Cancer By County: 1986-1996

Executive Summary

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Introduction

The purpose of this report, Cancer Incidence by County, New Jersey: 1986-1996, is to present cancer incidence data that will be useful for the development of cancer control and prevention interventions at the county level. The report presents cancer incidence in New Jersey by county for all cancers combined and for eleven major cancers - bladder, breast, cervical, colorectal, endometrial, leukemia, lung, non-Hodgkin's lymphoma, oral, ovarian, and prostate. These sites account for more than 70 percent of all cancers. Annual incidence counts and rates are provided for white men, white women and, if there are sufficient numbers of cases to protect confidentiality, for black men and black women. If the numbers of cases are not sufficient to present annual counts and rates for black men and women, we give counts and rates for the two time periods of 1986 through 1990 and 1991 through 1996. In addition, we include counts and rates for the eleven-year period of 1986 through 1996 for white men, white women, black men, and black women. Counts of fewer than five and their rates are not included in the tables in order to protect confidentiality of the data. Also, rates based on low counts are very unstable and may fluctuate greatly from year to year due to chance and other factors. For this reason, rates based on low counts should be interpreted very carefully.

This report updates data published previously, The Most Frequent Cancers in New Jersey Volume II Incidence and Mortality Rates by County, Race & Sex 1979-1985, which contains incidence counts and rates for 1979 (the registry's first full year of operation) through 1985.1 Our recent report, Cancer Incidence in New Jersey 1992-1996, issued in April 1998, includes statewide incidence counts and rates for many of the same types of cancer.2 (Please see the Glossary for the definition of incidence as well as other terms.)

Information On Cancer

Cancer is a group of more than 100 diseases caused by the uncontrolled growth and spread of abnormal cells. Cancers are caused by a variety of factors working alone or in combination. Some cancers are caused by external factors such as tobacco, diet, certain chemicals, radiation, and viruses. Other cancers are caused by internal factors such as hormones, immune conditions, and inherited genetic mutations. Usually ten or more years pass between exposure to a factor that causes cancer and detectable disease. Cancer occurs in people of all ages, but its occurrence increases greatly in people over 45 years of age.

Cancer is the second leading cause of death in the U.S., with 1,228,600 new cases and 564,800 deaths estimated for 1998. Over the past 50 years, the death rate from cancer has increased steadily, due mainly to a large rise in lung cancer death rates resulting from smoking. However, during the past few years the incidence and death rates for many cancers have begun to decline in the U.S., possibly as a result of healthier lifestyles, particularly decreases in smoking. In the U.S., men have about a 1 in 2 lifetime risk of developing cancer and women have about a 1 in 3 lifetime risk. (These figures do not include basal and squamous cell skin cancers or in situ cancers except for the bladder.) Compared to earlier years, a much higher percentage of people diagnosed with cancer now are surviving. Now, about four out of every ten people diagnosed with cancer will survive for at least five years. However, the survival rate varies by the type of cancer; for example the five-year relative survival rate for women with breast cancer is 84 percent but for individuals with lung cancer it is 14 percent.

Cancer Incidence In New Jersey - 1986-1996

As of February 1998, over 437,000 cases of cancer diagnosed in 1986 through 1996 among New Jersey residents were reported to the New Jersey State Cancer Registry, including over 192,500 cases among white men, nearly 22,000 cases among black men, over 191,500 cases among white women, and over 19,000 cases among black women. Statewide, black men had the highest age-adjusted incidence rate (561 cases per 100,000 population), white men the second highest age-adjusted incidence rate (484 cases per 100,000 population), white women the third highest rate (371), and black women the lowest rate (333). Most of the counties followed the same pattern; exceptions are noted in the text.

Over the eleven-year period, the overall incidence rates increased among black men between 1986 and 1993 and increased among white men between 1986 and 1992. In subsequent years the overall incidence rates declined among men of both races. The overall incidence rates for white women declined slightly since 1991; but the rates for black women remained fairly constant. The cancers that contributed most to the decline in all cancers among white and black men were colorectal, lung, oral, and prostate. Among women, decreases in bladder, breast, cervical, colorectal (white women only), leukemia, oral, and ovarian cancer were offset by increases in endometrial cancer, lung cancer, and non-Hodgkin's lymphoma.

Both black and white men had higher rates than black and white women for the cancers that occur in both sexes, with the exception of breast cancer which was much higher among women than men. Black men had higher rates of lung, oral, and prostate cancer than white men, while white men had higher rates of bladder and colorectal cancer, leukemia, and non-Hodgkin's lymphoma than black men. White women had higher rates of bladder, breast, endometrial, and ovarian cancer, leukemia, and non-Hodgkin's lymphoma than black women. Black women had higher rates of oral and cervical cancers than white women. Most of the counties followed these patterns; exceptions are noted in the text.

Our report, Cancer Incidence in New Jersey 1992-19962, presents trends in the New Jersey cancer incidence rates from 1979 through 1996 for the most common cancers.

Cancer Incidence In New Jersey Compared To The U.S.

The recent report of this Department, Cancer Incidence in New Jersey 1992-1996,2 includes comparisons of incidence rates in New Jersey and the U.S. for all cancers combined and several of the most common cancers for 1990 through 1994. Among men, the New Jersey incidence rates were greater for all cancers combined, colon cancer, lung cancer (except for blacks), prostate cancer (except for whites), and non-Hodgkin's lymphoma. Among women, the New Jersey incidence rates were greater for all cancers combined, colon cancer, lung cancer (except for blacks), breast cancer, and non-Hodgkin's lymphoma. Comparisons on a county-by-county basis are not made to national rates in this report; comparisons are made to state-wide cancer rates.

Conclusion

Since cancer incidence rates are declining in New Jersey, especially among men, it is important to continue the activities that appear to be contributing to the decline. These include lifestyle changes such as not smoking, not drinking to excess, and diets with more vegetables and fruits and less fat. Continued control of workers' exposures to carcinogens would also contribute to declines in certain cancers. Additional research is needed to discover how to prevent those cancers for which the causes are partly or largely unknown, such as breast, leukemia, non-Hodgkin's lymphoma, and prostate cancer. It is important to ensure widespread early detection of those cancers for which good screening methods exist, such as breast, cervical, colorectal, and prostate cancer. This will improve the survival rate and quality of life for those individuals who do contract cancer.