)
857
165.7
(154.7 - 177.4)
74
14.1
(11.0 - 17.8)
208
40.7
(35.4 - 46.8)
55
18.6
(13.9 - 24.6)
47
22.3
(16.4 - 29.8)
Wisconsin Cancer Facts and Figures 2011
53
Table B Cancer Mortality: Total Number of Deaths and Age-Adjusted Rates
by County in Wisconsin, 2003-2007 (continued)
54
County
Statistic
All Sites
Colon &
Rectum
Lung &
Bronchus
Female
Breast
Prostate
Marathon
Deaths
Rate
(95% CI)
1,150
159.9
(150.7 - 169.5)
94
12.7
(10.3 - 15.6)
274
39.1
(34.6 - 44.1)
81
20.5
(16.1 - 25.6)
83
28.7
(22.8 - 35.5)
Marinette
Deaths
Rate
(95% CI)
566
187.5
(172.1 - 204.1)
47
14.6
(10.7 - 19.8)
143
48.3
(40.6 - 57.1)
45
26.9
(19.2 - 37.1)
43
33.7
(24.4 - 45.7)
Marquette
Deaths
Rate
(95% CI)
242
221.7
(194.3 - 252.4)
15
13.7
(7.6 - 23.3)
79
70.6
(55.8 - 88.8)
16
29.1
(16.4 - 49.1)
13
23.7
(12.6 - 42.2)
Menominee
Deaths
Rate
(95% CI)
46
299.2
(209.7 - 410.2)
^
^
(^ - ^)
17
97.0
(53.2 - 160.1)
^
^
(^ - ^)
^
^
(^ - ^)
Milwaukee
Deaths
Rate
(95% CI)
9,283
195.8
(191.8 - 199.9)
807
16.8
(15.7 - 18.0)
2,505
53.8
(51.7 - 56.0)
635
22.5
(20.8 - 24.4)
464
26.4
(24.1 - 29.0)
Monroe
Deaths
Rate
(95% CI)
439
186.7
(169.5 - 205.2)
40
16.7
(11.9 - 22.9)
126
53.7
(44.7 - 64.0)
26
19.8
(12.9 - 29.5)
28
29.1
(19.3 - 42.0)
Oconto
Deaths
Rate
(95% CI)
390
176.4
(159.3 - 195.0)
39
17.6
(12.5 - 24.2)
112
50.6
(41.7 - 61.1)
27
24.1
(15.8 - 35.4)
27
29.5
(19.4 - 43.1)
Oneida
Deaths
Rate
(95% CI)
546
199.8
(183.2 - 217.7)
47
17.2
(12.6 - 23.2)
151
54.2
(45.9 - 63.9)
43
30.4
(21.9 - 41.6)
41
35.0
(25.0 - 48.1)
Outagamie
Deaths
Rate
(95% CI)
1,421
173.5
(164.5 - 182.8)
133
16.0
(13.4 - 19.0)
338
42.5
(38.0 - 47.3)
106
22.9
(18.7 - 27.8)
85
27.4
(21.9 - 33.9)
Ozaukee
Deaths
Rate
(95% CI)
846
175.2
(163.6 - 187.6)
85
17.7
(14.1 - 21.9)
200
41.4
(35.8 - 47.6)
63
22.7
(17.4 - 29.3)
51
26.9
(20.0 - 35.5)
Pepin
Deaths
Rate
(95% CI)
90
191.1
(152.8 - 236.7)
7
14.4
(5.7 - 31.2)
29
63.8
(42.4 - 92.6)
5
18.1
(5.7 - 46.8)
4
18.0
(4.9 - 47.9)
Pierce
Deaths
Rate
(95% CI)
279
176.2
(155.8 - 198.4)
27
17.3
(11.3 - 25.3)
62
41.2
(31.5 - 52.9)
25
25.9
(16.7 - 38.5)
26
42.4
(27.5 - 61.9)
Polk
Deaths
Rate
(95% CI)
514
193.8
(177.3 - 211.6)
67
24.8
(19.2 - 31.7)
120
45.7
(37.8 - 54.8)
25
16.6
(10.5 - 25.3)
37
33.7
(23.7 - 46.6)
Portage
Deaths
Rate
(95% CI)
536
168.0
(154.0 - 183.0)
34
10.5
(7.2 - 14.7)
120
38.6
(31.9 - 46.2)
45
25.5
(18.5 - 34.3)
31
24.6
(16.6 - 34.7)
Price
Deaths
Rate
(95% CI)
231
206.6
(180.1 - 236.4)
24
21.8
(13.9 - 33.4)
55
50.2
(37.7 - 66.2)
11
17.4
(8.6 - 34.0)
13
24.3
(12.9 - 43.3)
Racine
Deaths
Rate
(95% CI)
1,824
182.3
(174.0 - 191.0)
155
15.2
(12.9 - 17.8)
524
52.8
(48.4 - 57.6)
120
21.3
(17.6 - 25.6)
100
27.1
(22.0 - 32.9)
Richland
Deaths
Rate
(95% CI)
197
159.9
(138.0 - 184.5)
21
17.4
(10.8 - 27.1)
46
38.9
(28.4 - 52.4)
14
19.2
(10.0 - 34.4)
12
24.2
(12.5 - 42.7)
Rock
Deaths
Rate
(95% CI)
1,614
196.1
(186.6 - 205.9)
129
15.5
(12.9 - 18.4)
507
61.9
(56.6 - 67.5)
121
26.5
(21.9 - 31.7)
78
24.9
(19.6 - 31.0)
Rusk
Deaths
Rate
(95% CI)
195
183.1
(157.9 - 211.7)
13
10.7
(5.6 - 19.5)
46
45.2
(33.0 - 60.9)
20
36.1
(21.5 - 58.1)
19
39.1
(23.5 - 62.3)
Wisconsin Cancer Facts and Figures 2011
Table B Cancer Mortality: Total Number of Deaths and Age-Adjusted Rates
by County in Wisconsin, 2003-2007 (continued)
County
Statistic
All Sites
Colon &
Rectum
Lung &
Bronchus
Female
Breast
Prostate
St. Croix
Deaths
Rate
(95% CI)
553
173.6
(159.1 - 188.9)
41
13.6
(9.7 - 18.5)
129
40.9
(34.0 - 48.7)
33
18.1
(12.4 - 25.5)
44
39.5
(28.5 - 52.7)
Sauk
Deaths
Rate
(95% CI)
635
183.8
(169.6 - 198.9)
62
17.7
(13.5 - 22.9)
164
49.3
(41.9 - 57.5)
47
23.0
(16.7 - 31.1)
52
37.0
(27.7 - 48.6)
Sawyer
Deaths
Rate
(95% CI)
225
190.6
(166.3 - 217.8)
24
20.4
(12.9 - 31.0)
54
45.8
(34.3 - 60.3)
17
28.0
(16.2 - 46.4)
18
35.0
(20.6 - 56.2)
Shawano
Deaths
Rate
(95% CI)
482
175.6
(160.1 - 192.2)
45
15.9
(11.6 - 21.5)
122
44.9
(37.3 - 53.9)
42
29.8
(21.1 - 41.0)
33
27.4
(18.8 - 38.7)
Sheboygan
Deaths
Rate
(95% CI)
1,173
180.8
(170.5 - 191.5)
139
21.2
(17.8 - 25.1)
280
44.2
(39.1 - 49.8)
89
24.6
(19.6 - 30.5)
68
25.8
(20.1 - 32.8)
Taylor
Deaths
Rate
(95% CI)
187
154.0
(132.4 - 178.2)
19
15.2
(9.0 - 24.1)
39
34.1
(24.2 - 46.8)
15
22.8
(12.3 - 39.3)
11
20.1
(10.0 - 36.4)
Trempealeau
Deaths
Rate
(95% CI)
310
171.3
(152.3 - 192.2)
35
17.6
(12.1 - 25.0)
71
41.6
(32.4 - 52.9)
17
16.7
(9.3 - 28.0)
19
23.8
(14.3 - 37.4)
Vernon
Deaths
Rate
(95% CI)
304
163.1
(145.1 - 183.0)
34
17.1
(11.8 - 24.2)
76
41.4
(32.5 - 52.0)
19
18.3
(10.8 - 29.5)
25
29.8
(19.3 - 44.4)
Vilas
Deaths
Rate
(95% CI)
334
175.0
(156.2 - 196.0)
28
13.5
(9.0 - 20.4)
100
51.9
(42.0 - 63.9)
26
28.3
(17.8 - 43.7)
17
18.3
(10.7 - 30.9)
Walworth
Deaths
Rate
(95% CI)
954
183.1
(171.6 - 195.2)
111
21.0
(17.2 - 25.3)
246
48.0
(42.2 - 54.4)
62
21.6
(16.5 - 27.8)
37
18.0
(12.7 - 24.7)
Washburn
Deaths
Rate
(95% CI)
233
188.3
(164.6 - 214.9)
17
14.5
(8.2 - 24.1)
71
57.6
(44.9 - 73.3)
9
14.9
(6.7 - 30.1)
14
25.9
(14.1 - 44.5)
Washington
Deaths
Rate
(95% CI)
1,146
181.4
(171.0 - 192.4)
99
15.8
(12.8 - 19.3)
292
46.8
(41.6 - 52.5)
109
29.9
(24.5 - 36.2)
65
28.1
(21.6 - 35.9)
Waukesha
Deaths
Rate
(95% CI)
3,553
175.5
(169.7 - 181.4)
296
14.6
(13.0 - 16.4)
930
46.0
(43.1 - 49.1)
275
23.6
(20.9 - 26.6)
189
25.8
(22.1 - 29.8)
Waupaca
Deaths
Rate
(95% CI)
678
196.1
(181.4 - 211.8)
65
17.9
(13.8 - 23.1)
157
47.5
(40.3 - 55.7)
47
26.3
(19.1 - 35.5)
54
36.0
(27.1 - 47.2)
Waushara
Deaths
Rate
(95% CI)
333
195.8
(175.3 - 218.4)
31
17.6
(11.9 - 25.3)
94
55.9
(45.1 - 68.7)
22
25.1
(15.6 - 39.2)
14
17.8
(9.6 - 30.5)
Winnebago
Deaths
Rate
(95% CI)
1,542
185.9
(176.7 - 195.5)
138
16.2
(13.6 - 19.2)
435
53.5
(48.6 - 58.8)
91
20.0
(16.1 - 24.7)
84
25.9
(20.6 - 32.0)
Wood
Deaths
Rate
(95% CI)
802
163.6
(152.3 - 175.6)
82
15.9
(12.6 - 19.9)
203
42.4
(36.7 - 48.8)
45
16.9
(12.2 - 23.1)
46
22.1
(16.2 - 29.6)
Source: National Center for Health Statistics
1. Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.
2. ^ Statistic not displayed if there were fewer than 4 deaths.
Wisconsin Cancer Facts and Figures 2011
55
Glossary of Terms
Age-Adjusted Rate – Incidence or mortality rate adjusted to account for the different age distributions between populations.
In this report, all rates are age-adjusted using the 2000 U.S. standard population.
Benign – Noncancerous tumors.
Burden – Number of new cases and/or deaths from cancer or overall impact of cancer in the state or specified region.
Cancer Incidence – The number of new cancer cases that occur during a specified period for a population at risk for developing
the disease, expressed as number of cases or as a rate, usually per 100,000 persons.
Cancer Mortality – Deaths from cancer that occur during a specified period of time for a particular population, expressed as
number of deaths or as a rate, usually per 100,000 persons.
Colonoscopy – A screening/diagnostic procedure in which a health care professional views the entire colon through a flexible,
lighted instrument called a colonoscope.
Confidence Interval – A 95% confidence interval is commonly reported with rates and contains the true value 95% of the time.
The range between the lower and upper confidence interval defines with 95% probability the “true” rate. The larger the confidence
interval, the less precise the estimate.
Five-year Survival – The percentage of people with a specified disease who are alive five years after their initial diagnosis.
Invasive – Malignant cancer or tumor that has invaded tissue or surrounding organs.
Malignant – Cancerous tumors.
Mammography – A screening and diagnostic technique that uses low-dose x-rays to find tumors in the breast.
Metastasis – The spread of the disease from one part of the body to another.
Pap Test or Pap Smear – Developed by American Cancer Society funded researcher Dr. Papanicolaou and published in his
landmark paper in 1941. It refers to the microscopic examination of cervical cells to detect precancerous lesions or cancer. This
screening procedure has reduced the death rate from cervical cancer by 75% since the 1950s.
Percent Change – (PC) Percent of change from selected base year to most current year, usually computed for incidence and
mortality rates, in this report calculated using SEER Stat statistical software.
Prevalence – The percentage of people exhibiting a behavior out of the total number at risk for the behavior. In this report, the
prevalence is expressed as a percent of the population.
Prostate-Specific-Antigen (PSA) – A blood protein, the level of which is increased in many men who have prostate cancer or
benign prostate hyperplasia (overgrowth of prostate cells).
Rates – The number of cancer cases or deaths per 100,000 population.
Risk Factors – Behaviors/conditions related to the occurrence of a disease. Risk factors can be lifestyle, environmental, or
genetic. For example, smoking is a risk factor for lung cancer.
Sigmoidoscopy – A screening/diagnostic procedure in which a health care professional views the inside of the rectum and lower
part of the colon through a flexible, lighted instrument called a sigmoidoscope.
56
Wisconsin Cancer Facts and Figures 2011
Stage of Disease at Diagnosis:
In Situ – A small cancer confined to the cells in which the cancer began and has not invaded or penetrated the surrounding tissue.
Localized – An invasive tumor (penetrated the surrounding tissue) that is still confined to the organ of origin.
Regional – A tumor that has spread beyond the organ of origin to an adjacent organ, tissue or lymph nodes.
Distant – The tumor has spread beyond adjacent organs, tissue or lymph nodes, or has metastasized through the blood stream or lymph system.
Unknown/Unstaged – Insufficient information is available to determine the stage or extent of the tumor at the time of diagnosis.
Wisconsin Cancer Facts and Figures 2011
57
©2010 American Cancer Society, Midwest Division
http://dhs.wisconsin.gov/wcrs | Phone 608.261.8874