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Illinois State Capitol Building and Complex Who We Are What We Do The Illinois State Cancer Registry is the only source of population‐based cancer information in Illinois. The Illinois State Cancer Registry is a program within the Illinois Department of Public Health’s Division of Epidemiologic Studies and was created in 1986 by the Illinois Health and Hazardous Substances Registry Act. The cancer registry has a staff of 12 plus a registry manager. Cancer registry staff have 143 years of combined experience as certified tumor registrars. The registry collects information on cancer cases diagnosed or treated in Illinois. Hospitals, ambulatory surgical treatment centers, non‐hospital affiliated radiation therapy treatment centers, independent pathology labs, and physicians are required to report to the registry. Eleven other state cancer registries voluntarily report cancer patient data for Illinois residents who are diagnosed and/or treated out of state. Cancer information is collected by certified tumor registrars who have successfully completed the training and passed the examination required by the National Cancer Registrar’s Association. Ongoing continuing education is required to maintain certification. The registry has staff with years of service as cancer registrars. These legacy employees are one reason the Illinois State Cancer Registry has achieved “Gold Certification,” the highest level, from the North American Association of Central Cancer Registries for the past 15 years. All information about the patient and the facility that reported the cancer is kept confidential. What is cancer incidence? A cancer incidence rate is the number of new cancers of a specific site/type occurring in a specified population during a year, usually expressed as the number of cancers per 100,000 population at risk. That is, Incidence rate = (New cancers/Population) × 100,000 The numerator of the incidence rate is the number of new cancers; the denominator is the size of the population. The number of new cancers may include multiple primary cancers occurring in one patient. The primary site reported is the site of origin and not the metastatic site. In general, the incidence rate would not include recurrences. The population used depends on the rate to be calculated. For cancer sites that occur in only one sex, the sex‐specific population (e.g., females for cervical cancer) is used. For a cancer case to be complete it must have information about the person (where they were born, marital status, age, where they live), information on the type of cancer and its treatment. An age‐adjusted rate is a weighted average of the age‐specific rates, where the weights are the proportions of persons in the corresponding age groups of a standard population. The potential confounding effect of age is reduced when comparing age-adjusted rates computed using the same standard population. — www.cancer.gov What is cancer mortality? A cancer mortality rate is the number of deaths, with cancer as the underlying cause of death, occurring in a specified population during a year. Cancer mortality is usually expressed as the number of deaths due to cancer per 100,000 population. That is, To determine a cancer rate, researchers must have the population characteristics of the area. This is usually obtained from the U.S. Census. Mortality Rate = (Cancer Deaths/Population) × 100,000 The numerator of the mortality rate is the number of deaths; the denominator is the size of the population. The population used depends on the rate to be calculated. For cancer sites that occur in only one sex, the sex‐specific population (e.g., females for cervical cancer) is used. The mortality rate can be computed for a given cancer site or for all cancers combined. — www.cancer.gov Cancer in Illinois 2013 Illinois Department of Public Health 1 Why is it important to collect cancer information? The Illinois State Cancer Registry is one of 50 state central cancer registries in the United States. All central cancer registries share the same common activities and purposes. Most central cancer registries in the U.S. funnel data (but not personal identifiers) into a national cancer data base maintained by the U.S. Centers for Disease Control and Prevention. Cancer data collection by central cancer registries is also called cancer surveillance. Cancer data are the eyes used to see the impact of cancer, trends in various populations, patterns of occurrence and much more. n Doctors and researchers use cancer data to learn more about the causes of cancer. n Doctors and researchers use cancer data to learn how to detect cancers earlier, when they are more treatable. n Cancer specialists make treatment choices based on accurate cancer data. n Cancer data may point to environmental risk factors or high risk behaviors. n Cancer data may be used to make important public health decisions about where to direct funds or where to implement screening programs. n Cancer data may be used to show whether programs aimed at modifying risky behavior or increasing screening for people who are at risk are effective. n Cancer data may be used to advance clinical, epidemiologic and health services research. n Cancer data may be used to determine what present and future resources are needed in a specific area; these could be medical resources, such as physicians, cancer specialists, hospitals or other types of social services, or support services such as patient transport. The dome of the Illinois State Capitol Every day in Illinois……. n 173 people are diagnosed with cancer n 65 people die from cancer‐related causes n 25 women are diagnosed with breast cancer n 22 men are diagnosed with prostate cancer n 17 people are diagnosed with colorectal cancer n 24 people are diagnosed with lung cancer Cancer is the second leading cause of death among Americans. Cancer surveillance activities have been used to develop effective strategies to reduce cancer deaths and strategies for preventing new cases of cancer that include behavioral and environmental changes for some cancer types. Cancer in Illinois 2013 Illinois Department of Public Health 3 Top 10 Cancers in Men–2010 Top 10 Cancer Cases in Men Type of Cancer Rock River Valley Epidemiology is the study of the distribution and causes of diseases in human populations. It is concerned with the frequency and type of illness in groups of people, not individuals. Rate (per 100,000) Percent of Total 127.0 25.4% Lung and Bronchus 79.7 14.7% Colon and Rectum 54.8 10.3% Urinary Bladder 37.6 6.7% Non‐Hodgkin Lymphoma 24.3 4.5% Kidney and Renal Pelvis 21.7 4.3% Melanoma of the Skin 21.1 4.0% Oral Cavity and Pharynx 17.0 3.5% Leukemia 16.7 3.1% Pancreas 14.7 2.7% Prostate Illinois Department of Public Health, Illinois State Cancer Registry, public data file, data as of November 2012. Top 10 Cancer Deaths in Men Type of Cancer Central cancer registries collect data on all cancer cases within a defined population such as a state or region. Rate (per 100,000) Percent of Total Lung and Bronchus 62.1 29.3% Prostate 22.6 9.6% Colon and Rectum 20.1 9.5% Pancreas 13.0 6.1% Leukemia 9.9 4.4% Esophagus 7.9 3.9% Non‐Hodgkin Lymphoma 8.3 3.8% Liver 6.9 3.4% Bladder 7.6 3.3% Kidney 5.4 2.6% U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, released April 2013 4 ILLINOIS STATE CANCER REgISTRy Top 10 Cancers in Women–2010 Top 10 Cancer Cases in Women Type of Cancer Rate (per 100,000) Percent of Total Lung and Bronchus 58.4 13.8% Colon and Rectum 39.1 9.5% Corpus and Uterus 28.2 6.7% Thyroid 19.4 4.1% Non‐Hodgkin Lymphoma 16.3 3.8% Melanoma of the Skin 13.3 3.0% Ovary 12.0 2.8% Pancreas 11.2 2.7% Kidney and Renal Pelvis 11.7 2.7% Cancer data in Illinois is collected in a standard format so it can be compiled with other state registries to form a national database of cancer data. Illinois Department of Public Health, Illinois State Cancer Registry, public data file, data as of November 2012. Top 10 Cancer Deaths in Women Type of Cancer Rate (per 100,000) Percent of Total Lung and Bronchus 41.2 26.1% Breast 22.6 14.7% Colon and Rectum 14.3 9.6% Pancreas 10.2 6.7% Ovary 7.8 5.0% Leukemia 5.6 3.7% Corpus and Uterus 5.3 3.4% Non‐Hodgkin Lymphoma 4.8 3.2% Brain and Nervous System 3.3 2.0% Kidney 2.9 1.9% Each year Illinois cancer registry staff process about 80,000 cancer reports for about 65,000 cancer patients U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, released April 2013 Cancer in Illinois 2013 Illinois Department of Public Health 5 Colorectal Cancer in Illinois Colorectal cancer (CRC) is currently the third most commonly diagnosed cancer in the state of Illinois for both men and women and all races, representing 9.9% of all cancer diagnosed in 2010. It is the second most common cause of cancer‐related deaths, causing 9.5% of cancer deaths in 2010. Colorectal cancer can affect organs that include the colon, rectum, and appendix. There is no exact cause known for CRC, but several risk factors have been identified. They include: n Age – most cases occur after age 50 n Personal or family history of CRC or polyps n Conditions that cause inflammation of the colon n Diet high in fat and low in calcium, folate, and fiber n Obesity n Physical inactivity n Long‐term smoking n Heavy alcohol consumption What is the Colon and Rectum? The colon and rectum are parts of the digestive system, which is also called the gastrointestinal (GI) system. The first part of the digestive system (the stomach and small intestine) processes food for energy while the last part (the colon and rectum) absorbs fluid to form solid waste (fecal matter or stool) that then passes from the body. The small intestine joins the large intestine (or large bowel) in the right lower abdomen. Most of the large intestine is made up of the colon, a muscular tube about 5 feet long. The colon absorbs water and salt from food matter and serves as a storage place for waste matter. The rectum is the final 6 inches of the digestive system. Waste matter goes into the rectum where it is stored until it passes out of the body through the anus. Regular colorectal cancer screening is one of the most powerful weapons for preventing colorectal cancer. Screening is the process of looking for cancer or precancer in people who have no symptoms of the disease. — American Cancer Society 6 ILLINOIS STATE CANCER REgISTRy What Kind of Tests are Done to Find Colorectal Cancer? Colonoscopy: For this test, the doctor looks at the entire length of the colon and rectum with a colonoscope. The colonoscope has a video camera on the end that is connected to a display monitor so the doctor can see and examine the inside of the colon. Special instruments can be passed through the colonoscope to remove any suspicious-looking areas such as polyps, if needed. Virtual colonoscopy: This test is an advanced type of computed tomography (CT or CAT) scan of the colon and rectum. A CT scan is an x-ray test that produces detailed cross-sectional images of your body. Stool occult blood testing: This test is used to find occult blood (blood that can’t be seen with the naked eye) in feces. Sigmoidoscopy: During this test, the doctor looks at part of the colon and rectum with a sigmoidoscope—a flexible, lighted tube about the thickness of a finger with a small video camera on the end. — American Cancer Society Are We Getting Screened? Prevention and control of colorectal cancer focuses on screenings, which include colonoscopies, sigmoidoscopies, and blood stool tests for people older than 50 years of age. The U.S. Preventive Services Task Force recommends the following: n sigmoidoscopies should be done every five years, n colonoscopies should be done every 10 years, and n blood stool tests should be done every year. Colorectal Cancer Screening Prevalence Illinois, 2002-2010 70.00% 60.00% 50.00% You should check with your doctor to see if you need to schedule one of these life‐saving preventive procedures. 40.00% 30.00% 20.00% 10.00% 0.00% 2002 2003 2004 2005* 2006 Had Colon/Sigmoidoscopy (Ages 50+) 2007* 2008 2009* 2010 Had Blood Stool Test (Ages 50+) Source: Illinois Behavioral Risk Factor Surveillance System (BRFSS), 2000-2010. Illinois Department of Public Health * Note: Years with an asterisk represent a year when the specific question was omitted in the BRFSS survey for that year. Data from the Illinois Behavioral Risk Factor Surveillance System (BRFSS) showed that in 2010, 61.7 percent of people in Illinois reported ever having a colonoscopy or sigmoidoscopy. This percent has increased steadily since 2002. However, the percent of Illinois residents ever having a blood stool test has decreased since 2002; 34 percent of residents reported having this test. Cancer in Illinois 2013 Illinois Department of Public Health 7 Colorectal Cancer Cases in Illinois JO DAVIESS STEPHENSON 46.65 41.30 Age-adjusted Colorectal Cancer Incidence Rates, All Races, Both Genders, 2006-2010, Illinois WINNEBAGO BOONE CARROLL OGLE 58.32 51.89 LEE 49.13 54.86 DE KALB KANE 51.05 44.73 445 53.00 GRUNDY 51.12 58.11 55.21 53.29 52.99 KANKAKEE MARSHALL 49.06 KNOX WARREN 56.78 51.70 LIVINGSTON PEORIA WOODFORD 50.85 42.91 50.90 IROQUOIS 53.08 FULTON HANCOCK MCDONOUGH 62.64 53.83 61.95 TAZEWELL MCLEAN FORD 49.45 45.71 53.52 MASON 62.44 SCHUYLER 41.85 ADAMS 51.58 CASS 56.16 63.45 PIKE SCOTT 53.84 48.14 41.40 PIATT 57.54 29.39 MACON MORGAN SANGAMON 53.98 52.69 53.22 DOUGLAS 58.07 MOULTRIE 40.89 CHRISTIAN 55.69 SHELBY 59.55 53.03 62.15 63.65 BOND FAYETTE EFFINGHAM JASPER 52.91 52.32 41.76 CRAWFORD 82.61 63.73 MADISON 52.97 CLAY ST. CLAIR CLINTON MARION 61.09 49.95 58.16 RICHLAND LAWRENCE 53.95 65.57 47.75 41.13 JEFFERSON PERRY RANDOLPH 53.71 51.47 53.16 EDWARDS 46.50 55.62 HAMILTON WHITE 73.97 54.46 WILLIAMSON SALINE GALLATIN 52.50 64.53 FRANKLIN 51.95 JACKSON 54.87 UNION JOHNSON 49.83 ALEXANDER PULASKI 70.17 Source: Illinois Department of Public Health, Illinois State Cancer Registry, data as of November 2012. 77.11 HARDIN 42.96 55.97 POPE MASSAC 53.87 62.19 WABASH WAYNE WASHINGTON MONROE significantly higher than Illinois rate not significantly different than Illinois rate significantly lower than Illinois rate count not sufficient to produce stable rating 56.15 CUMBERLAND MONTGOMERY JERSEY 51.99 CLARK 48.59 MACOUPIN CALHOUN Illinois Rate 50.21 EDGAR 54.59 COLES 59.27 GREENE 48.29 54.30 CHAMPAIGN 59.05 65.51 MENARD BROWN VERMILION DE WITT LOGAN 41.01 ILLINOIS STATE CANCER REgISTRy 3,415 52.44 PUTNAM STARK 8 COOK WILL LA SALLE 55.10 46.29 n n n n DU PAGE 51.47 BUREAU HENRY MERCER The Illinois age‐adjusted colorectal cancer incidence rate for both genders and all races from 2006‐2010 was 50.21 cases per 100,000. Nine counties across Illinois had incidence rates that were significantly higher than the rate for Illinois, and seven counties had rates that were significantly lower. Counties with the highest incidence rates include Crawford, gallatin and Hamilton. 41.79 KENDALL 52.04 HENDERSON LAKE 47.48 42.35 WHITESIDE ROCK ISLAND Illinois County Map – Incidence Rates MC HENRY 50.65 45.66 Colorectal Cancer Deaths in Illinois JO DAVIESS STEPHENSON 21.44 14.63 Age-adjusted Colorectal Cancer Mortality Rates, All Races, Both Genders, 2006-2010, Illinois WINNEBAGO BOONE CARROLL OGLE 18.56 17.09 MC HENRY LAKE 17.08 14.39 15.32 16.01 DE KALB KANE 19.20 15.54 DU PAGE 14.62 WHITESIDE LEE 13.61 22.04 KENDALL ROCK ISLAND 13.99 BUREAU HENRY 18.31 19.03 WILL LA SALLE 22.37 18.04 22.35 GRUNDY MERCER 19.62 PUTNAM KANKAKEE STARK Illinois County Map – Mortality Rates The age‐adjusted colorectal cancer mortality rate for both genders and all races in Illinois was 18.1 per 100,000 for 2006‐2010. Five counties showed rates that were significantly higher than that for Illinois, and five counties had significantly lower rates. Illinois counties with the highest mortality rates include Hamilton, Clinton and Saline. 19.19 MARSHALL KNOX WARREN HENDERSON LIVINGSTON 19.13 16.11 PEORIA WOODFORD 17.42 11.23 17.64 IROQUOIS 14.30 FULTON HANCOCK MCDONOUGH 23.45 17.18 18.15 TAZEWELL MCLEAN FORD 17.95 17.58 19.57 MASON 15.52 SCHUYLER 20.47 MACON MORGAN SANGAMON 17.62 19.08 SCOTT PIKE 11.84 PIATT 19.12 20.96 DOUGLAS 16.29 15.91 MOULTRIE 22.62 CHRISTIAN 18.98 SHELBY 25.01 22.65 21.71 CUMBERLAND MONTGOMERY 23.02 14.28 BOND FAYETTE EFFINGHAM 13.04 20.08 JASPER CRAWFORD 23.51 22.84 MADISON 18.40 CLAY ST. CLAIR 18.85 CLARK 19.40 MACOUPIN JERSEY CLINTON MARION 27.12 20.53 23.94 RICHLAND LAWRENCE 22.00 18.42 20.76 17.59 JEFFERSON HAMILTON WHITE 33.17 26.40 WILLIAMSON SALINE GALLATIN 19.35 26.54 UNION JOHNSON POPE 18.56 24.24 15.77 18.04 EDWARDS 17.63 PERRY RANDOLPH 17.09 WABASH WAYNE WASHINGTON MONROE significantly higher than Illinois rate not significantly different than Illinois rate significantly lower than Illinois rate count not sufficient to produce stable rating EDGAR 20.00 COLES 18.41 GREENE Illinois Rate 18.1 19.72 CHAMPAIGN 18.74 CASS BROWN 16.55 VERMILION DE WITT LOGAN MENARD ADAMS CALHOUN n n n n COOK 19.18 FRANKLIN 20.90 JACKSON 17.81 ALEXANDER PULASKI HARDIN MASSAC 17.59 Source: Underlying mortality data provided by NCHS (www.cdc.gov/nchs). Data released April 2013. Cancer in Illinois 2013 Illinois Department of Public Health 9 Cancer Projections Did you know there is a world‐wide shortage of certified tumor registrars? More information about this rewarding career can be found at www.ncra‐usa.org. JO DAVIESS STEPHENSON 155 270 WINNEBAGO BOONE CARROLL OGLE 110 305 WHITESIDE LEE 370 230 MC HENRY LAKE 1,590 3,515 280 1,635 DE KALB KANE 440 2,265 DU PAGE 4,905 COOK 25,965 KENDALL ROCK ISLAND HENRY 925 340 3,415 780 GRUNDY 270 PUTNAM 105 MCDONOUGH 135 175 LIVINGSTON PEORIA WOODFORD 270 270 55 HANCOCK 90 335 95 650 MARSHALL 35 KNOX KANKAKEE 45 STARK WARREN WILL LA SALLE 235 MERCER HENDERSON 445 BUREAU 245 IROQUOIS 205 FULTON TAZEWELL MCLEAN FORD 265 880 780 100 MASON 110 SCHUYLER ADAMS 410 According to the National Cancer Institute, cancer care cost the United States an estimated $125 billion in 2010 and costs are expected to rise to at least $158 billion by 2020. 45 CASS 40 75 PIKE 790 90 315 CALHOUN MADISON 1,595 This map shows the number of cancer cases projected for each county for 2014. 70 BOND FAYETTE EFFINGHAM JASPER 130 215 60 110 CLAY RANDOLPH 200 Source: Incidence projections were derived from cancer incidence data from the Illinois Department of Public Health, Illinois State Cancer Registry, data as of November 2012. 150 120 WABASH WAYNE 105 EDWARDS JEFFERSON 45 265 PERRY 135 HAMILTON WHITE 55 105 FRANKLIN 280 JACKSON WILLIAMSON 270 SALINE GALLATIN 270 270 435 HARDIN UNION JOHNSON POPE 110 85 25 PULASKI ALEXANDER 55 95 280 230 90 190 CRAWFORD RICHLAND LAWRENCE 100 MARION WASHINGTON MONROE 110 CUMBERLAND 1,450 In 2014, Illinois expects a total of 66,190 cancer cases. ILLINOIS STATE CANCER REgISTRy CLARK 145 MONTGOMERY CLINTON ST. CLAIR 130 280 205 JERSEY EDGAR COLES SHELBY MACOUPIN 135 10 90 CHRISTIAN GREENE 120 MOULTRIE 245 35 DOUGLAS 1,135 30 95 105 MACON SANGAMON 230 SCOTT 545 860 PIATT 75 MORGAN VERMILION CHAMPAIGN 110 175 MENARD BROWN DE WITT LOGAN 40 MASSAC 110 25 80 Research Projects The Illinois State Cancer Registry has a long history of participating in valuable research through data sets or data linkages. When the registry is contacted to provide data or linkages for studies, an extensive process is used to guarantee that patient confidentiality is protected. Part of this process is review and approval from an institutional review board (IRB). An IRB ensures that research is conducted in accordance with rules outlined by the Code of Federal Regulations, which governs human subjects research and is designed to protect patients. A few of the studies that the registry participated in are listed below. Several of these studies have been ongoing for many years and have contributed significantly to our knowledge about cancer. Black Women’s Health Study Black women are more likely to develop certain health problems than white women. Until the 1990s, most of the studies of women’s health included only small numbers of black women or none at all. Improving the health of black women required more knowledge of the causes of these health problems and also more knowledge about how women stay healthy. More knowledge meant more research. The BWHS was begun in 1995 to play a key role in carrying out this research. The cancer registry receives funding from the State of Illinois general revenue fund, from the U.S. Centers for Disease Control and Prevention’s National Program of Cancer Registries and from researchers who use cancer data. The BWHS gathers information on many conditions that affect black women including breast cancer, lupus, premature birth, hypertension, colon cancer, diabetes, and uterine fibroids. The BWHS is a “follow‐up” study, following the 59,000 women who enrolled in 1995 over time. When the participants entered the study, they provided information on factors that might influence health and disease, such as contraceptive use, cigarette smoking, and diet. At regular intervals, participants provide updated information on these factors and on any illnesses they develop. www.bu.edu.bwhs/history Cancer in Illinois 2013 Illinois Department of Public Health 11 Cancer Among U.S. Firefighters In 2010, the National Institute of Occupational Safety and Health (NIOSH), with funding assistance from the U.S. Fire Administration, launched a multi‐year study to examine whether firefighters have a higher risk of cancer and other causes of death due to job exposures. It is the largest study of U.S. firefighters ever undertaken and both non‐white and female firefighters are represented. www.cdc.gov/niosh/firefighters/cii07.html The 13 employees of the Illinois State Cancer Registry have 187 combined years of experience with the Illinois Department of Public Health. The Nurses’ Health Study I and The Nurses’ Health Study II These two studies are among the largest and longest running investigations of factors that influence women’s health. Started in 1976 and expanded in 1989, the information provided by the 238,000 dedicated nurse‐participants has led to many new insights on health and disease. While the prevention of cancer is still a primary focus, the study also has produced landmark data on cardiovascular disease, diabetes and many other conditions. Most importantly, these studies have shown that diet, physical activity and other lifestyle factors can powerfully promote better health. These studies are funded by the National Institutes of Health. www.channing.harvard.edu/nhs The Health Professionals Follow‐up Study The Illinois State Cancer Registry has been certified as a “gold Registry” for the past 15 years. gold certification is the highest level and cancer data must meet strict guidelines for quality, completeness and timeliness to qualify. The Health Professionals Follow‐Up Study (HPFS) began in 1986. The purpose of the study is to evaluate a series of hypotheses about men’s health relating nutritional factors to the incidence of serious illnesses, such as cancer, heart disease, and other vascular diseases. This all‐male study is sponsored by the Harvard School of Public Health and is funded by the National Cancer Institute. www.hsph.harvard.edu/hpfs Cancer Prevention Study II (CPS II) The Cancer Prevention Study II (CPS‐II), which began in 1982, is a prospective mortality study of approximately 1.2 million American men and women. The registry participates in the subset CPS‐II Nutrition Survey. The CPS‐II Nutrition 12 ILLINOIS STATE CANCER REgISTRy Survey was established: 1) to obtain detailed information on dietary exposures and to update with additional exposure information, and 2) to conduct prospective cancer incidence follow‐up in addition to mortality follow‐up. ISCR performs a data linkage to validate self‐reported cancers as part of the ongoing cancer incidence follow‐up for the survey. This study is performed and funded by the American Cancer Society. www.cancer.org/research/researchtopreventcancer Transplant Cancer Match Study Cancer is a major adverse outcome of solid organ transplantation. The elevated risk of cancer is largely due to immunosuppression. The Transplant Cancer Match Study linked the U.S. solid organ transplant registry with state and regional cancer registries to get an overview of the cancer risk in more than 175,000 transplant recipients of all organ types. The study was designed to get a better understanding of cancer risk in transplant recipients to help clarify the role of the immune system, infections, and other factors in the development of malignancy, and to identify opportunities to improve transplant safety. JAMA, November 2, 2011–Vol. 306, No. 17 Cancer Resources Illinois Department of Public Health Office of Women's Health http://www.idph.state.il.us/about/ womenshealth/concern.htm American Cancer Society www.cancer.org National Cancer Institute www.cancer.gov U.S. Centers for Disease Control and Prevention www.cdc.gov Illinois Breast and Cervical Cancer Program http://www.cancerscreening.illinois.gov Illinois Tobacco Quitline www.quityes.org 1-866-QUIT-yES The official Illinois state insect is the Monarch butterfly. prepared by Lori Koch Lindsay Snodgrass Tiefu Shen Jayneece Bostwick Suggested citation: Koch L, Snodgrass L, Shen T, Bostwick J. Cancer in Illinois 2013. Illinois Department of Public Health, Springfield, Ill. June 2013. All material in this publication is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. The Illinois Department of Public Health, Illinois State Cancer Registry (ISCR), makes the cancer incidence data available as a public service. Use of these data does not constitute an endorsement of the user’s opinion or conclusions by the Department and none should be inferred. This publication would not have been possible without the assistance of the Illinois State Cancer Registry staff, the personnel at the reporting facilities who diagnose or treat cancer patients throughout Illinois, and the staff members at other state central cancer registries with data exchange agreements. This publication was supported, in part, by Cooperative Agreement Number 1US58DP0038883‐01 from the U.S. Centers for Disease Control and Prevention (CDC) National Cancer Prevention and Control Program. The contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. Printed by Authority of the State of Illinois P.O. #5114348 250 11/13 IOCI 14-0263