Cancer
Facts and
Figures
2006
Minnesota
Table of Contents
Introduction
Hope.Progress.Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Estimated New Cancer Cases and Cancer Deaths in Minnesota, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Acronyms/Abbreviations Used Frequently in this Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
American Cancer Society Challenge Goals for 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Cancer Plan Minnesota and the Minnesota Cancer Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Frequently Asked Questions about Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Cancer in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Cancer Disparities in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Lung and Bronchus Cancer in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Cancer of the Colon and Rectum in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Breast Cancer in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Prostate Cancer in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Cervical Cancer in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
Melanoma of the Skin in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Mesothelioma in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Childhood Cancer in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
Living a Healthy Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Survivorship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
ACS Resources to Improve Quality of Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Summary Tables and End Notes
Cancer Incidence in Minnesota, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
Cancer Mortality in Minnesota, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
Stage at Diagnosis for Screening-Sensitive Cancers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Average Number of New Cancer Cases by County, Minnesota, 1999-2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
Average Number of Cancer Deaths by County, Minnesota, 1999-2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
ACS Screening Guidelines for the Early Detection of Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Understanding Cancer Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Acknowledgments
This report was designed and printed by the American Cancer Society, Midwest Division. We gratefully
acknowledge the generous contributions of time and energy by ACS staff. The production of this document
was funded in part by the Centers for Disease Control and Prevention National Program of Cancer Registries
through MCSS staff time contributed by Carin Perkins, PhD and Margee Brown, MPH.
This report would not have been able to provide information specific to Minnesota without the Minnesota
Cancer Surveillance System (MCSS) and the Minnesota Behavioral Risk Factor Surveillance System (BRFSS).
We would like to thank the staff of MCSS, cancer registrars, and health care providers throughout the state
whose hard work and diligence make cancer surveillance in Minnesota possible. We also thank the
thousands of Minnesota residents who took time to participate in the BRFSS, and thereby provided us
with an invaluable picture of health behaviors in our state.
2
Minnesota Cancer Facts and Figures 2006
We are making progress in the fight against cancer. More people now recognize the dangers of tobacco,
and many Minnesotans have quit or never started smoking and live and work in smoke-free homes and
workplaces. Twice as many women get screened routinely for breast cancer than 15 years ago, and screening
for cancer of the colon and rectum has increased significantly in the past five years. Treatment has improved
dramatically for many cancers, and the five-year survival rate has increased so that the majority of cancer
patients survive more than five years. Because of these changes, the cancer mortality rate is declining
steadily. The slow but steady increase in the overall cancer incidence rate during the last decade appears
to be ending, but it is too early to determine if this will be sustained.
Answers
Research will continue to provide lifesaving information about what causes cancer, how to prevent and
detect it early, and how to successfully treat and cure cancer while maintaining quality of life. But we already
know enough to see more gains and to make progress in reducing disparities in the burden of cancer.
We ask you to join with us in our efforts to reduce the burden of cancer for all Minnesotans and to eliminate
cancer as a cause of illness and death. Live a healthy life. Volunteer with the American Cancer Society.
Join the Minnesota Cancer Alliance. Support cancer research. Be an activist for cancer control.
Prostate
Breast
Colorectal
Lung
Intro
Progress
Cervix
Cancer is the leading cause of death in Minnesota. But there is hope in the fight against cancer. Current
scientific information shows that one-third of cancer deaths would be prevented if no one smoked cigarettes
or used tobacco products, and another third of deaths from cancer could be prevented if we maintained a
healthy weight, ate a healthy diet, and exercised regularly. Many more lives could be saved if currently
available screening tests were more widely used to detect cancer early and if state-of-the-art treatment
were available to all Minnesotans.
Melanoma
Hope
Mesothelioma
We are pleased to present the second issue of Minnesota Cancer Facts and Figures. The American Cancer
Society, the Minnesota Cancer Surveillance System, and the Minnesota Cancer Alliance combined efforts
to produce this summary of cancer in our state. Stakeholders in cancer control will use this document to
measure progress in meeting the objectives in Cancer Plan Minnesota 2005-2010, the state's comprehensive
cancer control plan. We hope that patients, health care and public health professionals, policy makers,
advocates, news organizations, and the public will also find it useful when detailed, easy-to-read information
about cancer in Minnesota is needed.
Childhood
Hope.Progress.Answers.
Minnesota Cancer Facts and Figures 2006
Brian Rank, MD
Chair
Minnesota Cancer Alliance
3
Survivorship
Dianne M. Mandernach
Commissioner
Minnesota Department of Health
End Notes
Jari Johnston-Allen
CEO, Midwest Division
American Cancer Society
Healthy Life
Sincerely,
Intro
Colorectal
Lung
Estimated New Cancer Cases and Cancer Deaths
in Minnesota, 2006*
Melanoma
Cervix
Prostate
Breast
All Sites
Brain and Nervous System
Female Breast
Cervix
Colon and Rectum
Corpus Uteri (Uterus)
Leukemia
Liver
Lung and Bronchus
Melanoma of the Skin
Non-Hodgkin’s Lymphoma
Ovary
Pancreas
Prostate
Urinary Bladder
New Cases
Deaths
23,520
~
3,070
130
2,400
780
660
~
2,610
860
1,060
~
~
4,200
1,130
9,490
250
590
~
890
~
420
230
2,430
~
340
250
550
490
~
Source: American Cancer Society, Inc. Cancer Facts and Figures 2006.
* Rounded to the nearest 100. Excludes basal and squamous cell skin cancers and in situ carcinomas
except urinary bladder.
Mesothelioma
~ Not estimated by ACS.
Note: These estimates are offered as a rough guide and should be interpreted with caution. They were calculated
by ACS according to the distribution of estimated cancer deaths in Minnesota in 2006.
Childhood
If there are terms in this report that you do not understand, please see
the Glossary and Understanding Cancer Rates in the End Notes section
of this report.
Acronyms/Abbreviations Used Frequently in this Report
End Notes
Survivorship
Healthy Life
ACS: The American Cancer Society.
BRFSS: Behavioral Risk Factor Surveillance System. See Data Sources for a description of this program.
CDC: Centers for Disease Control and Prevention.
MCSS: Minnesota Cancer Surveillance System of the Minnesota Department of Health.
See Data Sources for a description of this program.
MDH: Minnesota Department of Health.
Urban Minnesota: The eighteen counties considered Metropolitan Areas in the 2000 U.S. Census: Anoka,
Benton, Carver, Chicago, Clay, Dakota, Hennepin, Houston, Isanti, Olmsted, Polk, Ramsey, St Louis, Scott,
Sherburne, Stearns, Washington, and Wright Counties.
NCI: National Cancer Institute.
SEER: Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.
See Data Sources for a description of this program.
4
Minnesota Cancer Facts and Figures 2006
Intro
Lung
American Cancer Society Challenge Goals for 2015
The American Cancer Society has set ambitious goals for 2015:
How is the plan being implemented?
Task forces are working to address each of the
priority areas. Each task force has one or more
teams committed to working on a specific project
over the next one to two years. These teams add
value to cancer control efforts by creating new
collaborations and bringing together the resources
of multiple organizations.
Minnesota Cancer Facts and Figures 2006
Who is part of the Alliance?
Leading health care organizations, community-based
groups and advocates have joined the Alliance.
Membership continues to grow. Membership is free
to any organization or individual interested in
working to reduce Minnesota's cancer burden. A
complete list of member organizations is available
at www.mncanceralliance.org.
How can I get involved?
Visit the Minnesota Cancer Alliance web site at
www.mncanceralliance.org and learn more about
Cancer Plan Minnesota, the Alliance, and its task
forces and committees. You can also contact
Elizabeth Moe, Program Coordinator, at (651) 201-3608.
5
Cervix
Melanoma
Mesothelioma
- Work with new partners
- Reduce unnecessary duplication of effort
- Improve coordination of resources
Childhood
• Expanding clean indoor air policies
• Reducing disparities in cancer screening
and treatment
• Improving access to information about locally
available services for cancer patients and their
families
• Increasing colorectal cancer screening
Healthy Life
What are the priorities of the plan?
Cancer Plan Minnesota has 24 objectives spanning
the entire spectrum of cancer care, from prevention
and early detection, to treatment and quality of life.
The initial priorities for plan implementation are:
What is the
Minnesota Cancer
Alliance?
The Minnesota
Cancer Alliance is a
coalition founded in
2005 committed to
implementing Cancer
Plan Minnesota. The
Alliance grew from the
statewide partnership
of individuals and
organizations that collaborated to develop the plan.
The Minnesota Cancer Alliance provides the cancer
community with opportunities to:
Survivorship
What is Cancer Plan Minnesota?
Cancer Plan Minnesota 2005-2010 is Minnesota's
first comprehensive cancer control plan. Published
in April 2004, it is the culmination of work done
by hundreds of Minnesotans who volunteered time
and energy by serving on committees and work
groups, and who provided input at community
meetings and statewide planning summits.
Cancer Plan Minnesota is a framework for action
to reduce the burden of cancer among all Minnesotans.
End Notes
Cancer Plan Minnesota and the Minnesota Cancer Alliance
Prostate
Breast
Colorectal
• Reduce the age-adjusted cancer mortality rate by 50 percent.
• Reduce the age-adjusted cancer incidence rate by 25 percent.
• Improve the quality of life for all cancer survivors.
Intro
What is cancer? Cancer is not a single disease.
It is a group of diseases that share in common the
uncontrolled growth and spread of abnormal cells.
Cancer cells can form a mass, referred to as a tumor,
that may compress, invade, and destroy normal
tissue. If cells break away from the tumor, they can be
carried by the lymph system or by way of the
bloodstream to other areas of the body. This
spreading, or traveling, of the original tumor is called
metastasis. In this new location, the cancerous cells
continue to grow. If the spread is not controlled,
it can result in death.
Cancer is classified by the part of the body in which
it originates, by its appearance under the microscope,
and by the results of laboratory tests. Since cancer is
not a single disease, each type of cancer will vary in
growth and pattern of spread, and will also respond
differently to various types of treatment. This makes
it very important to treat each cancer and each
cancer patient individually.
Causes of Cancer Death in the U.S.
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Frequently Asked Questions about Cancer
30
Diet & Obesity
30
Sedentary Lifestyle
5
Family History
5
Infectious Agents
5
Occupational Exposures
5
5
Prenatal Factors & Growth
Reproductive Factors
3
Socioeconomic Status
3
Alcohol
Healthy Life
Survivorship
End Notes
Tobacco Use
3
Pollution
2
Radiation
2
Medicine
1
Food Additives & Contaminants
1
0
5
10
15
20
25
30
35
Percent
Source: Harvard Report on Cancer Prevention, 1996.
6
Minnesota Cancer Facts and Figures 2006
Leading Sites of New Cancer Cases
and Deaths among Females,
Minnesota, 2003
Lung
Intro
Leading Sites of New Cancer Cases
and Deaths among Males,
Minnesota, 2003
100%
100%
Source: MCSS and Minnesota Center for Health Statistics.
~ Not one of the ten most commonly diagnosed cancers
among males.
** Not one of the ten most common sites of cancer death
among males.
Minnesota Cancer Facts and Figures 2006
All Sites Combined
Deaths
14.3%
22.7%
10.9%
3.1%
4.4%
4.0%
3.3%
2.8%
2.8%
2.7%
~
4.1%
**
5.6%
**
**
4.1%
6.2%
~
~
20.0%
2.3%
2.0%
24.7%
100%
100%
Mesothelioma
4.4%
**
3.1%
5.0%
**
5.0%
3.6%
3.2%
23.8%
Cases
30.7%
12.3%
11.0%
6.0%
Childhood
4.8%
3.8%
3.8%
3.5%
2.7%
2.1%
~
~
17.3%
Breast
Lung and Bronchus
Colon and Rectum
Uterus
Non-Hodgkin’s
Lymphoma
Melanoma of the Skin
Ovary
Urinary Bladder
Thyroid
Leukemia
Pancreas
Brain and Nervous
System
Multiple Myeloma
All Others
Healthy Life
Deaths
11.6%
27.0%
10.1%
3.2%
Source: MCSS and Minnesota Center for Health Statistics.
~ Not one of the ten most commonly diagnosed cancers
among females.
** Not one of the ten most common sites of cancer death
among females.
7
Survivorship
All Sites Combined
Cases
31.8%
12.8%
10.7%
6.7%
End Notes
Prostate
Lung and Bronchus
Colon and Rectum
Urinary Bladder
Non-Hodgkin’s
Lymphoma
Melanoma of the Skin
Kidney and Renal Pelvis
Leukemia
Oral Cavity and Pharynx
Pancreas
Esophagus
Liver and Bile Duct
All Others
Melanoma
Cervix
The cell can be damaged or inhibited from repairing
damage by external or internal factors. Some
examples of external factors are tobacco, chemicals,
sunlight and other forms of radiation, and viruses and
bacteria. Internal factors include hormone levels,
inherited conditions, immune function, and
mutations that occur from metabolism. Causal factors
Who is at risk? Anyone. Even people who
“do everything right” can develop cancer. Based
on current statistics for the state, about half of
Minnesotans will be diagnosed with a potentially
serious cancer during their lifetime, and about
25 percent will die from one of these diseases.
Cancer risk increases with age. Approximately
60 percent of cancers in Minnesota are diagnosed
among persons age 65 years and older, and nearly
75 percent of cancer deaths are in this age group.
Cancer is about 30 percent more common among
men than women.
Breast
may act together or in sequence to initiate or
promote cancer. Ten or more years often pass
between exposure or mutations and detectable cancer.
Prostate
What causes cancer? Although the cause of a cancer
in an individual can only rarely be determined,
scientists believe that the first step in developing
cancer is damage to a cell. This damage can either
directly lead to uncontrolled growth, or more
commonly, is part of a sequence of events that
ultimately prevents cell repair and growth from
functioning normally.
Colorectal
Frequently Asked Questions about Cancer
Intro
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Frequently Asked Questions about Cancer
Can cancer be prevented? Tobacco use is
responsible for about 30 percent of cancer deaths.
If no one used tobacco products, nearly one out of
three cancer deaths would be prevented. More and
more evidence indicates that poor diet, lack of
exercise, and obesity increase risk for cancer. It is
estimated that a third of deaths from cancer could be
prevented if we maintained a healthy weight, ate a
healthy diet, and exercised regularly.
Being vaccinated for hepatitis B virus and being
tested and treated for HBV may prevent many liver
cancers. Being treated for Helicobacter infections of
the stomach can prevent some stomach cancers.
Avoiding exposure to human papillomavirus (HPV)
and human immunodeficiency virus, both of which
are sexually transmitted, can also eliminate some
cervical and other cancers. A vaccine to prevent
infection with HPV may be released during 2006,
but will not prevent infection with all cancer-causing
strains of HPV or eliminate current infections.
Cancer of the colon and rectum and cervical cancer
can be prevented by early detection and removal of
precancerous growths. If everyone had access to and
followed screening recommendations, most, if not all,
of these cancers could be prevented.
What is meant by "stage at diagnosis"?
Stage at diagnosis describes the extent to which
the cancer has spread from the site in which it
originated at the time it is discovered. For most
cancers, it is one of the best predictors of survival.
A number of different staging systems are used to
classify tumors. It can be confusing, because some
systems use numbers (I, II, etc), some use terms
(in situ, localized, etc), and some are only used for
specific types of cancers. Some cancers, especially
those originating the blood and the immune
system, are not typically staged. Definitions of
terms related to stage at diagnosis used in this
report are provided in the Glossary.
Why are mortality rates a better measure of the
effectiveness of screening than survival rates?
Identifying a cancer through screening before there
are any symptoms of disease (that is, during the
preclinical stage of tumor development) only
8
benefits a patient if treatment is more effective
when begun during the preclinical stage than later
on. While it seems, intuitively, that this would
always be the case, it hasn't proven to be true for all
potential screening methods. In some cases this
occurs because certain tumors, if left undiagnosed,
would grow so slowly that they would never become
life-threatening, and the person would die of
another cause. In other cases this occurs because
treatment is equally effective, or ineffective,
whether the tumor is discovered during the
preclinical phase or early in the clinical stage.
When either of these situations exists, cancers can
be diagnosed at an earlier date without actually
extending life - a patient would live to the same age
with or without screening, but with screening, he or
she would simply have known about the cancer for
a longer period of time, called "lead time."
Survival rates measure the proportion of people
with cancer who are alive a certain length of time,
usually five years, after diagnosis. Because of lead
time, five-year survival rates can appear to be
higher in a group of people who are screened than
in a comparable group who haven't been screened,
simply because they found out about their cancer
earlier. If increases in survival are meaningful, and
not biased by lead time, screened cancer patients
will live to an older age, and mortality will be lower
than in an unscreened group. Since lead time
cannot be measured directly, a decrease in
mortality rates, rather than an increase in survival
rates, is considered the best measure of the
effectiveness of a screening method.
Can cancer be cured? The answer to this question
depends very much on the type of cancer and
whether or not the cancer is detected early.
The five-year relative survival rate for many
common cancers (cancers of the breast, prostate,
colon and rectum, cervix, uterus, bladder, and testis,
and melanoma of the skin) is greater than
90 percent if found before the cancer has
metastasized. Following guidelines for cancer
screening increases the likelihood of finding cancer
early, and therefore, of survival. Based on data from
the SEER Program, the five-year relative survival
rate for cancers diagnosed between 1995 and 2001
was 66 percent.
Minnesota Cancer Facts and Figures 2006
Rate per 100,000 persons
400
300
S EE R W hit e s
M i n nes ot a
1990-1992
504.6
4 67 . 4
2000-2002
486.1
4 77 . 6
U.S. Whites
M i n n e s ot a
1990-1992
210.1
1 9 7.5
2000-2002
193.7
185.3
Mortality
200
100
Colorectal
Breast
Survivorship
20
03
20
00
19
95
19
90
19
85
19
80
19
75
0
Y e a r o f D i ag no s i s / D ea t h
Source: MCSS and SEER public use files (November 2004). Rates are age-adjusted to the
2000 U.S. population. National incidence is for the white population in SEER 9 Regions,
covering 10% of the U.S. population. National mortality is for the white population in the
entire U.S.
Minnesota Cancer Facts and Figures 2006
Prostate
Childhood
SEER/U.S.
Minnesota
Incidence
Healthy Life
500
Lung
Intro
Cancer Occurrence in Minnesota and the U.S, All Cancer Sites Combined
600
Cervix
The overall cancer mortality rate in Minnesota
declined by a total of seven percent over the last
16 years. Between 1988 and 2003, the cancer
mortality rate declined significantly by an average of
1.0 percent each year among men and by 0.4 percent
each year among women. Cancer mortality is
decreasing significantly for several common
cancers: breast, prostate, colon and rectum, and
among men, lung and bronchus.
Mesothelioma
Overall cancer rates in Minnesota are currently
slightly lower than national rates. As this report is
being written, cancer incidence data from the SEER
Program are only available through 2002. During the
three-year period 2000-2002, the overall cancer
incidence rate in Minnesota was two percent lower
than the rate among the white population in the
geographic areas reporting to SEER. During the same
years, the overall cancer mortality rate in Minnesota
was four percent lower than among the white
population in the U.S. as a whole. Although both of
these comparisons are statistically significant, cancer
rates in Minnesota are now more similar to national
rates than they were a decade ago. During the
three-year period 1990-1992, the overall cancer
incidence rate was seven percent lower in Minnesota
than in the white population in the SEER Program,
and the cancer mortality rate was six percent lower
than among the white population in the U.S.
To a large extent, the reduction in the difference in
cancer risk between Minnesota and the nation as a
whole results from the fact that lung cancer rates are
not declining as rapidly in Minnesota as in the
nation. Prostate cancer is also contributing
substantially to the reduction in difference, but this
may be an artifact of screening, as discussed in more
detail in the section on prostate cancer in this report.
Breast cancer and non-Hodgkin's lymphoma are two
other common cancers for which incidence rates in
Minnesota became more similar to or exceeded the
national rate over the last decade.
9
End Notes
Cancer is very common. Since 2000, about 23,000
Minnesotans have been diagnosed with a potentially
serious cancer each year, and more than 9,000
Minnesotans died of this disease annually.
Melanoma
Cancer in Minnesota
Intro
The overall cancer incidence rate in Minnesota
appears to have stabilized among men.
Because prostate cancer accounts for about one out
of every three cancers diagnosed among men,
fluctuations in the prostate cancer incidence rate
exert a strong influence on the overall cancer trend.
The prostate cancer incidence rate increased
dramatically during the early 1990s due to the
introduction of screening with the prostate specific
antigen test. The overall cancer incidence rate
among men declined each year since 2000,
but the downward trend is not statistically
significant.
outweigh decreases in cancer of the colon and
rectum. However, the overall cancer incidence rate
among women declined between 2001 and 2002,
and again between 2002 and 2003, largely due to
substantial decreases in breast cancer incidence
and a slowing down of the increase in lung cancer.
Although the downward trend is not statistically
significant, the change in trend in 2001 is statistically
significant. Continued surveillance will indicate
whether this change is a temporary fluctuation or a
watershed in cancer incidence.
The overall cancer incidence rate among women
in Minnesota may also have stabilized. From
1995 to 2001, the overall cancer incidence rate
among women increased significantly by an average
of 1.2 percent each year. This increase was largely
due to significant increases in breast and lung
cancer incidence, which were large enough to
If there are terms in this report that you
do not understand, please see the
Glossary and Understanding Cancer Rates
in the End Notes section of this report.
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Cancer in Minnesota
Mesothelioma
Cancer Incidence by Gender in Minnesota,
All Cancer Sites Combined, 1988-2003
650
Childhood
600
Rate per 100,000 persons
Rate increased by
an average of 3.9%
annually.
Rate increased by an average of 0.8%
annually, but the trend is not statistically
significant.
550
500
Rate increased significantly
by an average of 1.2%
annually.
Healthy Life
450
Rate ceased increasing, but the decline
is not statistically significant.
400
350
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
300
Survivorship
End Notes
Males
Females
Year of Diagnosis
Source: MCSS. Rates are age-adjusted to the 2000 U.S. population.
Dotted bars indicate where trend significantly changed direction. Note that the Y axis is truncated
to emphasize trends.
10
Minnesota Cancer Facts and Figures 2006
Intro
Lung
Colorectal
Breast
While national trends for heart disease and cancer
mortality are similar to those in Minnesota,
Minnesota was the first state with cancer as the
leading cause of death. The crossover between
cancer and heart disease mortality occurred earlier
in Minnesota than in other states primarily because
heart disease mortality is about 30 percent lower in
Minnesota than in the U.S., while cancer mortality is
only slightly lower.
Melanoma
Cancer has become the leading cause of death
in Minnesota. For the first time in 2000, and each
year since then, more Minnesotans died of cancer
than heart disease. In 2004, 9,091 Minnesotans died
of cancer, compared to 7,888 from heart disease.
Cancer has become the leading cause of death in
Minnesota in part because the heart disease mortality
rate decreased by more than 50 percent between
1980 and 2004, while cancer mortality started
declining at a later date and decreased by only four
percent over the entire 25-year period.
Cervix
More than half of all Minnesotans will be
diagnosed with a potentially serious cancer.
Based on current statistics for the state, 58 percent
of men and 47 percent of women in Minnesota will
be diagnosed with a potentially serious cancer during
their lifetimes. The lifetime risk of developing cancer
is somewhat higher in Minnesota than in the
geographic areas participating in the SEER Program
because life expectancy is higher in Minnesota, and
therefore, more people live to develop cancer.
Prostate
Cancer in Minnesota
450
Mesothelioma
Deaths Due to Heart Disease and Cancer, Minnesota, 1980-2004
Rate per 100,000 persons
Heart Disease
Cancer
400
Childhood
350
300
250
Healthy Life
200
150
100
50
Survivorship
Year of Death
Source: MCSS. Rates are age-adjusted to the 2000 U.S. population.
Minnesota Cancer Facts and Figures 2006
11
End Notes
20
04
20
02
20
00
19
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
80
0
Intro
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Cancer Disparities in Minnesota
Measuring race/ethnic differences in cancer risk in
Minnesota is limited by incomplete and possibly
inaccurate reporting of race and ethnicity on the
medical record and death certificate, an uncertain
accuracy of population estimates, and the relatively
small size of populations of color and American
Indians in our state. However, it is clear that the
risk of being diagnosed with and dying from cancer
varies by race and ethnicity, and that for some
cancers, populations of color and American Indians
experience an excess burden. This is true nationally
as well as in Minnesota. Eliminating disparities in
cancer screening and treatment is one of the
priorities of the Minnesota Cancer Alliance.
previously reported. For more information, please
see Cancer in Minnesota, 1988-2002, available on
the MCSS web site. Cancer rates can now be
reported for five race/ethnic groups in the state:
African American/black, American Indian,
Asian/Pacific Islander, Hispanic (all races),
and non-Hispanic white.
African Americans: African American and
American Indian men have the highest overall
cancer incidence and mortality rates in Minnesota.
Over the five-year period 1999-2003, the overall
incidence rate was slightly lower among African
American than among American Indian men, but
the difference was not statistically significant.
The overall cancer mortality rate was nearly
identical in these two groups as well.
Since Minnesota Cancer Facts and Figures 2003 was
published, several steps have been taken to improve
the accuracy of information about the race and
ethnicity of persons with cancer reported to MCSS.
Because of this, cancer rates among American
Indians are now about 30 percent higher than
The cancer incidence rate among African American
men in Minnesota was 20 percent higher than for
Cancer Incidence by Race/Ethnicity and Gender, Minnesota, 1999-2003
800
700
Rate per 100,000 persons
662.3
679.1
600
551.2
500
440. 5
409. 9
383.5
400
African American
American Indian
Asian/Pacific Islander
Hispanic (all races)
Non-Hispanic White
317.2
300
268. 6
247.3
200
100
0
M a le s
F emales
Source: MCSS. Rates are age-adjusted to the 2000 U.S. population.
12
Minnesota Cancer Facts and Figures 2006
800
Rate per 100,000 persons
African American
American Indian
Asian/Pacific Islander
Hispanic (all races)
Non-Hispanic White
700
600
500
400
315.6 319.7
200
227.1
162.3 177.8
240.4
189.6
156.3
118.6 108.3
100
0
F emales
Source: MCSS. Rates are age-adjusted to the 2000 U.S. population.
Minnesota Cancer Facts and Figures 2006
Colorectal
Survivorship
Ma le s
Breast
Healthy Life
300
Lung
Intro
Cancer Mortality by Race/Ethnicity and Gender, Minnesota, 1999-2003
Mesothelioma
Melanoma
The cancer incidence rate among American Indian
men in Minnesota was 23 percent higher than for
non-Hispanic white men, while their mortality rate
was 41 percent higher. Higher cancer mortality
among American Indian compared to non-Hispanic
Prostate
American Indians: American Indian men have the
highest overall cancer rates in Minnesota. Over the
five-year period 1999-2003, the overall incidence
rate for American Indian men was slightly higher
than among African American men, but the
difference was not statistically significant. Their
overall cancer mortality rates were nearly identical
as well.
Childhood
Over the same time period, the overall cancer
incidence rate among African American women in
Minnesota was three percent lower than that of
non-Hispanic white women, but their cancer
mortality rate was 21 percent higher. Higher overall
cancer mortality among African American
compared to non-Hispanic white women was
primarily due to lung cancer (37% higher rate),
cancer of the colon and rectum (58% higher rate),
multiple myeloma (three times higher) and
pancreas cancer (50% higher rate).
Overall cancer incidence among African Americans
is very similar in Minnesota and the geographic
areas participating in the SEER Program.
The overall cancer mortality rate among African
Americans is similar in Minnesota and the
U.S. as a whole.
13
End Notes
African Americans, continued: non-Hispanic
white men, while their mortality rate was
39 percent higher. Higher overall cancer mortality
among African American compared to
non-Hispanic white men was primarily due to
lung cancer (53% higher rate), prostate cancer
(97% higher rate), and liver cancer (more than four
times higher).
Cervix
Cancer Disparities in Minnesota
Intro
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Cancer Disparities in Minnesota
American Indians, continued: white men was
primarily due to lung cancer (75% higher rate),
prostate cancer (62% higher rate), and colon and
rectum, kidney and esophageal cancer (each more
than two times higher).
Over the same time period, the overall cancer
incidence rate among American Indian women in
Minnesota was seven percent higher than that of
non-Hispanic white women, but their cancer
mortality rate was 54 percent higher. Higher cancer
mortality among American Indian compared to
non-Hispanic white women was primarily due to
lung cancer (more than two times higher), cancer
of the colon and rectum (69% higher), and stomach
cancer (almost five times higher).
Overall cancer incidence among American Indians
is more than two times higher in Minnesota than in
the geographic areas participating in the SEER
Program. The overall cancer mortality rate among
American Indians is more than two times higher in
Minnesota than in the U.S. as a whole.
Asian/Pacific Islanders: Asian/Pacific Islanders
have the lowest overall cancer incidence and
mortality rates in Minnesota. From 1999 to 2003,
the overall cancer incidence rate among
Asian/Pacific Islander men in Minnesota was
51 percent lower than among non-Hispanic white
men, but their mortality rate was only 29 percent
lower. Similarly, the overall cancer incidence rate
among Asian/Pacific Islander women in Minnesota
was 40 percent lower than among non-Hispanic
white women, but their mortality rate was only
24 percent lower. This indicates that although their
risk of developing cancer is lower, Asian/Pacific
Islanders in Minnesota may have poorer survival
than non-Hispanic whites, or are more likely to be
diagnosed with more lethal cancers.
Although Asian/Pacific Islanders had the lowest
rates for most of the cancers included in this report,
they had the highest rates of liver and stomach
cancer, three or more times higher than among
non-Hispanic whites. Asian/Pacific Islander women
were also at increased risk of cervical cancer
compared to non-Hispanic white women.
14
Although overall cancer incidence among
Asian/Pacific Islanders is 24 percent lower in
Minnesota than in the geographic areas covered by
the SEER Program, their cancer mortality rate is
15 percent higher than among Asian/Pacific
Islanders in the U.S. as a whole.
Hispanics (all races): Hispanics have the second
lowest overall cancer rate in Minnesota. From
1999 to 2003, the overall cancer incidence rate
among Hispanic men in Minnesota was 30 percent
lower than among non-Hispanic white men, and
their mortality rate was 22 percent lower. Similarly,
the overall cancer incidence rate among Hispanic
women in Minnesota was 23 percent lower than
among non-Hispanic white women, and their
mortality rate was 31 percent lower.
Although Hispanics had the lowest rates for most
of the cancers included in this report, they had the
second highest rates of liver and stomach cancer,
two or more times higher than among
non-Hispanic whites. Hispanic women were also at
increased risk of cervical cancer compared to
non-Hispanic white women.
Overall cancer incidence among Hispanics is very
similar in Minnesota and the geographic areas
covered by the SEER Program. Their cancer
mortality rate is very similar to Hispanics in the
U.S. as a whole.
Much remains to be learned about the
causes of race/ethnic differences in
cancer incidence and mortality, and the
relative importance of cultural, social,
economic, and genetic differences is
controversial. However, until all
Minnesotans have equal access to
quality health care, it is likely that
disparities will persist.
Minnesota Cancer Facts and Figures 2006
Over the five-year period 1999-2003, more than
2,700 Minnesotans were diagnosed with lung and
bronchus cancer each year. It was the second most
commonly diagnosed cancer among men and
among women. About 65 percent of Minnesotans
diagnosed with lung cancer were 65 years of age or
older. The age-adjusted incidence rate for lung
cancer in Minnesota in 2003 was 71.8 new cases
per 100,000 men and 50.7 new cases per 100,000
women. These rates may be underestimated
because MCSS only collects information on lung
cancers that are microscopically confirmed.
Nationally, about seven percent of lung cancers are
clinically diagnosed without microscopic
confirmation.
From 1999 to 2003, more than 2,250 Minnesotans
died of lung cancer each year. It was the leading
cause of cancer death for men and for women,
and killed as many Minnesotans as cancers of the
prostate, breast, and colon and rectum combined.
About 73 percent of deaths due to lung cancer
Minnesota Cancer Facts and Figures 2006
Although about the same number of Minnesotans
were diagnosed with cancers of the lung and of the
colon and rectum each year, nearly two and a half
times as many died from lung cancer. Based on data
from the SEER Program, the five-year relative survival
rate for lung cancer is 15 percent, compared to
65 percent for cancers of the colon and rectum.
Even when diagnosed at the same stage, lung
cancer patients have a poorer chance of survival
than persons diagnosed with many other major
cancers.
15
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Intro
occurred among Minnesotans 65 years of age or
older. The age-adjusted mortality rate for lung and
bronchus cancer in Minnesota in 2003 was 59.3
deaths per 100,000 men and 36.9 deaths per 100,000
women. These rates are based on the underlying
cause of death on the death certificate, whether or
not the cancer was microscopically
confirmed, and are therefore comparable to
mortality rates reported for the U.S.
Mesothelioma
The Burden of Lung Cancer in Minnesota
Childhood
Although much progress has been made, one out of
five Minnesota adults still smoke. Two of the most
effective ways of reducing smoking are strong
anti-tobacco legislation and statewide
comprehensive tobacco control programs.
Healthy Life
• Cigarette smoking, even low-tar
cigarettes
• Cigar smoking
• Pipe smoking
• Secondhand smoke, whether in the
home or workplace
• Exposure to asbestos fibers, especially
among smokers
• Breathing in radon, a radioactive gas
produced by uranium and present in
some homes
• Occupational exposures to diesel
exhaust, gasoline, radioactive ores,
chromium, arsenic, and metal dust
• Chronic inflammation of the lungs due
to pneumonia, tuberculosis, silicosis, or
berylliosis
• Air pollution
As many Minnesotans die from lung and bronchus
cancer as from cancers of the breast, prostate, and
colon and rectum combined. What is particularly
tragic is that we know how to prevent these deaths.
Approximately 90 percent of lung cancers are
caused by tobacco use. Tobacco use also increases
the risk of developing cancers of the nasal passages,
mouth, throat, esophagus, stomach, liver, pancreas,
kidney, bladder, and cervix, and some forms of
leukemia. When heart disease and other types of
lung disease caused by tobacco are considered,
CDC estimates that smoking reduces life
expectancy by 13.2 years for men and 14.5 years for
women. Given that current life expectancy in the
U.S. is 77.5 years, this means that smoking can
basically eliminate your retirement.
Survivorship
Risk Factors for Lung Cancer
End Notes
Lung and Bronchus Cancer in Minnesota
Intro
Lung and Bronchus Cancer Mortality
by Race/Ethnicity and Gender,
Minnesota, 1999-2003
60.6
Breast
60
50.4
34.3
40
17.2
20
36.7
20.7
0
African
American
American
Indian
Asian/Pacific Hispanic
(all races)
Islander
No nHispanic
White
Trends in Lung Cancer
Lung cancer trends are very different for men
and women, both nationally and in Minnesota.
Among men, lung cancer mortality has been
declining steadily and significantly since about
1990. Between 1988 and 2003, lung cancer mortality
decreased by a total of 13 percent among
Minnesota men.
End Notes
Lung and Bronchus Cancer Mortality by
Gender in Minnesota and the U.S.
100
Rate per 100,000 persons
Lung cancer mortality is still increasing
significantly among Minnesota women. However,
it appears that the rate of increase may be slowing
down. Between 1988 and 1993, the lung cancer
mortality rate among women in Minnesota
increased by an average of 3.9 percent each year,
while between 1993 and 2003 it increased by an
average of 1.3 percent annually. Nonetheless,
over the entire sixteen-year period lung cancer
mortality increased by a total of 36 percent among
women in Minnesota.
U.S.
Minnesota
Males
90
80
70
60
50
40
Females
30
20
10
0
Year of Death
Source: MCSS and SEER Cancer Statistics Review,
1975-2002. Rates are age-adjusted to the 2000 U.S.
population. National mortality is for the white population
in the entire U.S.
Five-Year Relative Survival from
Lung and Bronchus Cancer in the U.S.
Stage
Localized
Regional
Distant
All Stages
Survivorship
Healthy Life
Childhood
Mesothelioma
Cervix
Source: MCSS. Rates are age-adjusted to the 2000 U.S.
population.
Melanoma
Prostate
38.3
20
03
80
20
00
Ma le s
F em ales
87.8
19
95
92.8
19
90
106.1
100
19
85
Rate per 100,000 persons
African American and American Indian men in
Minnesota have the highest lung cancer rates.
Their risk of dying of this disease is nearly twice that
of non-Hispanic white men. Similarly, the lung
cancer rate among African American women is
about 40 percent higher, and among American
Indian women is more than twice that, of
non-Hispanic white women. Although overall lung
cancer mortality is 15 percent lower in Minnesota
than nationally, mortality among American Indians
is more than two and a half times higher in
Minnesota than in the U.S. as a whole.
19
80
120
Disparities in Lung Cancer
19
75
Colorectal
Lung
Lung and Bronchus Cancer in Minnesota
Whites
49.9%
16.4%
2.0%
15.5%
Blacks
43.8%
14.7%
1.6%
13.2%
Source: SEER Cancer Statistics Review, 1975-2002.
Based on cases diagnosed during 1995-2001.
16
Minnesota Cancer Facts and Figures 2006
Kittson
Intro
Koochiching
Northwest
57.1
Marshall
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Lake
of the
Woods
Roseau
St. Louis
Beltrami
Pennington
Polk
Cook
Clear
Water
Red Lake
Northeast
70.3
Itasca
Over the five-year period 1999-2003, the male lung
cancer mortality rate was significantly higher than
the statewide average in Northeast Minnesota and
in St. Louis and Ramsey Counties. Nonetheless,
lung cancer mortality among males was lower than
the U.S. average in each Minnesota region and in
the six largest counties.
Colorectal
Minnesota = 60.9
US** = 74.1
Lake
Breast
Among men: During 2000-2002, the lung cancer
mortality rate among men was 18 percent lower in
Minnesota than among white men in the U.S.
as a whole.
Lung Cancer Mortality Rates*
among Males in Minnesota Regions
and Six Largest Counties, 1999-2003
Mahnomen
Norman
+XEEDUG
Cass
Becker
Clay
Aitkin
Wadena
Crow Wing
Carlton
Ottertail
Wilkin
West Central
59.0
Grant
Douglas
Stevens
Pope
Pine
Todd
Central
61.9
Mille
Lacs
Benton
Traverse
Stearns
Isanti
Big Stone
Sherburne
Chisago
Swift
.DQGLYRKL
Anoka
Meeker
WashingRam- ton
sey
Wright
Chippewa
Metro
62.1
Hennepin
Lac Qui Parle
Carver
McLeod
Renville
Scott
Yellow Medicine
County
Rate
Anoka
Dakota
Hennepin
Ramsey
St Louis
Washington
68.1
54.6
60.7
70.6
70.4
61.2
Kanabec
Morrison
Prostate
Geographic Differences
in Lung Cancer Mortality
Lung
Lung and Bronchus Cancer in Minnesota
Dakota
Sibley
Goodhue
Southeast
South Central
54.2
Brown
Blue Earth
Murray
Cottonwood
Nobles
Jackson
Watonwan
Martin
Wabasha
Olmsted
Waseca
Steele
Dodge
Freeborn
Faribault
60.1
Mower
Winona
Cervix
Rock
Rice
Houston
Fillmore
Minnesota = 36.8
US** = 42.2
Koochiching
Northwest
34.6
Marshall
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Lake
of the
Woods
Roseau
St. Louis
Beltrami
Pennington
Polk
Mesothelioma
Kittson
Melanoma
Lung Cancer Mortality Rates*
among Females in Minnesota Regions
and Six Largest Counties, 1999-2003
Cook
Clear
Water
Red Lake
Northeast
40.3
Itasca
Lake
Mahnomen
Norman
+XEEDUG
Cass
Becker
Clay
Aitkin
Wadena
Crow Wing
Carlton
Ottertail
Wilkin
West Central
Pine
Douglas
Stevens
Pope
Central
34.0
Mille
Lacs
Benton
Traverse
Stearns
Isanti
Big Stone
Sherburne
The average numbers of lung cancer
cases and deaths each year in Minnesota
counties are shown in the End Notes
section of this report.
Chisago
Swift
.DQGLYRKL
Anoka
Meeker
WashingRam- ton
sey
Wright
Chippewa
Metro
42.3
Hennepin
Lac Qui Parle
McLeod
Renville
Carver
Scott
Yellow Medicine
County
Rate
Anoka
Dakota
Hennepin
Ramsey
St Louis
Washington
52.7
38.6
41.9
42.0
37.9
42.8
Kanabec
Morrison
Childhood
Todd
28.6
Grant
Dakota
Sibley
Lincoln
Lyon
Redwood
Southwest
27.0
Pipestone
Rock
Le
Sueur
Nicollet
South Central
27.4
Rice
Murray
Cottonwood
Nobles
Jackson
Goodhue
Southeast
Brown
Blue Earth
Watonwan
Martin
Faribault
Wabasha
Olmsted
Waseca
Steele
Freeborn
Dodge
Mower
31.5
Fillmore
Winona
Houston
Rates are per 100,000 persons, age-adjusted to the 2000
U.S. population. Significance was determined by
comparison of 95% confidence intervals.
* Rates based on fewer than 10 cases or deaths are not
shown.
**Whites in the U.S, 2000-2002, SEER public use files
(November 2004).
Minnesota Cancer Facts and Figures 2006
17
Healthy Life
Pipestone
Le
Sueur
Nicollet
Survivorship
Redwood
Southwest
54.6
Among women: During 2000-2002, the lung cancer
mortality rate among women was 11 percent lower
in Minnesota than among white women in the U.S.
as a whole.
The female lung cancer mortality rate varied
considerably throughout the state - it was
60 percent higher in the region with the highest rate
than in the region with the lowest. Anoka,
Hennepin, and Ramsey Counties and the Metro
Area had rates that were significantly higher than
the statewide average. Rates in these areas were
similar to U.S. rate. Rates were significantly lower
than the state average in the three regions in the
southern tier of the state and in West Central
Minnesota.
Lyon
End Notes
Lincoln
Intro
Prostate
Breast
Colorectal
Lung
Lung and Bronchus Cancer in Minnesota
Cigarette Smoking
Considerably lower lung cancer rates in Minnesota
indicate that in the past, cigarette smoking was
less common in Minnesota than in the U.S. as a
whole. However, this isn't the case today. Based on
data from the 2004 BRFSS, the percent of adults in
Minnesota who reported that they currently smoke
(21%) was the same as the median of the 52 states
and territories participating in the BRFSS (21%).
Smoking rates were not significantly lower in
Minnesota among either men (22% in Minnesota
and 23% in the U.S. as a whole) or women
(19% and 19%, respectively).
Combining responses from survey participants over
the five-year period 2000-2004, American Indians
were more than twice as likely to report that they
currently smoke than other gender/race groups
in the state.
Trends in Adult Smoking by Gender,
Minnesota, 1984-2004
70
Percent Current Smokers
Males
Females
Cervix
60
50
40
Melanoma
30
20
10
Childhood
Mesothelioma
04
Adult Smoking by Gender and Race/Ethnicity,
Minnesota, 2000-2004
70
Percent Current Smokers
African American
American Indian
Asian/Pacific Islander
Hispanic
Non-Hispanic White
58
58
60
Healthy Life
40
30
30
27
26
22
23
20
20
10
Survivorship
20
Source: Minnesota BRFSS. Analyses were conducted by MCSS.
Current smokers have smoked at least 100 cigarettes and smoke every day
or some days.
50
End Notes
02
20
20
00
98
96
19
19
94
19
19
92
90
19
88
19
86
19
19
84
0
19
7
0
Males
Females
Source: Minnesota BRFSS. Analyses were conducted by MCSS.
Current smokers have smoked at least 100 cigarettes and smoke every day
or some days.
18
Minnesota Cancer Facts and Figures 2006
Intro
Lung
Lung and Bronchus Cancer in Minnesota
Cigarette Smoking
than in urban (20%) Minnesota, among adults
with less than a high school education, smoking
is more common in urban (34%) than rural (27%)
Minnesota.
Colorectal
Cigarette smoking is strongly associated with
education: among persons who do not have a
high school degree, 31 percent currently smoke,
compared to 30 percent of high school graduates,
23 percent of those with some post-secondary
education, and 11 percent of college graduates.
Although cigarette smoking is slightly more
common among adults residing in rural (22%)
Breast
The Minnesota Student Survey reported that
cigarette smoking among students was lower in
2004 than in 2001.
Percent Current Smokers
50
40
30
Cervix
Not a HS Graduate
HS Graduate
Post-HS Education
College Grad
60
34
27
30
29
23
22
Melanoma
70
Prostate
Adult Smoking by Education and Residence,
Minnesota, 2000-2004
20
12
11
10
0
Urban
Mesothelioma
Rural
Source: Minnesota BRFSS. Analyses were conducted by MCSS.
Current smokers have smoked at least 100 cigarettes and smoke every day or
some days. HS is high school. Urban residents live in one of the 18 counties
designated as “metropolitan” in the 2000 census.
70
Childhood
Trends in Student Smoking by Grade,
Minnesota, 1992-2004
Percent Smoked Cigarettes during the Previous 30 Days
Grade 12
Grade 9
Grade 6
60
Healthy Life
50
42
39
40
35
31
30
30
31
10
19
19
8
5
15
7
3
3
2001
2004
Survivorship
20
0
1992
1995
1998
Source: Modified from tables in Minnesota Student Survey 1992-2004
Trends: a picture of the behaviors, attitudes and perceptions of Minnesota’s
6th, 9th, and 12th graders.
Minnesota Cancer Facts and Figures 2006
19
End Notes
21
Intro
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Cancer of the Colon and Rectum in Minnesota
More Minnesotans die of cancer of the colon and
rectum than either breast or prostate cancer.
Only lung cancer kills more people. Screening tests
offer a powerful opportunity for the prevention,
early detection, and successful treatment of this
disease, but less than two-thirds of Minnesotans
ages 50 and older report being screened as
recommended. Because screening can prevent
cancer of the colon and rectum by removing
precancerous polyps, not being screened is actually
a risk factor for this disease. Individuals with any of
the moderate to high risk factors listed below
should discuss with their physician the advisability
of initiating screening at an earlier age or being
screened more frequently.
Great progress against colon and rectum
cancer can be made by following screening
recommendations and by encouraging others
to do so as well.
Moderate to High Risk Factors for
Cancer of the Colon and Rectum
• Family history of colorectal cancer
• Family history of adenomatous polyps
• Family history of hereditary colorectal
cancer syndrome
• Personal history of colorectal polyps or
colorectal cancer
• Personal history of inflammatory bowel
disease
Other Risk Factors
•
•
•
•
•
Not being screened
Obesity
Alcohol
Poor diet
Physical inactivity
The Burden of Cancer of the Colon and Rectum in Minnesota
Over the five-year period 1999-2003, about 2,500
Minnesotans were diagnosed with cancer of the
colon and rectum each year. It was the third most
commonly diagnosed cancer for men and for
women, and the fourth most common for both
sexes combined. About 70 percent of Minnesotans
diagnosed with cancer of the colon and rectum
were 65 years of age or older. The age-adjusted
incidence rate for cancer of the colon and rectum
in Minnesota in 2003 was 59.2 new cases per
100,000 men and 42.7 new cases per 100,000 women.
From 1999 to 2003, more than 900 Minnesotans
died of cancer of the colon and rectum each year.
Cancer of the colon and rectum was the third
leading cause of cancer death for men and for
women, and the second leading cause for both
sexes combined.
20
About 80 percent of deaths due to cancer of the
colon and rectum occurred among Minnesotans
65 years of age or older. The age-adjusted mortality
rate for cancer of the colon and rectum in
Minnesota in 2003 was 22.5 deaths per 100,000
men and 16.0 deaths per 100,000 women.
The higher death rate for cancer of the colon and
rectum compared to breast and prostate cancer
results in part from the fact that only 40 percent of
cancers of the colon and rectum in Minnesota are
diagnosed at an early stage, when they can be more
successfully treated. In comparison, nearly 70
percent of breast cancers and more than 90 percent
of prostate cancers are diagnosed at an early stage.
Minnesota Cancer Facts and Figures 2006
Intro
Lung
Cancer of the Colon and Rectum in Minnesota
have rates that are 13 percent lower than American
Indian women and 18 percent higher than
non-Hispanic white women. Asian/Pacific Islander
men and women have the lowest rates. Mortality
due to cancer of the colon and rectum among
American Indians is twice as high in Minnesota
than in the U.S. as a whole.
Colorectal Cancer in Minnesota
and the U.S.
Colorectal Cancer Incidence by
Race/Ethnicity and Gender,
Minnesota, 1999-2003
I n ci de n c e
SEER/U.S.
Minnesota
120
Rate per 100,000 persons
108.9
Ma le s
F e m a le s
100
60
80
60
40
59.8
59.5
59.8
52.1
51.6
44.0
M o rt a l i ty
40
25.9
20
26.3
31.2
20
10
0
American
Indian
Asian/Pacific Hispanic
Islander
(all races)
Y e a r o f D i a g no s i s / D ea t h
Minnesota Cancer Facts and Figures 2006
Mesothelioma
Cancer of the colon and rectum incidence and
mortality rates in Minnesota have decreased
significantly since statewide cancer reporting was
implemented in 1988. Between 1988 and 2003,
the incidence rate decreased by 17 percent and
mortality by 25 percent. Trends in Minnesota are
similar to those reported by the SEER Program.
The reason for steadily decreasing rates of cancer
of the colon and rectum is not fully understood.
Increasing use of screening for cancer of the colon
and rectum may account for some of the decrease.
Other factors such as increasing use of hormone
replacement therapy among women and increasing
use of aspirin to prevent heart disease, both of
which may reduce the risk of cancer of the colon
and rectum, may also be involved.
Five-Year Relative Survival from
Colorectal Cancer in the U.S.
Stage
Localized
Regional
Distant
All Stages
Whites
90.8%
68.8%
9.9%
65.0%
Blacks
84.1%
61.0%
8.1%
55.0%
Childhood
Trends in Cancer of the
Colon and Rectum
Source: MCSS. Rates are age-adjusted to the 2000
U.S. population.
Healthy Life
Source: MCSS and SEER Cancer Statistics Review,
1975-2002. Rates are age-adjusted to the 2000 U.S.
population. National incidence is for the white
population in SEER 9 Regions, covering 10% of the U.S.
population. National mortality is for the white population
in the entire U.S.
No nHispanic
White
Melanoma
African
American
Source: SEER Cancer Statistics Review, 1975-2002.
Based on cases diagnosed during 1995-2001.
Survivorship
20
00
20
03
19
95
19
90
19
85
19
80
0
19
75
Cervix
50
30
Prostate
Rate per 100,000 persons
21
End Notes
80
70
Breast
American Indian men in Minnesota have the
highest incidence rate of cancer of the colon and
rectum. Their risk of being diagnosed with this
disease is 80 percent higher than for non-Hispanic
white men. African American men, non-Hispanic
white men and American Indian women have about
the same rates, while African American women
Colorectal
Disparities in Cancer of the Colon and Rectum
Intro
Colorectal
Lung
Cancer of the Colon and Rectum in Minnesota
Geographic Differences in the Incidence
of Cancer of the Colon and Rectum
During 2000-2002, the incidence rate of cancer of
the colon and rectum was about the same in
Minnesota as among whites in the geographic areas
reporting to the SEER Program.
Colorectal Cancer Incidence Rates*
in Minnesota Regions and Six Largest
Counties, 1999-2003
Minnesota = 51.6
SEER** = 52.1
Kittson
Roseau
Cook
Clear
Water
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Red Lake
Northeast
54.4
Itasca
During the five-year period 1999-2003, incidence
rates of cancer of the colon and rectum were
significantly higher in Southwest, West Central and
Northwest Minnesota than the state average.
Rates were significantly lower in the Metro Area
and Ramsey and Hennepin Counties.
+XEEDUG
Cass
Becker
Aitkin
Wadena
Crow Wing
Carlton
Ottertail
Wilkin
West Central
58.8
Grant
Douglas
Stevens
Pope
Pine
Todd
Central
52.7
Mille
Lacs
Benton
Traverse
Stearns
Isanti
Big Stone
Sherburne
Chisago
.DQGLYRKL
Anoka
Chippewa
Geographic differences in the incidence of cancer of
the colon and rectum may reflect differences in the
proportion of the population who are screened, as
well as differences in the underlying risk of
developing this disease.
During 2000-2002, the incidence rate of cancer of
the colon and rectum was six percent lower in
Minnesota than among whites in the U.S. as a whole.
Geographic differences in cancer mortality reflect
variations in incidence as well as factors affecting
survival, such as stage at diagnosis, treatment,
access to health care, and overall health status.
Survivorship
Carver
Rate
Anoka
Dakota
Hennepin
Ramsey
St Louis
Washington
46.4
47.6
46.6
47.2
54.3
47.4
Scott
Dakota
Sibley
Lyon
Redwood
Pipestone
Rock
Le
Sueur
Nicollet
Southwest
56.4
Rice
Goodhue
Southeast
South Central
55.1
Brown
Blue Earth
Murray
Cottonwood
Nobles
Jackson
Watonwan
Martin
Wabasha
Olmsted
Waseca
Steele
Dodge
Freeborn
Faribault
Winona
54.8
Mower
Houston
Fillmore
Colorectal Cancer Mortality Rates* in
Minnesota Regions and Six Largest
Counties, 1999-2003
Minnesota = 18.4
US** = 19.6
Kittson
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Lake
of the
Woods
Roseau
Koochiching
Northwest
19.8
St. Louis
Beltrami
Pennington
Polk
Cook
Clear
Water
Red Lake
Northeast
18.1
Itasca
Lake
Mahnomen
Norman
+XEEDUG
Cass
Becker
Clay
Aitkin
Crow Wing
Wadena
Carlton
Ottertail
Wilkin
West Central
20.1
Grant
Douglas
Stevens
Pope
Pine
Todd
Central
18.5
Mille
Lacs
Benton
Traverse
Stearns
Isanti
Sherburne
Chisago
Swift
.DQGLYRKL
Anoka
Meeker
WashingRam- ton
sey
Wright
Chippewa
Metro
17.6
Hennepin
Lac Qui Parle
McLeod
Renville
Carver
Scott
Yellow Medicine
County
Rate
Anoka
Dakota
Hennepin
Ramsey
St Louis
Washington
19.7
18.2
17.2
16.9
18.6
18.0
Kanabec
Morrison
Big Stone
Dakota
Sibley
Lincoln
Lyon
Redwood
Southwest
20.2
Rock
22
McLeod
Renville
Pipestone
The average numbers of cases and
deaths due to cancer of the colon and
rectum each year in Minnesota counties
are shown in the End Notes section of
this report.
Metro
46.9
Hennepin
Yellow Medicine
Lincoln
Marshall
None of the regions or counties had mortality rates
of cancer of the colon and rectum that were
significantly higher or lower than the state average.
In general, the areas with the highest incidence
rates had the highest mortality rates.
WashingRam- ton
sey
Wright
Lac Qui Parle
County
Kanabec
Morrison
Meeker
Geographic Differences in Mortality due
to Cancer of the Colon and Rectum
Lake
Mahnomen
Norman
Clay
Swift
Healthy Life
Childhood
St. Louis
Beltrami
Pennington
Polk
End Notes
Koochiching
Northwest
59.8
Marshall
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Lake
of the
Woods
Le
Sueur
Nicollet
South Central
19.0
Rice
Murray
Cottonwood
Nobles
Jackson
Goodhue
Southeast
Brown
Blue Earth
Watonwan
Martin
Faribault
Wabasha
Olmsted
Waseca
Steele
Freeborn
Dodge
Mower
18.8
Fillmore
Winona
Houston
Rates are per 100,000 persons, age-adjusted to the 2000
U.S. population. Significance was determined by
comparison of 95% confidence intervals.
* Rates based on fewer than 10 cases or deaths are
not shown.
**Whites in the SEER 9 Regions (incidence) or in the U.S.
(mortality), 2000-2002, SEER public use files
(November 2004).
Minnesota Cancer Facts and Figures 2006
Intro
40
20
62
37
39
16
16
7
7
~
2001
2002
2003
0
62
Breast
60
60
45
12
5
2004
Source: Minnesota BRFSS. Analyses were conducted by
MCSS. Up-to-date adults had an FOBT within one year or
had lower endoscopy in the past five years.
Minnesotans Up-to-Date on Colorectal
Cancer Screening by Education and
Residence, Minnesota, 2002 and 2004
100
Percent of Persons Ages 50 and Older
80
63
60
56
Colorectal
Lower Endoscopy Only
Both
FOBT Only
80
63
65
57
Not a HS Graduate
HS Graduate
Colle ge
Prostate
Based on data from the 2004 BRFSS, Minnesotans
were more likely to report having had at least one
lower endoscopic exam (66%) than the median of
the 52 states and territories participating in the
BRFSS (53%). The percent of Minnesotans ages 50
and older that either had lower endoscopy within
the last five years or a fecal occult blood test (FOBT)
within the last year was about the same in 2001,
2002 and 2004, and was similar for men (61%) and
women (62%).
Percent of Persons Ages 50 and Older
100
Cervix
Many colorectal cancers could be completely
prevented through screening. Lower endoscopic
examinations that view the interior of the colon and
rectum (sigmoidoscopy and colonoscopy) can find
polyps, the precursors of cancer. Removing these
small tissue growths can be done on an outpatient
basis. Colorectal cancer screening can also find
polyps that have become cancerous at an early stage
and thereby reduce cancer mortality. Several
methods of screening have been shown to be
effective. The important thing is to be screened.
Minnesotans Up-to-Date on Colorectal
Cancer Screening by Year and
Screening Test
Melanoma
Screening for Cancer of the
Colon and Rectum
Lung
Cancer of the Colon and Rectum in Minnesota
46
0
Rural
Urban
Source: Minnesota BRFSS. Analyses were conducted by
MCSS. Up-to-date adults had an FOBT within one year or
had lower endoscopy in the past five years. HS is high
school. Urban residents lived in one of the 18 counties
designated as “metropolitan” in the 2000 Census.
Healthy Life
American Cancer Society Screening Guidelines for the Early Detection of
Cancer of the Colon and Rectum in Asymptomatic People
Beginning at age 50, men and women should follow one of the examination
schedules below:
A fecal occult blood test (FOBT) every year
A fecal immunochemical test (FIT) every year
A flexible sigmoidoscopy (FSIG) every five years
Annual FOBT and FSIG every five years*
A double-contrast barium enema every five years
A colonoscopy every 10 years
Survivorship
•
•
•
•
•
•
*Combined testing is preferred over either annual FOBT or FSIG every five years, alone. People who are at
moderate or high risk for colorectal cancer should talk with a doctor about a different testing schedule.
Minnesota Cancer Facts and Figures 2006
Childhood
20
Mesothelioma
40
23
End Notes
The percent of Minnesotans who were "up-to-date"
on recommended colorectal cancer screening was
lower in rural Minnesota (57%) than urban (64%),
and increased with education (not a high school
graduate, 51%; high school graduate, 59%; some
post-secondary education or college graduate, 64%).
There were too few interviews among persons of
color and American Indians over the three-year
period to present colorectal cancer screening rates
by race/ethnicity.
Intro
Lung
Breast Cancer in Minnesota
Colorectal
Risk Factors for Female Breast Cancer
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
• First-degree family history of breast
cancer, especially at a young
(premenopausal) age
• Personal history of proliferative breast
disease
• Personal history of breast cancer
• Personal history of radiation therapy
to the chest as treatment for another
cancer as a child or young adult
• Onset of menstruation before age 12
• Onset of menopause after age 50
• Delayed childbearing, having fewer
or no children
• Use of hormone replacement therapy
• Obesity and high fat diet
• Physical inactivity
• Alcohol consumption
• Higher socioeconomic status
• Inherited mutations in BRCA1 or
BRCA2 genes
Many of the well-established risk factors for breast
cancer appear to increase a woman's lifetime
exposure to internally produced estrogen, and are
therefore not easy to modify. Although many risk
factors for breast cancer have been identified, they
only explain an estimated 30 to 50 percent of breast
cancers. The majority of women diagnosed with
this disease do not have a known risk factor.
The best defense against breast cancer is routine
screening with mammography and breast
examinations by a trained health care professional.
Screening cannot prevent breast cancer, but it does
increase the likelihood of finding tumors at an early
stage when survival is high.
The Burden of Breast Cancer
in Minnesota
From 1999 to 2003, more than 3,500 women and
about 25 men were diagnosed with invasive breast
cancer each year in Minnesota. Breast cancer is
uncommon among men, but is the most commonly
diagnosed cancer for women, accounting for nearly
one out of every three cancers. About 45 percent of
Minnesota women diagnosed with breast cancer
were 65 years of age or older, and 34 percent were
between the ages of 50 and 64. The age-adjusted
incidence rate for female breast cancer in
Minnesota in 2003 was 125.3 new cases per
100,000 women.
Between 1999 and 2003, about 670 women and
5 men died of breast cancer each year in
Minnesota. Despite substantial decreases in breast
cancer mortality in the last decade, it is the second
leading cause of cancer death for women; in 2003
it accounted for 14 percent of all female cancer
24
deaths. About 60 percent of deaths due to breast
cancer in Minnesota occurred among women
65 years of age or older. The age-adjusted mortality
rate for breast cancer in Minnesota in 2003 was
22.7 deaths per 100,000 women.
Compared to many other cancers, survival from
breast cancer is quite high. When diagnosed at
an early stage, five-year relative survival is nearly
98 percent.
Minnesota Cancer Facts and Figures 2006
Intro
the breast cancer incidence rate among American
Indian women in Minnesota is 34 percent lower
than among non-Hispanic white women, but their
mortality rate is about ten percent higher. These
relationships indicate that African American and
American Indian women are both considerably less
likely to survive breast cancer than non-Hispanic
white women in Minnesota.
105. 5
89. 2
83. 4
80
60
59.4
40
27. 7
20
27. 1
23. 5
24.4
8.2
0
Incidence
Mortality
Stage
Localized
Regional
Distant
All Stages
Whites
98.5%
82.9%
27.7%
89.5%
Blacks
92.2%
68.3%
16.3%
75.9%
Cervix
120
Source: SEER Cancer Statistics Review, 1975-2002.
Based on cases diagnosed during 1995-2001.
Melanoma
African American
American Indian
Asian/Pacific Islander
Hispanic (all races)
Non-Hispanic White
136. 1
140
100
Prostate
Rate per 100,000 females
Source: MCSS. Rates are age-adjusted to the 2000
U.S. population.
Mesothelioma
160
Rate per 100,000 females
140
Incidence
SEER/U.S.
Minnesota
120
100
80
60
40
M o r ta l i t y
20
20
03
20
00
19
95
19
90
19
85
0
19
80
Y e a r o f Di ag no s i s / D e a t h
Source: MCSS and SEER Cancer Statistics Review,
1975-2002. Rates are age-adjusted to the 2000 U.S.
population. National incidence is for the white
population in SEER 9 Regions. covering 10% of the U.S.
population. National mortality is for the white population
in the entire U.S.
Survivorship
During the 1980s, breast cancer incidence increased
sharply in the U.S. The reasons for this increase are
not fully understood, but are thought to be related
to increased use of mammography. Since 1988,
the breast cancer incidence rate has increased at a
slower, but statistically significant, rate. However,
in Minnesota the breast cancer incidence rate
peaked in 2001. This is true even when in situ breast
cancers are included in the trend (data not shown).
The decrease in breast cancer incidence between
2001 and 2003 was not statistically significant, but
the change in trend was. SEER has not yet released
data for 2003, but personal communication with
other cancer registries indicates that a similar
decrease has been seen nationally. Continued
surveillance will indicate whether this change is a
temporary fluctuation or a watershed in breast
cancer incidence.
Female Breast Cancer in Minnesota
and the U.S.
19
75
Trends in Female Breast Cancer
Despite steadily increasing incidence, breast cancer
mortality has been decreasing significantly and
steadily since the early 1990s in Minnesota and
nationally.
Minnesota Cancer Facts and Figures 2006
Childhood
160
Five-Year Relative Survival from
Female Breast Cancer in the U.S.
Healthy Life
Female Breast Cancer by Race/Ethnicity,
Minnesota, 1999-2003
25
End Notes
As elsewhere in the U.S., non-Hispanic white
women in Minnesota are at the greatest risk of
being diagnosed with breast cancer, but African
American women are at the greatest risk of dying
of this disease. The incidence rate among African
American women is nearly 25 percent lower than
among non-Hispanic white women, but their
mortality rate is about 15 percent higher. Similarly,
Breast
Disparities in Female Breast Cancer
Colorectal
Lung
Breast Cancer in Minnesota
Intro
Colorectal
Lung
Breast Cancer in Minnesota
Geographic Differences in Female
Breast Cancer Incidence
During 2000-2002, the female breast cancer
incidence rate was about the same in Minnesota as
among white women living in the geographic areas
reporting to the SEER Program.
Female Breast Cancer Incidence Rates*
in Minnesota Regions and Six Largest
Counties, 1999-2003
Minnesota = 135.8
SEER** = 141.0
Kittson
Koochiching
Northwest
125.2
Marshall
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Lake
of the
Woods
Roseau
St. Louis
Beltrami
Pennington
Polk
Cook
Clear
Water
Red Lake
Northeast
133.6
Prostate
Breast
Itasca
Breast cancer incidence in Minnesota was
significantly higher in the Metro Area than the
state average, and was highest in Hennepin and
Washington Counties. This may reflect the higher
socioeconomic level of women in urbanized areas
of the state, and a more widespread use of breast
cancer screening with mammography.
Lake
Mahnomen
Norman
+XEEDUG
Cass
Becker
Clay
Aitkin
Wadena
Crow Wing
Carlton
Ottertail
Wilkin
West Central
121.6
Grant
Pine
Todd
Central
127.0
Mille
Lacs
Douglas
Benton
Stevens
Traverse
Pope
Stearns
Isanti
Big Stone
Sherburne
Chisago
Swift
.DQGLYRKL
Anoka
Meeker
WashingRam- ton
sey
Wright
Chippewa
Metro
142.9
Hennepin
Lac Qui Parle
Carver
McLeod
Renville
Scott
Yellow Medicine
County
Rate
Anoka
Dakota
Hennepin
Ramsey
St Louis
Washington
124.9
139.3
145.6
144.2
136.6
157.7
Kanabec
Morrison
Dakota
Sibley
Breast cancer incidence was significantly lower in
South Central, Central and West Central Minnesota
than the state average.
Geographic Differences in Female
Breast Cancer Mortality
During 2000-2002, the female breast cancer
mortality rate was about the same in Minnesota as
among white women in the U.S. as a whole.
Although the female breast cancer mortality rate
varied by 40 percent from the region with lowest to
the region with the highest rate, no region had a
mortality rate that was significantly higher than the
state average. Female breast cancer mortality was
significantly lower in West Central Minnesota.
Redwood
Pipestone
Rock
Le
Sueur
Nicollet
Rice
Goodhue
Blue Earth
Cottonwood
Nobles
Jackson
Watonwan
Olmsted
Waseca
Martin
Wabasha
Southeast
South Central
123.9
Brown
Murray
Steele
Freeborn
Faribault
Dodge
132.4
Mower
Houston
Female Breast Cancer Mortality Rates*
in Minnesota Regions and Six Largest
Counties, 1999-2003
Minnesota = 24.3
US** = 25.5
Kittson
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Lake
of the
Woods
Roseau
Koochiching
Northwest
24.2
St. Louis
Beltrami
Pennington
Polk
Cook
Clear
Water
Red Lake
Northeast
25.3
Itasca
Lake
Mahnomen
Norman
+XEEDUG
Cass
Becker
Clay
Aitkin
Wadena
Crow Wing
Carlton
Ottertail
Wilkin
West Central
19.4
Grant
Douglas
Stevens
Pope
Pine
Todd
Central
22.8
Mille
Lacs
Stearns
Isanti
Sherburne
Chisago
Swift
.DQGLYRKL
Anoka
Meeker
WashingRam- ton
sey
Wright
Chippewa
Metro
25.2
Hennepin
Lac Qui Parle
McLeod
Renville
Carver
Scott
Yellow Medicine
County
Rate
Anoka
Dakota
Hennepin
Ramsey
St Louis
Washington
28.0
25.9
25.5
24.7
25.0
23.5
Kanabec
Morrison
Benton
Traverse
The average numbers of female breast
cancer cases and deaths each year in
Minnesota counties are shown in the
End Notes section of this report.
Winona
Fillmore
Big Stone
Dakota
Sibley
Lincoln
Lyon
Redwood
Southwest
23.8
Pipestone
Rock
Le
Sueur
Nicollet
South Central
26.0
Rice
Murray
Cottonwood
Nobles
Jackson
Goodhue
Southeast
Brown
Blue Earth
Watonwan
Martin
Faribault
Wabasha
Olmsted
Waseca
Steele
Freeborn
Dodge
Mower
23.9
Fillmore
Winona
Houston
Rates are per 100,000 persons, age-adjusted to the 2000
U.S. population. Significance was determined by
comparison of 95% confidence intervals.
* Rates based on fewer than 10 cases or deaths are not
shown.
**Whites in the SEER 9 Regions (incidence) or in the U.S.
(mortality), 2000-2002, SEER public use files
(November 2004).
Survivorship
End Notes
Lyon
Southwest
126.2
Marshall
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Lincoln
26
Minnesota Cancer Facts and Figures 2006
Intro
Lung
Breast Cancer in Minnesota
Mammography Use among Women
Ages 40 and Older by Education and
Residence, Minnesota, 2002 and 2004
Percent had Mammogram within 2 Years
80
80
64
67
70 70 69 70 69
70
68
70
Percent had Mammogram within 2 Years
84
80
72
79
78
80
79
73
58
60
Melanoma
100
81
Not a HS Graduate
HS Graduate
Colle ge
60
40
40
20
20
~
~
Source: Minnesota BRFSS. Analyses were conducted by
MCSS. ~ Questions not asked.
0
Rural
Urban
Source: Minnesota BRFSS. Analyses were conducted by
MCSS. HS is high school. Urban residents live in one of
the 18 counties designated as “metropolitan” in the
2000 Census.
Childhood
~
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
0
Mesothelioma
48
American Cancer Society Screening Guidelines for the Early Detection
of Breast Cancer in Asymptomatic Women
Healthy Life
Beginning in their early 20s, women should be told about the benefits and limitations of Breast Self-Examination (BSE).
The importance of prompt reporting of any new breast symptoms to a health professional should be emphasized.
Women who choose to do BSE should receive instruction and have their technique reviewed on the occasion of a
periodic health examination. It is acceptable for women to choose not to do BSE or to do BSE irregularly.
For women 20 - 39, it is recommended that Clinical Breast Examination (CBE) be part of a periodic health examination,
preferably at least every 3 years. Asymptomatic women aged 40 years and over should continue to receive a clinical
breast examination as part of a periodic health examination preferably annually.
Survivorship
Women age 40 and older should have a mammogram and CBE annually. As long as women 40 and older are in good
health, they should continue to receive an annual mammogram; age alone should not be the reason for the cessation
of regular mammograms. However, for women with serious health problems or a short life expectancy, the need for
on-going mammograms should be evaluated between the patient and the health care provider.
Women at increased risk of developing breast cancer (family history, genetic predisposition, history of the disease) may
benefit from starting early detection practices at a younger age or having additional tests or more frequent
examinations. These women should talk to their health care provider about the benefits and limitations of
beginning screening at an earlier age and then make a decision about breast cancer screening.
Minnesota Cancer Facts and Figures 2006
27
End Notes
100
Breast
Trends in Mammography Use among
Women Ages 40 and Older,
Minnesota, 1987-2004
Prostate
Combining data for 2002 and 2004, the percent of
women ages 40 and older who reported having a
mammogram in the previous two years was
somewhat lower in rural (77%) than urban (82%)
Minnesota. Screening was relatively high at all
education levels (not a high school graduate, 76%;
high school graduate, 79%; some post-secondary
education or college graduate, 82%). There were too
few interviews among women of color and
American Indians over the two-year period to
present screening rates by race/ethnicity.
Cervix
Even regular screening will not find all breast
cancers at an early stage because some breast
cancers grow rapidly and spread beyond the breast
in the interval between mammograms. Nonetheless,
the best available evidence indicates that breast
cancer screening saves lives. Based on data from the
2004 BRFSS, the marked increase in breast cancer
screening in Minnesota between 2000 (72%) and
2002 (81%) was sustained in 2004 (80%). The percent
of women ages 40 and older who reported in 2004
that they had a mammogram in the previous two
years was somewhat higher in Minnesota (80%) than
the median of the 52 states and territories
participating in the BRFSS (75%).
Colorectal
Breast Cancer Screening
Intro
Lung
Colorectal
Prostate cancers tend to grow very slowly and
appear to develop in the vast majority of men.
Autopsy studies indicate that up to 80 percent of
men in their 90s have evidence of prostate cancer.
Nonetheless, some prostate cancers do become
aggressive, and currently account for 12 percent of
cancer deaths among men. Now that asymptomatic
prostate cancers can be identified by screening with
the prostate specific antigen (PSA) test, the
unsolved challenge is to determine which ones will
go on to become life-threatening. This is
Prostate
Breast
Prostate Cancer in Minnesota
Risk Factors for Prostate Cancer
• Family history of prostate cancer (one or more first-degree relatives diagnosed with
prostate cancer at an early age)
• Being African American
• Poor diet (high fat and red meat)
• Physical inactivity
Cervix
Melanoma
Mesothelioma
Childhood
Healthy Life
Survivorship
End Notes
particularly important because treating prostate
cancer frequently results in incontinence and
impotence. Because of this dilemma, and because
PSA screening has not yet been shown in clinical
trials to reduce prostate cancer mortality, being
screened may not be the best choice for all men.
Men 50 years of age and over and those at high risk
because of family history or because they are
African American should discuss the risks and
benefits of screening with their physician to make
an informed decision.
The Burden of Prostate Cancer in Minnesota
Over the five-year period 1999-2003, more than
4,000 men were diagnosed with prostate cancer in
Minnesota each year. It was the most common
cancer among men, accounting for nearly one out
of every three cancers diagnosed. About 70 percent
of Minnesotans diagnosed with prostate cancer
were 65 years of age or older. In 2003, the ageadjusted incidence rate for prostate cancer in
Minnesota was 175.0 new cases per 100,000 males.
From 1999 to 2003, about 580 men died of prostate
cancer in Minnesota each year. Although it was the
most commonly diagnosed cancer among men, it
was the second leading cause of cancer death.
Lung cancer kills more than twice as many men.
About 94 percent of deaths due to prostate cancer
occurred among Minnesotans 65 years of age or
older. The age-adjusted mortality rate for prostate
cancer in Minnesota in 2003 was 27.5 deaths
per 100,000 males.
Based on data from the SEER Program, the
five-year relative survival rate for prostate cancer is
very high compared to most other cancers, even
when diagnosed at an advanced stage. The overall
five-year relative survival rate for prostate cancer
increased substantially from 81 percent among
cases diagnosed in 1986-1988 to 99 percent among
28
cases diagnosed in 1995-2001. It is likely that this
increase, to some unknown degree, reflects lead
time bias associated with the diagnosis of many
asymptomatic tumors through PSA screening that
may never have become life-threatening. Please see
Frequently Asked Questions about Cancer for a
fuller discussion of this issue.
Minnesota Cancer Facts and Figures 2006
Intro
Disparities in Prostate Cancer
192.3
African American
American Indian
Asian/Pacific Islander
Hispanic (all races)
Non-Hispanic White
184. 1
150
123. 9
100
53.9
50
60. 3
49. 6
26. 1
Stage
Local/Regional
Distant
Unstaged
All Stages
Whites
100%
32.6%
84.2%
99.9%
Blacks
100%
30.3%
77.0%
96.7%
Cervix
228. 9
200
Prostate
Rate per 100,000 males
30.6
14.6
0
Mortality
Source: SEER Cancer Statistics Review, 1975-2002.
Based on cases diagnosed during 1995-2001.
Melanoma
Incidence
Source: MCSS. Rates are age-adjusted to the 2000
U.S. population.
Minnesota Cancer Facts and Figures 2006
Mesothelioma
250
Rate per 100,000 males
SEER/U.S.
Minnesota
200
150
I nc i d e n c e
100
50
M o rt a l i t y
20
03
20
00
19
95
19
90
19
85
0
19
80
Y e a r o f D i a g no s i s / De at h
Source: MCSS and SEER Cancer Statistics Review,
1975-2002. Rates are age-adjusted to the 2000 U.S.
population. National incidence is for the white
population in SEER 9 Regions, covering 10% of the U.S.
population. National mortality is for the white population
in the entire U.S.
Survivorship
After the widespread introduction of the PSA
screening test, the U.S. prostate cancer incidence
rate increased by an unprecedented 70 percent over
a five-year period, peaking in 1992. Because prostate
cancers tend to grow slowly, many tumors were
found in the initial years of PSA screening that may
not have caused symptoms until years later or may
not have been apparent before the person died from
other causes. Once these tumors were found, the
prostate cancer rate declined. Since 1995, however,
the prostate cancer incidence rate has begun to
increase again. The higher prostate cancer incidence
rate in Minnesota compared to SEER since 1995 is
similar to the excess risk for prostate cancer in
Minnesota during the Third National Cancer Survey
(1969-1971). It is possible that an increased risk
existed during the period of PSA uptake as well, but
was masked by lower PSA utilization in Minnesota.
Despite increasing incidence rates, prostate cancer
mortality has been steadily declining since 1994 in
the U.S. and since 1995 in Minnesota. The mortality
rate in Minnesota decreased significantly by 30
percent between 1995 and 2003. Whether this is
due to PSA screening is not certain.
Prostate Cancer in Minnesota
and the U.S.
19
75
Trends in Prostate Cancer
Childhood
250
Five-Year Relative Survival from
Prostate Cancer in the U.S.
Healthy Life
Prostate Cancer by Race/Ethnicity,
Minnesota, 1999-2003
Breast
diagnosed with prostate cancer than non-Hispanic
white men, but are 60 percent more likely to die of
this disease. This pattern indicates that African
American and American Indian men are less likely
to survive prostate cancer than non-Hispanic white
men in Minnesota.
29
End Notes
African American men have the highest prostate
cancer rates. Their risk of being diagnosed with this
disease is 24 percent higher than among
non-Hispanic white men, and their risk of dying of
this disease is nearly two times higher. American
Indian men are four percent more likely to be
Colorectal
Lung
Prostate Cancer in Minnesota
Intro
Geographic Differences in
Prostate Cancer Incidence
During 2000-2002, the prostate cancer incidence
rate was more than ten percent higher in Minnesota
than among white men living in the geographic
areas reporting to the SEER Program. Prostate
cancer is one of the few cancers for which rates are
higher in Minnesota than in the SEER Program.
End Notes
Prostate Cancer Incidence Rates*
in Minnesota Regions and Six Largest
Counties, 1999-2003
Minnesota = 188.6
SEER** = 175.3
Kittson
Koochiching
Northwest
174.6
Marshall
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Lake
of the
Woods
Roseau
St. Louis
Beltrami
Pennington
Polk
Cook
Clear
Water
Red Lake
Aitkin
Wadena
During 2000-2002, the prostate cancer mortality
rate was more than fifteen percent higher in
Minnesota than among white men in the entire U.S.
Prostate cancer is one of the few cancers for which
rates are higher in Minnesota than in the U.S.
West Central
219.8
Grant
Mille
Lacs
Stevens
Traverse
Pope
Stearns
Isanti
Sherburne
Chisago
Swift
.DQGLYRKL
Anoka
Meeker
WashingRam- ton
sey
Wright
Chippewa
Metro
178.6
Hennepin
Lac Qui Parle
Carver
McLeod
Renville
Scott
Yellow Medicine
County
Rate
Anoka
Dakota
Hennepin
Ramsey
St Louis
Washington
197.8
170.9
176.2
177.0
177.5
186.3
Kanabec
Morrison
Big Stone
Dakota
Sibley
Lincoln
Lyon
Redwood
Pipestone
Le
Sueur
Nicollet
Southwest
186.7
Rice
Goodhue
Blue Earth
Cottonwood
Nobles
Jackson
Watonwan
Olmsted
Waseca
Martin
Wabasha
Southeast
South Central
181.4
Brown
Murray
Steele
Freeborn
Faribault
Dodge
181.0
Mower
Winona
Houston
Fillmore
Prostate Cancer Mortality Rates*
in Minnesota Regions and Six Largest
Counties, 1999-2003
Minnesota = 30.8
US** = 26.7
Kittson
Koochiching
Northwest
35.9
Marshall
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Lake
of the
Woods
Roseau
St. Louis
Beltrami
Pennington
Polk
Cook
Clear
Water
Red Lake
Northeast
34.7
Itasca
Lake
Mahnomen
Norman
+XEEDUG
Cass
Becker
Clay
Aitkin
Crow Wing
Wadena
Carlton
Ottertail
Wilkin
Grant
Douglas
Stevens
Pope
Pine
Todd
Central
31.7
Mille
Lacs
Benton
Traverse
Stearns
Isanti
Sherburne
Chisago
Swift
.DQGLYRKL
Anoka
Meeker
WashingRam- ton
sey
Wright
Chippewa
Metro
28.9
Hennepin
Lac Qui Parle
McLeod
Renville
Carver
Scott
Yellow Medicine
County
Rate
Anoka
Dakota
Hennepin
Ramsey
St Louis
Washington
27.7
26.8
28.4
29.5
37.1
30.4
Kanabec
Morrison
Big Stone
Dakota
Sibley
Lincoln
Lyon
Redwood
Southwest
35.1
Rock
30
Central
228.1
Douglas
Benton
Pipestone
The average numbers of prostate cancer
cases and deaths each year in Minnesota
counties are shown in the End Notes
section of this report.
Carlton
Pine
Todd
West Central
30.9
Comparing the region with the highest rate to the
one with the lowest, the prostate cancer mortality
rate in Minnesota varied by about 40 percent.
However, only the rate in St. Louis County was
significantly higher than the state average.
Crow Wing
Ottertail
Wilkin
Rock
Geographic Differences in
Prostate Cancer Mortality
Cass
Becker
Clay
Comparing the region with the highest rate to the
one with the lowest, prostate cancer incidence rates
in Minnesota varied by about 33 percent. Rates in
West Central and Central Minnesota were
significantly higher than the state average. Rates in
Northeast and Metro Area Minnesota and Dakota,
Hennepin and Ramsey Counties were
significantly lower.
Lake
Mahnomen
+XEEDUG
Because prostate cancer incidence is strongly
influenced by PSA screening, it is not known
whether these differences reflect differences in the
use of PSA testing or differences in the underlying
risk for developing this disease.
Northeast
173.4
Itasca
Norman
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Prostate Cancer in Minnesota
Le
Sueur
Nicollet
Rice
Goodhue
Southeast
South Central
Brown
Blue Earth
Murray
Cottonwood
Watonwan
Nobles
Jackson
Martin
29.0
Faribault
Wabasha
Olmsted
Waseca
Steele
Freeborn
Dodge
Mower
27.9
Fillmore
Winona
Houston
Rates are per 100,000 males, age-adjusted to the 2000 U.S.
population. Significance was determined by comparison
of 95% confidence intervals.
* Rates based on fewer than 10 cases or deaths are
not shown.
**Whites in the SEER 9 Regions (incidence) or in the U.S.
(mortality), 2000-2002, SEER public use files
(November 2004).
Minnesota Cancer Facts and Figures 2006
Intro
The proportion of men ages 40 and over who reported
having a PSA in the previous two years was lower in
Minnesota (45%) in 2004 than in the 52 states and
territories participating in the BRFSS (52%).
Colorectal
Percent had PSA within 2 Years
80
66
62
59
60
Breast
40
20
~
0
2002
20 0 3
20 0 4
Prostate
2001
Source: Minnesota BRFSS. Analyses were conducted by
MCSS. Men with a self-reported history of prostate
cancer were excluded. PSA is prostate-specific antigen.
~ Questions not asked.
Cervix
Among Minnesota men ages 50 and over who
participated in the 2004 Minnesota BRFSS and did
not have a history of prostate cancer, 59 percent
reported that they had a PSA test in the last two
years. This was somewhat lower than reported in
2002 (66%) and 2001 (62%).
100
PSA Testing among Men Ages 50 and
Older by Education and Residence,
Minnesota, 2001-2004
100
Percent had PSA within 2 Years
80
65
60
65
64
60
Not a HS Graduate
HS Graduate
Colle ge
58
51
Mesothelioma
40
20
0
Rural
Urban
Source: Minnesota BRFSS. Analyses were conducted by
MCSS. Men with a self-reported history of prostate
cancer were excluded. PSA is prostate-specific antigen.
HS is high school. Urban residents live in one of the 18
counties designated as “metropolitan” in the
2000 Census.
Childhood
Combining data for 2001, 2002, and 2004, PSA testing
was similar in rural and urban Minnesota (64% and
62%, respectively). Although screening increased
somewhat with education (not a high school
graduate, 56%; high school graduate, 60%; some
post-secondary education or college graduate, 64%),
this was more evident in urban than rural Minnesota.
There were too few interviews among men of color
and American Indians to present screening rates by
race/ethnicity.
Healthy Life
American Cancer Society Screening Guidelines for the Early Detection
of Prostate Cancer in Asymptomatic Men
Survivorship
The PSA test and the digital rectal examination should be offered annually. Men age 50
and older with a life expectancy of at least 10 years should have a Prostate Specific
Antigen (PSA) test and a Digital Rectum Exam (DRE) every year. *
*Information should be provided to men about the benefits and limitations of testing so
that an informed decision about testing can be made with the clinician's assistance.
Minnesota Cancer Facts and Figures 2006
Melanoma
The use of the PSA test to identify prostate cancer
early is controversial. The unsolved challenge of PSA
testing is to determine which tumors, once
discovered, will go on to become life-threatening.
This is important because treating prostate cancer
frequently results in incontinence and impotence,
decreasing quality of life. Because PSA testing has not
yet been shown in clinical trials to reduce mortality,
being screened may not be the best choice for all men,
especially those with a life expectancy of less
than ten years.
Trends in PSA Testing among Men
Ages 50 and Older, Minnesota, 2001-2004
31
End Notes
Prostate Cancer Screening
Lung
Prostate Cancer in Minnesota
Intro
Cervical cancer is unique because we know both its
primary cause -- persistent infection with the
human papilloma virus (HPV) -- and how to
prevent it -- early detection of precancerous lesions
with the Pap test and prompt treatment of detected
abnormalities. Nonetheless, women in Minnesota
continue to die from this preventable disease,
and women of color and American Indians are at
especially high risk. A vaccine to prevent infection
with HPV may be released during 2006, but it will
not prevent infection with all cancer-causing
strains of HPV or eliminate current infections. The
report Cervical Cancer Control in Minnesota:
Assessing its effectiveness with data from the
Minnesota Cancer Surveillance System provides
detailed information on cervical cancer in
Minnesota and is on the MCSS web site.
Cervix
Prostate
Breast
Colorectal
Lung
Cervical Cancer in Minnesota
Childhood
Mesothelioma
Melanoma
Five-Year Relative Survival from
Cervical Cancer in the U.S.
Stage
Localized
Regional
Distant
All Stages
Whites
92.8%
55.3%
17.7%
74.6%
Blacks
88.4%
48.2%
12.5%
66.1%
Source: SEER Cancer Statistics Review, 1975-2002.
Based on cases diagnosed during 1995-2001.
Cervical Cancer by Race/Ethnicity,
Minnesota, 1999-2003
16
14
13.4
12.8
12.3
12
Incidence
Mortality
End Notes
Survivorship
Healthy Life
10
8
6.2
6
5.0
4
1.4
2
0
*
African
American
*
American
Indian
*
Asian/Pacific
I s l a nd e r
Hispanic
(all races)
Non-Hispanic
White
Source: MCSS. Rates are age-adjusted to the 2000 U.S.
*Rates based on fewer than 10 cases or deaths are not
shown.
32
• Not being screened
• Infection with human papilloma
virus (HPV), a common sexually
transmitted disease
• Factors that increase the likelihood
of being exposed to HPV (sex at an
early age, multiple sexual partners,
non-monogamous sexual partners)
• Cigarette smoking
• Infection with human immunodeficiency
virus (HIV)
The Burden of Cervical Cancer
in Minnesota
Over the five-year period 1999-2003, about 175
women were diagnosed with invasive cervical
cancer each year in Minnesota. About 60 percent of
diagnoses were among women less than 50 years
old, and the median age at diagnosis was one of the
youngest among common cancers. In 2003, the
age-adjusted incidence rate for cervical cancer in
Minnesota was 6.7 new cases per 100,000 females.
From 1999 to 2003, about 40 women died of
cervical cancer in Minnesota each year. About
30 percent of deaths occurred among women less
than 50 years of age. The age-adjusted mortality
rate for cervical cancer in Minnesota in 2003 was
1.8 deaths per 100,000 females.
Disparities in Cervical Cancer
Rate per 100,000 females
12.6
Risk Factors for Cervical Cancer
During 1999-2003, women of color and American
Indians in Minnesota were twice as likely to be
diagnosed with invasive cervical cancer and three
times more likely to die of this disease than nonHispanic white women (4.6 deaths per 100,000
women of color and American Indians and 1.4
deaths per 100,000 non-Hispanic white women).
Cervical Cancer Control in Minnesota suggests that
the excess burden of cervical cancer among women
of color and American Indians in Minnesota is due
to less effective screening - that is, less access to or
utilization of Pap testing, poorer quality of screening,
or less timely and effective treatment of detected
abnormalities.
Minnesota Cancer Facts and Figures 2006
Intro
Rate per 100,000 females
SEER/U.S.
Minnesota
12
10
I nc i d e nc e
8
Breast
6
4
M o r ta l i t y
2
20
00
Y e ar o f D i a g no s i s / De a t h
Over the five-year period 1999-2003, the invasive
cervical cancer incidence rate varied by nearly
two-fold across the state, while mortality varied by
nearly four-fold. Nonetheless, in part because of the
relatively small number of cases and deaths, most of
the regional and county rates were not significantly
different from the state average. However, the
mortality rate in West Central Minnesota was two
and a half times higher than the state average, and
the difference was statistically significant.
Source: MCSS and SEER Cancer Statistics Review,
1975-2002. Rates are age-adjusted to the 2000 U.S.
population. National incidence is for the white population
in SEER 9 Regions, covering 10% of the U.S. population.
National mortality is for the white population in
entire U.S.
Cervical Cancer Mortality Rates*
in Minnesota Regions and six Largest
Counties, 1999-2003
Minnesota = 1.6
US** = 2.4
Kittson
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Lake
of the
Woods
Roseau
Koochiching
Northwest
Marshall
St. Louis
Beltrami
Pennington
Polk
Mesothelioma
During 2000-2002, the cervical cancer incidence
rate was six percent lower in Minnesota than
among white women in the geographic areas in the
SEER Program. During the same period, cervical
cancer mortality was a statistically significant
42 percent lower in Minnesota than among white
women in the U.S.
Cook
Clear
Water
Red Lake
Northeast
1.6
Itasca
Lake
Mahnomen
Norman
+XEEDUG
Cass
Becker
Clay
Aitkin
Crow Wing
Carlton
Ottertail
Wilkin
West Central
4.2
Grant
Douglas
Stevens
Pope
Pine
Todd
Central
1.5
Mille
Lacs
Morrison
Stearns
Isanti
Big Stone
Sherburne
Chisago
Swift
.DQGLYRKL
Anoka
Meeker
WashingRam- ton
sey
Wright
Chippewa
Metro
1.4
Hennepin
Lac Qui Parle
McLeod
Renville
Carver
Scott
Yellow Medicine
Rate
Anoka
Dakota
Hennepin
Ramsey
St Louis
Washington
1.9
*
1.3
1.7
2.1
2.2
Kanabec
Benton
Traverse
County
Childhood
The average numbers of cervical cancer
cases each year in Minnesota counties
are shown in the End Notes section of
this report.
Wadena
Prostate
20
03
19
95
19
90
19
80
19
85
0
19
75
Geographic Differences
in Cervical Cancer
Colorectal
14
Cervix
Incidence and mortality rates for invasive cervical
cancer have decreased by 50 percent in the U.S.
since 1975. Trends in Minnesota are very similar to
national trends. Since 1988, the incidence rate in
Minnesota has decreased significantly by about
30 percent, and the mortality rate by about 25 percent.
Cervical Cancer in Minnesota
and the U.S.
Melanoma
Trends in Cervical Cancer
Lung
Cervical Cancer in Minnesota
Dakota
Southwest
2.0
Pipestone
Rock
Le
Sueur
Nicollet
Rice
Goodhue
Southeast
South Central
Brown
Blue Earth
Murray
Cottonwood
Watonwan
Nobles
Jackson
Martin
Faribault
Wabasha
Olmsted
Waseca
Steele
Freeborn
Dodge
Mower
1.1
Fillmore
Winona
Houston
Source: Rates are per 100,000 persons, age-adjusted to the
2000 U.S. population. Significance was determined by
comparison of 95% confidence intervals.
*Rates based on fewer than 10 cases of deaths are not
shown.
**Whites in the U.S., 2000-2002, SEER public use files
(November 2004).
Minnesota Cancer Facts and Figures 2006
33
Survivorship
Redwood
End Notes
Lyon
Healthy Life
Sibley
Lincoln
Intro
Combining data for 2000, 2002, and 2004, women
residing in rural Minnesota were somewhat less
likely to report having a Pap test in the last three
years (84%) than women living in urban areas
(90%), but education was a stronger predictor of
being screened than residence (not a high school
graduate, 69%; high school graduate, 83%; some
post-secondary education or college graduate, 91%).
Percent Screened within 3 Years
86
80
85
18
20
86
19
84
20
86
19
20
87
85
83
18
19
69
67
88
21
18
69
70
Within 2-3 years
Within 1 year
25
40
69
64
67
64
67
64
60
20
20
04
~
20
03
20
02
20
00
19
99
19
98
19
96
19
97
19
94
19
92
20
01
~
0
Source: Minnesota BRFSS. Analyses were conducted by
MCSS. Women who had a hysterectomy were excluded.
Percents many not sum to the total due to rounding.
Pap Test Use among Women Ages 18
and Older by Education and Residence,
Minnesota, 2000-2004
100
Percent Screened within 3 Years
92
89
Although based on relatively small numbers of
interviews among women of color and American
Indians, the percent of women who reported having
been screened in the previous three years was similar
for non-Hispanic white (88%), African American
(91%), and Hispanic (91%) women, but considerably
lower for American Indian (75%) and Asian/Pacific
Islander women (72%).
90
86
60
Based on data from the 2004 BRFSS, the percent of
women ages 18 and older who reported that they
had a Pap test in the previous three years was about
the same in Minnesota (88%) as the median of the
52 states and territories participating in the
BRFSS (86%).
85
81
80
73
Not a HS Graduate
HS Graduate
Colle ge
64
60
40
20
0
Rural
Urban
Source: Minnesota BRFSS. Analyses were conducted by
MCSS. Women who had a hysterectomy were excluded.
HS is high school. Urban residents live in one of the
18 counties designated as “metropolitan” in the 2000
Census.
Healthy Life
American Cancer Society Screening Guidelines for the Early Detection
of Cervical Cancer in Asymptomatic Women
Screening should begin approximately three years after a woman begins having vaginal
intercourse, but no later than 21 years of age. Screening should be done every year
with conventional Pap tests or every two years using liquid-based Pap tests. At or after
age 30 years, women who have had three normal test results in a row may get screened
every 2-3 years with cervical cytology (either conventional or liquid-based Pap test)
alone, or every 3 years with an human papillomavirus DNA test plus cervical cytology.
Women age 70 or older who have had three or more normal Pap tests and no abnormal
Pap tests in the last 10 years and women who have had a total hysterectomy may
choose to stop cervical cancer screening.
Survivorship
End Notes
100
19
95
Almost all cervical cancers are caused by persistent
infection with the human papilloma virus (HPV)
and can be prevented by detecting precancerous
lesions with the Pap test.
Trends in Pap Test Use among Women
Ages 18 and Older, Minnesota, 1992-2004
19
93
Cervical Cancer Screening
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Cervical Cancer in Minnesota
34
Minnesota Cancer Facts and Figures 2006
Intro
risk factors for melanoma should regularly examine
their skin and report to their physician any moles
or other skin lesions with ABCD characteristics:
Asymmetry, Border irregularity, Color irregularity,
or Diameter of greater than a quarter inch (6 mm).
Breast
Risk Factors for Melanoma of the Skin
Lung
Melanoma of the skin is a more serious form of
cancer than the more commonly diagnosed basal
and squamous cell skin cancers. If not found early,
melanomas can spread to other parts of the body.
The best defense against all forms of skin cancer is
to limit or avoid exposure to the sun. People with
Colorectal
Melanoma of the Skin in Minnesota
Prostate
• Excessive exposure to sunlight, especially intense, intermittent exposure
• Fair skin, light eyes, and red or blond hair
• Family or personal history of melanoma
• Having freckles, dysplastic nevi, many moles, or large moles
Disparities in Melanoma
Melanoma of the skin can occur among persons of
color and American Indians, but the vast majority
of cases are diagnosed among whites. In Minnesota,
only 14 cases and 4 deaths occurred among persons
of color or American Indians during the five-year
period 1999-2003. Melanoma incidence rates are
about 30 percent higher among men than women.
However, among persons less than 50 years of age,
incidence rates are higher among women. Based on
national data, survival rates are somewhat poorer
among men than women.
Survivorship
• Limit or avoid exposure to the direct sun from 10 am to 4 pm.
• If you must be out in the sun, wear a hat with a large brim and clothing that covers as
much exposed skin as possible.
• Wear sunglasses to protect the eyes.
• Liberally and frequently apply sunscreen with an SPF of 15 or higher.
• Do not use tanning booths or sun lamps.
• Parents should be especially diligent in protecting their children from excessive exposure
to the sun. Severe sunburns in childhood greatly increase the risk of melanoma.
Minnesota Cancer Facts and Figures 2006
Melanoma
Healthy Life
Save Your Skin
Mesothelioma
From 1999 to 2003, about 115 Minnesotans died of
melanoma each year. Nearly 25 percent of deaths
occurred among persons less than 50 years old.
The age-adjusted mortality rate for melanoma of
the skin in Minnesota in 2003 was 2.1 deaths
per 100,000 persons.
Childhood
rate for melanoma of the skin in Minnesota was
17.7 new cases per 100,000 persons.
35
End Notes
Over the five-year period 1999-2003, about
870 Minnesotans were diagnosed with invasive
melanoma of the skin each year in Minnesota.
It was the sixth most commonly diagnosed cancer
among men and among women in the state.
About 40 percent of melanomas were diagnosed
among persons less than 50 years old, and it was
one of the most common cancers among 20 to
49 year olds. In 2003, the age-adjusted incidence
Cervix
The Burden of Melanoma in Minnesota
Intro
Trends in Melanoma
The incidence of melanoma of the skin has more
than doubled in the U.S. since 1975. However,
mortality rates have not increased since 1990.
Trends in Minnesota are very similar to what is
reported nationally. Since 1988, the incidence rate
in Minnesota has increased significantly by about
40 percent, while the mortality rate has
remained stable.
Melanoma of the Skin in Minnesota
and the U.S.
25
Rate per 100,000 persons
SEER/U.S.
Minnesota
20
15
I nc i d e n c e
10
5
M o rt al i ty
During 2000-2002, the melanoma incidence rate was
20 percent lower in Minnesota than among whites in
the geographic areas in the SEER Program, and the
mortality rate was 20 percent lower than among
whites in the U.S. as a whole.
Over the five-year period 1999-2003, incidence was
significantly higher in Hennepin and Washington
Counties (19.4 and 22.1 new cases per year per
100,000 persons, respectively) than in the state as a
whole (17.7), and was significantly lower in Northwest
Minnesota (11.9). Melanoma mortality rates did not
vary significantly among
Minnesota regions.
Sun Exposure
Nearly one out of every two (49%) Minnesota adults
participating in the BRFSS in 2003-2004 reported that
they had been sunburned during the past 12 months.
Men (55%) were more likely to report having been
sunburned than women (45%).
20
03
20
00
19
95
19
90
19
80
19
85
0
19
75
Geographic Differences
in Melanoma of the Skin
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Melanoma of the Skin in Minnesota
Y e a r o f D i a g no s i s / D e a t h
Source: MCSS and SEER Cancer Statistics Review,
1975-2002. Rates are age-adjusted to the 2000 U.S.
population. National incidence is for the white
population in SEER 9 Regions, covering 10% of the
U.S. population. National mortality is for the white
population in the entire U.S.
Five-Year Relative Survival from
Melanoma in the U.S.
Stage
Localized
Regional
Distant
All Stages
Males
98.6%
60.3%
14.7%
90.2%
Females
98.0%
68.9%
18.0%
93.3%
Source: SEER Cancer Statistics Review, 1975-2002.
Based on cases diagnosed during 1995-2001.
End Notes
Survivorship
The average numbers of melanoma
cases each year in Minnesota counties
are shown in the End Notes section
of this report.
36
Minnesota Cancer Facts and Figures 2006
Intro
Lung
Mesothelioma in Minnesota
Colorectal
Mesothelioma is a cancer of the tissues that line the
chest and abdominal cavity and is believed to be
caused almost exclusively by inhalation of asbestos
fibers. The delay between exposure to asbestos and
diagnosis with mesothelioma is 30-50 years, but the
average survival after diagnosis is about one year.
Cervix
Prostate
Breast
Although asbestos was widely used in commercial
products until the early 1970s, mesothelioma is a
relatively rare cancer. However, it has been a
concern in Minnesota because rates in Northeast
Minnesota are higher than elsewhere in the state.
A recent study by the Minnesota Department of
Health concluded that the occurrence of
mesothelioma in this part of the state could be
explained by occupational exposures to commercial
asbestos.
The Burden of Mesothelioma
in Minnesota
Mesothelioma
Melanoma
Over the five-year period 1999-2003, about 52 men
and 12 women were diagnosed with mesothelioma
in Minnesota each year. About 70 percent of
mesotheliomas were diagnosed among persons
65 years of age and older. This reflects both the long
delay between exposure and diagnosis and the fact
that asbestos use in the U.S. has dropped by
98 percent since the early 1970s. In 2003, the
age-adjusted incidence rate for mesothelioma in
Minnesota was 2.5 new cases for every 100,000 men,
and 0.6 new cases for every 100,000 women.
Healthy Life
Childhood
Over the five-year period 1999-2003, about 45 men
and 9 women died of mesothelioma each year in
Minnesota. About 70 percent of mesothelioma
deaths occurred among persons 65 years of age
and older. In 2003, the age-adjusted mortality rate
for mesothelioma in Minnesota was 2.6 deaths
per 100,000 men and 0.4 deaths for every
100,000 women.
Disparities in Mesothelioma
37
End Notes
Minnesota Cancer Facts and Figures 2006
Survivorship
Mesothelioma is about five times more common
among men than women both in Minnesota and
nationally, reflecting that most exposures to
asbestos occur occupationally in jobs primarily
held by men.
Intro
Geographic Differences
in Mesothelioma
Melanoma
Mesothelioma
Mesothelioma incidence rates in Minnesota are
somewhat higher than those reported by SEER
for men, but not for women.
Rates among men are significantly higher in
Northeast Minnesota and in St. Louis County than
the state average. Mesothelioma incidence rates
throughout the state do not vary significantly
for women.
3.5
Rate per 100,000 persons
SEER
Minnesota
3
2.5
2
1.5
Males
1
0.5
Females
Y e a r o f D i a g no s is / D e at h
Source: MCSS and SEER Cancer Statistics Review,
1975-2002. Rates are age-adjusted to the 2000 U.S.
population. National incidence is for the white
population in SEER 9 Regions, covering 10% of the
U.S. population.
Mesothelioma Incidence Rates*
Among Males in Minnesota Regions
and Six Largest Counties, 1999-2003
Minnesota = 2.5
SEER** = 2.0
Kittson
Roseau
Koochiching
Northwest
2.4
Marshall
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Lake
of the
Woods
St. Louis
Beltrami
Pennington
Polk
Cook
Clear
Water
Red Lake
Northeast
5.3
Itasca
Lake
Mahnomen
Norman
+XEEDUG
Cass
Becker
Clay
Aitkin
Wadena
Crow Wing
Carlton
Ottertail
Wilkin
West Central
3.1
Grant
Douglas
Stevens
Pope
Pine
Todd
Central
2.4
Mille
Lacs
Childhood
Traverse
Stearns
Isanti
Big Stone
Sherburne
Chisago
Swift
.DQGLYRKL
Anoka
Meeker
WashingRam- ton
sey
Wright
Chippewa
Metro
2.7
Hennepin
Lac Qui Parle
McLeod
Renville
Carver
Scott
Yellow Medicine
County
Rate
Anoka
Dakota
Hennepin
Ramsey
St Louis
Washington
*
4.7
2.4
3.0
4.8
*
Kanabec
Morrison
Benton
Dakota
Sibley
Lincoln
Lyon
Redwood
Southwest
1.4
Pipestone
Healthy Life
Rock
Le
Sueur
Nicollet
Rice
Goodhue
Southeast
South Central
Brown
Blue Earth
Murray
Cottonwood
Watonwan
Nobles
Jackson
Martin
Faribault
Wabasha
Olmsted
Waseca
Steele
Freeborn
Dodge
Mower
1.8
Fillmore
Winona
Houston
Rates are per 100,000 persons, age-adjusted to the
2000 U.S. population. Significance was determined by
comparison of 95% confidence intervals.
* Rates based on fewer than 10 cases or deaths are
not shown.
**White males in SEER 9 Regions, 2000-2002, SEER public
use file (November 2004).
Survivorship
End Notes
20
03
20
00
19
95
19
85
19
90
0
19
80
The incidence rate of mesothelioma increased by
50 percent among men in Minnesota from 1988,
when statewide cancer reporting was implemented,
to 2003. Similar increases have been seen among
men in the geographic areas participating in the
SEER Program. Rates did not increase significantly
among women in Minnesota over the same time
period. Because of the delay between exposure to
asbestos and diagnosis with mesothelioma, it is
likely that increasing rates reflect exposures that
occurred before the hazards of asbestos were
recognized.
Mesothelioma Incidence
in Minnesota and the U.S.
19
75
Trends in Mesothelioma
Cervix
Prostate
Breast
Colorectal
Lung
Mesothelioma in Minnesota
38
Minnesota Cancer Facts and Figures 2006
Intro
Lung
Childhood Cancer in Minnesota
Prostate
Breast
Colorectal
The cancers diagnosed among children less than
15 years of age are different from those diagnosed
among adults. While breast, prostate, colon and
rectum, and lung cancer account for more than
half of the cancers diagnosed in adults, children
with cancer are more likely to be diagnosed with
leukemia (30%), brain cancer (22%), or lymphoma
(12%). Despite active research, the causes of most
childhood cancers remain unknown. However,
dramatic improvements in treatment over the last
few decades mean that the majority of children
diagnosed with cancer have a very good chance
of surviving.
Melanoma
Source: SEER Cancer Statistics Review, 1975-2000.
Based on cases diagnosed during 1992-1999.
Survivorship
Based on national data, African American children
are somewhat less likely to be diagnosed with cancer
than white children, but have poorer overall survival.
The five-year relative survival rate for childhood
cancer is 73 percent among African American
children and 80 percent among white children.
Minnesota Cancer Facts and Figures 2006
Mesothelioma
78.6%
72.7%
80.2%
86.4%
52.4%
Childhood
The childhood cancer incidence rate is about 20
percent higher among boys than girls, and boys
tend to have higher rates for most of the common
childhood cancers.
All Sites
Brain and CNS
Leukemia
Acute lymphocytic
Acute myeloid
Healthy Life
Disparities in Childhood Cancer
Five-Year Relative Survival from
Childhood (0-14 years old) Cancer in the U.S.
Cancer
39
End Notes
Over the five-year period 1999-2003, about 160
children under the age of 15 were diagnosed with
cancer in Minnesota each year. Based on current
rates, it is estimated that 1 of every 385 children in
Minnesota will be diagnosed with a cancer before
age 15. In 2003, the age-adjusted incidence rate for
childhood cancer in Minnesota was 14.2 new cases
for every 100,000 children. From 1999 to 2003,
about 25 children died of cancer in Minnesota each
year. Although many more children die of accidents,
cancer is the leading cause of death from disease
among children. The age-adjusted mortality rate for
childhood cancer in Minnesota in 2003 was 3.3
deaths for every 100,000 children.
Cervix
The Burden of Childhood
Cancer in Minnesota
Intro
Despite the fact that childhood cancer has become
more common, the risk of dying from childhood
cancer has decreased dramatically due to
improvements in treatment. Nationally, the
childhood cancer mortality rate decreased by nearly
50 percent between 1975 and 2002. In Minnesota,
the rate decreased by 10 percent between 1988
and 2003, but was too unstable to be statistically
significant.
Rate per 100,000 children
SEER/U.S.
Minnesota
20
15
Incidence
10
M o r ta l i ty
5
20
03
20
00
19
95
19
90
19
85
0
Y e a r o f D i a g no s i s / De a t h
Source: MCSS and SEER Cancer Statistics Review,
1975-2002. Rates are age-adjusted to the 2000 U.S.
population. National incidence is for the white
population in SEER 9 Regions, covering 10% of the U.S.
population. National mortality is for the white population
in the entire U.S.
Geographic Differences in Childhood Cancer
During 2000-2002, the incidence of childhood
cancer in Minnesota was about the same as among
white children living in the geographic areas
reporting to the SEER Program. The mortality rate
was about the same as among white children in the
U.S. as a whole. The rates and types of cancer
diagnosed among children in Minnesota are very
similar to what is reported nationally.
There was no significant variation in childhood
cancer incidence and mortality rates among the
regions and counties examined in Minnesota.
Causes of Childhood Cancer
Healthy Life
• The causes of most childhood cancers remain unknown.
• The few risk factors that have been identified account for a very small
proportion of cases.
• Recent research funded by the National Cancer Institute has not found an
association between childhood cancer and radon, ultrasound during pregnancy,
residential magnetic field exposure from power lines, or specific occupational
exposures of parents.
• There are no screening methods to detect cancer in asymptomatic children,
and cancer is often difficult to diagnose in children until they are quite ill.
Survivorship
End Notes
25
19
80
Long-term trends from SEER indicate that
childhood cancer became more common during
the 1970s and 1980s, and that the overall incidence
rate of cancer among children under the age of 15
increased by about 30 percent from 1975 to 2002.
The reasons for the increase are not known, but
the rate of increase has slowed down since the late
1980s. The incidence rate of childhood cancer in
Minnesota is fairly unstable because of the small
number of cases, but on average is similar to what
is reported by SEER.
Childhood (0-14 Years of Age)
Cancer in Minnesota and the U.S.
19
75
Trends in Childhood Cancer
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Childhood Cancer in Minnesota
40
Minnesota Cancer Facts and Figures 2006
Intro
•
3.
•
•
4.
Colorectal
Breast
Prostate
Cervix
Adopt a physically active lifestyle.
Adults: Engage in at least moderate
activity for 30 minutes or more on 5 or
more days of the week; 45 minutes or
more of moderate to vigorous activity
on 5 or more days per week may
further enhance reductions in the risk
of breast and colon cancer.
Children and adolescents: Engage in
at least 60 minutes per day of moderate
to vigorous physical activity at least
5 days per week.
Melanoma
2.
•
Mesothelioma
Although Minnesota has a reputation for being a
healthy state and heart disease mortality rates in
our state are among the lowest in the nation,
self-reported behaviors indicate that there is much
that could be improved.
Recommendations for Individuals
1. Eat a variety of healthful foods, with
an emphasis on plant sources.
•
Eat five or more servings of a variety of
vegetables and fruits each day.
•
Choose whole grains in preference to
processed (refined) grains and sugars.
•
Limit consumption of red meats,
especially high-fat and processed
meats.
•
Choose foods that help maintain
a healthful weight.
Maintain a healthful weight throughout
life.
Balance caloric intake with physical
activity.
Lose weight if currently overweight or
obese.
Childhood
For people who do not use tobacco, dietary choices
and physical activity are the most important factors
affecting cancer risk that individuals can change.
Poor diet, inactivity, and obesity are related to an
estimated one-third of all cancer deaths. Eating
a healthy diet, exercising regularly, and maintaining
a healthy weight are effective ways that people can
reduce their risk of cancer and other serious chronic
diseases such as heart disease and diabetes.
ACS Guidelines on Nutrition and
Physical Activity for Cancer Prevention
If you drink alcoholic beverages, limit
consumption.
•
Minnesota Cancer Facts and Figures 2006
Increase access to healthful foods in
schools, worksites, and communities.
Provide safe, enjoyable, and accessible
environments for physical activity in
schools and for transportation and
recreation in communities.
Survivorship
•
Healthy Life
Recommendations For Community Action
Public, private, and community organizations
should work to create social and physical
environments that support the adoption
and maintenance of healthy nutrition and
physical activity behaviors.
41
End Notes
Smoking is the leading cause of preventable deaths,
and reduces life expectancy by nearly 14 years.
One-third of cancer deaths are caused by smoking.
Clearly, the healthiest choice is not to use tobacco
products.
Lung
Living a Healthy Life
Intro
Physical Activity in Minnesota
In both 2001 and 2003, slightly less than half (49%)
of Minnesota adults participating in the BRFSS
reported that they exercised either moderately for
at least 30 minutes five or more days a week or
vigorously for at least 20 minutes three or more days
a week. This was similar to the median of 54 states
and territories participating in the BRFSS in 2003
(47%). The percent of Minnesota adults meeting
these exercise recommendations was about the
same for men (50%) and women (48%), and
decreased from 56 percent among 18-24 year olds
to 42 percent among people ages 65 and older.
The Minnesota Student Survey reported that the
percent of students who were physically active for
30 minutes or more at least five days a week did not
change during the three years the questions were
asked (1998, 2001, and 2004). The percent of students
meeting this definition of physical activity was only
37 percent among high school seniors.
End Notes
60
50
40
32
30
30
24
24
23
20
20
10
20
03
02
20
04
~
20
00
01
20
99
~
20
98
19
96
~
19
19
19
95
~
97
~
0
94
The Minnesota Student Survey reported that fruit
and vegetable consumption among students did
not change during the three years the questions
were asked (1998, 2001, and 2004). The percent of
students reporting they consumed five or more
servings "yesterday" was lower than "usual"
consumption among adults, and was less than
15 percent among high school students.
Percent Eat Five or More Servings Usually
70
19
In 2003, approximately one out of four (24%)
Minnesota adults reported that they "usually" ate
five or more servings of fruits and vegetables a day.
This was about the same as the median of 54 states
and territories participating in the BRFSS (23%).
Trends in Adult Fruit and Vegetable
Consumption, Minnesota, 1994-2004
19
Nutrition in Minnesota
Source: Minnesota BRFSS. Analyses were conducted by
MCSS.
Trends in Student Fruit and Vegetable
Consumption by Grade, Minnesota,
1998, 2001 and 2004
70
Percent Ate Five or More Servings Yesterday
60
1998
2001
2004
50
40
30
22
21
21
20
15
15
14
13
13
12
10
0
Grade 6
Grade 9
Grade 12
Trends in Student Physical Activity by
Grade, Minnesota, 1998, 2001 and 2004
70
Percent Active 30 Minutes on 5 out of 7 Days
1998
2001
2004
60
51
50
44
44
50
52
46
40
37
37
37
30
20
10
0
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Living a Healthy Life
Grade 6
Grade 9
Grade 12
Source: Modified from tables in Minnesota Student Survey
1992-2004 Trends: a picture of the behaviors, attitudes and
perceptions of Minnesota’s 6th, 9th and 12th graders.
42
Minnesota Cancer Facts and Figures 2006
Intro
Lung
Living a Healthy Life
Overweight and Obesity in Minnesota
Colorectal
The body mass index (BMI) is a commonly used
measure of overweight and obesity, and is
calculated from height and weight. The CDC
defines a BMI of 25.0 to 29.9 as overweight but not
obese, and a BMI of 30.0 or greater as obese.
Cervix
Prostate
Breast
The percent of Minnesota adults who are either
overweight or obese increased from 44 percent in
1990 to 60 percent in 2004. The most dramatic
increase was in obesity, which more than doubled
from 10 percent of the adult Minnesota population
in 1990 to 23 percent in 2004. These trends are
similar to those reported by other states and
territories participating in the BRFSS, and are signs
of a nationwide epidemic in obesity. In 2004,
the percent of obese adults was the same in
Minnesota (23%) as the median of the 52 states
and territories participating in the BRFSS (23%).
Melanoma
Women are less likely to be overweight than men.
However, men and women are equally likely to be
obese (23% and 22%, respectively), which has the
greatest negative health consequences.
Percent
70
Obese
60
Overweight, but not
Obese
50
40
BMI 30.0 +
Percent
60
48
50
40
32
Me n
Wom e n
45
31
30
30
BMI 25.0 – 29.9
Childhood
70
Adult Overweight and Obesity by
Gender, Minnesota, 2004
23
22
20
20
10
Healthy Life
Trends in Adult Overweight and Obesity,
Minnesota, 1987-2004
Mesothelioma
The percent of adults in Minnesota who are obese
is highest among African American women (30%)
and American Indian men (29%) and is lowest
among Asian/Pacific Islander men and women
(17% and 14%, respectively).
10
Minnesota Cancer Facts and Figures 2006
Overweight, but
not Obese
Obese
Source: Minnesota BRFSS. Analyses were conducted by
MCSS.
43
End Notes
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
Source: Minnesota BRFSS. Analyses were conducted by
MCSS.
Not Overweight or
Obese
Survivorship
0
0
Intro
Lung
Colorectal
Breast
Prostate
Cancer survival has increased dramatically in the
U.S. over the last century. The overall five-year
relative survival rate increased from 20 percent in
the 1930s, to 33 percent in the 1960s, to 62 percent
in 1992-1994, to 65 percent in 1995-2001.
The five-year relative survival rate is commonly
used to measure progress in treating cancer.
Included as survivors are all persons who are living
five years after diagnosis, whether disease free, in
remission, or under treatment. For some cancers,
five years is a good measure of being cured, but for
others, it is not.
Five-year relative survival is the proportion of
persons who are alive five years after diagnosis after
adjusting for expected mortality. For example, a
five-year relative survival rate of 80 percent means
that 20 percent (100% - 80%) fewer persons were
alive five years after diagnosis than would have
been expected given mortality rates in persons of
the same age, gender, and race.
Survival rates depend in part on the type of cancer,
as cancer sites vary in the rate of growth, tendency
to metastasize, importance of the organ, and
likelihood of early detection. For most cancers,
survival is more likely if the cancer is detected early.
As mentioned in Frequently Asked Questions, the
introduction of a new screening test can appear to
increase survival due to lead time bias, even if
mortality is not improved.
MCSS does not currently have sufficient
information to calculate the survival of
Minnesotans diagnosed with cancer. The data
provided below are from the SEER Program.
Five-Year Relative Survival for SEER Cases Diagnosed in 1995-2001
Site
All Stages
Local
Regional
Distant
Unstaged
Brain and Other Nervous
Female Breast
Cervix
Colon and Rectum
Corpus Uteri (Uterus)
Leukemia
Liver
Lung and Bronchus
Melanoma of the Skin
Non-Hodgkin’s Lymphoma
Ovary
Pancreas
Prostate
Urinary Bladder
33.3%
88.2%
73.3%
64.1%
84.4%
47.6%
9.0%
15.3%
91.6%
60.2%
44.6%
4.6%
99.8%
81.8%
~
97.9%
92.4%
90.4%
96.1%
~
19.0%
49.5%
98.3%
~
93.6%
16.4%
100%
94.2%
~
81.3%
54.7%
67.9%
66.3%
~
6.6%
16.2%
63.8%
~
68.1%
7.0%
100%
48.4%
~
26.1%
16.5%
9.7%
25.2%
~
3.4%
2.1%
16.0%
~
29.1%
1.8%
33.5%
6.2%
~
55.6%
61.4%
35.4%
57.3%
~
3.3%
8.5%
80.9%
~
24.7%
4.3%
82.7%
61.1%
Source: SEER Cancer Statistics Review, 1975-2002. Rates are for all races combined from the nine SEER areas,
and are based on follow-up of patients into 2002. ~ The cancer type is not routinely staged.
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Survivorship
44
Minnesota Cancer Facts and Figures 2006
1.800.ACS.2345 is a toll-free call to connect you
with trained Cancer Information Specialists that
are available to assist you 24 hours a day, seven
days a week. Cancer Information Specialists can
refer you to ACS programs, services, and
resources in your community.
Click www.cancer.org for up-to-the minute
cancer information and details about American
Cancer Society programs, services, and events in
your community. You can also research a cancer
topic, find clinical trials, explore cancer
treatment options, connect with other patients
through the Cancer Survivors Network and find a
wealth of other resources at your fingertips.
Minnesota Cancer Facts and Figures 2006
45
Cervix
Prostate
Breast
Colorectal
Lung
Intro
Youth Cancer Survivors' Scholarship Program
awards scholarships to young survivors of
childhood cancer continuing their education at
college, university or technical school. These
scholarships encourage young survivors to pursue
educational and career goals.
Melanoma
At HOME is for families caring for cancer patients
(with limited or no insurance coverage) at home.
The American Cancer Society provides access to
preselected basic durable medical equipment
including: hospital beds, bath and shower devices,
standard wheelchairs, commodes, walkers and canes.
Mesothelioma
Lodging…Hope Lodge located in Rochester, MN
and Marshfield, WI provide comfortable lodging
and emotional support for patients and caregivers
who must travel for cancer treatment. Other
lodging partnerships with the American Cancer
Society exist on a local level to provide referrals to
low cost or free lodging.
I Can Cope is a cancer education class led by a
health professional with a focus on diagnosis,
treatment and side effects, emotions, pain control,
sexuality, self-image, nutrition, exercise, money
management and community resources. Brochures,
booklets and videotapes are provided free of charge
at many community Cancer Resource Centers.
Childhood
Transportation to Treatment
provides transportation options to lifesaving
treatment through a network of resources
including: Road to Recovery, referrals to community
transportation resources and donated airline
miles programs.
Reach to Recovery is a one-to-one support
program for women with breast cancer. Following
a diagnosis of breast cancer, many women have
specific concerns. Trained volunteers who have had
breast cancer themselves visit patients as soon as
possible after diagnosis, and provide support and
information.
Healthy Life
American Cancer Society Patient Navigators
provide ongoing, individualized assistance for
cancer patients throughout Minnesota. Navigators
help patients, their families, and their friends by
providing access to resources, information,
emotional support, and practical assistance from
the time of diagnosis and through the continuum of
the cancer experience.
Look Good…Feel Better is a program for women
in active cancer treatment. Women learn
techniques to restore their self-image and cope
with appearance-related side effects. Certified
volunteer cosmetologists conduct group sessions
or one-on-one salon visits to provide tips on makeup, skin and nail care, and head coverings.
Survivorship
Improving the quality of life for cancer patients is
one of the American Cancer Society's top priorities.
Consequently, the Society supports programs that
enable cancer patients, survivors, and their families
to seek and recognize ongoing sources of support
within their community networks.
End Notes
American Cancer Society Resources to Improve Quality of Life
Intro
Cancer Incidence in Minnesota, 2003
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Number of New Cases
All Sites
Brain and Other Nervous
Breast
Cervix Uteri
Colon and Rectum
Corpus Uteri
Esophagus
Hodgkin's Lymphoma
Kidney and Renal Pelvis
Larynx
Leukemia
Liver and Bile Duct
Lung and Bronchus
Melanoma of the Skin
Mesothelioma (all sites)
Multiple Myeloma
Non-Hodgkin’s Lymphoma
Oral Cavity and Pharynx
Ovary
Pancreas
Prostate
Stomach
Testis
Thyroid
Urinary Bladder
Incidence Rate
Male
Female
Total
Male
Female
Total
12,210
180
25
0
1,303
0
199
94
464
126
427
125
1,566
464
52
176
586
330
0
251
3,884
192
184
99
824
11,076
134
3,398
176
1,220
662
46
79
275
31
304
57
1,357
438
17
113
483
176
360
246
0
103
0
314
314
23,286
314
3,423
176
2,523
662
245
173
739
157
731
182
2,923
902
69
289
1,069
506
360
497
3,884
295
184
413
1,138
546.9
7.3
1.2
~
59.2
~
8.8
3.8
20.1
5.6
19.2
5.4
71.8
20.0
2.5
8.0
26.0
14.1
~
11.5
175.0
8.8
7.2
4.0
38.2
406.2
5.2
125.3
6.7
42.7
24.6
1.7
3.1
10.2
1.2
11.1
2.1
50.7
16.5
0.6
4.1
17.3
6.3
13.2
8.9
~
3.6
~
12.0
11.3
464.2
6.2
67.0
~
50.0
~
4.9
3.4
14.8
3.1
14.5
3.6
59.5
17.7
1.3
5.8
21.2
9.9
~
10.0
~
5.8
~
8.1
22.9
Cancer Mortality in Minnesota, 2003
Number of Deaths
All Sites
Brain and Other Nervous
Breast
Cervix Uteri
Colon and Rectum
Corpus Uteri
Esophagus
Hodgkin's Lymphoma
Kidney and Renal Pelvis
Larynx
Leukemia
Liver and Bile Duct
Lung and Bronchus
Melanoma of the Skin
Mesothelioma (all sites)
Multiple Myeloma
Non-Hodgkin’s Lymphoma
Oral Cavity and Pharynx
Ovary
Pancreas
Prostate
Stomach
Testis
Thyroid
Urinary Bladder
Mortality Rate
Male
Female
Total
Male
Female
Total
4,700
134
8
0
473
0
170
15
144
21
236
152
1,267
62
53
104
209
82
0
233
545
100
7
7
149
4,482
105
639
48
487
138
48
18
77
9
182
71
1,017
45
13
89
182
42
253
277
0
59
0
20
79
9,182
239
647
48
960
138
218
33
221
30
418
223
2,284
107
66
193
391
124
253
510
545
159
7
27
228
220.9
5.5
0.4
~
22.5
~
7.6
0.7
6.7
1.0
11.3
6.9
59.3
2.7
2.6
4.9
9.8
3.6
~
10.8
27.5
4.6
0.3
0.3
7.2
156.1
4.0
22.7
1.8
16.0
4.9
1.7
0.7
2.7
0.4
6.1
2.5
36.9
1.6
0.4
3.1
6.1
1.4
9.0
9.3
~
2.1
~
0.7
2.6
181.1
4.7
12.7
~
18.6
~
4.3
0.7
4.4
0.6
8.2
4.5
46.1
2.1
1.3
3.8
7.7
2.4
~
10.0
~
3.1
~
0.5
4.4
~ Not available or sex-specific site.
Source: All cases were microscopically confirmed or identified solely through death certificates and were reported to
the MCSS as of February 2006. In situ cancers except those of the urinary bladder are excluded. Deaths are from the
Minnesota Center for Health Statistics and include all deaths with the specified cancer as the underlying cause of death
during the time period, regardless of year of diagnosis. Rates are per 100,000 persons and are age-adjusted to the
2000 U.S. population.
46
Minnesota Cancer Facts and Figures 2006
Intro
Distribution of Stage at Diagnosis
Unstaged
Breast, female
MN
SEER
8,653
39,753
16.3%
19.2%
53.0%
51.8%
25.6%
24.1%
3.1%
3.3%
1.9%
1.7%
Cervix
MN
SEER
345
1,549
~
~
60.9%
52.5%
28.1%
30.9%
9.3%
12.7%
1.7%
4.0%
Colon and rectum
MN
SEER
5,329
22,934
5.3%
4.3%
35.6%
38.9%
39.2%
35.8%
15.6%
16.4%
4.4%
4.6%
Melanoma of the skin
MN
SEER
2,937
16,283
39.9%
40.9%
51.8%
50.9%
5.5%
4.6%
1.4%
2.1%
1.5%
1.6%
Prostate
MN
8,367
0.0%
SEER
32,620
0.0%
3.6%
3.1%
3.8%
2.1%
Registry
Age-adjusted (U.S. 2000) Rate per 100,000 Persons
All
Stages*
In Situ
Local
Regional
Distant
Unstaged
Breast, female
MN
SEER
164.0
174.4
27.1
33.9
86.6
89.9
42.5
42.3
5.0
5.6
2.7
2.7
Cervix
MN
SEER
6.8
7.1
0.0
0.0
4.2
3.8
1.9
2.2
0.6
0.9
0.1
0.3
Colon and rectum
MN
SEER
54.2
53.9
2.9
2.3
19.4
21.0
21.2
19.3
8.4
8.8
2.3
2.4
Melanoma of the skin
MN
SEER
29.7
38.3
11.9
15.7
15.3
19.4
1.6
1.8
0.4
0.8
0.4
0.6
Prostate
MN
195.6
0.1
SEER
175.1
0.1
7.4
6.8
7.0
4.2
(Local/Regional)
181.4
(Local/Regional)
163.8
Mesothelioma
Cancer Site
(Local/Regional)
93.2%
(Local/Regional)
94.1%
Colorectal
Distant
Breast
Regional
Prostate
Local
Cervix
In Situ
Melanoma
Registry Cases*
Childhood
Cancer Site
Lung
Stage at Diagnosis for Screening-Sensitive Cancers
in Minnesota and SEER, 2001-2002
Minnesota Cancer Facts and Figures 2006
47
End Notes
Survivorship
Healthy Life
*Total cases diagnosed over the two-year period 2001-2002, including in situ cases, except for cancer of the cervix.
~ In situ cervical cancers are not collected by either registry.
SEER cases are whites (including Hispanic whites) from the 9 SEER registries.
Source: MCSS (February 2006) and the SEER 9 Region public use file (November 2004).
Intro
Me
lan
om
a
NH
L
Pro
sta
te
Ur
ina
ry
Bla
dd
er
Re
ctu
Co
m
rpu
sU
ter
i (U
Le
ter
uk
em
us)
ia
Lu
ng
124
1,067
171
177
126
45
236
155
174
226
169
77
204
250
48
30
76
347
1,290
72
217
100
128
184
243
46
4,923
96
115
119
257
59
75
219
32
89
50
73
18
166
20
25
16
5
38
21
23
40
22
11
34
33
6
4
12
47
225
10
33
11
19
24
36
5
839
14
14
16
37
6
10
35
4
11
7
9
1
9
1
1
<1
<1
1
1
1
2
2
1
1
3
<1
<1
1
2
12
<1
2
1
<1
2
2
<1
37
1
1
1
3
1
<1
1
<1
1
<1
<1
12
99
20
20
10
7
32
21
21
25
19
11
21
32
6
3
11
39
121
8
25
15
16
25
28
6
481
12
18
12
33
7
9
25
4
11
7
10
1
31
7
3
2
2
8
9
6
6
4
2
4
5
2
1
3
6
40
1
5
3
5
5
8
1
141
3
2
4
8
2
4
7
<1
3
3
2
2
33
5
6
5
2
7
6
3
7
5
2
6
10
1
1
2
8
37
4
7
3
5
6
8
2
148
2
3
2
6
1
2
6
2
3
2
2
20
144
21
23
14
6
22
12
22
21
26
10
25
30
6
5
6
47
144
9
25
12
15
18
24
5
614
11
17
17
39
7
11
24
5
12
5
12
4
43
7
4
4
2
10
5
8
12
5
3
8
6
1
<1
3
12
59
3
7
5
3
7
11
1
212
4
5
4
9
3
1
8
1
2
1
3
7
45
9
7
8
1
11
7
9
12
6
4
6
10
2
2
4
12
64
5
8
5
7
10
11
2
221
5
6
4
10
2
2
8
2
4
2
3
24
195
32
32
32
8
39
31
27
36
34
15
39
53
10
5
16
74
196
14
45
19
20
38
46
10
753
16
20
23
45
13
14
43
6
16
11
13
7
47
10
9
4
3
10
8
8
9
6
3
7
13
2
2
3
17
54
2
15
4
6
8
10
3
233
3
8
5
13
4
3
10
1
5
1
4
23
130
46
120
164
3
18
7
17
23
<1
1
1
2
2
3
14
7
18
23
1
5
2
4
5
1
4
1
4
4
3
19
5
13
14
<1
4
<1
5
6
1
7
1
6
9
4
21
10
18
31
1
6
1
5
9
All
Sit
es
Fe
ma
le
Bre
ast
Ce
rvi
x
Aitkin
Anoka
Becker
Beltrami
Benton
Big Stone
Blue Earth
Brown
Carlton
Carver
Cass
Chippewa
Chicago
Clay
Clearwater
Cook
Cottonwood
Crow Wing
Dakota
Dodge
Douglas
Faribault
Fillmore
Freeborn
Goodhue
Grant
Hennepin
Houston
Hubbard
Isanti
Itasca
Jackson
Kanabec
Kandiyohi
Kittson
Koochiching
Lac Qui Parle
Lake
Lake of
the Woods
Le Sueur
Lincoln
Lyon
McLeod
Co
lon
&
Lung
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Average Number of New Cancer Cases Diagnosed Each Year for
Selected Cancers by County, Minnesota, 1999-2003
NHL is non-Hodgkin’s lymphoma; < 1 is less than one.
(continues)
Source: All cases were microscopically confirmed or identified solely through death certificates and were reported
to the MCSS as of February 2006. In situ cancers except those of the urinary bladder are excluded.
48
Minnesota Cancer Facts and Figures 2006
Intro
Source: All cases were microscopically confirmed or identified solely through death certificates and were
reported to the MCSS as of February 2006. In situ cancers except those of the urinary bladder are excluded.
Minnesota Cancer Facts and Figures 2006
49
Prostate
Breast
Colorectal
Lung
NHL is non-Hodgkin’s lymphoma; < 1 is less than one.
Cervix
3
3
8
6
10
8
13
3
8
4
3
26
23
4
9
3
8
4
103
1
3
4
11
3
3
58
11
11
3
29
7
3
4
6
2
6
7
3
34
3
1
11
18
3
Melanoma
8
11
26
20
38
41
50
10
19
23
11
92
90
9
28
14
32
13
350
4
22
16
41
12
12
185
49
51
15
146
28
10
11
29
8
15
21
15
131
14
6
37
67
14
2
3
4
4
5
7
13
2
5
5
2
31
13
2
5
3
7
3
113
2
4
5
10
4
2
48
14
11
3
30
8
1
4
6
1
4
5
4
37
3
2
9
15
3
Mesothelioma
<1
1
6
4
4
5
9
2
7
5
1
26
10
2
3
1
3
4
77
<1
3
4
6
2
3
33
16
11
2
23
6
1
3
3
1
6
2
4
38
3
1
7
14
2
Childhood
5
6
16
13
19
20
38
6
14
11
4
66
36
7
26
5
17
8
307
4
12
10
29
4
6
148
35
29
8
57
19
5
10
18
3
15
11
11
83
8
6
30
39
8
Healthy Life
2
2
5
5
3
6
7
3
4
3
3
21
10
3
5
1
5
3
64
1
2
4
10
1
2
30
8
8
3
14
5
2
1
4
1
6
4
3
23
1
1
8
13
2
Survivorship
1
1
4
2
5
5
7
2
4
4
1
13
10
3
4
2
7
4
73
<1
4
2
7
2
2
34
9
6
3
16
4
3
1
5
1
3
3
3
24
3
1
8
8
2
End Notes
Re
ctu
Co
m
rpu
sU
ter
i (U
Le
uk
ter
em
us)
ia
Lu
ng
4
8
16
12
18
21
28
10
14
17
5
49
42
10
16
10
29
13
230
3
14
14
41
7
10
135
27
24
11
63
22
9
8
16
5
15
13
11
72
8
7
33
37
7
Ur
ina
ry
Bla
dd
er
1
1
<1
<1
1
1
2
<1
2
1
<1
3
2
1
1
<1
2
1
19
1
<1
1
2
<1
1
9
3
2
1
3
1
<1
1
1
<1
<1
<1
<1
7
<1
<1
2
1
<1
Pro
sta
te
6
9
19
15
19
23
33
7
18
14
7
92
41
11
17
11
25
10
386
3
17
15
34
11
11
172
54
34
10
83
20
5
12
16
4
19
11
12
149
12
6
41
52
11
Me
lan
om
a
NH
L
Mahnomen
38
Marshall
58
Martin
134
Meeker
110
Mille Lacs
155
Morrison
184
Mower
253
Murray
56
Nicollet
125
Nobles
112
Norman
48
Olmsted
580
Otter Tail
349
Pennington
72
Pine
150
Pipestone
65
Polk
179
Pope
80
Ramsey
2,285
Red Lake
22
Redwood
104
Renville
103
Rice
254
Rock
59
Roseau
67
St Louis
1,123
Scott
304
Sherborne
248
Sibley
77
Stearns
615
Steele
158
Stevens
51
Swift
73
Todd
133
Traverse
30
Wabasha
118
Wadena
101
Waseca
93
Washington
789
Watonwan
71
Wilkin
40
Winona
239
Wright
348
Yellow Medicine
69
Co
lon
&
All
Sit
es
Fe
ma
le
Bre
ast
Ce
rvi
x
Average Number of New Cancer Cases Diagnosed Each Year for
Selected Cancers by County, Minnesota, 1999-2003, continued
Lu
ng
NH
L
Ov
ary
Pa
nc
rea
s
Pro
sta
te
45
395
70
70
60
24
96
66
70
74
73
35
78
91
22
12
33
128
446
25
77
41
51
79
91
16
1,924
38
41
53
122
29
33
89
13
39
26
31
1
13
1
2
2
<1
3
1
2
2
1
<1
2
3
<1
1
<1
3
18
1
1
1
1
3
1
<1
49
1
1
3
4
1
1
2
<1
1
<1
1
3
34
3
3
5
1
8
3
5
6
3
3
5
5
2
1
3
9
40
2
6
2
4
6
7
1
154
2
3
3
8
1
3
9
1
2
1
2
4
39
7
7
5
3
9
8
5
10
8
4
8
10
2
1
6
11
43
3
9
6
6
10
10
2
179
4
5
6
12
3
4
9
2
4
3
4
2
19
3
3
3
2
5
5
2
2
4
2
3
4
<1
1
2
6
21
2
3
2
3
4
5
1
84
2
1
2
4
1
2
4
<1
2
2
1
1
7
1
1
2
<1
2
1
1
1
1
<1
2
2
<1
<1
<1
3
8
1
1
1
<1
1
2
<1
50
<1
1
2
3
1
1
1
<1
<1
<1
1
15
119
18
21
13
6
18
10
17
14
19
7
18
22
6
4
6
33
110
5
19
10
12
17
19
3
496
8
9
12
34
5
9
21
4
12
4
10
2
16
4
3
3
1
6
4
4
4
3
1
3
4
<1
1
2
5
22
2
3
3
3
3
3
1
93
3
2
3
6
2
2
3
1
1
<1
1
2
8
2
2
1
1
3
2
2
3
2
1
4
3
1
<1
1
6
13
<1
2
1
1
2
2
1
51
2
1
1
2
1
1
3
<1
1
<1
<1
4
18
4
4
3
1
6
4
4
4
4
1
6
4
1
<1
1
10
21
1
5
2
3
4
5
1
106
2
2
2
6
2
2
5
<1
2
1
1
2
18
6
4
5
1
7
5
4
6
4
4
4
6
4
<1
3
9
22
2
5
3
5
5
8
2
105
4
4
4
10
3
2
7
1
3
2
2
10
57
20
50
64
1
1
<1
1
2
<1
4
<1
4
4
1
6
2
6
8
<1
3
1
3
5
<1
2
1
<1
1
4
16
5
13
10
<1
2
<1
3
4
<1
1
<1
1
2
<1
2
1
2
4
1
4
3
5
4
All
Sit
es
Bra
in
Fe
ma
le
Bre
ast
Co
lon
&
Re
ctu
Le
m
uk
em
ia
Liv
er
Intro
Lung
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Average Number of Cancer Deaths Each Year for Selected Cancers
by County, Minnesota, 1999-2003
Aitkin
Anoka
Becker
Beltrami
Benton
Big Stone
Blue Earth
Brown
Carlton
Carver
Cass
Chippewa
Chicago
Clay
Clearwater
Cook
Cottonwood
Crow Wing
Dakota
Dodge
Douglas
Faribault
Fillmore
Freeborn
Goodhue
Grant
Hennepin
Houston
Hubbard
Isanti
Itasca
Jackson
Kanabec
Kandiyohi
Kittson
Koochiching
Lac Qui Parle
Lake
Lake of
the Woods
LeSueur
Lincoln
Lyon
McLeod
Brain includes central nervous system; liver includes intrahepatic bile duct;
lung includes bronchus; NHL is non-Hodgkin’s lymphoma; < 1 is less than one.
(continues)
Source: Deaths are from the Minnesota Center for Health Statistics and include all deaths with the
specified cancer as the underlying cause of death on the death certificate during the time period,
regardless of year of diagnosis.
50
Minnesota Cancer Facts and Figures 2006
Intro
Lu
ng
NH
L
Ov
ary
Pa
nc
rea
s
Pro
sta
te
2
2
6
3
3
2
7
3
5
4
2
17
8
2
3
1
6
1
71
<1
3
2
6
3
3
35
8
7
3
13
5
1
2
5
2
3
3
3
21
1
1
9
11
2
3
5
15
12
16
17
30
7
12
9
5
49
32
6
17
4
19
7
253
3
10
8
24
5
5
125
28
22
4
46
16
5
8
12
2
13
9
9
71
6
5
26
34
6
<1
1
3
3
2
5
7
1
4
2
1
8
8
1
3
1
3
2
46
1
2
2
3
2
2
24
4
5
2
10
3
1
1
2
1
3
2
2
15
2
1
3
6
1
<1
1
1
2
2
2
1
1
1
1
1
5
2
1
2
<1
3
2
25
<1
1
1
2
1
1
13
5
3
1
3
1
1
1
2
<1
1
1
2
8
0
1
2
4
1
1
1
2
4
3
5
7
2
1
2
1
14
10
3
3
2
3
2
54
<1
2
2
6
2
2
33
5
4
2
15
4
1
2
3
<1
3
3
3
14
2
1
6
7
2
Melanoma
Cervix
Prostate
Breast
2
1
4
5
5
4
5
3
3
4
2
9
11
2
4
3
6
3
52
<1
4
5
7
2
3
38
7
4
2
17
5
2
1
3
2
3
4
2
14
2
1
5
7
3
Mesothelioma
1
<1
1
1
1
1
2
<1
1
<1
1
6
3
1
2
<1
1
<1
22
<1
1
1
2
<1
1
11
2
2
1
5
1
<1
<1
1
<1
2
1
1
6
<1
<1
3
2
1
Childhood
<1
1
3
3
3
4
5
3
2
2
2
10
7
2
3
2
3
1
41
<1
2
3
5
1
1
19
5
3
2
9
3
1
1
2
1
2
2
2
10
1
1
5
7
2
Healthy Life
1
3
5
6
6
9
10
3
7
6
2
20
19
3
6
3
10
2
85
1
7
7
13
2
4
48
10
9
5
18
6
3
3
6
2
7
4
3
25
4
3
10
14
3
Survivorship
<1
1
1
2
1
3
1
<1
1
2
<1
8
4
1
1
1
2
1
24
<1
2
1
3
<1
1
11
4
3
1
5
1
1
1
1
<1
2
1
1
8
1
<1
3
3
<1
Colorectal
Fe
ma
le
Bre
ast
Co
lon
&
Re
ctu
Le
m
uk
em
ia
Liv
er
15
23
61
56
59
74
107
28
52
48
22
203
147
32
61
27
78
31
944
9
48
47
104
27
31
508
106
88
35
201
66
21
27
52
15
51
41
41
273
27
18
99
127
30
Brain includes central nervous system; liver includes intrahepatic bile duct;
lung includes bronchus; NHL is non-Hodgkin’s lymphoma; < 1 is less than one.
Source: Deaths are from the Minnesota Center for Health Statistics and include all deaths with the
specified cancer as the underlying cause of death on the death certificate during the time period,
regardless of year of diagnosis.
Minnesota Cancer Facts and Figures 2006
51
End Notes
All
Sit
es
Bra
in
Mahnomen
Marshall
Martin
Meeker
Mille Lacs
Morrison
Mower
Murray
Nicollet
Nobles
Norman
Olmsted
Otter Tail
Pennington
Pine
Pipestone
Polk
Pope
Ramsey
Red Lake
Redwood
Renville
Rice
Rock
Roseau
St Louis
Scott
Sherburne
Sibley
Stearns
Steele
Stevens
Swift
Todd
Traverse
Wabasha
Wadena
Waseca
Washington
Watonwan
Wilkin
Winona
Wright
Yellow Medicine
Lung
Average Number of Cancer Deaths Each Year for Selected Cancers
by County, Minnesota, 1999-2003, continued
Intro
Lung
Site
Breast
Prostate
Mesothelioma
Melanoma
Cervix
Women at increased risk of developing breast cancer (family history, genetic predisposition, history of the
disease) may benefit from starting early detection practices at a younger age or having additional tests or
more frequent examinations. These women should talk to their health care provider about the benefits
and limitations of beginning screening at an earlier age and then make a decision about breast cancer
screening.
Colon &
Rectum
Beginning at age 50, men and women should follow one of the examination schedules below:
•A fecal occult blood test (FOBT) every year
•A fecal immunochemical test (FIT) every year
•A flexible sigmoidoscopy (FSIG) every five years
•Annual FOBT and FSIG every five years*
•A double-contrast barium enema every five years
•A colonoscopy every 10 years
*Combined testing is preferred over either annual FOBT or FSIG every five years, alone. People who are at
moderate or high risk for colorectal cancer should talk with a doctor about a different testing schedule.
Prostate
Men age 50 and older with a life expectancy of at least 10 years should have a Prostate Specific Antigen
(PSA) test and a Digital Rectum Exam (DRE) every year.
**Information should be provided to men about the benefits and limitations of testing so that an
informed decision about testing can be made with the clinician's assistance.
Uterus
Childhood
Healthy Life
Beginning in their early 20s, women should be told about the benefits and limitations of Breast
Self-Examination (BSE). The importance of prompt reporting of any new breast symptoms to a health
professional should be emphasized. Women who choose to do BSE should receive instruction and have
their technique reviewed on the occasion of a periodic health examination. It is acceptable for women to
choose not to do BSE or to do BSE irregularly.
Women age 40 and older should have a mammogram and CBE annually. As long as women 40 and older
are in good health, they should continue to receive an annual mammogram; age alone should not be the
reason for the cessation of regular mammograms. However, for women with serious health problems or a
short life expectancy, the need for on-going mammograms should be evaluated between the patient and
the health care provider.
Cervix: Screening should begin approximately three years after a woman begins having vaginal intercourse,
but no later than 21 years of age. Screening should be done every year with conventional Pap tests or every
two years using liquid-based Pap tests. At or after age 30 years, women who have had three normal test results
in a row may get screened every 2-3 years with cervical cytology (either conventional or liquid-based Pap test)
alone, or every 3 years with an human papillomavirus DNA test plus cervical cytology. Women age 70 or older
who have had three or more normal Pap tests and no abnormal Pap tests in the last 10 years and women who
have had a total hysterectomy may choose to stop cervical cancer screening.
Endometrium: At the time of menopause, women at average risk should be informed about risks and
symptoms of endometrial cancer and strongly encouraged to report any unexpected bleeding or spotting
to their physicians. Annual screening for endometrial cancer with endometrial biopsy beginning at age 35
should be offered to women with or at risk for hereditary nonpolyposis colon cancer (HNPCC).
Cancerrelated
checkup
Survivorship
End Notes
Recommendation
For women 20 - 39, it is recommended that Clinical Breast Examination (CBE) be part of a periodic health
examination, preferably at least every 3 years. Asymptomatic women aged 40 years and over should
continue to receive a clinical breast examination as part of a periodic health examination preferably
annually.
Breast
Colorectal
American Cancer Society Screening Guidelines for the
Early Detection of Cancer in Asymptomatic People
52
On the occasion of a periodic health examination, the cancer-related checkup should include examination
for cancers of the thyroid, testicles, ovaries, lymph nodes, oral cavity, and skin, as well as health counseling
about tobacco, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental and
occupational exposures.
Minnesota Cancer Facts and Figures 2006
Intro
Crude Cancer Rate: The number of new cases of
cancer diagnosed, or the number of cancer deaths,
divided by the size of the population in which the
cases or deaths occurred, over a specified period of
time. Cancer rates are usually expressed as the
number of cases or deaths per 100,000 persons
per year.
Five-year Relative Survival: The percentage of
persons who were still alive five years after
diagnosis, adjusted for (that is, relative to) expected
mortality from other causes. A five-year relative
survival of 80 percent means that 20 percent fewer
persons were alive five years after diagnosis than
would have been expected, given non-cancer
mortality rates in persons of the same age and sex.
Minnesota Cancer Facts and Figures 2006
Colorectal
Breast
Prostate
Cervix
Stage at Diagnosis: The extent to which the cancer
has spread at the time of diagnosis. In this report,
the following terms describing cancer stage are
used: in situ cancers are the earliest stage, and have
not infiltrated the tissue of the organ in which they
are growing; localized cancers have invaded the
tissue of the organ, but have not spread beyond the
organ in which the tumor originated; regional
cancers have spread beyond the organ in which
the tumor originated to adjacent lymph nodes or
tissues; distant cancers are the most advanced,
and have spread, or metastasized, to organs in
other parts of the body. Unstaged tumors have
insufficient information recorded in the medical
record to determine the extent of the tumor at the
time of diagnosis.
Melanoma
Palliation: Care focused on relieving symptoms
rather than curing a disease. Like hospice care,
it addresses the physical, emotional, and spiritual
needs of a patient and family.
Mesothelioma
Cancer Mortality: The number of deaths due to
cancer in a specified period of time, regardless of
when the disease was diagnosed.
Metastasis: Spread of cancer from one organ or
tissue to another, distant, part of the body.
Childhood
Cancer Incidence: The number of new cases of
cancer diagnosed during a specified period of time.
Lifetime Risk: The estimated percentage of
persons who will be diagnosed with cancer over
their entire lifetime, from birth to death, if cancer
incidence and mortality and all-cause mortality
rates do not change.
Healthy Life
Cancer Control: Reducing the effects of cancer in a
population through prevention, early detection,
treatment, rehabilitation, and palliation.
Invasive Cancer: A cancer is described as invasive
if it has penetrated the basement membrane of the
tissue in which it is growing. Cancers staged as
localized, regional, distant, and unstaged are
invasive. Unless otherwise stated, all cancer
incidence rates in this report are for invasive
cancers only.
Survivorship
Average Annual Percent Change (APC):
The average percent change in the age-adjusted rate
each year over a specific period of time. The APC is
a commonly used measure of cancer trends.
For example, an APC of +1.8% means that the
cancer rate increased, on average, by 1.8 percent
per year. Similarly, an APC of -1.8% means that the
cancer rate decreased, on average, by 1.8 percent
per year. The calculation of the APC assumes that
the rate of change has been consistent over time.
APCs in this report were calculated using the
statistical program SEER*Stat.
In Situ Cancer: See "stage at diagnosis.”
53
End Notes
Age-adjusted Cancer Rate: The crude rate
directly adjusted to an agreed-upon, or "standard"
population. Cancer rates that have been
age-adjusted to the same standard can be
compared without being biased by differences in
the age distribution of the populations.
Lung
Glossary
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Melanoma
Mesothelioma
Childhood
American Cancer Society: The expected numbers
of cancer cases and deaths in Minnesota in 2006
were obtained from the American Cancer Society
publication, Cancer Facts and Figures 2006.
It is available on their web site,
http://www.cancer.org.
Behavioral Risk Factor Surveillance System:
Information on behaviors related to cancer such as
smoking and screening utilization were obtained
from the BRFSS, a telephone survey of randomly
selected adults ages 18 and older. Results for
Minnesota were obtained by downloading data
from the CDC web site and analyzing it in SAS.
Prevalence rates were weighted by the age- and
sex-specific Minnesota population distribution in
2000. Information on county of residence was
obtained directly from the Minnesota Center for
Health Statistics, which conducts the Minnesota
BRFSS. The denominator represents all survey
respondents except those with missing, don't know,
or refused answers for the relevant questions.
Unless otherwise stated, data for the U.S. as a whole
represent the median value for all participating
states and territories, as reported by the Division of
Adult and Community Health, National Center for
Chronic Disease Prevention and Health Promotion,
Centers for Disease Control and Prevention,
Behavioral Risk Factor Surveillance System Online
Prevalence and Trends Data. Information on the
strengths and weaknesses of the BRFSS and
additional data can be found at
http://www.cdc.gov/brfss.
represented 3.4 percent of cases reported to the
SEER Program during 2000-2002. Information on
cancer deaths among Minnesota residents was
obtained from death certificates compiled by the
Center for Health Statistics, which is also part of
MDH. For more detailed information on MCSS and
cancer in Minnesota, please see Cancer in
Minnesota 1988-2002, available from MCSS and at
http://www.health.state.mn.us/divs/
hpcd/cdee/mcss.htm.
Surveillance, Epidemiology, and End Results
Program: In this report, cancer rates in Minnesota
are compared to those from the SEER Program of
NCI. SEER has been collecting population-based
cancer data from selected geographic areas in the
U.S. since 1973. Since a cancer registry covering the
entire U.S. does not exist, cancer incidence rates
from SEER are widely cited as national data. The
SEER incidence rates presented in this report are
for nine SEER registries covering about 10 percent
of the U.S. population, while mortality rates are for
the entire U.S., as reported in Cancer Statistics
Review, 1975-2002 available at
http://seer.cancer.gov/. During the period covered
by this report, 93 percent of Minnesotans were
white, compared to 78.5 percent in the nine
registries in the SEER Program. Because cancer
rates vary by race/ethnicity, we have chosen to
compare Minnesota rates to those for whites in the
SEER Program and in the U.S.
Minnesota Cancer Surveillance System:
The numbers and types of cancers diagnosed
among Minnesota residents were obtained from
MCSS, which was implemented in 1988 to provide
information on cancer incidence and mortality
among Minnesota residents. MCSS does not
include cancers that are solely diagnosed on clinical
observations (that is, which have not been
microscopically confirmed). Clinical diagnoses
End Notes
Survivorship
Healthy Life
Data Sources
54
Minnesota Cancer Facts and Figures 2006
Direct age-adjustment is a statistical method that
accomplishes this. It calculates the rate that would
occur if the population had the age distribution of an
agreed-upon, or "standard," population. If cancer
rates are age-adjusted to the same standard
population, they will not be biased by differences in
age. On the other hand, it is important to remember
that an age-adjusted rate is a hypothetical number
(the rate that would occur if…), and the value of the
rate will vary considerably depending on the choice
of standard population.
Minnesota Cancer Facts and Figures 2006
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Melanoma
Mesothelioma
Age-adjusted Cancer Rates: Because cancer occurs
more frequently with increasing age, a population
with a larger proportion of elderly individuals will
have more cancers occur than a younger population
of the same size, even if the risk of developing cancer
at each age is exactly the same in the two groups. To
make meaningful comparisons, the age of the
population therefore needs to be taken into
consideration.
Relationship between Incidence and Mortality
Rates: A frequent misconception when incidence
and mortality data are presented together is that
the mortality rates are directly related to the cases
included in the incidence rates; that is, incidence
rates based on 22,925 new cancer diagnoses in 2000
and mortality rates based on 9,197 cancer deaths in
the same year, are sometimes misconstrued to
mean that 40 percent (9,197 / 22,925) of the cases
diagnosed in 2000 died in the same year. That
interpretation is incorrect. Unless specifically
stated otherwise, cancer mortality rates include
every individual who died during the calendar year
with cancer as the underlying cause of death on the
death certificate, regardless of year of diagnosis.
Childhood
In 2000, 22,925 new cancers were diagnosed among
the 4,919,479 people living in Minnesota, and
9,197 Minnesotans died due to cancer. This results
in a crude cancer incidence rate of 466 new cases
per 100,000 Minnesotans per year, and a crude
cancer mortality rate of 187 deaths per 100,000
Minnesotans.
All rates in this report were age-adjusted to the
2000 U.S. population. The cancer incidence and
mortality rates in Minnesota in 2000, age-adjusted
to the 2000 U.S. population, were 483 new cases
per 100,000 persons and 191 deaths per 100,000
persons. If the same data were age-adjusted to the
1970 U.S. population, Minnesota cancer incidence
and mortality rates in 2000 would be reported as
409 new cases per 100,000 persons and 150 deaths
per 100,000 persons, respectively.
Survivorship
When comparing geographic areas, different types
of people, or time periods, cancer occurrence is
usually presented as a rate. The number of events
(cases or deaths) during a specified period of time
(usually a year) is divided by the number of people in
the population that generated the events
(for example, the population estimate for Minnesota
in that year). Typically, cancer rates are presented as
the average number of cases or deaths occurring for
every 100,000 persons during a calendar year.
Choice of Standard Population for
Age-adjustment: By convention, cancer registries
in the U.S. currently adjust their rates to the age
distribution of the U.S. population in 2000.
Until recently, the age distribution of the 1970 U.S.
population was used for age-adjusting cancer
incidence rates, while cancer mortality rates were
often age-adjusted to the 1940 U.S. population.
However, international cancer registries usually
age-adjust to the World Population. This means
that when comparing cancer rates, one must be
careful that they were age-adjusted to the same
standard population.
55
End Notes
Cancer Rates: The number of cases and deaths due
to cancer is important. But for many purposes the
number by itself isn't enough information - we can
only determine if the number is "high" or "low" if we
know the size of the population in which the cases
or deaths occurred, and the period of time involved.
Healthy Life
Understanding Cancer Rates
Minnesota Cancer Surveillance System
Minnesota Department of Health
85 East Seventh Place
PO Box 64882
St. Paul, MN 55164
Phone: 651.201.5900
TDD: 651.201.5797
Fax:
651.201.5926
http://www.health.state.mn.us/divs/hpcd/cdee/mcss
Minnesota Cancer Alliance
Minnesota Department of Health
85 East Seventh Place
P.O. Box 64882
St. Paul, MN 55164
Phone: 651.201.3608
Fax:
651.201.3603
http://www.mncanceralliance.org
April 2006
American Cancer Society, Midwest Division
2520 Pilot Knob Road, Suite 150
Mendota Heights, MN 55120-1158
Phone: 1.800.582.5152
Fax:
651.255.8133
http://www.cancer.org
8201.49