Cancer

SECTION 9
CANCER
BUREAU OF EPIDEMIOLOGY
Overall Trends
Prostate Cancer and Breast Cancer
Lung and Bronchial Cancers
Colorectal Cancer
Bladder Cancer
Non-Hodgkin’s Lymphoma
Oral Cancer
Uterine and Ovarian Cancer
Melanoma
Summary

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114
FLORIDA MORBIDITY STATISTICS 1997
OVERALL TRENDS
9.2). The seven cancer sites included in these tables
are those with the highest incidence rates in Florida
Cancer incidence rates from 1981 to 1997 for
for women and for men. Data are for all cancers,
selected types of cancer among Florida residents are
except non-melanoma skin cancer, recorded by the
shown for females (Table 9.1) and for males (Table
Florida Cancer Data System. Additional informa-
tion can be found in the 1996–1997 Florida Annual
Table 9.1. Age-Adjusted Incidence Rates per 100,000 Population for Selected Cancer Sites in Females, Florida, 1981–1997.
Year
All Cancers1
Breast Lung & Bronchus Colorectal
Body of Uterus
Ovary
Non-Hodgkin’s
Bladder
1981
299.2
85.2
32.5
42.2
18.7
14.2
7.9
8.3
1982
303.5
85.3
35.2
45.1
17.9
13.7
8.0
9.1
1983
298.4
84.3
35.4
43.0
18.6
13.9
8.3
8.0
1984
309.8
89.1
37.6
43.3
17.5
14.2
9.4
7.7
1985
319.8
97.4
39.6
44.0
17.3
14.3
8.6
8.1
1986
313.6
94.8
39.7
43.1
17.2
15.2
8.7
7.3
1987
322.8
103.4
39.0
42.6
17.3
14.6
9.4
7.6
1988
326.2
103.9
42.8
42.2
17.3
14.9
9.6
7.3
1989
323.7
99.7
42.9
41.7
16.7
15.2
10.1
7.7
1990
337.2
103.1
44.7
43.2
17.8
15.8
10.3
8.2
1991
330.0
103.0
45.5
40.7
17.3
15.4
10.1
7.7
1992
324.1
98.6
45.6
40.3
16.8
15.3
10.3
8.0
1993
321.7
98.1
46.1
38.2
17.1
14.7
10.0
7.5
1994
327.0
100.3
46.3
38.1
18.2
15.0
10.8
7.7
1995
320.1
98.5
45.0
36.5
17.4
14.3
10.7
7.9
1996
310.2
93.1
44.4
36.1
17.7
13.5
10.1
8.0
1997
305.7
95.4
44.4
33.8
17.1
12.9
10.0
7.3
Source: Florida Cancer Data System, Florida Department of Health.
1Rates exclude non-melanoma skin cancer (ICD-9 173) and are age-adjusted to U.S.1970 Standard Million.
Table 9.2. Age-Adjusted Incidence Rates per 100,000 Population for Selected Cancer Sites in Males, Florida, 1981–1997.
Year
All Cancers1
Prostate
Lung & Bronchus
Colorectal
Bladder
Non-Hodgkin’s
Oral
Melanoma2
1981
394.2
71.3
86.8
58.7
33.5
10.7
17.5
11.2
1982
395.0
72.2
86.1
60.9
32.5
11.3
17.6
11.1
1983
383.3
71.1
81.6
58.4
30.1
11.3
17.1
11.7
1984
392.9
71.2
85.0
61.3
32.7
10.4
17.1
10.8
1985
409.1
74.9
87.5
66.5
33.1
13.0
16.5
13.1
1986
395.4
74.1
85.2
58.9
31.8
12.6
17.4
12.8
1987
404.2
81.5
83.7
63.2
31.9
13.3
16.0
12.7
1988
412.7
88.7
83.0
62.7
31.5
14.3
15.1
14.0
1989
429.3
100.5
82.6
58.5
32.7
15.2
18.1
13.9
1990
441.0
113.4
82.6
58.9
32.2
15.7
16.7
13.6
1991
473.7
146.3
85.2
58.2
30.5
15.5
17.2
13.1
1992
485.1
157.8
83.8
57.5
30.7
16.1
16.2
13.1
1993
448.4
132.5
79.2
55.7
29.3
15.7
16.1
13.6
1994
439.3
123.5
79.7
53.1
29.1
17.6
16.9
13.9
1995
433.9
118.9
81.2
52.5
29.3
17.0
16.1
13.4
1996
401.0
106.2
73.6
47.9
27.7
15.9
15.2
13.1
1997
391.6
99.9
72.6
48.9
27.6
15.5
14.0
14.3
Source: Florida Cancer Data System, Florida Department of Health.
1Rates exclude non-melanoma skin cancer (ICD-9 173) and are age-adjusted to U.S.1970 Standard Million.
2Melanoma rates include whites only.

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SECTION 9 – CANCER
115
Cancer Report: Incidence and Mortality, which is
and declining smoking rates among men over the
posted on the Bureau of Epidemiology Web site
past few decades. These data suggest a need for
<http://www.doh.state.fl.us> (choose “epidemiolo-
more intensive targeting of anti-smoking education
gy” as subject).
efforts toward women, especially young women, in
order to prevent them from initiating tobacco use
Cancer is the second leading cause of death in
and to help them quit smoking.
Florida and contributes more to potential years of
life lost than any other cause. The number of new
COLORECTAL CANCER
cancers has increased over the past 17 years for
both women and men. This is not surprising given
Age-adjusted incidence rates of colorectal can-
the population growth in Florida during this peri-
cer declined from 1981 to 1997 for both sexes. Since
od, especially among the older age groups. Howev-
a diet high in fats and limited in fruits and vegeta-
er, the 17-year trend for age-adjusted incidence
bles is strongly implicated in colorectal cancer, it is
rates per 100,000 residents of all cancers combined
possible that the diets of Florida residents have
has remained stable for both sexes. Since the age-
improved. In addition, surgical removal of pre-can-
adjusted rates have not changed, much of the
cerous colorectal polyps may reduce colorectal can-
increase in the number of new cancers may be
cer. Documenting dietary changes and trends in
attributed to the aging of the population and to the
diagnosing and treating pre-cancerous colorectal
corresponding increase in the number of elderly
polyps in Florida residents would be useful for
Floridians.
establishing whether changes in these risk factors
have contributed to the decline in colorectal cancer.
PROSTATE CANCER AND BREAST CANCER
BLADDER CANCER
Age-adjusted rates of both prostate cancer in
men and breast cancer in women have been rising
Bladder cancer rates have declined over the
over the last 17 years. The temporary increase in the
past decade and a half for both women and men.
number and age-adjusted rates of prostate cancers
However, during this period this form of cancer
among men during the early to mid-1990s partly
declined by a greater margin in men than in
reflects a rise in the number of PSA screening tests,
women. Age-adjusted rates of bladder cancer have
which are highly sensitive in detecting prostate can-
historically been higher in men than in women but
cer. Similarly, some of the peaks in breast cancer
men’s rates are declining more rapidly than
incidence in women over the past decade and a half
women’s. Risk factors for bladder cancer include
might be due to improved diagnostic sensitivity of
smoking and occupational exposure to several
mammography or to higher screening rates.
chemicals including paint, chlorine, and chemicals
Increasing incidence rates of prostate cancer in men
used in textile and rubber processing. Understand-
and of breast cancer in women have been followed
ing why bladder cancer remains relatively intransi-
by gradually declining mortality rates from these
gent in women would enhance cancer prevention
cancers. These trends indicate that screening is
efforts. Relatively high smoking rates among
improving and is resulting in earlier detection and
women in the late 1970s and early 1980s might
prevention of death from these two forms of cancer,
explain the recent increase in rates of bladder can-
that treatment is improving, or possibly both factors
cer among women. Reduction of tobacco use—
are contributing to these trends.
especially stemming the rise of cigarette smoking in
women—and limiting occupational exposure are
LUNG AND BRONCHIAL CANCERS
important prevention strategies for bladder cancer.
Fortunately, women’s smoking rates have begun to
From 1981 to 1997, age-adjusted rates of lung
decline (based on Behavioral Risk Factor Surveil-
and bronchial cancers increased in women and
lance System data). The biggest drop in smoking
decreased in men (an increase of roughly
among women began in the early 1990s. Hopefully,
12/100,000 for women and a decrease of about
rates of tobacco-related cancers, including bladder
14/100,00 in men between 1981 and 1997). These
cancer, will decrease accordingly in a decade or
trends parallel increased smoking among women
two.

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116
FLORIDA MORBIDITY STATISTICS 1997
NON-HODGKIN’S LYMPHOMA
SUMMARY
Age-adjusted rates of non-Hodgkin’s lym-
In summary, breast, prostate, lung and
phoma in both women and men have increased
bronchial, colorectal, uterine, ovarian, bladder, and
steadily and sharply over the last 17 years. Causal
oral cancers; non-Hodgkin’s lymphoma; and
factors for non-Hodgkin’s disease are not well
melanoma continue to be the most common types
established, so it is unclear why non-Hodgkin’s
of cancer diagnosed in Floridians. Changes in rates
lymphoma has been increasing in Florida. Higher
for some of these forms of cancer are apparently
social class is associated with this disease, and it is
linked to changes in exposure to risk factors and
possible that an increase in the proportion of the
health behaviors (e.g., the decline in the number of
population that is financially well-off (e.g., elderly
men who smoke cigarettes followed by a recent
in-migrants) might underlie the rise in this type of
decline in men’s rates of lung/bronchial and oral
cancer.
cancers). As for all disease, when interpreting inci-
dence data for cancer it is important to consider
ORAL CANCER
that increases in incidence might be the result of a
positive public health effort (e.g., increased screen-
Incidence rates of oral cancer in men declined
ing) or of increasing exposure to risk factors. By
by 20% from 1981 to 1997. This downward trend
taking into account the range of factors that explain
parallels that for lung and bronchial cancers, which
changes in cancer rates, trends in cancer can be bet-
declined by about 16% during this period. Declin-
ter understood and improved targets and strategies
ing cigarette smoking in men likely accounts for the
for cancer control can be implemented.
dramatic decline in cancers of the lung and
bronchus and for some of the decline in oral can-
An extensive knowledge base exists regarding
cers.
the risk factors for several types of cancer. Public
health programs need to continue to improve trans-
UTERINE AND OVARIAN CANCER
lating that knowledge into public health programs
and activities such as screening and health promo-
Age-adjusted rates of cancers of the uterus and
tion efforts that reach communities and individuals
ovary have not changed notably since 1981, in part
residing in Florida. Additionally, accumulating
because early detection—especially for ovarian can-
more cancer data specific to particular demographic
cer—is difficult and does not affect survival very
groups (e.g., sex, race-ethnicity, class) over time will
much.
better guide public health strategies for preventing
and controlling cancer in all Florida residents.
MELANOMA
Melanoma has increased slightly in men over
the past 17 years with peaks in the late 1980s,
although the highest age-adjusted rate was in 1997
at 14.3 per 100,000 men.

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