A Presentation From the American Cancer Society

A Presentation From the American Cancer Society
Cancer Statistics 2009 A Presentation From the American Cancer Society The American Cancer Society presents Cancer Statistics 2009. ©2009, American Cancer Society, Inc.

2009 Estimated US Cancer Deaths*
Men 292,540 Women 269,800 Lung & bronchus 30% Prostate 9% Colon & rectum 9% Pancreas 6% Leukemia 4% Liver & intrahepatic 4% bile duct Esophagus 4% Urinary bladder 3% Non-Hodgkin % lymphoma Kidney & renal pelvis 3% All other sites % 26% Lung & bronchus 15% Breast 9% Colon & rectum 6% Pancreas 5% Ovary 4% Non-Hodgkin lymphoma 3% Leukemia 3% Uterine corpus 2% Liver & intrahepatic bile duct 2% Brain/ONS 25% All other sites Lung cancer is, by far, the most common fatal cancer in men (30%), followed by prostate (9%), and colon & rectum (9%). In women, lung (26%), breast (15%), and colon & rectum (9%) are the leading sites of cancer death. ONS=Other nervous system. Source: American Cancer Society, 2009.

US Mortality, 2006 No. of deaths % of all deaths Rank Cause of Death
1. Heart Diseases 631, 2. Cancer , 3. Cerebrovascular diseases 137, 4. Chronic lower respiratory diseases 124, 5. Accidents (unintentional injuries) 121, 6. Diabetes mellitus 72, 7. Alzheimer disease , 8. Influenza & pneumonia 56, Nephritis* , 10. Septicemia , Cancer accounts for nearly one-quarter of deaths in the United States, exceeded only by heart diseases. In 2006, there were 559,888 cancer deaths in the US. *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 1991 2006 Compared to the peak rate of per 100,000 in 1991, the cancer death rate decreased 16% to in Rates for other major chronic diseases decreased substantially during this period. * Age-adjusted to 2000 US standard population. Sources: US Mortality Data, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

Number of Cancer Deaths
Trends in the Number of Cancer Deaths Among Men and Women, US, Men Men Women Women Number of Cancer Deaths Despite a continuing decline in the cancer death rate from 2005 to 2006, there was an increase in the recorded number of cancer deaths in 2006 as a result of the aging and growth of the US population. The number of cancer deaths decreased by 358 in men and increased by 926 in women, resulting in a net increase of 568 cancer deaths. Source: US Mortality Data, , National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

Cancer Death Rates* by Sex, US, 1975-2005
Rate Per 100,000 Men Both Sexes Women The death rate from all cancers combined decreased by 2.0% per year from 2001 to 2005 in men and 1.6% per year from 2002 to 2005 in women. Cancer death rates have been decreasing since 1990 in men and since 1991 in women. Compared to the peak rates in 1990 for men and 1991 for women, the cancer death rate for all sites combined in 2005 was 19.2% lower in men and11.4% lower in women. *Age-adjusted to the 2000 US standard population. Source: US Mortality Data , National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

Cancer Death Rates* Among Men, US,1930-2005
Rate Per 100,000 Lung & bronchus Stomach Prostate Colon & rectum Most of the increase in cancer death rates for men prior to 1990 was attributable to lung cancer. However, since 1990, the age-adjusted lung cancer death rate in men has been decreasing; this decrease has been estimated to account for about 40% of the overall decrease in cancer death rates in men. Stomach cancer mortality has decreased considerably since Death rates for prostate and colorectal cancers have also been declining. Pancreas Leukemia Liver *Age-adjusted to the 2000 US standard population. Source: US Mortality Data , US Mortality Volumes , National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

Cancer Death Rates* Among Women, US,1930-2005
Rate Per 100,000 Lung & bronchus Uterus Breast Lung cancer is currently the most common cause of cancer death in women, with the death rate more than twice what it was 30 years ago. In comparison, breast cancer death rates changed little between 1930 and 1990, but decreased 27% between 1990 to The death rates for stomach and uterine cancers have decreased steadily since 1930; colorectal cancer death rates have been decreasing for more than 50 years. Colon & rectum Stomach Ovary Pancreas *Age-adjusted to the 2000 US standard population. Source: US Mortality Data , US Mortality Volumes , National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

Cancer Death Rates* by Race and Ethnicity, US, 2001-2005
Overall, cancer death rates are higher in men than women in every racial and ethnic group. African American men and women have higher rates of cancer mortality than their counterparts in every other racial and ethnic group. Asian American and Pacific Islander men and women have the lowest cancer death rates, about half the rate of African American men and women, respectively. Note: Rates for populations other than white and African American may be affected by problems in ascertaining race/ethnicity information from medical records. This is likely to result in reported death rates that are lower than true death rates. *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, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

Cancer Sites in Men for Which African American Death Rates
Cancer Sites in Men for Which African American Death Rates* Exceed White Death Rates*, US, Site Ratio of African American/White African American White All sites Prostate Larynx Stomach Myeloma Oral cavity and pharynx Small intestine Liver and intrahepatic bile duct Colon and rectum Esophagus Lung and bronchus Pancreas African Americans have higher cancer death rates than whites for numerous cancer sites. Death rates for myeloma and cancers of the prostate, larynx, stomach, oral cavity, esophagus, liver, small intestine, colon and rectum, lung and bronchus, and pancreas are all higher in African American men than in white men. *Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

Cancer Sites in Women for Which African American Death Rates
Cancer Sites in Women for Which African American Death Rates* Exceed White Death Rates*, US, Site Ratio of African American/White African American White All sites Stomach Myeloma Uterine cervix Esophagus Uterine corpus Small intestine Larynx Colon and rectum Pancreas Breast Gallbladder Urinary bladder Liver and intrahepatic bile duct Death rates are higher in African American women than white women for many cancer sites, including myeloma and cancers of the stomach, cervix, esophagus, uterus, small intestine, larynx, colon & rectum, pancreas, breast, gallbladder, bladder, and liver. *Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

Cancer Death Rates* by Sex and Race, US, 1975-2005
Rate Per 100,000 African American men White men African American women White women Although overall cancer death rates continue to be higher in African American men than white men, since 1996 the decline in death rates has been larger in African American (2.5% per year) than white men (1.6% per year). *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

2009 Estimated US Cancer Cases*
Men 766,130 Women 713,220 Prostate 25% Lung & bronchus 15% Colon & rectum 10% Urinary bladder 7% Melanoma of skin 5% Non-Hodgkin 5% lymphoma Kidney & renal pelvis 5% Leukemia 3% Oral cavity 3% Pancreas 3% All Other Sites 19% 27% Breast 14% Lung & bronchus 10% Colon & rectum 6% Uterine corpus 4% Non-Hodgkin lymphoma 4% Melanoma of skin 4% Thyroid 3% Kidney & renal pelvis 3% Ovary 3% Pancreas 22% All Other Sites Now we will turn our attention to the number of new cancers anticipated in the US this year. It is estimated that about 1.5 million new cases of cancer will be diagnosed in Cancers of the prostate and breast will be the most frequently diagnosed cancers in men and women, respectively, followed by lung and colorectal cancers in both men and in women. *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
Rate Per 100,000 Men Both Sexes Women This slide shows trends in cancer incidence for all sites combined, for the years Overall incidence rates for all racial and ethnic populations combined decreased by 0.8% per year from 1999 through 2005 in both sexes combined, by 1.8% per year from 2001 through 2005 in men, and by 0.6% per year from 1998 through 2005 in women. (Annual Report to the Nation on the Status of Cancer, , Featuring Trends in Lung Cancer, Tobacco Use, and Tobacco Control. JNCI December 3, 2008) *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, , National Cancer Institute, 2008.

Cancer Incidence Rates* Among Men, US, 1975-2005
Rate Per 100,000 Prostate Lung & bronchus Colon and rectum Incidence rates of prostate cancer have changed substantially over the last 20 years: rapidly increasing from 1988 to 1992, declining sharply from 1992 to 1995, increasing again from 1995 to 2001, and decreasing from 2001 to 2005, due, in part, to changes in prostate cancer screening with the prostate-specific antigen (PSA) blood testing. Incidence rates for both lung and colorectal cancers in men have declined in recent years. Urinary bladder Non-Hodgkin lymphoma Melanoma of the skin *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, , National Cancer Institute, 2008.

Cancer Incidence Rates* Among Women, US, 1975-2005
Rate Per 100,000 Breast Colon and rectum Lung & bronchus After increasing from 1994 to 1999, breast cancer incidence rates in women decreased by 2.2% per year from 1999 to 2005, likely due in part to a slight decline in mammography utilization and a reduction in use of hormone replacement therapy. During the most recent time period, incidence rates of lung cancer have increased slightly by 0.5% per year since 1991, while rates of colorectal cancer have been decreasing rapidly by 2.2% per year since 1998. Uterine Corpus Ovary Non-Hodgkin lymphoma *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, , National Cancer Institute, 2008.

Cancer Incidence Rates* by Race and Ethnicity, 2001-2005
Rate Per 100,000 Overall, cancer incidence rates are higher in men than women. Among men, African Americans have the highest incidence followed by white, Hispanic, Asian American/Pacific Islander, and American Indian/Alaskan Natives. Racial differences in cancer incidence among women are less pronounced; white women have the highest incidence rates followed by African American, Hispanic, American Indian/Alaskan Native, and Asian American/Pacific Islander women. Note: Rates for populations other than white and African American may be affected by problems in ascertaining race/ethnicity information from medical records. This is likely to result in reported incidence rates that are lower than true incidence rates. Data for American Indians/Alaska Natives is based on Contract Health Service Delivery Areas, comprising 54% of the total US American Indian/Alaska Native population. *Age-adjusted to the 2000 US standard population. †Person of Hispanic origin may be of any race. Source: Surveillance, Epidemiology, and End Results Program, , 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 African American men White men White women African American women Cancer incidence rates are consistently higher in African American men than white men. In contrast, cancer incidence rates are generally higher in white women than African American women, although the difference is not as great. *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, , National Cancer Institute, 2008.

Lifetime Probability of Developing Cancer, Men, 2003-2005*
Site Risk All sites† 1 in 2 Prostate 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 The next four slides look at the lifetime probability of developing cancer and relative survival rates of cancer. Presently, the risk of an American man developing cancer over his lifetime is one in two. The leading cancer sites are prostate, lung, and colon and rectum. * 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 Statistical Research and Applications Branch, NCI,

Lifetime Probability of Developing Cancer, Women, US, 2003-2005*
Site Risk All sites† in 3 Breast in 8 Lung & bronchus in 16 Colon & rectum in 20 Uterine corpus in 40 Non-Hodgkin lymphoma 1 in 53 Urinary bladder‡ in 84 Melanoma§ in 58 Ovary in 72 Pancreas in 75 Uterine cervix in 145 Approximately one in three women in the United States will develop cancer over her lifetime. The leading sites are breast, lung, and colon and rectum. * 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 Statistical Research and Applications Branch, NCI,

Cancer Survival*(%) by Race,1996-2004
African Absolute Difference Site White American All Sites Breast (female) Colon Esophagus Leukemia Non-Hodgkin lymphoma Oral cavity Prostate Rectum Urinary bladder Uterine cervix Uterine corpus The 5-year relative survival rate for cancer is 68% among whites and 58% among African Americans (taking normal life expectancy into consideration). For many sites, survival rates in African Americans are 10% to more than 20% lower than in whites. This is due, in part, to African Americans being less likely to receive a cancer diagnosis at an early, localized stage, when treatment can improve chances of survival. Additional factors that contribute to the survival differential include unequal access to medical care and tumor characteristics. *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, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

Trends in Five-year Relative Survival (%)* Rates, US, 1975-2004
Site All sites Breast (female) Colon Leukemia Lung and bronchus Melanoma Non-Hodgkin lymphoma Ovary Pancreas Prostate Rectum Urinary bladder The survival rates for all cancers combined and for certain site-specific cancers have improved significantly since the 1970s, due, in part, to both earlier detection and advances in treatment. Survival rates markedly increased for cancers of the prostate, breast, colon, rectum, and for leukemia. With new treatment techniques and increased utilization of screening, there is hope for even greater improvements in the not-too-distant future. *5-year relative survival rates based on follow up of patients through 2005. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

Cancer Incidence & Death Rates* in Children 0-14 Years, 1975-2005
Rate Per 100,000 Incidence The next series of slides look at the burden of cancer among our nation's children. Cancer incidence among children ages 0-14 years has been increasing slightly, by about 0.6% per year, since Cancer-related mortality in children ages 0-14 has been stable since 1998 after decreasing steadily from 1975 to 1998 by 2.9% per year. Mortality *Age-adjusted to the 2000 Standard population. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

Cancer Incidence Rates* in Children 0-14 Years by Sex, 2001-2005
Site Male Female Total All sites Leukemia Acute Lymphocytic Brain/ONS Soft tissue Non-Hodgkin lymphoma Kidney and renal pelvis Bone and Joint Hodgkin lymphoma Leukemia is the most common cancer among children ages 0-14 years and comprises approximately 30% of all childhood cancers. Acute lymphocytic leukemia is the most common form of leukemia in children. Cancer of the brain/other nervous system is the second most common incident cancer in both boys and girls. *Per 100,000, age-adjusted to the 2000 US standard population. ONS = Other nervous system Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

Cancer Death Rates* in Children 0-14 Years by Sex, US, 2001-2005
Site Male Female Total All sites Leukemia Acute Lymphocytic Brain/ONS Non-Hodgkin lymphoma Soft tissue Bone and Joint Kidney and Renal pelvis Leukemia also accounts for the most cancer deaths in children, comprising roughly a third of cancer deaths among boys and girls 0-14 years. Cancers of the brain/other nervous system are the second leading cause of cancer death in children 0-14. *Per 100,000, age-adjusted to the 2000 US standard population. ONS = Other nervous system Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

Trends in Cancer Survival by Age Group, Children 0-14 Years,1975-2004
Year of Diagnosis Age 5 - Year Relative Survival Rates * 0 - 4 Years 5 - 9 Years The 5-year relative survival rate for all three age groups has increased significantly since the mid 1970s. For example, among children ages years, the 5-year relative survival rate increased from 58.9% for those diagnosed in to 80.0% for those patients diagnosed in Years *5-year relative survival rates, based on follow up of patients through Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

Tobacco Use in the US, 1900-2005 Per capita cigarette consumption
Male lung cancer death rate Tobacco use is a major preventable cause of death, particularly from lung cancer. The year 2004 marks the anniversary of the release of the first Surgeon General’s report on Tobacco and Health, which initiated a decline in per capita cigarette consumption in the United States. As a result of the cigarette smoking epidemic, lung cancer death rates showed a steady increase through 1990, then began to decline among men. The lung cancer death rate among US women, who began regular cigarette smoking later than men, has begun to plateau after increasing for many decades. Female lung cancer death rate *Age-adjusted to 2000 US standard population. Source: Death rates: US Mortality Data, , US Mortality Volumes, , National Center for Health Statistics, Centers for Disease Control and Prevention, Cigarette consumption: US Department of Agriculture,

Trends in Cigarette Smoking Prevalence
Trends in Cigarette Smoking Prevalence* (%), by Sex, Adults 18 and Older, US, Men Women The reduction in cigarette consumption has been associated with a decrease in adult smoking prevalence in both men and women since The difference in cigarette smoking across gender narrowed from 1965 to 1985, a result of smoking becoming more popular among women and higher rates of quitting among male smokers following the Surgeon General’s Report. After declining significantly between 1997 and 2004, smoking prevalence in the US remained essentially unchanged between 2004 and However, in 2007, smoking prevalence declined significantly to 19.8%. *Redesign of survey in 1997 may affect trends. Source: National Health Interview Survey, , National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

Current* Cigarette Smoking Prevalence (%) Among High School Students by Sex and Race/Ethnicity, US, Reduction in cigarette smoking among youth is an important factor in reducing prevalence and addiction in adulthood. Smoking among high school students increased from 1991 to 1997, declined between 1997 and 2003, and remained stable between 2003 and It is thought that the increase in smoking from 1991 to 1997 was due to aggressive youth targeted marketing and promotions; tobacco companies greatly increased their expenditures and promotions during that period. The subsequent decline is thought to be due to increased price of cigarettes as well as comprehensive tobacco control efforts. However, the recent stall in the rate of decline may reflect increased tobacco industry expenditures on marketing and promotion and declines in funding for comprehensive tobacco control programs. Patterns were similar for all gender and racial/ethnic groups, except for African American females, who have shown a continuous decline since 1999. *Smoked cigarettes on one or more of the 30 days preceding the survey. Source: Youth Risk Behavior Surveillance System, 1991, 1995, 1997, 1999, 2001, 2003, 2005, 2007 National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2008.

Trends in Consumption of Five or More Recommended Vegetable and Fruit Servings for Cancer Prevention, Adults 18 and Older, US, The American Cancer Society recommends that individuals eat five or more servings of vegetables and fruits a day for cancer prevention. Fruit and vegetable consumption may protect against cancers of the mouth and pharynx, esophagus, lung, stomach, and colon and rectum. However, there has been little improvement in consumption since the mid-1990s. About one in four adults was eating the recommended servings in 2007. 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, 1998) and Public Use Data Tape (2000, 2003, 2005, 2007), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2001, 2004, 2006, 2008.

Trends in Prevalence (%) of No Leisure-Time Physical Activity, by Educational Attainment, Adults 18 and Older, US, Adults with less than a high school education All adults The American Cancer Society recommends that adults engage in at least 30 minutes of moderate to vigorous physical activity, above usual activities, on 5 or more days of the week; 45 to 60 minutes of intentional physical activity is preferable. However, similar to trends in nutrition, there has been little change in leisure-time physical activity during the 1990s. About one-fourth of adults do not engage in any leisure-time physical activity. Even more striking is that almost half of adults with less than a high school education do not participate in any leisure-time physical activity. It should be noted that leisure-time physical activity, as presented in this graph, does not reflect job-related physical activity for the currently employed population. While there has been little change in leisure-time physical activity since the early 1990s, data from other sources illustrates long-term social changes have contributed to reduced total physical activity in US adults, including reduced leisure time for physical activity, shifts from using walking as a mode of transportation to increased reliance on automobiles, and shifts to more sedentary or mechanized work. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Educational attainment is for adults 25 and older. Source: Behavioral Risk Factor Surveillance System CD-ROM ( , 1996, 1998) and Public Use Data Tape (2000, 2002, 2004, 2005, 2006, 2007), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2001, 2003, 2005, 2006, 2007, 2008.

Trends in Prevalence (%) of High School Students Attending PE Class Daily, by Grade, US, 1991-2007
Regular physical activity has many important health benefits, including reducing risk factors for cardiovascular disease, cancer, and other chronic diseases. Today however, the prevalence of students attending physical education (PE) class daily is significantly lower than it was in Given the dramatic rise in the prevalence of overweight among teens (it has tripled since 1980), schools are increasingly being identified as an opportunity to increase physical activity among students. Source: Source: Youth Risk Behavior Surveillance System, 1991, 1995, 1997, 1999, 2001, 2003, 2005, 2007 National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2008.

Trends in Obesity* Prevalence (%), Children and Adolescents, by Age Group, US, 1971-2006
People who become overweight in childhood and adolescence are more likely to be overweight or obese as adults. With at least half of the overweight children becoming overweight adults, future adult populations are at increased risk for developing cancer and other serious chronic diseases. The prevalence of obese children and adolescents has increased since the 1970s, with the most dramatic increases occurring in the late 1980s and 1990s. In fact, over the past three decades the proportion of obese children has more than doubled among children 2-5 years and 6-11 years, and tripled among adolescents years. More recently, however, no changes in obesity prevalence was observed between and *Body mass index (BMI) at or above the sex-and age-specific 95th percentile BMI cutoff points from the 2000 sex-specific 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, , , , , National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, : Ogden CL, et al. High Body Mass Index for Age among US Children and Adolescents, JAMA 2008; 299 (20):

Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20 to 74, US, 1960-2006†
Obesity has reached epidemic proportions in the United States. The percentage of adults age 20 to 74 who are obese increased from 1960 to 2004 with the largest increases occurring in the 1990s. Similar trends were observed among men and women. For the most recent time period, , obesity prevalence did not significantly increase in either men or women from *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 , National Health and Nutrition Examination Survey, , , , , National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, , : National Health and Nutrition Examination Survey Public Use Data Files, , , National Center for Health Statistics, Centers for Disease Control and Prevention, 2006, 2007.

Trends in Overweight* Prevalence (%), Adults 18 and Older, US, 1992-2007
1995 1998 2007 This slide highlights the obesity epidemic as mentioned in the previous slide. In 2007, over 55% of adults in all states, including District of Columbia, were overweight or obese, compared to none in 1992. Less than 50% 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 ( , 1998) and Public Use Data Tape ( ), 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 The American Cancer Society states that women aged 40 and older should have an annual mammogram and clinical breast exam (CBE) as part of a periodic health exam. Women should know how their breasts normally feel and report any changes to their health care provider. A breast self-examination (BSE) is an option for women starting in their 20s.

Mammogram Prevalence (%), by Educational Attainment and Health Insurance Status, Women 40 and Older, US, All women 40 and older Women with less than a high school education Women with no health insurance The prevalence of women reporting a mammogram within the past year increased from 50% in 1991 to 64% in 2000, and has since declined to 61% in During this time, mammogram utilization varied considerably by educational attainment. The prevalence of women with less than a high school education reporting a recent mammogram was approximately 10 percentage points lower than the prevalence for all women. Even more striking is that the prevalence for women with no health insurance is approximately 25 percentage points lower than the prevalence for all women. *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 ( , , 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. The American Cancer Society cervical cancer screening guidelines state that women should begin screening approximately three years after she 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 tests in a row may get screened every 2-3 years. Women 70 and older who have had three or more consecutive normal Pap tests in the last 10 years may choose to stop cervical cancer screening.

Trends in Recent* Pap Test Prevalence (%), by Educational Attainment and Health Insurance Status, Women 18 and Older, US, All women 18 and older Women with no health insurance Women with less than a high school education This graph shows that the prevalence of women who have had a Pap test within the past three years has remained high, and has increased during the late 1990s. Throughout the decade, the prevalence among women with less than a high school education as well as the prevalence among women with no health insurance was approximately 10 percent lower than the percentage for all women. * 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 ( , , 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 The American Cancer Society recommends that beginning at age 50, men and women, who are at average-risk, should receive one of several options as screening for the early detection of colorectal cancer and adenomas There are significant updates to the guidelines for colorectal cancer screening. Two new tests are now recommended as options for colorectal cancer screening. They are stool DNA (sDNA) and computerized tomographic colonography (also known as virtual colonoscopy). For the first time, screening tests are grouped into categories based on performance characteristics: those that primarily detect cancer early and those that can also detect precancerous polyps. Tests that primarily detect cancer early are fecal (stool) tests, including guaiac-based and immunochemical-based fecal occult blood tests (gFOBT & FIT), and stool DNA tests (sDNA). Tests that detect both precancerous polyps and cancer include flexible sigmoidoscopy, colonoscopy, the double contrast barium enema, and computerized tomographic colonography (also known as virtual colonoscopy). It is the strong opinion of the expert panel that colon cancer prevention should be the primary goal of colorectal cancer screening. Exams that are designed to detect both early cancer and precancerous polyps should be encouraged if resources are available and patients are willing to undergo an invasive test. 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, In 2006, approximately 16% of US adults 50 and older had a fecal occult blood test (FOBT) in the previous year. Adults with less than a high school education are less likely to report a recent FOBT. The prevalence for adults with no health insurance is about 8 percentage points lower than the prevalence for all adults. *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 ( , 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, While there has been a downward trend during recent years in the use of FOBT, the prevalence of flexible sigmoidoscopy (FSIG) or colonoscopy has continuously increased from 1997 to Adults with less than a high school education were less likely to report FSIG or colonoscopy than all adults. Even more striking is that the prevalence for adults with no health insurance is about half that for all adults. Continuing efforts are needed to address health system barriers to colon cancer screening, to encourage health care practitioners to promote screening to their patients, and to raise awareness among eligible adults about the importance of getting screened for CRC. *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 ( , 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. Health care providers should discuss the potential benefits and limitations of prostate cancer early detection testing with men. Information should be provided to men regarding the benefits and limitation of testing so that an informed decision concerning testing can be made with the clinician’s assistance. After such discussion about benefits and limitations of prostate cancer early detection testing with patients, providers can offer to patients, who are aged 50 and older and have a life expectancy of at least 10 years, testing with prostate-specific antigen (PSA) test and the digital rectal exam (DRE).

Recent* Prostate-Specific Antigen (PSA) Test Prevalence (%), by Educational Attainment and Health Insurance Status, Men 50 Years and Older, US, This graph shows that the percentage of men who have had a PSA test within the past year decreased 4 percentage points from 2001 to Men with less than a high school education and men with no health insurance were less likely to report a PSA test than all men 50 and older. *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, This graph shows that the percentage of men who have had a DRE within the past year decreased approximately seven percentage points from 2001 to Men with less than a high school education and men with no health insurance were less likely to report a DRE than all men 50 and older. The American Cancer Society suggests that men speak with their physician to make an informed decision on prostate cancer screening. *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.

Sunburn* Prevalence (%) in the Past Year, Adults 18 and Older, US, 2004
The vast majority of skin cancers are the result of unprotected and excessive ultraviolet radiation exposure. The American Cancer Society estimates that UV exposure is associated with more than one million cases of basal and squamous cell cancers and 59,940 cases of malignant melanoma in 2006. Sunburns, a short-term consequence of unprotected or excessive UV exposure, were reported more frequently by men than women. Variations by race, ethnicity, and gender were observed with the highest prevalence of sunburns among white non-Hispanic males and females. *Reddening of any part of the skin for more than 12 hours. Note: The overall prevalence of sunburn among adult males is 46.4% and among females is 36.3%. Source: Behavioral Risk Factor Surveillance System Public Use Data Tape , National Center for Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2005.

Ultraviolet Radiation Exposure Behaviors
Ultraviolet Radiation Exposure Behaviors* Prevalence (%), Adults 18 and Older, US, 2005 The vast majority of skin cancers are caused by unprotected exposure to excessive ultraviolet radiation (UVR), primarily from the sun. Studies also suggest that exposure to artificial UVR exposure from indoor tanning devices is a risk factor for skin cancer. UVR damage of unprotected skin can be avoided by practicing recommended sun protection behaviors and avoiding indoor tanning devices, including lamps and booths. The practice of UVR protection behaviors is generally low. In a national sample of US adults, application of sunscreen and shade seeking were the most commonly practiced sun protection behaviors, whereas clothing protection, especially the use of hats and long-sleeved shirts were less frequently practiced. The same survey showed that 14% of adults, primarily women and young adults, reported using an indoor tanning device at least once in the past year. *Proportion of respondents reporting always or often practicing the particular sun protection behavior on any warm sunny day. †Used an indoor tanning device, including a sunbed, sunlamp, or tanning booth at least once, in the past 12 months. Source: National Health Interview Survey Public Use Data File 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

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A Presentation From the American Cancer Society

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