Cancer in Alaska Natives
Transcript Of Cancer in Alaska Natives
Cancer in Alaska Natives
1969-2003
35-Year Report
Office of Alaska Native Health Research
Office of Alaska Native Health Research and Alaska Native Epidemiology Center
Alaska Native Tribal Health Consortium January 2006
Cancer in Alaska Natives 1969-2003
35-Year Report
Anne P. Lanier, MD, MPH Janet J. Kelly, MS, MPH Jeannine Maxwell, BS, CTR Terrie McEvoy, BSN, MBA, CTR Chriss Homan, BS
Office of Alaska Native Health Research and Alaska Native Epidemiology Center
Alaska Native Tribal Health Consortium January 2006
Acknowledgements
The authors wish to express thanks to tumor registrars, medical records personnel and many others throughout the state who helped assure the completeness and accuracy of these data. We could not have produced this report without the assistance of the staff of the New Mexico Tumor Registry, University of New Mexico, Albuquerque, NM: Dr. Charles Wiggins, Dr. Charles Key, Ron Darling, Lucinda Puckett, Vera Carrion-Schauweker, Ginger Williams and others. We also wish to acknowledge the assistance of the staff of the Alaska Cancer Registry: Jeanne Roche, David O’Brian and Elizabeth Blair; Seattle SEER Program and the Fred Hutchinson Cancer Research Center.
Partial funding for the Alaska Native Tumor Registry is provided through an Interagency Agreement (Y1-PC-4033-01) with the National Cancer Institute.
This report is available at the Alaska Native Tribal Health Consortium website at the following web addresses:
http://anthc.org/cs/chs/oanhr/
and
http://anthc.org/cs/chs/epi/pubs.cfm
For additional information concerning cancer among Alaska Natives, request additional copies, or for questions about this report, please contact:
Anne P. Lanier, MD, MPH, Director Office of Alaska Native Health Research Mailstop C-DCHS Alaska Native Tribal Health Consortium 4000 Ambassador Drive Anchorage, Alaska 99508
Janet J. Kelly, MS, MPH Alaska Native Epidemiology Center Mailstop C-DCHS Alaska Native Tribal Health Consortium 4000 Ambassador Drive Anchorage, Alaska 99508
(907) 729-3663 [email protected]
(907) 729-3949 [email protected]
Contents Summary…………………………………………………………………………..1
Five-Year Cancer Incidence 1999-2003
Leading Cancers 1969-1973 vs. 1999-2003....................................... 9 Cancer Incidence Rates in Alaska Natives and US Whites ............... 10 Number of Cancers by Age ............................................................... 15
Age-Specific Cancer Incidence Rates......................................... 19
Fifteen-Year Incidence 1989-2003
Number of Cancers by Year .............................................................. 23 Cancer Incidence Rates in Alaska Natives and US Whites ............... 27 Rank by Age ...................................................................................... 31 Number of Cancers by Age .............................................................. 35 Age-Specific Cancer Incidence Rates ............................................... 39 Age-Specific Cancer Rates in Alaska Natives and US Whites .......... 42
Fifteen-Year Incidence 1989-2003 by Service Unit
Ten Leading Cancers by Service Unit .............................................. 91 Number of Cancers by Service Unit .................................................. 94 Cancer Incidence Rates by Service Unit ........................................... 98
Thirty-Five-Year Trends 1969-2003
Number of Cancers by Five-Year Time Periods .............................. 103 Cancer Incidence Rates by Five-Year Time Periods…………......... 106 Alaska Native vs. US Trends ........................................................... 111
Cancer Stage at Diagnosis 1993-2002
Percent Distribution of Stage in Alaska Natives and US Whites ... 137
Survival 1992-2002
Five-Year Relative Survival in Alaska Natives and US Whites ........ 155
Mortality 1998-2002
Leading Causes of Death ............................................................... 163 Cancer Mortality Rates in Alaska Natives and US Races ............... 164 Cancer Mortality Rank Order........................................................... 165 Cancer Mortality Rates in Alaska Natives and US Whites............... 166
Appendix
Alaska Native Census Population ................................................... 169 Cancer Site ICD-O-3 Codes ............................................................ 171 Glossary .......................................................................................... 174 Publications ..................................................................................... 177
Summary Cancer in Alaska Native People
1969-2003
Introduction Data on cancer incidence (new cases) among the Alaska Native (AN) popula-
tion statewide are available since 1969 (1). These data provide current incidence rates, trends over time, and allow comparisons of cancer patterns in the Alaska Native population with other populations. The first detailed cancer incidence data for Alaska Native people were reported in 1976 (2). At that time, overall cancer incidence among Alaska Natives was lower than that of US Whites, however, incidence rates for several cancer sites exceeded the US rates (nasopharynx, stomach, liver, gallbladder, cervix and kidney). On the other hand, cancer incidence rates for other sites were significantly lower than US rates (prostate, breast, uterus, brain, urinary bladder, leukemia and lymphoma). Since that time, marked changes in cancer incidence have been identified among Alaska Natives.
Cancer is now the leading cause of death among Alaska Natives. This is a dramatic shift from the 1950s when deaths were primarily caused by infectious diseases. Cancer mortality rates among Alaska Native men and women are significantly higher than US White rates (3) .
This report provides numbers and age-adjusted cancer incidence rates among all Alaska Natives for several time periods including the most recent five years for which data are complete (1999-2003); for the 15 year period (1989-2003) by Indian
1
Health Service delivery areas (Service Units); and trends over time for the entire 35 year period (1969-2003)‡. Alaska Native data are compared with data for other populations from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program. Cancer mortality rates are also included.
Source of Data Data for Alaska Natives were collected by the Alaska Native Tumor Registry
(ANTR), a state-wide population-based registry of all cancers diagnosed among Alaska Natives during the 35-year time period 1969-2003. Alaska Native Tumor Registry includes Alaska Native patients living in Alaska at the time of diagnosis who met eligibility requirements for Indian Health Service benefits. ANTR case-finding includes: hospital and clinic discharge diagnoses for all tribal hospitals in the state; pathology reports of the Alaska Native Medical Center; other in-state hospital tumor registry, pathology, and autopsy reports; the Seattle Area SEER Cancer Surveillance System; and death certificates. Prior to 1984, data collected focused on patient demographics, primary cancer site, histology and basis of confirmation of the diagnosis. Since 1984, extensive information on cancer staging, treatment and follow-up has been included. Procedures for data collection and coding follow standards of the SEER program of the National Cancer Institute (4).
Yearly population statistics were interpolated directly from 1970, 1980, and 1990 US Census data. “Bridged” population counts were used for years 1991 to 2000,
‡ Prior reports show small differences in rates from those shown here due to changes in rate calculation methodology. In previous reports, rates were age-adjusted to the 1970 US standard population, whereas this report presents rates adjusted to the 2000 US standard population. In addition, population estimates for Alaska Native people were made to account for changes in new multiple race categories of the Census 2000.
2
from estimates for Alaska Natives provided to SEER by the National Center for Health Statistics(5). Bridged estimates were necessary because of the option in the Census 2000 to denote multiple, rather than single race designation. Rate calculations for Service Units were based on the direct Census 2000 counts for American Indians/Alaska Natives living in Alaska who chose one or more race categories including American Indian or Alaska Native. All rates are age-adjusted to the US 2000 standard population (all races).
Cancer incidence rates for other US populations for the years 1973-2002 are from SEER Stat, a public-use data source created by the Surveillance, Epidemiology, and End Results program of the National Cancer Institute .(6) Comparisons of rates were performed using odds ratios (OR) with corresponding 95% confidence intervals (CI). Rates for which the OR did not contain one were considered significantly different. A Chi-square test for linear trend was used to determine temporal changes in rates over the thirty-five year time period. Cancer mortality data were also obtained from SEER for the years 1998-2002 (7) .
Stage of disease at diagnosis utilized summary stage (local, regional, distant, unknown) of major cancer sites and all sites combined from SEER Stat (historical stage-A). Staging is available for Alaska Native cancer patients only since 1984.
Five-year relative survival (actuarial method) as well as cancer mortality rates were calculated from SEER public-use data files using SEER Stat. For relative survival statistics, second and later primary cases and cases identified through death certificates only were excluded.
3
Results Incidence
In the 35 years from 1969 to 2003, more than 6,000 Alaska Native men and women were diagnosed with invasive cancer. Nearly half (45%) of the cases were diagnosed during the last ten-year period, 1994-2003. During the most recent five-year period, 1999-2003, approximately 300 Alaska Native patients were diagnosed with invasive cancer each year. The most frequently diagnosed cancers in Alaska Natives for the years 1999-2003 were: colon/ rectum, lung, breast, and prostate. These four cancers accounted for over half (57%) of all cancers diagnosed. The leading cancers in men were lung, colon/ rectum and prostate, while in women the most frequently diagnosed were breast, colon/rectum and lung. In the recent five year period, more women than men were diagnosed with cancer.
Age-adjusted cancer incidence rates for the period 1999-2003 increased 23% among Alaska Native men and 30% among women from the earliest period, 1969-1973. Rate increases occurred especially in cancers of the colon/ rectum, lung, breast, prostate and uterus. Over the 35 year period, decreases occurred only in cancers of the cervix and gallbladder in women. Rapid increases in cancer incidence among Alaska Natives during the 35-year period have outpaced the US White population. Although cancer incidence rates among Alaska Natives were once lower than those of the US White population, rates are now as high. For select cancer sites rates are even higher among Alaska Natives than US Whites, including: oral cavity and pharynx (notably na-
4
sopharynx), esophagus, stomach, colon/rectum, liver, gallbladder, pancreas, lung and kidney. For other cancer sites, rates among Alaska Natives remain lower than US White rates. These include: melanoma, uterus, ovary, prostate, urinary bladder, brain and nervous system, Hodgkin and non-Hodgkin lymphoma, and leukemia.
Stage at Diagnosis The percent distribution of cancer by stage (local, regional, distant, un-
known) at diagnosis among Alaska Natives is reported and compared with US Whites. Cancers that are diagnosed when they are still localized are more likely to be cured. In general, the distribution by stage is similar. Statistical comparisons of stage at diagnosis between these groups is difficult because stage may be reported as ‘unknown’. For all cancers 1993-2002, 24% and 42% of Alaska Native men and women, respectively, were diagnosed while the cancer was still localized. Among Alaska Natives, liver cancer is more likely to be diagnosed at a local stage than among US Whites.
Relative Five-Year Survival Survival from cancer is largely dependent on the primary organ in which
the cancer arises, the stage at diagnosis, as well as treatment. Relative fiveyear survival rates for cancers diagnosed in the years 1992-2002 were calculated and compared to US Whites. Relative five-year survival for all invasive cancers combined was significantly lower than US Whites for both Alaska Na-
5
1969-2003
35-Year Report
Office of Alaska Native Health Research
Office of Alaska Native Health Research and Alaska Native Epidemiology Center
Alaska Native Tribal Health Consortium January 2006
Cancer in Alaska Natives 1969-2003
35-Year Report
Anne P. Lanier, MD, MPH Janet J. Kelly, MS, MPH Jeannine Maxwell, BS, CTR Terrie McEvoy, BSN, MBA, CTR Chriss Homan, BS
Office of Alaska Native Health Research and Alaska Native Epidemiology Center
Alaska Native Tribal Health Consortium January 2006
Acknowledgements
The authors wish to express thanks to tumor registrars, medical records personnel and many others throughout the state who helped assure the completeness and accuracy of these data. We could not have produced this report without the assistance of the staff of the New Mexico Tumor Registry, University of New Mexico, Albuquerque, NM: Dr. Charles Wiggins, Dr. Charles Key, Ron Darling, Lucinda Puckett, Vera Carrion-Schauweker, Ginger Williams and others. We also wish to acknowledge the assistance of the staff of the Alaska Cancer Registry: Jeanne Roche, David O’Brian and Elizabeth Blair; Seattle SEER Program and the Fred Hutchinson Cancer Research Center.
Partial funding for the Alaska Native Tumor Registry is provided through an Interagency Agreement (Y1-PC-4033-01) with the National Cancer Institute.
This report is available at the Alaska Native Tribal Health Consortium website at the following web addresses:
http://anthc.org/cs/chs/oanhr/
and
http://anthc.org/cs/chs/epi/pubs.cfm
For additional information concerning cancer among Alaska Natives, request additional copies, or for questions about this report, please contact:
Anne P. Lanier, MD, MPH, Director Office of Alaska Native Health Research Mailstop C-DCHS Alaska Native Tribal Health Consortium 4000 Ambassador Drive Anchorage, Alaska 99508
Janet J. Kelly, MS, MPH Alaska Native Epidemiology Center Mailstop C-DCHS Alaska Native Tribal Health Consortium 4000 Ambassador Drive Anchorage, Alaska 99508
(907) 729-3663 [email protected]
(907) 729-3949 [email protected]
Contents Summary…………………………………………………………………………..1
Five-Year Cancer Incidence 1999-2003
Leading Cancers 1969-1973 vs. 1999-2003....................................... 9 Cancer Incidence Rates in Alaska Natives and US Whites ............... 10 Number of Cancers by Age ............................................................... 15
Age-Specific Cancer Incidence Rates......................................... 19
Fifteen-Year Incidence 1989-2003
Number of Cancers by Year .............................................................. 23 Cancer Incidence Rates in Alaska Natives and US Whites ............... 27 Rank by Age ...................................................................................... 31 Number of Cancers by Age .............................................................. 35 Age-Specific Cancer Incidence Rates ............................................... 39 Age-Specific Cancer Rates in Alaska Natives and US Whites .......... 42
Fifteen-Year Incidence 1989-2003 by Service Unit
Ten Leading Cancers by Service Unit .............................................. 91 Number of Cancers by Service Unit .................................................. 94 Cancer Incidence Rates by Service Unit ........................................... 98
Thirty-Five-Year Trends 1969-2003
Number of Cancers by Five-Year Time Periods .............................. 103 Cancer Incidence Rates by Five-Year Time Periods…………......... 106 Alaska Native vs. US Trends ........................................................... 111
Cancer Stage at Diagnosis 1993-2002
Percent Distribution of Stage in Alaska Natives and US Whites ... 137
Survival 1992-2002
Five-Year Relative Survival in Alaska Natives and US Whites ........ 155
Mortality 1998-2002
Leading Causes of Death ............................................................... 163 Cancer Mortality Rates in Alaska Natives and US Races ............... 164 Cancer Mortality Rank Order........................................................... 165 Cancer Mortality Rates in Alaska Natives and US Whites............... 166
Appendix
Alaska Native Census Population ................................................... 169 Cancer Site ICD-O-3 Codes ............................................................ 171 Glossary .......................................................................................... 174 Publications ..................................................................................... 177
Summary Cancer in Alaska Native People
1969-2003
Introduction Data on cancer incidence (new cases) among the Alaska Native (AN) popula-
tion statewide are available since 1969 (1). These data provide current incidence rates, trends over time, and allow comparisons of cancer patterns in the Alaska Native population with other populations. The first detailed cancer incidence data for Alaska Native people were reported in 1976 (2). At that time, overall cancer incidence among Alaska Natives was lower than that of US Whites, however, incidence rates for several cancer sites exceeded the US rates (nasopharynx, stomach, liver, gallbladder, cervix and kidney). On the other hand, cancer incidence rates for other sites were significantly lower than US rates (prostate, breast, uterus, brain, urinary bladder, leukemia and lymphoma). Since that time, marked changes in cancer incidence have been identified among Alaska Natives.
Cancer is now the leading cause of death among Alaska Natives. This is a dramatic shift from the 1950s when deaths were primarily caused by infectious diseases. Cancer mortality rates among Alaska Native men and women are significantly higher than US White rates (3) .
This report provides numbers and age-adjusted cancer incidence rates among all Alaska Natives for several time periods including the most recent five years for which data are complete (1999-2003); for the 15 year period (1989-2003) by Indian
1
Health Service delivery areas (Service Units); and trends over time for the entire 35 year period (1969-2003)‡. Alaska Native data are compared with data for other populations from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program. Cancer mortality rates are also included.
Source of Data Data for Alaska Natives were collected by the Alaska Native Tumor Registry
(ANTR), a state-wide population-based registry of all cancers diagnosed among Alaska Natives during the 35-year time period 1969-2003. Alaska Native Tumor Registry includes Alaska Native patients living in Alaska at the time of diagnosis who met eligibility requirements for Indian Health Service benefits. ANTR case-finding includes: hospital and clinic discharge diagnoses for all tribal hospitals in the state; pathology reports of the Alaska Native Medical Center; other in-state hospital tumor registry, pathology, and autopsy reports; the Seattle Area SEER Cancer Surveillance System; and death certificates. Prior to 1984, data collected focused on patient demographics, primary cancer site, histology and basis of confirmation of the diagnosis. Since 1984, extensive information on cancer staging, treatment and follow-up has been included. Procedures for data collection and coding follow standards of the SEER program of the National Cancer Institute (4).
Yearly population statistics were interpolated directly from 1970, 1980, and 1990 US Census data. “Bridged” population counts were used for years 1991 to 2000,
‡ Prior reports show small differences in rates from those shown here due to changes in rate calculation methodology. In previous reports, rates were age-adjusted to the 1970 US standard population, whereas this report presents rates adjusted to the 2000 US standard population. In addition, population estimates for Alaska Native people were made to account for changes in new multiple race categories of the Census 2000.
2
from estimates for Alaska Natives provided to SEER by the National Center for Health Statistics(5). Bridged estimates were necessary because of the option in the Census 2000 to denote multiple, rather than single race designation. Rate calculations for Service Units were based on the direct Census 2000 counts for American Indians/Alaska Natives living in Alaska who chose one or more race categories including American Indian or Alaska Native. All rates are age-adjusted to the US 2000 standard population (all races).
Cancer incidence rates for other US populations for the years 1973-2002 are from SEER Stat, a public-use data source created by the Surveillance, Epidemiology, and End Results program of the National Cancer Institute .(6) Comparisons of rates were performed using odds ratios (OR) with corresponding 95% confidence intervals (CI). Rates for which the OR did not contain one were considered significantly different. A Chi-square test for linear trend was used to determine temporal changes in rates over the thirty-five year time period. Cancer mortality data were also obtained from SEER for the years 1998-2002 (7) .
Stage of disease at diagnosis utilized summary stage (local, regional, distant, unknown) of major cancer sites and all sites combined from SEER Stat (historical stage-A). Staging is available for Alaska Native cancer patients only since 1984.
Five-year relative survival (actuarial method) as well as cancer mortality rates were calculated from SEER public-use data files using SEER Stat. For relative survival statistics, second and later primary cases and cases identified through death certificates only were excluded.
3
Results Incidence
In the 35 years from 1969 to 2003, more than 6,000 Alaska Native men and women were diagnosed with invasive cancer. Nearly half (45%) of the cases were diagnosed during the last ten-year period, 1994-2003. During the most recent five-year period, 1999-2003, approximately 300 Alaska Native patients were diagnosed with invasive cancer each year. The most frequently diagnosed cancers in Alaska Natives for the years 1999-2003 were: colon/ rectum, lung, breast, and prostate. These four cancers accounted for over half (57%) of all cancers diagnosed. The leading cancers in men were lung, colon/ rectum and prostate, while in women the most frequently diagnosed were breast, colon/rectum and lung. In the recent five year period, more women than men were diagnosed with cancer.
Age-adjusted cancer incidence rates for the period 1999-2003 increased 23% among Alaska Native men and 30% among women from the earliest period, 1969-1973. Rate increases occurred especially in cancers of the colon/ rectum, lung, breast, prostate and uterus. Over the 35 year period, decreases occurred only in cancers of the cervix and gallbladder in women. Rapid increases in cancer incidence among Alaska Natives during the 35-year period have outpaced the US White population. Although cancer incidence rates among Alaska Natives were once lower than those of the US White population, rates are now as high. For select cancer sites rates are even higher among Alaska Natives than US Whites, including: oral cavity and pharynx (notably na-
4
sopharynx), esophagus, stomach, colon/rectum, liver, gallbladder, pancreas, lung and kidney. For other cancer sites, rates among Alaska Natives remain lower than US White rates. These include: melanoma, uterus, ovary, prostate, urinary bladder, brain and nervous system, Hodgkin and non-Hodgkin lymphoma, and leukemia.
Stage at Diagnosis The percent distribution of cancer by stage (local, regional, distant, un-
known) at diagnosis among Alaska Natives is reported and compared with US Whites. Cancers that are diagnosed when they are still localized are more likely to be cured. In general, the distribution by stage is similar. Statistical comparisons of stage at diagnosis between these groups is difficult because stage may be reported as ‘unknown’. For all cancers 1993-2002, 24% and 42% of Alaska Native men and women, respectively, were diagnosed while the cancer was still localized. Among Alaska Natives, liver cancer is more likely to be diagnosed at a local stage than among US Whites.
Relative Five-Year Survival Survival from cancer is largely dependent on the primary organ in which
the cancer arises, the stage at diagnosis, as well as treatment. Relative fiveyear survival rates for cancers diagnosed in the years 1992-2002 were calculated and compared to US Whites. Relative five-year survival for all invasive cancers combined was significantly lower than US Whites for both Alaska Na-
5