EPIDEMIOLOGIA – GENERALITA’L’incidenza (o morbidità) si riferisce alla percentuale di popolazione in cui si sviluppa la malattia durante un dato periodo di tempo.

INCIDENZA: Numero di nuovi casi di tumori individuati in un dato periodo di

tempo

______________________________

Numero di persone a rischio durante quel dato periodo

Abitualmente l’incidenza viene espressa in numero di nuovi casi per 100.000 persone per anno

EPIDEMIOLOGIA – GENERALITA’La prevalenza del cancro si riferisce alla percentuale di persone in una popolazione affetta dalla malattia, in un determinato momento

PREVALENZA: Numero di persone affette da tumore in un momento specifico

______________________________

Numero totale di persone valutabili in quel momento specifico

La prevalenza viene espressa abitualmente come totale dei casi vecchi e nuovi di cancro per 100.000 persone.

EPIDEMIOLOGIA – GENERALITA’La frequenza relativa si riferisce alla percentuale di casi di un tipo di cancro rapportata a tutti i casi di cancro rilevati in una popolazione

FREQUENZA RELATIVA: Numero di persone affette da un certo tipo di tumore

____________________________

Totale delle persone affette da cancro

L’abitualmente l’incidenza viene espressa abitualmente in numero di nuovi casi per 100.000 persone per anno

EPIDEMIOLOGIA – GENERALITA’Il tasso di mortalità si riferisce alla percentuale di persone che muore di cancro in un dato periodo di tempo

TASSO DI MORTALITA’: Numero di persone che muoiono di tumore in un

dato periodo

______________________________

Numero di persone a rischio durante lo stesso periodo

La mortalità viene abitualmente espressa in numero di decessi causati da cancro per 100.000 persone per anno

EPIDEMIOLOGIA – GENERALITA’Il tasso di mortalità specifica per classi di età o tasso relativo all’età si basa sul numero di soggetti di un particolare gruppo di età nel quale si sviluppa il cancro in un determinato periodo di tempo.

TASSO RELATIVO ALL’ETA’:

Numero di persone di una particolare età nel quale si

sviluppa il tumore

______________________________

Numero totale delle persone di quel particolare gruppo di età

EPIDEMIOLOGIA – GENERALITA’Il tasso di standardizzazione relativo all’età si calcola

riferendo il tasso relativo all’età ad una ipotetica popolazione standard. Abitualmente si calcola più di un tasso di standardizzazione relativo all’età:

1) Tasso di standardizzazione africano (alta percentuale di giovani)

2) Tasso mondiale ed europeo (alta percentuale di persone più anziane)

Questi tassi standardizzati permettono di confrontare i dati raccolti in tutto il mondo, il che è un’impresa che, con i dati bruti, sarebbe pressoché impossibile effettuare.

Cancer Statistics 2006A Presentation From the American Cancer Society

©2006, American Cancer Society, Inc.

US Mortality, 2003

Source: US Mortality Public Use Data Tape 2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

1. Heart Diseases 685,089 28.0

2. Cancer 556,902 22.7

3. Cerebrovascular diseases 157,689 6.4

4. Chronic lower respiratory diseases 126,382 5.2

5. Accidents (Unintentional injuries) 109,277 4.5

6. Diabetes mellitus 74,219 3.0

7. Influenza and pneumonia 65,163 2.7

8. Alzheimer disease 63,457 2.6

9. Nephritis 42,453 1.7

10. Septicemia 34,069 1.4

Rank Cause of DeathNo. of deaths

% of all deaths

Change in the US Death Rates* by Cause, 1950 & 2003

* Age-adjusted to 2000 US standard population.Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised.2003 Mortality Data: US Mortality Public Use Data Tape, 2003, NCHS, Centers for Disease Control and Prevention, 2006

21.9

180.7

48.1

586.8

193.9

53.3

190.1

231.6

0

100

200

300

400

500

600

HeartDiseases

CerebrovascularDiseases

Pneumonia/Influenza

Cancer

1950

2003

Rate Per 100,000

2006 Estimated US Cancer Deaths*

ONS=Other nervous system.Source: American Cancer Society, 2006.

Men291,270

Women273,560

26% Lung & bronchus

15% Breast

10% Colon & rectum

6% Pancreas

6% Ovary

4% Leukemia

3% Non-Hodgkin lymphoma

3% Uterine corpus

2% Multiple myeloma

2% Brain/ONS

23% All other sites

Lung & bronchus 31%

Colon & rectum 10%

Prostate 9%

Pancreas 6%

Leukemia 4%

Liver & intrahepatic 4%bile duct

Esophagus 4%

Non-Hodgkin 3% lymphoma

Urinary bladder 3%

Kidney 3%

All other sites 23%

Trends in the Number of Cancer Deaths Among Men and Women, US, 1930-2003

0

50,000

100,000

150,000

200,000

250,000

300,000

1930 1940 1950 1960 1970 1980 1990 2000

Women

Men

Nu

mb

er o

f C

ance

r D

eath

s

265,000

270,000

275,000

280,000

285,000

290,000

2000 2001 2002 2003

Men

Women

Source: US Mortality Public Use Data Tape, 2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

Cancer Death Rates*, All Sites Combined, All Races, US, 1975-2002

*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Mortality - All COD, Public-Use With State, Total U.S. (1969-2002), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2005. Underlying mortality data provided by NCHS (www.cdc.gov/nchs).

0

50

100

150

200

250

300

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

Men

Both Sexes

Rate Per 100,000

Women

Cancer Death Rates*, for Men, US,1930-2002

*Age-adjusted to the 2000 US standard population.Source: US Mortality Public Use Data Tapes 1960-2002, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2005.

0

20

40

60

80

100

1930

1935

1940

1945

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

Lung

Colon & rectum

Stomach

Rate Per 100,000

Prostate

Pancreas

LiverLeukemia

Cancer Death Rates*, for Women, US,1930-2002

*Age-adjusted to the 2000 US standard population.Source: US Mortality Public Use Data Tapes 1960-2002, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2005.

0

20

40

60

80

100

1930

1935

1940

1945

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

Lung

Colon & rectum

Uterus

Stomach

Breast

Ovary

Pancreas

Rate Per 100,000

242.5

148.0159.7164.5

194.3

99.4113.8 111.0

339.4

171.4

0

50

100

150

200

250

300

350

400

White AfricanAmerican

Asian/PacificIslander

AmericanIndian/ Alaskan

Native

Hispanic†

Men Women

*Per 100,000, age-adjusted to the 2000 US standard population.†Hispanic is not mutually exclusive from whites, African Americans, Asian/Pacific Islanders, and American Indians/Alaska Natives.Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2005.

Cancer Death Rates*, by Race and Ethnicity, US,1998-2002

All sites 339.4 242.5 1.4

Prostate 68.1 27.7 2.5

Larynx 5.2 2.3 2.3

Stomach 12.8 5.6 2.3

Myeloma 8.8 4.4 2.0

Oral cavity and pharynx 7.1 3.9 1.8

Esophagus 11.2 7.5 1.5

Liver and intrahepatic bile duct 9.5 6.2 1.5

Small intestine 0.7 0.5 1.4

Colon and rectum 34.0 24.3 1.4

Lung and bronchus 101.3 75.2 1.3

Pancreas 15.8 12.0 1.3

Cancer Sites in Which African American Death Rates* Exceed White Death Rates* for Men, US, 1998-2002

*Per 100,000, age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and Population Sciences, National Cancer Institute, 2005.

Site African American WhiteRatio of African American/White

All sites 194.3 164.5 1.2

Stomach 6.3 2.8 2.3

Myeloma 6.5 2.9 2.2

Uterine cervix 5.3 2.5 2.1

Esophagus 3.2 1.7 1.9

Larynx 0.9 0.5 1.8

Uterine corpus 7.0 3.9 1.8

Small intestine 0.5 0.3 1.7

Pancreas 12.6 9.0 1.4

Colon and rectum 24.1 16.8 1.4

Liver and intrahepatic bile duct 3.8 2.7 1.4

Breast 34.7 25.9 1.3

Urinary bladder 2.9 2.3 1.3

Gallbladder 1.0 0.8 1.3

Oral cavity and pharynx 1.9 1.6 1.2

Cancer Sites in Which African American Death Rates* Exceed White Death Rates* for Women, US, 1998-2002

*Per 100,000, age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and Population Sciences, National Cancer Institute, 2005.

Site African American WhiteRatio of African American/White

0

50

100

150

200

250

300

350

400

450

500

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

African American men

White men

African American women

White women

Rate Per 100,000

Cancer Death Rates* by Sex and Race, US, 1975-2002

*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2005.

2006 Estimated US Cancer Cases*

*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.Source: American Cancer Society, 2006.

Men720,280

Women679,510

31% Breast

12% Lung & bronchus

11% Colon & rectum

6% Uterine corpus

4% Non-Hodgkin lymphoma

4% Melanoma of skin

3% Thyroid

3% Ovary

2% Urinary bladder

2% Pancreas

22% All Other Sites

Prostate 33%

Lung & bronchus 13%

Colon & rectum 10%

Urinary bladder 6%

Melanoma of skin 5%

Non-Hodgkin4% lymphoma

Kidney 3%

Oral cavity 3%

Leukemia 3%

Pancreas 2%

All Other Sites 18%

Cancer Incidence Rates*, All Sites Combined, All Races, 1975-2002

*Age-adjusted to the 2000 US standard population and adjusted for delay in reporting.Source: Surveillance, Epidemiology, and End Results Program, 1973-2002, Division of Cancer Control and Population Sciences, National Cancer Institute, 2005.

0

100

200

300

400

500

600

700

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

Both Sexes

Men

Women

Rate Per 100,000

Cancer Incidence Rates* for Men, 1975-2002

*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and Population Sciences, National Cancer Institute, 2005.

0

50

100

150

200

250

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

Prostate

Lung

Colon and rectum

Urinary bladder

Non-Hodgkin lymphoma

Rate Per 100,000

Melanoma of the skin

Cancer Incidence Rates* for Women, 1975-2002

*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and Population Sciences, National Cancer Institute, 2005.

0

50

100

150

200

250

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

Colon and rectum

Rate Per 100,000

Breast

Lung

Uterine CorpusOvary

Non-Hodgkin lymphoma

Cancer Incidence Rates* by Race and Ethnicity, 1998-2002

*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, 1975-2002, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2005.

556.4

383.5

255.4

429.3398.5

303.6

220.5

310.9

682.6

420.7

0

100

200

300

400

500

600

700

800

White African American Asian/Pacific Islander American Indian/Alaska Native

Hispanic†

Men Women

Rate Per 100,000

Cancer Incidence Rates* by Sex and Race, All Sites, 1975-2002

*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2005.

0

100

200

300

400

500

600

700

800

900

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

African-American men

White men

White women

African-American women

Rate Per 100,000

* For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 2000 to 2002.

Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.0 Statistical Research and Applications Branch, NCI, 2005. http://srab.cancer.gov/devcan

Lifetime Probability of Developing Cancer, by Site, Men, 2000-2002*

† All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder .

Site Risk

All 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 52

Kidney 1 in 64

Leukemia 1 in 67

Oral Cavity 1 in 73

Stomach 1 in 82

‡ Includes invasive and in situ cancer cases

Lifetime Probability of Developing Cancer, by Site, Women, US, 2000-2002*

Site Risk

All sites† 1 in 3

Breast 1 in 8

Lung & bronchus 1 in 17

Colon & rectum 1 in 18

Uterine corpus 1 in 38

Non-Hodgkin lymphoma 1 in 55

Ovary 1 in 68

Melanoma 1 in 77

Pancreas 1 in 79

Urinary bladder‡ 1 in 88

Uterine cervix 1 in 135

Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.0 Statistical Research and Applications Branch, NCI, 2005. http://srab.cancer.gov/devcan

* For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 2000 to 2002.† All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder .‡ Includes invasive and in situ cancer cases

All Sites 66 56 10

Breast (female) 90 76 14

Colon 65 55 10

Esophagus 16 10 6

Leukemia 49 38 11

Non-Hodgkin lymphoma 61 52 9

Oral cavity 62 40 22

Prostate 100 97 3

Rectum 65 56 9

Urinary bladder 83 64 19

Uterine cervix 75 66 9

Uterine corpus 86 62 24

Cancer Survival*(%) by Site and Race,1995-2001

*5-year relative survival rates based on cancer patients diagnosed from 1995 to 2001 and followed through 2002. Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2005.

Site White%

DifferenceAfrican

American

Five-year Relative Survival (%)* during Three Time Periods By Cancer Site

*5-year relative survival rates based on follow up of patients through 2002. †Recent changes in classification of ovarian cancer have affected 1995-2001 survival rates.Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2005.

 

 

 

Site 1974-1976 1983-1985 1995-2001All sites 50 53 65

Breast (female) 75 78 88

Colon 50 58 64

Leukemia 34 41 48

Lung and bronchus 12 14 15

Melanoma 80 85 92

Non-Hodgkin lymphoma 47 54 60

Ovary 37 41 45

Pancreas 3 3 5

Prostate 67 75 100

Rectum 49 55 65

Urinary bladder 73 78 82

†

Cancer Incidence & Death Rates* in Children 0-14 Years, 1975-2002

0

2

4

6

8

10

12

14

16

18

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

Incidence

Mortality

Rate Per 100,000

*Age-adjusted to the 2000 Standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and Population Sciences, National Cancer Institute, 2005.

Cancer Incidence Rates* in Children 0-14 Years, by Site, 1998-2002

*Per 100,000, age-adjusted to the 2000 US standard population.ONS = Other nervous systemSource: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and Population Sciences, National Cancer Institute, 2005.

Site Male Female Total

All sites 15.6 14.3 15.0

Leukemia 4.9 4.2 4.6

Acute Lymphocytic 3.9 3.4 3.6

Brain/ONS 3.6 3.3 3.5

Soft tissue 1.1 0.9 1.0

Non-Hodgkin lymphoma 1.2 0.6 1.0

Kidney and renal pelvis 0.8 1.0 0.9

Bone and Joint 0.6 0.6 0.6

Hodgkin lymphoma 0.6 0.5 0.5

Cancer Death Rates* in Children 0-14 Years, by Site, US, 1998-2002

*Per 100,000, age-adjusted to the 2000 US standard population.ONS = Other nervous systemSource: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and Population Sciences, National Cancer Institute, 2005.

Site Male Female Total

All sites 2.7 2.3 2.5

Leukemia 0.8 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

Bone and Joint 0.1 0.1 0.1

Kidney and Renal pelvis 0.1 0.1 0.1

Trends in Survival, Children 0-14 Years, All Sites Combined1974-2001

*5-year relative survival rates, based on follow up of patients through 2002.Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2005.

5 - Year Relative Survival Rates *AgeYear ofDiagnosis

1974 - 1976

1995 - 2001

1974 - 1976

1995 - 2001

0 - 4 Years

1974 - 1976

1995 - 2001

5 - 9 Years

10 - 14 Years

Tobacco Use in the US, 1900-2002

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 C

igar

ette

Con

sum

ptio

n

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, 1960-2002, US Mortality Volumes, 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2005. Cigarette consumption: US Department of Agriculture, 1900-2002.

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, 1965-2004

*Redesign of survey in 1997 may affect trends.Source: National Health Interview Survey, 1965-2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2005.

0

10

20

30

40

50

60

1965

1974

1979

1983

1985

1990

1992

1994

1995

1997

1998

1999

2000

2001

2002

2003

2004

Year

Pre

vale

nce

(%

)

Men

Women

Trends in per capita cigarette consumption for selected states and the average consumption across all states, 1980-2003

0

20

40

60

80

100

120

140

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002

Year

Per Cap

ita

Sale

s (#

of Pa

cks) United States

Massachusetts

California

Data from: Orzechowski W, Walker RC. The tax burden on tobacco: historical compilation 2003: Volume 36. Arlington (VA): Orzechowski and Walker; 2003.

Current* Cigarette Smoking Prevalence (%), by Gender and Race/Ethnicity, High School Students, US, 1991-2003

*Smoked cigarettes on one or more of the 30 days preceding the survey.Source: Youth Risk Behavior Surveillance System, 1991, 1995, 1997, 1999, 2001, 2003, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2004.

28

35

31

13

16

27

23

11

19 18 19

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-HispanicFemale

White, non-Hispanic Male

AfricanAmerican, non-

HispanicFemale

AfricanAmerican, non-Hispanic Male

HispanicFemale

Hispanic Male

Pre

va

len

ce

(%

)

1991 1995 1997 1999 2001 2003

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, 2003), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2001, 2004.

24.2 24.4 24.1 24.4 23.6

0

5

10

15

20

25

30

35

1994 1996 1998 2000 2003

Year

Pre

vale

nce

(%)

Trends in Consumption of Five or More Recommended Vegetable and Fruit Servings for Cancer Prevention, Adults 18 and Older, US, 1994-2003

Trends in Prevalence (%) of No Leisure-Time Physical Activity, by Educational Attainment, Adults 18 and Older, US, 1992-2004

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, 2002, 2004), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2001, 2003, 2005.

05

1015202530354045505560

1992

1994

1996

1998

2000

2002

2003

2004

Year

Pre

vale

nce

(%)

Adults with less than a high school education

All adults

Trends in Prevalence (%) of High School Students Attending PE Class Daily, by Grade, US, 1991-2003

9th

10th

11th

12th

0

10

20

30

40

50

60

70

1991 1993 1995 1997 1999 2001 2003

Year

Pre

va

len

ce

(%

)

Source: Youth Risk Behavior Surveillance System, 1991-2003, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2004. MMWR 2004;53(36):844-847.

Trends in Overweight* Prevalence (%), Children and Adolescents, by Age Group, US, 1971-2002

*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 and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004.

54

65

7

5

7

11 1110

16 16

0

5

10

15

20

2 to 5 years 6 to 11 years 12 to 19 years

Pre

va

len

ce

(%

)

NHANES I (1971-74) NHANES II (1976-80) NHANES III (1988-94) NHANES 1999-2002

Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20 to 74, US, 1960-2002†

*Obesity is defined as a body mass index of 30 kg/m2 or greater. † Age adjusted to the 2000 US standard population. Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004.

1311

1615

12

1715

13

17

2321

26

3128

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 1999-2002

Trends in Overweight* Prevalence (%), Adults 18 and Older, US, 1992-2004

1992 1995

1998

Less than 50% 50 to 55% More than 55% State did not participate in survey

*Body mass index of 25.0 kg/m2or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995, 1998) and Public Use Data Tape (2004), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 2000, 2005.

2004

Screening Guidelines for the Early Detection of Breast Cancer, American Cancer Society

Yearly mammograms are recommended starting at age 40.

A clinical breast exam should be part of a periodic health exam, about every three years for women in their 20s and 30s, and every year for women 40 and older.

Women should know how their breasts normally feel and report any breast changes promptly to their health care providers. Breast self-exam is an option for women starting in their 20s.

Women at increased risk (e.g., family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (i.e., breast ultrasound and MRI), or having more frequent exams.

Mammogram Prevalence (%), by Educational Attainment and Health Insurance Status, Women 40 and Older, US, 1991-2004

*A mammogram within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States.Source: Behavior Risk Factor Surveillance System CD-ROM (1984-1995, 1996-1997, 1998, 1999) and Public Use Data Tape (2000, 2002, 2004), National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005.

0

10

20

30

40

50

60

70

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2002 2004

Year

Pre

va

len

ce

(%

)

Women with less than a high school education

Women with no health insurance

All women 40 and older

Screening Guidelines for the Early Detection of Cervical Cancer, American Cancer Society

Screening should begin approximately three years after a women begins having vaginal intercourse, but no later than 21 years of age.

Screening should be done every year with regular Pap tests or every two years using liquid-based tests.

At or after age 30, women who have had three normal test results in a row may get screened every 2-3 years. However, doctors may suggest a woman get screened more frequently if she has certain risk factors, such as HIV infection or a weakened immune system.

Women 70 and older who have had three or more consecutive Pap tests in the last ten years may choose to stop cervical cancer screening.

Screening after a total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer.

Trends in Recent* Pap Test Prevalence (%), by Educational Attainment and Health Insurance Status, Women 18 and Older, US, 1992-2004

* A Pap test within the past three years. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Educational attainment is for women 25 and older.Source: Behavior Risk Factor Surveillance System CD-ROM (1984-1995, 1996-1997, 1998, 1999) and Public Use Data Tape (2000, 2002, 2004), National Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005.

0

20

40

60

80

100

1992 1993 1994 1995 1996 1997 1998 1999 2000 2002 2004Year

Pre

vale

nce

(%

)

Women with no health insurance

Women with less than a high school education

All women 18 and older

Screening Guidelines for the Early Detection of Colorectal Cancer, American Cancer Society

Beginning at age 50, men and women should follow one of the following examination schedules:

A fecal occult blood test (FOBT) every year

A flexible sigmoidoscopy (FSIG) every five years

Annual fecal occult blood test and flexible sigmoidoscopy every five years*

A double-contrast barium enema every five years

A colonoscopy every ten years

*Combined testing is preferred over either annual FOBT or FSIG every 5 years alone.

People who are at moderate or high risk for colorectal cancer should talk with a doctor about a different testing schedule

20

16

8

21

16

9

18

12

22

16

9

19

14

9

24

0

5

10

15

20

25

30

Total Less than a high schooleducation

No health insurance

Pre

va

len

ce

(%

)

1997 1999 2001 2002 2004

Trends in Recent* Fecal Occult Blood Test Prevalence (%), by Educational Attainment and Health Insurance Status, Adults 50 Years and Older, US, 1997-2004

*A fecal occult blood test within the past year. 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 (1996-1997, 1999) and Public Use Data Tape (2001, 2002, 2004), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention and Prevention, 1999, 2000, 2002, 2003, 2005.

3128

16

34

29

16

39

32

17

41

33

18

45

36

19

0

5

10

15

20

25

30

35

40

45

50

Total Less than a high schooleducation

No health insurance

Prev

alen

ce (%

)

1997 1999 2001 2002 2004

Trends in Recent* Flexible Sigmoidoscopy or Colonoscopy Prevalence (%), by Educational Attainment and Health Insurance Status, Adults 50 Years and Older, US, 1997-2004

*A flexible sigmoidoscopy or colonoscopy within the past five years. 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 (1996-1997, 1999) and Public Use Data Tape (2001, 2002, 2004), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention and Prevention, 1999, 2000, 2002, 2003, 2005.

Screening Guidelines for the Early Detection of Prostate Cancer, American Cancer Society

The prostate-specific antigen (PSA) test and the digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have a life expectancy of at least 10 years.

Men at high risk (African-American men and men with a strong family history of one or more first-degree relatives diagnosed with prostate cancer at an early age) should begin testing at age 45.

For men at average risk and high risk, information should be provided about what is known and what is uncertain about the benefits and limitations of early detection and treatment of prostate cancer so that they can make an informed decision about testing.

58

46

30

42

28

52

39

25

55

0

10

20

30

40

50

60

70

Total Less than a high schooleducation

No health insurance

Pre

va

len

ce

(%

)

2001 2002 2004

Recent* Prostate-Specific Antigen (PSA) Test Prevalence (%), by Educational Attainment and Health Insurance Status, Men 50 Years and Older, US, 2001-2004

*A prostate-specific antigen (PSA) test within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System Public Use Data Tape (2001, 2002, 2004), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002, 2003, 2005.

57

44

29

53

42

26

50

37

22

0

10

20

30

40

50

60

Total Less than a high schooleducation

No health insurance

Pre

va

len

ce

(%

)

2001 2002 2004

Recent* Digital Rectal Examination (DRE) Prevalence (%), by Educational Attainment and Health Insurance Status, Men 50 Years and Older, US, 2001-2004

*A digital rectal examination (DRE) within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System Public Use Data Tape (2001, 2002, 2004), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002, 2003, 2005.

Sunburn* Prevalence (%) in the Past Year, Adults 18 and Older, US, 1999

44.1

35.3

27.4

23.5

13.3

18.0

11.0

5.3 5.1

22.0

0

5

10

15

20

25

30

35

40

45

50

Male Female

Ag

e-A

dju

ste

d P

rev

ale

nc

e (

%)

White non-Hispanic

AmericanIndian/AlaskanNative

Other

Asian/ PacificIslander

Black non-Hispanic

*Reddening of any part of the skin (regardless of size) for more than 12 hours. Source: Saraiya et al. Am J Prev Med 2002;23(2). Note: The overall prevalence of sunburn among adult males is 39.7% and among females is 28.8%. Behavioral Risk Factor Surveillance System CD-ROM, 1999. National Center for Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2000.

Sunburn* Prevalence (%) During the Past Summer, Youth 11-18, US, 1998

70.874.1

85.5

77.2

64.1

58.4

36.7

70.874.1

55.2

0

10

20

30

40

50

60

70

80

90

Male

FemaleWhite

BlackOther

American In

dian

Asian/Pacific Islander

Low Sun Sensitivity

Medium Sun Sensitivity

High Sun Sensitivity

Pre

va

len

ce

(%

)

*Any reddening of the skin that lasts for at least 12 hours from either exposure to the sun or from a tanning booth or sunlamp. Note: Prevalence estimates for racial/ethnic categories other than white may not be stable due to small sample sizes and have wide confidence intervals. Source: Davis et al. Pediatrics 2002;110(1).

Thank you