Descriptive Epidemiology and Cancer Prevention and Control

Resa M. Jones, M.P.H., Ph.D.

Special Topic: Cancer Control

January 23, 2006

rmjones2@vcu.edu

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