Wisconsin Cancer Facts & Figures 2011

Wisconsin Cancer Facts & Figures 2011

Table of Contents Welcome Letters 1 Cancer: Basic Facts 3 Understanding Cancer Incidence and Mortality s 5 Data Sources 7 Wisconsin Cancer Incidence and Mortality Data 8 Trends in Cancer Incidence and Mortality in Wisconsin 14 Lung & Bronchus Cancer/Tobacco Control in Wisconsin 16 Colorectal Cancer in Wisconsin 20 Female Breast Cancer in Wisconsin 23 Prostate Cancer in Wisconsin 26 Melanoma/Skin Cancer in Wisconsin 28 Cervical Cancer in Wisconsin 30 Childhood Cancer in Wisconsin 32 Nutrition, Physical Activity, Obesity, Alcohol and Cancer 33 Cancer in Diverse Populations 39 Cancer Survivorship and Quality of Life 42 Wisconsin Comprehensive Cancer Control Plan 44 Wisconsin Well Woman Program 46 Wisconsin Cancer Incidence and Mortality by County 47 Glossary of Terms 56 Acknowledgements 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. American Cancer Society Beth Brunner, B.S. Wisconsin Well Woman Program Gale Johnson, M.P.A. Wisconsin Comprehensive Cancer Control Program Amy Conlon, M.P.H.

The American Cancer Society saves lives and is creating a world with more birthdays. Due in large part to our lifesaving work, the five-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 fight 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 fiscal 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 fight. 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, policymakers, media outlets and others looking for detailed, easy-to-read information about the cancer burden in Wisconsin should find 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 Officer American Cancer Society, Midwest Division Wisconsin Cancer Facts and Figures 2011 1

DIVISION OF PUBLIC HEALTH 1 WEST WILSON STREET P O BOX 2659 Jim Doyle MADISON WI 53701-2659 G overnor State of Wisconsin 608-266-1251 Karen E. Timberlake Department of Health Services FAX: 608-267-2832 Secretary TTY: 888-701-1253 dhs.wisconsin.gov 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 2 Wisconsin Cancer Facts and Figures 2011

Cancer: Basic Facts 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. Figure 1. Estimated Percentage and Number of New Cancer in Wisconsin, 2010 Prostate 16% (n = 4,670) Urinary Bladder 5% (n = 1,510) Melanoma 4% (n = 1,050) Non-Hodgkin Lymphoma 5% (n = 1,340) Other 27% (n = 7,990) Figure 2. Estimated Percentage and Number of Cancer in Wisconsin, 2010 Other 32% (n = 3,670) Prostate 5% (n = 600) Pancreas 6% (n = 720) Who is at Risk of Cancer? Brain/Nervous System 2% (n = 270) Female Breast 6% (n = 690) Liver 3% (n = 330) Non-Hodgkin Lymphoma 4% (n = 410) Colon & Rectum 8% (n = 900) Leukemia 4% (n = 490) Lung & Bronchus 26% (n = 2,940) 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 Ovary 3% (n = 290) Anyone can develop cancer but the risk of developing cancer increases as people age. More than 78% of all cancers are diagnosed 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 of Cancer are Expected This 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). Lung & Bronchus 13% (n = 3,990) Uterine Corpus 3% (n = 1,040) Leukemia 3% (n = 940) Colon & Rectum 9% (n = 2,760) Uterine Cervix 1% (n = 200) Female Breast 14% (n = 4,120) How Many Cancer 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). Source: 2010 American Cancer Society, Inc., Surveillance and Health Policy Research Wisconsin Cancer Facts and Figures 2011 3

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 five years after diagnosis. Nationwide, the five-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. Scientific 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 Survival Generally, 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 classification. The stages from earliest to latest are: in situ, localized, regional and distant (see glossary, page 56). Causes of Cancer in the United States Estimated percentage of total cancer deaths attributable to established cause of cancer Tobacco 30% Reproductive factors 3% Adult diet/obesity 30% Alcohol 3% Sedentary lifestyle 5% Socioeconomic status 3% Occupational factors 5% Environmental pollution 2% Family history of cancer 5% Ionizing/ultraviolet radiation 2% Viruses/other biologic agents 5% Prescription drugs/medical procedures 1% Perinatal factors/growth 5% Salt/other food additives/contaminants 1% Source: Cancer Causes & Control, Harvard Report on Cancer Prevention, 1996. 4 Wisconsin Cancer Facts and Figures 2011

Understanding Cancer Incidence and Mortality s 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 s 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 geographic 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 ageadjusted 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 themselves 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 Wisconsin Cancer Facts and Figures 2011 5

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 ambiguous 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. Changes in Multiple Primary Rules Starting 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. 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. 6 Wisconsin Cancer Facts and Figures 2011

Data Sources Estimated and, 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 Reporting 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, Wisconsin 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 mortality 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 package, from the National Cancer Institute, was used to calculate both incidence and mortality rates. Wisconsin cancer publications available at: www.dhs.wisconsin.gov/wcrs 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 Surveillance 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 National Cancer Data and Survival Trends National cancer data and survival data are from the Surveillance, 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 Wisconsin Cancer Facts and Figures 2011 7

Wisconsin Cancer Incidence and Mortality Data Wisconsin for 2003-2007. For additional county-level information, such as the number of newly diagnosed cases and ageadjusted rates for specific cancer sites, refer to the supplemental Table A, pages 48-51. Cancer Incidence Figure 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 ageadjusted 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 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. in Figure 3. Leading Cancer Sites: Percentage of New and Among Males in Wisconsin, 2003-2007 Prostate 28% 11% L ung & Bronchus 14% 28% Colon & Rectum 10% 9% Urinary Bladder 7% 4% Non-Hodgkin Lymphoma 5% 4% Kidney & Renal Pelvis 4% 3% Melanoma of the Skin 4% 2% Oral Cavity & Pharynx 3% 2% Leukemia 3% 5% Pancreas Percent New 3% 6% Percent Cancer 30 20 10 0 10 20 30 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. 8 Wisconsin Cancer Facts and Figures 2011

Figure 4. Leading Cancer Sites: Percentage of New and Among Females in Wisconsin, 2003-2007 Breast 28% 14% Lung & Bronchus 13% 24% Colon & Rectum 10% 10% Corpus & Uterus, NOS 7% 3% Non-Hodgkin Lymphoma 4% 4% Ovary 4% 6% Melanoma of the Skin Thyroid 3% 3% 1% 0.4% Pancreas 3% 6% U rinary bladder 3% 2% Percent New Percent Cancer 30 20 10 0 10 20 30 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. Wisconsin Cancer Facts and Figures 2011 9

Table 1 Average Annual Number of and Age-Adjusted Incidence s by Sex, Wisconsin and U.S., 2003-2007 Primary Cancer Site/Type Males Females Total WI WI U.S. WI WI U.S. WI WI U.S. All Cancer 14,378 542.9 541.7 13,511 425.2 411.1 27,889 473.7 464.9 Brain and Other Nervous System 265 9.8 7.6 220 7.3 5.5 485 8.5 6.5 Cervix Uteri 189 6.6 6.8 Colon and Rectum 1,415 54.5 54.6 1,408 42.1 41.5 2,824 47.6 47.3 Corpus and Uterus, NOS 884 27.9 24.5 Esophagus 293 10.9 8.1 88 2.7 2.0 380 6.4 4.7 Female Breast 3,808 121.7 124.9 Hodgkin Lymphoma 104 3.8 3.3 98 3.5 2.6 202 3.6 2.9 Kidney and Renal Pelvis 538 19.9 18.7 329 10.3 9.9 867 14.7 13.9 Larynx 186 6.9 5.9 48 1.5 1.3 234 3.9 3.3 Leukemia 462 17.7 16.4 342 10.7 9.9 804 13.8 12.7 Liver and Intrahepatic Bile Duct 213 7.8 10.1 111 3.4 3.5 323 5.5 6.6 Lung and Bronchus 2,001 76.8 74.5 1,713 53.7 52.2 3,714 63.4 61.6 Melanoma of the Skin 509 18.8 25.8 416 13.9 17.3 925 15.9 20.8 Myeloma 170 6.5 7.1 135 4.1 4.6 306 5.2 5.7 Non-Hodgkin Lymphoma 674 25.5 24.6 605 18.7 17.0 1,279 21.7 20.3 Oral Cavity and Pharynx 479 17.2 15.5 237 7.5 6.2 716 12.0 10.5 Ovary 482 15.3 12.9 Pancreas 379 14.5 13.5 361 10.8 10.5 739 12.5 11.9 Prostate 3,992 148.3 163.1 Stomach 238 9.2 10.6 150 4.5 5.1 388 6.6 7.5 Testis 200 7.3 5.7 Thyroid 128 4.6 5.4 367 12.9 15.9 496 8.8 10.7 Urinary Bladder 1,007 39.6 37.2 373 11.1 9.3 1,379 23.3 21.1 Sources: Wisconsin Cancer Reporting System and the Surveillance, Epidemiology and End Results (SEER) Program, 2010. s are per 100,000 and age-adjusted to the 2000 U.S. standard population. 10 Wisconsin Cancer Facts and Figures 2011

Table 2 Average Annual Number of and Age-Adjusted Mortality s by Sex, Wisconsin and U.S., 2003-2007 Primary Cancer Site/Type Males Females Total WI WI U.S. WI WI U.S. WI WI U.S. All Cancer 5,633 223.5 225.4 5,235 154.5 155.4 10,868 182.0 183.8 Brain and Other Nervous System 149 5.6 5.2 120 3.8 3.5 269 4.6 4.3 Cervix Uteri 58 1.9 2.4 Colon and Rectum 496 19.9 21.2 504 14.0 14.9 1,000 16.5 17.6 Corpus and Uterus, NOS 157 4.6 4.1 Esophagus 240 9.2 7.8 65 1.9 1.7 305 5.1 4.4 Female Breast 757 22.6 24.0 Hodgkin Lymphoma 14 0.5 0.5 11 0.3 0.3 25 0.4 0.4 Kidney and Renal Pelvis 163 6.3 5.9 101 3.0 2.7 265 4.4 4.1 Larynx 52 2.0 2.2 1.4 0.4 0.5 66 1.1 1.2 Leukemia 281 11.3 9.7 208 6.0 5.4 489 8.2 7.2 Liver and Intrahepatic Bile Duct 182 6.8 7.7 101 2.9 3.2 282 4.7 5.2 Lung and Bronchus 1,590 62.3 68.8 1,260 38.5 40.6 2,851 48.5 52.5 Melanoma of the Skin 95 3.6 4.0 57 1.7 1.7 152 2.6 2.7 Myeloma 113 4.6 4.4 98 2.9 2.9 212 3.6 3.6 Non-Hodgkin Lymphoma 234 9.3 8.7 213 6.0 5.5 447 7.4 6.9 Oral Cavity and Pharynx 98 3.6 3.9 49 1.5 1.4 147 2.5 2.5 Ovary 314 9.5 8.6 Pancreas 323 12.6 12.3 325 9.4 9.4 649 10.9 10.7 Prostate 632 27.1 24.7 Stomach 120 4.7 5.3 74 2.1 2.7 193 3.2 3.8 Testis 4 0.1 0.2 Thyroid 12 0.5 0.5 20 0.6 0.5 32 0.5 0.5 Urinary Bladder 199 8.3 7.5 96 2.6 2.2 295 4.8 4.3 Source: National Center for Health Statistics, Surveillance, Epidemiology, and End Results (SEER) Publice-Use Mortality Files, 2010. s are per 100,000 and age-adjusted to the 2000 U.S. standard population. Wisconsin Cancer Facts and Figures 2011 11

Map 1. Cancer Incidence s for All Cancer by County in Wisconsin, 2003-2007 Douglas 383.5 Barron 431.3 Buffalo 409.0 Bayfield 389.1 Burnett Washburn Sawyer 346.3 462.8 435.8 Polk 372.8 St. Croix 288.6 Pierce 305.8 411.9 Dunn 385.5 Pepin Rusk 456.0 Chippewa 486.2 Eau Claire 389.7 Tremp ealeau 475.5 La Crosse 503.6 546.7 Crawford Ashland 483.5 Taylor 423.0 Clark 512.1 Jackson 512.1 Vernon 500.5 Monroe 487.1 Grant 391.3 Price 471.6 Richland 409.3 Iron 423.9 Wood 498.2 Iowa 346.2 Lafayette 391.6 Oneida 555.4 Lincoln 505.3 Marathon 456.7 Sauk 434.7 Vilas 475.5 Portage 414.1 Green 468.1 Columbia 487.3 Dane 431.6 Forest 442.5 Dodge 424.6 Florence 370.8 Marinette 463.8 Washington 504.2 Waushara Winnebagmet 487.8 Calu- Manitowoc Adams 459.6 391.0 493.7 411.5 Marquette Lake Fond du Lac Green Juneau 524.4 604.7 494.8 523.1 Sheboygan 526.7 Shawano 481.3 Waupaca 503.4 Outagamie 487.9 Rock 499.0 Langlade 464.2 Menominee Oconto 623.2 485.2 Walworth 506.8 Jefferson Waukesha 469.0 520.3 463.1 Brown Kewaunee 468.8 501.7 484.3 Ozaukee 497.3 Milwaukee 492.7 Racine Kenosha Door 531.9 County Cancer Incidence Wisconsin State Average - 473.7 Below or Equal to State Average Above State Average s are per 100,000 and age-adjusted to the 2000 U.S. standard population. is statistically significant above or below the state rate Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2010. 12 Wisconsin Cancer Facts and Figures 2011

Map 2. Cancer Mortality s for All Cancer by County in Wisconsin, 2003-2007 Douglas 208.7 Bayfield 176.6 Ashland 193.9 Iron 211.9 Vilas 175.0 Burnett Washburn Sawyer Florence 184.1 188.3 190.6 Oneida 192.3 Price 199.8 206.6 Forest 208.5 Rusk Marinette Polk Barron 183.1 187.5 193.8 184.2 Lincoln Langlade Taylor 171.8 213.8 St. Croix Chippewa 154.0 Menominee 173.6 190.8 Dunn Oconto Marathon 299.2 176.4 151.5 159.9 Pierce Eau Claire Shawano Door Clark 175.6 156.3 176.2 Pepin 166.2 161.3 Outagamie 169.7 191.1 Buffalo Wood Portage Waupaca Kewaunee Tremp Brown 169.3 ealeau Jackson 163.6 168.0 191.6 168.2 173.5 171.3 192.6 Waushara Winnebagmet Calu- Manitowoc Adams La 195.8 165.7 Crosse Monroe 228.2 185.9 164.5 Marquette Juneau Green 177.5 186.7 Fond du Lac Lake 229.0 184.2 Sheboygan 221.7 200.6 180.8 Vernon 163.1 Sauk Columbia Washington Ozaukee Richland 183.3 Dodge 210.0 159.9 183.8 208.8 181.4 175.2 Crawford Dane Iowa Jefferson Waukesha Milwaukee 167.5 161.5 183.6 195.8 175.5 Grant 188.5 Walworth 182.3 Racine Lafayette Green Rock 190.7 174.9 196.1 183.1 194.7 Kenosha County Cancer Mortality Wisconsin State Average - 182.0 Below or Equal to State Average Above State Average s are per 100,000 and age-adjusted to the 2000 U.S. standard population. is statistically significant above or below the state rate Source: National Center for Health Statistics, Surveillance, Epidemiology and End Results (SEER) Public-Use Mortality Files, 2010. Wisconsin Cancer Facts and Figures 2011 13

Trends in Cancer Incidence and Mortality in Wisconsin 1997-2007 Trends Overall, 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). 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%. 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. Figure 5. Trends in Wisconsin Cancer Incidence and Mortality s for All Cancer Sites, 1997-2007 700 600 s 500 400 300 200 Incidence Total Incidence Male Incidence Female Mortality Total Mortality Male Mortality Female 100 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Year 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. s are per 100,000 and age-adjusted to the 2000 U.S. standard population. 2. s are single-year rates. 2007 14 Wisconsin Cancer Facts and Figures 2011

Table 3. Trends for Leading Cancers: Incidence s in Wisconsin by Gender, 1997-2007 1997 1999 2001 2003 2005 2007 PC* All Sites Total 485.8 490.8 499.8 479.0 487.1 440.3-9.4 Male 583.0 584.0 584.7 553.3 551.2 504.4-13.5 Female 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 59.4-11.1 Male 91.8 89.0 84.2 83.0 74.1 71.4-22.2 Female 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 40.6-32.8 Male 71.5 74.3 66.7 63.2 53.9 46.4-35.2 Female 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 43.6 Male 13.5 14.9 18.2 16.2 19.5 19.2 42.1 Female 10.0 10.1 13.1 13.0 15.3 14.5 44.8 Female Breast 133.7 139.1 139.8 123.4 124.4 116.8-12.6. Cervical 8.8 9.2 6.8 6.7 7.2 5.4-38.5 Prostate 174.5 174.4 177.3 153.0 148.1 142.7-18.2 Source: Wisconsin Cancer Reporting System, Office of Public Health Informatics, Division of Public Health, Department of Health Services, 2010. s are per 100,000 and age-adjusted to the 2000 U.S. standard population. PC*: Percent Change based on 1997-2007 difference. Table 4. Trends for Leading Cancers: Mortality s in Wisconsin by Gender, 1997-2007 1997 1999 2001 2003 2005 2007 PC* All Sites Total 195.9 195.1 190.8 183.2 183.4 178.2-9.1 Male 245.0 249.2 237.9 228.3 222.8 218.1-11.0 Female 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 48.6-3.0 Male 68.5 66.7 65.1 63.9 61.2 61.4-10.3 Female 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 15.1-29.6 Male 26.4 26.7 25.1 22.2 19.8 18.0-31.8 Female 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 3.8 Male 3.5 3.8 3.8 3.1 3.7 3.8 8.7 Female 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 Cervical 2.7 2.4 1.8 1.8 1.9 1.7-36.4 Prostate 33.5 32.7 29.1 29.5 26.9 26.3-21.4 Source: National Center for Health Statistics, 2010. s are per 100,000 and age-adjusted to the 2000 U.S. standard population. PC*: percent change is based on 1997-2007 difference. Wisconsin Cancer Facts and Figures 2011 15

Lung & Bronchus Cancer/ Tobacco Control in Wisconsin 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 16 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. Wisconsin Cancer Facts and Figures 2011 Prevention/Screening/Early Detection Lung 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 contained 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

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 Use The 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 Smoke In 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 Diagnosis Lung 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 Wisconsin There 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. Wisconsin Cancer Facts and Figures 2011 17

Figure 6. Trends in Prevalence of Adult Current Cigarette Smoking by Sex in Wisconsin, 2000-2009 35 30 25 Percent 20 15 Males Females 10 5 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year 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. Figure 7. Trends in Prevalence of Adult Current Cigarette Smoking by Age in Wisconsin, 2000-2009 40 35 Percent 30 25 20 15 18-24 25-34 35-44 45-54 55-64 65+ 10 5 2000 2001 2002 2003 2004 Year 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. 2005 2006 2007 2008 2009 18 Wisconsin Cancer Facts and Figures 2011

Figure 8. Trends in Prevalence of Current Cigarette Smoking Among High School Students by Sex in Wisconsin, 1999-2009 45 40 35 Percent 30 25 Males Females 20 15 10 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year 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. Figure 9. Trends in Lung Cancer Stage at Diagnosis in Wisconsin, 1997-2007 50 50 1997 1999 2001 2003 2005 2007 40 40 Percent 30 30 20 20 10 10 0 0 Localized Regional Distant/Systemic Unknown/Unstaged Stage at Diagnosis 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. Wisconsin Cancer Facts and Figures 2011 19

Colorectal Cancer in Wisconsin 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. 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 developing 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 important 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. Risk Factors Several 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 Detection Screening tests that detect and remove adenomatous polyps are the most reliable method of preventing colorectal cancer. 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 20 Wisconsin Cancer Facts and Figures 2011