tobacco-associated cancers in texas, 2006-2015€¦ · texas cancer registry tobacco-associated...

Tobacco-Associated Cancers in Texas, 2006-2015

Prepared by the Texas Cancer RegistryTexas Department of State Health Services

April 2018

Background

• Tobacco use is associated with an increased risk of cancer, including cancers of the lung, bronchus, & trachea, lip, oral cavity, & pharynx, larynx (voice box), esophagus, kidney & renal pelvis, cervix, urinary bladder, pancreas, colon & rectum, stomach, and liver, as well as acute myeloid leukemia.1

• This statistical report describes the burden of tobacco-related cancers in Texas between 2006 and 2015.

Implications for Public Health Practice

• The burden of tobacco-associated cancers can be reduced through efforts to prevent tobacco use among youth and young adults, reduce exposure to secondhand smoke through compliance and support of tobacco laws, and support smoking cessation in current smokers.

• Comprehensive cancer control strategies could help decrease the incidence of these cancers in Texas.

Texas Cancer Registry Tobacco-Associated Cancers, May 2018 2

1 Henley et al. MMWR 2016;65(44)1212-18

Tobacco Use Among Adults

• Nationally, prevalence of tobacco use has decreased since 1965, but decline has slowed in recent years.1

• In 2016, 14.3% of Texas adults self-reported as current smokers (17.3% of males and 11.3% of females), which is lower than the national average of 17.1%.2

• Highest prevalence of current smoking in Texas is among those aged 25-34 years (18.2% currently smoke).2


1 U.S. Department of Health and Human Services. Surgeon General Report, 2014. 2 Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Study, 2016.

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Tobacco Use Among Youth

• In 2016, 14.4% of high school students in Texas used e-cigarettes and 10.6% used regular cigarettes.1

• The full health effects of e-cigarettes are unknown, as they still contain several harmful ingredients including nicotine, benzene, diacetyl, ultrafine particles, and heavy metals.


1 Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA). National Youth Tobacco Survey 2011-2016.

National High School Tobacco Use1

Tobacco-Related Health Effects

• Tobacco is the leading cause of preventable disease, disability, and death in United States, causing cancer, heart disease, stroke, lung disease, diabetes, and chronic obstructive pulmonary disease (COPD).1

• Tobacco use causes 1 in 5 deaths in the U.S. every year, totaling almost half a million deaths in 2017.

• While tobacco-related cancer deaths have decreased substantially since the 1980s, 3 in 10 cancer deaths are still caused by smoking.


1 U.S. Department of Health and Human Services. Surgeon General Report, 2014. Figure: National Vital Statistics System, CDC. 2017. Retrieved from https://www.cdc.gov/vitalsigns/cancerandtobacco/infographic.html

Tobacco-Related Health Effects in Texas

• Texas had the 13th lowest incidence rate of tobacco-related cancers in the U.S. from 2009-2013 (184 annual cases per 100,000).

• 27% of cancer deaths in 2014 among Texas adults 35 years of age or older were attributed to smoking (32% in males, 21% in females).1


1 Lortet-Tieulent et al. JAMA Intern Med. 2016;176(12):1792-1798.Figure: National Vital Statistics System, CDC. 2017. Retrieved from https://www.cdc.gov/vitalsigns/cancerandtobacco/infographic.html

Tobacco Use and Cancer

• Tobacco use is a key modifiable risk factor for cancer, with cigarette smoking contributing approximately 19% of all new cancer cases and 29% of all cancer deaths.1

• A high proportion of lung cancers (82%), laryngeal cancers (74%), lip, oral cavity & pharyngeal cancers (including nasal, 49%), esophageal cancer (50%), and bladder cancers (47%) are attributable to cigarette smoking.1


1 Islami et al. CA Cancer J Clin. 2018;68(1):31-54.Figure: Cancer and Tobacco Use, CDC. Retrieved from https://www.cdc.gov/vitalsigns/pdf/2016-11-vitalsigns.pdf

Tobacco Use and Cancer

• Tobacco use is attributed to a higher proportion of cancer cases than any other known modifiable risk factor.

• Cigarette smoke contains more than 70 chemicals that cause cancer.

• Low levels of smoke exposure, including secondhand smoke, are harmful.

• Smoking reduces a person’s ability to fight cancers unrelated to tobacco.

• Regular smokers lose on average at least 10 years of life.


1 Islami et al. CA Cancer J Clin. 2018;68(1):31-54.

Estimated Proportion of Incident Cancer Cases Attributable to Evaluated Risk Factors in Adults 30

Years and Older in the US in 20141

Definitions/Abbreviations

• Age-adjusted incidence rate: number of new (cancer) cases diagnosed per 100,000 people per year. Numbers are age-adjusted to allow for comparison between populations with different age compositions.

• Annual percent change (APC): measures the trend in rates over time, such as how quickly (or slowly) a cancer has increased in incidence over a given time period. For example, an APC of -2.0% over 10 years means that there was a 2% decrease in incidence rate per year. It is calculated by fitting a least squares regression line to the natural logarithm of the age-adjusted rates. The slope is tested for a significant difference from 0.

• Overall rates/trends: Where tobacco-related cancers are analyzed overall as one group, incidence rates are presented including colorectal cancer, while APCCs are presented without colorectal cancer, unless otherwise specified. Colorectal cancer rates have declined substantially in recent years due to increased screening to remove pre-cancerous polyps, therefore potentially masking overall rate changes from 2006-2015.

• Population Attributable Fraction (PAF): the proportion of (cancer) cases of interest that can be attributed to a given risk factor (e.g., tobacco use) among the entire population.

• Relative risk (RR): measures the risk (of cancer) between two groups. Here, a RR>1 means there is an increase in risk associated with tobacco use.

• Race/ethnicity group acronyms: Non-Hispanic (NH), Asian/Pacific Islander (A/PI), American Indian/Alaska Native (AI/AN).

• Note on confidence intervals (CIs): A 95% CI around the rate at least as large as the rate itself is generally considered unstable. Results with large CIs should be interpreted with caution. Data for American Indian/Alaskan native are often not shown in this report due to unstable rates and large CIs.


Tobacco-Associated Cancer Incidence

The proportion of cases at each site that are estimated to be attributable to cigarette smoking varies with cancer site and ranges from 84% for male lung cancer to 9% for female pancreatic cancer.


1 Islami et al. CA Cancer J Clin. 2018;68(1):31-54

PAF (%) PAF (%) PAF (%)

Site Males Females All

Lung 84.4 78.9 81.7

Larynx 74.9 69.5 73.8

Esophagus 52.1 42.2 50.0

Oral cavity, pharynx+ 51.9 42.8 49.2

Urinary bladder 49.4 39.1 46.9

Liver 24.8 18.4 23.2

Cervix ~ 19.9 19.9

Kidney, renal pelvis 19.2 14.2 17.4

Stomach 19.4 14.3 17.4

AML 17.1 12.5 15.1

Colorectal 13.5 9.7 11.7

Pancreas 11.7 8.5 10.2

Estimated proportion of cancer cases in U.S. adults age 30 years or older in 2014 attributed to cigarette smoking1

Tobacco-Associated Cancer Incidence Rates in Texas, 2015In 2015, 44% of 105,993 new cancer cases in Texans 18 years of age or older were diagnosed at tobacco-associated sites—52% of all cancers in males and 36% of all cancers in females (although not all of these cases are attributable to tobacco).


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All tobacco-associatedsites

All sites not associatedwith tobacco

All cancer sites

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Lip, oral cavity, & pharynx

Esophagus

Stomach

Colon & rectum

Liver

Pancreas

Larynx

Trachea, lung & bronchus

Kidney & renal pelvis

Urinary bladder

Acute myeloid leukemia

Cervix Uteri

2015 Incidence Rate per 100,000

Male Female All

Tobacco-Associated Cancer Incidence Rates in Texas, 2015• The most commonly diagnosed tobacco-associated cancer sites were trachea, lung, &

bronchus cancer and colorectal cancer.

• All sites were more common in males than females (except cervical cancer which only occurs in females).


Tobacco-Associated Cancer Incidence Rates in Texas, 2006-2015• Because colorectal cancer (CRC)

incidence rates have declined due to increased screening for precancerous polyps, trends were analyzed with and without CRC.

• The overall incidence rate of tobacco-associated cancers decreased from 2006-2015 (APC -1.5% with CRC, -1.2% without CRC), and this was seen in both males and females.

• The rate of decline was significantly faster in males than females.


^ Annual percent change significantly different to 0 (p<0.05).

Tobacco-Associated Cancer Incidence Trends in Texas, 2006-2015


Overall

• The incidence rate of most sites declined from 2006 to 2015, but liver cancer, pancreatic cancer, lip, oral cavity, & pharyngeal cancer, and kidney & renal cell cancer rates increased; the largest APC increase was for liver cancer.

• Cervical cancer and acute myeloid leukemia (AML) rates remained stable.

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-5.0 -4.0 -3.0 -2.0 -1.0 0.0 1.0 2.0 3.0 4.0 5.0

All cancer sites

All sites not associated with tobacco

Tobacco sites

Tobacco sites, excl. colorectal


Esophagus

Stomach

Colon & rectum

Liver

Pancreas

Larynx


Cervix uteri


Urinary bladder


Annual Percent Change 2006-2015

All

* APC significantly different to 0 (p<0.05).

Male vs. female

• Trachea, lung, & bronchus cancers decreased significantly faster in males than females.

• Lip, oral cavity, & pharyngeal cancers increased significantly in males but not females.

• Esophageal cancer decreased significantly in males but not females.

Tobacco-Associated Cancer Incidence Trends in Texas, 2006-2015


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-8.0 -6.0 -4.0 -2.0 0.0 2.0 4.0 6.0

All cancer sites

All sites not associated with tobacco

Tobacco sites

Tobacco sites, excl. colorectal


Esophagus

Stomach

Colon & rectum

Liver

Pancreas

Larynx



Urinary bladder



Males

Females


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18-49 yrs

50-64 yrs

65-74 yrs

75+ yrs


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Female

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Tobacco-Associated Cancer Incidence Trends in Texas by Age at Diagnosis, 2006-2015


• Excluding colorectal cancer, significant declines from 2006 to 2015 were seen across all ages groups, overall, and in both males and females.

• Incidence rates declined the slowest in those aged 50-64 years (APC -0.8).

• For ages 18-49 years and 50-64 years, the incidence rate in males (APC -1.7) declined significantly faster than in females (APC -0.6).

• For ages 65-74 years and 75+ years, the rate of change did not differ significantly between males and females, although the rate in males aged 75+ years tended to decrease at a faster rate.


Tobacco-Associated Cancer Incidence Rates in Texas by Race/Ethnicity, 2015


1 Texas Youth Tobacco Survey, Texas Department of State Health Services, 2016.

• Tobacco use varies across racial/ethnic groups. In 2016, 16.5% of non-Hispanic (NH) whites, 12.3% of NH blacks, and 12.2% of Hispanics in Texas currently smoked (BRFSS).

• Among high school students in Texas, 16.9% of NH whites, 16.0% of Hispanics, and 10.2% of NH blacks smoked in past month.1

• In 2015, the highest incidence of tobacco-related cancers was among NH blacks, followed by NH whites.

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Tobacco-Associated Cancer Incidence Trends in Texas by Race/Ethnicity, 2006-2015


• Incidence rate declined significantly in all groups, except non-Hispanic American Indian/Alaska Native (NH AI/AN) females where rates increased (although confidence intervals were large).

• Significantly faster decline in NH blacks compared to NH whites (APC -1.8% vs. -0.9%). Rate in Hispanics decreased by 1.2% per year, which did not differ significantly from the APC in NH whites or NH blacks.

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Urban-Rural Classifications

The Texas Cancer Registry uses the National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Counties1 to classify population areas across the state.

Texas Cancer RegistryAlcohol-Associated Cancers, May 2018

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1NCHS Urban-Rural Classification Scheme for Counties, NCHS/CDC, Updated June 2017.

Category Definition

Metropolitan

Large central metro

Counties in metropolitan statistical areas (MSA) with populations of 1 million or more that contain entire populations in the largest principal city, have entire populations contained in largest principal city, or contain at least 250,000 inhabitants of any principal city.

Large fringe metro Counties in MSAs with populations of 1 million or more that do not qualify as large central metro counties.

Medium metro Counties in MSAs of populations between 250,000 – 999,999.

Small metro Counties in MSAs of populations less than 250,000.

Nonmetropolitan

Micropolitan Counties with an urban cluster population of 10,000-49,999.

Noncore Nonmetro counties that do not qualify as micropolitan.

Urban-Rural Classifications of Texas Counties

Texas Cancer RegistryAlcohol-Associated Cancers, May 2018

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NCHS Urban-Rural Classification Scheme for Counties, NCHS/CDC, Updated June 2017.

Tobacco-Associated Cancer Incidence Rates in Texas by Urban-Rural Classification, 2015


Incidence rates for tobacco-associated cancers were higher in small metro and non-metro (micropolitan and non-core) areas than large metro areas in 2015.

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Tobacco-Associated Cancer Incidence Trends in Texas by Urban-Rural Classification, 2006-2015


• From 2006-2015, incidence rates decreased in all except non-core areas for males.

• For females, rates decreased significantly in large central metro, large fringe metro, and medium metro areas only, and tended to increase in micropolitanareas.

• When divided into metro and non-metro areas, tobacco-associated cancers decreased significantly faster in metro areas than non-metro areas in males (APC -1.6% vs. -0.6%).

• In females, a decline in rates was seen in metro but not in non-metro areas (-1.3% vs. 0.1%). By 2015, rates were significantly higher in non-metro areas than metro areas for females.


Tobacco-Associated Cancer Incidence Rates by Site and Urban-Rural Classification, 2006-2015


Large Central Metro

Large Fringe Metro

Medium Metro

Small Metro Micropolitan Non-Core

Rate APC Rate APC Rate APC Rate APC Rate APC Rate APCLip, oral cavity, & pharynx 14.4 0.2 15.4 0.8 12.4 0.2 15.7 0.6 17.8 2.2* 16.6 1.3*Esophagus 4.8 -2.5* 5.5 -2.1* 4.4 -3.2* 7.2 0.3 6.3 -1.2 6.6 1.7Stomach 9.1 -0.8 6.9 -1.8 10.8 -0.4 7.3 -0.3 9.4 0.5 8.7 0.4Colorectal 49.4 -2.5* 46.8 -2.9* 49.4 -2.4* 55.5 -1.9* 60.1 -0.7 56.2 -1.5*Liver 15.2 2.4* 10.3 3.4* 15.4 3.2* 11.1 3.9* 14.3 4.2* 11.7 4.6*Pancreas 17.4 1.2* 17.1 0.4 14.3 0.3 16.7 1.9 18.5 0.9 15.0 2.2*

* Annual percent change significantly different from 0 Significantly decreased from 2006-2015 Significantly increased from 2006-2015

• Lip, oral cavity, & pharyngeal cancer rates tended to be higher in non-metro areas than metro areas, and increased only in non-metro areas.

• Esophageal cancer rates declined in larger metro areas, but remained stable in small metro and non-metro areas. Rates tended to be higher in small metro and non-metro areas than in larger metro areas.

• Stomach cancer rates remained stable across all areas.

• Colorectal cancer rates also declined faster in non-metro than metro areas, remaining stable in micropolitan areas. Rates were higher in small metro and non-metro areas than in larger metro areas.

• Liver cancer rates increased in all areas, but at a faster rate in non-core areas.

• Pancreatic cancer remained stable in all areas except large central metro and non-core areas where rates increased.

Tobacco-Associated Cancer Incidence Rates by Site and Urban-Rural Classification, 2006-2015


Large Central Metro

Large Fringe Metro

Medium Metro

Small Metro Micropolitan Non-Core

Rate APC Rate APC Rate APC Rate APC Rate APC Rate APCLarynx 3.6 -4.5* 3.5 -4.2* 4.1 -2.3* 4.3 -4.3* 4.2 -3.5* 5.8 -0.8Trachea, lung, & bronchus 62.1 -3.7* 68.1 -3.5* 58.3 -2.8* 85.2 -2.3* 74.3 -2.0* 83.6 -1.4*Cervix uteri 11.9 -0.1 9.6 -2.1* 14.8 0.9 13.6 -0.9 16.0 1.0 14.0 -2.3Kidney & renal pelvis 23.4 0.1 22.8 -0.3 27.5 1.7* 25.3 0.8 27.9 0.4 25.1 2.1*Urinary bladder 18.6 -2.1* 20.3 -2.1* 17.0 -1.9* 22.5 -1.5* 19.7 -1.3 21.4 -1.4*Acute myeloid leukemia 4.6 1.2 4.1 -1.4 3.8 -0.6 5.5 2.6 5.7 2.2 4.9 3.7*

• Laryngeal cancer rates declined in all areas but remained stable in non-core areas.

• Trachea, lung, & bronchus cancer declined in all areas but at a faster rate in metro than non-metro areas. Rates were higher in small metro and non-metro areas than in larger metro areas.

• Cervical cancer rates remained stable in all areas except fringe metro areas, where they declined. Rates tended to be lower in large metro and large fringe metro areas.

• Kidney cancer increased in medium metro and non-core areas but not other areas.

• Bladder cancer rates declined in all areas except micropolitan areas. Declines in rates were faster in larger metro areas.

• Acute myeloid leukemia rates remained stable in all except non-core areas, where rates increased from 2006-2015.

* Annual percent change significantly different from 0 Significantly decreased from 2006-2015 Significantly increased from 2006-2015

Site-Specific Incidence Rate Trends


Tobacco-Associated Cancers in Texas, 2006-2015

Trachea, Lung, and Bronchus Cancer Incidence Trends by Sex and Race/Ethnicity, 2006-2015

• Lung cancer is the 2nd most commonly diagnosed cancer in men (after prostate cancer) and in women (after breast cancer).

• Lung cancer is the most common tobacco-associated cancer, and the leading cause of cancer death in males and females.

• 5-year relative survival rates are low (15%).

• 82% of lung cancer cases are attributed to cigarette smoking.1

• The relative risk of trachea, lung, & bronchus cancer is as high as 23 for smokers compared to non-smokers.2

• Smokers today have a higher risk of lung cancer than 50 years ago, due to changes in composition of cigarettes.2

• Overall, the incidence rate is higher among males than females (81/100,000 vs. 55/100,000).

• The rate was highest in non-Hispanic (NH) black males, followed by NH white males.

• The fastest decline was in Hispanic males (APC -4.5%).


1 Islami et al. CA Cancer J Clin. 2018;68(1):31-54.2 U.S. Department of Health and Human Services. Surgeon General Report, 2014

^ APC significantly different to 0, p<0.05.


Trachea, Lung, and Bronchus Cancer Incidence Rates by Race/Ethnicity and Age at Diagnosis, 2015

• For most age groups, the highest incidence rate was in non-Hispanic (NH) blacks, except for adults age 75 years or older where the highest incidence rate was in NH whites.

• Hispanics had a lower rate than NH whites and NH blacks for all ages.


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Trachea, Lung, and Bronchus Cancer Incidence Trends by Race/Ethnicity and Age, 2006-2015

• There was a significant decline for most age/race/ethnicity groups.

• Overall, the largest percentage declines were seen in ages 18-49 years (-6.1%), from 6.5/100,000 to 3.7/100,000.

• The largest APC decrease was for NH blacks aged 18-49 years (-8.3%), from 9.0/100,000 to 5.2/100,000.

• In those aged 75 years and older, the overall rate declined from 418/100,000 to 333/100,000 (APC -2.5%).

• When further stratified by sex, declines were not significant for Hispanic females aged 18-49 years, or for NH black females aged 65-74 years or age 75 years or older (although these groups showed tendencies to decline).


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* Annual percent change significantly different to 0 (p<0.05).

Lip, Oral Cavity, and Pharyngeal Cancer Incidence Trends by Sex and Race/Ethnicity, 2006-2015

• 49% of lip, oral cavity, & pharynx cancers cases are attributed to smoking.1

• It was the 8th most commonly diagnosed cancer in males in 2015.

• The relative risk is 5 for female smokers and 11 for male smokers.2

• Risk is highest for those who also consume large amounts of alcohol.3

• The rate is 3x higher in males (23.1/100,000) than females (7.4/100,000 in 2015).

• Overall, rates increased in males (APC 0.8%) but not females.

• Non-Hispanic (NH) white males had the highest rate and the only significant increase (APC 1.7%).

• Second highest rate was NH blacks, who showed a stable rate (non-significant decline, APC -2.0%).


1 Islami et al. CA Cancer J Clin. 2018;68(1):31-54.2 U.S. Department of Health and Human Services. Surgeon General Report, 2014. 3 Hashibe et al. Cancer Epidemiol Biomarkers Prev. 2009;18(2):541-50.


Lip, Oral Cavity, and Pharyngeal Cancer Incidence Rates by Race/Ethnicity and Age at Diagnosis, 2015

• By age group, the highest incidence rate was in ages 65-74 years.

• By race/ethnicity, the highest incidence rate was in Non-Hispanic (NH) whites.

• Rate was higher in NH whites aged 50-64 years than NH blacks and Hispanics of any age.


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Lip, Oral Cavity, and Pharyngeal Cancer Incidence Trends by Race/Ethnicity and Age, 2006-2015

• Rate increased significantly in Non-Hispanic (NH) whites aged 50 years and older (APC 1.6%). Rate remained stable in ages less than 50 years.

• Rates tended to decrease in NH blacks, but not significantly so.

• By sex, rates increased significantly for NH white males aged 50 years and over. Rates for all other groups remained stable. Largest increase was in NH white males aged 65-74 years that increased from 62/100,000 in 2006 to 87/100,000 in 2015.



Laryngeal Cancer Incidence Rates by Race/Ethnicity and Age at Diagnosis, 2015

• 74% of larynx cancer cases are attributed to cigarette smoking.1

• The relative risk is 13 for female smokers and 14 for male smokers.2

• Laryngeal cancer accounts for less than 1% of all new cancers diagnosed.

• The incidence rate is substantially higher in males than females.

• The rate peaked at age 65-74y in non-Hispanic (NH) whites and Hispanics, and at ages 75y and over in NH blacks.

• For ages 50-64 years and ages 75 and older, the highest incidence rate is in NH blacks.

• For ages 65-74 years, the highest incidence rate is in NH whites.


1 Islami et al. CA Cancer J Clin. 2018;68(1):31-54.2 U.S. Department of Health and Human Services. Surgeon General Report, 2014.

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Laryngeal Cancer Incidence Trends by Race/ Ethnicity and Age at Diagnosis, 2006-2015

• Rates declined in most age/race/ethnic groups, but not significantly so in NH blacks aged 18-49 years and 65 and older, and Hispanics aged 75 and older.

• The largest APC decrease was seen in those aged 18-49 years, although laryngeal cancer is relatively rare in this age group, decreasing from 1.1/100,000 to 0.8 cases/100,000 by 2015 in NH whites.


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Esophageal Cancer Incidence Trends by Sex and Race/Ethnicity, 2006-2015

• 50% of esophageal cancer cases are attributed to cigarette smoking.1

• The incidence rate is higher in males than females; The relative risk in female smokers is 8 and in male smokers is 7.2

• In 2006, the incidence rate was highest in non-Hispanic (NH) black males, but declined by 6.3% per year. By 2015, the rate was highest in NH white males.

• Rates tended to increase (not significantly) in NH Asian/Pacific Islander (A/PI) males.




Esophageal Cancer Incidence Rates by Race/Ethnicity and Age at Diagnosis, 2015

Esophageal cancer incidence rates were highest in non-Hispanic whites, across all age groups.


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Esophageal Cancer Incidence Trends by Race/ Ethnicity and Age at Diagnosis, 2006-2015

• Rates decreased significantly in non-Hispanic (NH) blacks aged 50-64 years and Hispanics aged 75 years and older.

• By sex, rates tended to decrease across all groups except for NH white females aged less than 65 years where the rates tended to increase (although incidence rate is low in this group, and APC was not significantly different from 0).



Urinary Bladder Cancer Incidence Rates by Race/Ethnicity and Age at Diagnosis, 2015

• 47% of bladder cancer cases are attributed to cigarette smoking.1

• The relative risk is 2-3 for smokers.2

• The incidence rate is more than 4 times higher in males than females: 34.2/100,000 vs. 7.6/100,000, respectively.

• There is a strong increase in incidence rates with age.

• The rate is substantially higher in non-Hispanic (NH) white males than any other group.

• Incidence rate in NH whites aged 75 years and older is more than twice as high as in NH blacks or Hispanics.


1 Islami et al. CA Cancer J. Clin. 2018;68(1):31-54.2 U.S. Department of Health and Human Services. Surgeon General Report, 2014.

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*

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*

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-20

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-5

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Urinary Bladder Cancer Incidence Trends by Race/Ethnicity and Age, 2006-2015

• Rates tended to decrease across most age/race/ethnicity groups.

• Significant declines were seen in both Non-Hispanic (NH) whites and Hispanics aged 18-74 years but not in those aged 75 years and older. Rates also decreased significantly in NH blacks aged 50-64 years.

• Hispanic females aged 50-64 years tended to show an increase in rates (APC 1.95%) but this was not significantly different from 0.



Cervical Cancer Incidence Rates by Race/ Ethnicity and Age at Diagnosis, 2015

• Approximately 20% of cervical cancer cases are attributed to cigarette smoking.1 While almost all cases are caused by HPV infection, smoking increases the risk of developing cervical cancer.

• Relative risk is 1.6 for current smokers versus non-smokers.2

• Overall, the highest incidence rate was among those aged 50-64 years.

• For ages 18-49 years, the incidence rates were highest in Hispanics, followed by non-Hispanic (NH) whites.

• For age groups 50 years and older, rates decline with age for NH whites, but remain relatively high for NH blacks and Hispanics.



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Cervical Cancer Incidence Trends by Race/ Ethnicity and Age at Diagnosis, 2006-2015

• Overall, rates remained stable, but tended to decline (APC -0.4%).

• Rates tended to decrease across most age/race/ethnic groups, but only significantly so in NH whites aged 65-74 years and NH blacks aged 18-49 years.

• Rates significantly increased in NH whites aged 50-64 years (APC 2.1%), from 10.1/100,000 to 12.0/100,000.


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Liver Cancer Incidence Trends by Age at Diagnosis, 2006-2015

• 23% of liver cancer cases are attributed to cigarette smoking.1

• The relative risk for current smokers is 1.5.2

• Rates were highest for ages 75 and older until 2015, when rates among 65-74 year olds increased to similar levels.

• Rates increased for ages 50-64 years and 65-74 years.

• In 50-64 year olds, a faster increase was seen from 2006-2011 (APC 8.7%) than from 2011-2015 (APC 1.4%, not significant).



^ Annual percent changesignificantly different to 0 (p<0.05).

Liver Cancer Incidence Rates by Race/Ethnicity and Age at Diagnosis, 2015

• The incidence rate was higher in non-Hispanic (NH) blacks and Hispanics than NH whites.

• For ages 50-64 years, the incidence rate was highest for NH blacks.

• For ages 65 years and older, the rate was highest for Hispanics.


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Liver Cancer Incidence Trends by Race/ Ethnicity and Age at Diagnosis, 2006-2015

• Incidence rates decreased in Non-Hispanic (NH) whites and NH blacks aged 18-49 years old (although when stratified by sex, decrease was not seen for NH white females).

• Rates increased significantly in 50-64 and 65-74 year olds in NH whites, NH blacks, and Hispanics.

• Rates were stable among those aged 75 years and older.


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Liver Cancer Incidence Trends in 50-74 Year Olds by Sex and Race/Ethnicity, 2006-2015

• There have been large increases in liver cancer incidence rates in those aged 50-74 years. This increase has been linked to hepatitis C infection in people born 1945-1965.

• The highest rate was in Non-Hispanic (NH) black males, followed by Hispanic males.

• Large APCs (≥4%) were observed for NH white males and females, and NH black males and females.

• Rates declined in NH Asian/Pacific Islanders (A/PI).



Kidney & Renal Pelvis Cancer Incidence Rates by Race/Ethnicity and Age at Diagnosis, 2015

• 17% of cases are attributed to cigarette smoking.1

• Rates are higher in males than females.

• Kidney and renal pelvis cancer is the 5th most commonly diagnosed cancer in males.

• Relative risk is 1.3 for female current smokers and 2.7 for male current smokers (vs. non-smokers).2

• Rates increase with age, but rates are similar in ages 65-74 years and 75 years and older.

• Rates higher in Hispanics and non-Hispanic (NH) blacks than in NH whites.



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-8

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Annual Perc

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Kidney & Renal Pelvis Cancer Incidence Trends by Race/Ethnicity and Age at Diagnosis, 2006-2015

• Overall, rates increased for ages 18-49 years, in both males and females, from 5.8/100,000 to 6.7/100,000.

• For ages 18-49 years, rates increased in Non-Hispanic (NH) whites and Hispanics, with a non-significant tendency to increase in NH blacks.

• By sex, the rate increase in 18-49 year olds was seen in NH white males, and both male and female Hispanics. The highest increase was in Hispanic females (APC 3.0%) from 5.6/100,000 to 7.1/100,000.

• There was also a significant increase in rates for NH white males aged 50-64 years (APC 0.9%) from 43.6/100,000 to 48.7/100,000.

• Rates remained stable in other groups.



Colorectal Cancer Incidence Rates by Race/Ethnicity and Age at Diagnosis, 2015

• 12% of colorectal cancer cases are attributed to cigarette smoking.1

• It’s the 3rd most commonly diagnosed cancer in men (after prostate and lung cancers) and 3rd

most commonly diagnosed cancer in women (after breast and lung cancers).

• Relative risk is approximately 1.9 for current tobacco users.2

• Recent declines in incidence rates are thought to be due to increased screening efforts in those aged 50 years and over.

• For ages 18-49 years, the highest rate was in non-Hispanic (NH) whites.

• For ages over 49 years, the highest rate was in NH blacks.


1 Islami et al. CA Cancer J Clin. 2018;68(1):31-54.2 Cross et al. Carcinogenesis. 2014;35(7):1516-1522.

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Colorectal Cancer Incidence Trends by Race/ Ethnicity and Age at Diagnosis, 2006-2015

• For ages 18-49 years, rates increased in NH whites from 10-14.2/100,000, and in Hispanic males from 10.9-15.9/100,000, but not Hispanic females, who tended to show a decline.

• Rates tended to decrease for most groups aged 50-64 years, but tended to increase for NH Asian/ Pacific Islanders (A/PI).

• Significant declines in rates for ages 65-74 years and 75 years and older (NH whites, NH blacks, and Hispanics), and in NH blacks aged 50-64 years.


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Acute Myeloid Leukemia (AML) Incidence Rates by Race/Ethnicity and Age at Diagnosis, 2015

• 15% of AML cases attributed to cigarette smoking.1

• Relative risk for current smokers is 1.1-1.9.2

• Rates remained stable across all age/race/ethnic groups, but in most groups, there was a non-significant tendency for rates to increase.



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Stomach Cancer Incidence Rates by Race/ Ethnicity and Age at Diagnosis, 2015

• 17% of stomach cancer cases are attributed to cigarette smoking.1

• Relative risk for current smokers is 1.4-2.0.2

• Rates decreased in NH blacks aged 75 years and older.

• Rates decreased in Hispanics aged 18-49 years, 50-64 years, and 75 years and older.

• Rates in all other age/race/ethnic groups remained stable.



Tobacco-Associated Cancers, May 2018

Technical Notes

• Data Source: Texas Cancer Registry (www.dshs.state.tx.us/tcr) SEER*Stat Database, Incidence - Texas, 1995-2015, statewide, Texas Department of State Health Services, created January 2018, based on NPCR-CSS Submission, cut-off 11/13/17.

• All incidence rates are age-adjusted to the 2000 US Standard population in 2000 (Single Ages to 84 -User standard).

• Adults 18 years of age and older are included in the analyses.

• Annual percentage change (APC) was calculated using SEER*Stat by fitting a least squares regression line to the natural logarithm of the age-adjusted rates, with calendar year as the regressor variable. Joinpoint was also used to determine whether the APC changed over the assessed time period (i.e. whether there was a joinpoint that resulted 2 lines of different slope) and to plot changes in incidence rates over time.

• Error bars represent 95% confidence intervals around rates.

• The CDC’s National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Counties was used in this report. This scheme is a six-level urban-rural classification scheme for US counties. The most urban category consists of “central” counties of large metropolitan areas; the most rural category consists of nonmetropolitan “noncore” counties. (Source: NCHS Urban-Rural Classification Scheme for Counties, NCHS/CDC, Updated June 2017. Accessed April 2018. https://www.cdc.gov/nchs/data_access/urban_rural.htm).

Texas Cancer Registry 51

https://www.cdc.gov/nchs/data_access/urban_rural.htm


References

• Cross AJ, Boca S, Freedman ND, et al. Metabolites of tobacco smoking and colorectal cancer risk. Carcinogenesis. 2014;35(7):1516-1522.

• Hashibe M, Brennan P, Chuang SC, et al. Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev. 2009;18(2):541-550.

• Henley SJ, Thomas CC, Sharapova SR, et al. Vital Signs: Disparities in tobacco-related cancer incidence and mortality - United States, 2004-2013. MMWR Morb Mortal Wkly Rep. 2016;65(44):1212-1218.

• Islami F, Goding Sauer A, Miller KD, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2018; 68(1):31-54.

• Lee YC, Cohet C, Yang YC, et al. Meta-analysis of epidemiologic studies on cigarette smoking and liver cancer. Int J Epidemiol. 2009;38(6):1497-1511.

• Lortet-Tieulent J, Kulhánová I, Jacobs E, et al. Cigarette smoking-attributable burden of cancer by race and ethnicity in the United States. Cancer Causes Control. 2017; 28(9):981-984.

• U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Printed with corrections, January 2014.



Acknowledgment

The Texas Cancer Registry (TCR) recognizes the following whose financial support is essential to accomplishing the Registry’s mission for our State.

Federal Grant Funding

• We acknowledge the Centers for Disease Control and Prevention (CDC) for its financial support under Cooperative Agreement #1NU58DP006308.

State Agency Funding

• Texas Department of State Health Services

• Texas Health and Human Services Commission

• Cancer Prevention and Research Institute of Texas

The TCR also wants to thank all cancer reporters for their hard work and collaboration. Cancer reporters help us meet national high quality and timeliness standards, and enable us to serve as the primary source of cancer data in Texas.


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