Descriptive Epidemiology and Cancer Prevention and Control
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Transcript of Descriptive Epidemiology and Cancer Prevention and Control
Descriptive Epidemiology and Cancer Prevention and Control
Resa M. Jones, M.P.H., Ph.D.
Special Topic: Cancer Control
January 23, 2006
Learning Objectives• Students should be able to:
– Explain the impact of cancer internationally and nationally– Identify the most prevalent cancers internationally and nationally– Identify the leading causes of cancer death internationally and nationally– Explain the difference in cancer incidence and death rates by gender,
age, and race/ethnicity– Identify the relationship between cancer control and disease frequency
measures– Explain the historical perspective of cancer control– Understand the cancer control continuum and explain its implication to
public health– Identify the differences between clinical and intervention studies– Explain important factors and trends affecting cancer control and
directions for future research
What is cancer?
• Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells.
• Cancer is caused by external factors and internal factors which may act together to initiate or promote carcinogenesis.
Biologic Basis for Cancer Control
Normalcell
Initiatedcell
Pre-cancerouscell
CANCER
Initiation Promotion Progression
Rates
• Incidence
• Prevalence
• Specific
• Crude
• Adjusted/Standardized
• SMR/SIR
Cancer incidence for the regions of the world, 2002 estimates
Age standardized incidence rates for all cancers*
by region of the world, 2002 estimates
The most commonly diagnosed cancers*
worldwide, 2002 estimates
Trends in the numbers of new cases being diagnosed worldwide, selected cancers,
1975-2000
The proportion of all deaths caused by cancer in
the different regions of the world, 2002
The most common causes of death from
cancer* worldwide, 2002 estimates
Surveillance
Mortality: Leading Causes of Death
Source: US Mortality Public Use Data Tape 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.
1. Heart Diseases 696,947 28.5
2. Cancer 557,271 22.8
3. Cerebrovascular diseases 162,672 6.7
4. Chronic lower respiratory diseases 124,816 5.1
5. Accidents (Unintentional injuries) 106,742 4.4
6. Diabetes mellitus 73,249 3.0
7. Influenza and pneumonia 65,681 2.7
8. Alzheimer disease 58,866 2.4
9. Nephritis 40,974 1.7
10. Septicemia 33,865 1.4
Rank Cause of DeathNo. of deaths
% of all deaths
Change in the US Death Rates* by Cause, 1950 & 2001
21.8
180.7
48.1
586.8
193.9
57.5
194.4
245.8
0
100
200
300
400
500
600
* Age-adjusted to 2000 US standard population.Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised.2001 Mortality Data–NVSR-Death Final Data 2001–Volume 52, No. 3. http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_03.pdf
* Age-adjusted to 2000 US standard population.Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised.2001 Mortality Data–NVSR-Death Final Data 2001–Volume 52, No. 3. http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_03.pdf
HeartDiseases
CerebrovascularDiseases
Pneumonia/Influenza
Cancer
1950
2001Rate Per 100,000
Estimated New Cancer Cases
*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.Source: American Cancer Society, 2005.
Men710,040
Women662,870 32% Breast
12% Lung and bronchus
11% Colon and rectum
6% Uterine corpus
4% Non-Hodgkin lymphoma
4% Melanomaof skin
3% Ovary
3% Thyroid
2% Urinary bladder
2% Pancreas
21% All Other Sites
Prostate 33%
Lung and bronchus 13%
Colon and rectum 10%
Urinary bladder 7%
Melanoma of skin 5%
Non-Hodgkin4% lymphoma
Kidney 3%
Leukemia 3%
Oral Cavity 3%
Pancreas 2%
All Other Sites 17%
Estimated New Cancer Cases and Survival
Site
Estimated new cases, 2005
Five-year relative survival rates1 (percent)
White Black All races
Total Male Female1983–1985
1992–1998
1983–1985
1992–1998
1983–1985
1992–1998
All sites2 1,372,910 710,040 662,870 54% 64% 40% 53% 52% 62%
Lung 172,570 93,010 79,500 14 15 11 12 14 15
Breast3 212,930 1,690 211,240 79 88 63 73 78 86
Colon 104,950 48,290 56,660 58 63 49 53 58 62
Rectum 40,340 23,530 16,810 56 62 44 53 55 62
Prostate 232,090 232,090 n.a. 76 98 64 93 75 97
Bladder 63,210 47,010 16,200 78 82 60 65 78 82
Uterine corpus 36,160 22,490 13,670 85 86 54 61 83 84
Non-Hodgkins lymphoma4 56,390 29,070 27,320 54 56 45 46 54 55
Oral cavity and pharynx 29,370 19,100 10,270 55 59 35 35 53 56
Leukemia4 34,810 19,640 15,170 42 47 34 38 41 46
Melanoma—skin 59,580 33,580 26,000 85 89 74 66 85 89
Pancreas 32,180 16,100 16,080 3 4 5 4 3 4
Kidney 36,160 22,490 13,670 56 62 55 60 56 62
Stomach 21,860 13,510 8,350 16 21 19 20 17 22
Ovary 22,220 n.a. 22,220 40 53 42 53 41 53
Uterine cervix 10,370 n.a. 10,370 71 72 60 60 69 71NOTE: n.a. = not applicable.1. The 5-year relative survival rate indicates that a person will not die from causes directly related to their cancer within 5 years.2. Includes other sites not shown separately.3. Survival rates for females only.4. All types combined.Source: U.S. National Institutes of Health, National Cancer Institute.
*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2004.
Cancer Incidence Rates* for Women, US, 1975-2001
0
50
100
150
200
250
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
Breast
Lung & bronchus
Uterine corpus
Ovary
Rate Per 100,000
Colon & rectum
Cancer Incidence Rates* for Men, US, 1975-2001
*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and Population Sciences, National Cancer Institute, 2004.
0
50
100
150
200
250
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
Prostate
Lung & bronchus
Colon & rectum
Urinary bladder
Non-Hodgkin lymphoma
Rate Per 100,000
Estimated Cancer Deaths
ONS=Other nervous system.Source: American Cancer Society, 2005.
Men295,280
Women275,000
27% Lung and bronchus
15% Breast
10% Colon and rectum
6% Ovary
6% Pancreas
4% Leukemia
3% Non-Hodgkin lymphoma
3% Uterine corpus
2% Multiple myeloma
2% Brain/ONS
22% All other sites
Lung and bronchus
31%
Prostate
10%
Colon and rectum
10%
Pancreas
5%
Leukemia
4%
Esophagus
4%
Liver and intrahepatic
3%bile duct
Non-Hodgkin 3% Lymphoma
Urinary bladder
3%
Kidney
3%
All other sites 24%
Cancer Death Rates*, for Women, US,1930-2001
*Age-adjusted to the 2000 US standard population.Source: US Mortality Public Use Data Tapes 1960-2001, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.
0
20
40
60
80
100
1930
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
Lung & bronchus
Colon & rectum
Uterus
Stomach
Breast
Ovary
Pancreas
Rate Per 100,000
Cancer Death Rates*, for Men, US,1930-2001
*Age-adjusted to the 2000 US standard population.Source: US Mortality Public Use Data Tapes 1960-2001, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.
0
20
40
60
80
100
1930
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
Lung & bronchus
Colon & rectum
Prostate
Pancreas
Stomach
Liver
Rate Per 100,000
Leukemia
Cancer Incidence Rates* by Sex and Race,All Sites, 1975-2001
*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and Population Sciences, National Cancer Institute, 2004.
0
100
200
300
400
500
600
700
800
900
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
African American men
White men
White women
African American women
Rate Per 100,000
SEER Age Adjusted Incidence Rates by RaceAll Cancer Sites, All Ages
SEER 9 Registries for 1973-2002
SEER Age Adjusted Incidence Rates by SexAll Cancer Sites, All Ages
SEER 9 Registries for 1973-2002
Cancer Incidence Rates* by Race and Ethnicity, 1997-2001
*Age-adjusted to the 2000 US standard population.†Hispanic is not mutually exclusive from whites, African Americans, Asian/Pacific Islanders, and American Indians.Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2004.
556.5
385.9
263.2
429.8400.1
302.8
222.5
309.9
689.2
419.8
0
100
200
300
400
500
600
700
800
White African American Asian/Pacific Islander American Indian/Alaskan Native
Hispanic†
Men Women
Rate Per 100,000
0
50
100
150
200
250
300
350
400
450
500
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
African American men
White men
African American women
White women
Rate Per 100,000
Cancer Death Rates* by Sex and Race, US, 1975-2001
*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and Population Sciences, National Cancer Institute, 2004.
Age-Adjusted Total US Mortality RatesAll Cancer Sites, All Ages
For 1992-2002 by 'Expanded' Race and Sex
Cancer Sites in Which African-American Death Rates* Exceed White Death Rates* for Men, US, 1996-2000
•All sites 356.2 249.5 1.4•Larynx 5.7 2.4 2.4•Prostate 73.0 30.2 2.4•Stomach 14.0 6.1 2.3•Myeloma 9.2 4.5 2.0 •Oral cavity and pharynx 7.9 4.0 2.0•Esophagus 12.2 7.3 1.7•Liver 9.3 6.0 1.6•Lung & bronchus 107.0 78.1 1.4•Pancreas 16.4 12.0 1.4•Small intestine 0.7 0.5 1.4•Colon & rectum 34.6 25.3 1.4
*Per 100,000, age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.
SiteAfrican American
WhiteRatio of African
American/White
Cancer Sites in Which African-American Death Rates* Exceed White Death Rates* for Women, US, 1996-2000
*Per 100,000, age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.
•All sites 198.6 166.9 1.2•Myeloma 6.6 2.9 2.3•Stomach 6.5 2.9 2.2•Uterine cervix 5.9 2.7 2.2•Esophagus 3.4 1.7 2.0•Uterine corpus, NOS 7.0 3.8 1.8•Larynx 0.9 0.5 1.8•Liver & intrahepatic bile duct 3.0 1.9 1.6•Pancreas 12.9 8.9 1.5•Colon & rectum 24.6 17.5 1.4•Breast 35.9 27.2 1.3•Urinary bladder 3.0 2.3 1.3•Soft tissue, including heart 1.7 1.3 1.3
African American White Ratio of African American/White
Lifetime Probability of Developing Cancer,
By Site, Men, US, 1999-2001
Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 5.2 Statistical Research and Applications Branch, NCI, 2004. http://srab.cancer.gov/devcan
Site RiskAll sites 1 in 2
Prostate 1 in 6
Lung and bronchus 1 in 13
Colon and rectum 1 in 17
Urinary bladder 1 in 28
Non-Hodgkin lymphoma 1 in 46
Melanoma 1 in 53
Kidney 1 in 67
Leukemia 1 in 68
Oral Cavity 1 in 73
Stomach 1 in 81
Lifetime Probability of Developing Cancer,
By Site, Women, US, 1999-2001
Source:DevCan: Probability of Developing or Dying of Cancer Software, Version 5.2 Statistical Research and Applications Branch, NCI, 2004. http://srab.cancer.gov/devcan
Site Risk
All sites 1 in 3
Breast 1 in 7
Lung & bronchus 1 in 18
Colon & rectum 1 in 18
Uterine corpus 1 in 38
Non-Hodgkin lymphoma 1 in 56
Ovary 1 in 68
Melanoma 1 in 78
Pancreas 1 in 81
Urinary bladder 1 in 88
Uterine cervix 1 in 130
Cancer Survival*(%) by Site and Race,1995-2000
*5-year relative survival rates based on cancer patients diagnosed from 1995 to 2000 and followed through 2001. Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and Population Sciences, National Cancer Institute, 2004.
All Sites 66 55 11
Breast (female) 89 75 14
Colon 64 54 10
Esophagus 16 9 7
Leukemia 48 39 9
Non-Hodgkin lymphoma 60 51 9
Oral cavity 61 39 22
Prostate 100 96 4
Rectum 65 55 10
Urinary bladder 83 62 21
Uterine cervix 74 66 8
Uterine corpus 86 63 23
Site White DifferenceAfricanAmerican
Cancer Incidence & Death Rates* in Children 0-14 Years, 1975-2000
0
2
4
6
8
10
12
14
16
18
1975
1980
1985 1990
1995
Incidence
Mortality
Rate Per 100,000
2000*Age-adjusted to the 2000 Standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences,
National Cancer Institute, 2003.
0
5
10
15
20
25
30
35
Ann
ual I
ncid
ence
per
Mil
lion
ALL BT NBS
NHLW
THD AM
LRM
SRBS
Yearly Incidence of Common Childhood Cancers
Cancer Incidence Rates* in Children 0-14 Years, by Site, US, 1996-2000
* Per 100,000, age-adjusted to the 2000 US standard population.ONS = Other nervous systemSource: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003
Site Male Female Total
All sites 15.4 13.8 14.6
Leukemia 4.9 4.1 4.5
Acute Lymphocytic 3.9 3.3 3.6
Brain/ONS 3.3 2.9 3.1
Non-Hodgkin lymphoma 1.2 0.4 0.8
Kidney & Renal pelvis 0.9 1.0 0.9
Soft tissue 1.0 1.1 1.0
Bones & Joint 0.8 0.5 0.6
Hodgkin’s disease 0.6 0.6 0.6
Cancer Death Rates* in Children 0-14 Years, by Site, 1996-2000
* Per 100,000, age-adjusted to the 2000 US standard population.ONS = Other nervous systemSource: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.
Site Male Female Total
All sites 2.8 2.3 2.5
Leukemia 0.9 0.7 0.8
Acute Lymphocytic 0.4 0.3 0.4
Brain/ONS 0.8 0.7 0.7
Non-Hodgkin lymphoma 0.1 0.1 0.1
Soft tissue 0.1 0.1 0.1
Bones & Joint 0.1 0.1 0.1
Kidney & Renal pelvis 0.1 0.1 0.1
Trends in Survival, Children 0-14 Years, All Sites Combined, 1974-1999
*5-year relative survival rates, based on follow up of patients through 2000.Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2003.
5 - Year Relative Survival Rates *AgeYear ofDiagnosis
1974 - 76
1974 - 76
1992 - 99
1974 - 76
0 - 4 Years
5 - 9 Years
10 - 14 Years
1992 - 99
1992- 99
Lung Cancer
• Risk factors– Cigarette smoking, environmental exposures,
tuberculosis
• Detection/Prevention– Reduce exposure to tobacco smoke
Breast Cancer
• Risk Factors– Age, family history, biopsy, breast density,
early menstruation, obesity after menopause, recent use of oral contraceptives, hormone therapy, late or no children, alcohol, breast feeding, exercise
• Early Detection– Mammography and clinical breast exam every
year after age 40 (ACS)
Prostate Cancer
• Risk factors– Age, ethnicity, family history, dietary fat?,
weight?
• Early detection/prevention >50yrs old– PSA blood test/yr– Digital rectal exam/yr
Colorectal Cancer
• Risk factors– Age, family history, smoking , alcohol, obesity,
exercise, high fat diet/red meat
• Early Detection/Prevention – 4 modalities recommended for people age 50 and
older• Fecal occult blood test (FOBT) every year• Flexible sigmoidoscopy every 5 years• Colonoscopy every 10 years• Double-contrast barium enema every 5 years
Cancer control: Historical perspective
• 1913– American Society for the Control of Cancer (became American
Cancer Society in 1945)– American College of Surgeons formed (Developed standards for
cancer clinics in 1930)
• 1937– National Cancer Institute formed “[to] prompt use of most
effective methods of prevention, diagnosis and treatment of cancer”
Cancer control: Historical perspective
• 1971– National Cancer Act Cancer centers responsible for conducting
cancer demonstration and outreach programs
• 1974– Division of cancer prevention and control (DCPC) formed at NCI
• 1983– Cancer control defined
• Clinical Community Oncology Programs (CCOP)• Clinical Cooperative Group Trials
Cancer control: Historical perspective
• 1997– DCPC at NCI splits into two divisions:
• Cancer Prevention• Cancer Control and Population Science
• 1998/1999– New Strategy, new definition, new model
Definition: Cancer control
• …the reduction of cancer incidence, morbidity, and mortality through an orderly sequence from research on interventions and their impact in defined populations to the broad systematic application of the research results. (Old)
• …the conduct of basic and applied research in the behavioral, social, health and population sciences to create or enhance interventions that, independently or in combination with biomedical approaches, reduce cancer risk, incidence, morbidity and mortality, and improve quality of life (Cancer Control Review Group, 1998 - modified).
Fig. 1 Cancer control research activities. Adapted from the 1994 Advisory Committee on Cancer Control, National Cancer Institute of Canada (61).
Knowledgesynthesis
FundamentalResearch
SurveillanceResearch
Application and Program Delivery
Intervention Research
Reducing the cancer burden
What is cancer control research?
• Research that aims to reduce risk, incidence, and deaths from cancer as well as enhance the quality of life for cancer survivors.
– The DCCPS conducts and supports an integrated program of the highest quality genetic, epidemiologic, behavioral, social, applied, and surveillance cancer research. Cancer control research aims to understand the causes and distribution of cancer in populations, support the development and implementation of effective interventions, and monitor and explain cancer trends in all segments of the population. Central to these activities is the process of synthesis and decision-making that aids in evaluating what has been learned, identifying new priorities and strategies, and effectively applying research discoveries to reduce the cancer burden.
How much cancer incidence and mortality can we prevent by 2015?
American Cancer Society challenge goal
25% 50%
If trends (1980-95) for risk factors continue
13 % 21%
If trends (1980-95) for risk factors are accelerated
19% 29%
Incidence Mortality
Comprehensive Cancer Control Plans
• Basic Implementation: – 28 States/Territories/Republics
• Capacity Building: – 33 States/Territories/Republics
• Not Yet Funded:– 3 States/Territories
Prevention
• Primary• Secondary• Tertiary
• Terms– Mortality– Morbidity– Incidence– Prevalence
Percent of cancer that could be prevented if risk factor were removed
Risk factors Lung Colorectal
Breast Prostate
Tobacco 78 --- --- ---
Diet 19 29 --- 9
Physical inactivity
--- 19 7 ---
Obesity --- 29 38 ---
Alcohol --- --- 5 ---
Non-use of Antiestrogens
--- --- 29 ---
Failure to screen --- 34 6 ---Byers, et al, Cancer 1999; 86: 715-727; * not in original report
Strategies for cancer prevention
Level of intervention Examples
Individual Group nutrition programs
Smoking cessation programs
Physician’s advice
Interpersonal Physician’s advice
Organizational Worksite cafeteria menu
Health care benefit policies
Restaurant smoking bans
Mass media
Societal Tobacco control legislation
Engineering the environment
IOM, fulfilling the potential of cancer prevention and early detection, 2003
Tobacco Use in the US, 1900-2000
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
1900
1905
1910
1915
1920
1925
1930
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
Year
Per
Cap
ita
Cig
aret
te C
onsu
mpt
ion
0
10
20
30
40
50
60
70
80
90
100
Age
-Adj
uste
d Lu
ng C
ance
r D
eath
R
ates
*
*Age-adjusted to 2000 US standard population. Source: Death rates: US Mortality Public Use Tapes, 1960-2000, US Mortality Volumes, 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002. Cigarette consumption: US Department of Agriculture, 1900-2000.
Per capita cigarette consumption
Male lung cancer death rate
Female lung cancer death rate
Trends in Cigarette Smoking Prevalence* (%), by Gender, Adults 18 and Older, US,
1965-2001
*Redesign of survey in 1997 may affect trends.Source: National Health Interview Survey, 1965-2001, National Center for Health Statistics, Centers for Disease Control and Prevention, 2003.
0
10
20
30
40
50
6019
65
1974
1979
1983
1985
1990
1992
1994
1995
1997
1998
1999
2000
2001
Year
Pre
vale
nce
(%
)
Men
Women
Trends in per capita cigarette consumption for selected states and the average consumption across all states,
1980-2001
0
20
40
60
80
100
120
140
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Year
Per
Capita S
ale
s (
# o
f P
acks)
United States
Massachusetts
California
Data from: Orzechowski W, Walker RC. The tax burden on tobacco: historical compilation 2001: impact and opportunity, Volume 36. Arlington (VA): Orzechowski and Walker; 2001. Reprinted with permission. Source: Weir et al. Annual report to the nation on the status of cancer, 1975-2000, featuring the uses of surveillance data for cancer prevention and control. J Natl Cancer Inst 2003; 95:1276-1299
Current* Cigarette Smoking Prevalence (%), by Gender and Race/Ethnicity, High School Students, US, 1991-2001
*Smoked cigarettes on one or more of the 30 days preceding the survey.Source: Youth Risk Behavior Surveillance System, 1991, 1995, 1997, 1999, 2001, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002.
28
35
31
13
16
3230
1114
23
40
37
12
28
33
4040
17
32
36
28
34
39 38
22
32
18
33
2726
0
10
20
30
40
50
White, non-Hispanic Female
White, non-Hispanic Male
AfricanAmerican, non-
Hispanic Female
AfricanAmerican, non-Hispanic Male
Hispanic Female Hispanic Male
Pre
vale
nce (
%)
1991 1995 1997 1999 2001
Trends in Consumption of Five or More Recommended Vegetable and Fruit Servings for Cancer Prevention, Adults
18 and Older, US, 1994-2002
Note: Data from participating states and the District of Columbia were aggregated to represent the United States.Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape (2000), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2001.
24.2 24.4 24.1 24.4 24.5
0
5
10
15
20
25
30
35
1994 1996 1998 2000 2002
Year
Pre
vale
nce
(%)
Trends in Leisure-Time Physical Activity Prevalence (%), by Educational Attainment, Adults 18 and Older,
US, 1992-2002
Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Educational attainment is for adults 25 and older.Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape (2000), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2001.
05
1015202530354045505560
1992
1994
1996
1998
2000
2002
Year
Prev
alen
ce (%
)Adults with less than a high school education
All adults
Trends in Overweight* Prevalence, Children and Adolescents, by Age Group (%), US, 1971-2000
*Overweight is defined as at or above the 95th percentile for body mass index by age and sex based on reference data. Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2000, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002.
54
55
7 67
11
5
10
15
11
0
5
10
15
20
2 to 5 years 6 to 11 years 12 to 19 years
Pre
vale
nce
(%
)
NHANES I (1971-74) NHANES II (1976-80) NHANES III (1988-94) NHANES 1999-2000
Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20 to 74, US, 1960-2000
*Obesity is defined as a body mass index of 30 kg/m2 or greater. Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2000, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002.
1311
1615
12
1715
13
17
2321
26
31
28
34
0
5
10
15
20
25
30
35
40
45
Both sexes Men Women
Pre
vale
nce
(%)
NHES I (1960-62) NHANES I (1971-74) NHANES II (1976-80)
NHANES III (1988-94) NHANES 1999-2000
Important trends affecting cancer control
Aging population
Diverse population
Revolution in communication and informatics
Discovery in molecular biology and genetics
Changes in health care delivery
Cancer control research directions for the 21st century
Basic research of behavioral, social & biological mechanisms
Informatics and communication
Prevention across the lifespan (modifiable risk factors)
Cancer screening
Health care delivery systems
Survivorship
Underserved populations
Methods research
Genetic predisposition and gene-environment interaction
Chemoprevention
Conferences
• American Society of Preventive Oncology
• American Society of Clinical Oncology
• American Association for Cancer Research