Wisconsin Cancer Facts and Figures, 2011

Cancer Facts& Figures 2011

Wisconsin

Welcome Letters…………………………………………………………………………………………………………………

Cancer: Basic Facts………………………………………………………………………………………………………………

Understanding Cancer Incidence and Mortality Rates…………………………………………………………………………

Data Sources………………………………………………………………………………………………………………………

Wisconsin Cancer Incidence and Mortality Data………………………………………………………………………………

Trends in Cancer Incidence and Mortality in Wisconsin………………………………………………………………………

Lung & Bronchus Cancer/Tobacco Control in Wisconsin……………………………………………………………………

Colorectal Cancer in Wisconsin…………………………………………………………………………………………………

Female Breast Cancer in Wisconsin……………………………………………………………………………………………

Prostate Cancer in Wisconsin…………………………………………………………………………………………………

Melanoma/Skin Cancer in Wisconsin…………………………………………………………………………………………

Cervical Cancer in Wisconsin……………………………………………………………………………………………………

Childhood Cancer in Wisconsin………………………………………………………………………………………………

Nutrition, Physical Activity, Obesity, Alcohol and Cancer……………………………………………………………………

Cancer in Diverse Populations……………………………………………………………………………………………………

Cancer Survivorship and Quality of Life………………………………………………………………………………………

Wisconsin Comprehensive Cancer Control Plan……………………………………………………………………………

Wisconsin Well Woman Program……………………………………………………………………………………………

Wisconsin Cancer Incidence and Mortality by County………………………………………………………………………

Glossary of Terms………………………………………………………………………………………………………………

Table of Contents

1

3

5

7

8

14

16

20

23

26

28

30

32

33

39

42

44

46

47

56

Special thanks for their contributions and assistance go to:

Wisconsin Cancer Reporting System Mary Foote, M.S. Laura Stephenson, B.A.

Wisconsin Office of Health Informatics Anne Ziege, Ph.D.

Wisconsin Comprehensive Cancer Control Program Amy Conlon, M.P.H.

American Cancer Society Beth Brunner, B.S.

Wisconsin Well Woman Program Gale Johnson, M.P.A.

Acknowledgements

Wisconsin Cancer Facts and Figures 2011 1

The American Cancer Society saves lives and is creating a world with more birthdays. Due – in large part – to our lifesaving work, the fi ve-year survival rate for all cancers is now 68 percent. Every day, we are creating more than 350 more birthdays.

The American Cancer Society has helped save countless lives. Yet, lives are still being lost to cancer. Until cancer is eliminated, we will continue to fi ght for every cancer, in every community by helping people:

• Stay well – Nearly 65% of Wisconsin women over the age of 40 receive an annual mammogram to aid in the detection of breast cancer when it is most treatable.

• Get well – The American Cancer Society is here around the clock to guide cancer patients, survivors and caregivers through every step of a cancer experience. In fi scal year 2009-2010, we provided information, day-to-day help, and emotional support to nearly 8,000 individuals in Wisconsin.

• Find cures – Since 1946, the American Cancer Society has invested more than $3.4 billion to better understand, prevent and cure cancer. Currently, we are funding 10 research grants in Wisconsin, totaling more than $5 million.

• Fight back – We work with lawmakers to pass laws to defeat cancer and rally communities to join our fi ght. Thanks to the thousands of American Cancer Society volunteers who advocated for the right to breathe smoke-free air, in July, Wisconsin joined nearly 80% of the U.S. population protected by smoke-free laws.

The information presented in Wisconsin Cancer Facts and Figures 2011 is intended to help demonstrate our progress and guide informed decision-making. For cancer patients, this publication can provide important details about their disease. Health care and public health professionals can use this book to monitor and better understand cancer trends. Also, policy-makers, media outlets and others looking for detailed, easy-to-read information about the cancer burden in Wisconsin should fi nd this publication useful.

Too many lives are still being lost to cancer. Every day, we are making progress. Every day, we are making more birthdays possible. With your ongoing support and dedication to our cause, our mission will be achieved.

Sincerely,

Jari Johnston-Allen Chief Executive Offi cer American Cancer Society, Midwest Division

Wisconsin Cancer Facts and Figures 20112

Dear Colleague:

The Wisconsin Cancer Reporting System (WCRS) in the Wisconsin Division of Public Health is pleased to join with the American Cancer Society (ACS) in presenting this new report, the third edition, Wisconsin Cancer Facts and Figures 2011. The WCRS greatly appreciates this opportunity to work with the Midwest Division of ACS to make this report available to our partners working on cancer control in Wisconsin.

Progress in cancer control demands accurate, timely, and complete data. This report contains the most recent data available on cancer incidence and mortality in Wisconsin. It includes county-specific rates for the most commonly diagnosed cancers and those for which public health interventions exist to reduce the cancer burden in Wisconsin. Equally important are the data provided for behaviors such as tobacco use, diet, physical activity, as well as rates for some types of cancer screening. These data help focus our efforts where they are most needed and are instrumental in measuring the impact of current cancer control programs. Information from ACS on screening recommendations is also provided to help professionals with preventive tools implement Healthiest Wisconsin 2020 (the state health plan) and the Wisconsin Comprehensive Cancer Control Plan 2010-2015.

Much of this data would not be available were it not for the dedication of hospital cancer registrars and reporters, physicians and staff, and the many other people who make the Wisconsin Cancer Reporting System work. We thank everyone for their participation in our cancer registry and other services that made this report possible.

We hope the Wisconsin Cancer Facts and Figures 2011 is a valuable resource for everyone interested in reducing the cancer burden in Wisconsin. Please visit the WCRS Web site http://dhs.wisconsin.gov/wcrs/index.htm to view this and other cancer-related reports, and offer your comments and suggestions. Join us in the Healthiest Wisconsin 2020 vision of “Everyone Living Better Longer” by using this report to help prevent and treat cancer more effectively.

Sincerely,

Henry Anderson, MD State Health Officer Division of Public Health Department of Health Services

DIVISION OF PUBLIC HEALTH

TEERTS NOSLIW TSEW 1 9562 XOB O P Jim Doyle 9562-10735 IW NOSIDAM

ronrevoG State of Wisconsin 1521-662-806 Karen E. Timberlake Department of Health Services 2382-762-806 :XAF Secretary 3521-107-888 :YTT dhs.wisconsin.gov


What is Wisconsin Cancer Facts and Figures?Wisconsin Cancer Facts and Figures is a publication designed to provide state and local cancer statistics along with cancer information and risk factors to individuals interested in cancer issues, community members, and public health and medical professionals.

What is Cancer?Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells. If the spread is not controlled, it can result in death. Cancer is caused by both external factors (tobacco, chemicals, radiation and infectious organisms) and internal factors (inherited mutations, hormones, immune conditions and mutations that occur from metabolism). These causal factors may act together or in sequence to initiate or promote the development of cancer. Ten or more years often pass between exposures to external factors and detectable cancer. Cancer is treated by surgery, radiation, chemotherapy, hormone therapy, biological therapy and targeted therapy. Many cancers can be cured if detected early and treated promptly.

Who is at Risk of Cancer?Anyone can develop cancer but the risk of developing cancer increases as people age. More than 78% of all cancers are diag-nosed in persons 55 and older. In the United States, men have about a 1 in 2 chance of developing cancer during the course of a lifetime; for women the risk is about 1 in 3.

How Many New Cases of Cancer are ExpectedThis Year?In 2010, approximately 29,610 Wisconsin residents will be diagnosed with cancer. This means each day 81 people in Wisconsin will hear the words “you have cancer” (Figure 1).

How Many Cancer Deaths are Expected This Year?In 2010, approximately 11,310 Wisconsin residents will die of cancer, which amounts to more than one person every hour (Figure 2).

Cancer: Basic Facts

Female Breast14% (n = 4,120)

Uterine Cervix1% (n = 200)Colon & Rectum

9% (n = 2,760)

Uterine Corpus3% (n = 1,040)

Leukemia3% (n = 940)

Lung & Bronchus13% (n = 3,990)

Melanoma4% (n = 1,050)

Non-Hodgkin Lymphoma5% (n = 1,340)

Prostate16% (n = 4,670)

Urinary Bladder5% (n = 1,510)

Other27% (n = 7,990)

Source: 2010 American Cancer Society, Inc., Surveillance and Health Policy Research

Figure 1. Estimated Percentage and Number of New Cancer Cases in Wisconsin, 2010

Colon & Rectum8% (n = 900)

Leukemia4% (n = 490)

Liver3% (n = 330) Non-Hodgkin Lymphoma

4% (n = 410)

Lung & Bronchus26% (n = 2,940)

Ovary3% (n = 290)

Pancreas6% (n = 720)

Brain/Nervous System2% (n = 270)

Prostate5% (n = 600)

Other32% (n = 3,670)

Female Breast6% (n = 690)

Source: U.S. Mortality Data, National Center for Health Statistics, Centers for Disease Control and Prevention, 2010. 2010 American Cancer Society, Inc., Surveillance and Health Policy Research

Figure 2. Estimated Percentage and Number of Cancer Deaths in Wisconsin, 2010


How Many People Survive Cancer?It is estimated that approximately 18,965 or 68% of Wisconsin residents who were diagnosed with cancer in 2006 survived fi ve years after diagnosis. Nationwide, the fi ve-year relative survival rate for all cancers diagnosed between 1999-2006 is 68%, up from 50% in 1975-1977.

Could More Lives be Saved?More lives could be saved through lifestyle changes such as eliminating tobacco use, increasing physical activity, improving dietary habits and obtaining appropriate cancer screenings. All cancers caused by cigarette smoking and heavy use of alcohol could be prevented. Scientifi c evidence also suggests that about one-third of cancer deaths are related to overweight or obesity, physical inactivity, and poor nutrition. In addition, regular cancer screening by a health care professional can result in early detection of many cancers, when treatment is more likely to be effective.

Impact of Stage at Diagnosis on SurvivalGenerally, the earlier the cancer is diagnosed, the better the prognosis for length of survival. The National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program developed a summary classifi cation. The stages from earliest to latest are: in situ, localized, regional and distant (see glossary, page 56).

Tobacco…………………………………………30%

Adult diet/obesity………………………………30%

Sedentary lifestyle………………………………5%

Occupational factors……………………………5%

Family history of cancer…………………………5%

Viruses/other biologic agents……………………5%

Perinatal factors/growth…………………………5%

Causes of Cancer in the United StatesEstimated percentage of total cancer deaths attributable to established cause of cancer

Reproductive factors……………………………3%

Alcohol……………………………………………3%

Socioeconomic status……………………………3%

Environmental pollution…………………………2%

Ionizing/ultraviolet radiation……………………2%

Prescription drugs/medical procedures…………1%

Salt/other food additives/contaminants…………1%Source: Cancer Causes & Control, Harvard Report on Cancer Prevention, 1996.


Understanding Cancer Incidence and Mortality Rates

Cancer rates in this document represent the number of new cases of cancer per 100,000 population (incidence) or the number of cancer deaths per 100,000 population (mortality) during a specific time period. Cancer incidence and mortality rates can be adjusted for demographic variables such as race, age and sex. The most commonly used adjustment for cancer rates is age.

Age-Adjusted Rates Older age groups generally have higher cancer rates than younger age groups. For example, more than 75% of new cancer cases occur in those aged 55 and older. As a result, if one county’s cancer incidence rate is higher than another, the first question asked is whether the county with a high rate has an older population.

To address this issue, all incidence and mortality rates presented in this booklet have been age-adjusted. This removes the disparity of different age distributions between populations and allows for direct comparison of those populations. Age-adjustment also allows for the comparison of rates within a single population over time.

All incidence and mortality rates in this publication, provided by the Wisconsin Cancer Reporting System, were age-adjusted using the direct method. The direct standardization method weights the age-specific rates for a given gender, race, or geo-graphic area by the age distribution of the standard population. The 2000 United States standard million population was used for all rates provided in this booklet.

There are three major components used to calculate age-adjusted rates: the number of cases or deaths being reported, the population being reported and a “standard” population. The rate (new cases or deaths per 100,000 population) is first computed for each age group, then weighted by multiplying it by the proportion of the 2000 U.S. standard population for that same age group. The results from each age group are added to arrive at the age-adjusted rate for the total population.

An age-adjusted rate should only be compared with another age-adjusted rate using the same U.S. standard population. Starting with all 1999 data, the National Center for Health Statistics (NCHS) and the National Cancer Institute (NCI) began using the year 2000 U.S. standard million-population age distribution reported by the Census Bureau. Cancer incidence increases with age and because the 2000 population was older than the 1970 population, the change to the 2000 U.S. standard population resulted in apparent higher rates for many cancers. Caution should be used when comparing the data in this report

with cancer incidence rates adjusted to standard populations other than the 2000 U.S. standard population.

The 2010 Census continued the option first started in the 2000 Census of allowing respondents the option of identifying them-selves as more than one race. The priority of reducing disparities in cancer prevention and control means that states need to report long-term trends for each race. NCHS and the Census Bureau developed bridged 2000 population estimates as implemented in NCI SEER* Stat software used in this report. Documentation of the modifications made by NCI to Census Bureau estimates is available at www.seer.cancer.gov/popdata/methods.html.

Age-adjusted incidence and mortality rates are grouped by primary cancer site or the site of origin per 100,000 population. For cancers that occur only in one sex (prostate, uterine, cervical, female breast), sex-specific population denominators are used to calculate incidence and mortality rates. Incidence rates are for invasive cancers unless otherwise specified. The only exception is the incidence rate for urinary bladder, which includes both in situ and invasive cancers. Cancer incidence rates may include multiple primary cancers that occur in single patients; each cancer is counted as a separate case if a patient has more than one primary cancer.

Limitations and Caveats

To accurately represent the burden of cancer in Wisconsin, it is important that all newly diagnosed cancer cases be reported annually to the Wisconsin cancer registry, Wisconsin Cancer Reporting System (WCRS). The North American Association of Central Cancer Registries (NAACCR) certification process indicated that Wisconsin state data was at least 95% complete for every year represented in this report. This national standard for completeness is one measure of data quality. However, incidence data for certain sites and counties in 1998-2007, the years widely represented in this report, are not necessarily 95% complete. Data for cancers diagnosed and treated at non-hospital settings (such as melanoma, leukemia and prostate cancers) are probably less complete than cancers primarily treated in hospitals (lung and colorectal cancers).

The primary reason for incomplete data is that there are some hospitals, laboratories and out-patient diagnostic and treatment facilities that are not reporting their cancer cases to the WCRS or are not reporting cases in a timely manner. Incomplete and late reporting of cancer data may underestimate the true burden of cancer in Wisconsin and Wisconsin counties.

Geographic Boundaries Two major factors affect interpretation of geographic location tabulations. First, many Wisconsin counties have a very small number of new cancer diagnoses or deaths in a year, resulting


in site-specific frequencies in the single digits. Such small numbers may easily double or triple (or decrease by equivalent amounts) from year to year. When years of data or primary sites are combined to produce larger number of events, the rates become more stable. County data in this report are averaged over the five years to provide more stable rates. Even with multiple years of data, however, the numbers may still be small and some random fluctuation is expected. To provide guidance in assessing the stability of rates, all county tables show the upper and lower limits of the confidence interval for each rate, which will include the true value 95% of the time. A large confidence interval indicates high variability of the “true” rate, while a small confidence interval indicates greater stability of the rate.

Second, reporting completeness and/or timeliness may vary by region. The largest reporting variations relate to out-of-state diagnosis and treatment of patients who live in the sparsely populated counties along the Wisconsin/Minnesota border and are seen in Minnesota hospitals. Reporting by Minnesota hospitals to WCRS is a voluntary process (established through memoranda of understanding that protect patient confidentiality) and is not covered under Section 255.04, Wisconsin Statutes. Therefore, the number of reports sent to WCRS from Minnesota can vary greatly from year to year.

Patient Race and Ethnicity

Historically, differences among facilities in recording patient race (information not required in medical chart, entered by proxy, or patient self-reporting) have led to a number of ambigu-ous or unknown race codes. As training and expanded codes have been introduced in recent years, the number of incidence cases reported with unknown race has decreased. Data in this report reflect American Indian cases reported by facilities and also those identified through the linkage with the U.S. Indian Health Service.

For this report, the NAACCR Hispanic/Latino Algorithm Identification Algorithm (NHIA) assigned Hispanic/Latino ethnicity to cases, using variables of birthplace, marital status, gender, race and surname to increase the number of cases identified as Hispanic in the registry during the years covered in this report. For a complete description of NHIA, and other updates to reporting guidelines, visit the following web site: http://www.naaccr.org/. The application of the NHIA increased the number of Hispanic cancer cases beyond the number identified by reporting facilities. The NHIA was developed and tested by NAACCR and endorsed by the Centers for Disease Control and Prevention to correct for documented under-reporting of Hispanic/Latino cases by facilities. Caution should be used when comparing rates for Hispanics/Latinos with the rates for race groups because ethnicity and race are not mutually exclusive categories in this report. Hispanics/Latinos who identify themselves as white or any other racial group are included in the race category as well as in the Hispanic category.

Changes in Multiple Primary RulesStarting with 2007 cases, all central state cancer registries received new rules and guidelines for counting and coding cases as primary tumors. For a complete discussion of the new rules, please see the web page: http://training.seer.cancer.gov/rules/changes/.

Wisconsin Population Characteristics The census population estimate for Wisconsin in 2009 was 5,654,774. Wisconsin’s population increased by 5.4% from 2000 to 2009 compared to the national 9.1% increase. While Wisconsin has experienced increased racial and ethnic diversity, the state’s minority populations are smaller than national proportions. Of the state’s 5.6 million residents, more than 14.9% are racial or ethnic minorities, compared to 34.4% nationally. Wisconsin’s population is comprised of 6.1% African Americans and 5.1% Hispanics, compared to U.S. proportions of 12.8% and 15.4%, respectively. By age, Wisconsin’s population is similar to the nation with 13.3% of the population over 65 years old compared to 12.8% nationally. Economically, Wisconsin has a lower poverty rate than the U.S., 10.5% compared to 13.2%, and the almost the same median household income as the nation, $52,103 compared to $52,029. Approximately one third of Wisconsin residents live in rural locations compared to one fifth of the national population. However, the rural population in Wisconsin has decreased by approximately 10% during the last decade.


Data Sources

Estimated Cases and Deaths, 2010 The National Home Office of the American Cancer Society publishes these estimates, which are based on incidence data from the Surveillance, Epidemiology and End Results (SEER) Program and the Center for Disease Control and Prevention’s National Program of Cancer Registries. Estimated deaths are based on mortality data are from the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention. Report available at: www.cancer.org

Wisconsin Cancer Incidence and Mortality Cancer incidence data are from the Wisconsin Cancer Report-ing System (WCRS), part of the Office of Health Informatics, Division of Public Health, Department of Health Services. The WCRS was established in 1976 to collect cancer incidence data on Wisconsin residents as mandated by chapter 255.04, Wis-consin Statutes. In 1994 WCRS became part of the National Program of Cancer Registries (NPCR) authorized and funded by the Centers for Disease Control and Prevention. Cancer mortal-ity data are from the NCHS and are based on the underlying cause of death. The WCRS staff prepared all data for the cancer incidence and mortality rates per 100,000 age-adjusted to the 2000 U.S. standard population. The SEER*Stat software pack-age, from the National Cancer Institute, was used to calculate both incidence and mortality rates. Wisconsin cancer publications available at: www.dhs.wisconsin.gov/wcrs

National Cancer Data and Survival Trends National cancer data and survival data are from the Surveil-lance, Epidemiology and End Results (SEER) Program of the National Cancer Institute. National incidence rates are based on nine SEER registries reporting from geographic areas covering about 10% the population. National mortality rates are from the SEER*Stat public-use database for mortality (www.seer.cancer.gov/seerstat), with underlying mortality data provided by NCHS (www.cdc.gov/nchs). The SEER registry program is considered an authoritative source of cancer incidence and mortality in the United States. Available at: www.seer.cancer.gov

Behavioral Risk Factor Data The Wisconsin Office of Health Informatics, Division of Public Health, annually conducts the Behavioral Risk Factor Survey through telephone interviews of randomly selected adults in Wisconsin. Respondents are asked to provide information about their health risk behaviors and health monitoring activities. The survey is done in cooperation with the Centers for Disease

Control and Prevention (CDC) and is part of the Behavioral Risk Factor Surveillance System (BRFSS), which is conducted in all 50 states and four U.S. territories. Available at: www.dhs.wisconsin.gov/stats/brfs.htm

Youth Smoking/Behavioral Risk Data

The 2009 Wisconsin Youth Risk Behavior Survey (YRBS) was conducted as part of the national survey efforts by CDC. The survey was designed to provide national, state and local prevalence estimates on health risk behaviors, such as tobacco use, unhealthy dietary behaviors and physical inactivity among youths who attend public and private schools. The YRBS is a biennial survey, which began in 1993. Available at: www.dpi.state.wi.us/sspw/yrbsindx.html

Burden of Tobacco in Wisconsin Data The 2010 Burden of Tobacco in Wisconsin Report was developed in partnership by the American Cancer Society, the Wisconsin Division of Public Health, within the Department of Health Services, and the UW Carbone Cancer Center’s Surveil-lance and Evaluation Program. The Burden of Tobacco Report measures tobacco’s impact on Wisconsin, including the number of deaths from tobacco use and health care costs related to tobacco. Available at: www.dhs.wisconsin.gov/tobacco/informationData.htm


Wisconsin Cancer Incidence and Mortality Data

Prostate %11%82

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9%%01 Colon & Rectum

%4%7reddalB yranirU

Non-Hodgkin Lymphoma 5% 4%

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Melanoma of the Skin

Oral Cavity & Pharynx 3% 2%

%5%3aimekueL

%6%3Pancreas

Cases Deaths

30 20 10 0 10 20 30

in

Percent Cancer Deaths

Figure 3. Leading Cancer Sites: Percentage of New Cases and Deaths Among Males in Wisconsin,2003-2007

Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Wisconsin Department of Health Services, and National Center for Health Statistics, 2010.

Kidney & Renal Pelvis 4% 3%

Percent New Cases

Cancer IncidenceFigure 3 displays the leading cancer sites among males in Wisconsin by percentage of new cases and cancer deaths. Prostate cancer is the most frequently diagnosed cancer among Wisconsin males, representing 28% of all cancers diagnosed between 2003 and 2007. Figure 4, page 9 shows that breast cancer remains the most frequently diagnosed cancer in Wisconsin women, representing 28% of all female cancer diagnoses. Overall, lung cancer continues to be the most frequently diagnosed cancer in Wisconsin for both genders combined.

Table 1, page 10 provides average annual new cases and age-adjusted incidence rates for 23 common cancers by gender with national comparisons. The lung cancer incidence rate for 2003-2007 was 76.8 per 100,000 for Wisconsin men, marginally higher than the national lung cancer incidence rate for men of 74.5 per 100,000.

Map 1, page 12 shows total cancer incidence for all counties in

Wisconsin for 2003-2007. For additional county-level informa-tion, such as the number of newly diagnosed cases and age-adjusted rates for specific cancer sites, refer to the supplemental Table A, pages 48-51.

Cancer Mortality Lung cancer is the leading cause of cancer deaths among both males and females in Wisconsin, with a yearly (2003-2007) average of 1,590 men and 1,260 women dying from the disease (Table 2, page 11).

Prostate cancer ranks as the second leading cause of cancer death for men (Figure 3), accounting for 11% of male cancer deaths, while breast cancer ranks as the second leading cause of cancer death for women at 14% (Figure 4).

Colorectal cancer is the second leading cause of cancer death in Wisconsin residents for males and females combined (Table 2). Wisconsin males have a higher mortality rate from colorectal cancer than do females (19.9 and 14.0, respectively).

Map 2, page 13 presents total mortality rates for all cancer in Wisconsin by county for 2003-2007. More detailed data on the number of deaths and the age-adjusted rates are provided in the supplemental Table B, pages 52-55.


Cases Deaths

30 20 10 0 10 20 30

Breast %4128%

%42%31 Lung & Bronchus

Corpus & Uterus, NOS 7% 3%

Non-Hodgkin Lymphoma 4% 4%

Ovary 4% 6%

%1%3nikS eht fo amonaleM

0.4%%3Thyroid

%6%3saercnaP

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Figure 4. Leading Cancer Sites: Percentage of New Cases and Deaths Among Females in Wisconsin,2003-2007

Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Wisconsin Department of Health Services, and National Center for Health Statistics, 2010.

%01%01 Colon & Rectum

Percent Cancer DeathsPercent New Cases


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391.0

483.5

431.3

389.1

468.8409.0

346.3

411.5

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487.3546.7

431.6

424.6

531.9

383.5

385.5

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503.6

391.6

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487.8

456.7

463.8

604.7

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492.7

487.1

485.2

555.4

497.3

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471.6

501.7

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288.6

434.7

435.8

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526.7

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475.5

500.5

475.5

506.8

462.8

504.2

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498.2

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Douglas Bayfield

Burnett Washburn Sawyer

Ashland Iron Vilas

Oneida Price

Rusk Barron Polk

St. Croix

Dunn

Pierce

Pepin

Buffalo

Chippewa

Eau Claire

Trempealeau Jackson

Clark

Taylor

Lincoln

Marathon

Wood Portage

Shawano

Menom-inee

Langlade

Forest

Florence

Marinette

Oconto

Door

Kewaunee

Manitowoc

Sheboygan

Ozaukee

Milwaukee

Racine

Kenosha

Wal-worth Rock

Green Lafayette

Grant

Iowa Dane Jefferson

Waukesha

Wash-ington Dodge

Columbia Sauk Richland

Crawford

Vernon

La Crosse

Monroe

Juneau

Adams

Mar-quette

Green Lake Fond du Lac

Winne-bago

Calu-met

Outa-gamie Brown

Waushara

503.4Waupaca305.8

Map 1. Cancer Incidence Rates for All Cancer by County in Wisconsin, 2003-2007

Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.

Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.

County Cancer Incidence

Wisconsin State Average - 473.7

Below or Equal to State Average

Above State Average

Rate is statistically signifi cant above or below the state rate

Above State Average


391.0

483.5

431.3

389.1

468.8409.0

346.3

411.5

486.2

512.1

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385.5

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Douglas Bayfield


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St. Croix

Dunn

Pierce

Pepin

Buffalo

Chippewa

Eau Claire

Trempealeau Jackson

Clark

Taylor

Lincoln

Marathon

Wood Portage

Shawano

Menom-inee

Langlade

Forest

Florence

Marinette

Oconto

Door

Kewaunee

Manitowoc

Sheboygan

Ozaukee

Milwaukee

Racine

Kenosha

Wal-worth Rock

Green Lafayette

Grant

Iowa Dane Jefferson

Waukesha

Wash-ington Dodge


Crawford

Vernon

La Crosse

Monroe

Juneau

Adams

Mar-quette

Green Lake Fond du Lac

Winne-bago

Calu-met

Outa-gamie Brown

Waushara

503.4Waupaca305.8

Map 1. Cancer Incidence Rates for All Cancer by County in Wisconsin, 2003-2007

Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.

Douglas Bayfield


Ashland Iron Vilas

Oneida Price

Rusk Barron Polk

St. Croix

Dunn

Pierce

Pepin

Buffalo

Chippewa

Eau Claire

Trempealeau Jackson

Clark

Taylor

Lincoln

Marathon

Wood Portage

Shawano

Menom-inee

Langlade

Forest

Florence

Marinette

Oconto

Door

Kewaunee

Manitowoc

Sheboygan

Ozaukee

Milwaukee

Racine

Kenosha

Wal-worth Rock Green Lafayette

Grant

Iowa Dane

Jefferson Waukesha

Wash-ington Dodge


Crawford

Vernon

La Crosse Monroe

Juneau

Adams

Mar-quette Green

Lake Fond du Lac

Winne-bago

Calu-met

Outa-gamie Brown

Waushara

Waupaca

Map 2. Cancer Mortality Rates for All Cancer by County in Wisconsin, 2003-2007

228.2

193.9

184.2

176.6

168.2169.3

184.1

164.5

190.8

161.3

183.3210.0

167.5

208.8

156.3

208.7

151.5

166.2

192.3

184.2

208.5

188.5

174.9

200.6

161.5

211.9

192.6

183.6

229.0

194.7

169.7

177.5

190.7

213.8171.8

165.7

159.9

187.5

221.7

299.2

195.8

186.7

176.4

199.8

173.5

175.2

176.2

193.8

168.0

206.6

182.3

159.9

196.1

183.1

173.6

183.8

190.6

175.6

180.8

171.3

163.1

175.0

183.1

188.3

175.5

191.6

195.8185.9

163.6191.1

181.4

154.0

Source: National Center for Health Statistics, Surveillance, Epidemiology and End Results (SEER) Public-Use Mortality Files, 2010.

Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.

County Cancer Mortality

Wisconsin State Average - 182.0

Below or Equal to State Average

Above State Average

Rate is statistically signifi cant above or below the state rate

Above State Average


1997-2007 TrendsOverall, the cancer mortality rates for both males and females in Wisconsin have declined from 1997 to 2007 (Figure 5). Incidence rate for all cancers declined 14% for males from 1997 to 2007. Females also experienced a decline of 7% in the overall incidence rate during this same time period (Table 3, page 15).

Displayed in Table 3, the cancer incidence rates have increased most dramatically for melanoma. For the period shown, male melanoma rates increased by approximately 42% while female rates increased by 45%. The other major trends in incidence rates are found for colorectal cancer, declining by approximately 35% for males and 31% for females and lung cancer declining 22% for men. Unfortunately, women have experienced an increase in lung cancer incidence by 3%, largely attributable to increased smoking.

The positive side, however, is that overall cancer mortality rates for both males and females have declined approximately 11% and 8%, respectively (Table 4, page 15). This decline in mortality is attributed to an increase in early detection, better treatments and increased awareness of risk reduction behaviors.

Table 4 displays the mortality rates and shows that female breast cancer mortality declined 20% during the 1997-2007 period. Also, cervical cancer mortality rates decreased by 36% during this same time.

Both males and females experienced lower mortality rates in colorectal cancer in 2007 than in 1997, with mortality rates declining by 32% and 29% respectively. However, lung cancer mortality rates parallel the incidence rates and show a gender disparity; male mortality dropped by 10% while female mortality increased by 4%.

Trends in Cancer Incidence and Mortality in Wisconsin

Figure 5. Trends in Wisconsin Cancer Incidence and Mortality Rates for All Cancer Sites, 1997-2007

Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services and National Center for Health Statistics, 2010.1. Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.2. Rates are single-year rates.

Mortality Total

Mortality Male

Mortality Female

Incidence Total

Incidence Male

Incidence Female

200

300

400

500

600

700

0

100

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rat

es

Year

2007


All Sites Total 195.9 195.1 190.8 183.2 183.4 178.2 -9.1Male 245.0 249.2 237.9 228.3 222.8 218.1 -11.0Female 164.7 160.1 159.9 154.0 156.8 151.2 -8.2

Lung Total 50.1 48.6 49.2 47.4 48.5 48.6 -3.0Male 68.5 66.7 65.1 63.9 61.2 61.4 -10.3Female 37.3 35.8 37.8 36.1 39.6 38.9 4.1

Colorectal Total 21.5 21.1 19.7 18.3 16.4 15.1 -29.6Male 26.4 26.7 25.1 22.2 19.8 18.0 -31.8Female 18.1 17.0 16.0 15.2 13.9 12.9 -28.5

Melanoma Total 2.5 2.6 2.7 2.4 2.9 2.6 3.8Male 3.5 3.8 3.8 3.1 3.7 3.8 8.7Female 1.6 1.7 1.7 1.8 2.3 1.6 -2.5

Female Breast 25.9 26.6 25.7 23.7 22.7 20.8 -19.6

4.63-7.19.18.18.14.27.2lacivreC

Prostate 33.5 32.7 29.1 29.5 26.9 26.3 -21.4

1997 1999 2001 2003 2005 2007 PC*

All Sites Total 485.8 490.8 499.8 479.0 487.1 440.3 -9.4Male 583.0 584.0 584.7 553.3 551.2 504.4 -13.5Female 421.5 428.6 441.7 428.8 443.3 393.5 -6.6

Lung Total 66.8 66.1 67.0 66.3 64.0 59.4 -11.1Male 91.8 89.0 84.2 83.0 74.1 71.4 -22.2Female 49.0 49.6 54.9 54.4 56.9 50.5 3.1

Colorectal Total 60.4 60.3 55.8 54.7 47.8 40.6 -32.8Male 71.5 74.3 66.7 63.2 53.9 46.4 -35.2Female 52.1 49.4 47.6 48.1 43.1 35.8 -31.3

Melanoma Total 11.4 12.1 15.2 14.3 16.9 16.4 43.6Male 13.5 14.9 18.2 16.2 19.5 19.2 42.1Female 10.0 10.1 13.1 13.0 15.3 14.5 44.8

.12.6-8.6114.4214.3218.9311.9317.331 Female Breast5.83-4.52.77.68.62.98.8lacivreC2.81-7.2411.8410.3513.7714.4715.471etatsorP

1997 1999 2001 2003 2005 2007 PC*

Source: Wisconsin Cancer Reporting System, Office of Public Health Informatics, Division of Public Health, Department of Health Services, 2010.Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.PC*: Percent Change based on 1997-2007 difference.

Source: National Center for Health Statistics, 2010.Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.PC*: percent change is based on 1997-2007 difference.

Table 3. Trends for Leading Cancers: Incidence Rates in Wisconsin by Gender, 1997-2007

Table 4. Trends for Leading Cancers: Mortality Rates in Wisconsin by Gender, 1997-2007


Overview

According to the report The Burden of Tobacco in Wisconsin, 2010, each year approximately 15% of all deaths in Wisconsin are attributable to smoking. Cigarette smoking causes 79% of all lung cancer deaths and 14% of deaths from cardiovascular disease in Wisconsin. Lung cancer was the leading cause of cancer deaths and killed more than 2,900 Wisconsin residents in 2007. Stopping the use of tobacco could eliminate most lung cancer. Quitting smoking reduces an individual’s risk significantly, although former smokers remain at greater risk than those who never smoked.

Risk Factors • Cigarette smoking is the most important risk factor for lung cancer. Lung cancer mortality rates are about 23 times higher for current male smokers and 13 times higher for current female smokers compared to people who have never smoked.

• Exposure to secondhand tobacco smoke.

• Environmental or occupational exposure to radon, asbestos (particularly among smokers), certain metals (chromium, cadmium, arsenic), some organic chemicals, radiations, air pollution, and a history of tuberculosis.

• Genetic susceptibility plays a contributing role in the development of lung cancer, especially in those who develop the disease at a younger age.

Groups at High Risk for Smoking: U.S. Adults • Adults living below the poverty level are more likely to smoke than adults with higher incomes.

• Adults without a high school degree are three times more likely to smoke than those with a college degree.

• American Indian, Alaskan Natives are more likely than other races/ethnicities to smoke cigarettes.

Groups at High Risk for Smoking: U.S. Youth • White, non-Hispanic students are the most likely to smoke cigarettes, followed by Hispanic students, then African-American students.

• High school boys are much more likely than girls to use smokeless tobacco, cigars, pipes and bidis.

• White high school students are more likely than African -American high school students to report current cigar use.

Prevention/Screening/Early DetectionLung cancer is the most preventable cancer. Tobacco use is responsible for 87% of lung cancers. Most people with early lung cancer do not have any symptoms. Only 19% of all lung cancers in Wisconsin were found at an early stage in 2007.

Currently, screening for early lung cancer detection has not been proven to reduce mortality. Chest x-ray, analysis of cells con-tained in sputum and fiber optic examination of the bronchial passages have all shown limited effectiveness in reducing lung cancer deaths. Newer tests, such as low-dose helical CT scans and molecular markers in sputum, have produced promising results in detecting lung cancer at earlier, more operable stages in high-risk patients, but have not yet been shown to reduce lung cancer deaths.

Cancer Burden More people die from lung cancer than from breast, prostate and colorectal cancers combined. In Wisconsin, lung cancer killed an average of 2,851 residents per year during the five-year period 2003 through 2007, and an average of 3,714 new cases of lung cancer were diagnosed each year.

Nationally, the incidence rate for men during the period of 2003-2007 averaged 74.5 per 100,000 population. For Wisconsin men, the lung cancer incidence rate for that same period was higher – 76.8 per 100,000 population. The national incidence rate for women during the 2003-2007 period was 52.2 per 100,000. The Wisconsin incidence rate for women during that period was 53.7 per 100,000. (Table 1, page 10).

The national lung cancer mortality rates for 2003-2007 were 68.8 for men and 40.6 for women, per 100,000 population. The Wisconsin 2003-2007 mortality rates were lower – 62.3 for men and 38.5 for women, per 100,000 population (Table 2, page 11). For the past 15 years, more women have died each year of lung cancer than breast cancer.

Both gender and race are factors in lung cancer incidence and mortality rates. Lung cancer incidence and mortality rates are significantly higher among Wisconsin males than Wisconsin females. Wisconsin males have an average of 1,590 deaths from lung cancer each year, compared to an average of 1,260 deaths for Wisconsin females during 2003-2007 (Table 2). While men traditionally experienced higher lung cancer rates, the difference has decreased in recent years, largely as the result of continuing smoking rates among women. In Wisconsin, between 1997 and 2007, deaths from lung cancer among women increased by 4%, compared to a 10% decrease among men.

African Americans and American Indians in Wisconsin are more likely than other races to die from lung cancer. The Wisconsin mortality rate for African Americans with lung cancer for the

Lung & Bronchus Cancer/Tobacco Control in Wisconsin


years of 2003-2007 was 78.9 per 100,000, similar to the mortality rate for American Indians of 73.1. The mortality rate for whites was 47.6, and Asian/Pacific Islanders had the lowest mortality rate of 16.5 per 100,000 (Table 6, page 41).

Trends in Tobacco UseThe devastating effects of tobacco use in the health and welfare of society are now widely recognized. Tobacco use is the single largest preventable cause of disease and premature death in the United States.

Tobacco use accounts for about one-third of all cancer deaths and 87% of lung cancer deaths each year in the U.S. The best way to avoid lung cancer is to not start using tobacco or to quit if you do use it. Cigarette smoking also causes cancers of the mouth, nasal cavities, larynx, pharynx, esophagus, stomach, colorectum, liver, pancreas, kidney, bladder, uterine cervix and ovary, and myeloid leukemia. Cigar smoking increases the risk of cancers of the lung, oral cavity, larynx, esophagus and probably pancreas.

The prevalence of smoking in Wisconsin has declined since 2000, but 19% of adults age 18 and older report current (2009) cigarette smoking. Figure 6, page 18 depicts tobacco use by gender in Wisconsin in 2000-2009. It shows the prevalence of smoking in 2000 was 24% for both genders, but by 2009 had declined to 17% among women and 20% among men. In 2008, for both sexes combined, the 25 to 34-year-old age group had the highest percentage of smokers, followed by the 18-24 year-olds (Figure 7, page 18). The large number of younger adults smoking will cause a rise in lung cancer mortality in 20-30 years, unless smoking cessation efforts intervene.

According to the Wisconsin Youth Risk Behavior Survey (YRBS) for 2009, approximately 18% of male high school students and 16% of female high school students in Wisconsin reported smoking (Figure 8, page 19). The YRBS also reports a decline in the percentage of all high school students who are current smokers (smoked a cigarette at least one day out of the prior 30 days) from 38% in 1999 to 17% in 2009.

Burden of Tobacco Dependence Quitting tobacco use substantially decreases the risk of cancer and cardiovascular disease. Smokers who quit, regardless of age, live longer than people who continue to smoke. Once smoking rates begin to decline in a population, it takes 20-30 years to see a decrease in lung cancer rates.

• According to the report The Burden of Tobacco in Wisconsin, an estimated $2.8 billion in health care costs were paid in 2007 in Wisconsin as a result of diseases caused by smoking.

• In Wisconsin almost 7,000 people die annually from illnesses directly related to smoking. and approximately 750 die from illnesses and fires indirectly related to smoking, for a total of 7,750 annual deaths.

Secondhand SmokeIn 2006, the U.S. Surgeon General published a report titled, The Health Consequences of Involuntary Exposure to Tobacco Smoke. Secondhand smoke contains numerous carcinogens for which there is no safe level of exposure. It is estimated that more than 126 million nonsmoking Americans are exposed to secondhand smoke.

Increasing smoke-free environments leads to fewer youth beginning to smoke and more teens and adults quitting. Studies have shown that smoking is not merely a bad habit but is an addiction, a chronic condition that may need treatment over an extended period of time.

• 3,400 lung cancer deaths occur annually in the U.S. in nonsmoking adults as a result of breathing secondhand smoke.

• Secondhand smoke contains over 4,000 substances, more than 50 of which are known or are suspected to cause cancer in humans and animals.

Stage at DiagnosisLung cancer in Wisconsin is most often (49% of new cases in 2007) diagnosed at the distant stage, which negatively impacts the length of survival (Figure 9, page 19). Five-year probability of survival is highest if lung cancer is diagnosed early, with a 55% five-year survival rate for lung cancers diagnosed at the local stage. However, only 19% of lung cancers in Wisconsin were diagnosed at this stage in 2007.

Quitting Smoking in WisconsinThere are a number of treatments that can help tobacco users quit and thus reduce the incidence of lung and bronchus cancer. Tobacco users who are ready to quit can consult their physicians, who will conduct an intervention and prescribe an appropriate medication.

Medication combined with practical, individualized counseling provides effective nicotine dependence treatment. The counseling component can be obtained by calling the Wisconsin Tobacco Quit Line (1-800-QUIT-NOW). The Quit Line conducts an assessment and provides ongoing, practical advice on the process of quitting tobacco use. A number of local programs are also available in Wisconsin. Information can be obtained on local programs by calling the Quit Line.


0

5

10

15

20

25

30

35

Males

Females

2009 2008 2007 2006 2005 2004 2003 2002 2001 2000

Figure 6. Trends in Prevalence of Adult Current Cigarette Smoking by Sex in Wisconsin, 2000-2009Pe

rcen

t

Source: Wisconsin Behavior Risk Factor Surveillance System, 2000-2009, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.1. Current cigarette smoking: persons who reported smoking at least 100 cigarettes in their lifetime and currently smoke every day or some days.

Year

Figure 7. Trends in Prevalence of Adult Current Cigarette Smoking by Age in Wisconsin, 2000-2009

5

10

15

20

25

30

35

40

18-24

25-34

2009 2008 2007 2006 2005 2004 2003 2002 2001 2000

35-44

45-54

55-64

65+

Perc

ent

Source: Wisconsin Behavior Risk Factor Surveillance System, 2000-2009, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.1. Current cigarette smoking: persons who reported smoking at least 100 cigarettes in their lifetime and currently smoke every day or some days.2. Data for 18-24 year olds were unavailable for 2009.

Year


0

10

20

30

40

50

1997

1999

2001

2003

2005

2007

Figure 9. Trends in Lung Cancer Stage at Diagnosis in Wisconsin, 1997-2007

Perc

ent

0

Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.1. Refer to page 57 for glossary of terms with definition of stage of disease at diagnosis.

Localized Regional Distant/Systemic Unknown/Unstaged Stage at Diagnosis

0

10

20

30

40

50

Figure 8. Trends in Prevalence of Current Cigarette Smoking Among High School Students by Sex in Wisconsin, 1999-2009

Source: 2009 Wisconsin Youth Risk Behavior Survey, 1999-2009, Department of Public Instruction, 2009.1. Cigarette Smoking: High school students who reported smoking at least once a day for the past thirty days.

Perc

ent

10

15

20

25

30

35

40

45

Males

Females

2009 2007 2005 2003 2001 1999

Year

2000 2002 2004 2006 2008


Colon and rectal cancers have many features in common and are referred to as colorectal cancer. Cancer can develop in any part of the colon or rectum.

Overview Colorectal cancer develops slowly over a period of several years. Before cancer develops there are usually precancerous growths called polyps. Screening tests offer a powerful opportunity for the prevention, early detection and successful treatment of colorectal cancers. While people cannot change their genetic makeup or family health history, most people can reduce their risk of colorectal cancer by following screening guidelines, eating a healthy, low-fat, high-fiber diet and increasing their level of physical activity.

Risk FactorsSeveral risk factors may contribute to the development of colorectal cancer. They include:

• Age (91% of colorectal cancers are diagnosed in individuals age 50 and over)

• Race (African Americans are more likely than other racial and ethnic groups to develop colorectal cancer)

• A family history of colorectal cancer or a personal history of colorectal cancer, colon polyps, or inflammatory bowel disease

• Inherited genetic mutations (familial adenomatous polyposis [FAP] and hereditary non-polyposis colorectal cancer [HNPCC], also known as Lynch syndrome)

• Studies have also found an association between diabetes and colorectal cancer

Modifiable risk factors

• Being sedentary or not physically active

• A diet that is high in fat (especially from red meat) or low in fruits and vegetables

• Obesity, particularly excess fat around the waist, increases the risk

• Long-term smoking

• Alcohol, especially heavy use

Prevention/Screening/Early DetectionScreening tests that detect and remove adenomatous polyps are the most reliable method of preventing colorectal cancer.

Modifiable factors for reducing the risk of colorectal cancer include healthy eating, regular physical activity, maintaining suggested body weight and avoiding smoking.

The American Cancer Society recommends screening beginning at age 50 for women and men who are at average risk for devel-oping colorectal cancer. Screening can result in the detection and removal of colorectal polyps before they become cancerous. Screening can also find colorectal cancer early, when treatment can be most effective.

Colorectal cancers can almost always be cured if detected early. There is a 91% chance of survival five years after diagnosis if a patient is diagnosed at the earliest stage. Therefore, it is impor-tant for all adults aged 50 and older (at average risk) to follow the American Cancer Society’s screening guidelines. Individuals at increased risk of colorectal cancer should begin screening before age 50 and should discuss their screening options with their healthcare provider.

Colorectal Cancer in Wisconsin

Signs and Symptoms of Colorectal Cancer• Bleeding from rectum

• Blood in stool or in the toilet after a bowel movement

• A change in bowel habits

• Cramping pain in lower abdomen


Cancer BurdenIn Wisconsin, colorectal cancer is the second most common cancer diagnosed in both men and women combined (Table 1, page 10).

From 2003-2007, an annual average of 2,824 Wisconsin residents were diagnosed with colorectal cancer and 1,000 residents died of the disease (Tables 1 and 2, pages 10 and 11). The incidence rate for both genders combined was 47.6 per 100,000 (2003-2007). Males had a higher incidence rate than females, 54.5 compared with 42.1, respectively. The Wisconsin colorectal

cancer mortality rate was 16.5 per 100,000, with a rate of 19.9 per 100,000 for males and 14.0 per 100,000 for females. The col-orectal mortality rate has dropped from 21.5 per 100,000 in 1997 to 15.1 per 100,000 in 2007 (Table 4, page 15).

Increased use of sigmoidoscopy or colonoscopy, which in turn has increased benign polyp removal, has been largely credited for the decline in colorectal cancer incidence rates. Mortality rates for colorectal cancer continue to decrease, due in part to the decline in colorectal cancer incidence and to improved cancer treatments.

Figure 10. Trends in Persons Aged 50 Years and Older Who Have Ever Had a Sigmoidoscopy or Colonoscopy in Wisconsin, 1997-2007

Source: Wisconsin Behavioral Risk Factor Surveillance System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.

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American Cancer Society Screening Recommendations for Colorectal 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:

• Flexible sigmoidoscopy**, or • Colonoscopy, or • Double-contrast barium enema (DCBE)**, or • CT colonography (virtual colonoscopy)**

When to get one:

• 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 • Fecal immunochemical test (FIT)*,** with at least 50% test sensitivity for cancer, or • Stool DNA test (sDNA)**

When to get one:

• 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.


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Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.1. Refer to page 57 for definitions of stage at diagnosis.

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Stage at DiagnosisSurvival from colorectal cancer is more than 91% when the cancer is diagnosed before it has extended beyond the intestinal wall. In 2003-2007, about 40% of invasive colorectal cancers diagnosed in Wisconsin were at an early (localized) stage. Figure 11 displays stages at diagnosis for colorectal cancer and shows an increase in the percent of colorectal cancers detected early in Wisconsin from 1997 to 2007.


Overview The majority of breast cancers can be treated successfully if detected early. An annual mammogram starting at age 40 is the most effective way to detect breast cancer at an early, curable stage. The American Cancer Society also recommends that women at increased risk of developing breast cancer (fam-ily history, genetic predisposition, history of the disease) may benefit from starting early detection practices at a younger age or having additional tests or more frequent examinations. These women should talk to their health care provider about the benefits and limitations of beginning screening at an earlier age, and then make a decision about breast cancer screening. Specific guidelines for clinical breast exams and breast examina-tions are also provided based on both age and level of risk.

Risk FactorsSeveral risk factors may contribute to the development of breast cancer. They include:

• Increasing age

• Personal or family history of breast cancer and inherited genetic mutations in the breast cancer susceptibility genes BRCA1 and BRCA2 (These mutations account for approximately 5%-10% of all breast cancer cases.)

• History of noncancerous breast disease

• Long menstrual history (menstrual periods that start early and end late in life)

Modifiable risk factors:

• Weight gain after age 18

• Being overweight or obese (postmenopausal breast cancer)

• Use of combined estrogen and progestin MHT

• Physical inactivity

• Alcohol consumption, especially two or more drinks daily

• Never having children or having the first child after age 30

• Recent use of oral contraceptives

Prevention/Screening/Early DetectionSome breast cancer risk factors, such as family history, cannot be changed. However, a woman’s risk of developing breast cancer may be reduced by staying physically active, avoiding obesity and limiting alcohol use. Management of risk factors may help some women decrease their chances of being diagnosed with breast cancer. For women at high risk for breast cancer, two medications, tamoxifen and raloxifene, have been approved to reduce breast cancer risk.

Mammography can detect breast cancer at an early stage, when treatment is more effective and a cure is more likely. Steady declines in breast cancer mortality among women since 1990

Figure 12. Trends in Prevalence of Mammography Screening Among Women Aged 40 Years and Older in Wisconsin, 1998-2008

Source: Wisconsin Behavioral Risk Factor Surveillance System, 1998-2008, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.

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Female Breast Cancerin Wisconsin


have been attributed to a combination of early detection and improvements in treatment.

Figure 12, page 23 displays the upward trend in mammography rates in both having a mammogram during the past two years, which increased from 71% in 1998 to 76% in 2008, and ever hav-ing had a mammogram, which increased from 85% in 1998 to 92% in 2008. Improved mammography screening to detect breast cancer early, along with better treatment options, have made breast cancer a more curable disease than it was 30 years ago.

Cancer BurdenBreast cancer is the most common cancer among women in Wisconsin regardless of race. Breast cancer accounts for nearly one-third of all cancers diagnosed among women. During 2003-2007, the age-adjusted incidence rate for female breast cancer was 121.7 per 100,000 population, representing more than 19,000 newly diagnosed breast cancers. Only lung cancer ac-counts for more cancer deaths in women. The mortality rate for breast cancer in Wisconsin females during 2003-2007 was 22.6 per 100,000 population. This represents 3,784 deaths from breast cancer during this time period. (Tables A & B, pages 48, 52).

The risk of developing breast cancer increases with age. Nation-ally, 95% of new cases and 97% of breast cancer deaths occur in women aged 40 and older. In Wisconsin, during the five year period from 2003 to 2007, approximately 95% of women who developed breast cancer were aged 40 and over, and 79% of women diagnosed with breast cancer were aged 50 and over. Of women who died from breast cancer in Wisconsin, 98% were over age 40 and 89% were aged 50 and older.

Earlier diagnosis and treatment have resulted in a reduction in mortality from breast cancer. Breast cancer mortality declined significantly from the 1997 rate of 25.9 per 100,000 population to the 2007 rate of 20.8 per 100,000 (Table 4, page 15).

Nationwide, after increasing from 1994 to 1999, female breast cancer incidence rates decreased from 1999 to 2006 by 2.0% each year. This decrease may reflect reductions in the use of menopausal hormone therapy (MHT), previously know as hormone replacement therapy, following the publication of results from the Women’s Health Initiative in 2002, which linked combined estrogen plus progestin MHT use to increase risk of breast cancer and coronary heart disease. In Wisconsin, the female breast cancer incidence rates has dropped from 133.7 per 100,000 population in 1997 to 116.8 per 100,000 population in 2007 (Table 3, page 15). Each year, about 50 men are diagnosed with breast cancer in Wisconsin and approximately 1,900 men are diagnosed with the disease nationally. Clinically, breast cancer in men is very similar to breast cancer in women, but the prognosis is often worse for men because they tend to be diagnosed at a later stage than women.

Stage at DiagnosisThe national five-year relative survival rate for women diagnosed with breast cancer at the local stage is 98%. Nationally, during 1999-2006, 60% of invasive breast cancer cases were diagnosed early, or at the local stage. In Wisconsin, 61% of invasive female breast cancers during that same period were diagnosed at the local stage.

Figure 13, page 25 shows both pre-invasive and invasive breast cancers in Wisconsin. It illustrates the percentage of diagnoses at the pre-invasive, or in situ stage, increased from approxi-mately 16% in 1997 to 20% in 2007. This increase in pre-invasive breast cancer largely reflects a rise in mammography use. Early detection through mammography screening provides the best chance of discovering breast cancer at an early stage and increasing survival.

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 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.


In Situ Regional Distant/Systemic

Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010. 1. Refer to page 57 for definitions of stage at diagnosis.

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Overview

Prostate cancer is the most commonly diagnosed cancer among men, excluding skin cancer. It is estimated that about 1 in 6 men in the U.S. will be diagnosed with prostate cancer during their lifetime. Prostate cancer is typically a disease found among older men and often is a relatively slow growing cancer. When prostate cancer is diagnosed at the localized or regional stage, the 5-year survival rate approaches 100%.

Risk FactorsAlthough a specific cause is unknown, the American Cancer Society recognizes that several risk factors may contribute to the development of prostate cancer. They include:

• Increasing age

• Race (African-American men have higher incidence and mortality rates than other races. Their mortality rate from prostate cancer is twice as high as white men.)

• Family history (Having a father or brother with prostate cancer can double a man’s risk of developing this disease.)

• Diet (Diets high in fat and red meat and low in fruits and vegetables may increase the chance of developing prostate cancer.)

Prevention/Screening/Early DetectionThree of the four main risk factors for prostate cancer are not preventable (age, race, family history), but maintaining a healthy body weight and being physically active may reduce the risk of developing aggressive prostate cancer and improve outcomes following treatment.

Most prostate cancers are diagnosed before symptoms develop through prostate specific antigen (PSA) screening or a digital rectal exam (DRE). The American Cancer Society recommends that 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, 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 relative (father or brother) diagnosed with prostate cancer before age 65, should receive this information beginning at age 45.

Cancer BurdenProstate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among men. In Wis-consin from 2003-2007, the average number of newly diagnosed prostate cancers per year was 3,992 (age-adjusted rate of 148.3 cases per 100,000 population) and the average number of deaths per year was 632 (27.1 deaths per 100,000 population). Nationally, the incidence rate was higher for that same period, 163.1 per 100,000. However, the national death rate, 24.7 per 100,000, was lower than Wisconsin’s rate (Tables 1 and 2, pages 10 and 11).

Stage at DiagnosisThe majority of prostate cancers were diagnosed at the local stage (Figure 14, page 27). In Wisconsin, the percent of prostate cancer diagnosed at the local stage increased from 77% in 1997 to 81% in 2007. However, in Wisconsin and nationally, African-American men were more likely to be diagnosed at a distant stage than men of other races. The national five-year survival rate, all races combined, for locally and regionally diagnosed prostate cancers was 100%. However, the survival rate for prostate cancer diagnosed at the distant stage dropped to 30%.

Prostate Cancerin Wisconsin

American Cancer Society Screening Recommendations for Prostate CancerAsymptomatic 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 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.


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Figure 14. Trends in Prostate Cancer Stage at Diagnosis in Wisconsin, 1997-2007


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Overview The number of melanoma cases in the United States, as well as Wisconsin, is increasing. From 1997 to 2007, the number of melanomas diagnosed in Wisconsin increased from 602 to 973. Although melanoma accounts for only 4% of all skin cancers, it causes 79% of skin cancer deaths. Fortunately melanoma is often curable if detected and treated at early stages.

Skin Cancer Definition Skin cancer is the most common form of cancer in the United States. Most skin cancers are classified as nonmelanoma (basal cell or squamous cell) and develop on sun-exposed areas of the body. Although these cancers are highly curable if detected and treated early, basal cell and squamous cell carcinomas can cause considerable damage and disfigurement if left untreated.

Melanoma is a skin cancer that develops in melanocytes, the cells that produce our skin color. This type of cancer can spread quickly to other parts of the body. Even though melanoma is very curable when detected in its early stages, melanoma is far more dangerous than other skin cancers.

Risk FactorsSeveral risk factors may contribute to the development of melanoma. They include:

• Personal or family history of melanoma

• Presence of atypical or numerous moles (more than 50)

Risk factors for the development of all types of skin cancer:

• Sun sensitivity (sunburning easily, difficulty tanning, natural blond or red hair color)

• A history of excessive sun exposure, including sunburns

• Use of tanning booths

• Personal history of skin cancer

• Diseases that suppress the immune system

Prevention/Screening/Early DetectionSkin should be protected from intense sun exposure by cover-ing with clothing or a hat and applying sunscreen that has a sun protection factor (SPF) of 15 or higher to uncovered skin. Children in particular should be protected from the sun because severe sunburns in childhood may greatly increase risk of melanoma in later life.

In order to detect skin cancer early, it is important to recognize changes in skin growths or the appearance of new growths. A new or unusual lesion should be evaluated promptly by a physician.

Signs and Symptoms of Skin CancerKey warning signs of melanoma include changes in size, shape, or color of a skin lesion or the appearance of a new growth on the skin. Basel cell carcinomas may appear as growths that are flat, or as small, raised, pink or red, translucent, shiny areas that may bleed following minor injury. Squamous cell cancer may appear as growing lumps, often with a rough surface, or as flat, reddish patches that grow slowly. Another sign of basal and squamous cell skin cancers is a sore that doesn’t heal.

Melanoma/Skin Cancerin Wisconsin

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. – 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 sunscreen with a sun protection factor (SPF) of 15 or higher.

• Avoid indoor tanning booths and sunlamps

• Sunburn protection should be emphasized in children; severe sunburns in childhood greatly increase the risk of melanoma in later life.

Early Detection of skin cancer: A simple ABCD rule outlines the warning signals of melanoma:

A is for asymmetry: one half of the mole does not match the other half.

B is for border irregularity: the edges are ragged, notched, or blurred.

C is for color: the pigmentation is not uniform, with variable degrees of tan, brown or black.

D is for diameter greater than six millimeters: any sudden or progressive increase in size should be of concern.


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Figure 15. Trends in Melanoma Stage at Diagnosis in Wisconsin, 1997-2007


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Cancer BurdenEvery year, approximately 925 Wisconsin residents were diag-nosed with melanoma, and 152 died from the disease between 2003 and 2007. Since 1997 the incidence rate has increased by almost 44%, from 11.4 to 16.4 per 100,000. The Wisconsin inci-dence rate for 2003-2007 was 15.9, lower than the national rate of 20.8 per 100,000. The Wisconsin mortality rate has remained stable at around 2.6 per 100,000, close to the national rate of 2.7 (for 2003-2007) (Tables 1 and 2, pages 10 and 11). Approximately 63% of the melanoma deaths occurred in men and 37% of the deaths occurred in women. Due to historical lower reporting for this cancer site (often diagnosed at clinic and outpatient set-tings), the reader should use some caution in making inferences from Wisconsin incidence data for melanoma.

Stage at DiagnosisMelanoma can spread to other parts of the body quickly, but is highly curable if detected early. The five-year national survival rate for patients with melanoma is 91%. For localized mela-noma, the national five-year survival rate is 98%. About 84% of

invasive melanomas in the U.S. are diagnosed at the local stage. In Wisconsin, 79% of invasive melanomas were diagnosed at the local stage in 2007.

Figure 15 shows trends in stage at diagnosis of invasive mela-nomas in Wisconsin. The percent of melanomas diagnosed in Wisconsin at the localized stage has remained high during 1997-2007, ranging from 71% to 81% each year.


Overview Screening tests offer a powerful opportunity for the prevention, early detection and successful treatment of cervical cancer. National cervical cancer incidence and mortality rates decreased 50% over the past three decades with most of the reduction attributed to the Pap test. Approximately 95% of Wisconsin women have had a Pap test at some time in their lives.

Risk Factors The primary cause of cervical cancer is infection with certain types of Human Papilloma Virus (HPV). Factors that increase a woman’s risk for cervical cancer and HPV infection include:

• Women who begin having sex at an early age

• Women who have many sexual partners, however, a woman may be infected with HPV even if she has had only one sexual partner

• Long term use of oral contraceptives

Prevention/Screening/Early DetectionCervical cancer is closely linked to sexual behavior and to sexually transmitted infections with certain types of Human Papilloma Virus (HPV). The Food and Drug Administration (FDA) has approved two vaccines for the prevention of the most common HPV infections that cause cervical cancer. The vaccines cannot

protect against established infections, nor do they protect against all HPV types. To be most effective, the HPV vaccine should be given before a person becomes sexually active.

Screening can prevent cervical cancer by detecting precancerous lesions. As screening has become more common, pre-invasive lesions of the cervix are detected far more frequently than invasive cancer. Cervical cancer can be cured if detected early.

Invasive cervical cancer has decreased significantly during the past 25 years due to increased screening with Pap tests. Since 2001, the percentage of Wisconsin women who reported having had a Pap test during the past three years has declined (Fig-ure 16). In 2001, 90% of Wisconsin women aged 18 and older reported having had a Pap test in the past three years. In 2008, 83% of adult women reported comparable Pap tests within that time frame.

American Cancer Society Screening Recommendations for Cervical CancerCervical 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 hysterec-tomy may choose to stop cervical cancer screening.

Cervical Cancer in Wisconsin

Figure 16. Trends in Prevalence Among Women Aged 18 Years and Older Who Have Had a Pap Smear Within Past Three Years in Wisconsin, 1998-2008

Source: Wisconsin Behavioral Risk Factor Surveillance System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.1. BRFS data for this figure are available for years: 1998, 1999, 2000, 2001, 2002, 2004, 2006, 2008.

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Cancer BurdenIn an average year, 189 Wisconsin women develop invasive cervical cancer and 58 women die of the disease (Tables 1 and 2, pages 10 and 11). The incidence rate of cervical cancer in Wis-consin from 2003-2007 was 6.6 per 100,000 population and the mortality rate was 1.9 per 100,000 population. The national inci-dence rate for those same years was 6.8 per 100,000 population and the national mortality rate was 2.4 per 100,000 population.

Stage at DiagnosisEarly detection through Pap screening provides the best chance of discovering cervical cancer at a local stage. Early stage invasive cervical cancer is one of the most successfully treatable cancers. In Wisconsin, from 1997-2007, the percent of invasive cervical cancers diagnosed at the local stage decreased from 51% to 48% (Figure 17). Nationally, during 1999 to 2006, 49% of cervical cancer cases were diagnosed early (at a local stage), and the relative survival rate for women diagnosed at the local stage was 91%.


Overview The types of cancers that occur in children vary greatly from those seen in adults. Leukemia, brain and other nervous system tumors, lymphoma (lymph node cancer), bone cancer, soft tis-sue sarcoma, and kidney cancer are the most common cancers of children. Because of significant advances in therapy, 80% of these children will survive five years or more, an increase of 40% since the early 1970s. Despite its rarity and the impressive improvements in treatment, cancer is still the leading cause of death from disease in children under 15, and is second only to accidents in most age groups. Encouragingly, childhood cancer mortality rates in the U.S. declined 53% from 1975-2007; mortal-ity for all childhood cancer was 4.9 per 100,000 population in 1975 compared with 2.3 per 100,000 in 2007.

Burden of Childhood Cancer in WisconsinAn estimated 175 children under the age of 15 in Wisconsin were diagnosed with cancer in 2007, and 25 children died from the disease. That year, the age-adjusted incidence rate for child-hood cancer in Wisconsin was 16.1 per 100,000 population and the cancer mortality rate that year was 2.3 per 100,000 popula-tion. In 2007, the most frequently diagnosed childhood cancers

in Wisconsin were leukemia (38%), brain cancer (23%), and lymphoma (6%).

Trends in Childhood Cancer Figure 18 shows the trends in childhood cancer during 1995-2007 for Wisconsin and the U.S.

The incidence rate for all childhood cancer in Wisconsin has varied more than the national rate, in part due to the relatively small number of cases each year. Wisconsin’s childhood mortal-ity rates were similar to U.S. mortality rates, but showed more variation from year to year.

Childhood Cancer in Wisconsin

Figure 18. Childhood Cancer in Wisconsin and U.S., 1995-2007

Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services and Surveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2010.1. Rates are per 100,000 population and age-adjusted to the U.S. standard population.

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Overview

Approximately one-third of the cancer deaths that occur in the U.S. each year are due to poor nutrition and physical inactivity, including excess weight. For the majority of people, next to not smoking tobacco, healthy dietary choices and physical activity are the most important choices they can make to reduce their cancer risk. Excessive caloric intake combined with inadequate physical activity leads to obesity. Being overweight and obese are clearly associated with increased risk for developing many cancers, including cancers of the breast in postmenopausal women, colon, endometrium, kidney, and adenocarcinoma of the esophagus. Evidence is highly suggestive that obesity also increases risk for cancers of the pancreas, gallbladder, thyroid, ovary, and cervix, as well as for myeloma, Hodgkin lymphoma and aggressive forms of prostate cancer. At the same time that evidence connecting excess weight to increased cancer risk has been accumulating, the rates of overweight and obesity have been increasing.

Physical activity indirectly reduces the risk of developing the many types of obesity related cancers because of its role in helping to maintain a healthy weight. Being active is thought to reduce cancer risk largely by improving energy metabolism and reducing circulating concentrations of estrogen, insulin, and insulin-like growth factors.

Recommendations for Community Action Public, private and community organizations should work to create social and physical environments that support the adoption and maintenance of healthy nutrition and physical activity behaviors.

• Increase access to healthful foods in schools, work sites and communities.

• Provide safe, enjoyable and accessible environments for physical activity in schools and for transportation and recreation in communities.

Reducing the Risk of CancerFactors that influence the risk of cancer such as age, gender, or family history cannot be modified and are classified as non-modifiable risk factors. Lifestyle factors that influence cancer risk, such as dietary and physical activity level and exercise habits, are modifiable. By changing these modifiable aspects of their lifestyle, people may reduce their risk of cancer.

Consuming Fruits and VegetablesThere is large gap between the current dietary recommenda-tions (five or more fruits and vegetables daily) and actual consumption patterns. Less than one in four adults in the U.S. reported eating five or more servings of vegetables and fruits daily in 2009. Similarly, only 23% of Wisconsin residents reported eating five or more servings of fruits and vegetables per day in the 2009 Wisconsin Behavioral Risk Factor Surveillance System (BRFSS).

Below are the groups that reported the highest percentage of “Consumed Fewer than Five Fruits and Vegetables Daily”:

• Adults aged 18 to 34 – 82%

• Adults with annual household income under $15,000 – 86%

• High school graduates, or less than high school education – 82%

• Hispanics* – 80%

* for combined years 2007-2009

American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer PreventionMaintain a healthful weight throughout life.

• Balance caloric intake with physical activity.

• Avoid excessive weight gain throughout life.

• Achieve and maintain a healthy weight if currently overweight or obese.

Adopt a physically active lifestyle.

• Adults: engage in at least 30 minutes of moderate to vigorous physical activity, above usual activities, on five or more days of the week; 45 – 60 minutes of intentional physical activity is preferable.

• Children and adolescents: engage in at least 60 minutes per day of moderate to vigorous physical activity at least five days per week.

Consume a healthy diet, with an emphasis on plant sources.

• Choose foods and beverages in amounts that help achieve and maintain a healthy weight.

• Eat five or more servings of a variety of vegetables and fruits each day.

• 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 or two per day for men.

Nutrition, Physical Activity, Obesity, Alcohol and Cancer


To improve dietary habits, both individual and community actions are important. Consumers should ask for nutritional in-formation when it is not available and request healthy changes to menu items in restaurants. Community programs are needed to support educational programs that promote nutritional qual-ity in food selections and to ensure quality meals are offered in public schools and other settings away from the home.

Physical Activity Many Wisconsin adults live relatively inactive lifestyles. Regular physical activity can lower cancer risk by maintaining a healthy weight, since obesity is a risk factor for many types of cancer. Insufficient physical activity is defined as adults having less than 30 minutes of moderate physical activity five or more days per week, or vigorous physical activity for at least 20 minutes three or more times per week. Almost one-half, or 47%, of Wisconsin adults reported less than moderate or vigorous physical activity.

In 2009, the highest percentage of insufficient physical activity was reported by following the groups of Wisconsin adults:

• Adults age 65 and older – 52%

• Adults with an annual household income of less than $15,000 – 58%

• Adults with high school education, or some college – 50%

• American Indian* – 52%


Increased opportunities for physical activity require individual and community efforts to provide social support, environmental opportunity and political policies promoting more accessible recreational facilities. Community programs need to include walking and bicycling trails, walking groups in malls, as well as incentives for physical activity during the workday at places of employment.

From an extensive array of activities (whether gardening, dancing, pushing a stroller, sports or walking) everyone should engage in physical activities that are fun, easy, practical and appropriate in relation to any health conditions.

ObesityObesity has reached epidemic proportions in the United States and in Wisconsin. The percentage of overweight and obese adults has increased dramatically in Wisconsin over the last decade. Being overweight is defined as a body mass index (BMI) of 25.0-29.9 kg/m2 and obesity is defined as a BMI equal to or greater than 30 kg/m2. According to the Wisconsin 2009 BRFSS, 36% of Wisconsin adults are overweight and 29% are obese. The percentage of obesity is highest among:

• Adults aged 50-64 – 34%

• Adults with an annual household income less than $15,000 – 41%

• Adults with less than a high school education – 37%

• African Americans* – 43%


Current behaviors such as eating meals away from home, reduced physical activity, longer work hours and the increased availability of electronic entertainment contribute to lifestyles highly conducive to weight gain. If the environments where people live, work, go to school and enjoy leisure time are not oriented to improve their eating and activity habits, efforts to decease obesity will have limited success. Community strategies are needed to create environments that support healthy dietary and physical activity behaviors. Strategies range from work site policies and benefit packages that support health promotion activities to school-based physical education programs that reward physical activity achievements.

Alcohol Consumption Alcohol consumption increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver and breast. For each of these cancers, risk increases substantially with the intake of more than two drinks per day. The combination of alcohol and tobacco significantly multiplies the risk for cancers of the mouth, larynx and esophagus more than either alcohol or tobacco use alone. The American Cancer Society recommends people who drink alcohol should limit their intake to no more than two drinks per day for men and one drink a day for women.

According to the BRFSS, 2009, Wisconsin had one of the highest rates of heavy drinking among all states. Heavy drinking was defined as when adults on average consume two or more drinks per day, or 60 or more alcoholic drinks a month for men and one or more drinks per day or 30 or more drinks a month for women. In Wisconsin, 8% of adults reported heavy drinking compared to 5% of the adults nationwide. The percentage of heavy drinking was highest among:

• Adults aged 18-34 – 10%

• Adults with annual household incomes of $15,000 - $24,999 – 10%

• Adults with a high school education – 10%

• American Indians* – 11%



0

Insufficient Physical Activity

Perc

ent

00

20

30

40

50

Source: Wisconsin Behavioral Risk Factor Surveillance System, 2009, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.Notes: Obesity is defined as Body Mass Index = 30.0-99.8.Insufficient Physical Activity is less than 30+ minutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ minutes three or more days per week.Heavy drinking is defined as 2 or more drinks per day for men and one or more drinks per day for women.

Obesity Fewer than 5 Fruits/Veg

0

20

40

60

80 18-34

35-49

50-64

65+

Heavy Drinking

Figure 19. Prevalence of Obesity, Nutrition, Sedentary Lifestyle and Heavy Drinking Among Adults Aged 18 and Older, by Age, in Wisconsin, 2009

Risk Factors


0


Figure 20. Prevalence of Obesity, Nutrition, Sedentary Lifestyle and Heavy Drinking Among Adults Aged 18 and Older, by Race/Ethnicity, in Wisconsin, 2007 and 2009*

Perc

ent

00

20

40

50

Source: Wisconsin Behavioral Risk Factor Surveillance System, 2009, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.Notes: Obesity is defined as Body Mass Index = 30.0-99.8.Insufficient Physical Activity is less than 30+ minutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ minutes three or more days per week.Heavy drinking is defined as 2 or more drinks per day for men and one or more drinks per day for women.*For combined years 2007 and 2009.

Obesity Fewer than 5 Fruits/Veg Heavy Drinking

White

Black

American Indian

Hispanic

0

10

20

30

40

50

60

70

80

Risk Factors


0

Figure 21. Prevalence of Obesity, Nutrition, Sedentary Lifestyle and Heavy Drinking Among Adults Age 18 and Older, by Income, in Wisconsin, 2009

Perc

ent

00

20

40


Heavy Drinking

< $15,000

$15,000-$24,999

$25,000-$34,999

$35,000-$49,999

$50,000+

0

20

40

60

80

Obesity Fewer than 5 Fruits/Veg Insufficient Physical Activity

Risk Factors


0


Perc

ent

00

20

40


Obesity Fewer than 5 Fruits/Veg Heavy Drinking

Less than High School

High School Grad

Some College

College Graduate

0

20

40

60

80

Figure 22. Prevalence of Obesity, Nutrition, Sedentary Lifestyle and Heavy Drinking Among Adults Aged 18 and Older, by Education, in Wisconsin, 2009

Risk Factors


According to the U.S. Census Bureau, the Wisconsin population increased by 9% from 2000 to 2009 and reached more than 5.6 million in 2009. Approximately 11% of Wisconsin residents are racial minorities: 6% African American, 1% American Indian, 2% Asian, with 1% multiple race. Including all races, more than 5% are of Hispanic or Latino ethnicity. In 2008, cancer was one of the two leading causes of death among all Wisconsin residents and accounted for 23.9% of deaths; only heart disease caused more deaths, at 24.2%. However, cancer was the leading cause of death among African Americans, American Indians, and Asian residents, while heart disease was the leading cause among whites.

The risk of developing and dying from cancer varies by race. During 2003-2007, Wisconsin’s age-adjusted incidence rate was 473.3 per 100,000 population. However, when examined by racial group, the incidence rates ranged from 293.3 for Asians to 556.6 for African Americans (Table 5, page 40). The same pat-tern was reflected in cancer mortality. The state mortality rate was 182.0 per 100,000 population, but the rates by racial group ranged from 98.1 for Asian/Pacific Islanders to 253.8 for African Americans (Table 6, page 41). Hispanics/Latinos of any race experienced the lowest rate of cancer mortality, 90.1 per 100,000 population.

For all cancer combined, incidence rates among African Ameri-cans were higher than the state average and highest of all racial groups during 2003-2007 (Figure 23, page 40). African Ameri-cans also had the highest incidence rates of the lung, colorectal and prostate cancers. Mortality rates were also higher for all cancers combined and the major cancers profiled in this report (Figure 24, page 41). The largest disparity between white and African-American mortality rates occurs for prostate and lung cancers (African-American rates being 80% and 66% higher than the white rates, respectively).

Female Breast Cancer While African-American women in Wisconsin are less likely to be diagnosed with breast cancer than white women (116.8 cases per 100,000 African-American women compared to 121.7 cases per 100,000 white women), they are more likely to die from the disease (26.5 per 100,000 African-American women compared to 22.6 per 100,000 white women). This may be due to diagnoses at later stages of the disease for African Americans and a higher frequency of more aggressive tumors.

Prostate Cancer During 2003-2007, African-American males experienced higher prostate cancer incidence and mortality rates than whites (243.7 cases per 100,000 and 48.4 deaths per 100,000 African-American males as compared to 142.6 cases per 100,000 and 26.7 deaths per 100,000 for white males).

Lung Cancer Lung cancer rates among African-American males were almost twice as high (141.5 incidence rate and 117.8 mortality rate, per 100,000 population) as rates among white males (73.7 incidence rate and 60.9 mortality rate). American Indian males also experienced high incidence and mortality rates of lung cancer (97.6 and 87.9, respectively, per 100,000 population) that exceeded comparable rates for white males.

Colorectal Cancer African Americans and American Indians in Wisconsin experienced higher colorectal incidence rates than whites (61.8 and 57.6 compared with 46.5, respectively, per 100,000 population) and higher colorectal mortality rates than whites (23.1 and 20.4 compared with 16.3, respectively, per 100,000 population).

The reasons behind the incidence and mortality disparities between racial and ethnic groups are not clearly defined. Explanations vary from problems with accurate reporting of racial information on incidence reports and death certificates to differences among socioeconomic, lifestyle, environmental, genetic, occupational and dietary factors. Access to care and timing of diagnoses (late stage diagnoses reduce treatment options and chances of long-term survival) are also important aspects in determining reasons for the disparities.

Cancer in Diverse Populations


0

Figure 23. Age-Adjusted Cancer Incidence Rates by Race and Ethnicity in Wisconsin, 2003-2007

Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.1. Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.2. Hispanic/Latino category includes all races.

00

100

200

300

400

500

600

Colon & Rectum

Rat

e p

er 1

00,0

00

White

African American

American Indian

Asian/Pacific Islander

Hispanic/Latino

All Races

All Sites Lung & Bronchus Female Breast Prostate

Cancer Site

All sites Male and Female Male Female

Lung & Bronchus Male & Female Male Female

Colon & Rectum Male and Female Male Female Breast Female

Cervical

Prostate

473.7542.9425.3

63.476.853.7

47.654.542.1

121.7

6.6

465.9530.1421.5

61.373.752.5

53.241.1

121.7

6.1

142.6

556.6710.2450.2

99.4141.570.3

61.871.2

116.8

12.9

243.7

293.3306.2293.8

31.835.6*30.4*

28.634.4*25.6*

74.8

11.1*

73.5

429.8470.5408.0

85.497.677.2

57.666.3*52.3*

87.0

13.6*

340.7 356.2334.3

35.936.335.3

36.141.930.8

92.4

15.3*

148.3

46.5

55.8

102.4 97.0

African Asian American/ Hispanic/Site All Races White American Pacific Islander American Indian Latino

Table 5. Age-adjusted Cancer Incidence Rates, by Race/Ethnicity and Sex, in Wisconsin, 2003-2007

Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.1. Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.2. Hispanic/Latino category includes all races. 3. * Rate based on small number (fewer than 20 cases) for the five-year period.


All Malignant Cancers Male and Female Male Female

Lung & Bronchus Male & Female Male Female

Colon & Rectum Male and Female Male Female Breast Female

Cervix Uteri

Prostate

182.0223.5154.5

48.562.338.5

16.519.914.0

22.6

1.9

179.8220.4152.9

47.660.938.1

19.613.7

22.6

1.6

26.7

253.8340.5198.5

78.9117.852.5

23.128.6

26.5

5.2*

48.4

98.198.597.4

16.5*21.9*13.4*

9.0*5.9*

7.6*

4.5*

5.0*

229.4276.1201.1

73.187.964.4

20.4*34.8*12.1*

25.4*

4.5*

90.1109.0

73.6

17.924.5*11.8*

7.5*7.1*7.7*

7.3*

2.4*

27.1

16.3

19.6

32.0* 6.0*

10.8*

African Asian American/ Hispanic/Site All Races White American Pacific Islander American Indian Latino

Table 6. Age-adjusted Cancer Mortality Rates, by Race/Ethnicity and Sex, in Wisconsin, 2003-2007

Source: National Center for Health Statistics. 1. Rates are per 100,000 and age-adjusted to the 2000 U.S. standard population.2. * The number of deaths used to calculate the rate was less than 10 deaths per year and the rate may be subject to great variability.

0

Figure 24. Age-Adjusted Cancer Mortality Rates by Race and Ethnicity in Wisconsin, 2003-2007

Source: National Center for Health Statistics.1. Rates are per 100,000 population and are age-adjusted to the 2000 U.S. standard population. 2. Hispanic/Latino category includes all races.

0

White

African American

American Indian

Asian/Pacific Islander

Hispanic/Latino

0

50

100

150

200

250

300

All Races

All Sites Lung & Bronchus Female Breast Prostate Colon & Rectum

Rat

e p

er 1

00,0

00

Cancer Site


What Percentage of People Survive Cancer? The fi ve-year relative survival rate for all cancers in the U.S. di-agnosed during 1999-2006 was 68%, up from 50% in 1975-1977. The National Cancer Institute estimates there are more than 11 million cancer survivors in the United States. The survival rate is different for different types of cancer, as cancer sites vary in the rate of growth and likelihood of early detection. The fi ve-year relative survival rate represents persons who are living fi ve years after diagnosis whether disease free, in remission, or under treatment with evidence of further cancer, after adjusting for

normal life expectancy (factors such as dying of heart disease, accidents and diseases of old age). Although fi ve-year survival rates are useful in monitoring progress in detection and treat-ment of cancer, they do not represent the proportion of people who are cured or permanently free of cancer.

The fi ve-year relative survival rates for major cancer sites de-cline with the advance of the disease at the time of diagnosis. Cancer is staged at the time of diagnosis based on the extent of the disease from the site of origin. Summary staging (in situ, lo-cal, regional and distant) is used by cancer registries for analysis relevant to diagnosis, treatment and survival statistics. See Glossary on page 57 for defi nitions of each summary stage.

The fi ve-year relative survival rates for major cancer sites in the United States are shown in Table 7.

Cancer Survivorship andQuality of Life

Table 7. Five-Year Survival Rates for Major Invasive Cancers by Stage at Diagnosis, United States, 1999-2006

Source: Surveillance, Epidemiology, and End Results Program, SEER Cancer Statistics Review 1975-2007, National Cancer Institute, 2010.1. In Situ cases are not included in the "all stages" group.2. Refer to page 57 in the glossary for definitions of stage at diagnosis.

Site All Stages Local Regional Distant Unstaged In Situ

% % % % % %Female Breast 89.0 98.0 83.6 23.4 57.9 100.0

Colon & Rectum

Esophagus

Kidney

Lung & Bronchus

Melanoma

Ovary

Pancreas

Prostate

Stomach

Thyroid

Uterine

Urinary Bladder

65.0 94.0 69.5 11.6 38.3

17.0 37.4 18.8 3.2 12.1

68.8 90.3 62.7 10.6 37.8

15.8 52.9 24.0 3.5 8.7

91.4 98.0 62.1 15.9 76.0

45.6 93.5 73.4 27.6 27.2

5.6 22.5 8.8 1.9 5.0

99.1 100.0 100.0 30.2 75.0

26.0 62.5 27.0 3.4 17.3

97.3 99.8 97.1 58.1 89.7

82.7 95.5 67.5 17.1 55.5

79.3 73.3 36.1 5.6 55.3 96.6

Cervix 70.2 91.2 57.8 17.0 58.1


Quality of Life FactorsFrom the time of diagnosis, the quality of life for every cancer patient and survivor is affected in some way.

Lung - People with lung cancer tend to be distressed about their physical appearance, including weight loss, the social stigma and guilt associated with a history of tobacco use and end of life issues due to the low survival rate for this cancer.

Colon and Rectal - People with colorectal cancer are often concerned with bowel dysfunction and the associated social stigma, as well as the effects of chemotherapy and radiation.

Female Breast - Women with breast cancer often feel uncertainty about treatment options and have concerns about their fatigue, sexuality and body image.

Melanoma of the Skin - People with skin cancer may have a fear of possible disfi gurement, and concern about protecting their skin from the sun may greatly increase.

Cervical - Women with cervical cancer also are often concerned about whether they will be able to get pregnant.

The American Cancer Society supports programs that empower cancer patients, survivors and their families to seek and recognize ongoing sources of support within their community.

Comprehensive cancer information and access to community based support are available 24-hours a day, seven days a week, by calling 1.800.227.2345 or visiting www.cancer.org.


The Wisconsin Comprehensive Cancer Control Plan 2010-2015 (WI CCC Plan) was developed in collaboration with partners across Wisconsin. Strategies and action steps across the cancer continuum are presented throughout the WI CCC Plan for organizations to implement over the next five years to reduce the burden of cancer in the state.

Here are a few examples of strategies and action steps from the plan that could be implemented by you and/or your organization. In no way is this list exhaustive of all the possible ways you or your organization might work to reduce the burden of cancer in Wisconsin over the next five years. Refer to the complete WI CCC Plan 2010-2015 for all the proposed strategies and action steps. The WI CCC Plan 2010-2015 can be accessed at www.wicancer.org.

How Can You Use the Wisconsin Comprehensive Cancer Control Plan 2010-2015?

If you are a Community Based Organization:

• Decrease youth tobacco use in your community through programs and policy.

• Create a local level action plan to eliminate barriers to cancer screenings.

• Provide community based educational forums to address specific and unique needs of cancer survivors.

• Work with health systems to improve health literacy resources for patients.

• Inform cancer patients that quality symptom management is an expected part of their cancer care.

If you are a State or Local Public Health Agency:

• Decrease youth tobacco use in your community through programs and policy.

• Promote physical activity and healthy balanced diets to those living in your community.

• Promote programs that cover recommended screenings for the underinsured or uninsured.

• Promote the use of existing cancer-related data and relevant reports.

• Collect data to measure emerging needs identified within the chapters of WI CCC Plan.

If you are a Health Care System:

• Implement office based reminders that identify patients due for cancer prevention and screening services.

• Seek and apply for accreditation by the American College of Surgeons.

• Increase the availability of culturally appropriate patient navigation systems within your health system.

• Practice shared decision making between providers, patients and family at your health system.

• Put survivorship best practice models into practice system wide.

• Promote advanced directives conversations with providers, patients and families.

• Ensure all cancer cases are reported as mandated to the Wisconsin Cancer Reporting System.

If you are a Health Care Provider:

• Ask all your patients if they smoke and provide tobacco cessation interventions to patients who do smoke.

• Screen patients for obesity and work with those that are receiving treatment.

• Encourage patients to get their recommended cancer screenings.

• Follow nationally validated practice guidelines when treating a cancer patient.

• Provide cancer patients with a written synopsis of their coordinated care plan.

• Pursue continued education to increase understanding of survivor needs and available best practices.

• Talk with your patients about the benefits of palliative care.

If you are a Advocacy Organization:

• Advocate for full funding of the Wisconsin Tobacco Prevention & Control Program.

• Advocate for regulation of tanning beds.

• Support legislation to provide insurance coverage and funding for recommended cancer screenings.

• Advocate for legislation to increase funding for survivorship services, research and surveillance.

• Advocate for the completion of advance care documents for all cancer patients.

• Advocate for full funding of the Wisconsin Cancer Reporting System.

If you are a Legislator:

• Support full funding of the Wisconsin Tobacco Prevention & Control Program.

• Support the regulation of tanning beds.

• Support legislation that provides full insurance coverage and funding for recommended cancer screenings.

Wisconsin ComprehensiveCancer Control Plan


• Support legislation to improve funding for survivorship services, research and surveillance.

• Support full funding of the Wisconsin Cancer Reporting System.

If you are a Professional Organization:

• Inform professional members of the importance and benefits of providing cancer clinical trials.

• Educate professional members on survivor needs and available best practices.

• Support policy changes and increase funding for survivorship services.

• Train professional members on standard cancer symptom management.

• Partner with other professional organizations to provide cancer risk assessments and counseling.

If you are a Insurance Company or Payer:

• Provide full coverage for tobacco addiction treatments.

• Reimburse for nutrition and physical activity counseling and interventions.

• Provide full coverage for HPV vaccination services.

• Provide incentives to members who get recommended cancer screenings.

• Provide full coverage for recommended cancer screenings.

• Reimburse providers for their time to discuss the importance of advance directives with patients.

• Provide full coverage for cancer risk assessments and genetic testing.

If you are a Business and/or Employer:

• Provide a smoke-free work environment and access to tobacco addiction treatment for employees.

• Encourage employees to be physically active and eat a healthy balanced diet.

• Provide sun-protective gear or products to those working outside.

• Provide full coverage for recommended cancer screenings and time off for employees to get screened.

• Implement a cancer screening event at the workplace.

• Provide information on return to work transition issues to survivors and their co-workers.

If you are an Academic or Research Institution:

• Assess possible environmental issues as they relate to cancer.

• Increase awareness of the connection between alcohol consumption and cancer risk.

• Train professionals on how to address cancer survivorship issues.

• Identify indicators and useful sources of data for monitoring quality symptom management.

• Collect data to measure emerging needs identified within the chapters of WI CCC Plan.

• Create a database to capture data on Wisconsin survivors.

If you are a Educator or School:

• Promote healthy lifestyles behaviors to students and staff.

• Provide information on return to school transition issues to survivors and those in their school environment.

If you are a Survivor:

• Share your experience to help educate the public about the needs of survivors and co-survivors.

• Mentor survivors and co-survivors to be active participants in their medical decision making teams.

• Encourage employers or schools to provide information on transition issues to survivors and others.

• Consider joining an advocacy group or organization working to improve survivors’ experiences.

If you are a Wisconsin Resident:

• Incorporate healthy lifestyles for you and your family.

• Get and follow recommended cancer screenings.

• Complete an advance directive.

WI Comprehensive Cancer Control Website www.wicancer.org


The Wisconsin Well Woman Program (WWWP) was established in 1993 as a state component of the Centers for Disease Control and Prevention’s (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The WWWP is located with the other chronic disease programs, in the Wisconsin Division of Public Health’s (DPH) Bureau of Community Health Promotion.

The program’s primary goal is to reduce mortality from breast and cervical cancers by increasing the number of low-income women who are routinely screened, and by improving the quality of screening, referral and follow-up.

The primary population targeted by the WWWP is women ages 45-64 with low incomes. Women must have a gross household income at or below 250% of the current federal poverty level. A woman who is age and income eligible must be uninsured or underinsured. The program also has some exceptions to the age eligibility criteria for women 65 and older who are not eligible for Medicare or who cannot afford Medicare Part B. The program also has exceptions for women ages 35-44 referred from the Medicaid Family Planning Waiver or women in this age group who have breast symptoms.

The majority of breast cancers can be treated successfully, if detected early. Early stage invasive cervical cancer is one of the most successfully treatable cancers. Early detection with Pap tests at appropriate intervals provides the best chance of discovering cervical cancer at a local stage.

Breast and cervical cancer screening rates among underserved populations are lower than the general population due to many barriers. Access to affordable screening services is a major barrier for some populations.

The WWWP has been providing breast and cervical cancer screening services since June 1, 1994. To date, more than 58,450 women have received screening services. On average, the WWWP has provided screening services to 9,900 women for each of the last three program years.

In calendar year 2009, the program provided screening services to 9,944 women. The majority of these women, 6,617, were ages 50-64. More than 7,400 were white, 553 African American and 1,815 were Hispanic. Program records indicate that 168 American Indian and 95 Asian women also received program screening services. During calendar year 2009, 52 women enrolled in the WWWP were diagnosed with invasive breast cancer and 11 were diagnosed with invasive cervical cancer.

The WWWP is a decentralized statewide screening program, with local coordinating agencies covering the state’s 72 counties and 11 tribes. The local coordinating agencies include local health departments, tribal agencies, family planning agencies and other community-based organizations. Each local coordinating agency has a designated coordinator, who is responsible for implementing local WWWP activities. These activities include recruitment, public education and outreach; eligibility determi-nation and enrollment; case management including follow-up for clients with abnormal screening results; provider support; and assisting women with their treatment needs. The local coordinators are the first line of contact for women accessing the WWWP through the 83 local coordinating agencies.

It has always been the goal of the WWWP to have provider agreements with health care providers across the state so that eligible women have access to screening services within a 50 mile radius of their residence. The WWWP works with mobile providers in some areas in order to improve access to screening services.

The WWWP currently has a statewide network of 995 provider sites. These providers include family planning clinics, hospitals, independent laboratories, mammography facilities, federally qualified health centers, medical clinics, and tribal health clinics. There is at least one screening provider in each of the 72 counties. There are 53 screening providers in the Milwaukee metropolitan area.

In order to maximize resources, coordinate activities and pro-vide services to as many women as possible, the WWWP has partnered with a variety of groups and organizations during its 16-year screening history. These partnerships include nursing schools, community-based organizations, public service organi-zations and other public health programs.

Wisconsin Well Woman Program website:

www.dhs.wisconsin.gov/womenshealth/wwwp

Phone number: 608-266-8311

Wisconsin Well WomanProgram


The following tables present Wisconsin cancer incidence and mortality data from 2003-2007 by county. The number of cases/deaths listed for each county is the total number of cancer cases or deaths, for that county, for the entire 5-year period represented in these tables. Five year age-adjusted rates are also included in the tables; the rates represent the average number of cases or deaths, per 100,000 population, weighted to refl ect the 2000 U.S. standard population. Due to wide variances in county popula-tions, rates are included to allow comparisons between counties. However, the number of cases/deaths should not be directly compared across counties.

The 95% confi dence intervals (95% CI) are also included in the tables to facilitate county comparisons. The range between the lower and upper limits of the confi dence interval defi nes where the “true” age-adjusted rate for the county or state actually falls, within 95% probability.

Comparing two sets of confi dence intervals can be equated to statistical signifi cance testing of county rate differences. A narrow confi dence interval (more common with larger popula-tions) implies that the rate has been more accurately estimated whereas a wider interval implies less certainty that the calculated rate is the “true” rate for that respective county.

Wisconsin Cancer Incidence and Mortality, by County, 2003-2007


Colon & Lung & FemaleCounty Statistic All Sites Rectum Bronchus Breast Prostate

All Counties CasesRate(95% CI)

Adams CasesRate(95% CI)

Ashland CasesRate(95% CI)

Barron CasesRate(95% CI)

Bayfield CasesRate(95% CI)

Brown CasesRate(95% CI)

Buffalo CasesRate(95% CI)

Burnett CasesRate(95% CI)

Calumet CasesRate(95% CI)

Chippewa CasesRate(95% CI)

Clark CasesRate(95% CI)

Columbia CasesRate(95% CI)

Crawford CasesRate(95% CI)

Dane CasesRate(95% CI)

Dodge CasesRate(95% CI)

Door CasesRate(95% CI)

Douglas CasesRate(95% CI)

Dunn CasesRate(95% CI)

Table A: Cancer Incidence, Total Number of Cases and Averaged-Annual Age-Adjusted Rates by County, 2003 - 2007

139,391473.5(471.0 - 476.0)

577391.0(359.0 - 425.5)

456483.5(439.5 - 530.8)

1,225431.3(407.1 - 456.6)

387389.1(350.4 - 431.2)

5,317468.8(456.2 - 481.7)

358409.0(367.3 - 454.5)

420346.3(313.0 - 382.5)841411.5(383.8 - 440.6)

1,577486.2(462.4 - 511.0)

983512.1(480.1 - 545.7)

1,520487.3(462.9 - 512.6)

577546.7(502.2 - 594.2)

8,823431.6(422.4 - 440.9)

2,034424.6(406.3 - 443.6)

1,105531.9(500.3 - 565.3)

951383.5(359.3 - 409.0)

748385.5(358.1 - 414.5)

14,113

56

49

125

55

538

36

39

97

175

86

163

58

778

221

125

83

81

47.6

35.8

50.5

43.6

53.7

47.8

39.1

30.1

49.9

53.5

43.6

51.9

53.4

39.4

45.4

58.1

32.3

40.8

(46.8 - 48.4)

(26.9 - 47.2)

(37.2 - 67.2)

(36.1 - 52.1)

(40.4 - 70.6)

(43.8 - 52.1)

(27.4 - 54.7)

(21.3 - 42.0)

(40.3 - 60.9)

(45.8 - 62.1)

(34.8 - 54.1)

(44.2 - 60.7)

(40.4 - 69.6)

(36.7 - 42.4)

(39.6 - 51.9)

(48.2 - 69.7)

(25.7 - 40.3)

(32.3 - 50.8)

18,558

125

86

161

63

599

44

68

67

219

94

236

95

1,063

280

132

151

93

63.3

81.4

90.7

55.8

62.9

54.5

50.2

52.5

32.9

67.4

48.4

74.5

86.6

55.1

58.5

60.6

60.5

50.0

(62.4 - 64.2)

(67.4 - 97.8)

(72.4 - 112.4)

(47.4 - 65.3)

(48.2 - 81.2)

(50.2 - 59.0)

(36.4 - 67.9)

(40.7 - 67.4)

(25.4 - 41.9)

(58.7 - 77.0)

(39.1 - 59.5)

(65.3 - 84.8)

(69.9 - 106.3)

(51.7 - 58.5)

(51.8 - 65.8)

(50.7 - 72.3)

(51.2 - 71.1)

(40.3 - 61.3)

19,037

50

66

164

48

757

36

57

133

199

129

210

49

1,406

272

161

110

112

121.7

74.0

140.5

113.0

103.6

123.1

83.7

103.4

122.7

116.3

131.7

130.5

92.7

123.9

110.8

156.5

84.5

112.1

(120.0 - 123.5)

(54.0 - 99.7)

(108.1 - 179.7)

(96.0 - 132.4)

(75.3 - 139.8)

(114.4 - 132.3)

(57.8 - 117.9)

(76.8 - 136.9)

(102.5 - 145.6)

(100.5 - 133.9)

(109.1 - 157.6)

(113.2 - 149.9)

(68.0 - 123.9)

(117.4 - 130.7)

(97.9 - 125.0)

(132.5 - 184.2)

(69.3 - 102.3)

(92.0 - 135.3)

19,957

60

54

163

51

763

64

60

147

253

170

213

94

1,235

274

160

139

96

148.2

77.6

123.9

123.2

96.8

147.6

149.0

96.0

150.9

168.4

187.5

147.6

180.0

132.7

122.4

160.5

124.7

111.4

(146.1 - 150.3)

(59.0 - 101.1)

(93.0 - 162.0)

(105.0 - 143.8)

(71.9 - 128.8)

(137.1 - 158.7)

(114.7 - 191.1)

(73.0 - 125.2)

(127.0 - 178.0)

(148.2 - 190.7)

(160.3 - 218.0)

(128.3 - 169.1)

(145.3 - 221.0)

(125.1 - 140.6)

(108.2 - 137.9)

(136.5 - 188.0)

(104.7 - 147.6)

(90.0 - 136.2)



Eau Claire CasesRate(95% CI)

Florence CasesRate(95% CI)

Fond du Lac CasesRate(95% CI)

Forest CasesRate(95% CI)

Grant CasesRate(95% CI)

Green CasesRate(95% CI)

Green Lake CasesRate(95% CI)

Iowa CasesRate(95% CI)

Iron CasesRate(95% CI)

Jackson CasesRate(95% CI)

Jefferson CasesRate(95% CI)

Juneau CasesRate(95% CI)

Kenosha CasesRate(95% CI)

Kewaunee CasesRate(95% CI)

La Crosse CasesRate(95% CI)

Lafayette CasesRate(95% CI)

Langlade CasesRate(95% CI)

Lincoln CasesRate(95% CI)

Manitowoc CasesRate(95% CI)

Table A: Cancer Incidence, Total Number of Cases and Averaged-Annual Age-Adjusted Rates by County, 2003 - 2007 (continued)

1,858

126

2,889

308

1,121

938

632

441

216

569

1,908

829

3,691

549

2,813

377

641

951

2,398

389.7

370.8

523.1

442.5

391.3

468.1

494.8

346.2

423.9

512.1

469.0

524.4

484.3

463.1

503.6

391.6

464.2

505.3

487.8

(372.0 - 408.1)

(307.5 - 445.0)

(504.0 - 542.8)

(393.2 - 496.9)

(368.3 - 415.3)

(438.3 - 499.4)

(456.1 - 536.2)

(314.4 - 380.4)

(366.8 - 488.9)

(470.7 - 556.3)

(448.0 - 490.7)

(489.0 - 561.9)

(468.7 - 500.3)

(424.7 - 504.1)

(485.0 - 522.7)

(352.8 - 433.8)

(428.2 - 502.6)

(473.2 - 539.0)

(468.2 - 508.0)

190

6

320

44

118

122

71

47

29

62

208

84

371

58

260

41

66

106

236

38.3

14.8

55.8

61.3

38.9

58.6

53.1

37.2

51.7

53.7

51.2

52.4

48.9

47.4

45.7

42.7

45.5

52.6

46.6

(33.0 - 44.2)

(5.4 - 36.9)

(49.7 - 62.3)

(44.0 - 83.9)

(32.1 - 46.9)

(48.5 - 70.2)

(41.2 - 67.6)

(27.3 - 49.7)

(34.3 - 77.5)

(41.1 - 69.0)

(44.4 - 58.7)

(41.7 - 65.1)

(44.0 - 54.2)

(35.8 - 61.6)

(40.2 - 51.6)

(30.6 - 58.3)

(35.1 - 58.4)

(43.0 - 64.0)

(40.8 - 53.0)

246

20

355

57

163

110

87

44

47

80

249

150

598

70

354

44

94

139

260

52.3

59.5

64.3

77.3

55.4

54.4

64.0

35.3

90.3

71.2

62.6

94.0

79.8

57.6

63.9

44.8

66.2

71.8

51.2

(45.9 - 59.3)

(36.0 - 94.9)

(57.7 - 71.4)

(58.3 - 101.3)

(47.1 - 64.7)

(44.7 - 65.7)

(51.1 - 79.5)

(25.6 - 47.5)

(66.0 - 123.0)

(56.4 - 88.8)

(55.0 - 71.0)

(79.5 - 110.5)

(73.5 - 86.5)

(44.8 - 73.2)

(57.4 - 71.0)

(32.5 - 60.4)

(53.3 - 81.4)

(60.3 - 85.1)

(45.2 - 58.0)

271

11

394

25

124

120

62

66

21

74

245

85

485

72

390

44

69

137

293

106.8

64.2

135.1

72.5

81.2

113.8

101.0

100.2

91.5

135.1

112.4

104.3

117.1

118.6

129.7

89.5

102.9

142.4

113.5

(94.2 - 120.5)

(31.6 - 122.4)

(121.8 - 149.4)

(46.2 - 109.6)

(66.9 - 97.8)

(94.1 - 136.7)

(76.5 - 131.4)

(77.3 - 127.9)

(55.4 - 146.1)

(105.6 - 170.7)

(98.6 - 127.6)

(82.9 - 129.8)

(106.8 - 128.1)

(92.5 - 150.2)

(117.0 - 143.5)

(64.9 - 120.9)

(79.5 - 131.6)

(119.0 - 169.4)

(100.6 - 127.8)

271

21

419

37

164

102

85

79

18

94

273

113

535

87

477

45

79

130

335

128.5

113.9

168.7

113.8

122.9

112.3

143.2

134.4

68.8

174.9

146.7

149.9

156.2

153.9

191.4

99.8

117.8

145.5

148.6

(113.5 - 145.0)

(70.2 - 180.1)

(152.8 - 185.8)

(79.9 - 158.6)

(104.8 - 143.4)

(91.4 - 136.7)

(114.3 - 177.6)

(106.0 - 167.9)

(40.7 - 114.7)

(141.1 - 214.4)

(129.6 - 165.5)

(123.5 - 180.6)

(143.0 - 170.3)

(123.1 - 190.2)

(174.5 - 209.5)

(72.7 - 134.0)

(93.2 - 147.5)

(121.5 - 173.1)

(133.0 - 165.6)



Marathon CasesRate(95% CI)

Marinette CasesRate(95% CI)

Marquette CasesRate(95% CI)

Menominee CasesRate(95% CI)

Milwaukee CasesRate(95% CI)

Monroe CasesRate(95% CI)

Oconto CasesRate(95% CI)

Oneida CasesRate(95% CI)

Outagamie CasesRate(95% CI)

Ozaukee CasesRate(95% CI)

Pepin CasesRate(95% CI)

Pierce CasesRate(95% CI)

Polk CasesRate(95% CI)

Portage CasesRate(95% CI)

Price CasesRate(95% CI)

Racine CasesRate(95% CI)

Richland CasesRate(95% CI)

Rock CasesRate(95% CI)

Rusk CasesRate(95% CI)


3,181

1,315

627

121

23,074

1,118

1,059

1,457

4,042

2,431

183

512

959

1,350

496

5,068

462

4,095

443

456.7

463.8

604.7

623.2

492.7

487.1

485.2

555.4

487.9

497.3

411.9

305.8

372.8

414.1

471.6

501.7

409.3

499.0

456.0

(440.8 - 473.0)

(438.6 - 490.2)

(557.0 - 655.7)

(511.1 - 752.1)

(486.3 - 499.2)

(458.8 - 516.8)

(456.2 - 515.6)

(526.6 - 585.5)

(472.8 - 503.3)

(477.4 - 517.9)

(353.5 - 477.6)

(279.3 - 334.0)

(349.3 - 397.4)

(392.1 - 437.1)

(430.0 - 516.6)

(487.9 - 515.8)

(372.1 - 449.5)

(483.8 - 514.6)

(413.6 - 502.0)

294

129

56

21

2,392

134

99

152

412

222

20

53

115

119

49

504

65

412

43

41.4

42.4

51.0

117.3

50.6

57.8

44.5

54.7

50.0

45.1

43.4

32.9

43.7

37.2

45.6

50.1

56.5

50.5

42.8

(36.8 - 46.5)

(35.3 - 50.6)

(38.3 - 67.1)

(69.3 - 184.1)

(48.6 - 52.7)

(48.4 - 68.5)

(36.1 - 54.3)

(46.3 - 64.4)

(45.3 - 55.1)

(39.3 - 51.5)

(26.1 - 68.4)

(24.5 - 43.2)

(36.0 - 52.6)

(30.8 - 44.6)

(33.4 - 61.3)

(45.8 - 54.7)

(43.4 - 72.5)

(45.7 - 55.6)

(30.8 - 58.5)

360

182

131

19

3,383

144

170

243

416

255

24

66

134

172

84

694

65

636

69

52.0

62.0

122.5

94.9

73.3

60.9

76.7

87.2

52.2

52.5

54.0

41.5

51.1

54.5

78.0

69.5

55.5

77.4

69.5

(46.7 - 57.7)

(53.2 - 72.0)

(102.1 - 146.3)

(56.4 - 149.9)

(70.8 - 75.8)

(51.3 - 71.8)

(65.5 - 89.2)

(76.6 - 99.2)

(47.3 - 57.5)

(46.2 - 59.4)

(34.4 - 81.2)

(31.9 - 52.9)

(42.8 - 60.7)

(46.6 - 63.3)

(62.0 - 97.4)

(64.4 - 74.9)

(42.8 - 71.2)

(71.5 - 83.7)

(54.0 - 88.6)

483

165

72

17

3,132

152

92

175

594

412

15

81

92

192

63

757

41

509

48

131.5

113.8

156.3

167.9

119.8

130.1

85.2

132.7

131.9

158.1

67.4

89.7

71.6

110.0

112.4

138.5

64.9

115.9

94.8

(119.9 - 144.0)

(96.6 - 133.6)

(120.2 - 200.1)

(96.7 - 271.8)

(115.6 - 124.1)

(110.0 - 152.8)

(68.6 - 104.9)

(113.2 - 154.9)

(121.4 - 143.0)

(143.0 - 174.5)

(37.1 - 113.7)

(71.0 - 111.9)

(57.4 - 88.3)

(94.8 - 126.9)

(85.9 - 145.8)

(128.7 - 148.8)

(45.6 - 90.2)

(105.9 - 126.5)

(69.1 - 127.9)

509

218

82

18

2,959

187

199

203

595

378

31

69

133

190

67

750

36

474

56

158.1

159.4

157.0

196.1

150.3

168.4

180.6

153.6

160.0

156.9

143.5

93.3

112.0

120.0

130.0

163.8

66.2

124.7

119.3

(144.5 - 172.6)

(138.9 - 182.4)

(124.6 - 196.1)

(109.9 - 320.4)

(144.8 - 155.8)

(144.9 - 194.7)

(156.2 - 208.0)

(133.1 - 176.9)

(147.2 - 173.6)

(141.2 - 174.0)

(97.4 - 204.9)

(71.9 - 118.7)

(93.6 - 133.0)

(103.2 - 138.6)

(100.7 - 166.3)

(152.1 - 176.1)

(46.3 - 92.3)

(113.6 - 136.6)

(90.0 - 155.8)



Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010.1. Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.2. Cases and rates include invasive cancers only.


St. Croix CasesRate(95% CI)

Sauk CasesRate(95% CI)

Sawyer CasesRate(95% CI)

Shawano CasesRate(95% CI)

Sheboygan CasesRate(95% CI)

Taylor CasesRate(95% CI)

Trempealeau CasesRate(95% CI)

Vernon CasesRate(95% CI)

Vilas CasesRate(95% CI)

Walworth CasesRate(95% CI)

Washburn CasesRate(95% CI)

Washington CasesRate(95% CI)

Waukesha CasesRate(95% CI)

Waupaca CasesRate(95% CI)

Waushara CasesRate(95% CI)

Winnebago CasesRate(95% CI)

Wood CasesRate(95% CI)

952

1,423

501

1,225

3,321

476

789

883

837

2,613

525

3,261

10,744

1,603

745

4,074

2,272

288.6

434.7

435.8

481.3

526.7

423.0

475.5

500.5

475.5

506.8

462.8

504.2

520.3

503.4

459.6

493.7

498.2

(270.1 - 307.9)

(412.2 - 458.2)

(397.9 - 476.6)

(454.4 - 509.5)

(508.8 - 545.1)

(385.4 - 463.4)

(442.4 - 510.6)

(467.5 - 535.2)

(442.2 - 510.9)

(487.5 - 526.7)

(422.8 - 505.9)

(486.9 - 522.0)

(510.4 - 530.3)

(478.8 - 529.0)

(426.7 - 494.5)

(478.5 - 509.2)

(477.6 - 519.4)

89

187

47

142

399

45

94

84

81

261

47

311

963

173

74

404

217

27.0

55.4

42.7

53.4

62.1

39.0

51.3

45.1

44.0

50.2

39.1

49.0

47.3

52.9

46.5

48.4

45.6

(21.6 - 33.3)

(47.7 - 64.1)

(31.1 - 57.5)

(44.9 - 63.1)

(56.1 - 68.6)

(28.4 - 52.6)

(41.2 - 63.3)

(35.8 - 56.1)

(34.6 - 55.7)

(44.3 - 56.7)

(28.5 - 52.8)

(43.6 - 54.8)

(44.3 - 50.4)

(45.2 - 61.5)

(36.3 - 58.9)

(43.7 - 53.4)

(39.7 - 52.3)

119

183

75

172

356

52

84

101

140

359

82

394

1,289

191

137

534

300

38.1

55.9

63.0

65.8

56.9

46.3

51.5

56.4

74.2

70.0

69.6

62.3

62.8

59.3

80.9

65.9

64.1

(31.4 - 45.7)

(48.0 - 64.7)

(49.4 - 79.5)

(56.2 - 76.5)

(51.1 - 63.1)

(34.5 - 61.0)

(41.0 - 64.0)

(45.8 - 68.8)

(62.0 - 88.5)

(62.9 - 77.7)

(55.2 - 87.0)

(56.2 - 68.8)

(59.4 - 66.4)

(51.1 - 68.4)

(67.9 - 96.0)

(60.4 - 71.8)

(57.0 - 71.9)

112

225

63

147

417

60

113

121

125

332

66

475

1,602

178

80

590

292

61.0

132.0

114.8

115.9

126.3

98.5

137.3

137.0

149.5

123.5

116.0

135.3

143.4

114.2

102.3

134.7

123.1

(50.0 - 73.6)

(115.0 - 150.9)

(87.6 - 148.3)

(97.6 - 136.9)

(114.3 - 139.3)

(74.1 - 128.8)

(112.6 - 166.0)

(113.0 - 164.9)

(123.1 - 180.7)

(110.5 - 137.8)

(89.0 - 149.5)

(123.3 - 148.1)

(136.4 - 150.7)

(97.8 - 132.8)

(80.6 - 128.6)

(123.9 - 146.1)

(109.1 - 138.5)

120

187

89

174

511

69

142

154

115

339

78

506

1,725

278

86

520

350

87.4

125.1

150.0

141.2

178.6

126.2

178.3

184.3

127.1

142.3

133.5

164.8

180.2

180.7

103.2

138.7

164.3

(71.9 - 105.0)

(107.7 - 144.5)

(120.3 - 185.6)

(121.0 - 164.0)

(163.3 - 194.9)

(98.1 - 160.0)

(150.0 - 210.5)

(156.3 - 216.2)

(104.6 - 154.0)

(127.4 - 158.4)

(105.4 - 167.8)

(150.4 - 180.2)

(171.5 - 189.1)

(160.1 - 203.4)

(82.4 - 128.1)

(126.9 - 151.3)

(147.5 - 182.6)



All Counties DeathsRate(95% CI)

Adams DeathsRate(95% CI)

Ashland DeathsRate(95% CI)

Barron DeathsRate(95% CI)

Bayfield DeathsRate(95% CI)

Brown DeathsRate(95% CI)

Buffalo DeathsRate(95% CI)

Burnett DeathsRate(95% CI)

Calumet DeathsRate(95% CI)

Chippewa DeathsRate(95% CI)

Clark DeathsRate(95% CI)

Columbia DeathsRate(95% CI)

Crawford DeathsRate(95% CI)

Dane DeathsRate(95% CI)

Dodge DeathsRate(95% CI)

Door DeathsRate(95% CI)

Douglas DeathsRate(95% CI)

Dunn DeathsRate(95% CI)

Table B Cancer Mortality: Total Number of Deaths and Age-Adjusted Rates by County in Wisconsin, 2003-2007

16.5

18.3

25.1

16.8

21.0

14.8

18.2

10.8

18.4

13.7

13.9

15.7

24.7

14.3

21.3

19.4

18.6

11.6

54,340

343

197

556

179

1,870

155

232

325

632

343

589

233

3,223

1,035

347

532

299

182.0

228.2

193.9

184.2

176.6

168.2

169.3

184.1

164.5

190.8

161.3

183.3

210.0

167.5

208.8

156.3

208.7

151.5

(180.5 - 183.6)

(204.3 - 254.5)

(167.3 - 223.8)

(169.0 - 200.5)

(151.4 - 205.2)

(160.6 - 176.1)

(143.5 - 198.8)

(160.9 - 210.3)

(146.9 - 183.6)

(176.2 - 206.4)

(144.3 - 179.8)

(168.7 - 198.9)

(183.6 - 239.5)

(161.7 - 173.5)

(196.2 - 222.1)

(140.2 - 174.1)

(191.1 - 227.5)

(134.6 - 169.9)

5,000

28

27

50

21

169

17

14

36

45

31

51

26

274

109

43

51

25

(16.0 - 17.0)

(12.1 - 27.1)

(16.4 - 37.1)

(12.4 - 22.4)

(13.0 - 32.8)

(12.7 - 17.3)

(10.6 - 29.8)

(5.8 - 19.0)

(12.9 - 25.5)

(10.0 - 18.4)

(9.4 - 20.1)

(11.6 - 20.7)

(16.0 - 36.6)

(12.6 - 16.1)

(17.5 - 25.8)

(14.0 - 26.5)

(13.8 - 24.7)

(7.5 - 17.3)

14,254

106

60

140

48

469

32

74

77

169

77

152

72

771

259

86

145

70

48.5

66.3

60.9

47.8

47.3

42.9

35.7

57.2

38.9

51.5

38.6

47.3

65.5

40.9

53.5

38.8

58.0

37.2

(47.7 - 49.3)

(54.2 - 80.8)

(46.3 - 78.9)

(40.2 - 56.6)

(34.9 - 63.4)

(39.0 - 47.0)

(24.3 - 51.0)

(44.8 - 72.6)

(30.6 - 48.7)

(44.0 - 60.0)

(30.4 - 48.4)

(40.1 - 55.6)

(51.2 - 83.0)

(38.1 - 44.0)

(47.2 - 60.5)

(31.0 - 48.4)

(48.9 - 68.4)

(29.0 - 47.1)

3,784

15

18

32

9

123

7

14

24

51

17

30

10

270

72

22

29

16

22.6

20.0

32.0

20.8

19.8

19.8

14.3

23.8

21.2

29.3

13.2

15.6

15.8

24.1

26.9

16.9

20.7

14.2

(21.9 - 23.4)

(11.1 - 34.8)

(18.4 - 52.6)

(14.1 - 29.7)

(8.6 - 39.7)

(16.4 - 23.7)

(5.6 - 31.6)

(12.4 - 42.3)

(13.5 - 31.7)

(21.7 - 38.8)

(7.4 - 22.3)

(10.4 - 22.8)

(7.5 - 30.9)

(21.3 - 27.2)

(20.9 - 34.2)

(10.4 - 27.0)

(13.6 - 30.3)

(8.0 - 23.5)

3,161

22

10

44

10

100

11

17

12

44

19

33

13

193

65

13

49

22

27.1

33.2

23.2

33.7

22.5

25.0

27.4

31.3

15.6

32.7

19.1

26.1

27.1

27.9

31.9

14.2

48.9

27.2

(26.1 - 28.0)

(20.5 - 51.5)

(11.1 - 43.0)

(24.5 - 45.4)

(10.8 - 42.5)

(20.3 - 30.4)

(13.6 - 49.8)

(18.2 - 51.4)

(8.0 - 26.8)

(23.7 - 43.8)

(11.5 - 30.1)

(18.0 - 36.7)

(14.4 - 46.9)

(24.0 - 32.1)

(24.6 - 40.7)

(7.5 - 25.0)

(36.2 - 64.7)

(17.0 - 41.0)



Eau Claire DeathsRate(95% CI)

Florence DeathsRate(95% CI)

Fond du Lac DeathsRate(95% CI)

Forest DeathsRate(95% CI)

Grant DeathsRate(95% CI)

Green DeathsRate(95% CI)

Green Lake DeathsRate(95% CI)

Iowa DeathsRate(95% CI)

Iron DeathsRate(95% CI)

Jackson DeathsRate(95% CI)

Jefferson DeathsRate(95% CI)

Juneau DeathsRate(95% CI)

Kenosha DeathsRate(95% CI)

Kewaunee DeathsRate(95% CI)

La Crosse DeathsRate(95% CI)

Lafayette DeathsRate(95% CI)

Langlade DeathsRate(95% CI)

Lincoln DeathsRate(95% CI)

Manitowoc DeathsRate(95% CI)

Table B Cancer Mortality: Total Number of Deaths and Age-Adjusted Rates by County in Wisconsin, 2003-2007 (continued)

816

68

1,061

155

574

370

280

205

121

221

752

376

1,464

215

1,013

189

320

340

857

166.2

192.3

184.2

208.5

188.5

174.9

200.6

161.5

211.9

192.6

183.6

229.0

194.7

169.7

177.5

190.7

213.8

171.8

165.7

(154.8 - 178.2)

(149.0 - 246.5)

(173.1 - 195.8)

(176.3 - 245.5)

(173.2 - 204.9)

(157.3 - 193.9)

(177.3 - 226.5)

(140.0 - 185.4)

(174.3 - 257.1)

(167.9 - 220.1)

(170.6 - 197.3)

(206.3 - 253.6)

(184.7 - 205.0)

(147.4 - 194.5)

(166.6 - 188.9)

(164.3 - 220.5)

(190.6 - 239.3)

(153.8 - 191.5)

(154.7 - 177.4)

73

^

116

16

61

49

26

23

12

28

74

33

131

24

102

28

24

34

74

14.1

^

20.1

20.8

19.3

22.1

16.8

17.8

18.6

23.9

17.4

20.0

17.5

18.2

17.0

27.3

15.2

17.0

14.1

(11.0 - 17.8)

(^ - ^)

(16.5 - 24.1)

(11.6 - 35.4)

(14.7 - 25.0)

(16.3 - 29.5)

(10.9 - 25.4)

(11.2 - 26.9)

(9.5 - 36.8)

(15.9 - 34.8)

(13.6 - 21.8)

(13.8 - 28.4)

(14.6 - 20.7)

(11.5 - 27.5)

(13.9 - 20.8)

(18.1 - 39.8)

(9.7 - 23.3)

(11.7 - 24.1)

(11.0 - 17.8)

212

20

266

43

151

91

69

47

31

57

177

129

463

44

288

45

88

101

208

44.6

59.3

47.8

58.1

50.9

44.7

48.9

37.7

56.2

49.8

44.4

78.6

62.7

36.3

52.0

45.8

60.6

51.7

40.7

(38.8 - 51.2)

(35.9 - 94.7)

(42.2 - 54.0)

(41.9 - 79.3)

(43.0 - 59.8)

(35.9 - 55.0)

(37.9 - 62.6)

(27.6 - 50.2)

(37.7 - 83.2)

(37.7 - 64.8)

(38.1 - 51.5)

(65.6 - 93.6)

(57.1 - 68.8)

(26.3 - 49.0)

(46.1 - 58.4)

(33.4 - 61.6)

(48.5 - 75.1)

(42.0 - 63.1)

(35.4 - 46.8)

51

^

86

9

33

22

16

17

4

18

40

18

97

15

95

14

14

23

55

19.5

^

26.8

22.5

20.6

18.1

23.0

26.3

15.3

32.2

16.8

20.3

22.2

22.9

30.2

27.3

15.6

22.9

18.6

(14.4 - 25.8)

(^ - ^)

(21.2 - 33.4)

(9.8 - 46.6)

(13.9 - 29.6)

(11.2 - 28.1)

(12.5 - 39.4)

(15.2 - 42.4)

(4.1 - 47.8)

(18.7 - 52.0)

(11.9 - 23.1)

(11.9 - 33.0)

(18.0 - 27.2)

(12.6 - 39.0)

(24.3 - 37.2)

(14.7 - 47.1)

(8.3 - 28.2)

(14.3 - 35.2)

(13.9 - 24.6)

62

8

70

8

37

18

9

12

8

11

43

22

32.3

49.0

30.9

24.8

29.7

20.9

14.8

22.6

31.0

22.9

26.4

31.3

(24.7 - 41.4)

(21.0 - 102.3)

(24.0 - 39.0)

(10.7 - 50.8)

(20.9 - 41.0)

(12.3 - 33.1)

(6.7 - 29.0)

(11.6 - 39.4)

(13.4 - 68.2)

(11.4 - 41.0)

(19.0 - 35.4)

(19.5 - 47.6)

(20.5 - 32.8)

(10.1 - 36.4)

(16.5 - 29.5)

(9.2 - 39.1)

(9.3 - 32.3)

(22.6 - 48.8)

(16.4 - 29.8)

74

11

49

9

12

29

47

26.2

20.2

22.3

20.3

18.0

33.7

22.3



Marathon DeathsRate(95% CI)

Marinette DeathsRate(95% CI)

Marquette DeathsRate(95% CI)

Menominee DeathsRate(95% CI)

Milwaukee DeathsRate(95% CI)

Monroe DeathsRate(95% CI)

Oconto DeathsRate(95% CI)

Oneida DeathsRate(95% CI)

Outagamie DeathsRate(95% CI)

Ozaukee DeathsRate(95% CI)

Pepin DeathsRate(95% CI)

Pierce DeathsRate(95% CI)

Polk DeathsRate(95% CI)

Portage DeathsRate(95% CI)

Price DeathsRate(95% CI)

Racine DeathsRate(95% CI)

Richland DeathsRate(95% CI)

Rock DeathsRate(95% CI)

Rusk DeathsRate(95% CI)


1,150

566

242

46

9,283

439

390

546

1,421

846

90

279

514

536

231

1,824

197

1,614

195

159.9

187.5

221.7

299.2

195.8

186.7

176.4

199.8

173.5

175.2

191.1

176.2

193.8

168.0

206.6

182.3

159.9

196.1

183.1

(150.7 - 169.5)

(172.1 - 204.1)

(194.3 - 252.4)

(209.7 - 410.2)

(191.8 - 199.9)

(169.5 - 205.2)

(159.3 - 195.0)

(183.2 - 217.7)

(164.5 - 182.8)

(163.6 - 187.6)

(152.8 - 236.7)

(155.8 - 198.4)

(177.3 - 211.6)

(154.0 - 183.0)

(180.1 - 236.4)

(174.0 - 191.0)

(138.0 - 184.5)

(186.6 - 205.9)

(157.9 - 211.7)

94

47

15

^

807

40

39

47

133

85

7

27

67

34

24

155

21

129

13

12.7

14.6

13.7

^

16.8

16.7

17.6

17.2

16.0

17.7

14.4

17.3

24.8

10.5

21.8

15.2

17.4

15.5

10.7

(10.3 - 15.6)

(10.7 - 19.8)

(7.6 - 23.3)

(^ - ^)

(15.7 - 18.0)

(11.9 - 22.9)

(12.5 - 24.2)

(12.6 - 23.2)

(13.4 - 19.0)

(14.1 - 21.9)

(5.7 - 31.2)

(11.3 - 25.3)

(19.2 - 31.7)

(7.2 - 14.7)

(13.9 - 33.4)

(12.9 - 17.8)

(10.8 - 27.1)

(12.9 - 18.4)

(5.6 - 19.5)

274

143

79

17

2,505

126

112

151

338

200

29

62

120

120

55

524

46

507

46

39.1

48.3

70.6

97.0

53.8

53.7

50.6

54.2

42.5

41.4

63.8

41.2

45.7

38.6

50.2

52.8

38.9

61.9

45.2

(34.6 - 44.1)

(40.6 - 57.1)

(55.8 - 88.8)

(53.2 - 160.1)

(51.7 - 56.0)

(44.7 - 64.0)

(41.7 - 61.1)

(45.9 - 63.9)

(38.0 - 47.3)

(35.8 - 47.6)

(42.4 - 92.6)

(31.5 - 52.9)

(37.8 - 54.8)

(31.9 - 46.2)

(37.7 - 66.2)

(48.4 - 57.6)

(28.4 - 52.4)

(56.6 - 67.5)

(33.0 - 60.9)

81

45

16

^

635

26

27

43

106

63

5

25

25

45

11

120

14

121

20

20.5

26.9

29.1

^

22.5

19.8

24.1

30.4

22.9

22.7

18.1

25.9

16.6

25.5

17.4

21.3

19.2

26.5

36.1

(16.1 - 25.6)

(19.2 - 37.1)

(16.4 - 49.1)

(^ - ^)

(20.8 - 24.4)

(12.9 - 29.5)

(15.8 - 35.4)

(21.9 - 41.6)

(18.7 - 27.8)

(17.4 - 29.3)

(5.7 - 46.8)

(16.7 - 38.5)

(10.5 - 25.3)

(18.5 - 34.3)

(8.6 - 34.0)

(17.6 - 25.6)

(10.0 - 34.4)

(21.9 - 31.7)

(21.5 - 58.1)

83

43

13

^

464

28

27

41

85

51

4

26

37

31

13

100

12

78

19

28.7

33.7

23.7

^

26.4

29.1

29.5

35.0

27.4

26.9

18.0

42.4

33.7

24.6

24.3

27.1

24.2

24.9

39.1

(22.8 - 35.5)

(24.4 - 45.7)

(12.6 - 42.2)

(^ - ^)

(24.1 - 29.0)

(19.3 - 42.0)

(19.4 - 43.1)

(25.0 - 48.1)

(21.9 - 33.9)

(20.0 - 35.5)

(4.9 - 47.9)

(27.5 - 61.9)

(23.7 - 46.6)

(16.6 - 34.7)

(12.9 - 43.3)

(22.0 - 32.9)

(12.5 - 42.7)

(19.6 - 31.0)

(23.5 - 62.3)


St. Croix DeathsRate(95% CI)

Sauk DeathsRate(95% CI)

Sawyer DeathsRate(95% CI)

Shawano DeathsRate(95% CI)

Sheboygan DeathsRate(95% CI)

Taylor DeathsRate(95% CI)

Trempealeau DeathsRate(95% CI)

Vernon DeathsRate(95% CI)

Vilas DeathsRate(95% CI)

Walworth DeathsRate(95% CI)

Washburn DeathsRate(95% CI)

Washington DeathsRate(95% CI)

Waukesha DeathsRate(95% CI)

Waupaca DeathsRate(95% CI)

Waushara DeathsRate(95% CI)

Winnebago DeathsRate(95% CI)

Wood DeathsRate(95% CI)


Source: National Center for Health Statistics1. Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population. 2. ^ Statistic not displayed if there were fewer than 4 deaths.

553

635

225

482

1,173

187

310

304

334

954

233

1,146

3,553

678

333

1,542

802

173.6

183.8

190.6

175.6

180.8

154.0

171.3

163.1

175.0

183.1

188.3

181.4

175.5

196.1

195.8

185.9

163.6

(159.1 - 188.9)

(169.6 - 198.9)

(166.3 - 217.8)

(160.1 - 192.2)

(170.5 - 191.5)

(132.4 - 178.2)

(152.3 - 192.2)

(145.1 - 183.0)

(156.2 - 196.0)

(171.6 - 195.2)

(164.6 - 214.9)

(171.0 - 192.4)

(169.7 - 181.4)

(181.4 - 211.8)

(175.3 - 218.4)

(176.7 - 195.5)

(152.3 - 175.6)

41

62

24

45

139

19

35

34

28

111

17

99

296

65

31

138

82

13.6

17.7

20.4

15.9

21.2

15.2

17.6

17.1

13.5

21.0

14.5

15.8

14.6

17.9

17.6

16.2

15.9

(9.7 - 18.5)

(13.5 - 22.9)

(12.9 - 31.0)

(11.6 - 21.5)

(17.8 - 25.1)

(9.0 - 24.1)

(12.1 - 25.0)

(11.8 - 24.2)

(9.0 - 20.4)

(17.2 - 25.3)

(8.2 - 24.1)

(12.8 - 19.3)

(13.0 - 16.4)

(13.8 - 23.1)

(11.9 - 25.3)

(13.6 - 19.2)

(12.6 - 19.9)

129

164

54

122

280

39

71

76

100

246

71

292

930

157

94

435

203

40.9

49.3

45.8

44.9

44.2

34.1

41.6

41.4

51.9

48.0

57.6

46.8

46.0

47.5

55.9

53.5

42.4

(34.0 - 48.7)

(41.9 - 57.5)

(34.3 - 60.3)

(37.3 - 53.9)

(39.1 - 49.8)

(24.2 - 46.8)

(32.4 - 52.9)

(32.5 - 52.0)

(42.0 - 63.9)

(42.2 - 54.4)

(44.9 - 73.3)

(41.6 - 52.5)

(43.1 - 49.1)

(40.3 - 55.7)

(45.1 - 68.7)

(48.6 - 58.8)

(36.7 - 48.8)

33

47

17

42

89

15

17

19

26

62

9

109

275

47

22

91

45

18.1

23.0

28.0

29.8

24.6

22.8

16.7

18.3

28.3

21.6

14.9

29.9

23.6

26.3

25.1

20.0

16.9

(12.4 - 25.5)

(16.7 - 31.1)

(16.2 - 46.4)

(21.1 - 41.0)

(19.6 - 30.5)

(12.3 - 39.3)

(9.3 - 28.0)

(10.8 - 29.5)

(17.8 - 43.7)

(16.5 - 27.8)

(6.7 - 30.1)

(24.5 - 36.2)

(20.9 - 26.6)

(19.1 - 35.5)

(15.6 - 39.2)

(16.1 - 24.7)

(12.2 - 23.1)

44

52

18

33

68

11

19

25

17

37

14

65

189

54

14

84

46

39.5

37.0

35.0

27.4

25.8

20.1

23.8

29.8

18.3

18.0

25.9

28.1

25.8

36.0

17.8

25.9

22.1

(28.5 - 52.7)

(27.7 - 48.6)

(20.6 - 56.2)

(18.8 - 38.7)

(20.1 - 32.8)

(10.0 - 36.4)

(14.3 - 37.4)

(19.3 - 44.4)

(10.7 - 30.9)

(12.7 - 24.7)

(14.1 - 44.5)

(21.6 - 35.9)

(22.1 - 29.8)

(27.1 - 47.2)

(9.6 - 30.5)

(20.6 - 32.0)

(16.2 - 29.6)



St. Croix DeathsRate(95% CI)

Sauk DeathsRate(95% CI)

Sawyer DeathsRate(95% CI)

Shawano DeathsRate(95% CI)

Sheboygan DeathsRate(95% CI)

Taylor DeathsRate(95% CI)

Trempealeau DeathsRate(95% CI)

Vernon DeathsRate(95% CI)

Vilas DeathsRate(95% CI)

Walworth DeathsRate(95% CI)

Washburn DeathsRate(95% CI)

Washington DeathsRate(95% CI)

Waukesha DeathsRate(95% CI)

Waupaca DeathsRate(95% CI)

Waushara DeathsRate(95% CI)

Winnebago DeathsRate(95% CI)

Wood DeathsRate(95% CI)


Source: National Center for Health Statistics1. Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population. 2. ^ Statistic not displayed if there were fewer than 4 deaths.

553

635

225

482

1,173

187

310

304

334

954

233

1,146

3,553

678

333

1,542

802

173.6

183.8

190.6

175.6

180.8

154.0

171.3

163.1

175.0

183.1

188.3

181.4

175.5

196.1

195.8

185.9

163.6

(159.1 - 188.9)

(169.6 - 198.9)

(166.3 - 217.8)

(160.1 - 192.2)

(170.5 - 191.5)

(132.4 - 178.2)

(152.3 - 192.2)

(145.1 - 183.0)

(156.2 - 196.0)

(171.6 - 195.2)

(164.6 - 214.9)

(171.0 - 192.4)

(169.7 - 181.4)

(181.4 - 211.8)

(175.3 - 218.4)

(176.7 - 195.5)

(152.3 - 175.6)

41

62

24

45

139

19

35

34

28

111

17

99

296

65

31

138

82

13.6

17.7

20.4

15.9

21.2

15.2

17.6

17.1

13.5

21.0

14.5

15.8

14.6

17.9

17.6

16.2

15.9

(9.7 - 18.5)

(13.5 - 22.9)

(12.9 - 31.0)

(11.6 - 21.5)

(17.8 - 25.1)

(9.0 - 24.1)

(12.1 - 25.0)

(11.8 - 24.2)

(9.0 - 20.4)

(17.2 - 25.3)

(8.2 - 24.1)

(12.8 - 19.3)

(13.0 - 16.4)

(13.8 - 23.1)

(11.9 - 25.3)

(13.6 - 19.2)

(12.6 - 19.9)

129

164

54

122

280

39

71

76

100

246

71

292

930

157

94

435

203

40.9

49.3

45.8

44.9

44.2

34.1

41.6

41.4

51.9

48.0

57.6

46.8

46.0

47.5

55.9

53.5

42.4

(34.0 - 48.7)

(41.9 - 57.5)

(34.3 - 60.3)

(37.3 - 53.9)

(39.1 - 49.8)

(24.2 - 46.8)

(32.4 - 52.9)

(32.5 - 52.0)

(42.0 - 63.9)

(42.2 - 54.4)

(44.9 - 73.3)

(41.6 - 52.5)

(43.1 - 49.1)

(40.3 - 55.7)

(45.1 - 68.7)

(48.6 - 58.8)

(36.7 - 48.8)

33

47

17

42

89

15

17

19

26

62

9

109

275

47

22

91

45

18.1

23.0

28.0

29.8

24.6

22.8

16.7

18.3

28.3

21.6

14.9

29.9

23.6

26.3

25.1

20.0

16.9

(12.4 - 25.5)

(16.7 - 31.1)

(16.2 - 46.4)

(21.1 - 41.0)

(19.6 - 30.5)

(12.3 - 39.3)

(9.3 - 28.0)

(10.8 - 29.5)

(17.8 - 43.7)

(16.5 - 27.8)

(6.7 - 30.1)

(24.5 - 36.2)

(20.9 - 26.6)

(19.1 - 35.5)

(15.6 - 39.2)

(16.1 - 24.7)

(12.2 - 23.1)

44

52

18

33

68

11

19

25

17

37

14

65

189

54

14

84

46

39.5

37.0

35.0

27.4

25.8

20.1

23.8

29.8

18.3

18.0

25.9

28.1

25.8

36.0

17.8

25.9

22.1

(28.5 - 52.7)

(27.7 - 48.6)

(20.6 - 56.2)

(18.8 - 38.7)

(20.1 - 32.8)

(10.0 - 36.4)

(14.3 - 37.4)

(19.3 - 44.4)

(10.7 - 30.9)

(12.7 - 24.7)

(14.1 - 44.5)

(21.6 - 35.9)

(22.1 - 29.8)

(27.1 - 47.2)

(9.6 - 30.5)

(20.6 - 32.0)

(16.2 - 29.6)


Age-Adjusted Rate – Incidence or mortality rate adjusted to account for the different age distributions between populations.

In this report, all rates are age-adjusted using the 2000 U.S. standard population.

Benign – Noncancerous tumors.

Burden – Number of new cases and/or deaths from cancer or overall impact of cancer in the state or specified region.

Cancer Incidence – The number of new cancer cases that occur during a specified period for a population at risk for developing

the disease, expressed as number of cases or as a rate, usually per 100,000 persons.

Cancer Mortality – Deaths from cancer that occur during a specified period of time for a particular population, expressed as

number of deaths or as a rate, usually per 100,000 persons.

Colonoscopy – A screening/diagnostic procedure in which a health care professional views the entire colon through a flexible,

lighted instrument called a colonoscope.

Confidence Interval – A 95% confidence interval is commonly reported with rates and contains the true value 95% of the time. The range between the lower and upper confidence interval defines with 95% probability the “true” rate. The larger the confidence

interval, the less precise the estimate.

Five-year Survival – The percentage of people with a specified disease who are alive five years after their initial diagnosis.

Invasive – Malignant cancer or tumor that has invaded tissue or surrounding organs.

Malignant – Cancerous tumors.

Mammography – A screening and diagnostic technique that uses low-dose x-rays to find tumors in the breast.

Metastasis – The spread of the disease from one part of the body to another.

Pap Test or Pap Smear – Developed by American Cancer Society funded researcher Dr. Papanicolaou and published in his landmark paper in 1941. It refers to the microscopic examination of cervical cells to detect precancerous lesions or cancer. This

screening procedure has reduced the death rate from cervical cancer by 75% since the 1950s.

Percent Change – (PC) Percent of change from selected base year to most current year, usually computed for incidence and

mortality rates, in this report calculated using SEER Stat statistical software.

Prevalence – The percentage of people exhibiting a behavior out of the total number at risk for the behavior. In this report, the

prevalence is expressed as a percent of the population.

Prostate-Specific-Antigen (PSA) – A blood protein, the level of which is increased in many men who have prostate cancer or

benign prostate hyperplasia (overgrowth of prostate cells).

Rates – The number of cancer cases or deaths per 100,000 population.

Risk Factors – Behaviors/conditions related to the occurrence of a disease. Risk factors can be lifestyle, environmental, or

genetic. For example, smoking is a risk factor for lung cancer.

Sigmoidoscopy – A screening/diagnostic procedure in which a health care professional views the inside of the rectum and lower

part of the colon through a flexible, lighted instrument called a sigmoidoscope.

Glossary of Terms


Stage of Disease at Diagnosis:

In Situ – A small cancer confined to the cells in which the cancer began and has not invaded or penetrated the

surrounding tissue.

Localized – An invasive tumor (penetrated the surrounding tissue) that is still confined to the organ of origin.

Regional – A tumor that has spread beyond the organ of origin to an adjacent organ, tissue or lymph nodes.

Distant – The tumor has spread beyond adjacent organs, tissue or lymph nodes, or has metastasized through the blood

stream or lymph system.

Unknown/Unstaged – Insufficient information is available to determine the stage or extent of the tumor at the time of diagnosis.

Wisconsin Cancer Facts and Figures, 2011

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