Minnesota Cancer Surveillance System
Minnesota Department of Health
85 East Seventh Place
P.O. Box 64882
Saint Paul, MN 55164
Phone: (651) 201-5900
TDD: (651) 201-5797
Fax: (651) 201-5926
www.state.mn.us/divs/hpcd/cdee/mcss/
Minnesota Cancer Alliance
Gonda Lobby, CEC 334
200 First Street SW
Rochester, MN 55905
Phone: (507) 266-9087
www.mncanceralliance.org
American Cancer Society, Midwest Division
2520 Pilot Knob Road, Suite 150
Mendota Heights, MN 55120-1158
Phone: 1-800-227-2345
Fax: (651) 255-8133
www.cancer.org
Minnesota
Cancer Facts
and Figures
2009
Special Section:
Increasing Colorectal Cancer
Screening in Minnesota
(see page 5)
8201.49
December, 2008
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 provide us with an invaluable picture of health behaviors in
our state.
Minnesota Cancer Facts and Figures 2009
1
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Intro
This report represents the efforts and contributions of many individuals and organizations. It was designed and printed
by the American Cancer Society (ACS), Midwest Division. We gratefully acknowledge the generous contributions
of time and energy of many ACS staff. The production of this document was also funded in part by the Centers
for Disease Control and Prevention through the National Program of Cancer Registries and through the National
Comprehensive Cancer Control Program.
Healthy Life
Acknowledgments
Survivorship
Introduction
Hope.Progress.Answers. 2
American Cancer Society Challenge Goals for 2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Estimated New Cancer Cases and Cancer Deaths in Minnesota, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
The Minnesota Cancer Alliance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Fond du Lac Wiidookaage Comprehensive Cancer Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Special Section: Increasing Colorectal Cancer Screening in Minnesota. . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Frequently Asked Questions about Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Cancer in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Cancer Disparities in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Lung Cancer in Minnesota. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Colorectal Cancer in Minnesota. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Breast Cancer in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Prostate Cancer in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Cervical Cancer in Minnesota. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Melanoma of the Skin in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Mesothelioma in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Childhood Cancer in Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Living a Healthy Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Survivorship. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
American Cancer Society Resources to Improve Quality of Life.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Summary Tables and End Notes
Cancer Incidence in Minnesota, 2005. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Cancer Mortality in Minnesota, 2005. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Stage at Diagnosis for Screening-Sensitive Cancers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Average Number of New Cancer Cases by County, Minnesota, 2001-2005. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Average Number of Cancer Deaths by County, Minnesota, 2001-2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
American Cancer Society Screening Guidelines for the Early Detection of Cancer. . . . . . . . . . . . . . . . . . . . . . 60
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Acronyms/Abbreviations Used Frequently in This Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Data Sources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Understanding Cancer Rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
End Notes
Table of Contents
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Melanoma
Mesothelioma
Childhood
Healthy Life
Survivorship
End Notes
Hope.Progress.Answers.
We are pleased to present the third issue of Minnesota Cancer Facts and Figures. The American Cancer Society, the
Minnesota Department of Health, and the Minnesota Cancer Alliance have collaborated to produce this summary
of cancer in our state. Stakeholders in cancer control will use this document to measure progress in meeting the objectives
stated in Cancer Plan Minnesota 2005-2010, the state’s comprehensive cancer control plan. We also hope cancer
patients, health care and public health professionals, policy makers, advocates, news organizations, and the public
will find it useful when seeking detailed, easy-to-read information about cancer in Minnesota.
New in this issue is a special section on colorectal cancer screening. In 2008, the Minnesota Cancer Alliance Steering
Committee voted to elevate colorectal cancer screening to its top priority. To help guide the discussion on this priority, the
special section summarizes activities that are being implemented to increase the demand for, access to, and delivery
of screening.
Hope.
Cancer has been the leading cause of death in Minnesota since 2000. But there is hope. Current scientific information
shows that one-third of cancer deaths would be prevented if no one smoked cigarettes or used tobacco products, and
that another third of deaths from cancer could be prevented if individuals maintained a healthy weight, ate a healthy
diet, and regularly exercised. Also, 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.
Progress.
We are making progress in the fight against cancer. The overall cancer mortality rate in Minnesota has been declining
steadily for more than a decade, and began declining at an even faster rate in 2003. The risk of a Minnesotan being
diagnosed with cancer has not increased significantly since 2001, due to decreasing incidence rates for several common
cancers. These gains are occurring because of the concerted efforts of many organizations and individuals to reduce
smoking, increase screening, and grow public awareness about cancer prevention strategies. Progress is also being
made because of research that seeks to understand how cancer works and to develop better treatments. Progress is
being made because cancer patients participate in clinical trials to test those treatments, and because physicians and
other health care providers incorporate improved treatments into their practice. Cancer still kills far too many in
Minnesota, and elsewhere around the nation and the world. But real progress is being made.
Answers.
Research will continue to provide us with life-saving information about what causes cancer, how to prevent it, and
how to detect it early, as well as how to successfully treat and cure cancer while maintaining a high quality of life.
But we already know enough to see more gains and to reduce 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.
Sincerely,
Jari Johnston-Allen
CEO, Midwest Division
American Cancer Society
2
Sanne Magnan, MD, PhD
Commissioner
Minnesota Department of Health
DeAnn Lazovich, PhD
Chair
Minnesota Cancer Alliance
Minnesota Cancer Facts and Figures 2009
Intro
Lung
American Cancer Society 2015 Challenge Goals
Colorectal
The American Cancer Society has set ambitious goals for 2015:
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.
Breast
• Reduce
Cervix
9,100
240
630
~
760
~
390
270
2,380
~
320
260
560
450
~
Melanoma
23,160
~
3,090
140
2,430
750
910
~
3,330
830
1,110
~
~
3,400
1,110
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 Lymphoma
Ovary
Pancreas
Prostate
Urinary Bladder
Mesothelioma
Deaths
Source: American Cancer Society, Inc. Cancer Facts & Figures 2008.
Childhood
* Rounded to the nearest 10. Excludes basal and squamous cell skin cancers and in situ carcinomas
except urinary bladder.
~ Not estimated by ACS.
Healthy Life
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 cancer deaths in Minnesota from 1969 to 2005.
Minnesota Cancer Facts and Figures 2009
Survivorship
If there are abbreviations or terms in this report that you do not
understand, please see pages 61 and 62 of this report.
3
End Notes
New Cases
Prostate
Estimated New Cancer Cases and Cancer Deaths
in Minnesota, 2008*
Intro
Lung
Who is part of the Alliance?
The Minnesota Cancer Alliance is a coalition committed
to implementing the state’s first comprehensive cancer
control plan, Cancer Plan Minnesota 2005-2010. Founded
in 2005, it is a voluntary association that offers free
membership to organizations and individuals interested
in working to reduce the state’s cancer burden.
More than 80 organizations have joined the Alliance. For
a complete list of members visit www.mncanceralliance.org.
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
What is the Minnesota Cancer Alliance?
Colorectal
The Minnesota Cancer Alliance
What are the priorities of the Alliance?
The Alliance is focused on implementing activities in
the following four initial priority areas:
• Increasing colorectal cancer screening
Conducting free colorectal cancer screening days and
advocating for Minnesota’s Colorectal Cancer
Prevention and Early Detection Act, which would
provide funding for a free statewide screening
program for under- or un-insured individuals
• Promoting policies to reduce the harmful effects
of tobacco
Working with insurers, employers and purchasers to
expand smoking cessation benefits
• Reducing disparities in cancer screening and treatment
Collaborating with community and faith-based
organizations, health care systems and worksites
to conduct screening and education interventions to
reach the underserved
• Enhancing quality of life for cancer survivors and their
caregivers
Partnering with health systems to improve continuity
of care through the use of survivor care plans
Why join the Alliance?
Cancer is the leading cause of death in Minnesota. By
joining the Alliance, members will:
• Become informed of the broad scope of cancer control
activities in Minnesota
• Find opportunities to collaborate with new partners
• Explore available resources and potential funding
sources for cancer-related activities
• Stay connected to cancer control initiatives by receiving
a quarterly Alliance newsletter, monthly e-mail
updates and upcoming event notices
• Become a part of a local and national effort to reduce
the cancer burden
How can my organization get involved?
There are a variety of opportunities for individuals
and organizations to become involved in the Alliance.
For more information, contact Nicole Bennett Engler
at (507) 266-9087 or [email protected], or
visit www.mncanceralliance.org.
Fond du Lac Band Wiidookaage Cancer Plan
The vision of concerned people. The Fond du
Lac (FDL) Band of Lake Superior Chippewa published
the Wiidookaage Cancer Plan 2007-2012 in April 2008.
“Wiidookaage” is an Ojibwe or Chippewa word for “they
help each other,” which tribal leaders say describes the
foundation of the reservation’s first cancer plan. The
plan was created by the collaborative efforts of the
FDL Reservation Business Committee (tribal council)
and Human Services Division, FDL community members
including cancer survivors and caregivers, and other
cancer control advocates.
4
“Our plan is a testimony to the vision of a small core of
concerned people who quietly set about creating a path
to follow where none had existed,” said Sharon Johnson,
Wiidookaage Cancer Team chair. “It is our dream that
early intervention, education, and awareness will begin
to erode the hold cancer has gained on our reservation.”
To view the plan, visit http://cancercontrolplanet.cancer.
gov/state_plans/Fond_du_Lac_Cancer_Control_Plan.pdf.
Minnesota Cancer Facts and Figures 2009
Minnesota Cancer Alliance partners have organized free
colorectal cancer screening days to provide colonoscopies
to individuals who need screening but cannot afford it.
These events rely on the volunteer services of hospital
and clinic staff as well as organizational and logistical
support from ACS, the Colon Cancer Coalition, MDH,
and other Alliance partners. For information, contact
David Simmons at the MDH Comprehensive Cancer
Control Program at (651) 201-3607 or
[email protected].
As a result of the Dialogue, priorities were established,
including the need for tribal resolutions that make
colorectal cancer screening a priority, the need to secure
funding for screening exams, and the importance of
community-based programs to educate the young and
the old. The MICCC continues to meet to further address
the issue and help provide support to Minnesota tribes.
For more information, contact David Perdue, M.D.,
at (612) 675-3741 or [email protected].
American Indians Unite to Address
Colorectal Cancer
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Healthy Life
American Indians have the highest colorectal cancer
incidence and mortality rates in Minnesota. Furthermore,
the risk of developing or dying from this cancer among
American Indians is twice as high in Minnesota as in the
U.S. as a whole.
Survivorship
Members of the Minnesota Cancer Alliance received
support from the Prevent Cancer Foundation to conduct
a Dialogue for Action to address colorectal cancer among
American Indians in our state. With this seed money,
a Minnesota Intertribal Colorectal Cancer Council
(MICCC) was formed to plan a day-long summit for
tribal leaders, health professionals and community
members to discuss how they could work together
to tackle this issue.
Minnesota Cancer Facts and Figures 2009
Melanoma
Advancing Access to Screening through
Partnership
“It is important for tribes to identify colorectal cancer not
just as a disease that affects individuals, but as one that
affects entire communities,” says Lana R. White-King,
M.D., internal medicine physician for the ShakopeeMdewakanton Sioux Community Wellness Center. “By
working among tribes to ensure the wellness of our
communities, we strengthen the future of our people.”
Childhood
As described in the section on colon and rectum cancer
starting on page 22, only lung cancer is responsible for
more cancer deaths—more Minnesotans die of colon
and rectum cancer than either breast or prostate cancer.
Screening can prevent this cancer or detect it at an early
stage, but fewer than two-thirds of Minnesotans ages
50 and older report being screened as recommended,
lagging considerably behind screening for other cancers
for which screening is recommended. Increasing screening
among at-risk individuals will reduce colorectal cancer
incidence and mortality, improve survival rates, and
reduce disparities.
After months of hard work and with support from the
University of Minnesota, Mayo Clinic, the Minnesota
Department of Health, the American Cancer Society,
and the Fond du Lac Band of Lake Superior Chippewa,
the first-ever tribal Dialogue for Action summit was held
in September 2007 in Mille Lacs, Minnesota. Seventy
participants representing nine tribes, the Indian Health
Service, and urban Indian community organizations
discussed how to work within their communities to
educate on the importance of colorectal cancer screening,
and on breaking down financial, health system, and
cultural barriers to screening.
5
End Notes
The American Cancer Society and the Minnesota
Cancer Alliance are focusing their energies on a
wide variety of activities to increase the number of
Minnesotans who are screened for colorectal cancer.
Colorectal cancer screening is a priority because this
cancer affects thousands of Minnesotans and because
there are opportunities to make real progress.
Mesothelioma
Special Section: Increasing Colorectal Cancer Screening in Minnesota
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Advancing Access to Screening through
Public Policy
Twelve states currently provide colorectal cancer
screening services for at-risk, low-income, uninsured
men and women.
Tackling the many barriers to screening requires a
multi-faceted approach with public policy playing
a central role.
Policymakers at the federal level have recognized the
need to do more to prevent and detect colorectal
cancer. Five colorectal cancer screening demonstration
projects were funded by the Centers for Disease Control
and Prevention (CDC) starting in 2005 to increase
screening rates among low-income individuals who have
inadequate or no health insurance (see map below). In
2008, Congress introduced The Colorectal Cancer Early
Detection, Prevention and Treatment Act, which would
authorize CDC to grant $50 million to states to provide
screening and treatment to the medically underserved.
The grants would match every $1 spent by the state with
$3 from the federal government.
The Minnesota Colorectal Cancer Prevention and Early
Detection Act was heard in both House and Senate
health policy committees during the 2008 Legislative
session. The act would provide funding for a statewide
colorectal cancer screening program for under- or
uninsured individuals and is expected to be reintroduced
in 2009.
For more information on increasing colorectal cancer
screening in Minnesota, contact Rebecca Thoman, M.D.,
at the American Cancer Society at (651) 255-8156 or
[email protected].
You can also read more about these and other activities
to eliminate the burden of cancer in our state in Working
Together, the Minnesota Cancer Alliance’s quarterly
newsletter, at www.mncanceralliance.org.
Colorectal Cancer Screening Programs by State
WA
MT
Mesothelioma
Melanoma
Special Section: Increasing Colorectal Cancer Screening in Minnesota
NH
ND
OR
ID
MA
WI
SD
NY
WY
MI
RI
IA
NE
NV
PA
CT
Childhood
OH
IL
UT
CA
ME
VT
MN
NJ
IN
DE
CO
WV
KS
MD
VA
MO
DC
KY
NC
AR
NM
Healthy Life
TN
OK
AZ
SC
MS
AL
GA
TX
LA
AK
End Notes
Survivorship
FL
States with statewide colorectal cancer
screening programs
States with county or local colorectal
cancer screening programs
HI
PR
None
Source: American Cancer Society Midwest Division Government Relations Department, June 2008.
6
Minnesota Cancer Facts and Figures 2009
Melanoma
Cervix
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.
Lung
Intro
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 sequence of events
that ultimately prevents cell repair and growth from
functioning normally. 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
may act together or in sequence to initiate or promote
cancer. Ten or more years often pass between exposure
or mutations and detectable cancer.
Colorectal
What causes cancer? Although the cause of a cancer
Breast
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.
Prostate
Frequently Asked Questions about Cancer
Causes of Cancer Deaths in the U.S.
Mesothelioma
30
Tobacco Use
30
Diet & Obesity
Sedentary Lifestyle
5
5
5
Occupational Exposures
5
Prenatal Factors & Growth
5
Reproductive Factors
3
Socioeconomic Status
3
Childhood
Family History
Infectious Agents
3
Alcohol
2
Pollution
1
Food Additives & Contaminants
1
0
5
10
15
20
25
30
35
Survivorship
Percent
Source: Harvard Report on Cancer Prevention, 1996.
Minnesota Cancer Facts and Figures 2009
7
End Notes
Medicine
Healthy Life
2
Radiation
Intro
Lung
Colorectal
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 35 percent more common among men
than women.
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Frequently Asked Questions about Cancer
Leading Sites of New Cancer Cases
and Deaths among Males,
Minnesota, 2005
Cases
Prostate
32.9%
Lung and Bronchus
11.9%
Colon and Rectum
9.8%
Urinary Bladder
6.8%
Non-Hodgkin Lymphoma 4.9%
Melanoma of the Skin
4.1%
Kidney and Renal Pelvis 3.6%
Leukemia
3.3%
Oral Cavity and Pharynx 3.1%
Pancreas
1.9%
Esophagus
~
Liver and Bile Duct
~
All Others
17.5%
All Sites Combined
100%
Deaths
11.0%
28.5%
8.6%
3.1%
4.3%
**
3.0%
4.5%
**
5.9%
4.2%
3.5%
23.3%
Leading Sites of New Cancer Cases
and Deaths among Females,
Minnesota, 2005
Cases
Breast
30.5%
Lung and Bronchus
11.2%
Colon and Rectum
10.5%
Uterus
6.9%
Non-Hodgkin Lymphoma 4.4%
Melanoma of the Skin 4.1%
Ovary
3.1%
Leukemia
3.0%
Thyroid
2.9%
Urinary Bladder
2.6%
Pancreas
~
Brain and Nervous System ~
Liver and Bile Duct
~
All Others
20.8%
100%
All Sites Combined
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.
8
Deaths
15.0%
23.1%
9.4%
2.8%
4.0%
**
6.0%
4.3%
**
**
6.8%
2.1%
2.0%
24.6%
100%
100%
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.
Minnesota Cancer Facts and Figures 2009
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 in 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
question depends very much on the type of cancer and
whether or not the cancer is detected early. The fiveyear 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 1996 and 2004 was 66
percent.
Minnesota Cancer Facts and Figures 2009
Colorectal
Breast
Prostate
Cervix
Survivorship
there are any symptoms of disease (that is, during the
preclinical stage of tumor development) only benefits a
patient if treatment is more effective when begun during
the preclinical stage than later on. While it seems,
Lung
Intro
Can cancer be cured? The answer to this
Melanoma
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 of these cancers
could be prevented.
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.
Mesothelioma
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 was
released during 2006, but will not prevent infection
with all cancer-causing strains of HPV or eliminate
current infections.
Childhood
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.
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.”
9
End Notes
Can cancer be prevented? Tobacco use is
Healthy Life
Frequently Asked Questions about Cancer
Intro
The overall cancer mortality rate in
Minnesota is declining significantly, and
began declining more rapidly in 2003. The
overall cancer mortality rate was declining gradually by
an average of 0.6 percent per year from 1988 to 2003,
but then began decreasing more sharply, by four percent
a year, from 2003 to 2005. After adjusting for population
growth and aging, the overall cancer mortality rate in
Minnesota was nine percent lower in 2005 (168.6 deaths
per 100,000 persons) than it was 30 years earlier, in 1975
(184.4 deaths per 100,000 persons).
The overall cancer incidence rate in
Minnesota has not increased significantly for
the last five years. After increasing by 1.3 percent
This progress is due to sharp declines in mortality for
several of the most common cancers: female breast,
prostate, colon and rectum, non-Hodgkin lymphoma
and among men, lung and bronchus. In fact, the only
cancer sites for which mortality rates in Minnesota
increased significantly over this period were cancers of
the esophagus and liver, and among women, lung and
bronchus cancer.
Despite this overall improvement, incidence rates for
a number of cancer sites are rapidly increasing. Two of
these sites, liver and esophagus, also showed significant
increases in mortality. Other cancer sites for which
incidence rates increased significantly over the period
had stable mortality rates (melanoma of the skin,
leukemia, cancers of the thyroid, kidney, bladder, and
uterus) or even had significant declines in mortality
(non-Hodgkin lymphoma and testis cancer).
per year from 1995 to 2001, the overall cancer incidence
rate was relatively stable from 2001 to 2005. This was
true for both men and women, but the stabilization
occurred earlier among men (in 1995) than among
women (in 2001).
Overall Cancer Trends in Minnesota, 1988-2005
600
1988-1992
Incidence increased by an
average of 2.1% annually
500
Incidence
1995-2001
Incidence increased by an
average of 1.3% annually
Mortality
Healthy Life
400
300
0
End Notes
Overall cancer mortality is decreasing significantly
among both men and women, but the decline is more
rapid among men. Because lung cancer is by far the
most common cause of cancer-related death, the
continuing increase in lung and bronchus cancer
mortality among women partially cancels gains for
other cancers.
2003-2005
Mortality decreased by an
average of 4.0% annually
1988-2003
Mortality decreased by an
average of 0.6% annually
200
20
05
20
04
20
03
19
88
100
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
Lung
Colorectal
Breast
Prostate
Cervix
Melanoma
Mesothelioma
Cancer is very common. From 2001 to 2005, an
average of 23,650 Minnesotans were diagnosed with
a potentially serious cancer each year, and more than
9,000 Minnesotans die of this disease annually.
Survivorship
Childhood
Cancer in Minnesota
Year of Diagnosis / Death
Source: MCSS. Rates are age-adjusted to the 2000 U.S. population. A hashed bar indicates where the trend significantly changed
direction. Intervals that are not annotated did not have a statistically significant trend.
10
Minnesota Cancer Facts and Figures 2009
Intro
Deaths Due to Heart Disease and Cancer, Minnesota 1980-2006
400
Rate per 100,000 persons
Heart Disease
350
Cancer
300
Mesothelioma
Melanoma
While national trends for heart disease and cancer
mortality are similar to those in Minnesota, the
crossover between cancer and heart disease mortality
occurred earlier in Minnesota than in other states
primarily because Minnesota consistently has one of
the lowest rates of heart disease mortality in the nation,
about 30 percent lower than the national average, while
the cancer mortality rate is only slightly lower.
Lung
since then, more Minnesotans died of cancer than heart
disease. In 2006, 9,065 Minnesotans died of cancer,
compared to 7,506 from heart disease. Cancer has
become the leading cause of death in Minnesota in
part because the heart disease mortality rate decreased
much more rapidly and began decreasing earlier than
cancer.
Colorectal
Based on current statistics for the state, 50 percent
of men and 42 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 (44% for males
and 37% for females) despite similar or lower cancer
rates in Minnesota because life expectancy is higher
in Minnesota, and therefore, more people live to
develop cancer.
Breast
Cancer is the leading cause of death in
Minnesota. For the first time in 2000, and each year
Prostate
More than half of all Minnesotans will be
diagnosed with a potentially serious cancer.
Cervix
Cancer in Minnesota
Childhood
250
200
150
Healthy Life
100
50
06
20
Survivorship
Year of Death
Source: MCSS. Rates are age-adjusted to the 2000 U.S. population.
Minnesota Cancer Facts and Figures 2009
11
End Notes
4
20
0
20
02
20
00
19
98
96
19
19
94
92
19
19
90
88
19
19
86
4
19
8
19
82
19
80
0
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Cancer in Minnesota
The overall cancer incidence rate in
Minnesota is similar to what is reported for
the nation. Over the five-year period 2001-2005, the
The overall cancer mortality rate in
Minnesota is somewhat lower than for the
nation. Over the five-year period 2001-2005, the over-
overall cancer incidence rate in Minnesota (472.3 new
cases per 100,000 persons) was marginally higher than
reported by the SEER Program (470.1). The incidence
rate was somewhat lower in Minnesota than nationally
for each race/ethnic group except American Indians. In
the geographic areas reporting to the SEER Program,
American Indians have the lowest cancer rate; in
Minnesota, they have the highest.
all cancer mortality rate in Minnesota (178.4 cancer
deaths per 100,000 persons) was seven percent lower
than for the U.S. as a whole (192.7). The mortality rate
was somewhat lower in Minnesota than nationally for
each race/ethnic group except American Indians and
Asian/Pacific Islanders. Among American Indians, the
cancer mortality rate is more than two times higher in
Minnesota than in the U.S.
Cancer Incidence by Race/Ethnicity, Minnesota and the U.S., 2001-2005
600
500
Rate per 100,000 persons
500.6
SEER
524.7
491.5
492.2
468.6
400
357.6
313.5
312.7
Melanoma
300
Minnesota
335
254.7
200
100
Healthy Life
Childhood
Mesothelioma
0
African
American
American
Indian
Asian/Pacific
Islander
Hispanic
(all races)
Non-Hispanic
White
Source: MCSS and SEER Cancer Statistics Review, 1975-2005. Rates are age-adjusted to the 2000 U.S. population. Incidence data
are from the SEER 17 Regions; rates for Hispanics and non-Hispanic whites exclude cases from Alaska and Kentucky.
Cancer Mortality by Race/Ethnicity, Minnesota and the U.S., 2001-2005
300
Rate per 100,000 persons
U.S.
276.9
250
234
Minnesota
226.2
192.2
200
177.9
150
128.2
129.8
113.8
127
108.3
100
End Notes
Survivorship
50
0
African
American
American
Indian
Asian/Pacific
Islander
Hispanic
(all races)
Non-Hispanic
White
Source: MCSS and SEER Cancer Statistics Review, 1975-2005. Rates are age-adjusted to the 2000 U.S. population. Mortality data are
for the entire U.S.; rates for Hispanics and non-Hispanic whites exclude deaths in Minnesota, New Hampshire and North Dakota.
12
Minnesota Cancer Facts and Figures 2009
African Americans: Over the five-year period
2001-2005, African American men had the highest
overall cancer incidence rate in Minnesota, but it was
only marginally higher than the rate for American
Indian men. African American and American Indian
men also had the highest cancer mortality rates compared
to other race/ethnic and gender groups in the state.
Cancer Incidence by Race/Ethnicity and Gender, Minnesota, 2001-2005
700
Rate per 100,000 persons
640.3
African American
633.8
600
American Indian
551.4
Asian/Pacific Islander
500
Colorectal
Breast
Melanoma
The cancer incidence rate among African American
men in Minnesota was 16 percent higher than for nonHispanic white men, while their mortality rate was 38
Lung
Intro
As shown on page 12, the overall cancer incidence rate
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.
Prostate
percent higher. Higher overall cancer mortality among
African Americans compared to non-Hispanic white
men was primarily due to lung cancer (31% higher
rate), prostate cancer (95% higher rate), and colon and
rectum cancer (11% higher rate). Over the same time
period, the overall cancer incidence rate among African
American women in Minnesota was eight percent lower
than that of non-Hispanic white women, but their cancer
mortality rate was 15 percent higher. Higher overall
cancer mortality among African American compared to
non-Hispanic white women was primarily due to lung
cancer (20% higher rate), colon and rectum cancer (40%
higher rate), and breast cancer (21% higher rate).
Mesothelioma
Measuring race/ethnic differences in cancer risk in
Minnesota is limited by incomplete and potentially
inaccurate reporting of race and ethnicity on the
medical record and death certificate, uncertain accuracy
of population estimates, and the relatively small size
of populations of color 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 experience an excess
burden. As seen on page 12, this is true nationally as
well as in Minnesota.
Cervix
Cancer Disparities in Minnesota
375.6
343.7
300
268.6
337.0
Hispanic (all races)
Non-Hispanic White
247.2
Healthy Life
200
100
0
Males
Females
Minnesota Cancer Facts and Figures 2009
Survivorship
Source: MCSS. Rates are age-adjusted to the 2000 U.S. population.
13
End Notes
409.7
400
Childhood
449.6
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Melanoma
Mesothelioma
American Indians: Over the five-year period
2001-2005, the overall cancer incidence rate among
American Indian men was only marginally lower than
that for African American men, and was higher than
other race/ethnic and gender groups in the state.
American Indian men had the highest overall cancer
mortality rate.
Over the same time period, the overall cancer incidence
rate among American Indian women in Minnesota was
ten percent higher than that of non-Hispanic white
women, but their cancer mortality rate was 58 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) and
colon and rectum cancer (33% higher).
The cancer incidence rate among American Indian
men in Minnesota was 15 percent higher than for
non-Hispanic white men, while their mortality rate
was 54 percent higher. Higher cancer mortality among
American Indian compared to non-Hispanic white men
was primarily due to lung cancer (two times higher),
prostate cancer (37% higher rate), and colon and
rectum cancer (two times higher).
Cancer rates among American Indians in Minnesota are
roughly two times higher than reported for the nation
as a whole. However, there is increasing evidence that
an increased risk for cancer is found in the Northern
Plains tribes in general, and is probably not limited to
Minnesota.
Cancer Mortality by Race/Ethnicity and Gender, Minnesota, 2001-2005
700
Rate per 100,000 persons
African American
600
American Indian
500
Asian/Pacific Islander
Hispanic (all races)
400
334.5
Non-Hispanic White
299.0
300
240.8
217.4
200
151.2
175.2
137.9
152.6
114.3
84.4
100
0
Males
Females
Source: MCSS. Rates are age-adjusted to the 2000 U.S. population.
End Notes
Survivorship
Healthy Life
Childhood
Cancer Disparities in Minnesota
14
Minnesota Cancer Facts and Figures 2009
Minnesota Cancer Facts and Figures 2009
Breast
Colorectal
Lung
Intro
15
End Notes
Survivorship
Healthy Life
Although overall cancer incidence among Asian/Pacific
Islanders was 19 percent lower in Minnesota than in the
geographic areas covered by the SEER Program, their
cancer mortality rate was 14 percent higher than among
Asian/Pacific Islanders 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.
Prostate
Overall cancer incidence among Hispanics is somewhat
lower in Minnesota than in the geographic areas covered
by the SEER Program. Their cancer mortality rate is
somewhat lower than Hispanics in the U.S. as a whole.
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.
Cervix
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.
2001-2005, Hispanics had the second lowest overall
cancer incidence rate in Minnesota, and the lowest
cancer mortality rate. The overall cancer incidence
rate among Hispanic men in Minnesota was 38 percent
lower than among non-Hispanic white men, and their
mortality rate was 37 percent lower. The overall cancer
incidence rate among Hispanic women in Minnesota
was 18 percent lower than among non-Hispanic white
women, and their mortality rate was 45 percent lower.
Melanoma
Hispanics (all races): Over the five-year period
Mesothelioma
Asian/Pacific Islanders: Over the five-year period
2001-2005, Asian/Pacific Islanders had the lowest
overall cancer incidence rate in Minnesota, and their
cancer mortality rate was somewhat higher than
among Hispanics, who had the lowest rate. 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 30 percent lower. Similarly, the overall cancer
incidence rate among Asian/Pacific Islander women
in Minnesota was 40 percent lower than among nonHispanic white women, but their mortality rate was only
25 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.
Childhood
Cancer Disparities in Minnesota
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Melanoma
Mesothelioma
Childhood
Healthy Life
Survivorship
End Notes
Lung and Bronchus Cancer in Minnesota
As many Minnesotans die from lung and bronchus
cancer as from breast, prostate, colon and rectum, and
pancreas cancer combined. What is particularly tragic
is that we know how to prevent these deaths.
Approximately 90 percent of lung cancers are caused
by cigarette smoking. 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 77.8 years, this means that smoking can
basically eliminate your retirement years.
The second leading cause of lung cancer is exposure
to radon. Radon is a radioactive gas that is emitted
naturally from rocks and soils containing uranium.
Radon can enter homes from the surrounding soil
through cracks, joints, and gaps in construction, and
without adequate ventilation, can reach rather high
levels. When inhaled, particles called “radon progeny”
can damage the lungs and increase the risk of
developing lung cancer. EPA estimated in 2003 that
of the 160,000 lung cancer deaths in the U.S. each
year, 21,000 (13%) are associated with exposure to
radon. About 2,900 of these radon-related deaths
occur among people who have never smoked.
Risk Factors for Lung Cancer
• Tobacco smoking, even low-tar cigarettes
• Breathing in radon, a radioactive gas
produced by uranium and present in
some homes, especially among smokers
• Breathing in secondhand smoke,
whether in the home or workplace
• Exposure to asbestos fibers, especially
among smokers
• 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
16
The amount of radon in the environment depends in
large part on geology and other characteristics of the
soil. Radon levels vary widely throughout the U.S. The
upper Midwest has geological formations that can yield
higher than average radon levels. MDH estimates that
one in three Minnesota homes have enough radon to
pose a significant risk to the occupants’ health over
many years of exposure. The risk of lung cancer among
persons exposed to radon is many times higher for
smokers than non-smokers. EPA estimates that a lifetime exposure to 4 pCi/L (picocuries per liter) of radon
will cause seven lung cancers among 1,000 non-smokers,
but 62 lung cancers among the same number of smokers.
The EPA and MDH recommend that all homes and
schools be tested for radon. Testing can be done for
as little as $6.00. Remediation is recommended if test
results show radon levels above 4 pCi/L. You can obtain
more information on radon and options for testing your
home from the MDH Indoor Air Unit at www.state.
mn.us/divs/eh/indoorair/radon/index.html or by calling
(651) 201-4601 to request a radon fact sheet.
The third leading cause of lung cancer is secondhand
smoke, estimated to cause 3,000 lung cancer deaths
among non-smokers each year in the U.S. Breathing
in the tobacco smoke of others is also estimated to be
responsible for 46,000 deaths each year from heart
disease, and to increase the risk among children for low
birthweight, SIDS and asthma. The Minnesota legislature
passed the Freedom to Breathe (FTB) provisions in 2007.
This expansion of the Minnesota Clean Indoor Air Act
went into effect on October 1, 2007. It prohibits smoking
in virtually all public indoor places and indoor places
of employment. Going “smoke free” in public places is
a big step forward in cancer control in our state. You
can obtain more information from MDH at www.state.
mn.us/freedomtobreathe.
Minnesota Cancer Facts and Figures 2009
Intro
Childhood
Five-Year Relative Survival from
Lung and Bronchus Cancer in the U.S.
Blacks
41.2%
17.5%
2.7%
12.1%
Healthy Life
Whites
50.1%
20.7%
2.7%
15.5%
Lung
Mesothelioma
Melanoma
Cervix
From 2001 to 2005, more than 2,300 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 prostate, breast, colon
and rectum, and pancreas cancer combined. About
73 percent of deaths due to lung cancer occurred
among Minnesotans 65 years of age or older. The
age-adjusted mortality rate for lung and bronchus
cancer in Minnesota in 2005 was 57.5 deaths per
100,000 men and 35.7 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.
Stage
Localized
Regional
Distant
All Stages
Colorectal
Over the five-year period 2001-2005, nearly 2,900
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 ageadjusted incidence rate for lung cancer in Minnesota
in 2005 was 71.1 new cases per 100,000 men and 48.8
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.
Although about the same number of Minnesotans
were diagnosed with lung cancer as with colon and
rectum cancer each year, more than 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 colon and rectum cancer. Even when
diagnosed at the same stage, lung cancer patients
have a poorer chance of survival than persons diagnosed
with many other of the most common cancers.
Prostate
The Burden of Lung Cancer in Minnesota
Breast
Lung and Bronchus Cancer in Minnesota
Minnesota Cancer Facts and Figures 2009
17
End Notes
Survivorship
Source: SEER Cancer Statistics Review, 1975-2005.
Based on cases diagnosed during 1996-2004.
Intro
Lung
Colorectal
Lung and Bronchus Cancer in Minnesota
Disparities in Lung Cancer
American Indian men and women have the highest lung
cancer rates in Minnesota. Their risk of dying of this
disease is more than twice that of non-Hispanic whites
Lung and Bronchus Cancer Mortality by Race/Ethnicity and Gender, Minnesota, 2001-2005
Rate per 100,000 persons
Breast
140
Males
119.6
120
Females
100
91
77.6
80
Prostate
of the same gender. Similarly, African American men
and women are 20-30 percent more likely to die of lung
cancer than non-Hispanic whites of the same gender.
59.2
60
44.8
37.3
40
31.9
23.8
20
15.7
14.9
African
American
Hispanic
(all races)
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
2005, lung cancer mortality decreased by a total of 17
percent among Minnesota men.
Non-Hispanic
White
Between 1988 and 1993, the lung cancer mortality
rate among women in Minnesota increased by an
average of 4.2 percent each year, while between 1993
and 2005 it increased by an average of 1.1 percent
annually. Nonetheless, over the entire eighteen-year
period lung cancer mortality increased by a total of
28 percent among women in Minnesota.
In sharp contrast, lung cancer mortality is still increasing
significantly among Minnesota women. However, it
appears that the rate of increase may be slowing down.
Lung Cancer Mortality by Gender in Minnesota and the U.S.
Rate per 100,000 persons
100
U.S.
90
80
Minnesota
Males
70
60
50
40
Females
20
10
20
05
20
00
95
19
19
90
85
19
0
75
0
19
Survivorship
Asian/Pacific
Islander
Source: MCSS. Rates are age-adjusted to the 2000 U.S. population.
30
End Notes
American
Indian
19
8
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
0
Year of Death
Source: MCSS and SEER Cancer Statistics Review, 1975-2005. Rates are age-adjusted to the 2000 U.S. population. National
mortality is for the white population in the entire U.S.
18
Minnesota Cancer Facts and Figures 2009
Lung Cancer Mortality Rates
among Males in Minnesota Regions
and Six Largest Counties, 2001-2005
Marshall
Northeast
43.0
Itasca
Mahnomen
Hubbard
Cass
Becker
Cass
Becker
Clay
Aitkin
Wadena
Aitkin
Crow Wing
Carlton
Ottertail
Wilkin
Grant
Douglas
Stevens
Pope
County
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
Pine
Todd
Central
63.8
Mille
Lacs
Kanabec
Morrison
Benton
Traverse
West Central
West
Central
28.6
Wadena
Wilkin
West Central
53.9
Stearns
Isanti
Big Stone
Sherburne
Chisago
Swift
Anoka
Kandivohi
Meeker
Wright
Chippewa
WashingRam- ton
sey
Metro
59.9
Hennepin
Lac Qui Parle
McLeod
Renville
Carver
Scott
Yellow Medicine
Rate
62.5
54.0
57.8
70.1
66.1
60.0
Ottertail
Crow Wing
Lyon
Pine
Douglas
Stevens
Pope
Morrison
Pipestone
Rock
Nicollet
Le
Sueur
Rice
Cottonwood
Nobles
Jackson
Kanabec
Stearns
Isanti
Sherburne
Chisago
Swift
Anoka
Kandivohi
Meeker
Metro
Wright
Chippewa
WashingRam- ton
sey
Hennepin
McLeod
Renville
Carver
41.4
Scott
Yellow Medicine
Blue Earth
Watonwan
Olmsted
Waseca
Faribault
Steele
Freeborn
Dodge
Mower
Fillmore
Lyon
Redwood
Southwest
25.7
Wabasha
South Central Southeast
50.3
57.4
Martin
Mille
Lacs
Benton
Traverse
Big Stone
Lincoln
Goodhue
Brown
Murray
36.7
Lac Qui Parle
Dakota
County
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
Todd
Grant
Rate
51.9
40.9
39.8
42.4
42.9
41.5
Colorectal
Breast
Prostate
Dakota
Sibley
Redwood
Southwest
56.0
Carlton
Central
Sibley
Lincoln
Lake
Lung
Intro
Cook
Clear
Water
Red Lake
Norman
Hubbard
St. Louis
Pennington
Polk
Lake
Mahnomen
Norman
Koochiching
Beltrami
Northeast
68.6
Itasca
Clay
Northwest
35.1
Marshall
Cook
Clear
Water
Lake
of the
Woods
Roseau
St. Louis
Beltrami
Pennington
Red Lake
Kittson
Koochiching
Northwest
55.1
Polk
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Minnesota = 37.3
U.S.* = 44.3
Winona
Pipestone
Houston
Rates are per 100,000 persons, age-adjusted to the 2000
US population. Statistical significance (p < 0.05) based
on SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the U.S. excluding Minnesota,
New Hampshire, and North Dakota, 2001-2005, SEER
Cancer Statistics Review, 1975-2005.
Minnesota Cancer Facts and Figures 2009
Rock
Nicollet
Le
Sueur
Rice
Goodhue
Wabasha
South Central Southeast
32.6
32.4
Brown
Murray
Cottonwood
Nobles
Jackson
Blue Earth
Watonwan
Martin
Olmsted
Waseca
Faribault
Steele
Freeborn
Dodge
Mower
Fillmore
Winona
Houston
Rates are per 100,000 persons, age-adjusted to the 2000
US population. Statistical significance (p < 0.05) based
on SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the U.S. excluding Minnesota,
New Hampshire, and North Dakota, 2001-2005, SEER
Cancer Statistics Review, 1975-2005.
19
Healthy Life
Lake
of the
Woods
Roseau
Lung Cancer Mortality Rates
among Females in Minnesota Regions
and Six Largest Counties, 2001-2005
Survivorship
Kittson
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
The average number of lung
cancer cases and deaths each year in
Minnesota counties is shown in the
End Notes section of this report.
End Notes
Minnesota = 59.4
U.S.* = 74.2
The female lung cancer mortality rate varied by twofold
across Minnesota. Anoka, Hennepin, Ramsey, and
St. Louis Counties and Metro and Northeast Minnesota
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 Southeast, Southwest, and West Central Minnesota.
Cervix
Over the same period, the male lung cancer mortality rate
was significantly higher than the statewide average
in Northeast and Central Minnesota and in Ramsey
County, and was significantly lower in South Central
Minnesota. Nonetheless, lung cancer mortality
among males was lower than the U.S. average in each
Minnesota region and in the six largest counties.
mortality rate among women was 16 percent lower in
Minnesota than among non-Hispanic white women in
the U.S. as a whole.
Melanoma
mortality rate among men was 20 percent lower in
Minnesota than among non-Hispanic white men in the
U.S. as a whole. Although lung cancer mortality was
about the same as or lower in Minnesota than nationally for
other race/ethnic and gender groups, mortality among
American Indians was more than two and a half times
higher in Minnesota than in the U.S. as a whole.
Among women: During 2001-2005, the lung cancer
Childhood
Geographic Differences in Lung
Cancer Mortality
Among men: During 2001-2005, the lung cancer
Mesothelioma
Lung and Bronchus Cancer in Minnesota
Intro
Lung
Considerably lower lung cancer rates in Minnesota
indicate that two or three decades ago, cigarette smoking
was much less common in Minnesota than in the U.S.
as a whole. For the last decade and a half, however, data
from the BRFSS have indicated that smoking rates in
Minnesota were only marginally lower than the median
Breast
Cigarette Smoking
Colorectal
Lung and Bronchus Cancer in Minnesota
of the other geographic areas participating in the survey.
In addition, the percent of Minnesota adults reporting
that they currently smoked showed little sign of declining.
However, smoking prevalence rates in Minnesota have
decreased steadily for the last seven years, from 22.2
percent in 2001 to 16.5 percent in 2007.
Trends in Adult Smoking, Minnesota and the US, 1990-2007
70
Percent Current Smokers
U.S.
Minnesota
Prostate
60
50
40
Cervix
30
20
10
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
07
06
20
20
04
20
20
02
00
20
19
98
96
19
19
94
92
19
90
19
Melanoma
0
Source: BRFSS web site. Current smokers have smoked at least 100 cigarettes and smoke every day or some days. U.S. is the
median of the 50 states, Washington D.C., and participating Territories.
2000-2004), smoking rates were similarly elevated
for American Indian males. It isn’t clear if this change
reflects a true decrease in the prevalence of smoking
among American Indian males or is an artifact of
data collection.
Combining responses from survey participants over
the five-year period 2003-2007, American Indian
women were more than twice as likely to report that
they currently smoke than other race/ethnic and gender
groups in the state. When last reported (data for
Adult Smoking by Gender and Race/Ethnicity, Minnesota, 2003-2007
60
Percent Current Smokers
African American
56
American Indian
50
Asian/Pacific Islander
40
Hispanic
29
30
27
25
22
20
Non-Hispanic White
25
20
18
15
13
10
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.
20
Minnesota Cancer Facts and Figures 2009
Cigarette smoking is strongly associated with education:
among persons who do not have a high school degree, 33
percent currently smoke, compared to 28 percent of high
school graduates, 22 percent of those with some postsecondary education, and 10 percent of college graduates.
Intro
Although cigarette smoking is slightly more common
among adults residing in rural (22%) than in urban
(19%) Minnesota, smoking rates are about the same
at each education level.
The Minnesota Student Survey reported that cigarette
smoking among students has declined each year since
1998, and is now lower in each group than it was in 1992.
Percent Current Smokers
60
HS Graduate
50
Post-HS Education
Prostate
Not a HS Graduate
College Grad
40
34
33
29
28
Cervix
30
22
21
20
11
9
10
0
Rural
Urban
Source: Minnesota BRFSS. Analysis 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 18 counties designated as “metropolitan” in the 2000 Census.
Melanoma
70
Breast
Adult Smoking by Education and Residence, Minnesota, 2003-2007
Lung
Cigarette Smoking
Colorectal
Lung and Bronchus Cancer in Minnesota
Percent Smoked Cigarettes during the Previous 30 Days
Grade 12
Grade 9
60
Grade 6
50
42
39
30
30
27
23
20
19
19
15
8
10
5
10
7
3
3
2
2001
2004
2007
0
1992
1995
1998
Source: Modified from tables in Minnesota Student Survey 1992-2007 Trends: Behaviors, attitudes and perceptions of Minnesota’s 6th,
9th and 12th graders.
Call it Quits
Call it Quits is a collaboration among Minnesota’s
major health plans and ClearWay MinnesotaSM to make
it easier for healthcare providers to help their patients
who want to stop smoking. The Minnesota Clinic Fax
Referral Program began on October 1, 2007, the same day
Minnesota’s statewide smoke-free law took effect.
Minnesota Cancer Facts and Figures 2009
The new program allows clinics across the state to more
easily refer a patient to stop-smoking phone coaching
support, regardless of the patient’s health care coverage.
To learn more about Call it Quits, the Minnesota Clinic
Fax Referral Program or about how to stop smoking, visit
www.preventionminnesota.com and click on the Call it
Quits icon on the home page.
21
Healthy Life
31
Childhood
35
31
Survivorship
40
End Notes
70
Mesothelioma
Trends in Student Smoking by Grade, Minnesota, 1992-2007
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Melanoma
Colon and Rectum Cancer in Minnesota
More Minnesotans die of colon and rectum cancer 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 colon
and rectum cancer 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.
Moderate to High Risk Factors for
Cancer of the Colon and Rectum
• A strong family history of colon and rectum
cancer or adenomatous polyps
• A known family history of hereditary colon
and rectum cancer syndromes
• Personal history of colon and rectum polyps
or colon and rectum cancer
• Personal history of inflammatory bowel
disease
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Other Risk Factors
•
•
•
•
•
Not being screened
Obesity
Alcohol
Poor diet
Physical inactivity
From 2001 to 2005, about 850 Minnesotans died of colon
and rectum cancer each year. Colon and rectum cancer
was the third leading cause of cancer death for men and
for women, and the second leading cause for both sexes
combined.
About 80 percent of deaths due to colon and rectum
cancer occurred among Minnesotans 65 years of age
or older. The age-adjusted mortality rate for colon and
rectum cancer in Minnesota in 2005 was 17.6 deaths
per 100,000 men and 12.7 deaths per 100,000 women.
The higher death rate for colon and rectum compared
to breast and prostate cancer results in part from the
fact that only 45 percent of colon and rectum cancers
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.
Five-Year Relative Survival from
Colon and Rectum Cancer in the U.S.
Stage
Localized
Regional
Distant
All Stages
Whites
90.3%
69.2%
11.1%
65.3%
Blacks
84.4%
61.2%
8.3%
55.1%
Source: SEER Cancer Statistics Review, 1975-2005.
Based on cases diagnosed during 1996-2004.
Great progress against colon and rectum cancer can be
made by following screening recommendations and by
encouraging others to do so as well.
The Burden of Colon and Rectum Cancer
in Minnesota
Over the five-year period 2001-2005, about 2,500
Minnesotans were diagnosed with colon and rectum
cancer 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 colon and
rectum cancer were 65 years of age or older. The ageadjusted incidence rate for colon and rectum cancer in
Minnesota in 2005 was 54.4 new cases per 100,000 men
and 40.7 new cases per 100,000 women.
22
Minnesota Cancer Facts and Figures 2009
Intro
men, non-Hispanic white men and American Indian
women have about the same rates. Colon and rectum
cancer incidence among American Indians is twice as
high in Minnesota as in the U.S. as a whole.
American Indian men have the highest colon and
rectum cancer incidence rate in Minnesota. Their risk
of being diagnosed with this disease is 50 percent higher
than for non-Hispanic white men. African American
100
Breast
Colorectal Cancer Incidence by Race/Ethnicity and Gender, Minnesota, 2001-2005
Rate per 100,000 persons
Males
86.8
90
Females
80
Lung
Disparities in Colon and Rectum Cancer
Colorectal
Colon and Rectum Cancer in Minnesota
60
56.8
57.5
54
44.4
50
37.4
40
Prostate
70
34.1
28.1
30
42.6
32.6
0
African
American
American
Indian
Asian/Pacific
Islander
Hispanic
(all races)
Non-Hispanic
White
Source: MCSS. Rates are age-adjusted to the 2000 U.S. population.
Trends in Colon and Rectum Cancer
Colon and rectum cancer incidence and mortality
rates in Minnesota have decreased significantly since
statewide cancer reporting was implemented in 1988.
Between 1988 and 2005, the incidence rate decreased
by 21 percent and mortality by 38 percent. Trends in
Minnesota are similar to those reported by the SEER
Program. The reason for steadily decreasing colon
and rectum cancer rates is related, at least in part, to
increased screening. Other factors such as use of
hormone replacement therapy among women and use
of aspirin to prevent heart disease, both of which may
reduce the risk of colon and rectum cancer, may also
be involved.
Mesothelioma
10
Melanoma
Cervix
20
Rate per 100,000 persons
Minnesota
Incidence
Healthy Life
60
50
40
30
Mortality
20
10
5
20
0
20
00
19
95
90
19
19
85
19
80
19
75
0
Year of Diagnosis / Death
Source: MCSS and SEER Cancer Statistics Review, 1975-2005. 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 2009
23
Survivorship
70
SEER/U.S.
End Notes
80
Childhood
Colorectal Cancer in Minnesota and the U.S.
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Melanoma
Colon and Rectum Cancer in Minnesota
Geographic Differences in Colon and
Rectum Cancer Incidence
Geographic Differences in Colon and Rectum
Cancer Mortality
During 2001-2005, the colon and rectum cancer
incidence rate was about the same in Minnesota as
among non-Hispanic whites in the geographic areas
reporting to the SEER Program.
During 2001-2005, the colon and rectum cancer
mortality rate was ten percent lower in Minnesota
than among non-Hispanic whites in the U.S. as a whole.
During the same period, colon and rectum cancer
incidence rates were significantly higher in Southwest,
West Central, Northeast and Northwest Minnesota
than the state average. Rates were significantly lower in
the Metro Area and in Ramsey and Hennepin Counties.
Geographic differences in colon and rectum cancer
incidence may reflect differences in the proportion of
the population who are screened, as well as differences
in the underlying risk of developing this disease.
Colorectal Cancer Incidence Rates in
Minnesota Regions and Six Largest
Counties, 2001-2005
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Minnesota = 49.8
SEER*= 50.8
Kittson
Lake
of the
Woods
Roseau
Marshall
Koochiching
Northwest
57.9
Mesothelioma
Childhood
Healthy Life
St. Louis
Northeast
53.9
Pennington
Cook
Clear
Water
Lake
Northeast
17.3
Itasca
Hubbard
Cass
Becker
Aitkin
Aitkin
Wadena
Wadena
Crow Wing
Carlton
Ottertail
Wilkin
West Central
55.8
Grant
Douglas
Stevens
Pope
County
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
Pine
Todd
Central
48.2
Mille
Lacs
Kanabec
Morrison
Benton
Traverse
Stearns
Isanti
Sherburne
Chisago
Anoka
Kandivohi
Meeker
Metro
Wright
Chippewa
WashingRam- ton
sey
Hennepin
Lac Qui Parle
McLeod
Renville
Carver
Rate
46.4
46.3
45.2
45.4
53.1
50.6
Lyon
Redwood
Southwest
59.5
Pipestone
Rock
Nicollet
Le
Sueur
Cottonwood
Nobles
Jackson
Rice
Pope
Mille
Lacs
Goodhue
Freeborn
Kanabec
Morrison
Stearns
Isanti
Big Stone
Sherburne
Chisago
Swift
Anoka
Kandivohi
Meeker
Metro
Wright
Chippewa
WashingRam- ton
sey
Hennepin
Dodge
Mower
Fillmore
Lyon
McLeod
Carver
Rate
16.8
16.7
15.6
14.6
18.4
17.8
15.8
Scott
Redwood
Southwest
19.1
Olmsted
Steele
County
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
Dakota
Sibley
Wabasha
Waseca
Faribault
Douglas
Stevens
Renville
Blue Earth
Martin
Grant
Central
17.3
Yellow Medicine
South Central Southeast
53.4
49.7
Watonwan
Carlton
Pine
Todd
Benton
Traverse
Lincoln
Brown
Murray
West Central
18.7
Dakota
Sibley
Lincoln
Crow Wing
Ottertail
Wilkin
Lac Qui Parle
46.1
Scott
Yellow Medicine
Lake
Mahnomen
Cass
Clay
Swift
Survivorship
Koochiching
Northwest
18.1
Norman
Hubbard
Lake
of the
Woods
Roseau
Red Lake
Becker
Big Stone
End Notes
Kittson
Polk
Mahnomen
Norman
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Minnesota = 16.9
U.S.* = 18.6
Beltrami
Cook
Clear
Water
Itasca
Clay
Colorectal Cancer Mortality Rates in
Minnesota Regions and Six Largest
Counties, 2001-2005
Marshall
Pennington
Red Lake
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.
St. Louis
Beltrami
Polk
Colon and rectum cancer mortality rates were
significantly higher than the state average in Southwest
Minnesota, and significantly lower in the Metro Area
and in Ramsey and Hennepin Counties.
Pipestone
Winona
Houston
Rates are per 100,000 persons, age-adjusted to the 2000
US population. Statistical significance (p < 0.05) based
on SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the SEER 17 areas excluding the
Alaska Native Registry and Kentucky, 2001-2005, SEER
Cancer Statistics Review, 1975-2005.
Rock
Nicollet
Le
Sueur
Rice
Goodhue
Wabasha
South Central Southeast
17.3
16.9
Brown
Murray
Cottonwood
Nobles
Jackson
Blue Earth
Watonwan
Martin
Olmsted
Waseca
Faribault
Steele
Freeborn
Dodge
Mower
Fillmore
Winona
Houston
Rates are per 100,000 persons, age-adjusted to the 2000
US population. Statistical significance (p < 0.05) based on
SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the U.S. excluding Minnesota,
New Hampshire, and North Dakota, 2001-2005, SEER
Cancer Statistics Review, 1975-2005.
The average number of colon
and rectum cancer cases and
deaths each year in Minnesota
counties is shown in the End
Notes section of this report.
24
Minnesota Cancer Facts and Figures 2009
Trends in Recent Colorectal Cancer Screening among Minnesotans by Year and Screening Test
Percent of Persons Ages 50 and Older
Lower Endoscopy Only
Melanoma
100
Both
80
20
0
60
62
62
37
39
45
16
16
7
7
2001
2002
~
12
2003
2004
5
Mesothelioma
40
FOBT Only
65
50
~
11
4
2005
2006
Childhood
60
Lung
Intro
The American Cancer Society recommends tests
that prevent cancer as long as they are available and
acceptable (see guidelines below). The important
thing is to be screened.
Cervix
Prostate
A number of effective tests have been developed to
screen for colon and rectum cancer. These tests are
divided into those whose effectiveness is limited to
finding presymptomatic cancers, and those that can
prevent cancer by finding polyps as well as finding
cancers at a presymptomatic stage. Finding and
removing polyps can prevent colon and rectum cancer
because these small tissue growths are the precursors
of cancer and can be removed on an outpatient basis,
usually during a colonoscopy.
Based on data from the 2006 BRFSS, Minnesotans
were more likely to report having had at least one
colonoscopy or sigmoidoscopy (66%) than the median
of the states and territories participating in the BRFSS
(57%). The percent of Minnesotans ages 50 and older
that either had a lower endoscopic exam (colonoscopy
or sigmoidoscopy) within the last five years or a fecal
occult blood test (FOBT) within the last year increased
from 60 percent in 2001 to 65 percent in 2006.
Colorectal
Colorectal Cancer Screening
Breast
Colon and Rectum Cancer in Minnesota
Minnesota Cancer Facts and Figures 2009
25
End Notes
Survivorship
Healthy Life
Source: Minnesota BRFSS. Analyses were conducted by MCSS. Recent means within five years for lower endoscopy
(sigmoidoscopy or colonoscopy) or within one year for FOBT.
~ Question not asked.
Intro
Lung
Colorectal
Breast
Colon and Rectum Cancer in Minnesota
Colorectal Cancer Screening, continued:
Combining data for 2004 and 2006, the percent of
Minnesotans who had either had a lower endoscopic
exam in the last five years or a FOBT in the last year
was the same in rural (64%) and urban (64%) Minnesota,
but increased with education (not a high school graduate,
Recent Colorectal Cancer Screening among Minnesotans by Education and Residence,
2004 and 2006
Prostate
100
Percent of Persons Ages 50 and Older
Not a HS Graduate
HS Graduate
80
63
Childhood
Mesothelioma
Melanoma
Cervix
60
67
66
59
College
59
51
40
20
0
Rural
Urban
Source: Minnesota BRFSS. Analyses were conducted by MCSS. Recent means within five years for lower endoscopy
(sigmoidoscopy or colonoscopy) or within one year for FOBT. HS is high school. Urban residents live in one of the 18 counties
designated as “metropolitan” in the 2000 Census.
American Cancer Society Screening Guidelines for the Early Detection of Colon and Rectum
Cancer in Asymptomatic People at Average Risk
Beginning at age 50, men and women should follow one of the screening tests below: The tests that are designed to find both early
cancer and polyps are preferred if these tests are available to you and you are willing to have one of these more invasive tests.
Tests that find polyps and cancer
Tests that mainly find cancer
• flexible sigmoidoscopy every 5 years*
• fecal occult blood test (FOBT) every year *,**
• colonoscopy every 10 years
• fecal immunochemical test (FIT) every year *,**
• double-contrast barium enema every 5 years* • stool DNA test (sDNA), interval uncertain*
• CT colonography (virtual colonoscopy) every 5 years*
*Colonoscopy should be done if test results are positive.
**For FOBT or FIT used as a screening test, the take-home multiple sample method should be used. FOBT or FIT done during a
digital rectal exam in the doctor’s office is not adequate for screening.
End Notes
Survivorship
Healthy Life
55%; high school graduate, 60%; some post-secondary
education or college graduate, 66%). There were too few
interviews among persons of color to present colorectal
cancer screening rates by race/ethnicity.
26
Minnesota Cancer Facts and Figures 2009
Stage
Localized
Regional
Distant
All Stages
Whites
98.6%
85.2%
28.8%
89.9%
Blacks
93.1%
72.3%
17.1%
77.1%
Source: SEER Cancer Statistics Review, 1975-2005.
Based on cases diagnosed during 1996-2004.
The Burden of Breast Cancer in Minnesota
Colorectal
Survivorship
From 2001 to 2005, more than 3,500 women and 28 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
2005 was 124.4 new cases per 100,000 women.
Minnesota Cancer Facts and Figures 2009
Breast
Healthy Life
Childhood
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.
Lung
Intro
Five-Year Relative Survival from
Female Breast Cancer in the U.S.
Prostate
Compared to many other cancers, survival from breast
cancer is quite high. When diagnosed at an early stage,
five-year relative survival is about 98 percent.
Cervix
• 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
Melanoma
Risk Factors for Female Breast Cancer
Between 2001 and 2005, about 650 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
deaths for women; in 2005 it accounted for 15 percent of
all female cancer 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 female breast cancer in Minnesota in 2005 was 22.3
deaths per 100,000 women.
27
End Notes
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.
Mesothelioma
Breast Cancer in Minnesota
Intro
Lung
Disparities in Breast Cancer
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. In Minnesota,
the incidence rate among African American women
is 23 percent lower than among non-Hispanic white
women, but their mortality rate is 20 percent higher.
Similarly, the breast cancer incidence rate among
American Indian women in Minnesota is 27 percent
lower than among non-Hispanic white women, but their
mortality rate is only six percent lower. These relationships
indicate that African American and American Indian
women are less likely to survive breast cancer than nonHispanic white women in Minnesota.
Prostate
Breast
Colorectal
Breast Cancer in Minnesota
Female Breast Cancer by Race/Ethnicity, Minnesota, 2001-2005
140
Rate per 100,000 females
African American
129.8
American Indian
Cervix
120
100
100
Asian/Pacific Islander
94.8
82.6
Hispanic (all races)
Melanoma
80
Non-Hispanic White
60
54.1
40
28.1
23.1
6.5
0
Incidence
Mortality
Source: MCSS. Rates are age-adjusted to the 2000 U.S. population.
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
18.8
17.7
20
28
Minnesota Cancer Facts and Figures 2009
Rate per 100,000 females
160
SEER/U.S.
140
Minnesota
120
Incidence
100
80
Mesothelioma
60
40
Mortality
20
05
20
00
95
20
19
19
90
85
19
80
19
75
0
19
Colorectal
Cervix
Female Breast Cancer in Minnesota and the U.S.
Melanoma
However, the female breast cancer incidence rate
began declining significantly by about three percent a
year in 2001. Since then, the female breast cancer
incidence rate has dropped by 13 percent in Minnesota.
The reasons for this sharp decline probably involve
multiple factors, but may include high levels of
Lung
Intro
Despite increases in the incidence of female breast
cancer throughout the 1990s, breast cancer mortality
has been decreasing significantly and steadily since the
early 1990s in Minnesota and nationally. Studies by NCI
indicate that decreases in breast cancer mortality are
due to more effective breast cancer treatment as well as
increased use of mammography.
Breast
mammography use for the past two decades and a
dramatic decline in hormone replacement therapy use
in 2002 following the publication of results from the
Women’s Health Initiative. The WHI demonstrated
that hormone replacement therapy did not prevent
heart disease and increased the risk for breast cancer.
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. From about 1988 to
2001, the breast cancer incidence rate in Minnesota
and in the SEER Program increased at a slower, but
statistically significant, rate.
Year of Diagnosis / Death
Minnesota Cancer Facts and Figures 2009
29
End Notes
Survivorship
Healthy Life
Source: MCSS and SEER Cancer Statistics Review, 1975-2005. 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.
Childhood
Trends in Female Breast Cancer
Prostate
Breast Cancer in Minnesota
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Breast Cancer in Minnesota
Geographic Differences in Female
Breast Cancer Incidence
Geographic Differences in Female
Breast Cancer Mortality
During 2001-2005, the female breast cancer incidence
rate was six percent lower in Minnesota than among
non-Hispanic white women living in the geographic
areas reporting to the SEER Program.
During 2001-2005, the female breast cancer mortality
rate was eight percent lower in Minnesota than among
non-Hispanic white women in the U.S. as a whole.
Breast cancer incidence in Minnesota was significantly
higher than the state average in Northeast Minnesota
and in Hennepin, St. Louis, and Washington Counties.
Breast cancer incidence was significantly lower than
the state average in West Central and South Central
Minnesota and in Dakota County.
Female Breast Cancer Incidence Rates
in Minnesota Regions and Six Largest
Counties, 2001-2005
Melanoma
Minnesota = 129.3
SEER* = 138.2
Kittson
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Lake
of the
Woods
Roseau
The female breast cancer mortality rate varied more
widely than incidence, but fewer comparisons were
statistically significant due to the much smaller number
of deaths than cases. The female breast cancer mortality
rate was significantly lower than the state average in
West Central Minnesota, which also had the lowest
incidence rate. St. Louis County had the highest female
breast cancer mortality rate and also had the highest
incidence rate.
Female Breast Cancer Mortality Rates
in Minnesota Regions and Six Largest
Counties, 2001-2005
Kittson
Northwest
125.5
St. Louis
Beltrami
Clear
Water
Northeast
137.9
Itasca
Pennington
Polk
Northeast
24.7
Itasca
Hubbard
Cass
Becker
Cass
Becker
Clay
Mesothelioma
Aitkin
Wadena
West Central
117.6
Grant
Douglas
Stevens
Pope
Childhood
Healthy Life
Pine
Mille
Lacs
County
Rate
Anoka
121.9
Dakota
119.2
Hennepin 133.9
Ramsey
131.7
St. Louis
146.3
Washington 145.5
Kanabec
Morrison
Stearns
Isanti
Big Stone
Sherburne
Chisago
Swift
Anoka
Kandivohi
Meeker
Metro
Wright
Chippewa
WashingRam- ton
sey
Hennepin
131.2
Lac Qui Parle
McLeod
Renville
Carver
Scott
Yellow Medicine
Dakota
Crow Wing
West Central
19.2
Lyon
Grant
Douglas
Stevens
Pope
Central
21.6
Rock
Nicollet
Le
Sueur
South Central
119.9
Rice
Nobles
Jackson
Blue Earth
Watonwan
Martin
Kanabec
Morrison
Benton
Traverse
Stearns
Isanti
Big Stone
Sherburne
Chisago
Swift
Anoka
Kandivohi
Meeker
Wright
Chippewa
WashingRam- ton
sey
Metro
23.3
Hennepin
Lac Qui Parle
McLeod
Renville
Carver
Scott
Yellow Medicine
Goodhue
Steele
Freeborn
Dodge
Mower
Winona
Fillmore
Lyon
Redwood
Southwest
23.5
Southeast
129.6
Olmsted
Waseca
Faribault
Lincoln
Wabasha
Brown
Cottonwood
Mille
Lacs
Rate
25.9
25.5
23.1
22.0
26.2
21.9
Dakota
Sibley
Redwood
Murray
County
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
Pine
Todd
Sibley
Lincoln
Carlton
Ottertail
Wilkin
Benton
Traverse
Pipestone
Survivorship
Wadena
Carlton
Todd
Southwest
125.7
End Notes
Aitkin
Crow Wing
Central
124.4
Ottertail
Wilkin
Lake
Mahnomen
Norman
Hubbard
Cook
Clear
Water
Red Lake
Lake
Mahnomen
Norman
Clay
St. Louis
Beltrami
Cook
Red Lake
Koochiching
Northwest
21.0
Marshall
Pennington
Polk
Lake
of the
Woods
Roseau
Koochiching
Marshall
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Minnesota = 22.9
U.S.* = 25.0
Pipestone
Houston
Rates are per 100,000 persons, age-adjusted to the 2000
US population. Statistical significance (p < 0.05) based on
SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the SEER 17 areas excluding the
Alaska Native Registry and Kentucky, 2001-2005, SEER
Cancer Statistics Review, 1975-2005.
Rock
Nicollet
Le
Sueur
Rice
Goodhue
Wabasha
South Central Southeast
25.8
23.0
Brown
Murray
Cottonwood
Nobles
Jackson
Blue Earth
Watonwan
Martin
Olmsted
Waseca
Faribault
Steele
Freeborn
Dodge
Mower
Fillmore
Winona
Houston
Rates are per 100,000 persons, age-adjusted to the 2000
US population. Statistical significance (p < 0.05) based on
SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the U.S. excluding Minnesota,
New Hampshire, and North Dakota, 2001-2005, SEER
Cancer Statistics Review, 1975-2005.
The average number of female
breast cancer cases and deaths
each year in Minnesota counties
is shown in the End Notes
section of this report.
30
Minnesota Cancer Facts and Figures 2009
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 2006 BRFSS, the marked increase in
Intro
Trends in Mammography Use among Women Ages 40 and Older, Minnesota, 1987-2006
Percent had Mammogram within 2 Years
81
80
64 67
Prostate
100
81
80
70 72
70 70 69 70 69 68 70
Lung
breast cancer screening in Minnesota between 2000 and
2002 was sustained through 2006. The percent of women
ages 40 and older who reported in 2006 that they had a
mammogram in the previous two years was somewhat
higher in Minnesota (81%) than the median of the states
and territories participating in the BRFSS (77%).
Colorectal
Breast Cancer Screening
Breast
Breast Cancer in Minnesota
58
60
Cervix
48
40
05
06
20
20
04
~
20
02
03
20
01
00
~
20
20
99
20
98
19
96
97
19
19
19
93
92
94
19
95
19
19
19
90
19
91
19
89
~
19
87
19
19
88
~
0
Melanoma
20
Mesothelioma
Source: Minnesota BRFSS. Analyses were conducted by MCSS. ~ Questions not asked.
Sage Screening Program
Healthy Life
Childhood
The Sage Screening Program provides free mammograms
and Pap tests to uninsured women over 40 if they meet
specific income guidelines. Sage will also cover the cost
of mammograms or Pap tests for women whose insurance
does not cover these cancer screenings or if they have a
co-payment or unmet deductible. The program—available
through more than 400 clinics statewide—offers treatment
to eligible women diagnosed with breast or cervical cancer
through medical assistance.
For more information, call 1-888-643-2584 or visit
http://www.state.mn.us/divs/hpcd/ccs/mbcccp.htm.
Minnesota Cancer Facts and Figures 2009
31
End Notes
Survivorship
The Sage Screening Program is primarily funded by the
CDC as part of the National Breast and Cervical Cancer
Early Detection Program. Funds also include money from
the State of Minnesota and from the Twin Cities Race for
the Cure.
Intro
Lung
Colorectal
Breast
Breast Cancer in Minnesota
Breast Cancer Screening, continued:
Combining data for 2002-2006, the percent of women
ages 40 and older who reported having a mammogram
in the previous two years was somewhat lower in rural
(78%) than urban (82%) Minnesota. Screening was
relatively high at all education levels (not a high school
Mammography Use among Women Ages 40 and Older by Education and Residence,
Minnesota, 2002, 2004 and 2006
100
Prostate
graduate, 75%; high school graduate, 79%; some postsecondary education or college graduate, 82%). There
were too few interviews among women of color to
present screening rates by race/ethnicity.
Percent had Mammogram within 2 Years
Not a HS Graduate
79
80
80
80
83
79
HS Graduate
71
College
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
60
40
20
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.
American Cancer Society Screening Guidelines for the Early Detection of Breast Cancer
in Asymptomatic Women
Yearly mammograms are recommended starting at age 40. The age at which screening should be
stopped should be individualized by considering the potential risks and benefits of screening in
the context of overall health status and longevity.
Clinical breast exam should be part of a periodic health exam about every 3 years for women in
their 20s and 30s and every year for women 40 and over.
Women should know how their breasts normally feel and report any breast change promptly to
their health care providers. Breast self-exam is an option for women starting in their 20s.
Screening MRI is recommended for women with an approximately 20%-25% or greater lifetime
risk of breast cancer, including women with a strong family history of breast or ovarian cancer and
women who were treated for non-Hodgkin lymphoma disease.
32
Minnesota Cancer Facts and Figures 2009
Over the five-year period 2001-2005, more than 4,100
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
2005, the age-adjusted incidence rate for prostate cancer
in Minnesota was 181.2 new cases per 100,000 males.
From 2001 to 2005, about 560 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 2005
was 24.1 deaths per 100,000 males.
Minnesota Cancer Facts and Figures 2009
Stage
Local/Regional
Distant
Unstaged
All Stages
Whites
100%
30.9%
79.1%
99.5%
Blacks
100%
28.3%
72.2%
95.4%
Source: SEER Cancer Statistics Review, 1975-2002.
Based on cases diagnosed during 1996-2004.
33
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Intro
Five-Year Relative Survival from
Prostate Cancer in the U.S.
Mesothelioma
The Burden of Prostate Cancer in Minnesota
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. Minnesota followed a very similar pattern.
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, prostate cancer
incidence has varied considerably both in Minnesota
and in the SEER Program, but trends have not been
statistically significant. However, the prostate cancer
incidence rate has been markedly higher in Minnesota
than in the SEER Program since 2000. The excess 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 2005. Whether this is due
to PSA screening is not certain.
Childhood
• 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
Trends in Prostate Cancer
Healthy Life
Risk Factors for Prostate Cancer
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 cases diagnosed in 1996-2004. 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.
Survivorship
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 11
percent of cancer deaths among men. Asymptomatic
prostate cancers can be identified by screening with the
prostate specific antigen (PSA) test, but the unsolved
challenge is to determine which ones will go on to
become life-threatening. This is 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 with a life expectancy of at least
10 years should discuss the risks and benefits of screening
with their physician to make an informed decision. Men
at high risk (African American men and men with a
strong family history) should discuss beginning testing
at age 45.
End Notes
Prostate Cancer in Minnesota
Intro
250
150
Prostate
Colorectal
Prostate Cancer in Minnesota and the U.S.
Breast
Lung
Prostate Cancer in Minnesota
Rate per 100,000 males
SEER/U.S.
Minnesota
200
Incidence
100
50
Mortality
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
05
20
20
00
95
19
90
19
19
19
85
80
75
19
Cervix
0
Year of Diagnosis / Death
Source: MCSS and SEER Cancer Statistics Review, 1975-2005. 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.
Disparities in Prostate Cancer
likely to be diagnosed with prostate cancer than nonHispanic white men, but are nearly 40 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.
African American men have the highest prostate cancer
rates. Their risk of being diagnosed with this disease is
22 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 five percent less
Prostate Cancer by Race/Ethnicity, Minnesota, 2001-2005
250
Rate per 100,000 males
African American
220.8
American Indian
200
181.5
173.6
Asian/Pacific Islander
Hispanic (all races)
150
Non-Hispanic White
106.9
100
51
50
55.2
38.7
12.3
21.6
28.3
0
Incidence
Mortality
End Notes
Source: MCSS. Rates are age-adjusted to the 2000 U.S. population.
34
Minnesota Cancer Facts and Figures 2009
Intro
Geographic Differences in
Prostate Cancer Mortality
During 2001-2005, the prostate cancer incidence rate
was 15 percent higher in Minnesota than among nonHispanic white men living in the geographic areas
reporting to the SEER Program. Prostate cancer is
one of the few cancers for which incidence rates are
significantly higher in Minnesota than in the SEER
Program.
During 2001-2005, the prostate cancer mortality rate
was 15 percent higher in Minnesota than among nonHispanic white men in the entire U.S. Prostate cancer
is one of the few cancers for which mortality rates are
significantly higher in Minnesota than in the U.S.
Marshall
Prostate
Marshall
Northeast
179.5
Itasca
Polk
Cook
Clear
Water
Red Lake
Northeast
32.4
Itasca
Hubbard
Cass
Cass
Becker
Clay
Becker
Aitkin
Aitkin
Wadena
West Central
192.3
Grant
Douglas
Stevens
Pope
Crow Wing
Wadena
Carlton
Central
220.0
Ottertail
Wilkin
County
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
Pine
Todd
Kanabec
Morrison
Benton
Traverse
Stearns
Isanti
Big Stone
Sherburne
Chisago
Swift
Anoka
Kandivohi
Meeker
Wright
Chippewa
Metro
178.9
WashingRam- ton
sey
Hennepin
Lac Qui Parle
McLeod
Renville
Carver
Lyon
Pipestone
Rock
Nicollet
Le
Sueur
Goodhue
Blue Earth
Watonwan
Nobles
Jackson
Martin
Stevens
Pope
Pine
Central
28.9
Mille
Lacs
Kanabec
Morrison
Benton
Traverse
Stearns
Isanti
Big Stone
Sherburne
Chisago
Swift
Anoka
Kandivohi
Meeker
Wright
Chippewa
WashingRam- ton
sey
Metro
27.1
Hennepin
Lac Qui Parle
McLeod
Renville
Rice
South Central Southeast
Cottonwood
Douglas
Lincoln
179.3
Faribault
Olmsted
Waseca
Steele
Freeborn
Dodge
Mower
Pipestone
173.6
Winona
Fillmore
Lyon
Carver
Scott
Redwood
Southwest
32.9
Wabasha
Brown
Murray
Carlton
County
Rate
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
21.3
27.1
27.2
26.8
33.5
29.5
Dakota
Sibley
Redwood
Southwest
187.9
Grant
Todd
Dakota
Sibley
Lincoln
West Central
26.1
Yellow Medicine
Scott
Yellow Medicine
Rate
187.1
169.9
176.1
188.2
177.8
193.0
Crow Wing
Ottertail
Wilkin
Mille
Lacs
Lake
Mahnomen
Norman
Hubbard
St. Louis
Pennington
Lake
Mahnomen
Norman
Clay
Koochiching
Northwest
31.9
Beltrami
Cook
Clear
Water
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
Red Lake
Kittson
Koochiching
Northwest
177.4
Polk
Minnesota = 28.4
U.S.* = 24.6
Houston
Rates are per 100,000 persons, age-adjusted to the 2000
US population. Statistical significance (p < 0.05) based on
SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the SEER 17 areas excluding the
Alaska Native Registry and Kentucky, 2001-2005, SEER
Cancer Statistics Review, 1975-2005.
Minnesota Cancer Facts and Figures 2009
Rock
Nicollet
Le
Sueur
Rice
Goodhue
Wabasha
South Central Southeast
26.2
26.3
Brown
Murray
Cottonwood
Nobles
Jackson
Blue Earth
Watonwan
Martin
Olmsted
Waseca
Faribault
Steele
Freeborn
Dodge
Mower
Fillmore
Winona
Houston
Rates are per 100,000 persons, age-adjusted to the 2000
US population. Statistical significance (p < 0.05) based on
SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the U.S. excluding Minnesota,
New Hampshire, and North Dakota, 2001-2005, SEER
Cancer Statistics Review, 1975-2005.
35
Childhood
Lake
of the
Woods
Roseau
Healthy Life
Kittson
Survivorship
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Minnesota = 185.6
SEER* = 161.5
Prostate Cancer Mortality Rates in
Minnesota Regions and Six Largest
Counties, 2001-2005
End Notes
Prostate Cancer Incidence Rates in
Minnesota Regions and Six Largest
Counties, 2001-2005
Mesothelioma
Melanoma
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.
The average number of prostate
cancer cases and deaths each year
in Minnesota counties is shown in
the End Notes section of this report.
Cervix
Comparing the region with the highest rate to the one
with the lowest, prostate cancer incidence rates in
Minnesota varied by about 30 percent. Rates in Central
Minnesota were significantly higher than the state average.
Rates in Southeast and Metro Minnesota and Dakota
and Hennepin Counties were significantly lower.
Compared to the state average, prostate cancer
mortality rates in Southeast and Northeast Minnesota
and St. Louis County were significantly higher, and the
rate in Anoka County was significantly lower.
Breast
Geographic Differences in
Prostate Cancer Incidence
Colorectal
Lung
Prostate Cancer in Minnesota
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Melanoma
Prostate Cancer in Minnesota
Prostate Cancer Screening
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.
Among Minnesota men ages 50 and over who
participated in the 2006 Minnesota BRFSS and did not
have a history of prostate cancer, 66 percent reported
Trends in PSA Testing among Men
Ages 50 and Older, Minnesota, 2001-2006
100
Mesothelioma
Childhood
Healthy Life
Survivorship
In 2006, the proportion of men ages 40 and over who
reported having a PSA in the previous two years was
lower in Minnesota (49%) than the median for the
states and territories participating in the BRFSS (54%).
Comparing PSA use in 2004 and 2006, it appears that
most of the increase in use was among men with at least
some college education, where testing increased from
61 percent in 2004 to 71 percent in 2006. There were too
few interviews among men of color to present screening
rates by race/ethnicity.
PSA Testing among Men Ages 50 and
Older by Education and Year, Minnesota,
2004 and 2006
Percent had PSA within 2 Years
100
80
Percent had PSA within 2 Years
80
71
66
66
62
59
60
61
60
40
End Notes
that they had a PSA test in the last two years. This was
somewhat higher than reported in 2004 (59%).
57
55
40
20
20
~
~
0
2001
2002
2003
2004
2005
2006
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.
0
2004
2006
HS or Less
College
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.
American Cancer Society Screening Guidelines for the Early Detection
of Prostate Cancer in Asymptomatic Men
The PSA test and the digital rectal examination should be offered annually, beginning
at age 50, to men who have a life expectancy of at least 10 years. Men at high risk
(African American men and men with a strong family history of one or more firstdegree relatives diagnosed with prostate cancer at an early age) should begin testing
at age 45. For both men at average risk and high risk, information should be provided
about what is known and what is uncertain about the benefits and limitations of
early detection and treatment of prostate cancer so that they can make an informed
decision about testing.
36
Minnesota Cancer Facts and Figures 2009
Intro
Five-Year Relative Survival from
Cervical Cancer in the U.S.
Stage
Localized
Regional
Distant
All Stages
Whites
92.6%
56.7%
17.5%
72.5%
Blacks
85.9%
47.5%
8.9%
66.8%
Cervical Cancer by Race/Ethnicity, Minnesota, 2001-2005
18
Rate per 100,000 females
Mortality
12.6
12.1
12
11.5
Healthy Life
10
8
6
6
4
*
0
African
American
*
*
American
Indian
Asian/Pacific
Islander
*
Hispanic
(all races)
1.5
Survivorship
2
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.
Minnesota Cancer Facts and Figures 2009
Breast
Incidence
16.9
16
14
Prostate
Mesothelioma
Source: SEER Cancer Statistics Review, 1975-2002.
Based on cases diagnosed during 1996-2004.
Childhood
Over the five-year period 2001-2005, about 170 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 2005, the age-adjusted incidence rate for
cervical cancer in Minnesota was 6.3 new cases per
100,000 females. From 2001 to 2005, about 45 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 2005 was 1.7 deaths
per 100,000 females.
37
End Notes
The Burden of Cervical Cancer in Minnesota
Cervix
During 2001-2005, women of color in Minnesota were
more than twice as likely to be diagnosed with or die
from invasive cervical cancer than non-Hispanic white
women (13.9 new cases per 100,000 women of color and
6.0 cases per 100,000 non-Hispanic white women; 3.6
deaths per 100,000 women of color and 1.5 deaths per
100,000 non-Hispanic white women). The available
evidence indicates that the excess burden of cervical
cancer among women of color in Minnesota results
primarily from less effective screening among women
of color —that is, less access to or utilization of Pap
testing, poorer quality of screening, or less timely and
recommended treatment of detected abnormalities.
Melanoma
Disparities in Cervical Cancer
Cervical cancer is unique because we know both its
primary cause — persistent infection with the human
papilloma virus (HPV) — and how to prevent it — HPV
vaccination plus regular Pap tests with prompt treatment
of detected abnormalities. Nonetheless, women in
Minnesota continue to die from this preventable disease,
and women of color are at especially high risk. A vaccine
to prevent infection with HPV is now available, and
will prevent infections that cause about 70 percent of
cervical cancers. A fact sheet on the HPV vaccine can
be found on the MDH web site at www.state.mn.us/
divs/idepc/dtopics/vpds/hpv/hpvfs.html.
Colorectal
Lung
Cervical Cancer in Minnesota
Intro
Lung
Colorectal
Breast
Cervical Cancer in Minnesota
Trends in Cervical Cancer
Incidence and mortality rates for invasive cervical cancer
have decreased by more than 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 35
percent, and the mortality rate by about 20 percent.
Cervical Cancer in Minnesota and the U.S.
14
Rate per 100,000 females
SEER/U.S.
Minnesota
12
Cervix
Prostate
10
Incidence
8
6
4
Mortality
2
Healthy Life
Childhood
Mesothelioma
05
20
00
20
95
19
90
19
85
19
19
80
75
19
Melanoma
0
Year of Diagnosis / Death
Source: MCSS and SEER Cancer Statistics Review, 1975-2005. 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 Cervical Cancer
During 2001-2005, the cervical cancer incidence rate
was six percent lower in Minnesota than among
non-Hispanic white women in the geographic areas in
the SEER Program. During the same period, cervical
cancer mortality was more than 25 percent lower in
Minnesota (1.6 deaths per 100,000 females) than among
non-Hispanic white women in the U.S. (2.2 deaths per
100,000 females).
Cervical Cancer Incidence Rates in
Minnesota Regions and Six Largest
Counties, 2001-2005
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Minnesota = 6.6
SEER* = 7.0
Kittson
Lake
of the
Woods
Roseau
Koochiching
Marshall
Northwest
8.5
St. Louis
Beltrami
Pennington
Polk
Cook
Clear
Water
Red Lake
Lake
Mahnomen
Norman
Hubbard
Over the five-year period 2001-2005, the invasive
cervical cancer incidence rate was significantly higher
than the state average in Southwest and Northeast
Minnesota. The mortality rate was significantly higher
than the state average in West Central Minnesota (4.2
deaths per 100,000 females) (data not shown).
Northeast
8.9
Itasca
Cass
Central
5.3
Becker
Clay
Wadena
Aitkin
Crow Wing
Carlton
Ottertail
Wilkin
West Central
6.3
Grant
Douglas
Stevens
Pope
Pine
Todd
Mille
Lacs
County
Rate
Anoka
5.4
Dakota
6.2
Hennepin 6.3
Ramsey
7.2
St. Louis
8.9
Washington 7.0
Kanabec
Morrison
Benton
Traverse
Stearns
Isanti
Big Stone
Sherburne
Chisago
Swift
Anoka
Kandivohi
Meeker
Wright
Chippewa
WashingRam- ton
sey
Metro
6.4
Hennepin
Lac Qui Parle
McLeod
Renville
Carver
Scott
Yellow Medicine
Dakota
Sibley
Lincoln
Redwood
Southwest
9.9
Survivorship
End Notes
Lyon
Pipestone
Rock
Nicollet
Le
Sueur
Rice
Goodhue
South Central Southeast
Wabasha
Brown
Blue Earth
Murray
Cottonwood
Watonwan
Nobles
Jackson
Martin
7.1
Faribault
Olmsted
Waseca
Steele
Freeborn
Dodge
Mower
5.6
Fillmore
Winona
Houston
Rates are per 100,000 persons, age-adjusted to the 2000
US population. Statistical significance (p < 0.05) based on
SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the SEER 17 areas excluding the
Alaska Native Registry and Kentucky, 2001-2005, SEER
Cancer Statistics Review, 1975-2005.
38
Minnesota Cancer Facts and Figures 2009
Almost all cervical cancers are caused by persistent
infection with the human papilloma virus (HPV). They
can be prevented by a combination of vaccination with
the HPV vaccine and regular Pap tests.
Intro
Breast
Based on data from the 2006 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 (87%) as the median of the states
and territories participating in the BRFSS (84%).
Trends in Pap Test Use among Women Ages 18 and Older, Minnesota, 1992-2006
Percent Screened within 3 Years
86
80
18
85
86
84
86
20
19
20
19
20
25
64
67
64
67
64
60
87
86
18
19
69
67
85
83
Within 2-3 years
90
88
87
21
18
19
69
70
68
Within 1 year
Prostate
100
Lung
Cervical Cancer Screening
Colorectal
Cervical Cancer in Minnesota
Source: Minnesota BRFSS. Analyses were conducted by MCSS. Women who had a hysterectomy were excluded. Percents may not
sum to the total due to rounding.
Minnesota Cancer Facts and Figures 2009
Healthy Life
• Not being vaccinated with the HPV
vaccine
• Not being screened with the Pap test
• Persistent 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 average number of
cases of cervical cancer
diagnosed each year in
Minnesota counties is
shown in the End Notes
section of this report.
Survivorship
Risk Factors for Cervical Cancer
Mesothelioma
06
20
05
20
04
~
20
03
20
02
~
20
20
00
20
19
99
98
19
97
19
96
95
19
19
94
19
92
93
19
19
01
~
0
Melanoma
20
Childhood
69
39
End Notes
40
Cervix
60
Intro
Lung
Colorectal
Breast
Prostate
Cervical Cancer in Minnesota
Cervical Cancer Screening, continued:
Combining data for 2002-2006, women residing in rural
Minnesota were marginally less likely to report having
a Pap test in the last three years (86%) than women
living in urban areas (89%), but education was a stronger
predictor of being screened than residence (not a high
school graduate, 74%; high school graduate, 84%; some
post-secondary education or college graduate, 91%).
Although based on relatively small numbers of interviews
among women of color, the percent of women who
reported having been screened in the previous three
years was similar for non-Hispanic white (89%) and
Hispanic (91%) women, but lower for African American
(84%), American Indian (80%), and Asian/Pacific Islander
women (80%).
Pap Test Use among Women Ages 18 and Older by Education and Residence, Minnesota, 2002-2006
Percent Screened within 3 Years
100
91
90
82
HS Graduate
77
80
Not a HS Graduate
85
72
Cervix
College
60
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
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.
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
regular Pap tests or every two years using liquid-based 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. Alternatively,
cervical cancer screening with HPV DNA testing and conventional or liquid-based cytology could
be performed every three years. However, doctors may suggest a woman get screened more
often is she has certain risk factors, such as HIV infection or a weak immune system. Women age
70 and older who have had three or more consecutive normal Pap tests in the last 10 years may
choose to stop cervical cancer screening. Screening after total hysterectomy (with removal of the
cervix) is not necessary unless the surgery was done as a treatment for cervical cancer.
40
Minnesota Cancer Facts and Figures 2009
Intro
Risk Factors for Melanoma of the Skin
Stage
Localized
Regional
Distant
All Stages
Males
98.3%
61.8%
15.1%
89.1%
Females
99.2%
70.2%
16.4%
93.7%
Source: SEER Cancer Statistics Review, 1975-2005.
Based on cases diagnosed during 1996-2004.
Minnesota Cancer Facts and Figures 2009
41
End Notes
Survivorship
From 2001 to 2005, 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 2005 was 2.0 deaths per 100,000 persons.
Five-Year Relative Survival from
Melanoma of the Skin in the U.S.
Childhood
The Burden of Melanoma in Minnesota
Mesothelioma
Melanoma
Cervix
• 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
Over the five-year period 2001-2005, about 930
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 2005, the age-adjusted incidence rate
for melanoma of the skin in Minnesota was 19.3 new
cases per 100,000 persons.
Colorectal
Prostate
Melanoma of the skin can occur among persons of color,
but the vast majority of cases are diagnosed among
whites. In Minnesota, only 32 cases and 6 deaths
occurred among persons of color during the five-year
period 2001-2005. Melanoma incidence rates are about
25 percent higher among men than women. However,
women have considerably higher incidence rates than
men from 15 to 49 years of age. Based on national data,
survival rates are somewhat poorer among men than
women.
Breast
Disparities in Melanoma
Healthy Life
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
exposure to the sun. People with 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).
Lung
Melanoma of the Skin in Minnesota
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Melanoma
Mesothelioma
Childhood
Melanoma of the Skin in Minnesota
Trends in Melanoma
Save Your Skin
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 65 percent, while the mortality rate has remained
stable or decreased somewhat.
• Cover up. When you are out in the sun,
wear clothing to protect as much skin as
possible.
• Use a sunscreen with a SPF of 15 or higher.
Be sure to apply the sunscreen properly.
Be generous.
Geographic Differences
in Melanoma of the Skin
• Wear a hat. One with at least a 2 to 3-inch
brim all around is ideal.
During 2001-2005, the melanoma incidence rate was 30
percent lower in Minnesota than among non-Hispanic
whites in the geographic areas in the SEER Program
(18.3 and 26.6 new cases per 100,000 persons, respectively),
and the mortality rate was 30 percent lower than
among non-Hispanic whites in the U.S. as a whole
(2.3 and 3.3 deaths per 100,000, respectively).
• Wear sunglasses that block UV rays.
• Limit direct sun exposure during midday.
• Avoid tanning beds and sunlamps.
• Protect children from the sun. Parents and
other caregivers should protect children
from excess sun exposure by using the
measures described above.
Over the five-year period 2001-2005, incidence was
significantly higher than the state average in Southeast
Minnesota (20.4 new cases per 100,000 persons) and
South Central Minnesota (23.0) and in Washington
County (23.0), and was significantly lower in Northwest
Minnesota (13.0) and Ramsey County (15.9) (data
not shown). The melanoma mortality rate was
significantly higher than the state average in West
Central Minnesota (3.4 deaths per 100,000 persons)
(data not shown).
The average number of cases of
melanoma of the skin diagnosed
each year in Minnesota counties is
shown in the End Notes section of
this report.
Melanoma of the Skin in Minnesota and the U.S.
Rate per 100,000 persons
30
SEER/U.S.
Minnesota
25
End Notes
15
Incidence
10
5
Mortality
05
20
00
20
95
19
90
19
85
19
19
80
75
0
19
Survivorship
Healthy Life
20
Year of Diagnosis / Death
Source: MCSS and SEER Cancer Statistics Review, 1975-2005. 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.
42
Minnesota Cancer Facts and Figures 2009
Intro
Over the five-year period 2001-2005, about 42 men
and 11 women died of mesothelioma each year in
Minnesota. About 70 percent of mesothelioma deaths
occurred among persons 65 years of age and older. In
2005, the age-adjusted mortality rate for mesothelioma
in Minnesota was 1.9 deaths per 100,000 men and 0.4
deaths for every 100,000 women.
Disparities in Mesothelioma
Minnesota Cancer Facts and Figures 2009
43
Colorectal
Breast
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Mesothelioma is four 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.
Prostate
Over the five-year period 2001-2005, about 48 men
and 14 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 2005,
the age-adjusted incidence rate for mesothelioma
in Minnesota was 2.3 new cases for every 100,000
men, and 0.5 new cases for every 100,000 women.
Cervix
Despite the fact that asbestos was widely used in
commercial products until the early 1970s, mesothelioma
is a relatively rare cancer. It is an ongoing concern in
Minnesota because rates among men are significantly
higher in the Northeast Region than elsewhere in the
state, and because a cohort of taconite miners from
across northern Minnesota appears to have an usually
high occurrence of this disease. More information on
mesothelioma and the studies being undertaken in
Minnesota to investigate this concern is on the MDH
Center for Occupational Health and Safety web site:
www.state.mn.us/divs/hpcd/cdee/occhealth/meso.html.
The Burden of Mesothelioma
in Minnesota
Melanoma
Mesothelioma is a cancer of the tissues that line the
chest and the 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. Data from
the SEER Program indicates that the five-year relative
survival rate is about eight percent, similar to survival
for pancreas and liver cancers.
Lung
Mesothelioma in Minnesota
Intro
Lung
Colorectal
Mesothelioma in Minnesota
Trends in Mesothelioma
slightly since then. A similar pattern has 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.
The incidence rate of mesothelioma increased by 30
percent among men in Minnesota from 1988, when
statewide cancer reporting was implemented, to 2005.
However, trend analyses suggest that the rate among
men peaked in 1999 and has been stable or declining
Breast
Mesothelioma Incidence in Minnesota and the U.S.
3.5
Rate per 100,000 persons
SEER
Minnesota
2.5
2
1
Survivorship
Healthy Life
Childhood
Mesothelioma
Females
05
20
00
20
95
19
90
19
85
19
75
0
19
Melanoma
0.5
End Notes
Males
80
Cervix
1.5
19
Prostate
3
Year of Diagnosis
Source: MCSS and SEER Cancer Statistics Review, 1975-2005 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.
Geographic Differences in Mesothelioma
Over the five-year period 2001-2005, mesothelioma
incidence rates in Minnesota (2.3 new cases per 100,000
males and 0.5 cases per 100,000 females) were the same
as those reported by SEER for non-Hispanic white men
and women.
Mesothelioma Incidence Rates
among Males in Minnesota Regions
and Six Largest Counties, 2001-2005
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Minnesota = 2.3
SEER* = 2.3
Kittson
Lake
of the
Woods
Roseau
Marshall
Koochiching
Northwest
2.3
St. Louis
Beltrami
Pennington
Polk
Mesothelioma incidence rates among men are
significantly higher in Northeast Minnesota and in
St. Louis County than the state average, and significantly
lower in Central Minnesota. Among women,
mesothelioma incidence rates varied from a low
of 0.1 or fewer new cases per 100,000 women (South
Central and Washington County) to a high of 1.1
(Dakota County), but none of the regional or county
rates for women were significantly different from the
state average (data not shown). The incidence rate
among women in Northeast Minnesota was 0.2 new
cases per 100,000 women.
Cook
Clear
Water
Red Lake
Northeast
4.9
Itasca
Lake
Mahnomen
Norman
Hubbard
Cass
Becker
Clay
Aitkin
Wadena
Crow Wing
Carlton
Ottertail
Wilkin
West Central
2.6
Grant
County
Pine
Todd
Central
1.4
Douglas
Mille
Lacs
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
Kanabec
Morrison
Benton
Stevens
Traverse
Stearns
Pope
Isanti
Big Stone
Sherburne
Chisago
Swift
Anoka
Kandivohi
Meeker
Wright
Chippewa
WashingRam- ton
sey
Metro
2.5
Hennepin
Lac Qui Parle
McLeod
Renville
Carver
Scott
Yellow Medicine
Rate
2.8
3.0
2.4
2.8
5.0
3.1
Dakota
Sibley
Lincoln
Lyon
Redwood
Southwest
1.5
Pipestone
Rock
Nicollet
Le
Sueur
Rice
Goodhue
South Central Southeast
Wabasha
Brown
Blue Earth
Murray
Cottonwood
Watonwan
Nobles
Jackson
Martin
1.6
Faribault
Olmsted
Waseca
Steele
Freeborn
Dodge
Mower
1.6
Fillmore
Winona
Houston
Rates are per 100,000 persons, age-adjusted to the 2000
US population. Statistical significance (p < 0.05) based on
SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the SEER 17 areas excluding the
Alaska Native Registry and Kentucky, 2001-2005, SEER
Cancer Statistics Review, 1975-2005.
44
Minnesota Cancer Facts and Figures 2009
Five-Year Relative Survival from
Childhood (0-14 years old) Cancer
in the U.S.
Intro
Colorectal
Breast
Over the five-year period 2001-2005, an average of
165 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 403 children in Minnesota
will be diagnosed with a cancer before age 15. In 2005,
the age-adjusted incidence rate for childhood cancer in
Minnesota was 14.2 new cases for every 100,000 children.
From 2001 to 2005, an average of 23 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
2005 was 1.7 deaths for every 100,000 children.
Minnesota Cancer Facts and Figures 2009
45
Melanoma
End Notes
Survivorship
Healthy Life
Source: SEER Cancer Statistics Review, 1975-2005.
Based on cases diagnosed during 1996-2004.
During 2001-2005, the overall incidence of childhood
cancer in Minnesota was similar for non-Hispanic
whites (15.6 new cases per 100,000 children less than
15 years of age), Hispanics (19.8), and Asian/Pacific
Islanders (17.5); the rate was significantly lower among
African American children (9.4) (data not shown).
There were too few cases to report the rate among
American Indian children, or to report race-specific
childhood cancer mortality rates. Based on national
data, the five-year relative survival rate for cancers
diagnosed among children 0-14 years of age during
1996-2004 was 74 percent among African American
children and 81 percent among white children.
Mesothelioma
80.0%
73.7%
95.9%
82.1%
88.1%
55.2%
86.1%
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.
Cervix
Disparities in Childhood Cancer
Childhood
Cancer
All Sites
Brain and CNS
Hodgkin Lymphoma
Leukemia
Acute lymphocytic
Acute myeloid
Non-Hodgkin Lymphoma
The Burden of Childhood
Cancer in Minnesota
Prostate
The cancers diagnosed among children less than 15
years of age are markedly 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 (34%), brain cancer
(19%), or lymphoma (10%). 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 will survive.
Lung
Childhood Cancer in Minnesota
Intro
Trends in Childhood Cancer
Geographic Differences in Childhood Cancer
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
40 percent from 1975 to 2005. The reasons for the
increase are not known. The incidence rate of childhood
cancer in Minnesota is fairly unstable, but the trend is
similar to that reported by SEER.
During 2001-2005, the incidence of childhood cancer
in Minnesota (15.8 new cases per 100,000 children) was
about the same as among white children living in the
geographic areas reporting to the SEER Program (15.9).
The mortality rate in Minnesota (2.3 deaths per 100,000
children) was about the same as among white children
in the U.S. as a whole (2.5). The rates and types of cancer
diagnosed among children in Minnesota are very similar
to what is reported nationally.
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 about 45 percent between 1975 and
2005. In Minnesota, the rate decreased significantly by
2.7 percent per year between 1988 and 2005, almost
identical to the national trend.
There was no statistically significant variation in
childhood cancer incidence and mortality rates among
the regions and counties examined in Minnesota (data
not shown).
Childhood (0-14 Years of Age) Cancer in Minnesota and the U.S.
20
Rate per 100,000 children
SEER/U.S.
18
Minnesota
16
14
Incidence
12
10
8
6
Mortality
4
2
20
05
20
00
5
19
9
19
90
5
19
8
75
19
80
0
19
Lung
Colorectal
Breast
Prostate
Cervix
Melanoma
Mesothelioma
Childhood
Healthy Life
Childhood Cancer in Minnesota
End Notes
Survivorship
Year of Diagnosis / Death
Source: MCSS and SEER Cancer Statistics Review, 1975-2005. 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.
46
Minnesota Cancer Facts and Figures 2009
Intro
Lung
Living a Healthy Life
Colorectal
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 to not use tobacco products.
Prostate
Breast
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.
Minnesota Cancer Facts and Figures 2009
If you drink alcoholic beverages,
limit consumption.
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.
• 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.
47
Childhood
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.
Maintain a healthful weight throughout life.
• Balance caloric intake with physical activity.
• Lose weight if currently overweight or
obese.
Healthy Life
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.
Survivorship
Recommendations for individuals
End Notes
American Cancer Society Guidelines on Nutrition and Physical Activity
Mesothelioma
Melanoma
Cervix
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.
Intro
Nutrition in Minnesota
Trends in Adult Fruit and Vegetable Consumption, Minnesota, 1994-2007
Percent Eat Five or More Servings Usually
60
50
40
20
24
23
25
24
19
20
10
Survivorship
07
20
06
20
05
Source: Minnesota BRFSS. Analyses were conducted by MCSS.
Trends in Student Fruit and Vegetable Consumption by Grade, Minnesota
70
Percent Ate Five or More Servings Yesterday
Grade 12
Grade 9
60
Grade 6
50
40
30
21
22
21
14
15
15
13
13
2001
2004
20
End Notes
~
20
04
03
20
20
02
20
00
20
~
01
~
99
19
98
19
97
19
96
19
19
~
20
~
~
0
19
Mesothelioma
Childhood
32
30
30
94
Melanoma
Cervix
Prostate
70
Healthy Life
The Minnesota Student Survey reported that fruit and
vegetable consumption among students was relatively
stable during the four years the questions were asked,
with modest increases among ninth- and twelfth-graders
in 2007. The percent of students reporting they consumed
five or more servings “yesterday” tended to be lower
than “usual” consumption among adults.
In 2007, only one out of five (19%) Minnesota adults
reported that they “usually” ate five or more servings
of fruits and vegetables a day. This was somewhat
lower than the median of the states and territories
participating in the BRFSS (24%).
95
Lung
Colorectal
Breast
Living a Healthy Life
10
12
20
18
16
0
1992
1995
1998
2007
Source: Modified from tables in Minnesota Student Survey 1992-2007 Trends: Behaviors, attitudes and perceptions of
Minnesota’s 6th, 9th and 12th graders.
48
Minnesota Cancer Facts and Figures 2009
Intro
Lung
Colorectal
In 2007, about half (51%) 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 figure has been fairly constant over
time, and was the same as the median of the states and
territories participating in the BRFSS in 2007 (51%). The
percent of Minnesota adults meeting these exercise
recommendations was about the same for men (50%)
and women (48%), and decreased from 53 percent
among 18-24 year olds to 38 percent among people ages
65 and older.
Making healthy choices can reduce your cancer risk
and add enjoyment and pleasure to your life. Take
the American Cancer Society’s Great American Health
Challenge to learn how you can reduce your risk of cancer.
The Great American Health Challenge provides personalized,
interactive tools that can assist you in making healthy
changes in your life. You can join a 10-week online
physical activity program or access tools to help you
adopt healthy eating habits. Visit www.cancer.org/
greatamericans to take the challenge and learn more.
Prostate
Physical Activity in Minnesota
Breast
Living a Healthy Life
Melanoma
Cervix
The percent of students who were physically active for 30
minutes or more at least five days a week was relatively
stable, but showed modest increases in 2007. However,
the percent of high school seniors meeting this definition
of physical activity was only 41 percent.
Percent Active 30 Minutes on 5 out of 7 Days
1998
50
44
44
46
48
50
52
2001
55
2004
41
37
40
37
37
2007
Childhood
51
30
Healthy Life
20
10
0
Grade 6
Grade 9
Grade 12
Source: Modified from tables in Minnesota Student Survey 1992-2007 Trends: Behaviors, attitudes, and perceptions of
Minnesota’s 6th, 9th and 12th graders.
Minnesota Cancer Facts and Figures 2009
49
Survivorship
60
End Notes
70
Mesothelioma
Trends in Student Physical Activity by Grade, Minnesota
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Living a Healthy Life
Overweight and Obesity in Minnesota
the percent of obese adults was the same in Minnesota
(26%) as the median of the states and territories
participating in the BRFSS (26%).
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.
Women are less likely to be overweight than men.
Over the 20-year period 1988 to 2007, the proportion of
Minnesota adults who are obese tripled among males
(from 10% to 30%), and doubled among females (from
11% to 22%).
The percent of Minnesota adults who are either overweight or obese increased from 44 percent in 1988 to
62 percent in 2007. The most dramatic increase was in
obesity, which increased from 10 percent of the adult
Minnesota population in 1988 to 26 percent in 2007.
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 2007,
Based on interviews conducted over the three-year
period 2005-2007, the percent of Minnesota adults who
are obese is highest among American Indian men and
women (37% and 36%, respectively), Hispanic men
(36%) and African American women (30%) (data not
shown).
Trends in Adult Overweight and Obesity, Minnesota, 1987-2007
Melanoma
70
Percent
Obese (BMI 30.0+)
60
Overweight, but
not Obese (BMI 25.0-29.9)
50
Mesothelioma
40
30
20
10
End Notes
Survivorship
Healthy Life
07
05
20
20
03
20
20
01
99
19
97
19
95
19
93
19
91
89
19
19
Childhood
19
87
0
Source: Minnesota BRFSS. Analyses were conducted by MCSS.
Adult Overweight and Obesity by Gender, Minnesota, 2007
70
Percent
Men
Women
60
47
50
41
40
29
30
31
30
22
20
10
0
Not Overweight or
Obese
Overweight, but not Obese
Obese
Source: Minnesota BRFSS. Analyses were conducted by MCSS.
50
Minnesota Cancer Facts and Figures 2009
Local
Regional
Distant
34.5%
88.7%
71.2%
64.4%
82.9%
51.2%
11.7%
15.2%
91.2%
64.9%
45.5%
5.1%
98.9%
79.8%
~
98.1%
91.7%
89.7%
95.5%
~
23.8%
49.5%
98.7%
~
92.7%
20.0%
100%
92.5%
~
83.8%
55.9%
68.4%
67.5%
~
7.7%
20.6%
65.1%
~
71.1%
8.2%
100%
44.7%
~
27.1%
16.6%
10.8%
23.6%
~
2.9%
2.8%
15.5%
~
30.6%
1.8%
31.7%
6.1%
Unstaged
~
56.9%
59.4%
36.6%
56.1%
~
4.9%
8.3%
77.4%
~
26.0%
4.3%
79.4%
58.8%
Source: SEER Cancer Statistics Review, 1975-2005. Rates are for all races combined, based on follow-up of patients into
2005. Survival rates for brain cancer, leukemia, and non-Hodgkin lymphoma are from the SEER 9 areas. Survival rates
for all other sites are from the SEER 17 areas, with some areas only contributing cases from 2000-2004.
~ The cancer type is not routinely staged.
Minnesota Cancer Facts and Figures 2009
Colorectal
Mesothelioma
Brain and Other Nervous
Female Breast
Cervix
Colon and Rectum
Corpus Uteri (Uterus)
Leukemia
Liver
Lung and Bronchus
Melanoma of the Skin
Non-Hodgkin Lymphoma
Ovary
Pancreas
Prostate
Urinary Bladder
All Stages
Childhood
Site
Lung
Intro
Five-Year Relative Survival for SEER Cases Diagnosed in 1995-2001
Melanoma
Cervix
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.
51
Healthy Life
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
Survivorship
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.
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.
Breast
(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.
End Notes
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 1993-1995,
to 66 percent among people diagnosed with cancer in
1996-2004.
Prostate
Survivorship
Intro
Lung
Colorectal
Breast
Prostate
Cervix
Melanoma
Mesothelioma
Childhood
Healthy Life
Survivorship
End Notes
American Cancer Society Resources to Improve Quality of Life
American Cancer Society Cancer
Resource Network: Support for
Patients and Caregivers
The American Cancer Society Cancer Resource Network
seeks to improve the lives of those touched by cancer
by providing valuable information and links to needed
programs and resources. The Cancer Resource Network
provides patients with free comprehensive cancer
information, day-to-day help, and emotional support
throughout every step of the cancer journey.
Information: Helping patients
understand their disease
The American Cancer Society offers a 24-hour cancer
information phone line (1-800-227-2345), where people
fighting cancer can turn anytime, day or night, to talk to
a trained Cancer Information Specialist and get referrals
to community resources.
The American Cancer Society Web site (www.cancer.org)
offers a vast amount of information on topics such as
managing the cancer experience, finding support programs
and services, meeting other cancer survivors, and learning
more about a particular cancer type.
Durable Medical Equipment
Through the At Home™ program, the American Cancer
Society provides access to preselected durable medical
equipment including: hospital beds, bath and shower
devices, standard wheelchairs, commodes, walkers and canes.
Wigs, headcoverings and hats
Whether it is through our tlc catalogue or the patient
resource room in our Mendota office, the American
Cancer Society is prepared to help patients find access to
free and low cost wigs, headcoverings and hats.
Emotional support: Connecting
patients with others who have
“been there”
Look Good...Feel Better™
A program to help restore self-esteem during treatment,
the Look Good...Feel Better™ program is a communitybased, free, national service that teaches people in active
cancer treatment techniques to deal with the appearance related side effects of treatment. Look Good…Feel Better™
is a collaboration of the American Cancer Society, the
Personal Care Products Council Foundation (formerly
the CTFA), and the National Cosmetology Association.
I Can Cope™
The American Cancer Society also offers free cancer
information and resources, such as brochures, pamphlets,
information kits, books, etc., for anyone looking for
information and answers.
I Can Cope™ classes are led by doctors, nurses, and other
experts to help people with cancer and those who love
them understand what they’re facing. Classes are offered
online and at select locations.
Day-to-day help: Helping ease the
physical, financial, and emotional
toll of cancer
Reach to Recovery™
Lodging
The American Cancer Society offers Hope Lodge
facilities across the country, that provide free, temporary
lodging for cancer patients and their families who must
travel outside their community for treatment. They are
welcomed into a comfortable and caring environment
where patients who are going through a similar experience can support one another. In Minnesota, there are
American Cancer Society Hope Lodges in Rochester and
in Minneapolis.
Trained breast cancer survivors provide one-on-one
support, information, and inspiration to breast cancer
patients to help them cope with the disease. Volunteer
survivors are trained to respond in person or by
telephone to individuals facing breast cancer diagnosis,
treatment, recurrence, or recovery.
Transportation
The American Cancer Society has established community
resources and recruited volunteers around the country to
drive patients to and from their appointments and treatments.
Transportation is provided according to the needs and
available resources in the patient’s community.
52
Minnesota Cancer Facts and Figures 2009
l Clinical Trials
Matching Service
l Treatment decision
tools
l Help finding
transportation and
lodging
l Help with financial
and insurance
questions
l Referral to
prescription
drug assistance
l Online community
for cancer patients
and their families
l Cancer education
classes
The American Cancer Society can help.
Call us anytime, day or night.
Prostate
Healthy Life
1.800.227.2345
1.800.ACS.2345
www.cancer.org
Hope.Progress.Answers.
Minnesota Cancer Facts and Figures 2009
Lung
Intro
l Help finding local
support groups
Cervix
l www.cancer.org
Childhood
l 1-800-227-2345
Emotional
Support
Melanoma
Day-to-Day
Help
53
Survivorship
Information
Mesothelioma
✔
End Notes
?
Breast
Having cancer is hard.
Finding help shouldn’t be.
Colorectal
American Cancer Society Resources to Improve Quality of Life
Intro
Cancer Incidence in Minnesota, 2005
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
Female
Total
Male
Female
Total
12,797
165
36
0
1,255
0
233
77
470
147
422
132
1,615
528
50
163
617
372
0
274
4,217
155
188
127
878
11,464
118
3,486
170
1,200
785
60
65
300
42
334
71
1,338
480
16
126
482
207
368
269
0
94
0
334
300
24,261
283
3,522
170
2,455
785
293
142
770
189
756
203
2,953
1,008
66
289
1,099
579
368
543
4,217
249
188
461
1,178
550.3
6.7
1.6
~
54.4
~
9.9
3.1
19.6
6.0
18.2
5.5
71.1
22.0
2.3
7.1
26.3
15.2
~
11.7
181.2
6.9
7.3
5.1
39.9
407.9
4.4
124.4
6.3
40.7
28.1
2.0
2.5
10.7
1.5
11.7
2.5
48.8
17.8
0.5
4.5
17.0
7.3
13.3
9.4
~
3.1
~
12.8
10.2
468.1
5.5
66.6
~
47.0
~
5.6
2.8
14.8
3.6
14.7
3.9
58.2
19.3
1.3
5.6
21.0
11.0
~
10.5
~
4.8
~
8.9
22.9
Cancer Mortality in Minnesota, 2005
Number of Deaths
Mortality Rate
Female
Total
Male
Female
Total
4,464
112
6
0
383
0
189
8
135
39
203
156
1,272
62
41
108
193
77
0
265
491
78
4
10
137
4,359
90
656
48
408
120
46
11
81
11
186
88
1,009
44
15
88
173
35
261
297
0
64
0
19
59
8,823
202
662
48
791
120
235
19
216
50
389
244
2,281
106
56
196
366
112
261
562
491
142
4
29
196
202.7
4.7
0.3
~
17.6
~
8.2
0.3
5.8
1.7
9.4
6.8
57.5
2.7
1.9
4.9
8.6
3.1
~
11.8
24.1
3.5
0.1
0.4
6.5
146.5
3.2
22.3
1.7
12.7
4.2
1.5
0.4
2.6
0.4
6.1
2.9
35.7
1.5
0.4
3.0
5.5
1.1
8.9
9.7
~
2.1
~
0.6
1.8
168.7
4.0
12.4
~
14.9
~
4.5
0.4
4.1
1.0
7.5
4.6
44.7
2.0
1.1
3.8
6.9
2.1
~
10.7
~
2.7
~
0.6
3.7
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
~ 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 June 2008. 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.
End Notes
Childhood
Mesothelioma
Healthy Life
Male
Survivorship
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Number of New Cases
Male
54
Minnesota Cancer Facts and Figures 2009
Intro
Distribution of Stage at Diagnosis (%)
MN
SEER
21,317
214,900
17.7%
19.0%
51.5%
51.0%
25.2%
24.5%
3.5%
3.5%
2.1%
1.9%
Cervix
MN
SEER
852
7,795
~
~
54.5%
49.2%
31.3%
33.7%
11.3%
12.5%
2.9%
4.6%
Colon and Rectum
MN
SEER
13,116
130,012
4.3%
5.6%
38.9%
38.0%
36.0%
34.2%
15.5%
17.0%
5.3%
5.2%
Melanoma of the Skin
MN
SEER
7,687
100,154
39.2%
39.2%
51.3%
51.4%
5.3%
5.0%
1.7%
2.2%
2.5%
2.1%
Prostate
MN
20,569
0.0%
3.5%
3.2%
SEER
172,426
0.0%
3.8%
3.4%
Cancer Site
Registry
(Local/Regional)
93.3%
(Local/Regional)
92.8%
Age-adjusted (U.S. 2000) Rate per 100,000 Persons
All
Stages*
In Situ
Local
Regional
Distant
Unstaged
Breast, female
MN
SEER
157.8
171.3
28.4
33.1
80.9
86.6
40.2
42.8
5.4
5.9
3.0
2.9
Cervix
MN
SEER
6.6
7.0
~
~
3.7
3.6
2.0
2.3
0.7
0.8
0.2
0.3
Colon and Rectum
MN
SEER
52.1
53.8
2.3
3.0
20.4
20.5
18.8
18.4
8.0
9.2
2.6
2.7
Melanoma of the Skin
MN
SEER
30.4
43.5
12.0
16.9
15.5
22.5
1.6
2.1
0.5
1.0
0.8
0.9
Prostate
MN
185.7
0.0
7.0
6.5
SEER
161.5
0.1
6.4
6.1
(Local/Regional)
172.2
(Local/Regional)
148.9
Minnesota Cancer Facts and Figures 2009
55
End Notes
Survivorship
*Total cases diagnosed over the five-year period 2001-2005, including in situ cases, except for cancer of the cervix.
~ In situ cervical cancers are not collected by either registry.
SEER cases are for non-Hispanic whites from the 17 SEER registries excluding the Alaska Native Registry and Kentucky.
Source: MCSS (June 2008) and the SEER 17 Region limited use file (November 2007).
Breast
Breast, female
Colorectal
Unstaged
Prostate
Distant
Cervix
Regional
Melanoma
Local
Mesothelioma
In Situ
Childhood
Registry Cases*
Healthy Life
Cancer Site
Lung
Stage at Diagnosis for Screening-Sensitive Cancers
in Minnesota and SEER, 2001-2005
s)
123
1,151
172
189
145
45
248
163
186
249
178
77
222
238
49
30
79
363
1,340
78
222
98
126
184
249
44
4,974
101
121
133
264
62
82
225
32
99
55
72
31
16
174
20
25
18
4
36
23
25
41
21
10
33
34
6
3
11
46
207
10
31
10
19
24
38
6
794
16
17
19
38
6
8
36
6
10
8
9
4
1
9
1
2
1
<1
2
1
1
2
1
1
1
2
1
1
1
2
12
<1
1
1
<1
1
2
<1
38
1
<1
1
2
1
1
2
<1
1
<1
<1
1
12
107
20
23
10
8
33
20
23
25
19
10
22
30
6
3
12
37
128
9
22
13
17
22
27
7
478
11
15
12
33
10
8
25
4
13
8
10
4
1
34
6
5
3
2
10
8
6
7
4
1
5
5
1
2
2
7
45
1
6
3
4
5
9
1
156
4
3
6
8
3
3
8
1
3
3
2
1
1
36
5
6
6
3
6
7
5
9
4
2
8
10
1
1
3
7
45
3
7
3
6
6
7
2
160
2
4
3
8
1
3
7
2
2
2
2
1
19
153
22
27
17
6
27
15
24
22
27
10
30
29
7
4
7
50
156
10
28
12
14
18
26
5
610
10
18
18
37
7
12
25
4
16
5
9
4
4
47
8
3
6
2
13
7
7
14
5
1
9
7
1
1
3
14
61
6
7
4
4
9
11
1
215
4
4
5
8
3
2
9
<1
2
2
4
1
8
52
7
7
7
1
8
7
9
12
6
5
10
11
2
2
4
14
65
6
9
5
7
7
12
2
229
6
6
4
11
3
2
10
1
3
2
3
2
25
204
30
36
34
7
44
30
33
38
36
13
41
39
10
6
17
76
212
11
46
17
23
38
44
9
784
18
20
24
48
12
16
39
6
18
12
15
6
134
47
125
171
18
6
18
24
1
1
1
2
15
6
18
20
4
2
4
6
4
1
4
4
19
6
13
17
5
1
4
8
6
1
7
8
21
11
21
35
ary
Ur
in
te
sta
Pro
NH
L
lan
Me
Lu
ng
om
ia
a
Bla
dd
er
(U
ter
u
Ut
eri
Le
rp
us
Re
Co
Co
lon
&
em
m
ctu
st
Ce
rvi
x
le
B
ma
Fe
Al
lS
ite
s
rea
Colorectal
Breast
Prostate
Cervix
Melanoma
Mesothelioma
Childhood
Healthy Life
Survivorship
End Notes
Aitkin
Anoka
Becker
Beltrami
Benton
Big Stone
Blue Earth
Brown
Carlton
Carver
Cass
Chippewa
Chisago
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
uk
Intro
Lung
Average Number of New Cancer Cases Diagnosed Each Year for
Selected Cancers by County, Minnesota, 2001-2005
6
51
12
7
7
3
11
10
7
11
7
4
8
13
2
2
4
17
55
4
17
6
5
11
10
2
239
5
7
6
13
4
5
11
2
6
1
3
2
7
2
6
10
(continues)
NHL is non-Hodgkin lymphoma; lung includes bronchus; < 1 is less than one.
Source: All cases were microscopically confirmed or identified solely through death certificates, and were
reported to the MCSS as of June 2008. In situ cancers except those of the urinary bladder are excluded.
56
Minnesota Cancer Facts and Figures 2009
Intro
NHL is non-Hodgkin lymphoma; lung includes bronchus; < 1 is less than one.
Source: All cases were microscopically confirmed or identified solely through death certificates, and were
reported to the MCSS as of June 2008. In situ cancers except those of the urinary bladder are excluded.
Minnesota Cancer Facts and Figures 2009
57
Breast
Prostate
Cervix
Melanoma
2
3
9
6
9
10
14
4
8
5
3
31
22
5
10
3
8
5
106
1
5
3
13
4
4
61
13
13
3
31
9
3
4
6
2
6
7
4
41
3
2
11
17
3
Mesothelioma
6
12
26
20
34
39
52
9
20
23
9
90
79
11
28
13
29
15
387
4
22
17
37
10
15
187
48
54
15
145
30
8
13
31
6
14
20
16
149
13
6
37
74
15
ary
sta
te
2
3
6
5
4
5
11
3
6
5
2
29
15
2
6
3
8
3
111
2
4
5
13
4
2
55
19
12
4
33
8
1
5
6
1
5
7
6
43
3
3
8
17
3
Childhood
1
1
6
4
4
7
8
1
7
5
1
31
13
4
3
1
3
3
80
1
3
3
9
1
3
36
20
13
3
24
7
2
2
3
1
6
3
5
44
3
1
6
15
1
Healthy Life
5
7
14
13
21
25
32
7
16
11
6
71
34
8
25
6
19
8
298
4
11
11
29
5
6
159
38
30
9
67
17
4
9
20
3
17
11
11
90
7
6
33
50
7
Survivorship
3
3
5
5
4
6
7
3
4
3
2
22
9
2
4
2
5
2
68
0
3
3
12
1
2
34
10
9
2
17
6
2
2
4
1
5
4
2
30
1
1
8
15
2
End Notes
2
2
4
3
5
6
7
2
4
4
1
19
9
3
5
2
5
4
76
1
4
4
7
3
3
39
11
8
4
16
6
2
2
4
1
3
3
4
28
3
1
8
10
2
Ur
in
4
9
17
15
14
19
25
9
15
19
4
49
41
9
16
12
28
14
227
3
14
16
37
7
8
130
35
19
10
64
18
7
11
17
4
12
12
10
80
8
9
32
37
9
Pro
<1
<1
1
<1
1
1
1
<1
1
1
<1
4
2
<1
1
1
1
1
19
1
<1
1
1
<1
1
9
3
1
1
2
1
<1
1
1
<1
<1
<1
<1
7
<1
<1
1
2
<1
NH
L
5
9
17
15
19
24
30
7
18
14
8
97
42
11
18
12
24
8
364
4
16
15
35
8
9
183
58
36
10
94
19
6
12
15
3
19
12
13
148
13
5
38
52
10
Colorectal
er
dd
Bla
a
om
Me
lan
Lu
ng
em
Le
uk
us
Co
rp
ia
Ut
eri
Re
&
lon
Co
rvi
x
le
B
ma
Ce
Mahnomen
35
Marshall
62
Martin
134
Meeker
115
Mille Lacs
148
Morrison
188
Mower
243
Murray
60
Nicollet
129
Nobles
117
Norman
48
Olmsted
613
Otter Tail
342
Pennington
73
Pine
154
Pipestone
71
Polk
172
Pope
81
Ramsey
2,320
Red Lake
25
Redwood
104
Renville
106
Rice
261
Rock
55
Roseau
71
St Louis
1,186
Scott
339
Sherburne
259
Sibley
80
Stearns
647
Steele
158
Stevens
48
Swift
78
Todd
139
Traverse
28
Wabasha
114
Wadena
104
Waseca
98
Washington
872
Watonwan
71
Wilkin
44
Winona
235
Wright
378
Yellow Medicine
67
Fe
All
S
ite
s
rea
st
ctu
m
(U
ter
u
s)
Lung
Average Number of New Cancer Cases Diagnosed Each Year for
Selected Cancers by County, Minnesota, 2001-2005, continued
Intro
te
Pa
Pro
sta
rea
Ov
a
nc
NH
L
ry
Lu
ng
Liv
uk
em
s
ia
Re
&
Le
er
st
Co
lon
le
B
ma
ain
Fe
Aitkin
Anoka
Becker
Beltrami
Benton
Big Stone
Blue Earth
Brown
Carlton
Carver
Cass
Chippewa
Chisago
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
Br
All
S
ite
s
rea
Colorectal
Breast
Prostate
Cervix
Melanoma
Mesothelioma
Childhood
Healthy Life
Survivorship
End Notes
ctu
m
Lung
Average Number of Cancer Deaths Each Year for Selected Cancers by County,
Minnesota, 2001-2005
46
404
67
73
63
23
96
70
78
78
76
36
78
92
22
11
31
132
476
26
79
45
51
77
96
16
1,869
37
42
55
119
29
34
87
13
40
24
31
12
1
11
1
2
2
<1
2
1
2
3
1
<1
2
3
<1
1
0
2
17
1
3
1
1
1
2
<1
45
1
1
2
4
1
<1
2
<1
1
<1
1
1
2
34
3
3
6
1
7
5
5
7
4
2
5
6
1
1
3
9
42
3
5
3
3
6
9
1
141
3
2
4
8
1
3
9
1
2
2
2
1
4
36
7
9
5
2
11
8
5
10
8
4
6
11
2
1
4
10
42
2
8
6
6
8
10
3
166
4
4
5
11
3
4
7
2
4
4
3
2
2
20
3
3
3
2
4
5
2
3
4
1
3
5
<1
1
3
5
21
2
5
1
4
4
5
<1
81
2
2
2
5
<1
<1
5
1
2
1
1
<1
1
9
2
1
2
<1
2
1
2
1
1
<1
2
2
1
<1
1
3
12
1
1
1
1
2
2
<1
56
<1
1
2
3
1
1
2
<1
<1
<1
1
<1
14
122
20
21
15
6
19
13
22
15
23
9
22
21
6
4
5
37
120
7
20
12
11
17
22
4
480
8
11
13
33
6
11
22
3
12
4
10
4
1
16
3
2
2
1
4
5
4
4
2
2
4
4
<1
<1
2
6
23
1
3
3
3
3
3
1
84
2
3
2
6
3
1
3
1
1
<1
1
<1
2
9
2
2
2
<1
2
2
2
2
2
1
3
3
1
<1
1
5
16
<1
3
1
1
3
3
1
54
2
<1
1
2
1
1
3
<1
1
<1
1
<1
4
21
3
5
3
2
5
4
5
5
3
1
5
4
1
<1
<1
13
23
1
6
2
3
4
6
1
108
2
3
3
7
2
2
4
1
3
1
2
<1
3
15
4
5
4
1
6
5
6
6
4
4
4
7
4
<1
4
10
24
1
4
3
5
4
8
1
103
3
3
4
9
3
3
6
1
3
2
1
<1
54
23
52
63
2
<1
1
1
4
1
4
4
4
4
7
7
2
3
2
5
2
1
1
1
14
5
12
12
2
1
3
4
1
<1
1
1
2
1
3
3
3
3
5
5
(continues)
Brain includes central nervous system; liver includes intrahepatic bile duct; lung includes bronchus; NHL
is non-Hodgkin 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 during the time period, regardless of year of diagnosis.
58
Minnesota Cancer Facts and Figures 2009
<1
1
2
4
3
3
5
1
1
2
1
15
11
2
3
2
4
1
53
<1
3
4
6
2
2
33
7
5
2
14
4
1
1
3
<1
2
2
3
15
1
1
7
8
3
2
1
3
4
5
5
7
2
2
3
3
9
10
3
3
2
3
2
49
<1
4
4
7
2
5
35
7
3
2
15
4
2
3
3
1
3
4
2
14
2
1
6
7
2
Brain includes central nervous system; liver includes intrahepatic bile duct; lung includes bronchus; NHL
is non-Hodgkin 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 during the time period, regardless of year of diagnosis.
Minnesota Cancer Facts and Figures 2009
59
Intro
Colorectal
<1
<1
1
2
1
1
2
1
1
1
1
5
3
1
2
<1
2
1
27
<1
1
1
3
1
1
13
5
3
1
5
1
1
1
1
<1
1
1
1
8
1
<1
3
4
1
Breast
<1
1
2
4
1
4
5
1
4
2
<1
8
6
1
1
1
3
2
42
1
2
3
6
2
1
22
5
4
1
10
3
1
1
2
1
3
1
1
14
2
1
5
7
1
Prostate
3
4
14
10
16
18
23
6
12
10
5
50
30
6
19
5
18
6
259
3
11
8
27
5
4
128
31
25
7
46
16
5
6
17
2
13
8
8
73
6
4
28
37
5
Cervix
<1
<1
2
1
1
<1
2
<1
1
<1
<1
6
3
1
2
<1
2
<1
25
<1
1
1
2
<1
<1
12
2
3
1
5
1
<1
<1
1
<1
2
1
2
9
<1
<1
3
1
<1
Melanoma
1
1
3
2
2
5
6
2
2
2
2
11
5
1
2
2
3
1
36
<1
3
3
5
1
1
18
4
3
2
8
4
1
1
1
1
2
3
2
11
<1
1
4
8
2
Mesothelioma
<1
3
5
6
5
10
7
3
5
6
2
20
17
3
7
3
8
3
76
2
6
6
13
2
3
48
10
9
5
22
6
2
4
6
1
6
3
2
26
2
3
10
12
4
Childhood
1
2
5
3
3
2
7
3
5
3
2
16
9
2
4
1
7
1
64
<1
4
2
5
3
2
36
10
6
2
13
6
1
1
5
1
3
3
4
20
2
1
8
10
2
Healthy Life
<1
1
1
1
1
3
1
<1
1
2
<1
8
4
<1
2
1
2
1
25
<1
1
<1
3
<1
1
9
3
3
1
5
1
1
1
2
1
2
<1
2
8
1
<1
2
4
1
Survivorship
Pro
13
21
59
53
54
72
100
30
51
44
22
206
143
31
62
27
71
30
917
10
47
46
109
27
30
499
115
90
36
199
68
21
29
60
13
49
36
40
279
25
17
100
133
29
End Notes
te
Pa
sta
rea
Ov
a
nc
NH
L
ry
Lu
ng
Liv
er
Le
uk
em
s
ia
Re
&
Co
lon
le
B
ma
Fe
ain
Br
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
All
S
ite
s
rea
st
ctu
m
Lung
Average Number of Cancer Deaths Each Year for Selected Cancers by County,
Minnesota, 2001-2005, continued
Intro
Site
Recommendation
Breast
• Yearly mammograms are recommended starting at age 40. The age at which screening should be stopped
should be individualized by considering the potential risks and benefits of screening in the context of overall health
status and longevity.
• Clinical breast exam should be part of a periodic health exam about every 3 years for women in their 20s and 30s and
every year for women 40 and older.
• Women should know how their breasts normally feel and report any breast change promptly to their health care
providers. Breast self-exam is an option for women starting in their 20s.
• Screening MRI is recommended for women with an approximately 20%-25% or greater lifetime risk of breast cancer,
including women with a strong family history of breast or ovarian cancer and women who were treated for Hodgkin
disease.
Colon &
Rectum
Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of the screening
tests below. The tests that are designed to find both early cancer and polyps are preferred if these tests are available to
you and you are willing to have one of these more invasive tests. Talk to your doctor about which test is best for you.
Tests that find polyps and cancer
• flexible sigmoidoscopy every 5 years*
• colonoscopy every 10 years
• double contrast barium enema every 5 years*
• CT colonography (virtual colonoscopy) every 5 years*
Prostate
Breast
Colorectal
Lung
American Cancer Society Screening Guidelines for the
Early Detection of Cancer in Asymptomatic People
Cervix
Tests that mainly find cancer
• fecal occult blood test (FOBT) every year*,**
• fecal immunochemical test (FIT) every year*,**
• stool DNA test (sDNA), interval uncertain*
Prostate
The PSA test and the digital rectal examination should be offered annually, beginning at age 50, to men who have a life
expectancy of at least 10 years. Men at high risk (African American men and men with a strong family history of 1 or
more first-degree relatives diagnosed with prostate cancer at an early age) should begin testing at age 45. For both men
at average risk and high risk, information should be provided about what is known and what is uncertain about the
benefits and limitations of early detection and treatment of prostate cancer so that they can make an informed decision
about testing.
Uterus
Cervix: Screening should begin approximately 3 years after a woman begins having vaginal intercourse, but no later than
21 years of age. Screening should be done every year with regular Pap tests or every 2 years using liquid-based tests. At or
after age 30, women who have had 3 normal test results in a row may get screened every 2 to 3 years. Alternatively, cervical cancer screening with HPV DNA testing and conventional or liquid-based cytology could be performed every 3 years.
However, doctors may suggest a woman get screened more often if she has certain risk factors, such as HIV infection or
a weak immune system. Women aged 70 and older who have had 3 or more consecutive normal Pap tests in the last 10
years may choose to stop cervical cancer screening. Screening after total hysterectomy (with removal of the cervix) is not
necessary unless the surgery was done as a treatment for cervical cancer.
Endometrium: The American Cancer Society recommends that at the time of menopause all women should be informed
about the 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).
Cancer
Related
Checkup
For individuals undergoing periodic health examinations, a cancer-related checkup should include health
related counseling and, depending on a person’s age and gender, might include examinations for cancers
of the thyroid, checkup oral cavity, skin, lymph nodes, testes, and ovaries, as well as for some nonmalignant diseases.
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
*Colonoscopy should be done if test results are positive.
**For FOBT or FIT used as a screening test, the take-home multiple sample method should be used. A FOBT or FIT done
during a digital rectal exam in the doctor’s office is not adequate for screening.
People should talk to their doctor about starting colorectal cancer screening earlier and/or being screened more often if
they have any of the following colorectal cancer risk factors:
• a personal history of colorectal cancer or adenomatous polyps
• a personal history of chronic inflammatory bowel disease (Crohns disease or ulcerative colitis)
• a strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative [parent, sibling, or child]
younger than 60 or in 2 or more first-degree relatives of any age)
• a known family history of hereditary colorectal cancer syndromes such as familial adenomatous polyposis (FAP) or hereditary
non-polyposis colon cancer (HNPCC)
American Cancer Society guidelines for early cancer detection are assessed annually in order to identify whether there is new scientific evidence sufficient to
warrant a reevaluation of current recommendations. If evidence is sufficiently compelling to consider a change or clarification in a current guideline or the
development of a new guideline, a formal procedure is initiated. Guidelines are formally evaluated every 5 years regardless of whether new evidence suggests
a change in the existing recommendations. There are 9 steps in this procedure, and these “guidelines for guideline development” were formally established
to provide a specific methodology for science and expert judgment to form the underpinnings of specific statements and recommendations from the Society.
These procedures constitute a deliberate process to ensure that all Society recommendations have the same methodological and evidence-based process at
their core. This process also employs a system for rating strength and consistency of evidence that is similar to that employed by the Agency for Health Care
Research and Quality (AHCRQ) and the US Preventive Services Task Force (USPSTF).
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Minnesota Cancer Facts and Figures 2009
Intro
Metastasis: Spread of cancer from one organ or
tissue to another, distant, part of the body.
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.
Stage at Diagnosis: The extent to which the cancer
Cancer Incidence: The number of new cases of
cancer diagnosed during a specified period of time.
Cancer Mortality: The number of deaths due to
cancer in a specified period of time, regardless of when
the disease was diagnosed.
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.
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.
Five-year Relative Survival: The percentage of
Minnesota Cancer Facts and Figures 2009
Colorectal
Breast
Survivorship
Healthy Life
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.
Prostate
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.
Cervix
Lifetime Risk: The estimated percentage of persons
Melanoma
Cancer Control: Reducing the effects of cancer in a
population through prevention, early detection, treatment,
rehabilitation, and palliation.
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.
Mesothelioma
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.
Invasive Cancer: A cancer is described as
Childhood
Average Annual Percent Change (APC):
In Situ Cancer: See “stage at diagnosis.”
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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
Healthy Life
Survivorship
End Notes
Acronyms/Abbreviations Used Frequently in This Report
ACS: The American Cancer Society.
BRFSS: Behavioral Risk Factor Surveillance System.
CDC: Centers for Disease Control and Prevention.
MCSS: Minnesota Cancer Surveillance System of the Minnesota Department of Health.
MDH: Minnesota Department of Health.
Urban Minnesota: The eighteen counties considered Metropolitan Areas in the 2000 U.S. Census: Anoka,
Benton, Carver, Chisago, Clay, Dakota, Hennepin, Houston, Isanti, Olmsted, Polk, Ramsey, St. Louis, Scott, Sherburne,
Stearns, Washington, and Wright Counties.
NCI: National Cancer Institute.
SEER Program: Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.
Data Sources
American Cancer Society: The expected numbers
of cancer cases and deaths in Minnesota in 2008 were
obtained from the American Cancer Society publication,
Cancer Facts & Figures 2008. It is available on their
Website, 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 www.cdc.gov/brfss.
represented 5.6 percent of cases reported to the SEER
Program during 2001-2005. The numbers of types
of cancer deaths among Minnesota residents were
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 1988-2004,
available from MCSS and at www.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.
Nine areas of the SEER Program have been collecting
population-based cancer data from selected geographic
areas in the U.S. since 1973. When long term trends are
presented, data from the white population in these areas
are used. When data from 2001-2005 are presented, they
are based on non-Hispanic whites in the 17 SEER areas
with exclusions used by SEER as noted. Mortality rates
are for the entire U.S., as reported in Cancer Statistics
Review, 1975-2005 available at http://seer.cancer.gov/.
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
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Minnesota Cancer Facts and Figures 2009
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.
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.
Cervix
Prostate
Breast
Colorectal
Lung
Intro
Relationship between Incidence and
Mortality Rates: A frequent misconception when
Minnesota Cancer Facts and Figures 2009
63
End Notes
Survivorship
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.
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.
Melanoma
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.
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.
Mesothelioma
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
Healthy Life
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.
Childhood
Understanding Cancer Rates
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Intro
Notes
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Minnesota Cancer Facts and Figures 2009
Minnesota Cancer Facts and Figures 2009
65
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Intro
Notes
End Notes
Survivorship
Healthy Life
Childhood
Mesothelioma
Melanoma
Cervix
Prostate
Breast
Colorectal
Lung
Intro
Notes
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Minnesota Cancer Facts and Figures 2009
Minnesota Cancer Surveillance System
Minnesota Department of Health
85 East Seventh Place
P.O. Box 64882
Saint Paul, MN 55164
Phone: (651) 201-5900
TDD: (651) 201-5797
Fax: (651) 201-5926
www.state.mn.us/divs/hpcd/cdee/mcss/
Minnesota Cancer Alliance
Gonda Lobby, CEC 334
200 First Street SW
Rochester, MN 55905
Phone: (507) 266-9087
www.mncanceralliance.org
American Cancer Society, Midwest Division
2520 Pilot Knob Road, Suite 150
Mendota Heights, MN 55120-1158
Phone: 1-800-227-2345
Fax: (651) 255-8133
www.cancer.org
Minnesota
Cancer Facts
and Figures
2009
Special Section:
Increasing Colorectal Cancer
Screening in Minnesota
(see page 5)
8201.49
December, 2008