Affiliations of authors: H. K. Weir, P. A. Wingo, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; M. J. Thun, A. Jemal, E. Ward, Epidemiology and Surveillance Research Department, American Cancer Society, Atlanta; B. F. Hankey, L. A. G. Ries, B. K. Edwards, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD; H. L. Howe, North American Association of Central Cancer Registries, Springfield, IL; R. N. Anderson, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD.
Correspondence to: Hannah K. Weir, PhD, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, MS K-53, 4770 Buford Hwy., Atlanta, GA 30341 (e-mail: hbw4{at}cdc.gov).
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ABSTRACT |
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INTRODUCTION |
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This report updates data on the four most common cancers (lung, female breast, prostate, and colon/rectal), which represent more than half of the cancer diagnoses and deaths in the U.S. population. This report also features a new section on the uses of surveillance data to plan, implement, and monitor cancer prevention and control programs for the four most common cancers.
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SUBJECTS AND METHODS |
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Information on newly diagnosed cancer cases in the United States is based on data collected by cancer registries participating in the NCIs Surveillance, Epidemiology, and End Results (SEER1) Program or the CDCs National Program of Cancer Registries (NPCR) (6,8). All registries are members of the North American Association of Central Cancer Registries (9). The data on incidence refer to invasive but not in situ cancers, except where specified. Of all in situ cancers, only bladder cancer is included in the category of all cancer sites combined. In situ bladder cancer cases are also included in the invasive bladder cancer rates. Percentages and rates of in situ breast cancer are provided in selected results, but are not included in incidence rates for invasive disease or all cancer sites combined.
For long-term (i.e., from 1975 through 2000) cancer incidence trend analyses, we used data from the original nine SEER areas (6), covering 10% of the U.S. population. Estimates of recent incidence and short-term (i.e., from 1992 through 2000) trends for racial and ethnic populations are based on data from 12 SEER areas, covering 14% of the U.S. population. To analyze state data from individual states, we used 19962000 incidence data from 34 statewide cancer registries that met NAACCR criteria for highest quality (9), covering 68% of the U.S. population. All information on primary cancer site and histology was coded according to the International Classification of Diseases for Oncology, second edition (10), and categorized according to SEER site groups (11).
Cancer deaths in the United States reported from 1975 through 2000 to state vital statistics offices and consolidated into a database by CDC through the National Vital Statistics System (12) were coded according to the version of the International Classification of Diseases (ICD) in use in the United States at the time (1315). Beginning with 1999 mortality data, ICD-10 was used to code the cause of death. Under ICD-10 rules, cancer was slightly more likely to be selected as the underlying cause of death than under previous ICD rules (16). A conversion algorithm allowed for comparability between versions of ICD codes, which are categorized according to SEER site groups (11).
Population Estimates
County level population estimates were provided by the U.S. Bureau of the Census. Population estimates for 19911999 were revised by using 1990 and 2000 decennial census data. The 2000 census allowed respondents to identify themselves, for the first time, as multiracial. To report long-term trends in disease rates for single-race groups, the CDC developed a method to bridge the multiracial populations into single-race categories, which were used by the U.S. Bureau of the Census, with funding from the NCI, to produce single-race census (2000) and intercensal (19911999) estimates for white, black, Asian/Pacific Islander (API), American Indian/Alaska Native (AI/AN), and Hispanic populations (www.seer.cancer.gov/popdata/methods.pdf).
Cancer Incidence and Death Rates
We computed age-adjusted cancer incidence and death rates, expressed per 100 000 population, by using the 2000 U.S. standard population, with the provision that no fewer than 25 events were reported in a specific race, sex, and/or cancer site category. Estimates of rates, standard errors, and 95% confidence intervals were generated by using SEER*Stat software (17). To reduce the variability of rates for single years of diagnosis among racial and ethnic populations other than white and black, we calculated 2-year moving average annual rates. Because of delayed reporting of cancers diagnosed in outpatient settings and other updates, long-term incidence trends from SEER are presented unadjusted and adjusted for delayed reporting, as discussed later in the "Statistical Analysis" section.
Screening and Risk Factor Data
Information on cancer risk factors and screening examinations was obtained primarily from data collected through CDCs Behavioral Risk Factor Surveillance System (BRFSS) (18) and was categorized according to Healthy People 2010 objectives (19). For this analysis, 2001 BRFSS data were used for prevalence estimates of current cigarette smoking among respondents aged 18 years or older and for colorectal and prostate cancer screening among respondents aged 50 years or older. Colorectal cancer screening was estimated for respondents who used a home-administered fecal occult blood test (FOBT) kit within the past 2 years or who reported ever having had a sigmoidoscopy or colonoscopy. Prostate cancer screening was estimated for men who reported no history of prostate cancer and who used the prostate-specific antigen (PSA) test in the past year. Prevalence estimates of mammography screening during the past 2 years for women aged 40 years or older were derived from 2000 BRFSS data instead of 2001 BRFSS data because mammography data are now only collected every other year. Response rates for BRFSS surveys by state ranged from 28.8% to 71.8% in 2000, and from 33.3% to 81.5% in 2001 (20,21).
Other sources provided supplemental information on tobacco use and tobacco control measures. The prevalence of cigarette smoking within the past 30 days among adolescents (i.e., those aged 1217 years) was derived from the National Household Survey on Drug Abuse (22,23). Data from the 1999 and 2000 surveys were combined to provide more stable prevalence estimates.
Historical information on annual per capita cigarette consumption by state was obtained from tobacco industry tax records (24). Sources of information on the average price of cigarettes, sales tax per pack, and per capita expenditure on tobacco control by state are listed elsewhere (25).
Statistical Analysis
In analyses of BRFSS data, proportions, standard errors, and exact 95% confidence intervals were calculated by using SAS and SUDAAN (2628) and were weighted to the age, sex, and racial distribution of the states adult population according to the sampling design. We excluded responses coded as Dont know/Not sure or Refused. Percentages were suppressed when numerator counts were fewer than 20. For the U.S. estimates, data were aggregated for all 50 states and the District of Columbia. State trends in annual per capita cigarette consumption from 1990 through 2001 were estimated by linear regression as average annual change (26).
The process of continually updating cancer registry databases for all years during which the registry has been in existence has been shown to affect recent estimates of observed incidence (29). Therefore, we used a statistical method to adjust SEER long-term trend data for reporting delays to provide a more accurate assessment of recent trends (11,29). Long-term incidence trends were expressed as observed incidence, unadjusted for reporting delay, and as rates adjusted for reporting delay (Table 1).
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More detailed information, figures, and methodology pertaining to this report are available at the NCI Web site: www.seer.cancer.gov. Additional data and information on cancer incidence and mortality are available at the following Internet addresses: www.cancer.org (ACS), www.cdc.gov/cancer/npcr/index.htm and www.cdc.gov/nchs/about/major/dvs/mortdata.htm (CDC), and www.naaccr.org/cinaplus/index.html (NAACCR).
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RESULTS |
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Cancer incidence rates for all cancer sites combined increased from the mid-1970s through 1992 and then declined from 1992 through 1995 (Fig. 1; Table 1
). Observed incidence rates for all cancers combined were essentially stable from 1995 through 2000, whereas the delay-adjusted trend showed an increase that had borderline statistical significance (P = .05). Delay-adjusted incidence rates were higher than the observed rates for all cancers combined (Fig. 1
) and for the four leading cancers (www.seer.cancer.gov). The long-term incidence rates for all cancer sites combined increased by 1.4% per year among men from 1975 through 1989, increased by 5.2% per year from 1989 through 1992, and then decreased by 4.8% per year until 1995 when rates stabilized. Recent incidence trends for white men continued to increase by 0.7% per year, whereas trends for black men continued to decrease by 1.7% per year. Recent incidence trends for API, AI/AN, and Hispanic men have declined (Fig. 2
). Among women, the incidence trends for all cancers combined have increased by 1.5% per year from 1979 through 1987 and increased by 0.4% per year through 2000. There were no consistent trends in incidence rates for API, AI/AN, and Hispanic women (Fig. 2
).
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For cancers of the prostate, colorectum, and lung, blacks had the highest observed incidence rates (Fig. 3; Table 1
). From 1996 through 2000, observed prostate cancer incidence rates were 66% higher among black men than among white men (Table 1
). From 1996 through 2000, observed breast cancer incidence rates were 16% higher among white women than among black women. Black men and women had the highest death rates of all racial and ethnic populations studied (Table 2
; Fig. 2
). From 1996 through 2000, for all cancer sites combined, AI/ANs had the lowest observed incidence rates and APIs had the lowest death rates of all racial and ethnic populations studied (Fig. 2
) (11).
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Female breast cancer incidence rates continued to increase although the rate of increase has slowed to 0.6% per year since 1986 (Table 1). In situ breast cancer incidence rates also continued to increase by 6.1% per year over the same period. Death rates from breast cancer decreased beginning in the early 1990s, with steeper declines reported among white women (decreases of 2.5% per year) than among black women (decreases of 1.0% per year) (Fig. 4
; Table 2
). Breast cancer death rates among API, AI/AN, and Hispanic women were lower than those among black and white women (Fig. 3
).
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Colorectal cancer incidence rates stabilized beginning in 1995 for all men and women (Table 1). Death rates declined beginning in the 1970s, with steeper declines reported beginning in the mid-1980s (Table 2
). Declines in death rates for men began later than those for women. Larger decreases in death rates were observed among white men and women than among black men and women (Fig. 4
). Colorectal cancer death rates were lower among API, AI/AN, and Hispanic populations than among black and white populations (Fig. 4
).
State Surveillance Data
Surveillance data for the four most common cancers for each state include state-specific incidence and/or death rates and selected data on screening, tobacco use, and other parameters used for cancer control. States were grouped into tertiles on the basis of selected variables and sorted alphabetically within tertiles (Tables 36). The first tertile includes states furthest from meeting Healthy People 2010 objectives according to selected cancer control parameters (19).
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The prevalence of current smoking among adults (males and females combined) was used to determine tertiles (Table 3). The prevalence of smoking among adults ranged from 30.9% in Kentucky to 13.3% in Utah. The percentage of adolescents (aged 1217 years) who currently smoked ranged from 22.4% in Kentucky to 8.9% in California. Per capita cigarette consumption was highest in Kentucky (152.6 packs) and lowest in California (38.0 packs), with declining consumption from 1990 through 2000 reported in 40 of 51 states. Delaware and Oklahoma reported increasing tobacco consumption. The decline in the annual per capita cigarette consumption for all states combined and for the two states (California and Massachusetts) with aggressive tobacco control campaigns (31) is shown in Fig. 5
. Most states invested less money in tobacco control in 2001 than the CDC recommended amount of between $5 and $10 per capita (25,31) (Table 3
). In 2001, expenditures for tobacco control were less than $1 per person in 16 states; 12 of these were in the tertile with the highest prevalence of current smoking. Lung cancer death rates were lowest in Utah, the state with the lowest adult smoking prevalence, and highest in Kentucky, the state with the highest adult smoking prevalence.
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The prevalence of recent mammography screening among white women aged 40 years or older was used to determine tertiles (Table 4) and found to range from 66.2% in Idaho to 87.0% in Delaware. Recent mammography screening prevalence was lower among women with no health insurance (Table 4
) than among women with insurance (data not shown). Thirty-two states had sample sizes large enough to estimate the prevalence of recent mammography screening among black women, which was found to range from 64.1% in Mississippi to 93.4% in Delaware. Small sample sizes in most states precluded us from estimating the prevalence of recent mammography screening among black women with no health insurance.
Breast cancer incidence rates from 1996 through 2000 among white women ranged from 118.7 per 100 000 women in Utah to 152.1 per 100 000 women in Hawaii. Among black women, breast cancer incidence rates ranged from 89.8 per 100 000 women in Rhode Island to 147.6 per 100 000 women in Alaska. The percentage of in situ breast cancers among white women was greater than 15% in all but eight states. The percentage of regional and distant stage tumors exceeded 30% in all but three states. Breast cancer incidence rates were stable in all states, with the exception of increasing rates among white women in Minnesota and North Carolina and decreasing rates among black women in Florida.
Breast cancer death rates among white women ranged from 23.7 per 100 000 women in Arkansas to 31.2 per 100 000 women in New Jersey. In the 1990s, death rates from breast cancer were higher among black women than among white women. From 1992 through 2000, breast cancer death rates among white women declined in 38 states. In states with breast cancer death rates reported for black women, rates increased in Mississippi and decreased in Texas, Tennessee, Maryland, Michigan, and New York.
Prostate Cancer
Prostate cancer death rates among white men were used to determine tertiles (Table 5). The ordering of the tertiles was based on death rates, rather than PSA prevalence estimates, to conform to Healthy People 2010 objectives (19). Death rates for white men ranged from 36.9 per 100 000 men in Maryland to 24.8 per 100 000 men in Hawaii. Rates for black men varied considerably more than those for white men and, in general, were more than twice as high as those for white men. Death rates decreased or were stable in all states for both white and black men.
The prevalence of self-reported use of the PSA test was estimated for men aged 50 years or older who reported no history of prostate cancer. The prevalence of PSA test use among white men ranged from 45.6% in Hawaii to 71.7% in Washington, DC. Among black men, the prevalence of the use of the PSA test ranged from 34.1% in Tennessee to 69.1% in New Jersey. The prevalence of PSA test use among black men could be estimated in 26 states.
Colorectal Cancer
The percentage of white men and women aged 50 years or older having ever had a sigmoidoscopy or colonoscopy was used to determine tertiles (Table 6). The prevalence of sigmoidoscopy or colonoscopy among white men ranged from 33.5% in Oklahoma to 63.5% in Delaware (Table 6
). Among white women, the prevalence ranged from 38.3% in Kentucky to 62.1% in Minnesota (Table 6
). Prevalence estimates were more variable among black men and women. The percentage of individuals screened by FOBT during the preceding 2 years was less than the percentage of individuals ever having received a sigmoidoscopy or colonoscopy. Approximately 50% of colorectal cancers were diagnosed at regional or distant stage; this percentage was more than 60% in many states.
In general, colorectal cancer incidence and death rates were higher among men than among women and were higher among black men and women than among white men and women. Five-year trends in death rates in all states were stable or declined for both men and women, with the exception of black men in Louisiana and Oklahoma.
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DISCUSSION |
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Overall cancer incidence rates have remained essentially stable from 1995 through 2000, after a decline in incidence from 1992 to 1995. The modest increase in the recent delay-adjusted trend will require monitoring with additional years of data. Increased incidence rates of breast cancer in women (4,5) and prostate cancer in men (3234) offset a long-term decrease in lung cancer in men.
This report is the first to present analyses of long-term trends in cancer incidence with and without adjustment for reporting delays. Cancer registries routinely take 23 years to compile their current cancer statistics. An additional 12 years may be required to revise the incidence data on certain cancers, particularly those diagnosed in outpatient settings, such as melanoma and prostate or breast cancer. Cancer registries continue to update the estimates of incidence to include these data. Consequently, the initial data on the incidence of certain cancers may be an underestimate. Long-term reporting patterns in SEER registries have been analyzed (29), and it is now possible to adjust site-specific and all-cancers-combined incidence rates to correct for expected reporting delays. These modeled delay-adjusted incidence rates provide the basis for a potentially more accurate assessment of rates and trends in the most recent years for which data are available. Currently, delay-adjustment methods are available only for SEER registries because they rely on historical reporting patterns that are registry-specific. In the future, delay adjustment may be developed for and applied to data from NPCR registries.
Overall cancer death rates declined from 1994 through 1998 and then stabilized from 1998 through 2000. Trends in cancer mortality for women stabilized, whereas death rates for men continued to decline. Lung cancer death rates among women continued to increase, although at a slower rate since the early 1990s. The lung cancer death rate for men continued to decline.
The introduction of ICD-10 (15), beginning with 1999 mortality data, affected the recent cancer mortality trends included in this report. Changes in the rules for selecting the underlying cause of death with ICD-10 resulted in a larger net allocation (0.7%) of deaths due to cancer for 1999 and 2000 (16). This change in classification rules contributed to the leveling off of death rates for all cancers combined from 1998 through 2000.
The incidence and death rates we report are improved by the use of recently released intercensal population estimates for the period 1990 through 2000. Improved accuracy of population estimates did not have a major impact on cancer rates at the national level, but may have had substantial impact for smaller populations, particularly for specific race/ethnicity, age, or county subgroups.
Trends in cancer incidence and death rates among API, AI/AN, and Hispanics are more difficult to assess because of the variability in the rates in the relatively smaller populations and the potential misclassification of race and ethnicity. Incidence and death rates are generally lower among API, AI/AN, and Hispanic populations than among white and black populations, whereas short-term trends in incidence and death rates among populations tend to be similar. However, an examination of colorectal and breast cancer death rates revealed growing disparities between white and black populations. By the year 2000, death rates for whites were substantially lower than those for blacks, an indication that black men and women may not have experienced the same benefits from screening and/or treatment as white men and women. These patterns in the death rates indicate that disparities in deaths from some cancers are increasing and that methods are needed to disseminate advances in prevention, screening, and treatment to all segments of the population (35).
Use of Surveillance Data for Cancer Prevention and Control
We examined surveillance data that are currently available at the state level to plan, implement, and monitor cancer prevention and control programs for the four most common cancers. The parameters considered in Tables 36 show how specific indicators of exposure, screening, and disease burden can be used by cancer control planners to assess current cancer burden and monitor progress with respect to cancer prevention and screening. Somewhat different measures were chosen for each of the four most common cancers, depending on the extent of scientific evidence regarding causation, the ability to modify the underlying risk factors, the evidence that screening tests are effective in reducing incidence or mortality, and the interpretability of incidence and/or death rates in measuring changes in the burden of disease. We did not consider all aspects of cancer control because population-based data on cancer treatment, quality of life, end-of-life care, and dissemination of cancer control in clinical practice have become available only during the last decade and state-specific data are limited. The data pertaining to various cancer risk factors and/or screening tests in this report cannot be used to assess the efficacy of specific screening tests or to make causal judgments about the contribution of these factors to temporal trends in cancer incidence or mortality. The data presented are largely cross-sectional and consider only a subset of factors that influence disease incidence and/or death rates, especially for breast, prostate, and colorectal cancer. Judgments about the efficacy and safety of various interventions for cancer control are derived from other sources (31,36,37).
Lung Cancer and Tobacco Use
Surveillance of tobacco use and the disease burden attributable to tobacco is an essential component of all cancer control programs. Cigarette smoking alone accounts for about 30% of cancer deaths in the United States (38) and an estimated 16% of incident cancers worldwide (39). Tobacco is a systemic carcinogen that causes cancers of the lung, oral cavity, oropharynx, nasopharynx and nasal sinuses, larynx, esophagus, stomach, urinary bladder, pancreas, liver, kidney, and uterine cervix, as well as myeloid leukemia, plus an even larger number of deaths from cardiovascular and respiratory diseases (40). Lung cancer accounts for 31% of deaths attributable to cigarette smoking (38); therefore, lung cancer is a useful measure in cancer surveillance because current incidence and mortality patterns reflect the cumulative effects of tobacco use over the past 50 years (41).
Declines in lung cancer death rates among white men since 1991 and black men since 1993 reflect reductions in tobacco use that began in the United States in the 1960s when the first Surgeon Generals report on smoking and health was published (42). The recent stabilization in lung cancer incidence and slowing rate of increase in death rates among white and black women suggest that a reversal in the trends among women in the United States may be occurring. Despite these encouraging observations, tobacco-attributable cancer will not continue to decrease without sustained efforts to reduce the percentage of adolescents who begin using tobacco, and to increase the percentage of adults who successfully stop using tobacco. Several community-based interventions have been effective in reducing tobacco use when used as part of a comprehensive tobacco control program (31). These interventions include regulations that restrict smoking in public places and limiting tobacco product advertising and promotion to children and adolescents. Also effective are anti-tobacco advertisements and increased tobacco excise taxes and cigarette prices, which have been shown to decrease the percentage of young people who start smoking (31). States, such as California and Massachusetts, which implemented substantial tobacco control programs during the 1990s, experienced some of the largest decreases in per capita tobacco consumption. Continued progress will require a sustained commitment to tobacco control. In most states, per capita funding for comprehensive tobacco control is substantially lower than the amount recommended by the CDC (31).
No state has reached the objective of Healthy People 2010 to reduce the percentage of adults who smoke to 12% (19). Although Utah, with a prevalence of adults who smoked of 13.3%, and California, with a prevalence of adults who smoked of 17.2%, are close to meeting the objective, the prevalence of adults who smoked either increased or remained stable in all but one state from 1991 through 2000 (43). Nationally, the prevalence of adult smoking decreased from 24.7% to 22.5% between 1997 and 2000 (www.cdc.gov/nchs/about/major/nhis/released200303.htm#8). Smoking among adults is a less sensitive indicator of trends in smoking initiation than is smoking among adolescents, but it does reflect the combined overall effect of changes in both smoking initiation and cessation.
Breast Cancer
Regular mammography screening is recommended by national cancer organizations and is a key surveillance measure, along with breast cancer incidence and mortality, for breast cancer control programs. Evidence-based guidelines from the federally supported U.S. Preventive Services Task Force recommend that women aged 40 years or older should have a mammogram every 12 years, with or without a clinical breast exam (37,44). The ACS recommends annual mammography screening among women aged 40 years or older (45). The Healthy People 2010 objective is that at least 70% of U.S. women aged 40 years or older will have a mammogram within the previous 2 years (19). Guidelines among national organizations have converged only recently, following much debate about the benefits of mammography screening, particularly for women aged 4049 years (44,4658). According to the U.S. Preventive Services Task Force, there is fair evidence that mammography reduces the risk of dying from breast cancer among women aged 40 years or older (37).
Decreasing breast cancer death rates and increasing breast cancer incidence rates reported during the 1990s have been attributed to, in part, increased mammography screening (1,4,5). The reductions in the death rate can be attributed also to the dissemination of adjuvant chemotherapy, including multi-agent chemotherapy and tamoxifen, into medical practice (59,60).
Some states, such as Arizona and New Jersey, have used population-based registry data to identify geographic areas with excess late-stage breast cancers for increased mammography screening (61,62). One reason for the excess in late-stage disease may be delayed access to care. The prevalence of recent mammography use was lowest among women who lacked health insurance and among recent immigrants (6264).
The observed differences in breast cancer incidence rates among states may also reflect demographic differences and variations in modifiable risk factors, including alcohol consumption, sedentary lifestyle, obesity, and use of hormone replacement therapy (6570). All of these risk factors are also related to the risk of other major chronic diseases. Therefore, cancer prevention and control plans should not only address mammography screening in specific populations, but also should devote resources to the development and dissemination of public health programs that promote and help people maintain a healthy lifestyle.
Prostate Cancer
Prostate cancer mortality in the United States has been declining since 1993. However, only a few states have met the Healthy People 2010 objective of reducing prostate cancer death rates to below 28.7 per 100 000 men (19). No currently recognized risk factors account for the decline in prostate cancer mortality (71,72), although the decrease might reflect improvements in treatment combined with PSA-related early detection. Currently, the PSA test is widely used in most states (Table 5). The observed decrease in the incidence of late-stage prostate cancer after 1992 is consistent with the effects of introducing screening into a population with little or no screening (73). A study that assessed the contribution of disease stage to the mortality reduction found that part of the initial decline in the prostate cancer death rate resulted from a decrease in late-stage cancers (74). However, a simulation study incorporating reasonable estimates of lead time found the recent decline in prostate cancer mortality was unlikely to be solely the result of screening (75). Furthermore, prostate cancer death rates have declined in countries in which PSA testing is rare (76). Advances in treatment that might have contributed to the decline in death rates are discussed elsewhere (77,78).
Screening for prostate cancer by the use of PSA or digital rectal examinations (DRE) is not currently recommended as a component of cancer control. The U.S. Preventive Services Task Force has concluded that the evidence is insufficient to make a recommendation for or against routine screening using PSA testing or DRE (7981). The U.S. Preventive Services Task Force cites the current lack of evidence that early detection improves health outcomes and the potential harm that can result from treatment. Recommendations vary on the approach to PSA testing in the clinical setting. The ACS recommends that physicians offer the PSA test and DRE annually to average-risk men beginning at age 50 years and to high-risk men beginning at age 45 years, and advises physicians to provide information about the benefits and risks to help patients make informed decisions (82). The U.S. Preventive Services Task Force does not recommend that clinicians offer screening to patients, and further states that clinicians should not order the test without discussing with the patient the potential but uncertain benefits and risks (79). Despite reservations about the benefits and risks of prostate cancer screening, its use is widespread. In 2001, higher proportions (75%) of men aged 50 years or older reported they had had a PSA test than the proportion of men who had had any colorectal cancer screening (63%), according to BRFSS data (83).
In 35 years, two randomized clinical trials now in progress will provide additional information about the benefits and risks of screening for prostate cancer (84,85). In the interim, public health agencies can play an important role in educating the medical community and the general public about the risks and benefits of prostate cancer screening. A recent publication provides guidance to physicians and their patients to make informed decisions about screening for prostate cancer (86).
Colorectal Cancer
Long-term declines in colorectal cancer incidence have slowed or stabilized since the mid-1990s, whereas declines in death rates have continued. Increased risk for developing colorectal cancer is associated with a sedentary lifestyle, obesity, and an unhealthy diet (69,87,88). The prevalence of these risk factors has increased in the general population over the last 20 years (89). The impact that such trends have had on colorectal cancer incidence and mortality is not well established (90,91). Many studies report that physical inactivity and obesity increase colorectal cancer risk (69). Thus, there is a continuing need to identify community interventions that effectively increase physical activity and support the maintenance of a healthy body weight. Accumulating evidence indicates a potential protective effect of non-steroidal anti-inflammatory drugs on the development and progression of colorectal cancer (9294). However, these agents are not currently recommended for general application for the prevention of colorectal cancer because of unresolved questions about safety and optimal treatment regimens.
The early detection and removal of pre-cancerous colorectal polyps may have contributed to the decline in colorectal cancer incidence and mortality. Early detection of colorectal cancer could further reduce cancer deaths and disparities between blacks and whites (9597). The U.S. Preventive Services Task Force and other organizations support the use of any of four screening tests: FOBT, flexible sigmoidoscopy, colonoscopy, and double contrast barium enema (98). Potential barriers to the use of these tests can include the limited capacity of the medical infrastructure to provide testing, the cost of screening, the lack of insurance coverage for these tests, and reluctance on the part of patients and providers to undertake the tests (99). Strategies for overcoming these barriers are needed if cancer control efforts are to address the disparities between male and female and black and white populations. The prevalence of screening in many states is below the Healthy People 2010 target of 50% for both FOBT and sigmoidoscopy or colonoscopy screening (19).
Treatment remains an important component of any colorectal cancer control plan (97,100103). Highly effective treatment protocols have been developed particularly for patients with stage III colon cancers (97,101103). However, more research or demonstration of the effectiveness in community-based interventions is needed.
Limitations and Issues in Interpretation
The interpretation of data in this report and the use of selected surveillance information in developing state and community cancer prevention and control plans are affected by certain limitations in the data. Although most states have population-based cancer registries that meet standard criteria for the completeness, quality, and timeliness of their cancer incidence data (8,9), there are 12 state and territorial cancer registries that do not submit their data to NAACCR for evaluation or do not currently meet NAACCR criteria for highest quality.
A second limitation is that the long-term trends in cancer incidence and death rates could be evaluated only for white and black populations because data for other racial and ethnic populations were unavailable before the 1990s. Furthermore, incidence rates may be unstable for specific racial and ethnic populations and within small geographic areas, especially for uncommon cancers.
A third limitation is the uncertain comparability of the racial/ethnic designations used in previous years to that of the bridged designations from the 2000 census used this year, which converted the multiracial classification to a single race group. A fourth limitation is racial and ethnic misclassification for certain populations, particularly American Indians, Asian/Pacific Islanders, and Hispanics (104106).
Limitations of data from the CDCs BRFSS have been discussed previously (3). Briefly, the response rates vary widely across states and the surveys rely exclusively on telephone interviews. Therefore, results may not be comparable to that of other nationally representative surveys, such as the National Health Interview Survey (63,64).
Future Directions and Resources for Cancer Control Planning, Implementation, and Evaluation
Opportunities to reduce the cancer burden in the United States now exist across the spectrum of primary prevention, early detection, treatment, rehabilitation, and palliative care (107). The greatest progress can be achieved through a combination of new research discoveries and systematic dissemination of existing knowledge into practice. For example, continued research is needed to develop effective means to prevent breast and prostate cancer. Research is also needed to develop effective interventions by which communities can facilitate regular physical activity and help people maintain a healthy body weight. The Institute of Medicine systematically reviews opportunities for dissemination of information regarding cancer prevention and early detection (108). Communities can act now to strengthen programs that are proven effective in reducing tobacco use and increasing per capita consumption of fruits and vegetables. Communities must extend the delivery of high quality mammography and colorectal cancer screening to the entire U.S. population.
A variety of new initiatives, coalitions, and resources have emerged to assist cancer control planners and to facilitate the application and dissemination of best practices. The National Dialogue on Cancer, a coalition of national partners, was initiated by the ACS in 1999 to serve as a national forum to bring together the leadership of public, private, and not-for-profit organizations, and to accelerate the identification and dissemination of advances in cancer prevention, early detection, treatment, rehabilitation, and palliation (http://www.ndoc.org/). One goal of the National Dialogue on Cancer is for each state to implement a collaborative cancer plan by 2005. Currently, the CDC funds 26 states to develop comprehensive cancer prevention and control plans, and 19 additional states are funded to implement their plans (http://www.cdc.gov/cancer/ncccp/partners.htm). Timely, reliable, and accessible surveillance data are important for the development, implementation, and monitoring of these plans.
Combined data from SEER and NPCR contribute to building a nationwide cancer surveillance infrastructure covering all U.S. residents (8,109). This infrastructure will improve our understanding of the national cancer burden and provide the basis for effective cancer control programs.
New resources are available to help cancer control planners at the state and local levels (Table 7). Most of these resources can be accessed through Cancer Control PLANET (Plan, Link, Act, Network with Evidence-based Tools), a Web portal that guides planners in their efforts to assess the cancer burden for a geographic area of interest, determine priorities, identify potential partners, select evidence-based interventions, and implement and evaluate cancer control plans (http://cancercontrolplanet.cancer.gov). Also available through PLANET are the State Cancer Profiles that provide planners with surveillance data, including incidence and mortality rates and trends, as well as information on the use of new techniques in data visualization and statistical analysis. State BRFSS data are available for selected risk factors and screening tests. Other resources are available through CDC, NCI, ACS, NAACCR, and others (Table 7
). More tools may be needed to guide local and community planners.
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Additional data regarding cancer treatment and quality of life need to be collected and disseminated at national, state, and local levels. Although inpatient data for surgery and radiation treatment from state-based cancer registries are considered reasonably complete, additional information is needed on comorbidities and treatment received in physician-office practices, ambulatory centers, and other non-hospital settings. Such information can be used to direct interventions to improve outcomes for cancer patients, including underserved populations. The Institute of Medicine encourages the use of population-based registries for quality-of-care initiatives and linkages between these registries and administrative data (110). The SEERMedicare linked data have been used extensively to evaluate cancer care and illustrate the potential for national and state population-based surveillance of cancer care to identify areas requiring improvement (111). In addition, state population-based cancer registries are being used as a sampling frame to conduct special studies focusing on patterns and quality of care (112,113).
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CONCLUSIONS |
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States face the challenge of addressing the cancer burden in times of constrained state budgets. Further reductions in the burden of cancer are possible but will require the continuation of strong federal, state, local, and private partnerships to ensure full implementation of comprehensive cancer control programs throughout the United States.
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NOTES |
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We thank Danielle Harkins and Martin Krapcho of Information Management Services, Inc., for preparing tables and graphs; Trevor Thompson, Jessica King, and Ronda Starr of the Centers for Disease Control and Prevention (CDC) for helping with manuscript and table preparation; and Don Blackman, Mona Saraiya, Ralph Coates, and Marion Nadel of CDC, and Martin Brown and Rachel Ballard-Barbash of the National Cancer Institute for comments and review of the cancer control strategies.
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REFERENCES |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
1 Wingo PA, Ries LA, Rosenberg HM, Miller DS, Edwards BK. Cancer incidence and mortality, 19731995: a report card for the U.S. Cancer 1998;82:1197207.[CrossRef][ISI][Medline]
2 Wingo PA, Ries LA, Giovino GA, Miller DS, Rosenberg HM, Shopland DR, et al. Annual report to the nation on the status of cancer, 19731996, with a special section on lung cancer and tobacco smoking. J Natl Cancer Inst 1999;91:67590.
3 Ries LA, Wingo PA, Miller DS, Howe HL, Weir HK, Rosenberg HM, et al. The annual report to the nation on the status of cancer, 19731997, with a special section on colorectal cancer. Cancer 2000;88:2398424.[CrossRef][ISI][Medline]
4 Howe HL, Wingo PA, Thun MJ, Ries LA, Rosenberg HM, Feigal EG, et al. Annual report to the nation on the status of cancer (1973 through 1998), featuring cancers with recent increasing trends. J Natl Cancer Inst 2001;93:82442.
5 Edwards BK, Howe HL, Ries LA, Thun MJ, Rosenberg HM, Wingo PA, et al. Annual report to the nation on the status of cancer, 19731999, featuring implications of age and aging on U.S. cancer burden. Cancer 2002;94:276692.[CrossRef][ISI][Medline]
6 Hankey BF, Ries LA, Edwards BK. The Surveillance, Epidemiology, and End Results program: a national resource. Cancer Epidemiol Biomarkers Prev 1999;12:111721.
7 Hutton MD, Simpson LD, Miller DS, Weir HK, McDavid K, Hall HI. Progress toward nationwide cancer surveillance: an evaluation of the National Program of Cancer Registries, 19941999. J Registry Manag 2001;28:11320.
8 U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999 Incidence. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2002.
9 Hotes JL, Wu XC, McLaughlin CC, Lake A, Firth R, Roney D, et al., editors. Cancer in North America, 19962000. Volume 1: incidence. Springfield (IL): North American Association of Central Cancer Registries; 2003.
10 Percy C, Van Holten V, Muir C, editors. International classification of diseases for oncology, 2nd ed. Geneva (Switzerland): World Health Organization; 1990.
11 Ries LA, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, et al., editors. SEER cancer statistics review, 19752000. Bethesda (MD): National Cancer Institute; 2003.
12 National Center for Health Statistics. Vital statistics of the United States, 19501999, volume II. Mortality, parts A and B. Washington (DC): Public Health Service; 2001.
13 U.S. Department of Health, Education and Welfare and National Center for Health Statistics. Manual of the international statistical classification of diseases, injuries, and causes of death, adapted for use in the United States, eighth revision. Washington (DC): Public Health Service; 1967.
14 World Health Organization. Manual of the international statistical classification of diseases, injuries, and causes of death, based on the recommendations of the 9th revision conference, 1975. Geneva (Switzerland): World Health Organization; 1977.
15 World Health Organization. International statistical classification of diseases and related health problems, 10th revision. Geneva (Switzerland): World Health Organization; 1992.
16 Anderson RN, Minino AM, Hoyert DL, Rosenberg HM. Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates. National Center for Health Statistics. Natl Vital Stat Rep 2001;49:2.
17 Surveillance, Epidemiology, and End Results (SEER) Program. SEER 19732000 public use data. SEER*Stat Database: IncidenceSEER 9 Regs, Nov 2002 Sub (19732000) <18 Age Groups>. National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2003, based on the November 2002 submission. Available at: http://seer.cancer.gov. [Last accessed July 2003.]
18 Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System users guide. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 1998.
19 U.S. Department of Health and Human Services. Tracking Healthy People 2010. Washington (DC): U.S. Government Printing Office; November 2000.
20 Centers for Disease Control and Prevention. 2000 BRFSS summary data quality report. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2001.
21 Centers for Disease Control and Prevention. 2001 BRFSS summary data quality report. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2002.
22 Kopstein A. Tobacco use in America: findings from the 1999 National Household Survey on Drug Abuse (analytic series: A-15, DHHS Publication No. SMA 02-3622). Rockville (MD): Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2001.
23 Wright D. State estimates of substance use from the 2000 National Household Survey on Drug Abuse. Vol. I. Rockville (MD): Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2002.
24 Orzechowski W, Walker RC. The tax burden on tobacco: historical compilation 2001: impact and opportunity. Vol. 36. Arlington (VA): Orzechowksi and Walker; 2001.
25 Gross CP, Soffer B, Bach PB, Rajkumar R, Forman H. State expenditures for tobacco-control programs and the tobacco settlement. New Engl J Med 2002;347:10806.
26 SAS Institute Inc. SAS/STAT users guide, version 8. Cary (NC): SAS Institute Inc.; 1999.
27 Research Triangle Institute. SUDAAN users manual, release 7.5. Research Triangle Park (NC): Research Triangle Institute; 1997.
28 Korn EL, Graubard BI. Analysis of health surveys. New York (NY): Wiley; 1999.
29 Clegg LX, Feuer EJ, Midthune DN, Fay MP, Hankey BF. Impact of reporting delay and reporting error on cancer incidence rates and trends. J Natl Cancer Inst 2002;94:153745.
30 Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates [published erratum appears in Stat Med 2001:28;20:655]. Stat Med 2000;19:33551.[CrossRef][ISI][Medline]
31 U.S. Department of Health and Human Services. Reducing tobacco use: a report of the surgeon general. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2000.
32 Potosky AL, Miller BA, Albertsen PC, Kramer BS. The role of increasing detection in the rising incidence of prostate cancer. JAMA 1995;273:54852.[Abstract]
33 Legler JM, Feuer EJ, Potosky AL, Merrill RM, Kramer BS. The role of prostate-specific antigen (PSA) testing patterns in the recent prostate cancer incidence decline in the United States. Cancer Causes Control 1998;9:51927.[CrossRef][ISI][Medline]
34 Etzioni R, Penson DF, Legler JM, di Tommaso D, Boer R, Gann PH, et al. Overdiagnosis due to prostate-specific antigen screening: lessons from U.S. prostate cancer incidence trends. J Natl Cancer Inst 2002;94:98190.
35 Haynes MA, Smedley BD, editors. The unequal burden of cancer: an assessment of NIH research and programs for ethnic minorities and the medically underserved. Washington (DC): Institute of Medicine, National Academy Press; 1999.
36 Agency for Healthcare Research and Quality. Diffusion and dissemination of evidence-based cancer control interventions: summary. Evidence Report/Technology Assessment, No. 79. Rockville (MD): U.S. Department of Health and Human Services, 2003. Available from AHRQ Publications Clearinghouse, 800-358-9295.
37 U.S. Preventive Services Task Force (USPSTF). Recommendations and rationale for screening for breast cancer. Washington (DC): Department of Health and Human Services. Available at: http://www.ahcpr.gov/clinic/3rduspstf/breastcancer/brcanrr.htm. [Last accessed May 2003.]
38 Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and economic costsUnited States, 19951999. MMWR Morb Mortal Wkly Rep 2002;51:3003.[Medline]
39 Parkin D, Pisani P, Ferlay J. Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 1999;80:82741.[CrossRef][ISI][Medline]
40 International Agency for Research on Cancer. Tobacco smoke and involuntary smoking. Vol. 83. Lyon (France): International Agency for Research on Cancer; 2002. Available at: http://193.51.164.11/htdocs/monographs/vol83/02-involuntary.html. [Last accessed July 2003.]
41 Peto R, Lopez A, Boreham J, Thun M, Heath CJ. Mortality from smoking in developed countries 19502000. New York (NY): Oxford University Press; 1994.
42 U.S. Public Health Service. Smoking and health. Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington (DC): U.S. Department of Health, Education and Welfare, Public Health Service, Centers for Disease Control; 1964.
43 Nelson DE, Bland S, Powell-Griner E, Klein R, Wells H, Hogelin G, et al. State trends in health risk factors and receipt of clinical services among U.S. adults during the 1990s. JAMA 2002;287:265967.
44 Department of Health and Human Services. HHS affirms value of mammography for detecting breast cancer. Press release. Feb. 21, 2002. Available at: http://www.hhs.gov/news/press/2002pres/20020221.html.
45 Smith RA, Saslow D, Sawyer KA, Burke W, Costanza ME, Evans WP, et al. American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin 2003;53:14169.
46 Kopans DB. The most recent breast cancer screening controversy about whether mammographic screening benefits women at any age: nonsense and nonscience. AJR Am J Roentgenol 2003;180:216.
47 Tabar L, Yen M, Vitak B, Chen H, Smith R, Duffy S. Mammography service screening and mortality in breast cancer patients: 20-year follow-up before and after introduction of screening. Lancet 2003;361:140510.[CrossRef][ISI][Medline]
48 Olsen O, Gotzsche PC. Cochrane review on screening for breast cancer with mammography. Lancet 2001;358:13402.[CrossRef][ISI][Medline]
49 Duffy SW. Interpretation of breast screening trials: commentary on the recent paper by Gotzsche and Olsen. The Breast 2001;10:20912.[CrossRef]
50 Veronese U, Forrest P, Wood W, Boyle P. Statement from the chair: global summit on mammographic screening, 35 June, 2002. Milan (Italy): European Institute of Oncology; 2002.
51 Nystrom L, Andersson I, Bjurstam N, Frisell J, Nordenskjold B, Rutqvist LE. Long-term effects of mammography screening: undated overview of the Swedish randomised trials. Lancet 2002;359:90919.[CrossRef][ISI][Medline]
52 Kerlikowske K, Grady D, Rubin SM, Sandrock C, Ernster VL. Efficacy of screening mammography. A meta-analysis. JAMA 1995:273:14954.[Abstract]
53 Smith RA. Breast cancer screening among women younger than age 50: a current assessment of the issues. CA Cancer J Clin 2000;50:31236.[Abstract]
54 Sox H. Screening mammography for younger women: back to basics. Ann Intern Med 2002;137:3612.
55 Hendrick RE, Smith RA, Rutledge JH III, Smart CR. Benefit of mammography screening in women aged 4049: a new meta-analysis of randomized controlled trials. J Natl Cancer Inst Monogr 1997;22:8792.[Medline]
56 National Institutes of Health Consensus Development Panel. National Institutes of Health consensus development conference statement: breast cancer screening for women ages 4049, January 2123, 1997. J Natl Cancer Inst Monogr 1997;22:viixii.[Medline]
57 Tabar L, Duffy SW, Vitak B, Chen HH, Prevost TC. The natural history of breast carcinoma: what have we learned from screening. Cancer 1999;86:44962.[CrossRef][ISI][Medline]
58 Tabar L, Vitak B, Chen HH, Yen MF, Duffy SW, Smith RA. Beyond randomized controlled trials: organized mammographic screening substantially reduces breast carcinoma mortality. Cancer 2001;91:172431.[CrossRef][ISI][Medline]
59 Mariotto A, Feuer E, Harlan L, Wun LM, Johnson K, Abrams J. Trends in use of adjuvant multi-agent chemotherapy and tamoxifen for breast cancer in the United States: 19751999. J Natl Cancer Inst 2002;94:162634.
60 Harlan LC, Abrams J, Warren JL, Clegg L, Stevens J, Ballard-Barbash R. Adjuvant therapy for breast cancer: practice patterns of community physicians. J Clin Oncol 2002;20:180917.
61 Centers for Disease Control and Prevention. Cancer registries: the foundation for cancer prevention and control. At-a-glance, 2001. Atlanta (GA): Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/cancer/npcr/2001aag-npcr.htm. [Last accessed May 2003.]
62 Roche LM, Skinner R, Weinstein RB. Use of a geographic information system to identify and characterize areas with high proportions of distant stage breast cancer. J Public Health Manag Pract 2002;8:2632.[Medline]
63 Swan J, Breen N, Coates R, Rimer B, Lee N. Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer 2003;97:152840.[CrossRef][ISI][Medline]
64 Breen N, Wagener DK, Brown ML, Davis WW, Ballard-Barbash R. Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst 2001;93:170413.
65 Kelsey JL. Breast cancer epidemiology: summary and future directions. Epidemiol Rev 1993;15:25663.[ISI][Medline]
66 Hulka BS, Stark AT. Breast cancer: cause and prevention. Lancet 1995;346:8837.[ISI][Medline]
67 Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer [published erratum appears in Lancet 1997;350:1484]. Lancet 1997;350:104759.[CrossRef][ISI][Medline]
68 Colditz GA. Relationship between estrogen levels, use of hormone replacement therapy, and breast cancer. J Natl Cancer Inst 1998;90:81422.
69 Vanio H, Bianchini F. IARC handbooks of cancer prevention. Volume 6: weight control and physical activity. Lyon (France): IARC Press; 2002.
70 Agency for Healthcare Research and Quality. Available at: http://www.ahrq.gov/clinic/. [Last accessed May 2003.]
71 Hsing A, Nomura A, Isaacs W, Armenian H. Epidemiologic reviews: prostate cancer. Vol. 23, No. 1. Baltimore (MD): Oxford University Press; 2001.
72 Boyle P, Severi G, Giles GG. The epidemiology of prostate cancer. Urol Clin North Am 2003;30:20917.[ISI][Medline]
73 Hankey BF, Feuer EJ, Clegg LX, Hayes RB, Legler JM, Prorok PC, et al. Cancer surveillance series: interpreting trends in prostate cancerpart I: evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates. J Natl Cancer Inst 1999;91:101724.
74 Feuer EJ, Merrill RM, Hankey BF. Cancer surveillance series: interpreting trends in prostate cancerpart II: cause of death misclassification and the recent rise and fall in prostate cancer mortality. J Natl Cancer Inst 1999;91:102532.
75 Etzioni R, Legler JM, Feuer EJ, Merrill RM, Cronin KA, Hankey BF. Cancer surveillance series: interpreting trends in prostate cancerpart III: quantifying the link between population prostate-specific antigen testing and recent declines in prostate cancer mortality. J Natl Cancer Inst 1999;91:10339.
76 Oliver SE, May MT, Gunnell D. International trends in prostate-cancer mortality in the "PSA ERA."Int J Cancer 2001;92:8938.[CrossRef][ISI][Medline]
77 Harris R, Lohr KN. Screening for prostate cancer: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002:137:91729.
78 Meng MV, Grossfeld GD, Sadetsky N, Mehta SS, Lubeck DP, Carroll PR. Contemporary patterns of androgen deprivation therapy use for newly diagnosed prostate cancer. Urology 2002 Sep;60(3 Suppl 1):711; discussion 112.
79 U.S. Preventive Services Task Force (USPSTF). Recommendations and rationale for screening for prostate cancer. Washington (DC): U.S. Department of Health and Human Services. Available at: http://www.ahrq.gov/clinic/3rduspstf/prostatescr/prostaterr.htm. [Last accessed May 2003.]
80 Potosky AL, Legler J, Albertsen PC, Stanford JL, Gilliland FD, Hamilton AS, et al. Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the Prostate Cancer Outcomes Study. J Natl Cancer Inst 2000;92:158292.
81 Stanford JL, Feng Z, Hamilton AS, Gilliland FD, Stephenson RA, Eley JW, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study [published erratum appears in CA Cancer J Clin 2001 MayJune;51:150]. JAMA 2000;283:35460.
82 Smith RA, von Eschenbach AC, Wender R, Levin B, Byers T, Rothenberger D, et al. American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. CA Cancer J Clin 2001;51:3875.
83 Sirovich BE, Schwartz LM, Woloshin S. Screening men for prostate and colorectal cancer in the United States: does practice reflect the evidence. JAMA 2003;289:141420.
84 de Koning HJ, Auvinen A, Berenguer Sanchez A, Calais da Silva F, Ciatto S, Denis L, et al. Large-scale randomized prostate cancer screening trials: program performances in the European Randomized Screening for Prostate Cancer Trial and the Prostate, Lung, Colorectal and Ovary Cancer Trial. Int J Cancer 2002;97:23744.[CrossRef][ISI][Medline]
85 Prorok PC, Andriole GL, Bresalier RS, Buys SS, Chia D, Crawford ED, et al. Design of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Control Clin Trials 2000;21(6 Suppl):273S309S.[CrossRef][ISI][Medline]
86 Centers for Disease Control and Prevention. Prostate cancer screening: a decision guide. Available at: http://www.cdc.gov/cancer/prostate/decisionguide/index.htm. [Last accessed May 2003.]
87 Le Marchand L, Wilkens LR, Kolonel LN, Hankin JH, Lyu LC. Associations of sedentary lifestyle, obesity, smoking, alcohol use, and diabetes with the risk of colorectal cancer. Cancer Res 1997;57:478794.[Abstract]
88 Flood A, Velie EM, Chaterjee N, Subar AF, Thompson FE, Lacey JV Jr, et al. Fruits, vegetables, and risk of colorectal cancer in the Breast Cancer Detection Demonstration Project (BCDDP) Follow-Up Cohort. Am J Clin Nutr 2002;75:93643.
89 American Cancer Society. Cancer Facts and Figures 2003. Atlanta (GA): American Cancer Society; 2003. Available at: http://www.cancer.org. [Last accessed June 2003.]
90 Cronin K, Krebs-Smith SM, Feuer EJ, Troiano RP, Ballard-Barbash R. Evaluating the impact of population changes in diet, physical activity and weight status on population risk for colon cancer (United States). Cancer Causes Control 2001;12:30516.[CrossRef][ISI][Medline]
91 Potter JD. Colorectal cancer: molecules and populations. J Natl Cancer Inst 1999;91:91632.
92 Thun MJ, Henley SJ, Patrono C. Nonsteroidal anti-inflammatory drugs as anticancer agents: mechanistic, pharmacologic, and clinical issues. J Natl Cancer Inst 2002;94:25266.
93 Baron JA, Cole BF, Sandler RS, Haile RW, Ahnen D, Bresalier R, et al. A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med 2003;348:8919.
94 Sandler RS, Halabi S, Baron JA, Budinger S, Paskett E, Keresztes R, et al. A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med 2003;348:88390.
95 Mandelblatt J, Andrews H, Kao R, Wallace R, Kerner J. The late-stage diagnosis of colorectal cancer: demographic and socioeconomic factors. Am J Public Health 1996;86:17947.[Abstract]
96 Cooper GS, Yuan Z, Landefeld CS, Rimm AA. Surgery for colorectal cancer: race-related differences in rates and survival among Medicare beneficiaries. Am J Public Health 1996;86:5826.[Abstract]
97 Potosky AL, Harlan LC, Kaplan RS, Johnson KA, Lynch CF. Age, sex, and racial differences in the use of standard adjuvant therapy for colorectal cancer. J Clin Oncol 2002;20:1192202.
98 U.S. Preventive Services Task Force (USPSTF). Recommendations and rationale for colorectal cancer screening. Washington (DC): U.S. Department of Health and Human Services. Available at: http://www.ahcpr.gov/clinic/colorsum.htm. [Lat accessed June 2003.]
99 Klabunde CN, Frame PS, Meadow A, Jones E, Nadel M, Vernon SW. A national survey of primary care physicians colorectal cancer screening recommendations and practice. Prev Med 2003;36:35262.[CrossRef][ISI][Medline]
100 Schrag D, Cramer L, Bach P, Begg C. Age and adjuvant chemotherapy use after surgery for stage III colon cancer. J Natl Cancer Inst 2001;93:8507.
101 Sundararajan V, Grann V, Jacobson J, Ahsan H, Neugut AI. Variations in the use of adjuvant chemotherapy for node-positive colon cancer in the elderly: a population-based study. Cancer 2001;7:2138.
102 Moertel CG. Chemotherapy for colorectal cancer. N Engl J Med 1994;330:113642.
103 National Cancer Institute, Consensus Conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:144450.[CrossRef][ISI][Medline]
104 Rosenberg HM, Maurer JD, Sorlie PD, Johnson NJ, MacDorman MF, Hoyert DL, et al. Quality of death rates by race and Hispanic origin: a summary of current research, 1999. Washington (DC): National Center for Health Statistics. Vital Health Stat Series 2, No. 128. Sept 1999.
105 Poe GS, Powell-Griner E, McLaughlin JK, Placek PJ, Thompson GB, Robinson K. Comparability of the death certificate and the 1986 National Mortality Followback Survey. Vital Health Stat 1993;2:118.
106 Hogan H. The 1990 Post-Enumeration Survey: operations and results. J Am Stat Assoc 1993;88:104760.[ISI]
107 Hiatt RA, Rimer BK. A new strategy for cancer control research. Cancer Epidemiol Biomarkers Prev 1999;8:95764.
108 Curry S, Byers T, Hewitt M. Fulfilling the potential of cancer prevention and early detection. Washington (DC): National Academy Press, National Research Council. In press 2003.
109 Wingo PA, Jamison PM, Hiatt RA, Weir HK, Gargiullo PM, Hutton M, et al. Building the infrastructure for nationwide cancer surveillance and controla comparison between the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) program (United States). Cancer Causes Control 2003;14:17593.[CrossRef][ISI][Medline]
110 Hewitt M, Simone JV, editors. Enhancing data systems to improve the quality of cancer care. Washington (DC): Institute of Medicine, National Academy Press; 2000.
111 Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEERMedicare data: content, research applications, and generalizability to the United States elderly population. Med Care 2002;40:IV318.
112 Wingo PA, Luke E, OBrien K, Brogan D, Chen VW, Wu XC, et al. Population-based patterns of care studies: collaboration among state cancer registries, the American College of Surgeons, and the American Cancer Society. J Registry Manag 2001;28:517.
113 Ayanian JZ, Zaslavsky AM, Fuchs CS, Guadagnoli E, Creech CM, Cress RD, et al. Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort. J Clin Oncol 2003;21:1293300.
114 Byers T, Mouchawar J, Marks J, Cady B, Lins N, Swanson GM, et al. The American Cancer Society challenge goals. How far can cancer rates decline in the U.S. by the year 2015? Cancer 1999;86:71527.[CrossRef][ISI][Medline]
Manuscript received June 6, 2003; revised July 16, 2003; accepted July 21, 2003.
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