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Cancer in Idaho: Data Update & Strategic Plan Objectives  Idaho Cancer Policy Agenda Meeting April 25, 2014 Chris Johnson, Epidemiologist Cancer Data Registry of Idaho cjohnson@teamiha.org. 3 Handouts. Cancer. 100+ different diseases Since 2008, #1 cause of death in Idaho

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  1. Cancer in Idaho: Data Update &Strategic Plan Objectives Idaho Cancer Policy Agenda MeetingApril 25, 2014Chris Johnson, EpidemiologistCancer Data Registry of Idahocjohnson@teamiha.org

  2. 3 Handouts

  3. Cancer • 100+ different diseases • Since 2008, #1 cause of death in Idaho • About 22% of deaths are from cancer • In 2011 in Idaho: 7,263 new invasive cases 849 new in situ cases 2,559 cancer deaths 30% of those diagnosed this year will die of cancer within five years

  4. Leading Cause of Death by AgeIdaho 2012 • Cancer is the leading cause of death among age groups 45-54, 55-64 and 65-74

  5. Trends in Crude Mortality Rates, Idaho

  6. Why is Cancer the Leading Cause of Death in Idaho? • Competing risks • Why are heart disease/stroke deaths down? • “Statins and Smoking” • Decreases in blood cholesterol levels and uncontrolled hypertension (risk factors), mostly through medication • Improvements in medical treatments for blocked arteries, stroke • Lower smoking rates in Idaho

  7. Cancer Risk Factors

  8. Levels of Disease Prevention • Primary Prevention • Aims to prevent the disease from occurring • Reduces incidence • Secondary Prevention • After the disease has occurred but before symptoms • Aims to find and treat disease early • Tertiary Prevention • Goals are to improve treatment outcomes, prevent complications

  9. Colon & Rectum Cancer Lung Cancer, Tobacco, other Tobacco-related Cancers Measures of cancer burden: incidence, mortality, YPLL Melanoma Breast Cancer Behavior: smoking, physical activity, diet, screening

  10. Lung Cancer/Smoking Constellation

  11. Lung Cancer • Idaho 2011: • 838 new cases • 616 deaths • By far the leading cause of cancer death among both men and women • Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined • Lung cancer has a poor prognosis; nearly 90% of persons with lung cancer die of the disease

  12. Lung Cancer Risk Factors • Smoking causes ~85% of lung cancer deaths • Radon – 2nd leading cause of lung cancer • About 10% of lung cancer deaths • Leading cause of lung cancer among non-smokers • Secondhand smoke • Asbestos, arsenic, chromium, nickel, other substances in workplace • Air pollution, including diesel exhaust

  13. Smoking • Accounts for at least 30% of all cancer deaths • Population attributable risk varies by cancer site for other smoking-related cancers: • Colon & Rectum • AML • Larynx • Oral Cavity • Nose and Sinuses • Pharynx • Esophagus • Stomach • Pancreas • Cervix • Kidney • Bladder • Ovary

  14. Counseling & Interventions • The USPSTF recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products. • Grade: A recommendation: there is high certainty that the net benefit is substantial.

  15. USPSTF Screening Recommendation (Dec 2013) • The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. • Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. • Screening cannot prevent most lung cancer–related deaths, and smoking cessation remains essential.

  16. Drilling Down into CCAI Strategic Plan Measures 2. Reduce the lung cancer death rate 6. Reduce the oropharyngeal cancer death rate 18. Decrease the proportion of adults aged 18+ who are current smokers 19. Reduce tobacco use by adolescents 23. Reduce the proportion of males who use smokeless tobacco

  17. Lung Cancer State Map

  18. Lung Cancer Trends - Idaho

  19. Lung Cancer Age-Specific Rates, Idaho, 2007-2011

  20. Variation and Disparities in Lung Cancer in Idaho • Geographic • Race/ethnicity • Area-based SES measures

  21. County Maps of Smoking and Lung Cancer Incidence & Mortality Smoking 11-12 Inc 07-11 Mort 08-12

  22. Smoking Prevalence, Idaho 2012 * In 2012, about 190,000 adult smokers in Idaho.

  23. Smoking Prevalence, Idaho 2012

  24. Smoking Prevalence, Idaho 2012

  25. Area-Based Measures • Used methods based on Harvard School of Public Health Disparities Geocoding Project • Geocoded cancer incidence data • Used area-based socioeconomic measures (ABSMs) to characterize both the cases and population • Computed rates stratified by the area-based measure of socioeconomic status • Ran multilevel models and will be showing the effects that were statistically significant

  26. Census Tract 2010PovertyAmerican Community Survey 2007-2011

  27. Census Tract 2010UninsuredAmerican Community Survey 2008-2012

  28. Lung Cancer Incidence by Census Tract % Uninsured

  29. Potentially Averted Lung Cancer Cases, 2007-2011

  30. Lessening the Burden from Lung Cancer • Primary Prevention • Don’t smoke! • Test for radon • Secondary Prevention • LDCT among high risk population • Tertiary Prevention • Ensure quality treatment • Access to care • Concordant with guidelines (e.g. NCCN) • Clinical trials

  31. Using the Drill-Down Results • Target geographic areas • Disparities by: • Income • Education • Uninsured • LGBT

  32. Colon & Rectum Cancer Constellation

  33. Colon & Rectum Cancer • Idaho 2011: • 639 new invasive cases • 17 new in situ cases • 222 deaths • Of cancers affecting both men and women, second leading cause of cancer death

  34. Colon & Rectum Cancer Risk Factors • UK (2011) study estimates 54% of colon & rectum cancer cases are attributable to lifestyle factors: Br J Cancer. 2011; 105(Suppl 2): S77–S81. • Red and preserved meat consumption (21%) • Overweight and obesity (13%) • Low fiber diet (12%) • Alcohol (12%) • Tobacco (8%) • Physical inactivity (3%) • Other [infections, radiation] (4%) • The percentages reflect the effect of removing one cause of cancer independently of other causes, and there is overlap, so the total is less than the sum

  35. USPSTF Recommendation (Oct 2008): • The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults beginning at age 50 years and continuing until age 75 years. • Grade: A recommendation – there is high certainty that the net benefit is substantial.

  36. Colorectal Cancer Screening • CDC: “If everyone aged 50 years or older had regular screening tests, at least 60% of deaths from this cancer could be avoided.” • Colorectal cancer screening helps find precancerous polyps so they can be removed before they turn into cancer. In this way, colorectal cancer is prevented. • Screening tests also can find colorectal cancer early, when the chance of cure is better.

  37. CCAI Strategic Plan ObjectivesPertaining to Colon & Rectum Cancer • 5 – Mortality • 9 – Incidence • 15 – Late stage CRC among persons aged 50+ • 16 – CRC Screening • 21 – Overweight • 22 – Physical activity

  38. Colon & Rectum Cancer State Map

  39. Colorectal Cancer ScreeningIdaho 2012, Ages 50-75

  40. Colorectal Cancer ScreeningIdaho 2012, Ages 50-75

  41. Colorectal Cancer ScreeningIdaho 2012, Ages 50-75

  42. Colon & Rectum Cancer Trends

  43. Colon & Rectum Cancer Incidence by Race/Ethnicity, 2007-2011

  44. Colon & Rectum Cancer Incidence by Census Tract % Poverty

  45. Potentially Averted Colon & Rectum Cancer Cases, 2007-2011

  46. Lessening the Burden from Colon & Rectum Cancer • Primary Prevention • Healthy diet, Healthy BMI, Physical activity • Don’t smoke • Secondary Prevention • Colon & rectum cancer screening • Tertiary Prevention • Ensure quality treatment • Access to care • Concordant with guidelines (e.g. NCCN) • Clinical trials

  47. Using the Drill-Down Results • Target geographic areas • Disparities by: • Income • Education • Area-based SES

  48. Breast Cancer Constellation

  49. Breast Cancer (Female) • Idaho 2011: • 1,006 new invasive cases • 225 new in situ cases • 194 deaths • Among Idaho women, breast cancer is: • the most common cancer (incidence) • 2nd most common for mortality

  50. Breast Cancer Risk Factors • Risk Factors you Cannot Change • Aging • Race and ethnicity • Genetic risk factors • 5-10% of breast cancers are hereditary • BRCA1 and BRCA2 • Family history • 15% of women who get breast cancer have a family history; 85% do not. • Dense breast tissue • Certain other breast conditions (LCIS, DCIS, atypical ductal or lobular hyperplasia) • Number of menstrual cycles • Previous chest radiation • Diethylstilbestrol exposure

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