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

# Cancer

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

3-9a Adolescents in grades 9-12

3-9b Adults aged 18 years and older

3-10 Provider counseling about cancer prevention

3-10a Internists---smoking cessation

3-10b Family physicians---smoking cessation

3-10c Dentists---smoking cessation

3-10d Primary care providers---blood stool tests

3-10e Primary care providers---proctoscopic examinations

3-10f Primary care providers---mammograms

3-10g Primary care providers---Pap tests

3-10h Primary care providers---physical activity

3-11 Pap tests

3-11a Ever received a Pap test

3-11b Received a Pap test within the preceding 3 years

3-12 Colorectal cancer screening

3-12a Fecal occult blood test

3-12b Sigmoidoscopy

3-13 Mammograms

3-14 Statewide cancer registries

3-15 Cancer survival

  -----------------------------------------------------------------------
  3-1. Reduce the        
  overall cancer death   
  rate.                  
  ---------------------- ------------------------------------------------
  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  16.1 (Cancer) (also 2.2), age adjusted to the
  Objective**            2000 standard population.

  **Measure**            Rate per 100,000 population (age adjusted---see
                         Comments).

  **Baseline**           202.4 (1998).

  **Numerator**          Number of deaths due to cancer (ICD-9 codes
                         140-208).

  **Denominator**        Number of persons.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Data are age adjusted to the 2000 standard
                         population. Age-adjusted rates are weighted sums
                         of age-specific rates. For a discussion on age
                         adjustment, see Part A, section 5.

                         This objective differs from Healthy People 2000
                         objective 16.1, which age adjusted the death
                         rates using the 1940 standard population. See
                         Appendix C for comparison data.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-2. Reduce the lung   
  cancer death rate.     
  ---------------------- ------------------------------------------------
  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Adapted from 16.2 (Cancer) (also 3.2).
  Objective**            

  **Measure**            Rate per 100,000 population (age adjusted---see
                         Comments).

  **Baseline**           57.6 (1998).

  **Numerator**          Number of deaths due to lung cancer (ICD-9 code
                         162).

  **Denominator**        Number of persons.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Data are age adjusted to the 2000 standard
                         population. Age-adjusted rates are weighted sums
                         of age-specific rates. For a discussion on age
                         adjustment, see Part A, section 5.

                         This objective is measured with slightly
                         different ICD-9 codes from those used to measure
                         the comparable Healthy People 2000 objective
                         16.2 (ICD-9 code 162 vs. 162.2-162.9).
                         Additionally, the Healthy People 2000 objective
                         age adjusted the death rates using the 1940
                         standard population. See Appendix C for
                         comparison data.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-3. Reduce the breast 
  cancer death rate.     
  ---------------------- ------------------------------------------------
  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  16.3 (Cancer), age adjusted to the 2000 standard
  Objective**            population.

  **Measure**            Rate per 100,000 female population (age
                         adjusted---see Comments).

  **Baseline**           27.9 (1998).

  **Numerator**          Number of female deaths due to breast cancer
                         (ICD-9 code 174).

  **Denominator**        Number of females.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Data are age adjusted to the 2000 standard
                         population. Age-adjusted rates are weighted sums
                         of age-specific rates. For a discussion on age
                         adjustment, see Part A, section 5.

                         This objective differs from Healthy People 2000
                         objective 16.3, which age adjusted the death
                         rates using the 1940 standard population. See
                         Appendix C for comparison data.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-4. Reduce the death  
  rate from cancer of    
  the uterine cervix.    
  ---------------------- ------------------------------------------------
  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  16.4 (Cancer), age adjusted to the 2000 standard
  Objective**            population.

  **Measure**            Rate per 100,000 female population (age
                         adjusted---see Comments).

  **Baseline**           3.0 (1998).

  **Numerator**          Number of female deaths due to cancer of the
                         uterine cervix (ICD-9 code 180).

  **Denominator**        Number of females.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Data are age adjusted to the 2000 standard
                         population. Age-adjusted rates are weighted sums
                         of age-specific rates. For a discussion on age
                         adjustment, see Part A, section 5.

                         This objective differs from Healthy People 2000
                         objective 16.4, which age adjusted the death
                         rates using the 1940 standard population. See
                         Appendix C for comparison data.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-5. Reduce the        
  colorectal cancer      
  death rate.            
  ---------------------- ------------------------------------------------
  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Adapted from 16.5 (Cancer) (also 2.23).
  Objective**            

  **Measure**            Rate per 100,000 population (age adjusted---see
                         Comments).

  **Baseline**           21.2 (1998).

  **Numerator**          Number of deaths due to colorectal cancer (ICD-9
                         codes 153, 154).

  **Denominator**        Number of persons.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Data are age adjusted to the 2000 standard
                         population. Age-adjusted rates are weighted sums
                         of age-specific rates. For a discussion on age
                         adjustment, see Part A, section 5.

                         This objective is measured with slightly
                         different ICD-9 codes from those used to measure
                         the comparable Healthy People 2000 objective
                         16.5 (ICD-9 codes 153.0-154.3, 154.8, 159.0).
                         Additionally, the Healthy People 2000 objective
                         age adjusted the death rates using the 1940
                         standard population. See Appendix C for
                         comparison data.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-6. Reduce the        
  oropharyngeal cancer   
  death rate.            
  ---------------------- ------------------------------------------------
  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Adapted from 13.7 (Oral Health) (also 3.17 and
  Objective**            16.17).

  **Measure**            Rate per 100,000 population (age adjusted---see
                         Comments).

  **Baseline**           3.0 (1998).

  **Numerator**          Number of deaths due to oropharyngeal cancer
                         (ICD-9 codes 140-149).

  **Denominator**        Number of persons.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Data are age adjusted to the 2000 standard
                         population. Age-adjusted rates are weighted sums
                         of age-specific rates. For a discussion on age
                         adjustment, see Part A, section 5.

                         This objective differs from Healthy People 2000
                         objective 16.17, which age adjusted the death
                         rates using the 1940 standard population.
                         Additionally, the Healthy People 2010 objective
                         targets the total population while the Healthy
                         People 2000 objective targeted only persons 45
                         to 74 years. See Appendix C for comparison data.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-7. Reduce the        
  prostate cancer death  
  rate.                  
  ---------------------- ------------------------------------------------
  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 100,000 male population (age
                         adjusted---see Comments).

  **Baseline**           32.0 (1998).

  **Numerator**          Number of male deaths due to prostate cancer
                         (ICD-9 code 185).

  **Denominator**        Number of males.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Data are age adjusted to the 2000 standard
                         population. Age-adjusted rates are weighted sums
                         of age-specific rates. For a discussion on age
                         adjustment, see Part A, section 5.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-8. Reduce the rate   
  of melanoma cancer     
  deaths.                
  ---------------------- ------------------------------------------------
  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 100,000 population (age adjusted---see
                         Comments).

  **Baseline**           2.8 (1998).

  **Numerator**          Number of deaths due to melanoma cancer (ICD-9
                         code 172).

  **Denominator**        Number of persons.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Data are age adjusted to the 2000 standard
                         population. Age-adjusted rates are weighted sums
                         of age-specific rates. For a discussion on age
                         adjustment, see Part A, section 5.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

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.           
  ---------------------- ------------------------------------------------
  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The Youth Risk Behavior Surveillance System
                         (YRBSS), CDC, NCCDPHP, is a proposed data source
                         for this objective.

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

+---------------------+------------------------------------------------+
| 3-9b. Increase the  |                                                |
| proportion of       |                                                |
| adults aged 18      |                                                |
| years and older who |                                                |
| follow protective   |                                                |
| measures that may   |                                                |
| reduce the risk of  |                                                |
| skin cancer.        |                                                |
+=====================+================================================+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 16.9 (Cancer).                    |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 47 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 18 years and older who   |
|                     | report that they are very likely to limit sun  |
|                     | exposure, use sunscreen, or wear protective    |
|                     | clothing.                                      |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 18 years and older.      |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   If you were to go outside on a very sunny  |
|                     |     day for MORE than one hour, are you very   |
|                     |     likely, somewhat likely, or unlikely to    |
|                     |     wear protective clothing such as wide      |
|                     |     brimmed hats or long sleeved shirts?       |
+---------------------+------------------------------------------------+
|                     | -   If you were to go outside on a very sunny  |
|                     |     day for MORE than one hour, are you very   |
|                     |     likely, somewhat likely, or unlikely to    |
|                     |     avoid the sun by staying in the shade?     |
+---------------------+------------------------------------------------+
|                     | -   If you were to go outside on a very sunny  |
|                     |     day for MORE than one hour, are you very   |
|                     |     likely, somewhat likely, or unlikely to    |
|                     |     use sunscreen or sun block lotion?         |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | For this objective, a person is defined as     |
|                     | following protective measures if the person    |
|                     | answers "very likely" to one or more of the    |
|                     | questions listed above.                        |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion of age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | Although similar questions are used to measure |
|                     | this objective and the comparable Healthy      |
|                     | People 2000 objective 16.9, the data for the   |
|                     | Healthy People 2010 objective are age adjusted |
|                     | while data for the Healthy People 2000         |
|                     | objective are unadjusted rates. Additionally,  |
|                     | the Healthy People 2010 objective combines the |
|                     | data from the three questions into one measure |
|                     | while the Healthy People 2000 objective        |
|                     | considered them individually.                  |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | BRFSS, and Appendix A for focus area contact   |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

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

  -----------------------------------------------------------------------
  3-10a. Internists who  
  counsel about smoking  
  cessation.             
  ---------------------- ------------------------------------------------
  **Comments**           A complete operational definition was not
                         specified at the time of publication.

                         This objective is adapted from Healthy People
                         2000 objectives 16.10 and 3.16.

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-10b. Family          
  physicians who counsel 
  about smoking          
  cessation.             
  ---------------------- ------------------------------------------------
  **Comments**           A complete operational definition was not
                         specified at the time of publication.

                         This objective is adapted from Healthy People
                         2000 objectives 16.10 and 3.16.

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-10c. Dentists who    
  counsel about smoking  
  cessation.             
  ---------------------- ------------------------------------------------
  **Comments**           A complete operational definition was not
                         specified at the time of publication.

                         This objective is adapted from Healthy People
                         2000 objectives 16.10 and 3.16.

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-10d. Primary care    
  providers who counsel  
  about blood stool      
  tests.                 
  ---------------------- ------------------------------------------------
  **Comments**           A complete operational definition was not
                         specified at the time of publication.

                         This objective is adapted from Healthy People
                         2000 objective 16.10.

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-10e. Primary care    
  providers who counsel  
  about proctoscopic     
  examinations.          
  ---------------------- ------------------------------------------------
  **Comments**           A complete operational definition was not
                         specified at the time of publication.

                         This objective is adapted from Healthy People
                         2000 objective 16.10.

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-10f. Primary care    
  providers who counsel  
  about mammograms.      
  ---------------------- ------------------------------------------------
  **Comments**           A complete operational definition was not
                         specified at the time of publication.

                         This objective is adapted from Healthy People
                         2000 objective 16.10.

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-10g. Primary care    
  providers who counsel  
  about Pap tests.       
  ---------------------- ------------------------------------------------
  **Comments**           A complete operational definition was not
                         specified at the time of publication.

                         This objective is adapted from Healthy People
                         2000 objective 16.10.

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-10h. Primary care    
  providers who counsel  
  about physical         
  activity.              
  ---------------------- ------------------------------------------------
  **Comments**           A complete operational definition was not
                         specified at the time of publication.

                         This objective is adapted from Healthy People
                         2000 objective 16.10.

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

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

+---------------------+------------------------------------------------+
| 3-11a. Women aged   |                                                |
| 18 years and older  |                                                |
| who have ever       |                                                |
| received a Pap      |                                                |
| test.               |                                                |
+=====================+================================================+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | 16.12 (Cancer), age adjusted to the 2000       |
| 2000 Objective**    | standard population.                           |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 92 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of women aged 18 years and older who    |
|                     | report ever receiving a Pap test.              |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of women aged 18 years and older.       |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Have you ever had a pap smear test?        |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Data include women without a uterine cervix.   |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion of age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | BRFSS, and Appendix A for focus area contact   |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

+---------------------+------------------------------------------------+
| 3-11b. Women aged   |                                                |
| 18 years and older  |                                                |
| who received a Pap  |                                                |
| test within the     |                                                |
| preceding 3 years.  |                                                |
+=====================+================================================+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | 16.12 (Cancer), age adjusted to the 2000       |
| 2000 Objective**    | standard population.                           |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 79 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of women aged 18 years and older who    |
|                     | report receiving a Pap test within the past 3  |
|                     | years.                                         |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of women aged 18 years and older.       |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Have you ever had a pap smear test?        |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   When did you have your most recent pap     |
|                     |     smear test? Was it a year ago or less,     |
|                     |     more than 1 year but not more than two     |
|                     |     years, more than two years but not more    |
|                     |     than three years, more than three years    |
|                     |     but not more than five years, or over 5    |
|                     |     years ago?                                 |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Data include women without a uterine cervix.   |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion of age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | BRFSS, and Appendix A for focus area contact   |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

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

+---------------------+------------------------------------------------+
| 3-12a. Adults aged  |                                                |
| 50 years and older  |                                                |
| who have received a |                                                |
| fecal occult blood  |                                                |
| test (FOBT) within  |                                                |
| the preceding 2     |                                                |
| years.              |                                                |
+=====================+================================================+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | 16.13 (Cancer), age adjusted to the 2000       |
| 2000 Objective**    | standard population.                           |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 35 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 50 years and older who   |
|                     | report receiving fecal occult blood testing    |
|                     | within the preceding 2 years.                  |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 50 years and older.      |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   A blood stool test is when the stool is    |
|                     |     examined to determine whether it contains  |
|                     |     blood. Have you ever had a blood stool     |
|                     |     test?                                      |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   When did you have your most recent blood   |
|                     |     stool test? Was it a year ago or less,     |
|                     |     more than 1 but not more than 2 years,     |
|                     |     more than 2 years but not more than 3      |
|                     |     years, more than 3 years but not more than |
|                     |     5 years, or more than 5 years ago?         |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A fecal occult blood test (FOBT) is referred   |
|                     | to as a blood stool tests in the NHIS.         |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion of age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | BRFSS, and Appendix A for focus area contact   |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

+---------------------+------------------------------------------------+
| 3-12b. Adults aged  |                                                |
| 50 years and older  |                                                |
| who have ever       |                                                |
| received a          |                                                |
| sigmoidoscopy.      |                                                |
+=====================+================================================+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | 16.13 (Cancer), age adjusted to the 2000       |
| 2000 Objective**    | standard population.                           |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 37 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 50 years and older who   |
|                     | report ever receiving a sigmoidoscopy.         |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 50 years and older.      |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   A proctoscopic examination is when a tube  |
|                     |     is inserted in the rectum to check for     |
|                     |     problems. Have you ever had a proctoscopic |
|                     |     examination?                               |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A sigmoidoscopy is referred to as a            |
|                     | proctoscopic examination in NHIS.              |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion of age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | BRFSS, and Appendix A for focus area contact   |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

+---------------------+------------------------------------------------+
| 3-13. Increase the  |                                                |
| proportion of women |                                                |
| aged 40 years and   |                                                |
| older who have      |                                                |
| received a          |                                                |
| mammogram within    |                                                |
| the preceding 2     |                                                |
| years.              |                                                |
+=====================+================================================+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 16.11 (Cancer).                   |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 67 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of women aged 40 years and older who    |
|                     | report receiving a mammogram within the past 2 |
|                     | years.                                         |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of women aged 40 years and older.       |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   A mammogram is an x-ray taken only of the  |
|                     |     breasts by a machine that presses the      |
|                     |     breast against a plate. Have you ever had  |
|                     |     a mammogram?                               |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   When did you have your most recent         |
|                     |     mammogram? Was it a year ago or less, more |
|                     |     than 1 year but not more than 2 years,     |
|                     |     more than 2 years but not more than 3      |
|                     |     years, more than 3 years but not more than |
|                     |     5 years, or over 5 years ago?              |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion of age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | Although similar questions are used to measure |
|                     | this objective and the comparable Healthy      |
|                     | People 2000 objective 16.11, the Healthy       |
|                     | People 2010 focuses solely on mammograms       |
|                     | received by women 40 years and older while the |
|                     | Healthy People 2000 objective measured women   |
|                     | 50 years and older who received both           |
|                     | mammograms and clinical breast examinations    |
|                     | by. Additionally, the data for the Healthy     |
|                     | People 2010 objective are age adjusted while   |
|                     | data for the Healthy People 2000 objective are |
|                     | unadjusted rates.                              |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | BRFSS, and Appendix A for focus area contact   |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

  -----------------------------------------------------------------------
  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.    
  ---------------------- ------------------------------------------------
  **National Data        National Program of Cancer Registries (NPCR),
  Source**               CDC, NCI.

  **State Data Source**  National Program of Cancer Registries (NPCR),
                         CDC, NCI.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Number of States and the District of Columbia.

  **Baseline**           21 (1999) (selected areas---see Comments).

  **Numerator**          Number of States not covered by the SEER program
                         that capture information on at least 95 percent
                         of the expected number of malignant cases
                         occurring in State residents each diagnosis
                         year.

  **Denominator**        Not applicable.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           For the purpose of reporting to state
                         registries, a diagnosis year is the date of
                         initial diagnosis by a recognized medical
                         practitioner for the tumor being reported.

                         The NPCR provides funds to 45 States, 3
                         territories, and the District of Columbia 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 Surveillance,
                         Epidemiology, and End Results Program (SEER)
                         covers the remaining five States.

                         NPCR supported registries are expected to meet
                         CDC data standards, as well as incorporate
                         standards for data quality and format as
                         described by the North American Association of
                         Cancer Registries. Additional information on the
                         standards for completeness, accuracy, and
                         timeliness of central registry reporting, can be
                         found at the following Web site:
                         http://www.cdc.gov/cancer/.

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  3-15. Increase the     
  proportion of cancer   
  survivors who are      
  living 5 years or      
  longer after           
  diagnosis.             
  ---------------------- ------------------------------------------------
  **National Data        Surveillance, Epidemiology, and End Results
  Source**               Program (SEER), NIH, NCI.

  **State Data Source**  Surveillance, Epidemiology, and End Results
                         Program (SEER), NIH, NCI.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent.

  **Baseline**           59 (1989--95) (selected areas---see Comments).

  **Numerator**          5-year observed survival rate.

  **Denominator**        5-year expected survival rate.

  **Population           Resident cancer survivors (selected areas---see
  Targeted**             Comments).

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           This measure is tracked with a calculation
                         commonly referred to as the relative survival
                         rate.

                         The relative survival rate is calculated using a
                         procedure whereby the observed survival rate is
                         adjusted for expected mortality. The relative
                         survival rate represents the likelihood that a
                         patient will not die from causes associated
                         specifically with the given cancer before some
                         specified time (usually 5 years) after
                         diagnosis.

                         To calculate the relative survival rate, the
                         observed survival rate is divided by the
                         expected survival rate. The observed survival
                         rate is based on all causes of death---no one is
                         excluded except for those lost to followup. The
                         expected survival rate is based on lifetables of
                         surviving 1 year in the general population based
                         on age (single year), race, sex, and year (1970,
                         1980, 1990) of the cohort of cancer patients.
                         This calculation is used so that one does not
                         have to depend on the accuracy and completeness
                         of the cause of death information in order to
                         calculate the effect of the cancer.

                         Survival rates are from the SEER program. They
                         are based of data from population-based
                         registries in Connecticut, New Mexico, Utah,
                         Iowa, Hawaii, Atlanta, GA, Detroit, Michigan,
                         Seattle-Puget Sound, WA, and San
                         Francisco-Oakland, CA. The 1989--95 survival
                         rates used in the baseline are based on patient
                         followup through 1996.

                         Additional information on the SEER program can
                         be found at the following Web site:
                         http://www.seer.ims.nci.nih.gov/.

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  