Xiao Cheng Wu, MD. MPH, Associate Professor and Assistant Director of the Louisiana Tumor Registry at LSU Health Sciences Center New Orleans School of Public Health, co-authored the Annual Report to the Nation on the Status on Cancer, 1975-2005, Featuring Trends in Lung Cancer, Tobacco Use, and Tobacco Control. The paper reports, for the first time, declines in both cancer incidence and death rates, as well as wide variations in lung cancer trends from state to state. It will be published by the Journal of the National Cancer Institute in the December 2, 2008 issue, available online on November 25, 2008.
Data were drawn from a number of sources including National Cancer Institute designated Surveillance Epidemiology and End Results (SEER) cancer registries, one of which is the Louisiana Tumor Registry at LSU Health Sciences Center New Orleans School of Public Health.
The report, which is a collaboration of the American Cancer Society, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries, reports that both incidence and death rates from all cancers combined are decreasing significantly in men and women overall and in most racial and ethnic populations. These decreases are largely driven by declines in the three most common cancers in men (lung, colorectum, and prostate) and in two of the three leading cancers in women (breast and colorectum), combined with a leveling off of lung cancer death rates in women. Although the national trend in female lung cancer death rates has stabilized since 2003, there is prominent state and regional variation. Lung cancer incidence and/or death rates among women increased in 18 states, 16 of them in the South or Midwest. California was the only state with decreasing lung cancer incidence and death rates in women."Lung cancer is the most frequently diagnosed cancer and leading cause of cancer death in Louisiana," notes Dr. Wu. "Although lung cancer incidence and death rates are declining among Louisiana men, they still rank the fourth and fifth, respectively, in the nation. Among Louisiana women, lung cancer incidence and death rates continue to increase. Cigarette smoking is the major cause of lung cancer in the United States. To reduce risk of lung cancer, we have to reduce cigarette smoking and exposure to second-hand smoke."
Among the findings:
- Overall incidence rates for all racial and ethnic populations combined decreased by 0.8% per year from 1999 through 2005 in both sexes combined, 1.8% per year from 2001 through 2005 in men, and 0.6% per year from 1998 through 2005 in women.
- Black men had the highest cancer incidence rate for 2001-2005 among all men and white women had the highest rate among all women.
- Among men, rates continued to decrease for lung and bronchus(lung), colon and rectal (colorectal), oral cavity and pharynx (oral cavity), and stomach cancers. For prostate cancer, rates decreased by 4.4% per year in the period 2001 through 2005 after increasing by 2.1% annually from 1995 through 2001. In contrast, rates increased for cancers of the kidney and renal pelvis (kidney), liver and intrahepatic bile duct (liver), and esophagus and for myeloma, non-Hodgkin lymphoma (NHL), and melanoma of the skin (melanoma). Incidence rates were stable for cancers of urinary bladder (bladder), pancreas, and brain and other nervous system (brain) and for leukemia.
- Among women, incidence rates decreased during the most recent joinpoint segments for six of the top 15 cancers [breast, colorectum, uterine corpus and uterus NOS (uterus), ovary, cervix uteri (cervix) and oral cavity]. Rates increased for the remaining 9 of the top 15 cancers (lung, thyroid, pancreas, bladder, kidney, brain, NHL, melanoma, and leukemia).
- Overall cancer death rates continued to decrease since the early 1990s in both
men and women. Death rates decreased by 1.5% per year from 1993 through 2001 and 2.0% per year from 2001 through 2005 in men and by 0.8% per year from 1994 through 2002 and 1.6% per year from 2002 through 2005 in women.
- Death rates for all cancers combined (2001-2005) were highest for blacks and lowest for Asian American/Pacific Islander(API) men and women. Cancers of the lung, prostate and colorectum were the three leading causes of cancer death in rank order among men for each major racial and ethnic population, except API men in whom cancer of the liver ranked second. The corresponding leading causes of cancer death in rank order among women were lung, breast and colorectum, except among Hispanic women in whom breast cancer ranked first.
- Among men, the lung cancer death rate decreased during the years 1996 to 2005 in 44 of the 50 states and in the District of Colombia, whereas in women, the death rate decreased in only three states (California, New Jersey, and Texas), and increased in 13 states (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Kansas, South Dakota, Indiana, Michigan, and Iowa.
- Trends in initiation of smoking among 12-17 year-old adolescents in the United States, 1940 through 2000, show that initiation rates increased sharply in girls from 1965 through 1975. Subsequently, rates decreased through mid the 1980s in both girls and boys, but rose again from 1990 through the mid-1990s, especially in boys. Initiation rates were similar for boys and girls during the most recent data years (1996 through 2000).
The researchers conclude that while the decrease in overall cancer incidence and death rates is encouraging, the large state and regional differences in lung cancer trends among women underscore the need to maintain and strengthen many state tobacco control programs.
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