{"response":{"docs":[{"id":"dlg_ggpd_i-ga-bp780-pd5-bs1-bc6-b2007-h2011-belec-p-btext","title":"Colorectal cancer in Georgia, 2007-2011","collection_id":"dlg_ggpd","collection_title":"Georgia Government Publications","dcterms_contributor":["Georgia. Department of Public Health"],"dcterms_spatial":["United States, Georgia, 32.75042, -83.50018"],"dcterms_creator":null,"dc_date":["2014"],"dcterms_description":["This plan contains statistics and other information on colorectal cancer in Georgia"],"dc_format":["application/pdf"],"dcterms_identifier":null,"dcterms_language":["eng"],"dcterms_publisher":["Atlanta, Ga. : Georgia. Department of Public Health"],"dc_relation":null,"dc_right":["http://rightsstatements.org/vocab/InC/1.0/"],"dcterms_is_part_of":null,"dcterms_subject":["Colon (Anatomy)--Cancer--Georgia--Periodicals","Rectum--Cancer--Georgia--Periodicals","Colon (Anatomy)--Cancer","Rectum--Cancer","Georgia","Periodicals"],"dcterms_title":["Colorectal cancer in Georgia, 2007-2011"],"dcterms_type":["Text"],"dcterms_provenance":["University of Georgia. Map and Government Information Library"],"edm_is_shown_by":["https://dlg.galileo.usg.edu/do:dlg_ggpd_i-ga-bp780-pd5-bs1-bc6-b2007-h2011-belec-p-btext"],"edm_is_shown_at":["https://dlg.galileo.usg.edu/id:dlg_ggpd_i-ga-bp780-pd5-bs1-bc6-b2007-h2011-belec-p-btext"],"dcterms_temporal":["2007-2011"],"dcterms_rights_holder":null,"dcterms_bibliographic_citation":null,"dlg_local_right":null,"dcterms_medium":["official reports"],"dcterms_extent":null,"dlg_subject_personal":null,"iiif_manifest_url_ss":null,"dcterms_subject_fast":null,"fulltext":"2007-2011 \nGEORGIA \n \nCOLORECTAL CANCER IN \n \n Acknowledgements \nGeorgia Department of Public Health..................................................................Brenda Fitzgerald, M.D., Commissioner Division of Health Protection...................................................................................J. Patrick O'Neal, M.D., Director Epidemiology Program.................................................Cherie Drenzek, D.V.M., M.S., Director/State Epidemiologist Chronic Disease, Healthy Behaviors, and Injury Epidemiology Section.................A. Rana Bayakly, M.P.H., Chief Georgia Comprehensive Cancer Registry...........................A. Rana Bayakly, M.P.H., Program Director Chrissy McNamara, M.S.P.H., Epidemiologist Victoria Davis, M.P.H., Epidemiologist Irene Solomon, M.P.H., Epidemiologist Division of Health Promotion.................................................................................... Yvette K. Daniels, JD, Director Chronic Disease Prevention Section..............................................Jean O'Connor, JD, MPH, DrPH, Director Georgia Comprehensive Cancer Control Program....................Tamira Moon, M.P.H., C.H.E.S, Manager Georgia Colorectal Cancer Screening Program.......................Melody Brown, RN, BSN, CDE, Manager \nWe would like to thank all the facilities in Georgia that contributed data to the Georgia Comprehensive Cancer Registry. Without their hard work, this report would not have been possible. \nFunding for this research was made possible (in part) by cooperative agreement award number 5/U58/DP003875-03 from the Centers for Disease Control and Prevention and through contract HHSN261201300015I with the National Cancer Institute. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Cancer Institute. \nSuggested Citation: Solomon, I., Davis, V., McNamara, C., Bayakly, A., Moon, T. Colorectal Cancer in Georgia, 2007-2011. Georgia Department of Public Health, Health Protection Office, Chronic Disease, Healthy Behaviors, and Injury Epidemiology, November 2014. \n2 \n \n Figure 1. Anatomy of the Digestive System and Sections of \nColon \nFigure 2. Colon Polyp \n \nIntroduction \nColorectal cancer is a collective term for cancers of the colon and rectum. Since cancers of the colon and rectum share many common features, they are often referred to as colorectal cancer. The colon and rectum are parts of the digestive system. Together, they form a long, muscular tube called the large intestine. The colon is the first four to five feet of the large intestine and the last four to six inches is the rectum (Figure 1). \nOnce food is chewed and swallowed, it travels through the esophagus to the stomach. In the stomach, it is partially digested and transferred to the small intestine. The small intestine continues digesting the food and absorbs most of the nutrients. The food then travels to the large intestine. The waste then moves from the colon into the rectum and passes out of the body through an opening called the anus during a bowel movement. \nThe colon consists of 4 sections (Figure 1): \nThe first section is called the ascending colon. It begins where the small intestine attaches to the colon and extends upward on the right side of the abdomen. \nThe second section, the transverse colon, runs across the body from right to the left side of the upper abdomen. \nThe third section, the descending colon, continues downward on the left side. \nThe fourth section, the sigmoid colon, named because of its S-shape, joins the rectum and the colon. \nColorectal cancers develop slowly over a period of several years. Most of them begin as a non-cancerous polyp, a growth of tissue on the lining of the colon or rectum (Figure 2). Polyps are also known as adenomas. More than 95 percent of colorectal cancers are adenocarcinomas, which arise from cells that line the inside of the colon and the rectum. Removing the polyp early may prevent it from becoming cancerous. \nColorectal cancer affects both men and women and most often occurs in people over 50 years of age. It is the third most commonly diagnosed cancer and cause of cancer death among Georgians. The Georgia Comprehensive Cancer Registry estimates that more than 4,300 new cases of colorectal cancer were diagnosed statewide in 2013 and nearly 1,600 Georgians died from this disease. \n3 \n \n Causes and Risk Factors \nA risk factor is anything that increases the chance of getting a disease such as cancer. Different cancers have different risk factors. Although it is hard to measure the contribution of a risk factor or know the exact cause of precancerous polyps or cancer, some factors may increase the risk of colorectal cancer development. However, some individuals develop colorectal cancer in the absence of any apparent risk factors. \nLifestyle-Related Risk Factors \nDiet: A diet high in red meats (beef, pork, lamb or liver), processed meats and animal fat, or a diet low in calcium, fiber and folate may increase the risk of developing colorectal cancer. Also, cooking meats at high temperatures such as frying, grilling or broiling may increase cancer risk. Diets high in vegetables and fruits have been linked with a decreased risk of colorectal cancer. More research is needed to better understand how diet affects colorectal cancer risk. \nPhysical inactivity: There is a greater chance of developing colorectal cancer if a person is not physically active. Participating in regular physical activity may reduce this risk. To gain substantial health benefits, the U.S. Department of Health and Human Services recommends 2 hours and 30 minutes of moderate-intensity aerobic physical activity each week (i.e. 30 minutes, five times a week) for adults and muscle-strengthening activities on two or more days a week that work all major muscle groups. \nObesity: People who are obese have an increased risk of developing colorectal cancer and an increased risk of dying of colorectal cancer when compared to people who are considered to be at normal weight. \nSmoking: Long term smokers are more likely than non-smokers to develop and die from colorectal cancer. \nAlcohol consumption: Heavy use of alcohol may increase the risk of developing colorectal cancer. The American Cancer Society recommends that alcohol use should be limited to no more than two drinks per day for men and one drink per day for women. \nDiabetes: People with Type 2 diabetes have an increased risk of developing colorectal cancer. They may also have a less favorable prognosis after diagnosis. \n \nTable 1: Prevalence (%) of Colorectal Cancer Risk Factors, Georgia and the United States, 2011 \n \nRisk Factors Obesity Smoking Physical Inactivity \nDiabetes \n \nAll (%) 28 21 27 \n10 \n \nGeorgia \n \nMales (%) Females (%) \n \n26 \n \n29 \n \n24 \n \n18 \n \n24 \n \n30 \n \n10 \n \n11 \n \nAll (%) 28 21 26 \n10 \n \nUnited States \n \nMales (%) Females (%) \n \n28 \n \n27 \n \n24 \n \n19 \n \n24 \n \n27 \n \n10 \n \n9 \n \nAccording to the 2011 Behavioral Risk Factor Surveillance System (Table1):  The prevalence of obesity, smoking, physical inactivity and diabetes in Georgia is similar to the United States.  The prevalence of obesity in Georgia females was greater than in males.  Georgia males were significantly more likely to be current smokers than females.  Georgia females were significantly more likely to be physically inactive than males.  The prevalence of diabetes was similar in Georgia males and females. \n4 \n \n Risk Factors You Cannot Change Age: The risk of developing polyps and colorectal cancer increase with age. More than 90 percent of people diagnosed with colorectal cancer are older than 50 years of age. Family history: Parents, siblings and children of a person who has had colorectal cancer or adenomatous polyps are more likely to develop colorectal cancer. The risk increases if any first-degree relative is affected at a young age or if more than one first-degree relative is affected. Cancers diagnosed frequently within the same family may also be due to inherited genes, shared exposure to environmental carcinogens, diet or lifestyle factors. Inherited syndromes: Certain genetic syndromes can increase the risk of developing colorectal cancer. These syndromes cause 5-10 percent of all colorectal cancers. The two most common syndromes are familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC). People with FAP develop hundreds or thousands of polyps in their colon and rectum in their teens or early adulthood. Cancer may develop in these polyps as early as age 20. Similar to FAP, HNPCC develops when people are relatively young. However, individuals with HNPCC have fewer polyps and develop colorectal cancer at an average age of 44 years. Racial and ethnic background: African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the United States. The reason for this is not yet understood. Personal history of colorectal cancer or polyps: A person who has had colorectal cancer is more likely to develop new cancers in other areas of the colon or rectum. Some types of polyps, such as adenomatous polyps and hyperplastic polyps, increase the risk of colorectal cancer. Personal history of bowel disease: Inflammatory Bowel Disease (IBD), which includes Ulcerative Colitis and Crohn's disease, is a condition in which the colon is inflamed over a long period of time. People with IBD have an increased risk of developing colorectal cancer and should be screened for colorectal cancer on a more frequent basis. \n5 \n \n Screening \nColorectal screening is the process of looking for cancer in people who have no symptoms of colorectal cancer. Regular screenings for colorectal cancer can find cancer early (when it is most likely to be curable). Screenings can also prevent colorectal cancer by finding polyps and removing them before they turn cancerous. Tests that are used for screening colorectal cancer can be divided into two groups: Tests that find both colorectal polyps and cancer: These tests look at the structure of the colon to find any abnormal areas. \n *Sigmoidoscopy: During this test, a doctor uses a sigmoidoscope to look inside the rectum and the lower section of the colon. The sigmoidoscope is a flexible lighted tube about two feet long with a video camera on the end. Images from the inside of the colon and rectum are displayed on a monitor. The tube is used to detect abnormal growths and if any are found, they are removed for biopsy. The procedure to remove polyps is called polypectomy. \n *Standard Colonoscopy: During this test, a colonoscope is used to look inside the entire length of the colon and rectum. The colonoscope is similar to a sigmoidoscope, but is longer. The doctor may also use the colonoscope to assist with the removal of polyps. \n Double-contrast barium enema (DCBE): X-ray pictures are taken of the colon and rectum after the patient is given an enema with a barium solution. The barium is used to show an outline of the colon and rectum. This test is rarely used for screening, because it is less sensitive in detecting small polyps and cancers. \n CT colonography (virtual colonoscopy): Done every five years based on ACS guidelines, this test is a more advanced form of a computed tomography (CT) scan. The CT scan takes multiple pictures of the colon and then combines all the pictures in order to create a 2-dimensional or 3-dimensional view of the inside of the colon and rectum. This test is considered less invasive than the colonoscopy, however if any abnormalities are found, a colonoscopy may be needed in order to determine if a cancer is present. Currently more studies are being conducted to compare virtual colonoscopy with other screening methods. \n*Preferred Tests \n6 \n \n Tests that find cancer: These tests involve testing the stool (feces) for signs that cancer may be present. These types of tests are considered to be less invasive and easier. \n *High-sensitivity fecal occult blood test (FOBT): Damaged blood vessels from polyps or cancers may release a small amount of blood into the feces. The FOBT detects blood in stool that may not be visible. Before the test, certain medications and foods cannot be consumed because they may interfere with the test. The screening test is given as a take home kit and stool samples are taken and returned to a doctor's office for testing. If the test detects blood, a colonoscopy is performed to determine the source. Other conditions such as hemorrhoids or ulcers may also cause blood to be detected. \n *Fecal immunochemical test (FIT): This test is also used to detect blood in the stool. The FIT is also performed at home but may be easier to use since there are no medication or dietary restrictions that are required to be followed before taking the test (unlike the FOBT). After the stool samples have been collected, the samples are returned to the doctor's office for testing. \n Cologuard: This test is also used to detect blood in the stool and nine DNA biomarkers from three genes associated with colorectal cancer and precancerous advanced adenomas. Colorectal cancer cells may contain DNA mutations in certain genes. These genes can be detected in the stool. People who test positive with this test should undergo a colonoscopy to confirm results. This test has not been incorporated into clinical practice guidelines and is not yet recommended by U.S. Preventive Service Task Force. This test is recommended every three years based on the ACS guidelines. \n*Preferred Test \nSigns/Symptoms \nIn the early stages of colorectal cancer, individuals may not have any symptoms. Symptoms usually appear when the disease has advanced. Signs and symptoms of colorectal cancer include: \n A change in bowel habits such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days \n A feeling that the bowel does not empty completely  Rectal bleeding or blood in the stool  Persistent cramping or abdominal pain  Weakness and fatigue  Unexplained weight loss \nOther conditions such as hemorrhoids and inflammatory bowel disease (IBD) may also have symptoms that mimic colorectal cancer. If you have any of the above symptoms, it is very important to talk to your doctor because it could be a sign of a serious medical condition such as colorectal cancer. \n7 \n \n The National Cancer Institute Recommendations for Colorectal \nCancer Early Detection \nThe National Cancer Institute (NCI) recommends that people at average risk for colorectal cancer should begin screening at age 50 and continue until age 75 as long as their results are negative. \nPreferred screening tests include: \nTests that find polyps and cancer  Sigmoidoscopy- every five years*  Colonoscopy- every 10 years \nTests that mainly find cancer  Fecal occult blood test (FOBT)-test every year+  Fecal immunochemical test (FIT)test every year+ \nColorectal Cancer Screening guidelines are recommended by the U.S. Preventive Services Task Force (USPSTF) and are used by NCI, BRFSS, and Healthy People 2020. \n* The USPSTF recommends sigmoidoscopy every five years along with FOBT every three years for people at average risk who have had negative test results. \n+ If FOBT is the only type of colorectal cancer screening test performed, the USPSTF recommends yearly testing. \nhttp://www.cancer.gov \n \nAccording to the Georgia Behavioral Risk Factor Surveillance System (BRFSS) in 2011: \n The percent of colorectal cancer screening among adults who had FOBT in the last year /or sigmoidoscopy in the last five years or colonoscopy in the last 10 years, for women 50-75 years of age was higher when compared to men. (Figure 3) (61 percent of Georgians had colorectal screening in 2011.) \n There was no significant difference in colorectal cancer screening by sex and race/ethnicity. (Figure 4) \n The Healthy People 2020 target for colorectal screening among adults 50-75 years of age was 70.5 percent. While Georgia colorectal cancer screening prevalence was lower than the Healthy People 2020 Objective of 70.5 percent for adults 50-75 years of age. \n \nFigure 3. Percent of Colorectal Screening* Among Adults 50-75 Years of Age by Sex, Georgia, 2011 \n \n100 \n \n59 \n \n63 \n \n50 \n \nAverage Risk 70.5% HP 2020 \n \nPercen t \n \n0 Males Females \n*The Colorectal Cancer Screening Recommendation is defined as the percent of adults who had a FOBT in the last year, and/or sigmoidoscopy in the last five years, and/or colonoscopy in the last 10 years. \n \n8 \n \n Percent \n \nFigure 4. Percent of Colorectal Screening Among Adults 50-75 Years of Age, by Race/Ethnicity, Georgia, 2011 \n \n100 \n \n60 \n \n60 \n \n61 \n \n65 \n \n50 \n \n0 Non-Hispanic Black Males \n \nNon-Hispanic White Males \n \nNon-Hispanic Black Females \n \nNon-Hispanic White Females \n \nFigure 5. Percent of Colorectal Screening* Among Adults 50-75 Years, Georgia, 2011, Percent of Colorectal Screening* Among Adults 50-75 Years Healthy People 2020 Goal, and Percent of Colorectal Screening* Among Adults Over Age 50 Georgia Cancer Plan 2014-2019 \n100 85 \n70.5 61 50 \n \nPercent \n \n0 Georgia \n \nHP 2020 \n \nGCCP 2014-2019 \n \nThe overall Georgia colorectal cancer screening prevalence (61 percent) was lower than the Healthy People 2020 objective of 70.5 percent for adults age 50-75 years at average risk, as well as lower than the Georgia goal of 85 percent for adults over age 50 by year 2019, based on the Georgia Cancer Plan 2014-2019. \n \n9 \n \n Incidence and Mortality \nColorectal cancer is the third most commonly diagnosed cancer and cause of cancer deaths among males and females in Georgia. \n \nTable 2: Georgia Leading Causes of Cancer Incidence (2007-2011) and Mortality (2006-2011*) \n \nTop 5 Causes of Cancer Incidence \n \nMales \n \nFemales \n \nProstate \n \nBreast \n \nLung \u0026 Bronchus \n \nLung \u0026 Bronchus \n \nColorectal \n \nColorectal \n \nBladder \n \nUterus \n \nMelanoma \n \nMelanoma \n \nTop 5 Causes of Cancer Mortality \n \nMales \n \nFemales \n \nLung \u0026 bronchus \n \nLung \u0026 Bronchus \n \nProstate \n \nBreast \n \nColorectal \n \nColorectal \n \nPancreas \n \nPancreas \n \nLeukemia \n \nOvary \n \n*Because of data quality issues, 2009 mortality data are not used for analysis. \n \nFrom 2007-2011 in Georgia:  The overall age-adjusted colorectal cancer incidence rate in Georgia was 43 per 100,000 in males and females combined. Males were 34 percent more likely to be diagnosed with colorectal cancer than females (age-adjusted rate 51/100,000 vs. 38/100,000).  The overall age-adjusted colorectal cancer mortality rate in Georgia was 16 per 100,000 in males and females combined.  Males were 43 percent more likely to die of colorectal cancer than females (age-adjusted rate 20/100,000 vs. 14/100,000).  Georgia colorectal cancer incidence and mortality rates were similar to the United States (U.S.) as a whole.  Non-Hispanic (NH) black males were more likely than NH white males to be diagnosed with colorectal cancer in Georgia and the U.S.  Similarly, NH black females were more likely than NH white females to be diagnosed with this disease  Black males were more likely than white males to die of colorectal cancer in Georgia and the U.S.  Similarly, black females were more likely than white females to die of this disease in Georgia and the U.S. \n \nFigure 6. Age-adjusted Colorectal Cancer Incidence Rates by Sex and Race/Ethnicity, Georgia and the U.S., 2007-2011 \nGeorgia United States 80 \n \n62 61 60 \n40 \n \n49 49 \n \n46 45 \n \n35 37 \n \n20 \n \nFigure 7. Age-adjusted Colorectal Cancer Mortality Rates by Sex and Race, Georgia 2006-2011* and the U.S., 2007-2011 \nGeorgia United States \n \n40 \n \n30 \n \n29 28 \n \n20 \n \n10 \n \n18 19 \n \n19 19 \n \n12 13 \n \n0 \n \nNH Black NH White NH Black NH White \n \nMales \n \nMales \n \nFemales Females \n \n0 \n \nBlack Males White Males Black Females \n \nWhite 10 Females \n \n*Because of data quality issues, 2009 mortality data are not used for analysis. \n \nRate per 100,000 Rate per 100,000 \n \n Colorectal Incidence Trends \n \nFigure 8. Age-adjusted Colorectal Cancer Incidence Rates Among Males by Race and Ethnicity, Georgia (2000-2011) \n \nNon-Hispanic Black Males \n \nNon-Hispanic White Males \n \nHispanic Males \n \nRate per 100,000 \n \n90 80 70 60 50 40 30 20 10 \n0 \n2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 \n \nDuring 2000-2011:  NH white males generally had lower incidence rates than NH black males.  Among NH black males, incidence rates declined by 2.7 percent per year during 2000 to 2011.  Among NH white males, incidence rates increased by 1.4 percent per year during 2000 to 2002, and significantly declined by 3.4 percent per year from 2002 to 2011.  Among Hispanic males, incidence rates declined by 4.6 percent per year during 2001 to 2011. \n \nFigure 9. Age-adjusted Colorectal Cancer Incidence Rates Among Females by Race and Ethnicity, Georgia (2000-2011) \n \nNon-Hispanic Black Females \n \nNon-Hispanic White Females \n \nHispanic Females \n \nRate per 100,000 \n \n90 80 70 60 50 40 30 20 10 \n0 \n2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 \n \nDuring 2000-2011:  NH black females had generally higher incidence rates than NH white females.  Among NH white females, incidence rates declined by 2.3 percent per year during 2000 to 2011.  Among NH black females, incidence rates increased by 2.2 percent per year during 2000 to 2004, and significantly declined by 3.7 percent per year from 2004 to 2011.  Among Hispanic females, incidence rates fluctuated due to small numbers. Overall incidence rates declined by 3.2 percent during 2004 to 2011. Incidence rates declined by 5.8 percent per year during 2001 to 2011. \n \n11 \n \n Colorectal Incidence Trends \nFigure 10. Age-adjusted Colorectal Cancer Incidence Rates Among Males by Age, Georgia (2000-2011) \n \nMales 49 age years \n \nMales 50-64 age years \n \nMales 65+ age years \n \nRate per 100,000 \n \n350 300 250 200 150 100 \n50 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 \n*The U.S. Prevention Task Force colorectal cancer screening recommendation was implemented in December 1995. \n Among adult males 49 years of age, incidence rates increased by 0.5 percent per year from 2000 (8/100,000) to 2011 (9/100,000). \n Among adult males 50-64 years of age, incidence rates declined by 0.5 percent per year from 2000 (106/100,000) to 2008 (104/100,000) and decreased by 5.9 percent per year from 2008 to 2011 (85/100,000). \n Among adult males 65+ years of age, incidence rates declined by 3.9 percent per year from 2000 (328/100,000) to 2011 (234/100,000). \n \nFigure 11. Age-adjusted Colorectal Cancer Incidence Rates Among Females by Age, Georgia (2000-2011) \n \nFemales 49 age years Females 65+ age years \n \nFemales 50-64 age years \n \nRate per 100,000 \n \n250 \n200 \n150 \n100 \n50 \n0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 \n*The U.S. Prevention Task Force colorectal cancer screening recommendation was implemented in December 1995. \n Among adult females 49 years of age, incidence rates increased by 1 percent per year during 2000 (6/100,000) to 2011 (7/100,000). \n Among adult females 50-64 years of age, incidence rates declined by 1.5 percent per year during 2000 (83/100,000) to 2011 (67/100,000). \n Among adult females 65+ years of age, incidence rates declined by 3.2 percent per year during 2000 (224/100,000) to 2011 (167/100,000). \n12 \n \n Rate per 100,000 \n \nMortality Trends \n \nFigure 12. Age-adjusted Colorectal Cancer Mortality Rates Among Males by Race, Georgia (1990-2011*) \n \nBlack Males \n \nWhite Males \n \n40 \n \nICD-9 \n \n35 \n \n30 \n \n25 \n \n20 \n \n15 \n \n10 \n \n5 \n \n0 \n \nICD-10 \n \n1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 \n \n*Because of data quality issues, 2009 mortality data are not used for analysis. **The U.S. Prevention Task Force colorectal cancer screening recommendation was implemented in December 1995. \n \n White males generally had lower mortality rates than black males.  Among black males, mortality rates fluctuated, however there was an overall decrease of 0.5 \npercent from 1990 to 2008. Rates appeared to level off in 2010 and 2011.  Among white males, mortality rates declined 2.9 percent per year from 1990 to 1999. From 1999 \nto 2002 mortality rates increased by 4.6 percent per year. From 2002 to 2008 mortality rates declined by 4.5 percent per year, but appeared to level off in 2010 and 2011. \n \nFigure 13. Age-adjusted Colorectal Cancer Mortality Rates Among Females by Race, Georgia (1990-2011*) \n \nBlack Females \n \nWhite Females \n \nRate per 100,000 \n \n30 \n \nICD-9 \n \n25 \n \nICD-10 \n \n20 \n \n15 \n \n10 \n \n5 \n \n0 \n \n1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 \n \n*Because of data quality issues, 2009 mortality data are not used for analysis. **The U.S. Prevention Task Force colorectal cancer screening recommendation was implemented in December 1995. \n \n Black females had generally higher mortality rates than white females.  Among white females, mortality rates declined by 1.4 percent per year from 1990 to 2008 but \nappeared to level off in 2010 and 2011.  Among black females, mortality rates declined by 0.5 percent per year during 1990 to 2008 and \ncontinued to decline in 2010 and 2011. \n \n13 \n \n Rate per 100,000 \n \nMortality Trends \nFigure 14. Age-adjusted Colorectal Cancer Mortality Rates Among Adult Males 30-49 Years of Age, and Adult Females 35-49 Years of Age, Georgia (1990-2011*) \n \nMales 30-49 age years \n \nFemales 35-49 age years \n \n2.5 \n \nICD-9 \n \nICD-10 \n \n2 \n \n1.5 \n \n1 \n \n0.5 \n \n0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 *Because of data quality issues, 2009 mortality data are not used for analysis. \n \n Among adult males 30-49 years of age, mortality rates increased by 0.1 percent per year during 1990 to 2008 but appeared to level off in 2010 and 2011. \n Among adult females 35-49 years of age, mortality rates increased by 0.9 percent per year during 1990 to 2008 but appeared to level off in 2010 and 2011. \n \nRate per 100,000 \n \nFigure 15. Age-adjusted Colorectal Cancer Mortality Rates Among Adults 50-64 Years of Age, by Sex, \n \nGeorgia (1990-2011*) \n \nMales 50-64 age years \n \nFemales 50-64 age years \n \n40 \n \nICD-9 \n \n35 \n \n30 \n \n25 \n \n20 \n \n15 \n \n10 \n \n5 \n \n0 \n \nICD-10 \n \n1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 *Because of data quality issues, 2009 mortality data are not used for analysis. \n \n Among adult males 50-64 years of age, mortality rates declined by 0.6 percent per year during 1990 to 2008 but appeared to level off in 2010 and 2011. \n Among adult females 50-64 years of age, mortality rates declined by 0.6 percent per year during 1990 to 2008 and this trend appeared to continue through 2011. \n \n14 \n \n Rate per 100,000 \n \nFigure 16. Age-adjusted Colorectal Cancer Mortality Rates Among Adults 65+ Years of Age, by Sex, \n \nGeorgia (1990-2011*) \n \nMales 65+ age years \n \nFemales 65+ age years \n \n200 \n \nICD-9 \n \nICD-10 \n \n150 \n \n100 \n \n50 \n \n0 \n1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 \n*Because of data quality issues, 2009 mortality data are not used for analysis. \n Among adult males 65+ years of age, mortality rates declined by 3.0 percent per year during 1990 to1998. Mortality rates increased by 2.9 percent per year during 1998-2002. Mortality rates declined by 4.8 percent per year from 2002 to 2008. This trend appeared to continue through 2011. \n Among adult females 65+ years of age, mortality rates declined by 1.5 percent per year during 1990 to 2008 and this trend appeared to continue through 2011. \n \n15 \n \n Survival \n \nStaging is a standardized way to summarize information about how far a cancer has spread and helps determine a treatment plan. The TNM staging system is used at hospitals to guide treatment options, however, many central cancer registries, such as the Georgia Comprehensive Cancer Registry and the National Program of Cancer Registries (NPCR) use SEER summary stage for surveillance purposes, categorizing cancer into these groups: \nLocalized: Cancer that is confined to the organ where it started. Regional: Cancer that has spread from its primary site to nearby lymph nodes or organs. Distant: Cancer that has spread from its primary site to distant organs or lymph nodes. Also referred to \nas distant metastasis. \n During 2004-2010, the overall five-year colorectal cancer survival rate among Georgians was 64 percent. [If the cancer was discovered at a local stage, the survival rate is 88 percent, however the survival rate is only 68 percent when discovered at a regional stage and 12 percent when discovered at a distant stage.] \n Early detection saves lives. Individuals diagnosed at an early stage (localized) have a better chance of surviving five years after diagnosis than those diagnosed at a later stage (Figures 17 and 18). \n \nFigure 17. Colorectal Cancer Five-Year Survival Rates by Race and Stage, Males, Georgia, 20042010 \n \nFigure 18. Colorectal Cancer Five-Year Survival Rates by Race and Stage, Females, Georgia, 20042010 \n \n100 \n \n89 87 \n \n90 \n \n80 \n \n70 \n \n60 \n \n50 \n \n40 \n \n30 \n \n20 \n \n10 \n \n0 \n \nLocalized \n \n% of tumors found at this stage* \n \nBlack \nMales White Males \n \n69 64 \nRegional Localized 39% 41% \n \nBlack Males White Males \n \n9 12 \n \nDistant \n \nRegional Distant \n \n33% \n \n25% \n \n37% \n \n20% \n \n100 90 \n \n86 89 \n \n80 \n \n70 \n \n60 \n \n50 \n \n40 \n \n30 \n \n20 \n \n10 \n \n0 \n \nLocalized \n \n71 65 Regional \n \nBlack Females White Females \n11 14 Distant \n \nLocalized Regional Distant \n \n% of tumors found at this stage* \n \nBlack \n \n40% \n \nFemales \n \nWhite \n \n40% \n \nFemales \n \n32% \n \n24% \n \n38% \n \n19% \n \n*Unstaged tumors are not shown. \n \n*Unstaged tumors are not shown. \n \nPercent Percent \n \n During 2004-2010, 53 percent of colorectal cancers were diagnosed at a late stage (regional and distant while only 43 percent were diagnosed early (local). \n The five-year survival rates for white males (64 percent) for all stages was higher than those for black males (59 percent) \n The five-year survival rates for white females (66 percent) for all stages was higher than those for black females (60 percent). \n However, the five-year survival rate for black males (89 percent) at the localized stage was higher than white males (87 percent) (Figure 17). \n Five-year survival rates dropped significantly for individuals when diagnosed at the distant stage. \n16 \n \n Incidence and Mortality, By Geographic Location \nFigure 19. Age-adjusted Colorectal Cancer Incidence Rates Among Males, by Public Health District, Georgia, 2007-2011 \nAccording to the Georgia Comprehensive Cancer Registry, during 2007-2011:  The Southwest (8-2) Public Health District had a significantly higher colorectal cancer incidence \nrate among males than the state as a whole.  The North Georgia (1-2) and South Central (5-1) Public Health Districts had significantly lower \ncolorectal cancer incidence rates among males than the state as a whole. Figure 20. Age-adjusted Colorectal Cancer Incidence Rates Among Females, by Public Health District, Georgia, 2007-2011 \n \nAccording to the Georgia Comprehensive Cancer Registry, during 2007-2011: \n \n The West Central (7) Public Health District had a significantly higher colorectal cancer incidence \n \nrate among females than the state as a whole. \n \n The North Georgia (1-2) and Southeast (9-2) Public Health Districts had significantly lower \n \ncolorectal cancer incidence rates among females than the state as a whole. \n \n17 \n \n Figure 21. Age-adjusted Colorectal Cancer Mortality Rates Among Males, by Public Health District, Georgia, 2006-2011* \n*Note: 2009 death data were excluded from the analysis due to data reliability \nAccording to the Georgia Vital Records Data, during 2006-2011:  The East Central (6) and West Central (7) Public Health Districts had significantly higher colorectal \ncancer death rates among males than the state as a whole.  The North Georgia (1-2), Cobb-Douglas (3-1), and South Central (5-1) Public Health Districts had \nsignificantly lower colorectal cancer death rates among males than the state as a whole. Figure 22. Age-adjusted Colorectal Cancer Mortality Rates Among Females, by Public Health District, Georgia, 2006-2011* \n*Note: 2009 death data were excluded from the analysis due to data reliability \nAccording to the Georgia Vital Records Data, during 2006-2011:  No Public Health Districts had significantly higher colorectal cancer death rates among females than \nthe state as a whole.  The North Georgia (1-2) Public Health District had a significantly lower colorectal cancer death rate \n18 \namong females than the state as a whole.  \n \n Figure 23. Age-adjusted Colorectal Cancer Incidence Rates Among Males, by County, Georgia, 2007-2011 \nAccording to the Georgia Comprehensive Cancer Registry, during 2007-2011:  Wilkes, Heard, Jefferson, Franklin, Banks, Tattnall, Meriwether, Wayne, Bartow and Muscogee Counties \nhad significantly higher colorectal cancer incidence rate among males than the state as a whole.  Gwinnett, Fayette, Columbia, Cherokee, Union and Oconee Counties had significantly lower colorectal \ncancer incidence rates among males than the state as a whole. Figure 24. Age-adjusted Colorectal Cancer Incidence Rates Among Females, by County, Georgia, 2007-2011 \nAccording to the Georgia Comprehensive Cancer Registry, during 2007-2011:  Terrell, Spalding, Muscogee, Jackson, Douglas, Burke, Bibb and Bartow Counties had significantly \nhigher colorectal cancer incidence rate among females than the state as a whole.  Ware, Walker, Union, Gwinnett, Columbia, Colquitt, Cobb, Chattooga, Bulloch and Barrow Counties \nhad significantly lower colorectal cancer incidence rates among females than the state as a whole. \n19 \n \n Figure 25. Age-adjusted Colorectal Cancer Mortality Rates Among Males, by County, Georgia, 2006-2011* \n \n*Note: 2009 death data were excluded from the analysis due to data reliability \nAccording to the Georgia Vital Records Data, during 2006-2011:  Greene, McDuffie, Emanuel, Bibb, Carroll and Muscogee Counties had significantly higher colorectal \ncancer incidence rates among males than the state as a whole.  Cobb, Hall, Cherokee and Fayette Counties had significantly lower colorectal cancer incidence rates \namong males than the state as a whole. \nFigure 26. Age-adjusted Colorectal Cancer Mortality Rates Among Females, by County, Georgia, 2006-2011* \n \n*Note: 2009 death data were excluded from the analysis due to data reliability \n \nAccording to the Georgia Vital Records Data, during 2006-2011: \n \n Troup, Monroe and Bibb Counties had significantly higher colorectal cancer incidence rates among \n \nfemales than the state as a whole. \n \n Cherokee and Whitfield counties had significantly lower colorectal cancer incidence rates among \n \nfemales than the state as a whole. \n \n20 \n \n \n \n Figure 27. Percent of Late Stage* Colorectal Cancer Incidence by Public Health District, Males 50-64 Years of Age, Georgia, 2007-2011 \n \n*Late Stage is defined as Regional or Distant at time of diagnosis. \n \nFigure 28. Percent of Late Stage* Colorectal Cancer Incidence by Public Health District, Non-Hispanic Black Males 50-64 Years of Age, Georgia, 2007-2011 \n \nFigure 29. Percent of Late Stage* Colorectal Cancer Incidence by Public Health District, Non-Hispanic White Males 50-64 Years of Age, Georgia, 2007-2011 \n \n*Late Stage is defined as Regional or Distant at time of diagnosis. \n \n*Late Stage is defined as Regional or Distant at time of diagnosis. \n \nAccording to Figures 27, 28 and 29, during 2007-2011 in Georgia: \n \n Fulton (3-2), East Metro (3-4), West Central (7), Southwest (8-2) and Northeast (10) Public Health Districts had the highest percentage of adult males age 50-64 who were diagnosed at late stage. \n \n Clayton (3-3), DeKalb (3-5), South Central (5-1), North Central (5-2) and South (8-1) Public Health Districts had the lowest percentage of adult males age 50-64 who were diagnosed at late stage. \n \n North Georgia (1-2), LaGrange (4) and Northeast (10) Public Health Districts had the highest percentage of black adult males age 50-64 who were diagnosed at late stage. \n Northwest (1-1), North (2), South Central (5-1), North Central (5-2), West Central (7) and South (8-1) Public Health Districts had the lowest percentage of black adult males age 50-64 who were diagnosed at late stage. \n \n West Central (7), Southwest (8-2) and Northeast (10) Public Health Districts had the highest \n \npercentage of white adult males age 50-64 who were diagnosed at late stage. \n \n Clayton (3-3), DeKalb (3-5), South Central (5-1) and North Central (5-2) Public Health Districts had \n \nthe lowest percentage of white adult males age 50-64 who were diagnosed at late stage. \n \n21 \n \n Figure 30. Percent of Late Stage* Colorectal Cancer Incidence by Public Health District, Females 50-64 Years of Age, Georgia, 2007-2011 \n \n*Late Stage is defined as Regional or Distant at time of diagnosis. \n \nFigure 31. Percent of Late Stage* Colorectal Cancer \n \nFigure 32. Percent of Late Stage* Colorectal Cancer \n \nIncidence by Public Health District, Non-Hispanic Black Incidence by Public Health District, Non-Hispanic White \n \nFemales 50-64 Years of Age, Georgia, 2007-2011 \n \nFemales 50-64 Years of Age, Georgia, 2007-2011 \n \n*Late Stage is defined as Regional or Distant at \n \n*Late Stage is defined as Regional or Distant at \n \ntime of diagnosis. \n \ntime of diagnosis. \n \nAccording to Figures 30, 31 and 32, during 2007-2011 in Georgia: \n \n Northwest (1-1), Cobb-Douglas (3-1), East Metro (3-4), Northeast (10) and West Central (7) Public \n \nHealth Districts had the highest percentage of adult females age 50-64 who were diagnosed at late stage. \n \n Clayton (3-3), DeKalb (3-5), South Central (5-1) and North Central (5-2) Public Health Districts had the \n \nlowest percentage of adult females age 50-64 who were diagnosed at late stage. \n \n Northwest (1-1), North Georgia (1-2), Cobb-Douglas (3-1), East Metro (3-4), South Central (5-1) and Southeast (9-2) Public Health Districts had the highest percentage of black adult females age 50-64 who were diagnosed at late stage. \n Clayton (3-3), LaGrange (4), East Central (6), South (8-1) and Southwest (8-2) Public Health Districts had the lowest percentage of black adult females age 50-64 who were diagnosed at late stage. \n Northwest (1-1), East Central (6), West Central (7), South (8-1) and Northeast (10) Public Health Districts had the highest percentage of white adult females age 50-64 who were diagnosed at late stage. \n Clayton (3-3), DeKalb (3-5), South Central (5-1), North Central (5-2) and Southeast (9-2) Public Health Districts had the lowest percentage of white adult females age 50-64 who were diagnosed at late stage. 22 \n \n Figure 33. Metro, Metro Adjacent, and Rural Counties, Georgia, 2013 \n \nRate per 100,000 Rate per 100,000 \n \n*For a more specific description, please refer to the technical notes \n \nFigure 34. Age-Adjusted Colorectal Cancer Incidence (2007-2011) by Geography and Sex, Georgia \n \nFigure 35. Age-Adjusted Colorectal Cancer Mortality (2006-2011*) by Geography and Sex, Georgia \n \nMales Females \n \n125 \n \n75 \n \n49 38 \n \n49 39 \n \n52 37 \n \n55 38 \n \n51 37 \n \n25 \n \n-25 Metro Metro Metro Smaller Rural 1M+ 250K- \u003c250K Urban 1M \n \nMales Females \n \n50 25 18 13 \n \n23 15 \n \n19 13 \n \n20 14 \n \n22 14 \n \n0 \n \nMetro 1M+ \n \nMetro 250K- \n1M \n \nMetro Smaller Rural \u003c250K Urban \n \n*Note: Because of data quality issues, 2009 mortality data are not used for analysis. \n \nDuring 2007-2011 in Georgia:  Age-adjusted colorectal cancer incidence and mortality rates were consistently higher among males than among females regardless of geographical area.  Males living in smaller urban counties had the highest incidence rates. Males living in metropolitan counties (250,000 to 1 million) had the highest mortality rates.  Males living in metropolitan counties (1 million or more) had the lowest mortality rates.  Males living in metropolitan counties with a population of 1 million or more or metropolitan counties (250,000 to 1 million) had significantly lower incidence rates than males living in all other counties.  Females living in metropolitan counties (250,000 to 1 million) had higher incidence rates than females living in metropolitan counties (Less than 250,000) and rural counties.  Females living in metropolitan counties (250,000 to 1 million) had the highest incidence rates.  Females living in metropolitan counties with a population of 1 million or more and metropolitan counties (Less than 250,000) had the lowest mortality rates. Females living in metropolitan counties 23 (250,000 to 1 million) had the highest mortality rates. \n \n Treatment \n \nSpotlight: \n \nDifferent types of treatment are available for patients with colorectal cancer. The choice of treatment \n \nCancer Coalition of South Georgia's Community Cancer Screening Program TM \n \ndepends on a variety of factors such as age, overall health and type and stage of colorectal cancer. The three standard types of treatment used in colorectal cancer are: surgery, radiation therapy and chemotherapy. Depending on the stage of cancer, multiple treatment modalities may be used at the same time or one after another. \n \nThe Community Cancer Screening Program TM developed in 2006 by the Cancer Coalition of South Georgia, is highly effective in providing South Georgia citizens with essential cancer screenings and medical care. Through the involvement of professionals such as health navigators \n \nSurgery: This is the main treatment for early stage colorectal cancer. If the cancer is found at an early stage, the doctor may remove it without cutting the abdomen by using a colonoscope (a tube that is inserted through the rectum). This procedure is called a local excision. If cancerous polyps are found and removed, the procedure is called a polypectomy. If the polyp is larger, the doctor performs a colectomy which removes a section of the large intestine on either side of the cancer including some lymph nodes \n \nthat identify patients in need of breast, cervical and colorectal cancer screenings, the program has increased its reach from serving 86 patients in one primary care center in 2006 to serving nearly 900 patients annually in 12 primary care centers. In 2014 alone, the program facilitated 980 breast, cervical and colorectal cancer screenings for 890 uninsured South Georgia adults. \n \nand connects the healthy parts of the intestine together. If the doctor is not able to connect the ends of the colon back together, an opening is made in the abdomen and a bag is placed over the opening to collect waste. This procedure is called a colostomy. Radiation Therapy: This treatment uses high energy x-rays to kill cancer cells. There are two types of radiation therapies: external radiation and internal radiation. External radiation comes from a machine and is directed at the cancer. During internal radiation therapy, radioactive material is placed directly into or near the cancer. Radiation therapy can be used to kill any cancer cells remaining that might not have been completely removed by surgery. Chemotherapy: This treatment uses drugs to kill cancer cells. Systemic chemotherapy uses drugs that are injected into a vein or taken by mouth. These \n \nThis program, which is nationally recognized by the Mutual of America Foundation and the Agency for Healthcare Research and Quality, served as a model for the initial development of Georgia's Colorectal Cancer Screening Program. The Community Cancer Screening ProgramTM in 2014 provided colorectal cancer screening and navigation services at no cost to 444 uninsured adult patients. Through these colorectal cancer screenings, approximately one-third of adult patients had high-risk polyps removed, saving thousands of dollars in healthcare costs. For more information please call 229-3121700. \n \ndrugs enter the bloodstream and reach cancer cells \n \nthroughout the body. In regional chemotherapy, \n \ndrugs are placed directly into an artery leading to a \n \npart of the body where the tumor is located. \n \nAdjuvant and Neoadjuvant Chemotherapy: \n \nAdjuvant chemotherapy is used after surgery when \n \nthere is no evidence of cancer remaining but there is a chance the cancer will return. Neoadjuvant \n \nchemotherapy is used for rectal cancers before surgery (along with radiation), to shrink the tumor size. \n \nChemotherapy helps to shrink tumors, relieve symptoms from the tumor and extend survival for some \n \npatients. \n \n24 \n \n Figure 36. Location of Hospitals and Surgical Facilities Providing Endoscopy Services, Georgia \n Georgia has a higher concentration of surgical facilities and hospitals located in the Northwest region and Metro Atlanta. \n Few surgical facilities or hospitals are located in the South Georgia. Figure 37. Location of Federally Qualified Heath Centers, State of Georgia \n Georgia health center sites are scattered throughout Georgia.  There are many gaps in coverage in rural counties. \n25 \n \n Incidence and Mortality, Adults 50-64 Years of Age, during 2007-2011 in Georgia \n The overall age-adjusted colorectal cancer incidence rate among adults ages 50-64 years in Georgia was 81 per 100,000 in males and females combined. Males were 41 percent more likely to be diagnosed with colorectal cancer than females (age-adjusted rate 96/100,000 vs. 68/100,000). \n The overall age-adjusted colorectal cancer mortality rate in adults ages 50-64 years, in Georgia is 24 per 100,000 in males and females combined. Males were 58 percent more likely to die of colorectal cancer than females (age-adjusted rate 30/100,000 vs.19/100,000) \n In Georgia, adults ages 50-64 years who were non-Hispanic black males, were more likely than nonHispanic white males to be diagnosed with colorectal cancer. Additionally, non-Hispanic black females were more likely than non-Hispanic white females to be diagnosed with colorectal cancer. \n Adults ages 50-64 years who were Black males, were more likely than white males to die of colorectal cancer in Georgia. Similarly, black females were more likely than white females to die of this disease in Georgia. \n \nFigure 38. Age-Adjusted Colorectal Cancer Incidence Rates for Adults 50-64 Years of Age by Race/Ethnicity and Sex, Georgia, 20072011 \n140 128 \n120 \n \n100 \n \n87 \n \n88 \n \n80 62 \n60 \n \n40 \n \n20 \n \n0 \n \nNon- \n \nNon- \n \nHispanic Hispanic Black Males White Males \n \nNonHispanic \nBlack Females \n \nNonHispanic \nWhite Females \n \nFigure 39. Age-Adjusted Colorectal Cancer Mortality Rates for Adults 50-64 Years of Age by Race and Sex, Georgia, 2006-2011* \n \n50 45 43 \n \n40 \n \n35 \n \n29 \n \n30 \n \n26 \n \n25 \n \n20 \n \n16 \n \n15 \n \n10 \n \n5 \n \n0 Black Males White Males Black Females White Females \n \n*Because of data quality issues, 2009 mortality data are not used for analysis. \n \nRate per 100,000 Rate per 100,000 \n \n26 \n \n Causes and Risk Factors, Adults 50-64 Years of Age \n \nTable 3: Prevalence (%) of Risk Factors Associated with Colorectal Cancer, Among Adults Age 50-64 Years of Age, By Sex, By Public Health District, Georgia, 2011 \n \nGeorgia 1.1 Northwest 1.2 North Georgia 2.0 North 3.1 Cobb-Douglas 3.2 Fulton 3.3 Clayton 3.4 East Metro 3.5 DeKalb 4.0 LaGrange 5.1 South Central 5.2 North Central 6.0 East Central 7.0 West Central 8.1 South 8.2 Southwest 9.1 Coastal 9.2 Southeast 10.0 Northeast \n \nObese \n34.5 35.9 27.1 28.2 29.3 17.2 48.5 29.2 34.2 35.2 48.3 41.8 44.9 38.1 35.0 36.7 36.8 44.8 40.8 \n \nCurrent Smoker \n20.9 23.2 33.4 17.6 17.8 17.3 20.6 17.9 14.4 26.6 15.5 19.3 16.9 23.0 26.8 22.8 21.3 22.8 18.9 \n \nPhysically Inactive \n29.0 34.7 33.9 29.7 23.9 20.1 22.9 25.4 17.9 24.6 36.3 25.7 27.8 40.1 39.6 30.5 33.8 32.0 39.8 \n \nDiabetes 17.0 18.9 12.2 15.4 10.8 10.7 16.4 14.0 18.3 16.8 23.0 16.6 21.1 27.2 21.8 18.6 17.5 24.0 15.7 \n \nColorectal Screening \n57.9 61.9 32.0 61.1 59.3 63.4 60.7 68.4 58.9 49.4 66.5 42.5 64.1 61.3 47.5 76.9 58.8 59.8 61.9 \n \nAccording to the Georgia 2011 Behavioral Risk Factor Surveillance System (Table 3): Obese \n Clayton (3-3) Public Health District has the highest percentage of adults age 50-64 who are obese (48.5 percent). \n Fulton (3-2) Public Health District has the lowest percentage of adults age 50-64 who are obese (17.2 percent). \n \nCurrent Smoker  North Georgia (1-2) Public Health District has the highest percentage of adults age 50-64 who are current smokers (33.4 percent).  DeKalb (3-5) Public Health District has the lowest percentage of adults age 50-64 who are current smokers (14.4 percent). \n \nPhysically Inactive  West Central (7) Public Health District has the highest percentage of adults age 50-64 who are physically inactive (40.1 percent).  DeKalb (3-5) Central Public Health District has the lowest percentage of adults age 50-64 who are physically inactive (17.9 percent). \n \n27 \n \n Diabetes  West Central (7-0) Public Health District has the highest percentage of adults age 50-64 who are diabetic (27.2 percent).  Fulton (3-2) Public Health District has the lowest percentage of adults age 50-64 who are diabetic (10.7 percent). \nColorectal Screening  Southwest (8-2) Public Health District has the highest percentage of adults age 50-64 who meet the recommendation for colorectal screening (76.9 percent).  North Georgia (1-2) Public Health District has the lowest percentage of adults age 50-64 who meet the recommendation for colorectal screening (32.0 percent). \n28 \n \n Table 4: Prevalence (%) of Risk Factors Associated with Colorectal Cancer and Colorectal Screening, Among Adults Age 50-64 Years of Age, By Demographic Factors, Georgia, 2011 \n \nSex Male Female \nInsurance Status Have Health Insurance No Health Insurance \nEducation Less than High School High School Graduate Some College College Graduate \nIncome Under $35,000 $35,000-$50,000 $50,000+ \n \nObese \n34 35 \n34 35 \n44 37 34 26 \n41 34 30 \n \nCurrent Smoker \n24 19 \n18 33 \n32 25 21 9 \n30 21 12 \n \nPhysically Inactive \n28 30 \n28 32 \n42 38 25 15 \n36 30 20 \n \nDiabetes \n18 16 \n16 20 \n25 21 15 9 \n24 17 10 \n \nColorectal Screening \n54 61 \n63 33 \n41 55 60 70 \n45 66 69 \n \nAccording to the Georgia 2011 Behavioral Risk Factor Surveillance System (Table 4):  The prevalence of obesity in males and females was similar.  The prevalence of obesity among adults who have health insurance and adults who do not have health insurance was similar.  As educational status increased the percentage of obese adults decreased.  As income increased the percentage of obese adults decreased. \n \n Males were more likely to be current smokers.  Adults who do not have health insurance were significantly more likely to be current smokers.  As educational status increased the percentage of current smokers decreased.  As income increased the percentage of current smokers significantly decreased. \n \n Females were more likely to be physically inactive.  Adults who do not have health insurance were more likely to be physically inactive.  As educational status increased the percentage of physically inactive adults decreased.  As income increased the percentage of physically inactive adults decreased. \n \n Males were more likely to be diabetic.  Adults who do not have health insurance were significantly more likely to be diabetic.  As educational status increased the percentage of diabetic adults decreased.  As income increased the percentage of diabetic adults significantly decreased. \n Females were more likely to meet the recommendation for colorectal screening than males.  Adults who have health insurance were significantly more likely to meet the recommendation.  As educational status increased so does the percentage of adults meeting the recommendation for \ncolorectal screening.  As income increased so does the percentage of adults meeting the recommendation for colorectal \nscreening. \n29 \n \n Screening, Adults 50-64 Years of Age \nColorectal cancer is the third most commonly diagnosed cancer and cause of cancer death among Georgian men and women. Colorectal cancer affects both men and women and most often occurs in people over 50 years of age. Regular screenings for colorectal cancer can find cancer early (when it is most likely to be curable). Screenings can also prevent colorectal cancer by finding polyps and removing them before they turn cancerous. \n \nHealthy People 2020 Goal/Objective for Colorectal Cancer Screening \n Goal: Reduce the number of new cancer cases, as well as the illness, disability and death caused by cancer \n Objective: Monitor the incidence of colorectal cancer and promote evidence based screening \nThe Healthy People 2020 objective measures the proportion of adults who receive colorectal cancer screening based on the most recent guidelines. \nAccording to Healthy People 20/20 objective, colorectal screening is defined as screening for colorectal cancer with fecal occult blood testing in the past year and/or sigmoidoscopy in the past five years, and/or blood stool test in the past three years or colonoscopy in the past 10 years. \nGeorgia Cancer Plan 2014-2019 for Colorectal Cancer Screening \nGeorgia's Objective and Target by 2019 Increase screening for colorectal cancer among adults over 50 years to 85 percent by 2019, regardless of insurance status, and increase screening among those with a family history of colorectal cancer. \n \nAccording to the Georgia 2011 Behavioral Risk Factor Surveillance System (Figure 17): \n In Georgia, 57.9 percent of adults ages 50-64 years reported having a blood stool test using a home kit within the past 12 months, having a sigmoidoscopy every five years and/or colonoscopy every 10 years. \n The Southwest Public Health District (8-2), has the highest percentage of adults age 50-64 who met the recommendation for colorectal screening (76.9 percent). \n North Georgia Public Health District (1-2), has the lowest percentage of adults age 50-64 meeting the recommendation for colorectal screening (32.0 percent). \n The 2014-2019 goal of the Georgia Cancer Plan is to increase screening from 69.4 to 85 percent by 2019, regardless of insurance status, and increase screening among those with a family history of colorectal cancer. \n The prevalence of colorectal cancer screening among adults with an income of less than $35,000 was 45 percent. Adults who have health insurance had a higher prevalence of colorectal screening (63 percent) than adults who do not have health insurance (33 percent). \nFigure 40. Prevalence (%) of Colorectal Cancer Screening* Among Adults 50-64 Years of Age by Public Health District, Georgia, 2011 \n \nTargets by 2019 \n \n Increase by 10 percent the proportion of individuals with a family history of colorectal cancer who receives evidence-based genetic risk assessment and appropriate screening. \n \n Reduce income and health insurance status disparities in colorectal cancer screening rates by 10 percent. \n \n30 \n*The Colorectal Cancer Screening Recommendation is defined as the percent of adults who had a FOBT in the last year, and/or sigmoidoscopy in the last 5 years, and/or colonoscopy in the last 10 years. \n \n Colorectal Cancer Resources: \nYou can learn more about colorectal cancer from the following organizations: American Cancer Society Telephone: 1-800-ACS-2345 (1-800-227-2345) Website: www.cancer.org Centers for Disease Control and Prevention Telephone: 1-800-CDC-INFO Website: www.cdc.gov National Cancer Institute, Cancer Information Service Telephone: 1-800-4-CANCER (1-800-422-6237) Website: www.cancer.gov National Colorectal Cancer Research Alliance Telephone: 424-283-3600 Website: www.eifoundation.org/programs/eifs-national-colorectal-cancer-research-alliance Cancer Research and Prevention Foundation Telephone: 1-800-227-2732 Website: www.preventcancer.org Cancer Control Planet Website: http://cancercontrolplanet.cancer.gov/ Colon Cancer Alliance Telephone: 1-877-422-2030 Website: www.ccalliance.org Georgia Comprehensive Cancer Registry Telephone: 404-463-3748 Website: http://dph.georgia.gov/georgia-comprehensive-cancer-registry \n31 \n \n Technical Notes \nDefinitions: Age-adjusted rate A rate calculated in a manner that allows for the comparison of rates derived from populations with different age structures. Cancer incidence The number of new cancer cases occurring in a population during a specified period of time, often expressed as a rate per 100,000 population. Cancer mortality The number of cancer deaths occurring in a population during a specified period of time, often expressed as a rate per 100,000 population. Prevalence The number of people with a disease or risk factor out of the total number of persons in a population, often expressed as a percentage. Average Risk Population includes most people who develop colorectal cancer and have no identifiable risk factors. People at increased risk of colorectal cancer consist of those with personal or family history of colorectal cancer, those with colorectal cancer symptoms or those who already have inflammatory bowel disease or certain genetic conditions. Obesity is defined as a body mass index (BMI) of 30 or greater. Smoking is defined as an adult smoking at least 100 cigarettes in their lifetime and is currently smoking. Physical Inactivity is defined as not participating in any physical activities within last 30 days. \n32 \n \n Number \n1-1 1-2 \n2-0 3-1 3-2 3-3 3-4 3-5 \n4-0 \n5-1 \n5-2 \n6-0 \n7-0 \n8-1 \n8-2 9-1 \n \nName Northwest \nNorth Georgia North \nCobb-Douglas Fulton Clayton East Metro DeKalb LaGrange \nSouth Central \nNorth Central \nEast Central \nWest Central \nSouth \nSouthwest \nCoastal Southeast \n \n9-2 Northeast \n10-0 \n \nGeorgia Public Health Districts \n \nMajor City Rome Dalton Gainesville \nJonesboro Lawrenceville \nDublin Macon Augusta Columbus Valdosta Albany Savannah Waycross \nAthens \n \nCounties Bartow, Catoosa, Chattooga, Dade, Floyd, Gordon, Haralson, Paulding, Polk, Walker Cherokee, Fannin, Gilmer, Murray, Pickens, Whitfield \nBanks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Stephens, Towns, Union, White Cobb, Douglas Fulton Clayton Gwinnett, Newton, Rockdale DeKalb Butts, Carroll, Coweta, Fayette, Heard, Henry, Lamar, Meriwether, Pike, Spalding, Troup, Upson Bleckley, Dodge, Johnson, Laurens, Montgomery, Pulaski, Telfair, Treutlen, Wheeler, Wilcox Baldwin, Bibb, Crawford, Hancock, Houston, Jasper, Jones, Monroe, Peach, Putnam, Twiggs, Washington, Wilkinson Burke, Columbia, Emanuel, Glascock, Jefferson, Jenkins, Lincoln, McDuffie, Richmond, Screven, Taliaferro, Warren, Wilkes Chattahoochee, Clay, Crisp, Dooly, Harris, Macon, Marion, Muscogee, Quitman, Randolph, Schley, Stewart, Sumter, Talbot, Taylor, Webster Ben Hill, Berrien, Brooks, Cook, Echols, Irwin, Lanier, Lowndes, Tift, Turner Baker, Calhoun, Colquitt, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas, Worth Bryan, Camden, Chatham, Effingham, Glynn, Liberty, Long, McIntosh Appling, Atkinson, Bacon, Brantley, Bryan, Bulloch, Camden, Candler, Charlton, Clinch, Coffee, Evans, Glynn, Jeff Davis, Liberty, Long, McIntosh, Pierce, Tattnall, Toombs, Ware, Wayne Barrow, Clarke, Elbert, Greene, Jackson, Madison, Morgan, Oconee, Oglethorpe, Walton \n \n33 \n \n 2013 Rural-Urban Continuum Codes: Rural-Urban Continuum Codes form a classification scheme that distinguishes metropolitan (metro) counties by the population size of their metro area, and nonmetropolitan (nonmetro) counties by degree of urbanization and adjacency to a metro area or areas: \n \nCode 1 2 3 4 5 6 7 8 \n9 \n \nDescription Counties in metro areas of 1 million population or more Counties in metro areas of 250,000 to 1 million population Counties in metro areas of fewer than 250,000 population Urban population of 20,000 or more, adjacent to a metro area Urban population of 20,000 or more, not adjacent to a metro area Urban population of 2,500 to 19,999, adjacent to a metro area Urban population of 2,500 to 19,999, not adjacent to a metro area Completely rural or less than 2,500 urban population, adjacent to a metro area Completely rural or less than 2,500 urban population, not adjacent to a metro area \n \nCounties \n \nRegroup 1 2 3 4,5,6, \u0026 7 8 \u0026 9 \n \nDescription Metro \u003e1 million Metro 250,000-1 million Metro \u003c250,000 Smaller Urban Rural \n \nData Sources: The number of new cases and incidence rates for the state of Georgia for 2007-2011 were obtained from the Georgia Department of Public Health, Division of Health Protection, Epidemiology Program, Georgia Comprehensive Cancer Registry. Incidence data were coded using ICD-O-3 codes and grouped using the SEER Site Recode ICD-O-3/WHO 2008. For more information on these groupings, please visit the Surveillance, Epidemiology, and End Results (SEER) Program on the web at http://seer.cancer.gov/ siterecode/icdo3_dwhoheme/. \nThe number of deaths and mortality rates for the state of Georgia for 2006-2008, 2010, and 2011 were obtained from the Georgia Department of Public Health, Office of Vital Records. Mortality data were coded using ICD10 codes and grouped using the SEER Cause of Death Recode 1969+. For more information on these groupings, please visit the SEER Program on the web at http://seer.cancer.gov/ codrecode/1969+_d04162012. \nIncidence trend and survival data for Georgia were obtained from the SEER Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2013 Sub (2000-2011) \u003cKatrina/Rita Population Adjustment\u003e - Linked To County Attributes - Total U.S., 1969-2012 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems \n34 \n \n Branch, released April 2014 (updated 5/7/2014), based on the November 2013 submission. Incidence and survival data were categorized using the SEER Site Recode ICD-O-3/WHO 2008. \nMortality trend data for Georgia were obtained from the SEER Program (www.seer.cancer.gov) SEER*Stat Database: Mortality - All COD, Aggregated With State, Total U.S. (1969-2011) \u003cKatrina/Rita Population Adjustment\u003e, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released July 2014. Underlying mortality data provided by NCHS (www.cdc.gov/nchs). Cause of death was categorized using the SEER Cause of Death Recode 1969+. \nPopulation estimates for 2006-2013 and the 2000 US standard million population were obtained from the US Bureau of the Census, available at http://www.census.gov/. \nIncidence and mortality rates for the United States for 2007-2011 were obtained from the North American Association of Central Cancer Registries (NAACCR) Cancer in North America: 2007-2011 publication. \nHealth risk and screening behavior data for adults were obtained from the Behavioral Risk Factor Surveillance System (BRFSS), a telephone health survey administered by the Georgia Department of Public Health, in collaboration with the CDC (Centers for Disease Control and Prevention). National data for the prevalence of similar risk factors was retrieved from Centers for Disease Control and Prevention at www.cdc.gov/brfss/ \nClinical information on colorectal cancer was retrieved from the Mayo Clinic at www.mayoclinic.com, Colorectal Cancer Medline Plus at www.nlm.nih.gov/medlineplus, National Cancer Institute at www.cancer.gov and the American Cancer Society at www.cancer.org. \nMethods: \nIncidence rates were calculated per 100,000 population and age-adjusted by the direct method to the 2000 US standard million population. Except where calculated to show trends, the incidence rates are five-year average annual rates for the period 2007 through 2011. \nMortality rates were calculated per 100,000 population and age-adjusted by the direct method to the 2000 US standard million population. Because of data quality issues, 2009 Georgia cancer death data are not used for analysis. Except where calculated to show trends, the mortality rates are five-year average annual rates including data for 2006-2008, 2010 and 2011 combined. \nThe estimated number of cases for 2013 was calculated by multiplying the age-specific state incidence rates (2007-2011) by the age-specific state population estimates for 2013. The results were then summed to obtain a state estimate. \nThe estimated number of deaths for 2013 was calculated by multiplying the age-specific state mortality rates (2006-2008, 2010 and 2011 combined) by the age-specific state population estimates for 2013. The results were then summed to obtain a state estimate. \nAnnual percent change computations for the incidence and mortality trends were calculated using Joinpoint Regression Program, Version 4.1.1 - August 2014; Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute. \nThe Rural-Urban classification of Georgia counties was based on the 2013 Rural-Urban Continuum Codes from the United States Department of Agriculture, Economic Research Service. Information about the Rural-Urban Continuum Codes can be retrieved from http://www.ers.usda.gov/Data/RuralUrbanContinuumCodes/. \n35 \n \n Appendix A \n \nFigures 18 \u0026 19 Number of Incident Colorectal Cancer Cases and Age-adjusted Colorectal Cancer Incidence Rates by Sex, by Public Health District, Georgia, 2007-2011 \n \nPublic Health District \nGeorgia 1.1 Northwest 1.2 North Georgia 2.0 North 3.1 Cobb-Douglas 3.2 Fulton 3.3 Clayton 3.4 East Metro 3.5 DeKalb 4.0 LaGrange 5.1 South Central 5.2 North Central 6.0 East Central 7.0 West Central 8.1 South 8.2 Southwest 9.1 Coastal 9.2 Southeast 10.0 Northeast \n \nCases 10,123 \n716 409 762 720 822 236 769 597 921 181 646 539 453 283 481 609 456 523 \n \nMales Incidence Rate 50.7 50.71 43.15 51.24 48.42 49.95 55.49 47.12 47.46 53.86 43.86 53.00 52.26 54.66 51.97 57.46 50.22 55.19 54.68 \n \nCases 9,316 631 373 634 673 823 221 722 652 842 169 601 486 474 244 423 570 328 450 \n \nFemales Incidence Rate 37.5 36.27 33.10 36.84 36.46 38.41 41.00 34.98 38.90 39.79 36.64 39.91 37.27 43.95 35.76 38.88 38.66 33.46 37.79 \n \nFigures 20 \u0026 21 Number of Colorectal Cancer Deaths and Age-adjusted Colorectal Cancer Mortality Rates by Sex, by Public Health District, Georgia, 2006-2011* \n \nPublic Health District \nGeorgia 1.1 Northwest 1.2 North Georgia 2.0 North 3.1 Cobb-Douglas 3.2 Fulton 3.3 Clayton 3.4 East Metro 3.5 DeKalb 4.0 LaGrange 5.1 South Central 5.2 North Central 6.0 East Central 7.0 West Central 8.1 South 8.2 Southwest 9.1 Coastal 9.2 Southeast 10.0 Northeast \n \nDeaths 3,555 274 125 245 216 294 \n78 247 230 297 56 242 238 181 106 153 225 156 192 \n \nMales Mortality Rate 19.8 21.92 14.26 17.42 16.85 19.70 20.93 17.73 20.54 19.36 14.95 22.18 24.61 23.53 20.29 20.08 20.30 21.12 21.80 \n \nDeaths 3,330 252 111 212 235 271 \n79 253 235 301 65 224 183 173 92 153 217 116 158 \n \nFemales Mortality Rate 13.8 14.76 10.36 12.46 13.74 12.75 15.78 13.79 14.67 14.82 13.99 15.10 14.30 15.87 13.35 13.89 14.68 12.00 13.48 \n \n36 \n \n Appendix B \n \nFigures 22 \u0026 23 Number of Incident Colorectal Cancer Cases and Age-adjusted Colorectal Cancer Incidence Rates by Sex, by Public Health District, Georgia, 2007-2011 \n \nCounty Name \n \nMales \n \nGeorgia Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur DeKalb Dodge \n \nCases 10,123 \n25 12 18 6 59 37 63 148 16 23 189 11 22 19 40 67 25 29 10 44 13 130 61 14 295 *** 35 145 91 5 236 6 592 38 53 101 24 143 16 31 18 30 38 597 27 \n \nIncidence Rate 50.7 61.3 ~ 60.0 ~ 51.0 79.0 47.1 71.5 36.1 49.6 55.0 ~ 51.1 42.6 76.7 53.4 47.7 46.8 ~ 44.0 ~ 58.0 41.4 ~ 50.1 ~ 49.8 35.7 53.4 ~ 55.5 ~ 47.2 38.0 53.9 36.9 57.9 53.1 40.6 51.9 38.9 50.3 56.7 47.5 49.2 \n \n*Note: 2009 death data were excluded from the analysis due to data reliability \n \nCases 9,316 \n21 8 11 7 45 24 44 121 21 22 214 17 13 18 36 37 51 22 9 45 8 126 60 7 294 \u003c5 22 164 95 6 221 6 538 50 34 95 24 113 9 35 17 28 34 652 25 \n \nFemales \nIncidence rate 37.5 37.6 ~ ~ ~ 38.5 50.0 27.1 47.8 37.8 36.4 45.3 37.4 ~ 32.6 54.1 24.6 77.6 34.7 ~ 42.3 ~ 45.3 31.5 ~ 38.8 ~ 26.2 34.2 39.7 ~ 41.0 ~ 34.4 47.0 26.1 30.7 47.3 37.0 ~ 44.0 33.8 44.4 38.0 38.9 41.7 \n \n37 \n \n Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Montgomery \n \n10 \n \n~ \n \n16 \n \n118 \n \n61.0 \n \n117 \n \n128 \n \n54.9 \n \n135 \n \n18 \n \n59.3 \n \n10 \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n58 \n \n60.0 \n \n52 \n \n38 \n \n71.1 \n \n29 \n \n36 \n \n65.9 \n \n27 \n \n18 \n \n67.9 \n \n13 \n \n40 \n \n51.1 \n \n29 \n \n92 \n \n37.2 \n \n115 \n \n112 \n \n46.6 \n \n104 \n \n159 \n \n49.3 \n \n130 \n \n50 \n \n82.5 \n \n40 \n \n822 \n \n49.9 \n \n823 \n \n40 \n \n46.7 \n \n27 \n \n9 \n \n~ \n \n6 \n \n104 \n \n48.8 \n \n85 \n \n58 \n \n48.0 \n \n59 \n \n42 \n \n63.3 \n \n37 \n \n32 \n \n58.7 \n \n17 \n \n585 \n \n45.8 \n \n539 \n \n72 \n \n61.1 \n \n55 \n \n187 \n \n48.7 \n \n154 \n \n12 \n \n~ \n \n14 \n \n38 \n \n53.5 \n \n39 \n \n37 \n \n42.4 \n \n33 \n \n39 \n \n53.4 \n \n40 \n \n30 \n \n98.0 \n \n10 \n \n191 \n \n53.3 \n \n169 \n \n163 \n \n57.6 \n \n138 \n \n16 \n \n64.6 \n \n12 \n \n85 \n \n62.8 \n \n79 \n \n11 \n \n~ \n \n17 \n \n20 \n \n48.5 \n \n20 \n \n36 \n \n90.1 \n \n19 \n \n8 \n \n~ \n \n14 \n \n13 \n \n~ \n \n5 \n \n36 \n \n52.8 \n \n24 \n \n28 \n \n61.9 \n \n25 \n \n11 \n \n~ \n \n9 \n \n70 \n \n53.8 \n \n58 \n \n27 \n \n45.4 \n \n27 \n \n43 \n \n43.5 \n \n39 \n \n18 \n \n68.5 \n \n11 \n \n12 \n \n~ \n \n6 \n \n102 \n \n52.3 \n \n88 \n \n36 \n \n43.6 \n \n25 \n \n27 \n \n80.4 \n \n24 \n \n43 \n \n63.4 \n \n31 \n \n13 \n \n~ \n \n10 \n \n29 \n \n59.0 \n \n25 \n \n13 \n \n~ \n \n13 \n \n43 \n \n77.5 \n \n33 \n \n6 \n \n~ \n \n9 \n \n35 \n \n62.2 \n \n26 \n \n42 \n \n57.9 \n \n26 \n \n9 \n \n~ \n \n7 \n \n35.6 41.8 46.8 \n~ ~ 46.2 39.8 40.5 ~ 29.8 35.5 34.4 35.8 50.4 38.4 28.4 ~ 32.9 40.5 49.2 26.6 33.8 40.5 34.8 ~ 44.1 33.6 40.0 ~ 38.3 39.9 ~ 50.3 41.9 46.2 32.0 ~ ~ 26.8 46.0 ~ 39.1 42.3 39.6 ~ ~ 34.4 31.6 55.5 37.3 ~ 35.2 ~ 42.9 ~ 36.4 32.5 ~ \n38 \n \n Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth \n \n24 \n \n49.9 \n \n25 \n \n57 \n \n69.1 \n \n36 \n \n226 \n \n59.8 \n \n251 \n \n106 \n \n57.6 \n \n99 \n \n23 \n \n30.3 \n \n30 \n \n21 \n \n52.8 \n \n24 \n \n127 \n \n53.3 \n \n102 \n \n39 \n \n67.4 \n \n34 \n \n35 \n \n39.5 \n \n35 \n \n30 \n \n62.8 \n \n19 \n \n20 \n \n48.0 \n \n19 \n \n48 \n \n52.3 \n \n45 \n \n12 \n \n~ \n \n15 \n \n27 \n \n39.2 \n \n24 \n \n9 \n \n~ \n \n5 \n \n26 \n \n47.5 \n \n23 \n \n11 \n \n~ \n \n12 \n \n205 \n \n48.3 \n \n189 \n \n78 \n \n43.9 \n \n84 \n \n7 \n \n~ \n \n5 \n \n29 \n \n75.1 \n \n20 \n \n12 \n \n~ \n \n13 \n \n94 \n \n62.3 \n \n93 \n \n49 \n \n65.4 \n \n41 \n \n13 \n \n~ \n \n7 \n \n37 \n \n51.0 \n \n36 \n \n6 \n \n~ \n \n12 \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n45 \n \n78.6 \n \n28 \n \n13 \n \n~ \n \n18 \n \n16 \n \n36.1 \n \n14 \n \n17 \n \n77.7 \n \n23 \n \n65 \n \n56.7 \n \n56 \n \n56 \n \n63.3 \n \n37 \n \n32 \n \n56.0 \n \n26 \n \n17 \n \n39.7 \n \n20 \n \n8 \n \n~ \n \n10 \n \n87 \n \n58.1 \n \n76 \n \n14 \n \n~ \n \n10 \n \n23 \n \n82.2 \n \n12 \n \n28 \n \n34.5 \n \n19 \n \n34 \n \n49.1 \n \n41 \n \n71 \n \n41.3 \n \n62 \n \n103 \n \n54.2 \n \n76 \n \n39 \n \n42.0 \n \n27 \n \n8 \n \n~ \n \n10 \n \n20 \n \n37.2 \n \n26 \n \n57 \n \n73.3 \n \n34 \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n*** \n \n~ \n \n\u003c5 \n \n32 \n \n42.3 \n \n35 \n \n92 \n \n44.9 \n \n82 \n \n10 \n \n~ \n \n16 \n \n32 \n \n100.2 \n \n18 \n \n9 \n \n~ \n \n18 \n \n34 \n \n58.1 \n \n21 \n \nAverage annual rate per 100,000, age-adjusted to the 2000 US standard population. *** Data suppressed for confidentiality purposes ~ Rates not calculated where the count is less than sixteen. \n \n43.1 35.1 47.0 40.8 35.4 52.5 35.7 45.5 35.8 33.5 39.0 36.8 \n~ 33.1 \n~ 33.7 \n~ 35.1 36.9 \n~ 42.6 \n~ 49.4 43.4 \n~ 37.6 \n~ ~ 44.2 61.2 ~ 71.7 38.5 32.8 30.7 35.5 ~ 39.4 ~ ~ 20.2 46.1 28.2 33.1 20.9 ~ 39.6 42.6 ~ ~ 37.8 31.9 56.9 43.5 53.1 28.5 \n39 \n \n Appendix C \n \nFigures 24 \u0026 25 Number of Colorectal Cancer Deaths and Age-adjusted Colorectal Cancer Mortality Rates by Sex, by Public Health District, Georgia, 2006-2011* \n \nCounty Name \nGeorgia Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur DeKalb Dodge Dooly Dougherty \n \nDeaths 3,555 \n10 *** \u003c5 \u003c5 15 14 17 39 9 \u003c5 93 \u003c5 *** 9 13 16 18 13 \u003c5 10 *** 55 23 \u003c5 115 \u003c5 18 51 26 \u003c5 78 \u003c5 177 13 12 37 7 41 \u003c5 15 10 9 15 230 10 7 35 \n \nMales \nMortality Rate 19.8 ~ ~ ~ ~ ~ ~ 16.4 20.7 ~ ~ 29.9 ~ ~ ~ ~ 13.1 37.9 ~ ~ ~ ~ 29.7 15.7 ~ 20.8 ~ 28.7 12.5 15.3 ~ 20.9 ~ 15.9 ~ ~ 15.9 ~ 19.0 ~ ~ ~ ~ ~ 20.5 ~ ~ 20.3 \n \nDeaths 3,330 \n5 \u003c5 *** \u003c5 17 9 15 38 6 *** 86 \u003c5 \u003c5 7 10 21 15 11 \u003c5 17 \u003c5 39 21 \u003c5 107 \u003c5 9 48 38 \u003c5 79 \u003c5 186 14 15 28 6 32 \u003c5 10 9 7 14 235 10 6 46 \n \nFemales \nMortality rate 13.8 ~ ~ ~ ~ 14.6 ~ ~ 15.7 ~ ~ 17.7 ~ ~ ~ ~ 14.2 ~ ~ ~ 16.5 ~ 14.5 10.9 ~ 13.8 ~ ~ 10.5 16.5 ~ 15.8 ~ 13.0 ~ ~ 10.1 ~ 11.4 ~ ~ ~ ~ ~ 14.7 ~ ~ 16.3 \n40 \n \n Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray \n \n39 \n \n22.4 \n \n49 \n \n7 \n \n~ \n \n5 \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n23 \n \n24.7 \n \n18 \n \n13 \n \n~ \n \n9 \n \n20 \n \n37.9 \n \n8 \n \n9 \n \n~ \n \n5 \n \n14 \n \n~ \n \n10 \n \n28 \n \n12.4 \n \n40 \n \n45 \n \n20.7 \n \n51 \n \n48 \n \n17.8 \n \n38 \n \n17 \n \n29.0 \n \n18 \n \n294 \n \n19.7 \n \n271 \n \n10 \n \n~ \n \n6 \n \n*** \n \n~ \n \n\u003c5 \n \n38 \n \n20.0 \n \n39 \n \n17 \n \n16.6 \n \n19 \n \n13 \n \n~ \n \n9 \n \n17 \n \n44.0 \n \n10 \n \n184 \n \n17.9 \n \n187 \n \n21 \n \n17.6 \n \n15 \n \n56 \n \n15.5 \n \n51 \n \n8 \n \n~ \n \n5 \n \n15 \n \n~ \n \n17 \n \n14 \n \n~ \n \n12 \n \n11 \n \n~ \n \n13 \n \n\u003c5 \n \n~ \n \n*** \n \n50 \n \n16.4 \n \n65 \n \n56 \n \n21.3 \n \n38 \n \n9 \n \n~ \n \n6 \n \n30 \n \n24.7 \n \n29 \n \n\u003c5 \n \n~ \n \n*** \n \n9 \n \n~ \n \n5 \n \n15 \n \n~ \n \n13 \n \n\u003c5 \n \n~ \n \n*** \n \n*** \n \n~ \n \n\u003c5 \n \n13 \n \n~ \n \n7 \n \n9 \n \n~ \n \n9 \n \n*** \n \n~ \n \n\u003c5 \n \n24 \n \n20.1 \n \n22 \n \n12 \n \n~ \n \n6 \n \n17 \n \n19.9 \n \n15 \n \n*** \n \n~ \n \n\u003c5 \n \n\u003c5 \n \n~ \n \n*** \n \n31 \n \n15.7 \n \n32 \n \n*** \n \n~ \n \n\u003c5 \n \n10 \n \n~ \n \n15 \n \n12 \n \n~ \n \n13 \n \n*** \n \n~ \n \n\u003c5 \n \n19 \n \n40.4 \n \n8 \n \n8 \n \n~ \n \n5 \n \n9 \n \n~ \n \n10 \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n10 \n \n~ \n \n14 \n \n16 \n \n24.7 \n \n21 \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n*** \n \n~ \n \n\u003c5 \n \n10 \n \n~ \n \n12 \n \n18.3 ~ ~ \n20.0 ~ ~ ~ ~ \n13.2 16.5 11.5 23.8 12.8 \n~ ~ 14.5 13.7 ~ ~ 13.7 ~ 11.6 ~ 19.4 ~ ~ ~ 16.9 11.2 ~ 19.0 ~ ~ ~ ~ ~ ~ ~ ~ 15.5 ~ ~ ~ ~ 12.7 ~ ~ ~ ~ ~ ~ ~ ~ ~ 27.1 ~ ~ ~ \n41 \n \n Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth \n \n96 \n \n26.7 \n \n93 \n \n34 \n \n19.9 \n \n38 \n \n12 \n \n~ \n \n6 \n \n7 \n \n~ \n \n7 \n \n52 \n \n25.2 \n \n34 \n \n13 \n \n~ \n \n12 \n \n11 \n \n~ \n \n11 \n \n12 \n \n~ \n \n6 \n \n5 \n \n~ \n \n6 \n \n14 \n \n~ \n \n20 \n \n\u003c5 \n \n~ \n \n*** \n \n8 \n \n~ \n \n11 \n \n*** \n \n~ \n \n\u003c5 \n \n16 \n \n27.5 \n \n9 \n \n6 \n \n~ \n \n5 \n \n89 \n \n22.2 \n \n84 \n \n29 \n \n16.7 \n \n28 \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n12 \n \n~ \n \n6 \n \n\u003c5 \n \n~ \n \n*** \n \n30 \n \n19.6 \n \n24 \n \n15 \n \n~ \n \n17 \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n\u003c5 \n \n~ \n \n*** \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n14 \n \n~ \n \n8 \n \n\u003c5 \n \n~ \n \n*** \n \n\u003c5 \n \n~ \n \n*** \n \n6 \n \n~ \n \n5 \n \n22 \n \n22.0 \n \n22 \n \n19 \n \n22.9 \n \n19 \n \n11 \n \n~ \n \n9 \n \n5 \n \n~ \n \n8 \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n37 \n \n24.0 \n \n45 \n \n11 \n \n~ \n \n5 \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n11 \n \n~ \n \n14 \n \n17 \n \n25.8 \n \n15 \n \n41 \n \n26.1 \n \n34 \n \n50 \n \n27.2 \n \n28 \n \n20 \n \n21.4 \n \n17 \n \n*** \n \n~ \n \n\u003c5 \n \n8 \n \n~ \n \n7 \n \n15 \n \n~ \n \n13 \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n\u003c5 \n \n~ \n \n\u003c5 \n \n10 \n \n~ \n \n9 \n \n29 \n \n16.6 \n \n24 \n \n\u003c5 \n \n~ \n \n*** \n \n7 \n \n~ \n \n6 \n \n\u003c5 \n \n~ \n \n*** \n \n*** \n \n~ \n \n\u003c5 \n \nAverage annual rate per 100,000, age-adjusted to the 2000 US standard population. *Note: 2009 death data were excluded from the analysis due to data reliability \n~ Rates not calculated where the count is less than sixteen. *** Data suppressed for confidentiality purposes \n \n17.1 16.2 \n~ ~ 14.2 ~ ~ ~ ~ 15.6 ~ ~ ~ ~ ~ 15.8 12.5 ~ ~ ~ 12.5 17.1 ~ ~ ~ ~ ~ ~ ~ ~ 14.0 15.9 ~ ~ ~ 22.6 ~ ~ ~ ~ 14.6 12.4 12.5 ~ ~ ~ ~ ~ ~ 9.6 ~ ~ ~ ~ \n42 \n \n Appendix D \n \nFigures 26, 27 \u0026 28 Number of Incident Late Stage Colorectal Cancer Cases and Percent of Late Stage Colorectal Cancer Incidence Rates by Sex, by Race/Ethnicity, by Public Health District, Georgia, 2007-2011 \n \nPublic Health District \nGeorgia 1.1 Northwest 1.2 North Georgia 2.0 North 3.1 Cobb-Douglas 3.2 Fulton 3.3 Clayton 3.4 East Metro 3.5 DeKalb 4.0 LaGrange 5.1 South Central 5.2 North Central 6.0 East Central 7.0 West Central 8.1 South 8.2 Southwest 9.1 Coastal 9.2 Southeast 10.0 Northeast \n \nCases 5,693 395 247 435 408 468 130 446 309 521 \n84 320 296 280 149 292 340 249 324 \n \nMales Percent 53.69 53.45 54.65 54.10 54.33 55.19 51.79 56.31 49.60 54.33 42.86 45.91 53.82 56.68 51.38 56.15 53.71 52.42 61.13 \n \nNon-Hispanic Black Males \n \nCases \n \nPercent \n \n1,576 \n \n54.33 \n \n26 \n \n52.00 \n \n9 \n \n56.25 \n \n22 \n \n53.66 \n \n67 \n \n54.03 \n \n249 \n \n55.58 \n \n75 \n \n54.35 \n \n86 \n \n55.48 \n \n180 \n \n54.88 \n \n130 \n \n58.30 \n \n19 \n \n42.22 \n \n119 \n \n47.04 \n \n116 \n \n55.24 \n \n108 \n \n53.73 \n \n43 \n \n49.43 \n \n105 \n \n54.4 \n \n109 \n \n54.77 \n \n50 \n \n54.95 \n \n63 \n \n63.64 \n \nNon-Hispanic White Males \n \nCases \n \nPercent \n \n3,863 \n \n53.16 \n \n366 \n \n53.74 \n \n224 \n \n53.72 \n \n396 \n \n54.17 \n \n314 \n \n53.58 \n \n191 \n \n53.95 \n \n45 \n \n47.87 \n \n287 \n \n54.56 \n \n113 \n \n43.30 \n \n380 \n \n53.45 \n \n65 \n \n44.52 \n \n195 \n \n45.14 \n \n175 \n \n52.87 \n \n167 \n \n59.86 \n \n105 \n \n53.57 \n \n185 \n \n57.28 \n \n217 \n \n52.29 \n \n190 \n \n51.35 \n \n248 \n \n59.90 \n \nFigures 29, 30 \u0026 31 Number of Incident Late Stage Colorectal Cancer Cases and Percent of Late Stage Colorectal Cancer Incidence Rates by Sex, by Race/Ethnicity, by Public Health District, Georgia, 2007-2011 \n \nPublic Health District \nGeorgia 1.1 Northwest 1.2 North Georgia 2.0 North 3.1 Cobb-Douglas 3.2 Fulton 3.3 Clayton 3.4 East Metro 3.5 DeKalb 4.0 LaGrange 5.1 South Central 5.2 North Central 6.0 East Central 7.0 West Central 8.1 South 8.2 Southwest 9.1 Coastal 9.2 Southeast 10.0 Northeast \n \nFemales \n \nCases \n \nPercent \n \n5,139 \n \n52.76 \n \n360 \n \n54.88 \n \n212 \n \n53.00 \n \n345 \n \n51.49 \n \n378 \n \n54.08 \n \n456 \n \n53.58 \n \n112 \n \n48.28 \n \n409 \n \n54.97 \n \n340 \n \n49.93 \n \n457 \n \n52.41 \n \n88 \n \n47.57 \n \n314 \n \n48.83 \n \n265 \n \n53.32 \n \n284 \n \n55.47 \n \n136 \n \n53.33 \n \n232 \n \n51.21 \n \n309 \n \n52.55 \n \n174 \n \n50.43 \n \n268 \n \n58.52 \n \nNon-Hispanic Black Females \n \nCases \n \nPercent \n \n1,591 \n \n52.40 \n \n37 \n \n58.73 \n \n7 \n \n58.33 \n \n24 \n \n52.17 \n \n87 \n \n59.59 \n \n248 \n \n54.75 \n \n69 \n \n48.25 \n \n103 \n \n56.28 \n \n210 \n \n51.22 \n \n90 \n \n47.87 \n \n32 \n \n56.14 \n \n150 \n \n52.45 \n \n103 \n \n49.76 \n \n117 \n \n50.43 \n \n34 \n \n47.22 \n \n90 \n \n49.45 \n \n109 \n \n51.42 \n \n33 \n \n60.00 \n \n48 \n \n53.93 \n \nNon-Hispanic White Females \n \nCases \n \nPercent \n \n3,367 \n \n53.08 \n \n317 \n \n55.32 \n \n201 \n \n53.17 \n \n312 \n \n51.91 \n \n278 \n \n53.15 \n \n187 \n \n52.53 \n \n37 \n \n48.68 \n \n252 \n \n53.50 \n \n119 \n \n48.57 \n \n353 \n \n53.81 \n \n55 \n \n44.00 \n \n158 \n \n45.14 \n \n156 \n \n57.35 \n \n161 \n \n59.63 \n \n101 \n \n56.42 \n \n139 \n \n52.26 \n \n188 \n \n52.08 \n \n136 \n \n48.40 \n \n217 \n \n60.28 \n \n43 \n \n Figure 40 Number of Incident Colorectal Cancer Cases and Percent of Colorectal Cancer Screening Among Adults 50-64 Years of Age by Public Health District, Georgia, 2011 \n \nPublic Health District \n1.1 Northwest 1.2 North Georgia 2.0 North 3.1 Cobb-Douglas 3.2 Fulton 3.3 Clayton 3.4 East Metro 3.5 DeKalb 4.0 LaGrange 5.1 South Central 5.2 North Central 6.0 East Central 7.0 West Central 8.1 South 8.2 Southwest 9.1 Coastal 9.2 Southeast 10.0 Northeast \n \nCases 39 26 38 38 48 27 37 43 40 36 29 40 43 28 36 39 19 45 \n \nAdults \n \nPercent 61.88 32.04 61.05 59.25 63.37 60.74 68.44 58.92 49.41 66.51 42.5 64.11 61.3 47.46 76.92 58.82 59.75 61.87 \n \n44 \n \n "},{"id":"dlg_ggpd_y-ga-bp780-pd5-bs1-bc6-b2003-h2007-belec-p-btext","title":"Colorectal cancer in Georgia, 2003-2007  [Aug. 2011]","collection_id":"dlg_ggpd","collection_title":"Georgia Government Publications","dcterms_contributor":["Georgia. Dept. of Public Health. Epidemiology Branch. Chronic Disease, Healthy Behaviors, and Injury Epidemiology Section"],"dcterms_spatial":["United States, Georgia, 32.75042, -83.50018"],"dcterms_creator":["Georgia. Dept. of Public Health. Epidemiology Branch. Chronic Disease, Healthy Behaviors, and Injury Epidemiology Section"],"dc_date":["2011-08"],"dcterms_description":["1999/2000-","Title from cover.","2007/2011 (online surrogate) ; (Georgia Government Publications database, viewed Aug. 22, 2017)."],"dc_format":["application/pdf"],"dcterms_identifier":null,"dcterms_language":["eng"],"dcterms_publisher":["Atlanta, Ga. : Georgia. Dept. of Public Health. Epidemiology Branch. Chronic Disease, Healthy Behaviors, and Injury Epidemiology Section"],"dc_relation":null,"dc_right":["http://rightsstatements.org/vocab/InC/1.0/"],"dcterms_is_part_of":null,"dcterms_subject":["Georgia"],"dcterms_title":["Colorectal cancer in Georgia, 2003-2007  [Aug. 2011]"],"dcterms_type":["Text"],"dcterms_provenance":["University of Georgia. Map and Government Information Library"],"edm_is_shown_by":["https://dlg.galileo.usg.edu/do:dlg_ggpd_y-ga-bp780-pd5-bs1-bc6-b2003-h2007-belec-p-btext"],"edm_is_shown_at":["https://dlg.galileo.usg.edu/id:dlg_ggpd_y-ga-bp780-pd5-bs1-bc6-b2003-h2007-belec-p-btext"],"dcterms_temporal":null,"dcterms_rights_holder":null,"dcterms_bibliographic_citation":null,"dlg_local_right":null,"dcterms_medium":["publications (documents)"],"dcterms_extent":null,"dlg_subject_personal":null,"iiif_manifest_url_ss":null,"dcterms_subject_fast":null,"fulltext":"Colorectal Cancer in Georgia, 2003 - 2007 \nColorectal Cancer \nG e o r g i a C oDl Oer pe cat arl tc amn cee rni tn g oe o fr g iPa , u2 0b0 3l- 2i0 0c7 H e a l t 1h \n \n Acknowledgements \nGeorgia Department of Public Health Brenda Fitzgerald, M.D., Commissioner \nHealth Protection Office Patrick O'Neal, M.D., Director \nEpidemiology Program Cherie Drenzek, DVM, M.P.H., State Epidemiologist \nChronic Disease, Healthy Behaviors, and Injury Epidemiology Section A. Rana Bayakly, M.P.H., Chief Epidemiologist \nGeorgia Comprehensive Cancer Registry A. Rana Bayakly, M.P.H., Director Chrissy McNamara, M.S.P.H., Epidemiologist Victoria Davis, M.P.H., Epidemiologist \nHealth Promotion \u0026 Disease Prevention Programs Kimberly Redding, M.D., M.P.H., Director \nGeorgia Comprehensive Cancer Control Program Tamira Moon, M.P.H., C.H.E.S, Manager \nWe would like to thank all the facilities in Georgia who contributed data to the Georgia Comprehensive Cancer Registry. Without their hard work, this report would not have been possible. \nFunding for this research was made possible (in part) by cooperative agreement award number 1/U58/DP00817-04 from the Centers for Disease Control and Prevention. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention. \n \nSuggested Citation: Davis, V., McNamara, C., Bayakly, A., Moon, T. Colorectal Cancer in Georgia, 2003-2007. Georgia Department of Public Health, Health Protection Office, Chronic Disease, Healthy Behaviors, and Injury Epidemiology, August 2011. \n \nColOrectal cancer in georgia, 2003-2007 \n \n2 \n \n Introduction \nColorectal cancer is a collective term for cancers of the colon and rectum. Since cancers of the colon and rectum share many common features, they are often referred to as colorectal cancer. The colon and rectum are parts of the digestive system. Together, they form a long, muscular tube called the large intestine. The colon is the first four to five feet of the large intestine and the last four to six inches is the rectum (Figure 1). \nOnce food is chewed and swallowed, it travels through the esophagus to the stomach. In the stomach, it is partially digested and transferred to the small intestine. The small intestine continues digesting the food and absorbs most of the nutrients. The food then travels to the large intestine. The waste then moves from the colon into the rectum and passes out of the body through an opening called the anus during a bowel movement. \nThe colon consists of 4 sections (Figure 1): \nThe first section is called the ascending colon. It begins where the small intestine attaches to the colon and extends upward on the right side of the abdomen. \nThe second section, the transverse colon, runs across the body from right to the left side of the upper abdomen. \nThe third section, the descending colon, continues downward on the left side. \nThe fourth section, the sigmoid colon, named because of its S-shape, joins the rectum and the colon. \nColorectal cancers develop slowly over a period of several years. Most of them begin as a non-cancerous polyp, a growth of tissue on the lining of the colon or rectum (Figure 2). Polyps are also known as adenomas. Over 95 percent of colorectal cancers are adenocarcinomas, which arise from cells that line the inside of the colon and the rectum. Removing the polyp early may prevent it from becoming cancerous. \nColorectal cancer affects both men and women and most often occurs in people over 50 years of age. It is the third most commonly diagnosed cancer and cause of cancer death among Georgian men and women. The Georgia Comprehensive Cancer Registry estimates that over 4,300 new cases of colorectal cancer will be diagnosed statewide in 2009 and about 1,300 Georgians will die from this disease. \n \nFigure 1. Anatomy of the Digestive System and Sections of Colon \n \nFigure 2. Colon Polyp \n \nColOrectal cancer in georgia, 2003-2007 \n \n3 \n \n Detection and Screening \nScreening is the process of looking for cancer in people who have no symptoms of colorectal cancer. Regular screenings for colorectal cancer can find cancer early (when it is most likely to be curable). Screenings can also prevent colorectal cancer by finding polyps and removing them before they turn cancerous. Tests that are used for screening colorectal cancer can by divided into two groups: \nTests that find both colorectal polyps and cancer: These tests look at the structure of the colon to find any abnormal areas. \n Flexible sigmoidoscopy During this test, a doctor uses a sigmoidoscope to look inside the rectum and the lower section of the colon. The sigmoidoscope is a flexible lighted tube about 2 feet long with a video camera on the end. Images from the inside of the colon and rectum are displayed on a monitor. The tube is used to detect polyps and if any polyps are found, they are removed. The procedure to remove polyps is called polypectomy \n Colonoscopy During this test, a colonoscope is used to look inside the entire length of the colon and rectum. The colonoscope is similar to a sigmoidoscope, but is longer. The doctor may also use the colonoscope to assist with the removal of polyps \n Double-contrast barium enema (DCBE) During this test, barium sulfate (chalky liquid) and air are used to show an outline of the colon and rectum. X-ray pictures are taken of the colon and rectum which can show abnormal areas. If any suspicious areas are seen, a colonoscopy may be performed \n CT colonography (virtual colonoscopy) This test is a more advanced form of a computed tomography (CT) scan. The CT scan takes multiple pictures of the colon and then combines all the pictures in order to create a 2-dimensional or 3-dimensional view of the inside of the colon and rectum. This test is considered less invasive than the colonoscopy, however if any abnormalities are found, a colonoscopy may be needed in order to determine if a cancer is present \nTests that find cancer: These tests involve testing the stool (feces) for signs that cancer may be present. These types of tests are considered to be less invasive and easier. \n Fecal occult blood test (FOBT) Damaged blood vessels from polyps or cancers may release a small amount of blood into the feces. The FOBT detects blood in stool that may not be visible. Before the test, certain medications and foods cannot be consumed because they may interfere with the test. The screening test is given as a take home kit and stool samples are taken and returned to a doctor's office for testing. If the test detects blood, a colonoscopy is performed to determine the source. Other conditions such as hemorrhoids or ulcers may also cause blood to be detected \n Fecal immunochemical test (FIT) This test is also used to detect blood in the stool. The FIT is also performed at home but may be easier to use since there are no medication or dietary restrictions that are required to be followed before taking the test (unlike the FOBT). After the stool samples have been collected, the samples are returned to the doctor's office for testing \n Stool DNA test (sDNA) Colorectal cancer cells may contain DNA mutations on certain genes. These genes are often shed in the stool, which enables tests to detect them. The sDNA test looks for certain abnormal sections of DNA from cancer or polyp cells. This test is new and how often to be tested has not yet been established \n \nColOrectal cancer in georgia, 2003-2007 \n \n4 \n \n American Cancer Society Recommendations \nfor Colorectal Cancer Early Detection \nThe American Cancer Society recommends that people at average risk for colorectal cancer should begin screening at age 50. \nScreening options include: \nTests that find polyps and cancer \n Flexible sigmoidoscopy- every 5 years* \n Double contrast barium enema- every 5 years* \n CT colonography (virtual colonoscopy-) every 5 years* \n Colonoscopy- every 10 years \nTests that mainly find cancer \n Fecal occult blood test (FOBT)-test every year*+ \n Fecal immunochemical test (FIT)-test every year+ \n Stool DNA test (sDNA)- interval uncertain** \n*Colonoscopy should be done if tests results are positive \n+For FOBT or FIT used as a screening test, the take- \nhome multiple sample method should be used. \n**Combined testing is preferred over either annual FOBT or FIT, or FSIG every 5 years alone \nFor people with Medicare, the most common colorectal cancer screening tests are covered \n \nAccording to the Georgia Behavioral Risk Factor Surveillance System (BRFSS): \n The percent of sigmoidoscopy/colonoscopy screening and FOBT screening is similar among men and women 50 years of age and older \n Adults 65 years of age and older have a significantly higher prevalence of receiving either screening when compared to adults 50 to 64 years of age \n The Healthy People 2010 objective was reached for adults age 50 years and older who ever had a sigmoidoscopy/colonoscopy \n The Healthy People 2010 objective was not reached for adults age 50 years and older who had a FOBT within the last 2 years \n \nFigurFe i3g.FuPCiregoerluco3ernen.ots3oc.foApydublytsSAexg,eG5e0o+r,gWiah2o00E4v-e2r0H08ad a Sigmoidoscopy/ \n100 100 \n \n50 50 \n \n59 59 \n \nPeHoTpPa5elre0aegHo%lTet2hpa5et0:ylr0ae1g%l0et2ht0:y10 \n \n59 59 \n \nPercent Percent \n \n00 \n \nMaleMsales \n \nFemFaelemsales \n \nFigurFe i4g.FuPCiregoerluco4ernenots4ocfoApydublytsAaggeeG50ro+u,pW, GhoeoErgviear \n \nHad a Sigmoidoscopy/ 2004-2008 \n \n100 100 \n \n50 50 \n \n53 53 \n \n68 68 \n \nPercent Percent \n \n00 \n \n50-6540-64 \n \n65+ 65+ \n \nColOrectal cancer in georgia, 2003-2007 \n \n5 \n \n Figure 5. Percent of Adults age 50+, Who Had a Fecal Occult Blood Test (FOBT) in the Past 2 years, by Sex, Georgia 2004-2008 \nFigure 5 \nFigure 1500 \n100 \n \nPercent Percent \n \n50 50 \n \n26 26 \n \nHealthy People 2010 Target: Healthy P5e0o%ple 2010 Target: 50% \n \n26 26 \n \n0 Males \n0 Males \n \nFemales Females \n \nFFigiugruer6e. P6ercent of Adults age 50+, Who Had a Fecal Occult Blood Test Figure 6 (FOBT) in the Past 2 years, by Age Group, Georgia 2004-2008 \n \n50 \n \n50 \n25 25 \n \n24 24 \n \n29 29 \n \nPercent Percent \n \n0 50-64 \n0 50-64 \n \n65+ 65+ \n \nColOrectal cancer in georgia, 2003-2007 \n \n6 \n \n Incidence and Mortality \n \n The overall age-adjusted colorectal cancer incidence rate in Georgia is 48 per 100,000 in males and females combined. Males are 39% more likely to be diagnosed with colorectal cancer than females (age-adjusted rate 57/100,000 vs. 41/100,000) \n The overall age-adjusted colorectal cancer mortality rate in Georgia is 17 per 100,000 in males and females combined. Males are 40% more likely to die of colorectal cancer than females (age-adjusted rate 21/100,000 vs. 15/100,000) \n In Georgia and the U.S., non-Hispanic black males and females are more likely than non-Hispanic white males and females to be diagnosed with colorectal cancer. \n Black males are more likely than white males to die of colorectal cancer in Georgia and the U.S. Similarly, black females are more likely than white females to die of this disease \n The overall age-adjusted colon cancer incidence rate in Georgia is 35 per 100,000 in males and females combined. Males are 32% more likely to be diagnosed with colon cancer than females (41/100,000 vs. 31/100,000) \n The overall age-adjused colon cancer mortality rate in Georgia is 14 per 100,000 in males and females combined. Males are 42% more likely to die from colon cancer than females (17/100,000 vs. 12/100,000) \n \nFigure 7. Age-adjusted Incidence Rate by Race and Sex, 2003-2007 \n \nRate per 100,000 \n \nGeorgia, 2003-2007 United States, 2003-2007 \n \n80 \n \n68 68 \n \n70 \n \n60 \n \n50 \n \n40 \n \n30 \n \n20 \n \n10 \n \n0 \n \nNon-Hispanic Black Males \n \n55 57 \n \n52 51 \n \n38 42 \n \nNon-Hispanic Non-Hispanic Non-Hispanic White Males Black Females White Females \n \nGeorgia, 2003-2007 United States, 2003-2007 100 \n \nRate per 100,000 \n \nFigure 8. Age-adjusted Mortality Rate by Race and Sex, 2003-2007 \n \n50 29 31 \n \n19 21 \n \n0 Black Males \n \nWhite Males \n \n20 21 \n \n13 14 \n \nBlack Females \n \nWhite Females \n \nColOrectal cancer in georgia, 2003-2007 \n \n7 \n \n Causes and Risk Factors \nA risk factor is anything that increases the chance of getting a disease such as cancer. Different cancers have different risk factors. Although it is hard to measure the contribution of a risk factor or know the exact cause of precancerous polyps or cancer, some factors may increase the risk of colorectal cancer development. However, some individuals develop colorectal cancer in the absence of any apparent risk factors. \nLifestyle-Related Risk Factors \nDiet: A diet high in red meats (beef, lamb, or liver), processed meats, and animal fat, or low in calcium, fiber, and folate may increase the risk of developing colorectal cancer. Also, cooking meats at high temperatures such as frying, grilling, or broiling may increase cancer risk. Diets high in vegetables and fruits have been linked with a decreased risk of colorectal cancer. More research is needed to better understand how diet affects colorectal cancer risk \nPhysical inactivity: There is a greater chance of developing colorectal cancer if a person is not physically active. Participating in regular physical activity may reduce this risk. To gain substantial health benefits, the U.S. Department of Health and Human Services recommends 2 hours and 30 minutes of moderate-intensity aerobic physical activity each week (i.e. 30 minutes, 5 times a week) for adults. \nObesity: People who are obese have an increased risk of developing colorectal cancer and an increased risk of dying of colorectal cancer when compared to people who are considered to be at normal weight. \nSmoking: Long term smokers are more likely than non-smokers to develop and die from colorectal cancer. \nAlcohol consumption: Heavy use of alcohol may increase the risk of developing colorectal cancer. The American Cancer Society recommends that alcohol use should be limited to no more than 2 drinks per day for men and 1 drink per day for women. \nDiabetes: People with Type 2 diabetes have an increased risk of developing colorectal cancer. They may also have a less favorable prognosis after diagnosis. \n \nColOrectal cancer in georgia, 2003-2007 \n \n8 \n \n Risk Factors You Cannot Change \nAge: The risk of developing colorectal polyps and cancer increase with age. More than 90% of people diagnosed with colorectal cancer are older than 50. \nFamily history: Parents, siblings, and children of a person who has had colorectal cancer or adenomatous polyps are more likely to develop colorectal cancer. The risk increases if any first-degree relative is affected at a young age or if more than one first-degree relative is affected. Cancers diagnosed frequently within the same family may also be due to inherited genes, shared exposure to environmental carcinogens, diet, or lifestyle factors. \nInherited syndromes: Certain genetic syndromes can increase the risk of developing colorectal cancer. These syndromes cause 5%-10% of all colorectal cancers. The 2 most common syndromes are familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC). People with FAP develop hundreds or thousands of polyps in their colon and rectum in their teens or early adulthood. Cancer may develop in these polyps as early as age 20. Similar to FAP, HNPCC develops when people are relatively young. However, individuals with HNPCC have fewer polyps and develop colorectal cancer at an average age of 44. \nRacial and ethnic background: African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the United States. The reason for this is not yet understood. \nPersonal history of colorectal cancer or polyps: A person who has had colorectal cancer is more likely to develop new cancers in other areas of the colon or rectum. Some types of polyps, such as adenomatous polyps and hyperplastic polyps increase the risk of colorectal cancer. \nPersonal history of bowel disease: Inflammatory Bowel Disease (IBD), which includes Ulcerative Colitis and Crohn's disease, is a condition in which the colon is inflamed over a long period of time. People with IBD have an increased risk of developing colorectal cancer and should be screened for colorectal cancer on a more frequent basis. \n \nColOrectal cancer in georgia, 2003-2007 \n \n9 \n \n Prevalence of Behavioral Risk Factors \n \nRisk Factors Obesity Smoking Physical Inactivity Diabetes \n \nTable 1: Prevalence (%) of Colorectal Cancer Risk Factors, Behavioral Risk Factor Surveillance System (BRFSS), 2009 \n \nGeorgia \n \nUnited States \n \nAll \n \nMales \n \nFemales \n \nAll \n \nMales \n \n28 \n \n28 \n \n27 \n \n27 \n \n29 \n \n18 \n \n20 \n \n16 \n \n18 \n \n20 \n \n24 \n \n21 \n \n27 \n \n24 \n \n22 \n \n10 \n \n10 \n \n9 \n \n8 \n \n9 \n \nFemales 26 17 26 8 \n \nAccording to the Georgia 2009 Behavioral Risk Factor Surveillance System (Table1):  The prevalence of obesity in males and females is similar  Males are more likely to be current smokers than females, however this difference is not significant  Females are significantly more likely to be physically inactive than males  The prevalence of diabetes is similar in males and females \n \nSymptoms \nIn the early stages of colorectal cancer, individuals may not have any symptoms. Symptoms usually appear when the disease has advanced. Signs and symptoms of colorectal cancer include: \n A change in bowel habits such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days \n A feeling that the bowel does not empty completely  Rectal bleeding or blood in the stool  Persistent cramping or abdominal pain  Weakness and fatigue  Unexplained weight loss \nOther conditions such as hemorrhoids and inflammatory bowel (IBD) disease may also have symptoms that mimic colorectal cancer. If you have any of the above symptoms, it is very important to talk to your doctor because it could be a sign of a serious medical condition such as colorectal cancer. \n \nColOrectal cancer in georgia, 2003-2007 \n \n10 \n \n Leading Causes of Cancer Incidence and Mortality \n \nTable 2: Leading Causes of Cancer Incidence and Mortality, Georgia 2003-2007 \n \nTop 5 Causes of Cancer Incidence \n \nTop 5 Causes of Cancer Mortality \n \nMales Prostate Lung \u0026 Bronchus Colorectal Bladder Melanoma \n \nFemales Breast Lung \u0026 Bronchus Colorectal Uterus Melanoma \n \nMales Lung \u0026 bronchus Prostate Colorectal Pancreas Leukemia \n \nFemales Lung \u0026 Bronchus Breast Colorectal Pancreas Ovary \n \nColorectal cancer is the third most commonly diagnosed cancer and cause of cancer death among males and females in Georgia. \n \nPictured is the Super Colon, which is a 20 foot replica of the human colon. Participants walking through the Super Colon are able to see what healthy colon tissue, non-malignant diseases (i.e. Crohn's disease and colitis), polyps, and different stages of colorectal cancer looks like. \n \nColOrectal cancer in georgia, 2003-2007 \n \n11 \n \n Age at Diagnosis \n \nFigure 9. Age-specific Colorectal Cancer Incidence and Mortality Rate by Sex, Georgia 2003-2007 \n \nRate per 100,000 \n \n400 \n300 \n200 \n100 21 \n0 0-39 \n \nMales \n \n27 7 \n \nIncidence Mortality \n \n85 23 \n \n182 56 \n \n353 282 \n202 \n102 \n \n40-49 50-59 60-69 70-79 \n \n80+ \n \nRate per 100,000 \n \n300 250 \n200 150 100 \n50 2 1 0 \n0-39 \n \nFemales \nIncidence Mortality \n \n23 6 40-49 \n \n65 16 \n50-59 \n \n118 34 \n60-69 \n \n201 75 \n70-79 \n \n259 141 \n80+ \n \n Males have higher incidence and mortality rates of colorectal cancer in all age groups \n The incidence and mortality rates of colorectal cancer increase with age for both males and females (Figure 9) \n The risk of being diagnosed with and dying from colorectal cancer increases sharply between ages 50-59 years for both males and females \n In both men and women less than 40 years of age, less than 65 cases and 15 deaths due to colorectal cancer occur each year \n \nColOrectal cancer in georgia, 2003-2007 \n \n12 \n \n Spotlight: \nIn July 2010, CDC Awarded Georgia a Grant for Colorectal Cancer Screening \nThe Centers for Disease Control and Prevention has awarded the state of Georgia a grant to provide colorectal cancer education and screening services for low-income residents age 50 years and older, who are underinsured or uninsured. The goal is to increase population-level screening among all persons age 50 years and older and to reduce the incidence and mortality of colorectal cancer, and health disparities in colorectal cancer screening. \nAccording to Laura Seeff, M.D., medical director of CDC's colorectal cancer screening program, \"This screening program has tremendous potential to address the disparities that exist in colorectal cancer screening and to save lives.\" \n \nTreatment \nDifferent types of treatment are available for patients with colorectal cancer. The choice of treatment depends on a variety of factors such as age, overall health, and type and stage of colorectal cancer. The three standard types of treatment used in colorectal cancer are: surgery, radiation therapy, and chemotherapy. Depending on the stage of cancer, multiple treatment modalities may be used at the same time or one after another. \nSurgery This is the main treatment for early stage colorectal cancer. If the cancer is found at an early stage, the doctor may remove it without cutting the abdomen by using a colonoscope (a tube that is inserted through the rectum). This procedure is called a local excision. If cancerous polyps are found and removed, the procedure is called a polypectomy. If the polyp is larger, the doctor performs a colectomy which removes a section of the large intestine on either side of the cancer including some lymph nodes and connects the healthy parts of the intestine together. If the doctor is not able to connect the ends of the colon back together, an opening is made in the abdomen and a bag is placed over the opening to collect waste. This procedure is called a colostomy. \nRadiation Therapy This treatment uses high energy x-rays to kill cancer cells. There are two types of radiation therapies: external radiation and internal radiation. External radiation comes from a machine and is directed at the cancer. During internal radiation therapy, radioactive material is placed directly into or near the cancer. Radiation therapy can be used to kill any cancer cells remaining that might not have been completely removed by surgery. \nChemotherapy This treatment uses drugs to kill cancer cells. Systemic chemotherapy uses drugs that are injected into a vein or taken by mouth. These drugs enter the bloodstream and reach cancer cells throughout the body. In regional chemotherapy, drugs are placed directly into an artery leading to a part of the body where the tumor is located. \nAdjuvant and Neoadjuvant Chemotherapy Adjuvant chemotherapy is used after surgery when there is no evidence of cancer remaining but there is a chance the cancer will return. Neoadjuvant chemotherapy is used for rectal cancers before surgery (along with radiation), to shrink the tumor size. Chemotherapy helps to shrink tumors, relieve symptoms from the tumor, and extend survival for some patients. \n \nColOrectal cancer in georgia, 2003-2007 \n \n13 \n \n Stages of Colorectal Cancer \n \nStaging is a standardized way to summarize information about how far a cancer has spread and helps determine a treatment plan. The TNM staging system is used at hospitals to guide treatment options, however, many central cancer registries, such as The Georgia Comprehensive Cancer Registry and the National Program of Cancer Registries (NPCR) use SEER summary stage for surveillance purposes, categorizing cancer into these groups: \nLocalized: Cancer that is confined to the organ where it started \nRegional: Cancer that has spread from its primary site to nearby lymph nodes or organs \nDistant: C ancer that has spread from its primary site to distant organs or lymph nodes. Also referred to as distant metastasis \n \nIncidence of Colorectal Cancer by Stage of Disease \n \nTable 3: Percent of Colorectal Cancer Found by Stage of Disease, Sex and Race, Georgia (2003-2007) and United States (1999-2006) \n \nLocalized (%) \n \nRegional (%) \n \nDistant (%) \n \nUS Males \n \n40 \n \n37 \n \n19 \n \nGA Males \n \n37 \n \n34 \n \n18 \n \nUS Females \n \n38 \n \n37 \n \n19 \n \nGA Females \n \n38 \n \n33 \n \n17 \n \nUS Black Males \n \n35 \n \n35 \n \n25 \n \nGA Black Males \n \n35 \n \n31 \n \n22 \n \nUS White Males \n \n40 \n \n37 \n \n19 \n \nGA White Males \n \n38 \n \n34 \n \n17 \n \nUS Black Females \n \n35 \n \n35 \n \n24 \n \nGA Black Females \n \n38 \n \n30 \n \n20 \n \nUS White Females \n \n38 \n \n38 \n \n19 \n \nGA White Females \n \n38 \n \n34 \n \n16 \n \nThe distribution of stage at diagnosis for colorectal cancer patients in Georgia is similar to colorectal cancer patients in the U.S. \n*Unknown/unstated category is not shown \n \nColOrectal cancer in georgia, 2003-2007 \n \n14 \n \n Figure 10. Stages of Colorectal Cancer \n \nThe TNM system is based on the size of the tumor (T), the spread of the tumor to the lymph nodes (N), and the presence of distant metastasis (M). The TNM system is then used to determine the stage of the cancer. The stages of colorectal cancer are: \n \nStage 0: The cancer is found only in the innermost lining of the colon or rectum, also known as carcinoma in situ. \n \nStage I: The tumor has grown into the inner wall of the colon or rectum. The tumor has not grown through the wall. \n \nStage II: The tumor extends more deeply into or through the wall of the colon or rectum. It may have invaded nearby tissue, but cancer cells have not spread to the lymph nodes. \n \nStage III: The cancer has spread to nearby lymph nodes, but not to other parts of the body. \n \nSurvival \n \nStage IV: The cancer has spread to other parts of the body, such as the liver or lung. It may or may not have spread to nearby lymph nodes. \n \nEarly detection saves lives. Individuals diagnosed at an early stage (localized) have a better chance of surviving five years after diagnosis than those diagnosed at a later stage (Figures 11 and 12). \n \nFigure 11. C olorectal Cancer Five-Year Survival Rates by Sex and Stage, United States, 1999-2006 \n \nFigure 12. Colorectal Cancer Five-Year Survival Rates by Sex, Race, and Stage, United States, 1999-2006 \n \n100 90 80 70 65 65 60 50 40 30 20 10 0 \n \n90 91 \n \n69 70 \n \nAll Stages Localized Regional \n \nM ales Females \n11 12 Distant \n \n100 \n \n91 91 \n \n90 \n \n85 86 \n \n80 \n \n70 \n \n66 66 \n \n60 56 57 \n \n70 70 63 63 \n \n50 \n \n40 \n \n30 \n \n20 \n \n10 \n \n0 \n \nAll Stages Localized Regional \n \nBlack M ales White M ales Black Females White Females \n8 11 9 13 \nDistant \n \n Overall, the five-year survival rate for the United States is 65% for both males and females at all stages. The five-year survival rate is highest in both males and females when detected at the localized stage \n The five-year survival rates for white males and white females for all stages are higher than those for black males and black females \n Five-year survival rates drop significantly for individuals when diagnosed at the distant stage \n \nPercent Percent \n \nColOrectal cancer in georgia, 2003-2007 \n \n15 \n \n Urban vs. Rural Georgia \nFigure 13. Metro, Metro Adjacent, and Rural Counties, Georgia 2003 \n \n*For a more specific description, please refer to the technical notes \n \nFigure 14. Age-Adjusted Colorectal Cancer Incidence and Mortality Rate by Geography and Sex, Georgia, 2003-2007 \n \nIncidence \n \nMales \n \nFemales \n \nMales \n \nFemales \n \n100 \n \n56 \n \n50 \n \n43 \n \n70 45 \n \n64 46 \n \n65 49 \n \n66 46 \n \n30 \n \n25 \n \n20 \n \n19 \n \n15 \n \n14 \n \n10 \n \nMortality Males Females \n \nMales \n \nFemales \n \n25 \n \n22 \n \n22 \n \n15 \n \n15 \n \n14 \n \n22 16 \n \nRate per 100,000 Rate per 100,000 \n \n5 \n \n0 Metro 1+ Metro 250K-1M Metro \u003c250K Metro Adjacent \n \nRural \n \n0 \n \nMetro 1+ \n \nMetro 250K-1M Metro \u003c250K Metro Adjacent \n \nRural \n \n Age-adjusted colorectal cancer incidence and mortality rates are consistently higher among males than among females regardless of geographical area \n Males living in metropolitan counties (250,000 to 1 million people) have the highest incidence and mortality rates. Males living in metropolitan counties (1 million or more) have the lowest incidence and mortality rates. \n Males living in metropolitan counties with a population of 1 million or more have significantly lower incidence rates than males living in all other counties \n Females living in metro adjacent and rural counties have significantly higher incidence rates than females living in metro counties with a population of 1 million or more \n Mortality rates for males living in metropolitan counties (250,000 to 1 million) are significantly higher than males living in metropolitan counties with a population of 1 million or more \n Mortality rates for females are similar among all geographical areas \n \nColOrectal cancer in georgia, 2003-2007 \n \n16 \n \n Associations between Poverty and Geography \nFigure 15. Counties by Poverty Level, Georgia, 2005 \n*For a more specific description, please refer to the technical notes \n \nColOrectal cancer in georgia, 2003-2007 \n \n17 \n \n Table 4. Age-Adjusted Incidence Rate, by Sex, Geography and Poverty, Georgia 2003-2007 \n \nLevel of Poverty \n \nMales \n \nFemales \n \nMetro Level \n \nLow \n \nMedium \n \nHigh \n \nLow \n \nMedium \n \nHigh \n \nMetro 1M+ \n \n55 \n \n57 \n \n79 \n \n42 \n \n43 \n \n39 \n \nMetro 250K-1M \n \n58 \n \n67* \n \n77* \n \n39 \n \n44 \n \n47 \n \nMetro \u003c250K \n \n60 \n \n63* \n \n66* \n \n41 \n \n46 \n \n47 \n \nMetro Adjacent \n \n- \n \n64 \n \n65* \n \n- \n \n51* \n \n47 \n \nRural \n \n- \n \n66* \n \n66* \n \n- \n \n48* \n \n45 \n \n Males have consistently higher incidence rates than females (Table 4) \n Males living in low poverty metro counties (1 million or more) have significantly higher incidence rates than females living in the same area \n Incidence rates are highest in males living in high poverty metropolitan counties (1 million or more) \n The lowest incidence rates occur in females living in high poverty metropolitan counties (1 million or more) and low poverty metropolitan counties (250,000 to 1 million) \n Among males, regardless of geographical region, incidence rates increase as poverty level increase \n In low poverty counties, incidence rates increase as metro level moves from large metropolitan counties to metro (less than 250,000) counties among males \n Incidence rates for females living in medium poverty counties increase as metro level moves from large metropolitan counties to metro adjacent counties \n Females living in medium poverty rural counties and medium poverty metro adjacent counties have significantly higher incidence rates than females living in low poverty metro counties (1 million or more) \n \n* Rate is statically significantly different ** Less than 20 cases - There were no counties classified as low poverty metro adjacent or low poverty rural \n \nColOrectal cancer in georgia, 2003-2007 \n \n18 \n \n Table 5. Age-Adjusted Incidence Rate, Males, by Race, Geography and Poverty, Georgia 2003-2007 \n \nLevel of Poverty \n \nBlack \n \nWhite \n \nMetro Level \n \nLow \n \nMedium \n \nHigh \n \nLow \n \nMedium \n \nHigh \n \nMetro 1M+ \n \n60 \n \n66 \n \n140* \n \n57 \n \n54 \n \n** \n \nMetro 250K-1M \n \n112 \n \n85* \n \n92* \n \n54 \n \n63 \n \n69* \n \nMetro \u003c250K \n \n** \n \n76* \n \n85* \n \n59 \n \n63* \n \n59 \n \nMetro Adjacent \n \n- \n \n61* \n \n80 \n \n- \n \n65 \n \n60 \n \nRural \n \n- \n \n78* \n \n73* \n \n- \n \n65* \n \n65* \n \n Black males have consistently higher incidence rates than white males, except black males living in medium poverty metro adjacent counties (Table 5) \n Incidence rates for black males and white males living in low poverty metro counties (1 million or more) are similar \n Incidence rates for black males living in high poverty counties decrease as metro level moves from large metropolitan counties to rural counties \n Incidence rates for white males living in medium poverty counties increase as metro level moves from large metropolitan to rural counties \n Incidence rates are significantly higher for black males in metro (1 million or more, 250,000 to 1 million, and less than 250,000) and rural counties living in high poverty, metro (250,000 to 1 million, less than 250,000, and adjacent) and rural counties living in medium poverty compared to black males living in low poverty metro counties (1 million or more) \n Incidence rates are significantly higher for white males in metro (250,000 to 1 million) and rural counties living in high poverty and metro (less than 250,000) and rural counties living in medium poverty compared to white males living in low poverty metro counties (1 million or more) \n \n* Rate is statically significantly different ** Less than 20 cases - There were no counties classified as low poverty metro adjacent or low poverty rural \n \nColOrectal cancer in georgia, 2003-2007 \n \n19 \n \n Table 6. Age-Adjusted Incidence Rate, Females, by Race, Geography and Poverty, Georgia 2003-2007 \n \nMetro Level \n \nLow \n \nMetro 1M+ \n \n49 \n \nMetro 250K-1M \n \n** \n \nMetro \u003c250K \n \n** \n \nMetro Adjacent \n \n- \n \nRural \n \n- \n \nBlack Medium \n54 62* 53 66* 63* \n \nLevel of Poverty \n \nHigh \n \nLow \n \n** \n \n41 \n \n57 \n \n35 \n \n57 \n \n38 \n \n60 \n \n- \n \n54 \n \n- \n \nWhite \n \nMedium \n \nHigh \n \n38 \n \n** \n \n39 \n \n41 \n \n45 \n \n40 \n \n46 \n \n44 \n \n47* \n \n41 \n \n Black females have consistently higher incidence rates than white females (Table 6) \n Black females living in low poverty metro counties (1 million or more) have significantly higher incidence rates than white females living in the same area \n The highest incidence rates occur in black females living in medium poverty metro adjacent counties \n Incidence rates for white females living in medium poverty levels increase as metro level move from large metropolitan to rural counties \n Incidence rates for both black and white females living in medium poverty rural counties are significantly higher than their counterparts living in low poverty metro counties (1 million or more) \n Additionally, black females living in medium poverty metro counties (250,000- 1 million and adjacent) have significantly higher incidence rates than black females living low poverty metro counties (1 million or more) \n \n* Rate is statically significantly different ** Less than 20 cases - There were no counties classified as low poverty metro adjacent or low poverty rural \n \nColOrectal cancer in georgia, 2003-2007 \n \n20 \n \n Table 7. Age-Adjusted Mortality Rate, by Sex, Geography and Poverty, Georgia 2003-2007 \n \nMetro Level Metro 1M+ \n \nLevel of Poverty \n \nMales \n \nFemales \n \nLow \n \nMedium \n \nHigh \n \nLow \n \nMedium \n \nHigh \n \n19 \n \n19 \n \n** \n \n14 \n \n15 \n \n** \n \nMetro 250K-1M \n \n23 \n \n25* \n \n26* \n \n9 \n \n15 \n \n16 \n \nMetro \u003c250K \n \n** \n \n22 \n \n23 \n \n** \n \n14 \n \n17 \n \nMetro Adjacent \n \n- \n \n23 \n \n20 \n \n- \n \n15 \n \n13 \n \nRural \n \n- \n \n19 \n \n25* \n \n- \n \n16 \n \n15 \n \n Males have consistently higher mortality rates than females (Table 7) \n Mortality rates for males living in low poverty metro counties (1 million or more) are significantly higher than females living in the same area \n Among males, the highest mortality rates occur in high poverty metropolitan counties (250,000 to 1 million). The lowest mortality rates occur in low and medium poverty metropolitan counties (1 million or more) and medium poverty rural counties \n Among females, the highest mortality rates occur in high poverty metropolitan counties (less than 250,000). The lowest mortality rates occur in low poverty metropolitan counties (250,000 to 1 million). \n Mortality rates for males living in medium and high poverty metropolitan counties (250,000 to 1 million) and high poverty rural counties are significantly higher than males living in large low poverty metro counties \n \nTable 8. Age-Adjusted Mortality Rate, Males, by Race, Geography and Poverty, Georgia 2003-2007 \n \nLevel of Poverty \n \nBlack \n \nWhite \n \nMetro Level \n \nLow \n \nMedium \n \nHigh \n \nLow \n \nMedium \n \nHigh \n \nMetro 1M+ \n \n26 \n \n27 \n \n** \n \n19 \n \n17 \n \n** \n \nMetro 250K-1M \n \n** \n \n29 \n \n35 \n \n23 \n \n24 \n \n22 \n \nMetro \u003c250K \n \n** \n \n29 \n \n33 \n \n** \n \n21 \n \n19 \n \nMetro Adjacent \n \n- \n \n35 \n \n23 \n \n- \n \n20 \n \n19 \n \nRural \n \n- \n \n23 \n \n32 \n \n- \n \n18 \n \n22 \n \n Black males have consistently higher mortality rates than white males (Table 8) \n The mortality rates for black males and white males living in low poverty metro counties (1 million or more) are similar \n Black males living in high poverty metropolitan counties (250,000 to 1 million) and medium poverty metro adjacent counties have the highest mortality rates \n White males living in medium poverty metro counties (1 million or more) have the lowest mortality rates \n Regardless of geographic location or poverty level, mortality rates for black males and white males are similar to their counterparts living in low poverty metro counties (1 million or more) \n \nColOrectal cancer in georgia, 2003-2007 \n \n21 \n \n Table 9. Age-Adjusted Mortality Rate, Females, by Race, Geography and Poverty, Georgia 2003-2007 \n \nLevel of Poverty \n \nBlack \n \nWhite \n \nMetro Level \n \nLow \n \nMedium \n \nHigh \n \nLow \n \nMedium \n \nHigh \n \nMetro 1M+ \n \n21 \n \n21 \n \n** \n \n13 \n \n12 \n \n** \n \nMetro 250K-1M \n \n** \n \n21 \n \n19 \n \n** \n \n13 \n \n13 \n \nMetro \u003c250 \n \n** \n \n23 \n \n22 \n \n** \n \n13 \n \n14 \n \nMetro Adjacent \n \n- \n \n23 \n \n18 \n \n- \n \n11 \n \n12 \n \nRural \n \n- \n \n21 \n \n20 \n \n- \n \n15 \n \n13 \n \n Black females have consistently higher mortality rates than white females (Table 9) \n Black females living in low poverty metro counties (1 million or more) have significantly higher mortality rates than white females living in the same area \n Black females living in medium poverty metro (less than 250,000) and metro adjacent counties have the highest mortality rates \n White females living in medium poverty metro adjacent counties have the lowest mortality rates \n Regardless of geographic location or poverty level, mortality rates for black females and white females are similar to their counterparts living in low poverty metro counties (1 million or more) \n \n* Rate is statically significantly different ** Less than 20 cases - There were no counties classified as low poverty metro adjacent or low poverty rural \n \nColOrectal cancer in georgia, 2003-2007 \n \n22 \n \n Incidence Trends \n \nFigure 16. Age-adjusted Colorectal Cancer Incidence Rates among Males by Race, Georgia (1998-2007) vs. United States (1999-2007) \n \nUS Black Males \n \nUS White Males \n \nGA Black Males \n \nGA White Males \n \nRate per 100,000 \n \n90 80 70 60 50 40 30 20 10 \n0 1997 \n \n1998 \n \n1999 \n \n2000 \n \n2001 \n \n2002 \n \n2003 \n \n2004 \n \n2005 \n \n2006 \n \n2007 \n \n2008 \n \n White males generally have lower incidence rates than black males, in both Georgia and the U.S.  Georgia incidence rates are slightly lower than the U.S. incidence rates for black and white males  Among U.S. black males, incidence rates declined by 1.2% per year during 1999 to 2007  Among black males in Georgia, incidence rates increased from 1998 to 2001. Since 2001, the rates have \nbeen declining slightly  Among U.S. white males, incidence rates declined by 2.4% per year during 1999 to 2007  Incidence rates for white males in Georgia increased from 1998-2002. From 2002 to 2007, incidence rates \nhave significantly declined at 3.7% per year \n \nFigure 17. Age-adjusted Colorectal Cancer Incidence Rates among Females by Race, Georgia (1998-2007) vs. United States (1999-2007) \n \nUS Black Females \n \nUS White Females \n \nGA Black Females \n \nGA White Females \n \nRate per 100,000 \n \n60 50 40 30 20 10 \n0 1997 \n \n1998 \n \n1999 \n \n2000 \n \n2001 \n \n2002 \n \n2003 \n \n2004 \n \n2005 \n \n2006 \n \n2007 \n \n2008 \n \n White females have consistently lower incidence rates than black females, in both Georgia and the U.S.  Georgia incidence rates are consistently lower than the U.S. incidence rates for black and white females  Incidence rates for black females in the U.S. declined by 1.5% from 1999-2007  Among Georgia black females, incidence rates have been stable since 1998  Incidence rates for white females in the U.S. declined by 2% from 1999-2007  Among Georgia white females, incidence rates significantly declined at 1.5% during 1998-2007 \n \nColOrectal cancer in georgia, 2003-2007 \n \n23 \n \n Figure 18. Age-adjusted Colorectal Cancer Mortality Rates among Males by Race, Georgia (1980-2007) vs. United States (1980-2006) \n \nUS Black M ales \n \nUS White M ales \n \nGA Black M ales \n \nGA White M ales \n \n50 \n \n40 \n \n30 \n \n20 \n \n10 \n \n0 \n \nRate per 100,000 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 \n \n Mortality rates are generally lower among white females than black females, in both Georgia and the U.S. \n Georgia mortality rates are consistently lower than the U.S. incidence rates for black and white females \n Since 2001, mortality rates for U.S. black females have significantly declined by 3.5% per year \n Among black females in Georgia, mortality rates were stable from 1980 to 2007 \n Among U.S. white females, mortality rates declined significantly from 1980 to 2001 and 2001 to 2006 (1.8% and 3.4% per year respectively) \n Since 1980, mortality rates have declined significantly by 1.6% per year among white females in Georgia \n \nColOrectal cancer in georgia, 2003-2007 \n \n24 \n \n Figure 19. Age-adjusted Colorectal Cancer Mortality Rates among Females by Race, Georgia (1980-2007) vs. United States (1980-2006) \n \nUS Black Females \n \nUS White Females \n \nGA Black Females \n \nGA White Females \n \n50 \n \n40 \n \n30 \n \n20 \n \n10 \n \n0 \n \nRate per 100,000 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 \n \n Mortality rates are generally lower among white females than black females, in both Georgia and the U.S. \n Georgia mortality rates are consistently lower than the U.S. incidence rates for black and white females \n Since 2001, mortality rates for U.S. black females have significantly declined by 3.5% per year \n Among black females in Georgia, mortality rates were stable from 1980 to 2007 \n Among U.S. white females, mortality rates declined significantly from 1980 to 2001 and 2001 to 2006 (1.8% and 3.4% per year respectively) \n Since 1980, mortality rates have declined significantly by 1.6% per year among white females in Georgia \n \nColOrectal cancer in georgia, 2003-2007 \n \n25 \n \n Mortality Trends \nColorectal Cancer Resources: \nYou can learn more about colorectal cancer from the following organizations: \nAmerican Cancer Society Telephone: 1-800-ACS-2345 (1-800-227-2345) Website: www.cancer.org \nCenters for Disease Control and Prevention Telephone: 1-800-CDC-INFO Website: www.cdc.gov \nNational Cancer Institute, Cancer Information Service Telephone: 1-800-4-CANCER (1-800-422-6237) Website: www.cancer.gov \nNational Colorectal Cancer Research Alliance Telephone: 1-213-481-3101 Website: www.eifoundation.org/programs/eifs-national-colorectal-cancer-research-alliance \nCancer Research and Prevention Foundation Telephone: 1-800-227-2732 Website: www.preventcancer.org \nCancer Control Planet Website: http://cancercontrolplanet.cancer.gov/ \nColon Cancer Alliance Telephone: 1-877-422-2030 Website: www.ccalliance.org \nGeorgia Comprehensive Cancer Registry Telephone: 404-657-6611 Website: http://health.state.ga.us/programs/gccr/index.asp \n \nColOrectal cancer in georgia, 2003-2007 \n \n26 \n \n Technical Notes \nDefinitions: \nAge-Adjusted Rate is calculated in a manner that minimizes the effects of differences in age composition when comparing rates derived from populations with different age structures. It is expressed per 100,000 population. \nCancer Incidence Rate is a measure of the development of new cancer cases in a population within a specified period of time. It is expressed as a rate per 100,000 population. \nCancer Mortality Rate is defined as the number of deaths, due to cancer, occurring in a specified population during a specified period of time. It is also expressed as a rate per 100,000 population. \nAverage Risk Population includes most people who develop colorectal cancer and have no identifiable risk factors. People at increased risk of colorectal cancer consist of those with personal or family history of colorectal cancer, those with colorectal cancer symptoms or those who already have inflammatory bowel disease or certain genetic conditions. \nObesity is defined as a body mass index (BMI) between 30.0 and 99.8. \nSmoking is defined as an adult smoking at least 100 cigarettes in their lifetime and is currently smoking. \nPhysical Inactivity is defined as not participating in any physical activities within last 30 days. \n2003 Rural-Urban Continuum Codes: Rural-Urban Continuum Codes form a classification scheme that distinguishes metropolitan (metro) counties by the population size of their metro area, and nonmetropolitan (nonmetro) counties by degree of urbanization and adjacency to a metro area or areas: \n1 = Counties in metro areas of 1 million population or more 2 = Counties in metro areas of 250,000 to 1 million population 3 = Counties in metro areas of fewer than 250,000 population 4 = Urban population of 20,000 or more, adjacent to a metro area 5 = Urban population of 20,000 or more, not adjacent to a metro area 6 = Urban population of 2,500 to 19,999, adjacent to a metro area 7 = Urban population of 2,500 to 19,999, not adjacent to a metro area 8 = Completely rural or less than 2,500 urban population, adjacent to a metro area 9 = Completely rural or less than 2,500 urban population, not adjacent to a metro area \nThe above codes were regrouped into the following categories: 1 = Metro \u003e1M 2 = Metro 250K-1M 3 = Metro \u003c250K 4 = Metro-Adjacent 5 = there are no counties in Georgia that fit category number 5 6, 7, 8 and 9 = Rural \nPoverty Codes: The Georgia Comprehensive Cancer Registry categorizes the poverty percent into three groups: Low poverty areas = less than 10% of county's population is below United States poverty level Medium poverty areas = 10%-19% of county's population is below United States poverty level High poverty areas = 20% or more of county's population is below United States poverty level \n \nColOrectal cancer in georgia, 2003-2007 \n \n27 \n \n Data Sources: \nThe number of new cases and incidence rates for the state of Georgia were obtained from the Georgia Department of Public Health, Georgia Comprehensive Cancer Registry. \nIncidence rates for the United States were obtained from the North American Association of Central Cancer Registries (NAACCR). \nThe number of deaths and mortality rates for the State of Georgia were obtained from the Georgia Department of Public Health, Vital Records Program. \nMortality rates for the United States were obtained from the North American Association of Central Cancer Registries (NAACCR) and from the Surveillance, Epidemiology, and End Results (SEER) program, National Cancer Institute. The mortality rates for the United States trend analysis were obtained from the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC). \nCancer stage and survival data for the United States were obtained from the Surveillance, Epidemiology, and End Results (SEER) program, National Cancer Institute. \nPrevalence of risk factors, such as obesity, smoking, physical inactivity, and diabetes (for the year 2009) and screening for colorectal cancer (average of years 2004, 2005, 2006, 2008) in Georgia were analyzed from the Behavioral Risk Factor Surveillance System (BRFSS), Epidemiology Program, Georgia Department of Public Health. National data for the prevalence of similar risk factors was retrieved from Centers for Disease Control and Prevention at www.cdc.gov/brfss/ \nClinical information on colorectal cancer was retrieved from the Mayo Clinic at www.mayoclinic.com , Colorectal Cancer Medline Plus at www.nlm.nih.gov/medlineplus, National Cancer Institute at www.cancer.gov , and the American Cancer Society at www.cancer.org. \n \nColOrectal cancer in georgia, 2003-2007 \n \n28 \n \n Methods: \nIncidence rates were calculated per 100,000 population and age-adjusted by the direct method to the 2000 US standard population. Except where calculated to show trends, the incidence rates are five-year average annual rates for the period 2003 through 2007. Incidence rates are calculated for the non-Hispanic black and non-Hispanic white populations for Georgia. Incidence data were coded using ICD-O-3 codes. The ICD-O-3 codes used for colorectal cancer are C180:C209, C260. \nMortality rates were calculated per 100,000 population and age-adjusted by the direct method to the 2000 US standard population. Except where calculated to show trends, the mortality rates are five-year average annual rates for the period 2003 through 2007. Mortality data were coded using ICD-9 codes (1980-1998) and ICD-10 codes (1999-2007). The ICD-9 codes for colorectal cancer are 153.0154.1, 159.0, while the ICD-10 codes for colorectal cancer are C180:C209, C260. \nThe estimated number of cases for 2009 was calculated by multiplying age-specific incidence rates for 2003-2007 by age-specific population projections for 2009. The estimated number of deaths for 2009 was calculated by multiplying age-specific mortality rates for 2003-2007 by age-specific population projections for 2009. Population projections were retrieved from the U.S. Census Bureau. \nTrend analysis was performed using the Joinpoint Regression Program Software developed and maintained by the National Cancer Institute. Incidence and mortality rates for the United States used in the trend analysis were obtained from the CDC Wonder Database. \nThe Rural-Urban classification of Georgia counties was based on the 2003 Rural-Urban Continuum Codes from the United States Department of Agriculture, Economic Research Service. Information about the Rural-Urban Continuum Codes can be retrieved from \nhttp://www.ers.usda.gov/Data/RuralUrbanContinuumCodes/. \nPoverty data for Georgia was retrieved from the U.S Census Bureau's Small Area Income and Poverty Estimates (SAIPE) Program at http://www.census.gov/did/www/saipe/. \n \nColOrectal cancer in georgia, 2003-2007 \n \n29 \n \n "},{"id":"dlg_ggpd_y-ga-bc900-pp8-bs1-bc6-b2002-h2006-belec-p-btext","title":"Colorectal cancer in Georgia: 2002-2006  [Sept. 2009]","collection_id":"dlg_ggpd","collection_title":"Georgia Government Publications","dcterms_contributor":["Georgia. Dept. of Community Health. Division of Public Health. Chronic Disease, Healthy Behaviors and Injury Epidemiology"],"dcterms_spatial":["United States, Georgia, 32.75042, -83.50018"],"dcterms_creator":["Georgia. Dept. of Community Health. Division of Public Health. Chronic Disease, Healthy Behaviors and Injury Epidemiology"],"dc_date":["2009-09"],"dcterms_description":["1999/2000-","Title from cover.","2007/2011 (online surrogate) ; (Georgia Government Publications database, viewed Aug. 22, 2017)."],"dc_format":["application/pdf"],"dcterms_identifier":null,"dcterms_language":["eng"],"dcterms_publisher":["Atlanta, Ga. : Georgia. Dept. of Community Health. Division of Public Health. Chronic Disease, Healthy Behaviors and Injury Epidemiology"],"dc_relation":null,"dc_right":["http://rightsstatements.org/vocab/InC/1.0/"],"dcterms_is_part_of":null,"dcterms_subject":["Georgia"],"dcterms_title":["Colorectal cancer in Georgia: 2002-2006  [Sept. 2009]"],"dcterms_type":["Text"],"dcterms_provenance":["University of Georgia. Map and Government Information Library"],"edm_is_shown_by":["https://dlg.galileo.usg.edu/do:dlg_ggpd_y-ga-bc900-pp8-bs1-bc6-b2002-h2006-belec-p-btext"],"edm_is_shown_at":["https://dlg.galileo.usg.edu/id:dlg_ggpd_y-ga-bc900-pp8-bs1-bc6-b2002-h2006-belec-p-btext"],"dcterms_temporal":null,"dcterms_rights_holder":null,"dcterms_bibliographic_citation":null,"dlg_local_right":null,"dcterms_medium":["publications (documents)"],"dcterms_extent":null,"dlg_subject_personal":null,"iiif_manifest_url_ss":null,"dcterms_subject_fast":null,"fulltext":"Colorectal \nin Georgia, 2002 - 2006 \n1 \n \n Acknowledgments \nGeorgia Department of Community Health Rhonda M. Medows, M.D., Commissioner and State Health Officer Division of Public Health Rhonda M. Medows, M.D., Acting Director Epidemiology Branch Susan Lance, D.V.M., Ph.D., Director Chronic Disease, Healthy Behaviors, and Injury Epidemiology Section A. Rana Bayakly, M.P.H., Acting Director Georgia Comprehensive Cancer Registry A. Rana Bayakly, M.P.H., Director Deepali Rane, M.B.B.S., M.P.H., Epidemiologist Health Promotion \u0026 Disease Prevention Branch Kimberly Redding, M.D, M.P.H., Director Georgia Comprehensive Cancer Control Program Tamira Moon, M.P.H, C.H.E.S., Manager Graphic Design Jimmy Clanton, Jr. \nWe would like to thank all the hospitals in Georgia who contributed data to the Georgia Comprehensive Cancer Registry. Without their hard work, this report would not have been possible. \nSuggested Citation: Rane D., Bayakly AR., Moon, T., Colorectal Cancer in Georgia, 2002-2006. Georgia Department of Community Health, Division of Public Health, Chronic Disease, Healthy Behaviors, and Injury Epidemiology, September, 2009. \n2 \n \n Figure 1. Anatomy of the Digestive System \nFigure 2. Colon Polyp \n \nIntroduction \nColorectal cancer is a collective term for cancers of the colon and rectum. Since cancers of the colon and rectum share many common features, they are often referred as colorectal cancer. The colon and rectum are parts of the digestive system. Together, they form a long, muscular tube called the large intestine. The colon is the first four to five feet of the large intestine and the last four to five inches is the rectum (Figure 1). \nOnce food is chewed and swallowed, it travels through the esophagus to the stomach. In the stomach, it is partially digested and transferred to the small intestine. The small intestine continues digesting the food and absorbs most of the nutrients. The small intestine is connected to the large intestine. In the large intestine, the colon absorbs water and electrolytes from the food and serves as a storage place for waste products. The waste then moves from the colon into the rectum and passes out of the body through an opening called the anus during a bowel movement. \nColorectal cancers develop slowly over a period of several years. Most of them begin as a polyp, a growth of tissue protruding into the center of the colon or rectum (Figure 2). Polyps are also known as adenomas. Removing the polyp early may prevent it from becoming cancerous. Over 95 percent of colorectal cancers are adenocarcinomas, which arise from cells that line the inside of the colon and the rectum. \nColorectal cancer affects both men and women and most often occurs in people over 50 years of age. It is the third most commonly diagnosed cancer and cause of cancer death among Georgia men and women, respectively. The Georgia Comprehensive Cancer Registry estimates that, over 3,700 new cases of colorectal cancer will be diagnosed statewide in 2009 and about 1,300 Georgians will die from this disease. \nScreening \u0026 Detection \nTreatment is more likely to be successful if colorectal cancers are detected early. Several screening tests are available to detect the disease. The American Cancer Society recommends that people at average risk for colorectal cancer should begin screening at age 50. \nScreening options include: Tests that find polyps and cancer \n Flexible Sigmoidoscopy every 5 years  Double contrast barium enema every 5 years  CT colonography (virtual colonoscopy) every 5 years  Colonoscopy every 10 years Tests that mainly find cancer  Fecal occult blood test every year (FOBT)*  Fecal immunochemical test every year (FIT)*  Stool DNA test (sDNA), interval uncertain \n*For FOBT or FIT used as a screening test, the take-home multiple sample method should be used. \n3 \n \n Incidence and Mortality \n The overall age-adjusted colorectal cancer incidence rate in Georgia is 49 per 100,000 in males and females combined. Males are 40% more likely to be diagnosed with colorectal cancer than females (age-adjusted rate 59/100,000 vs. 42/100,000) \n The overall age-adjusted colorectal cancer mortality rate in Georgia is 18 per 100,000 in males and females combined. Males are 47% more likely to die of colorectal cancer than females (age-adjusted rate 22/100,000 vs.15/100,000) \n In Georgia and the United States, black males are more likely than white males to be diagnosed with colorectal cancer. Similarly, black females are more likely than white females to be diagnosed with this disease (Figure 3) \n Black males are more likely than white males to die from colorectal cancer in Georgia and the United States. Similarly, black females are more likely than white females to die from this disease (Figure 4) \nFigure 3. Age-adjusted Incidence Rate by Race and Sex, 2002-2006 \n \n100 \n \nGeorgia 2002-2006 United States 2002-2006 \n \n69 70 \n50 \n \n57 59 \n \n53 52 \n \n39 43 \n \nRate per 100,000 \n \n0 Black Males \n \nWhite Males Black Females White Females \n \nFigure 4. Age-adjusted Mortality Rate by Race and Sex, 2002-2006 \n \n100 \n \nGeorgia 2002-2006 United States 2002-2006 \n \nRate per 100,000 \n \n50 \n30 31 \n \n20 21 \n \n21 22 \n \n13 15 \n \n0 \nBlack Males \n \nWhite Males Black Females White Females \n \n4 \n \n Causes and Risk Factors \nEveryone is at risk for colorectal cancer, some more than others. Different cancers have different risk factors. A risk factor is anything that increases a person's chance of getting a disease such as cancer. Some get colorectal cancer in the absence of any apparent risk factors. Although, it is hard to measure the contribution of a risk factor or know the exact cause for the development of precancerous polyps or cancer, researchers have found factors that can increase the risk of colorectal cancer. \nRisk Factors You Can Change \n Diet: People who eat a diet similar to that of Western countries, such as United States and Europe, have a higher risk of developing colon cancer then do people who eat diets typically seen in developing countries. The higher risk may be associated with a diet high in animal fat and processed meat, which is low in fiber. Diets high in vegetables and fruits have been linked with a decreased risk of colorectal cancer. The American Cancer Society recommends choosing most of your food from plant sources and limiting the amount of high-fat foods \n Physical inactivity: If you are not active, there is a greater chance of developing colorectal cancer. Getting regular physical activity may reduce your risk. To gain substantial health benefits, the U.S. Department of Health and Human Services recommends 60 minutes, five times a week of moderate-intensity aerobic physical activity for adults \n Obesity: People who are obese have an increased risk of developing colon cancer and an increased risk of dying of colon cancer when compared with people who are considered to be at normal weight \n Smoking: Long term smokers are more likely than nonsmokers to develop and die from colorectal cancer \n Alcohol Consumption: Heavy use of alcohol may increase the odds of getting colorectal cancer. The American Cancer Society recommends that alcohol use should be limited to no more than two drinks per day for men and one drink per day for women \n5 \n \n Risk Factors You Cannot Change \n \n Age: The risk of developing colorectal polyps and cancer Figure 5. Familial Adenomatous Polyposis \n \nincreases with age. More than 90% of people diagnosed with colorectal cancer are older \n \nFamilial \n \nthan 50 \n \nadenomatous \n \n Family History: Parents, siblings, and children of a person who have \n \npolyposis \n \ncolorectal adenomas or cancer \n \nare at least two to three \n \ntimes more likely to develop \n \ncolorectal cancer themselves. \n \nThe risk increases even further \n \nif any first-degree relative \n \nis affected before the age \n \nof 60, or if two or more \n \nfirst-degree relatives are \n \naffected. Cancers within \n \nthe same family may result \n \nfrom inherited genes, shared \n \nexposure to an environmental \n \ncarcinogen, diet, or lifestyle \n \nfactors. Also, certain genetic syndromes \n \npassed \n \nthrough generations of a person's family can increase one's \n \nrisk of developing colorectal cancer. These syndromes cause \n \n5% of all colon cancers. The two most common syndromes \n \nare Familial Adenomatous Polyposis (FAP) and Hereditary \n \nNon-Polyposis Colorectal Cancer (HNPCC). People with FAP \n \n(Figure 5) develop hundreds or thousands of polyps in their \n \ncolon and rectum in their teens or early adulthood. Cancer \n \nmay develop in these polyps as early as age 20. Similar to FAP, \n \nHNPCC develops when people are relatively young. However, \n \nindividuals with HNPCC have fewer polyps and develop \n \ncolorectal cancers at an average age of 44. These genetic \n \nsyndromes can be detected through genetic testing. For \n \nthose who have changes in their genes or have family history \n \nof colorectal cancer, health care providers suggest reducing \n \nthe risk of colorectal cancer by implementing strategies \n \nsuch as receiving regular screenings, eating a healthy diet, \n \nexercising, and other preventive measures at an early age \n \n Racial and Ethnic Background: African Americans have the \n \nhighest colorectal cancer incidence and mortality rates of all \n \nracial groups in the United States. The reason for this is not \n \nyet understood \n \n Personal history of Colorectal Cancer or Polyps: Once \n \na person suffers from colorectal cancer, it is likely to recur. \n \nAlso, some types of polyps, such as adenomatous polyps and \n \nhyperplastic polyps increase the risk of colorectal cancer \n \n Personal history of bowel disease: Inflammatory Bowel \n \nDisease (IBD), which includes Ulcerative Colitis or Crohn's \n \ndisease, is a condition in which the colon is inflamed over a \n \nlong period of time. People with IBD have an increased risk of \n \ndeveloping colorectal cancer and they should be screened for \n \ncolorectal cancer on a more frequent basis \n \n Diabetes: People with Type 2 diabetes have an increased \n \nrisk of developing colorectal cancer. The disease may also \n \ndevelop more aggressively in these patients \n \n6 \n \n Prevalence of Behavioral Risk Factors \n \nTable 1: Prevalence(%), Behavioral Risk Factor Surveillance System (BRFSS), 2008 \n \nGeorgia \n \nUnited States \n \nRisk Factors \n \nAll \n \nMales Females All Males Females \n \nObesity \n \n28 \n \n28 \n \n28 \n \n27 \n \n27 \n \n26 \n \nSmoking \n \n20 \n \n22 \n \n17 \n \n18 \n \n20 \n \n17 \n \nPhysical Inactivity \n \n23 \n \n20 \n \n26 \n \n25 \n \n23 \n \n27 \n \nAccording to the Georgia 2008 Behavioral Risk Factor Surveillance System (Table1): \n The prevalence of obesity in males and females is similar  Males (22%) are more likely to be current smokers than \nfemales (17%), however this difference is not significant  Females (26%) are significantly more likely to be physically \ninactive than males (20%) \n \nSymptoms \nIn the early stages of colorectal cancer, individuals with the disease may not have any symptoms. When symptoms appear, they vary depending on the location and size of the cancer in the large intestine. Signs and symptoms of colorectal cancer include: \n A change in bowel habits such as diarrhea, constipation, or change in the consistency of the stool that lasts for more than a couple of weeks \n A feeling that the bowel does not empty completely  Rectal bleeding or blood in the stool  Persistent cramping abdominal pain  Abdominal pain during a bowel movement  Weakness and fatigue  Unexplained weight loss Other conditions such as hemorrhoids and inflammatory bowel disease may also have symptoms that mimic colorectal cancer. If you have any of the above symptoms, it is very important to talk to your doctor because it could be a sign of a serious medical condition such as colorectal cancer. \n \nColorectal cancer is the third most commonly diagnosed cancer and cause of cancer death among males and females in Georgia. \n \nLeading Causes of Cancer Incidence and \n \nMortality \n \nTable 2: Leading Causes of Cancer Incidence and Mortality, Georgia 2002-2006 \n \nTop 5 Causes of Cancer Incidence \n \nTop 5 Causes of Cancer Mortality \n \nMales \n \nFemales \n \nMales \n \nFemales \n \nProstate \n \nBreast \n \nLung \u0026 bronchus Lung \u0026 Bronchus \n \nLung \u0026 Bronchus Lung \u0026 Bronchus Prostate \n \nBreast \n \nColorectal \n \nColorectal \n \nColorectal \n \nColorectal \n \nBladder \n \nUterus \n \nPancreas \n \nPancreas \n \nMelanoma \n \nMelanoma \n \nLeukemia \n \nOvary \n \n7 \n \n Age at Diagnosis \nFigure 6. Age-specific Colorectal Cancer Incidence and Mortality Rates by Sex, Georgia 2002-2006 \nMales \n \nRrate per 100,000 \n \n500 \n400 \n300 \n200 \n100 21 \n0 0-39 \n \nIncidence Mortality \n \n26 7 40-49 \n \n86 23 \n \n185 58 \n \n50-59 \n \n60-69 \n \nAge Group \n \n373 297 \n217 \n107 \n \n70-79 \n \n80+ \n \nFemales \n \nRate per 100,000 \n \n500 \n400 \n300 \n200 \n100 21 \n0 0-39 \n \nIncidence Mortality \n \n23 6 40-49 \n \n64 16 \n \n121 34 \n \n50-59 \n \n60-69 \n \nAge Group \n \n212 79 \n70-79 \n \n267 147 \n80+ \n \n The incidence and mortality rates of colorectal cancer increases with age for both males and females (Figure 6) \n The risk of being diagnosed with colorectal cancer increases sharply between ages 50-59 years for both males and females \n Similarly, the risk of dying from colorectal cancer increases sharply between ages 50-59 years for both males and females \n Fewer than 70 cases and 35 deaths due to colorectal cancer occur each year in individuals less than 40 \nyears of age in both males and females \n \n8 \n \n Screening \nAccording to the Georgia Behavioral Risk Factor Surveillance System (BRFSS): \n The percent of screening by sigmoidoscopy /colonoscopy is similar among both men and women 50 years of age and older (Figure 7) \n Adult males, 50 years of age and older have a significantly higher prevalence of receiving the fecal occult blood test in the past 12 months when compared to adult females 50 years of age and older (Figure 8) \n \nFigure 7. Percent of Adults age 50+, who ever had a Sigmoidoscopy/Colonoscopy by Sex, Georgia 2002-2008 \n100 \n \n51 \n \n50 \n \n42 \n \nPercent \n \n0 Males \n \nFemales \n \nFigure 8. Percent of Adults age 50+, who had a Fecal Occult Blood Test (FOBT) in the past 12 months, by Sex, Georgia 20022008 \n100 \n \n56 \n \n57 \n \n50 \n \nPercent \n \n0 Males \n \nFemales \n \n9 \n \n Treatment \nDifferent types of treatment are available for patients with colon cancer. The choice of treatment depends on a variety of factors such as age, overall health, and type and stage of colorectal cancer. Staging is a standardized way to summarize information about how far a cancer has spread from its point of origin. The three standard types of treatment used in colorectal cancer are surgery, radiation therapy, and chemotherapy. Depending on the stage of cancer, multiple treatment modalities may be used at the same time or one after another. \n Surgery: This is the main treatment for early stage colorectal cancer. If the cancer is at an early stage the doctor removes it without cutting through the abdominal wall, with a colonoscope (a tube that is inserted through the rectum into the colon, to cut the cancer out). This is called a local excision. If the cancer is found in a polyp, the operation is called a polypectomy. If the cancer is larger, the doctor removes a length of the large intestine on either side of the cancer including some lymph nodes and sews the healthy parts of the intestine together. This is termed as a colectomy. If the doctor is not able to sew the ends of the colon back together, an opening is made outside of the body for the waste to pass through. This procedure is called as a colostomy. A bag is placed around the stoma to collect the waste \n Radiation Therapy: This treatment uses high energy x-rays or other type of radiation to kill cancer cells. There are two types of radiation therapies: external radiation and internal radiation. External radiation comes from a machine and is directed at the cancer. For internal radiation therapy, radioactive material/implants are put directly into or near the cancer. This therapy is used when the cancer is attached to an internal organ or lining of the abdomen. In such instances the cancer may not be completely removed by surgery. Radiation therapy then helps to kill any cancer cells remaining after surgery \n Chemotherapy: This treatment uses drugs to stop the growth of cancer cells. Systemic chemotherapy uses drugs that are injected into a vein, muscle or taken by mouth. These drugs enter the blood stream and reach cancer cells throughout the body. In regional chemotherapy, drugs are placed directly into an artery leading to a part of the body containing the tumor. Chemotherapy is used in a variety of situations to treat colorectal cancers \n Adjuvant and Neoadjuvant Therapy: Chemotherapy may be used after surgery even when there is no evidence of cancer remaining, to kill cancer cells that may have escaped from the primary tumor and settled in other parts of the body. This is called as adjuvant chemotherapy. Neoadjuvant chemotherapy is used for some rectal cancers before surgery (along with radiation), to shrink the tumor size. Chemotherapy in advanced cancers helps to shrink tumors and relieve symptoms from the tumor. Although it is unlikely this procedure will completely remove the cancer, it helps to increase the survival time \n10 \n \n Survival \n Early detection saves lives. Individuals diagnosed at an early stage (localized) have a better chance of surviving five years after diagnosis than those diagnosed at a later stage (Figure 9) \n \nFigure 9. Colorectal Cancer Five-Year Survival Rates by Sex, Race and Stage, United States, 1999-2005 \n \n100 \n \n92859187 \n \nWhite Males \n \nBlack Males \n \n66 66 56 57 \n \n70 70 \n \nWhite Females \n \n63 63 Black Females \n \n50 \n \nPercent \n \n0 All Stages Localized \n \nRegional \n \n11 7 13 9 Distant \n \nPercent \n \n100 \n \n91 91 \n \n65 65 \n \n70 69 \n \n50 \n \nMales Females \n \n11 12 \n0 \nAll Stages Localized Regional Distant \n Overall, five-year survival rate is 65% for both males and females at all stages of the disease. However, when detected at a localized stage the five-year survival rate increases to 91% \n Overall, the five year survival rates for white males and females (66% each) for all stages are higher than those for blacks (56% for males, 57% for females) \n Black males (85%) and black females (87%) diagnosed at a localized stage have a lower five-year survival rate than white males (92%) and white females (91%) \n Five-year survival rates drop significantly for all individuals when diagnosed at a distant stage \n \n11 \n \n Colorectal Cancer by Stage of Disease \n \nTable 3: Percent of Colorectal Cancer found by Stage of Disease, Sex and Race, Georgia (2002-2006) and United States (1999-2005) \n \nUS Males \n \nLocalized Regional (%) Distant (%) Unstaged/ \n \n(%) \n \nUnknown (%) \n \n39 \n \n37 \n \n19 \n \n4 \n \nGA Males \n \n39 \n \n37 \n \n19 \n \n5 \n \nUS Females \n \n38 \n \n38 \n \n19 \n \n5 \n \nGA Females \n \n40 \n \n37 \n \n18 \n \n6 \n \nUS Black Males \n \n34 \n \n36 \n \n25 \n \n5 \n \nGA Black Males \n \n37 \n \n34 \n \n24 \n \n5 \n \nUS White Males \n \n40 \n \n37 \n \n19 \n \n4 \n \nGA White Males \n \n40 \n \n38 \n \n18 \n \n4 \n \nUS Black Females \n \n34 \n \n35 \n \n24 \n \n6 \n \nGA Black Females \n \n39 \n \n34 \n \n21 \n \n6 \n \nUS White Females \n \n38 \n \n38 \n \n19 \n \n5 \n \nGA White Females \n \n40 \n \n38 \n \n17 \n \n6 \n \nThe distribution of stage at diagnosis for colorectal cancer patients in Georgia is similar to the colorectal cancer patients in the U.S. \n \n12 \n \n Urban vs. Rural Georgia \n \nFigure 10-1. Urban -Rural Counties, Georgia, 2003 \n \nFigure 10-2. Counties by Poverty Level, Georgia, 2005 \n \nRate per 100,000 Rate per 100,000 \n \nBased on the U.S Department of Agriculture, Georgia has 89 rural counties and 70 urban counties. \n \nGeorgia has 79 counties at high poverty level, 69 counties at medium poverty level and 11 counties at low poverty level. \n \nFigure 11. Age-adjusted Colorectal Cancer Incidence and Mortality Rate by Geography, Race and Sex, Georgia, 2002-2006 \n \n100 \n69 52 \n50 \n \nIncidence \n \nMales Females \n \n56 39 \n \n69 55 \n \n63 42 \n \n0 Urban Black \n \nUrban White \n \nRural Black \n \nRural White \n \nMortality \n \n100 \n \nMales Females \n \n50 30 21 \n0 Urban Black \n \n20 13 \nUrban White \n \n30 20 \nRural Black \n \n22 14 \nRural White \n \n The age-adjusted colorectal cancer incidence and mortality rates are consistently higher among blacks than among whites living in urban and/or rural areas (Figure 11) \n Colorectal cancer incidence and mortality rates are significantly higher among urban black males and females than among urban white males and females \n Incidence rates are not significantly different between rural black males and rural white males  Mortality rates are significantly different between rural black males and rural white males  Colorectal cancer incidence and mortality rates are significantly higher among rural black \nfemales than among rural white females \n \n13 \n \n Associations between Poverty and Geography \n \nTable 4. Age-adjusted Colorectal Cancer Incidence Rates by Sex, Urban-Rural and Poverty, Georgia 2002-2006 \n \nMales \n \nFemales \n \nLevel of Poverty Low Medium High \n \nUrban 52 57* 68* \n \nRural *** 63* 63* \n \nUrban 41 42 45 \n \nRural *** 47* 44 \n \n Urban and rural males living in medium and high poverty level areas have significantly higher incidence rates when compared to urban males living in low poverty areas (Table 4) \n Rural females living in medium poverty areas have a significantly higher incidence rate when compared to urban females living in low poverty areas \n \nTable 5. Age-adjusted Colorectal Cancer Incidence Rates by Sex, Race, Urban-Rural and Poverty, Georgia 2002-2006 \n \nMales \n \nFemales \n \nLevel of Poverty \nLow Medium High \n \nUrban White \n53 \n56 \n62* \n \nRural White \n*** \n63* \n62* \n \nUrban Black \n62 \n66* \n83* \n \nRural Black \n*** \n68* \n69* \n \nUrban White \n40 \n38* \n39* \n \nRural White \n*** \n44* \n40* \n \nUrban Black \n47 \n53 \n53 \n \nRural Black \n*** \n65* \n52 \n \n Urban white males living in high poverty areas as well as rural white males living in medium and high poverty areas have significantly higher incidence rates when compared to the urban white males living in low poverty areas (Table 5) \n Urban and rural black males living in medium and high poverty areas have a significantly higher incidence rate than urban white males living in low poverty areas \n Urban black males living in high poverty areas have a significantly higher incidence rate than urban black males living in low poverty areas \n Urban and rural white females living in medium and high poverty areas have significantly higher incidence rates when compared to urban white females living in low poverty areas \n Rural black females living in medium poverty areas have significantly higher incidence rate when compared to urban black females living in low poverty areas \n \n14 \n \n Table 6. Age-adjusted Colorectal Cancer Mortality Rates by Sex, Urban-Rural and Poverty, Georgia 2002-2006 \n \nMales \n \nFemales \n \nLevel of Poverty Low Medium High \n \nUrban 21 22 23 \n \nRural *** 22 26* \n \nUrban 14 15 17* \n \nRural *** 16 15 \n \n Rural males living in high poverty areas have significantly higher mortality rates when compared to urban males living in low poverty areas (Table 6) \n Urban females living in high poverty areas have significantly higher mortality rates when compared to urban females living in low poverty areas \n \nTable 7. Age-adjusted Colorectal Cancer Mortality Rates by Sex, Race, Urban-Rural and Poverty, Georgia 2002-2006 \n \nMales \n \nFemales \n \nLevel of Poverty \nLow Medium High \n \nUrban White \n21 20 20 \n \nRural Urban White Black \n \n*** \n \n27 \n \n21 \n \n29* \n \n24 \n \n32* \n \nRural \nBlack *** 29 31 * \n \nUrban White \n13 13 15 \n \nRural White \n*** 15 14 \n \nUrban Rural Black Black \n \n20* \n \n*** \n \n22* \n \n25* \n \n19* \n \n19* \n \n Urban black males living in medium and high poverty areas as well as rural black males living in high poverty areas have significantly higher mortality rates when compared to urban white males living in low poverty areas (Table 7) \n Urban black females living in low, medium and high poverty areas as well as rural black females living in medium and high poverty areas have significantly higher mortality rates when compared to urban white females living in low poverty areas \n***There are no rural counties in Georgia with low poverty levels. \n \n15 \n \n Rate per 100,000 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 \n \nMortality Trends \n \nFigure 12. Age-adjusted Colorectal Cancer Mortality Rate among Males by Race, Georgia (1980-2006) vs. United States (1980-2005) \n \n50 \n \nUS Black Males \n \nUS White Males \n \nGA Black Males \n \nGA White Males \n \n40 \n \n30 \n \n20 \n \n10 \n \n0 \n \n From 1980 to 2005, the U.S. colorectal cancer mortality rate decreased at an average annual rate of 0.2% for black males and 1.96 % for white males (Figure 12) \n In Georgia from 1980 to 2006, the colorectal cancer mortality rate increased at an average annual rate of 1.9% for black males while it decreased by 0.76% for white males \n Since 2000, the colorectal cancer mortality rate decreased at an average annual rate of 3% for U.S. black males and 3.5% for U.S. white males; in Georgia the average annual rate decreased by 2.2% for both black and white males \n \nRate per 100,000 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 \n \nFigure 13. Age-adjusted Colorectal Cancer Mortality Rate among Females by Race, Georgia (1980-2006) vs. United States (1980-2005) \n \n50 \n \nUS Black Females \n \nUS White Females \n \nGA Black Females \n \nGA White Females \n \n40 \n \n30 \n \n20 \n \n10 \n \n0 \n \n Mortality rates among white females have been generally lower than those in black females, both in Georgia and in the U.S. (Figure 13) \n From 1980 to 2005, the colorectal cancer mortality rate decreased at an average annual rate of 0.7% for U.S. black females and 2% for U.S. white females, whereas in Georgia there was a slight increase at an average annual rate of 0.5% among black females and decrease at an average annual rate of 1.2% among white females \n Since 2000, there has been a decrease at an average annual rate in colorectal cancer mortality rates among females for both U.S. and Georgia (2.4% in U.S. black females, 3.7% in U.S. white females vs. 3.3% in Georgia black females and 1.7% in Georgia white females \n \n16 \n \n Colorectal Cancer: Resources \nYou can learn more about colorectal cancer from the following organizations: American Cancer Society Telephone: 1-800-ACS-2345 www.cancer.org \nCenters for Disease Control \u0026 Prevention Telephone: 1-800-CDC-INFO www.cdc.gov \nNational Cancer Institute, Cancer Information Service Telephone: 1-800-4-CANCER http://www.nci.nih.gov \nNational Colorectal Cancer Research Alliance Telephone: 818-760-7722 http://www.eifoundation.org/national/nccra/splash/ \nCancer Research and Prevention Foundation Telephone: 1-800-227-2732 http://www.preventcancer.org \nCancer Control Planet http://cancercontrolplanet.cancer.gov/ \n17 \n \n Technical Notes \nDefinitions: Age-Adjusted Rate is calculated in a manner that minimizes the effects of differences in age composition when comparing rates derived from populations with different age structures. It is expressed per 100,000 population. \nCancer Incidence Rate is a measure of the development of new cancer cases in a population within a specified period of time. It is expressed as a rate per 100,000 persons. \nCancer Mortality Rate is defined as the number of deaths, due to cancer, occurring in a specified population during a specified period of time. It is also expressed as a rate per 100,000 population. \nAverage Risk Population includes most people who develop colorectal cancer and have no identifiable risk factors. People at increased risk of colorectal cancer consist of those with personal or family history of colorectal cancer, those with colorectal cancer symptoms or those who already have inflammatory bowel disease or certain genetic conditions. \nData Sources: The number of deaths and mortality rates for the State of Georgia were obtained from the Georgia Department of Human Resources, Division of Public Health, Vital Records Branch. The number of deaths and mortality rates for the United States were obtained from the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC). Mortality data were coded using ICD-9 codes (1980-1998) and ICD-10 codes (1999-2005). The ICD-9 codes for colorectal cancer are 153.0154.1, 159.0, while the ICD-10 codes for colorectal cancer are C180:C209, C260. \nThe number of new cases and incidence rates for the state of Georgia were obtained from the Georgia Department of Human Resources, Division of Public Health, Georgia Comprehensive Cancer Registry. Incidence rates are calculated for the non-hispanic black and white population for the State of Georgia. The number of new cases and incidence rates for the United States were obtained from the North American Association of Central Cancer Registries (NAACCR). Incidence data were coded using ICD-O3 codes. The ICD-O3 codes used for colorectal cancer are C180:C209, C260. \nCancer stage and survival data for the United States were obtained from the Surveillance, Epidemiology, and End Results (SEER) program, National Cancer Institute. \nPrevalence of risk factors, such as obesity, smoking and physical inactivity (for the year 2008) and screening for colorectal cancer (average of years 2002, 2004, 2005 2006, 2008) in Georgia was analyzed from the Behavioral Risk Factor Surveillance System, Office of Epidemiology, Health Information and Evaluation, Georgia Department of Community Health. National data for the prevalence of similar risk factors was retrieved from Centers for Disease Control and Prevention at www.cdc.gov/brfss/ \nClinical information on colorectal cancer was retrieved from the Mayo Clinic at www.mayoclinic.com , Colorectal Cancer Medline Plus at www.nlm.nih. gov/medlineplus, National Cancer Institute at www.cancer.gov and the American Cancer Society at www.cancer.org \n18 \n \n Methods: Mortality rates were calculated per 100,000 population and ageadjusted by the direct method to the 2000 US standard population. Except where calculated to show trends, the mortality rates are fiveyear average annual rates for the period 2002 through 2006. Incidence rates were calculated per 100,000 population and ageadjusted by the direct method to the 2000 US standard population. Rates were calculated for 2002-2006, as these are the years in which Cancer Registry data are greater than 95% complete. The estimated number of cases for 2009 was calculated by multiplying age-specific incidence rates for 2002-2006 by age-specific population projections for 2009. The estimated number of deaths for 2009 was calculated by multiplying age-specific mortality rates for 2002-2006 by age-specific population projections for 2009. The Rural-Urban classification of Georgia counties was based on the 2003 Rural-Urban Continuum Codes from the United States Department of Agriculture, Economic Research Service. Information about the Rural-Urban Continuum Codes can be retrieved from http://www.ers.usda.gov/Data/RuralUrbanContinuumCodes/. Poverty data for Georgia was retrieved from the U.S Census Bureau's Small Area Income and Poverty Estimates (SAIPE) Program at http:// www.census.gov/did/www/saipe/. The Georgia Comprehensive Cancer Registry further categorized the poverty percent into three groups, low poverty areas (less than 10% of county's population is below United States poverty level), medium poverty areas (10%-19% of county's population is below United States poverty level) and high poverty areas (20% or more of county's population is below United States poverty level) for the data analysis. \n19 \n \n 20 \n \n "},{"id":"dlg_ggpd_y-ga-bh800-pp8-bs1-bc6-b1999-h2000-belec-p-btext","title":"Colorectal cancer in Georgia 1999-2000","collection_id":"dlg_ggpd","collection_title":"Georgia Government Publications","dcterms_contributor":["Georgia. Department of Human Resources.","Georgia. Department of Community Health.","Georgia. Department of Public Health."],"dcterms_spatial":["United States, Georgia, 32.75042, -83.50018"],"dcterms_creator":["Georgia. Department of Human Resources"],"dc_date":["1999/2000"],"dcterms_description":["Title from cover"],"dc_format":["application/pdf"],"dcterms_identifier":null,"dcterms_language":["eng"],"dcterms_publisher":["[Atlanta, GA] : Georgia Department of Human Resources, c2005"],"dc_relation":null,"dc_right":["http://rightsstatements.org/vocab/InC/1.0/"],"dcterms_is_part_of":null,"dcterms_subject":["Colon (Anatomy)--Cancer--Georgia","Rectum--Cancer--Georgia"],"dcterms_title":["Colorectal cancer in Georgia 1999-2000"],"dcterms_type":["Text"],"dcterms_provenance":["University of Georgia. Map and Government Information Library"],"edm_is_shown_by":["https://dlg.galileo.usg.edu/do:dlg_ggpd_y-ga-bh800-pp8-bs1-bc6-b1999-h2000-belec-p-btext"],"edm_is_shown_at":["https://dlg.galileo.usg.edu/id:dlg_ggpd_y-ga-bh800-pp8-bs1-bc6-b1999-h2000-belec-p-btext"],"dcterms_temporal":null,"dcterms_rights_holder":null,"dcterms_bibliographic_citation":null,"dlg_local_right":null,"dcterms_medium":["state government records"],"dcterms_extent":["ill. ; 28 cm."],"dlg_subject_personal":null,"iiif_manifest_url_ss":null,"dcterms_subject_fast":null,"fulltext":"Colorectal Cancer in Georgia, 1999-2000 \n \n Acknowledgments \nGeorgia Department of Human Resources.............................................................B. J. Walker, Commissioner Division of Public Health.........................................................................Stuart Brown, M.D., Acting Director Epidemiology Branch............................................. ..............................Paul A. Blake, M.D., M.P.H., Director Chronic Disease, Injury, and Environmental Epidemiology Section............Kenneth E. Powell, M.D., M.P.H., Chief Kristen J. Mertz, M.D., M.P.H., Deputy Chief Georgia Comprehensive Cancer Registry....................................A. Rana Bayakly, M.P.H., Program Director Chrissy McNamara, M.S.P.H., Epidemiologist Simple Singh, M.D., M.P.H., Epidemiologist Chronic Disease Prevention and Health Promotion Branch....................Carol B. Steiner, M.N., R.N., Acting Director Cancer Control Section.......................................................Kimberly Redding, MD, MPH, Medical Director Karen Boone, RN, MN, MPH, Nurse Consultant \nWe would like to thank all of the hospitals in Georgia that contributed data to the Georgia Comprehensive Cancer Registry. Without their hard work, this report would not have been possible. \nSuggested Citation: Singh S, Bayakly AR, McNamara C, Powell KE, Soman A, Steiner CB, Redding K. Colorectal Cancer in Georgia, 1999-2000. Georgia Department of Human Resources, Division of Public Health, Chronic Disease, Injury, and Environmental Epidemiology Section, May, 2005. Publication number DPH05/036W. \n \n What is Colorectal Cancer? \nColorectal cancer is a collective term for cancers of the colon and rectum. Since cancers of the colon and rectum share many features, they are often referred to as colorectal cancer. The colon and rectum are parts of the digestive system. They form a long, muscular tube called the large intestine. The colon is the first 4 to 5 feet of the large intestine and the rectum is the last 4 to 5 inches. After food is chewed and swallowed, it travels through the esophagus to the stomach. In the stomach, it is partly digested and then transferred to the small intestine. The small intestine continues digesting the food and absorbs most of the nutrients. The small intestine connects to the large intestine. The colon absorbs water and electrolytes from the food and serves as a storage place for waste. The waste moves from the colon into the rectum. From there, the waste passes out of the body through the opening called the anus during a bowel movement. Colorectal cancers develop slowly over a period of several years. Most of these cancers begin as a polyp--a growth of tissue protruding into the center of the colon or rectum. Polyps are also known as adenomas. Removing the polyp early may prevent it from becoming cancer. Over 95 percent of colon and rectal cancers are adenocarcinomas, cancers arising from the cells that line the inside of the colon and rectum. Colorectal cancer occurs in both men and women and most commonly occurs in people over 50 years of age. Colorectal cancer is the third most commonly diagnosed cancer in Georgia men and women. It is also the third most common cause of cancer death among Georgia men and women. Based on data from Georgia Comprehensive Cancer Registry it is estimated that in 2004, over 4,020 new cases of colorectal cancer will be diagnosed, and about 1,520 Georgians will die from this disease. \nHow is Colorectal Cancer Detected? \nTreatment is more likely to be successful if colorectal cancers are detected early. The American Cancer Society recommends routine colorectal cancer screening beginning at age 50. Several screening tests are available. These include, fecal occult blood tests, digital rectal examination, flexible sigmoidoscopy, colonoscopy, and double contrast barium enema. The American Cancer Society's recommendations for the early detection of colorectal cancer are as follows: Beginning at age 50, both men and women should follow one of the 5 screening options below: 1. A fecal occult blood test (FOBT) * every year 2. Flexible sigmoidoscopy every 5 years 3. A fecal occult blood test every year plus flexible sigmoidoscopy every 5 years* (Of these first 3 options, the combination of FOBT every year and flexible sigmoidoscopy every 5 years is preferable.) 4. Double-contrast barium enema every 5 years 5. Colonoscopy every 10 years *For FOBT, the take-home multiple sample method should be used. \n3 \n \n Rate per 100,000 Rate per 100,000 \n \nWho Develops Colorectal Cancer? \nColorectTahl eCoavnecrearllraagtee-saidnjuGsteeodrcgoialo:rectal cancer incidence rate in Georgia is 50 per 100,000. Males are 41% more likely to be diagnosed with colorectal cancer than females (age-adjusted rate 61/100,000 vs. 43/100,000). \n The overall age-adjusted colorectal cancer mortality rate is 19 per 100,000. Males are 44% more likely to die of colorectal cancer than females (age-adjusted rate 23/100,000 vs. 16/100,000. \nColorectal Cancer Incidence and Mortality Rates* by Race and Sex, Georgia (1999-2000; 1997-2001) and US (1996-2000) \n \nGA Incidence 1999-2000 US Incidence 1996-2000 \n \n80 68 70 70 60 50 40 30 20 10 \n0 \nBlack Males \n \n67 58 \nWhite Males \n \n51 54 \n \n48 41 \n \nBlack White Females Females \n \nGA Mortality 1997-2001 US Mortality 1996-2000 \n \n80 70 60 50 40 32 35 30 20 10 \n0 \nBlack Males \n \n21 25 \nWhite Males \n \n23 25 \n \n15 18 \n \nBlack White Females Females \n \n*Rates are age adjusted to 2000 US standard population. \n \nEach year from 1999-2000, over 3300 colorectal cancers were reported to the Georgia Comprehensive Cancer Registry. Black men and women were more likely to be diagnosed with the disease than were white men and women. \nEach year from 1997-2001 over 1200 Georgians died from colorectal cancer. Mortality rates were higher for black men and women than for white men and women. \n \nWhat are the Causes and Risk Factors for Colorectal Cancer? \nWhile we do not know the exact cause of most colorectal cancers, there are certain known risk factors. A risk factor is anything that indicates a person has a higher than normal chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, such as diet, can be controlled. Others, such as a person's age or family history, can't be controlled. Researchers have identified several risk factors that increase a person's chance of getting colorectal cancer. But having a risk factor, or even several, doesn't mean that a person will get the disease. \nWhile everyone is at risk for colorectal cancer, the following factors can increase one's chances of getting the disease. \nRisk Factors That Can Be Controlled  High fat diet: A diet made up mostly of foods that are high in fat, especially from animal sources, can increase the risk of colorectal cancer. The American Cancer Society recommends choosing most of your foods from plant sources and limiting the amount of high-fat foods you eat.  Physical inactivity: People who are not active have a higher risk of colorectal cancer.  Obesity: Being obese increases a person's colorectal cancer risk. Having extra fat in the waist area increases this risk more than having fat in the thighs or hips.  Smoking: Most people know that smoking causes lung cancer, but recent studies show that smokers are 30% to 40% more likely than nonsmokers to die of colorectal cancer.  Alcohol consumption: Heavy use of alcohol has been linked to colorectal cancer. \n \n4 \n \n Risk Factors That You Cannot Change  Age: The chances of getting colorectal cancer increase with age. More than 90% of people diagnosed with colorectal cancer are older than 50.  Family history: Colorectal cancer risk is higher in men and women who have a close relative who has had the disease. The risk increases even further if the relative is affected before the age of 60, or if more than one relative is affected (at any age). About 5% of patients with colorectal cancer have an inherited genetic abnormality that causes the cancer. People with a family history of colorectal cancer should talk with their doctor about when to begin and how often to have screening tests.  Ethnic Background: Jews of Eastern European decent (Ashkenazi Jews) have a higher rate of colon cancer. In one study about 10% of colorectal cancers in Ashkenazi Jews were associated with a genetic mutation.  Personal history of colorectal cancer: An individual with colorectal cancer, even though it has been completely removed, is more likely to develop new cancers in the other areas of the colon and rectum. The chances of this happening are greater if the first colorectal cancer was diagnosed at the age of 60 or less.  Personal history of polyps: Some types of polyps (inflammatory polyps) do not increase the risk of colorectal cancer. Other types, such as adenomatous polyps and hyperplastic polyps do increase the risk of colorectal cancer. This is especially true if the polyps are large or if there are many of them.  Personal history of bowel disease: Inflammatory bowel disease (ulcerative colitis or Crohn's disease) increases the risk of colon cancer. People with inflammatory bowel disease should talk with their doctor about when to begin and how often to have the screening tests.  Diabetes: People with diabetes have a 30%-40% increased chance of developing colon cancer. They also tend to have a higher death rate after diagnosis. \n \nWhat are the Symptoms for Colorectal Cancer? \nCancer that starts in the different sections of the colon and rectum may cause different symptoms. Symptoms of colorectal cancer can mimic other conditions like hemorrhoids, infections and inflammatory bowel disease. It is also possible to have colon cancer and not have any symptoms. If you have any of the following symptoms, it is important to talk to your doctor since finding colorectal cancer early makes successful treatment more likely: \n Change in bowel habits: Diarrhea, constipation, or narrowing of stools that last for more than a few days.  A feeling that you need to have a bowel movement that is not relieved by doing so  Rectal bleeding or blood in stool  Cramping or steady abdominal pain  Weakness and fatigue \n \nWhat is Your Risk of Being Diagnosed? \nTop Five Cancer Types and Cancer-Related Deaths in Georgia \n \nCases \n \nMale \n \nFemale \n \nProstate \n \nBreast \n \nLung \u0026 Bronchus \nColorectal \n \nLung \u0026 Bronchus \nColorectal \n \nBladder \n \nUterus \n \nMelanoma Ovary \n \nDeaths \n \nMale \n \nFemale \n \nLung \u0026 Bronchus Prostate \n \nLung \u0026 Bronchus Breast \n \nColorectal Pancreas Leukemia \n \nColorectal Pancreas Ovary \n \nColorectal cancer is the third most common cancer diagnosed and the third leading cause of cancer deaths among men and women in Georgia. One in 17 Americans will develop colorectal cancer in their lifetime. \n \n5 \n \n Rate per 100,000 Rate per 100,000 \n \nAt What Age is Colorectal Cancer Most Often Diagnosed? \nGeorgia Colorectal Cancer Incidence (1999-2000) and Mortality (1997-2001) Rates, by Age Group and Sex \n \nFemales \n \nIncidence Mortality \n \n500 \n \n400 300 \n200 100 \n21 0 \n \n20 6 \n \n64 17 \n \n125 39 \n \n218 83 \n \n298 171 \n \n0-39 40-49 50-59 60-69 70-79 80 \u003e \n \nAge Group \n \nMales \nIncidence Mortality \n \n500 \n \n422 \n \n400 \n \n306 \n \n300 \n \n182 \n \n200 \n \n78 \n \n100 2 1 26 7 \n \n22 \n \n63 \n \n204 126 \n \n0 \n \n0-39 40-49 50-59 60-69 70-79 80 \u003e \n \nAge Group \n \nColorectal cancer incidence and mortality rates are higher in older individuals. This cancer rarely occurs among individuals less than 40 years of age. In Georgia, men and women over the age of 80 have the highest incidence rate of colorectal cancer. Mortality rates also increase with age; the highest rates are seen in men and women 80 years of age and older. Before the age of 40, colorectal cancer deaths are rare. Less than 30 deaths occurred every year in males and females under 40 years of age from 1997 through 2001. \n \nWhat is the Treatment for Colorectal Cancer? \nEach type of treatment has benefits and side effects. Age, overall health, and the stage of the cancer are all factors that need to be considered. Staging is a standardized way to summarize information about how far a cancer has spread from its point of origin. In situ colorectal cancers are confined to the innermost lining of the colon and rectum. Localized colorectal cancers have invaded the middle layers of the colon or rectum, but have not spread to the outermost layer. Regional stage colorectal cancers have spread beyond the colon and rectum to the adjacent tissues, organs, or regional lymph nodes. Distant stage colorectal cancers have spread to sites such as the liver, lungs, or lymph nodes far from the colon and rectum. \nThere are three main types of treatment for colorectal cancer: surgery, radiation therapy, and chemotherapy. Depending on the stage of cancer, multiple treatment modalities may be used at the same time or one after another. \n Surgery: This is the most common treatment. Usually, the cancer and a length of colon or rectum on either side of the cancer including some lymph nodes are removed. A small malignant polyp can be removed from the colon or upper rectum with a colonoscope thus avoiding abdominal surgery. \n Chemotherapy: Systemic chemotherapy is given using anti-cancer drugs that are injected into a vein or taken by mouth. These drugs reach all areas of the body through the bloodstream, making it potentially useful to cancers that have metastasized to other parts of the body. \n Radiation Therapy: This treatment uses x-rays or other type of radiation to kill cancer cells. There are two types of radiation therapies: External  radiation comes from a machine and is directed to the cancer. Internal  radioactive material/implants are put directly into or near the cancer. Research has shown that radiation in combination with surgery will often decrease the risk of recurrence of rectal cancer. \nAdjuvant and Neoadjuvant Therapy: These terms refer to the timing of chemotherapy and radiation therapy. Neoadjuvant therapy is given prior to surgery to shrink the tumor so that it can be removed more completely. Adjuvant therapy is given after surgery to remove any residual cancer. \n \n6 \n \n Who Survives Colorectal Cancer? \nPercent of US Men and Women Surviving Five Years after Diagnosis of Colorectal Cancer, by Stage of Disease and Race, 1992-1999 \n \nSurvival Rate \n \n100 \n \n80 63 \n \n60 \n \n53 \n \n40 \n \n20 \n \n0 All Stages \n \nWhite Black \n \n91 83 \n \n66 59 \n \nLocalized \n \nRegional \n \nStage at Diagnosis \n \n9 \n \n8 \n \nDistant \n \n% of Tumors found at this stage* \n \nUS White US Black GA White GA Black \n \n*Unstaged tumors are not shown. US data is for 1992-1999, GA data is for 1999-2000 \n \nLocalized 38% 34% 33% 26% \n \nRegional 38% 33% 38% 39% \n \nDistant 19% 24% 14% 20% \n \nEarly detection is important because survival for early stage colorectal cancer is much greater than that for later stage disease. Fiveyear survival for tumors found in the localized stage, when the cancer is still contained within the colon, is 91 percent among US whites and 83 percent among US blacks. In Georgia, about 33 percent of white men and women and about 26 percent of black men and women are diagnosed at a localized stage. If the cancer spreads to organs away from the colon or rectum (distant stage), fiveyear survival rate drops to about 9 percent for US white men and women and 8 percent for US black men and women. \n \n7 \n \n How does Colorectal Cancer Vary by Region? \nUrban Appalachian Rural Appalachian Urban Non-Appalachian Rural Non-Appalachian \n \nRate per 100,000 Rate per 100,000 \n \nGeorgia Colorectal Cancer Incidence and Mortality Rates* by Geography \n \nFemales \nIncidence 1999-2000 Mortality 1997-2001 \n \nMales \nIncidence 1999-2000 Mortality 1997-2001 \n \n70 \n \n60 \n \n50 \n \n40 \n \n40 \n \n30 \n \n20 \n \n15 \n \n10 \n \n0 \nUrba n Appa la c hia n \n \n39 17 \nR ura l Appa la c hia n \n \n45 \n17 \nUrba n No nAppa la c hia n \n \n44 \n17 \nR ura l No nAppa la c hia n \n \n70 \n \n60 \n \n56 \n \n50 \n \n40 \n \n30 \n \n22 \n \n20 \n \n10 \n \n0 \nUrba n Appa la c hia n \n \n54 \n21 \nR ura l Appa la c hia n \n \n62 \n23 \nUrba n No nAppa la c hia n \n \n61 \n25 \nR ura l No nAppa la c hia n \n \n*Rates are age-adjusted to the 2000 US standard population \n \nAlthough incidence (1999-2000) and mortality (1997-2001) rates for urban and rural Appalachian males and females were lower than urban and rural non-Appalachian males and females, none of these differences were statistically significant. \n \n8 \n \n How Does Georgia Compare with the United States? \n \nRate per 100,000 Rate per 100,000 \n \nMale Colorectal Cancer Mortality Rate*, by Race, Georgia vs. US, 1980-2000 \n \nUS White \n \nGA White \n \n40 \n \nMales \n \nMales \n \n35 \n \n30 \n \n25 \n \n20 \n \n15 \n \n10 \n \n5 \n \n0 \n \n1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 Year of Death \n \nUS Black \n \nGA Black \n \nMales 40 \n \nMales \n \n35 \n \n30 25 20 \n \n15 10 \n5 \n \n0 \n \n1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 Year of Death \n \n*Rates are age-adjusted to the 2000 US Standard Population \n \nOverall, from 1980 to 2000, the colorectal cancer mortality rates among Georgia males were lower than US males. \nThe mortality rate among white men in Georgia has been declining at an average annual decrease of 2.1 percent. The mortality rate among black men has been rising at an average annual increase of 2.7 percent. \n \nFemale Colorectal Cancer Mortality Rate*, by Race, Georgia vs. US, 1980-2000 \n \nRate per 100,000 Rate per 100,000 \n \n30 \n \nUS White Females \n \nGA White Females \n \n30 \n \nUS Black Females \n \nGA Black Females \n \n25 \n \n25 \n \n20 \n \n20 \n \n15 \n \n15 \n \n10 \n \n10 \n \n5 \n0 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 \nYear of Death \n \n5 \n0 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 \nYear of Death \n \n*Rates are age-adjusted to the 2000 US standard population \n \nFrom 1980 to 2000, the colorectal cancer mortality rates among Georgia females were lower than US females. \nThe mortality rate for white women in Georgia has been declining at an average annual decrease of 1.3 percent. The mortality rates among black women have been rising at an average annual increase of 2.5 percent. \n \n9 \n \n Where Can I Find Out More about Colorectal Cancer? \n \nYou can learn more about colorectal cancer from the following organizations: \n \nAmerican Cancer Society Telephone: 1-800-ACS-2345 Internet Address: http://www.cancer.org \n \nColon Cancer Alliance Telephone: 212-627-7451 Internet Address: http://www.ccalliance.org \n \nNational Cancer Institute, Cancer Information Service Telephone: 1-800-4-CANCER Internet Address: http://www.nci.nih.gov \n \nNational Colorectal Cancer Research Alliance Telephone: 818-760-7722 Internet Address: http://www.eifoundation.org/home/ \n \nCancer Research and Prevention Foundation (Colossal Colon) Telephone: 1-800-227-2732 Internet Address: http://www.preventcancer.org \n \nCancer Control Planet Internet Address: http://cancercontrolplanet.cancer.gov/ \n \nTechnical Notes \nDefinitions: 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. \nData Sources: The number of deaths and mortality rates for the state of Georgia were obtained from the Georgia Department of Human Resources, Division of Public Health, Vital Records Branch. The number of deaths and mortality rates for the United States were obtained from the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC). Mortality data were coded using ICD-9 codes (1997-1998) and ICD-10 codes (1999-2001). The ICD-9 codes for colorectal cancer are 153.0154.1, 159.0, while the ICD-10 codes for colorectal cancer are C180:C209, C260. \nThe number of new cases and incidence rates for the state of Georgia were obtained from the Georgia Department of Human Resources, Division of Public Health, Georgia Comprehensive Cancer Registry. The number of new cases and incidence rates for the United States were obtained from the North American Association of Central Cancer Registries (NAACCR). Incidence data were coded using ICD-O2 codes. The ICD-O2 codes used for colorectal cancer are C180:C209, C260. \nCancer stage and survival data for the United States were obtained from the Surveillance, Epidemiology, and End Results (SEER) program, National Cancer Institute. \nPopulation projections for 2004 were obtained from the Office of Planning and Budget for the state of Georgia. Population estimates for 1997-2001 and the 2000 US standard population were obtained from the US Bureau of the Census. \nMethods: Mortality rates were calculated per 100,000 population and age-adjusted by the direct method to the 2000 US standard population. Except where calculated to show trends, the mortality rates are five-year average annual rates for the period 1997 through 2001. Incidence rates were calculated per 100,000 population and age-adjusted by the direct method to the 2000 US standard population. Rates were calculated for 1999-2000, as these are the years in which Cancer Registry data are greater than 95% complete. \nThe estimated number of cases for 2004 was calculated by multiplying age-specific incidence rates for 1999-2000 by agespecific population projections for 2004. The estimated number of deaths for 2004 was calculated by multiplying agespecific mortality rates for 1997-2001 by age-specific population projections for 2004. \n10 \n \n "},{"id":"dlg_ggpd_y-ga-bh800-pp8-bs1-bc6-b1999-h2002-belec-p-btext","title":"Colorectal cancer in Georgia 1999-2002","collection_id":"dlg_ggpd","collection_title":"Georgia Government Publications","dcterms_contributor":["Georgia. Department of Human Resources.","Georgia. Department of Community Health.","Georgia. Department of Public Health."],"dcterms_spatial":["United States, Georgia, 32.75042, -83.50018"],"dcterms_creator":["Georgia. Department of Human Resources"],"dc_date":["1999/2002"],"dcterms_description":["Title from cover"],"dc_format":["application/pdf"],"dcterms_identifier":null,"dcterms_language":["eng"],"dcterms_publisher":["[Atlanta, GA] : Georgia Department of Human Resources, c2005"],"dc_relation":null,"dc_right":["http://rightsstatements.org/vocab/InC/1.0/"],"dcterms_is_part_of":null,"dcterms_subject":["Colon (Anatomy)--Cancer--Georgia","Rectum--Cancer--Georgia"],"dcterms_title":["Colorectal cancer in Georgia 1999-2002"],"dcterms_type":["Text"],"dcterms_provenance":["University of Georgia. Map and Government Information Library"],"edm_is_shown_by":["https://dlg.galileo.usg.edu/do:dlg_ggpd_y-ga-bh800-pp8-bs1-bc6-b1999-h2002-belec-p-btext"],"edm_is_shown_at":["https://dlg.galileo.usg.edu/id:dlg_ggpd_y-ga-bh800-pp8-bs1-bc6-b1999-h2002-belec-p-btext"],"dcterms_temporal":null,"dcterms_rights_holder":null,"dcterms_bibliographic_citation":null,"dlg_local_right":null,"dcterms_medium":["state government records"],"dcterms_extent":["ill. ; 28 cm."],"dlg_subject_personal":null,"iiif_manifest_url_ss":null,"dcterms_subject_fast":null,"fulltext":"Colorectal Cancer in Georgia, 1999-2002 \n \n Acknowledgments \nGeorgia Department of Human Resources.............................................................B. J. Walker, Commissioner Division of Public Health.........................................................................Stuart Brown, M.D., Acting Director Epidemiology Branch............................................. .............................Susan Lance, D.V.M, M.P.H., Director Chronic Disease, Injury, and Environmental Epidemiology Section............ A. Rana Bayakly, M.P.H., Acting Chief Georgia Comprehensive Cancer Registry....................................A. Rana Bayakly, M.P.H., Program Director Chrissy McNamara, M.S.P.H., Epidemiologist Simple Singh, M.D., M.P.H., Epidemiologist Chronic Disease Prevention and Health Promotion Branch...........................Kimberly Redding, MD, MPH, Director Cancer Control Section........................................................Karen Boone, RN, MN, MPH, Nurse Consultant \nWe would like to thank all of the hospitals in Georgia that contributed data to the Georgia Comprehensive Cancer Registry. Without their hard work, this report would not have been possible. \nSuggested Citation: Singh S, Bayakly AR., McNamara C., Redding K. Colorectal Cancer in Georgia, 1999-2002. Georgia Department of Human Resources, Division of Public Health, Chronic Disease, Injury, and Environmental Epidemiology Section, October, 2005. Publication number DPH05/085W. \n \n What is Colorectal Cancer? \nColorectal cancer is a collective term for cancers of the colon and rectum. Since cancers of the colon and rectum share many features, they are often referred to as colorectal cancer. The colon and rectum are parts of the digestive system. They form a long, muscular tube called the large intestine. The colon is the first 4 to 5 feet of the large intestine and the rectum is the last 4 to 5 inches. After food is chewed and swallowed, it travels through the esophagus to the stomach. In the stomach, it is partly digested and then transferred to the small intestine. The small intestine continues digesting the food and absorbs most of the nutrients. The small intestine connects to the large intestine. The colon absorbs water and electrolytes from the food and serves as a storage place for waste. The waste moves from the colon into the rectum. From there, the waste passes out of the body through the opening called the anus during a bowel movement. Colorectal cancers develop slowly over a period of several years. Most of these cancers begin as a polyp--a growth of tissue protruding into the center of the colon or rectum. Polyps are also known as adenomas. Removing the polyp early may prevent it from becoming cancer. Over 95 percent of colon and rectal cancers are adenocarcinomas, cancers arising from the cells that line the inside of the colon and rectum. Colorectal cancer occurs in both men and women and most commonly occurs in people over 50 years of age. Colorectal cancer is the third most commonly diagnosed cancer in Georgia men and women. It is also the third most common cause of cancer death among Georgia men and women. Based on data from Georgia Comprehensive Cancer Registry it is estimated that in 2005, over 4,202 new cases of colorectal cancer will be diagnosed, and about 1,580 Georgians will die from this disease. \nHow is Colorectal Cancer Detected? \nTreatment is more likely to be successful if colorectal cancers are detected early. The American Cancer Society recommends routine colorectal cancer screening beginning at age 50. Several screening tests are available. These include, fecal occult blood tests, digital rectal examination, flexible sigmoidoscopy, colonoscopy, and double contrast barium enema. The American Cancer Society's recommendations for the early detection of colorectal cancer are as follows: Beginning at age 50, both men and women should follow one of the 5 screening options below: 1. A fecal occult blood test (FOBT) * every year 2. Flexible sigmoidoscopy every 5 years 3. A fecal occult blood test every year plus flexible sigmoidoscopy every 5 years* (Of these first 3 options, the combination of FOBT every year and flexible sigmoidoscopy every 5 years is preferable.) 4. Double-contrast barium enema every 5 years 5. Colonoscopy every 10 years *For FOBT, the take-home multiple sample method should be used. \n3 \n \n Who Develops Colorectal Cancer? \nColorectTahl eCoavnecrearllraagtee-saidnjuGsteeodrcgoialo:rectal cancer incidence rate in Georgia is 51 per 100,000. Males are 41% more likely to be diagnosed with colorectal cancer than females (age-adjusted rate 62/100,000 vs. 44/100,000). \n The overall age-adjusted colorectal cancer mortality rate is 19 per 100,000. Males are 44% more likely to die of colorectal cancer than females (age-adjusted rate 23/100,000 vs. 16/100,000). \nColorectal Cancer Incidence and Mortality Rates* by Race and Sex, Georgia (Incidence:1999-2002; Mortality:1998-2002) and US (1998-2002) \n \nRate per 100,000 Rate per 100,000 \n \nGA Incidence 1999-2002 US Incidence 1998-2002 \n100 \n \n90 \n \n80 71 70 70 60 50 40 \n \n66 60 \n \n53 54 \n \n47 42 \n \n30 \n \n20 \n \n10 \n \n0 Black Males \n \nWhite Males \n \nBlack White Females Females \n \n100 \n \nGA Mortality 1998-2002 US Mortality 1998-2002 \n \n90 \n \n80 \n \n70 \n \n60 \n \n50 \n \n40 32 34 30 20 \n \n21 24 \n \n24 24 \n \n14 17 \n \n10 \n \n0 Black Males \n \nWhite Males \n \nBlack White Females Females \n \n*Rates are age-adjusted to 2000 US standard population. \n \nEach year from 1999-2002, over 3,500 colorectal cancers were reported to the Georgia Comprehensive Cancer Registry. Black men and women were more likely to be diagnosed with the disease than were white men and women. \nEach year from 1998-2002 over 1,250 Georgians died from colorectal cancer. Mortality rates were higher for black men and women than for white men and women. \nWhat are the Causes and Risk Factors for Colorectal Cancer? \nWhile we do not know the exact cause of most colorectal cancers, there are certain known risk factors. A risk factor is anything that indicates a person has a higher than normal chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, such as diet, can be controlled. Others, such as a person's age or family history, can't be controlled. Researchers have identified several risk factors that increase a person's chance of getting colorectal cancer. But having a risk factor, or even several, doesn't mean that a person will get the disease. \nWhile everyone is at risk for colorectal cancer, the following factors can increase one's chances of getting the disease. \nRisk Factors That Can Be Controlled  High fat diet: A diet made up mostly of foods that are high in fat, especially from animal sources, can increase the risk of colorectal cancer. The American Cancer Society recommends choosing most of your foods from plant sources and limiting the amount of high-fat foods you eat.  Physical inactivity: People who are not active have a higher risk of colorectal cancer.  Obesity: Being obese increases a person's colorectal cancer risk. Having extra fat in the waist area increases this risk more than having fat in the thighs or hips.  Smoking: Most people know that smoking causes lung cancer, but recent studies show that smokers are 30% to 40% more likely than nonsmokers to die of colorectal cancer.  Alcohol consumption: Heavy use of alcohol has been linked to colorectal cancer. \n \n4 \n \n Risk Factors That You Cannot Change  Age: The chances of getting colorectal cancer increase with age. More than 90% of people diagnosed with colorectal cancer are older than 50.  Family history: Colorectal cancer risk is higher in men and women who have a close relative who has had the disease. The risk increases even further if the relative is affected before the age of 60, or if more than one relative is affected (at any age). About 5% of patients with colorectal cancer have an inherited genetic abnormality that causes the cancer. People with a family history of colorectal cancer should talk with their doctor about when to begin and how often to have screening tests.  Ethnic Background: Jews of Eastern European decent (Ashkenazi Jews) have a higher rate of colon cancer. In one study about 10% of colorectal cancers in Ashkenazi Jews were associated with a genetic mutation.  Personal history of colorectal cancer: An individual with colorectal cancer, even though it has been completely removed, is more likely to develop new cancers in the other areas of the colon and rectum. The chances of this happening are greater if the first colorectal cancer was diagnosed at the age of 60 or less.  Personal history of polyps: Some types of polyps (inflammatory polyps) do not increase the risk of colorectal cancer. Other types, such as adenomatous polyps and hyperplastic polyps do increase the risk of colorectal cancer. This is especially true if the polyps are large or if there are many of them.  Personal history of bowel disease: Inflammatory bowel disease (ulcerative colitis or Crohn's disease) increases the risk of colon cancer. People with inflammatory bowel disease should talk with their doctor about when to begin and how often to have the screening tests.  Diabetes: People with diabetes have a 30%-40% increased chance of developing colon cancer. They also tend to have a higher death rate after diagnosis. \n \nWhat are the Symptoms for Colorectal Cancer? \nCancer that starts in the different sections of the colon and rectum may cause different symptoms. Symptoms of colorectal cancer can mimic other conditions like hemorrhoids, infections and inflammatory bowel disease. It is also possible to have colon cancer and not have any symptoms. If you have any of the following symptoms, it is important to talk to your doctor since finding colorectal cancer early makes successful treatment more likely: \n Change in bowel habits: Diarrhea, constipation, or narrowing of stools that last for more than a few days.  A feeling that you need to have a bowel movement that is not relieved by doing so  Rectal bleeding or blood in stool  Cramping or steady abdominal pain  Weakness and fatigue \n \nWhat is Your Risk of Being Diagnosed? \n \nTop Five Cancer Types and Cancer-Related Deaths in Georgia \n \nMale Prostate \n \nCases Female \nBreast \n \nMale Lung \u0026 Bronchus \n \nLung \u0026 Bronchus \n \nLung \u0026 Bronchus \n \nProstate \n \nColorectal \n \nColorectal \n \nColorectal \n \nBladder \n \nUterus \n \nPancreas \n \nMelanoma \n \nOvary \n \nLeukemia \n \nDeaths Female \nLung \u0026 Bronchus \nBreast \nColorectal \nPancreas \nOvary \n \nColorectal cancer is the third most common cancer diagnosed and the third leading cause of cancer deaths among men and women in Georgia. One in 17 Americans will develop colorectal cancer in their lifetime. \n \n5 \n \n At What Age is Colorectal Cancer Most Often Diagnosed? \nGeorgia Colorectal Cancer Incidence (1999-2002) and Mortality (1998-2002) Rates, by Age Group and Sex \n \nFemales \n \nMales \n \nRate per 100,000 Rate per 100,000 \n \nIncidence Mortality 500 \n \n400 \n \n300 200 100 \n0 \n \n22 7 \n \n63 17 \n \n12 5 39 \n \n226 82 \n \n299 16 5 \n \n0-39 40-49 50-59 60-69 70-79 80+ \n \nAge Group \n \nIncidence Mortality \n \n500 430 \n \n400 317 \n \n300 \n \n209 189 \n \n200 \n \n124 \n \n100 \n \n85 \n \n62 \n \n26 7 \n \n23 \n \n0 \n \n0-39 40-49 50-59 60-69 70-79 80+ \n \nAge Group \n \nColorectal cancer incidence and mortality rates are higher in older individuals. This cancer rarely occurs among individuals less than 40 years of age. In Georgia, men and women over the age of 80 have the highest incidence rate of colorectal cancer. \nMortality rates also increase with age; the highest rates are seen in men and women 80 years of age and older. Before the age of 40, colorectal cancer deaths are rare. Less than 30 deaths occurred every year in males and females under 40 years of age from 1998 through 2002. \n \nWhat is the Treatment for Colorectal Cancer? \nEach type of treatment has benefits and side effects. Age, overall health, and the stage of the cancer are all factors that need to be considered. Staging is a standardized way to summarize information about how far a cancer has spread from its point of origin. In situ colorectal cancers are confined to the innermost lining of the colon and rectum. Localized colorectal cancers have invaded the middle layers of the colon or rectum, but have not spread to the outermost layer. Regional stage colorectal cancers have spread beyond the colon and rectum to the adjacent tissues, organs, or regional lymph nodes. Distant stage colorectal cancers have spread to sites such as the liver, lungs, or lymph nodes far from the colon and rectum. \nThere are three main types of treatment for colorectal cancer: surgery, radiation therapy, and chemotherapy. Depending on the stage of cancer, multiple treatment modalities may be used at the same time or one after another. \n Surgery: This is the most common treatment. Usually, the cancer and a length of colon or rectum on either side of the cancer including some lymph nodes are removed. A small malignant polyp can be removed from the colon or upper rectum with a colonoscope thus avoiding abdominal surgery. \n Chemotherapy: Systemic chemotherapy is given using anti-cancer drugs that are injected into a vein or taken by mouth. These drugs reach all areas of the body through the bloodstream, making it potentially useful to cancers that have metastasized to other parts of the body. \n Radiation Therapy: This treatment uses x-rays or other type of radiation to kill cancer cells. There are two types of radiation therapies: External  radiation comes from a machine and is directed to the cancer. Internal  radioactive material/implants are put directly into or near the cancer. Research has shown that radiation in combination with surgery will often decrease the risk of recurrence of rectal cancer. \nAdjuvant and Neoadjuvant Therapy: These terms refer to the timing of chemotherapy and radiation therapy. Neoadjuvant therapy is given prior to surgery to shrink the tumor so that it can be removed more completely. Adjuvant therapy is given after surgery to remove any residual cancer. \n \n6 \n \n Who Survives Colorectal Cancer? \nPercent of US Men and Women Surviving Five Years after Diagnosis of Colorectal Cancer, by Stage of Disease and Race, 1995-2001 \n \nSurvival Rate \n \n100 \n \n90 \n \n80 \n \n70 \n \n65 \n \n60 \n \n55 \n \n50 \n \n40 \n \n30 \n \n20 \n \n10 \n \n0 All stages \n \n91 84 \n \nWhite Black \n69 61 \n \nLocalized \n \nRegional \n \nStage at Diagnosis \n \n10 8 Distant \n \n% of Tumors found at this stage* \n \nUS White US Black GA White GA Black \n \n*Unstaged tumors are not shown. US data is for 1995-2001, GA data is for 1999-2002 \n \nLocalized 39% 35% 36% 30% \n \nRegional 38% 35% 40% 40% \n \nDistant 19% 24% 16% 22% \n \nEarly detection is important because survival for early stage colorectal cancer is much greater than that for later stage disease. Five-year survival for tumors found in the localized stage, when the cancer is still contained within the colon, is 91 percent among US whites and 84 percent among US blacks. In Georgia, about 36 percent of white men and women and about 30 percent of black men and women are diagnosed at a localized stage. If the cancer spreads to organs away from the colon or rectum (distant stage), five-year survival rate drops to about 10 percent for US white men and women and 8 percent for US black men and women. \n \n7 \n \n How does Colorectal Cancer Vary by Region? \nUrban Rural \n \nRate per 100,000 Rate per 100,000 \n \nGeorgia Colorectal Cancer Incidence and Mortality Rates* by Geography \n \nFemales \n \nIncidence 1999-2002 Mortality 1998-2002 \n \n80 \n \n70 \n \n60 55 \n \n50 \n \n50 \n \n42 42 \n \n40 \n \n30 \n \n24 23 \n \n20 \n \n14 15 \n \n10 \n \n0 \n \nUrban Rural Urban Rural \n \nBlack Black White White \n \nMales \n \nIncidence 1999-2002 Mortality 1998-2002 \n \n80 74 \n \n70 \n \n66 \n \n63 \n \n58 \n \n60 \n \n50 \n \n40 \n \n33 \n \n31 \n \n30 \n \n20 \n \n23 \n \n20 \n \n10 \n \n0 \n \nUrban Rural Urban Rural Black Black White White \n \n*Rates are age-adjusted to the 2000 US standard population \n \nIncidence (1999-2002) rates for rural white males were significantly higher than the urban white males. Incidence rates for urban black males and females were higher than the rural black males and females, but the results were not statistically significant. \nMortality (1998-2002) rates for urban black males and females were higher than the rural black males and females, but the results were not statistically significant. \n \n8 \n \n How Does Georgia Compare with the United States? \nMale Colorectal Cancer Mortality Rate*, by Race, Georgia vs. US, 1980-2002 \n \nRate per 100,000 \n \nUS White \n \nUS Black \n \nGA White \n \nGA Black \n \n40 \n \nMales \n \nMales \n \nMales \n \nMales \n \n35 \n \n30 \n \n25 \n \n20 \n \n15 \n \n10 \n \n5 \n \n0 \n \n1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 \n \n*Rates are age-adjusted to the 2000 US standard population \n \nOverall, from 1980 to 2002, the colorectal cancer mortality rates among Georgia males were lower than US males. \nFrom 1980 to 1999, the mortality rates among white males decreased by 0.8 percent. Since 1999 the rates have been rising again. The mortality rate among black men has been fluctuating. From 1980 to 1999, the rates increased by 3.2 percent per year and have been decreasing since 1999. \n \nFemale Colorectal Cancer Mortality Rate*, by Race, Georgia vs. US, 1980-2002 \n \nRate per 100,000 \n \n40 \n \nUS Whit e \n \nUS Black \n \nGA White \n \nGA Black \n \n35 \n \nFemales \n \nFemales \n \nFemales \n \nFemales \n \n30 25 \n \n20 15 10 \n \n5 0 \n \n1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 \n \n*Rates are age-adjusted to the 2000 US standard population \n \nOverall, from 1980 to 2002, the colorectal cancer mortality rates among Georgia females were lower than US females. \nThe mortality rate for white women in Georgia has been declining at an average annual decrease of 1.4 percent. The mortality rates among black women have been rising at an average annual increase of 1.7 percent. \n \n9 \n \n Where Can I Find Out More about Colorectal Cancer? \n \nYou can learn more about colorectal cancer from the following organizations: \n \nAmerican Cancer Society Telephone: 1-800-ACS-2345 Internet Address: http://www.cancer.org \n \nColon Cancer Alliance Telephone: 212-627-7451 Internet Address: http://www.ccalliance.org \n \nNational Cancer Institute, Cancer Information Service Telephone: 1-800-4-CANCER Internet Address: http://www.nci.nih.gov \n \nNational Colorectal Cancer Research Alliance Telephone: 818-760-7722 Internet Address: http://www.eifoundation.org/home/ \n \nCancer Research and Prevention Foundation (Colossal Colon) Telephone: 1-800-227-2732 Internet Address: http://www.preventcancer.org \n \nCancer Control Planet Internet Address: http://cancercontrolplanet.cancer.gov/ \n \nTechnical Notes \nDefinitions: 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. \nData Sources: The number of deaths and mortality rates for the state of Georgia were obtained from the Georgia Department of Human Resources, Division of Public Health, Vital Records Branch. The number of deaths and mortality rates for the United States were obtained from the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC). Mortality data were coded using ICD-9 codes (1980-1998) and ICD-10 codes (1999-2002). The ICD-9 codes for colorectal cancer are 153.0154.1, 159.0, while the ICD-10 codes for colorectal cancer are C180:C209, C260. \nThe number of new cases and incidence rates for the state of Georgia were obtained from the Georgia Department of Human Resources, Division of Public Health, Georgia Comprehensive Cancer Registry. The number of new cases and incidence rates for the United States were obtained from the North American Association of Central Cancer Registries (NAACCR). Incidence data were coded using ICD-O3 codes. The ICD-O3 codes used for colorectal cancer are C180:C209, C260. \nCancer stage and survival data for the United States were obtained from the Surveillance, Epidemiology, and End Results (SEER) program, National Cancer Institute. \nPopulation projections for 2005 were obtained from the Office of Planning and Budget for the state of Georgia. Population estimates for 1980-2002 and the 2000 US standard population were obtained from the US Bureau of the Census. \nMethods: Mortality rates were calculated per 100,000 population and age-adjusted by the direct method to the 2000 US standard population. Except where calculated to show trends, the mortality rates are five-year average annual rates for the period 1998 through 2002. Incidence rates were calculated per 100,000 population and age-adjusted by the direct method to the 2000 US standard population. Rates were calculated for 1999-2002, as these are the years in which Cancer Registry data are greater than 95% complete. \nThe estimated number of cases for 2005 was calculated by multiplying age-specific incidence rates for 1999-2002 by agespecific population projections for 2005. The estimated number of deaths for 2005 was calculated by multiplying agespecific mortality rates for 1998-2002 by age-specific population projections for 2005. \n10 \n \n "},{"id":"dlg_ggpd_y-ga-bh800-pp8-bs1-bc6-b1999-h2003-belec-p-btext","title":"Colorectal cancer in Georgia 1999-2003","collection_id":"dlg_ggpd","collection_title":"Georgia Government Publications","dcterms_contributor":["Georgia. Department of Human Resources.","Georgia. Department of Community Health.","Georgia. Department of Public Health."],"dcterms_spatial":["United States, Georgia, 32.75042, -83.50018"],"dcterms_creator":["Georgia. Department of Human Resources"],"dc_date":["1999/2003"],"dcterms_description":["Title from cover"],"dc_format":["application/pdf"],"dcterms_identifier":null,"dcterms_language":["eng"],"dcterms_publisher":["[Atlanta, GA] : Georgia Department of Human Resources, 2006"],"dc_relation":null,"dc_right":["http://rightsstatements.org/vocab/InC/1.0/"],"dcterms_is_part_of":null,"dcterms_subject":["Colon (Anatomy)--Cancer--Georgia","Rectum--Cancer--Georgia"],"dcterms_title":["Colorectal cancer in Georgia 1999-2003"],"dcterms_type":["Text"],"dcterms_provenance":["University of Georgia. Map and Government Information Library"],"edm_is_shown_by":["https://dlg.galileo.usg.edu/do:dlg_ggpd_y-ga-bh800-pp8-bs1-bc6-b1999-h2003-belec-p-btext"],"edm_is_shown_at":["https://dlg.galileo.usg.edu/id:dlg_ggpd_y-ga-bh800-pp8-bs1-bc6-b1999-h2003-belec-p-btext"],"dcterms_temporal":null,"dcterms_rights_holder":null,"dcterms_bibliographic_citation":null,"dlg_local_right":null,"dcterms_medium":["state government records"],"dcterms_extent":["ill. ; 28 cm."],"dlg_subject_personal":null,"iiif_manifest_url_ss":null,"dcterms_subject_fast":null,"fulltext":"Colorectal Cancer in Georgia, 1999-2003 \n \n Acknowledgments \nGeorgia Department of Human Resources.............................................................B. J. Walker, Commissioner Division of Public Health..................................................................................Stuart Brown, M.D., Director Epidemiology Branch............................................. .............................Susan Lance, D.V.M, M.P.H., Director Chronic Disease, Injury, and Environmental Epidemiology Section.................... John Horan, M.D., M.P.H., Chief Georgia Comprehensive Cancer Registry....................................A. Rana Bayakly, M.P.H., Program Director Chrissy McNamara, M.S.P.H., Epidemiologist Simple Singh, M.D., M.P.H., Epidemiologist Chronic Disease Prevention and Health Promotion Branch...........................Kimberly Redding, MD, MPH, Director Clinical Services Section......................................................Karen Boone, RN, MN, MPH, Nurse Consultant \nWe would like to thank all of the hospitals in Georgia who contributed data to the Georgia Comprehensive Cancer Registry. Without their hard work, this report would not have been possible. \nSuggested Citation: Singh S, Bayakly AR., McNamara C., Redding K. Colorectal Cancer in Georgia, 1999-2003. Georgia Department of Human Resources, Division of Public Health, Chronic Disease, Injury, and Environmental Epidemiology Section, December, 2006. Publication number DPH06/165W. \n \n What is Colorectal Cancer? \nColorectal cancer is a collective term for cancers of the colon and rectum. Since cancers of the colon and rectum share many features, they are often referred to as colorectal cancer. The colon and rectum are parts of the digestive system. They form a long, muscular tube called the large intestine. The colon is the first 4 to 5 feet of the large intestine and the rectum is the last 4 to 5 inches. \nAfter food is chewed and swallowed, it travels through the esophagus to the stomach. In the stomach, it is partly digested and then transferred to the small intestine. The small intestine continues digesting the food and absorbs most of the nutrients. The small intestine connects to the large intestine. The colon absorbs water and electrolytes from the food and serves as a storage place for waste. The waste moves from the colon into the rectum. From there, the waste passes out of the body through the opening called the anus during a bowel movement. \nColorectal cancers develop slowly over a period of several years. Most of these cancers begin as a polyp--a growth of tissue protruding into the center of the colon or rectum. Polyps are also known as adenomas. Removing the polyp early may prevent it from becoming cancer. Over 95 percent of colon and rectal cancers are adenocarcinomas, cancers arising from the cells that line the inside of the colon and rectum. \nColorectal cancer occurs in both men and women and most commonly occurs in people over 50 years of age. Colorectal cancer is the third most commonly diagnosed cancer in Georgia men and women. It is also the third most common cause of cancer death among Georgia men and women. Based on data from Georgia Comprehensive Cancer Registry it is estimated that in 2006, over 4,345 new cases of colorectal cancer will be diagnosed, and about 1,650 Georgians will die from this disease. \nThis picture shows colon and rectum. \nHow is Colorectal Cancer Detected? \nTreatment is more likely to be successful if colorectal cancers are detected early. The American Cancer Society recommends routine colorectal cancer screening beginning at age 50. Several screening tests are available, including fecal occult blood tests (FOBT), digital rectal examination (DRE), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema. The American Cancer Society's recommendations for the early detection of colorectal cancer are as follows: \nBeginning at age 50, both men and women should follow one of the 5 screening options below: 1. A fecal occult blood test (FOBT) * every year 2. Flexible sigmoidoscopy every 5 years 3. A fecal occult blood test every year plus flexible sigmoidoscopy every 5 years* (Of these first 3 options, the combination of FOBT every year and flexible sigmoidoscopy every 5 years is preferable.) 4. Double-contrast barium enema every 5 years 5. Colonoscopy every 10 years \n*For FOBT, the take-home multiple sample method should be used. \n3 \n \n Who Develops Colorectal Cancer? \nColorectTahl eCoavnecrearllraagtee-saidnjuGsteeodrcgoialo:rectal cancer incidence rate in Georgia is 51 per 100,000. Males are 41% more likely to be diagnosed with colorectal cancer than females (age-adjusted rate 62/100,000 vs. 44/100,000). \n The overall age-adjusted colorectal cancer mortality rate is 19 per 100,000. Males are 44% more likely to die of colorectal cancer than females (age-adjusted rate 23/100,000 vs. 16/100,000). \n \nRate per 100,000 Rate per 100,000 \n \nColorectal Cancer Incidence and Mortality Rates* by Race and Sex, Georgia (Incidence: 1999-2003; Mortality: 2000-2004) and United States (1999-2003) \n \nIncidence \n \n100 \n \nGeorgia 1999-2003 United States1999-2003 \n \n72 70 50 \n \n60 64 \n \n53 54 \n \n41 46 \n \n0 Black Males \n \nWhite Males \n \nBlack White Females Females \n \nMortality \n \n100 \n \nGeorgia 2000-2004 United States 1999-2003 \n \n50 32 34 22 24 \n \n0 Black Males \n \nWhite Males \n \n24 24 14 16 \nBlack White Females Females \n \n*Rates are age-adjusted to 2000 US standard population. \n \nEach year from 1999-2003, over 3,540 colorectal cancers were diagnosed in Georgia. Black men and women were more likely to be diagnosed with the disease than were white men and women. \nEach year from 2000-2004 over 1,315 Georgians died from colorectal cancer. Mortality rates were higher for black men and women than for white men and women. \n \nWhat are the Causes and Risk Factors for Colorectal Cancer? \nWhile we do not know the exact cause of most colorectal cancers, there are certain known risk factors. A risk factor is anything that indicates a person has a higher than normal chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, such as diet, can be controlled. Others, such as a person's age or family history, can't be controlled. Researchers have identified several risk factors that increase a person's chance of getting colorectal cancer. But having a risk factor, or even several, doesn't mean that a person will get the disease. \nWhile everyone is at risk for colorectal cancer, the following factors can increase one's chances of getting the disease. \nRisk Factors That Can Be Controlled  High fat diet: A diet made up mostly of foods that are high in fat, especially from animal sources, can increase the risk of colorectal cancer. The American Cancer Society recommends choosing most of your foods from plant sources and limiting the amount of high-fat foods you eat.  Physical inactivity: People who are not active have a higher risk of colorectal cancer.  Obesity: Being obese increases a person's colorectal cancer risk. Having extra fat in the waist area increases this risk more than having fat in the thigh or hip area.  Smoking: Most people know that smoking causes lung cancer, but recent studies show that smokers are 30% to 40% more likely than nonsmokers to die of colorectal cancer.  Alcohol consumption: Heavy use of alcohol has been linked to colorectal cancer. \n \n4 \n \n Risk Factors That You Cannot Change  Age: The chances of getting colorectal cancer increase with age. More than 90% of people diagnosed with colorectal cancer are older than 50.  Family history: Colorectal cancer risk is higher in men and women who have a close relative who has had the disease. The risk increases even further if the relative is affected before the age of 60, or if more than one relative is affected (at any age). About 5% of patients with colorectal cancer have an inherited genetic abnormality that causes the cancer. People with a family history of colorectal cancer should talk with their doctor about when to begin and how often to have screening tests.  Ethnic Background: Jews of Eastern European decent (Ashkenazi Jews) have a higher rate of colon cancer. In one study about 10% of colorectal cancers in Ashkenazi Jews were associated with a genetic mutation.  Personal history of colorectal cancer: An individual with colorectal cancer, even though it has been completely removed, is more likely to develop new cancers in the other areas of the colon and rectum. The chances of this happening are greater if the first colorectal cancer was diagnosed at the age of 60 or less.  Personal history of polyps: Some types of polyps (inflammatory polyps) do not increase the risk of colorectal cancer. Other types, such as adenomatous polyps and hyperplastic polyps do increase the risk of colorectal cancer. This is especially true if the polyps are large or if there are many of them.  Personal history of bowel disease: Inflammatory bowel disease (ulcerative colitis or Crohn's disease) increases the risk of colon cancer. People with inflammatory bowel disease should talk with their doctor about when to begin and how often to have the screening tests.  Diabetes: People with diabetes have a 30%-40% increased chance of developing colon cancer. They also tend to have a higher death rate after diagnosis. \nWhat are the Symptoms of Colorectal Cancer? \nCancer that starts in the different sections of the colon and rectum may cause different symptoms. Symptoms of colorectal cancer can mimic other conditions like hemorrhoids, infections and inflammatory bowel disease. It is also possible to have colon cancer and not have any symptoms. If you have any of the following symptoms, it is important to talk to your doctor since finding colorectal cancer early makes successful treatment more likely: \n Change in bowel habits: Diarrhea, constipation, or narrowing of stools that last for more than a few days.  A feeling that you need to have a bowel movement that is not relieved by doing so.  Rectal bleeding or blood in stool.  Cramping or steady abdominal pain.  Weakness and fatigue. \n \nTop Five Cancer Types and Cancer-Related Deaths in Georgia \n \nMale Prostate \n \nCases Female \nBreast \n \nDeaths \n \nMale \n \nFemale \n \nLung \u0026 Bronchus Lung \u0026 Bronchus \n \nLung \u0026 Bronchus Lung \u0026 Bronchus Prostate \n \nBreast \n \nColorectal \n \nColorectal \n \nColorectal \n \nColorectal \n \nBladder \n \nUterus \n \nPancreas \n \nPancreas \n \nMelanoma \n \nOvary \n \nLeukemia \n \nOvary \n \nColorectal cancer is the third most common cancer diagnosed and the third leading cause of cancer deaths among men and women in Georgia. One in 17 Americans will develop colorectal cancer in their lifetime. \n5 \n \n At What Age is Colorectal Cancer Most Often Diagnosed? \nGeorgia Colorectal Cancer Incidence (1999-2003) and Mortality (2000-2004) Rates, by Age Group and Sex \n \nRate per 100,000 Rate per 100,000 \n \nFemales \n \n500 \n \nIncidence Mortality 400 \n297 \n \n300 \n \n223 \n \n200 \n \n166 126 \n \n100 \n \n63 \n \n21 \n \n22 7 \n \n17 \n \n0 \n \n83 39 \n \n0-39 40-49 50-59 60-69 70-79 80 \u003e \n \nAge Groups (in years) \n \nMales \n \n500 \n \nIncidence Mortality \n \n422 \n \n400 \n \n315 \n \n300 \n \n232 \n \n188 \n \n200 \n \n85 \n \n100 2 1 26 8 \n \n24 \n \n62 \n \n114 \n \n0 \n \n0-39 40-49 50-59 60-69 70-79 80 \u003e \n \nAge Groups (in years) \n \nColorectal cancer incidence and mortality rates are higher in older individuals. This cancer rarely occurs among individuals less than 40 years of age. In Georgia, men and women over the age of 80 have the highest incidence rate of colorectal cancer. \nMortality rates also increase with age; the highest rates are seen in men and women 80 years of age and older. Before the age of 40, colorectal cancer deaths are rare. Fewer than 30 deaths occurred every year in males and females under 40 years of age from 2000 through 2004. \nWhat is the Treatment for Colorectal Cancer? \nEach type of treatment has benefits and side effects. Age, overall health, and the stage of the cancer are all factors that need to be considered. Staging is a standardized way to summarize information about how far a cancer has spread from its point of origin. In situ colorectal cancers are confined to the innermost lining of the colon and rectum. Localized colorectal cancers have invaded the middle layers of the colon or rectum, but have not spread to the outermost layer. Regional stage colorectal cancers have spread beyond the colon and rectum to the adjacent tissues, organs, or regional lymph nodes. Distant stage colorectal cancers have spread to sites such as the liver, lungs, or lymph nodes far from the colon and rectum. \nThere are three main types of treatment for colorectal cancer: surgery, radiation therapy, and chemotherapy. Depending on the stage of cancer, multiple treatment modalities may be used at the same time or one after another. \n Surgery: This is the most common treatment. Usually, the cancer and a length of colon or rectum on either side of the cancer including some lymph nodes are removed. A small malignant polyp can be removed from the colon or upper rectum with a colonoscope thus avoiding abdominal surgery. \n Radiation Therapy: This treatment uses x-rays or other type of radiation to kill cancer cells. There are two types of radiation therapies: External  radiation comes from a machine and is directed to the cancer. Internal  radioactive material/implants are put directly into or near the cancer. Research has shown that radiation in combination with surgery will often decrease the risk of recurrence of rectal cancer. \n Chemotherapy: Systemic chemotherapy is given using anti-cancer drugs that are injected into a vein or taken by mouth. These drugs reach all areas of the body through the bloodstream, making them potentially effective against cancers that have metastasized to other parts of the body. \nAdjuvant and Neoadjuvant Therapy: Neoadjuvant therapy is treatment given before the primary treatment. Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy. Adjuvant therapy is treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, or biological therapy. \n \n6 \n \n Who Survives Colorectal Cancer? \nPercent of US Men and Women Surviving Five Years after Diagnosis of Colorectal Cancer, by Stage of Disease and Race, 1996-2002 \n \nFive- year Survival Rate \n \n100 \n \n80 65 \n \n60 \n \n55 \n \n40 \n \n20 \n \n0 All stages \n \n91 85 \n \n69 60 \n \nLocalized \n \nRegional \n \nStage at Diagnosis \n \nWhite Black \n10 7 Distant \n \n% of Tumors found at this stage* \n \nUS White US Black GA White GA Black \n \n*Unstaged tumors are not shown. US data is for 1996-2002, GA data is for 1999-2003 \n \nLocalized 40% 35% 34% 29% \n \nRegional 37% 35% 38% 36% \n \nDistant 19% 24% 15% 20% \n \nEarly detection is important because survival for early stage colorectal cancer is much greater than that for later stage disease. Five-year survival for tumors found in the localized stage, when the cancer is still contained within the colon, is 91 percent among US whites and 85 percent among US blacks. In Georgia, about 34 percent of white men and women and about 29 percent of black men and women are diagnosed at a localized stage. If the cancer spreads to organs away from the colon or rectum (distant stage), five-year survival rate drops to about 10 percent for US white men and women and 7 percent for US black men and women. \n \n7 \n \n How does Colorectal Cancer Vary by Region? \nUrban and Rural Counties in Georgia \n \nUrban Counties Rural Counties \n \nRate per 100,000 Rate per 100,000 \n \nGeorgia Colorectal Cancer Incidence and Mortality Rates* by Geography \n \nFemales \n \nMales \n \nIncidence 1999-2003 100 \n \nMortality 2000-2004 \n \n54 \n \n51 \n \n50 \n \n41 \n \n42 \n \n24 \n \n23 \n \n16 \n \n14 \n \n0 Urban Black \n \nRural Black \n \nUrban White \n \nRural White \n \nIncidence 1999-2003 Mortality 2000-2004 \n \n100 \n \n74 \n \n67 \n \n65 \n \n58 \n \n50 \n \n32 \n \n32 \n \n21 \n \n24 \n \n0 Urban Black \n \nRural Black \n \nUrban White \n \nRural White \n \n*Rates are age-adjusted to the 2000 US standard population \n \nIncidence (1999-2003) rates for rural white males were significantly higher than for urban white males. Incidence rates for urban black males and females were higher than for rural black males and females, but the results were not statistically significant. \nMortality (2000-2004) rates for rural white males were significantly higher than for urban white males. Mortality rates for urban black males and females were higher than for rural black males and females, but the results were not statistically significant. \n \n8 \n \n How Does Georgia Compare with the United States? \nMale Colorectal Cancer Mortality Rate*, by Race, Georgia vs. US, 1980-2003 \n \nRate per 100,000 \n \n50 \n \nUS White Males \n \nUS Black Males \n \nGA White Males \n \nGA Black Males \n \n40 \n \n30 \n \n20 \n \n10 \n \n0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 *Rates are age-adjusted to the 2000 US standard population \n \nOverall, from 1980 to 2003, the colorectal cancer mortality rates among Georgia males were lower than among US males. \nFrom 1980 to 1999, the mortality rates among Georgia white males decreased by 0.8 percent. Since 1999 the rates have been rising again. The mortality rate among Georgia black men has been fluctuating. From 1980 to 1999, the rates increased by 3.4 percent per year and have been decreasing since 1999. \n \nRate per 100,000 \n \nFemale Colorectal Cancer Mortality Rate*, by Race, Georgia vs. US, 1980-2003 \n \n50 \n \nUS White Females \n \nUS Black Females \n \nGA White Females \n \nGA Black Females \n \n40 \n \n30 \n \n20 \n \n10 \n \n0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 \n \n*Rates are age-adjusted to the 2000 US standard population \nOverall, from 1980 to 2003, the colorectal cancer mortality rates among Georgia females were lower than among US females. The mortality rate for white women in Georgia has been declining at an average annual decrease of 1.3 percent. The mortality rates among black women have been rising at an average annual increase of 1.5 percent. \n9 \n \n Where Can I Find Out More about Colorectal Cancer? \n \nYou can learn more about colorectal cancer from the following organizations: \n \nAmerican Cancer Society Telephone: 1-800-ACS-2345 Internet Address: http://www.cancer.org \n \nColon Cancer Alliance Telephone: 212-627-7451 Internet Address: http://www.ccalliance.org \n \nNational Cancer Institute, Cancer Information Service Telephone: 1-800-4-CANCER Internet Address: http://www.nci.nih.gov \n \nNational Colorectal Cancer Research Alliance Telephone: 818-760-7722 Internet Address: http://www.eifoundation.org/home/ \n \nCancer Research and Prevention Foundation (Colossal Colon) Telephone: 1-800-227-2732 Internet Address: http://www.preventcancer.org \n \nCancer Control Planet Internet Address: http://cancercontrolplanet.cancer.gov/ \n \nTechnical Notes \nDefinitions: 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. \nData Sources: The number of deaths and mortality rates for the state of Georgia were obtained from the Georgia Department of Human Resources, Division of Public Health, Vital Records Branch. The number of deaths and mortality rates for the United States were obtained from the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC). Mortality data were coded using ICD-9 codes (1980-1998) and ICD-10 codes (1999-2004). The ICD-9 codes for colorectal cancer are 153.0154.1, 159.0, while the ICD-10 codes for colorectal cancer are C180:C209, C260. \nThe number of new cases and incidence rates for the state of Georgia were obtained from the Georgia Department of Human Resources, Division of Public Health, Georgia Comprehensive Cancer Registry. The number of new cases and incidence rates for the United States were obtained from the North American Association of Central Cancer Registries (NAACCR). Incidence data were coded using ICD-O3 codes. The ICD-O3 codes used for colorectal cancer are C180:C209, C260. \nCancer stage and survival data for the United States were obtained from the Surveillance, Epidemiology, and End Results (SEER) program, National Cancer Institute. \nPopulation projections for 2005 were obtained from the Office of Planning and Budget for the state of Georgia. Population estimates for 1980-2003 and the 2000 US standard population were obtained from the US Bureau of the Census. \nMethods: Mortality rates were calculated per 100,000 population and age-adjusted by the direct method to the 2000 US standard population. Except where calculated to show trends, the mortality rates are five-year average annual rates for the period 2000 through 2004. Incidence rates were calculated per 100,000 population and age-adjusted by the direct method to the 2000 US standard population. Rates were calculated for 1999-2003, as these are the years in which Cancer Registry data are greater than 95% complete. \nThe estimated number of cases for 2006 was calculated by multiplying age-specific incidence rates for 1999-2003 by agespecific population projections for 2006. 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