Edward J. Trapido, ScD
Numbers and Trends
Based on information from the state tumor registry,
the Florida Cancer Data System, approximately 99,100 new cases of cancer
will have been diagnosed in Florida in 1997, or approximately one new case
diagnosed every five minutes. Although this makes Florida the state with
the third highest number of cases in the nation, the state actually has
the
highest crude incidence rate in the nation. In Florida, 40,100
deaths from cancer are expected this year, which is second only to the
deaths experienced in California. The age-adjusted incidence rates of cancer
of all sites combined rose from 1985 to 1991, but then began to fall (Figure).
This is consistent with data from other states.
Cancer by Race and Site
For all sites combined, cancer incidence rates are highest
in non-white men, followed by white men, white women, and non-white women.
However, where mortality is concerned, rates among women are higher among
non-whites than among whites. Mortality rates have remained relatively
stable over the last 10 years.
Among men, prostate cancer is the most commonly diagnosed
site, accounting for approximately one third of all cases, followed by
lung cancer (approximately 20%), and colorectal cancers (approximately
12%). Among white men, bladder cancer is next most common (6%), followed
by non-Hodgkin’s lymphoma (4%). Among non-white men, cancers of the oral
cavity and pharynx are the fourth most common sites (4%), followed by non-Hodgkin’s
lymphoma (4%).
For Florida women, breast cancer is the most common
site (30% of all diagnoses). For white women, the next most common sites
are the lung (15%), colorectum (14%), endometrium (5%), and ovary (4%).
For non-white women, colorectal cancers are the second most commonly diagnosed
site (13%), followed by lung (10%), cervix (6%), and endometrium (6%).
Cancer Mortality
Cancer mortality shows a different pattern, by both
race and site. Among men, lung cancer and prostate cancer are the two most
common sites (34% among whites and 32% among non-whites for lung cancer;
12% among whites and 18% among non-whites for prostate cancer), followed
by deaths from colorectal cancer (10% and 8%, respectively). However, for
white men, cancers of the pancreas (5%) and non-Hodgkin’s lymphoma (4%)
are the fourth and fifth most common sites of deaths, while among non-whites,
esophageal cancers (4%) and stomach cancers (4%) are the fourth and fifth
most common causes of cancer related deaths. Among women, breast cancer
accounts for 27% and 20% of all cancer deaths among whites and non-whites,
respectively. Among white women, breast cancer is followed by cancer of
the lung (16%), colorectum (11%), pancreas (6%), and ovary (5%). Among
non-whites, the next most common sites after breast cancer are colorectal
neoplasms (16%), lung (12%), pancreas (5%), and stomach (4%).
Race and Gender Comparisons
When the incidence of major cancers occurring among
Florida non-whites and whites are compared, considerable differences are
noted. For example, non-white men have a 60% higher incidence of prostate
cancer than white men, and the mortality rate is 2.7 times higher. Among
women, breast cancer incidence is 30% higher in whites, while the mortality
rates for non-whites are actually lower. White women have a 10% higher
incidence rate of ovarian cancer and a 30% higher mortality rate. For cancer
of the endometrium, white women have a 10% increased incidence rate, but
only 40% of the mortality rate is experienced by Floridian non-white women.
In contrast, non-white women have a 60% higher cervical cancer rate than
white women but a mortality rate that is more than two times higher than
non-whites.
For lung cancer, non-white Floridian men have a 10%
higher incidence rate and a 30% higher mortality rate. However, Florida
non-white women have only 60% of the incidence and mortality rate of Florida
white women. Non-white men have a 20% higher incidence rate and an 80%
higher mortality of oral cancer than white men. Among women, non-whites
have a 20% higher incidence rate of oral cancer and a 70% higher mortality
rate than among whites. Finally, among men, colorectal cancer incidence
and mortality rates are very similar among whites and non-whites, while
among women, whites have a 10% higher incidence and a 40% higher mortality
rate than non-white women.
Cancer Among Hispanics
Rates of cancer for most sites are lower for Hispanics
who may be of any race than for non-Hispanics. Notable exceptions to this
are cancers of the liver and gallbladder and, in some age groups, cancers
of the uterine cervix. Among Hispanic men, prostate cancer is the most
commonly diagnosed site (31%), followed by lung (15%), colorectum (13%),
bladder (5%), and non-Hodgkin’s lymphoma. The most common causes of cancer
deaths among Hispanic men are lung (27%), prostate (14%), colorectum (11%),
non-Hodgkin’s lymphoma (6%), and pancreas (5%).
Among Hispanic women, breast cancer accounts for
nearly one of every three cases (29%), followed by colorectal cancers (15%),
lung (8%), endometrium (6%), and ovary. Breast cancer accounts for one
of every five cancer deaths among Hispanic women, followed by colorectal
cancer (13%), lung (11%), pancreas (7%), and non-Hodgkin’s lymphoma.
Variation Within Florida
There is considerable variation in rates of cancer throughout
the state. While these differences are at least partly a function of demographic
differences, they also suggest etiologic exposures. In general, lung cancer
rates are highest in the northern part of Florida, particularly along the
northeastern Gulf coast. Colorectal cancer rates for both incidence and
mortality are highest in the northern Atlantic coastal counties. The highest
incidence rates of breast cancer are observed in the northeastern counties
and in the north central part of the state. However, there is greater variation
in the mortality rates. Prostate cancer rates are highest along the central
Atlantic coast of the state, although mortality rates are highest in the
central Panhandle counties.
Selected References
Smith SA, Trapido EJ, Richman SP, et al. Use of tumor registry data
in minority health programs. J Registry Manage. May 1996;68-73.
Trapido EJ, Valdez RB, Obeso JL, et al. Epidemiology of cancer among
Hispanics in the United States. Monogr Natl Cancer Inst. 1995;18:17-28.
Trapido EJ, Chen F, Davis K, et al. Cancer in south Florida Hispanic
women: a 9-year assessment. Arch Intern Med. 1994;23:1083-1088.