produced by district of columbia cancer registry bureau of ...cancer is a reportable disease in...

BURDEN OF CANCER IN THE DISTRICT OF COLUMBIA

Produced by District of Columbia Cancer Registry Bureau of Cancer and Chronic Diseases Community Health Administration

April 2014

Acknowledgments

MayorGovernment of the District of Columbia DirectorChief Health OfficerDC Department of Health Senior Deputy DirectorCommunity Health Administration Deputy Director for Programs Community Health Administration Deputy Director of Strategic Planning, Policy, and EvaluationCommunity Health Administration State EpidemiologistCenter for Policy, Planning & Evaluation Bureau ChiefCancer and Chronic Disease Chief, Cancer Data DivisionDC Cancer Registry Chief, Cancer Programs DivisionCommunity Health Administration Statistician/EpidemiologistCommunity Health Administration Statistician Community Health Administration

Vincent C. Gray

Joxel Garcia MD, MBA

Ryan Springer MPH

Djinge Lindsay

MD, MPH

Keela S. Seales Esq.

John Davies-Cole PhD, MPH

Jason Brown,

MHSA

Kathleen Rogers CTR

Amari Pearson-Fields

PhD, MPH

Rolando Medina MPH, MBA, DrPH(c)

Alicia Vargas

The DC Cancer Registry (DCCR) would like to thank the cancer registrars throughout the District who abstract and submit data to the central registry. Without you, this report would not have been possible.

The DCCR wishes to acknowledge the Centers for Disease Control and Prevention (CDC) for its financial support under Cooperative Agreement #U5-8DP000846-05. The contents of this report are solely the responsibility of the authors and

do not necessarily represent the official views of the CDC.

Table of Contents

Introduction Chapter 1 A Note on Data Generation Chapter 2 District of Columbia Background Chapter 3 Incidence: How Many People in DC Get Cancer? Chapter 4 Incidence Trend for Selected Cancers in the District of Columbia Chapter 5 Cancer Mortality Trends Over Time Chapter 6 Site-Specific Trends in Cancer Incidence and Mortality by Sex, Race, Age, Stage, and Ward Chapter 7 Other Cancer Incidence Sites Chapter 8 Definitions and Technical Notes

pg 3 pg 5

pg 8 pg 12 pg 15 pg 17 pg 19 pg 43

pg 44

CitationMaterial appearing in this publication may be repro-duced or copied without permission; however, the fol-lowing citation must be used to indicate the source: District of Columbia (DC) Division of Cancer Data, DC Cancer Registry, a program funded by Centers for Dis-ease Control and Prevention (CDC). Medina R., Vargas A., Rogers K. & Pearson-Fields, A. (2014). Burden of Cancer in the District of Columbia. Washington, DC; District of Co-lumbia Department of Health (DOH), Community Health Administration, Bureau of Cancer and Chronic Disease.

The DOH website includes additional resources, such as in-dividual figures from the publication and an archive of pre-vious editions: (www.doh.dc.gov/service/cancer-registry-0).

The development of this publication over the years has benefited considerably from the comments and sugges-tions of readers. The DC Cancer Registry Advisory Commit-

tee appreciates and welcomes such comments. To be noti-fied about next year’s publication or to offer ideas on how the publication can be improved, please complete the evaluation form or e-mail [email protected]

About this PublicationThe aim of this annual publication is to provide detailed in-formation regarding incidence, mortality and other mea-sures of cancer burden for the most common types of cancer in the District of Columbia. By law, the District of Columbia Cancer Registry (DCCR) collects, analyzes, and disseminates information on cancers diagnosed and treated in the Dis-trict. Data are presented by sex, race, age, stage and Dis-trict ward by year of diagnosis. They also show trends over time. This publication is designed to help health profession-als, policy-makers and researchers identify and make deci-sions about new areas for investigation and allocation of resources. Media, educators and members of the public with an interest in cancer will also find this publication valuable.

District of Columbia Cancer Registry, Bureau of Cancer and Chronic Diseases, 20143

The District of Columbia Central Cancer Registry (DCCR) and the Comprehensive Cancer Control Program (CCCP) are pleased to present the annual Cancer Report for the District of Columbia, monograph series, docu-menting cancer incidence and mortality in the District for 2010.

The examination of cancer incidence trends can lead to the reduction of certain behavioral risk-factors, enhance early detection and decrease cancer mortality. By analyzing can-cer trends in this publication allows for an insight in how the data is collected, how to interpret the data, and what can be addressed in the future to keep the cancer incidence and mortality trend at a decline.

Introduction

District of Columbia Cancer Registry, Bureau of Cancer and Chronic Diseases, 2014 4District of Columbia

Cancer Registry, Bureau of Cancer and Chronic Diseases, 20144

Cancer Incidence* 2010* Only invasive cases are considered.

All Sites 2,955 Cases

Prostate Cancer 490 Cases

Lung and Bronchus Cancer

348 Cases

Colorectal Cancer 270 Cases

Female Breast Cancer 466 Cases


What is the Cancer Registry? Cancer is a reportable disease in every state and territory in the United States (U.S.). The District of Columbia Cancer Registry (DCCR) collects, main-tains, and reports cancer incidence on all cancers diagnosed and/or treated in the District of Colum-bia (DC). DCCR track all malignant, and certain be-nign tumors, and publishes annual reports on the incidence and mortality of cancer in DC.

DCCR gathers relevant data from hospitals, labora-tories, and other agencies with legislatively man-dated reporting under existing law. The Depart-ment of Health has also entered into reciprocal exchange agreements for cancer information with its neighboring states (Maryland, Virginia, Pennsyl-vania, West Virginia, Delaware), in order to capture all occurrences of cancer among DC residents.

Protocols such as completeness, accuracy, and timeliness are imperative when gathering data for the registry. Since 1996, the District’s cancer data has been closely reviewed by the North American Association of Central Cancer Registries (NAACCR), and the National Program of Cancer Registries (NPCR). Academic medical centers, re-

searchers, public health agencies, advocacy groups and interested lay persons rely heavily on the re-ports generated by the DCCR. Mortality occurrences are collected by the District of Columbia Cen-ter for Policy, Planning and Evaluation, Office of Vital Records. What is the Cancer Registry used for?

Local, state and national agencies use registry data to make important public health decisions that maximize the effectiveness of limited public health funds, such as the placement of screening programs. Cancer registry data is also used to:

• Evaluate patient outcomes• Provide follow-up information for surveillance• Calculate survival rates by various data items• Analyze referral patterns• Allocate resources• Develop educational programs• Report cancer incidence and cancer mortality• Evaluate efficacy of treatment modalities• Perform linkages with Project WISH (Breast &

Cervical Early Detection Program), HIV/AIDS Registry and Social Security Death Index.

Chapter 1: A Note on Data Generation

Chapter 1 A Note On Data Generation

District of Columbia Cancer Registry, Bureau of Cancer and Chronic Diseases, 2014 6

What does the Cancer Registry do to protect privacy? All information reported to the DCCR is con-fidential and strict procedures are in place to protect patients’ privacy. For example, access to the Registry is restricted and all employees are trained in handling confidential informa-tion. District law limits use of confidential cancer data to research. All research studies involving data with patient identifiers must be reviewed by the Health Department’s Institutional Review Board, to ensure privacy and informed consent.

What if information is collected about pa-tients with Cancer? When the Cancer Registry first started collect-ing data, only a minimal amount of informa-tion about patients and tumors were collected. Over the years, the volume of cancer cases has increased and the amount of data collected for each case has expanded. The Cancer Registry col-lects data on the anatomic tumor sites, stages at diagnosis, cancer histology and treatment infor-mation. When a person is diagnosed with more than one type of cancer, information is collected for each separate tumor. The Cancer Registry also collects socio-demographic information (age, gen-der, ethnicity, race, residence, place of birth, etc.) on each individual diagnosed with cancer. Infor-mation about the date and cause of death of per-sons diagnosed with cancer is also stored in the database. In total, more than 365 different data variables are abstracted on each tumor contained in the Registry database.

The Cancer Registry includes reports of all malig-nant cancers, and certain benign tumors, except basal cell and squamous cell cancers of the skin that are exempt from reporting. Malignant can-cers include those with both in situ and invasive stages. In situ cancers are generally identified

early and are less likely to spread, while invasive cancers have more potential to spread. The Can-cer Registry also collects data on brain and cen-tral nervous system tumors classified as benign or which have an uncertain behavior. Benign tumors are growths that do not have the potential to me-tastasize beyond the tissue where they originated.

Where do reports of cancer cases come from? Each time a person is diagnosed with a tumor, the hospital(s) where that person is diagnosed and/or treated reports information about the person and tumor to the Cancer Registry. Reporting is not vol-untary. The law specifies that reports will be sub-mitted within six months of diagnosis. Although the law requires that all cancer cases be reported to the Cancer Registry regardless of where they are diagnosed, in practice, cancer reports are mainly received from hospitals. Other types of re-porting facilities, such as pathology laboratories, and ambulatory care centers also report cases. Although Veterans’ Affairs Medical Centers and military hospitals are exempt from the reporting requirements, many voluntarily report cancer cas-es to the Cancer Registry. Death certificates and autopsy reports are also reported to the Registry.

Comprehensive Cancer Control Comprehensive cancer control (CCC) is a process through which communities and partner organizations pool resources to reduce the burden of cancer. These combined efforts help to:

• Encourage people to live a healthy lifestyle• Promote cancer screening tests• Increase access to good cancer care, and • Improve the quality of life for people who

survive cancer.



To guide this work, the CCC program utilizes the framework set out in the District’s Cancer Control Plan. The plan establishes goals and objectives for early detection, access to care, treatment and sur-vivorship. The District of Columbia CCC Program works with various community partners, stakehold-ers, policy makers, and activists to address the goals and objectives of the District’s Cancer Control Plan. The Centers for Disease Control and Preven-tion (CDC) started the National Comprehen-sive Cancer Control Program (NCCCP) to help states, tribes, U.S. Affiliated Pacific Islands, and territories form or support existing coalitions to fight cancer. These coalitions use data to determine the greatest cancer-related needs in their area, and develop and carry out cancer plans to meet those needs.

There are several building blocks to inform the development and implementation or es-tablish plans for strategy initiatives of Com-prehensive Cancer Control at the state level. These include:

• Enhancing infrastructure necessary to manage and support CCC efforts.

• Mobilizing support by improving the use of existing resources for cancer programming and increasing the level of support available.

• Performing research to guide decision making and determine priorities.

• Building partnerships to increase aware-ness and involvement across differ-ent disciplines and sectors including health/medical providers, public health, non-profit organizations, insurance compa-nies, businesses, cancer survivors, government agencies, academic institutions, and advocates.

• Assessing and addressing the cancer bur-den to reduce illness and death from cancer and disparities among population groups.

• Evaluating outcomes associated with CCC planning and implementation.



Chapter 2: District of Columbia Background

The District is home to an abundance of medi-cal care facilities and providers, but equal access to cancer care services is significantly under-mined by the physical location of those provid-ers. Access to cancer screening, treatment, and follow-up care is, in some measure, influenced by where a District resident lives. Geographi-cally, the District is divided into four quadrants: northwest, northeast, southwest, and south-east. Politically, it is divided into eight wards (see Figure 1). Wards 1, 3, and 4 are in the north-west quadrant; Ward 2 straddles northwest and southwest; Ward 5 is mainly in the northeast (and a small portion of northwest; Ward 6 is in north-east, southwest, and southeast; Ward 7 is in both northeast and southeast; and Ward 8 is in the southwest and southeast quadrants. Many cancer-related health care facilities are located in northwest Washington (in Wards 1, 2, 3, 4, and parts of Ward 5) (See Figure 1). There is one full-service hospital located east of the Ana-costia River (Wards 7 and 8), serving 20% of the District’s population.

For those dependent on public transportation, es-pecially those weakened by cancer, it can be diffi-

cult and exhausting to reach a hospital in another part of the city. Of the District’s eleven hospitals; Providence Hospital, is located in northeast, and United Medical Center is located in southeast. The other nine hospitals—Children’s National Medical Center, George Washington University Hospital, Georgetown University Medical Cen-ter, Howard University Hospital, Sibley Memorial Hospital, Veterans’ Affairs Medical Center, and the Washington Hospital Center—are all in north-west. All four cancer centers—Georgetown Uni-versity Hospital, George Washington University Hospital, Howard University Hospital and Wash-ington Hospital Center—are also located in north-west. The inequitable distribution of infrastruc-ture for cancer care in the District may impact the city’s cancer incidence and mortality rates. Disparities in access to care and in the quality of care are seen in every aspect of cancer control: screening, early detection, incidence, treatment, quality of care, and survival. Addressing the Dis-trict’s cancer disparities remains a central theme in the city’s comprehensive cancer control plan-ning and is addressed in nearly every chapter of the Cancer Plan.

Chapter 2 District of Columbia Background

8

76

5

2

1

4

3

United Medical Center

St. Elizabeths Hospital

George Washington University Hospital

Georgetown University Hospital

Howard University Hospital

Providence Hospital

Sibley Memorial Hospital

HH

H

H

H

H

H

H

Veterans Administration Hospital Washington Hospital Center

Children’s National Medical Center

Legend

1 Ward Number Hospital Location Border

H

District of Columbia Hospitals


Figure 1: D.C. Hospitals and Locations

2010

Under 5

5-9

10-1

415

-19

20-2

425

-34

35-4

445

-54

55-5

960

-64

65-7

475

-84

85 an

d Ove

r

5.4 4.3Population Percentage

4.2 6.6 10.7 20.7 13.4 12.6 5.7 4.9 6.1 3.6 1.7

Age Group (Years)

32,613 25,041 64,110 80,659 34,274 36,969 10,315

26,147 39,919 124,745 75,703 29,703 21,525Population Number

Total Population = 601,723

Under 5

5-9

10-1

415

-19

20-2

425

-34

35-4

445

-54

55-5

960

-64

65-7

475

-84

85 an

d Ove

r

5.7 6.2Population Percentage

5.2 6.6 9.1 17.8 15.3 13.2 4.9 3.8 6.3 4.4 1.6

Age Group (Years)

32,536 30,018 51,823 87,677 27,803 35,919 8,975

35,385 37,867 101,762 75,310 21,980 25,004Population Number

2000

Total Population = 572,059



District of ColumbiaPopulation Demographic Profile by Age, 2000 and 2010

Source: Census Bureau: Census 2000 & 2010

2000-2010 Population Percentage Change

-35 -30 -25 -20 -15 -10 -5 0 5 10 15 20 25 30

Total Population / 4.9% Under 5 / 0.2% 5-9 / -35.3%

10-14 / -19.9% 15-19 / 5.1% 20-24 / 19.2%

25-34 / 18.4% 35-44 / -8.7% 45-54 / 0.5%

55-59 / 18.9% 60-64 / 26% 65-74 / 2.8%

75-84 / -16.2% 85 & Over / 13%

-35 -30 -25 -20 -15 -10 -5 0 5 10 15 20 25 30



District of ColumbiaPopulation Demographic Profile by Race, 2000 and 2010

Race and Ethnicity — As of 2010, DC’s population was 50.7% Black, 38.5% White, and 3% Asian. Another 2% of residents describe themselves as “two races or other.” Approximately 10% of the population is His-panic (some self-identifying as White, some as Black). The Hispanic population, the fastest growing seg-ment in the city, is located mainly in Wards 1 and 4.

Income — Although the city’s population is distrib-uted equally among the eight wards, income dis-tribution is unequal. A significant number (roughly 147,000 or 26%) of residents have household in-comes below $20,000 a year. The high cost of living in

DC places households earning less than $20,000 in ex-treme poverty. Average per capita income is highest in Ward 3 ($68,477) and lowest in Ward 8 ($14,137). Similarly, average household income is highest in Ward 3 ($134,506) and lowest in Ward 8 ($38,754).

Education — Almost 300,000 Washingtonians — 22% of those older than 25 years — do not have a high school diploma. The highest number of people with college degrees is reported in Ward 3 (79%), and the lowest in Ward 8 (8%).

Source: Census Bureau: Census 2000 & 2010

Race

2000

30.8Population Percentage

176,101Population Number

60 0.3 7.9 2.7

343,312 1,713 15,18944,953

WhiteBlack or

African American

2010

38.5Population Percentage

Race

231,471Population Number

50.7 0.3 9.1 3.5

305,12521,056

54,749

2,079

WhiteBlack or

African American

American Indian Alaska Native

Asian

Hispanic or Latino (of any race)

2000-2010 Population Percentage Change White/ 23.9%

Black or African American / -12.5% Asian / 27.9% American Indian / Alaska Native / 17.6%

Hispanic or Latino (of any race) / 17.9%

American Indian Alaska Native

Asian

Hispanic or Latino (of any race)

Hispanic or Latino (of any race) / 17.9%

In all following graphics, these indicators are used to differentiate the study. Incidence and Mortality


The probability of developing a specific type of cancer depends on many factors, including the population characteristics (e.g. demographics), prevalence of risk factors (i.e., smoking, obesity), and life expectancy. This probability reflects the average experience of people in United States of America and does not take into account individu-al behaviors and risk factors.

In the U.S., 1 in 2.2 males and 1 in 2.6 females (approximately 2 in 5 Americans) are expected to develop cancer in their lifetime.

Cancer Incidence and Mortality trend over time

This chapter includes incidence data on more than 3,000 cases of invasive cancer, including approxi-mately 30 cases among children younger than 20 years, diagnosed in each of the individual years in the District of Columbia.

National mortality comparison with the District is also included. Individual years from 2000 through 2010 for cancer deaths occurring at major ana-tomic sites has been charted.

Chapter 3: Incidence: How Many People in DC Get Cancer?

Males | 43.92% (1 in 2.2)

Females | 38.00% (1 in 2.6)

Lifetime Probability of Developing Cancer USA, 2010

Figure 2: Lifetime Cancer Probability

Chapter 3 Incidence: How Many People in DC Get Cancer?

Data source: United States Cancer Statistics: 1999-2010 Incidence, WONDER Online Database. United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2013

12

Between 2000 and 2010, the cancer incidence rates in the District of Columbia decreased from 528.7 to 499.5 new cases per 100k. However, age adjust-ed incidence rates (Age-Ad-justed Rate) were mostly sta-ble for males and females.

• In males, a peak in the can-cer incidence rate in 2007 reflects the underlying trend in the prostate cancer incidence, the leading type of cancer in District men.

• Among females, the in-creasing incidence rate pri-marily reflects the steady rise in colorectal and breast cancer incidence rates.


Age-Adjusted Incidence Rates for All Cancers Combined, by Sex, District of Columbia, 2000-2010

New Cancer Cases and Age-Adjusted Incidence Rates for All Combined Cancer, District of Columbia, 2006-2010


700

600

500

400

300

200

100

0

2000

Year of Diagnosis

Ag

e-A

dju

sted

Rat

e

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

325,000

300,000

275,000

250,000

Year of Diagnosis2006 2007 2008 2009 2010

Pop

ula

tio

n G

row

th

650

600

550

500

450

400

350

2006 2007 2008 2009 2010

Ag

e-A

dju

sted

Rat

e

Year of Diagnosis

Data source: District of Columbia Cancer Registry, 2013

Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard.

13

656.3633.3

606.9

620.2583.2

574.1576.0

653.6559.0

541.3546.5

443.7414.1

399.6

502.5421.6

428.8427.6 426.8

405.2 431.7446.7

434.8423.2

410.2

442.2464.7

591.3 606.0 605.3575.9

553.1

269,359 301,322

271,455 302,949

273,971 306,265

280,400 311,828

285,626 316,097

Data source: District of Columbia Cancer Registry, 2013Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard.

Incidence

528.7 518.0543.1

538.8490.7

491.9486.6

520.9

487.8

492.7 499.5


Due to behavioral risks and other factors, women and men experience various cancers at different rates. For example, the distribution of lung and bronchus cancer among men is 19.0%, compared to 13.1% among women. This may be linked to the high proportion of District men who report tobacco use compared with (lower rates of use

among) women (Garner, Kassaye & Lewis, 2010). Additionally, new cases of colon cancer are almost twice as high in women (12.6%) than men (7.2%). Women’s distribution for kidney cancer is 3.1%, compared to men’s distribution at 2.2%.

Data source: United States Cancer Statistics: 1999-2010 Incidence, WONDER Online Database. United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2013


Urinary Bladder Kidney Ovary

Cervic Uteri Liver

All Other Cancer

3.2% 3.1% 2.7% 2.4% 2.3% 2.0%

Percent Distribution of Estimated New Cancer Cases, by Sex, District of Columbia, 2010

Kidney Liver

Pancreas Stomach

Myeloma All Other Cancer

2.2% 1.9% 1.9% 1.4% 1.2% 1.0%

Prostate 55.3%

Lung and Bronchus

19.0%

Colon 7.2%

Urinary Bladder 4.3%

Non-Hodgkins Lynphoma 2.3%

Oral Cavity and Pharynx 2.3%

Lung and

Bronchus 13.1%

Colon 12.6%

Breast 38.6%

Corp Uteri 9.8%

Thyroid 6.8%

Pancreas 3.4%


Chapter 4: Incidence Trend for Selected Cancers in the District of Columbia

Age-Adjusted incidence Rate for All Cancers Combined and Selected Cancers, District of Columbia, 2000-2010

The incidence trend depicted in this table portrays cancer incidence declining for several years, and then rising again nearing the year 2010. Breast cancer in females had a sharp increase in inci-dence during 2003, then declined and remained stable for the remainder of the reporting period.

Chapter 4 Incidence Trend for Selected Cancers in the District of Columbia

500

400

300

200

100

02000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Ag

e-A

dju

sted

Rat

e

600 528.7 518.0543.1 538.8

490.7 491.9 486.6520.9

487.8 492.7 499.5

65.0 74.7 67.8 67.3 62.5 64.0 64.7 59.6 61.4 60.6 60.2

64.7 58.8 82.0 63.8 52.9 53.1 47.9 55.8 43.4 47.3 45.9

Colorectal

All Sites

Lung

Year of Diagnosis

Data source: District of Columbia Cancer Registry, 2013.Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard.



250

200

150

100

50

0

LungColorectal

Prostate

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

ColorectalLung

Breast

200

150

100

50

02000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010


Ag

e-A

dju

sted

Rat

e

248.7220.8 229.3

207.1187.6 184.3

185.4

241.6212.8

187.7 188.3

70.532.5 30.1

72.8 58.9 60.9 51.163.1

43.753.5

44.5

82.6 84.9 87.2 88.7 89.1 82.3 82.9 80.4 72.8 78.1 76.0

49.638.0 38.5

51.3 42.3 52.4 49.8 46.2 46.6 49.4 49.2

58.724.0 21.7

59.548.3 46.0 45.0 49.7 40.4 43.5 46.7

138.8 144.5 133.1

188.6

128.7130.3 137.3 140.8 133.5 139.2 143.6

Chapter 4 Incidence Trend for Selected Cancers in the District of Columbia

Age-Adjusted incidence Rate for Selected Cancers by sex, District of Columbia, 2000-2010

Ag

e-A

dju

sted

Rat

e

Year of Diagnosis

Year of Diagnosis


Cancer mortality has declined in the District over the last decade. However, cancer remains the number two cause of death among District residents follow-ing heart disease. This chapter describes District can-cer mortality trends over ten years.

Chapter 5: Cancer Mortality Trends Over Time

Chapter 5 Cancer Mortality Trends Over Time

Age-Adjusted Mortality Rates for All Cancers Combined, by Sex, District of Columbia, 2000-2010

350

300

250

200

150

100

50

0

2000

Year of Diagnosis

Ag

e-A

dju

sted

Rat

e

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

311.1 315.6304.1

260.1260.9 268.3 273.5 257.3

270.4 258.6212.4

191.0192.4 186.3

165.7 162.0 156.6 153.6 179.9 161.9 164.4158.8


Data source: District of Columbia Cancer Registry, 2013.Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard.


Age-Adjusted Death Rates by Three Top Leading Causes of Death: District of Columbia, 2010 and United States, 2010

1 2 3

Heart Disease

Malignant Neoplasms (Cancer)

Accidents

239.7

177.9

36.9

District of Columbia United States

Cause of Death RateRank

1 2 3

Heart Disease

Malignant Neoplasms (Cancer)

Accidents

178.5

172.5

42.1

Cause of Death RateRank


Chapter 5 Cancer Mortality Trends Over Time

Cancer Death Rates District of Columbia Residents, 2010

Rate 212.4

Data source: United States Cancer Statistics: 1999-2010 Incidence, WONDER Online Database. United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2013.


Rate 158.8

Rate 211.9

Rate 140.7

Rate 43.8

Rate 183.6

Sex (Male/Female) Race (Black/White)Ethnicity (Hispanic/

Non-Hispanic)


506

528

763

259

24

1,004


District of Columbia Cancer Registry, Bureau of Cancer and Chronic Diseases, 201419 District of Columbia


This section presents trends in incidence (new cases) and mortality in the District of Colum-bia from 2000 through 2010 for cancers occurring at major anatomic sites. For each cancer site, a brief description of its risk factors is presented, followed by the main findings from the trend analysis of the District’s approximately 600,000 residents.

For each cancer site, incidence rates represent in-vasive cancers diagnosed for District of Columbia residents. Trends for four types of cancer (female breast, colorectal, prostate, and lung and bron-chus) are presented, along with stage at diagno-sis, age and ward distribution.

Incidence information is included for each cancer site by:

• Trend • Sex • Race• Age• Stage• Ward Similar information (trends, sex, race, age and wards) is included for mortality.

Maps for each cancer site are included; for inci-dence based in the number of new cancer cases and mortality based on the number of cancer deaths.

Chapter 6: Site-Specific Trends in Cancer Incidence and Mortality by Sex, Race, Age, Stage, and Ward

Chapter 6 Site-Specific Trends in Cancer Incidence and Mortality by Sex, Race, Age, Stage, and Ward

19



Cancer Incidence for All Sites Combined (Invasive) District of Columbia


600

500

400

Ten Year Incidence and Trend Data Comparison

Gender

DC (All Cases) Rate 499.5 Cases 2955

Ward Comparison

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 > 85

Age

Stage at Diagnosis

‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ‘10

Male

Rate 553.1

Cases 1437

Female

R 359.0 C 314

R 451.0 C 407

R 578.6 C 502

R 500.4 C 268

R 345.1 C 215 R 494.4

C 390

R 544.4 C 313

R 522.6 C 370

In Situ Local Regional Distant N/A No Staged

0 10 20 30 40Percentage

Percentage0 3 5 7 9 11 13 15

Rate 464.7

Cases 1517

Ag

eAg

e-A

dju

sted

Rat

e

Ward Number

1 23 4 5 6 7 8

Race

White

Cases 768

Rate 378.7

Black

Rate 545.6

Cases 1914

528.7518.0

543.1538.8

490.7491.9

486.6520.9

487.8492.7

499.5

Nu

mb

er

of

Cas

es

2958 3051 2757 2731 2741 2955

2908 3024 2765 2932 2772

Year of Diagnosis

~ ~ ~ ~

19 46 56 74 92

197 256 400 434 381 333 251 201 178

258 1268 560 654 100 373

Total3213

Number of Cases

Number of Cases

Total 2955

Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard.Data source: District of Columbia Cancer Registry, 2013.

Note: ~ Data are suppressed if fewer than 16 cases are reported in the specific category.

20



Prostate

Lung and Bronchus

Colorectal

Breast

District of Columbia Cancer Incidence by Ward Selected Sites, 2010

Ward 8

Ward 7

Ward 6

Ward 5

Ward 4

Ward 3

Ward 2

Ward 1

DC

0 50 100 150 200 250

Distribution of the Most Frequent Cancer Cases Incidence, 2010 Percentages

Colorectal

Lung and Bronchus

Breast

Prostate

Other Cancer Site

The most frequent cancer sites represent 53% of all cancer cases

46.7%

15.8%

11.8%

9.1%

16.6%

Age Adjusted Rates

21




70

60

50

40

30

20

10

0All Sites Colorectal Lung &

BronchusBreast Prostate

In Situ

Local

Regional

Distant

Unk/Unstaged

Stage at Diagnosis

Perc

enta

ge

8

76

5

2

1

4

3

Incidence for All Cancer Sites Combined by Wards, 2010

182

183-210

211-249

250-284

285-329

Number of Cases by Ward

22

District of Columbia Cancer Stage at Diagnosis, 2010 Percent of Total Cases by Site

62

63-97

98-125

126-160

161-190

Number of Deaths by Ward

Mortality for All Cancer Sites Combined by Wards, 2010

8

76

5

2

1

4

3




Cancer Mortality for All Sites Combined District of Columbia

250

200

150

Ten Year Mortality and Trend Data Comparison

Gender

DC (All Deaths) Rate 177.9 Deaths 1034

Ward Comparison

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 > 85

Age

‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ‘10

Male

Rate 212.4

Deaths 506

Female

R 137.5 D 123

R 163.9 D 164

R 191.6 D 185

R 210.6 D 97

R 110.7 D 61 R 195.6

D 156

R 237.7 D 129

R 182.2 D 113

Percentage0 5 10 15 20

Rate 158.8

Deaths 528

Ward Number

1 23 4 5 6 7 8

Ag

e-A

dju

sted

Rat

e 237.6234.4

227.5

196.7202.0

204.2

201.3206.9

202.6199.6

177.9

Ag

e

Race

BlackWhite

Deaths 259

Rate 140.7

Rate 211.9

Deaths 763

Nu

mb

er

of

Dea

ths

1329 1273 1131 1129 1135 1034

1311 1102 1144 1159 1122

Year of Death

~ ~ ~ ~ ~ ~ ~ ~ ~

31 89

127 96

110 129 127 111 184

Total1,034

Number of Deaths


Data source: District of Columbia Vital Records, 2013.


23




Distribution of the Most Frequent Cancer Deaths Mortality, 2010 Percentages

The most frequent cancer sites represent 49% of all cancers deaths

Colorectal

Lung and Bronchus

Breast

Prostate

Other Cancer Site

10.9%

6.8%

51.0%

9.5%

21.9%


Prostate

Lung and Bronchus

Colorectal

Breast

District of Columbia Cancer Mortality by Ward Selected Sites, 2010

Ward 8

Ward 7

Ward 6

Ward 5

Ward 4

Ward 3

Ward 2

Ward 1

DC

0 20 40 60 80 100Age Adjusted Rates


24



Colorectal Cancer

Cancer of the colon and rectum is the third most common cancer diagnosed in the District, and the third most common cause of cancer death. An average of 315 District residents are diagnosed annually with colorectal cancer, and 121 die each year from the disease. Rates of invasive colorec-tal cancer are highest among Blacks, followed by Whites. Tumors often begin as adenomas, non-cancerous growths, or polyps that may develop on the inner wall of the colon and rectum as people get older. Colorectal cancer can often be prevent-ed through regular screening, which can identi-fy and remove precancerous growths. Routine colorectal screening can also lead to improved prognosis by detecting cancers at earlier stag-es. The cause of colorectal cancer is not known, but there are factors that may increase risk (see graphic below).

Smoking and, possibly, a diet high in animal fat

85%

MORE THAN

of colorectal cancers occur in people over

Family history of colorectal cancer in a first-degree relative (parents, siblings, or children)

Inherited conditions: hereditary nonpolyposis colon cancer and familial adenomatous polyposis.

Presence of adenomas in the colon and rectum (if not removed) 50 Inflammatory bowel

disease like Ulcerative colitis or Crohn’s disease



Colorectal Cancer Incidence for (Invasive) District of Columbia

90

60

30


Gender

DC (Colorectal Cases) Rate 45.9 Cases 270

Ward Comparison

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 > 85

Age

Stage at Diagnosis

‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ‘10

Male

Rate 44.5

Cases 115

Female

R 22.0 C 20

R 32.8 C 30

R 70.0 C 62

R 46.4 C 25

R 25.4 C 16 R 40.7

C 32

R 73.2 C 36

R 44.1 C 31


0 10 20 30 40Percentage


Rate 46.7

Cases 154

Ward Number

1 23 4 5 6 7 8

Ag

e-A

dju

sted

Rat

e

64.758.8

82.0

63.8

52.953.1 47.9

55.8

43.447.3

45.9

Race

White

Cases 44

Rate 22.1

Black

Rate 59.1

Cases 208

Ag

e

330 358 297 313 265Nu

mb

er

of

Cas

es

363 460 297 270 245 270

Year of Diagnosis

0 0 0 0 0 ~ ~ ~ ~

18 31 29 42 28 30 23 26 22

Total270

Number of Cases

25 103 68 70 0

29Total

295

Number of Cases


Data source: District of Columbia Cancer Registry, 2013.




Unk/Unstaged

Distant

Regional

Local

In Situ

2040 0 20 40 60

Stage Distribution for Colorectal Cancer by Race, 2010

58% of colorectal cancers are diagnosed at the local and regional stage

White

Black

Percentage

Stage

8

7

6

5

2

1

4

3

Incidence for Colorectal Cancer by Wards, 2010

8

76

5

2

1

4

3

7

8-10

11-15

16-17

18-20


Mortality for Colorectal Cancer by Wards, 2010

19

20-26

27-35

36-40

41-70




Cancer Mortality for Colorectal District of Columbia

30

20

10


Gender

DC (Colorectal Deaths) Rate 19.0 Deaths 113

Ward Comparison

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 > 85

Age

‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ‘10

Male

Rate 21.3

Deaths 53

R 19.0 D 17

R 16.1D 18

R 18.3 D 19

R ~ D ~

R ~ D ~ R 19.9

D 16

R ~ D ~

R ~ D ~

Percentage0 5 10 15 20 30

Rate 17.7

Deaths 60

Ward Number

1 23 4 5 6 7 8

Race

Black

Rate 23.3

Deaths 86

Female

Ag

e-A

dju

sted

Rat

e

28.425.8

23.219.0

19.821.2

22.421.8

18.018.4

19.0

White

Deaths 25

Rate 13.4

Ag

e

Nu

mb

er

of

Dea

ths

159 130 111 126 101 113

144 106 119 123 103

Year of Death

0 0 0 0 0 ~ 0 ~ ~ ~ ~

17 ~ ~ ~ ~ ~

27Total

113

Number of Deaths






Lung and Bronchus Cancer

Lung cancer is the leading cause of cancer deaths in both men and women. An average of 360 Dis-trict residents are diagnosed with lung cancer each year and 284 die each year from the disease. Smoking is the predominant cause of lung can-cer and most lung cancers occur in people who smoke. Tobacco smoke further increases the chance of developing the disease. Other substanc-es that can cause lung cancer, even among people who have never smoked, include asbestos, radon, arsenic, chromium, nickel, tar, and soot. The im-pact of these chemicals on the incidence of lung cancer is small compared to smoking.

14%

27%

of all cancer diagnoses and

of all cancer deaths were due to lung cancer.

In 2010Cigarette smoking is the number one cause of lung cancer.

The most important way to lower lung cancer risk is to quit smoking and avoid secondhand smoke.



Cancer Incidence for Lung and Bronchus (Invasive) District of Columbia

80

65

50


Gender

DC (Lung and Bronchus Cases) Rate 60.2 Cases 348

Ward Comparison

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 > 85

Age

‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ‘10

Male

Rate 76.0

Cases 189

R 37.1 C 33

R 37.9C 36

R 64.9 C 58

R 65.7 C 31

R 38.4 C 22 R 75.3

C 61

R 66.6 C 36

R 58.7 C 40


Rate 49.2

Cases 159

Ag

e

Ward Number

1 23 4 5 6 7 8

Stage at Diagnosis


0 20 40 60Percentage

Female

Ag

e-A

dju

sted

Rat

e

Race

Black

Rate 68.9

Cases 248

White

Rate 44.7

Cases 80

65.0

74.767.8

67.362.5

64.064.7

59.661.4

60.660.2

Nu

mb

er

of

Cas

es

361 378 349 362 343 348

416 376 357 333 339

Year of Diagnosis

0 0 0 0 0 0 0 0 ~ ~

30 37 57 50 52 44 36 23

Total348

Number of Cases

0 49 75

183 0

41Total

348

Number of Cases





Incidence for Lung and Bronchus Cancer by Wards, 2010

8

7

6

5

2

1

4

3

22

23-33

34-36

37-40

41-61


8

76

5

2

1

4

3

6

7-20

21-26

27-34

35-38


Mortality for Lung and Bronchus by Wards, 2010

Unk/Unstaged

Distant

Regional

Local

In Situ

2040 0 20 40 60

Stage Distribution for Lung and Bronchus Cancer by Race, 2010

52.6% of lung and bronchus cancer are diagnosed at distant stage

Percentage

60 80

Stage

White

Black



Cancer Mortality for Lung and Bronchus District of Columbia

75

50

25


Gender

DC (Lung and Bronchus Deaths) Rate 38.7 Deaths 226

Ward Comparison

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 > 85

Age

‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ‘10

Male

Rate 50.4

Deaths 126

R 24.9 D 22

R 36.9D 36

R 35.7 D 32

R 55.2 D 26

R ~ D ~ R 44.3

D 36

R 71.1 D 39

R 41.2 D 27


Rate 30.5

Deaths 100

Ag

e

Ward Number

1 23 4 5 6 7 8

Female

Ag

e-A

dju

sted

Rat

e

Race

Black

Rate 49.6

Deaths 181

White

Deaths 44

Rate 24.7

59.358.3

58.152.1

49.651.3

47.649.1 52.2

41.6

38.7

Nu

mb

er

of

Dea

ths

330 324 277 266 292 226

325 291 287 274 233

Year of Death

0 0 0 0 0 0 ~ 0 ~~

28 38 26 25 24 33 20 23

Total226

Number of Deaths



Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard.Data source: District of Columbia Vital Records, 2013.


Female Breast Cancer

Breast cancer is the most common cancer among women in the District and in the U.S. An aver-age of 446 District women are diagnosed each year with breast cancer and 97 die annually from the disease. The risk of developing breast can-cer increases with age, with most cases develop-ing in women after menopause. Breast cancer rates vary by race/ethnicity: white women are more likely to develop breast cancer, but Af-rican-American women are more likely to die from the disease. The cause of breast cancer is still unknown and it is likely that multiple risk factors influence the development of the disease (although many cases of breast cancer oc-cur in women with no obvious risk factors). Risk factors for breast cancer are in the graphic below:

Lifestyle factors such as obesity, lack of exercise, and alcohol use

Personal history of breast cancer or a diagnosis of atypical hyperplasia of the breast

High doses of radiation, particularly

from puberty through child bearing years

Genetic mutations to BRCA1, BRCA2, and other breast cancer genes

History of breast cancer in a first-degree relative (mother, sister, daughter)

Long time exposure to estrogen:

12Menstruation starting

before age

55Menopause after age

30First pregnancy

after age or never having

had a full-term pregnancy

Use of hormone replacement therapy

Breast Cancer Risk Factors



Female Breast Cancer Incidence (Invasive) District of Columbia

200

150

100


Gender

DC (Female Breast Cases) Rate 143.6 Cases 466

Ward Comparison

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 > 85

Age

‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ‘10

Male

Rate —

Cases —

R 129.4 C 63

R 123.3C 64

R 140.4 C 66

R 161.8 C 46

R 123.2 C 39 R 120.2

C 58

R 173.9 C 60

R 149.9 C 55


Rate 143.6

Cases 466

Ag

e

Ward Number

1 23 4 5 6 7 8

Stage at Diagnosis



Female

Ag

e-A

dju

sted

Rat

e

Race

Black

Rate 140.2

Cases 282

White

Rate 155.5

Cases 158

138.8144.5

133.1

188.6

128.7

130.3

137.3140.8

133.5139.2

143.6

Nu

mb

er

of

Cas

es

439 423 401 433 419 466

456 584 412 445 436

Year of Diagnosis

0 0 0 0 0 ~ ~ ~

26 44 54 48 76 59 37 36 28 31

Total466

Number of Cases

129 269 141 280

28Total

595

Number of Cases


Data source: District of Columbia Cancer Registry, 2013.




8

76

5

2

1

4

3

52

53-63

64-74

75-83

84-89


Incidence for Breast Cancer by Wards, 2010

4

8

76

5

2

1

4

3

6

7-9

10-12

13-16

17-21


Mortality for Breast Cancer by Wards, 2010

Unk/Unstaged

Distant

Regional

Local

In Situ

2040 0 20 40 60

Stage Distribution for Breast Cancer by Race, 2010

68.9% of breast cancers are diagnosed at the local and regional stage

Percentage

60

Stage

White

Black



Female Breast Cancer Mortality District of Columbia

40

30

20


Gender

DC (Female Breast Deaths) Rate 29.8 Deaths 98

Ward Comparison

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 > 85

Age

‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ‘10

Male

R ~ D ~

R 38.1D 21

R 31.9 D 16

R ~ D ~ R ~

D ~

R ~ D ~

R ~ D ~


Ag

e

Ward Number

1 23 4 5 6 7 8

Race

Black

Rate 35.3

Rate —

Deaths —

Rate 29.8

Deaths 98

Female

Ag

e-A

dju

sted

Rat

e

WhiteRate 24.3

Deaths 24

25.9

38.5

33.8

27.6

25.529.2

27.732.8

28.228.5

29.8

Deaths 74

Nu

mb

er

of

Dea

ths

85 110 84 91 92 98

126 90 95 105 97

Year of Death

0 0 0 0 0 0 0 0~ ~ ~ ~ ~ ~ ~ ~ ~

16Total

98

Number of Cases



Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard.Data source: District of Columbia Vital Records, 2013.

R ~ D ~


Prostate Cancer

Prostate cancer is the most commonly diag-nosed non-skin cancer among men in the Dis-trict and nationwide. Each year, an average of 486 District residents are diagnosed with pros-tate cancer, and 84 die from the disease. The incidence of prostate cancer in DC is highest among African Americans, followed by non- Latino whites. Age is a strong risk factor, as the in-cidence of prostate cancer increases with age. The exact cause of prostate cancer is still unknown, but there are factors that may increase the risk (see graphic below).

Family history of prostate cancer in a brother or father

High levels of testosterone

Diet high in fat, especially animal fat



Cancer Incidence for Prostate (Invasive) District of Columbia

250

200

150


Gender

DC (Prostate Cases) Rate 188.3 Cases 490

Ward Comparison

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 > 85

Age

‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ‘10

Male

Rate 188.3

Cases 490

R 128.3 C 51

R 187.2 C 75

R 236.3 C 93

R 184.5 C 42

R 102.9 C 31 R 208.1

C 65

R 203.9 C 53

R 202.4 C 63


Rate —

Cases —

Ag

e

Ward Number

1 23 4 5 6 7 8

Stage at Diagnosis



Female

Ag

e-A

dju

sted

Rat

e

Race

Black

Rate 230.7

Cases 343

White

Rate 99.7

Cases 100

248.4220.8

229.3

207.1

187.6184.3

185.4

241.6

212.8

187.7188.3

Nu

mb

er

of

Cas

es

572 524 433 427 496 490

506 478 428 559 440

Year of Diagnosis

0 0 0 0 0 0 0 0 ~

24 36 78 97 93 76 48 20 ~

Total490

Number of Cases

0 340 50 340

66Total

490

Number of Cases





Incidence for Prostate Cancer by Wards, 2010

8

76

5

2

1

4

3

31

32-42

43-53

54-75

76-93


Mortality for Prostate Cancer by Wards, 2010

8

76

5

2

1

4

3

2-3

4-6

7

8-11

12-21


Unk/Unstaged

Distant

Regional

Local

In Situ

50100 0 50 100

Stage Distribution for Prostate Cancer by Race, 2010

69.4% of prostate cancer are diagnose at local stage

Percentage

Stage

White

Black



Cancer Mortality For Prostate District of Columbia

60

45

30

15

Gender

DC (Prostate Deaths) Rate 33.8 Deaths 70

Ward Comparison

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 > 85

Age

‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ‘10

Male

R ~ D ~

R ~ D ~

R 47.2 D 21

R ~ D ~ R ~

D ~

R ~ D ~

Percentage0 10 20 30 40 50

Ag

e

Ward Number

1 23 4 5 6 7 8

Race

BlackDeaths

55

Rate 33.8

Deaths 70

Rate —

Deaths —


Female

Ag

e-A

dju

sted

Rat

e

WhiteDeaths

~

51.746.7

53.4

38.645.7

45.9

42.444.5

29.9

45.6

33.8

Rate 46.2

Rate ~

Nu

mb

er

of

Dea

ths

103 103 91 83 58 70

92 75 88 86 84

Year of Death

00 0 0 0 0 0 0 0 0 ~ 0 ~ ~ ~ ~

1830

Total70

Number of Deaths





R ~ D ~

R ~ D ~


Cancer Incidence Age Adjusted Rates, 2010 DC and National Comparison (Per 100,000 People)

All Sites 499.5 457.5

378.7 465.4

545.6 479.7

553.1 519.3

358.8 521.4

646.1 597.5

464.7 413.3

408.1 425.8

White Black

Colorectal 45.9 40.6

22.1 39.2

59.1 48.6

44.5 46.6

17.7 45.1

62.2 56.1

46.7 35.7

25.3 34.3

Lung Bronchus 60.2

56.744.7 57.8

68.9 65.4

76.0 66.8

45.8 66.6

96.8 84.0

49.2 49.2

43.4 51.2

Breast 143.6 126.0

155.5129.8

Prostate 188.3 145.1

99.7 138.7

230.7 222.3

DC National

DC National

DC National

DC National

DC National

478.2 398.5

57.2 43.6

51.1 53.2

140.2 120.6

All Races White Black White Black

Both Genders Male Female

All Races

All Races

Source: DC Cancer Registry, National SEER9 Incidence.All rates are age adjusted per 100,000 men and women (only women in Breast and only men in Prostate) and include invasive cases only. * Includes White, Black and other races. All ages included.



Cancer Mortality Age Adjusted Rates, 2010 DC and National Comparison (Per 100,000 People)

All Sites 177.9 171.8

140.7 171.4

211.9 202.9

212.4 208.8

140.7 207.1

277.7 264.4

158.8 145.8

143.8 145.9

White Black

Colorectal 19.0 15.5

13.4 15.0

23.3 21.5

21.3 18.8

8.9 18.2

31.9 27.5

17.7 12.9

17.2 12.6

Lung Bronchus 38.7

47.424.7 48.1

49.6 51.2

50.4 60.1

25.9 59.9

71.4 73.6

30.5 37.9

23.4 39.2

Breast 29.8 21.9

24.3 21.3

Prostate 33.8 21.8

17.5 20.1

46.2 48.2

DC National

DC National

DC National

DC National

DC National

177.5 166.3

18.8 17.6

36.2 36.3

35.3 30.2

All Races White Black White Black

Both Genders Male Female

All Races

All Races

Source: DC Cancer Registry, National SEER9 Incidence. All rates are age adjusted per 100,000 men and women (only women in Breast and only men in Prostate) and include invasive cases only. * Includes White, Black and other races. All ages included.




Chapter 7 Other Cancer Incidence Sites

Chapter 7: Other Cancer Incidence Sites

What do these statistics mean? The incidence rate for DC males for all can-cers combined has been decreasing over the past decade. In contrast, the incidence rate for all cancers combined in females has continued to steadily increase.

Given that much of the increase in cancer incidence over the past 30 years is due to an aging population, an upward trend can be expected to continue as the population continues to age. With the rising incidence of cancer, there will be a commensurate increase in the need for diagnostic, treatment and support services in the healthcare system. It will also be important to develop upstream strategies to address the cancers that

are now showing significant increases in incidence. As cancer rates rise, so does the need for patients to have routine assessments and come to their prima-ry medical provider. Providers must thoroughly as-sess patients for risks, and offer appropriate screen-ings and interventions. These precautions may lead to earlier diagnosis of cancers and consequential mortality rate.

Primary prevention efforts should be improved to re-duce the impact of risk factors, such as tobacco use and obesity. A sustained focus on screening for breast, and colorectal will help catch and effectively treat these cancers earlier in their course.

43

Cancer Incidence by Sex, Race, and Stage at Diagnosis for the Most Common Cancer Sites for DC Residents, 2010, Number of Cases

Breast

Prostate

Lung

Colon

Blood Sys

Skin

Corp Uteri

Thyroid

Bladder

Kidney

Liver

Pancreas

Percent Total

White Black

Site

18.8

15.3

10.9

6.9

3.8

3.7

3.7

3.5

3.1

2.5

2.4

2.3

Sex

602

490

348

295

122

119

118

111

99

79

76

75

7

490

189

127

60

67

0

30

61

49

49

35

Other

595

0

159

167

62

52

118

81

38

30

27

40

Race

Male Female

207

100

80

46

20

55

32

52

32

15

12

9

353

343

248

225

79

17

81

46

56

56

56

57

30

21

18

16

18

3

5

12

5

8

7

8

In Situ Local Regional

Stage at Diagnosis

129

0

0

25

0

46

0

0

40

0

0

0

269

340

49

103

1

36

78

81

38

58

29

5

141

50

75

68

0

1

24

23

10

8

14

24

Distant

28

34

183

70

112

2

9

5

5

9

14

33

Unknown

28

66

41

29

9

34

7

2

6

4

19

13



Chapter 8: Definitions and Technical Notes

Chapter 8 Definitions and Technical Notes

Morbidity

Rate

Incidence

Incidence Rate

Mortality

Mortality Rate

Percentage of Change

Cancer Incidence Rate

Cancer Mortality Rate

Relative incidence of disease.

Number of cases divided by the population.

Number of new cases of disease that occur in a specific time period within a specific population. Number of new cases of disease that occur in a specific time period within a specific population, divided by the size of the population. Usually expressed per 100,000 pop-ulation.

Number of deaths that occur in a specific time period within a specific population.

Number of deaths that occur in a specific time period within a specific population, divided by the size of the population. Usually expressed per 100,000 population.

Change in a rate or count between two calendar years (ignoring years in between)

Number of new cancers of a specific site/type occurring in a specified population during a year, usually expressed as the number of cancers per 100,000 population at risk. Number of deaths, with cancer as the underlying cause of death, occur-ring in a specified population during a year. Cancer mortality is usual-ly express ed as the number of deaths due to cancer per 100,000 population.

The following definitions are taken from NCI/SEER website

End Rate - Initial Rate

Initial Rate100Percentage

of Change

New Cancers Cases

Population100,000Incidence

Rate

44

Cancer Deaths

Population100,000Mortality

Rate



Statistics by Race/Ethnicity

Age-adjusted Rate

Age-specific Rate

Crude Rate

Stage

Stage Distribution

SEER

Invasive Cancer

Primary Tumor

Primary Cancer Site

Case Counts

Measure of the cancer burden in racial/ethnic minorities and medically underserved populations.

Age-adjustment is a technique used to eliminate the effect of the age distribution of the population on incidence or mortality rates. Since the frequency of case or death varies with age, a measure free of the influences of population composition is needed to make comparisons between areas or over time.

Rate of incidence or mortality of a specific age group, calculated per 100,000 people.

Ratio of the number of people in which the event of interest happens in a speci-fied time period to the size of the population who may experience this event during the same time period. There are no adjustments made when a crude rate is given. Stage of diagnosis summarizes how far a cancer has spread when it is first discovered.

Stage provides a measure of disease progression, detailing the degree to which the cancer has advanced. Two methods commonly used to determine stage are American Joint Committee on Cancer (AJCC) and Surveillance Epidemiolo-gy and End Results (SEER) historic. The AJCC method is more commonly used in the clinical settings, while SEER has standardized and simplified staging to ensure consistent definitions over time.

Describes Cancers in five stages

• In situ cancer is early cancer that is present only in the layer of cells in which it began.

• Localized cancer is cancer that is limited to the organ in which it began, without evidence of spread.

• Regional cancer is cancer that has spread beyond the original (primary) site to nearby lymph nodes or organs and tissues.

• Distant cancer is cancer that has spread from the primary site to distant organs or distant lymph nodes.

• Unstaged cancer is cancer for which there is not enough information to indicate a stage.

Cancer that has spread beyond the layer of tissue in which it developed and is grow-ing into surrounding, healthy tissues -- generally, the stage is either “localized”, “re-gional”, or “distant”.

An original tumor. A tumor that did not initially arise in another site.

The organ of origin within the body where a given cancer occurs in an individual.

Case counts are counts of reportable cancers, not patients. A patient may have more than one reported tumor.

Count

Population100,000Crude Rate


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Chapter 8 Site-Specific Trends in Cancer Incidence and Mortality

Technical Notes for DC Cancer Registry

• All Counts and Rates are for DC residents only.

• Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard.

• Incidence Age-adjusted rates calculated on invasive cancers only.

• Only Black and White races are presented, due to the small number of cases or deaths in other races, same criterion applies to Hispanic.

• All races includes White, Black and other races.

• Information not shown for small number of cases or deaths.

• Statistic (rates) not calculated for small number of cases or deaths.

• Census tracts and Wards not include unknown, incomplete, incorrect addresses and PO Boxes for cancer cases or cancer deaths.

• Deaths - Cancer deaths are based on information from all death certificates in the District of Columbia and neighboring states, and processed by the National Vital Statistics System (NVSS) at the National Center for Health Statistics (NCHS).

• Source for Incidence: District of Columbia Cancer Registry.

• Source for Mortality: State Center for Health Statistics, Vital Records.

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Political subdivisions of the District of Columbia, created for the purpose of voting and representation. Ward boundaries were first established in 1801 and are updated every ten years, based on population changes reported by the U.S. Census Bureau.

DC Cancer Registry (DCCR) utilizes age-adjustment technique for incidence and mor-tality rates’ calculation. Age-adjusted rates allow DCCR to compare its rates with pop-ulations of different age distribution or compare its rates through time.

U.S. population utilized by DCCR in this process is U.S. 2000 Standard. Only rates ad-justed to the same standard population can be compared.

DC population utilized by DCCR in this process is produced by DC Government Office of Planning and it is produced by sex, race and ethnicity; ethnicity could be any race. DC does not have counties instead DC is divided into Wards; Ward population is pro-duced by DC Government Office of Planning, but after Census 2010 is completed the U.S. Census Bureau will produce DC Ward population through the Office of American Community Survey.

DC Ward population is not estimated every year.

For sex-specific cancer sites, the population was limited to the population of the appropriate sex.

DC utilized 19 groups of age to produce age adjusted rates, to be able to compare with national data.

Age-adjusted rates based on small numbers of cases or deaths will exhibit a large amount of random variation. A very rough guideline is that there should be at least 16 total cases or deaths over all age groups. When fewer than 16 health events oc-curred over a time period, it may be considered combining years, or using indirect age-adjustment.

DC population is considered to be small and when producing age-adjusted rates for cases or deaths by Ward, sex, and race and by selected sites, generates very small sub populations, creating unstable rates, it may be considered combining years. If the population of the specific category (area, sex, race, ethnicity) is less than 50,000 rates are suppressed and not ranked.

For reasons of confidentiality we cannot show cases or deaths with small numbers.


Wards

Age-Adjusted Rates

District of ColumbiaDepartment of Health

District of Columbia Cancer RegistryBureau of Cancer and Chronic Disease

Community Health AdministrationDepartment of Health

899 North Capitol St. NE, 3rd FloorWashington DC, 20002

produced by district of columbia cancer registry bureau of ...cancer is a reportable disease in...

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