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Report to the Nation, 19752004/Espey et al.

2137

TABLE 7 (continued)

Southwest

Cancer site or typea

Rank

AI/AN

Ratec

NHW ratec

RR

AI/AN:NHW 95% CI

Stomach

5

16.0

Oral cavity and pharynx

12

4.8

Liver and IBD

6

12.6

Leukemia

10

6.7

Pancreas

8

7.6

Esophagus

13

4.4

Myeloma

9

7.4

Melanoma of the skin

17

3.6

Larynx

Brain and ONS

16

3.8

Testis

14

4.2

Gallbladder

15

4.1

2.23

d

0.31

d

2.05

d

0.45

d

0.66

d

0.55

d

1.37

0.12d

0.48

d

0.67

d

6.33

d

7.2

1.79–2.74

15.5

0.21–0.43

6.2

1.62–2.56

14.8

0.34–0.59

11.5

0.48–0.87

8.0

0.36–0.79

5.4

0.98–1.84

29.5

0.08–0.18

6.1

8.0

0.32–0.68

6.3

0.50–0.89

0.7

3.87–9.81

Source: Surveillance, Epidemiology, and Ends Results and National Program of Cancer Registries areas are reported by the North American Association of Central Cancer Registries as meeting high-quality data

standards from 1999 through 2004.

CHSDA indicates Indian Health Service (IHS) Contract Health Service Delivery Area; AI/AN, American Indian/Alaska Native; NHW, non-Hispanic white; RR, rate ratio; 95% CI, 95% confidence interval; IBD, intra- hepatic bile duct; ONS, other nervous system.

a Cancers are sorted in descending order according to sex-specific rates for AI/AN. Greater than 15 cancers may appear to include the top 15 cancers in every IHS region. All sites excludes myelodysplastic syndromes and borderline tumors. Rates are per 100,000 persons and were age-adjusted to the 2000 U.S. standard population (19 age groups, Census p25–1130). The RR was statistically significant (P <.05). Statistic could not be calculated when <16 cases were reported. Years of data and registries used (30 states). 1999–2004: Alabama, Alaska, California, Colorado, Connecticut, Florida, Idaho, Indiana, Iowa, Louisiana, Maine, Massachusetts, Montana, Nebraska, Nevada, New Mexico, New York, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Washington, Wyoming; 1993–2003: Arizona, Wisconsin; 2000–2004: Michigan. Percent regional coverage of AI/AN CHSDA data to all AI/AN in region: Alaska, 100%; East, 12.2%; North Plains, 38.1%; Pacific Coast, 55.1%; South Plains, 65%; Southwest, 86.1%. b c d

After steadily decreasing for many years, the decline in colorectal cancer death rates has acceler- ated. The concurrent declines in colorectal cancer mortality and incidence are likely associated with preventing colorectal cancer through screening and removal of precancerous polyps, improving cancer outcomes by earlier stage diagnosis, reducing exposure to risk factors, and improving cancer treatment.46–52

Lung cancer incidence trends have stabilized for women and have continued declining for men. Both joinpoint and fixed-interval trends for lung cancer death rates in women demonstrated a considerably slower rate of increase (APC, 0.2%) from 1995 through 2004 than in earlier periods; lung cancer incidence rates remained essentially unchanged from 1998 through 2004. The data suggest that the epi- demic of tobacco-related lung cancer in women has reached a plateau and likely will begin to decline, similar to what is occurring in men, although some fluctuations still may occur as trends stabilize.8,9,53,54

Prostate cancer incidence rates remained stable over the past decade. However, substantial declines in prostate cancer death rates occurred in all racial/ ethnic populations, a phenomenon previously ob- served in the U.S.55 and in other western coun-

tries.56,57 The reasons for the decline in prostate cancer mortality are unclear. PSA has been used widely for prostate cancer screening,58 although to our knowl- edge its efficacy in reducing prostate cancer mortality has not been established,59 and its contribution to declining mortality is uncertain.60,61 Other factors pos- sibly related to declining prostate cancer mortality rates include more effective treatment62–65 and serendi- pitous effects of noncancer-directed therapies.66

The decrease in breast cancer incidence rates from 2001 through 2004 is a change from increasing rates during the previous 20 years. Although many factors influence breast cancer incidence rates, recent reports highlight changes in hormone-replace- ment therapy (HRT) and screening mammography use.67–71 Between the years 1987 and 2000, the per- centage of women aged 40 years reporting a mam- mogram within the past 2 years increased from 29.1% to 70.1%.72 Recently, however, the direction of the trend with the percentage of women who had a mammogram in the past 2 years reversed and declined nearly 4 percentage points to 66.4%. Reduc- tions in mammography use were observed in popu- lations that previously reported higher rates: women ages 50 to 64 years, NHW women, and women with

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