Minnesota
Cancer Facts
& Figures 2011
Table of Contents
Introduction
Stay Well. Get Well. Find Cures. Fight Back.…………………………………………………………………………1
American Cancer Society Challenge Goals for 2015.……………………………………………………………… 2
Estimated New Cancer Cases and Cancer Deaths in Minnesota, 2010.………………………………………… 2
Minnesota Cancer Alliance.………………………………………………………………………….……….………3
Frequently Asked Questions about Cancer.………………………………………………………………………… 4
Cancer in Minnesota.………………………………………………………………………….…………………………… 7
Cancer Disparities in Minnesota.………………………………………………………………………….…………………
10
Lung and Bronchus Cancer in Minnesota.…………………………………………………………………………………
13
Colon and Rectum Cancer in Minnesota.……………………………………………………………….…………………
19
Breast Cancer in Minnesota.………………………………………………………………………….……………………25
Prostate Cancer in Minnesota.………………………………………………………………………….……………………
31
Cervical Cancer in Minnesota.………………………………………………………………………….……………………
35
Melanoma of the Skin in Minnesota.………………………………………………………………………….……………
39
Mesothelioma in Minnesota.………………………………………………………………………….………………………
41
Childhood Cancer in Minnesota.………………………………………………………………………….…………………
43
Living a Healthy Life.………………………………………………………………………….…………………………… 45
Survivorship.………………………………………………………………………….…………………………….……………
49
American Cancer Society Resources to Improve Quality of Life.………………………………………………………
50
Summary Tables and End Notes
Cancer Incidence in Minnesota, 2007.………………………………………………………………………….……
52
Cancer Mortality in Minnesota, 2007.………………………………………………………………………….……
52
Stage at Diagnosis for Screening-Sensitive Cancers..…………………………………………………………………
53
Average Number of New Cancer Cases by County, Minnesota, 2003-2007.……………………………………54
Average Number of Cancer Deaths by County, Minnesota, 2003-2007.…………………………………………56
American Cancer Society Screening Guidelines for the Early Detection of Cancer.………………………………
58
Glossary.………………………………………………………………………….…………………………….…… 59
Acronyms/Abbreviations Used Frequently in This Report.……………………………………………………………
60
Data Sources.………………………………………………………………………….…………………………… 60
Understanding Cancer Rates.………………………………………………………………………….……………61
Acknowledgements
This report represents the efforts and contributions of many individuals and organizations. It was designed and printed by the
American Cancer Society, Midwest Division. We gratefully acknowledge the generous contributions of time and energy of many
American Cancer Society 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.
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.
Stay Well. Get Well.
Find Cures. Fight Back.
March 2011
We are pleased to present the fourth edition 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, the state’s comprehensive cancer control plan. Cancer
patients, health care and public health professionals, policy makers, advocates, news organizations and the public
may find it useful when seeking detailed, easy-to-read information about cancer in Minnesota.
Stay Well
This report shows the risk of developing several common cancers is falling. There is no doubt this progress is due
to the concerted efforts of many organizations and individuals to reduce smoking, increase screening and grow
public awareness about cancer prevention strategies. One-third of cancer deaths would be prevented if no one
smoked cigarettes or used tobacco products. Another third could be prevented if individuals maintained a healthy
weight, ate a healthy diet and regularly exercised. We are dedicated to making even more progress in helping Minnesotans stay well.
Get Well
An estimated 200,000 Minnesotans are living with a history of cancer. Cancer survival is improving because new
treatments are being developed, cancer patients participate in clinical trials to test those treatments, and physicians
and other health care providers incorporate improved treatments into their practice. We are committed to making
sure every Minnesotan diagnosed with cancer has access to the information and support needed to help them get well.
Find Cures
Research provides lifesaving information about the causes of cancer, how to prevent it and how to detect it early,
as well as how to successfully treat and cure the disease while maintaining a high quality of life. However, the
causes of many cancers are still unknown and cures for many remain elusive. We support research to find cures.
Fight Back
We ask you to join 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 for the American Cancer Society. Join the Minnesota
Cancer Alliance. Support cancer research. Be an activist for cancer control.
Sincerely,
Jari Johnston-Allen Chief Executive Officer
American Cancer Society
Midwest Division
Edward P. Ehlinger, MD, MSPH
Commissioner
Minnesota Department of Health
Cheri Rolnick, PhD, MPH
Chair
Minnesota Cancer Alliance
Minnesota Cancer Facts and Figures 2011
1
American Cancer Society
2015 Challenge Goals
The American Cancer Society has set ambitious goals for 2015:
• Reduce the age-adjusted cancer mortality rate by 50 percent.
• Reduce the age-adjusted cancer incidence rate by 25 percent.
• Improve the quality of life for all cancer survivors.
Estimated New Cancer Cases and Cancer Deaths in Minnesota, 2010*
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
New Cases
25,080
Deaths
9,200
380
3,330
140
2,410
850
830
340
3,150
970
1,110
410
720
3,870
1,160
240
610
90
780
140
390
280
2,450
120
330
220
600
440
240
Source: American Cancer Society, Inc. Cancer Facts & Figures 2010, including supplemental tables published online www.cancer.org.
* Rounded to the nearest 10. Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.
Note: Estimated new cases are based on 1995-2006 incidence rates from 44 states and the District of Columbia as reported by
the North American Association of Central Cancer Registries, representing about 89% of the U.S. population. Estimated deaths
are based on data from U.S. Mortality Data, 1969 to 2007, National Center for Health Statistics, Centers for Disease Control and
Prevention, 2010.
If there are abbreviations or terms in this report that you do
not understand, please see the End Notes section of this report.
2
Minnesota Cancer Facts and Figures 2011
Minnesota Cancer Alliance
The Minnesota Cancer Alliance is a coalition of almost 100 organizations committed to eliminating the burden of cancer in Minnesota.
Since 2005 Alliance members have worked together to identify, create and act on opportunities to implement strategies in Cancer
Plan Minnesota 2005-2010. By linking existing initiatives, leveraging resources and forging innovative partnerships, Alliance members
have contributed to the promotion of statewide smoke-free policy, and have generated momentum around efforts to increase colon and
rectum cancer screening, improve access to information regarding resources for cancer survivors and their families, create a model
survivor care plan and develop cancer-related training for community health workers. For a more complete list of Alliance teams and
projects, or to become a member, visit mncanceralliance.org.
Cancer Plan Minnesota 2011-2016
This year, the Minnesota Cancer Alliance released Cancer Plan Minnesota 2011-2016, a framework for action for the next five years.
Through a process which involved input from a broad range of stakeholders, objectives and strategies were refined, data indicators
were strengthened and updated and several new topic areas were added. The plan’s 23 objectives continue to address the spectrum
of cancer care, from primary prevention to screening and treatment to quality of life and survivorship. The Alliance is poised to
launch several new initiatives in 2011 while continuing to build on successful collaborations of the past five years. The plan is available at mncanceralliance.org.
A Call to Action
There are many ways that you or your organization can support implementation of Cancer Plan Minnesota 2011-2016. In addition
to joining an Alliance Project, below are a few examples of things that you can do which link to the goals and objectives of Cancer
Plan Minnesota 2011-2016.
If you are a COMMUNITY BASED ORGANIZATION
If you are a HEALTH CARE PROVIDER
• Conduct targeted outreach to increase breast, colon and rectum and cervical cancer screening among groups that have higher mortality rates
• Implement clinic systems that ensure appropriate follow-up of patients with abnormal screening results
• Become familiar with non-clinical support resources available for cancer patients at www.mncancerresources.org
If you are a PUBLIC HEALTH AGENCY
• Implement local policy, system and environmental changes that promote healthy eating and physical activity
• Refer eligible patients to SAGE Programs for free cancer screening
If you are a HEALTH SYSTEM
• Build existing cancer treatment summary templates into your system of care
• Incorporate tools for shared decision-making into the electronic health record
• Provide your patients with information about cancer clinical trials
• Discuss and promote the completion of advanced care directives with your patients
• Use community health workers to extend your reach into the community
If you are POLICYMAKER
• Support pricing strategies that discourage the use of tobacco products
• Support statewide and local smoke-free policies
• Ban the use of tanning beds by minors
If you are an EMPLOYER
• Provide comprehensive tobacco cessation benefits to your employees
Minnesota Cancer Facts and Figures 2011
3
Frequently Asked Questions
About Cancer
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, which 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.
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.
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.
What causes cancer? Although the cause of a cancer in an
individual can only rarely be determined, scientists believe
that the first step in developing cancer is damage to a cell. This
Causes of Cancer Deaths in the U.S.
Tobacco Use
30
Diet & Obesity
30
Sedentary Lifestyle
5
Family History
5
Infectious Agents
5
Occupational Exposures
5
Prenatal Factors & Growth
5
Reproductive Factors
3
Socioeconomic Status
3
Alcohol
3
Pollution
2
Radiation
2
Medicine
1
Food Additives & Contaminants
1
0
5
10
15
20
Percent
Source: Harvard Report on Cancer Prevention, 1996.
4
Minnesota Cancer Facts and Figures 2011
25
30
35
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 55 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.
Leading Sites of New Cancer Cases
and Deaths among Males,
Minnesota, 2007
Leading Sites of New Cancer Cases
and Deaths among Females,
Minnesota, 2007
Cases
Deaths
Prostate
33.9%
10.3%
Lung and Bronchus
11.5%
Colon and Rectum
Cases
Deaths
Breast
30.9%
14.6%
27.6%
Lung and Bronchus
11.8%
25.0%
9.1%
9.2%
Colon and Rectum
10.2%
9.4%
Urinary Bladder
6.4%
3.3%
Corpus and Uterus, NOS 6.7%
2.5%
Melanoma of the Skin
5.0%
**
Non-Hodgkin Lymphoma 4.7%
Kidney and Renal Pelvis
Leukemia
4.6%
**
4.2%
Non-Hodgkin Lymphoma 4.4%
3.5%
3.8%
3.2%
Thyroid
3.5%
**
3.6%
5.3%
Leukemia
2.8%
4.2%
Oral Cavity and Pharynx 3.2%
**
Ovary
2.8%
5.0%
2.8%
2.2%
Pancreas
Melanoma of the Skin
2.0%
5.7%
Kidney and Renal Pelvis
Liver and Bile Duct
~
3.8%
Pancreas
~
6.2%
Esophagus
~
3.7%
Brain and CNS
~
2.8%
All Others
16.8%
23.7%
19.3%
24.6%
100.0%
100.0%
100.0%
100.0%
All Sites
All Others
All Sites
Source: MCSS and Minnesota Center for Health Statistics.
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 commonly diagnosed cancers
among females.
** Not one of the ten most common sites of cancer death
among males.
** Not one of the ten most common sites of cancer death
among females.
Minnesota Cancer Facts and Figures 2011
5
Can cancer be prevented? Tobacco use is responsible for
about 30 percent of cancer deaths. If no one used tobacco products,
nearly one out of three cancer deaths would be prevented. More
and more evidence indicates that poor diet, lack of exercise,
and obesity increase risk for cancer. It is estimated that a third
of deaths from cancer could be prevented if we maintained a
healthy weight, ate a healthy diet, and exercised regularly.
Being vaccinated for hepatitis B virus and being tested and
treated for HBV may prevent many liver cancers. Being treated
for Helicobacter infections of the stomach can prevent some
stomach cancers. Avoiding exposure to human papilloma virus
(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.
Colon and rectum cancer 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.
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 is the mortality rate a better measure of the effectiveness of screening than the survival rate? Identifying a cancer through screening before 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, 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.”
6
Minnesota Cancer Facts and Figures 2011
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 the mortality rate, rather than
an increase in the survival rate, is considered the best measure
of the effectiveness of a screening method.
Can cancer be cured? The answer to this question depends
very much on the type of cancer and whether or not the cancer
is detected early. The five-year relative survival rate for many
common cancers (cancers of the breast, prostate, colon and
rectum, cervix, uterus, bladder, and testis, and melanoma of
the skin) is greater than 90 percent if found before the cancer
has metastasized. Following guidelines for cancer screening
increases the likelihood of finding cancer early and, therefore,
of survival. Based on data from the SEER Program, the five-year
relative survival rate for cancers diagnosed between 1999 and
2006 was 67 percent.
Cancer in Minnesota
Cancer is very common. From 2003 to 2007, an average of
24,420 Minnesotans were diagnosed with a potentially serious
cancer each year, and more than 9,060 Minnesotans died of
these diseases annually.
The overall cancer mortality rate in Minnesota has been
declining significantly for two decades and began declining
even more rapidly around 2000. The overall cancer mortality
rate declined gradually by an average of 0.5 percent each year
from 1988 to 2000 and then decreased by 1.6 percent a year from
2000 to 2007. After adjusting for population growth and aging,
the overall cancer mortality rate in Minnesota was 15 percent
lower in 2007 (169.5 deaths per 100,000 persons) than it was 20
years earlier, in 1988 (199.5); cancer mortality declined 17 percent
among men and 15 percent among women.
This hard won progress reflects significant declines in mortality
for many of the common cancers, such as cancers of the prostate,
colon and rectum, stomach, brain, oral cavity, and female breast,
as well as leukemia and Hodgkin and non-Hodgkin lymphomas.
Lung and bronchus cancer mortality has been significantly
declining for the last 20 years among men; among women, it
finally appears to have peaked around 2003 and is no longer
increasing. In fact, the only cancer sites for which mortality
rates in Minnesota were significantly increasing at the end of
the twenty-year period were liver cancer (for males and females)
and esophageal cancer (for males only).
The overall cancer incidence rate in Minnesota did not
increase significantly from 2000 to 2007 for either men
or women, but the long term trends are markedly different
for each gender. When data for both sexes are combined,
the overall cancer incidence rate increased significantly by 0.3
percent annually over the twenty-year period. After adjusting
for population growth and aging, the overall cancer incidence
rate in Minnesota was eight percent higher in 2007 (481.4 new
cases per 100,000 persons) than it was in 1988 (445.6); over the
twenty-year period, cancer incidence increased by six percent
among men and seven percent among women.
Incidence rates for thyroid cancer and melanoma of the skin are
increasing the most rapidly; the rate for each of these cancers
has doubled since 1988. However, mortality has not increased
for either site. Cancers of the liver and esophagus were the only
two cancers to show significant increases in both incidence and
mortality. Increasing incidence rates for these and a number of
other sites are partially balanced by substantial and significant decreases in incidence for colon and rectal, stomach, laryngeal,
cervical, and ovarian cancers, and among males, lung and oral
cancers.
Overall Cancer Trends in Minnesota, 1988-2007
600
500
Rate per 100,000 persons
1988-2007
Incidence increased
by an average of 0.3% annually.
400
Incidence
300
Mortality
1988-2000
Mortality decreased
by an average of 0.5% annually.
200
2000-2007
Mortality decreased
100
by an average of 1.6% annually.
0
1988 1989 1990
1991
1992 1993
1994
1995
1996 1997 1998 1999
2000
2001 2002 2003 2004
2005 2006 2007
Year of Diagnosis/Death
Source: MCSS (May 2010). Rates are age-adjusted to the 2000 U.S. population. A hashed bar indicates where the trend significantly changed direction.
Interval trends are statistically significant unless stated otherwise.
Minnesota Cancer Facts and Figures 2011
7
Nearly half of all Minnesotans will be diagnosed with a
potentially serious cancer. Based on current statistics for the
state, 51 percent of men and 41 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 17 geographic areas participating in
the SEER Program (44% for males and 38% for females) despite
similar cancer rates in Minnesota because life expectancy is
higher in Minnesota, and therefore, more people live to develop
cancer.
Cancer became the leading cause of death in Minnesota
in 2000. In 2008, 27 percent more Minnesotans died from cancer
(9,439 deaths) than from the second leading cause of death,
heart disease (7,451 deaths). Cancer became 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 mortality.
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.
The overall cancer incidence rate in Minnesota is similar
to what is reported for the nation. Over the five-year period
2003-2007, the overall cancer incidence rate in Minnesota (471.6
new cases per 100,000 persons) was about two percent higher
than reported by the 17 geographic areas participating in the
SEER Program (461.6). However, the incidence rate was somewhat
lower in Minnesota than SEER for each race/ethnic group except
American Indians. In the SEER Program, American Indians have
one of the lowest cancer rates; in Minnesota, they have the highest.
The overall cancer mortality rate in Minnesota is somewhat lower than for the nation. Over the five-year
period 2003-2007, the overall cancer mortality rate in Minnesota
(173.5 cancer deaths per 100,000 persons) was six percent lower
than for the U.S. as a whole (183.8). The mortality rate was
nearly the same or 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.
Deaths Due to Heart Disease and Cancer, Minnesota,1980-2008
400
Rate per 100,000 persons
350
300
250
Heart Disease
200
Cancer
150
100
50
0
80
19
82
19
84
19
86
19
88
19
90
19
92
94
19
19
Year of Death
Source: MCSS. Rates are age-adjusted to the 2000 U.S. population.
8
Minnesota Cancer Facts and Figures 2011
96
19
98
19
00
20
02
20
04
20
06
20
08
20
Cancer Incidence by Race/Ethnicity, Minnesota and the U.S., 2003-2007
Rate per 100,000 persons
700
621.0
600
500
516.8
489.8
489.8
484.8
468.5
400
SEER
342.5
317.7
340.8
Minnesota
310.8
300
255.3
235.3
200
100
0
African
American
AI/AN*
Statewide
AI/AN
CHSDA*
Asian/Pacific
Islander
Hispanic
(all races)
Non-Hispanic
White
Source: MCSS (May 2010) and SEER Cancer Statistics Review, 1975-2007. Rates are age-adjusted to the 2000 U.S. population. SEER incidence data are from the SEER 17 Areas;
rates for Hispanics and non-Hispanic whites exclude cases from the Alaska Native Registry.
* AI/AN=American Indian/Alaska Native; CHSDA=Contract Health Service Delivery Area.
Cancer Mortality by Race/Ethnicity, Minnesota and the U.S., 2003-2007
Rate per 100,000 persons
350
300
293.5
250
247.9
224.2
227.1
200
186.7
172.9
U.S.
156.7
150
Minnesota
123.7
123.2
110.8
100
122.1
102.0
50
0
African
American
AI/AN*
Statewide
AI/AN
CHSDA*
Asian/Pacific
Islander
Hispanic
(all races)
Non-Hispanic
White
Source: MCSS and SEER Cancer Statistics Review, 1975-2007. 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 the District of Columbia, New Hampshire and North Dakota.
* AI/AN=American Indian/Alaska Native; CHSDA=Contract Health Service Delivery Area.
Minnesota Cancer Facts and Figures 2011
9
men living in CHSDA counties, and just somewhat higher than
American Indian men statewide. 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 Disparities in
Minnesota
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. This is true
nationally as well as in Minnesota.
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. This report presents
American Indian cancer rates for two geographic areas in Minnesota: statewide, and for residents of the 29 counties which are part of the Indian Health Service’s Contract Health
Services Delivery Area (CHSDA). About half of the American
Indian population in the state lives in a CHSDA county. Cancer
rates calculated for the CHSDA counties are thought to provide
a more accurate picture of cancer rates among American Indians, but this is difficult to verify.
African Americans: Over the five-year period 2003-2007,
African American men had the second highest overall cancer
incidence rate in Minnesota, second only to American Indian
The cancer incidence rate among African American men in
Minnesota was 13 percent higher than for non-Hispanic white
men, while their mortality rate was 42 percent higher. Higher
overall cancer mortality among African American compared
to non-Hispanic white men reflected higher rates for the three
most common cancers: lung (36% higher), prostate (119%
higher), and colon and rectum (31% higher).
Over the same time period, the overall cancer incidence rate
among African American women in Minnesota was seven
percent lower than that of non-Hispanic white women, but
their cancer mortality rate was 21 percent higher. Higher overall
cancer mortality among African American compared to nonHispanic white women reflected higher rates for the three most
common cancers: lung (30% higher), colon and rectum cancer
(18% higher), and breast cancer (24% higher).
The overall cancer incidence rate among African Americans is
very similar in Minnesota and the 17 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.
Cancer Incidence by Race/Ethnicity and Gender, Minnesota, 2003-2007
800
Rate per 100,000 persons
698.2
700
620.2
600
589.4
African American
560.3
550.8
AI/AN* Statewide
500
463.1
409.4
351.0
300
AI/AN CHSDA*
379.7
400
338.5
281.8
Asian/Pacific Islander
Hispanic (all races)
240.3
Non-Hispanic White
200
100
0
Males
Source: MCSS (May 2010). Rates are age-adjusted to the 2000 U.S. population.
* AI/AN=American Indian/Alaska Native; CHSDA=Contract Health Service Delivery Area.
10
Minnesota Cancer Facts and Figures 2011
Females
American Indians: As discussed above, cancer rates for American
Indians have been calculated for residents of the CHSDA counties
as well as for the entire state. The overall cancer incidence and
mortality rates are each approximately 20 percent higher for
American Indians in CHSDA counties than when calculated
for American Indians statewide. Cancer rates calculated for the
CHSDA counties are thought to be more accurate, but this is
difficult to verify.
was 86 percent higher (49% higher statewide). 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 (55% 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 elevated risk for cancer
is found in the Northern Plains tribes in general, and is probably
not limited to Minnesota.
Over the five-year period 2003-2007, American Indian men
living the CHSDA counties had the highest overall cancer
incidence rate and the highest overall cancer mortality rate in
Minnesota; American Indian men statewide had the third highest
rates, only marginally lower than for African American men.
Asian/Pacific Islanders: Over the five-year period 2003-2007,
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 49 percent lower than among non-Hispanic
white men, but their mortality rate was only 29 percent lower.
Similarly, the overall cancer incidence rate among Asian/Pacific
Islander women in Minnesota was 41 percent lower than among
non- Hispanic white women, but their mortality rate was only
29 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.
The cancer incidence rate among American Indian men living
in CHSDA counties in Minnesota was 27 percent higher (7%
higher statewide) than for non-Hispanic white men, while their
mortality rate was 50 percent higher (35% higher statewide).
Higher cancer mortality among American Indian compared to
non-Hispanic white men was primarily due to lung cancer (two
times higher) and colon and rectum cancer (two times higher).
Over the same time period, the overall cancer incidence rate
among American Indian women living in CHSDA counties in
Minnesota was 27 percent higher (13% higher statewide) than
that of non-Hispanic white women, but their cancer mortality rate
Cancer Mortality by Race/Ethnicity and Gender, Minnesota, 2003-2007
700
Rate per 100,000 persons
600
African American
500
AI/AN* Statewide
400
300
AI/AN CHSDA*
299.1
316.4
Asian/Pacific Islander
284.2
277.1
200
Hispanic (all races)
221.4
210.8
Non-Hispanic White
179.2
150.1
148.6
129.6
105.2
100
79.8
0
Males
Females
Source: MCSS (May 2010). Rates are age-adjusted to the 2000 U.S. population.
* AI/AN=American Indian/Alaska Native; CHSDA=Contract Health Service Delivery Area.
Minnesota Cancer Facts and Figures 2011
11
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.
Although overall cancer incidence among Asian/Pacific Islanders
was 18 percent lower in Minnesota than in the 17 geographic
areas covered by the SEER Program, their cancer mortality rate
was 12 percent higher than among Asian/Pacific Islanders in
the U.S. as a whole.
Hispanics (all races): Over the five-year period 2003-2007,
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
36 percent lower than among non-Hispanic white men, and
their mortality rate was 39 percent lower. The overall cancer
incidence rate among Hispanic women in Minnesota was 17
percent lower than among non-Hispanic white women, and
their mortality rate was 46 percent lower.
Although Hispanics had the lowest rates for most of the cancers
included in this report, they had the second highest rates of liver
and stomach cancer, two or more times higher than among nonHispanic whites. Hispanic women were also at increased risk of
cervical cancer compared to non-Hispanic white women.
Overall cancer incidence among Hispanics is somewhat lower in
Minnesota than in the 17 geographic areas covered by the SEER
Program and their cancer mortality rate is somewhat lower than
Hispanics in the U.S. as a whole.
12
Minnesota Cancer Facts and Figures 2011
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.
Lung and Bronchus
Cancer in Minnesota
Almost as many Minnesotans die from lung and bronchus
cancer as from the next four leading causes of cancer death
combined: breast, prostate, colon and rectum, and pancreas
cancer. What is particularly tragic is that we know how to
prevent nearly all lung cancers.
Approximately 85-90 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 77.9 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.
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.
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.health.state.mn.us/
radon or by calling (651) 201-4601 (toll free 1-800-798-9050) 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.health.state.mn.us/freedomtobreath.
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, some organic chemicals, radioactive ores,
and dust from chromium, cadmium and arsenic
• Chronic inflammation of the lungs due to pneumonia,
tuberculosis, silicosis, or berylliosis
• Air pollution
The MDH recommends that all homes and schools in Minnesota
be tested for radon every 2-5 years. Testing can be done with a
radon test kit available from city and county health departments,
many hardware stores, or directly from radon testing laboratories.
Most are priced under $20, and some local health agencies have
a limited supply at low cost. Remediation is recommended if
Minnesota Cancer Facts and Figures 2011
13
The Burden of Lung Cancer in Minnesota
Over the five-year period 2003-2007, an average of 2,930
Minnesotans were diagnosed with lung and bronchus cancer
each year. It was the second most commonly diagnosed cancer
among men and among women. About 67 percent of Minnesotans
diagnosed with lung cancer were 65 years of age or older. The
age-adjusted incidence rate for lung cancer in Minnesota in
2007 was 67.1 new cases per 100,000 men and 50.6 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 eight percent of lung
cancers are clinically diagnosed without microscopic confirmation.
From 2003 to 2007, an average of 2,340 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 cancers combined.
About 72 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 2007 was 57.8
deaths per 100,000 men and 36.9 deaths per 100,000 women.
These rates are based on the underlying cause of death on the
death certificate, whether or not the cancer was microscopically
confirmed, and are therefore comparable to mortality rates
reported for the U.S.
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.
Five-Year Relative Survival from
Lung and Bronchus Cancer in the U.S.
Stage
Whites
Blacks
Localized
Regional
Distant
All Stages
53.5%
24.1%
3.5%
16.1%
45.1%
20.9%
3.1%
12.6%
Source: SEER Cancer Statistics Review, 1975-2007.
Based on cases diagnosed in 1999-2006 with follow-up into 2007.
Disparities in Lung Cancer
American Indian men and women living in the CHSDA counties
have the highest lung cancer rates in Minnesota, and American
Indian men and women statewide have the second highest
lung cancer rates. Their risk of dying of this disease is two to three
times higher than among non-Hispanic whites of the same gender.
Similarly, African American men and women are 30-40 percent
more likely to die of lung cancer than non-Hispanic whites of
the same gender.
Lung and Bronchus Cancer Mortality by Race/Ethnicity and Gender, Minnesota, 2003-2007
140
Rate per 100,000 persons
130.4
120.4
120
117.2
100
85.8
80
78.8
Males
Females
58.1
60
48.1
40
36.9
33.9
21.3
20
14.5
14.7
0
African
American
AI/AN*
Statewide
AI/AN
CHSDA*
Source: MCSS (May 2010). Rates are age-adjusted to the 2000 U.S. population.
* AI/AN=American Indian/Alaska Native; CHSDA=Contract Health Service Delivery Area.
14
Minnesota Cancer Facts and Figures 2011
Asian/Pacific
Islander
Hispanic
(all races)
Non-Hispanic
White
Trends in Lung Cancer
Lung cancer trends are very different for men and women, both
nationally and in Minnesota. Among men, lung cancer mortality has
been declining steadily and significantly since 1988. Between
1988 and 2007, lung cancer mortality decreased by 17 percent
among Minnesota men.
In sharp contrast, lung cancer mortality increased by 32
percent among women in Minnesota over the same time period.
However, the rate of increase slowed down in 1993, and for the
first time in Minnesota, there was no significant increase in lung
cancer mortality among women from 2002 to 2007.
Lung Cancer Mortality Trends by Gender in Minnesota and the U.S.
100
90
Rate per 100,000 persons
Males
80
70
60
1988-2007
1.1% annually.
U.S.
50
Minnesota
40
30
Females
2002-2007 No significant trend.
1993-2002
20
1988-1993
10
1.5% annually.
3.8% annually.
0
75
19
80
19
85
19
90
19
95
19
00
20
05
20
07
20
Year of Death
Source: MCSS (May 2010) and SEER Cancer Statistics Review, 1975-2007. Rates are age-adjusted to the 2000 U.S. population. National mortality is for the
U.S. white population. The results of Joinpoint trend analyses are only shown for Minnesota. A hashed bar indicates where the trend significantly changed
direction. Interval trends are statistically significant unless stated otherwise.
Minnesota Cancer Facts and Figures 2011
15
Geographic Differences in Lung Cancer Mortality
Among men: During 2003-2007, the lung cancer mortality
rate among men was 18 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
two to three times higher in Minnesota than in the U.S. as
a whole.
The male lung cancer mortality rate was significantly higher
than the statewide average in Northeast and Central
Minnesota, and was significantly lower in South Central
Minnesota. Lung cancer mortality among males was lower
than the U.S. average in each Minnesota region and in the
six largest counties.
Lung Cancer Mortality Rates among Males in
Minnesota Regions and Six Largest Counties,
2003-2007
Minnesota = 58.2
U.S.* = 71.1
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Roseau
Kittson
Lake
of the
Woods
Marshall
Northwest
57.1
Among women: During 2003-2007, the lung cancer
mortality rate among women was 16 percent lower in
Minnesota than among non-Hispanic white women in
the U.S. as a whole.
The female lung cancer mortality rate varied by nearly
twofold across Minnesota. Anoka 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.
The average number of lung cancer cases and deaths
each year in Minnesota counties is shown in the
End Notes section of this report.
Lung Cancer Mortality Rates among Females in
Minnesota Regions and Six Largest Counties,
2003-2007
Minnesota = 36.9
U.S.* = 43.8
Kittson
Lake
of the
Woods
Marshall
Koochiching
St. Louis
St. Louis
Beltrami
Pennington
Cook
Clear
Clear
Water
Itasca
Mahnomen
Norman
Mahnomen
Hubbard
Hubbard
Clay
Clay
Becker
Wilkin
Todd
Aitkin
Wilkin
Pine
Mille
Lacs
Kanabec
Benton
Traverse
Big Stone
Isanti
Pope
Stevens
Stearns
Sherburne
Chisago
Anoka
Swift
Chippewa Kandiyohi
Meeker
Wright
Hennepin
McLeod
Renville
Carver
Lincoln
Redwood
Murray
Cottonwood
Brown
Nicollet
30.3
Todd
Grant
Douglas
Stevens
Pope
South Central
49.8
Watonwan
Blue Earth
Rice
Nobles
Jackson
Martin
Faribault
Isanti
Chisago
Anoka
Swift
Chippewa Kandiyohi
Meeker
Wright
Hennepin
Renville
Dodge
Pipestone
Olmsted
Mower
Lyon
Murray
Ramsey
Washington
County
Rate
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
47.5
39.9
38.1
39.9
46.1
39.6
Metro
39.5
Carver
Dakota
Sibley
Redwood
Southwest
25.7
Brown
Nicollet
Le
Sueur
Rice
Goodhue
Wabasha
Southeast
South Central
Watonwan34.7
Steele 31.0
Waseca
Cottonwood
Dodge
Blue Earth
Olmsted
Winona
Winona
Fillmore
Nobles
Jackson
Martin
Faribault
Freeborn
Mower
Fillmore
Houston
Houston
Rates are per 100,000 persons, age-adjusted to the 2000 U.S. population. Statistical significance
(p < 0.05) based on SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the U.S. excluding the District of Columbia, New Hampshire, and North
Dakota, SEER Cancer Statistics Review, 1975-2007.
16
39.5
Scott
Southeast
55.6
Steele
Freeborn
Kanabec
Sherburne
Rock
Rock
Metro
Benton
McLeod
Wabasha
Waseca
Mille
Lacs
Morrison
Stearns
Yellow Medicine
Goodhue
Carlton
Pine
Traverse
Big Stone
Lincoln
Le
Sueur
Aitkin
Central
38.4
Lac Qui Parle
Sibley
Southwest
54.7
Pipestone
60.4
57.4
56.2
62.3
65.1
53.6
Dakota
Scott
Lyon
Washington
Rate
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
Metro
57.6
Lac Qui Parle
Yellow Medicine
Ramsey
County
Crow
Wing
Wadena
Ottertail
Carlton
West Central
Morrison
Douglas
Grant
Crow
Wing
Central
65.5
West Central
53.4
Becker
Cass
Cass
Wadena
Ottertail
Cook
Northeast
45.3
Red Lake
Northeast
67.4
Itasca
Water
Lake
Polk
Lake
Red Lake
Norman
Koochiching
Northwest
37.6
Beltrami
Pennington
Polk
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Roseau
Minnesota Cancer Facts and Figures 2011
Rates are per 100,000 persons, age-adjusted to the 2000 U.S. population. Statistical significance
(p < 0.05) based on SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the U.S. excluding the District of Columbia, New Hampshire, and North
Dakota, SEER Cancer Statistics Review, 1975-2007.
Lung Cancer Screening
Chest x-rays have not been found to reduce lung cancer mortality, even among smokers. In November 2010, the National Lung
Screening Trial reported a 20 percent reduction in lung cancer
mortality among heavy smokers age 55 to 74 who were screened
with low-dose spiral CT scanning. Although this is very promising
news, the full results have not yet been published. A number of
important questions will need to be answered before recommendations for lung cancer screening are updated.
Minnesota has decreased slowly but steadily for the last nine
years, from 22.2 percent in 2001 to 16.8 percent in 2009 (18.6%
among males and 14.9% among females).
American Indians are the least represented race/ethnic group
in the Minnesota BRFSS; on average, only 34 American Indians
participate each year. To obtain more stable estimates of smoking
prevalence for American Indians, data were combined for the
nine-year period 2001-2009 rather than the five-year period
2005-2009 for the other race/ethnic groups. American Indians
are nearly twice as likely to report that they currently smoke
than the other race/ethnic and gender groups in the state.
Cigarette Smoking
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, but statespecific smoking rates prior to 1984 are not available to confirm
this. Data from the BRFSS indicate that smoking rates in our
state have been the same or just slightly lower than nationally
for the last two decades. The smoking prevalence rate in Cigarette smoking is strongly associated with education: among
persons who do not have a high school degree, 33 percent currently
smoke, compared to 25 percent of high school graduates, 21
percent of those with some post-secondary education, and 9
percent of college graduates.
Trends in Adult Smoking, Minnesota and the U.S., 1990-2009
40
Percent Current Smokers
30
U.S.
20
Minnesota
10
0
90
94
92
19
19
19
96
19
98
19
02
00
04
20
20
06
20
20
08
20
Source: BRFSS Web site (http://apps.nccd.cdc.gov/BRFSS/). Current smokers have smoked at least 100 cigarettes and smoke every day or some
days. U.S. is the median of the 50 states and Washington D.C.
Adult Smoking by Gender and Race/Ethnicity, Minnesota, 2005-2009*
70
Percent Current Smokers
60
African American
50
American Indian
42*
39*
40
Asian/Pacific Islander
30
20
23
28
26
20
Hispanic
19
11
10
13
16
Non-Hispanic White
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.
* Due to the relatively small number of interviews with American Indians, data are for the nine-year period 2001-2009 to provide more stable estimates.
Minnesota Cancer Facts and Figures 2011
17
Adult Smoking by Education and Residence, Minnesota, 2005-2009
Percent Current Smokers
40
Not a HS Graduate
35
30
31
HS Graduate
26
23
20
20
Post-HS Education
21
College Grad
10
10
8
0
Rural
Urban
Source: Minnesota BRFSS. Analyses were conducted by MCSS. Current smokers have smoked at least 100 cigarettes and smoke every day or some days.
HS is high school. Urban residents live in one of the 21 counties designated as “metropolitan” by the Census Bureau in 2005.
Trends in Student Smoking by Grade, Minnesota, 1992-2010
Percent Smoked Cigarettes during the Previous 30 Days
50
42
39
40
35
31
30
Grade 12
27
31
23
30
19
10
Grade 9
19
20
5
Grade 6
19
8
15
7
3
10
3
2
2004
2007
9
2
0
1992
1995
1998
2001
2010
Source: Modified from online tables in 2010 Minnesota Student Survey Data 2010 (11/15/2010): Select trends in student behaviors and perceptions between
1992 and 2010.
Although cigarette smoking is slightly more common among
adults residing in rural (19%) than in urban (17%) Minnesota,
smoking rates are about the same at each education level.
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.
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.
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 preventionminnesota.com and click on
the Call it Quits icon on the home page.
Call it Quits
Call it Quits is a collaboration among Minnesota’s major health
plans and ClearWay MinnesotaSM to make it easier for healthcare
18
Minnesota Cancer Facts and Figures 2011
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
only 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 increases the risk for being diagnosed with 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
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 2007 was 19.1
deaths per 100,000 men and 12.5 deaths per 100,000 women.
The higher death rate for colon and rectum cancer compared
to breast and prostate cancer results in part from the fact that
only 49 percent of colon and rectum cancers in Minnesota are
diagnosed at an early stage, when they can be more successfully
treated. In comparison, nearly 65 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
Whites
90.0%
70.1%
Blacks
85.6%
63.0%
Distant
All Stages
12.0%
65.9%
8.4%
56.2%
Source: SEER Cancer Statistics Review, 1975-2007
1975-2007..
Based on cases diagnosed in 1999-2006 with follow-up into 2007.
Other Risk Factors
• Not being screened
• Obesity
• Alcohol
• Poor diet
• Physical inactivity
The Burden of Colon and Rectum Cancer in Minnesota
Over the five-year period 2003-2007, 2,475 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 66 percent of Minnesotans diagnosed with colon and
rectum cancer were 65 years of age or older. The age-adjusted
incidence rate for colon and rectum cancer in Minnesota in
2007 was 51.1 new cases per 100,000 men and 41.3 new cases per
100,000 women.
From 2003 to 2007, 845 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 76 percent of
Minnesota Cancer Facts and Figures 2011
19
Disparities in Colon and Rectum Cancer
American Indian men living in CHSDA counties have the highest
colon and rectum cancer incidence rate in Minnesota. Their risk
of being diagnosed with this disease is 85 percent higher than
for non-Hispanic white men. Colon and rectum cancer incidence
among American Indians living in Contract Health Services
Delivery Area (CHSDA) counties is 2.3 times higher in Minnesota
as in the U.S. as a whole. American Indians, African Americans
and Hispanics diagnosed with colon and rectum cancer are
more likely to have a late-stage tumor than non-Hispanic whites
or Asian/Pacific Islanders.
Percent of Colon and Rectum Cancers Diagnosed at
Late Stage by Race/Ethnicity, Minnesota, 2003-2007
Race/Ethnicity
Average Number
of Cases
Diagnosed/Year
Late
Stage*
African American
American Indian Statewide
American Indian CHSDA residents
Asian/Pacific Islander
Hispanic (all races)
Non-Hispanic White
45
21
15
26
23
2,328
60%
60%
57%
49%
61%
51%
Source: Minnesota Cancer Surveillance System (May 2010).
* Late stage cancers have extended beyond the colon or rectum
(regional or distant stage) when diagnosed. The denominator is
all invasive cancers, including those that were unstaged (5.9%).
Colon and Rectum Cancer Incidence by Race/Ethnicity and Gender, Minnesota, 2003-2007
120
Rate per 100,000 persons
100.3
100
80
71.0
67.8
Males
60
54.4
54.3
53.7
43.1
40
38.9
37.4
Females
41.0
33.8
30.3
20
0
African
American
AI/AN*
Statewide
AI/AN
CHSDA*
Source: MCSS (May 2010). Rates are age-adjusted to the 2000 U.S. population.
* AI/AN=American Indian/Alaska Native; CHSDA=Contract Health Service Delivery Area.
20
Minnesota Cancer Facts and Figures 2011
Asian/Pacific
Islander
Hispanic
(all races)
Non-Hispanic
White
Trends in Colon and Rectum Cancer
Colon and rectum cancer incidence and mortality rates in
Minnesota have decreased dramatically since statewide cancer
reporting was implemented in 1988. Between 1988 and 2007,
the incidence rate decreased by 25 percent and mortality by 36
percent. Trends in Minnesota are similar to those reported by
the SEER Program. Steadily decreasing colon and rectum cancer
rates are 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.
Colon and Rectum Cancer Trends in Minnesota and the U.S.
80
Rate per 100,000 persons
1988-1996
70
2.0% annually.
Incidence
1996-2000 No significant trend.
60
2000-2007
2.1% annually.
50
SEER/U.S.
40
Minnesota
Mortality
30
20
1988-2007
10
2.5% annually.
0
75
19
80
19
85
19
90
19
95
19
00
20
05
20
07
20
Year of Diagnosis / Death
Source: MCSS (May 2010) and SEER Cancer Statistics Review, 1975-2007. Rates are age-adjusted to the 2000 U.S. population. National incidence is for the
white population in SEER 9 Regions, delay-adjusted. National mortality is for the U.S. white population. The results of Joinpoint trend analyses are only shown
for Minnesota. A hashed bar indicates where the trend significantly changed direction. Interval trends are statistically significant unless stated otherwise.
Minnesota Cancer Facts and Figures 2011
21
Geographic Differences in Colon and Rectum
Cancer Incidence
During 2003-2007, 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.
Geographic Differences in Colon and Rectum
Cancer Mortality
During 2003-2007, the colon and rectum cancer mortality rate
was nine percent lower in Minnesota than among non-Hispanic
whites in the U.S. as a whole.
Colon and rectum cancer incidence rates were significantly
higher in the western third of the state (South Central, Southwest, West Central and Northwest Regions) than the state
average. Rates were significantly lower in the Metro Area and in
Ramsey and Hennepin Counties.
Colon and rectum cancer mortality rates were significantly
higher than the state average in St. Louis County. Although
mortality was generally higher in the western third of the state,
none of the differences were statistically significant. Colon and
rectum cancer mortality was significantly lower in the Metro Area.
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.
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.
Colon and Rectum Cancer Incidence Rates in Minnesota
Regions and Six Largest Counties, 2003-2007
Colon and Rectum Cancer Mortality Rates in Minnesota
Regions and Six Largest Counties, 2003-2007
Minnesota = 47.9
SEER* = 48.7
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Roseau
Kittson
Marshall
Lake
of the
Woods
Northwest
54.8
Lake
of the
Woods
Marshall
St. Louis
Beltrami
Pennington
Beltrami
Lake
Cook
Lake
Polk
Cook
Red Lake
Clear
Clear
Water
Mahnomen
Water
Northeast
49.1
Itasca
Northeast
17.7
Itasca
Mahnomen
Norman
Hubbard
Hubbard
Clay
Clay
Becker
Becker
Cass
Wadena
Ottertail
Wilkin
Todd
Aitkin
West Central
17.1
Pine
Kanabec
Benton
Traverse
Big Stone
Isanti
Pope
Stevens
Stearns
Sherburne
Chisago
Anoka
Swift
Chippewa Kandiyohi
Wright
Meeker
Hennepin
Lac Qui Parle
McLeod
Yellow Medicine
Lincoln
Lyon
Renville
Rock
Murray
Nobles
Metro
44.8
Scott
Sibley
Redwood
Southwest
54.6
Pipestone
Carver
Nicollet
Le
Sueur
Ramsey
Washington
County
Rate
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
49.6
49.5
42.5
43.4
47.8
49.7
Jackson
Faribault
Pope
Morrison
Kanabec
Benton
Isanti
Stearns
Sherburne
Chisago
Anoka
Swift
Chippewa Kandiyohi
Meeker
Wright
Hennepin
Lac Qui Parle
McLeod
Renville
Yellow Medicine
Steele Dodge
Mower
Lyon
Carver
Murray
Winona
Fillmore
Houston
Rates are per 100,000 persons, age-adjusted to the 2000 U.S. 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, SEER Cancer
Statistics Review, 1975-2007.
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.
Minnesota Cancer Facts and Figures 2011
Rock
Nobles
Ramsey
Washington
County
Rate
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
14.0
16.2
14.8
14.5
18.4
16.6
Metro
14.9
Dakota
Sibley
Redwood
Southwest
17.6
Pipestone
Wabasha
Freeborn
Mille
Lacs
Traverse
Big Stone
Lincoln
Goodhue
South Central Southeast
47.4
Cottonwood Watonwan 53.5
Olmsted
Waseca
Blue Earth
Stevens
Carlton
Pine
Scott
Brown
Martin
Douglas
Aitkin
Central
16.2
Todd
Grant
Dakota
Rice
Crow
Wing
Wadena
Ottertail
Wilkin
Carlton
Mille
Lacs
Morrison
Douglas
Grant
Cass
Crow
Wing
Central
46.5
West Central
52.5
22
Koochiching
Northwest
17.2
St. Louis
Red Lake
Norman
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Roseau
Kittson
Koochiching
Pennington
Polk
Minnesota = 15.9
U.S.* = 17.4
Brown
Nicollet
Le
Sueur
Rice
Goodhue
South Central Southeast
16.3
Watonwan 14.7
Waseca Steele
Cottonwood
Dodge
Olmsted
Blue Earth
Jackson
Martin
Faribault
Wabasha
Freeborn
Mower
Winona
Fillmore
Houston
Rates are per 100,000 persons, age-adjusted to the 2000 U.S. population. Statistical significance
(p < 0.05) based on SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the U.S. excluding the District of Columbia, New Hampshire, and North
Dakota, SEER Cancer Statistics Review, 1975-2007.
Colon and Rectum Cancer Screening
There is broad consensus that adults age 50 and older should
be screened for colon and rectum cancer, even if they have no
symptoms. A number of effective tests have been developed to
screen for this cancer which differ in how frequently they are
recommended to be performed (see guidelines below). 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). The important thing is to be screened.
Finding and removing polyps can actually prevent colon and
rectum cancer. These small tissue growths are the precursors
of cancer and can be removed on an outpatient basis, usually
during a colonoscopy, thus preventing the cancer from forming.
In this respect, screening for colon and rectum cancer is more
effective than screening for breast cancer, which is limited to
identifying abnormalities that have already become cancerous.
Despite this, screening for colon and rectum cancer has lagged
behind screening for breast cancer, both in Minnesota and
nationally. The proportion of Minnesota adults who have had
at least one sigmoidoscopy or colonoscopy increased over the
last decade from 49 percent in 1999 to 71 percent in 2008 (data
not shown). Based on data from the 2008 BRFSS, Minnesotans were
more likely to report having had at least one sigmoidoscopy or
colonoscopy (71%) than the median of the 50 states and the
District of Columbia (62%).
For the first time in 2008, participants in the BRFSS were asked
which type of endoscopy (sigmoidoscopy or colonoscopy)
they had received when screened for colon and rectum cancer,
making it possible to more accurately assess adherence to
recommendations. In that year, 68 percent of Minnesotans age
50 and older were up to date with Society guidelines for colon
and rectum cancer screening (had an FOBT in the last year, a
sigmoidoscopy within five years or a colonoscopy within ten
years), compared to 80 percent of women age 50 and older having
a mammogram in the previous two years. Fully 23 percent of
Minnesotans age 50 and older reported that they had never received a fecal occult blood test, sigmoidoscopy or colonoscopy; in
contrast, only three percent of women age 50 and older reported
never having had a mammogram.
Type of Colon and Rectum Cancer Screening
among Adults Age 50 and Older, Minnesota, 2008
Ever Screened
Up to Date*
FOBT Only
2%
3%
Both FOBT and Endoscopy
6%
10%
Sigmoidoscopy
5%
7%
55%
80%
Colonoscopy
Screened but not Up to Date
Never Screened
9%
23%
100%
Adherence to Cancer Screening Guidelines for
Colon and Rectum and Female Breast Cancer
among Persons Age 50 and Older, Minnesota, 2008
Colon and Rectum
Female Breast
68%
80%
9%
17%
23%
3%
Up to Date*
Screened but not Up to Date
Never Screened
Among Adults
Up to Date
100%
Source: Minnesota BRFSS. Analyses were conducted by MCSS.
* Fecal occult blood test (FOBT) within one year, sigmoidoscopy
within five years, or colonoscopy within ten years.
Source: Minnesota BRFSS. Analyses were conducted by MCSS.
* Colon and Rectum: FOBT within one year, sigmoidoscopy within
five years, or colonoscopy within ten years.
Female breast: mammogram within two years.
Minnesota Cancer Facts and Figures 2011
23
Sage Scopes Screening Program
The Sage Scopes screening program provides free colonoscopies
to approximately 250 men and women a year. Minnesotans who
are between the ages of 50 and 64 and meet specific income
guidelines may be eligible for these services. Sage Scopes covers
the cost of the bowel preparation, colonoscopy, and any pathology or follow-up required to diagnose colon and rectum cancer.
Only two screening sites are established at this time; both are in
the Twin Cities. Free treatment is not currently available.
In 2008, 67 percent of men and 69 percent of women age 50 and
older were up to date on colon and rectum cancer screening in
Minnesota. This measure was slightly lower in rural (66%) than
urban (70%) Minnesota. Screening adherence increased with
education (not a high school graduate, 62%; high school graduate, 64%; some post-secondary education, 67%; college graduate,
73%), but these differences were primarily evident in rural Minnesota. There were too few interviews among persons of color to
present colon and rectum cancer screening by race/ethnicity.
Sage Scopes is funded by the CDC as part of the National Colorectal
Cancer Prevention Program. For more information, call 1-888643-2584 or visit www.MNSage.com.
Colon and Rectum Cancer Screening among Minnesotans Ages 50 and Older by
Education and Residence, 2008
Percent of Persons Up to Date*
80
77
73
68
65
69
67
62
60
57
Not a HS Graduate
HS Graduate
40
Post-HS Education
College Grad
20
0
Rural
Urban
Source: Minnesota BRFSS. Analyses were conducted by MCSS.
* Up to Date means FOBT in the last year, sigmoidoscopy within 5 years or colonoscopy within 10 years. HS is high school. Urban residents live in
one of the 21 counties designated as “metropolitan” by the Census Bureau in 2005.
American Cancer Society Screening Recommendations for Colon and Rectum Cancer
Beginning at age 50, men and women at average risk should follow one of the examination schedules below:
Tests that find polyps and cancer
When to get one
• Flexible sigmoidoscopy**, or
• Colonoscopy, or
• Double-contrast barium enema (DCBE)**
(DCBE)**,, or
• CT colonography (virtual colonoscopy)**
colonoscopy)**
• Every five years, starting at age 50
• Every 10 years, starting at age 50
• Every five years, starting at age 50
• Every five years, starting at age 50
Tests that mainly find cancer
When to get one
• Fecal occult blood test (FOBT)*,** with at least 50%
test sensitivity for cancer, or
• Fecal immunochemical test (FIT)*,**
(FIT)*,** with at least
50% test sensitivity for cancer, or
• Stool DNA test (sDNA)**
(sDNA)**
• Annually, starting at age 50
• Annually, starting at age 50
• Interval uncertain, starting at age 50
*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.
**Colonoscopy should be done if test results are positive.
24
Minnesota Cancer Facts and Figures 2011
Breast Cancer in
Minnesota
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.
Risk Factors for Female Breast Cancer
• 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
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, and 27 percent were
among women between the ages of 50 and 64. The age-adjusted
mortality rate for female breast cancer in Minnesota in 2007
was 20.8 deaths per 100,000 women.
Compared to many other cancers, survival from breast cancer is
quite high. When diagnosed at an early stage, five-year relative
survival is 98 percent.
Five-Year Relative Survival from
Female Breast Cancer in the U.S.
Stage
Localized
Regional
Distant
Whites
98.6%
84.9%
24.8%
Blacks
93.0%
72.2%
15.2%
All Stages
90.2%
77.5%
Source: SEER Cancer Statistics Review, 1975-2007.
Based on cases diagnosed in 1999-2006 with follow-up into 2007.
The best defense against breast cancer is routine screening with
mammography. Screening cannot prevent breast cancer, but it
does increase the likelihood of finding tumors at an early stage
when survival is high.
The Burden of Breast Cancer in Minnesota
From 2003 to 2007, approximately 3,520 women and 30 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 43 percent of
Minnesota women diagnosed with breast cancer were 65 years
of age or older, and 35 percent were between the ages of 50 and
64. The age-adjusted incidence rate for female breast cancer in
Minnesota in 2007 was 132.1 new cases per 100,000 women.
Between 2003 and 2007, about 640 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 2007 it
Minnesota Cancer Facts and Figures 2011
25
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 18 percent
lower than among non-Hispanic white women, but their
mortality rate is 24 percent higher. African American and
Hispanic women are also more likely to be diagnosed with
late-stage disease.
Percent of Female Breast Cancers Diagnosed at
Late Stage by Race/Ethnicity, Minnesota, 2003-2007
Average Number
of Cases
Diagnosed/Year
Race/Ethnicity
Late
Stage*
African American
62
50%
American Indian Statewide
22
33%
American Indian CHSDA residents
13
29%
Asian/Pacific Islander
32
41%
Hispanic (all races)
30
50%
3,325
35%
Non-Hispanic White
Source: Minnesota Cancer Surveillance System (May 2010).
* Late stage cancers have extended beyond the breast (regional or
distant stage) when diagnosed. The denominator is all invasive cancers,
including those that were unstaged (2.2%).
Female Breast Cancer by Race/Ethnicity, Minnesota, 2003-2007
140
Rate per 100,000 females
126.7
120
108.0
103.4
100
African American
97.0
AI/AN* Statewide
80.4
80
AI/AN CHSDA*
Asian/Pacific Islander
60
53.4
Hispanic (all races)
40
Non-Hispanic White
27.1
21.9
20
12.7
13.8
17.1
9.7
0
Incidence
Source: MCSS (May 2010). Rates are age-adjusted to the 2000 U.S. population.
* AI/AN=American Indian/Alaska Native; CHSDA=Contract Health Service Delivery Area.
26
Minnesota Cancer Facts and Figures 2011
Mortality
Trends in Female Breast Cancer
During the 1980s, breast cancer incidence increased sharply in
the U.S. The reasons for this increase are not completely understood, but are thought to be related at least in part to increased
use of mammography. During the 1990s, the breast cancer
incidence rate continued to increase at a slow but steady pace
in Minnesota and in the SEER Program. It is likely that some
of this increase was related at least in part to increased use of
hormone replacement therapy.
may include high levels of mammography use for the past two
decades and a dramatic decline in the use of hormone replacement therapy 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.
Despite increases in the incidence of female breast cancer
for two decades, breast cancer mortality has been decreasing
significantly and steadily by 2.7 percent annually since cancer
registration was implemented in Minnesota in 1988. 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.
However, in 2000 the female breast cancer incidence rate began
declining significantly by about four percent a year, and from
2004 to 2007 it did not show a significant trend. The reasons
for this sharp decline probably involve multiple factors, but
Female Breast Cancer Trends in Minnesota and the U.S.
160
Rate per 100,000 females
Incidence
140
120
2000-2004
4.1% annually.
100
SEER/U.S.
80
Minnesota
60
Mortality
40
20
1988-2007
0
75
19
80
19
85
19
90
19
2.7% annually.
95
19
00
20
05
20
07
20
Year of Diagnosis/Death
Source: MCSS (May 2010) and SEER Cancer Statistics Review, 1975-2007. Rates are age-adjusted to the 2000 U.S. population. National incidence is for the
white population in SEER 9 Regions, delay-adjusted. National mortality is for the U.S. white population. The results of Joinpoint trend analyses are only
shown for Minnesota. A hashed bar indicates where the trend significantly changed direction. Interval trends are statistically significant unless stated otherwise.
Minnesota Cancer Facts and Figures 2011
27
Geographic Differences in Female Breast Cancer Incidence
During 2003-2007, the female breast cancer incidence rate was
five percent lower in Minnesota than among non-Hispanic
white women living in the 17 geographic areas reporting to the
SEER Program.
Breast cancer incidence was significantly higher than the state
average in Washington County and significantly lower than the
state average in West Central Minnesota.
Female Breast Cancer Incidence Rates in Minnesota
Regions and Six Largest Counties, 2003-2007
Minnesota = 125.9
SEER* = 133.2
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Roseau
Kittson
Lake
of the
Woods
Marshall
Northwest
121.5
Koochiching
The female breast cancer mortality rate varied more widely than
incidence, but no comparisons were statistically significant,
in part due to the much smaller number of deaths than cases.
Washington County had the highest female breast cancer mortality
rate and also had the highest incidence rate, while Northwest
and West Central Minnesota had the lowest female breast cancer
mortality rates and also had the lowest incidence rates.
Female Breast Cancer Mortality Rates in Minnesota
Regions and Six Largest Counties, 2003-2007
Minnesota = 21.7
U.S.* = 23.9
Kittson
Lake
of the
Woods
St. Louis
Lake
Cook
Marshall
Red Lake
Clear
Northeast
122.6
Water
Itasca
Koochiching
Northwest
18.2
St. Louis
Beltrami
Pennington
Lake
Polk
Mahnomen
Norman
Clear
Itasca
Mahnomen
Norman
Cass
Crow
Wing
Wadena
Ottertail
Todd
Grant
Douglas
Stevens
Pope
Aitkin
Central
123.7
West Central
114.0
Hubbard
Carlton
Clay
Kanabec
Benton
Isanti
Stearns
Sherburne
Chisago
Anoka
Swift
Chippewa Kandiyohi
Meeker
Wright
Hennepin
Renville
Yellow Medicine
Carver
Scott
Lincoln
Lyon
Rock
Murray
Nobles
Washington
Rate
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
124.0
131.7
127.3
123.7
126.0
139.4
Cass
Cottonwood
Jackson
Brown
Nicollet
Le
Sueur
Martin
Faribault
Todd
Grant
Douglas
Stevens
Pope
Morrison
Kanabec
Benton
Traverse
Big Stone
Isanti
Stearns
Sherburne
Chippewa Kandiyohi
Goodhue
Mower
Olmsted
Meeker
Chisago
Wright
Hennepin
Lac Qui Parle
Wabasha
McLeod
Renville
Yellow Medicine
Winona
Fillmore
Houston
Lincoln
Minnesota Cancer Facts and Figures 2011
Rock
Murray
Nobles
Washington
Rate
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
21.7
24.6
22.6
19.5
21.1
25.9
Dakota
Sibley
Redwood
Southwest
23.3
Pipestone
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.
Lyon
Ramsey
County
Metro
22.4
Carver
Scott
Rates are per 100,000 persons, age-adjusted to the 2000 U.S. 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, SEER Cancer
Statistics Review, 1975-2007.
28
Pine
Mille
Lacs
Anoka
Dodge
Freeborn
Carlton
Swift
Southeast
South Central
130.6
Watonwan 120.3
Steele
Waseca
Blue Earth
Aitkin
Central
21.2
West Central
18.9
Dakota
Rice
Crow
Wing
Wadena
Ottertail
Wilkin
Sibley
Redwood
Southwest
120.9
Pipestone
Ramsey
County
Metro
128.2
Lac Qui Parle
McLeod
Becker
Pine
Mille
Lacs
Morrison
Traverse
Big Stone
Northeast
20.9
Water
Becker
Wilkin
Cook
Red Lake
Hubbard
Clay
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Roseau
Beltrami
Pennington
Polk
Geographic Differences in Female Breast Cancer Mortality
During 2003-2007, 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.
Brown
Nicollet
Le
Sueur
Rice
Goodhue
Wabasha
Southeast
South Central
22.0
Watonwan 21.4
Steele
Waseca
Cottonwood
Dodge
Blue Earth
Jackson
Martin
Faribault
Freeborn
Mower
Olmsted
Winona
Fillmore
Houston
Rates are per 100,000 persons, age-adjusted to the 2000 U.S. population. Statistical significance
(p < 0.05) based on SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the U.S. excluding the District of Columbia, New Hampshire, and North
Dakota, SEER Cancer Statistics Review, 1975-2007.
Breast Cancer Screening
The American Cancer Society recommends annual screening mammography for women age 40 and older. 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.
Mammography use has increased considerably since the late
1980s when the BRFSS added these questions to the survey.
Since 2002, the proportion of women age 40 and older who
report having been screened in the last two years has been fairly
stable in Minnesota.
Combining data for 2006 and 2008, the percent of women
ages 40 and older who reported having a mammogram in the
previous two years increased with educational level (not a high
school graduate, 66%; high school graduate, 77%; some postsecondary education, 81%; college graduate, 83%), and was very
similar at each educational level in urban and rural Minnesota.
There were too few interviews among women of color to present
screening rates by race/ethnicity.
Based on data from the 2008 BRFSS, 79 percent of women age
40 and older in Minnesota reported having a mammogram in
the previous two years; this was slightly higher than the median
of the 50 states and the District of Columbia (74%).
Trends in Mammography Use among Women Ages 40 and Older, Minnesota, 1987-2008
100
Percent had Mammogram within 2 Years
80
80
67
69
69
69
70
68
68
70
70
81
80
79
72
64
60
58
47
40
20
~
~
~
~
~
0
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Source: Minnesota BRFSS. Analyses were conducted by MCSS.
~ These questions were only asked in even numbered years starting in 2000.
Minnesota Cancer Facts and Figures 2011
29
Sage Screening Program
The Sage Screening Program provides free mammograms and
Pap tests to women age 40 and older who meet specific income
guidelines. Uninsured women, and those whose insurance does
not fully cover the costs of breast and cervical cancer screening
(e.g., they have co-pays or unmet deductibles), can access Sage
services at more than 420 clinics statewide. Sage provides free
treatment services for uninsured women diagnosed with breast
or cervical cancer.
The Sage Screening Program is primarily funded by the CDC as
part of the National Breast and Cervical Cancer Early Detection
Program. Sage is also funded with money from the State of
Minnesota and from the Susan G. Komen, Twin Cities Affiliate,
Inc. (Race for the Cure).
For more information, call 1-888-643-2584 or visit MNSage.com.
Mammography Use among Women Ages 40 and Older by Education and Residence,
Minnesota, 2006 and 2008
100
Percent had Mammogram within 2 Years
81
80
84
82
81
79
74
66
65
Not a HS Graduate
60
HS Graduate
Post-HS Education
40
College Grad
20
0
Rural
Urban
Source: Minnesota BRFSS. Analyses were conducted by MCSS. HS is high school. Urban residents live in one of the 21 counties designated
as “metropolitan” by the Census Bureau in 2005.
American Cancer Society Screening Recommendations for Breast Cancer
Women at average risk should follow the examination schedules below:
• Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health
• Clinical breast exams (CBE) should be part of a periodic health exam, preferably at least every three years for women in
their 20s and 30s and every year for women 40 and older
• Breast self-exam (BSE) is an option for women starting in their 20s and women should report any breast change promptly
to their health care providers
• Women at increased risk (family history, genetic tendency, history of breast cancer) should talk with their health care
provider
pro
vider about the benefits and limitations of starting mammography screening earlier, having additional tests (breast,
ultrasound or MRI) or having more frequent exams
A mammogram is able to detect the earliest sign of breast cancer before it can be seen or felt physically.
30
Minnesota Cancer Facts and Figures 2011
Prostate Cancer in
Minnesota
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 and 40, respectively.
Risk Factors for Prostate Cancer
• Family history of prostate cancer (one or more firstdegree relatives diagnosed with prostate cancer at an
early age)
• Being African American
• Poor diet (high fat and red meat)
• Physical inactivity
The Burden of Prostate Cancer in Minnesota
Over the five-year period 2003-2007, more than 4,260 men were
diagnosed with prostate cancer in Minnesota each year. It was
the most common cancer among men, accounting for one out of
every three cancers diagnosed. About 62 percent of Minnesotans
diagnosed with prostate cancer were 65 years of age or older.
In 2007, the age-adjusted incidence rate for prostate cancer in
Minnesota was 187.0 new cases per 100,000 males.
From 2003 to 2007, 515 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 two and a half times more men than prostate
cancer. About 93 percent of deaths due to prostate cancer
occurred among Minnesotans 65 years of age or older. The ageadjusted mortality rate for prostate cancer in Minnesota in 2007
was 23.5 deaths per 100,000 males.
Based on data from the SEER Program, the five-year relative
survival rate for prostate cancer is very high compared to most
other cancers, even when diagnosed at an advanced stage.
The overall five-year relative survival rate for prostate cancer
increased substantially from 81 percent among cases diagnosed
in 1986-1988 to 99 percent among cases diagnosed in 1999-2006.
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.
Trends in Prostate Cancer
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. Higher
prostate cancer rates in Minnesota were noted several decades
ago 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 28 percent between 1995 and 2007.
Whether this is due to PSA screening is not certain.
Five-Year Relative Survival from
Prostate Cancer in the U.S.
Stage
Local/Regional
Distant
Unstaged
All Stages
Whites
Blacks
100.0%
29.7%
75.3%
99.6%
100.0%
28.9%
65.9%
95.9%
Source: SEER Cancer Statistics Review, 1975-2007.
Based on cases diagnosed in 1999-2006 with follow-up into 2007.
Disparities in Prostate Cancer
African American men have the highest prostate cancer
incidence and mortality rates. Their risk of being diagnosed
with this disease is 16 percent higher than among non-Hispanic
white men, and their risk of dying of this disease is more than
twice as high. This indicates that African American men are less
likely to survive prostate cancer than non-Hispanic white men
in Minnesota.
Minnesota Cancer Facts and Figures 2011
31
Prostate Cancer Trends in Minnesota and the U.S.
250
Rate per 100,000 males
1988-1992
200
13.1% annually.
150
SEER/U.S.
Incidence
Minnesota
100
50
1995-2007
Mortality
4.2% annually.
0
80
75
90
85
19
19
05
00
95
19
19
20
20
19
07
20
Year of Diagnosis/Death
Source: MCSS (May 2010) and SEER Cancer Statistics Review, 1975-2007. Rates are age-adjusted to the 2000 U.S. population. National incidence is for the
white population in SEER 9 Regions, delay-adjusted. National mortality is for the U.S. white population. The results of Joinpoint trend analyses are only
shown for Minnesota. A hashed bar indicates where the trend significantly changed direction. Interval trends are statistically significant unless stated otherwise.
Prostate Cancer by Race/Ethnicity, Minnesota, 2003-2007
250
Rate per 100,000 males
209.1
200
180.1
177.9
African American
AI/AN* Statewide
155.3
150
AI/AN CHSDA*
Asian/Pacific Islander
105.2
100
Hispanic (all races)
56.6
Non-Hispanic White
55.3
50
19.5
24.2
12.4
0
Incidence
Source: MCSS (May 2010). Rates are age-adjusted to the 2000 U.S. population.
* AI/AN=American Indian/Alaska Native; CHSDA=Contract Health Service Delivery Area.
32
Minnesota Cancer Facts and Figures 2011
Mortality
19.1
25.2
Geographic Differences in Prostate Cancer Incidence
During 2003-2007, the prostate cancer incidence rate was 19
percent higher in Minnesota than among non-Hispanic white
men living in the 17 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. It is unlikely that this excess risk results from
more prevalent PSA testing in Minnesota, because interviews
conducted by the BRFSS indicate that PSA testing is consistently
lower in Minnesota than the median value for all participating
states.
Comparing the regions with the highest and lowest rates, the
prostate cancer incidence rate in Minnesota varied by about 17
percent. The rate in Central Minnesota was significantly higher
than the state average; rates in Southeast Minnesota and Hennepin
County were significantly lower.
Geographic Differences in Prostate Cancer Mortality
During 2003-2007, the prostate cancer mortality rate was 10
percent higher in Minnesota than among non-Hispanic 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.
The prostate cancer mortality rate varied by approximately
40 percent among the regions and counties examined, but
none of the differences were statistically significant. Only two
geographic areas (West Central Minnesota and Anoka County)
had prostate cancer mortality rates that were lower than the
national average.
The average number of prostate cancer cases and deaths
each year in Minnesota counties is shown in the End Notes
section of this report.
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.
Prostate Cancer Incidence Rates in Minnesota Regions
and Six Largest Counties, 2003-2007
Minnesota = 183.3
SEER* = 154.4
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Roseau
Kittson
Lake
of the
Woods
Marshall
Northwest
182.3
Koochiching
Marshall
St. Louis
Clear
Water
Itasca
Northwest
28.9
Koochiching
St. Louis
Beltrami
Cook
Northeast
179.0
Red Lake
Pennington
Lake
Polk
Itasca
Hubbard
Hubbard
Clay
Cass
Aitkin
Central
202.5
West Central
182.9
Todd
Mille
Lacs
Kanabec
Benton
Traverse
Big Stone
Isanti
Pope
Stevens
Stearns
Sherburne
Chisago
Anoka
Swift
Chippewa Kandiyohi
Meeker
Wright
Hennepin
McLeod
Renville
Carver
Scott
Lincoln
Lyon
Rock
Nobles
Rate
Brown
Nicollet
Le
Sueur
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
189.3
179.7
172.3
191.1
175.9
185.5
Faribault
Aitkin
Mille
Lacs
Todd
Morrison
Douglas
Grant
Rice
Kanabec
Benton
Traverse
Big Stone
Isanti
Pope
Stevens
Stearns
Sherburne
Freeborn
Meeker
Wright
Hennepin
McLeod
Renville
Yellow Medicine
Carver
Scott
Goodhue
Lincoln
Pipestone
Olmsted
Lyon
Winona
Fillmore
Houston
Rates are per 100,000 persons, age-adjusted to the 2000 U.S. 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, SEER Cancer
Statistics Review, 1975-2007.
20.5
25.7
24.6
24.5
30.3
28.1
Rock
Ramsey
Washington
Dakota
Sibley
Redwood
Southwest
27.6
Wabasha
Rate
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
Metro
24.8
Lac Qui Parle
Mower
Chisago
County
Anoka
Swift
Chippewa Kandiyohi
Dodge
Carlton
Pine
Dakota
Blue Earth
Martin
Crow
Wing
West Central
21.4
Washington
South Central Southeast
175.0
Watonwan173.5
Steele
Waseca
Cottonwood
Jackson
Central
26.4
Wadena
Ottertail
Wilkin
Sibley
Redwood
Southwest
192.7
Pipestone
Murray
County
Metro
180.0
Lac Qui Parle
Yellow Medicine
Ramsey
Becker
Cass
Carlton
Pine
Morrison
Douglas
Grant
Crow
Wing
Wadena
Ottertail
Wilkin
Northeast
28.6
Water
Mahnomen
Norman
Becker
Cook
Red Lake
Clear
Mahnomen
Clay
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Roseau
Kittson
Beltrami
Lake
Norman
Minnesota = 25.3
U.S.* = 22.9
Lake
of the
Woods
Pennington
Polk
Prostate Cancer Mortality Rates in Minnesota Regions
and Six Largest Counties, 2003-2007
Murray
Cottonwood
Nobles
Jackson
Brown
Nicollet
Le
Sueur
Rice
Goodhue
South Central Southeast
23.0
24.0
Watonwan
Steele
Blue Earth
Martin
Faribault
Waseca
Freeborn
Dodge
Mower
Wabasha
Olmsted
Winona
Fillmore
Houston
Rates are per 100,000 persons, age-adjusted to the 2000 U.S. population. Statistical significance
(p < 0.05) based on SEER*Stat analysis using Tewari modification.
*Non-Hispanic whites in the U.S. excluding the District of Columbia, New Hampshire, and North
Dakota, SEER Cancer Statistics Review, 1975-2007.
Minnesota Cancer Facts and Figures 2011
33
Prostate Cancer Screening
Most experts agree that current evidence is insufficient to
recommend for or against routine testing for early prostate
cancer detection. The PSA test is very sensitive and can find
tumors before they become symptomatic, but the unsolved
challenge 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. The American Cancer Society
recommends that men should not be screened unless they have
discussed the uncertainties, risks, and potential benefits of
prostate cancer screening with their health care provider.
Among Minnesota men ages 50 and over who participated in
the 2008 Minnesota BRFSS and did not have a history of prostate
cancer, 63 percent reported that they had a PSA test in the last
two years. This was somewhat lower than reported in 2006 (66%).
In 2008, the proportion of men ages 40 and over who reported
having a PSA test in the previous two years was lower in
Minnesota (49%) than the median for the 50 states and the
District of Columbia (55%). Minnesota men have consistently
reported lower PSA screening rates in each of the four years in
which BRFSS participants were asked.
Trends in PSA Testing among Men Ages 50 and Older, Minnesota, 2001-2008
80
Percent had PSA within 2 Years
66
66
63
62
59
60
40
20
~
~
~
0
2001
2002
2003
2004
2005
2006
2007
2008
Source: Minnesota BRFSS. Analyses were conducted by MCSS. Men with a self-reported history of prostate cancer were excluded. PSA is
prostate-specific antigen.
~ These questions were only asked in even numbered years starting in 2002.
American Cancer Society Screening Recommendations
Recommendations for Prostate Cancer
Asymptomatic men who have at least a 10-year life expectancy should have an opportunity to make an informed decision
with their health care provider about screening for prostate cancer, including the prostate specific antigen (PSA) screening
and digital rectal examination (DRE), after receiving information about the uncertainties, risks and potential benefits associated
with prostate cancer screening.
• Men at average risk should receive this information beginning at age 50.
• Men at higher risk, including African-American men and men with a first-degree
first-degree relative (father or brother) diagnosed
with prostate cancer before age 65, should receive this information beginning at age 45.
• Men at appreciably higher risk (multiple family members diagnosed with prostate cancer before age 65) should receive this
information beginning at age 40.
34
Minnesota Cancer Facts and Figures 2011
died of cervical cancer in Minnesota each year. About 25 percent
of deaths occurred among women less than 50 years of age. The
age-adjusted mortality rate for cervical cancer in Minnesota in
2007 was 1.0 deaths per 100,000 females.
Cervical Cancer in
Minnesota
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. The HPV vaccine protects against the HPV types that cause
about 70 percent of cervical cancer in adulthood. CDC recommends that young girls get the HPV vaccine as part of their
preteen healthcare visit at age 11-12 years. It’s also recommended
for females ages 13-26 who haven’t yet been vaccinated. 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.
The Burden of Cervical Cancer in Minnesota
Over the five-year period 2003-2007, about 165 women were
diagnosed with invasive cervical cancer each year in Minnesota.
About 55 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 2007, the age-adjusted
incidence rate for cervical cancer in Minnesota was 5.7 new
cases per 100,000 females. From 2003 to 2007, about 45 women
Disparities in Cervical Cancer
During 2003-2007, women of color in Minnesota were two to
three times more likely to be diagnosed with or die from invasive
cervical cancer than 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.
Five-Year Relative Survival from Cervical Cancer
in the U.S.
Stage
Localized
Regional
Distant
All Stages
Whites
92.4%
58.8%
17.9%
71.7%
Blacks
83.5%
50.3%
11.6%
60.7%
Source: SEER Cancer Statistics Review, 1975-2007.
Based on cases diagnosed in 1999-2006 with follow-up into 2007.
Cervical Cancer by Race/Ethnicity, Minnesota, 2003-2007
18
Rate per 100,000 females
17.0
16
15.0
14
12.5
12
11.6
11.6
10
Incidence
8
Mortality
6.2
6
5.5
4
2
1.5
~
~
~
African
American
AI/AN*
Statewide
AI/AN
CHSDA*
~
0
Asian/Pacific
Islander
Hispanic
(all races)
Non-Hispanic
White
Source: MCSS (May 2010). Rates are age-adjusted to the 2000 U.S. population.
AI/AN=American Indian/Alaska Native; CHSDA=Contract Health Service Delivery Area.
~ Rates based on fewer than ten cases or deaths are not presented.
Minnesota Cancer Facts and Figures 2011
35
Trends in Cervical Cancer
Incidence and mortality rates for invasive cervical cancer have
each decreased by 56 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 42
percent and the mortality rate by 52 percent.
Cervical Cancer Trends in Minnesota and the U.S.
14
Rate per 100,000 females
12
1988-2007
10
2.9% annually.
Incidence
8
SEER/U.S.
Minnesota
6
1988-2007
4
2.0% annually.
Mortality
2
0
75
19
80
19
85
19
90
19
95
19
00
20
05
20
07
20
Year of Diagnosis/Death
Source: MCSS (May 2010) and SEER Cancer Statistics Review, 1975-2007. Rates are age-adjusted to the 2000 U.S. population. National incidence is for the
white population in SEER 9 Regions, delay-adjusted. National mortality is for the U.S. white population. The results of Joinpoint trend analyses are only
shown for Minnesota. A hashed bar indicates where the trend significantly changed direction. Interval trends are statistically significant unless stated otherwise.
36
Minnesota Cancer Facts and Figures 2011
Geographic Differences in Cervical Cancer
During 2003-2007, the cervical cancer incidence rate was thirteen
percent lower in Minnesota than among non-Hispanic white
women in the 17 geographic areas in the SEER Program. During
the same period, cervical cancer mortality was 24 percent lower
in Minnesota (1.6 deaths per 100,000 females) than among non- Hispanic white women in the U.S. (2.1 deaths per 100,000 females).
Cervical Cancer Incidence Rates in Minnesota Regions
and Six Largest Counties, 2003-2007
Minnesota = 6.1
SEER* = 7.0
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Roseau
Kittson
Lake
of the
Woods
Marshall
Northwest
8.6
Koochiching
St. Louis
Beltrami
Over the five-year period 2003-2007, the invasive cervical cancer
incidence rate was significantly higher than the state average in
Southwest Minnesota. No county or region had a mortality rate
that was significantly different from the state average, but the
highest rate was in Southwest Minnesota (2.5 deaths per 100,000
women).
Pennington
Lake
Polk
Cook
Red Lake
Northeast
8.0
Clear
Water
Itasca
Mahnomen
Norman
Hubbard
Clay
Becker
Cass
Todd
Grant
Douglas
Stevens
Pope
Aitkin
Central
5.8
West Central
5.1
Cervical Cancer Screening 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.
Crow
Wing
Wadena
Ottertail
Wilkin
Carlton
Pine
Mille
Lacs
Morrison
Kanabec
Benton
Traverse
Big Stone
Isanti
Stearns
Sherburne
Chisago
Anoka
Washington
Swift
Chippewa Kandiyohi
Meeker
Wright
Hennepin
Lac Qui Parle
McLeod
Based on data from the 2008 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 (86%) as the median
of the 50 states and the District of Columbia (83%).
Renville
Yellow Medicine
Redwood
Brown
Southwest
9.0
Murray
Rock
5.7
5.1
5.6
6.6
7.9
7.0
Dakota
Sibley
Lyon
Pipestone
Rate
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
Metro
5.8
Carver
Scott
Lincoln
Ramsey
County
Nobles
Nicollet
Le
Sueur
Rice
Goodhue
South Central Southeast
5.2
Watonwan 8.0
Steele
Waseca
Cottonwood
Dodge
Blue Earth
Jackson
Martin
Faribault
Freeborn
Wabasha
Olmsted
Mower
Winona
Fillmore
Houston
Rates are per 100,000 persons, age-adjusted to the 2000 U.S. 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, SEER Cancer
Statistics Review, 1975-2007.
Trends in Pap Test Use among Women Ages 18 and Older, Minnesota, 1992-2008
100
Percent Screened within 3 Years
90
86
85
80
86
84
86
83
85
20
25
87
86
18
19
21
18
20
19
20
19
88
87
86
18
19
25
60
Within 2-3 years
Within 1 year
40
69
69
64
67
64
67
64
60
69
70
67
68
61
20
~
~
~
~
0
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007 2008
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.
~ Question only asked in even numbered years starting in 2000.
Minnesota Cancer Facts and Figures 2011
37
Combining data for 2004, 2006 and 2008, women residing in
rural Minnesota were marginally less likely to report having
a Pap test in the last three years (85%) than women living in
urban areas (88%), but education was a stronger predictor of
being screened than residence (not a high school graduate,
72%; high school graduate, 79%; some post-secondary
education, 88%; college graduate, 93%).
Risk Factors for Cervical Cancer
• 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
exposed
to HPV (sex at an early age, multiple sexual partners,
non-monogamous
nonmonogamous sexual partners)
• Cigarette smoking
• Infection with human immunodeficiency virus (HIV)
• Long term (greater than five years) use of oral
contraceptives
The average number of cases of cervical cancer
diagnosed each year in Minnesota counties is shown
in the End Notes section of this report.
Pap Test Use among Women Ages 18 and Older by Education and Residence,
Minnesota, 2004, 2006, and 2008
100
Percent Screened within 3 Years
93
92
89
88
80
80
79
73
71
Not a HS Graduate
60
HS Graduate
Post-HS Education
40
College Grad
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 21 counties designated as “metropolitan” by the Census Bureau in 2005.
American Cancer Society Screening Recommendations for Cervical Cancer
Cervical cancer screening should begin approximately three years after a woman begins having vaginal intercourse, but
no later than 21 years of age. Screening should be done every year with conventional Pap tests or every two years using
liquid-based Pap tests. At or after age 30, women who have had three
three normal test results
results in a row may get screened
every two to three years with cervical cytology (either conventional or liquid-based Pap test) alone, or every three years
with an HPV DNA test plus cervical cytology. Women 70 years of age and older who have had three or more normal Pap
tests and no abnormal Pap tests in the past 10 years and women who have had a total hysterectomy
hysterectomy may choose to stop
cervical cancer screening.
38
Minnesota Cancer Facts and Figures 2011
Melanoma of the Skin
in Minnesota
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).
Risk Factors for Melanoma of the Skin
• 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
• Use of tanning booths
The Burden of Melanoma in Minnesota
Over the five-year period 2003-2007, about 1,050 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 34 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 2007, the age-adjusted incidence rate for melanoma of
the skin in Minnesota was 23.3 new cases per 100,000 persons.
From 2003 to 2007, about 120 Minnesotans died of melanoma
each year. Nearly 20 percent of deaths occurred among persons
less than 50 years old. The age-adjusted mortality rate for
melanoma of the skin in Minnesota in 2007 was 2.3 deaths per
100,000 persons.
Disparities in Melanoma
Melanoma of the skin can occur among persons of color, but the
vast majority of cases are diagnosed among whites. In Minnesota,
only 41 cases and 9 deaths occurred among persons of color
during the five-year period 2003-2007. Melanoma incidence
rates are about 30 percent higher among men than women.
However, women have considerably higher incidence rates than
men until 49 years of age. Based on national data, survival rates
are somewhat poorer among men than women.
Five-Year Relative Survival from Melanoma of
the Skin in the U.S.
Stage
Localized
Regional
Distant
All Stages
Males
97.3%
58.5%
14.9%
89.3%
Females
98.7%
67.5%
18.0%
93.9%
Source: SEER Cancer Statistics Review, 1975-2007.
Based on cases diagnosed in 1999-2006 with follow-up into 2007.
Trends in Melanoma
The incidence of melanoma of the skin has tripled since 1975
among the white population in the U.S. In Minnesota, incidence
has nearly doubled for each gender since cancer reporting was
implemented in 1988. It is the most rapidly increasing cancer
both nationally and in Minnesota. U.S. mortality rates were increasing from 1975 to 1989, but have not increased significantly
since then, and are not increasing in Minnesota.
Geographic Differences in Melanoma of the Skin
During 2003-2007, the melanoma incidence rate was 26 percent
lower in Minnesota than among non-Hispanic whites in the 17
geographic areas in the SEER Program (20.3 and 27.4 new cases
per 100,000 persons, respectively), and the mortality rate was six
percent lower than among non-Hispanic whites in the U.S. as a
whole (3.1 and 3.3 deaths per 100,000, respectively).
Over the five-year period 2003-2007, the incidence of melanoma
of the skin was significantly higher than the state average in
Southeast (25.5 new cases per 100,000 persons) and South
Central (23.3) Minnesota and in Washington County (27.0),
and was significantly lower in Northwest (15.9), Northeast
(17.9), and Southwest (17.7) Minnesota and Ramsey (16.4) and
St. Louis (16.5) Counties (data not shown). No county or region
had a melanoma of the skin mortality rate that was significantly
different from the state average (data not shown).
The American Cancer Society recommends the
following for the prevention of skin cancer:
• Limit or avoid sun exposure during the midday hours
(10 a.m. to 4 p.m.).
• Wear a hat that shades the face, neck and ears, as
well as a long-sleeved shirt and long pants.
• Wear sunglasses to protect the eyes.
• Use a sunscreen with SPF of 15 or higher.
• Avoid indoor tanning booths and sunlamps.
• Sunburn protection should be emphasized with
children; severe sunburns in childhood greatly
increase the risk of melanoma later in life.
Minnesota Cancer Facts and Figures 2011
39
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 Trends in Minnesota and the U.S.
30
Rate per 100,000 persons
25
20
15
2003-2007
7.3% annually.
Incidence
SEER/U.S.
Minnesota
4.9% annually.
1991-2000
10
Mortality
5
0
75
19
80
19
85
19
90
19
95
19
00
20
05
20
07
20
Year of Diagnosis/Death
Source: MCSS (May 2010) and SEER Cancer Statistics Review, 1975-2007. Rates are age-adjusted to the 2000 U.S. population. National incidence is for the
white population in SEER 9 Regions, delay-adjusted. National mortality is for the U.S. white population. The results of Joinpoint trend analyses are only
shown for Minnesota. A hashed bar indicates where the trend significantly changed direction. Interval trends are statistically significant unless stated otherwise.
40
Minnesota Cancer Facts and Figures 2011
The Burden of Mesothelioma in Minnesota Over the five-year period 2003-2007, an average of 47 men and
17 women were diagnosed with mesothelioma in Minnesota
each year. Nearly 80 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 2007, the age-adjusted incidence rate for mesothelioma in Minnesota was 2.0 new cases for every 100,000 men,
and 0.4 new cases for every 100,000 women.
Mesothelioma
in Minnesota
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.
Over the five-year period 2003-2007, an average of 44 men and
12 women died of mesothelioma each year in Minnesota. About
85 percent of mesothelioma deaths occurred among persons 65
years of age and older. In 2007, the age-adjusted mortality rate
for mesothelioma in Minnesota was 1.5 deaths per 100,000 men
and 0.2 deaths for every 100,000 women.
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.health.state.mn.us/divs/hpcd/
cdee/occhealth/meso.htm.
Disparities in Mesothelioma
Mesothelioma is nearly 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.
Mesothelioma Incidence Trends by Gender in Minnesota and the U.S.
Rate per 100,000 persons
3.5
3
1988-1999
1999-2007
4.0% annually.
4.5% annually.
2.5
2
SEER
Minnesota
Males
1.5
1
1988-2007 No significant trend.
.5
Females
0
75
19
80
19
85
19
90
19
95
19
00
20
05
20
07
20
Year of Diagnosis
Source: MCSS (May 2010) and SEER Cancer Statistics Review, 1975-2007. Rates are age-adjusted to the 2000 U.S. population. National incidence is for the
white population in SEER 9 Regions, delay-adjusted. National mortality is for the U.S. white population. The results of Joinpoint trend analyses are only
shown for Minnesota. A hashed bar indicates where the trend significantly changed direction. Interval trends are statistically significant unless stated otherwise.
Minnesota Cancer Facts and Figures 2011
41
Trends in Mesothelioma
The incidence rate of mesothelioma among men in Minnesota
increased rapidly by 4.5 percent a year on average from 1988 to
1999. Since 1999 the rate has decreased significantly by an average
of 4.0 percent annually. The incidence rate among women has
been stable over the 20-year entire period. A similar pattern has
been seen among men in the geographic areas participating in
the SEER Program.
Geographic Differences in Mesothelioma
Over the five-year period 2003-2007, mesothelioma incidence
rates in Minnesota (2.2 new cases per 100,000 males and 0.6
cases per 100,000 females) were very similar to those reported
by SEER for non-Hispanic white men and women (2.2 new cases
per 100,000 males and 0.5 cases per 100,000 females).
Mesothelioma Incidence Rates among Males in
Minnesota Regions and Six Largest Counties,
2003-2007
Minnesota = 2.2
SEER* = 2.2
Significantly higher than state average
Not significantly different from state average
Significantly lower than state average
Roseau
Kittson
Lake
of the
Woods
Marshall
Northwest
2.3
Koochiching
St. Louis
Beltrami
Pennington
Polk
Lake
Red Lake
Cook
Northeast
4.5
Clear
Water
Itasca
Mahnomen
Norman
Hubbard
Clay
Becker
Cass
Crow
Wing
Wadena
Ottertail
Aitkin
Wilkin
West Central
2.7
Central
1.6
Todd
Grant
Douglas
Stevens
Pope
Carlton
County
Pine
Anoka
Dakota
Hennepin
Ramsey
St. Louis
Washington
Mille
Lacs
Morrison
Kanabec
Benton
Traverse
Big Stone
Isanti
Stearns
Sherburne
Chisago
Anoka
Swift
Chippewa Kandiyohi
Meeker
Wright
Hennepin
McLeod
Renville
Carver
Lyon
Sibley
Redwood
Southwest
1.6
Pipestone
Murray
Rock
Nobles
Washington
Dakota
Scott
Lincoln
2.9
3.3
2.1
1.9
4.1
3.4
Metro
2.3
Lac Qui Parle
Yellow Medicine
Ramsey
Rate
Brown
Nicollet
Le
Sueur
Rice
South Central
Watonwan 1.6
Waseca
Cottonwood
Blue Earth
Jackson
Martin
Faribault
Goodhue
Wabasha
Southeast
1.3
Steele
Freeborn
Dodge
Mower
Olmsted
Winona
Fillmore
Houston
Rates are per 100,000 persons, age-adjusted to the 2000 U.S. 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, SEER Cancer
Statistics Review, 1975-2007.
42
Minnesota Cancer Facts and Figures 2011
The mesothelioma incidence rate among men was about two
times higher in Northeast Minnesota (4.5 new cases per 100,000
males) and in St. Louis County (4.1) than the state average for
males. Among women, the mesothelioma incidence rate was
significantly higher in Anoka (1.4) and Dakota (1.4) Counties
than the state average for females (data not shown). Mesothelioma
incidence rates among women in Northeast Minnesota and St. Louis County were the same (0.3) and well below the state
rate. The fact that mesothelioma rates in northeast Minnesota
are elevated among men but not among women supports the
contention that the increased risk may be due to occupational
rather than environmental factors.
Disparities in Childhood Cancer
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.
Childhood Cancer
in Minnesota
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
(33% of childhood cancers), brain cancer (19%), or lymphoma
(9%). Despite active research, the cause of most childhood
cancers remains unknown. However, dramatic improvements in
treatment over the last few decades mean that the majority of
children diagnosed with cancer will survive.
Five-Year Relative Survival from Childhood
(0-14 years old) Cancer in the U.S.
U.S.
Cancer
All Sites
Brain and Other Nervous System
Hodgkin Lymphoma
Leukemia
Acute lymphocytic
Acute myeloid
Non-Hodgkin Lymphoma
81.5%
74.4%
96.0%
84.0%
89.2%
60.9%
86.6%
Source: SEER Cancer Statistics Review, 1975-2007.
Based on cases diagnosed in 1999-2006 with follow-up into 2007.
The Burden of Childhood Cancer in Minnesota
Over the five-year period 2003-2007, an average of 160 children
under the age of 15 were diagnosed with cancer in Minnesota
each year. Based on current rates, it is estimated that 1 of every
390 children in Minnesota will be diagnosed with a cancer
before age 15. In 2007, the age-adjusted incidence rate for childhood cancer in Minnesota was 15.2 new cases for every 100,000
children. From 2003 to 2007, an average of 24 children died of
cancer in Minnesota each year. Although many more children
die of accidents than from cancer, cancer is the leading cause of
death from disease among children. The age-adjusted mortality
rate for childhood cancer in Minnesota in 2007 was 2.3 deaths
for every 100,000 children.
During 2003-2007, the overall incidence of childhood cancer
in Minnesota was similar for non-Hispanic whites (15.0 new
cases per 100,000 children less than 15 years of age), American
Indians statewide (11.6), Hispanics (18.5), and Asian/Pacific
Islanders (16.7); the rate was significantly lower among African
American children (10.1) (data not shown). There were too few
cases to report the rate among American Indian children living
in the CHSDA counties, 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 1999-2006 was 74 percent among African American
children and 83 percent among white children.
Trends in Childhood Cancer
Long-term trends from the SEER Program indicate that the
incidence of childhood cancer has been increasing steadily by
0.6 percent a year, increasing by a total of 24 percent from 1975
to 2007. The reasons for the increase are not known. Because of
the relatively small number of cases, the incidence rate of childhood cancer in Minnesota is fairly unstable without a measurable
trend, but appears to be similar to that reported by SEER.
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 53 percent
between 1975 and 2007. Because of the relatively small number
of deaths, the mortality rate of childhood cancer in Minnesota
is fairly unstable without a measurable trend, but appears to be
similar to that in the U.S. as a whole.
Minnesota Cancer Facts and Figures 2011
43
Geographic Differences in Childhood Cancer
During 2003-2007, the incidence of childhood cancer in
Minnesota (16.6 new cases per 100,000 children) was about
the same as among white children living in the 17 geographic
areas reporting to the SEER Program (15.9). The mortality rate
in Minnesota (2.5 deaths per 100,000 children) was about the
same as among white children in the U.S. (2.4). The rates and
types of cancer diagnosed among children in Minnesota are
very similar to what is reported nationally.
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 Trends in Minnesota and the U.S.
20
Rate per 100,000 children
1988-2007 No significant trend.
18
16
Incidence
14
12
SEER/U.S.
10
Minnesota
8
Mortality
6
1988-2007 No significant trend.
4
2
0
75
19
80
19
85
19
90
19
95
19
00
20
05
20
07
20
Year of Diagnosis/Death
Source: MCSS (May 2010) and SEER Cancer Statistics Review, 1975-2007. Rates are age-adjusted to the 2000 U.S. population. National incidence is for the
white population in SEER 9 Regions, delay-adjusted. National mortality is for the U.S. white population. The results of Joinpoint trend analyses are only
shown for Minnesota. A hashed bar indicates where the trend significantly changed direction. Interval trends are statistically significant unless stated otherwise.
44
Minnesota Cancer Facts and Figures 2011
Living a Healthy Life
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.
For people who do not use tobacco, dietary choices and physical
activity are the most important factors affecting cancer risk
that individuals can control. 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.
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.
American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention
Maintain a healthful weight throughout life.
• Balance caloric intake with physical activity.
Consume a healthy diet, with an emphasis on
plant sources.
• Avoid excessive weight gain throughout life.
• Choose foods and beverages in amounts that help
achieve and maintain a healthy weight.
• Achieve and maintain a healthy weight if currently
overweight
over
weight or obese.
• Eat five or more servings of a variety of vegetables and
fruits each day.
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.
• Choose whole grains in preference to processed
(refined) grains.
• Limit consumption of processed and red meats.
If you drink alcoholic beverages, limit consumption.
• Consume no more than one alcoholic beverage per day
for women and two per day for men.
Minnesota Cancer Facts and Figures 2011
45
Nutrition in Minnesota
In 2009, just slightly more than one out of five (22%) Minnesota
adults reported that they “usually” ate five or more servings
of fruits and vegetables a day. This was about the same as the
median of the 50 states and the District of Columbia (23%).
The Minnesota Student Survey indicates that fruit and vegetable
consumption did not increase from 1998 to 2010 among students
in Grade 6, but increased modestly among ninth- and twelfthgraders in 2007 and 2010. The percent of students reporting they
consumed five or more servings “yesterday” tended to be lower
than “usual” consumption among adults.
Trends in Adult Fruit and Vegetable Consumption, Minnesota, 1994-2009
60
Percent Eat Five or More Servings Usually
50
40
32
30
30
24
20
23
25
24
20
10
~
0
1994
22
19
1995
~
1996 1997
~
1998
1999
~
2000
2001
2002
2003 2004
~
~
~
2005
2006
2007
2008
2009
Source: Minnesota BRFSS. Analyses were conducted by MCSS.
Trends in Student Fruit and Vegetable Consumption by Grade, Minnesota
50
Percent Ate Five or More Servings Yesterday
40
Grade 12
30
20
21
22
21
12
13
13
20
10
14
15
15
2001
2004
17
16
18
Grade 9
21
Grade 6
18
0
1992
1995
1998
2007
2010
Source: Modified from online tables in 2010 Minnesota Student Survey Data 2010 (11/15/2010): Select trends in student behaviors and perceptions
between 1992 and 2010.
46
Minnesota Cancer Facts and Figures 2011
Physical Activity in Minnesota
In 2009, about half (53%) 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 the last decade, and was just slightly higher
than the median of the 50 states and the District of Columbia
(51%). The percent of Minnesota adults meeting these exercise
recommendations was somewhat higher for men (55%) than
women (51%), and decreased from 63 percent among 18-24 year
olds to 41 percent among people ages 65 and older.
The percent of students who were physically active for 30
minutes or more at least five days a week has shown modest
increases between 1998 and 2010. However, the percent of high
school seniors meeting this definition of physical activity was
only 43 percent.
Trends in Student Physical Activity by Grade, Minnesota
100
Percent Active 30 Minutes on 5 out of 7 Days
90
80
70
60
55
51
50
44
44
46
48
48
50
56
52
41
40
37
37
37
30
43
1998
2001
2004
2007
20
2010
10
0
Grade 6
Grade 9
Grade 12
Source: Modified from online tables in 2010 Minnesota Student Survey Data 2010 (11/15/2010): Select trends in student behaviors and perceptions
between 1992 and 2010.
Minnesota Cancer Facts and Figures 2011
47
Overweight and Obesity in Minnesota
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.
The percent of Minnesota adults who are either overweight or
obese increased from 44 percent in 1988 to 63 percent in 2009.
The most dramatic increase was in obesity, which increased
from 10 percent of the adult Minnesota population in 1988 to
25 percent in 2009. These trends are similar to those reported
by the other states participating in the BRFSS, and are signs of
a nationwide epidemic in obesity. In 2009, the percent of obese
adults was only marginally lower in Minnesota (25%) than the
median of the 50 states and the District of Columbia (27%).
In Minnesota, women are more likely than men to have a
healthy weight, but are just as likely to be obese, which carries
the greatest health risks.
Based on interviews conducted over the three-year period 20072009, the percent of Minnesota adults who are obese is highest
among American Indian men and women (32% and 48%,
respectively) and African American women (35%) (data not shown).
Adult Overweight and Obesity by Gender, Minnesota, 2009
Percent
60
50
45
44
40
Men
30
30
30
Women
26
25
20
10
0
Not Overweight or
Obese
Overweight, but not
Obese
BMI < 25.0
BMI 25.0-29.9
Obese
BMI > 30.0
Source: Minnesota BRFSS. Analyses were conducted by MCSS.
BMI is body mass index.
Trends in Adult Overweight and Obesity, Minnesota,1987-2009
80
Percent
70
60
BMI 30.0 +
50
Obese
BMI 25.0 – 29.9
40
Overweight, but not Obese
30
20
10
0
1987
1989
1991
1993
1995
1997
1999
2001
Source: Minnesota BRFSS. Analyses were conducted by MCSS.
BMI is body mass index
48
Minnesota Cancer Facts and Figures 2011
2003
2005
2007
2009
cancer were alive five years after diagnosis than would have
been expected given mortality rates in persons of the same age,
gender, and race.
Survivorship
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 1999-2006.
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.
MCSS does not currently have sufficient information to
calculate the survival of Minnesotans diagnosed with cancer.
The data provided below are from the SEER Program.
Five-year relative survival 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 fewer persons diagnosed with
Five-Year Relative Survival for SEER Cases Diagnosed in 1999-2006
Site
Brain and Other Nervous System
Female Breast
Cervix
Colon and Rectum
Corpus Uteri (Uterus)
Leukemia
Liver and Intrahepatic Bile Duct
Lung and Bronchus
Melanoma of the Skin
Non-Hodgkin Lymphoma
Ovary
Pancreas
Prostate
Urinary Bladder
All Stages
Local
Regional
Distant
Unstaged
35.1%
89.0%
70.2%
65.0%
82.7%
56.6%
13.8%
6.1%
91.4%
67.4%
45.6%
5.6%
99.1%
79.3%
37.6%
98.0%
91.2%
90.4%
95.5%
~
26.4%
21.0%
98.0%
81.0%
93.5%
22.5%
100.0%
73.3%
23.5%
83.6%
57.8%
69.5%
67.5%
~
9.0%
13.3%
62.1%
70.6%
73.4%
8.8%
100.0%
36.1%
38.6%
23.4%
17.0%
11.6%
17.1%
~
2.5%
2.7%
15.9%
58.0%
27.6%
1.9%
30.2%
5.6%
34.3%
57.9%
58.1%
38.3%
55.5%
~
6.1%
8.2%
76.0%
65.8%
27.2%
5.0%
75.0%
55.3%
Source: SEER Cancer Statistics Review, 1975-2007
1975-2007..
~ The cancer type is not staged.
Minnesota Cancer Facts and Figures 2011
49
American Cancer Society Resources to Improve Quality of Life
American Cancer Society Cancer Resource Network: Support for Patients and Caregivers
The American Cancer Society seeks to improve the lives of those touched by cancer by providing valuable information and links to needed programs and resources. The Society’s 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 cancer patients, family members and caregivers may turn anytime, day or night, to talk to a trained Cancer Information Specialist.
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.
The American Cancer Society also offers free cancer information and resources, such as brochures, pamphlets, and information kits for anyone looking for information and answers.
Day-to-day help: Helping ease the physical, financial, and emotional toll of cancer
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 Minneapolis.
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.
Wigs, head coverings and hats
The American Cancer Society is prepared to help patients find access to free and low cost wigs, head coverings and hats. If a patient
does not have health insurance or does not have health insurance that covers head coverings, patients may be able to locate one,
free of charge, from the Society.
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 community-based, 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™
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.
Reach to Recovery™
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.
50
Minnesota Cancer Facts and Figures 2011
Having cancer is hard.
Finding help shouldn’t be.
?
Information
l 1-800-227-2345
l cancer.org
l Clinical Trials
Matching Service
l Treatment decision
tools
4
Day-to-Day
Help
l Help finding
transportation and
lodging
l Help with financial
and insurance
questions
l Referral to
prescription
drug assistance
Emotional
Support
l Help finding local
support groups
l Online community
for cancer patients
and their families
l Cancer education
classes
The American Cancer Society can help.
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Minnesota Cancer Facts and Figures 2011
51
Cancer Incidence in Minnesota, 2007
Number of New Cases
Incidence Rate
Male
Female
Total
Male
Female
All Sites
13,533
Brain and Other Nervous System 180
Breast
32
Cervix Uteri
0
Colon and Rectum
1,230
Corpus and Uterus, NOS
0
Esophagus
213
Hodgkin Lymphoma
89
Kidney and Renal Pelvis
513
Larynx
121
Leukemia
481
Liver and Intrahepatic Bile Duct 170
Lung and Bronchus
1,558
Melanoma of the Skin
677
Mesothelioma (all sites)
45
Multiple Myeloma
169
Non-Hodgkin Lymphoma
632
Oral Cavity and Pharynx
430
Ovary
0
Pancreas
276
Prostate
4,593
Stomach
186
Testis
194
Thyroid
135
Urinary Bladder
863
12,284
139
3,801
154
1,256
824
68
66
344
39
350
75
1,446
571
11
114
545
217
350
256
0
117
0
425
280
25,817
319
3,833
154
2,486
824
281
155
857
160
831
245
3,004
1,248
56
283
1,177
647
350
532
4,593
303
194
560
1,143
559.6
7.1
1.4
~
51.1
~
8.8
3.5
20.4
5.0
20.2
6.7
67.1
27.2
2.0
7.2
26.3
16.9
~
11.4
187.0
8.1
7.6
5.3
38.3
425.3
5.1
132.1
5.7
41.3
28.2
2.3
2.5
11.9
1.4
12.1
2.6
50.6
20.7
0.4
3.9
18.7
7.4
12.1
8.7
~
4.0
~
15.9
9.3
Total
481.4
6.0
70.1
~
46.0 ~
5.2
3.0
15.9
3.1
15.6
4.4
57.5
23.3
1.1
5.3
22.1
11.8
~
9.9
~
5.8
~
10.5
21.6
Cancer Mortality in Minnesota, 2007
Number of Deaths
Mortality Rate
Male
Female
Total
Male
Female
Total
All Sites
4,813
Brain and Other Nervous System 141
Breast
6
Cervix Uteri
0
Colon and Rectum
444
Corpus and Uterus, NOS
0
Esophagus
180
Hodgkin Lymphoma
22
Kidney and Renal Pelvis
153
Larynx
48
Leukemia
255
Liver and Intrahepatic Bile Duct 183
Lung and Bronchus
1,327
Melanoma of the Skin
79
Mesothelioma (all sites)
33
Multiple Myeloma
107
Non-Hodgkin Lymphoma
201
Oral Cavity and Pharynx
72
Ovary
0
Pancreas
274
Prostate
498
Stomach
107
Testis
6
Thyroid
14
Urinary Bladder
159
4,355
120
636
28
411
109
51
10
96
9
182
91
1,088
49
6
80
153
47
218
272
0
66
0
11
55
9,168
261
642
28
855
109
231
32
249
57
437
274
2,415
128
39
187
354
119
218
546
498
173
6
25
214
209.8
5.6
0.2
~
19.1
~
7.4
0.9
6.4
2.0
11.5
7.6
57.8
3.3
1.5
4.8
9.1
3.1
~
11.7
23.5
4.6
0.2
0.5
7.3
142.5
4.2
20.8
1.0
12.5
3.5
1.7
0.3
3.1
0.3
6.1
3.0
36.9
1.6
0.2
2.6
4.9
1.5
7.2
8.9
~
2.2
~
0.4
1.7
169.5
4.8
11.6
~
15.4
~
4.2
0.6
4.6
1.0
8.3
5.1
45.6
2.3
0.8
3.5
6.6
2.2
~
10.1
~
3.2
~
0.4
3.9
~ Not available or sex-specific site.
Source: All cases were microscopically confirmed or identified solely through death certificates, and were reported to
MCSS as of May 2010. 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.
52
Minnesota Cancer Facts and Figures 2011
Stage at Diagnosis for Screening-Sensitive Cancers
in Minnesota and SEER, 2003-2007
Distribution of Stage at Diagnosis (%)
Cancer Site
Registry
Cases*
In Situ
Local
Regional
Distant
Unstaged
Female Breast
MN
SEER
21,712
229,156
19.0%
19.4%
50.6%
51.0%
24.8%
24.1%
3.8%
3.7%
1.8%
1.8%
Cervix Uteri
MN
SEER
813
8,488
~
~
52.0%
47.9%
31.9%
35.0%
11.9%
12.3%
4.2%
4.7%
Colon and Rectum
MN
SEER
12,824
136,706
3.5%
5.3%
41.8%
38.5%
33.3%
33.6%
15.7%
17.2%
5.7%
5.3%
Melanoma of the Skin
MN
SEER
8,761
113,370
39.8%
39.0%
51.0%
51.4%
5.2%
5.2%
1.8%
2.3%
2.3%
2.1%
Prostate
MN
SEER
21,322
184,350
0.0%
0.0%
81.5%
81.1%
12.1%
11.8%
3.5%
3.8%
2.9%
3.2%
Age-adjusted (U.S. 2000) Rate per 100,000 Persons
Registry All Stages*
In Situ
Local
Regional
Distant
Unstaged
Female Breast
MN
SEER
156.0
165.9
30.1
32.7
78.5
83.9
39.1
40.7
5.8
6.1
2.5
2.6
Cervix Uteri
MN
SEER
6.1
7.0
~
~
3.3
3.6
1.9
2.3
0.7
0.8
0.2
0.3
Colon and Rectum
MN
SEER
49.3
51.4
1.7
2.8
20.7
19.8
16.4
17.3
7.7
8.9
2.7
2.6
Melanoma of the Skin
MN
SEER
33.8
44.7
13.5
17.2
17.2
23.2
1.7
2.3
0.6
1.0
0.8
0.9
Prostate
MN
SEER
183.3
154.5
0.0
0.0
149.8
125.6
20.8
17.2
6.7
6.3
5.9
5.4
* Total cases diagnosed over the five-year period 2003-2007, 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.
Source: MCSS (May 2010) and SEER Research Data (November 2009).
Minnesota Cancer Facts and Figures 2011
53
dd
Bla
te
Pro
Ur
in
sta
NH
L
ary
a
om
lan
dB
an
ng
em
ia
ro
n
er
ch
ter
us
,N
Me
2
35
4
7
4
2
9
8
6
8
4
3
4
7
1
1
2
9
55
1
6
3
4
5
8
2
163
4
3
6
9
3
3
10
2
4
2
2
<1
4
1
4
5
Lu
12
121
19
22
15
6
30
20
18
22
22
12
22
29
7
3
10
36
142
8
23
16
17
20
27
6
463
10
13
11
34
9
8
25
3
12
8
8
5
15
5
14
17
uk
or
pu
sa
Ce
1
9
1
2
1
<1
2
2
<1
2
1
1
2
1
1
<1
<1
1
10
1
1
<1
1
1
1
<1
34
<1
<1
2
2
<1
1
2
<1
1
<1
<1
<1
1
1
1
1
Le
17
188
20
26
23
5
35
20
21
46
23
12
33
32
8
5
11
45
240
13
27
14
21
25
38
6
775
16
17
23
38
6
11
30
6
11
8
7
4
20
5
16
26
nd
U
m
st
rvi
xU
ter
i
Co
lon
&
Re
ctu
C
rea
le
B
ma
Fe
ite
s
Al
lS
Aitkin
129
Anoka
1,305
Becker
180
Beltrami
195
Benton
169
Big Stone
38
Blue Earth
248
Brown
159
Carlton
186
Carver
295
Cass
200
Chippewa
85
Chisago
217
Clay
235
Clearwater
50
Cook
33
Cottonwood
74
Crow Wing
374
Dakota
1,518
Dodge
90
Douglas
222
Faribault
106
Fillmore
137
Freeborn
192
Goodhue
247
Grant
43
Hennepin
5,009
Houston
108
Hubbard
132
Isanti
146
Itasca
269
Jackson
62
Kanabec
93
Kandiyohi
218
Kittson
29
Koochiching
94
Lac Qui Parle
56
Lake
69
Lake of the Woods
33
Le Sueur
139
Lincoln
42
Lyon
124
McLeod
177
us
OS
Average Number of New Cancer Cases Diagnosed Each Year for Selected Cancers by County, Minnesota, 2003-2007
2
41
7
5
6
2
7
6
5
11
5
3
7
11
1
1
3
7
52
4
7
3
6
6
7
2
173
3
4
4
9
1
3
6
1
2
2
1
<1
4
1
4
5
20
171
22
29
21
5
28
15
25
29
29
9
31
27
6
3
8
51
173
12
28
13
14
21
25
5
598
11
20
19
33
7
15
22
4
16
6
9
4
19
5
14
17
4
58
6
4
9
1
14
8
9
17
8
1
8
8
1
1
2
17
73
7
9
4
4
11
12
1
224
6
5
5
8
3
2
11
1
2
2
3
1
7
2
5
8
7
63
9
6
8
1
9
7
9
11
9
5
10
10
3
2
3
15
73
5
10
4
7
7
12
2
230
6
5
5
13
4
3
10
1
4
3
4
1
6
1
6
9
26
224
33
36
31
7
43
26
35
58
40
16
39
34
9
7
15
78
243
13
44
20
24
36
44
8
803
21
23
26
49
10
17
37
5
16
13
17
7
24
11
24
40
8
55
11
7
8
1
11
11
10
11
8
4
9
14
2
2
4
19
63
6
18
6
5
11
12
2
236
5
6
7
11
4
6
11
1
5
1
3
3
6
1
5
9
(continues)
Source: MCSS (May 2010). All cases were microscopically confirmed or identified solely through death certificates,
and were reported to MCSS as of May 2010. In situ cancers except those of the urinary bladder are excluded.
NHL is non-Hodgkin lymphoma; lung includes bronchus; < 1 is less than one.
54
Minnesota Cancer Facts and Figures 2011
er
Pro
Ur
in
ary
NH
L
sta
te
om
a
Bla
dd
ro
n
lan
dB
an
ng
ia
em
uk
Me
1
1
4
3
4
5
6
3
4
4
1
20
9
2
5
3
5
3
75
1
4
4
9
3
2
38
10
9
2
17
5
2
2
4
1
3
4
3
31
2
<1
9
10
2
Lu
4
10
16
15
13
18
24
11
17
17
4
55
45
9
18
12
26
9
224
3
10
13
27
6
6
117
40
22
11
60
19
5
11
20
3
15
11
11
86
7
6
29
37
7
Le
or
pu
sa
Ce
<1
<1
2
<1
1
1
1
<1
1
1
<1
4
1
1
2
1
1
1
18
<1
<1
1
1
<1
1
8
4
1
1
3
1
<1
1
1
<1
<1
1
1
7
<1
<1
1
2
<1
ch
ter
us
,N
m
4
9
20
15
18
23
29
8
15
14
7
95
46
8
22
12
25
7
349
3
15
14
34
8
8
155
66
41
9
90
25
8
12
16
2
18
11
14
151
11
5
42
54
8
nd
U
st
rvi
xU
ter
i
Co
lon
&
Re
ctu
C
rea
le
B
ma
Fe
ite
s
Al
lS
Mahnomen
28
Marshall
59
Martin
136
Meeker
122
Mille Lacs
149
Morrison
185
Mower
230
Murray
64
Nicollet
132
Nobles
117
Norman
48
Olmsted
669
Otter Tail
363
Pennington
74
Pine
161
Pipestone
74
Polk
171
Pope
69
Ramsey
2,350
Red Lake
25
Redwood
96
Renville
107
Rice
253
Rock
55
Roseau
76
St Louis
1,145
Scott
390
Sherburne
282
Sibley
77
Stearns
652
Steele
169
Stevens
49
Swift
74
Todd
136
Traverse
26
Wabasha
117
Wadena
97
Waseca
98
Washington
921
Watonwan
66
Wilkin
37
Winona
237
Wright
408
Yellow Medicine
64
us
OS
Average Number of New Cancer Cases Diagnosed Each Year for Selected Cancers by County, Minnesota, 2003-2007, continued
2
2
6
4
5
6
7
2
3
3
2
23
10
1
4
4
7
2
69
1
3
4
11
1
2
30
10
10
2
19
6
1
1
2
1
5
5
2
38
1
2
7
14
2
4
5
14
13
23
24
30
8
16
13
6
72
43
10
25
7
19
10
285
3
11
11
30
4
8
156
43
32
9
75
14
5
8
18
3
17
10
12
91
7
4
31
53
7
1
1
5
3
4
6
10
1
7
6
2
46
15
4
3
2
5
2
84
1
2
4
9
2
4
38
25
15
3
33
8
2
1
2
1
6
5
5
55
3
1
8
16
1
1
2
6
6
5
5
10
3
6
5
2
29
14
3
6
3
8
1
108
2
3
5
11
4
4
54
18
14
4
32
8
2
5
7
1
6
5
6
44
3
2
7
17
5
5
13
24
24
29
36
46
9
22
22
10
101
80
15
28
12
27
13
413
5
20
21
41
9
17
189
54
55
15
130
36
7
12
29
5
14
16
14
156
12
6
37
80
14
1
2
7
6
8
12
13
5
7
4
2
37
22
4
10
3
9
4
102
2
5
4
14
3
5
61
13
13
3
33
8
3
4
5
2
7
8
4
42
3
2
12
14
3
Source: MCSS (May 2010). All cases were microscopically confirmed or identified solely through death certificates,
and were reported to MCSS as of May 2010. In situ cancers except those of the urinary bladder are excluded.
NHL is non-Hodgkin lymphoma; lung includes bronchus; < 1 is less than one.
Minnesota Cancer Facts and Figures 2011
55
Pa
Pro
sta
te
s
rea
Ov
a
nc
NH
L
ry
Lu
ng
Liv
er
Le
uk
em
an
ia
Re
&
Co
lon
dB
ctu
st
rea
le
B
ma
Fe
ain
Br
ite
s
Al
lS
Aitkin
46
Anoka
408
Becker
66
Beltrami
76
Benton
71
Big Stone
20
Blue Earth
90
Brown
67
Carlton
86
Carver
90
Cass
79
Chippewa
32
Chisago
79
Clay
88
Clearwater
20
Cook
13
Cottonwood
30
Crow Wing
140
Dakota
509
Dodge
29
Douglas
78
Faribault
44
Fillmore
54
Freeborn
80
Goodhue
98
Grant
20
Hennepin
1,854
Houston
40
Hubbard
47
Isanti
54
Itasca
114
Jackson
26
Kanabec
34
Kandiyohi
79
Kittson
12
Koochiching
44
Lac Qui Parle
23
Lake
30
Lake Of The Woods
13
Le Sueur
50
Lincoln
21
Lyon
55
McLeod
63
ro
n
m
ch
us
Average Number of Cancer Deaths Each Year for Selected Cancers by County,
Minnesota, 2003-2007
1
10
2
2
2
< 1
3
1
1
4
2
< 1
2
2
1
< 1
< 1
3
17
1
4
1
1
1
2
< 1
41
2
2
2
3
1
< 1
2
< 1
1
< 1
1
1
1
< 1
< 1
1
2
30
4
2
6
1
6
5
5
9
4
3
5
6
2
1
2
8
42
2
5
3
5
6
9
2
141
3
3
5
6
1
3
7
1
2
3
2
1
4
1
5
5
4
32
6
9
6
2
10
7
7
8
7
4
5
11
1
1
3
12
44
2
7
4
8
11
8
2
159
4
4
5
12
3
2
8
1
4
4
2
3
3
4
6
7
2
20
2
3
4
2
3
4
3
4
5
1
3
4
< 1
1
2
5
23
2
6
1
4
3
6
1
80
2
2
1
5
1
1
3
1
2
1
1
< 1
3
2
3
4
1
11
2
1
2
< 1
2
1
2
3
1
< 1
2
2
1
< 1
1
4
14
2
1
1
1
2
2
0
61
< 1
1
1
3
< 1
1
1
< 1
1
< 1
1
< 1
2
1
2
1
14
121
20
24
18
5
22
14
25
20
28
7
25
19
5
4
6
40
129
9
20
13
10
19
24
5
472
9
14
13
31
5
12
23
2
14
4
8
4
14
5
12
13
2
17
3
2
3
1
2
3
4
4
2
2
4
4
1
< 1
1
7
21
1
3
1
2
3
4
1
82
2
1
2
4
2
1
3
1
2
1
1
< 1
2
< 1
2
2
2
9
2
1
1
< 1
2
2
1
2
1
1
2
3
< 1
< 1
< 1
3
17
1
3
2
1
3
3
1
53
1
1
1
2
1
1
3
< 1
1
< 1
1
< 1
1
< 1
1
2
4
22
3
5
4
2
5
4
6
6
4
1
5
5
1
1
1
11
29
1
5
2
3
4
5
1
111
3
2
4
7
2
2
4
1
3
1
2
< 1
3
1
4
3
3
15
3
5
3
1
5
4
5
5
4
2
4
6
2
<1
3
10
23
2
4
3
4
5
8
1
95
2
3
4
7
1
3
4
1
3
2
1
<1
3
2
6
4
(continues)
Source: Deaths are from the Minnesota Center for Health Statistics, and include all deaths with the specified cancer
as the underlying cause of death during the time period, regardless of year of diagnosis. Brain includes other nervous
system; liver includes intrahepatic bile duct; lung includes bronchus; NHL is non-Hodgkin lymphoma; < 1 is less
than one.
56
Minnesota Cancer Facts and Figures 2011
sta
te
s
Pro
rea
Pa
1
2
5
2
4
3
7
2
3
2
2
15
8
2
5
2
5
1
58
1
3
4
5
3
2
29
11
5
2
14
5
1
2
5
1
4
3
3
25
2
1
6
9
2
< 1
3
5
5
5
9
8
2
5
5
1
17
15
3
8
3
7
4
78
1
4
4
12
3
3
48
12
8
3
20
7
2
4
7
1
7
3
4
26
2
2
10
14
3
1
1
3
3
3
5
5
1
2
2
1
9
6
1
3
2
4
1
35
1
2
2
4
0
1
19
5
3
1
11
4
2
1
2
< 1
3
3
2
12
< 1
1
4
8
2
< 1
< 1
2
1
1
1
3
< 1
< 1
1
< 1
8
3
1
2
1
2
1
28
< 1
< 1
1
3
< 1
1
13
3
3
1
3
1
< 1
< 1
1
< 1
1
1
2
8
1
< 1
3
5
< 1
4
4
12
11
16
20
22
6
12
11
7
48
32
7
21
5
15
8
246
3
10
8
25
4
5
133
33
24
7
50
16
4
5
19
3
14
8
9
74
6
3
23
39
7
< 1
1
3
2
2
2
3
1
3
2
1
8
4
2
2
1
2
1
38
1
2
4
5
2
2
19
6
3
1
9
2
1
1
2
1
1
1
2
11
2
1
4
7
2
< 1
< 1
1
2
1
1
2
< 1
2
1
1
5
3
< 1
2
1
2
1
27
< 1
1
1
3
1
< 1
15
4
3
1
5
1
1
1
1
< 1
1
2
1
7
1
< 1
3
3
1
< 1
1
3
3
4
3
4
2
3
2
1
15
9
2
2
1
3
3
56
< 1
3
4
6
1
2
31
9
5
3
12
4
1
1
3
< 1
2
3
3
16
2
1
8
9
2
1
1
3
3
5
4
7
3
2
2
3
8
8
3
3
1
2
2
47
1
5
4
6
2
5
32
7
4
3
14
4
1
4
3
1
2
3
2
14
2
1
5
8
2
nc
Ov
a
ry
NH
L
ng
Lu
< 1
1
1
1
1
2
2
1
1
1
< 1
7
4
< 1
2
1
2
1
25
< 1
1
< 1
3
< 1
1
11
4
2
1
5
1
1
1
1
1
1
< 1
2
11
1
< 1
2
4
1
er
Liv
12
19
57
51
57
70
94
28
52
42
24
204
136
31
70
28
63
31
906
10
45
44
106
26
31
495
130
86
31
202
64
20
29
59
12
49
37
37
293
27
15
95
147
30
uk
Le
em
an
ia
Re
&
Co
lon
dB
ctu
st
rea
le
B
ma
Fe
ain
Br
ite
s
Al
lS
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
ro
n
m
ch
us
Average Number of Cancer Deaths Each Year for Selected Cancers by County,
Minnesota, 2003-2007, continued
Source: 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. Brain includes other nervous
system; liver includes intrahepatic bile duct; lung includes bronchus; NHL is non-Hodgkin lymphoma; < 1 is less
than one.
Minnesota Cancer Facts and Figures 2011
57
Screening Guidelines for the Early Detection of Cancer in Average-risk Asymptomatic People
Cancer Site Population
Test or Procedure
Frequency
Breast
Breast self-examination
Beginning in their early 20s, women should be told about the benefits and limitations
of breast self-examination (BSE). The importance of prompt reporting of any new
breast symptoms to a health professional should be emphasized. Women who
choose to do BSE should receive instruction and have their technique reviewed on
the occasion of a periodic health examination. It is acceptable for women to choose
not to do BSE or to do BSE irregularly.
Clinical breast examination
For women in their 20s and 30s, it is recommended that clinical breast examination
(CBE) be part of a periodic health examination, preferably at least every three years.
Asymptomatic women aged 40 and over should continue to receive a clinical breast
examination as part of a periodic health examination, preferably annually.
Mammography
Tests that find polyps and cancer:
Flexible sigmoidoscopy, or Colonoscopy, or Double-contrast barium enema (DCBE), or CT Colonography (virtual colonoscopy)
Begin annual mammography at age 40.*
Women, age 20+
Colorectal †
Men and women, age 50+
Every five years, starting at age 50
Every 10 years, starting at age 50
Every five years, starting at age 50
Every five years, starting at age 50
Tests that mainly find cancer:
Fecal occult blood test (FOBT) with at least
50% test sensitivity for cancer, or Annual, starting at age 50
fecal immunochemical test (FIT) with at
least 50% test sensitivity for cancer ‡ § or Annual, starting at age 50
Stool DNA test (sDNA) ‡
Interval uncertain, starting at age 50
Prostate
Men, age 50+
Prostate-specific antigen test (PSA) with or Asymptomatic men who have at least a 10-year life expectancy should have an
opportunity to make an informed decision with their health care provider about
without digital rectal exam (DRE)
screening for prostate cancer after receiving information about the uncertainties,
risks, and potential benefits associated with screening. Men at average risk should
receive this information beginning at age 50. Men at higher risk, including African
American men and men with a first degree relative (father or brother) diagnosed
with prostate cancer before age 65, should receive this information beginning at
age 45. Men at appreciably higher risk (multiple family members diagnosed with
prostate cancer before age 65) should receive this information beginning at age 40.
Cervix
Women, age 18+
Pap test
Endometrial
Women, at menopause
At the time of menopause, women at average risk should be informed about risks and symptoms of endometrial cancer and
strongly encouraged to report any unexpected bleeding or spotting to their physicians.
Cancer Related
Checkup
Men and women, age 20+
On the occasion of a periodic health examination, the cancer-related checkup should include examination for cancers of the thyroid,
testicles, ovaries, lymph nodes, oral cavity, and skin, as well as health counseling about tobacco, sun exposure, diet and nutrition,
risk factors, sexual practices, and environmental and occupational exposures.
Cervical cancer screening should begin approximately three years after a woman
begins having vaginal intercourse, but no later than 21 years of age. Screening
should be done every year with conventional Pap tests or every two years using
liquid-based Pap tests. At or after age 30, women who have had three normal test
results in a row may get screened every two to three years with cervical cytology
(either conventional or liquid-based Pap test) alone, or every three years with an
HPV DNA test plus cervical cytology. Women 70 years of age and older who have
had three or more normal Pap tests and no abnormal Pap tests in the past 10 years
and women who have had a total hysterectomy may choose to stop cervical cancer
screening.
* Beginning at age 40, annual clinical breast examination should be performed prior to mammography.
†Individuals with a personal or family history of colon and rectum cancer or adenomas, inflammatory bowel disease, or high-risk genetic syndromes should continue to follow
the most recent recommendations for individuals at increased or high risk.
‡ 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.
58
Minnesota Cancer Facts and Figures 2011
Glossary
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.
Average Annual Percent Change (APC): The average percent change in the age-adjusted rate each year over a specific period of
time. The APC is a commonly used measure of cancer trends. For example, an APC of +1.8% means that the cancer rate increased,
on average, by 1.8 percent per year. Similarly, an APC of -1.8% means that the cancer rate decreased, on average, by 1.8 percent per
year. The calculation of the APC assumes that the rate of change has been consistent over time. APCs in this report were calculated
using the statistical program SEER*Stat.
Body Mass Index (BMI): The standard adopted by the World Health Organization for the classification of body weight categories.
BMI, which measures a person’s weight in relation to his height, is calculated using the formula: BMI = weight / height2 (kg/m2).
Cancer Control: Reducing the effects of cancer in a population through prevention, early detection, treatment, rehabilitation, and
palliation.
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.
Contract Health Services Delivery Area (CHSDA): The geographic area within which health services are provided from public
or private medical or hospital facilities at the expense of the Indian Health Service (IHS). Services are provided to members of an
identified Indian community who reside in the area. In Minnesota there are 29 CHSDA counties, and about half of the American
Indian population in the state lives in a CHSDA county.
Crude Cancer Rate: The number of new cases of cancer diagnosed, or the number of cancer deaths, divided by the size of the
population in which the cases or deaths occurred, over a specified period of time. Cancer rates are usually expressed as the number
of cases or deaths per 100,000 persons per year.
Five-year Relative Survival: The percentage of persons who were still alive five years after diagnosis, adjusted for (that is, relative
to) expected mortality from other causes. A five-year relative survival of 80 percent means that 20 percent fewer persons were alive
five years after diagnosis than would have been expected, given non-cancer mortality rates in persons of the same age and sex.
In Situ Cancer: See “stage at diagnosis.”
Invasive Cancer: A cancer is described as invasive if it has penetrated the basement membrane of the tissue in which it is growing.
Cancers staged as localized, regional, distant, and unstaged are invasive. Unless otherwise stated, all cancer incidence rates in this
report are for invasive cancers only.
Lifetime Risk: The estimated percentage of persons who will be diagnosed with cancer over their entire lifetime, from birth to
death, if cancer incidence and mortality and all-cause mortality rates do not change.
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 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.
Minnesota Cancer Facts and Figures 2011
59
Acronyms/Abbreviations Used Frequently in This Report
BMI: Body mass index
BRFSS: Behavioral Risk Factor Surveillance System
CHSDA: Contract Health Services Delivery Area counties in Minnesota: Aitkin, Becker, Beltrami, Carlton, Cass, Chippewa, Clearwater,
Cook, Goodhue, Houston, Hubbard, Itasca, Kanabec, Koochiching, Lake of the Woods, Mahnomen, Marshall, Mille Lacs, Norman, Pennington, Pine, Polk, Redwood, Renville, Roseau, St. Louis, Scott, Traverse, and Yellow Medicine
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 21 counties considered Metropolitan Areas by the Census Bureau in 2005: Anoka, Benton, Carlton, Carver,
Chisago, Clay, Dakota, Dodge, Hennepin, Houston, Isanti, Olmsted, Polk, Ramsey, St. Louis, Scott, Sherburne, Stearns, Wabasha, 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 2010 were obtained from the American
Cancer Society publication, Cancer Facts & Figures 2010. It is available on their Web site, 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 the District of Columbia, 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.
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 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 1988-2006, 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
2003-2007 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 SEER Cancer Statistics Review, 1975-2007 available at http://seer.cancer.gov/.
60
Minnesota Cancer Facts and Figures 2011
Understanding
Cancer Rates
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.
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.
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.
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.
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.
Choice of Standard Population for Age-adjustment: By convention, cancer registries in the U.S. currently adjust their rates
to the age distribution of the U.S. population in 2000. Until recently, the age distribution of the 1970 U.S. population was used for
age-adjusting cancer incidence rates, while cancer mortality rates were often age-adjusted to the 1940 U.S. population. However,
international cancer registries usually age-adjust to the World Population. This means that when comparing cancer rates, one must
be careful that they were age-adjusted to the same standard population.
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.
Relationship between Incidence and Mortality Rates: A frequent misconception when incidence and mortality data are
presented together is that the mortality rates are directly related to the cases included in the incidence rates; that is, incidence rates
based on 22,925 new cancer diagnoses in 2000 and mortality rates based on 9,197 cancer deaths in the same year, are sometimes
misconstrued to mean that 40 percent (9,197/22,925) of the cases diagnosed in 2000 died in the same year. That interpretation is
incorrect. Unless specifically stated otherwise, cancer mortality rates include every individual who died during the calendar year
with cancer as the underlying cause of death on the death certificate, regardless of year of diagnosis.
Minnesota Cancer Facts and Figures 2011
61
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
Minnesota Cancer Alliance
Health Promotion and Chronic Disease Division
P.O. Box 64882
Saint Paul, MN 55164-0882
Phone: (651) 201-3607
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
©2011 American Cancer Society, Midwest Division
8201.49