Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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