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All stages

50

11.2

(8.2–15.0)

100.0

Local

22

4.6

(2.8–7.0)

44.0

Regional/distant

22

4.9

(3.1–7.5)

44.0

270.2

(196.0–363.6)

100.0

233

238.1

(207.2–272.3)

100.0

172.5

(116.4–247.3)

68.0

144

141.8

(118.7–168.1)

61.8

54

52.9

(39.1–69.9)

23.2

35

43.4

(29.8–60.8)

15.0

Cervix uteri (aged 20 years and older)

2141

TABLE 9 (continued)

Cancer sitea/stageb

Count

Report to the Nation, 19752004/Espey et al.

R%

Regional/distant

Unknown

Unknown

Prostate (aged 50 years and older)

All stages

50

Local

34

East AI/AN

Ratec

(95% CI)

R%

Count

Southwest AI/AN

Ratec

(95% CI)

Source: Surveillance, Epidemiology, and Ends Results (SEER) and National Program of Cancer Registries areas are reported by the North American Association of Central Cancer Registries as meeting high-quality data standards for the specified years. CHSDA indicates Indian Health Service (IHS) Contract Health Service Delivery Area; AI/AN, American Indian/Alaska Native; NHW, non-Hispanic white; 95% CI, 95% confidence interval; R%, percent distribution of the stage-specific incidence rate.

a Cancers were chosen based on existing evidence base for early detection.

b 2000 SEER Summary Stage was used for stage of disease at diagnosis. Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population (19 age groups, Census p25–1130). Statistic could not be calculated when <16 cases were reported. Years of data and registries used (30 states), 2001—2003: Alabama, Alaska, Arizona, California, Colorado, Connecticut, Florida, Idaho, Indiana, Iowa, Louisiana, Maine, Massachusetts, Michigan, Montana, Nebraska, Nevada, New Mexico, New York, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Washington, Wisconsin, and Wyoming. c

evaluation for unrelated conditions.78 Trends from SEER from 1997 through 2004 show that increases over the past decade are confined to disease in a localized stage.20

Long-term increases in incidence rates of NHL continue in women but currently are stable in men, and death rates have declined in recent years for both men and women. Incidence trends for NHL vary by histologic subtype, sex, race/ethnicity, and age; long-term trends have been influenced, but are not fully explained, by trends in human immunodefi-

ciency virus-related subtypes.79,80

Moreover, changes

in coding and classification complicate the analysis of incidence trends by histologic subtype.81,82 Recent mortality trends may be influenced by improving survival; 5-year relative survival increased from

    • 53.6

      % for cases diagnosed from 1993 through 1995 to

    • 63.8

      % for cases diagnosed in 1996 through 2003.55

The rapid increase in thyroid cancer incidence rates described in the 2006 annual report continued between 2003 and 2004 across all populations.9 It is postulated that increases in the detection of small tumors related to increased use of ultrasound and fine-needle aspiration account for a large part of this increase.83

both men and women was also smaller than the 5% increase per year during the mid-1970s to the mid- 1980s. Although long-term increases in melanoma incidence rates are influenced by early detection and improved reporting of cases diagnosed outside hospi- tals, increasing trends are not confined to early-stage tumors and also may be influenced by changes in sun exposure.84

Increases in liver cancer incidence and mortality in the U.S. population also have been noted previously. The risk of liver cancer is elevated in persons with cir- rhosis and chronic liver disease, and in the U.S., the main preventable causes of these conditions are chronic infection with hepatitis B and C viruses, chronic alcohol

abuse, and nonalcoholic fatty liver disease.85,86

In many

developing countries in which hepatitis B is endemic, chronic hepatitis B virus infection is the major causal agent,87 and it is likely that elevated liver cancer rates for API and Hispanic men and women are related to high rates of chronic viral hepatitis infection acquired in the countries of origin of recent immigrants.88 Obesity and Type 2 diabetes mellitus (Type 2 diabetes) also are emer- ging as risk factors.86

The increase in melanoma incidence trends has slowed over the years, especially among men, in whom the rates stabilized from 2000 through 2004. The increase in the fixed-interval trends (1995 through 2004) of approximately 3% per year among

Cancer in American Indians and Alaska Natives The current report enhances AI/AN cancer surveil- lance by presenting U.S. regional cancer incidence rates and by addressing the significant race misclas- sification of this population in cancer statistics. Link-

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