A Healthier Future for West Virginia - Healthy People 2010

3 - Cancer

Objectives | References

Background

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 our state.
Breast cancer is the most commonly diagnosed cancer among West Virginia women. From 1993 through 1997, approximately 1,200 new cases were diagnosed annually. The incidence rate in 1997 was 89.5 per 100,000 women.

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.

Cancers of the colon and rectum were the third most common cancer diagnosed in both men and women in West Virginia. The 1997 incidence rate was slightly higher for men than for women (52.7 cases among every 100,000 men, compared to 42.7 cases among every 100,000 women).

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.

The Objectives

FLAGSHIP OBJECTIVE
OBJECTIVE 3.1. Reduce lung cancer deaths to no more than 59 per 100,000 West Virginia residents. (Age-adjusted Baseline: 62.2 per 100,000 WV residents in 1997)

OBJECTIVE 3.2. Reduce breast cancer deaths to no more than 21 per 100,000 West Virginia females. (Age-adjusted Baseline: 22.6 per 100,000 West Virginia females in 1997)

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.

OBJECTIVE 3.3. Reduce prostate cancer-related deaths to 19.5 per 100,000 West Virginia males. (Age-adjusted Baseline: 20.5 per 100,000 West Virginia males in 1997)

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.

OBJECTIVE 3.4. (Developmental) Decrease the number of persons who have had a sunburn with redness lasting at least 12 hours within the past 12 months. (Baseline data for West Virginia will be available from the 1999 BRFSS.)

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.)

Exposure to the sun's ultraviolet rays appears to be the most important environmental risk factor in developing skin cancer. Melanoma is the most serious form of skin cancer, and since 1973 its incidence has been increasing at a faster rate than any other cancer. By the year 2000, the lifetime risk for melanoma in the U.S. will be one in 75. Educating West Virginians to protect themselves against exposure to ultraviolet rays by wearing protective clothing and using sunscreen with Sun Protection Factor (SPF) 15 or more and decreasing the number of persons who experience sunburn would prevent many melanomas and other skin cancers.

OBJECTIVE 3.5. (Developmental) Increase the proportion of adults aged 18 and older who have received from a physician:
3.5.a. Counseling about tobacco use cessation (Baseline data on tobacco use cessation will be available from the 2000 BRFSS);
3.5b. Counseling about diet modification (Baseline data on diet modification will be available from the 2000 BRFSS);
3.5c. Counseling about cancer screening recommendations. (The Comprehensive Cancer Plan needs to identify a source of funding to add a question on cancer screening counseling to the 2001 questionnaire 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.

OBJECTIVE 3.6. Increase to at least 95% the proportion of women aged 18 and older who have ever received a Pap test and to at least 85% those who received a Pap test within the preceding three years. (Baseline: by 1997, 93.4% of women aged 18 and older in West Virginia had ever had a Pap test and 78.9% of women aged 18 and older in West Virginia had a Pap test in the previous three years.)

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.

OBJECTIVE 3.7. Attain a level of at least 50% of people aged 50 and older who have received a colorectal screening examination (fecal occult blood testing) within the preceding 1-2 years and increase to at least 40% those who have ever received proctosigmoidoscopy. (Baseline: by 1997, 27.2% of West Virginians aged 40 and older had ever had a sigmoidoscopy or proctoscopy examination)

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.

OBJECTIVE 3.8. Increase to 95% the expected number of cancer cases reported to the West Virginia Cancer Registry within 12 months of the close of the diagnosis year and publish incidence and mortality data within 18 months of the close of the diagnosis year.
(Baseline: 75% of the expected number of 1997 cases were reported to the WVCR by December 31, 1998, and the 1997 incidence rates will be published by December 31, 1999.)

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.

OBJECTIVE 3.9. (Developmental) Increase the number of cancer survivors who are living five years or longer after diagnosis of cancer. (Baseline data available in 2002)

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.

Meeting the Objectives

Health Promotion Channels for Achieving Objectives:

• Worksites
• Schools
• Public Health Programs
• Networks
• Health Care System
• Higher Education

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:

American Association of Retired Persons
American Cancer Society
Betty Puskar Breast Cancer Center
CamCare Health Education and Research Institute
Center for Rural Health Development
Charleston Area Medical Center
Coalition for a Tobacco-Free West Virginia
HBA Cytology Center, Inc.
Kanawha County Schools
Leukemia Society of America
Marshall University School of Medicine
Mary Babb Randolph Cancer Center
West Virginia Cancer Registrars Association
WV Department of Health & Human Resources-Bureau for Public Health
West Virginia Hospital Association
West Virginia School of Osteopathic Medicine
West Virginia State Medical Association
West Virginia Rural Health Education Partnership
West Virginia University (WVU) Center on Aging
WVU Extension Service
WVU School of Dentistry
WVU School of Medicine
WVU School of Pharmacy
Young Women's Christian Association- ENCORE Plus

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.

Work Group Members

Beverly Keener, RN, MPH, Work Group Leader, Director, West Virginia Cancer Registry, WVBPH
Hersha Arnold, Cancer Control Manager/Advocacy, American Cancer Society, West Virginia Division
Pamela Brown, MPA, Assoc. Dir. of Education, Mary Babb Randolph Cancer Center
Alan M. Ducatman, MD, MSC, Chair, Department of Community Medicine, Robert C. Byrd Health Sciences Center, WVU
Delilah Foster, Past President, American Association of Retired Persons-West Virginia Chapter
Gladys Kuhn, Corporate Director, Oncology Services, Charleston Area Medical Center (CAMC) -Memorial Division
Leesa Prendergast, Community Health Promotion Specialist, Region 7 North
Amy Reasinger Allen, CIS Project Director/ Assistant Director for Cancer Prevention, Mary Babb Randolph Cancer Center
Robin Seabury, Acting Director, West Virginia Breast and Cervical Cancer Screening Program, WVBPH
Judith Schreiman, MD, Professor and Vice Chair, Radiology Department, Robert C. Byrd Health Sciences Center, WVU
Mary Shuttlesworth, Americorps volunteer
Susan Watkins, RNC, MSN, Clinical Nurse Specialist, Family Resources Department, CAMC - Women and Children's Division

References/Resources

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:
risk factors and recommendations for early detection." American Family Physician 59, no.11 (1999): 3083-3092.

Ries LAG et al. SEER Cancer Statistics Review: 1973-1996. Bethesda, MD: National Cancer Institute, 1999.

United States Census Bureau. Population
Estimates for the U.S. Regions, Divisions, by 5-Year Age Groups and Sex: Annual Time Series Estimates, July 1, 1990 to July 1, 1998. Internet Release. Date: June 15, 1999. http://www.census.gov/population/estimates/state.5age9890.txt.

United States Preventative Services Task
Force. Guide to Clinical Preventative Services. 2nd ed. Baltimore, MD: 1996.

West Virginia Bureau for Public Health.
Behavioral Risk Factor Survey 1997. Charleston, WV: West Virginia Department of Health and Human Resources, 1998.

West Virginia Bureau for Public Health.
"Breast and cervical cancer prevalence, risk factors and screening in West Virginia." Epidemiological Snapshot 1, no.2 (July 1997).
West Virginia Bureau for Public Health. Cancer in West Virginia: Incidence and Mortality, 1993-1997. Charleston, WV: West Virginia Department of Health and Human Resources, November 1999.

West Virginia Bureau for Public Health. West Virginia Vital Statistics 1998. Charleston, WV: West Virginia Department of Health and Human Resources, March 1999.

For More Information

West Virginia Cancer Registry
Office of Epidemiology and Health Promotion
Room 127
350 Capitol Street,
Charleston, WV 25301-3715
Phone: (304) 558-5353; Fax: (304) 558-6335

This page was last updated June 12, 2001.
For additional information about HP2010, contact Chuck Thayer at (304) 558-0644 or Chuck.E.Thayer@wv.gov