Cancer Incidence & Mortality

Date posted: 03/02/2007

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 American Cancer Society.

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 that 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-

What this chart shows: Cancer Incidence Rates (per 100,000) in Colorado & Larimer County, 1993-2002

Data Source: Colorado Health Information Dataset- Cancer Incidence Statistics

See data table

What these data tell us:

In Larimer County, the average rate of new cancer cases (incidence) was lower than that of Colorado from 1993 to 2002, (432 versus 449 per 100,000). However, for the years 1998-2002, Larimer County had a higher rate than Colorado (450 versus 448). The decline in the incidence rate (Colorado, 1992-1994; Larimer County 1993-1994) may have been reflective of a national trend for the period 1990-1995. However, from 1995-2003, national incidence rates were relatively stable (National Cancer Institute), while Larimer County rates sharply increased (1994-2001) and Colorado rates gradually decreased (1996-2000).

The Colorado Department of Public Health & Environment attributes the decline in overall incidence rates in Colorado (1995-1999) to lower lung, prostate, and colorectal cancer rates (resulting from a decreased smoking rate [lung] and early detection [prostate, colorectal] statewide). 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's 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. To see a chart/ table of Increasing Cancer Incidence Rates (per 100,000) in Larimer County, 1994-2001, click here.

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

Data Source: Colorado Health Information Dataset- Death Statistics

See data table

What these data tell us:

From 2000 to 2005, cancer mortality rates for Colorado and Larimer County followed similar trends. In fact, the average rates for cancer mortality in

Colorado and Larimer County were comparable at 171 and 163 per 100,000, respectively.

Larimer County first met Healthy People 2010 objectives (160 per 100,000) in 2003 and has remained within these limits, while Colorado reached this level in 2004 and currently resides just outside the standard. The decline in mortality rates (2003-2004) is most likely reflective of a national trend showing decreases in a number of the most common types of cancer (such as breast, prostate, and colorectal cancers) during that period. Again, it must be noted that the standard used for age-adjusted comparisons was updated in 1998. It is unknown how this change affected the mortality trend. To see cancer mortality data by gender, click here. 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 (2002)

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 2002, African-Americans had the highest rates of rates of prostate and lung (& bronchus) cancers in Colorado. Additionally, Asian-Americans/Pacific Islanders had the highest rates of both stomach and liver (& intrahepatic bile duct) cancers, while Hispanics (females) had the highest rate of cervical cancer. Finally, Whites (females) had the highest rate of breast and colorectal cancer.

National data (1998-2002) on new cancer diagnoses by racial/ethnic categories were similar to that of Colorado, with the only exception being that African-Americans had a higher rate of colorectal cancer. Nationally, all sites cancer incidence rates were highest in African-American males and White females. National (site-specific) cancer incidence data by race & gender can be viewed by clicking here.

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: African-Americans may have a higher prevalence of risk factors for colorectal cancer: smoking, family history, obesity, alcohol use, physical inactivity, inflammatory bowel disease, high consumption of red meat and low consumption of fruits and vegetables.

• 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.

A 2003 news release from the Colorado Department of Public Health & Environment discussed cancer mortality data for racial and ethnic groups in Colorado. The release reported that for the 1990's every group in Colorado, except Black males, had a drop in rates of 1-2% per year throughout the decade. The report highlighted that mortality rates for blacks during the late nineties were 6-42% higher than rates for whites. This survival differential is attributed to African-Americans receiving lower quality of healthcare when accessible, possessing higher rates of coexisting conditions and differences in tumor biology. Meanwhile, Asian/ Pacific Islanders have the lowest death rates. While it is not know exactly why Asian/ Pacific Islanders have lower rates of cancer mortality, environmental (smoking, diet, and alcohol intake) and genetic factors are thought to play a primary role.

A data table of total cancer deaths in Colorado by racial/ethnic group (1995-2005) can be viewed by clicking here.

Additional Information:

National Incidence Rates (per 100,000) by Type and Race (1998-2002), Age Adjusted Rates

	Gender	White	African-American	Asian-American & Pacific Islander	American Indian & Alaskan Native	Hispanic/ Latino
Breast	Female	141	119	97	55	90
Cervix	Female	9	11	9	5	16
Prostate	Male	169	272	101	50	142
Colon & Rectum	Female	45	56	40	32	32
	Male	62	73	56	37	48
Lung & Bronchus	Female	51	55	28	24	23
	Male	77	114	59	43	45
Stomach	Female	5	10	12	9	10
	Male	11	18	21	16	17
Liver & Bile Duct	Female	3	4	8	5	6
	Male	7	12	21	9	14

Data Source: American Cancer Society

What this chart shows: Increasing Cancer Incidence Rates (per 100,000) by Type in Larimer County (1994-2001), Crude Rate

Data Source: Colorado Health Information Dataset- Cancer Incidence Statistics

On Compass-

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

Outside Compass-

• American Cancer Society
• Centers for Disease Control and Prevention
• Centers for Disease Control and Prevention: Skin Cancer
• Health District of Northern Larimer County, Community Health Survey: Risk Factors
• Health District of Northern Larimer County, Community Health Survey: Preventive Screenings
• Healthy People 2010
• National Cancer Institute and 2003 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 September 2003, contains a special feature that focuses on surveillance data for cancer prevention and control.

Industry Standards or Targets:

Healthy People 2010:

• Reduce the overall cancer death rate.

• Reduce the lung cancer death rate.

• Reduce the breast cancer death rate.

• Reduce the death rate from cancer of the cervix.

• Reduce the colorectal cancer death rate.

• Reduce the oropharyngeal cancer death rate.

• Reduce the prostate cancer death rate.

• Reduce the rate of melanoma cancer deaths.

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

Data Tables:

Cancer Incidence Rates (per 100,000) in Colorado & Larimer County (1992-2002), Age-Adjusted Rate

	Colorado (Rate)	Larimer (Rate)	Colorado (#)	Larimer (#)
1993	467	455	13,986	753
1994	428	390	13,336	671
1995	451	400	14,436	717
1996	455	408	14,936	755
1997	453	418	15,235	798
1998	451	447	15,658	878
1999	448	430	16,033	886
2000	449	456	16,605	967
2001	452	462	17,471	1028
2002	440	457	17,505	1054

See chart

Data Source: http://www.cdphe.state.co.us/cohid/agreement.html

Cancer Mortality Rates (per 100,000) in Colorado & Larimer County (1995-2005), Age-Adjusted Rate

	Colorado (Rate)	Larimer (Rate)	Colorado (#)	Larimer (#)
1996	180	163	5,656	287
1997	175	170	5,638	312
1998	175	166	5,798	311
1999	171	171	5,830	334
2000	168	164	5,896	334
2001	171	168	6,134	349
2002	174	171	6,372	355
2003	170	160	6,400	352
2004	160	147	6,185	331
2005	161	153	6,367	359

Data Source: http://www.cdphe.state.co.us/cohid/agreement.html

See chart

Site-Specific Cancer Incidence Rate (per 100,000) by Race/Ethnicity

- Colorado (2002), Age-Adjusted Rate

	White		Black		Asian-American/ Pacific Islander		Hispanic
	Rate	#	Rate	#	Rate	#	Rate	#
Breast	73	2,467	51	69	37	34	46	223
Cervix	3	116	5	7	4	5	6	36
Prostrate	76	2,411	88	105	23	16	46	211
Colon & Rectum	46	1,434	36	38	31	25	37	174
Lung & Bronchus	57	1,754	72	72	36	24	35	160
Stomach	5	138	8	9	13	11	9	42
Liver & Intrahepatic Bile Duct	4	123	7	7	23	19	10	46

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

Data Source: http://www.cdphe.state.co.us/cohid/agreement.html

See chart

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