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.
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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
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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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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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