Tobacco Documents Online

w 1~1PtER1C~1 ~` ~CANTM3 0 OREGON 11,800 CALIF. 101,000 WAS H. 17,300 NEV. 4,100 IDAHO 3,500 MONT. 3,200 ARIZ. 13,000 WYO. 1,300 W lS. 20,200 0 ILL 48,000 LA. 17,500 " MICH. -;~ 37,400 IND. 23,200 KY. 16,800 TENN. 21,000 MISS. 12,000 ALA. 18,000 = N.Y. 77,500 PA. 59,000 OHIO 49,000 W. VA. ' ° 8,900 VA. 23,500 N.C. 24,500 GA. 22,500 S.C. 13,000 FLA: ~ 65,500 i~..i, ~~r [~, ~_ 9 I UTAH 3,500 ALASKA 1,000 VT. 2,300 N.H. 4,000 MAINE 5,500, 4,900 CONN. 14,400 ~ N.J. ' 36,500 DEL • MD. 2,800 19,300 ~ D.C. 3,200 PUERTO RICO 6,000 MASS. 28,400 Estimated number of new cancer cases in 1989 by states, total:1,010,000' (excluding Puerto Rico). 'Excluding non-melanoma skin cancer and carcinoma in situ. BASED ON RATES FROM NCl SEER PROGRAM (1983-1985}. 202554S910

CONTENTS CANCER: BASIC DATA .................................... 3 Basic Data ................................................. 3 How Cancer Works ...................................... 4 Trends in DiagTosis and Treatment .................... 4 Cancer Death Rates by Site, U.S., 1930-1985" ........... 5 New Cancer Cases-1989* .............................. 6 Cancer Deaths--1989* .................................... 7 Estimated New Cancer Cases and Deaths by Sex for A11 Sites-1989* ........................... 8 SELECTED CANCER SITES .............................. 9 Lung Cancer .............................................. 9 Colon and Rectu.m Cancer .............................. 9 Breast Cancer ............................................. 10 Uterine Cancer ........................................... 10 Ovarian Cancer ........................................... 11 Oral Cancer ............................................... 11 Cancer Incidence and Deaths by Site and Sex-1989 Estimates* ............................ 12 Prostate Cancer ...............:.......................... 12 Bladder Cancer ........................................... 13 Skin Cancer ............................................... 13 Pancreatic Cancer ........................................ 14 Leukemia ................................................. 14 Five-Year Cancer Survival Rates for Selected Sites" ......................................... 15 How to Estimate Cancer Statistics Locally* ............ 15 CANCER BY AGFs AND RACE ............................ 16 Black Americans .......................................... 16 The Economically Disadvantaged ....................... 16 Hispanic-Americans ..................................... 16 Children ................................................... 16 Trends in Survival by Site of Cancer, by Race* ........ 17 PREVENTION ............................................... 18 Primary Prevention ...................................... 18 Secondary Prevention ................................... 18 Cancer-Related Checkup Guidelines ................... 19 Colorectal Cancer: Early Detection Is the Key ......... 19 Breast Cancer: A Program of Action .................... 20 Tobacco Use .............................................. 20 Nutrition and Cancer: A Common Sense Approach ........................ 21 THE AMERICAN CANCER SOCIETY .................. 22 Profile ..................................................... 22 Public Education ......................................... 22 Professional Education .................................. 23 Service and Rehabilitation ............................... 24 Costs of Cancer ........................................... 25 Allocation of ACS Funds, 1987-1988* ................... 25 RESEARCH .................................................. 26 The ACS and Research ................................... 26 Cancer and the Environment ........................... 27 Cancer's Seven Warning Signals ...................... .. 28 30-Year Trends in Age-Adjusted Cancer Death Rates* .......................................... 29 Summary of Research Grants and Fellowships* .......................................... 30 Comprehensive Cancer Centers ........................ 31 Chartered Divisions of the ACS .............. Back Cover 'Table/Chart SOURCES OF STATISTICS @ ncicCence Since there is no national office which records every new cancer case, there is no way of knowing exactly how many new cases of cancer are diagnosed each year. In the past, estimates of cancer incidence were made by extrapolating from the experience of the few population-based cancer registries. Estimates of incidence in Facts & Figures editions prior to 1974 were based on data from two state cancer registries. The issues from 1974 through 1978 used information from the National Cancer Institute's Third National Cancer Survey (1969-1971) of nine major areas of the United States. Then in 1973, NCI began a new and larger program, gathering data from 11 population-based registries. It is called SEER, standing for Surveillance, Epidemiology and End Results. Beginning with the 1979 edition of Facts & Figures, SEER incidence information has been used. Each time a new data base is introduced, there may be some sharp changes in figures, due to the more accurate data. The changes do NOT indicate either a cancer epidemic or miracle cure. For valid comparisons between years, incidence statistics from the 1974 through 1978 editions of Facts & Figures may be compared with one another, while those from the 1979 to 1984 editions may be compared. The latest available information for this 1989 edition is SEER data from the years 1983-1985. Mortality The source for mortality statistics has remained constant over the years: the National Center for Health Statistics, Department of Health and Human Services. The 1989 figures are estimates based on the latest available information, which includes mortality data through 1985. Beginning with the 1981 edition of Facts & Figures, mortality rates per 100,000 population were age-adjusted to the 1970 census population, rather than the 1940 census population. Comparing these charts and figures with those of previous years may indicate false trends. Survival Because of the 5-year waiting period, survival statistics take longer to compile. In this edition, we show the latest survival rates for cases diagnosed in the period 1979-84 in the SEER program. C1989, American Cancer Society, Inc. All rights reserved, including the right to reproduce this publication or portions thereof in any form. For written permission, address American Cancer Society, 1599 Clifton Road, N.E., Atlanta, GA 30329. 2

C A N C E R F A C T S A N D F 1 G U R E S 1 9 8 9 CANCER: BASIC DATA BASIC DATA What is cancer? Cancer i:5 a large group of diseases characterized by uncontrolled growth and spread of abnormal cells. If the spread is not controlled or checked, it results in death. However, many cancers can be cured if detected and treated promptly. How is cancer treated? By surgery, radiation, radioactive substances, chem- icals, hormones and immunotherapy. Who get<.; cancer? Cancer strikes at any age. It kills more children 3 to 14 than a ny other disease. And cancer strikes more frequently with advancing age. In the 1980's, there were estimated over 4.5 million cancer deaths, almost 9 million new cancer cases, and some 15 million people under medical care for cancer. How many people alive today will get cancer? About 76 million Americans now living will even- tually have cancer; about 30%, according to present rates. Over the years, cancer will strike in approximately three out of four families. How many ipeople alive today have ever had canceir? There are over 5 million Americans alive today who have a history of cancer, 3 million of them with diag- nosis five or more years ago. Most of these 3 million can be considered cured, while others still have evi- dence of cancer. By "cured" is meant that a patient has no evidence of disease and has the same life expectancy as a person who never had cancer. The decision as to when a patient may be considered cured is one that must be made by the physician after examining the individual patient. For most forms of cancer, five years without symptoms following treat- ment is the accepted time. However, some patients can be considerect cured after one year, others after three years, whereas some have to be followed much longer than five years. How many new cases will there be this year? In 1989 about 1,010,000 people will be diagnosed as having cancer.* How many people are surviving cancer? In the early 1900's few cancer patients had any hope of long-term survival. In the 1930's less than one in five was alive at least five years after treatment. In the 1940's it was one in four, and in the 1960's it was one in three. Today, about 405,000 Americans, or 4 out of 10 patients who get cancer this year, will be alive 5 years after diagnosis. The gain from 1 in 3 to 4 in 10 represents about 67,000 persons this year. This 4 in 10, or about 40% is called the "observed" survival rate. When normal life expectancy is taken into consideration (factors such as dying of heart disease, accidents and diseases of old age) 49%~o will be alive 5 years after diagnosis. This is the "relative" survival rate, and is considered a more accurate yardstick of our battle against cancer. Could more people be saved? Yes. About 178,000 people with cancer will probably die in 1989 who might have been saved by earlier diagnosis and prompt treatment. How many people will die? This year about 502,000 will die of the disease-1,375 people a day, about one every 63 seconds. Of every five deaths from all causes in the U.S., one is from cancer. In 1988 an estimated 494,000 Americans died of cancer. In 1987 it was 483,000; in 1986 the figure was 469,376. What is the national death rate? There has been a steady rise in the age-adjusted** national death rate. In 1930 the number of cancer deaths per 100,000 population was 143. In 1940 it was 152. By 1950 it had risen to.158 and in 1986 the number was 171. The major cause of these increases has been cancer of the lung. Except for that form of cancer, age-adjusted cancer death rates for major sites are leveling off, and in some cases declining. Can cancer be prevented? Some cancers, not all. Most lung cancers are caused by cigarette smoking, and most skin cancers by fre- quent overexposure to direct sunlight. These cancers can be prevented by avoiding their causes. Certain can- cers caused by occupational-environmental factors can be prevented by eliminating or reducing contact with carcinogenic agents. See Prevention section, pp.18-22 'These estimates of the incidence of cancer are based upon data from the National Cancer Institute's SEER Program (1983-1985). Non- melanoma skin cancer and carcinoma in situ have not been included in the statistics. The incidence of non-melanoma skin cancer is esti- mated to be over 5f)0,000 cases annually. "Age-adjusted-a m,ethod used to make valid statistical comparisons by assuming the same age distribution among different groups being compared. 3

C A N C E R F A C T S A N D F I G U R E S 7 9 8 9 BASIC DATA HOW CANCER WORKS Normally, the cells that make up the body reproduce themselves in an orderly manner so that worn-out tissues are replaced, injuries are repaired and growth of the body proceeds. Occasionally, certain cells undergo an abnormal change and begin a process of uncontrolled growth and spread: One cell divides into two, those redivide into four, and so on. These cells may grow into masses of tissue called tumors-some benign and others malig- nant (cancerous). The danger of cancer is that it invades and destroys normal tissue. In the beginning, cancer cells usually remain at their original site, and the cancer is said to be localized. Later, some cancer cells may invade neighboring organs or tissue. This occurs either by direct extension of growth or by becoming detached and carried through the lymph or blood systems to other parts of the body. This is called metastasis of a cancer. This spread may be regional-confined to one region of the body-when cells are trapped by lymph nodes. If left untreated, however, the cancer is likely to spread throughout the body. That condition is known as advanced cancer, and usually results in death. Because a case of cancer becomes progressively more serious with each stage, it is important to detect cancer as early as possible. Aids to early detection include cancer's Seven Warning Signals and the cancer risk factors. TRENDS IN DIAGNOSIS AND TREATMENT The diagnosis and treatment of cancer has become increasingly individualized. Early detection is followed by more precise staging, and the use of more than one kind of therapy, often in combination. Some cancers, which only a few decades ago had a very poor outlook, are often being cured today; acute lymphocytic letikemia in children, Hodgkin's disease, Burkitt's lymphoma, Ewing's sarcoma (a form of bone cancer), Wilms' tumor (a kidney cancer in children), rhabdomyosarcoma (a cancer in certain muscle tissue), choriocarcinonla (placental cancer), testicular cancer, ovarian cancer and osteogenic sarcoma. Other cancers have not yet yielded to effective treatment, and are the focus of continuing research. An outstanding example of progress is the improve- ment in the management of testicular cancer in young men. More prec,ise diagnostic tools and staging allow better selection of treatment. The use of combinations of cancer drugs has resulted in remarkably improved survival. In 20 years, the 5-year survival rate of testicular cancer rose from 63% to 91%. The following developments indicate the directions of current and luture research: • New ways have been found to use an old drug, 5- fluorouracil, more effectively against metastatic colon cancer. By combining it with leukovorin it is a much more potent inhibitor of colon cancer cells. * Analysis of onc:ogene products is a promising new means of predicting which tumors are likely to recur after surgery. o Use of potent growth factors stimulates normal bone marrow cells to withstand very high doses of che- motherapeutic: drugs. • P,A genetic fusing; of cancer cells with normal cells can produce disease-fighting "monoclonal antibodies"- specific antibod:ies tailored to seek out chosen targets on cancer cells. Their potential in the diagnosis and treatment of can,cer is under study. • New understanding of the causes of pain in cancer patients has increased the options for controL Regular use of oral pain medicines, infusions or injections of analgesics, procedures to interrupt pain pathways, are among the effective approaches available. • Studies with agents like synthetic retinoids (cousins of vitamin A), and other substances are being under- taken to see if recurrences of certain cancers can be prevented. Another step is to see if these agents can reduce cancer in high risk groups. • New approaches to drug therapy use combination chemotherapy and chemotherapy with surgery or radiation. New classes of agents are being tested for their effectiveness in treating patients resistant to drug therapies now in use. • Many patients with primary bone cancer now are treated successfully by removing and replacing a section of bone rather than by amputating the leg or arm. Drugs and radiation therapy are being used effectively after bone cancer surgery, resulting in dra- matic improvement in survival. • New high technology diagnostic imaging techniques have replaced exploratory surgery for some cancer patients. Magnetic Resonance Imaging (MRI) is one example of such technology under study. It uses a huge electromagnet to detect tumors by sensing the vibrations of the different atoms in the body. Com- puterized tomography (CT scanning) uses X rays to examine the brain and other parts of the body. Cross- section pictures are constructed which show a tumor's shape and location more accurately than is possible with conventional x-ray techniques. For patients undergoing radiation therapy, CT scanning may enable the therapist to pinpoint the tumor more precisely to provide more accurate radiation dosage while sparing normal tissue. • Immunotherapy holds the hope of enhancing the body's own disease-fighting systems to control cancer. Interferon, interleukin-2 and other biologic response modifiers are under study. Recently, interferon was made available as the treatment for hairy cell leukemia, a rare blood cancer of older Amer- icans. Interleukin-2 is under very active research in the treatment of kidney cancer and melanoma. 4

C A N C E R F A C T S A N D F 1 G U R E S 1 9 8 9 BASIC DATA This research area will take many years to find the proper role of these agents in cancer treatment. • Many cancers are caused by a two-stage process through exposure to substances known as initiators and promoters. Research scientists are exploring ways of interrupting these processes to prevent the development of cancer. • New technologies have made it possible to use bone marrow transplantation as an important treatment option in selected patients with aplastic anemia and leukemia. Bone marrow transplantation for other cancers is under study. The administration of larger doses of anti-cancer drugs or radiation therapy may be tolerated by some patients if their bone marrow is storecl and later transplanted to restore marrow function (autologous bone marrow transplants). • Hyperthermia is a way to increase the heat or tem- perature of the entire body or a part of the body. It is known that heat can kill cancer cells. A cell tem- perafure of'45 degrees kills cancer cells. A temperature of 42-43 degrees makes the cell more susceptible to damage by ionizing radiation (X rays). Studies are underway to learn if hyperthermia can increase the effect of radiation or chemotherapy. • With medical progress producing longer survival periods for many cancer patients, clinical concerns are expanding to include not only patients' physical well-being but also their psychosocial needs. The patient's and family's reactions to the disease, sexual concerns, employment and insurance needs, and ways to provide psychosocial support, have emerged as important areas of research and clinical care. • Improvements in cancer treatment have made possible more conservative management of some early cancers. In early cancer of the larynx, many patients have been able to retain their larynx and their voice; in colorectal cancer, fewer permanent colostomies are needed; and the surgery required in many cases of breast cancer is often more limited. • Prostatic ultrasound, a rectal probe using ultrasonic waves producing an image of the prostate, is currently being investigated as a potential means to increase the early detection of occult, or not clinically sus- pected, prostate cancer. • Neoadjuvant chemotherapy has been successful against certain types of cancers. This involves giving chemotherapy to shrink the cancer and then removing it surgically. CANCER DEATH RATES* BY SITE, UNITED STATES, 1930-85 . ~ ; LUNG .• . : : .• : .•' : .~ . BREAST ATE i COLON r `x s UTERUS E~t VE~t U V . $ C ~ ~. 10 ~~ STOMA -,_ ~y.W P NCRla- - - ° I . -- LEUKEMIA BL0 ECTUM YEAR 'Rate for the population standardized for age on the 1970 U.S. population. Sources of Data: National Center for Health Statistics and Bureau of the Census, United States. Note: Rates are for both sexes combined except breast and uterus female population only and prostate male population only. 5

NEW CANCER CASES-1989 Estimated New Cancer Cases for All Sites Plus Major Sites, by State-1989 _ ALL SITES* MAJOR SITES Number of Female Colon & Skin STATE Cases Breast Rectum Lung Oral Uterus Prostate Melanoma Pancreas Leukemia Alabama 18,000 2,400 2,300 2,800 450 950 2,100 400 500 450 Alaska 1,000 150 125 150 40 20 100 50 20 10 Arizona 13,000 1,800 1,700 1,900 350 550 1,500 300 350 375 Arkansas 11,300 1,100 1,500 1,900 200 400 1,000 350 350 300 California 101,000 14,200 13,500 15,400 3,500 5,000 10,000 3,200 2,600 2,800 Colorado 9,400 1,500 1,5()O 1,200 225 450 1,100 400 250 250 Connecticut 14,400 2,200 2,300 2,000 450 600 1,400 40a 375 375 Delaware 2,800 400 450 500 40 125 275 70 70 80 Dist. of Columbia 3,200 450 400 450 250 150 450 60 90 60 Florida 65,500 8,300 10,200 10,600 2,200 2,800 7,600 1,800 1,700 1,600 Georgia 22,500 2,800 2,900 3,700 850 1,100 2,400 600 550 600 Hawaii 3,300 350 450 450 150 150 275 80 90 80 Idaho 3,500 500 475 475 60 125 425 150 80 125 Illinois 48,000 •7,000 7,800 7,400 1,400 2,400 4,700 950 1,300 1,300 Indiana 23,200 3,200 3,700 3,800 650 1,200 2,200 600 550 550 Iowa 12,700 1,800 2,100 1,800 400 550 1,500 300 375 375 Kansas 9,900 1,400 1,600 1,600 300 450 1,200 200 300 325 Kentucky 16,800 2,100 2,500 3,000 450 850 1,600 350 375 425 Louisiana 17,500 2,200 2,200 3,000 550 750 1,700 300 500 400 Maine 5,500 750 950 850 150 250 600 100 150 150 Maryland 19,300 2,700 2,900 3,000 650 800 1,900 550 400 450 Massachusetts 28,400 4,800 4,500 3,800 800 1,000 2,600 800 700 700 Michigan 37,400 5,500 5,300 5,800 1,000 1,700 3,600 900 950 1,000 Minnesota 16,400 2,300 2,600 2,100 400 650 2,00D 400 450 450 Mississippi 12,000 1,100 1,400 1,800 300 600 1,200 250 325 300 Missouri 23,500 3,200 3,900 3,700 700 1,200 2,000 600 650 700 Montana 3,200 500 425 425 60 150 400 90 100 100 Nebraska 6,400 900 1,100 900 150 350 750 175 225 175 Nevada 4,100 500 500 750 150 175 375 150 90 70 New Hampshire 4,000 650 650 600 80 200 400 125 125 90 New Jersey ^ 36,500 5,500 6,200 5,300 1,200 1,800 3,500 950 1,000 850 New Mexico 4,500 600 600 550 125 175 550 80 150 150 New York 77,500 12,100 13,200 10,900 2,500 4,000 7,900 2,100 2,300 2,000 North Carolina 24,500 3,400 3,200 4,000 900 1,300 2,700 750 700 700 North Dakota 2,700 400 450 325 70 125 450 40 90 90 Ohio 49,000 6,800 7,700 7,900 1,400 2,200 4,700 1,200 1,300 1,300 Ok9ahoma 14,000 1,800 1,900 2,500 400 550 1,400 500 425 450 Oregon 11,800 1,700 1,600 2,000 300 425 1,200 350 325 350 Pennsyfvania 59,000 8,800 10,000 8,600 1,700 2,500 5,300 1,600 1,500 1,500 Rhode Island 4,900 700 900 700 200 200 500 150 150 100 South Carolina 13,000 1,900 1,700 2,000 500 750 1,500 400 350 250 South Dakota 2,900 425 500 375 40 125 350 80 90 100 Tennessee 21,000 2,600 2,800 3,500 700 950 2,200 500 550 600 Texas 54,500 7,300 7,200 8,800 1,800 2,600 5,000 1,600 1,400 1,700 Utah 3,500 550 450 350 100 200 600 100 100 125 Vermont 2,300 350 375 350 80 150 250 50 50 90 Virginia 23,500 3,300 3,400 3,800 800 1,100 2,500 700 600 600 Washington 17,300 2,500 2,300 2,800 550 830 1,800 500 500 450 West Vitrginia 8,900 1,200 1,200 1,500 200 375 800 200 250 250 Wisconsin 20,200 3,100 3,200 2,700 450 900 2,300 400 550 650 Wyoming 1,300 225 200 204 30 30 150 50 30 30 United States 1,010,000 142,000 151,000 155,000 31,000 47,000 103,000 27,000 27,000 27,000 Puerto Rico 6,000 450 450 350 425 750 400 500 100 175 oDoes not include carcinoma in situ or non-melanoma skin cancer. iheae estimates are offered as a rough guide and shou{d not be regarded as definitive. They are calculated according to the distribution of estimated 1989 canc cv deaths by state. Especially note that year-to-year changes may only represent improvements in the basic da:ta. 6

CANCER DEATHS-1989 Estimated Cancer Deaths for Al! Sites Plus Major Sites, by State-1989 ALL SITES MA JOR SITES _ Number Death Rate Skin of per 100,000 Female Colon & Mela- STATE Deaths Population` Breast Rectum Lung Oral Uterus Prostate noma Pancreas Leukemia Alabama 8,900 214 700 950 2,600 125 200 550 100 425 300 Alaska, 500 221 30 50 150 10 10 20 10 25 10 Arizxta 6,500 180 550 700 1,800 100 50 400 70 300 225 Arkansas 5,600 190 350 600 1,800 60 100 300 80 300 225 Calitornia 50,000 181 4,400 5,500 14,100 950 900 2,600 700 2,500 1,800 Colorado 4,700 141 450 600 1,200 60 70 275 80 250 200 Connecticut 7,200 217 650 950 1,800 125 125 375 90 400 275 Delaware 1,400 250 125 175 450 10 20 60 10 60 50 Dist. of Columbia 1,700 264 175 175 400 70 60 125 10 100 50 Florida 32,500 182 2,500 4,100 9,800 600 490 2,100 400 1,600 1,000 Ge)r;;ia 11,200 202 850 1,200 3,400 250 250 700 150 500 400 Hawaii 1,700 191 100 175 375 50 20 80 20 80 50 tdafio 1,800 158 150 175 400 20 25 125 30 100 80 Illinois 24,000 201 2,100 3,100 6,600 450 600 1,300 200 1,300 900 Indiana 11,500 217 950 1,500 3,500 175 300 600 125 550 425 Iowa 6,400 190 550 850 1,600 125 125 400 70 350 300 iCamas 4,900 171 425 650 1,300 90 100 350 50 275 225 Kenv.ky 8,400 207 650 1,000 2,800 125 175 425 80 375 300 Louisiana 8,800 212 650 900 2,800 150 175 475 80 450 300' Maine 2,800 199 225 400 800 40 60 175 20 150 90 Maryland 9,600 244 800 1,200 2,700 175 175 500 125 425 300 Massachusetts 14,100 220 1,500 1,900 3,500 250 275 750 175 650 475 Michigan 18,600 226 1,600 2,100 5,300 275 400 1,000 200 900 650 Minnesota 8,100 181 700 1,100 2,000 125 125 550 90 450 350 Misshsippi 5,100 186 325 .500 1,700 80 100 350 60 300 225 Misscuri 11,800 196 950 1,500 3,400 175 250 550 125 550 450 Montana 1,600 186 150 175 375 20 30 100 20 100 70 Nebraska 3,300 173 300 450 800 40 70 200 40 200 175 Nevada 2,100 216 150 200 600 40 20 100 30 80 40 New IHampshire 2,100 197 200 250 550 30 40 90 30 100 70 New JetSey 18,100 230 1,600 2,500 4,900 325 375 950 225 900 550 New Mexico 2,300 168 200 250 500 30 40 150 20 125 70 New 1'ork 38,500 200 3,800 5,400 9,800 750 950 2,200 475 2,100 1,400 North Carolina 12,200 203 1,000 1,300 3,700 225 275 750 175 550 425 North Dakota 1,300 171 125 175 300 20 20 125 10 90 60 Ohio 24,000 227 2,100 3,100 7,300 400 600 1,300 250 1,200 850 Oklahoma 7,000 163 550 800 2,300 100 100 375 100 325 275 Oregon 5,900 198 500 650 1,800 100 75 350 70 300 225 Pennsylvania 29,500 221 2,600 4,000 7,800 475 700 1,500 350 1,400 1,000 Rhode Island 2,500 227 250 350 650 60 40 125 30 125 70 South Carolina 6,500 209 550 650 1,900 125 125 425 90 325 175 South Dakota 1,500 180 125 200 325 10 30 125 20 100 80 Tennessee, 10,400 202 800 1,100 3,300 200 200 600 125 500 375 Texas 27,000 155 2,200 2,900 8,100 475 500 1,400 350 1,300 1,000 Utah 1,800 118 175 175 275 20 30 175 30 90 80 Vermont 1,200 196 100 150 275 20 30 70 10 60 50 Virginia 11,700 219 950 1,400 3,500 225 225 650 150 500 375 Washington 8,600 181 750 900 2,600 150 150 500 100 425 300 West Virginia 4,400 202 350 500 1,400 60 100 225 50 200 175 Wisconsin 10,000 197 950 1,300 2,500 125 175 650 90 500 425 Wyomin;; 700 128 70 75 175 10 10 30 10 40 30 United States 502 000 204 43,000 61,000 142,000 8,700 10,000 28,500 6,000 25,000 18,000 Puerto Rico 3,500 150 200 250 400 175 150 300 400 80 150 `Adjusted to the age distribution of the 1970 U.S. Census Population. 7

ESTIMATED NEW CANCER CASES AND DEATHS BY SEX FOR ALL SITES-1989• ESTIMATED NEW CASES ESTIMATED DEATHS ~ Total Male Female Total Male Female ALL SITES 1,010,000' 505,000' 505,000' 502,000 266,000 236,000 Buccal Cavity & Pharynx (ORAL) 30,600 20,600 10,000 8,650 5,775 2,875 Lip 4,200 3,700 500 100 75 25 Tongue 6,000 3,900 2,100 1,950 1,300 650 Mouth 11,700 7,000 4,700 2,600 1,600 1,000 Pharynx 8,700 6,000 2,700 4,000 2,800 1,200 Digestive Organs 227,800 115,200 112,600 123,000 64,400 58,600 Esophagus 10,100 7,200 2,900 9,400 6,900 2,500 Stomach 20,000 11,900 8,100 13,900 8,200 5,700 Small Intestine E 2,700 1,400 1,300 900 500 400 Large Intestine ~ (COLON-RECTUM) 107,000 50,000 57,000 53,500 26,000 27,500 Rectum 44,000 23,000 21,000 7,800 4,000 3,800 Liver & Biliaxy Passages 14,500 7,500 7,000 11,400 5,800 5,600 Pancreas 27,000 13,000 14,000 25,000 12,500 12,500 Other& Unspecified Digestive 2,500 1,200 1,300 1,100 500 600 Respiratory System 171,600 114,000 57,600 147,100 96,900 50,200 Larynx 12,300 10,000 2,300 3,700 3,000 700 LUNG 155,000 101,000 54,000 142,000 93,000 49,000 Other & Umapecified Respiratory 4,300 3,000 1,300 1,400 900 500 Bone 2,100 1,200 900 1,300 700 600 Connective Tissue 5,600 3,000 2,600 3,000 1,400 1,600 SKIN 27,000" 14,500" 12,500" 8,200t 3,200 3,000 _ BREAST 142,900"' 900"' 142,000'°` 43,300 300 43,000 _ GenitalOrgaws 181,800•" 109,900 71,900•" 52,200 29,100 23,100 Cervix Uteri ~ (UTERUS) 13,000"' - 13,000•°' 6,000 - 6,000 Corpus, Endometrium 34,000 - 34,000 4,000 - 4,000 Ovary 20,000 - 20,000 12,000 ~ 12,000 Other & Unspecified Genital, Female 4,900 - 4,900 1,100 - 1,100 Prostate 103,000 103,000 - 28,500 28,500 - Testis 5,700 5,700 - 350 350 - Other & Unspecified Genital, Male 1,200 1,200 - 250 250 - Urinary Organs 70,200 49,000 21,200 20,200 12,900 7,300 Bladder 47,100 34,500 12,600 10,200 6,900 3,300 Kidney & Other Urinary 23,100 14,500 8,600 10,000 6,000 4,000 Eye 1,900 1,000 900 300 150 150 Brain & Central N ervous System 15,000 8,200 6,800 11,000 6,000 5,000 Endocrine Glands 12,600 3,700 8,900 1,750 775 975 Thyroid 11,300 3,000 8,300 1,025 375 650 Other Endocrine 1,300 700 600 725 400 . 325 Leukemia 27,300 15,200 12,100 18,100 9,800 8,300 Lymphocytic Leukemia s13, 00 7,500 5,500 7,000 3,900 3,100 Granulocytic Leukemia V,300 7,200 6,100 10,600 5,600 5,000 Monocytic Leukemia 1,000 500 500 500 300 200 Other Blood & Lymph Tissues 51,800 27,000 24,800 27,400 14,100 13,300 Hodgkin's Disease 7,400 4,200 3,200 1,500 900 600 Non-Hodgkin's Lymphomas 32,800 16,800 16,000 17,300 8,900 8,400 Multiple Myeloma 11,600 6,000 5,600 8,600 4,300 4,300 All Other & Unspiecified Sites 41,800 21,600 20,200 36,500 18,500 18,000 NOTE: The estimates of new cancer cases are offered as a rough guide and should not be regarded as definitive. Especially note that year-to-year changes may only represent improvements in the basic data. ACS six major sites appear in boldface caps. 'Carcinoma in situ and non-melanoma skin cancers are not included in totals. Carcinoma in situ of the uterine cervix accounts for more than 50,000 new casEs annually, and carcinoma in situ of the female breast accounts for about 10,000 new cases annually. Non-melanoma skin cancer accounts for more than 500,000 new cases annually. °•tvlelanoma only. '••Invasive cancer only. iNCIDENCE ESTIMATES ARE BASED ON RATES FROM NCI SEER PROGRAM 1983-85. tMelanoma 6,000; other skin 2_)00 8

C A N C E R F A C T 5 A N D F I G U R E 5 1 9 8 9 SELECTED CANCER SITES LUNG CANCER Incidence: An estimated 155,000 new cases in 1989. The incidence rate in white males rose from 82.7 per 100,000 in 1982 to 84.2 in 1984. The incidence rate in white females and in black males and females also rose. Mortality: An estimated 142,000 deaths in 1989. The age-standardized lung cancer death rate for women is higher than that of any other cancer. It has surpassed breast cancer which for over 50 years was the number one cancer Ici:ller of women. Warning Signals: A persistent cough; sputum streaked with blood; chest pain; recurring attacks of pneumonia or bronchitis. Risk Factors: Cigarette smoking; history of smoking 20 or more years; exposure to certain industrial sub- stances such as asbestos, particularly for those who smoke. Involuntary smoking increases the risk. Expo- sure to radiation may also contribute to lung cancer. Early Detecl,ion: Lung cancer is very difficult to detect early; symptoms often don't appear until the disease has advanced considerably. If a smoker quits at the time of early precancerous cellular changes, the damaged bronchial lining often returns to normal. If a smoker continues the habit, cells may form abnormal growth patterns that lead to cancer. Diagnosis may be aided by such procedures as the chest X ray, sputum cytology test and fiberoptic bronchoscopy. Treatment: Treatment depends on the type of, and stage of lung cancer. Surgery, radiation therapy and chemotherapy are all options. For many localized cancers, surgery is usually the treatment of choice. Since the majority of patients with lung cancer have tumor spread, radiation therapy and chemotherapy are often combined with surgery. In small cell cancer of the lung, chemotherapy alone or combined with radiation has largely replaced surgery as the treatment of choice, with a large percentage of patients experiencing remission- in some cases, long-lasting remission. Survival: Only 13% of lung cancer patients (all stages, whites and blacks) live five or more years after diag- nosis. The rate is 33% for cases detected in a local- ized stage; but only 24% of lung cancers are discovered that early. Rates have improved only slightly over a recent 10-year period. COLON AND RECTUM CANCER Incidence: An estimated 151,000 new cases in 1989, including 107,000 of colon cancer and 44,000 of rectum cancer. Their combined incidence is second only to that of lung cancer i;excluding common skin cancers). Mortality: Aii estimated 61,300 deaths in 1989, second only to lung cancer. This includes 53,500 for colon cancer and 7,800 for rectum cancer. Warning Signals: Bleeding from the rectum, blood in the stool, change in bowel habits. Risk Factors: Personal or family history of colon and rectum cance, personal or family history of polyps in the colon or rectum; inflammatory bowel disease. Evidence suggests that bowel cancer may be linked to the diet. A diet high in fat and/or low in fiber content may be a signii.ficant causative factor. Early Detection: The ACS recommends three tests as valuable aids in detecting colon and rectum cancer early in people without symptoms. The digital rectal examination is performed by a physician during an office visit. The ACS recommends one every year after age 40. The stool blood slide test is a simple method of testing the feces for hidden blood. The specimen is obtained by the patient at home, and returned to the physician's office, a hospit:al or clinic for examination. The ACS recommends the test every year after 50. Proctosigmoidoscopy, known as the "procto," is an examination in which a physician inspects the rectum and lower colon with a hollow lighted tube. As the site of most colorectal cancers appears to be shifting higher in the colon, longer, flexible instruments are being used as well as the rigid scope. The ACS rec- ommends a procto every 3 to 5 years after the age of 50, following two annual normal exams. If any of these tests reveals possible problems, a physician may recommend more extensive studies, such as colonoscopy and a barium enema. Colono- scopes view the entire colon. Treatment: Surgery, at times combined with radia- tion, is the most effective method of treating colorec- tal cancer. Chemotherapy is being studied to determine its possible role in treating advanced cases. In cases of colon cancer, a permanent colostomy, the creation of an abdominal opening for the elimination of body wastes, is seldom needed, and is infrequently required for patients with rectal cancer. One report found permanent colostornies necessary for only 15% of patients whose rectal cancers are detected early. For those who do have permanent colostomies, the Society has a special patient assistance program. (See p. 25) Survival: When colorectal cancer is detected and treated in an early, localized stage, the 5-year survival rate' is 87% for colon cancer and 79% for rectal cancer, compared with 40% and 31% respectively, after the cancer has spread to other parts of the body. 9

C A N C E R F A C T S A N D F 1 G U R E S 1 9 B 9 SELECTED CANCER SITES BREAST CANCER Incidence: An estimated 142,900 new cases in the United States during 1989. About one out of 10 women will develop b reast cancer at some time during her life. Mortality: An estimated 43,300 deaths (43,000 females; 300 males) in 1989, in females, second only to lung cancer, now th,e foremost site of cancer deaths in women. Warning Sij;rdals: Breast changes that persist such as a lump, thickening, swelling, dimpling, skin irrita- tion, distortion, retraction or scaliness of the nipple, nipple discharge, pain or tenderness. Risk Factors: Over age 50; personal or family history of breast cancer; never had children; first child after age 30. Early Detection: The American Cancer Society rec- ommends the monthly practice of breast self-exami- nation (BSE) by women 20 years and older as a routine good health habit. Most breast lumps are not cancer, but only a physician can make a diagnosis. The A.merican Cancer Society and the National Cancer Institute, in their joint Breast Cancer Detection Demonstration program, found that mammography- a low-dose x-ray examination-could find cancers too small to be felt by the most experienced examiner. Besides its effectiveness in screening women without symptoms, mammography is recognized as a valuable diagnostic technique for women who do have findings suggestive of breast cancer. Once a breast lump is found, mammography can help determine if there are other lesions in the same or opposite breast which are too small to be felt. All suspicious lumps should be biopsied for a definitive diagnosis-even when the mammogram is described as normal. The Society recommends a mammogram every year for asymptomatic women age 50 and over, and a baseline mammogram for those 35 to 39. Asymptom- atic women 40 to 49 should have mammography every 1-2 years. In addition, a professional physical exam- ination of the breast is recommended every three years for women 20 to 40, and every year for those over 40. Treatment: Several methods may be used, depending on the individual woman's preferences and medical situation-surgery varying from local removal of the tumor to mastectomy, radiation therapy, chemotherapy or hormone manipulation. Often two or more methods may be used in combination. Patients should discuss with their physicians possible options available con- cerning the specific management of their breast cancer. New techniques in recent years have made breast reconstruction possible after mastectomy, and the cos- metic results are good. Reconstruction now has be- come an important part of treatment and rehabilitation. (See p. 25) Survival: The 5-year survival rate for localized breast cancer has risen from 78% in the 1940's to 90% today. If the breast cancer is not invasive (in situ), the survival rate approaches 100%. If the cancer has spread, how- ever, the rate is 60%. Despite an increasing incidence of breast cancer, longer survival has helped to stabilize mortality rates over the last 50 years. UTERINE CANCER Incidence: An E=.stimated 47,000 new invasive cases in 1989, including 13,000 cases of cancer of the cervix, and 34,000 cases of cancer of the endometrium or body of the uterus. Invasive cervical cancer incidence has steadily decreased over the years, while cancer in situ has risen in all groups. Cervical cancer is most common today among low s,ocioeconomic groups but all groups are at risk. Endom etrial cancer afflicts mostly mature women, and diagnosis usually is made between the ages of 55 and 69. Mortality: An e;>timated 6,000 deaths in 1989 from cervical cancer, 4,000 from endometrial cancer. Overall, the death rate from uterine cancer has decreased more than 70% during the last 40 years, due mainly to the Pap test and regular checkups. Warning Signal's; Intermenstrual or postmenopausal bleeding or unusual discharge. RLk Factors: Fo r cervical cancer: early age at first intercourse, multiple sex partners. For• endometrial cancer: history of infertility, failure of ovulation, pro- longed estrogen therapy and obesity. Early Detection: The Pap test, an examination under a rnicroscope of cells from the cervix and body of the 10 uterus, is a simple procedure which can be performed at appropriate intervals by physicians as part of every pelvic examination. For cervical cancer, women who are or have been sexually active, or have reached age 18 years, should have an annual Pap test and pelvic examination. After a woman has had three or more consecutive satisfactory normal annual examinations, the Pap test may be performed less frequently at the discretion of her physician. The Pap test is highly effective in detecting early cancer of the uterine cervix; it is only 50% effective in detecting endometrial cancer. Women at high risk of developing endometrial cancer should have an endo- metrial tissue sample at menopause. The hormone estrogen frequently is given to women during and after menopause to make up for the decline in estrogens normally produced by the ovaries. Estrogen helps to control menopausal symptoms such as hot flashes or thinning of the vaginal lining causing painful sexual intercourse. For mature women, there are certain risks associated with such treatment, including an increased risk of endometrial cancer. Women and their physicians should carefully discuss