# Presentation: 103832

## Healthy People 2010 Focus Area 3:CancerProgress ReviewAugust 17, 2006

## Status of Cancer Objectives

- Little or no change

**Status of Cancer Objectives**

***Infrastructure***

-  Overall cancer deaths             Cervical cancer deaths                   Prostate cancer deaths
-  Lung cancer deaths                Colorectal cancer deaths                Melanoma cancer deaths
-  Breast cancer deaths              Oropharyngeal cancer deaths        Cancer survival

***Mortality***

- Sun exposure and skin cancer (adolescents)      Sun exposure and skin cancer (adults)
- Provider counseling about cancer prevention      Provider counseling about physical activity
-                                               Provider counseling about  mammograms

***Cancer Prevention***

*   *Pap tests ever                                                          Colorectal cancer screening (FOBT)
-    Pap tests in past 3 years                                          Colorectal cancer screening
-    Mammograms 				          sigmoidoscopy

***Cancer Detection/Treatment***

- Improving

- Getting worse

- Baseline data only

- Target met

**Notes:**
No objective that can be assessed is moving in the wrong direction.

## Highlighted Objectives

**Overall cancer deaths**
**Lung cancer deaths**
**Breast cancer deaths**
**Colorectal cancer deaths**
**Sun exposure and skin cancer - adults**
**Pap smear - ever**
**Cancer survival**

**Highlighted Objectives**

***Getting worse/Little or no change***

**Pap smear within past three years**
**Colorectal cancer screening - FOBT**

***Developmental***

***Sun exposure and skin cancer - adolescents***

- Improving

- Getting worse

- Little or no change

- Baseline data only

- Target met

*Developmental*

**Colorectal cancer screening - sigmoidoscopy **
**Mammograms**

***Target met***

**Notes:**
No objective that can be assessed is moving in the wrong direction.

## Mortality and associated health behaviors

- Note: The  Black and white groups exclude persons of Hispanic origin.  Persons of Hispanic origin may be any race.
- SOURCE: National Vital Statistics System- Mortality, NCHS, CDC.

- SOURCES: National Vital Statistics System- Mortality, NCHS, CDC; National Health Interview Survey, NCHS, CDC; Youth Risk Behavior Survey, YRBS, CDC.

- Improving

- Getting worse

- Little or no change

- Baseline data only

- Target met

*Developmental*

|             Mortality | Prevention/Detection |
| --- | --- |
|    3-2.  Lung cancer deaths | 27-1.  Cigarette smoking (adults)
27-2.  Cigarette smoking (students) |
|    3-3.  Breast cancer deaths | 3-13.  Mammograms |
|    3-4.  Cervical cancer deaths | 3-11a. Pap test (ever)
3-11b. Pap test (past 3 years) |
|    3-5.  Colorectal cancer deaths | 3-12a. Fecal occult blood test (past 2 years)
3-12b. Sigmoidoscopy (ever) |
|    3-6.  Oropharyngeal deaths | Tobacco and Alcohol |
|    3-8.  Melanoma deaths | 3-9a. Sun safety behavior (students)
3-9b. Sun safety behavior (adults) |

## Overall cancer mortality,

**Overall cancer mortality,**
**by race and ethnicity**

**Age-adjusted rate per 100,000**

**1960**

**0**

**100**

**150**

**200**

**250**

**300**

**White**

**Black**

**Obj. 3-1**

**1950**

**1970**

**1980**

- Note: Data are age adjusted to the 2000 standard population. American Indian includes Alaska Native. Asian includes Pacific Islander. Persons of Hispanic origin may be any race. Only one race category could be recorded. Recording more than one race was not an option.
- SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

**Asian**

**Hispanic**

**American Indian**

**2010 Target**

**2003**

**1990**

**2000**

## Overall cancer mortality,

**Overall cancer mortality,**
**by race and ethnicity**

**Age-adjusted rate per 100,000**

**White**

**Black**

**Obj. 3-1**

- Note: Data are age adjusted to the 2000 standard population. American Indian includes Alaska Native. Asian includes Pacific Islander. Persons of Hispanic origin may be any race. Only one race category could be recorded. Recording more than one race was not an option.
- SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

**Asian**

**Hispanic**

**American Indian**

**1960**

**1950**

**1970**

**1980**

**2003**

**1990**

**2000**

**1000**

**10**

**2010 Target**

**100**

## Leading causes of cancer mortality,by gender, 2003

**Leading causes of cancer mortality,****by gender, 2003**

**Number of deaths**

_**Men**_
**Total = 287,990**

_**Women**_
**Total = 268,912**

**Lung**
**68,122**

**Breast**
**41,620**

**Colon/Rectum**
**27,951**

**Lymph/blood**
**25,603**

**Pancreas**
**15,717**

**Ovary**
**14,657**

**Other**
**75,242**

**Lung**
**    ****89,964**

**Lymph/ blood**
**30,076**

**Colon/Rectum**
**28,007**

**Prostate**
**29,554**

**Pancreas**
**15,060**

**Esophagus**
**9,921**

**Other**
**85,408**

- SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

## Lung cancer mortality,

**Asian**

**Lung cancer mortality,**
**by race and ethnicity**

**Age-adjusted rate per 100,000**

**0**

**10**

**20**

**30**

**White**

**Black**

**Hispanic**

**American Indian**

**Obj. 3-2**

**40**

- Note: Data are age adjusted to the 2000 standard population.  American Indian includes Alaska Native. Asian includes Pacific Islander.  Persons of Hispanic origin may be any race. Only one race category could be recorded. Recording more than one race was not an option.
- SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

**50**

**60**

**70**

**80**

**2010 Target**

**1960**

**1950**

**1970**

**1980**

**2003**

**1990**

**2000**

**Notes:**
From 1950 until 1980, whites had the highest breast cancer mortality rate.  However, since this point, blacks have had the highest breast cancer mortality rate.  Asians have the lowest breast cancer mortality rate.

 Since the mid to late 90s, the disparity among racial and ethnic groups has stagnated.

## Lung cancer mortality,

**Asian**

**Lung cancer mortality,**
**by race and ethnicity**

**Age-adjusted rate per 100,000 (log scale)**

**White**

**Black**

**Hispanic**

**American Indian**

**Obj. 3-2**

- Note: Data are age adjusted to the 2000 standard population.  American Indian includes Alaska Native. Asian includes Pacific Islander.  Persons of Hispanic origin may be any race. Only one race category could be recorded. Recording more than one race was not an option.
- SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

**1960**

**1950**

**1970**

**1980**

**2003**

**1990**

**2000**

**1**

**10**

**100**

**2010 Target**

**Notes:**
From 1950 until 1980, whites had the highest breast cancer mortality rate.  However, since this point, blacks have had the highest breast cancer mortality rate.  Asians have the lowest breast cancer mortality rate.

 Since the mid to late 90s, the disparity among racial and ethnic groups has stagnated.

## Lung cancer mortality, by gender

- Note: Data are age adjusted to the 2000 standard population.
- SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

**Lung cancer mortality, by gender**

**Age-adjusted rate per 100,000**

**Total**

**0**

**10**

**20**

**Obj. 3-2**

**Males**

**Females**

**30**

**40**

**50**

**60**

**70**

**80**

**90**

**100**

**2010 Target**

**1960**

**1950**

**1970**

**1980**

**2003**

**1990**

**2000**

## Lung cancer mortality, by gender

- Note: Data are age adjusted to the 2000 standard population.
- SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

**Lung cancer mortality, by gender**

**Age-adjusted rate per 100,000 (log scale)**

**Total**

**10**

**Obj. 3-2**

**Males**

**Females**

**100**

**1960**

**1950**

**1970**

**1980**

**2003**

**1990**

**2000**

**1**

**2010 Target**

## Female breast cancer mortality,

**Asian**

**Female breast cancer mortality,**
**by race and ethnicity**

**Age-adjusted rate per 100,000**

**0**

**5**

**10**

**20**

**25**

**30**

**35**

**White**

**Black**

**Hispanic**

**American Indian**

**Obj. 3-3**

**15**

**40**

- Note: Data are age adjusted to the 2000 standard population.  American Indian includes Alaska Native. Asian includes Pacific Islander. Persons of Hispanic origin may be any race. Only one race category could be recorded. Recording more than one race was not an option.
- SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

**45**

**2010 Target**

**1960**

**1950**

**1970**

**1980**

**2003**

**1990**

**2000**

**1995**

**Notes:**
From 1950 until 1980, whites had the highest breast cancer mortality rate.  However, since this point, blacks have had the highest breast cancer mortality rate.  Asians have the lowest breast cancer mortality rate.

 Since the mid to late 90s, the disparity among racial and ethnic groups has stagnated.

## Female breast cancer mortality, 

**Asian**

**Female breast cancer mortality, **
**by race and ethnicity**

**Age-adjusted rate per 100,000 (log scale)**

**10**

**White**

**Black**

**Hispanic**

**American Indian**

**Obj. 3-3**

- Note: Data are age adjusted to the 2000 standard population.  American Indian includes Alaska Native. Asian includes Pacific Islander. Persons of Hispanic origin may be any race. Only one race category could be recorded. Recording more than one race was not an option.
- SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

**100**

**1**

**1960**

**1950**

**1970**

**1980**

**2003**

**1990**

**2000**

**1995**

**2010 Target**

**Notes:**
From 1950 until 1980, whites had the highest breast cancer mortality rate.  However, since this point, blacks have had the highest breast cancer mortality rate.  Asians have the lowest breast cancer mortality rate.

 Since the mid to late 90s, the disparity among racial and ethnic groups has stagnated.

## Colorectal cancer mortality,

**Asian**

**Colorectal cancer mortality,**
**by race and ethnicity**

**Age-adjusted rate per 100,000**

**White**

**Black**

**Hispanic**

**American Indian**

**Obj. 3-5**

**35**

**0**

**5**

**10**

**20**

**25**

**30**

**15**

- Note: Data are age adjusted to the 2000 standard population.  American Indian includes Alaska Native. Asian includes Pacific Islander. Persons of Hispanic origin may be any race. Only one race category could be recorded. Recording more than one race was not an option.
- SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

**2010 Target**

**1960**

**1970**

**1980**

**2003**

**1990**

**2000**

## Colorectal cancer mortality,

**Asian**

**Colorectal cancer mortality,**
**by race and ethnicity**

**White**

**Black**

**Hispanic**

**American Indian**

**Obj. 3-5**

**10**

- Note: Data are age adjusted to the 2000 standard population.  American Indian includes Alaska Native. Asian includes Pacific Islander. Persons of Hispanic origin may be any race. Only one race category could be recorded. Recording more than one race was not an option.
- SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

**100**

**1**

**1960**

**1970**

**1980**

**2003**

**1990**

**2000**

**Age-adjusted rate per 100,000 (log scale)**

**2010 Target**

## Colorectal cancer mortality,

- Note: Data are age adjusted to the 2000 standard population.
- SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

**Obj. 3-1**

**2010 target: 13.7**

**Colorectal cancer mortality,**
**by Health Service Area, 1999-2003**

**Notes:**
Color groupings:
1 – top 10%
2 –  20%
3 – 40%
4 – 20%
5 – bottom 10%

## Sun safety behavior in adults and adolescents

**Age-adjusted percent**

**Adults**
**(18+)**

**2010 Target**

- Note: The  Black and white groups exclude persons of Hispanic origin.  Persons of Hispanic origin may be any race.
- SOURCE: National Vital Statistics System- Mortality, NCHS, CDC.

- Note: Sun safety behavior includes sunscreen use, wearing a hat, and wearing long-sleeved clothing.  Data are age adjusted to the 2000 standard population.  I = 95% confidence interval.
- SOURCES: National Health Interview Survey, NCHS, CDC; Youth Risk Behavior Survey, YRBS, CDC.

**Objs. 3-9a, 3-9b**

**2000**

**2005**

**2005**

**Students, grades 9-12**

******

****Developmental objective, target to be determined.**

## Adults who ever received a colorectal endoscopy or FOBT in the past 2 years, aged 50 years and older

**Asian**

** ****Age-adjusted percent**

**2000**

**2003**

**0**

**10**

**20**

**30**

**40**

**50**

**60**

**White**

**Black**

**Hispanic**

**70**

- Note: American Indian includes Alaska Native. The categories black and white exclude persons of Hispanic origin. Persons were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. Data for Native Hawaiian and other Pacific Islanders are statistically unreliable.
- SOURCE:  National Health Interview Survey, NCHS, CDC.

**2005**

**Adults who ever received a colorectal endoscopy or FOBT in the past 2 years, aged 50 years and older**

**American Indian**

**2 or more races**

**Notes:**
There has been a dramatic increase in mammography since the late 1980s.  Mammography screening went from 29 percent in 1987 to 70 percent in 2003, meeting the HP2010 target (70%).  However, during this time, disparity grew and has since leveled off since the late 1990s.  So, this is a situation in which all groups are moving in a positive direction, but the disparity has increased since when we started measuring mammography rates.

71 percent of both whites and blacks received a mammography in 2003. What is interesting is that although black and white women have a significant disparity in mortality, they have the same rates of mammography.  

Asians have the lowest screening, 58 percent in 2003---but they also have the lowest mortality rate.  It’s possible that their low screening may reflect a knowledge of their lower risk of breast cancer mortality.....or may also reflect a language barrier which prevents them from getting mammographies.

## Colorectal cancer screening,

**Age-adjusted percent**

**2000**

**2003**

**2010 Target- endoscopy**

**FOBT**

**0**

**20**

**30**

**50**

**Objs. 3-12a, 3-12b**

- Note: Data are age adjusted to the 2000 standard population.
- SOURCE: National Health Interview Survey, NCHS, CDC.

**Colorectal cancer screening,**
**aged 50 years and older**

**2005**

**10**

**40**

**60**

**Endoscopy**

**2010 Target- FOBT**

## Women receiving a mammogram within past 2 years, aged 40 years and older

**Asian**

**Women receiving a mammogram within past 2 years, aged 40 years and older**

**Percent**

**1987**

**2000**

**2003**

**0**

**10**

**20**

**30**

**40**

**50**

**60**

**White**

**Black**

**Hispanic**

**Obj. 3-13**

**1990**

**70**

**80**

- Note:  The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one race prior to 1999. For 1999 and later years, persons were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. Data for American Indian/Alaska Native, Native Hawaiian and other Pacific Islanders, and 2 or more races are statistically unreliable.
- SOURCE:  National Health Interview Survey, NCHS, CDC.

**1994**

**1998**

**2005**

**2010 Target**

**Notes:**
There has been a dramatic increase in mammography since the late 1980s.  Mammography screening went from 29 percent in 1987 to 70 percent in 2003, meeting the HP2010 target (70%).  However, during this time, disparity grew and has since leveled off since the late 1990s.  So, this is a situation in which all groups are moving in a positive direction, but the disparity has increased since when we started measuring mammography rates.

71 percent of both whites and blacks received a mammography in 2003. What is interesting is that although black and white women have a significant disparity in mortality, they have the same rates of mammography.  

Asians have the lowest screening, 58 percent in 2003---but they also have the lowest mortality rate.  It’s possible that their low screening may reflect a knowledge of their lower risk of breast cancer mortality.....or may also reflect a language barrier which prevents them from getting mammographies.

## Women receiving Pap test in past 3 years, aged 18 years and older

**Asian**

**Women receiving Pap test in past 3 years, aged 18 years and older**

**Percent**

**White**

**Black**

**Hispanic**

**American Indian**

**Obj. 3-11b**

**0**

**10**

**20**

**30**

**40**

**50**

**60**

**70**

**80**

**90**

**100**

**1987**

**2000**

**2003**

**1990**

**1994**

**1998**

**2005**

- Note: American Indian includes Alaska Native.  The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one race prior to 1999. For 1999 and later years, persons were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. Data for Native Hawaiian and other Pacific Islanders, and 2 or more races are statistically unreliable.
- SOURCE:  National Health Interview Survey, NCHS, CDC.

**2010 Target**

**Tota****l**

**Cervical cancer mortality**

**Age-adjusted rate per 100,000**

- Note: Data are age adjusted to the 2000 standard population.
- SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

**2010 Target**

## Early cancer detection procedures,by family income level, 2005

**Age-adjusted percent**

**Mammogram (past 2 years):**
**Females 40+**

**Pap test **
**(past 3 years):**
**Females 18+**

**Fecal occult blood test **
**(past 2 years):**
**Adults 50+**

**Colorectal endoscopy exam* (ever):**
**Adults 50+**

**Poor**

**Near poor**

**Middle/High**

- *Includes sigmoidoscopy, colonoscopy, and proctoscopy  Note: Data are age adjusted to the 2000 standard population.  Poor includes those below the Federal poverty level, Near poor includes those 100-199% of the Federal poverty level, and Middle/high income includes those 200% or more of the Federal poverty level.
- SOURCE: National Health Interview Survey, CDC, NCHS.

**Objs. 3-13, 3-11b, 3-12a, 3-12b**

## http://www.cdc.gov/nchs/hphome.htm

**Progress review data and slides**
**are available on the web at:**

**http://www.cdc.gov/nchs/hphome.htm**