Delaware cancer incidence and mortality report released

Cancer screening and early detection have contributed to a continuing decline in Delaware’s all-site cancer mortality rate over the past decade, say Delaware Public Health officials. From 1998-2002 to 2008-2012, Delaware’s cancer death rate decreased 14 percent, an improvement that was identical to the decline seen nationally, according to the latest cancer data announced by the Division of Public Health.

DPH presented its new report, Cancer Incidence and Mortality in Delaware 2008-2012, to the Delaware Cancer Consortium following its meeting July 19 in Dover. The annual report provides data for all cancer sites combined (all-site cancer) and eight cancer types, risk factors, early detection and screening recommendations and census tract maps. Delaware Department of Health and Social Services Secretary Rita Landgraf and DPH Director Dr. Karyl Rattay opened the presentation to DCC members by covering highlights.

Delaware’s all-site cancer mortality rate fell 17 percent among men, 13 percent among women, 21.9 percent among African-Americans and 13.9 percent among Caucasians over the last decade according to the report. However, at 181 deaths per 100,000 people, the state’s mortality rate was still 5.8 percent higher than the U.S. rate for 2008-12. Delaware’s ranking of 14th among the states for highest all-site cancer mortality remains relatively unchanged from last year’s report which looked at the 2007-11 time period, but still represents considerable progress since the 1990s, when the state ranked second.

Regarding incidence, Delaware’s 2008-12 all-site cancer incidence rate (503.9 diagnoses per 100,000) was 10.8 percent higher than the comparable U.S. rate. Between the time periods of 1998-2002 and 2008-12 though, Delaware’s all-site cancer incidence rate declined 2 percent, falling 4 percent among both men and women, 9.5 percent among African-Americans, and 0.6 percent among Caucasians.

Among Hispanic Delawareans, the 2008-12 all-site cancer incidence (412.6 cases per 100,000) and mortality (118.5 deaths per 100,000) rates were significantly lower than the state’s incidence rate (503.9 per 100,000) and mortality rate (181.0 per 100,000).

“I’m pleased that Delaware continues to make progress in battling this disease, particularly in the African-American and Hispanic communities,” said Gov. Jack Markell. “We have never had more attention on addressing the causes and barriers associated with cancer as we do at this time in our state’s history, and I am hopeful that by continuing our efforts, and by supporting Vice President Biden’s historic work on the Cancer Moonshot, we can make great strides toward ending cancer deaths in our lifetime.”

“Delawareans are getting screened more frequently and finding cancer earlier,” Landgraf said. “The sustained, coordinated work of the Cancer Consortium, Screening for Life Program, the Nurse Navigation Programs at our hospitals, and the DPH Comprehensive Cancer Control Program is leading to opportunities for Delawareans to live longer fuller lives.”

Breast Cancer

• In terms of screening, Delaware maintained its national state ranking for having the third-highest prevalence of women ages 40 and over (80.1 percent) who had a mammogram within the past two years (2014 Behavioral Risk Factor Survey).
• The proportion of breast cancer cases among Delaware women diagnosed in the local stage (the most treatable stage) increased from 42.2 percent in 1980-84 to 65.1 percent in 2008-12. 
• Breast cancer mortality in Delaware declined 22.3 percent over the last decade (1998-2002 to 2008-12).

Colorectal Cancer

• In 2012, Delaware ranked fifth-highest in prevalence in the U.S. for colorectal cancer screening (2014 BRFS) with nearly 77 percent of Delawareans age 50 and older reporting ever having a sigmoidoscopy or colonoscopy.
• From 1998-2002 to 2008-12, Delaware’s colorectal cancer incidence rate decreased 31.8 percent, more than the comparable U.S. rate (22.3 percent).
• During the same period, Delaware’s colorectal cancer mortality rates declined 49.7 percent among African-American males, and 44.6 percent among African-American females, compared to 29.3 percent among Caucasian males and 29 percent among Caucasian females.

Prostate Cancer

• From 1980-84 through 2008-12, Delaware’s percentage of prostate cancer cases diagnosed at the local stage increased substantially, from 49.6 percent to 84.7 percent.
• From 1998-2002 to 2008-12, prostate cancer mortality declined 39.2 percent among African-American Delawareans, compared to 23.3 percent among Caucasian Delawareans.
• Still, the prostate cancer incidence rate among African-American Delawareans continues to be significantly greater than the comparable rate for Caucasians.

“There are many things Delawareans can do to reduce the risk of cancer,” said Rattay. In addition to having recommended cancer screenings, DPH advises Delawareans to have regular physician visits, not smoke or quit if they do, get regular physical activity, eat a healthy diet and limit alcohol consumption and sugar-sweetened beverages. “Diets high in fruits and vegetables protect against cancers of the breast, cervix, colon/rectum, uterus, esophagus, oral cavity, ovary, pancreas, prostate and stomach. Being overweight or obese increases the risk for developing uterine, gallbladder, kidney, cervical and thyroid cancers, and leukemia,” said Rattay.

Despite progress in many areas, DPH officials acknowledge there is more work to be done, particularly with respect to lung cancer. Lung cancer, the most frequently diagnosed cancer in the nation and in Delaware, accounted for 14.4 percent of all newly diagnosed cancer cases and 30 percent of all cancer deaths in Delaware from 2008-12. Most lung cancer cases are diagnosed in the distant stage, when the cancer has spread to distant tissues, organs or lymph nodes.

Lung cancer issues among Delaware women are of particular concern. In the 2008-12 period, Delaware women ranked fifth-highest in the nation for lung cancer mortality while Delaware men ranked 16th-highest. Also, from 1998-2002 to 2008-12, the lung cancer incidence rate for Delaware females increased 6.5 percent, compared to a 3.6 percent decline in the U.S. rate.

Still, there is some positive news in this area. From 1998-2002 to 2008-2012, Delaware’s lung cancer mortality rates declined 32.6 percent among African-American males and 23.7 percent among African-American females.

According to the U.S. Department of Health and Human Services, 85 percent to 90 percent of lung cancers are caused by tobacco use. Though cigarette smoking prevalence among Delaware adults was at an all-time low of 19.6 percent, according to the 2014 BRFS, it remains largely unchanged over the last four years. DPH continues to remind smokers of the dangers of secondhand smoke, both to children and other adults. Secondhand smoke can also aggravate the symptoms of asthma and COPD.

Also, while smoking among teens is also at an all-time low, DPH is aware of the increasing use of electronic vaporizing devices (e-cigarettes). Delaware public high school students reporting current use of e-cigarettes through the 2015 Youth Tobacco Survey jumped from 2.1 percent in 2012 to 23.5 percent in 2015, and approximately 40.5 percent of Delaware public high school students said they have tried e-cigarettes. In 2014, Delaware banned the sale of e-cigarettes to minors, and in 2015, Delaware’s Clean Indoor Air Act was expanded to include prohibiting the use of e-cigarettes and other electronic vapor devices in workplaces and indoor public places.

DPH reminds current and former smokers deemed at high risk for lung cancer to get screened with a low-dose CT scan. DPH's Screening for Life Program covers lung cancer screenings for qualified uninsured or underinsured Delawareans who are not eligible for Medicaid or Delaware’s Health Insurance Marketplace and who are current or former smokers deemed at high risk for lung cancer: Current smokers or those who quit smoking within the last 15 years; those who smoke or have smoked the equivalent of a pack a day for 30 or more years; and those who are 55 to 80 years of age.

To speak with a screening nurse navigator for more information about lung cancer screenings, go to www.HealthyDelaware.org/lung or call 302-401-4212. For Delaware tobacco users seeking help quitting, contact the Delaware Quitline, a free tobacco cessation counseling hotline for residents 18 and older, at 1-866-409-1858 and http://dhss.delaware.gov/dph/dpc/quitline.html.