Mission Statement for Georgia Department of Human Resources Our mission is to promote and protect the health of people in Georgia wherever they live, work, and play.We unite with individuals, families, and communities to improve their health and enhance their quality of life. Mission Statement for American Cancer Society The American Cancer Society is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives and diminishing suffering from cancer, through research, education, advocacy, and service. If you would like more information on cancer, visit our web site at www.ph.dhr.state.ga.us. If you would like more information on cancer, call 1-800-ACS-2345 24 hours a day, seven days a week. Or visit our web site at www.cancer.org. 2000, American Cancer Society, Inc. 15-102 GEORGIA Cancer Data REPORT 2000 September 1, 2000 Dear Friends: The Georgia Cancer Data Report 2000 describes the immense impact of cancer in our state. During this year an estimated 32,900 Georgians will develop cancer and 13,700 will die from the disease.This means that a citizen of our state will be diagnosed with cancer every 16 minutes and that a Georgian will die of cancer about every 38 minutes. Here are some highlights from this report: Cancer is the second leading cause of death in this state, accounting for one in four deaths each year. Twenty-seven percent more African-American Georgians will die of cancer than whites. Cancers of the lung, breast, prostate, and colorectum account for 54 percent of our state's cancer deaths. Unless current trends are reversed, one in two Georgia men and one in three Georgia women will develop cancer in their lifetime. This important document will serve as a guide to help us develop a plan to reverse these trends. Promising new screening tests and research show clearly that we can intervene and prevent cancer from becoming deadly. In order to take advantage of these new opportunities, we must capitalize on our existing resources and new research opportunities.Working together, we can dramatically reduce the number of Georgians who are currently projected to die of cancer. I commend the Georgia Department of Human Resources' Division of Public Health and the American Cancer Society, Southeast Division for their partnership in developing and releasing this document.Through their joint efforts we have a much better perspective of the burden of cancer in our state, identification of risk factors for the more prevalent types of cancers, and guidelines for early detection and screening.This information will help us better plan our efforts in cancer prevention, screening, education, research, and treatment to meet the current and future needs of Georgians. Sincerely, Roy E. Barnes TABLE OF CONTENTS E XECUTIVE SUMMARY ....................................................3 INTRODUCTION ........................................................4 GEORGIA DEMOGRAPHICS ........................................4 BASIC CANCER INFORMATION ......................................5 CANCER IN GEORGIA IN 2000 ......................................6 C A N C E R M O R T A L I T Y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 C A N C E R I N C I D E N C E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 B R E A S T C A N C E R .......................................................... 22 U T E R I N E C E R V I X C A N C E R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 C O L O N & R E C T U M C A N C E R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 L U N G & B R O N C H U S C A N C E R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 P R O S T A T E C A N C E R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 C A N C E R R I S K B E H A V I O R S I N G E O R G I A . . . . . . . . . . . . . . . . . . . . . . . . 30 C O N C L U S I O N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 T E C H N I C A L A P P E N D I X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 R E F E R E N C E S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 S T A T I S T I C A L A P P E N D I X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 ACKNOWLEDGEMENTS American Cancer Society, Southeast Division . . . . . Jack Shipkoski, Chief Executive Officer Cancer Control Department . . . . . . . . . . . . . . . . . . . . . . Kristen Copes, M.S.W.,Vice President Sarah H. Landis, M.P.H., Manager, Regional Planning Marketing and Communications Department . . . . . . . . . . . . . . . Laurie Stephens,Vice President Public Health Internship Program . . . . . . . . . . . . . . . . . . . . . . . . . . Janae Zolna, M.P.H., Intern Georgia Department of Human Resources . . . . . . . . . . . . Audrey W. Horne, Commissioner Division of Public Health . . . . . . . . . . . . . . . . . . . . Kathleen E.Toomey, M.D., M.P.H., Director Chronic Disease Prevention and Health Promotion Branch . . . . . . . . . . . . James H. Brannon Jr., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .M.S., M.Ed., Director Cancer Control Section . . . . . . . . . . . . . . . . . . . . . . . . . Carol B. Steiner, M.N., R.N., Director Epidemiology Branch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Paul A. Blake, M.D., M.P.H., Director Chronic Disease, Injury, and Environmental Epidemiology Section . . . . . . . . . . .Kenneth Powell, M.D., M.P.H., Director Suggested Citation--Landis SH, Steiner CB, Bayakly AR, McNamara C, Powell KE. Georgia Cancer Data Report, 2000. Georgia Department of Human Resources, Division of Public Health, Cancer Control Section, and the American Cancer Society, Southeast Division, May, 2000. Publication Number: DPH00.27HW. 03 G E O R G I A Cancer Data Report 2000 EXECUTIVE SUMMARY Cancer is a major health problem in Georgia More than 32,900 Georgians will develop cancer in 2000, and 13,700 will die from this disease. Cancer was the second leading cause of death in Georgia in 1994-1998, accounting for 22% of all deaths. One in 2 males, and 1 in 3 females in the US will develop cancer in their lifetime. Cancer mortality rates in Georgia declined 6% between 1993-1998. Lung cancer is the leading cause of cancer death among Georgians and accounts for 30% of all cancer deaths. Lung cancer mortality rates among Georgia females have doubled since 1980. Blacks in Georgia are 27% more likely to die of cancer than whites. Much of the burden of death and disability from cancer is preventable Tobacco use accounts for at least 30% of all cancer deaths. Tobacco use is responsible for about 87% of all lung cancers in Georgia. Between 1992-1998, smoking rates in Georgia increased 5% per year among females and 4% per year among males. In 1999, 55% of middle school students reported ever having used tobacco; 19% reported current use of tobacco. About one-third of cancer deaths are related to diet, nutrition, and physical activity. In 1998, only 21% of Georgia adults consumed 5 or more fruits and vegetables per day. Less than one-third of Georgia adults are physically active on a regular basis. Some cancers can be detected early when treatment is most effective For 1996-1998, 55% of Georgia females aged 50 and older had a mammogram and clinical breast examination within the previous year. For 1996-1998, 90% of Georgia females aged 18 and older had a Pap test in the past 3 years. In 1997, 52% of Georgia males and 45% of Georgia females had ever had a sigmoidoscopy. Age-adjusted Rates and Standard Populations Age-adjusted rates allow for direct comparison of cancer incidence and mortality among populations with different age structures. Recently, the National Center for Health Statistics recommended that all rates calculated for deaths occurring during 1999 and thereafter be age-adjusted to the 2000 US standard population. Changing from previously used standards, such as the 1970 US standard, to the 2000 US standard will affect the magnitude of age-adjusted rates. Rates adjusted to the 2000 US standard will be higher in magnitude (see figure below). In order to begin the transition to the new standard population, this report displays rates calculated to both the 1970 US standard (Tables 2, 3 and 4, pages 14-17, 19-21 and 24) and the 2000 US standard (Statistical Appendix Tables 2A, 3A and 4A, pages 37-45).The reader must use caution when comparing the rates presented in this report with rates from other data sources. It is important to note the standard population used for age-adjustment in order to make accurate comparison of rates from a variety of sources. Rates calculated using different standard populations are not directly comparable. Rate per 100,000 250.0 Cancer Death Rates in Georgia, 1980-1998 200.0 150.0 100.0 1980 1982 2000 Standard 1970 Standard 1940 Standard 1986 1990 Year 1994 1998 04 G E O R G I A Cancer Data Report 2000 INTRODUCTION The Challenge Cancer is the second leading cause of death in Georgia, accounting for 22% of all deaths between 1994-1998 (Figure 1). In 2000, an estimated 13,700 Georgians will die of cancer and 32,920 Georgians are expected to be diagnosed with this disease.The most common forms of cancer, lung, colorectal, breast and prostate, will account for 55% of all cancer diagnoses and 54% of all cancer deaths. Hope and Progress Currently, there is no universal cure for all types of cancer. However, there is hope in reducing the number of lives lost to this disease. New and better treatments for cancer continue to be developed and survival rates for cancer are Figure 1. Figure 1. LeadinLgeCaadusiensgofCDeaauthsien sGeorfgiDa,e19a9t4h-1i9n98Georgia, 1994-1998 Heart disease 30% Diabetes 2% Pneumonia & influenza 4% COPD 4% Unintentional injury 5% Stroke 7% Cancer 22% Lung & bronchus 30% Colon & rectum 9% Breast 8% Prostate 7% Other cancers 46% Other 26% improving. Many cancers can be detected early, increasing the chances of successful treatment and survival. More significantly, the risk of death from cancer can be reduced by adopting a healthy lifestyle. About 30% of all cancer deaths could be prevented by not smoking and another one-third could be prevented by adopting healthy diet and exercise practices. Answers This report 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. Data provided at the state and local level can be used to measure outcomes and effectiveness of cancer control programs, develop plans for future programs, develop funding proposals, and coordinate effective collaborations. This report describes the burden of cancer in Georgia and includes: 1) the 2000 estimated number of new cancer cases and deaths for Georgia and each county; 2) the number of cases and incidence rates for Georgia and each county; 3) the number of cancer deaths and mortality rates for Georgia and each county; 4) the prevalence of cancer screening in Georgia; and 5) the prevalence of cancer risk factors in Georgia. GEORGIA DEMOGRAPHICS During the 1990's, Georgia experienced substantial population growth. Between 19901998, the population of Georgia increased 18% compared to only 9% for the United States.1 Approximately half of Georgia's 7.6 million residents live in Metropolitan Atlanta.1, 2 In 1997, 70% of Georgians were white, 28% black, and 2% of other races; 3% of the population was of Hispanic origin.3 Between 2000-2015, the Hispanic population of Georgia is expected to increase by 48%. During these same years, the black population is expected to increase by 29% and will comprise approximately one-third of the total population of Georgia.4 Like the United States, Georgia's population is aging. Between 2000-2015, the number of Georgians over the age of 65 will increase by 51% to 1.2 million.4 Since the risk of developing cancer increases with age, this aging of the population will increase the burden of cancer in Georgia. 05 G E O R G I A Cancer Data Report 2000 BASIC CANCER INFORMATION What Is Cancer? Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells. If the growth is not controlled, it can result in death. Cancer is caused by both internal and external factors. Many cancers can be prevented by lifestyle changes and many can be cured if detected and treated promptly. How Many New Cases are Expected to Occur This Year? In 2000, about 32,920 Georgians will be diagnosed with cancer -- about 90 per day (Table 1, page 7). In the United States, 1.2 million cases of cancer are expected to occur in 2000. These estimates do not include non-melanoma skin cancer and carcinoma in situ for sites other than urinary bladder. Based on national estimates, more than 39,000 cases of non-melanoma skin cancer are expected to be diagnosed in Georgia this year. How Many People are Expected to Die of Cancer This Year? In 2000, about 13,700 Georgians are expected to die from cancer (Table 1, page 7). Cancer is the second leading cause of death in Georgia, with approximately 1 out of every 4 deaths from cancer. In the United States, 552,200 cancer deaths are expected to occur in 2000. Can Cancer Be Prevented? Many cancers can be prevented. Nearly two-thirds of cancer deaths can be linked to modifiable risk factors such as tobacco use, diet, obesity, and lack of exercise. In addition, many skin cancers could be prevented by protection from the sun's rays. Regular screening examinations by a health care provider can result in early detection of many cancers, when treatment is more likely to be successful. Who Is at Risk of Developing Cancer? Everyone. Since the occurrence of cancer increases as individuals age, most cases affect adults who are middle-aged or older. Nearly 72% of all cancers in Georgia are diagnosed at ages 55 and older. In the United States, males have a 1 in 2 lifetime risk of developing cancer, and for females the lifetime risk is 1 in 3. Lifetime risk refers to the probability that an individual, over the course of a lifetime, will develop cancer. How is Cancer Treated? Cancer is commonly treated by surgery, radiation, chemotherapy, hormones, and immunotherapy (agents to stimulate the body's defenses) or a combination of two or more of these methods. What Are the Costs of Cancer? The financial costs of cancer are great both to the individual and to society as a whole. Using estimates from the National Institutes of Health, the overall annual costs for cancer in Georgia is approximately $2.9 billion; $1.0 billion for direct medical costs (total of all health expenditures), $300 million for indirect morbidity costs (cost of lost productivity due to illness), and $1.6 billion for indirect mortality costs (cost of lost productivity due to premature death).Treatment of breast, lung, and prostate cancers account for over half of the direct medical costs. Causes of Cancer in the United States Estimated percentage of total cancer deaths attributable to established causes of cancer Risk Factor Percentage Tobacco 30% Adult diet/obesity 30% Sedentary lifestyle 5% Occupational factors 5% Family history of cancer 5% Viruses/other biologic agents 5% Perinatal factors/growth 5% Reproductive factors 3% Alcohol 3% Socioeconomic status 3% Environmental pollution 2% Ionizing/ultraviolet radiation 2% Prescription drugs/medical procedures 1% Salt/other food additives/contaminants 1% Source: Cancer Causes & Control, Harvard Report on Cancer Prevention, 1996 06 G E O R G I A Cancer Data Report 2000 CANCER IN GEORGIA IN 2000 Figure 2. Cancer Cases in Georgia, 2000 Estimates Male Female Prostate 5,030 Lung & bronchus 3,480 Colon & rectum 1,640 Non-Hodgkin's lymphoma 930 Melanoma 810 Urinary bladder 720 Oral cavity 520 Kidney 450 Leukemia 440 Pancreas 290 ALL SITES* 17,760 Breast 4,650 Lung & bronchus 1,810 Colon & rectum 1,640 Uterine corpus 840 Ovary 780 Melanoma 670 Non-Hodgkin's lymphoma 580 Uterine cervix 550 Leukemia 350 Pancreas 270 ALL SITES* 15,160 * Excludes non-melanoma skin cancer and carcinoma in situ except urinary bladder. Figure 3. Cancer Deaths in Georgia, 2000 Estimates Male Female Lung & bronchus 2,770 Prostate 910 Colon & rectum 610 Pancreas 310 Leukemia 280 Non-Hodgkin's lymphoma 240 Esophagus 210 Stomach 190 Brain 170 Liver 150 ALL SITES* 7,490 Lung & bronchus 1,360 Breast 1,100 Colon & rectum 650 Pancreas 330 Ovary 330 Leukemia 220 Non-Hodgkin's lymphoma 220 Brain 140 Uterine cervix 130 Stomach 130 ALL SITES* 6,210 * Excludes non-melanoma skin cancer and carcinoma in situ except urinary bladder. 07 Table 1. Estimated New Cancer Cases and Cancer Deaths by County, Georgia, 2000 ESTIMATED NEW CASES ESTIMATED DEATHS County All sites Female breast Colon & Lung & Prostate rectum bronchus All sites Female breast Colon & Lung & rectum bronchus Georgia 32,920 4,650 3,280 5,290 5,030 13,700 1,100 1,260 4,130 Appling 90 10 10 20 20 40 10 10 Atkinson 30 10 10 10 Bacon 60 10 10 10 10 30 10 Baker 20 10 10 Baldwin 190 30 20 30 30 80 10 10 20 Banks 50 10 10 10 20 10 Barrow 150 20 10 30 10 70 10 20 Bartow 320 40 40 60 50 140 10 10 50 Ben Hill 80 10 10 10 10 40 10 Berrien 80 10 10 20 10 30 10 Bibb 730 90 90 120 130 320 30 30 100 Bleckley 60 10 10 10 30 10 Brantley 70 20 30 10 Brooks 80 10 10 10 20 40 10 Bryan 70 10 10 10 10 30 10 Bulloch 190 30 20 30 40 80 10 10 20 Burke 100 20 10 10 10 40 10 10 Butts 90 10 10 10 10 40 10 Calhoun 30 20 10 Camden 100 10 10 20 20 40 10 Candler 50 10 10 20 10 Carroll 360 50 40 60 40 140 10 20 50 Catoosa 250 30 30 50 20 110 10 10 40 Charlton 50 10 10 10 10 20 10 Chatham 1,160 150 130 190 160 510 40 50 150 Chattahoochee 30 10 Chattooga 140 20 10 30 10 60 10 20 Cherokee 420 60 50 60 40 160 10 20 50 Clarke 290 50 30 50 70 130 10 10 40 Clay 20 10 Clayton 860 110 70 150 110 310 20 30 110 Clinch 30 10 10 10 Cobb 2,060 320 190 310 260 800 80 70 230 Coffee 150 20 10 20 60 10 10 20 Colquitt 190 20 20 30 50 90 10 10 30 Columbia 310 50 20 50 50 130 10 10 40 Cook 80 10 10 10 10 30 10 Coweta 270 40 20 50 50 120 10 10 40 Crawford 40 10 10 20 10 Crisp 140 20 10 30 20 60 10 20 Dade 60 10 10 10 30 10 Dawson 60 10 10 10 10 30 10 Decatur 130 20 20 20 20 70 10 20 DeKalb 2,580 480 260 350 460 1,040 100 100 280 Dodge 110 10 10 20 10 40 10 Dooly 60 10 10 10 10 30 Dougherty 440 60 50 80 80 200 20 20 60 Douglas 360 50 30 60 50 140 10 10 50 Early 70 10 10 10 10 30 10 Echols 10 10 Effingham 130 20 10 20 10 40 20 Elbert 120 20 10 20 30 50 10 10 20 Estimate is fewer than 5 cases or deaths. Cases or deaths between 5 and 9 were rounded to 10. Note: County estimates may not add to Georgia total due to rounding. Prostate 910 10 10 20 10 10 10 10 30 10 10 20 40 10 10 10 10 70 10 10 08 Table 1. Estimated New Cancer Cases and Cancer Deaths by County, Georgia, 2000 (continued) ESTIMATED NEW CASES ESTIMATED DEATHS County All sites Female breast Colon & Lung & Prostate rectum bronchus All sites Female breast Colon & Lung & Prostate rectum bronchus Emanuel 120 10 20 20 20 50 10 10 10 Evans 50 10 10 10 20 10 Fannin 120 10 10 30 20 50 10 20 Fayette 350 50 50 50 30 150 20 10 40 10 Floyd 490 60 50 90 60 230 20 20 70 10 Forsyth 180 30 20 30 30 80 10 10 30 Franklin 100 10 10 20 10 50 10 Fulton 3,260 530 330 430 600 1,290 130 130 330 100 Gilmer 100 10 10 20 10 40 20 Glascock 10 10 Glynn 380 50 30 70 90 170 10 10 60 10 Gordon 200 20 20 40 20 90 10 10 30 10 Grady 120 20 10 20 30 50 20 Greene 70 10 10 10 20 30 10 Gwinnett 1,460 250 140 190 220 540 50 50 160 30 Habersham 150 20 20 30 10 60 10 10 20 Hall 480 70 50 80 80 210 20 20 60 10 Hancock 60 10 10 10 20 20 Haralson 130 20 10 30 20 50 10 20 Harris 110 10 10 20 30 50 10 10 Hart 110 20 10 20 20 50 10 20 10 Heard 40 10 10 10 20 10 Henry 310 50 30 50 30 120 10 10 40 10 Houston 430 70 40 80 70 180 20 20 60 10 Irwin 60 10 10 10 10 30 10 Jackson 160 20 20 30 20 70 10 10 20 10 Jasper 60 10 10 10 10 20 10 Jeff Davis 80 10 10 20 10 40 10 Jefferson 110 20 10 20 20 50 10 10 10 Jenkins 50 10 10 10 10 20 10 Johnson 50 10 10 20 10 Jones 100 20 10 20 20 40 20 Lamar 80 10 10 10 10 30 10 Lanier 30 10 10 10 Laurens 230 20 20 40 60 100 10 10 30 10 Lee 90 10 10 20 10 30 10 Liberty 160 30 10 20 40 60 10 20 10 Lincoln 50 10 10 10 10 20 10 Long 30 10 10 10 Lowndes 360 40 30 60 60 150 10 10 50 10 Lumpkin 80 10 10 20 10 30 10 McDuffie 110 20 10 20 10 40 10 McIntosh 80 10 10 10 20 30 10 Macon 70 10 10 10 20 30 10 Madison 120 20 10 20 10 50 20 Marion 20 10 10 10 10 Meriwether 120 10 10 20 20 50 10 10 Miller 30 10 10 20 Mitchell 110 10 10 20 20 50 20 Monroe 100 10 10 20 10 40 20 Montgomery 40 10 10 20 10 Morgan 70 10 10 10 10 30 10 Murray 130 10 10 30 10 50 20 Estimate is fewer than 5 cases or deaths. Cases or deaths between 5 and 9 were rounded to 10. Note: County estimates may not add to Georgia total due to rounding. 09 Table 1. Estimated New Cancer Cases and Cancer Deaths by County, Georgia, 2000 (continued) ESTIMATED NEW CASES ESTIMATED DEATHS County All sites Female breast Colon & Lung & Prostate rectum bronchus All sites Female breast Colon & Lung & Prostate rectum bronchus Muscogee 840 120 90 140 120 370 30 40 110 30 Newton 250 30 20 40 30 100 10 10 30 10 Oconee 80 10 10 10 10 30 10 Oglethorpe 50 10 10 10 20 10 Paulding 220 30 20 40 20 80 10 10 30 10 Peach 100 20 10 20 10 40 10 Pickens 90 10 10 20 20 40 20 Pierce 90 10 10 20 10 40 10 Pike 60 10 10 30 10 Polk 210 30 20 40 30 90 10 10 30 10 Pulaski 50 10 10 10 10 20 10 Putnam 100 10 20 30 40 10 Quitman 20 10 Rabun 90 10 10 10 10 40 10 Randolph 50 10 10 10 10 20 10 Richmond 1,010 130 100 160 120 420 30 40 120 20 Rockdale 280 50 30 50 30 110 10 10 30 Schley 30 10 10 10 Screven 80 10 10 10 20 30 10 Seminole 50 10 10 10 10 20 10 Spalding 260 40 20 40 30 120 10 10 40 10 Stephens 140 20 10 20 20 60 10 10 20 Stewart 40 10 10 20 10 10 Sumter 170 30 10 30 20 70 10 20 Talbot 40 10 10 10 20 Taliaferro 10 10 Tattnall 100 10 10 20 10 40 10 Taylor 40 10 10 20 10 Telfair 80 10 10 20 10 30 10 Terrell 70 10 10 10 30 10 Thomas 220 20 20 40 30 90 10 10 30 10 Tift 170 30 10 30 30 80 10 10 20 Toombs 150 10 10 30 10 60 10 20 Towns 60 10 10 10 10 30 10 Treutlen 40 10 10 Troup 320 40 30 60 60 140 10 10 40 10 Turner 40 10 10 20 Twiggs 50 10 10 10 10 20 10 Union 100 10 10 20 10 40 10 Upson 140 30 10 20 30 60 10 10 20 10 Walker 350 40 30 70 40 150 10 10 50 10 Walton 200 20 20 40 30 90 10 10 30 10 Ware 200 20 30 40 30 90 10 10 30 10 Warren 40 10 10 10 10 Washington 120 10 10 20 30 40 10 10 Wayne 120 20 10 20 10 50 20 Webster 20 10 Wheeler 30 10 10 10 10 White 70 10 10 10 10 30 10 Whitfield 370 50 30 70 60 170 10 10 60 10 Wilcox 40 10 10 20 Wilkes 80 10 10 10 20 30 10 Wilkinson 40 10 10 10 10 20 10 Worth 90 10 20 10 10 40 10 10 Estimate is fewer than 5 cases or deaths. Cases or deaths between 5 and 9 were rounded to 10. Note: County estimates may not add to Georgia total due to rounding. 10 G E O R G I A Cancer Data Report 2000 CANCER MORTALITY Cancer Mortality in Georgia Between 1994-1998, there was an average of 12,714 cancer deaths in Georgia per year; 6,818 among males and 5,896 among females (Table 2, page 14). Four cancer sites -- lung, colorectal, breast and prostate accounted for 54% of cancer deaths in Georgia.The burden of these cancers can be significantly reduced by broadening the use of mammography, colorectal screening, and other early detection examinations and by preventing or stopping tobacco use, improving diet, and increasing physical activity. Figure 4. Counties with Significantly* High or Low Cancer Mortality Rates, 1994-1998 Males in Georgia are about 70% more likely to die of cancer than females. Lung cancer is the leading cause of cancer death among Georgia males and females and accounts for 30% of all cancer deaths each year. Among males, prostate and colorectal cancer are the second and third leading causes of cancer death; while breast and colorectal cancer rank second and third among females. There are a large number of counties in rural south and east Georgia where mortality rates are significantly higher than the state average. All counties in the Metropolitan Atlanta area, with the exception of Fulton County, have significantly lower mortality rates than the state average. Rome Gainesville Atlanta Athens Augusta Columbus Macon Dublin Albany Valdosta Waycross * p < 0.05 Counties with rates significantly higher than state rate No significant difference Counties with rates significantly lower than state rate Savannah Brunswick 11 G E O R G I A Cancer Data Report 2000 Cancer Mortality in Georgia and the United States Lung and prostate cancer mortality rates are higher among Georgia males compared to US males by 20% and 19%, respectively (Figure 5). Pancreatic cancer and leukemia mortality rates are slightly lower or the same among Georgia males compared to US males. Colorectal cancer mortality rates are 12% lower among Georgia males compared to US males and 10% lower among Georgia females compared to US females (Figures 5 and 6). Lung, breast, pancreatic and ovarian cancer mortality rates are slightly lower or the same among Georgia females compared to US females (Figure 6). Figure 5. Cancer Mortality Rates* in Georgia (1994-1998) and the United States (1993-1997), Males 100.0 80.0 83.0 69.4 Georgia United States 60.0 Rate per 100,000 40.0 29.3 24.7 18.4 21.0 20.0 9.3 9.7 0.0 Lung & bronchus Prostate Colon & rectum Cancer Site * Average annual rate per 100,000, age-adjusted to the 1970 US standard population. Pancreas 8.2 8.3 Leukemia Rate per 100,000 Figure 6. Cancer Mortality Rates* in Georgia (1994-1998) and the United States (1993-1997), Females 100.0 Georgia 80.0 United States 60.0 40.0 33.0 34.0 20.0 23.6 24.8 13.0 14.4 6.9 7.2 0.0 Lung & bronchus Breast Colon & rectum Cancer Site * Average annual rate per 100,000, age-adjusted to the 1970 US standard population. Pancreas 7.3 7.5 Ovary 12 G E O R G I A Cancer Data Report 2000 Rate per 100,000 Rate per 100,000 Trends in Cancer Mortality in Georgia Between 1991-1998, overall cancer mortality rates among Georgia males declined 9%. Lung cancer is the leading cause of cancer deaths among Georgia males; mortality rates are 2 times higher than rates of any other cancer. Since 1991, mortality rates from lung cancer have declined 14% (Figure 7). Prostate cancer is the second leading cause of cancer death among Georgia males. During 1980-1992, prostate cancer mortality rates in Georgia increased 29% followed by a 20% decline between 1992-1998. Colorectal cancer is the third leading cause of cancer death among Georgia males. During 1980-1990, colorectal cancer mortality rates increased 12% followed by a 20% decline between 1990-1998. Cancer of the pancreas and leukemia are the fourth and fifth leading causes of cancer death among Georgia males; mortality rates for these cancers have been relatively steady since 1980. 100.0 80.0 Figure 7. Trends in Cancer Mortality Rates* in Georgia, Males, 1980-1998 Lung & bronchus 100.0 Figure 8. Trends in Cancer Mortality Rates* in Georgia, Females, 1980-1998 80.0 60.0 60.0 40.0 20.0 0.0 1980 Prostate Colon & rectum Pancreas 1985 1990 Leukemia 1995 1998 Year * Rate per 100,000, age-adjusted to the 1970 US standard population. 40.0 Breast 20.0 0.0 1980 Ovary 1985 Lung & bronchus Colon & rectum Pancreas 1990 1995 1998 Year * Rate per 100,000, age-adjusted to the 1970 US standard population. Unlike males, overall cancer mortality rates among females have been steadily increasing over the past 2 decades; however, the increase appears to be slowing in recent years. Lung cancer is the leading cause of cancer death among Georgia females; the mortality rate has doubled since 1980 (Figure 8). Since 1988, more females have died each year of lung cancer than breast cancer, which, for over 40 years, had been the major cause of cancer death among females. Breast cancer is the second leading cause of cancer death among Georgia females. During 19801987, breast cancer mortality rates in Georgia increased 25% followed by a 14% decline between 1987-1998. Colorectal cancer is the third leading cause of cancer death among Georgia females; since 1980, colorectal cancer mortality rates have declined 16%. Cancers of the pancreas and ovary are the fourth and fifth leading causes of cancer death among Georgia females; mortality rates for these cancers have been relatively steady since 1980. 13 G E O R G I A Cancer Data Report 2000 Racial Differences in Cancer Mortality in Georgia Blacks in Georgia are 27% more likely to die of cancer than whites. During 1994-1998, overall cancer mortality rates were 205.1 per 100,000 among blacks and 161.1 per 100,000 among whites. Lung, prostate, colorectal, and pancreatic cancer mortality rates are higher (17%, 162%, 41%, and 50% respectively) among black males in Georgia compared to white males (Figure 9). Black males are more than twice as likely to die of prostate cancer than white males. Breast, colorectal, and pancreatic cancer mortality rates are higher (36%, 54%, and 48% respectively) among black females in Georgia compared to white females (Figure 10). Lung and ovarian cancer mortality rates are lower (33% and 17% respectively) among black females in Georgia compared to white females. 100.0 80.0 60.0 Figure 9. Cancer Mortality Rates* in Georgia by Race, Males, 1994-1998 96.0 82.0 Black White 59.8 Rate per 100,000 40.0 22.8 24.5 17.4 20.0 12.9 8.6 0.0 Lung & bronchus Prostate Colon & rectum Cancer Site * Average annual rate per 100,000, age-adjusted to the 1970 US standard population. Note: These rates are for non-Hispanic white and black males. Pancreas 8.0 8.5 Leukemia Rate per 100,000 100.0 80.0 Figure 10. Cancer Mortality Rates* in Georgia by Race, Females, 1994-1998 Black White 60.0 36.3 40.0 24.2 20.0 30.2 22.2 18.2 11.8 0.0 Lung & bronchus Breast Colon & rectum Cancer Site * Average annual rate per 100,000, age-adjusted to the 1970 US standard population. Note: These rates are for non-Hispanic white and black females. 9.3 6.3 Pancreas 6.4 7.7 Ovary Table 2. Average Annual Number of Cancer Deaths and Mortality Rates by County, Georgia, 1994-1998 ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Male Female Female Male Female Male Female Male County Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Georgia 6,818 227.3 5,896 135.5 1,014 23.6 553 18.4 599 13.0 2,478 83.0 1,353 33.0 830 29.3 14 Appling 22 277.7 15 125.9 2 20.1 <2 3 21.5 9 118.9 3 23.4 4 51.5 Atkinson 6 196.7 7 175.3 <2 <2 <2 3 96.2 <2 <2 Bacon 13 259.1 12 168.1 <2 <2 <2 5 100.8 <2 <2 Baker 3 156.6 4 136.3 <2 <2 <2 <2 <2 <2 Baldwin 43 224.4 33 132.4 6 26.7 5 23.0 3 10.4 17 86.5 9 36.9 6 30.0 Banks 12 224.7 8 114.4 <2 <2 <2 5 84.5 2 33.4 <2 Barrow 34 229.8 26 122.9 4 16.7 2 15.2 <2 14 96.8 8 41.5 <2 Bartow 72 257.4 50 129.7 9 22.2 6 21.8 6 15.0 27 95.8 13 35.5 8 34.0 Ben Hill 19 223.3 16 116.8 2 20.1 2 27.7 <2 8 98.4 3 25.7 2 23.3 Berrien 17 220.0 15 137.6 2 21.5 <2 2 17.1 8 108.1 4 31.4 2 31.0 Bibb 178 248.2 150 130.6 24 21.9 16 23.0 17 13.6 67 93.1 38 34.1 23 31.4 Bleckley 15 274.1 11 122.1 <2 <2 <2 7 123.0 2 25.4 <2 Brantley 13 219.6 13 177.4 <2 <2 <2 6 110.3 4 61.3 <2 Brooks 20 229.9 15 114.0 <2 2 23.6 2 14.8 7 84.9 3 23.1 3 35.8 Bryan 18 240.6 14 148.3 <2 <2 <2 7 86.9 4 48.9 2 33.3 Bulloch 42 218.8 38 140.1 8 30.4 4 18.3 4 12.1 13 69.0 6 23.8 6 34.5 Burke 22 253.6 20 152.8 4 35.9 <2 2 15.3 6 67.2 4 29.0 4 41.2 Butts 17 211.7 16 156.2 2 26.0 <2 <2 6 72.8 4 40.1 <2 Calhoun 7 269.8 6 115.0 <2 <2 <2 <2 <2 <2 Camden 21 226.7 19 149.6 3 20.6 <2 <2 6 68.0 6 49.2 4 44.8 Candler 12 256.3 9 134.0 <2 <2 <2 3 75.7 2 33.9 <2 Carroll 75 228.0 65 139.8 11 22.6 8 24.1 7 15.6 30 90.2 14 33.9 7 23.5 Catoosa 52 219.1 41 127.8 6 19.7 5 22.3 3 9.0 22 91.4 13 42.0 3 15.6 Charlton 10 251.8 11 204.4 <2 <2 <2 3 79.2 2 37.2 <2 Chatham 248 224.8 229 142.0 36 23.7 21 19.3 26 15.5 88 80.3 55 35.3 32 28.9 Chattahoochee 4 388.2 3 176.0 <2 <2 <2 <2 <2 <2 Chattooga 31 240.8 30 156.1 4 25.8 2 15.2 3 11.6 14 107.9 8 42.8 3 19.8 Cherokee 83 215.3 64 121.3 11 19.2 8 19.6 7 12.7 26 71.2 14 29.2 7 22.0 Clarke 63 207.4 55 117.5 11 24.5 5 17.7 4 7.4 23 76.7 13 30.4 10 32.4 Clay 5 225.9 5 157.6 <2 <2 <2 <2 <2 <2 Clayton 136 222.5 126 148.2 18 20.4 11 18.6 10 10.7 53 86.2 37 46.1 12 24.3 Clinch 8 259.1 5 124.2 <2 <2 <2 2 78.9 <2 <2 Cobb 349 211.4 338 140.7 58 23.2 29 17.9 33 13.8 122 73.5 80 35.4 37 26.9 Coffee 31 222.0 25 127.4 4 22.4 3 22.4 <2 12 86.7 5 29.2 <2 Colquitt 45 222.1 40 136.9 5 17.5 3 14.4 6 17.5 17 85.0 7 26.8 9 41.4 Columbia 56 198.2 54 141.2 9 21.1 3 11.0 4 10.6 21 68.4 14 38.0 6 25.1 Cook 21 291.7 14 128.8 3 27.2 <2 <2 8 107.1 3 30.2 2 28.9 Coweta 66 231.8 52 125.6 10 21.9 6 21.7 3 7.1 23 79.1 13 33.2 10 40.4 Crawford 9 195.1 6 114.3 <2 <2 <2 3 68.0 <2 <2 * Average annual rate per 100,000, age-adjusted to the 1970 US standard population. Rate not calculated for fewer than 2 average deaths. Table 2. Average Annual Number of Cancer Deaths and Mortality Rates by County, Georgia, 1994-1998 (continued) ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Male Female Female Male Female Male Female Male County Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Crisp 32 326.5 22 130.9 4 25.5 <2 <2 15 149.9 5 30.6 4 44.0 15 Dade 15 194.4 12 128.4 <2 <2 <2 6 79.6 3 38.0 3 36.8 Dawson 13 257.3 9 129.3 2 34.3 <2 <2 5 89.7 2 34.5 <2 Decatur 32 248.8 28 150.4 5 29.2 3 23.8 2 9.5 12 96.7 6 35.5 4 30.6 DeKalb 433 208.0 421 134.6 89 27.8 36 17.4 46 14.0 134 65.5 89 30.4 58 31.4 Dodge 26 273.1 21 153.1 3 25.5 2 23.4 2 16.8 10 107.3 4 27.9 3 27.9 Dooly 12 243.2 12 145.3 3 36.3 <2 <2 4 80.0 <2 <2 Dougherty 101 251.8 81 132.6 14 23.4 10 24.3 8 11.1 39 95.5 19 34.0 15 38.9 Douglas 68 228.6 55 138.5 10 24.1 4 13.3 4 9.6 24 83.6 14 38.1 6 22.7 Early 17 263.5 15 139.1 4 33.0 <2 2 14.0 6 87.4 3 25.0 3 41.4 Echols 3 243.1 <2 <2 <2 <2 <2 <2 <2 Effingham 28 222.2 22 132.4 3 21.0 <2 2 14.5 13 98.4 4 27.7 2 23.1 Elbert 29 266.1 23 142.4 4 26.5 2 21.1 3 15.1 10 95.9 5 32.0 2 22.7 Emanuel 33 302.0 20 120.2 3 21.1 3 31.2 2 10.7 10 94.1 5 28.7 3 29.1 Evans 12 249.4 9 129.2 <2 <2 <2 5 101.2 <2 2 41.2 Fannin 29 208.2 22 132.2 3 20.6 2 18.0 3 16.0 12 88.3 7 45.2 3 19.6 Fayette 55 188.5 54 132.0 8 19.2 6 19.9 6 14.0 18 60.3 13 31.9 7 28.5 Floyd 111 244.8 96 141.8 15 23.5 9 19.0 9 11.8 43 94.4 23 36.8 10 22.0 Forsyth 41 156.1 38 103.7 6 16.6 <2 5 15.0 16 58.2 8 22.7 5 22.3 Franklin 23 203.4 20 132.7 4 22.8 <2 2 13.8 8 71.3 3 20.9 3 27.3 Fulton 627 235.0 636 149.4 125 29.4 55 20.3 72 15.7 190 72.3 134 33.5 89 35.1 Gilmer 24 230.3 20 145.9 2 16.4 2 20.1 2 12.4 9 86.7 7 51.9 3 25.1 Glascock 4 207.8 <2 <2 <2 <2 <2 <2 <2 Glynn 78 205.9 73 142.4 11 23.7 5 13.2 7 12.6 27 70.8 21 41.1 9 25.3 Gordon 44 246.0 32 128.5 5 20.3 3 17.6 3 11.5 16 90.8 9 37.2 5 30.6 Grady 32 269.5 19 117.9 4 24.4 2 15.8 <2 13 115.7 3 22.0 5 38.8 Greene 16 242.6 12 133.4 3 34.7 <2 2 20.4 6 89.5 2 22.8 2 35.4 Gwinnett 233 186.3 227 129.9 44 23.2 22 17.8 23 13.5 72 59.3 52 31.4 23 22.4 Habersham 34 191.8 29 122.3 6 26.5 3 17.0 4 13.5 14 80.4 6 25.3 3 16.6 Hall 103 205.8 84 122.1 15 22.1 10 20.1 8 10.5 39 76.7 21 33.0 12 24.6 Hancock 13 292.6 11 154.0 2 33.2 <2 <2 3 77.5 <2 3 65.6 Haralson 29 238.1 24 133.3 3 19.5 <2 3 14.2 13 105.1 5 35.6 3 25.1 Harris 28 239.7 18 122.8 4 24.8 2 21.3 <2 8 64.3 4 27.4 5 41.2 Hart 27 209.8 20 107.9 4 25.7 2 17.6 2 11.2 10 78.9 3 17.2 4 31.7 Heard 8 178.7 6 111.2 <2 <2 <2 3 75.3 <2 <2 Henry 68 202.6 62 136.2 11 23.0 5 13.5 7 15.4 23 70.5 15 33.6 6 21.6 Houston 87 230.5 76 139.8 15 26.0 6 17.6 6 10.8 33 82.7 22 41.0 10 35.9 Irwin 14 297.9 10 136.7 <2 <2 <2 8 159.4 <2 2 36.0 Jackson 36 216.5 29 129.8 5 23.1 4 21.2 <2 16 93.6 7 34.6 3 21.3 Jasper 12 252.5 11 179.6 2 38.3 <2 <2 5 96.4 <2 <2 * Average annual rate per 100,000, age-adjusted to the 1970 US standard population. Rate not calculated for fewer than 2 average deaths. Table 2. Average Annual Number of Cancer Deaths and Mortality Rates by County, Georgia, 1994-1998 (continued) ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Male Female Female Male Female Male Female Male County Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Jeff Davis 20 340.5 10 119.6 <2 <2 <2 9 156.3 2 32.2 2 44.8 16 Jefferson 24 283.1 22 153.6 5 45.0 <2 4 22.1 10 119.6 3 21.5 4 47.9 Jenkins 13 269.2 7 122.5 <2 <2 <2 5 115.9 2 35.5 2 43.4 Johnson 11 249.9 11 147.6 <2 <2 <2 4 97.8 <2 <2 Jones 21 231.8 18 134.9 3 22.7 <2 2 15.7 9 92.2 4 31.4 3 34.2 Lamar 19 261.4 15 149.6 2 22.7 <2 <2 8 106.7 3 36.6 3 43.1 Lanier 8 286.4 4 104.8 <2 <2 <2 3 110.5 <2 <2 Laurens 58 266.0 37 121.4 6 18.2 3 15.5 3 10.3 21 91.3 7 23.3 10 44.3 Lee 14 249.8 14 148.3 2 17.8 <2 <2 6 95.8 3 35.7 <2 Liberty 31 285.9 23 147.9 5 27.4 2 18.4 <2 9 86.1 7 48.5 5 56.5 Lincoln 12 276.6 8 137.6 <2 <2 <2 5 115.2 <2 2 44.5 Long 6 212.2 5 135.1 <2 <2 <2 2 68.0 <2 <2 Lowndes 78 241.6 66 141.1 8 17.5 4 13.3 7 14.7 31 96.0 18 40.6 11 35.6 Lumpkin 18 222.0 14 136.6 2 25.5 <2 <2 7 90.1 4 42.3 2 25.7 McDuffie 23 237.5 21 151.6 4 27.6 <2 2 12.4 11 110.4 5 37.2 <2 McIntosh 15 287.9 10 155.9 2 35.4 <2 <2 5 88.4 <2 3 49.3 Macon 16 280.0 13 148.1 <2 <2 <2 6 99.2 <2 3 52.3 Madison 25 232.6 22 147.9 4 27.3 <2 2 16.2 9 86.3 4 27.3 3 27.0 Marion 8 272.4 3 72.5 <2 <2 <2 4 128.7 <2 <2 Meriwether 27 236.8 24 141.2 3 17.6 <2 3 13.8 9 81.1 5 30.6 5 40.9 Miller 7 192.0 6 103.2 <2 <2 <2 2 53.4 <2 <2 Mitchell 26 275.0 21 144.3 2 17.2 <2 3 20.0 12 129.5 5 33.1 3 30.6 Monroe 25 292.7 18 141.8 3 20.5 <2 3 18.6 11 133.7 4 32.3 2 28.9 Montgomery 10 265.2 7 142.5 <2 <2 <2 4 95.8 <2 <2 Morgan 15 206.3 12 115.4 <2 2 31.4 <2 5 70.8 3 25.1 <2 Murray 25 211.4 22 137.0 3 20.4 2 19.0 2 11.9 12 101.7 6 40.1 2 21.0 Muscogee 190 242.7 166 136.7 28 23.7 16 21.4 16 12.5 70 87.8 39 33.5 27 35.7 Newton 49 224.8 45 141.6 6 21.1 4 16.7 4 12.6 20 95.0 8 27.3 6 28.3 Oconee 18 208.7 14 106.5 3 22.6 <2 <2 5 65.4 4 31.3 <2 Oglethorpe 12 237.7 9 124.4 <2 <2 <2 4 80.0 3 45.5 <2 Paulding 47 231.8 37 139.1 6 23.3 5 25.1 2 8.0 19 91.5 11 45.9 5 29.1 Peach 22 230.9 18 125.3 4 26.2 <2 <2 9 94.5 3 22.3 3 29.0 Pickens 21 223.6 13 98.0 3 26.6 <2 <2 9 92.1 3 21.2 <2 Pierce 21 279.9 12 130.5 2 26.5 <2 <2 9 121.9 <2 3 34.4 Pike 18 290.3 10 120.3 <2 <2 <2 7 112.2 3 39.9 2 36.8 Polk 51 276.2 41 148.2 7 26.5 4 23.2 4 12.2 21 112.1 11 41.6 5 26.7 Pulaski 11 230.2 10 132.0 2 38.7 <2 <2 3 56.6 2 27.2 2 45.3 Putnam 21 225.9 16 137.8 <2 <2 <2 8 86.8 4 36.2 3 34.7 Quitman 4 264.1 3 138.9 <2 <2 <2 <2 <2 <2 Rabun 22 220.3 17 137.1 3 25.1 2 21.2 2 14.9 7 76.4 2 18.1 3 23.6 * Average annual rate per 100,000, age-adjusted to the 1970 US standard population. Rate not calculated for fewer than 2 average deaths. Table 2. Average Annual Number of Cancer Deaths and Mortality Rates by County, Georgia, 1994-1998 (continued) ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Male Female Female Male Female Male Female Male County Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Randolph 13 296.7 10 132.5 <2 <2 <2 4 90.5 <2 2 53.9 17 Richmond 210 267.1 175 149.4 28 23.7 15 19.8 18 14.8 73 93.8 43 37.4 19 26.1 Rockdale 49 191.8 52 147.2 10 27.1 4 17.6 5 13.3 19 72.7 13 38.1 4 19.1 Schley 5 311.2 5 195.7 <2 <2 <2 2 118.9 <2 <2 Screven 24 311.9 16 153.1 4 38.9 2 27.6 2 21.6 8 104.8 3 28.9 4 48.7 Seminole 11 225.6 9 121.5 <2 <2 <2 4 75.1 <2 <2 Spalding 58 231.8 52 133.4 9 24.8 4 16.5 4 9.5 20 79.7 12 36.1 7 27.5 Stephens 34 232.7 28 128.5 5 24.7 3 17.6 2 10.2 13 89.5 5 27.7 5 29.8 Stewart 8 248.1 7 143.9 <2 <2 <2 4 137.5 <2 3 73.8 Sumter 33 246.4 33 151.1 5 29.2 2 15.1 3 12.5 11 83.9 7 33.9 4 30.3 Talbot 9 254.6 7 142.5 <2 <2 <2 3 100.8 <2 <2 Taliaferro 3 281.1 <2 <2 <2 <2 <2 <2 <2 Tattnall 28 283.9 16 123.0 3 27.1 <2 <2 10 104.3 3 27.2 3 26.2 Taylor 8 195.5 8 128.6 <2 <2 <2 3 80.2 2 35.5 <2 Telfair 19 311.9 15 151.9 3 32.2 3 45.3 <2 8 132.0 3 38.3 <2 Terrell 17 320.5 11 139.4 <2 <2 <2 8 151.5 <2 2 41.8 Thomas 54 259.1 39 120.4 4 13.8 5 25.9 3 9.2 21 100.0 8 24.5 6 26.9 Tift 38 245.9 33 140.4 5 24.7 2 13.6 <2 15 99.5 8 34.4 5 30.1 Toombs 31 273.2 28 154.2 3 17.9 <2 <2 14 119.0 6 35.3 4 35.6 Towns 13 164.3 11 117.8 2 26.0 <2 <2 4 56.5 <2 <2 Treutlen 7 220.1 7 151.6 <2 <2 <2 3 87.4 <2 <2 Troup 71 254.9 61 138.8 7 19.2 5 19.3 8 14.5 29 106.3 14 35.2 9 32.5 Turner 12 256.0 8 118.1 <2 <2 <2 4 83.1 2 28.1 <2 Twiggs 13 263.4 7 120.0 <2 <2 <2 6 118.5 2 33.0 <2 Union 27 225.3 18 117.0 <2 2 17.4 2 13.2 11 92.2 5 36.4 2 17.2 Upson 28 192.2 31 138.6 7 33.7 2 13.2 3 14.8 9 63.3 6 27.9 5 35.2 Walker 81 241.2 62 134.0 9 21.8 6 18.8 6 12.0 36 106.4 16 35.3 6 18.9 Walton 49 225.3 36 120.4 4 12.2 4 17.4 4 13.8 18 83.3 9 34.0 5 25.9 Ware 50 250.8 36 121.7 4 13.7 4 21.1 5 13.7 22 110.0 8 27.6 6 28.2 Warren 8 239.1 7 130.6 <2 <2 <2 3 107.4 <2 <2 Washington 25 280.9 23 155.4 3 18.2 3 28.6 2 11.1 7 75.1 6 45.1 4 42.2 Wayne 28 228.4 22 140.9 4 23.4 <2 <2 13 104.3 6 36.7 3 23.4 Webster 4 275.7 3 169.5 <2 <2 <2 <2 <2 <2 Wheeler 7 255.1 4 121.1 <2 <2 <2 3 119.8 <2 <2 White 17 163.1 14 106.6 3 25.3 <2 <2 7 64.9 3 23.9 <2 Whitfield 76 219.7 67 136.2 12 25.3 6 18.1 6 10.7 33 96.1 16 36.5 9 26.9 Wilcox 10 227.1 7 114.2 <2 <2 <2 4 91.2 <2 <2 Wilkes 18 301.7 14 154.4 3 35.0 <2 <2 7 114.5 <2 2 42.3 Wilkinson 10 197.2 9 132.8 2 32.1 <2 <2 4 81.5 <2 <2 Worth 22 220.5 17 122.6 3 19.8 3 27.9 2 15.8 8 76.8 4 26.8 2 23.1 * Average annual rate per 100,000, age-adjusted to the 1970 US standard population. Rate not calculated for fewer than 2 average deaths. 18 G E O R G I A Cancer Data Report 2000 CANCER INCIDENCE The Georgia Comprehensive Cancer Registry The Georgia Comprehensive Cancer Registry was established to be a tool for Georgia health professionals at the state and local level to better understand the state's cancer burden.The Cancer Registry collects statewide data on new cases of cancer and these data are used to estimate cancer incidence rates within Georgia, monitor cancer trends, evaluate possible clusters of cancer, respond to inquiries about cancer from the public, and conduct research. Data from the Cancer Registry also assist state and local agencies in focusing cancer control programs on early detection and the prevention of risk behaviors. The State's goal is to produce cancer incidence and mortality reports yearly for use by the public and health professionals. Figure 11. Completeness of Case Reporting by Health District, Georgia, 1997 64% 42% 100% 100% 69% 48% 100% 97% In order to accurately understand the burden of cancer in Georgia it is important to have at least 90% of the newly diagnosed cancer cases reported to the Cancer Registry annually. For 1995, the first year cancer incidence data were required to be reported by all health care providers, reporting is 93% complete; for 1996 it is 75% complete; for 1997 it is 72% complete; and for 1998 it is only 51% complete. The primary reason for incomplete data is that there are still hospitals, laboratories, and outpatient treatment and diagnostic facilities that are not reporting their cancer data to the Cancer Registry. Projections show that if all hospitals, laboratories, and outpatient treatment and diagnostic facilities reported their newly diagnosed cancer cases completely and accurately, Cancer Registry data would be more than 90% complete each year. The State's goal for 2000 is to have all health care providers reporting data to the Cancer Registry. The reader must use caution when analyzing the incidence data on Table 3 as these data are only 93% complete and may be an underestimate of the true cancer burden in Georgia and Georgia counties. 100% 68% 57% 47% Cancer Incidence in Georgia In 1995, there were more than 23,000 cancer cases diagnosed in Georgia (Table 3). Four cancer sites account for over half of Georgia's cancer 50% 48% burden -- lung, colorectal, breast and prostate 36% cancer. In 1995, these four cancer sites accounted for 57% of new cancer cases in Georgia. 53% 59% 74% 36% Males in Georgia are nearly 50% more likely to develop cancer than females. Prostate cancer is the most common cancer diagnosed among Georgia males, followed by lung and colorectal cancer. Among females, breast cancer is the most commonly diagnosed cancer, followed by lung and colorectal cancer. 19 Table 3. Reported Number of Cancer Cases and Incidence Rates by County, Georgia, 1995 ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Total Female Total Total Male County Cases Rate* Cases Rate* Cases Rate* Cases Rate* Cases Rate* Georgia Appling Atkinson 23,669 49 18 331.1 276.3 247.1 3,558 14 5 87.8 144.5 2,464 34.1 <5 <5 3,884 56.4 <5 <5 3,490 <5 <5 121.6 Bacon 31 263.8 8 <5 <5 <5 Baker Baldwin 17 372.2 53 121.1 <5 5 <5 <5 <5 13 30.2 5 7 Banks 32 265.1 <5 <5 <5 8 Barrow Bartow Ben Hill Berrien Bibb Bleckley 119 348.5 140 216.7 49 254.7 36 202.9 384 220.8 26 211.1 23 116.3 23 65.6 7 5 40 41.3 <5 8 17 26.3 <5 <5 38 21.6 <5 20 61.4 28 44.0 11 59.7 10 58.8 90 51.4 5 19 144.1 11 40.2 10 112.7 5 73 104.1 <5 Brantley 41 309.9 <5 <5 7 <5 Brooks 39 194.8 <5 <5 11 52.6 6 Bryan 68 369.5 8 6 14 82.6 6 Bulloch Burke 151 344.0 58 265.2 30 113.4 13 88.1 12 25.2 9 23 51.5 7 19 102.4 <5 Butts 64 373.5 9 6 13 79.7 12 159.1 Calhoun Camden Candler Carroll Catoosa 25 434.3 64 286.5 22 196.8 99 127.3 13 23.4 5 9 <5 14 31.5 <5 <5 8 <5 <5 <5 <5 14 68.0 <5 20 26.9 <5 5 6 <5 15 50.6 <5 Charlton 15 170.8 <5 <5 <5 <5 Chatham 977 377.9 137 97.1 151 56.5 172 66.7 101 93.1 Chattahoochee 15 584.1 <5 <5 <5 <5 Chattooga 100 319.8 18 103.1 11 33.3 17 55.9 12 87.0 Cherokee 245 268.6 35 63.0 22 24.6 42 52.8 37 107.6 Clarke Clay 307 411.6 <5 49 106.4 <5 27 33.3 <5 32 46.8 <5 60 208.3 <5 Clayton 666 429.5 113 117.2 61 41.1 115 79.6 93 157.5 Clinch 21 300.1 5 <5 6 <5 Cobb 1,812 431.3 305 119.2 171 44.1 271 70.9 282 175.4 Coffee Colquitt 120 354.8 99 216.6 17 86.9 12 54.6 13 39.4 <5 16 47.5 22 47.7 19 140.1 20 102.6 Columbia Cook 274 411.0 50 309.9 28 68.0 8 29 45.5 6 60 97.3 9 37 144.1 7 Coweta Crawford 245 355.1 13 125.4 39 92.9 <5 32 47.0 <5 41 62.3 <5 30 108.3 <5 Crisp Dade 90 371.4 <5 10 65.8 <5 <5 <5 16 69.3 <5 18 192.2 <5 Dawson Decatur 42 366.4 60 204.9 8 11 68.0 <5 6 8 12 39.6 6 <5 DeKalb Dodge Dooly 2,180 45 35 407.6 205.6 289.1 365 116.6 6 6 221 42.0 6 8 286 56.5 15 72.0 <5 386 187.6 <5 <5 Dougherty 393 400.2 66 119.1 49 48.3 68 68.9 65 162.9 Douglas Early Echols 192 268.3 11 79.5 <5 24 63.5 <5 <5 23 31.2 <5 <5 28 43.8 <5 <5 21 68.5 <5 <5 Effingham Elbert 105 364.6 71 301.2 21 132.1 8 6 7 25 89.9 13 53.0 13 109.9 12 108.7 * Rate per 100,000, age-adjusted to the 1970 US standard population. Rate not calculated for fewer than 10 cases. Cancer cases for this county may be underreported to the Cancer Registry. Please use caution when comparing these data with mortality data for the same county. 20 Table 3. Reported Number of Cancer Cases and Incidence Rates by County, Georgia, 1995 (continued) ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Total Female Total Total Male County Cases Rate* Cases Rate* Cases Rate* Cases Rate* Cases Rate* Emanuel 72 292.0 6 10 39.2 19 73.2 8 Evans Fannin 32 295.0 58 212.9 6 11 77.2 <5 <5 9 12 40.0 <5 13 106.2 Fayette 245 353.2 57 143.6 35 53.8 29 44.2 42 137.9 Floyd 339 311.6 54 87.1 40 32.8 70 66.1 28 62.9 Forsyth 140 234.7 21 61.3 17 29.5 25 42.2 20 77.5 Franklin 67 276.9 9 14 59.6 9 10 88.4 Fulton Gilmer 2,957 55 433.8 254.7 433 109.8 <5 294 42.2 6 376 58.6 11 48.3 478 192.6 10 95.9 Glascock 10 231.1 <5 <5 <5 <5 Glynn Gordon Grady 315 366.2 114 279.2 76 283.3 43 87.2 19 81.7 19 126.9 26 28.6 8 6 53 61.3 30 74.0 11 42.3 53 146.9 7 6 Greene 62 421.5 8 11 63.7 8 8 Gwinnett 1,254 404.3 208 109.7 131 47.2 174 62.9 187 169.3 Habersham 121 329.6 13 64.7 11 30.7 21 53.8 17 100.3 Hall 405 356.1 56 90.4 42 35.2 67 59.8 70 146.7 Hancock Haralson Harris Hart Heard 49 451.6 45 169.1 65 261.6 40 151.3 21 209.2 7 <5 8 7 <5 8 <5 6 <5 <5 10 94.0 13 48.4 14 57.6 11 42.9 <5 7 <5 7 <5 <5 Henry Houston 285 368.6 159 165.1 41 93.3 15 28.8 26 34.7 14 13.9 44 61.0 22 23.5 43 140.6 33 85.2 Irwin 17 173.4 <5 <5 <5 <5 Jackson 130 352.0 20 103.5 17 46.6 15 40.5 16 103.7 Jasper 48 444.4 7 7 6 <5 Jeff Davis 45 330.5 5 8 10 73.1 11 199.5 Jefferson 80 362.0 5 14 60.6 17 84.4 10 116.5 Jenkins Johnson Jones 36 327.5 25 249.5 26 115.5 <5 6 <5 <5 <5 <5 8 8 6 6 <5 <5 Lamar Lanier 60 355.4 17 278.1 7 <5 <5 <5 15 95.7 <5 11 144.0 <5 Laurens 107 208.7 8 11 20.7 26 53.0 16 71.1 Lee 51 349.8 7 <5 9 13 237.3 Liberty 103 364.6 14 73.2 13 49.3 17 74.7 12 123.8 Lincoln Long 39 390.1 12 175.4 5 <5 <5 <5 13 133.5 <5 <5 <5 Lowndes 300 391.9 46 106.5 30 35.5 48 64.9 59 192.4 Lumpkin 50 291.1 11 116.6 5 9 7 McDuffie 76 334.4 12 79.1 12 55.5 13 55.8 10 104.3 McIntosh Macon 45 393.6 33 219.3 <5 <5 5 <5 7 <5 6 7 Madison Marion 76 310.7 12 168.0 9 <5 9 <5 12 52.5 <5 <5 <5 Meriwether Miller 88 320.6 16 189.8 11 75.5 <5 14 44.2 <5 16 60.0 <5 13 120.5 <5 Mitchell Monroe Montgomery 84 371.8 33 164.9 16 224.8 12 94.0 <5 <5 8 <5 <5 18 79.1 9 <5 8 8 <5 Morgan 74 435.1 12 120.6 9 9 13 188.1 Murray 80 290.4 11 72.5 7 14 54.1 6 * Rate per 100,000, age-adjusted to the 1970 US standard population. Rate not calculated for fewer than 10 cases. Cancer cases for this county may be underreported to the Cancer Registry. Please use caution when comparing these data with mortality data for the same county. 21 Table 3. Reported Number of Cancer Cases and Incidence Rates by County, Georgia, 1995 (continued) ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Total Female Total Total Male County Cases Rate* Cases Rate* Cases Rate* Cases Rate* Cases Rate* Muscogee 636 328.8 97 90.2 78 38.9 111 57.8 93 118.3 Newton 144 286.3 25 92.2 14 27.4 31 61.0 7 Oconee Oglethorpe Paulding Peach Pickens 80 422.1 30 257.4 97 212.7 52 234.8 50 259.3 16 137.6 <5 13 45.7 6 <5 6 <5 9 7 <5 8 <5 22 55.7 9 10 51.9 11 145.0 5 11 64.0 7 13 144.2 Pierce Pike 52 313.0 36 283.9 9 6 5 8 8 6 5 6 Polk Pulaski 152 345.9 17 164.3 32 129.8 <5 8 <5 31 70.5 5 17 94.6 <5 Putnam Quitman Rabun 83 406.9 <5 47 249.0 11 105.3 <5 6 8 <5 <5 16 77.7 <5 11 55.5 11 114.6 <5 5 Randolph 40 353.4 <5 10 81.6 7 8 Richmond 768 400.7 109 98.9 74 38.3 138 73.3 117 151.9 Rockdale 182 298.9 33 91.6 17 29.2 31 54.1 15 58.6 Schley 21 497.7 <5 7 <5 <5 Screven Seminole 62 349.0 8 9 <5 7 <5 15 83.5 <5 10 121.3 <5 Spalding 232 369.7 38 109.5 28 44.1 38 61.7 33 136.2 Stephens 109 325.5 20 104.1 9 15 44.1 20 140.5 Stewart 23 312.5 <5 <5 6 <5 Sumter 134 408.3 16 76.4 19 59.1 22 70.0 23 185.7 Talbot 44 518.1 8 7 6 <5 Taliaferro Tattnall 6 47 214.9 <5 9 <5 7 <5 9 <5 <5 Taylor Telfair 31 321.5 29 209.1 <5 <5 <5 7 7 5 8 <5 Terrell 53 419.1 6 <5 13 101.7 9 Thomas Tift Toombs 177 352.7 105 278.9 54 208.2 25 85.3 17 81.1 <5 20 38.9 11 29.5 <5 39 77.4 16 43.3 12 44.5 14 69.0 22 139.2 7 Towns Treutlen 44 345.2 12 177.8 <5 <5 <5 <5 10 68.1 <5 9 <5 Troup Turner Twiggs Union 223 330.2 25 245.0 18 165.1 48 209.8 33 84.7 <5 <5 5 27 38.3 <5 <5 <5 38 61.6 6 <5 9 36 133.0 <5 6 <5 Upson Walker Walton 96 272.1 13 17.5 92 189.5 15 77.2 <5 13 51.2 15 44.0 <5 5 10 27.9 <5 12 26.0 17 118.9 <5 15 71.1 Ware 148 315.8 24 96.6 22 43.1 14 30.1 23 117.5 Warren 33 419.7 5 <5 8 8 Washington Wayne Webster Wheeler 88 376.0 65 249.6 5 11 188.4 13 99.3 6 <5 <5 13 50.5 6 <5 <5 17 73.5 17 65.1 <5 <5 12 137.9 5 <5 <5 White 61 288.7 7 <5 10 46.3 13 133.4 Whitfield 335 411.5 58 127.6 31 38.4 75 95.4 35 107.5 Wilcox Wilkes Wilkinson 25 285.5 36 252.2 17 145.5 <5 <5 <5 <5 <5 <5 <5 10 68.5 <5 6 5 <5 Worth 64 292.6 6 9 15 68.4 9 * Rate per 100,000, age-adjusted to the 1970 US standard population. Rate not calculated for fewer than 10 cases. Cancer cases for this county may be underreported to the Cancer Registry. Please use caution when comparing these data with mortality data for the same county. 22 G E O R G I A Cancer Data Report 2000 BREAST CANCER New Cases An estimated 4,650 new cases of breast cancer are expected to be diagnosed among Georgia females in 2000. Breast cancer is the most commonly diagnosed cancer among Georgia females and in 2000 will account for over 30% of all female cancer cases. One in 8 American females will develop breast cancer in her lifetime. Breast cancer can also occur in males, but is rare. Figure 12. Health Districts with Significantly* High or Low Breast Cancer Mortality Rates, 1994-1998 1-2 2-0 1-1 3-1 3-4 10-0 3-2 3-5 3-3 6-0 4-0 5-2 7-0 5-1 9-1 9-3 8-2 8-1 9-2 * p < 0.05 Health districts with rates significantly higher than state rate No significant difference Health districts with rates significantly lower than state rate Deaths An estimated 1,100 Georgia females are expected to die of breast cancer in 2000. Breast cancer is the second leading cause of cancer death in Georgia females and in 2000 will account for 18% of all cancer deaths in females. Breast cancer mortality rates increased 25% between 1980-1987 followed by a 14% decline between 1987-1998. This decrease is probably the result of earlier detection through mammography and improved treatment. The Fulton (3-2), DeKalb (3-5), and Augusta (6-0) health districts have significantly higher mortality rates than the state average; while the Athens (10-0),Waycross (9-2), and Valdosta (8-1) health districts have significantly lower rates (Figure 12). Risk Factors Risk increases with age A personal or family history of breast cancer Biopsy-confirmed atypical hyperplasia A long menstrual history (menstrual periods that start early and end late in life) Recent use of oral contraceptives or post- menopausal estrogens Never having children or having the first child after age 30 Consuming 2 or more drinks of alcohol daily Prevention There is no known way to prevent breast cancer. For now, the best strategy for women at average risk is to manage modifiable risk factors (above), such as alcohol and estrogen use. The use of anti-estrogen drugs, such as Tamoxifen, have been shown to reduce the risk of recurrence in localized breast cancer. Following the guidelines for early detection of breast cancer will not prevent breast cancer, but can find cancers when the likelihood of successful treatment is greatest. 23 G E O R G I A Cancer Data Report 2000 Early Detection Early detection of breast cancer saves lives. Mammograms and clinical breast examinations are both important screening tools. A mammogram, or low-dose x-ray of the breast, is valuable because it can identify breast abnormalities before they can be felt by a women or her health care provider. Numerous studies have shown that early detection increases survival and treatment options. Breast Cancer Screening in Georgia According to the 1998 Behavioral Risk Factor Surveillance System, only 44% of females aged 40-49 and 45% of females aged 65 and older reported having had a mammogram and clinical breast examination within the past year. Females aged 50-64 were more likely to have had an annual mammogram and clinical breast examination (57%) (Figure 13). Although the sample size in some health districts is small, there is apparent geographical variation in mammography and clinical breast examination among women aged 50 and older in Georgia. For the 3 year period 1996-1998, the prevalence ranged from 37% in the Clayton health district (3-3) to 70% in the Gwinnett health district (3-4); the state average was 55% (Figure 14). American Cancer Society Guidelines for Early Detection of Breast Cancer Females 40 and older: Annual mammogram, annual clinical breast examination by a health care professional, monthly breast self-examination.The clinical breast examination should be conducted close to the scheduled mammogram. Females aged 20-39: Clinical breast examination by a health care professional every three years, monthly breast self-examination. Health District Percent (%) Figure 13. Mammogram and Clinical Breast Examination*, Females Aged 40 and Older, Georgia, 1998 60 57% 50 44% 45% 40 30 20 10 0 40-49 50-64 65+ Age Group * Reported having had a mammogram and clinical breast examination within the past year. Figure 14. Mammogram and Clinical Breast Examination* by Health District, Females Aged 50 and Older, Georgia, 1996-1998 Georgia = 55% 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 9-2 ^9-3 10-0 50% 61% 62% 54% 61% 37% 70% 64% 49% 63% 45% 58% 57% 44% 40% 67% 48% 65% 51% 0 10 20 30 40 50 60 70 80 Percent (%) * Reported having had a mammogram and clinical breast examination within the past year. ^ Fewer than 50 respondents, data may be unstable. Note: 95% confidence interval for Georgia was 3% and intervals for the health districts ranged from 9% to 20%. 24 G E O R G I A Cancer Data Report 2000 UTERINE CERVIX CANCER New Cases An estimated 550 new cases of invasive cervical cancer are expected to be diagnosed among Georgia females in 2000. Deaths An estimated 130 Georgia females are expected to die of cervical cancer in 2000. In Georgia, mortality rates from cervical cancer have declined nearly 35% during the past 20 years. The Dublin (5-1),Valdosta (8-1), and Savannah (9-1) health districts have significantly higher mortality rates than the state average; while the Dalton (1-2), Cobb (3-1), Gwinnett (3-4) and DeKalb (3-5) health districts have significantly lower rates (Figure 15 and Table 4). Figure 15. Health Districts with Significantly* High or Low Cervical Cancer Mortality Rates, 1994-1998 1-2 2-0 1-1 3-1 3-4 10-0 3-2 3-5 3-3 6-0 4-0 5-2 7-0 5-1 9-1 9-3 8-2 8-1 9-2 * p < 0.05 Health districts with rates significantly higher than state rate No significant difference Health districts with rates significantly lower than state rate Risk Factors Risk is closely linked to sexual behavior and to sexually transmitted infections with certain types of human papillomavirus First intercourse at an early age Multiple sexual partners, or partners who have had multiple sexual partners Cigarette smoking Prevention The vast majority of invasive cervical cancers can be prevented. Preventing the development of precancers by decreasing the risk of exposure to sexually transmitted human papillomavirus, and early detection and treatment of precancers Table 4. Invasive Cervical Cancer Incidence and Average Annual Mortality by Health District, Georgia Incidence (1995) Mortality (1994-1998) Health District Cases Rate* Deaths Rate* Georgia 1-1 389 8.9 19 6.6 124 2.9 10 3.3 1-2 2-0 3-1 12 7.9 14 6.5 34 9.4 3 1.7 5 2.2 7 2.4 3-2 44 10.7 11 2.7 3-3 15 14.7 3 3.1 3-4 33 11.1 7 2.1 3-5 31 8.0 6 1.7 4-0 5-1 5-2 6-0 7-0 8-1 34 10.6 <5 12 4.6 20 8.4 20 9.4 10 7.7 11 3.4 4 4.7 7 2.6 8 3.2 8 3.6 7 5.5 8-2 9-1 25 12.1 14 8.2 8 3.7 7 4.3 9-2 18 9.4 5 2.7 9-3 14 12.9 4 3.6 10-0 17 10.0 4 2.3 * Incidence rate or average annual mortality rate per 100,000, age-adjusted to the 1970 US standard population. Rate not calculated for fewer than 10 cases. Cancer cases for these health districts may be underreported to the Cancer Registry. Please use caution when comparing these data with mortality data from the same health district. 25 G E O R G I A Cancer Data Report 2000 are the best strategies for preventing invasive disease. Cervical cancer and precancers of the cervix can be prevented by managing modifiable risk factors, such as delaying onset of first sexual intercourse, and limiting the number of lifetime sexual partners. Early Detection Deaths from cervical cancer were reduced dramatically with the advent of the Pap smear test developed in the 1940's.With regular Pap tests and appropriate follow-up care, death from cervical cancer is almost totally preventable. Cervical Cancer Screening in Georgia According to the 1998 Behavioral Risk Factor Surveillance System, the rate of Pap test screening (within the past 3 years) was similar for all age groups except for females aged 65 and older, who had the lowest rate (66%) (Figure 16). Although the sample size in some health districts is small, there is apparent geographical variation in Pap test prevalence among women aged 18 and older in Georgia. For the 3 year period 19961998, the prevalence ranged from 76% in the Brunswick health district (9-3) to 96% in the Fulton health district (3-2); the state average was 90% (Figure 17). American Cancer Society Guidelines for Early Detection of Cervical Cancer Annual Pap test and pelvic examination in females who are or have been sexually active, or have reached age 18. After three or more consecutive annual exams with normal findings, the Pap test may be performed less frequently at the discretion of the physician. Health District Percent (%) Figure 16. Pap Test, Females Aged 18 and Older*, Georgia, 1998 100 91% 88% 90% 85% 80 66% 60 40 20 0 18-24 25-39 40-49 50-64 65+ Age Group * Reported having had a Pap test within the past 3 years, women with intact uterine cervix. Figure 17. Pap Test by Health District, Females Aged 18 and Older, Georgia, 1996-1998 Georgia = 90% 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 9-2 9-3 10-0 84% 88% 89% 92% 96% 85% 94% 94% 90% 92% 89% 94% 90% 80% 89% 93% 86% 76% 94% 0 20 40 60 80 100 Percent (%) * Reported having had a Pap test within the past 3 years, women with intact uterine cervix. ^ Fewer than 50 respondents, data may be unstable. Note: 95% confidence interval for Georgia was 1% and intervals for the health districts ranged from 2% to 23%. 26 G E O R G I A Cancer Data Report 2000 COLON & RECTUM CANCER New Cases An estimated 3,280 new cases of colorectal cancer are expected to be diagnosed in Georgia in 2000; 1,640 males and 1,640 females. Colorectal cancer is the third most common cancer diagnosed among Georgia males and females. Figure 18. Health Districts with Significantly* High or Low Colon and Rectum Cancer Mortality Rates, 1994-1998 1-2 2-0 1-1 3-1 3-4 10-0 3-2 3-5 3-3 6-0 4-0 5-2 Deaths An estimated 1,260 Georgians are expected to die of colorectal cancer in 2000; 610 males and 650 females. Colorectal cancer is third leading cause of cancer death among Georgia males and females. Mortality rates for colorectal cancer declined 20% among males between 1990-1998 and declined 16% among females between 1980-1998. The Augusta (6-0), Savannah (9-1) and Fulton (3-2) health districts have significantly higher mortality rates than the state average; while the Gainesville (2-0), Athens (10-0),Waycross (9-2) and Brunswick (9-3) health districts have significantly lower rates (Figure 18). Risk Factors Personal or family history of colorectal cancer or polyps, and inflammatory bowel disease Physical inactivity A high fat and/or low fiber diet Inadequate intake of fruits and vegetables Prevention 7-0 5-1 The early detection and removal of precancerous 9-1 polyps can greatly reduce the risk of developing or dying of invasive colorectal cancer. Other 9-3 strategies for prevention include managing modifiable risk factors (above), such as diet and 8-2 8-1 9-2 physical activity. * p < 0.05 Health districts with rates significantly higher than state rate No significant difference Health districts with rates significantly lower than state rate 27 G E O R G I A Cancer Data Report 2000 Early Detection Early detection of colorectal cancer can save lives. Two effective tools available for screening for colorectal cancer are fecal occult blood tests, which detect blood in a person's stool sample, and sigmoidoscopy, an examination of the rectum and lower colon using a lighted flexible tube. American Cancer Society Guidelines for Early Detection of Colorectal Cancer Beginning at age 50, males and females should follow one of the examination schedules below: Fecal occult blood test every year and flexible sigmoidoscopy every five years.* A colonoscopy every 10 years.* A double-contrast barium enema every 5 to 10 years.* People who are at moderate or high risk for colorectal cancer should talk with their doctor about an appropriate testing schedule. * A digital rectal examination should be done at the same time as sigmoidoscopy, colonoscopy, or double-contrast barium enema. Percent (%) Colorectal Cancer Screening in Georgia According to the 1997 Behavioral Risk Factor Surveillance System, 52% of males and 45% of females aged 50 and older reported ever having had a sigmoidoscopic or proctoscopic examination (Figure 19). Figure 19. Sigmoidoscopic/Proctoscopic Examination*, Persons Aged 50 and Older, Georgia, 1997 60 52% 50 45% 40 30 20 10 0 Male Female Gender * Reported ever having had a sigmoidoscopic/proctoscopic examination. 28 G E O R G I A Cancer Data Report 2000 LUNG & BRONCHUS CANCER New Cases An estimated 5,290 new cases of lung cancer are expected to be diagnosed in Georgia in 2000; 3,480 males and 1,810 females. Lung cancer is the most common cancer diagnosed in Georgia and in 2000 will account for 16% of all cancer diagnoses. Figure 20. Health Districts with Significantly* High or Low Lung and Bronchus Cancer Mortality Rates, 1994-1998 Deaths An estimated 4,130 Georgians are expected to die of lung cancer in 2000; 2,770 males and 1,360 females. In 2000, lung cancer deaths will account for 30% of all cancer deaths in Georgia. In recent years, mortality rates from lung cancer have declined among males; however, among females, rates have doubled since 1980. Decreasing mortality rates among males are most likely a result of decreased smoking rates over the previous 30 years. 1-2 2-0 1-1 3-1 3-4 10-0 3-2 3-5 3-3 6-0 4-0 5-2 7-0 5-1 9-1 9-3 8-2 8-1 9-2 * p < 0.05 Health districts with rates significantly higher than state rate No significant difference Health districts with rates significantly lower than state rate The northwest and southern health districts have significantly higher mortality rates than the state average; while most of the Metropolitan Atlanta, Gainesville (2-0), and LaGrange (4-0) health districts have significantly lower rates (Figure 20). Risk Factors Tobacco use (accounts for almost 87% of all lung cancer cases) Exposure to environmental (second-hand) tobacco smoke Exposure to certain industrial substances, such as arsenic; some organic chemicals; radon and asbestos, particularly for persons who smoke Radiation exposure from occupational, medical, and environmental sources Air pollution Prevention The best strategy for preventing lung cancer is not to smoke and to avoid exposure to environmental or second hand smoke. In those who stop smoking, damaged lung tissue often returns to normal. People who work with potentially cancer causing chemicals should take appropriate protective measures to avoid harmful exposure. Early Detection There is no known effective way to routinely screen for lung cancer. Because symptoms often do not appear until the disease is advanced, early detection is difficult. 29 G E O R G I A Cancer Data Report 2000 PROSTATE CANCER New Cases An estimated 5,030 new cases of prostate cancer are expected to be diagnosed among Georgia males in 2000. Prostate cancer is the most commonly diagnosed cancer among Georgia males and in 2000 will account for 28% of all male cancer cases. Deaths An estimated 910 Georgia males are expected to die of prostate cancer in 2000. Prostate cancer is the second leading cause of cancer death among males. During 1980-1992, prostate cancer mortality rates in Georgia increased 29% followed by a 20% decline in rates from 1992-1998. Mortality rates among black males are more than twice as high as rates among white males. Figure 21. Health Districts with Significantly* High or Low Prostate Cancer Mortality Rates, 1994-1998 1-2 2-0 1-1 3-1 3-4 10-0 3-2 3-5 3-3 6-0 4-0 5-2 The Fulton (3-2) and DeKalb (3-5) health districts as well as many of the southern and central Georgia health districts have significantly higher mortality rates than the state average, while the northern health districts have significantly lower rates (Figure 21). Risk Factors Risk increases with age; 91% of cases are diagnosed in males over age 55 Black race Family history; genetic predisposition (may be responsible for 5%-10% of prostate cancers) A high fat diet Prevention There is no known way to prevent prostate cancer. Many known risk factors such as age, race, and family history cannot be controlled; however managing diet may help to reduce prostate cancer risk. Early Detection A blood test for prostate specific antigen (PSA) and digital rectal examination of the prostate gland are two tools commonly used to detect prostate cancer early. Neither the PSA nor the digital rectal examination have been proven to reduce mortality from prostate cancer. Currently, there are no commonly accepted recommendations regarding routine screening for prostate cancer. Men should discuss prostate cancer screening options with their health care professional. 7-0 5-1 9-1 9-3 8-2 8-1 9-2 * p < 0.05 Health districts with rates significantly higher than state rate No significant difference Health districts with rates significantly lower than state rate American Cancer Society Guidelines for Early Detection of Prostate Cancer Males aged 50 and older who have at least a 10-year life expectancy should talk with their health care professional about having a digital rectal examination of the prostate gland and a prostatespecific antigen (PSA) blood test every year. Males who are at high risk for prostate cancer (blacks or males who have a history of prostate cancer in close family members) should consider beginning these tests at an earlier age. 30 G E O R G I A Cancer Data Report 2000 CANCER RISK BEHAVIORS IN GEORGIA Tobacco Use Smoking is the most preventable cause of death in our society.Tobacco use accounts for at least 30% of all cancer deaths, about 87% of all lung cancer cases and is also associated with cancers of the mouth, pharynx, larynx, esophagus, pancreas, uterine cervix, kidney, and bladder. In 1996, tobacco use was responsible for 17% or one in six deaths in Georgia; and Georgians who die as a result of their smoking habit lose an average of 14.6 years of life. The use of spit tobacco and cigars is on the rise. In 1986, the US Surgeon General concluded that the use of spit tobacco is not a safe substitute for smoking cigarettes. Spit tobacco causes cancer, a number of non-cancerous oral conditions and can lead to nicotine addiction and dependence.5 Cigars contain most of the same carcinogens and cancer-producing chemicals found in cigarettes and regular cigar smoking causes cancer of the lung, oral cavity, larynx, esophagus, and probably cancer of the pancreas.6 Tobacco Use Among Georgia Adults According to the 1998 Behavioral Risk Factor Surveillance System, an estimated 24% of Georgia adults smoke. Males (28%) are more likely to smoke than females (20%) and whites (25%) are more likely to smoke than blacks (19%). The prevalence of smoking among both males and females in Georgia declined between 1984-1992. However, since 1992, the prevalence has increased 4.4% per year among males and 5.0% among females (Figure 22). Although the sample size in some health districts is small, there is apparent geographical variation in adult cigarette use. For the 3 year period 1996-1998, the prevalence ranged from 17% in the Fulton health district (3-2) to 30% in the Valdosta health district (8-1); the state average was 23% (Figure 23). There are many benefits to smoking cessation. People who quit smoking, regardless of age, live longer than people who continue to smoke. Percent (%) Figure 22. Current Cigarette Use*, Persons Aged 18 and Older, Georgia, 1984-1998 40 Decreased 5.9% 35 per year Increased 4.4% per year 30 Male 25 20 15 Female 10 Decreased 4.7% 5 per year Increased 5.0% per year 0 1984 1986 1988 1990 1992 1994 Year * Reported having smoked at least 100 cigarettes in their lifetime, and now are current smokers. 1996 1998 31 G E O R G I A Cancer Data Report 2000 Quitting smoking decreases the risk of developing many cancers and other major diseases, including coronary heart disease and other cardiovascular diseases.7 According to the 1998 Behavioral Risk Factor Surveillance System, 46% of Georgia males and 49% of Georgia females who were current smokers reported that they had tried to quit smoking for at least one day during the past year. Tobacco Use Among Georgia Youth According to the 1999 Georgia Youth Tobacco Survey, the prevalence of middle school students who have ever used tobacco was 59% among males and 50% among females (Figure 24). During 1999, 21% of male and 16% of female middle school students reported current tobacco use (Figure 24). The prevalence of students in grades six, seven and eight who have ever used tobacco was 43%, 57% and 65%, respectively. Students in grade eight were significantly more likely to have ever used tobacco compared to students in grade six. The prevalence of Hispanic middle school students who have ever used tobacco was 68%, while 54% of white students and 53% of black students reported having ever used tobacco. Health District Figure 23. Current Cigarette Use* by Health Districts, Adults aged 18 and Older, Georgia, 1996-1998 Georgia = 23% 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 9-2 9-3 10-0 28% 21% 28% 21% 17% 18% 26% 18% 29% 27% 24% 23% 18% 30% 23% 24% 20% 18% 22% 0 20 40 60 80 100 Percent (%) * Reported having smoked at least 100 cigarettes in their lifetime and now are current smokers. Note: 95% confidence interval for Georgia was 1% and intervals for the health districts ranged from 3% to 13%. Percent (%) Percent (%) Figure 24. Ever and Current Tobacco Use by Gender, Middle School Students, Georgia, 1999 59% 60 55% 60 50% 50 50 40 40 30 30 21% 19% 20 20 16% 10 10 0 Male Female Total Ever Used Tobacco* ** Reported ever having used cigarettes, smokeless tobacco, ** or cigars. 0 Male Female Total Current Tobacco Use** ** Reported cigarette, smokeless tobacco, or cigar use on 1 or more ** of the preceding 30 days. 32 G E O R G I A Cancer Data Report 2000 Diet and Nutrition Existing scientific evidence suggests that about one-third of the cancer deaths that occur in the US each year are due to dietary factors.8 The introduction of healthful diet and exercise practices at any time from childhood to old age can promote health and probably reduces cancer risk. Many dietary factors can affect cancer risk: type of food, food preparation methods, portion Figure 25. Fruit and Vegetable Intake, Persons Aged 18 and Older, Georgia, 1998 3-4 servings per day 37% 5 or more servings per day 21% < 1 serving per day 5% 1-2 servings per day 37% sizes, food variety, and overall caloric balance. Cancer risk can be reduced by an overall dietary pattern that includes a high proportion of plant foods (fruits, vegetables, grains and beans), limited amounts of meat, dairy, and other high-fat foods and a balance of caloric intake and physical activity. The recommendations of the American Cancer Society Advisory Committee on Diet, Nutrition, and Cancer Prevention (see text boxes on pages 32 and 33) are consistent in principle with the 1992 US Department of Agriculture (USDA) Food Guide Pyramid, the 1995 Dietary Guidelines for Americans, and dietary recommendations of other agencies.Although no diet can guarantee full protection against any disease, these recommendations offer the best nutrition information currently available to help Americans reduce their risk of cancer. Nutrition in Georgia According to the 1998 Behavioral Risk Factor Surveillance System, only 21% of Georgia adults were eating the recommended 5 or more servings of fruits and vegetables per day; 37% reported eating 3-4 servings or 1-2 servings per day; and 5% reported eating less than 1 serving per day. (Figure 25). Choose most of the foods you eat from plant sources. Eat five or more servings of fruits and vegetables each day; eat other foods from plant sources, such as breads, cereals, grain products, rice, pasta, or beans several times each day. Consumption of fruits and vegetables can reduce the risk of developing some cancers.The evidence is particularly strong for reducing the risk of colon cancer. Limit the intake of high-fat foods, particularly from animal sources. Choose foods low in fat; limit consumption of meats, especially high-fat meats. High-fat diets have been associated with an increased risk of cancers of the colon and rectum, prostate, and uterine corpus (endometrium). Limit consumption of alcoholic beverages, if you drink at all. Alcohol consumption increases the risk of cancers of the mouth, esophagus, pharynx, larynx, and liver. Studies have also noted an association between alcohol consumption and an increased risk of breast cancer. The mechanism is unknown but may be due to alcohol-induced changes in hormones in the blood, or to a carcinogenic effect of alcohol or its metabolites on breast tissue. 33 G E O R G I A Cancer Data Report 2000 Physical Activity Physical activity can help protect against some cancers, either by balancing caloric intake with energy expenditure or by some other unknown mechanisms.8 An imbalance of caloric intake and output can lead to being overweight or obese, and increases the risk of developing several cancers. Maintaining a healthy body weight can also reduce the risk of chronic diseases such as coronary heart disease and diabetes. Moderate physical activity may increase caloric needs and encourage consumption of healthful foods while maintaining a recommended body weight. The physical activity recommendations of the American Cancer Society Advisory Committee on Diet, Nutrition, and Cancer Prevention (see text box below) are consistent in principle with the recommendations of the Centers for Disease Control and Prevention, the American College of Sports Medicine, a National Institutes of Health Consensus Conference, and the US Surgeon General. Be physically active: achieve and maintain a healthy weight. Be at least moderately active for 30 minutes or more on most days of the week; stay within your healthy weight range. Percent (%) Physical Activity in Georgia According to the 1998 Behavioral Risk Factor Surveillance System, only 25% of Georgia adults were participating in regular physical activity; while 30% reported no leisure time physical activity at all (Figure 26). Between 1984-1998, there was a gradual increase among those reporting no leisure time physical activity and a gradual decrease among those reporting regular physical activity. Figure 26. Physical Activity, Persons Aged 18 and Older, Georgia, 1984-1998 60 50 No leisure-time physical activity 40 30 20 Regular physical activity* 10 0 1984 1986 1988 1990 1992 1994 1996 1998 Year * Five+ times per week and 150+ minutes per week and at least 10 minutes per session OR 3+ times per week of vigorous intensity activity for at least 20 minutes per session. 34 G E O R G I A Cancer Data Report 2000 CONCLUSION This report summarizes the most recent information available on cancer incidence, mortality, and risk in Georgia. Cancer is a significant health problem in Georgia; accounting for 1 in 4 deaths each year. Black Georgians suffer an increased burden of cancer; they are 27% more likely to die of cancer than whites. Although overall mortality rates have declined slightly in recent years, there is still much progress to be made. The practical implications of the findings in this report are clear. Nearly two-thirds of cancer deaths could be prevented by adopting a healthy lifestyle including not smoking, eating a healthy diet and engaging in regular physical activity. Additionally, the risk of cancer death can be reduced by following recommended guidelines for early detection of cancer. There is hope that Georgia can reduce its burden from cancer; prevention, early detection, and prompt treatment can make a difference. Greater effort needs to be made by all Georgians to reduce the prevalence of risk factors for cancer and to participate in cancer early detection examinations. Sustained behavior change is difficult to make, even for highly motivated individuals.Therefore, it is essential to engage a variety of state and local governments, nonprofit organizations and private groups in a process to encourage policy and environmental changes that make it easier for people to change their behavior. Much of the death and disability from cancer in Georgia is preventable. If we focus our attention on realistic ways to reduce risk and encourage early detection, we can increase the decline in cancer death rates and reduce the number of Georgians who receive a diagnosis of cancer. Georgians can work together to reduce the number of individuals who suffer and die from cancer. Kathleen E. Toomey, M.D., M.P.H. Director, Division of Public Health Georgia Department of Human Resources Jack Shipkoski Chief Executive Officer, American Cancer Society, Southeast Division 35 G E O R G I A Cancer Data Report 2000 TECHNICAL APPENDIX 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 rate: The number of new cancer cases occurring in a population during a specified period of time. Often expressed per 100,000 population. Cancer mortality rate: The number of cancer deaths occurring in a population during a specified period of time. Often expressed per 100,000 population. Confidence interval: A range of probable values for a prevalence estimate. A 95% confidence interval is one that will contain the true prevalence in 95 out of 100 samples surveyed. 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 percent. Risk factor: A behavior, characteristic or finding on clinical examination that is consistently associated with increased probability of a disease or complications from the disease. Data Sources: The number of deaths and death rates by county and for the state of Georgia were obtained from the Georgia Department of Human Resources, Division of Public Health,Vital Records Branch. Deaths and death rates for the United States were obtained from the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC). For Figure 1, the ICD-9 codes for the disease categories were 1) cancer: 140-208; 2) heart disease: 390-398, 402, 404-429; 3) chronic obstructive pulmonary disease: 490-496; 4) diabetes: 250; 5) pneumonia and influenza: 480-487; 6) stroke: 430438; 7) unintentional injuries: E800-E949; and 8) other: all disease codes not already categorized. For Tables 2 and 4, Figures 1, 4-10, 12, 15, 18 and 20-21, the ICD-9 codes used to define cancer sites were: 1) all cancers: 140.0-208.9; 2) breast: 174.0174.9; 3) colon & rectum: 153.0-153.9, 154.0-154.1, 159.0; 4) leukemia: 202.4, 203.1, 204.0-207.2, 207.8, 208.0-208.9; 5) lung & bronchus: 162.2162.9; 6) pancreas: 157.0-157.9; 7) prostate: 185; 8) uterine cervix: 180.0-180.9. The number of cases and incidence rates by county and for the state of Georgia were obtained from the Georgia Department of Human Resources, Division of Public Health, Georgia Comprehensive Cancer Registry. For Tables 3 and 4, the ICD-O2 codes used for disease categories were: 1) breast: C500:C509; 2) colon & rectum: C180:C189, C260, C199, C209; 3) lung & bronchus: C340:C349; 4) prostate: C619; 5) uterine cervix: C530:C539. Population projections for 2000 were obtained from the Office of Planning and Budgeting for the state of Georgia. Population estimates for 1994-1998 and the 2000 US standard population were obtained from the US Bureau of the Census. Risk factor and screening behavior data were obtained from the Behavioral Risk Factor Surveillance System, a state-based surveillance system administered by the Georgia Department of Human Resources, Division of Public Health, in collaboration with the CDC.The objective of the Behavioral Risk Factor Surveillance System is to collect uniform, statespecific data on preventative health practices and risk behaviors that are linked to chronic diseases, injuries and preventable infectious diseases in the adult population. Limitations of Behavioral Risk Factor Surveillance System data include bias that may result from self-reporting of behaviors and sampling error as a result of surveying a sample rather than taking a complete population enumeration. As well, these data do not include Georgians without a telephone in the household. Data on youth tobacco use were obtained from the Georgia Youth Tobacco Survey (GYTS).The GYTS is a random sample of students in public schools grades 6, 7 or 8 and grades 9-12. The purpose of this survey is to collect information on cigarette, smokeless tobacco, and cigar use; knowledge and attitudes; media and advertising; minors access; school curriculum; environmental tobacco smoke; and cessation.The survey was jointly developed by the Division of Public Health's Tobacco Prevention Program and the CDC.The results of the survey of high school students are not included in this report because the overall participation rate of high schools is too low for statewide generalization. 36 G E O R G I A Cancer Data Report 2000 Methods: Mortality rates were calculated per 100,000 population and age-adjusted by the direct method to the 1970 and 2000 US standards. Except where calculated to show trends, the mortality rates are five-year average annual rates for the period 1994 through 1998. Incidence rates were calculated per 100,000 population and age-adjusted by the direct method to the 1970 and 2000 US standards. Rates were calculated for only 1995 as this is the only year in which Cancer Registry data are greater than 90% complete. The estimated number of cases for 2000 was calculated by multiplying age-specific state incidence to mortality rate ratios by the county mortality rate. The results were then multiplied by county agespecific population estimates for 2000 and summed to obtain a county estimate. County values were summed to obtain a state total.This was done for each cancer site individually. For Cobb, Clayton, DeKalb, Fulton and Gwinnett counties, the Metro Atlanta SEER incidence to mortality rate ratio was used in place of the state ratio. The estimated numbers of deaths for 2000 were calculated by multiplying age-specific county population estimates for 2000 by gender- and agespecific county mortality rates for 1994-1998 and summing the resultant values. County values were summed to obtain a state total.This was done for each cancer site individually. For Figures 2 and 3, the top ten sites chosen for cases and deaths were selected by ranking cancer incidence and mortality rates. Consequently, estimates for those sites were calculated. For Figure 11, the percent of data completeness by health district was calculated by dividing the observed cases for 1997 by the expected cases for 1997 and multiplying by 100. REFERENCES 1. US Bureau of the Census. ST-99-3 State Population Estimates: Annual Time Series, July 1, 1990 to July 1, 1999. 2. US Bureau of the Census. MA-98-3b Population Estimates for Metropolitan Areas and Components, Annual Time Series April 1, 1990 to July 1, 1998. 3. The Georgia County Guide, 1999. Boatright SR, Bachtel DC, Editors. Center for Agribusiness and Economic Development,The University of Georgia, Athens, GA, 1999. 4. US Bureau of the Census. PPL-47 Population Projections for States by Age, Sex, Race and Hispanic Origin: 1995 to 2025. 5. US Department of Health and Human Services. The Health Consequences of Using Smokeless Tobacco: A Report of the Advisory Committee to the Surgeon General. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute. DHHS Pub. No. (NIH) 86-2874, 1986. 6. Shanks TG, Burns DM. Disease Consequences of Cigar Smoking (Chapter 4). In: Cigars: Health Effects and Trends, Monograph No 9. Burns D, Cummings KM, Hoffman D, Editors, Bethesda, MD, US Department of Health and Human Services, National Institutes of Health, NIH Pub. No. 98-4302, 1998. 7. US Department of Health and Human Services. The Health Benefits of Smoking Cessation. US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 90-8416, 1990. 8. American Cancer Society. Guidelines on Diet, Nutrition, and Cancer Prevention: Reducing the Risk of Cancer with Healthy Food Choices and Physical Activity. Originally published in: CA-A Cancer Journal for Clinicians 46:325341;1996. Revised: March, 1999. 37 G E O R G I A Cancer Data Report 2000 STATISTICAL APPENDIX INCIDENCE AND MORTALITY RATE TABLES AGE-ADJUSTED TO THE 2000 US STANDARD POPULATION Table 2A: Average Annual Number of Cancer Deaths and Mortality Rates by County, Georgia 1994-1998 (Age-adjusted to 2000 US Standard) Table 3A: Reported Number of Cancer Cases and Incidence Rates by County, Georgia, 1995 (Age-adjusted to 2000 US Standard) Table 4A: Invasive Cervical Cancer Incidence and Average Annual Mortality by Health District, Georgia (Age-adjusted to 2000 US Standard) Table 2A. Average Annual Number of Cancer Deaths and Mortality Rates by County, Georgia, 1994-1998 (Age-adjusted to 2000 US Standard) ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Male Female Female Male Female Male Female Male County Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Georgia 6,818 288.2 5,896 167.8 1,014 28.8 553 23.7 599 17.0 2,478 100.6 1,353 38.8 830 43.4 38 Appling 22 353.6 15 166.4 2 26.2 <2 3 29.7 9 140.1 3 27.8 4 77.0 Atkinson 6 231.2 7 206.9 <2 <2 <2 3 111.5 <2 <2 Bacon 13 323.0 12 203.3 <2 <2 <2 5 122.5 <2 <2 Baker 3 215.7 4 174.7 <2 <2 <2 <2 <2 <2 Baldwin 43 288.0 33 161.5 6 31.2 5 30.0 3 13.6 17 107.1 9 42.6 6 43.1 Banks 12 308.1 8 137.2 <2 <2 <2 5 111.8 2 36.4 <2 Barrow 34 277.1 26 144.8 4 19.9 2 19.6 <2 14 117.2 8 47.5 <2 Bartow 72 326.5 50 157.9 9 27.2 6 26.8 6 18.8 27 112.7 13 40.6 8 52.7 Ben Hill 19 295.6 16 149.7 2 24.1 2 34.8 <2 8 130.1 3 28.3 2 33.5 Berrien 17 278.3 15 173.3 2 25.2 <2 2 22.7 8 128.6 4 40.2 2 46.3 Bibb 178 312.4 150 161.5 24 26.5 16 30.4 17 17.8 67 112.2 38 40.8 23 45.3 Bleckley 15 336.3 11 154.9 <2 <2 <2 7 143.8 2 29.2 <2 Brantley 13 272.7 13 218.7 <2 <2 <2 6 133.8 4 70.8 <2 Brooks 20 298.4 15 145.5 <2 2 30.0 2 19.4 7 108.9 3 28.2 3 56.0 Bryan 18 318.7 14 178.6 <2 <2 <2 7 108.5 4 53.5 2 59.7 Bulloch 42 272.0 38 172.3 8 36.8 4 23.4 4 17.4 13 82.5 6 28.0 6 49.7 Burke 22 312.6 20 182.9 4 39.3 <2 2 19.9 6 87.6 4 36.2 4 58.8 Butts 17 255.0 16 185.8 2 29.9 <2 <2 6 86.9 4 44.9 <2 Calhoun 7 336.8 6 142.9 <2 <2 <2 <2 <2 <2 Camden 21 294.7 19 189.1 3 27.7 <2 <2 6 81.1 6 56.6 4 66.7 Candler 12 307.3 9 167.3 <2 <2 <2 3 81.1 2 40.2 <2 Carroll 75 282.1 65 169.9 11 28.2 8 30.2 7 18.8 30 108.2 14 37.5 7 34.0 Catoosa 52 271.4 41 157.0 6 23.7 5 28.2 3 12.9 22 109.4 13 47.8 3 22.3 Charlton 10 310.1 11 238.4 <2 <2 <2 3 88.2 2 44.7 <2 Chatham 248 287.6 229 177.2 36 28.7 21 25.1 26 19.6 88 97.9 55 42.0 32 43.4 Chattahoochee 4 509.2 3 215.0 <2 <2 <2 <2 <2 <2 Chattooga 31 302.6 30 199.0 4 31.4 2 20.0 3 17.2 14 126.8 8 50.6 3 31.0 Cherokee 83 273.0 64 150.6 11 23.9 8 24.3 7 17.2 26 88.7 14 33.1 7 32.4 Clarke 63 265.6 55 143.1 11 29.2 5 22.7 4 10.4 23 92.4 13 35.0 10 48.9 Clay 5 312.4 5 189.1 <2 <2 <2 <2 <2 <2 Clayton 136 277.4 126 181.2 18 23.8 11 22.2 10 14.6 53 103.6 37 53.2 12 37.0 Clinch 8 330.9 5 140.0 <2 <2 <2 2 102.0 <2 <2 Cobb 349 275.4 338 175.9 58 28.2 29 24.0 33 17.6 122 91.0 80 42.2 37 41.1 Coffee 31 281.3 25 157.9 4 26.9 3 29.8 <2 12 97.2 5 33.2 <2 Colquitt 45 291.0 40 170.5 5 21.5 3 19.6 6 24.1 17 107.2 7 31.4 9 62.1 Columbia 56 254.8 54 179.5 9 26.5 3 14.0 4 12.8 21 80.0 14 47.9 6 37.5 Cook 21 376.8 14 158.2 3 32.2 <2 <2 8 134.3 3 32.1 2 49.1 Coweta 66 307.8 52 153.3 10 27.3 6 28.8 3 8.6 23 101.5 13 38.2 10 62.6 Crawford 9 222.0 6 133.7 <2 <2 <2 3 75.8 <2 <2 * Average annual rate per 100,000, age-adjusted to the 2000 US standard population. Rate not calculated for fewer than 2 average deaths. Table 2A. Average Annual Number of Cancer Deaths and Mortality Rates by County, Georgia, 1994-1998 (Age-adjusted to 2000 US Standard) (continued) ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Male Female Female Male Female Male Female Male County Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Crisp 32 414.2 22 164.3 4 33.4 <2 <2 15 190.8 5 38.1 4 65.8 39 Dade 15 249.4 12 158.6 <2 <2 <2 6 96.2 3 45.8 3 59.1 Dawson 13 341.6 9 160.1 2 43.4 <2 <2 5 116.5 2 36.9 <2 Decatur 32 307.2 28 193.3 5 34.9 3 27.1 2 14.0 12 107.9 6 43.7 4 49.9 DeKalb 433 268.2 421 166.8 89 33.7 36 22.5 46 18.2 134 81.5 89 36.1 58 46.1 Dodge 26 338.1 21 183.4 3 29.0 2 28.7 2 19.3 10 131.6 4 31.6 3 46.6 Dooly 12 316.4 12 185.4 3 48.0 <2 <2 4 103.8 <2 <2 Dougherty 101 324.2 81 162.2 14 27.9 10 31.4 8 15.3 39 117.6 19 38.8 15 60.3 Douglas 68 279.1 55 170.3 10 28.9 4 14.8 4 12.6 24 101.1 14 43.1 6 31.5 Early 17 333.6 15 180.9 4 42.8 <2 2 20.5 6 101.7 3 32.0 3 64.0 Echols 3 279.5 <2 <2 <2 <2 <2 <2 <2 Effingham 28 276.5 22 165.5 3 25.0 <2 2 19.1 13 116.7 4 33.1 2 36.9 Elbert 29 330.4 23 177.9 4 34.0 2 28.6 3 19.5 10 115.5 5 37.5 2 29.8 Emanuel 33 372.3 20 156.7 3 24.7 3 41.7 2 16.1 10 109.3 5 38.6 3 41.7 Evans 12 315.6 9 157.5 <2 <2 <2 5 115.4 <2 2 52.9 Fannin 29 265.9 22 163.4 3 25.1 2 20.0 3 20.1 12 106.5 7 52.8 3 31.4 Fayette 55 245.2 54 169.1 8 24.2 6 25.8 6 19.3 18 75.8 13 40.1 7 44.2 Floyd 111 308.9 96 173.0 15 28.5 9 25.5 9 15.8 43 113.2 23 41.5 10 30.4 Forsyth 41 209.3 38 131.8 6 21.0 <2 5 19.5 16 73.6 8 28.7 5 33.8 Franklin 23 261.5 20 161.1 4 28.4 <2 2 18.3 8 85.7 3 25.2 3 40.9 Fulton 627 297.3 636 185.8 125 36.1 55 26.1 72 20.7 190 87.8 134 40.3 89 50.2 Gilmer 24 294.1 20 178.5 2 19.8 2 25.6 2 17.1 9 105.9 7 59.8 3 45.0 Glascock 4 278.1 <2 <2 <2 <2 <2 <2 <2 Glynn 78 258.2 73 179.0 11 28.5 5 17.0 7 16.8 27 86.3 21 49.6 9 33.9 Gordon 44 307.1 32 159.6 5 24.9 3 22.2 3 16.1 16 111.7 9 43.0 5 47.2 Grady 32 340.6 19 147.6 4 30.4 2 21.8 <2 13 141.4 3 26.6 5 54.0 Greene 16 303.0 12 154.5 3 38.1 <2 2 26.1 6 103.4 2 27.0 2 45.5 Gwinnett 233 240.6 227 162.3 44 28.0 22 23.6 23 18.1 72 72.5 52 38.3 23 34.2 Habersham 34 243.8 29 154.6 6 31.5 3 22.4 4 18.9 14 97.6 6 30.6 3 25.4 Hall 103 256.8 84 150.9 15 26.4 10 25.8 8 14.5 39 91.4 21 37.1 12 36.0 Hancock 13 372.3 11 189.1 2 39.7 <2 <2 3 86.1 <2 3 92.6 Haralson 29 292.1 24 163.0 3 24.6 <2 3 18.5 13 120.5 5 38.6 3 40.5 Harris 28 309.4 18 151.2 4 31.2 2 30.5 <2 8 82.4 4 30.9 5 58.3 Hart 27 278.2 20 136.0 4 30.5 2 22.9 2 14.9 10 99.9 3 22.2 4 48.5 Heard 8 213.8 6 126.3 <2 <2 <2 3 84.4 <2 <2 Henry 68 252.0 62 166.8 11 27.6 5 17.1 7 19.2 23 85.6 15 39.0 6 32.3 Houston 87 299.4 76 175.3 15 33.1 6 24.2 6 14.6 33 101.4 22 50.1 10 55.8 Irwin 14 361.3 10 169.7 <2 <2 <2 8 197.0 <2 2 51.9 Jackson 36 277.3 29 160.3 5 27.6 4 24.9 <2 16 116.0 7 41.0 3 33.4 Jasper 12 316.6 11 213.0 2 43.8 <2 <2 5 112.2 <2 <2 * Average annual rate per 100,000, age-adjusted to the 2000 US standard population. Rate not calculated for fewer than 2 average deaths. Table 2A. Average Annual Number of Cancer Deaths and Mortality Rates by County, Georgia, 1994-1998 (Age-adjusted to 2000 US Standard) (continued) ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Male Female Female Male Female Male Female Male County Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Jeff Davis 20 419.1 10 146.8 <2 <2 <2 9 188.9 2 36.2 2 67.8 40 Jefferson 24 358.8 22 191.8 5 53.0 <2 4 30.1 10 147.1 3 25.7 4 66.6 Jenkins 13 348.3 7 149.5 <2 <2 <2 5 142.2 2 41.4 2 64.4 Johnson 11 317.3 11 186.3 <2 <2 <2 4 111.8 <2 <2 Jones 21 294.9 18 173.8 3 27.6 <2 2 22.3 9 112.4 4 39.3 3 46.4 Lamar 19 341.3 15 179.5 2 27.0 <2 <2 8 136.1 3 40.6 3 65.5 Lanier 8 380.5 4 127.9 <2 <2 <2 3 146.0 <2 <2 Laurens 58 334.6 37 151.7 6 23.0 3 17.9 3 13.9 21 110.2 7 28.4 10 63.7 Lee 14 311.8 14 199.3 2 25.2 <2 <2 6 107.9 3 40.4 <2 Liberty 31 376.5 23 185.3 5 35.5 2 26.9 <2 9 109.5 7 57.2 5 86.6 Lincoln 12 348.6 8 172.2 <2 <2 <2 5 150.3 <2 2 62.8 Long 6 236.2 5 161.2 <2 <2 <2 2 73.3 <2 <2 Lowndes 78 300.7 66 176.2 8 22.3 4 16.0 7 18.4 31 116.7 18 49.4 11 50.4 Lumpkin 18 278.8 14 165.3 2 29.5 <2 <2 7 112.5 4 46.2 2 37.6 McDuffie 23 306.7 21 183.8 4 33.9 <2 2 16.8 11 133.5 5 41.2 <2 McIntosh 15 354.8 10 184.7 2 39.1 <2 <2 5 99.1 <2 3 66.4 Macon 16 344.8 13 177.8 <2 <2 <2 6 121.9 <2 3 75.5 Madison 25 294.5 22 178.9 4 31.5 <2 2 19.3 9 105.5 4 32.4 3 39.2 Marion 8 353.9 3 88.8 <2 <2 <2 4 152.1 <2 <2 Meriwether 27 293.9 24 170.8 3 20.6 <2 3 18.1 9 97.5 5 35.9 5 60.9 Miller 7 231.6 6 134.0 <2 <2 <2 2 66.4 <2 <2 Mitchell 26 338.1 21 176.8 2 20.3 <2 3 23.6 12 151.5 5 39.5 3 43.4 Monroe 25 348.4 18 175.4 3 25.5 <2 3 25.8 11 150.4 4 37.3 2 39.1 Montgomery 10 346.1 7 183.9 <2 <2 <2 4 132.4 <2 <2 Morgan 15 271.5 12 145.6 <2 2 34.8 <2 5 96.0 3 32.9 <2 Murray 25 251.7 22 168.5 3 23.9 2 24.2 2 16.5 12 112.9 6 45.4 2 30.7 Muscogee 190 309.2 166 166.9 28 28.6 16 27.6 16 16.1 70 105.7 39 38.7 27 53.0 Newton 49 284.1 45 173.7 6 24.3 4 20.2 4 16.1 20 117.0 8 31.1 6 42.2 Oconee 18 266.7 14 134.2 3 27.7 <2 <2 5 79.1 4 36.9 <2 Oglethorpe 12 294.1 9 153.0 <2 <2 <2 4 88.5 3 53.3 <2 Paulding 47 287.1 37 175.0 6 27.4 5 29.3 2 11.9 19 102.6 11 54.4 5 47.2 Peach 22 283.7 18 159.2 4 33.2 <2 <2 9 114.3 3 27.4 3 43.7 Pickens 21 265.4 13 124.5 3 33.1 <2 <2 9 111.2 3 26.1 <2 Pierce 21 341.4 12 156.1 2 28.3 <2 <2 9 139.8 <2 3 52.2 Pike 18 375.8 10 149.5 <2 <2 <2 7 133.5 3 45.7 2 55.4 Polk 51 344.8 41 182.8 7 31.9 4 30.1 4 18.2 21 132.3 11 47.4 5 35.5 Pulaski 11 291.2 10 170.0 2 46.4 <2 <2 3 73.0 2 33.8 2 66.2 Putnam 21 285.5 16 168.9 <2 <2 <2 8 112.2 4 42.7 3 48.1 Quitman 4 352.1 3 202.1 <2 <2 <2 <2 <2 <2 Rabun 22 270.7 17 170.7 3 29.1 2 25.8 2 20.6 7 85.8 2 22.6 3 35.0 * Average annual rate per 100,000, age-adjusted to the 2000 US standard population. Rate not calculated for fewer than 2 average deaths. Table 2A. Average Annual Number of Cancer Deaths and Mortality Rates by County, Georgia, 1994-1998 (Age-adjusted to 2000 US Standard) (continued) ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Male Female Female Male Female Male Female Male County Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Deaths Rate* Randolph 13 378.7 10 169.6 <2 <2 <2 4 123.3 <2 2 65.4 41 Richmond 210 334.2 175 184.8 28 29.2 15 26.1 18 18.8 73 113.6 43 45.0 19 37.1 Rockdale 49 254.3 52 181.9 10 34.0 4 26.3 5 19.0 19 89.0 13 44.0 4 29.8 Schley 5 378.9 5 234.8 <2 <2 <2 2 144.9 <2 <2 Screven 24 397.5 16 176.7 4 44.9 2 35.8 2 23.8 8 130.7 3 32.0 4 68.3 Seminole 11 287.5 9 149.0 <2 <2 <2 4 90.4 <2 <2 Spalding 58 293.5 52 163.7 9 30.2 4 20.5 4 13.0 20 99.3 12 40.3 7 42.1 Stephens 34 303.0 28 161.1 5 30.9 3 21.4 2 13.1 13 110.3 5 31.4 5 48.1 Stewart 8 308.6 7 184.4 <2 <2 <2 4 156.6 <2 3 100.0 Sumter 33 307.9 33 178.7 5 34.0 2 20.0 3 15.6 11 97.7 7 38.0 4 46.2 Talbot 9 326.0 7 164.5 <2 <2 <2 3 122.0 <2 <2 Taliaferro 3 381.8 <2 <2 <2 <2 <2 <2 <2 Tattnall 28 351.6 16 154.7 3 32.5 <2 <2 10 119.1 3 30.2 3 38.8 Taylor 8 251.0 8 163.0 <2 <2 <2 3 101.4 2 43.2 <2 Telfair 19 389.1 15 191.6 3 41.9 3 63.8 <2 8 155.1 3 45.6 <2 Terrell 17 400.9 11 160.7 <2 <2 <2 8 172.1 <2 2 68.3 Thomas 54 334.8 39 153.1 4 17.8 5 31.0 3 12.9 21 121.6 8 30.1 6 42.6 Tift 38 306.7 33 171.8 5 29.8 2 18.9 <2 15 116.2 8 41.2 5 42.5 Toombs 31 348.0 28 192.9 3 23.3 <2 <2 14 144.5 6 41.5 4 56.8 Towns 13 202.3 11 155.9 2 35.1 <2 <2 4 64.8 <2 <2 Treutlen 7 284.1 7 184.3 <2 <2 <2 3 103.5 <2 <2 Troup 71 321.8 61 170.7 7 23.1 5 25.1 8 20.2 29 125.2 14 40.7 9 46.1 Turner 12 303.2 8 150.5 <2 <2 <2 4 99.3 2 33.7 <2 Twiggs 13 329.0 7 148.3 <2 <2 <2 6 151.6 2 38.0 <2 Union 27 265.2 18 153.6 <2 2 21.0 2 18.3 11 103.1 5 45.1 2 24.5 Upson 28 240.8 31 173.4 7 40.8 2 16.4 3 18.6 9 75.8 6 34.4 5 49.4 Walker 81 300.9 62 167.1 9 26.2 6 23.5 6 15.3 36 128.6 16 42.0 6 27.0 Walton 49 285.7 36 145.8 4 16.2 4 22.6 4 17.2 18 103.4 9 38.2 5 38.3 Ware 50 311.7 36 150.8 4 18.5 4 26.6 5 18.6 22 132.1 8 32.2 6 39.3 Warren 8 305.2 7 164.6 <2 <2 <2 3 130.6 <2 <2 Washington 25 344.5 23 190.4 3 22.9 3 36.5 2 15.8 7 86.0 6 51.4 4 64.4 Wayne 28 277.2 22 169.9 4 28.3 <2 <2 13 122.5 6 43.0 3 34.6 Webster 4 337.6 3 225.0 <2 <2 <2 <2 <2 <2 Wheeler 7 313.3 4 135.5 <2 <2 <2 3 138.1 <2 <2 White 17 200.3 14 127.4 3 29.7 <2 <2 7 72.1 3 25.9 <2 Whitfield 76 277.8 67 168.7 12 30.3 6 24.9 6 15.9 33 114.3 16 41.1 9 40.2 Wilcox 10 285.3 7 140.4 <2 <2 <2 4 117.2 <2 <2 Wilkes 18 382.5 14 188.3 3 43.3 <2 <2 7 141.3 <2 2 63.2 Wilkinson 10 252.3 9 160.8 2 39.2 <2 <2 4 104.0 <2 <2 Worth 22 285.3 17 158.7 3 25.8 3 33.0 2 19.6 8 100.5 4 34.3 2 36.6 * Average annual rate per 100,000, age-adjusted to the 2000 US standard population. Rate not calculated for fewer than 2 average deaths. 42 Table 3A. Reported Number of Cancer Cases and Incidence Rates by County, Georgia, 1995 (Age-adjusted to 2000 US Standard) ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Total Female Total Total Male County Cases Rate* Cases Rate* Cases Rate* Cases Rate* Cases Rate* Georgia Appling Atkinson Bacon 23,669 49 18 31 388.1 306.3 286.5 327.3 3,558 14 5 8 103.4 170.1 2,464 41.8 <5 <5 <5 3,884 64.9 <5 <5 <5 3,490 <5 <5 <5 141.9 Baker Baldwin 17 443.9 53 139.2 <5 5 <5 <5 <5 13 35.0 5 7 Banks 32 291.3 <5 <5 <5 8 Barrow Bartow Ben Hill Berrien Bibb Bleckley 119 396.8 140 251.2 49 287.8 36 243.0 384 253.9 26 233.0 23 136.2 23 75.0 7 5 40 48.3 <5 8 17 30.8 <5 <5 38 25.6 <5 20 69.2 28 52.1 11 64.8 10 67.7 90 59.1 5 19 163.9 11 43.2 10 136.8 5 73 121.9 <5 Brantley Brooks 41 372.3 39 229.4 <5 <5 <5 <5 7 11 64.1 <5 6 Bryan 68 458.1 8 6 14 99.8 6 Bulloch Burke 151 398.6 58 314.5 30 141.5 13 117.2 12 32.8 9 23 61.8 7 19 114.2 <5 Butts 64 425.8 9 6 13 86.3 12 182.8 Calhoun Camden Candler Carroll Catoosa Charlton 25 472.9 64 356.0 22 233.7 99 144.3 13 26.9 15 186.2 5 9 <5 14 38.3 <5 <5 <5 8 <5 <5 <5 <5 <5 14 72.6 <5 20 30.5 <5 <5 5 6 <5 15 56.0 <5 <5 Chatham 977 444.6 137 112.0 151 70.5 172 76.1 101 105.3 Chattahoochee 15 661.2 <5 <5 <5 <5 Chattooga 100 387.3 18 121.1 11 40.4 17 67.0 12 119.2 Cherokee 245 302.2 35 74.6 22 27.2 42 57.8 37 112.4 Clarke Clay 307 480.3 <5 49 130.0 <5 27 40.3 <5 32 51.3 <5 60 239.1 <5 Clayton 666 501.3 113 136.9 61 52.3 115 89.8 93 183.5 Clinch 21 343.5 5 <5 6 <5 Cobb 1,812 509.9 305 140.4 171 56.0 271 82.8 282 211.4 Coffee Colquitt 120 429.1 99 260.8 17 109.5 12 61.4 13 49.8 <5 16 54.7 22 57.1 19 157.5 20 128.7 Columbia Cook 274 479.8 50 353.0 28 75.1 8 29 60.3 6 60 113.8 9 37 171.4 7 Coweta Crawford 245 430.1 13 151.7 39 113.4 <5 32 59.3 <5 41 75.7 <5 30 125.9 <5 Crisp Dade 90 425.3 <5 10 82.1 <5 <5 <5 16 77.0 <5 18 234.9 <5 Dawson Decatur 42 430.2 60 237.6 8 11 78.3 <5 6 8 12 47.2 6 <5 DeKalb Dodge Dooly 2,180 45 35 483.1 236.1 334.5 365 137.7 6 6 221 52.2 6 8 286 66.4 15 78.2 <5 386 216.4 <5 <5 Dougherty 393 464.8 66 138.3 49 57.6 68 82.0 65 192.2 Douglas Early Echols 192 304.8 11 84.2 <5 24 71.5 <5 <5 23 37.7 <5 <5 28 50.0 <5 <5 21 73.5 <5 <5 Effingham Elbert 105 437.2 71 345.6 21 152.5 8 6 7 25 109.0 13 62.0 13 135.3 12 120.6 * Rate per 100,000, age-adjusted to the 2000 US standard population. Rate not calculated for fewer than 10 cases. Cancer cases for this county may be underreported to the Cancer Registry. Please use caution when comparing these data with mortality data for the same county. 43 Table 3A. Reported Number of Cancer Cases and Incidence Rates by County, Georgia, 1995 (Age-adjusted to 2000 US Standard) (continued) ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Total Female Total Total Male County Emanuel Cases 72 Rate* 327.4 Cases 6 Rate* Cases 10 Rate* 47.6 Cases 19 Rate* 80.8 Cases 8 Rate* Evans Fannin 32 344.1 58 250.1 6 11 97.3 <5 <5 9 12 51.4 <5 13 112.2 Fayette 245 402.7 57 164.1 35 67.7 29 51.7 42 149.3 Floyd 339 372.4 54 104.8 40 43.1 70 75.7 28 73.8 Forsyth 140 264.2 21 71.5 17 31.9 25 48.5 20 80.6 Franklin 67 315.6 9 14 69.5 9 10 92.9 Fulton Gilmer 2,957 55 515.7 296.4 433 129.5 <5 294 52.8 6 376 68.4 11 59.2 478 224.2 10 109.9 Glascock 10 317.8 <5 <5 <5 <5 Glynn Gordon Grady 315 441.6 114 320.6 76 342.3 43 108.7 19 94.8 19 154.7 26 37.6 8 6 53 71.4 30 83.9 11 48.3 53 186.6 7 6 Greene 62 477.8 8 11 82.1 8 8 Gwinnett 1,254 477.7 208 129.8 131 59.0 174 73.2 187 202.5 Habersham 121 376.4 13 72.9 11 35.3 21 62.9 17 110.0 Hall 405 405.5 56 102.6 42 43.5 67 67.5 70 163.0 Hancock Haralson Harris Hart Heard 49 541.1 45 188.0 65 310.8 40 172.0 21 239.5 7 <5 8 7 <5 8 <5 6 <5 <5 10 112.8 13 52.4 14 69.8 11 44.5 <5 7 <5 7 <5 <5 Henry Houston Irwin 285 438.0 159 184.2 17 180.9 41 109.4 15 30.5 <5 26 42.2 14 16.5 <5 44 70.5 22 27.1 <5 43 174.6 33 101.4 <5 Jackson 130 409.5 20 118.1 17 54.4 15 46.2 16 115.7 Jasper 48 529.0 7 7 6 <5 Jeff Davis 45 389.3 5 8 10 87.0 11 256.6 Jefferson 80 442.4 5 14 73.2 17 100.3 10 150.4 Jenkins Johnson Jones 36 430.4 25 271.6 26 133.5 <5 6 <5 <5 <5 <5 8 8 6 6 <5 <5 Lamar Lanier Laurens 60 418.7 17 309.5 107 247.3 7 <5 8 <5 <5 11 25.5 15 104.6 <5 26 58.9 11 177.3 <5 16 83.5 Lee 51 413.2 7 <5 9 13 290.7 Liberty 103 424.7 14 95.5 13 54.9 17 85.6 12 155.8 Lincoln Long 39 441.4 12 189.0 5 <5 <5 <5 13 142.8 <5 <5 <5 Lowndes 300 465.5 46 125.0 30 48.8 48 75.7 59 229.4 Lumpkin 50 341.8 11 146.9 5 9 7 McDuffie 76 382.5 12 107.5 12 62.2 13 60.5 10 109.4 McIntosh Macon 45 479.0 33 255.5 <5 <5 5 <5 7 <5 6 7 Madison Marion 76 350.8 12 221.9 9 <5 9 <5 12 56.0 <5 <5 <5 Meriwether Miller 88 388.2 16 240.3 11 86.6 <5 14 60.5 <5 16 69.5 <5 13 156.6 <5 Mitchell Monroe Montgomery 84 431.8 33 191.5 16 232.9 12 116.3 <5 <5 8 <5 <5 18 90.8 9 <5 8 8 <5 Morgan 74 535.7 12 157.3 9 9 13 226.9 Murray 80 335.6 11 79.6 7 14 57.6 6 * Rate per 100,000, age-adjusted to the 2000 US standard population. Rate not calculated for fewer than 10 cases. Cancer cases for this county may be underreported to the Cancer Registry. Please use caution when comparing these data with mortality data for the same county. 44 Table 3A. Reported Number of Cancer Cases and Incidence Rates by County, Georgia, 1995 (Age-adjusted to 2000 US Standard) (continued) ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS PROSTATE Total Female Total Total Male County Cases Rate* Cases Rate* Cases Rate* Cases Rate* Cases Rate* Muscogee 636 381.8 97 106.9 78 47.8 111 65.5 93 137.5 Newton 144 329.3 25 101.1 14 32.9 31 72.4 7 Oconee Oglethorpe Paulding Peach Pickens 80 467.1 30 288.4 97 252.9 52 252.1 50 282.2 16 161.0 <5 13 55.5 6 <5 6 <5 9 7 <5 8 <5 22 60.6 9 10 60.2 11 166.8 5 11 73.0 7 13 151.1 Pierce Pike 52 370.0 36 316.9 9 6 5 8 8 6 5 6 Polk Pulaski 152 417.9 17 192.2 32 159.0 <5 8 <5 31 82.3 5 17 105.7 <5 Putnam Quitman Rabun 83 501.6 <5 47 277.2 11 125.3 <5 6 8 <5 <5 16 101.3 <5 11 56.8 11 119.9 <5 5 Randolph 40 431.6 <5 10 106.2 7 8 Richmond 768 468.9 109 115.7 74 46.7 138 84.9 117 172.7 Rockdale 182 357.4 33 110.8 17 36.5 31 65.4 15 64.8 Schley 21 585.0 <5 7 <5 <5 Screven Seminole 62 411.8 8 9 <5 7 <5 15 96.1 <5 10 170.0 <5 Spalding 232 445.9 38 124.9 28 53.8 38 72.5 33 160.9 Stephens 109 382.2 20 129.4 9 15 51.2 20 160.9 Stewart 23 370.6 <5 <5 6 <5 Sumter 134 472.5 16 95.5 19 67.3 22 76.8 23 212.8 Talbot 44 609.4 8 7 6 <5 Taliaferro Tattnall 6 47 250.2 <5 9 <5 7 <5 9 <5 <5 Taylor Telfair 31 371.7 29 228.9 <5 <5 <5 7 7 5 8 <5 Terrell 53 468.0 6 <5 13 112.1 9 Thomas Tift Toombs 177 421.4 105 317.0 54 227.2 25 103.8 17 91.9 <5 20 46.7 11 34.0 <5 39 92.7 16 47.5 12 50.7 14 84.4 22 167.9 7 Towns Treutlen 44 385.7 12 202.9 <5 <5 <5 <5 10 73.8 <5 9 <5 Troup Turner Twiggs Union 223 388.3 25 274.5 18 197.1 48 240.9 33 100.2 <5 <5 5 27 46.9 <5 <5 <5 38 65.9 6 <5 9 36 152.6 <5 6 <5 Upson Walker Walton 96 320.5 13 20.3 92 217.4 15 91.0 <5 13 56.4 15 49.7 <5 5 10 32.6 <5 12 29.5 17 149.2 <5 15 89.5 Ware 148 373.2 24 112.0 22 55.2 14 32.5 23 143.4 Warren 33 489.7 5 <5 8 8 Washington Wayne Webster Wheeler 88 453.2 65 279.6 5 11 216.8 13 121.4 6 <5 <5 13 64.4 6 <5 <5 17 88.2 17 71.8 <5 <5 12 183.2 5 <5 <5 White 61 328.5 7 <5 10 51.4 13 159.1 Whitfield 335 486.0 58 149.1 31 46.0 75 108.2 35 131.1 Wilcox Wilkes Wilkinson 25 315.9 36 294.0 17 171.2 <5 <5 <5 <5 <5 <5 <5 10 77.0 <5 6 5 <5 Worth 64 328.5 6 9 15 80.8 9 * Rate per 100,000, age-adjusted to the 2000 US standard population. Rate not calculated for fewer than 10 cases. Cancer cases for this county may be underreported to the Cancer Registry. Please use caution when comparing these data with mortality data for the same county. 45 Table 4. Invasive Cervical Cancer Incidence and Average Annual Mortality by Health District, Georgia (Age-adjusted to 2000 US Standard) Incidence (1995) Mortality (1994-1998) Health District Cases Rate* Deaths Rate* Georgia 1-1 389 10.6 19 8.4 124 3.4 10 4.0 1-2 2-0 12 9.2 14 7.5 3 2.2 5 2.7 3-1 34 11.0 7 2.9 3-2 44 12.2 11 3.1 3-3 15 16.7 3 3.4 3-4 33 13.1 7 2.6 3-5 31 9.9 6 2.0 4-0 5-1 5-2 6-0 7-0 8-1 34 12.5 <5 12 5.3 20 9.6 20 11.4 10 9.0 11 4.0 4 5.5 7 3.2 8 3.8 8 4.4 7 6.4 8-2 9-1 25 14.5 14 10.2 8 4.4 7 5.1 9-2 18 12.1 5 3.2 9-3 14 16.2 4 4.3 10-0 17 11.6 4 2.7 * Incidence rate or average annual mortality rate per 100,000, age-adjusted to the 2000 US standard population. Rate not calculated for fewer than 10 cases. Cancer cases for these health districts may be underreported to the Cancer Registry. Please use caution when comparing these data with mortality data from the same health district. For further information about this report or the two organizations contact: Department of Human Resources Division of Public Health Cancer Control Section 2 Peachtree Street 16th Floor Atlanta, GA 30303 (404) 657-6611 http://www.ph.dhr.state.ga.us American Cancer Society, Southeast Division 2200 Lake Boulevard Atlanta, GA 30319 (404) 816-7800 or 1-800-ACS-2345 http://www.cancer.org.