Overview of Cancer in New Jersey

Antoinette (Nan) Stroup, PhD1

New Jersey Cancer Prevention SummitSeptember 18, 2014

1 Director, Cancer Epidemiology Services/New Jersey State Cancer Registry, NJDOHAssociate Professor and Chief, Cancer Epidemiology DivisionRutgers School of Public Health and Rutgers Cancer Institute of New Jersey

Outline

• “Who” is New Jersey? (population)• “What” is their cancer story? (cancer profile)

– Race/Ethnic Disparities• “Where” are we now? (2011 vs Healthy NJ

2020)– Lung Cancer– Colorectal Cancer– Melanoma of the Skin– Invasive Cervical Cancer (Females)

• “How” we’ve come a long way (time trends)• Concluding thoughts

Data

• US Census Bureau, Social Explorer• New Jersey State Cancer Registry (NJSCR)

– NCI Surveillance, Epidemiology, and End Results (SEER) Program (SEER*Stat, GIS.Gov)

– CDC National Program of Cancer Registries (NPCR) Program [United States Cancer Statistics (USCS)]

– North American Association of Central Cancer Registries (NAACCR)

– State Cancer Profiles, Cancer Rates Info

POPULATION CHARACTERISTICS

“Who” is New Jersey?

Year % TotalPopulation

Age45-64

Age65+

2000 22.7 13.2

2010 27.1 13.7

2020 26.6 16.4

NJ Population Changes

Source: U.S. Census

4.5%

57.4%

50.2%

39.2%

6.1%

1.6%

-1.8%

-6.5%

-60% -50% -40% -30% -20% -10% 0% 10% 20% 30% 40% 50% 60%

All

Multiracial

Asian

Hispanic

Am Indian/AK Native

Black

Pacific Islander

White

% Change from 2000 to 2010

NJ Population Change 2000 to 2010by Race/Ethnicity

All race categories non-Hispanic

Population Changes by Race/Ethnicity & Geography from 2000 to 2010

Figure: New Jersey’s Changing PopulationThe New York Times: New Jersey’s Ethnic Makeup Shifts, and Population Drifts SouthwardBy Richard Perez-PenaFebruary 3, 2011.Sources: Census Bureau; Social Explorerhttp://www.nytimes.com/interactive/2011/02/04/nyregion/20100204-jersey.html?ref=nyregion

State of New Jersey - Population Characteristics 2012

Characteristic2 New Jersey U.S.

Population 8,867,749 (2.8%) 313,873,685

Pop Density, 2010 (persons/mi2) 1,195.5 87.4

65+ 14.1% 13.7%Female 51.2% 50.8%

NH White (alone) 58.2% 63.0%

Black (alone) 14.7% 13.1%Hispanic or Latino 18.5% 16.9%Asian (alone) 9.0% 5.1%Native Hawaiian/Pacific Islander (alone) 0.1% 0.2%

% Foreign Born (2008-2012) 20.8% 12.9%

2 Source: US Census Bureau: State and County QuickFacts - 2012, unless otherwise specified.

State of New Jersey - Population Characteristics(continued)

Characteristic2 New Jersey U.S.

Language other than English (5+) 29.6% 20.5%

College Degree (25+) 35.4% 28.5%

Median Household Income $71,637 $53,046

Persons below poverty 9.9% 14.9%

Mean travel time to work (16+) (minutes) 30.3 25.4

2 Source: US Census Bureau: State and County QuickFacts – 2008-2012, unless otherwise specified

CANCER PROFILE“What” is their cancer story?

http://apps.nccd.cdc.gov/DCPC_INCA/DCPC_INCA.aspx

Males & Females, 2011

State: New JerseyRate: 480.5 (95% CI: 476.1, 484.9)Rank: 41 out of 50

Higher than USLower than US

-60% -55% -50% -45% -40% -35% -30% -25% -20% -15% -10% -5% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60%

All SitesMesothelioma

ThyroidGallbladder

StomachProstate

Urinary BladderHodgkin Lymphoma

Soft Tissue including HeartPancreas

Melanoma of the SkinBones and Joints

MyelomaLymphoma

Non-Hodgkin LymphomaLeukemia

Brain and Other Nervous SystemColon and Rectum

TestisKaposi Sarcoma

Kidney and Renal PelvisEsophagus

Anus, Anal Canal and AnorectumSmall Intestine

LiverLung and Bronchus

Oral Cavity and PharynxEye and Orbit

Age-Adjusted Rate Difference (%)

Cancer Incidence3 by Site: NJ vs US* Males

3 NJ Data from SEER*Stat, Nov 2013 Submission; US data from NAACCR 2014 Call for Data, Dec 2013 Submission* US = 47 States + DC (excl. NV, MN, AS)

-60% -55% -50% -45% -40% -35% -30% -25% -20% -15% -10% -5% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60%

All SitesKaposi Sarcoma

MesotheliomaThyroid

GallbladderUreter

Urinary BladderStomach

Hodgkin LymphomaCorpus Uteri

LymphomaUterus, NOS

Non-Hodgkin LymphomaBones and Joints

Ovary PancreasMyeloma

Melanoma of the SkinEsophagus

Cervix UteriBreast

Colon and RectumLeukemia

Soft Tissue including HeartBrain and Other Nervous System

Lung and BronchusOral Cavity and Pharynx

Small IntestineAnus, Anal Canal and Anorectum

Liver Kidney and Renal Pelvis

Eye and Orbit

Age-Adjusted Rate Difference (%)

Cancer Incidence3 by Site: NJ vs US* Females

Higher than USLower than US

(150%, 0.2)

3 NJ Data from SEER*Stat, Nov 2013 Submission; US data from NAACCR 2014 Call for Data, Dec 2013 Submission* US = 47 States + DC (excl. NV, MN, AS)

NJ Cancer Incidence 2007-2011 by Race and Ethnicity, Males

Stomach & Liver in Top 10 for minority populations only: Likely due to high prevalence ofH.Pylori, high dietary sources of nitrates, and hepatitis infections.

Only race with Melanomain Top 10

Highest rates of prostate, lung, & colorectal

Lowest incidence overall

http://apps.nccd.cdc.gov/USCS/cancersbyraceandethnicity.aspx

NJ Cancer Incidence 2007-2011 by Race and Ethnicity, Females

Invasive cervical cancer in Top 10 for Blacks & Hispanics only

Only race with Melanomain Top 10 Stomach & liver in Top 10

http://apps.nccd.cdc.gov/USCS/cancersbyraceandethnicity.aspx

HEALTHY NEW JERSEY 2020“HNJ”

“Where” are we now?

Cancers with Effective Primary Prevention: Incidence (per 100,000)

Cancer Site HNJ 2010Incidence

Rate Target

2011 Incidence4

(95% CI)HNJ 2020Incidence

Rate TargetInvasive Cervical(Females)

6.8 7.6(6.8-8.4)

7.2

Melanoma of the Skin(Males & Females)

12.0 20.8(19.9-21.7)

None

Colorectal(Males & Females)

None 41.6(40.4-42.9)

39.7

Lung(Males & Females)

None 58.6(57.1-60.1)

None

4 U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999-2011 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2014. Available at: www.cdc.gov/uscs.

Higher than targetLower than target

Cancers with Effective Primary Prevention:Mortality (per 100,000)

Cancer Site HNJ 2010Mortality

Rate Target

2011 Mortality4

(95% CI)HNJ 2020Mortality

Rate TargetInvasive Cervical(Females)

1.6 2.6(2.2-3.2)

1.9

Melanoma of the Skin(Males & Females)

None 2.3(2.0-2.6)

2.4

Colorectal(Males & Females)

19.0 15.5(14.7-16.2)

15.8

Lung(Males & Females)

43.0 41.4(40.1-42.7)

42.0

Higher than targetLower than target

4 U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999-2011 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2014. Available at: www.cdc.gov/uscs.

Incidence (per 100,000)by Race/Ethnicity

HNJ 2010Target

20114

(95% CI)HNJ 2020

TargetWhite 6.8 7.5

(6.6-8.4)7.1

Black 6.8 9.5(7.4-12.1)

9.0

Hispanic (Any Race) 6.8 10.9(8.5-13.8)

11.6

Racial/Ethnic Disparities: Invasive Cervical Cancer

Deaths (per 100,000)by Race/Ethnicity

HNJ 2010Target

20114

(95% CI)HNJ 2020

TargetWhite 1.6 2.3

(1.8-2.8)1.6

Black 6.0 4.8(3.3-6.7)

3.6Higher than targetLower than target

4 U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999-2011 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2014. Available at: www.cdc.gov/uscs.

Incidence (per 100,000)by Race/Ethnicity

HNJ 2010Target

20114

(95% CI)HNJ 2020

Target

White None 40.5(39.1-41.9)

39.8

Black None 45.1(41.2-49.3)

41.2

Hispanic (Any Race) None 37.2(33.3-41.4)

31.2

Racial/Ethnic Disparities: Colorectal Cancer

Deaths (per 100,000)by Race/Ethnicity

HNJ 2010Target

20114

(95% CI)HNJ 2020

TargetWhite 19.0 15.2

(14.4-16.1)16.2

Black 22.0 21.8(19.0-24.8)

20.1

Hispanic None 9.3(7.3-11.5)

9.5Higher than targetLower than target

4 U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999-2011 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2014. Available at: www.cdc.gov/uscs.

TRENDS OVER TIME(My!) “How” we’ve come a long way!

Geographic Disparities Over Time:NJ LungCancer DeathRates 1971-2010 HNJ

2020 Target42.0

https://gis.cancer.gov/atlas/

Geographic Disparities Over Time:NJ MelanomaDeathRates 1971-2010

HNJ 2020 Target

2.4

https://gis.cancer.gov/atlas/

Geographic Disparities Over Time:NJ ColorectalCancer DeathRates 1971-2010

HNJ 2020 Target15.8

https://gis.cancer.gov/atlas/

Concluding Thoughts

• NJ has seen progress in decreasing the mortality from cancers that can be prevented through screening or behavioral changes (melanoma, colorectal, and lung)

• Work remains to reach Healthy New Jersey 2020 goals for invasive cervical cancer and incidence of melanoma and colorectal cancers

• Disparities demographically and geographically persist– Stomach & liver cancer among minorities– Melanoma among whites– Invasive colorectal and cervical among blacks

NAN.STROUP@RUTGERS.EDUANTOINETTE.STROUP@DOH.STATE.NJ.US

Thank you.

Acknowledgements: This work was supported by the New Jersey State Cancer Registry and Rutgers Cancer Institute of New Jersey, which are funded by SEER (Contract No. HHSN261201000027C), the Centers for Disease Control and Prevention NPCR (Grant No. 5U58DP003931-03), and the State of New Jersey.