2001 Annual Report

Executive Summary

A. Overview

Each day in 2001, 46 Oregonians were diagnosed with an invasive*, reportable** cancer and 19 Oregonians died due to malignant tumors. Cancer risk increases with age, and Oregon?s population is aging. Consequently, there is the potential for an upsurge in cancer incidence and mortality. However, by controlling modifiable risk factors (see Cancer Risks) and appropriately screening for cancers that can be detected at an early stage (see Cancer Screening and Prevention), Oregonians can help reduce their burden of cancer.


Cancer Leading Cause of Death Among Oregonians

In 2000, a long-standing trend was broken when deaths due to cancers surpassed heart disease to become the leading cause of death among Oregonians***. (See Figure 1.)

Mortality rates due to cancers**** have been declining by 1% a year since 1996 while heart disease mortality has been declining by 4% a year. The 3rd leading cause of death, cerebrovascular disease (stroke), has been declining 2% a year. In 2001, the mortality rate for all cancers combined was 198.4; the rate was 194.6 for heart disease and 71.1 for stroke.

Leading Cancer Sites

Breast Cancer is the most common reportable malignancy, with 2,761 invasive cases diagnosed among women and 16 among men in 2001. Breast cancer is the 3rd leading cause of cancer death in Oregon. Though Oregon has one of the highest female breast cancer incidence rates in the nation, the mortality rate due to female breast cancer mirrors that seen nationally. Appropriate screening through breast exams and mammography could decrease the number of women diagnosed at advanced stages of disease and, thereby, decrease mortality.

Prostate Cancer is the 2nd most common reportable malignancy, with 2,657 cases diagnosed in 2001. It is also the 4th leading cause of cancer death in Oregon. Currently, the causes of prostate cancer are poorly understood, and there is no consensus on the benefit of prostate cancer screening.

Lung Cancer is the 3rd most common reportable malignancy, with 2,476 cases diagnosed in 2001. Lung cancer is the leading cause of cancer death in Oregon. At present there are no effective early detection tools for lung cancer, so this malignancy is often diagnosed at an advanced stage, resulting in a poor prognosis. Tobacco use is the single, greatest risk factor for lung cancer. In 2001, tobacco use was implicated in over 80% of lung cancer deaths. Although lung cancer incidence rates among Oregon men are similar to those seen nationally, Oregon women have a rate nearly 27% higher than the national average among women. Decreasing tobacco use in Oregon could significantly lower lung cancer incidence and mortality.

Colorectal Cancer is the 4th most common reportable malignancy, with 1,712 cases diagnosed in 2001. Colorectal cancer is the 2nd most common cause of cancer death among Oregonians. Routine screening can reduce both the incidence and mortality of colorectal cancer through early detection and removal of precancerous polyps.

Urinary Bladder Cancer is the 5th most common reportable malignancy with 854 cases diagnosed in 2001. Smoking is the greatest risk factor for bladder cancer. Exposure to chemicals in the workplace can also increase the risk for bladder cancer if safety measures are not taken. Workers at highest risk are rubber, leather, textiles, and paint products workers as well as hairdressers, machinists, printers and truck drivers. Although there are no screening tests, blood in the urine is an early sign of bladder cancer. Having the bladder checked by a health care provider at the first sign of blood in the urine can catch bladder cancer in the earliest and most treatable stage.

Malignant Melanomas are the 6th most common reportable malignancy with 832 cases diagnosed in 2001. Melanomas diagnosed at an early stage have an excellent prognosis. Oregon has one of the highest melanoma incidence rates in the nation and a higher melanoma mortality rate than the national average. Incidence rates have been fairly flat nationally, but melanomas have been increasing 5% annually in Oregon since 1996. Sun avoidance, particularly during childhood, is the best protective measure against developing melanomas.

B. Oregon Historical Cancer Trends
(1996-2001)

The following historical trends include six years of data. These trends differ slightly from the current, five-year trends presented in other areas of this report, specifically the Fast Facts tables and Tables 1-4 because they include an additional year of data. Trends are affected by a number of factors including the following: general reporting improvements from early years,

• site-specific reporting deficiencies in recent years as more sites are being treated outside of the rigorous hospital reporting system,
• changes in reporting requirements and/or coding standards,
• changes in characteristics of underlying populations, natural fluctuations, and true changes in population risk and/or burden.

• All Cancers incidence for all invasive cancers combined has increased in Oregon by 1% annually since 1996. This matches the national upward trend of 1% annually for years 1995-2000. Mortality for all cancers combined decreased in Oregon 1% a year from 1996-2001. This was similar to the national annual decrease from 1992-2000, but slightly higher than the recent <0.5% decrease nationally from 1998-2000.
  
  
• Female Breast Cancer incidence has increased 1% annually. This was equal to the national increase of 1% annually for years 1986-2000. Female breast cancer death rates decreased 2% annually. This decrease paralleled the national annual decrease for years 1990-2000.



• Prostate Cancer incidence increased 4% annually. This was larger than the national annual increase of 2% for years 1995-2000. This difference may reflect registry efforts to increase prostate cancer reporting from physician offices rather than any increased risk for the disease among Oregon men. Prostate cancer mortality decreased 5% annually. This was slightly larger than the national decrease of 4% a year from 1994-2000.
  
  
• Lung Cancer incidence has decreased 1% annually. This decrease is analogous to the 1% annual decrease nationally for years 1991-2000. However, while lung cancer has decreased over 2% a year among Oregon men, it has increased 1% annually among Oregon women. This gender-specific disparity is also seen on the national level. While the APC was the same for all years for Oregon women, Oregon men had a faster decline from 1999-2001.
  
  Lung cancer incidence decreased 1% annually from 1996-1999 and 4% annually from 1999-2001 for men. Lung cancer mortality decreased 2% annually. This is greater than the 1% decline nationally for years 1991-2000. However, while lung cancer mortality decreased 4% annually among Oregon men, the rate increased 1% annually among Oregon women. As with incidence, this sex disparity is also seen nationally, but it is more prominent among Oregonians.
  
  
• Colorectal Cancer incidence has increased 1% annually in Oregon. Nationally, colorectal cancer incidence has been decreasing 2% annually since 1998. The increase for Oregon men was constant and nominal, <0.5% per year. Oregon women, however, had a variable APC. Initially, colorectal cancer incidence for Oregon women increased 7% a year from 1996-1999, and then the trend reversed to decrease 8% a year from 1999-2001. Colorectal cancer death rates decreased 2% a year. This was similar to the 2% annual decrease nationally for years 1984-2000. However, Oregon women had a statistically significant annual decrease of 3% annually while Oregon men showed a slight annual increase. Nationally, both men and women had an annual decline of about 2%.