# ![](media/image1.wmf){width="2.3986111111111112in" height="2.2930555555555556in"} {#section .Chapter-#}

# 3 {#section-1 .Chapter-#}

# Cancer

Co-Lead Agencies: Centers for Disease Control and Prevention\
National Institutes of Health

### Contents {#contents .Heading-Special}

[Goal Page 3-3](#goal)

[Overview Page 3-3](#overview)

[Issues and Trends Page 3-3](#issues-and-trends)

[Disparities Page 3-4](#disparities)

[Opportunities Page 3-6](#opportunities)

[Interim Progress Toward Year 2000 Objectives Page
3-7](#interim-progress-toward-year-2000-objectives)

[Healthy People 2010---Summary of Objectives Page
3-9](#healthy-people-2010summary-of-objectives)

[Healthy People 2010 Objectives Page
3-10](#healthy-people-2010-objectives)

[Related Objectives From Other Focus Areas Page
3-29](#related-objectives-from-other-focus-areas)

[Terminology Page 3-29](#terminology)

[References Page 3-30](#references)

## Goal

Reduce the number of new cancer cases as well as\
the illness, disability, and death caused by cancer.

## Overview

Cancer is the second leading cause of death in the United States. During
2000, an estimated 1,220,100 persons in the United States were expected
to be diagnosed with cancer; 552,200 persons were expected to die from
cancer.[^1] These estimates did not include most skin cancers, and new
cases of skin cancer are estimated to exceed 1 million per year.
One-half of new cases of cancer occur in people aged 65 years and
over.[^2]

About 491,400 persons who get cancer in a given year, or 4 in 10
patients, are expected to be alive 5 years after diagnosis. When
adjusted for normal life expectancy (accounting for factors such as
dying of heart disease, injuries, and diseases of old age), a relative
5-year survival rate of 60 percent is seen for all cancers.Error:
Reference source not found This rate means that the chance of a person
recently diagnosed with cancer being alive in 5 years is 60 percent of
the chance of someone not diagnosed with cancer. Five-year relative
survival rates commonly are used to monitor progress in the early
detection and treatment of cancer and include persons who are living 5
years after diagnosis, whether in remission, disease free, or under
treatment.

### Issues and Trends

Cancer death rates for all sites combined decreased an average of 0.6
percent per year from 1990 to 1996.[^3] This decrease occurred after
rates had increased by 0.4 percent per year from 1973 to 1990.[^4] Death
rates for male lung, female breast, prostate, and colorectal cancers
decreased significantly during the 1990--96\
period.Error: Reference source not found The lung and bronchus,
prostate, female breast, and colon and rectum were the most common
cancer sites for all racial and ethnic populations in the United States
and together accounted for approximately 54 percent of all newly
diagnosed cancers.Error: Reference source not found

In addition to the human toll of cancer, the financial costs of cancer
are substantial.[^5] The overall annual costs for cancer are estimated
at \$107 billion, with \$37 billion for direct medical costs (the total
of all health expenditures), \$11 billion for costs of illness (the cost
of low productivity due to illness), and \$59 billion for costs of death
(the cost of lost productivity due to death). Treatment for lung,
breast, and prostate cancers alone accounts for more than half of the
direct medical costs.

### ![](media/image2.wmf){width="4.539583333333334in" height="7.15625in"}Disparities

Cancer death rates vary by gender, race, and ethnicity.Error: Reference
source not found Male cancer death rates peaked in 1990 at 220.8 per
100,000, and female death rates peaked a year later at 142.2 per
100,000. After the peak year, through 1996, male cancer deaths for all
sites decreased on average by 1 percent per year, and female deaths
decreased on average by 0.4 percent per year. There were significant
decreases in death for lung, prostate, brain, and other nervous system
cancers in males and a significant decrease in breast cancer death for
females.Error: Reference source not found Among males, lung cancer death
rates have declined since 1990. In contrast, lung cancer death rates
have continued to increase among females. Since 1987, more females have
died from lung cancer than breast cancer.

African Americans are about 34 percent more likely to die of cancer than
are whites and more than two times more likely to die of cancer than are
Asian or Pacific Islanders, American Indians, and Hispanics.Error:
Reference source not found African American women are more likely to die
of breast and colon cancers than are women of any other racial and
ethnic group, and they have approximately the same lung cancer death
rates as white women. African American men have the highest death rates
of colon and rectum, lung, and prostate cancers. Age-adjusted lung
cancer death rates are approximately 40 percent higher among African
American males than white males. Little difference in age-adjusted lung
cancer death rates has been observed between African American females
and white females. Hispanics have higher rates of cervical, esophageal,
gallbladder, and stomach cancers. Similarly, some specific forms of
cancer affect other ethnic groups at rates higher than the national
average (for example, stomach and liver cancers among Asian American
populations and colorectal \[CRC\] cancer among Alaska Natives). Certain
racial and ethnic groups have lower survival rates than whites for most
cancers.Error: Reference source not found

Differences among the races represent both a challenge to understand the
reasons and an opportunity to reduce illness and death and to improve
survival rates.

The Hispanic cancer experience also differs from that of the
non-Hispanic white population, with Hispanics having higher rates of
cervical, esophageal, gallbladder, and stomach cancers. New cases of
female breast and lung cancers are increasing among Hispanics, who are
diagnosed at later stages and have lower survival rates than whites.

The recent decrease in deaths from breast cancer in white females is
attributed to greater use of breast cancer screening in regular medical
care. However, deaths due to breast cancer in African American females
continue to increase, in part, because breast cancer is diagnosed at
later stages in African American females.Error: Reference source not
found

Data on CRC show a decline in new cases and death rates in white males
and females, stable new case rates in African Americans, and a continued
rise in death rates in African American males. Five-year survival rates
for the 1989--94 period are 64 percent in whites and 52 percent in
African Americans.Error: Reference source not found Early detection and
treatment play a key role in these survival rates.

New cases of prostate cancer peaked in 1992 at 190.8 per 100,000 people
and declined on average by 8.5 percent each year from 1992 to 1996.
Prostate cancer death rates peaked in 1991 at 26.7 per 100,000 people;
rates decreased on average by 2.1 percent each year from 1991 to
1995.Error: Reference source not found Causes of the trends are unclear
but may be attributed to a number of factors that are under
investigation.

Possible disparities regarding the health status of lesbian women and
possible barriers to access to health services by lesbians have been
identified by the Institute of Medicine as a research priority.[^6]

### Opportunities

Evidence suggests that several types of cancer can be prevented and that
the prospects for surviving cancer continue to improve. The ability to
reduce cancer death rates depends, in part, on the existence and
application of various types of resources. First, the means to provide
culturally and linguistically appropriate information on prevention,
early detection, and treatment to the public and to health care
professionals are essential. Second, mechanisms or systems must exist
for providing people with access to state-of-the-art preventive services
and treatment. Where suitable, participation in clinical trials also
should be encouraged. Third, a mechanism for maintaining continued
research progress and for fostering new research is essential. Genetic
information that can be used to improve disease prevention strategies is
emerging for many cancers and may provide the foundation for improved
effectiveness in clinical and preventive medicine services.

To provide new opportunities for cancer prevention and control in the
future, there is a continuing and vital need to foster new, innovative
research on both the causes of cancer (including genetic and
environmental causes) and on methods to translate biologic and
epidemiologic findings into effective prevention and control programs
for use by government and community organizations to reduce further the
Nation's cancer burden.

These needs can be met, in part, with the network of cancer control
resources now in place. This network has the organizational and
personnel capabilities for various cancer interventions. Despite the
extent of these resources, they alone are insufficient to reduce deaths
from cancer. Gaps exist in information transfer, optimal practice
patterns, research capabilities, and other areas. These gaps must be
recognized and filled to meet cancer prevention and control needs.

It is estimated that as much as 50 percent or more of cancer can be
prevented through smoking cessation and improved dietary habits, such as
reducing fat consumption and increasing fruit and vegetable
consumption.[^7]**^,^** [^8] Physical activity and weight control also
can contribute to cancer prevention.[^9]**^,^** [^10]

Scientific data from randomized trials of cancer screening together with
expert opinions indicate that adherence to screening recommendations for
cancers of the breast, cervix, and colon/rectum reduces deaths from
these cancers.

To reduce breast cancer deaths in the United States, a high percentage
of females aged 40 years and older need to comply with screening
recommendations. A reduction in breast cancer deaths could be expected
to occur after a delay of roughly 7 years.[^11] To reduce cervical
cancer deaths, a high percentage of females in the United States who are
aged 18 years and older need to comply with screening recommendations.
Evidence from randomized preventive trials is unavailable, but expert
opinion suggests that a beneficial impact on cervical cancer death rates
would be expected to occur after a delay of a few years.

Evidence shows that a reduction in CRC deaths can be achieved through
detection and removal of precancerous polyps and treatment of CRC in its
earliest stages. The findings from three randomized controlled trials
indicate that biennial screening with fecal occult blood tests (FOBT)
can reduce deaths from CRC by 15 to 21 percent in people aged 45 to 80
years.[^12]**^,^** [^13]**^,^** [^14] One trial[^15] reported a 33
percent reduction in deaths with annual screening in the same age
groups, and a simulation model showed a 56 percent reduction.[^16] The
efficacy of sigmoidoscopy has been supported by three case-control
studies[^17]**^,^** [^18]**^,^** [^19] that showed 59 to 79 percent
reductions in CRC deaths from cancers within reach of the sigmoidoscope
in age groups 45 years and older.

Prostate cancer prevention strategies are not available at this time.
Race and age are the only clearly identified risk factors for prostate
cancer. African Americans and older men are at higher risk. There is no
scientific agreement on the benefits of screening for prostate cancer,
and screening is not recommended in the general population or in
high-risk groups because it is unclear if screening and treatment do
more good than harm.[^20] Clinical trials currently are under way to
assess the benefits and risks of screening and treatments, and
additional research is needed to identify modifiable risk factors for
prostate cancer.

Melanoma and other skin cancers were expected to claim the lives of
almost 9,600 persons in 2000.Error: Reference source not found
Insufficient evidence exists to determine whether routine skin
examinations (self or physician) decrease deaths from melanoma or other
skin cancers. However, many of the skin cancers diagnosed each year
could be prevented by limiting exposure to the sun, by wearing
protective clothing, and by using sunscreen.

For all cancers, treatments designed to increase survival are needed
along with improved access to state-of-the-art care. In addition to
measurements of survival, indices of quality of life for both the short
term and long term are regarded as important considerations.

## Interim Progress Toward Year 2000 Objectives

The Healthy People 2000 objective for total cancer deaths was achieved
for the total population by 1995. Lung cancer deaths declined for the
first time in 50 years in 1991, declined again in 1992, remained level
in 1993, and then dropped again in 1994, 1995, and 1996. The decline in
the age-adjusted death rate for CRC for the total population has gone
beyond the year 2000 target, but declines in death rates have not been
as substantial for the black population. Improvements were observed in
cancer risk factors, such as tobacco use and dietary fat intake. Data
also showed some improvement in the proportion of women receiving
mammograms and Pap tests. In addition, for both mammograms and Pap
tests, the disparity in use rates for most of the population subgroups
and those for all women either has been reduced or eliminated.

Note: Unless otherwise noted, data are from the Centers for Disease
Control and\
Prevention, National Center for Health Statistics, *Healthy People 2000
Review, 1998--99.*

## Healthy People 2010---Summary of Objectives

### Cancer {#cancer-1 .Heading-Special-Sub}

**Goal:** Reduce the number of new cancer cases as well as the illness,\
disability, and death caused by cancer.

  ------------ ------------------------------------------------------------
  **Number**   **Objective Short Title**

  3-1          Overall cancer deaths

  3-2          Lung cancer deaths

  3-3          Breast cancer deaths

  3-4          Cervical cancer deaths

  3-5          Colorectal cancer deaths

  3-6          Oropharyngeal cancer deaths

  3-7          Prostate cancer deaths

  3-8          Melanoma deaths

  3-9          Sun exposure and skin cancer

  3-10         Provider counseling about cancer prevention

  3-11         Pap tests

  3-12         Colorectal cancer screening

  3-13         Mammograms

  3-14         Statewide cancer registries

  3-15         Cancer survival
  ------------ ------------------------------------------------------------

## Healthy People 2010 Objectives

3-1. Reduce the overall cancer death rate.

**Target:** 159.9 deaths per 100,000 population.

**Baseline:** 202.4 cancer deaths per 100,000 population occurred in
1998 (age adjusted to the year 2000 standard population).

**Target setting method:** 21 percent improvement.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

+------------------------------------------------+---------------------+
| **Total Population, 1998**                     | **Cancer Deaths**   |
+================================================+=====================+
|                                                | Rate per 100,000    |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 202.4               |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 129.3               |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 124.2               |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 255.1               |
+------------------------------------------------+---------------------+
| > White                                        | 199.3               |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 123.7               |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 206.6               |
+------------------------------------------------+---------------------+
| > Black or African American                    | 261.8               |
+------------------------------------------------+---------------------+
| > White                                        | 203.0               |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 169.2               |
+------------------------------------------------+---------------------+
| > Male                                         | 252.4               |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 to 64 years)      |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 137.8               |
+------------------------------------------------+---------------------+
| > High school graduate                         | 139.7               |
+------------------------------------------------+---------------------+
| > At least some college                        | 79.6                |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

3-2. Reduce the lung cancer death rate.

**Target:** 44.9 deaths per 100,000 population.

**Baseline:** 57.6 lung cancer deaths per 100,000 population occurred in
1998 (age adjusted to the year 2000 standard population).

**Target setting method:** 22 percent improvement.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

+------------------------------------------------+---------------------+
| **Total Population, 1998**                     | **Lung Cancer       |
|                                                | Deaths**            |
+================================================+=====================+
|                                                | Rate per 100,000    |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 57.6                |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 38.2                |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 29.3                |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 66.7                |
+------------------------------------------------+---------------------+
| > White                                        | 57.5                |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 22.7                |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 59.6                |
+------------------------------------------------+---------------------+
| > Black or African American                    | 68.6                |
+------------------------------------------------+---------------------+
| > White                                        | 59.6                |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 41.5                |
+------------------------------------------------+---------------------+
| > Male                                         | 79.9                |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 to 64 years)      |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 49.0                |
+------------------------------------------------+---------------------+
| > High school graduate                         | 41.8                |
+------------------------------------------------+---------------------+
| > At least some college                        | 17.6                |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Lung cancer is the most common cause of cancer death among both females
and males in the United States. Estimates indicated that 164,100 (74,600
females and 89,500 males) new cases of lung cancer would be diagnosed in
2000; 156,900 persons (67,600 females and 89,300 males) would die from
lung cancer in 2000, accounting for 28 percent of all cancer
deaths.**^Error:\ Reference\ source\ not\ found^**

Cigarette smoking is the most important risk factor for lung cancer,
accounting for 68 to 78 percent of lung cancer deaths among females and
88 to 91 percent of lung cancer deaths among males.[^21] Other risk
factors include occupational exposures (radon, asbestos) and indoor and
outdoor air pollution (radon, environmental tobacco smoke).[^22] One to
two percent of lung cancer deaths are attributable to air
pollution.[^23] After 10 years of abstinence, smoking cessation
decreases the risk of lung cancer to 30 to 50 percent of that of
continuing smokers.Error: Reference source not found

3-3. Reduce the breast cancer death rate.

**Target:** 22.3 deaths per 100,000 females.

**Baseline:** 27.9 breast cancer deaths per 100,000 females occurred in
1998 (age adjusted to the year 2000 standard population).

**Target setting method:** 20 percent improvement.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

+------------------------------------------------+---------------------+
| **Females, 1998**                              | **Breast Cancer     |
|                                                | Deaths**            |
+================================================+=====================+
|                                                | Rate per 100,000    |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 27.9                |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 14.2                |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 13.1                |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 35.7                |
+------------------------------------------------+---------------------+
| > White                                        | 27.3                |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 16.8                |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 28.5                |
+------------------------------------------------+---------------------+
| > Black or African American                    | 36.7                |
+------------------------------------------------+---------------------+
| > White                                        | 27.9                |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 to 64 years)      |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 20.0                |
+------------------------------------------------+---------------------+
| > High school graduate                         | 28.4                |
+------------------------------------------------+---------------------+
| > At least some college                        | 22.0                |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Breast cancer is the most common cancer among women in the United
States. An estimated 184,200 new cases were expected to be diagnosed in
2000. About 40,800 U.S. women were expected to die from breast cancer in
2000, accounting for about 15.2 percent of cancer deaths among
women.Error: Reference source not found Death from breast cancer can be
reduced substantially if the tumor is discovered at an early stage.
Mammography is the most effective method for detecting these early
malignancies. Clinical trials have demonstrated that mammography
screening can reduce breast cancer deaths by 20 to 39 percent in women
aged 50 to 74 years and about 17 percent in women aged 40 to 49
years.[^24] Breast cancer deaths can be reduced through increased
adherence with recommendations for regular mammography screening.

Many breast cancer risk factors, such as age, family history of breast
cancer, reproductive history, mammographic densities, previous breast
disease, and race and ethnicity, are not subject to
intervention.[^25]**^,^** [^26] However, being overweight is a
well-established breast cancer risk for postmenopausal women that can be
addressed.Error: Reference source not found Avoiding weight gain is one
method by which older women may reduce their risk of developing breast
cancer.

3-4. Reduce the death rate from cancer of the uterine cervix.

**Target:** 2.0 deaths per 100,000 females.

**Baseline:** 3.0 cervical cancer deaths per 100,000 females occurred in
1998 (age adjusted to the year 2000 standard population).

**Target setting method:** Better than the best.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

Note: The table below may continue to the following page.

+------------------------------------------------+---------------------+
| **Females, 1998**                              | **Cervical Cancer   |
|                                                | Deaths**            |
+================================================+=====================+
|                                                | Rate per 100,000    |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 3.0                 |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 2.5                 |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 3.3                 |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 6.0                 |
+------------------------------------------------+---------------------+
| > White                                        | 2.7                 |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 3.3                 |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 3.0                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 6.2                 |
+------------------------------------------------+---------------------+
| > White                                        | 2.6                 |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 to 64 years)      |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 7.2                 |
+------------------------------------------------+---------------------+
| > High school graduate                         | 4.8                 |
+------------------------------------------------+---------------------+
| > At least some college                        | 2.1                 |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

Cervical cancer is the 10th most common cancer among females in the
United States, with an estimated 12,800 new cases in 2000. The number of
new cases of cervical cancer is higher among females from racial and
ethnic groups than among white females. An estimated 4,600 U.S. females
were expected to die from cervical cancer in 2000.Error: Reference
source not found Cervical cancer accounts for about 1.7 percent of
cancer deaths among females. Infections of the cervix with certain types
of sexually transmitted human papilloma virus increase risk of cervical
cancer and may be responsible for most cervical cancer in the United
States.[^27]

Considerable evidence suggests that screening can reduce the number of
deaths from cervical cancer. Invasive cervical cancer is preceded in a
large proportion of cases by precancerous changes in cervical tissue
that can be identified with a Pap test. If cervical cancer is detected
early, the likelihood of survival is almost 100 percent with appropriate
treatment and followup; that is, almost all cervical cancer deaths could
be avoided if all females complied with screening and followup
recommendations.[^28] Risk is substantially decreased among former
smokers in comparison to continuing smokers.Error: Reference source not
found

3-5. Reduce the colorectal cancer death rate.

**Target:** 13.9 deaths per 100,000 population.

**Baseline:** 21.2 colorectal cancer deaths per 100,000 population
occurred in 1998 (age adjusted to the year 2000 standard population).

**Target setting method:** 34 percent improvement.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

+------------------------------------------------+---------------------+
| **Total Population, 1998**                     | **Colorectal Cancer |
|                                                | Deaths**            |
+================================================+=====================+
|                                                | Rate per 100,000    |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 21.2                |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 13.3                |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 13.7                |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 28.2                |
+------------------------------------------------+---------------------+
| > White                                        | 20.8                |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 12.8                |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 21.7                |
+------------------------------------------------+---------------------+
| > Black or African American                    | 28.9                |
+------------------------------------------------+---------------------+
| > White                                        | 21.1                |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 18.2                |
+------------------------------------------------+---------------------+
| > Male                                         | 25.4                |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 to 64 years)      |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 10.4                |
+------------------------------------------------+---------------------+
| > High school graduate                         | 12.0                |
+------------------------------------------------+---------------------+
| > At least some college                        | 7.5                 |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Colorectal cancer is the second leading cause of cancer-related deaths
in the United States. An estimated 130,200 cases (66,600 females and
63,600 males) of CRC and 56,300 deaths (28,500 females and 27,800 males)
from CRC were expected to occur in 2000. When cancer-related deaths are
estimated separately for males and females, however, CRC becomes the
third leading cause of cancer death behind lung and breast cancers for
females and behind lung and prostate cancers for males.Error: Reference
source not found

Risk factors for CRC may include age, personal and family history of
polyps or colorectal cancer, inflammatory bowel disease, inherited
syndromes, physical inactivity (colon only), obesity, alcohol use, and a
diet high in fat and low in fruits and vegetables.[^29] Detecting and
removing precancerous colorectal polyps and detecting and treating the
disease in its earliest stages will reduce deaths from CRC. FOBT and
sigmoidoscopy are widely used to screen for CRC, and barium enema and
colonoscopy are used as diagnostic tests.

3-6. Reduce the oropharyngeal cancer death rate.

**Target:** 2.7 deaths per 100,000 population.

**Baseline:** 3.0 oropharyngeal cancer deaths per 100,000 population
occurred in 1998 (age adjusted to the year 2000 standard population).

**Target setting method:** 10 percent improvement.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

+------------------------------------------------+---------------------+
| **Total Population, 1998**                     | **Oropharyngeal     |
|                                                | Cancer Deaths**     |
+================================================+=====================+
|                                                | Rate per 100,000    |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 3.0                 |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 2.1                 |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 2.2                 |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 4.5                 |
+------------------------------------------------+---------------------+
| > White                                        | 2.8                 |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 1.8                 |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 3.1                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 4.7                 |
+------------------------------------------------+---------------------+
| > White                                        | 2.9                 |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 1.7                 |
+------------------------------------------------+---------------------+
| > Male                                         | 4.5                 |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 to 64 years)      |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 3.6                 |
+------------------------------------------------+---------------------+
| > High school graduate                         | 3.0                 |
+------------------------------------------------+---------------------+
| > At least some college                        | 1.2                 |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Oral and pharyngeal (oropharyngeal) cancers comprise a diversity of
malignant tumors that affect the oral cavity and pharynx; the
overwhelming majority of these tumors are squamous cell carcinomas. In
2000, 30,200 new cases of oropharyngeal cancer were expected to be
diagnosed, and approximately 7,800 deaths were expected to occur from
the disease. Oropharyngeal cancer is the 10th most common cancer among
U.S. men and the 14th most common among U.S. women.Error: Reference
source not found Its 5-year survival rate is only 53 percent. The risk
of oral cancer is increased in current smokers. Alcohol consumption is
an independent risk factor, and when alcohol is combined with use of
tobacco products, 90 percent of all oral cancers are explained.[^30]

3-7. Reduce the prostate cancer death rate.

**Target:** 28.8 deaths per 100,000 males.

**Baseline:** 32.0 prostate cancer deaths per 100,000 males occurred in
1998 (age adjusted to the year 2000 standard population).

**Target setting method:** 10 percent improvement.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

+------------------------------------------------+---------------------+
| **Males, 1998**                                | **Prostate Cancer   |
|                                                | Deaths**            |
+================================================+=====================+
|                                                | Rate per 100,000    |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 32.0                |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 15.9                |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 12.4                |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 68.7                |
+------------------------------------------------+---------------------+
| > White                                        | 29.4                |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 20.9                |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 32.4                |
+------------------------------------------------+---------------------+
| > Black or African American                    | 70.2                |
+------------------------------------------------+---------------------+
| > White                                        | 29.7                |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 to 64 years)      |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 4.4                 |
+------------------------------------------------+---------------------+
| > High school graduate                         | 5.0                 |
+------------------------------------------------+---------------------+
| > At least some college                        | 2.8                 |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Prostate cancer is the most commonly diagnosed form of cancer (other
than skin cancer) in males and the second leading cause of cancer death
among males in the United States. Prostate cancer was expected to
account for an estimated 180,400 cases and 31,900 deaths in 2000, or
about 29 percent and 11 percent of the cases and deaths due to all
cancers, respectively.Error: Reference source not found Prostate cancer
is most common in men aged 65 years and older, who account for
approximately 80 percent of all cases of prostate cancer.

Digital rectal examination (DRE) and the prostate-specific antigen (PSA)
test are two commonly used methods for detecting prostate cancer.
Clinical trials of the benefits of DRE and PSA screening are under way,
with results expected in the early 21st century.

Although several treatment alternatives are available for prostate
cancer, their impact on reducing death from prostate cancer when
compared with no treatment in patients with operable cancer is
uncertain.[^31]**^,^** [^32]**^,^** [^33] Efforts aimed at reducing
deaths through screening and early detection remain controversial
because of the uncertain benefits and potential risks of screening,
diagnosis, and treatment.

3-8. Reduce the rate of melanoma cancer deaths.

**Target:** 2.5 deaths per 100,000 population.

**Baseline:** 2.8 melanoma cancer deaths per 100,000 population occurred
in 1998 (age adjusted to the year 2000 standard population).

**Target setting method:** 11 percent improvement.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

Note: The table below may continue to the following page.

+------------------------------------------------+---------------------+
| **Total Population, 1998**                     | **Melanoma Cancer   |
|                                                | Deaths**            |
+================================================+=====================+
|                                                | Rate per 100,000    |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 2.8                 |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | DSU                 |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 0.3                 |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 0.5                 |
+------------------------------------------------+---------------------+
| > White                                        | 3.1                 |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 0.8                 |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 2.9                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 0.5                 |
+------------------------------------------------+---------------------+
| > White                                        | 3.3                 |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 1.8                 |
+------------------------------------------------+---------------------+
| > Male                                         | 4.1                 |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 to 64 years)      |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 1.8                 |
+------------------------------------------------+---------------------+
| > High school graduate                         | 2.7                 |
+------------------------------------------------+---------------------+
| > At least some college                        | 2.3                 |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

Melanoma, the deadliest of all skin cancers, was expected to account for
an estimated 47,700 new cancer cases and 7,700 deaths in 2000.Error:
Reference source not found Trends show annual rises in the number of new
cases of 4.3 percent (1973--90) and 2.5 percent (1990--95) and an annual
rise in deaths of 1.7 percent (1973--90) followed by a decline of 0.4
percent in 1990--95. In whites, the population at highest risk, death
rates are twice as high in males as in females.Error: Reference source
not found

Although the cause of melanoma is unknown, risk factors include a
personal or family history of melanoma, the presence of atypical moles,
a large number of moles, intermittent sun exposure, a history of
sunburns early in life, freckles, and sun-sensitive skin (as measured by
poor tanning ability and light skin, eye, or hair color).[^34] Evidence
is insufficient to determine whether early detection through routine
skin examination (self or physician) decreases the number of deaths from
melanoma, but reduced ultraviolet exposure is likely to have a
beneficial impact on the risk of melanoma and other skin cancers (basal
and squamous cell skin cancers).Error: Reference source not found

3-9. Increase the proportion of persons who use at least one of the
following protective measures that may reduce the risk of skin cancer:
avoid the sun between 10 a.m. and 4 p.m., wear sun-protective clothing
when exposed to sunlight, use sunscreen with a sun-protective factor
(SPF) of 15 or higher, and avoid artificial sources of ultraviolet
light.

**3-9a.** (Developmental) Increase the proportion of adolescents in
grades 9 through 12 who follow protective measures that may reduce the
risk of skin\
cancer.

**Potential data source:** Youth Risk Behavior Surveillance System
(YRBSS), CDC, NCCDPHP.

**3-9b.** Increase the proportion of adults aged 18 years and older who
follow protective measures that may reduce the risk of skin cancer.

**Target:** 75 percent of adults aged 18 years and older use at least
one of the identified protective measures.

**Baseline:** 47 percent of adults aged 18 years and older regularly
used at least one protective measure in 1998 (age adjusted to the year
2000 standard population).

**Target setting method:** Better than the best.

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.
Data on artificial ultraviolet light source are developmental.

Note: The table below may continue to the following page.

+---------------------------+---------+---------+---------+---------+
| **Persons Aged 18 Years   | **Type  |         |         |         |
| and Older, 1998 (unless   | of      |         |         |         |
| noted)**                  | Pro     |         |         |         |
|                           | tective |         |         |         |
|                           | Me      |         |         |         |
|                           | asure** |         |         |         |
+===========================+=========+=========+=========+=========+
|                           | *       | **      | **Wore\ | **Used\ |
|                           | *3-9b.\ | Limited | Pro     | Sunscr  |
|                           | Re      | Sun\    | tective | een**\* |
|                           | gularly | Expos   | Cloth   |         |
|                           | Used at | ure**\* | ing**\* |         |
|                           | Least   |         |         |         |
|                           | One\    |         |         |         |
|                           | Pro     |         |         |         |
|                           | tective |         |         |         |
|                           | Me      |         |         |         |
|                           | asure** |         |         |         |
+---------------------------+---------+---------+---------+---------+
|                           | Percent |         |         |         |
+---------------------------+---------+---------+---------+---------+
| > **TOTAL**               | 47      | 28      | 24      | 31      |
+---------------------------+---------+---------+---------+---------+
| **Race and ethnicity**    |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| > American Indian or      | 48      | 28      | 26      | 31      |
| > Alaska Native           |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| > Asian or Pacific        | 44      | 34      | 25      | 22      |
| > Islander                |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| > Asian                   | 44      | 34      | 25      | 23      |
+---------------------------+---------+---------+---------+---------+
| > Native Hawaiian and     | 50      | 39      | 31      | 17      |
| > other                   |         |         |         |         |
| >                         |         |         |         |         |
| > Pacific Islander        |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| > Black or African        | 44      | 37      | 23      | 12      |
| > American                |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| > White                   | 49      | 26      | 24      | 34      |
+---------------------------+---------+---------+---------+---------+
|                           |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| > Hispanic or Latino      | 41      | 30      | 24      | 22      |
+---------------------------+---------+---------+---------+---------+
| > Not Hispanic or Latino  | 48      | 27      | 24      | 32      |
+---------------------------+---------+---------+---------+---------+
| > Black or African        | 44      | 37      | 24      | 12      |
| > American                |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| > White                   | 49      | 26      | 24      | 35      |
+---------------------------+---------+---------+---------+---------+
| ###### Gender             |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| > Female                  | 54      | 33      | 25      | 39      |
+---------------------------+---------+---------+---------+---------+
| > Male                    | 40      | 22      | 24      | 22      |
+---------------------------+---------+---------+---------+---------+
| **Education level** (aged |         |         |         |         |
| 25 years and older)       |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| > Less than high school   | 41      | 29      | 24      | 17      |
+---------------------------+---------+---------+---------+---------+
| > High school graduate    | 45      | 28      | 24      | 27      |
+---------------------------+---------+---------+---------+---------+
| > Some college            | 54      | 30      | 29      | 39      |
+---------------------------+---------+---------+---------+---------+
| **Family income level**   |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| > Poor                    | 43      | 33      | 25      | 19      |
+---------------------------+---------+---------+---------+---------+
| > Near poor               | 46      | 32      | 25      | 24      |
+---------------------------+---------+---------+---------+---------+
| > Middle/high income      | 51      | 27      | 26      | 35      |
+---------------------------+---------+---------+---------+---------+
| **Geographic location**   |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| > Urban                   | 49      | 29      | 25      | 32      |
+---------------------------+---------+---------+---------+---------+
| > Rural                   | 44      | 25      | 24      | 28      |
+---------------------------+---------+---------+---------+---------+
| **Disability status**     |         |         |         |         |
+---------------------------+---------+---------+---------+---------+
| > Persons with activity\  | 57      | 38      | 33      | 27      |
| > limitations             | (1992)  | (1992)  | (1992)  | (1992)  |
+---------------------------+---------+---------+---------+---------+
| > Persons without         | 53      | 31      | 28      | 29      |
| > activity\               | (1992)  | (1992)  | (1992)  | (1992)  |
| > limitations             |         |         |         |         |
+---------------------------+---------+---------+---------+---------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

\*Data for limited sun exposure, used sunscreen, and wore protective
clothing are displayed to further\
characterize the issue.

Note: The table above may have continued from the previous page.

3-10. Increase the proportion of physicians and dentists who counsel
their at-risk patients about tobacco use cessation, physical activity,
and cancer screening.

Target and baseline:

+------------+--------------------------------+------------+----------+
| Objective  | Increase in Counseling About\  | 1988\      | 2010\    |
|            | Tobacco Use Cessation,         | Baseline\  | Target   |
|            | Physical\                      | (unless    |          |
|            | Activity, and Cancer Screening | noted)     |          |
+------------+--------------------------------+------------+----------+
|            |                                | #####      |          |
|            |                                | ## Percent |          |
+------------+--------------------------------+------------+----------+
| **3-10a.** | Internists who counsel about   | 50         | 85       |
|            | smoking cessation              |            |          |
+------------+--------------------------------+------------+----------+
| **3-10b.** | Family physicians who counsel  | 43         | 85       |
|            | about smoking cessation        |            |          |
+------------+--------------------------------+------------+----------+
| **3-10c.** | Dentists who counsel about     | 59 (1997)  | 85       |
|            | smoking cessation              |            |          |
+------------+--------------------------------+------------+----------+
| **3-10d.** | Primary care providers who     | 56         | 85       |
|            | counsel about blood stool      |            |          |
|            | tests                          |            |          |
+------------+--------------------------------+------------+----------+
| **3-10e.** | Primary care providers who     | 23         | 85       |
|            | counsel about proctoscopic     |            |          |
|            | examinations                   |            |          |
+------------+--------------------------------+------------+----------+
| **3-10f.** | Primary care providers who     | 37         | 85       |
|            | counsel about mammograms       |            |          |
+------------+--------------------------------+------------+----------+
| **3-10g.** | Primary care providers who     | 55         | 85       |
|            | counsel about Pap tests        |            |          |
+------------+--------------------------------+------------+----------+
| **3-10h.** | Primary care providers who     | 22 (1995)  | 85       |
|            | counsel about physical         |            |          |
|            | activity                       |            |          |
+------------+--------------------------------+------------+----------+

**Target setting method:** Better than the best.

**Data sources:** Survey of Physicians' Attitudes and Practices in Early
Cancer Detection, NIH, NCI; National Ambulatory Medical Care Survey
(NAMCS), CDC, NCHS; Survey of Current Issues in Dentistry, American
Dental Association.

Smoking cessation,Error: Reference source not
found**^,\ Error:\ Reference\ source\ not\ found^** adoption of healthy
diets,7 increased physical activity,Error: Reference source not
found**^,\ Error:\ Reference\ source\ not\ found^** and increased cancer
screeningError: Reference source not
found**^,\ Error:\ Reference\ source\ not\ found,\ Error:\ Reference\ source\ not\ found,\ Error:\ Reference\ source\ not\ found,\ Error:\ Reference\ source\ not\ found,\ Error:\ Reference\ source\ not\ found,\ Error:\ Reference\ source\ not\ found,\ Error:\ Reference\ source\ not\ found,\ Error:\ Reference\ source\ not\ found^**
can all contribute to reduced numbers of cancer deaths. Experts
recommend that providers screen patients for breast, cervical, and
colorectal cancers and counsel patients to prevent or reduce tobacco
use, promote physical activity, and promote a healthy diet.Error:
Reference source not found Provider counseling should be conducted in a
linguistically and culturally appropriate manner.

3-11. Increase the proportion of women who receive a Pap test.

Target and baseline:

+---------+------------------------------------+----------+-----------+
| Ob      | Increase in Pap Testing            | 1998\    | 2010\     |
| jective |                                    | Ba       | Target    |
|         |                                    | seline\* |           |
+---------+------------------------------------+----------+-----------+
|         |                                    | #######  |           |
|         |                                    |  Percent |           |
+---------+------------------------------------+----------+-----------+
| **3     | Women aged 18 years and older who  | 92       | 97        |
| -11a.** | have ever received a Pap test      |          |           |
+---------+------------------------------------+----------+-----------+
| **3     | Women aged 18 years and older who\ | 79       | 90        |
| -11b.** | received a Pap test within the     |          |           |
|         | preceding 3 years                  |          |           |
+---------+------------------------------------+----------+-----------+

\*Age adjusted to the year 2000 standard population. Includes women
without a uterine cervix.

**Target setting method:** Better than the best.

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.

Note: The table below may continue to the following page.

+-------------------------------+------------------+------------------+
| **Women Aged 18 Years and     | **Pap Test**     |                  |
| Older, 1998 (unless noted)**  |                  |                  |
+===============================+==================+==================+
|                               | **3-11a.\        | **3-11b.\        |
|                               | Ever**           | In Preceding\    |
|                               |                  | 3 Years**        |
+-------------------------------+------------------+------------------+
| > **TOTAL**                   | 92               | 79               |
+-------------------------------+------------------+------------------+
| **Race and ethnicity**        |                  |                  |
+-------------------------------+------------------+------------------+
| > American Indian or Alaska   | 88               | 72               |
| > Native                      |                  |                  |
+-------------------------------+------------------+------------------+
| > Asian or Pacific Islander   | 78               | 67               |
+-------------------------------+------------------+------------------+
| > Asian                       | 78               | 67               |
+-------------------------------+------------------+------------------+
| > Native Hawaiian and other\  | 80               | 66               |
| > Pacific Islander            |                  |                  |
+-------------------------------+------------------+------------------+
| > Black or African American   | 94               | 83               |
+-------------------------------+------------------+------------------+
| > White                       | 93               | 79               |
+-------------------------------+------------------+------------------+
|                               |                  |                  |
+-------------------------------+------------------+------------------+
| > Hispanic or Latino          | 85               | 74               |
+-------------------------------+------------------+------------------+
| > Not Hispanic or Latino      | 93               | 80               |
+-------------------------------+------------------+------------------+
| > Black or African American   | 94               | 83               |
+-------------------------------+------------------+------------------+
| > White                       | 94               | 80               |
+-------------------------------+------------------+------------------+
| **Education level** (aged 25  |                  |                  |
| years and older)              |                  |                  |
+-------------------------------+------------------+------------------+
| > Less than high school       | 89               | 69               |
+-------------------------------+------------------+------------------+
| > High school graduate        | 95               | 78               |
+-------------------------------+------------------+------------------+
| > At least some college       | 97               | 83               |
+-------------------------------+------------------+------------------+
| ###### Family income level    |                  |                  |
+-------------------------------+------------------+------------------+
| > Poor                        | 88               | 69               |
+-------------------------------+------------------+------------------+
| > Near poor                   | 92               | 73               |
+-------------------------------+------------------+------------------+
| > Middle/high income          | 94               | 83               |
+-------------------------------+------------------+------------------+
| **Geographic location**       |                  |                  |
+-------------------------------+------------------+------------------+
| > Urban                       | 92               | 80               |
+-------------------------------+------------------+------------------+
| > Rural                       | 93               | 78               |
+-------------------------------+------------------+------------------+
| ###### Disability status      |                  |                  |
+-------------------------------+------------------+------------------+
| > With activity limitations   | 95 (1994)        | 74 (1994)        |
+-------------------------------+------------------+------------------+
| > Without activity            | 94 (1994)        | 78 (1994)        |
| > limitations                 |                  |                  |
+-------------------------------+------------------+------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population. Includes women
without a uterine cervix.

Note: The table above may have continued from the previous page.

3-12. Increase the proportion of adults who receive a colorectal cancer
screening examination.

Target and baseline:

+--------------+---------------------------+-------------+-------------+
| Objective    | Increase in Colorectal    | 1998\       | 2010\       |
|              | Cancer Screening          | Baseline\*  | Target      |
+--------------+---------------------------+-------------+-------------+
|              |                           | ####        |             |
|              |                           | ### Percent |             |
+--------------+---------------------------+-------------+-------------+
| **3-12a.**   | Adults aged 50 years and  | 35          | 50          |
|              | older who have received a |             |             |
|              | fecal occult blood test   |             |             |
|              | (FOBT) within the         |             |             |
|              | preceding 2 years         |             |             |
+--------------+---------------------------+-------------+-------------+
| **3-12b.**   | Adults aged 50 years and  | 37          | 50          |
|              | older who have ever       |             |             |
|              | received a\               |             |             |
|              | sigmoidoscopy             |             |             |
+--------------+---------------------------+-------------+-------------+

\*Age adjusted to the year 2000 standard population.

**Target setting method:** Better than the best.

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.

+--------------------------------+------------------+-----------------+
| **Adults Aged 50 Years and     | **Colorectal     |                 |
| Older, 1998 (unless noted)**   | Cancer           |                 |
|                                | Screening**      |                 |
+================================+==================+=================+
|                                | **3-12a.\        | **3-12b.\       |
|                                | Fecal Occult\    | Sigmoidoscopy** |
|                                | Blood Test**     |                 |
+--------------------------------+------------------+-----------------+
|                                | **Percent**      |                 |
+--------------------------------+------------------+-----------------+
| > **TOTAL**                    | 35               | 37              |
+--------------------------------+------------------+-----------------+
| **Race and ethnicity**         |                  |                 |
+--------------------------------+------------------+-----------------+
| > American Indian or Alaska    | 24               | 29              |
| > Native                       |                  |                 |
+--------------------------------+------------------+-----------------+
| > Asian or Pacific Islander    | 31               | 34              |
+--------------------------------+------------------+-----------------+
| > Asian                        | 33               | 35              |
+--------------------------------+------------------+-----------------+
| > Native Hawaiian and other\   | DSU              | DSU             |
| > Pacific Islander             |                  |                 |
+--------------------------------+------------------+-----------------+
| > Black or African American    | 30               | 32              |
+--------------------------------+------------------+-----------------+
| > White                        | 35               | 38              |
+--------------------------------+------------------+-----------------+
|                                |                  |                 |
+--------------------------------+------------------+-----------------+
| > Hispanic or Latino           | 23               | 27              |
+--------------------------------+------------------+-----------------+
| > Not Hispanic or Latino       | 35               | 38              |
+--------------------------------+------------------+-----------------+
| > Black or African American    | 30               | 32              |
+--------------------------------+------------------+-----------------+
| > White                        | 36               | 39              |
+--------------------------------+------------------+-----------------+
| **Gender**                     |                  |                 |
+--------------------------------+------------------+-----------------+
| > Female                       | 34               | 33              |
+--------------------------------+------------------+-----------------+
| > Male                         | 36               | 43              |
+--------------------------------+------------------+-----------------+
| **Education level**            |                  |                 |
+--------------------------------+------------------+-----------------+
| > Less than high school        | 26               | 29              |
+--------------------------------+------------------+-----------------+
| > High school graduate         | 34               | 35              |
+--------------------------------+------------------+-----------------+
| > At least some college        | 41               | 44              |
+--------------------------------+------------------+-----------------+
| **Family income level**        |                  |                 |
+--------------------------------+------------------+-----------------+
| > Poor                         | 23               | 28              |
+--------------------------------+------------------+-----------------+
| > Near poor                    | 31               | 31              |
+--------------------------------+------------------+-----------------+
| > Middle/high income           | 39               | 43              |
+--------------------------------+------------------+-----------------+
| **Geographic location**        |                  |                 |
+--------------------------------+------------------+-----------------+
| > Urban                        | 36               | 38              |
+--------------------------------+------------------+-----------------+
| > Rural                        | 31               | 36              |
+--------------------------------+------------------+-----------------+
| ###### Disability status       |                  |                 |
+--------------------------------+------------------+-----------------+
| > Persons with activity        | 32 (1992)        | 37 (1992)       |
| > limitations                  |                  |                 |
+--------------------------------+------------------+-----------------+
| > Persons without activity     | 28 (1992)        | 31 (1992)       |
| > limitations                  |                  |                 |
+--------------------------------+------------------+-----------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

3-13. Increase the proportion of women aged 40 years and older who have
received a mammogram within the preceding\
2 years.

**Target:** 70 percent.

**Baseline:** 67 percent of women aged 40 years and older received a
mammogram within the preceding 2 years in 1998 (age adjusted to the year
2000 standard population).

**Target setting method:** Better than the best.

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.

Note: The table below may continue to the following page.

+------------------------------------------------+---------------------+
| **Women Aged 40 Years and Older, 1998 (unless  | **Mammogram**       |
| noted)**                                       |                     |
+================================================+=====================+
|                                                | Percent             |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 67                  |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 45                  |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 61                  |
+------------------------------------------------+---------------------+
| > Asian                                        | 61                  |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DSU                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 66                  |
+------------------------------------------------+---------------------+
| > White                                        | 67                  |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 61                  |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 68                  |
+------------------------------------------------+---------------------+
| > Black or African American                    | 66                  |
+------------------------------------------------+---------------------+
| > White                                        | 68                  |
+------------------------------------------------+---------------------+
| **Education level**                            |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 53                  |
+------------------------------------------------+---------------------+
| > High school graduate                         | 66                  |
+------------------------------------------------+---------------------+
| > At least some college                        | 73                  |
+------------------------------------------------+---------------------+
| ######## Family income level                   |                     |
+------------------------------------------------+---------------------+
| > Poor                                         | 50                  |
+------------------------------------------------+---------------------+
| > Near poor                                    | 54                  |
+------------------------------------------------+---------------------+
| > Middle/high income                           | 73                  |
+------------------------------------------------+---------------------+
| ###### Geographic location                     |                     |
+------------------------------------------------+---------------------+
| > Urban                                        | 68                  |
+------------------------------------------------+---------------------+
| > Rural                                        | 65                  |
+------------------------------------------------+---------------------+
| ###### Disability status                       |                     |
+------------------------------------------------+---------------------+
| > Persons with activity limitations            | 55 (1994)           |
+------------------------------------------------+---------------------+
| > Persons without activity limitations         | 61 (1994)           |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

3-14. Increase the number of States that have a statewide\
population-based cancer registry that captures case\
information on at least 95 percent of the expected number of reportable
cancers.

**Target:** 45 States.

**Baseline:** 21 States had a statewide population-based cancer registry
that captured case information on at least 95 percent of the expected
number of reportable cancers in 1999.

**Target setting method:** 114 percent improvement.

**Data source:** National Program of Cancer Registries, CDC.

Cancer surveillance serves as the foundation for a national
comprehensive strategy to reduce illness and death from cancer. Such
surveillance is the indispensable tool that enables public health
professionals at the national, State, and community levels to better
understand and tackle the cancer burden while advancing clinical,
epidemiologic, and health services research. In addition, surveillance
data from cancer registries, such as cancer incidence and deaths, stage
at diagnosis, treatment, and demographics of cancer patients, are
essential for planning and evaluating cancer control programs,
allocating preventive and treatment resources, targeting and conducting
research, and responding to concerns from citizens about the occurrence
of cancer in their communities.

Population-based State cancer registries that provide accurate,
complete, and timely data are a critical component of the public health
infrastructure in the United States. The National Program of Cancer
Registries (NPCR) provides funds to 45 States to assist in planning or
enhancing cancer registries; develop model legislation and regulations
for programs to increase the viability of registry operations; set
standards for data quality, completeness, and timeliness; provide
training for registry personnel; and help establish computerized
reporting and data processing systems. The National Cancer Institute's
SEER Program covers the remaining 5 States.

3-15. Increase the proportion of cancer survivors who are living 5 years
or longer after diagnosis.

**Target:** 70 percent.

**Baseline:** 59 percent of persons with invasive cancer of any type
were living 5 years or longer after diagnosis in 1989--95.

**Target setting method:** 19 percent improvement.

**Data source:** Surveillance, Epidemiology, and End Results (SEER)
Program, NIH, NCI.

+------------------------------------------------+---------------------+
| **Persons With Invasive Cancer of Any Type,    | **5 Years or Longer |
| 1989--95**                                     | Survival**          |
+================================================+=====================+
|                                                | Percent             |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 59                  |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | DNA                 |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | DNA                 |
+------------------------------------------------+---------------------+
| > Asian                                        | DNA                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNA                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 48                  |
+------------------------------------------------+---------------------+
| > White                                        | 61                  |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | DNA                 |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | DNA                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | DNA                 |
+------------------------------------------------+---------------------+
| > White                                        | DNA                 |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 61                  |
+------------------------------------------------+---------------------+
| > Male                                         | 58                  |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 to 64 years)      |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | DNA                 |
+------------------------------------------------+---------------------+
| > High school graduate                         | DNA                 |
+------------------------------------------------+---------------------+
| > At least some college                        | DNA                 |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

## Related Objectives From Other Focus Areas

19\. Nutrition and Overweight

19-5. Fruit intake

19-6. Vegetable intake

19-8. Saturated fat intake

19-9. Total fat intake

21\. Oral Health

21-6. Early detection of oral and pharyngeal cancers

21-7. Annual examinations for oral and pharyngeal cancers

27\. Tobacco Use

27-1. Adult tobacco use

27-2. Adolescent tobacco use

27-5. Smoking cessation by adults

27-7. Smoking cessation by adolescents

27-8. Insurance coverage of cessation treatment

## Terminology

(A listing of abbreviations and acronyms used in this publication
appears in Appendix H.)

**Cancer:** A term for diseases in which abnormal cells divide without
control. Cancer cells can invade nearby tissue and can spread through
the bloodstream and lymphatic system to other parts of the body.

**Cancer screening:** Checking for changes in tissue, cells, or fluids
that may indicate the possibility of cancer when there are no symptoms.

**Carcinoma:** Cancer that begins in the epithelial tissue that lines or
covers an organ.

**Clinical trials:** Research studies that evaluate the effectiveness of
new treatment or disease prevention methods on patients.

**Colonoscopy:** An examination of the rectum and entire colon using a
lighted instrument called a colonoscope. A colonoscope allows the
physician to remove polyps or other abnormal tissue for examination
under a microscope.

**Digital rectal exam (DRE):** A test in which the health care provider
inserts a lubricated, gloved finger into the rectum to feel for abnormal
areas.

**Fecal occult blood test (FOBT):** A test to check for small amounts of
hidden blood in stool.

**Grade:** A system for classifying cancer cells in terms of how
abnormal they appear under a microscope. The grading system provides
information about the probable growth rate of the tumor and its tendency
to spread. The systems used to grade tumors vary with each type of
cancer. Grading plays a role in treatment decisions.

**Invasive cervical cancer:** Cancer that has spread from the surface of
the cervix to tissue deeper in the cervix or to other parts of the body.

**Malignant:** Cancerous.

**Mammogram:** An x ray of the breast.

**Melanoma:** Cancer of the cells that produce pigment in the skin.

**Pap (Papanicolaou) test:** Microscopic examination of cells collected
from the cervix. The Pap test is used to detect cancer, changes in the
cervix that may lead to cancer, and noncancerous conditions, such as
infection or inflammation.

**PSA (prostate-specific antigen) test:** A test that measures the level
of an enzyme (PSA) in the blood that increases due to diseases of the
prostate gland, including prostate cancer.

**Risk factor:** Something that increases a person's chance of
developing a disease.

**Sigmoidoscopy:** A procedure in which the physician or health care
provider looks inside the rectum and the lower part of the colon
(sigmoid colon) through a flexible lighted tube. During the procedure,
the physician or health care provider may collect samples of tissues or
cells for closer examination.

**Squamous cells:** Flat cells that look like fish scales. These cells
are found in the tissue that forms the surface of the skin, the lining
of the hollow organs of the body, and the passages of the respiratory
and digestive tracts.

**Stage:** The size and extent of a cancer, including whether the
disease has spread from the original site into surrounding tissue and
other parts of the body.

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