Understanding Cancer and the Numbers Camdenton Community Advisory - - PowerPoint PPT Presentation
Understanding Cancer and the Numbers Camdenton Community Advisory Team Meeting May 8, 2018 Missouri Department of Health and Senior Services Division of Community and Public Health Office of Epidemiology Overview What is cancer? How
Missouri Department of Health and Senior Services Division of Community and Public Health Office of Epidemiology
What is cancer? How common is cancer? What factors increase our risk? Can we do anything to decrease the risk? What do the numbers tell us? What is Epidemiology?
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Study of disease or
Determinants of the
Application of
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Summary data Population groups Disease surveillance Risks or protective
Community screening
Requires special study Many factors involved
Exposure or contact? For how long? Personal & Family history? Many others…
Staff resources & expertise Very costly
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1972 MCR established with voluntary hospital reporting 1984 bill passed required hospital inpatient cancer
1992 National Program of Cancer Registries (Public Law
1996 NPCR reference year 1999 bill passed expanding reporting to other entities such
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Demographics at diagnosis Date of diagnosis Primary tumor location Tumor characteristics Lymph nodes Initial treatment Death data Risk factors (Mo specific) Usual occupation / industry (when available)
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Prior to 1996 data are in various degrees of
Captures address at time of diagnosis May not be able to account for people who
moved away from the area and then
were diagnosed and died prior to 1996
Limited information on occupation and risk
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Works with individuals or communities to:
Explore their cancer concern Provide health education on cancer and lifestyle
Provide epidemiological information
Most identified cancer excesses are due to
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How many people are diagnosed each year (incidence) Number of people living with cancer (prevalence) Number of people who die from cancer (mortality) Are there significant differences among certain groups
Historic data used to monitor changes over time
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Why do I know so many people with
Why am I burying so many of my friends
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1.7 million new cases
35,000 new cases in
600,000 deaths in the
11 American Cancer Society, Inc. Cancer Facts & Figures 2018 https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual- cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf
Group of diseases – more than 100 types
Named by organ or tissue of
Uncontrolled growth of abnormal cells due to genetic changes / DNA damage
Occurrence varies by population groups Brain Cancer Cells Breast Cancer Cell Dividing lung cancer cell National Institutes of Health
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Multiple genes can interact with a number of environment and social factors
Institute of Medicine (US) Cancer and the Environment: Gene-Environment Interaction and From Cancer Patient to Cancer Survivor Lost in Transition
Tobacco use 30%* Diet 20-35%* Physical inactivity 5% Excess body weight 7% Occupation 4% Genetic susceptibility 5-10% Alcohol 2-4% Infectious agents 10%* Reproductive factors 7%* Environmental pollution 2% Low economic status 3% Ultraviolet light/Radiation 3%
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The time between exposure and clinical recognition – varies by cancer May be 10 years, 20 years, or more
Environmental Contaminant
Health effects depend on several factors:
Potential increased risk for certain
Primary cancers sites:
16 Agency for Toxic Substances and Disease Registry, Toxicological Profile https://www.atsdr.cdc.gov/index.html
Human carcinogen – liver cancer Lengthy latency period Occupational exposure - cancers Lung and respiratory tract Lymphatic and blood Brain and central nervous system Newer studies did not find significant association
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Inhalation Ingestion Dermal
Duration of exposure
Acute (14 days or less) Intermediate (15 – 364 days) Chronic (365 days or more)
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Multisite carcinogen in rats and mice. The EPA concluded that TCE is
19 Agency for Toxic Substances and Disease Registry. Draft Toxicological Profile for Trichloroethylene, October 2014 (page 83), https://www.atsdr.cdc.gov/toxprofiles/tp19.pdf
Lung and Bronchus 5,349 Female Breast 4,843 Prostate 3,154 Colon/Rectum/ Rectosigmoid 2,902 Urinary Bladder 1,466 Melanoma 1,330 Non-Hodgkin Lymphoma 1,324 Kidney and Renal Pelvis 1,276 Corpus and Uterus, NOS 991 Pancreas 960 Other cancers 8,339 Missouri Department of Health and Senior Services. Cancer Incidence Missouri Information for Community Assessment (MICA). https://webapp01.dhss.mo.gov/MOPHIMS/MICAHome 20
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Missouri
1 2 3 4 5 7 6
10 Missouri Cancer Registry and Research Center http://mcr.umh.edu/mcr-county-level-data.php
*Risks: Tobacco use and heavy alcohol (30-fold), human papillomavirus
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Lung / bronchus*
Kidney / renal pelvis*
Non-Hodgkin lymphoma*
Leukemia
Brain / central nervous system
Liver / intrahepatic bile ducts
Hodgkin lymphoma
Female Breast* (community interest)
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Camden County compared to Missouri
*Included in top 10 cancers
Rate is the number of cases divided by the
Age-adjustment is a process applied to rates of
Confidence Intervals a range around a
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Random fluctuations X X
Statistical Significance Statistical Significance
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126.4 78.6 19.0 15.9 13.0 7.0 5.8 120.8 75.1 16.6 14.4 12.1 6.0 3.6
20 40 60 80 100 120 140
Female Breast Lung / Bronchus Non-Hodgkin Lymphoma Kidney / Renal Pelvis Leukemia Brain / Other CNS Liver / Bile Ducts*
Age-adjusted Rate
Missouri Camden
^Age-adjustment uses 2000 US standard population; rate per 100,000 people CNS = central nervous system
*Rate statistically significantly lower in Camden County for liver and intrahepatic bile ducts cancer No significant difference for remaining cancers
Missouri Department of Health and Senior Services, Missouri Information for Community Assessment Cancer Incidence, https://webapp01.dhss.mo.gov/MOPHIMS/MICAHome
57.9 24.3 7.6 6.7 5.4 4.6 4.5 51.4 21.0 6.1 5.0 4.5 4.1 4.0
10 20 30 40 50 60 70
Lung / Trachea / Bronchus* Female Breast Leukemia Non-Hodgkin Lymphoma* Liver / Intrahepatic Bile Ducts Brain / Meninges / CNS Kidney / Renal Pelvis
Age adjusted Rate
Missouri Camden
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*Rate statistically significantly lower in Camden County for lung and non-Hodgkin lymphoma
Missouri Department of Health and Senior Services, Death MICA, https://webapp01.dhss.mo.gov/MOPHIMS/MICAHome
In situ Localized Regional Distant Unknown
Camden 13.3 53.3 25.7 4.4 3.3 Missouri 16.5 50.8 25.1 4.5 3.2
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Stage at diagnosis is similar between Camden County and Missouri
Missouri Department of Health and Senior Services, Missouri Information for Community Assessment Cancer Incidence, https://webapp01.dhss.mo.gov/MOPHIMS/MICAHome
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297 66 65 40 21 18 10 302.5 70.0 58.8 46.0 22.3 20.3 7.5 50 100 150 200 250 300 350 Lung / Bronchus Non-Hodgkin Lymphoma Kidney / Renal Pelvis Leukemia Brain Liver / Intrahepatic bile ducts Hodgkin Lymphoma
Number of Cases Observed Expected Missouri Cancer Registry and Research Center
297 66 65 40 21 18 10 278.6 57.1 46.5 39.9 17.1 12.2 8.2
50 100 150 200 250 300 350
Lung / Bronchus Non-Hodgkin Lymphoma Kidney / Renal Pelvis Leukemia Brain Liver / Intrahepatic bile ducts Hodgkin Lymphoma
Number of Cases Observed Expected
Kidney / renal pelvis Observed 65 cases Expected 46.5 cases SIR 1.40 95% CI 1.08 – 1.78
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55% were 65 years of age or older 65% were men 60% were diagnosed early in a localized
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31 2 4 6 8 10 12 14 16 18 20 1996-1999 2000-2003 2004-2007 2008-2011 2012-2015
Number of Cases
Joinpoint analysis showed an annual percent change -2.1% Not statistically significant (p = 0.2)
Smoking Obesity Family history Occupation exposures Environmental exposures High blood pressure Certain medicines Gender – males Certain genetic conditions Others
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No statistically significant difference for 6 of
Significantly lower for two cancers:
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No statistically significant differences when
One statistically significant difference when
Most of the kidney cancer cases occurred in at-
Trend in kidney cancer cases may be headed
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Cancer inquiry recommended and Patient
Each person completing a form mails the form
Would like to have as many forms returned to the CI
Once the forms are received, case verification is
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Assessment is completed of the patient information
Types of primary cancers involved Number of cancer cases Population demographics, geographic area
Cases that meet criteria Feasibility and recommendations
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