U.S. Predicted Cancer Incidence, 1999:

Complete Maps by County and State

From Spatial Projection Models

This publication was prepared by:

Linda Williams Pickle, Ph.D.

Eric J. Feuer, Ph.D.

Brenda K. Edwards, Ph.D.

Surveillance Research Program

Division of Cancer Control and Population Sciences

National Cancer Institute

6116 Executive Blvd., Suite 504

Bethesda, Maryland 20892-8317

Fax: 301-480-2046

Suggested citation for the monograph:

Pickle LW, Feuer EJ, Edwards BK. U.S. Predicted Cancer Incidence, 1999: Complete Maps by County and

State From Spatial Projection Models. NCI Cancer Surveillance Monograph Series, Number 5. Bethesda,

MD: National Cancer Institute, 2003. NIH Publication No. 03-5435.

This publication is available on the SEER web site: http://srab.cancer.gov/incidence

Copyright information:

All material in this report is in the public domain and may be reproduced or copied without

permission; citation as to source, however, is appreciated.

Acknowledgments

The author wishes to thank the staff at IMS, Inc., for computer support, particularly Timothy McNeel

and Mike Barrett, and Marsha Reichman and B. Sue Bell of NCI for their thoughtful comments that

clarified the presentation. The advice of Bradley Carlin, University of Minnesota, greatly shortened

the time needed to implement the hierarchical models. Thanks also to Jim Pearson for insightful

discussions and novel ideas for the graphs and tables. The designs of the micromap plots and maps

are the result of ongoing collaborations with Daniel Carr, George Mason University, and Cynthia

Brewer and Alan MacEachren, The Pennsylvania State University Department of Geography.

Acknowledgements

Table of Contents

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Statistical Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Graphical Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Reader’s Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

State Maps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

County Maps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Micromap Plots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

State Maps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

County Maps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Tables

Table 1. Predicted Number of New Cancer Cases by Type of Cancer and State, Males, 1999 . . . . . . . 16

Table 2. Predicted Number of New Cancer Cases by Type of Cancer and State, Females, 1999 . . . . . 18

Table 3. Predicted Cancer Incidence Rates by Type of Cancer and State, Males, 1999 . . . . . . . . . . . . . 20

Table of Contents
Table 4. Predicted Cancer Incidence Rates by Type of Cancer and State, Females, 1999 . . . . . . . . . . . 22

State Maps

Predicted Cancer Incidence Rates and Observed Mortality Rates by Type of Cancer and State, Males,

1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Predicted Cancer Incidence Rates and Observed Mortality Rates by Type of Cancer and State, Females,

1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Predicted Cancer Incidence Rates by Type of Cancer and State, Males and Females, 1999 . . . . . . . . . 26

Predicted Cancer Incidence Rates Relative to the U.S. Rate by Type of Cancer and State, Males and

Females, 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

County Maps

Smoothed Predicted Lung Cancer Incidence Rates by County, Males and Females, 1999 . . . . . . . . . . 28

Smoothed Predicted Colorectal Cancer Incidence Rates by County, Males and Females, 1999 . . . . . 29

Smoothed Predicted Prostate Cancer Incidence Rates by County, Males, 1999 . . . . . . . . . . . . . . . . . . . 30

Smoothed Predicted Breast Cancer Incidence Rates by County, Females, 1999 . . . . . . . . . . . . . . . . . . . 31

Smoothed Predicted Other Cancer Incidence Rates by County, Males and Females, 1999 . . . . . . . . . 32

Smoothed Predicted Total Cancer Incidence Rates by County, Males and Females, 1999 . . . . . . . . . . 33

Micromap Plots

Predicted Lung Cancer Incidence Rates and Counts by State, Males, 1999 . . . . . . . . . . . . . . . . . . . . . . . 34

Predicted Lung Cancer Incidence Rates and Counts by State, Females, 1999 . . . . . . . . . . . . . . . . . . . . . 35

Predicted Colorectal Cancer Incidence Rates and Counts by State, Males, 1999 . . . . . . . . . . . . . . . . . . 36

Predicted Colorectal Cancer Incidence Rates and Counts by State, Females, 1999 . . . . . . . . . . . . . . . . 37

Predicted Prostate Cancer Incidence Rates and Counts by State, Males, 1999 . . . . . . . . . . . . . . . . . . . . 38

Predicted Breast Cancer Incidence Rates and Counts by State, Females, 1999 . . . . . . . . . . . . . . . . . . . . 39

Predicted Other Cancer Incidence Rates and Counts by State, Males, 1999 . . . . . . . . . . . . . . . . . . . . . . 40

Predicted Other Cancer Incidence Rates and Counts by State, Females, 1999 . . . . . . . . . . . . . . . . . . . . 41

Predicted Total Cancer Incidence Rates and Counts by State, Males, 1999 . . . . . . . . . . . . . . . . . . . . . . . 42

Predicted Total Cancer Incidence Rates and Counts by State, Females, 1999 . . . . . . . . . . . . . . . . . . . . . 43
While NCI has published U.S. cancer mortality maps since 1974, this monograph presents, for the

first time, state- and county-level maps of estimated cancer incidence. These estimates are based on a

statistical modeling of county-level demographic and lifestyle characteristics, in addition to data from

the Surveillance, Epidemiology, and End Results (SEER) Program. This new ability to map both

incidence and mortality enables us to explore issues including survival and effects of screening. Data

are included for total cancers; for the four most frequent cancers—lung and bronchus, colon and

rectum, prostate, and breast; and for all other cancer sites combined.

The maps presented here represent a qualitative advance in their use of state- and county-level

sociodemographic and lifestyle data for estimation. Previous estimates of cancer incidence by state

have assumed that the ratio of each state’s incidence to mortality is the same as that found for the

combined SEER registries, an assumption we know is not justified in all cases. 

These data fill gaps where state cancer registries have not yet reached the level of complete

reporting required for inclusion in the United States Cancer Statistics (USCS). However, rapid progress

is being made toward that goal, but even after it is reached these data will prove valuable on both

national and state levels.

From a national perspective, the maps included in this monograph allow examination of the

geographic distribution of cancer incidence across the country and of the magnitude of differences

among states. They show higher predicted incidence rates for lung cancer in states in the Southeast,

for colorectal cancer in midwestern states, and for all cancers combined in northeastern states. 

A greater range of predicted incidence rates among states is observed for lung and colorectal cancers

than for other cancers. 

Smoothed maps of county-level incidence allow us to see the differences among geographic

regions other than by state only. This is important because using administrative boundaries, such as

state borders, may not be the most accurate or meaningful method of tabulating differences in cancer

rates. For example, the high predicted female lung cancer incidence rates for counties along the

northern Pacific coast are clearly visible in smoothed county maps. Smoothed county-level maps of

cancer incidence may also allow correlation with geologic data or environmental data of other types.

County-level maps may allow those with community-level knowledge to see correlations between

local conditions and cancer incidence patterns.

Foreword

Foreword
From the perspective of individual states, these data offer the ability to utilize county-level data

to provide estimates of the numbers of new cancer cases expected at the beginning of the data

collection year. Importantly, this will allow cancer control specialists to target interventions to specific

areas by using these data in conjunction with information from various state programs (e.g.,

screening and early detection) and with demographic characteristics including income, race/ethnicity,

medical insurance, etc. These data are also useful for quality control both for states that are in the

process of improving their cancer registries and for states where the variation in cancer incidence

from the national levels is sufficiently great that predictions are needed that emphasize local

conditions rather than the national average.

We hope that the presentation of this data will excite and stimulate researchers and those

involved in cancer surveillance, control, and prevention activities to utilize this novel approach to

further reduce the cancer burden in America.

Robert T. Croyle, Ph.D.

Director

Division of Cancer Control and Population

Sciences

National Cancer Institute

National Institutes of Health

2
The primary source of information about cancer

incidence in the United States for the past 30

years has been the Surveillance, Epidemiology,

and End Results (SEER) program of the National

Cancer Institute (NCI) (see http://seer.cancer.gov).

With the most recent expansion of the SEER

Program, these population-based cancer

registries now cover approximately 26% of the

U.S. population. However, even in combination

with high-quality registries from additional

states funded by the CDC National Program for

Cancer Registries (NPCR), gaps in the collection

of data prevent the calculation of cancer

incidence statistics for many states, for regions,

and for the U.S. as a whole (USCS 2002). In this

report, we present the results of a statistical

model that predicts the number of new cases

and incidence rates for the major types of

cancer for every U.S. state and county.

Estimates of the numbers of new cancer

cases and rates expected in an area are useful for

cancer surveillance, cancer control, health

resource planning, and quality control activities.

Geographic targeting of cancer-related activities

to local areas with the most need has been

shown to greatly improve their effectiveness

(Kerner et al. 1988). For example, scarce health

department resources for cancer prevention

programs can be allocated to locations of the

greatest need. In addition, with more accurate

estimates of expected cases, the cancer registrar

can monitor the cumulative number of cases

found throughout the year to judge the degree

of completeness of data collection and to

identify locations with unexpectedly high

counts that may require further investigation.

This independent source of expected case counts

can also provide an objective means of deriving

a completeness index for certification purposes

(Tucker and Howe 2001). Finally, by providing a

complete set of predicted rates for each state

and region, state registries may compare their

cancer experience with that of neighboring

states.

Currently, the only source of complete

estimates of expected case counts and rates by

state is the American Cancer Society’s annual

report Cancer Facts and Figures (ACS 2003). These

figures are the result of both spatial and

temporal projections. For each year, they

compute the estimated number of new cancer

cases and rates for each state using the cancer

incidence rates and cancer incidence-mortality

ratios aggregated across all SEER registries and

each state’s mortality and population for that

year (Wingo et al. 1998). Then these state

estimates are projected ahead in time several

years using a time series model to provide a set

of expected numbers for the next calendar year.

This method has the potential for improvement,

particularly for cancers whose rates vary by

geographic area. 

3

Introduction

Introduction
The results presented here are computed by

a spatial projection model that predicts the

number of cases in each county based on the

sociodemographic and lifestyle profile for that

county. The utility of this approach was

demonstrated by an analysis of SEER breast

cancer incidence using similar methods with a

simpler model (Frey et al. 1993). By the

inclusion of these additional cancer risk factors

and by allowing the cancer rates to vary by

geographic area, these results should form a

better basis for the temporal projection of state

data. We are currently working to extend this

method to project these spatial estimates ahead

in time to provide state estimates for the

upcoming calendar year. Collaborations are

underway with the ACS to incorporate these

improvements into their annual report.

The purpose of this report is to present

complete county and state maps and tables of

rates and case counts for 1999 estimated by

these new statistical models. Numbers of cases

and rates are shown with and without

adjustment for reporting delay (Clegg et al.

2002) and figures reported in the recently

published United States Cancer Statistics: 1999

Incidence are shown for comparison (USCS

2002). Differences between the predicted cancer

incidence figures and those reported in USCS

cannot be ascribed to any particular source

without further exploration, and we urge

readers to take a systematic approach in

exploring them. This monograph demonstrates

that this new method can successfully be used

to predict cancer incidence. Not only can this

method fill in the current gaps in cancer data

collection, but even when all U.S. states collect

their own cancer data, it can provide a baseline

expectation for the cancer incidence in each

state for the coming year.

4
Data Sources

Numbers of cases of cancer reported as first

diagnosed during 1999 and reported to the NCI

by the SEER cancer registries on November 1,

2001, were stratified by sex, race (white, black,

other), age group (0–4, 5–14, 15–24, ..., 75–84,

85+) and county. Cancers of the lung and

bronchus, colon and rectum, female breast, and

prostate were analyzed separately; all other types

of cancer were grouped together for analysis (for

International Classification of Disease codes for

these sites, see http://seer.cancer.gov/

siterecode/icdo2_d04152002). Statistics for all

cancers combined are the aggregation of these

five cancer groups. Only malignant tumors were

included; in situ and other benign tumors were

excluded. These incidence data were available

for the 480 counties included in the SEER

Program in 1999, including 10 rural counties in

Georgia and the first SEER data submission by

the registries in Greater California, Kentucky,

New Jersey, and Louisiana.

The numbers of deaths that occurred in

1999 were provided by the National Center for

Health Statistics. Mortality was available for all

3074 U.S. counties, stratified by county, sex,

race, age, and underlying cause of death.

Stratified rates for death due to lung and

bronchus, colorectal, breast, prostate, and other

cancer were used as predictors of incidence for

those cancers. 

Population intercensal estimates for 1999,

modified after the 2000 Census, were provided

by the Census Bureau (see http://seer.cancer.gov/

popdata/methods.pdf and http://www.

cancer.gov/newscenter/pressreleases/

Census2000). These counts were stratified in the

same way as the incidence and mortality counts

above. 

Sociodemographic variables constructed for

each county from the Area Resource File (Bureau

of Health Professions 1999) and Census data

(GeoLytics Inc. 1998) included urban/rural

status (Butler and Beale 1994), household

characteristics, income, education, occupation,

medical facilities, and the percentage

distribution of the population by race and

ethnicity. The percentages of state and county

residents who ever smoked cigarettes (males and

females separately), who were at risk of obesity,

who had no health care coverage, and female

residents aged 50–64 who had had a

mammogram in the last two years were lifestyle

covariates calculated by aggregating public-use

data for 1992–1998 from the CDC Behavioral

Risk Factor Surveillance System (BRFSS) surveys

(see http://www.cdc.gov/brfss; Pickle and Su

2002) at the state and county level. Age and race

were available for each individual case but were

grouped into the strata defined above for

computational convenience. Geographic units

for the analysis were county, state, and Census

Region (Northeast, South, Midwest, West).

5

Methods

Methods
Statistical Methods

A hierarchical Poisson regression model was

used to estimate the number of cases for all U.S.

counties by their demographic and lifestyle

profiles, based on the association of these

profiles with cancer occurrence in the SEER

counties. Specifically, the number of new cancer

cases in county i (i = 1,...,3074), age group j

(j = 1,...,10), denoted dij, was assumed to be

distributed as a Poisson random variable, with

mean nijλij where nij is the corresponding

population at risk and λij is the incidence rate in

county i, age group j. We assumed a log-linear

rate structure, i.e.,

where αr is the intercept for region r (r = 1,2,3,4)

where county i is located, aj is the centered

midpoint of age group j, and for county i mij is

the age j-specific mortality rate, Xi is a vector of

demographic covariates, and Yi is a vector of

lifestyle covariates. A cubic function of age (aj

)

was used to accommodate possible downturns

in some cancer rates among the oldest groups. 

Because the self-reported lifestyle covariates

(smoking, obesity, health insurance and

mammography use) from the BRFSS telephone

surveys were thought to be fairly stable

estimates of state values but likely to be

measured with more error at the county level,

an additional variance term was included for the

“county residuals,” i.e., the differences in

county and state percentages for each of these

covariates. That is, the vector Yi was

decomposed into state effect Ys(i) and county

residual Y*i

. Then the observed (BRFSS) county

residuals y*i were assumed to be normally

distributed with mean 0 and variance σ2

yi where

σ2

yi is inversely proportional to the population.

This is equivalent to assuming that the observed

county values vary randomly about their

respective state values, with greater variation in

small counties than in larger ones. This type of

model is referred to as an errors-in-covariates

model (Carroll et al. 1995).

The incident cases of cancer were analyzed

separately by gender and location of the

primary malignancy: breast, colon and rectum,

prostate, lung and bronchus, and all other.

Because of the computational difficulty in

estimating the parameters when many of the

age-county strata had no cases, we constrained

the ages for analysis to be a minimum of 25 for

breast cancer, 35 for lung and colorectal cancer,

and 45 for prostate cancer. No age constraints

were needed for other cancers. These age

restrictions deleted 1.75% of the total cases from

the analysis.

Covariates listed in the previous section

were entered into the model as either scaled

continuous variables or a series of binary

variables. Collinearity diagnostics were used to

select representative variables from each of the

broad variable groups to include in the model.

For example, only three of the four lifestyle

covariates could be included in any one model;

we kept smoking but excluded obesity in the

lung cancer model, but did the reverse for the

other sites. All main effects and two-way

interactions were first included in the model but

only very significant interactions (p < 0.0001)

6

ln(λij| , , γ, , ) = αr + f(aj) + ln(mij) γ + X'i + Y'i
were selected for the final models using

backward stepwise fixed effects regression (SAS

1999). A Markov Chain Monte Carlo iterative

process was then used to estimate the

parameters of the full errors-in-covariates model

structure described above (Spiegelhalter et al.

1999). With the inclusion of so many predictor

variables, it was not necessary to include spatial

correlation in the covariance structure. 

This model was validated in several ways.

First, the set of SEER counties with data

available for 1995–1996 was split randomly into

a training half and a validation half. Observed

counts from the validation set were compared to

predictions for these counties derived from the

model on the training data. Results

demonstrated the validity of the model and

suggested ways to improve it. Then, for 1999

data from all SEER counties, predictions were

compared to the observed SEER data; the model

explained most of the variation in counts by

age, sex, race, and county, and fewer outliers

than expected were seen. Finally, predictions for

other states (not in the SEER Program) were

compared to the data reported to CDC (USCS

2002). All comparisons showed that this

method provides accurate estimates of state

incidence counts and rates. More detail on the

parameter estimation methods and validation

studies is available (Pickle et al. 2001;

http://srab.cancer.gov/incidence).

The posterior mean predicted numbers of

cases of each type of cancer were calculated for

each combination of age, race, sex, and county.

These estimates were summed to provide

corresponding estimates for each state and

region and for all cancers combined. Ageadjusted predicted incidence rates were

calculated using the direct method of

adjustment and the 2000 standard million

population (Fleiss 1981). All rates are shown as

cases per 100,000 population. The model

predictions were also adjusted for reporting

delay, as recently suggested by Clegg et al., in

order to provide the numbers of cases that

would be expected after data collection is

complete at some time in the future (Clegg et al.

2002).

Graphical Methods

Results are presented in tables, maps, and

graphs. All maps are shaded by county or state

using colors chosen to permit use by color-blind

readers (Brewer et al. 2003). Colors for state

maps are assigned according to quintiles, i.e.,

about 10 states fall into each color category. 

A second series of maps shows these same ageadjusted state rates relative to the overall U.S.

predicted rate. In this presentation, colors are

assigned to equal intervals representing the

proportional difference of each state’s rate from

the U.S. rate. 

Although the basic geographic unit of the

model was county, many counties have small

populations that lead to a high degree of

uncertainty about their expected number of

cases. This uncertainty is greatly reduced by

summing the predictions to the state level.

However, interesting within-state patterns of

incidence were apparent in maps of the county

predictions. As a compromise, we present

smoothed maps of age-adjusted county rates. 

7
A nonparametric algorithm that included

population weights was used to smooth away

some of the underlying random variation of the

county rates while highlighting broad patterns

in the data (Mungiole et al. 1999). This

algorithm is a two-dimensional version of a

median-based moving average that readers may

be familiar with from time series graphs.

Because these maps present the same statistic as

the state quintile maps, the same color scheme

was used.

A graphic combining predicted counts and

rates with maps of the rates is included for

comparison of the relative (rate) and absolute

(count) measures of the cancer burden by state.

States are ordered by rates. In this graphic, the

statistical estimates are shown as dots on the

graphs, linked to the maps in the leftmost panel

by color. Ninety-five percent confidence limits

are shown as bars for each predicted rate and

count, although the large dot size masks the

bars for all but the most uncertain predictions.

Note that the standard errors for model-based

rates are generally smaller than those for

empirical rates as shown in USCS. Guidance on

the use of this and the other graphics is

provided in the next section.

8

Figure 1. Definitions of Census Divisions in the United States

Pacific West North

Central

Mountain

West South

Central

East North

Central

East South

Central

South

Atlantic

New 

England

Middle

Atlantic
Tables

The predicted rates and counts for males and

females are presented in separate tables, each

ordered by state within Census Division (see

Figure 1, page 8). Within a table, three columns

of data for each of the cancer sites list the

original prediction (rate or count), the delayadjusted prediction, and the state’s reported data

from United States Cancer Statistics: 1999

Incidence (USCS 2002). The original predictions

may be compared to the USCS report to judge

the reasonableness of the model. The model

predictions may also be used to supplement the

USCS report where state and regional reports

were unavailable. Data from high-quality cancer

registries in 37 states and the District of

Columbia were included in the USCS report (see

USCS 2002, p. 4–5, for eligibility criteria).

Comparison of the predictions with and

without delay adjustment can provide an

estimate of the change in the numbers of cases

or in rates that will occur in the future as more

cancer cases that were diagnosed in 1999 are

identified. As discussed by Clegg et al. (2002),

the delay-adjusted figures provide a more

accurate measure of the cancer burden in an

area by removing variations due to reporting

delay and updates in the records over time.

Since these models are fit to SEER data, the

modeled predictions implicitly project the

counts assuming a reporting delay equivalent to

that in the SEER registries. Variations from this

assumed timing of data collection will affect the

closeness of the predictions and the USCS

reported figures. However, the delay-adjusted

predictions do reflect what each state registry

ultimately should report as data collection

continues, assuming that the ultimate level of

completeness is equivalent to that in SEER

registries and that the ecologic associations

inherent in the model hold for that area.

The reader will note that not all regions

show counts or rates in the USCS report. Count

totals were only published for two regions

where all states reported data; rates were not

computed if an insufficient number of states

reported data (see Appendix L, USCS 2002, for

details). The model predictions help to fill in

these gaps and thus provide estimates for all

regions. Since no delay adjustment is available

for our “other cancer” group, only rates without

adjustment are shown for this aggregated site;

delay-adjusted counts were calculated by

subtracting the sum of lung, colorectal, and

prostate or breast cancer from this total count. 

What might account for any differences

between the predicted and reported cancer

incidence? The prediction model assumes that

the associations between the covariates and

incidence rates is the same in all states as in the

SEER areas; if this is not the case, the predictions

will be inaccurate. Sudden spikes in screening

9

Reader’s Guide

Reader’s Guide
rates, as were observed for prostate cancer in the

early and mid 1990s, perturb incidence and are

difficult to capture accurately in models of this

type. At the top of the table, predicted rates are

given for the aggregated SEER and NPCR states

for comparison. Also, regions with more

population coverage by the SEER Program, e.g.,

Pacific, are expected to be estimated more

accurately than those with lower SEER coverage.

On the other hand, there is natural year-to-year

variation in cancer incidence, especially in small

population areas, and the model smooths over

these to provide a more stable estimate of

incidence than the observed data itself. Also,

even though all the states included in the USCS

report are certified as high quality, differences

may arise from variations in registry operations

such as completeness, timeliness, and specificity

in coding the cancer site (Wingo et al. 2003).

Finally, it should be noted that the USCS ageadjusted rates were calculated using 1999

population estimates extrapolated from the

1990 census, whereas we used updated estimates

interpolated between the 1990 and 2000

censuses. These denominator differences will

affect the calculated rates and their

comparisons.

State Maps

State rates are presented as a series of small

maps to facilitate the comparison of patterns

across cancer type and gender and between

predicted incidence and observed mortality rates

(Tufte 1983). The map design is uncluttered;

e.g., the legend is not shown on each map so

the reader can focus on the patterns. A reader

who wishes to know the actual rate predicted

for a state should refer to the tables. Predicted

incidence rates are presented both as ageadjusted rates and relative rates, i.e., the ageadjusted rate for the state divided by the

corresponding U.S. rate. The quintile color

categorization of the age-adjusted rates

illustrates the patterns of rankings of the states

whereas the equal interval color categorization

of the relative rates illustrates patterns of the

actual levels of the rates. For example, the ageadjusted rate map for other cancer among males

shows a strong cluster of highest-ranking rates

in the Northeast and low rates in the South but

the relative rate map shows that these are all

within 15% of the U.S. rate. This comparison

highlights the small differences in age-adjusted

rates that can appear to be striking on a rankbased map. It is important for the reader to

remember that the colors are assigned for each

map independently, so that the same color

represents different ranges of actual rates for

each type of cancer, although these ranges

correspond to the same quintile category (lowest

20% of states, etc.). The rank-based quintile

maps can best be used to answer the question,

“Where are there rate differences?”, while the

relative maps best answer the question, “How

large are these differences?”. The relative maps

illustrate the range of rates in comparison to the

overall U.S. rate. Figure 2, page 11, shows the

distribution of these predicted state rates for the

four cancer sites overlaid on one density graph

(a smoothed histogram). From these graphs, it is

obvious that the breast and “other” cancer rates

have narrower ranges than those of the lung,

colon/rectum, and prostate.

10
County Maps

The purpose of the smoothed county maps is to

show within-state patterns of the predicted

rates. These maps are shown in half-page size to

facilitate identification of patterns at this scale.

As noted above in the discussion of state maps,

it can be misleading to compare similar colors

across different types of maps or cancers. For

example, Montana is classified as an averagerate state for prostate cancer incidence although

many of its counties are in the highest quintile

categories. This is the result of different

distributions of state and county rates; the range

of rates for the middle color category is

154.2–163.2 for states and 128.8–142.7 for

counties.

The predicted county rates have been

smoothed to remove some of the inherent

variability in rates calculated for small

populations. An example of a proper use of

these maps would be to characterize the lung

cancer rates among Texas males as being higher

in the eastern than western parts of the state. 

It would be incorrect to try to identify the rate

predicted for a particular county because its

original prediction from the model may have

been changed by the smoothing algorithm to be

more like rates in neighboring counties.

Micromap Plots

The micromap plots summarize the results of

the state maps and tables, but provide more

detail than is possible in the color-categorized

maps. For example, it is clear from this graphic

that Utah’s lung cancer rate is predicted to be

much lower than New Mexico’s, the second

lowest state, but the state map categorizes all of

the southwestern states into the low color

category. Comparison of the rate and count

panels demonstrates the dependence of the

cancer count on population size—the highest

number of male lung cancer cases is predicted in

Florida, whose rate ranks only 9th. A glance at

the series of small maps can identify clusters of

similar-rate states, such as the band of high rates

of male lung cancer along the Mississippi and

Ohio rivers.

11

Figure 2. Distribution of Predicted State Relative Incidence Rates by Cancer Site for Males (Left) and

Females (Right), 1999

Relative Rate

–100% –50% 0 +50% +100%

Lung

Colon

Prostate

Other

6

5

4

3

2

1

0

Lung

Colon

Breast

Other

6

5

4

3

2

1

0

Relative Rate

–100% –50% 0 +50% +100%

Probability Density

Tables

• Rates and counts are presented for all states

and regions. Clear differences are seen among

the regional rates.

• The effect of the exclusion of some states

from the pooled regional rates in USCS can be

seen, for example, by the comparison of the

predicted and USCS-reported rates for colorectal

cancer among males in New England (Table 3).

Vermont and Maine, states not reported in

USCS, have the highest predicted rates of the six

New England states. The predicted regional rate

with all states included is 73.4, higher than the

70.2 calculated from the four New England

states included in the USCS report.

• In general, greater differences between

predicted and reported results are seen for states

with smaller populations, such as Alaska,

Delaware, North Dakota, New Hampshire, and

the District of Columbia

• States that did not contribute data to the

USCS report had the greatest impact on prostate

cancer rates—the predicted rate for these states

is 20% lower than for the contributing states.

Rates for breast, other, and total cancer are

approximately 12%–15% lower in nonreporting

states; lung cancer rates are slightly higher in

the nonreporting states.

• Rates in SEER registries are lower than in

NPCR registries. It cannot be determined

whether this is a real difference in incidence

patterns or one due to other causes.

State Maps

• Comparison of male and female predicted

incidence rates shows few differences in their

geographic patterns. Alaska is notable for its

higher ranking for lung and total cancer among

women.

• Predicted incidence rates are higher in the

Southeast for lung cancer, in the Midwest for

colorectal cancer, in the Great Lakes for prostate

cancer, and in the Northeast for breast, other,

and total cancer.

• Patterns of incidence and mortality are similar

except for breast and prostate cancer, sites for

which screening may play a major role. Thus

patterns of incidence for breast and prostate

cancer may reflect the changing intensity of

screening rather than any differential in risk

factors across the country.

• Relative rate maps show that there is a greater

range of rates across the country for lung and

colorectal cancers than the others (also seen in

Figure 2, page 11).

13

Highlights

Highlights
County Maps

• In addition to the state patterns noted above,

these maps identify within-state differences. For

example, lung cancer rates among women are

higher in northern than southern California.

• The lung cancer excess among women living

along the northern Pacific coast, first seen in

mortality rates in the 1970s, is more apparent in

these county maps.

• Prostate cancer incidence rates are high in the

Northwest and New England where mortality

rates are high for whites, and in South Carolina

where mortality rates are high for blacks.

• The sharp change in colorectal cancer rates

predicted at the edge of the western region

suggests that the model is unable to identify

localized patterns in this large area of low rates.

14
Results presented here provide a complete

picture of cancer incidence patterns across the

U.S. at the regional, state and county level. We

hope that they will prove useful in providing a

complete picture of the cancer burden at both

the national and local levels, in planning cancer

control activities, and in stimulating further

thought, debate, and research about the

associations between cancer rates and

geography. While the models utilized have been

validated to provide a reasonable fit across the

entire nation, the ecologic associations inherent

in these models may not fit well in every area.

We encourage readers to systematically explore

the possible causes of differences between the

predicted and observed figures in their areas

(e.g., interesting local exceptions to ecologic

associations, spikes in screening rates,

differences in the population estimates used for

this report and the USCS, and registry operation

issues). 

Experience has shown that cancer

patterns tend to change slowly, particularly for

the major sites included in this report. This

suggests that current cancer incidence patterns

would strongly resemble those for 1999 shown

in this report, except where rates are perturbed

due to the sudden change in screening

utilization or diagnostic technology. However,

because health planners would prefer

projections for the current calendar year and

beyond, we are working to extend the models to

project forward over time as well as over space.

In addition, since registry operations have been

expanding in this country since the early 1970s,

those studying past trends have had to rely on

trends for only a portion of the U.S. We will be

investigating the potential of these models to

project backward in time to provide truly

national trends of cancer incidence. We feel that

models of the type developed here have the

potential to be extended to serve both of these

important needs.

15

Summary

Summary
16

Table 1. Predicted Number of New Cancer Cases by Type of Cancer and State, Males, 1999

Lung Colorectal Prostate Other 

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

State Without With Report* Without With Report* Without With Report* Without With** RepoTotal U.S. 110,548 112,228 NR 79,083 80,404 NR 189,679 202,255 NR 279,495 286,186 NComparison of counts by source of dataStates in USCS report*** 85,830 87,135 82,869 62,218 63,257 60,642 155,520 165,831 151,711 223,844 229,016 

SEER registries 23,971 24,335 23,860 18,132 18,435 17,988 45,931 48,976 45,791 68,994 70,590 68,5NPCR registries 61,859 62,799 59,009 44,086 44,822 42,654 109,589 116,855 105,920 154,850 158,427 

States not in USCS report 24,718 25,094 16,865 17,147 34,159 36,424 55,651 57,170 New England 5,790 5,878 NR 4,465 4,540 NR 11,178 11,919 NR 16,347 16,720 N

Connecticut 1,313 1,333 1,293 1,128 1,147 1,091 2,529 2,697 2,559 3,925 4,019 NMaine 646 656 NR 475 483 NR 1,147 1,223 NR 1,601 1,638 NMassachusetts 2,596 2,635 2,440 1,941 1,973 1,904 5,246 5,594 5,002 7,510 7,674 NNew Hampshire 492 499 419 368 374 280 971 1,035 764 1,386 1,417 NRhode Island 498 506 493 342 348 356 824 879 861 1,235 1,266 NVermont 246 250 NR 210 214 NR 461 492 NR 690 708 N

Middle Atlantic 16,462 16,712 15,312 14,311 14,550 12,739 33,146 35,344 29,505 45,509 46,521 N

New Jersey 3,113 3,160 3,164 2,706 2,751 2,770 6,808 7,259 6,989 9,359 9,559 NNew York 7,060 7,167 6,480 6,275 6,380 5,566 14,636 15,606 12,280 20,306 20,755 NPennsylvania 6,289 6,385 5,668 5,330 5,419 4,403 11,702 12,478 10,236 15,844 16,207 N

East North Central 18,549 18,830 NR 13,292 13,514 NR 34,338 36,615 NR 47,057 48,104 N

Illinois 4,400 4,467 4,831 3,516 3,575 3,520 8,421 8,979 7,861 12,064 12,341 NIndiana 2,567 2,606 NR 1,827 1,858 NR 4,426 4,719 NR 6,278 6,425 NMichigan 4,281 4,346 3,973 2,741 2,787 2,580 8,371 8,926 8,534 10,573 10,784 N

Detroit 1,778 1,805 1,734 1,089 1,107 1,089 3,610 3,849 3,805 4,340 4,422 N

Ohio 5,085 5,162 5,132 3,422 3,479 3,452 9,164 9,772 7,709 12,352 12,625 NWisconsin 2,216 2,250 1,950 1,786 1,816 1,643 3,955 4,217 3,787 5,790 5,930 N

West North Central 7,140 7,248 NR 6,329 6,435 NR 12,719 13,563 NR 19,990 20,493 N

Iowa 1,179 1,197 1,232 1,056 1,074 1,062 2,175 2,319 2,164 3,191 3,268 NKansas 875 888 1,079 907 922 787 1,482 1,580 1,990 2,648 2,721 NMinnesota 1,576 1,600 1,514 1,413 1,437 1,267 3,169 3,379 3,668 4,833 4,947 NMissouri 2,473 2,511 2,610 1,863 1,894 1,676 4,010 4,276 3,515 6,156 6,311 NNebraska 570 579 596 602 612 539 1,031 1,099 1,329 1,697 1,741 NNorth Dakota 212 215 216 222 226 213 414 441 599 671 688 NSouth Dakota 255 259 NR 268 272 NR 438 467 NR 794 816 N

South Atlantic 24,876 25,254 NR 13,491 13,716 NR 36,128 38,523 NR 51,025 52,269 N

Delaware 411 417 368 190 193 214 638 680 559 775 791 NDistrict of Columbia 202 205 258 119 121 149 373 398 542 442 450 NFlorida 10,071 10,224 8,851 5,758 5,854 6,270 13,599 14,501 13,820 20,186 20,712 NGeorgia 2,503 2,541 NR 1,468 1,493 NR 4,091 4,362 NR 5,938 6,077 N

Atlanta 649 659 674 430 437 432 1,371 1,462 1,383 1,887 1,927 NRural Georgia 52 53 NR 28 28 NR 72 77 NR 95 97 N

Maryland 2,062 2,093 1,904 1,018 1,035 1,289 3,904 4,163 3,866 4,604 4,688 NNorth Carolina 3,792 3,850 3,336 1,883 1,914 1,701 5,178 5,521 4,630 7,332 7,514 NSouth Carolina 1,809 1,836 1,820 920 935 1,031 2,660 2,836 2,888 3,538 3,622 NVirginia 2,865 2,909 NR 1,553 1,579 NR 4,364 4,653 NR 6,186 6,333 N

West Virginia 1,161 1,179 1,164 582 592 643 1,322 1,410 1,322 2,024 2,081 N

Continued on page 17
17

Table 1. Predicted Number of New Cancer Cases by Type of Cancer and State, Males, 1999 (continued)

Lung Colorectal Prostate Other 

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

State Without With Report* Without With Report* Without With Report* Without With** RepoEast South Central 8,432 8,561 NR 4,596 4,673 NR 10,236 10,915 NR 15,904 16,344 N

Alabama 2,167 2,200 NR 1,081 1,099 NR 3,049 3,251 NR 4,206 4,308 NKentucky 2,227 2,261 2,321 1,159 1,178 1,170 2,296 2,448 2,613 3,948 4,067 NMississippi 1,260 1,279 NR 819 833 NR 1,654 1,764 NR 2,457 2,524 NTennessee 2,778 2,820 NR 1,538 1,564 NR 3,238 3,453 NR 5,292 5,445 N

West South Central 11,357 11,529 NR 8,745 8,891 NR 13,881 14,802 NR 26,143 26,937 N

Arkansas 1,433 1,455 NR 961 977 NR 1,609 1,716 NR 2,719 2,802 NLouisiana 2,042 2,073 2,005 1,191 1,211 1,201 2,543 2,712 2,817 4,044 4,157 NOklahoma 1,301 1,321 NR 1,030 1,047 NR 1,640 1,749 NR 3,251 3,348 NTexas 6,581 6,681 NR 5,563 5,656 NR 8,090 8,626 NR 16,129 16,629 N

Mountain 5,063 5,140 NR 3,813 3,876 NR 11,757 12,536 NR 16,784 17,129 N

Arizona 1,523 1,546 1,643 1,196 1,216 1,166 3,422 3,649 2,525 5,059 5,168 NColorado 1,079 1,095 952 722 734 829 2,820 3,007 2,621 3,798 3,867 NIdaho 373 379 361 324 329 271 834 889 828 1,196 1,221 NMontana 318 323 327 229 233 266 686 731 684 974 994 NNevada 817 829 NR 529 538 NR 1,397 1,490 NR 2,090 2,141 NNew Mexico 458 465 435 364 370 389 1,014 1,081 1,096 1,589 1,624 NUtah 345 350 306 361 367 349 1,179 1,257 1,269 1,584 1,611 NWyoming 151 153 144 88 89 136 405 432 367 494 502 N

Pacific 12,880 13,075 12,910 10,039 10,207 10,027 26,294 28,038 28,034 40,736 41,669 N

Alaska 130 132 140 170 173 117 161 172 280 481 497 NCalifornia 8,863 8,998 8,995 7,153 7,272 7,232 18,589 19,821 19,886 29,233 29,903 N

San Francisco/Oakland 1,160 1,178 1,172 970 986 1,014 2,534 2,702 2,785 3,948 4,037 NSan Jose/Monterey 512 520 521 477 485 459 1,131 1,206 1,413 1,950 1,996 NLos Angeles 2,093 2,125 2,131 1,858 1,889 1,872 4,820 5,140 5,261 7,465 7,631 NOther counties 5,098 5,175 NR 3,848 3,912 NR 10,104 10,774 NR 15,870 16,239 N

Hawaii 402 408 397 343 349 351 742 791 774 1,185 1,215 NOregon 1,366 1,387 1,319 970 986 864 2,653 2,829 2,715 3,816 3,901 NWashington 2,119 2,151 2,059 1,403 1,426 1,463 4,150 4,425 4,379 6,020 6,151 N

Seattle 1,420 1,442 1,436 955 971 965 2,842 3,030 3,026 4,131 4,221 N

NR = Not Reported*Source: United States Cancer Statistics: 1999 Incidence. Aggregated SEER and NPCR registry counts calculated by summing corresponding rows in table.

**Delay-adjusted count for other cancer calculated by subtracting corresponding counts for lung, colorectal, and prostate cancer from the total delay-adjusted count.

***Registries that report to both the SEER and the NPCR programs were counted as SEER (KY, LA, NJ, CA). Data from Georgia, Michigan, and Washington were split isince some counties are in the SEER system and some are not in these states.Note: Unshaded rows indicate SEER registries that provided data for model input.
18

Table 2. Predicted Number of New Cancer Cases by Type of Cancer and State, Females, 1999

Lung Colorectal Breast Other 

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

State Without With Report* Without With Report* Without With Report* Without With** RepoTotal U.S. 86,271 87,824 NR 76,551 77,891 NR 200,961 205,523 NR 272,802 284,827 NComparison of counts by source of dataStates in USCS report*** 69,528 70,780 63,929 60,341 61,397 59,892 160,434 164,076 155,069 219,515 229,166 

SEER registries 19,213 19,559 19,079 17,659 17,968 17,527 49,229 50,346 48,916 67,437 70,364 67,0NPCR registries 50,314 51,220 44,850 42,682 43,429 42,365 111,205 113,729 106,153 152,079 158,804 

States not in USCS report 16,743 17,044 16,210 16,494 40,527 41,447 53,287 55,661 New England 5,012 5,102 NR 4,497 4,576 NR 12,193 12,470 NR 16,749 17,479 N

Connecticut 1,143 1,164 1,079 1,138 1,158 1,148 2,845 2,910 2,865 4,048 4,225 NMaine 474 483 NR 417 424 NR 1,334 1,364 NR 1,582 1,652 NMassachusetts 2,371 2,414 2,185 2,047 2,083 2,016 5,410 5,533 5,123 7,749 8,086 NNew Hampshire 431 439 375 344 350 306 1,077 1,101 844 1,379 1,440 NRhode Island 407 414 406 365 371 416 937 958 821 1,299 1,356 NVermont 185 188 NR 187 190 NR 590 603 NR 691 722 N

Middle Atlantic 13,355 13,595 12,453 13,555 13,792 13,169 34,809 35,600 30,099 46,055 48,085 N

New Jersey 2,615 2,662 2,710 2,641 2,687 2,653 6,449 6,595 6,529 9,387 9,793 NNew York 6,002 6,110 5,595 5,939 6,043 6,000 15,926 16,288 13,412 21,367 22,300 NPennsylvania 4,738 4,823 4,148 4,975 5,062 4,516 12,435 12,717 10,158 15,301 15,991 N

East North Central 13,428 13,670 NR 13,256 13,488 NR 32,273 33,006 NR 47,666 49,722 N

Illinois 3,365 3,426 3,654 3,612 3,675 3,505 8,651 8,847 8,879 12,530 13,071 NIndiana 1,806 1,839 NR 1,834 1,866 NR 4,333 4,431 NR 6,285 6,559 NMichigan 3,260 3,319 3,098 2,714 2,761 2,624 7,025 7,184 6,977 10,636 11,095 N

Detroit 1,373 1,398 1,387 1,128 1,148 1,134 2,927 2,993 2,951 4,440 4,630 N

Ohio 3,477 3,540 3,712 3,365 3,424 3,407 8,326 8,515 8,631 12,419 12,953 NWisconsin 1,520 1,547 1,366 1,730 1,760 1,471 3,938 4,027 3,798 5,795 6,045 N

West North Central 5,423 5,521 NR 6,570 6,684 NR 14,268 14,592 NR 20,070 20,951 N

Iowa 832 847 826 1,071 1,090 1,068 2,254 2,305 2,254 3,249 3,391 NKansas 642 654 787 919 935 769 1,975 2,020 1,965 2,616 2,731 NMinnesota 1,301 1,324 1,148 1,490 1,516 1,225 3,485 3,564 3,484 5,028 5,245 NMissouri 1,859 1,892 1,894 1,962 1,996 1,645 4,262 4,359 3,914 6,009 6,276 NNebraska 440 448 436 602 613 524 1,273 1,302 1,216 1,717 1,793 NNorth Dakota 170 173 137 245 249 167 482 493 460 687 717 NSouth Dakota 180 183 NR 280 285 NR 538 550 NR 764 797 N

South Atlantic 22,375 22,778 NR 13,017 13,245 NR 36,415 37,242 NR 48,450 50,673 N

Delaware 479 488 274 178 181 231 566 579 563 776 812 NDistrict of Columbia 160 163 168 146 149 190 401 410 435 539 564 NFlorida 9,175 9,340 6,767 5,066 5,155 5,862 13,218 13,518 12,934 17,109 17,918 NGeorgia 1,942 1,977 NR 1,568 1,595 NR 4,594 4,698 NR 6,097 6,367 N

Atlanta 575 585 571 458 466 461 1,634 1,671 1,648 1,926 2,011 NRural Georgia 27 27 NR 30 31 NR 71 73 NR 103 107 N

Maryland 2,354 2,396 1,542 1,094 1,113 1,256 3,730 3,815 3,711 4,887 5,111 NNorth Carolina 3,199 3,257 2,208 1,899 1,932 1,833 5,253 5,372 5,159 7,240 7,568 NSouth Carolina 1,394 1,419 1,003 926 942 954 2,564 2,622 2,667 3,562 3,721 NVirginia 2,695 2,744 NR 1,574 1,602 NR 4,737 4,845 NR 6,268 6,553 N

West Virginia 976 994 817 566 576 640 1,352 1,383 1,403 1,973 2,063 N

Continued on page 19
19

Table 2. Predicted Number of New Cancer Cases by Type of Cancer and State, Females, 1999 (continued)

Lung Colorectal Breast Other 

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

State Without With Report* Without With Report* Without With Report* Without With** RepoEast South Central 5,212 5,305 NR 4,622 4,703 NR 11,089 11,341 NR 15,478 16,166 N

Alabama 1,338 1,362 NR 1,117 1,137 NR 2,862 2,927 NR 4,052 4,230 NKentucky 1,529 1,557 1,580 1,166 1,186 1,194 2,733 2,795 2,785 3,820 3,993 NMississippi 560 570 NR 735 748 NR 1,707 1,746 NR 2,401 2,506 NTennessee 1,785 1,817 NR 1,604 1,632 NR 3,787 3,873 NR 5,204 5,437 N

West South Central 7,024 7,151 NR 8,093 8,235 NR 19,190 19,625 NR 24,072 25,155 N

Arkansas 717 730 NR 871 886 NR 1,875 1,918 NR 2,501 2,613 NLouisiana 1,207 1,229 1,223 1,125 1,145 1,113 2,807 2,871 2,826 3,809 3,979 NOklahoma 875 891 NR 1,062 1,081 NR 2,437 2,492 NR 3,048 3,184 NTexas 4,225 4,301 NR 5,035 5,123 NR 12,071 12,345 NR 14,715 15,379 N

Mountain 3,370 3,431 NR 3,286 3,343 NR 11,288 11,545 NR 15,224 15,865 N

Arizona 1,014 1,032 1,254 1,049 1,067 1,053 3,298 3,373 3,099 4,460 4,649 NColorado 760 774 785 673 685 768 2,752 2,814 2,829 3,609 3,760 NIdaho 205 209 260 264 269 250 791 809 807 1,108 1,154 NMontana 198 202 247 202 206 218 662 677 606 918 957 NNevada 563 573 NR 413 420 NR 1,367 1,398 NR 1,707 1,782 NNew Mexico 338 344 320 298 303 284 1,080 1,105 1,077 1,475 1,537 NUtah 178 181 185 307 312 297 1,009 1,032 994 1,490 1,550 NWyoming 114 116 116 80 81 121 329 336 325 457 476 N

Pacific 11,071 11,270 11,053 9,656 9,825 9,707 29,435 30,103 29,871 39,038 40,731 N

Alaska 154 157 125 160 163 87 363 371 294 426 446 NCalifornia 7,761 7,901 7,828 6,887 7,008 7,028 21,165 21,645 21,439 28,260 29,480 N

San Francisco/Oakland 1,074 1,093 1,104 954 971 1,051 3,094 3,164 3,135 3,789 3,955 NSan Jose/Monterey 478 487 481 454 462 420 1,518 1,552 1,482 1,910 1,992 NLos Angeles 1,806 1,839 1,826 1,818 1,850 1,890 5,414 5,537 5,460 7,823 8,151 NOther counties 4,402 4,481 NR 3,661 3,725 NR 11,140 11,393 NR 14,739 15,381 N

Hawaii 272 277 265 314 319 319 815 834 869 1,027 1,071 NOregon 1,132 1,152 1,144 929 945 947 2,722 2,784 2,792 3,543 3,698 NWashington 1,753 1,785 1,691 1,366 1,390 1,326 4,369 4,468 4,477 5,783 6,033 N

Seattle 1,209 1,231 1,248 934 950 927 3,077 3,147 3,109 3,979 4,153 N

NR = Not Reported*Source: United States Cancer Statistics: 1999 Incidence. Aggregated SEER and NPCR registry counts calculated by summing corresponding rows in table.

**Delay-adjusted count for other cancer calculated by subtracting corresponding counts for lung, colorectal, and breast cancer from the total delay-adjusted count.

***Registries that report to both the SEER and the NPCR programs were counted as SEER (KY, LA, NJ, CA). Data from Georgia, Michigan, and Washington were split isince some counties are in the SEER system and some are not in these states.Note: Unshaded rows indicate SEER registries that provided data for model input.
20

Table 3. Predicted Cancer Incidence Rates by Type of Cancer and State, Males, 1999

Lung Colorectal Prostate Other 

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

State Without With Report* Without With Report* Without With Report* Without With** RepoTotal U.S. 93.5 94.9 89.1 68.3 69.5 66.4 159.1 169.7 162.0 232.8 NR NR Comparison of rates by source of dataStates in USCS report*** 91.9 93.3 89.1 67.9 69.0 66.4 165.2 176.2 162.0 236.5 

SEER registries 82.9 84.2 82.5 63.6 64.7 63.2 157.7 168.2 157.3 230.0 228.NPCR registries 96.0 97.5 69.9 71.1 168.6 179.8 239.5 

States not in USCS report 99.1 100.6 69.7 70.9 136.3 145.3 218.6 New England 93.8 95.2 88.2 73.4 74.6 70.2 179.5 191.4 174.0 261.6 NR NR 

Connecticut 85.0 86.3 84.5 74.0 75.2 72.1 162.6 173.4 166.5 251.9 NR NR Maine 105.2 106.8 NR 79.3 80.6 NR 185.7 198.0 NR 262.6 NR NR Massachusetts 94.2 95.7 88.1 71.4 72.6 70.0 188.8 201.4 180.1 268.3 NR NR New Hampshire 94.8 96.2 83.5 72.4 73.6 58.3 184.8 197.1 151.7 260.0 NR NR Rhode Island 104.6 106.2 105.0 73.0 74.2 76.8 172.5 183.9 185.1 258.9 NR NR Vermont 91.6 92.9 NR 80.1 81.4 NR 169.6 180.9 NR 252.9 NR NR 

Middle Atlantic 92.8 94.2 86.4 82.3 83.7 73.3 185.5 197.8 164.9 255.6 NR NR 

New Jersey 85.1 86.4 86.1 75.2 76.5 77.0 184.3 196.5 188.4 252.5 NR NR New York 88.0 89.4 80.7 79.8 81.2 70.7 181.1 193.1 151.1 249.9 NR NR Pennsylvania 103.8 105.4 94.2 89.8 91.3 74.6 191.8 204.5 169.0 265.5 NR NR 

East North Central 97.1 98.5 NR 71.3 72.4 NR 178.3 190.1 NR 243.1 NR NR 

Illinois 87.7 89.0 95.8 71.5 72.7 71.3 166.3 177.3 155.2 234.9 NR NR Indiana 101.1 102.6 NR 74.0 75.3 NR 173.0 184.5 NR 244.0 NR NR Michigan 102.3 103.8 94.6 67.3 68.4 62.5 198.8 211.9 202.2 249.3 NR NR 

Detroit 107.8 109.4 100.5 67.6 68.7 64.3 217.5 232.0 219.0 257.8 NR NR 

Ohio 101.7 103.3 102.5 70.3 71.5 70.8 181.7 193.7 153.6 246.5 NR NR Wisconsin 93.5 94.9 83.0 76.7 78.0 70.6 166.0 177.0 161.2 241.8 NR NR 

West North Central 83.4 84.7 88.8 75.2 76.5 68.9 148.0 157.8 162.3 232.1 NR NR 

Iowa 83.9 85.1 88.0 76.1 77.3 76.6 154.2 164.4 154.4 228.4 NR NR Kansas 74.5 75.6 91.9 78.1 79.4 67.2 125.9 134.2 169.4 222.8 NR NR Minnesota 77.4 78.6 74.4 70.2 71.4 63.1 154.9 165.1 181.7 230.9 NR NR Missouri 98.8 100.3 105.2 76.4 77.6 69.2 159.0 169.6 139.9 246.6 NR NR Nebraska 74.4 75.6 78.3 79.7 81.0 71.8 134.1 143.0 174.4 220.3 NR NR North Dakota 67.8 68.9 69.3 71.6 72.8 69.1 132.6 141.4 192.9 215.4 NR NR South Dakota 71.7 72.8 NR 76.1 77.4 NR 122.9 131.0 NR 223.6 NR NR 

South Atlantic 107.6 109.2 NR 59.9 60.8 NR 154.3 164.5 NR 220.8 NR NR 

Delaware 119.3 121.1 109.9 57.0 57.9 66.4 181.6 193.7 163.3 225.8 NR NR District of Columbia 90.0 91.4 111.4 53.8 54.7 66.1 163.2 174.0 234.7 192.1 NR NR Florida 111.6 113.3 101.8 64.6 65.7 72.9 148.6 158.5 155.5 231.9 NR NR Georgia 89.1 90.4 NR 54.0 54.9 NR 145.9 155.6 NR 201.7 NR NR 

Atlanta 82.3 83.6 89.1 54.8 55.7 57.4 170.1 181.4 172.4 210.5 NR NR Rural Georgia 94.5 96.0 NR 53.7 54.5 NR 130.9 139.5 NR 175.1 NR NR 

Maryland 98.4 99.9 92.1 49.8 50.6 63.2 182.2 194.3 184.7 214.0 NR NR North Carolina 115.4 117.1 103.2 59.4 60.4 53.4 156.1 166.4 140.8 220.8 NR NR South Carolina 108.4 110.0 109.5 57.5 58.4 64.3 158.5 169.0 176.1 211.9 NR NR Virginia 102.7 104.2 NR 57.4 58.3 NR 154.1 164.3 NR 215.6 NR NR 

West Virginia 126.3 128.3 126.3 65.6 66.7 73.3 142.9 152.4 144.8 225.4 NR NR 

Continued on page 21
21

Table 3. Predicted Cancer Incidence Rates by Type of Cancer and State, Males, 1999 (continued)

Lung Colorectal Prostate Other 

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

State Without With Report* Without With Report* Without With Report* Without With** RepoEast South Central 117.1 118.9 NR 66.2 67.3 NR 142.0 151.4 NR 220.3 NR NR 

Alabama 112.3 114.0 NR 58.0 59.0 NR 157.3 167.7 NR 218.7 NR NR Kentucky 129.0 130.9 135.6 69.8 70.9 71.4 133.0 141.8 155.5 227.8 NR NR Mississippi 110.2 111.9 NR 74.0 75.3 NR 145.9 155.6 NR 213.9 NR NR Tennessee 115.7 117.5 NR 66.5 67.7 NR 134.2 143.1 NR 219.3 NR NR 

West South Central 95.9 97.3 NR 75.7 76.9 NR 116.8 124.5 NR 213.6 NR NR 

Arkansas 115.1 116.9 NR 79.3 80.6 NR 128.3 136.8 NR 221.1 NR NR Louisiana 115.9 117.7 114.9 69.9 71.1 70.5 144.6 154.2 163.1 226.5 NR NR Oklahoma 85.0 86.3 NR 69.1 70.2 NR 106.4 113.4 NR 212.2 NR NR Texas 90.2 91.5 NR 77.8 79.1 NR 110.3 117.6 NR 209.5 NR NR 

Mountain 69.6 70.6 NR 53.4 54.3 NR 159.2 169.8 NR 224.0 NR NR 

Arizona 66.4 67.4 75.8 53.2 54.1 54.7 147.0 156.7 114.4 220.8 NR NR Colorado 71.5 72.6 63.2 47.8 48.6 54.8 181.8 193.8 166.7 231.3 NR NR Idaho 70.9 72.0 69.0 62.3 63.3 52.2 157.0 167.4 157.4 221.2 NR NR Montana 73.7 74.8 76.6 53.9 54.8 63.3 157.8 168.2 157.1 225.6 NR NR Nevada 96.4 97.9 NR 65.2 66.3 NR 160.9 171.5 NR 244.0 NR NR New Mexico 60.9 61.8 60.5 49.3 50.1 53.5 133.1 141.9 148.2 206.7 NR NR Utah 50.3 51.0 44.3 53.0 53.9 50.7 169.7 180.9 182.8 213.0 NR NR Wyoming 70.9 72.0 68.9 42.5 43.2 65.9 188.1 200.6 172.0 226.9 NR NR 

Pacific 75.0 76.2 74.1 58.8 59.8 58.0 151.7 161.7 159.7 225.9 NR NR 

Alaska 75.1 76.2 77.3 100.8 102.4 67.3 92.8 99.0 155.8 237.2 NR NR California 70.7 71.8 70.5 57.4 58.4 57.1 146.8 156.5 154.7 221.0 NR NR 

San Francisco/Oakland 69.6 70.7 68.9 58.1 59.1 60.0 149.2 159.1 162.1 224.9 NR NR San Jose/Monterey 62.0 62.9 62.5 57.2 58.2 54.1 133.5 142.3 166.1 214.9 NR NR Los Angeles 65.1 66.1 64.1 58.1 59.1 56.8 148.6 158.5 156.6 216.1 NR NR Other counties 74.7 75.8 NR 57.0 57.9 NR 146.9 156.6 NR 223.1 NR NR 

Hawaii 71.1 72.2 69.1 60.9 61.9 61.8 131.2 139.9 135.5 206.7 NR NR Oregon 89.3 90.7 86.1 64.0 65.0 56.7 172.1 183.5 176.2 245.0 NR NR Washington 89.4 90.8 86.6 59.5 60.5 62.1 173.1 184.6 182.4 243.0 NR NR 

Seattle 89.3 90.6 90.3 60.1 61.1 61.0 176.1 187.7 187.5 245.8 NR NR 

NR = Not Reported*Source: United States Cancer Statistics: 1999 Incidence. Aggregated SEER registry rates calculated using SEER*Stat databases (SEER 2002). Aggregated NPCR reg

**No delay adjustment is available for other cancer rates***Registries that report to both the SEER and the NPCR programs were counted as SEER (KY, LA, NJ, CA). Data from Georgia, Michigan, and Washington were split i

since some counties are in the SEER system and some are not in these states.Note: Unshaded rows indicate SEER registries that provided data for model input.
22

Table 4. Predicted Cancer Incidence Rates by Type of Cancer and State, Females, 1999

Lung Colorectal Breast Other 

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

State Without With Report* Without With Report* Without With Report* Without With** RepoTotal U.S. 56.1 57.1 53.4 48.4 49.2 48.5 134.5 137.6 134.1 179.5 NR NR Comparison of rates by source of dataStates in USCS report*** 57.3 58.3 53.4 48.3 49.1 48.5 136.7 139.8 134.1 183.5 

SEER registries 51.3 52.2 50.9 46.1 46.9 45.7 132.8 135.8 131.9 179.3 178.NPCR registries 60.0 61.1 49.2 50.1 138.5 141.6 185.5 

States not in USCS report 51.6 52.5 49.0 49.9 126.6 129.5 164.4 New England 60.6 61.7 58.3 51.8 52.7 52.7 153.6 157.1 145.1 205.6 NR NR 

Connecticut 55.5 56.4 54.3 52.7 53.6 54.2 144.4 147.6 150.1 200.1 NR NR Maine 60.5 61.5 NR 51.0 51.9 NR 176.6 180.6 NR 206.8 NR NR Massachusetts 62.9 64.0 59.0 51.5 52.4 51.2 150.0 153.4 144.7 208.3 NR NR New Hampshire 65.8 67.0 61.0 50.8 51.7 47.4 164.3 168.0 137.9 209.1 NR NR Rhode Island 62.4 63.5 65.2 52.3 53.2 61.8 153.1 156.6 139.7 203.5 NR NR Vermont 54.4 55.3 NR 52.8 53.7 NR 174.4 178.4 NR 203.2 NR NR 

Middle Atlantic 55.5 56.5 52.4 54.5 55.4 53.3 152.1 155.6 133.5 196.7 NR NR 

New Jersey 52.7 53.6 55.5 51.9 52.8 52.6 135.5 138.6 139.6 193.6 NR NR New York 54.9 55.9 51.5 52.8 53.7 53.5 150.8 154.2 128.7 198.6 NR NR Pennsylvania 58.2 59.2 51.9 58.2 59.2 53.5 164.4 168.2 136.2 196.0 NR NR 

East North Central 53.5 54.5 NR 51.0 51.9 NR 132.6 135.7 NR 192.1 NR NR 

Illinois 50.1 51.0 54.8 51.9 52.8 50.4 132.6 135.6 136.6 187.6 NR NR Indiana 53.9 54.9 NR 53.0 53.9 NR 133.3 136.4 NR 189.9 NR NR Michigan 60.3 61.4 57.4 48.9 49.8 47.2 133.0 136.0 131.6 198.5 NR NR 

Detroit 61.5 62.6 59.6 49.4 50.3 47.9 134.2 137.3 129.9 200.6 NR NR 

Ohio 52.4 53.4 56.1 49.1 49.9 50.0 130.5 133.5 135.8 191.2 NR NR Wisconsin 50.8 51.7 46.9 54.6 55.5 47.3 136.1 139.2 132.8 194.7 NR NR 

West North Central 49.6 50.5 50.6 56.3 57.3 48.9 135.9 138.9 133.1 184.9 NR NR 

Iowa 46.0 46.8 46.2 54.3 55.3 55.0 132.6 135.6 132.3 183.1 NR NR Kansas 42.6 NR 52.8 NR NR 48.0 NR NR 135.8 NR NR NR Minnesota 50.7 51.6 45.8 54.5 55.4 45.5 137.8 140.9 140.1 193.4 NR NR Missouri 56.8 57.9 59.2 57.3 58.3 48.9 135.9 139.0 127.7 187.0 NR NR Nebraska 45.3 46.1 44.4 57.6 58.6 50.7 137.1 140.2 130.4 178.1 NR NR North Dakota 45.1 46.0 37.2 59.5 60.5 42.0 135.1 138.2 130.3 183.8 NR NR South Dakota 41.0 41.8 NR 59.3 60.3 NR 130.9 133.9 NR 177.8 NR NR 

South Atlantic 74.6 75.9 NR 42.7 43.4 NR 126.8 129.6 NR 166.1 NR NR 

Delaware 108.3 110.2 65.8 39.8 40.5 54.4 132.4 135.4 138.0 179.6 NR NR District of Columbia 48.7 49.6 50.8 43.8 44.6 55.3 127.7 130.6 138.0 166.6 NR NR Florida 82.4 83.9 62.9 44.3 45.1 53.0 131.8 134.8 132.9 165.0 NR NR Georgia 51.4 52.4 NR 41.0 41.7 NR 118.5 121.2 NR 157.0 NR NR 

Atlanta 52.7 53.6 55.1 41.0 41.7 43.5 133.3 136.3 141.3 159.6 NR NR Rural Georgia 37.6 38.3 NR 40.3 41.0 NR 101.2 103.4 NR 146.4 NR NR 

Maryland 84.5 86.0 57.0 38.8 39.5 45.6 133.1 136.1 137.0 174.5 NR NR North Carolina 72.5 73.8 51.0 42.5 43.2 42.1 121.8 124.6 123.2 166.4 NR NR South Carolina 63.1 NR 46.2 NR NR 44.1 NR NR 125.6 NR NR NR Virginia 73.5 74.8 NR 42.5 43.2 NR 128.7 131.7 NR 170.3 NR NR 

West Virginia 82.1 83.6 67.5 45.8 46.6 52.2 119.9 122.6 123.5 172.7 NR NR 

Continued on page 23
23

Table 4. Predicted Cancer Incidence Rates by Type of Cancer and State, Females, 1999 (continued)

Lung Colorectal Breast Other 

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

Delay Adjustment

USCS

State Without With Report* Without With Report* Without With Report* Without With** RepoEast South Central 54.4 55.3 NR 47.1 47.9 NR 118.9 121.6 NR 163.9 NR NR 

Alabama 51.6 52.5 NR 42.2 42.9 NR 114.6 117.2 NR 160.0 NR NR Kentucky 67.7 68.9 70.4 50.3 51.2 52.2 123.7 126.5 126.8 171.1 NR NR Mississippi 36.3 36.9 NR 46.4 47.2 NR 114.2 116.8 NR 157.2 NR NR Tennessee 55.9 56.9 NR 49.2 50.0 NR 121.2 124.0 NR 165.2 NR NR 

West South Central 45.8 46.6 NR 51.8 52.7 NR 125.9 128.8 NR 155.7 NR NR 

Arkansas 44.8 45.6 NR 52.5 53.4 NR 123.4 126.2 NR 161.1 NR NR Louisiana 51.5 52.4 52.4 47.4 48.2 47.5 121.9 124.6 123.1 163.3 NR NR Oklahoma 44.4 45.1 NR 51.9 52.8 NR 128.7 131.6 NR 157.7 NR NR Texas 44.9 45.7 NR 52.7 53.7 NR 126.6 129.5 NR 152.5 NR NR 

Mountain 38.5 39.2 NR 37.3 37.9 NR 129.6 132.5 NR 173.5 NR NR 

Arizona 36.8 37.5 47.7 37.9 38.5 40.0 125.2 128.0 123.6 167.2 NR NR Colorado 39.8 40.5 40.7 34.6 35.2 39.4 137.9 141.0 139.4 181.2 NR NR Idaho 32.9 33.5 42.0 41.2 42.0 38.7 127.8 130.7 131.4 176.6 NR NR Montana 38.9 39.6 48.5 38.3 39.0 41.9 132.8 135.8 122.2 183.1 NR NR Nevada 59.7 60.8 NR 45.3 46.1 NR 144.1 147.3 NR 182.4 NR NR New Mexico 36.8 37.5 36.3 32.4 32.9 32.3 118.1 120.7 122.8 160.9 NR NR Utah 21.4 21.7 22.4 36.3 36.9 35.4 119.0 121.7 119.3 169.0 NR NR Wyoming 45.6 46.5 46.5 31.5 32.0 48.4 131.1 134.0 131.2 182.3 NR NR 

Pacific 51.0 52.0 50.9 43.7 44.5 43.8 135.8 138.9 138.9 178.0 NR NR 

Alaska 84.0 85.5 69.3 89.9 91.4 49.6 160.9 164.6 127.8 194.7 NR NR California 48.5 49.4 48.8 42.4 43.1 42.9 132.5 135.5 135.1 174.4 NR NR 

San Francisco/Oakland 49.4 50.3 49.6 42.8 43.5 45.9 142.4 145.7 143.8 173.2 NR NR San Jose/Monterey 45.3 46.1 44.5 42.2 43.0 38.4 139.0 142.2 137.1 174.2 NR NR Los Angeles 42.7 43.5 41.5 42.4 43.1 42.2 126.3 129.2 125.5 179.4 NR NR Other counties 51.6 52.6 NR 42.3 43.0 NR 132.1 135.1 NR 172.1 NR NR 

Hawaii 40.5 41.3 39.5 47.3 48.1 48.0 126.6 129.5 134.0 158.5 NR NR Oregon 59.8 60.9 60.8 47.2 48.0 48.4 146.4 149.7 151.5 188.8 NR NR Washington 59.6 60.7 58.5 45.0 45.8 44.3 147.4 150.8 153.8 193.7 NR NR 

Seattle 60.7 61.8 63.3 45.5 46.3 45.7 151.8 155.3 156.1 195.4 NR NR 

NR = Not Reported*Source: United States Cancer Statistics: 1999 Incidence. Aggregated SEER registry rates calculated using SEER*Stat databases (SEER 2002). Aggregated NPCR reg

**No delay adjustment is available for other cancer rates***Registries that report to both the SEER and the NPCR programs were counted as SEER (KY, LA, NJ, CA). Data from Georgia, Michigan, and Washington were split i

since some counties are in the SEER system and some are not in these states.Note: Unshaded rows indicate SEER registries that provided data for model input.
Lung

Predicted Incidence Rates Observed Mortality Rates

Colorectal

Prostate

Other Cancers

Total

Lowest 20% Next Lowest 20% Middle 20% Next Highest 20% Highest 20%

*States are color coded according to quintiles of the 50 states plus the District of Columbia.

24

Predicted Cancer Incidence Rates and Observed Mortality Rates by Type of Cancer and State*,

Males, 1999
Other Cancers

Lung

Predicted Incidence Rates Observed Mortality Rates

Colorectal

Breast

Total

Lowest 20% Next Lowest 20% Middle 20% Next Highest 20% Highest 20%

25

*States are color coded according to quintiles of the 50 states plus the District of Columbia.

Predicted Cancer Incidence Rates and Observed Mortality Rates by Type of Cancer and State*,

Females, 1999
26

Predicted Cancer Incidence Rates by Type of Cancer and State*, Males and Females, 1999

*States are color coded according to quintiles of the 50 states plus the District of Columbia.

Lung

Males Females

Colorectal

Prostate

Other Cancers

Total

Lowest 20% Next Lowest 20% Middle 20% Next Highest 20% Highest 20%

Lung

Colorectal

Breast

Other Cancers

Total
27

Lung

Males Females

Colorectal

Prostate

Other Cancers

Total

< 0.76 0.76 – 0.85 0.86 – 0.95 0.96 – 1.05 1.06 – 1.15

Lung

Colorectal

Breast

Other Cancers

Total

1.16 – 1.25 > 1.26

Predicted Cancer Incidence Rates Relative to the U.S. Rate by Type of Cancer and State, Males and

Females, 1999
28

Smoothed Predicted Lung Cancer Incidence Rates by County, Males and Females, 1999

Males

, 

Females

28.1 – 73.8

73.9 – 89.5

89.6 – 99.7

99.8 – 112.7

112.8 – 137.9

Rate per 100,000

4.1 – 34.9

35.0 – 44.8

44.9 – 51.6

51.7 – 60.5

60.6 – 85.7

Rate per 100,000
29

Smoothed Predicted Colorectal Cancer Incidence Rates by County, Males and Females, 1999

Males

Females

39.2 – 56.3

56.4 – 65.8

65.9 – 70.1

70.2 – 73.6

73.7 – 91.6

Rate per 100,000

31.1 – 41.4

41.5 – 47.2

47.3 – 50.9

51.0 – 54.5

54.6 – 59.1

Rate per 100,000
30

Males

70.0 – 118.7

118.8 – 134.0

134.1 – 148.1

148.2 – 162.2

162.3 – 189.3

Rate per 100,000

Smoothed Predicted Prostate Cancer Incidence Rates by County, Males, 1999
31

Females

73.8 – 109.7

109.8 – 115.7

115.8 – 123.6

123.7 – 129.2

129.3 – 203.9

Rate per 100,000

Smoothed Predicted Breast Cancer Incidence Rates by County, Females, 1999
32

Males

Females

168.2 – 201.8

201.9 – 213.1

213.2 – 221.0

221.1 – 234.2

234.3 – 262.9

Rate per 100,000

130.6 – 156.6

156.7 – 164.2

164.3 – 172.4

172.5 – 185.1

185.2 – 210.2

Rate per 100,000

Smoothed Predicted Other Cancer Incidence Rates by County, Males and Females, 1999
33

Males

Females

387.2 – 466.5

466.6 – 513.1

513.2 – 533.4

533.5 – 558.5

558.6 – 643.3

Rate per 100,000

300.6 – 355.2

355.3 – 376.9

377.0 – 399.1

399.2 – 418.3

418.4 – 520.2

Rate per 100,000

Smoothed Predicted Total Cancer Incidence Rates by County, Males and Females, 1999
34

Micromaps

Appears Below

Appears Above

Median

States

Kentucky

West Virginia

Delaware

Louisiana

Tennessee

North Carolina

Arkansas

Alabama

Florida

Mississippi

South Carolina

Maine

Rhode Island

Pennsylvania

Virginia

Michigan

Ohio

Indiana

Missouri

Maryland

Nevada

New Hampshire

Massachusetts

Wisconsin

Vermont

Texas

D.C.

Washington

Oregon

Georgia

New York

Illinois

New Jersey

Connecticut

Oklahoma

Iowa

Minnesota

Alaska

Kansas

Nebraska

Montana

South Dakota

Colorado

Hawaii

Idaho

Wyoming

California

North Dakota

Arizona

New Mexico

Utah

60 80 100 120

Per 100,000

Age-adjusted Rate

60 80 100 120

Per 100,000

0 2000 6000 10000

Predicted # Cases

0 2000 6000 10000

Key Dot Color Links Horizontally

Nebraska

95% Confidence Intervals U.S. Values

Predicted Lung Cancer Incidence Rates and Counts by State, Males, 1999
35

Micromaps

Appears Below

Appears Above

Median

States

Delaware

Maryland

Alaska

Florida

West Virginia

Virginia

North Carolina

Kentucky

New Hampshire

South Carolina

Massachusetts

Rhode Island

Maine

Michigan

Oregon

Nevada

Washington

Pennsylvania

Missouri

Tennessee

Connecticut

New York

Vermont

Indiana

New Jersey

Ohio

Alabama

Louisiana

Georgia

Wisconsin

Minnesota

Illinois

D.C.

California

Iowa

Wyoming

Nebraska

North Dakota

Texas

Arkansas

Oklahoma

Kansas

South Dakota

Hawaii

Colorado

Montana

New Mexico

Arizona

Mississippi

Idaho

Utah

20 40 60 80 100 120

Per 100,000

Age-adjusted Rate

20 40 60 80 100 120

Per 100,000

0 2000 6000 10000

Predicted # Cases

0 2000 6000 10000

Key Dot Color Links Horizontally

Nebraska

95% Confidence Intervals U.S. Values

Predicted Lung Cancer Incidence Rates and Counts by State, Females, 1999
36

Predicted Colorectal Cancer Incidence Rates and Counts by State, Males, 1999

Micromaps

Appears Below

Appears Above

Median

States

Alaska

Pennsylvania

Vermont

New York

Nebraska

Arkansas

Maine

Kansas

Texas

Wisconsin

Missouri

South Dakota

Iowa

New Jersey

Mississippi

Indiana

Connecticut

Rhode Island

New Hampshire

North Dakota

Illinois

Massachusetts

Ohio

Minnesota

Louisiana

Kentucky

Oklahoma

Michigan

Tennessee

West Virginia

Nevada

Florida

Oregon

Idaho

Hawaii

Washington

North Carolina

Alabama

South Carolina

California

Virginia

Delaware

Georgia

Montana

D.C.

Arizona

Utah

Maryland

New Mexico

Colorado

Wyoming

40 60 80 100

Per 100,000

Age-adjusted Rate

40 60 80 100

Per 100,000

0 2000 4000 6000

Predicted # Cases

0 2000 4000 6000

Key Dot Color Links Horizontally

Nebraska

95% Confidence Intervals U.S. Values
37

Predicted Colorectal Cancer Incidence Rates and Counts by State, Females, 1999

Micromaps

Appears Below

Appears Above

Median

States

Alaska

North Dakota

South Dakota

Pennsylvania

Nebraska

Missouri

Kansas

Wisconsin

Minnesota

Iowa

Indiana

Vermont

New York

Texas

Connecticut

Arkansas

Rhode Island

Illinois

New Jersey

Oklahoma

Massachusetts

Maine

New Hampshire

Kentucky

Tennessee

Ohio

Michigan

Louisiana

Hawaii

Oregon

Mississippi

West Virginia

Nevada

Washington

Florida

D.C.

Virginia

North Carolina

California

Alabama

South Carolina

Idaho

Georgia

Delaware

Maryland

Montana

Arizona

Utah

Colorado

New Mexico

Wyoming

40 60 80 100

Per 100,000

Age-adjusted Rate

40 60 80 100

Per 100,000

0 2000 4000 6000

Predicted # Cases

0 2000 4000 6000

Key Dot Color Links Horizontally

Nebraska

95% Confidence Intervals U.S. Values
38

Predicted Prostate Cancer Incidence Rates and Counts by State, Males, 1999

Micromaps

Appears Below

Appears Above

Median

States

Michigan

Pennsylvania

Massachusetts

Wyoming

Maine

New Hampshire

New Jersey

Maryland

Colorado

Ohio

Delaware

New York

Washington

Indiana

Rhode Island

Oregon

Utah

Vermont

Illinois

Wisconsin

D.C.

Connecticut

Nevada

Missouri

South Carolina

Montana

Alabama

Idaho

North Carolina

Minnesota

Iowa

Virginia

Florida

Arizona

California

Georgia

Mississippi

Louisiana

West Virginia

Tennessee

Nebraska

New Mexico

Kentucky

North Dakota

Hawaii

Arkansas

Kansas

South Dakota

Texas

Oklahoma

Alaska

80 120 160 200

Per 100,000

Age-adjusted Rate

80 120 160 200

Per 100,000

0 5000 15000

Predicted # Cases

0 5000 15000

Key Dot Color Links Horizontally

Nebraska

95% Confidence Intervals U.S. Values
39

Predicted Breast Cancer Incidence Rates and Counts by State, Females, 1999

Micromaps

Appears Below

Appears Above

Median

States

Maine

Vermont

Pennsylvania

New Hampshire

Alaska

Rhode Island

New York

Massachusetts

Washington

Oregon

Connecticut

Nevada

Colorado

Minnesota

Nebraska

Kansas

Wisconsin

Missouri

New Jersey

North Dakota

Indiana

Maryland

Michigan

Montana

Iowa

Illinois

California

Delaware

Florida

Wyoming

South Dakota

Ohio

Virginia

Oklahoma

Idaho

D.C.

Hawaii

Texas

Arizona

Kentucky

Arkansas

Louisiana

North Carolina

Tennessee

West Virginia

Utah

South Carolina

Georgia

New Mexico

Alabama

Mississippi

120 140 160 180

Per 100,000

Age-adjusted Rate

120 140 160 180

Per 100,000

0 5000 15000

Predicted # Cases

0 5000 15000

Key Dot Color Links Horizontally

Nebraska

95% Confidence Intervals U.S. Values
40

Predicted Other Cancer Incidence Rates and Counts by State, Males, 1999

Micromaps

Appears Below

Appears Above

Median

States

Massachusetts

Pennsylvania

Maine

New Hampshire

Rhode Island

Vermont

New Jersey

Connecticut

New York

Michigan

Missouri

Ohio

Oregon

Nevada

Indiana

Washington

Wisconsin

Alaska

Illinois

Florida

Colorado

Minnesota

Iowa

Kentucky

Wyoming

Louisiana

Delaware

Montana

West Virginia

South Dakota

Kansas

Idaho

Arkansas

California

North Carolina

Arizona

Nebraska

Tennessee

Alabama

Virginia

North Dakota

Maryland

Mississippi

Utah

Oklahoma

South Carolina

Texas

New Mexico

Hawaii

Georgia

D.C.

200 220 240 260

Per 100,000

Age-adjusted Rate

200 220 240 260

Per 100,000

0 10000 20000 30000

Predicted # Cases

0 10000 20000 30000

Key Dot Color Links Horizontally

Nebraska

95% Confidence Intervals U.S. Values
41

Predicted Other Cancer Incidence Rates and Counts by State, Females, 1999

Micromaps

Appears Below

Appears Above

Median

States

New Hampshire

Massachusetts

Maine

Rhode Island

Vermont

Connecticut

New York

Michigan

Pennsylvania

Alaska

Wisconsin

Washington

New Jersey

Minnesota

Ohio

Indiana

Oregon

Illinois

Missouri

North Dakota

Montana

Iowa

Nevada

Wyoming

Colorado

Delaware

Nebraska

South Dakota

Idaho

Kansas

Maryland

California

West Virginia

Kentucky

Virginia

Utah

Arizona

D.C.

North Carolina

Tennessee

Florida

South Carolina

Louisiana

Arkansas

New Mexico

Alabama

Hawaii

Oklahoma

Mississippi

Georgia

Texas

150 170 190 210

Per 100,000

Age-adjusted Rate

150 170 190 210

Per 100,000

0 10000 20000 30000

Predicted # Cases

0 10000 20000 30000

Key Dot Color Links Horizontally

Nebraska

95% Confidence Intervals U.S. Values
42

Predicted Total Cancer Incidence Rates and Counts by State, Males, 1999

Micromaps

Appears Below

Appears Above

Median

States

Pennsylvania

Maine

Massachusetts

Michigan

New Hampshire

Rhode Island

Ohio

New York

New Jersey

Vermont

Indiana

Delaware

Missouri

Wisconsin

Connecticut

Oregon

Nevada

Washington

Illinois

West Virginia

Kentucky

Louisiana

Florida

North Carolina

Alabama

Maryland

Mississippi

Arkansas

Iowa

South Carolina

Tennessee

Minnesota

Colorado

Virginia

Wyoming

Idaho

Montana

Nebraska

Alaska

Kansas

D.C.

California

South Dakota

Georgia

Texas

Arizona

North Dakota

Utah

Oklahoma

Hawaii

New Mexico

450 500 550 600 650

Per 100,000

Age-adjusted Rate

450 500 550 600 650

Per 100,000

0 20000 40000 60000

Predicted # Cases

0 20000 40000 60000

Key Dot Color Links Horizontally

Nebraska

95% Confidence Intervals U.S. Values
43

Predicted Total Cancer Incidence Rates and Counts by State, Females, 1999

Micromaps

Appears Below

Appears Above

Median

States

Alaska

Maine

New Hampshire

Vermont

Pennsylvania

Massachusetts

Rhode Island

Delaware

New York

Connecticut

Washington

Oregon

Michigan

Missouri

Minnesota

Wisconsin

New Jersey

Nevada

Maryland

Indiana

North Dakota

Florida

Ohio

Illinois

West Virginia

Nebraska

Iowa

Virginia

Kentucky

Kansas

South Dakota

North Carolina

California

Colorado

Montana

Tennessee

Wyoming

South Carolina

D.C.

Louisiana

Oklahoma

Arkansas

Idaho

Texas

Hawaii

Alabama

Georgia

Arizona

Mississippi

New Mexico

Utah

350 400 450 500 550

Per 100,000

Age-adjusted Rate

350 400 450 500 550

Per 100,000

0 20000 40000 60000

Predicted # Cases

0 20000 40000 60000

Key Dot Color Links Horizontally

Nebraska

95% Confidence Intervals U.S. Values

45

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