Cancer Incidence and

Document Sample
Cancer Incidence and Powered By Docstoc
					Cancer Incidence and
Mortality in Nebraska:
         1997




    Nebraska Cancer Registry




Nebraska Health and Human Services System
            Lincoln, Nebraska

              February 2000
The Nebraska Cancer Registry contains a wealth of information,
     not all of which can be included in this summary report:

What types of data are available?

      •   Demographic information: age at diagnosis, gender, race/ethnicity, county of
          residence
      •   Medical history: diagnosis, primary site, cell type, stage of disease at
          diagnosis
      •   Therapy: surgery, radiation therapy, chemotherapy, immunotherapy, hormone
          therapy
      •   Follow-Up: length of survival, cause of death


Who may request data from the Nebraska Cancer Registry?

      •   Medical Researchers
      •   Health Planners
      •   Marketing Researchers
      •   Health Care Facility Administrators
      •   Physicians
      •   Nurses
      •   Health Care Facility Cancer Committees
      •   Oncology Conference Planners and Speakers
      •   Patient Care Evaluators
      •   Pharmaceutical Companies
      •   Government Officials
      •   Concerned Citizens
      •   Students


How do I make a request?

                    Contact the Data Management Section at the
                    Nebraska Health and Human Services System
                      Department of Regulation and Licensure
                      P.O. Box 95007, Lincoln, NE 68509-5007
            Phone 402/471-2241, Monday-Friday between 8 a.m. and 5 p.m.


 Please note: To comply with confidentiality regulations, the
NHHSS reserves the right to limit the amount and type of data
         that are released in response to a request.
           NEBRASKA CANCER REGISTRY
              1997 ANNUAL REPORT




            Nebraska Health & Human Services System
             Department of Regulation and Licensure
                   Richard P. Nelson, Director




                       Public Health Assurance Division
                         Data Management Section


Stephen R. Frederick, M.A.                Carla Becker, R.H.I.A.
Section Administrator                     Health Data Manager

                              Victor Filos, M.S.
                              Statistical Analyst




                      Department of Finance and Support
                             Jeff Elliott, Director


                Strategic Management Services Division
              Research and Performance Measurement Unit


Norm Nelson, M.S.                                   Bryan Rettig, M.S.
Statistical Analyst                                 Program Analyst
                                           CONTENTS

INTRODUCTION ...................................................................... 1

METHODOLOGY ..................................................................... 2
    Data Collection and Management ................................... 2
    Confidentiality.................................................................. 2
    Quality Assurance ........................................................... 3
    Definitions ....................................................................... 4
    Data Analysis .................................................................. 5

CANCER INCIDENCE IN NEBRASKA ..................................... 7

CANCER MORTALITY IN NEBRASKA .................................. 13

INCIDENCE AND MORTALITY FOR SELECTED SITES....... 19
     Lung .............................................................................. 20
     Breast............................................................................ 22
     Colorectal (Colon and Rectum) ..................................... 24
     Prostate......................................................................... 26
     Urinary Bladder ............................................................. 28
     Non-Hodgkins Lymphoma ............................................. 30
     Leukemia....................................................................... 32
     Oral Cavity and Pharynx................................................ 34
     Melanoma of the Skin.................................................... 36
     Uterine Cervix................................................................ 38

APPENDICES ........................................................................ 41

REFERENCES ....................................................................... 62
1


INTRODUCTION
This publication represents the eleventh          cancer clusters (the term “cancer cluster”
annual statistical summary of the Nebraska        refers to any alleged or actual increase in the
Cancer Registry (NCR) since it began              number of cases of cancer in a
collecting data in 1987. The purpose of this      neighborhood or community) throughout the
report is to present the registry’s most recent   state. The NHHSS also uses these data to
data to the citizens of the State of Nebraska.    plan and evaluate the effectiveness of its
The majority of the data cover cancer             cancer control programs. Outside of the
diagnoses and cancer deaths that occurred         NHHSS       the    registry   has    furnished
between January 1, 1997 and December 31,          information to many individuals, institutions,
1997, as well as during the past five years       and organizations, including the University of
(January 1, 1993-December 31, 1997).              Nebraska Medical Center, the National
                                                  Cancer Institute, and the American Cancer
The NCR was founded in 1986, when the             Society.
Nebraska Unicameral authorized funding for
a state cancer registry using a portion of        The NHHSS welcomes inquiries about
funds generated by the state’s cigarette tax.     cancer from the public. For more information
The     establishment      of   the    registry   about the NCR, please call the Data
successfully combined the efforts of many         Management Section at 402/471-2241. For
Nebraska physicians, legislators, concerned       more information about the cancer control
citizens, and the Nebraska Medical                programs of the NHHSS, please call the
Foundation, all of whom had worked for            Chronic Disease Prevention and Control
years toward this goal.        The Nebraska       Division    at    402/471-2647.      Written
Medical Foundation also helped to establish       correspondence to the Data Management
the registry with financial assistance. Since     Section should be addressed to P.O. Box
1994, the NCR has received additional             95007, Lincoln, NE 68509-5007, and written
funding from the federal Centers for Disease      correspondence to the Chronic Disease
Control and Prevention.                           Prevention and Control Division to P.O. Box
                                                  95044, Lincoln, NE 68509-5044.
The Nebraska Health and Human Services
System (NHHSS) currently manages the
NCR, although data collection and editing
are performed by the Nebraska Methodist
Hospital of Omaha, under contract to the
Nebraska Medical Foundation. Analysis of
registry data and preparation of the annual
statistical report is the responsibility of the
NHHSS.

The purpose of the registry is to gather data
with which to describe cancer incidence,
mortality, treatment, and survival in
Nebraska. These data have a wide variety
of uses, both inside and outside of the
NHHSS.      Within the NHHSS, they are
monitored closely from year to year to
determine the trends that are developing,
and to review how Nebraska fares relative to
the rest of the nation.            They are
indispensable for investigating reports of
2

METHODOLOGY
Data Collection and Management

The NCR gathers data on Nebraska                   according to the Ninth Edition of the
residents diagnosed and treated for invasive       International Classification of Diseases (ICD-
and in situ tumors. Benign tumors, benign          9)
polyps, basal cell carcinomas of the skin,
and in situ and localized squamous cell            National cancer incidence data are available
carcinomas of the skin are excluded from the       from the National Cancer Institute's
registry.    Information collected on each         Surveillance, Epidemiology, and End Results
newly diagnosed case includes the patient’s        (SEER) Program and national cancer
name, address, birthdate, race, gender, and        mortality data are available from the National
Social Security number; date of diagnosis;         Center for Health Statistics. The SEER
primary site of the cancer (coded according        Program compiles incidence data from 14
to the International Classification of Diseases    population-based cancer registries located
for Oncology, 2nd edition [ICD-O-2]); stage of     throughout the United States, and these data
disease at diagnosis; facility where the initial   provide estimates       of national cancer
diagnosis was made; basis of staging;              incidence.     The mortality data from the
method of diagnostic confirmation; and             National Center for Health Statistics include
histological type (also classified according to    all cancer deaths occurring in the United
the ICD-O-2).          Follow-up information       States, with cancer deaths defined as only
gathered on registered cases on at least an        those deaths for which cancer is listed as the
annual basis, and includes the date of last        underlying cause.
contact with the patient, status of disease,
type of additional treatment, quality of
survival, and if death has occurred, the date      Confidentiality
and cause of death and the status of the
cancer at the time of death. The registry          All data obtained by the NCR from the
gathers this information from every hospital       medical records of individual patients are
in the state for all Nebraska residents            held in strict confidence by the NHHSS. As
diagnosed with and treated for cancer. In          specified in state statute, bonafide
addition, the registry includes Nebraska           researchers can obtain case-specific and
residents who are diagnosed with and/or            patient-identifiable information from the
treated for cancer out of state. NCR data          registry, by submitting a written application
from 1990 forward also include cases               that describes how the data will be used for
diagnosed and/or treated as outpatients at         scientific study. If contact with a patient or
pathology laboratories and physician’s             patient’s family is proposed, then the
offices.                                           applicant must substantiate the need for
                                                   such contact and secure permission to do so
Nebraska cancer mortality data are obtained        from the patient’s physician. Upon favorable
from death certificates on file with the           review by the NHHSS, the applicant must
NHHSS. Mortality data are available for            also pledge to maintain the confidentiality
every deceased Nebraska resident who dies          and security of the data throughout the
from cancer, whether death occurs in               course of the study.
Nebraska or in another state. The cancer
mortality data presented in this report are        Aggregate data (i.e., statistical information)
limited to those deaths where cancer is listed     from the registry are considered open to the
as the underlying (i.e., primary) cause of         public and are available upon request.
death.        Causes of death are coded            Details on how to obtain such data are
                                                   provided on page one of this report.
3


Quality Assurance

The NCR and the reporting hospitals spend
a great deal of time and energy to ensure
that the information they gather is both
accurate and complete. In recent years,
these efforts have met with great success.
In 1995 and 1996, the NCR achieved all of
the criteria necessary to reach the Gold
Standard of quality developed by the North
American Association of Central Cancer
Registries (NAACCR).            These criteria
include:       1) completeness of case
ascertainment (the registry must find at least
95% of the total number of cases that are
estimated      to     have     occurred);    2)
completeness of information (the proportion
of registry cases missing information on age
at diagnosis, gender, and county of
residence must be no more than 2%, and the
proportion missing information on race must
be no more than 3%; 3) data accuracy (error
rates based on edit checks of selected data
items must be no greater than 1%); and 4)
timeliness (all data for a single calendar year
must be submitted to the NAACCR for
review no more than 23 months after the
year has ended). Gold standard certification
also requires that the proportion of registry
cases found solely through a review of death
certificates must be no more than 3%, and
that the proportion of cases reported more
than once to the registry must be no more
than one per 1000.
4

Definitions                                       Stage of Disease at Diagnosis

Several technical terms are used in               In situ
presenting the data in this report. The           Cases diagnosed as in situ include tumors
following definitions are presented here to       that fulfill all of the microscopic criteria for
assist the reader.                                malignancy, but do not invade or penetrate
                                                  surrounding tissue.
Incidence rate
An incidence rate is the number of new            Invasive
cases of a disease that occur within a            Cases diagnosed as invasive include
specific population, divided by the size of the   malignant tumors that, unlike in situ tumors,
population. For example, if 15 residents of a     can infiltrate and invade surrounding tissue,
county with 25,000 residents are diagnosed        and have the ability to spread to distant
with colorectal cancer during a single year,      sites. Invasive tumors are subdivided into
then the incidence rate for that county for       three categories:
that year is .0006. Since cancer incidence
rates are usually expressed per 100,000           Localized--A localized invasive tumor has
population, this figure is then multiplied by     not spread beyond the site of origin.
100,000 to yield a rate of 60 per 100,000 per
year.                                             Regional--A regional invasive tumor has
                                                  spread by direct extension to immediately
 Mortality rate                                   adjacent organs         or tissues, and/or
A mortality rate is the number of deaths that     metastasized to regional lymph nodes or
occur within a specific population, divided by    other regional tissues.
the size of the population. Only those
persons whose death certificate lists cancer      Distant--A distant invasive tumor has spread
as the underlying (i.e., primary) cause of        beyond the immediately adjacent organs or
death are included in a cancer mortality rate.    tissues, and/or metastasized to distant lymph
Like incidence rates, mortality rates are         nodes or other distant tissues.
usually expressed as the number of deaths
per 100,000 population.

Age-adjusted rate
Age-adjustment is a simple mathematical
procedure that makes it possible to compare
rates between populations that have different
age distributions, and to compare rates
within a single population over time. In this
report, all incidence and mortality rates are
age-adjusted using the United States
population for 1970 as the standard.
5


Data Analysis

Most of the incidence and mortality rates      With the exception of bladder cancer, all of
presented in this report are calculated for    the site-specific incidence rates in this report
cancer diagnoses and deaths that occurred      are calculated with invasive cases alone, to
during 1997 and 1993-1997 combined. The        maintain comparability with statistics from
incidence and mortality rates that are based   the SEER Program and other cancer
on five years worth of data should be          registries throughout the United States. For
interpreted as the average annual rates that   bladder cancer, however, both the NCR and
occurred from 1993 through 1997. Rates for     the SEER Program calculate bladder cancer
1997 were calculated using 1997 population     incidence rates with in situ and invasive
estimates developed by the United States       cases combined. All incidence and mortality
Bureau of the Census, while the 1993-1997      rates in this report are calculated per
rates were calculated using 1995 population    100,000 population, and are age-adjusted
estimates also developed by the Census         according to the age distribution of the
Bureau.                                        population of the United States in 1970.
                                               Statewide rates are also calculated for males
All of the data presented in this report are   and females separately, and for both sexes
current through November 15, 1999.             combined. Rates based on five or fewer
However, because some cases diagnosed          events are not presented, due to their
during or even before 1997 may not yet have    unreliability.
been reported to the registry, the incidence
data presented in this report should be
considered subject to change. In addition,
the incidence data reported in previous
editions of this publication may no longer
be accurate.
6

This page is blank.
7


CANCER INCIDENCE IN
NEBRASKA
The Nebraska Cancer Registry recorded            Nebraska for all cancers (invasive only) and
8,548 diagnoses of          cancer    among      cancers of specific sites diagnosed in 1997
Nebraskans in 1997. Of this number, 7,764        and 1993-1997. National incidence rate
were invasive cancers and 784 were in situ       estimates for the year 1995 are also
cancers. The latter figure excludes 75 in situ   presented. Comparison of Nebraska and
bladder cancers, which are, as explained on      U.S. rates shows that, for all sites combined
page 5, counted as invasive cases. The           and for most individual sites, the incidence of
1997 data show a very slight increase from       cancer among Nebraskans is about equal to
1996, when 8,521 diagnoses were reported.        or lower than that experienced by Americans
Excluding in situ cases, Nebraska's 1997         as a whole. Table 2 presents the number of
cancer diagnoses translate into an annual        cancers diagnosed (invasive cases only) and
incidence rate of 384.9 cases per 100,000        the incidence rates for 1997 and 1993-1997
population.    The four most frequently          by county of residence for every county in
mentioned sites (breast, , lung, and             Nebraska, with comparable statewide and
colorectal) accounted for more than half         national rates also included.
(56.4%) of all invasive cancer diagnoses
among Nebraskans in 1997.

Table 1 presents the number of cases
diagnosed and the incidence rates for
  8



                                                                     TABLE 1
                                            Cancer Incidence (Invasive Cases Only), By Site and Gender
                                              Nebraska (1997 and 1993-1997) and USA (SEER) (1995)

                                        NEBRASKA                                              NEBRASKA                                    U.S. (SEER)
        SITE                              1997                                                1993-1997                                      1995

(ICD-O-2 Codes)           MALE            FEMALE            TOTAL              MALE             FEMALE             TOTAL          MALE    FEMALE        TOTAL

                       NO.    RATE       NO.    RATE      NO.    RATE        NO.    RATE       NO.    RATE       NO.    RATE      RATE       RATE       RATE

      All Sites       3,990   449.4     3,774   340.7    7,764   384.9     20,201   454.6    18,287   329.5    38,488   381.3     464.9      346.3       395.2
    (C000-C809)

     Oral Cavity       116       13.4     64       5.3    180        9.1     578      13.3     287       5.0     865        8.8    14.7        6.0        10.0
     & Pharynx
    (C000-C149)

     Esophagus          66        7.9     13       1.0     79        4.2     268       6.2      72       1.1     340        3.5     6.0        1.8         3.7
    (C150-C159)

      Stomach           51        5.5     34       2.5     85        3.8     321       7.2     185       2.8     506        4.8     9.9        4.1         6.6
    (C160-C169)

  Colon & Rectum       531       59.0    483     37.6    1,014      47.0    2,509     55.6    2,409    38.0     4,918      45.7    50.5       37.0        42.9
    (Colorectal)
 (C180-C209,C260)

       Liver &          31        3.5     22       1.7     53        2.5     157       3.6      98       1.6     255        2.5     5.6        2.3         3.8
  Intrahepatic Duct
    (C220-C221)

      Pancreas          68        7.5     86       6.7    154        7.0     385       8.6     395       6.2     780        7.3     9.9        7.7         8.7
    (C250-C259)

       Larynx           48        5.5      7       0.7     55        2.8     278       6.5      56       1.2     334        3.6     6.8        1.4         3.8
    (C320-C329)

 Lung & Bronchus       648       72.9    430     39.2    1,078      53.6    3,207     73.2    1,956    35.7     5,163      52.2    74.1       42.7        56.2
   (C340-C349)

   Melanoma of         148       16.7    125     12.2     273       14.2     591      13.4     476       9.3    1,067      11.1    16.5       11.3        13.5
 Skin (C440-C449,
   M872-M879)

       Breast            7        0.8   1,164   110.8    1,171      59.7      30       0.7    5,634   106.2     5,664      57.3     0.8      111.6        60.6
    (C500-C509)
  9



                                                                 TABLE 1
                                                               (Continued)
                                        Cancer Incidence (Invasive Cases Only), By Site and Gender
                                          Nebraska (1997 and 1993-1997) and USA (SEER) (1995)

                                      NEBRASKA                                           NEBRASKA                                   U.S. (SEER)
        SITE                            1997                                             1993-1997                                     1995
(ICD-0-2 Codes)
                        MALE           FEMALE            TOTAL             MALE            FEMALE            TOTAL          MALE    FEMALE        TOTAL

                     NO.     RATE     NO.    RATE      NO.    RATE       NO.    RATE      NO.    RATE      NO.    RATE      RATE       RATE       RATE

  Uterine Corpus       --        --   243     22.7     243       12.3      --       --   1,193    22.9    1,193      12.4      --       21.9         --
   & Unspecified
  (Endometrium)
(C540-C549, C559)

       Ovary           --        --   142     13.7     142        7.3      --       --    713     13.9     713        7.4      --       14.5         --
      (C569)

  Prostate Gland    1,120    127.3      --       --   1,120      56.4   6,257   140.5       --       --   6,257      61.8   139.3          --        --
      (C619)

  Urinary Bladder    246       26.9    88       6.7    334       15.5   1,205     26.2    428       6.7   1,633      15.2    28.4        7.7       16.6
   (C670-C679)

   Brain & CNS        62        7.1    50       4.8    112        5.8    299       7.0    238       5.2    537        6.0     7.0        4.8        5.9
   (C710-C719)

   Thyroid Gland      22        2.5    81       8.2    103        5.4    108       2.5    336       7.1    444        4.9     2.9        7.8        5.4
      (C739)

    Hodgkin’s         40        4.7    32       3.4     72        4.0    133       3.2    132       2.9    265        3.1     3.0        2.3        2.6
     Disease
  (M9650-M9667)

   Non-Hodgkin’s     160       17.8   155     13.5     315       15.4    792      17.6    719     12.3    1,511      14.7    20.5       12.4       16.2
    Lymphoma
  (M9590-M9595,
  M9670-M9714)

 Multiple Myeloma     50        5.5    30       2.8     80        3.9    205       4.5    189       3.9    394        3.7     5.4        3.6        4.4
 (M9731-M9732)

    Leukemia          92       10.3    79       6.5    171        8.2    530      11.9    442       7.7    972        9.6    13.5        8.2       10.5
  (M9800-M9941)
  Rates are expressed per 100,000 and are age-adjusted to the 1970 U.S. standard population
  10

                                 TABLE 2

             Cancer (All Sites) Incidence, by County of Residence
              Nebraska (1997 and 1993-1997) and USA (1995)
                                      1997                             1993-97

                                # Cases            Rate         # Cases          Rate

USA (SEER)                                                                       395.2

NEBRASKA                          7,764           384.9             38,488       381.3

COUNTY
ADAMS                              172            417.2               850        412.5
ANTELOPE                            33            258.8               219        380.6
ARTHUR                               2                *                 8        192.9
BANNER                               2                *                11        188.4
BLAINE                               5                *                25        588.3
BOONE                               34            299.1               191        354.3
BOX BUTTE                           52            333.6               265        346.9
BOYD                                 8            147.1                71        258.9
BROWN                               27            425.9               104        327.4
BUFFALO                            176            426.3               857        418.4
BURT                                61            443.8               257        366.4
BUTLER                              55            409.3               224        340.1
CASS                               115            420.0               490        365.1
CEDAR                               43            281.6               188        246.8
CHASE                               29            394.2               141        412.4
CHERRY                              36            383.3               170        382.2
CHEYENNE                            51            344.1               236        331.8
CLAY                                40            346.0               215        392.5
COLFAX                              54            375.5               266        318.2
CUMING                              41            229.9               267        310.4
CUSTER                              69            331.5               389        374.1
DAKOTA                              73            378.7               354        368.6
DAWES                               29            275.1               185        330.7
DAWSON                             119            395.7               599        392.2
DEUEL                               13            307.8                68        343.1
DIXON                               23            220.1               156        309.8
DODGE                              206            421.1              1105        438.0
DOUGLAS                           1978            420.0              9737        413.9
DUNDY                               10            274.2                72        350.8
FILLMORE                            43            348.3               204        364.7
FRANKLIN                            39            582.1               154        432.7
FRONTIER                            17            349.1                85        355.0
FURNAS                              39            336.2               200        378.3
GAGE                               103            281.4               610        330.3
GARDEN                              18            507.3                80        416.7
GARFIELD                            12            278.4                83        408.5
GOSPER                              12            350.2                54        333.0
GRANT                                3                *                19        371.1
GREELEY                             21            386.7               109        431.1
HALL                               252            399.9              1192        372.0
HAMILTON                            57            465.7               273        440.0
HARLAN                              27            350.9               152        460.7
HAYES                                3                *                24        270.3
HITCHCOCK                           26            502.6               116        421.2
HOLT                                64            319.6               328        345.9
HOOKER                               4                *                32        469.1
HOWARD                              35            334.8               161        319.2
  11

                                                         TABLE 2
                                                       (continued)

                            Cancer (All Sites) Incidence, by County of Residence
                             Nebraska (1997 and 1993-1997) and USA (1995)


                                                             1997                   1993-97

                                                       # Cases       Rate      # Cases        Rate

COUNTY
JEFFERSON                                                  59        402.9          297       385.6
JOHNSON                                                    26        291.2          155       361.1
KEARNEY                                                    30        311.7          171       369.2
KEITH                                                      49        410.0          224       354.0
KEYA PAHA                                                   4            *           25       281.1
KIMBALL                                                    20        324.6          130       397.8
KNOX                                                       40        214.6          215       238.9
LANCASTER                                                 969        413.7         4532       387.9
LINCOLN                                                   148        343.0          823       372.9
LOGAN                                                       2            *           22       403.3
LOUP                                                        2            *           14       274.5
McPHERSON                                                   1            *           12       243.2
MADISON                                                   174        410.8          941       437.4
MERRICK                                                    42        376.0          232       382.4
MORRILL                                                    29        331.9          144       355.5
NANCE                                                      25        371.5          114       319.7
NEMAHA                                                     39        358.0          214       365.3
NUCKOLLS                                                   41        363.9          211       389.1
OTOE                                                       82        342.4          423       380.2
PAWNEE                                                     26        401.4          112       301.8
PERKINS                                                    21        450.5           82       322.0
PHELPS                                                     65        437.4          280       382.6
PIERCE                                                     34        249.9          206       332.0
PLATTE                                                    144        428.6          676       401.6
POLK                                                       35        354.3          160       333.4
RED WILLOW                                                 62        373.0          302       343.8
RICHARDSON                                                 63        361.9          267       302.1
ROCK                                                       15        502.4           58       380.5
SALINE                                                     76        378.3          339       351.7
SARPY                                                     352        429.7         1661       408.8
SAUNDERS                                                   88        340.4          489       377.6
SCOTTS BLUFF                                              188        370.2          965       372.6
SEWARD                                                     85        409.9          360       335.8
SHERIDAN                                                   27        255.3          166       295.7
SHERMAN                                                    16        274.0          102       299.9
SIOUX                                                       2            *           12        96.6
STANTON                                                    21        264.2          104       281.8
THAYER                                                     44        382.7          218       369.0
THOMAS                                                      7        728.1           26       536.1
THURSTON                                                   24        284.0          157       386.9
VALLEY                                                     32        396.0          172       381.2
WASHINGTON                                                 94        427.6          392       352.1
WAYNE                                                      25        219.8          175       304.7
WEBSTER                                                    25        350.6          129       338.1
WHEELER                                                     6        441.6           19       295.5
YORK                                                       74        351.4          364       341.6


  *Rate not shown if based on five or fewer events.
   Rates are expressed per 100,000 total population.
12

This page is blank.
13



CANCER MORTALITY IN
NEBRASKA
The NHHSS recorded 3,234 cancer deaths           Nebraska for all cancers and cancers of
among Nebraskans in 1997. This figure            specific sites for 1997 and 1993-1997.
represents     a     slight  decrease    from    National cancer mortality rates for the year
Nebraska’s 1996 tally of 3,313 cancer            1995 are also included. Comparison of
deaths.     Nebraska’s 1997 cancer death         Nebraska and U.S. rates shows that, for
count translates into a statewide cancer         most specific sites and for all sites
death rate of 148.1 per 100,000 population.      combined, cancer mortality is about equal or
The four most frequently-mentioned sites         lower for Nebraskans than for Americans in
(lung, colorectal, breast, and ) accounted for   general. Table 4 presents the number of
slightly more than half (53.7%) of all cancer    cancer deaths and the mortality rates for
deaths among Nebraskans in 1997. Taken           1997 and 1993-1997 by county of residence
together, all deaths attributed to cancer        for every county in Nebraska, with
comprised over one of every five (21.1%)         comparable statewide and national rates
Nebraska deaths in 1997.                         included.

Table 3 presents the number of cancer
deaths and cancer mortality rates for
  14
                                                                             TABLE 3
                                                              Cancer Mortality, By Site and Gender
                                                          Nebraska (1997 and 1993-1997) and USA (1995)

                                         NEBRASKA                                            NEBRASKA                                     U.S.
        SITE                               1997                                              1993-1997                                    1995

(ICD-9 Codes)              MALE            FEMALE            TOTAL             MALE            FEMALE             TOTAL          MALE    FEMALE    TOTAL

                        NO.    RATE       NO.    RATE       NO.   RATE       NO.    RATE      NO.    RATE       NO.    RATE      RATE      RATE    RATE

      All Sites        1,720   187.5     1,514   119.6    3,234   148.1     8,760   191.3    7,760   125.1    16,520   152.7     210.5     140.8    169.0
     (140-208)

    Oral Cavity          21        2.5     14       1.0      35       1.7    132       3.1     66       1.0     198        1.9     4.1       1.5      2.7
    & Pharynx
    (140-149)

    Esophagus            51        6.1     11       0.7      62       3.2    258       5.9     73       1.1     331        3.3     6.4       1.4      3.6
      (150)

       Stomach           50        5.7     16       1.1      66       3.2    223       4.9    124       1.8     347        3.2     6.0       2.8      4.2
        (151)

  Colon & Rectum        208       22.0    183     13.0      391      16.7   1,075     23.2    981     14.2     2,056      18.0    21.2      14.5     17.3
    (Colorectal)
(153.0-154.1, 159.0)

      Liver and          34        3.8     25       1.9      59       2.8    171       3.8    111       1.7     282        2.7     5.1       2.3      3.6
  Intrahepatic Duct
    (155.0-155.2)

       Pancreas          72        7.8     72       5.2     144       6.4    419       9.2    418       6.3     837        7.6     9.6       7.2      8.3
        (157)

 Lung & Bronchus        562       62.7    314     26.5      876      42.2   2,773     62.2   1,573    27.6     4,346      42.7    69.5      34.2     49.3
   (162.2-162.9)

    Melanoma of          27        3.1     14       1.4      41       2.2    146       3.2     75       1.4     221        2.2     3.2       1.5      2.2
        Skin
       (172)

       Breast             1        0.1    253     21.3      254      11.8      6       0.1   1,381    23.6     1,387      13.0     0.3      25.2     14.1
     (174-175)

   Uterine Cervix         --        --     13       1.3      13       0.7      --       --    112       2.1     112        1.1      --       2.7       --
       (180)
  15

                                                                         TABLE 3
                                                                       (Continued)
                                                           Cancer Mortality, By Site and Gender
                                                       Nebraska (1997 and 1993-1997) and USA (1995)

                                       NEBRASKA                                          NEBRASKA                                   U.S.
        SITE                             1997                                            1993-1997                                  1995

 (ICD-9 Codes)           MALE           FEMALE            TOTAL            MALE           FEMALE             TOTAL         MALE    FEMALE   TOTAL

                       NO.   RATE      NO.    RATE       NO.   RATE      NO.    RATE     NO.    RATE       NO.    RATE     RATE      RATE   RATE

  Uterine Corpus        --        --    23       1.9      23      1.1      --       --   107       1.6     107       0.9      --      3.3      --
  (Endometrium)
   & Unspecified
   (182.0-182.8)

        Ovary           --        --    92       7.2      92      4.1      --       --   418       6.8     418       3.8      --      7.6      --
       (183.0)

       Gland           215      21.1     --       --     215      8.7   1,055     20.8     --        --   1,055      8.1    24.9       --      --
       (185)

  Urinary Bladder       41       4.2    28       1.8      69      2.8    226       4.6   108       1.3     334       2.6     5.5      1.6     3.2
       (188)

   Brain & CNS          55       6.2    41       4.0      96      5.0    243       5.7   198       3.9     441       4.7     4.9      3.4     4.1
    (191-192)

     Hodgkin’s           5       0.5     8       0.6      13      0.6     26       0.6    26       0.4      52       0.5     0.6      0.4     0.5
      Disease
       (201)

   Non-Hodgkin’s        72       7.8    81       5.6     153      6.6    374       8.0   353       5.1     727       6.4     8.5      5.6     6.9
    Lymphoma
(200.0-200.8, 202.0-
202.2, 202.8-202.9)

 Multiple Myeloma       31       3.5    27       2.1      58      2.7    151       3.3   162       2.5     313       2.9     3.8      2.7     3.2
  (203.0-203.8)

    Leukemia            74       7.9    65       4.9     139      6.2    371       7.9   321       4.8     692       6.0     8.4      4.8     6.3
(202.4,203.1, 204-
       208)

  Rates are expressed per 100,000 and are age-adjusted to the 1970 U.S. standard population
  16

                                  TABLE 4

             Cancer (All Sites) Mortality, by County of Residence
              Nebraska (1997 and 1993-1997) and USA (1995)
                                       1997                         1993-1997

                                # Deaths          Rate        # Deaths          Rate

USA (SEER)                                                                      169.0

NEBRASKA                           3,234         148.1          16,520          152.7

COUNTY
ADAMS                                72          153.9               362        159.0
ANTELOPE                             15          115.9                95        148.2
ARTHUR                                1              *                 7        193.3
BANNER                                1              *                 3            *
BLAINE                                3              *                12        297.7
BOONE                                14           90.0                78        122.4
BOX BUTTE                            25          139.8               116        138.6
BOYD                                  6           92.6                41        117.2
BROWN                                 8           90.1                51        133.9
BUFFALO                              59          143.1               309        138.1
BURT                                 34          217.7               123        147.4
BUTLER                               15           89.1               113        150.9
CASS                                 47          167.7               227        157.2
CEDAR                                17           91.6               100        113.2
CHASE                                11          193.1                62        173.5
CHERRY                               16          140.1                64        125.6
CHEYENNE                             18          128.1               100        122.1
CLAY                                 17          112.9                81        137.1
COLFAX                               16           79.7                99        102.0
CUMING                               28          146.7               121        127.1
CUSTER                               30          132.1               142        126.5
DAKOTA                               25          125.4               164        163.6
DAWES                                18          146.4               110        173.0
DAWSON                               35          104.2               247        151.1
DEUEL                                 8          153.9                44        192.3
DIXON                                14           88.7                65        110.7
DODGE                                77          141.5               424        152.0
DOUGLAS                             826          169.0              4092        169.5
DUNDY                                10          161.6                38        159.2
FILLMORE                             13           80.9                93        147.6
FRANKLIN                              8          101.4                61        147.8
FRONTIER                              5              *                39        152.3
FURNAS                               17          105.8                95        162.2
GAGE                                 49          107.0               301        144.0
GARDEN                                7          168.8                31        122.7
GARFIELD                             11          307.7                44        208.2
GOSPER                                4              *                19         95.9
GRANT                                 2              *                 7        139.3
GREELEY                               8          127.7                36        123.1
HALL                                109          171.5               550        164.4
HAMILTON                             18          125.2               117        165.9
HARLAN                               12          149.7                57        153.0
HAYES                                 6          344.9                16        185.2
HITCHCOCK                             9          202.5                39        129.5
HOLT                                 27          115.0               148        138.7
HOOKER                                2              *                12        139.4
HOWARD                               14          118.1                81        155.1
  17

                                                         TABLE 4
                                                       (continued)

                             Cancer (All Sites) Mortality, by County of Residence
                              Nebraska (1997 and 1993-1997) and USA (1995)


                                                           1997                     1993-1997

                                                   # Deaths          Rate       # Deaths        Rate

COUNTY
JEFFERSON                                                 31         212.6           144        163.6
JOHNSON                                                   15         139.2            68        148.3
KEARNEY                                                   12         127.4            70        150.8
KEITH                                                     13          98.8            93        140.5
KEYA PAHA                                                  1             *             9        115.4
KIMBALL                                                    9         180.0            63        192.1
KNOX                                                      24         118.0           122        120.5
LANCASTER                                                355         139.5          1938        156.8
LINCOLN                                                   72         151.2           340        145.0
LOGAN                                                      -             -             5            *
LOUP                                                       5             *            13        180.0
McPHERSON                                                  -             -             -            -
MADISON                                                   77         163.5           372        162.6
MERRICK                                                   22         165.1           104        144.6
MORRILL                                                   15         152.9            88        186.5
NANCE                                                     12         168.0            46        123.0
NEMAHA                                                    20         183.0           109        153.0
NUCKOLLS                                                  18         135.7           103        179.7
OTOE                                                      46         163.2           183        140.8
PAWNEE                                                    10         156.0            63        139.3
PERKINS                                                   10         154.1            40        137.9
PHELPS                                                    25         128.6           102        117.7
PIERCE                                                    13          94.3            88        125.9
PLATTE                                                    55         151.2           277        156.8
POLK                                                      17         160.2            74        124.3
RED WILLOW                                                27         140.1           139        146.8
RICHARDSON                                                26         132.6           131        138.0
ROCK                                                       5             *            23        150.8
SALINE                                                    29         125.3           169        153.6
SARPY                                                    137         174.8           582        150.8
SAUNDERS                                                  45         165.1           218        155.7
SCOTTS BLUFF                                              74         131.7           421        154.6
SEWARD                                                    37         149.5           157        134.3
SHERIDAN                                                  20         141.9            87        137.3
SHERMAN                                                   15         249.8            51        145.8
SIOUX                                                      5             *            16        112.4
STANTON                                                    8          99.4            53        138.7
THAYER                                                    15         120.4            83        118.1
THOMAS                                                     2             *            10        208.2
THURSTON                                                  13         136.6            70        154.6
VALLEY                                                    17         176.5            84        151.9
WASHINGTON                                                43         174.4           173        147.4
WAYNE                                                     10          64.0            69        104.7
WEBSTER                                                   11         130.6            68        156.8
WHEELER                                                    1             *             9        140.5
YORK                                                      30         145.5           157        145.1


  *Rate not shown if based on five or fewer events.
   Rates are expressed per 100,000 total population.
18

This page is blank.
                          19




INCIDENCE AND MORTALITY
   FOR SELECTED SITES
20

Lung

Although lung cancer was only the third most                although it takes 10-15 years for an ex-
frequently   diagnosed    cancer      among                 smoker’s risk to decline to the level of a
Nebraskans in 1997, it was the year’s                       lifelong non-smoker.
leading    cause   of   cancer     mortality,
accounting for more than 25% of the state’s                 Despite its heavy toll in human lives, both
cancer deaths. Long the leading cause of                    lung cancer incidence and mortality remain
cancer deaths among Nebraska men, lung                      lower for Nebraskans than for Americans in
cancer overtook breast cancer in 1993 to                    general. In fact, the lung cancer mortality
become the leading cause of cancer deaths                   rate for the state of Nebraska has been
among Nebraska women as well. In recent                     consistently lower than the U.S. rate for
years, lung cancer has averaged about                       several decades.       This is undoubtedly
1,000 diagnoses and more than 850 deaths                    attributable to Nebraska’s traditionally low
per year among Nebraskans.                                  smoking prevalence rate, although the
                                                            difference between smoking prevalence in
Cigarette smoking is the major cause of lung                Nebraska and the rest of the nation has
cancer and is estimated to cause 85% of                     diminished in recent years.
lung cancer deaths. People who smoke two
or more packs of cigarettes per day are 15 to               Lung cancer incidence and mortality
25 times more likely to die from lung cancer                statistics by county of residence are
than non-smokers. Quitting smoking will                     presented in Appendix I (Table 5).
reduce the risk of dying from lung cancer,



                               Lung Cancer Incidence (Invasive Cases Only)
                                             Rates, By Year
                          Nebraska (1990-1997) and United States (SEER) (1990-1996)

                                   Age-adjusted rate per 100,000 population
                        70.0
                        60.0
                        50.0
                        40.0
                        30.0
                        20.0
                        10.0
                         0.0       1990   1991   1992   1993   1994      1995   1996   1997
                   Nebraska        52.8   48.5   50.8   51.4   49.4      54.6   52.7   53.6
                   United States   58.6   59.6   59.6   57.9   57.1      56.2   54.2


                                                 Nebraska             United States
                                                                                  21

                               Lung Cancer Mortality
                                  Rates, By Year
       Nebraska (1990-1997) and United States (SEER) (1990-1996)

                Age-adjusted rate per 100,000 population
     60.0
     50.0
     40.0
     30.0
     20.0
     10.0
       0.0      1990    1991     1992   1993    1994     1995      1996    1997
Nebraska         45.1   39.9     42.0   43.5    43.9      42.1     42.6    42.2
United States    50.1   50.0     50.0   50.1    49.6      49.3     48.8

                                Nebraska               United States




                Lung Cancer Incidence
     % of Cases, By Stage of Disease at Diagnosis
                 Nebraska (1993-1997)
        Distant
        41.3%
                                                                   Regional
                                                                    29.5%




                                                                 In Situ
                                                                  0.1%
                Unstaged                       Local
                  9.9%                         19.2%
22

Breast (Female only)

Cancer of the breast is by far the most                         To date, knowledge about the risk factors for
common malignancy diagnosed among                               breast cancer has not translated into
women and the second most frequent cause                        practical ways to prevent it from occurring.
of female cancer deaths. In Nebraska, the                       Early diagnosis and treatment remain the
disease accounted for nearly 6,000 cases                        only effective methods for saving lives that
(both invasive and in situ) between 1993 and                    the disease might otherwise claim. Periodic
1997. Nearly one of every three cancers                         mammograms and clinical breast exams are
diagnosed among women during these years                        the surest way to find breast tumors early in
involved breast as the primary site.                            their development, when they are extremely
                                                                small in size and without symptoms. The
Age is one of the strongest risk factors for                    most recent American Cancer Society
breast cancer. Among Nebraska women,                            guidelines recommend that asymptomatic
fewer than one of every five breast cancers                     women aged 40 to 49 should have a
are detected among women under 50, and                          screening mammogram every 1-2 years, and
more than half are diagnosed among women                        annually thereafter.       The ACS also
65 and older. In addition to age, other risk                    recommends that women 20 to 40 years of
factors for the disease include a personal or                   age have a clinical breast exam every three
family history of breast cancer, some forms                     years, and every year for women over 40.
of benign breast disease, early menstruation,
late menopause, and never having children                       Female breast cancer incidence and
or having a first-born child after the age of                   mortality statistics by county of residence are
30.                                                             presented in Appendix II (Table 6).




            Female Breast Cancer Incidence (Invasive Cases Only)
                              Rates, By Year
              Nebraska (1990-1997) and United States (SEER) (1990-1996)
                      Age-adjusted rate per 100,000 females

                   120.0

                   100.0

                     80.0

                     60.0

                     40.0

                     20.0

                      0.0       1990    1991    1992    1993     1994       1995   1996    1997
                Nebraska        98.1    104.5   102.1   104.2    106.8     105.8   105.8   110.8
                United States   110.4   112.0   111.1   108.9    110.8     111.6   110.7


                                                Nebraska                 United States
20
                                Female Breast Cancer Mortality
                                       Rates, By Year
                 Nebraska (1990-1997) and United States (SEER) (1990-1996)

                     Age-adjusted rate per 100,000 females
          30.0
          25.0
          20.0
          15.0
          10.0
           5.0
           0.0       1990     1991   1992   1993    1994      1995   1996      1997
     Nebraska        28.1     24.9   26.1   23.0    26.0      23.4    25.0     21.3
     United States   27.4     27.0   26.2   25.9    25.5      25.2    24.3

                                     Nebraska              United States




                            Local                                    Distant
                            54.0%                                     4.1%




                                                                        Regional
                                                                         26.2%


                               Unstaged
                                                In Situ
                                 3.5%
                                                12.2%
24

Colorectal (Colon and Rectum)

In 1997, colorectal cancer was the fourth                       studies have also suggested that estrogen
most frequently diagnosed cancer among                          replacement therapy and non-steroidal anti-
Nebraskans, accounting for about 1,000 new                      inflammatory drugs may reduce risks.
cases. It was also the second leading cause
of cancer mortality in the state, accounting                    Although changes in diet or other risk factors
for nearly 400 deaths. Both state and                           may eventually prove an effective strategy
national trends show a substantial decline in                   for the prevention of colorectal cancer,
colorectal cancer deaths over the past two                      screening to detect asymptomatic polyps
decades, attributable most likely to the                        and tumors is currently the best method for
introduction of improved early detection                        reducing the number of new cases and
procedures (specifically, the fecal occult                      deaths. Several scientific organizations now
blood       test,   sigmoidoscopy,       and                    offer guidelines recommending specific
colonoscopy).                                                   techniques and intervals for colorectal
                                                                cancer screening. Most agree that, for
Recent studies have demonstrated that a                         people of average risk (i.e., no personal or
high intake of fats (i.e., meat, milk and other                 family history of colorectal cancer or related
dairy products, salad and cooking oils,                         conditions), screening should began at age
margarine) increases the risk of colorectal                     50 and include an annual fecal occult (stool)
cancer, and that a high intake of fiber (i.e.,                  blood test and/or a flexible sigmoidoscopy at
fruits, vegetables, and whole grain products)                   least once every five years.
decreases the risk. Other risk factors for
colorectal cancer include a personal or                         Colorectal cancer incidence and mortality
family history of colorectal cancer or polyps,                  statistics by county of residence are
a personal history of inflammatory bowel                        presented in Appendix III (Table 7).
disease, physical inactivity, and age. Some


                          Colorectal Cancer Incidence (Invasive Cases Only)
                                           Rates, By Year
                          Nebraska (1990-1997) and United States (SEER) (1990-1996)

                                    Age-adjusted rate per 100,000 population
                         60.0

                         50.0
                         40.0

                         30.0

                         20.0

                         10.0

                           0.0
                                    1990   1991   1992   1993    1994    1995    1996   1997
                    Nebraska        49.1   48.7   46.3   45.7    47.4     43.0   46.1   47.0
                    United States   48.3   47.3   46.4   45.2    44.3     42.9   42.7

                                                  Nebraska              United States
                                                                                      25
                           Colorectal Cancer Mortality
                                 Rates, By Year
       Nebraska (1990-1997) and United States (SEER) (1990-1996)

                Age-adjusted rate per 100,000 population
     60.0
     50.0
     40.0
     30.0
     20.0
     10.0
      0.0       1990      1991    1992   1993      1994      1995    1996      1997
Nebraska         17.7     17.5    17.1   19.1      17.4      19.8     17.5     16.7
United States    18.8     18.3    18.0   17.8      17.6      17.3     16.8


                                  Nebraska                United States




                    Colorectal Cancer Incidence
            % of Cases, By Stage of Disease at Diagnosis
                       Nebraska (1993-1997)
                        Distant
                        16.8%


           Unstaged                                                 Regional
             6.2%                                                    44.0%




                        Local
                        27.7%                   In Situ
                                                 5.3%
26



 cancer is currently the most frequently                        Although screening can reduce mortality for
diagnosed cancer among men, accounting                          some types of cancer (e.g., breast, cervical,
for nearly one of every three male cancer                       colorectal), screening for cancer remains
diagnoses in Nebraska. Although survival                        controversial,      with  many     scientists
rates are quite high (nearly 90% of all cases                   maintaining that its effectiveness is still
are still alive five years after diagnosis,                     unproven. The American Cancer Society
according to national data), it is also the third               recommends that men aged 50 and older
leading cause of male cancer deaths, and                        should talk with their health professional
was responsible for over 1,000 deaths                           about having an annual -specific antigen
among Nebraska men between 1993 and                             (PSA) blood test and digital rectal
1997.                                                           examination, and that men who are at high
                                                                risk for cancer (African-Americans and men
Little is known about the risk factors for                      who have a history of cancer in close family
cancer. However, there are two well-known                       members) should consider having these
high-risk groups: the elderly (men 65 and                       tests at an earlier age.
older account for over 80% of all diagnoses,
both statewide and nationally) and African-                      cancer incidence and mortality statistics by
Americans. There also is some evidence                          county of residence are presented in
that family history of the disease, dietary fat                 Appendix IV (Table 8).
consumption,          and        occupational
exposure to cadmium may each increase the
risk of cancer.



                              Cancer Incidence (Invasive Cases Only)
                                          Rates, By Year
                   Nebraska (1990-1997) and United States (SEER) (1990-1996)

                              Age-adjusted rate per 100,000 males
                 200.0


                 150.0


                 100.0


                   50.0


                    0.0       1990    1991    1992    1993    1994    1995    1996    1997
              Nebraska        127.1   147.7   184.3   169.4   142.6   134.8   131.4   127.3
              United States   132.5   169.2   190.8   171.1   148.4   139.3   135.7


                                              Nebraska            United States
                                                                                    27
                                       Cancer Mortality
                                       Rates, By Year
                Nebraska (1990-1997) and United States (SEER) (1990-1996)

                 Age-adjusted rate per 100,000 males
     30.0

     25.0

     20.0

     15.0

     10.0

      5.0

      0.0         1990   1991   1992      1993   1994      1995    1996      1997
Nebraska          23.6   21.9   23.1      22.6   21.2       22.5   17.3      21.1
United States     26.4   26.7   26.6      26.4   25.9       24.9   24.1



                                Nebraska                United States




                           Prostate Cancer Incidence
                  % of Cases, By Stage of Disease at Diagnosis
                              Nebraska (1993-1997)



                     Local                                         Unstaged
                     68.8%                                          12.0%

                                                                   Distant
                                                                    6.1%

                                                              Regional
                                                 In Situ       13.1%
                                                  0.0%
28

Urinary Bladder

Between 1993 and 1997, over 1,600                           Cigarette smoking is the most important
Nebraskans were diagnosed with bladder                      known risk factor for bladder cancer.
cancer. Bladder cancer occurs far more                      Smokers develop bladder cancer two to
frequently among men than women (by                         three times more often than non-smokers,
about a 3:1 ratio, according to NCR data),                  and estimates suggest that about one-third
and now ranks fourth as the most common                     of all cases are attributable to smoking.
site of cancer diagnoses among Nebraska                     Occupational      exposures     to    certain
men. However, deaths from the disease are                   substances used in the manufacture of dyes
much less frequent (334 Nebraskans died                     (benzidine and 2-naphthylamine) also
from it during 1993-1997), which is the                     increase the risk of bladder cancer, as does
result of a high percentage of early-stage                  employment in the rubber and leather
diagnoses and the widespread availability of                industries.
effective treatments.    Survival prospects
have improved considerably in recent                        Urinary bladder cancer incidence and
decades, to the point where the most current                mortality statistics by county of residence are
national data show that over 80% of all                     presented in Appendix V (Table 9).
cases are still alive five years after
diagnosis.



                    Bladder Cancer Incidence (Invasive and In Situ Cases)
                                       Rates, By Year
                      Nebraska (1990-1997) and United States (SEER) (1990-1996)

                              Age-adjusted rate per 100,000 population
                   20.0


                   15.0


                   10.0


                    5.0


                    0.0        1990   1991    1992   1993      1994    1995   1996    1997
              Nebraska         16.7   17.3    16.9   15.5      16.3    14.9    13.9   15.5
              United States    17.1   16.9    17.2   17.3      16.9    16.6    16.2



                                             Nebraska             United States
                                                                                       29

                           Bladder Cancer Mortality
                               Rates, By Year
      Nebraska (1990-1997) and United States (SEER) (1990-1996)

                          Age-adjusted rate per 100,000 population


      3.5
      3.0
      2.5
      2.0
      1.5
      1.0
      0.5
      0.0        1990      1991    1992    1993      1994       1995     1996   1997
Nebraska          2.8       2.7    2.7     2.8       2.1         2.8     2.7    2.8
United States     3.3       3.2    3.2     3.3       3.3         3.2     3.2


                                   Nebraska                United States




                          Bladder Cancer Incidence
                % of Cases, By Stage of Disease at Diagnosis
                            Nebraska (1993-1997)

                  Local                                      Unstaged
                  65.6%                                        4.5%



                                                               In Situ
                                                               18.3%

                                                     Distant
                                          Regional    2.5%
                                           9.0%
30

Non-Hodgkin’s Lymphoma

Lymphomas are cancers that affect the white                   The causes of non-Hodgkin’s lymphoma are
blood cells of the immune system, and are                     unclear. There is some evidence that viral
usually classified as either Hodgkin’s                        exposures and reduced immune function are
Disease or non-Hodgkin’s lymphoma. Non-                       associated with the disease. People whose
Hodgkin’s lymphoma is by far the more                         immune systems have been suppressed by
common disorder of the two, accounting for                    drugs, particularly those who have received
over 1,500 diagnoses and about 700 deaths                     an organ transplant, have an extraordinarily
among Nebraskans between 1993 and 1997.                       high incidence of non-Hodgkin’s lymphoma,
Incidence is tied closely to age, with more                   and it also occurs more frequently among
than six of every ten Nebraska cases                          people with congenital and acquired
diagnosed among people 65 years of age                        immunologic disorders, including AIDS. The
and older. National statistics indicate that                  increased incidence of the disease among
the incidence rate for non-Hodgkin’s                          people with congenital disorders of the
lymphoma has increased by about 80%                           immune system suggests that hereditary
since the mid-1970s, and some of this                         influences may also be a risk factor. Some
increase is related to the appearance of                      studies have found that occupational
AIDS. However, both state and national                        exposure to certain herbicides are a risk
data show that deaths attributable to non-                    factor as well.
Hodgkin’s lymphoma have been increasing
since at least 1950, which indicates that                     Non-Hodgkin’s lymphoma incidence and
other factors are also responsible.                           mortality statistics are presented in Appendix
                                                              VI (Table 10).


                                  Non-Hodgkin’s Lymphoma Incidence
                                           Rates, By Year
                      Nebraska (1990-1997) and United States (SEER) (1990-1996)

                                 Age-adjusted rate per 100,000 population
                      18.0
                      16.0
                      14.0
                      12.0
                      10.0
                       8.0
                       6.0
                       4.0
                       2.0
                       0.0       1990    1991   1992   1993      1994      1995   1996   1997
                 Nebraska         14.6   14.3   13.6   14.4      12.5      16.0   15.4   15.4
                 United States    15.3   15.6   15.3   15.6      16.3      16.2   15.5


                                                Nebraska                United States
                                                                                           31
                            Non-Hodgkin’s Lymphoma Mortality
                                    Rates, By Year
                Nebraska (1990-1997) and United States (SEER) (1990-1996)

                 Age-adjusted rate per 100,000 population
     10.0

      8.0

      6.0

      4.0

      2.0

      0.0         1990       1991   1992   1993       1994       1995     1996      1997
Nebraska           7.0        8.0   6.4    6.7         6.4        5.7         6.8   6.6
United States      6.2        6.5   6.5    6.5         6.9        6.9         6.8


                                    Nebraska                 United States




                        Non-Hodgkin's Lymphoma Incidence
                   % of Cases, By Stage of Disease at Diagnosis
                               Nebraska (1993-1997)
                         Unstaged
                          12.2%                                     Distant
                                                                    43.0%




                    Local
                    27.0%

                                                 Regional
                                                  17.7%
32

Leukemia

Between 1993 and 1997, 972 Nebraskans                         The major causes of most types of leukemia
were diagnosed with leukemia, and close to                    are unknown. Nevertheless, several risk
700 Nebraskans died from it. Although it is                   factors have been identified, and include
often thought of as a children’s disease, data                genetic abnormalities (such as Down’s
from the NCR show that this is not strictly                   syndrome), exposure to ionizing radiation,
true. Like most cancers, the incidence of                     and workplace exposure to benzene and
leukemia increases with age: in fact, about                   other related solvents. Adult T-cell leukemia
six of every ten Nebraska cases that                          is strongly associated with infection by a
occurred during 1993-1997 were 65 or older                    retrovirus, HTLV-I (human T-lymphotropic
at diagnosis. At the same time, however,                      virus, type I). Some evidence also suggests
leukemia is the most common type of cancer                    that cigarette smoking is a risk factor for
among children, accounting for about one-                     certain types of leukemia.
third of all cases diagnosed during 1993-
1997 among Nebraskans under the age of                        Leukemia incidence and mortality statistics
15. Acute lymphocytic leukemia is most                        by county of residence are presented in
common type of leukemia among children,                       Appendix       VII     (Table          11).
while acute myelocytic and chronic
lymphocytic are the most common types
among adults.



                                               Leukemia Incidence
                                                 Rates, By Year
                           Nebraska (1990-1997) and United States (SEER) (1990-1996)

                               Age-adjusted rate per 100,000 population
                    12.0

                    10.0

                     8.0

                     6.0

                     4.0

                     2.0

                     0.0        1990   1991    1992    1993       1994       1995   1996   1997
               Nebraska         8.7     10.0   10.0    9.4        9.6        10.7   9.9    8.2
               United States    10.5    10.8   10.6    10.4       10.2       10.5   9.7


                                               Nebraska                  United States
                                                                                                33
                                          Leukemia Mortality
                                            Rates, By Year
                    Nebraska (1990-1997) and United States (SEER) (1990-1996)

                               Age-adjusted rate per 100,000 population
              7.0
              6.0
              5.0
              4.0
              3.0
              2.0
              1.0
              0.0       1990      1991    1992   1993   1994       1995   1996   1997
        Nebraska        6.1        5.5    4.8     6.6    5.6       6.5    5.4    6.2
        United States   6.4        6.4    6.4     6.4    6.3       6.3    6.3


                                         Nebraska              United States



NOTE:              Unlike most other cancers, leukemia diagnoses can not be classified according to
                   the stage of disease scheme used elsewhere in this report.
34

Oral Cavity and Pharynx

Cancers of the oral cavity and pharynx (i.e.,                These cancers most often develop at the site
mouth and throat) accounted for over 800                     directly exposed to tobacco, with cancers of
diagnoses and nearly 200 deaths among                        the gum and cheek developing most
Nebraskans between 1993 and 1997. Both                       frequently among snuff-dippers; cancer of
state and national data show that it occurs                  the throat developing most frequently among
more than twice as often among men than                      cigarette smokers; and cancer of the lip
women, and in Nebraska it currently ranks                    developing most frequently among pipe-
seventh as the most common site for male                     smokers. Alcohol is also a known risk factor
cancer diagnoses. Although incidence                         for cancers of the oral cavity and pharynx,
increases with age, well over 40% of all                     with the risk especially high for those who
Nebraska cases recorded between 1993 and                     both smoke and drink.
1997 were under the age of 65 at diagnosis.
                                                             Oral cavity and pharynx cancer incidence
Tobacco use in all its forms--smoking,                       and mortality statistics by county of
chewing, and dipping--is the major risk factor               residence are presented in Appendix VIII
for cancers of the oral cavity and pharynx.                  (Table 12).




                Oral Cavity & Pharynx Cancer Incidence (Invasive Cases Only)
                                       Rates, By Year
                            Nebraska (1990-1997) and United States (SEER) (1990-1996)

                            Age-adjusted rate per 100,000 population
               12.0

               10.0

                 8.0

                 6.0

                 4.0

                 2.0

                 0.0          1990    1991    1992    1993      1994      1995    1996   1997
            Nebraska          10.8    9.7     9.3     8.4       9.4        9.6    7.9    9.1
            United States     11.2    10.8    10.5    10.9      10.4       10.0   10.0


                                               Nebraska               United States
                                                                                         35
                  Oral Cavity & Pharynx Cancer Mortality
                              Rates, By Year
           Nebraska (1990-1997) and United States (SEER) (1990-1996)

                Age-adjusted rate per 100,000 population
      3.0

      2.5

      2.0

      1.5

      1.0

      0.5

      0.0        1990        1991   1992   1993        1994       1995     1996   1997
Nebraska          2.2        2.2    1.9    2.2         1.8        2.0      2.0    1.7
United States     3.0        2.9    2.8    2.8         2.7        2.7      2.6


                                    Nebraska                 United States




                    Oral Cavity & Pharynx Cancer Incidence
                  % of Cases, By Stage of Disease at Diagnosis
                             Nebraska (1993-1997)
                                                              Local
                        In Situ                               46.3%
                         2.7%




                  Regional
                   35.9%                                        Unstaged
                                                  Distant         9.6%
                                                   5.5%
36

Melanoma of the Skin

There are several different types of skin                    nevi (large moles with irregular coloration
cancer, but melanomas are the most                           and shape) also carry some increased risk.
serious. Nationally, melanomas comprise
only about 5% of all skin cancer diagnoses                   Skin melanomas are among the most
but about 75% of all skin cancer deaths. In                  preventable and treatable of all cancers.
Nebraska, melanomas of the skin accounted                    Wearing protective clothing and using
for 1,067 diagnoses and over 200 deaths                      sunscreen are the best methods for
between 1993 and 1997.           Increasing                  preventing the disease, and children in
numbers of melanoma diagnoses and                            particular should have such protection. In
deaths have occurred both statewide and                      addition, early detection can greatly reduce
nationally in recent decades.                                the risk of melanoma mortality. Recognition
                                                             of changes in skin growths or the
Melanoma is related to exposure to                           appearance of new growths is the best way
ultraviolet radiation (most of which comes                   to find melanomas early in their
from the sun), particularly exposures during                 development. The American Cancer Society
childhood that resulted in severe sunburns.                  suggests that adults should practice skin
The risk of developing melanoma is                           self-exam once a month.
particularly high among people with light
skin. Sun exposure is not the only risk                      Melanoma of the skin incidence and
factor, however, as family history of                        mortality statistics by county of residence are
melanoma and the presence of dysplastic                      presented in Appendix IX (Table 13).



                           Melanoma of Skin Incidence (Invasive Cases Only)
                                           Rates, By Year
                           Nebraska (1990-1997) and United States (SEER) (1990-1996)

                                Age-adjusted rate per 100,000 population
                     14.0
                     12.0
                     10.0
                      8.0
                      6.0
                      4.0
                      2.0
                      0.0        1990   1991   1992   1993      1994      1995   1996   1997
                Nebraska         8.5    9.0    8.2    8.0        8.6      12.5   12.4   14.2
                United States    11.6   12.3   12.5   12.4      13.0      13.5   13.8


                                               Nebraska                United States
                                                                                37
                       Melanoma of Skin Mortality
                            Rates, By Year
  Nebraska (1990-1997) and United States (SEER) (1990-1996)

                Age-adjusted rate per 100,000 population
      3.0

      2.5

      2.0

      1.5

      1.0

      0.5

      0.0       1990     1991   1992   1993   1994      1995      1996   1997
Nebraska         2.0     2.1    1.6    2.5     1.9       2.2      2.3    2.2
United States    2.3     2.2    2.2    2.2     2.2       2.2      2.3


                                Nebraska             United States




              Melanoma of Skin Incidence
      % of Cases, By Stage of Disease at Diagnosis
                Nebraska (1993-1997)

                                                       Unstaged
                                                        11.3%

           Local                                           Regional
           62.8%                                            3.2%



                                                        In Situ
                                                        18.4%
                                         Distant
                                          4.3%
38

Uterine Cervix

Cancer of the uterine cervix is one of the                responsible for this risk.       In addition,
most frequently detected cancers among                    cigarette smoking is an important risk factor
women. In fact, in Nebraska it now accounts               for cervical cancer, with approximately 25%
for over 2,100 female cancer diagnoses                    of all cases attributable to it.
between 1993 and 1997. Because most
cases are diagnosed before the disease                    Limiting exposures to sexually-transmitted
becomes invasive, fatalities are relatively               diseases through the use of condoms and
infrequent, with just 112 recorded among                  other means is an effective way to reduce
Nebraska       women       during   1993-1997.            the risk of cervical cancer, as is abstaining
Although about 85% of all cervical cancer                 from smoking. In addition, use of the Pap
cases are diagnosed among women under                     smear test to screen asymptomatic women
50, women 50 and older account for about                  now saves many lives that the disease used
70% of all cervical cancer deaths. This                   to claim. Throughout the United States, the
finding is attributable to the higher proportion          widespread adoption of the Pap smear test
of invasive cancer diagnoses and the                      for screening since the 1950s has resulted in
decreased frequency of cervical cancer                    large declines in the number of cervical
screening among middle-aged and elderly                   cancer deaths.        The American Cancer
women.                                                    Society recommends an annual Pap smear
                                                          with a pelvic examination for all women who
The risk of developing cervical cancer is                 are or have been sexually active, or who are
closely linked to sexual behavior. Women                  18 years of age or older. After three or more
who have first intercourse at an early age,               consecutive annual exams with normal
multiple sexual partners, partners who have               results, the Pap smear may be performed
had multiple sexual partners, or a history of             less often at the discretion of the physician.
sexually transmitted disease are all at
increased risk for cervical cancer. Sexual                Uterine Cervix cancer incidence and
transmission of the human papilloma virus                 mortality statistics by county of residence are
and other infectious agents is believed to be             presented in Appendix X (Table 14).

                               Uterine Cervix Cancer Incidence (Invasive Cases Only)
                                                  Rates, By Year
                             Nebraska (1990-1997) and United States (SEER) (1990-1996)
                                 Age-adjusted rate per 100,000 females
                      10.0
                       8.0
                       6.0
                       4.0
                       2.0
                       0.0        1990    1991    1992    1993     1994       1995       1996   1997
                 Nebraska          8.9     8.6     9.4     6.1     7.1         7.6       8.7    7.3
                 United States     8.9     8.4     8.3     8.1     7.9         7.4       7.7


                                                     Nebraska            United States
                                                                                    39
                            Uterine Cervix Cancer Mortality
                                    Rates, By Year
            Nebraska (1990-1997) and United States (SEER) (1990-1996)

                Age-adjusted rate per 100,000 females
      3.0

      2.5

      2.0

      1.5

      1.0

      0.5

      0.0        1990       1991   1992   1993   1994      1995      1996    1997
Nebraska         2.4        2.0    1.6    1.8    2.2       2.8        2.5    1.3
United States    3.0        2.9    2.9    2.8    2.8       2.7        2.7


                                   Nebraska            United States




                      Uterine Cervix Cancer Incidence
                % of Cases, By Stage of Disease at Diagnosis
                            Nebraska (1993-1997)

                                                                 Distant
                                                                  1.6%
                  In Situ                                         Local
                  83.2%                                            9.7%
                                                                  Unstaged
                                                                     1.2%
                                                                 Regional
                                                                   4.4%
40

This page is blank.
                                                                            41

                                   APPENDICES

Appendix   Content                                                   Page

    I      Table 5 - Lung Cancer Incidence & Mortality                 42
                     By County of Residence


   II      Table 6 - Breast Cancer Incidence & Mortality               44
                     By County of Residence


   III     Table 7 - Colorectal Cancer Incidence & Mortality           46
                     By County of Residence


   IV      Table 8 - Cancer Incidence & Mortality                      48
                    By County of Residence


   V       Table 9 - Bladder Cancer Incidence & Mortality              50
                     By County of Residence


   VI      Table 10 - Non Hodgkin’s Lymphoma Incidence & Mortality     52
                      By County of Residence


  VII      Table 11 - Leukemia Incidence & Mortality                   54
                      By County of Residence


  VIII     Table 12 - Oral Cavity Cancer Incidence & Mortality         56
                      By County of Residence


   IX      Table 13 – Melanoma of Skin Incidence & Mortality           58
                      By County of Residence


   X       Table 14 – Uterine Cervix Incidence & Mortality             60
                     By County of Residence
 42
                                      TABLE 5
                          Lung Cancer Incidence and Mortality
             By County of Residence, Nebraska (1993-1997) and USA (1995)


                                        Incidence                      Mortality

                                    # Cases           Rate        # Deaths         Rate

USA (SEER)                                            56.2                         49.3



NEBRASKA                              5,163           52.2           4,346         42.7

COUNTY
ADAMS                                   118           58.1             95          45.0
ANTELOPE                                 18           27.6             18          24.4
ARTHUR                                    2              *              1             *
BANNER                                    1              *              1             *
BLAINE                                    5              *              4             *
BOONE                                    26           45.7             18          30.0
BOX BUTTE                                31           41.4             29          40.0
BOYD                                      9           31.5              9          31.5
BROWN                                    12           37.8             12          34.9
BUFFALO                                 111           57.0             94          45.9
BURT                                     30           40.3             23          30.4
BUTLER                                   20           29.6             21          27.9
CASS                                     76           58.3             71          53.0
CEDAR                                    17           20.9             18          23.5
CHASE                                    19           50.9             16          43.4
CHERRY                                   20           46.5             19          42.6
CHEYENNE                                 34           47.7             26          34.5
CLAY                                     29           57.5             23          42.5
COLFAX                                   26           32.9             18          19.9
CUMING                                   28           33.1             27          28.8
CUSTER                                   41           36.4             36          33.0
DAKOTA                                   63           67.3             47          49.2
DAWES                                    25           40.0             29          48.9
DAWSON                                   83           54.8             66          42.5
DEUEL                                     7           34.9             11          61.1
DIXON                                    13           27.5             14          27.2
DODGE                                   151           58.1            119          43.2
DOUGLAS                                1567           68.6           1233          53.4
DUNDY                                     5              *              8          30.0
FILLMORE                                 22           39.0             23          36.5
FRANKLIN                                 21           56.1             14          38.4
FRONTIER                                  9           39.3              9          39.2
FURNAS                                   24           51.7             22          47.5
GAGE                                     80           41.3             73          35.7
GARDEN                                    9           42.0             13          47.1
GARFIELD                                  5              *              6          28.3
GOSPER                                    2              *              1             *
GRANT                                     4              *              3             *
GREELEY                                  11           39.6              9          33.8
HALL                                    177           56.2            154          47.6
HAMILTON                                 25           42.7             26          40.4
HARLAN                                   19           63.7             22          61.8
HAYES                                     2              *              2             *
HITCHCOCK                                14           44.6             12          43.5
HOLT                                     30           32.3             26          23.9
HOOKER                                    3              *              1             *
HOWARD                                   15           33.3             18          40.4
                                                                                              43
                                                      TABLE 5
                                                      (continued)

                                 Lung Cancer Incidence and Mortality
                    By County of Residence, Nebraska (1993-1997) and USA (1995)

                                                          Incidence               Mortality

                                                      # Cases         Rate   # Deaths         Rate

COUNTY
JEFFERSON                                                 35          42.9        31          38.8
JOHNSON                                                   24          58.0        16          30.2
KEARNEY                                                   17          45.2        12          33.2
KEITH                                                     29          45.3        28          43.4
KEYA PAHA                                                  2             *         4             *
KIMBALL                                                   18          57.1        16          52.5
KNOX                                                      28          33.4        27          29.4
LANCASTER                                                567          50.1       477          41.5
LINCOLN                                                  103          44.5        88          36.2
LOGAN                                                      -             -         -             -
LOUP                                                       3             *         4             *
McPHERSON                                                  -             -         -             -
MADISON                                                   97          47.4        94          46.3
MERRICK                                                   36          63.3        34          57.9
MORRILL                                                   23          51.4        20          44.0
NANCE                                                     14          42.1        14          38.7
NEMAHA                                                    30          54.7        32          49.2
NUCKOLLS                                                  30          56.8        27          45.7
OTOE                                                      41          39.8        39          34.4
PAWNEE                                                    15          46.9        11          29.3
PERKINS                                                   12          48.3        16          63.1
PHELPS                                                    30          43.7        16          23.8
PIERCE                                                    21          33.7        26          40.8
PLATTE                                                    80          48.6        60          34.9
POLK                                                      23          46.3        13          24.4
RED WILLOW                                                42          44.4        41          44.1
RICHARDSON                                                33          37.7        35          40.1
ROCK                                                       7          56.9         7          56.9
SALINE                                                    48          54.3        40          38.8
SARPY                                                    211          58.7       155          42.0
SAUNDERS                                                  67          51.5        58          42.3
SCOTTS BLUFF                                             116          44.4       106          39.2
SEWARD                                                    48          45.7        40          37.7
SHERIDAN                                                  12          21.1        17          30.8
SHERMAN                                                    9          21.0         6          14.4
SIOUX                                                      2             *         2             *
STANTON                                                   13          35.6        11          31.5
THAYER                                                    26          43.6        19          26.0
THOMAS                                                     3             *         2             *
THURSTON                                                  25          59.0        16          34.9
VALLEY                                                    18          40.9        20          36.6
WASHINGTON                                                51          46.6        40          34.5
WAYNE                                                     19          32.8        15          26.6
WEBSTER                                                   12          40.0        16          38.3
WHEELER                                                    2             *         4             *
YORK                                                      62          57.6        51          49.4

 *Rate not shown if based on five or fewer events.
  Rates are expressed per 100,000 total population.
 44
                                      TABLE 6
                 Breast Cancer Incidence and Mortality (Females Only)
             By County of Residence, Nebraska (1993-1997) and USA (1995)


                                        Incidence                      Mortality

                                    # Cases           Rate        # Deaths         Rate

USA (SEER)                                           111.6                         25.2



NEBRASKA                              5,634          106.2           1,381         23.6

COUNTY
ADAMS                                   109          104.1             23          19.9
ANTELOPE                                 29           99.4              3             *
ARTHUR                                    -              -              1             *
BANNER                                    2              *              -             -
BLAINE                                    -              -              1             *
BOONE                                    28          101.2              9          23.8
BOX BUTTE                                40          100.1             10          19.7
BOYD                                      7           56.3              2             *
BROWN                                    13           94.2              5             *
BUFFALO                                 134          117.0             26          19.2
BURT                                     32           99.5             11          27.3
BUTLER                                   25           81.5             12          32.6
CASS                                     74          106.9             12          16.8
CEDAR                                    28           70.4              5             *
CHASE                                    13           78.9              6          35.0
CHERRY                                   19           90.0              6          26.0
CHEYENNE                                 35           93.5              7          16.3
CLAY                                     36          123.4              5             *
COLFAX                                   32           68.1             10          22.1
CUMING                                   31           69.7             13          30.5
CUSTER                                   57           92.7             11          20.6
DAKOTA                                   49           95.9             14          26.3
DAWES                                    39          134.0             11          37.9
DAWSON                                   87          106.8             24          25.5
DEUEL                                    11          103.2              3             *
DIXON                                    19           68.5              4             *
DODGE                                   174          133.0             33          24.1
DOUGLAS                                1474          114.9            327          23.1
DUNDY                                     4              *              3             *
FILLMORE                                 22           73.1              5             *
FRANKLIN                                 15           90.2              2             *
FRONTIER                                  9           81.9              3             *
FURNAS                                   21           88.5              7          17.7
GAGE                                    105          105.9             21          21.3
GARDEN                                   12          122.6              1             *
GARFIELD                                 12          130.6              4             *
GOSPER                                    4              *              2             *
GRANT                                     2              *              -             -
GREELEY                                  12           84.2              4             *
HALL                                    169           99.8             62          32.8
HAMILTON                                 36          103.5             12          29.3
HARLAN                                   28          182.0              4             *
HAYES                                     2              *              -             -
HITCHCOCK                                14          112.3              4             *
HOLT                                     41           88.0             17          32.9
HOOKER                                    3              *              1             *
HOWARD                                   21           83.4             11          42.2
                                                                                            45
                                                  TABLE 6
                                                  (continued)

                        Breast Cancer Incidence and Mortality (Females Only)
                    By County of Residence, Nebraska (1993-1997) and USA (1995)

                                                       Incidence                Mortality

                                                  # Cases          Rate    # Deaths         Rate

COUNTY
JEFFERSON                                               35          82.2        14          24.3
JOHNSON                                                 17          77.3         5             *
KEARNEY                                                 23          99.2         8          36.4
KEITH                                                   41         119.3         4             *
KEYA PAHA                                                3             *         -             -
KIMBALL                                                 19         112.6         4             *
KNOX                                                    13          39.5         6          12.0
LANCASTER                                              733         115.6       202          28.7
LINCOLN                                                110          93.9        21          18.8
LOGAN                                                    5             *         1             *
LOUP                                                     1             *         -             -
McPHERSON                                                4             *         -             -
MADISON                                                132         113.3        27          22.2
MERRICK                                                 28          78.1         9          15.6
MORRILL                                                 18          92.1         5             *
NANCE                                                   13          59.7         4             *
NEMAHA                                                  30         109.4         8          19.6
NUCKOLLS                                                24         104.5         7          27.0
OTOE                                                    69         116.9        18          25.3
PAWNEE                                                  10          69.6         4             *
PERKINS                                                 17         141.3         3             *
PHELPS                                                  31          80.5         5             *
PIERCE                                                  26          72.1         9          22.5
PLATTE                                                 117         127.3        32          31.9
POLK                                                    27         130.1         8          29.1
RED WILLOW                                              36          90.1        10          22.6
RICHARDSON                                              33          74.6         5             *
ROCK                                                     8          86.5         2             *
SALINE                                                  37          65.5        16          39.4
SARPY                                                  276         120.8        54          24.5
SAUNDERS                                                77         112.0        12          21.9
SCOTTS BLUFF                                           150         121.8        31          23.6
SEWARD                                                  44          77.2         9          11.9
SHERIDAN                                                26          72.4         3             *
SHERMAN                                                 17          84.7         8          32.4
SIOUX                                                    3             *         2             *
STANTON                                                 20          90.1         7          41.8
THAYER                                                  30         109.8         7          24.9
THOMAS                                                   4             *         1             *
THURSTON                                                18          90.4         8          31.8
VALLEY                                                  30         149.3        10          30.4
WASHINGTON                                              57          99.9        14          23.6
WAYNE                                                   19          61.4         8          24.0
WEBSTER                                                 20         100.0         4             *
WHEELER                                                  -             -         -             -
YORK                                                    54         105.1         9          16.6


 *Rate not shown if based on five or fewer events.
  Rates are expressed per 100,000 female population.
 46
                                      TABLE 7
                       Colorectal Cancer Incidence and Mortality
             By County of Residence, Nebraska (1993-1997) and USA (1995)


                                        Incidence                      Mortality

                                    # Cases           Rate        # Deaths         Rate

USA (SEER)                                            42.9                         17.3



NEBRASKA                              4,918           45.7           2,056         18.0

COUNTY
ADAMS                                    94           40.9             42          17.1
ANTELOPE                                 34           54.0             20          36.9
ARTHUR                                    2              *              2             *
BANNER                                    -              -              1             *
BLAINE                                    7          161.7              2             *
BOONE                                    24           48.5              8          10.9
BOX BUTTE                                31           39.2             12          13.1
BOYD                                     11           41.5              4             *
BROWN                                    12           32.4              5             *
BUFFALO                                  80           35.9             27          10.3
BURT                                     41           56.5             19          23.4
BUTLER                                   34           40.7             12          15.0
CASS                                     64           46.4             32          21.8
CEDAR                                    32           42.1             16          13.3
CHASE                                    23           58.8             12          32.0
CHERRY                                   19           37.9             11          20.3
CHEYENNE                                 28           36.5             16          18.5
CLAY                                     29           46.8              8          12.0
COLFAX                                   47           47.5             15          12.3
CUMING                                   44           43.6             27          26.4
CUSTER                                   45           43.5             12           8.5
DAKOTA                                   49           50.9             17          15.8
DAWES                                    18           30.4             12          17.5
DAWSON                                   83           52.0             30          18.2
DEUEL                                    11           41.2             12          44.1
DIXON                                    15           26.2              3             *
DODGE                                   148           50.6             48          15.3
DOUGLAS                                1188           48.6            457          18.3
DUNDY                                    19           84.9              5             *
FILLMORE                                 34           56.7             11          17.8
FRANKLIN                                 26           66.2             11          25.5
FRONTIER                                 10           34.2              2             *
FURNAS                                   24           39.6             15          30.0
GAGE                                     75           33.4             47          18.6
GARDEN                                   15           71.2              3             *
GARFIELD                                 14           57.3              9          28.6
GOSPER                                    4              *              2             *
GRANT                                     -              -              -             -
GREELEY                                  23           90.7              6          24.5
HALL                                    158           46.4             64          18.9
HAMILTON                                 30           42.8             17          24.7
HARLAN                                   19           44.0              9          24.0
HAYES                                     3              *              2             *
HITCHCOCK                                16           53.7              5             *
HOLT                                     47           45.9             17          17.6
HOOKER                                    3              *              -             -
HOWARD                                   18           32.0              8          11.8
                                                                                              47
                                                      TABLE 7
                                                      (continued)

                              Colorectal Cancer Incidence and Mortality
                    By County of Residence, Nebraska (1993-1997) and USA (1995)

                                                          Incidence               Mortality

                                                      # Cases         Rate   # Deaths         Rate

COUNTY
JEFFERSON                                                 40          48.5        22          25.8
JOHNSON                                                   26          51.2        10          17.2
KEARNEY                                                   14          28.2         6          12.2
KEITH                                                     25          36.8        11          14.6
KEYA PAHA                                                  5             *         2             *
KIMBALL                                                   18          51.9         7          18.7
KNOX                                                      41          37.6        19          14.8
LANCASTER                                                533          44.5       218          17.0
LINCOLN                                                  103          44.0        41          17.0
LOGAN                                                      3             *         1             *
LOUP                                                       2             *         1             *
McPHERSON                                                  -             -         -             -
MADISON                                                  132          58.0        49          18.2
MERRICK                                                   37          64.0        18          20.3
MORRILL                                                   17          34.5        14          27.2
NANCE                                                     20          54.0         6          20.2
NEMAHA                                                    32          47.4        17          19.3
NUCKOLLS                                                  26          42.4        12          24.6
OTOE                                                      74          57.6        41          30.9
PAWNEE                                                    21          47.2        12          20.7
PERKINS                                                    8          28.7         5             *
PHELPS                                                    25          26.2        13          11.1
PIERCE                                                    33          58.5        12          20.7
PLATTE                                                    88          50.5        36          19.4
POLK                                                      18          35.3         9          15.4
RED WILLOW                                                42          45.7        20          18.3
RICHARDSON                                                51          53.4        21          21.3
ROCK                                                       2             *         2             *
SALINE                                                    51          47.4        20          16.4
SARPY                                                    178          46.3        65          17.4
SAUNDERS                                                  62          48.1        30          21.3
SCOTTS BLUFF                                              98          33.5        50          18.5
SEWARD                                                    52          44.1        15          13.5
SHERIDAN                                                  28          52.1        11          18.3
SHERMAN                                                   10          27.2         5             *
SIOUX                                                      1             *         2             *
STANTON                                                   16          41.7        10          21.7
THAYER                                                    35          58.2        16          27.1
THOMAS                                                     3             *         -             -
THURSTON                                                  17          38.7         8          15.6
VALLEY                                                    21          34.9        15          24.7
WASHINGTON                                                55          42.5        29          22.0
WAYNE                                                     21          39.4         7          10.8
WEBSTER                                                   19          48.3        12          30.2
WHEELER                                                    3             *         1             *
YORK                                                      61          54.4        20          17.9


 *Rate not shown if based on five or fewer events.
  Rates are expressed per 100,000 total population.
 48
                                      TABLE 8
                        Prostate Cancer Incidence and Mortality
             By County of Residence, Nebraska (1993-1997) and USA (1995)


                                        Incidence                      Mortality

                                    # Cases           Rate        # Deaths         Rate

USA (SEER)                                           139.3                         24.9



NEBRASKA                              6,257          140.5           1,055         20.8

COUNTY
ADAMS                                   162          180.7             20          18.4
ANTELOPE                                 43          166.4              7          21.8
ARTHUR                                    -              -              -             -
BANNER                                    2              *              1             *
BLAINE                                    1              *              -             -
BOONE                                    38          148.3              3             *
BOX BUTTE                                41          128.8              7          16.8
BOYD                                     13           95.5              1             *
BROWN                                    17          111.6              6          30.8
BUFFALO                                 148          169.0             24          22.5
BURT                                     46          129.9             11          22.9
BUTLER                                   40          127.9              9          28.1
CASS                                     47           79.9             16          23.0
CEDAR                                    33           86.2              8          16.0
CHASE                                    26          161.3              3             *
CHERRY                                   34          154.9              2             *
CHEYENNE                                 33           99.2             14          38.1
CLAY                                     42          152.1              6          20.7
COLFAX                                   47          128.9              4             *
CUMING                                   52          123.6              4             *
CUSTER                                   96          200.1             17          26.8
DAKOTA                                   39           89.0             17          37.9
DAWES                                    21           87.4              4             *
DAWSON                                  112          155.3             17          20.2
DEUEL                                     8           88.8              3             *
DIXON                                    29          130.5              5             *
DODGE                                   156          136.6             24          16.0
DOUGLAS                                1220          126.2            213          21.8
DUNDY                                    10           72.9              2             *
FILLMORE                                 28          110.1              7          14.9
FRANKLIN                                 44          262.8              9          28.5
FRONTIER                                 12          109.0              1             *
FURNAS                                   51          207.5              6          14.8
GAGE                                     94          120.0             17          18.4
GARDEN                                   14          131.7              4             *
GARFIELD                                 16          144.5              6          45.2
GOSPER                                   17          202.9              1             *
GRANT                                     5              *              1             *
GREELEY                                  22          187.5              3             *
HALL                                    196          133.9             30          19.1
HAMILTON                                 73          249.9              5             *
HARLAN                                   27          149.9              4             *
HAYES                                     5              *              1             *
HITCHCOCK                                21          158.1              2             *
HOLT                                     67          140.1             12          20.5
HOOKER                                   11          442.7              2             *
HOWARD                                   35          139.0              6          22.1
                                                                                              49
                                                     TABLE 8
                                                     (continued)

                                    Cancer Incidence and Mortality
                    By County of Residence, Nebraska (1993-1997) and USA (1995)

                                                         Incidence                Mortality

                                                     # Cases         Rate    # Deaths         Rate

COUNTY
JEFFERSON                                                50          133.1        12          24.7
JOHNSON                                                  30          174.2         6          32.2
KEARNEY                                                  53          243.5         4             *
KEITH                                                    40          126.2         7          21.7
KEYA PAHA                                                 9          204.3         -             -
KIMBALL                                                  18          119.1         2             *
KNOX                                                     45          103.0        13          24.9
LANCASTER                                               744          155.6       111          21.6
LINCOLN                                                 147          146.9        14          12.8
LOGAN                                                     5              *         1             *
LOUP                                                      1              *         2             *
McPHERSON                                                 3              *         -             -
MADISON                                                 195          213.1        30          28.9
MERRICK                                                  45          155.4         8          16.2
MORRILL                                                  27          150.3         5             *
NANCE                                                    22          124.7         3             *
NEMAHA                                                   31          115.2        13          35.5
NUCKOLLS                                                 49          181.8         5             *
OTOE                                                     66          130.8        13          19.0
PAWNEE                                                   18          103.2         3             *
PERKINS                                                  12           87.2         2             *
PHELPS                                                   73          226.3        10          21.8
PIERCE                                                   41          154.1         5             *
PLATTE                                                  120          163.6        18          23.4
POLK                                                     30          122.9         7          17.8
RED WILLOW                                               57          137.9         4             *
RICHARDSON                                               36           83.2        11          23.1
ROCK                                                     17          239.6         2             *
SALINE                                                   57          133.6        10          16.5
SARPY                                                   206          132.1        32          24.0
SAUNDERS                                                 85          143.3        26          34.1
SCOTTS BLUFF                                            173          143.5        30          22.7
SEWARD                                                   62          130.0        17          31.1
SHERIDAN                                                 36          124.6         5             *
SHERMAN                                                  23          138.4         5             *
SIOUX                                                     1              *         1             *
STANTON                                                  28          173.5         5             *
THAYER                                                   45          151.4         5             *
THOMAS                                                   10          477.5         2             *
THURSTON                                                 28          148.3         5             *
VALLEY                                                   39          172.1         5             *
WASHINGTON                                               72          143.0        14          26.6
WAYNE                                                    40          160.1         3             *
WEBSTER                                                  22          116.6         4             *
WHEELER                                                   7          242.6         1             *
YORK                                                     45           93.2         9          16.0


 *Rate not shown if based on five or fewer events.
  Rates are expressed per 100,000 male population.
 50
                                      TABLE 9
                         Bladder Cancer Incidence and Mortality
             By County of Residence, Nebraska (1993-1997) and USA (1995)


                                        Incidence                      Mortality

                                    # Cases           Rate        # Deaths         Rate

USA (SEER)                                            16.6                          3.2



NEBRASKA                              1,633           15.2            334           2.6

COUNTY
ADAMS                                    43           20.2             10           3.8
ANTELOPE                                  9           13.4              2             *
ARTHUR                                    2              *              -             -
BANNER                                    1              *              -             -
BLAINE                                    2              *              -             -
BOONE                                     9           14.8              -             -
BOX BUTTE                                13           15.4              3             *
BOYD                                      3              *              3             *
BROWN                                     5              *              1             *
BUFFALO                                  33           15.0              8           2.4
BURT                                     16           21.7              2             *
BUTLER                                   13           18.1              3             *
CASS                                     18           12.4              5             *
CEDAR                                     8            8.0              5             *
CHASE                                     5              *              -             -
CHERRY                                   11           17.7              3             *
CHEYENNE                                  7            9.4              3             *
CLAY                                     10           17.0              2             *
COLFAX                                    8            8.9              5             *
CUMING                                    8            8.0              1             *
CUSTER                                   13           13.0              7           4.5
DAKOTA                                    9            8.1              3             *
DAWES                                    13           21.8              5             *
DAWSON                                   23           12.5              4             *
DEUEL                                     3              *              1             *
DIXON                                     8           11.5              4             *
DODGE                                    44           16.7              8           3.4
DOUGLAS                                 385           15.8             77           2.9
DUNDY                                     1              *              1             *
FILLMORE                                 16           26.1              2             *
FRANKLIN                                  6           11.6              1             *
FRONTIER                                  6           25.3              -             -
FURNAS                                    9           17.2              1             *
GAGE                                     26           14.1              3             *
GARDEN                                    7           38.5              1             *
GARFIELD                                  4              *              -             -
GOSPER                                    3              *              -             -
GRANT                                     1              *              -             -
GREELEY                                   4              *              -             -
HALL                                     60           18.0              8           1.7
HAMILTON                                 12           17.3              5             *
HARLAN                                    7           15.3              1             *
HAYES                                     -              -              -             -
HITCHCOCK                                 4              *              -             -
HOLT                                     18           16.4              4             *
HOOKER                                    1              *              -             -
HOWARD                                    7           13.2              1             *
                                                                                              51
                                                      TABLE 9
                                                      (continued)

                                Bladder Cancer Incidence and Mortality
                    By County of Residence, Nebraska (1993-1997) and USA (1995)

                                                          Incidence               Mortality

                                                      # Cases         Rate   # Deaths         Rate

COUNTY
JEFFERSON                                                 10          11.1         -             -
JOHNSON                                                    8          22.1         1             *
KEARNEY                                                    9          16.1         1             *
KEITH                                                     13          20.0         3             *
KEYA PAHA                                                  -             -         -             -
KIMBALL                                                    2             *         -             -
KNOX                                                       7           6.8         1             *
LANCASTER                                                175          14.5        36           2.4
LINCOLN                                                   43          17.2        10           4.3
LOGAN                                                      -             -         -             -
LOUP                                                       1             *         -             -
McPHERSON                                                  -             -         -             -
MADISON                                                   40          16.9         3             *
MERRICK                                                   13          18.6         1             *
MORRILL                                                    3             *         1             *
NANCE                                                      2             *         -             -
NEMAHA                                                    11          14.8         4             *
NUCKOLLS                                                   7          14.4         2             *
OTOE                                                      19          16.4         2             *
PAWNEE                                                     7          15.2         2             *
PERKINS                                                    4             *         1             *
PHELPS                                                    17          25.0         2             *
PIERCE                                                    16          18.0         4             *
PLATTE                                                    24          14.1         3             *
POLK                                                       5             *         -             -
RED WILLOW                                                14          14.0         1             *
RICHARDSON                                                12          12.6         2             *
ROCK                                                       1             *         -             -
SALINE                                                    14          12.6         1             *
SARPY                                                     68          18.5        12           3.3
SAUNDERS                                                  25          18.6         4             *
SCOTTS BLUFF                                              54          19.7        11           3.6
SEWARD                                                    10           7.4         3             *
SHERIDAN                                                   7          11.2         3             *
SHERMAN                                                    5             *         1             *
SIOUX                                                      1             *         1             *
STANTON                                                    2             *         -             -
THAYER                                                     9          15.7         5             *
THOMAS                                                     -             -         -             -
THURSTON                                                   2             *         -             -
VALLEY                                                    16          27.6         4             *
WASHINGTON                                                11           8.7         4             *
WAYNE                                                      9          14.1         3             *
WEBSTER                                                    5             *         4             *
WHEELER                                                    -             -         -             -
YORK                                                      18          16.4         5             *


 *Rate not shown if based on five or fewer events.
  Rates are expressed per 100,000 total population.
 52
                                      TABLE 10
                   Non-Hodgkin’s Lymphoma Incidence and Mortality
             By County of Residence, Nebraska (1993-1997) and USA (1995)


                                        Incidence                      Mortality

                                    # Cases           Rate        # Deaths         Rate

USA (SEER)                                            16.2                          6.9



NEBRASKA                              1,511           14.7            727           6.4

COUNTY
ADAMS                                    29           14.2             15           6.1
ANTELOPE                                 13           20.2              5             *
ARTHUR                                    -              -              -             -
BANNER                                    -              -              -             -
BLAINE                                    1              *              -             -
BOONE                                     7           10.4              -             -
BOX BUTTE                                10           13.6              7           7.7
BOYD                                      3              *              1             *
BROWN                                     4              *              1             *
BUFFALO                                  40           17.8             10           3.7
BURT                                     13           16.8              4             *
BUTLER                                   11           17.2              6           8.3
CASS                                     20           12.9              7           3.9
CEDAR                                     4              *              3             *
CHASE                                     5              *              1             *
CHERRY                                    6           17.6              2             *
CHEYENNE                                 13           19.4              -             -
CLAY                                     13           26.8              8          14.9
COLFAX                                    9           11.4              4             *
CUMING                                   11           16.3              4             *
CUSTER                                   16           15.8              4             *
DAKOTA                                   13           14.0              3             *
DAWES                                     5              *              3             *
DAWSON                                   14           10.1              4             *
DEUEL                                     5              *              1             *
DIXON                                    12           24.0              7           9.9
DODGE                                    59           23.4             25           9.9
DOUGLAS                                 373           15.4            186           7.4
DUNDY                                     4              *              2             *
FILLMORE                                  8           15.0              7          11.9
FRANKLIN                                  5              *              3             *
FRONTIER                                  4              *              1             *
FURNAS                                    8           11.3              5             *
GAGE                                     28           13.0             14           6.6
GARDEN                                    3              *              -             -
GARFIELD                                  3              *              -             -
GOSPER                                    2              *              2             *
GRANT                                     -              -              -             -
GREELEY                                   3              *              1             *
HALL                                     52           16.5             28           7.6
HAMILTON                                 11           17.4              5             *
HARLAN                                    6           18.4              3             *
HAYES                                     -              -              1             *
HITCHCOCK                                 7           29.4              3             *
HOLT                                     12            9.8              7           3.5
HOOKER                                    -              -              -             -
HOWARD                                   11           25.9              8          15.3
                                                                                              53
                                                      TABLE 10
                                                      (continued)

                          Non-Hodgkin’s Lymphoma Incidence and Mortality
                    By County of Residence, Nebraska (1993-1997) and USA (1995)

                                                          Incidence               Mortality

                                                      # Cases         Rate   # Deaths         Rate

COUNTY
JEFFERSON                                                 12          16.3         5             *
JOHNSON                                                    7          13.8         4             *
KEARNEY                                                    5             *         2             *
KEITH                                                      9          13.8         4             *
KEYA PAHA                                                  2             *         -             -
KIMBALL                                                    3             *         4             *
KNOX                                                       7           7.0         4             *
LANCASTER                                                162          13.1        92           7.1
LINCOLN                                                   31          14.8        19           7.3
LOGAN                                                      -             -         -             -
LOUP                                                       2             *         -             -
McPHERSON                                                  -             -         -             -
MADISON                                                   35          14.5        16           6.6
MERRICK                                                    7          14.0         5             *
MORRILL                                                    3             *         5             *
NANCE                                                      9          27.1         4             *
NEMAHA                                                     9          13.1         4             *
NUCKOLLS                                                  11          19.4         6          10.9
OTOE                                                      18          16.0         8           5.2
PAWNEE                                                     4             *         3             *
PERKINS                                                    5             *         4             *
PHELPS                                                     8          12.1         4             *
PIERCE                                                     8          10.0         4             *
PLATTE                                                    33          20.2        12           7.4
POLK                                                       7          13.0         3             *
RED WILLOW                                                16          18.0         8           7.6
RICHARDSON                                                11          11.6         8           7.2
ROCK                                                       4             *         -             -
SALINE                                                    14          13.0         8           7.0
SARPY                                                     53          11.6        17           4.4
SAUNDERS                                                  19          14.5         9           5.5
SCOTTS BLUFF                                              31          10.9        18           6.2
SEWARD                                                    23          22.7         7           5.1
SHERIDAN                                                   4             *         7           9.0
SHERMAN                                                    3             *         1             *
SIOUX                                                      -             -         1             *
STANTON                                                    2             *         3             *
THAYER                                                    11          14.5         5             *
THOMAS                                                     1             *         -             -
THURSTON                                                   3             *         1             *
VALLEY                                                     5             *         2             *
WASHINGTON                                                16          14.9         7           6.2
WAYNE                                                      7          12.0         3             *
WEBSTER                                                    5             *         3             *
WHEELER                                                    2             *         1             *
YORK                                                       8           9.5         5             *


 *Rate not shown if based on five or fewer events.
  Rates are expressed per 100,000 total population.
 54
                                      TABLE 11
                           Leukemia Incidence and Mortality
             By County of Residence, Nebraska (1993-1997) and USA (1995)


                                        Incidence                      Mortality

                                    # Cases           Rate        # Deaths         Rate

USA (SEER)                                            10.5                          6.3



NEBRASKA                                972            9.6            692           6.0

COUNTY
ADAMS                                    17            8.6             16           6.3
ANTELOPE                                  5              *              6           7.5
ARTHUR                                    -              -              -             -
BANNER                                    -              -              -             -
BLAINE                                    -              -              -             -
BOONE                                     5              *              2             *
BOX BUTTE                                 3              *              4             *
BOYD                                      -              -              -             -
BROWN                                     5              *              4             *
BUFFALO                                  22           10.9             11           5.5
BURT                                      3              *              4             *
BUTLER                                   12           15.7             10          11.0
CASS                                     13            8.8             10           6.5
CEDAR                                     5              *              4             *
CHASE                                     5              *              3             *
CHERRY                                    7           18.6              4             *
CHEYENNE                                  6            7.7              5             *
CLAY                                      6           10.0              5             *
COLFAX                                    9            9.3              8           5.9
CUMING                                    6            8.5              6           5.9
CUSTER                                   12           11.1              2             *
DAKOTA                                   14           13.3              7           7.1
DAWES                                     2              *              8           7.4
DAWSON                                   21           15.2             10           5.8
DEUEL                                     -              -              -             -
DIXON                                     9           17.5              4             *
DODGE                                    32           13.0             15           5.3
DOUGLAS                                 231            9.8            154           6.2
DUNDY                                     5              *              2             *
FILLMORE                                  7           10.9              6           9.7
FRANKLIN                                  4              *              3             *
FRONTIER                                  3              *              3             *
FURNAS                                    5              *              2             *
GAGE                                      8            4.6              7           3.1
GARDEN                                    4              *              -             -
GARFIELD                                  2              *              1             *
GOSPER                                    -              -              -             -
GRANT                                     1              *              -             -
GREELEY                                   3              *              1             *
HALL                                     30            9.6             24           6.7
HAMILTON                                  5              *              8           9.0
HARLAN                                    5              *              4             *
HAYES                                     -              -              -             -
HITCHCOCK                                 4              *              1             *
HOLT                                      6            6.3             11           9.6
HOOKER                                    1              *              -             -
HOWARD                                    6           21.7              4             *
                                                                                              55
                                                      TABLE 11
                                                      (continued)

                                  Leukemia Incidence and Mortality
                    By County of Residence, Nebraska (1993-1997) and USA (1995)

                                                          Incidence               Mortality

                                                      # Cases         Rate   # Deaths         Rate

COUNTY
JEFFERSON                                                  3             *         5             *
JOHNSON                                                    5             *         3             *
KEARNEY                                                    3             *         4             *
KEITH                                                      7           9.4         4             *
KEYA PAHA                                                  -             -         -             -
KIMBALL                                                    5             *         4             *
KNOX                                                       6           4.1         4             *
LANCASTER                                                125          10.3        82           6.4
LINCOLN                                                   21          10.1        14           5.7
LOGAN                                                      1             *         1             *
LOUP                                                       -             -         -             -
McPHERSON                                                  1             *         -             -
MADISON                                                   26          13.0        21           8.6
MERRICK                                                    6          10.7         2             *
MORRILL                                                    1             *         2             *
NANCE                                                      2             *         -             -
NEMAHA                                                     4             *         2             *
NUCKOLLS                                                   9          18.3         6          10.7
OTOE                                                       8           8.0        10           5.6
PAWNEE                                                     1             *         3             *
PERKINS                                                    3             *         2             *
PHELPS                                                     9           9.4         5             *
PIERCE                                                     4             *         1             *
PLATTE                                                    11           6.1        10           5.1
POLK                                                       6           8.2         3             *
RED WILLOW                                                10          12.1         8           8.0
RICHARDSON                                                 8          11.1         3             *
ROCK                                                       3             *         3             *
SALINE                                                     8          10.2         8           7.8
SARPY                                                     33           7.9        22           5.2
SAUNDERS                                                  11           9.4         9           7.3
SCOTTS BLUFF                                              23           8.6        17           7.3
SEWARD                                                    11          10.0        11           8.5
SHERIDAN                                                   4             *         4             *
SHERMAN                                                    6          18.5         3             *
SIOUX                                                      -             -         2             *
STANTON                                                    -             -         2             *
THAYER                                                     8          15.4         4             *
THOMAS                                                     -             -         -             -
THURSTON                                                   4             *         2             *
VALLEY                                                     2             *         3             *
WASHINGTON                                                10           9.9        10           8.5
WAYNE                                                      5             *         2             *
WEBSTER                                                    3             *         3             *
WHEELER                                                    -             -         1             *
YORK                                                       7           6.1         8           7.5


 *Rate not shown if based on five or fewer events.
  Rates are expressed per 100,000 total population.
 56
                                      TABLE 12
                       Oral Cavity Cancer Incidence and Mortality
             By County of Residence, Nebraska (1993-1997) and USA (1995)


                                        Incidence                      Mortality

                                    # Cases           Rate        # Deaths         Rate

USA (SEER)                                            10.0                          2.7



NEBRASKA                                865            8.8            198           1.9

COUNTY
ADAMS                                    22           10.8              7           3.9
ANTELOPE                                  6            9.1              1             *
ARTHUR                                    -              -              -             -
BANNER                                    1              *              -             -
BLAINE                                    1              *              1             *
BOONE                                     5              *              -             -
BOX BUTTE                                 7            5.8              -             -
BOYD                                      -              -              -             -
BROWN                                     2              *              -             -
BUFFALO                                  22           11.0              3             *
BURT                                      4              *              -             -
BUTLER                                    4              *              4             *
CASS                                      9            6.8              -             -
CEDAR                                     4              *              2             *
CHASE                                     5              *              -             -
CHERRY                                    5              *              1             *
CHEYENNE                                 12           18.2              3             *
CLAY                                      4              *              -             -
COLFAX                                    7           11.4              -             -
CUMING                                    5              *              2             *
CUSTER                                    6            4.7              1             *
DAKOTA                                   13           14.8              -             -
DAWES                                     7           15.6              1             *
DAWSON                                   10            7.4              1             *
DEUEL                                     3              *              1             *
DIXON                                     4              *              2             *
DODGE                                    22            8.6              7           1.8
DOUGLAS                                 235           10.3             69           3.0
DUNDY                                     3              *              -             -
FILLMORE                                  2              *              -             -
FRANKLIN                                  -              -              -             -
FRONTIER                                  5              *              2             *
FURNAS                                    6           11.6              -             -
GAGE                                     15            8.9              2             *
GARDEN                                    -              -              -             -
GARFIELD                                  4              *              2             *
GOSPER                                    1              *              1             *
GRANT                                     2              *              -             -
GREELEY                                   3              *              1             *
HALL                                     30            9.2              6           2.0
HAMILTON                                  4              *              3             *
HARLAN                                    2              *              -             -
HAYES                                     -              -              1             *
HITCHCOCK                                 3              *              -             -
HOLT                                      5              *              -             -
HOOKER                                    -              -              -             -
HOWARD                                    4              *              3             *
                                                                                              57
                                                      TABLE 12
                                                      (continued)

                              Oral Cavity Cancer Incidence and Mortality
                    By County of Residence, Nebraska (1993-1997) and USA (1995)

                                                          Incidence               Mortality

                                                      # Cases         Rate   # Deaths         Rate

COUNTY
JEFFERSON                                                  9          13.0         3             *
JOHNSON                                                    2             *         1             *
KEARNEY                                                    3             *         1             *
KEITH                                                      5             *         1             *
KEYA PAHA                                                  -             -         -             -
KIMBALL                                                    4             *         1             *
KNOX                                                       6           5.9         1             *
LANCASTER                                                 96           8.4        19           1.6
LINCOLN                                                   17           8.6         3             *
LOGAN                                                      1             *         -             -
LOUP                                                       -             -         -             -
McPHERSON                                                  -             -         -             -
MADISON                                                   21          11.6         3             *
MERRICK                                                    3             *         2             *
MORRILL                                                    4             *         -             -
NANCE                                                      2             *         -             -
NEMAHA                                                     4             *         -             -
NUCKOLLS                                                   1             *         -             -
OTOE                                                      11           8.8         4             *
PAWNEE                                                     6           7.8         1             *
PERKINS                                                    -             -         -             -
PHELPS                                                     5             *         1             *
PIERCE                                                     5             *         -             -
PLATTE                                                     9           5.6         3             *
POLK                                                       1             *         1             *
RED WILLOW                                                 8           9.8         2             *
RICHARDSON                                                 3             *         -             -
ROCK                                                       1             *         -             -
SALINE                                                     3             *         1             *
SARPY                                                     32           8.1         6           1.7
SAUNDERS                                                  14          12.1         -             -
SCOTTS BLUFF                                              31          12.1         2             *
SEWARD                                                     5             *         1             *
SHERIDAN                                                   3             *         3             *
SHERMAN                                                    2             *         2             *
SIOUX                                                      -             -         -             -
STANTON                                                    3             *         1             *
THAYER                                                     4             *         -             -
THOMAS                                                     -             -         -             -
THURSTON                                                   8          21.0         1             *
VALLEY                                                     2             *         1             *
WASHINGTON                                                10           9.2         1             *
WAYNE                                                      2             *         3             *
WEBSTER                                                    2             *         2             *
WHEELER                                                    -             -         -             -
YORK                                                       3             *         -             -


 *Rate not shown if based on five or fewer events.
  Rates are expressed per 100,000 total population.
 58
                                      TABLE 13
                         Skin Melanoma Incidence and Mortality
             By County of Residence, Nebraska (1993-1997) and USA (1995)


                                        Incidence                      Mortality

                                    # Cases           Rate        # Deaths         Rate

USA (SEER)                                            13.5                          2.2



NEBRASKA                              1,067           11.1            221           2.2

COUNTY
ADAMS                                    26           14.4              5             *
ANTELOPE                                  7           16.2              -             -
ARTHUR                                    -              -              -             -
BANNER                                    1              *              -             -
BLAINE                                    -              -              1             *
BOONE                                     1              *              -             -
BOX BUTTE                                11           16.4              1             *
BOYD                                      2              *              -             -
BROWN                                     1              *              -             -
BUFFALO                                  30           15.0              3             *
BURT                                      6           13.7              1             *
BUTLER                                    2              *              -             -
CASS                                     22           16.5              2             *
CEDAR                                     3              *              2             *
CHASE                                     3              *              -             -
CHERRY                                    3              *              -             -
CHEYENNE                                 11           14.4              -             -
CLAY                                      4              *              1             *
COLFAX                                   12           11.6              3             *
CUMING                                    6            9.8              1             *
CUSTER                                   11           12.7              5             *
DAKOTA                                    4              *              1             *
DAWES                                     3              *              1             *
DAWSON                                   15           10.0              6           4.4
DEUEL                                     3              *              1             *
DIXON                                     4              *              -             -
DODGE                                    26           12.8              5             *
DOUGLAS                                 265           11.1             53           2.2
DUNDY                                     5              *              1             *
FILLMORE                                  3              *              1             *
FRANKLIN                                  4              *              -             -
FRONTIER                                  2              *              -             -
FURNAS                                    4              *              1             *
GAGE                                     14            8.5              2             *
GARDEN                                    2              *              -             -
GARFIELD                                  -              -              -             -
GOSPER                                    3              *              -             -
GRANT                                     -              -              -             -
GREELEY                                   1              *              -             -
HALL                                     27            8.7              7           2.4
HAMILTON                                 10           19.3              4             *
HARLAN                                    5              *              1             *
HAYES                                     1              *              -             -
HITCHCOCK                                 3              *              -             -
HOLT                                     10           10.1              3             *
HOOKER                                    1              *              1             *
HOWARD                                    1              *              -             -
                                                                                              59
                                                      TABLE 13
                                                      (continued)

                                Skin Melanoma Incidence and Mortality
                    By County of Residence, Nebraska (1993-1997) and USA (1995)

                                                          Incidence               Mortality

                                                      # Cases         Rate   # Deaths         Rate

COUNTY
JEFFERSON                                                  7          11.2         1             *
JOHNSON                                                    3             *         -             -
KEARNEY                                                    3             *         1             *
KEITH                                                      4             *         2             *
KEYA PAHA                                                  1             *         -             -
KIMBALL                                                    1             *         1             *
KNOX                                                       8          14.2         1             *
LANCASTER                                                161          13.4        30           2.6
LINCOLN                                                   22          12.1         8           4.6
LOGAN                                                      1             *         -             -
LOUP                                                       -             -         -             -
McPHERSON                                                  1             *         -             -
MADISON                                                   17           7.2         5             *
MERRICK                                                    2             *         -             -
MORRILL                                                    9          22.0         5             *
NANCE                                                      4             *         2             *
NEMAHA                                                     3             *         -             -
NUCKOLLS                                                   3             *         2             *
OTOE                                                      15          16.6         2             *
PAWNEE                                                     2             *         -             -
PERKINS                                                    7          29.5         2             *
PHELPS                                                    11          13.7         -             -
PIERCE                                                     3             *         -             -
PLATTE                                                    12           7.5         5             *
POLK                                                       2             *         -             -
RED WILLOW                                                 4             *         2             *
RICHARDSON                                                 8           9.1         2             *
ROCK                                                       2             *         -             -
SALINE                                                    10          13.8         2             *
SARPY                                                     72          14.9        13           2.8
SAUNDERS                                                  12          10.6         3             *
SCOTTS BLUFF                                              26          10.7         6           2.0
SEWARD                                                     8           8.4         3             *
SHERIDAN                                                   2             *         -             -
SHERMAN                                                    3             *         1             *
SIOUX                                                      -             -         -             -
STANTON                                                    4             *         1             *
THAYER                                                     3             *         -             -
THOMAS                                                     1             *         -             -
THURSTON                                                   3             *         -             -
VALLEY                                                     3             *         -             -
WASHINGTON                                                 9           8.2         3             *
WAYNE                                                      7          12.0         1             *
WEBSTER                                                    4             *         2             *
WHEELER                                                    -             -         -             -
YORK                                                       6           6.1         2             *


 *Rate not shown if based on five or fewer events.
  Rates are expressed per 100,000 total population.
 60
                                       TABLE 14
                     Uterine Cervix Cancer Incidence and Mortality
             By County of Residence, Nebraska (1993-1997) and USA (1995)


                                 Incidence                             Mortality

                     # Cases         # Cases    Rate (Invasive    # Deaths         Rate
                       In Situ       Invasive    Cases Only)

USA (SEER)                                                7.4                       2.7



NEBRASKA               1,774             359              7.3         112           2.1

COUNTY
ADAMS                     27               9              9.1           3             *
ANTELOPE                   4               1                *           1             *
ARTHUR                     -               -                -           -             -
BANNER                     1               -                -           -             -
BLAINE                     -               -                -           -             -
BOONE                      6               1                *           -             -
BOX BUTTE                 13               5                *           1             *
BOYD                       -               -                -           -             -
BROWN                      4               -                -           -             -
BUFFALO                   25               9              8.5           3             *
BURT                      10               4                *           3             *
BUTLER                     6               1                *           -             -
CASS                      23               2                *           1             *
CEDAR                      2               -                -           -             -
CHASE                      -               1                *           1             *
CHERRY                     2               1                *           -             -
CHEYENNE                  10               4                *           1             *
CLAY                       7               2                *           1             *
COLFAX                     6               1                *           -             -
CUMING                     6               1                *           -             -
CUSTER                     6               1                *           1             *
DAKOTA                     8               5                *           2             *
DAWES                      6               4                *           -             -
DAWSON                    21               7             12.7           -             -
DEUEL                      2               -                -           -             -
DIXON                      4               -                -           -             -
DODGE                     54              10              8.9           4             *
DOUGLAS                  556             100              7.6          29           2.2
DUNDY                      4               -                -           -             -
FILLMORE                   5               -                -           1             *
FRANKLIN                   -               1                *           -             -
FRONTIER                   2               -                -           -             -
FURNAS                     5               2                *           2             *
GAGE                      26               5                *           2             *
GARDEN                     4               1                *           -             -
GARFIELD                   2               -                -           1             *
GOSPER                     -               -                -           -             -
GRANT                      -               -                -           -             -
GREELEY                    -               -                -           -             -
HALL                      48              11              5.9           6           2.8
HAMILTON                   3               2                *           -             -
HARLAN                     1               -                -           -             -
HAYES                      -               -                -           -             -
HITCHCOCK                  4               1                *           -             -
HOLT                      13               4                *           3             *
HOOKER                     1               -                -           -             -
HOWARD                     6               -                -           -             -
                                                                                                 61
                                                 TABLE 14
                                                 (continued)

                            Uterine Cervix Cancer Incidence and Mortality
                    By County of Residence, Nebraska (1993-1997) and USA (1995)

                                              Incidence                              Mortality

                               # Cases            # Cases      Rate (Invasive   # Deaths         Rate
                                 In Situ          Invasive      Cases Only)

COUNTY
JEFFERSON                            8                     4               *          1             *
JOHNSON                              1                     1               *          1             *
KEARNEY                              4                     -               -          2             *
KEITH                                9                     1               *          1             *
KEYA PAHA                            -                     -               -          -             -
KIMBALL                              6                     -               -          -             -
KNOX                                 2                     -               -          -             -
LANCASTER                          309                    41             6.0         11           1.7
LINCOLN                             31                     7             7.7          1             *
LOGAN                                -                     1               *          -             -
LOUP                                 -                     -               -          -             -
McPHERSON                            -                     -               -          -             -
MADISON                             43                     7             6.6          3             *
MERRICK                              2                     1               *          1             *
MORRILL                              6                     1               *          1             *
NANCE                                3                     1               *          -             -
NEMAHA                               5                     1               *          -             -
NUCKOLLS                             5                     2               *          1             *
OTOE                                17                     6            13.7          1             *
PAWNEE                               2                     -               -          -             -
PERKINS                              2                     -               -          -             -
PHELPS                               7                     4               *          1             *
PIERCE                              10                     1               *          -             -
PLATTE                              38                     5               *          3             *
POLK                                 5                     2               *          -             -
RED WILLOW                          14                     4               *          -             -
RICHARDSON                           6                     1               *          -             -
ROCK                                 1                     -               -          -             -
SALINE                              10                     3               *          3             *
SARPY                              164                    31            10.0          2             *
SAUNDERS                            21                     7            11.5          2             *
SCOTTS BLUFF                        38                     8             7.7          5             *
SEWARD                              16                     2               *          -             -
SHERIDAN                             2                     -               -          -             -
SHERMAN                              -                     1               *          -             -
SIOUX                                -                     -               -          -             -
STANTON                              2                     1               *          1             *
THAYER                               4                     1               *          -             -
THOMAS                               -                     2               *          -             -
THURSTON                             4                     2               *          -             -
VALLEY                               1                     1               *          1             *
WASHINGTON                          19                     6            10.3          2             *
WAYNE                                6                     2               *          -             -
WEBSTER                              2                     2               *          -             -
WHEELER                              -                     -               -          -             -
YORK                                16                     3               *          2             *

 *Rate not shown if based on five or fewer events.
  Rates are expressed per 100,000 female population.
62
  REFERENCES
American Cancer Society; Cancer Facts and     Percy C, Van Holten V, Muir C: International
Figures – 1996. Atlanta: American Cancer      Classification of Diseases for Oncology, 2nd
Society, 1996.                                edition. Geneva, Switzerland: World Health
                                              Organization, 1990.
Brownson RC, Reif JS, Alavanja MCR, Bal
DG:    Cancer.    In    Chronic     Disease   Ries LAG, Kosary CL, Hankey BF, Miller BA,
Epidemiology and Control (Brownson RC,        Harras A, Edwards BK (eds.): SEER Cancer
Remington PL, Davis JR, eds.). Washington:    Statistics Review, 1973-1995. Bethesda,
American Public Health Association, 1993.     MD: National Cancer Institute, 1997; NIH
                                              Publication # 97-2789.
Goldberg J, Gelfand HM, Levy PS: Registry
evaluation methods: a review and case         World Health Organization: International
study.    Epidemiologic Reviews 2:31-41,      Classification of Diseases: Manual of the
1980.                                         Statistical   Classification  of   Diseases,
                                              Injuries, and Causes of Death, 9th revision.
Harras A (ed.): Cancer Rates and Risks, 4th   Geneva,      Switzerland:    World    Health
edition. Bethesda, MD: National Cancer        Organization, 1977.
Institute, 1996; NIH Publication #96-691.

Nebraska Department of Health and Human
Services System: Nebraska Vital Statistics
Report(s),   1959-1996.   Lincoln,    NE:
Nebraska Department of Health/Nebraska
Health and Human Services System, 1960-
1997.
                                                                                                        63
                             Participants in the Nebraska Cancer Registry
                                           (City, Organization)

Ainsworth, Brown County Hospital                       Norfolk, Pathology Medical Services
Albion, Boone County Health Center                     North Platte, Great Plains Regional Medical Center
Alliance, Box Butte General Hospital                   North Platte, Pathology Services, P.C.
Alma, Harlan County Health System                      Oakland, Oakland Memorial Hospital
Atkinson, West Holt Memorial Hospital, Inc.            Offutt AFB, Ehrling Berquist
Auburn, Nemaha County Hospital                         Ogallala, Ogallala Community Hospital
Aurora, Memorial Hospital                              Omaha, Alegent Health Bergan Mercy Medical Ctr.
Bassett, Rock County Hospital                          Omaha, Alegent Health Immanuel Medical Center
Beatrice, Beatrice Community Hosp. & Hlth. Ctr. Inc.   Omaha, Bishop Clarkson Memorial Hospital
Benkelman, Dundy County Hospital                       Omaha, Children's Hospital
Blair, Memorial Community Hospital                     Omaha, The Nebraska Methodist Hospital
Bridgeport, Morrill County Community Hospital          Omaha, Methodist Hospital Pathology Center
Broken Bow, Jennie M. Melham Mem. Med. Ctr., Inc.      Omaha, St. Joseph Hospital
Callaway, Callaway District Hospital                   Omaha, University Hospital
Cambridge, Tri Valley Health System                    Omaha, Veterans Administration Medical Center
Central City, Litzenberg Memorial County Hospital      Omaha, Bergan Mercy Medical Ctr. Pathology
Chadron, Chadron Community Hosp & Hlth Services        Omaha, Bishop Clarkson Hospital Pathology
Columbus, Columbus Community Hospital, Inc.            Omaha, Creighton Pathology Associates
Cozad, Cozad Community Hospital                        Omaha, Nichols Institute
Creighton, Creighton Area Health Services              Omaha, Physicians Lab
Crete, Crete Municipal Hospital                        O'Neill, St. Anthony's Hospital
David City, Butler County Health Care Center           Ord, Valley County Hospital
Fairbury, Jefferson County Health Center, Inc.         Osceola, Annie Jeffrey Memorial County Hlth. Ctr.
Falls City, Community Medical Center, Inc.             Oshkosh, Garden County Hospital & Nursing Home
Franklin, Franklin County Memorial Hospital            Osmond, Osmond General Hospital
Fremont, Fremont Area Medical Center                   Papillion, Alegent Health Midlands Community Hosp.
Friend, Warren Memorial Hospital                       Pawnee City, Pawnee County Memorial Hospital
Geneva, Fillmore County Hospital                       Pender, Pender Community Hospital
Genoa, Genoa Community Hospital                        Plainview, Plainview Public Hospital
Gordon, Gordon Memorial Hospital District              Red Cloud, Webster County Community Hospital
Gothenburg, Gothenburg Memorial Hospital               Sargent, Goli Medical Center
Grand Island, St. Francis Medical Center               Schuyler, Alegent Health-Memorial Hospital
Grand Island, Veterans Administration Medical Ctr      Scottsbluff, Regional West Medical Center
Grant, Perkins County Health Services                  Scottsbluff, Western Pathology Consultants
Hastings, Mary Lanning Memorial Hospital               Seward, Memorial Hospital
Hebron, Thayer County Memorial Hospital                Sidney, Memorial Health Center
Henderson, Henderson Health Care Services              St. Paul, Howard County Community Hospital
Holdrege, Phelps Memorial Health Center                Superior, Brodstone Memorial Nuckolls Cnty Hosp.
Humboldt, Community Memorial Hospital, Inc.            Syracuse, Community Memorial Hospital
Imperial, Chase County Community Hospital              Tecumseh, Johnson County Hospital
Kearney, Good Samaritan Hospital                       Tilden, Tilden Community Hospital
Kearney, Good Samaritan Hospital Pathology             Valentine, Cherry County Hospital
Kimball, Kimball County Hospital                       Wahoo, Saunders County Community Hospital
Lexington, Tri-County Area Hospital District           Wayne, Providence Medical Center
Lincoln, Bryan Memorial Hospital                       West Point, St. Francis Memorial Hospital
Lincoln, Bryan LGH West                                Winnebago, U.S. Public Health Services Hospital
Lincoln, Saint Elizabeth Comm. Health Center           York, York General Hospital
Lincoln, Veterans Administration Medical Center
Lincoln, Pathology Medical Services                    Other States:
Lynch, Niobrara Valley Hospital Corp.                  Rapid City, SD, Rapid City Regional Hospital
McCook, Community Hospital                             Sioux Falls, SD, Sioux Valley Hospital
Minden, Kearney County Health Services-Hospital        Yankton, SD, Sacred Heart Hospital
Nebraska City, St. Mary's Hospital                     Sioux City, IA, Marian Health Center
Neligh, Antelope Memorial Hospital                     Sioux City, IA, St. Luke's Hospital
Norfolk, Faith Regional Health Services                State Cancer Registries of Missouri, Colorado, Iowa
                                                       and Wyoming

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:22
posted:8/12/2011
language:English
pages:69