The Journal – October 2011
Tex Med. 2011;107(10):e1.
By Stephen W. Wyatt, DMD, MPH; William R. Maynard, MBA; Eric A. Miller, PhD; Rebecca Garcia, PhD; and Lewis E. Foxhall, MD
Dr Wyatt, chair, Cancer Prevention Research Institute of Texas Prevention Council, and dean and professor, College of Public Health, University of Kentucky, Lexington, Kentucky; Mr Maynard, Louisville, Kentucky, research associate for Stephen W. Wyatt, DMD, MPH; Dr Miller, epidemiology manager, Texas Cancer Registry, Department of State Health Services, Austin, Texas; Dr Garcia, chief prevention officer, Cancer Prevention Research Institute of Texas; and Dr Foxhall, vice president, Health Policy, and associate professor of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, Texas. Send correspondence to Rebecca Garcia, PhD, Cancer Prevention Research Institute of Texas, 211 E 7th St, Suite 300, Austin, TX 78701; e-mail:bgarcia[at]cprit[dot]state[dot]tx[dot]us.
Cancer is the second leading cause of death in Texas. Even though the state's cancer incidence and mortality rates have decreased slightly in recent years, the number of cases and deaths are increasing each year with the growth and aging of the population. The US Centers for Disease Control and Prevention releases annually an updated US Cancer Statistics report containing incidence and mortality data for all states and aggregate US data that allow for more meaningful comparisons across populations and geographic regions than do the number of new cases and deaths. This article examines major Texas findings from the most recent report (for the 5-year period 2003-2007) and compares Texas and US data.
Cancer, as a collection of diseases, significantly impacts Texas families. Cancer is the second leading cause of death in Texas and the leading cause among persons aged 40-74 years.1 Even though Texas cancer incidence and mortality rates have decreased slightly in recent years (Figure), the number of cases and deaths are increasing each year with the growth and aging of the population. In 2011, the Texas Cancer Registry (TCR) estimates that 107,111 Texans will be diagnosed with cancer and 38,586 will die of the disease.2-3 Annually, the Centers for Disease Control and Prevention (CDC) releases an updated US Cancer Statistics (USCS) report containing incidence and mortality data for all states and aggregate US data that allow for more meaningful comparisons across populations and geographic regions than do the number of new cases and deaths.4 The most recent report provides aggregate incidence and mortality data for the 5-year period 2003-2007. This article reports major Texas findings from these analyses and compares Texas with the US data.
This overview reports only analyses for all-races combined and for the entire state. However, cancer incidence and mortality can vary by geographic region and across racial and ethnic population subgroups. This is critical for Texas because of the large Hispanic/Latino population, in which cancer rates are usually lower than in non-Hispanic whites and African Americans. Future analyses will explore incidence and mortality rates across different segments and regions of the Texas population and will highlight significant disparities among populations and geographic subgroups in Texas and as compared with the United States.
The Cancer Prevention Research Institute of Texas (CPRIT) was formed when Texas voters approved a constitutional amendment to position Texas as a leader in cancer research and prevention efforts. In addition to advancing research, expanding research capabilities, and supporting evidence-based prevention initiatives in Texas, CPRIT is charged to develop and implement the Texas Cancer Plan. Implementation of the Texas Cancer Plan requires the collaboration and commitment of organizations throughout the state. TCR is an integral partner in this comprehensive effort by CPRIT and provides high-quality and current cancer incidence data to inform policy decisions, research, and cancer prevention and control efforts.
The TCR of the Department of State Health Services (DSHS) is the statewide, population-based surveillance system for the state. TCR collects information on incident cancer cases diagnosed in state residents, including the types of cancer, their anatomic location, disease stage, first course of treatment received, survival time, and selected patient characteristics. The data are received from hospitals, cancer treatment facilities, ambulatory surgery centers, pathology laboratories, and physicians' offices. The data are available for review on the TCR website at www.dshs.state.tx.us/tcr. Typically, data are complete enough for analysis approximately 24 months following the close of a reporting year. CDC aggregates cancer incidence data from population-based state registries and reports all-cancers and anatomic site-specific incidence rates for the United States as a whole. Mortality data are collected by the State of Texas from the death certificate issuance process, and cancer mortality rates are calculated by TCR from data provided by the DSHS Center for Health Statistics. From the state-based mortality data, CDC develops aggregate rates for the United States. Mortality data are typically available for use approximately 24 to 36 months after the close of a reporting year.
A total of 94,396 Texans received cancer diagnoses in 2007, and the overall incidence rate was 444.2 per 100,000 population.2 As a comparison, the overall incidence rate for the United States in 2007 was 465.1 per 100,000 population.4Table 1 presents the number of women with newly diagnosed cancer in 2007 for the 10 most commonly diagnosed cancers and compares Texas and US age-adjusted rates for the 5-year period 2003-2007.2,4 Among women, breast cancer is by far the most commonly diagnosed cancer, with more than double the number of diagnoses compared with lung or colorectal cancer. Comparable data for men are provided in Table 2.2,4 Among men, prostate cancer is the most commonly diagnosed, having approximately twice the number of diagnoses compared with lung cancer, which is the second most common cancer. Colorectal cancer is the third most commonly diagnosed cancer among both men and women.
Comparison of Texas and US age-adjusted mortality rates for the 5-year period 2003-2007 is presented in Table 3 and Table 4 for women and men, respectively. In addition, the number of deaths that occurred in 2007 for these leading 10 sites is also presented.3,4 Lung cancer is by far the leading killer among men and women. Among men, the number and rate of deaths from lung cancer are approximately three times higher than those for colorectal cancer, the second leading cause of cancer deaths. Women have approximately 50% more deaths from lung cancer than from breast cancer, which is the second leading cause of cancer deaths.
The data presented in this article illustrate the disease impact cancer has on Texas residents, including comparisons to national incidence and mortality rates. As noted in the introduction of this article, the initial all-races analysis approach used for this article fails to capture the disparities of the cancer disease burden that exist across population subgroups in Texas. Unlike the overall rates, race-specific and ethnic-specific rates tend to be worse in Texas compared with each group overall in the United States. Future analyses and reports will address this important issue.
The data show that progress is being made and mortality rates are slowly declining; however, the fact that in 2011 alone approximately 107,111 Texans will be diagnosed with cancer and 38,586 will die of the disease is unacceptable.2,3 The citizens of Texans have chosen to address the human and economic costs of cancer by creating CPRIT. This institute together with TCR and the many dedicated organizations and professionals across the state are partnering to accelerate progress in the fight against cancer.
The timely and comprehensive data on cancer incidence and mortality available from TCR are valuable resources for communities, researchers, public health agencies, and policy makers. The routine dissemination of this data for use in Texas is an important effort. CPRIT and TCR will partner with the Texas Medical Association to increase dissemination of data through published articles and increased use of the TCR website.
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