Georgia epidemiology report [Vol. 25, no. 8 (Aug. 2009)]

August 2009

volume 25 number 08

Colorectal Cancer in Georgia

Introduction Colorectal cancer is a collective term for cancers of the colon and rectum. Since these cancers share many common features, they are often grouped as colorectal cancer. The colon and rectum are parts of the digestive system. Together, they form a long, muscular tube called the large intestine. The colon is the first 4 to 5 feet of the large intestine and the last 4 to 5 inches is the rectum.
Colorectal cancers develop slowly over a period of several years. Most of them begin as a polyp, a growth of tissue protruding into the center of the colon or rectum. Polyps are also known as adenomas. Removing the polyp early may prevent it from becoming cancerous. Over 95 percent of colorectal cancers are adenocarcinomas, which arise from cells that line the inside of the colon and the rectum.
Colorectal cancer affects both men and women and often occurs in people over 50 years of age. It is the third most commonly diagnosed cancer and cause of cancer death among Georgia men and women (Table 1). The Georgia Comprehensive Cancer Registry estimates that over 3,700 new cases of colorectal cancer will be diagnosed in 2009 and about 1,300 Georgians will die from this disease.

Risk factor behavior data were obtained from the Behavioral Risk Factor Surveillance System, a state-based surveillance system administered by the Georgia Department of Community Health, Division of Public Health, in collaboration with the CDC.
Incidence and Mortality The overall age-adjusted colorectal cancer incidence rate, 2002-2006, in Georgia, is 49 per 100,000 for males and females combined. The overall age-adjusted colorectal cancer mortality rate, 2002-2006, is 18 per 100,000 in males and females combined.
Males are 40% more likely to be diagnosed with colorectal cancer than females (age-adjusted rate 59/100,000 vs. 42/100,000)
Males are 47% more likely to die of colorectal cancer than females (age-adjusted rate 22/100,000 vs.15/100,000)
In Georgia and the United States (U.S.), black males are more likely than white males to be diagnosed with colorectal cancer. Similarly, black females are more likely than white females to be diagnosed with this disease (Figure 1)
Black males are more likely than white males to die from colorectal cancer in Georgia and the U.S. Similarly, black females are more likely than white females to die from this disease (Figure 2)

Top 5 causes of Cancer Incidence Top 5 Causes of Cancer Mortality

Males

Females

Males

Females

Prostate

Breast

Lung & bronchus

Lung & Bronchus

Lung & Bronchus Lung & Bronchus Prostate

Breast

Colorectal

Colorectal

Colorectal

Colorectal

Bladder

Uterus

Pancreas

Pancreas

Melanoma

Melanoma

Leukemia

Ovary

Rate per 100,000

Figure 1. Age-adjusted Incidence Rate by race and sex, 2002-2006

100

Georgia 2002-2006 United States 2002-2006

69 68
50

57 58

53 52

39 43

Methods The number of cancer cases and incidence rates for the state of Georgia were obtained from the Georgia Comprehensive Cancer Registry (GCCR). The GCCR is a population-based cancer registry that includes all cancer cases diagnosed in Georgia residents since January 1, 1995. GCCR collects, analyzes, uses and disseminates data on cancer. This information is used to assist state agencies, health care providers, and Georgia citizens to monitor cancer incidence trends, plan and implement cancer control and prevention activities, develop public and professional education programs, and stimulate scientific cancer research.
The number of cancer deaths and mortality rates for the state of Georgia were obtained from the Georgia Division of Public Health, Vital Records Branch.

0
Black Males

White Males Black Females White Females

Figure 2. Age-adjusted Mortality Rate by race and sex, 2002-2006

100

Georgia 2002-2006 United States 2002-2006

Rate per 100,000

50 30 31
0 Black Males

20 21

21 22

13 15

White Males Black Females White Females

The Georgia Epidemiology Report via e-mail , see last page for details. Please visit, http://health.state.ga.us/epi/manuals/ger.asp for all current and past pdf issues of the GER.

Figure 3. Rural-Urban counties, Georgia 2003

Figure 4. Age-adjusted Colorectal Cancer Incidence and Mortality Rate by Geography, Georgia, 2002-2006

Incidence

100

Males Females

Rate per 100,000

50 44 33

35 24

43 35

39 27

0
Urban Black
100

Urban White Rural Black
Mortality
Males Females

Rural White

Rate per 100,000

50
30 21

21 14

3301 210

22 14

Rural-urban classification of Georgia counties is fromFtihgeuUre.S5. . Age-Specific Col0orectal Cancer Incidence and Mortality Rates by Sex, Georgia 200

Department of Agriculture, Economic Research Service. The

Urban Black Urban White Rural Black Rural White

classification is based on the county's population and its proximity to a

metropolitan county.

Figure 5. Age-Specific Colorectal Cancer IncidencMeaalnedsMortality Rates by Sex, Georgia 200

Urban vs. Rural Georgia Based on definitions from the U.S. Department of Agriculture, Georgia has 89 rural counties and 70 urban counties (Figure 3). The Georgia Comprehensive Cancer Registry further analyzed the colorectal cancer incidence and mortality by rural/urban location (Figure 4).
Colorectal cancer incidence and mortality rates are significantly higher among urban black males and females than among urban white males and females
Incidence and mortality rates are not significantly different between rural black males and rural white males
Incidence and mortality rates are significantly higher among rural black females than among rural white females

Rate per 100,000Rate per 100,000

Figu50r0e 5. Age-Specific CInocliodreenccetal CMoarntaclietyr Incidence and Mortality Rates by Sex, Georgia 2002-2006

400

373

Males

300

271

500

Incidence Mortality

217

200

Males 168

400

100

300

21

0

22 7

77 23

107 373 58
271 217

200 0-39

40-49

50-59 16680-69

70-79

80+

107

100

77

58

21 0

22 7

23

Females

0-39

40-49 50-59 60-69 70-79

80+

Age at Diagnosis

500

In Georgia the incidence and mortality rates of colorectal cancer

increase with age for both males and females (Figure 5)

400

Incidence Mortality
FeFmemaaleless

Rate per 100,000Rate per 100,000

The risk of being diagnosed with colorectal cancer increases

300

267

sharply between ages 50-59 years for both males and females

500 200

Incidence Mortality

194

147

Similarly, the risk of dying from colorectal cancer increases sharply between ages 50-59 years for both males and females

400 100

300

21

0

19 6

58 16

109 34

79 267

Fewer than 65 cases and 35 deaths due to colorectal cancer

200

0-39

40-49

50-59

60-69 19740-79

8104+7

occur each year in individuals less than 40 years of age

109

100

-2 -

21 0

19 6

58 16

34

79

0-39

40-49 50-59 60-69 70-79

80+

gure 6. Colorectal Cancer Five-Year Survival Rates by Sex, Race and Stage, United States, 999-2005

Figure 6. Colorectal Cancer Five-Year Survival Rates by Sex, Race and Stage, United States, 1999-2005

100

91 91

Males

65 65

70 69

Females

50

Figure 7. Percent of Adults age 50+, who ever had a Sigmoidoscopy/Colonoscopy, by Sex, Georgia 2002-2008
100

56

57

50

Percent

Percent

11 12
0
All Stages Localized Regional Distant

0 Males

Females

100

92859187

White Males

Black Males

66 66 56 57

70 70

White Females

63 63 Black Females

50

Figure 8. Percent of Adults age 50+, who had a Fecal Occult Blood Test (FOBT) in the past 12 months, by Sex, Georgia 2002-2008
100

51

50

42

Percent

Percent

11 7 13 9

0 All Stages Localized Regional

Distant

0 Males

Females

Survival Early detection saves lives. Individuals diagnosed at an early stage (localized) have a better chance of surviving five years after diagnosis than those diagnosed at a later stage (Regional and Distant) (Figure 6).
Overall, five-year survival rate is 65% for both males and females for all stages. However, when detected at a localized stage the five-year survival rate increases to 91%
Overall, the five-year survival rates for white males and females (66% each) for all stages are higher than those for blacks (56% for males, 57% for females)
Black males and females diagnosed at a localized stage have a lower five-year survival rate than do their white counterparts (85% and 87% vs. 92% and 91% respectively)
Five-year survival rates drop significantly for all individuals when diagnosed at a distant stage
Screening and Detection Treatment is more likely to be successful if colorectal cancers are detected early. Several screening tests are available to detect the disease. Most people who develop colorectal cancer do not have identifiable risk factors, and are considered to be at average risk. The American Cancer Society recommends that people at an average risk for colorectal cancer should begin screening at age 50.
Screening options Tests that find polyps and cancer:
Flexible Sigmoidoscopy every 5 years; Double contrast barium enema every 5 years;

CT colonography (virtual colonoscopy) every 5 years; or Colonoscopy every 10 years.
Tests that mainly find cancer: Fecal occult blood test every year (FOBT)* ; Fecal immunochemical test every year (FIT)*; and Stool DNA test (sDNA), interval uncertain.
*For FOBT or FIT used as a screening test, the take-home multiple sample method should be used.
People at increased risk of developing colorectal cancer include those with personal or family history of colorectal cancer, those with colorectal cancer symptoms, or those who already have inflammatory bowel disease or certain genetic conditions. It is recommended that people at increased risk begin screening at an earlier age; undergo screening more frequently; and receive specialized medical care (Centers for Disease Control and Prevention www.cdc.gov/pcd/issues/2008/ apr/07_0206.htm).
Based on the Georgia Behavioral Risk Factor Surveillance System (BRFSS) data from 2002-2008:
The overall percent of screening by sigmoidoscopy /colonoscopy is similar for both men and women 50 years of age and older (Figure 7)
Among adults aged 50 years of age and older, a significantly higher percentage of males than females reported having received a Fecal Occult Blood test in the past 12 months (Figure 8)

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Mortality Trends

The age-adjusted colorectal cancer mortality rate has been decreasing in

the rate decreased by 2.2% for both black and white males

the U.S. and Georgia. However, the annual average decrease is different Mortality rates among white females have been generally lower

by race and sex (Figures 9 and 10).

than those in black females, both in Georgia and in the U.S.

FFirgoumre199.8A0geto-a2d0ju0s5t,etdhCeoUlo.Sre. ccotalloCreacntcael rcaMnocretralmityorRtaatleityamraotneg Males by RacFer,oGmeo1r9g8ia0(t1o98200-02050t6h)evcso. lUonreitcetdalSctaantecser(1m98o0r-t2a0li0t5y)rate decreased

decreased at an average rate of 0.2% annually for black males and

by 0.7% for U.S. black females and 2% for U.S. white females,

1.96 % for white males

whereas in Georgia there was a slight increase of 0.5% among



50In

Georgia

from

US Black Males
1980 to 2006, the

US White Males
colorectal cancer mortality

GA BlackblMacaklefesmales aGndAdWechrietaeseMoafle1s.2% among white females

rate increased at an annual average rate of 1.9% for black males 40while it decreased by 0.76% for white males

Since 2000, there has been a decrease in colorectal cancer mortality among females for both U.S and Georgia (2.4% in U.S.

Rate per 100,000

Since 2000, the colorectal cancer mortality rate decreased by 3%

black females, 3.7% in U.S. white females vs. 3.3% in Georgia

30for U.S. black males and 3.5% for U.S. white males; in Georgia

black females and 1.7% in Georgia white females)

Figure 9. Age-adjusted Colorectal Cancer Mortality Rate among Males by Race, Georgia (1980-2006) vs. United States (1980-2005)

20 Figure 9. Age-adjusted Colorectal Cancer Mortality Rate among Males by Race, Georgia (1980-2006) vs. U.S. (1980-2005)

50

US Black Males

US White Males

GA Black Males

GA White Males

10 40

0 30

2006

2005

2004

2003

2002

2001

2000

1999

1998

1997

1996

1995

1994

1993

1992

1991

1990

1989

1988

1987

1986

1985

1984

1983

1982

1981

1980

Rate per 100,000

20

10

2006

2005

2004

2003

2002

2001

2000

1999

1998

1997

1996

1995

1994

1993

1992

1991

1990

1989

1988

1987

1986

1985

1984

1983

1982

1981

1980

0 Figure 10. Age-adjusted Colorectal Cancer Mortality Rate among Females by Race, Georgia (1980-2006) vs. United States (1980-2005)

Figure 10. Age-adjusted Colorectal Cancer Mortality Rate among Females by Race, Georgia (1980-2006) vs. U.S. (1980-2005)

50

US Black Females

US White Females

GA Black Females

GA White Females

Rate per 100,000

40 3F0igure 10. Age-adjusted Colorectal Cancer Mortality Rate among Females by Race, Georgia (1980-2006) vs. United States (1980-2005)

20 10 50

US Black Females

US White Females

GA Black Females

GA White Females

2006

2005

2004

2003

2002

2001

2000

1999

1998

1997

1996

1995

1994

1993

1992

1991

1990

1989

1988

1987

1986

1985

1984

1983

1982

1981

1980

Rate per 100,000

0 40 30

Definitio2n0

malignant cancer either (1) has extended beyond the limits of the organ

Age-adjusted rate: A rate calculated in a manner that allows for

of origin directly into surrounding organs or tissue, or (2) involves

the com10parison of rates derived from populations with different age

regional lymph nodes by way of lymphatic system, or (3) has both regional

structures Cancer0incidence rate: The number of new cancer cases occurring

extension and involvement of regional lymph nodes. Distant stage includes malignant cancer that has spread to parts of the body remote

2006

2005

2004

2003

2002

2001

2000

1999

1998

1997

1996

1995

1994

1993

1992

1991

1990

1989

1988

1987

1986

1985

1984

1983

1982

1981

1980

in a population during a specified period of time. Often expressed per

from the primary tumor either by direct extension, or by metastasis to

100,000 population

distant organs or tissues, or via the lymphatic system to distant lymph

Cancer mortality rate: The number of cancer deaths occurring in

nodes

a population during a specified period of time. Often expressed per

Rural-Urban Classification: The rural urban classification of Georgia

100,000 population

counties was based on the 2003 Rural-Urban Continuum Codes from the

Risk factor: A behavior, characteristic, or finding on clinical

United States Department of Agriculture, Economic Research Service.

examination that is consistently associated with increased probability of

Information about the Rural-Urban Continuum Codes can be retrieved

a disease or complications from the disease

from http://www.ers.usda.gov/Data/RuralUrbanContinuumCodes/

Cancer Stages: Local stage includes an invasive malignant cancer confined entirely to the organ of origin. Regional stage is where the

This article was written by Deepali Rane, MBBS, MPH, Rana Bayakly, MPH, Aimee Pragle, MPH.

Division of Public Health http://health.state.ga.us
Please send comments to: gaepinfo@dhr.state.ga.us

Rhonda M. Medows, M.D., F.A.A.F.P. Acting Director, State Health Officer
Cherie Drenzek, D.V.M., M.S. Director, Acute Disease Epi Section

Georgia Epidemiology Report Editorial Board
Carol A. Hoban, M.P.H., Ph.D. Editor Kathryn E. Arnold, M.D.
Cherie Drenzek, D.V.M., M.S.
Angela Alexander - Mailing List Jimmy Clanton, Jr. - Graphic Designer

Two Peachtree St., N.W., Atlanta, GA 30303-3186 Phone: (404) 657-2588 | Fax: (404) 657-7517

The Georgia Epidemiology Report Epidemiology Section Two Peachtree St., NW Atlanta, GA 30303-3186
Providers can contact Public Health IMMEDIATELY 24 hours a day, 7 days a week, by calling: 1-866-PUB-HLTH (1-866-782-4584) to report immediately notifiable diseases and public health emergencies
August 2009

Due to the rising costs of printing and mailing the GER to over 30,000 subscribers, we are switching to an electronic version of the GER. The electronic version will be available as a portable document format (pdf ) file on the Division of Public Health web site, http://www.health.state.ga.us/epi/manuals/ger.asp. We will send an e-mail notification to all subscribers when the monthly GER has been posted to the web site. This will enable us to continue distributing the GER to all of our subscribers.
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We look forward to continuing to provide you with important public health information in Georgia.
Volume25Number08

Reported Cases of Selected Notifiable Diseases in Georgia, Profile* for May 2009

Selected Notifiable Diseases
Campylobacteriosis Chlamydia trachomatis Cryptosporidiosis E. coli O157:H7 Giardiasis Gonorrhea Haemophilus influenzae (invasive) Hepatitis A (acute) Hepatitis B (acute) Legionellosis Lyme Disease Meningococcal Disease (invasive) Mumps Pertussis Rubella Salmonellosis Shigellosis Syphilis - Primary Syphilis - Secondary Syphilis - Early Latent Syphilis - Other** Syphilis - Congenital Tuberculosis

Total Reported for May 2009
2009 71 3010 29 1 49 1101 6 3 7 6 6 5 0 7 0 171 65 4 65 46 57 0 31

Previous 3 Months Total Ending in May

2007

2008

2009

161

155

187

11051

11061

10743

37

72

88

2

6

5

141

137

173

4489

3963

3502

40

32

47

22

11

9

33

38

34

12

10

11

2

9

9

3

6

12

0

2

0

3

3

37

0

0

0

296

379

370

489

401

159

26

38

42

130

164

188

114

149

174

313

396

202

3

6

1

134

139

100

Previous 12 Months Total Ending in May

2007

2008

2009

587

698

724

41763

42825

42576

272

272

302

37

48

44

689

712

812

19706

17213

15648

124

137

148

69

57

45

180

169

173

49

39

48

9

19

38

18

25

26

3

2

1

28

15

61

0

0

0

1940

2051

2329

1702

1576

761

108

118

175

530

677

805

422

493

621

1075

1354

1101

9

16

8

516

478

422

* The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office, and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia.
** Other syphilis includes latent (unknown duration), late latent, late with symptomatic manifestations, and neurosyphilis.
AIDS Profile Update

Report Period
Latest 12 Months

Disease

Total Cases Reported*

Classification <13yrs

>=13yrs Total

HIV, non-AIDS 12

2,896

2,908

Percent Female MSM

26

31

Risk Group Distribution %

IDU

MSM&IDU HS

Unknown Perinatal White

2

1

4

62

<1

24

Race Distribution %

Black

Hispanic Other

71

4

<1

7/08-06/09 AIDS

1

1,692

1,693

22

34

3

1

6

57

<1

25

68

5

<1

Five Years Ago:**

HIV, non-AIDS 43

2,116

2,159

31

33

10

4

12

40

<1

20

75

3

<1

07/04-06/05 AIDS

8

1,524

1,532

26

34

7

3

13

43

<1

19

76

4

<1

Cumulative: HIV, non-AIDS 226

13,796

13,908

31

29

5

2

10

54

<1

21

74

4

1

07/81-06/09 AIDS

240

34,304

34,544

20

43

14

5

14

24

<1

30

66

3

<1

Yrs - Age at diagnosis in years

MSM - Men having sex with men

IDU - Injection drug users

HS - Heterosexual

* Case totals are accumulated by date of report to the Epidemiology Section ** Due to a change in the surveillance system, case counts may be artificially low during this time period

***HIV, non-AIDS was not collected until 12/31/2003

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