Cancer:  On-Line Information

Table of Contents and Programmed Study:  Oncology Content, Practice Questions and Practice Exams

Content, site developer:  Michael Gordon, Ph.D.

comments/suggestions, email:  Michael Gordon

 

 

Cancer Topics

Introduction Cancer incidence Causes of Cancer Practice Question Set 1 Practice Question Set 2 Practice Question Set 3 Practice Question Set 4 Practice Question Set 5 Practice Question Set 6 Practice Question Set 7 Practice Question Set 8

Anticancer Drugs: Cytarabine Etoposide (Vepesid®, Toposar®, Etopophos) Medical Pharmacology Site

Lifetime Risks (of diagnosis and death) for Some Cancers and for Overall Disease³

Incidence and Mortality of the 10 Cancers most common in the U.S. for Males^d

Rank

Men

Incidencea

Mortalitya

1	Prostate	178	30
2	Lung	82	76
3	Colorectal	63	25
4	Bladder	38	8
5	Non-Hodgkin's lymphoma	24	10
6	Melanoma	23	4
7	Oral cavity/pharynxc	16	4
8	Kidney	17	6
9	Leukemiasb	16	10
10	Pancreas	13	12

a Rates per 100,000 (1998-2002, age adjusted using year 2000 U.S. census data with 5-year grouping b All leukemia subtypes included: [Major subtypes include: ALL (acute lymphoblastic leukemia), AML (acute myelogenous leukemia), CLL (chronic lymphocytic leukemia), and CML (chronic myelogenous leukemia] c Includes both larynx and oropharynx d SEER database (NCI SEER program; Ries LAD et al (eds): SEER Cancer Statistics Review, 1975-2002, NCI, 2005 and reference 1.

• There are many risk factors for the development of cancer; however, the most important risk factor is age. Over 75% of cancers are diagnosed in individuals who are 75 years or older. From a population point of view, in the United States, with an aging population, it is likely that the incidence of cancer will increase. For example, by midcentury the number of cases may double, increasing from 1.3 million to about 2.6 million cases a year.

• Again in the United States, cancer incidence has remained relatively constant while cancer-related deaths have tended to decrease about 1% per year (1995-2002). When considering racial and ethnic factors, this reduction in cancer-related mortality is uneven.¹

  • African American patients exhibit higher rates of cancer-deaths even in those cancers for which the incidence in the black population is less than observed in the white population. Furthermore, five-year survival rates are reduced stage-for-stage.¹  

  • Possible explanations for this discrepancy:¹

    • Differences in cancer therapy

    • Presence of comorbid pathologies

    • Important variations in cancer biology

    • Furthermore, factors contributing to racial disparities with respect to mortality can vary with different cancers. There can be differences in the extent of exposure to the contributing risk factors. These differences might include, for instance, extent of Helicobacter pylori in the case of stomach cancer, prompt diagnosis and treatment (applies to many cancers) as well as access to professional screening a regular basis (cervical, breast, and colorectal cancers). The example of higher breast cancer incidence among white women could be accounted for by more frequent mammography as well as factors that influence intrinsic disease risk such as later age of first birth as well as a higher degree of hormone replacement therapy use in white women compared to African-American women. The issue of higher stomach and liver cancer incidence and death rates (by a factor of two) in Asian American/Pacific Islanders relative to whites may be due to increased exposure to hepatitis B and Helicobacter pylori. Annual age-adjusted cancer death rates for males for several cancers are described below.

Annual Age-adjusted Cancer Death Rates Among Men (Selected Cancers)⁵

These rates are age-adjusted to the 2000 US standard population. The information is obtained from the US Mortality Public Use Data Tapes, 1960-2003, US Mortality Volumes, 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

Annual Age-adjusted Cancer Death Rates Among Females (Selected Cancers)⁵

Rates are age-adjusted to the 2000 US standard population with the following notations:

† the uterus classification includes uterine cervix and uterine corpus.

The information is obtained from the US Mortality Public Use Data Tapes, 1960-2003, US Mortality Volumes, 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

• Cancer rates are higher for whites and blacks relative to Asians/Pacific Islanders. Considering prostate cancer, the incidence among black men is 150% higher, compared to whites, and 270% higher compared to Asian/Pacific Islanders. ¹

  • On the other hand, white women exhibit a 120% higher breast cancer incidence relative to black women and 170% higher incidence compared to Asians/Pacific Islanders.

  • Other examples of racial differences include higher rates of multiple myeloma in black men and women as well as a higher rate of liver, intrahepatic bile duct, and stomach cancer in Asians/Pacific Islander men and women.¹  

• More detailed information concerning differences between white and black patients overall and with respect to five-year survival rates associated with different cancer sites and race is presented in the following graphs developed in the SEER program.

SEER Incidence: All Cancer Combined by Race and Sex^2,4

Incidence rates are derived from SEER 17 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, and New Jersey) and these rates are age-adjusted in accordance with the 2000 US Census using 19 age groups.

5-Year Survival Rates Comparing White and Black Patients, both Sexes, based on SEER data collected from 1996-2004^2,4

Case data were obtained from SEER 17 areas: (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, and New Jersey).  California with the above California-state exclusions, Kentucky, Louisiana, and New Jersey contributed cases for this analysis for diagnostic years 2000-2004, whereas the remaining 13 SEER areas contributed cases for the entire 1996-2004 timeframe.

SEER Cancer Incidence and US Death Rates based on data compiled between 2001-2005 by Cancer Site and Race^2,4

Incidence (red)

Cancer Site

Mortality (blue)

Information for this table was obtained from SEER 17 areas: (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, and New Jersey) along with U.S. Mortality Files, National Center for Health Statistics, Centers for Disease Control (CDC) and Prevention.  Rates are expressed as per 100,000 and are age-adjusted to the 2000 US Std. Population, using 19 age groups [Census P25-1003]. Rates for American Indian/Alaska Native were based on the CHSDA (Contract Health Service Deliver Area) counties.  Hispanic is noted not to be mutually exclusive from whites, blacks, Asian/Pacific Islanders, and American Indians/Alaska Natives.  The data for Hispanics were based on NHIA and excluded cases from the Alaska Native Registry and Kentucky.  Mortality data for Hispanics excluded cases from Minnesota, New Hampshire, and North Dakota.