CANCER of TRACHEA, BRONCHUS, LUNG, PLEURA

CANCER of TRACHEA, BRONCHUS, LUNG, PLEURA Data Highlights There were 9,888 cases of cancer of the trachea, bronchus, lung and pleura diagnosed among Pennsylvania residents in 1995, the highest annual number ever recorded by the Pennsylvania Cancer Registry. The 1995 age-adjusted incidence rate was 85.4 per 100,000 for males and 41.3 for females. National Cancer Institute SEER rates (for invasive lung and bronchus cases) for 1994 (the latest available year of U.S. data) were lower for males (73.9) but similar for females (42.4). In Pennsylvania, the average annual (1991-95) age-adjusted incidence rate for black males was 122.2, almost 52 percent higher than the corresponding rate of 80.6 for white males. This major cancer site accounted for the second largest number of cancer cases among males (6,028) and females (3,860) in 1995. The annual age-adjusted incidence rates for males of both races from 1986 through 1995 remained fairly stable. However, the annual numbers and rates for both white and black females have been on the increase. Black males had the highest average annual (1991-95) incidence rates for nearly every age group. Almost 72 percent of all cancers of the trachea, bronchus, lung and pleura reported for 1995 were diagnosed at the regional or distant stages of the disease. Because lung cancer is very difficult to detect early, survival is poor, and mortality rates in the population approach the incidence rates. The 1991-95 average annual age-adjusted death rate was 48.2, compared to 57.9 for the corresponding incidence rate. In 1995, almost one third of all cancer deaths in males were from lung cancer (4,941) while the proportion was almost 22 percent (3,176) in females, making this site the leading cause of cancer mortality in 1995. These numbers also made this site responsible for both the most male and female deaths due to cancer in 1995. Cigarette smoking accounted for about 85 percent of these deaths. The annual age-adjusted mortality rates from 1986 to 1995 showed increases among females of both races and declines among males of both races. FIGURE 9 Average Annual Age-Adjusted Incidence and Mortality Rates* by Sex and Race, Pennsylvania Residents, 1991-1995 Incidence Mortality Race/Sex All Cases/Deaths All Males All Females 57.9 48.2 39.1 31.7 37.8 30.5 54.2 47.4 83.5 71.2 80.6 68.7 109.9 122.2 Risk Factors Cigarette, cigar and pipe smoking. Diet low in vitamin A is suggestive. Family history of cancers of the trachea, bronchus, lung and pleura. 0 25 50 75 100 125 Age-Adjusted Rate Early Detection Neither sputum cytology nor x-rays have proven to be effective. *per 100,000 1970 U.S. standard million population. Exposure to ionizing radiation, asbestos, mustard gas, nickel, polycyclic hydrocarbons, chromium, inorganic arsenic or chloromenthyl ethers. Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 84

Cancer of the Trachea, Bronchus, Lung, Pleura: INCIDENCE TABLE 9-A NUMBER OF CASES AND AGE-ADJUSTED INCIDENCE RATES BY SEX AND RACE, BY YEAR PENNSYLVANIA RESIDENTS, 1986-1995 M A L E S F E M A L E S ALL* CASES ALL RACES* WHITE BLACK ALL RACES* WHITE BLACK YEAR NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE 1995 9,888 60.0 6,028 85.4 5,409 82.0 566 127.1 3,860 41.3 3,482 40.2 355 54.5 1994 9,465 58.2 5,766 82.8 5,181 79.6 537 123.6 3,699 40.3 3,337 39.0 340 53.8 1993 9,391 58.1 5,821 84.3 5,272 82.0 516 117.6 3,570 39.0 3,182 37.5 369 57.5 1992 8,971 56.3 5,631 82.4 5,088 79.8 505 115.4 3,340 37.1 2,998 35.8 326 51.9 1991 8,950 56.7 5,611 82.9 5,008 79.4 560 128.3 3,339 37.7 2,993 36.5 334 53.1 1990 8,748 56.0 5,591 83.7 5,044 81.2 515 121.2 3,157 35.9 2,858 34.9 285 47.9 1989 8,559 57.0 5,502 86.0 4,969 83.3 490 115.5 3,057 35.8 2,767 35.0 274 44.6 1988 8,508 56.9 5,571 87.0 4,980 83.3 552 130.8 2,937 34.9 2,666 34.2 250 41.6 1987 8,104 54.6 5,392 84.7 4,850 81.7 500 118.3 2,712 32.3 2,436 31.3 254 42.2 1986 8,177 54.7 5,488 85.4 4,916 81.9 542 128.9 2,689 32.2 2,405 30.9 266 45.5 * Includes any unknowns. NOTE: Age-adjusted rates are per 100,000 and are computed by the direct method using the 1970 U.S. standard million population. See technical notes. FIGURE 9-A AGE-ADJUSTED INCIDENCE RATES BY SEX AND RACE PENNSYLVANIA RESIDENTS, 1986-1995 140 120 100 RATE PER 100,000 80 60 40 20 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 YEAR Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 85

Cancer of the Trachea, Bronchus, Lung, Pleura: INCIDENCE TABLE 9-B AVERAGE ANNUAL AGE-SPECIFIC INCIDENCE RATES BY SEX AND RACE M A L E S F E M A L E S AGE ALL GROUP CASES ALL RACES WHITE BLACK ALL RACES WHITE BLACK Total 77.6 100.0 100.8 100.3 57.0 57.5 56.8 Under 5 0.0 - - - 0.1-0.7 5-9 0.0 0.0 0.1 - - - - 10-14 0.1 - - - 0.1 0.1-15-19 0.1 0.1 0.2-0.1 0.1 0.4 20-24 0.3 0.4 0.4-0.2 0.2 0.4 25-29 0.5 0.7 0.6 1.3 0.4 0.4-30-34 2.5 2.7 2.1 7.7 2.3 2.3 2.4 35-39 6.1 6.6 5.4 16.9 5.6 5.4 6.8 40-44 14.9 16.7 14.2 44.1 13.2 12.4 22.0 45-49 37.4 45.6 41.7 97.2 29.6 28.1 47.7 50-54 77.3 95.9 89.8 175.8 60.1 56.1 103.9 55-59 141.6 188.0 175.4 351.0 100.1 94.9 158.1 60-64 225.9 312.0 300.2 467.8 152.3 145.0 239.7 65-69 326.9 472.5 458.0 661.2 211.4 206.7 268.5 70-74 378.0 564.4 551.5 740.1 243.4 238.7 310.4 75-79 379.6 597.3 588.9 725.5 242.7 240.9 259.3 80-84 319.4 554.7 552.3 571.7 195.2 194.8 205.9 85+ 178.6 357.7 355.1 407.7 108.4 106.2 140.8 NOTE: Rates are per 100,000 population (1991-1995) for each specified group. FIGURE 9-B AVERAGE ANNUAL AGE-SPECIFIC INCIDENCE RATES BY SEX AND RACE 800 600 RATE PER 100,000 400 200 0 Under 5 5-9 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80-84 15-19 25-29 35-39 45-49 55-59 65-69 75-79 AGE GROUP 85+ Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 86

Cancer of the Trachea, Bronchus, Lung, Pleura: INCIDENCE TABLE 9-C TOTAL NUMBER OF CASES BY AGE, SEX AND RACE M A L E S F E M A L E S AGE ALL* GROUP CASES ALL RACES* WHITE BLACK ALL RACES* WHITE BLACK Total 46,665 28,857 25,958 2,684 17,808 15,992 1,724 Under 5 2 0 0 0 2 0 2 5-9 1 1 1 0 0 0 0 10-14 2 0 0 0 2 2 0 15-19 6 3 3 0 3 2 1 20-24 12 8 8 0 4 3 1 25-29 23 15 12 3 8 8 0 30-34 117 63 44 17 54 48 6 35-39 287 153 113 34 134 115 16 40-44 652 359 277 76 293 245 45 45-49 1,383 821 685 131 562 479 80 50-54 2,376 1,418 1,213 190 958 805 146 55-59 3,923 2,462 2,105 332 1,461 1,251 201 60-64 6,321 4,025 3,581 409 2,296 1,993 292 65-69 9,213 5,890 5,310 537 3,323 3,000 304 70-74 9,327 5,838 5,344 456 3,489 3,186 289 75-79 7,248 4,403 4,081 301 2,845 2,643 186 80-84 3,964 2,378 2,229 134 1,586 1,485 98 85+ 1,808 1,020 952 64 788 727 57 * Includes any unknowns. FIGURE 9-C STAGE OF DISEASE AT DIAGNOSIS, PERCENT BY SEX AND RACE PENNSYLVANIA RESIDENTS, 1995 60 In Situ 48.7 47.2 Local Regional 43.5 41.2 Distant 40 PERCENT 27.2 29.1 23.9 31.0 27.4 27.8 26.6 25.6 20 0 0.2 0.1 0.6 NUMBER AND PERCENT OF CASES MICROSCOPICALLY CONFIRMED: 8,993-91.0% Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 87

Cancer of the Trachea, Bronchus, Lung, Pleura: MORTALITY TABLE 9-D NUMBER OF DEATHS AND AGE-ADJUSTED DEATH RATES BY SEX AND RACE, BY YEAR PENNSYLVANIA RESIDENTS, 1986-1995 M A L E S F E M A L E S ALL* DEATHS ALL RACES* WHITE BLACK ALL RACES* WHITE BLACK YEAR NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE 1995 8,117 47.6 4,941 69.3 4,452 66.8 478 108.3 3,176 31.9 2,839 30.5 317 47.5 1994 8,030 47.8 4,864 69.0 4,373 66.4 476 109.1 3,166 32.6 2,850 31.5 308 46.9 1993 8,015 48.2 4,957 71.2 4,462 68.7 482 110.7 3,058 31.7 2,705 30.1 346 52.7 1992 8,074 49.1 5,017 72.6 4,521 70.0 479 110.3 3,057 32.2 2,752 31.0 293 46.0 1991 7,890 48.5 5,060 74.2 4,558 71.7 490 111.7 2,830 30.3 2,543 29.2 280 44.1 1990 7,774 48.6 4,969 73.7 4,453 70.9 509 119.2 2,805 30.7 2,536 29.8 259 41.9 1989 7,531 48.8 4,931 76.1 4,388 72.5 514 122.0 2,600 29.1 2,348 28.3 244 39.6 1988 7,384 48.3 4,952 76.7 4,425 73.4 519 123.8 2,432 27.7 2,215 27.2 214 34.9 1987 7,489 49.0 5,054 78.4 4,506 74.8 541 129.4 2,435 27.9 2,173 26.7 258 43.2 1986 6,982 45.8 4,771 73.9 4,281 71.0 482 115.3 2,211 25.5 1,980 24.5 229 38.6 * Includes any unknowns. NOTE: Age-adjusted rates are per 100,000 and are computed by the direct method using the 1970 U.S. standard million population. See technical notes. FIGURE 9-D AGE-ADJUSTED DEATH RATES BY SEX AND RACE PENNSYLVANIA RESIDENTS, 1986-1995 140 120 100 RATE PER 100,000 80 60 40 20 0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 YEAR Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 88

Cancer of the Trachea, Bronchus, Lung, Pleura: MORTALITY TABLE 9-E NUMBER OF DEATHS AND AVERAGE ANNUAL AGE-SPECIFIC DEATH RATES BY SEX AND RACE M A L E S F E M A L E S ALL* AGE DEATHS ALL RACES* WHITE BLACK ALL RACES* WHITE BLACK GROUP NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE TOTAL* 40,126 66.8 24,839 86.1 22,366 86.8 2,405 89.8 15,287 48.9 13,689 49.3 1,544 50.9 UNDER 5 0-0 - 0-0 - 0-0 - 0-5-9 0-0 - 0-0 - 0-0 - 0-10-14 1 0.0 1 0.1 1 0.1 0-0 - 0-0 - 15-19 1 0.0 1 0.0 1 0.1 0-0 - 0-0 - 20-24 7 0.2 3 0.1 2 0.1 1 0.4 4 0.2 3 0.2 1 0.4 25-29 12 0.3 6 0.3 5 0.3 1 0.4 6 0.3 5 0.3 1 0.4 30-34 47 1.0 23 1.0 19 0.9 4 1.8 24 1.0 22 1.0 2 0.8 35-39 192 4.1 101 4.4 74 3.6 27 13.4 91 3.8 80 3.8 11 4.7 40-44 406 9.3 242 11.3 191 9.8 50 29.0 164 7.4 128 6.5 35 17.1 45-49 950 25.7 571 31.7 477 29.1 92 68.3 379 19.9 322 18.9 57 34.0 50-54 1,758 57.2 1,077 72.8 914 67.7 158 146.2 681 42.7 567 39.5 111 79.0 55-59 2,905 104.9 1,905 145.4 1,620 135.0 272 287.6 1,000 68.5 838 63.6 157 123.5 60-64 4,952 177.0 3,243 251.4 2,875 241.1 361 412.9 1,709 113.4 1,465 106.6 239 196.2 65-69 7,434 263.8 4,779 383.4 4,270 368.3 497 611.9 2,655 168.9 2,379 163.9 264 233.2 70-74 7,904 320.3 4,923 476.0 4,490 463.4 421 683.3 2,981 208.0 2,677 200.6 290 311.4 75-79 6,811 356.7 4,116 558.4 3,844 554.7 265 638.7 2,695 229.9 2,500 227.9 190 264.9 80-84 4,233 341.1 2,486 579.9 2,323 575.6 157 669.8 1,747 215.0 1,638 214.8 105 220.6 85+ 2,510 247.9 1,361 477.2 1,260 469.9 98 624.2 1,149 158.0 1,063 155.3 81 200.1 * Includes any unknowns. NOTE: Rates are per 100,000 population (1991-1995) for each specified group. FIGURE 9-E AVERAGE ANNUAL AGE-SPECIFIC DEATH RATES BY SEX AND RACE 800 600 RATE PER 100,000 400 200 0 UNDER 5 5-9 10-14 15-19 20-24 25-29 30-34 40-44 50-54 35-39 45-49 AGE GROUP 55-59 60-64 65-69 70-74 75-79 80-84 85+ Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 89

Cancer of the Trachea, Bronchus, Lung, Pleura: INCIDENCE TABLE 9-F TOTAL NUMBER OF CASES AND AVERAGE ANNUAL AGE-ADJUSTED INCIDENCE RATES* BY COUNTY AND SEX M A L E S F E M A L E S M A L E S F E M A L E S TOTAL TOTAL COUNTY CASES NO. RATE NO. RATE COUNTY CASES NO. RATE NO. RATE ALL COUNTIES 46,665 28,857 83.5 17,808 39.1 ADAMS 233 146 66.3 87 31.6 JUNIATA 71 52 86.0 19 21.3 ALLEGHENY 6,467 3,743 90.2 2,724 47.6 LACKAWANNA 940 618 87.0 322 33.2 ARMSTRONG 351 236 99.8 115 37.1 LANCASTER 1,191 759 66.9 432 29.8 BEAVER 846 567 92.0 279 34.7 LAWRENCE 366 256 79.7 110 25.4 BEDFORD 151 112 71.8 39 21.2 LEBANON 379 263 76.3 116 24.8 BERKS 1,203 764 74.6 439 33.8 LEHIGH 910 566 64.9 344 30.1 BLAIR 543 370 93.5 173 30.4 LUZERNE 1,389 888 80.9 501 33.3 BRADFORD 219 153 85.7 66 30.3 LYCOMING 458 295 86.0 163 37.0 BUCKS 1,749 1,057 77.8 692 40.9 MCKEAN 175 103 71.0 72 37.9 BUTLER 545 344 81.0 201 35.9 MERCER 463 308 78.0 155 31.6 CAMBRIA 692 457 83.6 235 31.3 MIFFLIN 163 105 74.7 58 30.1 CAMERON 23 17 88.0 6 18.0 MONROE 405 254 89.2 151 44.4 CARBON 226 142 72.9 84 32.7 MONTGOMERY 2,525 1,449 71.4 1,076 40.7 CENTRE 292 182 72.9 110 33.9 MONTOUR 64 46 91.3 18 23.0 CHESTER 1,139 708 74.4 431 36.3 NORTHAMPTON 902 576 79.9 326 34.8 CLARION 102 76 66.3 26 18.0 NORTHUMBERLAND 373 253 80.2 120 26.6 CLEARFIELD 297 201 82.4 96 30.1 PERRY 132 89 86.1 43 35.2 CLINTON 158 103 88.8 55 39.9 PHILADELPHIA 7,499 4,355 113.1 3,144 56.4 COLUMBIA 207 137 74.4 70 29.9 PIKE 72 41 38.2 31 28.4 CRAWFORD 285 183 71.1 102 32.4 POTTER 50 30 57.5 20 29.0 CUMBERLAND 647 408 74.9 239 33.2 SCHUYLKILL 646 428 82.8 218 31.5 DAUPHIN 894 553 84.9 341 38.9 SNYDER 83 58 59.0 25 21.5 DELAWARE 2,243 1,305 83.6 938 45.5 SOMERSET 226 157 61.4 69 21.9 ELK 156 86 77.4 70 51.3 SULLIVAN 33 17 76.6 16 65.0 ERIE 954 614 82.6 340 36.2 SUSQUEHANNA 109 85 69.2 24 16.5 FAYETTE 657 430 93.2 227 36.1 TIOGA 143 85 67.2 58 37.4 FOREST 26 14 69.6 12 57.8 UNION 105 73 76.7 32 25.1 FRANKLIN 359 229 63.7 130 30.0 VENANGO 214 141 79.6 73 31.6 FULTON 40 25 59.4 15 31.7 WARREN 156 103 73.5 53 29.8 GREENE 114 79 68.4 35 24.3 WASHINGTON 949 619 91.6 330 37.2 HUNTINGDON 160 123 101.1 37 22.9 WAYNE 207 109 78.5 98 59.5 INDIANA 290 193 76.1 97 31.6 WESTMORELAND 1,655 1,035 83.3 620 38.1 JEFFERSON 173 107 71.2 66 35.9 WYOMING 94 60 80.3 34 41.0 YORK 1,077 717 76.0 360 31.0 * Age-adjusted rates are per 100,000 and are computed by the direct method using the 1970 U.S. standard million population. See technical notes regarding reliability of rates. Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 90

Cancer of the Trachea, Bronchus, Lung, Pleura: MORTALITY TABLE 9-G TOTAL NUMBER OF DEATHS AND AVERAGE ANNUAL AGE-ADJUSTED DEATH RATES* BY COUNTY AND SEX M A L E S F E M A L E S M A L E S F E M A L E S TOTAL TOTAL COUNTY DEATHS NO. RATE NO. RATE COUNTY DEATHS NO. RATE NO. RATE ALL COUNTIES 40,126 24,839 71.2 15,287 31.7 ADAMS 220 141 63.3 79 28.4 JUNIATA 54 36 59.0 18 19.8 ALLEGHENY 5,533 3,319 79.2 2,214 36.7 LACKAWANNA 768 484 67.3 284 26.4 ARMSTRONG 277 182 75.4 95 27.8 LANCASTER 1,123 726 62.8 397 25.5 BEAVER 702 468 75.6 234 27.8 LAWRENCE 336 231 71.6 105 23.2 BEDFORD 104 71 45.1 33 17.1 LEBANON 334 240 68.6 94 18.0 BERKS 1,035 663 64.1 372 27.1 LEHIGH 875 545 61.7 330 27.2 BLAIR 453 310 76.9 143 24.2 LUZERNE 1,162 750 67.8 412 25.8 BRADFORD 171 115 64.0 56 24.0 LYCOMING 373 236 67.9 137 28.4 BUCKS 1,511 903 67.2 608 34.3 MCKEAN 171 98 65.8 73 37.8 BUTLER 448 277 64.4 171 30.5 MERCER 389 256 64.4 133 25.3 CAMBRIA 618 421 75.7 197 24.7 MIFFLIN 142 96 66.4 46 22.7 CAMERON 18 14 69.3 4 11.0 MONROE 328 206 72.1 122 34.4 CARBON 198 122 62.5 76 27.9 MONTGOMERY 2,005 1,152 56.1 853 30.2 CENTRE 220 136 54.3 84 26.0 MONTOUR 42 34 65.8 8 8.9 CHESTER 1,016 625 66.0 391 31.9 NORTHAMPTON 749 490 66.4 259 26.2 CLARION 114 78 68.1 36 25.9 NORTHUMBERLAND 355 237 73.6 118 24.7 CLEARFIELD 258 181 72.9 77 23.3 PERRY 127 80 77.9 47 37.5 CLINTON 141 96 81.8 45 31.5 PHILADELPHIA 6,361 3,671 94.2 2,690 45.9 COLUMBIA 173 120 63.6 53 20.6 PIKE 90 53 48.2 37 32.7 CRAWFORD 247 153 57.8 94 27.9 POTTER 45 24 45.5 21 27.7 CUMBERLAND 570 361 65.6 209 27.0 SCHUYLKILL 569 380 72.6 189 24.7 DAUPHIN 742 459 70.3 283 30.2 SNYDER 75 57 57.6 18 14.9 DELAWARE 2,043 1,175 74.8 868 39.6 SOMERSET 190 131 50.4 59 16.8 ELK 120 61 53.6 59 42.1 SULLIVAN 27 14 49.6 13 43.3 ERIE 844 530 71.0 314 31.6 SUSQUEHANNA 115 86 68.9 29 18.5 FAYETTE 587 382 82.0 205 30.4 TIOGA 117 69 54.1 48 30.5 FOREST 22 11 56.9 11 49.9 UNION 76 50 51.3 26 18.6 FRANKLIN 323 206 57.0 117 24.3 VENANGO 191 124 70.4 67 28.6 FULTON 38 31 74.7 7 14.5 WARREN 154 97 68.2 57 31.2 GREENE 137 93 78.7 44 30.8 WASHINGTON 794 516 75.8 278 29.4 HUNTINGDON 125 91 73.9 34 20.6 WAYNE 145 77 55.0 68 37.8 INDIANA 242 157 61.5 85 25.8 WESTMORELAND 1,412 875 70.2 537 31.5 JEFFERSON 145 87 59.3 58 28.9 WYOMING 72 41 54.4 31 36.3 YORK 965 638 67.3 327 26.5 * Age-adjusted rates are per 100,000 and are computed by the direct method using the 1970 U.S. standard million population. See technical notes regarding reliability of rates. Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 91