CANCER FACTS
and FIGURES
Pennsylvania, 1999
ERIE
1,450
SUSQUEHANNA
WARREN MCKEAN TIOGA BRADFORD
POTTER 250 WAYNE
225 255 275 315
CRAWFORD 80 280
480
WYOMING LACKA-
FOREST WANNA
SULLIVAN 150
25 ELK LYCOMING
CAMERON 1,355 PIKE
VENANGO 40
220 605 110
MERCER 290 40 CLINTON
740 MONTOUR LUZERNE
CLARION 215
JEFFERSON 105
2,220 MONROE
160 245 COLUMBIA
LAW- CLEARFIELD 645
UNION 310
RENCE
BUTLER 520 CENTRE CARBON
580 135
NORTH- 320
1,005 ARMSTRONG 400
UMBER- NORTH-
SNYDER
355 LAND AMPTON
BEAVER MIFF- 170 SCHUYLKILL 1,695
INDIANA 570
1,225 LIN 1,085 LEHIGH
425 JUN-
CAMBRIA 290 1,675
BLAIR IATA BERKS
ALLEGHENY
1,130 105 PERRY
8,030 845 DAUPHIN 1,955 BUCKS
195 LEBANON
MONT- 3,075
WESTMORELAND 1,315
HUNTINGDON 650
GOMERY
2,230 215 CUMBERLAND
WASHINGTON 3,955
990 LANCASTER
1,245
BEDFORD CHESTER
FULTON 1,760
SOMERSET
240 YORK 2,115 DEL-
FAYETTE 100 FRANKLIN PHILA-
585 ADAMS AWARE DELPHIA
1,930
GREENE 920 610
475 8,950
190 3,410
Estimated Number of New Cancer Cases For 1999 By County; State Total: 70,010
Pennsylvania Cancer Registry
Division of Health Statistics
Tom Ridge, Governor
Robert S. Zimmerman, Jr., M.P.H., Secretary of Health
INTRODUCTION
This is the third annual publication to present forecasted cancer incidence and mortality statistics for the entire Commonwealth
of Pennsylvania. Utilizing information collected by the Pennsylvania Cancer Registry, the Department of Health can develop
programs to better address Pennsylvania's cancer program needs. Registry data can be used to plan and evaluate cancer control
measures in areas of risk assessment, prevention, early detection, patient care, public and professional education, and clinical
research. Detailed incidence data for Pennsylvania are now available to government agencies, as well as educational, planning
and research organizations and concerned private citizens.
A Technical Notes section appears at the beginning of this report to emphasize the importance of understanding and appropri-
ately using the data shown. This section explains all steps used in the presentation of the data for this report. If you use any of
the statistics presented in this report, we highly recommend that you read the Technical Notes section carefully and thoroughly.
Especially note all the qualifications listed and review as many of the cited references as possible before you proceed any
further.
The Division of Health Statistics would specifically like to acknowledge the American Cancer Society. The Society granted
permission to use their annual publication Cancer Facts and Figures as a direct reference in the development of this publication.
We appreciate their cooperation.
The Division welcomes comments and suggestions on the content and format of this report. Staff are available to answer
questions regarding the report, including utilization and limitations of the data. Please address all comments, questions, requests
for data, etc. to:
Division of Health Statistics
Pennsylvania Department of Health
555 Walnut Street, 6th Floor
Harrisburg, PA 17101-1900
Telephone: 717-783-2548
Fax: 717-772-3258
This report and many other cancer and health statistics are on the Health Statistics page of the Department’s website at
>
September 1999
The Pennsylvania Department of Health is an equal opportunity provider of grants, contracts, services, and employment.
HD0059P
CONTENTS
Page Page
Average Day of Cancer Cases and Deaths ............ 2 1999 Projected Cancer Cases by Site and Sex ............. 10
Basic Facts About Cancer in Pennsylvania ........... 3 1999 Projected Cancer Deaths by Site and Sex ........... 12
TRENDS: All Cancers and by Sex ........................ 4 1999 Projected Cancer Cases by County ..................... 14
TRENDS by Race ................................................. 6 1999 Projected Cancer Deaths by County ................... 15
Behavioral Risk Factors ........................................ 7 Guidelines for Early Detection .................................... 16
TRENDS for Top Four Cancer Sites ..................... 8 References ................................................................... 17
TECHNICAL NOTES
Incidence Data:
Data collected by the Pennsylvania Cancer Registry (PCR) is the source for Pennsylvania cancer incidence data shown here.
The actual data reported to the PCR were used to forecast the expected number of cancer cases listed in this report. Effective
with cases diagnosed in 1996, cervix uteri cases staged as in situ (non-invasive) are no longer reported to the PCR. Therefore,
there are no in situ cervix uteri cases included in any calculation or projection contained in this report. 1996 is the latest year
of available incidence data for the Commonwealth.
Mortality Data:
Pennsylvania's Certificate of Death is the source document for Pennsylvania cancer mortality data. The actual number of
Pennsylvania cancer deaths reported were used to forecast the expected number of cancer deaths listed in this report. 1997 is
the latest year of available mortality data for the Commonwealth.
Incidence and Mortality Projections:
The projections of new cancer cases in this report were obtained by producing a regression line using the method of least
squares. This approach utilized the actual number of cases reported to the PCR with a diagnosis year of 1992 through 1996. This
method constructed the regression line that minimizes the sum of the squared residuals. A residual is the difference between
each data point (actual or observed event) and the regression line (predicted event).
Once a regression line has been computed, then an estimate of the population standard error of the estimate is computed. This
estimate measures the variability of the line. Also computed is the estimate of the population standard deviation of the depen-
dent variable (year of diagnosis). This is a measure of the variability of forecasted cancer cases based on the arithmetic mean
of cancer cases for the five years of 1992 through 1996. The estimate of the population standard error of the estimates was then
compared to the estimate of the population standard deviation to identify which method had less variability. If the population
standard deviation was lower, then the arithmetic mean for the five-year period was used as the forecasted number of cancer
cases. This same method was applied to forecasting the number of cancer deaths. However, since the cancer mortality file is
more current, the five-year period of 1993 through 1997 was used to project the number of cancer deaths.
Precision of Projections:
The projected number of new cancer cases and new cancer deaths have been rounded to the nearest whole five. The projected
figures should be used cautiously. Considerable variation may occur, particularly with estimates of small numbers.
Age-Adjusted Rates (Direct Method):
Age-specific rates for a selected population are applied to a standard population (in this report the 1970 U.S. standard million
population) in order to calculate what rate would be expected if the selected population had the same age distribution as the
standard. The total of these expected events divided by the total of the standard population and multiplied by 100,000 yields
the age-adjusted rate per 100,000. It is important to use the same standard population in the computation of each age-adjusted
rate to allow comparability. Age-adjusted rates should never be compared with any other type of rate or be used as absolute
measurements of vital events. All state population figures used for calculating rates are estimates produced jointly by the U.S.
Census Bureau and the State Data Center of Penn State at Harrisburg.
Data Use and Limitations:
It is highly recommended that any user of the data presented in this report read the information provided in this Technical Notes
section carefully and thoroughly and review as many of the cited references as possible. Of primary concern when using
forecasted values is the high probability of chance variation due to unknown (or uncontrollable) factors. This includes the
concern of chance variation associated with the small number of events that can occur when using county statistics.
Pennsylvania Department of Health - Cancer Facts and Figures Pennsylvania, 1999 - Page 1
An Average Day of Expected Pennsylvania Cancer Cases and Deaths
For Major Primary Sites by Sex, 1999
MALES Cases Deaths
42
All Sites 94
Prostate 22 5
Trachea, Bronchus, 17 14
Lung, Pleura
Colon 9 4
FEMALES Cases Deaths
40
All Sites 99
Female Breast 31 7
Trachea, Bronchus,
12 9
Lung, Pleura
Colon 10 4
= 5 Males = 5 Females
BASIC FACTS ABOUT CANCER IN PENNSYLVANIA
What is Cancer? Why Are the Number of Cancer Cases
• Group of diseases related to the uncontrolled growth Increasing in Pennsylvania?
and spread of abnormal cells. • Larger percentage of early stage detection.
• Death can occur if growth of abnormal cells spreads. • Aging population.
• If detected early and treated promptly, many cancers • Better awareness of symptoms/signs.
can be cured.
What Causes Cancer? Are Cancer Death Rates Declining in
• Environmental factors include chemicals, radiation, Pennsylvania?
viruses, and lifestyle (tobacco use, diet, alcohol • Declining trend for total cancer deaths since 1993.
consumption). • Generally declining trend for male cancer deaths since
• Internal factors include hormones, immune status, and 1990.
inherited conditions. • Declining trend for female cancer deaths since 1993.
How is Cancer Prevented? What Is a Cancer Cluster?
• Primary prevention includes avoiding oncogenic • Larger than expected number of cancer cases during a
exposures (tobacco, sun exposure, excess dietary fat). limited time period in a specific geographic area.
• Secondary prevention includes early detection and
treatment of benign precursor lesions. How Are Cancer Clusters Investigated?
• By examining data from cancer registries.
How is Cancer Treated? • By comparing the observed number of cancers in a
• Surgery, radiation, chemotherapy, hormones, and specific geographic area to the expected number.
immunotherapy.
Where Can Additional Information on
Who Gets Cancer? Cancer Be Obtained?
• Cancer strikes all segments of the state’s population. • National statistics and information
• Occurrence of cancer rises with age and exposure to - National Cancer Institute
risk factors. Cancer Information Service (800) 422-6237
- American Cancer Society (800) 227-2345
What Are the Most Common Cancers? - Cancer Care, Inc. (800) 813-HOPE (813-4673)
• Female Breast - Y-ME National Organization for Breast Cancer
• Trachea, Bronchus, Lung and Pleura Information Support Program (800) 221-2141
• Prostate - CDC, Office on Smoking and Health (800) 232-1311
or (404) 488-5705
• Colon
- Prostate Cancer:
• Urinary Bladder
US TOO International (800) 808-7866
CaPCURE (800) 757-2873
How Many New Cancer Cases and National Prostate Cancer Coalition (813) 253-0541
Deaths Will There Be This Year? - Skin Cancer:
• About 70,010 Pennsylvanians are projected to be American Academy of Dermatology (708) 330-0230
diagnosed with cancer in 1999. Skin Cancer Foundation (800) SKIN-490 (754-6490)
- National Ovarian Cancer Coalition (888) 682-7426
• 68,906 Pennsylvania residents were diagnosed with
cancer in 1996. • State and local statistics and information
- Pennsylvania Department of Health
• About 30,105 Pennsylvanians are projected to die
Health Statistics (717) 783-2548
from cancer in 1999.
Cancer Control Program (717) 787-5251
• 30,066 Pennsylvania residents died as a result of
- Your local American Cancer Society
cancer in 1997.
- Your local Department of Health
- Your local American Lung Association
Pennsylvania Department of Health - Cancer Facts and Figures Pennsylvania, 1999 - Page 3
TRENDS: Annual Cancer Incidence and Cancer Mortality
Age-Adjusted Rates by Sex, Pennsylvania Residents
Cancer Incidence Rates, 1986-1996
Males
520
500
480
460
Rate per 100,000
440
All Cases
420
400
380
360
Females
340
320
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996
Cancer Mortality Rates, 1986-1997
260
Males
240
220
Rate per 100,000
200
180 All Deaths
160
140 Females
120
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
NOTE: Age-adjusted rates are computed by the direct method using 1970 U.S. standard million population.
TRENDS: All Cancers and By Sex
Incidence Rates - Between 1986 and 1996, Pennsylvania’s Stage of Disease - In 1996, approximately 55 percent of the
age-adjusted cancer incidence rate for all cancers increased by cancers reported among residents of Pennsylvania were diag-
13.6 percent, from 369.2 per 100,000 to 419.4 in 1996. The rates nosed at the in situ and local stages of the disease when treat-
for both sexes have also increased since 1986, especially for ment can be effective and survival rates are high. In 1986, the
males. A large portion of the increase for males can be attrib- percent of in situ and local diagnoses was somewhat lower at
uted to the higher numbers of prostate cancers being diag- 48.5. In addition, the percent of regional stage diagnoses de-
nosed more easily with use of a simple blood test. Male rates clined from 25.5 in 1986 to 23.5 in 1996. Diagnoses of Pennsyl-
have also consistently been much higher than the rates for vania residents at the distant stage of the disease also de-
female residents of the state. The age-adjusted incidence rate clined from 26.0 percent in 1986 to 21.3 percent by 1996.
for males in 1996 was 491.2, compared to 373.1 for females. Among males, there was a slight increase in the percentage
However, while rates for males have generally declined since of cancers diagnosed at the in situ stage between 1986 and
1993, female rates continued to increase since then. 1996 (from 3.3 to 4.5 percent). The percent of local stage diag-
noses also increased, from 44.0 in 1986 to 50.8 in 1996. For
Mortality Rates - Pennsylvania’s age-adjusted cancer mor- females, the percentage of diagnoses at the in situ stage al-
tality rate for all cancers declined by 5.4 percent between 1986 most doubled between 1986 and 1996, from 4.4 to 8.2. The
and 1997, from 177.8 to 168.2. The age-adjusted mortality rates percent of local stage diagnoses also increased among females,
for both males and females have also declined since 1986 but from 45.1 to 46.8.
the mortality rates for males remained over 50 percent higher There were declines for both sexes in the percentages of
than the rates for females. In 1986, the age-adjusted mortality diagnoses at the regional and distant stages. Among males,
rate for all male cancers was 223.7. By 1997, the rate had de- the diagnoses at the regional and distant stages declined from
clined by 7.3 percent to 207.3. Among female residents, the almost 53 percent in 1986 to about 45 percent by 1996. The
age-adjusted mortality rate was 141.7 in 1997 which was 3.6 figures were similar for female residents – from approximately
percent lower than the 1986 rate of 147.0. 50 percent in 1986 to 45 percent in 1996.
Percent of Cancer Cases by Stage of Disease at Diagnosis
All Cancers and by Sex, Pennsylvania Residents, 1986 and 1996
IN SITU LOCAL REGIONAL DISTANT
ALL 1996 6.4 48.8 23.5 21.3
CANCERS
1986 3.9 44.6 25.5 26.0
1996 4.5 50.8 22.0 22.7
MALES
1986 3.3 44.0 23.3 29.4
1996 8.2 46.8 25.0 20.0
FEMALES
1986 4.4 45.1 27.5 22.9
Pennsylvania Department of Health – Cancer Facts and Figures Pennsylvania, 1999 – Page 5
TRENDS: Annual Cancer Incidence and Cancer Mortality
Age-Adjusted Rates by Race, Pennsylvania Residents
Black Incidence Rates
500 White Incidence Rates
450
400
350
Rate per 100,000
300
Black Mortality Rates
250
200
150 White Mortality Rates
100
50
0
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
Note: Age-adjusted rates are computed by the direct method using the 1970 U.S. standard million population.
Percent of Cancer Cases by Stage of Disease at Diagnosis
Pennsylvania Residents by Race, 1986 and 1996
IN SITU LOCAL REGIONAL DISTANT
1996 6.4 49.2 23.4 21.0
WHITES
1986 3.9 45.1 25.4 25.5
1996 4.9 43.6 25.5 26.0
BLACKS
1986 3.1 37.3 26.9 32.7
TRENDS By Race Behavioral Risk Factors
Incidence Rates – Pennsylvania’s age-adjusted cancer in- The Pennsylvania Department of Health conducts a tele-
cidence rates increased since 1986 for both whites and blacks. phone sample survey of adult residents as part of its Behav-
Among whites, the 1996 rate (409.5 per 100,000) was 12.3 per- ioral Risk Factor Surveillance System . Results from the 1997
cent higher than the 1986 rate (364.8). The 1996 rate for blacks survey for selected risk factors that impact on cancer inci-
(482.5) was 20.4 percent higher than their 1986 rate (400.6). The dence are shown below for all, white, and black adults.
rates for blacks were about 5 percent higher than for whites in Thirty-one percent of the adults who responded to the sur-
1987 and 1989; however, by 1996, the black rate was 17.8 per- vey were considered to be overweight. Pennsylvania usually
cent higher. The rates for both whites and blacks have not is among those states with the highest percentages of over-
changed much since 1993. weight adults in the country. Twenty-four percent of the re-
spondents smoked cigarettes regularly in 1997. The percent-
Mortality Rates – The age-adjusted cancer mortality rates ages of women who had ever had mammograms, breast ex-
for white residents have been on the decline since 1990. The ams and Pap smears were relatively high; however, somewhat
1997 rate of 162.6 per 100,000 was 6.0 percent lower than the lower percentages were reported for women aged 50 and older
1986 rate of 173.0. Among blacks, the rate has fluctuated be- who had had a mammogram and breast exam in the past two
tween 255.6 and 235.5 during the period, with their lowest rate years. Only 27 percent of adults aged 50 and older reported
recorded in 1995. Unfortunately, black rates have remained that they had had a home blood stool test in the previous two
about 40-45 percent higher than the rates for whites. years. Thirty-one percent of Pennsylvania adults responded
in 1997 that they always or often used sunscreen when out-
Stage of Disease – Between 1986 and 1996, both whites and doors.
blacks experienced increases in the percentages of diagnoses A few risk factors highlighted some differences between
at the in situ and local stages and decreases in the percentages the races. More blacks were overweight (36 vs. 30 percent)
of regional and distant stages. The more dramatic changes oc- and smokers (33 vs. 24 percent). However, more black women
curred among blacks for every stage, compared to whites. had had mammograms, breast exams or Pap smears.
Selected Behavioral Risk Factors by Race, Pennsylvania Adults, 1997
31%
Overweight 30% All Adults White Black
36%
24%
Smoker 24%
33%
71%
Ever Had Mammogram &
72%
Breast Exam (Women 40+) 74%
60%
Mammogram/Breast Exam
60%
Last 2 Years (women 50+) 65%
92%
Ever Had Pap Smear 93%
96%
81%
Pap Smear Within
81%
Last 3 Years 92%
27%
Home Blood Stool Test
27%
Last 2 Years, 50+ 26%
31%
Always or Often Use
33%
Sunscreen When Outdoors 7%
0% 20% 40% 60% 80% 100%
Notes: Percentages were calculated using weighted data, i.e., the age, sex and race distribution of the estimated state population. Racial data exclude Hispanics.
Pennsylvania Department of Health – Cancer Facts and Figures Pennsylvania, 1999 – Page 7
BREAST CANCER LUNG CANCER
Trends: Trends:
The age-adjusted incidence rate for breast cancer among The chart below shows that the age-adjusted incidence rate for
Pennsylvania women has generally been on the increase since cancer of the trachea, bronchus, lung and pleura among
1986 (see chart below). A review of staging data shows more Pennsylvania residents has increased since 1986. Approxi-
diagnoses at earlier stages in recent years. It is projected that mately 74% of these cancers are diagnosed at late (regional and
there will be about 11,350 new cases diagnosed in 1999, distant) stages of the disease. There were 10,025 cases reported
compared to 10,756 in 1996. The number of deaths in 1999 due in 1996 and over 10,800 are expected in 1999. Deaths are
to this disease is estimated to be about 2,375, lower than the projected to increase slightly, from 8,211 in 1997 to approxi-
2,457 deaths reported for 1997. mately 8,290 in 1999.
140 65
Age-Adjusted Incidence Rate per 100,000
Age-Adjusted Incidence Rate per 100,000
60
120
55
100
50
80 45
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996
Signs and Symptoms: Signs and Symptoms:
Earliest sign is an abnormality appearing on a mammogram. Persistent cough, sputum streaked with blood, chest pain,
Symptoms that are physically detectable may include a lump, recurring pneumonia or bronchitis.
thickening, swelling, dimpling, skin irritation, distortion,
retraction, scaliness, pain, tenderness of the nipple or nipple Risk Factors:
discharge. Breast pain is usually due to a benign condition and Cigarette smoking is by far the most important risk factor in the
is rarely a first symptom of breast cancer. development of lung cancer. Other factors include exposure to
certain industrial substances, such as arsenic; some organic
Risk Factors: chemicals and radon and asbestos, particularly for smokers;
Risk increases with age and for family history of breast cancer, radiation exposure from occupational, medical and environ-
early menarche, late menopause, exposure to estrogens, recent mental sources; air pollution; tuberculosis; and second-hand
use of oral contraceptives, never having children or having first tobacco smoke for nonsmokers.
births at a late age, and higher socioeconomic status.
Early Detection:
Early Detection: See page 16.
See page 16.
Treatment:
Treatment: The options include surgery, radiation therapy and chemo-
Lumpectomy or mastectomy and removal of lymph nodes therapy, determined by type and stage of the disease. Since the
under the arm, radiation therapy, chemotherapy or hormone cancer has usually spread by the time it is diagnosed, radiation
therapy. Two or more methods are often used in combination. therapy and chemotherapy are often used in combination with
The patient’s condition and preferences are taken into account. surgery.
Survival: Survival:
The five-year relative survival rate for localized breast cancer The one-year survival rate has increased from 32% in 1973 to
is 97%. However, it decreases to 77% for regional stages of the 41% in 1994, largely due to improvements in surgical tech-
disease and to 22% for distant metastases. Sixty-nine percent of niques. Five-year survival is only 14%. The survival rate for
women with breast cancer survive 10 years, and 57% survive localized cases is 50%, but only 15% of lung cancers are
15 years. discovered that early.
Pennsylvania Department of Health – Cancer Facts and Figures Pennsylvania, 1999 – Page 8
PROSTATE CANCER COLON CANCER
Trends: Trends:
As the area graph below shows, the age-adjusted incidence rate There has generally been a decline in the age-adjusted inci-
for prostate cancer among Pennsylvania residents rose dramati- dence rate for Pennsylvanians diagnosed with colon cancer
cally between 1986 and 1992. A lot of this increase was due to between 1986 and 1996. The number of cases projected for
more widespread use of a simple blood test (PSA) to detect this 1999 is 6,805 which is slightly higher than the 7,011 reported
disease at its early stages. However, rates have generally been to the Pennsylvania Cancer Registry for 1996. Among deaths,
declining since 1993. Projections for 1999 suggest that 8,000 only a slight decline is expected in the number for 1999,
new cases will be diagnosed, 1,675 less than in 1996. About compared to 1997. It is expected that just over 2,900 residents
1,750 deaths are projected for 1999, similar to the number will die this year due to colon cancer.
reported in 1997.
200 50
Age-Adjusted Incidence Rate per 100,000
Age-Adjusted Incidence Rate per 100,000
150 45
100 40
50 35
0 30
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996
Signs and Symptoms: Signs and Symptoms:
Weak/interrupted urine flow; inability to urinate or difficulty Rectal bleeding, blood in the stool, a change in bowel habits.
starting or stopping flow; need to urinate frequently; blood in
urine; pain or burning on urination; chronic pain in lower back, Risk Factors:
pelvis or upper thighs. Most of these symptoms can also be Familial history of colon cancer or polyps and inflammatory
caused by other conditions such as infection or prostate bowel disease have been associated with increased colon cancer
enlargement. risk. Other possibilities include physical inactivity, high-fat
and/or low-fiber diet, as well as inadequate consumption of
Risk Factors: fruits and vegetables.
Over 75% of all prostate cancers are diagnosed in men over age
65. Blacks have the highest incidence rates in the world. There Early Detection:
may be some familial tendency. Dietary fat may also be a See page 16.
factor.
Treatment:
Early Detection: Surgery is the most common form of treatment and frequently
See page 16. results in a cure for cancers that have not spread. Chemo-
therapy or chemotherapy with radiation before or after surgery
Treatment: is recommended for patients whose cancer has significantly
Surgery or radiation depending on patient’s age and stage of the perforated the bowel wall or spread to the lymph nodes.
cancer. Hormones and chemotherapy can also help reduce pain. Permanent colostomy (creation of an abdominal opening for
“Watchful waiting” may be appropriate, too, especially for elimination of body wastes) is seldom needed for colon cancer
older persons and early stage diagnoses. patients.
Survival: Survival:
Almost 83% of the prostate cancers diagnosed among Pennsyl- One-year and five-year survival rates are 82% and 62%,
vania residents in 1996 were at the local stage. The five-year respectively. For early, localized stages, the five-year survival
survival rate for these patients is 100%. The survival rate for all rate is 91%; however, only 37% are discovered then. Five-year
stages is 93%. Recent data also show that 68% of men with survival for regional stages is 66% but drops to 9% for those
prostate cancer survive 10 years and 52% survive 15 years. with distant metastases.
Pennsylvania Department of Health – Cancer Facts and Figures Pennsylvania, 1999 – Page 9
1999 PROJECTED CANCER CASES By SITE and SEX
All Cases - The number of cancer cases among residents is cancer cases may decline by almost 1700. Five other sites
projected to increase by 1.6 percent between 1996 and 1999, could have fewer cases between 1996 and 1999 – brain, co-
from 68,906 to 70,010. Lung and breast cancers will account lon, Hodgkin’s disease, larynx, stomach, and thyroid. The larg-
for approximately 825 and 600 more cases, respectively, in est increases should occur for lung (over 300 more cases) and
1999. Two other sites are projected to increase by around 400 melanoma of skin (over 200 more cases).
cases each – melanoma of skin and non-Hodgkin’s Females - The number of female cancer cases is expected to
lymphomas. Seven sites are estimated to have fewer cases in increase by 5.6 percent between 1996 and 1999, from 34,223
1999 compared to 1996 – cervix uteri, colon, corpus uteri, to 36,140. Sites with the largest numerical increases include
Hodgkin’s disease, larynx, prostate, and stomach. However, breast cancer which may increase by almost 600 cases; lung
except for prostate (1,675 fewer cases) and colon (200 less cancer (500 cases); and, non-Hodgkin’s lymphomas (200
cases), the declines for these sites are expected to be rather small. cases). Eight sites could see a decrease in cases - buccal cav-
Males - The number of male cancer cases for 1999 (34,395) ity/pharynx, cervix uteri, corpus uteri, Hodgkin’s disease, lar-
is projected to be slightly lower than the 1996 figure. Prostate ynx, leukemias, pancreas, and stomach.
1999 Projected and 1996 Observed Cancer Cases, Pennsylvania Residents
Percent Change 1996 to 1999, All Cancers and 23 Selected Sites by Sex
ALL CASES MALES FEMALES
1999 1996 Percent 1999 1996 Percent 1999 1996 Percent
Cancer Site Projected Observed Change Projected Observed Change Projected Observed Change
All Cancers 70,010 68,906 1.6 34,395 * 34,683 -0.8 36,140 34,223 5.6
Brain and Other
Nervous System 880 875 0.6 435 * 501 -13.2 385 * 374 2.9
Buccal Cavity/Pharynx 1,375 1,338 2.8 940 906 3.8 420 * 432 -2.8
Cervix Uteri 625 * 636 -1.7 - - - 625 * 636 -1.7
Colon 6,805 * 7,011 -2.9 3,265 * 3,353 -2.6 3,725 3,658 1.8
Corpus Uteri 2,085 * 2,153 -3.2 - - - 2,085 * 2,153 -3.2
Esophagus 785 739 6.2 595 566 5.1 190 173 9.8
Female Breast 11,350 10,756 5.5 - - - 11,350 10,756 5.5
Hodgkin's Disease 395 * 418 -5.5 215 * 230 -6.5 180 * 188 -4.3
Kidney/Renal Pelvis 1,810 1,637 10.6 1,130 1,007 12.2 680 630 7.9
Larynx 645 709 -9.0 480 536 -10.4 160 * 173 -7.5
Leukemias 1,625 1,510 7.6 960 869 10.5 635 * 641 -0.9
Melanoma of Skin 2,175 1,766 23.2 1,230 999 23.1 950 767 23.9
Multiple Myeloma 885 766 15.5 445 389 14.4 440 377 16.7
Non-Hodgkin's
Lymphomas 2,935 2,556 14.8 1,505 1,329 13.2 1,430 1,227 16.5
Ovary 1,405 1,286 9.3 - - - 1,405 1,286 9.3
Pancreas 1,580 1,459 8.3 815 721 13.0 710 * 738 -3.8
Prostate 8,000 9,675 -17.3 8,000 9,675 -17.3 - - -
Rectum, Anus,
Rectosigmoid 2,960 2,830 4.6 1,620 1,533 5.7 1,340 1,297 3.3
Stomach 1,180 * 1,208 -2.3 710 * 755 -6.0 435 453 -4.0
Testis 315 * 311 1.3 315 * 311 1.3 - - -
Thyroid 915 773 18.4 175 * 180 -2.8 725 593 22.3
Trachea, Bronchus,
Lung and Pleura 10,850 10,025 8.2 6,350 6,025 5.4 4,500 4,000 12.5
Urinary Bladder 3,535 3,354 5.4 2,505 2,408 4.0 1,030 946 8.9
NOTE: Males and females may not sum to the total due to independent analysis by sex and by total. Projections were rounded to the nearest whole five.
* The arithmetic mean for the five-year period of 1992-1996 was used to estimate the number of cases. See Technical Notes for additional information.
Pennsylvania Department of Health – Cancer Facts and Figures Pennsylvania, 1999 – Page 10
Expected Change in Number of Cancer Cases, 1996 to 1999
All Cancers and Top 4 Sites
All Cancers
1104
Female Breast
594
Trachea, Bronchus,
825
Lung and Pleura
-1675
Prostate
Colon -206
-1750 -1500 -1250 -1000 -750 -500 -250 0 250 500 750 1000 1250
19 Other Selected Sites
Brain and Other 5
Nervous System
Buccal Cavity and Pharynx 37
Cervix Uteri (invasive) -11
Corpus Uteri -68
Esophagus 46
Hodgkin's Disease -23
Kidney and Renal Pelvis 173
Larynx -64
Leukemias 115
Melanoma of Skin 409
Multiple Myeloma 119
Non-Hodgkin's Lymphomas 379
Ovary 119
Pancreas 121
Rectum, Anus, 130
and Rectosigmoid
-28
Stomach
Testis 4
Thyroid 142
Urinary Bladder 181
-100 -50 0 50 100 150 200 250 300 350 400 450
1999 PROJECTED CANCER DEATHS By SITE and SEX
All Deaths - The number of cancer deaths among residents recorded for cancers of the kidney/renal pelvis, pancreas, and
in 1999 is projected to be about 30,105, almost the same num- brain, as well as non-Hodgkin’s lymphomas and leukemias.
ber that occurred in 1997 (30,066). Among the 23 major sites, The largest declines in numbers of deaths among males be-
11 are expected to have fewer deaths in 1999, compared to tween 1997 and 1999 could occur for cancers of the colon,
1997, and 12 could have more deaths by 1999. The largest stomach, buccal cavity/pharynx, and prostate.
increases in the number of deaths are expected for lung, pan- Females - Unlike males, the number of female cancer deaths
creas, leukemia, kidney, non-Hodgkin’s lymphomas, and uri- in Pennsylvania is expected to decline slightly (0.8 percent)
nary bladder cancer. The largest declines in the number of between 1997 and 1999, from 14,774 to 14,650. Cancers of
resident deaths between 1997 and 1999 could be for cancers the breast, ovary, and cervix uteri should experience the larg-
of the female breast, stomach, and buccal cavity/pharynx. est declines while cancers of the lung, colon, urinary bladder,
Males - The number of male cancer deaths for 1999 is pro- and pancreas as well as leukemias will probably have the larg-
jected to increase by 1.1 percent, from 15,292 in 1997 to est increases in the number of deaths between 1997 and 1999.
15,455. Among the 23 sites, the largest increases could be
1999 Projected and 1997 Observed Cancer Deaths, Pennsylvania Residents
Percent Change 1997 to 1999, All Cancers and 23 Selected Sites by Sex
ALL DEATHS MALES FEMALES
1999 1997 Percent 1999 1997 Percent 1999 1997 Percent
Cancer Site Projected Observed Change Projected Observed Change Projected Observed Change
All Cancers 30,105 * 30,066 0.1 15,455 * 15,292 1.1 14,650 * 14,774 -0.8
Brain and Other
Nervous System 655 620 5.6 360 325 10.8 290 * 295 -1.7
Buccal Cavity/Pharynx 300 356 -15.7 190 224 -15.2 120 * 132 -9.1
Cervix Uteri 220 * 241 -8.7 - - - 220 * 241 -8.7
Colon 2,935 2,960 -0.8 1,355 1,412 -4.0 1,595 * 1,548 3.0
Corpus Uteri 200 * 199 0.5 - - - 200 * 199 0.5
Esophagus 620 * 605 2.5 470 * 461 2.0 150 * 144 4.2
Female Breast 2,375 2,457 -3.3 - - - 2,375 2,457 -3.3
Hodgkin's Disease 75 * 77 -2.6 40 * 46 -13.0 25 31 -19.4
Kidney/Renal Pelvis 680 631 7.8 430 388 10.8 240 * 243 -1.2
Larynx 215 * 199 8.0 170 * 157 8.3 45 * 42 7.1
Leukemias 1,190 1,136 4.8 630 602 4.7 560 534 4.9
Melanoma of Skin 395 382 3.4 225 * 215 4.7 160 167 -4.2
Multiple Myeloma 590 597 -1.2 335 320 4.7 270 * 277 -2.5
Non-Hodgkin's
Lymphomas 1,355 1,306 3.8 700 666 5.1 655 640 2.3
Ovary 740 768 -3.6 - - - 740 768 -3.6
Pancreas 1,585 1,513 4.8 765 724 5.7 820 789 3.9
Prostate 1,755 1,784 -1.6 1,755 1,784 -1.6 - - -
Rectum, Anus,
Rectosigmoid 505 * 504 0.2 265 * 269 -1.5 235 * 235 0.0
Stomach 610 676 -9.8 340 391 -13.0 270 285 -5.3
Testis 15 * 18 -16.7 15 * 18 -16.7 - - -
Thyroid 70 * 79 -11.4 25 * 33 -24.2 45 * 46 -2.2
Trachea, Bronchus,
Lung and Pleura 8,290 8,211 1.0 4,930 * 4,921 0.2 3,340 3,290 1.5
Urinary Bladder 735 688 6.8 470 451 4.2 270 237 13.9
NOTE: Males and females may not sum to the total due to independent analysis by sex and by total. Projections were rounded to the nearest whole five.
* The arithmetic mean for the five-year period of 1993-1997 was used to estimate the number of cases. See Technical Notes for additional information.
Pennsylvania Department of Health – Cancer Facts and Figures Pennsylvania, 1999 – Page 12
Expected Change in Number of Cancer Deaths, 1997 to 1999
All Cancers and 23 Selected Sites
All Cancers 39
Brain and Other
35
Nervous System
Buccal Cavity -56
and Pharynx
Cervix Uteri -21
Colon -25
1
Corpus Uteri
15
Esophagus
Female Breast -82
-2
Hodgkin's Disease
Kidney and 49
Renal Pelvis
Larynx 16
Leukemias 54
Melanoma of Skin 13
Multiple Myeloma -7
Non-Hodgkin's 49
Lymphomas
Ovary -28
Pancreas 72
Prostate -29
Rectum, Anus, 1
and Rectosigmoid
Stomach -66
Testis -3
Thyroid -9
Trachea, Bronchus, 79
Lung and Pleura
47
Urinary Bladder
-100 -80 -60 -40 -20 0 20 40 60 80 100
1999 Projected and 1996 Observed Cancer Cases
Percent Change 1996 to 1999 by Pennsylvania County of Residence
1999 1996 Percent 1999 1996 Percent
County Projected Observed Change County Projected Observed Change
ALL COUNTIES 70,010 68,906 1.6 JUNIATA 105 * 110 -4.5
ADAMS 475 424 12.0 LACKAWANNA 1,355 * 1,358 -0.2
ALLEGHENY 8,030 * 8,056 -0.3 LANCASTER 1,760 2,111 -16.6
ARMSTRONG 355 434 -18.2 LAWRENCE 580 * 617 -6.0
BEAVER 1,225 1,162 5.4 LEBANON 650 * 712 -8.7
BEDFORD 240 * 243 -1.2 LEHIGH 1,675 * 1,792 -6.5
BERKS 1,955 1,919 1.9 LUZERNE 2,220 * 2,284 -2.8
BLAIR 845 804 5.1 LYCOMING 605 641 -5.6
BRADFORD 315 * 364 -13.5 MCKEAN 255 * 276 -7.6
BUCKS 3,075 2,861 7.5 MERCER 740 * 791 -6.4
BUTLER 1,005 877 14.6 MIFFLIN 290 * 296 -2.0
CAMBRIA 1,130 1,045 8.1 MONROE 645 607 6.3
CAMERON 40 * 48 -16.7 MONTGOMERY 3,955 * 4,149 -4.7
CARBON 320 366 -12.6 MONTOUR 105 * 101 4.0
CENTRE 400 442 -9.5 NORTHAMPTON 1,695 1,653 2.5
CHESTER 2,115 1,894 11.7 NORTHUMBERLAND 570 621 -8.2
CLARION 160 196 -18.4 PERRY 195 * 194 0.5
CLEARFIELD 520 497 4.6 PHILADELPHIA 8,950 9,210 -2.8
CLINTON 215 * 218 -1.4 PIKE 110 * 123 -10.6
COLUMBIA 310 349 -11.2 POTTER 80 * 70 14.3
CRAWFORD 480 472 1.7 SCHUYLKILL 1,085 1,040 4.3
CUMBERLAND 990 * 1,027 -3.6 SNYDER 170 * 172 -1.2
DAUPHIN 1,315 * 1,301 1.1 SOMERSET 585 484 20.9
DELAWARE 3,410 3,278 4.0 SULLIVAN 40 * 44 -9.1
ELK 220 * 208 5.8 SUSQUEHANNA 250 221 13.1
ERIE 1,450 1,422 2.0 TIOGA 275 242 13.6
FAYETTE 920 * 863 6.6 UNION 135 168 -19.6
FOREST 25 32 -21.9 VENANGO 290 318 -8.8
FRANKLIN 610 * 558 9.3 WARREN 225 * 211 6.6
FULTON 100 54 85.2 WASHINGTON 1,245 * 1,261 -1.3
GREENE 190 175 8.6 WAYNE 280 * 282 -0.7
HUNTINGDON 215 * 201 7.0 WESTMORELAND 2,230 * 2,217 0.6
INDIANA 425 * 425 0.0 WYOMING 150 * 170 -11.8
JEFFERSON 245 295 -16.9 YORK 1,930 1,850 4.3
Percent Change
-8.2 or lower -8.1 to -0.3 -0.2 to 5.8 5.9 or higher
1996-99
NOTE: Projections were rounded to the nearest whole five.
* The arithmetic mean for the five-year period of 1992-96 was used to estimate the number of cases. See Technical Notes for additional information
Pennsylvania Department of Health - Cancer Facts and Figures Pennsylvania, 1999 - Page 14
1999 Projected and 1997 Observed Cancer Deaths
Percent Change 1997 to 1999 by Pennsylvania County of Residence
1999 1997 Percent 1999 1997 Percent
County Projected Observed Change County Projected Observed Change
ALL COUNTIES 30,105 * 30,066 0.1 JUNIATA 45 * 48 -6.3
ADAMS 180 * 179 0.6 LACKAWANNA 640 * 650 -1.5
ALLEGHENY 3,780 * 3,724 1.5 LANCASTER 935 925 1.1
ARMSTRONG 190 * 141 34.8 LAWRENCE 265 * 260 1.9
BEAVER 550 540 1.9 LEBANON 315 283 11.3
BEDFORD 120 104 15.4 LEHIGH 705 * 701 0.6
BERKS 825 * 875 -5.7 LUZERNE 925 930 -0.5
BLAIR 380 352 8.0 LYCOMING 290 * 273 6.2
BRADFORD 140 * 153 -8.5 MCKEAN 155 144 7.6
BUCKS 1,200 1,161 3.4 MERCER 315 308 2.3
BUTLER 410 375 9.3 MIFFLIN 110 * 118 -6.8
CAMBRIA 430 * 415 3.6 MONROE 305 275 10.9
CAMERON 20 * 22 -9.1 MONTGOMERY 1,665 * 1,671 -0.4
CARBON 170 * 177 -4.0 MONTOUR 70 56 25.0
CENTRE 180 * 192 -6.3 NORTHAMPTON 595 * 559 6.4
CHESTER 820 790 3.8 NORTHUMBERLAND 280 * 269 4.1
CLARION 85 * 90 -5.6 PERRY 80 * 72 11.1
CLEARFIELD 195 * 184 6.0 PHILADELPHIA 4,140 4,383 -5.5
CLINTON 105 102 2.9 PIKE 60 * 68 -11.8
COLUMBIA 120 134 -10.4 POTTER 40 * 45 -11.1
CRAWFORD 230 226 1.8 SCHUYLKILL 465 * 457 1.8
CUMBERLAND 425 * 391 8.7 SNYDER 70 72 -2.8
DAUPHIN 570 * 563 1.2 SOMERSET 190 * 190 0.0
DELAWARE 1,445 * 1,470 -1.7 SULLIVAN 25 * 31 -19.4
ELK 95 * 87 9.2 SUSQUEHANNA 95 * 114 -16.7
ERIE 625 * 628 -0.5 TIOGA 85 * 90 -5.6
FAYETTE 420 * 366 14.8 UNION 70 * 73 -4.1
FOREST 15 * 23 -34.8 VENANGO 145 * 143 1.4
FRANKLIN 270 * 254 6.3 WARREN 110 * 124 -11.3
FULTON 25 * 23 8.7 WASHINGTON 565 * 584 -3.3
GREENE 100 * 104 -3.8 WAYNE 150 144 4.2
HUNTINGDON 90 * 83 8.4 WESTMORELAND 1,005 * 967 3.9
INDIANA 200 186 7.5 WYOMING 55 * 67 -17.9
JEFFERSON 95 102 -6.9 YORK 760 * 756 0.5
Percent Change
-5.6 or lower -5.5 to 1.2 1.3 to 6.3 6.4 or higher
1997-99
NOTE: Projections were rounded to the nearest whole five.
* The arithmetic mean for the five-year period of 1993-97 was used to estimate the number of cases. See Technical Notes for additional information
Pennsylvania Department of Health - Cancer Facts and Figures Pennsylvania, 1999 - Page 15
American Cancer Society Guidelines
for Early Detection of Cancer in Asymptomatic People
CANCER SITE RECOMMENDATION
General Recommended every 3 years for adults aged 20-39 and every year for those age 40
Cancer-Related and older. The checkup should include health counseling and might also include
Checkup examinations for cancers of the thyroid, oral cavity, skin, lymph nodes, testes, and
ovaries, as well as for some nonmalignant diseases. Extent of the checkup should be
related to the person’s age. (The Pennsylvania Department of Health highly recommends
a complete clinical skin examination every year.)
Breast Women aged 40 and older should have an annual mammogram, an annual clinical
breast exam (CBE) performed by a health care professional, and should perform a
monthly breast self-examination. The CBE should be performed at about the same
time as a scheduled mammogram.
Women aged 20-39 should have a clinical breast exam performed by a health care
professional every 3 years and should perform a monthly breast self-examination.
(The Department of Health endorses these guidelines.)
Colon and Men and women aged 50 and older should follow one of the exam schedules below:
Rectum • A fecal occult blood test every year and a flexible sigmoidoscopy every five years.*
• A colonoscopy every 10 years.*
• A double-contrast barium enema every 5 to 10 years.*
(The Department of Health endorses the U.S. Preventive Services Task Force
Recommendation on colorectal cancer screening.)
* A digital rectal exam should be done at the same time as sigmoidoscopy, colonoscopy
or double-contrast barium enema. Those at moderate or high risk for colorectal cancer
should talk with a doctor about a different schedule.
Prostate Both a prostate-specific antigen (PSA) blood test and a digital rectal exam annually
begining at age 50 for men who have a life expectancy of at least 10 years and for
younger men who are at high risk. (The Department of Health has taken a
neutral position on prostate cancer screening at this time. The Department is neither
recommending for nor against prostate cancer screening but encourages men to discuss
the issue with their physician.)
Men in high risk groups, such as those with a strong familial predisposition (e.g., two or
more affected first-degree relatives) or black men may begin at a younger age (e.g., 45).
Uterus Cervix: Annual Pap test and pelvic exam for all women who are or have been sexually
active or who are age 18 and older. After three or more consecutive satisfactory exams
with normal findings, the Pap test may be performed less frequently. Discuss this with
your physician. (The Department of Health endorses these guidelines.)
Endometrium: Women at high risk for uterine cancer should have a sample of
endometrial tissue examined when menopause begins.
Pennsylvania Department of Health – Cancer Facts and Figures Pennsylvania, 1999 – Page 16
REFERENCES
American Cancer Society. Cancer Facts and Figures - 1999, Atlanta, GA: 1999.
North Carolina Department of Environment, Health, and Natural Resources. Cancer Facts and Figures North Carolina
1994, Raleigh, North Carolina: July 1994.
Pennsylvania Department of Health. An Analysis of Cancer Incidence in Pennsylvania Counties 1991-1995, Harrisburg,
PA: August 1998.
Pennsylvania Department of Health. Cancer Facts and Figures Pennsylvania, 1998, Harrisburg, PA: August 1998.
Pennsylvania Department of Health. Pennsylvania Cancer Incidence and Mortality 1991-1995, Harrisburg, PA: May 1998.
Samuel B. Richmond. Statistical Analysis, Second Edition. Graduate School of Business, Columbia University: John Wiley
and Sons, 1964.
World Health Organization. ICD-O International Classification of Diseases for Oncology Second Edition, Geneva. ISBN
92 4 1544147: 1990.
World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of
Death. Geneva: Ninth Revision. ISBN 92 4 154005 2: 1977.
Pennsylvania Department of Health - Cancer Facts and Figures Pennsylvania, 1999 - Page 17