Transcript Document

US Cancer Burden
Epi 242 Cancer Epidemiology
Binh Goldstein, Ph.D.
October 7, 2009
US Mortality, 2006
Rank Cause of Death
No. of
deaths
% of all
deaths
1.
Heart Diseases
631,636
26.0
2.
Cancer
559,888
23.1
3.
Cerebrovascular diseases
137,119
5.7
4.
Chronic lower respiratory diseases
124,583
5.1
5.
Accidents (unintentional injuries)
121,599
5.0
6.
Diabetes mellitus
72,449
3.0
7.
Alzheimer disease
72,432
3.0
8.
Influenza & pneumonia
56,326
2.3
9.
Nephritis*
45,344
1.9
10.
Septicemia
34,234
1.4
*Includes nephrotic syndrome and nephrosis.
Source: US Mortality Data 2006, National Center for Health Statistics, Centers for Disease Control and Prevention,
2009.
Change in US Death Rates* from 1991 to 2006
Rate Per 100,000
400
1991
313.0
2006
300
215.1
200.2
200
180.7
100
63.3
43.6
34.8
17.8
0
Heart diseases
Cerebrovascular
diseases
Influenza &
pneumonia
Cancer
* Age-adjusted to 2000 US standard population.
Sources: US Mortality Data, National Center for Health Statistics, Centers for Disease Control and
Prevention, 2009.
Age Standardized Incidence Rates
More developed
countries
US
Less developed
countries
Site
Males
Females
Males
Females
Males
Females
Lung
61.9
36.1
54.9
17.0
25.9
9.4
─
101.1
─
67.8
─
23.8
Colon/Rectum
44.6
33.1
40.0
26.6
10.2
7.7
Stomach
7.2
3.3
22.3
10.0
21.5
10.4
Liver
5.5
2.0
8.5
3.0
18.5
7.1
124.8
─
56.2
─
9.4
─
─
7.7
─
10.3
─
19.1
4.9
1.3
6.7
1.3
12.8
6.5
Breast
Prostate
Cervix
Esophagus
Source: GLOBOCAN 2002
Ten Leading Cancer Types for New Cancer Cases
2009 Estimates
Number of New Cases
Site
Both
Male
Female
Lung & Bronchus
219,440
116,090
103,350
Breast
194,280
1,910
192,370
Prostate
192,280
192,280
--
Colon/Rectum
146,970
75,590
71,380
Bladder
70,980
52,810
18,170
Skin Melanoma
68,720
39,080
29,640
Non-Hodgkin Lymphoma
65,980
35,990
29,990
Kidney
57,760
35,430
22,330
Leukemia
44,790
25,630
19,160
Pancreas
42,470
21,050
21,420
All Sites
1,479,350
766,130
713,220
2009 Estimated US Cancer Cases*
Men
766,130
Women
713,220
Prostate
25%
27%
Breast
Lung & bronchus
15%
14%
Lung & bronchus
Colon & rectum
10%
10%
Colon & rectum
Urinary bladder
7%
6%
Uterine corpus
Melanoma of skin
5%
4%
Non-Hodgkin
lymphoma
5%
Non-Hodgkin
lymphoma
4%
Melanoma of skin
Kidney & renal pelvis
5%
4%
Thyroid
Leukemia
3%
3%
Kidney & renal pelvis
Oral cavity
3%
3%
Ovary
Pancreas
3%
3%
Pancreas
19%
22%
All Other Sites
All Other Sites
*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.
Source: American Cancer Society, 2009.
Cancer Incidence Rates* by Sex, US, 1975-2005
700
Rate Per 100,000
Men
600
Both Sexes
500
400
Women
300
200
100
0
1975
1978
1981
1984
1987
1990
1993
1996
1999
*Age-adjusted to the 2000 US standard population and adjusted for delays in reporting.
Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database:
SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008.
2002
2005
Cancer Incidence Rates* Among Men, US, 1975-2005
Rate Per 100,000
250
Prostate
200
150
Lung & bronchus
100
Colon and rectum
50
Urinary bladder
Non-Hodgkin lymphoma
Melanoma of the skin
0
1975
1978
1981
1984
1987
1990
1993
1996
1999
2002
*Age-adjusted to the 2000 US standard population and adjusted for delays in reporting.
Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database:
SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008.
2005
Cancer Incidence Rates* Among Women, US, 1975-2005
Rate Per 100,000
250
200
150
Breast
100
Colon and rectum
Lung & bronchus
50
Uterine Corpus
Ovary
0
1975
Non-Hodgkin lymphoma
1978
1981
1984
1987
1990
1993
1996
1999
2002
*Age-adjusted to the 2000 US standard population and adjusted for delays in reporting.
Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database:
SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008.
2005
Cancer Incidence Rates* by Race and Ethnicity, 2001-2005
Rate Per 100,000
800
Men
700
600
Women
651.5
551.4
500
423.6
419.4
398.9
400
354.0
336.6
287.8
300
296.4
317.8
200
100
0
White
African American
Asian/Pacific Islander
American Indian/
Alaska Native
Hispanic†
*Age-adjusted to the 2000 US standard population.
†Person of Hispanic origin may be of any race.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2008.
Cancer Incidence Rates* by Sex and Race, US,1975-2005
Rate Per 100,000
900
800
African American men
700
White men
600
500
White women
400
African American women
300
200
100
0
1975
1978
1981
1984
1987
1990
1993
1996
1999
2002
*Age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database:
SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008.
2005
Ten Leading Cancer Types for Cancer Deaths
2009 Estimates
Number of Deaths
Site
Both
Male
Female
Lung & Bronchus
159,390
88,900
70,490
Colon/Rectum
49,920
25,240
24,680
Breast
40,610
440
40,170
Pancreas
35,240
18,030
17,210
Prostate
27,360
27,360
--
Leukemia
21,870
12,590
9,280
Non-Hodgkin Lymphoma
19,500
9,830
9,670
Liver
18,160
12,090
6,070
Ovary
14,600
--
14,600
Esophagus
14,530
11,490
3,040
All Sites
562,340
292,540
269,800
2009 Estimated US Cancer Deaths*
Lung & bronchus
30%
Men
292,540
Women
269,800
26%
Lung & bronchus
15%
Breast
Prostate
9%
Colon & rectum
9%
9%
Colon & rectum
Pancreas
6%
6%
Pancreas
Leukemia
4%
5%
Ovary
Liver & intrahepatic
bile duct
4%
4%
Non-Hodgkin
lymphoma
Esophagus
4%
3%
Leukemia
Urinary bladder
3%
3%
Uterine corpus
Non-Hodgkin
lymphoma
3%
2%
Liver & intrahepatic
bile duct
Kidney & renal pelvis
3%
2%
Brain/ONS
25%
25%
All other sites
ONS=Other nervous system.
Source: American Cancer Society, 2009.
All other sites
Cancer Death Rates* by Sex, US, 1975-2005
300
Rate Per 100,000
Men
250
Both Sexes
200
Women
150
100
50
0
1975
1978
1981
1984
1987
1990
1993
1996
1999
2002
2005
*Age-adjusted to the 2000 US standard population.
Source: US Mortality Data 1960-2005, National Center for Health Statistics, Centers for Disease Control and
Prevention, 2008.
Trends in the Number of Cancer Deaths Among Men and
Women, US, 1930-2006
300,000
295,000
290,000
Men
285,000
250,000
280,000
Women
275,000
200,000
270,000
Women
265,000
150,000
20
00
20
01
20
02
20
03
20
04
20
05
20
06
Number of Cancer Deaths
Men
100,000
50,000
0
1930
1940
1950
1960
1970
1980
1990
2000
Source: US Mortality Data, 1930-2006, National Center for Health Statistics, Centers for Disease
Control and Prevention, 2009.
Cancer Death Rates* Among Men, US,1930-2005
100
Rate Per 100,000
Lung & bronchus
80
60
Stomach
Prostate
40
Colon & rectum
20
Pancreas
*Age-adjusted to the 2000 US standard population.
Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959,
National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.
2005
2000
1995
1990
1985
1980
1975
1970
1965
1960
Liver
1955
1950
1945
1940
1935
0
1930
Leukemia
Cancer Death Rates* Among Women, US,1930-2005
100
Rate Per 100,000
80
60
Lung & bronchus
40
Uterus
Breast
Colon & rectum
Stomach
20
Ovary
*Age-adjusted to the 2000 US standard population.
Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959,
National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.
2005
2000
1995
1990
1985
1980
1975
1970
1965
1960
1955
1950
1945
1940
1935
Pancreas
1930
0
Cancer Death Rates* by Race and Ethnicity, US, 2001-2005
400
Men
350
Women
313.0
300
250
230.7
190.0
186.7
200
159.2
142.0
138.8
150
105.2
95.6
100
159.0
50
0
White
African
American
Asian/Pacific
Islander
American
Indian/ Alaskan
Native
Hispanic†
*Per 100,000, age-adjusted to the 2000 US standard population.
† Persons of Hispanic origin may be of any race.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2008.
Cancer Death Rates* by Sex and Race, US, 1975-2005
500 Rate Per 100,000
450
African American men
400
350
300
White men
250
African American women
200
150
White women
100
50
0
1975
1978
1981
1984
1987
1990
1993
1996
1999
2002
2005
*Age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2008.
Cancer Sites in Men for Which African American Death Rates*
Exceed White Death Rates*, US, 2001-2005
Site
African American
White
Ratio of African
American/White
All sites
313.0
230.7
1.4
Prostate
59.4
24.6
2.4
4.8
2.1
2.3
Stomach
11.5
5.0
2.3
Myeloma
8.3
4.3
1.9
Oral cavity and pharynx
6.7
3.8
1.8
Small intestine
0.7
0.4
1.8
Liver and intrahepatic bile duct
10.3
6.7
1.5
Colon and rectum
31.8
22.1
1.4
9.8
7.8
1.3
Lung and bronchus
93.1
71.3
1.3
Pancreas
15.4
12.1
1.3
Larynx
Esophagus
*Per 100,000, age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2008.
Cancer Sites in Women for Which African American Death
Rates* Exceed White Death Rates*, US, 2001-2005
Site
All sites
African American
White
Ratio of African
American/White
186.7
159.2
1.2
Stomach
5.5
2.5
2.2
Myeloma
6.0
2.8
2.1
Uterine cervix
4.7
2.3
2.0
Esophagus
2.8
1.6
1.8
Uterine corpus
7.1
3.9
1.8
Small intestine
0.5
0.3
1.7
Larynx
0.8
0.5
1.6
Colon and rectum
22.4
15.3
1.5
Pancreas
12.4
9.0
1.4
Breast
33.5
24.4
1.4
Gallbladder
1.0
0.8
1.3
Urinary bladder
2.8
2.2
1.3
Liver and intrahepatic bile duct
3.9
2.9
1.3
*Per 100,000, age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control
and Population Sciences, National Cancer Institute, 2008.
Lifetime Probability of Developing Cancer, Men, 2003-2005*
Site
Risk
All sites†
Prostate
1 in 2
1 in 6
Lung and bronchus
1 in 13
Colon and rectum
1 in 18
Urinary bladder‡
1 in 27
Melanoma§
1 in 39
Non-Hodgkin lymphoma
1 in 45
Kidney
1 in 57
Leukemia
1 in 67
Oral Cavity
1 in 72
Stomach
1 in 90
* For those free of cancer at beginning of age interval.
† All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder.
‡ Includes invasive and in situ cancer cases
§ Statistic for white men.
Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0 Statistical Research and
Applications Branch, NCI, 2008. http://srab.cancer.gov/devcan
Lifetime Probability of Developing Cancer, Women, US, 2003-2005*
Site
Risk
All sites†
Breast
1 in 3
1 in 8
Lung & bronchus
1 in 16
Colon & rectum
1 in 20
Uterine corpus
1 in 40
Non-Hodgkin lymphoma
1 in 53
Urinary bladder‡
1 in 84
Melanoma§
1 in 58
Ovary
1 in 72
Pancreas
1 in 75
Uterine cervix
1 in 145
* For those free of cancer at beginning of age interval.
† All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder.
‡ Includes invasive and in situ cancer cases
§ Statistic for white women.
Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0 Statistical Research and
Applications Branch, NCI, 2008. http://srab.cancer.gov/devcan
Cancer Survival*(%) by Race,1996-2004
Absolute
Difference
White
African
American
All Sites
68
58
10
Breast (female)
91
78
13
Colon
66
55
11
Esophagus
18
11
7
Leukemia
52
42
10
Non-Hodgkin lymphoma
66
58
8
Oral cavity
62
42
20
Prostate
99
96
3
Rectum
67
59
8
Urinary bladder
82
66
16
Uterine cervix
74
65
9
Uterine corpus
86
61
25
Site
*5-year relative survival rates based on cancer patients diagnosed from 1996 to 2004 and followed through 2005.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2008.
Trends in Five-year Relative Survival (%)* Rates, US, 1975-2004
1975-1977
50
1984-1986
54
Breast (female)
75
79
89
Colon
52
59
65
Leukemia
35
42
51
Lung and bronchus
13
13
16
Melanoma
82
87
92
Non-Hodgkin lymphoma
48
53
65
Ovary
37
40
46
Pancreas
3
3
5
Prostate
69
76
99
Rectum
49
57
67
Urinary bladder
74
78
81
Site
All sites
1996-2004
66
*5-year relative survival rates based on follow up of patients through 2005.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2008.
100
4500
90
4000
80
3500
70
Per capita cigarette
consumption
3000
60
2500
50
Male lung cancer
death rate
2000
40
1500
30
1000
20
500
10
0
2000
2005
1995
1970
1960
1965
1950
1955
1940
1945
1935
1925
1930
1915
1920
1905
1910
1900
0
1985
1990
Female lung cancer
death rate
Age-Adjusted Lung Cancer Death
Rates*
5000
1975
1980
Per Capita Cigarette Consumption
Tobacco Use in the US, 1900-2005
Year
*Age-adjusted to 2000 US standard population.
Source: Death rates: US Mortality Data, 1960-2005, US Mortality Volumes, 1930-1959, National Center for Health
Statistics, Centers for Disease Control and Prevention, 2006. Cigarette consumption: US Department of
Agriculture, 1900-2007.
Trends in Cigarette Smoking Prevalence* (%), by Sex, Adults 18
and Older, US, 1965-2007
60
Prevalence (%)
50
40
30
Men
20
Women
10
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1995
1994
1992
1990
1985
1983
1979
1974
1965
0
Year
*Redesign of survey in 1997 may affect trends.
Source: National Health Interview Survey, 1965-2007, National Center for Health Statistics, Centers for Disease
Control and Prevention, 2008.
Trends in Obesity* Prevalence (%), Children and Adolescents, by
Age Group, US, 1971-2006
20
18
17
16
16
Prevalence (%)
15
12
11
11
10
10
7
5
7
5
6
5
4
5
0
2 to 5 years
NHANES I (1971-74)
NHANES 1999-2002
6 to 11 years
NHANES II (1976-80)
NHANES 2003-2006
12 to 19 years
NHANES III (1988-94)
*Body mass index (BMI) at or above the sex-and age-specific 95th percentile BMI cutoff points from the 2000 sexspecific BMI-for-age CDC Growth Charts. Note: Previous editions of Cancer Statistics used the term “overweight”
to describe youth in this BMI category.
Source: National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National
Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003-2006: Ogden CL, et al.
High Body Mass Index for Age among US Children and Adolescents, 2003-2006. JAMA 2008; 299 (20): 2401-05.
Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20
to 74, US, 1960-2006†
45
40
35
Prevalence (%)
34
33
35
34 35
36
32
31
28
30
26
23
25
21
20
15
13
16 17
15 15
11
17
12 13
10
5
0
Both sexes
Men
NHES I (1960-62)
NHANES I (1971-74)
NHANES II (1976-80)
NHANES 1999-2002
NHANES 2003-2004
NHANES 2005-2006
Women
NHANES III (1988-94)
*Obesity is defined as a body mass index of 30 kg/m2 or greater. † Age adjusted to the 2000 US standard population. Source:
National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980,
1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 20032004, 2005-2006: National Health and Nutrition Examination Survey Public Use Data Files, 2003-2004, 2005-2006, National
Center for Health Statistics, Centers for Disease Control and Prevention, 2006, 2007.
Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20
to 74, US, 1960-2006†
45
40
35
Prevalence (%)
34
33
35
34 35
36
32
31
28
30
26
23
25
21
20
15
13
16 17
15 15
11
17
12 13
10
5
0
Both sexes
Men
NHES I (1960-62)
NHANES I (1971-74)
NHANES II (1976-80)
NHANES 1999-2002
NHANES 2003-2004
NHANES 2005-2006
Women
NHANES III (1988-94)
*Obesity is defined as a body mass index of 30 kg/m2 or greater. † Age adjusted to the 2000 US standard population. Source:
National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980,
1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 20032004, 2005-2006: National Health and Nutrition Examination Survey Public Use Data Files, 2003-2004, 2005-2006, National
Center for Health Statistics, Centers for Disease Control and Prevention, 2006, 2007.
Trends in Overweight* Prevalence (%), Adults 18 and Older,
US, 1992-2007
1992
1995
1998
Less than 50%
2007
50 to 55%
More than 55%
State did not participate in survey
*Body mass index of 25.0 kg/m2or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995,
1998) and Public Use Data Tape (2004-2007), National Center for Chronic Disease Prevention and Health Promotion,
Centers for Disease Control and Prevention, 1997, 2000, 2005, 2007, 2008.
Screening Guidelines for the Early Detection of
Breast Cancer, American Cancer Society
 Yearly mammograms are recommended starting at age 40.
 A clinical breast exam should be part of a periodic health examination,
about every 3 years for women in their 20s and 30s. Asymptomatic women
aged 40 and older should continue to undergo a clinical breast exam,
preferably annually*.
 Beginning in their early 20s, women should be told about the benefits and
limitations of breast-self examination. Women should know how their
breasts normally feel and report any breast changes promptly to their
health care providers.
__________
* Beginning at age 40 years, annual CBE should be performed prior to mammography
Mammogram Prevalence (%), by Educational Attainment and
Health Insurance Status, Women 40 and Older, US, 1991-2006
70
All women 40 and older
60
Prevalence (%)
50
Women with less than a high school education
40
30
Women with no health insurance
20
10
0
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2002
2004
2006
Year
*A mammogram within the past year. Note: Data from participating states and the District of Columbia were
aggregated to represent the United States.
Source: Behavior Risk Factor Surveillance System CD-ROM (1984-1995, 1996-1997, 1998, 1999) and Public Use Data
Tape (2000, 2002, 2004, 2006), National Centers for Chronic Disease Prevention and Health Promotion, Centers for
Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005, 2007.
Screening Guidelines for the Early Detection of
Cervical Cancer, American Cancer Society
Screening should begin approximately three years after a women begins
having vaginal intercourse, but no later than 21 years of age.
Screening should be done every year with regular Pap tests or every two
years using liquid-based tests.
At or after age 30, women who have had three normal test results in a row
may get screened every 2-3 years with cervical cytology (either
conventional or liquid-based Pap test) alone, or every 3 years with a
human papillomavirus DNA test plus cervical cytology.
Women 70 and older who have had three or more consecutive Pap tests
in the last ten years may choose to stop cervical cancer screening.
Screening after a total hysterectomy (with removal of the cervix) is not
necessary unless the surgery was done as a treatment for cervical cancer.
Trends in Recent* Pap Test Prevalence (%), by Educational
Attainment and Health Insurance Status, Women 18 and Older,
US, 1992-2006
100
All women 18 and older
Prevalence (%)
80
Women with no health insurance
Women with less than a high school education
60
40
20
0
1992
1993
1994
1995
1996
1997 1998
Year
1999
2000
2002
2004
2006
* A Pap test within the past three years. Note: Data from participating states and the District of Columbia
were aggregated to represent the United States. Educational attainment is for women 25 and older.
Source: Behavior Risk Factor Surveillance System CD-ROM (1984-1995, 1996-1997, 1998, 1999) and Public
Use Data Tape (2000, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health
Promotion, Center for Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005, 2007.
Screening Guidelines for the Early Detection of Colorectal Cancer
and Adenomas, American Cancer Society 2008
Beginning at age 50, men and women should follow one of the
following examination schedules:
 A flexible sigmoidoscopy (FSIG) every five years
 A colonoscopy every ten years
 A double-contrast barium enema every five years
 A Computerized Tomographic (CT) colonography every five years
 A guaiac-based fecal occult blood test (FOBT) or a fecal
immunochemical test (FIT) every year
 A stool DNA test (interval uncertain)


Tests that detect adenomatous polyps and cancer
Tests that primarily detect cancer
People who are at moderate or high risk for colorectal cancer should talk with
a doctor about a different testing schedule
Trends in Recent* Fecal Occult Blood Test Prevalence (%), by
Educational Attainment and Health Insurance Status, Adults 50
Years and Older, US, 1997-2006
30
24
Prevalence (%)
25
20
1997
2004
20
21
1999
2006
2001
2002
22
19
18
16
16 16
16
14
15
12
10
12
8
9
9
9
8
5
0
Total
Less than a high school
education
No health insurance
*A fecal occult blood test within the past year. Note: Data from participating states and the District of Columbia were
aggregated to represent the United States.
Source: Behavioral Risk Factor Surveillance System CD-ROM (1996-1997, 1999) and Public Use Data Tape (2001,
2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control
and Prevention and Prevention, 1999, 2000, 2002, 2003, 2005, 2007.
Trends in Recent* Flexible Sigmoidoscopy or Colonoscopy
Prevalence (%), by Educational Attainment and Health Insurance
Status, Adults 50 Years and Older, US, 1997-2006
60
56
1999
2001
2002
2004
2006
50
50
45
44 44
Prevalence (%)
41
37
40
43
36 36
30
22 21 21 22
25
20
10
0
Total
Less than a high school
education
No health insurance
*A flexible sigmoidoscopy or colonoscopy within the past ten years. Note: Data from participating states and the
District of Columbia were aggregated to represent the United States.
Source: Behavioral Risk Factor Surveillance System CD-ROM (1996-1997, 1999) and Public Use Data Tape (2001,
2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control
and Prevention and Prevention, 1999, 2000, 2002, 2003, 2005, 2007.
Screening Guidelines for the Early Detection of
Prostate Cancer, American Cancer Society
 Beginning at age 50, to men who have a life expectancy of
at least 10 years, health care providers should discuss the
potential benefits and limitations of prostate cancer early
detection testing with men and offer the PSA blood test and
the digital rectal examination.*
___________
* Information should be provided to men regarding the benefits and
limitations of testing so that an informed decision concerning testing
can be made with the clinician’s assistance.
Recent* Prostate-Specific Antigen (PSA) Test Prevalence (%),
by Educational Attainment and Health Insurance Status, Men 50
Years and Older, US, 2001-2006
70
Prevalence (%)
60
58
55
2001
2004
52
50
2002
2006
54
46
42
40
39
40
30
30
28
25
27
20
10
0
Total
Less than a high school
education
No health insurance
*A prostate-specific antigen (PSA) test within the past year. Note: Data from participating states and the District of
Columbia were aggregated to represent the United States.
Source: Behavioral Risk Factor Surveillance System Public Use Data Tape (2001, 2002, 2004, 2006), National Center
for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002, 2003, 2005,
2007.
Recent* Digital Rectal Examination (DRE) Prevalence (%), by
Educational Attainment and Health Insurance Status, Men 50
Years and Older, US, 2001-2006
60
57
53
Prevalence (%)
50
50
2001
2004
50
44
42
37
40
2002
2006
35
29
30
26
22
23
20
10
0
Total
Less than a high school
education
No health insurance
*A digital rectal examination (DRE) within the past year. Note: Data from participating states and the District of
Columbia were aggregated to represent the United States.
Source: Behavioral Risk Factor Surveillance System Public Use Data Tape (2001, 2002, 2004, 2006), National Center
for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002, 2003, 2005,
2007.
Resources
American Cancer Society
• Cancer Facts & Figures
• www.cancer.org