Cancer Statistics 2009

Slide 1:Cancer Statistics 2009

A Presentation From the American Cancer Society ©2009, American Cancer Society, Inc. The American Cancer Society presents Cancer Statistics 2009. The American Cancer Society presents Cancer Statistics 2009.

Slide 2:2009 Estimated US Cancer Deaths*

ONS=Other nervous system. Source: American Cancer Society, 2009. Men292,540 Women269,800 26% Lung & bronchus 15% Breast 9% Colon & rectum 6% Pancreas 5% Ovary 4% Non-Hodgkin lymphoma 3% Leukemia 3% Uterine corpus 2% Liver & intrahepatic bile duct 2% Brain/ONS 25% All other sites Lung & bronchus 30% Prostate 9% Colon & rectum 9% Pancreas 6% Leukemia 4% Liver & intrahepatic 4%bile duct Esophagus 4% Urinary bladder 3% Non-Hodgkin 3% lymphoma Kidney & renal pelvis 3% All other sites 25% Lung cancer is, by far, the most common fatal cancer in men (30%), followed by prostate (9%), and colon & rectum (9%). In women, lung (26%), breast (15%), and colon & rectum (9%) are the leading sites of cancer death. Lung cancer is, by far, the most common fatal cancer in men (30%), followed by prostate (9%), and colon & rectum (9%). In women, lung (26%), breast (15%), and colon & rectum (9%) are the leading sites of cancer death.

Slide 3:US Mortality, 2006

*Includes nephrotic syndrome and nephrosis. Source: US Mortality Data 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 1. Heart Diseases 631,636 26.0 2. Cancer 559,888 23.1 3. Cerebrovascular diseases 137,119 5.7 4. Chronic lower respiratory diseases 124,583 5.1 5. Accidents (unintentional injuries) 121,599 5.0 6. Diabetes mellitus 72,449 3.0 7. Alzheimer disease 72,432 3.0 8. Influenza & pneumonia 56,326 2.3 Nephritis* 45,344 1.9 10. Septicemia 34,234 1.4 Rank Cause of Death No. of deaths % of all deaths Cancer accounts for nearly one-quarter of deaths in the United States, exceeded only by heart diseases. In 2006, there were 559,888 cancer deaths in the US.Cancer accounts for nearly one-quarter of deaths in the United States, exceeded only by heart diseases. In 2006, there were 559,888 cancer deaths in the US.

Slide 4:Change in US Death Rates* from 1991 to 2006

* Age-adjusted to 2000 US standard population. Sources: US Mortality Data, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 1991 2006 Rate Per 100,000 Compared to the peak rate of 215.1 per 100,000 in 1991, the cancer death rate decreased 16% to 180.7 in 2006. Rates for other major chronic diseases decreased substantially during this period. Compared to the peak rate of 215.1 per 100,000 in 1991, the cancer death rate decreased 16% to 180.7 in 2006. Rates for other major chronic diseases decreased substantially during this period.

Slide 5:Trends in the Number of Cancer Deaths Among Men and Women, US, 1930-2006

Women Men Number of Cancer Deaths Men Women Source: US Mortality Data, 1930-2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. Despite a continuing decline in the cancer death rate from 2005 to 2006, there was an increase in the recorded number of cancer deaths in 2006 as a result of the aging and growth of the US population. The number of cancer deaths decreased by 358 in men and increased by 926 in women, resulting in a net increase of 568 cancer deaths. Despite a continuing decline in the cancer death rate from 2005 to 2006, there was an increase in the recorded number of cancer deaths in 2006 as a result of the aging and growth of the US population. The number of cancer deaths decreased by 358 in men and increased by 926 in women, resulting in a net increase of 568 cancer deaths.

Slide 6:Cancer Death Rates* by Sex, US, 1975-2005

*Age-adjusted to the 2000 US standard population. Source: US Mortality Data 1960-2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. Men Both Sexes Rate Per 100,000 Women The death rate from all cancers combined decreased by 2.0% per year from 2001 to 2005 in men and 1.6% per year from 2002 to 2005 in women. Cancer death rates have been decreasing since 1990 in men and since 1991 in women. Compared to the peak rates in 1990 for men and 1991 for women, the cancer death rate for all sites combined in 2005 was 19.2% lower in men and11.4% lower in women. The death rate from all cancers combined decreased by 2.0% per year from 2001 to 2005 in men and 1.6% per year from 2002 to 2005 in women. Cancer death rates have been decreasing since 1990 in men and since 1991 in women. Compared to the peak rates in 1990 for men and 1991 for women, the cancer death rate for all sites combined in 2005 was 19.2% lower in men and11.4% lower in women.

Slide 7:Cancer Death Rates* Among Men, US,1930-2005

*Age-adjusted to the 2000 US standard population. Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. Lung & bronchus Colon & rectum Stomach Rate Per 100,000 Prostate Pancreas Liver Leukemia Most of the increase in cancer death rates for men prior to 1990 was attributable to lung cancer. However, since 1990, the age-adjusted lung cancer death rate in men has been decreasing; this decrease has been estimated to account for about 40% of the overall decrease in cancer death rates in men. Stomach cancer mortality has decreased considerably since 1930. Death rates for prostate and colorectal cancers have also been declining. Most of the increase in cancer death rates for men prior to 1990 was attributable to lung cancer. However, since 1990, the age-adjusted lung cancer death rate in men has been decreasing; this decrease has been estimated to account for about 40% of the overall decrease in cancer death rates in men. Stomach cancer mortality has decreased considerably since 1930. Death rates for prostate and colorectal cancers have also been declining.

Slide 8:Cancer Death Rates* Among Women, US,1930-2005

*Age-adjusted to the 2000 US standard population. Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. Lung & bronchus Colon & rectum Uterus Stomach Breast Ovary Pancreas Rate Per 100,000 Lung cancer is currently the most common cause of cancer death in women, with the death rate more than twice what it was 30 years ago. In comparison, breast cancer death rates changed little between 1930 and 1990, but decreased 27% between 1990 to 2005. The death rates for stomach and uterine cancers have decreased steadily since 1930; colorectal cancer death rates have been decreasing for more than 50 years. Lung cancer is currently the most common cause of cancer death in women, with the death rate more than twice what it was 30 years ago. In comparison, breast cancer death rates changed little between 1930 and 1990, but decreased 27% between 1990 to 2005. The death rates for stomach and uterine cancers have decreased steadily since 1930; colorectal cancer death rates have been decreasing for more than 50 years.

Slide 9:Cancer Death Rates* by Race and Ethnicity, US, 2001-2005

Overall, cancer death rates are higher in men than women in every racial and ethnic group. African American men and women have higher rates of cancer mortality than their counterparts in every other racial and ethnic group. Asian American and Pacific Islander men and women have the lowest cancer death rates, about half the rate of African American men and women, respectively. Note: Rates for populations other than white and African American may be affected by problems in ascertaining race/ethnicity information from medical records. This is likely to result in reported death rates that are lower than true death rates. Overall, cancer death rates are higher in men than women in every racial and ethnic group. African American men and women have higher rates of cancer mortality than their counterparts in every other racial and ethnic group. Asian American and Pacific Islander men and women have the lowest cancer death rates, about half the rate of African American men and women, respectively. Note: Rates for populations other than white and African American may be affected by problems in ascertaining race/ethnicity information from medical records. This is likely to result in reported death rates that are lower than true death rates.

Slide 10:All sites 313.0 230.7 1.4 Prostate 59.4 24.6 2.4 Larynx 4.8 2.1 2.3 Stomach 11.5 5.0 2.3 Myeloma 8.3 4.3 1.9 Oral cavity and pharynx 6.7 3.8 1.8 Small intestine 0.7 0.4 1.8 Liver and intrahepatic bile duct 10.3 6.7 1.5 Colon and rectum 31.8 22.1 1.4 Esophagus 9.8 7.8 1.3 Lung and bronchus 93.1 71.3 1.3 Pancreas 15.4 12.1 1.3

Cancer Sites in Men for Which African American Death Rates* Exceed White Death Rates*, US, 2001-2005 *Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Site African American White Ratio of African American/White African Americans have higher cancer death rates than whites for numerous cancer sites. Death rates for myeloma and cancers of the prostate, larynx, stomach, oral cavity, esophagus, liver, small intestine, colon and rectum, lung and bronchus, and pancreas are all higher in African American men than in white men. African Americans have higher cancer death rates than whites for numerous cancer sites. Death rates for myeloma and cancers of the prostate, larynx, stomach, oral cavity, esophagus, liver, small intestine, colon and rectum, lung and bronchus, and pancreas are all higher in African American men than in white men.

Slide 11:All sites 186.7 159.2 1.2 Stomach 5.5 2.5 2.2 Myeloma 6.0 2.8 2.1 Uterine cervix 4.7 2.3 2.0 Esophagus 2.8 1.6 1.8 Uterine corpus 7.1 3.9 1.8 Small intestine 0.5 0.3 1.7 Larynx 0.8 0.5 1.6 Colon and rectum 22.4 15.3 1.5 Pancreas 12.4 9.0 1.4 Breast 33.5 24.4 1.4 Gallbladder 1.0 0.8 1.3 Urinary bladder 2.8 2.2 1.3 Liver and intrahepatic bile duct 3.9 2.9 1.3

Cancer Sites in Women for Which African American Death Rates* Exceed White Death Rates*, US, 2001-2005 *Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Site African American White Ratio of African American/White Death rates are higher in African American women than white women for many cancer sites, including myeloma and cancers of the stomach, cervix, esophagus, uterus, small intestine, larynx, colon & rectum, pancreas, breast, gallbladder, bladder, and liver. Death rates are higher in African American women than white women for many cancer sites, including myeloma and cancers of the stomach, cervix, esophagus, uterus, small intestine, larynx, colon & rectum, pancreas, breast, gallbladder, bladder, and liver.

Slide 12:Cancer Death Rates* by Sex and Race, US, 1975-2005

*Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Although overall cancer death rates continue to be higher in African American men than white men, since 1996 the decline in death rates has been larger in African American (2.5% per year) than white men (1.6% per year). Although overall cancer death rates continue to be higher in African American men than white men, since 1996 the decline in death rates has been larger in African American (2.5% per year) than white men (1.6% per year).

Slide 13:2009 Estimated US Cancer Cases*

*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: American Cancer Society, 2009. Men766,130 Women713,220 27% Breast 14% Lung & bronchus 10% Colon & rectum 6% Uterine corpus 4% Non-Hodgkin lymphoma 4% Melanoma of skin 4% Thyroid 3% Kidney & renal pelvis 3% Ovary 3% Pancreas 22% All Other Sites Prostate 25% Lung & bronchus 15% Colon & rectum 10% Urinary bladder 7% Melanoma of skin 5% Non-Hodgkin 5% lymphoma Kidney & renal pelvis 5% Leukemia 3% Oral cavity 3% Pancreas 3% All Other Sites 19% Now we will turn our attention to the number of new cancers anticipated in the US this year. It is estimated that about 1.5 million new cases of cancer will be diagnosed in 2009. Cancers of the prostate and breast will be the most frequently diagnosed cancers in men and women, respectively, followed by lung and colorectal cancers in both men and in women. Now we will turn our attention to the number of new cancers anticipated in the US this year. It is estimated that about 1.5 million new cases of cancer will be diagnosed in 2009. Cancers of the prostate and breast will be the most frequently diagnosed cancers in men and women, respectively, followed by lung and colorectal cancers in both men and in women.

Slide 14:Cancer Incidence Rates* by Sex, US, 1975-2005

*Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008. Both Sexes Men Women Rate Per 100,000 This slide shows trends in cancer incidence for all sites combined, for the years 1975-2005. Overall incidence rates for all racial and ethnic populations combined decreased by 0.8% per year from 1999 through 2005 in both sexes combined, by 1.8% per year from 2001 through 2005 in men, and by 0.6% per year from 1998 through 2005 in women. (Annual Report to the Nation on the Status of Cancer, 1975-2005, Featuring Trends in Lung Cancer, Tobacco Use, and Tobacco Control. JNCI December 3, 2008)This slide shows trends in cancer incidence for all sites combined, for the years 1975-2005. Overall incidence rates for all racial and ethnic populations combined decreased by 0.8% per year from 1999 through 2005 in both sexes combined, by 1.8% per year from 2001 through 2005 in men, and by 0.6% per year from 1998 through 2005 in women. (Annual Report to the Nation on the Status of Cancer, 1975-2005, Featuring Trends in Lung Cancer, Tobacco Use, and Tobacco Control. JNCI December 3, 2008)

Slide 15:Cancer Incidence Rates* Among Men, US, 1975-2005

Prostate Lung & bronchus Colon and rectum Urinary bladder Non-Hodgkin lymphoma Rate Per 100,000 Melanoma of the skin *Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008. Incidence rates of prostate cancer have changed substantially over the last 20 years: rapidly increasing from 1988 to 1992, declining sharply from 1992 to 1995, increasing again from 1995 to 2001, and decreasing from 2001 to 2005, due, in part, to changes in prostate cancer screening with the prostate-specific antigen (PSA) blood testing. Incidence rates for both lung and colorectal cancers in men have declined in recent years.Incidence rates of prostate cancer have changed substantially over the last 20 years: rapidly increasing from 1988 to 1992, declining sharply from 1992 to 1995, increasing again from 1995 to 2001, and decreasing from 2001 to 2005, due, in part, to changes in prostate cancer screening with the prostate-specific antigen (PSA) blood testing. Incidence rates for both lung and colorectal cancers in men have declined in recent years.

Slide 16:Cancer Incidence Rates* Among Women, US, 1975-2005

*Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008. Colon and rectum Rate Per 100,000 Breast Lung & bronchus Uterine Corpus Ovary Non-Hodgkin lymphoma After increasing from 1994 to 1999, breast cancer incidence rates in women decreased by 2.2% per year from 1999 to 2005, likely due in part to a slight decline in mammography utilization and a reduction in use of hormone replacement therapy. During the most recent time period, incidence rates of lung cancer have increased slightly by 0.5% per year since 1991, while rates of colorectal cancer have been decreasing rapidly by 2.2% per year since 1998. After increasing from 1994 to 1999, breast cancer incidence rates in women decreased by 2.2% per year from 1999 to 2005, likely due in part to a slight decline in mammography utilization and a reduction in use of hormone replacement therapy. During the most recent time period, incidence rates of lung cancer have increased slightly by 0.5% per year since 1991, while rates of colorectal cancer have been decreasing rapidly by 2.2% per year since 1998.

Slide 17:Cancer Incidence Rates* by Race and Ethnicity, 2001-2005

*Age-adjusted to the 2000 US standard population. †Person of Hispanic origin may be of any race. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Rate Per 100,000 Overall, cancer incidence rates are higher in men than women. Among men, African Americans have the highest incidence followed by white, Hispanic, Asian American/Pacific Islander, and American Indian/Alaskan Natives. Racial differences in cancer incidence among women are less pronounced; white women have the highest incidence rates followed by African American, Hispanic, American Indian/Alaskan Native, and Asian American/Pacific Islander women. Note: Rates for populations other than white and African American may be affected by problems in ascertaining race/ethnicity information from medical records. This is likely to result in reported incidence rates that are lower than true incidence rates. Data for American Indians/Alaska Natives is based on Contract Health Service Delivery Areas, comprising 54% of the total US American Indian/Alaska Native population. Overall, cancer incidence rates are higher in men than women. Among men, African Americans have the highest incidence followed by white, Hispanic, Asian American/Pacific Islander, and American Indian/Alaskan Natives. Racial differences in cancer incidence among women are less pronounced; white women have the highest incidence rates followed by African American, Hispanic, American Indian/Alaskan Native, and Asian American/Pacific Islander women. Note: Rates for populations other than white and African American may be affected by problems in ascertaining race/ethnicity information from medical records. This is likely to result in reported incidence rates that are lower than true incidence rates. Data for American Indians/Alaska Natives is based on Contract Health Service Delivery Areas, comprising 54% of the total US American Indian/Alaska Native population.

Slide 18:Cancer Incidence Rates* by Sex and Race, US,1975-2005

*Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008. African American men White men White women African American women Rate Per 100,000 Cancer incidence rates are consistently higher in African American men than white men. In contrast, cancer incidence rates are generally higher in white women than African American women, although the difference is not as great. Cancer incidence rates are consistently higher in African American men than white men. In contrast, cancer incidence rates are generally higher in white women than African American women, although the difference is not as great.

Slide 19:Lifetime Probability of Developing Cancer, Men, 2003-2005*

Site Risk All sites† 1 in 2 Prostate 1 in 6 Lung and bronchus 1 in 13 Colon and rectum 1 in 18 Urinary bladder‡ 1 in 27 Melanoma§ 1 in 39 Non-Hodgkin lymphoma 1 in 45 Kidney 1 in 57 Leukemia 1 in 67 Oral Cavity 1 in 72 Stomach 1 in 90 The next four slides look at the lifetime probability of developing cancer and relative survival rates of cancer.  Presently, the risk of an American man developing cancer over his lifetime is one in two. The leading cancer sites are prostate, lung, and colon and rectum. The next four slides look at the lifetime probability of developing cancer and relative survival rates of cancer.  Presently, the risk of an American man developing cancer over his lifetime is one in two. The leading cancer sites are prostate, lung, and colon and rectum.

Slide 20:Lifetime Probability of Developing Cancer, Women, US, 2003-2005*

Site Risk All sites† 1 in 3 Breast 1 in 8 Lung & bronchus 1 in 16 Colon & rectum 1 in 20 Uterine corpus 1 in 40 Non-Hodgkin lymphoma 1 in 53 Urinary bladder‡ 1 in 84 Melanoma§ 1 in 58 Ovary 1 in 72 Pancreas 1 in 75 Uterine cervix 1 in 145 Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0 Statistical Research and Applications Branch, NCI, 2008. http://srab.cancer.gov/devcan * For those free of cancer at beginning of age interval. Approximately one in three women in the United States will develop cancer over her lifetime. The leading sites are breast, lung, and colon and rectum. Approximately one in three women in the United States will develop cancer over her lifetime. The leading sites are breast, lung, and colon and rectum.

Slide 21:Cancer Survival*(%) by Race,1996-2004

*5-year relative survival rates based on cancer patients diagnosed from 1996 to 2004 and followed through 2005. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Site White Absolute Difference African American The 5-year relative survival rate for cancer is 68% among whites and 58% among African Americans (taking normal life expectancy into consideration). For many sites, survival rates in African Americans are 10% to more than 20% lower than in whites. This is due, in part, to African Americans being less likely to receive a cancer diagnosis at an early, localized stage, when treatment can improve chances of survival. Additional factors that contribute to the survival differential include unequal access to medical care and tumor characteristics. The 5-year relative survival rate for cancer is 68% among whites and 58% among African Americans (taking normal life expectancy into consideration). For many sites, survival rates in African Americans are 10% to more than 20% lower than in whites. This is due, in part, to African Americans being less likely to receive a cancer diagnosis at an early, localized stage, when treatment can improve chances of survival. Additional factors that contribute to the survival differential include unequal access to medical care and tumor characteristics.

Slide 22:Trends in Five-year Relative Survival (%)* Rates, US, 1975-2004

*5-year relative survival rates based on follow up of patients through 2005. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.       Site 1975-1977 1984-1986 1996-2004 All sites 50 54 66 Breast (female) 75 79 89 Colon 52 59 65 Leukemia 35 42 51 Lung and bronchus 13 13 16 Melanoma 82 87 92 Non-Hodgkin lymphoma 48 53 65 Ovary 37 40 46 Pancreas 3 3 5 Prostate 69 76 99 Rectum 49 57 67 Urinary bladder 74 78 81 The survival rates for all cancers combined and for certain site-specific cancers have improved significantly since the 1970s, due, in part, to both earlier detection and advances in treatment. Survival rates markedly increased for cancers of the prostate, breast, colon, rectum, and for leukemia. With new treatment techniques and increased utilization of screening, there is hope for even greater improvements in the not-too-distant future. The survival rates for all cancers combined and for certain site-specific cancers have improved significantly since the 1970s, due, in part, to both earlier detection and advances in treatment. Survival rates markedly increased for cancers of the prostate, breast, colon, rectum, and for leukemia. With new treatment techniques and increased utilization of screening, there is hope for even greater improvements in the not-too-distant future.

Slide 23:Cancer Incidence & Death Rates* in Children 0-14 Years, 1975-2005

Incidence Mortality Rate Per 100,000 *Age-adjusted to the 2000 Standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. The next series of slides look at the burden of cancer among our nation's children. Cancer incidence among children ages 0-14 years has been increasing slightly, by about 0.6% per year, since 1975. Cancer-related mortality in children ages 0-14 has been stable since 1998 after decreasing steadily from 1975 to 1998 by 2.9% per year.The next series of slides look at the burden of cancer among our nation's children. Cancer incidence among children ages 0-14 years has been increasing slightly, by about 0.6% per year, since 1975. Cancer-related mortality in children ages 0-14 has been stable since 1998 after decreasing steadily from 1975 to 1998 by 2.9% per year.

Slide 24:Cancer Incidence Rates* in Children 0-14 Years by Sex, 2001-2005

*Per 100,000, age-adjusted to the 2000 US standard population. ONS = Other nervous system Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Site Male Female Total All sites 16.1 14.1 15.1 Leukemia 5.4 4.5 5.0 Acute Lymphocytic 4.3 3.6 3.9 Brain/ONS 3.4 3.1 3.2 Soft tissue 1.1 1.0 1.1 Non-Hodgkin lymphoma 1.2 0.6 0.9 Kidney and renal pelvis 0.8 0.8 0.8 Bone and Joint 0.7 0.7 0.7 Hodgkin lymphoma 0.7 0.4 0.5 Leukemia is the most common cancer among children ages 0-14 years and comprises approximately 30% of all childhood cancers. Acute lymphocytic leukemia is the most common form of leukemia in children. Cancer of the brain/other nervous system is the second most common incident cancer in both boys and girls. Leukemia is the most common cancer among children ages 0-14 years and comprises approximately 30% of all childhood cancers. Acute lymphocytic leukemia is the most common form of leukemia in children. Cancer of the brain/other nervous system is the second most common incident cancer in both boys and girls.

Slide 25:Cancer Death Rates* in Children 0-14 Years by Sex, US, 2001-2005

*Per 100,000, age-adjusted to the 2000 US standard population. ONS = Other nervous system Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Site Male Female Total All sites 2.7 2.3 2.5 Leukemia 0.8 0.7 0.8 Acute Lymphocytic 0.4 0.3 0.4 Brain/ONS 0.8 0.7 0.7 Non-Hodgkin lymphoma 0.1 0.1 0.1 Soft tissue 0.1 0.1 0.1 Bone and Joint 0.1 0.1 0.1 Kidney and Renal pelvis 0.1 0.1 0.1 Leukemia also accounts for the most cancer deaths in children, comprising roughly a third of cancer deaths among boys and girls 0-14 years. Cancers of the brain/other nervous system are the second leading cause of cancer death in children 0-14.Leukemia also accounts for the most cancer deaths in children, comprising roughly a third of cancer deaths among boys and girls 0-14 years. Cancers of the brain/other nervous system are the second leading cause of cancer death in children 0-14.

Slide 26:Trends in Cancer Survival by Age Group, Children 0-14 Years,1975-2004

*5-year relative survival rates, based on follow up of patients through 2005.Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. 5 - Year Relative Survival Rates * Age Year ofDiagnosis 1975 - 1977 1996 - 2004 1975 - 1977 1996 - 2004 0 - 4 Years 1975 - 1977 1996 - 2004 5 - 9 Years 10 - 14 Years The 5-year relative survival rate for all three age groups has increased significantly since the mid 1970s. For example, among children ages 10-14 years, the 5-year relative survival rate increased from 58.9% for those diagnosed in 1975-77 to 80.0% for those patients diagnosed in 1996-2004. The 5-year relative survival rate for all three age groups has increased significantly since the mid 1970s. For example, among children ages 10-14 years, the 5-year relative survival rate increased from 58.9% for those diagnosed in 1975-77 to 80.0% for those patients diagnosed in 1996-2004.

Slide 27:Tobacco Use in the US, 1900-2005

*Age-adjusted to 2000 US standard population. Source: Death rates: US Mortality Data, 1960-2005, US Mortality Volumes, 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. Cigarette consumption: US Department of Agriculture, 1900-2007. Per capita cigarette consumption Male lung cancer death rate Female lung cancer death rate  Tobacco use is a major preventable cause of death, particularly from lung cancer. The year 2004 marks the anniversary of the release of the first Surgeon General’s report on Tobacco and Health, which initiated a decline in per capita cigarette consumption in the United States. As a result of the cigarette smoking epidemic, lung cancer death rates showed a steady increase through 1990, then began to decline among men. The lung cancer death rate among US women, who began regular cigarette smoking later than men, has begun to plateau after increasing for many decades. Tobacco use is a major preventable cause of death, particularly from lung cancer. The year 2004 marks the anniversary of the release of the first Surgeon General’s report on Tobacco and Health, which initiated a decline in per capita cigarette consumption in the United States. As a result of the cigarette smoking epidemic, lung cancer death rates showed a steady increase through 1990, then began to decline among men. The lung cancer death rate among US women, who began regular cigarette smoking later than men, has begun to plateau after increasing for many decades.

Slide 28:Trends in Cigarette Smoking Prevalence* (%), by Sex, Adults 18 and Older, US, 1965-2007

*Redesign of survey in 1997 may affect trends. Source: National Health Interview Survey, 1965-2007, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. Men Women The reduction in cigarette consumption has been associated with a decrease in adult smoking prevalence in both men and women since 1965. The difference in cigarette smoking across gender narrowed from 1965 to 1985, a result of smoking becoming more popular among women and higher rates of quitting among male smokers following the Surgeon General’s Report. After declining significantly between 1997 and 2004, smoking prevalence in the US remained essentially unchanged between 2004 and 2006. However, in 2007, smoking prevalence declined significantly to 19.8%.The reduction in cigarette consumption has been associated with a decrease in adult smoking prevalence in both men and women since 1965. The difference in cigarette smoking across gender narrowed from 1965 to 1985, a result of smoking becoming more popular among women and higher rates of quitting among male smokers following the Surgeon General’s Report. After declining significantly between 1997 and 2004, smoking prevalence in the US remained essentially unchanged between 2004 and 2006. However, in 2007, smoking prevalence declined significantly to 19.8%.

Slide 29:Current* Cigarette Smoking Prevalence (%) Among High School Students by Sex and Race/Ethnicity, US, 1991-2007

*Smoked cigarettes on one or more of the 30 days preceding the survey.Source: Youth Risk Behavior Surveillance System, 1991, 1995, 1997, 1999, 2001, 2003, 2005, 2007 National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2008. Reduction in cigarette smoking among youth is an important factor in reducing prevalence and addiction in adulthood. Smoking among high school students increased from 1991 to 1997, declined between 1997 and 2003, and remained stable between 2003 and 2007. It is thought that the increase in smoking from 1991 to 1997 was due to aggressive youth targeted marketing and promotions; tobacco companies greatly increased their expenditures and promotions during that period. The subsequent decline is thought to be due to increased price of cigarettes as well as comprehensive tobacco control efforts. However, the recent stall in the rate of decline may reflect increased tobacco industry expenditures on marketing and promotion and declines in funding for comprehensive tobacco control programs. Patterns were similar for all gender and racial/ethnic groups, except for African American females, who have shown a continuous decline since 1999. Reduction in cigarette smoking among youth is an important factor in reducing prevalence and addiction in adulthood. Smoking among high school students increased from 1991 to 1997, declined between 1997 and 2003, and remained stable between 2003 and 2007. It is thought that the increase in smoking from 1991 to 1997 was due to aggressive youth targeted marketing and promotions; tobacco companies greatly increased their expenditures and promotions during that period. The subsequent decline is thought to be due to increased price of cigarettes as well as comprehensive tobacco control efforts. However, the recent stall in the rate of decline may reflect increased tobacco industry expenditures on marketing and promotion and declines in funding for comprehensive tobacco control programs. Patterns were similar for all gender and racial/ethnic groups, except for African American females, who have shown a continuous decline since 1999.

Slide 30:Trends in Consumption of Five or More Recommended Vegetable and Fruit Servings for Cancer Prevention, Adults 18 and Older, US, 1994-2007

The American Cancer Society recommends that individuals eat five or more servings of vegetables and fruits a day for cancer prevention. Fruit and vegetable consumption may protect against cancers of the mouth and pharynx, esophagus, lung, stomach, and colon and rectum. However, there has been little improvement in consumption since the mid-1990s. About one in four adults was eating the recommended servings in 2007.The American Cancer Society recommends that individuals eat five or more servings of vegetables and fruits a day for cancer prevention. Fruit and vegetable consumption may protect against cancers of the mouth and pharynx, esophagus, lung, stomach, and colon and rectum. However, there has been little improvement in consumption since the mid-1990s. About one in four adults was eating the recommended servings in 2007.

Slide 31:Trends in Prevalence (%) of No Leisure-Time Physical Activity, by Educational Attainment, Adults 18 and Older, US, 1992-2007

Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Educational attainment is for adults 25 and older. Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape (2000, 2002, 2004, 2005, 2006, 2007), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2001, 2003, 2005, 2006, 2007, 2008. Adults with less than a high school education All adults The American Cancer Society recommends that adults engage in at least 30 minutes of moderate to vigorous physical activity, above usual activities, on 5 or more days of the week; 45 to 60 minutes of intentional physical activity is preferable. However, similar to trends in nutrition, there has been little change in leisure-time physical activity during the 1990s. About one-fourth of adults do not engage in any leisure-time physical activity. Even more striking is that almost half of adults with less than a high school education do not participate in any leisure-time physical activity. It should be noted that leisure-time physical activity, as presented in this graph, does not reflect job-related physical activity for the currently employed population. While there has been little change in leisure-time physical activity since the early 1990s, data from other sources illustrates long-term social changes have contributed to reduced total physical activity in US adults, including reduced leisure time for physical activity, shifts from using walking as a mode of transportation to increased reliance on automobiles, and shifts to more sedentary or mechanized work. The American Cancer Society recommends that adults engage in at least 30 minutes of moderate to vigorous physical activity, above usual activities, on 5 or more days of the week; 45 to 60 minutes of intentional physical activity is preferable. However, similar to trends in nutrition, there has been little change in leisure-time physical activity during the 1990s. About one-fourth of adults do not engage in any leisure-time physical activity. Even more striking is that almost half of adults with less than a high school education do not participate in any leisure-time physical activity. It should be noted that leisure-time physical activity, as presented in this graph, does not reflect job-related physical activity for the currently employed population. While there has been little change in leisure-time physical activity since the early 1990s, data from other sources illustrates long-term social changes have contributed to reduced total physical activity in US adults, including reduced leisure time for physical activity, shifts from using walking as a mode of transportation to increased reliance on automobiles, and shifts to more sedentary or mechanized work.

Slide 32:Trends in Prevalence (%) of High School Students Attending PE Class Daily, by Grade, US, 1991-2007

Source: Source: Youth Risk Behavior Surveillance System, 1991, 1995, 1997, 1999, 2001, 2003, 2005, 2007 National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2008. Regular physical activity has many important health benefits, including reducing risk factors for cardiovascular disease, cancer, and other chronic diseases. Today however, the prevalence of students attending physical education (PE) class daily is significantly lower than it was in 1991. Given the dramatic rise in the prevalence of overweight among teens (it has tripled since 1980), schools are increasingly being identified as an opportunity to increase physical activity among students.Regular physical activity has many important health benefits, including reducing risk factors for cardiovascular disease, cancer, and other chronic diseases. Today however, the prevalence of students attending physical education (PE) class daily is significantly lower than it was in 1991. Given the dramatic rise in the prevalence of overweight among teens (it has tripled since 1980), schools are increasingly being identified as an opportunity to increase physical activity among students.

Slide 33:Trends in Obesity* Prevalence (%), Children and Adolescents, by Age Group, US, 1971-2006

*Body mass index (BMI) at or above the sex-and age-specific 95th percentile BMI cutoff points from the 2000 sex-specific BMI-for-age CDC Growth Charts. Note: Previous editions of Cancer Statistics used the term “overweight” to describe youth in this BMI category. Source: National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003-2006: Ogden CL, et al. High Body Mass Index for Age among US Children and Adolescents, 2003-2006. JAMA 2008; 299 (20): 2401-05. People who become overweight in childhood and adolescence are more likely to be overweight or obese as adults. With at least half of the overweight children becoming overweight adults, future adult populations are at increased risk for developing cancer and other serious chronic diseases. The prevalence of obese children and adolescents has increased since the 1970s, with the most dramatic increases occurring in the late 1980s and 1990s. In fact, over the past three decades the proportion of obese children has more than doubled among children 2-5 years and 6-11 years, and tripled among adolescents 12-19 years. More recently, however, no changes in obesity prevalence was observed between 2003-2004 and 2005-2006.People who become overweight in childhood and adolescence are more likely to be overweight or obese as adults. With at least half of the overweight children becoming overweight adults, future adult populations are at increased risk for developing cancer and other serious chronic diseases. The prevalence of obese children and adolescents has increased since the 1970s, with the most dramatic increases occurring in the late 1980s and 1990s. In fact, over the past three decades the proportion of obese children has more than doubled among children 2-5 years and 6-11 years, and tripled among adolescents 12-19 years. More recently, however, no changes in obesity prevalence was observed between 2003-2004 and 2005-2006.

Slide 34:Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20 to 74, US, 1960-2006†

*Obesity is defined as a body mass index of 30 kg/m2 or greater. † Age adjusted to the 2000 US standard population. Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003-2004, 2005-2006: National Health and Nutrition Examination Survey Public Use Data Files, 2003-2004, 2005-2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006, 2007. Obesity has reached epidemic proportions in the United States. The percentage of adults age 20 to 74 who are obese increased from 1960 to 2004 with the largest increases occurring in the 1990s. Similar trends were observed among men and women. For the most recent time period, 2005-2006, obesity prevalence did not significantly increase in either men or women from 2003-2004.Obesity has reached epidemic proportions in the United States. The percentage of adults age 20 to 74 who are obese increased from 1960 to 2004 with the largest increases occurring in the 1990s. Similar trends were observed among men and women. For the most recent time period, 2005-2006, obesity prevalence did not significantly increase in either men or women from 2003-2004.

Slide 35:Trends in Overweight* Prevalence (%), Adults 18 and Older, US, 1992-2007

1992 1995 1998 *Body mass index of 25.0 kg/m2or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995, 1998) and Public Use Data Tape (2004-2007), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 2000, 2005, 2007, 2008. 2007 This slide highlights the obesity epidemic as mentioned in the previous slide. In 2007, over 55% of adults in all states, including District of Columbia, were overweight or obese, compared to none in 1992. This slide highlights the obesity epidemic as mentioned in the previous slide. In 2007, over 55% of adults in all states, including District of Columbia, were overweight or obese, compared to none in 1992.

Slide 36:Screening Guidelines for the Early Detection of Breast Cancer, American Cancer Society

Yearly mammograms are recommended starting at age 40. A clinical breast exam should be part of a periodic health examination, about every 3 years for women in their 20s and 30s. Asymptomatic women aged 40 and older should continue to undergo a clinical breast exam, preferably annually*. Beginning in their early 20s, women should be told about the benefits and limitations of breast-self examination. Women should know how their breasts normally feel and report any breast changes promptly to their health care providers. __________ * Beginning at age 40 years, annual CBE should be performed prior to mammography The American Cancer Society states that women aged 40 and older should have an annual mammogram and clinical breast exam (CBE) as part of a periodic health exam. Women should know how their breasts normally feel and report any changes to their health care provider. A breast self-examination (BSE) is an option for women starting in their 20s. The American Cancer Society states that women aged 40 and older should have an annual mammogram and clinical breast exam (CBE) as part of a periodic health exam. Women should know how their breasts normally feel and report any changes to their health care provider. A breast self-examination (BSE) is an option for women starting in their 20s.

Slide 37:Mammogram Prevalence (%), by Educational Attainment and Health Insurance Status, Women 40 and Older, US, 1991-2006

*A mammogram within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavior Risk Factor Surveillance System CD-ROM (1984-1995, 1996-1997, 1998, 1999) and Public Use Data Tape (2000, 2002, 2004, 2006), National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005, 2007. Women with less than a high school education Women with no health insurance All women 40 and older The prevalence of women reporting a mammogram within the past year increased from 50% in 1991 to 64% in 2000, and has since declined to 61% in 2006. During this time, mammogram utilization varied considerably by educational attainment. The prevalence of women with less than a high school education reporting a recent mammogram was approximately 10 percentage points lower than the prevalence for all women. Even more striking is that the prevalence for women with no health insurance is approximately 25 percentage points lower than the prevalence for all women. The prevalence of women reporting a mammogram within the past year increased from 50% in 1991 to 64% in 2000, and has since declined to 61% in 2006. During this time, mammogram utilization varied considerably by educational attainment. The prevalence of women with less than a high school education reporting a recent mammogram was approximately 10 percentage points lower than the prevalence for all women. Even more striking is that the prevalence for women with no health insurance is approximately 25 percentage points lower than the prevalence for all women.

Slide 38:Screening Guidelines for the Early Detection of Cervical Cancer, American Cancer Society

Screening should begin approximately three years after a women begins having vaginal intercourse, but no later than 21 years of age. Screening should be done every year with regular Pap tests or every two years using liquid-based tests. At or after age 30, women who have had three normal test results in a row may get screened every 2-3 years with cervical cytology (either conventional or liquid-based Pap test) alone, or every 3 years with a human papillomavirus DNA test plus cervical cytology. Women 70 and older who have had three or more consecutive Pap tests in the last ten years may choose to stop cervical cancer screening. Screening after a total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer. The American Cancer Society cervical cancer screening guidelines state that women should begin screening approximately three years after she begins having vaginal intercourse, but no later than 21 years of age. Screening should be done every year with regular Pap tests or every two years using liquid-based tests. At or after age 30, women who have had three normal tests in a row may get screened every 2-3 years. Women 70 and older who have had three or more consecutive normal Pap tests in the last 10 years may choose to stop cervical cancer screening. The American Cancer Society cervical cancer screening guidelines state that women should begin screening approximately three years after she begins having vaginal intercourse, but no later than 21 years of age. Screening should be done every year with regular Pap tests or every two years using liquid-based tests. At or after age 30, women who have had three normal tests in a row may get screened every 2-3 years. Women 70 and older who have had three or more consecutive normal Pap tests in the last 10 years may choose to stop cervical cancer screening.

Slide 39:Trends in Recent* Pap Test Prevalence (%), by Educational Attainment and Health Insurance Status, Women 18 and Older, US, 1992-2006

* A Pap test within the past three years. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Educational attainment is for women 25 and older. Source: Behavior Risk Factor Surveillance System CD-ROM (1984-1995, 1996-1997, 1998, 1999) and Public Use Data Tape (2000, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005, 2007. Women with no health insurance Women with less than a high school education All women 18 and older This graph shows that the prevalence of women who have had a Pap test within the past three years has remained high, and has increased during the late 1990s. Throughout the decade, the prevalence among women with less than a high school education as well as the prevalence among women with no health insurance was approximately 10 percent lower than the percentage for all women. This graph shows that the prevalence of women who have had a Pap test within the past three years has remained high, and has increased during the late 1990s. Throughout the decade, the prevalence among women with less than a high school education as well as the prevalence among women with no health insurance was approximately 10 percent lower than the percentage for all women.

Slide 40:Screening Guidelines for the Early Detection of Colorectal Cancer and Adenomas, American Cancer Society 2008

Beginning at age 50, men and women should follow one of the following examination schedules: A flexible sigmoidoscopy (FSIG) every five years A colonoscopy every ten years A double-contrast barium enema every five years A Computerized Tomographic (CT) colonography every five years A guaiac-based fecal occult blood test (FOBT) or a fecal immunochemical test (FIT) every year A stool DNA test (interval uncertain) Tests that detect adenomatous polyps and cancer Tests that primarily detect cancer People who are at moderate or high risk for colorectal cancer should talk with a doctor about a different testing schedule The American Cancer Society recommends that beginning at age 50, men and women, who are at average-risk, should receive one of several options as screening for the early detection of colorectal cancer and adenomas There are significant updates to the guidelines for colorectal cancer screening. Two new tests are now recommended as options for colorectal cancer screening. They are stool DNA (sDNA) and computerized tomographic colonography (also known as virtual colonoscopy). For the first time, screening tests are grouped into categories based on performance characteristics: those that primarily detect cancer early and those that can also detect precancerous polyps. Tests that primarily detect cancer early are fecal (stool) tests, including guaiac-based and immunochemical-based fecal occult blood tests (gFOBT & FIT), and stool DNA tests (sDNA). Tests that detect both precancerous polyps and cancer include flexible sigmoidoscopy, colonoscopy, the double contrast barium enema, and computerized tomographic colonography (also known as virtual colonoscopy). It is the strong opinion of the expert panel that colon cancer prevention should be the primary goal of colorectal cancer screening. Exams that are designed to detect both early cancer and precancerous polyps should be encouraged if resources are available and patients are willing to undergo an invasive test. The American Cancer Society recommends that beginning at age 50, men and women, who are at average-risk, should receive one of several options as screening for the early detection of colorectal cancer and adenomas There are significant updates to the guidelines for colorectal cancer screening. Two new tests are now recommended as options for colorectal cancer screening. They are stool DNA (sDNA) and computerized tomographic colonography (also known as virtual colonoscopy). For the first time, screening tests are grouped into categories based on performance characteristics: those that primarily detect cancer early and those that can also detect precancerous polyps. Tests that primarily detect cancer early are fecal (stool) tests, including guaiac-based and immunochemical-based fecal occult blood tests (gFOBT & FIT), and stool DNA tests (sDNA). Tests that detect both precancerous polyps and cancer include flexible sigmoidoscopy, colonoscopy, the double contrast barium enema, and computerized tomographic colonography (also known as virtual colonoscopy). It is the strong opinion of the expert panel that colon cancer prevention should be the primary goal of colorectal cancer screening. Exams that are designed to detect both early cancer and precancerous polyps should be encouraged if resources are available and patients are willing to undergo an invasive test.

Slide 41:Trends in Recent* Fecal Occult Blood Test Prevalence (%), by Educational Attainment and Health Insurance Status, Adults 50 Years and Older, US, 1997-2006

*A fecal occult blood test within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System CD-ROM (1996-1997, 1999) and Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention and Prevention, 1999, 2000, 2002, 2003, 2005, 2007. In 2006, approximately 16% of US adults 50 and older had a fecal occult blood test (FOBT) in the previous year. Adults with less than a high school education are less likely to report a recent FOBT. The prevalence for adults with no health insurance is about 8 percentage points lower than the prevalence for all adults. In 2006, approximately 16% of US adults 50 and older had a fecal occult blood test (FOBT) in the previous year. Adults with less than a high school education are less likely to report a recent FOBT. The prevalence for adults with no health insurance is about 8 percentage points lower than the prevalence for all adults.

Slide 42:Trends in Recent* Flexible Sigmoidoscopy or Colonoscopy Prevalence (%), by Educational Attainment and Health Insurance Status, Adults 50 Years and Older, US, 1997-2006

*A flexible sigmoidoscopy or colonoscopy within the past ten years. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System CD-ROM (1996-1997, 1999) and Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention and Prevention, 1999, 2000, 2002, 2003, 2005, 2007. While there has been a downward trend during recent years in the use of FOBT, the prevalence of flexible sigmoidoscopy (FSIG) or colonoscopy has continuously increased from 1997 to 2006. Adults with less than a high school education were less likely to report FSIG or colonoscopy than all adults. Even more striking is that the prevalence for adults with no health insurance is about half that for all adults. Continuing efforts are needed to address health system barriers to colon cancer screening, to encourage health care practitioners to promote screening to their patients, and to raise awareness among eligible adults about the importance of getting screened for CRC.While there has been a downward trend during recent years in the use of FOBT, the prevalence of flexible sigmoidoscopy (FSIG) or colonoscopy has continuously increased from 1997 to 2006. Adults with less than a high school education were less likely to report FSIG or colonoscopy than all adults. Even more striking is that the prevalence for adults with no health insurance is about half that for all adults. Continuing efforts are needed to address health system barriers to colon cancer screening, to encourage health care practitioners to promote screening to their patients, and to raise awareness among eligible adults about the importance of getting screened for CRC.

Slide 43:Screening Guidelines for the Early Detection of Prostate Cancer, American Cancer Society

Beginning at age 50, to men who have a life expectancy of at least 10 years, health care providers should discuss the potential benefits and limitations of prostate cancer early detection testing with men and offer the PSA blood test and the digital rectal examination.* ___________ * Information should be provided to men regarding the benefits and limitations of testing so that an informed decision concerning testing can be made with the clinician’s assistance. Health care providers should discuss the potential benefits and limitations of prostate cancer early detection testing with men. Information should be provided to men regarding the benefits and limitation of testing so that an informed decision concerning testing can be made with the clinician’s assistance. After such discussion about benefits and limitations of prostate cancer early detection testing with patients, providers can offer to patients, who are aged 50 and older and have a life expectancy of at least 10 years, testing with prostate-specific antigen (PSA) test and the digital rectal exam (DRE). Health care providers should discuss the potential benefits and limitations of prostate cancer early detection testing with men. Information should be provided to men regarding the benefits and limitation of testing so that an informed decision concerning testing can be made with the clinician’s assistance. After such discussion about benefits and limitations of prostate cancer early detection testing with patients, providers can offer to patients, who are aged 50 and older and have a life expectancy of at least 10 years, testing with prostate-specific antigen (PSA) test and the digital rectal exam (DRE).

Slide 44:Recent* Prostate-Specific Antigen (PSA) Test Prevalence (%), by Educational Attainment and Health Insurance Status, Men 50 Years and Older, US, 2001-2006

*A prostate-specific antigen (PSA) test within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002, 2003, 2005, 2007. This graph shows that the percentage of men who have had a PSA test within the past year decreased 4 percentage points from 2001 to 2006. Men with less than a high school education and men with no health insurance were less likely to report a PSA test than all men 50 and older. This graph shows that the percentage of men who have had a PSA test within the past year decreased 4 percentage points from 2001 to 2006. Men with less than a high school education and men with no health insurance were less likely to report a PSA test than all men 50 and older.

Slide 45:Recent* Digital Rectal Examination (DRE) Prevalence (%), by Educational Attainment and Health Insurance Status, Men 50 Years and Older, US, 2001-2006

*A digital rectal examination (DRE) within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002, 2003, 2005, 2007. This graph shows that the percentage of men who have had a DRE within the past year decreased approximately seven percentage points from 2001 to 2006. Men with less than a high school education and men with no health insurance were less likely to report a DRE than all men 50 and older. The American Cancer Society suggests that men speak with their physician to make an informed decision on prostate cancer screening. This graph shows that the percentage of men who have had a DRE within the past year decreased approximately seven percentage points from 2001 to 2006. Men with less than a high school education and men with no health insurance were less likely to report a DRE than all men 50 and older. The American Cancer Society suggests that men speak with their physician to make an informed decision on prostate cancer screening.

Slide 46:Sunburn* Prevalence (%) in the Past Year, Adults 18 and Older, US, 2004

*Reddening of any part of the skin for more than 12 hours. Note: The overall prevalence of sunburn among adult males is 46.4% and among females is 36.3%. Source: Behavioral Risk Factor Surveillance System Public Use Data Tape , 2004. National Center for Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2005. The vast majority of skin cancers are the result of unprotected and excessive ultraviolet radiation exposure. The American Cancer Society estimates that UV exposure is associated with more than one million cases of basal and squamous cell cancers and 59,940 cases of malignant melanoma in 2006. Sunburns, a short-term consequence of unprotected or excessive UV exposure, were reported more frequently by men than women. Variations by race, ethnicity, and gender were observed with the highest prevalence of sunburns among white non-Hispanic males and females.The vast majority of skin cancers are the result of unprotected and excessive ultraviolet radiation exposure. The American Cancer Society estimates that UV exposure is associated with more than one million cases of basal and squamous cell cancers and 59,940 cases of malignant melanoma in 2006. Sunburns, a short-term consequence of unprotected or excessive UV exposure, were reported more frequently by men than women. Variations by race, ethnicity, and gender were observed with the highest prevalence of sunburns among white non-Hispanic males and females.

Slide 47:Ultraviolet Radiation Exposure Behaviors* Prevalence (%), Adults 18 and Older, US, 2005

*Proportion of respondents reporting always or often practicing the particular sun protection behavior on any warm sunny day. †Used an indoor tanning device, including a sunbed, sunlamp, or tanning booth at least once, in the past 12 months. Source: National Health Interview Survey Public Use Data File 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. The vast majority of skin cancers are caused by unprotected exposure to excessive ultraviolet radiation (UVR), primarily from the sun. Studies also suggest that exposure to artificial UVR exposure from indoor tanning devices is a risk factor for skin cancer. UVR damage of unprotected skin can be avoided by practicing recommended sun protection behaviors and avoiding indoor tanning devices, including lamps and booths. The practice of UVR protection behaviors is generally low. In a national sample of US adults, application of sunscreen and shade seeking were the most commonly practiced sun protection behaviors, whereas clothing protection, especially the use of hats and long-sleeved shirts were less frequently practiced. The same survey showed that 14% of adults, primarily women and young adults, reported using an indoor tanning device at least once in the past year. The vast majority of skin cancers are caused by unprotected exposure to excessive ultraviolet radiation (UVR), primarily from the sun. Studies also suggest that exposure to artificial UVR exposure from indoor tanning devices is a risk factor for skin cancer. UVR damage of unprotected skin can be avoided by practicing recommended sun protection behaviors and avoiding indoor tanning devices, including lamps and booths. The practice of UVR protection behaviors is generally low. In a national sample of US adults, application of sunscreen and shade seeking were the most commonly practiced sun protection behaviors, whereas clothing protection, especially the use of hats and long-sleeved shirts were less frequently practiced. The same survey showed that 14% of adults, primarily women and young adults, reported using an indoor tanning device at least once in the past year.

Slide 48:Thank you