South Atlantic Division Cancer Facts & Figures 2008

South Atlatic Divisio Cacer Facts & Figures 2008 Icludes Appedix With State & Couty Data We Are Here. Makig A Differece I Every Commuity. Delaware District of Columbia Georgia North Carolia South Carolia Virgiia Marylad West Virgiia South Atlatic Divisio, Ic.

Cotets Itroductio...1 Demographics...2 Estimated New Cacer Cases & Deaths, 2008...4 Icidece ad Mortality...5 Treds i Cacer Icidece ad Mortality...6 Cacer Amog Hispaics ad Latios...8 Health Profile amog Hispaic Adults Health Profile amog Hispaic Youth Cacer Screeig Patters amog Hispaics Cacer Icidece ad Mortality amog Hispaics Stage at Cacer Diagosis ad Survival Access to Care Programs to Promote Healthy Behaviors amog Hispaics Limitatios Refereces Delaware...18 District of Columbia...26 Georgia...34 Marylad...42 North Carolia...50 South Carolia...58 Virgiia...66 West Virgiia...74 Colorectal Cacer Screeig Guidelies...82 America Cacer Society Screeig Guidelies...83 Cacer Research...84 Data Sources & Techical Notes...88 State Cacer Registries & Vital Statistics...91 America Cacer Society South Atlatic Divisio Offices...92 Couty Level Data... Appedix Couty Level Icidece ad Mortality Data By State ad Cacer Site America Cacer Society Missio Statemet The America Cacer Society is the atiowide, commuity-based, volutary health orgaizatio dedicated to elimiatig cacer as a major health problem by prevetig cacer, savig lives ad dimiishig sufferig from cacer, through research, educatio, advocacy, ad service. Ackowledgemets With grateful appreciatio for their cotributio ad assistace: Delaware Cacer Registry Aliso Shevock, PhD District of Columbia Cacer Registry Aaro Adade, PhD; Alicia Vargas Georgia Comprehesive Cacer Registry Raa Bayakly, MPH Marylad Cacer Registry Kimberly Ster, MHA, CTR; Diae Dwyer, MD Marylad Vital Statistics Admiistratio Hal Sommers, MA North Carolia Cetral Cacer Registry Kare Kight, MS; Chadrika Rao, PhD South Carolia Cetral Cacer Registry Susa Bolick-Aldrich, MSPH, CTR; Deborah Hurley, MSPH Virgiia Cacer Registry Jim Marti, PhD; Caroly Halbert, MA, MPH Virgiia Ceter For Health Statistics Calvi Reyolds; Robert Magotti West Virgiia Cacer Registry Patricia Colsher, PhD; Sharo Hill West Virgiia Health Statistics Ceter Daiel Christy, MPA; Tom Light Editor: Judy Walrath, PhD Plaig Maager South Atlatic Divisio, Ic. 2008 America Cacer Society, South Atlatic Divisio, Ic. All rights reserved, icludig the right to reproduce this publicatio or portios thereof i ay form. However, data provided from the State Cacer Registries/State Ceters for Health Statistics may be reproduced without permissio. For writte permissio, address the America Cacer Society, South Atlatic Divisio, 2200 Lake Boulevard, Atlata, GA 30319.

Cacer is a group of diseases characterized by ucotrolled growth ad spread of abormal cells. Cacer is caused by both exteral factors (tobacco, poor diet, physical iactivity, chemicals, radiatio ad ifectious orgaisms) ad iteral factors (iherited mutatios, hormoes, immue coditios ad mutatios that occur from metabolism). These causal factors may act together or i sequece to iitiate or promote carciogeesis. Ayoe ca develop cacer. The risk of beig diagosed with cacer icreases with icreasig age; about 77% of all cacers are diagosed i persos 55 ad older. I the U.S., me have slightly less tha a 1 i 2 lifetime risk of developig cacer ad for wome, the risk is a little more tha 1 i 3. How to Use Cacer Facts America & Cacer Figures Society for Plaig Cacer Cotrol South Atlatic Divisio Cacer Facts & Figures 2008 provides a comprehesive resource for state ad commuity cacer cotrol plaig ad implemetatio withi the South Atlatic Divisio, which icludes Delaware, District of Columbia, Georgia, Marylad, North Carolia, South Carolia, Virgiia ad West Virgiia. South Atlatic Divisio Marylad West Virgiia Hutigto Parkersburg Charlesto Abigdo Morgatow This resource icludes a special sectio Asheville etitled Cacer amog Hispaics/Latios (pp. 8-17) that icludes Dalto Greeville Gaiesville Greewood demographic data o the Hispaic Duluth Keesaw Athes Atlata Divisio Headquarters Augusta populatio ad provides a summary of Peachtree City cacer risk factor data as well as cacer Maco Statesboro Columbus icidece ad mortality patters amog persos of Hispaic origi. Iitiatives Albay Bruswick curretly uderway i the South Atlatic Divisio that are desiged to improve the overall healthcare of Hispaics i the Divisio are highlighted. Roaoke Greesboro Savaah Estimates of ew cacer cases ad deaths (p. 4) for major cacer sites are icluded for each South Atlatic state as a resource for comprehesive cacer cotrol efforts; particularly i the plaig of survivorship programs. Bluefield State-specific Cacer Iformatio Each eight-page state sectio icludes the followig cacer iformatio: demographics, cacer treds, cacer icidece ad mortality rates, case ad death couts, ad stagig data. We iclude cacer icidece ad mortality data o: all cacers combied, cacers of the female breast, cervix, colo/rectum, lug, prostate, ad melaoma of the ski. Whe sufficiet umbers permit, these cacer data are preseted by race (white ad black) ad by geder for cacers that are ot sex-specific. Data o stage of cacer at time of diagosis are show for cacers of the female breast, cervix, colo/rectum, prostate ad maligat melaoma. Cumberlad Charlotte Columbia North Charlesto America Cacer Society South Atlatic Cacer Facts & Figures 2008 1 Wichester Florece Charlottesville Myrtle Beach Hilto Head Lychburg Martisville Raleigh Georgia Wilmigto Gle Alle Greeville Newport News South Carolia Virgiia Virgiia Beach North Carolia Local Office Hope Lodge studets Discovery Shop i high school. Itroductio Each state sectio also icludes a At A Glace report that summarizes state-specific iitiatives o tobacco cotrol, cacer screeig programs, Comprehesive Cacer Cotrol, access to care measures ad other achievemets. Couty-specific Data Appedix For each South Atlatic state ad the District of Columbia, cacer icidece ad mortality data are provided by couty/ward i the Appedix. Five-year couts of cacer cases ad cacer deaths are show, alog with five-year average age-adjusted cacer icidece ad mortality rates for 2001-2005 uless otherwise oted. Cacer Prevetio & Early Detectio It is estimated that obtaiig recommeded cacer screeig tests ad adoptig healthy behaviors such New Castle as good utritio, reasoable body Eldersburg Hagerstow Baltimore Delaware Divisio Headquarters Silver Sprig Gambrills weight ad regular physical exercise DC Washigto, DC Viea Salisbury could elimiate at least 50% of cacer Harrisoburg deaths. The prevalece of each of these modifiable risk behaviors amog both adults ad high school studets is reported here by state sice these factors ca impact each state s cacer burde. Risk factor data used i this publicatio are obtaied from surveys coducted by the Behavioral Risk Factor Surveillace System (BRFSS) for adults ages 18 ad over ad by the Youth Risk Behavioral Surveillace System (YRBSS) ad Youth Tobacco Survey (YTS) for New Colorectal Cacer Screeig Guidelies Iformatio o the ew colorectal guidelies, issued i March 2008, is icluded i Updated Colorectal Guidelies. These guidelies, show i detail o page 82, list colorectal cacer screeig recommedatios categorized ito (1) tests that fid polyps ad cacer ad (2) tests that maily fid cacer. ACS Supported Research i the South Atlatic Divisio The America Cacer Society is the largest source of private, ot-for-profit cacer research fuds i the Uited States, secod oly to the federal govermet. The 111 grats totalig $50,557,202 that have bee awarded for research i the South Atlatic Divisio as of Jauary 2008 are listed o pages 84-87. For additioal details ad source iformatio, refer to the Techical Notes sectio o pages 88-90.

Demographics The South Atlatic (SA) Divisio, comprised of Delaware, District of Columbia, Georgia, Marylad, North Carolia, South Carolia, Virgiia ad West Virgiia, has a diverse ad growig populatio of 39,196,122 residets (2007 estimate). The primary racial ad ethic categories i the SA Divisio are White, o-hispaic (64.6%), Black, o-hispaic (24.3%), Hispaic (6.1%), Asia/Pacific Islader (o-hispaic) (2.9%) ad America Idia, No-Hispaic (0.5%). The size of the Hispaic populatio varies across the South Atlatic Divisio, with the District of Columbia havig the largest proportio at 8.7% ad West Virgiia the smallest (0.9%). The Hispaic/Latio subgroups i the South Atlatic Divisio are Mexica (49.3%), Puerto Rica (9.2%), Cuba (2.4%) ad other (39.1%). The largest subpopulatios of Asia Americas are Asia Idia (23.8% of the Asia populatio), Chiese (17.0%), Korea (16.4%), Vietamese (12.4%) ad Filipio (12.3%). Nearly oe quarter (24.3%) of residets i the South Atlatic Divisio are uder age eightee ad 11.9% of residets are ages 65 ad over. Estimated South Atlatic Populatio by Race/Ethicity ad State South Atlatic Divisio Delaware District of Columbia Georgia Marylad North Carolia South Carolia Virgiia West Virgiia Cout/% Cout/% Cout/% Cout/% Cout/% Cout/% Cout/% Cout/% Cout/% Total 39,196,122 862,225 580,271 9,339,947 5,675,034 8,875,404 4,332,306 7,708,938 1,821,997 White/No-Hispaic 25,305,921 (64.6%) Black/No-Hispaic 9,538,836 (24.3%) America Idia/No- Hispaic Asia / Pacific Islader/No-Hispaic 178,243 (0.5%) 1,154,790 (2.9%) Hispaic 2,400,500 (6.1%) Other/Multi-Race, No-Hispaic 617,832 (1.6%) 592,324 (68.7%) 174,609 (20.3%) 2,594 (0.3%) 23,613 (2.7%) 54,319 (6.3%) 14,766 (1.7%) 181,710 (31.3%) 315,148 (54.3%) 1,236 (0.2%) 17,796 (3.1%) 50,711 (8.7%) 13,670 (2.4%) 5,494,797 (58.8%) 2,735,208 (29.3%) 19,460 (0.2%) 257,240 (2.8%) 702,087 (7.5%) 131,155 (1.4%) * Hispaic is a ethicity, ot a race. Percets may ot add up to 100 due to roudig. Source: Claritas Ic., Copyright 2008 Thomso Medstat. All Rights Reserved. 3,307,000 (58.3%) 1,626,374 (28.7%) 13,339 (0.2%) 272,957 (4.8%) 340,026 (6.0%) 115,338 (2.0%) 6,000,159 (67.6%) 1,893,321 (21.3%) 105,676 (1.2%) 163,189 (1.8%) 598,562 (6.7%) 114,497 (1.3%) 2,823,716 (65.2%) 1,248,872 (28.8%) 13,857 (0.3%) 48,229 (1.1%) 151,248 (3.5%) 46,384 (1.1%) 5,190,200 (67.3%) 1,488,118 (19.3%) 18,846 (0.2%) 361,206 (4.7%) 487,057 (6.3%) 163,511 (2.1%) 1,716,015 (94.2%) 57,186 (3.1%) 3,235 (0.2%) 10,560 (0.6%) 16,490 (0.9%) 18,511 (1.0%) 2 America Cacer Society South Atlatic Cacer Facts & Figures 2008

Distributio of South Atlatic Divisio by Race/Ethicity Distributio of the South Atlatic Divisio by Race & Ethicity South Atlatic Divisio s Hispaic/Latio Populatio by Sub-Ethicity 0.5% Native America, No-Hispaic 1.6% Other/Multi-Race, No-Hispaic 2.4% Cuba 2.9% Asia/Pacific Islader, No-Hispaic 9.2% Puerto Rica 6.1% Hispaic* 39.1% Other Hispaic or Latio 24.3% Black, No-Hispaic 49.3% Mexica 64.6% White, No-Hispaic South Atlatic Divisio s Populatio by State South Atlatic Divisio s Asia Populatio by Sub-Ethicity 4.6% 19.7% 11.1% West Virgiia Virgiia South Carolia 12.3% 12.4% Filipio Vietamese 22.6% North Carolia 16.4% Korea 14.5% Marylad 17.0% Chiese, exc Taiwaee 23.8% Georgia 18.1% Other 1.5% 2.2% District of Columbia Delaware 23.8% Asia Idia Factors Related to Access to Care i the South Atlatic Divisio Percetage with less tha high school educatio 12.9% Media household icome $50,717 Percet households with icome < $15,000 13.0% Percet households with icome $50,000 49.9% Percet of households with o vehicle 7.7% Percet rural populatio 31.8% Percet miority 35.4% % speak laguage other tha Eglish at home 11.0% % with o usual source of health care coverage 16.5% Age Distributio of South Atlatic Divisio Age Group Number % 30 30 < 18 10,111,456 25.8% 18-24 3,859,735 9.8% 20 20 25-39 8,089,987 20.6% 40-49 8,512,892 21.7% 10 10 50-64 4,078,380 10.4% 65 + 4,543,672 11.6% 0 < 18 18-24 25-39 40-49 50-64 65+ 0 1 Total is sum of White, Black, Native America, Asia/Pacific Islader, Other/Multi-Race, ad Hispaic. 2 Hispaic is a ethicity, ot a race. 3 Departmet of Labor http://www.bis.gov/lau/, April 2008 Data Sources: Copyright 2008, Thomso Medstat. ALL RIGHTS RESERVED; US Cesus Bureau, Populatio Fact Sheet, 2008, America Commuity Survey @ http://factfider.cesus.gov America Cacer Society South Atlatic Cacer Facts & Figures 2008 3

Estimated New Cacer Cases & Deaths, 2008 Estimated New Cacer Cases by Site ad State, 2008* State All Cases Female Breast Uterie Cervix Colo & Rectum Uterie Corpus Leukemia Lug & Brochus Melaoma of the Ski No- Hodgki Lymphoma Prostate Uriary Bladder DE 4,950 580 480 130 110 760 180 190 530 220 DC 2,560 300 270 60 50 350 50 100 330 80 GA 36,980 4,910 340 3,760 840 1,030 5,980 1,600 1,550 4,700 1,380 MD 27,380 3,670 210 2,920 810 640 4,100 1,110 1,080 3,420 1,120 NC 40,420 5,000 340 4,380 1,050 1,110 6,510 1,830 1,610 5,050 1,740 SC 20,740 2,510 180 2,170 500 590 3,550 940 780 2,520 850 VA 35,590 4,680 260 3,690 1,000 850 5,340 1,620 1,410 4,430 1,460 WV 10,250 1,150 80 1,200 320 290 2,000 440 410 1,180 530 SA** 178,870 22,800 1,410 18,870 4,710 4,670 28,590 7,770 7,130 22,160 7,380 U.S. 1,437,180 182,460 11,070 148,810 40,100 44,270 215,020 62,480 66,120 186,320 68,810 * Rouded to the earest 10. Estimate is 50 or fewer cases. ** South Atlatic Divisio Note: These estimates are offered as a rough guide ad should be iterpreted with cautio. Data Source: America Cacer Society, Cacer Facts ad Figures, 2008 Estimated Cacer Deaths by Site ad State, 2008* State All Cases Brai/ Nervous System Female Breast Colo & Rectum Leukemia Liver Lug & Brochus No- Hodgki Lymphoma Ovary Pacreas Prostate DE 1,870 110 150 70 50 590 60 50 110 100 DC 990 70 90 250 60 70 GA 15,040 300 1,110 1,330 540 400 4,570 480 430 850 730 MD 10,360 220 830 940 390 300 2,920 350 280 660 550 NC 17,450 350 1,300 1,400 600 460 5,470 500 460 1,020 750 SC 8,860 190 620 730 320 260 2,860 270 210 520 420 VA 13,990 310 1,140 1,260 500 390 4,600 420 390 840 630 WV 4,580 100 310 450 150 120 1,450 170 130 210 150 SA** 73,140 1,470 5,490 6,350 2,570 1,980 22,710 2,250 1,950 4,270 3,400 U.S. 565,650 13,070 40,480 49,960 21,710 18,410 161,840 19,160 15,520 34,290 28,660 * Rouded to the earest 10. Estimate is 50 or fewer cases. ** South Atlatic Divisio Note: These estimates are offered as a rough guide ad should be iterpreted with cautio. Data Source: America Cacer Society, Cacer Facts ad Figures, 2008 4 America Cacer Society South Atlatic Cacer Facts & Figures 2008

Icidece ad Mortality *, ** Cacer Icidece Rates for Selected Sites, 2001-2005, by State ad US ALL SITES BREAST CERVICAL COLORECTAL LUNG AND BRONCHUS MELANOMA PROSTATE Both Geders Female Female Both Geders Male Female Both Geders Male Female Both Geders DE 507.3 126.4 8.2 53.5 62.6 46.4 79.6 97.8 66.2 20.9 175.5 DC* 538.5 172.4 12.5 62.7 64.5 61.2 66.9 84.7 52.3 12.1 200.9 GA 465.6 120.6 9.0 50.0 60.1 42.6 74.4 104.3 53.4 19.9 163.7 MD** 477.3 130.4 8.1 53.3 62.1 46.7 68.7 86.0 56.2 18.8 182.7 NC 461.6 121.7 7.9 48.6 57.3 41.9 73.8 100.9 54.4 16.6 156.1 SC 483.9 120.3 8.8 53.4 64.2 45.3 74.9 104.9 52.8 19.9 174.1 VA 436.4 120.1 6.9 48.6 56.8 42.5 66.7 86.6 52.2 17.1 156.5 WV 490.1 115.4 10.2 59.8 70.5 51.6 89.5 116.8 69.4 16.9 139.3 US 467.4 126.1 8.4 50.6 59.2 43.8 63.9 79.4 52.6 19.4 163.0 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. * - Icidece rates for the District of Columbia are for 2000-2004. ** Icidece rates for Marylad are for 1999-2003. Source: DE, DC, GA, MD, NC, SC, VA ad WV Cacer Registries; US Estimates:http://seer.cacer.gov/csr/1975_2005/, based o November 2007 SEER data submissio, posted to the SEER web site, 2008. Male Cacer Mortality Rates for Selected Sites, 2001-2005, by State ad US* ALL SITES BREAST CERVICAL COLORECTAL LUNG AND BRONCHUS MELANOMA PROSTATE Both Geders Female Female Both Geders Male Female Both Geders Male Female Both Geders Male DE 203.8 25.1 2.9 19.8 23.7 16.8 61.9 80.2 48.5 3.3 29.3 DC* 221.0 32.4 3.7 23.3 24.3 22.5 55.9 71.1 43.3 1.3 37.1 GA 193.0 24.6 2.7 18.4 22.6 15.6 58.5 85.6 39.6 2.5 30.4 MD 194.9 27.2 2.4 19.8 23.8 16.8 55.7 72.3 43.7 2.7 28.6 NC 197.1 25.6 2.6 18.4 22.2 15.6 59.7 85.4 41.5 2.9 30.0 SC 201.4 25.4 2.8 19.2 23.8 15.9 60.8 89.3 40.3 2.5 32.9 VA 192.5 26.4 2.2 18.6 22.8 15.6 56.2 75.7 42.2 2.9 29.5 WV 213.5 25.1 3.4 21.6 26.0 18.2 68.8 93.1 51.1 3.0 24.0 US 189.8 25.0 2.5 18.8 22.7 15.9 54.1 72.0 41.0 2.7 26.7 * - Mortality rates for the District of Columbia are for 2000-2004. Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Data Sources: DC, DE, GA, NC ad SC cacer registries; MD Vital Statistics Admiistratio, VA Ceter for Health Statistics; WV Health Statistics Ceter; US: http://seer.cacer.gov/csr/1975_2005/, based o November 2007 SEER data submissio, posted to the SEER web site, 2008. America Cacer Society South Atlatic Cacer Facts & Figures 2008 5

Treds i Cacer Icidece ad Mortality I 1996, the America Cacer Society Board of Directors set a ambitious challege goal of a 50% reductio i age-adjusted cacer mortality rates by the year 2015. As a measure of our progress towards the 2015 goal, U.S. cacer mortality rates have decreased 14.6% sice 1990. I 1998, the Board of Directors set a parallel challege goal for a 25% reductio i age-adjusted cacer icidece rates by 2015. As of 2005, the cacer icidece for the U.S., based o SEER data, has decreased 5.4% sice 1990. Two South Atlatic (SA) Divisio states, Georgia ad Virgiia, have a 2005 icidece rate that is lower tha the U.S. rate. The Natioal Cacer Istitute raks five-year average ageadjusted cacer mortality rates from 1 to 51, with 1 beig the highest (worst) rate. The District of Columbia raks 6th highest i the Natio for all cacers combied for 2001-2005 (4th amog me ad 10th amog wome). The District is also highest i mortality from prostate cacer ad cacers of the breast ad cervix i wome. Colorectal cacer mortality i the District is 3rd highest i the Natio, both amog me ad wome. West Virgiia raks 3rd i mortality from all sites combied (2d amog wome ad 8th amog me), with colorectal cacer 2d, lug cacer 4th (3rd amog wome ad 7th amog me) ad cervical cacer 4th. Seve of the eight South Atlatic states are i the top te highest for prostate cacer mortality. The District of Columbia raks highest, South Carolia 4th, Georgia 6th, Virgiia 7th, North Carolia 8th, Delaware 9th ad Marylad 10th. Me i Delaware rak highest i mortality from maligat melaoma. Amog Delaware wome, lug cacer mortality raks 4th, mortality from all sites combied raks 8th ad cervical cacer mortality raks 9th. Me i South Carolia are 9th highest i overall mortality ad 8th highest i mortality from cacers of the lug ad brochus. I Virgiia, mortality from maligat melaoma raks 9th i wome ad breast cacer mortality is also 9th highest. State Rakigs* of Selected Cacer Mortality Rates 2001-2005 by SA State, Both Sexes Combied SAD State All Sites Colo / Rectum Lug / Brochus Maligat Melaoma DE 11 16 11 5 DC 6 4 34 51 GA 24 33 17 34 MD 19 14 20 30 NC 20 35 15 22 SC 14 25 13 38 VA 23 27 18 20 WV 3 2 4 9 State Rakigs* of Selected Cacer Mortality Rates 2001-2005 by SA State, Males SAD State State Rakigs* of Selected Cacer Mortality Rates by SAD State, Females SAD State All Sites All Sites Colo / Rectum Colo / Rectum Lug / Brochus Lug / Brochus Maligat Melaoma Maligat Melaoma Breast (female) Prostate DE 13 18 15 1 9 DC 4 3 18 49 1 GA 17 30 12 36 6 MD 22 16 23 26 10 NC 16 33 13 22 8 SC 9 20 8 34 4 VA 20 23 17 23 7 WV 8 2 7 12 45 Cervix DE 8 18 4 21 20 9 DC 10 3 44 51 1 1 GA 31 33 33 30 25 15 MD 14 15 19 33 5 27 NC 28 34 28 15 15 21 SC 29 30 32 39 19 13 VA 26 32 23 9 9 31 WV 2 2 3 13 21 4 Note: Rakigs are of Average Cacer Mortality Rates for all races combied for 2001-2005 that are age-adjusted to the 2000 U.S. stadard populatio. * A rak of 1 idicates the highest (worst) age-adjusted mortality rate for that cacer amog the 50 states ad the District of Columbia ad 51 is the best (lowest) rate amog all 51 states ad the District of Columbia Source: Ries LAG, Melbert D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, Clegg L, Horer MJ, Howlader N, Eiser MP, Reichma M, Edwards BK (eds). SEER Cacer Statistics Review, 1975-2005, Natioal Cacer Istitute. Bethesda, MD, http://seer.cacer.gov/csr/1975_2005/, based o November 2007 SEER data submissio, posted to the SEER web site, 2008. 6 America Cacer Society South Atlatic Cacer Facts & Figures 2008

Cacer Icidece Rates, All Sites, by State ad U.S., 1995-2005* 650 600 550 Rate Per 100,000 500 450 400 350 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. *District of Columbia data for years 1995-2004, Georgia data years 1999-2005, South Carolia data years 1996-2005, Marylad data years 1995-2003 Data Sources: DC, DE, MD, GA, NC, SC, VA ad WV cacer registries; US: http://seer.cacer.gov/csr/1975_2005/, based o November 2007 SEER data submissio, posted to the SEER web site, 2008. DE DC GA MD NC SC VA WV US Cacer Mortality Rates, All Sites, by State ad U.S., 1995-2005* 270 250 Rate Per 100,000 230 210 DE DC GA MD NC 190 SC VA WV 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 US Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. * District of Columbia data for years 1995-2004 Data Sources: DC, DE, GA, NC ad SC cacer registries; MD Vital Statistics Admiistratio, VA Ceter for Health Statistics; WV Health Statistics Ceter; US: http://seer.cacer.gov/csr/1975_2005/, based o November 2007 SEER data submissio, posted to the SEER web site, 2008. America Cacer Society South Atlatic Cacer Facts & Figures 2008 7

Cacer Amog Hispaics ad Latios Itroductio The Hispaic/Latio populatio is ofte described as a mosaic of cultures. Moreover, the diversity exteds to atioality, customs, heritage, lifestyles ad socioecoomic status. The Hispaic heritage ca be traced back to Spai. Latio/a refers to persos livig i Spaish-speakig Lati America ad their heritage ca be traced back to the Lati laguage. The terms Hispaic ad Latio/a are used iterchageably i this report. The Hispaic/Latio populatio comprises early 15% of the U.S. populatio ad is the fastest growig racial/ethic group. As of 2007, a estimated 2,400,500 Hispaic/Latios reside i This report icludes the followig sectios: Health profile amog Hispaic adults Health profile amog Hispaic youth Cacer screeig patters Cacer icidece & mortality amog Hispaics Stage at diagosis ad survival Access to care Programs to promote healthy behaviors amog Hispaics Limitatios Table 1. Percetage of Hispaic Residets by South Atlatic State (raked from highest to lowest) South Atlatic State/District Number of Hispaic Residets Percet of Total State Populatio District of Columbia 50,711 8.7% Georgia 702,087 7.5% North Carolia 598,562 6.7% Delaware 54,319 6.3% Virgiia 487,057 6.3% Marylad 340,026 6.0% South Carolia 151,248 3.5% West Virgiia 16,490 0.9% South Atlatic Divisio 2,400,500 6.1% Source: Claritas the South Atlatic Divisio (SAD) ad they make up 6.1% of the populatio. 7 The fastest populatio growth for Hispaics is i the South; Georgia, North Carolia ad South Carolia are amog the top states with a icrease of more tha 300% i the last te years. Withi the Divisio, the District of Columbia raks highest i the proportio of Hispaic residets (8.7%), followed by Georgia at 7.5%, ad West Virgiia has the smallest proportio at 0.9%. (Table 1) Official cesus couts of the Hispaic/Latio populatio, however, are believed to be uderrepreseted due to idividual idetity preferece (black/white versus Hispaic/Latio) as well as legal status cocers of the commuity ad recet chages i immigratio patters. Overall, six out of te Hispaic/Latio residets i the SAD have reported to be from Mexico, Puerto Rico or Cuba. 8 I North Carolia, Georgia ad South Carolia, Mexicas comprise the majority of Hispaic residets, with 66.6%, 65.4% ad 63.0%, respectively. Delaware has the largest proportio of Latios of Puerto Rica descet (27.3%) ad District of Columbia has the highest proportio from Cuba (4.9%). Persos from other Hispaic/Latio coutry are most commo i the District of Columbia (76.5%), Marylad (67.6%) ad Virgiia (61.3%). (Table 2) Additioal data reveal that the District of Columbia, with more tha three-quarters of its populatio i the other Hispaic/ Latio category, is home to the largest Bolivia populatio i the U.S., the secod largest cocetratio of Salvadoras ad sigificat populatios from Peru, Colombia, Mexico, Guatemala, Hoduras, Ecuador ad Nicaragua. The District also icludes embassies ad cosulates from may Lati America coutries. Health Profile amog Hispaic Adults Experts believe that if curret kowledge about cacer prevetio ad early detectio were applied, at least half of all cacer deaths could be preveted. The America Cacer Society estimates that i 2008, about 10,000 cacer deaths will be attributed to tobacco use aloe. I additio, approximately oe-third (188,550) of the 565,650 cacer deaths expected i 2008 are attributable to poor utritio, overweight/obesity ad lack of physical activity. Cacer screeig tests ca detect pre-cacerous lesios, improve survival or decrease mortality by detectig cacer at a earlier stage whe treatmet is more effective. 3 Table 2. Distributio of Hispaic/Latio Residets by Coutry of Origi ad SA States, 2007 populatio estimates Coutry of Origi DE DC GA MD NC SC VA WV SA* Mexico 45.8% 12.8% 65.4% 19.1% 66.6% 63.0% 25.1% 40.0% 49.3% Puerto Rico 27.3% 5.7% 7.4% 10.9% 7.5% 10.1% 10.9% 12.6% 9.2% Cuba 1.7% 4.9% 2.7% 2.3% 1.8% 1.7% 2.7% 2.9% 2.4% Other Hispaic/Latio 25.3% 76.5% 24.6% 67.6% 24.1% 25.2% 61.3% 44.5% 39.1% Total Kow Hispaic/ Latio Residets 54,319 50,711 702,087 340,026 598,562 151,248 487,057 16,490 2,400,500 Source: Cesus; *Populatio - weighted average. 8 America Cacer Society South Atlatic Cacer Facts & Figures 2008

limited, smokig patters amog Latios i the South Atlatic Divisio do geerally follow the atioal patter where 16.7% of Hispaics are curret smokers i 2007, compared with 19.4% o-hispaic (NH) white ad 21.7% o-hispaic (NH) blacks. A exceptio is oted i South Carolia, where the cigarette smokig rate amog Hispaics (24.8%) is higher tha amog o-hispaic whites (22.0%) ad the same as o-hispaic blacks (24.7%). (Table 3) Smokig rates amog Hispaic me are about 25% lower tha i o-hispaic white me, ad Hispaic wome are about half as likely to smoke as o-hispaic white wome. 6 Cigarette smokig rates amog Hispaics bor i the U.S. are higher tha amog those bor elsewhere. 2 Tobacco Use: The Natioal Latio Coucil o Alcohol ad Tobacco Prevetio, more commoly kow as LCAT, is a oprofit 501(c)(3) atioal orgaizatio established i 1989 i order to combat alcohol ad tobacco problems ad their uderlyig causes i Latio commuities (www.lcatp.org). As the oly Latio atioal orgaizatio dedicated solely to reducig the harm caused by alcohol ad tobacco i the Latio commuity, their work is coducted through research, advocacy, policy aalysis, commuity educatio, traiig ad iformatio dissemiatio. Results of their research show that: Puerto Ricas are more likely tha other Latios to be curret smokers. For Latias, there is a positive relatioship betwee level of acculturatio ad smokig. I 2005, 22 percet of Hispaic high school studets smoked, a 19 percet icrease over the 2003 smokig rate of 18.4 percet. I 2004, 9.4 percet of Hispaic middle school studets smoked. Puerto Rica wome are early twice as likely to smoke as wome of other Hispaic groups. Lug cacer is the leadig cause of cacer deaths amog Latios livig i the Uited States. The Behavioral Risk Factor Surveillace System survey (BRFSS) is a aual survey of the Ceters for Disease Cotrol ad Prevetio (CDC) ad the U.S. states ad territories. 6 Although the state-specific data o risk behaviors amog Hispaics are Poor utritio, lack of physical activity ad beig obese or overweight are major cacer risk factors, secod oly to tobacco use. Approximately oe-third, or 188,550 of the 565,650 cacer deaths i 2008 will have bee associated with these three risk factors. This statistic would mea that 7,772 of the 23,320 U.S. cacer deaths expected amog Hispaics i 2006 could have bee preveted through a healthy diet, regular physical activity ad weight cotrol. Nutritio ad Physical Activity: The ACS Recommedatios for Nutritio ad Physical Activity, updated i 2006, highlight the importace of havig a healthy weight ad physical activity i the prevetio of cacer. 5 The recommedatios iclude the followig: Maitai a healthy weight throughout life. Balace calorie itake with physical activity. Avoid excessive weight gai throughout life. Achieve ad maitai a healthy weight if curretly overweight or obese. Adopt a physically active lifestyle. Adults: Egage i at least 30 miutes of moderate to vigorous physical activity, above usual activities, o 5 or more days of the week; 45 to 60 miutes of itetioal physical activity are preferable. Childre ad adolescets: Egage i at least 60 miutes per day of moderate to vigorous physical activity at least 5 days per week. Fruits ad Vegetables: Eatig five or more servigs of a variety of vegetables ad fruits every day is a recommedatio i the America Cacer Society s Nutritio Guidelies, updated i 2006. 5 Ufortuately, BRFSS estimates show that more tha Cotiued Table 3. Estimated Prevalece of Curret Cigarette Smokig amog Adults (%) by Race/Ethicity for SAD States ad U.S., 2007 DE DC GA MD NC SC VA WV SA* US Hispaic /a 11.0 15.0 13.9 19.2 24.8 8.2 /a 15.0 16.7 NH White 19.4 24.1 19.1 17.4 23.1 22.0 13.7 21.9 19.0 19.4 NH Black 14.6 22.0 19.6 19.0 23.0 24.7 15.1 /a 19.5 21.7 Source: BRFSS; * Populatio-weighted estimated average of South Atlatic states with available data America Cacer Society South Atlatic Cacer Facts & Figures 2008 9

three-quarters of adult Americas DO NOT meet the ACS recommedatio for miimum fruit ad vegetable cosumptio. I the SAD, cosumptio is lowest amog Hispaics (80.9%), followed by NH blacks (77.9%) ad NH whites (75.7%). (Table 4) Physical Activity: Research idicates that regular physical activity ca prevet cacer by helpig reduce overweight ad obesity. Achievig ad/or maitaiig a ideal weight ca help decrease the risk of cacers of the colo/rectum, breast (premeopausal), uterus ad prostate. Regular physical activity is also beeficial i the prevetio of chroic diseases, particularly diabetes ad heart disease. The BRFSS questio do you have at 30+ miutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ miutes three or more days per week? is the measure of adult physical activity that most closely resembles the ACS guidelie listed above. The South Atlatic Divisio overall has a higher prevalece tha the U.S. of persos that DO NOT have regular physical activity i each of the race/ethicity groups show i Table 5. The rate of physical iactivity amog Hispaics i the SAD is 18% higher tha the U.S. Hispaic rate, but data are oly available for the District of Columbia, Marylad ad North Carolia. I North Carolia ad South Carolia, prevalece of physical iactivity is higher tha the U.S. amog both white ad black o-hispaics. Obesity/Overweight: Beig overweight or obese is associated with icreased risk of cacers of the breast, prostate, colo/ rectum ad uterus, i additio to other chroic diseases such as diabetes, high blood pressure, heart disease ad premature death. A commo measure to establish whether a perso is u- derweight, ormal weight, overweight or obese is the Body Mass Idex (BMI) which is determied by the perso s height ad weight. Obese is havig a BMI of 30 or higher ad overweight is defied as havig a BMI of 25 to less tha 30. Obesity has bee icreasig i the U.S. i both Hispaics ad o-hispaics. Data from the BRFSS survey, where overweight ad obese are classified based o the idividual s self-reported height ad weight, show that i the U.S. early 67 percet of Hispaic residets were overweight or obese compared with 62.6% of o-hispaic whites. No-Hispaic blacks, however, had a obesity/overweight prevalece of 72.6%. Data from other surveys suggest that the rate of obesity is higher amog Puerto Ricas ad Mexicas tha i other Hispaic subgroups. 2 I the South Atlatic Divisio, the prevalece of overweight/ obesity amog o-hispaics is similar to the U.S. rate. A exceptio is the District of Columbia, where the prevalece of overweight/obesity for NH whites at 39.3% is 37% lower tha the U.S. rate for that race/ethic group. Although data for Hispaics are oly available for 2 states ad the District of Columbia, the SA combied rate (58.9%) is lower tha the U.S ad lower tha NH whites ad NH blacks i the SA Divisio; 62.0% ad 72.6%, respectively. (Table 6) Health Profile amog Hispaic Youth The Youth Risk Behavior Surveillaces Survey (YRBSS) is a aual survey that is also coducted by the Ceters for Disease Prevetio ad Cotrol. 13 Although the data o Hispaic youth are limited at the state level, data for the etire U.S. ca provide Table 4. Estimated Prevalece of Not Eatig 5 Fruits & Vegetables per Day (%) amog Adults by Race/Ethicity for SAD States ad U.S., 2007 DE DC GA MD NC SC VA WV SA* US Hispaic /a 71.2 78.6 79.1 85.3 81.5 75.6 /a 80.9 77.4 NH White 79.3 64.7 75.2 72.9 76.9 80.9 73.5 80.9 75.7 75.5 NH Black 77.1 69.5 74.8 74.8 81.5 82.0 72.9 /a 77.9 76.9 Source: BRFSS; * Populatio-weighted estimated average of South Atlatic states with available data Table 5. Estimated Lack of Physical Activity (%) amog Adults by Race/Ethicity for SAD States ad U.S., 2007 DE DC GA MD NC SC VA WV SA* US Hispaic /a 56.2 /a 60.2 69.0 /a /a /a 65.2 55.3 NH White 50.1 33.3 50.9 48.4 53.1 51.7 49.0 54.5 50.6 48.4 NH Black 61.8 54.7 57.3 58.7 62.3 60.0 56.7 /a 59.0 58.6 Source: BRFSS; * Populatio-weighted estimated average of South Atlatic states with available data Table 6. Estimated Prevalece of Overweight/Obesity amog Adults (%) by Race/Ethicity for SAD States ad U.S., 2007 DE DC GA MD NC SC VA WV SA* US Hispaic /a 57.2 /a 56.5 62.4 /a /a /a 58.9 66.9 NH White 64.2 39.3 63.2 60.7 62.5 63.0 60.3 68.6 62.0 62.6 NH Black 73.2 68.8 69.6 74.2 74.7 73.6 72.4 /a 72.6 72.6 Source: BRFSS; * Populatio-weighted estimated average of South Atlatic states with available data 10 America Cacer Society South Atlatic Cacer Facts & Figures 2008

Table 7. Estimated Prevalece of Risk Behaviors amog High School Studets (%) by Race/Ethicity for the U.S., 2007 Hispaic White No-Hispaic Black No-Hispaic Risk Factor Male Female Male Female Male Female Curret Cigarette Smokig 18.7 14.6 23.8 22.5 14.9 8.4 Curret Smokeless Tobacco Use 6.7 2.7 18.0 2.5 2.0 0.5 Did Not Cosume 5 Fruits & Vegetables per Day 74.1 77.9 79.9 82.4 73.4 76.6 Did Not Meet Recommeded Level of Physical Activity 18.8 35.2 16.7 28.2 21.8 42.1 Are Overweight or Obese 38.6 30.6 30.3 19.6 35.5 39.2 Source: YRBSS, 2007 a ivaluable profile of risk behavior patters amog Hispaic studets. (Table 7) Data are show here for high school studets. Cigarette Smokig: Data from the YRBSS 2007 show that the prevalece of cigarette smokig amog white NH youth (23.8% male ad 22.5% female) is still higher tha amog Hispaic youth (18.7% male ad 14.6% female). (Table 7) Amog black o-hispaic studets, 14.9% of male ad 8.4% of female studets reported curret cigarette use (at least oe cigarette per day over the past 30 days). Although Hispaic youth i the U.S. ted to smoke less tha NH youth, these patters may chage as marketig efforts icrease i Lati America coutries, particularly amog wome, ad also target Hispaic wome ad youth i the Uited States. 2 Smokeless Tobacco Use: Smokeless tobacco products, icludig chewig tobacco ad suff, are ot safe substitutes for cigarette smokig. These products ca cause oral ad pacreatic cacers, ocacerous oral coditios ad ca lead to icotie addictio. The tobacco idustry cotiues to market ew ad existig products as supplemetal sources of icotie i smoke-free settigs ad misleadigly markets these products as a low-risk optio for smokers who are uable to quit. I Table 7 are usage rates for smokeless tobacco products amog high school studets. Amog Latios, 6.7% of male ad 2.7% of female studets used smokeless tobacco products. The highest prevalece rate was 18.0% of white NH youth usig smokeless tobacco products ad the lowest rate was 0.5% amog black o-latias. I each race/ethicity category i Table 7, male studets are more likely tha female studets to be users of smokeless tobacco products, Fruits ad Vegetables: ACS recommedatios o fruit ad vegetable cosumptio for childre/youth parallel those for adults. Amog male studets, the prevalece of ot eatig 5 or more fruits ad vegetables was highest amog white NH (72.2%) tha Hispaic (76.0%) ad black NH (75.1%). I each race/ethicity category, female studets ate more fruits ad vegetables daily tha male studets, although the differece was oly about two percetage poits i each category. (Table 7) Physical Activity: The recommeded physical activity for childre ad adolescets is to egage i at least 60 miutes per day of moderate to vigorous physical activity at least 5 days per week. I each race/ethicity category, the prevalece of studets who DO NOT meet the recommeded physical activity level is higher amog female tha male studets. Amog male studets, 18.8% of Hispaics did ot meet the physical activity requiremets; black o-hispaics had the highest rate (21.8%) ad white o-hispaics the lowest rate at 16.7%. A similar patter is see amog female studets. (Table 7) Overweight/Obesity: Sice 1990, the prevalece of overweight childre has icreased sharply i childre of all racial ad ethic groups i the U.S. Overweight childre ofte become overweight adults, with icreased risks of poor health outcomes such as high blood pressure, high cholesterol ad diabetes. 3 I Table 7 are prevalece rates for overweight/obese by geder ad ethicity/race category. As i adults, the weight category for childre is determied by the Body Mass Idex (BMI), but the formulas for the childhood BMI vary by age. Amog male youth, the rate of beig overweight/obese is highest amog Hispaic high school studets (38.6%), followed by o-hispaic black (35.5%) ad NH white (30.3%) high school studets. Amog female high school studets, o-latia blacks have the highest rate of overweight (39.2%), followed by Latias (30.6%) ad o-latia white high school studets (19.6%). Cacer Screeig Patters amog Hispaics Cacer screeig as recommeded by the America Cacer Society (ACS) ca measurably improve oe s chaces for a favorable outcome by detectig the cacer at a early stage whe treatmets are most effective. These guidelies are for people at average risk for cacer (uless otherwise specified) ad without ay Cotiued America Cacer Society South Atlatic Cacer Facts & Figures 2008 11

specific symptoms. Those that are at icreased risk for certai cacers should cosult their physicia as they may eed to follow a differet screeig schedule, such as startig at a earlier age or beig screeed more ofte. Also, persos with symptoms that could be related to cacer should see their doctor right away. 4 Breast Cacer Screeig: The ACS guidelies state that yearly mammograms are recommeded startig at age 40 ad cotiuig for as log as a woma is i good health. 2 A mammogram is a low-dose X-ray procedure that ca detect breast cacer at a early stage whe treatmet would be more effective. I 2006 i the South Atlatic Divisio, Latias have a lower rate of mammography screeig (60.7%) tha o-latia whites (62.8%) ad o-latia blacks (63.8%). (Table 8) Additioal survey data from 2003 show that wome from Cetral ad South America, ad Cuba have higher mammography screeig rates tha Mexica wome. 2 U.S. data show a screeig patter that is similar to the SAD, but the U.S. screeig rate i each race/ethicity group is 1-2 percetage poits lower tha see i the SAD. Although the mammography screeig rates amog Latias have improved cosiderably durig the past 20 years ad are approachig those of o-latias, breast cacers diagosed amog Latias are, o average, diagosed at a more advaced stage tha those diagosed amog o-latias. 2 Prostate Cacer Screeig: The ACS suggests screeig for prostate cacer by a combiatio of the prostate-specific atige (PSA) test ad digital rectal exam (DRE) at ages ad time itervals that are depedet upo each ma s race, age ad kow risk factors. 5 The BRFSS questioaire asks me ages 40 ad older if they have had a PSA (prostate-specific atige) test withi the past two years. I the U.S., Hispaic me have the lowest PSA screeig rate (43.0%), followed by NH black me (48.1%) ad NI white me (55.6%). No-Hispaic me i the SA Divisio follow the same patter as U.S. me. I fact, PSA screeig rates are lower for black NH me tha white NH me i each state i the South Atlatic Divisio, most otably i Delaware ad South Carolia. (Table 9) Colorectal Cacer Screeig: New screeig guidelies for colorectal cacer released i March 2008 iclude: (1) tests that fid polyps ad cacer ad (2) tests that maily fid cacer ad are show i detail o page 82 of this publicatio. 5 The BRFSS questioaire asks adults ages 50+ if they have ever had a sigmoidoscopy or colooscopy (i.e. a edoscopy) (Table 10). Although the ew guidelies recommed a flexible sigmoidoscopy every 5 years or a colooscopy every 10 years, the BRFSS questio ca still be used to approximate regioal as well as sex- ad race/ ethicity-specific screeig patters across the SAD. The rate of screeig by edoscopy amog South Atlatic Divisio residets ages 50+ is higher tha that see for the U.S. i each race/ethicity category. (Table 10) Although Hispaic adults have the lowest screeig rates of the three race/ethicity groups, their screeig rate i the SAD (49.2%) is early oethird higher tha that amog U.S. Hispaics (38.2%). Marylad has the highest screeig rate for Hispaics (64.3%), followed by Georgia with 55.2% screeed. Amog o-hispaic whites, the District of Columbia ad Delaware have the highest screeig Table 8. Estimated Mammography Screeig Rates amog Wome Ages 40+ by Race/Ethicity for SAD ad U.S., 2006 DE DC GA MD NC SC VA WV SA* US Hispaic /a /a 60.7 67.2 52.6 56.3 74.0 /a 60.7 58.7 NH White 68.9 62.0 63.3 63.1 64.1 56.4 63.3 62.4 62.8 61.6 NH Black 77.8 64.7 67.8 65.3 66.1 61.0 55.1 /a 63.8 62.7 Source: BRFSS; * Populatio-weighted estimated average of South Atlatic states with available data Table 9. Estimated Prostate Cacer Screeig (PSA) Rates (%) for Me Ages 40 + by Race/Ethicity for SAD ad U.S., 2006 DE DC GA MD NC SC VA WV SA* US Hispaic /a /a /a /a 32.1 /a /a /a /a 43.0 NH White 63.6 57.2 56.7 58.0 57.7 57.3 55.0 54.0 56.9 55.6 NH Black 43.5 50.0 49.9 46.9 50.4 41.2 53.7 /a 49.2 48.1 Source: BRFSS; * Populatio-weighted estimated average of South Atlatic states with available data Table 10. Estimated Colorectal Cacer Screeig (edoscopy) Rates (%) for Adults Ages 50 + by Race/Ethicity for SAD ad U.S., 2006 DE DC GA MD NC SC VA WV SA* US Hispaic /a /a 55.2 64.3 41.1 51.8 38.7 /a 49.2 38.2 NH White 61.7 62.7 50.5 57.7 54.2 51.4 58.4 46.1 54.2 51.5 NH Black 59.3 55.4 47.3 58.4 52.3 43.0 59.3 /a 52.5 49.3 Source: BRFSS; * Populatio-weighted estimated average of South Atlatic states with available data 12 America Cacer Society South Atlatic Cacer Facts & Figures 2008

rates at 62.7% ad 61.7%, respectively. No-Hispaic blacks have the highest screeig rates i Delaware ad Virgiia (both at 59.3%). The BRFSS survey also asks adults ages 50+ if they have had a blood stool test withi the past two years. (Table 11) The blood stool test, ofte referred to as the Fecal Occult Blood Test or FOBT, is also oe of the tests recommeded i the ACS guidelies. Hispaics have the lowest frequecy of FOBT screeig of the race/ethic groups i the U.S. (11.3%) ad i the SAD (10.9%). The FOBT rate amog NH blacks is higher tha or equal to the rate for NH whites i each South Atlatic state. Cervical Cacer Screeig: The ACS suggests screeig for cervical cacer by Pap tests at time itervals that are depedet upo the woma s age, risk factors ad sexual history. 5 The BRFSS questioaire measures cervical cacer screeig by the questio have you had a Pap test withi the past 2 years? for wome ages 18 ad older. Although Latias have bee less likely to participate i cervical cacer screeig, their rates have improved i recet decades. Amog Latias, cervical cacer screeig rates are lowest amog Mexica wome ad amog uisured wome. 2 Latias have the lowest cervical cacer screeig rates i the South Atlatic Divisio (82.8%) as well as the U.S. (82.0%). I Delaware, however, the rate for Latias is higher tha that for o-latias, but the opposite is true (higher amog o-latias tha Latias) i the District of Columbia, Georgia, Marylad ad North Carolia. (Table 12) Cacer Icidece ad Mortality amog Hispaics About 39,940 ew cacer cases i Hispaic me ad 42,140 cases i Hispaic wome were expected to be diagosed i the U.S. i 2006. The most commoly diagosed cacers amog Hispaic me were expected to be prostate (30%), colo/rectum (11%) ad lug (8%). Amog Latias, the most commo cacers were expected to be breast (34%), colo/rectum (9%) ad lug (6%). 2 Cacer Icidece: State-specific data o cacer icidece ad mortality have ot bee published by South Atlatic state cacer registries due to the relatively small umbers of Hispaic residets i each state. Data for the Uited States, however, show that Hispaics have 30% lower icidece rates for all cacers combied whe compared to whites, but Latios geerally have higher rates of cacers associated with certai ifectios, such as cacers of the uterie cervix, liver, gallbladder ad stomach. 2 Hispaic me ad wome are 1.5 to 2 times more likely to have oe of these four cacers tha o-latios. Cacer Mortality: The umbers of cacer deaths i 2006 were expected to be 12,320 amog Hispaic me ad 11,000 i Latias i the U.S. I Hispaic me, lug cacer would accout for 21% of the deaths, followed by colo/rectum (11%) ad prostate (9%). Amog Latias, breast cacer is the leadig cause of cacer death (21% expected), followed by lug (9%) ad colo/rectum (6%). This patter is i cotrast with white o-hispaic wome, amog whom lug cacer is the most commo cause of cacer death. Childhood Cacer: Cacer is relatively rare amog childre (0-14 years) ad adolescets (15-19 years), ad the types of cacers foud i childre/adolescets are differet from those see i adults. It was estimated that 1,850 Hispaic childre would be diagosed with cacer i the U.S. i 2006. The prevalece of child/adolescet cacers i Hispaics (2.3% of all cacers) is higher tha that see i the total U.S. populatio, where oly 1% Cotiued Table 11. Estimated Fecal Occult Blood Test Rates (%) for Adults Ages 50 + by Race/Ethicity for South Atlatic Divisio ad U.S., 2006 DE DC GA MD NC SC VA WV SA* US Hispaic /a /a 11.0 23.3 9.5 12.6 2.4 /a 10.9 11.3 NH White 14.4 22.5 17.3 18.6 21.1 13.5 14.7 18.4 17.5 16.5 NH Black 16.1 22.5 19.8 21.1 21.1 17.6 15.9 /a 19.2 16.9 Source: BRFSS; * Populatio-weighted estimated average of South Atlatic states with available data Table 12. Estimated Pap Smear Screeig Rates by Race/Ethicity Amog Wome Ages 18+ for SAD ad U.S., 2006 DE DC GA MD NC SC VA WV SA* US Hispaic 91.3 86.6 75.3 82.2 83.9 87.2 87.5 /a 82.8 82.0 NH White 89.4 90.3 87.6 87.7 86.3 85.7 85.3 83.6 86.5 84.2 NH Black 86.8 88.6 90.3 88.5 89.6 90.3 89.2 /a 89.5 87.2 Source: BRFSS; * Populatio-weighted estimated average of South Atlatic states with available data America Cacer Society South Atlatic Cacer Facts & Figures 2008 13

of cacers are childhood cacers. Oe reaso is that the U.S. Hispaic populatio is youger o average tha the rest of the U.S. populatio; childre accout for 34% of the Hispaic populatio compared to 25% of the total U.S. populatio. 2 It was estimated that 350 Hispaic childre would die from cacer i 2006. Latios are affected by may ecoomic ad cultural disparities i health care, icludig a disproportioate lack of participatio i federally-fuded cacer research. Their lack of iclusio i health research had hidered the developmet of prevetio guidelies ad treatmets appropriate for this special populatio group. Amog Latios, iadequate screeig ad prevetive care ofte lead to late diagosis, delayed ad/or iadequate treatmet ad, with some cacers, higher mortality. The iequalities see i cacer icidece ad mortality betwee Latio ad o-latio populatios ca be reduced by elimiatig exposure to ifectious agets that cause cacer, prevetig Hispaics from adoptig traditioally-avoided high risk cacer behaviors, icreasig use of effective cliical prevetive behaviors ad assurig that every perso diagosed with cacer has affordable ad timely access to state-of-the-art, affordable cacer care. 10 Stage at Cacer Diagosis ad Survival Stage at diagosis idicates whether or ot the cacer has spread to other orgas ad regios of the body ad is oe of the tumor characteristics that is used to select a treatmet for the patiet. I geeral, cacers diagosed i the later stages (regioal ad distat) have a poorer progosis because the tumor has spread beyod the site of origi. Health care barriers such as lack of health isurace or a usual source of care are experieced by may Hispaic me ad wome i the U.S., as reflected i their lower rates of cacer screeig as well as other prevetive behaviors. Oe example of the effects of lack of access to care ca be see for female breast cacer. 14 Stages At Diagosis I Situ refers to a eoplasm that is oivasive ad cofied to a small area withi the tissue of origi Localized is a ivasive maligat cacer cofied etirely to the orga of origi Regioal is a cacer that 1) exteds beyod the limits of the orga of origi ito surroudig orgas/tissues or 2) ivolves regioal lymph odes by way of lymphatic system Distat idicates that the cacer has spread to other parts of the body, such as the lugs, liver, brai or to distat lymph odes. Breast cacer is the leadig cacer amog wome i the Uited States, represetig 32% of all cacer cases amog wome. It is estimated that 1 i 7 wome will develop breast cacer durig their lifetime. Although breast cacer icidece rates are lower amog Latias compared to o-latias, Latias are more frequetly diagosed at a later stage of breast cacer tha o-latias. Data for the U.S. below show that for female breast cacers diagosed durig 2000-2003, oly 54% of Latias compared with 63% of o-latias were diagosed i the local stage. (Chart 1) Latias are also more likely to be diagosed with larger breast tumors tha o-hispaic wome. I additio, Natioal data show that Hispaic me diagosed with prostate cacer are 3.7 times more likely to be diagosed at a later stage tha o-latios. 2 A cacer survival rate idicates the percetage of patiets who are alive for a give time period, usually five years, after a diagosis of cacer. SEER data show that Hispaic me ad wome have lower survival rates for most cacers, eve after adjustig for differece i age ad stage distributio. For example, a Hispaic ma diagosed with stomach cacer is 26% more likely to die from stomach cacer durig the five years after diagosis compared to a o-hispaic white ma of the same age ad same stage at diagosis. SEER data show that five-year survival from breast cacer for Latias durig 1992-2000 was oly 83.0% compared to 87.5% for o-latias. I additio, whe survival is adjusted for stage ad age at diagosis, Latias were 22% more likely to die from breast cacer tha white o-latias. 2 These differeces may reflect poorer access to timely, adequate health care. Access to Care Health disparities have log bee documeted amog Latios ad other special ethic ad/or racial miority groups i the U.S. Research studies, however, cosistetly show that whe patiets from ethic ad racial miority groups receive the same quality of health care as o-hispaic whites, for example, their health outcomes are very similar. Although the Spaish laguage is the secod most commo laguage i the U.S. ad the Natio has the fifth largest Spaish-speakig populatio i the world, laguage barriers prevet may Latios from uderstadig iformatio from a doctor s office or istructios for prescriptio medicie. Lack of culturally-appropriate services adds to barriers for Hispaics to access adequate health care services ad for them to be able to avigate successfully through the complex health care system. I additio, Hispaics i the U.S. are less likely to have health isurace coverage tha o-hispaics. 2 The Hispaic populatio comprises 15% of the U.S. populatio but Hispaics make up 31.3% of the Natio s uisured. 11 Data from the 2007 BRFSS survey show that whe asked Do you have Chart 1. Stage at Diagosis of Female Breast Cacer Cases for Latias ad White No-Latias, U.S., 2000-2003 Latia ethicity No-Latia white 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged America Cacer Society South Atlatic Cacer Facts & Figures 2008

ay usual source of health care coverage?, Hispaics are more likely to aswer o tha o-hispaics. I the SAD, sparse data from the BRFSS also show that the proportio of adults without ay usual source of health care coverage is markedly higher amog Hispaic (58.9%) tha o-hispaic whites (12.7%) ad blacks (22.8%). (Table 13) Although data are limited to three states, the weighted average of these states estimates that 58.9% of South Atlatic Hispaics do ot have access to health care, compared to 43.3% for the U.S. I the South Atlatic Divisio 12.7% of o-hispaic whites ad 22.8% of o-hispaic blacks do ot have a usual source of health care coverage compared with 13.0% ad 22.9%, respectively, for the U.S. Several measures of disparities amog Hispaics are 9 : Demographics: Hispaics/Latios (H/L) are twice as likely to live i poverty as white o-hispaics (WN-H). H/L have a media icome that is 39% lower tha WN-H ad oe-third lower tha the atioal average H/L have lower rates of educatioal attaimet tha WN-H; oly 57% of H/L have completed a high school educatio compared with 89% of W-NH Health Status: 51% of H/L compared with 65% of WN-H ad 51% of BN-H report their health status as fair or poor. Access to Health Care: H/L are 2.5 times more likely to report ot havig a doctor tha WN-H. This disparity holds eve whe cotrollig for icome ad isurace status. H/L are more likely (54%) tha WN-H (43%) ad BN-H (44%) to go without eeded care. H/L are most likely to use a commuity health ceter, as their usual place of care (21% vs. 9% WN-H). Health Isurace Coverage: H/L are three times more likely to lack health isurace coverage tha NH-W (35% H/L vs. 12% WN-H). Eve at high icome levels, Hispaics are more likely to be uisured. Nearly half of Hispaics report beig uisured at some poit i the past year. H/L are least likely to have cotiuous isurace coverage eve whe a family member has full-time employmet (53% H/L vs. 82% WN-H). Quality Care (i additio to cacer screeig patters): H/L (140/1,000 discharges with complicatios), alog with Asia/Pacific Isladers (155/1,000), are more likely to die from complicatios i hospital care tha WN-H ad BN-H (both 133/1,000). Hispaics (55%) ad Asias (54%) are less likely to get a same day or ext day appoitmet tha WN-H (66%), ad more likely to wait six days or loger to see a doctor (26% H/L ad 18% Asia compared with 14% WN-H ad 19% BN-H). Hispaics ad Asias are less likely to uderstad their doctor ad less likely to feel their doctor listeed to them tha WN-H ad BN-H. H/L are twice as likely as WN-H to leave the doctor s office with uasked questios. America Cacer Society South Atlatic Cacer Facts & Figures 2008 15 Programs to Promote Healthy Behaviors amog Hispaics The lack of access to health care amog Hispaics as well as other disadvataged populatios ca adversely affect cacer icidece ad mortality throughout the cacer spectrum, from cacer prevetio ad early detectio to treatmet, survivorship ad palliative care. Studies have show, however, that social support offered i local outreach programs ad culturally-appropriate itervetios will help icrease participatio i these services. Lay Hispaic health advisors, alog with physicia ecouragemet, are a effective strategy to improve participatio i cacer screeig as well as prevetio iitiatives. 2 Numerous Hispaic outreach programs have bee active or are i various phases of developmet i the South Atlatic Divisio. Below are just a few examples of such programs desiged to improve access to care amog Hispaics ad help improve the overall health amog Latios i the SAD. Dedicated staff members for Hispaic outreach are strategically placed i regios with the highest Hispaic populatio. The SAD has hired biligual ad/or bicultural staff employed i key positios, icludig commuity outreach to specific populatios, patiet avigatio, ad Cacer Resource Network iformatio specialists. I some istaces, the South Atlatic Divisio was able to ifluece, ad i some cases, provide fudig for hirig of full time staff dedicated to Hispaic/Latio Outreach: Hispaic Parterships Project Maager, Hispaic Outreach Project Maager, Biligual Missio Delivery Maager ad Missio Delivery Maager. I. Promotores de Salud - Promoters of Health Promotores de Salud (Promoters of Health) are ofte referred to as Commuity Health Advisors or Commuity Health Workers. These terms are used iterchageably Cotiued Table 13. Estimated Proportio of Adults With o Usual Source of Health Care Coverage by Race/Ethicity for South Atlatic Divisio ad U.S., 2007 DE DC GA MD NC SC VA WV SA* US Hispaic /a 22.2 /a 53.5 64.7 /a /a /a 58.9 43.3 NH White 8.5 2.4 14.1 8.6 15.1 14.2 10.0 20.6 12.7 13.0 NH Black 8.5 12.7 28.2 15.8 25.4 27.8 17.8 /a 22.8 22.9 Source: BRFSS; * Populatio-weighted estimated average of South Atlatic states with available data

implemetig a coordiated health commuicatio campaig targetig the Hispaic commuity i the greater Columbia area ad (3) recruit ad trai four Promotoras o use of the adapted Spaish Cacer Educatio Guide ad have them deliver cacer educatioal sessios to groups of te Spaish-speakig Hispaics. Promotoras will also distribute the Su Salud ewsletters ad promote activities of the Partership for Cacer Prevetio i their commuities. II. Vetailla de Salud (VDS) - Health Widow here with the ackowledgemet that cultural uaces exist betwee Promotores ad Commuity Health Worker (CHW) programs. The Promotores are members of a commuity who provide educatio ad other assistace to fellow commuity members so that their health eeds may be met. They each use their uique stregths of their ow experiece ad cultural backgroud to provide health educatio, help others avigate through health care systems, provide support as eeded so that others may access iformatio ad eeded care, moitor vital sigs ad/or advise o selfmaagemet of chroic diseases. Although Promotores have traditioally performed their duties i a advocacy role without pay or with a small stiped ad perhaps some support services, such as providig a place to keep records ad materials, they ca also be paid for their work. A. Baltimore City, MD: Oe example of Promotores i the South Atlatic Divisio is the Latio Provider Network that works for the rights of Latios through (1) exchage of iformatio amog providers ad (2) advocacy ad educatio to Latias i the City of Baltimore. The primary objective is to promote early detectio, prevetio ad successful treatmet of breast ad cervical cacer usig Promotoras de Salud. These wome dissemiate breast ad cervical cacer educatio materials ad iformatio o where to obtai free or low-cost breast ad cervical cacer screeig to the Latia commuity i Baltimore. B. South Carolia: A secod Promotores program i the SAD is called the Partership for Cacer Prevetio Latio/a Iitiative i South Carolia. The objectives of the Iitiative are to: (1) promote access to cacer prevetio ad early detectio health services amog Hispaics i South Carolia who are ot proficiet i Eglish through the developmet of resources that ca be used by members of the partership, cacer cotrol agecies ad healthcare providers withi the South Atlatic Divisio, (2) to promote partership activities ad icrease commuity awareess of cacer prevetio ad cotrol resources by developig ad The Vetailla de Salud (VDS) or Health Widow program is a partership amog local health advocacy ad health service orgaizatios ad the Mexica cosular etwork. This partership is led by local Uited States 501(c)3 service agecies with the appropriate admiistrative capacity ad techical expertise to maage ad implemet the program. The Istitute of Mexicas Abroad (IME), a divisio of the Secretary of Foreig Affairs of Mexico, has established VDS program guidelies ad officially promoted the developmet of this program sice 2004. The America Cacer Society is curretly i parterships with the Mexica cosulates i the District of Columbia; Raleigh, North Carolia ad Atlata, Georgia. The VDS Program Objectives are (1) to provide persoal ad culturally sesitive couselig ad referral services osite to cosular cliets ad their families o how to access available health services i both coutries, (2) whe ecessary ad appropriate, provide backup legal advocacy to cosular cliets o health-related issues such as erollmet i public health isurace programs ad establishig medical homes, (3) to educate ad iform cosular cliets o health issues ad prevetio topics relevat to their commuity ad their specific eeds ad (4) to build a close, direct partership likage of cliet referral ad health educatio amog local Mexica cosulates, local health departmets, commuity health orgaizatios ad the major health istitutios i Mexico. VDS or Health Widows icorporates biligual, bicultural ad highly traied health educators ad health advocates ito the regular flow of cosular services to provide o-site assessmet, referral ad likage to available health services. Advocates assess cosulate cliets for eligibility for govermet-fuded health isurace ad for other primary care services, facilitated by a tool called Guide to Health Programs. I additio, health educators coduct 15 to 30 miute cosumer educatio sessios for a large umber of persos per day. The educatioal presetatios iclude a array of importat public health ad health care access topics. Materials such as Public Service Aoucemets ad short health educatio videos are ofte used to ehace the presetatios. 16 America Cacer Society South Atlatic Cacer Facts & Figures 2008

III. Estacio de Salud y Servicios de El Cosulado de El Salvador - Health ad Services Statio of the Salvadora Cosulate The Hispaic Istitute for Blidess Prevetio (HIBP) is a o-profit orgaizatio (status 501 (3)) whose missio is to cotribute to lowerig the risk of blidess by focusig o uderserved families, miorities ad other groups who are more likely to be at risk of eye-related diseases. Sice November 2005, HIBP has partered with the Salvadora Cosulate ad other local ad federal agecies to create ad implemet a Program called Estacio de Salud y Servicios de El Cosulado de El Salvador (Health ad Services Statio of the Salvadora Cosulate). HIBP is the leadig agecy for this program i both the Cosulates of El Salvador i Washigto, D.C. ad Woodbridge, VA. The goal of this partership is to help overcome barriers such as laguage, educatio, opportuity ad icome that limit access to existig health programs, commuity health resources ad public health isurace programs. The Salvadora Cosulate Program improves cacer awareess amog Salvadora families who atted the cosulate for their legal eeds. Through a o-site cliic for prevetive health care, family members receive health screeigs for chroic diseases ad culturally-appropriate iformatio through educatioal sessios, speakers, prit ad audiovisual materials. For example, patiets who receive a screeig for diabetes, hypertesio or other disease risk factors will also have a oe-o-oe cacer educatio sessio which icludes persoalized cacer iformatio ad referral for cacer screeig as appropriate for age ad geder of the patiet. Topics iclude cacer prevetio, early detectio ad treatmet for the most commo types of cacer amog Hispaics, as well as iformatio o commuity programs that offer free or low-cost screeigs for the uderserved. Limitatios These data should be iterpreted with cautio. Although BRFSS ad YRBSS data i this report are suppressed if less tha 50 persos, the relatively small umbers of resposes preseted here may result i variatios due to small umbers aloe. The risk factor data, however, ca give a geeral idicatio of the cacer risk behaviors amog Latios relative to o-hispaic whites ad o-hispaic blacks. Also, cacer icidece ad mortality data for U.S. Hispaics caot easily be extrapolated to the experieces of Hispaics withi the South Atlatic states because of regioal ad cultural differeces. Idetificatio of ethic populatios is still icosistet ad uderreported i medical records ad death certificates. I additio to the suspected uderrepresetatio of the Hispaic/ Latio populatio i U.S. Cesus data, aecdotal reports are that Hispaic immigrats may retur to their ative couty after a diagosis of cacer, which would result i uderreportig of cacer deaths amog Latios. 10 Refereces 1. ACS-1 America Cacer Society, Cacer Facts & Figures, 2008, 2. ACS-2 America Cacer Society, Cacer Facts & Figures for Hispaics, 2006-2008, http://www.cacer.org/dowloads/stt/caff2006hispp- WSecured.pdf 3. ACS-3 America Cacer Society, Cacer Prevetio & Early Detectio Facts ad Figures 2008, http://www.cacer.org/dowloads/stt/cped_ 2008.pdf 4. ACS-4 America Cacer Society Guidelies for the Early Detectio of Cacer, http://www.cacer.org/docroot/ped/ped_2.asp?sitearea=ped 5. ACS-5 America Cacer Society Guidelies o Nutritio ad Physical Activity for Cacer Prevetio, http://www.cacer.org/docroot/ped/ped_ 3.asp?siteare=PED 6. BRFSS Behavioral Risk Factor Surveillace System Survey Data. Atlata, Georgia: U.S. Departmet of Health ad Huma Services, Ceters for Disease Cotrol ad Prevetio, 2007, 2008, http://www.cdc.gov/brfss/ 7. Claritas Ic., Copyright 2007 Thomso Healthcare. ALL RIGHTS RE- SERVED 8. Cesus America Fact Fider, U.S. Cesus Bureau: http://factfider. cesus.gov/ 9. CWF The Commowealth Fud: H Mead, L Cartwright-Smith, K Joes, C Ramos, K Woods ad B Siegel, Racial ad Ethic Disparities i U.S. Health Care: A Chartbook, March 2008. 10. NAACCR Aual Report to the Natio o the Status of Cacer, 1975-1993, Featurig Cacer Amog U.S. Hispaic/Latio Populatios. HL Howe, X Wu, LA Ries, et al. Cacer 2006; (107):1711-42. 11. NCHS Natioal Ceter for Health Statistics, Health, Uited States, 2007, With Chartbook o Treds i the Health of Americas, Hyattsville, MD: 2007. 12. SEER LAG Ries, D Melbert, M Krapcho, et al (eds). SEER Cacer Statistics Review, 1975-2005, Natioal Cacer Istitute. Bethesda, MD, http://seer.cacer.gov/csr/1975_2005/, based o November 2007 SEER data submissio, posted to the SEER web site, 2008. 13. YRBSS Youth Risk Behavior Surveillace System Survey Data, Atlata, Georgia: U.S. Departmet of Health ad Huma Services, Ceters for Disease Cotrol ad Prevetio, 2008, http://www.cdc.gov/healthyyouth/yrbs/ Begiig i 1995, cacer rates ca ow be geerated by site ad sex for most of the U.S. populatio stratified by ethicity ad three major race groups. Broad racial ad ethic groupigs, however, may mask wide variatios i the cacer burde for specific high-risk populatios defied by cultural characteristics such as urbaicity, ecoomic depravatio ad recet immigratio. 10 America Cacer Society South Atlatic Cacer Facts & Figures 2008 17

Delaware DEMOGRAPHICS... State Level Data, 2007 Estimates 2000 Cesus Populatio 736,600 2007 Estimate 1 862,225 White, No-Hispaic 592,324 Black, No-Hispaic 174,609 America Idia, No-Hispaic 2,594 Asia/Pacific Islader, No-Hispaic 23,613 Hispaic 2 54,319 Other/Multi-Race, No-Hispaic 14,766 Distributio of Delaware Populatio by Race & Ethicity New Castle Ket 0.3% Native America, No-Hispaic 1.7% Other/Multi-Race, No-Hispaic 2.7% 6.3% Asia/Pacific Islader, No-Hispaic Hispaic* Sussex 20.3% Black, No-Hispaic 68.7% White, No-Hispaic Delaware s Hispaic/Latio Populatio by Sub-Ethicity 1.7% 25.3% 27.3% 45.8% Cuba Other Hispaic or Latio Puerto Rica Mexica Factors Related to Access to Care Percet uemployed 3 3.7% Percetage with less tha high school educatio 12.5% Media household icome $55,760 Percet households with icome < $15,000 9.9% Percet households with icome $50,000 55.4% Percet of households with o vehicle 6.7% Percet rural populatio 24.0% Percet miority 31.3% % speak laguage other tha Eglish at home 12.1% % with o usual source of health care coverage 11.4% Age Distributio of Delaware Age Group Number % < 18 198,368 23.0% 18-24 83,925 9.7% 25-39 173,402 20.1% 40-49 132,450 15.4% 50-64 156,593 18.2% 65 + 117,487 13.6% 30 20 10 0 < 18 18-24 25-39 40-49 50-64 65+ 1 Total is sum of White, Black, Native America, Asia/Pacific Islader, Other/Multi-Race, ad Hispaic. 2 Hispaic is a ethicity, ot a race. 3 Departmet of Labor http://www.bis.gov/lau/, April 2008. Data Sources: Claritas Ic., Copyright 2008, Thomso Medstat. ALL RIGHTS RESERVED; US Cesus Bureau, Populatio Fact Sheet, 2008, America Commuity Survey @ http://factfider.cesus.gov 18 America Cacer Society Delaware South Atlatic Cacer Facts & Figures 2008

Treds Delaware Cacer Icidece Rates by Cacer Site (1995-2005) 600 500 400 Rate Per 100,000 300 200 All Sites 100 Breast (Female) Colorectal Lug 0 1995 1996 1997 1998 1999 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Source: Delaware Cacer Registry 2000 2001 2002 2003 2004 2005 Prostate Delaware Cacer Mortality Rates by Cacer Site (1995-2005) 250 200 Rate Per 100,000 150 100 All Sites 50 Breast (Female) Colorectal Lug 0 1995 1996 1997 1998 1999 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Source: Delaware Cacer Registry 2000 2001 2002 2003 2004 2005 Prostate America Cacer Society Delaware South Atlatic Cacer Facts & Figures 2008 19

Delaware Cacer Icidece, 2001-2005, by Site, Geder ad Race All Races 1 White Black BOTH GENDERS Cases Rate Cases Rate Cases Rate ALL SITES 21,867 507.3 18,109 501.5 3,264 530.7 COLORECTAL 2,300 53.5 1,911 52.4 328 56.8 LUNG & BRONCHUS 3,454 79.6 2,925 79.4 495 85.4 MELANOMA 894 20.9 821 23.5 ^ ~ All Races 1 White Black MALE Cases Rate Cases Rate Cases Rate ALL SITES 11,551 601.7 9,536 586.0 1,741 676.8 COLORECTAL 1,176 62.6 982 61.2 162 68.6 LUNG & BRONCHUS 1,863 97.8 1,562 95.8 280 114.8 MELANOMA 542 28.1 504 31.2 ^ ~ PROSTATE 3,430 175.5 2,652 159.0 677 263.6 All Races 1 White Black FEMALE Cases Rate Cases Rate Cases Rate ALL SITES 10,316 438.6 8,573 440.9 1,523 426.9 BREAST(FEMALE) 2,938 126.4 2,413 126.4 473 125.2 CERVICAL 179 8.2 134 8.0 41 10.0 COLORECTAL 1,124 46.4 929 45.1 166 49.5 LUNG & BRONCHUS 1,591 66.2 1,363 67.3 215 64.9 MELANOMA 352 15.6 317 17.7 ^ ~ Note: Data exclude basal ad squamous cell ski ad i situ cacers except uriary bladder. Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races ^ Number of cases 5 or less ot reported due to cofidetiality issues ~ Number of cases too small (25 or less) to calculate reliable rate. Source: Delaware Cacer Registry Delaware Cacer Mortality, 2001-2005, by Site, Geder ad Race All Races 1 White Black BOTH GENDERS Deaths Rate Deaths Rate Deaths Rate ALL SITES 8,730 203.8 7,332 200.5 1,334 236.6 COLORECTAL 843 19.8 698 19.1 141 25.9 LUNG & BRONCHUS 2,673 61.9 2,265 61.4 387 68.7 MELANOMA (SKIN) 142 3.3 140 3.8 ^ ~ All Races 1 White Black MALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 4,585 252.1 3,855 246.7 695 303.2 COLORECTAL 429 23.7 354 22.8 72 32.5 LUNG & BRONCHUS 1,497 80.2 1,262 78.8 224 94.1 MELANOMA (SKIN) 97 5.2 96 6.0 ^ ~ PROSTATE 477 29.3 373 26.5 99 53.1 All Races 1 White Black FEMALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 4,145 170.7 3,477 168.8 639 193.0 BREAST (FEMALE) 600 25.1 492 24.5 104 28.7 CERVICAL 67 2.9 49 2.7 18 ~ COLORECTAL 414 16.8 344 16.2 69 21.1 LUNG & BRONCHUS 1,176 48.5 1,003 48.6 163 50.7 MELANOMA (SKIN) 45 1.9 44 2.3 ^ ~ Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races ^ Number of deaths 5 or less ot reported due to cofidetiality issues ~ Number of deaths too small (25 or less) to calculate reliable rate. Source: Delaware Cacer Registry 20 America Cacer Society Delaware South Atlatic Cacer Facts & Figures 2008

Delaware Cacer Stage at Diagosis, Percet of Total Cases, 2001-2005, by Site ad Race Delaware Female Breast Cacer Stage of Disease at Diagosis by Race, 2001-2005 I Situ Local Regioal Distat Female, All Races 1 21.7 50.1 23.2 2.9 2.0 White Female 22.2 50.7 22.4 3.0 1.8 Black Female 17.7 48.4 28.7 3.1 2.1 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 I Situ Local Regioal Distat Ukow/Ustaged Delaware Cervical Cacer 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow Female, All Races 1 54.2 29.6 10.1 6.2 White Female 52.2 33.6 9.0 5.2 Black Female 63.4 19.5 12.2 4.9 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Delaware Colorectal Cacer 3 Stage of Disease at Diagosis by Sex ad Race, 2001-2005 Local Regioal Distat Ukow Male, All Races 1 37.6 70.4 16.0 6.2 White Male 37.1 69.8 15.8 5.9 Black Male 40.5 74.6 18.5 4.6 Female, All Races 1 37.1 69.6 14.8 7.7 White Female 37.1 70.3 14.2 7.7 Black Female 36.1 64.4 20.0 3.9 Black Female White Female Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Delaware Maligat Melaoma 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow All Races 1 81.9 8.7 3.0 6.4 White 81.1 9.5 3.3 6.1 Black 100.0 0.0 0.0 0.0 Black White 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Delaware Cacer of the Prostate 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow All Races 1 86.7 6.8 2.9 3.6 White 87.0 7.0 2.8 3.2 Black 86.0 6.2 3.6 3.6 Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Notes: Stages ot reported for lug ad brochus cacer due to uavailability of cost-effective early detectio test. 1 Icludes White, Black ad other races 2 Stages reported for ivasive cervical, melaoma ad prostate cacers oly. 3 I situ ad local stages combied for colorectal cacer Source: Delaware Cacer Registry America Cacer Society Delaware South Atlatic Cacer Facts & Figures 2008 21

Delaware At a Glace Tobacco Tobacco Statistics Tobacco Use i Delaware (2007) High school studets who smoke 20.2% (10,300) Male high school studets who use smokeless or spit tobacco 8.1% (female use much lower) Kids (uder 18) who become ew daily smokers each year 1,300 Kids exposed to secodhad smoke at home 32,000 Packs of cigarettes bought or smoked by kids each year 2.1 millio Adults i Delaware who smoke 18.9% (112,800) Deaths i Delaware From Smokig Adults who die each year from their ow smokig 1,200 Kids ow uder 18 ad alive i Delaware who will ultimately die prematurely from smokig 18,000 Adult osmokers who die each year from exposure to secodhad smoke 70 to 210 Smokig-Caused Moetary Costs i Delaware Aual health care costs i Delaware directly caused by smokig $284 millio - Portio covered by the state Medicaid program $79 millio Residets state & federal tax burde from smokig-caused govermet expeditures $635 / household Smokig-caused productivity losses i Delaware $304 millio Tobacco Idustry Ifluece i Delaware Estimated portio spet for Delaware marketig each year $105.5 millio Estimated Tobacco Reveue i Delaware - FY2008 Tobacco Settlemet Reveues $30.4 billio Tobacco Tax Reveues $148.7 billio Total Aual State Reveues from Tobacco $179.1 billio % of Tobacco Reveue Spet o Tobacco Prevetio 6.0% Spedig o Tobacco Prevetio - FY2008 $10.7 millio CDC Recommeded Miimum Spedig o Tobacco Prevetio $8.6 millio % of CDC Recommeded Miimum 123.8% Rak Amog States (1-51) 2 Access to Care Number of Federally Qualified Health Ceters ad free cliics: 4 mai cliics; 2 satellite cliics State fud for Uisured Cacer Patiets: Delaware Cacer Treatmet Program ow covers up to two years of cacer treatmet for eligible Delawareas. www.dhss.delaware.gov/dhss/dph/dpc/catreatmet.html Number of ACoS approved hospitals: 7 Uisured Populatio (18+): 9.1% (was 9.6% i 2005) 22 America Cacer Society Delaware South Atlatic Cacer Facts & Figures 2008

Delaware State Screeig Programs Screeigs for cacers of the cervix, breast, colo/rectum ad prostate are available through Screeig for Life (SFL) for persos meetig the followig requiremets: Delaware residet, do t have health isurace or have health isurace that does t cover screeig, are i a specific age group (see below for details) or are age 65 ad older ad do ot qualify for Medicare, ad meet the icome guidelies of SFL (less tha 250% of the Federal Poverty Level). www.dhss.delaware.gov/dhss/dph/dpc/sfl.html Breast ad Cervical Cacer Screeig: BCCEDP* - Target Populatios: Wome 18-64 (cervical) Wome 40-64 (breast), uisured or uderisured ad uder 250% of Federal Poverty Level. Colorectal cacer screeig: There is madatory coverage for colorectal screeig. The Delaware Divisio of Public Health provides fulltime colorectal care avigators ad advocates i each hospital system. Target populatios are ages 50-64 (average risk) or ages 18-49 (icreased/high risk). Prostate cacer screeig: Prostate cacer screeig has bee added to SFL. Several healthcare systems offer periodic free/ low-cost screeigs. The Cacer Screeig Nurse Navigatio Program provides idividuals i eed of cacer screeig with educatio, iformatio, resources ad support to udergo colorectal, breast, cervical ad prostate cacer screeig. *The Breast ad Cervical Cacer Early Detectio Program (BCCEDP) is a CDC-fuded program i every state admiistered through the Natioal Breast ad Cervical Cacer Early Detectio Program (NBCCEDP). Nutritio ad Physical Activity The Delaware Departmet of Health ad Social Services oversees several programs to promote health ad well-beig: The Coucil o Lifestyle ad Fitess has reported sigificat progress i two areas: tobacco use ad safety belt use. www.dhss.delaware.gov/dph/dpc/gclfreportcard05.html, The Lt. Goveror s Challege Get Up ad Do Somethig! www.getupaddosomethig.org/, The Delaware Ceter to Promote Physical Activity ad Healthy Nutritio (U.D./Lt. Goveror/Healthy Delaware Foudatio) - www.behealthydelaware.org, The Delaware Divisio Services for Agig ad Adults with Disabilities sposors health fairs, Walk Delaware ad the Seior Olympics. Obesity iitiatives: www.dhss.delaware.gov/dhss/dsaapd/idex.html ; Nemours Health ad Prevetio Services: 5-2-1-Almost Noe: Our Prescriptio for Health - www.emours.org/iteret?url=o/hps/pubs/521.html The Sussex Couty Child Health Promotio Collaborative - www.emours.org/iteret?url=o/hps/cyp/collaborative/child_health.html Delaware Cacer Cosortium www.delawarecacercosortium.org/ Status of Cacer Cotrol Pla: The Delaware Cacer Cosortium has implemeted its secod four-year pla for 2007-2011. Accomplishmets Colorectal cacer screeig rates (colooscopy ad/or edoscopy) i Delaware (2006) are 20% higher tha the Natioal average for both o-hispaic blacks ad o-hispaic whites. Amog the uisured i Delaware, the colorectal cacer screeig rate is 73% higher tha the Natioal average of the uisured i 2006. Compared with the U.S. i 2007, the rate of those uisured i Delaware is 63% lower amog o-hispaic blacks, 35% lower amog Delaware o-hispaic whites ad 50% lower amog those who have ot completed high school. Delaware Health Iformatio Network (DHIN) - was created i 1997 to advace creatio of a state-wide health iformatio ad electroic data iterchage etwork for public ad private use. The missio of DHIN, curretly i plaig stages, is To facilitate the desig ad implemetatio of a itegrated, statewide health data system to support the iformatio eeds of cosumers, health plas, policymakers, providers, purchasers ad research to improve the quality ad efficiecy of health care services i Delaware. http://dhcc.delaware.gov/iformatio/dhi.shtml America Cacer Society Delaware South Atlatic Cacer Facts & Figures 2008 23

Adult Risk Behavior Early Detectio Recet Mammogram*, Wome 40 ad Older, Delaware ad U.S., 2006 % Delaware % U.S. 40 years ad older 70.2 61.2 40-64 years old 70.2 59.7 65 years ad older 70.2 64.6 White oly, o-hispaic 68.9 61.1 Black oly, o-hispaic 77.8 62.7 Other race oly, o-hispaic /a 59.3 Hispaic /a 58.7 Low Educatio** 53.7 51.6 Uisured*** 57.1 34.9 * Mammogram withi the past year. ** Wome 40 years old ad older with less tha a high school educatio ***Wome 40-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Pap Test*, Wome 18 ad Older, Delaware ad U.S., 2006 % Delaware % U.S. 18 years ad older 88.7 83.7 18-44 years 91.3 85.1 45-64 years old 91.2 86.6 65 years ad older 74.1 70.8 * A pap test withi the precedig 3 years for wome with itact uteri. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Sigmoidoscopy/Colooscopy*, Adults 50 ad Older, Delaware ad U.S., 2006 % Delaware % U.S. 50 years ad older 60.9 50.0 50-64 years old 55.8 44.9 65 years ad older 67.8 57.1 Male, 50 years or older 62.1 50.5 Male, 50-64 years old 56.6 45.1 Male, 65 years ad older 70.2 59.5 Female, 50 years ad older 59.9 49.5 Female, 50-64 years old 55.2 44.8 Female, 65 years ad older 65.9 55.4 White oly, o-hispaic 61.7 51.5 Black oly, o-hispaic 59.3 49.3 Other races oly, o-hispaic /a 43.9 Hispaic /a 38.2 Low Educatio** 44.3 38.8 Uisured*** 36.2 20.9 * Sigmoidoscopy/Colooscopy withi the past 5 years ** Adults 50 years old ad older with less tha a high school educatio ***Adults 50-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Prostate-Specific Atige Test*, Me 50 ad Older Delaware ad U.S., 2006 % Delaware % U.S. 50 years ad older 62.4 53.8 50-64 years old 54.8 48.5 65 years ad older 74.7 63.4 White oly, o-hispaic 63.6 55.6 Black oly, o-hispaic (45+) 43.5 48.1 Other races oly, o-hispaic /a 44.9 Hispaic /a 43.0 Low Educatio** 55.5 40.3 * Prostate-specific atige test withi the past year for me who reported they were ot told by a doctor, urse, or other health professioal that they had prostate cacer ** Adults 50 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2006 Prevetio Curret Cigarette Smokig*, Adults 18 ad Older, Delaware ad U.S., 2007 % Delaware % U.S. Total 18.9 19.7 18-24 years old 22.4 24.0 25-34 years old 22.9 23.9 35-44 years old 20.2 20.4 45-54 years old 21.7 22.3 55-64 years old 17.1 18.0 65 years ad older 9.9 9.0 Male 23.3 21.2 Female 20.2 18.4 White oly, o-hispaic 19.4 19.4 Black oly, o-hispaic 14.6 21.7 Other race oly, o-hispaic /a 18.3 Hispaic /a 16.7 Low Educatio** 28.2 33.2 Female 18-44 (2006) 24.5 20.6 * Ever smoked 100 cigarettes i lifetime ad are curret smokers (regular ad irregular). ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Physical Activity, Adults 18 ad Older, Delaware ad U.S., 2007 No Leisure Time Physical Activity* % Delaware % U.S. Total 52.1 50.5 Male 47.8 48.5 Female 55.9 52.5 White oly, o-hispaic 50.1 48.4 Black oly, o-hispaic 61.8 58.6 Other race oly, o-hispaic /a 51.0 Hispaic /a 55.3 Low Educatio** 59.6 59.8 * Adults with 30+ miutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ miutes three or more days per week. ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 24 America Cacer Society Delaware South Atlatic Cacer Facts & Figures 2008

Nutritio, Adults 18 ad Older, Delaware ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day % Delaware % U.S. Total 21.4 24.4 Male 19.4 19.4 Female 23.2 28.8 White oly, o-hispaic 20.7 24.5 Black oly, o-hispaic 22.9 23.1 Other race oly, o-hispaic /a 26.6 Hispaic /a 22.6 Low Educatio* 14.0 18.4 * Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Overweight*, Adults 18 ad Older, Delaware ad U.S., 2007 % Delaware % U.S. Total 65.1 63.0 Male 73.4 70.8 Female 57.0 55.4 White oly, o-hispaic 64.2 62.6 Black oly, o-hispaic 73.2 72.6 Other race oly, o-hispaic /a 51.2 Hispaic /a 66.9 Low Educatio** 68.5 65.7 *Overweight is defied as havig body mass idex of 25 kg/m 2 or greater **Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Youth Risk Behavior Tobacco Use, High School Studets, Delaware ad U.S., 2007 Curret Cigarette Smokig* % Delaware % U.S. Total 20.2 20.0 Male 20.7 21.3 Female 19.1 18.7 Curret Smokeless Tobacco Use** Total 5.2 7.9 Male 8.1 13.4 Female 1.9 2.3 * Smoked cigarettes o 1 or more of the 30 days precedig the survey ** Used chewig tobacco, suff or dip o 1 or more of the 30 days precedig the survey Source: Youth Risk Behavior Surveillace System, 2007 Nutritio, High School Studets, Delaware ad U.S., 2005 Eatig 5 or More Fruits ad Vegetables per Day % Delaware % U.S. Total 16.3 20.1 Male 18.6 21.4 Female 13.7 18.7 Source: Youth Risk Behavior Surveillace System, 2005 Physical Activity, High School Studets, Delaware ad U.S., 2007 Met Curret Physical Activity Level* % Delaware % U.S. Total 40.4 34.7 Male 49.2 43.7 Female 32.1 25.6 * Were physically active durig ay kid of physical activity that icreased their heart rate ad made them breathe hard some of the time for a total of at least 60 miutes/day o 5 or more days durig the 7 days before the survey Source: Youth Risk Behavior Surveillace System, 2007 Overweight/Obese High School Studets, Delaware ad U.S., 2007 Obese* % Delaware % U.S. Total 13.3 13.0 Male 15.6 16.3 Female 10.9 9.6 Overweight** Total 17.5 15.8 Male 16.0 16.4 Female 10.2 15.1 * Obese - At or above the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey ** - Overweight - At or above the 85th percetile but below the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey. Source: Youth Risk Behavior Surveillace System, 2007 America Cacer Society Delaware South Atlatic Cacer Facts & Figures 2008 25

District of Columbia DEMOGRAPHICS... State Level Data, 2007 Estimates 2000 Cesus Populatio 572,059 2007 Estimate 1 580,271 White, No-Hispaic 181,710 Black, No-Hispaic 315,148 Native America, No-Hispaic 1,236 Asia/Pacific Islader, No-Hispaic 17,796 Hispaic 2 50,711 Other/Multi-Race, No-Hispaic 13,670 Distributio of District of Columbia s Populatio by Race & Ethicity Ward 3 Ward 1 Ward 2 Ward 4 Ward 5 Ward 6 Ward 7 0.2% Native America, No-Hispaic 2.4% 3.1% 8.7% Other/Multi-Race, No-Hispaic Asia/Pacific Islader, No-Hispaic Hispaic* Ward 8 31.3% 54.3% White, No-Hispaic Black, No-Hispaic District of Columbia s Hispaic/Latio Populatio by Sub-Ethicity 4.9% 5.7% 12.8% 76.5% Cuba Puerto Rica Mexica Other Hispaic or Latio Factors Related to Access to Care Percet uemployed 3 6.0% Percetage with less tha high school educatio 14.5% Media household icome $49,508 Percet households with icome < $15,000 17.4% Percet households with icome $50,000 49.6% Percet of households with o vehicle 36.0% Percet rural populatio 0.0% Percet miority 68.7% % speak laguage other tha Eglish at home 15.3% % with o usual source of health care coverage 9.8% Age Distributio of District of Columbia Age Group Number % < 18 117,358 20.2% 18-24 56,649 9.8% 25-39 154,950 26.7% 40-49 80,816 13.9% 50-64 98,174 16.9% 65 + 72,324 12.5% 30 20 10 0 < 18 18-24 25-39 40-49 50-64 65+ 30 20 10 0 1 Total is sum of White, Black, Native America, Asia/Pacific Islader, Other/Multi-Race, ad Hispaic. 2 Hispaic is a ethicity, ot a race. 3 Departmet of Labor http://www.bis.gov/lau/, April 2008 Data Sources: Copyright 2008, Thomso Medstat. ALL RIGHTS RESERVED; US Cesus Bureau, Populatio Fact Sheet, 2008, America Commuity Survey @ http://factfider.cesus.gov 26 America Cacer Society District of Columbia South Atlatic Cacer Facts & Figures 2008

Treds District of Columbia Cacer Icidece Rates by Cacer Site 1995-2004 700 600 500 Rate Per 100,000 400 300 200 All Sites Breast (Female) 100 Colorectal Lug 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Prostate Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Data Source: District of Columbia Cacer Registry District of Columbia Cacer Mortality Rates by Cacer Site 1995-2004 300 250 Rate Per 100,000 200 150 100 All Sites Breast (Female) 50 Colorectal Lug 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Prostate Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Data Source: District of Columbia Cacer Registry America Cacer Society District of Columbia South Atlatic Cacer Facts & Figures 2008 27

District of Columbia Cacer Icidece, 2000-2004, By Site, Geder ad Race All Races 1 White Black BOTH GENDERS Cases Rate Cases Rate Cases Rate ALL SITES 14,901 538.5 4,209 498.5 9,941 592.3 COLORECTAL 1,733 62.7 381 45.4 1,284 76.2 LUNG & BRONCHUS 1,839 66.9 398 48.0 1,396 83.3 MELANOMA 347 12.1 239 27.0 18 ~ All Races 1 White Black MALE Cases Rate Cases Rate Cases Rate ALL SITES 7,430 595.8 2,005 539.1 5,052 661 COLORECTAL 803 64.5 190 51.4 576 75.1 LUNG & BRONCHUS 1,050 84.7 208 56.9 815 106.8 MELANOMA 193 15.0 134 34.7 11 ~ PROSTATE 2,491 200.9 612 166.2 1,761 230.2 All Races 1 White Black FEMALE Cases Rate Cases Rate Cases Rate ALL SITES 7,471 491.5 2,204 466.9 4,889 534.9 BREAST(FEMALE) 2,610 172.4 920 194.9 1,552 170.7 CERVICAL 194 12.5 36 7.5 135 14.7 COLORECTAL 930 61.2 191 40.7 708 77.1 LUNG & BRONCHUS 789 52.3 190 40.9 581 63.7 MELANOMA 154 9.7 105 20.9 7 ~ Note: Data exclude basal ad squamous cell ski cacers ad i situ cacers except uriary bladder. Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races ~ Number of cases too small (25 or less) to calculate reliable rate. Source: District of Columbia Cacer Registry District of Columbia Cacer Mortality, 2000-2004, by Site, Geder ad Race All Races 1 White Black BOTH GENDERS Deaths Rate Deaths Rate Deaths Rate ALL SITES 6,099 221.0 1,352 162.6 4,670 277.1 COLORECTAL 645 23.3 135 16.2 502 29.7 LUNG & BRONCHUS 1,537 55.9 320 38.5 1,204 71.7 MELANOMA (SKIN) 36 1.3 25 ~ 11 ~ All Races 1 White Black MALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 3,121 250.7 672 183.9 2,411 314.1 COLORECTAL 303 24.3 71 19.4 228 29.6 LUNG & BRONCHUS 883 71.1 180 49.3 695 90.9 MELANOMA (SKIN) 23 ~ 18 ~ ^ ~ PROSTATE 463 37.1 75 20.7 382 49.1 All Races 1 White Black FEMALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 2,978 196.5 680 145.9 2,259 246.2 BREAST (FEMALE) 492 32.4 120 25.6 367 40.1 CERVICAL 56 3.7 7 ~ 46 5.0 COLORECTAL 342 22.5 64 13.6 274 29.8 LUNG & BRONCHUS 654 43.3 140 30 509 55.7 MELANOMA (SKIN) 13 ~ 7 ~ 6 ~ Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races ^ Number of deaths 5 or less ot reported due to cofidetiality issues ~ Number of deaths too small (25 or less) to calculate reliable rate. Source: District of Columbia Cacer Registry 28 America Cacer Society District of Columbia South Atlatic Cacer Facts & Figures 2008

District of Columbia Cacer Stage at Diagosis, Percet of Total Cases, 2000-2004, by Site ad Race District of Columbia Female Breast Cacer Stage of Disease at Diagosis by Race, 2000-2004 I Situ Local Regioal Distat Ukow Female, All Races 1 17.5 42.6 21.1 4.2 14.6 White Female 19.1 44.2 19.5 2.6 14.6 Black Female 16.0 42.3 22.4 5.4 13.9 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 I Situ Local Regioal Distat Ukow/Ustaged District of Columbia Cervical Cacer 2 Stage of Disease at Diagosis by Race, 2000-2004 Local Regioal Distat Ukow Female, All Races 1 39.2 26.3 9.8 24.7 White Female 55.6 22.2 5.6 16.7 Black Female 36.3 30.4 11.9 21.5 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged District of Columbia Colorectal Cacer 3 Stage of Disease at Diagosis by Sex ad Race, 2000-2004 Local Regioal Distat Ukow Male, All Races 1 37.9 26.3 18.2 17.7 White Male 43.7 25.8 14.7 15.8 Black Male 35.9 26.7 19.3 18.1 Female, All Races 1 39.9 25.6 15.6 18.9 White Female 42.9 27.2 12.0 17.8 Black Female 38.6 26.0 16.8 18.6 Black Female White Female Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged District of Columbia Maligat Melaoma 2 Stage of Disease at Diagosis by Race, 2000-2004 Local Regioal Distat Ukow All Races 1 57.9 6.5 2.3 33.3 White 62.3 5.7 2.3 29.7 Black 33.3 26.7 6.7 33.3 Black White 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged District of Columbia Cacer of the Prostate 2 Stage of Disease at Diagosis by Race, 2000-2004 Local Regioal Distat Ukow Male, All Races 1 69.0 5.7 4.8 20.5 White Male 75.6 5.7 2.6 16.0 Black Male 69.4 5.9 5.7 18.9 Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Notes: Stages ot reported for lug ad brochus cacer due to uavailability of cost-effective early detectio test. 1 Icludes White, Black ad other races 2 Stages reported for ivasive cervical, melaoma ad prostate cacers oly. 3 I situ ad local stages combied for colorectal cacer Source: District of Columbia Cacer Registry America Cacer Society District of Columbia South Atlatic Cacer Facts & Figures 2008 29

District of Columbia At a Glace Tobacco Tobacco Statistics Tobacco Use i Washigto, DC (2007) High school studets who smoke 10.6% (2,800) Male high school studets who use smokeless or spit tobacco 8.1% (female use much lower) Kids (uder 18) who become ew daily smokers each year 500 Kids exposed to secodhad smoke at home 40,000 Packs of cigarettes bought or smoked by kids each year 0.6 millio Adults i Washigto, DC who smoke 17.2% (80,200) Deaths i Washigto, DC From Smokig Adults who die each year from their ow smokig 700 Kids ow uder 18 ad alive i Washigto, DC who will ultimately die prematurely from smokig 8,000 Adult osmokers who die each year from exposure to secodhad smoke 40 to 120 Smokig-Caused Moetary Costs i Washigto, DC Aual health care costs i Washigto, DC directly caused by smokig $243 millio - Portio covered by the state Medicaid program $78 millio Residets state & federal tax burde from smokig-caused govermet expeditures $609 / household Smokig-caused productivity losses i Washigto, DC $233 millio Tobacco Idustry Ifluece i Washigto, DC Estimated portio spet for Washigto, DC marketig each year $14.7 millio Estimated Tobacco Reveue i Washigto, DC - FY2008 Tobacco Settlemet Reveues $43.3 millio Tobacco Tax Reveues $22.5 millio Total Aual District Reveues from Tobacco $65.8 millio % of Tobacco Reveue Spet o Tobacco Prevetio 5.5% Spedig o Tobacco Prevetio (FY2008) $3.6 millio % of CDC Recommeded Miimum 48.1% Rak Amog States (1-51) 22 District of Columbia Screeig Programs Breast cacer screeig: BCCEDP* Project WISH, Target Populatio: wome 40-64, uisured or uderisured Colorectal cacer screeig: There is madatory coverage for colorectal screeig but o city screeig programs are available. Prostate cacer screeig: There is a city prostate screeig program. *The Breast ad Cervical Cacer Early Detectio Program (BCCEDP) is a CDC-fuded program i every state admiistered through the Natioal Breast ad Cervical Cacer Early Detectio Program (NBCCEDP). 30 America Cacer Society District of Columbia South Atlatic Cacer Facts & Figures 2008

Nutritio ad Physical Activity State coalitio: DC Cacer Cosortium addresses utritio ad physical activity i the DC Cacer Pla. Obesity iitiatives: Are beig addressed through a DC Departmet of Health Iitiative uder Materal Health. Access to Care Number of Federally Qualified Health Ceters ad free cliics: 4 mai cliics; 49 satellite cliics State fud for Uisured Cacer Patiets: DC HealthCare Alliace Number of ACoS approved hospitals: 7 Number of NCI Cacer Ceters: 1 Comprehesive Cacer Ceter Uisured Populatio (18+): 9.5% (was 11.2% i 2005) District of Columbia Cacer Cosortium www.dccacercosortium.org/ The District of Columbia Cacer Cosortium was formed by a group of over 60 cocered health care professioals, advocates ad commuity leaders i the District. The District of Columbia s Cacer Pla, Facig the Challege: The DC Cacer Cotrol Pla 2005-2010, completed i April, 2006, is firmly focused o District-wide efforts i cacer prevetio, screeig, public educatio ad outreach. Accomplishmets A iteractive website keeps stakeholders iformed about Cosortium activities, resources ad opportuities. A Commuity Resource Guide, prepared for survivors, caregivers ad healthcare professioals, provides useful iformatio coverig the Greater Washigto area o may topics. www.dccacercosortium.org/resource/dcccresourceguide.pdf A colorectal summit of key medical ad lay stakeholders has outlied actio steps to icrease colorectal cacer screeig amog the uderserved. A pediatric hospice program ad a coordiated patiet avigatio system are beig developed. Requests for Proposals have bee released to icrease early detectio of breast, colorectal, prostate ad cervical cacers, to icrease access to care, ad to icrease awareess ad educatio about ovaria ad edometrial cacers. America Cacer Society District of Columbia South Atlatic Cacer Facts & Figures 2008 31

Adult Risk Behavior Early Detectio Recet Mammogram*, Wome 40 ad Older, District of Columbia ad U.S., 2006 % District of Columbia % U.S. 40 years ad older 64.2 61.2 40-64 years old 63.0 59.7 65 years ad older 66.8 64.6 White oly, o-hispaic 62.0 61.6 Black oly, o-hispaic 64.7 62.7 Other race oly, o-hispaic /a 59.3 Hispaic /a 58.7 Low Educatio** 64.9 51.6 Uisured*** 36.6 34.9 * Mammogram withi the past year. ** Wome 40 years old ad older with less tha a high school educatio ***Wome 40-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Pap Test*, Wome 18 ad Older, District of Columbia ad U.S., 2006 % District of Columbia % U.S. 18 years ad older 89.0 83.7 18-44 years 89.2 85.1 45-64 years old 92.4 86.6 65 years ad older 80.4 70.8 * A pap test withi the precedig 3 years for wome with itact uteri. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Sigmoidoscopy/Colooscopy*, Adults 50 ad Older, District of Columbia ad U.S., 2006 % District of Columbia % U.S. 50 years ad older 57.2 50.0 50-64 years old 49.9 44.9 65 years ad older 67.4 57.1 Male, 50 years or older 53.8 50.5 Male, 50-64 years old 46.2 45.1 Male, 65 years ad older 66.8 59.5 Female, 50 years ad older 59.8 49.5 Female, 50-64 years old 53.2 44.8 Female, 65 years ad older 67.7 55.4 White oly, o-hispaic 62.7 51.5 Black oly, o-hispaic 55.4 49.3 Other races oly, o-hispaic /a 43.9 Hispaic /a 38.2 Low Educatio** 50.5 38.8 Uisured*** 26.7 20.9 * Sigmoidoscopy/Colooscopy withi the past 5 years. ** Adults 50 years old ad older with less tha a high school educatio ***Adults 50-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Prostate-Specific Atige Test*, Me 50 ad Older District of Columbia ad U.S., 2006 % District of Columbia % U.S. 50 years ad older 55.2 53.8 50-64 years old 49.9 48.5 65 years ad older 65.2 63.4 White oly, o-hispaic 57.2 55.6 Black oly, o-hispaic (45+) 50.0 48.1 Other races oly, o-hispaic /a 44.9 Hispaic /a 43.0 Low Educatio** /a 40.3 * Prostate-specific atige test withi the past year for me who reported they were ot told by a doctor, urse, or other health professioal that they had prostate cacer ** Adults 50 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2006 Prevetio..... Curret Cigarette Smokig*, Adults 18 ad Older, District of Columbia ad U.S., 2007 % District of Columbia % U.S. Total 17.2 19.7 18-24 years old 18.1 14.0 25-34 years old 19.5 23.9 35-44 years old 15.5 20.4 45-54 years old 20.6 22.3 55-64 years old 20.1 18.0 65 years ad older 10.5 9.0 Male 17.5 21.2 Female 20.3 18.4 White oly, o-hispaic 8.5 19.4 Black oly, o-hispaic 24.1 21.7 Other race oly, o-hispaic 22.2 18.3 Hispaic 11.0 16.7 Low Educatio** 26.2 33.2 Female 18-44 (2006) 14.8 20.6 * Ever smoked 100 cigarettes i lifetime ad are curret smokers (regular ad irregular). ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Physical Activity, Adults 18 ad Older, District of Columbia ad U.S., 2007 No Leisure Time Physical Activity* % District of Columbia % U.S. Total 46.1 50.5 Male 41.9 48.5 Female 49.8 52.5 White oly, o-hispaic 33.3 48.4 Black oly, o-hispaic 54.7 58.6 Other race oly, o-hispaic 42.8 51.0 Hispaic 56.2 55.3 Low Educatio** 66.7 59.8 * Adults with 30+ miutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ miutes three or more days per week. ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 32 America Cacer Society District of Columbia South Atlatic Cacer Facts & Figures 2008

Nutritio, Adults 18 ad Older, District of Columbia ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day % District of Columbia % U.S. Total 32.5 24.4 Male 28.8 19.4 Female 35.8 28.8 White oly, o-hispaic 35.3 24.5 Black oly, o-hispaic 30.5 23.1 Other race oly, o-hispaic 38.6 26.6 Hispaic 28.8 22.6 Low Educatio* 28.7 18.4 * Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Overweight*, Adults 18 ad Older, District of Columbia ad U.S., 2007 % District of Columbia % U.S. Total 55.3 63.0 Male 57.0 70.8 Female 53.7 55.4 White oly, o-hispaic 39.3 62.6 Black oly, o-hispaic 68.8 72.6 Other race oly, o-hispaic 44.8 51.2 Hispaic 57.2 66.9 Low Educatio** 69.3 65.7 *Overweight is defied as havig body mass idex of 25 kg/m 2 or greater **Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Youth Risk Behavior Tobacco Use, High School Studets, District of Columbia ad U.S., 2007 Curret Cigarette Smokig* % District of Columbia % U.S. Total 10.6 20.0 Male 13.5 21.3 Female 7.5 18.7 Curret Smokeless Tobacco Use** Total 5.6 7.9 Male 8.1 13.4 Female 2.6 2.3 * Smoked cigarettes o 1 or more of the 30 days precedig the survey ** Used chewig tobacco, suff or dip o 1 or more of the 30 days precedig the survey Source: Youth Risk Behavior Surveillace System, 2007 Nutritio, High School Studets, District of Columbia ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day % District of Columbia % U.S. Total 19.3 21.4 Male 20.9 22.9 Female 17.3 19.9 Source: Youth Risk Behavior Surveillace System, 2007 Physical Activity, High School Studets, District of Columbia ad U.S., 2007 Met Curret Physical Activity Level* % District of Columbia % U.S. Total 30.2 34.7 Male 33.9 43.7 Female 26.0 25.6 * Were physically active durig ay kid of physical activity that icreased their heart rate ad made them breathe hard some of the time for a total of at least 60 miutes/day o 5 or more days durig the 7 days before the survey Source: Youth Risk Behavior Surveillace System, 2007 Overweight/Obese High School Studets, District of Columbia ad U.S., 2007 Obese* % District of Columbia % U.S. Total 17.7 13.0 Male 19.6 16.3 Female 15.8 9.6 Overweight** Total 17.8 15.8 Male 15.8 16.4 Female 19.9 15.1 * Obese - At or above the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey ** - Overweight - At or above the 85th percetile but below the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey. Source: Youth Risk Behavior Surveillace System, 2007 America Cacer Society District of Columbia South Atlatic Cacer Facts & Figures 2008 33

Georgia DEMOGRAPHICS... State Level Data, 2007 Estimates 2000 Cesus Populatio 8,186,453 2007 Estimate 1 9,339,947 White, No-Hispaic 5,494,797 Black, No-Hispaic 2,735,208 Native America, No-Hispaic 19,460 Asia/Pacific Islader, No-Hispaic 257,240 Hispaic 2 702,087 Other/Multi-Race, No-Hispaic 131,155 Distributio of Georgia s Populatio by Race & Ethicity 0.2% 1.4% 2.8% 7.5% Native America, No-Hispaic Other/Multi-Race, No-Hispaic Asia/Pacific Islader, No-Hispaic Hispaic* Dade Catoosa Walker Chattooga Floyd Whitfield Jackso Elbert Madiso Polk Pauldig Cobb Barrow Gwiett Clarke Oglethorpe Haralso Walto Wilkes Douglas Fulto DeKalb Carroll Muscogee Murray Gordo Radolph Fai Clayto Dawso Hall Newto Worth Tows White Lumpki Housto Rabu Morga Greee Taliaferro Fayette Hery Jasper Warre Coweta Putam Heard Butts Hacock Spaldig Troup Early Decatur Gilmer Pickes Baker Schley Mitchell Uio Bartow Cherokee Forsyth Harris Chattahoochee Quitma Meriwether Lamar Habersham Wilcox Cook Stephes Baks Frakli Hart Be Hill Irwi Berrie Coffee Atkiso Motgomery Jeff Davis Licol McDuffie Glascock Columbia Pike Moroe Joes Baldwi Jefferso Washigto Burke Upso Bibb Wilkiso Jekis Screve Talbot Crawford Johso Twiggs Emauel Taylor Peach Laures Mario Maco Treutle Cadler Bulloch Effigham Stewart Webster Sumter Terrell Lee Clay Calhou Dougherty Miller Semiole Rockdale Bleckley Pulaski Dooly Dodge Crisp Turer Colquitt Ocoee Tift Telfair Laier Wheeler Grady Thomas Brooks Clich Lowdes Echols Toombs Applig Baco Ware Richmod Pierce Tattall Charlto Waye Bratley Evas Brya Liberty Log McItosh Gly Camde Chatham 29.3% 58.8% Black, No-Hispaic White, No-Hispaic Georgia s Hispaic/Latio Populatio by Sub- Ethicity 2.7% 7.4% 24.6% 65.4% Cuba Puerto Rica Other Hispaic or Latio Mexica Factors Related to Access to Care Percet uemployed 3 5.3% Percetage with less tha high school educatio 13.7% Media household icome $49,495 Percet households with icome < $15,000 13.4% Percet households with icome $50,000 49.5% Percet of households with o vehicle 6.1% Percet rural populatio 30.4% Percet miority 41.2% % speak laguage other tha Eglish at home 12.2% % with o usual source of health care coverage 17.9% Age Distributio of Georgia Age Group Number % < 18 2,411,585 25.8% 18-24 945,171 10.1% 25-39 2,116,112 22.7% 40-49 1,416,668 15.2% 50-64 1,524,368 16.3% 65 + 926,043 9.9% 30 20 10 0 < 18 18-24 25-39 40-49 50-64 65+ 30 20 10 0 1 Total is sum of White, Black, Native America, Asia/Pacific Islader, Other/Multi-Race, ad Hispaic. 2 Hispaic is a ethicity, ot a race. 3 Departmet of Labor http://www.bis.gov/lau/, April 2008 Data Sources: Copyright 2008, Thomso Medstat. ALL RIGHTS RESERVED; US Cesus Bureau, Populatio Fact Sheet, 2008, America Commuity Survey @ http://factfider. cesus.gov 34 America Cacer Society Georgia South Atlatic Cacer Facts & Figures 2008

Treds Georgia Cacer Icidece Rates by Cacer Site (1999-2005) 500 450 400 350 Rate Per 100,000 300 250 200 150 All Sites 100 Breast (Female) Colorectal 50 Lug 0 1999 2000 2001 2002 2003 2004 2005 Prostate Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Source: Georgia Comprehesive Cacer Registry Georgia Cacer Mortality Rates by Cacer Site (1995-2005) 250 200 Rate Per 100,000 150 100 All Sites Breast (Female) 50 Colorectal Lug 0 1995 1996 1997 1998 1999 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Source: Georgia Comprehesive Cacer Registry 2000 2001 2002 2003 2004 2005 Prostate America Cacer Society Georgia South Atlatic Cacer Facts & Figures 2008 35

Georgia Cacer Icidece, 2001-2005, by Site, Geder ad Race All Races 1 White Black BOTH GENDERS Cases Rate Cases Rate Cases Rate ALL SITES 177,686 465.6 131,623 473.5 41,390 480.7 COLORECTAL 18,586 50.0 13,264 48.2 4,874 59.0 LUNG & BRONCHUS 27,409 74.4 21,563 78.3 5,491 67.9 MELANOMA 7,967 19.9 7,663 27.2 97 1.1 All Races 1 White Black MALE Cases Rate Cases Rate Cases Rate ALL SITES 93,008 571.7 68,910 567.2 21,825 652.7 COLORECTAL 9,576 60.1 7,065 59.0 2,270 70.0 LUNG & BRONCHUS 16,293 104.3 12,604 105.9 3,476 110.0 MELANOMA 4,539 26.3 4,392 34.6 48 1.4 PROSTATE 26,503 163.7 17,747 144.0 8,218 257.7 All Races 1 White Black FEMALE Cases Rate Cases Rate Cases Rate ALL SITES 84,675 395.1 62,711 410.9 19,564 375.4 BREAST(FEMALE) 26,168 120.6 19,257 125.7 6,230 113.8 CERVICAL 1,986 9.0 1,185 8.2 657 11.5 COLORECTAL 9,010 42.6 6,199 40.0 2,604 52.7 LUNG & BRONCHUS 11,115 53.4 8,959 58.4 2,014 41.8 MELANOMA 3,428 15.6 3,271 22.2 49 0.9 Note: Data exclude basal ad squamous cell ski ad i situ cacers except uriary bladder. Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races Source: Georgia Comprehesive Cacer Registry Georgia Cacer Mortality, 2001-2005, by Site, Geder ad Race All Races 1 White Black BOTH GENDERS Deaths Rate Deaths Rate Deaths Rate ALL SITES 70,074 193.0 51,547 186.1 17,892 223.4 COLORECTAL 6,603 18.4 4,582 16.7 1,957 25.1 LUNG & BRONCHUS 21,212 58.5 16,763 60.2 4,327 54.4 MELANOMA 966 2.5 938 3.3 27 0.3 All Races 1 White Black MALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 36,904 249.4 27,254 236.4 9,337 313.8 COLORECTAL 3,303 22.6 2,391 21.0 872 29.8 LUNG & BRONCHUS 13,005 85.6 10,088 84.9 2,850 92.7 MELANOMA 599 3.6 585 4.6 13 ~ PROSTATE 3,625 30.4 2,155 22.9 1,455 65.1 All Races 1 White Black FEMALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 33,170 157.4 24,293 153.2 8,555 173.2 BREAST(FEMALE) 5,312 24.6 3,641 22.8 1,629 30.4 CERVICAL 601 2.7 352 2.3 238 4.5 COLORECTAL 3,300 15.6 2,191 13.6 1,085 22.5 LUNG & BRONCHUS 8,207 39.6 6,675 42.6 1,477 30.9 MELANOMA 367 1.7 353 2.2 14 ~ Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races ~ Number of deaths too small (25 or less) to calculate reliable rate. Source: Georgia Comprehesive Cacer Registry 36 America Cacer Society Georgia South Atlatic Cacer Facts & Figures 2008

Georgia Cacer Stage at Diagosis, Percet of Total Cases, 2001-2005, by Site ad Race Georgia Female Breast Cacer Stage of Disease at Diagosis by Race, 2001-2005 I Situ Local Regioal Distat Ukow Female, All Races 1 18.5 49.0 26.1 3.5 3.0 White Female 18.8 51.4 24.2 2.7 2.9 Black Female 17.6 41.6 31.6 6.0 3.3 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 I Situ Local Regioal Distat Ukow/Ustaged Georgia Cervical Cacer 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow Female, All Races 1 50.1 35.5 8.3 5.9 White Female 53.7 31.8 7.7 6.5 Black Female 42.5 43.1 9.8 4.5 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Georgia Colorectal Cacer 3 Stage of Disease at Diagosis by Sex ad Race, 2001-2005 Local Regioal Distat Ukow Male, All Races 1 40.8 36.2 17.2 5.8 White Male 42.1 36.5 15.9 5.5 Black Male 37.2 34.7 21.3 6.8 Female, All Races 1 40.5 36.3 16.3 6.8 White Female 41.7 36.6 15.2 6.5 Black Female 38.4 35.4 19.0 7.2 Black Female White Female Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Georgia Maligat Melaoma 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow All Races 1 83.6 7.5 3.0 5.9 White 83.8 7.4 2.9 5.9 Black 64.6 20.8 7.3 7.3 Black White 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Georgia Cacer of the Prostate 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow Male, All Races 1 82.1 7.5 3.6 6.8 White Male 83.5 7.6 2.6 6.3 Black Male 79.1 7.2 5.6 8.1 Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Notes: Stages ot reported for lug ad brochus cacer due to uavailability of cost-effective early detectio test. 1 Icludes White, Black ad other races 2 Stages reported for ivasive cervical, melaoma ad prostate cacers oly. 3 I situ ad local stages combied for colorectal cacer Source: Georgia Comprehesive Cacer Registry America Cacer Society Georgia South Atlatic Cacer Facts & Figures 2008 37

Georgia At a Glace Tobacco Tobacco Statistics Tobacco Use i Georgia (2007) High school studets who smoke 18.6% Male high school studets who use smokeless or spit tobacco 14.8% (female use much lower) Kids (uder 18) who become ew daily smokers each year 13,100 Kids exposed to secodhad smoke at home 423,000 Packs of cigarettes bought or smoked by kids each year 18.7 millio Adults i Georgia who smoke 19.4% (1,340,300) Deaths i Georgia From Smokig Adults who die each year from their ow smokig 10,300 Kids ow uder 18 ad alive i Georgia who will ultimately die prematurely from smokig 184,000 Adult osmokers who die each year from exposure to secodhad smoke 750 to 2,120 Smokig-Caused Moetary Costs i Georgia Aual health care costs i Georgia directly caused by smokig 2.25 billio - Portio covered by the state Medicaid program $537 millio Residets state & federal tax burde from smokig-caused govermet expeditures $569 / household Smokig-caused productivity losses i Georgia $3.08 billio Tobacco Idustry Ifluece i Georgia Estimated portio spet for Georgia marketig each year $444.8 millio Estimated Tobacco Reveue i Georgia - FY2008 Tobacco Settlemet Reveues $157.8 millio Tobacco Tax Reveues $247.4 millio Total Aual State Reveues from Tobacco $405.2 millio % of Tobacco Reveue Spet o Tobacco Prevetio 0.6% Spedig o Tobacco Prevetio - FY2008 $2.3 millio CDC Recommeded Miimum Spedig o Tobacco Prevetio $42.6 millio % of CDC Recommeded Miimum 5.3% Rak Amog States (1-51) 48 Georgia State Screeig Programs Breast cacer screeig program: BCCEDP* Breast ad Cervical Cacer Program (BCCP): Target populatio: Wome 40-64, uisured, uder 200% of Federal Poverty Level - www.georgiacacer.org/treat-screeig.php BCCP employs Cliet Navigators i some health districts to assist with cliet recruitmet ad avigatio. Also cotracts with the America Cacer Society to maage recruitmet. Colorectal cacer screeig program: There is madatory coverage for colorectal screeig, but o state screeig program. A state work group was formed i 2005 to address colorectal cacer screeig for the uisured or uderisured i the state. Prostate cacer screeig program: Noe. *The Breast ad Cervical Cacer Early Detectio Program (BCCEDP) is a CDC-fuded program i every state admiistered through the Natioal Breast ad Cervical Cacer Early Detectio Program (NBCCEDP). 38 America Cacer Society Georgia South Atlatic Cacer Facts & Figures 2008

Nutritio ad Physical Activity State coalitio: Policy Leadership for Active Youth (PLAY) Leadership Coucil Obesity iitiatives: Noe Access to Care Number of Federally Qualified Health Ceters ad free cliics: 24 mai cliics; 122 satellite cliics State screeig program: Cacer State Aid Number of ACoS approved hospitals: 43 Number of NCI Cacer Ceters: 0 Uisured Populatio (18+): 19.5% (was 18.7% i 2005) Georgia Cacer Coalitio www.georgiacacer.org Status of Cacer Cotrol Pla: The Georgia Cacer Coalitio, i its seveth year, has a ew Comprehesive Cacer Cotrol Pla that covers 2008-2012. Over 100 stakeholders from across the state were egaged i a facilitated work group process to desig the state pla. www.georgiacacer.org/gcccp/idex.html The Pla s goals fall ito five categories across the spectrum of cacer care: prevetio; early detectio ad screeig; cacer diagosis ad stagig; treatmet ad palliatio; ad data ad metrics. Implemetatio of a ew Comprehesive Cacer Cotrol Pla has begu with the formatio of a state-wide steerig committee to begi assessmet of curret iitiatives, idetificatio of gaps ad determiatio of resources to fulfill the Comprehesive Cacer Cotrol Pla. Accomplishmets The 2008 Georgia Cacer Summit, held i Jauary, 2008, drew cacer caregivers, educators, researchers, admiistrators, busiess ad civic leaders from across the state. Its purpose was to showcase ad refie Georgia s 5-Year Comprehesive Cacer Cotrol Pla. The Georgia Tobacco Quit Lie fielded more tha 35,000 calls sice its iceptio i 2001. The Breast Cacer Licese Plate Iitiative cotributes to the Idiget Care Trust Fud that supports breast cacer screeigs ad treatmet for uderserved wome. Additioal Iitiatives: Pai ad Palliatio iitiatives were icluded i the ew State Cacer Pla ad Georgia has developed a State Cacer Pai Coalitio as a result. America Cacer Society Georgia South Atlatic Cacer Facts & Figures 2008 39

Adult Risk Behavior Early Detectio Recet Mammogram*, Wome 40 ad Older, Georgia ad U.S., 2006 % Georgia % U.S. 40 years ad older 64.0 61.2 40-64 years old 62.2 59.7 65 years ad older 69.1 64.6 White oly, o-hispaic 63.3 61.6 Black oly, o-hispaic 67.8 62.7 Other race oly, o-hispaic 57.1 59.3 Hispaic 60.7 58.7 Low Educatio** 56.9 51.6 Uisured*** 42.5 34.9 * Mammogram withi the past year ** Wome 40 years old ad older with less tha a high school educatio ***Wome 40-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Pap Test*, Wome 18 ad Older, Georgia ad U.S., 2006 % Georgia % U.S. 18 years ad older 87.2 83.7 18-44 years 87.8 85.1 45-64 years old 88.5 86.6 65 years ad older 78.7 70.8 * A pap test withi the precedig 3 years for wome with itact uteri. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Sigmoidoscopy/Colooscopy*, Adults 50 ad Older, Georgia ad U.S., 2006 % Georgia % U.S. 50 years ad older 49.2 50.0 50-64 years old 43.6 44.9 65 years ad older 58.5 57.1 Male, 50 years or older 48.8 50.5 Male, 50-64 years old 43.9 45.1 Male, 65 years ad older 58.2 59.5 Female, 50 years ad older 49.5 49.5 Female, 50-64 years old 43.4 44.8 Female, 65 years ad older 58.6 55.4 White oly, o-hispaic 50.5 51.5 Black oly, o-hispaic 47.3 49.3 Other races oly, o-hispaic 31.7 43.9 Hispaic 55.2 38.2 Low Educatio** 38.2 38.8 Uisured*** 25.1 20.9 * Sigmoidoscopy/Colooscopy withi the past 5 years ** Adults 50 years old ad older with less tha a high school educatio ***Adults 50-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Prostate-Specific Atige Test*, Me 50 ad Older Georgia ad U.S., 2006 % Georgia % U.S. 50 years ad older 57.4 53.8 50-64 years old 52.7 48.5 65 years ad older 67.7 63.4 White oly, o-hispaic 56.7 55.6 Black oly, o-hispaic (45+) 49.9 48.1 Other races oly, o-hispaic /a 44.9 Hispaic /a 43.0 Low Educatio** 38.2 40.3 * Prostate-specific atige test withi the past year for me who reported they were ot told by a doctor, urse, or other health professioal that they had prostate cacer ** Adults 50 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2006 Prevetio..... Curret Cigarette Smokig*, Adults 18 ad Older, Georgia ad U.S., 2007 % Georgia % U.S. Total 19.4 19.7 18-24 years old 23.4 24.0 25-34 years old 22.0 23.9 35-44 years old 18.8 20.4 45-54 years old 23.2 22.3 55-64 years old 18.3 18.0 65 years ad older 9.9 9.0 Male 21.2 21.2 Female 17.6 18.4 White oly, o-hispaic 19.1 19.4 Black oly, o-hispaic 19.6 21.7 Other race oly, o-hispaic /a 21.7 Hispaic 15.0 16.7 Low Educatio** 35.1 33.2 Female 18-44 (2006) 19.5 20.6 * Ever smoked 100 cigarettes i lifetime ad are curret smokers (regular ad irregular). ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Physical Activity, Adults 18 ad Older, Georgia ad U.S., 2007 No Leisure Time Physical Activity* % Georgia % U.S. Total 51.8 50.5 Male 48.8 48.5 Female 54.7 52.5 White oly, o-hispaic 50.9 48.4 Black oly, o-hispaic 57.3 58.6 Other race oly, o-hispaic 46.6 51.0 Hispaic /a 55.3 Low Educatio** 57.9 59.8 * Adults with 30+ miutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ miutes three or more days per week. ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 40 America Cacer Society Georgia South Atlatic Cacer Facts & Figures 2008

Nutritio, Adults 18 ad Older, Georgia ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day % Georgia % U.S. Total 25.0 24.4 Male 21.1 19.4 Female 28.8 28.8 White oly, o-hispaic 24.8 24.5 Black oly, o-hispaic 25.2 23.1 Other race oly, o-hispaic 28.7 26.6 Hispaic 21.4 22.6 Low Educatio* 16.2 18.4 * Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Overweight*, Adults 18 ad Older, Georgia ad U.S., 2007 % Georgia % U.S. Total 65.0 63.0 Male 71.5 70.8 Female 58.6 55.4 White oly, o-hispaic 63.2 62.6 Black oly, o-hispaic 69.6 72.6 Other race oly, o-hispaic 60.8 51.2 Hispaic /a 66.9 Low Educatio** 69.2 65.7 *Overweight is defied as havig body mass idex of 25 kg/m 2 or greater **Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Youth Risk Behavior Tobacco Use, High School Studets, Georgia ad U.S., 2007 Curret Cigarette Smokig* % Georgia % U.S. Total 18.6 20.0 Male 20.7 21.3 Female 16.5 18.7 Curret Smokeless Tobacco Use** Total 8.4 7.9 Male 14.8 13.4 Female 1.8 2.3 * Smoked cigarettes o 1 or more of the 30 days precedig the survey ** Used chewig tobacco, suff or dip o 1 or more of the 30 days precedig the survey Source: Youth Risk Behavior Surveillace System, 2007 Nutritio, High School Studets, Georgia ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day % Georgia % U.S. Total 19.0 21.4 Male 21.4 22.9 Female 16.7 19.9 Source: Youth Risk Behavior Surveillace System, 2007 Physical Activity, High School Studets, Georgia ad U.S., 2007 Met Curret Physical Activity Level* % Georgia % U.S. Total 43.8 34.7 Male 57.2 43.7 Female 30.5 25.6 * Were physically active durig ay kid of physical activity that icreased their heart rate ad made them breathe hard some of the time for a total of at least 60 miutes/ day o 5 or more days durig the 7 days before the survey Source: Youth Risk Behavior Surveillace System, 2007 Overweight/Obese High School Studets, Georgia ad U.S., 2007 Obese* % Georgia % U.S. Total 13.8 13.0 Male 16.6 16.3 Female 11.1 9.6 Overweight** Total 18.2 15.8 Male 17.5 16.4 Female 18.9 15.1 * Obese - At or above the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey ** - Overweight - At or above the 85th percetile but below the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey. Source: Youth Risk Behavior Surveillace System, 2007 America Cacer Society Georgia South Atlatic Cacer Facts & Figures 2008 41

Marylad Garrett Allegay Washigto Frederick Carroll Baltimore Howard Motgomery Ae Arudel Harford Cecil Ket Quee Ae's DEMOGRAPHICS... State Level Data, 2007 Estimates 2000 Cesus Populatio 5,296,486 2007 Estimate 1 5,675,034 White, No-Hispaic 3,307,000 Black, No-Hispaic 1,626,374 Native America, No-Hispaic 13,339 Asia/Pacific Islader, No-Hispaic 272,957 Hispaic 2 340,026 Other/Multi-Race, No-Hispaic 115,338 Distributio of Marylad s Populatio by Race & Ethicity 0.2% Native America, No-Hispaic Carolie Talbot Price George's Charles Calvert Dorchester Wicomico St. Mary's Worcester Somerset Factors Related to Access to Care Percet uemployed 3 3.7% Percetage with less tha high school educatio 10.8% Media household icome $64,357 Percet households with icome < $15,000 8.9% Percet households with icome $50,000 61.7% Percet of households with o vehicle 9.4% Percet rural populatio 15.4% Percet miority 41.7% % speak laguage other tha Eglish at home 14.9% % with o usual source of health care coverage 11.8% 2.0% 4.8% 6.0% 28.7% 58.3% Other/Multi-Race, No-Hispaic Asia/Pacific Islader, No-Hispaic Hispaic* Black, No-Hispaic White, No-Hispaic Marylad s Hispaic/Latio Populatio by Sub-Ethicity 30 Age Distributio of Marylad Age Group Number % < 18 1,409,242 24.8% 18-24 539,364 9.5% 25-39 1,104,942 19.5% 40-49 908,114 16.0% 50-64 1,042,028 18.4% 65 + 671,344 11.8% 30 2.3% Cuba 20 20 10.9% Puerto Rica 10 10 19.1% 67.6% Mexica Other Hispaic or Latio 0 < 18 18-24 25-39 40-49 50-64 65+ 0 1 Total is sum of White, Black, Native America, Asia/Pacific Islader, Other/Multi-Race, ad Hispaic. 2 Hispaic is a ethicity, ot a race. 3 Departmet of Labor http://www.bis.gov/lau/, April 2008 Data Sources: Copyright 2008, Thomso Medstat. ALL RIGHTS RESERVED; US Cesus Bureau, Populatio Fact Sheet, 2008, America Commuity Survey @ http://factfider.cesus.gov 42 America Cacer Society Marylad South Atlatic Cacer Facts & Figures 2008

Treds Marylad Cacer Icidece Rates by Cacer Site (1995-2003) 550 500 450 400 350 Rate Per 100,000 300 250 200 150 100 50 0 1995 1996 1997 1998 1999 2000 2001 2002 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Source: Marylad Cacer Registry 2003 All Sites* Breast (Female) Colorectal Lug Prostate Marylad Cacer Mortality Rates by Cacer Site (1995-2005) 250 200 Rate Per 100,000 150 100 50 All Sites Breast (Female) Colorectal Lug 0 1995 1996 1997 1998 1999 2000 2001 2002 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Source: Marylad Vital Statistics Admiistratio 2003 2004 2005 Prostate America Cacer Society Marylad South Atlatic Cacer Facts & Figures 2008 43

Marylad Cacer Icidece, 1999-2003, By Site, Geder ad Race All Races 1 White Black BOTH GENDERS Cases Rate Cases Rate Cases Rate ALL SITES 123,951 477.4 90,530 470.6 26,634 462.4 COLORECTAL 13,602 53.3 9,851 51.0 3,058 56.7 LUNG & BRONCHUS 17,513 68.7 13,290 69.0 3,881 70.9 MELANOMA 5,030 18.8 4,344 22.8 66 1.2 All Races 1 White Black MALE Cases Rate Cases Rate Cases Rate ALL SITES 63,566 567.8 46,095 544.5 13,612 586.7 COLORECTAL 6,761 62.1 5,010 60.3 1,383 63.8 LUNG & BRONCHUS 9,420 86.0 7,030 84.0 2,193 98.8 MELANOMA 2,823 24.0 2,452 28.1 33 1.5 PROSTATE 20,540 182.7 13,501 157.6 5,261 229.8 All Races 1 White Black FEMALE Cases Rate Cases Rate Cases Rate ALL SITES 60,370 415.1 44,429 420.6 13,018 381.0 BREAST(FEMALE) 19,055 130.4 13,945 133.5 4,251 117.0 CERVICAL 1,181 8.1 659 6.7 379 10.1 COLORECTAL 6,838 46.7 4,839 43.7 1,672 52.1 LUNG & BRONCHUS 8,091 56.2 6,258 58.1 1,688 52.5 MELANOMA 2,207 15.2 1,892 19.0 33 0.9 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races Data Source: Marylad Cacer Registry Marylad Cacer Mortality, 2001-2005, By Site, Geder ad Race All Races 1 White Black BOTH GENDERS Deaths Rate Deaths Rate Deaths Rate ALL SITES 51,426 194.9 37,680 188.2 12,779 233.2 COLORECTAL 5,199 19.8 3,704 18.4 1,406 26.8 LUNG & BRONCHUS 14,681 55.7 11,025 55.1 3,447 62.5 MELANOMA (SKIN) 716 2.7 All Races 1 White Black MALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 26,081 238.0 19,125 226.9 6,456 306.9 COLORECTAL 2,606 23.8 1,890 22.4 670 32.8 LUNG & BRONCHUS 8,092 72.3 5,949 69.5 2,018 91.3 MELANOMA (SKIN) PROSTATE 2,732 28.6 1,753 23.0 939 59.2 All Races 1 White Black FEMALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 25,345 166.4 18,555 162.0 6,323 190.4 BREAST (FEMALE) 4,168 27.2 2,871 25.3 1,222 33.7 CERVICAL 356 2.4 193 1.8 151 4.1 COLORECTAL 2,593 16.8 1,814 15.3 736 23.1 LUNG & BRONCHUS 6,589 43.7 5,076 44.8 1,429 43.8 MELANOMA (SKIN) Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races Source: Marylad Vital Statistics Admiistratio Notes o Marylad Cacer Registry Data Icidece data for 2004 ad 2005 from the Marylad Cacer Registry have bee suppressed sice these data are udergoig a data quality review ad were uavailable at time of publicatio. Marylad state ad couty icidece data are icluded up to 2003, or for multiple years 1999-2003. Stage at diagosis data are available for 1999-2003. 44 America Cacer Society Marylad South Atlatic Cacer Facts & Figures 2008

Marylad Cacer Stage at Diagosis, Percet of Total Cases, 1999-2003, by Site ad Race Marylad Female Breast Cacer Stage of Disease at Diagosis by Race, 1999-2003 I Situ Local Regioal Distat Ukow Female, All Races 1 19.0 46.1 22.4 3.0 9.5 White Female 14.4 51.1 22.6 3.0 8.9 Black Female 19.1 40.2 26.4 3.8 10.4 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 I Situ Local Regioal Distat Ukow/Ustaged Marylad Cervical Cacer 2 Stage of Disease at Diagosis by Race, 1999-2003 Local Regioal Distat Ukow Female, All Races 1 42.4 25.1 6.9 25.6 White Female 46.4 25.4 5.2 23.0 Black Female 41.8 29.5 11.4 17.2 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Marylad Colorectal Cacer 3 Stage of Disease at Diagosis by Sex ad Race, 1999-2003 Local Regioal Distat Ukow Male, All Races 1 31.4 38.2 15.7 14.7 White Male 33.1 38.8 15.8 12.3 Black Male 28.3 39.3 17.8 14.5 Female, All Races 1 31.7 37.8 16.6 14.3 White Female 33.6 39.7 15.2 11.5 Black Female 29.0 35.1 20.4 15.5 Black Female White Female Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Marylad Maligat Melaoma 2 Stage of Disease at Diagosis by Race, 1999-2003 Local Regioal Distat Ukow All Races 1 52.6 6.3 2.8 38.2 White 58.8 7.1 3.1 31.0 Black 28.8 10.6 4.6 56.1 Black White 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Marylad Cacer of the Prostate 2 Stage of Disease at Diagosis by Race, 1999-2003 Local Regioal Distat Ukow Male, All Races 1 65.9 6.6 2.7 24.8 White Male 69.5 6.8 2.3 21.3 Black Male 70.7 7.5 4.1 17.8 Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Notes: Stages ot reported for lug ad brochus cacer due to uavailability of cost-effective early detectio test. 1 Icludes White, Black ad other races 2 Stages reported for ivasive cervical, melaoma ad prostate cacers oly. 3 I situ ad local stages combied for colorectal cacer Source: Marylad Cacer Registry America Cacer Society Marylad South Atlatic Cacer Facts & Figures 2008 45

Marylad At a Glace Tobacco Tobacco Statistics Tobacco Use i Marylad (2007) High school studets who smoke 16.8% Male high school studets who use smokeless or spit tobacco 6.7% (female use much lower) Kids (uder 18) who become ew daily smokers each year 7,700 Kids exposed to secodhad smoke at home 270,000 Packs of cigarettes bought or smoked by kids each year 10.8 millio Adults i Marylad who smoke 17.1% (727,600) Deaths i Marylad From Smokig Adults who die each year from their ow smokig 6,800 Kids ow uder 18 ad alive i Marylad who will ultimately die prematurely from smokig 108,000 Adult osmokers who die each year from exposure to secodhad smoke 410 to 1,160 Smokig-Caused Moetary Costs i Marylad Aual health care costs i Marylad directly caused by smokig $1.96 billio - Portio covered by the state Medicaid program $476 millio Residets state & federal tax burde from smokig-caused govermet expeditures $627 / household Smokig-caused productivity losses i Marylad $1.78 billio Tobacco Idustry Ifluece i Marylad Estimated portio spet for Marylad marketig each year $192.7 millio Estimated Tobacco Reveue i Marylad FY2008 Tobacco Settlemet Reveues $165.2 millio Tobacco Tax Reveues $375.6 millio Total Aual State Reveues from Tobacco $540.8 millio % of Tobacco Reveue Spet o Tobacco Prevetio 3.4% Spedig o Tobacco Prevetio FY2008 $18.4 millio CDC Recommeded Miimum Spedig o Tobacco Prevetio $38.9 millio % of CDC Recommeded Miimum 60.7% Rak Amog States (1-51) 19 Marylad State Screeig Programs Breast cacer screeig: BCCEDP* Breast ad Cervical Cacer Screeig Program (BCCP), target populatio: wome 40-64, uisured, uder 250% of Federal Poverty Level. BCCP employs Lay Health Outreach Workers to educate, motivate ad recruit wome from priority populatios. Colorectal cacer screeig: There is madatory coverage for colorectal screeig. Cigarette Restitutio Fuds are distributed to local Couty health departmets ad 22 of 24 departmets ru CRC screeig programs with these moies. Prostate cacer screeig: Cigarette Restitutio Fuds are distributed to local Couty health departmets ad several ru screeig programs with these moies. *The Breast ad Cervical Cacer Early Detectio Program (BCCEDP) is a CDC-fuded program i every state admiistered through the Natioal Breast ad Cervical Cacer Early Detectio Program (NBCCEDP). 46 America Cacer Society Marylad South Atlatic Cacer Facts & Figures 2008

Nutritio ad Physical Activity State coalitio: Marylad Healthy Eatig ad Active Lifestyle (HEAL) Coalitio, www.healthyactivemarylad.org/ Marylad State Nutritio Actio Pla (SNAP) focuses educatioal efforts o parets ad teachers. www.fs.usda.gov/oae/snap/accomplishmets/marylad.htm Marylad Nutritio ad Physical Activity Pla - www.ketothemove.org/pdf/npa_summary.pdf Access to Care Number of Federally Qualified Health Ceters ad free cliics: 15 mai cliics; 92 satellite cliics State fud for Uisured Cacer Patiets: State-fuded program pays for breast ad cervical cacer diagosis ad treatmet. Number of ACoS approved hospitals: 37 Number of NCI Cacer Ceters: 1 Comprehesive Cacer Ceter Uisured Populatio (18+): 14.9% (was 12.7% i 2005) Marylad Comprehesive Cacer Cotrol Pla www.maryladcacerpla.org Status of Cacer Cotrol Pla: Marylad Comprehesive Cacer Cotrol Pla is curretly implemetig the 2004-2008 Pla: Our Call to Actio, A Pla By Maryladers, For Maryladers. www.fha.state.md.us/cacer/cacerpla/ I collaboratio with the Marylad State Coucil o Cacer Cotrol, hosted the 14th Aual State Coferece Cacer Issues ad Challege o Cacer Cotrol i November 2007 with over 400 attedees. This Year s Activities: To cotiue establishig priorities for implemetatio ad workig to brig the messages cotaied i the Marylad cacer pla to the citizes of Marylad through programs ad parterships. America Cacer Society Marylad South Atlatic Cacer Facts & Figures 2008 47

Adult Risk Behavior Early Detectio Recet Mammogram*, Wome 40 ad Older, Marylad ad U.S., 2006 % Marylad % U.S. 40 years ad older 63.9 61.2 40-64 years old 62.7 59.7 65 years ad older 67.0 64.6 White oly, o-hispaic 63.1 61.6 Black oly, o-hispaic 65.3 62.7 Other race oly, o-hispaic 61.6 59.3 Hispaic 67.2 58.7 Low Educatio** 58.4 51.6 Uisured*** 39.6 34.9 * Mammogram withi the past year ** Wome 40 years old ad older with less tha a high school educatio ***Wome 40-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Pap Test*, Wome 18 ad Older, Marylad ad U.S., 2006 % Marylad % U.S. 18 years ad older 87.7 83.7 18-44 years 87.7 85.1 45-64 years old 91.6 86.6 65 years ad older 76.9 70.8 * A pap test withi the precedig 3 years for wome with itact uteri. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Sigmoidoscopy/Colooscopy*, Adults 50 ad Older, Marylad ad U.S., 2006 % Marylad % U.S. 50 years ad older 57.4 50.0 50-64 years old 53.1 44.9 65 years ad older 64.0 57.1 Male, 50 years or older 59.9 50.5 Male, 50-64 years old 54.0 45.1 Male, 65 years ad older 70.4 59.5 Female, 50 years ad older 55.3 49.5 Female, 50-64 years old 52.3 44.8 Female, 65 years ad older 59.4 55.4 White oly, o-hispaic 57.7 51.5 Black oly, o-hispaic 58.4 49.3 Other races oly, o-hispaic 47.3 43.9 Hispaic 64.3 38.2 Low Educatio** 45.8 38.8 Uisured*** 28.3 20.9 * Sigmoidoscopy/Colooscopy withi the past 5 years ** Adults 50 years old ad older with less tha a high school educatio ***Adults 50-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Prostate-Specific Atige Test*, Me 50 ad Older Marylad ad U.S., 2006 % Marylad % U.S. 50 years ad older 57.1 53.8 50-64 years old 51.3 48.5 65 years ad older 67.9 63.4 White oly, o-hispaic 58.0 55.6 Black oly, o-hispaic (45+) 46.9 48.1 Other races oly, o-hispaic /a 44.9 Hispaic /a 43.0 Low Educatio** 31.8 40.3 * Prostate-specific atige test withi the past year for me who reported they were ot told by a doctor, urse, or other health professioal that they had prostate cacer ** Adults 50 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2006 Prevetio Curret Cigarette Smokig*, Adults 18 ad Older, Marylad ad U.S., 2007 % Marylad % U.S. Total 17.1 19.7 18-24 years old 24.0 24.0 25-34 years old 20.5 23.9 35-44 years old 19.3 20.4 45-54 years old 17.2 22.3 55-64 years old 15.1 18.0 65 years ad older 7.5 9.0 Male 18.3 21.2 Female 15.9 18.4 White oly, o-hispaic 17.4 19.4 Black oly, o-hispaic 19.0 21.7 Other race oly, o-hispaic /a 18.3 Hispaic 13.9 16.7 Low Educatio** 30.6 33.2 Female 18-44 (2006) 17.0 20.6 * Ever smoked 100 cigarettes i lifetime ad are curret smokers (regular ad irregular). ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Physical Activity, Adults 18 ad Older, Marylad ad U.S., 2007 No Leisure Time Physical Activity* % Marylad % U.S. Total 51.8 50.5 Male 49.9 48.5 Female 53.5 52.5 White oly, o-hispaic 48.4 48.4 Black oly, o-hispaic 58.7 58.6 Other race oly, o-hispaic 50.9 51.0 Hispaic 60.2 55.3 Low Educatio** 62.9 59.8 * Adults with 30+ miutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ miutes three or more days per week. ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 48 America Cacer Society Marylad South Atlatic Cacer Facts & Figures 2008

Nutritio, Adults 18 ad Older, Marylad ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day % Marylad % U.S. Total 26.6 24.4 Male 22.3 19.4 Female 30.5 28.8 White oly, o-hispaic 27.1 24.5 Black oly, o-hispaic 25.2 23.1 Other race oly, o-hispaic 31.0 26.6 Hispaic 20.9 22.6 Low Educatio* 19.3 18.4 * Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Overweight*, Adults 18 ad Older, Marylad ad U.S., 2007 % Marylad % U.S. Total 62.7 63.0 Male 68.6 70.8 Female 56.9 55.4 White oly, o-hispaic 60.7 62.6 Black oly, o-hispaic 74.2 72.6 Other race oly, o-hispaic 40.2 51.2 Hispaic 56.5 66.9 Low Educatio** 62.8 65.7 *Overweight is defied as havig body mass idex of 25 kg/m 2 or greater **Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Youth Risk Behavior Tobacco Use, High School Studets, Marylad ad U.S., 2007 Curret Cigarette Smokig* % Marylad % U.S. Total 16.8 20.0 Male 17.4 21.3 Female 15.8 18.7 Curret Smokeless Tobacco Use** Total 4.2 7.9 Male 6.7 13.4 Female 1.8 2.3 * Smoked cigarettes o 1 or more of the 30 days precedig the survey ** Used chewig tobacco, suff or dip o 1 or more of the 30 days precedig the survey Source: Youth Risk Behavior Surveillace System, 2007 Nutritio, High School Studets, Marylad ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day % Marylad % U.S. Total 19.0 21.4 Male 20.3 22.9 Female 17.6 19.9 Source: Youth Risk Behavior Surveillace System, 2007 Physical Activity, High School Studets, Marylad ad U.S., 2005 Met Curret Physical Activity Level* % Marylad % U.S. Total 30.6 34.7 Male 36.4 43.7 Female 25.0 25.6 * Were physically active durig ay kid of physical activity that icreased their heart rate ad made them breathe hard some of the time for a total of at least 60 miutes/day o 5 or more days durig the 7 days before the survey ** At least 20 miutes of vigorous physical activity that made them sweat ad breathe hard o 3 or more of the 7 days precedig the survey Source: Youth Risk Behavior Surveillace System, 2007 Overweight/Obese High School Studets, Marylad ad U.S., 2007 Obese* % Marylad % U.S. Total 13.1 13.0 Male 16.7 16.3 Female 9.2 9.6 Overweight** Total 15.2 15.8 Male 15.1 16.4 Female 15.4 15.1 * Obese - At or above the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey ** - Overweight - At or above the 85th percetile but below the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey. Source: Youth Risk Behavior Surveillace System, 2007 America Cacer Society Marylad South Atlatic Cacer Facts & Figures 2008 49

North Carolia Currituck Ashe Alleghay Stokes Caswell Warre Northampto Gates Surry Perso Vace Camde Watauga Rockigham Graville Hertford Pasquotak Wilkes Avery Yadki Perquimas Forsyth Guilford Orage Bertie Mitchell Caldwell Durham Frakli Alamace Edgecombe MadisoYacey Alexader Nash Tyrrell McDowell Burke Iredell Davidso Wake Marti Washigto Dare Bucombe Catawba Rowa RadolphChatham Wilso Pitt Swai Haywood Rutherford Johsto Greee Beaufort Graham Licol Hederso Cabarrus Moore Lee Hyde Jackso Polk Cherokee Staly Motgomery Harett Gasto Maco Waye Crave Clevelad Leoir Clay Trasylvaia Meckleburg Cumberlad Pamlico Richmod Hoke Uio Aso Sampso Joes Scotlad Dupli Oslow Carteret Robeso Blade Peder DEMOGRAPHICS State Level Data, 2007 Estimates Davie 2000 Cesus Populatio 8,049,313 2007 Estimate 1 8,875,404 White, No-Hispaic 6,000,159 Black, No-Hispaic 1,893,321 Native America, No-Hispaic 105,676 Asia/Pacific Islader, No-Hispaic 163,189 Hispaic 2 598,562 Other/Multi-Race, No-Hispaic 114,497 Distributio of North Carolia s Populatio by Race & Ethicity 1.2% 1.3% 1.8% Native America, No-Hispaic Other/Multi-Race, No-Hispaic Asia/Pacific Islader, No-Hispaic Columbus Bruswick Halifax New Haover Factors Related to Access to Care Chowa Percet uemployed 3 5.4% Percetage with less tha high school educatio 13.7% Media household icome $44,988 Percet households with icome < $15,000 14.4% Percet households with icome $50,000 44.6% Percet of households with o vehicle 6.5% Percet rural populatio 41.0% Percet miority 32.4% % speak laguage other tha Eglish at home 9.6% % with o usual source of health care coverage 20.9% North Carolia s Hispaic/Latio Populatio by Sub-Ethicity 6.7% 21.3% 67.6% Hispaic* Black, No-Hispaic White, No-Hispaic Age Distributio of North Carolia Age Group Number % < 18 2,157,416 24.3% 18-24 867,970 9.8% 25-39 1,886,342 21.3% 40-49 1,316,418 14.8% 50-64 1,544,451 17.4% 65 + 1,102,807 12.4% 1.8% Cuba 30 30 7.5% Puerto Rica 20 20 24.1% Other Hispaic or Latio 10 10 66.6% Mexica 0 < 18 18-24 25-39 40-49 50-64 65+ 0 1 Total is sum of White, Black, Native America, Asia/Pacific Islader, Other/Multi-Race, ad Hispaic. 2 Hispaic is a ethicity, ot a race. 3 Departmet of Labor http://www.bis.gov/lau/, April 2008 Data Sources: Copyright 2008, Thomso Medstat. ALL RIGHTS RESERVED; US Cesus Bureau, Populatio Fact Sheet, 2008, America Commuity Survey @ http://factfider.cesus.gov 50 America Cacer Society North Carolia South Atlatic Cacer Facts & Figures 2008

Treds North Carolia Cacer Icidece Rates by Cacer Site (1995-2005) 500 450 400 350 Rate Per 100,000 300 250 200 150 All Sites 100 Breast (Female) Colorectal 50 Lug 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Prostate Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Note: Data exclude i situ cacers except uriary bladder. Source: North Carolia Cetral Cacer Registry North Carolia Cacer Mortality Rates by Cacer Site (1995-2005) 250 200 Rate Per 100,000 150 100 All Sites Breast (Female) 50 Colorectal Lug 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Source: North Carolia Cetral Cacer Registry 2004 2005 Prostate America Cacer Society North Carolia South Atlatic Cacer Facts & Figures 2008 51

North Carolia Cacer Icidece, 2001-2005, by Site, Geder ad Race All Races 1 White Black BOTH GENDERS Cases Rate Cases Rate Cases Rate ALL SITES 194,014 461.6 155,021 458.0 35,246 478.9 COLORECTAL 20,240 48.6 15,847 46.9 4,053 56.3 LUNG & BRONCHUS 30,914 73.8 25,545 74.9 4,957 69.0 MELANOMA 6,998 16.6 6,843 20.5 56 0.8 All Races 1 White Black MALE Cases Rate Cases Rate Cases Rate ALL SITES 101,237 555.4 80,486 538.7 18,861 641.3 COLORECTAL 10,281 57.3 8,215 55.8 1,916 66.1 LUNG & BRONCHUS 18,082 100.9 14,689 99.3 3,164 110.3 MELANOMA 3,975 21.3 3,903 25.7 21 ~ PROSTATE 28,757 156.1 21,051 138.2 7,080 248.2 All Races 1 White Black FEMALE Cases Rate Cases Rate Cases Rate ALL SITES 92,766 398.4 74,528 404.2 16,384 376.0 BREAST(FEMALE) 28,057 121.7 22,411 123.2 5,138 116.1 CERVICAL 1,746 7.9 1,205 7.2 453 10.1 COLORECTAL 9,957 41.9 7,631 39.9 2,136 49.9 LUNG & BRONCHUS 12,832 54.4 10,856 57.2 1,793 42.2 MELANOMA 3,022 13.4 2,939 17.0 35 0.8 Note: Data exclude basal ad squamous cell ski ad i situ cacers except uriary bladder. Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races Source: North Carolia Cetral Cacer Registry North Carolia Cacer Mortality, 2001-2005, by Site, Geder ad Race All Races 1 White Black BOTH GENDERS Deaths Rate Deaths Rate Deaths Rate ALL SITES 81,428 197.1 64,091 190.4 16,412 233.3 COLORECTAL 7,553 18.4 5,753 17.2 1,711 24.5 LUNG & BRONCHUS 24,856 59.7 20,408 60.1 4,183 59.2 MELANOMA (SKIN) 1,203 2.9 1,159 3.5 41 0.6 All Races 1 White Black MALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 42,952 252.7 33,777 240.3 8,710 327.8 COLORECTAL 3,759 22.2 2,915 20.9 806 30.1 LUNG & BRONCHUS 15,010 85.4 12,107 83.3 2,741 98.7 MELANOMA (SKIN) 740 4.1 719 4.9 ^ ~ PROSTATE 4,341 30.0 2,854 23.8 1,444 67.3 All Races 1 White Black FEMALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 38,475 161.1 30,313 157.3 7,702 179.9 BREAST (FEMALE) 6,026 25.6 4,458 23.6 1,490 34.0 CERVICAL 591 2.6 394 2.2 186 4.1 COLORECTAL 3,793 15.6 2,837 14.4 905 21.3 LUNG & BRONCHUS 9,846 41.5 8,301 43.4 1,442 34.1 MELANOMA (SKIN) 463 2.0 440 2.4 ^ ~ Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races ~ Number of deaths too small (25 or less) to calculate reliable rate. Source: North Carolia Cetral Cacer Registry 52 America Cacer Society North Carolia South Atlatic Cacer Facts & Figures 2008

North Carolia Cacer Stage at Diagosis, Percet of Total Cases, 2001-2005, by Site ad Race North Carolia Female Breast Cacer Stage of Disease at Diagosis by Race, 2001-2005 I Situ Local Regioal Distat Ukow Female, All Races 1 18.0 50.0 25.0 4.0 3.0 White Female 18.0 52.0 24.0 3.0 3.0 Black Female 17.0 43.0 30.0 6.0 4.0 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 I Situ Local Regioal Distat Ukow/Ustaged North Carolia Cervical Cacer 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow Female, All Races 1 52.0 33.0 9.0 6.0 White Female 55.0 31.0 8.0 6.0 Black Female 46.0 35.0 12.0 7.0 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged North Carolia Colorectal Cacer 3 Stage of Disease at Diagosis by Sex ad Race, 2001-2005 Local Regioal Distat Ukow Male, All Races 1 44.0 33.0 17.0 6.0 White Male 45.0 33.0 16.0 6.0 Black Male 41.0 31.0 20.0 8.0 Female, All Races 1 43.0 34.0 16.0 7.0 White Female 43.0 34.0 16.0 7.0 Black Female 40.0 33.0 18.0 9.0 Black Female White Female Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged North Carolia Maligat Melaoma 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow All Races 1 81.0 9.0 3.0 7.0 White 81.0 9.0 3.0 7.0 Black 50.0 16.0 16.0 18.0 Black White 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged North Carolia Cacer of the Prostate 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow Male, All Races 1 79.0 9.0 4.0 8.0 White Male 81.0 9.0 3.0 7.0 Black Male 76.0 9.0 6.0 8.0 Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Notes: Stages ot reported for lug ad brochus cacer due to uavailability of cost-effective early detectio test. 1 Icludes White, Black ad other races 2 Stages reported for ivasive cervical, melaoma ad prostate cacers oly. 3 I situ ad local stages combied for colorectal cacer Source: North Carolia Cetral Cacer Registry America Cacer Society North Carolia South Atlatic Cacer Facts & Figures 2008 53

North Carolia At a Glace Tobacco Tobacco Statistics Tobacco Use i North Carolia (2007) High school studets who smoke 22.5% Male high school studets who use smokeless or spit tobacco 14.5% (female use much lower) Kids (uder 18) who become ew daily smokers each year 13,800 Kids exposed to secodhad smoke at home 416,000 Packs of cigarettes bought or smoked by kids each year 18.6 millio Adults i North Carolia who smoke 22.9% (1,534,500) Deaths i North Carolia From Smokig Adults who die each year from their ow smokig 11,900 Kids ow uder 18 ad alive i North Carolia who will ultimately die prematurely from smokig 193,000 Adult osmokers who die each year from exposure to secodhad smoke 810 to 2,270 Smokig-Caused Moetary Costs i North Carolia Aual health care costs i North Carolia directly caused by smokig $2.46 billio - Portio covered by the state Medicaid program $769 millio Residets state & federal tax burde from smokig-caused govermet expeditures $589 / household Smokig-caused productivity losses i North Carolia $3.30 billio Tobacco Idustry Ifluece i North Carolia Estimated portio spet for North Carolia marketig each year $569.3 millio Estimated Tobacco Reveue i North Carolia FY2008 Tobacco Settlemet Reveues $158.6 millio Tobacco Tax Reveues $267.3 millio Total Aual State Reveues from Tobacco $425.9 millio % of Tobacco Reveue Spet o Tobacco Prevetio 4.0% Spedig o Tobacco Prevetio - FY2008 $17.1 millio CDC Recommeded Miimum Spedig o Tobacco Prevetio $42.6 millio % of CDC Recommeded Miimum 40.2% Rak Amog States (1-51) 28 North Carolia State Screeig Programs Breast cacer screeig: BCCEDP* Breast ad Cervical Cacer Cotrol Program (NC BCCCP), target populatio: wome 50-64, uisured or uderisured, uder 200% of Federal Poverty Level. www.commuityhealth.dhhs.state.c.us/cacer.htm BCCCP has CDC fudig for the WISEWOMAN program ehacemet that provides itegrated cardiovascular screeig ad educatio o utritio, physical activity, ad tobacco use for BCCCP cliets. Colorectal cacer screeig: There is madatory coverage for colorectal screeig. Colorectal cacer screeig is promoted but there is o formal state screeig activity. Prostate cacer screeig: There is o state screeig program but prostate health ad iformed decisio makig are promoted per CDC guidelies ad based o USPSTF recommedatios. *The Breast ad Cervical Cacer Early Detectio Program (BCCEDP) is a CDC-fuded program i every state admiistered through the Natioal Breast ad Cervical Cacer Early Detectio Program (NBCCEDP). 54 America Cacer Society North Carolia South Atlatic Cacer Facts & Figures 2008

Nutritio ad Physical Activity State coalitio: Eat Smart, Move More...North Carolia Leadership Team www.cpabrach.com www.eatsmartmovemorec.com/idex.html Obesity iitiatives: I additio to Eat Smart, Move More; the North Carolia Health ad Welless Trust Fud provides support for several adolescet-specific projects. www.healthwellc.com/hwtfc/htmfiles/fudprty_obesity.htm Access to Care Number of Federally Qualified Health Ceters ad free cliics: 28 mai cliics; 111 satellite cliics State fud for Uisured Cacer Patiets: The NC Cacer Assistace Uit provides limited fudig for diagosis ad treatmet for eligible patiets. www.commuityhealth.dhhs.state.c.us/cacer/ccp.htm Number of ACoS approved hospitals: 43 Number of NCI Cacer Ceters: 3 Comprehesive Cacer Ceters Uisured Populatio (18+): 22.1% (was 22.5% i 2005) North Carolia Advisory Committee o Cacer Coordiatio ad Cotrol www.ccacer.com Status of Cacer Cotrol Pla: The North Carolia Advisory Committee o Cacer Coordiatio ad Cotrol (NCAC), established i 1993, icludes represetatives from public ad private orgaizatios ad istitutios, cacer survivors, ad legislators who are committed to reducig the burde of cacer i North Carolia. The third 5-year pla is uderway ad i December, 2007, the ACCCC implemeted the Livig Pla for the People of North Carolia that is web-based so that it ca be cotiuously updated ad tracked. Accomplishmets The North Carolia (NC) Ocology Navigatio Associatio (NCONA) held its iaugural meetig i April, 2008. Patiet Navigators from across the state met to discuss how to better address quality of care through patiet avigatio. Goals of the NCONA are to embrace the visio ad missio of the NC State Cacer pla; icrease awareess of the Ocology Navigator role; esure that all ewlydiagosed patiets ad their caregivers will be provided with patiet avigatio resources; ad promote collegiality for best practice. The secod North Carolia Cacer Survivorship Summit was held i Jue, 2008. A evaluatio of the North Carolia Cacer Pla is uderway usig data collected by staff at the NC Comprehesive Cacer Program ad the NCAC i order to measure processes employed i the implemetatio of the Pla. Measuremet data o impact ad outcome are obtaied through the NC Cetral Cacer Registry, the NC Behavioral Risk Factor Surveillace System, North Carolia Cacer Survey as well as the Natioal Cacer Istitute ad the Commissio o Cacer of the America College of Surgeos. America Cacer Society North Carolia South Atlatic Cacer Facts & Figures 2008 55

Adult Risk Behavior Early Detectio Recet Mammogram*, Wome 40 ad Older, North Carolia ad U.S., 2006 % North Carolia % U.S. 40 years ad older 63.9 61.2 40-64 years old 63.5 59.7 65 years ad older 64.9 64.6 White oly, o-hispaic 64.1 61.6 Black oly, o-hispaic 66.1 62.7 Other race oly, o-hispaic 62.4 59.3 Hispaic 52.6 58.7 Low Educatio** 48.8 51.6 Uisured 35.9 34.9 * Mammogram withi the past year ** Wome 40 years old ad older with less tha a high school educatio ***Wome 40-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Pap Test*, Wome 18 ad Older, North Carolia ad U.S., 2006 % North Carolia % U.S. 18 years ad older 86.5 83.7 18-44 years 87.5 85.1 45-64 years old 89.6 86.6 65 years ad older 74.6 70.8 * A pap test withi the precedig 3 years for wome with itact uteri. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Sigmoidoscopy/Colooscopy*, Adults 50 ad Older, North Carolia ad U.S., 2006 % North Carolia % U.S. 50 years ad older 53.3 50.0 50-64 years old 49.1 44.9 65 years ad older 59.4 57.1 Male, 50 years or older 53.0 50.5 Male, 50-64 years old 47.5 45.1 Male, 65 years ad older 62.4 59.5 Female, 50 years ad older 53.6 49.5 Female, 50-64 years old 50.6 44.8 Female, 65 years ad older 57.3 55.4 White oly, o-hispaic 54.2 51.5 Black oly, o-hispaic 52.3 49.3 Other races oly, o-hispaic 47.5 43.9 Hispaic 41.1 38.2 Low Educatio** 42.1 38.8 Uisured*** 26.0 20.9 * Sigmoidoscopy/Colooscopy withi the past 5 years ** Adults 50 years old ad older with less tha a high school educatio ***Adults 50-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Prostate-Specific Atige Test*, Me 50 ad Older North Carolia ad U.S., 2006 % North Carolia % U.S. 50 years ad older 56.1 53.8 50-64 years old 50.5 48.5 65 years ad older 66.8 63.4 White oly, o-hispaic 57.7 55.6 Black oly, o-hispaic (45+) 50.4 48.1 Other races oly, o-hispaic 51.1 44.9 Hispaic 32.1 43.0 Low Educatio** 46.4 40.3 * Prostate-specific atige test withi the past year for me who reported they were ot told by a doctor, urse, or other health professioal that they had prostate cacer ** Adults 50 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2006 Prevetio Curret Cigarette Smokig*, Adults 18 ad Older, North Carolia ad U.S., 2007 % North Carolia % U.S. Total 22.9 19.7 18-24 years old 31.3 24.0 25-34 years old 25.6 23.9 35-44 years old 24.4 20.4 45-54 years old 26.7 22.3 55-64 years old 19.7 18.0 65 years ad older 9.9 9.0 Male 25.2 21.2 Female 20.7 18.4 White oly, o-hispaic 23.1 19.4 Black oly, o-hispaic 23.0 21.7 Other race oly, o-hispaic 23.5 18.3 Hispaic 19.2 16.7 Low Educatio** 32.0 33.2 Female 18-44 (2006) 22.6 20.6 * Ever smoked 100 cigarettes i lifetime ad are curret smokers (regular ad irregular). ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Physical Activity, Adults 18 ad Older, North Carolia ad U.S., 2007 No Leisure Time Physical Activity* % North Carolia % U.S. Total 56.0 50.5 Male 53.4 48.5 Female 58.4 52.5 White oly, o-hispaic 53.1 48.4 Black oly, o-hispaic 62.3 58.6 Other race oly, o-hispaic 52.9 51.0 Hispaic 69.0 55.3 Low Educatio** 67.7 59.8 * Adults with 30+ miutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ miutes three or more days per week. ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 56 America Cacer Society North Carolia South Atlatic Cacer Facts & Figures 2008

Nutritio, Adults 18 ad Older, North Carolia ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day % North Carolia % U.S. Total 21.6 24.4 Male 18.2 19.4 Female 24.8 28.8 White oly, o-hispaic 23.1 24.5 Black oly, o-hispaic 18.5 23.1 Other race oly, o-hispaic 25.2 26.6 Hispaic 14.7 22.6 Low Educatio* 12.9 18.4 * Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Overweight*, Adults 18 ad Older, North Carolia ad U.S., 2007 % North Carolia % U.S. Total 64.6 63.0 Male 70.5 70.8 Female 58.8 55.4 White oly, o-hispaic 62.5 62.6 Black oly, o-hispaic 74.7 72.6 Other race oly, o-hispaic 57.3 51.2 Hispaic 62.4 66.9 Low Educatio** 66.9 65.7 *Overweight is defied as havig body mass idex of 25 kg/m 2 or greater **Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Youth Risk Behavior Tobacco Use, High School Studets, North Carolia ad U.S., 2007 Curret Cigarette Smokig* % North Carolia % U.S. Total 22.5 20.0 Male 22.5 21.3 Female 22.2 18.7 Curret Smokeless Tobacco Use - ot available * Smoked cigarettes o 1 or more of the 30 days precedig the survey Source: Youth Risk Behavior Surveillace System, 2007 Nutritio, High School Studets, North Carolia ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day - data ot available % North Carolia % U.S. Total 14.8 21.4 Male 15.1 22.9 Female 14.3 19.9 Source: Youth Risk Behavior Surveillace System, 2007 Physical Activity, High School Studets, North Carolia ad U.S., 2007 Met Curret Physical Activity Level* % North Carolia % U.S. Total 44.3 34.7 Male 54.0 43.7 Female 34.8 25.6 * Were physically active durig ay kid of physical activity that icreased their heart rate ad made them breathe hard some of the time for a total of at least 60 miutes/day o 5 or more days durig the 7 days before the survey Source: Youth Risk Behavior Surveillace System, 2007 Overweight/Obese High School Studets, North Carolia ad U.S., 2007 Obese* % North Carolia % U.S. Total 12.8 13.0 Male 15.9 16.3 Female 9.5 9.6 Overweight** Total 17.1 15.8 Male 17.0 16.4 Female 17.2 15.1 * Obese - At or above the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey ** - Overweight - At or above the 85th percetile but below the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey. Source: Youth Risk Behavior Surveillace System, 2007 America Cacer Society North Carolia South Atlatic Cacer Facts & Figures 2008 57

South Carolia Greeville Cherokee DEMOGRAPHICS State Level Data, 2007 Estimates 2000 Cesus Populatio 4,012,012 2007 Estimate 1 4,332,306 White, No-Hispaic 2,823,716 Black, No-Hispaic 1,248,872 Native America, No-Hispaic 13,857 Asia/Pacific Islader, No-Hispaic 48,229 Hispaic 2 151,248 Other/Multi-Race, No-Hispaic 46,384 Ocoee Pickes Spartaburg York Uio Lacaster Marlboro Chester Chesterfield Aderso Laures Fairfield Kershaw Darligto Dillo Newberry Abbeville Lee Mario Greewood Saluda Richlad Florece McCormick Sumter Horry Lexigto Edgefield Calhou Aike Orageburg Claredo Williamsburg Georgetow Barwell Bamberg Alledale Dorchester Berkeley Colleto Hampto Charlesto Distributio of South Carolia s Populatio by Race & Ethicity Jasper Beaufort 0.3% 1.1% 1.1% Native America, No-Hispaic Other/Multi-Race, No-Hispaic Asia/Pacific Islader, No-Hispaic Factors Related to Access to Care Hispaic* Black, No-Hispaic White, No-Hispaic South Carolia s Hispaic/Latio Populatio by Sub-Ethicity 3.5% 28.8% 65.2% 1.7% 10.1% Cuba Puerto Rica Percet uemployed 3 5.9% Percetage with less tha high school educatio 15.0% Media household icome $43,023 Percet households with icome < $15,000 15.9% Percet households with icome $50,000 42.5% Percet of households with o vehicle 5.9% Percet rural populatio 40.8% Percet miority 34.8% % speak laguage other tha Eglish at home 6.0% % with o usual source of health care coverage 19.6% 25.2% 63.0% Other Hispaic or Latio Mexica Age Distributio of South Carolia Age Group Number % < 18 1,029,257 23.8% 18-24 437,783 10.1% 25-39 872,906 20.1% 40-49 633,506 14.6% 50-64 797,000 18.4% 65 + 561,854 13.0% 30 20 10 0 < 18 18-24 25-39 40-49 50-64 65+ 30 20 10 0 1 Total is sum of White, Black, Native America, Asia/Pacific Islader, Other/Multi-Race, ad Hispaic. 2 Hispaic is a ethicity, ot a race. 3 Departmet of Labor http://www.bis.gov/lau/, April 2008 Data Sources: Copyright 2008, Thomso Medstat. ALL RIGHTS RESERVED; US Cesus Bureau, Populatio Fact Sheet, 2008, America Commuity Survey @ http://factfider.cesus.gov 58 America Cacer Society South Carolia South Atlatic Cacer Facts & Figures 2008

Treds South Carolia Cacer Icidece Rates by Cacer Site (1996-2005) 600 500 400 Rate Per 100,000 300 200 100 All Sites Breast (Female) Colorectal Lug 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Prostate Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Source: South Carolia Cetral Cacer Registry South Carolia Cacer Mortality Rates by Cacer Site (1995-2005) 250 200 Rate Per 100,000 150 100 All Sites 50 Breast (Female) Colorectal Lug 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Source: South Carolia Cetral Cacer Registry 2004 2005 Prostate America Cacer Society South Carolia South Atlatic Cacer Facts & Figures 2008 59

South Carolia Cacer Icidece, 2001-2005, by Site, Geder ad Race All Races 1 White Black BOTH GENDERS Cases Rate Cases Rate Cases Rate ALL SITES 102,813 483.9 76,730 478.6 24,621 492.7 COLORECTAL 11,243 53.4 8,097 50.5 3,021 61.7 LUNG & BRONCHUS 15,946 74.9 12,548 77.0 3,274 66.8 MELANOMA 4,201 19.9 4,052 26.0 48 1.0 All Races 1 White Black MALE Cases Rate Cases Rate Cases Rate ALL SITES 55,393 599.3 41,004 574.2 13,568 676.7 COLORECTAL 5,842 64.2 4,288 61.0 1,482 75.4 LUNG & BRONCHUS 9,642 104.9 7,422 103.6 2,150 108.4 MELANOMA 2,405 25.7 2,327 32.4 16 ~ PROSTATE 16,348 174.1 10,856 147.6 5,158 263.9 All Races 1 White Black FEMALE Cases Rate Cases Rate Cases Rate ALL SITES 47,420 403.7 35,726 412.4 11,053 373.6 BREAST(FEMALE) 14,065 120.3 10,598 123.1 3,294 109.4 CERVICAL 973 8.8 582 7.6 363 11.9 COLORECTAL 5,401 45.3 3,809 42.6 1,539 52.7 LUNG & BRONCHUS 6,304 52.8 5,126 57.1 1,124 39.0 MELANOMA 1,796 15.8 1,725 21.5 32 1.1 Note: Data exclude basal ad squamous cell ski ad i situ cacers except uriary bladder. Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. ~ Number of cases too small (25 or less) to calculate reliable rate 1 Icludes White, Black ad other races Source: South Carolia Cetral Cacer Registry South Carolia Cacer Mortality, 2001-2005, by Site, Geder ad Race All Races 1 White Black BOTH GENDERS Deaths Rate Deaths Rate Deaths Rate ALL SITES 41,991 201.4 30,467 191.4 11,309 235.8 COLORECTAL 3,979 19.3 2,746 17.4 1,224 25.8 LUNG & BRONCHUS 12,836 60.8 10,067 62.2 2,710 56.0 MELANOMA (SKIN) 527 2.5 503 3.2 23 ~ All Races 1 White Black MALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 22,863 265.3 16,566 247.0 6,207 337.7 COLORECTAL 2,053 23.8 1,431 21.5 619 33.3 LUNG & BRONCHUS 8,010 89.3 6,141 87.8 1,841 95.3 MELANOMA (SKIN) 331 3.7 326 4.8 ^ ~ PROSTATE 2,366 32.9 1,353 24.2 1,007 68.2 All Races 1 White Black FEMALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 19,128 159.4 13,901 153.9 5,102 175.4 BREAST (FEMALE) 3,016 25.4 2,052 23.1 950 32.0 CERVICAL 325 2.8 173 2.1 145 4.9 COLORECTAL 1,926 15.9 1,315 14.4 605 20.8 LUNG & BRONCHUS 4,826 40.3 3,926 43.4 869 30.2 MELANOMA (SKIN) 196 1.7 177 2.0 19 ~ Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races ^ Number of deaths less tha 5 ot reported due to cofidetiality issues Cells with 5-10 observatios are rouded to 10 ~ Number of deaths too small (25 or less) to calculate reliable rate. Source: South Carolia Cetral Cacer Registry 60 America Cacer Society South Carolia South Atlatic Cacer Facts & Figures 2008

South Carolia Cacer Stage at Diagosis, Percet of Total Cases, 2001-2005, by Site ad Race South Carolia Female Breast Cacer Stage of Disease at Diagosis by Race, 2001-2005 I Situ Local Regioal Distat Ukow Female, All Races 1 18.1 49.1 25.6 3.6 3.7 White Female 18.2 51.3 24.1 3.0 3.4 Black Female 17.8 42.1 30.4 5.4 4.3 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 I Situ Local Regioal Distat Ukow/Ustaged South Carolia Cervical Cacer 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow Female, All Races 1 54.3 29.7 7.3 8.7 White Female 57.0 28.0 6.9 8.1 Black Female 49.0 33.1 8.5 9.4 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged South Carolia Colorectal Cacer 3 Stage of Disease at Diagosis by Sex ad Race, 2001-2005 Local Regioal Distat Ukow Male, All Races 1 43.7 34.7 15.5 6.1 White Male 45.0 35.0 14.5 5.4 Black Male 39.4 33.9 18.9 7.9 Female, All Races 1 40.7 36.0 15.8 7.6 White Female 41.3 36.5 24.7 7.5 Black Female 38.7 34.9 18.7 7.7 Black Female White Female Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged South Carolia Maligat Melaoma 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow All Races 1 82.4 7.1 3.4 7.1 White 83.0 7.2 3.4 6.5 Black 60.4 14.6 12.5 12.5 Black White 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged South Cacer of the Prostate 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow Male, All Races 1 78.0 8.6 3.9 9.4 White Male 79.1 9.2 3.0 8.7 Black Male 76.6 7.7 6.0 9.8 Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Notes: Stages ot reported for lug ad brochus cacer due to uavailability of cost-effective early detectio test. 1 Icludes White, Black ad other races 2 Stages reported for ivasive cervical, melaoma ad prostate cacers oly. 3 I situ ad local stages combied for colorectal cacer Source: South Carolia Cetral Cacer Registry America Cacer Society South Carolia South Atlatic Cacer Facts & Figures 2008 61

South Carolia At a Glace Tobacco Tobacco Statistics Tobacco Use i South Carolia (2007) High school studets who smoke 17.8% Male high school studets who use smokeless or spit tobacco 13.4% (female use much lower) Kids (uder 18) who become ew daily smokers each year 7,300 Kids exposed to secodhad smoke at home 240,000 Packs of cigarettes bought or smoked by kids each year 9.7 millio Adults i South Carolia who smoke 21.9% (718,600) Deaths i South Carolia From Smokig Adults who die each year from their ow smokig 5,900 Kids ow uder 18 ad alive i South Carolia who will ultimately die prematurely from smokig 103,000 Adult osmokers who die each year from exposure to secodhad smoke 400 to 1,120 Smokig-Caused Moetary Costs i South Carolia Aual health care costs i South Carolia directly caused by smokig $1.09 billio - Portio covered by the state Medicaid program $393 millio Residets state & federal tax burde from smokig-caused govermet expeditures $578 / household Smokig-caused productivity losses i South Carolia $1.83 billio Tobacco Idustry Ifluece i South Carolia Estimated portio spet for South Carolia marketig each year $280.3 millio Estimated Tobacco Reveue i South Carolia FY2008 Tobacco Settlemet Reveues $82.9 millio Tobacco Tax Reveues $32.4 millio Total Aual State Reveues from Tobacco $115.3 millio % of Tobacco Reveue Spet o Tobacco Prevetio 1.7% Spedig o Tobacco Prevetio - FY2008 $2.0 millio CDC Recommeded Miimum Spedig o Tobacco Prevetio $23.9 millio % of CDC Recommeded Miimum 8.4% Rak Amog States (1-51) 45 Access to Care Number of Federally Qualified Health Ceters ad free cliics: 19 mai cliics; 95 satellite cliics State fud for Uisured Cacer Patiets: Noe Number of ACoS Approved Hospitals: 19 Number of NCI Cacer Ceters: 0 Uisured Populatio (18+): 19.3% (was 22.3% i 2005) 62 America Cacer Society South Carolia South Atlatic Cacer Facts & Figures 2008

South Carolia State Screeig Programs Breast cacer screeig: BCCEDP * The Best Chace Network (BCN) Target Populatio: Wome 47-64 (will be lowered to 40-64 i September, 2008), uisured or uderisured, uder 200% of Federal Poverty Level. www.scdhec.et/health/chcdp/cacer/bc.htm Uique aspect of BCN is that they cotract with the America Cacer Society to provide recruitmet ad service delivery coordiatio services. Best Chace Network screeed 8,858 wome durig the 2006-2007 fiscal year. Of that umber, 1,222 were idetified as havig breast follow-ups with 74% havig ormal cliical breast exams but abormal mammograms. This year, the first-ever state allocatio of $2 millio will provide a additioal 9,000 wome with access to life-savig cacer screeig. I additio, the CDC has awarded SC a five-year grat of $650,000 aually to implemet the Wisewoma program. Wisewoma adds cardiovascular ad diabetes screeig for BCN cliets, plus cliet educatio o risk factors Colorectal cacer screeig: The state has awarded oe millio dollars for a statewide colorectal cacer screeig program. The South Carolia Cacer Alliace Colorectal Cacer Work Group Screeig Subcommittee is i the process of developig the pla for the statewide colorectal cacer screeig program etitled SCOPE SC. Prostate cacer screeig: There are o state prostate screeig programs. *The Breast ad Cervical Cacer Early Detectio Program (BCCEDP) is a CDC-fuded program i every state admiistered through the Natioal Breast ad Cervical Cacer Early Detectio Program (NBCCEDP). Nutritio ad Physical Activity State coalitio: Healthy Schools ad Healthy South Carolia Obesity iitiatives: Goveror s Healthy Challege, Weight Loss Matters for Kids; Wizdom Kit, South Carolia Coalitio for Obesity Prevetio Efforts (SCCOPE) www.scdhec.gov/health/chcdp/obesity/coalitio.htm South Carolia Cacer Alliace www.sccaceralliace.org Status of Cacer Cotrol Pla: The Comprehesive Cacer Pla is i its third year of implemetatio. The South Carolia Cacer Alliace has five task forces (Advocacy/Policy, Early Detectio, Patiet Care, Prevetio, ad Research) to coordiate ad promote parterships ad collaboratios to address cacer prevetio ad cotrol strategies that will reduce the impact of cacer o all South Caroliias. The goals of the South Carolia Pla are to: Reduce the umber of ew cases of cacer. Reduce deaths attributable to cacer. Improve the quality of life of those livig with cacer ad their families/caregivers. Elimiate ad/or reduce health disparities attributable to cacer. Improve access to ad provisio of quality cacer care. Accomplishmets Movig To Actio: Addressig Cervical Cacer i SC was held i Jue, 2008. America Cacer Society South Carolia South Atlatic Cacer Facts & Figures 2008 63

Adult Risk Behavior Early Detectio Recet Mammogram*, Wome 40 ad Older, South Carolia ad U.S., 2006 % South Carolia % U.S. 40 years ad older 57.4 61.2 40-64 years old 55.7 59.7 65 years ad older 61.2 64.6 White oly, o-hispaic 56.4 61.6 Black oly, o-hispaic 61.0 62.7 Other race oly, o-hispaic 56.0 59.3 Hispaic 56.3 58.7 Low Educatio** 48.7 51.6 Uisured*** 34.0 34.9 * Mammogram withi the past year ** Wome 40 years old ad older with less tha a high school educatio ***Wome 40-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Pap Test*, Wome 18 ad Older, South Carolia ad U.S., 2006 % South Carolia % U.S. 18 years ad older 86.3 83.7 18-44 years 88.3 85.1 45-64 years old 86.0 86.6 65 years ad older 77.6 70.8 * A pap test withi the precedig 3 years for wome with itact uteri. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Sigmoidoscopy/Colooscopy*, Adults 50 ad Older, South Carolia ad U.S., 2006 % South Carolia % U.S. 50 years ad older 49.4 50.0 50-64 years old 44.5 44.9 65 years ad older 56.2 57.1 Male, 50 years or older 47.7 50.5 Male, 50-64 years old 43.0 45.1 Male, 65 years ad older 55.1 59.5 Female, 50 years ad older 50.7 49.5 Female, 50-64 years old 45.8 44.8 Female, 65 years ad older 57.0 55.4 White oly, o-hispaic 51.4 51.5 Black oly, o-hispaic 43.0 49.3 Other races oly, o-hispaic 43.2 43.9 Hispaic 51.8 38.2 Low Educatio** 41.0 38.8 Uisured*** 27.1 20.9 * Sigmoidoscopy/Colooscopy withi the past 5 years ** Adults 50 years old ad older with less tha a high school educatio ***Adults 50-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Prostate-Specific Atige Test*, Me 50 ad Older South Carolia ad U.S., 2006 % South Carolia % U.S. 50 years ad older 54.4 53.8 50-64 years old 49.0 48.5 65 years ad older 64.0 63.4 White oly, o-hispaic 57.3 55.6 Black oly, o-hispaic (45+) 41.2 48.1 Other races oly, o-hispaic /a 44.9 Hispaic /a 43.0 Low Educatio** 41.6 40.3 * Prostate-specific atige test withi the past year for me who reported they were ot told by a doctor, urse, or other health professioal that they had prostate cacer ** Adults 50 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2006 Prevetio Curret Cigarette Smokig*, Adults 18 ad Older, South Carolia ad U.S., 2007 % South Carolia % U.S. Total 21.9 19.7 18-24 years old 24.0 24.0 25-34 years old 28.4 23.9 35-44 years old 23.7 20.4 45-54 years old 25.0 22.3 55-64 years old 19.9 18.0 65 years ad older 9.3 9.0 Male 25.3 21.2 Female 18.7 18.4 White oly, o-hispaic 22.0 19.4 Black oly, o-hispaic 20.7 21.7 Other race oly, o-hispaic 19.5 18.3 Hispaic 24.8 16.7 Low Educatio** 33.8 33.2 Female 18-44 (2006) 22.3 20.6 * Ever smoked 100 cigarettes i lifetime ad are curret smokers (regular ad irregular). ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Physical Activity, Adults 18 ad Older, South Carolia ad U.S., 2007 No Leisure Time Physical Activity* % South Carolia % U.S. Total 53.5 50.5 Male 48.5 48.5 Female 58.0 52.5 White oly, o-hispaic 51.7 48.4 Black oly, o-hispaic 60.0 58.6 Other race oly, o-hispaic /a 51.0 Hispaic /a 55.3 Low Educatio** 62.6 59.8 * Adults with 30+ miutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ miutes three or more days per week. ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 64 America Cacer Society South Carolia South Atlatic Cacer Facts & Figures 2008

Nutritio, Adults 18 ad Older, South Carolia ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day % South Carolia % U.S. Total 18.7 24.4 Male 16.2 19.4 Female 21.1 28.8 White oly, o-hispaic 19.1 24.5 Black oly, o-hispaic 18.0 23.1 Other race oly, o-hispaic 19.1 26.6 Hispaic 18.5 22.6 Low Educatio* 14.8 18.4 * Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Overweight*, Adults 18 ad Older, South Carolia ad U.S., 2007 % South Carolia % U.S. Total 65.3 63.0 Male 71.5 70.8 Female 59.4 55.4 White oly, o-hispaic 63.0 62.6 Black oly, o-hispaic 73.6 72.6 Other race oly, o-hispaic /a 51.2 Hispaic /a 66.9 Low Educatio** 64.4 65.7 *Overweight is defied as havig body mass idex of 25 kg/m 2 or greater **Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Youth Risk Behavior Tobacco Use, High School Studets, South Carolia ad U.S., 2007 Curret Cigarette Smokig* % South Carolia % U.S. Total 17.8 20.0 Male 18.1 21.3 Female 17.4 18.7 Curret Smokeless Tobacco Use** Total 7.9 7.9 Male 13.4 13.4 Female 2.2 2.3 * Smoked cigarettes o 1 or more of the 30 days precedig the survey ** Used chewig tobacco, suff or dip o 1 or more of the 30 days precedig the survey Source: Youth Risk Behavior Surveillace System, 2007 Nutritio, High School Studets, South Carolia ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day % South Carolia % U.S. Total 17.1 21.4 Male 17.0 22.9 Female 17.0 19.9 Source: Youth Risk Behavior Surveillace System, 2007 Physical Activity, High School Studets, South Carolia ad U.S., 2007 Met Curret Physical Activity Level* % South Carolia % U.S. Total 38.0 34.7 Male 45.1 43.7 Female 30.7 25.6 * Were physically active durig ay kid of physical activity that icreased their heart rate ad made them breathe hard some of the time for a total of at least 60 miutes/day o 5 or more days durig the 7 days before the survey Source: Youth Risk Behavior Surveillace System, 2007 Overweight/Obese High School Studets, South Carolia ad U.S., 2007 Obese* % South Carolia % U.S. Total 14.4 13.0 Male 16.6 16.3 Female 12.2 9.6 Overweight** Total 17.1 15.8 Male 15.3 16.4 Female 18.9 15.1 * Obese - At or above the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey ** - Overweight - At or above the 85th percetile but below the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey. Source: Youth Risk Behavior Surveillace System, 2007 America Cacer Society South Carolia South Atlatic Cacer Facts & Figures 2008 65

Virgiia Bath Albemarle Carolie Louisa Northumberlad Rockbridge Kig Nelso Haover Kig AdQuee Lacaster Accomack William Middlesex Amherst Buckigham Powhata New Botetourt Cumberlad Ket Gloucester Craig Appomattox Charles James Mathews Chesterfield Northampto Amelia City City Buchaa Giles Roaoke Bedford Price York Motgomery Campbell Edward Dickeso Tazewell Blad Nottoway Surry Newport Pulaski News Charlotte Hampto Diwiddie Isle of Wise Russell Frakli Lueburg Sussex Wythe Wright Floyd Smyth Bruswick Halifax Chesapeake Lee Scott Washigto Carroll Hery Suffolk Virgiia Grayso Meckleburg Patrick Greesville Beach Virgiia DEMOGRAPHICS.. State Level Data, 2007 Estimates Alleghay Highlad Pittsylvaia Rockigham Augusta Rappahaock Page Greee Frederick Clarke Loudou Warre Sheadoah Fauquier Madiso Fluvaa Culpeper Orage Goochlad Price William Fairfax Stafford Kig George Spotsylvaia Herico Essex Price George Westmorelad Southampto Richmod 2000 Cesus Populatio 7,078,515 2007 Estimate 1 7,708,938 White, No-Hispaic 5,190,200 Black, No-Hispaic 1,488,118 Native America, No-Hispaic 18,846 Asia/Pacific Islader, No-Hispaic 361,206 Hispaic 2 487,057 Other/Multi-Race, No-Hispaic 163,511 Distributio of Virgiia s Populatio by Race & Ethicity 0.2% Native America, No-Hispaic Factors Related to Access to Care Percet uemployed 3 3.5% Percetage with less tha high school educatio 11.0% Media household icome $56,827 Percet households with icome < $15,000 10.4% Percet households with icome $50,000 55.9% Percet of households with o vehicle 6.3% Percet rural populatio 28.1% Percet miority 32.7% % speak laguage other tha Eglish at home 13.1% % with o usual source of health care coverage 12.0% Other/Multi-Race, No-Hispaic Asia/Pacific Islader, No-Hispaic Hispaic* Black, No-Hispaic White, No-Hispaic Virgiia s Hispaic/Latio Populatio by Sub- Ethicity 2.1% 4.7% 6.3% 19.3% 67.3% Age Distributio of Virgiia Age Group Number % 30 < 18 1,836,310 23.8% 18-24 764,967 9.9% 25-39 1,570,607 20.4% 40-49 1,207,192 15.7% 50-64 1,421,731 18.4% 65 + 908,131 11.8% 30 20 20 2.7% 10.9% Cuba Puerto Rica 10 10 25.1% Mexica 0 < 18 18-24 25-39 40-49 50-64 65+ 0 61.3% Other Hispaic or Latio 1 Total is sum of White, Black, Native America, Asia/Pacific Islader, Other/Multi-Race, ad Hispaic. 2 Hispaic is a ethicity, ot a race. 3 Departmet of Labor http://www.bis.gov/lau/, April 2008 Data Sources: Copyright 2008, Thomso Medstat. ALL RIGHTS RESERVED; US Cesus Bureau, Populatio Fact Sheet, 2008, America Commuity Survey @ http://factfider.cesus.gov 66 America Cacer Society Virgiia South Atlatic Cacer Facts & Figures 2008

Treds Virgiia Cacer Icidece Rates by Cacer Site (1995-2005) 500 450 400 350 Rate Per 100,000 300 250 200 150 100 50 0 1995 1996 1997 1998 1999 2000 2001 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Source: Virgiia Divisio of Health Statistics 2002 2003 2004 2005 All Sites Breast (Female) Colorectal Lug Prostate Virgiia Cacer Mortality Rates by Cacer Site (1995-2005) 250 200 Rate Per 100,000 150 100 All Sites Breast (Female) 50 Colorectal Lug 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Source: Virgiia Divisio of Health Statistics 2004 2005 Prostate America Cacer Society Virgiia South Atlatic Cacer Facts & Figures 2008 67

Virgiia Cacer Icidece, 2001-2005, by Site, Geder ad Race All Races 1 White Black BOTH GENDERS Cases Rate Cases Rate Cases Rate ALL SITES 157,362 436.4 127,474 431.5 27,290 461.0 COLORECTAL 17,255 48.6 13,348 46.7 3,401 59.2 LUNG & BRONCHUS 23,570 66.7 19,113 66.9 4,012 70.4 MELANOMA 6,319 17.1 5,952 20.5 64 1.1 All Races 1 White Black MALE Cases Rate Cases Rate Cases Rate ALL SITES 81,790 520.5 64,226 504.0 14,712 606.4 COLORECTAL 8,738 56.8 6,819 54.5 1,663 70.1 LUNG & BRONCHUS 13,238 86.6 10,587 84.8 2,412 103.3 MELANOMA 3,653 22.3 3,442 26.2 31 1.3 PROSTATE 24,891 156.5 18,203 140.2 5,620 233.6 All Races 1 White Black FEMALE Cases Rate Cases Rate Cases Rate ALL SITES 75,566 378.6 60,244 382.3 12,576 364.3 BREAST(FEMALE) 24,113 120.1 19,078 121.0 4,161 117.4 CERVICAL 1,357 6.9 973 6.6 290 8.0 COLORECTAL 8,514 42.5 6,527 40.6 1,737 51.8 LUNG & BRONCHUS 10,332 52.5 8,526 53.8 1,600 48.3 MELANOMA 2,666 13.5 2,510 16.6 33 1.0 Note: Data exclude basal ad squamous cell ski ad i situ cacers except uriary bladder. Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races Source: Virgiia Cacer Registry See Notes o Virgiia Cacer Registry Data for more iformatio. Virgiia Cacer Mortality, 2001-2005, by Site, Geder ad Race All Races 1 White Black BOTH GENDERS Deaths Rate Deaths Rate Deaths Rate ALL SITES 67,315 192.5 52,577 185.8 13,563 241.2 COLORECTAL 6,477 18.6 4,890 17.3 1,472 26.5 LUNG & BRONCHUS 19,690 56.2 15,897 56.0 3,550 63.3 MELANOMA (SKIN) 1,023 2.9 All Races 1 White Black MALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 34,971 240.6 27,143 228.4 7,275 329.9 COLORECTAL 3,319 22.8 2,537 21.4 729 32.8 LUNG & BRONCHUS 11,295 75.7 8,932 73.2 2,233 98.6 MELANOMA (SKIN) PROSTATE 3,671 29.5 2,496 24.4 1,145 62.1 All Races 1 White Black FEMALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 32,344 161.2 25,434 157.8 6,288 187.4 BREAST (FEMALE) 5,323 26.4 3,972 24.7 1,244 35.7 CERVICAL 437 2.2 302 1.9 120 3.5 COLORECTAL 3,158 15.6 2,353 14.3 743 22.3 LUNG & BRONCHUS 8,395 42.2 6,965 43.6 1,317 39.9 MELANOMA (SKIN) Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races Source: Virgiia Ceter for Health Statistics 68 America Cacer Society Virgiia South Atlatic Cacer Facts & Figures 2008

Virgiia Cacer Stage at Diagosis, Percet of Total Cases, 2001-2005, by Site ad Race Virgiia Female Breast Cacer Stage of Disease at Diagosis by Race, 2001-2005 I Situ Local Regioal Distat Ukow Female, All Races 1 20.1 47.9 24.2 3.7 4.1 White Female 20.0 49.6 23.2 3.4 3.8 Black Female 20.2 41.4 28.7 5.2 4.5 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 I Situ Local Regioal Distat Ukow/Ustaged Virgiia Cervical Cacer 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow Female, All Races 1 49.3 33.3 9.2 8.3 White Female 51.6 31.9 9.2 7.3 Black Female 41.2 40.2 10.3 8.3 Black Female White Female 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Virgiia Colorectal Cacer 3 Stage of Disease at Diagosis by Sex ad Race, 2001-2005 Local Regioal Distat Ukow Male, All Races 1 41.8 34.7 16.1 7.4 White Male 42.7 35.0 15.7 6.6 Black Male 38.4 33.9 18.3 9.4 Female, All Races 1 40.0 36.0 15.5 8.5 White Female 40.3 36.8 15.0 7.9 Black Female 38.8 33.7 17.3 10.2 Black Female White Female Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Virgiia Maligat Melaoma 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow All Races 1 83.8 4.8 2.2 9.2 White 84.8 5.0 2.2 8.0 Black 64.0 11.2 14.6 10.1 Black White 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Virgiia Cacer of the Prostate 2 Stage of Disease at Diagosis by Race, 2001-2005 Local Regioal Distat Ukow Male, All Races 1 72.2 7.9 3.1 16.7 White Male 74.7 8.1 2.7 14.5 Black Male 70.3 7.7 4.7 16.7 Black Male White Male 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Notes: Stages ot reported for lug ad brochus cacer due to uavailability of cost-effective early detectio test. 1 Icludes White, Black ad other races 2 Stages reported for ivasive cervical, melaoma ad prostate cacers oly. 3 I situ ad local stages combied for colorectal cacer Source: Virgiia Divisio of Health Statistics America Cacer Society Virgiia South Atlatic Cacer Facts & Figures 2008 69

Virgiia at a Glace Tobacco Tobacco Statistics Tobacco Use i Virgiia (2007) High school studets who smoke (2005) 22..0% Male high school studets who use smokeless or spit tobacco 13.3% (female use much lower) Kids (uder 18) who become ew daily smokers each year 10,800 Kids exposed to secodhad smoke at home 336,000 Packs of cigarettes bought or smoked by kids each year 18.4 millio Adults i Virgiia who smoke 18.5% (1,079,600) Deaths i Virgiia From Smokig Adults who die each year from their ow smokig 9,300 Kids ow uder 18 ad alive i Virgiia who will ultimately die prematurely from smokig 152,000 Adult osmokers who die each year from exposure to secodhad smoke 610 to 1,720 Smokig-Caused Moetary Costs i Virgiia Aual health care costs i Virgiia directly caused by smokig $2.08 billio - Portio covered by the state Medicaid program $401 millio Residets state & federal tax burde from smokig-caused govermet expeditures $576 / household Smokig-caused productivity losses i Virgiia $2.42 billio Tobacco Idustry Ifluece i Virgiia Estimated portio spet for Virgiia marketig each year $438.5 millio Estimated Tobacco Reveue i Virgiia FY2008 Tobacco Settlemet Reveues $131.2 millio Tobacco Tax Reveues $188.5 millio Total Aual State Reveues from Tobacco $319.7 millio % of Tobacco Reveue Spet o Tobacco Prevetio 4.5% Spedig o Tobacco Prevetio - FY2008 $14.5 millio CDC Recommeded Miimum Spedig o Tobacco Prevetio $38.9 millio % of CDC Recommeded Miimum 37.3% Rak Amog States (1-51) 32 Virgiia Screeig Programs Breast cacer screeig: BCCEDP* Every Woma s Life (EWL). The target populatio is wome 50-64, uisured or uderisured ad uder 200% of Federal Poverty Level. A uique aspect of EWL is that it ivolves several coalitios aroud the state that assist with local recruitmet ad program coordiatio. Colorectal cacer screeig: There is curretly o statewide program for colo cacer screeig. Prostate cacer screeig: There is o statewide screeig program. The Virgiia Prostate Cacer Coalitio (VPCC), however, focuses o icreasig awareess ad screeig of prostate cacer. The VPCC s website has iformatio o prostate cacer screeigs, local support groups ad evets. www.vapcacoalitio.org *The Breast ad Cervical Cacer Early Detectio Program (BCCEDP) is a CDC-fuded program i every state admiistered through the Natioal Breast ad Cervical Cacer Early Detectio Program (NBCCEDP). 70 America Cacer Society Virgiia South Atlatic Cacer Facts & Figures 2008

Nutritio ad Physical Activity Virgiia received fudig from CDC i Jue to implemet the WISEWOMAN program through the ifrastructure of the BCCEDP. WISEWOMAN provides itegrated cardiovascular screeig ad educatio o utritio, physical activity ad tobacco use. Access to Care Number of Federally Qualified Health Ceters ad free cliics: 21 mai cliics; 132 satellite cliics State fud for Uisured Cacer Patiets: Uisured Medical Catastrophe Fud Number of ACoS approved hospitals: 42 Number of NCI Cacer Ceters: 2 Uisured Populatio (18+): 14.7% (was 12.8% i 2005) Virgiia Cacer Pla Actio Coalitio (CPAC) www.vahealth.org/cdpc/cacerprevetio/vcp.htm The C-PAC Cacer Pla for 2008-2012 will be uveiled at Virgiia s First Comprehesive Statewide Cacer Coferece JOIN- ING THE RACE TO CONQUER CANCER, to be held i November, 2008. Virgiia Cacer Pla Actio Coalitio (CPAC) cotracted with Divisio of Commuity Health ad Research at Easter Virgiia Medical School to coduct a evaluatio of the coalitio. Report was released i July 2008 ad will serve to make improvemets i the Coalitio effectiveess. Additioal Iitiatives ACS sposored two Africa America Me s Health Forums i 2008 with presetatios o cardiovascular health, diabetes, ad cacers of the colo, lug ad prostate. Locatios were Richmod ad Norfolk with a average attedace of 500 me. Virgiia has hosted 14 Clergy Cofereces this past year, educatig the faith-based commuity leaders of the may programs ad services available to their costituets. The model cotiues to be used i other states aroud South Atlatic Divisio. Virgiia awarded oe summer fellowship to a secod year medical studet for their cacer research study. America Cacer Society Virgiia South Atlatic Cacer Facts & Figures 2008 71

Adult Risk Behavior Early Detectio Recet Mammogram*, Wome 40 ad Older, Virgiia ad U.S., 2006 % Virgiia % U.S. 40 years ad older 62.2 61.2 40-64 years old 60.6 59.7 65 years ad older 66.5 64.6 White oly, o-hispaic 63.3 61.6 Black oly, o-hispaic 55.1 62.7 Other race oly, o-hispaic /a 59.3 Hispaic 74.0 58.7 Low Educatio** 52.4 51.6 Uisured*** 25.2 34.9 * Mammogram withi the past year ** Wome 40 years old ad older with less tha a high school educatio ***Wome 40-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Pap Test*, Wome 18 ad Older, Virgiia ad U.S., 2006 % Virgiia % U.S. 18 years ad older 85.4 83.7 18-44 years 87.9 85.1 45-64 years old 87.1 86.6 65 years ad older 67.6 70.8 * A pap test withi the precedig 3 years for wome with itact uteri. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Sigmoidoscopy/Colooscopy*, Adults 50 ad Older, Virgiia ad U.S., 2006 % Virgiia % U.S. 50 years ad older 57.1 50.0 50-64 years old 53.8 44.9 65 years ad older 62.6 57.1 Male, 50 years or older 58.1 50.5 Male, 50-64 years old 53.9 45.1 Male, 65 years ad older 65.7 59.5 Female, 50 years ad older 56.3 49.5 Female, 50-64 years old 53.7 44.8 Female, 65 years ad older 60.3 55.4 White oly, o-hispaic 58.4 51.5 Black oly, o-hispaic 59.3 49.3 Other races oly, o-hispaic 45.3 43.9 Hispaic 38.7 38.2 Low Educatio** 42.7 38.8 Uisured*** 32.5 20.9 * Sigmoidoscopy/Colooscopy withi the past 5 years ** Adults 50 years old ad older with less tha a high school educatio ***Adults 50-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Prostate-Specific Atige Test*, Me 50 ad Older Virgiia ad U.S., 2006 % Virgiia % U.S. 50 years ad older 53.9 53.8 50-64 years old 47.0 48.5 65 years ad older 67.4 63.4 White oly, o-hispaic 55.0 55.6 Black oly, o-hispaic (45+) 53.7 48.1 Other races oly, o-hispaic /a 44.9 Hispaic /a 43.0 Low Educatio** 43.6 40.3 * Prostate-specific atige test withi the past year for me who reported they were ot told by a doctor, urse, or other health professioal that they had prostate cacer ** Adults 50 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2006 72 America Cacer Society Virgiia South Atlatic Cacer Facts & Figures 2008

Prevetio Curret Cigarette Smokig*, Adults 18 ad Older, Virgiia ad U.S., 2007 % Virgiia % U.S. Total 18.5 19.7 18-24 years old 23.0 24.0 25-34 years old 23.9 23.9 35-44 years old 17.6 20.4 45-54 years old 20.5 22.3 55-64 years old 17.2 18.0 65 years ad older 8.1 9.0 Male 15.4 21.2 Female 12.8 18.4 White oly, o-hispaic 13.7 19.4 Black oly, o-hispaic 15.1 21.7 Other race oly, o-hispaic /a 18.3 Hispaic 8.2 16.7 Low Educatio** 31.4 33.2 Female 18-44 (2006) 23.6 20.6 * Ever smoked 100 cigarettes i lifetime ad are curret smokers (regular ad irregular). ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Physical Activity, Adults 18 ad Older, Virgiia ad U.S., 2007 No Leisure Time Physical Activity* % Virgiia % U.S. Total 50.5 50.5 Male 50.1 48.5 Female 50.8 52.5 White oly, o-hispaic 49.0 48.4 Black oly, o-hispaic 56.7 58.6 Other race oly, o-hispaic 0.0 51.0 Hispaic /a 55.3 Low Educatio** 62.7 59.8 * Adults with 30+ miutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ miutes three or more days per week. ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Tobacco Use, High School Studets, Virgiia 2005 Curret Cigarette Smokig* % Virgiia % U.S. Total 21.7 20.0 Male 25.7 21.3 Female 17.8 18.7 Curret Smokeless Tobacco Use** Total 7.4 7.9 Male 13.3 13.4 Female 1.8 13.4 *Smoked cigarettes o 1 or more of the 30 days precedig the survey ** Used chewig tobacco, suff or dip o 1 or more of the 30 days precedig the survey Source: Youth Tobacco Survey, 2005 Nutritio, Adults 18 ad Older, Virgiia ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day % Virgiia % U.S. Total 26.3 24.4 Male 20.3 19.4 Female 32.0 28.8 White oly, o-hispaic 23.1 24.5 Black oly, o-hispaic 18.5 23.1 Other race oly, o-hispaic 25.2 26.6 Hispaic 14.7 22.6 Low Educatio* 24.9 18.4 * Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Overweight*, Adults 18 ad Older, Virgiia ad U.S., 2007 % Virgiia % U.S. Total 61.8 63.0 Male 69.9 70.8 Female 54.0 55.4 White oly, o-hispaic 60.3 62.6 Black oly, o-hispaic 72.4 72.6 Other race oly, o-hispaic /a 51.2 Hispaic /a 66.9 Low Educatio** 61.4 65.7 *Overweight is defied as havig body mass idex of 25 kg/m 2 or greater **Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Youth Risk Behavior Additioal data are ot available sice Virgiia did ot participate i the Youth Risk Behavior Surveillace System, a volutary collaboratio betwee the state s departmets of health ad educatio ad the Ceters for Disease Cotrol ad Prevetio. America Cacer Society Virgiia South Atlatic Cacer Facts & Figures 2008 73

West Virgiia West Virgiia Demographics State Level Data, 2007 Estimates 2000 Cesus Populatio 1,808,344 2007 Estimate 1 1,821,997 White, No-Hispaic 1,716,015 Black, No-Hispaic 57,186 Native America, No-Hispaic 3,235 Asia/Pacific Islader, No-Hispaic 10,560 Hispaic 2 16,490 Other/Multi-Race, No-Hispaic 18,511 Distributio of West Virgiia s Populatio by Race & Ethicity Hacock Brooke Ohio Marshall Wetzel Moogalia Tyler Mario Morga Presto Berkeley Pleasats Mieral Wood Doddridge Taylor Harriso Hampshire Jefferso Ritchie Barbour Tucker Grat Wirt Calhou Gilmer Lewis Upshur Hardy Jackso Radolph Maso Roae Braxto Pedleto Putam Cabell Clay Webster Kaawha Waye Licol Nicholas Pocahotas Booe Fayette Greebrier Loga Migo Raleigh Wyomig Moroe Summers 0.2% Native America, No-Hispaic McDowell Mercer 0.6% Asia/Pacific Islader, No-Hispaic 0.9% Hispaic* 1.0% 3.1% 94.2% Other/Multi-Race, No-Hispaic Black, No-Hispaic White, No-Hispaic West Virgiia s Hispaic/Latio Populatio by Sub-Ethicity 2.9% 12.6% Cuba Puerto Rica Factors Related to Access to Care Percet uemployed 3 5.0% Percetage with less tha high school educatio 14.7% Media household icome $35,643 Percet households with icome < $15,000 20.5% Percet households with icome $50,000 34.4% Percet of households with o vehicle 7.6% Percet rural populatio 54.4% Percet miority 5.8% % speak laguage other tha Eglish at home 11.0% % with o usual source of health care coverage 18.9% 40.0% 44.5% Mexica Other Hispaic or Latio Age Distributio of West Virgiia Age Group Number % < 18 378,162 20.8% 18-24 169,809 9.3% 25-39 342,151 18.8% 40-49 265,777 14.6% 50-64 378,689 20.8% 65 + 287,409 15.8% 30 20 10 0 < 18 18-24 25-39 40-49 50-64 65+ 30 20 10 0 1 Total is sum of White, Black, Native America, Asia/Pacific Islader, Other/Multi-Race, ad Hispaic. 2 Hispaic is a ethicity, ot a race. 3 Departmet of Labor http://www.bis.gov/lau/, April 2008 Data Sources: Copyright 2008, Thomso Medstat. ALL RIGHTS RESERVED; US Cesus Bureau, Populatio Fact Sheet, 2008, America Commuity Survey @ http://factfider.cesus.gov 74 America Cacer Society West Virgiia South Atlatic Cacer Facts & Figures 2008

Treds West Virgiia Cacer Icidece Rates by Cacer Site (1995-2005) 600 500 Rate Per 100,000 400 300 200 All Sites 100 Breast (Female) Colorectal Lug 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 Note: Data exclude basal ad squamous cell ski ad i situ cacers except uriary bladder. Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Source: West Virgiia Cacer Registry 2004 2005 Prostate West Virgiia Cacer Mortality Rates by Cacer Site (1995-2004) 250 200 Rate Per 100,000 150 100 All Sites 50 Breast (Female) Colorectal Lug 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. Data Source: West Virgiia Health Statistics Ceter 2004 2005 Prostate America Cacer Society West Virgiia South Atlatic Cacer Facts & Figures 2008 75

West Virgiia Cacer Icidece, 2001-2005, by Site, Geder ad Race All Races 1 White Black BOTH GENDERS Cases Rate Cases Rate Cases Rate ALL SITES 52,803 490.1 51,322 494.5 1,268 460.8 COLORECTAL 6,513 59.8 6,311 60.0 181 64.2 LUNG & BRONCHUS 9,836 89.4 9,628 90.7 185 67.9 MELANOMA 1,730 16.8 1,722 17.5 ^ ~ All Races 1 White Black MALE Cases Rate Cases Rate Cases Rate ALL SITES 27,363 575.4 26,601 579.3 659 589 COLORECTAL 3,313 70.5 3,237 71.2 66 60.2 LUNG & BRONCHUS 5,597 116.8 5,463 117.9 116 105.2 MELANOMA 988 21.0 985 21.7 ^ ~ PROSTATE 6,713 139.2 6,455 138.4 228 210.5 All Races 1 White Black FEMALE Cases Rate Cases Rate Cases Rate ALL SITES 25,440 433.6 24,721 438 609 383.9 BREAST(FEMALE) 6,608 115.3 6,423 116.5 153 99.4 CERVICAL 512 10.2 490 10.2 ^ ~ COLORECTAL 3,200 51.6 3,074 51.4 115 69.5 LUNG & BRONCHUS 4,239 69.4 4,165 70.7 69 43.3 MELANOMA 742 14.0 737 14.5 ^ ~ Note: Data exclude basal ad squamous cell ski ad i situ cacers except uriary bladder. Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races ^ Number of cases 5 or less ot reported due to cofidetiality issues ~ Number of cases too small (25 or less) to calculate reliable rate. Source: West Virgiia Cacer Registry West Virgiia Cacer Mortality, 2001-2005, by Site, Geder ad Race All Races 1 White Black BOTH GENDERS Deaths Rate Deaths Rate Deaths Rate ALL SITES 23,274 213.0 22,577 214.8 673 241.4 COLORECTAL 2,362 21.6 2,275 21.6 85 29.7 LUNG & BRONCHUS 7,566 68.5 7,401 69.7 160 58.1 MELANOMA (SKIN) 314 3.0 314 3.1 0 0.0 All Races 1 White Black MALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 12,170 262.5 11,832 265.8 325 303.4 COLORECTAL 1,188 25.9 1,150 26.1 36 32.8 LUNG & BRONCHUS 4,404 92.3 4,322 94.5 81 74.7 MELANOMA (SKIN) 201 4.3 201 4.4 0 0.0 PROSTATE 993 24.1 929 23.2 64 67.0 All Races 1 White Black FEMALE Deaths Rate Deaths Rate Deaths Rate ALL SITES 11,104 179.5 10,745 180.1 348 207.4 BREAST (FEMALE) 1,516 25.1 1,455 25.1 58 36.4 CERVICAL 185 3.4 180 3.5 ^ ~ COLORECTAL 1,174 18.3 1,125 18.2 49 27.5 LUNG & BRONCHUS 3,162 51.1 3,079 51.6 79 47.2 MELANOMA (SKIN) 113 1.9 113 2.0 0 0.0 Note: Rates are per 100,000 persos ad are age-adjusted to the 2000 U.S. stadard populatio. 1 Icludes White, Black ad other races ^ Number of deaths 5 or less ot reported due to cofidetiality issues ~ Number of deaths too small (25 or less) to calculate reliable rate. Source: West Virgiia Health Statistics Ceter 76 America Cacer Society West Virgiia South Atlatic Cacer Facts & Figures 2008

West Virgiia Cacer Stage at Diagosis, Percet of Total Cases, 2001-2005, by Site West Virgiia Female Breast Cacer Stage of Disease at Diagosis, 2001-2005 I Situ Local Regioal Distat Ukow Female, All Races 1 17.5 49.4 24.4 4.2 4.4 Female All Races 0 10 20 30 40 50 60 70 80 90 100 I Situ Local Regioal Distat Ukow/Ustaged West Virgiia Cervical Cacer 2 Stage of Disease at Diagosis, 2001-2005 Local Regioal Distat Ukow Female, All Races 1 48.2 28.1 10.9 12.7 Female All Races 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged West Virgiia Colorectal Cacer 3 Stage of Disease at Diagosis by Sex, 2001-2005 Local Regioal Distat Ukow Male, All Races 1 44.7 31.5 15.3 8.5 Female, All Races 1 44.9 31.6 14.6 8.8 Male All Races Female All Races 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged West Virgiia Maligat Melaoma 2 Stage of Disease at Diagosis, 2001-2005 Local Regioal Distat Ukow All Races 1 76.2 9.8 4.0 10.0 All Races 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged West Virgiia Cacer of the Prostate 2 Stage of Disease at Diagosis, 2001-2005 Local Regioal Distat Ukow Male, All Races 1 76.1 5.6 4.0 14.3 Male All Races 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged Notes: Stages ot reported for lug ad brochus cacer due to uavailability of cost-effective early detectio test. 1 Icludes White, Black ad other races 2 Stages reported for ivasive cervical, melaoma ad prostate cacers oly. 3 I situ ad local stages combied for colorectal cacer Source: West Virgiia Cacer Registry America Cacer Society West Virgiia South Atlatic Cacer Facts & Figures 2008 77

West Virgiia At a Glace Tobacco Tobacco Statistics Tobacco Use i West Virgiia (2007) High school studets who smoke 27.6% Male high school studets who use smokeless or spit tobacco 27.0% (female use much lower) Kids (uder 18) who become ew daily smokers each year 3,200 Kids exposed to secodhad smoke at home 128,000 Packs of cigarettes bought or smoked by kids each year 4.8 millio Adults i West Virgiia who smoke 26.9% (384,500) Deaths i West Virgiia From Smokig Adults who die each year from their ow smokig 3,900 Kids ow uder 18 ad alive i West Virgiia who will ultimately die prematurely from smokig 46,000 Adult osmokers who die each year from exposure to secodhad smoke 200 to 560 Smokig-Caused Moetary Costs i West Virgiia Aual health care costs i West Virgiia directly caused by smokig $690 millio - Portio covered by the state Medicaid program $229 millio Residets state & federal tax burde from smokig-caused govermet expeditures $591 / household Smokig-caused productivity losses i West Virgiia $994 millio Tobacco Idustry Ifluece i West Virgiia Estimated portio spet for West Virgiia marketig each year $132.0 millio Estimated Tobacco Reveue i West Virgiia FY2008 Tobacco Settlemet Reveues $72.9 millio Tobacco Tax Reveues $113.5 millio Total Aual State Reveues from Tobacco $186.4 millio % of Tobacco Reveue Spet o Tobacco Prevetio 3.0% Spedig o Tobacco Prevetio - FY2008 $5.7 millio CDC Recommeded Miimum Spedig o Tobacco Prevetio $38.9 millio % of CDC Recommeded Miimum 40.0% Rak Amog States (1-51) 29 Access to Care Number of Federally Qualified Health Ceters ad free cliics: 34 mai cliics; 153 satellite cliics State fud for Uisured Cacer Patiets: The WV Legislature set up a Catastrophic Illess Commissio i 1999 to provide fuds whe other aveues are exhausted. Uisured Populatio (18+): 20.6% (was 22.2% i 2005) Number of ACoS Approved Hospitals: 11 Number of NCI Cacer Ceters: 0 78 America Cacer Society West Virgiia South Atlatic Cacer Facts & Figures 2008

West Virgiia State Screeig Programs Breast ad Cervical Cacer Screeig: BCCEDP* - Breast ad Cervical Cacer Screeig Program (BCCSP); target populatio: wome 50-64 (wome 40-49 if high risk), uisured or uderisured, uder 200% of Federal Poverty Level. Uique Aspect of BCCSP: Employs regioal Cacer Iformatio Specialists who maage cliet recruitmet ad avigatio i their assigmet areas. BCCSP has CDC fudig for the WISEWOMAN program ehacemet, which provides itegrated cardiovascular screeig ad educatio o utritio, physical activity, ad tobacco use for BCCSP cliets. Colorectal cacer screeig: There is madatory coverage for colorectal cacer screeig, however, there is o statewide screeig program. The Moutais of Hope (MOH) Cacer Coalitio state comprehesive cacer program has a iitiative i cojuctio with Mary Babb Radolph Cacer Ceter that addresses screeig eeds of the uderserved. The WVCCI (West Virgiia Colorectal Cacer Iitiative) seeks to raise awareess ad kowledge amog the public ad health professioals about the critical role screeig plays i prevetio ad early detectio of colo cacer. The WVCCI recetly coducted a assessmet of colorectal cacer screeig capacity i West Virgiia i aticipatio of a statewide screeig program. Prostate cacer screeig: There is o statewide screeig program, but the Moutais of Hope Cacer Coalitio has a iitiative i cojuctio with Mary Babb Radolph Cacer Ceter that addresses screeig eeds of uderserved me. *The Breast ad Cervical Cacer Early Detectio Program (BCCEDP) is a CDC-fuded program i every state admiistered through the Natioal Breast ad Cervical Cacer Early Detectio Program (NBCCEDP). Nutritio ad Physical Activity Physical Activity Iitiatives: Begu as a pilot i 2005, Dace, Dace Revolutio is ow i 160 middle schools i West Virgiia. The video game is a iteractive dace game that burs more calories i 15 miutes tha walkig o a treadmill. Over 25 weeks i 2008, 35 overweight childre betwee ages 7-12 were tracked to gauge a samplig of results. Weight loss was see i those who also had diet modificatios, ad there was weight stall i those who oly used the game but did ot chage their diet habits. Dace will cotiue i the schools ext year. Gov. Joe Machi asked the legislature to provide $350,000 i the 08-09 school budget for games for a health project i state schools. West Virgiia Comprehesive Cacer Program www.wvhpcd.org/ccp West Virgiia has a Comprehesive Cacer Program (WVCCP) at the Bureau for Public Health ad a ovaria cacer iitiative called Reachig Out at the Edwards Comprehesive Cacer Ceter. These programs are fuded by a cooperative agreemet with CDC. The WVCCP coordiates all cacer cotrol efforts i West Virgiia, oversees the Moutais of Hope Cacer Coalitio, tracks implemetatio of the WV Cacer Pla ad educates the public about the early detectio of ovaria cacer. Status of Cacer Cotrol Pla: The West Virgiia Cacer Pla is i its secod year of implemetatio by the Moutais of Hope Coalitio. This Year s Activities: As implemetatio of the WV Cacer Pla is just begiig its secod year of implemetatio, results from year oe are ot yet compiled. This past year s activities cosisted of (1) idetificatio of two key priorities from each sectio of the Pla ad (2) securig several sources of fudig for implemetatio of the cacer pla, icludig $100,000 from the West Virgiia Legislature. Accomplishmets: The West Virgiia Ocology Society was formed i May 2008 Moutais of Hope after a meetig with 26 West Virgiia ocologists ad several other iterested idividuals. Plas are i progress for a West Virgiia Cliical Trials Network. Both of these ew efforts will help i meetig the objectives of the cacer pla. Three mii-grats were awarded to commuity orgaizatios for educatio ad awareess of ovaria cacer amog health professioals ad older wome. Aother mii-grat was awarded to a prostate cacer awareess program called Prime Rib, Prizes ad Your Prostate. America Cacer Society West Virgiia South Atlatic Cacer Facts & Figures 2008 79

Adult Risk Behavior Early Detectio Recet Mammogram*, Wome 40 ad Older, West Virgiia ad U.S., 2006 % West Virgiia % U.S. 40 years ad older 61.9 61.2 40-64 years old 61.5 59.7 65 years ad older 62.7 64.6 White oly, o-hispaic 62.4 61.6 Black oly, o-hispaic /a 62.7 Other race oly, o-hispaic /a 59.3 Hispaic /a 58.7 Low Educatio** 52.2 51.6 Uisured*** 28.3 34.9 * Mammogram withi the past year ** Wome 40 years old ad older with less tha a high school educatio ***Wome 40-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Pap Test*, Wome 18 ad Older, West Virgiia ad U.S., 2006 % West Virgiia % U.S. 18 years ad older 83.3 83.7 18-44 years 86.5 85.1 45-64 years old 85.2 86.6 65 years ad older 68.0 70.8 * A pap test withi the precedig 3 years for wome with itact uteri. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Sigmoidoscopy/Colooscopy*, Adults 50 ad Older, West Virgiia ad U.S., 2006 % West Virgiia % U.S. 50 years ad older 45.8 50.0 50-64 years old 41.5 44.9 65 years ad older 51.4 57.1 Male, 50 years or older 43.8 50.5 Male, 50-64 years old 39.8 45.1 Male, 65 years ad older 49.7 59.5 Female, 50 years ad older 47.6 49.5 Female, 50-64 years old 43.2 44.8 Female, 65 years ad older 52.7 55.4 White oly, o-hispaic 46.1 51.5 Black oly, o-hispaic 0.0 49.3 Other races oly, o-hispaic 0.0 43.9 Hispaic 0.0 38.2 Low Educatio** 40.7 38.8 Uisured*** 20.2 20.9 ** Adults 50 years old ad older with less tha a high school educatio ***Adults 50-64 who reported that they did ot have coverage, icludig health isurace, prepaid plas such as HMOs, or govermet plas such as Medicare. Source: Behavioral Risk Factor Surveillace System, 2006 Recet Prostate-Specific Atige Test*, Me 50 ad Older West Virgiia ad U.S., 2006 % West Virgiia % U.S. 50 years ad older 53.9 53.8 50-64 years old 49.2 48.5 65 years ad older 61.6 63.4 White oly, o-hispaic 54.0 55.6 Black oly, o-hispaic (45+) /a 48.1 Other races oly, o-hispaic /a 44.9 Hispaic /a 43.0 Low Educatio** 38.2 40.3 * Prostate-specific atige test withi the past year for me who reported they were ot told by a doctor, urse, or other health professioal that they had prostate cacer ** Adults 50 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2006 Prevetio Curret Cigarette Smokig*, Adults 18 ad Older, West Virgiia ad U.S., 2007 % West Virgiia % U.S. Total 26.9 19.7 18-24 years old 34.9 24.0 25-34 years old 36.2 23.9 35-44 years old 33.1 20.4 45-54 years old 28.8 22.3 55-64 years old 22.2 18.0 65 years ad older 11.5 9.0 Male 22.0 21.2 Female 21.3 18.4 White oly, o-hispaic 21.9 19.4 Black oly, o-hispaic /a 21.7 Other race oly, o-hispaic /a 18.3 Hispaic /a 16.7 Low Educatio** 35.6 33.2 Female 18-44 34.0 20.6 * Ever smoked 100 cigarettes i lifetime ad are curret smokers (regular ad irregular). ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Physical Activity, Adults 18 ad Older, West Virgiia ad U.S., 2007 No Leisure Time Physical Activity* % West Virgiia % U.S. Total 54.1 50.5 Male 50.0 48.5 Female 57.9 52.5 White oly, o-hispaic 54.5 48.4 Black oly, o-hispaic /a 58.6 Other race oly, o-hispaic /a 51.0 Hispaic /a 55.3 Low Educatio** 66.3 59.8 * Adults with 30+ miutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ miutes three or more days per week. ** Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 80 America Cacer Society West Virgiia South Atlatic Cacer Facts & Figures 2008

Nutritio, Adults 18 ad Older, West Virgiia ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day % West Virgiia % U.S. Total 19.7 24.4 Male 15.1 19.4 Female 24.1 28.8 White oly, o-hispaic 19.1 24.5 Black oly, o-hispaic /a 23.1 Other race oly, o-hispaic /a 26.6 Hispaic /a 22.6 Low Educatio* 12.2 18.4 * Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Overweight*, Adults 18 ad Older, West Virgiia ad U.S., 2007 % West Virgiia % U.S. Total 68.0 63.0 Male 75.1 70.8 Female 61.1 55.4 White oly, o-hispaic 68.6 62.6 Black oly, o-hispaic /a 72.6 Other race oly, o-hispaic /a 51.2 Hispaic /a 66.9 Low Educatio** 68.7 65.7 *Overweight is defied as havig body mass idex of 25 kg/m 2 or greater **Adults 25 years old ad older with less tha a high school educatio Source: Behavioral Risk Factor Surveillace System, 2007 Youth Risk Behavior Tobacco Use, High School Studets, West Virgiia ad U.S., 2007 Curret Cigarette Smokig* % West Virgiia % U.S. Total 27.6 20.0 Male 26.7 21.3 Female 28.4 18.7 Curret Smokeless Tobacco Use** Total 14.8 7.9 Male 27.0 13.4 Female 2.2 2.3 * Smoked cigarettes o 1 or more of the 30 days precedig the survey ** Used chewig tobacco, suff or dip o 1 or more of the 30 days precedig the survey Source: Youth Risk Behavior Surveillace System, 2007 Nutritio, High School Studets, West Virgiia ad U.S., 2007 Eatig 5 or More Fruits ad Vegetables per Day % West Virgiia % U.S. Total 19.8 21.4 Male 21.7 22.9 Female 17.5 19.9 Source: Youth Risk Behavior Surveillace System, 2007 Physical Activity, High School Studets, West Virgiia ad U.S., 2007 Met Curret Physical Activity Level* % West Virgiia % U.S. Total 42.8 34.7 Male 53.1 43.7 Female 31.8 25.6 * Were physically active durig ay kid of physical activity that icreased their heart rate ad made them breathe hard some of the time for a total of at least 60 miutes/day o 5 or more days durig the 7 days before the survey Source: Youth Risk Behavior Surveillace System, 2007 Overweight/Obese High School Studets, West Virgiia ad U.S., 2007 Obese* % West Virgiia % U.S. Total 14.7 13.0 Male 17.6 16.3 Female 11.7 9.6 Overweight** Total 17.0 15.8 Male 15.0 16.4 Female 19.0 15.1 * Obese - At or above the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey ** - Overweight - At or above the 85th percetile but below the 95th percetile for body mass idex, by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey. Source: Youth Risk Behavior Surveillace System, 2007 America Cacer Society West Virgiia South Atlatic Cacer Facts & Figures 2008 81

Colorectal Cacer Screeig Guidelies The America Cacer Society, the America College of Radiology, ad the U.S. Multi-Society Task Force o Colorectal Cacer (a group that comprises represetatives from the America College of Gastroeterology, America Gastroeterological Associatio, ad America Society for Gastroitestial Edoscopy) have released the first-ever joit cosesus guidelies for colorectal cacer screeig. The guidelies, which represet the most curret scietific evidece ad expert opiio available, also outlie quality elemets essetial to each of the recommeded testig methods. Of sigificace i the ew guidelies: two ew tests are added to the list of recommeded optios: stool DNA (sdna) ad CT coloography (CTC), also kow as virtual colooscopy a preferece is stated for screeig tests that ot oly detect cacer early but also detect precacerous polyps, as those tests provide a greater potetial for cacer prevetio through polyp removal. ay proposed colorectal screeig test that has ot bee show i the medical literature to detect the majority of cacers preset at the time of testig should ot be offered to patiets for colorectal cacer screeig. That icludes some types of previously edorsed guiaic-based stool tests. Based o a review of the historic ad recet evidece, the ew recommedatios are: Begiig at age 50, both me ad wome at average risk for developig colorectal cacer should use oe of the screeig tests below. The tests that are desiged to fid both early cacer ad polyps are preferred if these tests are available to you ad you are willig to have oe of these more ivasive tests. Talk to your doctor about which test is best for you. Tests That Detect Adeomatous Polyps ad Cacer flexible sigmoidoscopy every 5 years* colooscopy every 10 years double cotrast barium eema every 5 years* CT coloography (virtual colooscopy) every 5 years* Tests That Primarily Detect Cacer fecal occult blood test (FOBT) every year*,** fecal immuochemical test (FIT) every year*,** stool DNA test (sdna), iterval ucertai* *Colooscopy should be doe if test results are positive. **For FOBT or FIT used as a screeig test, the take-home multiple sample method should be used. A FOBT or FIT doe durig a digital rectal exam i the doctor s office is ot adequate for screeig. I additio, people should talk to their doctor about startig colorectal cacer screeig earlier ad/or beig screeed more ofte if they have ay of the followig colorectal cacer risk factors: a persoal history of colorectal cacer or adeomatous polyps a persoal history of chroic iflammatory bowel disease (Crohs disease or ulcerative colitis) a strog family history of colorectal cacer or polyps (cacer or polyps i a first-degree relative [paret, siblig, or child] youger tha 60 or i 2 or more first-degree relatives of ay age) a kow family history of hereditary colorectal cacer sydromes such as familial adeomatous polyposis (FAP) or hereditary o-polyposis colo cacer (HNPCC) It was the strog opiio of the expert pael that colo cacer prevetio should be the primary goal of colorectal cacer screeig, so the guidelies state a preferece for tests desiged to detect both early cacer ad adeomatous polyps, as log as resources are available ad patiets are willig to udergo a ivasive test. The pael recogized that some patiets will ot wat to udergo a ivasive test that requires a bowel prep, may prefer to have screeig i the privacy of their home, or may ot have access to the ivasive tests due to lack of coverage or local resources, so will opt for stool occult blood or DNA testig, which ca be performed at home, without bowel prep. But the pael said providers ad patiets should uderstad that those tests are less likely to prevet cacer compared with the ivasive tests; they must be repeated at regular itervals to be effective; ad if the test is abormal, a ivasive test (colooscopy) will still be eeded. The full guidelie ca be viewed at http://caolie.amcacersoc.org/. 82 America Cacer Society South Atlatic Cacer Facts & Figures 2008

America Cacer Society Screeig Guidelies For the Early Detectio of Cacer i Asymptomatic People Site Breast Colo & rectum Prostate Uterus Cacer-related checkup Recommedatio Yearly mammograms are recommeded startig at age 40. The age at which screeig should be stopped should be idividualized by cosiderig the potetial risks ad beefits of screeig i the cotext of overall health status ad logevity. Cliical breast exam should be part of a periodic health exam about every 3 years for wome i their 20s ad 30s ad every year for wome 40 ad older. Wome should kow how their breasts ormally feel ad report ay breast chage promptly to their health care providers. Breast self-exam is a optio for wome startig i their 20s. Screeig MRI is recommeded for wome with a approximately 20%-50% or greater lifetime risk of breast cacer, icludig wome with a strog family history of breast or ovaria cacer ad wome who were treated for Hodgki disease. Begiig at age 50, me ad wome at average risk should begi screeig with oe of the examiatio schedules below. Tests that detect adeomatous polyps ad cacer: A flexible sigmoidoscopy every 5 years A colooscopy every 10 years A double-cotrast barium eema every 5 years Computed Tomographic (CT) coloography every 5 years Tests that primarily detect cacer: A guaiac-based fecal occult blood test (gfobt) or fecal immuochemical test (FIT), with high test sesitivity for cacer every year Stool DNA test (iterval ucertai) Idividuals with a persoal or family history of colorectal cacer or adeomas, iflammatory bowel disease, or high-risk geetic sydromes should cotiue to follow the most recet recommedatios for idividuals at icreased or high risk. The PSA test ad the digital rectal examiatio should be offered aually, begiig at age 50, to me who have a life expectacy of at least 10 years. Me at high risk (Africa America me ad me with a strog family history of 1 or more first-degree relatives diagosed with prostate cacer at a early age) should begi testig at age 45. For both me at average risk ad high risk, iformatio should be provided about what is kow ad what is ucertai about the beefits ad limitatios of early detectio ad treatmet of prostate cacer so that they ca make a iformed decisio about testig. Cervix: Screeig should begi approximately 3 years after a woma begis havig vagial itercourse, but o later tha 21 years of age. Screeig should be doe every year with regular Pap tests or every 2 years usig liquidbased tests. At or after age 30, wome who have had 3 ormal test results i a row may get screeed every 2 to 3 years. Alteratively, cervical cacer screeig with HPV DNA testig ad covetioal or liquid-based cytology could be performed every 3 years. However, doctors may suggest a woma get screeed more ofte if she has certai risk factors, such as HIV ifectio or a weak immue system. Wome aged 70 ad older who have had 3 or more cosecutive ormal Pap tests i the last 10 years may choose to stop cervical cacer screeig. Screeig after total hysterectomy (with removal of the cervix) is ot ecessary uless the surgery was doe as a treatmet for cervical cacer. Edometrium: The America Cacer Society recommeds that at the time of meopause all wome should be iformed about risks ad symptoms of edometrial cacer ad strogly ecouraged to report ay uexpected bleedig or spottig to their physicias. Aual screeig for edometrial cacer with edometrial biopsy begiig at age 35 should be offered to wome with or at risk for hereditary opolyposis colo cacer (HNPCC). For idividuals udergoig periodic health examiatios, a cacer-related checkup should iclude health couselig about tobacco, su exposure, diet ad utritio, sexual practices, evirometal ad occupatioal exposures ad depedig o a perso s age ad geder, might iclude examiatios for cacers of the thyroid, oral cavity, ski, lymph odes, testes, ad ovaries, as well as for some omaligat diseases. America Cacer Society guidelies for early cacer detectio are assessed aually i order to idetify whether there is ew scietific evidece sufficiet to warrat a re-evaluatio of curret recommedatios. If evidece is sufficietly compellig to cosider a chage or clarificatio i a curret guidelie or the developmet of a ew guidelie, a formal procedure is iitiated. Guidelies are formally evaluated every 5 years regardless of whether ew evidece suggests a chage i the existig recommedatios. There are 9 steps i this procedure, ad these guidelies for guidelie developmet were formally established to provide a specific methodology for sciece ad expert judgmet to form the uderpiigs of specific statemets ad recommedatios from the Society. These procedures costitute a deliberate process to esure that all Society recommedatios have the same methodological ad evidece-based process at their core. This process also employs a system for ratig stregth ad cosistecy of evidece that is similar to that employed by the Agecy for Heath Care Research ad Quality (AHCRQ) ad the US Prevetive Services Task Force (USPSTF). 2008, America Cacer Society, Ic. America Cacer Society South Atlatic Cacer Facts & Figures 2008 83

Cacer Research The America Cacer Society pursues its goal of elimiatig cacer as a major health problem by fudig the work of qualified researchers at scietific ad medical istitutios across the coutry. The ACS is the largest source of private, ot-for-profit cacer research fuds i the Uited States, secod oly to the federal govermet. Sice the ACS Research Program bega i 1946, the Society has devoted over $3.2 billio to cacer research. By fudig groudbreakig research, the America Cacer Society has cotributed to may importat discoveries that have led to a better uderstadig of cacer ad cacer treatmet. The research program is composed of two mai umbrellas: Extramural Grats ad the Itramural compoets of Epidemiology ad Surveillace Research, the Behavioral Research Ceter (BRC) ad the Statistics ad Evaluatio Ceter (SEC). The extramural program supports ivestigator-iitiated projects takig place i leadig ceters across the coutry ad as well as health professioal traiig grats (HPTGs) awarded to urses, physicias ad ocology social work professioals. Applicatios for grats are subjected to a rigorous exteral peer review which esures that oly the highest quality applicatios receive fudig. The Society is justly proud of the 42 ivestigators who were supported before they wet o to wi the Nobel Prize, cosidered the highest accolade ay scietist ca receive. This is a tribute to the ACS s Research Program ad the stregth of its peer-review process. As importat as ay medal, however, is the cotributio each of these scietists has made toward uderstadig more about cacer ad traslatig that kowledge ito prevetio ad treatmet measures that help patiets ad their families. For more details o the impact that the ACS research program has had: http://www.cacer.org/docroot/res/ RES_7.asp?sitearea=RES As of Jauary, 2008, 111 grats totalig $4,299,500 have bee awarded for research i the South Atlatic Divisio. America Cacer Society Research i the South Atlatic Divisio 1/1/2008 Curret Grats: 111 Totalig: $50,557,202 Curret ACS Research ad Traiig Grats i DISTRICT OF COLUMBIA 10 GRANTS TOTAL $4,299,500 Childre s Natioal Medical Ceter 1 $12,000 Hardesty, Ly L, MSS, LICSW Master s Traiig Grat i Cliical Ocology Social Work ($12,000) George Washigto Uiversity 2 $879,000 Leiteberg, David, MD, PhD CD45 Regulatio of T Lymphocyte Activatio ($699,000) Patiero, Steve, PhD Istitutioal Research Grat* ($180,000) Georgetow Uiversity 6 $3,368,500 Maric, Maja, PhD Disulfide Bod Processig ad the Immue Respose ($543,000) Shields, Peter G, MD Istitutioal Research Grat* ($247,500) Sheppard, Vaessa B, PhD Narrowig the Gap i Breast Adjuvat Therapy for Africa America Wome ($729,000) Taylor, Kathry L, PhD Quality of Life of Log-Term Prostate Cacer Survivors i the PLCO Trial (400,000) Wladma, Todd, MD, PhD Iitiatio ad Effector Mechaisms of a PTEN-Depedet Size Checkpoit ($720,000) Wag, Judy H, PhD Promotig Adherece to Mammography Use i Chiese Wome ($729,000) The Catholic Uiversity of America 1 $40,000 Domigue, Philip M, MSW Cliical Trial of Adapted Emotioally Focused Therapy for Bereaved Parets ($40,000) Curret ACS Research ad Traiig Grats i GEORGIA 16 GRANTS TOTAL $9,369,000 Emory Uiversity 9 $5,204,000 Elrod, Heath Acuff, PhD The Role of COX-2 i Perifosie-iduced Apoptosis ($138,000) Howard, David H, PhD The Impact of Progosis o the Treatmet of Patiets with Localized Tumors ($608,000) Jacob, Joshy, PhD B Cell Memory ($720,000) * Istitutioal Research Grat is a block grat awarded to a istitutio. The istitutio establishes its ow review board to award smaller grats to its juior ivestigators. 84 America Cacer Society South Atlatic Cacer Facts & Figures 2008

Curret ACS Research ad Traiig Grats i GEORGIA, Cotiued Kersh, Gilbert J, PhD Regulatio of T Cell Fate ($720,000) Ly, Hih, PhD Telomerase Dysfuctio i Aplastic Aemia ad Myelodysplastic Sydromes ($720,000) Marcus, Adam, PhD Ivestigatig the Role of LKB1i Cacer Cell Polarity ($720,000) McCabe, Michael T, PhD Local Features Affectig DeNovo Methylatio of CpG Islads i Cacer ($138,000) Wei Zhou, PhD Disease Progressio i Patiets with 8p Allelic Imbalace Prostate Tumors ($720,000) Ye, Keqiag, PhD Dissectio of the Nuclear GTPase PIKE Sigalig ($720,000) Georgia State Uiversity 1 $780,000 Kig, Tricia, PhD Childhood Brai Tumor Survivors: Predictors of Adult Fuctioal Outcomes ($780,000) Medical College of Georgia 2 $1,440,00 Browig, Darre D, PhD The Role of G-Kiase i Tumor Progressio ($720,000) Du, Quasheg, PhD Iteractio betwee Astra Microtubules ad the Cell Cortex ($720,000) Uiversity of Georgia 3 $1,645,000 Abbott, Kare L, PhD Idetificatio of Glycoprotei Biomarkers of Breast Carcioma ($138,000) Douga, Scott T, PhD The Role of Nodal-Related Gees i Embryoic Developmet ($707,000) Zhao, Shayig, PhD Idetificatio of Boa Fide Colorectal Tumorigeesis Evets ad Gees ($800,000) Morehouse School of Medicie 1 $300,000 Taylor, Beverly D, MD Physicia Traiig Award i Prevetive Medicie ($300,000) Curret ACS Research ad Traiig Grats i MARYLAND 33 GRANTS TOTAL $12,745,000 Johs Hopkis Hospital 1 $717,000 Xig, Michael M, PhD Cliical Use of Gee Mutatio ad Methylatio Markers i Thyroid Cacer ($717,000) Johs Hopkis Uiversity 18 $9,475,000 Brovitz-Palmer, Sallie, BSN Masters Degree Scholarship i Cacer Nursig ($20,000) Casero, Robert A, PhD Istitutioal Research Grat* ($240,000) Clegg Smith, Catherie M, PhD The Relatioship Betwee Media Advocacy ad Tobacco Attitudes ad Use ($434,000) Dikova-Kostova, Albea T, PhD Protectio agaist Ski Cacer by Phase 2 Ezyme Iductio ($720,000) Emes, Leisha, MD, PhD Maipulatig Immuoregulatory Pathways to Maximize Breast Cacer Immuity ($720,000) Grote, Eric, PhD Cell Fusio of Matig Yeast ($720,000) Hedrickso, Tamara, PhD GPI Membrae Achorig: Substrate Specificity ad Tumorigeicity ($720,000) Hristova, Kalia, PhD Role of FGFR3 Trasmembrae Domai i Cacer ($645,000) Hug, Chie-fu, PhD Cotrol of Ovaria Cacer by Immuotherapy ($720,000) Kirk, Gregory D, MD, MPH, PhD Novel Approaches for Idetifyig Hepatitis C Progressio to Liver Cacer ($729,000) Mohammad, Helai P, PhD The Role of CBX7 i Tumor Suppressor Gee Silecig ($138,000) Pomeratz, Joel L, PhD Fuctio of CARD11 i T Cell Receptor Sigalig ($720,000) Powell, Joatha D, MD, PhD De Novo Methylatio as a Meas of Promotig Tumor-iduced T cell Tolerace ($720,000) Robiso, Douglas N, PhD Ivestigatio ito Mechaical Feedback Regulatio of Cytokiesis ($720,000) Ruble, Kathy J, BSN, MSN, PNP Musculoskeletal Outcomes after Childhood Boe Marrow Trasplat ($30,000) Shag, Jigjig, MSN Fatigue-Reducig Strategies ad Ifluecig Factors i Cacer Survivors ($30,000) Syder, Claire, PhD Usig Patiet-Reported Outcomes Assessmet to Improve the Quality of Care ($729,000) Umbricht, Christopher B, MD, PhD Geetic ad Epigeetic Aalysis of Thyroid Cacer ($720,000) Marylad Biotechology Istitute 1 $538,000 Wuyua Lu, PhD Mirror Image Phage Display Targetig Survivi (538,000) Cotiued * Istitutioal Research Grat is a block grat awarded to a istitutio. The istitutio establishes its ow review board to award smaller grats to its juior ivestigators. America Cacer Society South Atlatic Cacer Facts & Figures 2008 85

Curret ACS Research ad Traiig Grats i MARYLAND, CONTINUED NIH/Natioal Cacer Istitute 1 $138,000 Yatrik M Shah, PhD Mechaisms for Species Differece to Fibrate-Iduced Liver Tumors ($138,000) Uiversity of Marylad, Baltimore 12 $1,877,000 Beckma, Tammy, BSN Masters Degree Scholarship i Cacer Nursig ($20,000) Broge, Kristie M, BSN Masters Degree Scholarship i Cacer Nursig ($10,000) Frakehauser, Ted R, BSN Masters Degree Scholarship i Cacer Nursig ($20,000) Haisfield-Wolfe, Mary Elle, BSN, MS, RN, OCN Ucertaity ad First Lie Treatmet for Head ad Neck Cacer Patiets ($30,000) Mai, Volker, PhD, MPH Diet, Microflora ad Colorectal Carciogeesis i Africa Americas ($727,000) Nguye, Phuog, BSN, BA Masters Degree Scholarship i Cacer Nursig ($20,000) Parker, Kare L., MSW Social Workers ad Smokig Cessatio Couselig ($40,000) Staies, Carrie A., BSN Masters Degree Scholarship i Cacer Nursig ($20,000) Taer, Alicia, BSN Masters Degree Scholarship i Cacer Nursig ($20,000) Tomkiso, Ala, PhD Istitutioal Research Grat* ($220,000) Wilso, Gerald M, PhD The Role of Tristetraproli i Tumor Cell Progressio ($720,000) Woolery, Myra, MN Costipatio i the Pediatric Ocology Patiet ($30,000) Curret ACS Research ad Traiig Grats i NORTH CAROLINA 39 GRANTS TOTAL $17,530,702 Duke Uiversity 3 $296,000 Briegar, Agela M, BSN Masters Degree Scholarship i Cacer Nursig ($20,000) Cushma, Ia, PhD Role of Icmt-Catalyzed Methylatio i Rho Sigalig ad Cacer ($138,000) Thomeius, Michael J, PhD Scythe Regulatio of Apoptosis i Vertebrates ad Ivertebrates ($138,000) Duke Uiversity Medical Ceter 5 $3,065,000 Berchuck, Adrew, MD Barbara Thomaso Ovaria Cacer Professorship ($500,000) Koh, James, PhD Chromati Immuoprecipitatio Through the Retioblastoma Tumor Suppressor ($756,000) Lyerly, Herbert K, MD Istitutioal Research Grat* ($360,000) Potti, Ail, MD A Geomic Approach to Targeted Therapy i Lug Carcioma ($729,000) York, Sally, MD, PhD The Role of DNA Mismatch Repair i Respose to 5-Fluorouracil ($720,000) Research Triagle Istitute 1 $156,000 Subramaia, Sujha, PhD Impact of Medicaid Copaymet Policies o Access to Quality Cacer Treatmet ($156,000) Uiversity of North Carolia, Chapel Hill 24 $10,818,702 Brewer, Noel T, PhD Geomic Testig to Select a Optimal Breast Cacer Treatmet ($684,000) Cheever, Matthew L, PhD R7-RGS Proteis: Essetial Compoets i Heterotrimeric G Protei Sigalig ($138,000) Cook, Jeaette G, PhD Cotrol of Prereplicatio Complexes i Mammalia Cells ($688,000) Cykert, Samuel, MD Lug Cacer Surgery: Aatomy of Decisios agaist Life Savig Care ($1,733,000) Doughma, Reee PhD Characterizatio of Slit-Robo GTPase Activatig Protei 2 i Tumorigeesis ($138,000) Duroio, Robert J, PhD Geetic Aalysis of SCF E3 Ubiquiti Ligase Fuctio i Drosophila ($720,000) Healy, Kevi D, PhD DLC-1 Tumor Suppressio, Aberrat Rho GTPase Activatio, ad Lug Cacer ($138,000) Huggis, Bruce W, PhD HTLV-1 Geomic RNA Dimer Structure ad Fuctio ($138,000) Karpiich, Natalie, PhD Role of PTEN i Astrocytoma Suppressio ($138,000) Liu, Rihe, PhD Novel Calmoduli-bidig Proteis i Regulatig Ubiquiti-Proteasome System ($720,000) Maresca, Thomas J, PhD Idetifyig Novel Spidle Assembly Checkpoit Compoets ad Mechaisms ($138,000) Porterfield, Deborah S, MD, MPH- Physicia Traiig Award i Prevetive Medicie PTAPM-01-085-05 TRAINEE: Arroyave, Aa Maria, MD, MPH ($300,000) Porterfield, Deborah S, MD, MPH Physicia Traiig Award i Prevetive Medicie PTAPM-01-085-09 ($300,000) * Istitutioal Research Grat is a block grat awarded to a istitutio. The istitutio establishes its ow review board to award smaller grats to its juior ivestigators. 86 America Cacer Society South Atlatic Cacer Facts & Figures 2008

Curret ACS Research ad Traiig Grats i NORTH CAROLINA, Cotiued Rusa, Nasser M, PhD Neural Stem Cells: Mitotic-spidle ad Cotractile Rig Positioig ($138,000) Satia, Jessie, PhD, MPH Logitudial Study of White ad Africa America Colo Cacer Survivors ($1,465,000) Schroeder, Jae C, DVM, PhD Health Care Access ad Prostate Cacer Treatmet i North Carolia: HCaP-NC ($926,000) Sekelsky, Jeff, PhD Drosophila Blm i Double-strad Break Repair ($720,000) Spector, Deise J, BSN, MSN, MPH Breast Cacer Risk Perceptio ad Lifestyle Factors i Wome at High Risk ($30,000) Thomso, Joh Michael, PhD The Role of MicroRNAs i Tumorigeesis ($138,000) Vigil, Domiico, PhD Role of the Ral Guaie Nucleotide Exchage Factors i Pacreatic Cacer ($138,000) Yakaskas, Boie C, PhD Assessig ad Improvig Radiologists Mammography Iterpretive Skills ($143,902) Yakaskas, Boie C, PhD Evaluatio of False Positive Mammography i Commuity Practice ($208,800) Zawistowski, Jo, PhD Spatio-Temporal Cotrol of MAP Kiase Activatio by Scaffold Proteis ($138,000) Zhag, Yapig, PhD Cellular Fuctios ad Biochemical Mechaisms of ARF ($800,000) Wake Forest Uiversity 6 $3,195,000 Dubey, Purima, PhD Effector T Cell Fuctio i Adroge-idepedet Prostate Cacer ($720,000) Foley, Kristie L, PhD Colo Cacer Treatmet, Surveillace, ad Survival amog the Poor ($274,000) Hollis, Thomas, PhD Structural Biology of DNA Repair Proteis ($720,000) Ioue, Kazushi, MD, PhD Roles of Dmp1 i the Prevetio of HER2/eu-iduced Breast Cacer ($850,000) Miller, David P, MD Overcomig Literacy Barriers i Colorectal Cacer Screeig ($195,000) Petty, W Jeffrey, MD Retioic Acid Receptor Beta 1 : B99A Target for Lug Cacer Chemoprevetio ($436,000) Curret ACS Research ad Traiig Grats i SOUTH CAROLINA 4 GRANTS TOTAL $2,124,000 Medical Uiversity of South Carolia 2 $693,000 Chavi, Keeth D, MD, PhD Effects of Obesity o Musculocutaeous Flaps Used for Breast Recostructio ($333,000) Reed, Caroly E, MD Istitutioal Research Grat* ($360,000) Uiversity of South Carolia 2 $1,431,000 Dixo, Da A, PhD Post-Trascriptioal Targetig COX-2 Gee Expressio i Colorectal Cacer ($711,000) Pittma, Douglas L,A168 PhD Uderstadig the Roles of RAD51-Related Gees i Cacer Iitiatio ($720,000) Curret ACS Research ad Traiig Grats i VIRGINIA 7 GRANTS $3,049,000 Uiversity of Virgiia 4 $2,001,000 Bauer, Todd W, MD Role of upar Sigalig i Pacreatic Cacer Growth, Ivasio ad Metastasis ($729,000) Beder, Timothy P, PhD Istitutioal Research Grat* ($360,000) Erickso, Lore D, PhD Targetig Plasma Cell Precursors as the Multiple Myeloma Stem Cell ($717,000) Strayer, Scott M, MD, MPH A Itervetio to Improve Smokig Cessatio Couselig by Medical Studets ($195,000) Uiversity of Virgiia Health System 1 $138,000 Elliott, Michael R, PhD The Role of ELMO1 i Apoptotic Cell Egulfmet I Vivo ($138,000) Virgiia Commowealth Uiversity 2 $910,000 Gewitz, David A, PhD Istitutioal Research Grat* ($270,000) Hart, Alto, MD, MPH A Decisio Makig Tool for Prostate Cacer Screeig ($640,000) Curret ACS Research ad Traiig Grats i WEST VIRGINIA 2 GRANT TOTAL $1,440,000 West Virgiia Uiversity 2 $1,440,00 Jiag, Big-Hua, PhD Role of P13K Sigalig i Ovaria Tumorigeesis ($720,000) Liu, Ju, MD, PhD The Role of Caveoli i Edothelial Cell Migratio ($720,000) * Istitutioal Research Grat is a block grat awarded to a istitutio. The istitutio establishes its ow review board to award smaller grats to its juior ivestigators. America Cacer Society South Atlatic Cacer Facts & Figures 2008 87

Data Sources & Techical Notes Demographic Data Demographic data describe the populatio distributio withi a commuity. These data iclude age, race, icome, educatio, as well as a host of other variables that describe the socioecoomic ad cultural compositio of a commuity. Demographic data are helpful i idetifyig populatios most at risk for cacer i order to better target cacer cotrol efforts. We must, however, esure that itervetios utilize messages ad huma resources reflective of the racial ad cultural make-up of the commuity. Populatio data are obtaied from the U.S. Cesus Bureau ad Claritas. 9 Cacer Icidece ad Mortality Data Cacer icidece data are cases that are ewly-diagosed durig a specific time period; 2001-2005 i this issue, uless otherwise oted. Data o aual cacer icidece couts ca be helpful, for example, i plaig a particular survivorship program. Deaths due to cacer durig a specific time period are referred to as cacer mortality. Couts of cacer deaths ca also be used to describe the cacer burde i a commuity. Comparig the umber of ew cacer cases/deaths from year to year is ot recommeded because populatio demographics chage over time. Further, it is difficult to compare cacer patters across two or more regios i the same year because of potetial differeces i populatio characteristics. Therefore, age-adjusted rates, which accout for populatio differeces, are used to track year-to-year chages i the cacer burde. Both icidece ad mortality rates are age-adjusted to the 2000 U.S. stadard populatio to allow for comparisos across populatios with differet age distributios. Age-adjusted cacer icidece rates are the umber of people per 100,000 who are diagosed with cacer durig a give time period, 2001-2005 uless otherwise oted. Age-adjusted cacer icidece rates are adjusted as oted above for the age distributio of the populatio. Cacer mortality rates are defied as the umber of people per 100,000 who die ad have cacer listed as the uderlyig cause of death o their death certificate. Age-adjusted cacer mortality rates, like age-adjusted icidece rates, accout for populatio differeces ad should be used whe comparig cacer mortality patters from differet populatios. These mortality data also cover 2001-2005 uless otherwise oted. Couts of cacer cases ad deaths are preseted as total couts for the 5-year period 2001-2005 uless otherwise oted. For a average aual cout, divide the 5-year cout by five. For the couty- ad ward-specific cacer data, certai restrictios apply to the presetatio of the cacer case/death couts ad rates. I order to maitai privacy of idividuals, the umber of cases/deaths is ot icluded for categories i which the cout is less tha six. Also, to avoid variatio i data due to small umbers, icidece ad mortality rates are oly prseted 88 if the case/death cout exceeds 25. Exceptios to these restrictios are oted where applicable. Statistical sigificace is tested o the idividual couty/ward age-adjusted icidece ad mortality rates to determie whether or ot the rate is statistically sigificatly differet from the overall state rate. If a icidece or mortality rate is statistically sigificatly lower tha the state rate, this is idicated by a < placed ext to the rate ad if a rate is sigificatly higher tha the state rate, a > is ext to that rate. Statistical sigificace is oly tested i case/death categories whe the cout exceeds 25. A statistically sigificatly higher or lower rate does ot ecessarily mea that the differece is biologically or cliically importat or of special ote. These differeces could have occurred by chace aloe sice we are makig multiple comparisos. Stage at Time of Cacer Diagosis idicates whether or ot the cacer has spread to other orgas ad regios of the body. Also, stage at diagosis is oe of the tumor characteristics that the ocologist uses to select a treatmet for the patiet. Summary categories for stage at diagosis are as follows: I Situ refers to a eoplasm that is oivasive ad cofied to a small area withi the tissue of origi; Localized is a ivasive maligat cacer cofied etirely to the orga of origi; Regioal is a maligat cacer that 1) exteds beyod the limits of the orga of origi ito surroudig orgas/tissues or 2) ivolves regioal lymph odes by way of lymphatic system; ad Distat idicates that the cacer has spread to other parts of the body, such as the lugs, liver, brai or to distat lymph odes. Estimates of New Cacer Cases ad Deaths for 2008 are provided by the America Cacer Society s Surveillace Research Departmet. 2 Begiig i 2007, estimated ew cacer cases were computed usig a ew, more accurate method developed by re- America Cacer Society South Atlatic Cacer Facts & Figures 2008

searchers at the Natioal Cacer Istitute ad the America Cacer Society. Improvemets i the ew model iclude use of data from a much larger percetage of the US populatio, allowace for geographical variatio i cacer icidece, adjustmet for delays i reportig ad the iclusio of may socio-demographic, medical facility, lifestyle ad cacer screeig behavior variables. For more detail, visit www.cacer.org/docroot/stt/stt_0.asp State ad couty cacer icidece ad mortality data are provided by the State Cacer Registries i the South Atlatic (SA) Divisio. I most SA states, mortality data are also provided by the State Cacer Registry, but i Marylad, Virgiia ad West Virgiia, these data are provided by the State Vital Statistics Departmets. Cotact iformatio for these state registries ad vital statistics offices is o page 87. Data o U.S. cacer icidece, mortality ad survival are from the Surveillace, Epidemiology ad Ed Results (SEER) Program. 7 Prevetio ad Early Detectio - Risk Factor Data Thirty percet of cacer deaths, icludig early 90% of lug cacer deaths, are the result of tobacco use. 3 Although tobacco use, primarily cigarette smokig, has bee associated most strogly with cacers of the lug, brochus ad other respiratory orgas, it also icreases risks of cacers of the pacreas, cervix, kidey, bladder ad stomach, ad acute myeloid leukemia. Utilizig tobacco prevalece data to idetify differeces betwee geder, race/ethicity, age ad educatioal status will help focus comprehesive efforts to decrease cosumptio of tobacco products i specific populatios. Idetificatio of populatios with high smokig rates will also help target areas where policies ad ordiaces regardig clea idoor air are still eeded. Eatig a healthy diet, egagig i physical activity ad maitaiig a healthy weight are additioal lifestyle factors that help reduce the risk of developig cacer. The prevalece of each of these modifiable risk behaviors amog both adults ad youth is reported here as a importat measure of each state s cacer burde. It is estimated that obtaiig recommeded cacer screeig tests ad adoptig healthy behaviors such as good utritio, reasoable body weight ad regular physical exercise could elimiate at least 50% of cacer deaths. 2 Adult Risk Factor Data: The BRFSS is a survey of the Ceters for Disease Cotrol ad Prevetio (CDC), Natioal Ceter for Chroic Disease Prevetio ad Health Promotio (NCCDPHP) ad the US states ad territories. Data are gathered through computer-assisted telephoe iterviews with adults ages 18 ad older who live i a household i a state or US territory. BRFSS data are reported o a aual basis although ot all questios are asked aually. Screeig data are from the 2006 BRFSS Survey ad risk factor data are from the 2007 survey. 5 Youth Risk Factor Data: The YRBSS is a state-based survey of the CDC ad NCCDPHP i volutary collaboratio with states. The survey is desiged to provide state ad local prevalece estimates o health risk behaviors, such as tobacco use, uhealthy dietary behaviors ad physical iactivity, amog youth who atted public high schools. The YRBSS is a bieial survey coducted i odd-umbered years ad data preseted here are from the 2007 survey. Not all states participate i the YRBSS. 11 Youth Tobacco Data (Virgiia): The Youth Tobacco Survey (YTS), also developed by the CDC, icludes iteratioal, atioal ad state school-based surveys of middle school ad high school studets. The YTS ad YRBSS use idetical samplig methods ad the same wordig for questios about tobacco use to eable states to use the high school data o tobacco use collected by both surveys. Not all states participate i the YTS. 11 Risk factor data selected for this publicatio are related to specific recommedatios i the Society s guidelies o Nutritio ad Physical Activity for Cacer Prevetio as follows: 2 Tobacco Use: ACS Recommedatio: Do ot use ay tobacco products. BRFSS Questio: Adults who are curret smokers. YRBSS Questios: High school studets who (1) have smoked cigarettes at least oe day durig the last 30 days, (2) have used chewig tobacco, suff or dip o at least 1 day durig the 30 days before the survey. Physical activity: ACS Recommedatio: Egage i at least 30 miutes of moderate to vigorous physical activity, above usual activities, o 5 or more days of the week; 45 to 60 miutes of itetioal physical activity are preferable. Risk factor data used i the South Atlatic Divisio Cacer Facts & Figures 2008 were obtaied from surveys coducted by the Behavioral Risk Factor Surveillace System (BRFSS), the Youth Risk Behavior Surveillace System (YRBSS) ad the Youth Tobacco Survey (YTS) for studets i high school. A descriptio of the data sources as well as a summary of the risk factor determiats is provided below. BRFSS Questio: Adults with 30+ miutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ miutes three or more days per week. YRBSS Questio: High school studets who were physically active durig ay kid of physical activity that icreased their heart rate ad made them breathe hard some of the time, for a total of at least 60 miutes/day o 5 or more days durig the 7 days before the survey. Cotiued America Cacer Society South Atlatic Cacer Facts & Figures 2008 89

Nutritio: ACS Recommedatio: Eat 5 or more servigs of a variety of vegetables ad fruits every day. BRFSS Questio: Adults who have cosumed fruits ad vegetables 5 or more times per day. YRBSS Questio: High school studets who have cosumed 5 or more fruits ad vegetables per day. Overweight: ACS Recommedatios: (1) Avoid excessive weight gai throughout life, (2) Achieve ad maitai a healthy weight if curretly overweight or obese. BRFSS Questio: Weight classificatio by Body Mass Idex (BMI) that is overweight (BMI = 25 -< 30) or obese (BMI >= 30.0). YRBSS Questio: High school studets who were at or above the 85th percetile but below the 95th percetile for body mass idex (overweight) or above the 95th percetile (obese), by age ad sex, based o referece data from the Natioal Health ad Nutritio Examiatio Survey. Each state sectio also icludes a two-page At A Glace report that summarizes state-specific iitiatives o tobacco cotrol 10, cacer screeig 6, comprehesive cacer cotrol efforts 8, improved access to care 3 ad other achievemets 4. Special State Notes Notes o Marylad Cacer Registry Data Icidece data for 2004 ad 2005 from the Marylad Cacer Registry have bee suppressed sice these data are udergoig a data quality review ad were uavailable at time of publicatio. Marylad state ad couty icidece data are icluded up to 2003, or for multiple years 1999-2003. Stage at diagosis data are also available for 1999-2003. Notes o Virgiia Cacer Registry Data Data i the Virgiia Cacer Registry (VCR) reflect a coservative accout of the disease. Not all outpatiet facilities ad private pathology laboratories report cases to the registry yet. Virgiia residets sometimes travel out-of-state for diagosis ad treatmet ad may ot be reported to the VCR. While the registry does maitai exchage agreemets with cacer registries i eighborig states, there is some lag time i postig those cases. Cacer data for areas primarily i Southwest Virgiia may be uder-reported; iterpret these data carefully. Because the completeess of reportig varies i differet areas of the state, some observed differeces i case couts or rates are most likely reportig artifacts. For istace, rates may be higher i more urbaized areas because case ascertaimet is more complete. Similarly, case reportig may be more complete for certai racial groups, cacer sites, or diagosis stages. Cacer registry staff have ot bee able to assess the extet to which these biases exist, so iterpret the data with cautio. Data Sources 1. America Cacer Society, Cacer Facts & Figures 2008. Atlata, GA 2008 2. America Cacer Society, Cacer Prevetio & Early Detectio Facts ad Figures 2008. Atlata, GA 2008 3. Access to Care: Health Resources ad Services Admiistratio s Bureau of Health Professioals, 2005 Uite for Sight, Ic., 2008 (Federally Qualified Health Ceter ad free cliic Iformatio) http://uiteforsight.org/freecliics.php 4. ACoS Approved Hospitals: http://web.facs.org/cpm/default.htm 5. Adult Risk Factor Data: Behavioral Risk Factor Surveillace System Survey Data (BRFSS). Atlata, Georgia: U.S. Departmet of Health ad Huma Services, Ceters for Disease Cotrol ad Prevetio, 2007, 2008, www.cdc.gov/brfss 6. BCCEDP, 2004 Isurace Coverage Data: Natioal Cacer Istitute: State Cacer Legislative Database, 2008 7. Cacer Data (U.S): SEER Cacer Statistics Review, 1975-2005, Ries LAG, Melbert D, Krapcho M, Stichcomb DG, Howlader N, Horer MJ, Mariotto A, Miller BA, Feuer EJ, Altekruse SF, Lewis DR, Clegg L, Eiser MP, Reichma M, Edwards BK (eds). Natioal Cacer Istitute. Bethesda, MD, http://seer.cacer.gov/csr/1975_2005/, based o November 2007 SEER data submissio, posted to the SEER web site, 2008, www.seer. cacer.gov 8. Comprehesive Cacer Cotrol: Natioal Comprehesive Cacer Cotrol Program (NCCCP), Divisio of Cacer Protectio ad Cotrol, Ceters for Disease Cotrol ad Prevetio, www.cdc.gov/cacer/cccp/ 9. Demographic Data: Claritas Ic., Copyright 2007 Thomso Healthcare. ALL RIGHTS RESERVED America Fact Fider, U.S. Cesus Bureau: http://factfider.cesus.gov/ 10. Tobacco: Americas For Nosmokers Rights Foudatio, 2008 (www.o-smoke.org) State Medicaid Tobacco Depedece Treatmet Survey 2005, (MMWR (2006) 55(44):1194-1197) Cigarette Excise Tax as of 7/01/2008: www.tobaccofreekids.org/research/factsheets/pdf/0097.pdf Ceters for Disease Cotrol ad Prevetio (CDC). Reducig the Health Cosequeces of Smokig: 25 Years of Progress, Atlata, GA. U.S. Departmet of Health ad Huma Services, 1989. State Tobacco Prevetio Spedig vs. State Tobacco Reveues (April 2008): www.tobaccofreekids.org/reports/settlemets/2008/spedigreveues.pdf. 11. Youth Risk Data: Youth Tobacco Survey (YTS), 2005 VA ad Youth Risk Behavior Surveillace System (YRBSS), 2007 for DE, DC, GA, MD, NC, SC, WV, Ceters for Disease Cotrol ad Prevetio 2008, www.cdc.gov/yrbss. 90 America Cacer Society South Atlatic Cacer Facts & Figures 2008

State Cacer Registries & Vital Statistics DELAWARE Aliso Shevock, PhD, Cacer Epidemiologist Delaware Chroic Disease Bureau 540 South DuPot Highway, Suite 10 Dover, DE 19901 Phoe: (302) 744-1036 http://www.dhss.delaware.gov/dhss/dph/dpc/registry.html DISTRICT OF COLUMBIA Aaro Adade, PhD, Director District of Columbia Cacer Registry 825 N. Capitol, NE Washigto, DC 20002 Phoe: (202) 442-5910 http://doh.dc.gov/doh/ uder Special Programs/Cacer Cotrol Registry GEORGIA Raa Bayakly, MPH, Director Georgia Comprehesive Cacer Registry 2 Peachtree St, NW, Suite 14.283 Atlata, GA 30303 Phoe: (404) 657-1943 http://health.state.ga.us/programs/gccr/ MARYLAND Kimberly Ster, MHA, CTR, Director Marylad Cacer Registry Marylad Dept of Health & Metal Hygiee 201 West Presto Street Baltimore, MD 21201 Phoe: (410) 767-5521 http://www.fha.state.md.us/cacer/registry/ Hal Sommers, MA, Research Statisticia Marylad Vital Statistics Admiistratio Marylad Dept of Health & Metal Hygiee 201 West Presto Street, Room 425 Baltimore, MD 21201 Phoe: (410) 767-5937 http://www.vsa.state.md.us/ NORTH CAROLINA Kare Kight, MS, Director North Carolia Cetral Cacer Registry 1908 Mail Service Ceter Raleigh, NC 27699-1908 Phoe: (919) 715-4556 http://www.schs.state.c.us/schs/ccr/ SOUTH CAROLINA Susa Bolick-Aldrich, MSPH, CTR, Director South Carolia Cetral Cacer Registry SC Dept of Health & Evirometal Cotrol 810 Dutch Square Blvd, Suite 220 Columbia, SC 29210 Phoe: (803) 731-1419, x107 http://www.scdhec.gov/co/phsis/biostatistics/scccr/scccrmai.htm VIRGINIA Jim Marti, PhD, Director Virgiia Cacer Registry Virgiia Departmet of Health 109 Goveror Street, 10th Floor Richmod, VA 23219 Phoe: (804) 864-7865 http://www.vahealth.org/cdpc/cacer/idex.asp Calvi Reyolds, Director Divisio of Health Statistics Virgiia Departmet of Health 1601 Willow Law Drive, Ste 237 Richmod, VA 23230 Phoe: (804) 662-6276 http://www.vdh.virgiia.gov/healthstats/ WEST VIRGINIA Patricia Colsher, PhD, Director West Virgiia Cacer Registry WV Dept of Health & Huma Resources 350 Capitol Street, Room 125 Charlesto, WV 25301 Phoe: (304) 558-6421 http://www.wvdhhr.org/idep/cacer.htm Daiel Christy, MPA, Director WV Health Statistics Ceter 350 Capitol Street, Room 165 Charlesto, WV 25301 Phoe: (304) 558-9100 http://www.wvdhhr.org/bph/oehp/vital04/ America Cacer Society South Atlatic Cacer Facts & Figures 2008 91

America Cacer Society South Atlatic Divisio Offices Atlata Headquarters PO Box 56567 250 Williams Street Atlata, GA 30343 404-816-7800 Regio 1 PO Box 56566 250 Williams Street Atlata, GA 30343 404-315-1123 Regio 2 323 Pie Aveue, Suite 100 Albay, GA 31701 229-446-1073 Regio 10 1875 Coecticut Ave, NW, Suite 730 Washigto, DC 20009 202-483-2600 Regio 11 White Marsh Headquarters 8219 Tow Ceter Drive Baltimore, MD 21236 410-931-6850 Regio 12 92 Read s Way, Suite 205 New Castle, DE 19720 302-324-4227 Regio 3 5900 Core Road, Suite 504 North Charlesto, SC 29406 843-744-1922 Regio 4 8300 Health Park, Suite 10 Raleigh, NC 27615 919-334-5218 Regio 5 6000 Fairview Road, Suite 200 Charlotte, NC 28210 704-552-6147 Regio 6 4240 Park Place Court Gle Alle, VA 23060 804-527-3700 Regio 7 4416 Expressway Drive Virgiia Beach, VA 23452 757-493-7940 Regio 8 301 RHL Blvd, Suite 6 & 7 Charlesto, WV 25309 304-746-9950 Regio 9 2840 Electric Road, Suite 106A Roaoke, VA 24018 540-774-2716 92 America Cacer Society South Atlatic Cacer Facts & Figures 2008

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Havig cacer is hard. Fidig help should t be. The America Cacer Society ca help. 1.800.ACS.2345 1-800-227-2345 www.cacer.org Hope.Progress.Aswers. South Atlatic Divisio, Ic. 2008, America Cacer Society South Atlatic Divisio, Ic. All Rights Reserved. 9/08 15-102