2007-2011
GEORGIA

COLORECTAL CANCER IN

Acknowledgements
Georgia Department of Public Health..................................................................Brenda Fitzgerald, M.D., Commissioner Division of Health Protection...................................................................................J. Patrick O'Neal, M.D., Director Epidemiology Program.................................................Cherie Drenzek, D.V.M., M.S., Director/State Epidemiologist Chronic Disease, Healthy Behaviors, and Injury Epidemiology Section.................A. Rana Bayakly, M.P.H., Chief Georgia Comprehensive Cancer Registry...........................A. Rana Bayakly, M.P.H., Program Director Chrissy McNamara, M.S.P.H., Epidemiologist Victoria Davis, M.P.H., Epidemiologist Irene Solomon, M.P.H., Epidemiologist Division of Health Promotion.................................................................................... Yvette K. Daniels, JD, Director Chronic Disease Prevention Section..............................................Jean O'Connor, JD, MPH, DrPH, Director Georgia Comprehensive Cancer Control Program....................Tamira Moon, M.P.H., C.H.E.S, Manager Georgia Colorectal Cancer Screening Program.......................Melody Brown, RN, BSN, CDE, Manager
We would like to thank all the facilities in Georgia that contributed data to the Georgia Comprehensive Cancer Registry. Without their hard work, this report would not have been possible.
Funding for this research was made possible (in part) by cooperative agreement award number 5/U58/DP003875-03 from the Centers for Disease Control and Prevention and through contract HHSN261201300015I with the National Cancer Institute. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Cancer Institute.
Suggested Citation: Solomon, I., Davis, V., McNamara, C., Bayakly, A., Moon, T. Colorectal Cancer in Georgia, 2007-2011. Georgia Department of Public Health, Health Protection Office, Chronic Disease, Healthy Behaviors, and Injury Epidemiology, November 2014.
2

Figure 1. Anatomy of the Digestive System and Sections of
Colon
Figure 2. Colon Polyp

Introduction
Colorectal cancer is a collective term for cancers of the colon and rectum. Since cancers of the colon and rectum share many common features, they are often referred to 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 four to five feet of the large intestine and the last four to six inches is the rectum (Figure 1).
Once food is chewed and swallowed, it travels through the esophagus to the stomach. In the stomach, it is partially digested and transferred to the small intestine. The small intestine continues digesting the food and absorbs most of the nutrients. The food then travels to the large intestine. The waste then moves from the colon into the rectum and passes out of the body through an opening called the anus during a bowel movement.
The colon consists of 4 sections (Figure 1):
The first section is called the ascending colon. It begins where the small intestine attaches to the colon and extends upward on the right side of the abdomen.
The second section, the transverse colon, runs across the body from right to the left side of the upper abdomen.
The third section, the descending colon, continues downward on the left side.
The fourth section, the sigmoid colon, named because of its S-shape, joins the rectum and the colon.
Colorectal cancers develop slowly over a period of several years. Most of them begin as a non-cancerous polyp, a growth of tissue on the lining of the colon or rectum (Figure 2). Polyps are also known as adenomas. More than 95 percent of colorectal cancers are adenocarcinomas, which arise from cells that line the inside of the colon and the rectum. Removing the polyp early may prevent it from becoming cancerous.
Colorectal cancer affects both men and women and most often occurs in people over 50 years of age. It is the third most commonly diagnosed cancer and cause of cancer death among Georgians. The Georgia Comprehensive Cancer Registry estimates that more than 4,300 new cases of colorectal cancer were diagnosed statewide in 2013 and nearly 1,600 Georgians died from this disease.
3

Causes and Risk Factors
A risk factor is anything that increases the chance of getting a disease such as cancer. Different cancers have different risk factors. Although it is hard to measure the contribution of a risk factor or know the exact cause of precancerous polyps or cancer, some factors may increase the risk of colorectal cancer development. However, some individuals develop colorectal cancer in the absence of any apparent risk factors.
Lifestyle-Related Risk Factors
Diet: A diet high in red meats (beef, pork, lamb or liver), processed meats and animal fat, or a diet low in calcium, fiber and folate may increase the risk of developing colorectal cancer. Also, cooking meats at high temperatures such as frying, grilling or broiling may increase cancer risk. Diets high in vegetables and fruits have been linked with a decreased risk of colorectal cancer. More research is needed to better understand how diet affects colorectal cancer risk.
Physical inactivity: There is a greater chance of developing colorectal cancer if a person is not physically active. Participating in regular physical activity may reduce this risk. To gain substantial health benefits, the U.S. Department of Health and Human Services recommends 2 hours and 30 minutes of moderate-intensity aerobic physical activity each week (i.e. 30 minutes, five times a week) for adults and muscle-strengthening activities on two or more days a week that work all major muscle groups.
Obesity: People who are obese have an increased risk of developing colorectal cancer and an increased risk of dying of colorectal cancer when compared to people who are considered to be at normal weight.
Smoking: Long term smokers are more likely than non-smokers to develop and die from colorectal cancer.
Alcohol consumption: Heavy use of alcohol may increase the risk of developing colorectal cancer. The American Cancer Society recommends that alcohol use should be limited to no more than two drinks per day for men and one drink per day for women.
Diabetes: People with Type 2 diabetes have an increased risk of developing colorectal cancer. They may also have a less favorable prognosis after diagnosis.

Table 1: Prevalence (%) of Colorectal Cancer Risk Factors, Georgia and the United States, 2011

Risk Factors Obesity Smoking Physical Inactivity
Diabetes

All (%) 28 21 27
10

Georgia

Males (%) Females (%)

26

29

24

18

24

30

10

11

All (%) 28 21 26
10

United States

Males (%) Females (%)

28

27

24

19

24

27

10

9

According to the 2011 Behavioral Risk Factor Surveillance System (Table1): The prevalence of obesity, smoking, physical inactivity and diabetes in Georgia is similar to the United States. The prevalence of obesity in Georgia females was greater than in males. Georgia males were significantly more likely to be current smokers than females. Georgia females were significantly more likely to be physically inactive than males. The prevalence of diabetes was similar in Georgia males and females.
4

Risk Factors You Cannot Change Age: The risk of developing polyps and colorectal cancer increase with age. More than 90 percent of people diagnosed with colorectal cancer are older than 50 years of age. Family history: Parents, siblings and children of a person who has had colorectal cancer or adenomatous polyps are more likely to develop colorectal cancer. The risk increases if any first-degree relative is affected at a young age or if more than one first-degree relative is affected. Cancers diagnosed frequently within the same family may also be due to inherited genes, shared exposure to environmental carcinogens, diet or lifestyle factors. Inherited syndromes: Certain genetic syndromes can increase the risk of developing colorectal cancer. These syndromes cause 5-10 percent of all colorectal cancers. The two most common syndromes are familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC). People with FAP develop hundreds or thousands of polyps in their colon and rectum in their teens or early adulthood. Cancer may develop in these polyps as early as age 20. Similar to FAP, HNPCC develops when people are relatively young. However, individuals with HNPCC have fewer polyps and develop colorectal cancer at an average age of 44 years. Racial and ethnic background: African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the United States. The reason for this is not yet understood. Personal history of colorectal cancer or polyps: A person who has had colorectal cancer is more likely to develop new cancers in other areas of the colon or rectum. Some types of polyps, such as adenomatous polyps and hyperplastic polyps, increase the risk of colorectal cancer. Personal history of bowel disease: Inflammatory Bowel Disease (IBD), which includes Ulcerative Colitis and Crohn's disease, is a condition in which the colon is inflamed over a long period of time. People with IBD have an increased risk of developing colorectal cancer and should be screened for colorectal cancer on a more frequent basis.
5

Screening
Colorectal screening is the process of looking for cancer in people who have no symptoms of colorectal cancer. Regular screenings for colorectal cancer can find cancer early (when it is most likely to be curable). Screenings can also prevent colorectal cancer by finding polyps and removing them before they turn cancerous. Tests that are used for screening colorectal cancer can be divided into two groups: Tests that find both colorectal polyps and cancer: These tests look at the structure of the colon to find any abnormal areas.
*Sigmoidoscopy: During this test, a doctor uses a sigmoidoscope to look inside the rectum and the lower section of the colon. The sigmoidoscope is a flexible lighted tube about two feet long with a video camera on the end. Images from the inside of the colon and rectum are displayed on a monitor. The tube is used to detect abnormal growths and if any are found, they are removed for biopsy. The procedure to remove polyps is called polypectomy.
*Standard Colonoscopy: During this test, a colonoscope is used to look inside the entire length of the colon and rectum. The colonoscope is similar to a sigmoidoscope, but is longer. The doctor may also use the colonoscope to assist with the removal of polyps.
Double-contrast barium enema (DCBE): X-ray pictures are taken of the colon and rectum after the patient is given an enema with a barium solution. The barium is used to show an outline of the colon and rectum. This test is rarely used for screening, because it is less sensitive in detecting small polyps and cancers.
CT colonography (virtual colonoscopy): Done every five years based on ACS guidelines, this test is a more advanced form of a computed tomography (CT) scan. The CT scan takes multiple pictures of the colon and then combines all the pictures in order to create a 2-dimensional or 3-dimensional view of the inside of the colon and rectum. This test is considered less invasive than the colonoscopy, however if any abnormalities are found, a colonoscopy may be needed in order to determine if a cancer is present. Currently more studies are being conducted to compare virtual colonoscopy with other screening methods.
*Preferred Tests
6

Tests that find cancer: These tests involve testing the stool (feces) for signs that cancer may be present. These types of tests are considered to be less invasive and easier.
*High-sensitivity fecal occult blood test (FOBT): Damaged blood vessels from polyps or cancers may release a small amount of blood into the feces. The FOBT detects blood in stool that may not be visible. Before the test, certain medications and foods cannot be consumed because they may interfere with the test. The screening test is given as a take home kit and stool samples are taken and returned to a doctor's office for testing. If the test detects blood, a colonoscopy is performed to determine the source. Other conditions such as hemorrhoids or ulcers may also cause blood to be detected.
*Fecal immunochemical test (FIT): This test is also used to detect blood in the stool. The FIT is also performed at home but may be easier to use since there are no medication or dietary restrictions that are required to be followed before taking the test (unlike the FOBT). After the stool samples have been collected, the samples are returned to the doctor's office for testing.
Cologuard: This test is also used to detect blood in the stool and nine DNA biomarkers from three genes associated with colorectal cancer and precancerous advanced adenomas. Colorectal cancer cells may contain DNA mutations in certain genes. These genes can be detected in the stool. People who test positive with this test should undergo a colonoscopy to confirm results. This test has not been incorporated into clinical practice guidelines and is not yet recommended by U.S. Preventive Service Task Force. This test is recommended every three years based on the ACS guidelines.
*Preferred Test
Signs/Symptoms
In the early stages of colorectal cancer, individuals may not have any symptoms. Symptoms usually appear when the disease has advanced. Signs and symptoms of colorectal cancer include:
A change in bowel habits such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days
A feeling that the bowel does not empty completely Rectal bleeding or blood in the stool Persistent cramping or abdominal pain Weakness and fatigue Unexplained weight loss
Other conditions such as hemorrhoids and inflammatory bowel disease (IBD) may also have symptoms that mimic colorectal cancer. If you have any of the above symptoms, it is very important to talk to your doctor because it could be a sign of a serious medical condition such as colorectal cancer.
7

The National Cancer Institute Recommendations for Colorectal
Cancer Early Detection
The National Cancer Institute (NCI) recommends that people at average risk for colorectal cancer should begin screening at age 50 and continue until age 75 as long as their results are negative.
Preferred screening tests include:
Tests that find polyps and cancer Sigmoidoscopy- every five years* Colonoscopy- every 10 years
Tests that mainly find cancer Fecal occult blood test (FOBT)-test every year+ Fecal immunochemical test (FIT)test every year+
Colorectal Cancer Screening guidelines are recommended by the U.S. Preventive Services Task Force (USPSTF) and are used by NCI, BRFSS, and Healthy People 2020.
* The USPSTF recommends sigmoidoscopy every five years along with FOBT every three years for people at average risk who have had negative test results.
+ If FOBT is the only type of colorectal cancer screening test performed, the USPSTF recommends yearly testing.
http://www.cancer.gov

According to the Georgia Behavioral Risk Factor Surveillance System (BRFSS) in 2011:
The percent of colorectal cancer screening among adults who had FOBT in the last year /or sigmoidoscopy in the last five years or colonoscopy in the last 10 years, for women 50-75 years of age was higher when compared to men. (Figure 3) (61 percent of Georgians had colorectal screening in 2011.)
There was no significant difference in colorectal cancer screening by sex and race/ethnicity. (Figure 4)
The Healthy People 2020 target for colorectal screening among adults 50-75 years of age was 70.5 percent. While Georgia colorectal cancer screening prevalence was lower than the Healthy People 2020 Objective of 70.5 percent for adults 50-75 years of age.

Figure 3. Percent of Colorectal Screening* Among Adults 50-75 Years of Age by Sex, Georgia, 2011

100

59

63

50

Average Risk 70.5% HP 2020

Percen t

0 Males Females
*The Colorectal Cancer Screening Recommendation is defined as the percent of adults who had a FOBT in the last year, and/or sigmoidoscopy in the last five years, and/or colonoscopy in the last 10 years.

8

Percent

Figure 4. Percent of Colorectal Screening Among Adults 50-75 Years of Age, by Race/Ethnicity, Georgia, 2011

100

60

60

61

65

50

0 Non-Hispanic Black Males

Non-Hispanic White Males

Non-Hispanic Black Females

Non-Hispanic White Females

Figure 5. Percent of Colorectal Screening* Among Adults 50-75 Years, Georgia, 2011, Percent of Colorectal Screening* Among Adults 50-75 Years Healthy People 2020 Goal, and Percent of Colorectal Screening* Among Adults Over Age 50 Georgia Cancer Plan 2014-2019
100 85
70.5 61 50

Percent

0 Georgia

HP 2020

GCCP 2014-2019

The overall Georgia colorectal cancer screening prevalence (61 percent) was lower than the Healthy People 2020 objective of 70.5 percent for adults age 50-75 years at average risk, as well as lower than the Georgia goal of 85 percent for adults over age 50 by year 2019, based on the Georgia Cancer Plan 2014-2019.

9

Incidence and Mortality
Colorectal cancer is the third most commonly diagnosed cancer and cause of cancer deaths among males and females in Georgia.

Table 2: Georgia Leading Causes of Cancer Incidence (2007-2011) and Mortality (2006-2011*)

Top 5 Causes of Cancer Incidence

Males

Females

Prostate

Breast

Lung & Bronchus

Lung & Bronchus

Colorectal

Colorectal

Bladder

Uterus

Melanoma

Melanoma

Top 5 Causes of Cancer Mortality

Males

Females

Lung & bronchus

Lung & Bronchus

Prostate

Breast

Colorectal

Colorectal

Pancreas

Pancreas

Leukemia

Ovary

*Because of data quality issues, 2009 mortality data are not used for analysis.

From 2007-2011 in Georgia: The overall age-adjusted colorectal cancer incidence rate in Georgia was 43 per 100,000 in males and females combined. Males were 34 percent more likely to be diagnosed with colorectal cancer than females (age-adjusted rate 51/100,000 vs. 38/100,000). The overall age-adjusted colorectal cancer mortality rate in Georgia was 16 per 100,000 in males and females combined. Males were 43 percent more likely to die of colorectal cancer than females (age-adjusted rate 20/100,000 vs. 14/100,000). Georgia colorectal cancer incidence and mortality rates were similar to the United States (U.S.) as a whole. Non-Hispanic (NH) black males were more likely than NH white males to be diagnosed with colorectal cancer in Georgia and the U.S. Similarly, NH black females were more likely than NH white females to be diagnosed with this disease Black males were more likely than white males to die of colorectal cancer in Georgia and the U.S. Similarly, black females were more likely than white females to die of this disease in Georgia and the U.S.

Figure 6. Age-adjusted Colorectal Cancer Incidence Rates by Sex and Race/Ethnicity, Georgia and the U.S., 2007-2011
Georgia United States 80

62 61 60
40

49 49

46 45

35 37

20

Figure 7. Age-adjusted Colorectal Cancer Mortality Rates by Sex and Race, Georgia 2006-2011* and the U.S., 2007-2011
Georgia United States

40

30

29 28

20

10

18 19

19 19

12 13

0

NH Black NH White NH Black NH White

Males

Males

Females Females

0

Black Males White Males Black Females

White 10 Females

*Because of data quality issues, 2009 mortality data are not used for analysis.

Rate per 100,000 Rate per 100,000

Colorectal Incidence Trends

Figure 8. Age-adjusted Colorectal Cancer Incidence Rates Among Males by Race and Ethnicity, Georgia (2000-2011)

Non-Hispanic Black Males

Non-Hispanic White Males

Hispanic Males

Rate per 100,000

90 80 70 60 50 40 30 20 10
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

During 2000-2011: NH white males generally had lower incidence rates than NH black males. Among NH black males, incidence rates declined by 2.7 percent per year during 2000 to 2011. Among NH white males, incidence rates increased by 1.4 percent per year during 2000 to 2002, and significantly declined by 3.4 percent per year from 2002 to 2011. Among Hispanic males, incidence rates declined by 4.6 percent per year during 2001 to 2011.

Figure 9. Age-adjusted Colorectal Cancer Incidence Rates Among Females by Race and Ethnicity, Georgia (2000-2011)

Non-Hispanic Black Females

Non-Hispanic White Females

Hispanic Females

Rate per 100,000

90 80 70 60 50 40 30 20 10
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

During 2000-2011: NH black females had generally higher incidence rates than NH white females. Among NH white females, incidence rates declined by 2.3 percent per year during 2000 to 2011. Among NH black females, incidence rates increased by 2.2 percent per year during 2000 to 2004, and significantly declined by 3.7 percent per year from 2004 to 2011. Among Hispanic females, incidence rates fluctuated due to small numbers. Overall incidence rates declined by 3.2 percent during 2004 to 2011. Incidence rates declined by 5.8 percent per year during 2001 to 2011.

11

Colorectal Incidence Trends
Figure 10. Age-adjusted Colorectal Cancer Incidence Rates Among Males by Age, Georgia (2000-2011)

Males 49 age years

Males 50-64 age years

Males 65+ age years

Rate per 100,000

350 300 250 200 150 100
50 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
*The U.S. Prevention Task Force colorectal cancer screening recommendation was implemented in December 1995.
Among adult males 49 years of age, incidence rates increased by 0.5 percent per year from 2000 (8/100,000) to 2011 (9/100,000).
Among adult males 50-64 years of age, incidence rates declined by 0.5 percent per year from 2000 (106/100,000) to 2008 (104/100,000) and decreased by 5.9 percent per year from 2008 to 2011 (85/100,000).
Among adult males 65+ years of age, incidence rates declined by 3.9 percent per year from 2000 (328/100,000) to 2011 (234/100,000).

Figure 11. Age-adjusted Colorectal Cancer Incidence Rates Among Females by Age, Georgia (2000-2011)

Females 49 age years Females 65+ age years

Females 50-64 age years

Rate per 100,000

250
200
150
100
50
0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
*The U.S. Prevention Task Force colorectal cancer screening recommendation was implemented in December 1995.
Among adult females 49 years of age, incidence rates increased by 1 percent per year during 2000 (6/100,000) to 2011 (7/100,000).
Among adult females 50-64 years of age, incidence rates declined by 1.5 percent per year during 2000 (83/100,000) to 2011 (67/100,000).
Among adult females 65+ years of age, incidence rates declined by 3.2 percent per year during 2000 (224/100,000) to 2011 (167/100,000).
12

Rate per 100,000

Mortality Trends

Figure 12. Age-adjusted Colorectal Cancer Mortality Rates Among Males by Race, Georgia (1990-2011*)

Black Males

White Males

40

ICD-9

35

30

25

20

15

10

5

0

ICD-10

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

*Because of data quality issues, 2009 mortality data are not used for analysis. **The U.S. Prevention Task Force colorectal cancer screening recommendation was implemented in December 1995.

White males generally had lower mortality rates than black males. Among black males, mortality rates fluctuated, however there was an overall decrease of 0.5
percent from 1990 to 2008. Rates appeared to level off in 2010 and 2011. Among white males, mortality rates declined 2.9 percent per year from 1990 to 1999. From 1999
to 2002 mortality rates increased by 4.6 percent per year. From 2002 to 2008 mortality rates declined by 4.5 percent per year, but appeared to level off in 2010 and 2011.

Figure 13. Age-adjusted Colorectal Cancer Mortality Rates Among Females by Race, Georgia (1990-2011*)

Black Females

White Females

Rate per 100,000

30

ICD-9

25

ICD-10

20

15

10

5

0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

*Because of data quality issues, 2009 mortality data are not used for analysis. **The U.S. Prevention Task Force colorectal cancer screening recommendation was implemented in December 1995.

Black females had generally higher mortality rates than white females. Among white females, mortality rates declined by 1.4 percent per year from 1990 to 2008 but
appeared to level off in 2010 and 2011. Among black females, mortality rates declined by 0.5 percent per year during 1990 to 2008 and
continued to decline in 2010 and 2011.

13

Rate per 100,000

Mortality Trends
Figure 14. Age-adjusted Colorectal Cancer Mortality Rates Among Adult Males 30-49 Years of Age, and Adult Females 35-49 Years of Age, Georgia (1990-2011*)

Males 30-49 age years

Females 35-49 age years

2.5

ICD-9

ICD-10

2

1.5

1

0.5

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 *Because of data quality issues, 2009 mortality data are not used for analysis.

Among adult males 30-49 years of age, mortality rates increased by 0.1 percent per year during 1990 to 2008 but appeared to level off in 2010 and 2011.
Among adult females 35-49 years of age, mortality rates increased by 0.9 percent per year during 1990 to 2008 but appeared to level off in 2010 and 2011.

Rate per 100,000

Figure 15. Age-adjusted Colorectal Cancer Mortality Rates Among Adults 50-64 Years of Age, by Sex,

Georgia (1990-2011*)

Males 50-64 age years

Females 50-64 age years

40

ICD-9

35

30

25

20

15

10

5

0

ICD-10

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 *Because of data quality issues, 2009 mortality data are not used for analysis.

Among adult males 50-64 years of age, mortality rates declined by 0.6 percent per year during 1990 to 2008 but appeared to level off in 2010 and 2011.
Among adult females 50-64 years of age, mortality rates declined by 0.6 percent per year during 1990 to 2008 and this trend appeared to continue through 2011.

14

Rate per 100,000

Figure 16. Age-adjusted Colorectal Cancer Mortality Rates Among Adults 65+ Years of Age, by Sex,

Georgia (1990-2011*)

Males 65+ age years

Females 65+ age years

200

ICD-9

ICD-10

150

100

50

0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
*Because of data quality issues, 2009 mortality data are not used for analysis.
Among adult males 65+ years of age, mortality rates declined by 3.0 percent per year during 1990 to1998. Mortality rates increased by 2.9 percent per year during 1998-2002. Mortality rates declined by 4.8 percent per year from 2002 to 2008. This trend appeared to continue through 2011.
Among adult females 65+ years of age, mortality rates declined by 1.5 percent per year during 1990 to 2008 and this trend appeared to continue through 2011.

15

Survival

Staging is a standardized way to summarize information about how far a cancer has spread and helps determine a treatment plan. The TNM staging system is used at hospitals to guide treatment options, however, many central cancer registries, such as the Georgia Comprehensive Cancer Registry and the National Program of Cancer Registries (NPCR) use SEER summary stage for surveillance purposes, categorizing cancer into these groups:
Localized: Cancer that is confined to the organ where it started. Regional: Cancer that has spread from its primary site to nearby lymph nodes or organs. Distant: Cancer that has spread from its primary site to distant organs or lymph nodes. Also referred to
as distant metastasis.
During 2004-2010, the overall five-year colorectal cancer survival rate among Georgians was 64 percent. [If the cancer was discovered at a local stage, the survival rate is 88 percent, however the survival rate is only 68 percent when discovered at a regional stage and 12 percent when discovered at a distant stage.]
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 (Figures 17 and 18).

Figure 17. Colorectal Cancer Five-Year Survival Rates by Race and Stage, Males, Georgia, 20042010

Figure 18. Colorectal Cancer Five-Year Survival Rates by Race and Stage, Females, Georgia, 20042010

100

89 87

90

80

70

60

50

40

30

20

10

0

Localized

% of tumors found at this stage*

Black
Males White Males

69 64
Regional Localized 39% 41%

Black Males White Males

9 12

Distant

Regional Distant

33%

25%

37%

20%

100 90

86 89

80

70

60

50

40

30

20

10

0

Localized

71 65 Regional

Black Females White Females
11 14 Distant

Localized Regional Distant

% of tumors found at this stage*

Black

40%

Females

White

40%

Females

32%

24%

38%

19%

*Unstaged tumors are not shown.

*Unstaged tumors are not shown.

Percent Percent

During 2004-2010, 53 percent of colorectal cancers were diagnosed at a late stage (regional and distant while only 43 percent were diagnosed early (local).
The five-year survival rates for white males (64 percent) for all stages was higher than those for black males (59 percent)
The five-year survival rates for white females (66 percent) for all stages was higher than those for black females (60 percent).
However, the five-year survival rate for black males (89 percent) at the localized stage was higher than white males (87 percent) (Figure 17).
Five-year survival rates dropped significantly for individuals when diagnosed at the distant stage.
16

Incidence and Mortality, By Geographic Location
Figure 19. Age-adjusted Colorectal Cancer Incidence Rates Among Males, by Public Health District, Georgia, 2007-2011
According to the Georgia Comprehensive Cancer Registry, during 2007-2011: The Southwest (8-2) Public Health District had a significantly higher colorectal cancer incidence
rate among males than the state as a whole. The North Georgia (1-2) and South Central (5-1) Public Health Districts had significantly lower
colorectal cancer incidence rates among males than the state as a whole. Figure 20. Age-adjusted Colorectal Cancer Incidence Rates Among Females, by Public Health District, Georgia, 2007-2011

According to the Georgia Comprehensive Cancer Registry, during 2007-2011:

The West Central (7) Public Health District had a significantly higher colorectal cancer incidence

rate among females than the state as a whole.

The North Georgia (1-2) and Southeast (9-2) Public Health Districts had significantly lower

colorectal cancer incidence rates among females than the state as a whole.

17

Figure 21. Age-adjusted Colorectal Cancer Mortality Rates Among Males, by Public Health District, Georgia, 2006-2011*
*Note: 2009 death data were excluded from the analysis due to data reliability
According to the Georgia Vital Records Data, during 2006-2011: The East Central (6) and West Central (7) Public Health Districts had significantly higher colorectal
cancer death rates among males than the state as a whole. The North Georgia (1-2), Cobb-Douglas (3-1), and South Central (5-1) Public Health Districts had
significantly lower colorectal cancer death rates among males than the state as a whole. Figure 22. Age-adjusted Colorectal Cancer Mortality Rates Among Females, by Public Health District, Georgia, 2006-2011*
*Note: 2009 death data were excluded from the analysis due to data reliability
According to the Georgia Vital Records Data, during 2006-2011: No Public Health Districts had significantly higher colorectal cancer death rates among females than
the state as a whole. The North Georgia (1-2) Public Health District had a significantly lower colorectal cancer death rate
18
among females than the state as a whole.

Figure 23. Age-adjusted Colorectal Cancer Incidence Rates Among Males, by County, Georgia, 2007-2011
According to the Georgia Comprehensive Cancer Registry, during 2007-2011: Wilkes, Heard, Jefferson, Franklin, Banks, Tattnall, Meriwether, Wayne, Bartow and Muscogee Counties
had significantly higher colorectal cancer incidence rate among males than the state as a whole. Gwinnett, Fayette, Columbia, Cherokee, Union and Oconee Counties had significantly lower colorectal
cancer incidence rates among males than the state as a whole. Figure 24. Age-adjusted Colorectal Cancer Incidence Rates Among Females, by County, Georgia, 2007-2011
According to the Georgia Comprehensive Cancer Registry, during 2007-2011: Terrell, Spalding, Muscogee, Jackson, Douglas, Burke, Bibb and Bartow Counties had significantly
higher colorectal cancer incidence rate among females than the state as a whole. Ware, Walker, Union, Gwinnett, Columbia, Colquitt, Cobb, Chattooga, Bulloch and Barrow Counties
had significantly lower colorectal cancer incidence rates among females than the state as a whole.
19

Figure 25. Age-adjusted Colorectal Cancer Mortality Rates Among Males, by County, Georgia, 2006-2011*

*Note: 2009 death data were excluded from the analysis due to data reliability
According to the Georgia Vital Records Data, during 2006-2011: Greene, McDuffie, Emanuel, Bibb, Carroll and Muscogee Counties had significantly higher colorectal
cancer incidence rates among males than the state as a whole. Cobb, Hall, Cherokee and Fayette Counties had significantly lower colorectal cancer incidence rates
among males than the state as a whole.
Figure 26. Age-adjusted Colorectal Cancer Mortality Rates Among Females, by County, Georgia, 2006-2011*

*Note: 2009 death data were excluded from the analysis due to data reliability

According to the Georgia Vital Records Data, during 2006-2011:

Troup, Monroe and Bibb Counties had significantly higher colorectal cancer incidence rates among

females than the state as a whole.

Cherokee and Whitfield counties had significantly lower colorectal cancer incidence rates among

females than the state as a whole.

20



Figure 27. Percent of Late Stage* Colorectal Cancer Incidence by Public Health District, Males 50-64 Years of Age, Georgia, 2007-2011

*Late Stage is defined as Regional or Distant at time of diagnosis.

Figure 28. Percent of Late Stage* Colorectal Cancer Incidence by Public Health District, Non-Hispanic Black Males 50-64 Years of Age, Georgia, 2007-2011

Figure 29. Percent of Late Stage* Colorectal Cancer Incidence by Public Health District, Non-Hispanic White Males 50-64 Years of Age, Georgia, 2007-2011

*Late Stage is defined as Regional or Distant at time of diagnosis.

*Late Stage is defined as Regional or Distant at time of diagnosis.

According to Figures 27, 28 and 29, during 2007-2011 in Georgia:

Fulton (3-2), East Metro (3-4), West Central (7), Southwest (8-2) and Northeast (10) Public Health Districts had the highest percentage of adult males age 50-64 who were diagnosed at late stage.

Clayton (3-3), DeKalb (3-5), South Central (5-1), North Central (5-2) and South (8-1) Public Health Districts had the lowest percentage of adult males age 50-64 who were diagnosed at late stage.

North Georgia (1-2), LaGrange (4) and Northeast (10) Public Health Districts had the highest percentage of black adult males age 50-64 who were diagnosed at late stage.
Northwest (1-1), North (2), South Central (5-1), North Central (5-2), West Central (7) and South (8-1) Public Health Districts had the lowest percentage of black adult males age 50-64 who were diagnosed at late stage.

West Central (7), Southwest (8-2) and Northeast (10) Public Health Districts had the highest

percentage of white adult males age 50-64 who were diagnosed at late stage.

Clayton (3-3), DeKalb (3-5), South Central (5-1) and North Central (5-2) Public Health Districts had

the lowest percentage of white adult males age 50-64 who were diagnosed at late stage.

21

Figure 30. Percent of Late Stage* Colorectal Cancer Incidence by Public Health District, Females 50-64 Years of Age, Georgia, 2007-2011

*Late Stage is defined as Regional or Distant at time of diagnosis.

Figure 31. Percent of Late Stage* Colorectal Cancer

Figure 32. Percent of Late Stage* Colorectal Cancer

Incidence by Public Health District, Non-Hispanic Black Incidence by Public Health District, Non-Hispanic White

Females 50-64 Years of Age, Georgia, 2007-2011

Females 50-64 Years of Age, Georgia, 2007-2011

*Late Stage is defined as Regional or Distant at

*Late Stage is defined as Regional or Distant at

time of diagnosis.

time of diagnosis.

According to Figures 30, 31 and 32, during 2007-2011 in Georgia:

Northwest (1-1), Cobb-Douglas (3-1), East Metro (3-4), Northeast (10) and West Central (7) Public

Health Districts had the highest percentage of adult females age 50-64 who were diagnosed at late stage.

Clayton (3-3), DeKalb (3-5), South Central (5-1) and North Central (5-2) Public Health Districts had the

lowest percentage of adult females age 50-64 who were diagnosed at late stage.

Northwest (1-1), North Georgia (1-2), Cobb-Douglas (3-1), East Metro (3-4), South Central (5-1) and Southeast (9-2) Public Health Districts had the highest percentage of black adult females age 50-64 who were diagnosed at late stage.
Clayton (3-3), LaGrange (4), East Central (6), South (8-1) and Southwest (8-2) Public Health Districts had the lowest percentage of black adult females age 50-64 who were diagnosed at late stage.
Northwest (1-1), East Central (6), West Central (7), South (8-1) and Northeast (10) Public Health Districts had the highest percentage of white adult females age 50-64 who were diagnosed at late stage.
Clayton (3-3), DeKalb (3-5), South Central (5-1), North Central (5-2) and Southeast (9-2) Public Health Districts had the lowest percentage of white adult females age 50-64 who were diagnosed at late stage. 22

Figure 33. Metro, Metro Adjacent, and Rural Counties, Georgia, 2013

Rate per 100,000 Rate per 100,000

*For a more specific description, please refer to the technical notes

Figure 34. Age-Adjusted Colorectal Cancer Incidence (2007-2011) by Geography and Sex, Georgia

Figure 35. Age-Adjusted Colorectal Cancer Mortality (2006-2011*) by Geography and Sex, Georgia

Males Females

125

75

49 38

49 39

52 37

55 38

51 37

25

-25 Metro Metro Metro Smaller Rural 1M+ 250K- <250K Urban 1M

Males Females

50 25 18 13

23 15

19 13

20 14

22 14

0

Metro 1M+

Metro 250K-
1M

Metro Smaller Rural <250K Urban

*Note: Because of data quality issues, 2009 mortality data are not used for analysis.

During 2007-2011 in Georgia: Age-adjusted colorectal cancer incidence and mortality rates were consistently higher among males than among females regardless of geographical area. Males living in smaller urban counties had the highest incidence rates. Males living in metropolitan counties (250,000 to 1 million) had the highest mortality rates. Males living in metropolitan counties (1 million or more) had the lowest mortality rates. Males living in metropolitan counties with a population of 1 million or more or metropolitan counties (250,000 to 1 million) had significantly lower incidence rates than males living in all other counties. Females living in metropolitan counties (250,000 to 1 million) had higher incidence rates than females living in metropolitan counties (Less than 250,000) and rural counties. Females living in metropolitan counties (250,000 to 1 million) had the highest incidence rates. Females living in metropolitan counties with a population of 1 million or more and metropolitan counties (Less than 250,000) had the lowest mortality rates. Females living in metropolitan counties 23 (250,000 to 1 million) had the highest mortality rates.

Treatment

Spotlight:

Different types of treatment are available for patients with colorectal cancer. The choice of treatment

Cancer Coalition of South Georgia's Community Cancer Screening Program TM

depends on a variety of factors such as age, overall health and type and stage of colorectal cancer. The three standard types of treatment used in colorectal cancer are: surgery, radiation therapy and chemotherapy. Depending on the stage of cancer, multiple treatment modalities may be used at the same time or one after another.

The Community Cancer Screening Program TM developed in 2006 by the Cancer Coalition of South Georgia, is highly effective in providing South Georgia citizens with essential cancer screenings and medical care. Through the involvement of professionals such as health navigators

Surgery: This is the main treatment for early stage colorectal cancer. If the cancer is found at an early stage, the doctor may remove it without cutting the abdomen by using a colonoscope (a tube that is inserted through the rectum). This procedure is called a local excision. If cancerous polyps are found and removed, the procedure is called a polypectomy. If the polyp is larger, the doctor performs a colectomy which removes a section of the large intestine on either side of the cancer including some lymph nodes

that identify patients in need of breast, cervical and colorectal cancer screenings, the program has increased its reach from serving 86 patients in one primary care center in 2006 to serving nearly 900 patients annually in 12 primary care centers. In 2014 alone, the program facilitated 980 breast, cervical and colorectal cancer screenings for 890 uninsured South Georgia adults.

and connects the healthy parts of the intestine together. If the doctor is not able to connect the ends of the colon back together, an opening is made in the abdomen and a bag is placed over the opening to collect waste. This procedure is called a colostomy. Radiation Therapy: This treatment uses high energy x-rays to kill cancer cells. There are two types of radiation therapies: external radiation and internal radiation. External radiation comes from a machine and is directed at the cancer. During internal radiation therapy, radioactive material is placed directly into or near the cancer. Radiation therapy can be used to kill any cancer cells remaining that might not have been completely removed by surgery. Chemotherapy: This treatment uses drugs to kill cancer cells. Systemic chemotherapy uses drugs that are injected into a vein or taken by mouth. These

This program, which is nationally recognized by the Mutual of America Foundation and the Agency for Healthcare Research and Quality, served as a model for the initial development of Georgia's Colorectal Cancer Screening Program. The Community Cancer Screening ProgramTM in 2014 provided colorectal cancer screening and navigation services at no cost to 444 uninsured adult patients. Through these colorectal cancer screenings, approximately one-third of adult patients had high-risk polyps removed, saving thousands of dollars in healthcare costs. For more information please call 229-3121700.

drugs enter the bloodstream and reach cancer cells

throughout the body. In regional chemotherapy,

drugs are placed directly into an artery leading to a

part of the body where the tumor is located.

Adjuvant and Neoadjuvant Chemotherapy:

Adjuvant chemotherapy is used after surgery when

there is no evidence of cancer remaining but there is a chance the cancer will return. Neoadjuvant

chemotherapy is used for rectal cancers before surgery (along with radiation), to shrink the tumor size.

Chemotherapy helps to shrink tumors, relieve symptoms from the tumor and extend survival for some

patients.

24

Figure 36. Location of Hospitals and Surgical Facilities Providing Endoscopy Services, Georgia
Georgia has a higher concentration of surgical facilities and hospitals located in the Northwest region and Metro Atlanta.
Few surgical facilities or hospitals are located in the South Georgia. Figure 37. Location of Federally Qualified Heath Centers, State of Georgia
Georgia health center sites are scattered throughout Georgia. There are many gaps in coverage in rural counties.
25

Incidence and Mortality, Adults 50-64 Years of Age, during 2007-2011 in Georgia
The overall age-adjusted colorectal cancer incidence rate among adults ages 50-64 years in Georgia was 81 per 100,000 in males and females combined. Males were 41 percent more likely to be diagnosed with colorectal cancer than females (age-adjusted rate 96/100,000 vs. 68/100,000).
The overall age-adjusted colorectal cancer mortality rate in adults ages 50-64 years, in Georgia is 24 per 100,000 in males and females combined. Males were 58 percent more likely to die of colorectal cancer than females (age-adjusted rate 30/100,000 vs.19/100,000)
In Georgia, adults ages 50-64 years who were non-Hispanic black males, were more likely than nonHispanic white males to be diagnosed with colorectal cancer. Additionally, non-Hispanic black females were more likely than non-Hispanic white females to be diagnosed with colorectal cancer.
Adults ages 50-64 years who were Black males, were more likely than white males to die of colorectal cancer in Georgia. Similarly, black females were more likely than white females to die of this disease in Georgia.

Figure 38. Age-Adjusted Colorectal Cancer Incidence Rates for Adults 50-64 Years of Age by Race/Ethnicity and Sex, Georgia, 20072011
140 128
120

100

87

88

80 62
60

40

20

0

Non-

Non-

Hispanic Hispanic Black Males White Males

NonHispanic
Black Females

NonHispanic
White Females

Figure 39. Age-Adjusted Colorectal Cancer Mortality Rates for Adults 50-64 Years of Age by Race and Sex, Georgia, 2006-2011*

50 45 43

40

35

29

30

26

25

20

16

15

10

5

0 Black Males White Males Black Females White Females

*Because of data quality issues, 2009 mortality data are not used for analysis.

Rate per 100,000 Rate per 100,000

26

Causes and Risk Factors, Adults 50-64 Years of Age

Table 3: Prevalence (%) of Risk Factors Associated with Colorectal Cancer, Among Adults Age 50-64 Years of Age, By Sex, By Public Health District, Georgia, 2011

Georgia 1.1 Northwest 1.2 North Georgia 2.0 North 3.1 Cobb-Douglas 3.2 Fulton 3.3 Clayton 3.4 East Metro 3.5 DeKalb 4.0 LaGrange 5.1 South Central 5.2 North Central 6.0 East Central 7.0 West Central 8.1 South 8.2 Southwest 9.1 Coastal 9.2 Southeast 10.0 Northeast

Obese
34.5 35.9 27.1 28.2 29.3 17.2 48.5 29.2 34.2 35.2 48.3 41.8 44.9 38.1 35.0 36.7 36.8 44.8 40.8

Current Smoker
20.9 23.2 33.4 17.6 17.8 17.3 20.6 17.9 14.4 26.6 15.5 19.3 16.9 23.0 26.8 22.8 21.3 22.8 18.9

Physically Inactive
29.0 34.7 33.9 29.7 23.9 20.1 22.9 25.4 17.9 24.6 36.3 25.7 27.8 40.1 39.6 30.5 33.8 32.0 39.8

Diabetes 17.0 18.9 12.2 15.4 10.8 10.7 16.4 14.0 18.3 16.8 23.0 16.6 21.1 27.2 21.8 18.6 17.5 24.0 15.7

Colorectal Screening
57.9 61.9 32.0 61.1 59.3 63.4 60.7 68.4 58.9 49.4 66.5 42.5 64.1 61.3 47.5 76.9 58.8 59.8 61.9

According to the Georgia 2011 Behavioral Risk Factor Surveillance System (Table 3): Obese
Clayton (3-3) Public Health District has the highest percentage of adults age 50-64 who are obese (48.5 percent).
Fulton (3-2) Public Health District has the lowest percentage of adults age 50-64 who are obese (17.2 percent).

Current Smoker North Georgia (1-2) Public Health District has the highest percentage of adults age 50-64 who are current smokers (33.4 percent). DeKalb (3-5) Public Health District has the lowest percentage of adults age 50-64 who are current smokers (14.4 percent).

Physically Inactive West Central (7) Public Health District has the highest percentage of adults age 50-64 who are physically inactive (40.1 percent). DeKalb (3-5) Central Public Health District has the lowest percentage of adults age 50-64 who are physically inactive (17.9 percent).

27

Diabetes West Central (7-0) Public Health District has the highest percentage of adults age 50-64 who are diabetic (27.2 percent). Fulton (3-2) Public Health District has the lowest percentage of adults age 50-64 who are diabetic (10.7 percent).
Colorectal Screening Southwest (8-2) Public Health District has the highest percentage of adults age 50-64 who meet the recommendation for colorectal screening (76.9 percent). North Georgia (1-2) Public Health District has the lowest percentage of adults age 50-64 who meet the recommendation for colorectal screening (32.0 percent).
28

Table 4: Prevalence (%) of Risk Factors Associated with Colorectal Cancer and Colorectal Screening, Among Adults Age 50-64 Years of Age, By Demographic Factors, Georgia, 2011

Sex Male Female
Insurance Status Have Health Insurance No Health Insurance
Education Less than High School High School Graduate Some College College Graduate
Income Under $35,000 $35,000-$50,000 $50,000+

Obese
34 35
34 35
44 37 34 26
41 34 30

Current Smoker
24 19
18 33
32 25 21 9
30 21 12

Physically Inactive
28 30
28 32
42 38 25 15
36 30 20

Diabetes
18 16
16 20
25 21 15 9
24 17 10

Colorectal Screening
54 61
63 33
41 55 60 70
45 66 69

According to the Georgia 2011 Behavioral Risk Factor Surveillance System (Table 4): The prevalence of obesity in males and females was similar. The prevalence of obesity among adults who have health insurance and adults who do not have health insurance was similar. As educational status increased the percentage of obese adults decreased. As income increased the percentage of obese adults decreased.

Males were more likely to be current smokers. Adults who do not have health insurance were significantly more likely to be current smokers. As educational status increased the percentage of current smokers decreased. As income increased the percentage of current smokers significantly decreased.

Females were more likely to be physically inactive. Adults who do not have health insurance were more likely to be physically inactive. As educational status increased the percentage of physically inactive adults decreased. As income increased the percentage of physically inactive adults decreased.

Males were more likely to be diabetic. Adults who do not have health insurance were significantly more likely to be diabetic. As educational status increased the percentage of diabetic adults decreased. As income increased the percentage of diabetic adults significantly decreased.
Females were more likely to meet the recommendation for colorectal screening than males. Adults who have health insurance were significantly more likely to meet the recommendation. As educational status increased so does the percentage of adults meeting the recommendation for
colorectal screening. As income increased so does the percentage of adults meeting the recommendation for colorectal
screening.
29

Screening, Adults 50-64 Years of Age
Colorectal cancer is the third most commonly diagnosed cancer and cause of cancer death among Georgian men and women. Colorectal cancer affects both men and women and most often occurs in people over 50 years of age. Regular screenings for colorectal cancer can find cancer early (when it is most likely to be curable). Screenings can also prevent colorectal cancer by finding polyps and removing them before they turn cancerous.

Healthy People 2020 Goal/Objective for Colorectal Cancer Screening
Goal: Reduce the number of new cancer cases, as well as the illness, disability and death caused by cancer
Objective: Monitor the incidence of colorectal cancer and promote evidence based screening
The Healthy People 2020 objective measures the proportion of adults who receive colorectal cancer screening based on the most recent guidelines.
According to Healthy People 20/20 objective, colorectal screening is defined as screening for colorectal cancer with fecal occult blood testing in the past year and/or sigmoidoscopy in the past five years, and/or blood stool test in the past three years or colonoscopy in the past 10 years.
Georgia Cancer Plan 2014-2019 for Colorectal Cancer Screening
Georgia's Objective and Target by 2019 Increase screening for colorectal cancer among adults over 50 years to 85 percent by 2019, regardless of insurance status, and increase screening among those with a family history of colorectal cancer.

According to the Georgia 2011 Behavioral Risk Factor Surveillance System (Figure 17):
In Georgia, 57.9 percent of adults ages 50-64 years reported having a blood stool test using a home kit within the past 12 months, having a sigmoidoscopy every five years and/or colonoscopy every 10 years.
The Southwest Public Health District (8-2), has the highest percentage of adults age 50-64 who met the recommendation for colorectal screening (76.9 percent).
North Georgia Public Health District (1-2), has the lowest percentage of adults age 50-64 meeting the recommendation for colorectal screening (32.0 percent).
The 2014-2019 goal of the Georgia Cancer Plan is to increase screening from 69.4 to 85 percent by 2019, regardless of insurance status, and increase screening among those with a family history of colorectal cancer.
The prevalence of colorectal cancer screening among adults with an income of less than $35,000 was 45 percent. Adults who have health insurance had a higher prevalence of colorectal screening (63 percent) than adults who do not have health insurance (33 percent).
Figure 40. Prevalence (%) of Colorectal Cancer Screening* Among Adults 50-64 Years of Age by Public Health District, Georgia, 2011

Targets by 2019

Increase by 10 percent the proportion of individuals with a family history of colorectal cancer who receives evidence-based genetic risk assessment and appropriate screening.

Reduce income and health insurance status disparities in colorectal cancer screening rates by 10 percent.

30
*The Colorectal Cancer Screening Recommendation is defined as the percent of adults who had a FOBT in the last year, and/or sigmoidoscopy in the last 5 years, and/or colonoscopy in the last 10 years.

Colorectal Cancer Resources:
You can learn more about colorectal cancer from the following organizations: American Cancer Society Telephone: 1-800-ACS-2345 (1-800-227-2345) Website: www.cancer.org Centers for Disease Control and Prevention Telephone: 1-800-CDC-INFO Website: www.cdc.gov National Cancer Institute, Cancer Information Service Telephone: 1-800-4-CANCER (1-800-422-6237) Website: www.cancer.gov National Colorectal Cancer Research Alliance Telephone: 424-283-3600 Website: www.eifoundation.org/programs/eifs-national-colorectal-cancer-research-alliance Cancer Research and Prevention Foundation Telephone: 1-800-227-2732 Website: www.preventcancer.org Cancer Control Planet Website: http://cancercontrolplanet.cancer.gov/ Colon Cancer Alliance Telephone: 1-877-422-2030 Website: www.ccalliance.org Georgia Comprehensive Cancer Registry Telephone: 404-463-3748 Website: http://dph.georgia.gov/georgia-comprehensive-cancer-registry
31

Technical Notes
Definitions: Age-adjusted rate A rate calculated in a manner that allows for the comparison of rates derived from populations with different age structures. Cancer incidence The number of new cancer cases occurring in a population during a specified period of time, often expressed as a rate per 100,000 population. Cancer mortality The number of cancer deaths occurring in a population during a specified period of time, often expressed as a rate per 100,000 population. Prevalence The number of people with a disease or risk factor out of the total number of persons in a population, often expressed as a percentage. Average Risk Population includes most people who develop colorectal cancer and have no identifiable risk factors. People at increased risk of colorectal cancer consist of 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. Obesity is defined as a body mass index (BMI) of 30 or greater. Smoking is defined as an adult smoking at least 100 cigarettes in their lifetime and is currently smoking. Physical Inactivity is defined as not participating in any physical activities within last 30 days.
32

Number
1-1 1-2
2-0 3-1 3-2 3-3 3-4 3-5
4-0
5-1
5-2
6-0
7-0
8-1
8-2 9-1

Name Northwest
North Georgia North
Cobb-Douglas Fulton Clayton East Metro DeKalb LaGrange
South Central
North Central
East Central
West Central
South
Southwest
Coastal Southeast

9-2 Northeast
10-0

Georgia Public Health Districts

Major City Rome Dalton Gainesville
Jonesboro Lawrenceville
Dublin Macon Augusta Columbus Valdosta Albany Savannah Waycross
Athens

Counties Bartow, Catoosa, Chattooga, Dade, Floyd, Gordon, Haralson, Paulding, Polk, Walker Cherokee, Fannin, Gilmer, Murray, Pickens, Whitfield
Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Stephens, Towns, Union, White Cobb, Douglas Fulton Clayton Gwinnett, Newton, Rockdale DeKalb Butts, Carroll, Coweta, Fayette, Heard, Henry, Lamar, Meriwether, Pike, Spalding, Troup, Upson Bleckley, Dodge, Johnson, Laurens, Montgomery, Pulaski, Telfair, Treutlen, Wheeler, Wilcox Baldwin, Bibb, Crawford, Hancock, Houston, Jasper, Jones, Monroe, Peach, Putnam, Twiggs, Washington, Wilkinson Burke, Columbia, Emanuel, Glascock, Jefferson, Jenkins, Lincoln, McDuffie, Richmond, Screven, Taliaferro, Warren, Wilkes Chattahoochee, Clay, Crisp, Dooly, Harris, Macon, Marion, Muscogee, Quitman, Randolph, Schley, Stewart, Sumter, Talbot, Taylor, Webster Ben Hill, Berrien, Brooks, Cook, Echols, Irwin, Lanier, Lowndes, Tift, Turner Baker, Calhoun, Colquitt, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas, Worth Bryan, Camden, Chatham, Effingham, Glynn, Liberty, Long, McIntosh Appling, Atkinson, Bacon, Brantley, Bryan, Bulloch, Camden, Candler, Charlton, Clinch, Coffee, Evans, Glynn, Jeff Davis, Liberty, Long, McIntosh, Pierce, Tattnall, Toombs, Ware, Wayne Barrow, Clarke, Elbert, Greene, Jackson, Madison, Morgan, Oconee, Oglethorpe, Walton

33

2013 Rural-Urban Continuum Codes: Rural-Urban Continuum Codes form a classification scheme that distinguishes metropolitan (metro) counties by the population size of their metro area, and nonmetropolitan (nonmetro) counties by degree of urbanization and adjacency to a metro area or areas:

Code 1 2 3 4 5 6 7 8
9

Description Counties in metro areas of 1 million population or more Counties in metro areas of 250,000 to 1 million population Counties in metro areas of fewer than 250,000 population Urban population of 20,000 or more, adjacent to a metro area Urban population of 20,000 or more, not adjacent to a metro area Urban population of 2,500 to 19,999, adjacent to a metro area Urban population of 2,500 to 19,999, not adjacent to a metro area Completely rural or less than 2,500 urban population, adjacent to a metro area Completely rural or less than 2,500 urban population, not adjacent to a metro area

Counties

Regroup 1 2 3 4,5,6, & 7 8 & 9

Description Metro >1 million Metro 250,000-1 million Metro <250,000 Smaller Urban Rural

Data Sources: The number of new cases and incidence rates for the state of Georgia for 2007-2011 were obtained from the Georgia Department of Public Health, Division of Health Protection, Epidemiology Program, Georgia Comprehensive Cancer Registry. Incidence data were coded using ICD-O-3 codes and grouped using the SEER Site Recode ICD-O-3/WHO 2008. For more information on these groupings, please visit the Surveillance, Epidemiology, and End Results (SEER) Program on the web at http://seer.cancer.gov/ siterecode/icdo3_dwhoheme/.
The number of deaths and mortality rates for the state of Georgia for 2006-2008, 2010, and 2011 were obtained from the Georgia Department of Public Health, Office of Vital Records. Mortality data were coded using ICD10 codes and grouped using the SEER Cause of Death Recode 1969+. For more information on these groupings, please visit the SEER Program on the web at http://seer.cancer.gov/ codrecode/1969+_d04162012.
Incidence trend and survival data for Georgia were obtained from the SEER Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2013 Sub (2000-2011) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2012 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems
34

Branch, released April 2014 (updated 5/7/2014), based on the November 2013 submission. Incidence and survival data were categorized using the SEER Site Recode ICD-O-3/WHO 2008.
Mortality trend data for Georgia were obtained from the SEER Program (www.seer.cancer.gov) SEER*Stat Database: Mortality - All COD, Aggregated With State, Total U.S. (1969-2011) <Katrina/Rita Population Adjustment>, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released July 2014. Underlying mortality data provided by NCHS (www.cdc.gov/nchs). Cause of death was categorized using the SEER Cause of Death Recode 1969+.
Population estimates for 2006-2013 and the 2000 US standard million population were obtained from the US Bureau of the Census, available at http://www.census.gov/.
Incidence and mortality rates for the United States for 2007-2011 were obtained from the North American Association of Central Cancer Registries (NAACCR) Cancer in North America: 2007-2011 publication.
Health risk and screening behavior data for adults were obtained from the Behavioral Risk Factor Surveillance System (BRFSS), a telephone health survey administered by the Georgia Department of Public Health, in collaboration with the CDC (Centers for Disease Control and Prevention). National data for the prevalence of similar risk factors was retrieved from Centers for Disease Control and Prevention at www.cdc.gov/brfss/
Clinical information on colorectal cancer was retrieved from the Mayo Clinic at www.mayoclinic.com, Colorectal Cancer Medline Plus at www.nlm.nih.gov/medlineplus, National Cancer Institute at www.cancer.gov and the American Cancer Society at www.cancer.org.
Methods:
Incidence rates were calculated per 100,000 population and age-adjusted by the direct method to the 2000 US standard million population. Except where calculated to show trends, the incidence rates are five-year average annual rates for the period 2007 through 2011.
Mortality rates were calculated per 100,000 population and age-adjusted by the direct method to the 2000 US standard million population. Because of data quality issues, 2009 Georgia cancer death data are not used for analysis. Except where calculated to show trends, the mortality rates are five-year average annual rates including data for 2006-2008, 2010 and 2011 combined.
The estimated number of cases for 2013 was calculated by multiplying the age-specific state incidence rates (2007-2011) by the age-specific state population estimates for 2013. The results were then summed to obtain a state estimate.
The estimated number of deaths for 2013 was calculated by multiplying the age-specific state mortality rates (2006-2008, 2010 and 2011 combined) by the age-specific state population estimates for 2013. The results were then summed to obtain a state estimate.
Annual percent change computations for the incidence and mortality trends were calculated using Joinpoint Regression Program, Version 4.1.1 - August 2014; Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute.
The Rural-Urban classification of Georgia counties was based on the 2013 Rural-Urban Continuum Codes from the United States Department of Agriculture, Economic Research Service. Information about the Rural-Urban Continuum Codes can be retrieved from http://www.ers.usda.gov/Data/RuralUrbanContinuumCodes/.
35

Appendix A

Figures 18 & 19 Number of Incident Colorectal Cancer Cases and Age-adjusted Colorectal Cancer Incidence Rates by Sex, by Public Health District, Georgia, 2007-2011

Public Health District
Georgia 1.1 Northwest 1.2 North Georgia 2.0 North 3.1 Cobb-Douglas 3.2 Fulton 3.3 Clayton 3.4 East Metro 3.5 DeKalb 4.0 LaGrange 5.1 South Central 5.2 North Central 6.0 East Central 7.0 West Central 8.1 South 8.2 Southwest 9.1 Coastal 9.2 Southeast 10.0 Northeast

Cases 10,123
716 409 762 720 822 236 769 597 921 181 646 539 453 283 481 609 456 523

Males Incidence Rate 50.7 50.71 43.15 51.24 48.42 49.95 55.49 47.12 47.46 53.86 43.86 53.00 52.26 54.66 51.97 57.46 50.22 55.19 54.68

Cases 9,316 631 373 634 673 823 221 722 652 842 169 601 486 474 244 423 570 328 450

Females Incidence Rate 37.5 36.27 33.10 36.84 36.46 38.41 41.00 34.98 38.90 39.79 36.64 39.91 37.27 43.95 35.76 38.88 38.66 33.46 37.79

Figures 20 & 21 Number of Colorectal Cancer Deaths and Age-adjusted Colorectal Cancer Mortality Rates by Sex, by Public Health District, Georgia, 2006-2011*

Public Health District
Georgia 1.1 Northwest 1.2 North Georgia 2.0 North 3.1 Cobb-Douglas 3.2 Fulton 3.3 Clayton 3.4 East Metro 3.5 DeKalb 4.0 LaGrange 5.1 South Central 5.2 North Central 6.0 East Central 7.0 West Central 8.1 South 8.2 Southwest 9.1 Coastal 9.2 Southeast 10.0 Northeast

Deaths 3,555 274 125 245 216 294
78 247 230 297 56 242 238 181 106 153 225 156 192

Males Mortality Rate 19.8 21.92 14.26 17.42 16.85 19.70 20.93 17.73 20.54 19.36 14.95 22.18 24.61 23.53 20.29 20.08 20.30 21.12 21.80

Deaths 3,330 252 111 212 235 271
79 253 235 301 65 224 183 173 92 153 217 116 158

Females Mortality Rate 13.8 14.76 10.36 12.46 13.74 12.75 15.78 13.79 14.67 14.82 13.99 15.10 14.30 15.87 13.35 13.89 14.68 12.00 13.48

36

Appendix B

Figures 22 & 23 Number of Incident Colorectal Cancer Cases and Age-adjusted Colorectal Cancer Incidence Rates by Sex, by Public Health District, Georgia, 2007-2011

County Name

Males

Georgia Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur DeKalb Dodge

Cases 10,123
25 12 18 6 59 37 63 148 16 23 189 11 22 19 40 67 25 29 10 44 13 130 61 14 295 *** 35 145 91 5 236 6 592 38 53 101 24 143 16 31 18 30 38 597 27

Incidence Rate 50.7 61.3 ~ 60.0 ~ 51.0 79.0 47.1 71.5 36.1 49.6 55.0 ~ 51.1 42.6 76.7 53.4 47.7 46.8 ~ 44.0 ~ 58.0 41.4 ~ 50.1 ~ 49.8 35.7 53.4 ~ 55.5 ~ 47.2 38.0 53.9 36.9 57.9 53.1 40.6 51.9 38.9 50.3 56.7 47.5 49.2

*Note: 2009 death data were excluded from the analysis due to data reliability

Cases 9,316
21 8 11 7 45 24 44 121 21 22 214 17 13 18 36 37 51 22 9 45 8 126 60 7 294 <5 22 164 95 6 221 6 538 50 34 95 24 113 9 35 17 28 34 652 25

Females
Incidence rate 37.5 37.6 ~ ~ ~ 38.5 50.0 27.1 47.8 37.8 36.4 45.3 37.4 ~ 32.6 54.1 24.6 77.6 34.7 ~ 42.3 ~ 45.3 31.5 ~ 38.8 ~ 26.2 34.2 39.7 ~ 41.0 ~ 34.4 47.0 26.1 30.7 47.3 37.0 ~ 44.0 33.8 44.4 38.0 38.9 41.7

37

Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Montgomery

10

~

16

118

61.0

117

128

54.9

135

18

59.3

10

<5

~

<5

58

60.0

52

38

71.1

29

36

65.9

27

18

67.9

13

40

51.1

29

92

37.2

115

112

46.6

104

159

49.3

130

50

82.5

40

822

49.9

823

40

46.7

27

9

~

6

104

48.8

85

58

48.0

59

42

63.3

37

32

58.7

17

585

45.8

539

72

61.1

55

187

48.7

154

12

~

14

38

53.5

39

37

42.4

33

39

53.4

40

30

98.0

10

191

53.3

169

163

57.6

138

16

64.6

12

85

62.8

79

11

~

17

20

48.5

20

36

90.1

19

8

~

14

13

~

5

36

52.8

24

28

61.9

25

11

~

9

70

53.8

58

27

45.4

27

43

43.5

39

18

68.5

11

12

~

6

102

52.3

88

36

43.6

25

27

80.4

24

43

63.4

31

13

~

10

29

59.0

25

13

~

13

43

77.5

33

6

~

9

35

62.2

26

42

57.9

26

9

~

7

35.6 41.8 46.8
~ ~ 46.2 39.8 40.5 ~ 29.8 35.5 34.4 35.8 50.4 38.4 28.4 ~ 32.9 40.5 49.2 26.6 33.8 40.5 34.8 ~ 44.1 33.6 40.0 ~ 38.3 39.9 ~ 50.3 41.9 46.2 32.0 ~ ~ 26.8 46.0 ~ 39.1 42.3 39.6 ~ ~ 34.4 31.6 55.5 37.3 ~ 35.2 ~ 42.9 ~ 36.4 32.5 ~
38

Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

24

49.9

25

57

69.1

36

226

59.8

251

106

57.6

99

23

30.3

30

21

52.8

24

127

53.3

102

39

67.4

34

35

39.5

35

30

62.8

19

20

48.0

19

48

52.3

45

12

~

15

27

39.2

24

9

~

5

26

47.5

23

11

~

12

205

48.3

189

78

43.9

84

7

~

5

29

75.1

20

12

~

13

94

62.3

93

49

65.4

41

13

~

7

37

51.0

36

6

~

12

<5

~

<5

45

78.6

28

13

~

18

16

36.1

14

17

77.7

23

65

56.7

56

56

63.3

37

32

56.0

26

17

39.7

20

8

~

10

87

58.1

76

14

~

10

23

82.2

12

28

34.5

19

34

49.1

41

71

41.3

62

103

54.2

76

39

42.0

27

8

~

10

20

37.2

26

57

73.3

34

<5

~

<5

***

~

<5

32

42.3

35

92

44.9

82

10

~

16

32

100.2

18

9

~

18

34

58.1

21

Average annual rate per 100,000, age-adjusted to the 2000 US standard population. *** Data suppressed for confidentiality purposes ~ Rates not calculated where the count is less than sixteen.

43.1 35.1 47.0 40.8 35.4 52.5 35.7 45.5 35.8 33.5 39.0 36.8
~ 33.1
~ 33.7
~ 35.1 36.9
~ 42.6
~ 49.4 43.4
~ 37.6
~ ~ 44.2 61.2 ~ 71.7 38.5 32.8 30.7 35.5 ~ 39.4 ~ ~ 20.2 46.1 28.2 33.1 20.9 ~ 39.6 42.6 ~ ~ 37.8 31.9 56.9 43.5 53.1 28.5
39

Appendix C

Figures 24 & 25 Number of Colorectal Cancer Deaths and Age-adjusted Colorectal Cancer Mortality Rates by Sex, by Public Health District, Georgia, 2006-2011*

County Name
Georgia Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur DeKalb Dodge Dooly Dougherty

Deaths 3,555
10 *** <5 <5 15 14 17 39 9 <5 93 <5 *** 9 13 16 18 13 <5 10 *** 55 23 <5 115 <5 18 51 26 <5 78 <5 177 13 12 37 7 41 <5 15 10 9 15 230 10 7 35

Males
Mortality Rate 19.8 ~ ~ ~ ~ ~ ~ 16.4 20.7 ~ ~ 29.9 ~ ~ ~ ~ 13.1 37.9 ~ ~ ~ ~ 29.7 15.7 ~ 20.8 ~ 28.7 12.5 15.3 ~ 20.9 ~ 15.9 ~ ~ 15.9 ~ 19.0 ~ ~ ~ ~ ~ 20.5 ~ ~ 20.3

Deaths 3,330
5 <5 *** <5 17 9 15 38 6 *** 86 <5 <5 7 10 21 15 11 <5 17 <5 39 21 <5 107 <5 9 48 38 <5 79 <5 186 14 15 28 6 32 <5 10 9 7 14 235 10 6 46

Females
Mortality rate 13.8 ~ ~ ~ ~ 14.6 ~ ~ 15.7 ~ ~ 17.7 ~ ~ ~ ~ 14.2 ~ ~ ~ 16.5 ~ 14.5 10.9 ~ 13.8 ~ ~ 10.5 16.5 ~ 15.8 ~ 13.0 ~ ~ 10.1 ~ 11.4 ~ ~ ~ ~ ~ 14.7 ~ ~ 16.3
40

Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray

39

22.4

49

7

~

5

<5

~

<5

23

24.7

18

13

~

9

20

37.9

8

9

~

5

14

~

10

28

12.4

40

45

20.7

51

48

17.8

38

17

29.0

18

294

19.7

271

10

~

6

***

~

<5

38

20.0

39

17

16.6

19

13

~

9

17

44.0

10

184

17.9

187

21

17.6

15

56

15.5

51

8

~

5

15

~

17

14

~

12

11

~

13

<5

~

***

50

16.4

65

56

21.3

38

9

~

6

30

24.7

29

<5

~

***

9

~

5

15

~

13

<5

~

***

***

~

<5

13

~

7

9

~

9

***

~

<5

24

20.1

22

12

~

6

17

19.9

15

***

~

<5

<5

~

***

31

15.7

32

***

~

<5

10

~

15

12

~

13

***

~

<5

19

40.4

8

8

~

5

9

~

10

<5

~

<5

10

~

14

16

24.7

21

<5

~

<5

***

~

<5

10

~

12

18.3 ~ ~
20.0 ~ ~ ~ ~
13.2 16.5 11.5 23.8 12.8
~ ~ 14.5 13.7 ~ ~ 13.7 ~ 11.6 ~ 19.4 ~ ~ ~ 16.9 11.2 ~ 19.0 ~ ~ ~ ~ ~ ~ ~ ~ 15.5 ~ ~ ~ ~ 12.7 ~ ~ ~ ~ ~ ~ ~ ~ ~ 27.1 ~ ~ ~
41

Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

96

26.7

93

34

19.9

38

12

~

6

7

~

7

52

25.2

34

13

~

12

11

~

11

12

~

6

5

~

6

14

~

20

<5

~

***

8

~

11

***

~

<5

16

27.5

9

6

~

5

89

22.2

84

29

16.7

28

<5

~

<5

12

~

6

<5

~

***

30

19.6

24

15

~

17

<5

~

<5

<5

~

***

<5

~

<5

<5

~

<5

14

~

8

<5

~

***

<5

~

***

6

~

5

22

22.0

22

19

22.9

19

11

~

9

5

~

8

<5

~

<5

37

24.0

45

11

~

5

<5

~

<5

11

~

14

17

25.8

15

41

26.1

34

50

27.2

28

20

21.4

17

***

~

<5

8

~

7

15

~

13

<5

~

<5

<5

~

<5

10

~

9

29

16.6

24

<5

~

***

7

~

6

<5

~

***

***

~

<5

Average annual rate per 100,000, age-adjusted to the 2000 US standard population. *Note: 2009 death data were excluded from the analysis due to data reliability
~ Rates not calculated where the count is less than sixteen. *** Data suppressed for confidentiality purposes

17.1 16.2
~ ~ 14.2 ~ ~ ~ ~ 15.6 ~ ~ ~ ~ ~ 15.8 12.5 ~ ~ ~ 12.5 17.1 ~ ~ ~ ~ ~ ~ ~ ~ 14.0 15.9 ~ ~ ~ 22.6 ~ ~ ~ ~ 14.6 12.4 12.5 ~ ~ ~ ~ ~ ~ 9.6 ~ ~ ~ ~
42

Appendix D

Figures 26, 27 & 28 Number of Incident Late Stage Colorectal Cancer Cases and Percent of Late Stage Colorectal Cancer Incidence Rates by Sex, by Race/Ethnicity, by Public Health District, Georgia, 2007-2011

Public Health District
Georgia 1.1 Northwest 1.2 North Georgia 2.0 North 3.1 Cobb-Douglas 3.2 Fulton 3.3 Clayton 3.4 East Metro 3.5 DeKalb 4.0 LaGrange 5.1 South Central 5.2 North Central 6.0 East Central 7.0 West Central 8.1 South 8.2 Southwest 9.1 Coastal 9.2 Southeast 10.0 Northeast

Cases 5,693 395 247 435 408 468 130 446 309 521
84 320 296 280 149 292 340 249 324

Males Percent 53.69 53.45 54.65 54.10 54.33 55.19 51.79 56.31 49.60 54.33 42.86 45.91 53.82 56.68 51.38 56.15 53.71 52.42 61.13

Non-Hispanic Black Males

Cases

Percent

1,576

54.33

26

52.00

9

56.25

22

53.66

67

54.03

249

55.58

75

54.35

86

55.48

180

54.88

130

58.30

19

42.22

119

47.04

116

55.24

108

53.73

43

49.43

105

54.4

109

54.77

50

54.95

63

63.64

Non-Hispanic White Males

Cases

Percent

3,863

53.16

366

53.74

224

53.72

396

54.17

314

53.58

191

53.95

45

47.87

287

54.56

113

43.30

380

53.45

65

44.52

195

45.14

175

52.87

167

59.86

105

53.57

185

57.28

217

52.29

190

51.35

248

59.90

Figures 29, 30 & 31 Number of Incident Late Stage Colorectal Cancer Cases and Percent of Late Stage Colorectal Cancer Incidence Rates by Sex, by Race/Ethnicity, by Public Health District, Georgia, 2007-2011

Public Health District
Georgia 1.1 Northwest 1.2 North Georgia 2.0 North 3.1 Cobb-Douglas 3.2 Fulton 3.3 Clayton 3.4 East Metro 3.5 DeKalb 4.0 LaGrange 5.1 South Central 5.2 North Central 6.0 East Central 7.0 West Central 8.1 South 8.2 Southwest 9.1 Coastal 9.2 Southeast 10.0 Northeast

Females

Cases

Percent

5,139

52.76

360

54.88

212

53.00

345

51.49

378

54.08

456

53.58

112

48.28

409

54.97

340

49.93

457

52.41

88

47.57

314

48.83

265

53.32

284

55.47

136

53.33

232

51.21

309

52.55

174

50.43

268

58.52

Non-Hispanic Black Females

Cases

Percent

1,591

52.40

37

58.73

7

58.33

24

52.17

87

59.59

248

54.75

69

48.25

103

56.28

210

51.22

90

47.87

32

56.14

150

52.45

103

49.76

117

50.43

34

47.22

90

49.45

109

51.42

33

60.00

48

53.93

Non-Hispanic White Females

Cases

Percent

3,367

53.08

317

55.32

201

53.17

312

51.91

278

53.15

187

52.53

37

48.68

252

53.50

119

48.57

353

53.81

55

44.00

158

45.14

156

57.35

161

59.63

101

56.42

139

52.26

188

52.08

136

48.40

217

60.28

43

Figure 40 Number of Incident Colorectal Cancer Cases and Percent of Colorectal Cancer Screening Among Adults 50-64 Years of Age by Public Health District, Georgia, 2011

Public Health District
1.1 Northwest 1.2 North Georgia 2.0 North 3.1 Cobb-Douglas 3.2 Fulton 3.3 Clayton 3.4 East Metro 3.5 DeKalb 4.0 LaGrange 5.1 South Central 5.2 North Central 6.0 East Central 7.0 West Central 8.1 South 8.2 Southwest 9.1 Coastal 9.2 Southeast 10.0 Northeast

Cases 39 26 38 38 48 27 37 43 40 36 29 40 43 28 36 39 19 45

Adults

Percent 61.88 32.04 61.05 59.25 63.37 60.74 68.44 58.92 49.41 66.51 42.5 64.11 61.3 47.46 76.92 58.82 59.75 61.87

44