Cancer Incidence & Mortality

Date posted: 08/24/2009

Cancer develops when cells in a part of the body begin to grow out of control. Cancer cells develop because of damage to DNA (a substance present in every cell that directs all activities) and once formed, these cells may travel to other parts of the body and replace normal tissue (a process called metastasis). The sooner a cancer is found, the better the odds for survival. The risk for developing most types of cancer may be reduced through lifestyle changes (such as quitting smoking and improved diet). For more information on cancer and resources see the American Cancer Society website.

The following data were obtained from the Colorado Department of Public Health & Environment's Colorado Health Information Database (COHID). CDPHE protects patient confidentiality by limiting access to data when identification is statistically possible. Therefore, in certain circumstances (such as for Racial & Ethnic Health Data), data for Larimer County were suppressed and unavailable for analysis. Rates used in this report were per 100,000 residents and include: 1) age-adjusted rates (used to provide a basis of comparison for two groups) and crude rates (utilized only in cases where one population was observed). In 2002, the standard comparison group for age-adjusted cancer incidence rates was updated. It is recommended that data from 2002 and later not be compared with data before 2002. Additionally, in 1999, the standard comparison group for age-adjusted mortality rates was also updated. COHID states this change may affect trends in mortality.

Definitions:

Incidence - the number of new diagnoses within a population

Mortality - the number or rate of deaths that occur in a population

Age-adjusted rates - the rate that would occur if populations had age distributions equal to a standard population

Crude rates - = Number of deaths from a specific disease / Number of people in the population

What this chart shows: Cancer Incidence Rates (per 100,000) in Colorado & Larimer County, 1996-2005

*Age-Adjusted Rate

Data Source: Colorado Health Information Dataset

See data table

What these data tell us:

In Larimer County, the rate of new cancer cases (incidence) was lower than that of Colorado from 1996 to 1999. The trend changed, beginning in 2000, and since then Larimer County's incidence rates have been higher than Colorado's rates.

The increases in Larimer County may have been due to higher rates of breast, skin (melanoma), colorectal and urinary bladder cancers, as well as an increase in non-Hodgkin lymphoma. The decline in rates for 2002 (Colorado & Larimer County) may have been due to changes in the standard used for age-adjusted comparisons. It is unknown how the rates may have been affected by the change in the standard, however the Colorado Department of Public Health and Environment suggests that rates based on the new standard will appear 15-20% higher. For more information, see the chart/ table of Increasing Cancer Incidence Rates (per 100,000) in Larimer County, 1996-2005.

What this chart shows: Cancer Mortality Rates (per 100,000) in Colorado & Larimer County, 1998-2007

*Age-Adjusted Rate

Data Source: Colorado Health Information Dataset

See data table

What these data tell us:

From 1998 to 2007, cancer mortality rates for Colorado and Larimer County generally followed similar trends. In fact, the average rates for cancer mortality in Colorado and Larimer County were comparable at 167 and 161 per 100,000, respectively.

Larimer County first met Healthy People 2010 objectives (160 per 100,000) in 2003 and has remained within these limits with the exception of 2006. Colorado reached this level in 2004 and currently resides just outside the standard. The decline in mortality rates (2003, 2004 and 2007) is most likely reflective of a national trend showing decreases in lung, prostate, and colon cancer in men, and breast and colorectal cancer in women during that period. The decline in death rate is important because this is the best indicator of progress against cancer. The American Cancer Society attributed national decreases to reduced exposure to tobacco, earlier detection through screening, and more effective treatment.

What this chart shows: Site-Specific Cancer Incidence Rate (per 100,000) by Race/Ethnicity, Colorado (2005)

Rates for Native Americans were unavailable or suppressed to protect patient confidentiality.

*Age-Adjusted Rate

Data Source: Colorado Health Information Dataset

See data table

What these data tell us:

Colorado figures were used, because Larimer County race and ethnicity data were withheld to protect patient confidentiality. In 2005, African-Americans had the highest incidence rates of prostate and lung cancers in Colorado. Additionally, Hispanics had the highest rates of stomach, liver & intrahepatic bile duct, and colorectal cancers. Finally, White females had the highest rate of breast cancer.

National data (2001-2005) on new cancer diagnoses by racial/ethnic categories were similar to that of Colorado, with the exception that African-Americans had a higher incidence rate of colorectal and stomach cancers. Nationally, all sites cancer incidence rates were highest in African-American males and White females. For more information on national statistics by race and gender, see National Incidence Rates by Type and Race (2001-2005).

The reasons for these ethnic/racial differences in cancer incidence are not well understood. The differences are most likely a combination of environmental (dietary, lifestyle, etc), occupational, and genetic factors. Potential reasons why ethnic/racial groups are prone to certain types of cancer are discussed below.

• African-Americans

Lung cancer: Many African-Americans lack access to healthcare, experience poverty, may be exposed to cancer-causing agents in the workplace, and have higher rates of cigarette smoking (also smoke more intensely, and smoke cigarettes that are higher in tar and carcinogenic materials, i.e., menthol).

Prostate cancer: African-Americans have a higher risk of early-onset familial prostate cancer due to an alteration in a specific gene.

Colorectal cancer: More African-Americans lack health insurance coverage and have fewer screenings than Whites, two major factors in early cancer detection and increased survival rates.

• Asian/ Pacific Islanders

Liver cancer: People born in Southeast Asia and the Pacific Islands are at high-risk for the Hepatitis B virus. This is due to a high prevalence rate and lack of access to vaccine. Hepatitis B is easily transmitted and significantly increases the risk of getting liver cancer.

Stomach cancer: Many Asians eat smoked, salted, and pickled foods and do not consume enough fresh fruits and vegetables. Also, infection with H pylori bacteria (which is reported to be higher in most Asian countries) doubles the risk for stomach cancer.

• Hispanic/ Latino

Cervical cancer: Hispanic females have lower rates of Pap screenings and higher rates of human papilloma virus, the main cause of cervical cancer.

• Whites

Breast cancer: White females are more likely to consume alcohol and utilize hormone replacement therapy.

Hispanics comprise the largest minority group in Larimer County (Population by Race & Ethnicity) and are disproportionately diagnosed with several types of cancer. According to the Intercultural Cancer Council, only 38% of Hispanic women age 40 and older have regular mammograms. Even though Hispanic women have lower rates of breast cancer than White or African-American women, breast cancer is the leading cause of cancer death among Hispanics. In addition, the five-year survival rate for White women with breast cancer is 85% compared to 76% for Hispanic women. Hispanics also have higher incidence and mortality rates for stomach and primary liver cancer. It is believed there are many reasons for these discrepancies including poverty, lack of insurance, lower education, limited access to health care, lack of awareness of risks and screening methods, acculturation levels and barriers related to language, culture, and negative provider attitudes to name a few.

See Total Cancer Deaths by Race/Ethnicity in Colorado (1998-2007) for a breakdown of cancer deaths in Colorado by race/ethnicity.

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What this chart shows: Increasing Cancer Incidence Rates* by Type in Larimer County, 1996-2005

*Age-Adjusted Rate

Data Source: Colorado Health Information Dataset - Cancer Incidence Statistics

Additional Information:

National Incidence Rates (per 100,000) by Type and Race (2001-2005), Age-Adjusted Rates

	Gender	White	African-American	Asian-American & Pacific Islander	Native American & Alaskan Native	Hispanic
Breast	Female	130.6	117.5	89.6	75.0	90.1
Cervix	Female	8.2	10.8	8.0	6.9	13.2
Prostate	Male	156.7	248.5	93.8	73.3	138.0
Colon & Rectum	Male	58.9	71.2	48.0	46.0	47.3
	Female	43.2	54.5	35.4	41.2	42.8
Lung & Bronchus	Male	79.3	107.6	53.9	54.3	44.2
	Female	54.9	54.6	28.0	39.7	25.4
Stomach	Male	10.0	17.4	18.6	16.8	15.5
	Female	4.7	8.9	10.5	7.7	9.5
Liver & Bile Duct	Male	8.2	13.2	21.7	14.4	15.0
	Female	2.9	4.0	8.3	6.3	5.8

Data Source: American Cancer Society

Total Cancer Deaths by Race/ Ethnicity in Colorado

	White	African-American	Asian American & Pacific Islander	American Indian & Alaskan Native	Hispanic
1998	5,552	175	54	16	423
1999	5,535	212	59	23	411
2000	5,619	207	60	9	442
2001	5,813	229	70	21	505
2002	6,063	205	77	26	545
2003	6,079	214	81	23	603
2004	5,878	190	92	25	579
2005	6,004	228	103	29	574
2006	6,164	224	97	31	606
2007	6,240	243	72	29	576

Data Source: Colorado Health Information Dataset - Death Statistics

On Compass-

• Adult Alcohol Use
• Adult Tobacco Use
• Lung Cancer Incidence & Mortality
• Men's Health
• Mortality
• Women's Health

Outside Compass-

• American Cancer Society
• Centers for Disease Control and Prevention
• Healthy People 2010
• National Cancer Institute and Report to the Nation on the Status of Cancer: An annual update on cancer occurrence and trends in the United States. The current report, published in November 2008, contains a special feature that focuses on lung cancer, tobacco use, and tobacco control.

Industry Standards or Targets:

Healthy People 2010:

• 3-1. Reduce the overall cancer death rate to 159.9 per 100,000 population.
• 3-2. Reduce the lung cancer death rate to 44.9 per 100,000 population.
• 3-3. Reduce the breast cancer death rate to 22.3 per 100,000 population.
• 3-4. Reduce the cervical cancer death rate to 2.0 per 100,000 population.
• 3-5. Reduce the colorectal cancer death rate to 13.9 per 100,000 population.
• 3-6. Reduce the oropharyngeal cancer death rate to 2.7 per 100,000 population.
• 3-7. Reduce the prostate cancer death rate to 28.8 per 100,000 population.
• 3-8. Reduce the melanoma cancer death rate to 2.5 per 100,000 population.

• See a comprehensive list of Healthy People 2010 objectives related to cancer.

Data Tables:

Cancer Incidence Rates (per 100,000) in Colorado & Larimer County, Age-Adjusted Rate

	Colorado		Larimer County
	Number	Rate	Number	Rate
1996	14,954	455.3	756	408.6
1997	15,252	453.9	798	417.8
1998	15,714	452.2	883	449.7
1999	16,118	450.5	891	432.3
2000	16,705	451.3	981	462.6
2001	17,729	467.4	1,054	482.8
2002	17,832	458.9	1,067	471.9
2003	17,887	447.5	1,063	462.9
2004	17,942	434.9	1,064	444.8
2005	18,494	437.0	1,107	450.1

See chart

Cancer Mortality Rates (per 100,000) in Colorado & Larimer County, Age-Adjusted Rate

	Colorado		Larimer County
	Number	Rate	Number	Rate
1998	5,798	174.9	311	165.6
1999	5,830	170.9	334	170.7
2000	5,896	167.8	334	164.3
2001	6,134	170.6	349	168.0
2002	6,372	173.8	355	170.7
2003	6,400	169.7	352	160.0
2004	6,185	159.6	331	146.0
2005	6,367	160.5	359	151.7
2006	6,523	160.2	393	162.6
2007	6,590	157.9	386	152.7

See chart

Site-Specific Cancer Incidence Rate (per 100,000) by Race/Ethnicity* -
Colorado (2005), Age-Adjusted Rate

	White		Hispanic		African-American		Asian-American/ Pacific Islander
	Number	Rate	Number	Rate	Number	Rate	Number	Rate
Breast	2,563	69.8	257	55.2	62	44.3	44	39.4
Cervix	103	2.7	34	5.8	9	5.9	4	3.6
Prostate	228	62.0	2,580	72.4	130	96.6	21	24.1
Colon & Rectum	1,526	44.6	197	48.5	50	39.8	25	30.9
Lung & Bronchus	1,728	51.1	136	40.3	65	52.7	30	33.6
Stomach	150	4.4	47	12.2	7	5.7	9	9.7
Liver & Intrahepatic Bile Duct	149	4.1	52	12.3	8	4.6	10	9.9

* Colorado Native American figures were either unavailable or suppressed to protect confidentiality.

See chart

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