December 2002 volume 18 number 12 Division of Public Health http://health.state.ga.us Kathleen E. Toomey, M.D., M.P.H. Director State Health Officer Epidemiology Branch http://health.state.ga.us/epi Paul A. Blake, M.D., M.P.H. Director State Epidemiologist Mel Ralston Public Health Advisor Georgia Epidemiology Report Editorial Board Carol A. Hoban, M.S., M.P.H. - Editor Kathryn E. Arnold, M.D. Paul A. Blake, M.D., M.P.H. Susan Lance-Parker, D.V.M., Ph.D. Kathleen E. Toomey, M.D., M.P.H. Angela Alexander - Mailing List Jimmy Clanton, Jr. - Graphic Designer Highlights from the Georgia Childhood Cancer Report 2002 Introduction Cancer is the third most common cause of death among children between 1 and 19 years of age, accounting for 6% of childhood mortality in Georgia in 1999 (Figure 1). The most common forms of childhood cancer, leukemias, central nervous system (CNS) neoplasms, and lymphomas account for almost 50% of all childhood cancer diagnoses and over 60% of childhood cancer deaths (Table 1). The Georgia Childhood Cancer Report 2002 was written to assist health professionals, volunteers, and staff of cancer control organizations, community groups, and others who are working to reduce the burden of cancer throughout Georgia. The full report is available at http://www.ph.state.ga.us/pdfs/chronic/cancer/childcancer.02.pdf. Figure 1. Childhood Mortality by Cause, Ages 1 to 19 Years, Georgia, 1999 (n=901) Homicide 11% (n=98) Cancer 6% (n=58) Suicide 6% (n=58) Heart Disease 5% (n=41) Congenital Malformations 4% (n=38) Unintentional Injuries 47% (n=419) Other 21% (n=189) Table 1. Incidence vs Mortality for the Top Three Cancer Sites in Children Ages 0 to 19 Years in Georgia Georgia Department of Human Resources Division of Public Health Epidemiology Branch Two Peachtree St., N.W. Atlanta, GA 30303-3186 Phone: (404) 657-2588 Fax: (404) 657-7517 Please send comments to: Gaepinfo@dhr.state.ga.us The Georgia Epidemiology Report is a publication of the Epidemiology Branch, Division of Public Health, Georgia Department of Human Resources Leukemia CNS Cancer Lymphoma Incidence % of Cases Cases* 22% 75 15% 50 12% 40 Mortality % of Deaths Deaths 30% 16 23% 12 8% 4 *Estimated cases per year in Georgia. Figures have been rounded to the nearest five. The Georgia Epidemiology Report Via E-Mail To better serve our readers and reduce expenses, we would like to know if you would prefer to receive the GER by e-mail as a readable PDF file starting in 2003. If yes, please send your name and e-mail address to Gaepinfo@dhr.state.ga.us. Methods The counties with the most complete long-term cancer incidence data were included in the incidence analysis. They include the five counties in Metro Atlanta and the ten rural counties served by the Surveillance, Epidemiology, and End Results (SEER) Program and the eleven counties that were originally part of the Savannah River Region Health Information System (SRRHIS) (Figure 2). These counties represent 45% of the total population in Georgia. Figure 2. Georgia Counties Included in the Childhood Cancer Incidence Analysis SEER Metro Atlanta Counties SEER Rural Counties SRRHIS Counties SEER Metro Atlanta Counties: Clayton, Cobb, Dekalb, Fulton, and Gwinnett. SEER Rural Counties: Glascock, Greene, Hancock, Jasper, Jefferson, Morgan, Putnam, Taliaferro, Warren, and Washington. SRRHIS Counties: Bryan, Bulloch, Burke, Chatham, Columbia, Effingham, Evans, Jefferson, Jenkins, McDuffie, Richmond, and Screven. Results Childhood Cancer Incidence in Georgia (Selected Counties) Childhood Cancer Mortality in Georgia Between 1993 and 1997, there were 729 cancer diagnoses among chil- Between 1990 and 1999, there were 523 cancer deaths among Georgia's dren aged 0 to 19 years living in Georgia's SEER and SRRHIS counties. children aged 0 to 19 years. The age-adjusted rate for this time period The age-adjusted incidence rate for this time period was 154.2 per was 24.9 per 1,000,000. 1,000,000. The highest cancer mortality rate (7.5 per 1,000,000) among children The highest cancer incidence rate (34.2 per 1,000,000) among children aged 0 to 19 years was for leukemia, followed by CNS neoplasms with a aged 0 to 19 years was leukemia, followed by CNS neoplasms with a rate of 5.6 per 1,000,000. rate of 23.5 per 1,000,000. Overall, males had a slightly higher cancer mortality rate than females. Overall, males had a higher cancer incidence rate than females. This This difference was most apparent in the 15 to 19 year old age group. difference was most apparent in leukemias, lymphomas, and soft tissue Cancer mortality increased with age, with the 15 to 19 year old age sarcomas. group having the highest number of cancer deaths among children for Children aged 0 to 4 years were most likely to be diagnosed with most cancer types. leukemias, neuroblastomas, or renal tumors. Children aged 15 to 19 Mortality rates for all childhood cancers combined decreased steadily years were more likely to be diagnosed with lymphomas, especially Hodgkin's lymphoma. from 1979 to 1999 in Georgia (Figure 4). This decrease results from improvements in survival for most childhood cancers, especially leuke- Incidence rates for all childhood cancers combined increased steadily mia and lymphoma. from 1975 to 1998 in Metro Atlanta (Figure 3). At least some of this increase is due to changes in diagnostic technology, reporting, and classification. -2 - Rate per 1,000,000 Figure 3. Childhood Cancer Incidence Rates* Metro Atlanta, All Sites, Ages 0 to 19, 1975-1998 200.0 180.0 160.0 140.0 120.0 100.0 80.0 60.0 EAPC**=1.4% 40.0 20.0 0.0 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 199 Year of Diagnosis * Rate per 1,000,000, age-adjusted to the 1970 US standard population **Estimated Annual Percent Change Figure 4. Childhood Cancer Mortality Rates* Georgia, All Sites, Ages 0 to 19, 1979-1999 60.0 50.0 Rate per 1,000,000 40.0 30.0 20.0 ICD-9 ICD-10 10.0 EAPC**=-0.6% 0.0 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 Year of Death * Rate per 1,000,000, age-adjusted to the 1970 US standard population **Estimated Annual Percent Change Conclusion Childhood cancers are uncommon but they remain an important public recent decades, the treatment of childhood cancers has improved health issue. The information in the Georgia Childhood Cancer Report markedly. Presently more than 75% of children with cancer survive 5 2002 summarizes current incidence and mortality rates for childhood can- years or more. National estimates suggest that about 20% of children cers in Georgia. It also provides short summaries about what is known with cancer may not receive the most appropriate treatment. about the more common types of childhood cancers. The information will be useful to many individuals concerned about cancer such as public health Improve the quality of information about childhood cancer in Georgia. Presently, workers, health care providers, volunteer workers and groups, and families and friends of children with cancer. The report also calls attention to needed actions. accurate and reliable information about childhood cancer in Georgia is available for only the 26 counties included in this report. The quality of information reported by hospitals and other cancer care To reduce the incidence and mortality from childhood cancers, several steps are being taken: providers to the Georgia Comprehensive Cancer Registry varies across the state but is improving. Efforts to achieve accurate and reliable information from the entire state are in progress. Search for causes so that childhood cancer can be prevented. The cause or Thus, by participating in the search for causes, by assuring access to appro- causes of most childhood cancers are unknown, making preventive priate treatment, and by improving the quality of information contained in actions impossible. The search for causes is difficult because the the Georgia Comprehensive Cancer Registry, Georgians will be participatcancers are rare. Efforts are underway to pool information from ing in efforts to reduce the burden of childhood cancers, a group of states with high quality cancer registries for the purposes of research. uncommon but devastating illnesses. Georgia will participate in these group research projects. This article was written by Chrissy McNamara, M.S.P.H., A. Rana Bayakly, Assure that every child with cancer in Georgia has access to the best treatment. In M.P.H., and Kenneth E. Powell, M.D., M.P.H. -3 - The Georgia Epidemiology Report Epidemiology Branch Two Peachtree St., NW Atlanta, GA 30303-3186 PRESORTED STANDARD U.S. POSTAGE PAID ATLANTA, GA PERMIT NO. 4528 December 2002 Volume 18 Number 12 Reported Cases of Selected Notifiable Diseases in Georgia Profile* for September 2002 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 September 2002 2002 31 1312 5 1 43 778 2 7 0 2 0 2 0 1 0 182 60 5 14 28 10 0 11 Previous 3 Months Total Ending in September 2000 2001 2002 181 220 162 7825 8555 6185 79 61 34 23 13 13 382 305 240 5529 5080 3609 7 16 10 127 289 69 100 128 34 1 2 4 0 1 0 6 8 5 0 1 0 17 6 4 1 0 0 680 716 712 94 145 287 29 32 19 89 78 61 119 136 125 198 200 81 9 6 0 178 120 98 Previous 12 Months Total Ending in September 2000 2001 2002 634 655 559 27771 31718 31264 190 160 124 51 35 53 1288 1032 829 18805 18428 17270 77 101 96 341 850 538 305 427 354 10 13 13 0 1 1 61 52 39 2 8 3 59 25 15 1 0 0 1786 1677 1779 300 367 1379 127 103 90 305 281 261 559 579 629 728 823 599 23 22 11 674 556 539 * 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: 11/01-10/02 Five Years Ago: 11/97-10/98 Cumulative: 07/81-10/02 Total Cases Reported* <13yrs >=13yrs Total 2 1,658 1,660 6 1,245 1,251 212 25,318 25,530 Percent Female 25.4 19.3 17.7 Risk Group Distribution (%) MSM IDU MSM&IDU HS Blood Unknown 39.4 7.1 2.5 13.8 2.0 35.2 41.4 19.2 5.9 16.1 1.0 16.4 47.6 17.3 5.4 13.4 1.9 14.3 Race Distribution (%) White Black Other 18.4 76.6 5.1 23.6 73.9 2.6 34.0 63.5 2.4 MSM - Men having sex with men IDU - Injection drug users HS - Heterosexual * Case totals are accumulated by date of report to the Epidemiology Section - 4 -