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A Healthier Future for West Virginia - Healthy People 2010
Federal 2010 Initiative
3 - Cancer
For more than half a century, cancer has been the second leading cause of death in West Virginia, surpassed only by heart disease. In 1997, 4,766 West Virginians died from cancer. From 1992 to 1996, the state's average annual age-adjusted cancer mortality rate was 232.2 deaths per 100,000 population, 9% higher than the U.S. rate of 213.1. In 1997 nearly one out of every four deaths (22.8% ) in West Virginia was due to cancer. Clearly this is a problem of immense proportions.
The four most deadly types of cancer are the same in West Virginia and the U.S. For both sexes lung cancer is the greatest killer; in 1997, it claimed the lives of 953 of our men and 631 of our women, one-third of all cancer deaths. Breast cancer is the second leading cause of cancer deaths among women, killing 331 women in 1997. Prostate cancer took 231 lives that year, making it the second most deadly cancer among men. Colorectal cancer follows as the third leading cause of cancer mortality for both sexes, with 221 men and 283 women lost to this cancer in 1997.
Each year from 1993 through 1997, over 9,000 West Virginians were diagnosed with cancer. This number does not include basal cell and squamous cell carcinomas of the skin, which are not captured in the state cancer registry. The number of new cancer cases each year was distributed virtually equally between men and women, with a total of 23,582 cases diagnosed among men over the five-year period and 22,914 diagnosed among women. Cancer incidence increases significantly with age, and West Virginia now has the distinction of having the "oldest" population of the 50 states, with a median age of 37.7 in 1996, higher even than that in Florida (37.6). Given this fact, cancer will continue to increase in the state if steps are not taken toward its control.
Each year from 1993 through 1997, about 1,800 new cases of lung cancer
were diagnosed in West Virginians. Still a disease that is more prevalent
among men than among women, lung cancer was diagnosed at an average rate
of 101.8 new cases per 100,000 men and 52.4 per 100,000 women annually
from 1993 through 1997. The gap between men and women in the number of
lung cancer cases diagnosed was larger in the past, however, and it will
continue to close as the smoking prevalence rises among young women in
Among West Virginia men, prostate cancer is the most commonly diagnosed
cancer, accounting for one in every four cancer diagnoses. An average
of 1,180 new cases were diagnosed annually from 1993 through 1997. The
1997 incidence rate was 104.3 for every 100,000 men.
Statistics reflect only a portion of the enormous health problem of cancer, yet there is evidence that the prospect of preventing and surviving cancer continues to improve. Perhaps 50% or more of cancer incidence can be prevented through smoking cessation and changed dietary habits. The early detection of cancers through screening can save even more lives.
The American Cancer Society reports that smoking is responsible for 87% of lung cancers and is also associated with cancers of the mouth, pharynx, larynx, esophagus, pancreas, cervix, kidney, and urinary bladder. Smoking accounts for about 30% of all cancer deaths. In 1997, 27% of West Virginia adults were current cigarette smokers (27% of men and 28% of women). The state ranked fifth
among the 50 states, the District of Columbia, and Puerto Rico in the prevalence of current smoking.
Even more alarming is the prevalence of smoking among the youth of West Virginia. In 1997, the Youth Risk Behavior Survey (YRBS), which was conducted in 33 states, found that West Virginia ranked third among those states in frequent cigarette use by high school students. Of those surveyed, one in four (24%) were frequent smokers, 23% of girls and 25% of boys. Three out of every four high school students surveyed had tried smoking cigarettes at least once.
Mortality from breast cancer can be substantially reduced if the tumor is discovered at an early stage. For women in their forties, there is recent evidence that having mammograms on a regular basis may reduce their chances of dying from breast cancer by about 17%. For women between the ages of 50 and 69, mammography is even more effective in preventing breast cancer mortality. There is strong evidence that regular screening among women of these ages reduces breast cancer deaths by about 30%.
Opinions vary regarding routine screening of asymptomatic men for prostate cancer; however, the American Cancer Society suggests an annual digital examination and Prostate Specific Antigen (PSA) test for men over 50 who have a life expectancy of at least 10 years.
Many cancers related to dietary factors also can be prevented. Diets high in fat and low in fiber have been associated with cancers of the colon and rectum, uterus, prostate, and breast. Scientific evidence suggests that are approximately one-third of the cancer deaths related to diet. In 1997, West Virginia ranked first among the 50 states, the District of Columbia, and Puerto Rico in prevalence of obesity (41%). In addition, many of the skin and lip cancers could be prevented by limiting exposure to the sun and by wearing protective clothing and using sunscreens.
Many types of resources are necessary to reduce the burden of cancer in West Virginia. First, the means of providing information on prevention, early detection, and treatment to the public and to health care professionals must be improved. Second, access to state-of-the-art cancer treatment for all West Virginians must be made available. Third, surveillance of cancer occurrence in the state must be maintained. Gaps in the network of resources exist, and it is imperative that these gaps in information, practice patterns, surveillance, and other areas be recognized and filled to meet the objectives.
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Data Sources: West Virginia Bureau for Public Health (WVBPH), Office of Epidemiology and Health Promotion (OEHP), Health Statistics Center (HSC); West Virginia Cancer Registry (WVCR)
Lung cancer is the leading cause of cancer deaths for both men and women in
West Virginia and the U.S. Lung cancer deaths in West Virginia in 1997 accounted for approximately 33% of all cancer deaths and 8% of all deaths. West Virginia's high smoking rates, high rates of occupational lung disease and exposure to environmental lung carnogens, and insufficient intake of dietary antioxidants such as fruits and vegetables among state residents make ung cancer prevention a particularly important target.
Data Sources: WVBPH, OEHP, HSC; WVCR
The breast cancer death rate among West Virginia women steadily decreased in the 1990s, from 34.2 deaths per 100,000 women in 1990 to 22.6 in 1997. Experts believe that this decline is largely due to increased mammography screening. The percentage of women in West Virginia aged 18 and older who have ever had a mammogram increased from 38.2% in 1988 to 58.9% in 1997. This suggests that improved breast cancer management, from early detection to treatment, is having a beneficial effect.
Data Source: WVBPH, OEHP, HSC; WVCR
Since 1991, U.S. mortality rates for prostate cancer have decreased modestly each year due to early detection and improved treatment. This same downward trend has been noted in state rates, from 25.7 deaths per 100,000 men in 1993 to 20.5 in 1997. At this rate of decline, the 2010 objective of 19.5 deaths per 100,000 men will be met.
Data Source: WVBPH, OEHP, BRFSS (The Comprehensive Cancer
Plan needs to identify a source of funding to repeat the question in the
2002 and 2005 questionnaires to assess the progress toward this objective.)
Data Source: WVBPH, OEHP, BRFSS
Physicians are a key resource for informing their patients about cancer prevention and early detection. Opportunities for providing counseling about reducing the risk for cancer must not be missed.
Data Source: WVBPH, OEHP, BRFSS
Data from 1995 show the annual age-adjusted mortality rate for cervical cancer in West Virginia was 51% higher than the corresponding U.S. rate (4.1 deaths per 100,000 women vs. 2.7 deaths). Early detection of cervical cancer through regular Pap test screening, followed by proper treatment, clearly lowers the mortality from this disease.
Data Source: WVBPH, OEHP, BRFSS
There is increasing evidence that the detection and treatment of early-stage colorectal cancers and adenomatous polyps can reduce mortality. The American Cancer Society recommends screening for persons 50 years and older with an annual fecal occult blood test plus either flexible sigmoidoscopy every five years, colonoscopy every ten years, or double contrast barium enema every five to ten years. Screening for persons with increased risk factors should begin at an earlier age, depending on the family history of colorectal cancer or polyps. Although screening for colon cancer is clearly beneficial, studies are still being done to determine which test or combinations of screening tests provide the most practical and effective approach.
Data Source: WVBPH, WVCR
The completeness and timeliness of West Virginia cancer data is dependent upon the reporting practices of a vast number of health care providers, including hospitals, physicians, pathology laboratories, cancer treatment centers, surgery centers, nursing homes, other state cancer registries, the Office of Vital Registration, and the West Virginia Breast and Cervical Cancer Screening Program. It is imperative to keep all of these reporting sources informed of their responsibility for cancer reporting to the WVCR within six months of initial diagnosis.
With improving technology and changing patterns of diagnosis and treatment of cancer, an increasing number of patients are receiving all of their cancer care outside the hospital setting. This poses challenges to the WVCR to identify these cases and to obtain the information necessary to include them in the registry. Greater emphasis must be placed on identifying new reporting sources, informing them of the reporting requirements and monitoring the quality, completeness, and timeliness of their reporting.
Data Source: WVBPH, WVCR
In the early 1900s, few cancer patients had hope of long-term survival. In the 1930s, about one in four was alive five years after treatment. About 491,400 Americans, or four of every 10 patients who were diagnosed with cancer in 1998 were expected to be alive five years after diagnosis. This four in 10, or 40%, is called the observed survival rate. When adjusted for normal life expectancy (factors such as dying of other causes), a relative five-year survival rate of 58% is seen for all cancers. Five-year relative survival rates, commonly used to monitor progress in early detection and treatment, include persons who are living five years after diagnosis, whether in remission, disease free, or under treatment. While these rates provide some indication about the average survival experience of cancer patients in a given population, they are less informative when used to predict individual prognosis.
The WVCR currently contains five complete years of cancer data, i.e., 1993-1997. As the registry matures, five-year survival rates will become available. U.S. five-year survival rates are available for specific cancer sites from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. The SEER program currently has cancer data for 1973-1996.Top of Page
Meeting the Objectives
Health Promotion Channels for Achieving Objectives:
The West Virginia Comprehensive Cancer Control Coalition (WVCCCC) will use the objectives as the framework for the West Virginia Comprehensive Cancer Plan to be developed in 2000. The WVBPH's Office of Epidemiology and Health Promotion is the coordinating agency for the Coalition. The mission of the WVCCCC is to provide leadership through facilitating and coordinating statewide and community level collaborations resulting in a comprehensive effort to reduce the human and economic impact of cancer in West Virginia. The Coalition will address the problem of cancer in the state by using the six health promotion channels listed above.
The following is a partial list of agencies represented on the WVCCCC:
There are currently two cancer programs within the Bureau for Public Health: the West Virginia Breast and Cervical Cancer Screening Program (WVBCCSP) and the West Virginia Cancer Registry. The WVBCCSP will continue to address Objectives 2 and 6 and the WVCR will address Objective 8.
The remaining six objectives will be addressed in the upcoming West Virginia Comprehensive Cancer Control Plan.Top of Page
Work Group Members
American Cancer Society. Cancer Facts & Figures 1998. Atlanta, GA: American Cancer Society, 1998.
American Cancer Society. Cancer Facts & Figures 1999. Atlanta, GA: American Cancer Society, 1999.
American Cancer Society. Cancer Risk Report: Prevention and Control 1998. Atlanta, GA: American Cancer Society, 1998.
CDC. "National melanoma/skin cancer detection month - May 1998." Mortality and Morbidity Weekly Report 47, no.16 (1998): 343.
CDC. 1999 State Health Profile - West Virginia. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, 1999.
CDC. "Strategies for providing follow-up and treatment services in the National Breast and Cervical Cancer Early Detection Program - United States, 1997." Mortality and Morbidity Weekly Report 47, no.11 (1998): 215-218.
National Cancer Institute. "Breast Cancer and Mammography Facts." Cancer Fact Sheets 6.29. Bethesda, MD: National Institutes of Health, 1999.
National Cancer Institute. "Improvements in breast cancer death rate." Cancer Facts Sheet 6.25. Bethesda, MD: National Institutes of Health, 1999.
National Cancer Institute. "Questions and answers about the Pap test." Cancer Facts Sheet 5.16. Bethesda, MD: National Institutes of Health, 1998.
National Cancer Institute. "Screening mammograms." Cancer Facts Sheet 5.28. Bethesda, MD: National Institutes of Health, 1998.
Read TE and Kodner IJ. "Colorectal cancer:
Ries LAG et al. SEER Cancer Statistics Review: 1973-1996. Bethesda, MD: National Cancer Institute, 1999.
United States Census Bureau. Population
United States Preventative Services Task
West Virginia Bureau for Public Health.
West Virginia Bureau for Public Health.
West Virginia Bureau for Public Health. West Virginia Vital Statistics 1998. Charleston, WV: West Virginia Department of Health and Human Resources, March 1999.Top of Page
For More Information
West Virginia Cancer Registry
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This page was last updated June 12, 2001.